PHARM 1 EXAM #1 Flashcards

Question

Factors that alter or affect bioavailability in pharmacokinetics

Answer 1

— The drug form — Route of administration — GI mucosa and motility — Food and other drugs — Changes in liver metabolism.

Answer 2

— Neonates + infants have *less* albumin (#1 protein in blood) and fewer protein receptor sites, which means they have more *FREE DRUG* —> Elevated *free* drug level (b/c do not have a lot more binding receptor sites) —> must give a *lower* dosage — ONLY medication that can have therapeutic effects = *FREE* medication —> medications that bound to protein *not really* therapeutic & dose appropriately knowing that

Answer 3

— The blood brain barrier (BBB) in infants is immature and allows medications to pass easily into nervous system tissue increasing risk of toxicity — Children inherently have higher metabolic rates than adults, causing metabolism to occur more rapidly. This may necessitate a HIGHER medication requirement including increased dosage and frequency. — Until age of ~2, pediatric patients may need HIGHER doses of water-soluble medications to achieve therapeutic levels

Answer 4

1. Drug-drug 2. Drug-food/nutrient — e.g. grapefruit juice, calcium, *high* protein meals, tyramine-rich foods (cheese, wine, organ meats, beer, yogurt, bananas) 3. Drug-laboratory 4. Drug-induced photosensitivity

Answer 5

— Be easy to administer and able to reach the infectious agent anywhere in the body — Be absolutely toxic to the infectious agent and absolutely nontoxic to the host — Remain in the body as long as needed and be safely and easily broken down and excreted

Answer 6

— _Additive:_ Sum of effects of 2 drugs | 1 + 1 = 2 — _Synergistic:_ Effect is *much greater* than effects of either drug alone | 1 + 1 = > 2 — _Antagonistic:_ One drug reduces/blocks effect of the other drug

Answer 7

—Interactions with specific foods can decrease/increase absorption, can cause adverse rxns, or toxicity _______________________________________________ *Examples:* — Avoid calcium and fluoroquinolones (Cipro, Levaquin) —> decreases absorption — Avoid calcium and tetracyclines —> decreases absorption — Avoid food with levothyroxine (Synthroid) —> decreases absorption — Give pantoprazole (Protonix, a PPI) on empty stomach —> increases absorption — Avoid high protein meals with levodopa (one of the ingredients in Sinemet for Parkinson’s dz) —> decreases absorption — Avoid tyramine-rich foods (cheeses, wine, organ meats, beer, yogurt, bananas) with MAOI antidepressants —> can cause hypertensive crisis

Answer 8

Drugs may cause misinterpretation of test results. —*E.g.* Diuretics can alter electrolytes which can be dangerous within itself AND can increase the risk of toxicity of digoxin

Answer 9

Skin reaction/increased risk caused by sunlight exposure —*E.g.* Exposure to UVA/B light can cause allergic reaction or cellular damage; see *table 2.3*

Answer 10

**Pharmacokinetics:** — **ADME = absorption, distribution, metabolism, excretion** *differs between infants, children, adults, and older adults* — It takes about 5 1/2 lives to eliminate a drug from the body OR if the person continues taking the drugs, it takes about 4-5 1/2 lives to reach a _steady state_ (rate of intake of the drug will ~equal the rate of elimination) **Pharmacodynamics:** — 1ary vs 2ndary effect — Therapeutic vs toxic/potency effect —**Onset, Peak, Duration** — Monitor peak and trough drug levels — “Lock-and-key:” Many drugs work by effect on receptors – can produce *(agonists)* or block responses *(antagonists)*

Answer 11

— Stimulation or depression; *e.g. beta agonist or beta blocker* — Replacement – hormone; *e.g. insulin, thyroid* — Inhibition or killing – *e.g. antimicrobials/antibiotics (bactericidal or bacteriostatic) or cytotoxic (chemotherapy)* — Irritation; *e.e. laxatives* — Modification of immune status – drugs that alter the immune response such as steroids or biologics

Answer 12

*Drugs that produce a response but do not act on a receptor may act by stimulating or inhibiting enzyme activity or hormone production. Some drugs are just a chemical reaction…no systemic effect…i.e. antacids* — Stimulation — Depression — Irritation — Replacement — Cytotoxic action — Antimicrobial action — Modification of immune status

Answer 13

Neonates and infants have immature livers, decreased protein concentrations compared with adults, and they have fewer protein receptor sites with an affinity for drug binding in the first 12 months after birth; this results in higher levels of unbound drug and an increased risk of drug toxicity.

Answer 14

— Gastric pH is alkaline at birth and may not reach adult acidity until age 1 to 3 years – this may hinder or enhance drug absorption — Gastric emptying is delayed in neonates and infants but increased in children – again changing the absorption of drugs — Because children’s skin is thinner and more porous they absorb topical drugs more readily than adults — 70% of body is water in neonates and infants (percentage decreases in adulthood to 50-60%) – thus until about the age of 2 pediatric patients may need HIGHER doses of *water-soluble* medications to achieve therapeutic levels — Children have higher metabolic rates than adults, causing metabolism to occur _more rapidly._ This may necessitate a **HIGHER** medication requirement including increased dosage and frequency. — Infants, until about 9 months of age, have DECREASED renal elimination capacity. This occurs again in early adolescence. *NOTE: Remember, dehydration can impair excretion. You need water for effective excretion.*

Answer 15

**Child’s weight in kilograms (kg)** Drugs for pediatric patients are ordered based on either the child’s weight in kilograms (mg/kg) or on body surface area (BSA or mg/m2).

Answer 16

— Stranger anxiety (infants) — Hospitalization, illness, or injury viewed as punishment (3- to 6-year-olds) — Fear of procedure (3- to 6-year-olds)

Answer 17

— for potentially inappropriate medication use in older adults = guideline foro HCP to help improve the safety of prescribing medications for O.A. — Renal dosing of drugs — Drug-drug interactions — Provide safety information

Answer 18

— Alcohol — Tobacco — Cannabis — Cocaine — Opioids — Caffeine — Nicotine — Methamphetamines

Answer 19

— Taking too many drugs at different times — Failure to understand the purpose/reason for a drug — Impaired memory — Decreased mobility/dexterity (can they open the bottles?) — Visual/hearing disturbances (can they read the labels of what meds they’re taking?) — Cost of prescriptions ($$$, will go without) — Child proof drug bottles (may request *non-*childproof bottle caps — Side effects/adverse rxns from the drug (educate family/patient)

Answer 20

There are five types of adverse drug events: 1. Adverse drug reactions 2. Medication errors 3. Therapeutic failures 4. Adverse drug withdrawal events 5. Overdoses **_3 drugs that cause 1/3 of elderly ED visits: digoxin, warfarin (Coumadin), insulin_** — The immune system of the older adult decreases rather than increases in allergic responses. — It is common for older adults to take many drugs together. Polypharmacy is due to multiple health care providers ordering many medications for older adults. — Older adults are prone to self-medicate with OTC preparations.

Answer 21

—*MILD:* — *MODERATE:* — *SEVERE:*

Answer 22

— *Short-term:* — *Long-term:*

Answer 23

— During toxicity: — During withdrawal: — During maintenance of abstinence from commonly misused drugs:

Answer 24

— **QSEN = Quality Safety Education for Nurses** — Competencies: *Patient and family-centered care* *Collaborating and teamwork* *Evidence-based practice* *Quality improvement* *Safety* *Informatics*

Answer 25

**Subjective data: what the _patient_ tells you** — Current health history — Patient signs and symptoms — Current medications and concerns — Allergies — Financial barriers — Tobacco, alcohol, and caffeine use — Cultural dietary barriers — Home safety needs — Caregiver needs and support system

Answer 26

**Objective data: what _YOU_ see, hear, feel, touch, smell, perform, etc** — Physical health assessment — Laboratory and diagnostic test results — Physician’s notes (health history) — Measurement of vital signs — Patient’s body language

Answer 27

**5-Step decision-making approach** **1. Assessment** — _purpose:_ obtain subjective + objective data, which provides evidence (based on the assessment) in order to determine a diagnosis **2. Diagnosis** — _purpose:_ what is wrong with the patient? **3. Planning** — _purpose:_ what do I need to do because of the diagnosis based upon the assessment with patient @ center? Collaborate with other team; patient-centered goal…”the patient will…” — Anyone going in should be able to follow and measure the same goal reported/charted **4. Implementation** — _purpose:_ educate, drug administration (yes to therapeutic effects, no to adverse rxns), patient care being provided, any interventions needed for establishing goals?, promote patient teaching (ready to learn?), eliminate barriers **5. Evaluation** — _purpose:_ Determine if goals/teaching, were met, any need for follow-ups/community resources, and document successful goal attainment

Answer 28

*Nursing Process —**Implementation** ________________________________ — Factors promoting patient teaching — Patient must be ready to learn —> Telling a patient that he or she *must* do something is inappropriate. — Nurse and patient must be *fully* engaged. — Timing is important. — Conducive quiet environment — Eliminate barriers (i.e. pain). -Have interpreter if language barrier. -Have family member present if patient is forgetful. -Provide written material as appropriate. — Tailor teaching to patient’s education level. — Utilize several sessions to avoid overload. — Utilize community resources. — Evaluate patient’s understanding of instruction.

Answer 29

— General information (e.g., instructions for taking drug, importance of compliance, monitoring of laboratory values) — Self-administration (drug administration, route, appropriate technique) — Diet (foods to include or avoid in the diet) — Side effects (which side effects to expect and which to report to HCP) — Cultural considerations.

Answer 30

*5 Additional rights include:* — Right documentation — Right assessment — Patient’s right to education — Right evaluation — Patient’s right to refuse

Answer 31

— Determine if goals were met. — Determine if teaching objectives were met. — Determine need for follow-up. — Refer to community resources. — Document successful goal attainment.

Answer 32

— name of drug — dose — route (injection site if applicable) — time and date — RN’s initials/signature — patient’s response to the medication (opioids, no opioid analgesics, sedatives, antiemetics, and unexpected rxns to meds)

Answer 33

— _Administration_ – 41% —> pill splitting, crushing meds, wrong “rights” involved (patient, drug, dose, time & route) — _Documenting_ – 21% —> — _Dispensing_ – 17% —> Pharmacists — _Prescribing_ – 11% —> MD/PA/NP — _Monitoring_ – 1 % —> Laboratory values/reports, peaks/troughs data, liver/kidney functions — _Other_ – 9% **RN’s risk of medication error INCREASES BY 60% if interrupted/distracted during the preparation phase of medication administration**

Answer 34

— ANA encourages organization to avoid punitive approaches in drug error reporting. — Individuals should be encouraged to report drug errors, so the system can be repaired and fixed. — The safe administration of medication by registered nurses is regulated by state law and regulation

Answer 35

— Education — Drug administration — Patient care — Interventions needed for established goals

Answer 36

— Follow specific information on drug label or insert. — Transfer drug from original container to undesirable substance (i.e., kitty litter). — Place mixture in container (i.e., sealed plastic bag). — Remove all identifying information on label before disposing of empty container. — Do not flush drugs down toilet unless specifically instructed. — Return drugs to community “drug take-back” program. — Consult pharmacist if any disposal questions. — Place removed topical patches in a non-accessible garbage container

Answer 37

Concept —> Assessment —> Patient Problem (Diagnosis) —> Planning —> Implementation

Answer 38

— Joint Commission announced accredited organizations can **no longer** use certain abbreviations including _qod_ “every other day” — “SALAD” = sound alike, look alike; *e.g. Celebrex (a NSAID) & Cerebyx (an AED)* — Use of TALL MAN LETTERS = safety strategy to reduce confusion b/w SALAD drugs; *e.g. hydrALAZINE (vasodilator) & hydrOXYzine (1st gen. Antihistamine) ____________________ *High-alert medications: Epinephrine, INSULIN, opium tincture, nitroprusside, potassium chloride injection concentrate, heparin, warfarin*

Answer 39

— Right to a complete and clear order — Right to have the correct drug, route (form), and dose dispensed — Right to have access to information — Right to have policies to guide safe medication administration — Right to administer medications safely and to identify system problems — Right to stop, think, and be vigilant when administering medications **RN administering drug is to adhere to standard medication protocols and know the drug’s purpose, risks, S/Eff, and contraindications for a particular patient**

Answer 40

**FDA Pregnancy Categories** — *A:* _No_ risk to fetus. — *B:* _No risk in animal studies,_ and well-controlled studies in pregnant women are not available. — *C:* Animal studies indicate a _risk to the fetus_. Risk versus benefit of the drug must be determined. — *D:* A risk to the _human fetus_ has been _proved._ Risk versus benefit of the drug must be determined. — *X:* A risk to the _human fetus_ has been _proved._ Risk outweighs the benefit, and drug should be _avoided during pregnancy._ **Drugs _proven_ to be a risk to the human fetus are included in FDA pregnancy categories: **C, D, X**

Answer 41

— **Must be patient centered** — Realistic and measurable — Reasonable deadlines — Acceptable to both patient and nurse — Dependent on patient’s decision-making ability — Shared with other health care providers, family, and caregivers — Identifies components for evaluation _________________________________ *Examples* — “The patient will independently administer prescribed dose of 4 units of regular insulin by the end of the fourth session of instruction.” — “The patient will prepare a 3-day medication recording sheet that correctly reflects the prescribed medication schedule by the end of the second session of instruction.”

Answer 42

—Pain, acute related to surgery — Confusion, acute related to adverse reaction to medication — Health maintenance, ineffective related to not receiving recommended preventive care — Knowledge, deficient related to effects of anticoagulant medication — Noncompliance related to forgetfulness — Health maintenance, ineffective related to lack of finances

Answer 43

— Check patient’s medications with health care provider’s order for accuracy. — Check for allergies. — Prepare medications for only one patient at a time. — Calculate medication dose and perform a double-check of the calculation. — Check expiration date on drug labels and only use current drugs. — Never leave medications unattended. — Administer only drugs that you have prepared. — Identify patient with at least two patient identifiers. — Stay with patient until all medications have been taken. — Record effectiveness and results of medication administered. — Drug reference book, pharmacist, or acceptable technology resource for safety — FDA MedWatch Program: http://www.fda.gov/safety/medwatch/default.htm

Answer 44

- **Parenteral** —quicker b/c OUTSIDE of gut—> does NOT go through 1st pass metabolism —> straight to the blood - **Enteral** —slower b/c GOES to the gut—> Go through 1st pass metabolism —> 1mg to blood —> 3mg absorbed (Portal circulation) —> LIVER —> BILE —> EXCRETION

Answer 45

— Always check for proper placement and gastric residual before administering drugs — Place the patient in high Fowler position or elevate the head of the bed at least 30 degrees — **Always** flush copiously _after_ administration to ensure tube remains patent — Ensure line is patent has **any** remaining medication found; **DO NOT** want to harden and occlude tube

Answer 46

- **Parenteral:** IV, subQ, topical, SL (sublingual) —Dose: ~1mg - **Enteral:** PO (including via peg, NG tubes) —Dose: ~4mg

Answer 47

— Sublingual, buccal — _Oral:_ tablets, capsules; liquids, suspensions, elixirs; a.k.a. *enteral* — Transdermal (make sure to rotate), topical — Instillation: drops, sprays — Inhalation — Nasogastric and gastrostomy tubes — Suppositories — Parenteral _______________ *Note:* Transdermal drugs provide more consistent blood levels than oral and injection forms and AVOID GI absorption problems associated with oral products.

Answer 48

— **OVER** 3 yrs pull auricle **UP** + **OUT** —**UNDER** 3 yrs pull [straightening] external ear canal **DOWN** + **BACK**

Answer 49

The study of how genetics affect pharmacokinetics (absorption, distribution, metabolism, and excretion) ___________ — Helps individualize optimal drug treatment regimens — Helps decrease drug reactions — Promotes drug regimen adherence — Reduces overall healthcare costs

Answer 50

— **Biologic variations:** Study of genetic factors influencing individual response — **Tolerance:** Decreased drug responsiveness over time — **Tachyphylaxis:** Acute, rapid decrease in drug responsiveness regardless of time — **Placebo effect:** Drug response not attributed to chemical drug properties

Answer 51

— Factors affecting absorption — Blood circulation (gastric mucosa blood flow) — Pain, stress — Food texture, fat content, temperature — pH — Route of administration — Hunger, fasting

Answer 52

**Nasal spray:** occlude other nostril/nare to promote effective dispersion **Nose drops:** tilt head back prior to administration

Answer 53

— Intradermal: - needle = 25-27 gauge; 3/8 to 5/8 inch long

Answer 54

**Locations:** — Esophagus — Stomach — Small + large intestines (GI tract) ___________ **Methods:** — Oral — Sublingual — Rectal — via Nasogastric (NG), gastrostomy, and percutaneous endoscopic (PEG) tubes

Answer 55

— The Z-track injection technique prevents medication from leaking back into the subcutaneous tissue. It is frequently advised for medications that cause visible and permanent skin discolorations such as iron dextran. **Process:** — Put your needle down and as you withdraw the needle, you let the skin go — Instead of having a straight up and down injection site that the medication can leak out of, you have a “Z-track” — Pulled needle out a little bit, let a little bit of skin go, pulled out a little bit more, let the skin go completely, and pulled needle all the way out — _Purpose:_ Medication is LESS likely to come through and irritate subcutaneous layer, epidermal layer, discolor skin or cause pain; *e.g. GIVING IRON = discolors skin AND painful, therefore…Z-TRACK METHOD*

Answer 56

— Necessary for adequate absorption. — Assess patient’s ability to swallow oral medication. — Do not crush or mix medications without properly consulting pharmacist or reliable drug source. — Check if patient is scheduled for diagnostic procedures or dialysis. — Administer antibiotics at even intervals throughout the day to maintain therapeutic drug levels. — Offer patient water but not juice (iron may be taken with orange juice). **Call pharmacists if you are unsure of the route of medication adminstration**

Answer 57

— *Rectal:* make sure it is far enough past the rectal sphincter so it does not come back out — *Vaginal:* want to make sure its closer to the cervix so it does not come back out

Answer 58

— Intravenous (into a vein) — Subcutaneous (under the skin) — Intramuscular (into muscle) — Infusions typically given by the IV route

Answer 59

— Insert needle, bevel up, @ 10-15-degree angle — The outline of the needle under the skin should be visible — Needle: 25 to 27 gauge; 3/8 to 5/8 inch long *NOTE:* Because many Americans are overweight and have a lot of fat/tissue, going at a 90-degree angle will be fine; however, the thinner you are the more acute the angle will be

Answer 60

— Abdomen is most consistent absorption (best choice) for Insulin, Heparin, & Lovenox —_Must rotate sites_ when giving _insulin_ for fear of *lipodistrophy* – fat will become scarred due to continual usage

Answer 61

— *Right assessment:* — *Right documentation:* — *Right to education:* — *Right evaluation:* refers to an appraisal of a drug’s therapeutic + adverse effects —*Right to refuse:* patient’s have the right to make decisions regarding their medications/healthcare; RN’s role = help ensure the decision is an informed one, but should _always_ honor said individuals preferences

Answer 62

— Using head of humerus to draw a line — The underarm line is the lower point, and making a triangle — Give in the: deltoid muscle

Answer 63

— Administered in the lateral part of quadriceps — Hand below groin, hand above knee — Give: OUTSIDE/LATERAL side of leg, IN muscle **FOR BABIES**

Answer 64

— Using your palm on the greater trochanter, pointer finger on the illiac crest, and thumb toward the front of the lilac crest — Give injection between: pointer finger + thumb

Answer 65

— Median cubital = antecubital (on the median side of it) — Cephalic vein = on the outside — Basilic vein = on the inside — Radial vein = lowest side

Answer 66

-kilogram (kg): -milligram (mg): -microgram (mcg): -nanogram (nm):

Answer 67

Convert **lbs TO kg** —> *DIVIDE* by 2.5 Convert **kg TO lbs** —> *MULTIPLY* by 2.5

Answer 68

increase absorbability

PHARM 1 EXAM #1 Flashcards

(117 cards)