Pharm quiz 1 study guide Flashcards
(208 cards)
1
Q
9 rights(reason)
A
1 - right drug
2 - right dose
3 - right time
4 - right route and form
5 - right patient
6 - right documentation
7 - right reason or indications
8 - right response
9 - right to refuse
2
Q
fastest to slowest absorption
A
fasteste to slowest:
epidural
IV
IM
SC
PO
3
Q
allergic
A
an immunologic hypersensitivity reaction resulting from unusual sensitivity of a patient to a particular medication; a type of adverse drug event
4
Q
idosynchratic reaction (ritalin is idosychratic)
A
an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient
5
Q
cultural assessment
A
languages spoken, written and understood. need for an interpreter.
health beliefs and practices
past uses of medicine
use of herbal treatments, folk remedies, home remedies, or supplements
use of otc drugs
usual responses to illness
religious practices and beliefs (christian scientists don’t take any meds at all)
support from the patient’s cultural community that may provide resources or assistance as needed, such as religious connections, leaders, family members, or friends
dietary habits
6
Q
how to identify a patient before giving a med
A
2 unique identifiers - (full name, dob, name band)
7
Q
therapeutic index - lethal dose etc
A
To establish Toxicity & Effectiveness:
-“LD50” dose lethal to 50% animals tested
- Median effective dose-
-Therapeutic dose for 50% of animals tested
To determine Therapeutic Index
- LD50/ Median effective dose
8
Q
med error (the patient and the provider are errors)
A
preventable adverse drug event involving inappropriate medicaiton use by patient or health care provider, may or may not cause harm
9
Q
nursing process (ANPIE is the process, the framework)
A
organizational framework for the practice of nursing. all steps taken by nurse in caring for patietn. AI (human needs) PIE
10
Q
outcomes (the specific outcome is measurable) - this is the planning phase of ANPIE
A
specific patient behaviors or responses that meet or achieve patient human needs. specific and measurable
11
Q
additive effects
A
similiar or equivalent to the sum of the individual effects 1 + 1 = 2
12
Q
adverse drug event (the event is the admin’s fault)
A
undesirable occurance related to administering or failing to administer meds
13
Q
adverse drug reaction (the reaction is therapeutic)
A
unexpected, unintended, undesired response given at theraupetic doses (unlike an overdose)
14
Q
adverse effects
A
undesirable effects that are a direct response to one or more drugs
15
Q
agonist
A
drug that stimulates the activity of one or more receptors
16
Q
antagonist effect
A
1 + 1 = less than 2. a substance that stops the action or effect of another substance. also called inhibitors
17
Q
bioavailability (available to absorb)
A
a measure of the extent of drug absorption for a given drug and route (from 0 - 100%)
18
Q
biotransformation
A
one or more biochemical reactions involving a parent drug. occurs mainly in the liver and produces a metabolite that is either active or inactive. also called metabolism.
19
Q
cytochrome P-450
A
general name for a larger class of enzymes that plays significant role in drug metabolism and interactions
20
Q
dependence (your dependence is compulsive)
A
compulsive or chronic need for a drug
21
Q
dissolution (before entering where?)
A
solid form disentigartes in gi tract and becomes soluble before entering circulation
22
Q
drug
A
a chemical that affects the phsyiology of a living thing
23
Q
drug effect
A
The physiologic reaction of the body to the drug
can be good or bad
24
Q
teratogenic
A
Structural defects to Fetus
25
duration
The time a drug concentration is sufficient to elicit a
therapeutic response
26
first pass
initial metabolism in liver before reaching ciriculation
27
high first pass rate
a large amount of drug is absorbed by liver and less will reach target sites
28
glucose-6-phosphate dehydrogenase
hereditary - RBC break down when body is exposed to certain drugs
29
incompatability
2 parental drugs when mixed together result in deteroration of one drug
30
medication use process
prescribing, despensing, admin of meds and their effects
31
metabolite
chemical form of a drug that is the product of one ore more biochemical reactions involving parent drug. active metabolites have activity of their own, even if parent drug is inactive. inactive are drug waste products.
32
onsest
time to reach therapeutic response
33
p-gylcoprotein (p for pusher)
transporter protein that moves drugs out of cells into gut, urine or bile
34
pharmaceutics (ceut the dose)
the study of how various dosage forms influence the way in which the drug affects the body
35
pharmacodynamics
drug-receptor relationship.
the mechanism of drug actions in living tissues
36
pharmacogenomics
study of genetic factors
37
pharamcognosy
from natural plants or animals
38
pharmacokinetics (what does coke-netics do to the body from start to finish)
body does to the drug.
- Absorption
- Distribution
- Metabolism
-Excretion
39
receptor
reactive site on cell surface or inside cell
40
substrates
substances on which an enzyme acts
41
toxic
quality of being poisonous
42
trough
lowest concentration of a drug after peak.
43
neonate
younger than 1 month
44
pediatric
12 or younger
45
polypharmacy
use of multiple meds by older ppl
46
bias (bias against this measurement)
systematic error in measurement process
47
drug polymorphism
variation in response to a drug because of a patient's age, gender, size and body composition
48
HIPAA
protects health insurance coverage for workers when they change jobs. protects patient info.
49
investigational new drug
not yet approved by FDA but safe
50
malpractice
type of negligence or failure by person with SPECIALIZED education to act in a reasonable or prudent way
51
negligence
failure to act in prudent or reasonable way
52
orphan drugs
treat rare diseases
53
adverse drug event - just basic description but also includes what?
adverse drug reaction and medication errors
54
adverse drug reaction (the reaction is therapeutic)
unexepected or unitended or excessive response to meds given at therapeutic dose
55
med reconciilation
maintain up to date list of meds for all patients and all phases of health care
56
affective domain (you affect my feelings)
expression of feelings
57
Iiatrogenic effects (analis is liatrogenic)
unitentional adverse effects caused by actions of a prescriber or health care person.
58
integrative medicine
use of western and nontraditional meds at the same time
59
phytochemicals
active ingredients in herbal remedies
60
adjuvant analgesic drugs
drugs added for combined therapy
61
agonist
drug binds to the receptor; there is a response
62
agonist-antagonist
bind to receptor and cause partial response not as strong as agonist
63
antagonist
drug binds to the receptor: there is no response. drug prevents biding of agonists.
64
central pain
pain caused by CNS damage
65
chronic pain
longer than 3 - 6 months
66
nociception (the process is nociception)
processing pain signals in brain that give rise to feelings of pain
67
partial agonist
drug binds to the receptor; the response is diminished compared to agonist
68
somatic pain
skeltal muscles, ligaments, or joints
69
superficial pain
skin or mucosa
70
general anesthesia
a drug induced state in which the CNS nerve impulses are altered to reduce pain and other sensations throughout the entire body. total loss of consciousness and respiratory drive.
71
monitored anesthesia care (MAC)
planned procedure where patient undergoes local anesthesia with sedation and analgesia
72
overton-meyer theory (over a ton lipid)
theory describing the relationship between lipid solubility of anesthetic drugs and their potentency
73
barbituates (barb will put you to sleep)
induce sedation
74
benzos (benzo for my anxiety)
anxiolytic (anxiety) drugs
75
GABA - gamma-aminobutyric acid (gaba all of em)
inhibitory neurotransmitter found in brain. key compound affected by sedative, benzos, psychotropic and muscle relaxers
76
hypontics (hypnotized but not sleepy)
calm or soothe cns without inducing sleep unless at high doses
77
non REM
4 stages before REM
78
REM interference
drug induced reduction of REM sleep time
79
REM rebound
excessive REM following discontinuation of drug
80
sedatives (sedate me, but don't sleep)
inhibitory effect on CNS that reduce nervousnes, irritabilty without causing sleep
81
amphetamines
stimulants
82
analeptics (ana loves stimulants)
CNS stimulates that produce increase in responsiveness to external stimuli and stimulate respiration
83
anorexiants
drugs used to control or suppress appetite
84
catplexy
abprut attacks of muscle weakness triggers by joy, laughter, anger, fear, suprise
85
ergot alkaloids
drugs that constrict blood vessels in brain - for migraines
86
seratonin receptor agonists
CNS stimulants used to treat migraines
87
sympathomimetic drugs (mimic the sympthatic)
CNS stimulants such as nonadrenengic drugs who mimic those of the sympathetic nervous system
88
Schedule I
Schedule I: No accepted medical use w/high potential for Abuse.
Example: Heroin, Ecstasy, LSD, & Marijuana
89
Schedule II (Schedule II is MAD, FC V)
Schedule II: accepted severe restrictions use w/ high potential for Abuse.
Example: Cocaine, Morphine, Vicodin, Demerol, Fentanyl, & Adderall
90
Schedule III (schedule III is SKTCH)
Schedule III: accepted medical use w/moderate to low potential for Abuse.
Example: Ketamine, Anabolic Steroids, Codeine, Hydrocodone, Tylenol/ASA
91
Schedule IV (schedule 4 is VAAXK)
Schedule IV: accepted medical use w/ low potential for Abuse.
Example: Valium, Ambien, Xanax, Klonopin, Ativan
92
Schedule V
Schedule V: accepted medical use w/ low potential for Abuse.
Example: Robitussin AC
93
PQRST
P = provoking factors - what factors precipitate pain - What were you doing when the pain started? What caused it? What makes it better or worse? What seems to trigger it? Stress? Position? Certain activities? -
Q=Quality - description of pain - What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or stretching
R=region or radiation
S=severity on a pain scale
T = how long has it been present? what makes it better or worse? - When/at what time did the pain start? How long did it last? How often does it occur: hourly? daily? weekly? monthly?
94
WHO pain management scale/ladder (WHO is the adjuvant?)
1) (bottom) nonopiod +/- adjuvant
2) pain persisitng or increasing
3) opioid for mild or moderate pain
+/- opioid
+/_ adjuvant
4) pain persiting or increasing
5) (top) opioid for moderate to severe pain
+/- opioid
+/_ adjuvant
95
pinpoint pupils is called...
myosis, miosis. possible overdose opiates
96
post op is what type of therapy and what to do?
maintain integrity of body functions, provide fluids and electrolytes to prevent dehydration if they are vomiting, or blood products to patient who has lost blood during surgery. manage pain.
97
sleep cycles - 1 (small to start)
non-REM - dozing, can be easily awakened 2-5% of sleep time
98
sleep cycle - 2 (2 is at the top)
sleep deepening, high arousal required to be woken up . 50% of sleep
99
sleep cycle 3 (3 is 3) and what about breathing? (second smallest)
deep sleep, difficult to wake, respiration, etc decreases 5% of sleep
100
sleep cycle 4 (a little sleep before REM)
very difficult to wake. 10-15% of sleep time
101
REM (REM is my favorite number)
vivid dreams, irregular breathing 25-33% of sleep
102
Dantrolene (Dan trolled the hyperthermia)
used to treat malignant hyperthermia
103
malignant hyperthermia
uncommon, genetic metabolic reaction to general anesthesia. associated with inhaled anesthesias. at risk - children, adolescents, and ppl with skeletal abnormalities
104
pregnancy - B
Animal reproductive studies failed to
determine Risk to Fetus & there are no adequate & well controlled studies in pregnant women
105
pregnancy category - C (c, there is an adverse effect on animals)
Animal reproductive studies shown an
adverse effect on Fetus & there are no adequate & well controlled studies in humans, but potential Benefits may warrant drug use in pregnant women despite potential Risks.
106
pregnancy category - D (delightfully not animals this time)
Positive evidence of human fetal Risk based
on adverse reaction data from investigational, marketing experience or studies in humans, but potential benefits may warrant use of drug in pregnant women despite Risks
107
9 rights
1. RIGHT Patient X
2. RIGHT Drug X
3. RIGHT Dose X
4. RIGHT Route X
5. RIGHT Time X
6. RIGHT Documentation X
7. RIGHT to Refuse X
8. RIGHT response X
9. RIGHT Reason X
108
ex of human needs statement
altered safety needs (human response), risk for injury related to medication
109
implementation
nurse intervenes on behalf of patient, ie physical therapy
110
QSEN (patient is the center, then the team, then the evidence, then quality brings safety and info)
patient-centered care, teamwork, evidence-based practice, quality improvement, safety, and informatics.
111
rectal drugs are given for what reason?
for systemic effects - reduce fever, anything system--wide
112
do sublingual and buccal bypass the liver?
YES, ie nitroglycerin
113
fastest to slowest routes for absorption
parenteral (IV), enteral, topical
114
do topical meds bypass the liver?
Yes, ALL but rectal
115
nurse practic act defines the..
scope
116
affective domain learning
expression of feelings
117
Pharmaceutical - (does the drug suit the dissolution)
Dosage form determines the rate drug dissolution (dissolving of solid dosage forms and their absorption from the GI tract). goes from solid and breaks down in gut
🞑 Enteric-coated tablets
🞑 Extended-release form
118
Pharmacokinetic (what does coke-netics do to the body from start to finish)
The study of what the body does to the drug
- Absorption
- Distribution
- Metabolism
-Excretion
also onset, peak, duration and UNTIL the parent drug and metabolites have left the body.
119
Absorption (absorb the bupe into your bloodstream to your sore muscles)
the movement from administration into the bloodstream for distribution to the tissues
120
Pharmacodynamics involves..(the dynamic between the drug and receptor)
drug-receptor relationship.
the mechanism of drug actions in living tissues
121
examples of enteral routes (enteral BROS)
- Oral
- Sublingual
-Buccal
-Rectal (can also be topical)
122
lungs are what route?
topical
123
ANA - Provision 1 (it takes one for compassion)
Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
124
Provision 2 - ANA (it takes 2 to commit)
The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
125
Provision 3 - ANA (advocate for the number 3)
Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
126
Provision 4 ANA (accountable for 4 chambers in the heart)
The nurse has authority, accountability and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.
127
Provision 5 - ANA (five fingers make up the self)
The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
128
Provision 6 ANA (666 is not safe)
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
129
Provision 7 (educated at 7/11)
The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
130
Provision 8 ANA (I ate your human rights with other professionals)
The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
131
Provision 9 ANA (nine social justices)
The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
132
kidney stone is what type of pain?
visceral
133
adjuvant
second drug when first isn't enough
134
somatic pain
skeletal muscles, ligaments or joints
135
neuorpathic pain
damage to peripheral nerve
136
central pain
tumors, trauma or inflammation of the brain (anything CNS related)
137
meripidine (D for demerol)
(D for demerol and D for die 7x stronger than morphine) - can cause seizures - toxic
138
antidote for benzos (benzo has the flu, what's the antidote?)
flumazenil
139
neuropathic tissue is unhealthy tissue - like
neuropathy
140
analgesic
analgesic - more relief from pain without losing consciousness
141
morphine - agonist or antagonist?
opioid agonist analgesic - mimics endogenous opiate
142
opiate contraindications (Ana nicole is BAB)
benzos, alcohol, and barbiturates
143
what to give for alcohol withdrawals?
benzos
144
do sublingual and buccal bypass the liver?
yes, nitrogylcerin
145
do topical meds bypass the liver?
yes, all but rectal
146
recovering from an illness is what type of therapy?
supportive
147
Examples of drugs with a narrow therapeutic index (Amine in the corner)
1. Aminoglycosides (Gentamicin®)
2. Digoxin (Lanoxin®)
3. Lithium (Lithobid®)
4. Phenytoin (Dilantin®)
5. Valproic Acid (Depakote®)
6. Warfarin (Coumadin®)
148
Potentiation (potent for the other drug)
when one drug does not elicit a response on its own but enhances the response to another drug.
149
gate theory
injured tissue releases bradykinin, histamine, potassium, prostaglandins, seratonin. This release causes an action potential in sensory nerve fibers through pain receptors called nonciceptors. These impulses activate pain receptors in spinal cord (dorsal horn). The gates are here.
If impulses are stopped at the gate, no pain is felt. Doesn't reach the brain.
If the gate allows many action potentials through, they reach the brain and pain is felt. This is known as nonciception.
150
Nurses Practice Act
The Nursing Practice Act (NPA) is the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs.
151
major adverse effect with opioids - what about cough?
it's a cough suppressant and patients can't cough and clear their throat. They are at risk for post-op pneumonia.
152
don't combine morphine, demerol (or any opiates) with
MAO inhibitors (depression meds) excessive activation of
serotonin receptors causing excitation, delirium,
hyperthermia, seizures, coma & death
153
demerol pregnancy category (demerol is surprisingly low)
B
154
naloxone pregnancy category
C
155
vicodin pregnancy category
C
156
methadone pregnancy category
C
157
xanax pregnancy category (xanax is Damn bad)
D
158
diazapam pregnancy category (think benzo)
D
159
demerol w/ antihistamine?
increases effect of demerol which is good...you can use less of it, less toxic
160
vicodin inhibitors and inducers
Inhibitors: Amiodarone (cardiovascular drug)
🞑 Inducers: barbiturates, tegretol
161
methadone inhibitors and inducers
Inhibitors: sertraline, rifampin
🞑 Inducers: tegretol, phenobarb, phenytoin, barbiturate anesthetics
162
Interactions: NSAIDS
njury to gastric mucosa Tylenol® =
liver damage with only 2-4 drinks per day (limit should not
exceed 2 grams per day)
163
Chlor-DI-ze-POX-ide (chlora is a libra)
librium
Action:
🞑 Potentiates the actions of GABA, especially in the limbic
system, reticular formation
Uses:
🞑 Short-term management of anxiety, acute alcohol
withdrawal, preoperatively for relaxation
164
during non-REM
bp falls
pulse rate slows
metabolic rate decreases
gastro slows
urine formation slow
O2 consumption and CO2 production is reduced
temp decreases slightly
respiration slower and more shallow
body movement is minimal
165
ativan (my Ortho takes Ativan)
Adverse Effects
🞑 Dizziness, drowsiness, Orthostatic hypotension, ECG
changes, tachycardia, hypotension; apnea, cardiac
arrest (IV, rapid)
166
benzos have what in the name?
zepam or zolam
167
Hypnotics are used to
Hypnotics are used to induce sleep with greater
CNS depression than sedatives.
at low or moderate doses, calms CNS. At high doses, induces sleep
168
drug classifications (BC M at the clinic)
1) Clinical indication
2) Mechanism of Action
3) Body system
169
1) Clinical indication
(Bronchodilator)
170
2) Mechanism of Action (just what a drug does)
(biochemical process through which a drugproduces its effect)
171
Body system
Body system - ( CNS)
172
WHO pain scale (goes in 3s)
Pain Description
“Mild pain” - 1 to 3
“Moderate pain” - 4 to 6
“Severe pain” 7 to 10
173
Chlordiazepoxide (chlora loves librium)
librium - for alcohol withdrawals, benzo
174
Lorazepam (Lorazepam in LA)
Ativan® (for anxiety) sedative
175
alprazolam (al loves xanax)
xanax - sedative
176
diazapam
valium (pam, so it's a benzo). anxiety, insomnia
177
nonceceptors respond to what kind of pain? (TMC)
🞑 "thermal" (heat or cold),
🞑 "mechanical"(crushing, tearing, etc.) and
🞑 "chemical"(iodine in a cut, chili powder in the eyes).
178
tylenol antidote
N-acetylcysteine
179
6 rights - use these for the exam
rights patient, dose, route, time, med, right reason
180
digoxin antidote (binding to digoxin)
Digibind or Digifab
181
cholenergic toxic antidote (cholera airplane)
atropine
182
To name a few, aged cheese and wine
interact with
MAO inhibitors
183
Tachyphylaxis (law of diminishing returns is tacky)
rapidly diminishing response to successive doses of a drug, rendering it less effective
184
steady state
elimination is equal to absorption
185
nociceptors
sensory nerves that transmit pain signals to the CNS
186
analeptics (ana loves stimulants)
CNS stimulants that produce an increased reaction to external stimulus
187
a medication error is what type of event?
adverse drug event
188
if you want to sleep, use..
then hypnotics - barbs not recommended for sleep anymore
189
only use barbs for
convultions
190
for benzos muscle relaxers, what to check?
check sleep patterns, full phsycial, and depression and drug use
191
for zolidepem,
(ambien) head to toe, allergies, and drug use
192
Nociceptive pain is caused by
Nociceptive pain is caused by stimulation of
peripheral nerve fibers (cold, crushing, burning)
193
methadone nursing consideration
chest pain
194
2 types of adverse drug reactions (my allergy is reacting to my idiosynchocy)
allergic and idiosynchratic
195
OD (OD once a day)
once daily
196
per OS
by mouth, orally
197
qn (n for nightly)
nightly
198
qod (od = other day)
every other day
199
ss
sliding scale
200
SSI or SSRI
sliding scale insulin
201
TIW
3 times a week
202
human needs statements usually say (I'm altering your human needs)
altered
203
threshold is the level of
stimulus
204
adverse effect to opioids
itching, CNS depression
205
local anethetics work on what nerves?
peripheral
206
succincoyline
depolarizing NMBD
207
barbs stimulate
enzymes
208
leafy green vegetables interact with
warfarin
