Pharmacology Basics Part 1 Flashcards

Question

Plants (Natural Sources (Sources of meds)

Answer 1

Active chemical found in a plant (ex. Digitalis) do have some meds from plants but most synthetically

Answer 2

Replace human chemicals not produced because of disease or genetic issues Genetic engineering (ex. Insulin, thyroid) Some from animal products; insulin first discovered chemical lower BG take insulin from pigs and modified and engineered so safe for humans now most synthetically; thyroid - meds for hypo from pigs and some made synthetically

Answer 3

Salts of various elements (ex. Iron or fluoride)

Answer 4

Most drugs produced synthetically Most meds made synthetically in lab - most effective and cheapest way

Answer 5

FDA Legal regulation of drugs: Drug enforcement agency (DEA) Schedule controlled substances OTC drugs Herbal and dietary supplements

Answer 6

Responsible for protecting public health by ensuring safety, efficacy, and security of drugs, biological products and medical devices Takes sig role that drugs are safe - do all reg for the creation meds, how meds studied, brought to market in US Ensure safety of nation's food supply, cosmetics, and products that emit radiation and more... Drug approval process tightly controlled by FDA

Answer 7

Takes several years - meds go through rigorous testing process; 5-10 years for entire process Several phases (next slide) - Phases of FDA drug approval

Answer 8

Preclinical Investigational Studies Phase I Studies Phase II Studies Phase III Studies Phase IV Studies

Answer 9

Tested on laboratory animals Have ideas; biochemists figure out how to treat disease on molecular level and test on animals to see if do what do and if any major consequences Trying to figure out how make drug work way want to without major adverse effects

Answer 10

Tested on healthy human volunteers (dose range and pharmacokinetics) How drug works in humans; start looking at dose appropriate to have affect want without too many adverse effects

Answer 11

Tested on clients with disease (therapeutic effects, adverse effects) See How works on them

Answer 12

Large sample size; placebo and/or blinded studies (effectiveness, safety, dose) Submission of new drug application/approval; approved by FDA and given name; patent 5-7 years Get drug approval from FDA and given generic and brand name by company and brought to market and drug patented for 5-7 years; patent because costs lot money to make drugs so pharmaceutical company can make money before goes generic and no competition

Answer 13

Post marketing studies (2+ years); new or severe adverse effects; black box or recall After drug brought to market, cont monitor drug, prescribers prescribing meds to pat report if find anything that might be related to med; some meds taken off the market

Answer 14

Controlled Substances Act of 1970 Controlled drugs divided into five DEA schedules Physicians and dispensing pharmacists must be registered with DEA Nurses must be familiar with regulations and standard of practice

Answer 15

Responsible for regulating controlled substances; where all fed laws come in - if someone tampers with regulation of drugs get in big trouble with fed govt, go to jail, etc Regulates manufacturing, distribution, and dispensing of drugs with known abuse potential (controlled substances) Anyone convicted of unlawfully manufacturing, distributing, or dispensing of controlled substances faces severe penalties Need know how handle meds as nurse; admin opioids to pats - major controlled substance admin to pats regularly regardless where work and need to protect self and admin correctly

Answer 16

Based on potential for abuse/physical and psychological dependence

Answer 17

Discussed in more detail in pain management

Answer 18

Schedule I Schedule II Schedule III Schedule IV Schedule V

Answer 19

(heroin, LSD) Very High abuse potential and no accepted medical use Street drugs

Answer 20

(narcotics/opioids, amphetamines, barbiturates) High abuse potential with severe dependence liability - someone can become addicted to pain meds; must be carefully prescribed; must handle them correctly as a nurse

Answer 21

(nonamphetamines stimulates, nonbarbiturates sedatives) Less abuse potential and dependence liability than II (moderate)

Answer 22

(antianxiety agents, some sedative) Less abuse potential and dependence liability than III (moderate)

Answer 23

(codeine) Limited abuse potential - still regulated to some degree

Answer 24

No prescription required to buy med want Many originally approved as prescription at one time - went through process and submission/appeal to FDA that drug safe for OTC if FDA approves it can be switched to OTC; found safe used as directed Problems with OTC use: Nurse – always ask patient about OTC, herbs, supplement use

Answer 25

Ex: loratidine (Claritin); fluticasone (Flonase); ibuprofen (Advil)

Answer 26

Not always and absolutely safe and lot stuff can go wrong with these Get history from pat - ask specifically about OTC because often interact with prescription drugs; easily misdose themselves and still have to be responsible with OTC Delay seeking treatment from healthcare provider - self-treat themself and kind of work but some went away because self treat; could also be causing other probs by self treating Mask s/s of disease, drug-drug interactions, overdose/toxicity (acetaminophen), potential abuse (pseudoephedrine - make meth and why behind counter and only buy so much so often, Robitussin)

Answer 27

Grapefruit juice - can affect liver enzymes and other drugs Anticoags (warfarin) - affects using herbs have on anticoags and can prolong bleeding time

Answer 28

Answer: C Rationale: definition

Answer 29

Assessment: Diagnosis: Planning: Implementation Patient edu: med Pat edu: teach points to reduce errors Pat edu: maintaining compliance Eval

Answer 30

gather info Health History Physical assessment

Answer 31

Allergies (ask reaction – true allergy vs. adverse effect) - most allergies are medication related; step do not want to skip this; gather info to understand if true allergy/adverse effect; find info so that everything is relevat; hives - allergic rxn Past medical history Medications (current and recent past, OTC, herbals, supplements) Diet, alcohol, drug use Education level (understanding on disease and therapy) Reproductive history (Pregnancy/nursing)

Answer 32

Baseline VS, head to toe; cognition, wt, ht, age Lab tests and other diagnostics

Answer 33

determine the probs and issues related to meds Most/a lot problems related to adverse effects (anything not wanted with med but comes with it), toxicities, drug-drug interactions (drugs competing or interacting with each other), medication error, ineffective self-care Probs and issues related to meds Examples ND related to meds:

Answer 34

Fluid imbalance related to diuretic medication Nausea related to opioid medication Risk for falls related to sedating effects of medication Ineffective health maintenance related to inappropriate dosing of medication

Answer 35

goals/expected outcomes Expected outcomes - what want client to achieve; start with client will and helps remember what want to happen Client will maintain a blood pressure within the normal range. Client will maintain normal gas exchange and remain free from respiratory depression. Client will demonstrate correct administration of medication. Client will explain 3 adverse effects of medication.

Answer 36

Addresses therapeutic effect of medication

Answer 37

Addresses potential adverse effect

Answer 38

Demonstrates adequate teaching/learning for self-care

Answer 39

Demonstrates adequate teaching/learning for self-care

Answer 40

Actually admin med and interventions for meds in terms admin/monitoring Administering medication High alert medications (Box 5.1) - more sig things can go wrong if do not do things correct Interventions:

Answer 41

Right drug Right dose Right route Right time Right patient Right documentation

Answer 42

Meet expected outcomes Interventions related to medication - administration related to medication Educate patient

Answer 43

Part implementenation - educating pat about everything med; education about we need know How often take it, what taking for, how work, common adverse effects, when call provider if having probs, manage adverse effects if appropriate Name, dose, action of drug Timing of administration How to measure/administer home medications Special storage and preparation instructions Specific OTC, herbs, supplements to avoid Special monitoring (BP checks, lab test, etc.) Adverse effects and potentials for toxicity Warnings about discontinuing drug abruptly Special considerations (diet, sun exposure, etc.)

Answer 44

Comfort measure for adverse effects

Answer 45

Always keep list of meds, herbals, etc. with you - making sure educate pats keep list of all meds and herbal and OTC meds with you; so many probs arise if not know what taking and what taken today esp if have chronic illness or going to hospital often because big probs can happen and if cannot talk to us then do not have it Know each drug and why prescribed Read labels/follow directions Store drugs in dry place away from children and pets Speak up to provider about reporting use of herbals, etc. Never share medications Measure liquids with appropriate measuring devices Call provider immediately if problem develops

Answer 46

About education is ensuring - compliance - means pat taking meds how prescribed; if not treat prob supposed to and causes lot probs - got to figure out why not compliant and can be multititude of things - not always think about implementation of what want - need think about how carried out Client has an active role in ensuring compliance Taking a medication in manner prescribed by health care provider Factors related to patient deviation from compliance: Nurse must be vigilant in verifying patients understand education about medications

Answer 47

Poor education on drug Cost of drug Forgetting doses Annoying adverse effects Self-adjustment of doses Fear of dependency

Answer 48

Last step Reassess patient Compare status with desired outcome(s) Overall goal is safe, effective medication administration

Answer 49

See if have effect desired to and if not need change plan; need more med or do something else; reassess did drug have desired effect/have lot adverse effects that now need to address Physical condition, I&0, VS, wt, labs (as appropriate to medication) Therapeutic effect Adverse effects/toxicities

Answer 50

If outcome met, shift to next highest priority health need If not met, may need to revise plan and interventions

Answer 51

Answer: D Analysis of all data

Answer 52

Albuterol (ProAir) - asthma Lisinopril (Zestril) - hypertension Acetaminophen (Tylenol) - headaches

Answer 53

Risk for acetaminophen overdose and hepatotoxicity related to exceeding recommended dose.

Answer 54

Client will demonstrate understanding of correct dosing of acetaminophen by stating normal dose range and maximum dose in 24 hours.

Answer 55

Patient edu

Answer 56

Patient can correctly state appropriate dose and frequency of acetaminophen

Answer 57

Most common cause of morbidity and preventable death in hospitals Preventable event! National Coordinating Council for Medication Error Reporting and Prevention definitions:

Answer 58

Errors in patient assessment Errors in prescribing Errors in administration Distracting environmental factors and stress Nurse is the last line of defense to prevent errors! - someone orders med, pharmacists check that norm dosage range, but need due diligence because what is done is done and need stop and question before make an error that can be prevented Quite prevalent - cause increased length of stay, deaths Require lot thinking

Answer 59

Example: Inadequate medication or medical history Forget to ask on allergy Improperly assess and forget to take VS

Answer 60

Example: Wrong drug, incorrect dose, illegible written order Concentration can be off; lot probs with these errors - lot flaws can happen for it Problematic if one 2 exactly same meds; careful with TO and verify what need do

Answer 61

Example: One of the “rights” of administration compromised

Answer 62

Example: Interruptions during preparation or administration

Answer 63

Proper assessment, administration, monitoring, evaluation, and documentation Question a medication order for any reason when in doubt Always listen if client questions the drug Do not use medical abbreviations and acronyms Minimize telephone orders; use “read back” order to prescriber, spell drug name Be careful with look alike, sound alike drugs

Answer 64

Student: notify clinical faculty or assigned nurse immediately Nurse: Institutions have reporting system with non-punitive approach (depending on level of error)

Answer 65

Notify primary care provider for additional orders Monitor, intervene as prescribed/appropriate Report (legal and ethical responsibility)

Answer 66

Improve systems and procedures; reduce future errors

Answer 67

Psychological impact Loss of trust Named defendants in malpractice litigation; financial implications Administrative response: Board of nursing

Answer 68

Continuing education or refresher Discipline – suspension or termination of employment

Answer 69

Suspend or revoke license