Pharmacology Test 1 Flashcards
(76 cards)
0
Q
Intramuscular/ subcutaneous
A
- barriers: capillary wall, pH has to match blood
- unpredictable: absorption pattern
- advantages: slowly dissolves in tissue
- disadvantages: discomfort, cal tissue and nerve damage, bleeding risk
1
Q
Parenteral
A
- no Barrie to absorption, instant and complete
- advantages: rapid onset, control, use of large fluid volume, use of irritant drugs
- disadvantages: high cost, difficult, irreversible, fluid overload, infection, embolism
2
Q
Enteral route (oral)
A
- various absorption pattern
- can be destroyed by stomach acid
- patient age and other me can also ruin the drug effects
- advantage: easy, convenient, inappropriate, safe
- disadvantage: variablilty, inactivation by food and drug, patient requirement vary from person to person, local irritation
3
Q
Additional drug routes
A
- rectal: local or systemic (can’t swallow)
- vaginal: local
- direct: only dose by physician not nurse
4
Q
Distribution
A
- dependent upon circulation
- act quicker in area of good blood supply (heat, brain)
- act slower in area of low blood supply (muscle)
- BBB: only lipid soluble, can pass through or injected
- placenta not absolute barrier to fetus, important to look at safe drugs
- know patients history
5
Q
Metabolism
A
- most takes place in liver
- P450 responsible for inactivating drugs and varies from person and ethnicity
6
Q
Drug excretion
A
- kidneys
- change pH or urine to get rid of drugs
- can change pH of urine so drug goes back into body and continues to work
7
Q
Drug monitoring
A
All drugs can cause toxic effects but most often doesn’t expect it
8
Q
Drug levels
A
- monitor if drug can be lethal in overdose
- MEC: minimum of drug amount needed to be present in order to take effect. Must be at or above MEC level
- To be effective takes effect. Must be at or above MEC level
- to be effective takes 4-5 half lives. If long 1/2 life then give 1 per day.
9
Q
Half- life
A
If have 100 mg with 1/2 life of 12 hours
Time. 1/2 life. % in body
0. - 100mg (100%)
12. 1. 50 mg (50%)
24 2. 25 mg (25%)
36. 3. 12.5 (12.5%)
10
Q
Pharmacodynamics
A
- what drug does to body
- receptor theory
- any macromolecule to which a drug binds and initiates a biological response
- site of action = interaction beween receptor and drug
- affinity/ efficacy: between drug and receptor. Bette fit the better the drug works
- agonist: interact with receptor and similar effect of what happens in body naturally
- antagonist: inhibits natural body effects
11
Q
Variables affecting drug actions
A
Drug related:
- dose, route, drug-diet interaction, drug-herb interaction, compliance
- drug-drug interaction: addictive effects (2 drug, do same like alcohol and sedative)
- synergism: combo works better than only giving one
Patient related:
- age (1-12 high metabolism)
- weight, genes, gender, pathological condition, physiologic consideration
12
Q
Drug tolerances
A
Wen body acostoimed to drug over time so have to take a larger amount.
13
Q
Drug dependence
A
Person needs drug to function, will experience withdrawal
14
Q
Drug addiction
A
Impaired control over use. Compulsive use. Cause despite harm. Crave.
15
Q
Medication route
A
Oral, NG tube, subqutaneous, IM, IV, topical, eye, nose, ears
16
Q
aa
A
Of each
17
Q
DS
A
Double strength
18
Q
Elix
A
Elixir ( drug dissolved in alcohol and water)
19
Q
Fl
A
Fluid
20
Q
Gtt
A
Drops
21
Q
NS
A
Normal saline
22
Q
q.s.
A
Sufficient amount
23
Q
ss
A
One half
24
SR
Sustained release
25
XL
Long-lasting, extended release
26
XR
Extended release
27
amp
Ampule
28
aq
Aquatic
29
c
Cup
30
Cap
Capsule
31
EC
Enteric coated
32
Mix
Mixture
33
Sol/soln
Solution
34
Supp
Suppository
35
Susp
Suspension
36
Syp
Syrup
37
Tab
Tablet
38
Tr
Tincture
| - special mixture
39
Abbreviations
```
A = ear
D= right
S = left
U = both
O = eye
```
```
AD - right ear
AS - left ear
AU - both ears
OD - right eye
os - mouth
OS - left eye
OU - both eyes
```
40
Oral route
- do not give if committing, lacks gag reflex or unsponsored
- with or without food,
- dilute, shake or stir is required
- refrigerate as directed
- read meniscus at lowest fluid mark
- powder must be mixed with water completely and drank immediately
- if less than 5 mL then must be in syringe
41
Sublingual or buccal route
- no food or liquid intake until medication is COMPLETELY ABSORBED
- SL medications (nitro) can be given to unresponsive patients
- cant swallow because stomach will inactivate it
42
Transdermal route
- do not cut patch
- remove old patch before applying new patch
- apply to specified area of the body
- WEAR GLOvEs
- clean, dry and hairless area
- transdermal medicine in tube form
- nitro - Chet and upper arm
- nicotine - chest and upper arm
- fentanyl - DANGeROUs - apply anywhere
43
Topical route
- clean sterile technique with broken skin
- stroke firmly into skin
- do not use giant feathery touch touch when applying
44
Eye drop installation
Liquid
- position, never over cornea
- gently pull down conjunctival sac, administer drops into center of sac
- do to touch lashes or lids with dropper
- release skin and gently press eye with cotton ball for 1-2 minutes
Ointment
- squeeze 1 1/2 inch into sac
- instruct patient about blurred vision and keep eyes clod 1-2 minutes
- avoid placing on corne
45
Eardrops
- make sure medication is at room temperature
- tilt head toward unaffected side
- adult position: up and bAck
- child position: down and back
- instill number of drops ordered
- Instruct patient to keep head tilted 2-3 minutes
46
Nasal
Sprays
- ask patient to blow nose before administration and close unaffected area, tilt head toward good side, spray medication, hold breath or open closed nostril
Drops
- if frontal sinus infected, tilt head back
- if ethmoid sinus position head to affected side
- administer prescribed number of drops
- instruct patient keep head tilted 2-3 minutes
47
Inhalation route
- position patient in Fowler or semi-fowler , open using bronchodilator first or steroid
- teach patient wait two minutes between puffs
- have patient rinse mouth with water and spit following steroid inhalation
- breathe out through pursed lips
- keep inhaler 1 inch away from mouth
48
NG route
- check position
- remove plunger and pour medication into syringe
- close NG tube
- 'attach syringe
- open clamp, pour medication into syringe and hold tube up to allow medication free flow
- flush within 30 minutes with water
- close clamp, check tube placement and remove syringe
49
Medication errors
The chain
- physician - transcriber- pharmacy - pharmacy tech - pharmacist- nurse
Most common errors
- incomplete patient history
- unknown allergy, current mess, previous diagnosis, lab results, miscommunication, similar drug names
50
Adverse drug reactions
Any undesirable drug response
- side effects: expected response based n drug action (dry mouth, constipation, drowsy)
- toxicity: adverse reaction related to excessive dosing
- Allergic reaction
- idiosyncratic reaction: petticoat to person or a culture
- latrogenic - disease by physician, rugs mimic disease
51
The five rights
```
Dose
Drug
Patient
Route
Time
Documentation ( if not documented then not done)
```
52
Preventing errors
- unit dose system
- computerized provider order entry
- bar coding
- limiting use of abbreviation and decimal points
- medication reconciliation (sheet follows them through hospital)
- follow the rights continually
- learn essential information about med posted
- interpret prescribers orders accurately
- read med labs carefully
- minimize abbreviations to prevent errors
- trailing zeros, failure to use zeros
- calculate doses accurately
- Measure dose accurately
- use correct procedures and technique for administration use
- listen and educate patients
- verify identity of clients BEFoRe med administration
- omit and delay dose indicated by client condition and document accordingly
- be careful administering medication to children due to high error rate
53
Medication order
Must include
- Client full name
- name of medication (brand, generic)
- dose, route, frequency
- date, time, provider signature
Prescriptions
- amount to be dispensed
- purpose of medication
- duration of therapy and refill information
54
Medication order transcription
- typed into computer ( preferred method)
- handwritten order sheet
- verbal orders (signed by prescriber and countersigned by prescriber)
- telephone orders ("")
55
Medication order interpretation
- nurses must know commonly used abbreviations
- route, dose, time of administration
- do not use abbreviation - due to misinterpretation
- illegible orders must be clarified before administration
56
Legal responsibility
- safe and accurate administration
- recognizing and questioning orders
- refusing to administer unsafe medication on
- delegating in compliane with the law
- respond to reporting and documenting
57
Steps of the nursing process
- assessment
- nursing diagnosis
- planning
- implementation (intervention) collaboration with other disciplines (physical, occupational, doctors)
- evaluation
58
Component of client assessment in drug therapy
- cant evaluate without baseline data
- observe and interview client
- interview caregivers and family
- complete physical exam
- age, weight, vital, health status, pathological conditions, related with ADL's
- reviewing medical records
- pertinent lab and diagnostic test report
- previous or current u of prescription and nonprescription medication and no therapeutic medications (alcohol, nicotine)
59
Medication history questions
- current medication orders
- clients knowledge regarding current medications
- history or allergic reaction, type and severity
- can client swallow medication, communicate verbally
- history of herbal and dietary supplement use
60
Nursing diagnosis
- analysis of data to determine actual and potential health problems
- caution using noncompliance
61
Planning
- outlines specific interventions and goals
- should be individualized
- stated in terms of patient behavior
62
Drug therapy goals
- use of medications to prevent or treat disease processes and manifestations
- stated in terms of client behavior
- maximize beneficial effects and minimize adverse effects
- expected benefits shouldn't outweigh potential adverse effects, effect life quality. Individualized
63
Implementation and intervention
- collaborative (requires order) and independent
- often requires intra and interprofesaional collaboration
- doctor, radiology, physical and occupational
- interventions related to drug therapy include
- decreasing or preventing need of doing therapy
- using nonpharmacological enhance therapeutic effects and or decrease adverse effects
- individual care
- administering drugs
- observing responses
- well planned patient education
64
Drug selection and dosage
- factors in choosing medication and dose range
- minimize medication number and administration frequeny increases client compliance
- fixed dose combination medication contribute to increased client compliance
- lowest effective dosage of least potent to decrease adverse reaction
- recommend dosage likely to be effective for most people guideline
- medication can be started rapid or slowly
65
General non-drug intervention
- promoting health
- preventing/decreasing need for drug therapy
- using no drug measures to enhance therapeutic effects or decrease adverse effects
- client teaching
- individualized care
- observing client response
66
Specific examples of non drug interventions
- promoting healthy lifestyles regarding nutrition, fluid, exercise, rest and sleep
- consciously performing hand hygiene and infection prevention
- ambulatory, positioning and exercise
- assisting to cough and deep breathe
- applying heat and cold
- scheduling activities to promote rest or sleep
67
Evaluation
- evaluating status in relation to goals and objectives
- utilize same technique as assessment
- progess includes
- symptom relief
- accurate administration
- avoidance of preventable adverse effects
- compliance with instruction for follow-up care
68
Patient education
- drug name
- dosage
- dosage schedule
- route/ technique of administration
- expected therapeutic response when it should develop
- non drug measures to enhance therapeutic response
- duration of treatment
- method of storage
- symptoms of adverse effects
- drug-drug, drug-food interaction
69
Herbal and dietary supplement
- reasons
- available without prescription
- cheaper
- sense of empowerment
- frustration with health care provider
- distrust of convention medicine
- aggressive marketing
- regulated by DSHEA instead of FDA
- must have labeling constrictions
- concerns
- questionable safety due to unknown human effect
- supplement use may keep client from seeking medical care
- supplements may interact with prescription medications to decrease therapeutic effects
- use of supplement not communicating to healthcare provider
70
Major considerations for special population
Children
- physiological difference after pharmacokinetics
- all drug must be guided by age, weight, growth and development
- safe dose less defined
Pregnancy
- Ifnteratagenic harmful to fetus and cause abortion and defects
- fetus increases risk in one and lat trimester
Pregnancy drug categories
- A: no fetal risk
- B : no risk to animal fetus but no human information
- C: adverse animal effects but no human information
- D: possible risk to fetus reported
- X: absolute positive risk to fetus evidence
Children
- increase absorption of topical drug
- increase distribution into CNS
- decrease volume of distribution does not include need for larger dose
- decrease in protein binding results in more active drug
- decrease in glomerular filtration rate
- decrease drug bio transformation for drugs
- decrease IM absorption due to decrease blood flow to muscle
71
Geriatric Client
- lower GI absorption
- altered drug distribution due to
- inreased body fat
- decreased lean body mass, body water, concentration of serum albumin
- decline in hepatic metabolism
- decline in renal function
- common side effects
- constipation, malabsorption, hepatoxicity, diarrhea
- problems
- antibiotics, NSAIDS, hyperglycemia, anticoagulant, glucosteriod
- drug accumulation, poly pharmacy, multiple pathologies, inadequate supervision, poor adherence
- difficult to determine if symptoms are effects of aging or adverse reactions
- no drug interventions to decrease med
- OTc taken only when necessary
- review me list with them
- accommodate memory change
72
Clients with renal impairment
- drugs used carefully due to high risk of accumulation and adverse effects
- require adequate fluid intake to excrete drug
- may respond to drug dose/ concentration differently
- monitor serum creatine closely
- monitor kidneys usually 0.7-1.3 men, 0.6-1.11 women
73
Clients with hepatic impairment
- can effect drug metabolism and elimination
- liver function test
- increase: serum bilirubin, prothrombin time, serum alanine, serum aspartame
- decrease: serum albumin
- common hepatoxic drugs
- drugs that decrease hepatic blood flow
- drugs that inhibit hepatic metabolism
74
Clients with critical illness
- at risk for multiple organ dysfunction
- drug therapy more complex, problematic
- receive aggressive treatment
- route of administration (IV)
- dosage requirements may vary
75
Home care clients
- teach drug administration and drug monitoring
- communication methods established
- assess client attitude toward medication and self-care
- assess safety of environment
- use return demonstration to assess abilities
- interview client/ caregiver about
- medication compliance, efficacy
- OTC drug use: herbs and supplements
- ability to obtain medication
- keeping appointments
