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NRSG258 > Sem 1 Study > Flashcards

Sem 1 Study Flashcards

1
Q

What is the clinical reasoning cycle? (CRC)

A

Clinical reasoning—the process of applying cognitive skills, knowledge, and
experience to diagnose and treat patients” ( Royce et al., 2019)

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2
Q

Why do we use the CRC

A

The clinical reasoning cycle was developed to help beginner nurses use the same
framework when evaluating patient care that experienced nurses do

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3
Q

What are the 8 aspects of the CRC

A
  1. Consider the pt
  2. collect cues/ information
  3. Process information
  4. identify problems/ issues
  5. establish goals
  6. take action
  7. evaluate outcomes
  8. reflect on process and new learning
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4
Q

What is the Roper Logan Tierney Model of Nursing

A

A model of nursing care which looks holistically at a patient and their needs

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5
Q

Who developed the roper logan tierney model of nursing?

A

Nancy Roper

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6
Q

What was the roper logan tierney model created

A

to identify the core nursing activities that
applied to all nurses regardless of speciality areas

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7
Q

What are risk factors of gall stones

A

age, female sex, pregnancy, obesity, metabolic syndrome, genetic predisposition, low levels of physical activity

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8
Q

What are symptoms of gall stones?

A

nausea and vomiting, tachycardia,
hypertension and diaphoresis.

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9
Q

3 Risks of gall stones

A
  1. Cause severe abdominal pain if blocks bile duct
  2. May also lead to bacterial infection of gallbladder
  3. May block pancreatic duct which can cause acute
    pancreatitis
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10
Q

What is a Laparoscopic Cholecystectomy

A

Minimally invasive surgical procedure to remove
the gallbladder

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11
Q

When is a Laparoscopic Cholecystectomy used/ indicated

A

Indicated for chronic or acute cholecystitis

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12
Q

What are common complications of laparoscopic cholecystectomy?

A

bleeding, infection,
damage to surrounding structures – particularly
the hepatic duct.

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13
Q

What surgery would you use for chronic cholecystitis?

A

laparoscopic cholecystectomy

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14
Q

What is chronic cholecystitis?

A

swelling and irritation of the gallbladder

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15
Q

Less common complications of a laparoscopic cholecystectomy

A

may be a bile leak or conversion to open surgery.

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16
Q

What is Escitalopram?

A

SSRI – selective serotonin reuptake inhibitor. Used for major depression.

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17
Q

What are side affects of escitalopram?

A

nausea, diarrhoea, agitation, insomnia, drowsiness, tremor, dry mouth, dizziness, headache, sweating, weakness, anxiety, sexual dysfunction,
rhinitis, myalgia, rash, prolonged QT interval/tachycardia, abnormal platelet
aggregation/haemorrhagic complications

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18
Q

What are considerations of escitalopram?

A

can cause blurred vision and affect people’s ability to drive or operate machinery, must be slowly weaned off to avoid withdrawal affects

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19
Q

What is elective surgery in regards to wait times

A

clinical condition of patients means their procedure can be put
on a waiting list

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20
Q

what is the time frame for a Category 1 surgery

A

clinically indicated within 30 days

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21
Q

what is the time frame for a Category 2 surgery

A

Clinically indicated within 90 days

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22
Q

what is the time frame for a Category 3 surgery

A

Clinically indicated within 365 days

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23
Q

What is the time frame of emergency surgery?

A

the patient needs a procedure to treat trauma or acute
illness or deteriorating to an existing condition within 10 days.

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24
Q

What does open surgery mean?

A

requires larger cuts so the
surgeon can visualise the structures
involved

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25
Q

What is minimally invasive surgery

A

– any technique which
allows a smaller incision

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26
Q

Common risks of surgery (6)

A
  • Fasting Status – recommended 6hrs for food
    and 2 hrs clear fluids minimum
  • Anaesthetic
  • Positioning
  • Infection
  • Haemorrhage
  • Damage to other structures
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27
Q

What are two parts of general anaesthesia (administration)

A
  • Total IV anaesthesia
  • inhalation
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28
Q

What is general anaesthesia

A
  • Technique of choice for surgeries with significant duration or that
    require relaxation/uncomfortable
    position/control of ventilation
  • Balanced technique with adjunctive medications
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29
Q

How is Regional anaesthesia administered?

A

Always injected
* May be peripheral (e.g. brachial
plexus block) or central (e.g.
epidural block)

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30
Q

What is the result of regional anaesthesia?

A

Loss of sensation in body region without loss of consciousness when
specific nerve or group of nerves is
blocked by administration of local
anaesthetic

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31
Q

What are types of Local anaesthesia (4)

A
  • Topical
  • Ophthalmic
  • Nebulised
  • Injectable
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32
Q

What does local anaesthesia do?

A

Produces loss of sensation without
loss of consciousness

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33
Q

What are preoperative risk factors (6)

A
  • age
  • nutritional status
  • medical/ surgical history
  • medications
  • lifestyle
  • procedural
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34
Q

What are the two type of age preop risk factors

A
  • paeds
  • advanced age
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35
Q

What are nutritional status risks pre op (3)

A
  • Obesity
  • Malnutrition
  • Electrolyte or fluid imbalances
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36
Q

What are medical surgery pre op risks (4)

A
  • Previous reactions to anaesthetic
  • Kidney or liver impairment
  • Cardiovascular or respiratory disorders
  • Diabetes
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37
Q

What are medication preop risks (6)

A
  • Anticoagulants
  • Diuretics
  • Antihypertensives
  • Antidepressants
  • Antibiotics
  • Herbal supplements
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38
Q

What are lifestyle choices preop risks (2)

A
  • smoking
  • alcohol use
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39
Q

What are common Intraoperative medication types? (5)

A
  • Anaesthetic
  • sedation
  • muscle relaxant
  • analgesia
  • prophylactic medication (antibiotics)
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40
Q

What are common Postoperative medication types (3)

A
  • analgesia
  • antibiotics
  • laxatives
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41
Q

What body systems have risks of postoperative complications (9)

A
  • Respiratory
  • Cardiovascular
  • Fluid and electrolyte
  • Neuropsychological
  • Integumentary
  • Gastrointestinal
  • Renal
  • Endocrine
  • Musculoskeletal
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42
Q

What does IDEAL mean in discharge

A
  • Include – patient and family (with consent)
  • Discuss – medications, potential complications or side effects to look for and what to do if they happen, appointments, who to contact if concerned, support
    needed, strategies to prevent problems at home
  • Educate – patient about their condition/discharge/plan of care
  • Assess – understanding of diagnosis/health plan. Use teach back
  • Listen – respect their goals and wishes/address their concerns
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43
Q

What does RPAO

A

Routine Post Anaesthetic Observations

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44
Q

What are the 3 phases of perioperative nursing:

A

✓ Pre-operative – before admission/before surgery
✓ Intra-operative – during surgery
✓ Post-operative – after surgery, including before and after discharge

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45
Q

Perioperative risk factors (9)

A
  • Age
  • Nutritional status
  • Fluid and electrolyte balance
  • Co-morbidities
  • Medications
  • Lifestyle
  • Allergies
  • Anaesthesia
  • Procedure
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46
Q

Risks for older adults >65yrs in surgery (10)

A

↑ risk & severity of complications due to altered physiological, cognitive & psychosocial responses to surgery.
Due to normal aging, even a healthy older person may have:
* ↓ ability to cope with stress
* ↓ tolerance of general anaesthesia & medications
* ↓ muscle tissue → hypothermia & ↓ drug metabolism
* ↓ respiratory function
* Delayed wound healing
* Co-morbidities
* Polypharmacy
* Malnourishment
* ↓ body water (45%)

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47
Q

Risks relating to obesity surgically (14)

A
  • Due to stress on multiple systems
  • Anaesthetic risk
    ✓ Difficulty with intubation
  • Slower recovery from anaesthetic
    ✓ Adipose tissue stores inhalation gases
    ✓ May require higher dosage of medications
  • ? decresed mobilisation → increase risk of VTE, atelectasis, pressure injury
  • Stress on abdominal suture line → wound dehiscence, delayed healing; incisional hernia
  • Skin folds moist & hard to keep clean → increased risk of infection
  • Adipose tissue less vascular → increased susceptibility to infection
  • May have comorbidities e.g.
  • Diabetes type II with abdominal obesity → ↑ risk of infection & poor wound healing
  • Cardiac complications:
  • Hypertension due to increased length of blood vessels due to excess weight & alterations
    in the renin/angiotensin mechanism
  • High cholesterol resulting in atherosclerosis
  • Atrial fibrillation
  • Gastro-oesophageal reflux disease (GORD)
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48
Q

What is GORD

A

Gastro-oesophageal reflux disease

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49
Q

What are different Diagnostic tests (9)

A
  • Urinalysis
  • ECG
  • Chest X-ray
  • Full blood count/examination (FBC or FBE)
  • Liver function test (LFT)
  • Electrolytes e.g. Na+, K+, Ca2+, Mg2+ & renal function –
    urea, creatinine (EUC)
  • Coagulation studies
  • Cross match, group and hold if blood transfusion required
  • Pregnancy test if applicable
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50
Q

What are the elements in a urinalysis (4)

A
  • Protein
  • Glucose
  • Ketones
  • Nitrates
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51
Q

What is the normal level of protein in a urinalysis?

A

none- small

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52
Q

What is the normal glucose level in a urinalysis?

A

none

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53
Q

What is the normal ketone level in a urinalysis?>

A

none - small

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54
Q

What is the normal nitrate level in urinalysis?

A

none

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55
Q

What can increased protein in urinalysis mean? (9)

A
  • proteinuria
  • acute and chronic renal disease
  • hypertension
  • high protein diet
  • hypokalaemia
  • strenuous exercise
  • dehydration
  • fever
  • emotional stress
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56
Q

What is a consideration in a protein result in a urinalysis for a female

A

Vaginal secretions may contaminate urine and give a positive test

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57
Q

What can abnormal glucose results in a urinalysis mean? (3)

A
  • glycosuria
  • diabetetis mellitus OR low urine threshold for glucose reabsorption
  • small amount may be found post glucose testing
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58
Q

What is glycosuria?

A

a condition characterized by an excess of sugar in the urine, typically associated with diabetes or kidney disease.

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59
Q

What can abnormal ketone results mean in a urinalysis?

A

Altered carbohydrates and fat metabolism indicates diabetes mellitus and starvation

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60
Q

What can altered nitrates mean in a urinalysis?

A

Bacteruria with gram negative organisms which convert nitrates to nitrites eg E Coli.

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61
Q

What is the normal bilirubin in urine?

A

None

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62
Q

What can abnormal bilirubin in urine mean

A

Bilirubinuria, hepatice disorders, jaundice

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63
Q

What is Bilirubinuria

A

The presence of bilirubin in the urine, usually detected while performing a routine urine dipstick test. Its presence is abnormal and can be the first clinical pointer of serious underlying hepatobiliary disorder even before clinical jaundice is appreciated.

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64
Q

What is the normal SG of a urinalysis

A

1.003-1.030

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65
Q

What does low SG in a urinalysis mean?

A

Dilute urine - excess diuresis

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66
Q

What does high SG in a urinalysis mean?

A

Dehydration

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67
Q

What is the normal PH of a urinalysis? Range and ‘best’

A

Range 4.5-8 Best 6.0

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68
Q

What could a PH of greater than 8.0 mean in a urinalysis

A

Bacterial infection decompose uria -> ammonia. Metabolic or respiratory alkalosis

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69
Q

What could a PH of less than 4.5 mean in a urinalysis? And what can the pH be affected by

A

Respiratory or metabolic acidosis
pH affected by diet and some drugs

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70
Q

What is the normal range of blood in a urinalysis

A

None

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71
Q

What can presence of blood in urinalysis mean? (7)

A

Presence of blood in females may indicate menustration. Bleeding in urinary tract may be caused by calculi, tumours, glomerulonephritis, TB, kidney biopsy or trauma

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72
Q

What should the WBC be in a urinalysis? (White blood cells)

A

None

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73
Q

What can presence of WBC in a urinalysis indicate?

A

Pyuria - UTI or inflammation

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74
Q

What can cause a false + WBC reading in a urinalysis?

A

Contamination from vaginal secretions

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75
Q

What can cause a false - WBC reading in a urinalysis?

A

Antibiotics

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76
Q

What does A B C D E mean as a primary assessment

A

Airway
Breathing
Circulation
Disability
Exposure

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77
Q

What dos F G H mean as a secondary assessment

A

Fluids/ full set of vital signs
Glucose/ give comfort
Head to toe assessment

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78
Q

What is atelectasis?

A

Complete or partial collapse of a lung or a section (lobe) of a lung.

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79
Q

What is a primary cause of atelectasis

A

GA

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80
Q

What is laryngospasm?

A

Uncontrolled spasm/ constriction of the laryngeal vocal cords

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81
Q

What can cause a laryngospasm in surgery?

A

Anaesthetics gas or ET tube

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82
Q

What impact does smoking cause in respiratory function that causes a GA risk?

A

decreased ability to expectorate due to flattened cilia

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83
Q

What does expectorate mean

A

Cough or spit out fluid of phlegm from the lungs

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84
Q

How does COPD/asthma and smoking impact respiratory systems from surgical perspective

A

decreased secretions and ability to exchange gases.

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85
Q

Why is there a cardiovascular risk in surgery?

A

CVS maintains tissue perfusion i.e. O2 and nutrients to cells and removal of waste and CO2 from cells

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86
Q

What are potential CVS complications due to anaesthetic agents

A

Arrythmias
Hypotension
Hypertension
VTE

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87
Q

Why is hypotension a CVS risk with surgery

A

Hypotension = low cardiac output = renal failure

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88
Q

Why is hypertension a CVS risk with surgery

A

Hypertension = increased risk of intra/post op bleeding/ stroke

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89
Q

Why is VTE a CVS risk with surgery

A

Risk of PE/DVT due to immobility

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90
Q

How many ml of blood is class 1 of hemorrhagic shock?

A

up to 750ml

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91
Q

How many ml of blood is class 2 of hemorrhagic shock?

A

750ml - 1500ml

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92
Q

How many ml of blood is class 3 of hemorrhagic shock?

A

1500ml - 2000ml

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93
Q

How many ml of blood is class 4 of hemorrhagic shock?

A

greater than 2000

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94
Q

What is the blood loss (% blood volume) in class 1 hemorrhagic shock?

A

up to 15%

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95
Q

What is the blood loss (% blood volume) in class 2 hemorrhagic shock?

A

15% - 30%

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96
Q

What is the blood loss (% blood volume) in class 3 hemorrhagic shock?

A

30% - 40%

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97
Q

What is the blood loss (% blood volume) in class 4 hemorrhagic shock?

A

Greater than 40%

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98
Q

What is the pulse rate (BPM) in class 1 hemorrhagic shock?

A

<100

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99
Q

What is the pulse rate (BPM) in class 2 hemorrhagic shock?

A

100-120

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100
Q

What is the pulse rate (BPM) in class 3 hemorrhagic shock?

A

120-140

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101
Q

What is the pulse rate (BPM) in class 4 hemorrhagic shock?

A

> 140

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102
Q

What is the blood pressure in class 1 hemorrhagic shock?

A

normal

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103
Q

What is the blood pressure in class 2 hemorrhagic shock?

A

normal

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104
Q

What is the blood pressure in class 3 hemorrhagic shock?

A

decreased

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105
Q

What is the blood pressure in class 4 hemorrhagic shock?

A

decreased

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106
Q

What is the pulse pressure in class 1 hemorrhagic shock?

A

normal or increased

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107
Q

What is the pulse pressure in class 2 hemorrhagic shock?

A

decreased

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108
Q

What is the pulse pressure in class 3 hemorrhagic shock?

A

decreased

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109
Q

What is the pulse pressure in class 4 hemorrhagic shock?

A

decreased

110
Q

What is the resp rate (per min) in class 1 hemorrhagic shock?

A

14-20

111
Q

What is the resp rate (per min) in class 2 hemorrhagic shock?

A

20-30

112
Q

What is the resp rate (per min) in class 3 hemorrhagic shock?

A

30-40

113
Q

What is the resp rate (per min) in class 4 hemorrhagic shock?

A

Greater than 40

114
Q

What is the urine output (ml/hour) in class 1 hemorrhagic shock?

A

> 30

115
Q

What is the urine output (ml/hour) in class 2 hemorrhagic shock?

A

20-30

116
Q

What is the urine output (ml/hour) in class 3 hemorrhagic shock?

A

5-15

117
Q

What is the urine output (ml/hour) in class 4 hemorrhagic shock?

A

Negligible

118
Q

What is the CNS/ mental status in class 1 hemorrhagic shock?

A

Normal or slightly anxious

119
Q

What is the CNS/ mental status in class 2 hemorrhagic shock?

A

Mildly anxious

120
Q

What is the CNS/ mental status in class 3 hemorrhagic shock?

A

Anxious and/or confused

121
Q

What is the CNS/ mental status in class 4 hemorrhagic shock?

A

Confused, lethargic

122
Q

Why is the gastrointestinal system a surgical risk?

A

Anaesthetics + opioids - decreased mobility and increased nausea

123
Q

What are potential surgical complications with the gastro system? (4)

A

decreased peristalsis
gastric ulceration due to stress
constipation
vomiting

124
Q

Why is decreased peristalsis a surgical risk

A

paralytic ileus

125
Q

What is paralytic ileus

A

A condition in which the muscles of the intestines do not allow food to pass through, resulting in a blocked intestine.

126
Q

Why are fluids and electrolytes a surgical risk?

A

Fluid and electrolyte imbalance can occur periop due to the release of hormones from surgical stress EG ADH and aldosterone

127
Q

What are potential fluid and electrolyte complications surgically?

A

Electrolyte imbalances
Hypovolaemia/ hypervolaemia

128
Q

What is hypovolaemia?

A

Low fluid volume

129
Q

What hypervolaemia?

A

Excess fluid volume

130
Q

What is hyponatraemia?

A

Low Na+ due to release of ADH = low h2O retention

131
Q

What is ADH?

A

Anti-diuretic hormone - arginine vasopressin.

132
Q

What is hypokalaemia?

A

K+ <3.5mmol/L due to release of aldosterone which retaines Na+ and excretes k+

133
Q

What is the normal range of Ca2+ (calcium)

A

2.1-2.6mmol/L

134
Q

What is the normal range of Mg2+ (magnesium)

A

0.75-1.0mmol/L

135
Q

What is the normal range of Na+ (sodium)

A

135-145mmol/L

136
Q

What is the normal range of K+ (potas)

A

3.5-5.0mmol/L

137
Q

What is the surgical risk for the integumentary system?

A
  • Anaesthetics decrease the ability to maintain homeostasis and body temp. Can increase nausea
  • surgery increase disruption of skin integrity
138
Q

What are potential surgical complications in the integumentary system? (4)

A
  • poor wound healing/ wound infection and or tissue breakdown due to inadequate nutrition
  • pressure injuries due to decreased mobility
    -nerve injuries due to inappropriate position
  • hypothermia ^ cardiac arrhytyhmias
139
Q

What is the surgical risk for the endocrine system? (2(

A

-Surgery/ anaesthetics are a stress on the body and negative nitrogen balance
- anaesthetics suppress the immune system (pain affects the endocrine system ed. ^ adrenaline/noradrenaline

140
Q

What type of hormones are adrenaline/noradrenaline

A

Stress hormones

141
Q

What are potential surgical complications for the endocrine system? (4)

A
  • high or low BGL levels due to diabetes
  • long term glucocorticoids = ^^ risk of poor wound healing, fractures, GI haemorrhage, hyperglycaemia
  • hypothermia/ slower recovery from anaesthetic agents due to hypothyroidism
  • unable to cope with stress due to lack of cortisol response from adrenal glands
142
Q

What is glucocorticoids?

A

any of a group of corticosteroids (e.g. hydrocortisone) which are involved in the metabolism of carbohydrates, proteins, and fats and have anti-inflammatory activity.

143
Q

Why are medications a potential surgical risk? (2)

A

-Anaesthetics can cause ^ levels of some drugs in the body due to increased blood flow to the liver .
- Some drugs can interact with some anaesthetic agents

143
Q

Why are medications a potential surgical risk? (2)

A

-Anaesthetics can cause ^ levels of some drugs in the body due to increased blood flow to the liver .
- Some drugs can interact with some anaesthetic agents

144
Q

What are complications that can occur surgically from medications?

A
  • Anticoagulants, antiplatelets, NSAIDS = ^ increased risk of bleeding
  • ACE inhibitors = ^ hypotension post anaesthesia
  • Steroids = poor wound healing + increased risk of infection
  • St Johns Wart = ^ hypotension
145
Q

What are anticoagulants

A

an agent that prevents blood clotting

146
Q

What are antiplatelets?

A

directed against or destructive to blood platelets; called also antithrombocytic

147
Q

What are NSAIDS

A

nonsteroidal antiinflammatory drug

148
Q

What are ACE inhibitors and what do they treat?

A

Angiotensin-converting-enzyme inhibitors high blood pressure and heart failure

149
Q

What are the elements of valid consent?

A
  • Voluntary
  • Specific
  • Informed
  • Legal Capacity
  • Current
150
Q

When does a person have legal capacity

A

18+ sound mind and legally competent

151
Q

Who might be able to consent on a patients behalf if the person doesnt have capacity?

A
  • doctor
  • next of kin
  • carer
  • enduring (medical) power of attorney
152
Q

3 points about advanced care directives

A
  • is a legal document that outlines the care a person wishes to receive if they no longer have the capacity to make their own decisions
  • cannot be over ruled by staff or relatives
  • contravening an ACD can result in criminal charges
153
Q

8 Factors that affect legal capacity

A
  • unconscious
  • has an intellectual disability such as dementia or brain injury
  • an emergency
  • a child
  • severe pain
  • opioids
  • being under the influence of illegal drugs or alcohol
  • language barrier
154
Q

How do you test capacity

A

Threshold Test of Capacity

155
Q

What is the ‘Doctrine of Emergency’ or “Doctrine of Necessity’

A

In an emergency where the patient is able to consent the health care professionals may provide reasonable treatment to SAVE LIFE or PREVENT SERIOUS INJURY OR DEATH

156
Q

What is the age of consent in NSW

A

15

157
Q

What is the age of consent in Victoria

A

18 HOWEVER Gillick Competency is inplace

158
Q

What is Gillick Competency

A

Children under 18 years can consent if the child is of an age and intelligence where they can understand and comprehend the consequence oof their decision they can legally consent

159
Q

Age of consent in ACT

A

18

160
Q

Age of consent in QLD

A

18 BUT Gillicks competency

161
Q

What is a medical example of assault and what is assault

A

Assault = to cause fear of injury to another person
Example = Threaten to medicate/ restrain a patient if they do not cooperate

162
Q

What is battery and give a medical example

A

Battery = actual physical contact but not necessarily causing injury - touching without consent
Example = dragging a pt out of bed

163
Q

What is negligence

A

Breach of duty of care

164
Q

What is power of attorney (POA)

A

A legal document where a person over 18 years and of sound mind is appointed by you to make limited or total financial decisions on your behalf eg manage shares and pay bills

165
Q

When would a general POA end

A

If you loose your legal capacity

166
Q

What is an enduring/ medical POA

A

A legal document where you appoint someone to make decisions for you if you lose capacity

167
Q

what is guardianship

A

legislation in all states and territories that protects people who are incompetent or disabled

168
Q

What are the three criteria that a person needs a guardian

A
  • has a disability within the definition in the legislation
  • is unable to make their own decisions
  • there is a need to appoint a guardian eg a minor
169
Q

Does a guardain control finances

A

no

170
Q

What are deaths that are reportable to the coroner (8)

A
  • unexpected, violent or unnatural (homicide or suicide), due to accident or injury
  • occurred during or following a health- related procedure that the doctor would not have expected death
  • death cert has not been signed as cause of death unclear
  • death that occurs within 24 hours of presentation to hospital or 24 hour post surgery
  • has not seen dr in 6 months
  • unknown identity
  • died in custody
  • was in or temporarily absent from a mental health facility
171
Q

What does potency mean in drugs

A

The amount of chemical that is required to produce an effect

172
Q

What does selectivity mean in drugs

A

A particular drugs ability to produce the desired effect on receptors, cellular processed or tissues

173
Q

What does specificity mean in drugs

A

Relationship between the structure and the pharmacological agent

174
Q

What impacts a drug class (6)

A
  • source
  • chemical formula or structure
  • pharmokinetics
  • activity
    -mechanism of action
  • clinical use
175
Q

What is a schedule two drug

A

Pharmacy medicine

176
Q

What is a schedule three drug

A

Pharmacist only medicine

177
Q

What is a schedule 4 drug

A

Prescription only medicine

178
Q

What is a schedule 8 drug

A

controlled drug

179
Q

what is a schedule 9 drug

A

prohibited substance

180
Q

What is the quality use of medications (QUM)

A

One of the central objectives of australias national medicines policy

181
Q

What are the 10 rights of medication administration

A
  • right medication
  • right route
  • right dose
  • right time
  • right person
  • right documentation
  • right reason
  • right response
  • right education
  • right to refuse
182
Q

What is phamacodynamics

A

The study of the interaction between the drug and its molecular target and the pharmacological response = what the drug does to the body

183
Q

What are 4 factors that affect the concentration of the drug

A
  • absorption
  • distribution
  • metabolism
  • excretion
184
Q

What does affinity mean (pharm)

A

Strength of the interactions between the drug and the molecular target

185
Q

What are 4 molecular drug targets

A
  • transporters
  • ion channels
  • enzymes
  • receptors
186
Q

What is an agonist

A

A drug binds to a receptor and causes a response

187
Q

What is an antagonist

A

Binds to a receptor without eliciting a response or prevents (blocks) activation of the receptor

188
Q

What does the drug do in the body?

A
  • Absorption
  • Distribution
  • Metabolism
  • Excretion
189
Q

What does absorption mean (pharm)

A

Diffusion across membranes

190
Q

What is drug absorption affected by (6)

A
  • blood flow
  • formulation
  • route of admin
  • bioavailability
  • first pass metabolism
  • bioequivalence
191
Q

What does distribution mean (pharm)

A

The process of reversable transfer of a drug between one location and another in the body

192
Q

What impacts the rate and extent of drug distribution

A
  • permeability of capillaries
  • partitioning
  • perfusion
  • drug transporters
  • plasma protein binding
  • tissue binding
  • tissue specific barriers
193
Q

What is the process of oral digestion of a drug (10)

A
  1. oral ingestion of the drug
  2. gradual absorption
  3. to the liver
  4. drug metabolism in liver
  5. drug moves gradually into general circulation
  6. through the heart
  7. to brain
  8. to muscle
  9. muscle to fatty tissue - storage
  10. urine
194
Q

What is drug metabolism

A

The process of chemical modification of the drug by enzymes - most common in the liver

195
Q

3 affecting factors of drug metabolism

A
  • age
  • genetics
  • drug interactions
196
Q

What are the classifications of metabolism (pharm)

A
  • Excreted unchanged
  • Phase 1 - Functionalisation
  • Phase 2 - Conjunction
197
Q

What happens in the metabolism stage Functionalisation

A

Modify drugs - oxidisation, reduction, hydrolysis

198
Q

What is an example of a drug that goes through phase 1 metabolism

A

Caffeine

199
Q

What is an example of a drug that goes through metabolism excreted unchanged

A

Gentamicin

200
Q

What happens in the drug metabolic stage conjugation

A

joined with an endogenous substance (glucuronic adic, sulfate, glycine) - drug detoxification

201
Q

What is an example of a drug that goes through stage 2 metabolism: Conjugation

A

Paracetamol

202
Q

What is drug excretion

A

Removal of chemically unchanged drugs and metabolites from the body

203
Q

How can drug excretion occur and where does it primarily occur

A
  • exhalation
  • saliva
  • tears
  • sweat
  • breast milk
  • urination
  • defecation
    Primarily occurs in kidneys and GIT
204
Q

How are drugs excreted in the kidneys

A
  • Glomerular filtration
  • reabsorption
  • tubular secretion
205
Q

How are drugs excreted in the GIT

A
  • Canalicular membrane
  • Bile
  • Secreted to duodenum
206
Q

What is an adverse drug reaction (ADR)

A

A response to a medicine which is noxious and unintended and which occurs at doses normally used in man

207
Q

What is an adverse drug event (ADE)

A

Any untoward medical occurrence that may present during treatment with a medicine
eg unwanted effect that occurs in a different mechanism from the pharmacological

208
Q

What are risk factors of an ADE or ADR

A
  • age, gender, genetics
  • hepatic disease
  • polypharmacy
  • frequencys
  • chemical characteristics
  • renal insufficency
209
Q

What is pharmacology

A

Involves study of drugs

210
Q

what is pharmacodynamics

A

The study of interactions between drugs, molecular targets and the pharmacological response

211
Q

What is pharamcokinetics

A

Refers to how the drug is absorbed, distributed, metabolised and excreted

212
Q

What are types of anaesthetics

A
  • general
  • local
  • regional
  • sedation/ analgesia
213
Q

What is an example of regional anaesthetics

A

Central Nerve Blocks

214
Q

What are the central nerve blocks

A
  • spinal
  • epidural
215
Q

What are adjuncts used in anaesthesia

A
  • opioids
  • benzodiazepines
  • neuromuscular blocking agents (muscle relaxants)
  • antimetics
216
Q

What is the mode of action of propofol

A

Positive modulation of the inhibitory function of the GABA neurotransmitter (gama-amniobutyric) through GABA-A receptors

217
Q

What is the onset time of propofol

A

10-20 seconds

218
Q

What is the duration of propofol

A

3-5 mins

219
Q

What is the half life of propofol

A

elimination 3-8 hours

220
Q

What is propofol

A

A rapid acting non-barbituate

221
Q

What is propofol used for

A

Induction and maintenance for GA/ light sedation/ day surgery

222
Q

What is the IV induction dose of propofol

A

1.5-2.5mg/kg

223
Q

What is the infusion dose of propofol

A

4-12mg/kg/hr

224
Q

What are ADE of propofol

A
  • respiratory and cardiac depressant
  • involuntary muscle spasms
  • ^ inter-cranial pressure
  • pain at injection site
225
Q

What are some drug interactions with propofol

A

Sedative and bradycardic effects of other drugs are increased w/ other CNS depressants (fent)

226
Q

4 Facts about intravenous induction agents

A
  • induction/ maintenance of GA
  • rapid onset - unconscious in approx 20 secs
  • short acting
  • iv injusion or injection
227
Q

What are two examples of intravenous induction agents

A
  • Thopentone
  • Propofol
228
Q

5 Facts about inhalation anaesthetics

A
  • gasses/ volatile liquids mixed with oxygen via alveoli in the lungs
  • lung function is critical for effective use and excretion
  • rapid onset
  • variable concentration
  • quick recovery
229
Q

4 examples of inhalation anaesthetics

A
  • sevoflurane
  • isoflurane
  • oxygen
  • nitrous oxide
230
Q

What is sevoflurane

A
  • induction and maintenance for GA/ light sedation/ day surgery - used for paediatrics
231
Q

What is the dosage of sevoflurane induction

A

up to 8% +/- N2O

232
Q

What is the dosage of sevoflurane maintenance

A

0.5% - 5% (up t0 7% child)

233
Q

What is the onset of sevoflurane

A

2 mins

234
Q

What is the half life of sevoflurane

A

elimination 15-23 hours

235
Q

What is the MoA of sevoflurane

A

Depress neurotransmission of excitatory paths within the CNS

236
Q

ADE of sevoflurane

A
  • cardia + resp depression
  • shivering
  • ^ salivation
  • ^ post op N&V
  • coughing and laryngospasm
  • agitation post op
237
Q

Contradictions and precautions of sevoflurane

A
  • renal/hepatic impairment - coronary artery disease
    -nitrous oxide - analgesic effects
238
Q

What is neuroleptoanalgesia

A

Joint administration of multiple drugs eg anxiolytics, antipsychotics and opioids

239
Q

What are anxiolytics

A

a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety

240
Q

What are three examples of opioid analgesics + what do they do

A
  • fentanyl
  • morphine
  • pethidine
    Induce and maintaine anaesthesia + reduce stimuli
241
Q

What is the MOA of fent, morph, peth

A

Mu-selective opioid agonist. Stimulate opioid receptors within the CNS (opioid antagonist)

242
Q

Adverse effects of opioids (fent, morp, peth)

A
  • resp depression
  • vomiting
  • bradycardia
  • peripheral vasodilation when combined with anaesthesia
  • pruitis
243
Q

What are three examples of benzodiazepines and what are they used for

A
  • Midazolam
  • Lorazepam
  • Diazepam
    Antianxiety + sedation + amnesia - induce and maintaine anaesthesia
244
Q

what is the MoA of benzodizepines

A

Mu-selective opioid agonist. Causes the neurotransmitter dopamine (Da) is increased causes relaxation effects

245
Q

Adverse effects of benzodiazepines

A
  • potentiates effects of opiods
  • hallucinations
  • dysphoria
246
Q

What are neuormuscular agents

A

Skeletal muscle relaxtion agents

247
Q

What is an example of a depolarising neuromuscular agent

A

Suxamethonium (succinycholine)

248
Q

What are two examples on non depolarising neuromuscular agents

A
  • rocuronium
  • vercuonium
249
Q

What is an example of a neuromuscular agent that can be reversed by anticholinesterase agents

A

Negostigmine

250
Q

What is the pathway of neuromuscular agents (1-8)

A
  1. motor neuron action potential
  2. Ca+ enters voltage-gated channels
  3. acetylcholine release
  4. Na+ entry
  5. Local current between depolarized end plate and adjacent muscle plasma membrane
  6. muscle fibre action potential initation
  7. propagated action in muscle plasma membrane
  8. Acetylcholine degradation
251
Q

What is the definition of depolarising neuromuscular blockers

A

Noncompetitive skeletal muscle relaxants that act as acetycholine receptor antagonists

252
Q

What is the MoA of depolarising neuromuscular blockers

A

Act as acetylcholine receptor agents

253
Q

Where to depolarizing neuromuscular blockers depolarize?

A

In the muscle

254
Q

Do depolarising neuromuscular blockers open the sodium channels

A

No

255
Q

What is the definition of nondepolarizing neuromuscular blockers

A

Competitive antagonists that compete with acetylcholine for receptor binding sites

256
Q

what is the MoA of nondepolarizing neuromuscular blockers

A

function as competitive antagonists

257
Q

do nondepolarizing neuromuscular blockers open sodium channels

A

Yes

258
Q

2 facts about depolarising anaesthetic agents

A
  • ACh receptor agonist
  • bind to the ACh receptors and generate an action potential
259
Q

ADE of depolarising anaesthetic agents (2)

A
  • hyperkalemia
  • malignant hyperthermia
260
Q

3 facts about non depolarising anaesthetic agents

A
  • competitive antagonists
  • bind to ACh receptors - unable to induce ion channel openings
  • Prevent ACh from binding - end plate potentials do not develop
261
Q

ADE of non depolarising anaesthetic agents (2)

A
  • hypotension
  • bronchospasm
262
Q

What are the 4 stages of anaesthesia

A

1 - analgesia
2 - delirium stage
3 - surgical anaesthesia
4 - medullary depression

263
Q

What is an example of local anaesthetia and what does it do

A

it blocks pathways eg. bupivacaine

264
Q

Where does an epidural go

A

Into epidural space

265
Q

Where does a spinal nerve block go

A

Into CSF (subarachnoid space)

266
Q

What is included in haemodynamic monitoring (9)

A
  • ECG
  • Blood pressure (direct - ART line, indirect - cuff)
  • Central venous pressure (CVP)
  • Pulse ox
  • capnography
  • temp
  • fluids + electrolytes
  • blood loss
  • art blood gas
267
Q

What is the first line of defence

A

intact skin and mucous membranes

268
Q

What is the second line of defence

A

AIR and fever

269
Q

What is the third line of defence

A

B & T lymphocytes

270
Q

What is innate immune response

A

Generic

271
Q

What is adaptive immune response

A

Specific

NRSG258 (1 decks)

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