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Nursing Fundamentals > Unit 10 Pharmacology > Flashcards

Unit 10 Pharmacology Flashcards

1
Q

Chemical Name

A

describes molecular structure of the drug

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2
Q

Generic Name

A

the active ingredient (lower case)

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3
Q

Trade name

A

name given by drug manufacturer (Proper name)

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4
Q

Prescription vs OTC

A

RX needs provider order, lower dosages are OTC.. differentiated due to risk associated with dosage amount

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5
Q

Can a drug fall under more than one classification?

A

NO

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6
Q

USAGE CLASSIFICATION

A

WHY the drug is used, CLINICAL INDICATION of the drug (i.e. antipyretic, decrease fever)

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7
Q

BODY SYSTEM CLASSIFICATION

A

WHERE the drug works, the BODY SYSTEM the drug targets (stimulants, CNS, nicotine)

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8
Q

CHEMICAL/PHARMACOLOGICAL CLASS

A

WHAT the drug is made of, DRUG STRUCTURE/COMPOSITION (i.e. H2 blocker- Pepcid)

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9
Q

Sources of drug information

A 
***NOT ANOTHER PERSON!
~US Pharmacopoeia- lists FDA approved
~National Formulary
~PDR
~Nursing drug handbooks
~PHARMACISTS!
~Electronic (i.e. UpToDate)
~Med Package insert
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10
Q

US DRUG LEGISLATION

A 
~Sets official drug standards
~Define prescription drugs
~Regulates controlled substances
~Improves safety
~Requires proof of efficacy
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11
Q

Nurse Practice Act

A

Identifies nursing responsibilities for med administration and patient monitoring

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12
Q

DEA

A

Drug Enforcement Agency

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13
Q

STATE BON- scope of practice/nsg responsibility

A

~KNOW what you are giving and WHY.. ONLY for REASONS PRESCRIBED
~CHECK ALLERGIES, LAB VALUES, VITALS (if needed) before admin
~KNOW you can give type and form of medication
~STANDARD OF CARE (breach=negligence) Would professional under same circumstances, with same knowledge at the time have concluded such action was reasonable?
~LIABILITY d/t action or inaction you caused harm to patient- i.e. providing insulin without checking BS

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14
Q

SAFETY GOALS

A

~Accuracy: two identifies (ie NAME, DOB)
~Communication (i.e. quiet during med pass/avoid distractions)
~IDENTIFY medicaion
~MED RECONCILIATION
~Patient involvement
~ID risky populations (i.e. fall risk and benzos)

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15
Q

Can methadone be prescribed by PCP?

A

NO. Needs to be dispensed from specialty clinic.

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16
Q

Controlled Substances (Schedules)

A

I: ILLEGAL (i.e. heroin)
II: medicinal purposes, high risk for abuse/dependence (i.e. dilaudid)
III: Lower risk than schedule II (i.e. testosterone/steriod)
IV: Low risk of abuse/dependence (i.e. benzodiazepines-xanax)
V: Lowest risk, preparations with limited amounts of certain narcotics (i.e. Robitussin AC)

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17
Q

What do you do if you suspect diversion with a nurse?

A

Contact charge nurse, NOT the RN (in question) directly

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18
Q

What do you do if the controlled substance count is off?

A

Notify supervisor immediately with discretion in count before/after

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19
Q

Do you need a witness to waste controlled substances?

A

YES, another RN or LPN.. NOT LNA!

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20
Q

What provider number needs to be on a prescription for a controlled substance?

A

Provider’s DEA number

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21
Q

PREGNANCY RISK CATEGORIES

A 
A alright
B be careful
C controversial 
D don't do it
X NEVER
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22
Q

What is pharmacokinetics?

A

How medications travel through the body.

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23
Q

ADME

A 
PHASES OF PHARMACOKINETICS
Absorption
Distribution
Metabolism
Excretion
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24
Q

ABSORPTION

A

Transmission of medications from the location of administration to the bloodstream.
~Rate of medication absorption determines how soon drug takes effect
~Amount of medication the body absorbs determines intensity
~The route of admin affects the rate/amount of absorption

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25
Q

Enteral vs parenteral?

A 
Enteral= through the GI tract
Parenteral= IV
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26
Q

ORAL ROUTE (ABSORPTION NOTES)

A

BARRIERS TO ABSORPTION: medications must pass through layer of epithelial cells that line GI tract
ABSORPTION PATTERN varies due to:
~stability/solubility of the med
~GI pH and emptying time
~Presence of food in the stomach
~concurrent medications
~form of med (i.e. liquid vs enteric coated pills)

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27
Q

SUBCUTANEOUS AND IM ROUTE (ABSORPTION NOTES)

A

BARRIERS: no significant barriers d/t capillary walls having large spaces between cells.
ABSORPTION PATTERN factors:
~solubility of med in water (+solubility= rapid absorption 10-30min// -solubilty=slow absorption)
~blood perfusion at site- +perfusion =rapid, -perfusion=slow

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28
Q

INTRAVENOUS ROUTE (ABSORPTION NOTES)

A

BARRIERS: NONE
ABSORPTION PATTERNS:
~IMMEDIATE enters directly into blood
~COMPLETE reaches blood in its entirety

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29
Q

DISTRIBUTION

A

The transportation of medications to site of action by bodily fluids.

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30
Q

What are the factors that influence distribution?

A

~CIRCULATION: blood flow to organs, condition that inhibit flow/perfusion
~PERMEABILITY OF CELL MEMBRANE: pass through tissues and membranes to reach target areas. Meds that are lipid soluble /have transport system can cross BBB and placenta.
~PLASMA PROTEIN BINDING: medications compete for binding sites, primarily albumin and cannot be used until unbound/free. Hypoalbuminemia can = toxicity

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31
Q

METABOLISM

A

BREAKDOWN/DETOXIFY
Change of medication into less active forms or inactive forms by the action of enzymes.
~Primarily occurs in liver, but can also happen in kidneys, lungs, intestines and blood.

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32
Q

What are factors that influence med metabolism rate?

A

~Age (infants have limited capacity, hepatic med metabolism tends to slow with age)
~Increase in some med metabolizing enzymes
~first-pass effect: liver inactivation
~similar metabolic pathways: if pathway metabolizes two medications, can alter breakdown of one/both of them, could lead to accumulation
~nutritional status: malnourished pts can be deficient in factors needed to produce med metabolizing enzymes, impairs processing

33
Q

What is bioavailability?

A

What is left after liver is done with it.. NOTE liver dz can affect process with medication metabolism, +risk of toxicity

34
Q

EXCRETION

A

The elimination of medications from the body, primarily the kidneys.
~Can also be via liver, lungs, intestines, exocrine glands
~Kidney dz can lead to toxicity/+duration and intensity of med response

35
Q

What is MEC?

A

Minimum effective concentration

36
Q

What is meant by plasma medication level? (therapeutic level)

A

Therapeutic range when it is effective and not toxic. Used to monitor response to medication.

37
Q

High TI (therapeutic index)

A

wide safety margin, no need for routine blood medication-level monitoring

38
Q

Low TI (therapeutic index)

A

requires close monitoring, nurse to consider route of administration when monitoring for peak levels

39
Q

Peak levels occur when?

A

highest plasma level when elimination=absorption

40
Q

When do you obtain trough level?

A

30 minutes BEFORE medication is administered. (trough= lowest concentration in blood)

41
Q

What is meant by plateau?

A

medication concentration in plasma during series of doses

42
Q

What is half-life?

A

The time for the medication in the body to drop by 50%. (to be eliminated)
~Liver and kidney function affect half-life
~Usually takes four half-lives to achieve a steady blood concentration

43
Q

What are pharmacodynamics?

A

What the drug does to the body.
MoA! (mechanism of action)
The interactions between medications and target cells, body systems and organs to produce effects. Interactions result in functional changes that are the MoA of the medication

44
Q

What is an agonist?

A

Medication that mimics that receptor activity that endogenous compounds regulate. (i.e. morphine activates receptors that produce pain)

45
Q

What is an antagonist?

A

Medication that can block the usual receptor activity that endogenous compounds regulate. (i.e. narcan)

46
Q

What is a partial agonist?

A

Medication that acts as an agonist and an antagonist, with limited affinity to receptor sites. (i.e. suboxone)

47
Q

What are factors that influence EXCRETION?

A

~Kidney dysfunction
~Increased Peristalsis (ACCELERACTES drug excretion)
~Decreased Peristalsis (DELAYS excretion)

48
Q

What organ is responsible for “first pass effect?”

A

LIVER

49
Q

What are factors that influence absorption?

A

~Route of administration
~pH/ionization (GI pH/emptying time)
~solubility of drug (EC, TR, liquid vs solid)
~Circulation.. +flow=+absorption

50
Q

What primary organ/source of excretion?

A

Kidney

51
Q

Factors that affect Pharmacokinetics?

A

Age, body mass, sex, pregnancy, environment, RoA, ToA, Fluids, Pathological states, genetic, psychological

52
Q

Medications are tested for ‘recommended dose’ on male or female weight?

A

Average male weight (consider muscle mass/metabolism)

53
Q

How would a patient with a fever affect absorption rate of a transdermal patch?

A

Skin is warm, will increase rate of absorption; sweating can increase absorption/metabolism

54
Q

Why are some medications dosed at night?

A

May not be able to take with food; circadian rhythm

55
Q

How can anxiety affect medication?

A

+sympathetic nervous system, + effect

56
Q

Why could someone wake up during surgery?

A

Some people metabolism medications differently (i.e. quicker), may be related to genetics

57
Q

The patient has been on a low-protein diet. This will most likely affect which pharmacokinetic process?

A

DISTRIBUTION!

58
Q

What is medication onset?

A

When medication appears to start working (i.e. minimum effect)

59
Q

What is medication peak?

A

Medication is highest in the blood. (i.e. maximum effect)

60
Q

What is medication duration?

A

Period of time in which medication has reached peak action.

61
Q

Are peak and half-life the same?

A

NO.

62
Q

When do you draw a peak level?

A

60-90 minutes after infusion is complete.

63
Q

What would you anticipate the provider’s order to be if a drawn peak level was high? (i.e. vanco was 30 when TR is 15-20)

A

You would anticipate the provider would want to hold the next dose.

64
Q

Adverse effect

A

UNINTENDED undesirable effect that merits d/c drug (major, unpredictable)

65
Q

Side effect

A

undesirable effect, expected, not severe-

benefit >risk

66
Q

Allergic reaction

A

immune response, anaphylactic shock

67
Q

Primary effects

A

Therapeutic effect, intended, desired

68
Q

Secondary effects

A

UNINTENDED, NONTHERAPEUTIC

~side effect, adverse reactions, allergic, toxicity

69
Q

toxic effect

A

medication exceed therapeutic dose-> adverse reaction

*medications with narrow TI

70
Q

Idiosyncratic effect

A

unusual or peculiar response

71
Q

interactions

A

~Synergistic effect (compliment)

~Additive effect (taking two meds in same class)

72
Q

Cross-sensitivity

A

high likelyhood that allergy exists within classification of medication (i.e. penicillin allergy = allergy to others in class)

73
Q

Local effect

A

usually affecting one body part, effect occurs at the site of application

74
Q

Systemic response/effect

A

may affect more than one body part, effect may not occur at site of admin

75
Q

Local/Systemic

A

agent may be given for local effect, but also produce systemic effect (i.e. meta blocker eye drops can decrease HR/BP)

76
Q

Which P.O. medications do you NOT crush?

A

enteric coated (EC), SR, ER, LA, XL, SR, SA

77
Q

What is best practice for admin multiple medications via tube?

A

Crush, mix with tap water.. flush between EACH INDIVIDUAL MED (do not combine)

78
Q

What is purpose of nasal decompression?

A

suctioning out, resting bowels

79
Q

Do I need an order to stop suction?

A

YES

Nursing Fundamentals (3 decks)

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