NURS 504 Disease and Drugs Exam 1

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1

Sources of drugs

Plants (poppy), animals, synthetic chemicals and genetically engineered chemicals

2

Chemical Name of Drugs

describes drug's anatomic and molecular structure (P- isobutylhydratropic acid)

3

Generic Name of Drugs

identifies drug's active ingredient (ibuprofen)

4

Trade (proprietary) Name of Drugs

brand name (Advil)

5

Prototype Drug

often the first drug of a particular drug class to be developed; the standard against which newer, similar drugs are compared

6

Pharmacologic group or family

drugs that share similar characteristics

7

How can be drugs be classified?

chemical, physiologic, therapeutic

8

What are controlled substances?

categorized by federal law according to therapeutic usefulness and potential for abuse

9

Category I or Schedule I

  • no accepted medical use or accepted safety use
  • high abuse potentials
  • heroin, LSD, MDMA, peyote
10

Category II or Schedule II

  • used medically
  • high abuse potentials
  • requires prescription (not by phone), no refills
  • opioids (morphine, codeine, oxycodone)/ narcotics
  • amphetamines
  • stimulants (cocaine, meth)
  • sedatives
11

Category III or Schedule III

  • accepted medical use
  • moderate potential for abuse
  • but abuse may lead to psychological or physical dependence
  • prescription, may be refilled within 6 months
  • opioid narcotics, steroids, stimulants
12

Category IV or Schedule IV

  • accepted medical use
  • low potential for abuse
  • prescription, may be refilled within 6 months
  • benzodiazapines, sedatives, appetite suppressants, muscle relaxants
13

Category V or Schedule V

  • contain moderate amts of controlled substances
  • limited abuse potential
  • OTC but restrictions on amount
  • cough suppressants, antidiarrheal drugs
14

What responsibilities does a nurse have regarding the administration of controlled substances?

Storing in locked containers
Administer only to people for whom prescribed
Record each dose on agency narcotic sheets
Record each dose on patients MAR
Maintain accurate inventory
Report discrepancies

15

The Controlled Substances Act regulates the manufacture and distribution of what?

Narcotics
Stimulants
Depressants
Hallucinogens
Anabolic steroids

16

What are the 6 competencies of QSEN?

Patient-Centered Care
Teamwork and Collaboration
Evidence-Based Practice (EBP)
Quality Improvement
Safety
Informatics

17

What does the FDA do?

create guidelines for approval and use of drugs

18

Procedure for Drug Development and Approval

Discovery, Preclinical Trials, Clinical Trials and Approval

19

Phase 0 Testing

tested on animals

20

Phase I Testing

given to healthy individuals to determine safe dosages, routes of admin, side effects

21

Phase II Testing

given to volunteers with the disease or symptoms the drug targets and compare side effects

22

Phase III Testing

given to different populations in different dosages to determine benefit vs risk

23

Phase IV Testing

Drug marketed and monitored w/ reports of safety and effectiveness

24

Prescription Drug Marketing Act

safety and effectiveness of prescription drugs

25

Controlled Substances Act

  • Created the DEA
  • combat and control drug abuse
26

What does the DEA do?

  • Drug Enforcement Agency
  • enforce the controlled substances laws and regulations
27

Sources of Drug Information

drug publications, pharmacists, healthcare providers, drug guides

28

Pharmacokinetics

  • what the body does to the drug
29

What are the 4 processess of pharmacokinetics?

  1. Absorption
  2. Distribution
  3. Metabolism
  4. Excretion
30

Ways that drugs move through body

  • cross cell membranes
  • pass through membrane with transport system
  • penetrate membrane directly
31

What is absorption?

  • Rate at which drug leaves its site of administration
32

A Drug's route of administration will affect the _____ and _____ of that drug

rate and extent of absorption

33

Absorption characteristics vary according to the ______ and _____

dosage form and route

34

Factors that affect absorption

  • foods/fluids
  • dosage
  • acidity of the stomach
  • pH
  • blood flow
  • surface area
35

3 Routes of Administration

  • GI Tract
  • Parenteral
  • Topical
36

GI Tract

  • oral
  • sublingual
  • buccal (between cheek and gum)
  • rectal
37

Parenteral Route

  • intravenous
  • intramuscular
  • subcutaneous
38

Topical Route

  • skin
  • eyes
  • ears
  • nose
  • rectum
  • vagina
39

What is distribution?

  • transport of a drug in the body by bloodstream to site of action
40

Factors that affect distribution

  • blood flow to the tissues
  • ability to leave the blood and enter cells
41

Areas of rapid distribution of a drug in the body

Brain, heart, liver, kidneys

42

Protein binding and distribution

  • unable to pass through capillary walls
  • bonds dissolve in time
43

Blood brain barrier

keeps toxins and proteins from reaching the brain

44

Placental membrane

  • if it can pass through a membrane, it can pass through the placenta
45

What is metabolism?

  • in liver
  • changed from original form to a new form
  • from lipophilic to hydrophilic
46

Where can metabolism occur?

liver, kidneys, lungs, plasma, intestines

47

What are prodrugs?

  • inactive to active form
  • may be dangerous
48

What are the products of metabolism?

metabolites

49

First-pass effect

  • % of drug that is metabolized and loses much of its effectiveness during first pass through liver
50

High first-pass effect

a drug given orally is extensively metabolized by liver before reaching systemic circulation

51

How do you prevent the first-pass effect from taking place?

administer with another route, like an IV, because it bypasses the liver and more of the drug can reach the circulation

52

P-450 System

  • specific liver enzymes that metabolize drugs in the liver
53

Inducer

  • drug that stimulates the enzyme
  • chronic alcohol use, St. John's wart, smoking
54

Inhibitor

  • drug that blocks or slows down the enzyme
  • antidepressants, antibiotics, antifungals, grapefruit juice
55

What is excretion?

elimination of drugs from the body

56

What are the organs responsible for excretion?

kidneys, liver, bowels

57

Kidneys

glomerular filtration, passive tubular reabsorption, active tubular secretion

58

Biliary Excretion

drug molecules in bile are reabsorbed, prolongs time drug is in the bloodstream

59

Half-life

  • time it takes for one half of the original amount of a drug to be removed from the body
  • most drugs considered to be effectively removed after about 5 half-lives
60

Steady state

point at which the amount of drug being administered and the amount of drug being eliminated are equal

61

Clearance

rate at which drug molecules disappear from the circulatory system

62

Factors that affect clearance

gender, renal excretion and hepatic metabolism

63

Pharmacodynamics

what the drug does to the body

64

Receptor Theory

  • agonist: causes the cell to act
  • antagonist: stops the cell from action
65

Variables that influence the dose of a drug

potency (level needed to produce an effect), efficacy, maintenance

66

Loading dose

larger than usual dose to reach a therapeutic effect quicker

67

Therapeutic index

difference between an effective dose and a toxic dose

narrow = effective dose and toxic dose do not differ by much

68

Therapeutic range

blood levels of a drug are compared to the therapeutic range to guide dosage

69

Drug interactions

  • drug and drug
  • drug and food
  • may create a new effect
  • may increase or decrease effect
70

Allergic response

  • response occurs when drug is taken again
  • symptoms may become more severe each time
71

Idiosyncratic response

responses are the opposite of what is anticipated

72

Neurotoxicity

drowsiness, seizures, auditory/visual disturbances

73

Hepatoxicity

hepatitis, jaundice, fatty infiltration

74

Nephrotoxicity

decreased urinary output, elevated BUN/creatinine, altered acid-base balance, electrolyte imbalances

75

Ototoxicity

tinnitus, hearing loss, vertigo

76

Cardiotoxicity

conduction defects, heart failure, damage to the myocardium

77

Immunotoxicity

immunosuppression, increased in infections

78

Nursing Management

understanding of drug actions and adverse effects, drug response, how to maximize therapeutic effects, minimize adverse effects, patient and family education, collaboration with providers

79

Factors affecting medication dosage and responses

age, sex, body weight, genetics, diet, tolerance, accumulation

80

What are the 10 rights of medication administration?

1. Right Patient

2. Right Drug
3. Right dose
4. Right time
5. Right route
6. Right client education

7. Right documentation

8. Right to refuse

9. Right assessment

10. Right evaluation

81

Select correct drug by

1. check label before you take bottle from shelf
2. check label before you pour drug out.
3. check label before you put bottle back on shelf.

82

Vitamin Supplements

A,D,E,K, Vitamin C

83

Mineral/element supplements

iron, magnesium, sodium, potassium, calcium

84

Herbal supplements

  • derived from plants
  • botanicals phytochemicals, nutraceuticals
85

DSHEA

  • Dietary Supplement Health and Education Act
  • defines and regulates dietary supplements
86

Dietary Supplement

a vitamin, mineral, an herb, or other botanical use to supplement the diet

87

Herbs

  • can be labeled with possible effects on body
  • can't claim to diagnose, prevent, relieve or cure
88

Controls for alternative therapies

  • not controlled by FDA
  • no regulation by any industry
89

Concerns about CAM

  • questionable safety due to unknown effect on humans
  • non-standardized ingredients (may contain heavy metals, drugs)
  • limited research to support
90

Concerns about CAM and patients

  • may keep patient from seeking medical care
  • use not always communicated to HC provider
91

What could happen if CAM interacts with prescription medications?

may decrease therapeutic effect or increase adverse effects

92

CAM product labels should

  • state the specific percentage, amounts and strengths or active ingredients
  • have clear instructions
93

Dosage forms of CAM

tablet, capsule, tea or extract

94

Patients using CAM should

  • inform HC provider
  • discontinue use 2-3 weeks pre-operatively
  • avoid if pregnant or lactating
95

Children and CAM

  • don't use for children
  • store out of reach of children