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Exam 2 prep

front 1

what is pharmacology?

back 1

study of drugs and their actions on living organisms

front 2

what are drugs used for?

back 2

  • prevent, treat, or cure disease or disorders (vaccines)
  • restore or maintain body system function (insulin)
  • relieving symptoms (ibuprofen)
  • aid in diagnosing disease (dye)

front 3

what is the nurse responsible for when administering a medication?

back 3

  • understanding how medication works
  • correct administration (safe dose, route, pt, time)
  • therapeutic effects, side effects, contraindications
  • questioning an order that is unclear or may contain an error
  • following the 6 rights of administration
  • pt and family education
  • correct documentation
  • evaluation of effectiveness

front 4

what meds can chronic lung patients not have?

back 4

beta blockers; can be detrimental

front 5

how are OTC & prescription drugs similar?

back 5

  • can be as effective as the other one
  • can have as many side effects as the other
  • can be as safe as the other

front 6

what are the drug categories?

back 6

  • curative
  • prophylactic
  • diagnostic
  • palliative
  • replacement
  • destructive

front 7

when asking a pt about their medications, what do we need to know?

back 7

ALL their meds: OTC, prescription, & any herbals

routine & PRN

front 8

what are the different names of drugs?

back 8

  • generic
  • trade

front 9

the official and nonproprietary name approved by the USAN Council; there is only ONE for each drug; always lowercase

back 9

generic name

front 10

registered name; are always capitalized; may be more than one

back 10

trade/brand name

front 11

why is it important to get information from patients about all of their medications?

back 11

because of the risk for drug-drug interaction

front 12

who regulates drugs?

back 12

United States Pharmacopeia (USP)

front 13

assures that drugs have met high standards for therapeutic use, pt safety standards, quality, purity, strength, packaging safety, and dosage form by the U.S. Pharmacopeia National Formulary

back 13

United States Pharmacopeia (USP)

front 14

the USP designation does not indicate

back 14

FDA approval

front 15

ensures drugs are labeled correctly

back 15

Food and Drug Administration (FDA)

front 16

all drug administration laws are initiated, implemented, and enforced by

back 16

FDA

front 17

requires drug companies to study their products in children for safety and efficacy to be marketed for pediatric use

back 17

Pediatric Research Quality Act

front 18

when pediatric studies are required, they must be conducted with

back 18

the same drug and for the same use for which they were approved in adults

front 19

identifies and regulates the manufacture and sale of narcotics and dangerous drugs

back 19

Controlled Substance Act (1970)

front 20

which drugs have the highest abuse potential?

back 20

I and II

front 21

which drugs have the lowest abuse potential?

back 21

IV and V

front 22

examples of schedule I drugs?

back 22

  • heroin
  • LSD
  • peyote
  • ecstasy

front 23

examples of schedule II drugs?

back 23

  • morphine
  • hydromorphone
  • methadone
  • meperidine
  • oxycodone
  • fentanyl
  • adderall
  • ritalin
  • cocaine

front 24

examples of schedule III drugs?

back 24

  • tylenol w/ codeine
  • steroids
  • ketamine (requires new prescription after 6 months or 5 refills)

front 25

examples of schedule IV drugs?

back 25

  • tramadol
  • talwin
  • benzos
  • zolpidem
  • phentermine

front 26

examples of schedule V drugs?

back 26

  • lyrica
  • lomotil
  • robitussin AC

front 27

what can cocaine be used to treat?

back 27

nose bleeds

front 28

where can we, as nurses, find reliable and up-to-date drug information?

back 28

  • Micromedex
  • Hospital Formulary
  • Facts and Comparisons
  • Physicians Desk Reference (PDR)
  • Package Inserts
  • FDA
  • Drug Books

front 29

the study of how drugs are processed in the body (how medications travel through the body)

back 29

pharmacokinetics

front 30

the process of pharmacokinetics begins and ends when?

back 30

from administration to elimination

front 31

What is the process of pharmacokinetics?

back 31

ADME

  • Absorption
  • Distribution
  • Metabolism
  • Excretion

front 32

the first step in which a drug enters the body

back 32

absorption

front 33

what are the ways to introduce and administer drugs into the body?

back 33

  • enteral
  • topical
  • inhalation
  • parenteral

front 34

enteral

back 34

oral, SL, buccal

front 35

topical

back 35

transdermal, eye, ear, nose, rectal, vaginal

front 36

inhalation

back 36

MDI

front 37

parenteral

back 37

IV, IM, ID, SQ, IO, epidural

front 38

certain medications have to be given by certain means because

back 38

of the way drugs are absorbed

front 39

why must insulin be given SQ as opposed to PO?

back 39

if it was taken PO, by the time it would reach the small intestine, digestive enzymes from the GI tract would destroy the insulin, and it would no longer function

front 40

what is the primary site for GI absorption of a drug?

back 40

small intestine

front 41

what are some factors that could affect the absorption of drugs in the small intestine?

back 41

Crohn's, small intestine surgery

front 42

the process of a drug going from the bloodstream to tissues from circulating body fluids (bloodstream) to receptor sites

back 42

distribution

front 43

what affects distribution of drugs?

back 43

  • blood flow (too little): PVD, CVD, hypovolemia, hypotension
  • plasma protein binding (albumin-taxi cab)
  • blood-brain barrier
  • body weight/distrubution (muscle mass and fat composition)

front 44

what does albumin do?

back 44

carries molecules to the sites they need to go to

front 45

if albumin level is low, what can happen?

back 45

problems related to distribution

front 46

is the process of changing medications into less active or inactive forms by the action of enzymes

back 46

metabolism

front 47

where are most drugs metabolized?

back 47

liver

front 48

what can inhibit enzyme action (metabolism) resulting in excess drug accumulation in the body?

back 48

  • liver disease (hepatitis, cirrhosis)
  • liver failure

** this would increase the drugs effect and can lead to toxicity

front 49

if a pt has high liver enzymes, how might we alter the medication dose?

back 49

decrease it

front 50

process by which a drug is removed or eliminated by the body

back 50

excretion

front 51

drugs are eliminated either

back 51

unchanged or as metabolites in the urine

front 52

what is the primary organ involved in excretion?

back 52

kidneys

front 53

what labs would you follow to ensure safe medication administration and excretion?

back 53

BUN & Creatinine

front 54

if above labs are elevated, what should you do as a nurse?

back 54

call MD & suggest decreasing dose or changing to a medication that is not excreted by the kidneys

front 55

what can impair excretion causing drugs to accumulate?

back 55

  • kidney disease
  • kidney failure
  • decreased blood flow to the kidneys (hypotension)

front 56

what are some factors affecting pharmacokinetics? "ADME"

back 56

  • age-elderly changes (GI system, GU system, decreased body weight)
  • body composition
  • liver and kidney conditions
  • polypharmacy
  • inadequate blood flow (hypotension, PVD, CAD)
  • nutritional status

front 57

what are some issues seen in the elderly?

back 57

  • delayed emptying
  • decreased blood flow to liver and kidneys
  • decreased lean body weight & increased SQ fat

front 58

The registered nurse is providing care for a pt with a brain tumor. Which nursing action helps to prevent cerebral edema?

back 58

Administering glucocorticoids to the pt

front 59

a pt is started on low molecular wt heparin (LMWH). what complications should the nurse monitor for?

back 59

thrombocytopenia

front 60

what is an example of an ototoxic medication that can cause damage to the sensitive structures of the ear, with prolonged or overuse?

back 60

furosemide

front 61

what medication may cause patients to develop a dry, nonproductive cough

back 61

angiotensin-converting enzyme inhibitor

front 62

a pt reporting chest tightness arrives at the hospital. on assessment, the nurse noted wheezing, cough, elevated BP, and pulse rate. the primary healthcare provider prescribes corticosteroids, which is the most likely outcome of the prescribed therapy?

back 62

decreases the inflammation of the airway

front 63

what is true regarding herbal remedies' impact during surgery?

back 63

they can decrease the effectiveness of anesthesia

front 64

what is it called when a pt takes six or more medications?

back 64

polypharmacy

front 65

the pt with systemic lupus erythematosus (SLE) is experiencing pancytopenia. what would be the cause of this?

back 65

immunosuppression

front 66

which test measures the amount of glucose that binds to RBC's in a nonpregnant adult patient?

back 66

Hemoglobin A1c

front 67

what is true regarding long acting insulin?

back 67

it is a dose of basal insulin used in combination with rapid acting or short acting

front 68

which is true of the action of proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease?

back 68

they block gastric acid production

front 69

The nurse is assessing a patient with a history of angina. The patient states that "I usually experience chest pain while climbing the stairs or after walking for 5 minutes." What question should the nurse ask next?

back 69

"If you rest, does the pain subside?"

Rationale: This question will help to determine if the angina is stable or unstable.

front 70

The nurse is admitting a patient in the emergency department with new onset of confusion. The laboratory report shows Na 120 mEq/L; K 5 mEq/L; urine specific gravity 1.038. Which intervention is the highest priority?

back 70

Pad the siderails of the bed.

Rationale: The sodium level is very low and the risk for seizures is very high. Implementing seizure precautions is the priority.

front 71

While caring for a patient who underwent surgical repair of a fracture, the nurse finds edema in the area where the surgery occurred. Which should the nurse assess next based on these findings?

back 71

Distal pulses

Rationale: Edema in the area of the surgery may be the cause of impaired perfusion.

front 72

involves the interactions between medications and target cells-the drugs actions and effects "lock and key"

back 72

pharmacodynamics

front 73

primary effect of pharmacodynamics is called

back 73

therapeutic effect

front 74

what are receptror sites?

back 74

proteins on the surface of cells that are capable of recognizing a specific molecule

front 75

drugs that combine with a specific receptor site to cause a pharmacologic response; the drug action will begin once it attaches to receptor sites

back 75

agonists

front 76

drugs that prevent a receptor response or block a normal cellular response

back 76

antagonist

front 77

act both as agonists and antagonists with limited affinity to receptor sites; act differently depending on the receptor site that is used

back 77

partial agonists

front 78

time it takes for drug to reach an effective blood level and to initiate a response (depends on the route of administration)

back 78

onset

front 79

when drug achieves its highest blood concentration

back 79

peak

front 80

length of time the drug has a pharmacologic effect

back 80

duration

front 81

amount of time needed for elimination process to decrease original blood concentration by 50%

back 81

half-life

front 82

how the drug works

back 82

mechanism of action

front 83

the patient's response to drug action

back 83

therapeutic effect

front 84

ability of a drug to produce maximal effects

back 84

efficacy

front 85

amount of drug required to produce 50% of maximal response possible for that drug

back 85

potency

front 86

affects the time that a drug stays in the body and can also have an effect upon the drug's efficiency

back 86

plasma protein binding (PPB); it affects both pharmacodynamics and pharmacokinetics

front 87

the most common plasma protein that drugs are bound to is

back 87

albumin

front 88

the part of the medication that is bound to the protein is

back 88

inactive

front 89

what are some things that increase the risk of having interactions:

back 89

  • drug-drug
  • food-drug
  • chronically ill (polypharmacy)
  • seeing several specialists
  • multiple pharmacies
  • taking OTC, prescription, & herbals

front 90

highest concentration of a drug in the patient's bloodstream

back 90

peak

front 91

lowest concentration of a drug in the pt's bloodstream

back 91

trough

front 92

the difference between average toxic and therapeutic doses

back 92

therapeutic index

front 93

rapidly achieving a higher level of a drug into the patients system to quickly achieve a therapeutic effect

back 93

loading dose

front 94

maintaining the drug level within a therapeutic range

back 94

maintenance dose

front 95

examples of medications that may require a loading dose

back 95

  • azithromycin
  • digoxin
  • diltiazem
  • amiodarone

front 96

how a drug produces its response

back 96

pharmacodynamics

front 97

what affects pharmacodynamics?

back 97

  • age
  • body composition/weight
  • genetics
  • ethnicity
  • disease conditions
  • psychosocial conditions
  • nutritional status

front 98

relationship between a person's genetic make-up and response to medication

back 98

pharmacogenetics

front 99

effects that occur when the actions of one drug are affected by another drug; example: antacid and abx

back 99

drug-drug interactions

front 100

when 2 drugs with similar actions are taken together and the additive effect increases the sum of the effects; example: ASA and codeine

back 100

additive effect

front 101

when 2 drugs together cause a greater response than each drug given individually; example: lisinopril and furosemide (BP responds much better)

back 101

synergism

front 102

the action of one drug increases the effect of the second drug; example: warfarin and ASA (causes increase in bleeding potential)

back 102

potentiation

front 103

drug not a suitable composition to be combined or mixed with another agent or substance, results in an undesirable reaction including chemical alteration or destruction

back 103

drug incompatibility

front 104

what puts a client at risk for drug interactions?

back 104

  • chronic health conditions
  • polypharmacy
  • more than one provider
  • supplement use
  • OTC use
  • use of more than one pharmacy

front 105

anticipated effects, usually mild (opioids-nausea, constipation_

back 105

side effects

front 106

pt becoming sensitized to drug, producing antibodies against drug creating antigen-antibody reaction (rash, hives, itching)

back 106

allergy

front 107

severe allergic rxn (bronchospasm, angioedema, etc.)

back 107

anaphylaxis

front 108

unusual or unexpected response; opposite the desired effect (diphenhydramine should induce sleepiness, however, if it causes hyperactivity, restlessness-that would be this rxn)

back 108

idiosyncratic effect

front 109

harmful, undesired effects of the possibility of organ damage

back 109

toxic effect

front 110

no data

back 110

hepatotoxicity

front 111

no data

back 111

nephrotoxicity

front 112

no data

back 112

ototoxicity

front 113

drugs that cause birth defects

back 113

teratogenic effect

front 114

sociological factors affecting medication administration

back 114

socioeconomic status, housing, marital status/children, season, religious beliefs, finances, transportation

front 115

psychological factors affecting medication administration

back 115

ethics/cultural beliefs, cognitive functioning, food preferences

front 116

physiological factors affecting medication administration

back 116

health, senses, chronic disease processes, medication use, dental health

front 117

what are the rights of medication administration

back 117

  1. patient
  2. drug
  3. time
  4. route
  5. dose
  6. documentation
  7. some consider technique

front 118

what is the most common medication error?

back 118

incorrect dosage of drug

front 119

_________________ people are injured annually by medication errors in the U.S. according to the CDC. Medication errors cause at least one death every day.

back 119

1,300,000

front 120

through absorption from GI tract

back 120

enteral

front 121

parenteral

back 121

by injection: ID, SQ, IM, IV

front 122

percutaneous administration routes?

back 122

  • transdermal
  • ophthalmic
  • otic
  • nasal
  • vaginal
  • rectal

front 123

what organs must be carefully considered in pediatric medication administration?

back 123

liver and brain b/c they are not fully developed in pediatric patients

front 124

elderly population-specific information R/T pharmacology

back 124

  • body processes slow down
  • decrease blood flow to liver and kidney therefore decreasing the effectiveness (which are responsible for metabolizing and eliminating excess medication from body)
  • decreased albumin levels
  • doses may need to be decreased

front 125

females of childbearing age-specific information R/T pharmacology

back 125

  • could be pregnant, medication could be potentially harmful to fetus (teratogenic)

front 126

1 c is ____ mL

back 126

240

front 127

1 tbsp is ____ tsp

back 127

3

front 128

1 unit is __________ milliU

back 128

1,000

front 129

requires lifelong learning and ability to acquire relevant experiences

back 129

critical thinking

front 130

what are the levels of critical thinking?

back 130

  • basic
  • complex
  • commitment

front 131

an inner sensing that facts do not currently support something; should spark the nurse to search the data to confirm or disprove the feeling

back 131

intuition

front 132

a nurse trusts the experts and thinks concretely based on the rules

back 132

basic critical thinking

front 133

the nurse begins to express autonomy by analyzing and examining data to determine the best alternative

back 133

complex critical thinking

front 134

the nurse expects to make choices without help from others and fully assumes the responsibility for those choices

back 134

commitment

front 135

what are the components of critical thinking?

back 135

  • knowledge
  • experience
  • competence
  • attitude
  • standards

front 136

information that's specific to nursing and comes from:

-basic nursing education

-use of evidence-based practice

-continuing education courses

-advanced degrees and certification

back 136

knowledge

front 137

decision-making ability derived from opportunities to observe, sense, and interact with clients followed by active reflection

back 137

experience

front 138

cognitive processes a nurse uses to make nursing judgments

back 138

competence

front 139

mindsets that affect how a nurse approaches a problem

back 139

attitudes

front 140

model for comparing care to determine acceptability, excellence, and appropriateness

back 140

standards