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Medication, Pharmacology and Screening for Midwives. > 1663. > Flashcards

1663. Flashcards

1
Q

What factors determine the optimal route by which a medicine should be given?

A

1) Site of effect. ( So an effective dose level is achieved in the target tissues and level of drug in other parts of the body where it is not needed is kept to a minimum) eg drugs acting on cells in the airway are best taken by inhalation.
2) Pharmacokinetic factors eg first pass metabolism.
3) Pharmacodynamic factors, eg blood-brain barrier.
4) Pathological factors eg diarrhoea and vomiting will be unable to obtain high serum levels of an oral antibiotic.
5) Dose requirements.
6) Time of onset and duration of effect.

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2
Q

What is first pass metabolism?

A

Blood from the gastrointestinal system passes via the portal vein directly to the liver before being circulated around the body. First pass rate refers to how much of the blood supply from an area goes to the liver eg rectal route has a lower first pass rate ( 50%) than oral. sublingual, topical and parenteral routes avoid this altogether.

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3
Q

What are the routes of drug administration?

A
  • intravenous
  • intramuscular
  • subcutaneous.
  • topical ( local effect)
  • inhalation ( rapid targeted).
  • oral (first pass metabolism up to 90%)
  • sublingual ( rapid, no first pass).
  • rectal ( first pass 50%)
  • intrathecal (CSF).
  • transdermal ( sustained effect.).
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4
Q

What are exipients?

A
  • Ingredients added to medications that are not in themselves a medicine eg sweeteners, fillers to increase bulk of a tablet.
    • Enteric coating is a special outer coating is applied to a tablet or granule within a capsule which resists breakdown by the acid in the stomach so remains intact until it reaches the small intestine.
  • Sustained and controlled release tablets also have special coatings which effect their behaviour.
    • Exipients to slow the rate of transfer of a drug into the blood stream causing a sustained release action of the drug, eg depo provera or depo ralovera where a single injection provides contraception for 3 months.
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5
Q

What are examples of oral medications commonly used in maternity care?

A
  • Iron
  • folic acid.
  • Antibiotic tablets and capsules.
  • Nifedipine ( given sublingually to stop preterm contractions.
  • Vitamin K ( when administered orally to the neonate).
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6
Q

What are the types of parenteral ( non enteral) injections?

A
  • intradermal (eg sterile water injected for pain relief during labour.)
  • Subcutaneous. (low molecular weight heparins given to prevent or treat deep vein thrombosis during and after pregnancy).
  • Intramuscular. ( eg morphine for labour analgesia).
  • Intravenous ( benzylpenicillin during labour when there is a risk of early onset group B streptococcal disease in the newborn.
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7
Q

What are the formulations of oral medications. of oral medication?

A

*Tablets
* Capsules ( gelatin outer shell disolves in the gastrointestinal system, releasing the contents).
* Liquids ( for infants, children and adults with difficulty swallowing tablets or capsules).
# sublingual ( under the tongue)
# bucal ( medication placed between the tongue and the teeth).

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8
Q

What is the mode of action of oral medications?

A

Usually absorbed from the small intestine and enter the portal venous system, passing through the liver before circulating around the body.

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9
Q

Define parenteral medications.

A

Any drug administration route which doesn’t involve the gastrointestinal tract. In common use the term refers to drugs administered by injection.

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10
Q

What are the intramusdrops or sprays

A
  • Deltoid muscle (arm).
  • Dorsogluteal muscle ( upper outer quadrant of buttock).
  • Vastus Lateralis muscle. ( thigh)
  • Ventrogluteal muscle. ( Illiac region of back).
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11
Q

Define topical medication.

A

The application of a medicine directly to the area of the body where it is required.

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12
Q

Name the sites of topical application.

A
  • the skin : creams ( water soluble)
    : ointments ( oil based).
    : pastes
    : gels.
    : lotions
    : patches.
    • The eye ( drops and ointments applied to the conjunctiva)
    • the ear ( drops).
    • the nose ( drops or sprays). Absorption rate is high and avoids the first pass effect so drugs can be delivered to other parts of the body can be given this way eg oxytocin when IV equipment for this is not available.
    • Rectal ( suppositories which soften at body temperature and the active ingredient is released.Can treat local conditions eg haemorrhoid creams or systemic eg panadol.)
    • Vaginal : pessaries, creams , tablets. ( can be local eg antifungal agents to treat candidiasis or systemic. Absorption is significant and avoids first pass effect. eg vaginal ring ( nuvaring) releases hormones over a three week period for contraception. This is now available in Australia.
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13
Q

What are the 6 “ Rights” of medication administration?

A
  • Right person.
  • Right medication.
  • Right dose.
  • Right time.
  • Right route.
  • Right documentation.
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14
Q

What are the other “ Rights” to consider?

A
  • Right action. ( eg antiobiotic given to treat an infection not to cause sedation).
  • Right form ( eg oral drug not given intravenously).
  • Right response ( Drug has the correct effect. If not, then further doses should not be given until appropriateness has been reviewed).
  • Right to refuse. ( A drug should only be given with the patient’s consent).
  • Right allergy risk ( Check the person is not allergic to the drug prior to giving it.
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15
Q

What are consideratiions when storing drugs in hospitals?

A
  • Correct temperature, humidity and avoiding light exposure. ( Storage information is given on the label of the medication.
  • Don’t store two drugs with similar names next to each other ( to reduce risk of error or wrong drug being selected).
  • Store emergency drugs together in a labelled container eg “ PPH box”, “ Eclampsia box”.
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16
Q

How should drugs be stored safely in the home?

A
  • Read storage requirements onthe label of medications.
  • Most oral medications should be stored at less than 25 degrees.
  • Store away from moisture.
  • Near stove, oven, top of refrigerator, bathroom cabinet are NOT good locations.
  • Store out of reach and sight of children and domestic animals.
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17
Q

What is the formula for oral drug calculations?

A

*Dose required/dose in stock = number of tablets.
* To convert units : going from smaller to bigger- move decimal point to the left ( eg mili to kilo).
: going from larger to smaller - move decimal point to the right ( eg kilo to mili, mili to micro etc).

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18
Q

Conversion unit table.

A

kilo, hecta, deka, BASE UNIT, deci, centi, milli, micro
meter
litre
gram

1000, 100, 10, 0, 10, 100, 1000, 1000000
(and 1000 nanos to a micro.)

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19
Q

What is the formula for liquid calculation?

A

Dose required in mg/ dose in stock x volume in ml

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20
Q

What are the formulas for percentages?

A
  • For what percentage something is of something (eg what percentage is 35 out of 40) : 35/40 x100
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21
Q

Define medication.

A

‘One that contains a compound with proven biological effects, plus exipients, or exipients only; it may also contain contaminants. The active compound is usually a drug or prodrug, but may be a cellular element.

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22
Q

What is a medicinal product?

A

One intended to be taken by or administered to a person or animal for one or more of the following reasons:

  • As a placebo.
  • To prevent a disease.
  • To make a diagnosis.
  • To test for the possibility of an adverse effect.
  • To modify a physiological, biochemicalor anatomical function or abnormality.
  • To replace a missing factor.
  • To ameliorate a symptom.
  • To treat a disease
  • To induce anaesthesia.
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23
Q

What is a drug?

A

A chemical substance that brings about changes in a biological system through its chemical actions.

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24
Q

Define prescribing.

A

Prescribing is ‘ An iterative process involving the steps of information gathering, clinical decision making, communication and evaluation that results in the initiation, cessation or continuation of a medicine.

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25
Q

Which agencies are relevant to the professional regulation of midwifery in Australia?

A
  • The Australian Health Practitioners Regulation Agency ( AHPRA).
  • The Nursing and Midwifery Board of Australia ( NMBA): supports the work of AHPRA.
  • The Australian College of Midwives.
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26
Q

What are the functions of the Australian College of Midwives?

A
  • Setting national education standards.
  • Assisting midwives to plan for, participate in, document and reflect on relevant continuing professional development through enrolment in the midPLUS program for midwives.
  • Offering all midwives the opportunity to participate in supported peer review via the Midwifery Practice Review Program.
  • Organising national and state conferences where midwives can hear the latest research and network with colleagues.
  • Facilitating local workshops and seminars.
  • Providing professional practice tools and publications.
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27
Q

What documents represent the current Australian midwifery framework?

A
  • ANMC National Midwifery Competency Standards 2006.
  • ANMC National Code of Ethics for Midwives in Australia 2008.
  • ANMC National Framework for the Development of Decision Making Tools for Nursing and Midwifery Practice 2007.
  • ANMC Code of Professional Conduct for Midwives in Australia 2008.
  • ANM National Midwifery Guidelines for Consultation and Referral 3rd edition.
28
Q

What is the NMBAs “ Prescribing Formulary for Eligible Midwives with a Scheduled Medicines Endorsement?

A

A list of medications that are considered to be appropriate for midwives to prescribe if they have the authority to do so.

29
Q

Which agencies may complaints against a midwife be directed to ( By an individual health care user, another health care professional or hospital administrator

A
  • Personally for you to address.
  • To the hospital in which the clinical incident occurred if relevant.
  • To a state health complaints angency.
  • To the state coroner in the event of a maternal or postnatal death.
  • To AHPRA.
  • To a legal firm dealing with civil law.
  • Or rarely, to a criminal law firm.
30
Q

What is the name of the government agency dedicated to handling complaints from health care users about their care in Queensland?

A

The Office of the Health Ombudsman.

31
Q

What are the two distinct areas of law that are relevant to midwifery practice?

A
  • Criminal law: an individual is accused by the government (the prosecution) of having broken the law and a trial takes place. Laws are made at both the national and state level.
  • Civil law ( tort law: Involves a private individual or business who files a lawsuit against another individual or business. Fines and incarceration never occur under civil law but ‘damages’ may be required to be paid to the injured party.
32
Q

What is the name of the legislation which governs drug administration, manufacture and sale?

A
  • National: The Therapeutic Goods Act and The Narcotic Drugs Act.
  • Queensland: The Health Act 1937 and the Health ( Drugs and Poisons) Regulation 1996. The authority for midwifery prescribing is determined within State legislation.
33
Q

How does the ‘ National Medicines Policy’ define the ‘ Quality Use of Medicines ( QUM)?

A
  • Selecting management options wisely by :
    • considering the place of medicines in treating and maintaining health.
    • Recognizing that there may be better ways than medicine to manage many disorders.
  • Choosing suitable medicines so that the best available option is selected, by taking into account:
    - The individual.
    - The clinical condition.
    - Risks and benefits.
    - Dosage and length of treatment.
    - Any co existing conditions.
    - Other therapies.
    - Monitoring considerations.
    - Cost for the individual, community and health system as a whole.
  • Using medicines safely and effectively to get the best possible results by - Monitoring outcomes.
    - Minimising misuse, over-use and under-use.
  • Improving people’s ability to solve problems related to medication, such as negative effects or managing multiple medications.
34
Q

What are the aims of rational prescribing?

A

1) Maximise clinical effectiveness.
2) Minimize harms.
3) Avoid wasting scarce healthcare resources.
4) Respect the choice of the medication user.

35
Q

What are the central elements in the clinical decision making process around prescribing.

A
  • Making a diagnosis.
  • Defining a Prognosis. (eg self limiting such as flu or unlikely to resolve without treatment, such as gestational diabetes).
  • Establishing goals of Therapy.
  • Treatment selection.
36
Q

What are the potential factors which need to be considered when deciding between one pharmacological agent or another?

A

1) Drug related factors * pharmacokinetics and pharmacodynamics of the drug.
* Therapeutic efficacy.
* Safety profile.
* Cost and Availability.
2) Factors related to the medication user
* Past history of drug reactions.
* Physiology ( both normal and pathological processes).
* Current therapies.
* Personal preferences.
3) Prescriber related factors.
* Familiarity with the medicine.
* Ease of follow up.
* Monitoring.

37
Q

What are the two items of information central to a medication history?

A

1) What medications the woman is currently using.
* include name of medication, route, dose, frequency, why being used, when it was started, whether there is a plan for when it will be ceased, whether it appears to be effective, any problems with it and woman’s understanding of the medication.
2) Is there a history of adverse drug reactions?

38
Q

What does the National Medicines Policy (NMP) state about how sources of inormation about drugs should be?

A

*balanced and accurate.
* informed by evidence and based on agreed standards.
* Available in a timely manner.
* accesible and understandable by users.
* provided in a variety of forms suitable for users.
* independently sourced and free of any advertising.
* relevant to the wants and needs of users.
* conscious of the heterogeneity and diversity of the Australian community.
* Evaluated for its usefulness
*

39
Q

what are the common prescription formulary used in Australia?

A
  • The Australian Medicines Handbook (AMH).

* MIMs ( Monthly Index of Medical Specialties).

40
Q

What are the two main subdivisions of pharmacology ( the scientific study of drugs?

A
  • Pharmacokinetics ( the study of the effect the body has on the drug)
  • Pharmacodynamics ( the study of the efeect the drug has on the body).
41
Q

What are the four basic elements of pharmacokinetics?

A
  • Absorption A
  • Distribution D
  • Metabolism M
  • Excretion. E
42
Q

What is C max?

A

The maximum concentration of a drug in the body ( top of the curve.

43
Q

What is T max?

A

The time at which the maximum concentration occurs.

44
Q

What is the half life of a drug?

A

The time it takes to remove half of the current concentration of a drug from the body.

45
Q

What are legislative frameworks?

A
  • Each state and territory has it’s own act.
  • QLDs are Health Act 1937
  • Health ( drugs and poisons) Regulation 1996.
46
Q

What are the Regulatory Frameworks for

A

*Pharmaceutical Benefits Scheme - funded by medicare.
- exists to ensure people are able to afford medicines needed to maintain their health.
Pharmaceutical Benefits Advisory Committee advise which medicines are to be included on the PBS.

47
Q

What does Quality Use of Medicines include?

A
  • Always choose the cheapest drug.
  • Includes the “ Rational Use of Medicines”
  • Understanding what the prescriber and medication user hope to achieve through the use of the medication.
  • Reducing the risk of medication errors.
  • Keeping up to date on medications.
  • Keeping up to date records.
48
Q

What is Pharmacodynamics?

A
  • How the drug influences the body.
  • Most drugs work by binding to receptor sites
  • Or they act on enzymes.
  • Or both.
49
Q

What is Competitive Inhibition?

A
  • Drugs compete with natural substances for access to the enzyme binding site.
  • An enzyme inhibitor can be displaced by adding more substrates.
50
Q

What is non Competitive Inhibition?

A
  • Drug renders an enzyme inactive by changing the structure of the enzyme.
    • Blocks the substrates access to the enzyme binding site by changing the enzymes configuration, usually irreversible. Inhibitor tends to bind to part of the enzyme’s structure that is distinct and often remote from the binding site.
51
Q

What are drug interactions?

A
  • Drugs react with their environment or with other chemicals.
  • The effects of the drug are different from what is expected - enhanced
    - diminished or
    - completely inactive.
  • An example would be that Vitamin C enhances absorption of ferrous iron.
52
Q

Define Pharmacogenetics.

A
  • Genetic differences may result in alterations to enzymes important in drug metabolism. eg Codeine ( Must be converted by the enzyme CYP2D6 into morphine to have an effect. 10% of the population lack activity in this enzyme so no analgesic effect and 3% of the population are ultra rapid metabolisers so will have high levels in their blood stream in a short spacr of time.
53
Q

Explain the evaluation of screening tests.

A

SENSITIVITY: The percentage of all people with a disease identified by the test.
- Sensitivity A/( A+C).
SPECIFICITY: The percentage of all people who do not have the disease that test negative for the disease.
- Specificity D/( D+B).
POSITIVE PREDICTIVE VALUE: The percentage of all people with a positive test that actually have the disease.
- Positive Predictive Value A/(A+B).
NEGATIVE PREDICTIVE VALUE: The percentage of all people with a negative test that actually don’t have the disease.
- Negative Predictive Value D/(C+D).

54
Q

Table of Evaluation of Screening Test.

A

SICK NOT SICK

TEST POSITIVE a b a+b

TEST NEGATIVE c d c+d _______________________________
a+c b+d Total.

55
Q

What are the types of adverse drug events?

A
  • Type A) Adverse Drug Reaction (ADR) = side effects.
  • Type B) ADR= Idiosyncratic Reaction. Allergies most common.
    eg of a side effect: morphine and nausea ( context specific).
56
Q

What are the 3 factors that the Passage of drugs across the placenta dependant on?

A

1) Properties of drug itself. (eg, highly ionized molecules do not cross the placenta easily. Small molecules cross easier than large.
2) Transplacental transport systems.( eg the most common transport process is by passive diffusion.)
3) The dose of the drug.(the higher the concentration of a drug in the maternal circulation the higher the likelihood of transport across the placenta.

57
Q

What is tetrogenesis?

A

The process by which an agent ( drug, environmental or chemical) induces PHYSICAL defects in the unborn child,eg phenytoin increases the incidence of neural tube defects as it is a folate antagonst.

58
Q

What are the Risk categories of drugs in pregnancy as set out by the Advisory Commitee of Prescription Medications (ACPM)?

A

CATEGORY
A. Drugs taken by large numbers of pregnant women and women of childbearing age. No proven increase in occurence of fetal damage or other proven harmful effects on the fetus.

B. Drugs taken by a limited number of pregnant women and women of childbearing age. No proven increase in occurence of fetal damage or other proven harmful effects on the fetus.

  • Subcategory B1: Animal studies have not produced evidence of increased incidence of fetal damage.
  • Subcategory B2: Animal studies may be inadequate but available data have not produced evidence of increased risk of fetal damage.
  • Subcategory B3: Animal studies have shown evidence of fetal damage but the significance to humans is unclear.

C. Drugs that have caused or are suspected of causing fetal harm without causing malformations. Harmful effects may be reversible.

D. Drugs that have caused or are suspected of causing higher occurences of fetal malformations or irreversible damage.

X. Drugs with a high risk of causing irreversible damage. They should not be used during pregnancy or when there is a possibility of pregnancy.

59
Q

What are the effects of tobacco during pregnancy?

A
  • Tobacco contains a large amount of pharmacologically active substances. The principle additive agent is nicotine.
  • Nicotine is both water and lipid soluble so passes very easily across cell membranes ( including the placenta) to enter the brain of both mother and fetus.
  • Metabolised in the liver and speeds up the metabolism of many other drugs. Smokers may therefore require higher than usual doses or more frequent doses of medications to ensure therapeutic levels are achieved.On cessation of smoking the doses of medication would need to be reviewed.
60
Q

What is the effect of alcohol during pregnancy?

A
  • Alcohol is a small molecule. Like nicotine it is water and lipid soluble. It readily crosses the blood brain barrier of both mother and fetus.
  • Causes not only sedation, but addiction and analgesia.
  • Rapidly metabolised by the liver
  • High level use over a long period can cause liver damage, reducing the metabolic capacity of the liver.
  • Sporadic consumption can result in fluctuations in the serum levels of prescribed medications, making the therapeutic effects difficult to predict.
61
Q

What are risks of vitamin D deficiency in pregnancy?

A
  • Associated with gestational diabetes, preeclampsia, preterm birth and low birth weight.
  • Vitamin D is important for maintaining bone integrity and calcium homeostasis.
62
Q

What is an antibiotic?

A

An antibiotic is a substance produced by one microorganism that inhibits the growth of others.

63
Q

What are tocolytics?

A
  • Drugs used to reduce uterine activity to manage threatened premature labour, reduce fetal distress and enable external cephalic version (ECV).
64
Q

What are the three classes of tocolytics?

A
  • Calcium channel blockers eg nifedipine.
  • Beta antagonists eg terbutaline
  • Prostoglandin synthesis inhibitors eg indomethacin
65
Q

What are the lactation safety risk categories?

A

L1) SAFEST: Drugs which have been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant.
L2) SAFER: Drugs which have been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant.
L3) MODERATELY SAFE: There are no controlled studies in breastfeeding women however the risk of untoward effects to a breastfed infant is possible. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4): POTENTIALLY HAZARDOUS: There is positive evidence of risk to a breastfed infant or production of breast milk, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant eg in life threatening situations or for a serious disease for which safer drugs cannot be used or are ineffective.
L5) CONTRAINDICATED: Studies in breastfeeding mothers have demonstrated that ther is a significant and documented risk to the infant based on human experience or it is a medication that has a high risk of causing significant damage to an infant.

Medication, Pharmacology and Screening for Midwives. (1 decks)

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