305 Escape Room Review Flashcards
1
Q
Which of the following are considered significant roles for nursed as defined by the Joint Commission?
A
Ensuring patient safety
Promoting effective Communication
Providing patient centered care
2
Q
What is the difference between a generic drug and a brand name drug?
A
Brand name drugs can have multiple names why generic names have only one.
3
Q
Learning prototypes will help you to learn pharmacology. What is the definition a prototype drug?
A
Most effective drug in its class
a drug used as a model to which other drugs in the class are compared to.
4
Q
What resources are preferred to learn more about a drug?
A
Peer reviewed journal
Physicians Desk Reference
Pharmacist
5
Q
Tall Man Lettering
A
used within a drug name to highlight its primary dissimilarities and help to differentiate look-alike names
6
Q
Terotogenic Risks
(Escape Room answer)
A
Category A: has shown no fetal injury when taken during pregnancy; folic acid belongs to this category
Category B: Animal studies have shown no fetal risk; but no studies in pregnant women; Metformin belongs in this category
Category C: There is evidence of fetal risk but benefits may outweigh the risks; Warfarin falls into this category.
7
Q
A black box warning is important because it means?
A
a serious safety warning required by the U.S. Food and Drug Administration (FDA) for certain medications
7
Q
Routine
A
Taken on regular basis
8
Q
What is a standard of nursing practice?
A
Specifies the nurses provide care that reflects current practice when performing client care
9
Q
Asap
A
within 30 min
10
Q
Stat
A
Immediately
11
Q
PRN
A
As needed
12
Q
What is the correct way to use an inhaler
A
Patient exhales fully, coordinate medication with inhale, hold breath for 10-15 seconds… If unable to do so use a spacer
13
Q
What should be assessed before giving an intradermal medication?
A
Skin
13
Q
The nurse is caring for a patient with impaired kidney function. Which pharmacokinetic process is most likely to be affected?
A
Excretion
14
Q
The nurse is monitoring a patient receiving intravenous medication. Which factors affect the drug’s distribution in the body?
A
Blood flow to tissues
Drug Solubility
Plasma protein binding
14
Q
A nurse is teaching a patient about the first-pass effect and how it impacts the effectiveness of certain medications. Which of the following statements made by the patient indicate a correct understanding
A
Medications that undergo the first pass effect are metabolized by the liver before reaching the bloodstream
Oral medication are more likely to experience the first pass effect than other forms of administration
The first pass effect can reduce the bioavailability of some drugs.
15
Q
A patient asks the nurse why it takes some medications longer to start working than others. The nurse explains this is related to the drug’s:
A
Onset of action
15
Q
A medication is prescribed to be given every 8 hours. The nurse knows this schedule is most likely related to the drug’s
A
Duration of action
16
Q
The nurse explains to the patient that potency refers to which of the following?
A
The amount of drug needed to produce a therapeutic effect
17
Q
A nurse is explaining how an agonist medication works to a patient. Which statement best describes the action of an agonist?
A
An agonist binds to a receptor and activates it, producing a physiological response.
17
Q
The nurse tells the patient that efficacy is defined as:
A
The maximum effect the drug can produce
18
Q
Which of the following best describes the action of a competitive antagonist?
A
It competes with an agonist for receptor sites and prevents activation.
19
Q
The lethal dose (LD50) of a drug is defined as:
A
A measure determined during clinical trials.
20
Know the early history of drug research
- Likely began when humans first used plants to relieve symptoms of disease
- Modern pharmacology is thought to have begun in the early 1800s
- Pharmacology was recognized as a distinct discipline when the first department of pharmacology was established in 1847
- John Jacob Abel is considered the father of American Pharmacology, Founded the first department of pharmacology in the United States in 1890
- In the twentieth century, the pace of change continued exponentially, pharmacologist could synthesize drugs
21
Know the difference between pharmacology and therapeutics.
Pharmacology: Derived from two Greek words, Pharmakon means “medicine”, and Logos means “Study”. Most simply put the study of medicine
Pharmacology is composed of four foundational principles, Anatomy and Physiology, Chemistry, Microbiology, and Pathophysiology
Pharmacology is applicable in all areas of nursing (Clinics, Hospitals, Home Healthcare Settings, Academics)
Therapeutics: Focuses on disease prevention as well as treatment and pain.
Pharmacotherapy (Pharmacotherapeutics) is the application of drugs for treating diseases and alleviating pain
22
Know the pharmacologic and therapeutic classification systems.
Therapeutic classification:
Organized based on therapeutic usefulness
Pharmacological classification:
Organization based on the way the drug works at a molecular, tissue, or body system level
Often represents mechanism of action
23
Drugs or Medications
Chemical agent capable of producing biological responses within the body
Responses may be desirable (Therapeutic) or undesirable (Adverse)
Drug becomes a medication after it is administered
23
Biologics and Biosimilar drugs
Agents naturally produced in animal cells, by microorganisms, or by the body itself
Large complex molecules or mixtures of molecules
Examples include: Hormones monoclonal antibodies, natural blood products, interferons, vaccines
24
Biosimilar:
drugs are chemically synthesized but are still closely related to biological medications
Testing not as rigorous for biosimilars as for their reference products
24
Complementary and alternative medicine therapies (CAM therapies)
Involve natural plant extracts, herbs, vitamins, minerals, dietary supplements
Body-based practices: Physical therapy, massage, acupuncture, hypnosis, biofeedback
25
Understand what a prototype drug is.
The most effective drug in its class
Is a drug used as a model to which other drugs in the class are compared.
26
Know the reason for the use of TALL man letters
- Tall man lettering is used to accentuate the differences in spelling between similarly named drugs
27
Know what a black box or boxed warning is.
- indicates a medication has serious risks or adverse reactions
28
Know the difference between physical and psychological dependence
Physical:
An altered physical condition caused by the adaptation of the repeated drug us
withdrawal- physical signs of discomfort (Monitor Vital Signs)
Psychological: Feeling of an intense, compelling desire to use the substance
Placebo effect- extreme psychological distress- anxiety, depression, anger (Assess for suicide risk)
29
Review different types of order ex stat, asap, prn
Routine- Taken on a regular basis
Single order- Given only once at a specific time
Stat Order- Given once and given immediately (Within 5 minutes)
ASAP- Given only once as soon as possible (Within 30 minutes)
PRN- As needed to treat a specific condition, required parameters must be specified
Standing order- Written in advance of a situation for specific circumstances.
30
Review phases of drug testing and approval
Stage 1: Preclinical investigation
Ranges from 1-3 years, initial synthesis, animal testing
Stage 2: Clinical investigation
Ranges from 2-10 years
Stage 3: NDA review
Ranges from 2 months - to 7 years
Stage 4: Post-marketing studies
Adverse reaction reporting, Surveys/Sampling/Testing, Inspections
30
Understand the different teratogenic risk categories
Category A: Safest medications to give during pregnancy
Category B: Animal studies have shown no fetal risk; but no studies in pregnant women; Metformin belongs in this category
Category C and D: Medications have positive evidence to fetal risk but benefits may outweigh the risks
Category X: High risk- Animal and human studies show that fetal abnormalities. The drug is contraindicated in women who are or may become pregnant
31
Review drug schedules
- Schedule 1: Highest potential for abuse, high for physical dependency, High psychological dependency
- Schedule 2: High potential for abuse, high for physical dependency, High psychological dependency
- Schedule 3: Moder potential for abuse, moderate for physical dependency, High psychological dependency
- Schedule 4: Lower risk for abuse, Lower physical dependency, Lower psychological dependency
- Schedule 5: Lowest risk for abuse, Lowest physical dependency, Lowest psychological dependency
32
Review the different routes of drug administration and nursing assessments with each route.
Enteral:
By Mouth, By Tube, Sublingually, Buccally
Topical/Other routes:
Transdermal: Skin
Ophthalmic: Eye
Otic: Ear
Nasal
Vaginally
Rectal
Inhalation
Parenteral
Intradermal, Subcutaneous, Intramuscular, Intrave
33
Review the symptoms of an anaphylactic reaction.
- Dyspnea, Tachycardia, Hypotension
33
Know nursing concerns with abnormal levels of serum albumin.
- Too much albumin in the blood will bind up all of the protein bound drugs and result in no therapetic effect because its not in its free form
- Too little albumin could result in drug toxicity by not binding with enough free drug resulting in too much
34
Understand what action a nurse should take with a protein-bound drug.
- Protein-bound drugs will not be able to activate receptors unless they are free
- Monitor serum albumin levels
34
Know what half-life means.
- Time it takes for the amount of the active drug form to be reduced by 50%
35
Know about the first pass effect.
- Occurs with oral medications
- Once absorbed by the small intestine, medication is processed through the liver first, resulting in a smaller amount of the oral medication to be available
36
Define passive transport and active transport.
Passive
Diffusion: Small uncharged molecules such as H2O, urea, Glycerol, and other hydrophobic molecules such as O2, CO2, and N2 can pass through the hydrophobic heads of the lipid bilayer without needing cellular transport
- Facilitated diffusion: Large uncharged molecules are able to use channel proteins to enter the cell and do not require energy to activate.
Active
Protein transport: Require ATP to open channel proteins, this allows molecules to flow against their concentration gradient if needed.
- Endocytosis & Exocytosis: Use of vesicles to carry multiple molecules at once. This allows molecules to be transported against the concentration if need be. The opening and closing of vesicles requires ATP
37
What should nurses be concerned with for medications Metabolized by CYP450 enzymes?
- CYP enzymes are liver enzymes that metabolize drugs and other endogenous substances. The majority of these enzymes inactivate drugs and accelerate their excretion
- Enzyme inhibitors (Grapefruit juice) cause an increase in the amount of active medication entering the bloodstream
- Enzyme induction results in a decreased amount of active medication reaching the bloodstream
38
Know nursing priorities and interventions with protein-bound medications.
- If medication is highly protein-bound, make sure the client eats a diet with little to no protein. An increase in protein level will result in more of the medication being bound to proteins reducing the effects
39
Know peak and trough levels and nursing interventions.
Peak: Highest level of medication in the bloodstream
Trough: Lowest level of medication in the bloodstream
Importance here is determined by the duration of action, understanding when the drug is at the highest concentration and at the lowest allows us to know when it’s appropriate to gove another dose
40
Review ADME and factors that can affect it.
Absorption: Type of administration, Active or passive
Distribution: How is it moving through the body, if given orally the first pass effect will occur
Metabolism: AKA biotransformation, the process of chemically converting a drug to a form that is more easily removed from the body
Liver is primary site of drug metabolism
Oral meds have a first-pass effect, all other routes enter systemic circulation first
Elimination: How is it leaving the body, sweat, urine, feces, etc
41
What is the effect of a median effective dose?
- Middle of the frequency distribution curve
- Dose that produces therapeutic responses in 50% of a group
- Sometimes called average or standard dose
- Many clients require more or less
42
Know lethal dose measures.
- Used to assess the safety of a drug
- Shown on frequency distribution curves
- Determined in preclinical trials
- Lethal dose in 50% of a group of animals
- Cannot be experimentally determined in humans
43
Calculating therapeutic index
Therapeutic Index = Median LD50
-------------------- Median ED50
43
Know the difference between antagonist, partial antagonist and agonist.
Agonist
Enhances (Increases, supports, potentiates) the body’s normal functions
Antagonist
Inhibits (Blocks, stops, slows down) the body’s normal functions
Partial agonist
Produces effect less than that of an agonist
44
Review potency and efficacy
Potency
A more potent drug will produce a therapeutic effect at a lower dose, as compared with another drug in the same class
Efficacy
The magnitude of maximal response that can be produced from a particular drug. This is not dose-dependent but related to the mechanism of action
45
History of Pharmacology
Began with plants and herbs
3000 BC Babylonians recorded ‘prescriptions’
Pharmacology couldn’t advance until science recognized by religious doctrines
Pharm recognized as distinct discipline in 1847
1693 first reference to pharm
46
Father of Pharmacology
John Jacob Abel
Founded 1st dept of pharm in 1890 in US
47
Sciences Involved in Pharm
A&P
Chemistry
Microbiology
Pathopharm
48
Therapeutics VS Pharmacotherapy
Therapeutics: Focuses on disease prevention as well as treatment and pain
Pharmacotherapy: Application of drugs for treating disease and alleviating pain
49
Classification of Therapeutic Agents
Drugs or meds
Biologics or biosimilar agents
Complementary and alternative medicine therapies
50
Drugs
Chemical agent that produces biological response in body
Can be desirable or undesirable
51
Medication
Drug after it is administered
52
Biologics
Agents naturally produced in animal cells, microorganisms
53
Biosimilar Drugs
Chemically synthesized
Closely related to biologic meds
Test not as rigorous
54
Complementary and Alternative Therapies
AKA CAM therapies
Natural plants, herbs vitamins, minerals
Body based Practices (PT, exercise, massage)
55
Therapeutic Drugs
Organization based on therapeutic usefulness
56
Pharmacological Classification
Way it works at a molecular, tissue, body system level
Represents mechanism of action
57
Chemical Name
Name assigned by IUPAC
Only one chemical name
Convey clear info on drug
Difficult to remember and pronounce
58
Trade Name
Short, easy
Assigned by company
Trade name known as proprietary, product, brand name
Usually capitalized
Combo of drugs have >1 generic active ingredient
59
Generic Name
Assigned by US Adopted Name Council
Less complicated
Many organizations use generic name
Only one
Biosimilars should not e called generic medications
Lowercase
59
Prescription Drug
Written Order
Numerous Benefits: specific diagnosis, maximum therapy, opportunity to teach patient proper use, monitor adverse effects
60
Over the Counter Drugs
AKA OTC
No Rx required
May have serious side effects if improper use
More easy to get than Rx drugs
Self-treatment sometimes ineffective
61
Drug Regulations and Standards
Few regulations in 1800s
Formulary: 1st standard that was common for pharmacist
Pharmacopia: Medical references summarizing the standards of drug purity strength, directions for synthesis
Many products were harmless but some had severe adverse effects
62
American Pharmaceutical Association
US pharmacopia covered all drug products
National Formulary: Covered all drug ingridients
These 2 components merged in 1975 to create UPC-NF
National data base for drugs
63
The FDA
Est. 1988 as part of US Dept of Health and Human Services
Center for Drug evaluation and research
Center for Biologics Evaluation and Research
64
National Drug Acts
Biologics Control Act 1902: Standardized quality of serums and other blood products
Pure Food and Drug Act 1906: Government could regulate labels
Sherley Amendment 1912: Couldn’t falsely advertise
Food Drug and Cosmetic Act 1938: Drugs had to be proven safe before sale
65
Phases for Approval for Therapeutic and Biologic Drugs
Stage 1:
1-3 years, pre-clinical investigation
Synthesis and some animal testing
Stage 2:
10 years of clinical investigation
Healthy volunteers Phase 1
Diseased volunteers Phase 2
Phase 3: Roughly 3000 people in hospitals
Stage 3:
2 years
NDA review
Stage 4:
Adverse reaction reporting
Surveys, sampling, testing
Inspections
66
Controlled Substances
-High addiction rate
67
Addiction
Overwhelming feeling that drives someone to take a drug or perform action
67
Dependence
-Physical: Altered physical condition caused by adaptation of nervous system to repeated drug use (monitor vitals)
-Withdrawal: Physical signs of discomfort
-Psychological: Feelings of intense, compelling desire to use the substance
-With Withdrawal: Increase heart rate, blood pressure, temperature, respirations
68
Schedule I Drugs
Limited use or therapeutic use
Increase abuse, dependency, psychological dependency
69
Schedule II Drugs
Some therapeutic use
Still highly restricted
69
Schedule III Drugs
Used therapeutically with prescription
Moderate abuse and dependency
Combination drugs
Ketamine, codeine
70
Schedule IV Drugs
Lower abuse
Xanax, diazepam, alprozolam
70
Teratogen Risk Categories
Category A: Safest meds during pregnancy
Category B: Failed to demonstrate risk to fetus
Category C&D: Positive evidence of fetal risk, benefits outweigh risks
Category X: HIGH risk of fetal abnormalities. Reliable pregnancy prevention measure must be followed
71
Serious Adverse Drug Event (ADE)
Life threatening reaction that requires med intervention to prevent death or permanent disability
Must report to FDA to improve safety
Black Box warnings issued on dangerous meds
72
Allergic Reactions
Body perceives foreign substance and produces antibodies to counteract allergen
The adverse reaction produces histamines in response to tissue injury
Know patient allergies to avoid contraindications
72
Drug Reactions
Anaphylaxis: Severe, life threatening reaction from histamine release producing dyspnea, hypotension, tachycardia
Stevens-Johnson Syndrome
Develops 1-14 days after drug admin
Manifested by respiratory distress, fever, chills, a diffuse fine rash, then blisters, skin sloughs off
73
Med Rights
Right client
Right drug
Right dose
Right route
Right time
Right documentation
73
Patient Adherence and Successful Pharmacotherapy
Compliance to drug regimen is a major factor for success
Adherence: taking med in prescribed manner or following manufacturer instructions
RN education is #1 action to promote compliance and adherence
74
3 Checks
Pull
Prepare
Put
75
Types of Orders
Routine Orders: Taken on a regular basis
Single Order: Taken on a regular basis
STAT Order: Given only once and immediately (goal within 5 min)
PRN Orders: As needed to treat specific condition (required parameters must be specified)
Standing Orders: Written in advance of a situation for specific circumstances
76
Parenteral Administration
Intradermal: No hair, 15 degree angel, will bubble, do not rub
Subcutaneously: Go where fat, abdomen, back of arm
Intramuscular: Vascus lateralis or deltoid
Intravenous: Check IV site, flush with saline, check for leak
77
Pharmacokinetics
Drug movement throughout the body
To achieve a therapeutic effect the medication must reach the target cells - intact and sufficient quantity to potentiate the mechanism of action
78
AADME
A: Administration
A: Absorption
D: Distribution
M: Metabolism
E: Elimination
79
Oral Administration
Advantages
Stable, inexpensive, safe
Disadvantage
Swallow problem, gastric irritation, uncertain absorption
80
Sublingual Administration
Advan
Convenient, rapid action
Disadvan
Tablets soft, unstable
80
Subcutaneous Injection
Advan
Simplest injection, only small doses can be given
Disadvan
Requires asepsis, can be irritating
80
Intramuscular
Advan
Use when unconscious, nauseated, rapid, prolonged effect
Disadvan
Requires asepsis, short shelf life, discomfort
81
Intravenous
Adavan
Immediate, predictable, use when unconscious
Disadvan
Costly, skill required, no recovery of drug, irritation at site
81
Inhalation
Advan
Local effect or absorption, rapid, good for anesthesia
Disadvan
Requires effective technique
82
Topical
Advan
Easy to apply, few systemic effects, useful local anesthetic
Disadvan
Can be messy, sometimes difficult application
83
Onset of Action
Oral: 30-45min
Sublingual: 3-5min
Subcutaneous: 15-30min
IM: 10-20min
IV: 1-3min, check back 15-30min later
Inhalation: 1-5min
Topical: 1-30min
84
Absoprtion
Site of admin, cross membranes, circulating fluids
Each route is different
85
Factors Influencing Absorption Rate and Amount
Drug Form
Dose
Route
Size and ionization of molecules
Surface area of absorptive site
Blood flow to surface area
Digestive motility (too fast or too slow)
Lipid Solubility
85
Passive Diffusion
Hydrophobic Molecules (pass through)
O2, CO2, N2
Small uncharged molecules (pass through)
H2O, urea, glycerol
Large Uncharged Molecules
Glucose, sucrose
Ions (Don’t Pass)
H+, Na+, HCO3-
85
Active-Protein Transport
Transport Channel
Enzymes
Cell Surface Receptor
Cell Surface Marker
Cell Adhesion
85
Protein Binding
Normal serum albumin 3.4-5.4 g/dL
Drug can exist in free state or bond to plasma protein
Drug-protein complexes are too large to cross membrane
If highly protein bound, give before eating and let time to absorb before eating
86
Addition
Action of drugs taken together as a total
87
Synergism
Actions of drugs potentiate each other
87
Antagonism
Action of one drug blocks the other
88
Displacement
One drug can displace the binding of another (has more affinity for the binding site)
89
Pharmacodynamics
How medicine changes the body
Mechanism of action
Relationship of drug concentration at site of action
Resulting effects on the body
Not all meds affect all patients the same
90
Dosage Range
Recommneded dosage range applies to approximately half of population
Some individuals require more, others less
IMPORTANT to discuss patient experiences with meds
91
Therapeutic Index and Drug Safety
The LARGER the difference between median lethal dose and median effective dose, the GREATER the therapeutic index
Therapeutic index is a measure of drug’s safety margin
The HIGHER the therapeutic index, the safer the drug
92
Frequency Distribution Curve
Peak of curve indicates LARGEST number of patients responding to drub
Does not show magnitude of response
93
Median Effective Dose (ED50)
Dose that produces therapeutic response in 50% of group
Sometimes called “average” or “standard” dose
Many patients require more or less
94
Median Lethal Dose (LD50)
Used to assess safety of a drug
Determined in preclinical trials on animals
Is lethal dose in 50% of group of animals
94
Graded Dose-Response Relationship
Some meds have an increased effect at a higher dose
Increase dose increases risk of toxicity when plateau has been reached
95
Potency
Drug will produce a therapeutic effect at a lower dose, as compared with another drug in the same category
96
Efficacy
Magnitude of maximal response that can be produced
Not dose dependent but related to mechanism of action
Efficacy is more important because goal is to achieve therapeutic response
96
Cellular Receptors and Drug Actions
Drugs act by changing existing physiological and biochemical processes
Bind to receptor sites (majority are proteins)
Actions can be specific (limited to specific site, cell type, or organ)
Actions can be non-specific (vasoconstriction on all vessels in a body)
97
Agonist
Enhances, increases, supports, potentiates
98
Antagonist
Inhibits, blocks, stops, slows down
99
Review Enteric coated and SR/XR and nursing implications
Before you crush, open, or cut any medication, ensure that in doing so, you will not alter the action of the medication or cause unintentional, harmful effects. By altering the original form of a drug, the pharmacokinetics of that drug may be altered.
