305 Escape Room Review Flashcards
Which of the following are considered significant roles for nursed as defined by the Joint Commission?
Ensuring patient safety
Promoting effective Communication
Providing patient centered care
What is the difference between a generic drug and a brand name drug?
Brand name drugs can have multiple names why generic names have only one.
Learning prototypes will help you to learn pharmacology. What is the definition a prototype drug?
Most effective drug in its class
a drug used as a model to which other drugs in the class are compared to.
What resources are preferred to learn more about a drug?
Peer reviewed journal
Physicians Desk Reference
Pharmacist
Tall Man Lettering
used within a drug name to highlight its primary dissimilarities and help to differentiate look-alike names
Terotogenic Risks
(Escape Room answer)
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.
A black box warning is important because it means?
a serious safety warning required by the U.S. Food and Drug Administration (FDA) for certain medications
Routine
Taken on regular basis
What is a standard of nursing practice?
Specifies the nurses provide care that reflects current practice when performing client care
Asap
within 30 min
Stat
Immediately
PRN
As needed
What is the correct way to use an inhaler
Patient exhales fully, coordinate medication with inhale, hold breath for 10-15 seconds… If unable to do so use a spacer
What should be assessed before giving an intradermal medication?
Skin
The nurse is caring for a patient with impaired kidney function. Which pharmacokinetic process is most likely to be affected?
Excretion
The nurse is monitoring a patient receiving intravenous medication. Which factors affect the drug’s distribution in the body?
Blood flow to tissues
Drug Solubility
Plasma protein binding
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
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.
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:
Onset of action
A medication is prescribed to be given every 8 hours. The nurse knows this schedule is most likely related to the drug’s
Duration of action
The nurse explains to the patient that potency refers to which of the following?
The amount of drug needed to produce a therapeutic effect
A nurse is explaining how an agonist medication works to a patient. Which statement best describes the action of an agonist?
An agonist binds to a receptor and activates it, producing a physiological response.
The nurse tells the patient that efficacy is defined as:
The maximum effect the drug can produce
Which of the following best describes the action of a competitive antagonist?
It competes with an agonist for receptor sites and prevents activation.
The lethal dose (LD50) of a drug is defined as:
A measure determined during clinical trials.
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
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
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
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
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
Biosimilar:
drugs are chemically synthesized but are still closely related to biological medications
Testing not as rigorous for biosimilars as for their reference products
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
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.
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
Know what a black box or boxed warning is.
- indicates a medication has serious risks or adverse reactions
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)
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.
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
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
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
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
Review the symptoms of an anaphylactic reaction.
- Dyspnea, Tachycardia, Hypotension
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
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
Know what half-life means.
- Time it takes for the amount of the active drug form to be reduced by 50%
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
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
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
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
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
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
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
