305 final Flashcards
Understand prototype and its use in pharmacology
Prototype drug: Most effective drug in its class, makes pharmacology easier when using prototype drug approach
Understand the role and scope of the nurse
Don’t delegate what you can EAT
- Evaluate
- Assess
- Teach
Review the different routes of drug administration
Oral (PO)
- Topical (Lotion, Creams)
- Intravenous
- Intramuscular
- Sublingual
- Inhalation
- etc
Know what happens during the first pass effect
Oral meds after absorbed in the small intestine are passed through the liver before entering the bloodstream, they then pass through the liver again once in the blood
Know how CYP450 can affect drug metabolism and what foods clients should avoid.
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
Review what a nurses responsibilities in reporting a med error
*RN’s legal and ethical responsibility to report all errors
*The RN’s errors and near misses, and
*The errors and near misses the RN observes
*FDA coordinates the reporting of medication errors
*MedWatch
*NCC MERP
*DMEPA
Follow the healthcare facilities policy on reporting medication errors.
This policy will specify who to report the incident to and the documents that must be completed (example: incident report).
Review the steps that a nurse can do to prevent a med error
*5 rights & 3 checks
*Follow the pharmaceutical instructions and RN Scope of Practice Standards for preparing and administering the medication
*Educate the client about the medication BEFORE administering the first dose
Review drug administration for a toddler
- Encourage participation, Give lots of choices when possible
- Mix meds (When applicable) in jams, not in juice because they may not drink all of it
Know about teratogenic medication and teaching for pregnant clients
Category A: Adequate well controlled studies have shown no risks in any trimester during the pregnancy
Category B: Animal studies have revealed no evidence of fetal harm
Category C: Animal studies have demonstrated risk to fetus
Category D: Observation in pregnant women demonstrated risks to fetus, but benefits may outweigh the risk
Category X: Contraindicated for pregnancy
Know what constitutes a natural disaster
Naturally occurring phenomenon that causes disruption (Earthquake, Tornado, etc)
Know the adverse effects of alendronate (Fosamax)
Jaw Pain, Dysphagia, Blurred Vision, Diarrhea, Nausea, Vomiting, GI irritation, Metallic/Altered Taste, Pathologic Fractures (Long term use)
Know how to screen for lice
Use a fine toothed comb to assess for white knits firmly attached to the hair shaft.
Know the differences between a superficial, partial thickness, and full thickness burn.
Superficial: Redness, No Blistering
Partial thickness: Redness, Blistering, Swollen
Full thickness: Full thickness, white, blackened, or charred skin, can affect skin or muscle
Know how to administer ear drops to a child and an adult
Children: Have client lay on their side, Gently pull pinna down and back
- Adult: Have client lay on their side, Gently pull pinna up and back
Know key teaching points when administering topical scabicide
Monitor the area daily for the next couple of weeks
Know risk factors for atopic dermatitis
- Chronic; Genetic predisposition
- Family history of asthma
- Skin disorder: Pain, redness, pruritus
Know adverse effects of hypocalcemia and hypercalcemia
Hypocalcemia
- Cell membranes become hyperexcitable
- Convulsions or muscle spasms
- (CRAMPSS) Convulsions, Hyperactive reflex, Arrhythmias, Muscle spasms, Positive Trousseaus and Chvostek’s sign, sensation of tingling and numbness, stridor (Bronchospasms)
- Hypercalcemia
- Decreased sodium permeability across cell membranes
- Fractures, calcium based kidney stones, muscle weakness, nausea/vomiting, polyuria/constipation, altered mentation/psychosis, forgetfulness
- Painful bones, Kidney stones, Tired moans, GI groans, On the throne, Psych overtones
Know the adverse effects of raloxifene
Used to increase bone mass and density (Evista)
- weight gain, Increased risk of venous thromboembolism, Death from strokes, Hot flashes, migraine headaches,
Know common side effects of timolol eye drops
Burning and stinging upon irritation, vision may become temporarily blurred
What is a first line drug for osteoarthritis?
Acetaminophen
What are the therapeutic uses of tretinoin
Antiacne
- Early treatment and control of mild to moderate acne
- Decreases comedone formation and increases extrusion of comedones
Know the characteristics of Rosacea
Small papule without pus
- Flushed face around nose and cheeks
- Soft tissue of nose may swell (Rhinophyma)
Know precautions and contraindications for lindane (Kwell)
Used for Lice and Scabies
- Hypersensitivity, Pregnant or Breastfeeding (Category C drug), Children under 2, Risk of seizures, Avoid using on broken skin
What is the function of the dermis
Foundation for hair and nails
- Contains nerve endings, oil glands, sweat glands, blood vessels
Know the use of calcium salts and nursing administration
Restore levels of calcium in the blood (Hypocalcemic)
- Give oral supplements with meals or 1 hour post meals
- Administer slowly through IV site to avoid Hypotension, Dysrhythmias, and Cardiac Arrest
- Pregnancy Category B
Review allopurinol adverse effects and nursing administration
Stevens-Johnson syndrome (Flu like symptoms and rash), Fatal toxic epidermal necrolysis
- Give with or after meals
- Tablets may be crushed and mixed with food or fluids
- Pregnancy Category C
Know modifiable risk factors for osteoporosis
High alcohol consumption, Tobacco use, Physical inactivity, Low vitamin D or Calcium in diet, Drugs that lower calcium in blood.
Review nursing considerations and how to assess for effectiveness of bisphosphonate therapy.
Take on an empty stomach with plain water 30 minutes before first meal
- Remain in an upright position for 30 minutes to reduce esophageal irritation
- Assess using a bone mineral density scan (DXA)
Review the signs and symptoms of gout
Acute arthritis caused by a build up of uric acid (Urate) crystals in the joints and other body tissues
- Most common attacks are at night
- Sudden onset, extreme pain
Primary Gout
Hereditary defect
Secondary Gout
Certain drugs can cause gout
Diseases that affect uric acid metabolism
Know the adverse effects of topical glucocorticoids
Skin Discoloration, Delayed Wound Healing, Skin Thinning
Know the mechanism of actions of Selective estrogen receptor modulators.
Decrease bone resorption and increase bone mass and density
- May be either estrogen agonist or antagonist depending on the drug or tissue involved
Know the symptoms of psoriasis.
Red patches on the skin covered with flaky silver-covered scales (Plaques)
- Caused by extremely fast skin turnover rate (4-7 days instead of 14 days)
- Underlying skin may be irritated and inflamed
What is the treatment for rickets?
Rickets: Osteomalacia in children (Softening of the bone due to demineralization)
- Signs: Bow legs and pigeon breast, may also have slight fever and restless at night
- Best treatment: Expose children to sunlight to get natural vitamin D
What happens when there are high levels of calcium in the bloodstream?
Fractures, Calcium based kidney stones, Muscle Weakness, Nausea/Vomiting, Polyuria, Constipation, Altered mentation, Psychosis, Forgetfulness, Stupor
Adverse effect of topical medications for psoriasis
Topical medications: Stinging, Irritation, Itching, Burning, usually mild adverse effects
Know the different layers of the skin and their functions.
Epidermis: Forms barrier that repels bacteria and foreign matter (5% thickness)
- Stratum basale (Stratum germination) is the deepest layer that supplies new skin cells
- Dermis: Foundation for hair and nails (95% thickness)
- Contains nerve endings, oil glands, sweat glands, blood vessels
- Subcutaneous layer: Cushions, insulates, provides source of energy
- Composed of adipose tissue
Know the names and different areas of fungal infections
Tinea pedis (Athletes Foot)
- Tinea cruris (Jock Itch)
- Tinea capitis (Ringworm of scalp)
- Tinea unguium (Nails)
What is true about antibiotics when treating infections
Even if you feel better, take them all
Know the difference between open glaucoma and closed angle glaucoma
- Open angle glaucoma: Chronic onset due to drainage resistance through the trabecular meshwork
- Closed Angle glaucoma: Path of aqueous humor drainage is completely blocked causing a build of aqueous humor increasing the intraocular pressure
Know administration technique for eye drops
Tilt client head back
- Pull lower eyelid down creating a pocket
- Put a drop in the pocket without touching your eye to the dropper
- Occluded nasolacrimal duct for 30-60 seconds
- Observe for systemic effects
What medications are given for both open angle and closed angle glaucoma
Prostaglandins
-Dilate trabecular meshwork
-Increase aqueous humor outflow
Beta-adrenergic blockers
-Decrease production of aqueous humor
-Adverse Effects: Bronchoconstriction, dysrhythmias, hypotension
Alpha2-adrenergic agonists
-Decrease production of aqueous humor
Carbonic anhydrase inhibitors
-Decrease production of aqueous humor
Know the symptoms of otitis media
Upper respiratory infections, Allergies, Auditory tube irritation
Know the adverse effects of Raloxifene
Weight Gain, Increased risk for venous thromboembolism, Death from strokes, Hot Flashes, Leg Cramps,
Know the adverse effects and client teaching for Humira
Upper respiratory site infection, serious infections, malignancies, injection site pain,
Different Routes of Drug Admin
-Oral (30-45min onset)
-Sublingual (3-5min onset)
-Subcutaneous (15-30min onset)
-IM (10-20min onset)
-IV (1-3min onset)
-Inhalation (1-5min onset)
-Topical (1-30min onset)
What happens during the first pass effect?
- Oral drug taken
- Drug absorbed across the intestinal mucosa
- Drug enters portal circulation and travels to liver
- On first pass through the liver, drug is metabolized to less active forms
- Drug metabolites (less active) leave the liver for distribution to tissues
How can CYP450 affect drug metabolism and what food should be avoided?
-Inactivates drugs and accelerates their excretion
-Sometimes creates metabolite that produces a greater therapeutic effect
EX: codeine metabolized to morphine
AVOID grapefruit juice
Assessment for ADPIE
-Health history
-Baseline data
-Med use, otc use, illicit drug use, lifestyle, habits, reproductive history
-Most important step (creates baseline)
Reassessment
-Desired response?
-Adverse effects?
-Pt capability of assuming responsibility for self-care
Nursing Diagnosis for ADPIE
-Focus on pt needs
-Promote therapeutic drug effect
-Minimize adverse effects
-Maximize pt self care
Risk diagnosis:
1. Diagnostic statement
2. Related factor or inferred cause
Actual Diagnosis
1. Diagnostic statement
2. Related factor or inferred cause
3. Evidence to support statement
Planning for ADPIE
-Goals for pt
Outcomes for pt
-Evaluate degree of goal completion
-Focus on what pt will do
-Discussed with pt or caregiver
-Should be written
