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
Implementation for ADPIE
-Administer
-Continue
-Monitor
-Carry out
-Provide education
Monitor Med
-Admin of med, therapeutic/adverse effects, pt statements, objective data
Patient education
-Primary role for nurses
-Implement teach back
Evaluation for ADPIE
-Compare current status with goals
-Evaluation begins new cycle when
1. New assessment data gathered/analyzed
2. Nursing diagnosis reviewed/rewritten
3. Goals or outcomes are refined
4. New interventions are carried out
Nurse’s responsibilities for reporting med error
-Legal and ethical responsibility to report all errors
-Report errors and near misses
-Report observed errors and near misses
-FDa coordinates reporting of med errors
1. MedWatch
2. NCC MERP
3. DMEPA
Document
-Med given
-Monitor VS
-Assess for adverse effects
-Notify provider
-Document everyone notified
-Inform patient
What can be done to prevent med errors?
-Look up med
-Assess pt to get baseline
-5 rights, 3 checks
-Educate pt about med before giving
-Reassess client after med
-Watch for look alike, black box warning, narrow therapeutic window
-Clarify confusing orders
-2 client identifiers
Adverse effects of alendronate (Fosamax)
-Diarrhea
-Nausea
-Vomiting
-GI irritation
-Metallic or altered taste
-Pathologic fractures with long term use
What is alendronate (Fosamax) used to treat
To prevent postmenopausal osteoporosis
How to screen for lice
-Look for eggs and debris on hair shaft
-Called nits
What is used to treat lice?
lindane (kwell)
Superficial burn characteristics
-Red
-Painful
-Dry
-No blisters
Partial thickness burn characteristics
-Red
-Blistered
-Swollen
-Painful
Full thickness burn characteristics
-White or charred
-No pain since nerve endings are destroyed
Admin of ear drops to child/adult
-Lie on side
-Pull up and back for adults
-Pull down and back for child
Key teaching points when administering topical scabicide
-Monitor daily for 1-2 weeks
Know risk factors for atopic dermatitis
-Tend to have family history of eczema
-Chronic-genetic disposition
-Family history of asthma
Adverse effects of hypocalcemia (CRAMPSS)
-Convulsions
-Reflexes hyperactive
-Arrhythmias
-Muscle spasms
-Positive Trousseau’s and Chvostek’s signs
-Sensation of tingling/numbness
-Stridor (bronchospasms and laryngospasms)
Hypercalcemia Adverse Effects
-Painful bones (and fractures)
-Kidney stones (calcium bases)
-Tired moans (muscle weakness)
-GI groans (nausea and vomiting)
-On the throne (polyuria and constipation)
-Psych overtones (altered mentation, psychosis, forgetfulness, stupor)
Adverse Effects of raloxifene
-Hot flashes
-Migraine
-Flu like symptoms
-Endometrial disorder
-Breast pain
-Vaginal bleeding
-Potential fetal harm
Use of raloxifene
Prevent and treat osteoporosis
Common side effects of timolol eyedrops
-local burning and stinging upon instillation
Use for timolol eyedrops
Used to treat glaucoma
First line drug for osteoarthritis
-Tylenol (acetaminophen)
Therapeutic uses of trentinoin
Treat and control mild to moderate acne vulagris
Adverse effects of trentinoin
-Dry skin, erythema, itching, photosensitivity
-Don’t give to people with fish allergy
Characteristics of Rosacea
-Non pustule papules
-Flushed face around nose and cheeks
-Soft tissues of nose may swell (rhinophyma)
Rosacea Treatments
Benzoyl Peroxide
Known precautions and contraindications for lindane (Kwell)
-Use only after other treatments have failed
-Need RX
-Known to cause seizures
What is lindane (Kwell) used to treat
-Lice and scabies
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
-Prevent and treat mild hypocalcemia for osteoporosis
-Paget disease
-Chronic hypoparathyroidism
-Rickets
-Pregnancy and lactation
-Rapid childhood growth
Adverse effects of calcium salts
-Hypercalcemia
-Dysrhythmias
-Cardiac Arrest
-Hypotension
-Bradycardia
allopurinol adverse effects and nursing admin
-Steven-johnson syndrome
-Hypersensitivity syndrome, drowsiness, headache, vertigo
-Give after or with meals. May be crushed and mixed with food or fluids
What is allopurinol used to treat
Gout
allopurinol Adverse Effects
-Stevens-Johnson sydrome
Nursing considerations and how to assess for effectiveness of bisphosphonate therapy
Bone density scan
What is bisphosphonate used to treat?
osteoporosis
Modifiable risk factors for osteoporosis
-No alcohol or tobacco
-Increase physical activity
-Increase vitamin D or calcium
Signs and symptoms of gout
-Extreme pain, red, inflamed tissue
-Sudden onset, often at night
-Can be triggered by alcohol, dehydration, stress, joint injury, or fever
What is used to treat gout
allopurinol
Adverse effects of topical glucocorticoids
-No serious adverse effects
-Usually stinging, burning, redness of skin
Adverse effects of PO and sub q psoriasis drugs
-Malignancies
-Serious infections
-Skin peeling
-Depression
-Myocardial infarction (MI)
-Gingival enlargement
Symptoms of psoriasis
-Red patches of skin covered with flaky-silver-colored scales (plaques)
What is the treatment of rickets?
-Calcium salts
-Returns serum calcium levels to normal
What happens when there is high levels of calcium in the bloodstream?
-Hypotension
-Bradycardia
-Dysrhythmias and cardiac arrest
Adverse Effect of topical medications for psoriasis
Common Side Effects
-Stinging, irritation, itching
Adverse Effects
-Paresthesia, arthralgia, malignancies, infections, elevated liver function tests
Epidermis Layers
Stratum Corneum
-outermost, strongest layer
-large amount of keratin
-forms barrier to repel bacteria and foreign matter
Stratum basale:
-deepest layer
-supplies new cells to epidermis
Middle layers
-stratum spinosum
-stratum granulosum
-stratum lucidum
Names and areas of different fungal infections
-Tinea pedis (athletes foot)
-Tinea cruris (jock itch)
-Tinea capitis (ringworm on scalp)
-Tinea unguium (nails)
What should you do when taking antibiotics?
Finish the entire series
Open angle glaucoma
-Resistance to drainage of aqueous humor through trabecular meshwork
-Usually bilateral
Closed angle glaucoma
-Drainage channel is blocked usually by the iris
-Usually unilateral
Know admin technique for eyedrops
-Tilt head back
-Pull lower lid down creating a pocket
-Put a drop in the pocket without touching eye with the bottle
-Close eye and press finger against the inside corner of eye
What meds 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
Symptoms of otitis media
-Associated with upper respiratory infections and allergies
-Auditory tube irrigation
Adverse effects of Raloxifene
Hot flashes, migraine, headache, breast pain, vaginal bleeding, flu-like symptoms
What is Raloxifene used to treat?
-Prevent osteoporosis in postmenopausal women
-Decrease bone resorption
Adverse effects and education for Humira
-Injection site pain, upper respiratory infection, headache, rash
-Increased risk for serious infections and malignancies (TB and Hep B, leukemias, lymphomas)
What is Humira used to treat?
-Reduce signs and symptoms of moderate to severe rheumatoid arthritis
-Psoriasis
Permethrin uses and contraindications
-used to treat scabies and pediculides
-chrysanthemums are a contraindication
Psoriasis vulgaris characteristics
-Lesions that form into plaques
-Usually silver or grey and bleed when removed
Psoriatic arthritis
-Resembles rheumatoid arthritis
-Fingers and toes are most common sites
Risk factors for Glaucoma
-Long term use of some meds (glucocorticoids, antihypertensives, antihistamines, antidepressants)
-Hypertension
-Mirgraines
-Severe near or farsightedness
-Normal aging
What pressure range indicates need for treatment of glaucoma?
21-30 mmHg
OR
Signs of optic nerve damage or visual-field changes are present
What does the parathyroid secrete in calcium balance?
PTH
Causes breakdown of the bone to release more calcium into the blood
Calcitonin
Removes calcium from the blood
increasing bone density
Decreased absorption of calcium in small intestine
Vitamin D from inactive form to active
Sun -> Cholecalciferol (inactive vit D) -> Liver-> Calcifediol (intermediate form) -> PTH is released from Parathyroid -> Kidney -> Calciferol (Active form) -> increased absorption of calcium in small intestine
Permethrin (Nix) use and contraindications
Kills lice
Don’t use if allergic to chrysanthemums
Adult infections (Herpes zoster treatments)
Acyclovir (Zovirax)
Atopic dermatitis
Chronic: genetic
Family history of asthma
Normal serum calcium range
8.5-10 mg/dL
How to bisphosphonates work?
Block bone resorption by inhibiting osteoclast activity
what is the prototype Selective Estrogen Receptor Modulator (SERM)
raloxifene (Evista)
Normal intraocular pressure
15-16 mmHg
What is the standard of practice of a newly licensed nurse?
A set of skills that all nurse are competent to perform
Outlines competencies that every nurse should be able to perform regardless of their role
When passing medication your nurse explains to you that the best way to provide medication education is what?
Discussing medications each time they are administered
Carl was prescribed allopurinol for gout. What in Carl’s medication history would be a risk for ototoxicity while taking allopurinol.
Thiazides
Jon comes to the ER after being struck in the face by a baseball. His eye is blood shot and he is c/o severe left eye pain. His diagnosis is closed angle glaucoma. What immediate medication do you anticipate the doctor prescribing?
mannitol
