Exam 1 Flashcards
ADPIE
Assessment
Diagnosis
Planning
Intervention
Evaluation
5 Rights
Patient
Med
Dose
Time
Route
The 3 Check
CHECK DRUG with MAR when removing from storage
CHECK DRUG when prepping
CHECK DRUG against the eMAR at the bedside
Sound Alike, Look Alike
Medications whose spellings or pronunciations are so similar they could be mistaken for one another
How to avoid drug admin errors
Check 5 rights
3 checks
Check patient variables (age, sex)
Reading back orders
Don’t rush
Polypharmacy
Multiple prescriptions, sometimes for the same condition, that have conflicting pharmacological actions
Avoid by: getting patient information from healthcare and documentation (med reconciliation)
Medication reconciliation
Checking what meds they are taking, so that there is one solid list and drugs dont interact in a way that could be harmful
Making sure patients know each med and how to take them and what not to take them with
E-prescribing
Use of electronic Rx transferred directly from the MD to pharmacy
More reliable than paper prescriptions
Cant do this with narcotics
Barcoding
Use of a barcode scanner to Identify the patient, the meds, and even the pump
Pharmacokinetics
The study of how drug moves throughout the body
ADME
Absorption
Distribution
Metabolism
Excretion
Absorption
Movement of a substance from site of administration across body membranes to circulation fluids
Determines how long before the drug shows it effect (onset)
Things that determine absorption rate:
- size
- form (liquids absorbed faster)
- lipid- soluble absorbed faster
- metabolism
- drug/drug or drug/food interactions
Distribution
The transport of pharmacological agents through the body
Things that influence distribution:
- blood flow
- lipid soluble drugs more easily distributed
- tissues can store drugs
Blood Brain Barrier
A group of tight junctions that keep the brains blood flow separate from the rest of the body
Sedatives, anti-anxiety (can pass)
Anti cancer drugs (cannot cross)
Metabolism
“Biotransformation”
Changing the medication to a form more easily excreted by the body
LIVER!!! Primary organ for metabolism of drugs
Enzymes in liver can:
- inactivate drugs for easy excretion
- biotransform to result in more active medication
Could cause first pass effect
First pass effect
The medication may be rendered inactive as it goes through the liver
Oral will go to liver before it gets to the bloodstream (makes effects less reliable)
IV ensures that medication is sent straight to bloodstream
Excretion
The removal of drugs from the body
KIDNEY (primary organ for excretion)
Also lungs (anesthetics), bile (poop), and glands(saliva, sweat)
Water soluble drugs more easily excreted than lipid soluble
Loading Dose
Usually a higher dose of the med given one time
- given to quickly achieve therapeutic level
Maintenance Dose
The daily dose that a patient will take as long as they are on the drug to keep plasma levels constant
Therapeutic Range
The dosage range or serum concentration that achieves the drugs desired effects
Onset, peak, duration
- gives us the chance to see how often to give drug and how much to give
Therapeutic Index
Range between a drugs lethal dose and its effective dose
Half-life
Length of time required for the plasma concentration of drug to decrease by one-half after administration
-helps determine time we need to give another dose
Half life abbreviations
Qd (every day)
Qid (4 times a day)
Tid (3 times a day)
Bid (2 times a day)
Pharmacodynamics
How does the medicine change the body
Receptor drugs
A macromolecule (protein) to which a medication binds to produce an effect
Signals a reaction within the body or can block a reaction from happening
Agonist
A drug that mimics the effect of an endogenous molecule
Partial agonist - produces a weaker response
Antagonist
A drug that occupies the receptor and blocks the endogenous molecule action
Lactating clients drug restrictions
Stay away from drugs that can enter the breast milk
- H2O soluble lower levels in BM
- Protein bound drugs bind to mom
Recommendations:
- give drugs w shorter half life
- use non-pharmacological alternatives
Teratogen
An embryo or fetus is exposed to a substance, organism, or physical agent that can produce a permanent abnormality
Children’s drug restrictions
Determined by child’s weight
Older adults drug considerations
More likely to have polypharmacy
- drug/drug interactions
- side effects
Need more help administering drugs
Allergy
Patient should have allergy band
Not throwing up (thats a side effect)
Anaphylaxis
Life threatening allergies
Adverse Recation
An undesired event
Side effect
A known, unavoidable response to a med
Generic name
There is one generic name (know for NCLEX)
Found on the MAR
ibuprofen
Trade name
There can be many trade names for a single drug.
Owned by a company
(Advil, Motrin)
Therapeutic Class
Drugs classification based off what they are intended for
Pharmacological Class
Group of drugs that are classified together because they are similar on a molecular level
Prescription (rx)
Ordered by a practitioner
Can be more costly
Teaching how to use, when to take, what to take it with
Over the counter
No prescription needed
Self-treatment can be done wrong
STAT order
Used in emergency situations
To be done immediately
PRN
Drug to be administered as needed
Requires nursing judgement
Single Order
One-time dose of medication
Routine/scheduled order
Given on a specific schedule
Anything that is not STAT, single order, or PRN is considered routine
Continuous Order
IV fluids that run continuously
Enteral Route
“Go through GI tract”
PO (oral)
- capsule, tablet
- sublinguinal
- buccaneers
- nasogastric and gastrostomy tube (if tablet make sure it can be crushed)
Topical Route
Applied to skin, eyes, nose, respiratory tract
Parenteral Route
“Outside the GI tract”
IV, IM, Subq, Intradermal
Antidote
Reversal drug
- mostly for narcotics
Central Nervous System
Brain and spinal cord
Cholinergic
ACh neurotransmitter that produces a rest and digest response
Anticholinergic
Produces a fight or flight response
PNS
Rest and digest
Parasympathetic
Fight or flight
Sympathetic
Muscanarinic
Parasympathetic receptor of ACh
Affects smooth muscle and slows heart rate
Nicotinic
ACh parasympathetic receptor types
Affects skeletal muscle
Alpha receptors
Sympathetic receptor type, takes Epi and Norepi
Affects blood vessels
Alpha 1: vasoconstriction
Alpha 2: vasodilation
Beta Receptors
Sympathetic receptor type, takes Epi and Norepi
Beta 1: affects Heart (inc HR, inc contractility)
Beta 2: lungs (bronchodilation, Dec urine contractions)
Neurotransmitters
Chemical substances produced and released by axons that transmits a signal to target neurons, cells, or glands
Synapse
Cholinergic crisis
There’s too much cholinergic given and the parasympathetic system is activated to the point where it becomes dangerous
Control over ANS
No control… involuntary
SNS
Fight or flight
Pupils - dilate
Lungs - bronchodilate
Heart- tachycardia, inc HR
Liver- inc glucose production
BV - constrict, inc BP
Gastrointestinal - relaxes SM
Bladder - relaxes muscle
PNS
Rest and digest
Pupils - constrict
Lungs- bronchioconstrict
Heart- Dec HR
BV- dilate, Dec BP
Gastrointestinal - inc Peristalsis
Bladder - constrict bladder SM
Salivary - inc salivation
2 NT of ANS
SNS
NT - Nori, Epi
Receptor- Alpha /Beta
PNS
NT - ACh
Receptor - Nicotinic / Muscarinic
Mimic SNS
Sympathomimetic
Adrenergic agonist
Adrenergics
- treatment of shock or hypotension
Block SNS
Sympatholytics
Adrenergic blocker
- antihypertensive
Mimic PNS
Parasympathomimetic
Cholinergic
- stimulates SM and contracts
Block PNS
Parasympatholytic
Anticholinergics
- induces fight or flight
Fever
Natural defense mechanism for neutralizing foreign organisms
If fever is prolonged it becomes dangerous
- break down body tissues
- reduce mental capacity
- lead to delirium/coma
Drugs that lead to fevers
- anti infectives (they release pyrogens)
- SSRI associated with serotonin
- some anesthetics
- cytotoxic drugs
How to treat a fever
Determine cause!!
Over the counter drugs to treat
Cold compress
Ice packs on
Cooling blanket
Inflammation
A non-specific defense system of the body
Acute and chronic (ongoing)
Chemical Mediators of Inflammation
Histamine
Leukotrienes
Bradykinin
Complement
Prostaglandins
2 Main drug classes to treat inflammation
NSAIDS - good for mild to moderate pain; low side effects
Corticosteroids - saved for severe symptoms; serious side effects
Corticocosteroids
Hormones released by the adrenal cortex
Used to treat cancer, asthma, arthritis
Inhibit the biosynthesis of prostaglandins but have multiple mechanisms to treat inflammation
MOST POWERFUL anti-inflammatory
Cushings Syndrome
Disorder caused by the amount of corticosteroids in the body
