Exam 1 Flashcards
1
Q
Medication Error
A
Any preventable event that may cause or lead to inappropriate med use or patient harm
2
Q
Rights of Drug Administration
A
- Right Drug
- Right Dose
- Right Time
- Right Route
- Right Patient
- Right Documentation
- Right to refuse
- Right Reason
- Right Reaction
3
Q
Chemical Name
A
Describes the drug’s chemical composition and molecular structure
4
Q
Generic Name
A
Given by the U.S. Adopted Names Council; nonproprietary name
5
Q
Trade Name
A
Drug has a registered trademark- use of drug name is restricted by patent owner; proprietary name
6
Q
Pharmacokinetics
A
Study of what the body does to a drug
(Absorption, Distribution, Metabolism, Excretion)
7
Q
Toxicology
A
Science of adverse effects of drugs and other chemicals on living organisms
8
Q
Pharmacognosy
A
Study of natural vs. synthetic drug sources
9
Q
Pharmacoeconomics
A
Study of economic factors influencing the cost of drug therapy, cost-benefit analysis
10
Q
Enteral Route
A
Drug absorbed into systemic circulation through the oral or gastric mucosa or small intestine
(EX: oral, sublingual, buccal, rectal)
11
Q
Parenteral Route
A
EX: IV, IM, subcutaneous, intradermal, intraarterial, intrathecal, intraarticular
12
Q
Topical Route
A
EX: Skin, eyes, ears, nose, mouth, lungs (inhalation), rectum (local effects), vagina
13
Q
Bioavailability
A
The extent of drug absorption
14
Q
First Past Effect
A
Large portion of the drug is broken down by the liver into inactive metabolites
15
Q
Distribution
A
Transport of the drug by blood to site of action
(Albumin is the most common blood protein)
16
Q
Metabolism
A
How the body breaks down the drug
17
Q
Excretion
A
Elimination of the drug from the body
-renal
-biliary
-bowel
18
Q
Half-Life
A
Time required for half of the given drug to be removed from the body
19
Q
Steady State
A
Amount of drug removed = amount of drug absorbed
20
Q
Peak Level
A
Highest blood level of drug
21
Q
Trough Level
A
Lowest blood level of drug
22
Q
Toxicity
A
Occurs if peak is too high
23
Q
Pharmacotherapeutics
A
Clinical use of drugs to prevent and treat diseases
24
Q
Tolerance
A
Decreased response to repeated drug dosages
25
Dependence
Physiologic or psychological need for a drug
26
Psychological Dependence
"Addiction"
-Obsessive desire for euphoric effects of drug
27
When can med errors occur?
-Prescribing
-Administering
-Dispensing
-Monitoring
28
Adverse reactions to medications:
-Pharmacologic reaction
-Hypersensitivity reaction (allergy)
-Idiosyncratic reaction: rare and unpredictable reactions
-Drug interaction
29
Drug therapy during pregnancy:
-Drugs cross the placenta via diffusion
-Factors impacting safety: drug properties, fetal gestational age, maternal factors
30
What trimester is drug transfer to the fetus most likely to occur in?
Third trimester
31
Neonatal and Pediatric Considerations
-Absorption: gastric pH less acidic until 1-2; gastric emptying slowed; IM absorption faster and irregular
-Distribution: lower fat content, decreased protein binding, immature BBB
-Metabolism: immature liver, older children may have higher metabolism
-Excretion: immature kidneys
32
Factors affecting pediatric drug doses:
-Skin is thin and permeable
-Stomach lacks acid to kill bacteria
-Lungs have weaker mucous barriers
-Body temp. not well regulated
-Easy dehydration
-Immature liver and kidneys
-MUST DETERMINE DOSAGE BY WEIGHT IN KG
32
Factors affecting older adults and drugs:
-Decline in organ function
-Drug therapy more likely to result in adverse effects and toxicity
-High use of medications
-Polypharmacy
-Noncompliance
-Nonadherence
-Sensory and motor deficits
33
Older Adult Considerations:
-Absorption: gastric pH less acidic, gastric emptying and movement slowed, blood flow to GI tract reduced, absorptive surface reduced
-Distribution: increased fat content, decreased proteins by liver, decreased drug binding
-Metabolism: decreased liver blood flow and breakdown
-Excretion: decreased filtration rate and fewer nephrons, drugs cleared less efficiently
34
Adverse Drug Events
Composed of both medication errors and adverse drug responses (allergic reactions and idiosyncratic reactions)
35
Drugs commonly involved in med errors:
CNS drugs, anticoagulants, chemotherapy drugs
36
Near Miss
Event/situation did not produce patient injury but only due to chance
37
Types of Med Errors:
1. No error, although circumstances/events occurred that could have led to one
2. Med error that causes harm
3. Med error that causes no harm
4. Med error that results in death
38
Med error Prevention:
-Check med orders 3 times before administration
-Rights of med admin
-Assessment
-2 patient identifiers
-Do NOT administer if you did not prepare the meds yourself
-minimize verbal/telephone orders
-Don't assume or use unapproved shorthand
-Use generic names
-Mandatory second nurse verifications for high risk meds/patients
-Minimize interruptions
39
Reporting Errors:
-Report to prescriber and nursing management
-Document error per policy
-Factual information only
40
When should medication reconciliation be done?
Admission, status change, patient transfer within/between facilities or providers, discharge
41
Tylenol affects the _______
Liver
42
Ibuprofen affects the __________
Kidneys
43
Over the Counter Drugs
Nonprescription drugs used for short-term treatment of common minor illnesses
44
Criteria for OTC Drugs:
1. Indication for use: the consumer must be able to easily diagnose and monitor themselves for effectiveness; benefits must outweigh the risks
2. Safety: drugs must have limited interaction with other drugs, low potential for abuse, and high therapeutic index
3. Practicality: drugs must be easy to use and monitor
45
OTC potential hazards:
-May delay treatment of serious or fatal disorders
-May relieve symptoms but not the cause
-Toxicity
-Interactions with current prescriptions
-Abuse
46
Conditions commonly treated with herbal products:
-Anxiety
-Colds, cough
-Depression
-Headache
-Insomnia
-Ulcers
-PMS
-Arthritis
-Constipation
-Fever
-Infection
-Stress
-Weakness
47
Commonly used herbal/dietary supplements:
-Aloe
-Feverfew
-Gingko
-Goldenseal
-St. John's Wort
-Valerian
-Kava
-Echinacea
-Garlic
-Ginseng
-Hawthorn
-Saw palmetto
-Cranberry
-Ginger root
48
Assessment for OTC/Herbal:
-Check med history and document all used
-Allergies, level of education and understanding
-Info specific to various products
-System functions
-Conditions that could be potential contraindications
-Lifespan considerations
49
Implementation for OTC/Herbal:
-Patient education!!!
-Ensure patients understand that manufacturers of herbs and supplements do not have to prove safety or effectiveness
50
Evaluation of OTC/Herbal:
-Patients need to carefully monitor themselves for therapeutic responses, effectiveness, and adverse effects
51
Administering Oral Drugs:
-assess for dysphagia or aspiration precautions
-age considerations
-crushing pills
-remain w/patient until all medication is swallowed
-document med admin and patient response
52
Administering Enteral Drugs with a G-Tube
-Position in Semi-Fowler's or Fowlers
-Leave HOB elevated for 30 minutes after
-Check compatibility with feedings if applicable
-Use liquid forms of meds if available
-Adminster meds separately, flushing in between
-Flush with 30 mL of water after the last med and document fluid intake
53
Adminsitering Rectal Drugs:
-Assess for active rectal bleeding or diarrhea
-Sims Position unless contraindicated
-Retention enemas
-Remain laying on left side for 15-30 mins.
-Age related considerations
54
Parenteral Drugs
-NEVER recap a used needle
-Filter needles used to withdraw meds from an ampule but NEVER to stick a patient
55
Injections
-90 degree angle
-Z track method
56
Analgesics
Medications that relieve pain without causing loss of consciousness
57
Pain
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
58
Pain Tolerance
Amount of pain someone can endure without interfering with normal function
59
Acute Pain
Sudden onset, usually subsides once treated
60
Chronic Pain
Persistent or recurring, lasting longer than 3-6 months
-Often difficult to treat
-Tolerance, physical dependence
61
Adjuvant Drugs
Assist primary drugs in relieving pain
-EX: NSAID, antidepressants, anticonvulsants, corticosteroids
62
Lowered Pain Threshold:
Anxiety, sleeplessness, tiredness, anger, fear, fright, depression, discomfort, pain, isolation
63
Raised Pain Threshold:
Diversion, empathy, rest, sympathy, medications
64
Agonists
-Bind to opioid pain receptor in brain, making pt less sensitive to pain receptors
-Cause an analgesic response
65
Agonists-Antagonists
-Binds to pain receptor, causing a weaker neurologic response than a full agonist
66
Antagonists
-Bind to a pain receptor and exert no response
-Reverse the effects of opioid analgesics on pain receptors
67
Opioid Analgesic Indications:
-Relief of moderate to severe pain
-Can also be used for cough suppression, treat diarrhea, or for anesthesia
68
Opioid Caution in patients with:
-Elevated intracranial pressure
-Breathing issues
-Morbid obesity
-Sleep apnea
-Pregnancy
69
Schedule 1
Drugs with no currently accepted medical use and a high potential for abuse
-EX: heroin, LSD, ecstacy
70
Schedule 2
Drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence
-EX: cocaine, methamphetamine, Dilaudid, Dermerol, oxycodone, fentanyl
71
Schedule 3
Drugs with a moderate to low potential for physical and psychological dependence
-EX: tylenol with acodeine, ketamine, anabolic steroids, testosterone
72
Schedule 4
Drugs with a low potential for abuse and low risk for dependence
-EX: Xanax, Soma, Darvon, Darvocet, Valium, Ativan
73
Schedule 5
Drugs with lower potential for abuse than schedule 4 and consist of preparations containing liquid quantities of certain narcotics
-EX: cough preparation with less than 200 mg of codeine per 100 mL
74
Opioid Tolerance
-Common physiologic result of chronic opioid treatment
-A larger dose is required to maintain the same level of analgesia
75
Opioid Physical Dependence
Physiologic adaptation of the body to the presence of an opioid
76
Treatment of Opioid OD
Naloxone (Narcan) or Naltrexone (ReVia)
77
Naloxone Hydrochloride (Narcan)
-Pure opioid antagonist
-Drug of choice for complete or partial reversal of opioid-induced respiratory depression
78
Opioid Withdrawal Syndrome
Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea diaphoresis, N/V, cramps, diarrhea, confusion
79
Acetaminophen (Tylenol)
-NOT AN NSAID
-Analgesic and antipyretic effects (mild to moderate pain)
80
Tylenol Max Daily Limits:
4,000 mg/day for a healthy pt
3,000 mg/day for older adult
2,000 mg/day for pt with liver disease or chronic alcohol use
81
Tramadol Hydrochloride (Ultram)
-Moderate to severe pain
-Adverse effects similar to opioids
-Careful use in pts taking SSRIs, MAOIs, neuroleptics
82
Lidocaine Transdermal Patch
-Topical anesthetic
-Left in place no longer than 12 hours
83
Commonly Abused Substances:
-Heroine (most commonly)
-Codeine
-Hydrocodone
-Hydromorphone
-Morphine
-Oxycodone
84
Opioids
Synthetic versions of pain-relieving substances
85
Opioids used to treat dependence:
Methadone and Clonidine
86
Opioid Withdrawl
- Peak period: 1-3 days
-Duration: 5-7 days
-Signs: drug seeking, dilated pupils, sweating, runny nose, tears, diarrhea, elevated BP and pulse
-Symptoms: nausea, muscle aches, dilated pupils, sweating, yawning (babies), fever, insomnia
87
Opioid Relapse Prevention
Naltrexone works by blocking opioid receptors so opioids do not produce euphoria (must be 1 week free from opioids to begin this therapy)
88
Stimulant Indications
-ADHD
-Narcolepsy
-Obesity treatment
89
Stimulant Adverse Effects:
-CNS: restlessness, tremors, hyperactive reflexes, irritability, insomnia, paranoid hallucinations, panic states, suicidal/homicidal tendencies
(fatigue and depression follow CNS stim.)
-CV: cardiac dysrhythmias, hyper/hypotension, tachycardia
-GI: dry mouth, GI upset
90
Stimulant Toxicity
-Death due to poisoning or toxic levels:
1. convulsions
2. coma
3. cerebral hemorrhage
91
Stimulant Withdrawal
-Peak: 1-3 days
-Duration: 5-7 days
-Signs: social withdrawal, psychomotor retardation, hypersomnia, hyperphagia
92
Depressants
Drugs that relieve anxiety, irritability, tension when used as intended
-EX: Benzodiazepines, barbiturates, marijuana
93
Depressant adverse effects:
-Overexpression of therapeutic effects
-CNS: CNS depression
-GI upset
94
Depressant Withdrawal
-Peak Period: 2-4 days (short acting) 4-7 days (long acting)
-Duration: 4-7 days (short acting) 4-12 days (long acting)
-Signs: increased psychomotor activity, agitation, hyperthermia, sweating, delirium, convulsions, increased BP pulse and temp
95
Benzodiazepines
-Depressant
-Withdrawal: seizures, delirium, anxiety, myclonus, myalgia, sleep disturbances
-Flumazenil reversal
96
Alcohol (Ethanol) Withdrawal
Increased BP, pulse, temp; insomnia; tremors; agitation
-Benzodiazepines can be used as a treatment
-ICU monitoring for severe withdrawal
97
Treatment for Alcoholism
-Disulfiram
-Naltrexone
-Acamprosate
-Counseling
98
Nicotine adverse effects:
Increased HR and BP, tremors, convulsions, increased tone and activity of bowel, respiratory stimulation
99
Nicotine Withdrawal
-Cigarette craving
-Irritability, restlessness, lowered HR and BP
-Treatment includes gum, patches, inhalers, nose spray
100
Psychotherapetic Drugs
Used in the treatment of emotional and mental disorders
101
Benzodiazepines
-Anxiolytic
-Largest and most commonly prescribed anxiolytic
-Used to treat alcohol withdrawal, insomnia, muscle spasms, adjuvant for depression
102
Benzodiazepine Overdose
-Dangerous when taken with other
depressants
-Treatment generally symptomatic and supportive
-Flumazenil may be used to reverse effects
103
Benzodiazepine Interactions
-Alcohol and CNS depressants can result in additive CNS depression and even death
-Most likely to occur in patients with renal or hepatic compromise
104
Buspirone (Buspar) adverse effects
-Nonsedating and nonhabit forming anxiolytic
-paradoxical anxiety, blurred vision, headache, nausea
-DO NOT administer with MAOIs
105
Mood Stabilizing Drugs
-Used to treat bipolar
-Lithium (other drugs may also be used in combination)
106
Therapeutic range for lithium
0.6-1.2 mEq/L
107
Normal sodium range
135-145 mEq/La
108
Adverse effects of lithium
-cardiac dysrhythmias, drowsiness, slurred speech, seizures, ataxia, hypotension
109
Tricyclic Antidepressants Overdose
-Lethal
-CNS and CV mainly affected
-No specific "antidote"; manage symptoms and provide basic life support
110
Monoamine Oxidase Inhibitors (MAOI's)
-Ingestion of foods or drinks with tyramine leads to hypertensive crisis
111
Second-Generation Antidepressants
-Indications: Depression, bipolar, eating disorders, obesity, OCD, panic disorders, social anxiety, PTSD, PMS
112
Serotonin Syndrome
Delirium, headache, agitation, tachycardia, sweating, myclonus, hyperreflexia, shivering, tremors
Severe: hyperthermia, seizures, renal failure, cardiac dysrhythmias, disseminated intravascular coagulation
113
