Exam 1 Flashcards
Medication Error
Any preventable event that may cause or lead to inappropriate med use or patient harm
Rights of Drug Administration
- Right Drug
- Right Dose
- Right Time
- Right Route
- Right Patient
- Right Documentation
- Right to refuse
- Right Reason
- Right Reaction
Chemical Name
Describes the drug’s chemical composition and molecular structure
Generic Name
Given by the U.S. Adopted Names Council; nonproprietary name
Trade Name
Drug has a registered trademark- use of drug name is restricted by patent owner; proprietary name
Pharmacokinetics
Study of what the body does to a drug
(Absorption, Distribution, Metabolism, Excretion)
Toxicology
Science of adverse effects of drugs and other chemicals on living organisms
Pharmacognosy
Study of natural vs. synthetic drug sources
Pharmacoeconomics
Study of economic factors influencing the cost of drug therapy, cost-benefit analysis
Enteral Route
Drug absorbed into systemic circulation through the oral or gastric mucosa or small intestine
(EX: oral, sublingual, buccal, rectal)
Parenteral Route
EX: IV, IM, subcutaneous, intradermal, intraarterial, intrathecal, intraarticular
Topical Route
EX: Skin, eyes, ears, nose, mouth, lungs (inhalation), rectum (local effects), vagina
Bioavailability
The extent of drug absorption
First Past Effect
Large portion of the drug is broken down by the liver into inactive metabolites
Distribution
Transport of the drug by blood to site of action
(Albumin is the most common blood protein)
Metabolism
How the body breaks down the drug
Excretion
Elimination of the drug from the body
-renal
-biliary
-bowel
Half-Life
Time required for half of the given drug to be removed from the body
Steady State
Amount of drug removed = amount of drug absorbed
Peak Level
Highest blood level of drug
Trough Level
Lowest blood level of drug
Toxicity
Occurs if peak is too high
Pharmacotherapeutics
Clinical use of drugs to prevent and treat diseases
Tolerance
Decreased response to repeated drug dosages
Dependence
Physiologic or psychological need for a drug
Psychological Dependence
“Addiction”
-Obsessive desire for euphoric effects of drug
When can med errors occur?
-Prescribing
-Administering
-Dispensing
-Monitoring
Adverse reactions to medications:
-Pharmacologic reaction
-Hypersensitivity reaction (allergy)
-Idiosyncratic reaction: rare and unpredictable reactions
-Drug interaction
Drug therapy during pregnancy:
-Drugs cross the placenta via diffusion
-Factors impacting safety: drug properties, fetal gestational age, maternal factors
What trimester is drug transfer to the fetus most likely to occur in?
Third trimester
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
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
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
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
Adverse Drug Events
Composed of both medication errors and adverse drug responses (allergic reactions and idiosyncratic reactions)
Drugs commonly involved in med errors:
CNS drugs, anticoagulants, chemotherapy drugs
Near Miss
Event/situation did not produce patient injury but only due to chance
Types of Med Errors:
- No error, although circumstances/events occurred that could have led to one
- Med error that causes harm
- Med error that causes no harm
- Med error that results in death
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
Reporting Errors:
-Report to prescriber and nursing management
-Document error per policy
-Factual information only
When should medication reconciliation be done?
Admission, status change, patient transfer within/between facilities or providers, discharge
Tylenol affects the _______
Liver
Ibuprofen affects the __________
Kidneys
Over the Counter Drugs
Nonprescription drugs used for short-term treatment of common minor illnesses
Criteria for OTC Drugs:
- Indication for use: the consumer must be able to easily diagnose and monitor themselves for effectiveness; benefits must outweigh the risks
- Safety: drugs must have limited interaction with other drugs, low potential for abuse, and high therapeutic index
- Practicality: drugs must be easy to use and monitor
OTC potential hazards:
-May delay treatment of serious or fatal disorders
-May relieve symptoms but not the cause
-Toxicity
-Interactions with current prescriptions
-Abuse
Conditions commonly treated with herbal products:
-Anxiety
-Colds, cough
-Depression
-Headache
-Insomnia
-Ulcers
-PMS
-Arthritis
-Constipation
-Fever
-Infection
-Stress
-Weakness
Commonly used herbal/dietary supplements:
-Aloe
-Feverfew
-Gingko
-Goldenseal
-St. John’s Wort
-Valerian
-Kava
-Echinacea
-Garlic
-Ginseng
-Hawthorn
-Saw palmetto
-Cranberry
-Ginger root
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
Implementation for OTC/Herbal:
-Patient education!!!
-Ensure patients understand that manufacturers of herbs and supplements do not have to prove safety or effectiveness
Evaluation of OTC/Herbal:
-Patients need to carefully monitor themselves for therapeutic responses, effectiveness, and adverse effects
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
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
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
Parenteral Drugs
-NEVER recap a used needle
-Filter needles used to withdraw meds from an ampule but NEVER to stick a patient
Injections
-90 degree angle
-Z track method
Analgesics
Medications that relieve pain without causing loss of consciousness
Pain
Unpleasant sensory and emotional experience associated with actual or potential tissue damage
Pain Tolerance
Amount of pain someone can endure without interfering with normal function
Acute Pain
Sudden onset, usually subsides once treated
Chronic Pain
Persistent or recurring, lasting longer than 3-6 months
-Often difficult to treat
-Tolerance, physical dependence
Adjuvant Drugs
Assist primary drugs in relieving pain
-EX: NSAID, antidepressants, anticonvulsants, corticosteroids
Lowered Pain Threshold:
Anxiety, sleeplessness, tiredness, anger, fear, fright, depression, discomfort, pain, isolation
Raised Pain Threshold:
Diversion, empathy, rest, sympathy, medications
Agonists
-Bind to opioid pain receptor in brain, making pt less sensitive to pain receptors
-Cause an analgesic response
Agonists-Antagonists
-Binds to pain receptor, causing a weaker neurologic response than a full agonist
Antagonists
-Bind to a pain receptor and exert no response
-Reverse the effects of opioid analgesics on pain receptors
Opioid Analgesic Indications:
-Relief of moderate to severe pain
-Can also be used for cough suppression, treat diarrhea, or for anesthesia
Opioid Caution in patients with:
-Elevated intracranial pressure
-Breathing issues
-Morbid obesity
-Sleep apnea
-Pregnancy
Schedule 1
Drugs with no currently accepted medical use and a high potential for abuse
-EX: heroin, LSD, ecstacy
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
Schedule 3
Drugs with a moderate to low potential for physical and psychological dependence
-EX: tylenol with acodeine, ketamine, anabolic steroids, testosterone
Schedule 4
Drugs with a low potential for abuse and low risk for dependence
-EX: Xanax, Soma, Darvon, Darvocet, Valium, Ativan
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
Opioid Tolerance
-Common physiologic result of chronic opioid treatment
-A larger dose is required to maintain the same level of analgesia
Opioid Physical Dependence
Physiologic adaptation of the body to the presence of an opioid
Treatment of Opioid OD
Naloxone (Narcan) or Naltrexone (ReVia)
Naloxone Hydrochloride (Narcan)
-Pure opioid antagonist
-Drug of choice for complete or partial reversal of opioid-induced respiratory depression
Opioid Withdrawal Syndrome
Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea diaphoresis, N/V, cramps, diarrhea, confusion
Acetaminophen (Tylenol)
-NOT AN NSAID
-Analgesic and antipyretic effects (mild to moderate pain)
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
Tramadol Hydrochloride (Ultram)
-Moderate to severe pain
-Adverse effects similar to opioids
-Careful use in pts taking SSRIs, MAOIs, neuroleptics
Lidocaine Transdermal Patch
-Topical anesthetic
-Left in place no longer than 12 hours
Commonly Abused Substances:
-Heroine (most commonly)
-Codeine
-Hydrocodone
-Hydromorphone
-Morphine
-Oxycodone
Opioids
Synthetic versions of pain-relieving substances
Opioids used to treat dependence:
Methadone and Clonidine
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
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)
Stimulant Indications
-ADHD
-Narcolepsy
-Obesity treatment
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
Stimulant Toxicity
-Death due to poisoning or toxic levels:
1. convulsions
2. coma
3. cerebral hemorrhage
Stimulant Withdrawal
-Peak: 1-3 days
-Duration: 5-7 days
-Signs: social withdrawal, psychomotor retardation, hypersomnia, hyperphagia
Depressants
Drugs that relieve anxiety, irritability, tension when used as intended
-EX: Benzodiazepines, barbiturates, marijuana
Depressant adverse effects:
-Overexpression of therapeutic effects
-CNS: CNS depression
-GI upset
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
Benzodiazepines
-Depressant
-Withdrawal: seizures, delirium, anxiety, myclonus, myalgia, sleep disturbances
-Flumazenil reversal
Alcohol (Ethanol) Withdrawal
Increased BP, pulse, temp; insomnia; tremors; agitation
-Benzodiazepines can be used as a treatment
-ICU monitoring for severe withdrawal
Treatment for Alcoholism
-Disulfiram
-Naltrexone
-Acamprosate
-Counseling
Nicotine adverse effects:
Increased HR and BP, tremors, convulsions, increased tone and activity of bowel, respiratory stimulation
Nicotine Withdrawal
-Cigarette craving
-Irritability, restlessness, lowered HR and BP
-Treatment includes gum, patches, inhalers, nose spray
Psychotherapetic Drugs
Used in the treatment of emotional and mental disorders
Benzodiazepines
-Anxiolytic
-Largest and most commonly prescribed anxiolytic
-Used to treat alcohol withdrawal, insomnia, muscle spasms, adjuvant for depression
Benzodiazepine Overdose
-Dangerous when taken with other
depressants
-Treatment generally symptomatic and supportive
-Flumazenil may be used to reverse effects
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
Buspirone (Buspar) adverse effects
-Nonsedating and nonhabit forming anxiolytic
-paradoxical anxiety, blurred vision, headache, nausea
-DO NOT administer with MAOIs
Mood Stabilizing Drugs
-Used to treat bipolar
-Lithium (other drugs may also be used in combination)
Therapeutic range for lithium
0.6-1.2 mEq/L
Normal sodium range
135-145 mEq/La
Adverse effects of lithium
-cardiac dysrhythmias, drowsiness, slurred speech, seizures, ataxia, hypotension
Tricyclic Antidepressants Overdose
-Lethal
-CNS and CV mainly affected
-No specific “antidote”; manage symptoms and provide basic life support
Monoamine Oxidase Inhibitors (MAOI’s)
-Ingestion of foods or drinks with tyramine leads to hypertensive crisis
Second-Generation Antidepressants
-Indications: Depression, bipolar, eating disorders, obesity, OCD, panic disorders, social anxiety, PTSD, PMS
Serotonin Syndrome
Delirium, headache, agitation, tachycardia, sweating, myclonus, hyperreflexia, shivering, tremors
Severe: hyperthermia, seizures, renal failure, cardiac dysrhythmias, disseminated intravascular coagulation
