Exam 1 Flashcards

1
Q

Medication Error

A

Any preventable event that may cause or lead to inappropriate med use or patient harm

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2
Q

Rights of Drug Administration

A
  1. Right Drug
  2. Right Dose
  3. Right Time
  4. Right Route
  5. Right Patient
  6. Right Documentation
  7. Right to refuse
  8. Right Reason
  9. Right Reaction
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3
Q

Chemical Name

A

Describes the drug’s chemical composition and molecular structure

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4
Q

Generic Name

A

Given by the U.S. Adopted Names Council; nonproprietary name

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5
Q

Trade Name

A

Drug has a registered trademark- use of drug name is restricted by patent owner; proprietary name

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6
Q

Pharmacokinetics

A

Study of what the body does to a drug

(Absorption, Distribution, Metabolism, Excretion)

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7
Q

Toxicology

A

Science of adverse effects of drugs and other chemicals on living organisms

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8
Q

Pharmacognosy

A

Study of natural vs. synthetic drug sources

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9
Q

Pharmacoeconomics

A

Study of economic factors influencing the cost of drug therapy, cost-benefit analysis

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10
Q

Enteral Route

A

Drug absorbed into systemic circulation through the oral or gastric mucosa or small intestine

(EX: oral, sublingual, buccal, rectal)

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11
Q

Parenteral Route

A

EX: IV, IM, subcutaneous, intradermal, intraarterial, intrathecal, intraarticular

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12
Q

Topical Route

A

EX: Skin, eyes, ears, nose, mouth, lungs (inhalation), rectum (local effects), vagina

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13
Q

Bioavailability

A

The extent of drug absorption

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14
Q

First Past Effect

A

Large portion of the drug is broken down by the liver into inactive metabolites

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15
Q

Distribution

A

Transport of the drug by blood to site of action

(Albumin is the most common blood protein)

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16
Q

Metabolism

A

How the body breaks down the drug

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17
Q

Excretion

A

Elimination of the drug from the body
-renal
-biliary
-bowel

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18
Q

Half-Life

A

Time required for half of the given drug to be removed from the body

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19
Q

Steady State

A

Amount of drug removed = amount of drug absorbed

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20
Q

Peak Level

A

Highest blood level of drug

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21
Q

Trough Level

A

Lowest blood level of drug

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22
Q

Toxicity

A

Occurs if peak is too high

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23
Q

Pharmacotherapeutics

A

Clinical use of drugs to prevent and treat diseases

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24
Q

Tolerance

A

Decreased response to repeated drug dosages

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25
Q

Dependence

A

Physiologic or psychological need for a drug

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26
Q

Psychological Dependence

A

“Addiction”
-Obsessive desire for euphoric effects of drug

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27
Q

When can med errors occur?

A

-Prescribing
-Administering
-Dispensing
-Monitoring

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28
Q

Adverse reactions to medications:

A

-Pharmacologic reaction
-Hypersensitivity reaction (allergy)
-Idiosyncratic reaction: rare and unpredictable reactions
-Drug interaction

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29
Q

Drug therapy during pregnancy:

A

-Drugs cross the placenta via diffusion
-Factors impacting safety: drug properties, fetal gestational age, maternal factors

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30
Q

What trimester is drug transfer to the fetus most likely to occur in?

A

Third trimester

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31
Q

Neonatal and Pediatric Considerations

A

-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

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32
Q

Factors affecting pediatric drug doses:

A

-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

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32
Q

Factors affecting older adults and drugs:

A

-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

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33
Q

Older Adult Considerations:

A

-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

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34
Q

Adverse Drug Events

A

Composed of both medication errors and adverse drug responses (allergic reactions and idiosyncratic reactions)

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35
Q

Drugs commonly involved in med errors:

A

CNS drugs, anticoagulants, chemotherapy drugs

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36
Q

Near Miss

A

Event/situation did not produce patient injury but only due to chance

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37
Q

Types of Med Errors:

A
  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
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38
Q

Med error Prevention:

A

-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

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39
Q

Reporting Errors:

A

-Report to prescriber and nursing management
-Document error per policy
-Factual information only

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40
Q

When should medication reconciliation be done?

A

Admission, status change, patient transfer within/between facilities or providers, discharge

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41
Q

Tylenol affects the _______

A

Liver

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42
Q

Ibuprofen affects the __________

A

Kidneys

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43
Q

Over the Counter Drugs

A

Nonprescription drugs used for short-term treatment of common minor illnesses

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44
Q

Criteria for OTC Drugs:

A
  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
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45
Q

OTC potential hazards:

A

-May delay treatment of serious or fatal disorders
-May relieve symptoms but not the cause
-Toxicity
-Interactions with current prescriptions
-Abuse

46
Q

Conditions commonly treated with herbal products:

A

-Anxiety
-Colds, cough
-Depression
-Headache
-Insomnia
-Ulcers
-PMS
-Arthritis
-Constipation
-Fever
-Infection
-Stress
-Weakness

47
Q

Commonly used herbal/dietary supplements:

A

-Aloe
-Feverfew
-Gingko
-Goldenseal
-St. John’s Wort
-Valerian
-Kava
-Echinacea
-Garlic
-Ginseng
-Hawthorn
-Saw palmetto
-Cranberry
-Ginger root

48
Q

Assessment for OTC/Herbal:

A

-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
Q

Implementation for OTC/Herbal:

A

-Patient education!!!
-Ensure patients understand that manufacturers of herbs and supplements do not have to prove safety or effectiveness

50
Q

Evaluation of OTC/Herbal:

A

-Patients need to carefully monitor themselves for therapeutic responses, effectiveness, and adverse effects

51
Q

Administering Oral Drugs:

A

-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
Q

Administering Enteral Drugs with a G-Tube

A

-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
Q

Adminsitering Rectal Drugs:

A

-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
Q

Parenteral Drugs

A

-NEVER recap a used needle
-Filter needles used to withdraw meds from an ampule but NEVER to stick a patient

55
Q

Injections

A

-90 degree angle
-Z track method

56
Q

Analgesics

A

Medications that relieve pain without causing loss of consciousness

57
Q

Pain

A

Unpleasant sensory and emotional experience associated with actual or potential tissue damage

58
Q

Pain Tolerance

A

Amount of pain someone can endure without interfering with normal function

59
Q

Acute Pain

A

Sudden onset, usually subsides once treated

60
Q

Chronic Pain

A

Persistent or recurring, lasting longer than 3-6 months

-Often difficult to treat
-Tolerance, physical dependence

61
Q

Adjuvant Drugs

A

Assist primary drugs in relieving pain

-EX: NSAID, antidepressants, anticonvulsants, corticosteroids

62
Q

Lowered Pain Threshold:

A

Anxiety, sleeplessness, tiredness, anger, fear, fright, depression, discomfort, pain, isolation

63
Q

Raised Pain Threshold:

A

Diversion, empathy, rest, sympathy, medications

64
Q

Agonists

A

-Bind to opioid pain receptor in brain, making pt less sensitive to pain receptors
-Cause an analgesic response

65
Q

Agonists-Antagonists

A

-Binds to pain receptor, causing a weaker neurologic response than a full agonist

66
Q

Antagonists

A

-Bind to a pain receptor and exert no response
-Reverse the effects of opioid analgesics on pain receptors

67
Q

Opioid Analgesic Indications:

A

-Relief of moderate to severe pain
-Can also be used for cough suppression, treat diarrhea, or for anesthesia

68
Q

Opioid Caution in patients with:

A

-Elevated intracranial pressure
-Breathing issues
-Morbid obesity
-Sleep apnea
-Pregnancy

69
Q

Schedule 1

A

Drugs with no currently accepted medical use and a high potential for abuse

-EX: heroin, LSD, ecstacy

70
Q

Schedule 2

A

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
Q

Schedule 3

A

Drugs with a moderate to low potential for physical and psychological dependence

-EX: tylenol with acodeine, ketamine, anabolic steroids, testosterone

72
Q

Schedule 4

A

Drugs with a low potential for abuse and low risk for dependence

-EX: Xanax, Soma, Darvon, Darvocet, Valium, Ativan

73
Q

Schedule 5

A

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
Q

Opioid Tolerance

A

-Common physiologic result of chronic opioid treatment
-A larger dose is required to maintain the same level of analgesia

75
Q

Opioid Physical Dependence

A

Physiologic adaptation of the body to the presence of an opioid

76
Q

Treatment of Opioid OD

A

Naloxone (Narcan) or Naltrexone (ReVia)

77
Q

Naloxone Hydrochloride (Narcan)

A

-Pure opioid antagonist
-Drug of choice for complete or partial reversal of opioid-induced respiratory depression

78
Q

Opioid Withdrawal Syndrome

A

Anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea diaphoresis, N/V, cramps, diarrhea, confusion

79
Q

Acetaminophen (Tylenol)

A

-NOT AN NSAID
-Analgesic and antipyretic effects (mild to moderate pain)

80
Q

Tylenol Max Daily Limits:

A

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
Q

Tramadol Hydrochloride (Ultram)

A

-Moderate to severe pain
-Adverse effects similar to opioids
-Careful use in pts taking SSRIs, MAOIs, neuroleptics

82
Q

Lidocaine Transdermal Patch

A

-Topical anesthetic
-Left in place no longer than 12 hours

83
Q

Commonly Abused Substances:

A

-Heroine (most commonly)
-Codeine
-Hydrocodone
-Hydromorphone
-Morphine
-Oxycodone

84
Q

Opioids

A

Synthetic versions of pain-relieving substances

85
Q

Opioids used to treat dependence:

A

Methadone and Clonidine

86
Q

Opioid Withdrawl

A
  • 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
Q

Opioid Relapse Prevention

A

Naltrexone works by blocking opioid receptors so opioids do not produce euphoria (must be 1 week free from opioids to begin this therapy)

88
Q

Stimulant Indications

A

-ADHD
-Narcolepsy
-Obesity treatment

89
Q

Stimulant Adverse Effects:

A

-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
Q

Stimulant Toxicity

A

-Death due to poisoning or toxic levels:
1. convulsions
2. coma
3. cerebral hemorrhage

91
Q

Stimulant Withdrawal

A

-Peak: 1-3 days
-Duration: 5-7 days

-Signs: social withdrawal, psychomotor retardation, hypersomnia, hyperphagia

92
Q

Depressants

A

Drugs that relieve anxiety, irritability, tension when used as intended

-EX: Benzodiazepines, barbiturates, marijuana

93
Q

Depressant adverse effects:

A

-Overexpression of therapeutic effects
-CNS: CNS depression
-GI upset

94
Q

Depressant Withdrawal

A

-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
Q

Benzodiazepines

A

-Depressant
-Withdrawal: seizures, delirium, anxiety, myclonus, myalgia, sleep disturbances
-Flumazenil reversal

96
Q

Alcohol (Ethanol) Withdrawal

A

Increased BP, pulse, temp; insomnia; tremors; agitation

-Benzodiazepines can be used as a treatment
-ICU monitoring for severe withdrawal

97
Q

Treatment for Alcoholism

A

-Disulfiram
-Naltrexone
-Acamprosate
-Counseling

98
Q

Nicotine adverse effects:

A

Increased HR and BP, tremors, convulsions, increased tone and activity of bowel, respiratory stimulation

99
Q

Nicotine Withdrawal

A

-Cigarette craving
-Irritability, restlessness, lowered HR and BP

-Treatment includes gum, patches, inhalers, nose spray

100
Q

Psychotherapetic Drugs

A

Used in the treatment of emotional and mental disorders

101
Q

Benzodiazepines

A

-Anxiolytic
-Largest and most commonly prescribed anxiolytic
-Used to treat alcohol withdrawal, insomnia, muscle spasms, adjuvant for depression

102
Q

Benzodiazepine Overdose

A

-Dangerous when taken with other
depressants
-Treatment generally symptomatic and supportive
-Flumazenil may be used to reverse effects

103
Q

Benzodiazepine Interactions

A

-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
Q

Buspirone (Buspar) adverse effects

A

-Nonsedating and nonhabit forming anxiolytic
-paradoxical anxiety, blurred vision, headache, nausea
-DO NOT administer with MAOIs

105
Q

Mood Stabilizing Drugs

A

-Used to treat bipolar
-Lithium (other drugs may also be used in combination)

106
Q

Therapeutic range for lithium

A

0.6-1.2 mEq/L

107
Q

Normal sodium range

A

135-145 mEq/La

108
Q

Adverse effects of lithium

A

-cardiac dysrhythmias, drowsiness, slurred speech, seizures, ataxia, hypotension

109
Q

Tricyclic Antidepressants Overdose

A

-Lethal
-CNS and CV mainly affected
-No specific “antidote”; manage symptoms and provide basic life support

110
Q

Monoamine Oxidase Inhibitors (MAOI’s)

A

-Ingestion of foods or drinks with tyramine leads to hypertensive crisis

111
Q

Second-Generation Antidepressants

A

-Indications: Depression, bipolar, eating disorders, obesity, OCD, panic disorders, social anxiety, PTSD, PMS

112
Q

Serotonin Syndrome

A

Delirium, headache, agitation, tachycardia, sweating, myclonus, hyperreflexia, shivering, tremors

Severe: hyperthermia, seizures, renal failure, cardiac dysrhythmias, disseminated intravascular coagulation

113
Q
A