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2020 Pharmacology I > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

absorption

A

transmission of drug from site of administration to bloodstream

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2
Q

rate of absorption

A

how soon the medication takes effect

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3
Q

What determines how strong the effect of a medication will be?

A

amount absorbed

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4
Q

What affects the rate and amount of absorption?

A

route of administration

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5
Q

oral/enteral medication barriers to absorption

A
  • must pass through GI epithelial layer
  • swallowing ability
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6
Q

What factors influence absorption of oral and enteral medications?

A
  • solubility and stability of drug
  • GI pH
  • GI contents
  • gastric emptying time
  • form of medication (enteric coated, ER, etc.)
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7
Q

advantages of oral or enteral medications

A
  • safe
  • inexpensive
  • easy to administer and take
  • convenient
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8
Q

disadvantages of oral or enteral medications

A
  • highly variable absorption
  • first-pass effect
  • client must be conscious, willing, able
  • can’t give if pt has N&V
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9
Q

nursing implications of oral or enteral medications

A
  • do not give if pt:
    • can’t swallow
    • has no gag reflex
    • has N&V
    • isn’t conscious
  • pt in high Fowler’s unless contraindicated
  • unless otherwise instructed, give on empty stomach: 1 hr AC or 2 hrs PC
  • administer irritating meds with very small amount of food (NOT GRAPEJUICE or other interacting foods)
  • follow manufacturer instructions about crushing, cutting, etc.
  • liquid if pt can’t swallow pills
    • follow instructions on diluting
    • measure at base of meniscus
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10
Q

How do sublingual and buccal medications absorb?

A

rapidly through highly vascular membrane

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11
Q

barriers to absorption of sublingual and buccal medications

A

swallowing before dissolved–gastric pH can inactivate medication

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12
Q

nursing implications for administration of sublingual and buccal medications

A
  • instruct pt to keep med in place until completely dissolved
  • pt should not eat or drink while med is in place
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13
Q

How are suppositories absorbed and what type of effect can they have?

A
  • easily absorbed by intestinal or vaginal wall
  • local or systemic effects
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14
Q

barriers to absorption of suppositories

A

presence of stool or infection can limit absorption

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15
Q

pattern of absorption for inhaled medications

A

rapidly through alveolar capillary network

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16
Q

barriers to absorption of inhaled medications

A

inspiratory effort

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17
Q

pattern of absorption for topical and transdermal medications

A
  • slow
  • local or systemic effects
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18
Q

barriers to absorption of topical and transdermal medications

A

epidermal cells are closely packed

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19
Q

What factors affect absorption of topical and transdermal medications?

A
  • placement: fat vs muscle tissue
  • tissue quality
  • age: infants absorb more readily than older children, adults
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20
Q

What instructions do you give a patient using a transdermal medication?

A
  • don’t alter dosing schedule
  • wash skin with soap and water and dry
  • remove old patch before applying new
  • rotate sites to avoid skin irritation
  • use hairless area
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21
Q

what to remember when applying topical medications

A

ALWAYS use a glove to avoid absorbing pt’s medication

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22
Q

What factors affect the rate of absorption of IM meds?

A
  • solubility of med in water: more soluble = faster absorption
  • perfusion at injection site: higher = faster
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23
Q

barriers to absorption of IM medications

A

no significant barriers

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24
Q

pattern of absorption for IV meds

A
  • immediate and complete
  • directly into bloodstream
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25
Q

barriers to absorption for IV meds

A

none

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26
Q

distribution

A

transmission of drug from bloodstream to site of action

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27
Q

What factors affect distribution of a drug?

A
  • traffic
    • perfusion
    • physical barriers
    • speed
  • exits: ability to travel between capillary cells
  • binding
    • binder needed?
    • binder available?
    • competition for binder?
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28
Q

most common protein needed for plasma protein binding

A

albumin

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29
Q

What lab might we check for certain drugs to ensure distribution?

A

serum albumin

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30
Q

free drug

A
  • unbound med in bloodstream
  • can lead to toxicity
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31
Q

How would insufficient serum albumin affect the distribution of one or more protein-bidning drugs?

A
  • one drug: could lead directly to toxicity for lack of binding sites
  • two or more: drugs compete for binding sites, and somebody gets left out, leading to toxicity
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32
Q

barriers to distribution of medications

A
  • low albumin/malnourishment (for protein-binding drugs)
  • BBB and placental barrier: only fat-soluble meds can get through
  • BBB not fully developed at birth; can lead to neurotoxicity
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33
Q

metabolism of drugs

A
  • biotransformation
  • how the drug is broken down into less active or inactive form
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34
Q

What factors affect metabolism of drugs?

A
  • age
    • infants have limited metabolic capacity
    • older adults have lower hepatic metabolic capacity
    • less drug
  • increased enzymes
    • rapid metabolism
    • more drug
  • first-pass effect
    • oral meds pass through liver first and become inactive
    • more drug
  • similar meds
    • some metabolized through same pathway
    • pt could have toxicity of one
  • nutritional status
    • malnourishment affects production of enzymes, impairs metabolism
    • less drug
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35
Q

excretion

A

how drug is eliminated from body after metabolism

36
Q

How are drugs excreted?

A
  • primarily through kidneys
  • also through sweat glands, GI tract, etc.
    *
37
Q

What affects excretion of a drug?

A
  • kidney dysfunction
  • lower dose needed
38
Q

What lab values do we monitor for excretion?

A
  • BUN
  • creatinine
39
Q

agonist

A
  • drug that increases an action
  • bind or mimic receptor activity of endogenous compounds
40
Q

antagonist

A
  • blocks an action
  • blocks normal receptor activity regulated by endogenous compounds
41
Q

half-life

A

time it takes for drug in the body to be reduced by half

42
Q

short half-life

A
  • drug leaves body quickly (4-8 hrs)
  • more frequent dosing required
43
Q

long half-life

A
  • leaves body slowly
  • less frequent dosing
  • takes longer to reach plateau
44
Q

therapeutic range

A

serum level of drug in which it produces a therapeutic effect without causing toxicity

45
Q

plateau

A
  • med’s plasma concentration during a series of doses
  • should be inside therapeutic range
46
Q

minimum effective concentration

A

lowest serum level of drug that produces a therapeutic effect

47
Q

toxicity

A

serum level higher than the therapeutic range that negatively affects body function

48
Q

therapeutic index

A

safety margin between minimum effective concentration and toxicity

49
Q

low therapeutic index

A

requires close monitoring of plasma levels to ensure effectiveness and pt safety

50
Q

high therapeutic index

A
  • wide safety margin
  • no frequent monitoring
51
Q

tolerance

A
  • body’s decreased response to a drug over time
  • higher dose required to achieve therapeutic effect
52
Q

dependence

A
  • mental or physical state in which a person is compelled to take a drug continuously or periodically to experience its effects or avoid discomfort of its absence
  • tolerance may be present
  • can be dependent on multiple drugs
  • withdrawal symptoms possible
53
Q

process for instilling eye drops

A
  • use surgical aseptic technique
  • client upright or supine, head tilted slightly, looking at ceiling
  • dominant hand resting on forehead, holding dropper 1-2 cm over conjunctival sac
  • nondominant hand on cheekbone, pulling downward to expose conjunctival sac
  • drop med into center of sac
  • have client close eye gently
  • FOR SOME MEDS: apply gentle pressure to nasolacrimal duct for 30-60 sec to prevent systemic absorption
54
Q

process for instilling ear drops

A
  • use medical aseptic technique
  • client upright with head tilted or side-lying
  • straighten ear canal: pull auricle up and out for adults, down and back for children younger than 3 yrs
  • hold dropper 1 cm above canal, instill med
  • press gently on tragus
55
Q

process for instilling nose drops

A
  • use medical aseptic technique
  • pt supine with head slightly tilted and extended
  • support head with nondominant hand
  • hold dropper 1.5 cm above nostril with dominant hand and instill drops
  • instruct pt: breath through mouth, stay in position, avoid blowing nose for 5 min
56
Q

process for applying eye ointment

A
57
Q

administering any suppository

A
  • follow manufacturer instructions for storage
  • wear glove
  • remove wrapper and lubricate
58
Q

administering rectal suppository

A
  • pt in left lateral/Sim’s
  • insert just beyond anal sphincter
  • instruct pt: retain med for 30-60 min for stimulation of defecation or 60 min for systemic absorption
59
Q
  • pt supine with knees bent, feet flat and close to hips
  • generally inserted with applicator
  • pt instruct: remain in position for prescribed amount of time
A
60
Q

administration of MDI inhaled medication

A
  • shake
  • deep breath in and out
  • tilt head back a little
  • spray inhaler into mouth and take 3-5 second breath in
  • hold breath 10 seconds
  • slowly exhale through pursed lips
  • breathe normally
61
Q

administering MDI inhalation med with spacer

A
  • spacer lets more med get to lungs, less stuck in oropharynx
  • insert spacer at end of MDI
  • shake
  • use same as MDI without spacer
62
Q

administering DPI inhalation medication

A
  • DO NOT SHAKE
  • follow manufacturer instructions for prep
  • inhaled just like MDI
63
Q

administration of IM injection

A
  • appropriate for irritating meds, those in oil, aqueous suspensions
  • common sites
    • ventrogluteal
    • vastus lateralis
    • deltoid
  • needle size 18-27 (usually 22-25), 1-1/5 in
  • volume usually 1-3 mL; divide into separate injections if more
  • Z-Track
    • prevents med from leaking into SC tissue
    • often for meds that cause skin stains (e.g. iron)
64
Q

administering IV medications

A
  • for medications, fluids, blood products
  • IV catheters for short-term
  • infusion ports for long-term
    • trauma: 16-gauge
    • surgical: 18-gauge
    • children, older adults, medical, stable post-op: 22- to 24-gauge
  • adult peripheral preferred sites: arm or hand; ask client which side
  • neonate sites: head, lower legs, feet
  • after admin, immediately monitor for therapeutic and side/adverse effects
65
Q

intrathecal med administration

A

admin of IV opioid analgesia

infusion pump necessary

epidural: catheter

intrathecal is injection only

66
Q

advantages of IM and SC injection

A
  • good for meds poorly absorbed in GI tract
  • good for meds meant for slow absorption over extended period
67
Q

disadvantages of IM and SC injection

A
  • more expensive
  • inconvenient
  • painful
  • risk of tissue/nerve damage
  • risk of infection
68
Q

advantages of IV medication

A
  • rapid onset
  • control of amount given
  • allows for larger volumes
  • can dilute irritating meds
69
Q

disadvantages of IV administration

A
  • very expensive
  • requires skilled admin
  • higher risk of med error having drastic consequences
  • increased infection risk
70
Q

List the necessary components of a prescription.

A
  • pt full name
  • date and time of Rx
  • name of med
  • strength and dosage
  • route of admin
  • time and frequency: exact times or number of times per day
  • quantity to dispense and number of refills
  • signature of provider
71
Q

Describe the process of medication reconciliation.

A
  • compile list of current meds with dosages and frequency
  • compare list with new prescriptions
  • consult with provider to resolve discrepancies
  • occurs at admission, transfer, and discharge
72
Q

List the six (seven) rights of medication administration.

A
  • right pt
  • right drug
  • right dose
  • right time
  • right route
  • right documentation
  • (right of refusal)
73
Q

common medication errors

A
  • wrong med or IV fluid
  • incorrect dose or IV rate
  • wrong client, route, or time
  • admin of allergy-inducing med
  • omission of dose or admin of extra doses
  • incorrect DC of med or IV fluid
  • inaccurate prescribing
  • incorrect med: similarly named
74
Q

nursing responsibilities when administering drugs

A
  • know about meds administered
  • get info about diagnoses and conditions that affect admin
  • get necessary preadministration data (VS, baseline data) for evaluation and to assess appropriateness
  • omit or delay doses due to pt status
  • determine if Rx is complete
  • interpret Rx accurately
  • question provider if Rx is unclear or seems inappropriate
  • question abrupt and excessive med changes
75
Q

how to document med errors

A
  • document facts
  • fill out facility paperwork
  • don’t mention facility paperwork in chart
76
Q

how to prevent med errors

A
  • avoid distractions
  • prep meds for one pt at a time
  • check labels for name and concentration
  • measure doses accurately, double-check with colleague
  • check expiration date
  • question more than two tablets or one vial
  • follow Six Rights
  • do not give meds someone else prepped
  • teach pt about meds and to question changes
  • follow correct procedures for admin
  • follow all laws and regs for prep, admin of controlled substances
  • don’t leave meds at bedside
  • educate pt and anyone assisting (verbal and written)
77
Q

side effect

A
  • occurs when med is given at therapeutic level
  • usually doesn’t require DC
78
Q

adverse effect

A
  • undesired, inadvertent, unexpected, severe response to med
  • at therapeutic or higher levels
  • DC drug immediately
  • reported to FDA
79
Q

allergic reaction

A

reaction resulting from hypersensitivity to an antigen

80
Q

steps if you suspect an allergic reaction

A
  • stop the medication
  • notify the prescriber
  • initiate lifesaving measures if needed
81
Q

What do you do if a pt says they’re allergic to a med?

A

withhold the med

82
Q

PPI mechanism of action

A
  • blocks proton pump that exchanges H+ for potassium
  • suppresses gastric acid secretion
83
Q

PPI onset

A

up to 4 days

84
Q

PPI duration

A

24 hrs to 3 days

85
Q

PPI vs H2 blockers

A
  • PPIs have greater acid suppression
  • works on two stomach acid stimuli instead of just one
86
Q
A

2020 Pharmacology I (21 decks)

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