Exam 1 (CH 1-5 And 7) Flashcards
Intrinsic drugs
Hormones, enzymes, growth factors
Extrinsic drugs
Outside factors (I.e: drugs) that produce identical effects to intrinsic drugs
When do you give drugs to pregnant woman
When the benefit out weighs the risk
3 drug names
Chemical- chemical composition
generic- 1st letter not capitalized, given by US adopted names council, short name
Brand- “trade/proprietary “ 1st letter capitalized, given by drug company
What is PINCH and what does it stand for
High alert drugs
P- potassium I- insulin N- arcotics C- chemo products H- eparin (anticoags)
Herbal product warnings
May interfere with pts prescribed meds
Agonist
Enhances a drugs effects
Antagonists
Blocks a drugs effect
Pharmacodynamics
Drug on body
Pharmacokinetics
Body’s effect on drugs A- bsorption D- istribution M- metabolism E- xcretion
What constitutes a true allergic reaction?
The bodies release of antihistamine and inflammation
AKA: anaphylaxis
MEC
Minimum effective concentration
: minimum amount of a drug in blood to cause intended reaction
Steady state
Continuous balance of drug entry and exit
Half life
Time needed for 1/2 of the drug to be eliminated from the body
Paradoxical drugs
Drugs that cause opposite responses in children than adult
Vital organ to metabolism
Liver
Vital organ to elimination
Kidneys
Teratogenic drugs
Drugs that cause birth defects
Pregnancy categories
A, B, C, D, (X)
8 pt rights
Right patient Right drugs Right dose Right route Right time Right documentation Right diagnosis Right response
Who can prescribe meds
Physicians Practitioners Dentists Podiatrist PAs
Standing order
Prescription on a regular basis
Single dose order
Order given only once
STAT
Order given immediately 1 time
PRN order
As needed order but still has a schedule to give
What are nurses in reference to drug administration
The final defense for detecting and preventing drug errors
Best way to prevent drug errors
medication reconciliations
5 steps
How many times should a calculation be checked?
Twice once by you and by a co worker
Principles of drug administration
Know PT history, Allergies Past ADR LAB VALUES AND ANY changes in condition
Enteral route entrance
Though GI tract by oral, NG or rectal
What do you have to make sure when administering enterally
If pt can swallow
Enteral route rate of absorption and commonality
Slowest absorption because it has to pass GI system.
Most commonly given
When taking oral enteral drugs what do you do to the pt
Have them sit up right, test if they can swallow, have them finish the full glass of water
Feeding tube types
NG nasogastric
PEG percutaneous endoscopic gastrostomy
NG tube precautions
Take sure that there is no CO2 tidal wave because that means tube is in lung and not stomach, hold med
Rectal considerations
Absorption affected by diarrhea
Do SIMS pose
Lay for 20 minutes
Parentral routes
ID, SC, IV, IM
Dump ID info
Injected between layers of skin Sites: inner forearm Common uses: TB test Volume: 0.01- 0.1 Needle size: 3/8 in Gauge: 25 Angle: 15
Dump SQ info
Between skin and muscle Sites: upper arm, abdomen Common uses: insulin/ heparin Volume: 0.5 - 1.0 mL Needle size: 3/8 in Gauge: 25-27 Angle: 45 ( 90 in obese)
Dump IV info
In vein Fastest and most dangerous form of admin Rapid absorption Sites: vein Given by IVP ( intravenous push) IVPB ( intravenous piggyback)
Dump IM info
In muscle Sites: deltoid (arm), ventrogluteal, vastus lateralis (knee) Volume: 1-3 mL Needle size: 1-1.5 in Gauge: 20-22 Angle: 90
Percutaneous route absorbed by and ways to administer
Absorbed by mucous membranes
Topical/ transdermal - don’t shave skin, thin layer Buccal Sublingual Ear drops Nose drops Spray Suppositories( vaginal)
Temp conversion formula
9C=5F-160
Fahrenheit freezing and boiling / normal
Freezing: 32
Boiling: 212
Normal: 97-100
Celsius freezing, boiling, normal
Freezing: 0
Boiling: 100
Normal: 36.1- 37.8
T/F
Household measurements are just as accurate as metric ones
F
3 systems of measurement
Apothecary
Metric
Household
Kg—-g—-mg—-mcg
King gram married mrs gram and had micrograms
KHDBDCM__M
Kids hate songs because dogs chase mailman many many mailman
Are insulin syringes interchangeable
No, use insulin syringes specific for insulin
Is “u” acceptable for units?
No spell out units
Why give IV?
Meds needed STAT
steady admin required
Pt controlled pain meds
Flow rate and how to calculate
(mL/ Hr)
Divide total volume by total hours VTBI
Macro drip info
For who?
Drop size?
Drip factors?
Macro drip for healthy people
Drops are large for fast infusion
In 10,15,20 gtts/ mL
Micro drip
For who?
Drop size?
Drip factors?
For children and those at risk for fluid over load
Small drops
60 gtts/ mL
Drip rate ?
Gtts/ min
Controller mechanisms and obstruction details
Device that uses gravity to control flow
Will stop if obstructed to avoid infiltration
Infusion pump mechanism and obstruction detail
Commuter based machine that pushes based on fluid
Will beep if pressure is changed but won’t stop
What is needed for an IV ORDER
What fluid is being admin
Volume: how much is being admin
Duration: for how long
Rate: how fast to be infused
What’s is IV LOCK
Lock that doesn’t let anyone mess with pump
Define infiltration
The pulling or needle or catheter from vein that leaks fluid into tissues
Cool to touch
Swollen
Define fluid overload
The rapid absorption of fluid
Extravasation
The leaking of harmful substances into the skin causing tissue damage/ loss
No hard vein streak
What do you do if your infusion falls behind schedule
Nothing, don’t play catch up,
Will cause complications
Define Pain
Pain is whatever the pt says it is
How to monitor 5th vital( pain)
As the pt, get their accounts and value
What is pains greatest problem
Pain is so often under reported and under treated
How much pain the pt feels
Pain intensity
Pain threshold
Certain level of pain until pt starts to feel pain
Persons ability to “stand” pain intensity
Pain tolerance
What happens as your pain tolerance increases
You need more drug to create the same therapeutic effect
Who do you use the numerical pain scale for
A A&O X3, X4 adult, communicative
What pain scale would you use for a child and or those who are communicative
Wong baker” faces ”
Who do you use the FLACC scale for
F- ace L- egs A- ctivity C- rying C- onsoluability
Someone who is noncommunicative and infants
Pain scale is objective
Describe how pain is felt
Your brain perceives pain, it is not actually “felt”
How often do you check for pain
Every 4 hours or as often as you asses your pt
Who or what sends signals to your brain to let you know there is injury?
Nociceptors
Describe acute pain
Causes
Duration
S&S
Causes: immediate identifiable pain
Duration: short lasting
S&s: physiological changes (high BP)
Chronic pain
Causes
Duration
S&S
Causes: unidentifiable
Duration: pain that lasts longer than 6 months
S&S: doesn’t trigger physiological response
What is addiction
Psychological need for the “high” without pain
Name: physiological changes in autonomic NS when opioids are used long term when not needed for pain
Dependence
What happens when you suddenly stop opioids after dependence has been established
Withdrawl;
Vomiting
Nausea
Delirium
Schedule 1
No medical use
Heroin
Schedule 2
Very high potential for abuse And dependence with medical use
Fentanyl
Schedule 3
Hugh potential for abuse and dependence with medical use
Steroids
Schedule 4
Potential for abuse and small dependence with medical use
Benzos
Schedule 5
Lowest potential for abuse and dependence, medical use
Cough syrup with codeine
What characterized an analgesic
Any drug that controls pain
Opioid and non opioids
What makes an opioid an opioid?
If it consists of an addictive chemical
What do you check before administering opioids
O2 and resp rate
How do you get the best pain relief?
Taking pain meds on regular schedule v PRN the
Do opioids alter perception of pain
Yes
Side effects of opioids
Constipation, nausea and vomiting, drowsiness, dizziness, (sedation)
Opioid ADR
Respiratory depression addiction dependence tolerance withdrawal Reduced vision (falling in elders)
Fentanyl forms
Patch, spray, lollipop
Opioid PT teachings
Take with food and fluids
do not drive
change position slowly
if opioids are taken for true pain addiction is unlikely
Can you substitute narcotics
No! They act differently on different pain receptors
Opioid anecdote
Narcan ( naloxone)
Acetaminophen name
Max amount per day
Risks
Actions it does not do
Tylenol
3g per day
Liver and kidney damage
Does not have anti inflammatory affects
Acetaminophen anecdote
Acetylcysteine
NSAIDS types and uses
Aspirin ibuprofen(4x a day), naproxen (2x a day)
For inflammation
Adjuvant pain meds
Antidepressants not immediately
Anticonvulsants (neuropathic pain)
Pregabalin - lyrica
Gabapentin- Neurontin
Muscle relaxers
Must be for muscle spasmsCan opioids cross placental barrier?
Yes
Narcan needed for babies who’s moms abused of meds while pregnant and used opioids
How many times should an order be checked ?
3 times
- Look at order
- What Preparing medication
- is it accurate? - At bedside right before administering
2 pt identifiers
Name and DOB
8 drug errors
Omission error Wrong patient Wrong drug Wrong route Wrong rate Wrong dose age form Wrong time Prep error
