Exam 1 Review of EBP for Med Admin.

Question 1

First Pass Effect

Answer 1

Oral Route:
Drug passes through gut and liver(P450 enzymes), before reaching systemic circulation.
Fraction of the drug lost during metabolism
(nitrates- large first pass effect)
Liver - metabolism.

Question 2

Drug-Drug interaction

Answer 2

Active ingredient in one drug interacts with another drug.
(ie patient on Birth control, seizure meds -will dec. effectiveness of BC)

Question 3

Half Life

Answer 3

The amount of time it takes for half of the drug to be eliminated.
Aspirin 1/2 life 2-3 hours. 325 mg. aspirin in 3 hours 160 mg. left. Longer half life, higher risk of drug interactions and drug toxicity because the drug is in the body longer.
(ie Warfarin, 1/2 life of 2-3 days.)

Question 4

Protein bound

Answer 4

Amount of drug attached to protein affects the distribution to the body. Not enough protein, less metabolism of the drug, more available drug. If the drug is attached to protein, it is not active. It needs to be released from the protein to be active.
Concern with patients that are malnourished, so decrease of drug, so no toxicity. Or two drugs that are highly protein bound, or 90% protein bound drug. One of the drugs will not be bound and then active in the body, and maybe become toxic.

Question 5

Adverse effect

Answer 5

UNDESIRABLE or UNPREDICTABLE effects
of medication that can result in harm.
ie Statins adverse effect, skeletal muscle disorder, rhabdomyolysis- muscle wasting (potential renal failure)

Question 6

Side effect

Answer 6

Secondary effect that occurs with drug therapy. Usually predictable. Anticipate them. ABX - Nausea. BP amlodipine, calcium channel blocker, swelling in the ankles is predictabe.

Question 7

What are the five rights +

Answer 7

Five rights:

Right patient (2 identifiers),

Right drug (scan barcode),

Right doseage (is the dose appropriate for that patient kidney/liver status, is there a weight calculation (heparin dose by body weight, kg) Is dose appropriate
time, (thyroid meds before meals ) 2x day every 12 hours

Right route -

Five rights+: Right:
ASSESSMENT (vital signs) BP meds
DOCUMENTATION,
EDUCATION- what, why and side effects
EVALUATION how has that med affected that patient, urine med - inc urine?
RIGHT TO REFUSE. if refused document, inform HCP
If patient cannot state it - consent for treatment in chart.

Question 8

Drug interactions - 4 ways

Answer 8

1. Other drugs
2. Food (grapefruit/amiodarone (antirhtymnia
3. Supplements - fish oil to lower cholesterol, inc risk of bleeding with anticoagulants
4. Medical condition - renal insufficiency may need lower doses

Question 9

What are 3 results of drug interactions

Answer 9

DECREASE or
INCREASE the action of the drug
ADVERSE EFFECTS.

Question 10

Pharmogenomics
Pharmacology + Genomics

Answer 10

study of indiv. genetic inheritance affects the body’s response to drugs. ie P450 enzymne

Question 11

3 Joint Commission National Safety Goals

Answer 11

1. LABEL the unlabeled (multidose vial, draw up syringe, label syringe). name, drug, dosage. IV bags patient name, room number, etc
2. Take extra care with patients who take meds to THIN BLOODS
   Inc risk of bleeding
   bloody nose, pitichia, blood in urine
3. RECONCILIATION- nurse review every meds with the patient, so make sure the patient is getting all the meds they should.
   admission, transfer from floor to floor, dr visit, every new interaction, or, ie removing foley with BPH.

Question 12

Reconciliation

Answer 12

Creating an accurate drug list

Question 13

Affects distribution of an active drug

Answer 13

Protein