Exam 1 Study Guide Flashcards
what are the 5 rights of medication administration?
right dose
right time
right patient
right route
right medication
right documentation?
what is missing from this prescription?
Metoprolol 25mg BID for 30 days
does not include route
must say PO
True or False:
medications are dosed specifically for the route they are given:
PO vs IV
True
what do these abbreviations mean:
PR
SC
IO
SL
ODT
Buccal
IN
PR = per rectal
SC = subcutaneous (into the fat)
IO = intraosseous (into the bone - everything that is given IV can be given IO, they are identical routes, IO cath must be removed w/in 24 hours)
SL = sublingual (under the tongue. i.e. nitro for chest pain)
ODT = orally disintegrating tablet (dissolves on tongue in less than a minute i.e. Zofran)
Buccal = cheek (absorbed into MM)
IN = intranasal (i.e. versed and narcan)
what is the difference between therapeutics and pharmacotherapeutics?
therapeutics:
- what we do to make you feel better
i.e. use ice, exercise more, massage
pharmacotherapeutics:
- medication involved to treat things
what is pharmacology?
the study of medicine
naturally occurring vs. synthetic substances
naturally occurring:
- something that is naturally in the body
i.e. morphine - body can release morphine
synthetic:
- made in a lab
i.e. fentanyl similar to morphine but made in a lab
what is CAMs?
complementary and alternative medications (CAM)
- any substance people take for therapeutic effect that has not been proven to have that effect
i.e. st. johns wort, garlic, omega 3, cranberry juice for UTI prevention
- advertised as FDA cleared (not approved): they say it probably won’t cause harm but distinguished from medications because they have been found through clinical trials to have the intended effect
story or because thats the way we’ve always done it
i.e. crushed something and gave it to gma, it worked, now give it to everyone else
anecdotal
proven, proper clinical trial that found most people benefit from something
EBP
evidence based practice
4 ways medicine is a called?
generic name
trade/brand name
chemical name
pharmaceuticals
what are factors that affect absorption?
formulation:
dose
route
molecular size
lipid
surface area drug acting upon
blood flow
GI
filters blood coming into the brain
blood brain barrier (BBB)
filters blood coming to the fetus from the rest of the body
fetal placental barrier (FPB)
how the drug changes in the body, change in the formulation of the drug
biotransformation (metabolism)
medication that only works after it is changed in the body
prodrug
through the GI tract
PO mainly
enteral
round the GI tract
IV, IM, SC, IO
always quicker than enteral
parenteral
what routes have the quickest speed on onset?
IV > IO > IM > SC
what may help a patient that gets nauseous after taking their medication
take medications with food
what drug reverses an opioid overdose?
narcan/naloxone/evzio
blocks the enzyme to allow ACH levels to increase
inhibitors
way to manipulate things/levels without being able to directly impact them
enzyme induction
how the body gets rid of a drug
kidney or liver disease will impact drug doses
mainly through kidney or liver
excretion
when the concentration of X gets up to Y in the blood then drug starts to work
minimum effective concentration
level in the blood that will now cause damage
toxic concentration
range between toxi concentration and minimum effective concentration
therapeutic range
dose at which more than 50% of all patients will have the desired effect
median effective dose
dose at which more than 50% of all patients will die
median lethal dose
difference between median effective dose and median lethal dose
therapeutic index
amount of a drug you can increase and continue to get an increased response
graded dose response
plugs into receptor and lights it up - increases effect
agonist
binds to receptor and causes the high
heroine opioid agonists
blocks the receptor and prevents anything binding or any effect
antagonist
blocks the opioid receptor and prevents anything from binding
narcan opioid antagonists
drug inidcated for one thing but can be effective for another, just hasnt been clinically proven yet/FDA approved for
off-label drug
off label:
can be used to treat ED
nitroglycerine - chest pain
off label:
SSRI used for sleeping/insomnia
seroquel
off label:
seizure med used for weight loss
topomax
what tablets cannot be chewed, crushed, or broken?
coated capsules or tablets
cure the disease and fix the problem
antibiotics
a side effect that requires intervention versus one that is expected/minor
priority side effects
what may help a patient that gets nauseous after taking their medication?
take medication with food
a drug that is teratogenic cannot be used in what patients?
pregnant patients
drug that damages or kills a fetus
cannot be given to women of childbearing age that are not on birth control
must have negative pregnancy test and a form of birth control
teratogen/teratogenic
what medication is always safe in pregnancy?
none, must contact the provider
should a patient stop their medications if they become pregnant?
no, notify the provider
many medications required titration
what are important points about giving medication to infants?
use a syringe - put in cheek
give a small amount at a time and make sure they dont spit it out
important points about give medication to toddlers?
giving education to parents
do not tell them it is candy to get them to take it
do not crush into healthy snacks
important points when treating teenagers?
questions about pregnancy, contraception, or STI
may abuse medications
what age group is most likely to have polypharmacy (multiple drugs)?
geriatric
what is neuropathic pain?
nerve pain
five examples of non-pharmacological pain management interventions
hot/cold application
accupuncture
guied imagery
distraction
movement
conversation/talking
massage
hypnosis
exercise
important points about opioid use and addiction?
you are not likely to get addicted from an appropriate short term opioid use
will not avoid prescribing opioids to someone who needs them based solely on risk of addiction
five examples of opioids
fentanyl
hydromorphone
morphine
tramadol
codeine
vicodin
GI bleeds are a priority side effect with what medication?
NSAIDs
what are s/s of GI bleeding?
blood in stool
fatigue
weakness
hypotension
name two conditions that opioids are used to treat besides pain?
cough: codeine
diarrhea: loperamide/imodium
what is the highest priority effect of opioids?
Respiratory depression
low RR <12
what is the most common side effect of opioids?
constipation
what are considered the weaker opioids?
codeine and tramadol/ultram
less likely to cause addiction and less effective against pain
which opioids are considered stronger opioids?
fentanyl
hydromorphone/dilaudid
meperoline/demerol
morphine
morphine is natural
fentanyl is synthetic
what are combination drugs and their benefits?
combination of an opioid and non-opioid
goal is to give less opioid to control pain
vicodin: acetaminophen and hyrocodone
percocet: acetaminophen and oxycodone
what is the opioid mechanism of action?
bind to opioid receptor sites to elicit response
what is PCA?
patient controlled analgesia
PCA pump - usually in hospice or cancer patient who is discharged
what is the advantage to using a mixed agonist antagonist?
lower change for addiction and easier to discontinue use
methadone - used in narcotic rehab: prevents physical withdrawal without high
name four classes of non-opioid analgesics
aspirin
traditional NSAID: COX-1/COX-2 inhibitor
COX-2 inhibitors
centrally acting non-opioid analgesics
what are the 3 uses of aspirin/ASA?
antipieuretics: fever reducer
analgesic: pain
antiplatelet aggregator: prevents blood clots/blood thinner
not considered an anti-inflammatory
aspirin/ASA
what is first line treatment for migraines?
Triptans
MOA: vasoconstriction of cranial arteries
indication: first line migraines
side effect: drowsiness
Sumatriptan
what are other drug classes used for migraines?
ergot: alkaloids
antiepileptics, beta blockers, calcium channel blockers, and tricyclic antidepressants
what is the key inflammation chemical mediator?
histamine: causes swelling
what are two overall classes of drugs that treat inflammation?
steroids and NSAIDs
what is NSAID?
nonsteroidal anti-inflammatory drugs
what is MOA
inhibiting/antagonists for COX/cyclooxygenase receptors (COX-1 and COX-2)
what is indication
anti-inflammatory
gout, RA, headaches, everyday pain
what is BB warning
GI bleeds/peptic ulcers (blood in stool, fatigue, weakness, hypotension)
Naproxen
Ibuprofen
OTC
Ketorolac
Meloxicam
Indomethacin
Celecoxib
Rx
what are NSAIDs used for?
anti-inflammatory:
gout/RA
pain
headaches
everyday pain
what would be an appropriate escalation plan for the treatment of pain?
nonpharmacological
pharmacological
nonopioid analgesics
opioid analgesics
