Exam 1 Study Guide Flashcards by Lindsay Cabalo

what are the 5 rights of medication administration?

right dose
right time
right patient
right route
right medication
right documentation?

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what is missing from this prescription?

Metoprolol 25mg BID for 30 days

does not include route

must say PO

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True or False:

medications are dosed specifically for the route they are given:
PO vs IV

True

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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)

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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

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what is pharmacology?

the study of medicine

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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

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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

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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

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proven, proper clinical trial that found most people benefit from something

EBP
evidence based practice

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4 ways medicine is a called?

generic name
trade/brand name
chemical name
pharmaceuticals

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what are factors that affect absorption?

formulation:
dose
route
molecular size
lipid
surface area drug acting upon
blood flow
GI

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filters blood coming into the brain

blood brain barrier (BBB)

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filters blood coming to the fetus from the rest of the body

fetal placental barrier (FPB)

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how the drug changes in the body, change in the formulation of the drug

biotransformation (metabolism)

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medication that only works after it is changed in the body

prodrug

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through the GI tract
PO mainly

enteral

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round the GI tract
IV, IM, SC, IO
always quicker than enteral

parenteral

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what routes have the quickest speed on onset?

IV > IO > IM > SC

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what may help a patient that gets nauseous after taking their medication

take medications with food

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what drug reverses an opioid overdose?

narcan/naloxone/evzio

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blocks the enzyme to allow ACH levels to increase

inhibitors

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way to manipulate things/levels without being able to directly impact them

enzyme induction

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how the body gets rid of a drug

kidney or liver disease will impact drug doses
mainly through kidney or liver

excretion

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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

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