Exam 1 Terms Flashcards
What is the precautions on a drug label?
steps taken before to prevent harm
relative contraindication
does the benefit outweigh the risk? vice versa
absolute contraindication
used together could cause life threatening effect
indications
what is the drug approved for?
therapeutic classification
what is being treated by the drug (i.e. antihypertensive)
pharmacologic classification
how the drug acts (i.e. beta blocker)
bioavailability
how long and what it has to do in order to be absorbed and put into the blood stream
reconstituions
creating a powder into a liquid for oral or parenteral admin
what do you reconstitute oral meds with?
water
what do you reconstitute parenteral meds with?
saline
sterile h20
follow label directions
what is a suspension?
powder mixed with medicated liquid
what do you do after reconstitution?
date and time of prep strength date and time of expiration store directions my initials
what pills should not be crushed?
extended release
slow release
time crucial pills
when should you crush a no crush pill
when the doc prescribes it
when should you use the z track method?
during IM injections
mixing meds rule of thumb
clear and clear you’re in the clear
clear and cloudy you’re getting noddy
sharps precautions
drop in box immediately after covering (after injection)
change at 2/3 full
don’t reach in
onset
how long does it take to start working?
peak
when it is working most
med order includes…
full name dob date and time of order name of med dosage route time and freq phys signature
what are the four different types of orders?
single/1time
STAT
standing
PRN
when should a STAT order be given?
within 30 min
when should a single order be given?
within 1 hour
when should a standing order be given?
until discontinued order has been given
ASA
aspirin
APAP
tylenol or acetaminaphin
10 traits of an ideal drug
effective inexpensive safe and no adverse effects reversible short duration with infrequent dose no interactions easy name convenient fast eliminated quickly
what are the schedules of a controlled substance?
1 thru 5
what is an example of a schedule 1 drug
heroine
what is an example of a schedule 2 drug
morphine and codeine, cocaine
what is an example of a schedule 3 drug
buprenorphine
what is an example of a schedule 4 drug
the “AM’s”
alazaopram
what is an example of a schedule 5 drug
cough medicines
what are the five rights
med dose person time route
what is the nurses role to administer meds?
transcribe, verify, dispense and deliver
why are drugs enteric coated?
to be dissolved and absorbed in small intestine because it might bother the stomach
what is pharmacokinetics?
how the drug moves through the body
how do drugs move across a membrane?
through active and passive transport
what is passive transport?
transportation from a high to low concentration
what kind of drugs use passive transport?
small, non ionized and lipid soluble
what kind of drugs use active transport?
large, ionized and water soluable
what is active transport?
transportation that uses a carrier protein
what are the two types of active transport?
active and facilitated
what is facilitated diffusion?
active transport without energy
what is drug absorption
the movement of the site of administration to the blood
what are the two things that drug absorption determine?
intensity and onset
factors that affect absorption of a drug
dissolution of the drug (dissolving) surface area blood circulation route bioavailablity
what is the order of fastest drugs?
sublingual subcutaenous IM PO topical
metabolism
enzymatic alteration of drug structure
where does most metabolism take place?
liver and sometimes kidneys
what is the purpose of metabolism?
to change drugs from lipid to water soluble for an easier way to excrete them
what are prodrugs?
a drug that needs metabolism to become therapeutic
first pass effect
inactivation of a drug before reaching the target organ
what type of drugs experience the first pass effect?
PO oral - swallowed
ones that reach the stomach and small intestine
what are the therapeutic consequences of metabolism?
accelerated renal excretion drug inactivation increased therapeutic action activation of pro drugs decrease toxicity increased toxicity
how does drug excretion work?
drugs are metabolized into small compounds to be removed from body
how are drugs excreted?
renal
pulmonary
glandular
fecal
what happens when there is renal failure?
pt may retain the meds
what should you do with patients with renal failure who are on meds?
lab values!!
make drug dosages lower
minimum effective dose
amount of drug required for effect
therapeutic range
range the drug has to release therapeutic action
what determines drug safety?
the closeness of toxic level range and therapeutic range
toxic concentration
level resulting in serious adverse effects
half life
length of time required for drug to reduce by 1/2 after admin
plateau
amount of drug absorbed equals amount excreted
how many half lives until usually eliminated?
4.5
loading dose
high amount given to prime blood stream to induce quick therapeutic response
efficacy
max response produced from a particular drug
potency
amount of drug needed to produce a therapeutic effect
rule of thumb for dosing and potency
less dose given for more potent drug
how do most drugs produce their effect?
binding onto receptors!
how is intermittent variability measured?
by frequency distribution curve
what is the median effective dose?
the amount required to produce 50% therapeutic effect in patients
what is the standard dose?
median effective dose
what is the nurses role in medication dosage accuracy?
monitor the patient and change as needed
look at lab values
vitals
assessment
what is the therapeutic index?
it describes drug safety
how to compute therapeutic index?
median lethal/median effective
what is the four different types of pharmacokinetic drug drug interactions
absorption
distribution
metabolism
excretion
what is the absorption drug drug interaction?
changing GI speed
what is the distribution drug drug interaction
ph change
receptor change
more unbound particles raise blood serum levels
what is the excretion drug drug interaction
increased and decrease excretion
what is the three pharmacodynamic drug drug interactions
additive
synergystic
antagonistic
what is the additive drug drug interaction
two drugs produce a combined summation effect
what is the synergistic drug drug interaction
enhanced response
antagonistic drug drug interaction
action being canceled
what are the drug and food interaction?
drug absorption
drug metabolism
drug toxicity
drug action
what is the idiosyncratic effect?
unusual or unexpected reactions unrelated to the drug often due to genetic variability
what is the iatrogenic effect?
causing another problem from treatment
what is the side effect of dependence?
the organ does not function the same after treatment stops
what are some geriatric considerations and drug effects (7)
absorption distribution metabolism and excretion decreased polypharmacy pathology ability to self manage meds lack of understanding meds
what do geriatrics need in regards to dosage?
a smaller dose
how does illness and disease affect nutrition? (4)
nutritional requirements may increase
intake may increase or decrease
absorption and metabolism of meds and nutrients
excretion (diarrhea, constipation, bloating)`
7 ways that drug affect nutrition
cause nausea and vomitting inhibit and stimulate appetite alter sense of smell or taste alter saliva secretion alter oral mucosa delay gastric emptying absorption and excretion of nutrients
what are our goals when providing nutritional support?
provide adequate nutrients
deliver in through route that is most useful
prevent disability - give them ability!
restore patient function
how much fat, carbs, fiber should we have in our diet
65 g fat
300 g carbs
25 g fiber
how do we prevent malnutrition?
CALORIES
MACRO
MICRO
what does the nurse do when assessing nutritional status?
Antropometric
Biochemical (lab val)
Clinical assessment (appearance?)
Dietary (what do they know?)
what happens to your hematocrit when you are dehydrated?
it increases
how much water should we be drinking in a 24 hour period?
2 to 2.5 liter
what is the normal range for albumin and what does it test for?
3.5 to 5.5 g/dL
does their diet include protein?
what is the normal range for pre albumin and what does it do?
15 to 36 mg/dL
shorter half life of albumin
better indicator for protein stat
what is the normal range for hematocrit and what does it mean?
men 38 to 50%
women 35 to 45%
looks at anemia.. low iron, b12, folate
what is the normal range for blood urea nitrogen and what does it mean?
7 to 20 mg/dL
end product of protein digestion and metabolism
tests kidneys
dehydration and a lot of protein can increase this
why do they use clear liquid diets
to give the bowels a rest
why do they soft low fiber diets
for dental problems and choking
why do they give mechanical soft diets
for chewing problems
why do they give high fiber diets
to create peristalsis and prevent constiparion
what are some ways to prevent aspiration?
oral care rest between meals small frequent meals no distractions time meds keep hydrated
what does a standard formula contain? for an enteric feeding
whole proteins that require normal digestion and absorption
what does a hydrolyzed formula contain? or an enteric feeding
partially or total digested proteins carbs and fats and usually for those who have problem digesting and absorbing
how to avoid re feeding syndrome
assess! low and slow
electrolyte imbalance? check.
what should you look for in residual for feedings?
more than 50 % don’t feed
or
2x the hourly continuous rate
what should be done first before feeding he patient?
raise head of bed!
polymeric feedings
pt absorbs whole nutrients
modular feedings
macronutrients, not nutritioanlly complete
elemental feedings
predigested nutrients
specialty feedings
target what is needed by the body for certain disorders
what is included in dumping syndrome?
diarrhea, vomitting and cramping and distension
how should a nurse manage dumping syndrome?
slow tube feedings
avoid bacterial growth
administer at room temp
assess new meds that may contribute
what is PPN
peripheal parenteral nutrition
temporary
isotonic solution
what is TPN
hypertonic solution
total parenteral nutrition
long term
central vein
what is a precaution for TPN?
blood glucose readings
