Exam #2 Flashcards
What are some of the reasons someone may be prescribed Hydrocodone?
They need a decrease in the severity of their pain or suppression of the cough reflex.
What is the trade name of Hydrocodone?
Norco/Vicodin
What classification is Hydrocodone associated with?
Opioid Analgesics
What are the usual routes of Hydrocodone?
By mouth (PO) or By mouth ER (Extended Release)
What is some of the patient teaching for Hydrocodone?
Take this medicine as directed. Potential abuse to this medication. Teach how to recognize respiratory depression. May cause drowsiness or dizziness. Change positions slowly. Notify of current medications. Advise important oral hygiene. Notify if pregnant.
Why would you not allow someone to take Hydrocodone?
If the client is susceptible to drug abuse or vitals are abnormal.
What are some potential side effects of Hydrocodone?
Respiratory Depression
Blurred Vision, Diplopia, Miosis
Urinary Retention
Confusion, dizziness, sedation, nausea, constipation, dyspepsia.
What is the antidote for Hydrocodone?
Naloxone
What drugs does Hydrocodone have interactions with?
Trazodone, alcohol, tramadol, nalbuphine, antipsychotics, mirtazapine, etc.
What do you evaluate or look for after someone has taken Hydrocodone?
Look for suppression of nonproductive cough, and also see if this medication has decreased their severity in pain.
What do you assess before administering Hydrocodone?
Assess vitals, bowel function. Assess the type, location, and severity of pain. Assess for opioid addiction or abuse in the past.
What are some lab value alterations that may be caused by Hydrocodone?
A rise in plasma amylase and limase concentrations may occur.
What is the trade name for Hydrochlorothiazide?
HCTZ/Microzide
What classification is Hydrochlorothiazide associated with?
Antihypertensives/Diuretic
What are the usual routes Hydrochlorothiazide is given?
By mouth (PO)
What are some of the reasons someone may be given Hydrochlorothiazide?
May help with lowering BP in hypertensive patients and diuresis with mobilization of edema.
Promotes excretion of chloride, potassium, hydrogen, magnesium, phosphate, calcium, and bicarbonate.
Increase excretion of sodium and water by inhibiting sodium reabsorption in the distal tube.
What are some potential side effects of Hydrochlorothiazide?
Skin Cancer, Steven Johnson Syndrome
Pancreatitis
Dehydration, anorexia, cramping, hepatitis.
Dizziness, drowsiness, lethargy, weakness, nausea, vomiting.
What is some of the patient teaching for Hydrochlorothiazide?
Take medicine same time everyday. Monitor weight biweekly. Change positions slowly. Use sunscreen. Undergo skin cancer screenings. Need Follow-up exams. Discuss dietary potassium requirements. Notify of current medications.
What are some of the lab value alterations that may be caused by Hydrochlorothiazide?
Monitor electrolytes, potassium, blood glucose, BUN, serum creatinine, and uric acid.
What are the drugs Hydrochlorothiazide has interactions with?
Antihypertensives, alcohol, digoxin, cholestyramine, colestipol, piperacillin, tazobactam.
What do you assess before administering Hydrochlorothiazide?
Monitor vitals and weight. Assess for skin rash and for allergies.
Why would you not give someone Hydrochlorothiazide?
If rash occurs!
What do you evaluate or look for after administering Hydrochlorothiazide?
Look for a decrease in BP and decrease in edema.
What is the trade name for Heparin?
Hepalean
What classification is Heparin associated with?
Anticoagulants
What are the usual routes Heparin is given?
Sub Q, IV
What are the reasons you would prescribe Heparin?
To prevent thrombus formation (clots), extension of existing thrombi.
What is the antidote for Heparin?
Protamine sulfate
What are the potential side effects of Heparin?
Alopecia, rash, urticaria.
Osteoporosis
Fever, hypersensitivity reactions
Bleeding, Heparin-Induced Thrombocytopenia (HIT)
What is some of the patient teaching for Heparin?
Report any symptoms of unusual bleeding or bruising. No meds with aspirin. Stay away from things that cause bleeding such as razors, knifes, etc. Report pregnancy and current medications.
What are some of the lab value alterations that may be caused by Heparin?
Monitor activated partial thromboplastin time. Monitor platelet count.
What drugs may have interactions with Heparin?
Streptokinase, digoxin, nicotine, warfarin, antihistamines, aspirin, dextran, cefotetan, thrombolytics, clopidogrel, tirofiban.
What do you assess before administering Heparin?
Asses for signs of bleeding and hemorrhage. Monitor for hypersensitivity reactions.
Why would you not allow someone to take Heparin?
If signs of bleeding, bruising, or hemorrhage occur.
What do you evaluate or look for after administering Heparin?
Patency of IV catheters.
Prevention of deep vein thrombosis and pulmonary emboli.
Prolonged partial thromboplastin time.
What is the trade name for Haloperidol?
Haldol
What classification is Haloperidol associated with?
Antipsychotics
What are the usual routes Haloperidol are given?
By mouth (PO), IM, IM decanoate
What are the reasons someone may be given Haloperidol?
Diminished signs and symptoms of psychoses.
Improved behavior in children with Tourettes syndrome or other behavioral problems.
What are some potential side effects of Haloperidol?
Seizures, confusion, drowsiness, restlessness, tardive dyskinea.
Neuroleptic Malignant Syndrome.
Agranulocytosis
Torsades de Pointes, hypotension, tachycardia.
What is some of the patient teaching for Haloperidol?
Take medicine as directed. Inform possibility of extrapyramidal symptoms. Change positions slowly. May cause drowsiness. Notify of current medications. No alcohol. Use sunscreen. Use frequent mouth rinses. Notify if pregnant. Need follow-up exams.
What drugs can Haloperidol possible have interactions with?
Antihypertensives, alcohol, antihistamines, antidepressants, atropine, opioid analgesics, sedatives/hypnotics, etc.
What needs to be assessed before administration of Haloperidol?
Mental status, assess positive symptoms of schizophrenia. Assess weight and vital signs. Monitor intake and output. Assess for fall risks.
Why would you not administer Haloperidol to someone?
If mental health is not improving.
What do you evaluate or look for after administering Haloperidol?
Decrease in hallucinations, insomnia, agitation, hostility, and delusions.
Decreased Tics.
Improved behavior in children with severe behavior problems.
What is the trade name for Gabapentin?
Neurotin
What classification is Gabapentin associated with?
Anticonvulsant
What are the usual routes Gabapentin is given?
PO-IR (Immediate Release), PO-SR (Sustained Release)
What are the reasons someone would be given Gabapentin?
To decrease incidence of seizures.
Decrease postherpeutic pain.
Decrease leg restlessness.
What are some of the potential side effects of Gabapentin?
Steven-Johnson Syndrome
Rhabdomyolysis
Hypersensitivity Reactions
Suicidal Thoughts
What is some of the patient teaching for Gabapentin?
Take medicine as directed. Do not take this med within 2 hrs of antacid. May cause dizziness or drowsiness. Notify if pregnant and any current medications. Notify risk of respiratory depression. Notify risk of suicidal thoughts.
What drugs may have interactions with Gabapentin?
Antacids, antihistamines, alcohol, sedative/hypnotics, hydrocodone.
What needs to be assessed before administering Gabapentin?
Monitor behavior changes. Seizures, pain, migraines. Look for a good change.
Why would you not administer Gabapentin?
If having suicidal thoughts!
What needs to be evaluated or looked at after administering Gabapentin?
Desired frequency or cessation of seizures. Decreased pain. Increased mood stability. Decreased frequency of headaches. Decreased effects of restless leg syndrome.
What is the trade name for Fentanyl?
Duragesic
What classification is Fentanyl associated with?
Opioid Analgesics
What are the usual routes Fentanyl is given?
Transdermal
What are the reasons you would administer Fentanyl?
To decrease the severity of chronic pain.
What is the antidote for Fentanyl?
Naloxone
What food interacts with Fentanyl?
Grapefruit Juice
What are some of the potential side effects of Fentanyl?
Bradycardia, hypotension.
Anorexia, constipation, dry mouth, vomiting, nausea.
Apnea, Respiratory Depression.
Confusion, sedation, weakness, sweating.
What is some of the patient teaching for Fentanyl?
Instruct how often to take med. Instruct correct application and disposal of patch. Advise about addiction.
What lab value alterations can be caused by Fentanyl?
May increase plasma amylase and lipase levels.
What drugs may interact with Fentanyl?
Antidepressants, other analgesics.
What needs to be assessed before administration of Fentanyl?
Find out about pain, vital signs, bowel function, risk of addictions or abuse. Notify if pregnant or breastfeeding. Watch for symptoms of respiratory depression.
Why would you not administer Fentanyl?
Breathing problems, drug abuse past, constipation.
What needs to be evaluated or looked at after the administration of Fentanyl?
Decreased in severity of pain.
What is the trade name for Enoxaparin?
Lovenox
What classification is Enoxaparin associated with?
Anticoagulant
What are the usual routes Enoxaparin is given?
Subcutaneous
What are the reasons someone would be prescribed Enoxaparin?
Prevention of blood clots.
What are the reasons someone would be prescribed Enoxaparin?
Prevention of Blood clots.
What is the antidote for Enoxaparin?
Protamine Sulfate 1mg for each mg of enoxaparin should be administered by slow IV injection.
What are some of the potential side effects of Enoxaparin?
Bleeding, anemia.
Dizziness, headache, insomnia.
Nausea, vomiting, fever.
Edema, rash
What is some of the patient teaching for Enoxaparin?
Teach proper injection care, and disposal of equipment. Report unusual bleeding, bruising, dizziness, itching, rash, fever, swelling, or difficulty breathing. Do not take aspirin, naproxen, ibuprofen. Notify before dental or medical treatment or surgery. Notify if pregnant or breastfeeding.
What drugs may have interactions with Enoxaparin?
Warfarin, aspirin, dipyridamole, some penicillins, clopidogrel, dextran, tirofiban, abciximab, eptifibatide, other anticoagulants.
What needs to be assessed before administration of Enoxaparin?
Watch for increased clots, and inflammation of injection site.
Why would someone not be administered Enoxaparin?
Unusual bleeding or bruising occurs.
What needs to be evaluated or looked at after administering Enoxaparin?
Prevention of blood clots and resolution of acute deep vein thrombosis.
What is the trade name for Docusate Sodium?
Colace
What classification is Docusate Sodium associated with?
Laxative
What are the usual routes Docusate Sodium is given?
By mouth (PO) and Rectal
What are some of the reasons someone may be prescribed Docusate Sodium?
Needs stool softened to allow regular bowel movements.
What are some potential side effects of Docusate Sodium?
Throat Irritation
Mild cramps, diarrhea
Rashes
What is some of the patient teaching for Docusate Sodium?
Only use short-term! Encourage bulk diet, fluid intake increase, increase in mobility. Do not use when having abdominal pain, nausea, vomiting, or fever. Advise to not take other laxatives 2 hr within Docusate Sodium.
What drugs may interact with Docusate Sodium?
None!
What needs to be assessed before administering Docusate Sodium?
Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function. Assess color, consistency, and amount of stool produced.
Why would someone not be administered Docusate Sodium?
If the client is having abdominal pain, nausea, vomiting, fever.
What needs to be evaluated or looked at after administration of Docusate Sodium?
Hopefully will see relief and client will have a soft, formed bowel movement usually within 24-48 hours.
What is the trade name for Hydromorphone?
Dilaudid
What classification is Hydromorphone associated with?
Opioid Analgesics
What are the usual routes that Hydromorphone are given?
PO-IR (Immediate Release), PO-ER (Extended Release), Subcut, IM, IV, Rectal
What is the antidote for Hydromorphone?
Naloxone
What are some of the potential side effects of Hydromorphone?
Respiratory Depression
Adrenal Insufficiency
Hypotension, Bradycardia
Confusion, sedation, dizziness, dry mouth, nausea, vomiting
What is some of the patient teaching for Hydromorphone?
Advise about potential abuse. Learn to recognize respiratory depression. May cause drowsiness, dizziness. Change positions slowly. Avoid alcohol. Notify about current medications.
What are the lab value alterations that may be caused by Hydromorphone?
May rise plasma amylase and lipase concentrations.
What drugs may interact with Hydromorphone?
MAO, antipsychotics, alcohol, tramadol, trazodone, linezolid, mirtazapine, etc.
What needs to be assessed before the administration of Hydromorphone?
Assess vitals, bowel function. Assess the type, location and intensity of pain. Assess for abuse or addiction signs and symptoms.
Why would someone not be able to take Hydromorphone?
If abuse or addiction occurs or vitals are abnormal.
What needs to be evaluated or looked at after the administration of Hydromorphone?
Decrease in severity of pain and suppression of cough.
What is the trade name for Furosemide?
Lasix
What classification is Furosemide associated with?
Diuretic/Water Pill
What are the usual routes that Furosemide is given?
PO, IM, IV
What are some of the potential side effects of Furosemide?
Steven-Johnson Syndrome, Toxic Epidermal Necrolysis, Erythema Multiforme
Aplastic Anemia, Agranulocytosis
Dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia
Hyponatremia, hypovolemia, metabolic alkalosis.
What are some of the reasons someone would be administered Furosemide?
Hypertension
Edema due to heart failure, hepatic impairment, or renal disease
What needs to be evaluated or looked at after the administration of Furosemide?
Decrease in Edema.
Decrease in BP.
Increase in urinary output.
What needs to be assessed before administration of Furosemide?
Assess fluid status and monitor weight daily. Monitor BP. Assess fall risks. Assess for allergy to sulfonamides. Assess for tinnitus and hearing loss. Assess for skin rash.
Why would someone not be administered Furosemide?
If skin rash occurs, or if allergy appears.
What is some of the patient teaching for Furosemide?
Advise to take medicine as directed. Change positions slowly. Advise to ask about potassium since it could possibly drop potassium levels. If gained more than 3 lbs in 1 day inform health care professional. Notify of current medications. Use sunscreen. Notify health care professionals immediately if rash or any other symptoms occur. Advise diabetic patients to monitor glucose levels as levels may rise. Notify is pregnant. Needs follow-up appointments.
What drugs may have interactions with Furosemide?
Antihypertensives, alcohol, diuretics, corticosteroids, digoxin, lithium, cisplatin, etc.
A nurse receives a prescription for phenobarbital for a client who has a seizure disorder. The medication has a long half-life of 4 days. How many times per day should the nurse expect to administer the medication?
A. One
B. Two
C. Three
D. Four
A. One
Medications with long half-lives remain at their therapeutic levels between doses for long periods of time. Expect to administer this medication once a day.
A nurse is reviewing medication metabolism. Which of the following factors should the nurse determine as a reason to administer lower medication dosages? (Select all that Apply)
A. Increased renal excretion
B. Increased medication-metabolizing enzymes
C. Liver failure
D. Peripheral vascular disease
E. Concurrent use of medication the same pathway metabolizes
C. Liver failure
Liver failure decreases metabolism and thus increases the concentration of a medication. This requires decreasing the dosage.
E. Concurrent use of medication the same pathway metabolizes
When the same pathway metabolizes two medications, they compete for metabolism, thereby increasing the concentration of one or both medications. This requires decreasing the dosage of one or both medications.
A nurse is preparing to administer eye drops to a client. Which of the following actions should the nurse take? (Select all that apply)
A. Have the client lie on one side
B. Ask the client to look up at the ceiling
C. Tell the client to blink when the drops enter the eye
D. Drop the medication into the client’s conjunctival sac
E. Instruct the client to close the eye gently after instillation
B. Ask the client to look up at the ceiling
The client should look upward to keep the drops from falling onto the cornea.
D. Drop the medication into the client’s conjunctival sac
Drop the medication into the conjunctival sac to promote distribution.
E. Instruct the client to close the eye gently after instillation
The client should close the eye gently to promote distribution of the medication.
A nurse is reinforcing teaching to a client about transdermal patches. Which of the following statements should the nurse identify as an indication that the client understands?
A. “I will clean the site with an alcohol swab before I apply the patch.”
B. “I will rotate the application sites weekly.”
C. “I will apply the patch to an area of skin with no hair.”
D. “I will place the new patch on the site of the old patch.”
C. “I will apply the patch to an area of skin with no hair.”
The client should apply the patch to a hairless area of skin to promote absorption of the medication.
A nurse reviewing a client’s medical record notes a new prescription for verifying the trough level of the client’s medication. Which of the following actions should the nurse take?
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
B. Verify that the client has been taking the medication for 24hr before obtaining a blood specimen.
C. Ask the client to provide a urine specimen after the next dose of medication.
D. Administer the medication, and obtain a blood specimen 30 min later.
A. Obtain a blood specimen immediately prior to administering the next dose of medication.
To verify trough levels of a medication, obtain a blood specimen immediately before administering the next dose of medication.
A nurse is preparing a client’s medications. Which of the following actions should the nurse take in following legal practice guidelines? (Select all that apply)
A. Reinforce teaching with the client about the medication.
B. Determine the dosage.
C. Monitor for adverse effects.
D. Lock compartments for controlled substances.
E. Determine the client’s insurance status.
A. Reinforce teaching with the client about the medication.
Reinforcing teaching with the client about the medication is part of the rights of medication administration.
C. Monitor for adverse effects.
Monitor for adverse effects as part of the rights of medication administration.
D. Lock compartments for controlled substances.
Lock controlled substance in a drawer, cart, or other compartment to prevent misuse.
A nurse is preparing to administer digoxin to a client who states, “ I don’t want to take that medication. I do not want one more pill.” Which of the following responses should the nurse make?
A. “Your physician prescribed it for you, so you really should take it.”
B. Well, let’s just get it over quickly then.”
C. “Okay, I’ll just give you your other medications.”
D. “Tell me your concerns about taking this medication.”
D. “Tell me your concerns about taking this medication.”
Although clients have the right to refuse a medication, this response is correct in determining the reason for refusal by asking about the client’s concerns. Then information can be provided about the risk of refusal and facilitate and informed decision. At that point, if the client still exercises their right to refuse a medication, notify the provider and document the refusal and the actions taken.
A nurse is reviewing a client’s prescribed medications. Which of the following situations represents a contraindication to medication administration?
A. The client drank grapefruit juice, which could reduce a medication’s effectiveness.
B. The medication has orthostatic hypotension as an adverse effect.
C. A medication is approved for ages 12 and older, and the client is 8 years old.
D. An anti anxiety medication that has an adverse effect of drowsiness is prescribed as a preoperative sedative.
C. A medication is approved for ages 12 and older, and the client is 8 years old.
Age is one factor that can be a contraindication to medication administration. Contraindications are findings that indicate the client should not receive a medication and are different from instances where an undesirable effect or more monitoring are needed.
A nurse is collecting data from a client before administering medications. Which of the following data should the nurse obtain? (Select all that apply)
A. Use of herbal products
B. Daily fluid intake
C. Ability to swallow
D. Previous surgical history
E. Allergies
A. Use of herbal products
Inquire about the client’s use of herbal products, which often contain caffeine, prior to medication administration because caffeine can affect medication biotransformation.
C. Ability to swallow
Determine the client’s ability to swallow to see what route or formulation of the medication the client requires.
E. Alleriges
Inquire about food allergies during the pre-assessment to identify any potential reactions or interactions.
A nurse is working with a newly licensed nurse who is administering medications to clients. Which of the following actions should the nurse identify as in indication that the newly hired nurse understands medication error prevention?
A. Taking all medications out of the unit-does wrappers before entering the client’s room.
B. Checking the prescription when a single dose requires administration of multiple tablets.
C. Administering a medication, then looking up the usual dosage range.
D. Relying on another nurse to clarify a medication prescription.
B. Checking the prescription when a single dose requires administration of multiple tablets.
If a single dose requires multiple tablets, it is possible that an error has occurred in the prescription or transcription of the medication. This action could prevent a medication error.
A nurse is observing a client’s IV infusion site. Which of the following findings should the nurse identify as indications of phlebitis? (Select all that apply)
A. Pallor
B. Dampness
C. Erythema
D. Coolness
E. Pain
C. Erythema
Erythema and warmth at the insertion site are manifestations of phlebitis.
E. Pain
Pain and burning at the insertion site are manifestations of phlebitis.
A nurse is assisting with the initiation of IV therapy for an older adult client. Which of the following actions should the nurse plan to take?
A. Use a disposable razor to remove excess hair on the extremity.
B. Select the back of the client’s hand to insert the IV catheter.
C. Distend the veins by using a blood pressure cuff.
D. Direct the client to raise their arm above the heart.
C. Distend the veins by using a blood pressure cuff.
Distend the veins using a blood pressure cuff to reduce overfilling of the vein, which can result in a hematoma.
A nurse monitoring the IV catheter insertion site for a client receiving a nonvesicant solution and notes swelling at the site with decrease skin temperature. Which of the following actions should the nurse take? (Select all that apply)
A. Stop the infusion
B. Start a new IV access distal to this site.
C. Apply warm compresses to the insertion site.
D. Elevate the client’s arm.
E. Obtain a specimen for culture at the insertion site.
A. Stop the infusion
Decreases temperature and swelling at the insertion site are manifestations of IV infiltration. Stop the infusion and start a new line in the other extremity.
C. Apply warm compresses to the insertion site.
Apply a warm or cold compress for a client who is experiencing manifestations of an IV infiltration, depending on the solution.
D. Elevate the client’s arm
Elevate the arm of a client who is experiencing edema with an infiltration.
A nurse is preparing to administer a medication the nurse has never administered previously. Which of the following information should the nurse identify as a contraindication to administering the medication? (Select all that apply)
A. Decrease heart rate is an adverse effect of the medication.
B. The client is allergic to a component of the medication.
C. The client is five years younger than the age requirement for the medication.
D. The client’s kidney function tests indicate a need for a dosage reduction.
E. The client will need additional monitoring of liver function if the medication is administered long-term.
B. The client is allergic to a component of the medication.
An allergy to a component of the medication is a contraindication because taking the medication will cause client harm.
C. The client is five years younger than the age requirement for the medication.
Not meeting age or weight requirements for a medication is a contraindication to medication administration.
A nurse is preparing to administer an IM dose of penicillin to a client who has a new prescription. The client states when they took penicillin 3 years ago, they developed a rash. Which of the following actions should the nurse take?
A. Administer the prescribed dose.
B. Withhold the medication.
C. Ask the provider to change the prescription to an oral form.
D. Administer an oral antihistamine at the same time.
B. Withhold the medication.
Withhold the medication and notify the provider of the client’s previous reaction to penicillin so that an alternative antibiotic can be prescribed. Allergic reactions to penicillin can range from mild to severe anaphylaxis, and prior sensitization should be reported to the provider.
A nurse is comparing a newly prescribed medication to a client’s current medications. Which of the following interactions should the nurse identify as increasing the risk of medication toxicity?
A. One of the client’s current medications minimizes the adverse effects the new medication.
B. The new medication increases the effectiveness of one of the clients current medications.
C. One of the client’s current medications has a similar adverse effect as the new medication.
D. The new medication decreases the rate of metabolism of another medication.
D. The new medication decreases the rate of metabolism of another medication.
When metabolism of a medication is reduced, it remains active in the body for longer time periods or at higher levels.
A nurse is reviewing a client’s health record and notes that the client experienced permanent extrapyramidal symptoms (EPS) caused by a previous medication. The nurse should recognize that the medication affected which of the following systems in the client?
A. Cardiovascular
B. Immune
C. Central Nervous
D. Gastrointestinal
C. Central Nervous
EPS are movement disorders that can be caused by a number of central nervous system medications (typical antipsychotic medications).
A nurse is caring for a client who is experiencing anaphylaxis. Which of the following medications should the nurse expect to administer?
A. Angiotensin-converting enzyme (ACE) inhibitors
B. Naloxone
C. Antihistamines
D. Anticholingerics
C. Antihistamines
Antihistamines medications (diphenhydramine) reduce angioedema and urticaria associated with anaphylaxis.
Pharmacokinetics
Refers to how medications travel through the body. They undergo variety of biochemical processes that result in absorption, distribution, metabolism, and excretion.
Absorption
The transmission of medications from the location of administration (gastrointestinal [GI] tract, muscle, skin, mucous membranes, or subcutaneous tissue) to the bloodstream.
Distribution
The transportation of medications to sites of action by bodily fluids.
Metabolism
(Biotransformation) changes medications into less active or inactive forms by the action of enzymes. This occurs primarily in the liver, but it also takes place in the kidneys, lungs, intestines, and blood.
What are the factors influencing the rate of medication metabolism?
Age
Increase in some medication-metabolizing enzymes
First-pass effect
Similar metabolic pathways
Nutritional status
Metabolism Factor: Age
Infants have a limited medication-metabolizing capacity. The aging process also can influence medication metabolism, but varies with the individual. In general, hepatic medication metabolism tends to decline with age. Older adults require smaller doses of medications due to the possibility of accumulation in the body.
Metabolism Factor: Increase in some medication-metabolizing enzymes
This can metabolize a particular medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level. It can also cause an increase in the metabolism of other concurrent-use medications.
Metabolism Factor: First-pass effect
The liver inactivates some medications on their first pass through the liver, and thus they require a nonenteral route (sublingual, IV) because of their high first-pass effect.
Metabolism Factor: Similar metabolic pathways
When the same pathway metabolizes two medications, it can alter the metabolism of one or both of them. In this way, the rate of metabolism can decrease for one or both of the medications, leading to medication accumulation.
Metabolism Factor: Nutritional status
Clients who are malnourished can be deficient in the factors that are necessary to produce specific medication-metabolizing enzymes, thus impairing medication metabolism.
Outcomes of Metabolism
Increased renal excretion of medication
Inactivation of medications
Increased therapeutic effect
Activation of pro-medications (also called pro-drugs) into active forms
Decreased toxicity when active forms of medications become inactive forms
Increased toxicity when inactive forms of medications become active forms
Excretion
The elimination of medications from the body, primarily through the kidneys. Elimination also takes place through the liver, lungs, intestines and exocrine glands (such as in breast milk). Kidney dysfunction can lead to an increase in the duration and intensity of a medication’s response, so it is important to monitor BUN and creatinine levels.
Therapeutic Index
Medications with a high (TI) have a wide safety margin. Therefore, there is no need for routine blood medication-level monitoring. Medications with a low TI require close monitoring of medication levels.
Half-Life
Refers to the time for the medication in the body to drop by 50%. Liver and kidney function affect half-life. It usually takes four half-lives to achieve a steady blood concentration (medication intake = medication metabolism and excretion).
Short Half-Life
-Medications leave the body quickly(4 to 8 hrs)
-Short-dosing interval or MEC drops between doses
Long Half-Life
-Medication leave the body more slowly: over more than 24 hr, with a greater risk for medication accumulation and toxicity.
-Medications can be given at longer intervals without loss of therapeutic effects.
-Medications take a longer time to reach a steady state.
Pharmacodynamics
Describes the interactions between medications and target cells, body systems, and organs to produce effects. These interactions result in functional change that are the mechanism of action of the medication. Medications interact with cells on one of two ways or in both ways.
Agonists
Medications that bind to or mimic the receptor activity that endogenous compounds regulate. For example, morphine is an agonist because it activates the receptors that produce analgesia, sedation, constipation, and other effects. (Receptors are the medication’s target sites on or within the cells.)
Antagonists
Medications that can block the usual receptor activity that endogenous compounds regulate or the receptor activity of other medications. For example, losartan, an angiotensin II receptor blocker, is an antagonist. It works by blocking angiotensin II receptors on blood vessels, which prevents vasoconstriction.
Partial Agonists
Act as agonists and antagonists, with limited affinity to receptor sites. For example, nalbuphine acts as an antagonists at mu receptors and an agonist at kappa receptors, causing analgesia with minimal respiratory depression at low doses.
Oral or Enteral Medications
The most common route that comes in tablets, capsules, liquids, suspensions, elixirs, lozenges.
Sublingual
Medication given under the tongue.
Buccal
Medication given between the cheek and the gum. Directly enters the bloodstream and bypasses the liver.
Topical Medications
Medications directly applied to the mucous membranes or skin. Includes powders, sprays, creams, ointments, pastes, oil-and suspension-based lotions.
Transdermal Medications
Medication in a skin patch for absorption through the skin, producing systemic effects.
Inhalation Medications
Administered through metered-dose inhalers (MDI) or dry-powder inhalers (DPI).
Chemical Name
The name of the medication that reflects its chemical composition and molecular structure (isobutylphenylpropanoic acid).
Generic Name
The official or nonproprietary name the United States Adopted Names Council gives a medication. Each medication has only one generic name (Ibuprofen).
Trade Name
The brand or proprietary name the company that manufactures the medication gives it. One medication can have multiple trade names (Advil, Motrin).
Uncontrolled Substances
Require monitoring by a provider, but do not generally pose risks of misuse and addiction. Antibiotics are an example of uncontrolled prescription medications.
Controlled Substances
Have a potential for misuse and dependence an have a “Schedule” classification. Heroin is in Schedule 1 and has no medical use in the United States. Medications in Schedules II through V have legitimate applications. Each subsequent level has a decreasing risk of misuse and dependence. For example, morphine is a Schedule II medication that has a greater risk for misuse and dependence than phenobarbital, which is a Schedule IV medication.
Intravenous Therapy (IV)
Involves administering fluids via an IV catheter to administer medications, supplement fluid intake, or give fluid replacement, electrolytes, or nutrients.
What is the antidote for Acetaminophen?
Acetylcysteine (Mucomust)
What is the antidote for Anticholingerics?
Physostigmine
What is the antidote for Benzodiazepines?
Flumazenil (Romazicon)
What is the antidote for Calcium Channel Blockers?
Calcium Gluconate
What is the antidote for Cyanide or Nitrate?
Methylene Blue
