Exam 2 Flashcards
What is a drugs generic name?
The generic name, which identifies the drugs active ingredient, is the name assigned by the manufacture that first developed the drug. Often the generic name is drive from the chemical name
What is pharmacology?
The study that deals with chemicals that affect the body functioning
What is a drugs official name?
The official name is the name by which the drug is identified in the official publication. The official name is often the generic name
What is a drugs trade name?
The tradename, also referred to as the brand-name or propriety name, is selected by the drug company that sells the drug and is protected by trademark. A drug have several trade names when produced by different manufacturers.
What is tylenols generic and trade names?
Acetaminophen is the generic name.
Tylenol, Tempra, liquiprin are trade names
What is pharmokinetics?
Pharmacokinetics is the effect of the body on the drug
Which drugs usually take the longest to be absorbed?
Drugs given orally or injected intradermally?
Describe pHs effect on drugs
Acidic drugs are well absorbed in the stomach. Drugs that are basic remain ionized or insoluble in an acid environment,these drugs are not absorbed before reaching the small intestine
What could cause a drugs unequal distribution?
The drug may bind to plasma proteins, which causes unequal distribution and prevents the drug from reaching its intended site of action. Another factor affecting distribution is the blood brain barrier.
(Drugs readily move across the placenta)
Where is the primary source for drug metabolism?
Metabolism, or biotransformation, is a change of a drug from its original form to a new form. The liver is the primary site for drug metabolism
Describe excretion of a drug
After the drug is broken down to an inactive form, excretion of the drug occurs. Excretion is the process of removing a drug or it’s metabolites from the body. The kidneys excrete most drugs. The lungs are the primary route for the excretion of gases substances, such as inhalation anesthetics. Many drugs are excreted through bile in the gastrointestinal tract. The sweat, salivary and mammory glands are also routes for drug excretion
What is pharmacodynamics?
The process by which drugs alter cell physiology and affect the body
What is an idosyncratic effect?
It’s any unusual or particular response to a drug that may manifest itself by over response, under response, or even the opposite of expected response
Antagonist vs. Synergistic
In a drug to drug interaction, the combined effect of two or more drugs acting simultaneously produces an effect either less than that of each drug alone (antagonist effect) or greater than that of each drug alone (synergistic effect)
True or false
Christian scientists do participate in childhood vaccines
False, they believe in spiritual healing and thus do not take medications
Look lower protein levels in the body mean for drug absorption?
Many drugs normally buying two proteins in the plasma, so lower protein levels in the body means less drug down to plasma proteins, leading to a higher concentration free drug in the potty
What is a drugs peak level?
The peak level, our highest plasma concentration, of the drug should be measured when absorption is complete.
What is a drugs trough level?
The trough level is the point when the drug is at its lowest concentration, and the specimen is usually drawn in the 30 minute interval for the next dose
What does a medication order consist of?
- Patients name
- Date and time the orders written
- Name of the drug to be administered
- Dosage of he drug
- Route by which the drug to be administered
- Frequency of administration of the drug
- Signature of person writing the order
What is the trailing zero?
The use of a trailing zero (e.g. 1.0) is not considered good practice.
A zero should always precede a decimal point (e.g. 0.1)
Formulas for drug dosages
Dose on hand Dose desired
——————- = ——————
Quantity on hand X (quantity desired)
Amoxicillin , 625 mg PO is ordered. Is supplied as a liquid preparation containing 250 mg and 5 mL. Much does a nurse administer?
250 mg 625 mg
———– = ———-
5 mL X mL
3,125=250X
X=12.5 mL
How do you calculate pediatric medication doses?
Base it on bodyweight
How often should a nurse check the drug label?
Three times
- When the nurse reaches for the container or unit dose package
- After retrieval from the drawer and compared with the CMAR, or compared with the CMAR immediately before pouring from the multidose containers
- When are placing the container to the drawer are shelf or before giving the dose medication to the patient
What is the most common route for drug administration?
Orally, drug action at the slower onset and a more prolonged, but less potent, affect with oral administration of drugs vs Administration via other route
What does parenteral mean?
It means outside the intestines or alimentary canal
The patient has an abnormal, unexpected response to a drug. This is defined as which of the following?
Idiosyncratic effect
What does the abbreviation b.i.d. Stand for?
Twice a day (administration)
Describe needles
Needle gauges are numbered 18 through 30. At the diameter of the needle increases, the gauge number decreases. For example, an 18 gauge needle is larger in diameter than a 30 gauge steel. The bevel is sloped edge, designed to make a narrow slit like opening recluses quickly
True or false
A longer needle is required for intramuscular injections than for an intradermal or subcutaneous injection
True
When administering parenteral injections what rule must be followed?
When administering parental injections, it is imperative that surgical a sepsis is sterile technique must be followed strictly to avoid introducing organisms into the body
List the parts of the syringe and needle it must be kept sterile during the procedure of preparing in administering an injection
The inside of the barrel
the part of the plunger that enters the barrel
The tip of barrel
The needle
True or false
Most prefilled cartridges are overfilled
True
True or false
Prefilled cartridges provide a single dose of medication
True
What is the first step before mixing two medications and one syringe?
Ensuring the two drugs are compatible
True or false
Incompatible drugs may become cloudy or form a precipitate in the syringe
True
When using the single-dose vial and a multidose vial inject air to both vials and draw medication in the multidose vial into the syringe first. Why should you do this?
This prevents the contents of the multidose vial from being contaminated with the medication in the single-dose vial
When preparing medications from an ampule and vial what medication should you prepare first?
Prepare the medication in the vial first
What is insulin?
Insulin, A naturally occurring hormone produced by the pancreas, enable cells to use carbohydrates.
Prandial vs. Preprandial vs. Postprandial
Prandial: with a meal
Preprandial: before a meal
Postprandial: after a meal
Give an example of a basal insulin
Insulin glargine (lantus)
Insulin detemir (levemir)
True or false
Lantus and levemir cannot be mixed with other insulins
True
True or false
Insulin doses are calculated in units
True
What is reconstitution?
The technique of adding a dilutent to a powder drug is called reconstitution
Where is information needed for reconstitution usually located?
Information needed for reconstitution, such as the specific solution to use for the dilutent and dosage calculation, is usually found on the vial label
Describe intradermal injection
Intradermal injections administered into the dermis, just below the epidermis. The intradermal route has the longest absorption time of all the parental routes. These injections are for sensitivity test and local Anesthia
What has the longest absorption time of all the parental route?
The intradermal route
What drugs are delivered subcutaneously?
Insulin and heparin
What angle are subcutaneous injections administered at?
45 to 90° angle
Generally the shorter 3/8 needle should be inserted at a 90° angle and the longer 5/8 needle is inserted out of 45° angle
True or false
Aspiration, or pulling back on the plunger to check the blood vessel has been entered, is not necessary and has not been proved to be a reliable indicator of needle placement. Likelihood of injecting into a blood vessel is small.
True
True or false
Shorter needles are less painful
True
What are muscular injections?
Intramuscular injections deliver medication to skin and subcutaneous tissues into certain muscles. Muscle’s have larger in a greater number of blood vessels then does subcutaneous tissue, allowing faster onset of action than with subcutaneous injection
What is at risk when giving an injection in the deltoid site?
Damage to the radial nerve and artery is a risk with use of the deltoid site
What are common intramuscular site?
Deltoid
Vastus lateralis
Ventrogluteal
What degree should intramuscular injection be given at?
A 72 or 90 degree angle
What degree should an intradermal injection be given at?
5-15 degrees
What is the Z track technique?
Many of the drugs given intramuscularly can cause irritation just subcutaneous tissues and backflow into the tissues occurs along the injection track. Therefore, the Z track technique is recommended for all intramuscular injections to ensure medication does not leak back along the needle track and into the subcutaneous tissue.
Described the z track technique
The track technique, attach a clean needle to the syringe after the syringe is filled with the medication to prevent ejection of any residual medication on the needle and just superficial tissue. Pull the skin down or to one side about an inch and hold in this position with the nondominant hand insert the needle and injecting medication slowly. Withdraw the needle steadily and released the displaced tissue to Lowe’s to return to its normal position. Massage is not recommended however gentle pressure maybe applied with a dry sponge
What is the general excepted volume of them in the case in administration for IM?
1-4 ml
True or false
The vial is a closed system and therefore requires that air be injected to equal the amount of solution to be withdrawn.
True
Describe mix-o-vials, when are they used?
Medications that are packaged in Mix-O-Vials have the powder form of the medication in the bottom compartment and the diluent solution in the top portion of the vial. The powder and the liquid are separated by a rubber stopper. Medications that are unstable in solution over long periods of time are packaged in this manner.
Describe syringes
Syringes are available in several sizes. There are three main types of syringes: the hypodermic syringe, the tuberculin syringe, and the insulin syringe. These syringes vary in volumes of 1 mL, 3 mL, 5 mL, 10 mL, 20 mL, 30 mL, 50 mL, and 60 mL. Each syringe is designed for a specific use, but the parts of all syringes are the same.
How many different tips are there on syringes?
There are two different tips to a syringe. One tip is known as a Luer Lok, which has a needle designed to twist and lock on the syringe. The other is a Plain Tip, which has a needle that is pushed on.
List the parts of the needle
The parts of the needle are:
the hub, which is the large end of the needle and is the part that attaches to the syringe
the shaft, which is the determinate of the length of the needle
the bevel, which is the sharp end of the needle that enters the patient or the intravenous tubing or access device.
What routes can you give parenteral meds?
Parenteral medications are given by four routes: Subcutaneous (SubQ) Intradermal (ID) Intramuscular (IM) Intravenous (IV)
Medication order: heparin 2,500 units, SubQ
10,000 units equals 1 ml
How many ml would you administer?
0.25
What is the formula for dose calculation?
H : V :: D : X
H: dose on hand
V: volume on hand
D: desired dose
H x X & V x D
Medication order: heparin 7,500 units q12h SubQ
Drug available: heparin 10,000 USP units/mL in a 5-mL vial
How many mL will the patient receive?
0.75
Parenteral meds come in what two preparations?
Liquids and powders
True or false
Profiled cartridges often contain 0.1-0.2 ml of excess drug solution
True
True or false
An insulin syringe is calibrated by units and 100 units equals 1 ml
True
True or false
Insulin and prefilled syringes come with permanently attached needles
True
True or false
The gauge of a needle is related to the viscosity of the medication
True
True or false
The amount of fatty tissue a patient has will relate directly to gauge and length of needle
False
True or false
The lumen of a 19 gauge needle has a smaller diameter than that of a 25 gauge needle
False, the smaller the gauge of a needle the larger the diameter of the lumen
True or false
Subcutaneous injections can be given in any part of the body
True
True or false
Intradermal injections are usually administered with tuberculin syringe
True
True or false
The inner forearm and upper back are preferred sites for intradermal injections
True
Describe insulin syringes
Insulin is measured in USP units. Insulin is manufactured in multi-dose vials of 100 units per milliliter. There are three main syringes that are used to measure and administer insulin.
The first syringe is the Lo-Dose syringe. This syringe can be either 50 units in 0.5 mL total volume or 30 units in 0.3 mL total volume. Each calibration on these syringes is 1 unit. When smaller doses of insulin are to be given, the smaller the syringe, the more accurately the dose is measured.
The second syringe designed to administer insulin is the single scale 1 mL syringe. This syringe is calibrated in 2 unit increments. This syringe is ideal for the patient with vision problems.
The third syringe is the 1 mL double scale syringe. The syringe is marked on one side in even calibrations (10, 20, 30, 40, etc.) and odd calibrations on the opposite side (5, 15, 25, 35, etc.). To avoid confusion, use the odd scale for odd doses, i.e., 17 units and the even scale for even doses, i.e., 20 units.
List the 3 types of insulin
- rapid-acting,
- intermediate-acting
- long-acting.
What insulin is a intermediate acting human derived insulin?
Humilin N
What is the fastest acting insulin and can be given 5 min before a meal?
Humalog
An intermediate acting insulin derived from pork
NPH llentin 2
Which insulin is drawn up first, humulin N or humulin R?
Humulin R
R before N (RN)
True or false
The nurse would choose a 20 gauge needle for an IM injection
True
True or false
A nurse would give an IM injection at a 90 degree angle
True
True or false
The volume for an IM injection is no more than 5 ml
False, 0.5-3.0 ml is the range….1-2 ml is the average
What size needle would a nurse choose for an IM injection for an average sized person?
An average sized person would require a 1 1/4- 1 1/2 long needle with a gauge of 20-23
What are the 7 rights?
- Right Drug
- Right Dose
- Right Client
- Right Route
- Right Time
- Right Documentation
- Right Reason
What is the sterile areas of the needle?
Plunger
Shaft
Bevel
IM needle length
- Vastus Lateralis: 5/8”-1”
- Deltoid (Children): 5/8”-1 ¼”
- Deltoid (Adults): 5/8”-1 ½”
- Ventrogluteal (Adults): 1 ½”
Locations for IM injections
- Deltoid
- Dorsogluteal
- Ventrogluteal
- Vastus Lateralis
True or false
Insulin is a high risk medication
True
Name one fast acting insulin and one long lasting insulin
Fast acting: lispro aspin
Long lasting: lantis
How long does a duragesic patch stay on?
72 hours
Put date/time/initials on patch
What degree is a tuberculin skin test done at?
15 degrees
What is the most common needle used for IM injections?
1 inch
What are the sterile parts of the syringe?
Inner aspect of plunger
Needle
Luer lock
Hub
What IM site is easiest to use?
Vastus lateralis
How do you find the deltoid injection site?
2.5-5 finger breadths below acromion process
True or false
Never exceed 1 ml of IM injection in deltoid
True
What is an intermediate basal insulin?
NPH (Novolin N)
Onset: 1.5 hours
Duration: 14-18 hours
What is a long lasting basal insulin?
Detemir (Levemir)
Onset: 3-4 hours
Duration: 6-23 hours
Glargine (Lantus)
Onset: 1 hour
Duration: 24 hours
Name 3 rapid acting insulins
Aspart (Novolog)
GLulisine (Apidra)
Lispro (Humalog)
Onset: 5-15 min
Duration: 3-5 hours
Name a short acting insulin
Regular (Novolin R)
Onset: 30-60 min
Duration: 5-8 hours
What degrees can you give intramuscular injections?
72 and 90°
What degrees can you give subcutaneous injections?
90 and 45°
What degrees can you give intradermal injections?
5 and 15°
IM needle lengths
- Vastus Lateralis: 5/8”-1”
- Deltoid (Children): 5/8”-1 ¼”
- Deltoid (Adults): 5/8”-1 ½”
- Ventrogluteal (Adults): 1 ½”
How long should you take to push in medication?
• Inject the medication slowly and steadily (take 10 seconds to inject 1 ml)
What equipment would you choose when giving a subcutaneous injection?
A 25-30 gauge needle, 3/8 to 1 inch needle……
3/8 & 5/8 are most commonly used
3/8 needle inserted at 90 degrees
5/8 needle inserted at 45 degrees
What are the most common needle lengths used for insulin?
5/16
True or false
Heparin is administered subcutaneously
True
How do you locate the Vastus lateralis site?
The Vastus lateralis involve the quadriceps femoris muscle and is located along the anterior lateral aspect of the thigh. To locate the site, divide the thigh into thirds horizontally and vertically and administer the injections in the outer middle third.
What’s the iM needles length for Vastus lateralis?
5/8-1 inch
What’s the IM length for the deltoid?
5/8-1.5 inches
What’s the IM length for deltoid in children?
5/8-1 1/4
Adults 5/8-1.5
What’s the IM length for ventrogluteal?
1.5 inches
True or false
Dry powdered inhalers are breath activated
True
The process by which a drug is transferred from side of entry into the body to the bloodstream is known as which of the following?
Absorption
Distribution, metabolism, and excretion occur after the drug has been absorbed
