Introduction to Pharmacology & Applied Therapeutics

Question 1

Critical Thinking

Answer 1

The ability to reason and think rationally in order to understand, solve problems, and make decisions; a major component of the nursing process, often considered the foundation on which to provide the best possible patient care, supported by current best evidence

Question 2

Adverse Drug Effects

Answer 2

general term for any undesirable effects that are a direct response to one or more drugs

Question 3

Allergic Reaction

Answer 3

An immunological hypersensitivity reaction resulting from the unusual sensitivity of a patient to a medication; a type of adverse drug event

Question 4

Adverse Drug Reaction

Answer 4

Any unexpected, unintended, undesired, or excessive response to a medication given in therapeutic dosages

Question 5

Drug Classification

Answer 5

A method of grouping drugs; may be based on structure or therapeutic use

Question 6

Contraindications

Answer 6

Any condition, especially one that is a result of a disease state or patient characteristic, including current or recent drug therapy, that renders a form of treatment improper or undesirable

Question 7

Drug Induced Teratogenesis

Answer 7

The development of congenital anomalies or defects in the developing fetus that are caused by the toxic effects of the drug

Question 8

Idiosyncratic reaction

Answer 8

An abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient

Question 9

Side Effects

Answer 9

Unwanted undesirable effects that are possible related to a drug

Question 10

Generic Name

Answer 10

The medicines active ingredient that makes it work

ie., Acetaminophen

Question 11

Brand Name/Trade Name

Answer 11

Name from the pharmaceutical company that markets the medicine

ie., Tylenol

Question 12

Nursing Process and Medication Administration:
Assessment

Answer 12

• Subjective and Objective data collection
• Collection of specific information about prescribed, OTC, and natural health products or complementary and alternative drug use, with attention to the drugs actions; signs and symptoms of allergic reaction; adverse effects; dosages and routes of administration; contraindications; drug incompatibilities; drug to drug, drug to food, and drug laboratory test interactions; and toxicities and available antidotes
• Gather data about the patient and a given drug by asking yourself these simple questions:
  What is the patient’s oral intake?
  Tolerance of fluids?
  Swallowing ability for pills, tablets, capsules, and liquids?
• What are the laboratory results and other diagnostic tests related to organ functioning and drug therapy? What are the kidney function studies? What are the results of the liver function tests? Etc.,

Question 13

What should the order from a prescriber be checked for? (6)

Answer 13

1) Patient’s Name

2) Date the drug order was written

3) Name of the drug

4) Drug dosage amount and frequency

5) Route of Administration

6) Prescriber’s Signature

Question 14

Nursing Process and Medication Administration: Diagnosis

Answer 14

• Inadequate knowledge
• Risk of injury
• Nonadherence
• Various disturbances, deficits, excesses, or impairments in bodily functions; and other problems or concerns related to drug therapy

Question 15

Nursing Process and Medication Administration: Planning

Answer 15

• Goals and expected patient outcome criteria of the medications
• Medication administration:
  These outcomes may address special storage and handling techniques, administration procedures, equipment needed, drug interactions, adverse effects, and contraindications
• There needs to be a timeframe in mind (is it a quick goal or an overarching goal)
• Do you have all of your supplies needed to give this medication?
• Do you need to review a procedure prior to doing something?
• Objective, measurable, realistic goals

Question 16

Nursing Process and Medication Administration: Implementation

Answer 16

• Nursing interventions or actions may be independent, collaborative, or dependent upon a prescribers order
• Statements of interventions include frequency, specific instructions, and any other pertinent information
• Constant communication and collaboration
• Implementation is based on the nurse’s clinical judgment and knowledge
• The principles of informed consent and choice should underpin medication administration
• Nurses must adhere to safe administration practice to prevent errors
• *The Ten Rights of Medication Administration

Question 17

Nursing Process and Medication Administration: Evaluation

Answer 17

• Includes monitoring the fulfillment of goals and outcome criteria, as well as the patient’s therapeutic response to the drug and its adverse effects and toxic effects
• Documentation is also an important component of evaluation

Question 18

What are the 10 Rights of Medication Administration?

Answer 18

1) Right Drug

2) Right Dose

3) Right Time

4) Right Route

5) Right Patient

6) Right Reason

7) Right Documentation

8) Right Evaluation (or right assessment) - ie., Blood Pressure, Lab results, pulse rate etc.,

9) Right Patient Education

10) Right to Refuse

Question 19

What are Pharmaceutics?

Answer 19

Study of how various dosages forms influence the way in which a drug affects the body

ie., Tablet, Capsule or liquid (these are all broken down differently)

Controlled release, sustained release. Can I crush this medication? When is the onset?)

Question 20

What is Pharmacokinetics?

Answer 20

Study of what the body does to the drug (Absorption, Distribution, Metabolism, Excretion)

Question 21

Pharmacokinetics: Absorption

Answer 21

The drug moves from its site of administration into the bloodstream for distribution into the tissues

If a drug is absorbed in the intestine, it must first pass through the liver before it reaches systemic circulation

Is dependent on the route of administration (ie., Enteral route (PO meds, SL), Parenteral route (any other administration that is not through the gastrointestinal tract ie., SC, Intradermal, IM, IV

Topical route

Inhalation route

Question 22

Pharmacokinetics: Distribution

Answer 22

The transport of the blood by the bloodstream to its site of action

Question 23

What is an area of slow distribution for meds?

Answer 23

Areas of slower distribution include muscle, skin and fat

Question 24

What are the areas that drugs are distributed to first?

Answer 24

Drugs are distributed first to those areas with extensive blood supply such as the heart, liver, kidneys and the brain

Question 25

What is an area that is difficult for the distribution of a medication to occur?

Answer 25

There are some sites in the body which are difficult to distribute a drug such as those with poor blood supply like bone or have physiological barriers that make it difficult to pass through such as the blood brain barrier

Question 26

What is the role of Albumin in the distribution of medications? (Pharmacokinetics)

Answer 26

Albumin is the most common blood protein and carries the majority of protein bound drug molecules

If a medication is given it binds to albumin, only a limited amount of the drug is not bound. This unbound portion is pharmacologically active and is considered “free” drug whereas “bound” drug is pharmacologically inactive - this can raise the risk of drug toxicity

Question 27

Pharmacokinetics: Metabolism

Answer 27

Medication is broken down into its primary components

Intersectionality considerations: genetics, ethnicity (liver enzymes)

Question 28

Pharmacokinetics: Elimination

Answer 28

The elimination of the drug from the body

Question 29

What is the primary organ for medication elimination?

Answer 29

Primary organ for elimination is the kidney - Kidney’s (labs- assess the kidney function such as Crea, GFR, Urea), assess their urine output

Question 30

What is the primary organ where drugs are metabolized?

Answer 30

Liver

However…drugs are also metabolized by the
- Integumentary system
- Respiratory System
- Gastrointestinal Tract

Question 31

Pharmacodynamics

Answer 31

Relationship between drug concentration and pharmacological response (Mechanism of Action)

Relationship between drug concentration and pharmacological response - There needs to be a certain “level” in our bloodstream for it to have its effects. We look at therapeutic concentrations and critical concentrations (ie., Vancomycin Trough)

Drug induced changes in normal physiological functions are explained by the principles of pharmacodynamics

A positive change is called a therapeutic effect

Question 32

Pharmacotherapeutics

Answer 32

Clinical use of drugs to prevent or treat

Question 33

Pharmacotherapeutics: Acute Therapy

Answer 33

Often involves more intensive drug therapy and is implemented for patients who are have a rapid onset of illness

Ex. vasopressors to maintain Blood Pressure and cardiac output

Question 34

Pharmacotherapeutics: Maintenance Therapy

Answer 34

Typically does not eradicate problems the patient already has but does prevent the progression of a disease or condition

Used for the treatment of chronic conditions such as blood pressure medications to treat hypertension. Oral contraceptives for birth control

Question 35

Pharmacotherapeutics: Supplemental Therapy

Answer 35

Supplemental or replacement therapy supplies the body with a substance needed to maintain normal function

Ex. administration of insulin to patients with diabetes and iron to patients with iron-deficiency anemia

Question 36

Pharmacotherapeutics: Palliative Therapy

Answer 36

The goal to make the patient as comfortable as possible

The goal is to improve quality of life for both the patient and the family

Ex: opioid analgesics for pain management

Question 37

Pharmacotherapeutics: Supportive Therapy

Answer 37

Maintains the integrity of bodily functions while the patient is recovering from illness or trauma

Ex: fluids and electrolytes to prevent dehydration in a patient with influenza who is vomiting and has diarrhea, IV therapy or blood products to a patient who has lost lots of blood during surgery

Question 38

Pharmacotherapeutics: Prophylactic Therapy and Empirical Therapy

Answer 38

Drug therapy provided to prevent illness other undesirable outcome during planned events

Ex: administering disease specific vaccines to individuals

Question 39

Pharmacotherapeutics: What is the therapeutic index?

Answer 39

The ratio of the drugs toxic level to the level that provides therapeutic benefits

Question 40

Pharmacotherapeutics: What are some components of monitoring with pharmacotherapeutics?

Answer 40

• Drug Concentration
• Patient’s Condition
• Tolerance and Dependence
• Interactions
• Adverse Drug Events

Question 41

What is important to keep in mind regarding pharmacotherapeutics?

Answer 41

Outcomes need to be clearly defined - the desired therapeutic outcome for the patient

Examples include curing a disease, eliminating or reducing pre-existing symptoms, arresting or slowing a disease process, preventing a disease or other unwanted conditions, or otherwise, improving quality of life

Question 42

What is a carcinogenic reaction to medications?

Answer 42

Cancer causing (ie., Immunotherapy)

Question 43

What is an example of an Adverse Drug Reaction?

Answer 43

Anaphylaxis

Question 44

4 Clinical Phases of New Drug Development: Phase 1

Answer 44

Trial where individuals are healthy and do not need this medication, clinical setting, the individual will keep a journal of their symptoms with this medication.

Less than 100 people

What is the optimal range? (what is lowest or highest dose we can do?)

Pharmacokinetics

We look to make sure there are no life threatening reactions

Question 45

4 Clinical Phases of New Drug Development: Phase 2

Answer 45

Involves a large amount of individuals, with individuals who have the disease or a disease , adverse effects/reactions are monitored here, the the dosage is changed here based off of effects

Question 46

4 Clinical Phases of New Drug Development: Phase 3

Answer 46

Lots of people such as 1000 people reaching out to medical research centers. Looking for infrequent or rare adverse reactions

Placebo is introduced here to prevent bias

Question 47

4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)

Answer 47

This medication is deemed to be safe

Pharmaceutical companies are going to follow this medication for a couple years

Documentation

Recalls due to being available to a lot of people

Question 48

4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)

What is a class I recall?

Answer 48

The medication is DONE

Question 49

4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)

What is a class II recall?

Answer 49

the adverse drug reactions are temporary or reversible (black box on the med label)

Question 50

4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)

What is a class III recall?

Answer 50

Warning on the medication