LA 1 Flashcards
supp
Suppository
gtt
drops, glucose tolerance test
AM
morning
cap
capsule
hs
at bedtime
OD
Right eye
PM
in evening
tid
3 times a day
qod
every other day
q
every
q4h
every 4 hours
ss
half
d/c
discontinue
stat
immediately
Aq
Aqueous
tinct
tincture
tsp
teaspoon
SC, SQ
Subcutaneous Injection
qd
every day
Qid
4 times a day
PO
by mouth
OS
Left eye
IM
intramuscular injection
g, gm
gram
Bid
2 times a day
Ac
Before meal
IU
International Units
ad lib
freely, as desired
AAT
Activity as tolerated
IVPB
Intravenous piggy back
c
with
h, hr
hour
IV
intravenous
pc
after meals
prn
when required
qh
every hour
qs
quantity sufficient
SL
Sublingual
susp
suspension
tbsp
tablespoon
NS
Normal Saline
Penicillin 500,000 IU IM q6h X 3 days
Penicillin 500000 international units intramusc every 6 hours for 3 days
Digoxin 0.125 mg po qd.
Digoxin zero point 1 2 5 milligrams or one hundred twenty five micrograms orally once a day
Lasix 40 mg. IV stat.
Lasix forty milligrams intravenously immediately
Garamycin ii gtts OD bid X 5 days.
Garamycin two drops right eye twice a day for five days
Ativan 1 mg. SL prn hs.
Ativan one milligrams sublingual as needed at hour of sleep
Morphine 6 mg. SQ q4h.
morphine six milligrams subcutaneously every four hours
Timolol ii gtts OD BID
Administer two drops of Timolol to the right eye twice a day.
Toronto insulin 5 u SQ stat and 15 mg SQ QD am ac
Give 5 units of Toronto insulin now and then give 15 units each morning before breakfast.
Chemical name:
Name describing the drug’s chemical composition and molecular structure (EG. Paracetamol)
Generic name (nonproprietary name):
Name given to the drug and approved by Health Canada under the Food and Drugs Act and Food and Drug Regulations A name that is not or does not include a trademark or brand name (EG. ACETAMINPHEN)
Trade name (proprietary name):
Name given to a drug product; this name is a registered trademark and its use is restricted by the patent owner (usually the manufacturer) (EG. TYLENOL)
Over the counter drugs (OTC):
a drug that is sold without a prescription
N (written on a prescription bottle)
Narcotic
Pharmacokinetics:
the action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion
Pharmacodynamic:
the study of the biochemical and physiological effects of drugs and the mechanisms of their actions, including the correlation of their actions and effects with their chemical structure
Protein binding:
interaction where a drug binds to proteins in the body
Biotransformation:
the series of chemical alterations of a compound (e.g., a drug) occurring within the body, as by enzymatic activity
Lipid solubility:
v
Receptors:
a molecule on the surface or within a cell that recognizes and binds with specific molecules, producing a specific effect in the cell; e.g., the cell-surface receptors for antigens or cytoplasmic receptors for steroid hormones
Onset of action:
the time required after administration of a drug for a response to be observed; the length of time needed for a medicine to become effective
Peak of action:
The time period when the effect of something is at optimal strength
Duration of action:
The length of time that a particular drug is effective
Agonists:
a drug that has an affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances
Antagonists:
a substance that tends to nullify the action of another, as a drug that binds to a cell receptor without eliciting a biological response, blocking binding of substances that could elicit such responses
Therapeutic Index:
The ratio between the toxic dose and the therapeutic dose of a drug, used as a measure of the relative safety of the drug for a particular treatment
Peak drug level:
the highest concentration, usually in the blood, that a substance reaches during the period under consideration, after which it declines, such as the highest blood glucose level attained during a glucose tolerance test
Trough level:
The lowest concentration reached by a drug before the next dose is administered, as determined by therapeutic drug monitoringhe lowest concentration reached by a drug before the next dose is administered, as determined by therapeutic drug monitoring
Toxic effects:
an adverse effect of a drug produced by an exaggeration of the effect that produces the theraputic response
Loading dose:
a large initial dose of a substance or series of such doses given to rapidly achieve a therapeutic concentration in the body
Indications:
a symptom or particular circumstance that indicates the advisability or necessity of a specific medical treatment or procedure <postpartum>
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Contraindications:
Any characteristic of the patient, especially a disease state, that makes the use of a given medication dangerous for the patient
Desired action:
the means by which a drug exerts a desired effect. Drugs are usually classified by their actions; for example, a vasodilator, prescribed to decrease the blood pressure, acts by dilating the blood vessels
Side effects:
A peripheral or secondary effect, especially an undesirable secondary effect of a drug or therapy
Adverse effects:
Any reaction to a drug that is unexpected and undesirable and occurs at therapeutic drug dosages
Allergic reactions:
hypersensitivity reaction to a particular allergen; symptoms can vary greatly in intensity
Unbound drugs:
The fraction of drug in serum that is not bound to a carrier protein or other molecule, which generally is pharmacologically active
Half life:
the time required for the activity of a substance taken into the body to lose one half its initial effectiveness.
Additive effect:
An effect in which two substances or actions used in combination produce a total effect the same as the sum of the individual effects.
Drug interactions:
The pharmacological result, either desirable or undesirable, of drugs interacting with themselves or with other drugs, with endogenous chemical agents, with components of the diet, or with chemicals used in or resulting from diagnostic tests.
Food drug interactions:
the effect produced when some drugs and certain foods or beverages are taken at the same time. For example, grapefruit juice blocks the metabolism of some drugs in the GI tract, an action that can cause normal dosages of a drug to reach toxic levels in the plasma
Enteral route:
Enteral refers to anything involving the alimentary tract, from the mouth to the rectum. There are four enteral routes of administration: oral, sublinqual, buccal, and rectal.
Parenteral route:
- Located outside the alimentary canal; 2. Taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection.
Percutaneous route:
a path of entry via the skin
ABSORPTION: Definition
The process by which a drug is made available to the body fluids for distribution. It takes place through passive absorption, active absorption and pinocytosis
ABSORPTION: Location
- oral (enteral)
- rectal (enteral)
- nasogastric tube (enteral)
- inhalation (percutaneous)
- mucous membrane (percutaneous)
- topical (percutaneous)
- injectable (IM, S/C, IV)
(parenteral) - Sublingual & buccal (percutaneous)
ABSORPTION: Influencing Factors
- Solubility of drug
- Route of administration
- Decreased villi in small intestine
- Degree of blood flow to the tissue where medication is found (shock, disease or vasoconstrictor drugs)
- If drugs are destroyed by digestive enzymes
- Slowing of the stomach’s emptying time due to stress, pain, hot/cold and fatty foods
- Age
DISTRIBUTION: Definition
Transport of a drug by bloodstream to site of action
DISTRIBUTION: Location
Blood stream bound to plasma proteins (commonly albumin) or “free” unbound
DISTRIBUTION: Influencing Factors
Blood supply to target organ or tissue
Protein bound or not
Water soluability
Fat soluability
BIOTRANSFOR-MATION
(metabolism): Definition
Alteration of drug into inactive metabolite
Breaking down drug
Also… converting prodrug into active form
BIOTRANSFOR-MATION
(metabolism): Location
Mainly liver,
Also muscle, kidneys, lung, plasma, intestinal mucosa
BIOTRANSFORMATION
(metabolism): Influencing Factors
Cytochrome p450
Other meds
Genetics
Diseases
Table 2-6
EXCRETION: Definition
Removal of drug from body
EXCRETION: Location
Kidney
To a lesser extent liver and bowel
Even less often lungs, sweat, saliva, breast milk
EXCRETION: Influencing Factors
How well the excretory organ functions
e.g. poor kidney function can result in slower excretion
Sequence of Ingestion to target area:
ENTERAL
* mouth
* stomach
* liver
* bloodstream
* target area
Sequence of Ingestion to target area:
PARENTERAL
* bloodstream
* target area
Critical Thinking Questions:
Because of the changes in the ordering, distribution, and administration of drugs; the advances in technology; and the increased potency of medications, what is the crucial responsibility of the nurse when implementing drug therapy?
Nurses are responsible for being adequately informed about both the client and the drug before implementing drug therapy. Nurses must assess clients before giving any medication and must then observe each individual’s response to the drug therapy; determine any other actions to be implemented; and continue to assess, teach, and work collaboratively with pharmacists and diligently with the client to enhance compliance at home. Carrying out the nursing process with astute assessment, nursing diagnoses, planning, implementation, and evaluation is as critical to safe nursing care with drug therapy as it is to the overall nursing care of clients.
Being efficient, safe, and knowledgeable about clients and their medication; using proper administration techniques; and constantly monitoring the client and all other sources of data also are important to safe and effective drug therapy.
Critical Thinking Questions:
On the night shift, a client refused to take his 0200 dose of an antibiotic, claiming that he had just taken it. What actions by the nurse would ensure sound decision making and maintain client safety?
Whenever a client questions a particular medication or mentions something about the medication that is not in accordance with what the nurse thinks, the nurse should always be prudent—stop, recheck the doctor’s order against the medication administration record or profile, and check the medication record/profile to determine if a dose was given and signed off by another nurse. With this client, it would be prudent to check the orders against the medication profile as stated above, just to be safe. If all records and orders have been checked and the nurse is certain that the drug has not been given, then the nurse should proceed with medication administration. Never assume that the client is unaware of his or her medication; always double-check to be safe. A simple explanation could then be given to the client. If the client continues to refuse the medication, document this in the nurses’ notes and report it to the charge nurse or nurse supervisor and the physician.
Critical Thinking Questions:
What are the implications of biotransformation on drug therapy?
Biotransformation, or drug metabolism, often causes drug inaction because many chemical changes occur, resulting in more water-soluble compounds that are more easily eliminated. However, drugs such as codeine, diazepam, and amitriptyline, which produce active metabolites as they go through biotransformation, remain in the body longer. The nurse must understand this process in order to recognize situations that cause increased or decreased drug effects as a result of metabolism. It is very important to know that biotransformation may result in either less potent substances compared with the parent drug or in metabolites that are more potent than the parent drug. In summary, it is crucial to understand the metabolic functions of drugs to be aware of those drugs that are broken down into more potent and possibly toxic chemicals.
Crtitical Thinking Questions:
Your client is inquiring about the benefits that transdermal medication offers over the administration of some oral medications. In relation to the pharmacological principle of absorption, what is one major benefit of transdermal patches versus oral medication administration?
Transdermal patches are useful because they offer the advantage of bypassing the liver and possible first-pass effects (pre-systemic metabolism). The patches are also suitable for clients who cannot tolerate orally administered medications. They may be applied and remain on the skin, sometimes for 3 to 5 days, resulting in effective blood levels of the drug and better client compliance.
Crtitical Thinking Questions:
Mr. L is admitted the burn trauma unit with multi-system injuries from an automobile accident. He presented to the unit with multiple abnormal findings including shock, decreased cardiac output, and less than 30 ml/hr urinary output. Which route of administration would be indicated for any medications in this client? Explain your rationale.
Intravenous therapy would be most appropriate because it allows immediate access of the drug to the bloodstream. With intramuscular (IM) or subcutaneous injectable forms of medications, absorption of the drug from the vascular area within a muscle, or within subcutaneous tissues, is required before absorption into the bloodstream. With clients who are in shock or have decreased cardiac output or decreased peripheral circulation, the IM forms would not be so well absorbed.
Explain the difference between a medication’s action and its effect.
A medication’s mechanism of action is the way that it can produce therapeutic responses. The effects of a medication depend on the cells or tissue targeted by that medication. The medication has to go through its mechanism of action prior to having an effect.
Explain the importance of each phase of pharmacokinetics.
A medication must go through the phases of pharmacokinetics before it can exert its mechanism of action and have its effect on the body. The phases of pharmacokinetics are absorption—the drug gets into the systemic circulation once the dosage form is administered; distribution—the drug is distributed or transported to the site of action; metabolism—the drug is biotransformed into an inactive metabolite, more soluble compound, or a more potent metabolite; and excretion—the drug is eliminated from the body. Understanding all these phases and subsequent principles related to each phase, as well as their altering factors, is critical to understanding the basics of drug therapy and some of the nuances of drug responses by clients.
Five RIghts of Medication Administration
- Right drug
- Right dose
- Right time
- Right route
- Right patient
Additional Rights
- Right reason
- Right documentation
- Right evaluation (assessment)
- Right patient education
- Right to refuse
Other “Rights” of Med Admin
- Proper drug storage
- Accurate dosage calculation
- Accurate dosage preparation
- Careful checking of transcription of orders
- Patient safety
- Close consideration of special situations
- Prevention and reporting of medication errors
- Monitoring for therapeutic effects, adverse effects, toxic effects
Six Elements of a Drug Order
- Patient’s name
- Date the order is written
- Name of medication
- Dosage (includes size, frequency, and number of doses)
- Route of administration
- Signature of the prescriber
9 Essential Components of a Prescription
- Patient’s name, address, health insurance number (or identification number)
- Date prescription was written
- The Rx symbol, meaning “take thou”
- Medication name, dosage, and strength
- Route of administration
- Dispensing instructions for the pharmacist
- Directions for administration to be given to the patient
- Number of refills
- Signature of the prescriber
Any chemical that affects the physiological
processes of a living organism
DRUG
The study or science of drugs
PHARMACOLOGY
Name describing the drug’s chemical composition and molecular structure
CHEMICAL NAME
Name given to the drug and approved by Health Canada under the Food and Drugs Act and Food and Drug Regulations
GENERIC NAME (NONPROPRIETARY NAME)
Name given to a drug product; this name is a registered trademark and its use is restricted by the patent owner (usually the manufacturer)
TRADE NAME (PROPRIETARY NAME)
Pharmacological Principles
- Pharmaceutics
- Pharmacokinetics
- Pharmacodynamics
- Pharmacotherapeutics
- Pharmacognosy
- Toxicity
The science of preparing and dispensing
drugs, including dosage form design (e.g., tablets, capsules, injections, patches, etc.).
Pharmaceutics
The study of what the body does to the drug
- Absorption
- Distribution
- Metabolism
- Excretion
Pharmacokinetics
- The study of what the drug does to the body
- The mechanism of interactions of drugs at their sites of activity
Pharmacodynamics
The treatment of pathological
conditions through the use of drugs.
- Empirical therapeutics
- Rational therapeutics
Pharmacotherapeutics
The study of drugs that are obtained
from natural plant and animal sources
Pharmacognosy
The condition of producing adverse bodily effects
because of poisonous qualities.
Toxicity
The movement of a drug from its site of administration into the bloodstream for distribution to the tissues
- Bioavailability
- Bioequivalent
Pharmacokinetics: Absorption
Factors That Affect Absorption
- Absorption characteristics vary according to the dosage form and route
- Food or fluids administered with the drug
- Dosage formulation
- Status of the absorptive surface
- Rate of blood flow to the small intestine
- Acidity of the stomach
- Status of gastrointestinal (GI) motility
Enteral Route
Drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine
- ORAL
- sublingual
- buccal
The metabolism of a drug and its passage from the liver into the circulation
First-Pass Effect
A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation
high first-pass effect
Parenteral Route
- Intravenous (fastest delivery into the blood circulation)
- Intramuscular
- Subcutaneous
- Intradermal
- Intrathecal - space under the arachnoid membrane of the brain or spinal cord.
- Intra-arterial - ARTERY
- Intra-articular - JOINT
T OR F
MEDICATIONS GIVEN BY THE PARENTERAL ROUTE BYPASS THE FIRST-PASS EFFECT OF THE LIVER
TRUE
HOW CAN YOU INCREASE ABSORPTION FROM IM OR ID SITES?
- Applying heat to the injection site
- Massaging the injection site
Most intramuscularly injected drugs are
absorbed over ______________ hours
several
Specially formulated long-acting intramuscular dosage forms are designed for slow absorption and may be absorbed over a period of several days to a few months or longer
DEPOT DRUGS
Topical Routes
- Skin (including transdermal patches)
- Eyes
- Ears
- Nose
- Lungs (inhalation)
- Rectum
- Vagina
- Slower onset of effects
- Prolonged duration of action
- Avoidance of first-pass effects of the liver (except for rectally administered drugs)
Topical Route
PROS TO TRANSDERMAL APPLICATION
- Patches deliver a constant amount of drug per unit of time for a specified time period
- Drug bypasses the liver and its first-pass effects
HOW ARE INHALANTS ABSORBED
THROUGH THE ALVEOLI
HOW ARE INHALED DRUGS DELIVERED
AS MICROMETRE-SEIZED DRUG PARTICLES
The transport of a drug in the body by the bloodstream to its site of action
Distribution
AREAS OF RAPID DISTRIBUTION
heart, liver, kidneys, brain
Areas of slow distribution
muscle, skin, fat
The biochemical transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite
Metabolism(also known as biotransformation)
WHERE DOES METABOLISM OCCUR
- Liver (main organ)
- Skeletal muscle
- Kidneys
- Lungs
- Plasma
- Intestinal mucosa
Metabolism/Biotransformation
Biologic transformation of a drug into:
- An inactive metabolite
- A more soluble compound
- A more potent metabolite
The elimination of drugs from the body
Excretion
WHERE DOES EXCRETION OCCUR
- Kidneys (main organ)
- Liver
- Bowel
- Biliary excretion
- Enterohepatic recirculation
- Lungs
- Glands (sweat, salivary, and mammary)
The time it takes for one-half of the original amount of a drug in the body to be removed; a measure of the rate at which drugs are removed from the body
Half-Life
Most drugs are considered to be effectively removed after about ____________ half-lives
five
the physiological state in which the amount of the drug removed via elimination is equal to the amount of drug absorbed with each dose
steady state
Onset
The time it takes for the drug to elicit a therapeutic response
Peak
The time it takes for a drug to reach its maximum therapeutic response
Duration
The time that a drug concentration is sufficient to elicit a therapeutic response
Peak Level
Highest blood level
Trough Level
Lowest blood level
Ways Drugs Produce Therapeutic Effects
- Once the drug is at the site of action, it can modify the rate (increase or decrease) at which the cells or tissues function
- A drug cannot make a cell or tissue perform a function it was not designed to perform
Pharmacodynamics: Mechanisms of Action
(3)
- Receptor interactions
- Enzyme interactions
- Nonspecific interactions
Receptor interactions
3
- Agonist Drug
- Partial agonist receptor
- Antagonist Drug
AgonisT
Drug binds to the receptor; there is a response.
Partial agonist (agonist–antagonist)
Drug binds to the receptor; the response is diminished compared with that elicited
by an agonist.
Antagonist
Drug binds to the receptor; there is no response. Drug prevents binding of agonists
Pharmacotherapeutics: Types of Therapies
- Acute therapy
- Maintenance therapy
- Supplemental/replacement therapy
- Palliative therapy
- Supportive therapy
- Prophylactic therapy
- Empiric therapy
_________ therapy often involves more intensive drug therapy and is implemented in the acutely ill (those with a rapid onset of illness) or even the critically ill. It is often needed to sustain life or treat disease.
Examples are the administration of vasopressors to maintain blood pressure and cardiac output after open-heart surgery.
Acute
______________ therapy typically does not eradicate problems the patient may have but does prevent progression of a disease or condition.
It is used for the treatment of chronic illnesses such as hypertension.
Maintenance
___________ OR __________ therapy supplies the body with a substance needed to maintain normal function. This substance may be needed because it either cannot be made by the body or is produced in insufficient quantity.
Examples are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia.
Supplemental or replacement
The goal of __________ therapy is to make the patient as comfortable as possible. It is typically used in the end stages of an illness when all attempts at curative therapy have failed.
palliative
___________ therapy maintains the integrity of body functions while the patient is recovering from illness or
trauma.
Examples Are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia.
Supportive
_____________ therapy is drug therapy provided to prevent illness or other undesirable outcome. Its use is based on scientific knowledge often acquired during years of observation of a disease and its causes.
example, a surgeon knows that when an incision is made through the skin there is the possibility that skin bacteria are present that can later infect the incision. Thus the surgeon administers an antibiotic before making the incision
Prophylactic
_________ therapy does not have a scientific basis but instead is based on experience. It is the administration of a drug when a certain pathological process is suspected, based on the patient’s symptoms, because the drug has been found in the past to be beneficial in such cases.
example, acetaminophen is given to a patient who has a fever. The cause of the fever may not be known, but empirically the patient is given acetaminophen because it has been demonstrated to lower the body temperature.
empiric
Contraindication
Any characteristic of the patient, especially a disease state, that makes the use of a given medication dangerous for the patient
One must be familiar with the drug’s:
8
- Intended therapeutic action (beneficial)
- Unintended but potential adverse effects (predictable, adverse reactions)
- Therapeutic index
- Drug concentration
- Patient’s condition
- Tolerance and dependence
- Interactions
- Adverse drug effects
Therapeutic index
The ratio between a drug’s therapeutic benefits and its toxic effects
Tolerance
A decreasing response to repeated drug doses
Dependence
A physiological or psychological need for a drug
Interactions may occur with other _____ OR _____
drugs or food
Drug interactions are the alteration of action of a drug by:
3
- Other prescribed drugs
- Over-the-counter medications
- Natural health products
DRUG INTERACTIONS MAY HAVE 4 EFFECTS
- Additive effect
- Synergistic effect
- Antagonistic effect
- Incompatibility
Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone (compare with synergistic effects).
Additive effects
Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone (compare with additive effects).
Synergistic effects
Drug interactions in which the effect of a combination of two or more drugs is less than the sum of the individual effects of the same drugs given alone.
Antagonistic effects
The quality of two parenteral drugs or solutions that leads to a reaction resulting in chemical deterioration of at least one of the drugs when the two substances are mixed together.
Incompatibility
Adverse Drug Events
2
- Medication errors
- Adverse drug reactions
Adverse Drug Reaction (ADR)
Any reaction to a drug that is unexpected and Undesirable and occurs at therapeutic drug dosages
ADVERSE DRUG REACTIONS ARE CAUSED BY
PROCESSES WITHIN A PATIENTS BODY
ADVERSE DRUG REACTIONS HAVE FOUR GENERAL CATEGORIES
- Pharmacological reaction
- Hypersensitivity (allergic) reaction
- Idiosyncratic reaction
- Drug interaction
Adverse effects
- Predictable, well-known reactions that result in little or no change in patient management
- Predictable frequency
- Related to the size of the dose
- Usually resolve when the drug is discontinued
TERATOGENIC EFFECTS
Drugs or other chemicals result in structural defects in the fetus.
MUTAGENIC EFFECTS
permanent changes in the genetic composition of living organisms and consist of alterations in the chromosome structure, the number of chromosomes, or the genetic code of the deoxyribonucleic acid (DNA) molecule.
CARCINOGENIC EFFECTS
cancer-causing effects of drugs, other chemicals, radiation, and viruses.
Pharmacognosy:
Four main sources for drugs
- Plants: e.g. foxglove
- Animals: Insulin, estrogen
- Minerals: aluminum hydroxide
- Laboratory synthesis: most drugs
Evidence-Informed Practice
Applying current, valid, and relevant information when making clinical decisions
HOW TO APPLY EVIDENCE INFORMED PRACTICE
3
- Systematically reviewing randomized clinical trials (RCTs)
- Reading descriptive and qualitative studies
- Acknowledging expert opinions
PROS OF EVIDENCE INFORMED PRACTICE
3
Leads to more:
- Accurate diagnoses
- Effective and efficient interventions
- Improved patient outcomes
PREFERED SITE FOR Intramuscular injections
- Ventrogluteal site (preferred)
- Vastus lateralis site
- Deltoid site
