Lecture 2

Question 1

Medication polymorphism

Answer 1

pt’s age, gender, size, and body composition influence their response to a medication.

Question 2

pharmacogenetics

Answer 2

the study of how people respond differently to medication based on their genetic makeup or genes (variations in medication-processing enzymes and elimination)

Question 3

Cytochrome P450

Answer 3

system of enzymes responsible for synthesis and metabolism of molecules and chemicals. may metabolize a medication faster (lack of desired fx) or slower (toxicity) than desired.

Question 4

What are responsible for 70% of medication metabolism in the body?

Answer 4

CYP2C9, CYP2C19, CYP2D6

Question 5

Poor metabolizers

Answer 5

metabolize a medication very slowly

Question 6

Intermediate metaboliers

Answer 6

metabolize meds at a rate between poor and nomal

Question 7

Normal metabolizer

Answer 7

most common; metabolizes @ expected/normal rate

Question 8

Rapid Metabolizer

Answer 8

Metabolize med so fast it does not reach optimal blood levels; lower than expected med level

Question 9

Ultra-rapid Metabolizer

Answer 9

metabolize med so fast it does not reach optimal blood levels; inadequate response to medications/metabolize medications so fast they receive no benefit from the standard dose

Question 10

Medication adherence

Answer 10

extent to which a person’s behavior coincides with clinical prescription
Poor medication adherence is a potential contributor to disparities in health outcomes that cross racial and ethnic group

Question 11

Adherence is higher with diseases…

Answer 11

greater perceived threat to health (higher = HIV/AIDS, cancer; lower = asthma, COPD, diabetes)

Question 12

Adherence is impacted by:

Answer 12

individual characteristics of patient
patient family and culture
interact with healthcare providers
healthcare system

Question 13

Factors leading to lower adherence rates

Answer 13

• perceived discrimination from healthcare providers
• depression
• low-income
• distrust (long history of medical abuse of minority populations)
• complementary and alternative med use (e.g. Mexican-American, Vietnamese less likely to use diabetic meds)
• language barriers
• unintentional/implicit biases

Question 14

language barriers

Answer 14

• takes longer to explain, even with translators

- familiar translators may edit or leave out med info

Question 15

unintentional or implicit biases

Answer 15

• communication patterns different between white and POC
• time pressured comm rather than pt centered comm
• lack of understanding of cultural norms

Question 16

room for growth

Answer 16

• pt will be more compliant with meds if they understand the reason for their use
• pt needs to value the med

Question 17

1906 Pure Food and Drug Act

Answer 17

• first fed legislation regarding meds
• goal = to ensure safety by requiring label to ID dangers and additives
• created first standards for med use and quality

Question 18

1938 Food Drug and Cosmetic Act

Answer 18

required proper testing of drugs for basic safety - doesn’t have to work, but can’t kill you

Question 19

1951 Durham-Humphrey Act

Answer 19

made meds either prescription or OTC

- classified some meds that cannot be refilled w a new prescription each time (highly addictive drugs)

Question 20

1962 Kefauver-Harris Amendment

Answer 20

additional legislation requiring drug companies to prove that the medication really worked for what they said it was for

Question 21

1970 Controlled Substance Act

Answer 21

categorized addictive drugs into 5 categories with dispensing restrictions

Question 22

C-1

Answer 22

Ilegal drugs

• no prescription can be written
• not medically recognized

Question 23

C-2

Answer 23

highly addictive pain meds and stimulants in high doses

- no refills

Question 24

C-3

Answer 24

moderately addictive pain meds in small doses

• some combination drugs
• limited refills

Question 25

C-4

Answer 25

limited addictive meds, some psych meds and anti-anxiety meds - limited refills

Question 26

C-5

Answer 26

low dose opiates and limited addictive | - cough suppressants, antidiarrheals, etc

Question 27

handling of controlled substances

Answer 27

- locked in Automated drug dispensing devices (ADDD) - must be signed out and every dose accounted for - any wastage must be witnessed - narcotics counted per hospital policy

Question 28

Nurse Role in Medication Administration

Answer 28

1) know institution policies regarding med admin (know standard expectations of you) 2) use the eight rights 3) must be licensed to give meds 4) no negligence (less than is expected of RN) 5) no malpractice (wrong med is serious error)

Question 29

Medication error - what do you do?

Answer 29

* focus on pt response * assess * call MD * document pt response and your actions (don't use words like error or mistake) * state the facts * do an incident report * tell your clinical instructor

Question 30

Ethics requires:

Answer 30

``` do what is best for the patient (beneficence) do no harm/keep pt safe (nonmaleficence) informed consent/no coercion (autonomy) be fair (justice) tell the truth (veracity) maintain confidentiality ```

Question 31

black box warnings

Answer 31

indicate that serious adverse effects have been reported with med (may still be prescribed if prescriber is aware of potential risk)

Question 32

Common OTC medications

Answer 32

cold meds, pain meds, GI meds, topical steroids, smoking cessation

Question 33

Herbal meds/dietary supplements

Answer 33

no prescription needed, but can have side fx and interact with other meds. many have no proof of effectiveness and have not been researched

Question 34

potential dangers of OTC/herbal

Answer 34

- people feel they are completely safe - people self-prescribe - mix with other meds with no fear - herbal meds are not FDA approved , so no labels are required - some can be toxic to children, pregnant or breastfeeding women

Question 35

for information, search:

Answer 35

OTC - label or package insert, PDR for non-prescription Herbal - difficult to find food researched info; limited evidence or may not be studied

Question 36

Aloe Vera

Answer 36

uses: topically for wound healing; good for burns. orally as a laxative s/e: diarrhea, kidney damage, abd pain, skin rash interacts with: some heart meds, diuretics, steroids

Question 37

Echinacea

Answer 37

``` "the natural antibiotic" uses: antiviral; for influenza s/e: liver toxicity, skin rash interacts with: steroids, fungal meds, cancer meds take occasionally only for best fx ```

Question 38

Ginko Biloba

Answer 38

uses: stimulates brain, dissolves clots, vertigo s/e: stomach upset, HA, *bleeding* interacts with: ASA, NSAIDS, heparin/coumadin, antidepressants

Question 39

Ginseng

Answer 39

uses: stimulant, analgesic s/e: HTN, diarrhea, nervousness, HA, insomnia, *bleeding* interacts with: heparin/Coumadin, ASA, NSAIDS

Question 40

Kava Kava

Answer 40

uses: anxiety, stress s/e: enlargement of pupils interacts with: alcohol, psych meds

Question 41

St John's Wart

Answer 41

uses: depression s/e: GI upset, fatigue, dizziness, confusion, dry mouth interacts with: psych meds, huge list of foods

Question 42

Saw Palmetto

Answer 42

uses: shrinks enlarged prostate s/e: GI upset interacts with: contraceptives, estrogen (OK since used for men)

Question 43

Valerian

Answer 43

uses: restlessness, muscle pain s/e: CNS depression interacts with: sleeping pills tastes and smells terrible

Question 44

Grapefruit

Answer 44

interacts with MANY meds it "uses up" enzymes needed to metabolize medications; therefore if taken with grapefruit, some meds can be at toxic levels.