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NRSG 213 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

Medication polymorphism

A

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

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2
Q

pharmacogenetics

A

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

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3
Q

Cytochrome P450

A

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.

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4
Q

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

A

CYP2C9, CYP2C19, CYP2D6

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5
Q

Poor metabolizers

A

metabolize a medication very slowly

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6
Q

Intermediate metaboliers

A

metabolize meds at a rate between poor and nomal

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7
Q

Normal metabolizer

A

most common; metabolizes @ expected/normal rate

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8
Q

Rapid Metabolizer

A

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

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9
Q

Ultra-rapid Metabolizer

A

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

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10
Q

Medication adherence

A

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

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11
Q

Adherence is higher with diseases…

A

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

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12
Q

Adherence is impacted by:

A

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

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13
Q

Factors leading to lower adherence rates

A
  • 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
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14
Q

language barriers

A
  • takes longer to explain, even with translators

- familiar translators may edit or leave out med info

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15
Q

unintentional or implicit biases

A
  • communication patterns different between white and POC
  • time pressured comm rather than pt centered comm
  • lack of understanding of cultural norms
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16
Q

room for growth

A
  • pt will be more compliant with meds if they understand the reason for their use
  • pt needs to value the med
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17
Q

1906 Pure Food and Drug Act

A
  • 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
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18
Q

1938 Food Drug and Cosmetic Act

A

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

19
Q

1951 Durham-Humphrey Act

A

made meds either prescription or OTC

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

20
Q

1962 Kefauver-Harris Amendment

A

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

21
Q

1970 Controlled Substance Act

A

categorized addictive drugs into 5 categories with dispensing restrictions

22
Q

C-1

A

Ilegal drugs

  • no prescription can be written
  • not medically recognized
23
Q

C-2

A

highly addictive pain meds and stimulants in high doses

- no refills

24
Q

C-3

A

moderately addictive pain meds in small doses

  • some combination drugs
  • limited refills
25
Q

C-4

A

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

26
Q

C-5

A

low dose opiates and limited addictive

- cough suppressants, antidiarrheals, etc

27
Q

handling of controlled substances

A
  • 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
28
Q

Nurse Role in Medication Administration

A

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)

29
Q

Medication error - what do you do?

A
  • 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
30
Q

Ethics requires:

A 
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
31
Q

black box warnings

A

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

32
Q

Common OTC medications

A

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

33
Q

Herbal meds/dietary supplements

A

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

34
Q

potential dangers of OTC/herbal

A
  • 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
35
Q

for information, search:

A

OTC - label or package insert, PDR for non-prescription

Herbal - difficult to find food researched info; limited evidence or may not be studied

36
Q

Aloe Vera

A

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

37
Q

Echinacea

A 
"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
38
Q

Ginko Biloba

A

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

39
Q

Ginseng

A

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

40
Q

Kava Kava

A

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

41
Q

St John’s Wart

A

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

42
Q

Saw Palmetto

A

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

43
Q

Valerian

A

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

44
Q

Grapefruit

A

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

NRSG 213 (9 decks)

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