Lecture 2 Exam Review Week 4 Lecture Flashcards
Study of drugs that alter functions of living organisms
Pharmacology
Use of drugs to prevent, diagnose, or treat signs and symptoms and disease process
Drug therapy
Drugs given for therapeutic process derived from plants, animals, minerals, and synthetic compounds
Medications
Acts on the site of application
Local
Taken into the body and circulated via the bloodstream to sites of action, and then eliminated by the body
Systemic
Drugs are classified according to their ?
Therapeutic uses
Body Systems
Chemical Characteristics
Individual drugs that represent groups of a drug
Prototypes
CDER
FDAs Center Drug Evaluation and Research
Approves new drugs annually, approves for OTC availability, determines need for clinical trials, ensuring safety and efficacy, and black box warnings
Name legal routes of access
Prescription
OTC
Generic Name
Related to the chemical or official name, independent of manufacturer
Trade Name
Designated and partnered by manufacturer
Title II =
Controlled Substances
Comprehensive Drug Abuse Prevention and Control Act
Manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, anabolic steroids
Schedule 1
No Use
ex : LSD, Ecstacy
Schedule II
High Abuse potential
ex Morphine, cocaine, meth, Phen orbital
Schedule III
Less potential for abuse
ex anabolic steroids and mixed codeine
Schedule IV
Accepted Medical Use
Benzos, phentermine
Schedule V
Moderate amounts of a controlled substance
ex Anti diarrheal and cough suppressants
ISMP
Institute for Safe Medication Practices
High Alert Meds
Pregnancy categories for Safety
BEERS Criteria
National Patient Safety Goals
TJC ( Sentinel Event 2001)
Do not use Abbreviations list
Targeted High risk activities
Cells are dynamic factories that take in?
Raw Materials
Manufacture products for the body
Differ from one tissue to another
Deliver to appropriate destination
Cells can ?
Exchange materials with immediate environment
Obtain energy from nutrients
Communicate with another via biologic chemicals
Sites of Administration
PO
GI Tract
Liver
Capillaries
Go to Bloodstream
Circulate to Target Cells
Perform Action
Return to Bloodstream
Liver- Metabolites
Bloodstream
Kidneys
Urine
Pharmacokinetics
Movement and modification inside the body
ADME
A Absorption
D Distribution
M Metabolism
E Excretion
Onset of drug action determined by the rate of absorption.
Absorption
Distribution
Carried by blood and tissue to fluids to action, metabolism, and excretion sites.
Metabolism
Method by which drugs are inactivated or Bio transformed by the body.
Drug- metabolizing enzymes are located within the kidneys, liver, RBCs, plasma, lungs, gastrointestinal mucosa.
Excretion
Elimination of medication from the body requiring adequate function of circulatory system, kidneys, BM, lungs and skin
Pharmacodynamics
Drug actions on target cells
DF
Process by which drugs alter cell physiology and affect the body.
What can turn on and off, promote or block responses that are part of the body process
DRUGS
Drugs interact with one or more cellular structures to alter cell function
Drug Receptor Interaction
Drugs may also combine with other molecules in the body to achieve their effect. True or False
True
Frequency, size, number of doses
Meet ADQ. concentration
loading doses
Maint. doses
Dosage
Route of Admin.
Influences absorption
Iv= Most effective
Name some Drug- Diet interaction examples.
Tyramine foods plus MAIOs may lead to HTN and Intracranial Hemorrhage
Green veggies vs Warfarin
Grapefruit and statins= metabolism inhibited
Additive Effects
2 similar actions
Synergism
2 Different sites = greater effects
Interference
Drugs that interfere with metabolism of each other
Displacemtn
One drug bullies another protein binding drug
ANtidote
Antagonize toxic effects
Decrease intestinal absorption
Increased rate of metabolism
Therapeutic Range
Concentration of drug in the blood serum that produces desired effect without toxicity
Peak Level
Highest Plasma Concentration
Trough Level
The point at when the drug is at its lowest concentration, and indication the rate of elimination is
Half Life
Amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body.
Serum Drug Level
Laboratory Measurement of the amount of a drug in the blood at particular time which reflects
Dosage
Bioavailability
Rates of Metabolism
MEC
Min Effective Concentration
Must be present for efficacy
Toxic Concentration
Excessive Level of medication in bloodstream caused by
Single Large Dose
Repeated Small Doses
Slow Metabolism of medication
Name Some PT related Variables
Age
Weight
Genetics
Pre existing Conditions
Psycho
Developmental
Sex
Environment
Timing
Adverse Drug Reactions
Side Effects
Allergic Reactions
Drug Tolerance
Toxic Effect
Idiosyncratic - Unpredictable
Drug Interactions
Any undesired responses to med admin.
Adverse effects
All Drugs can produce adverse effects
More likely to occur with specific drugs
Toxicology Drug Overdose
Results from excessive medication
May damage body tissues
Common in peds and older adults
Start Treatment as soon as possible
Support and stabilize function
Prevent further absorption
Activated Charcoal
Name Principles of Accurate Drug Administration
Follow Rights
Learn information of the drug
Interpret Prescribers order
VO/TBO/RBO
Read labels
Use approved abbreviations
Calculate Doses accurately
Measure Doses accurately
General Principles of Drug Administration
Use correct procedures
Seek info from Patient
Verify the Identity
Omit or Delay doses as indicated
Vigilance with Peds
Maintain up to date skills and knowledge
Internal and external reporting
Name 5 Rights of Medication Administration
RIGHT
Patient
Drug
Dose
Time
Route
Three Checks READ THE LABEL
- When Nurse reaches for the container or the unit dose package at MSS
- After retrieval from the drawer and compared with the MAR/ EMAR immediately before pouring from multidose container
- Before giving to the patient or when replacing the mult dose container in the drawer or shelf
Name the parts of the medication order
PT name
Date and Time
Name of Drug
Dosage
Route
Frequency
Signature of Person
How to Identify the Patient
Checking the ID bracelet
Validatiing the PT name
Validating ID number, Medical record number, or birth
Comparing CMAR or MAR
Routine Order
Carried out until cancelled by another order
Standing order
As needed
PRN
Stat
Single or 1 TIme
NOW
One time
Controlled Substances orders
Controlled Act of 1970
Name of the Patient
Amount
Hour
Name of provider
Name of the nurse administer
Oral Route
Capsule, pill, tablet, ER, suspension, syrup
Topical Route
Linient, lotion, ointment, suppository, and transdermal patich
Parenteral Route
Injectable
Infusion
Implantation
Pharm Class
MOA and Physiologic Class
Oral Medications can be in
Solid Form
Liquid Form
Oral Route
Enteral Route
Sublingual Administration
Buccal Administration
Controlled Release Tablets
Enteric Coated to prevent stomach upset
Maintains more consistent serum levels
Allows less frequent administration
Contains high amount
Never should be broken, open, crushed, or chewed
Administration of Paternal Medications
Sub Q
Im
ID
IV
Intra arterial
Intra cardial
Intra peritoneal
Intraspinal
Intraosseous
Criteria for Equipment for Injections
Route
Viscosity
Quantity
Body Size
Type of Medication
Sites for IM
Ventrogluteal
Vastus Lateralis
Deltoid Muscle
Sub Q Injections
Into Adipose Tissues
Sites:
Abdomen
Outer aspect of arm
Anterior of thighs
Upper back
Upper ventral or dorsogluteal
Name some Less common injection sites
Nurses may perform
ID
Intraarterial
Physicians must perform
Intra articular
Intrathecal
Longest absorption of all Paternal Routes
Intradermal Injections
Sites include inner forearm and the upper back and under the scapula
Needle Size for ID
1/4 inch or 1/2 inch
25- 27 gauge needle at 5 - 15 degrees
Dose less 0.5 ml
IV medication administered
Delivers drug directly into the bloodstream
Immediate effect and can not be recalled
Used most often in emergency situations
Name some Medication Delivery Systems
Transdermal
Pump Delivery Systems
External or implanted
refillable or long acting without refills
Name ways of preparing medication for Injection
Ampules
Vials
Prefilled
Mixing
Mixing insulins
Reconstituting meds
Topical Administration of Medications
Skin applications
Eye instillations
Ear instillations
Nasal instillations
Vaginal Applicators
Topical
Creams
Suppositories
used for local effect
What should be included in the Medical Record Documentation
Name and Dosage
Route of time
Name of person administering
Site Used
Location of topical or transdermal application
Refused Drugs
Medication of errors
Intentional or inadvertently omitted drugs
Name some type of medication errors
Inappropriate prescribing
extra and omitted or wrong doses
Administration to wrong patient, route or rate
Failure to give medication within time
Incorrect prep
Improper technique
Giving the drug that has deteriorated
Medication Errors
Check the PT condition immediately observe for adverse effects
Notify nurse manager
Complete form used for reporting errors as dictated by facility
Patient Teaching Includes
Review of Techniques
Remind to take as prescribed
Instruct not to alter doses
Caution PT not to share medications
What is included in Medical History Questions?
Current medication orders
The PTs Knowledge of current medications
History of allergic reactions
Can the PT swallow
History of dietary or supplement use
Herbal and Dietary Supplement Concerns
Questionable safety due to unknown substance
Use of supplements may keep the Patient from receiving care.
Supplements may react with prescription drugs to decrease or increase effects
What are some general non drug interventions ?
Promoting Health
Preventing or decreasing the need for drug therapy
Using non drug measures to enhance therapeutic effects or decrease adverse effects
PT teaching
Individualizing Care
Observe the Pt response
Name some specific non drug intervention examples
Promoting health with diet or nutrition
Perform Hand Hygiene
Ambulating, positioning, or exercising
Assisting to cough or deep breath
Applying heat or cold
Scheduling activities to promote rest or sleep
Drug Therapy Evaluation Criteria
Progress to stated outcomes
Accurate administration
Avoidance
Patient compliance
Specific parameters measure to evaluate response to particular medications
Evidence Based Practice
Requires conscientious and continuing effort to provide high quality care to patients
Scientific evidence is integrated with the nurse’s clinical expertise and the PT’s values to yield best practice
Infants and Pediatrics Medication
Differ from adults
Physiological changes influence the pharmacodynamics and pharmacokinetic actions of medications
Variables in absorption, distribution, metabolism, and excretion further to complicate medication process
Pediatric Rule 1994
Pharm industry to submit all known date about the pharmacokinetics, safety, and efficacy of medications used for children
Drug Dosages for Peds
Based on
Growth
Weight
Body Surface Area
Infants things to consider with medications
Correct dosages
comfort care
Safety in administration
Muscle development
Education to parents
Toddlers and Preschoolers with Med Admin.
Involve the group
Short and simple explanations
Adults need to control the administration
School aged and Adolescents
Explain in more detail
May take by themselves but need supervision
Educate on med practices
BEERS Criteria
Potentially inappropriate meds for older adults and meds to avoid for this group with certain medications.
Medication combinations that may lead to harmful effects
List of meds that should be avoided or dosed differently due to renal function
What are some prevention of adverse effects?
Strategies to prevent adverse drug effects in older adults include
Assess medication therapy
Assess Kidney function
Assess therapeutic drug levels
PT education
Medication Adherence and Aging
Poly pharm
Economic Factors
Start slow with low doses
Asymptomatic
Medication in general should be avoided in lactation and pregnancy. True or False
True
Pregnancy
Physiologic changes can alter drug Pharmakinetics
Drug effects are less predictable
Infertility
Drug therapy is crucial
Increases follicular maturation and promote ovulation
Maternal-placental- fetal circulation is complete when?
3rd week after conception
Drugs cross into fetal circulation via the
Placenta
Drugs are metabolized by fetus fast or slow?
Slowly in fetal liver
Enter the brain easily
Excretion slow and inefficient due to immature kidneys
Name principles of drug therapy in Pregnancy
pregnancy
Lactation
Home Care
Teratogenicity
Birth Defects
Likely to occur in first trimester
2nd and 3rd manifest adverse effects
Growth, retardation, resp,. problems, infection, and bleeding
Medication to administered to mother to treat the fetus
Digoxin Fetal Tachy and HF
Penicillin - Exposure to Maternal Syphilis
Brain Effects of Fetus
Can occur with meds taken time during pregnancy
Brain development continues from gestation and after birth
Name some Pregnancy Management Symptoms
Anemias
Constipation
GERD
Gestational Diabetes
N/V
Pregnancy Induced HTN
Selected Infections
Medications that alter uterine motility
Abortifacients- Drugs used to terminate a pregnancy
Tocolytics
Drugs given to inhibit labor, maintain pregnancy,
Postpone birth longer to reduce problems of pre maturity
Name some Labor inducing medications
Prostaglandins
Oxytocic
Analgesics
Anesthetics
Estrogen and Progesterone
Female Sex hormones
Produced by ovaries and secondarily by the adrenal cortex by nonpregnant women
Made from Cholesterol
Hormones combine with serum proteins and are transported to target tissues where they enter body cells
Main Functions is to promote growth in tissues related to reproduction and sex characteristics in women
Estrogen
When is estrogen secreted?
During menstrual cycle
What is necessary during pregnancy for the growth and birth of the fetus
Estrogens
Secreted during menstrual cycle to change endometrial lining of the uterus
Acts to maintain pregnancy if ovum is fertilized
Maintains pregnancy by decreasing uterine contractions
Progesterone
Menstrual Cycle
Follicular Phase
Luteal Phase
Usual is 28 days
Ovulation phase
Common Reproductive Health Problems for Females
PMS
Endometriosis
Menopause
PMDD
Male sex hormones made from cholesterol
Androgens
Most important is Testosterone
Defiance in Primary and Secondary Gonadism
Increased production leads to changes in associated in puberty
Functions include the development of male sexual characteristics, reproduction, and metabolism. Necessary for normal sperm development.
Testosterone
Name Causes Of Erectile Dysfunction
Drugs
Lifestyle Factors
Diseases
Spinal Cord Injuries
Psychological Factors
Prototype PDE 5 Inhibitor- sildenafil
Do not cause erection Enhance the erection by increasing the blood flow to the penis
BPH
50 percent experience by 60. 90 percent by age 70s and 80s
Androgen Deficiency
Hypogonadism
Clinical Manifestations of Androgen Deficiency
Infertility
ED
Decreased hair growth
Decreased Muscle Mass
Breast Tissue
Loss of Bone Mass
Drug Therapy
Androgens
Anabolic Steroids
PDE5 Inhibitors
Prostaglandins
5- Alpha reductase Inhibitors and Alpha - adrenergic receptors
Use of drugs in both classes in combo has demonstrated to be more effective than either drug class alone and is the gold standard for treatment of symptoms of BPH
Adverse Effects of abusing this drug includes
CV Disorders
Liver Disorders
CNS Disorders
Reproductive Disorders
Metabolic Disorders
Derm Disorders
Androgens and Anabolic Steroids
