Med Admin chapter 2&3 Flashcards
An order for a drug to be given as needed based on a nurse’s judgement of safety and patient need
as needed or PRN drug order
A special designation from the FDA that the drug has a higher than normal risk for causing serious and even life threatening problems in addition to its positive benefits for some people
black box warning
Drugs that are highly regulated because they are commonly abused. Also known as “scheduled drugs”
controlled substances
A one time drug order to be given immediately
emergency or stat drug order
Drugs that have the potential to cause significant harm to patients
high alert drugs
The nurse’s authority as defined by the state NPA. It involves the nurse’s judgement and actions while performing professional duties. All nurses must know what is legal in regard to drugs in the state they practice in
legal responsibility
The state law that licenses LPN, RN, Nurse anesthetists, nurse practitioners, and nurse midwives. It describes the minimal educational preparation and professional requirements needed to perform specific functions, including drug administration, to protect the public safety
NPA, nurse practice act
Category of drugs identified by federal legislation as having low risk to patients and may be purchased without a prescription; have low risk for abuse; and are safe when directions are followed
Over the counter (OTC) drugs
The actual physical symptoms that occur with drug withdrawal
physical dependence
Category of drugs regulated by federal legislation because they are dangerous and their use must be controlled; may be purchased only when prescribed. Examples are antibiotics or oral birth control pills
prescription drugs
The authority designated by a individual state that determines who is legally permitted to write an order or prescription for drugs
prescriptive authority
The obligation of nurses to act appropriately, ethically, and to the best of their ability as a healthcare provider
professional responsibility
Feeling of anxiety, stress, or tension when a patient does not have a medication
psychologic dependence
A one-time order to be given at a specified time
single drug order
A drug order that indicates that the drug is to be given until discontinued or for a certain number of doses
standing drug order
What are two examples of medication you do not crush?
24hour tablets and ER or XR
What is the description for a Schedule 1 drug
High potential for abuse. No accepted medical use in treatment in the United States. Lack of accepted safety for use of the drug or other substance under medical supervision.
What are examples for a Schedule 1 drug
alpha-acetylmethadol, gamma-hydroxybutyric acid (GHB), heroin, lysergic acid diethylamide (LSD), marijuana, mescaline, peyote, Quaaludes
What is the description for a Schedule 2 drug
High potential for abuse. Currently accepted use for treatment in the United States. Abuse may lead to severe psychologic dependence or physical dependence.
What are examples for a schedule 2 drug
Amphetamines, cocaine, codeine, fentanyl, hydromorphone (dilaudid), meperidine (demerol), methadone, methylphenidate (ritalin), morphine, oxycodone (percodan), pentobarbital, secobarbital
What is the description for a Schedule 3 drug
Potential for abuse is less than the drugs or substances in Schedules 1 and 2. Currently accepted medical use for treatment in the united states. Abuse may lead to moderate or low physical dependence or high psychologic dependence
What are examples for a Schedule 3 drug
Most drugs are compounds containing some small amounts of drugs from Schedule 2 along with acetaminophen or aspirin such as Tylenol #3 or #4 and Fiorinal. Other drugs include anabolic steroids such as testosterone preparations and sodium oxybate (Xyrem), a drug that contains GHB for use with the sleep disorder narcolepsy. (#3 has codine in it)
What is the description for a Schedule 4 drug
Low potential for abuse relative to the drugs or substances in Schedule 2. Currently accepted medical use for treatment in the United States. Abuse may lead to limited physical dependence or psychologic dependence relative to the drugs or substances in Schedule 2
What are examples for a Schedule 4 drug
Include diet drugs with propionic acid. Other well-known drugs include benzodiazepines (lorazepam [ativan], flurazepam [dalmane], diazepam [valium], midazolam [versed}, alprazolam [xanax]), chloral hydrate, paraldehyde, pentazocine (talwin), phenobarbital (Versed has paralyzing effects)
What is the description for a Schedule 5 drug
Low potential for abuse relative to the drugs or substances in schedule 4. Currently accepted medical use in the United States. Abuse may lead to limited physical dependence or psychologic dependence relative to the drugs or substances in schedule 4
What are examples for a Schedule 5 drug
Include cough preparations with small amounts of codeine and drugs for diarrhea that also contain small amounts of opioids such as diphenoxylate with atopine (Lomotil)
What are two examples of medication that need a 2nd nurse witness
anti-seizure meds and opioids
What is the goal of all regulations and policies?
to verify and account for all controlled substances
What is the most common cause of common cold drug overdoses?
They occur in children because of confusion by parents over the correct dosage to give, so these drugs are no longer recommended for use in pediatric patients (such as Benadryl)
Older patients are at high risk for problems with prescription drugs because they may not take the drug properly because of poor eyesight, memory, or coordination; they may take many drugs that interact with each other; or they may have chronic diseaase that interfere with how the drug works. What is this known as?
poly pharmacy’s
Can you refill a controlled substance?
no, you must acquire a new prescription every time
What is an example for a standing drug order
Amoxicillin 500 mg orally every 8 hours for 10 days
What is an example of an emergency or stat drug order?
Diphenhydramine 50 mg IV stat
What is an example of a single drug order
Cefazolin 1 g IV at 10:00am before surgery
What is an example of a PRN drug order
docusate 100 mg orally at bedtime as needed for constipation
What does PDR stand for?
Physician’s drug reference
Where is the original drug order found?
in the chart
What are the 9 rights of drug administration in order
#1 right patient #2 Right drug #3 Right dose #4 right route #5 Right time #6 Right documentation #7 Right reason #8 Right response #9 Right to refuse
How do you check if it is the right patient
Check the patient’s name using two methods to identify the patient
How do you check if it is the right drug
Check drug order and check drug label
How do you check if it is the right dose
Check drug order and confirm drug dose is appropriate
How do you check if it is the right route
Confirm the drug can be given by the route ordered and confirm the patient can take or receive the drug by the route ordered
How do you check if is is the right time
Confirm the times the drug is ordered are correct. Check for correct time before giving the drug. Check the last time the drug was given.
How do you check if it is the right documentation
Document drug administration after the drug is given. Chart the time, route, and any other specific information as necessary
How do you check if it is the right reason
Confirm the reason or need for the drug
How do you check if it is the right response
Confirm the drug has had the desired effect and document any monitoring needed or adverse effects as needed
What is a Kardex?
It is a pen and paper flip-file card system used for many years that has important patient information and the physician’s orders. It is regularly updated and changed to reflect current orders. This format keeps important information about the patient easily available for all team members. When a unit-dose system is used, all drugs are listed in the Kardex or drug profile sheet. Know Kardex is right now
What are the 3 most common points where drug errors are made
#1 during drug preparation #2 bringing the drug to the patient #3 Giving the drug to the patient
What did the studies say when about potential causes of drug errors?
Studies have pointed to the fast pace of current clinical practice, lower staffing levels, multitasking, and interruptions during the process of preparing and giving drugs
Categories of common high alert drugs can be remembered using the acronym PINCH. What does PINCH stand for?
P is for potassium, I is for insulin, N is for narcotics (opioids), C is for cancer chemotherapy drugs, and H is for heparin or any drug type that interferes with blood clotting
What is medication (drug) reconciliation
The practice of comparing the patient’s drug orders to all of the drugs that the patient has been taking
Needlestick injuries expose nurses to serious infectious diseases such as :
Hepatitis B, Hepatitis C, and HIV
What do you do if a needlestick injury does occur
It is to be carefully recorded in the agency’s needlestick injury documentation system. The exposure control plan, selection of safety products, and needlestick injury documentation system must be reviewed at least once every year
What are some tips used for the safe disposal of prescription drugs
#1 follow the disposal directions on the drug packaging or insert #2 unless directed, do not flush drugs down the toilet; because they can pollute the environment #3 bring unused or expired drugs to a local drug take back program #4 consult with a pharmacist about drug disposal guidelines
What happens when you crush capsules and tablets
it releases all of the drug at once, instead of slowly over time, and can result in accidental overdose
How does the American Nurse Association define an impaired nurse
one who cannot meet the professional Code of Ethics because of excessive use of alcohol or drugs
Some keys to behaviors that may signal a drug or alcohol dependency problem in the nurse include :
increase absences, lateness to work, unexplained “disappearance” from the assigned unit, and decreased alertness. Drug diversion should also be suspected if patients continually report pain despite appropriate drug treatment and if inaccurate narcotic counts are noted. Also frequent spills
Nurses who give drugs are required to follow these 3 levels of rules :
#1 federal laws, which describe rules that control how certain drugs may be given #2 state laws and regulations, or rules, which say who may prescribe, dispense, (give a supply), and administer (or give) drugs and the process to be used #3 individual hospital or agency rules, which may use other guidelines or policies about how and when drugs are given ad the records that must be kept to record drug treatment
Who classified control drugs into 5 schedules
the controlled substances act of 1970
Who can write prescriptions?
Physicians, dentists, nurse practitioners, physician assistants, and sometimes nurse midwives
What should the report form include?
The patient’s name, date, drug, dosage, and the signature of the nurse giving the drug. A follow up note about the patient’s response to the drug may also be required.
Providers who write the prescriptions are also called ___
prescribers
A legal prescription order must contain
#1 the patients full name #2 date #3 name of drug #4 route of administration #5 dose #6 frequency #7 duration #8 signature of prescriber
What do you do if you suspect an error has been made?
immediately check the patient, notify the healthcare provider promptly, and follow any orders the provider gives to reduce the effect of the drug error. It is critical to watch the patient’s condition through measuring vital signs, drawing blood for tests, or using any other method ordered by the provider. Also notify the nursing supervisor and fill out any other agency required reports
(?) According to the patient’s record, a controlled substance has been ordered for pain relief. A review of the narcotics log and the patient’s drug record indicates the drug has been given as ordered. However, the patient reports not receiving relief of pain. What may be a likely reason for the lack of pain relief?
The drug is likely being diverted for illegal purposes
Drugs enter the body and pass into the circulation to reach the part of the body it needs to affect through the processes of diffusion, osmosis, and filtration
absorption
When two drugs are given together and either make one drug stronger or make the action of the two drugs more powerful
additive effect
severe symptoms or problems that can cause great harm
adverse reaction
drugs that work by activating or unlocking cell receptors causing the same actions as the body’s own chemicals
agonist
An antigen-antibody response that can cause hives, rashes, itching, or swelling
allergy
A severe life-threatening form of an allergic reaction
anaphylactic reaction
Drugs that attach at a drug receptor site but do not activate or unlock the receptor
antagonist
drug products that are chemically the same or identical
bioequivalent
The transformation or altering of a drug into either active or inactive chemicals after it has been absorbed
biotransformation
The proprietary name that a manufacturer gives to a specific drug. Also known as a trade name
brand name
drug placement against the cheek
buccal
The names of the chemicals that actually form the drug
chemical name
The drug does what it is supposed to do
desired action
Movement of a drug in the body to reach its site of action by way of the blood and lymph system
distribution
When one drug changes the action of another drug
drug interaction
Giving a drug by way of the gastrointestinal system; oral, feeding tube, sublingual, and rectally
enteral (route)
After they are consumed, drugs are inactivated in the liver before being distributed to other parts of the body
first-pass (effect)
The most common drug name used by the manufacturer in all countries. Also known as the nonproprietary name
generic name
The time it takes the body to remove 50% of the drug from the body
half-life
Adverse drug effects that can result in liver damage
hepatotoxic
An exaggerated response to a drug. An allergy is an example.
hypersensitivity
Responses to a drug that are peculiar and unpredicted
idiosyncratic response
Giving a drug by way of an injection deep into the muscle
intramuscular (IM)
giving a drug by way of injection into a vein or giving the drug into tubing that is connected to a catheter that is inserted into to a vein
Intravenous (IV)
Adverse drug effects that can result in kidney damage
nephrotoxic
Giving a drug by way of an injection or an infusion underneath the skin
parenteral (route)
Drugs that attach to the receptor site but produce only aa partial effect rather than a full effect (agonist)
partial agonist
Giving a drug by way of absorption through the skin. Topical creams, patches, or devices under the skin are common examples
percutaneous (route)
The effects of a drug on body function (what a drug does to your body)
pharmacodynamics
The metabolism of a drug within the body (what the body does to a drug)
pharmacokinetics
The use of drugs in the treatment of disease
pharmacotherapeutics
Drugs that must be metabolized before they are active
prodrug
Small “lock-like” areas of cell membranes that control what substances either enter the cell or change its activity
receptor site
Mild but annoying responses to the drug. Nausea and headache are common and usual side effects to many drugs
side effect
The ability of a drug to dissolve in body fluids
solubility
Drug placement into fatty tissue
subcutaneous
Drug placement under the tongue
sublingual
The effect of two drugs taken at the same time is greater than the sum of the effects of each drug given alone
synergistic effect
The proprietary name that a manufacturer gives to a specific drug. Also known as a brand name
trade name
