Midterm - Combined deck Flashcards
What are the four basic pharmacokinetic processes? Hint: MOTIONAcronym: MADE
- absorption2. distribution3. metabolism4. excretion
MEtabolism + excretion = ___________
elimination
The movement of a drug from its site of administration into the blood?
absorption
Drug movement from the blood to the interstitial space of tissues and from there into cells (from blood to target)
distribution
AKA Biotransformation; enzymatically mediated alteration of drug structure.
Metabolism
Movement of drugs and their metabolites out of the body.
excretion.
What are the three ways a a drug can cross cell membranes?
- passage through channels or pores
- passage with aid of transport system
- direct penetration of the membrane itself.
In order to directly penetrate membranes, a drug must be ______ ______ .
Lipid Soluble (lipophilic) p.28Remember: Like dissolves like. If chemical is lipid soluble it can get through lipid membrane
The ____ of absorption is how soon effects will begin. The _____ of absorption helps determine how intense effects will be.
Rate;amount
Rate of dissolution, surface area, blood flow, lipid solubility and pH partitioning are all factors affecting _______.
absorption
The two common routes of drug administration are:
enteral and parenteral.
What is the difference between enteral and parenteral?
enteral is in the GI Tract. Parenteral is anywhere else. Usually means by IV,IM, SC.
Why does the site of drug administration matter? How does it change the effects?
The barriers to absorption associated with each route are different.
Does absorption take place when IV drugs are administered?
No. Absorption is the movement from site of administration INTO the blood. WIth IV, it goes directly into the blood.
What is the advantage to using IV for poorly soluble drugs?
The drugs can be dissolved in large volume of fluid and into the body through IV.
What is the recommended time for injecting a drug via IV? Why?
Over a 1 minute interval at least. It takes 15 second from arm to brain. We would have the chance to see any negative effects before emptying a syringe into the patient. p.33
What should you check for in IV solutions before administering drugs?
Check that drugs are in solution. If cloudy or contains particles, do not use!!!
What is the only barrier to absorption for IM administration?
the capillary wall; The same goes for SC (or SubQ)
What determines the absorption rate of IM administration?
- water solubility
2. blood flow at the site of injection.
If a drug is has poor solubility, even in IV solution, what method of administration can we use?
IM
What is a depot injection?
the administration of a sustained-action drug formulation that allows slow release and gradual absorption, so that the active agent can act for much longer periods than is possible with standard injections. Depot injections are usually given deep into a muscle.
What is a benefit to an IM Depot injection?
Long lasting means fewer injections
If your patient is on coumadin, warfarin or any other anticoagulant, can you give them IM medications?
No. The risk of bleeding is too high.
What are two barriers to absorption in the case of oral administration?
- GI Tract epithelial cells2. Capillary Wall
The rate and extent of drug absorption following oral admistration can be highly variable due to:1. solubility and stability of drug2. gastric and intenstinal pH3. gastric emptying time4. _____________________5. other drugs in system3. coatings on the drug itself
Food in the gut.
What is the safest administration?
oral! no risk of fluid overload, infection or embolism, reversible.
A ______ is a mixture of a drug plus binders and fillers, all of which have been compressed together.
tablet
An ________-________preparation is covered with material designed to dissolve in the intestine, but not the stomach. Those materials used in the covering include fatty acids, waces and shellac.
Enteric-Coated
________ - _________ preparations are capsules filled with tiny spheres which contain the actual drug. The spheres have their own coatings. Why?
Sustained-Release; because the coatings dissolve at different times, allowing the drug to be released over time.
Drug distribution (movement of drugs throughout the body via the blood) is determined by three major factors:
- blood flow to tissues
- ability of drug to exit vascular system
- ability to enter cells
Why are abscesses and tumors resistant to drug therapy?
no blood supply in abscesslimited blood supply in tumor
Drugs enter into the blood and are transported where to exit the vascular system?
Capillary beds
Only drugs that are _____ ______ or have a _______ _____ can cross the BBB.
lipid soluble ; transport system
what protein in the blood binds to free drugs in the bloodstream?
plasma albumin
T or F: Hepatic metabolism always results in the breakdown of drugs into smaller molecules.
False, sometimes is synthesizes a molecule larger than the parent drug.
Drugs must be converted from ______-soluble to _______-soluble so that they may be excreted from kidneys. The most important consequence of drug metabolism is promotion of renal drug excretion.
lipid;water
A drug that is pharmacologically inactive as administered, but becomes active in the body after conversion.
Prodrug (p.39)….like provirus…sits around and waits.
List some reasons children under 1 are at risk with medication…
- BBB not fully developed2. liver not fully developed3. Kidneys are not full developed.
_______ is the process of stimulating enzyme synthesis.
induction p.39
How can malnutrition effect hepatic-drug metabolism?
poor diet may be missing important cofactors required for the drug to metabolize/function.p.40
The most important organ for drug excretion is the ______.
kidney
What are the three steps in renal drug excretion?
http://www.youtube.com/watch?v=4X8pAizadWI
- glomerular filtration (moves drugs from blood to urine)
- passive tubular reabsorption (lipid soluble drugs move into blood)
- active tubular secretion (tubular pumps organic acid /base from blood to urine)
What are some examples of nonrenal routes of drug excretion?
- Breast milk
- Bile (bile goes to small intestine, then our through feces)
- Lungs (anesthetics)
- Sweat and Saliva (in small amts)
If we administer two drugs that use the same transport system, will excretion of them be delayed? if so, why?
Yes, because the renal tubules are like revolving doors and can only carry a limited number of drug molecules per unit of time.
T or F: There is a direct correlation between therapeutic and toxic responses and the amount of drug present in plasma.
True. We can measure concentration in plasma instead of at the site (ie. can’t take sample from epileptic brain). p.43
Two plasma drug levels are super important:
- minimum effective concentration;
- ______ ______
toxic concentration
T or F: Concentration of drug must be at or above MEC.
TRUE; MEC = MINIMUM!
The _______ range is between the MEC and the toxic concentration.
Therapeutic Range
Which drug is harder to administer, one with a broad or narrow therapeutic range?
narrow. broad has more room to move within the range.
____ ___-___ is defined as the time required for the amount of drug in the body to decrease by 50%. Affects the potency for a medication.
Drug Half-Life
T or F: Regardless of the size of the dose, reaching the plateau takes the same amount of time for that particular drug.
True. The grams in the body would be greater, but the time it takes would not be different since it is always based on half-life (the time it takes to leave the body).
Fluctuations are seen between doses. The high concentration is called peak. The low concentration is the trough. How can we reduce fluctuations in drug levels?
- Administer by continuous infusion
- Administer depot preparation
- reduce the size of each dose and the dosing interval simultaneously.
The longer the half-life, the longer it takes to plateau. What can be done to reach the initial high level quicker upfront?
Administer a loading dose. By definition it is a large initial dose. p. 45
After the loading dose, _______ doses are given.
maintenance
T or F: It takes four half-lives for a drug to clear the body.
True. Each drug has it’s own individual half-life (length of time). It will take four of those to clear the system.
Avoirdupois 1kg = ___ lbs?
2.2 lbs
Gr stands for?
grain
dr stands for ?
dram
how many minims is 1 dram?
60 minims (60 minute drama on tv)
oz means?
ounce
how many ounces in a cup?
8 oz
how many cups in a pint?
2 cups
what does the symbol “T” stand for? How about “t”?
T = Tbspt= tsp
how many mL is 1 t?
5 ml
how many mL is 1T?
15 ml
how many pints to 1 quart?
2 pints
How many micrograms (mcg) to 1 gram?
1 million (1,000,000) mcg
how many grams to 1 kg?
1000g
The study of drugs in humans
Clinical Pharmocology
Use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy. Also considered medical use of drugs.
Therapeutics (aka pharmacotherapeutics)
Any chemical that can affect the living processes.
Drug
Study of drugs and their interactions with living systems.
Pharmacology
What are the three most important characteristics that any drug should have?
Effectiveness (most important), Safety and selectivity.
Is there such thing as a safe drug?
No. All drugs have the ability to cause injury, esp with high dose and/or prolonged use.
How can we reduce the chance of adverse effects?
Proper drug selection and proper dosing.
What does selectivity mean?
A drug that elicits only the response it was given for.
T or F: We want drugs to be reversible and predictable.
True.
What is the therapeutic objective?
To provide maximum benefit with minimum harm.
What factors determine the intensity of drug responses.
- Administration (dosage, time, route)2. Pharmacokinetics3. Pharmacodynamics
(In human body) Drug absorption, distribution, metabolism and excretion are four major ______ processes.
Pharmacokinetics
Impact of the drug on the body once it reaches its target site?
Pharmacodynamics
The _____ - ____ _____ refers to the rapid hepatic inactivation of certain oral drugs (liver metabolizes quickly). When the drug is absorbed from the GI tract, they are carried straight to the liver. If the capacity of the liver to metabolize the drug is high, the drug becomes completely inactivated with no therapeutic effect.
First Pass Effect
For a great short video:
http://www.youtube.com/watch?v=QVCNfja7wkk
http://www.youtube.com/watch?v=xiuWdJYyIKs
What can we do to circumvent (bypass) the first-pass effect?
administer the medication parenterally (under the tongue, through injection or IV). This allows it to reach therapeutic levels in the systemic blood and bypass the liver. Gets to the site of action before hitting the liver.
The study of the biochemical and physiologic effects of drugs and the molecular mechanisms by which those effects are produced.
Simply put, the study of what drugs do to the body and how they do it?
Pharmacodynamics
____-_____ ______ is the relationship between the size of an administered dose and the intensity of the response produced.
dose-response relationship
Is the dose-response relationship graded or all-or-nothing? what is the importance of this?
Graded, which gives us more control and allows us to fit the needs of the patient. If it were all-or-nothing, and could only produce one intensity of response, we could not treat various patients with that drug.
_____ _____ is defined as the largest effect that a drug can produce. It is indicated by the height of the dose-response curve.
Maximum Efficacy
T or F: A drug with very high maximal efficacy is more desirable than a drug with lower efficacy.
False, we want to match the intensity of the response to the patient’s needs. Ex. Furosemide can cause dehydration because it is a high efficacy diuretic. We may choose a lower efficacy to reduce the intensity of volume of water to be mobilized.
The term ______ refers to the amount of drug we must give to elicit an effect.
potency
If morphine produces pain relief at a lower dose than meperidine, is it more potent or less potent?
more potent
Drugs are chemicals that interact with chemicals inside the body. ________ are the special chemicals in the body that produce effects. It is any functional macromolecule in a cell to which a drug binds to to produce effects.
Receptors
The binding of drugs to receptors can either _____ or ____ the action of the body’s own regulatory molecules.
mimic (agonist) or block (antagonist)
T or F: Drugs produce their therapeutic effects by helping the body use its pre-existing capabilities. Drugs cannot give cells new functions.
TRUE
There are four primary receptor families.
- Cell membrane embedded ______
- __ protein-coupled systems
- ligand-gated ____ channels
- transcription factors
- enzymes
- G
- ion
Transcription factors differ from other receptors in two ways. 1. They are found _____ the cell rather than _____ the cell. 2. Responses to activation of these receptors are _____ instead of _____.
p.52
- inside/within the cell rather than outside the membrane
- delayed versus instant, or within milliseconds.
Transcription factors are situated in the nucleus on the DNA; therefore, they can only be activated by ______ that are ______ soluble.
ligands; lipid
The more selective a drug is, the fewer side effects it will produce. Why is that?
Selective drug action is possible because drugs act through specific receptors. p.52
If drugs are selective for one receptor only, why does the drug still cause some side effects?
The receptor may be located in more than one area of the body, causing side effects.
_______ _______ Theory states that the intensity of response to a drug is proportional to the number of receptors occupied.
Simple Occupancy Theory
The strength of the attraction between a drug and its receptor.
Affinity
T or F: Drugs with high affinity (attraction to receptors) can bind when present in low concentrations. This means drugs with high affinity are potent.
True.
This term refers to the ability of a drug to activate a receptor upon binding. The higher this activity, the more intensely a receptor is activated.
intrinsic activity
Affinity is to potency as Intrinsic activity is to ______ _____. Drugs with high intrinsic activity cause intense receptor activation, therefore intense responses.
maximal efficacy
T or F: Agonists are molecules that activate receptors. These molecules include neurotransmitters, hormones, other endogenous regulators as well as drugs that mimic them.
TRUE
__________ produce their effects by preventing receptor activation by endogenous regulatory molecules and drugs.
antagonists
Affinity allows the agonist to bind to receptors. What does intrinsic activity allow?
Allows the bound agonist to activate or turn on the receptor function. p.54
T or F: If there is no agonist present, antagonist will still have an effect.
False. antagonist prevents agonist from activating receptor. If there is no activation, antagonist cannot deactivate.
Antagonist can be competitive or non-competitive. Non-competitive bind ________ to receptors. They reduce the maximal response an agonist can elicit.
irreversibly.
Because irreversible they are rarely used therapeutically.
Because competitive antagonists bind reversibly to receptors, the inhibition they cause is _________.
surmountable.
What causes down-regulation? Hint: Down-regulation is also referred to as desensitized or refractory.
When receptors of a cell are continually exposed to an agonist, the cell usually becomes less responsive.
Does-response curves demonstrate efficacy and potency. There are three phases:
Phase 1 - does is too low to elicit a response (curve relatively flat)
Phase 2 - bigger dose elicits a bigger response (curve climbs upward)
Phase 3 - ______________ (curve levels off)
Phase 3 - bigger doses are unable to elicit a further increase in response.
What are the seven rights of medication administration?
Right Patient, Drug, Dose, Time, Route, Technique, Documentation.PRTTDDD
How can you ensure you have the right patient?
Ask the patient for his or her name and birthdate. Double check ID bracelet.
How can you double check that you have the correct drug?
CHECK LABEL!!!!
- Check before taking from shelf.
- Check before pouring the drug out.
- Check before putting bottle back on shelf.
If you suspect that a doctor prescribe an incorrect dose, what do you do?
Double check before administering.
Does the condition of the liver matter in dosing?
Yes, if the liver does not function properly, a toxic amount of medication could build up.
T or F: Drug administration takes place in the hospital at times the patient chooses?
False. Drugs such as antibiotics have regular intervals at which drugs must be given to be effective.
Can you rely on the pharmacy to send the correct form of a medication or must you alert them as to your patient needs.
We must alert. Where the medication will be given depends on the patient and his/her condition. If they cannot swallow, we may need an IV or GI version.
If you are unsure of where or how to administer a medication, what can you do?
Access written procedure manuals available in the workplace.
When you are documenting (charting), what info must be included about drugs you administered?
Drug,Dose,Route, lot#, expiration date.
What are some important physical factors to consider before administering drugs?
Age, weight, nutrition, gender, culture, environment, pregnancy and organ function.
Where can I find a list of commonly confused drug names?
http://www.ismp.org/tools/confuseddrugnames.pdf
What do abbreviations tell us? examples: ID, qid, IM
When a med may be taken, how often it can be take, where it should be administered.
The sinister hand is the left, with which many countries use for “dirty” deeds such as toileting. Remeber S is for left. So what is D?
Dextrous - Right
If someone writes a.s., what location on the body are they referring to?
Hint: The letter “a” looks like an ear.
a = ear s = sinister left
Left Ear
The abbreviation “U” means what?
“Both”Remeber: U for union…
What does “bid” abbreviation mean?
bid = bi daily = twice daily
What does the abbreviation o.d. mean?
right eyeRemeber: “o” looks like an eye
NPO?
nothing per oral
IV
intravenously
IM
intramuscularly
ID
intradermallyDef:1. within the dermis.2. intracutaneous.
What does the abbreviation of “C” w /line over the top of it mean?
with (c with a line)
qid?
4x a dayquattro times a day (cuatro - espanol)
s with a line
without
SC
subcutaneously (into fat)
tid
three times perday
If a diabetic patient is NPO, should you administer insulin?
no, there is no food to interact with.
Where can I find a sample med schedule for patients to use at home?
page 30 - watkins
Why is nutrition an important factor when administering medication?
Some nutrients may be needed for absorption of med. Some nutrients may block absorption.
Although there are normal doses for some medications, may that does change if the patient is an amputee or obese?
Yes.
How does age effect medication administration?
Geriatric patients (over 55) may have decreased muscle mass and function of organs. Examples: Liver - decrease in metabolism / Kidney - decrease in filtration
What is polypharmacy? What is the issue with polypharmacy?
Taking several meds for more than one problem; it increases risk of side effects and interactions.
What do you need to do if you think a child may be having an adverse reaction to a medication you administered?
Fill out a MedWatch form.
Why does gender matter in drug administration?
Men have more muscle to fat compared to women. Medication is absorbed and distributed more quickly in men.
A ________ drug causes deformities when it crosses the placenta.
Teratogenic
Which organs are most affected by SYSTEMIC drug accumulation?
Kidneys, liver, heart
Liver produces ____ ______. A decrease in these levels, can alter the capacity of a drug to bond.
serum protein
Why is it important to educate patients in their own language?
Misunderstanding can lead to injury, overdose, or subtherapeutic treatment (not producing a therapeutic effect).You must tell them the risks of taking too much.
Patients can refuse medication. What can you do to help them feel better about taking it? (patient consent p.35)
Educate them on what it is for, how to take it, etc. If they still refuse, let them know risks of not taking the treatment. Do not force them . Technically forcing med on someone is considered assault and battery. It is there choice. Inform the dr and chart that they refused treatment.
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
______ allows patient control over their medical record include access and how it is shared with other.
HIPAA
If, after being notified that your patient has ingested a toxic substance, you activated the emergency response system and were connected to poison control, what may you be asked to do? (Hint: Steps to treating the patient)
- Administer charcoal (binds with poison); usually after stomach pumping (lavage)
- Have patient drink large amount of water to dilute poison
- Have patient drink milk to reduce acidity.
- Monitor patient for symptoms: HR, Resp Rate, Seizures, etc.)
What is the name of the syrup that induces vomiting? Why is it no longer suggested?
Ipecac. Not effective and can cause complications.
Before administering medication (including emergencies), what should you ask the patient?
Are you allergic to any medications?
Why is important to observe a patient for 15 minutes following an injection antibiotic or allergy shot?
To watch for allergic reaction. Document this in your charts!
If a patient has swelling in the neck, difficulty breathing, itching, wheezing, anxiety and light-headedness, they may experiencing __________.
Anaphylaxis - a sever allergic reaction
T or F: Some drug interactions are desired.
True.
When drugs interact, there are three possible outcomes. List them.
- One drug may intensify the effects of the other
- one drug may reduce the effects of the other
- the combo can produce a new response not seen with each drug individually.
What is the term used for the type of interaction where one drug intensifies the other?
potentiative (poh ten she uh tiv)
Drug interactions can occurs when combined in an IV solution. They may form a precipitate. What should you do if a precipitate forms? Should you rely on a precipitate to form to know whether or not an interaction has taken place?
If you see a precipitate in an IV, the IV must be discarded.You cannot rely on the precipitate because it does not ALWAYS happen. You must NEVER combine two drugs in one IV unless it has been established that a direct interaction will not occur.
if the pH increases does it become more basic or acidic?
Basic
if a drug were to increase extracellular pH, would it increase the ionization of a acidic drugs?
Yes.
How do drugs increase the metabolies?
by inducing synthesis of hepatic drug metabolizing enzymes..
How does a drug causing reduction in cardiac output decrease drug filtration?
Glomerular filtration is decreased by drugs that decrease cardiac output. The blood flow is reduced, decreasing excretion.
What are a some simple things we can do to minimize drug-drug interactions?
- Take a thorough drug history
- Encourage patients to share any “street drugs,” supplements and OTC drugs they are taking.
- Monitor for early signs of toxicity.
How does grapefruit juice raise drug levels in the blood?
By inhibiting metabolism. The drug becomes built up in the system.
When a medication order says to administer a drug “with food”, when should the medication be given?
With the meal or right after eating.
Why do some medications require to be taken with food?
It may increase absorption or it could help prevent stomach upset.
To administer a drug on an empty stomach, you should give the medication either ____ before a meal or ____ after.
1 hour before or 2 hours after.
If medical orders do not dictate with or without food, what should you do?
Ask the prescriber to confirm whether or not the patient should eat.
ADR (Adverse Drug Reactions) are any noxious, unintended, undesired effect that occurs at normal doses. Does this definition include undesired effects of excessive dosage?
No!
What is neutropenia?
presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection. It is an undesirable side effect of some cancer treatments.neutro = neutrophilspenia = lack of
What do neutropenia, hepatocellular injury, cardiac dysrhythmias, anaphylaxis and hemorrhage have in common?
They are all severe drug reactions.
A _______ _______ is a nearly unavoidable secondary drug effect produced at therapeutic dose. Ex. drowsiness, stomach upset, nausea, constipation and sensitivity to light.
Side Effect
___________ is an adverse drug reaction caused by excessive dosing. Can cause coma, hypoglycemia, neutropenia.
Toxicity
overdose induced
An _____ ______ is an immune response. In order for this to take place, prior exposure/sensitization must have taken place. Can range from itching to rash or even anaphylaxis.
Allergic Reaction
_______ is a life threatening response characterized by bronchospasm, laryngeal edema, and a precipitous drop in BP.
anaphylaxis
T or F: Intensity of allergic reactions is independent of dosage.
True.
_________ __________ is an uncommon/unique drug reaction. Results from a genetic predisposition. One example is succinylcholine. The effects may last longer because the person produces the enzymes that inactivate the drug slower than normal.
Idiosyncratic Effect
The effect may not have appeared in clinical trials, but must be managed. If serious, report through MedWatch.
“Disease produced bye a physician/drug.”
Iatrogenic Disease
Iatro= relating to physician or medical treatment
Physical dependence develops during long-term use of certain drugs. If this occurs, an abstinence syndrome will result when the drug is discontinued. Is it a good or bad idea to stop “cold turkey?”
Patients should be warned against abrupt discontinuation of any med without consulting a health professional.p.68
__________ __________ refers to the ability of certain medications and environmental chemicals to cause cancer.
Carcinogenic Effect
_________ _______ is a drug-induced birth defect.
Teratogenic Effect (TUR RAT OH JEN ICK)
What are we looking for when we test a blood sample for aspartate or alanine aminotransferases?
We are checking liver function. This is done for patients who need to take known hepatotoxic drugs.
How can drugs that are not supposed to cause liver damage, end up causing liver damage?
When they are mixed with other substances. An example is tylenol + alcohol. Therapeutic dose of tylenol is not toxic. 2-3 drinks combined with it can cause severe liver injury.
What are some signs/symptoms of liver damage?
Jaundice, dark urine, light-colored stools, nausea, vomiting malaise, abdominal discomfort, loss of appetite.
What is a QT interval?
Measure of time required for ventricles to repolarize after each contraction.
What are QT drugs?
Drugs that prolong the qt interval.
What happens when the QT interval is prolonged?
patients can develop dysrhythmias (abnormal rhythm known as torsades de pointes) which can lead to fatal ventricular fibrillaton.
How can we identify if a drug administered is causing the symptoms we see (what questions can we ask):
- Did symptoms appear shortly after the drug was first used?2. Did symptoms abate when the drug was discontinued?3. If drug was reinstituted, did symptoms reappear?4. Is the illness itself sufficient to explain the event?5. Are other drugs in the regimen sufficient to explain the event?p.69
If you suspect a brand new drug is causing an unknown adverse effect, what should you do?
Report it to MEDWATCH FDA Medical Products Reporting Program.
How can you effectively assist your patient in watching for ADRs?
Inform them of what possible ADRs there are with the med being given. This way if something happens, they can report it before it’s too late to treat.
Can a provider or pharmacy withhold GDA med guides?
Yes, if it will deter the patient from taking the med. However, if the patient asks for it, it must be given to the patient (even if it was intentionally witheld).
________ is a preventable event that may cause or lead to inappropriate medication use or patient harm.
Medication Errors
What are some causes of medication errors?>
Events may be related to roles, products, procedures, and systems, including prescribing, order communication, labeling, packaging and nomenclature, compounding, dispensing, distribution, administration, education, monitoring and use.
What are some preventative measure we can take to prevent med errors?
Clarify order No abbreviations/clarify abbreviations Only accept metric system measurements Pay attention to decimal units If multiple drug units clarify Read back order when verbal Clarify order with metric weight, frequency and route Check orders when transcribed Don’t borrow medications Check patient by name verbally and by wrist band Use standard administration times Understand infusion devices
These are all considered what? Allergic Reaction Idiosyncratic effect Iatrogenic Disease Physical Dependence Carcinogenic effect Teratogenic effect Toxicity
side effects
Toxicity is: an ADVERSE REACTION caused by excessive dosing.
What does contraindication mean?
A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the patient.
T or F: The nurse can trust the pharmacy to send the correct medication.
False, always double check meds before administering them.
T or F: The nurse serves as a line of defense against medication errors.
True. Even if a dr prescribes a medicine that can cause harm, it is your responsibility to protect the patient!
What are the three basic goals for preadministration (of drugs) assessment?
- collect baseline data needed to evaluate therapeutic and adverse responses. (condition, weight, agec cond. of liver,BP, etc)
- Identify High Risk Patients (allergies, genetic factors, pregnant, old age, premature?)
- Assessing the patient’s capacity for self-care (can they pay for medication? administer for themselves? forgetful?)
______ is leakage of a fluid out of its container. example: IV fluid leakage.
Extravasation DELETE IN MIDTERM CARD DECK
You should know the specific indication for which the drug is being used. Why?
Depending on which indication used for (headache vs inflammation in the case of aspirin), the dosage changes. Without knowing what indication, you cannot double check the dose nor evaluate for the proper response to the dosage given. ie, given for pain, check for pain change, if no change you change dose. If it’s for inflammation, a change in pain is not necessarily going to tell you if the inflammation has decreased.
What is a PRN (pro re nata) medication order?
One in which the nurse has discretion regarding how much drug to give and when to give it (pro re nata = as needed)
There are four major components to implementing a care plan:
- Drug administration
- interventions to enhance therapeutic effects (exercise AND cholesterol med)
- interventions to minimize adverse effects and interactions (know side effects, foods that block absorption etc.)and
- ___________ ___________
Patient education!!!
Over the course of drug therapy, patient must be evaluated. We check for 1) therapeutic response (is the drug working), 2) adverse reactions/interactions, 3)interventions to promote effects and 4) ________________
interventions to minimize adverse effects.
The nurse is responsible for educating the patient. List some areas we are responsible for. (Some examples are: Who to contact in the event that the patient has a reaction, duration of treatment, method of storage….)
- Drug name and therapeutic category (penicillin - antibiotic)
- Dosage size (take one pill)
- Dosing schedule (take on pill each day for five days in the morning)
- Route and technique of administration (Insert vaginal cream into vagina while lying on your side…etc.
- expected therapeutic response and when it should develop (you will experience a decrease in itching after two days of use).
- nondrug measures to enhance therapeutic effects (if you walk for 30 minutes a day you will decrease stiffness in your hips from rheumatoid arthritis).
- Duration of treatment (you will be on this drug for 7 days)
- method of drug storage
- Symptoms of major adverse effects and measure to minimize discomfort and harm (This drug is known to cause stomach issues. Please be sure to eat before taking the medication).
- Major adverse drug-drug and food-drug reactions (Do not take this with grapefruit because it neutralizes the drug. Don’t take aspirin with warfarin because your blood will become to thin and you are at high risk for bleeding out).
- Who to contact if experience any reactions or a lack of therapeutic effect.
What are the steps in the nursing process?
nursing process Lehne pg. 9
1) assessment (Roy has two levels
2) analysis of the assessment aka nursing diagnosis
3) planning (setting of goals)
4) implementation aka nursing interventionf) evaluation (and modify when necessary)
Why is obtaining baseline data needed in order to evaluate therapeutic effect and adverse effects?
In order to know if we have produced the response we are looking for, we need to est. a baseline to measure against. Same goes for adverse effects we do not expect. Of course hair loss while undergoing chemo is expected… but if liver dysfunction exists and we had no baseline, we cannot tell if it was pre existing.
Why is safe medication storage important?
- Keep away from children
- Teens may abuse vitamins, cough syrup, cold meds and inhalable drugs.
- Elders people who are confused may take medication left on counter.
Why is it important to double check medication before administering to a child?
Babies and young children require lower dosages because their bodies are small and process drugs faster.
T or F: When charting units you should use “U”.
False. Do not use it because it may be mistaken for a zero. write the word unit.
T or F: The abbreviation that should be used for international unit is IU.
False. write international unit. Too easy to mistake IU for IV.
T or F: You should always use a zero before a decimal.
True. This helps spot the decimal.
T or F: You should write out morphine sulfate or magnesium sulfate.
True. Can be confused for each other MS, MS04, MgSO4
What abbreviation should be used for micrograms?
mcg. you may also write out micrograms but DO NOT use the greek symbol.
Can you use the @ symbol when charting?
No. It can be mistaken for a 2. write the word at.
1 cc is equal to 1 ml. Which abbreviations should we use and why?
use mL or milliliters. cc may be mistaken for U (units)
What are some questions we can ask ourselves to identify whether or not an adverse reaction has occurred?
- Did symptoms appear shortly after the drug was first used?
- Did symptoms abate when the drug was discontinued?
- Did symptoms reappear when the drug was reinstituted?
- Is the illness itself sufficient to explain the event?
- Are other drugs in the regimen sufficient to explain the event?
As a result of concerns over patent medicine (questionable remedies), congress passed it’s first federal drug law in 1906 called?
Pure Food and Drug Act of 1906, which required accurate labeling of drugs to prevent substitution or mislabeled ingredients.
A new law replaced the Pure Food and Drug Act of 1906, with more specific regulations including holding the drug developer responsible for drug safety. What was this law called?
The Food, Drug and Cosmetic Act of 1938.
This governing body oversees the safe development of new drugs…
FDA (Food and Drug Administration)
This governing body regulates manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids as well as substances used in their production
DEA (Drug Enforcment Agency)
This federal organization ensures occupational sagety by enforcing standards and providing workplace safety training…
OSHA (Occupational Safety and Health Administration)
Enacts laws geared toward protecting health-care workers from patients’ diseases and requires yearly education to ensure safety of workers.
Controlled substances are categorized in schedules from I to V. Which is the most controlled with the highest abuse potential? Least?
Most is I; least is V
What are some examples of drugs that are in schedule I? Are schedule I drugs approved for medical use?
Heroin, LSD…No!
Why are schedule II drugs so restricted?
Subject to high abuse and severe dependence risk: morphine and opium
Schedule III drugs are right in the middle… what is the chance for dependency? Examples?
Lower abuse potential than schedule II, moderate to low dependence risk; steroids and codeine.
Do drugs in schedule IV such as Valium and Xanax have abuse potential? Dependence risk?
low abuse potential; low dependence risk
What type of drugs are in schedule V?
OTCs like cough medicine
Drug development takes a long time and is expensive. Before bringing a new product to market, it must go through ______ ________.
Clinical trials
What is the purpose of pre-clinical trials?
to determine safe dose and to evaluate drug safety profile.
What is the main difference in preclinical versus clinical trials?
Animals are used in pre/Humans in clinical
What are the goals of phase I in clinical trials?
- evaluate drug metabolism
- pharmacokinetics
- Biologic effects
Clinical trials have three phases. What happens during phase I?
Drug is tested for safety using 20-100 healthy volunteers (unless severe side effects…then tested in ill). Test best administration of the drug and the highest dose to be given without serious side effects.
What happens during phases II and III of clinical trial?
Drug is tested on several hundred patients to see if it works, dosage range, safety and effectiveness.
Upon completing phase III, the manufacturer can apply for conditional approval from FDA. What happens in phase IV?
Postmarketing surveillance. It’s allowed to be used by public under surveillance.
What is the most reliant way to objectively assess drug therapies?
RCTs - Randomaly Controlled Trials
What are three factors that make RCTs reliable?
Control groups, randomization, and blinding (blind tests)
Why is it hard to know what adverse effects will take place with long-term use of drugs?
Clinical trial periods are short.
Drugs have three types of names. What are they?
- chemical name (n-acetyl-para-aminophenol)
- generic or non-proprietary name (acetaminophen)
- Trade or proprietary name (brand name - tylenol)
If there is a new med on the market that does the same thing as a drug that has been on the market for years, which do you prescribe?
The old. It has known side effects and effectiveness. The new one might have unknown risks.
T or F: Brand name products can change active ingredients without changing the product name.
True. This may be dangerous for someone who may have problems with the new active ingredient. Inform patients about brand name medicines and this possibility.
Why is labeling medication with the generic name (instead of the trade/brand name) a good idea?
If a patient has multiple doctors prescribing a med such as ibuprofen, the bottles will read the same and will be more easily recognized by the patient. This will decrease the chance of double dosing.
T or F: Brand name products can change active ingredients without changing the product name.
True. This may be dangerous for someone who may have problems with the new active ingredient. Inform patients about OTC medicines and this possibility.
Is there a diff in the drug of two brands of the same drug?
No. The difference may be absorption rate and/or fillers….
When a drug is first developed, it is known as a mix of chemicals. Although the _____ ______ means nothing to the general population, it is very meaningful to researchers and drugs companies.
chemical name
Once a drug clears phase I to III, it is ready to be put on the market and given a _____ ______or _____ ____. Sometimes called proprietary name.
brand name or trade name.
Example: Aleve is the brand/trade name.
Once the patent period has ended, the drug’s trademark is no longer protected, so other companies ma produce it under a ______ _______.
Generic Name
What is the difference between generic drugs and the original drug?
Fillers.
How can you tell if the name of a drug is generic?
lower case first letter unless it’s the first word in a sentence.
When a drug is first developed it is known as a mix of _____. It gets a _____ name. This helps researchers and people who want to copy the drug.
chemicals; chemicals
Once a drug clears phases I to III of clinical trials, it is given a name to be on the market. What is that name called?
Can be referred to as brand, proprietary or trade name.
Once the patent or trademark status is no longer protected, the drug is produced by others under its ____ name.
generic
What is the difference between a proprietary and generic drug?
The fillers
T or F: Generic names are not capitalized
TRUE
READ: Box 4.1 on page 54
FDA requirements for generic remakes
T or F: Schedule I is the most controlled, while V is the least.
True p. 56
Schedule II drugs have a high potential for _________. ____ number of refills are allowed. Can someone call this prescription in?
Addiction (both psychological and physical); zero refills (ex oxycodone). No, cannot call it in.
Schedule III drugs are ________ addictive. Are these refillable?
moderately; refillable - yes (up to 5 times in 6 months). Ex Tylenol 3. Prescriber has to sign.
Schedule IV have lower abuse potential. Can this be phoned or faxed in once signed by prescriber?
yes
T or F: Prescribers may shorten names by leaving off terms like carbonate, citrate, gluconate, hydrochloride, hydroxide, phosphate, sodium, sulfate.
True.
What is the term for “maladaptive pattern of behavior marked by the use of chemical agents”? A second definition is “drug used in a fashion inconsistent with medical or social norms.”
substance abuse
Some individual may be good at functioning while abusing substances. However, there are physical signs that make them obvious.
What are some signs of substance abuse?
- Changes in sleep patterns
- Excessive weight change
- Excessive sweating
- Excessive tremors
- Poor coordination
- Needle marks
What is addiction?
compulsively driven to take drug; often to the exclusion of other activities.
If a person has developed _______ , they must increase the amount of drugs used to get the same desired effect.
tolerance
After discontinuing a drug, a patient may experience tremors, emotional distress, and hallucinations. These are signs of ________ .
withdrawal
What are some behaviors you may spot in a coworker who is abusing drugs?
- Poor work performance
- Sloppy charting
- Moodiness, restlessness, irritability, and violent temper
- Forgetfulness
- Change in hygiene
With pregnancy drug categories, is the beginning of the alphabet more of a concern or less?
Less. A has no increased risk of fetal abnormalities, but X is the exact opposite. It has definitely shown to cause fetal abnormalities.
Category ___ : Animal studies have shown adverse effects. No adequate studies in pregnant women.
C - memorization tip: we can’t C whether or not it’s harmful because there are no studies.
Category ____: Adequate well-controlled and observational studies of pregnant women demonstrate risk to fetus. Benefits outweigh risk.
D - memorization tip: D is for demonstrated risk
Category ___ ; Positive evidence that harm will absolutely take place. Pregnant women should not take this.
X - memorization tip: cross this one off the list (X it off)
If a drug causes birth defects, it is called _______.
teratogenesis (teras = monster + genesis = to produce literally means to produce a monster)
Fetal development has three major stages:
- preimplantation
- embryonic
- fetal period
In which stage can teratogens cause demise of the conceptus (fertilized egg)?
First stage: perimplantation. The fertilized egg has not implanted at this point. Kennet said fetal demise, however, it is not yet referred to as a fetus.
During which stage of fetal development does gross malformations (including anatomic distortions) occur?
Hint: think about what happens during each stage. During which stage do major organs and structures form?
The embryonic phase (phase 2 - first trimester)
During which stage of development would FUNCTION be affected more than malformations?
(Hint: by function - think learning disabilities, behavioral issues, etc.)
Fetal period; this is when the brain is developing (2nd - 3rd trimester)
T or F: The lack of proof of teratogenicity means a drug is safe.
False!!!!
What is the best way to minimize risk to a fetus?
- Minimize drug use. Do not take any unnecessary drugs!
- Give medication after breast-feeding
- Avoid drugs that have a long half-life
- Avoid sustained release drugs
- Choose drugs that are excluded from milk (Textbook explains, has examples)
- Avoid drugs that are hazardous (don’t give)
- Lowest dose for shortest period
What groups of drugs should be avoided by nursing mothers?
Controlled substances, Anticancer agents/immunosupressants, Others (lithium/nictotine/ergotamine/bromocriptine)
See table 9-3 page 93 of ch9 Lehne
Intensity of the response to a drug is determined in large part by the concentration - the higher the concentration, the more intense the response. If you gave the same dose to a large and small person, which will have more intense effects?
Smaller.
Why is using BSA (Body Surface Area - mg per m2) an accurate way to adjust a dosage?
BSA determinations account for weight AND for how fat or lean the person is. The percentage of body fat can change distribution thereby changing concentration.
What affect does age have on drug sensitivity?
Infants are sensitive because of organ immaturity.Elderly are sensitive due to organ degeneration and first pass effect decreases.
T or F: Abnormal pathophysiology does not affect drug response.
False! Kidney disease, liver disease, acid-base imbalance and altered electrolyte status can affect drug response.
Kidney disease, such as nephrosclerosis, can reduce ________, causing drugs to accumulate in the body (potentially to a toxic level).
Excretion. The dosage must be reduced when this is happening.
If liver function declines, rates of ______ will decline too, and drug level will climb.
metabolism
T or F: Changes in acid-base status can alter absorption, distribution, metabolism, and excretion of drugs.
True. Drugs accumulate on the side where the pH most favors its ionization (remember acid ionizes in alkaline, alkaline ionizes in acid).
What is an example of altered electrolyte status affecting drug response?
Digoxin, a drug for heart disease can cause dysrhythmias when potassium levels are depressed.
NOT IN PPT: Tolerance resulting from accelerated drug metabolism…
Metabolic Tolerance; dosage must be increased to maintain therapeutic levels.
NOT IN PPT: ________ is a form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time. An example is leaving a transdermal nitroglycerin patch on for 24 hours. Must be removed and fiven intermittently to allow cofactors to be replenished.
tachyphylaxis
NOT IN PPT: __________ refers to the ability of a drug to reach the systemic circulation from its site of administration.
bioavailability; different formulations can alter bioavailability, and can thereby make drug responses variable.
What is CYP2D6?
An enzyme; a member of the cytochrome P450 family of enzymes involved in the oxidative metabolism of drugs. CYP2D6 is responsible for the metabolism and elimination of approximately 25% of clinically used drugs.
If a person inherited a deficiency in the CYP2D6 gene, and the drug requires activation by the CYP2D6 enzyme what happens to metabolism?
Metabolism of the drug slows AND toxicity may occur. The dosage may need to be adjusted. The FDA does not require testing for this deficiency but a test is available.
What happens if a person takes two drugs requiring CYP2D6?
They have a drug-drug interaction.
Does ethnicity change the likelihood of having a CYP2D6 Deficiency?
Yes. African Americans and Middle Eastern people have highest risk of deficiency. Asians have the lowest.
What is the purpose of testing CYP2C19?
to determine haplotypes, which tells us what type of metabolizer the person is. Helps predict side effects and expected outcomes of benefit.
T or F: Gene changes can affect how well a medication works and the risks of side effects.
True. If the genes that produce particular enzymes used in drug metabolism decline, so will the enzymes and therefore metabolism.
What are some reasons that pediatric patients are more sensitive to drugs?
- ogran system immaturity
2. pharmacokinetics are different than adults
What are some pharmacokinetic differences from adults in pediatrics ?
- Absorption
BEHIND THE SHORT ANSWER:
ORAL:gastric emptying is irregular and unpredictable, therefore oral drug impact is not predictable
-low acidity in the stomach allows acid-labile drug absorption; not good when not intended. IM: low blood flow to muscles slows absorption. TransDerm: infant skin super thin and allows too much in causing toxicity.
- DISTRIBUTION (protein binding and entrance through BBB)
BEHIND THE SHORT ANSWER: Pediatric pt has less available albumin to bind to for transport. BBB is underdeveloped in infants, allowing chemicals to reach the brain.
- METABOLISM (hepatic)
BEHIND THE SHORT ANSWER: Capacity of liver to metabolize increases after one month, fully developed at one year. From 1-2 y/o, children metabolize drugs faster than adults. At age 2, decreases.
- EXCRETION (renal)
BEHIND THE SHORT ANSWER: excretion limited in infant; inability to move drugs along. adult levels reached at one year. need reduced dosages.
T or F: When medication is administered subcutaneously to a pediatric patient, the levels remain above MEC longer AND effects are more intense and prolonged.
True; 25 minutes until effects
IM takes 15-20 minutes
T or F: When a drug is administered to a pediatric patient intravenously, the levels decline more slowly in the infant than in an adult, yet have the quickest effect.
True; as little as 15 minutes to work.
The aging process can affect pharmacokinetics. How is absorption affected?
Absorp. rate may be affected due to delayed gastric emptying and reduced splanchnic blood flow. Gastric acidity is reduced in the elderly, may later absorp.
Four major factors can alter drug distribution in the elderly. What are they?
(1) Increased body fat - BACKGROUND: creates a storage depot for lipi-soluble drugs; causes plasma level of drugs to be reduced,thereby reducing response.+
(2) decreased percent lean body mass & (3) Decreased total body water and - BACKGROUND: water soluble drugs distribute in smaller volume, conc increases and effects intensify.
(4) reduced conc. of albumin - BACKGROUND: binding is reduced
Kennett wrote: cardiac output - can only assume he is stating that this changes with age and slows how the drugs circulate through the body…
What are the factors that may alter drug metabolism in the elderly?
- decreased hepatic flow
2. enzymes
What are the factors that may alter drug metabolism in the elderly?
- decreased renal blood flow
2. number of nephrons
T or F: Side note: Drug accumulation (secondary to reduced renal excretion) is the most important cause of adverse drug reactions in the elderly.
True
Lehne p100
What are some causes of adverse drug reactions and interactions for the elderly?
- Drug accumulation
- polypharmacy
- multiple pathologies (end up taking multiple meds)
- poor med supervision
- difficulty adhering to med (forgetful, doesn’t understand)
- Intentional nonadherence (“I don’t need that med”)
How can nurses help promote adherence?
- Simplify the regimen
- explain treatment clearly; write it down
- label containers; avoid hard to open containers
- Find easy method: liquid if hard to swallow, etc.
- Monitor therapeutic response, adverse reactions and plasma levels.
The acronym FAST means what? Is used for what?
FAST – Facial changes, Arm weakness, Speech changes, Time lapsed.
FAST is used to evaluate strokes
Do you crush or cut enteric pills? Why?
No because the coating being damaged will not protect the pill and it will not work properly.
Can you cut a non scored tablet?
You are not supposed to
Where do you administer those tiny little pills?
Sublingual
When administering ointment to an eye, where do you put it?
In the conjunctivial sac. Educate patient not to rub the eye.
What is another abbrev for ointments beside oints?
UNG
What are some external meds?
ointmentpatcheseye ung/gttsear gtts
When giving ear drops how do you administer adults? children? Why?
Adults - pull upChild - Pull downDirects the canal
Why do we need to avoid touching tip to patient or infection?
Medication becomes infected
Can we give med that fell on the floor to a patient?
No
Can we touch pills with hands?
No
How long are inhalers good for?
30 days
The graduated portion is called?
Syringe
The portion of syringe that is depressed is called?
PLunger
Luer lock syringe is different because it ______ in place.
Screws
End of the needle is called the ______.
Bevel (It’s beveled….); allows easier entry into the skin
When are we allowed to recap?
Never! Remove the needle after drawing med. Insert new needled at bedside.
What is TB syringe used for?
ID injections
Insulin syringes are always ______ in color. Measurement in _____.
orange; unitsDo not confuse with ID/TB syringe….
T or F: The difference between ID and SQ syringes is the type/gauge of needle.
True
Do you need to document location of injection?
Yes. Give specific anatomical location (butt, abdomen, etc)
Syringes come in various sizes. What are the general measurements?
1ml,3ml,5ml,10ml
What size in mL syringe should you use if the med you are administering is less than 1 mL? If less than 3 but greater than 1?
1mL; 3mL
What is the largest injection you can give in one site?
3mL
What are 5mL and 10mL syrgines typically used for?
IV Pushes
Insulin syringes come in various sizes. What are typical units?
25,50 and 100.
In reference to needles, what does G stand for? The measurement such as 5/7”?
Gauge; length
Which needle is larger: 18g or 24g?
18g
Which vein can accept a large amount of fluid fast?
Antecubital
If you are administering 125mL vs 50mL, what needle do you choose?
Larger volume, larger needle.
Do we want the needle floating or snug against the intima of the vein?
floating
What is the portion of the syringe called where the needle meets the syringe?
Hub
What is the cannula?
The part that is left in the patient’s body after inserting an IV.
When you insert an IV is the bevel facing up or down?
up
When inserting the IV, what is the part called that fills with blood once you have inserted into the vein?
The flash
On a vile, when you remove the cap, what lies beneath?
The diaphragm where you insert the needle to draw med.
T or F: Reconstitution is used when a med is not stable.
True
When administering blood you have to administer along with ________.
Saline.
What tubing do you use for secondary IV?
Secondary tubing. It is labeled. Has a hanger.
What is the part of the tube called that goes into the IV bag?
Spike
What is the name for the part of the IV tubing that you can use to inject meds into or add more tubes to? Are these on the secondary?
Ports; no
T or F: The piggy back(secondary) is closet to chamber. IV push is given at the port closest to the patient.
True
How do you get ampule med to drop into the tube?
twist or tap
How do you open ampule?
break the top off
Why would you use a butterfly needle?
It is smaller and gives more control. Used for tiny hard to reach veins.Typically used for drawing blood.
All medication that are not ingested or introduced into the gastrointestinal system.
Parenteral
Ointments are petroleum base which keeps the medication in contact with skin, therefore we must ______ before applying an addition dose.
wipe
Creams are _____ based
water
____ are semisolid suspensions. Particles of drugs are suspended in a thickened water base.
Gels
______ are medication preprations that adhere to skin with paper, linen, moleskin or plastic such as salicylic acid plaster to treat warts
Plasters
______ are semisolid and purposefully cause an irritation to the skin. The irritation draws blood to the affected area, decreasing pain.
Liniments
Poweder or patches can be applied to skin. Give an example of an application for powder?
Desenex (miconazole nitrate) used to fight funal infection and dry up moisture in athlete’s foot.
T or f: failure to wipe away leftover medication at the site When changing patches can lead to medication overdose
True
What is the name of a transdermal patch used to opem up the coronary arteries, allowing more blood flow to the heart?
nitroglycerin
How do you dispose of a patch properly?
Wearing gloves, remove patch, fold inward, dispose where children and pets will not come into contact with it.
How do you make a transdermal patch?
Get an empty patch that matches the size of the area you need to treat. Patches are typically ruled. Squeeze the tube of medication to place it onto the patch.
_____ medications are used in the eye
opthalmic
Eye drops may be used to lube the eyes or to treat infection. The medication absorbs through the ______.
canthus
_____ ____ are small transparent membranes that contain medication. Their advantage is proloning contact of the med with the surface of the eye.
ocular inserts
Which direction should a patient look toward when you are administering eye drops?
upward
Where should you administer opthalmic ointment?
place a line of ointment on the inner aspect of the lower eyelid.
After administering eye drops, have the patient close his or her eyes. WHy?
Helps prevent the med from entering a tube called the nasolacrimal duct which runs from the inside corner of the eye to the nose.
After administering otic drops, the patient must keep the affected ear upright for ____ ____ to allow ___.
few minutes; to allow max absorption
Nasal medication can be in the form of a ____, ____- or _____.
spray, inhaler, installation.
T or F: A patient does not need to blow their nose before using a nasal spray.
False, they should clear the mucosa for max absorption.
Type of medications that involve the GI tract such as capsules, enemas, suppositories and many others.
Enteral Medication
Can insulin be given by mouth? Why?
No, because stomach acid destroys it.
What is the name of the pair of devices used to crush pills?
pestle and mortar
What type of drugs are you not allowed to crush?
enteric-coated pills; they need to be released in the intestines. If the coating is destroyed the medicine will not make it past the stomach.
_____ tablets have added antacids to prevent stomach irritation.
Buffered
Why can’t you open or crush time released or delayed action pills?
Doing so can release all the drug at once, causing an overdose.
When administering solid medication, what are the first few things you should do to ensure 7 rights?
- Read order2. Check container for match to order3. Double check container4. RIght dosage?5. Right patient?6. Check a third time to ensure you have the right med.
After administering medication, what do you do?
- Watch for negative response2. Document date, time, dosage, med, RESPONSE (ie no problem noted)
Why do elixirs (containing alcohol) need to remain tightly capped?
To prevent evaporation of the alcohol, because this would change the concentration of the medication in the elixir, and dosing errors could occur.
Elixirs should never be given to ______, ______ or _____.
children, alcoholics, diabetics
_______ is a liquid drug preparation that contains oils and fats in water.
Emulsions
_____ are liquid and fine particles in water such as Milk of magnesia.
magma
_____ are finely ground forms of an active drug, sometimes given for pain relief.
Powders
What is the difference between a liquid medication as a solution versus a suspension?
solution is completely distributed into the liquid and will not separate; no need to shake. The first mL should be identical to the last mL. As for suspensions, the medication is suspended in the liquid and may separate and MUST be shaken.
Why are kids at risk of overdosing on medications such as Robitussin?
They are syrups that taste sweet. Children may enjoy the taste and drink too much. Keep out of reach!!!
When should you avoid giving a patient water to rinse down oral liquid medication?
When it is meant to coat the throat.
If you pour too much liquid med, what do you do with the excess?
Dispose of it. DO NOT PUT BACK INTO STOCK!!!
To check liquid medication dosage, the ______ medicine cup should be at ____ ______. View the _____ to ensure proper amount has been poured.
calibrated; eye level; meniscus.
You can check NG tube placemnt for slippage by?
Injecting air and listening through stethoscope…or, drawing back on a syringe to see if fluid comes back.
What is NSS?
Normal Saline Solution
When administering medicine through an NG tube, the medication must be _____ and _____ with _____. Be sure to flush tube with _____ before and after medication administration.
crushed and mixed in water.NSS
Why and how would you use a needleless syringe to administer liquid med?
When a person such as a small child has a hard time swallowing. You can insert it into the buccal pouch aka the cheek.
T or F: sublingual means on the tongue.
False…sub means below… sublingual means below the tongue.
Why is sublingual medicine, such as nitroglycerin - - given during heart attack, so beneficial?
There are many capillaries under the tongue, providing a rich blood supply for quick absorption.
Is IV or Sublingual faster?
IV. But sublingual also bypasses the stomach.
When giving rectal medication, have the patient remove undergarments and then lie down on to a their ____ side. Before inserting the enema or suppository, apply a ____-based _____. Ask the patient to lie still for _____ minutes.
Left. (Place chux under them… absorbent/waterproof pad)water based lubricant30 minutes
T or F: The most common route used by patients is sublingual.
False. Orally.
What is a troche?
lozenge; used in buccal and allowed to melt.
A common way that individual medication doses are packed together is called a _____ _____.
Blister pack
What are the four methods for calculating drugs dosages for nonparenteral route?
- Ratio and proportion method2. Formulation method3. Dimensional analysis4. Fraction
The desired dose (D) is the _____ dose.
ordered
What is the equation for formulation? What does each letter stand for?
D/HXQD= Dosage desired (Dr’s order)H = What we HAVE on HANDQ = QUANTITY of units given
When using the fraction method, the ordered dose and units must be in the _____ proportion as the amount on the label.
same
Fraction method equation?
Dosage on hand/Dosage unit = Desired dose/dose given
In the pediatric population, ____ is frequently used to calculate dosages because body systems have not matured.
Weight
If a medication is not approved for pediatric use, but was prescribed for a child, what do you do?
Contact the prescriber and the pharmacist. Use dosage calculation for peds.
_________ is the process of converting powdered medication into a liquid form
Reconstituting
The amount of fluid used in reconstituting is referred to as?
Diluent
According to Watkins, what is the best way to calculate an IV drip rate?
Dimensional analysis. p.137
What is an electronic regulator pump?
A machine that delivers and monitors IV fluids at a set rate. p137
What is equation for programming an electronic regulator pump?
Total mL ordered/Total time ordered in hours = mL/HrmL ordered/hours ordered=mL/Hours orderedmL/Hr
What does it mean for an IV to be infiltrated?
Leakage of IV fluid or medication into the surrounding tissue; can be caused by infusing too quickly.
Manual IV sets use _____ to infuse a solution at a set rate.
gravity
The drop factor for a manual IV equals drops per __.
mL
manual iv micro drip is ___ gtt/mL
60
manual macro drip is ____ gtt/mL
10 or 15
