Mod 5 Chap 33 Flashcards
used in the treatment, palliation, diagnosis, cure, and prevention of disease
Drug therapy is used for?
?? is affected by the drugs chemical and physical properties and the patients physical status; a greater percentage of body fat results in slower drug ?? the less a pt wigs, the more concentrated the drug is and the more powerful its effect.
Distribution of a drug is affected by?
what causes an increase in unbound drug in circulation; this causes increased drug activity and possible toxicity. Eldery often have decreased levels.
Decreased albumin causes?
most drugs are ? in the liver and excreted by the kidneys
Metabolized
is the intended effect
Primary effect
may be desirable or undesirable, often the side effects of the drug
secondary effect
is the range of levels of the drug in the blood that will produce the desired effect without causing toxic effects
therapeutic range
stimulation or depression,
replacement,
inhibition or killing,
irritation.
four types of action
alcohol has a ? effect when combined with drugs that depress the CNS
synergistic effect
foods can affect the ? or ? of drugs
absorption; action
what must be followed when administering drugs?
The six rights
when giving medications to children the does is based on ? and ?
age; weight
? can be related to lack of info, financial problems, health beliefs, unpleasant side effects, or cognitive issues
Noncompliance
n.urses are held legally responsible for the ? and ? effects of drugs
safe and therapeutic effects of the drugs
1) be able to locate the information about each drug
2) consistently calculate drug dosages accurately,
3) devise a method for consistently using the six rights of medication administration
4) recognize the nursing implications for each drug administered
to be able to prepare for medication administration you need to know these 4 things
points you need to remember about the druge or teach to the patient.
nursing implications
name not protected by trade mark (ibuprofen)
generic name
name protected by a trademark (may have many different names) (advil motron ect.)
trade name
describes the chemical composition of the drug
chemical name
to administer and individual dose of a medication at a specified time.
Nurses role in drug therapy
what determines the route of administration
form of a drug
? of a particular form is designed to enhance its absorption and metabolism in the body?
composition
further regulates dispensing and handling of all controlled substances. it classifies drugs according to their medical usefulness and their potential for abuse.
The comprehensive drug abuse prevention and control acts of 1970
for a drug to pass U.S. Food and Drug Administration (FDA) approval and be marketed it must meet 5 standards in what areas?
1) purity
2) potency
3) bioavailability
4) efficacy
5) safety
what med stimulates heart muscle fibers to contract more powerfully and its effect on the hearts electrical properties causes changes in rate and rhythm
Digoxin
what med depresses the function of cell groups in the central nervous system, causing drowsiness.
barbiturates
what med has the ability to block cell division
antineoplastic drugs such as vincristine
study of how drugs enter the body and reach their site of action and how they are metabolized and excreted?
pharmacokinetics
The rate of absorption is determined by many factors including? (8)
1) body weight
2) age
3) sex
4) disease conditions
5) genetic factors
6) immune mechanisms
7) physiologic and emotional factors
8) hot and cold weather
types and concentrations of substances other than the drug that can be in the tablet, capsule suspension ect.
purity
amount of active drug in the preparation contributing to its strength
potency
drugs ability to dissolve, be absorbed, and be transported in the body to its desired site of action
bioavailability
laboratory studies providing proof that the drug is effective for its intended use
efficacy
sufficient studies completed to indicate potential side effects, adverse effects, and toxic reactions; safety is determined from the data
safety
drugs with no accepted medical use, a high potential for abuse, and lacking accepted safety measures. (opiods, psychedelics, cannabis derivatives, methaqualone, phencyclidine) ex: heroin, lysergic acid diethylamide (LSD), phenosulfonphthalein (PSP) and peyote
schedule I drugs
drugs with a medical use, a high potential for abuse, with severe psychological or physical dependence (opioids, psychostimulants, barbiturates and cannabinoids) ex: amobarbital (tuinal) amphetamine, meperidine, morphine, and methadone
schedule II drugs
drugs that are medically useful but with less potential for abuse that lead to moderate or low physical and high psychological dependence. (lesser opioids, stimulants, some barbiturates, miscellaneous depressants, and anabolic steroids) ex: paregoric, butabarbital, and acetaminophen with codeine
schedule III drugs
drugs that are medically useful, but with less potential for abuse than scheduled III drugs, their abuse causing limited physical or psychological dependence. (lesser opioids, stimulants that suppress appetite, some barbiturates, benzodiazepines, and miscellaneous depressants) ex: tranquilizers such as chlordiazepoxide (Librium) diazepam (valium) fenfluramine, temazepam, and chloral hydrate
schedule IV drugs
drugs with medical use, low potential for abuse, and producing less physical dependence than the schedule IV drugs. (few opiods) ex: mixtures with small amounts of narcotics….cough syrup containing codeine
schedule V drugs
the rapidity with which concentration at a target site occurs depends on ?
the blood supply to the site
if a pt is taking 2 drugs hat are protein bound, one or the other drug may have a higher concentration in the unbound state than it would if it had been given alone….why?
because the drug with the lower unbound concentration has a greater ability to bind to available protein, leaving less protein to bind to the other drug.
? and ? help the post surgery pt rid the body of anesthetic more rapidly.
deep breathing and coughing
Adequate fluid intake of ? mL/kg/day is essential for the pt to eliminate drugs properly
50
study of a drugs effect on cellular physiology and biochemistry and its mechanism of action ?
pharmacodynamics
occurs when the highest blood or plasma concentration of the drug is achieved
peak action
the length of time the drug exerts a pharmacologic effect is?
the duration of action
begins when the drug reaches a minimum effective concentration level.
the onset of drug action
time it takes for excretion to lower the drug concentration by half
the half life
the next dose of a drug is scheduled at the time the previous dose should reach its? thus sustaining a therapeutic level of the drug.
half life
peak levels
highest concentration
trough levels
lowest concentration
drugs work by?
attaching to receptor sites on cells or preventing other substances from attaching to those sites.
drugs that produce a response are
agonists
drugs that block a response are
antagonists
direct action on a receptor site such as when the rate of cell activity is stimulated or secretion from a gland is increased, or cell activity is depressed and the function of a specific organ is reduced.
stimulation or depression
this action such as injected insulin for people who do not produce their own
replacement
this action of organisms, such as the action of an antibiotic when it blocks synthesis of the bacterial cell wall
inhibition or killing
this action such as that produced by a laxative on the colon wall, resulting in peristalsis and defecation
irritation
the less specific the drugs action,
the more side effects the drug may have
example of an adverse reaction
nausea produced by an antibiotic when its desired action is to kill pathogenic organisms.
harmful effects that occur when blood levels of a drug rises above the therapeutic range and causes unintended damage to normal cells
toxic effects
toxic effects occur if the blood level rises above ?
30 mcg/mL
FDA designation that the drug may have serious side effects or health risks
black box warnings
)combined interaction) occurs when the action of the two drugs combined is increased or greater than the effect of the drugs given separately.
synergistic effect
factors affecting drug therapy (clinical factors 4)
1) age, weight
2) prsent health disorder
3) other disease entities
4) pt drug compliance
factors affecting drug therapy (administartion 4)
1) drug form
2) route of drug
3) multiple drug therapy
4) drug interactions
factors affecting drug therapy ( pharmacodynamics 3)
1) onset, peak, and duration
2) therapeutic range
3) side effects, adverse reactions
factors affecting drug therapy ( pharmacokinetics 4)
1) absorption
2) distribution
3) metabolism
4) excretion
medication is injected into the dermis just under the epidermis
intradermal
medication is injected into the tissues just below the dermis of the skin
subcutaneous
medication is injected into a muscle
intramuscular
medication is injected into the epidural space of spinal cord
epidural
medication is injected into the intrathecal space of spinal cord
intrathecal
fourth leading cause of death in the US is from ?
ADE ( adverse drug event) from medication errors
strategies to prevent errors
1) persevering
2) being physically present
3) reviewing care plans
3) offering options
4) using standards
5) involving another nurse or physician
affect the ability to absorb, metabolize, and excrete drugs (5)
difference in 1) size
2) age
3) weight
4) surface area
5) organ maturiity
older pts on long term anti-inflammatory therapy for arthritis should be monitored for ?
gastrointestinal bleeding and anemia
if the pt has had a stroke, causing weakness on one side, where should the medication be placed?
be certain the medication is placed on the strongest side of the mouth ( always assess swallowing ability before giving anything by mouth to a pt who has had a stroke or neurologic problem causing weakness)
what position do you want your pt in when assessing swallowing ability?
high fowler’s position
process of identifying all the pts medications and communicating this info to the pt and staff.
medication reconciliation
if a drug has a narrow therapeutic range it is important to assess the ?
serum blood level of the drug
assess information about each drug including (7)
1) noting how the drug works
2) its purpose
3) usual dosages
4) routes of administration
5) side effects
6) the nursing implications for administration
7) monitoring of the pt
what is one way to assess the pt’s subjective response to a medication?
as the pt if they are noticing any ill effects that is associated with taking the medication.
possible nursing diagnoses for pts receving drug therapy include the following (2)
1) deficient knowledge related to use and adverse effects of prescribed drugs
2) noncompliance with medication regimen
what are the Six Rights of medication administration
1) Right drug
2) Right dose
3) Right route
4) Right time
5) Right patient
6) Right documentation
(DDRTPD)
at least how many pt identifiers must be used to ensure that the medication is administered to the correct person?
two
what will you document in the pts chart after the drug is given
route, time and site, info about assessment for side effects from previous doses of the drug. any pt teaching that was done, the dosage schedule or precautions
a ? day limit may be imposed by some agencies on all medications
30 day limit
used to record a pts medications, nurses record the doses of drugs administered each day, referred to when giving regularly scheduled and PRN medications
MAR ( medication Administration Record)
CPOE
computerized physician order entry - prescriber directly enters the mediation order in the comp;
