NSG 100 Test 1 Prep Flashcards
Pharmacology & Safety
What is the rationale of proper hand hygiene?
Reduces transmission of microorganism
What are the objectives of proper hand hygiene?
Define the risk assessments to patient care across the life span?
Age >85
Bone disorders
Coagulation disorders
Surgery
Identify the fall precautions and prevention interventions.
Height of bed allows ambulatory patient to get in and out of bed easily and safely.
Mats provide nonslippery surface for preventing falls and injuries.
Explain environmental safety assessments across the lifespan and patient care environment?
Define the Joint Safety Commission Patient Safety Goals
National Patient Safety Goals, which focus on problems in health care safety and how to solve them, updated and published annually. Once a goal becomes a standard, the goal number is retired and is not used again, and the standard must be adopted by all TJC. Two goals are (1) the “do not use” abbreviations and (2) the list of acceptable abbreviations.
Define the safe medication administration process from order to administration of medications to patients across the life span
Preparation
1. Perform hand hygiene.
2. Access patient’s drug administration record (MAR) or electronic health record (EHR).
3. Check patient’s drugs with the health care provider’s order for accuracy.
4. Obtain the patient’s drugs from automatic dispensing cabinet (ADC), remote stock, or pharmacy while checking the drug label with the patient’s drug order for accuracy.
5. Check drug allergies.
6. Prepare drugs for only one patient at a time.
7. Calculate the drug dose and perform a double-check of the calculation.
8. Check the expiration date on the drug label, and use the drug only if the date is current.
9. While preparing the drug, check the label against the MAR for accuracy.
10. If a unit dose is prescribed, open the packet at the patient’s bedside.
11. If a liquid is prescribed, measure in a calibrated syringe and put it into a drug cup (see Chapter 10; Fig. 10.2).
12. Never leave medications unattended.
Administration
13. Only administer drugs that have been personally prepared.
14. Identify patients by using at least two patient identifiers (e.g., name and birth date). Compare the patient’s name and birth date from the MAR, computer printout, or EHR with the information on the patient’s identification (ID) bracelet. If possible, ask the patient to state their name and birth date.
15. Assist patient into an appropriate position, depending on the route of administration.
16. Before administering compare label on medication with the MAR to complete the three checks.
17. Explain each drug and its action to the patient.
18. For patients who cannot hold the drug, place the cup to their lips. Introduce one drug at a time, and do not rush the patient.
19. Stay with the patient until all drugs have been taken.
20. Dispose of used supplies and perform hand hygiene.
21. Evaluate the patient’s response to the drugs.
22. Educate patients and family members about drug actions and side effects.
Define process of medication metabolism from absorption to excretion
Also known as the “pharmacokinetic” phase. 4 processes:
(1) absorption:
(2) distribution
(3) metabolism (biotransformation)
(4) excretion (elimination)
Define absorption
Absorption is the movement of the drug into the bloodstream after administration. Solid form drugs must be broken down via dissolution.
Where do most oral drugs enter the bloodstream?
After absorption across the mucosal lining of the small intestine. This occurs via passive transport.
Passive transport occurs through what process(es)?
Diffusion and facilitated diffusion.
Explain and differentiate diffusion and facilitated transport.
In diffusion, drugs move across the cell membrane from an area of higher concentration to one of lower concentration; does not require energy. Facilitated diffusion relies on a carrier protein to move the drug from an area of higher concentration to an area of lower concentration.
Define active transport.
___ transport requires a carrier, such as an enzyme or protein, to move the drug against a concentration gradient.
Define pinocytiosis
____ is a process by which cells carry a drug across their membranes by engulfing the drug particles in a vesicle.
Which drugs need a carrier, either an enzyme or a protein, to pass through the mucous membrane
Water-soluble
Large particles are able to pass through the mucous membrane if they are _____?
Nonionized
What factors slow gastric emptying time, which causes drugs to remain in the stomach longer.
Pain, stress, and foods that are solid, hot, or high in fat
Which route is faster: subcutaneous or oral?
SQ
Which absorption is slower: rectal or oral?
Rectal
Define the first-pass effect
In the liver, some drugs are metabolized to an inactive form and are excreted, thus reducing the amount of active drug available to exert a pharmacologic effect
Define bioavailability
Percentage of administered drug available for activity
What is the bioavailability of IV drugs?
100%
Define distrubution
Movement of the drug from the circulation to body tissues.
Distribution is influenced by what?
Vascular permeability and permeability of cell membranes
Regional blood flow and pH
Cardiac output
Tissue perfusion
Ability of the drug to bind tissue
Plasma proteins
Lipid solubility
Albumin, lipoproteins, and alpha-1-acid-glycoproteins AGP) are what kind of proteins?
Plasma proteins
Drugs that are more than ___ % bound to proteins are known as highly protein-bound drugs.
90
Drugs that are less than __ % bound to protein are weakly protein-bound drugs.
Weakly protein-bound drugs.
Portion of the drug that are bound to protein is ____ because:
Inactive because it is not available to interact with tissue receptors.
The portion of the drug that remains unbound is _____?
Free, active drug.
Define Free Drugs:
Drugs that are able to exit blood vessels and reach their site of action, causing a pharmacologic response.
What happens when two highly protein-bound drugs are administered together?
They compete for protein-binding sites, leading to an increase in free drug being released into the circulation
The BBB protects the brain from about __ % of all drugs on the market.
98%
Some drugs that are ________are able to cross the BBB through diffusion, and others cross via transport proteins
Highly lipid soluble and of low molecular weight
What drugs are are not able to cross the BBB, which makes it difficult for these drugs to reach the brain
Water-soluble drug and drugs that are not bound to transport proteins (free drugs)
What kind of drugs bind with plasma proteins?
Acidic
What kind of drugs bind with AGP?
Basic
Define metabolism
The process by which the body chemically changes drugs into a form that can be excreted.
Drugs that promote induction of enzymes are called?
enzyme inducers
What are the effects of drug enzyme inducers?
Onset and termination of drug effect is slow, approximately 1 week.
Drug dosage may need to be increased with use of drug inducer.
Drug dosage should be adjusted after termination of drug inducer.
Monitor serum drug levels, especially if the drug has a narrow therapeutic drug range.
What are the effects drug enzyme inhibitors?
Onset of drug effect usually occurs rapidly.
Half-life (t½) of the second drug may be increased, causing a prolonged drug effect.
Interaction may occur related to the dosage prescribed.
Disease entities affect drug dosing.
Monitor serum drug levels, especially if the drug has a narrow therapeutic range.
What is a prodrug?
Compound that is metabolized into an active pharmacologic substance. Used to improve pharmacokinetics, decrease toxicity, or target a specific site of action.
Define steady state
When the amount of drug being administered is the same as the amount of drug being eliminated
Define loading dose
Large initial dose, known as a loading dose, that is significantly higher than maintenance dosing
Define excretion
The elimination of drugs from the body, is through the kidneys.
Normal urine pH is what?
4.8 to 8.0
What kind of urine promotes elimination of weak base drugs?
Acidic
What kind of urine promotes elimination of weak acid drugs?
Alkaline
What is BUN?
Blood Urea Nitrogen. A byproduct of protein metabolism.
What is creatine?
Metabolic byproduct of muscle excreted by the kidneys.
Decreased eGFR is expected in what patients and why?
Older and female, due to decreased muscle mass.
Define excipients
Fillers and inert substances—such as simple syrup, vegetable gums, aromatic powder, honey, and various elixirs. During preparation to allow the drug to take on a particular size and shape and to enhance drug dissolution.
Generally, drugs are both disintegrated and absorbed faster in _____
Acidic fluids with a pH of 1 or 2.
What population(s) have less gastric activity
The very young and older adults.
What routes are not subject to first pass elimination?
IV, IM, SQ
Drug interaction
An altered or modified action or effect of a drug as a result of interaction with one or multiple drugs.
Drug compatibility
**Not referred to in Pharm book. But drug INcompa is?
Side effects of drugs
Side effects are secondary effects of drug therapy.
Adverse effects of drugs
Unintentional, unexpected reactions to drug therapy that occur at normal drug dosages.
Drug tolerance
A decreased responsiveness to a drug over the course of therapy
Anaphylaxis
Severe allergic reaction with cardiovascular collapse.
Drug toxicity
Occurs when drug levels exceed the therapeutic range; toxicity may occur secondary to overdose
Drug half life
time it takes for the amount of drug in the body to be reduced by half.
Drug induced photosensitivity
Reaction is a skin reaction caused by exposure to sunlight
