NUR 325 Exam 1 Flashcards
Brand name vs Generic drugs
Brand name: commercial name, capitalized
Generic: lowercase, name given by manufacturer, safest way to refer to the drug
What are the different types of oral medication forms?
tablet, capsule, powder, liquid
What is the order of absorption rate for oral medications (quickest to slowest)?
liquid, suspension, powder, capsule, tablet, coated tablet, enteric coated tablet
LSPCTCE
Lucas Says People Can’t Think Clearly Early
What types of oral medications cannot be altered?
-enteric-coated (EC)
-extended-release (ER)
-sustained-release (SR or XR)
-immediate-release (IR)
What are some factors that affect rates of absorption of PO meds?
-drug solubility
-mucosal permeability
-stability in the GI tract environment
-metabolism rate
What are 3 ways that a drug can be administered parenterally? What are the absorption rates and onset effects?
-IV: absorption is immediate and complete, onset actions are immediate
-IM: absorption varies (rapid if water soluble and good circulatory flow), onset actions vary
-SubQ: absorption varies (rapid if water soluble and good circulatory flow, more muscle mass increases absorption), onset actions vary
What parenteral injection is absorbed the quickest?
IV
What is absorption?
What are the factors that affect it?
Absorption is movement from administration site to various tissues
Factors: administration site, solubility, dosage, drug formula, etc.
Explain the first pass effect
Drugs entering the stomach or intestine are absorbed into the portal circulation and routed to the liver where they undergo metabolism prior to entering the systemic circulation, causing the body to utilize less of the drug than originally administered
What factors affect distribution to different parts of the body?
body weight, body composition, muscle mass, cellular binding, etc.
Define metabolism
a change in the drug that may make it more or less potent, soluble, or inactive
where does metabolism primarily take place?
liver
define “half-life”
the time it takes for the concentration of a drug in the body to be reduced by 50%
define “onset”
the amount of time it takes for a med to demonstrate a therapeutic response
define “peak”
the amount of time it takes for a med to achieve it’s full therapeutic effect
define “duration”
the amount of time the therapeutic effect lasts
peak vs trough levels. Why is this important?
-peak: point in time when med is at its highest level
-trough: point in time when med is at its lowest level
-this is important because it indicates the amount of drug present in the patient’s body and indicates if/when they need another dose
pharmacokinetics vs pharmacodynamics
pharmacoKINETICS: what the body does to the drug
pharmacoDYNAMICS: what the drug does to the body
define “adverse drug reactions”
ADR: occur when a medication is given at the APPROPRIATE DOSE. Non-theraputic, unintended, predictable or unpredictable, vary in severity
describe “off-label”
drug not used for original therapeutic use
ex. Benadryl for sleep or ketamine for headaches
describe the most severe type of ADR and how the patient could present in this case
-most severe type ADR is anaphylaxis
-pt might present with hives, facial/throat swelling, wheezing, light-headedness, vomiting, shock, tachycardia, hypotension, decrease in LOC
tolerance
the body’s decreased response to a drug over a period of time or repeated use
cumulative effect
aka drug sensitivity
may be caused by a metabolic change in the liver/kindey, occurs when the body is unable to excrete an existing dose of medication before another dose is administered
toxicity
excessive doses result in a negative physiologic effect and can be a result of impaired drug excretion/metabolism
may cause irreversible damage and potentially life threatening
contraindications
reasons why you shouldn’t give the med
the potential to cause a serious or life threatening ADR in relation to a specific factor (ex. food, combinations of meds, or specific populations)
drug-drug interactions
one drug changes the way another drug effects the body
additive effect
when the sum of effects of individual treatment = effects of combined treatment
synergistic
when sum of effects of individual treatment < effects of combined treatment
antagonistic
sum of effects of individual treatment > effects of combined treatment
teratogenic
teratogens are substances that may produce physical or functional defects in a fetus
what physiological factors are important to consider when administering drugs to an aging patient?
-increased body fat, decreased body water, decreased muscle mass, changes in renal/liver function
define and describe the physiological/psychological effects of acute stress
acute stress: immediate, temporary reaction to stressor
-physiological: palpitations, chest pain, headaches, stomach pain, nausea, sweating
-psychological: irritability, low mood, anxiety
define and describe the physiological/psychological effects of chronic stress
chronic stress: long term stress, individuals experiencing this often believe they have little control over their circumstances
-physiological: weak immunity, aches, low energy, hypertension, change in appetite
-psychological: insomnia, anxiety, strained relationships
non-pharmacological interventions for stress
mediation, breathing exercises, yoga, hypnosis, massage, nutrition
positive coping strategies for stress
social support, exercise, music therapy, relaxation, etc
ineffective/maldaptive coping strategies for stress
alcohol, substances, smoking, overeating, underrating, denial, avoidance
appropriate assessment strategies for a client experiencing acute stress
-mental status exam
-gather relevant client information (health beliefs, coping strategies, etc)
-consult family members
-consult health records
-objective observations (vitals, appearance)
list the defense mechanisms
- denial
- rationalization
- projection
- repression
- regression
- compartmentalization
DRP RRC
denial
refusal to acknowledge or accept reality to avoid emotional impact
rationalization
justify pr explain undesirable behaviors to avoid emotional discomfort/save face
projection
attribute negative or uncomfortable thoughts/feelings/motives onto someone else
repression
conceal unpleasant or painful thoughts/memories/beliefs in hopes of forgetting about them completely
regression
movement back to a more comfortable place in time
compartmentalization
categorize life experiences into segments to avoid facing anxieties
factors that can alter a patient’s stress level
relationship issues, work, financial strain, food insecurity, injury, illness, etc.
concept of pain
pain is whatever the person experiencing it says, existing whenever he says it does
acute pain
-sudden, < 3 months, improves over time, usually can identify precipitating event
-SNS activation, increased HR, RR, BP, diaphoresis (sweating, pallor (paleness), anxiety, agitation, confusion, urine retention
chronic pain
- > 3 months, typically does not go away, can have periods of increasing and decreasing pain
-fatigue, declined activity, withdrawl
psychosocial consequences of untreated pain
-fear
-anger
-depression
-anxiety
-difficulty maintaining relationships
-suicidal thoughts
physiological consequences of untreated pain
-urinary retention
-weakened immune system
-GI disturbances
-muscle weakness
-hormonal imbalances
nociceptive pain and the 2 types
pain caused by damage to body tissues
somatic: bone, joint, muscle, skin, or connective tissue pain; sharp and localized, throbbing
visceral: within body cavity affecting internal organs, harder to identify
neuropathic pain
pain due to nerve/nervous system damage
described as burning, shooting, stabbing, shock-like, pins and needles
mixed pain syndrome
nociceptive pain as a result of neuropathic pain
pain classifications
-nociceptive
-neuropathic
-mixed pain syndrome
pain assessment
PQRST
-Provoked (what causes or increases the pain?)
-Quality (dull, burning, stabbing, throbbing)
-Region (location)
-Severity (1-10)
-Time (when did it start and how long does it last?)
nursing interventions for managing pain
-schedule pain interventions as needed
-review provider orders for analgesics
-be proactive (takes less meds to prevent pain than treat pain)
-instruct clients to report reoccurring pain
-help reduce fear and anxiety
-include both non-pharmacological and pharmacological measures
non-pharmacological interventions for pain
-repositioning, thermal interventions, massage, splinting, exercise
Aspirin
generic name & drug category
acetylsalicylic acid
first gen NSAID
Advil/Motrin
generic name & drug category
ibuprofen
first gen NSAID
Celecoxib
generic name & drug category
celebrex
second gen NSAID
Tylenol
generic name & drug category
acetaminophen
non-opioid analgesic
Ultram
generic name & drug category
tramadol
centrally acting non-opioids
Morphine
drug category
opioid agonist
Butorphanol
drug category
opioid agonist-antagonist
Narcan
generic name & drug category
naloxone
opioid antagonist
acetylsalicylic acid brand name
aspirin
ibuprofen brand name
Advil, motrin
Celebrex brand name
celecoxib
acetaminophen brand name
Tylenol
tramadol brand name
ultram
What does COX-1 do?
protects gastric mucosa, enhance platelet aggregation, promotes renal function
what does COX-2 do?
causes inflammation, pain, and fever in response to injury
1st gen vs 2nd gen NSAIDS
1st gen: inhibits both COX-1 and 2 and prostaglandin production
2nd gen: only inhibits COX-2
-gastric effects decreased but increased risk for cardiovascular events due to vasoconstriction and platelet aggregation
what role do prostaglandins serve?
contributors to the inflammatory response from injury
what safety issues should the nurse be aware of related to opioid agonists?
-renal/liver impairment from opioid abuse can affect meds in terms of effectiveness and ADR
-insufficient prescribing for opioid dependent clients could have a different effect than on a client that is not dependent
-client must be educated on risks and pain management
-withdrawl can cause harm to client
-possible OD
alzheimer’s dementia
-chronic, progressive, neurodegenerative bran disease
-most common form of dementia
-cannot be prevented or cured; cannot slow progression
anterograde amnesia
can’t learn and recall new information
retrograde amnesia
can’t remember info from the past
aphasia/dysphasia
difficulty producing/comprehending language
agraphia
inability to write
agnosia
impaired ability to recognize objects or persons
apraxia
inability to perform purposeful movements/manipulate objects, although sensory and motor ability is intact
hemispatial neglect
inability to process and perceive stimuli on one side of the body despite intact senses
flight of ideas
topic of speech changes within a sentence
confundabulation
making up answers
clanging
use of meaningless, rhyming words
pressured speech
frantic, energetic, jumbled speech
