Pamacology

Question 0

System of weight / measures ?

Answer 0

Metric System: (measures)
	Gram measures weight
	1kg = 1,000 g
	1g = 1,000 mg
	1mg = 1,000 mcg
The Apothecary System (It is another method of expressing units of measure.  It is an old system and is not used exclusively because it is not standardized.  That means that each measure is an approximate amount, not an exact amount. But, some doctors still order medicines using this system, and some labels contain this system as well.  
	Grain measure weight and is written gr. gr 1 = 60mg
	Gr XV = 1g

Question 1

What are diffrent forms of drug ?

Answer 1

 Oral Solids:
Tablets
 Scored tablets (lines, markings to cut into 2 or in 4) – for easy division
 Enteric coated (protective from the stomach acid)– coating prevents the tablet from dissolving in the stomach, designed to dissolve or be absorb in the small intestine. (DO NOT CRUSH/CHEW!) (time release tabs you don’t crush either)
Capsules
 Drug is enclosed in a hard or soft soluble shell, usually made of gelatin or plastic shell
 May also contain drug impregnated beads designed to release drugs at different rates
Troches/lozenges (help sooth or numb throat)
 Generally disc shaped
 Should be dissolved slowly in the mouth. (Do not chew just suck)
 Usually release medication that provides an antiseptic or anesthetic effect on the tissues of the oral cavity/throat
 Oral liquids:
Solutions:
 Syrups-sweetened
 Elixirs – contain alcohol
 Tinctures- contain alcohol as primary solvent dissolving meds
 Douches (vaginal) -used in cleansing part of the body
 Solutions that are given IV must be sterile & free of particles that could serve as embolus. (pushed into IV and must be sterile)
Suspensions
 Liquid dosage forms that contain drug particles
 Most administered orally or sometimes topically or by injection
 Should be shaken immediately before administration
 Not given IV because has solid particles (could cause a blood clout)

Emulsions (oil in water for nutrition)
 Dispersions of fine droplets of an oil in water or water in oil
 Must be shaken thoroughly before administering
 Oral, topical, or IV
 Topical dosage forms:
• Ointments
 A viscous semisolid preparation (80% oil/
20% water) used topically on a variety of body surfaces-skin, eye, vagina, nose
 Often medicated & more potent than creams
• Creams
 A semi-solid emulsion (50% water & 50% oil)
 A topical preparation for application to the skin or mucus membranes i.e. rectum or vagina
 May or may not be medicated
• Lotions (thinner, lighter & less greasy or oily)
 Thinner than creams often packaged in a pump, absorb quickly feel light on the skin
• Transdermal Patches
 Medicated adhesive patch placed on the skin to deliver a time released dose of medication through the skin & into the blood stream
 Clean & rotate sites
 Look for a non hairy place
 Put date & time on patch
 Make sure old patch is taken off before putting on a new one
 Parenteral:
 Given by injections via a route other than the GI tract including:
 Subcutaneous (SQ)
 Intramuscular (IM)
 Intravenous (IV)
 Intradermal (ID)
 Several different ways are used to package sterile medication intended to use an injection
 Ampules –Sterile, sealed glass or plastic containers containing a single dose
 Vials Single or multiple-dose glass or plastic containers that are sealed with a rubber stopper
 Pre-filled syringes - Syringes containing a single dose

 External body orifices:
 Suppositories – a dosage inserted in external body orifices usually the rectum, vagina, or urethra
 Other body orifices: Eye, Ear, nose
 Suppositories hold for 30 min for it to dissolve
 Rectally give on left side

 Inhaled Medications –
 inhaler
 nebulizer breathing treatment

Question 2

What are commonly used abbreviations for route , frequency of medication

Answer 2

 Gastrostomy tube (GT)
 Nasogastric tube (NGT)
 Oral (p.o) – oral medication is one that is given by mouth and swallowed
 Sublingual (SL) – A sublingual medication is one that is placed under the tongue.
 Buccal – A buccal medication is one that is placed in the mouth next to the cheek. It is in tablet form.
 Hand held nebulizer (HHN)
 Inhalation – medications administered by inhalation are those that are sprayed or inhaled into the nose, throat, and lungs
 Meter dose inhaler (MDI)
 Rectal- Rectal medications are those inserted into the rectum and are slowly absorbed into the mucous membrane lining of the rectum
 Vaginal – Vaginal medication are those inserted into the vagina
 Topical – A topical medication is one applied directly to the skin or mucous membrane for a local effect to the area
 Transdermal – a method of applying a drug to unbroken skin. The drug is absorbed continuously and produces a systemic effect (packaged in an adhesive-backed disk)
 Parenteral – Any route of administration not involving the gastrointestinal tract, e.g., topical, inhalation or injection (parentaral medication for injection must be in a liquid form and administered by one four methods: intradermal, intramuscular, intravenous or subcutaneous
 Intradermal (ID) – a small amount of medication is injected just beneath the epidermis
 Intramuscular (IM) – The medication is injected directly into large muscles.
 Intravenous (IV) – The medication is injected directly into the vein, entering the bloodstream immediately
 Intravenous piggyback (IVPB) – wide shape tubing elevated up high and flow in main line like usually an antibiotic. Piggybacking on a main line of IV fluids. Now have IV pumps and don’t have to elevate it.
 Intravenous push (IVP)
 Subcutaneous (Sub Q) – the medication is injected into the subcutaneous layer, or fatty tissue, of the skin.
 Swish and Swallow (S & S)
 OU – both eyes
 OD – Right eye
 OS – Left eye

Question 4

SYSTEMIC ACTION

Answer 4

• The drug has a widespread influence on the body

- because it is absorbed into the bloodstream

Question 5

SIDE EFFECT

Answer 5

• Actions other than intended therapeutic effects
• resulting from the pharmacological action of a drug.
• (e.g. headaches, itchiness, things happen because of the drug).

Question 6

ADVERSE EFFECT

Answer 6

• real bad side effect or specific side effects)

- Negative action resulting from the pharmacological action of a drug, among other factors.

Question 7

ANTOGONISTIC

Answer 7

one drug diminished the action of another.

• Agent that resists or opposes the action of another agent.
• e.g. antibiotics has an antagonist effect on birth control pills).
• 2 medications together oppose each other or make the effect less or cancel each other out.

Question 8

AGONIST

Answer 8

-Drug capable of combining with receptors to initiate drug actions

Question 9

POTENTIATION

Answer 9

• occurs when two drugs administered together

- produce a more powerful response than the sum of their individual effects.

Question 10

ALLERGIC RESPONSE

Answer 10

(Anaphylactic shock the same thing) - hypersensitive response of the client’s immunological system in the presence of a drug.
o Not the result of pharmacological effects of the drug, but rather a response of the client’s immunological system to the presence of a drug
o Prior sensitization to the drug is generally required

Question 11

TOXIC EFFECT

Answer 11

: Effects caused by drugs that can result in poisonous injury to a client.
o Those related to the dosage administered
o All drugs are capable of producing toxic effects
o May result from cumulation of drug which occurs when drug is not completely excreted from the body before another dose is given

Question 12

What is the half life of a drug ?

Answer 12

(The shorter the half-life the more you give it and the longer the half life the less you give it.)

• Half peak level eliminated. (half of the maximum amount dose is eliminated)
• The time it takes for the total amount of the drug to be diminished by ½
• Prescribers will determine the frequency of dosing based on this
• IV has a shorter half life, oral longer
• Short half life means effects wear off faster. Need to give more
• Long half life means will last longer, therefore can give less frequently

Question 13

What factors affect the half life ??

Answer 13

 The shorter the half-life the more frequently you give the drug
 The longer the half-life the less frequently you give the drug

Question 14

What are the following effects of drug ? LOCAL ACTION

Answer 14

A response (to a medication) confined to a specific part of the body.

Question 14

What route produce most rapid effect ?

Answer 14

 IV – most rapid
 IM & SQ- speed depends on condition of blood flow
 ID - slow, confined to area injected
 Oral- rate & Degree depend on GI motility, presence of food, gastric pH & use of other drugs

Question 15

Is it safe to give medication prepared by another nurse ?

Answer 15

Never

Question 16

How many times do you need to read a drug lable before administering ?

Answer 16

3 times

Question 17

What is a loading dose ?

Answer 17

No

Question 18

How do you safely identify the patient ?

Answer 18

 Check the tag on the client’s bed
 Check the client’s identification band
 Ask the client to state his or her name
 Ask parents to tell you the name of their child
 Address the person by name before administering the medication
 Always double-check a prescription that the clients questions

Question 19

What is the peak blood concentration ?

Answer 19

B

Question 20

What should you do if patient refuse to take medication ?

Answer 20

 Document in chart that patient refuses to take their medication
 Notify the Physician

Question 21

What are the 7 rights of medication administration ?

Answer 21

Right drug 
Right dose 
Right time 
Right route 
Right patient 
Right documentation 
Right to refuse

Question 22

When should you withhold a medication ?

Answer 22

 When the patient says they have an allergic reaction to a medication
 Hold it and let the physician know and get a new order for another medication

Question 23

What should you do if you cannot read the medication lable ?

Answer 23

M

Question 24

How do you withdraw medication from a vial ?

Answer 24

19. How do you withdraw medication from a vial?  Remove metal cap from vial.  Cleanse top with alcohol wipe.  Remove guard from needle.  Pull back on barrel of syringe to draw up the volume of air equal to the ordered medication dose.  Holding vial between thumb & fingers of the non-dominant hand, insert needle through the rubber stopper into the air space- not the solution- in the vial & inject air.  Invert vial & withdraw the ordered dose of medication by pulling back on the plunger. Make sure needle is in the solution to be withdrawn.  Expel air bubbles & adjust dose if necessary  Remove needle from vial, & cover the needle with guard.

Question 25

How do you select needle gauge / length ?

Answer 25

 IM injection (intramuscular) – 1 to 1 ½ inch needle length, depending on the amount of muscle tissue the patient has. – 20 – 22 or 21-23 gauge  SQ or sub-Q (subcutaneous) – ½ to 5/8 inch length, based on depth of appropriate tissue (7/8 inch in obese people) – 25- 28 gauge   ID (intradermal) – 3/8 to 5/8 inch (short needle) needle length or ¼-3/8” – 26-28 gauge

Question 26

What should you do if a medication error occur ?

Answer 26

Assess the patient Notify the physican Write an incident report

Question 27

Describe the procedure for eye drop administration ?

Answer 27

 If the eye has crust or drainage along the margins or inner canthus, gently wash the eye. Wipe from inner canthus to outer with warm washcloth. Use warm soaks to soften the material if needed.  Remove cap from bottle & place on side  Squeeze prescribed amount of medication into dropper.  Have client look up. Hold eye dropper ½ to ¾ inch above the eyeball, rest hand on client’s forehead to stabilize. Don not touch the eye directly.

Question 28

Describe IM injection technique ?

Answer 28

 Use the 1-3 cc syringe, 21-23 gauge, 1- 1 ½ inch needle  After locating site, cleanse with alcohol using circulation motion (in to out) from the site outward, allow to dry  Spread skin taut, insert needle at 90 degree angle with quick, dart-like action  Holding syringe with left hand, aspirate by pulling back on the plunger with the right hand. If blood appears, remove needle & discard.  If no blood appears, slowly introduce the medication. This allows time to accommodate the fluid & prevents leakage back through the needle tract. (Drawing an air bubble of 0.3 ml after the volume of medication may help to clear needle & prevent leakage also.)  Smoothly & quickly withdraw the needle. Place pressure over the site to stop any bleeding  Dispose of the needle & syringe in the sharps container  Chart the date, tie, route & site of injection & name & dosage of the medication

Question 29

Describe SQ & ID injection technique ?

Answer 29

SQ injection Technique:  Identify the injection site using circular motion working from the site outward. Allow the site to dry.  Grasp the skin between thumb & forefinger to elevate the subcutaneous tissue  Holding the syringe at a 45 degree angle thrust the needle into the tissue (90 degree angle may be used esp. with insulin or heparin)  Slowly inject the medication, remove the needle, deploy safety & place in sharps box ID injection Technique:  Cleanse site with alcohol using a circular motion outward. Allow to dry thoroughly  Stretch the skin of the forearm taut  Positing the syringe with the bevel of the needle up, so that the needle is almost flat against the skin  Insert the needle through the epidermis so that the point of the needle is visible through the skin  Insert about 1/8 inch below the skin’s surface, gradually inject the medication  As you inject, a small blister or wheal should be visible. Withdraw the needle & apply gentle pressure. Never massage. Instruct patient not to rub or scratch the area  A control wheal may be made on the opposite arm  Dispose of the needle  Observe for local redness, itching & systemic reactions

Question 30

Describe the procedure for NG tube medication , what should you do if the NGT is attached to suction ?

Answer 30

 #1 Check Tube Placement  Check residual routinely– (left overs in stomach) before flushing  Flush tube at least 30ml of water before & after medication administration- follow doctor’s orders (make sure it’s not clogged)  Mix crushed or opened medications with 20-30ml water  Gelcaps may have a pinhole pricked in one end and the liquid squeezed out  If NG tube is attached to suction, do not reconnect suction for 30 minutes. (the medication will then have time to absorb because medication will not be aspirated through tube.)

Question 31

What are the nurses responsibility related to narcotics ?

Answer 31

LVN Responsibilities:  Narcotics are kept in a double locked cabinet  “Narcotic keys” are kept by designated nurses per shift  Each controlled drug used is logged into the narcotic log book  At the end of each shift, controlled drugs are carefully counted by nurse from the outgoing shift and a nurse from the incoming shift.  Always have a witness to the “wasting” of a controlled substance. Have witness co-sign and document you wasted it.

Question 32

What law regulates habit - forming drugs ?

Answer 32

 1970- Comprehensive Drug Abuse Prevention & Control Act-required drugs be classified by potential for causing abuse  Controlled Substances Act enforced by Drug Enforcement Administration (DEA)  FDA (Federal and Drug Administration is responsible for administering and enforcing the FDCA within the U.S) has to approve  Drugs that fall under the Controlled Substances Act are knows as controlled substances or Schedule drugs. • Schedule I (tightly controlled, illegal drugs such as Heroine or Cocaine) - high potential for abuse, no accepted medical use (i.e. heroin)

Question 33

How is the nursing process used in nursing administration ?

Answer 33

 Assessment o Take a medication history. Ask about any medication allergies o Assess the client’s understanding about illness, including past experience o Conduct a Physical assessment (V/S & assessing Apical pulse) o Assess, DX, Plan, Implementation, Evaluation o Part of plan is how to teach self administering o Obtain information about social networks and resources  Diagnosis o Nursing diagnoses: problems (primary and secondary) for which the nurse can legally prescribe interventions independently o Identify relevant nursing diagnoses:  Ineffective Health maintenance  Risk for Injury  Noncompliance r/t drug regimens  Deficient Knowledge  Ineffective Management of therapeutic regimen  Ineffective breathing pattern o Social Psychological, educational, environmental, safety, nutritional problems. Why aren’t they taking their medications? Is that they can’t afford them or not proper administering them.  Planning o Identify desired outcomes of nursing interventions & planning appropriate nursing actions  Set priorities  Determine nursing interventions  Set goals for the client or pt.  Formulate teaching plan: why drug needed, adverse effects, nursing measures that will enhance the likelihood of achieving desired outcomes.  Therapeutic goals  Medical knowledge  Special needs equipment  PT teaching needs (know about meds or if they have to self administer meds or injections and how to do that  Planning the medication and when your going to give the meds  Implementation or Intervention: (actually giving the meds) Preparing Drugs for Administration: o Ensure cleanliness of your hands, work area, and supplies o Ensure availability of supplies o Ensure adequate lighting o Decrease environmental distractions o Prepare medications safely o If medication gets on your skin wash thoroughly\ o Focus on Med cart o Anytime you give meds you practice the 7 rights o Teach your pt  Evaluation o Compare actual client outcome with expected outcome  Assess medication effectiveness  Adverse Effects  Client’s ability to self-administer  Evaluate: 1) therapeutic effects – did b/p meds work 2) Adverse effects – have bad negative side effects 3) Allergy – breakout in hives, any problems breathing?

Question 34

Who is liable for a medication error ?

Answer 34

LVN & RN | The person closest to the incident

Question 35

Describe effective patient teaching ?

Answer 35

``` Self Administration:  Drug actions  Dosage  Route Medical Schedule  Importance of taking medications as ordered  Consequences of not taking medications ``` Side Effects:  What are they How to hand them Emergency measures: Rx Refill:  When and where to get prescription filled and obtain other medical supplies or services Insulin & blood sugar:  Types of Insulin  Injection areas & injection technique  Storing insulin in refrigerator  Appearance of insulin  Throwing away syringes (how to dispose of sharps)  Common side effects of insulin ( dizzy, shaky, weak, thirsty, tremors, hungry)  When to take insulin (@ bedtime and between meals)  Testing blood sugar / dipstick Compliance Issues:  Assess why pt not taking their medications  Cost of meds  Inconvenience  # of medications  Forgetfulness ( use memory aids: pillboxes, countdown timers, vibrating watches  Pt Right to refuse

Question 36

Dorsogluteal (buttock, avoid sciatic nerve)

Answer 36

o Not used in infants or children who have not been walking | o Care must be taken to avoid the sciatic nerve

Question 37

How do you administer ear drops to children / adults ?

Answer 37

Pull pinna back & down | Pull pinna back & up

Question 38

deltoid

Answer 38

(arm) o May be used for 1 ml or less of clear, non irritating solutions o Located 2-3 fingerwidths below acromion process