PHARM 1 EXAM #1 Flashcards
Identify the three core ethical principles of research.
-
Respect for persons:
- Veracity – providing accurate data…both good/bad
- Autonomy – the right to self-determination
- Beneficence –> to do good and do no harm to others; the duty to protect research subjects from harm (a moral obligation)
- Justice –> to treat all populations fairly, research should reflect all social classes and racial/ethnic groups
Relate the core ethical principles that govern informed consent to risk-benefit ratio.
Informed consent includes:
- promoting individual autonomy (the right to say no)
- protecting patients from harm
- avoiding fraud and duress in health care
- encouraging professionals to be thorough and clear in communicating information (it is the HCPs responsibility to educate the patient…NOT the RN)
- promoting educated decision making among patients
- promoting self-determination by patients.
What are the NINE (9) provisions from the American Nurses Association Code of Ethics?
- The nurse practices with compassion and respect for the inherent dignity,
worth, and unique attributes of every person. - The nurse’s primary commitment is to the patient, whether an individual,
family, group, community, or population. - The nurse promotes, advocates for, and protects the rights, health, and
safety of the patient. - The nurse has authority, accountability and responsibility for nursing
practice; makes decisions; and takes action consistent with the obligation
to provide optimal patient care. - The nurse owes the same duties to self as to others, including the
responsibility to promote health and safety, preserve wholeness of
character and integrity, maintain competence, and continue personal and
professional growth. - The nurse, through individual and collective effort, establishes, maintains,
and improves the ethical environment of the work setting and conditions
of employment that are conducive to safe, quality health care. - The nurse, in all roles and settings, advances the profession through
research and scholarly inquiry, professional standards development, and
the generation of both nursing and health policy. - The nurse collaborates with other health professionals and the public to
protect human rights, promote health diplomacy, and reduce health
disparities. - The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the integrity of the
profession, and integrate principles of social justice into nursing and
health policy.
Describe the objectives of each phase of human clinical experimentation.
— Total time from lab to the pharmacy = ~12 years
— Limitations: pregnant/childbearing age women & children
— NDA= New Drug Application
Distribution in pharmacokinetics is the process by which
The drug becomes available to the body fluids and body tissues
F
How is drug distribution influenced in pharmacokinetics?
— Blood flow
— The drug’s affinity to tissue
— The protein-binding effect
— It can also be affected by the effects of edema in the fluid overload/dehydration
Discuss federal legislation acts related to U.S. Food and Drug Administration drug approvals.
The primary purpose of federal legislation is to ensure public safety.
Only free drugs are active, true or false?
True
— Protein bound drugs compete for protein binding sites.
— Low serum protein can also decrease binding sites (increasing free drug, which could be toxic)
Describe the function of state nurse practice acts.
To regulate and protect the public from practitioners who are a risk to the health, safety, and welfare of the citizens within its state board jurisdiction.
Differentiate between chemical, generic, and brand names of drugs.
Generic Name: official name given by the pharmaceutical company; NOT normally capitalized
Brand/Trade Name: commercial or proprietary name, CAPITALIZED
Chemical Name: given when a new chemical entity (NCE) is developed and is the scientific name based on the compounds chemical structure; all generic, brand or trade names have the same chemical composition
_____________________________________________________________________
Examples: Acetaminophen | Furosemide | Ibuprofen = GENERIC NAME
Tylenol | Lasix | Advil = BRAND NAME
Examples of TRADE NAME vs. GENERIC NAME
GENERIC =
1. Phenytoin
2. Metformin
3. Acetaminophen
4. Furosemide
5. Metoprolol
6. Diphenhydramine
TRADE/BRAND = parenthesis ()
1. (Dilantin)
2. (Glucophage)
3. (Tylenol)
4. (Lasix)
5. (Lopressor)
6. (Benadryl)
Define “over the counter” as it relates to drugs.
— FDA standardized OTC labeling:
- Active/Inactive ingredients,
- Purpose of product
- Specific warnings
- Dosage instructions
— OTC drugs may cause delay in professional Dx & Tx
— Sx/S may be masked
— Inactive ingredients may cause adverse rxns
— Be aware of potential for overdose, esp. when combining products
— Polypharmacy increases risk for drug-drug interactions
Fun fact: More than 90% of illnesses are initially treated with OTC!
Identify three useful drug reference resources.
— American Hospital Formulary Service Drug Information
— U.S. Pharmacopeia—Drug Information
— Medical Letter
— Prescriber’s Letter
— MedlinePlus: www.nlm.nih.gov/medlineplus/druginformation
— The Handbook of Nonprescription Drugs
NOTE: These publications are published by pharmacists for HCPs/professionals
— Credible internet websites (any websites with .gov), Davis Drug Guide, Taber’s Medical Dictionary
Differentiate the three phases of drug action.
- Pharmaceutical phase — disintegration + dissolution
- Pharmacokinetic phase — what the body does to the drug;* describes the movement of the drug throughout the body
- Pharmacodynamics — the effects of the drug on the body; what the drug does TO the body; drug reaches target cell, tissues, organs, and therapeutic effects
What happens during the pharmacodynamic phase?
— Receptor binding
— Post-receptor effects
— Chemical reactions
Describe the four processes of pharmacokinetics.
“ADME”= All Dinosaurs Move Effortlessly
1. Absorption
—blood circulation, pain, stress, food texture, fat content, temperature, pH, route of administration
— movement via portal vein; FIRST PASS EFFECT
2. Distribution
3. Metabolism
4. Excretion/Elimination
These consist of fillers and inert substances, known as excipients – giving it its shape and size. Excipients can also effect the absorption of the actual drug. D
TABLETS
What drugs are commonly taken by mouth?
PILLS, TABLETS, & CAPSULES
Anticipate potential unique responses of drugs based on biologic variations.
RIGHT ASSESSMENT
— collect appropriate baseline data before drug administration
— understand their health history, allergies, VS, lab results
_____________
RIGHT DOCUMENTATION
— record drug administration immediately
— document patient’s response to medication
______________
RIGHT TO EDUCATION
— teach patient accurate and complete drug information
T/F
Drugs that are low lipid soluble and of high molecular weight can cross the BBB
False
— Drugs that are _highly_ lipid soluble and of _low_ molecular weight (i.e. benzodiazepines) are able to cross the BBB either via diffusion or transport proteins.
— 98% of the drugs on the market do not cross the BBB.
Examples of weakly protein-bound drugs
<10% bound
— Gentamycin
— Metformin
— Metoprolol
— Lisinopril
Examples of moderately high to highly protein-bound drugs
72%-92% bound
— Carbidopa/Levodopa (Sinemet)
Examples of highly protein-bound drugs
over 90% bound
— Warfarin
— Glyburide
— Sertraline
— Furosemide
— Diazepam
Factors that alter or affect bioavailability in pharmacokinetics
— The drug form
— Route of administration
— GI mucosa and motility
— Food and other drugs
— Changes in liver metabolism.
Describe the influence of protein binding on drug bioavailability.
— Neonates + infants have less albumin (#1 protein in blood) and fewer protein receptor sites, which means they have more FREE DRUG —> Elevated free drug level (b/c do not have a lot more binding receptor sites) —> must give a lower dosage
— ONLY medication that can have therapeutic effects = FREE medication —> medications that bound to protein not really therapeutic & dose appropriately knowing that
Check drugs for half-life, percentage of protein binding, therapeutic index, and side effects in
a drug reference book
— The blood brain barrier (BBB) in infants is immature and allows medications to pass easily into nervous system tissue increasing risk of toxicity
— Children inherently have higher metabolic rates than adults, causing metabolism to occur more rapidly. This may necessitate a HIGHER medication requirement including increased dosage and frequency.
— Until age of ~2, pediatric patients may need HIGHER doses of water-soluble medications to achieve therapeutic levels
Differentiate the four types of drug interactions.
- Drug-drug
- Drug-food/nutrient
— e.g. grapefruit juice, calcium, high protein meals, tyramine-rich foods (cheese, wine, organ meats, beer, yogurt, bananas) - Drug-laboratory
- Drug-induced photosensitivity
A drug must be able to?
— Be easy to administer and able to reach the infectious agent anywhere in the body
— Be absolutely toxic to the infectious agent and absolutely nontoxic to the host
— Remain in the body as long as needed and be safely and easily broken down and excreted
Explain the three mechanisms involved with drug-drug interactions.
— Additive: Sum of effects of 2 drugs | 1 + 1 = 2
— Synergistic: Effect is much greater than effects of either drug alone | 1 + 1 = > 2
— Antagonistic: One drug reduces/blocks effect of the other drug
Described the effects of drug-nutrient interactions.
—Interactions with specific foods can decrease/increase absorption, can cause adverse rxns, or toxicity
_______________________________________________
Examples:
— Avoid calcium and fluoroquinolones (Cipro, Levaquin) —> decreases absorption
— Avoid calcium and tetracyclines —> decreases absorption
— Avoid food with levothyroxine (Synthroid) —> decreases absorption
— Give pantoprazole (Protonix, a PPI) on empty stomach —> increases absorption
— Avoid high protein meals with levodopa (one of the ingredients in Sinemet for Parkinson’s dz) —> decreases absorption
— Avoid tyramine-rich foods (cheeses, wine, organ meats, beer, yogurt, bananas) with MAOI antidepressants —> can cause hypertensive crisis
Explain the meaning of drug-laboratory interactions
Drugs may cause misinterpretation of test results.
—E.g. Diuretics can alter electrolytes which can be dangerous within itself AND can increase the risk of toxicity of digoxin
Explain the meaning of drug-induced photosensitivity.
Skin reaction/increased risk caused by sunlight exposure
—E.g. Exposure to UVA/B light can cause allergic reaction or cellular damage; see table 2.3
Describe the nursing implications of pharmacokinetics and pharmacodynamics.
Pharmacokinetics:
— ADME = absorption, distribution, metabolism, excretion
differs between infants, children, adults, and older adults
— It takes about 5 1/2 lives to eliminate a drug from the body OR if the person continues taking the drugs, it takes about 4-5 1/2 lives to reach a steady state (rate of intake of the drug will ~equal the rate of elimination)
Pharmacodynamics:
— 1ary vs 2ndary effect
— Therapeutic vs toxic/potency effect
—Onset, Peak, Duration
— Monitor peak and trough drug levels
— “Lock-and-key:” Many drugs work by effect on receptors – can produce (agonists) or block responses (antagonists)
Examples of Pharmacodynamics mechanism of drug action
— Stimulation or depression; e.g. beta agonist or beta blocker
— Replacement – hormone; e.g. insulin, thyroid
— Inhibition or killing – e.g. antimicrobials/antibiotics (bactericidal or bacteriostatic) or cytotoxic (chemotherapy)
— Irritation; e.e. laxatives
— Modification of immune status – drugs that alter the immune response such as steroids or biologics
Mechanisms of drug action for pharmacodynamics
Drugs that produce a response but do not act on a receptor may act by stimulating or inhibiting enzyme activity or hormone production. Some drugs are just a chemical reaction…no systemic effect…i.e. antacids
— Stimulation
— Depression
— Irritation
— Replacement
— Cytotoxic action
— Antimicrobial action
— Modification of immune status
Recognize verbal and nonverbal communication practices of various social and cultural
groups.
Explain appropriate spatial configurations for patients when delivering nursing care.
Discuss the importance of including significant members of the social group in the planning
and implementation of patient care.
Compare patients’ perception of time based on cultural constructs.
Describe patients’ need to exercise control in their environment.
Anticipate potential unique responses to drugs based on social, cultural, and biologic
influences.
Safeguard patients’ rights to confidentiality during inclusion of significant others in the plan
of care.
Discuss at least six important points associated with the use of complementary and
alternative medicine (CAM).
Compare common herbs and their associated toxicity.
Differentiate the most common herbal therapies and the potential use for each.
Differentiate the steps of the nursing process and their purpose in relation to drug therapy.
5-Step decision-making approach
1. Assessment
— purpose: obtain subjective + objective data, which provides evidence (based on the assessment) in order to determine a diagnosis
2. Diagnosis
— purpose: what is wrong with the patient?
3. Planning
— purpose: what do I need to do because of the diagnosis based upon the assessment with patient @ center? Collaborate with other team; patient-centered goal…”the patient will…”
— Anyone going in should be able to follow and measure the same goal reported/charted
4. Implementation
— purpose: educate, drug administration (yes to therapeutic effects, no to adverse rxns), patient care being provided, any interventions needed for establishing goals?, promote patient teaching (ready to learn?), eliminate barriers
5. Evaluation
— purpose: Determine if goals/teaching, were met, any need for follow-ups/community resources, and document successful goal attainment
Analyze safety risks for medication administration.
— Administration – 41% —> pill splitting, crushing meds, wrong “rights” involved (patient, drug, dose, time & route)
— Documenting – 21% —>
— Dispensing – 17% —> Pharmacists
— Prescribing – 11% —> MD/PA/NP
— Monitoring – 1 % —> Laboratory values/reports, peaks/troughs data, liver/kidney functions
— Other – 9%
RN’s risk of medication error INCREASES BY 60% if interrupted/distracted during the preparation phase of medication administration
Discuss the culture of safety and include the Institute of Medicine’s “To Err is Human” and
the American Nurses Association’s “Just Culture” impact on nursing.
— ANA encourages organization to avoid punitive approaches in drug error reporting.
— Individuals should be encouraged to report drug errors, so the system can be repaired and fixed.
— The safe administration of medication by registered nurses is regulated by state law and regulation
Explain the Z-track IM injection technique.
— The Z-track injection technique prevents medication from leaking back into the subcutaneous tissue. It is frequently advised for medications that cause visible and permanent skin discolorations such as iron dextran.
Process:
— Put your needle down and as you withdraw the needle, you let the skin go
— Instead of having a straight up and down injection site that the medication can leak out of, you have a “Z-track”
— Pulled needle out a little bit, let a little bit of skin go, pulled out a little bit more, let the skin go completely, and pulled needle all the way out
— Purpose: Medication is LESS likely to come through and irritate subcutaneous layer, epidermal layer, discolor skin or cause pain;
e.g. GIVING IRON = discolors skin AND painful, therefore…Z-TRACK METHOD
Routes for Suppository Drug Administration
— Rectal: make sure it is far enough past the rectal sphincter so it does not come back out
— Vaginal: want to make sure its closer to the cervix so it does not come back out
Intradermal Drug Adminstration
— Insert needle, bevel up, @ 10-15-degree angle
— The outline of the needle under the skin should be visible
— Needle: 25 to 27 gauge; 3/8 to 5/8 inch long
NOTE: Because many Americans are overweight and have a lot of fat/tissue, going at a 90-degree angle will be fine; however, the thinner you are the more acute the angle will be
Vastos lateralis Drug Administration
— Administered in the lateral part of quadriceps
— Hand below groin, hand above knee
— Give: OUTSIDE/LATERAL side of leg, IN muscle
FOR BABIES
Ventrogluteal Drug Administration
— Using your palm on the greater trochanter, pointer finger on the illiac crest, and thumb toward the front of the lilac crest
— Give injection between: pointer finger + thumb
Intravenous Drug Administration
— Median cubital = antecubital (on the median side of it)
— Cephalic vein = on the outside
— Basilic vein = on the inside
— Radial vein = lowest side
