Pharm class Flashcards
core ethical principles
respect for person: pt should be treated as independent person capable of making decisions in their own best interests.
beneficence: Nursing practice that does good and avoids harm.
justice: requires that the selection of research subjects be fair.
patient centered
focus on patient care
nursing process
organize patient information around a medical diagnose. is used by nurses for the appropriate delivery of patient care and drug administration. describe the who, what , where, why and how of nursing practice.
thiazide (diuretic)
management of mild to moderate hypertension. treatment of edema
assessment
subjective data: current health history, patient
increase medication adherence (the extend to which a patient continues an agreed on mode of treatment without close supervision)
1) ensuring access to providers across the continuum of care and implementing team-based care;
2) educating and empowering patients to understand the treatment regimen and its benefits;
3) reducing barriers to obtaining medication, including cost reduction
Which information will the nurse include in the patient teaching? (Select all that apply.)
administration technique.
instructions regarding drug discontinuation.
foods to avoid when taking a certain drug.
side effects to report to health care provider.
Which is a correctly written goal by the nurse?
patient will independently administer the prescribed dose of insulin at the end of 1 hour of instruction.
What is the first step of the nursing process when working with patients receiving drug therapy?
assessment
Before information about drug therapy is presented to a patient, it is most important for the nurse to
assess the patient’s readiness to learn
The Nursing Alliance for Quality Care (NAQC)
Supports highest-quality safe patient-centered health care
NAQC and ANA
Published guidelines supporting core principles
Six-step decision-making approach
Concept Assessment Patient problems Planning Nursing interventions Evaluation
Concept
Influences delivery of patient care
Focuses on patient-centered model of care
Pertain to patient’s problems
Includes health, illness, and health promotion
Includes preventive, primary, acute, and chronic health care
patient problems
identifies patient needs
better identifies clinical practice and the plan of care.
Pharmacogenetics
Study of how a patient’s genomes affect drug response
Helps individualize optimal drug treatment regimens
Helps decrease drug reactions
Promotes drug regimen adherence
Reduces overall healthcare costs
Patients who benefit most from pharmacogenetics
Those taking multiple prescription drugs
Those not responding to current therapy
Those having adverse drug reactions
Those taking black box warning drugs
Individual Variation in Metabolism of Select Drugs
Mercaptopurine Irinotecan Abacavir Warfarin Clopidogrel Opioids Mental health drugs Carbamazepine
Legal and Ethical Issues
Privacy
Who has access to patient’s genetic information?
Who owns genetic information
Concerns about patient “labeling”
Autonomy
Patient may consent to or refuse genetic testing
Patient may change their mind about testing
Justice
Equal and fair treatment for all
Nursing Process: Pharmacogenetics
Assessment
Assess family history back three generations.
Determine side effects/adverse effects to drug therapy
Concept
Safety
Planning
Integrate patient preferences and family implications into developing evidence-based plans of care
Nursing Interventions
Refer identified patients to genetic counseling as needed
Guide patients in the implications and uses of genetic results.
Ensure patient knows to report genetic findings to all healthcare providers.
Evaluation
A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours. The nurse expects the duration of this medication to
increase
When assessing older adults and those with renal dysfunction, the nurse knows that creatinine clearance is usually
decreased
A patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. The nurse would anticipate that this will interfere most with which phase of pharmacodynamics?
Distribution
Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index?
Pharmacokinetic phase
Absorption
Distribution
Metabolism
Excretion
Pharmacodynamic phase
Receptor binding
Postreceptor effects
Chemical reactions
Pharmacokinetics
Drug absorption
Drug movement from GI tract into bloodstream
Disintegration
Breakdown of oral drug form into small particles
Dissolution
Combining small drug particles with liquid to form a solution
Absorption methods
Passive transport
-Diffusion
-Facilitated diffusion
Active transport
—Requires energy to move drug against a concentration gradient
Pinocytosis
—Cell carries drug across membrane by engulfing drug particles.
Factors affecting absorption
Blood flow, pain, stress, pH
Exercise, hunger, fasting
Food texture, fat content, temperature
Route of administration
Drug movement from GI tract to liver
Via portal vein
First pass effect
Bioavailability
Factors affecting bioavailability
Absorption First-pass metabolism Drug form Route of administration Gastric mucosa and motility Administration with food and other drugs Changes in liver metabolism
Drug distribution
Movement of drug from circulation to body tissues Influencing factors Protein binding Free drugs Volume of drug distribution (Vd)
Drug metabolism (biotransformation)
Process of body chemically changing drug into a form to be excreted Prodrug Half-life (t½) Steady state Loading dose
Drug excretion (elimination)
Kidneys Liver (bile) Lungs Saliva Sweat Breast milk
Pharmacodynamics
Study of the way drugs affect the body --Primary effect Desirable response () --Secondary effect Desirable or undesirable
Drug response relationship
—Body’s physiologic response to changes in drug concentration at site of action
—Potency
Amount of drug needed to elicit specific physiologic response
—–Maximal efficacy
Point which increasing a drug’s dosage no longer increases desired therapeutic response
—-Therapeutic index (5-10)
Relationship between therapeutic dose and toxic dose
Pharmacodynamics
Onset
-Time it takes for drug to reach minimum effective concentration
Peak
-Highest concentration in blood
Duration
-Length of time drug exerts a therapeutic effect
Therapeutic drug monitoring
Peak drug level
Trough drug level
Pharmacodynamics
Receptor theory
Drugs act by binding to receptors
To activate receptor
To produce a response
To inactivate a receptor
pharmacodynamics-
Four receptor families
Cell membrane–imbedded enzymes
Ligand-gated ion channels
G protein–coupled receptor systems
Transcription factors
Agonists
produce the desire response. Activate receptors
Produce desired response
Antagonists
Prevent receptor activation
Block response
bethanechol
epinephrine
alergic reactions
pharmacodynamics
i know the side effects of medications
psychotoxic drugs
affects the cells. used for cancer patients
Mechanisms of drug action
Stimulation Depression Irritation Replacement Cytotoxic action Antimicrobial action Modification of immune status
Pharmacokinetic interactions
Changes occurring in absorption, distribution, metabolism, and excretion
Drug interactions
Altered drug effect due to interaction with another drug
Pharmacodynamic interactions
Additive
Sum of effects of two drugs
Synergistic
Effect of two drugs is much greater than effects of either drug alone.
Antagonistic
One drug reduces or blocks effect of other drug
Drug-nutrient interactions
Food may increase, decrease, or delay drug response
Drug-laboratory interactions
Drugs may cause misinterpretation of test results.
Drug-induced photosensitivity
Drug induced skin reaction caused by sunlight exposure.
cancer drugs, prograph or chemotherapy
Nursing Process: Pharmacokinetics and Pharmacodynamics
-Concept
Caring intervention, safety
–Assessment
Determine potential for drug interaction problems.
Identify patient’s current drugs.
—Patient problems
Anxiety, need for health teaching
—–Planning
The patient will describe rationale for therapeutic regimen.
—Nursing interventions
Advise patient not to eat high-fat foods before ingesting an enteric-coated tablet.
Monitor therapeutic range of drugs that are more toxic or have narrow therapeutic ranges.
Notify health care provider of drugs ordered that have antagonistic effects.
—-Evaluation
A patient has liver and kidney disease. He is given a medication with a half-life of 30 hours. What is the expected duration of this medication?
increase
When assessing older adults and those with renal dysfunction, the nurse would expect the creatinine clearance to be which of the following?
decreased
A patient sustains significant burns to the skin and is experiencing fluid shift associated with edema in the fluid overload phase. The nurse would anticipate that this will interfere most with which phase of pharmacodynamics?
Distribution
Which nursing actions would be most appropriate for ensuring patient safety with a medication that has a low therapeutic index?
Monitoring serum peak and trough levels
What is the primary site of metabolism for most drugs?
liver
