Pharm Deck - Exam 1 Flashcards
Chapters 1-8, 33-39
What is “therapeutics”
(Pharm Ch 1. pg 4)
Therapeutics is concerned with the prevention of disease and treatment of suffering
What is “pharmacotherapy”?
(Pharm Ch 1. pg 4)
aka “pharmacotherapeutics” is the application of drugs for the purpose of treating diseases and alleviating human suffering.
What is a drug?
(Pharm Ch 1. pg 4)
a drug is a chemical agent capable of producing biologic responses with in the body.
The responses may be desirable (therapeutic) or undesirable (adverse).
What is a biologic?
(Pharm Ch 1. pg 4)
biologics are agents naturally produced in animal cells, by microorganisms, or by the body itself.
Biologics are large, complex molecules or mixtures of molecules that may be composed of living material e.g., hormones, monoclonal antibodies, antibodies, nat. blood products & components, interferons, and vaccines.
Biosimilar Drugs or Biosimilars
chemically synthesized drugs that are closely related to biologic medications having already received FDA approval. Maybe referred to as “reference products.”
Biosimilars are NOT required to undergo rigorous preclinical/clinical trials.
Complementary and alternative medicine (CAM) therapies.
Natural plant extracts, herbs, vitamins, minerals, dietary supplements. Might include body-based practices i.e., physical therapy, massage, acupuncture, hypnosis, and biofeedback
Therapeutic Classification
What is the drugs therapeutic USEFULNESS in treating a particular disease? e.g. Cardiac medicine: anticoagulant, antihyperlipidemic, antihyperintensive, etc. Also can be simply written as “drug used for stroke,” or “drug used for shock.” The key is to clearly state what a drug does clinically.
Pharmacologic Classification
Addresses a drug’s mechanism of action, or how a drug produces a PHYSIOLOGIC effect in the body e.g., a drug that lowers plasma volume is classified as a “diuretic,” a drug that blocks heart calcium channels is classified as a “calcium channel blocker.”
Chemical Name
Assigned using IUPAC nomenclature. A drug only has ONE chemical name, often COMPLICATED and DIFFICULT to remember or pronounce. Example: diazepam’s chemical name is 7-chloro-1
Generic Name
Assigned by UANC. Usually less complicated and easier to remember. THERE IS ONLY ONE generic name for each drug.
Example: ibuprofen is the GENERIC name for Advil (trade name).
Keep in mind: Biosimilars (hormones, etc.) are NOT exact copies of original medications so they should not be called generic medications, instead biosimilars use the generic name of the drug FOLLOWED by 4 lowercase letters. Example: infliximab-abda.
Trade Name
Short, EASY to remember and is assigned by the COMPANY that is MARKETING 💵 the drug. Also can be referred to as proprietary or brand name. Example: Advil, Benadryl , Excedrin.
Remember: A drug developer is given exclusive rights to name and market the drug for 17 years after a new drug application is submitted.
Differences between Generic & Trade Named Drugs
The answer is unclear and depends. Dosages may be identical, but drug FORMULATIONS are not always the same (I.e., different inactive or filler ingredients)
The key to comparing trade and generic may lie in measuring their bioavailability.
Bioavailability
the physiologic ability of the drug to reach its TARGET cells and produce its EFFECT.
Critical Thinking: what is a prototype drug, and how does it differ from other drugs in the same class?
Prototype drugs exhibit typical or essential features of the drugs within a specific class. By learning the characteristics of the prototype drugs, students may better anticipate the actions and adverse effects of other drugs in the same class.
Critical Thinking: what are biosimilar drugs? How do they differ from generic drugs?
Biosimilar drugs are drugs which are highly similar to biologic medications that have already received FDA approval. They are chemically synthesized and not required to undergo rigorous preclinical/clinical testing.
Because biosimilars are not exact duplicate copies of original medications (reference products) they should NOT be called generic medications.
What is a “pharmacopeia”
A comprehensive publication of drug standards; medical reference summarizing standards of drug purity, strength, and directions for synthesis.
What is the FDA (US Food and Drug Administration)?
Established in 1988, exercises control over whether prescription and OTC drugs may be used for therapy.
Mission:
1. facilitating the availability of safe, effective drugs, keeping unsafe products off the market.
2. Provide clear easy to understand drug labels
However… herbal and dietary suppliments can be marketed withOUT prior approval from the FDA.
What is a “black box warning”?
1997 FDA created to regulate drugs with “special problems.” A black box serves as a primary alert for identifying EXTREME adverse drug reactions i.e., death or serious injury.
Phases of Approval for Therapeutic and Biologic Drugs
- Preclinical Investigation
- Clinical Investigation (3 phases)
- Review of the New Drug Application
- Post marketing Surveillance
Preclinical Investigation
extensive laboratory research; testing on human and microbial cells cultured in the lab; Studies are performed in several species of animals; preclinical results are always considered inconclusive.
Clinical Investigation
Clinical Phases
1: Tests performed on volunteers to determine proper dosage, assess adverse effects
2: large groups of selected patients with the particular disease are then given the medication.
3: Is the drug effective? Did it make things worse? Does it safely interact with other meds?
New Drug Application
3rd phase of the drug approval process; drug’s trade name is finalized; FDA has 6 months to review drug
Postmarketing Surveillance
Final phase to survery for harmful drug effects in a larger population;
Prescriptive Authority for Nurses
ADVANCED practice nurses can prescribe drugs; regulated by state law
Dependence
The physiologic or psychologic NEED for a substance.
physical dependence refers to an altered physical condition caused by the adaptation of the nervous system to repeated drug use; when drug is no longer available the individual expresses physical signs of discomfort known as WITHDRAWL.
psychological dependence typically shows few physical signs of discomfort however the individual feels an INTENSE , COMPELLING desire to continue drug use.
What is a “controlled substance”?
What is a “scheduled drug”?
A drug that is restricted by the CSA of 1970. This law states that drugs that have a significant potential for ABUSE are placed into 5 categories called schedules.
Scheduled drugs are classified according to their potential for abuse ranked 1-5, 1 having the highest potential for abuse.
Can a telephone order be taken by the pharmacy for a controlled substance?
NOPE!!! Also refills are not permitted, a patient must see their doc once a month for a new written script.
What is a tetragon?
a substance that has the potential to cause a defect in an unborn child during a mother’s pregnancy.
Classifications are: A,B,C,D and X. Category A is the safest group while X poses the most danger to fetus
Identify opportunities the nurse has in educating about, administering, and monitoring the proper use of drugs?
The nurse is reponsible for safe administration, monitoring for therapeutic and adverse effects, and providing education.
Learning pharmacology, proper administration, and pt education are all nursing responsibilities.
A nurse is preparing to give a patient a med and notes that the drug is a Schedule 3. What info does this tell the nurse about this medicaiton?
A schedule 3 drug has a moderate abuse potential, moderate potential for physical dependency, and high potential for psychologic dependency
The nurse’s responsibilities when administering drugs:
hint it’s a lot
Knowledge and Understanding of the following:
1.what drug is ordered
2.Name (generic and trade) AND drug classification
3. Intended or proper use
4. effects on the body
5. Contraindications
6. Special considerations (e.g., how does age/weight/body fat distribution/individual pathophysiologic states affect pharmacotherapeutic response)
7. Side effects
8. Why the med has been prescribed for this particular patient
9.how is the medication supplied by the pharmacy
10. how will med be administered, including dosage ranges
11. what nursing process considerations r/t the medication apply to this patient
Some unfavorable effects are not preventable, the nurse must be prepared to recognize and respond to potential harmful effects of medications, such as?
- adverse event and/or effect
- side effects
- allergic reaction
- anaphylaxis
What is an adverse event?
any undesirable experience associated with the use of a medical product in a patient.
AEs are generally described in terms of intensity (e.g., mild, moderate, severe, life threatening)
remember…a serious adverse event SAE is used to define threat of death or immediate risk of death
What is an adverse effect?
Can be used interchangeably with adverse event; Most use adverse effect; An AE warrant either lowering the dose or discontinuing use of drug.
don’t confuse with “side effect”!
What is a side effect?
Describes a nontherapeutic reaction to a drug; may be transient, but not always the case. They may require nursing intervention, but most of the time they are perceived as TOLERABLE e.g., fatigue, mild pain
what is an allergic reaction?
an acquired hyper-response of body defenses to a foreign substance (allergen).
Signs may vary: rash, pruritis, edema, runny nose, red eyes.
What is the nurse’s responsibility when a patient has a known allergy?
- alert all personnel by DOCUMENTING the allergy in medical record and by appropriately labeling patient records and the medication administration record (MAR).
A bracelet should be placed on the patient.
Communicate with physician and pharmacy
What is anaphylaxis?
What are the symptoms?
A severe type of allergic reaction that involves a MASSIVE, SYSTEMIC release of histamine and other chemical mediators of inflammation that can lead to life threatening shock.
Symptoms: acute dyspnea, hypotension, tachycardia.
Requires immediate treatment❗️
What is toxic epidermal necrolysis (TEN)
Severe, deadly allergic reaction, widespread epidermal SLOUGHING, occurs when liver fails to properly breakdown drug thus cant be excreted normally
associated with teh use of some anticonvulsants, carbamazepine, sulfamethoxazole, and other drugs, but can occur with any drug
What is Stevens-Johnson Syndrome (SJS)?
Often prompted by the same or similar drugs as TEN, usually within 1 to 14 days of pharmacotherapy;
usually signaled by nonspecific upper respiratory infection with CHILLS, FEVER, MALAISE;
generalized BLISTER-LIKE lesions follow within a few days, skin sloughing may occur on 10% of body
What are those Five Rights of Drug Administration!
What are some additions?
- Right patient
- Right medication
- Right dose
- Right route of administration
- Right time of delivery
additions:
right to refuse medication
right to receive drug education
right preparation
right documentation
What action does the nurse take when a patient refuses a medication?
it is the nurse’s responsibility to EDUCATE the patient on the benefits and risks, assess for fears and reasons why refusing, the nurse should notify doc and DOCUMENT all of the information.
What are the 3 checks of drug administration?
- Checking the drug with MAR when removing it from the medication drawer
- Checking the drug when preparing it, pouring it, etc
- Checking the drug before administering it to a patient
The nurse must address essential information that the patient must know in regards to their medication - what are they?
name of drug
why its been ordered
expected drug actions
side effects
potential interactions
What is a STAT order? How is an ASAP order different?
a med that is needed immediately and is to be given only once; within 5 minutes; often associated with emergencies
An asap is not considered urgent, it should be administered to patient within 30 minutes of written order.
What is a standing order?
*Remember what a single, prn, routine order is :)
written in ADVANCE of a situation that is to be carried out under SPECIFIC circumstances.
Example: set of postoperative prn rx that are written for all patients who have undergone a specific procedure.
“tonsillectomy: “Tylenol elixir 325 mg PO q6h prn sore throat”
standing orders are no longer permitted in some facilities.
Why is timing of a medication important?
drug may cause gi issues - take with meal, others shoudn’t be taken with food, some may cause sleepiness and should be taken at night, viagra should be taken 30 to 60 minutes before sex.
When do nurses document administration of a medication?
AFTER administration! NOT during preparation!
document: drug, dosage, time, any assessments, nurses signature, patient refusal and why.
Systems of measurement:
Metric
Apothecary
Household
What specific measurement is no longer used and why?
Metric: most common, vol: liters or milliliters, weight: kg, g, mg, mcg, length: cm
apothecary: old system, joint commission has added to DO NOT USE list
Household: typical household measurements such as tablespoon, cup, etc. know your conversion table
*the cubic centimeter cc is equivalent to 1 mL of fluid, HOWEVER cc can be mistaken for “u” and cause medication errors. No longer used in most facilities
How do we identify the patient for safe drug administration?
Ask patient to state full name while checking id band and comparing this info with the MAR and date of birth.
After identification, what do we ALWAYS ask a patient?
“Do you have any allergies (known)?”
What do we tell the patient about the drug?
name, expected actions, common adverse effects, how it will be administered.
Why is properly positioning a patient important?
Avoid possibility of choking/aspiration
Routes of Drug Administration:
What is the enteral route?
given orally, nasogastric, or thru gastrostomy tubes
most common, convenient, least costly, safest (in an overdose meds remaining in stomach can be retrieved by inducing vomiting)
What are some of the absorptive surfaces via the enteral route?
oral mucosa, stomach, small intestine
Why can’t we just crush a medication for convience?
Some drugs are inactivated by crushing or opening, others may irritate stomach mucosa and cause nausea or vomiting, they are bitter, may stain teeth.
What is an enteric-coated tablet?
Where does it dissolve?
What will happen if an enteric-coated tablet is opened and then taken?
hard, waxy coating that resists acidity; designed to dissolve in the alkaline environment of small intestine; if opened the med would be directly exposed to the stomach environment
What is an SR med? What are some other abbreviations?
How does an SR med help the patient adhere to a medication schedule?
“Sustained Release”
adherence to a drug regiment declines as the number of doses per day increases, allows for conviene of once or twice a day dosing
an SR are designed to dissolve slooooowly and med is released over an extended time and results in longer duration of action for the med
XR(extended-release)
LA (long-acting)
What are some of the disadvantages of oral route?
pt must be conscious, able to swallow, certain types of drugs are inactivated by digestive enzymes in the stomach and small intestine; gi motility and its ability to absorb can create differences in its bioavailability
VERY important to remember**meds absorbed from stomach and sml intestine first travel to the liver where they may be inactivated before they ever reach their target organs -The First-Pass Effect
Enteral Drug Administration:
Explain Sublingual and Buccal Drug Admin
**when multiple drugs are ordered, in what order would you administer sublingual or buccal drugs?
tablet not swallowed but kept in the mouth; mucosa of oral cavity contains rich blood supply for excellent absorbption and meds are not exposed to destructive digestive enzymes and avoid First-pass effect.
sublingual/buccal drugs given after oral medications that need to be swallowed
pg 25 provides specific guide of administration guidelines for enteral route
Nasogastric & Gastrostomy Drug administration:
What form does a drug to be administered usually take?
Can crushed meds be given?
liquid form;
Yes..it depends (look at table 3.3 and/or pg 26) “although solid drugs can be crushed or dissolved, they tend to cause clogging within the tube, SR should NOT be administed thru these tubes.”
what are the different types of Topical Administrations?
1.Dermatologic preparations
2.instillations and irrigantions (drugs applied into body cavities or orifices; ears, rectum, vagina etc)
3. Inhalations
Why would a drug be applied topically?
many drugs needed to produce a LOCAL effect e.g., antibiotic for a skin infections, corticosteroids sprayed into nose, etc.
HOWEVER for some drugs it allows for slow release and absorption of the drug in the general circulation. These agents are used for their systemic effects example: nitroglycerin patch is applied not to treat a skin condition but a systemic cond. like coronary artery disease. another example is compazine suppositories are inserted rectally not to treat disease of rectum but to alleviate nausea
Tell me about nasal administration
nasal route is used for local AND systemic drug administration; nasal mucosa excellent absorption; advantages: ease of use, avoid first-pass and digestive enzymes;
Disadvantages: potential damage to the cilia and mucosal irritation
Nasal Route: with drops or sprays what is an astringent effect?
SHRINKS swollen mucous membranes or LOOSEN secretions and facilitate DRAINAGE
What are some different forms a medication may take when used for a vaginal condition?
cream, gel, foam, suppository
*have patient empty bladder prior to administration
Tell me about rectal administration
may be used for local and systemic drug administration; safe for comatose patients or those who are nauseous or vomiting; may be a suppository or an enema; avoids first pas effect
What is parenteral drug administration?
Is it invasive? How so?
dispensing of meds by routes other than oral or topical; delievers drugs via NEEDLE into skin layers sub q tissue, muscles, or veins;
much more INVASIVE; potential for introducing pathogenic microbes directly into the blood or body tissues, needs ASEPTIC technique.
tell me about ID injections. advantages? what are they usually used for? injection sites?
admin into dermis; easy absorbtion; usually used for allergy and disease testing or for local anesthetic; limited to very small volumes of drug (0.1-0.2 mL);
usual sites: non hairy upper back, over scapulae. high upper chest, inner forearm
Example: tuberculosis test
What are some of the advantages of intradermal/sub q admin? disadvantages?
advantages: offer a means of admin drugs to patient who can’t swallow them orally, avoid first-pass effect
disadvantages: only small volumes can be administered, pain/irritation at injection site
tell me about subcutaneous injections
deeper tissue; insulin, heparin, vitamins, some vaccines are given in this site because they are easily accessible and rapid absorption; sml volume of drug (0.5-1 mL)
sites: upper arm above triceps, anterior thigh, abdomen, etc
Tell me about IM injections
muscle tissue has rich supply of blood, med moves quickly into blood vessels more rapid onset of action; larger vol (1-3 mL)
Tell me about intravenous IV medications
admin directly to blood stream, immediately available for use by the body; bypasses first pass and digestive enzymes;
What are the 3 basic types of IV administration?
- large-volume infusion
- intermittent infusion
- IV bolus (push) administration
What is a large-volume infusion?
used for fluid maintenance, replacement, or supplementation.
what is intermittent infusion?
small amount of iv solution that is arranged in tandem with or piggybacked to the primary large volume infusion. it is used to instill adjunct meds, such as antibiotics or analgesics, over a short period of time
what is IV bolus (push) administration?
this is a CONCENTRATED dose delivered directly to the circulation via syringe to administer single dose meds
What makes an IV injection dangerous?
although its the fastest onset of drug action, once injected the med CANNOT be retrieved; possible pathogen introduced to bloodstream and body tissues.
Remember some adverse reactions may take minutes or days, antidotes must always be readily availiable.
Why do errors continue to occur despite nurses’ following the 5 rights and 3 drug check of administration?
pg 824
what strategies can the nurse use to ensure adherence to drug therapy for a patient who is refusing to take his medication?
pg 824
compare routes of administration.. which has fastest onset of drug action? which routes avoid first pass effect?
pg 824
What is pharmacokinetics
the study of drug movement throughout the body. In practical terms, it describes how the body deals with medications.
