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Pharm final Flashcards

1
Q

Appropriate authoritative sources for drug information

A

References within the last 3 years: textbook, Physician’s desk reference, drug manufacturer’s inserts, nursing drug handbooks, US Pharmacopeia, FDA, Pharmacist
· Meditech or an actual source, not another RN

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2
Q

Considerations for appropriate timing of administration of drugs

A

· 30 minutes before and after it is due
· Some drugs have specific instructions like levothyroxine
maintain therapeutic level
Stat - w/in 15 mins. Now = w/in 1 hour

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3
Q

Rights of medication administration

A 
·         Who – right patient
·         What- right drug
·         When- right time
·         Where- right route
·         Why –right documentation
·         How- right dose
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4
Q

Pharmaceutics: rate of drug absorption

A

Fastest -> slowest: oral disintegration, liquids, suspension solutions, powders, capsules, tablets, coated tablets, enteric coated tablets
· Affected by parenteral or enteral- first pass effect
· Affected by the design of the capsule

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5
Q

Drugs that go through first pass

A

anything ingested with be processed through the liver causing a first pass

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6
Q

Drugs that don’t go through first pass

A

subcutaneous, intradermal, IM, IV, topical, buccal, sublingual

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7
Q

Rate of absorption

A

· IV or inhalation for fastest distribution, ingestion for slowest distribution
· The slower the distribution the longer it has a therapeutic effect
distro quicker where there is more vascular - heart, liver, kidney, brain. Slower with bone, muscle, skin, fat
· Distribution can be affected by how protein-bound the drug is

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8
Q

Organ that metabolizes drugs

A

liver

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9
Q

organ that excretes drug

A

kidneys

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10
Q

Considerations for drug metabolism

A

Know if the pt has an abnormal albumin levels, it could alter drug dose
· Pt with burns, liver problems, vegans, or severely malnourished will have low or no albumin
low albumin needs incr dose.

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11
Q

Half life-

A

how long it takes for half of the drug to be excreted from your body

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12
Q

onset

A

When the drug starts to have a therapeutic effect on the body

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13
Q

peak

A

when the drug has its highest therapeutic effect

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14
Q

duration

A

how long the drug has a therapeutic effect in your system

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15
Q

Pharmacodynamics: MOA and three types

A

Agonist or antagonist to a receptor it cannot make the cell/tissue do something it was not designed to do
3 different kinds of MOA: cell receptor (reacts to receptor), enzyme (reacts to enzyme), non-selective (doesn’t react to receptor or enzyme)

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16
Q

Pharmacotherapeutics: monitoring for AE, therapeutic index, drug concentration, interactions, adverse drug events (med errors; allergic reactions)

A

Interactions can be additive or competitive
Medication errors: adverse drug event, preventable, compromise of one of the 6 rights.
Allergic reactions: also adverse drug event, involves immune system

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17
Q

Considerations for pediatric patients (characteristics of pediatric patients)

A

· Will need a smaller dose
like elderly, but liver isn’t mature enough so doesn’t metabolize well
fat content lower because they have more body water
more drugs will enter brain due to immature blood brain barrier
Everything is decreased because of immature instead of overused

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18
Q

Considerations for elderly patients (issues, physiologic changes, pharmacokinetic changes)

A

· Livers will not be able to metabolize as well
· Less muscle mass, fat increased
· Elderly patients will need a lower dose, because less protein to bind to (low albumin)
· polypharmacy
-pH goes up, so less acidic
- everything is slower and decreased

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19
Q

Common practices and barriers among selected cultural groups

A

· may affect compliance
· may affect how their body reacts to a drug
language, poverty, practices
Asian don’t take as much pain meds - ying-yang and herbals
African Americans & European - slow acetylators (so less dose)
Japanese & Inuit (like eskimos) - fast acetylators (more dose needed)

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20
Q

Scope and role of RN

A

Nurse is responsible for being aware of the drug’s AE and interactions, and the signs of those
· Just culture- reporting incidents is not punitive

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21
Q

autonomy

A

self reliance

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22
Q

benefience

A

doing good

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23
Q

non-maleficence

A

not harming others

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24
Q

veracity

A

telling the truth

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25
Adverse drug event
- undesirable occurrence related to admin. or failure to admin a med
26
adverse drug reaction
unexpected, unintended response to a med at therapeutic dose
27
Idiosyncratic reaction-
peculiar, abnormal reaction
28
medication error
preventable adverse drug event by pt or health professional
29
How to prevent medication errors
check chart for allergies, check meds twice, Multiple systems of checks and balances legible orders w/ correct info or electronic orders authoritative resources should be consulted nurses check med order 3X use 6 rights of med, admin, consistently
30
Special considerations: treating pain in pts who have chronic pain, drug addiction (psychologic dependence)
Pt with chronic pain will have palliative care and a high tolerance · A drug addict or has been taking them from chronic pain will need higher doses because of their high tolerance. can give opioid if it helps with other issue o Psychological dependence is like an addiction to pot
31
indications for morphine
Indicated for extreme pain, like breakthrough pain - somatic/cancer/visceral pain, not neuropathic. May give end of life to help with breathing
32
Adverse effects of morphine
constipation, slow RR, nausea, vomiting, urinary retention, sweating, pupil constriction, itching
33
toxicity of morphine or other opioids and it's treatment
respiratory depression. Treat with naloxone
34
Contraindications for morphine
resp insufficiency, elevated ICP, fat, sleep apnea, paralytic ileus, pregnancy
35
Interactions with morphine
alcohol, antihistamines, barbiturates, benzodiazepines, MAOI (all decr respirs and BP) · Give with an NSAID for synergistic effects · Opioid withdrawal abstinence syndrome- anxiety, irritability, chills and hot flashes, joint pain, lacrimation, rhinorrhea, diaphoresis, N/V, ab cramps, diarrhea, confusion,
36
Acetaminophen (indications, AE, toxicity; pt teaching)
· Analgesic and antipyretic, little to no antiinflammatory · Blocks peripheral pain pulse, and lowers body temp at hypothalamus · Healthy adult can have 3000 mg/day, 2000 mg/day if elderly or liver disease · Can OD which can lead to hepatotoxicity: OD can be intentional or from unintentional chronic misuse · Long term ingestion of large doses can lead to nephropathy
37
Antagonist for acetaminophen
Acetylcysteine
38
Aspirin(salicylate)
``` - antiplatelet aggregation oral, topical, or rectal 81mg for cardioprotective properties, any higher is usually for the analgesic effect (325 max) do give to children (Reyes syndrome) AE - tinnitus decr platelet aggregation watch kidneys ```
39
Ketorolac
stronger NSAID, won’t be on it long term, no more than 5 days, I have that it is equal to morphine in effectiveness PO or IV, for severe acute pain can cause renal impairment, so monitor creatinine and BUN levels can cause edema, GI pain, dyspespsia, nausea
40
Ibuprophen
PO form used for RA, OA, primary dysmenorrhea, gout, dental pain, musculoskeletal disorders, and fevers post op pain- max dosage of 3200 mg/day, 400-800mg IV Q6H fever- 400 mg Q4-6H or 100 mg Q4H caution in pt with CHF, kidney impairment, risk of blood clots, history of GI ulcers or bleeding can cause N/V, flatulence, headache
41
GI treatment for all NSAIDs
misoprostol
42
Propofol (indications, nursing considerations)
A general anesthetic for sedation for mechanical ventilation in ICU (high dose). Also a hypnotic induction and maintenance of anesthesia (low dose) Nursing - very fast half life, typically well tolerated with few side effects prop the pt up before their O2 stats fol(fall) quickly-quick half life, ventilation
43
NMBD: succinylcholine indications
paralysis starts in extremities and diaphragm, and comes back in reverse order indications- induction of endotracheal intubation, paralyzes(be ready to intubate), reduces muscle contractions in surgery, diagnostic test for myasthenia gravis
44
NMBD: succinylcholine overdose considerations
OD- causes prolonged paralysis requiring prolonged mechanical ventilation cardiovascular collapse may occur, several conditions may increase sensitivity to NMBDs
45
NMBD: Succinylcholine adverse effects
AE- hypotension, tachycardia, few if used appropriately be careful with patient who has a history of malignant hypothermia it succs because it can cause malignant hypothermia, and you can’t succ(paralysis)
46
Midazolam (indications, therapeutic effects, nursing considerations)
indication- conscious sedation with morphine, high anxiety, breathing on their own therapeutic effect- reduced anxiety and sensitivity to pain, induces amnesia for certain procedures ``` nursing considerations- it is a benzo, so it can be abused, monitor VS to make sure they don’t go too low Don’t give with grapefruit juice, alcohol, other suppressants (ANY benzos!) mid day (conscious) sedation you can’t remember ```
47
Diazepam (indications, AE, interactions)
Indications - an anticonvulsant and for skeletal muscle relaxation AE - HA, nervousness, drowsiness, vertigo, fall hazard, hangover effect Interactions - alcohol and other benzos pam needs a muscle relaxant. Dizzy (for diaze)
48
Zolpidem (indications, AE, nursing considerations)-Ambien
For sleep induction AE - daytime drowsiness, dizziness, weakness, feeling "drugged" or light-headed; tired feeling, loss of coordination; stuffy nose, dry mouth, nose or throat irritation; nausea, constipation, diarrhea, upset stomach; or. headache, muscle pain. Nursing considerations - monitor VS, make sure the pt knows how it affects them before they operate a vehicle need help getting zzz’s.
49
Phenobarbital therapeutic index and indication
Barbiturate: has a low therapeutic index, meaning the level at which it has a therapeutic effect is close to the level at which it is toxic it is not used as much today because benzodiazepines are safer and more effective indication- preventing tonic-clonic seizures and fever-induced convulsions, treats hyperbilirubinemia not used as a sedative or hypnotic today
50
Phenobarbital adverse effects
vasodilation, hypotension, drowsiness, lethargy, vertigo, reduced REM(irritability, agitation), respiratory depression, cough, N/V, constipation, agranulocytosis, thrombocytopenia it slows everything down - Barb = barbituate, barb = barbeque (charcoal is needed with OD)
51
Phenobarbital toxicity and treatment for OD
OD causes CNS depression(seizure, coma, death) | activated charcoal to counteract OD
52
Principles (overview) of AED therapy; therapeutic ranges; contraindications)
goal of therapy is to prevent seizures, therapy is usually life long drug therapy will not be necessary if the pt only had one seizure start small with doses to reduce AE, serum drug concentrations are measured frequently contraindications- drug allergy, cautious use with pregnancy(risks over benefits) phenytoin only- bradycardia, AV block
53
Therapeutic index of phenytoin
10-20 mcg/ml
54
Therapeutic index of carbamazepine
4-12 mcg/ml
55
Phenytoin adverse effects
Terrible side effects!!! thrombocytopenia, agranulocytosis, liver enzyme induction, may cause hepatitis, bradycardia, gingival hyperplasia, acne, hirsutism(hair growth on woman’s face), dilantin facies, osteoporosis monitor CBC for 1 year, monitor liver enzymes
56
Phenytoin interactions
it is highly bound to albumin so it has many interactions
57
Phenytoin IV considerations
pH=12, so very toxic to the vein and surrounding tissues. Prevent extravasation if at all possible. GIVE SLOWLY into a large vein! Dilute in NS and do not exceed 50mg/day
58
Carbamazepine (AE, )
AE-nausea, ha, dizziness, unusual eye movement, visual change, behavioral change, rash abdominal pain, abnormal gait causes hepatic autoinduction, which increases liver enzymes, so effectiveness of drug decreases (AE: bam bam likes to hit you in the head and hates grapefruit Carbs are metabolized in the liver, so liver enzymes increased)
59
Carbamazepine (interactions)
interactions- do not administer with grapefruit or grapefruit juice, this can lead to toxicity
60
Gabapentin (indications)
neuropathic pain partial seizures how I remember it: Gaba is part of the word, the drug is a chemical analogue of Gaba, it treats partial seizures
61
Pantoprazole (NG tubes, IV gtt for GI bleeds)
First PPI to be available in IV drip for GI bleeds | Clogs NG tube, so use 16+ inch French tubing and crush WELL

Pharmacology (4 decks)

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