Pharm FINAL Flashcards
What is half-life?
A pharmacokinetic parameter that is defined as the time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words, after one half-life, the concentration of the drug in the body will be half of the starting dose.
Note: A drug is considered eliminated when less than ##% of the drug remains.
10%
A patient receives 100 mg of a drug at noon, 1800, and midnight. The drug has a half-life of 6 hours. How much of the drug remains in the patient at 0600 the next day?
(answer = 87.5mg)
Why? 100 / 2, + 100 / 2, + 100 /2 = 87.5mg
The nurse administers 500 mg of a drug at 1100 with a half-life of 4 hours. At what earliest time will be the patient’s blood drug level be less than 65 mg?
(answer 2300)
Why? 500 / 2 / 2 / 2 = 62.5…. Then since we went through 3 half lifes, we do 3x4 = 12…. Then we add those 12 hours to 1100.
Intrinsic drugs
Chemicals the body makes
Extrinsic drugs
Taken into the body to change cell, organ, or body action
Pharmacodynamics:
how the drug works to change body function.)
Pharmacokinetics:
How the body uses & changes those drugs.
Minimum effective concentration, Steady state, Duration of action, Potency
Trade (Brand) name:
Created by drug manufacturer. First letter capitalized and followed by ® or TM
Generic name:
Used by pharmacists, prescribers, nurses, other health care professionals; first letter is lowercase
(Receptor) Agonist:
Receptor agonists have “the right key” to turn on cell’s ignition. Agonist drugs must interact with correct receptor to change cell activity
Antagonist:
Block receptors so intrinsic drug can’t bind with it.
Receptors: Sites of direct action for many drugs
1 kg = ____ grams
1 cup = ____ fluid ounces
1000
8
The nurse is administering 0900 medications to the following clients. Which medication should the nurse question administering?
The client receiving a calcium channel blocker who drank a full glass of water.
The client receiving a nitroglycerin patch who is complaining of a headache.
The client receiving an antiplatelet medication who has a platelet count of 33,000.
The client receiving a beta blocker who has a blood pressure of 109/78.
The client receives a calcium channel blocker who drank a full glass of water.
-No, water is irrelevant. The meds are for high BP. They block calcium from entering muscle cells of heart and arteries; decrease strength in heart contractions; dilate arteries = reduce heart workload.
The client receives a nitroglycerin patch who is complaining of a headache.
-No, headache is a common side effect. Nitroglycerin is a vasodilator for HF. It literally just dilates arteries to lower BP and decrease workload of heart. (“hi I nit” to remember the 3 drugs)
The client receives antiplatelet medication who has a platelet count of 33,000.
-YES, 33k is really low. 150k is minimum!
The client receives a beta blocker (hypertension) who has a blood pressure of 109/78.
-No, this is still normal! “We don’t worry until we’re in the single digit systolic
What are the 8 rights of med administration?
Give examples
- Right patient
Check the name on the order and the patient.
Use 2 identifiers.
Ask patient to identify himself/herself.
When available, use technology (for example, bar-code system). - Right medication
Check the medication label.
Check the order. - Right dose
Check the order.
Confirm appropriateness of the dose using a current drug reference.
If necessary, calculate the dose and have another nurse calculate the dose as well. - Right route
Again, check the order and appropriateness of the route ordered.
Confirm that the patient can take or receive the medication by the ordered route. - Right time
Check the frequency of the ordered medication.
Double-check that you are giving the ordered dose at the correct time.
Confirm when the last dose was given. - Right documentation
Document administration AFTER giving the ordered medication.
Chart the time, route, and any other specific information as necessary. For example, the site of an injection or any laboratory value or vital sign that needed to be checked before giving the drug. - Right Diagnosis(reason)
Confirm the rationale for the ordered medication. What is the patient’s history? Why is he/she taking this medication?
Revisit the reasons for long-term medication use. - Right response
Make sure that the drug led to the desired effect. If an antihypertensive was given, has his/her blood pressure improved? Does the patient verbalize improvement in depression while on an antidepressant?
Be sure to document your monitoring of the patient and any other nursing interventions that are applicable.
Give me the antidote for Coumadin(Warfarin)
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
Vitamin K
^Classification: Clotting factor synthesis inhibitor anticoagulant
^Med Indications: After heart surgery, during prolonged bed rest, for dysrhythmias such as atrial fibrillation
^Med MOA: Decrease production of clotting factors in liver. Fux w/ Vitamin K
Give me the antidote for Heparin
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
Protamine Sulfate
^Classification: Thrombin Inhibitor, anticoagulant
^Med Indications: clotting, dysrhythmias, after heart surgery
^Med MOA: Prevents fibrin from forming a clot. Blocks action of thrombin. Acts rapidly!
Give me the antidote for Thrombolytics(lteplase/t-PA, reteplase)
And give me its(the med listed^):
1) Indications
2) MOA
Aminocaproic Acid … “amigo-capris ordains the trombone & lemon(acid) wedding”
^Med Indications: Emergency IV medications. Heart attacks, strokes, & pulmonary emboli
^Med MOA: The only ones that ACTUALLY DISSOLVE CLOTS. nickname “clot busters”
Give me the antidote for Acetaminophen(Tylenol)
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
N-acetylcysteine
^Classification: Non-opioid(non-narcotic) analgesic
^Med Indications: Pain relief
^Med MOA: Unknown! But we know that it works in the brain to change the perception of pain and reduces the sensitivity of pain receptors. It may reduce the production of prostaglandins in the brain. Prostaglandins are chemicals that cause inflammation and swelling.
Give me the antidote for Benzodiazepines
And give me its(the med listed^):
1) Indications
2) MOA
Flumazenil
^Med Indications: Anxiety
^Med MOA: Depresses the central nervous system.
Give me the antidote for Digoxin
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
Digibind
^Classification: Cardiac Glycosides
^Med Indications: Heart Failure
^Med MOA: Works on the muscle fibers of the heart. Lowers HR but increases contractility.
Give me the antidote for Opioids (aka Narcotics)
And give me its(the med listed^):
1) Classification
2) Indications
3) MOA
naloxone (Narcan)
^Classification: Analgesics
^Med Indications: Pain
^Med MOA: Bind to opioid receptor sites in brain, altering perception of pain
furosemide (Lasix)
Classification:
Indications:
MOA:
Classification: Loop Diuretic
Indications: Hypertension. Also edema from other conditions
MOA: Slowing down sodium pumps, so instead of reabsorbing sodium, we excrete it. “Where sodium goes, water follows”
What physiological parameters should be monitored prior to administration of Lasix?
-Blood pressure!!
- Causes loss of Potassium (K+) (excretting volume = electrolytes go down)
- -If patient’s K+ is below normal it is NOT safe to give this med until corrected
-Look for Dehydration. Signs & Symptoms = Increased (thready) pulse rate, low blood pressure, thirst, sunken appearance to eyes, dry mouth, skin “tenting”, constipation, decreased urine output.
What would be appropriate teaching about Lasix?
4 things
1- Take in AM
2 - Still ingest a normal amount of fluids to prevent dehydration
3 - Increase K+ in their diet, or if they’re prescribed K+ supplements -> take them!
4 - Orthostatic hypertension = make sure they change positions slowly. If they’re dizzy they need to talk to their prescriber
What’s the SAFE rate of an IV Push of Lasix?
How long does it last in the body?
KNOW THE RATE OF A SAFE IV PUSH! = 20mg/min
Lasix “lasts six”
digoxin (Lanoxin)
Classification:
Indications:
MOA:
Classification: Cardiac Glycosides
Indications: Heart Failure
MOA: Works on muscle fibers of the heart. BIG IDEA: it Lowers HR and Increases contractility = stronger, more efficient beat
What physiological parameters should be monitored prior to administration of Digoxin?
3 things (one of them is the safe therapeutic level)
1) #1 = atypical Heart Rate (listen for 1 FULL MINUTE) to check for irregularities. If HR is less than 60 = DO NOT give this med
2) K+ = if low, it’s NT safe to give this medication
Why? As K+ drops, their risk of toxicity increases
3) Lastly, check Digoxin level! 0.5 to 2 ng/mL (drug card says 0.8 to 2 ng/mL)
Patient teachings for Digoxin?
Toxicity is the #1 thing, so teach patients to look for:
- # 1 = nausea & vomiting
- Super low HR (bradycardia)
- Halos
- Check their pulse every day and take meds every day
What is Warfarin? What are the appropriate lab tests to monitor warfarin (Coumadin)? How do we know if they are therapeutic?
What is Heparin? What are the appropriate lab tests to monitor Heparin? How do we know if they are therapeutic?
Warfarin is an anticoagulant, specifically ‘clotting factor synthesis inhibitor.
-Lab test is an INR (international normalized ratio). Normal = 0.8 to 1.2. Therapeutic = 2 to 3.
Heparin is an Anticoagulants - Thrombin Inhibitor.
-Lab test is an aPTT. Ideal Therapeutic Range: 1.5-2.5x the control value(amt. of aPPT in a normal person). I.e, should take this person twice as long to clot.
What are colony stimulating factors for WBC’s, RBC’s, and platelets.
Contraindications for these medications?
Given AFTER chemo for rapid recovery of bone marrow. Essentially it puts your bone marrow in overdrive!
Procrit/Aranesp/Epogen: to increase RBC’s
Neupogen/ Neulasta: to increase WBC’s
Neumega: to increase platelets
Contraindication = Leukemia (why? Forcing bone marrow to go into overdrive…. Leukemia is derived from bone marrow so it would ^ it.
What are essential teaching issues for patients taking benzodiazepines? (2)
1 DO NOT STOP COLD-TURKEY. If patient takes it everyday and suddenly stops, withdrawals can be life-threatening
Secondly, reduce alcohol and sleeping pills; don’t take with antacids
What are bisphosphonates?
What are essential teaching issues for patients taking bisphosphonates? (3)
For osteoporosis. These are aka calcium-modifying drugs (a step up from supplements)
1) Don’t lie down or eat for 30 minutes after taking meds to prevent acid reflux, GERD, and esophageal ulcers!
2) Take on an empty stomach with PLENTY of water. Take early in the morning BEFORE breakfast!
3) Patients can develop jaw bone necrosis, so make sure their dentist knows they’re on these meds.
What is the MOA for proton pump inhibitors (PPIs) and H2 Blockers (how do they differ)?
H2 blockers work by blocking the histamine receptors in parietal cells to decrease the amount of acid produced (although there are other stimuli so that some acid is still produced).
PPIs work by “shutting down the proton pumps in these cells and preventing the acid from being secreted into the stomach.
What is the MOA for Albuterol?
Is this a SABA or a LABA?
MOA: Bronchodilator that mimics adrenaline to relax the airway’s smooth muscle = open the airways.
Short acting rescue drug (SABA)
Teaching issues for Albuterol? 2 main ones
1) Correct administration technique for inhalers!
* (see study guide for video)
2) correctly. Teach patients to carry a short-acting beta agonist (SABA) inhaler with them at all times and to ensure that it contains enough drug to be effective.
MDI = Metered-dose inhaler
- -Shake? YES
- -Get wet? YES, CLEAN W/ WARM WATER
- -Slow deep breath
DPI = Dry-powder inhalers
- -Shake? NO!
- -Get wet? NO, THE POWDER MUST STAY DRY TO WORK!
- -Quick sharp breath (then hold it in)
Other:
• Remove the inhaler from your mouth as soon as you have inhaled (breathed in).
• Never exhale (breathe out) into your inhaler. Your breath will moisten the powder, causing it to clump and not be delivered accurately.
• Always rinse your mouth out if it’s a steroid
• Always carry a rescue inhaler!
• Take prevention drugs even with absence of symptoms
• Tachycardia is most common side effect
Provide examples of enteral, percutaneous, and parenteral routes:
Enteral route refers to the gastrointestinal tract.
–liquids, tablets, or capsules.
Percutaneous route means that the drug enters through the skin or mucous membranes.
–Ointments, patches, tablets under the tongue or between the gum and the cheek, sprayed in the nose or under the tongue, inhaled through the nose or mouth, or placed as a liquid or a suppository in the rectum or vagina
Parenteral route means that the drug is injected into the body.
–ANY injection, whether it’s into the blood, skin, or tissues.
What is the MOA for aspirin? (for pain) (are they acting on perception of pain or the actual inflammation)
Whats the main ingredient?
COX-1 or COX-2?
MOA: Act on the tissue where the pain is. They’re NOT changing perception, they’re actually affecting the actual inflammation!
Salicylic acid is main ingredient
COX-1
What is the therapeutic responses for aspirin?
4 uses
1) Anti-inflammatory
2) Anti-pain
3) Antipyretic (reduce fever)
4) Anti-platelet aggregation
What are the appropriate doses for aspirin?
Adults: 325-650 mg orally 3-4 times daily
Children: 80-320 mg orally 3-4 times daily, depending on size
*See study guide for detailed chart
How do you know when to draw the peak and trough of an antibacterial medication?
What’s really the med class we’re talking about here?
Aminoglycosides (a protein synthesis inhibitor) can be very toxic so we typically don’t see them unless we’re dealing with “VERY BAD BUGS”. SO, this is a medication where we focus on the PEAKS & TROUGHS more than other meds.
Note: 30 MINUTES AFTER IM OR IV HAS BEEN STARTED, WE TEST FOR THE PEAK LEVEL OF THAT DOSE. WHY? WE’RE CHECKING TO BE SURE IT’S IN A NORMAL RANGE.
NOTE: 30 MINUTES PRIOR TO THE NEXT DOSE, WE TEST FOR THE TROUGH. WHY? TO BE SURE THAT THE DOSE WERE GIVING THE PATIENT IS ENOUGH TO SUSTAIN UNTIL THE NEXT DOSE.
**see study guide for cartoons
⦿ GT =
⦿ ID =
⦿ IM =
⦿ GT = Gastrostomy tube
⦿ ID = Intradermal
⦿ IM = Intramuscular
⦿ IV =
⦿ IVP =
⦿ IVPB =
⦿ IV = Intravenous
⦿ IVP = Intravenous push
⦿ IVPB = Intravenous piggyback
⦿ NGT =
⦿ PEG =
⦿ PO =
⦿ NGT = Nasogastric tube
⦿ PEG = Percutaneous endoscopic gastrostomy
⦿ PO = By mouth
⦿ PR =
⦿ SL =
⦿ Supp =
⦿ PR = By rectum
⦿ SL = sublingual
⦿ Supp = suppository
⦿ Ac =
⦿ ad lib =
⦿ BID =
⦿ Ac = before meals
⦿ ad lib = As desired
⦿ BID = Two times a day
⦿ hr or h =
⦿ hs =
⦿ pc =
⦿ hr or h = hour
⦿ hs = At bedtime
⦿ pc = After meals
⦿ prn = ⦿ q = ⦿ q2h = ⦿ q4h = ⦿ q8h = ⦿ q12h =
⦿ prn = As needed ⦿ q = every ⦿ q2h = Every 2 hours ⦿ q4h = Every 4 hours ⦿ q8h = Every 8 hours ⦿ q12h = Every 12 hours
⦿ QID =
⦿ STAT =
⦿ TID =
⦿ NKA =
⦿ QID = 4 times a day
⦿ STAT = immediately
⦿ TID = Three times a day
⦿ NKA = No known allergies
⦿ NPO =
⦿ OD =
⦿ OS =
⦿ OU =
⦿ NPO = Nothing by mouth
⦿ OD = Right eye
⦿ OS = Left eye
⦿ OU = Both eyes
What abbreviations are on The Joint Commission’s official do not use list? And what do you write instead?
*see table in study guide
*see table in study guide
How can a nurse safely administer IV potassium?
NEVER IV push (this is death-row to stop someone’s heart)
Oral (PO) is fine
IV = 1hr -> no more than 10mEq -> diluted in at least 100mL
What is the role of anti-inflammatory medications for asthma and/or COPD?
To reduce mucosal swelling(i.e. inflammation) occurring in the airway
ONLY work on inflammation, they do NOTHING for bronchodilation(smooth muscle + pulmonary constriction)
**PLEASE see study guide for more info
What are essential nursing implications for patients taking anticonvulsants?
4 items
1) NEVER stop meds abruptly (withdrawls).
2) NEVER take with antacids(decreases effectiveness).
3) Steady state important so administer at timed intervals.
4) Teach patients on Phenytoin (Dilantin) about Steven-Johnson syndrome.
What are implications specific to phenytoin (Dilantin)?
2 items
1) Dilantin Side Effect = gingival hyperplasia bradycardia (gums inflamed) so not for kids or ppl w/ bad gums.
2) Teach patients on Phenytoin (Dilantin) about Steven-Johnson syndrome.
What are essential nursing implications for patients taking an antibacterial medication?
And why?
Teach patients to take drugs exactly as prescribed and for as long as prescribed (ppl stop meds once they feel better. Also BE SURE THEY TAKE THEM WITHIN THE TIMEFRAME THEY’RE PRESCRIBED TO. We want to see even in/out levels with these drugs. Meaning - if it’s dosed 2x per day we want them to take it 12 hours apart. If it’s dosed 3x per day we want them to take it 8 hours apart. This achieves a “steady state”
Why is it so important to teach patients to take antibacterial drugs exactly as prescribed? Failure to complete a prescription can lead to a recurrence of the infection and the development of resistant bacteria
tardive dyskinesia - Definition + S&S:
What: A condition affecting the nervous system, often caused by long-term use of some psychiatric drugs. Mostly caused by drugs that end in -azine.
S&S: involuntary movements of the mouth, face, or extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; and rapid or worm-like movements of the tongue. RISK: MOVEMENTS CAN BECOME PERMANENT
neuroleptic malignant syndrome - Definition + S&S:
What: A rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder, and other mental health conditions. It affects the nervous system. The primary trigger is dopamine receptor blockade and the standard causative agent is an antipsychotic.
S&S: fever, respiratory distress, tachycardia, seizures, diaphoresis, blood pressure changes, pallor, fatigue, severe muscle stiffness, and loss of bladder control.
serotonin syndrome - Definition + S&S:
What: SSRI (Selective serotonin reuptake inhibitors) are the most common antidepressants. Examples are Prozac & Zoloft. They ^serotonin by inhibiting serotonin reuptake. Serotonin syndrome is an adverse reaction to SSRI antidepressants caused by too much serotonin in your body.
S&S: Confusion! Agitation, tachycardia, sweating, diarrhea
Steven Johnsons syndrome - Definition + S&S:
What are meds that cause? (3 categories)
What: Lethal skin disorder, causes damages to the blood vessels of the skin.
S&S: Rashes, blisters, itching, fever, joint aches, feels ill
Meds That Cause: Calcium Channel Blockers, Phenytoin (Dilantin), Antifungals
What are the different types of insulins and essential teaching issues?
*See slides 38 & 39
*See slides 38 & 39
What is the appropriate technique to administer eye drops as well as prevent systemic absorption for glaucoma medications?
*See slide 67
*See slide 67
Identify common antiemetics (5 categories) and their typical side effects.
Common Side Effects: Sedation! (except for the 5HT3-receptor antagonists).
–Also Compazine can cause urine color change & decreased sweating -> overheating)
1) Phenothiazines - promethazine (Phenergan) (Compazine)
2) Anticholinergics - scopolamine (L-hyoscine)
3) Antihistamines - meclizine (Dramamine)
4) 5HT3-receptor antagonists - ondansetron (Zofran), granisetron (Kytril) = newest drugs. OG for chemo. Now we use it for all types of nausea issues.
5) Dopamine receptor antagonists - metoclopramide (Reglan) (note: kids can get twitches). Reglan can cause mild-to-severe depression.
What are essential nursing implications for thyroid hormone agonists?
*See slide 42 + speaker notes
*See slide 42 + speaker notes
