Pharm/Med Exam 1 Flashcards
1
Q
ADL
A
Activities of daily living
2
Q
MDS
A
Minimum data set
3
Q
Emergent
Urgent
Minor
Expectant
A
Emergent - highest priority
Urgent - can wait 2 hours
Minor - can wait several hours
Expectant - expected to die
4
Q
Medication order should include
A
Medication order should include:
DDDFRS
Date
Drug
Dose
Frequency
Route
Signature
5
Q
Medication specific NANDA diagnosis
A
Medication specific NANDA diagnosis:
Deficient knowledge
Risk for injury
Non-compliance
Problems related to drug therapy
6
Q
NANDA-I
A
North American Nursing Diagnosis Association
7
Q
Subjective or objective?
Pain scale (1-10)
Rebound pain
Crying
Facial expression
A
Pain scale - subjective
Rebound pain - objective
Crying - objective
Facial expression - objective
8
Q
Included in assessment data regarding medication list
A
Medication list
Herbal/home/folk remedies
Alcohol/tobacco/caffeine
OTCs
Hormonal therapies
Etc.
9
Q
Five steps to nursing care plan
A
Five steps to nursing care plan:
Assessment (data collection both objective and subjective)
Diagnosis (NANDA-I, Human needs statement)
Planning (patient-centered, patient included)
Implementation (interventions, patient-education)
Evaluation (monitor goals, objectives met? Recess if necessary)
10
Q
3 parts to nursing diagnosis statement
A
3 parts to nursing diagnosis statement:
(Response to injury/illness) related to (factors involved) as evidenced by (data supporting theory).
11
Q
Implementation step for medication administration considerations.
A
Medication administration in Implementation:
6 rights
Patient safety
Patient education
Drug storage
Accurate calculations
12
Q
Five steps to nursing care plan
A
Assessment
Diagnosis
Planning (Patient-centered)
Implementation (Medication admin; Patient education)
Evaluation
13
Q
Half-hour rule
A
Give medication a half hour before or after assigned time
14
Q
6 rights of medication administration
A
6 rights of medication administration:
Patient
Drug
Dose
Frequency
Route
Documentation
15
Q
TJC
A
The Joint Commission
16
Q
Documentation items for medication administration
A
Documentation items for medication administration:
Drug
Dose
Route
Time
Date
Site of administration
17
Q
Dose is in what measurement?
A
g, mg, mcg, units
18
Q
Volume of a drug is measured in what?
A
mL, tabs, capsules, tsp, oz, cups…
19
Q
What volume do you convert all meds to except for tablets?
A
mL
20
Q
Definitions:
Dose
Volume
Concentration
A
Dose - amount ordered
Volume - what you see that contains the dose
Concentration - dose/volume
21
Q
Do you ever reduce concentrations in calculations?
A
No, never reduce concentrations in calculations
22
Q
Another name for metabolism
A
Biotransformation
23
Q
Another name of biotransformation
A
metabolism
24
Q
What is a drug effect?
A
Physiological reaction of the body to drug
25
What is a physiological reaction of the body to a drug?
Drug effect
26
What is a therapeutic drug effect?
Beneficial
27
What is a toxic drug effect?
Harmful
28
Three types of drug effects
Additive => 1+1=2
Antagonistic => 1+1<2
Synergistic => 1+1>2
29
Teratogenesis
Congenital abnormalities in fetus from antagonist reaction from drug
30
What type of drug effect is teratogenesis?
Antagonistic
31
What is an adverse drug event?
Event from administration or failing to administer a drug
32
What is an adverse drug reaction?
Allergic rx
Idiosyncratic rx
Medication error
Teratogenic
Mutagenic
Carcinagenic
33
What is an allergic drug rx?
An adverse effect that causes an allergic rx.
34
What is an idiosyncratic drug effect?
An unusual or unexpected but not allergic drug rx.
35
What is a medication error?
An adverse drug effect from administering the wrong medication.
36
What is the trough level of a drug?
The lowest level of the drug in the body
37
What is drug tolerance?
Reduced response to the drug from prolonged use
38
What are the two types of drug classes?
Therapeutic or structure
39
Therapeutic and structure are the two types of what?
Drug classes
40
What is pharmacology?
Study of drugs
41
What is a drug?
Something that affects the physiological processes in the body. (Any chemical that affects the physiologic processes of a living organism.)
42
What is pharmacology?
Study of science of drugs (umbrella)
43
What is pharmacokinetics?
What happens to drugs when they enter the body.
44
What is drug incompatibility?
One drug chemically deteriorates another when mixed.
45
What is a prodrug?
The inactive form that is converted to an active form through metabolism
46
What is a prototypical drug?
The very first form of a drug.
47
What are the three types of drug names?
Chemical, generic, brand
48
What is the chemical name of a drug?
The scientific name based on the chemical composition and molecular structure of the drug. This is important to people who work with drugs at chemical level: chemists, pharmacists, researchers.
49
What is the generic name of a drug?
The non-proprietary name given as soon as the drug is shown to have therapeutic effect. Given by US Adopted Names Council.
50
What is the trade name of a drug?
The brand name, registered trademark, restricted by drug owner's patent, usually catchy and easy to remember that is given to the drug by the manufacturer. Each manufacturer will give a generic drug that they are manufacturing a brand name different than the brand name of another manufacturer.
51
Do hospitals use generic or trade names?
Generic
52
Three phases of drug activity
Pharmaceutical, pharmacokinetic, pharmacodynamic
53
What is the pharmaceutical phase of drug activity?
Dissolution for absorption
Dosage form changes drug rx and dissolution rate
54
What is dissolution?
What happens to a drug in the pharmaceutical phase of drug activity. Drug made available for absorption.
55
Put these drug forms in order from fastest to slowest:
Capsules
Liquids, elixirs, syrups
Oral disintegration forms (buccal, sublin, oral wafers)
Suspensions
Enteric
Tablets
Coated
Powders
Fastest to slowest:
Oral disintegration
Liquids, elixirs, syrups
Suspensions
Powders
Capsules
Tablets
Coated
Enteric
56
What is the pharmacokinetic phase?
The second of the three phases of drug activity.
What the body does to the drug to make it available for action.
- Absorption
- Distribution
- Metabolism
- Excretion
57
In what phase of the drug activity are absorption, distribution, metabolism and excretion involved in?
Pharmacokinetics
58
In what phase of drug activity does the drug undergo dissolution?
Pharmaceutical
59
In what phase of drug activity does the dosage form affect the drug reaction?
Pharmaceutical
60
Where does the dissolution of solid drug forms occur in the body?
GI tract
61
What occurs in the drug activity phase of pharmacodynamics?
Receptor interaction
62
What is pharmacodynamics?
The third phase of drug activity which is what the drug does to the body.
63
Put these phases of drug activity in the correct order from beginning to end:
- Ready for action
- Pharmacokinetic phase
- Effect
- Pharmaceutical phase
- Administration
- Pharmacodynamic phase
- Ready for absorption
Correct order from beginning to end:
1. Administration
2. Pharmaceutical phase
3. Ready for absorption
4. Pharmacokinetic phase
5. Ready for action
6. Pharmacodynamic phase
7. Effect
64
What is pharmacology?
The study of the science of drugs.
65
Two dosage forms of drugs
Enteral and Parenteral
66
What are enteral drugs?
PO, oral (oral, sublingual, buccal, rectal)
67
What are parental drugs?
Anything other than enteral (IV, IM, subq, intradermal, interarterial, intrathecal, intraarticular)
68
Which dosage form of drugs has a gastrointestinal effect?
Enteral - absorbed through stomach or intestines
69
What forms of drugs are topical?
Transdermal patches, inhalers, ointment, gel, cream, drops, vaginal, rectal.
70
What forms are these drugs? Transdermal patches, inhalers, ointment, gel, cream, drops
Topical
71
Do parenteral drugs go through dissolution?
No.
72
The injectable drugs have a pH that matches what?
Blood
73
What is the fastest route of drug administration?
IV
74
Which drugs are absorbed through the blood stream?
IV
75
Which drugs are absorbed through the muscle?
IM
76
Why do you have to calculate IV medication carefully?
Because it's distributed directly.
77
Can extended release drugs be sprinkled on soft food?
Yes.
78
Can enteric drugs be crushed?
No.
79
What is bioavailability?
The extent of drug absorption
80
What is the extent of drug absorption?
Bioavailability
81
What three drug forms can you add to soft food?
Capsules, powders, liquid
82
What are the two drug classifications?
By structure (beta-blockers) or therapeutic use (antibiotics).
83
What are pharmaceutics?
The study of how various drug forms influence the way the drug affects the body - dissolution.
84
Steps in pharmacokinetic phase of drug effects.
Absorption
Distribution
Metabolism
Excretion
85
What questions do absorption, distribution, metabolism and excretion ask?
Absorption: How will it get in?
Distribution: Where will it go?
Metabolism: How is it broken down?
Excretion: How does it leave?
86
What is absorption?
Movement of drug from its site of administration into the blood stream for distribution to tissues
87
Factors affecting absorption.
Route of administration
Bioavailability (extent of drug absorption)
First pass effect (Large proportion of drug is chemically changed into inactive metabolites by the liver - much less is bioavailable)
88
Definition of enteral drugs.
Absorbed into the systemic circulation through the oral or gastric mucosa or small intestine.
89
Definition of distribution.
Transport of a drug by the bloodstream to its site of action.
90
What is the most common blood protein that carries the majority of protein-bound drug molecules?
Albumin
91
What are the areas that facilitate rapid drug distribution?
Highly vascular areas: Heart, kidneys, brain, liver
Less vascular areas: muscle, skin, fat
92
After a drug is absorbed, where does it go?
Bloodstream
93
Do metabolism and excretion begin at distribution?
Yes.
94
What can delay distribution and therapeutic effect?
Protein-binding, blood-brain barrier
95
What are the two forms of drugs that bind to proteins?
Bound and unbound
96
What is the bound form of a drug?
That which is bound to a protein like albumin. This slows absorption because the protein cannot move through the capillary walls.
97
A bound drug is active/inactive?
Inactive as long as it's bound to protein.
98
Will bound drugs in be system longer or shorter?
Longer
99
What is the duration of a protein-bound drug?
Longer
100
What happens when a drug that tends to bind to protein is administered to a patient with low protein levels?
The drug may be more bioavailalble and therefore the therapeutic effect may be stronger. More "free" or unbound medication will be absorbed.
101
What is the type of drug interaction that can occur when two protein binding drugs are administered simultaneously?
Drug-to-drug. Will compete for binding. Action of one drug will be higher than other.
102
The bound form of a drug is active or inactive?
Inactive
103
The free form of a drug is active or inactive?
Active
104
What is a synergistic drug effect?
Synergistic 1 + 1 > 2, the effect of two drugs with similar actions is greater than the sum of the individual effects.
For test: Effect will be more when 2 drugs that have similar effects are administered.
105
What is an additive drug effect?
Additive 1 + 1 = 2, the effect of two drugs is equal to the sum of the individual effects alone.
106
When two drugs with similar effects are administered will the effect be more or less?
More. This is synergistic effect.
107
What is biotransformation?
Metabolism or biochemical alteration of a drug into an:
- Insoluble metabolite
- A more soluble compound
- A more potent active metabolite (prodrug)
- A less active metabolite
108
Which organ is most responsible for the metabolism of drugs?
Liver
109
What does metabolism depend on?
Enzymes
110
What step in pharmacokinetics are enzymes involved in?
Metabolism
111
What is excretion?
Elimination of drugs from the body
112
What organ is most responsible for excretion?
Renal tubules in kidneys
113
What are other routes of excretion in the body besides kidneys?
Billary, bowel, sometimes exercise, less common breathing, bowels
114
What is the half-life of a drug?
Time required for half of a given drug to be removed from the body.
115
What is the measure of the rate at which a drug is eliminated from the body?
Half-life
116
After how many half-lives is a drug effectively removed from the body?
Five
117
If the half-life of a drug is 2 hours, how long will it take that drug to be eliminated from the body?
10 hours
118
What is a steady state?
The physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each does.
119
How do we maintain a steady state of drug administration?
IV drip
Administer drugs on regular schedule
Adminster another does when drug level reached 50%.
120
What is the peak level?
The highest level of a drug in the blood
121
What is the trough level?
The lowest blood level of a drug
122
When can drug toxicity occur?
When the blood level of a drug exceeds the peak level.
123
What is therapeutic drug monitoring?
Monitoring the blood level of a drug to ensure that it does not exceed the toxic level.
124
What level of drug in a blood is higher: peak of toxic?
Toxic.
125
The nurse is giving a med that has a high first-pass effect. The route is changed to IV. What can the nurse expect?
The IV does will be lower because of the first-pass effect.
126
The first pass effect is what?
The metabolism of a drug before it becomes systemically available. It reduces the bioavailability of a drug.
127
With what drug route does the first-pass effect normally occur?
Oral
128
Why do IV doses need to be lower than PO doses?
Because of first-pass effect
129
What route is slowest?
IV
IM
Subq
PO
PO
130
When administering two drugs that are highly protein bound, what should the nurse watch for?
Increase in risk of drug-to-drug interaction
131
What is the study of physiochemical properties of drugs and how they influence the body called?
Pharmacodynamics
132
What state best describes pharmacokinetics?
- Adverse effects and toxic reactions to meds
- Physiologic interaction between a drug and body cells
- Converts meds into active chemical substance
- What the body does to the drug after it is administered.
What the body does to the drug after it is administered.
133
Another term for metabolism
Biotransformation
134
What is the mechanism of drug actions in living tissues
Pharmacodynamics
135
What is the therapeutic effect?
What change we should see in the body; what the drug should do.
136
When a drug is specifically designed to match up with something it's supposed to fix, is what type of drug action?
Receptor
137
All cells have what type of sites?
Receptor sites
138
What drugs are designed to find certain receptor sites?
Chemothereapy
139
What is in grapefruit juice that blocks some receptor sites?
Certain proteins
140
Why are there precautions are eating before taking meds?
Certain foods might block receptor sites
141
Receptor sites come into play in what phase of drug administration?
Pharmacodynamics
142
What is pharmacotherapeutics?
The desired therapeutic outcome
143
What two things should the therapeutic effect of drugs (pharmacotherapeutics) consider?
Therapeutic administration should be individualized and collaborative.
144
What things come together in a collaborative effort to administer pharmacotherapeutics?
Provider, healthcare history
145
What are the goals of individualized, collaborative drug administration (pharmacotherapeutics)?
- Curing disease (infection)
- Eliminating or reducing symptoms (acid reflux)
- Stopping/slowing disease process (BP meds)
- Preventing disease or unwanted condition (statins, vaccinations)
- Improving quality of life (seizures)
146
What is the difference between a contraindication and an adverse effect?
A contraindication renders a particular form of treatment improper or undesirable because of a disease state or patient characteristic. (pregnancy, children, elderly, drug addiction)
An adverse effect is an undesirable direct response to one or more drugs (allergic rx)
147
A patient has a rash, is itchy and sleep after morphine. Adverse affect?
No, is side effect.
148
What are the types of drug therapy?
- Acute (more intensive drug treatment)
- Maintenance (chronic condition managed with med)
- Supplemental (Pt using to fill need)
- Palliative (relieve symptoms)
- Supportive (give one drug with another to support function)
- Prophylactic (prevents something)
- Empiric (drug admin when clinical probability of condition is high due to patient's presentation)
149
What is the therapeutic index?
Ratio of drug's toxic level to the level that provides therapeutic benefit.
150
Drug concentration
Concentration of drug in blood
151
Patient condition
Concurrent disease or other medical condition
152
When is most drug available in the blood?
During peak levels
153
Patient monitoring involves the therapeutic index?
Yes.
154
Patient monitoring considers what two things?
Patient condition and drug concentration.
155
Patient condition and drug concentration are important in what?
Patient monitoring
156
What two organs are monitored during some drug administration?
Liver/kidneys
157
What is drug tolerance?
Decreasing response to repeated drug doses.
158
What is drug dependence?
Physiologic or psychological need for a drug
159
What is physical drug dependence?
Physiologic need for a drug to avoid physical withdrawal symptoms
160
What is psychological drug dependence?
Addiction. Obsessive desire for the euphoric effects of a drug.
161
In adverse drug effects, what is a pharmacologic rx?
A pharmacologic reaction is an extension of the drug's normal effects in the body.
162
In adverse drug effects, what is hypersensitivity?
An allergic reaction
163
In adverse drug effects, what is an idiosyncratic reaction?
An abnormal, unexpected response that is peculiar to an individual patient.
164
In adverse drug effects, what is a drug interaction?
What happens when there is more than one drug administered.
165
What is a teratogenic drug effect?
Causes structural defect in fetus
166
What is a mutagenic drug effect?
Causes permanent change in genetic composition
167
What is a carcinogenic drug effect?
Causes cancer
168
In antagonistic drug effects, what happens?
A combination of 2 drugs results in drug effects that are less than the sum of the two drugs' effects. 1 + 1 < 2.
169
In drug interactions, what are incompatibilities?
For parenteral drugs, cannot administer one with the other.
170
What type of drug therapy treats acutely ill, rapid onset or critically ill patients?
Acute - antibiotics
171
What type of drug therapy is used to to prevent the progression of a disease such as hypertension?
Maintenance (BP meds)
172
What type of drug therapy is used to support the body's needs for normal activity?
Supportive - insulin
173
What type of drug therapy is used to prevent illness?
Prophylactic - antibiotics before dental surgery
174
What type of drug therapy is used to relieve patients of symptoms or pain or stress of serious disease but not correct disease?
Palliative
175
What type of drug therapy is administered based on clinical knowledge that the condition being treated is likely present?
Empiric
176
Collaborative effort in pharmacotherapeutics involves what two things?
Provider's knowledge of condition and medication and the patient's history and medication list.
177
What step in the nursing process are pharmacotherapeutics involved?
Implementation
178
When monitoring a patient, what information is objective?
Temp, BP, level of consciousness, blood tests for levels
179
Dependence is associated with drug tolerance. T/F
True
180
What are the two types of drug dependence?
Physical and psychologically
181
What is physical dependence?
The body's physiologic dependence on the drug that results in withdrawal symptoms.
182
What is psychological dependence
"Addiction" or obsessive need for a drug for the euphoric effects.
183
Difference between pharmacotherapeutic drug interactions and adverse effects, name each.
Interactions:
Antagonistic effects - combo os 2 drugs results in effects that are less than the sum (1 + 1 < 2)
Incompatibilities - Cannot administer at same time (IV meds - precipitant)
Synergistic - 1 + 1 >2
Additive - 1 + 1 = 2
Adverse Effects:
1. Allergic rx - hypersensitivity
2. Idosyncratic rx - unexpected, abnormal or unusual rx
3. Drug interaction - presence of one or more drugs
4. Medication error
5. Teratogenic - structural damage in fetus
6. Mutagenic - causes permanent genetic damage
7. Carcinogenic - causes cancer
184
Peak and trough levels of drugs are part of what step?
Pharmacokinetics
185
This statement is an example of what? "Foot pain related to patient complaint of pain and accident as evidenced by redness, swelling."
Nursing diagnosis statement
