Pharm/Med Exam II Flashcards
1
Q
Ethnopharmacology
A
Understanding the specific impact of cultural factors on patient drug response. (physiological, genetic and body reactions).
2
Q
Drug polymorphism
A
Effect of patient’s age, gender, size, and body composition on pharmacokinetics (what body does to drug).
3
Q
Cultural considerations with pharmacologics
A
Ethnopharmacology - Understanding the impact of cultural factors on patient drug response.
Drug polymorphism - how age, gender, size, body composition affect on what drug does to body (pharmacokinetics).
4
Q
Cultural competance
A
Understanding a patient’s cultural context (their belief system, values regarding health and wellness, specific responses to drug therapies).
5
Q
African beliefs
A
Folk medicine
Close extended family
Women play important role in HC decisions
6
Q
Asian beliefs
A
Traditional medicine
Hot/cold food
Herbs/teas
Acupuncture/Acupressure
Close extended family
Family needs more important than individual needs
7
Q
Hispanic beliefs
A
Good luck and living right
Illness is doing bad deed
Close extended family
All family members involved in HC decisions
8
Q
Native Americans
A
Harmony with nature
Ill spirits cause disease
Medicine man
Close extended family
Emphasis on family
9
Q
What ethnic group has the following medical beliefs?
Traditional medicine
Hot/cold foods
Teas/Herbs
Acupuncture/Acupressure
A
Asian
10
Q
What ethnic group has the following medical beliefs?
Ill spirits cause disease
A
Native Americans
11
Q
What ethnic group has the following medical beliefs?
Have close extended family and women play important role in HC decisions.
A
African Americans
12
Q
What ethnic group has the following medical beliefs?
Use medicine man
A
Native Americans
13
Q
What ethnic group has the following medical beliefs?
Use folk medicine, root doctors as healers, herbs, oils, roots
A
African
14
Q
What ethnic group has the following medical beliefs?
All family members are involved in health care decisions
A
Hispanic
15
Q
What ethnic group has the following medical beliefs?
Family needs are more important than individual needs
A
Asian
16
Q
What ethnic group has the following medical beliefs?
View health as a result of good luck and living right. Illness when do bad deed.
A
Hispanic
17
Q
What ethnic group has the following medical beliefs?
Close extended family, emphasis on family
A
Native Americans
18
Q
What ethnic group has the following medical beliefs?
When traditional, acupuncture and acupressure, herbs, foods don’t work they come to the hospital.
A
Asians
19
Q
Can cultural beliefs influence drug compliance?
A
Yes
20
Q
When consideration cultural influence on drug compliance, what three factors are considered?
A
Cultural beliefs
Level of education
Ability to afford medication
21
Q
Considering cultural beliefs in patient compliance, who has to sometimes be educated?
A
The family
22
Q
What two genetic factors influence drug metabolism?
A
Slow or rapid acetylators
Varying levels of P-450 enzymes
23
Q
Slow or rapid acetylators and varying levels of P-450 enzymes are two types of what?
A
Genetic factors that influence drug metabolism.
24
Q
What is the U.S. drug related legislation that exists for legal considerations?
A
HIPAA - Health Insurance Portability and Accountability Act
25
What is the primary purpose of the FDA?
The Food and Drug Administration protects the patient and ensures drug effectiveness.
26
What organization protects patients and ensures drug effectiveness?
The Food and Drug Administration (FDA)
27
What legislation was passed to protect patient information?
Health Insurance Accessibility and Accountability Act (HIPAA)
28
The Dietary Supplement Health and Education Act was created for what purpose?
Regulates vitamins, herbs and homeopathics for the only purpose of ensuring safety, not effectiveness.
29
The Dietary Supplement Health and Education Act covers safety not effectiveness of what?
Vitamins, homeopathics, herbs
30
The safety of vitamins, homeopathics and herbs are controlled by what act?
The Dietary Supplement Health and Education Act (DSHEA)
31
What does the Dietary Supplement Health and Education Act control?
The safety of vitamins, homeopathics and herbs.
32
What doesn't the Dietary Supplement Health and Education Act control?
The effectiveness of vitamins, homeopathics and herbs.
33
What are the four phases of drug development?
Phase 1 - small # of healthy individuals
Phase 2 - small # of people who many benefit from the treatment
Phase 3 - Large # of patients
Phase 4 - Post-marketing studies
34
What type of group is recruited and what is the purpose of Phase I of new drug development?
Small group
Determine optimal dosage range and pharmacokinetics (absorptions, distribution, metabolism, excretion)
35
In what phase of new drug development is this the protocol:
Determine optimal dosage range and pharmacokinetics (absorptions, distribution, metabolism, excretion)
Phase I
36
What type of group is recruited and what is the purpose of Phase 2 of new drug development?
Small group
Determine effectiveness, monitor for adverse rxs, and refine dose
37
In what phase of new drug development does this occur?
Determine effectiveness, monitor for adverse rxs, and refine dose.
Phase 2
38
What type of group is recruited and what is the purpose of Phase 3 of new drug development?
Large # of patients
Identify infrequent or rare side effects, experimental design with a placebo (double blind study)
39
In what phase of new drug development does the following occur?
Identify infrequent or rare side effects, experimental design with a placebo (double blind study)
Phase 3
40
What is a placebo?
A pill with no medication in it
41
What is the purpose of Phase 4 of new drug development?
Severe adverse reactions drug may have, black box warning to alert consumers of the potential of severe adverse reactions. Drug could be recalled by FDA.
42
In what phase of new drug development is the following the protocol?
Severe adverse reactions drug may have, black box warning to alert consumers of the potential of severe adverse reactions. Drug could be recalled by FDA.
Phase 4
43
In what phase of new drug development will the FDA recall the drug?
Phase 4
44
In what phase of new drug development will a black box warning be made?
Phase 4
45
What phase of new drug development may go on for years?
Phase 4
46
What are the three designated classes of drug recall?
Class 1 - Reasonable probability of severe rex or death.
Class 2 - Less severe or temporary or reversible health effects.
Class 3 - Lease severe, not likely to cause a problem.
47
In what classification of drug recall is there a reasonable probability of severe rx or death?
Class I
48
In what class of drug recall is there a less severe or temporary or reversible health effects.
Class 2
49
What class of drug recall is the least severe and not likely to cause a reaction?
Class 3
50
List the classes of drug recall from most severe to least severe.
Class 1 - Most severe
Class 2 - Less severe
Class 3 - Least severe
51
What is the ANA?
The American Nurses Association
52
What does the ANA do?
Established code of ethics and refuses to participate in any personally unethical practices.
53
What organization establishes a code of ethics for nurses?
ANA - American Nurses Association
54
What are the 4 main principles of nursing code of ethics?
Autonomy
Beneficence
Justice
Non-maleficence
55
What are the following?
Autonomy
Beneficence
Justice
Non-maleficence
The principles of the nursing code of ethics.
56
What are the four qualities of the nursing process to medication administration?
Assessment
Planning
Implementation
Evaluation
57
In what phase of the nursing process with drug administration does a cultural assessment belong?
Assessment
58
What phase of the nursing process is based on individual patient needs with medication administration?
Planning
59
What phase of the nursing process is based on culturally competent nursing care?
Implementation
60
What phase of the nursing process in medication administration is based on compliance to the medication regimen?
Evaluation
61
What phase of the nursing process in medication administration dependent on nurses maintaining current knowledge of various cultures, activities and practices?
Implementation
62
What is this: a guide for "carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession"?
The nursing code of ethics
63
What are ethics?
Moral principles that dictate how a person will conduct themselves.
64
What are moral principles that dictate how a person will conduct themselves?
Ethics
65
Are ethical values essential for nurses?
Yes
66
What is recognizing each individual patient’s right to self-determination and decision-making?
Autonomy
67
What is autonomy?
Recognizing each individual patient’s right to self-determination and decision-making.
68
If the medical team might not agree in with the wishes of the patient, what will the nurse be required to do?
Advocate for the patient
69
What do the following influence?
Culture, age, gender, sexual orientation, general health, and social support system
A patient's acceptance or refusal of medical treatment.
70
What is the nickname for the nursing code of ethics?
The Nightingale Pledge.
71
Who is the founder of modern nursing?
Florence Nightingale
72
What is beneficence?
Acting for the good and welfare of others and including such attributes as kindness and charity (ANA defines as compassion)
73
What is acting for the good and welfare of others, including such attributes as kindness and charity?
Beneficence
74
What attribute does the ANA recognized as "compassion?"
Beneficence
75
What is justice?
An element of fairness in all medical and nursing decisions and care (no preferences - ability to prioritize)
76
What is the ethical principle that relates to fairness in all medical decisions?
Justice
77
What is Nonmaleficence?
Do no harm
78
What is the ethical principle defined as "do no harm?"
Nonmaleficence
79
What guides everyday practice and assists in navigating the daily complexities of the healthcare profession?
The code of ethics
80
What is informed consent?
Explain what will happen after the physician has.
81
Can nurses ask for informed consent?
No.
82
What healthcare provider is the only one who can ask a patient for informed consent?
The physician.
83
To witness informed consent, the nurse has to do what?
Be in the room and see it.
84
What two medication administration practices require informed consent?
Chemotherapy
Blood products
85
Chemotherapy and blood products are two medication administration practices that require what?
Informed consent
86
How many people a year do medication errors harm?
1.5 million
87
What is a medical error?
Any error in any phase of clinical patient care.
88
What is a medication error?
Any preventable adverse drug event
89
What is any preventable adverse drug event?
A medication error
90
What is any error in any phase of patient care?
A medical error
91
What differentiates a medical error and a medication error?
A medication error is specifically related to medication.
92
What is an adverse drug event?
Undesirable occurrence related to administration of or failure to administer a drug
93
What is an undesirable occurrence related to administration of or failure to administer a drug
An adverse drug event
94
What is an adverse drug reaction?
An unexpected unintended, undesired, or excessive response to a drug.
95
What is an unexpected, unintended, undesired, or excessive response to a drug?
An adverse drug reaction
96
What is the difference between an adverse drug event and an adverse drug reaction?
An event relates to administration or failure to administer a drug while an adverse drug reaction relates to the specific undesired effect that the drug has after administration.
97
Are the following adverse drug events or adverse drug reactions?
Anaphylactic shock, itching/rash, diarrhea
Adverse drug reactions
98
What to do if a patient has an adverse drug reaction to an IV medication?
Stop medication
Take vitals
Call rapid response team or physician
99
Medication errors are preventable or non-reventable?
Preventable
100
What protects against medication errors?
The 6 rights
101
Drugs commonly causing adverse drug reactions?
CNS drugs
Anticoagulants
Chemotherapeutic drugs
102
What are these three types of drugs responsible for?
CNS drugs
Anticoagulants
Chemotherapeutic drugs
Most common drugs that cause adverse drug reactions
103
What are the two types of adverse drug reactions?
Allergic and idiosyncratic
104
What is an allergic drug reaction?
Immunological hypersensitivity
Itching rash
105
What is an idiosyncratic drug reaction?
An abnormal, unusual, unexpected response to a drug but not an allergic reaction
106
What is an abnormal, unusual or unexpected response to a drug called?
Idiosyncratic reaction (i.e. liver damage)
107
What is an immunological hypersensitivity to a drug called?
An allergic reaction
108
With high alert medications, do what?
Take extra precautions - Takes 2 nurses
109
When administering what type of medications do nurses take extra precautions?
High alert meds
110
What are SALAD drugs?
Sound alike, look alike
111
What are drugs that sound alike and look alike called?
SALAD drugs
112
What are LASA drugs?
Look alike, sound alike drugs.
113
What are look alike, sound alike drugs called?
LASA
114
What are high alert drugs?
Drugs that bear a heightened risk of causing significant patient harm when they are used in error.
115
What are drugs that bear a heightened risk of causing significant patient harm when they are used in error?
High alert drugs
116
What are examples of high alert drugs?
Opioids and narcotics
Insulin
Heparin
117
Opioids and narcotics
Insulin
Heparin
are considered what type of drugs?
High alert drugs
118
What is the most common point in the process at which medication errors occur?
Prescribing
Dispensing
Administering
Monitoring
Administration
Also many errors in prescribing
119
When can errors occur in the medication administration process?
At any step
120
Four issues contributing to medication errors are?
Organizational issues
Educational system issues
Sociologic factors
Use of abbreviations
121
The following issues contribute to what?
- Organizational issues
- Educational system issues
- Sociologic factors
- Use of abbreviations
Medication errors
122
How to avoid educational system issues that cause medication errors?
- Double check everything
- Use only approved abbreviations
- Instill a culture of safety early on
123
How to avoid sociological factors that contribute to communication errors.
Communication between team members. If in doubt, ask.
124
What is a "near miss" in medication administration?
Event or situation that did not produce patient injury, but only because of chance. Either did not reach patient, capture before reaching patient, or timely intervention (an antidote was administerted).
125
What is a close call in medication administration?
An event or situation or error that took place but was identified and capture prior to reaching the patient (i.e. a drug a patient has an allergy to was prescribed but the pharmacist was alerted to the allergy via data entry, not administered or the wrong medication was dispensed by the pharmacy and the nurse caught it before administration).
126
What is the difference between a close call and a near miss?
A near miss was prevented from causing harm (i.e. antidote administered) and a close call never reached the patient because a provider stopped the administration somewhere along the line.
127
What type of medication error occurs when the medication was prescribed but the pharmacist recognized that the patient is allergic?
A close call
128
What type of medication error occurs when the wrong medication was administered but either an antidote was given or somehow the drug didn't reach the patient?
Near miss
129
What are processes that nurses use to prevent medication errors?
- Check the order three times
- Follow the 6 rights
- Assess patient before administration
- Use two patient identifiers
- Minimize verbal or telephone orders
- List indication next to each order
- Never assume anything about items not specified in drug order
- When in doubt question.
- Do not use unapproved abbreviations or acronyms
- Check safe doses
130
What are the 6 rights of medication administration?
Right patient
Right drug
Right dose
Right route
Right frequency
Right documentation
131
What are three processes in assessing a patient before drug administration?
- Take vitals
- Glucose before insulin administration
- Check for allergies
132
Should nurses use generic or trade names when referring to medicaiton?
Always generic to avoid LASA drugs and SALAD.
133
When preparing to administer medication should nurses multitask?
No, always avoid interruptions.
134
How do nurses respond to medication errors?
- Follow institutions policies and procedures
- Report to physician, charge nurse, supervisor
- Document incident report
- Follow-up
135
Why is medication reconciliation important?
To continue medications throughout the patient's care at home, in nursing home and at hospital.
136
Three parts of medication reconciliation (KNOW THIS)
- In the assessment, document a list of medications including OTC, herbal and supplements.
- Education, emphasize the importance of maintaining a current and complete med list.
- Complete list at every step of health care delivery
137
What process are these instrumental to?
- Document medication list
- Educate patient on important of maintaining a current and complete med list
- Complete list at every step of health care delivery
Medication reconciliation
138
Medication available as 500 mg/10mL. Patient order is to receive 1000 mg q6hrs.
What is dose?
1000 mg
139
Medication available as 500 mg/10mL. Patient order is to receive 1000 mg q6hrs.
What is concentration?
500mg/10 mL
140
Medication available as 500 mg/10mL. Patient order is to receive 1000 mg q6hrs.
How many mL should the nurse administer?
80 mL
141
A nurse is administering amoxicillin 350 mg PO. Available is amoxicillin 250 mg/5mL. How many mL should the nurse administer?
7 mL
142
A nurse if providing discharge teaching to the parent of a child who is prescribed diphenhydramine 25 mg elixir every 4 hr as needed. The amount available is diphenhydramine elixir 12.5 mg/5 mL. How many mL should the nurse administer per dose?
10 mL
143
A nurse if providing discharge teaching to the parent of a child who is prescribed diphenhydramine 25 mg elixir every 4 hr as needed. The amount available is diphenhydramine elixir 12.5 mg/5 mL. How many mL should the nurse administer per day?
60 mL
144
A nurse is preparing to administer olanzapine 20 mg PO daily. Available is olanzapine 10 mg orally-disintegrating tablets.
How many tablets should the nurse administer per dose?
2 tablets
145
A nurse is preparing to administer olanzapine 20 mg PO daily. Available is olanzapine 10 mg orally-disintegrating tablets. How many total tablets for 7 days?
14 tabs
146
A nurse is caring for an adolescent client who has pneumonia and a prescription for cefpodoxime 5 mg/kg PO every 12 hr for 5 days. The client weights 88 lbs. How many mg should the nurse administer per dose?
200 mg
147
A nurse is caring for an adolescent client who has pneumonia and a prescription for cefpodoxime 5 mg/kg PO every 12 hr for 5 days. The client weights 88 lbs. Total dose per day?
400 mg
148
First trimester pregnancy concerns with medication administration
All major organs develop within first 3 months. Fetus at most risk during this time.
149
The fetus is most are risk during which part of pregnancy?
First trimester (first three months)
150
How does diffusion work?
Passive movement from an area of higher concentration to lower concentration; requires no energy.
151
What is the process by which a substance moves from an area of higher concentration to lower concentration.
Diffusion
152
What movement of molecules requires no energy?
Diffusion
153
What is the organ that connects the developing fetus to the uterine wall?
The placenta
154
What is the placenta?
The organ that connects the fetus to the uterine wall.
155
What is the active movement of substances between different tissues?
Active transport
156
What method of molecules moving between tissues occurs with a pumping mechanism?
Active transport
157
What method of molecules moving between tissues requires energy?
Active transport
158
What method of molecules between tissues occurs with a pumping mechanism within cell membranes?
Active transport
159
What is the difference between diffusion and active transport?
Diffusion happens passively with no energy. Active transport requires energy.
160
What organ is involved in the exchange of nutrients between the fetus and the mother?
The placenta
161
What are the maternal effects that affect drug administration during pregnancy?
Maternal physiology - liver and kidney function
162
What are the properties of drugs that should be considered during pregnancy?
Drug chemistry and dose
163
Kidney problems and liver problems affect what in medication administration?
How much drug is administered.
164
What happens when kidney function is decreased with medication administration during pregnancy?
Rate of excretion is decreased and level of drug in body stays higher so there's a better chance that the drug will reach the fetus.
165
What happens when liver function is decreased with medication administration during pregnancy?
Rate of metabolism is decreased so the amount of drug in the body remains higher so there's a better change that the drug will reach the fetus.
166
Look at p. 37, table 3-1
In category A in pregnancy safety categories what is the risk to the fetus?
A - No risk
167
In category D in pregnancy safety categories, what is the risk to the fetus?
D - Possible risk to fetus
168
In category X in pregnancy safety categories, what is the risk to the fetus?
X- Not to be used in pregnancy
169
What is a drug that is safe during pregnancy?
Tylenol
170
With breastfeeding, what factors need to be considered for medication administartion?
Fat solubility
Low molecular weight
Excretion
171
When doing dose calc for pediatrics, always calculate rate in which measure?
Kilograms
172
Table 3-2 in Lilley, age range for pediatrics.
Premature/preterm
Neonate
Infant
Toddler
Preschool
School age
Adolescent
- Premature/preterm <38 weeks
- Neonate < 1 month
- Infant 28 days to 12 months
- Toddler 12 months to 3 years
- Preschool 3-5 years
- School age 6-10 years
- Adolescent 11 years to 16 or 18 years
173
What is the age range for premature infants?
< 38 weeks
174
What is the age range for infants?
28 days to 12 months
175
What is the age range for a toddler?
12 months to 3 years
176
What is the age range for a preschooler?
3-5 years
177
What is the age range for a school-aged child?
6 to 10 years
178
What is the age range for an adolescent?
11 - 16/18 years
179
Age range for
- Premature/preterm
- Infant
- Toddler
- Preschool
- School age
- Adolescent
- Premature/preterm <38 weeks
- Infant 28 days to 12 months
- Toddler 12 months to 3 years
- Preschool 3-5 years
- School age 6-10 years
- Adolescent 11 years to 16 or 18 years
180
What percentage of water is the body of a pediatric and neonatal patient?
70-80% as compared to elderly.
181
Pediatric and neonatal patients have a higher risk of what?
Drug interactions
182
Why are weight-based dosages used with pediatric medication administration?
Because sizes within age ranges varies too much.
183
What four medication administration steps are to be used for children?
Preparation
Positioning
Explaining
Comforting
184
Preparation
Positioning
Explaining
Comforting
are four steps to use in what?
Medication administration to children
185
What is a consideration of administering medication to elderly people?
Vital organ function (liver and kidney function)
186
Who is considered elderly?
People > 65 years of age
187
Geriatric or gerontology patients are how old?
> 65 years of age
188
Polypharmacy
Multiple medications usually paired with OTC meds.
189
What factors contribute to medication errors in the elderly?
Visual acuity, manual dexterity, confusion and compliance
190
Visual acuity, manual dexterity, confusion and compliance are factors that contribute to what?
Medication errors in the elderly
191
What physiologic changes in the elderly should be considered when administering meds?
Decreased body weight
Decreased organ function
192
What two lab tests confirm kidney and liver function?
BUN and creatinine - kidney
Enzyme levels - liver
193
Do problems with kidney and liver function result in high or low lab results in BUN/creatinine and liver enzymes?
Higher.
194
What are the four steps in pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
195
Absorption
Distribution
Metabolism
Excretion
are the four steps in what?
Pharmacokinetics
196
What should be addressed during assessment with medication administration in pregnancy, pediatric, and the elderly?
Pregnancy - #1 question: problems in previous pregnancies, allergies
Pediatrics - don't have allergies so MONITOR
Elderly - Allergies, OTCs, herbals, complaints about med?
197
What should be done in the planning phase when dealing with pregnant, pediatric or elderly?
Educate patient
Promote compliance
198
What is important to do in the implementation phase?
Demonstrate and have the patient return the demonstration
199
What should be done in the evaluation phase when administering medication to pregnant, pediatric and elderly patients?
Did the patient tolerate the med?
Any adverse rx?
Document!
200
Chapter 9 in Lilley - study definitions
201
Domains of learning p. 73-74 in Lilley
202
Cognitive domain
Level at which basic knowledge is learned and stored. Thinking portion of learning process that incorporates previous experiences and perceptions.
203
What is an example of cognitive learning?
Educating a patient about pain medication and the patient storing that information in their memory.
204
Affective domain
Conduct that expresses feelings, needs, beliefs, values, and opinions, emotions.
205
What is an example of affective domain in medication administration?
The patient sharing that they stopped talking their medication because the family told them is was dangerous.
206
Psychomotor domain
Learning a new procedure or skill - the doing domain.
207
What is an example of psychomotor domain learning?
Demonstrating the administration of insulin and having the pat return the demonstration.
208
What is the difference between teaching and learning?
Teaching is sharing information.
Learning is the result of effective patient education resulting in a change in behavior.
209
What is the sharing of information?
Teaching
210
What results in effective patient education that creates in a change in behavior?
Learning
211
Categories of risk during pregnancy, lactation and reproduction.
Category A
Category B
Category C
Category D
Category X
A - no risk to human fetus
B - no risk to animal fetus; not studied in humans
C - risk to animal fetus; not studied in humans
D - possible risk to human fetus; risk vs. benefit should be weighed
X - Drugs not to used during pregnancy
212
In the medication risk for pregnancy, what is category A?
A - no risk to humans
213
In the medication risk for pregnancy, what is category B?
No risk to animal fetus; not studied in humans
214
In the medication risk for pregnancy, what is category C?
Risk to animal fetus; not studied in humans
215
In the medication risk for pregnancy, what is category D?
Risk to human fetus; benefits should be weighed against risks.
216
In the medication risk for pregnancy, what is category X?
Should not be prescribed during pregnancy.
217
Classification of young patients:
Premature or preterm
Neonate or newborn
Infant
Child
Preemie <38 weeks
Neonate <1 month
Infant 1 month to 1 year
Child 1 - 12 years
