Pharm quiz 1 study guide Flashcards
9 rights(reason)
1 - right drug
2 - right dose
3 - right time
4 - right route and form
5 - right patient
6 - right documentation
7 - right reason or indications
8 - right response
9 - right to refuse
fastest to slowest absorption
fasteste to slowest:
epidural
IV
IM
SC
PO
allergic
an immunologic hypersensitivity reaction resulting from unusual sensitivity of a patient to a particular medication; a type of adverse drug event
idosynchratic reaction (ritalin is idosychratic)
an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient
cultural assessment
languages spoken, written and understood. need for an interpreter.
health beliefs and practices
past uses of medicine
use of herbal treatments, folk remedies, home remedies, or supplements
use of otc drugs
usual responses to illness
religious practices and beliefs (christian scientists don’t take any meds at all)
support from the patient’s cultural community that may provide resources or assistance as needed, such as religious connections, leaders, family members, or friends
dietary habits
how to identify a patient before giving a med
2 unique identifiers - (full name, dob, name band)
therapeutic index - lethal dose etc
To establish Toxicity & Effectiveness:
-“LD50” dose lethal to 50% animals tested
- Median effective dose-
-Therapeutic dose for 50% of animals tested
To determine Therapeutic Index
- LD50/ Median effective dose
med error (the patient and the provider are errors)
preventable adverse drug event involving inappropriate medicaiton use by patient or health care provider, may or may not cause harm
nursing process (ANPIE is the process, the framework)
organizational framework for the practice of nursing. all steps taken by nurse in caring for patietn. AI (human needs) PIE
outcomes (the specific outcome is measurable) - this is the planning phase of ANPIE
specific patient behaviors or responses that meet or achieve patient human needs. specific and measurable
additive effects
similiar or equivalent to the sum of the individual effects 1 + 1 = 2
adverse drug event (the event is the admin’s fault)
undesirable occurance related to administering or failing to administer meds
adverse drug reaction (the reaction is therapeutic)
unexpected, unintended, undesired response given at theraupetic doses (unlike an overdose)
adverse effects
undesirable effects that are a direct response to one or more drugs
agonist
drug that stimulates the activity of one or more receptors
antagonist effect
1 + 1 = less than 2. a substance that stops the action or effect of another substance. also called inhibitors
bioavailability (available to absorb)
a measure of the extent of drug absorption for a given drug and route (from 0 - 100%)
biotransformation
one or more biochemical reactions involving a parent drug. occurs mainly in the liver and produces a metabolite that is either active or inactive. also called metabolism.
cytochrome P-450
general name for a larger class of enzymes that plays significant role in drug metabolism and interactions
dependence (your dependence is compulsive)
compulsive or chronic need for a drug
dissolution (before entering where?)
solid form disentigartes in gi tract and becomes soluble before entering circulation
drug
a chemical that affects the phsyiology of a living thing
drug effect
The physiologic reaction of the body to the drug
can be good or bad
teratogenic
Structural defects to Fetus
duration
The time a drug concentration is sufficient to elicit a
therapeutic response
first pass
initial metabolism in liver before reaching ciriculation
high first pass rate
a large amount of drug is absorbed by liver and less will reach target sites
glucose-6-phosphate dehydrogenase
hereditary - RBC break down when body is exposed to certain drugs
incompatability
2 parental drugs when mixed together result in deteroration of one drug
medication use process
prescribing, despensing, admin of meds and their effects
metabolite
chemical form of a drug that is the product of one ore more biochemical reactions involving parent drug. active metabolites have activity of their own, even if parent drug is inactive. inactive are drug waste products.
onsest
time to reach therapeutic response
p-gylcoprotein (p for pusher)
transporter protein that moves drugs out of cells into gut, urine or bile
pharmaceutics (ceut the dose)
the study of how various dosage forms influence the way in which the drug affects the body
pharmacodynamics
drug-receptor relationship.
the mechanism of drug actions in living tissues
pharmacogenomics
study of genetic factors
pharamcognosy
from natural plants or animals
pharmacokinetics (what does coke-netics do to the body from start to finish)
body does to the drug.
- Absorption
- Distribution
- Metabolism
-Excretion
receptor
reactive site on cell surface or inside cell
substrates
substances on which an enzyme acts
toxic
quality of being poisonous
trough
lowest concentration of a drug after peak.
neonate
younger than 1 month
pediatric
12 or younger
polypharmacy
use of multiple meds by older ppl
bias (bias against this measurement)
systematic error in measurement process
drug polymorphism
variation in response to a drug because of a patient’s age, gender, size and body composition
HIPAA
protects health insurance coverage for workers when they change jobs. protects patient info.
investigational new drug
not yet approved by FDA but safe
malpractice
type of negligence or failure by person with SPECIALIZED education to act in a reasonable or prudent way
negligence
failure to act in prudent or reasonable way
orphan drugs
treat rare diseases
adverse drug event - just basic description but also includes what?
adverse drug reaction and medication errors
adverse drug reaction (the reaction is therapeutic)
unexepected or unitended or excessive response to meds given at therapeutic dose
med reconciilation
maintain up to date list of meds for all patients and all phases of health care
affective domain (you affect my feelings)
expression of feelings
Iiatrogenic effects (analis is liatrogenic)
unitentional adverse effects caused by actions of a prescriber or health care person.
integrative medicine
use of western and nontraditional meds at the same time
phytochemicals
active ingredients in herbal remedies
adjuvant analgesic drugs
drugs added for combined therapy
agonist
drug binds to the receptor; there is a response
agonist-antagonist
bind to receptor and cause partial response not as strong as agonist
antagonist
drug binds to the receptor: there is no response. drug prevents biding of agonists.
central pain
pain caused by CNS damage
chronic pain
longer than 3 - 6 months
nociception (the process is nociception)
processing pain signals in brain that give rise to feelings of pain
partial agonist
drug binds to the receptor; the response is diminished compared to agonist
somatic pain
skeltal muscles, ligaments, or joints
superficial pain
skin or mucosa
general anesthesia
a drug induced state in which the CNS nerve impulses are altered to reduce pain and other sensations throughout the entire body. total loss of consciousness and respiratory drive.
monitored anesthesia care (MAC)
planned procedure where patient undergoes local anesthesia with sedation and analgesia
overton-meyer theory (over a ton lipid)
theory describing the relationship between lipid solubility of anesthetic drugs and their potentency
barbituates (barb will put you to sleep)
induce sedation
benzos (benzo for my anxiety)
anxiolytic (anxiety) drugs
GABA - gamma-aminobutyric acid (gaba all of em)
inhibitory neurotransmitter found in brain. key compound affected by sedative, benzos, psychotropic and muscle relaxers
hypontics (hypnotized but not sleepy)
calm or soothe cns without inducing sleep unless at high doses
non REM
4 stages before REM
REM interference
drug induced reduction of REM sleep time
REM rebound
excessive REM following discontinuation of drug
sedatives (sedate me, but don’t sleep)
inhibitory effect on CNS that reduce nervousnes, irritabilty without causing sleep
amphetamines
stimulants
analeptics (ana loves stimulants)
CNS stimulates that produce increase in responsiveness to external stimuli and stimulate respiration
anorexiants
drugs used to control or suppress appetite
catplexy
abprut attacks of muscle weakness triggers by joy, laughter, anger, fear, suprise
ergot alkaloids
drugs that constrict blood vessels in brain - for migraines
seratonin receptor agonists
CNS stimulants used to treat migraines
sympathomimetic drugs (mimic the sympthatic)
CNS stimulants such as nonadrenengic drugs who mimic those of the sympathetic nervous system
Schedule I
Schedule I: No accepted medical use w/high potential for Abuse.
Example: Heroin, Ecstasy, LSD, & Marijuana
Schedule II (Schedule II is MAD, FC V)
Schedule II: accepted severe restrictions use w/ high potential for Abuse.
Example: Cocaine, Morphine, Vicodin, Demerol, Fentanyl, & Adderall
Schedule III (schedule III is SKTCH)
Schedule III: accepted medical use w/moderate to low potential for Abuse.
Example: Ketamine, Anabolic Steroids, Codeine, Hydrocodone, Tylenol/ASA
Schedule IV (schedule 4 is VAAXK)
Schedule IV: accepted medical use w/ low potential for Abuse.
Example: Valium, Ambien, Xanax, Klonopin, Ativan
Schedule V
Schedule V: accepted medical use w/ low potential for Abuse.
Example: Robitussin AC
PQRST
P = provoking factors - what factors precipitate pain - What were you doing when the pain started? What caused it? What makes it better or worse? What seems to trigger it? Stress? Position? Certain activities? -
Q=Quality - description of pain - What does it feel like? Use words to describe the pain such as sharp, dull, stabbing, burning, crushing, throbbing, nauseating, shooting, twisting or stretching
R=region or radiation
S=severity on a pain scale
T = how long has it been present? what makes it better or worse? - When/at what time did the pain start? How long did it last? How often does it occur: hourly? daily? weekly? monthly?
WHO pain management scale/ladder (WHO is the adjuvant?)
1) (bottom) nonopiod +/- adjuvant
2) pain persisitng or increasing
3) opioid for mild or moderate pain
+/- opioid
+/_ adjuvant
4) pain persiting or increasing
5) (top) opioid for moderate to severe pain
+/- opioid
+/_ adjuvant
pinpoint pupils is called…
myosis, miosis. possible overdose opiates
post op is what type of therapy and what to do?
maintain integrity of body functions, provide fluids and electrolytes to prevent dehydration if they are vomiting, or blood products to patient who has lost blood during surgery. manage pain.
sleep cycles - 1 (small to start)
non-REM - dozing, can be easily awakened 2-5% of sleep time
sleep cycle - 2 (2 is at the top)
sleep deepening, high arousal required to be woken up . 50% of sleep
sleep cycle 3 (3 is 3) and what about breathing? (second smallest)
deep sleep, difficult to wake, respiration, etc decreases 5% of sleep
sleep cycle 4 (a little sleep before REM)
very difficult to wake. 10-15% of sleep time
REM (REM is my favorite number)
vivid dreams, irregular breathing 25-33% of sleep
Dantrolene (Dan trolled the hyperthermia)
used to treat malignant hyperthermia
malignant hyperthermia
uncommon, genetic metabolic reaction to general anesthesia. associated with inhaled anesthesias. at risk - children, adolescents, and ppl with skeletal abnormalities
pregnancy - B
Animal reproductive studies failed to
determine Risk to Fetus & there are no adequate & well controlled studies in pregnant women
pregnancy category - C (c, there is an adverse effect on animals)
Animal reproductive studies shown an
adverse effect on Fetus & there are no adequate & well controlled studies in humans, but potential Benefits may warrant drug use in pregnant women despite potential Risks.
pregnancy category - D (delightfully not animals this time)
Positive evidence of human fetal Risk based
on adverse reaction data from investigational, marketing experience or studies in humans, but potential benefits may warrant use of drug in pregnant women despite Risks
9 rights
- RIGHT Patient X
- RIGHT Drug X
- RIGHT Dose X
- RIGHT Route X
- RIGHT Time X
- RIGHT Documentation X
- RIGHT to Refuse X
- RIGHT response X
- RIGHT Reason X
ex of human needs statement
altered safety needs (human response), risk for injury related to medication
implementation
nurse intervenes on behalf of patient, ie physical therapy
QSEN (patient is the center, then the team, then the evidence, then quality brings safety and info)
patient-centered care, teamwork, evidence-based practice, quality improvement, safety, and informatics.
rectal drugs are given for what reason?
for systemic effects - reduce fever, anything system–wide
do sublingual and buccal bypass the liver?
YES, ie nitroglycerin
fastest to slowest routes for absorption
parenteral (IV), enteral, topical
do topical meds bypass the liver?
Yes, ALL but rectal
nurse practic act defines the..
scope
affective domain learning
expression of feelings
Pharmaceutical - (does the drug suit the dissolution)
Dosage form determines the rate drug dissolution (dissolving of solid dosage forms and their absorption from the GI tract). goes from solid and breaks down in gut
🞑 Enteric-coated tablets
🞑 Extended-release form
Pharmacokinetic (what does coke-netics do to the body from start to finish)
The study of what the body does to the drug
- Absorption
- Distribution
- Metabolism
-Excretion
also onset, peak, duration and UNTIL the parent drug and metabolites have left the body.
Absorption (absorb the bupe into your bloodstream to your sore muscles)
the movement from administration into the bloodstream for distribution to the tissues
Pharmacodynamics involves..(the dynamic between the drug and receptor)
drug-receptor relationship.
the mechanism of drug actions in living tissues
examples of enteral routes (enteral BROS)
- Oral
- Sublingual
-Buccal
-Rectal (can also be topical)
lungs are what route?
topical
ANA - Provision 1 (it takes one for compassion)
Provision 1 The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
Provision 2 - ANA (it takes 2 to commit)
The nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population.
Provision 3 - ANA (advocate for the number 3)
Provision 3 The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.
Provision 4 ANA (accountable for 4 chambers in the heart)
The nurse has authority, accountability and responsibility for nursing practice; makes decisions; and takes action consistent with the obligation to provide optimal patient care.
Provision 5 - ANA (five fingers make up the self)
The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
Provision 6 ANA (666 is not safe)
The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care.
Provision 7 (educated at 7/11)
The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.
Provision 8 ANA (I ate your human rights with other professionals)
The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.
Provision 9 ANA (nine social justices)
The profession of nursing, collectively through its professional
organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.
kidney stone is what type of pain?
visceral
adjuvant
second drug when first isn’t enough
somatic pain
skeletal muscles, ligaments or joints
neuorpathic pain
damage to peripheral nerve
central pain
tumors, trauma or inflammation of the brain (anything CNS related)
meripidine (D for demerol)
(D for demerol and D for die 7x stronger than morphine) - can cause seizures - toxic
antidote for benzos (benzo has the flu, what’s the antidote?)
flumazenil
neuropathic tissue is unhealthy tissue - like
neuropathy
analgesic
analgesic - more relief from pain without losing consciousness
morphine - agonist or antagonist?
opioid agonist analgesic - mimics endogenous opiate
opiate contraindications (Ana nicole is BAB)
benzos, alcohol, and barbiturates
what to give for alcohol withdrawals?
benzos
do sublingual and buccal bypass the liver?
yes, nitrogylcerin
do topical meds bypass the liver?
yes, all but rectal
recovering from an illness is what type of therapy?
supportive
Examples of drugs with a narrow therapeutic index (Amine in the corner)
- Aminoglycosides (Gentamicin®)
- Digoxin (Lanoxin®)
- Lithium (Lithobid®)
- Phenytoin (Dilantin®)
- Valproic Acid (Depakote®)
- Warfarin (Coumadin®)
Potentiation (potent for the other drug)
when one drug does not elicit a response on its own but enhances the response to another drug.
gate theory
injured tissue releases bradykinin, histamine, potassium, prostaglandins, seratonin. This release causes an action potential in sensory nerve fibers through pain receptors called nonciceptors. These impulses activate pain receptors in spinal cord (dorsal horn). The gates are here.
If impulses are stopped at the gate, no pain is felt. Doesn’t reach the brain.
If the gate allows many action potentials through, they reach the brain and pain is felt. This is known as nonciception.
Nurses Practice Act
The Nursing Practice Act (NPA) is the body of California law that mandates the Board to set out the scope of practice and responsibilities for RNs.
major adverse effect with opioids - what about cough?
it’s a cough suppressant and patients can’t cough and clear their throat. They are at risk for post-op pneumonia.
don’t combine morphine, demerol (or any opiates) with
MAO inhibitors (depression meds) excessive activation of
serotonin receptors causing excitation, delirium,
hyperthermia, seizures, coma & death
demerol pregnancy category (demerol is surprisingly low)
B
naloxone pregnancy category
C
vicodin pregnancy category
C
methadone pregnancy category
C
xanax pregnancy category (xanax is Damn bad)
D
diazapam pregnancy category (think benzo)
D
demerol w/ antihistamine?
increases effect of demerol which is good…you can use less of it, less toxic
vicodin inhibitors and inducers
Inhibitors: Amiodarone (cardiovascular drug)
🞑 Inducers: barbiturates, tegretol
methadone inhibitors and inducers
Inhibitors: sertraline, rifampin
🞑 Inducers: tegretol, phenobarb, phenytoin, barbiturate anesthetics
Interactions: NSAIDS
njury to gastric mucosa Tylenol® =
liver damage with only 2-4 drinks per day (limit should not
exceed 2 grams per day)
Chlor-DI-ze-POX-ide (chlora is a libra)
librium
Action:
🞑 Potentiates the actions of GABA, especially in the limbic
system, reticular formation
Uses:
🞑 Short-term management of anxiety, acute alcohol
withdrawal, preoperatively for relaxation
during non-REM
bp falls
pulse rate slows
metabolic rate decreases
gastro slows
urine formation slow
O2 consumption and CO2 production is reduced
temp decreases slightly
respiration slower and more shallow
body movement is minimal
ativan (my Ortho takes Ativan)
Adverse Effects
🞑 Dizziness, drowsiness, Orthostatic hypotension, ECG
changes, tachycardia, hypotension; apnea, cardiac
arrest (IV, rapid)
benzos have what in the name?
zepam or zolam
Hypnotics are used to
Hypnotics are used to induce sleep with greater
CNS depression than sedatives.
at low or moderate doses, calms CNS. At high doses, induces sleep
drug classifications (BC M at the clinic)
1) Clinical indication
2) Mechanism of Action
3) Body system
1) Clinical indication
(Bronchodilator)
2) Mechanism of Action (just what a drug does)
(biochemical process through which a drugproduces its effect)
Body system
Body system - ( CNS)
WHO pain scale (goes in 3s)
Pain Description
“Mild pain” - 1 to 3
“Moderate pain” - 4 to 6
“Severe pain” 7 to 10
Chlordiazepoxide (chlora loves librium)
librium - for alcohol withdrawals, benzo
Lorazepam (Lorazepam in LA)
Ativan® (for anxiety) sedative
alprazolam (al loves xanax)
xanax - sedative
diazapam
valium (pam, so it’s a benzo). anxiety, insomnia
nonceceptors respond to what kind of pain? (TMC)
🞑 “thermal” (heat or cold),
🞑 “mechanical”(crushing, tearing, etc.) and
🞑 “chemical”(iodine in a cut, chili powder in the eyes).
tylenol antidote
N-acetylcysteine
6 rights - use these for the exam
rights patient, dose, route, time, med, right reason
digoxin antidote (binding to digoxin)
Digibind or Digifab
cholenergic toxic antidote (cholera airplane)
atropine
To name a few, aged cheese and wine
interact with
MAO inhibitors
Tachyphylaxis (law of diminishing returns is tacky)
rapidly diminishing response to successive doses of a drug, rendering it less effective
steady state
elimination is equal to absorption
nociceptors
sensory nerves that transmit pain signals to the CNS
analeptics (ana loves stimulants)
CNS stimulants that produce an increased reaction to external stimulus
a medication error is what type of event?
adverse drug event
if you want to sleep, use..
then hypnotics - barbs not recommended for sleep anymore
only use barbs for
convultions
for benzos muscle relaxers, what to check?
check sleep patterns, full phsycial, and depression and drug use
for zolidepem,
(ambien) head to toe, allergies, and drug use
Nociceptive pain is caused by
Nociceptive pain is caused by stimulation of
peripheral nerve fibers (cold, crushing, burning)
methadone nursing consideration
chest pain
2 types of adverse drug reactions (my allergy is reacting to my idiosynchocy)
allergic and idiosynchratic
OD (OD once a day)
once daily
per OS
by mouth, orally
qn (n for nightly)
nightly
qod (od = other day)
every other day
ss
sliding scale
SSI or SSRI
sliding scale insulin
TIW
3 times a week
human needs statements usually say (I’m altering your human needs)
altered
threshold is the level of
stimulus
adverse effect to opioids
itching, CNS depression
local anethetics work on what nerves?
peripheral
succincoyline
depolarizing NMBD
barbs stimulate
enzymes
leafy green vegetables interact with
warfarin
