Pharm week 1 Flashcards
d5 steps in nursing (ANPIE)
- Assessment- not Judgement….
- Nursing Diagnoses (human needs statement_
- Planning- with outcome identification
- Implementation- & Patient Education
- Evaluation
nursing addresses…(PESS FCC)
Physical
• Emotional
• Spiritual
• Sexual
• Financial
• Cultural
• Cognitive
drug classifications based on…(CMB in clinicals)
1) Clinical indication -(Bronchodilator)
2) Mechanism of Action – (biochemical
process through which a drug
produces its effect)
3) Body system - ( CNS)
legend drugs
need a prescription
Hx (it’s a false hex)
drugs had harmful additives & false claims
To be considered an ingredient
for a dietary supplement, must have…(CHAD VM concentrate on herbs, amino cavies and dietary supplements)
Vitamin
• Mineral
• Herb or botanical
• Amino Acid
• Dietary substance used by man to supplement diet by
Increasing total dietary intake (enzymes, organ tissue, or
glands)
• Concentrate, metabolite, constituent or extract
O/P/D/HL
onset, peak, duration, half life
MOA (moa chiv)
how drug affects the body
NTE (night exceeds)
not to exceed
S/E (you’re afraid of ses)
side effects
evaluate involves…(evaluate tracks, chiv side effects, and documents)
• - Track the daily dose
• - Check for Side Effects ( S/E)
• - Document the response
To determine Therapeutic Index
- LD50/ Median effective dose (meaning - lethal dose for 50% of the pop. divided by the median effective dose for 50 % of the population)
human studies - phase I (initiate evaluation of phase 1)
Initial Pharmacological evaluation
human studies - phase II (control tu)
Limited controlled evaluation
human studies - phase III (3 ways to extend and evaluate)
Extended clinical evaluation
pregnancy category - A (A is a trimester)
Category A: Adequate & well-controlled studies have
failed to determine a Risk to Fetus in 1st Trimester of Pregnancy & No evidence of Risk in later trimesters
pregnancy category - B (be an animal)
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)
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 adverse)
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
pregnancy category - X
Studies in animals or humans demonstrated
fetal abnormalities w/ positive evidence of human fetal Risk based on adverse reaction to use of drug in pregnant women clearly outweighs potential benefits
- Phase IV is when…(learn in phase 5)
the marketing and widespread of drug use is how we learn.
nursing role - 10 basic rights (pdd rtrr eae)
- RIGHT Patient
- RIGHT Drug
- RIGHT Dose
- RIGHT Route
- RIGHT Time
- RIGHT Reason & Documentation
- RIGHT to Refuse
- RIGHT Education
- RIGHT Assessment
- RIGHT Evaluation
OS (so it’s your left eye)
left eye
OD (right eye od’ed)
right eye
OU (o u have 2 eyes)
both eyes
ad lib
freely, as needed
Bid (bid twice a day)
twice a day
Prn
as needed
q (q every light)
every
q3h
every 3 hours
qd
every day
qid (quad)
four times a day
qod (every other qod)
every other day
tib
three times a day
if patient says they didn’t get meds, first thing to do is?
Check medication administration recorded in EHR
do this if you make a medication error? (check this)
Records completion of an incident report in the
medical chart
Does nothing since the patient doesn’t experience
any side effects
6 rights of medication (right MDD TRP)
1) right patient (2 unique identifiers - full name, dob, name band)
2) right medication (verify medication to MAR, then verify to the MAR when you put in med cup)
3) right dose (check math to make sure right dose and correct med is about to be given), then make sure dose is within therapeutic range.
4) right time (make sure to document if medication is late from pharmacy)
5) right route
6) right documentation - document that you gave meds - also educating the patient
do not use abbrevations
1) QD or QID - write once daily or every other day
2) IU - write international unit
3) MS or MG - write morphine sulfate or magnesium sulfate
4) ug - write mcg
5) HS - write at bedtime, or half strength
6) TIW - write 3 times a week
100mg
Peak
50 mg
at 8 hours, 50% removed from body
25 mg
for 16 hr 1/2 life, 75 % removed from body
24 hours
12.5 mg,
pr route
per rectum
ex of human needs statement
altered safety needs (human response), risk for injury related to medication
outcomes (not smoking)
objective, real and measurable w/ timelines
implementation
nurse intervenes on behalf of patient, ie physical therapy
evaluation
monitoring patient outcomes
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.
assessment allows you to organize information in the form of…
human needs statements, which involves a problem, strength, or vulernability.
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
when you can’t do oral meds, what is good alternative?
rectal
subcutaneous
into fatty subcutaneous under dermal
injections into the superficial layer right below epidermal into dermal
intradermal injections
muscles have more blood vessels, so
they are absorbed faster than subcutaneous
topical can be a problem if…
the patient is having a reaction and they’ve already absorbed too much of the med over several days
do topical meds bypass the liver?
Yes, ALL but rectal
both first pass and non first pass - only one place
rectal
problems w/ topcial
systemic absorption is unreliable and erratic
transdermal is good for long or short periods?
long - delivered over 72 hours for example
can’t use inhalation if…
patient has pulmonary disease
only drugs that are not bound to plasma proteins can…
be distributed to extravascular tissues (tissue outside of the blood vessel)
drug-drug interaction
2 drugs increase or decrease the actions of each other
P-450
responsible for metabolism of most meds
primary organ for excretion
kidneys, then liver and bowels
nonselective interactions (vancomycin is nonselective)
drugs that don’t use enzyme or receptors, but they change the formation of cell structures, like distrupt the cell wall leading to cell death
supportive therapy
when a person is recovering from illness
phrophylactic therapy
prevent illness
more dangerous - low or high theraputic index?
low, there is little wiggle room
antagonist effects (1 + 1 = )
less than 2
most common adverse drug events are…
medication errors and adverse drug reactions (ADRs) `
idiosynchratic reaction
unexpected response to a drug
pharmacognosy (cognizant of nature)
natural drug sources, plants and animals
transfer to fetus occurs via
diffusion
when does the greatest amount of maternal drugs get absorped by fetus?
last trimester
neonate
birth to 1 month old
infant age
1 -12 months
child age
1 - 12 years old
polypharmacy
use of multiple meds by older ppl
ph goes up with what age group?
elderly - everything else decreases
kidney measured by
creatine
liver measured by
AST - tranferase
water soluble drugs higher or lower absorption in older adults?
higher bc they are more dehydrated
toddlers - meds explination
brief but concrete explinatiaon with realistic expectations of child’s understanding
infants- giving meds
let parent rock or hold child
preschoolers giving meds
brief but concrete explinatiaon with realistic expectations of child’s understanding, use magical thinking
meds for school aged children
explain and allow some body control. provide comfort. ok to cry. complete picture
pregnant women should or should not take over the counter meds?
generally not
drug polymorphism
patient’s age, gender, size, body comp, and other stuff on the pharmokentics of drugs
phase 1
determine dose range
phase 2
drug effectiveness and adverse effects
phase 3
rare side effects
phase 4
further proof of therauptic effect
nurse practic act defines the…
scope
veracity
the duty to tell the truth
adverse drug event is (2 things)
adverse drug reaction and medication errors
drugs common in severe medication erros
anticoagulants, CNS drugs, and chemo drugs
half of all medication errors began with the..
medication ordering, then adminstration and dispensing
most errors during transition of patients to home occur due to
communication errors
affective domain learning
expression of feelings
words used for outcomes
demonstrate, describe, discuss, self-administer
herbal products…
are not FDA approved, so you can’t rely on the labels.
human needs statement - example
altered oxygen - it’s something you’re doing for the patient
planning/outcome
patient remains hydrated, patient remains free from injury - something about an outcome
planning/outcome
patient remains hydrated, patient remains free from injury - something about an outcome
general anesthesia
loss of ability to feel pain bc CNS impulses are altered
local anesthetics
alter peripheral or spinal nerve impulses to eliminate pain
short acting barbs
pentobarbital and seconal
intermidiate barbs
butabarbital
long acting barbs
phenobarbital and mephobarbital
long acting benzos
clonazepam
intermediate acting benzos
alprozolam
short acting benzos
zolipem (ambien)
