Pharmacology Flashcards
List the types of history questions or clinical indicators a nurse or other health care provider should assess before drug administration.
Before giving a patient any drugs, the nurse or other provider should question the individual about their historical health status, presence of any allergies and use of medications. Clinically, basic data like age, weight, height, and body temperature should be known prior to drug administration. The skin should be examined for its elastic properties and appearance including the presence of any rashes or wounds or redness. Any swelling or other means of fluid loss such as vomiting or diarrhea should be documented. The patient should be observed for their ability to respond to sensory stimulation.
CRNI Exam Secrets Test Prep Team (2011-11-22). CRNI Exam Flashcard Study System: CRNI Test Practice Questions & Review for the Certified Registered Nurse Infusion Exam (Kindle Locations 1612-1616). Mometrix Media LLC. Kindle Edition.
List the types of laboratory testing that should be done when medicating patients.
A number of clinical chemistry and hematology tests should be performed for patients being given drugs.
· Blood tests include coagulation parameters, chemical analysis of components, and cell counts.
· A urine sample is typically taken to analyze its properties often including the pattern of drug elimination.
· Therapeutic drug monitoring may be done in which test samples are taken at intervals after administering a single drug dose and then measuring the time to maximum and minimum drug concentrations present in the blood.
· Other screening tests could include bacterial sensitivity or resistance or toxicology screens.
List the information that must be documented by the nurse every time a drug is administered and why.
For legal purposes to protect themselves, when giving drugs the nurse should either write or have a prepared form to fill out with all of the following information:
· Drug administered.
· Dose given.
· Rate administered.
· Time period given.
· Route of administration.
· Response by the patient to the medication.
Legally, each individual (in this case the nurse) is liable for their own actions and could be held accountable. Offenses could include negligence, battery or untoward bodily touching, and assault (fear of impending bodily harm). In the hospital, protocols are usually established by the Institutional Review Board. In non-hospital settings such as infusion centers, clinics, or doctors’ offices the same standards apply.
Explain what admixing is and the conditions under which is performed.
Admixing is the process by which medications are prepared or compounded. It is usually performed by the pharmacy in a clean, assigned area usually under a laminar flow hood. The hood greatly eliminates the possibility of including bacteria or other microorganisms from the air, especially if good sterile technique is used. Admixing should only be performed after considering the compatibility of the components in terms of whether untenable chemical or physical changes could occur or whether the drug effectiveness of the medication can be maintained. Parameters to consider include drug concentration, pH, buffering capacity, and the length of contact time with diluents or other components before giving the drug to the patient.
Indicate the major types of complications that might result when drugs are administered.
Some drugs or other agents are either vesicants or irritants. Vesicants can cause blisters or destroy tissue when they leak into surrounding tissue, know as extravasation. Extravasation of irritants can produce pain in the vein at the site and sometimes inflammation. Even if the agent is not a vesicant or irritant, complications can arise if it is administered accidentally into the surrounding tissue. If two drugs are given simultaneously, they could affect each other either by antagonism, synergism, or potentiation. In other words, the action of one drug could cross react and be inhibited by the other, the drugs acting together could produce either unique or enhanced reactions, or in extreme cases greatly enhanced reactions occur. A patient might be allergic to the reagent and anaphylactic shock could occur after administration. Another type of shock called speed shock can happen with rapid injection. Bacterial infections or some other type of disturbance could be introduced that inflames the walls of the vein, causing a condition called phlebitis as a result.
List commonly utilized anti-infective agents classified as penicillins and give their indications.
Penicillin is an antibiotic that was originally isolated from mold but now has many synthetic forms including the following:
· Ampicillin sodium (Omnipen-N)— Used to treat both gram-positive and negative bacteria, excluding staphylococci that produce penicillinase.
· Nafcillin sodium (Unipen)— To treat staphylococci that generate penicillinase.
· Oxacillin sodium (Bactocill)— Indicated for penicillinase-producing bacteria
· Penicillin G potassium/ sodium— For serious infections including anaerobic ones and those affecting the heart or brain.
Piperacillin sodium (Pipracil)— Used to treat organisms affecting the respiratory or urinary tracts as well as solid areas such as the bones.
· Ticarcillin disodium (Ticar)— Broad spectrum penicillin to treat bacterial infections that have become septicemic.
List currently available cephalosporins and their indications.
Currently available cephalosporins are generally given to treat gram-negative, gram-positive or occasionally anaerobic infections that do not require oxygen. Any generic drug name with a cef- prefix is probably a cephalosporin. Broad-spectrum cephalosporins include cefazolin sodium (Kefzol), cefamandole nafate (Mandol), cefotetan disodium (Cefotan), cefuroxime sodium (Kefurox) and others. Some cephalosporins are usually employed to treat bacterial infections in specific body areas, typically on the skin or bones, genitalia, urinary tract, or respiratory tract. Examples include cephapirin sodium (Cefadyl) and ceftizoxime sodium (Cefizox).
Explain the relationship between penicillins and cephalosporins.
Cephalosporin was originally isolated from a mold just like penicillin and is very similar in structure. Cephalosporins, which now include a variety of further generation derivatives, are more resistant than penicillins to the action of penicillinase. Because of their similar structure, some of the cephalosporins can cross-react in a patient with penicillin allergy and therefore be contraindicated. Cephalosporins are generally effective against gram-positive, gram-negative and often anaerobic bacteria.
Describe what aminoglycosides are and give their primary use.
Aminoglycosides are antibiotics that structurally have their amino sugars attached as glycosides. Their primary use is to treat infections caused by aerobic bacilli. Bacilli are rod-shaped, spore-forming bacteria. They include Escherichia coli, Klebsiella, and Pseudomona, and Proteus species. Some aminoglycosides are effective against both gram stain-negative and gram-positive bacilli, and these include gentamicin sulfate (Garamycin), netilmicin sulfate (Netromycin), and Tobramycin sulfate (Nebcin). Some are effective against primarily gram-negative organisms, including kanamycin sulfate (Kantrex) and amikacin sulfate (Amikin).
Give the most common type of tetracycline antibiotic prescribed and explain it mode of action.
A tetracycline is a type of antibiotic whose structure contains four rings. It is effective because it inhibits protein synthesis by inhibiting the binding of transfer RNA. Tetracyclines are broad-spectrum reagents that can inhibit the growth of both gram-positive as well as gram-negative bacteria as well as rickettsiae, Chlamydia, and Mycoplasma pneumoniae. The most commonly used tetracycline is doxycycline hyclate (Vibramycin IV). Side effects of Vibramycin can include skin rashes and photosensitivity so the patient should be instructed to avoid sun exposure.
Explain when erythromycins are administered. Give the most common example.
Erythromycins are a type of antibiotic effective against gram-positive organisms. Originally, erythromycin was isolated from Streptomyces erythreus. Today, erythromycin lactobionate (Erythrocin) is commonly given and indicated for treatment of staphylococci, pneumococci, or streptococci. It is usually administered at a dosage of 15 to 20 mg/ kg per day. Major side effects can be hives, phlebitis, or pain along the vein.
List some common antifungal agents and their indications.
Common antifungal drugs include the following:
· Amphotericin B (Fungizone) - given to treat fungal infections that have invaded the patient’s whole body
· Fluconazole (Diflucan) - for treatment of Candida, infections with cryptococcus, or some systemic infections
· Miconazole (Monistat IV) - specifically used to combat Candida, Cryptococcus neoformans, or Aspergillus fumigatus
A special note would be that Amphotericin B, given usually at a dose of 10 mg/ 250 mL over 4 hours by slow infusion, needs to first prepared in preservative-free sterile water followed by dilution in 5% dextrose in water and then filtered and protected from the light. CRNI Exam Secrets Test Prep Team (2011-11-22). CRNI Exam Flashcard Study System: CRNI Test Practice Questions & Review for the Certified Registered Nurse Infusion Exam (Kindle Locations 1752-1761). Mometrix Media LLC. Kindle Edition.
A few agents are currently available with antiviral properties. List some of them and their indications.
Antibiotics are not effective in treating viral infections. There are, however, a few agents with antiviral properties; their principal mode of action is to block or inhibit replication of viral DNA. All of these drugs are given intermittently. Current antiviral drugs include acyclovir sodium (Zovirax), which is used to treat herpes simplex infections; foscarnet sodium (Foscavir), which is useful to reduce the viral load in acyclovir-resistant herpes or cytomegalovirus infections; ganciclovir sodium (Cytovene, DHPG), indicated for eye infections with cytomegalovirus, herpes or Epstein-Barr virus; and zidovudine (AZT, Retrovir), which is the primarily drug used to treat patients with human immunodeficiency virus (HIV).
Explain what protozoa are and give examples of current treatment modalities.
Protozoa are unicellular, non-photosynthetic, flagellated organisms. They are parasites, meaning they have some sort of symbiotic relationship with their host, in this case the human body. Currently available antiprotozoals include metronidazole hydrochloride (Flagyl I.V.), usually utilized for severe skin, bone, or joint infections, and pentamidine isethionate (Pentam 300), and usually indicated for Pneumocystis carinii type of pneumonia. The latter is also used as an investigational drug for some other protozoal diseases such as sleeping sickness.
Explain the unique conditions under which some miscellaneous types of antibiotics might be chosen.
Chloramphenicol sodium succinate (Chloromycetin) is indicated for mild cases of bacterial infection in the blood and also for patients with Rocky Mountain spotted fever or cystic fibrosis. Vancomycin hydrochloride (Vancocin HCL Intravenous) is given to treat gram-positive cocci. Quinolones, such as levofloxacin (Levaquin) are indicated for respiratory tract infections. Co-trimoxazole (Bactrim IV Infusion) is a combination of antibiotics of the sulfonamide type, and is used to treat serious urinary tract infections.
Explain what an analgesic is and give some examples.
An analgesic is a drug that is given to alleviate pain without concurrent loss of consciousness. Each has some sort of effect on the central nervous system. Some are actually narcotics and do induce drowsiness or dizziness or blurred vision. Morphine sulfate is one of the most well-known analgesics, used to treat severe pain, but it must be used cautiously because it can cause respiratory or circulatory side effects or allergic reactions. Other analgesics include dezocine (Dalgan), nalbuphine hydrochloride (Nubain), buprenorphine hydrochloride (Buprenex Injection), hydromorphone hydrochloride (Dilaudid), meperidine (Demerol) and fentanyl citrate.
Describe intrathecal analgesia.
In intrathecal analgesia, a narcotic, is delivered directly to the spinal cord. To minimize risk, the catheter is usually inserted between the lumbar vertebrae into the cord, and the dosage and interval of administration greatly reduced relative to that of epidural procedures. Intrathecal analgesia is commonly utilized for patients with chronic pain syndrome or those undergoing simultaneous chemotherapy, antibiotic therapy or anesthesia. The same precautions required for epidural analgesia apply for intrathecal. The medication can be delivered by an implantable pump, an external pump, or a ventricular reservoir.
