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Pharm > Pharmacology Basics Part 1 > Flashcards

Pharmacology Basics Part 1 Flashcards

1
Q

Overview Nursing Responsibilities

A

Responsibility is rather vast; lot info have to know about every drug; lot nursing action need do related to med admin: how adequately give drugs, in how assess before give med, parameters monitor for med, how eval affect med, teach about med
What drug is ordered – name and classification
Why medication prescribed
Therapeutic effects on body
Adverse and/or toxic effects possible
Contraindication/special considerations
How medication is supplied by pharmacy
Correct route/dosage
Patient education
Patient monitoring and evaluation

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2
Q

Prototype drugs (like exemplars)

A

Impossible to memorize thousands of drugs and individual differences
Course addresses general drug information
Prototypes serves as a model for a pharmacologic class
Once students grasp basic concepts, information can be applied to other medications in same class

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3
Q

Course addresses general drug information (Prototype drugs (like exemplars))

A

Practicing nurses must have current knowledge of specific details for drugs administering – see drug guides (Mosby’s Nursing Drug Handbook)

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4
Q

Prototypes serves as a model for a pharmacologic class (Prototype drugs (like exemplars))

A

Drug is well understood
Has known action and adverse effects
Is used to compare other drugs in the same pharmacologic class

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5
Q

Drug names and classifications

A

Names:
Classifications:

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6
Q

Names: (Drug names and classifications)

A

See 3 diff names in handbook
Chemical: speaks to actual chemical structure of drug; not care about this; is chemical components
Generic: original name for common understanding; same affect but diff fillers/binders from brand and generic
Trade (brand) name: assigned by pharmaceutical company; familiar with and ones can say
EX:

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7
Q

Trade (brand) name: assigned by pharmaceutical company; familiar with and ones can say (Names: (Drug names and classifications)

A

Fillers/binders differ between brand and generic but they are the same in the end basically

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8
Q

Fillers/binders differ between brand and generic but they are the same in the end basically (Trade (brand) name: assigned by pharmaceutical company; familiar with and ones can say (Names: (Drug names and classifications)

A

May alter bioavailability - means active part of the drug

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9
Q

EX: (Names: (Drug names and classifications)

A

Class: histamine 2 (receptor) antagonists - class pharmacologically - telling how drug works
Class: Proton pump inhibitor - speaking terms pharmacologic action

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10
Q

Class: histamine 2 (receptor) antagonists - class pharmacologically - telling how drug works (EX: (Names: (Drug names and classifications)

A

More than just 1
dine - generic names
Ranitidine (Zantac)
Cimetidine (Tagamet)
Famotidine (Pepcid)
Nizatidine (Axid AR)
Prototype: cimetidine
Largely same thing between brand and generic but fillers/binders may differ but does not matter; same effect and same things but fillers/binders differ; each brand just made their own specialty to put on the market to make it diff and better

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11
Q

Class: Proton pump inhibitor - speaking terms pharmacologic action (EX: (Names: (Drug names and classifications)

A

Omeprazole (Prilosec)
Esomeprazole (Nexium)
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
And more….
Prototype: omeprazole

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12
Q

Classifications: (Drug names and classifications)

A

Can be classified by both
Therapeutic use:
Pharmacologic structure:
EX:

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13
Q

Therapeutic use: (Classifications: (Drug names and classifications))

A

based on usefulness in treating diseases or disorders; how treats disease
Analgesics (pain meds), antihypertensives (used treat high BP)

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14
Q

Pharmacologic structure: (Classifications: (Drug names and classifications))

A

how drug produces physiological effect at molecular/tissue level; how drug works
Calcium channel blocker - also antihypertensive (therapeutic use)

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15
Q

EX: (Classifications: (Drug names and classifications))

A

Therapeutic class: Antihypertensives
Pharmacologic class: Angiotensin converting enzyme inhibitor

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16
Q

Therapeutic class: Antihypertensives (EX: (Classifications: (Drug names and classifications)))

A

Angiotensin converting enzyme inhibitor
Beta adrenergic blocker
Vasodilators
Calcium channel blockers
And more….

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17
Q

Pharmacologic class: Angiotensin converting enzyme inhibitor (EX: (Classifications: (Drug names and classifications)))

A

Lisinopril
Captopril
Enalapril
Quinapril
Benazepril…

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18
Q

Sources of drug/med info

A

Lots diff source
Drug References - (many)
Medication Label
Package Insert

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19
Q

Drug References - (many) (Sources of drug/med info)

A

Nursing drug handbook (first as nurse) - always look at drug handbook to look it up and see what already know and can apply any past knowledge but need do research on own; see if have questions; handbooks written for what really need know as nurse - highlights
Pharmacology textbook
Food and Drug Administration website (www.fda.gov)
Pharmacist on unit - people on unit; pharmacist - do homework before; ask charge nurse because seen it and done it and can help you out; prescriber - call person who ordered make sure armed with knowledge

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20
Q

Medication Label (Sources of drug/med info)

A

Other sources of info - need be able identify imp areas of label
Labels have specific information that identifies a specific medication
Understanding how to read a label is essential!!

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21
Q

Package Insert (Sources of drug/med info)

A

Prepared by manufacturer; full prescribing information
Always lot info in those; not used often by nurse but with every drug

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22
Q

Drug label

A

Most imp parts as a nurse: start at center very center: brand name (because circle with R - registered trademark); generic name on label (lot times have trouble with it); drug dose - tells how prepared; expiration date - check before admin make sure not expired; storage information - really pertinent and special

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23
Q

Sources of meds

A

Meds from variety sources; original meds found from active chems in plants
Natural Sources
Synthetic sources

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24
Q

Natural Sources (Sources of meds)

A

Plants
Animal products
Inorganic compounds

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25
Q

Plants (Natural Sources (Sources of meds)

A

Active chemical found in a plant (ex. Digitalis)
do have some meds from plants but most synthetically

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26
Q

Animal products (Natural Sources (Sources of meds)

A

Replace human chemicals not produced because of disease or genetic issues
Genetic engineering (ex. Insulin, thyroid)
Some from animal products; insulin first discovered chemical lower BG take insulin from pigs and modified and engineered so safe for humans now most synthetically; thyroid - meds for hypo from pigs and some made synthetically

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27
Q

Inorganic compounds (Natural Sources (Sources of meds)

A

Salts of various elements (ex. Iron or fluoride)

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28
Q

Synthetic sources (Sources of meds)

A

Most drugs produced synthetically
Most meds made synthetically in lab - most effective and cheapest way

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29
Q

Drug approval and legal regulation

A

FDA
Legal regulation of drugs: Drug enforcement agency (DEA)
Schedule controlled substances
OTC drugs
Herbal and dietary supplements

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30
Q

FDA (Drug approval and legal regulation)

A

Responsible for protecting public health by ensuring safety, efficacy, and security of drugs, biological products and medical devices
Takes sig role that drugs are safe - do all reg for the creation meds, how meds studied, brought to market in US
Ensure safety of nation’s food supply, cosmetics, and products that emit radiation and more…
Drug approval process tightly controlled by FDA

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31
Q

Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Takes several years - meds go through rigorous testing process; 5-10 years for entire process
Several phases (next slide) - Phases of FDA drug approval

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32
Q

Several phases (next slide) - Phases of FDA drug approval ( Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Preclinical Investigational Studies
Phase I Studies
Phase II Studies
Phase III Studies
Phase IV Studies

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33
Q

Preclinical Investigational Studies (Several phases (next slide) - Phases of FDA drug approval ( Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Tested on laboratory animals
Have ideas; biochemists figure out how to treat disease on molecular level and test on animals to see if do what do and if any major consequences
Trying to figure out how make drug work way want to without major adverse effects

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34
Q

Phase I Studies (Several phases (next slide) - Phases of FDA drug approval ( Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Tested on healthy human volunteers (dose range and pharmacokinetics)
How drug works in humans; start looking at dose appropriate to have affect want without too many adverse effects

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35
Q

Phase II Studies (Several phases (next slide) - Phases of FDA drug approval ( Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Tested on clients with disease (therapeutic effects, adverse effects)
See How works on them

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36
Q

Phase III Studies (Several phases (next slide) - Phases of FDA drug approval ( Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Large sample size; placebo and/or blinded studies (effectiveness, safety, dose)
Submission of new drug application/approval; approved by FDA and given name; patent 5-7 years
Get drug approval from FDA and given generic and brand name by company and brought to market and drug patented for 5-7 years; patent because costs lot money to make drugs so pharmaceutical company can make money before goes generic and no competition

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37
Q

Phase IV Studies (Several phases (next slide) - Phases of FDA drug approval ( Drug approval process tightly controlled by FDA (FDA (Drug approval and legal regulation)

A

Post marketing studies (2+ years); new or severe adverse effects; black box or recall
After drug brought to market, cont monitor drug, prescribers prescribing meds to pat report if find anything that might be related to med; some meds taken off the market

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38
Q

Legal regulation of drugs: Drug enforcement agency (DEA) (Drug approval and legal regulation)

A

Controlled Substances Act of 1970
Controlled drugs divided into five DEA schedules
Physicians and dispensing pharmacists must be registered with DEA
Nurses must be familiar with regulations and standard of practice

39
Q

Controlled Substances Act of 1970 (Legal regulation of drugs: Drug enforcement agency (DEA) (Drug approval and legal regulation)

A

Responsible for regulating controlled substances; where all fed laws come in - if someone tampers with regulation of drugs get in big trouble with fed govt, go to jail, etc
Regulates manufacturing, distribution, and dispensing of drugs with known abuse potential (controlled substances)
Anyone convicted of unlawfully manufacturing, distributing, or dispensing of controlled substances faces severe penalties
Need know how handle meds as nurse; admin opioids to pats - major controlled substance admin to pats regularly regardless where work and need to protect self and admin correctly

40
Q

Controlled drugs divided into five DEA schedules (Legal regulation of drugs: Drug enforcement agency (DEA) (Drug approval and legal regulation)

A

Based on potential for abuse/physical and psychological dependence

41
Q

Nurses must be familiar with regulations and standard of practice (Legal regulation of drugs: Drug enforcement agency (DEA) (Drug approval and legal regulation)

A

Discussed in more detail in pain management

42
Q

Schedule controlled substances (Drug approval and legal regulation)

A

Schedule I
Schedule II
Schedule III
Schedule IV
Schedule V

43
Q

Schedule I (Schedule controlled substances (Drug approval and legal regulation)

A

(heroin, LSD)
Very High abuse potential and no accepted medical use
Street drugs

44
Q

Schedule II (Schedule controlled substances (Drug approval and legal regulation)

A

(narcotics/opioids, amphetamines, barbiturates)
High abuse potential with severe dependence liability - someone can become addicted to pain meds; must be carefully prescribed; must handle them correctly as a nurse

45
Q

Schedule III (Schedule controlled substances (Drug approval and legal regulation)

A

(nonamphetamines stimulates, nonbarbiturates sedatives)
Less abuse potential and dependence liability than II (moderate)

46
Q

Schedule IV (Schedule controlled substances (Drug approval and legal regulation)

A

(antianxiety agents, some sedative)
Less abuse potential and dependence liability than III (moderate)

47
Q

Schedule V (Schedule controlled substances (Drug approval and legal regulation)

A

(codeine)
Limited abuse potential - still regulated to some degree

48
Q

OTC drugs (Drug approval and legal regulation)

A

No prescription required to buy med want
Many originally approved as prescription at one time - went through process and submission/appeal to FDA that drug safe for OTC if FDA approves it can be switched to OTC; found safe used as directed
Problems with OTC use:
Nurse – always ask patient about OTC, herbs, supplement use

49
Q

Many originally approved as prescription at one time - went through process and submission/appeal to FDA that drug safe for OTC if FDA approves it can be switched to OTC; found safe used as directed (OTC drugs (Drug approval and legal regulation)

A

Ex: loratidine (Claritin); fluticasone (Flonase); ibuprofen (Advil)

50
Q

Problems with OTC use: (OTC drugs (Drug approval and legal regulation)

A

Not always and absolutely safe and lot stuff can go wrong with these
Get history from pat - ask specifically about OTC because often interact with prescription drugs; easily misdose themselves and still have to be responsible with OTC
Delay seeking treatment from healthcare provider - self-treat themself and kind of work but some went away because self treat; could also be causing other probs by self treating
Mask s/s of disease, drug-drug interactions, overdose/toxicity (acetaminophen), potential abuse (pseudoephedrine - make meth and why behind counter and only buy so much so often, Robitussin)

51
Q

Herbal and dietary supplements (Drug approval and legal regulation)

A

Grapefruit juice - can affect liver enzymes and other drugs
Anticoags (warfarin) - affects using herbs have on anticoags and can prolong bleeding time

52
Q

What activity occurs in Phase I of clinical trials?
A.Testing on laboratory animals
B.Drug released for marketing by FDA
C.Drug are tested on healthy human volunteers
D.Drug administered to clients with target disease

A

Answer: C
Rationale: definition

53
Q

Pharm and nursing process

A

Assessment:
Diagnosis:
Planning:
Implementation
Patient edu: med
Pat edu: teach points to reduce errors
Pat edu: maintaining compliance
Eval

54
Q

Assessment: (Pharm and nursing process)

A

gather info
Health History
Physical assessment

55
Q

Health History (Assessment: (Pharm and nursing process)

A

Allergies (ask reaction – true allergy vs. adverse effect) - most allergies are medication related; step do not want to skip this; gather info to understand if true allergy/adverse effect; find info so that everything is relevat; hives - allergic rxn
Past medical history
Medications (current and recent past, OTC, herbals, supplements)
Diet, alcohol, drug use
Education level (understanding on disease and therapy)
Reproductive history (Pregnancy/nursing)

56
Q

Physical assessment (Assessment: (Pharm and nursing process)

A

Baseline VS, head to toe; cognition, wt, ht, age
Lab tests and other diagnostics

57
Q

Diagnosis: (Pharm and nursing process)

A

determine the probs and issues related to meds
Most/a lot problems related to adverse effects (anything not wanted with med but comes with it), toxicities, drug-drug interactions (drugs competing or interacting with each other), medication error, ineffective self-care
Probs and issues related to meds
Examples ND related to meds:

58
Q

Examples ND related to meds: (Diagnosis: (Pharm and nursing process)

A

Fluid imbalance related to diuretic medication
Nausea related to opioid medication
Risk for falls related to sedating effects of medication
Ineffective health maintenance related to inappropriate dosing of medication

59
Q

Planning: (Pharm and nursing process)

A

goals/expected outcomes
Expected outcomes - what want client to achieve; start with client will and helps remember what want to happen
Client will maintain a blood pressure within the normal range.
Client will maintain normal gas exchange and remain free from respiratory depression.
Client will demonstrate correct administration of medication.
Client will explain 3 adverse effects of medication.

60
Q

Client will maintain a blood pressure within the normal range. (Planning: (Pharm and nursing process)

A

Addresses therapeutic effect of medication

61
Q

Client will maintain normal gas exchange and remain free from respiratory depression. (Planning: (Pharm and nursing process)

A

Addresses potential adverse effect

62
Q

Client will demonstrate correct administration of medication. (Planning: (Pharm and nursing process)

A

Demonstrates adequate teaching/learning for self-care

63
Q

Client will explain 3 adverse effects of medication. (Planning: (Pharm and nursing process)

A

Demonstrates adequate teaching/learning for self-care

64
Q

Implementation (Pharm and nursing process)

A

Actually admin med and interventions for meds in terms admin/monitoring
Administering medication
High alert medications (Box 5.1) - more sig things can go wrong if do not do things correct
Interventions:

65
Q

Administering medication (Implementation (Pharm and nursing process)

A

Right drug
Right dose
Right route
Right time
Right patient
Right documentation

66
Q

Interventions: (Implementation (Pharm and nursing process)

A

Meet expected outcomes
Interventions related to medication - administration related to medication
Educate patient

67
Q

Patient edu: med (Pharm and nursing process)

A

Part implementenation - educating pat about everything med; education about we need know
How often take it, what taking for, how work, common adverse effects, when call provider if having probs, manage adverse effects if appropriate
Name, dose, action of drug
Timing of administration
How to measure/administer home medications
Special storage and preparation instructions
Specific OTC, herbs, supplements to avoid
Special monitoring (BP checks, lab test, etc.)
Adverse effects and potentials for toxicity
Warnings about discontinuing drug abruptly
Special considerations (diet, sun exposure, etc.)

68
Q

Adverse effects and potentials for toxicity (Patient edu: med (Pharm and nursing process)

A

Comfort measure for adverse effects

69
Q

Pat edu: teach points to reduce errors (Pharm and nursing process)

A

Always keep list of meds, herbals, etc. with you - making sure educate pats keep list of all meds and herbal and OTC meds with you; so many probs arise if not know what taking and what taken today esp if have chronic illness or going to hospital often because big probs can happen and if cannot talk to us then do not have it
Know each drug and why prescribed
Read labels/follow directions
Store drugs in dry place away from children and pets
Speak up to provider about reporting use of herbals, etc.
Never share medications
Measure liquids with appropriate measuring devices
Call provider immediately if problem develops

70
Q

Pat edu: maintaining compliance (Pharm and nursing process)

A

About education is ensuring - compliance - means pat taking meds how prescribed; if not treat prob supposed to and causes lot probs - got to figure out why not compliant and can be multititude of things - not always think about implementation of what want - need think about how carried out
Client has an active role in ensuring compliance
Taking a medication in manner prescribed by health care provider
Factors related to patient deviation from compliance:
Nurse must be vigilant in verifying patients understand education about medications

71
Q

Factors related to patient deviation from compliance: (Pat edu: maintaining compliance (Pharm and nursing process)

A

Poor education on drug
Cost of drug
Forgetting doses
Annoying adverse effects
Self-adjustment of doses
Fear of dependency

72
Q

Eval (Pharm and nursing process)

A

Last step
Reassess patient
Compare status with desired outcome(s)
Overall goal is safe, effective medication administration

73
Q

Reassess patient (Eval (Pharm and nursing process)

A

See if have effect desired to and if not need change plan; need more med or do something else; reassess did drug have desired effect/have lot adverse effects that now need to address
Physical condition, I&0, VS, wt, labs (as appropriate to medication)
Therapeutic effect
Adverse effects/toxicities

74
Q

Compare status with desired outcome(s) (Eval (Pharm and nursing process)

A

If outcome met, shift to next highest priority health need
If not met, may need to revise plan and interventions

75
Q

When establishing the nursing interventions appropriate for a given client, which statement is most accurate?
A.The client is too ill to be actively involved
B.The client’s family should be included only at discharge
C.Care should only be done when the client states they are ready
D.Analysis of all the data accumulated should be incorporated to achieve an effective care plan

A

Answer: D
Analysis of all data

76
Q

The nurse is caring for a 60-year-old client hospitalized with pneumonia
Past medical history: asthma, hypertension, headaches
Medication list:
Albuterol (ProAir)
Lisinopril (Zestril)
Acetaminophen (Tylenol)
What is the indication for each medication based on the past medical history?

A

Albuterol (ProAir) - asthma
Lisinopril (Zestril) - hypertension
Acetaminophen (Tylenol) - headaches

77
Q

Pt states headaches hard to control at times and will take 2 tablets of extra strength acetaminophen (500 mg per tablet) every 4 hours for 24 hours until the headache subsides
What is the problem?

A

Risk for acetaminophen overdose and hepatotoxicity related to exceeding recommended dose.

78
Q

What is the expected outcome?

A

Client will demonstrate understanding of correct dosing of acetaminophen by stating normal dose range and maximum dose in 24 hours.

79
Q

What intervention(s) will need to be done to meet the expected outcome?

A

Patient edu

80
Q

How would you evaluate the effectiveness of the intervention?

A

Patient can correctly state appropriate dose and frequency of acetaminophen

81
Q

Med errors

A

Most common cause of morbidity and preventable death in hospitals
Preventable event!
National Coordinating Council for Medication Error Reporting and Prevention definitions:

82
Q

Most common med errors

A

Errors in patient assessment
Errors in prescribing
Errors in administration
Distracting environmental factors and stress
Nurse is the last line of defense to prevent errors! - someone orders med, pharmacists check that norm dosage range, but need due diligence because what is done is done and need stop and question before make an error that can be prevented
Quite prevalent - cause increased length of stay, deaths
Require lot thinking

83
Q

Errors in patient assessment (Most common med errors)

A

Example: Inadequate medication or medical history
Forget to ask on allergy
Improperly assess and forget to take VS

84
Q

Errors in prescribing (Most common med errors)

A

Example: Wrong drug, incorrect dose, illegible written order
Concentration can be off; lot probs with these errors - lot flaws can happen for it
Problematic if one 2 exactly same meds; careful with TO and verify what need do

85
Q

Errors in administration (Most common med errors)

A

Example: One of the “rights” of administration compromised

86
Q

Distracting environmental factors and stress (Most common med errors)

A

Example: Interruptions during preparation or administration

87
Q

Prevention of med errors

A

Proper assessment, administration, monitoring, evaluation, and documentation
Question a medication order for any reason when in doubt
Always listen if client questions the drug
Do not use medical abbreviations and acronyms
Minimize telephone orders; use “read back” order to prescriber, spell drug name
Be careful with look alike, sound alike drugs

88
Q

Reporting med errors

A

Student: notify clinical faculty or assigned nurse immediately
Nurse:
Institutions have reporting system with non-punitive approach (depending on level of error)

89
Q

Nurse: (Reporting med errors)

A

Notify primary care provider for additional orders
Monitor, intervene as prescribed/appropriate
Report (legal and ethical responsibility)

90
Q

Institutions have reporting system with non-punitive approach (depending on level of error) (Reporting med errors)

A

Improve systems and procedures; reduce future errors

91
Q

Possible consequences of med errors for nurses

A

Psychological impact
Loss of trust
Named defendants in malpractice litigation; financial implications
Administrative response:
Board of nursing

92
Q

Administrative response: (Possible consequences of med errors for nurses)

A

Continuing education or refresher
Discipline – suspension or termination of employment

93
Q

Board of nursing (Possible consequences of med errors for nurses)

A

Suspend or revoke license

Pharm (30 decks)

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