Pharmacology Exam 1 Part 1 Flashcards
What is the Nursing Process & Medication Administration?
The Nursing Process & Medication Administration involves Assessment, Diagnosis, Planning, Implementation, and Evaluation.
Assessment: Collect data on patient’s health status, history of allergies, medications, and baseline vitals. Diagnosis: Identify patient needs or risks related to medication (e.g., pain, fluid imbalance). Planning: Plan medication administration, considering timing, route, and dosage. Implementation: Administer medications safely, considering the 6 rights of medication administration. Evaluation: Assess patient response to medication, adverse effects, and the need for adjustments.
The difference between medical and nursing diagnosis?
Medical diagnosis- focuses on a patient’s disease or illness
Nursing diagnosis- focuses on a patient’s response to health issues
Pharmacokinetics
The study of what happens to a drug from the time it is put into the body until a parent drug and all metabolites have left the body. How does the drug move and distribute throughout the body?
Phases of Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Absorption
Movement of a drug from its site of administration into the bloodstream for distribution of the tissues. Factors: route, drug form, food, pH levels.
Bioavailability
the fraction absorbed into the systemic circulation
First Pass Effect
The process by which the liver metabolizes a drug before it reaches systemic circulation, reducing its effectiveness. This primarily affects oral medications.
Absorption Rates by Route
PO (oral): Slow absorption due to the digestive process.
IV (intravenous): Fastest absorption, directly into the bloodstream.
SQ (subcutaneous): Moderate, slower than IV, absorbed into the bloodstream through the skin.
IM (intramuscular): Faster than SQ due to better blood supply in muscles.
Routes of Administration:
Enteral- drug is absorbed from the oral or gastric mucosa of the small intestine and transported to the liver where it is metabolized by hepatic enzymes, then passed into the general circulation.
Oral
Sublingual
Buccal- cheek
Rectal- can also be topical
Parenteral Route:
Fastest route a drug can be absorbed
Intravenous(IV)
Subcutaneous(SQ, SubQ)
Intraarterial
Intrathecal(spinal fluid)
Intramuscular(IM)
Intradermal(TB skin test)
Intraarcticular(joint injection) - steroid mixed to reduce inflammation
Parenteral Route:
Fastest route a drug can be absorbed
Intravenous(IV)
Subcutaneous(SQ, SubQ)
Intraarterial
Intrathecal(spinal fluid)
Intramuscular(IM)
Intradermal(TB skin test)
Intraarcticular(joint injection) - steroid mixed to reduce inflammation
Topical Route
Application of drugs to various body surfaces. Several different delivery systems:
- Ointments, creams, gels, drops and suspensions, sprays, rings, suppositories(helps with hemorrhoids and with using th bathroom), patches, inhaled.
to reduce inflammation
What can affect protein binding?
Amount of Albumin in blood
- Decreased amount due? Malnutrition
- Competition of drugs for protein binging sites. The ones that has the bigger buck wins the competition.
- The winner has less free drug, the loser has more free drug. Causes a drug-drug interaction. So, one drug increases or decreases the actions of another drug
Distribution
How the drug is transported to target tissues. Factors: blood flow, protein binding.
Volume of Distribution Principle
Used to describe various areas in which drugs may be distributed-i.e. Body water, body fat, body tissues, and organs(also called compartments).
Hydrophilic
water soluble-smaller = smaller volume of distribution which leads to high blood concentration
Lipophilic
fat-soluble = larger volume of distribution and low blood concentration
The blood-brain barrier(bbb)
a protective mechanism. Hard to distribute a drug to the brain. Need to formulate the medication in such a way as it can pass through the BBB.
Metabolism
The breakdown of drugs, mainly in the liver. Also reffered to as biotransformation, involves the biochemical alteration of a drug into: an active metabolite, a more soluble compound, a more patent active metabolite, or a less active metabolite. Factors: liver function, age, genetics.
What does the liver do in metabolism?
The liver is the major player of metabolism. Involves enzymes which control a variety of reactions that aide in the metabolism of medications. The P-450s!!
Why is it important? Some drugs increase or decrease the activity of these enzymes which results in higher or lower levels of drugs anticipated.
Excretion
Removal of drugs from the body, All drugs, whether parent compounds, active or inactive metabolites, eventually have to go!!
Main ways drugs leave the body
Kidneys- glomerular filtration, active tubular reabsorption, active tubular secretion.
Liver and bowel- Biliary excretion, drugs taken up by the liver, released into the bile, and eliminated in feces. Factors: renal function.
Half-Life
Definition: The time it takes for the concentration of a drug to reduce by half in the body. Drugs with long half-lives stay in the system longer and require less frequent dosing.
Steady state
refers to the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose. Drugs with longer half lives may take longer to reach steady state.
Drug effects: Descriptors
Onset of action- time required for the drug to elicit a therapeutic response
Peak effect- the time required for a drug to reach its maximum therapeutic response
Duration of action- the length of time that the drug concentration is sufficient to elicit a therapeutic response.
Drug Formulation & Absorption
Liquids vs. Tablets: Liquids absorb faster than tablets because they don’t need to be broken down. Coated tablets or extended-release forms may delay absorption.
Peak & Trough Levels
Peak: The highest concentration of a drug in the bloodstream. Nurse’s role: draw blood at the right time. -
Trough: The lowest concentration before the next dose. Nurse’s role: draw blood just before the next dose. Usually 1 hour before.
What happens if the peak level is too high?
Then a drug toxicity may occur
What happens if the trough level is too low?
Then the drug may not be at therapeutic level to produce a response
Pharmacodynamics
The study of what the drug does to the body
Therapeutic effect
Mechanism of action
- Drug receptor relationships(drug may have higher affinity)
- Enzymes
- Nonselective interactions
Goal is a therapeutic effect where the drug causes a positive change in a faulty physiologic system.
Mechanism of action
The effects of a drug on the action or function of the cell tissue. Can increase or decrease the rate of cell function; or strengthen cell function
Contraindications
Medication that may be dangerous for the patient
Acute and maintenance
Acute: Short term
Maintenance: long term
Supplemental
Vitamins
Palliative
Terminal end-stage disease
Supportive
Drugs absorbed within the body
Prophylactic
Before surgery
Empiric
To cancel out a lot of organisms
What are you monitoring when giving medication?
- Expected therapeutic effect (BP come down with BP meds)
-Toxic effects (low blood count after chemotherapy)
- Patient’s condition
- Drug interactions: additive effects, synergistic effects, antagonistic effects, incompatibility
- Adverse drug reactions: allergy, SE
- Medication error
Additive effects
When two similar drugs are taken together to achieve the same degree of therapeutic effect.
Synergistic effects
When two or more drugs are combined the effect is greater than the sum of the effects seen when each drug is given alone
Antagonistic effects
When the combined effects of two or more chemicals and substances is less than the sum of their individual effects
Incompatibility
When two or more drugs are mixed together and their structure or stability is altered, making the solution unsafe or no longer optimal for the patient.
Other monitoring issues
Teratogenic, mutagenic, and carcinogenic effects
Teratogenic effects
Cross placenta and cause harm to fetus (Accutane DES). Drugs graded for safety in pregnancy.
Mutagenic effects
Permanent change in the genetic composition or chromosome structure (radiation, viruses, chemicals)
Carcinogenic effects
Cancer-causing effects
U.S. Drug Legislation
Harrison Narcotic Act 1914-legal team narcotic
Durham-Humphrey amendment 1951- legend dugs, or Rx drug labels
Controlled Sub. Act 1070- schedules
HIPPA 1996-PHI
Medicare Prescription Drug improvement and Modernization act 2003- Medicare part D
FDA: Food and Drug Administration
- Primary purpose is to protect patients and ensure drug effectiveness.
- Approval process of new drugs
- preclinical testing
- clinical studies: involve informed consent
- Phases I-IV
- Investigational drug studies
- Expedited drug approval
U.S Drug Recall
This is a bad side effects!!
- class I: most serious type of recall:thalidomide
- Class II: less severe may result in temporary or medically reversible health effects (Vioxx)
- Class III: use of drug not likely to result in any significant health problems, Contaminated precessing.
Black Box Warning
A strict warning that indicates a serious adverse effect has been reported. can still be prescribed. I.E. SSRI in teens, tendon rupture with quinolones in elderly.
Controlled Substance Categories
Schedule I: No medical use, high abuse potential (e.g., heroin).
Schedule II: High abuse potential, some medical use (e.g., morphine).
Schedule III-V: Decreasing potential for abuse.
C-I: only with approved protocol
C-II: written Rx only, no electronic Rx, no refills, 30 day supply. (Hydrocodone, morphine, Ritalin)
C-III: written or verbal Rx. No more than 6 months. Codeine mixed with Tylenol
C-IV: written or verbal Rx (Benzos, phenobarbital)
CV: written or OTC, usually cough meds. Or diarrhea meds. In some states pseudoephedrine
Pregnancy Drug Safety Categories
Category A: Safe in human studies. No risk to human fetus.
Category B: Safe in animal studies, no human studies.
Category C: Risk cannot be ruled out. Adverse effects reported in the animal fetus; information for humans not available.
Category D: Evidence of possible risk to the fetus has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women.
Category X: Contraindicated in pregnancy. Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs may not be used in pregnant women
Drug therapy during pregnancy
Drugs cross the placenta be diffusion
Factors affecting safety:
- drug properties
- fetal gestational age
- maternal factors
Drug therapy during breastfeeding
Breastfed infants are at risk for exposure to drugs consumed by the mother
Polypharmacy
Definition: The concurrent use of multiple medications by a patient, often common in the elderly.
Rights of Medication Administration
Right patient
Right drug
Right dose
Right route
Right time
Right documentation
Right reason
Right Assessment data
Right response
Right education
Right to refuse
Complete Medication Order
Patient name, date, medication name, dose, route, time/frequency, provider’s signature.
Patient Education Considerations
Consider age, education level, disabilities, language, cognitive function, and cultural factors.
OTC Medication Precautions
Can interact with prescribed medications, may have hidden ingredients, and patients often overlook dosage instructions.
