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Pharmacology > Pharmacology Test 1 > Flashcards

Pharmacology Test 1 Flashcards

0
Q

Intramuscular/ subcutaneous

A
  • barriers: capillary wall, pH has to match blood
  • unpredictable: absorption pattern
  • advantages: slowly dissolves in tissue
  • disadvantages: discomfort, cal tissue and nerve damage, bleeding risk
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1
Q

Parenteral

A
  • no Barrie to absorption, instant and complete
  • advantages: rapid onset, control, use of large fluid volume, use of irritant drugs
  • disadvantages: high cost, difficult, irreversible, fluid overload, infection, embolism
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2
Q

Enteral route (oral)

A
  • various absorption pattern
  • can be destroyed by stomach acid
  • patient age and other me can also ruin the drug effects
  • advantage: easy, convenient, inappropriate, safe
  • disadvantage: variablilty, inactivation by food and drug, patient requirement vary from person to person, local irritation
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3
Q

Additional drug routes

A
  • rectal: local or systemic (can’t swallow)
  • vaginal: local
  • direct: only dose by physician not nurse
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4
Q

Distribution

A
  • dependent upon circulation
  • act quicker in area of good blood supply (heat, brain)
  • act slower in area of low blood supply (muscle)
  • BBB: only lipid soluble, can pass through or injected
  • placenta not absolute barrier to fetus, important to look at safe drugs
  • know patients history
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5
Q

Metabolism

A
  • most takes place in liver

- P450 responsible for inactivating drugs and varies from person and ethnicity

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6
Q

Drug excretion

A
  • kidneys
  • change pH or urine to get rid of drugs
  • can change pH of urine so drug goes back into body and continues to work
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7
Q

Drug monitoring

A

All drugs can cause toxic effects but most often doesn’t expect it

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8
Q

Drug levels

A
  • monitor if drug can be lethal in overdose
  • MEC: minimum of drug amount needed to be present in order to take effect. Must be at or above MEC level
  • To be effective takes effect. Must be at or above MEC level
  • to be effective takes 4-5 half lives. If long 1/2 life then give 1 per day.
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9
Q

Half- life

A

If have 100 mg with 1/2 life of 12 hours

Time. 1/2 life. % in body
0. - 100mg (100%)
12. 1. 50 mg (50%)
24 2. 25 mg (25%)
36. 3. 12.5 (12.5%)

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10
Q

Pharmacodynamics

A
  • what drug does to body
  • receptor theory
    • any macromolecule to which a drug binds and initiates a biological response
    • site of action = interaction beween receptor and drug
    • affinity/ efficacy: between drug and receptor. Bette fit the better the drug works
  • agonist: interact with receptor and similar effect of what happens in body naturally
  • antagonist: inhibits natural body effects
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11
Q

Variables affecting drug actions

A

Drug related:
- dose, route, drug-diet interaction, drug-herb interaction, compliance
- drug-drug interaction: addictive effects (2 drug, do same like alcohol and sedative)
- synergism: combo works better than only giving one
Patient related:
- age (1-12 high metabolism)
- weight, genes, gender, pathological condition, physiologic consideration

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12
Q

Drug tolerances

A

Wen body acostoimed to drug over time so have to take a larger amount.

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13
Q

Drug dependence

A

Person needs drug to function, will experience withdrawal

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14
Q

Drug addiction

A

Impaired control over use. Compulsive use. Cause despite harm. Crave.

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15
Q

Medication route

A

Oral, NG tube, subqutaneous, IM, IV, topical, eye, nose, ears

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16
Q

aa

A

Of each

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17
Q

DS

A

Double strength

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18
Q

Elix

A

Elixir ( drug dissolved in alcohol and water)

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19
Q

Fl

A

Fluid

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20
Q

Gtt

A

Drops

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21
Q

NS

A

Normal saline

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22
Q

q.s.

A

Sufficient amount

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23
Q

ss

A

One half

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24
Q

SR

A

Sustained release

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25
Q

XL

A

Long-lasting, extended release

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26
Q

XR

A

Extended release

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27
Q

amp

A

Ampule

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28
Q

aq

A

Aquatic

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29
Q

c

A

Cup

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30
Q

Cap

A

Capsule

31
Q

EC

A

Enteric coated

32
Q

Mix

A

Mixture

33
Q

Sol/soln

A

Solution

34
Q

Supp

A

Suppository

35
Q

Susp

A

Suspension

36
Q

Syp

A

Syrup

37
Q

Tab

A

Tablet

38
Q

Tr

A

Tincture

- special mixture

39
Q

Abbreviations

A 
A = ear
D= right
S = left
U = both
O = eye
AD - right ear
AS - left ear 
AU - both ears
OD - right eye
os - mouth
OS - left eye
OU - both eyes
40
Q

Oral route

A
  • do not give if committing, lacks gag reflex or unsponsored
  • with or without food,
  • dilute, shake or stir is required
  • refrigerate as directed
  • read meniscus at lowest fluid mark
  • powder must be mixed with water completely and drank immediately
  • if less than 5 mL then must be in syringe
41
Q

Sublingual or buccal route

A
  • no food or liquid intake until medication is COMPLETELY ABSORBED
  • SL medications (nitro) can be given to unresponsive patients
  • cant swallow because stomach will inactivate it
42
Q

Transdermal route

A
  • do not cut patch
  • remove old patch before applying new patch
  • apply to specified area of the body
  • WEAR GLOvEs
  • clean, dry and hairless area
  • transdermal medicine in tube form
  • nitro - Chet and upper arm
  • nicotine - chest and upper arm
  • fentanyl - DANGeROUs - apply anywhere
43
Q

Topical route

A
  • clean sterile technique with broken skin
  • stroke firmly into skin
  • do not use giant feathery touch touch when applying
44
Q

Eye drop installation

A

Liquid

  • position, never over cornea
  • gently pull down conjunctival sac, administer drops into center of sac
  • do to touch lashes or lids with dropper
  • release skin and gently press eye with cotton ball for 1-2 minutes

Ointment

  • squeeze 1 1/2 inch into sac
  • instruct patient about blurred vision and keep eyes clod 1-2 minutes
  • avoid placing on corne
45
Q

Eardrops

A
  • make sure medication is at room temperature
  • tilt head toward unaffected side
  • adult position: up and bAck
  • child position: down and back
  • instill number of drops ordered
  • Instruct patient to keep head tilted 2-3 minutes
46
Q

Nasal

A

Sprays
- ask patient to blow nose before administration and close unaffected area, tilt head toward good side, spray medication, hold breath or open closed nostril

Drops

  • if frontal sinus infected, tilt head back
  • if ethmoid sinus position head to affected side
  • administer prescribed number of drops
  • instruct patient keep head tilted 2-3 minutes
47
Q

Inhalation route

A
  • position patient in Fowler or semi-fowler , open using bronchodilator first or steroid
  • teach patient wait two minutes between puffs
  • have patient rinse mouth with water and spit following steroid inhalation
  • breathe out through pursed lips
  • keep inhaler 1 inch away from mouth
48
Q

NG route

A
  • check position
  • remove plunger and pour medication into syringe
  • close NG tube
  • ‘attach syringe
  • open clamp, pour medication into syringe and hold tube up to allow medication free flow
  • flush within 30 minutes with water
  • close clamp, check tube placement and remove syringe
49
Q

Medication errors

A

The chain
- physician - transcriber- pharmacy - pharmacy tech - pharmacist- nurse

Most common errors

  • incomplete patient history
  • unknown allergy, current mess, previous diagnosis, lab results, miscommunication, similar drug names
50
Q

Adverse drug reactions

A

Any undesirable drug response

  • side effects: expected response based n drug action (dry mouth, constipation, drowsy)
  • toxicity: adverse reaction related to excessive dosing
  • Allergic reaction
  • idiosyncratic reaction: petticoat to person or a culture
  • latrogenic - disease by physician, rugs mimic disease
51
Q

The five rights

A 
Dose
Drug
Patient
Route
Time
Documentation ( if not documented then not done)
52
Q

Preventing errors

A
  • unit dose system
  • computerized provider order entry
  • bar coding
  • limiting use of abbreviation and decimal points
  • medication reconciliation (sheet follows them through hospital)
  • follow the rights continually
  • learn essential information about med posted
  • interpret prescribers orders accurately
  • read med labs carefully
  • minimize abbreviations to prevent errors
  • trailing zeros, failure to use zeros
  • calculate doses accurately
  • Measure dose accurately
  • use correct procedures and technique for administration use
  • listen and educate patients
  • verify identity of clients BEFoRe med administration
  • omit and delay dose indicated by client condition and document accordingly
  • be careful administering medication to children due to high error rate
53
Q

Medication order

A

Must include

  • Client full name
  • name of medication (brand, generic)
  • dose, route, frequency
  • date, time, provider signature

Prescriptions

  • amount to be dispensed
  • purpose of medication
  • duration of therapy and refill information
54
Q

Medication order transcription

A
  • typed into computer ( preferred method)
  • handwritten order sheet
  • verbal orders (signed by prescriber and countersigned by prescriber)
  • telephone orders (“”)
55
Q

Medication order interpretation

A
  • nurses must know commonly used abbreviations
    - route, dose, time of administration
    - do not use abbreviation - due to misinterpretation
  • illegible orders must be clarified before administration
56
Q

Legal responsibility

A
  • safe and accurate administration
  • recognizing and questioning orders
  • refusing to administer unsafe medication on
  • delegating in compliane with the law
  • respond to reporting and documenting
57
Q

Steps of the nursing process

A
  • assessment
  • nursing diagnosis
  • planning
  • implementation (intervention) collaboration with other disciplines (physical, occupational, doctors)
  • evaluation
58
Q

Component of client assessment in drug therapy

A
  • cant evaluate without baseline data
  • observe and interview client
  • interview caregivers and family
  • complete physical exam
    - age, weight, vital, health status, pathological conditions, related with ADL’s
  • reviewing medical records
    - pertinent lab and diagnostic test report
  • previous or current u of prescription and nonprescription medication and no therapeutic medications (alcohol, nicotine)
59
Q

Medication history questions

A
  • current medication orders
  • clients knowledge regarding current medications
  • history or allergic reaction, type and severity
  • can client swallow medication, communicate verbally
  • history of herbal and dietary supplement use
60
Q

Nursing diagnosis

A
  • analysis of data to determine actual and potential health problems
  • caution using noncompliance
61
Q

Planning

A
  • outlines specific interventions and goals
  • should be individualized
  • stated in terms of patient behavior
62
Q

Drug therapy goals

A
  • use of medications to prevent or treat disease processes and manifestations
  • stated in terms of client behavior
  • maximize beneficial effects and minimize adverse effects
    - expected benefits shouldn’t outweigh potential adverse effects, effect life quality. Individualized
63
Q

Implementation and intervention

A
  • collaborative (requires order) and independent
  • often requires intra and interprofesaional collaboration
    - doctor, radiology, physical and occupational
  • interventions related to drug therapy include
  • decreasing or preventing need of doing therapy
  • using nonpharmacological enhance therapeutic effects and or decrease adverse effects
  • individual care
  • administering drugs
  • observing responses
  • well planned patient education
64
Q

Drug selection and dosage

  • factors in choosing medication and dose range
A
  • minimize medication number and administration frequeny increases client compliance
  • fixed dose combination medication contribute to increased client compliance
  • lowest effective dosage of least potent to decrease adverse reaction
  • recommend dosage likely to be effective for most people guideline
  • medication can be started rapid or slowly
65
Q

General non-drug intervention

A
  • promoting health
  • preventing/decreasing need for drug therapy
  • using no drug measures to enhance therapeutic effects or decrease adverse effects
  • client teaching
  • individualized care
  • observing client response
66
Q

Specific examples of non drug interventions

A
  • promoting healthy lifestyles regarding nutrition, fluid, exercise, rest and sleep
  • consciously performing hand hygiene and infection prevention
  • ambulatory, positioning and exercise
  • assisting to cough and deep breathe
  • applying heat and cold
  • scheduling activities to promote rest or sleep
67
Q

Evaluation

A
  • evaluating status in relation to goals and objectives
  • utilize same technique as assessment
  • progess includes
    - symptom relief
    - accurate administration
    - avoidance of preventable adverse effects
    - compliance with instruction for follow-up care
68
Q

Patient education

A
  • drug name
  • dosage
  • dosage schedule
  • route/ technique of administration
  • expected therapeutic response when it should develop
  • non drug measures to enhance therapeutic response
  • duration of treatment
  • method of storage
  • symptoms of adverse effects
  • drug-drug, drug-food interaction
69
Q

Herbal and dietary supplement

A
  • reasons
    • available without prescription
    • cheaper
    • sense of empowerment
    • frustration with health care provider
    • distrust of convention medicine
    • aggressive marketing
  • regulated by DSHEA instead of FDA
  • must have labeling constrictions
  • concerns
    • questionable safety due to unknown human effect
    • supplement use may keep client from seeking medical care
    • supplements may interact with prescription medications to decrease therapeutic effects
    • use of supplement not communicating to healthcare provider
70
Q

Major considerations for special population

A

Children

  • physiological difference after pharmacokinetics
  • all drug must be guided by age, weight, growth and development
  • safe dose less defined

Pregnancy

  • Ifnteratagenic harmful to fetus and cause abortion and defects
  • fetus increases risk in one and lat trimester

Pregnancy drug categories

  • A: no fetal risk
  • B : no risk to animal fetus but no human information
  • C: adverse animal effects but no human information
  • D: possible risk to fetus reported
  • X: absolute positive risk to fetus evidence

Children

  • increase absorption of topical drug
  • increase distribution into CNS
  • decrease volume of distribution does not include need for larger dose
  • decrease in protein binding results in more active drug
  • decrease in glomerular filtration rate
  • decrease drug bio transformation for drugs
  • decrease IM absorption due to decrease blood flow to muscle
71
Q

Geriatric Client

A
  • lower GI absorption
  • altered drug distribution due to
    • inreased body fat
    • decreased lean body mass, body water, concentration of serum albumin
  • decline in hepatic metabolism
  • decline in renal function
  • common side effects
    - constipation, malabsorption, hepatoxicity, diarrhea
  • problems
    - antibiotics, NSAIDS, hyperglycemia, anticoagulant, glucosteriod
  • drug accumulation, poly pharmacy, multiple pathologies, inadequate supervision, poor adherence
  • difficult to determine if symptoms are effects of aging or adverse reactions
  • no drug interventions to decrease med
  • OTc taken only when necessary
  • review me list with them
  • accommodate memory change
72
Q

Clients with renal impairment

A
  • drugs used carefully due to high risk of accumulation and adverse effects
  • require adequate fluid intake to excrete drug
  • may respond to drug dose/ concentration differently
  • monitor serum creatine closely
    • monitor kidneys usually 0.7-1.3 men, 0.6-1.11 women
73
Q

Clients with hepatic impairment

A
  • can effect drug metabolism and elimination
  • liver function test
    - increase: serum bilirubin, prothrombin time, serum alanine, serum aspartame
    - decrease: serum albumin
  • common hepatoxic drugs
  • drugs that decrease hepatic blood flow
  • drugs that inhibit hepatic metabolism
74
Q

Clients with critical illness

A
  • at risk for multiple organ dysfunction
  • drug therapy more complex, problematic
  • receive aggressive treatment
  • route of administration (IV)
  • dosage requirements may vary
75
Q

Home care clients

A
  • teach drug administration and drug monitoring
  • communication methods established
    - assess client attitude toward medication and self-care
  • assess safety of environment
  • use return demonstration to assess abilities
  • interview client/ caregiver about
    - medication compliance, efficacy
    - OTC drug use: herbs and supplements
    - ability to obtain medication
    - keeping appointments

Pharmacology (4 decks)

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