test 1 Flashcards
supp
Suppository
gtt
drops
AM
before noon
cap
capsule
hs
at bedtime (hour of sleep)
OD
right eye (oeil droit)
PM
afternoon
tid
three times daily
qod
every other day
q
every
q2h
every 2 hours
ss
half
d/c
discontinue
stat
immediately
Ac
before meals
bid
twice daily
g, gm
gram
IM
intermuscular
OS
left eye
PO
by mouth
Qid
four times a day
qd
every day
SC,SQ
subcutaneous
tsp
teaspoon
susp
suspended
tinct
tincture
Aq
aqueous
IU
international units
ad lib
as desired
AAT
activity as tolerated
IVPB
iv piggyback
c
with
h, hr
hour
IV
intravenous
pc
after meals (post cibum)
prn
as needed (pro re nata)
qh
every hour
qs
as much as suffices
SL
sublingual
tbsp
tablespoon
NS
normal saline
cf
with food
The name that describes the chemical composition and molecular structure of a drug.
chemical name
The name given to a drug approved by Health Canada; also called the nonproprietary name or the official name (EG. ACETAMINPHEN)
generic name
indicates that the drug has a registered trademark and that its commercial use is restricted to the owner of the patent for the drug until the patent expires. (EG. TYLENOL)
trade name
a drug that is sold without a prescription
Over the counter drugs (OTC)
The letter N is printed on the label of all _____________ agents
narcotic
The rate of drug distribution among body compartments after a drug has entered the body, includes 4 stages
Pharmacokinetics
The study of the biochemical and physiological interactions of drugs at their sites of activity.
Pharmacodynamics
interaction where a drug binds to proteins in the body
Protein binding
soluable in lipids
Lipid solubility
the series of chemical alterations of a compound (e.g., a drug) occurring within the body, as by enzymatic activity
Biotransformation
A molecular structure within or on the outer surface of cells to which specific substances (e.g., drug molecules) bind.
Receptors
the time required after administration of a drug for a response to be observed; the length of time needed for a medicine to become effective
Onset of action
The time period when the effect of something is at optimal strength
Peak of action
The length of time that a particular drug is effective
Duration of action
A drug that binds to and stimulates the activity of one or more biochemical receptor types in the body
Agonists
A drug that binds to and inhibits the activity of one or more biochemical receptor types in the body, resulting in inhibitory drug effects; also called inhibitors
Antagonists
The ratio between the toxic dose and the therapeutic dose of a drug, used as a measure of the relative safety of the drug for a particular treatment
Therapeutic Index
The maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring
Peak drug level
The lowest concentration of a drug reached in the body after it falls from the peak level, usually measured in a blood sample for therapeutic drug monitoring.
Trough level
The condition of producing adverse bodily effects because of poisonous qualities
Toxicity
a large initial dose of a substance or series of such doses given to rapidly achieve a therapeutic concentration in the body
Loading dose
a symptom or particular circumstance that indicates the advisability or necessity of a specific medical treatment or procedure
Indications
Any condition, especially one related to a disease state or other patient characteristic, including current or recent drug therapy, that renders a particular form of treatment improper or undesirable
Contraindications
the means by which a drug exerts a desired effect. Drugs are usually classified by their actions; for example, a vasodilator, prescribed to decrease the blood pressure, acts by dilating the blood vessels
Desired action
A peripheral or secondary effect, especially an undesirable secondary effect of a drug or therapy
Side effects
Any undesirable bodily effects that are a direct response to one or more drugs
Adverse effects
An immunological hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of ADE.
Allergic reactions
The fraction of drug in serum that is not bound to a carrier protein or other molecule, which generally is pharmacologically active
Unbound drugs
In pharmacokinetics, the time required for one half of an administered dose of drug to be eliminated by the body
Half life
Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the sum of the individual effects of the same drugs given alone
Additive effect
Alteration of the pharmacological activity of a given drug caused by the presence of one or more additional drugs
Drug interactions
the effect produced when some drugs and certain foods or beverages are taken at the same time. For example, grapefruit juice blocks the metabolism of some drugs in the GI tract, an action that can cause normal dosages of a drug to reach toxic levels in the plasma
Food drug interactions
refers to anything involving the alimentary tract, from the mouth to the rectum.
Enteral route
4 enteral routes of administration:
oral,
sublinqual,
buccal,
rectal.
- Located outside the alimentary canal; 2. Taken into the body or administered in a manner other than through the digestive tract, as by intravenous or intramuscular injection.
Parenteral route
a path of entry via the skin
Percutaneous route
Any chemical that affects the physiological processes of a living organism
Drug
Broadest term for the study or science of drugs.
Pharmacology
The science of preparing and dispensing drugs, including dosage form design (e.g., tablets, capsules, injections, patches, etc.).
Pharmaceutics
Pharmacokinetics is the study of what the body does to the drug including the following 4 processes:
Absorption
Distribution
Metabolism
Excretion
A measure of the extent of drug absorption for a given drug and route (can vary from 0% to 100%).
bioavailability
Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone
Synergistic effects
The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches the systemic circulation through the bloodstream.
first-pass effect
An abnormal and unexpected response to a drug, other than an allergic reaction, that is peculiar to an individual patient
Idiosyncratic reaction
The time required for a drug to elicit a therapeutic response after dosing.
onset of action
The chemical form of a drug that is administered before it is metabolized by the body’s biochemical reactions into its active or inactive metabolites
parent drug
Pain that is sudden in onset, usually subsides when treated, and typically occurs over less than a 6-week period
acute pain
Strong psychological or physical dependence on a drug or other psychoactive substance, usually resulting from habitual use, that is beyond normal voluntary control
addiction
A substance that binds to a receptor and causes a partial response that is not as strong as that caused by an agonist (also known as a partial agonist).
Agonist–antagonist
A phenomenon that occurs when a given pain drug no longer effectively controls a patient’s pain despite the administration of the highest safe dosages.
analgesic ceiling effect
Medications that relieve pain without causing loss of consciousness (sometimes referred to as painkillers).
analgesics
Pain that lingers despite doses of a long-acting dosage form for every 12 hours.
breakthrough pain
A common and well-described theory of pain transmission and pain relief. It uses a gate model to explain how impulses from damaged tissues are sensed in the brain
gate theory
Pain that results from a disturbance of function or pathological change in a nerve
neuropathic pain
Pain that arises from mechanical, chemical, or thermal irritation of peripheral sensory nerves (e.g., after surgery or trauma or associated with degenerative processes)
nociceptive pain
A large, chemically diverse group of drugs that are analgesics and possess anti-inflammatory and antipyretic activity but are not steroids.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
A natural narcotic drug containing or derived from opium that binds to opiate receptors in the brain to relieve pain
opiate analgesic
A synthetic narcotic drug that binds to opiate receptors in the brain to relieve pain
Opioid analgesic
Describes patients who are receiving opioid analgesics for the first time and who therefore are not accustomed to their effects
opioid naive
A normal physiological condition that results from long-term opioid use, in which larger doses of opioids are required to maintain the same level of analgesia and in which abrupt discontinuation of the drug results in withdrawal symptoms (same as physical dependence)
opioid tolerance
The signs and symptoms associated with abstinence from or withdrawal of an opioid analgesic when the body has become physically dependent on the substance.
opioid withdrawal
An unpleasant sensory and emotional experience associated with actual or potential tissue damage
pain
The level of stimulus that results in the perception of pain
pain threshold
The amount of pain an individual can endure without its interfering with normal function.
pain tolerance
A drug that binds to a receptor and causes an activation response and that is less than that caused by a full agonist.
partial agonist
Typically it is pain that lasts longer than 3 months.
persistant pain
Pain experienced in a body part that has been surgically or traumatically removed.
phantom pain
The physical adaptation of the body to an addictive substance; it is usually indicated by tolerance to the effects of the substance and withdrawal symptoms that develop when use of the substance is terminated.
physical dependence
Pain that is of psychological origin in nature but is actual pain in the sense that pain impulses travel through nerve cells
psychogenic pain
A pattern of compulsive use of any addictive substance that is characterized by a continuous craving for the substance and the need to use it for effects other than pain relief (also called addiction).
psychological dependence
Pain occurring in an area away from the organ of origin
referred pain
Pain that originates from skeletal muscles, ligaments, or joints
somatic pain
Pain that originates from the skin or mucous membranes
superficial pain
Pain that results from pathology of the vascular or perivascular tissues.
vascular pain
Pain that originates from organs or smooth muscles.
visceral pain
Drugs used in combination with anaesthetic drugs to control the adverse effects of anaesthetics or to help maintain the anaesthetic state in the patient
adjunctive anaesthetic drugs
Loss of the ability to feel pain, resulting from the administration of an anaesthetic drug or other medical intervention
anaesthesia
Drugs that depress the central nervous system (CNS) to produce diminution of consciousness, loss of responsiveness to sensory stimulation, or muscle relaxation
anaesthetics
The practice of using combinations of drugs rather than a single drug to produce anaesthesia. A common combination is a mixture of a sedative–hypnotic, an antianxiety drug, an analgesic, an antiemetic, and an anticholinergic.
balanced anaesthesia
drug-induced state in which the CNS is altered to produce varying degrees of pain relief thoughout the body as well as depression of consciousness, skeletal muscle relaxation, and diminished or absent reflexes
general anaesthesia
A drug that induces a state of anaesthesia. Its effects are global in that it involves the whole body, with loss of consciousness being one of those effects
General Anaesthetic
Drugs that render a specific portion of the body insensitive to pain at the level of the peripheral nervous system, normally without affecting consciousness; also called regional anaesthetics.
local anaesthetic
A genetically linked major adverse reaction to general anaesthesia, characterized by a rapid rise in body temperature, as well as tachycardia, tachypnea, and sweating.
Malignant hyperthermia
A form of anaesthesia induced by combinations of parenteral benzodiazepines and an opiate; also called conscious sedation
moderate sedation
A theory that describes the relationship between the lipid solubility of anaesthetic drugs and their potency
Overton-Meyer theory
Any anaesthetic drugs that can be administered by injection via any route (e.g., intravenously, spinally/epidurally) as a local nerve block.
parenteral anaesthetics
A class of local anaesthetics consisting of solutions, ointments, gels, creams, powders, ophthalmic drops, and suppositories that are applied directly to the skin and mucous membranes.
topical anaesthetics
Nurses are entrusted with _____________ information and with the lives of their patients during all facets of patient care, including drug therapy
confidential
Safe, therapeutic, and effective _____________ _______________ is a major responsibility of professional nurses in the care of patients of all ages and in a wide variety of facilities.
medication administration
Nurses need to document in clear, concise ___________ and avoid the use of abbreviations.
language
An 86-year-old patient is being discharged home on digitalis therapy and has little information regarding the medication. Which of the following statements best reflects a realistic goal or outcome of patient teaching activities?
a. The patient will call the physician if adverse effects occur.
b. The patient will state all the symptoms of digitalis toxicity.
c. The nurse will provide teaching about the drug’s adverse effects.
d. The patient and patient’s daughter will state the correct dosing and administration of the drug.
a
What is the most appropriate response to a patient who informs the nurse that she does not want to share information about the drugs she takes at home?
a. “We’re just asking to make sure that you do not have any drug allergies.”
b. “It sounds like something you are taking is something that you do not want us to know about.”
c. “This information will not become part of your medical record, but we need to know so that we can monitor your responses to therapy while you are here.”
d. “Information about the drugs that you take at home, including any natural health products, is important for safe administration of drugs while you are here and will be kept confidential.”
d. “Information about the drugs that you take at home, including any natural health products, is important for safe administration of drugs while you are here and will be kept confidential.”
A patient’s chart includes an order that reads as follows: Lanoxin 0.025 mcg once daily at 0900. Which of the following statements regarding the dosage route for this drug is correct?
a. The drug should only be given orally.
b. The drug should be given intravenously.
c. The drug should be given via the transdermal route.
d. The dosage route should never be assumed when an order does not specify a route.
d. The dosage route should never be assumed when an order does not specify a route.
Which of the following questions is most effective in compiling a drug history for a patient?
a. “What childhood diseases did you have?”
b. “Do you have a family history of heart disease?”
c. “Do you depend on sleeping pills to get to sleep?”
d. “When you take your pain medicine, does it relieve the pain?”
d. “When you take your pain medicine, does it relieve the pain?”
A 77-year-old male who has been diagnosed with an upper respiratory infection tells the nurse that he is allergic to penicillin. Which of the following would be the nurse’s most appropriate response?
a. “That is to be expected—lots of people are allergic to penicillin.”
b. “What type of reaction did you have when you took penicillin?”
c. “This allergy is not of major concern because the drug is given so commonly.”
d. “Drug allergies don’t usually occur in older individuals because they have built up resistance.”
b. “What type of reaction did you have when you took penicillin?”
What are the 4 crucial responsibilities of the nurse when implementing drug therapy?
- Nurses must assess patients before giving any medication and must then:
- observe each individual’s response to the drug therapy;
- determine any other actions to be implemented; and
- continue to assess, teach, and work collaboratively with pharmacists and diligently with the patient to enhance adherence at home.
When medications were administered during the night shift, a patient refused to take his 0200 dose of an antibiotic, claiming that he had just taken it. What actions by the nurse would ensure sound decision making and maintain patient safety?
- the nurse should always be prudent—stop, recheck the doctor’s order against the medication administration record or profile, and check the dispensing system or medication record or profile to determine whether a dose was given and signed off by another nurse.
- If all records and orders have been checked, and the nurse is certain that the drug has not been given, the nurse should then proceed with medication administration. A simple explanation could then be given to the patient. If the patient continues to refuse the medication, this should be documented in the nurses’ notes and reported to the appropriate individual.
During a busy shift, you note that the chart of your newly admitted patient has few orders for medications and diagnostic tests, taken by telephone by another nurse. You were on the way to the patient’s room to do your assessment when the unit secretary tells you that one of the orders reads as follows: “Lasix, 20 mg, stat.” What should you do first? How do you go about giving this drug? Explain.
Because this is a newly admitted patient, the nurse should first perform an assessment before giving any medications. However, because the order is “stat” (meaning “give immediately”), this assessment has to be a brief, focused assessment. Assess the patient’s vital signs (blood pressure, pulse, respirations, temperature) and level of consciousness. Check for signs of fluid retention (pedal edema), ask about urine output and function, and listen to breath and heart sounds. Also, assess for drug allergies and other drug reactions. However, this stat order is missing something—the route. Never assume the route via which a medication is to be given. Even though this patient was just admitted and may or may not have an intravenous line, it is important to clarify the route by which this drug should be given. The order was a telephone order taken by another nurse, so you can ask that nurse whether a route was specified when she spoke to the physician. If not, the physician must be contacted right away for clarification. To streamline the process, the order can be checked by another nurse while you are performing the assessment.
True or false?
The nurse’s role in drug therapy and the nursing process as it relates to pharmacological treatment is more than just memorizing the names of drugs, their uses, and associated interventions.
True.
It involves a thorough comprehension of all aspects of pharmaceutics, pharmacokinetics, and pharmacodynamics and the sound application of this drug knowledge to a variety of clinical situations.
Drug actions are related to the _____________, ________________, _______________, and ______________ properties of a given medication, and each of these has a specific influence on the overall effects produced by the drug in a patient.
pharmacological
pharmaceutical
pharmacokinetic
pharmacodynamic
Selection of the ____________ of administration is based on patient variables and the specific characteristics of a drug.
route
An older adult woman took a prescription medicine to help her to sleep; however, she felt restless all night and did not sleep at all. Which term below best describes this patient’s response to the drug?
a. Allergic reaction
b. Mutagenic effect
c. Synergistic effect
d. Idiosyncratic reaction
d. Idiosyncratic reaction
In which phase of pharmacokinetics may patients with cirrhosis or hepatitis have abnormalities?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
c. Metabolism
A patient who has advanced cancer is receiving opioid medications around the clock to “keep him comfortable” as he nears the end of his life. Which term best describes this type of therapy?
a. Palliative therapy
b. Maintenance therapy
c. Supportive therapy
d. Supplemental therapy
a. Palliative therapy
The nurse is giving medications to a patient in cardiogenic shock. The intravenous route is chosen instead of the intramuscular route. Which patient factor most influences this decision?
a. Altered biliary function
b. Diminished circulation
c. Reduced liver metabolism
d. Increased glomerular filtration
b. Diminished circulation
A patient has just received a prescription for an enteric-coated stool softener. Which of the following statements is most important to include when teaching the patient?
a. “Take the tablet with 60 to 90 mL of orange juice.”
b. “Be sure to swallow the tablet whole without chewing it.”
c. “Avoid taking all other medications with any enteric-coated tablet.”
d. “Crush the tablet before swallowing if you have problems with swallowing.”
b. “Be sure to swallow the tablet whole without chewing it.”
Mr. L. is admitted to the trauma unit with multisystem injuries as a result of an automobile accident. He arrived at the unit with multiple abnormal findings including shock, decreased cardiac output, and urinary output of less than 30 mL/hr. Which route of administration would be indicated for any medications for this patient? Explain your reasoning.
Intravenous therapy would be most appropriate because it allows immediate access of the drug to the bloodstream. With intramuscular (IM) or subcutaneous (SC) injectable forms of medications, absorption of the drug from the vascular area within a muscle or within subcutaneous tissues is required before absorption into the bloodstream. With clients who are in shock or who have decreased cardiac output or decreased peripheral circulation, these forms would not be so well absorbed. Last, oral forms may not be appropriate because of the longer absorption time via the gastrointestinal tract, and the patient may not be conscious enough to take oral drugs owing to his critical condition.
Explain the difference between a medication’s action and its effect.
A drug’s mechanism of action is the way in which it can produce therapeutic responses. The effects of a drug depend on the cells or tissues targeted by that drug. The drug has to go through its mechanism of action prior to having an effect.
which phase of pharmacokinetics?
the drug gets into the systemic circulation once the dosage form is administered
absorption
which phase of pharmacokinetics?
the drug is distributed or transported to the site of action
distribution
which phase of pharmacokinetics?
the drug is biotransformed into an inactive metabolite, a more soluble compound, or a more potent metabolite
metabolism
which phase of pharmacokinetics?
the drug is eliminated from the body
excretion
Pain is individual and involves __________ and ___________. It is ___________ by age, ethnoculture, race, spirituality, and all other aspects of the person.
senses
emotions
influenced
Pain is associated with actual or potential ___________ ___________ and may be exacerbated or alleviated depending on the __________ and ___________ of pain.
tissue damage
treatment
type
2 types of analgesics
- nonopioids
2. opioids
___________ include acetaminophen and aspirin and other NSAIDs
Nonopioids
natural or synthetic drugs that either contain or are derived from morphine (opiates) or have opiate-like effects or activities (opioids)
Opioids
___________ dosages of morphine should be calculated cautiously with close attention to the dose and kilograms of body weight.
Child
The __________ ____________ generally tolerates morphine well but seem less tolerant of other opioids such as meperidine.
older adult
In treating the __________ ____________, the nurse should remember that these patients experience pain the same as the general population does, but they may be reluctant to report pain
older adult
____________ __________ metabolize opiates at a slower rate and thus are at increased risk for adverse effects such as sedation and respiratory depression.
older adults
When treating severe pain associated with pathological spinal fractures related to metastatic bone cancer, which type of pain medication dosage schedule should be used for best results?
a. As needed
b. Round the clock
c. On schedule during waking hours only
d. Round the clock, with additional doses as needed for breakthrough pain
d. Round the clock, with additional doses as needed for breakthrough pain
A patient is receiving an opioid via a PCA pump as part of his postoperative pain management program. During rounds, the nurse notices that his respirations are 8 breaths/min and he is extremely lethargic. After stopping the opioid infusion, what should the nurse do next?
a. Notify the charge nurse
b. Administer oxygen
c. Administer an opiate antagonist per standing orders
d. Perform a thorough assessment, including mental status examination
c. Administer an opiate antagonist per standing orders
Which of the following is a benefit of using transdermal fentanyl patches in the management of bone pain from metastatic cancer?
a. More analgesia for longer time periods
b. Less constipation and minimal dry mouth
c. Greater CNS stimulation than with oral narcotics
d. Lower dependency potential and no major adverse effects
a. More analgesia for longer time periods
The nurse suspects that a patient is showing signs of respiratory depression. Which of the following drugs could be the cause of this complication?
a. naloxone
b. hydromorphone (Dilaudid)
c. acetaminophen (Tylenol)
d. naltrexone (ReVia)
b. hydromorphone (Dilaudid)
Several patients have standard prn orders for acetaminophen as needed for pain. When the nurse reviews their histories and assessments, it is discovered that one of the patients has a contraindication to acetaminophen therapy. Which of the following patients should receive an alternate medication?
a. A patient who has a fever of 39.7°C
b. A patient admitted with severe hepatitis
c. A patient admitted with a deep vein thrombosis
d. A patient who had abdominal surgery 1 week earlier
b. A patient admitted with severe hepatitis
The nurse administers 5 mg morphine sulfate IV to a patient with severe postoperative pain, as ordered. What assessment data should be gathered before and after the administration of this drug?
- assess the patient’s blood pressure, pulse, and respirations before administering any narcotic such as morphine sulfate.
- this allows comparison of baseline vital signs with those taken after the drug has been administered, as well as allowing assessment of the effect of the drug on the physiological response to pain.
The patient complains that the drugs he is receiving for severe pain are not really helping. What would be the most appropriate response to this patient?
- assess the patient and any previous reactions to pain medications;
- then assess the dose, action, route, and appropriateness of the drug.
The patient’s medical history, nursing assessment, and medication history should also be studied carefully because the patient’s diagnosis may not correspond with the type of analgesic ordered.
oral, im or transdermal?
Opioids usually have many adverse effects and have even more when in this form because of gastric upset related to gastric irritation.
oral
oral, im or transdermal?
Dependent on the drug and dosage, but the effects are generally more profound in this form because of increased absorption.
IM
oral, im or transdermal?
adverse effects related to CNS depression, such as sedation and decreased vital signs, are more often associated with this dosage form.
IM
oral, im or transdermal?
Likely to occur once the steady state of the drug has been achieved. Because of the steady absorption that occurs with consistent dosing, the adverse effects will depend on the dosage and drug.
transdermal
oral, im or transdermal?
Most difficult form for home management
IM
Patients should be informed of the adverse effects of analgesics such as:
GI tract upset, constipation, drowsiness, dizziness, headache, sleepiness, tinnitus (ringing in the ears), blurred vision, palpitations, bradycardia, and hypotension.
Patients taking an opioid drug should be instructed to ambulate and perform activities of daily living with ____________
caution
Patients should be instructed that opioids should not be used with _________ or other CNS depressants because of worsening of CNS-depressant effects.
alcohol
Patients should be instructed to change positions slowly to prevent possible ____________ _____________
orthostatic hypotension.
Patients should be encouraged to drink fluids at up to 3 L/day, unless contraindicated, and increase of fibre and bulk consumption and exercise as tolerated is recommended to prevent problems with __________________
constipation.
Patients should be informed that _____________ does occur with opioid use, so if the level of pain increases while the patient remains on the prescribed dosage, the patient should contact the physician or health care provider for assistance.
tolerance
Which form or forms are most affected by the first-pass effect?
Oral forms would have the highest level of first-pass effect because the drug is taken orally and will be absorbed into the portal circulation before being circulated to the rest of the body.
Where in the body does absorption take place?
- oral (enteral)
- rectal (enteral)
- nasogastric tube (enteral)
- inhalation (percutaneous)
- mucous membrane (percutaneous)
- topical (percutaneous)
- injectable (IM, S/C, IV)
(parenteral) - Sublingual & buccal (percutaneous)
Where in the body does distribution take place?
- Areas of rapid distribution: heart, liver, kidneys, brain
2. Areas of slow distribution: muscle, skin, fat
What is the main organ where metabolism takes place?
liver
____________ excretion: excretion of drugs by the intestines
biliary
______________ recirculation: certain drugs, such as fat-soluble drugs, that are in the bile, may be reabsorbed into the bloodstream, returned to the liver, and again secreted into the bile
enterohepatic
Factors influencing excretion:
- age (declines with age),
2. organ function (kidney)
What is the purpose of a “drug holiday” with clients who are taking narcotics on a long-term basis?
to obtain more therapeutic effectiveness
to reduce drug tolerance
true or false?
Cancer clients should never receive strong narcotics at the beginning of any pain experience because of the fear of addiction.
false
Addiction is not the primary concern for those with cancer pain. Rather, the focus should be on the quality of life. Also important for preventing the escalation of pain; the pain should be managed before it becomes too severe.
You administer 100 mg meperidine (Demerol) intramuscularly to a client in severe post-operative pain, as ordered. What assessment data should be gathered before and after administering this drug?
assess patient’s blood pressure, pulse, and respirations before administering any narcotic
withhold the dose and contact the physician if there is any decline in the patient’s condition or if vital signs are abnormal (see normal values given earlier), especially if the _______________rate is less than:
respiratory
12 bpm
_____________ anaesthetic: commonly used for patients undergoing major abdominal or limb surgery for whom the risks of general anaesthesia are too high or for patients who prefer this technique over complete loss of consciousness during their surgical procedure
intrathecal
______________: commonly used to reduce maternal discomfort during labour and delivery and to manage postoperative acute pain after major abdominal or pelvic surgery
epidural
What is the purpose of adding epinephrine to a local anesthetic?
to help confine the local anaesthetic to the injected area and prevent systemic absorption
One particular complication of spinal anaesthesia is “__________ _____________,” which occurs in varying numbers of patients.
spinal headache
The body produces neurotransmitters that are used to help fight pain naturally. What are they and how do they work?
endorphins
they interact with the opiate receptors in the brain to reduce our perception of pain and act similarly to drugs such as morphine and codeine.
Three classifications of opiates based on their actions:
- agonist
- partial agonist
- antagonist
which classification of opiate?
- Bind to an opioid pain receptor in the brain
- Cause an analgesic response (reduction of pain sensation)
agonist
which classification of opiate?
- Bind to a pain receptor
- Cause a weaker neurological response than a full agonist
- Also called agonist–antagonists or mixed agonist
partial agonist
which classification of opiate?
- Reverse the effects of these drugs on pain receptors
- Bind to a pain receptor and exert no response
- Are also known as competitive antagonists
antagonist
An antidote to an overdose of morphine is _____________ (naloxone).
NARCAN
Sequence of Ingestion to target area:
ENTERAL
- mouth
- stomach
- liver
- bloodstream
- target area
Sequence of Ingestion to target area:
PARENTERAL
- bloodstream
* target area
Five RIghts of Medication Administration
Right drug Right dose Right time Right route Right patient Additional Rights
Right reason Right documentation Right evaluation (assessment) Right patient education Right to refuse
Six Elements of a Drug Order
Patient's name Date the order is written Name of medication Dosage (includes size, frequency, and number of doses) Route of administration Signature of the prescriber
9 Essential Components of a Prescription
Patient’s name, address, health insurance number (or identification number)
Date prescription was written
The Rx symbol, meaning “take thou”
Medication name, dosage, and strength
Route of administration
Dispensing instructions for the pharmacist
Directions for administration to be given to the patient
Number of refills
Signature of the prescriber
Topical Routes
Skin (including transdermal patches) Eyes Ears Nose Lungs (inhalation) Rectum Vagina
HOW ARE INHALANTS ABSORBED
THROUGH THE ALVEOLI
HOW ARE INHALED DRUGS DELIVERED
AS MICROMETRE-SEIZED DRUG PARTICLES
Ways Drugs Produce Therapeutic Effects
Once the drug is at the site of action, it can modify the rate (increase or decrease) at which the cells or tissues function
True or False?
A drug cannot make a cell or tissue perform a function it was not designed to perform
true
___________ OR __________ therapy supplies the body with a substance needed to maintain normal function. This substance may be needed because it either cannot be made by the body or is produced in insufficient quantity.
Examples are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia.
Supplemental or replacement
___________ therapy maintains the integrity of body functions while the patient is recovering from illness or
trauma.
Examples Are the administration of insulin to diabetic patients and of iron to patients with iron-deficiency anemia.
Supportive
_____________ therapy is drug therapy provided to prevent illness or other undesirable outcome. Its use is based on scientific knowledge often acquired during years of observation of a disease and its causes.
example, a surgeon knows that when an incision is made through the skin there is the possibility that skin bacteria are present that can later infect the incision. Thus the surgeon administers an antibiotic before making the incision
prophylactic
_________ therapy does not have a scientific basis but instead is based on experience. It is the administration of a drug when a certain pathological process is suspected, based on the patient’s symptoms, because the drug has been found in the past to be beneficial in such cases.
example, acetaminophen is given to a patient who has a fever. The cause of the fever may not be known, but empirically the patient is given acetaminophen because it has been demonstrated to lower the body temperature.
empiric
Drugs or other chemicals result in structural defects in the fetus.
TERATOGENIC EFFECTS
permanent changes in the genetic composition of living organisms and consist of alterations in the chromosome structure, the number of chromosomes, or the genetic code of the deoxyribonucleic acid (DNA) molecule.
MUTAGENIC EFFECTS
cancer-causing effects of drugs, other chemicals, radiation, and viruses.
CARCINOGENIC EFFECTS
Pharmacognosy:
Four main sources for drugs
Plants: e.g. foxglove
Animals: Insulin, estrogen
Minerals: aluminum hydroxide
Laboratory synthesis: most drugs
Applying current, valid, and relevant information when making clinical decisions
Evidence-Informed Practice
HOW TO APPLY EVIDENCE INFORMED PRACTICE
3 THINGS
- Systematically reviewing randomized clinical trials (RCTs)
- Reading descriptive and qualitative studies
- Acknowledging expert opinions
PROS OF EVIDENCE INFORMED PRACTICE
3
Leads to more:
- Accurate diagnoses
- Effective and efficient interventions
- Improved patient outcomes
Enflurane is a(n) ______ anaesthetic.
inhalation general
Halothane is a(n) ____________ anaesthetic.
inhalation general
Nitrous oxide is primarily indicated for use in __________?
dental procedures (such as removal of “wisdom teeth”) or as a useful supplement to other, more potent anaesthetics.
pain that results from any disorder that causes central nervous system damage
CENTRAL PAIN
These contraindications are for???
i) known drug allergy
ii) severe asthma or other respiratory insufficiency, especially in the absence of resuscitative equipment,
iii) conditions involving elevated intracranial pressure, and
iv) pregnancy, especially in long-term or high doses
NARCOTICS
3 Chemical Classification of Opioids
Meperidine-like drugs
Methadone-like drugs
Morphine-Like drugs
Often given with adjuvant analgesic drugs to assist the primary drugs with pain relief
NSAIDS AND CORTISONES reduce
INFLAMMATION
Often given with adjuvant analgesic drugs to assist the primary drugs with pain relief
Antidepressants and Anticonvulsants are used for ___________ pain
NERVE
What kind of drug can be used for Cough centre suppression,Treatment of diarrhea (causes constipation), & Procedural pain during surgery as an adjunct to anaesthesia
Opioids
Overdose, whether intentional or due to chronic unintentional misuse, can cause?
hepatic necrosis (liver)
Long-term ingestion of large doses of acetaminophen can also cause?
nephropathy (kidneys damage)
What is the Maximum daily dose of acetaminophen for healthy adults?
4000 mg per day
What is the most common adverse effect and may be prevented with adequate fluid and fibre intake
CONSTIPATION
How is general anaestheia administered?
Inhaled anaesthetics
Injectable anaesthetics
When would an Injectable Anaesthetics be used?
To induce or maintain general anaesthesia
To induce amnesia
To reduce anxiety
As an adjunct to inhalation-type anaesthetics
During surgical procedures general anaesthetics is used to produce
Unconsciousness
Skeletal muscular relaxation
Visceral smooth muscle relaxation
General Anaesthetics: Interactions
General anaesthetics are associated with a wide array of drug interactions varying in severity
More common drug–drug interactions occur with:
ANTIHYPERTENSIVES
β-blockers
Tetracycline
Blood pressure drugs
What does NMBAs stand for?
Neuromuscular Blocking Agents
A neuromuscular blocking drug is used to?
Prevent nerve transmission in certain muscles, resulting in paralysis of the muscle
True or False
NMBAs cause sedation or relief of pain
FALSE
TRUE OR FALSE
When NMBAS are used during surgery, artificial mechanical ventilation is required
TRUE
TRUE or FALSE
Patient may be paralyzed yet conscious when NMBAs are used
TRUE
Drugs ending in AM such as diazepam,
lorazepam are what types of drugs
ANTI ANXIETY
Nondepolarizing NMBAs prevent ______ from acting at the neuromuscular junctions
ACh
Overdose of a NMBA can cause?
prolonged paralysis
Moderate Sedation is also known as?
conscious sedation
During moderate/conscious sedation a combination of ______________and an _______ is often used.
intravenous (IV) Benzodiazepine and Opiate analgesic
During conscious sedation it preserves the patient’s ability to maintain____________________.
own airway and to respond to verbal commands
What are the main things to know about NMBAs?
- Lots of drugs interact with neuromuscular drugs
- Causes Paralysis
- Can feel pain
- Doesn’t treat pain
What are the two types of Local Anaesthetics?
- Central
- Spinal or intraspinal
- Intrathecal
- Epidural
- Peripheral
- Infiltration
- Nerve block
- Topical
What is a common form of a Parenteral Anaesthetic Drug?
lidocaine (Xylocaine)-freezing, used in combination with ephinephrine to keep it local
What are some Local Anaesthetics: Contraindications
Contraindications include known drug allergy
Ophthalmic use requires specially designed dosage forms
What would a Local Anaesthetics be used for?
Used to render a specific portion of the body insensitive to pain
Do not cause loss of consciousness
What are the four processes to the gate theory?
Transduction
Transmission
Perception
Modulation
What are the two types of nerves stimulated?
A fibres
C fibres
