Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacotherapeutics > Week 1 > Flashcards

Week 1 Flashcards

1
Q

5 health care professionals that can write prescriptions

A
  1. Physicians MD or DO
  2. Advanced Practice Nurses
  3. PA
  4. Dentists DDS or DMD
  5. Podiatrist DPM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Can a LPN administer medications?

A

Yes, however there are certain restrictions to what kinds of medications she can administer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Protocol for telephone or verbal orders

A
  1. Follow the institutions policy and READ BACK.
  2. Health care provider that gave the order must sign it within 24 hours of giving it
  3. Usually only given during emergencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

8 components of a medication order

A
  1. Date and Time of order
  2. Drug name- preferred generic
  3. Drug dosage
  4. Route of administration
  5. Freq and duration ( twice daily X 7 days)
  6. Any special instructions for the medication
  7. HCP signature if it was TO or VO order
  8. RN signature taking the order
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

5 types of drug orders

A
  1. Standing orders- all have different exp. dates
  2. One time (single) orders
  3. PRN (Pro-re-nata)- as needed
  4. STAT (Statim)- NOW orders
  5. Opioid orders- not automatically refilled- when extension needed a new prescription is req.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

6 Rights of Drug Administration + bonus right

RMR- even if all the rights are followed a deadly medication error can still occur!!!

A
  1. Right PT
  2. Right drug
  3. Right dose
  4. Right route
  5. Right time
  6. Right documentation
    * Right reason for giving the drug- sometimes we give medications for their side effects ex. benedryl for drowsiness*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Addition Rights of Drug Administration 4

A
  1. Right Assessment
  2. Right Education
  3. Right to Refuse
  4. Right Evaluation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

8 Drug Administration Guidelines

A
  1. Wash hands
  2. Check allergies
  3. Check label of drug 3 times (once when retriving from drawer, once when getting the correct dosage, once by the bedside right before giving)
  4. Use 2 PT identifiers
  5. Assess PT before giving them the meds (ex. HBP meds take BP before giving them)
  6. Check exp date
  7. Recheck any med calculations
  8. Make sure PT takes the drug before you leave the room and DOCUMENT!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

DO NOT USE LIST- what should you write instead

  1. U or UI
  2. QD
  3. QOD
  4. MS04 & MS
  5. c.c
  6. ug
  7. should we use the less than or greater then signs
A
  1. units or international units
  2. every day or daily
  3. every other day
  4. morphine sulfate
  5. mL or millimeter
  6. microgram or mcg
  7. nope write it out!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Disposal of Medications

-should you flush medications down the toilet

A
  • Follow information on the drug insert
  • Remove all identifying information
  • Consult a pharmacists
  • Community Drug-Take-Back service
  • Transfer the substance into an undesirable substance such as kitty litter
  • Not unless it states on the leaflet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Crushing Medications

A

-Enteric coated medications cannot be crushed normally bc they have a protective covering which prevents them from dissolving in the stomach so they can dissolve in the small intestine instead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

High Alter Medications

A 
-Medications that can cause great danger or harm if not used correctly 
PINCH
Potassium 
Insulin 
Narcotics
Chemotherapy
Heparin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Client Educations

A
  • Most of the information we tell PT about their meds is either forgotten or misunderstood
  • Many pt feel bad that they cant understand the pharm insert of medication information
  • Health care environment makes it hard for pt to tell us they do not understand the pharm info
  • Many insurance companies require client teaching to be documented and recorded for $ back ex. stroke education before discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Teach Back

A

Effective way to determine how well the information was understood by the pt, more of an indicator of how well you taught the information then anything to do with them. Ask them to repeat you tell you how their medication should be taken etc in a non demeaning manner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

During which process of med admin do more then 40% of med errors occur?

A

Administration of medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Types of medication errors

A
  1. Omission

2. Commission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

4 Omission Errors

A
  1. Not prescribed
  2. Not dispensed
  3. Not administrated
  4. Not taken
    Nurses must make sure when a PT is NPO if they should still be taking medications or not
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  1. Commission Errors
A
  1. Wrong drug
  2. Wrong dose
  3. Wrong pt
  4. Allergic reaction
  5. Drug food therapy reaction
  6. Wrong drug substitute
  7. Wrong route
  8. Drug overuse
  9. Failure to follow drug specific instructions
  10. failure to follow policy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Errors of commission and communication

A

communication failures:

  1. Bad handwriting
  2. Incomplete order
  3. Vague instructions
  4. Prescription not recognized
  5. Unknown or illegible HCP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should you never give a drug?

A
  1. If the order is unclear or incomplete
  2. Dosage appears incorrect
  3. Client is having an adverse reaction

In any of the above or any situation getting worse call and report to HCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stock vs Unit Dose

A 
Advantages of Stock:
1. Always available
2. Cost effective 
Disadvantages of Stock:
1. More errors- many people pour from the bottle, more drugs to choose from
2. Exp date might be missed
Advantages of Unit:
1. Fewer errors
2. Saves time
3. Correct dose without calculation 
4. Billed for specific doses 
Disadvantages of Unit;
1. Time delay when you need more
2. If contaminated or damaged hard to replace
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Pharmaceutics

A

Packaging, pharmacies, oral vs. tablets vs. soln

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pharmacokinetics

A

‘Motion’ What the body does to the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pharmacodynamics

A

‘Action’- What the drug does to the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

1938- The FDA

A

Food, Drug, Cosmetic Acts

  • Monitors and regulates the manufacturing of drugs and marketing of drugs
  • Testing, labels, packaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Health Insurance Portability & Accountability Act HIPAA 2003

A
  • Privacy of health information
  • Pharmacy cant access all of the PT information
  • Private consult with the pharmacist
  • Clients sign statements they received copy of the privacy practice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nurse Practice Acts

A
  • Vary by states
  • NY/NJ- prohibits nurse from giving medications without valid prescription for HCP
  • Outlines criminal offenses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Civil Offenses as outlined by the Nurse Practice Acts

A
  • Misfeasances - negligence (wrong drug/dose) results in death
  • Nonfeasance- Omission results in death
  • Malfeasance- Correct drug by wrong route causes death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

FDA Pregnancy Categories

A
  • Classifies risks to fetus

- A, B, C, D, X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which categories are safe during pregnancy?

A
  • A & B especially during the 1st trimester
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Category A Fetal Risk

A
  • Studies show NO RISK
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Category B Fetal Risk

A
  • No fetal risk in animals so no risk is assumed in humans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Category C Fetal Risk

A
  • Fetal risk in animal studies; weigh risk vs. benefits
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Category D Fetal Risk

A
  • Proven risk to fetus; weigh risk vs. benefits if life threatening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Category X Fetal Risk

A
  • Proven fetal risk is greater then benefit AVOID DURING PREGNANCY
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Phases of Human Clinical Drug Experimentation: Phase I

A
  • Determines human drug dosage in healthy subjects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Phases of Human Clinical Drug Experimentation: Phase II

A
  • Demonstrates drug safety & efficacy in subjects with disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Phases of Human Clinical Drug Experimentation: Phase III & IV

A
  • Demonstrates drug safety & efficacy in wide client population & collect long term data
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

EthnoPharmacology - define and give an example

A
  • Study of drug responses that are specific to a specific group belonging to a certain social, cultural or biological phenomena
  • AA respond poorly to ACE inhibitors causing a really bad cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Pharmacogenetics

A
  • Variations in the predicated responses to medications due to genetic factors
41
Q

Transcultural Nursing

A
  • combination of traditional health care practices ( use of teas, herbs, spices, special food, homeopathic remedies– all of which can provide neutral, beneficial or bad effects)
    & complementary health practices & alternative health practices & mainstream health practices
42
Q

Giger and Davidhizar Transcultural Assessment Model

A

The nursing assessment includes: communication, space, social org, time, environmental control, biological variations (pharmacogenomics), culturally unique

43
Q

Additive Effects

A
  • Sum of the effects
  • Two drugs with the similar actions sum their effects
  • Could be desirable or undesirable
    1 + 1 = 2
  • ex. Hydralazine and Nitroglycerin
    ex. beta blocker and diuretic both used to dec BP
44
Q

Synergism or Potentiation

A
  • Clinical effect is greater than simply the combined effect of the two so its a higher then the additive effects
  • two drugs with different mechanisms of action produces greater effects
    1 + 1 = 3
  • ex. codine and ASA for pain relief
    ex. amicillin and sulbactam- inc. the antibiotic’s potency (this is an enzyme inhibitor so drug enters cell of bacteria)
45
Q

Drug Interference

A
  • One drug creates a difference in the other
  • One drug increases or decreases the metabolism or excretion of another
  • ex. Probenicid slows renal excretion of penicillin
    ex. Warfarin, barbiturates & cimetidine affect metabolism of many drugs
46
Q

Displacement

A
  • One takes the place of the other
  • Two drugs compete for binding sites on plasma proteins ( usually on albumin so when you give two drugs that need to bind to albumin only one gets to bind and the other stays unbound which can be a toxicity issue)
47
Q

Antagonism

A
  • One drug cancels out the effects of another
  • ex. Narcan( do not push all at once) cancels the effects of opioid overdose
  • 1 + 1 = 0
  • ## Basis for antidotes to toxic effects of another drug or chemical
48
Q

How does malnourishment impact the potential of a drug overdose?

A
  • Malnourished individuals have a higher chance of having an drug overdose because they have less albumin so more unbound meds
49
Q

Incompatibility

A
  • One cannot exist with the other
  • Interaction of 2 drugs interferes with action of at least 1 drug
  • Always check before mixing IV drugs or injections
  • Basis for drugs that bind/inactivate another toxic drug in GI tract
  • Ex. Mg in antacids and tetracycline may impair absorption of tetracycline
    Mixing different types of IV meds in the same tubing can cause crystalized drug and line occlusion
    ex. laxatives dec absorption of medications bc inc paraslytasis so less time for the drug to be absorbed
50
Q

Drug Abuse

A
  • Using a drug in a way that is inconsistent with medical or social norms
  • Overindulgence
  • Has negative impact on psychologic, physical or social functioning
    EVERYONE IS AT RISK
51
Q

What does food do to drug absorption

A

-Food slows most drug absorption but does not always impact drug action

52
Q

Some food and what drugs they impact

A
  • Grapefruit- Ca channel blockers; possible toxicity and inc BP
  • Vitamin K rich foods like leafy greens, bananas, fish and Coumadin and Warfarin
  • Dairy Products- impairs absorption of tetracycline
  • Tyramine Foods like beer, wine, cheese, pickled, liver- MAO inhibitors so can cause serve HBP
53
Q

Which lab values impact drug interactions

A
  • Plasma or serum electrolytes can impact how drug works in the body
  • ex. Digoxin & low K or low Mg or high Ca: may cause digitalis toxicity
    low K can happen when a PT is on a diuretic
54
Q

What impacts can OTC or herbal therapies have?

A
  • They might delay professional diagnosis and treatment
  • Symptoms may be masked
  • PT should always read label and consult a health care professional before use
  • Potential for overdose
  • Risk for drug-drug interactions
  • Inactive ingredients can end up causing adverse reactions
  • Could end up helping
55
Q

Potential Risks/ Hazards of Herbs

A
  • Lack of standards and regulation

- Possible interactions with other drugs

56
Q

When should herbs never be used?

A
  • Pregnancy
  • Infants or small kids
  • Alongside Chemo
  • In large quantities
57
Q

3 Phases of drug action

A
  1. Pharmaceutics- drug getting into the body
  2. Pharmacokinetics- body acting on drug
  3. Pharmacodynamics - drug acting on body
58
Q

Pharmaceutic Phase

A

Drug becomes a solution so that it can cross the biologic membrane of the cells
Mainly applies to orally consumed tablets, does not apply to IV, Sub Q or intramuscular shots bc they are absorbed via blood or tissues

59
Q

Pharmacokinetic Phase

A
  • Absorption
  • Distribution- protein binding
  • Metabolism
  • Biotransformation
  • Excretion or elimination
    WHAT YOUR BODY DOES TO THE DRUG
60
Q

Pharmacokinetic Phase-

Absorption of Oral Meds

A
  • First Phase Effect

- Bio-availability

61
Q

First Phase Effect

A
  • Drug passes through the liver before entering systemic circulation- chemical and biological barriers in GI environment (pH of GI tract can alter the power of a drug sometimes)
  • oral drugs are metabolized to a certain level before going into the blood so not all of the dosage is being used by the body hence oral tablet form dosage is usually higher then the dosage given IV
62
Q

Bio-availability

A
  • % of drug that reaches systemic circulation
  • PO drugs less then 100
  • IV drugs usually 100
63
Q

Pharmacokinetics: Distribution

A
  • Process by which the drug becomes available to body fluids and tissues. so some of the drug gets bound to proteins (inactive) some into the blood (active/free) some to blood tissue affinity. All of these things produce the pharmacologic effect.
  • Different drugs bind to different things some to proteins, some to tissue, some remain free in the blood.
64
Q

How to drugs get excreted?

A

Protein bound drugs need to become free floating to be excreted.

65
Q

Distribution: Protein Binding

A
  • Bound drug is inactive
  • Drugs can be highly binding 89% or low binding 30%
  • Taking 2 highly binding drugs can lead to toxicity bc 1 drug takes all the protein and the other remains free
  • Free drugs are the only ones that are active
  • Hypo-albuminemia can lead to excess free drug & cause toxicity
66
Q

Distribution: Impact of blood flow and Body Tissue Affinity

A
  • Abscesses and exudates, glands, and tumors decrease distribution
  • Amiodarone can cause lung toxicities
  • Some drugs accumulate in fat, bone, liver, muscle & eye tissue
  • In overweight people anesthesia stays in fat cells and releases slowly
67
Q

Metabolism

A
  • Process by which the body in-activates or bio-transforms the drugs
68
Q

What is the primary site of metabolism?

A

Liver- enzymes convert or transform drugs into inactive metabolites or water- soluble substances for excretion therefore liver diseases such as cirrhosis or hep can affect metabolism

69
Q

What happens hen metabolism decreases?

A
  • Excess drug accumulates and it can lead to toxicity
70
Q

What implications does an increase in bilirum signify?

A
  • The liver may be leaking these enzymes which means the liver has decreased functioning and it can lead to toxic level of drugs bc the bio-avialabilty of these drugs will be very high.
71
Q

What is the importance of knowing a drugs half life?

Liver dysfunction does what to a medication’s half-life?

A
  • Half life helps us estimate the time req for a drug to reach a biologically steady state (this can req. 3-5 dosages before we can determine that the amount of drug going into the system is the same as is being secreted)
  • it prolongs half life meaning that it takes longer for a drug to reach half potency
72
Q

What is the main source of drug excretion?

A
  • Kidneys - they filter unbound drugs and water soluable drugs and unchanged drugs
  • Other routes include bile, feces, salvia, sweat, breast milk
73
Q

Urine pH and drug excretion

A
  • Acid urine excretes weak base drugs
  • Alkaline urine excretes weak acid drugs
  • Sometimes pt are given serum Bicarb to help them excrete drugs via urine
74
Q

What is a good measure of kidney function aka most accurate renal function test?

A
  • Creatinine Clearance or Cr Cl
  • Creatine is the metabolic byproduct of muscle tissue that is excreted by the kidneys therefore people who have low muscle mass have lower values such as women and old pple so might need to dec dose for these people
75
Q

Normal levels for creatine clearance

A

85-135

76
Q

What is the standard protocol for drawing Cr Cl labs?

A
  • Usually done in the morning and it is a snap shot of that the renal function that time, it may change rapidly even throughout the day!
77
Q

Pharmcodynamic Phase

A
  • Way that drugs affect out body and has 2 phases
    1. Primary physiologic phase
    2. Secondary physiologic phase
78
Q

Primary Physiologic Phase

A

Desirable result- the dug is doing what we want it to do!

79
Q

Secondary Physiologic Phase

A
  • Could either be desirable or undesirable

- ex. Benadryl- could be desirable for someone who has trouble sleeping

80
Q

Pharmacodynamics- Therapeutic Index

A
  • Low or High
  • Low-narrow margin of safety so need a much more exact dose and must be cautious
  • High- large area of acceptable dose so has more room for error
81
Q

Peak Level

A
  • Highest plasma drug conc. and shows the rate of absorption
  • Drug blood work done at prescribed time
82
Q

Trough Level

A
  • Lowest plasma drug conc and shows us the rate of excretion
  • Drawn right before the next due dosage
83
Q

Loading Dose

A
  • Large initial dose
84
Q

Side Effects

A
  • Could be desirable or undesirable
85
Q

Adverse Effects

A
  • More serve than side effects
  • Always undesirable
  • Can be mild or serve
  • Ex. hives or anaphylaxis
86
Q

Toxic Effects

A
  • Likely to occur when drug levels exceed therapeutic range
87
Q

Drug Tolerance

A
  • Occurs due to freq and repeated drug administration
88
Q

Placebo Effect

A

Your mind thinks your getting better even without an active drug, just the thought of taking medication sometimes makes you feel better

89
Q

Receptor Theories

A
  • There are receptors on every cell membrane

- Ligand binding domain is the site on the receptor where the drug binds

90
Q

What are the 4 receptor binding sites

A
  1. Kinase linked
  2. Ligand gated ion channels
  3. G- protein coupled receptors systems
  4. Nuclear Receptors
91
Q

Kinase linked receptors

A

Ligand binding domain on cell surface. Drug activates an enzyme inside cell which signals an effect to take place

92
Q

Ligand gated ion channels

A
  • Drug spans cell membrane

- Ion channels Na and Ca open and begins the effect

93
Q

G - protein

A
  • Coupled receptor systems - drug activates receptor which activates G- Protein which activates effect
94
Q

Nuclear Receptors

A
  • Effect is achieved through the functions of the cell nucleus via a transcription process
  • Activation is prolonged in this receptor family
95
Q

Agonists

A

Drugs that produce a response

96
Q

Antagonists

A

Drugs that block a response

97
Q

Nonspecific/ Nonselective

A

Drugs that affect multiple sites and receptors- do not attach

98
Q

Potentially Inappropriate Drugs PIM

A

Beers Criteria

  • Meds to avoid in older adults regardless of diseases or conditions
  • Meds considered potentially inappropriate when used i older people

Pharmacotherapeutics (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions