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Pharmacy week 1, 2, 3, 4 > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Briefly list/identify and describe the 5 steps to the nursing process.

Diagnosis

A

Nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs

The diagnosis is the basis for the nurse’s care plan

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2
Q

Examples of nursing diagnosis

A

-Activity Intolerance
-Risk for Falls
-Impaired gas exchange
-Acute/Chronic Pain
-Impaired skin integrity
-Delayed growth and development

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3
Q

The Nursing Process: Planning

A

Goals & Outcome criteria

(SMART)
Objective, measurable, & realistic w/ an established time period

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4
Q

Implementation

A

Includes client education (HUGE!!!)

Initiation & completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria

Can be independent, collaborative, or dependent upon a prescriber’s order

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5
Q

Examples of implementation

A
  1. RN will administer scheduled oral pain medication as ordered and assess client’s response to pain medication hourly
  2. RN will teach client relaxation and techniques to reduce abdominal pain
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6
Q

Evaluation

A

Both the client’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified PRN

*Accurate & timely documentation related to
*Goal met
*Goal partially met
*Goal not met

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7
Q

Clinical Judgement Measurement Model (CJMM)

Recognize cues

A

-Filtering information from different sources (e.g., signs, symptoms, medical history)

-What are some expected responses and behaviors??

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8
Q

Clinical Judgement Measurement Model (CJMM)

Analyzing cues

A

-Linking the recognized cues to the client’s clinical presentation and establishing probable client needs, concerns, or problems

-Expected responses and behaviors??

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9
Q

Clinical Judgement Measurement Model (CJMM)

Prioritize hypothesis

A

-Establish priorities of care based on the client’s health problems (e.g., environmental factors, risk assessment, urgency, signs/symptoms, diagnostic test, lab values, etc.)

-Expected responses and behaviors???

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10
Q

Clinical Judgement Measurement Model (CJMM)

Generate solutions

A

-Identify expected outcomes and related nursing interventions to ensure clients’ needs are met

-Expected responses and behaviors??

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11
Q

Clinical Judgement Measurement Model (CJMM)

Take-Action(s)

A

-Implement appropriate interventions based on nursing knowledge, priorities of care, and planned outcomes to promote, maintain, or restore a client’s health

-Expected responses and behaviors??

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12
Q

Briefly list/identify and describe the 6 steps to the clinical judgement measurement model (CJMM).

Evaluate outcomes

A

-Evaluate a client’s response to nursing interventions and reach a nursing judgment regarding the extent to which outcomes have been met

-Expected responses and behaviors??

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13
Q

Discuss the 9 rights of medication administration.

A

1.Right Drug
2.Right Dose
3.Right Time
4.Right Route & Form
5.Right Client
6. Right Documentation
7. Right Reason/Indication
8. Right Response
9. Right to Refuse

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14
Q

Briefly describe a medication error.

A

Defined as any preventable event that may cause or lead to inappropriate medication use or patient harm

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15
Q

Discuss the “DO’S“of documentation

A

-Make sure you’re in the correct client chart

-Document only the facts

-Document client education

-Document client’s refusal of medication (alert HCP & CN)

-Record each and any phone call to the HCP with the exact time, message, and response

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16
Q

Discuss the “DONT’S“of documentation

A

-Document ahead of time

-If you had to fill out an incident report, don’t document that you did in the EHR

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17
Q

Discuss the influences of the patient’s age on the effects of drugs and drug responses.

A

As people grow older, there is a higher risk for toxicity and adverse effects.

18
Q

Identify drug-related concerns during pregnancy and lactation and provide an explanation of the physiologic basis for these concerns.

A

Any medication taken has the potential to reach the developing fetus

Passive Diffusion via the placenta

lipid soluble
smaller molecular weight
unionized/non-polar etc

19
Q

Lactation A vast number of drugs can enter breast/chest milk

A

Drug profiles that can easily cross:
-Lipid soluble
-Small molecular weight
-Non-ionized

Avoid long-acting drugs (XL, long half lives)

Typically give medications AFTER breastfeeding/ chest-feeding

20
Q

1st trimester is generally the period of

A

Greatest risk

21
Q

The last trimester involves the highest % of drug absorption by the fetus why?

A

(increased blood flow + a larger fetus!)

22
Q

What are Teratogenic drugs?

A

Drugs that may cause birth defects

Category A: no risk
Category X: Fetal abnormalities

23
Q

Summarize the impact of age-related physiologic changes on the pharmacokinetic and pharmacodynamics aspects of drug therapy.

What happens as we age?

A

total body water mass decrease
muscle mass decrease
body fat increases

24
Q

Explain how these age-related changes in pharmacokinetics influence various drug effects and drug responses across the lifespan.

Geriatrics
ADME

A

Absorption:
Decreased gastric acid production + slower gastric emptying time

Distribution:
Decreased body water + mass, more fat content
Decreased protein binding

Metabolism
Declined liver function

Elimination
Declined kidney function

25
Q

Provide several examples of how age affects the absorption, distribution, metabolism, and excretion of drugs.

Pediatrics
ADME

A

Absorption
-decreased gastric acid production + slower gastric emptying time
-More blood flow to skin (topical drugs get rapidly absorbed)

Distribution
-Limited protein binding sites (until age 1)
-Still developing Blood Brain Barrier (drugs may enter the brain)
-Higher body water content (dilutes water soluble drugs)

Metabolism
-Immature liver function

Elimination
-Immature kidney function

(also dont have a lot of protein, so if given high protein binding drug there will be more free drug)

26
Q

Describe one major safety intervention utilized in pediatric medication

A

Dose must be checked with weight (kg) or Body Surface Area (BSA)

Be mindful of easy risk for overdose

27
Q

NON-PHYSIOLOGIC CONSIDERATIONS
in geriatric patients

A

-Compliance Decreases with age
-Comorbidities, Changes in vision/hearing, Decreased mobility
-ENCOURAGE READING GLASSES!

28
Q

Recommendations to support compliance
geriatrics
8

A

Clear and Concise instructions (verbal + written)

Ensure appropriate dosage form

Liquid for difficulty swallowing

Daily calendar/pill counter

Dispose of medications they are no longer taking

Take-back programs

Flush certain drugs (FDA FLUSH LIST) (fentanyl patch- pets, children)

Mix drugs in sealable bags with cat litter/coffee and throw in trash

29
Q

CHEMICAL NAME

A

Describes the drug’s chemical composition & molecular structure (IUPAC)

This name is generally NOT used in the clinical/prescribing setting

30
Q

GENERIC NAME (refers to active ingredient in drug)

A

Name given by the United States Adopted Names Council

Active ingredient

31
Q

BRAND/TRADE NAME

A

The drug has a registered trademark

use of the name is restricted by the drug’s patent owner (usually the manufacturer)

32
Q

BIOEQUIVALANCE

A

The FDA says that generic drugs must be bioequivalent to brand name drugs

Manufacturers prove this via studies

33
Q

NARROW THERAPEUTIC INDEX DRUGS

What if a patient is taking a narrow therapeutic index drug (like a seizure medication?

A

A 4% difference can be the difference between seizure free or active seizures

In this RARE scenario, prescribers will encourage patients use the SAME manufacturer, not necessarily the BRAND, but a CONSISTENCY in the product they use

34
Q

PRESCRIPTION (RX)

A

Regulated by the FDA (pre-approval process)

Means that these drugs require periodic monitoring

They must be prescribed by a health care professional

Example: Hydrochlorothiazide- diuretic/blood pressure medication

We must check blood pressure and electrolytes

35
Q

NON-PRESCRIPTION/OVER THE COUNTER (OTC)

A

Regulated by the FDA (pre-approval process)

Means that these are generally safe and don’t require periodic monitoring

Example: Acetaminophen (Tylenol®)

We know this is safe at normal doses

We don’t monitor your liver routinely or require annual check ups if using this at OTC doses

36
Q

Vitamins/Herbals/Homeopathic

A

Regulated by third party manufacturers/distributors

FDA is not involved in the PRE-approval process

FDA only intervenes if the product causes harm or is proven to be adulterated/misbranded

You will find this statement on the label, “These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.”

37
Q

Drug classifications

  1. Prescriptions
  2. Non-prescriptions
  3. Dietary supplements
A
  1. presciption
    -controlled (DEA) (medications that can cause physical and mental dependence)
    -non controlled
    (require FDA testing)
  2. non prescription
    -OTC
    -Behind the counter
    (require FDA testing)
  3. Dietary supplements
    -vitamins
    -herbals
    -homeopathic
    (doesn’t require FDA testing)
38
Q

DRUG APPROVAL

A

Before a drug can reach the MARKET, the FDA must approve the drug

Drug companies submit their research (Clinical Trials) to the FDA for approval

Companies must show their drug is 1)SAFE, 2) EFFECTIVE

39
Q

REMS PROGRAMS

A

Risk Evaluation and Mitigation Strategies

Benefits > Risk, but we monitor for risk

Pharmacy and Prescriber register

Monthly requirements and criteria

◦Teamwork between patient, pharmacy and prescriber

40
Q

DRUG ENFORCEMENT AGENCY (DEA)

A

Government Agency established by the 1973 Controlled Substances Act

(prescription drugs split into two catergories)

1)CONTROLLED SUBSTANCES

2) SCHEDULES

41
Q

Schedules
Ranked by what?

A

A classification system that the DEA uses to rank controlled substances
-5 “SCHEDULES”

Ranked by:
-Abuse/Misuse Potential
-Medical Use
-Dependency Potential

Pharmacy week 1, 2, 3, 4 (6 decks)

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