lecture 1

Question 1

controlled substances - schedule 1

Answer 1

abuse potential - high
medical use - none
dependency potential - severe physical and psychological
Ex - heroin

Question 2

controlled substances - schedule II

Answer 2

abuse potential - high
medical use - accepted
dependency potential - severe physical and psychological
Ex - fentanyl

Question 3

controlled substances - schedule III

Answer 3

abuse potential - less than 2
medical use - accepted
dependency potential - moderate to low physical and psychological
Ex - anabolic steroids, acetaminophen w/codiene

Question 4

controlled substances - schedule IV

Answer 4

abuse potential - less than 3
medical use - accepted
dependency potential - less
Ex - alprazolom, zolpidem, tramadol

Question 5

controlled substances - schedule V

Answer 5

abuse potential - less than 4
medical use - accepted
dependency potential - less
Ex - cough medicine w/ <200mg of codiene

Question 6

controlled substances count

Answer 6

counted by two nurses at the start of each shift, must be equal. must sign out a controlled substance for administration

Question 7

drug polymorphism

Answer 7

the effects of a patient’s age, gender, size, body composition, and other characteristics on the pharmacokinetics of drugs

Question 8

How do the rights of medication administration guide safe nursing practice? How can you prevent medication errors?

Answer 8

o Provide a structured framework for that ensures that meds are given safely, accurately, and legally. Doing the 7 rights of med admin helps prevent wrong patient, wrong medication, and wrong dose errors.
o Performing the three safety checks
Taking the drug out
Alongside MAR
before opening the package and administering
Using two patient identifiers
Using BCMA, MAR, CPO
Do not administer if you didn’t draw up or prepare the medication yourself
Question a medication order when in doubt or when verbalized
Never assume
Do not use list of abbreviations; use tall man letters
Listen to concerns of the patient

Question 9

what is pharmacokinetics

Answer 9

the process of what the body does to the drug; how meds move through the body. Absorption  Distribution  Metabolism  Excretion

Question 10

absorption

Answer 10

: movement of the drug from admin site to the bloodstream
 Bioavailability - extent of drug absorption to be used by the body
 First-pass effect – oral medications have to make it past the liver
 Route – enteral (GI – oral), parenteral (injections), topical (transdermal and inhalation)

Question 11

distribution

Answer 11

: movement of the drug from admin site to the bloodstream
 Bioavailability - extent of drug absorption to be used by the body
 First-pass effect – oral medications have to make it past the liver
 Route – enteral (GI – oral), parenteral (injections), topical (transdermal and inhalation)

Question 12

metabolism

Answer 12

chemically altering a substance so it can be excreted from the body after it has produced an action.
 Most common site is the liver
 Also kidneys, GI tract, skin, plasma, and the lungs
 Co-existing conditions can affect metabolism.
 Ex: CV dysfunction or renal insufficiency can decrease a drug’s metabolism

Question 13

excretion

Answer 13

 Often in kidneys, lungs, skin and GI tract.
 Half-live – time required for 50% of the drug to be removed
 Ex: administer 40 mg, half-life is 2 hours
 In two hours, you can expect half of that initial dose to be in the body
 Usually take around 5 half-lives for the medication to be removed.

Question 14

pharmacokinetics: older adult considerations

Answer 14

high use of medications, polypharmacy: multiple medications, noncompliance/nonadherence, increased incidence of chronic illnesses, sensory and motor deficits, decreased renal and hepatic function, higher risk for toxicity, and altered protein binding. May require lower doses and Beers list screening

Question 15

pharmacokinetics: pregnant patients

Answer 15

drugs cross the placenta by diffusion. Must consider risk-to-benefit ration. FDA has a labeling rule for pregnancy and breastfeeding, must know how it affects these patients

Question 16

pharmacokinetics: pediatric and neonatal patients

Answer 16

skin is thin and permeable, stomach lacks acid to kill bacteria, lungs have weaker mucous barriers, body temperature less regulated, easily dehydrated, live and kidney are immature. Use weight-based dosages and KIDs list

Question 17

how do different routes of administration affect onset of action, effectiveness, and patient safety?

Answer 17

o IV: fastest onset, highest bioavailability, highest toxicity risk
o Oral: slower onset, affected by food, GI absorption, and first-pass metabolism.
o IM/Subcutaneous: moderate onset, influenced by muscle mass and circulation
o Topical/Inhalation: localized or rapid effects with reduced systemic exposure

Question 18

what is the first-pass effect, and how does it influence the effectiveness of certain medications

Answer 18

o Oral medications are metabolized by the liver before reaching systemic circulation, reducing bioavailability.
 May need higher doses

Question 19

legal responsibilities for safe med admin and nursing decision-making

Answer 19

nurses are legally accountable for knowing medication actions, side effects, contraindications, and administration practices.
 Controlled substances are controlled by the DEA, and must be counted by two nurses at the start of each shift (1 coming in, one leaving)

Question 20

ethical responsibilities for safe med admin and nursing decision-making

Answer 20

: practicing autonomy (patient choose for themselves), beneficence (promoting the best outcome, protecting from mistreatment), nonmalefiecense (avoiding harm), and justice (treating fairly)

Question 21

professional responsibilities for safe med admin and nursing decision-making

Answer 21

accurate documentation, patient education, and timely reporting for errors

Question 22

how can drug interactions affect med effectiveness

Answer 22

can increase therapeutic effects, cause toxicity, and reduce medication effectiveness. Can interact with medical conditions, food, drugs, and supplements
 Meds from the same class – augmented effects of those medications.
 Meds from different classes – can be positive or cause adverse effects. Continuously monitor.
 Cardiac meds interact with many herbal remedies
 Most frequent drug-food interactions are with grapefruits because they are metabolized in the same pathway – liver.
 Other frequent foods are dairy, vitamin K, tyramine, and alcohol

Question 23

drug interactions - monitor

Answer 23

for therapeutic actions, adverse and side effects. Look at black box warnings which are from the FDA meaning serious adverse effects were reported. Check lab results (serum drug levels, prothrombin time or partial thrombin time, electrolytes, and cardiac monitoring), ensure right med and dose, patient adherence, detect toxicity, and prevent client harm. Check the therapeutic index (link/ratio between the therapeutic and toxic medication concentrations). Also, check for tolerance, dependance, and withdrawal