1
Q
T or F: The nurse can trust the pharmacy to send the correct medication.
A
False, always double check meds before administering them.
2
Q
T or F: The nurse serves as a line of defense against medication errors.
A
True. Even if a dr prescribes a medicine that can cause harm, it is your responsibility to protect the patient!
3
Q
What are the three basic goals for preadministration (of drugs) assessment?
A
- collect baseline data needed to evaluate therapeutic and adverse responses. (condition, weight, agec cond. of liver,BP, etc)2. Identify High Risk Patients (allergies, genetic factors, pregnant, old age, premature?)3. Assessing the patient’s capacity for self-care (can they pay for medication? administer for themselves? forgetful?)
4
Q
______ is leakage of a fluid out of its container. example: IV fluid leakage.
A
Extravasation DELETE IN MIDTERM CARD DECK
5
Q
You should know the specific indication for which the drug is being used. Why?
A
Depending on which indication used for (headache vs inflammation in the case of aspirin), the dosage changes. Without knowing what indication, you cannot double check the dose nor evaluate for the proper response to the dosage given. ie, given for pain, check for pain change, if no change you change dose. If it’s for inflammation, a change in pain is not necessarily going to tell you if the inflammation has decreased.
6
Q
What is a PRN (pro re nata) medication order?
A
One in which the nurse has discretion regarding how much drug to give and when to give it (pro re nata = as needed)
7
Q
There are four major components to implementing a care plan:1. Drug administration2. interventions to enhance therapeutic effects (exercise AND cholesterol med)3. interventions to minimize adverse effects and interactions (know side effects, foods that block absorption etc.)and 4. ___________ ___________
A
Patient education!!!
8
Q
Over the course of drug therapy, patient must be evaluated. We check for 1) therapeutic response (is the drug working), 2) adverse reactions/interactions, 3)interventions to promote effects and 4) ________________
A
interventions to minimize adverse effects.
9
Q
The nurse is responsible for educating the patient. List some areas we are responsible for. (Some examples are: Who to contact in the event that the patient has a reaction, duration of treatment, method of storage….)
A
- Drug name and therapeutic category (penicillin - antibiotic)2. Dosage size (take one pill)3. Dosing schedule (take on pill each day for five days in the morning)4. Route and technique of administration (Insert vaginal cream into vagina while lying on your side…etc.5. expected therapeutic response and when it should develop (you will experience a decrease in itching after two days of use).6. nondrug measures to enhance therapeutic effects (if you walk for 30 minutes a day you will decrease stiffness in your hips from rheumatoid arthritis).7. Duration of treatment (you will be on this drug for 7 days)8. method of drug storage9. Symptoms of major adverse effects and measure to minimize discomfort and harm (This drug is known to cause stomach issues. Please be sure to eat before taking the medication).10. Major adverse drug-drug and food-drug reactions (Do not take this with grapefruit because it neutralizes the drug. Don’t take aspirin with warfarin because your blood will become to thin and you are at high risk for bleeding out).11. Who to contact if experience any reactions or a lack of therapeutic effect.
10
Q
What are the steps in the nursing process?
A
nursing process Lehne pg. 91) assessment (Roy has two levels2) analysis of the assessment aka nursing diagnosis3) planning (setting of goals)4) implementation aka nursing interventionf) evaluation (and modify when necessary)
11
Q
Why is obtaining baseline data needed in order to evaluate therapeutic effect and adverse effects?
A
In order to know if we have produced the response we are looking for, we need to est. a baseline to measure against. Same goes for adverse effects we do not expect. Of course hair loss while undergoing chemo is expected… but if liver dysfunction exists and we had no baseline, we cannot tell if it was pre existing.
12
Q
Why is safe medication storage important?
A
- Keep away from children2. Teens may abuse vitamins, cough syrup, cold meds and inhalable drugs.3. Elders people who are confused may take medication left on counter.
13
Q
Why is it important to double check medication before administering to a child?
A
Babies and young children require lower dosages because their bodies are small and process drugs faster.
14
Q
T or F: When charting units you should use “U”.
A
False. Do not use it because it may be mistaken for a zero. write the word unit.
15
Q
T or F: The abbreviation that should be used for international unit is IU.
A
False. write international unit. Too easy to mistake IU for IV.
16
Q
T or F: You should always use a zero before a decimal.
A
True. This helps spot the decimal.
17
Q
T or F: You should write out morphine sulfate or magnesium sulfate.
A
True. Can be confused for each other MS, MS04, MgSO4
18
Q
What abbreviation should be used for micrograms?
A
mcg. you may also write out micrograms but DO NOT use the greek symbol.
19
Q
Can you use the @ symbol when charting?
A
No. It can be mistaken for a 2. write the word at.
20
Q
1 cc is equal to 1 ml. Which abbreviations should we use and why?
A
use mL or milliliters. cc may be mistaken for U (units)
21
Q
What are some questions we can ask ourselves to identify whether or not an adverse reaction has occurred?
A
- Did symptoms appear shortly after the drug was first used?2. Did symptoms abate when the drug was discontinued?3. Did symptoms reappear when the drug was reinstituted?4. Is the illness itself sufficient to explain the event?5. Are other drugs in the regimen sufficient to explain the event?
22
Q
As a result of concerns over patent medicine (questionable remedies), congress passed it’s first federal drug law in 1906 called?
A
Pure Food and Drug Act of 1906, which required accurate labeling of drugs to prevent substitution or mislabeled ingredients.
23
Q
A new law replaced the Pure Food and Drug Act of 1906, with more specific regulations including holding the drug developer responsible for drug safety. What was this law called?
A
The Food, Drug and Cosmetic Act of 1938.
24
Q
This governing body oversees the safe development of new drugs…
A
FDA (Food and Drug Administration)
25
This governing body regulates manufacture and distribution of narcotics, stimulants, depressants, hallucinogens, and anabolic steroids as well as substances used in their production
DEA (Drug Enforcment Agency)
26
This federal organization ensures occupational sagety by enforcing standards and providing workplace safety training…
OSHA (Occupational Safety and Health Administration)Enacts laws geared toward protecting health-care workers from patients' diseases and requires yearly education to ensure safety of workers.
27
Controlled substances are categorized in schedules from I to V. Which is the most controlled with the highest abuse potential? Least?
Most is I; least is V
28
What are some examples of drugs that are in schedule I? Are schedule I drugs approved for medical use?
Heroin, LSD…No!
29
Why are schedule II drugs so restricted?
Subject to high abuse and severe dependence risk: morphine and opium
30
Schedule III drugs are right in the middle… what is the chance for dependency? Examples?
Lower abuse potential than schedule II, moderate to low dependence risk; steroids and codeine.
31
Do drugs in schedule IV such as Valium and Xanax have abuse potential? Dependence risk?
low abuse potential; low dependence risk
32
What type of drugs are in schedule V?
OTCs like cough medicine
33
Drug development takes a long time and is expensive. Before bringing a new product to market, it must go through ______ ________.
Clinical trials
34
What is the purpose of pre-clinical trials?
to determine safe dose and to evaluate drug safety profile.
35
What is the main difference in preclinical versus clinical trials?
Animals are used in pre/Humans in clinical
36
What are the goals of phase I in clinical trials?
1. evaluate drug metabolism 2. pharmacokinetics 3. Biologic effects
37
Clinical trials have three phases. What happens during phase I?
Drug is tested for safety using 20-100 healthy volunteers (unless severe side effects…then tested in ill). Test best administration of the drug and the highest dose to be given without serious side effects.
38
What happens during phases II and III of clinical trial?
Drug is tested on several hundred patients to see if it works, dosage range, safety and effectiveness.
39
Upon completing phase III, the manufacturer can apply for conditional approval from FDA. What happens in phase IV?
Postmarketing surveillance. It's allowed to be used by public under surveillance.
40
What is the most reliant way to objectively assess drug therapies?
RCTs - Randomaly Controlled Trials
41
What are three factors that make RCTs reliable?
Control groups, randomization, and blinding (blind tests)
42
Why is it hard to know what adverse effects will take place with long-term use of drugs?
Clinical trial periods are short.
43
Drugs have three types of names. What are they?
1. chemical name (n-acetyl-para-aminophenol) 2. generic or non-proprietary name (acetaminophen) 3. Trade or proprietary name (brand name - tylenol)
44
If there is a new med on the market that does the same thing as a drug that has been on the market for years, which do you prescribe?
The old. It has known side effects and effectiveness. The new one might have unknown risks.
45
T or F: Brand name products can change active ingredients without changing the product name.
True. This may be dangerous for someone who may have problems with the new active ingredient. Inform patients about brand name medicines and this possibility.
46
Why is labeling medication with the generic name (instead of the trade/brand name) a good idea?
If a patient has multiple doctors prescribing a med such as ibuprofen, the bottles will read the same and will be more easily recognized by the patient. This will decrease the chance of double dosing.
47
T or F: Brand name products can change active ingredients without changing the product name.
True. This may be dangerous for someone who may have problems with the new active ingredient. Inform patients about OTC medicines and this possibility.
48
Is there a diff in the drug of two brands of the same drug?
No. The difference may be absorption rate and/or fillers....
49
When a drug is first developed, it is known as a mix of chemicals. Although the _____ ______ means nothing to the general population, it is very meaningful to researchers and drugs companies.
chemical name
50
Once a drug clears phase I to III, it is ready to be put on the market and given a _____ ______or _____ ____. Sometimes called proprietary name.
brand name or trade name.Example: Aleve is the brand/trade name.
51
Once the patent period has ended, the drug's trademark is no longer protected, so other companies ma produce it under a ______ _______.
Generic Name
52
What is the difference between generic drugs and the original drug?
Fillers.
53
How can you tell if the name of a drug is generic?
lower case first letter unless it's the first word in a sentence.
54
When a drug is first developed it is known as a mix of _____. It gets a _____ name. This helps researchers and people who want to copy the drug.
chemicals; chemicals
55
Once a drug clears phases I to III of clinical trials, it is given a name to be on the market. What is that name called?
Can be referred to as brand, proprietary or trade name.
56
Once the patent or trademark status is no longer protected, the drug is produced by others under its ____ name.
generic
57
What is the difference between a proprietary and generic drug?
The fillers
58
T or F: Generic names are not capitalized
TRUE
59
READ: Box 4.1 on page 54
FDA requirements for generic remakes
60
T or F: Schedule I is the most controlled, while V is the least.
True p. 56
61
Schedule II drugs have a high potential for _________. ____ number of refills are allowed. Can someone call this prescription in?
Addiction (both psychological and physical); zero refills (ex oxycodone). No, cannot call it in.
62
Schedule III drugs are ________ addictive. Are these refillable?
moderately; refillable - yes (up to 5 times in 6 months). Ex Tylenol 3. Prescriber has to sign.
63
Schedule IV have lower abuse potential. Can this be phoned or faxed in once signed by prescriber?
yes
64
T or F: Prescribers may shorten names by leaving off terms like carbonate, citrate, gluconate, hydrochloride, hydroxide, phosphate, sodium, sulfate.
True.
65
What is the term for "maladaptive pattern of behavior marked by the use of chemical agents"? A second definition is "drug used in a fashion inconsistent with medical or social norms."
substance abuse
66
Some individual may be good at functioning while abusing substances. However, there are physical signs that make them obvious.What are some signs of substance abuse?
1. Changes in sleep patterns2. Excessive weight change3. Excessive sweating4. Excessive tremors5. Poor coordination6. Needle marks
67
What is addiction?
compulsively driven to take drug; often to the exclusion of other activities.
68
If a person has developed _______ , they must increase the amount of drugs used to get the same desired effect.
tolerance
69
After discontinuing a drug, a patient may experience tremors, emotional distress, and hallucinations. These are signs of ________ .
withdrawal
70
What are some behaviors you may spot in a coworker who is abusing drugs?
1. Poor work performance2. Sloppy charting3. Moodiness, restlessness, irritability, and violent temper4. Forgetfulness5. Change in hygiene
71
With pregnancy drug categories, is the beginning of the alphabet more of a concern or less?
Less. A has no increased risk of fetal abnormalities, but X is the exact opposite. It has definitely shown to cause fetal abnormalities.
72
Category ___ : Animal studies have shown adverse effects. No adequate studies in pregnant women.
C - memorization tip: we can't C whether or not it's harmful because there are no studies.
73
Category ____: Adequate well-controlled and observational studies of pregnant women demonstrate risk to fetus. Benefits outweigh risk.
D - memorization tip: D is for demonstrated risk
74
Category ___ ; Positive evidence that harm will absolutely take place. Pregnant women should not take this.
X - memorization tip: cross this one off the list (X it off)
75
If a drug causes birth defects, it is called _______.
teratogenesis (teras = monster + genesis = to produce literally means to produce a monster)
76
Fetal development has three major stages:1. preimplantation 2. embryonic 3. fetal period In which stage can teratogens cause demise of the conceptus (fertilized egg)?
First stage: perimplantation. The fertilized egg has not implanted at this point. Kennet said fetal demise, however, it is not yet referred to as a fetus.
77
During which stage of fetal development does gross malformations (including anatomic distortions) occur? Hint: think about what happens during each stage. During which stage do major organs and structures form?
The embryonic phase (phase 2 - first trimester)
78
During which stage of development would FUNCTION be affected more than malformations?(Hint: by function - think learning disabilities, behavioral issues, etc.)
Fetal period; this is when the brain is developing (2nd - 3rd trimester)
79
T or F: The lack of proof of teratogenicity means a drug is safe.
False!!!!
80
What is the best way to minimize risk to a fetus?
1. Minimize drug use. Do not take any unnecessary drugs!1.Give medication after breast-feeding 2. Avoid drugs that have a long half-life3. Avoid sustained release drugs4. Choose drugs that are excluded from milk (Textbook explains, has examples)5. Avoid drugs that are hazardous (don’t give)6. Lowest dose for shortest period
81
What groups of drugs should be avoided by nursing mothers?
Controlled substances, Anticancer agents/immunosupressants, Others (lithium/nictotine/ergotamine/bromocriptine)See table 9-3 page 93 of ch9 Lehne
82
Intensity of the response to a drug is determined in large part by the concentration - the higher the concentration, the more intense the response. If you gave the same dose to a large and small person, which will have more intense effects?
Smaller.
83
Why is using BSA (Body Surface Area - mg per m2) an accurate way to adjust a dosage?
BSA determinations account for weight AND for how fat or lean the person is. The percentage of body fat can change distribution thereby changing concentration.
84
What affect does age have on drug sensitivity?
Infants are sensitive because of organ immaturity.Elderly are sensitive due to organ degeneration and first pass effect decreases.
85
T or F: Abnormal pathophysiology does not affect drug response.
False! Kidney disease, liver disease, acid-base imbalance and altered electrolyte status can affect drug response.
86
Kidney disease, such as nephrosclerosis, can reduce ________, causing drugs to accumulate in the body (potentially to a toxic level).
Excretion. The dosage must be reduced when this is happening.
87
If liver function declines, rates of ______ will decline too, and drug level will climb.
metabolism
88
T or F: Changes in acid-base status can alter absorption, distribution, metabolism, and excretion of drugs.
True. Drugs accumulate on the side where the pH most favors its ionization (remember acid ionizes in alkaline, alkaline ionizes in acid).
89
What is an example of altered electrolyte status affecting drug response?
Digoxin, a drug for heart disease can cause dysrhythmias when potassium levels are depressed.
90
NOT IN PPT: Tolerance resulting from accelerated drug metabolism...
Metabolic Tolerance; dosage must be increased to maintain therapeutic levels.
91
NOT IN PPT: ________ is a form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time. An example is leaving a transdermal nitroglycerin patch on for 24 hours. Must be removed and fiven intermittently to allow cofactors to be replenished.
tachyphylaxis
92
NOT IN PPT: __________ refers to the ability of a drug to reach the systemic circulation from its site of administration.
bioavailability; different formulations can alter bioavailability, and can thereby make drug responses variable.
93
What is CYP2D6?
An enzyme; a member of the cytochrome P450 family of enzymes involved in the oxidative metabolism of drugs. CYP2D6 is responsible for the metabolism and elimination of approximately 25% of clinically used drugs.
94
If a person inherited a deficiency in the CYP2D6 gene, and the drug requires activation by the CYP2D6 enzyme what happens to metabolism?
Metabolism of the drug slows AND toxicity may occur. The dosage may need to be adjusted. The FDA does not require testing for this deficiency but a test is available.
95
What happens if a person takes two drugs requiring CYP2D6?
They have a drug-drug interaction.
96
Does ethnicity change the likelihood of having a CYP2D6 Deficiency?
Yes. African Americans and Middle Eastern people have highest risk of deficiency. Asians have the lowest.
97
What is the purpose of testing CYP2C19?
to determine haplotypes, which tells us what type of metabolizer the person is. Helps predict side effects and expected outcomes of benefit.
98
T or F: Gene changes can affect how well a medication works and the risks of side effects.
True. If the genes that produce particular enzymes used in drug metabolism decline, so will the enzymes and therefore metabolism.
99
What are some reasons that pediatric patients are more sensitive to drugs?
1. ogran system immaturity2. pharmacokinetics are different than adults
100
What are some pharmacokinetic differences from adults in pediatrics ?
1. Absorption BEHIND THE SHORT ANSWER:ORAL:gastric emptying is irregular and unpredictable, therefore oral drug impact is not predictable-low acidity in the stomach allows acid-labile drug absorption; not good when not intended. IM: low blood flow to muscles slows absorption. TransDerm: infant skin super thin and allows too much in causing toxicity.2. DISTRIBUTION (protein binding and entrance through BBB)BEHIND THE SHORT ANSWER: Pediatric pt has less available albumin to bind to for transport. BBB is underdeveloped in infants, allowing chemicals to reach the brain.3. METABOLISM (hepatic)BEHIND THE SHORT ANSWER: Capacity of liver to metabolize increases after one month, fully developed at one year. From 1-2 y/o, children metabolize drugs faster than adults. At age 2, decreases.5. EXCRETION (renal)BEHIND THE SHORT ANSWER: excretion limited in infant; inability to move drugs along. adult levels reached at one year. need reduced dosages.
101
T or F: When medication is administered subcutaneously to a pediatric patient, the levels remain above MEC longer AND effects are more intense and prolonged.
True; 25 minutes until effectsIM takes 15-20 minutes
102
T or F: When a drug is administered to a pediatric patient intravenously, the levels decline more slowly in the infant than in an adult, yet have the quickest effect.
True; as little as 15 minutes to work.
103
The aging process can affect pharmacokinetics. How is absorption affected?
Absorp. rate may be affected due to delayed gastric emptying and reduced splanchnic blood flow. Gastric acidity is reduced in the elderly, may later absorp.
104
Four major factors can alter drug distribution in the elderly. What are they?
(1) Increased body fat - BACKGROUND: creates a storage depot for lipi-soluble drugs; causes plasma level of drugs to be reduced,thereby reducing response.+(2) decreased percent lean body mass & (3) Decreased total body water and - BACKGROUND: water soluble drugs distribute in smaller volume, conc increases and effects intensify.(4) reduced conc. of albumin - BACKGROUND: binding is reducedKennett wrote: cardiac output - can only assume he is stating that this changes with age and slows how the drugs circulate through the body...
105
What are the factors that may alter drug metabolism in the elderly?
1. decreased hepatic flow 2. enzymes
106
What are the factors that may alter drug metabolism in the elderly?
1. decreased renal blood flow 2. number of nephrons
107
T or F: Side note: Drug accumulation (secondary to reduced renal excretion) is the most important cause of adverse drug reactions in the elderly.
True Lehne p100
108
What are some causes of adverse drug reactions and interactions for the elderly?
1. Drug accumulation2. polypharmacy3. multiple pathologies (end up taking multiple meds)4. poor med supervision5. difficulty adhering to med (forgetful, doesn't understand)6. Intentional nonadherence ("I don't need that med")
109
How can nurses help promote adherence?
1. Simplify the regimen2. explain treatment clearly; write it down3. label containers; avoid hard to open containers4. Find easy method: liquid if hard to swallow, etc.5. Monitor therapeutic response, adverse reactions and plasma levels.
110
The acronym FAST means what? Is used for what?
FAST – Facial changes, Arm weakness, Speech changes, Time lapsed.FAST is used to evaluate strokes
Pharmocology
flashcards
Decks in class (22)
# Cards
-
Lehne Book: Chapter 1 - Pharm Orientation13
-
Conversions28
-
Watkins Books: Chapter 3 - Patient Safety in Med Administration48
-
Lehne Book: Chapter 2 - Pharm App in Nursing12
-
Lehne Book: Chapter 3 - Drug Regulation, Development, Names, and Information13
-
Lehne Book: Chapter 4 - Pharmacokinetics63
-
Lehne Book: Chapter 5 - Pharmacodynamics30
-
Lehne Book: Chapter 6 - Drug Interactions14
-
Lehne Book: Chapter 7 - Adverse Drug Reactions and Med Errors24
-
Medical Abbreviations - suffixes - etc.56
-
Watkins Book: Chapter 8 - Dosage17
-
OPTIONAL: Watkins - Ch. 5 - Prescriptions and Labels8
-
Midterm questions-Show n Tell Class Notes44
-
Watkins - Chapter 9 - Enteral Medications and Administration29
-
Watkins - Chapter 10 - Parenteral Medications and Administration20
-
Mixed Books - Naming and Classifying Drugs10
-
Midterm - Combined deck419
-
lehne ch 8: Individual variation in drug response17
-
MIDTERM DECK A98
-
MIDTERM DECK - B96
-
MIDTERM DECK - C110
-
MIDTERM DECK - D110
