1
Q
What are the 3 phases of pharmacology?
A
1= pharmaceutics
2= pharmacodynamics
3= pharmacokinetics
2
Q
What do the 3 phases of pharmacology describe?
A
Relationship between the dose of a drug given to a pt and the activity of the drug in treating pts disorder
3
Q
What does pharmacotheraputics focus on?
A
Clinical use of drugs to prevent + treat disease → defines the principles of drug actions ( chemical )
4
Q
What happens during the pharmaceutical phase? (First phase)
A
Dissolution → drug disintegrates and dissolves in digestive tract
5
Q
What happens in the pharmacokinetic phase? (phase 2)
A
Absorption, distribution, metabolism, excretion (drugs Journey through the body)
6
Q
What happens in the pharmacodynamic phase? (Phase 3)
A
What the drug did to the body ( interactions with receptors, enzymes, or ion channels to produce response)
7
Q
Whats the difference between pharmacokentics and pharmacodynamics?
A
Pharmacokinetics—> what the body does to the drug
Pharmacodynamics —> what the drug does to the body
8
Q
What form of drug allows for quickest absorption?
A
For the med forms allowed to give in 10 D, Liquid form → med is already digested
True quickest absorption = IV → med delivered straight to bloodstream → skips absorption
9
Q
ung stands for?
A
Ointment
10
Q
parenteral meds?
A
Meds administered via IV or injection ( IM (intro muscular), SC (subcutaneous ), and ID (intradermal)
frequently a combination of multiple components → often have more than just one active pharmaceutical ingredient (complex formulations)
Ex. Can have the drug itself, solvents like water, additives/excipients like buffering agents, solubilizing agents, antimicrobial agents,…
11
Q
What are enteric coated tablets?
A
Type of med that’s covered in a special coating to bypass stomach acid and dissolve in the small intestine (has a higher pH) → used to ↓gi side effects
12
Q
Can you crush enteric-coated tabs?
A
No sir! → defeats the purpose, breaks the barrier
13
Q
Ave enteric-coated tablets extended - release (ER) or delayed- release (DR)?
A
They be delayed-release (DR) -coating delays start of release DC only dissolves once in small intestine → once coating dissolves, the med is released quickly
14
Q
Elixir =?
A
Clear fluid with med and either water or alcohol (or both) → often sweetened (but less sweet than syrup meds)
15
Q
Syrup meds =?
A
Thick, sugary , ageous solutions → mask the taste for easier digestion
16
Q
Tincture med=?
A
Medicinal alcoholic extract from plant or vegetable
17
Q
Why are some drugs time-release?
A
Allows the med to be release continuously and more slowly into the blood stream → maintains therapeutic effect over longer period of time
18
Q
Generic drug name vs trade name
A
Generic = harder to pronounce- ex. Acetaminophen
Trade name= common names EX. Tylenol
19
Q
What is the priority of drug therapy?
A
Improve pts well-being → symptom management, slow progression of disease,…
20
Q
What do you need to be aware of to monitor the effects of drug Tx?
A
Intended actions of med + possible adverse effects it can cause
21
Q
What is the therapeutic index?
A
Range of a medications therapeutic level to toxic level
22
Q
If a drug has a low therapeutic index, that means…
A
Small range from therapeutic to toxic ex: warfarin
REQUIRES CLOSER MONITORING
23
Q
If a drug has a high therapeutic index that means…
A
Large range from therapeutic effects to toxic → ex. Penicillin
24
Q
True or false: compromised kidney or liver damage increase chances of drug toxicity
A
True → if ø functioning properly, may not be able to metabolize the drug (liver) or excrete it (kidneys) efficiently → cause a ↑ in drug concentration → lead to toxicity
25
What is the difference between drug tolerance and drug dependence?
Drug tolerance → ↓ response to the med due to repeated use (body adapts to it, no longer has therapeutic effect)
Drug dependence → psychological need for the drug (addiction) ex. Nicotine, horoine, cocaine, methanfetamines...) because they enjoy there effects or physical dependence
26
What is physical dependence?
Physiological need for a drug to avoid withdrawal symptoms → body gets used to regular long-term use of the drug, causing it to go haywire when not in the system (withdrawal)
27
Is physical dependence always associated with addiction?
No - → person com be physically dependent (ex. Take Rx heart meds ) without psychological dependence (addiction))
28
Psychological drug dependence?
Obsessive desire for the effects of a drug → feelings of satisfaction und desire to repeat the use to avoid pain and produce pleasure
- Extremely tied to one's mental state
29
Are older adults more@ risk of drug interaction? If so, why?
Yes they are -→ they usually have more sensitivity to drug effects + usually on many different meds (polypharmacy)
30
What is drug interaction?
When the effects of a med are altered by another substance, like another med, food, drinks, dietary supplements..
Can result in ↓ therapeutic effects, ↑ side effects or dangerous toxicity
31
Can some drug interactions be desired /intentional?
Yes ma'am! → some interactions are done intentionally for therapeutic benefits
Ex. Potassium - sparing diuretics (like Spironolactone) with loop diuretics ( like Furosemide) → loop diuretics cause potassium loss, while potassium sparing diuretics retain potassium → combined to maintain normal potassium levels while still producing the desired effect (excess fluid removal)
Low potassium is bad because it disrupts electrical signals needed for cit muscle and nerve function especially in the heart → leads to potentially fatal arrhythmiaS
32
What is a synergistic drug effect?
2 (or more) drugs given together interact → combined effect= greater than it would have been separately
1+1 = greater than 2
Used to achieve therapeutic effect with lower, less toxic doses of of each drug
Example → combining chemo with radiation → treatment is more effective together
33
What is are the risks with synergistic drug effect?
↑ potential toxicity or unintended side effects (negative effects )
34
What is meant by antagonistic effects of drug interaction?
When combo of 2 (or more) drugs = effects that are less than the sum of each individual drug if they were to be given separately
- one drug reduces or blocks the physiological action of the other → prevent therapeutic response
(1+1= less than 2)
Positive aspect → EX. Using naloxone against an opiddod → naloxone blocks opioid receptors → reverses overdose
Negative aspect → significantly reduces or completely cancels out efficacy of treatment
Ex. Combo of A drug that ↑ bp (as a side effect), with a drug that maintains bp, negates the effect
35
True or false: incompatibility is a term most commonly used to describe certain parenteral drugs resulting in physical or chemical reaction
True →resuts in chemical reaction that produces a change in the solution → cause hazy, precipitation ( crystallization) or lose of drug potency
Can lead to ↓ efficacy of meds, toxic byproduct formation, or hazardous IV tubing blockages
36
Before admin of parental solution you have to
Inspect the bag
Make sure solution =clear and free from suspended particles
Discard if appearance differs from what its supposed to look like
* some parenteral drug are naturally cloudy* ex. Suspension meds, lipid emulsions / lipid -based solutions, some vaccines
37
What are the 2 major kinds of adverse drug events (ADE)?
1- medication errors
2- adverse drug reactions (ADR)
38
Which of the 2 adverse drug events (ADE) are entirely preventable?
Medication errors → happens when there's a breach in the 10 rights of medication administration
39
What is a pharmacological reaction?
pharmacological reaction → dose-dependent (worsen with ↑ doses ), predictable, and non- allergic effect that happens due to the drugs known mechanism of action (expected side effects. Ex. Dizziness, dry mouth... )
Reaction happens within the therapeutic or supra-therapeutic range
40
What is drug hypersensitivity?
Immune - mediated response to a drug
- unpredictable and can be harmful → range from rashes and itchiness to life-threatening anaphylaxis
Can be immediate (within mins to hours after exposure) or delayed (days to weeks after exposure)
41
What is allergic reaction as an adverse drug event?
Unpredictable → immune system mistakenly attacks the med → it identifies the drug as a harmful substance
Common symptoms = hives, itchiness, rashes, fever, facial swelling
Severe symptoms = anaphylaxis → trouble breathing, wheezing, throat tightening, ↓ bp, dizziness, LOC
Can be immediate reaction (within mins to 2 hours ) or delayed ( hours to days after exposure)
42
What is an idiosyncratic reaction in terms of adverse drug events?
Unpredictable and rare → life-threatening reaction that happens for unknown reason (not explained by the drugs mechanism of action)
Often immune mediated response or caused by genetic metabolic deficencies → affect only susceptible people at a small percentage (not common side effects)
Can be dose-dependent, is unpredictable and often has delayed onset (days to weeks after exposure)
43
Do adverse drug reaction events happen outside the therapeutic drug dosage range?
No - within the range → unexpected or undesirable
44
What are the 10 rights of medication administration?
1) right med
2) right dose
3) right client
4) right route
5) right time and frequency
6) right documentation
7) right reason
8) right to client to refuse
9) right client education
10) right evaluation
45
Interms of the right drug/med, what 3 checks do you do?
1) read the MAR (the pts medical administration record) and take the right meds out of storage
2) verify the pts name and hospital number and make sure they match with the MAR
3) compare the med labels with the MAR, check expiration date
46
True of false: it's ok to give your patient their medications that you did not prepare
FALSE → never do this - your pt, your responsibility
47
What dose the right dose mean?
That you are giving your pt the right amount of their medication
→ check the dosage on the MAR and confirm that it's a safe dose
Dosage can depend on pts weight, age, if they have renal or liver function issues...
48
True or false: only tablets that are scored can be cut in half
True
49
What do you look at to determine the right dose of liquid med poured into a cup??
The meniscus
50
How many identifiers do you need to check to ensure you have the right pt?
At least 2 -> band with their name and date of birth, id card,... And compare to the info on the MAR
51
Is it ok to use the pts room number as an identifier?
No sir → room #can change
52
Right route means?
Giving the med by the right route. ( right mode of admin)
53
Can all tablets or capsules be swallowed?
No some are sublingual only (dissolve under the tongue), some capusels are meant to be put in inhalers......
54
The right time refers to?
Giving the pt their meds at the right time of day and at the right frequency
55
BID,TID and QID stand for?
BID → 2x day
TID → 3x day
QID → 4x day
56
ac and pc mean?
Ac = before meals
Pc = after meals
57
q2h,q4h, q6h…
q= every → every 2 hrs, every 4 hours, every 6 hrs...
58
die means?
Daily »ex. @ 8h, or 8h30, 17h
59
What is the window of time that meds can be administered?
30 - 1 hr window → 30 - 1 hr before or after the scheduled time exception → stat meds
60
Can a nurse try to have a med schedule changed?
Yes → ex. Pt to be given diuretic BID @ 9h and 17h
→ you should know that the diuretic should ø be given late in the evening so the cl closest have to yet up to go to the bathroom all night..
61
With right documentation (#6), should you document before or after med admin?
After
62
Do you document if a RX med was not given/taken by the pt?
Yes - document the reason, if the pt was informed of potential consequences of refusal and who you notified + the discussion had
63
The right reason refers to?
Drug ordered is being given for the right reasons → understand the rationale for the med + know the meds action and effects
64
Right client education means?
Educating the pt about the meds they are taking → why they're receiving it, what to expect, any precautions, adverse effects... Name of the med, dose, route, frequency and times of admin should also be given
65
Do clients have a right to refuse meds??
Yes → explore the reason, clarify any misconceptions about the med, inform the pt about potential consequences of refusal...
Communicate w/dr
66
Right evaluation refers to?
Following up of the med effects → was desired affect reached, dry adverse effects,
67
If a med err or happens, who do you inform?
The pt, head nurse, clinical teacher (#1), call the Dr,document
68
Should you use trailing zeros when it comes to med admin?
No - 1.0 mg could be read as 10mg
69
Should you use leading zeros?
Always → 0.25mg is allot more clear than . 25mg
70
Do you give pts expired meds?
Never
71
If a pt questions a med, should you take it into account?
Yes → may be opportunity to identify a med error → talking to and listening to pts con prevent errors (pts questions should be encouraged)
72
Can you leave meds with the pt?
No - have to make sure the meds were ingested (actually given)
73
What symbol represents narcotics on med packaging?
An N
74
What is a schedule 1 drug?
Drugs with a high potential for abuse → no currently accepted medical use
Ex. Heroin
75
What are schedule 2 drugs?
High potential for abuse that can lead to severe psychological or physical dependence
EX. Methamphetamines, adrenal, Ritalin, fentanyl...
76
What are schedule 3 drugs?
Drugs with moderate to low potential for physical and psychological dependence
Ex. Tylenol with codeine, ketamine, testosterone...
77
What are schedule 4 meds?
Drugs with low potential for abuse and low risk of dependence
Ex. Xanax, soma, Valium, ambein...
78
How many people arc needed to dispense and waste narcotics?
2 people - 2 signatures
79
If there is a discrepancy in the #of narcotics you?
Report it immediately
80
What do you check before med admin to pt?
1. Pts history → any cognitive/physical issues that might affect med admin )
2. Allergies (check for red allergy band)
3. Pts current condition, current meds
4. Pts learning needs, their diet
5. Pts medical history
81
What are narcotics?
Opioids → CNS depressants that produce numbing, pain relief, and sleep → highly controlled due to addiction risk → potent class of analgesics for moderate to severe pain
Ex, morphine, fentanyl, oxycodline...
82
What are schedule 5 drugs?
Lowest potential for abuse → have limited quantity of certain narcotics
They're usually used for anticliarrheal, antitussive, and analgesic purposes
83
What is pharmacokinetics?
How the body interacts with a drug — its journey —>
absorption, distribution, metabolism, and excretion
84
What are the 3 characteristics of pharmacokinetics?
Onset of action,
peak effect,
duration
85
What is an essential part in determining the pharmacokentics of a drug?
The route that its given through
86
What are the 4 foci of pharmacokenetics?
Absorption
Distribution
Metabolism
Excretion
87
Absorption of pharmkenetics is?
Movement of the drug from the admin site into the bloodstream so it can be distributed to tissues
88
What does determines the amount that a drug is absorbed and the rate thats absorbed?
bioavailability of the drug which is dependent on route
89
Which route of drug administration has 100% bioavailability?
Iv - goes directly into blood stream, surpasses the need for liver metabolism
90
Bioavailability is?
The percentage of the dose that enters the bloodstream stream
Can range from 0-100%
91
What effect reduces the bioavailability of a med to less than 100%
First pass metabolism
92
Do enteric coated meds bypass first pass metabolism?
Not really → they're absorbed in the small intestine and then go to the liver (still undergo first pass metabolism )
Their purpose = protect the stomach from irritation → coating only dissolves in higher pH enviros
93
What factors can alter the absorption of drugs?
Many factors
Ex. Acid changes (time of day changes the acidity of the stomach- food too..)
- previous abdominal surgery
- sepsis
Exercise - pulls blood away from the gi tract - less blood flow, less absorption
94
The fastest route a drug can be absorbed is?
Parenteral route, followed by enteral (PO) and then topical routes
95
What layer of skin do subcuanteous injections reach?
Fatty subcutaneous tissues under the dermal layer (adipose tissues)
96
What can affect the absorption rate of the subcutaneous, intradermal, or intramuscular parenteral routes?
Absorption can be increased or decreased if any of the sites have damage or if the pt is in shock —-> absorption is dependent on blood flow
97
Explain the topical route
Application of med, like onitments, eye drops, ear drops… to a given body surface
Gives uniform amount of drug over longer time period
98
Where can topical meds be applied?
Skin
Eyes
Ears
Nose
Lungs (less often)
Rectum (specialized form of topical meds - suppository)
Vaginal (speciialized form of topical meds- suppository)
99
Are inhalation meds a type of topical med?
Yes
100
Are the effects of ointment localized or systemic?
Localized
101
What does distribution in pharmacokinetics imply?
Transport of a drug by bloodstream to the site of action
102
What protein is the most common blood protein that carries majority of protein - bound drug molecules?
Albumin
103
Does having less protein in the body increase or decrease the risk of drug toxicity?
Increases risk- less proteins = less opportunities for drug to bound its self to protein → more free, active drug in body, ↑ concentration
Need to be careful w/dosing pts that are malnourished (less proteins) or who have severe burns
104
Which body sites make drug absorption more difficult?
Sites with poor blood supply (ex.bones)
Certain body barriers - ex. Blood-brain barrier (highly selective, semi- permeable membrane → shields brain from toxins + pathogens that might be in the bloodstream
105
What is the term for drug metabolism and where does it happen in the body?
Drug metabolism = biotransformation → biochemical alteration of drug
Happens in the liver, (mostly) but also skeletal muscle, kidneys, lungs, and intestinal mucosa
106
What is hepatic metabolism?
Large class of enzymes, cytochrome p450 in liver metabolize drug
107
What is the main property of cytochrome p450 (microsmal enzyme)?
Lipophilic → fat loving
108
What can alter drug metabolism (biotransformation)?
Diseases that affect the liver
Age
109
Drugs that stimulate biotransformation=?
Enzyme inducers
110
Which organ is primarily responsible for the secretion (elimination) and excretion of drugs?
Kidneys - through glomerular filtration, active tubular reabsorption, and active tubular secretion.
Liver also secretes drug molecules into bile but kidneys= main excretory route for drugs
111
What 2 other organs also help with drug excretion?
Liver and the bowels (intestine)
112
What disease can affect renal drug elimination?
Chronic kidney disease (CKD)
(Have to use renal doses or else may have build up because kidneys ø excrete properly/enough )
113
114
What is another route of drug excretion?
Biliary excretion ( by intestines) → drug taken up by liver then released into the bile and eliminated into poop
115
What are the 4 less common routes of elimination?
Lungs, sweet glands, salivary glands, and mammory glands
116
What is drug half-life?
The time needed for the concentration or amount of the drug in the body to ↓ by exactly 50% → drugs have multiple half- lives
Ex. After 1 half-life,50% of drug remains
After 2 half-lives, 25% of drug
After 3 half life, 12.5%
After4, 6.25 % left in body
117
How many half-lives until most drugs are excreted?
After ~5 half-lives (97%)
118
Peak level of drug =?
Point of highest drug concentration in the body →
119
Through level of drug =?
Point of lowest drug concentration in body
120
Onset of action of a drug is?
Time need for drug to initiate a therapeutic response →depends on drug admin route!
121
Peck effect of drug =?
Time needled for drug to reach maximal therapeutic response
122
Duration of action of drug=?
Length of time its concentration is enough (without additional doses ) to keep therapeutic response
123
Pharmacodynamics =?
What drug does to the body →relationship between drug concentration and action of the drug
124
What determines the way a drug will work in the body? (3)
Receptors,
enzymes or transporter proteins
Non-selective interactions
125
What is the reactive site on the surface or inside a cell?
Receptors
126
What happens when a drug molecule joins with a reactive cite/receptor?
When drug molecule joins with a reactive site on the surface or inside a body cell= drug-receptor interaction
127
What happens once drug binds + interacts with receptors on/in a cell??
Pharmacological response
128
Best fit refers to?
Strongest affinity →. Drug with best fit for a receptor elects the greatest response form the cell
129
True or false: the higher the affinity, the weaker the receptor- drug bond @ lower concentrations
False → higher affinity: = stronger bond (they like eachother, want to be close together)
130
What are agonist drugs?
Drugs with best fit → complete attachment to a given cell ( lock and key)
Activates the receptor to produce biological response → they trigger action whereas antagonist drugs stop action (block)
131
Do agonist drugs stimulate activate or block/inhibit a response from the receptor?
They stimulate a response → activate the receptor to produce biological response (trigger action)
EX. Opioids
132
What are antagonist drugs?
Drugs that attach to receptor, but ø elect response - they block the receptor sites → preventing natural body substances or other drugs from activating the cell
Ex. Naloxone → reverses opioid overdose by blocking the drug molecules from binding to receptors (naloxone gets there first, opioid ø bind )
Antagonists have affinity to receptors like agonists BUT they ø trigger biochemical response
133
A client receiving histamine antagonist to treat their gastric ulcer, asks the nurse how the drug works in the body. The nurse explains: (choose the right response)
A) it mimics the action of the chemical histamine
B) it is precursor to the histamine molecule naturally produced by your body
C) it blocks the action of histamine in your stomach
D) it stimulates the action of histamine in your stomach
C) antagonists block - stop action
134
What is a drug- enzyme interaction?
Happens when drugs inhibit or induce metabolic enzymes →drug binds to the enzyme causing an alteration of the enzymes interaction with normal target molecules in the body
135
What are the 2 types of drug-enzyme interactions?
Enzyme inhibition → drug (inhibitor) binds to enzyme → blocks it's ability to metabolize a second drug (substrate) →↑ levels of of substrate drug in body I * may cause toxicity) *
↓ enzyme activity)
Enzyme induction → drug (inducer) ↑ production or activity of metabolic enzymes → causes faster metabolism of substrate drug- →↓ drug con.in blood
* may cause sub-therapeutic con. *
( ↑ enzyme activity)
136
What are non-selective drug interactions?
Drug has no interaction with enzymes or cell receptors → alter and interfere with cell structure or function
137
138
Give an example of non-selective drug interactions
Chemotherapy drugs »→ chemo interfere with the rapid grow and multiplication of cancer cells and their structure → stops the creation of all new cells and thus cancer cells
139
What is the opqrstuv pain assessment?
0 = onset
P= palliation or provocation
Q = quality (pain scale)
R= radiation radiating
S= severity
T= treatment or timing
U= understanding of the pain
V= values (ex. Culture views on pain...)
140
How does pain come about? (Physiologically)
Stimulation of sensory nerve fibres → nociceptors
They transmit pain signals from given body regions to spinal cord and brain-→ leads to nociception (reception of nociceptor signals)
141
Describe acute pain
Sudden onset of pain → short-term
142
Chronic pain is pain that lasts more than?
3-6 months → is daily or recurrent
143
Noceceptive pain is?
Pain that happens because of pain signals nociceptors send to the brain as result of chemical, thermal, or mechanical stimuli
144
What are the 2 types of nociceptive pain?
Visceral → pain that comes from internal organs in the thoracic, abdominal, or pelvic cavities ex. Pain that happens with appendicitis
Not well localized → hard to pinpoint
Somatic → pain that comes from damage to muskloseletal system, skin, or connective tissues
Ex. Bones, muscles, and joints
Well-localized → easy to pinpoint
145
What is somatic noceceptive pain?
Pain that comes from the damaged skin, muscles, skeleton, ligament, or joints
EX) back ache, hip pain
Well localized, often sharp, achy
146
You start _ and go- with pain meds
Start low, go slow
147
What are the 3 categories of analgesics ?
1) opioids → narcotics (morphine, dilated...) top class
2) non-opioids → Tylenol, Advil, aspirins
3) adjuvant meds → Ø true analgesics, but secondary effects treat pain→ mainly to ↑ effectiveness of primary analgesics or for specific pain
148
What are some examples of adjuvant medications?
Antidepressants, anticonvulsants, corticosteroids, muscle relaxants
149
What category of analgesic is the main choice for mild to moderate pain?
Non- opioid analgesics → anti prostaglandins
150
What are the 2 sub categories of non-opioids?
NSAIDs (anti-inflammatory). Ex → Advil, aspirin
non- NSAIDs (ø anti-imm properties → ex. Tylenol
151
What is the main job of NSAIDs?
↓ inflammation, ↓ fever (ant-pyretic),↓ pain
152
How do NSAIDs work?
By inhibiting cyclooxygenase (cox) → inhibits pain mediators (transporters) at the nociceptor level (nerve endings )
Blocks pain from going to head
153
What is cyclooxygenase (cox)?
Enzyme that converts arachidonic acid into prostaglandins
154
What are prostaglandins?
Signalling molecules that make nerve endings more sensitive to stimuli → magnify pain signals
155
What is cox 1 enzyme?
Version of cyclooxygenase that creates prostaglandins that do house keeping functions
Protects the stomach and intestinal lining
Activates platlets (helps with blood clotting)
156
What is cox 2 enzyme?
Type of cyclooxygenase enzyme that makes prostaglandins in response to tissue damage or cellular distress → promote healing and immune response
Lead to inflammation, pain and fever
157
Do NSAIDs inhibit both cox-1 and cox-2 from making their prostilandings?
Yes but some can target one more than the other
158
Describe how acetylsalicyic acid (aspirin) works
Molecules of aspirin enter cell → chemically modify cox enzymes, especially cox 1. → block them from making their prostaglandins
↓ pain, ↓ fever ↓inflammation
↓ work of platlets (blood-thinner) →can protect against MI and stroke → thinner blood= ↓ thrombi formation thrombosis ( formation of blood clots) → ↓ injury to heart ( no clot formation in coronary arteries= no heart attack ), or brain (no thrombi in arteries supplying brain =no stroke) →=thrombotic stroke
also ↓embolism ( travaling thrombi) → which can cause strokes (embolic stroke)
159
What are the adverse effects of aspirin?
Short-term → dyspepsia (indigestion), heartburn, epigastric distress, nausea
Severe → GI bleeding → very good COX1 inhibitor so stops them from making stomach protecting ( stomach acid ↑ gi risk because ø protection) + platelet production ( ↓ platelet production, ↑ bleeding )
160
Is aspirin still good to use if it smells like vinegar?
No → straight to garbage
161
Salicylate toxicity means?
Aspirin Poisoning → too much aspirin in body → ↓ blood pH → causes ( metabolic acidosis ) and respiratory alkalosis (hyperventilation)
Early signs = ringing in ear (tinnitus), loss of hearing, nausea, vaunting...
Can also be caused by other salicylate containing products ex. Pepto- bismol
162
What are the signs + symptoms of aspirin toxicity?
Tinnitus
Hearing loss
163
Does aspirin have an antidote?
No - activated charcoal used to ↓absorption
164
Do you give aspirin to children?
No → risk of Reyes syndrome (inflammation of brain + liver - can be fatal )
Kids ø metabolize good enough
165
Should NSAIDs be used for pts who take ace inhibitors (meds that ↓ BP )?
No - ↑ risk of acute kidney injury + make their bp↓ job less effective
166
Should you take antiacids (ex. Tuns) with NSAIDs?
No → effects absorption,→↓nsaid effect, →ø pain management
167
Is Tylenol (acetomenaphin) an NSAID ?
No - has no anti-inflammatory properties (works more with CNS ø as cox inhibitors)
168
What is the maximum daily dose of Tylenol?
4 g die (4000 mg)
169
If pt has hepatic issues (liver problems) what be the max dose of Tylenol?
2 g die → liver function ↓ so Ø filter out the med as good → can cause build up, con cause liver damage + possible toxicity
170
Why is Tylenol and alcohol a bad pair?
Both are metabolized in liver → when paired,↑ strain on liver,↑ toxin production in liver → ↑ liver damage
171
What is Tylenol toxicity antidote ?
Acetylcysteine (mucomyst) → stops toxins from forming in liver → protects liver → 100% effectiveness within 8-10 hrs of overdose
Given po or IV
172
What type of pain are opioids/ narcotics used for?
Moderate (4-6) - severe pain (7-10)
173
What forms can opioids come in?
Oral (long or short acting)
Parental (IV or injections)
Transdermal patch
174
How do opioids work as analgesics?
Alter persons perception + emotional response to pain
Person goes to a happy place mentally → change pain interpretation
Act directly on the CNS → alter brains perception of pain
They're potent and addictive
175
Are opioids agonists?
Yes → bind to receptors in brain + nervous system so that pain receptors can't → close the gate
176
What is the PRESSS assessment for opioid adverse effects?
P = pain level
R= respiratory rate (opioids can RR )
E= effects.
S = sedation level
S= 02 saturation
S= safety
177
What is the major, life threatening side effect of opioids?
Respiratory depression → often fatal breathing disorder- too slow or shallow breathing, ↑ CO 2 levels
Death from overdose almost always caused by this
178
Who is most at risk for opioid induced respiratory depression? (3)
Opioid naive ppl (never taken before)
Elderly
Ppl abusing the drug
179
What do you need to monitor before + after admin of opioids?
Respiratory rate
180
What is the antidote to opioids?
Narcan → stops opioid from biding
But → half-life= 60 -90 mins ( 50% of drug effect gone)
Opioid stays in system longer → may need more doses
Narcan = antidote for all opioids (universal antidote)
Knocks off opioids from the opioid receptors → reverses respiratory depression that causes death
181
How long do po opioids stay in system?
Peak = 90 - 120 mins
Duration of total action = 240 mins
182
Hou long do IM and subcut routes of opioids stay in body?
Peak= 30-60 mins
Duration of action = 240 mins
183
How long do IV opioids stay in system?
Peak= 10-30 mins
Duration of action n= 120 - 180 mins
184
What are the consequences of Narcan?
For ppl with physical dependence on opioids, Narcan can cause sudden, intense withdrawal symptoms
185
What causes addictions to opioids?
The side effect of euphoria
186
Emesis is?
Vomiting
187
Missis is?
Pinpoint pupils
188
An 86-year-old patient is being discharged to home on digoxin and has little information regarding the medication. Which statement best reflects a realistic outcome of patient teaching activities?
A. The patient and the patient’s adult child will state the proper way to take the drug.
B. The nurse will provide teaching about the drugs adverse effects.
C. The patient will state all the symptoms of toxicity.
D. The patient will call the prescriber if adverse effects occur.
A. The patient and the their adult child Will understand the proper way to take the drug
Looking for OUTCOME of teaching
189
A patient has a new prescription for a blood pressure medication that causes them to feel dizzy during the first days of therapy. What is the best nursing diagnosis for this situation?
A) activity intolerance
B) potential for injury
C) disturbed body image
D) self-care deficit.
B) dizziness = potential for injury, ↑ risk of falls
190
A patient’s chart includes an order that reads as follows med 0.025 MCG once daily at 9 o’clock. Which action by the nurse is correct?
A) the nurse gives the drug via the transdermal route
B) The nurse gives the drug orally
C) The nurse gives the drug intravenously
D) The nurse contacts the prescriber to clarify the dosage route
D → they ø indicate route
191
The nurse is compiling a drug history for a patient. Which question from the nurse will obtain the most information from the patient?
A) Do you depend on sleeping pills to get to sleep?
B) Do you have a family history of heart disease?
C) When you have pain, what do you do to relieve it?
D) What childhood diseases did you have?
A) → nurse needs direct info about the pts med habits
192
A 77-year-old man has been diagnosed with an upper respiratory infection tells the nurse that he is allergic to penicillin. What is the most appropriate response by the nurse?
A) That is to be expected. Lots of people are all allergic to penicillin.
B) this allergy is not a major concern because the drug is given so commonly
C) what type of reaction did you have when you took penicillin?
D) drug allergies don’t usually occur in older individuals because they have built-up resistance
C)
193
The nurse is preparing a care plan for a patient who has been newly diagnosed with type two diabetes. . put into correct order the steps of the nursing process with one being the first step in five being the last step.
1) implementation
2) planning
3) assessment
4) evaluation
5) nursing diagnosis
Assessment, nursing diagnosis, planning, implementation, evaluation
194
The nurse is reviewing new medication orders that have been written for a newly admitted patient. Which orders will the nurse need to clarify? Select all that apply.
A) Metformin (glucophage) 1000 mg po bid
B) stagliptin (januvia) 50 mg die
C) simvasatin ( zocor ) 20mg PO every evening
D) irbesartan (avapro) 300 mg po once daily
E) docusate ( colace ) prn for constipation
B) no route
C) needs dosing time or indication (too generalized)
E) pro orders should include specific parameters to guide admin
→ indication criteria - when to give
→ frequency limit - ex. Minimum 2 die
195
The nurse is reviewing data collected from medication history. Which of these data are considered objective data? Select all that apply.
A) white blood cell count to 22,000 MM 3
B) blood pressure 150 –904MMHG
C) patient rates pain as an 8 on a 10 point scale
D) patient spouse report reports that the patient has been very sleepy during the day
E ) patient’s weight is 68 KG 
A, B, E,
196
Which measures does the nurse keep in mind to reduce the risk of medical errors?
A) when questioning a drug order keep in mind that the prescriber is correct
B) be careful about questioning the drug order that a board certified physician has written for a patient
C) always double check the many drugs with sound alike and look alike names because of the high risk of
D) if the drug route has not been specified, use the oral route 
C
197
During the medication administration process, it is important that the nurse remembers which guideline?
A) when in doubt about a drug ask colleague about it before giving the drug
B) ask what the patient knows about the drug before giving it
C) when giving a new drug be sure to read about it after giving it
D) if a patient expresses a concern about a drug stop, listening and investigate the concerns
A) → key guideline is to verify information when in doubt before admin
D is an important paitent-centered practice
198
If a student nurse realizes that a drug error has been made, the instructor should remind the student of what concept?
A) The student bear is no legal responsibility when giving medication’s
B) The major legal responsibility lies with the healthcare institution at which the student is placed for nursing practice experience
C) the major legal responsibility for drug errors, lies with the, faculty members
D) Once the student has committed an ME, the responsibility is to the patient and to being honest and accountable
D → prioritize pt safety and honestly
199
The nurse is giving medications to a newly admitted patient who is receiving nothing by mouth and finds an order written as follows medication 250 MCG stat - which action is appropriate
A) give the medication immediately stat by mouth because the patient has no intravenous access at the time
B) Clarify the order with the prescribing physician before giving the drug
C) ask the charge nurse which route the physician meant to use
D) Start an IV line and then give the medication IV so that it will work faster because the patient status is NPO at the time
B)
200
The nurse reviewing medication orders, which dose is written correctly?
A) med . 25 mg
B) med .250 mg
C) med 0.250 mg
D) med 0.25 mg
D
C has an extra number that's Ø needed
201
250 micrograms is how many milligrams?
250 mCg =x mg
250 divided by 1000 = 0.25 mg
202
The nurse is performing medication reconciliation during patient’s admission assessment. Which question by the nurse reflects medical reconciliation?
a) do you have any medication allergies?
B) do you have a list of all the medication’s including over-the-counter you are currently taking
C) Do you need to take anything to help you sleep at night?
D) What pharmacist do you use when you fill your prescriptions? 
B ) → med reconciliation = accurate, complete list of all medications pt is taking
203
Patient should be identified using how many patient identifiers, neither of which can be the ?
2 pt identifiers, neither of which can be room #
204
An opioid analgesic is provided prescribed for a patient. The nurse checks the patient’s medical history, knowing the medication is contradicted in which disorder?
A) renal insufficiency
B) severe asthma
C) liver disease
D) diabetes
C) opioid analgesics are primarily metabolized by the liver → pt w/ liver disease, ↑ risk of toxicity or adverse effects
205
Several patients have standard 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 the therapy. Which of the following patients should receive an alternative medication?
A) a patient with a fever of 39.7°c
B) a patient admitted with deep vein thrombosis
C) a patient admitted with severe hepatitis
D) a patient who had abdominal surgery one week earlier
C→ acetaminophen contraindicated in pts w/ severe liver disease → can cause hepatoxicity
206
A patient with bone pain caused by metastatic cancer will be receiving transdermal fentanyl patches. The patient asked the nurse what benefits these patches will have. The nurse best response includes, which of these features?
A) More constant drug levels for analgesia
B) Less constipation and minimal dry mouth
C ) Less drowsiness than with oral opioid
D) Lower dependency potential and no major adverse effects
A → transdermal opioid patches give steady, continuous release of meds for sustained pain relief
207
Sam’s nurse uses gentle touch to soothe him after his physical examination. The intent of gentle massage is to provide comfort. What is this non-pharmacological pain intervention known as?
A) recall
B) Distract
C) imagery
D) Relaxation technique
D
208
Does acetaminophen have a renal dose?
No - because its primarily metabolized in the liver into inactive, no toxic compounds that Ø hurt the kidneys
Acetaminophen = safest analgesic for ppl with renal dysfunction/disease
NSAIDs (Advil, aspirin ) should be avoided → NSAIDs inhibit prostaglandins needed for maintaining blood flow to kidneys bc stop cox-2 from making those prostaglandins
* NSAIDs and acetaminophen both inhibit cox BUT, NSAIDs work in the brain + throughout the body whereas acetaminophen / non-asaids only work in the CNS *
Nursing Unit Two
flashcards
Decks in class (11)
# Cards
-
Pharm208
-
Needs And Organizers + Nursing Process (Npp)61
-
Coping With Loss21
-
Growth And Development20
-
Comfort And Pain28
-
Hazards Of Immobility55
-
Communication: Documentation, TNP, ISBAR9
-
Illness31
-
Lab 5 → Aids To Saftey And Activity And Feeding61
-
Lab 6 → Med Admin100
-
Pre-clinical Diagnoses7
