Pharmacology Exam #1

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Chapters 2, 3, 7, 43, and 45

nurse practice act

rules and regulations est. by state boards as to what a nurse can and can not do

standards of care

guidelines developed for the practice of nursing

before admin. any meds. what must the nurse have?

current license, policy statement that authorizes the act, med order signed by Dx w/ prescriptive privileges, understand the Pt's Diagnosis and symptoms, and correlate w/ the rationale for drug use, know why med is ordered, expected actions, usual dosing, proper dilution, route and rate of asmin. side effects to expect/report, contraindications of the drug, if IV know how to calculate the drip factor, and the compatibility, site be confirmed before admin, accurate calculations, and Pt teaching

claiming unfamiliarity w/ any nursing responsibililites, when avoidable complications, is what?

unacceptable and is considered negligence of nursing responsibility

Summary sheet

gives Pt's name, address, dob, attending physician, gender, marital status, allergies, nearest relative, occupation and employer, insurance carrier, religion, date of admin, Dx, previous hospital admissions

Consent form

grants permission to HC facility and Doc. to provide treatment.

Physician's Order form

all procedures and treatments are ordered by the Doc. are on this form...they MUST be on this form

History & physical Exam form

full exam/interviewed and all findings are listed (recorded) on this form

Progress Notes

recording frequent observations of the Pt's health status

Critical Pathways

also referred to as integrated care plans, care or clinical maps... this describes a multidisciplinary plan used by all caregivers to tract the Pt's progress

Nurses Notes

start w/ a Nursing History

Nursing History

head to toe physical assessment and a Pt and family History, cultural data...spiritual needs

Nursing Care Plan

incorporate nursing Diagnosis, Critical Pathway information and physician ordered & nursing ordered care

Lab. Tests Record

where all lab tests results are kept in one section of the chart

Graphic Record

graphing Pt's info....temp. pulse, respiration, BP

Flow Sheets

condensed form for recording info. for quick comparison

Consultation Reports

where the specialists summary of findings is recorded

Medication Administration Record (MAR)

printed from Pt database, insuring that the Pharmacist and the nurse have identical medication profiles for the PT, it also provides space for recording the time the med was administered and who gave it. nurse also records her initials and time admin

PRN

as necessary

Unscheduled Med. Orders

PRN meds are recorded on a separate MAR sheet

Case Mgmnt.

to coordinate Pt care provided to individuals, their families and sig. others on a continuum

Kardex (this is not legal doc)

large index card kept on flip file of seperate holder that contains personal info, Dx, allergies, schedule of current meds, w/ stop dates,treatments, Pt's name, and the current meds

Floor or Ward Stock System

no charges, small hospitals, dangerous drugs are kept at the nursing station, gov. hospitals, increased danger of of unnoticed passing of expiration date, increased amts of expired drugs to be discarded, INCREASED POTENTIAL FOR MEDICATION ERRORS BECAUSE OF THE LARGE ARRAY OF DRUGS STOCKED IN THE CART....PHAMASISTS DOES NOT GET THE OPPORTUNITY TO OVERSEE WHAT IS HANDED OUT

individual prescription order system

meds are dispensed from the pahrm. upon receipt of prescription or drug order for an individual Pt, usually a 3-5 day supply

Computer Controlled Dispensing System

newer, that is supplied by pharmacy daily, and stocked w/ singel unit packages of meds. scanners are used, barcodes, i the wrong med for that Pt is selected an alarm will sound to stop the nurse...this is the SAFEST AND MOST ECOMICAL METHOD TODAY

Unit Dose System

single unit dose, placed in drawers assigned to that Pt,, pharmacists can over see and make any adjustments or watch for contraindications, no dose calculations, credit is given for unused unopened meds....THE ONLY PROBLEM IS THAT THESE MEDS WERE PREPARED BY SOMEONE "OTHER" THAN THE NURSE

Long Term Care Unit Dose System

1 weeks worth......Pt has drawer, used in acute care, this may have a color code system as well that is used...for PRN, AM, PM, Noon...etc

Stat Order

emergency basis....only 1 time

Single Order

admin at a certain time only oncem

Standing Order

specific number of doses

Renewal Order

must be written and signed by Doc before nurse can continue

PRN Order

as necessary needed by the Pt (If needed)

ADE's Adverse Drug Reaction

serious drug complications...mostly happen at the ordering and administration stage

Verification

nurse is to be sure med is Ok to admin. if not notify the prescriber and give an explanation as to why the order should not be executed

Transcription

after the order is verified, then the nurse transcribes the order from the Doc's order sheet onto the Cardex or onto an MAR

the 6 "R's"

Right: Drug, Time, Dose, Patient, Route, Documentation,

why are standards of care essential to nursing practice?

they are guidelines developed for the practice of nursing , developed by each state, nurses must adhere to minimum standards of state regulatory authorities, so all is sure that nurses are educated to to all the necessary tasks that are needed in their medical field...calculations, preparations, administrations of meds etc

if Pt refuses an essential heart med that has been prescribed,,,,what should the nurse so?

seek Pt reasons

general guidelines for entering nurses' notes includes nursing entries whenever?

periodically throughout the shift as care needs dictate.....ASAP

Computerized Prescriber Order Entry (CPOE) is good for what?

checking (electronically) for potential drug interactions, assoc w/ Lab. values and appropriateness of drugs ordered

telephone order is used when?

only in an acute emergency

what was the last "R" added to the 5 now 6 "R's"

Right Documentation

if nurse can not read a Doc's order for med...what should the nurse do?

call the Doc to have the order clarified

most medication errors occur when?

the nurse fails to follow routine procedures

receptors

drugs form chemical bonds with specific sites, this bond forms only if the drug and its receptor have similar shape....lock and key idea...

pharmacodynamics

the study of interactions between drugs and their receptors and the series of events that result in a pharmacologic response

agonists

drugs that interact w/ a receptor to stimulate a response

antagonists

drugs that attach to a receptor but do not stimulate a response

partial agonists

drugs that interact w/ a receptor to stimulate a response BUT, inhibit other responses

ADME

this is what happens to drugs once they are administered....ABSORPTION, DISTRIBUTION, METABOLISM, EXCTRETION

pharmocokinetics

is the study of mathematical relationships among ADME of individual meds over time

absorption

is process a drug is transferred from its site of entry into the body to the circulating fluids of the body for distro (ie blood and lymph)

enteral (cat 1)

drug is administered directly into the GI tract by oral, rectal, or NG routes

parenteral (cat 2)

routes bypass the GI tract by using Sub Q , IM or IV injections

percutaneous (cat 3)

includes Inhalation, Sublingual (under the tongue) , or Topical

distribution

refers to ways drugs are transported by the circulating body fluids to the sites of action (receptors), metabolism, & excretion

drug blood level

when a drug is circulating in the blood, a sample may be drawn and assayed to determine the amt. of drug present

metabolism

aka (Biotransformation) is the process by which the body inactivates drugs

biotransformation

see metabolism

excretion

elimination of the drug...2 primary routes...GI tract to the feces & thru the renal tubules into the Urine....other routes can be evaporation thru the skin, exhalation, secretion to saliva and breast milk

half life

the amt of time required for 50% of the drug to be eliminated from the body

when circulation is impaired should you give an injection?

circulatory insufficiency & respiratory distress may lead to HYPOXIA & further complicate the situation by resulting in vasoconstriction

Hypoxia

deficient amounts of oxygen in tissue cells

what is the slowest absorption rate?

Sub Q (it is furthest from the veins)

what is more rapid absorption thru?

IM

what is the fastest way for absorption?

IV....but it CANNOT be retrieved

what does heat or coolness do w/ an injection?

coolness slows the absorption and heat speeds it up

what organs receive distro. of drugs more rapidly?

the ones w/ most extensive blood supply....heart, liver, kidneys, & brain

what are 2 factors that influence drug distro?

protein binding & lipid (fat) solubility

only free or unbound portion of a drug is able to diffuse into tissues, interact w/ receptors and produce physiological effects or be metabolized and excreted...T?F

TRUE

what about drugs that are bound to plasma proteins?

they are pharmacologically inactive because the large size of the complex keeps them in the bloodstream & prevents them from reaching the sites of action, metabolism, and exctretion

do more lipid soluble drugs stay in the body longer? T/F

Yes,,,,True

what organ is the primary site for drug metabolism?

Liver

a Pt w/ renal failure often has an increase in what? (when it comes to excretion)

in the action & duration of a drug is the dosage & frequency of admin. are not adjusted to allow for the Pt's reduced renal function

desired effect

expected response (no drug has a single action)

side effects

effect more than 1 system simultaneously

adverse effects

severe side effects

toxicity

level of drug is too high in the blood

parameters

therapeutic actions to expect, side effects to expect , adverse effects to REPORT, & possible drug interactions

idiosyncratic reaction

when something unusual or abnormal happens when a drug is 1st admin.

allergic reaction

aka hypersensitivity....it occurs when PT's have been previously exposed to a drug and have developed antibodies to it from their immune system

urticaria

raised, irregularly shaped patches on the skin...severe itchingche f

hives

same as urticaria

carcinogenicity

is the ability of the drug to induce living cells to mutate & become cancerous

teratogen

a drug that induces BIRTH DEFECTS (organs formed during the 1st trimester)

ADR

adverse drug reaction...any noxious unintended, and undesired effect of a drug

ADE

Adverse Drug Events...this is a medication error

Anaphylactic Reaction

life threatening reaction...causes respiratory distress & cardiovascular collapse....this is a medical emergency

is a person weighs allot, will they need a stronger drug...or more of it?

yes....may require increased dosage to attain effect

Placebo Effect

believeing in a positive effect of the drug

Nocebo Effect

negative expectation of a drug can produce this, resulting in less than optimal results

Placebo

tablet of capsule that has no pharmacologic activity.....no active ingredients

Tolerance

begins when a person requires a higher dosage to provide the same effects that a lower dosage once provided

Drug Dependence

addiction.....when a person is unable to control the ingestion of drugs

Drug Accumulation

accumulation in the body may occur if the next dose is admin. before the previously admin. dose has been metabolized or excreted

physical dependence

when a person develops w/drawal if the drug is withdrawn for a certain period

Psychological

person is emotionally attached to the drug

drug interaction

occurs when the action of 1 drug is altered by the action of another drugeneh

unbound drug

are the only pharmacologically active part

additive effect

2 drugs w/ similar actions are taken for a doubled effect 1+1=2

synergistic effect

combined effects of 2 drugs is greater than the sum of the effect of each drug given alone ____________

antagonistic effect

1 drug interferes w/ the action of another 1+2 = 1

interference

the 1st drug inhibits the metabolism of excretion of the 2nd drug, causing increased activity of the 1st drug

incompatibility

1st drug is chemically incompatible w/ the 2nds drug, causing deterioration when both drugs are mixed in the same syringe or solution......signs of incompatibility are haziness...a precipitate ..or change of color of solution when mixed

a portion of the drug that is pharmacologically active is known as?

unbound drug

a person who has an increased metabolic rate (hyperthyroidism) would generally require a dosage that is ?

higher than normal

a PT takes 50 mg of a drug that has a 1/2 life of 12 hours....what % dose remains in the body after 35 hours of the drug being administered?

6.25% it is reduced by 1/2 every 12 hourss

gender specific medicine

is a developing science that studies the diff. in normal function of men and women and how people of each sex perceive and experience diseasec

pharmcogenitics

study of how drug response may vary according to inherited differences on drug metabolism

polymorphisms

naturally occurring variations in the structures of genes and the products they make for the body

passive diffusion

absorption this way is across the membranes and gastric emptying time depend on the pH of the environment

hydrolysis

in infants the absence of enzymes

intestinal transit

varies w/ age...when some meds. are absorbed poorly or too fast

protein binding

is reduced in preterm infants because of decreased plasma protein concentrations.....because serum protein binding is diminished, the drugs are distributed over a wider area of the neonates body, and a larger loading dose is required than in older children to achieve therapeutic affect

drug metabolism (age considerations)

is the process by which the body inactivates meds

metabolites (drug excretion)

of drugs and , in some cases, the active drug itself, are eventually excreted from the body

polypharmacy

multiple drug therapy (this happens mostly in geri. Pt's)

therapeutic drug monitoring

is measurement of drug's concentrations in biologic fluids to correlate the dosage admin. & the level of med. in the body w/ the pharmacologic response (saliva samples can give this)

drug action depends on what 4 factors?

ADME absorption, distribution, metabolism, excretion

do peds and geriatric Pt's require specail considerations for medication admin?

yes, usually 1/2 the strength or 1/3rd

is topical admin. Ok with peds?

yes, because the outer layer of skin is not fully developed (thin)...skin is more hydrated at this age

premature infants and geri Pt's have a slower gastric emptying time; partly because of reduced acid secretionT/ F???

True this may allow for drug to stay in contact with absortive tissue longer....allowing increased absorption and higher serum levels....toxicity could be a problem

women's stomachs empty solids more SLOWLY than men...and women have a greater gastric acidity...thus slowing the absorption of certain types of med...like aspirin.....T / F

TRUE....the slower gastric emptying time may allow the drug to stay in contact w/ absorptive tissue....= higher serum levels = could go into toxicity

Distribution depends on what?

pH, body water concentrations, (intra and extracellular & total body water)

what does serum creatinine give a general estimate on?

Renal Function

how old should a child be before he is given tablets of capsules?

5 yrs old

Reye's Syndrome

assoc. w/ aspirin...do not admin aspirin to peds. from infancy to teenage years....this can happen after a viral infection of chickenpox or the flu

what meds are admin for peds?

ibuprofen and acetaminophen

what are factors that put geri Pt's at a higher risk? (in regards to admin. drugs)

reduced renal and hepatic function,chronic illnesses that require multiple drug therapy (ploypharmacy) and a greater likelihood of malnutrition

enteric-coated and sublingual tablets should NEVER be what?

crushed...because of the effect on the absorption rate

if planning a pregnancy, when should you stop drinking?

2-3 months before planned conception

protein binding is ________in preterm infants; therefore __________dosage adjustment on a mg/kg basis would be required.

reduced; higher load

enzyme systems are primarily found in the ________therefore lab values to assess functioning of teh organ may be a required premedication assessment.

Liver

pediatric renal function is = to that of an adult at?

and infant at 9 - 12 months

geri and infants have lower gastric acids in stomach.....what impact does this (can it) have on drugs?

because they have lower gastric acids, drugs are absorbed slower and they are in contact w/ tissues....creating higher serum concentration levels...which can lead to toxicity...caused by extended contact time is the stomach

cornea

outermost sheath of the anterior eyeball...it is transparent so light can enter the eye

sclera

white portion of the eye, and is continuous w/ the cornea & nontransparent

iris

diaphragm that surrounds the pupil and gives the eye its color, blue, green, hazel, brown, or gray

sphincter muscle

within the iris encircles the pupil 7 is innervated by the parasympathetic nervous system PNS

miosis

is the contraction of the iris sphincter muscle, which causes the pupil to narrow

dilator muscle

runs radially from teh pupillary margin tot eh iris periphery, is SYMPATHETICALLY innervated

mydriasis

is contraction of the dialtor muscle & relaxation of the sphincter muscle, which causes the pupil to dilate

lens

transparent , gelatinous mass of fibers encased in an elastic capsule situated behind the iris....function is to ensure that the image on the retina is in sharp focus

near point

the closest point that can be seen clearly.....we loose this as we age

zonular fibers

these are the ligaments around the edge of the lens, that connect with the cilary body.....tension on these zonal fibers helps change the shape of the lens

cycloplegia

paralysis of the ciliary muscle, this muscle is innervated by PARASYMPATHETIC nerve fibers (PNS)

lacrimal canaliculi

this is where tear fluid is lost.....these are the 2 small ducts at the inner corners of the eyelids. Tear fluid is also lost from evaporation

intraocular pressure

(IOP) glaucoma is an eye disease characterized by abnormally elevated (IOP), which may result from excessive production of the aqueous humor or from diminished ocular fluid outflow

closed-angle glaucoma

(primary glaucoma) occurs when there is a sudden increase in IOP caused by a mechanical obstruction of the trabecular network network in the iridocorneal angle...this occurs in Pt's who have narrow anterior chamber angles......symptoms appear intermittently for short periods , especially when the pupil is dilated. (dialationof pupil pushes the iris against the trabecular meshwork, causing the obstruction) S&S are blurred vision, halos around white lights, frontal headache, & eye pain. Stress and fatigue can also play a part

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