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Pharm - Lecture - Day 1 - #1 of 2
Terms in this set (307)
Who is the last line of defense for the patient?
THE SCIENCE THAT STUDIES THE EFFECTS OF DRUGS WITHIN A LIVING SYSTEM, & ABOUT THE KNOWLEDGE OF THE PHARMACOKINETIC PROPERTIES.
Pharmacology includes both _________ and ___________ drugs
Both legal and illegal drugs
A CHEMICAL THAT AFFECTS LIVING PROCESSES
The medical use of drugs
What is the focus of this course?
Therapeutics (the medical use of drugs)
3 uses of drugs
1) Diagnose disease
2) Prevent disease (or pregnancy)
3) Treat disease
3 MOST IMPORTANT CHARACTERISTICS OF A DRUG
WHETHER OR NOT A DRUG ELICITS A RESPONSE
SAFETY OF A DRUG
WHETHER OR NOT A DRUG CAUSES HARM
IS THERE SUCH A THING AS A 100% SAFE DRUG?
NO - ONLY MORE SAFE AND LESS SAFE
SELECTIVITY OF A DRUG
THE DRUG ELICITS A RESPONSE ONLY FOR WHICH IT IS GIVEN. SOME DRUGS. Some drugs work on many receptors, others work only on a few receptors.
Other important properties of a drug
Reversible action, Predictability, easy to administer, few drug interactions, low cost, chemically stable, simple generic name
Federal drug regulations
Federal Food, Drug and Cosmetic Act, Controlled Substances Act
State drug regulations
Code of CO Regulations, Nurse Practice Act; licensure regulations
Drug regulations at the institution level
Do insurance have their own formularies as to what is covered and what is not?
Official source of drug info
Sources of drug info
USP, PDR, drug handbooks, package inserts, electronic databases, poison control, handheld devices/apps, nursing drug guide, etc
Physician desk reference
4 factors that influence a drug's response
4) Individual patient variables
4 parts of pharmacokinetics
1) Right drug
2) Right dose
3) Right patient
4) Right route
5) Right time
6) Right documentation
How the BODY affects DRUGS. Includes ADME
Absorption, distribution, metabolism, and excretion
COMMON ROUTES OF ABSORPTION
GI tract, blood vessels
COMMON ROUTES OF DISTRIBUTION
COMMON ROUTES OF METABOLISM
COMMON ROUTES OF EXCRETION
Kidneys, GI tract
How to remember pharmacokinetics
The K looks like a B - so it's hos the BODY affects the drugs
How the DRUG affects the BODY - The impact of drugs on the body once the drug has reached its site of action
How to remember pharmacodynamics
D for "dynamics" and "drug" (how the DRUG affects the body)
3 parts of individual variation
1) Patient's physiology (age, gender, weight, etc)
2) Patient's genetic makeup (race, family, etc)
3) Patient's pathophysiology or underlying disease processes (liver/kidney function, etc)
Historically, who were all drugs tested on?
White, middle-aged men. Only recently have we started studying drugs in women, children, and people of color.
Drug therapy should provide MAXIMAL BENEFIT with MINIMAL HARM
Therapeutic objective and the pregnant woman
In a pregnant woman, this means maximum benefit and minimal harm for BOTH the mom AND the baby!
Who is responsible for anticipating and responding to adverse events that occur before, during, and after a drug is administered?
Things to assess before giving a drug
Assess whether or not the patient has a fever, or other signs of symptoms
Things to assess while giving a drug
6 rights, continue to monitor the patient
Things to assess after giving a drug
Anticipate, recognize and respond to S/S of anaphylaxis, adverse reactions, therapeutic effects; Make quick decisions using critical thinking and Communicate with patient and HC Team
5 steps of the nursing process
1) Pre-administration assessment
2) Analysis and nursing diagnoses
Identifying high-risk patients
Identify people who will develop adverse reactions or experience drug-drug interactions
Parts of the pre-administration assessment
Baseline data, if pt is high-risk, assess pt's capacity for self-care, determine nursing diagnoses, know why the drug is being given and what the expected response is, promote pt compliance, implement non-drug measures
Patient's self-care - things to consider
Visual acuity, manual dexterity, intellectual ability, memory, finances, cultural attitudes
If the medical diagnosis is angina, what is the nursing diagnosis?
Acute pain related to decreased coronary artery perfusion as evidenced by patient grabbing at chest area and grimacing.
Things to consider when analyzing drug therapy
Appropriateness of the drug for the patient, actions of the drug, patient's prior response, potential health problems, contraindications, analyze patient's self-care ability, determine nursing diagnoses
Nursing process - things to consider in planning and implementation
Goals, priorities and interventions, how to evaluate drug therapy, administration, patient teaching, anticipate and minimize adverse reactions
Evaluation - things to evaluate
Therapeutic response, adverse drug reactions and interactions, patient compliance, satistaction with the drug regimen, labs, etc
Why a drug is given, the reason for administering a particular drug to a patient
How long does it take to develop a new drug?
2 basic phases of new drug development
2) Clinical (has 4 phases)
Required before a new drug may be tested in humans; tested on animals
New drug development - what are drugs evaluated for?
Toxicities, pharmacokinetic properties, potentially useful biologic effect
How long does preclinical testing take?
Is preclinical testing done on humans or animals?
When can drug testing begin on humans?
After preclinical testing, as long as sufficient preclinical data are collected
HOW MANY PHASES ARE THERE IN CLINICAL TESTING?
Who is phase I clinical testing done on?
Normal (well, healthy) volunteers
Purpose of phase I clinical testing
Evaluates the drug metabolism in humans
Phases II and III of clinical testing are done in what types of people?
Purpose of phase II of clinical testing
Determine therapeutic utility and dosage range in patients
How long do phases II and III of clinical testing take?
Total number of subjects in phases II and III of clinical testing
500 to 5,000
What happens after phase III of clinical testing?
An application for conditional approval is made
Purpose of phase III of clinical testing
Determine safety and effectiveness in patients
Postmarketing surveillance is which phase of clinical testing?
When does phase IV of clinical testing begin?
Once the FDA has given conditional approval
Phase IV of clinical testing is for who?
The general population
Phase IV of clinical testing
Postmarketing surveillance, done with conditional approval from the FDA. The general population. New side effects may be discovered. Voluntary reporting of health professions is essential.
Phase IV of clinical testing and voluntary reporting
Voluntary reporting of health professions is essential for this phase to be effective!
Why do unforeseen side effects sometimes show up during phase IV of clinical testing?
Because small samples may not produce all adverse effects that will be seen in the general public
Phase IV of clinical testing and "failure to detect"
When side effects weren't discovered until phase IV, when the drug became available to the public. It's not possible to identify every single side effect during stages I through III!
Who assigns generic names to drugs?
The United States Adopted Names Council
Proprietary or brand name proposed by the drug company and approved by the FDA
Trade names need to be approved by the ________
Another term for "brand name"
Another term for "trade name"
Is Monistat the same thing as Monistat 1?
No - these are both trade names. They have different generics in them!
Sarafem and Prozac
Sarafem is basically the same thing as Prozac, except only given during two weeks of the menstrual cycle. So a woman who was on Prozac couldn't also take Sarafem, because they could overdose on the same medication.
Do drugs create new function in the body?
No - NO new function in the body, they only MODIFY the physiologic function that already exists in the body
Do most drugs have a single action on the body, or multiple actions?
Most have multiple actions (they have therapeutic effects, as well as unwanted side effects)
Are most drugs "targeted" to just one tissue?
3 things that drugs do to the body's existing physiology
4 main sources of drugs
2) Animals or humans
3) Minerals or mineral products
Alkaloids, glycosides, gums, oils
Drugs that come from animals or humans
Hormones, DNA splicing of genes into E. coli
Drugs that come from minerals or mineral products
Iron, iodine, gold
Made in the laboratory (same molecular function as the natural molecule). Ex - insulin
Example of a major synthetic drug
Any drug that requires a prescription
Any drug that requires a prescription is called a __________ drug
Any drug with the potential of being abused. Organized into 5 classes (class I-V)
Is tramadol considered a controlled substance?
Yes - a class IV controlled drug.
Do the newest OTC drugs have the same doses as when they were legend drugs?
Is aspirin a legend drug?
How many former prescription drugs are now available over-the-counter?
Examples of current OTC drugs that were once prescription drugs
Ibuprofen, Claritin, Allegra, Zyrtec, Pepcid, Prilosec, Zantac
Can OTC drugs interact adversely with prescription drugs?
Do OTC drugs need to be included on patients' med lists?
OTC drugs are a $_____ billion industry
What percent of all drugs are OTC?
What % of Americans take at least one drug every day?
The average American home medicine cabinet contains _____ drugs
How are drug classifications organized?
Drugs with similar characteristics are grouped together (they have the same effect on a particular body system, similar desired effects).
Oral hypoglycemic agents
A classification of medications to lower blood sugar
Examples of drug classifications
Hypoglycemic agents, anti-hypertensives, etc.
Generic names often have the same _________
Suffix for beta blockers
Propanolol and metoprolol belong to what classification?
Beta blockers ("-olol")
Suffix for HMG-CoA reductase inhibitors (cholesterol-lowering drugs)
HMG-CoA reductase inhibitors (cholesterol-lowering drugs)
Simvastatin, Atorvastatin, etc belong in what drug classification?
HMG-CoA reductase inhibitors (cholesterol-lowering drugs) - "-statin"!
Which is the only classification of drugs that deals with prefixes?
All drugs in the same class have 5 things that are all similar - what are they?
1) Similar indications
2) Similar mechanisms of action
3) Similar containdications or precautions
4) Similar interactions
5) Similar side effects
If you know one drug, do you know a low about other drugs in the same class?
Yes (remember the 5 things that are similar for all drugs within a class). BUT - you still need to always look up a drug before administering!
Do drugs in the same class differ?
Yes - they must differ. They have to be somewhat different, or they would not be able to be on the market as a separate drug.
Things that may differ between drugs in the same class
Different doses (ex - daily vs 3 times a day), time action (half life), formulation (liquid vs patch vs pill), side effects
Characteristics of newer drugs in a particular class
More potent, fewer side effects, fewer adverse effects, higher cost, etc
If newer drugs are better, why are the earlier drugs still on the market?
Because some patients respond to those better because of genetics (ex - 3 times a day, etc)
Is Brand X aspirin the same as Bayer aspirin?
Yes and no - same chemical reactions and effect, but different coating, fillers, coloring, etc.
Does the color of a pill really matter?
Yes - some patients have allergies to food coloring - they can only be given white pills.
5 types of liquid drug preparations
4 types of solid drug preparations
5 types of topical drug preparations
Types of drug preparations: aqueous
Dissolved in water
Types of drug preparations: emulsion
Types of drug preparations: elixir
Alcohol as a sweetener
Types of drug preparations: suspension
Particles in liquid
Types of drug preparations: aerosol
Volatile liquid in a spray
Types of drug preparations: capsule
Types of drug preparations: tablet
Types of drug preparations: TROCHE
Dissolves in orifice
Types of drug preparations: powder/granule
Must mix with a liquid
Types of drug preparations: cream
Water and oil base
Types of drug preparations: ointment
Types of drug preparations: lotion
Types of drug preparations: patch
Absorb via skin, has adhesive
Types of drug preparations: paste
Things to consider when picking a specific drug from a class
Client characteristics, dosing frequency, efficacy, prescriber experience, cost, culture, etc. Remember that the physical and chemical composition of meds within a class may be slightly different!
Harrison Narcotic Act of 1914
Regulated the importation, manufacture, sale, and use of opium, cocaine, marijuana products
The sole legal drug enforcement agency in the US
Is the FDA involved in legal drug enforcement?
No - this is the DEA!
Schedule I controlled substances
No accepted medical use, high abuse potential
Schedule II controlled substances
Accepted medical use, high potential for abuse and or/dependence
Schedule III controlled substances
Less abuse potential, moderate dependence possible
Schedule IV controlled substances
Lower abuse potential than III, limited dependence
Schedule V controlled substances
Lower abuse potential than IV, limited dependence, may require prescription or may be sold OTC
Examples of Schedule I controlled substances
Heroin, LSD, marijuana
Examples of Schedule II controlled substances
Morphine, cocaine, codeine
Example of Schedule III controlled substances
Examples of Schedule IV controlled substances
Valium, all "-pam"s, "-lam"s, tramadol
Examples of Schedule V controlled substances
Lomotil, Robitussin AC
What classification of controlled substance is marijuana?
Where are controlled substances stored?
Kept in double-locked cabinets, with keys in custody of the RN
"Counting" controlled substances
Record of amount on hand, amount distributed, verified by "count" at beginning and end of shift
Is it a federal offense to transfer a controlled substance to another person than for whom originally ordered?
What must the nurse know about a drug?
Purpose, actions, major side effects, normal doses, toxic effects, teaching points
Can LPN's administer IV meds?
No, unless it is according to unit protocol
Who can administer meds?
RN, LPN (but usually not IV's), pharmacists, EMT, RT, MD, Nursing students under the DIRECT supervision of a provider or RN
Can nursing students administer meds?
Yes, but ONLY under the DIRECT supervision of the provider or RN
Who typically DISPENSES meds?
Can a nurse refuse to give a med if they believe it could be harmful to the patient?
What to do if you're unfamiliar with a drug on the order
Look it up
Is "I was following orders" an appropriate legal defense for giving the wrong med/dose/route, etc?
No. Even if the MD/NP made a mistake, it's still up to YOU to find it and correct it!
Potential issues that may keep a patient from taking their meds
Money, housing, illiteracy, depression, depentia
5 factors that influence drug responses
1) Body weight & composition
2) Diet/nutritional status
5) Pathophysiology (kidney/liver function, acid-base partitioning, alteration in electrolyte status)
Age: who experiences most complications?
The very young and the very old
How long it takes for HALF of the drug to be excreted by the body
Abbreviation for half-life
Will the half-life be longer or shorter than normal in a patient with impaired renal function?
t1/2 of penicillin V is 60 mins. Give at 1200 - how many half-lives will it have gone through by 1400?
Gave 500 mg's of Penicillin V. 2 half-lives are complete. How much drug is left in the body?
Decreased responsiveness to a drug due to repeated drug administration
3 categories of drug tolerance
Pharmacodynamic drug tolerance
From long-term administration
Metabolic drug tolerance
Accelerated drug metabolism by enzymes in the liver
Tachyphylaxis drug tolerance
Repeated dosing over a very short time; uncommon (trying to prevent drug tolerance)
If someone has tolerance to opiates and then has surgery, what will happen to our ability to control their pain?
It will be very hard to get their pain under control
The ability of a drug to reach the systemic circulation from its site of administration
6 factors that influence bioavailability
1) Product preparation (i.e. 2) Oral vs IV)
3) Route of administration
4) Gastric pH
6) Foods/Timing with food
7) Foods/Type of food
Things that may cause someone to fail to take their meds as prescribed
Lack of patient education, attitude toward taking meds, self-care capacity, finances, side effects, etc
Why do pregnant women have a higher risk of drug toxicity from "regular" doses?
Slower GI tract - more time for drugs to be absorbed more absorption "regular" doses can be toxic to pregnant women because there is more absorption.
3 physiologic changes during pregnancy that impact drug dosing:
1) Kidney: increased GFR during the 3rd trimester
2) Liver: increased hepatic metabolism
3) GI: decreased bowel motility (--> increased absorption time)
Drugs and breast milk
Slower GI tract - more time for drugs to be absorbed more absorption "regular" doses can be toxic to pregnant women because there is more absorption.
Which drugs can cross the placenta?
ALL drugs can cross the placenta
For which types of drugs is transfer across the placenta easier?
Lipid-soluble drugs (they can go through the phospholipid bilayer)
For which types of drugs is transfer across the placenta more difficult?
Ionized, highly-polar or protein-bound (water-loving drugs don't pass through the placenta)
When to use drugs during pregnancy
When the benefit of the treatment is greater than the combined risk to the "mom" and the risk to the fetus
Adverse drug effects during pregnancy
Osteoporosis, uterine stimulation (--> abortion), uterine suppression (decreases contractions when you actually WANT contractions), drug-dependent baby, respiratory neonate suppression
Acts in a specific time frame to cause a characteristic set or pattern of malformations in the baby. Causes an increase in malformations related to dosages and exposure
The effect of a teratogen is highly dependent on what?
When the drug is given during the pregnancy
3 stages of fetal development
1) Preimplantation/ presomite period
2) Embryonic period
3) Fetal period
Preimplantation/ presomite period of fetal development
Conception to week 2
Embryonic period of fetal development
Week 3 to week 8
Fetal period of fetal development
Week 9 to term
During which of the 3 stages of fetal development do we REALLY not want to be giving drugs to the mother
During the embryonic period (week 3 to week 8). This is tricky because the mom may not even know that she is pregnant during this time!
Weeks 1 and 2 of fetal development
Dividing zygote, implantation and gastrulation. Not susceptible to teratogens
During what weeks of fetal development is the fetus most susceptible to teratogens?
Weeks 3 through 8
What develops during weeks 3-8 of fetal development?
CNS, heart, eyes, limbs, ears, teeth, palate, external genitalia
Teratogens may be ________ or _________
Proven or unproven
Does every exposure to a teratogen result in a birth defect?
Risk of malformation from a teratogen
5 types of fetal complications from exposure to a teratogen
1) Developmental delay, low birth weight
2) Premature labor, miscarriage
3) Fetal hemorrhage
4) Fetal alcohol syndrome
5) Narcotic addiction
Every time you take a teratogen during the 3-8 week period, what happens to your risk of malformation to the baby?
It increases by 10% (? - check on this)
5 "old" pregnancy categories
A, B, C, D, X
Pregnancy category: A
Remote risk; human studies show no risk
Pregnancy category: B
Slightly more risk; animal studies no risk, no human studies completed
Pregnancy category: C
Animal studies show risk of fetal harm; no human studies were done after the animal studies showed some risk
Pregnancy category: D
Proven risk of fetal harm in humans; may use if benefits>risks
Pregnancy category: X
Animal studies show "definite" risk with proven risk for fetal harm in humans. Risks >benefits
Do we "officially" still use the ABCDX system for pregnancy risk?
Technically, no. It was changed in 2015, and the new way is very confusing.
Pregnancy category: are there many "A" drugs?
No - there are almost none. Ex: thyroid hormone, because our bodies already makes it so there isn't really a risk
Example of a drug in pregnancy category C
Albuterol (because you need to be able to breathe) - not exactly safe for the baby, but we need to keep mom breathing.
Why might we still give albuterol to a pregnant woman, even though it's technically a Class C teratogen?
Because you need to be able to breathe) - not exactly safe for the baby, but we need to keep mom breathing.
Pregnancy: 9 category X drugs
1) ACE inhibitors
Drug therapy while breast-feeding: 4 things to remember
1) Dose after feeding
2) Avoid drugs with long half-life
3) Avoid those that most effect the infant
4) Avoid cocaine, amphetamines, heroin
Drug therapy in neonates
Lack protective mechanisms, immature body systems. Maternal drugs accumulate in breast milk
Drug therapy in children
Weight or body surface area is used to calculate safe dosages. The nurse needs to know the safe range
Less than 36 weeks gestation
First 4 weeks
Pediatrics includes all patients under what age?
All patients under age 16
6 groups of pediatric populations
1) Premature infants
2) Full-term infants
5 pharmacokinetic processes that are immature in infants:
1) Drug absorption
2) Renal excretion
3) Hepatic metabolism
4) Protein binding of drugs
5) Blood-brain barrier is lacking
Drug dosages are primarily the result of what?
Clinical outcome and plasma concentration levels
6 parts of patient education
1) Dosage size and timing
2) Route and technique of administration
3) Duration of treatment
4) Storage of drug
5) Desired responses
6) Adverse responses
Do we say "compliance" or "adherence"?
We now say "adherence"
9 ways to promote drug adherence and safety in pediatric patients
1) Use convenient drug forms
2) Select dosing times to lifestyle
3) Mix drugs with foods
4) Calibrated spoons (not kitchen spoons)
5) Returned demonstrations
6) Safe dose at any age
7) Establish a positive relationship
8) Age-appropriate explanations
9) Keeping drugs safe at home
Which 2 systems are most affected by aging?
1) Central nervous system
2) Cardiovascular system
What % of the population are elderly patients?
What % of the nation's prescribed drugs are taken by elderly people?
Drug absorption in the older adult: 3 things to consider
1) Decreased saliva leads to difficulty swallowing drugs
2) Decreased GI motility, delayed gastric emptying
3) Increased gastric pH
Drug distribution in the older adult: 5 things to consider
1) Increased percentage of body fat
2) Decreased percentage of lean body mass
3) Decreased total body water
4) Reduced concentration of serum albumin
5) Decreased cardiac output
Drug metabolism in the older adult: 2 things to consider
1) Decreased hepatic metabolism
2) Decreased hepatic mass and blood flow
Drug excretion in the older adult: 2 things to consider
1) Decreased renal blood flow and GFR
2) Decreased renal excretion and tubular secretion
Most important cause of adverse drug effects
Drug accumulation secondary to decreased renal excretion
What is the proper index for measuring renal function in the elderly?
Creatinine clearance (NOT serum creatinine)
Adverse drug reactions are how many times more likely in the elderly?
7 times more likely in the elderly
Adverse drug reactions in the elderly account for what % of hospital admissions?
Adverse drug reactions account for what % of all medication-related deaths in elderly patients?
50% (renal insufficiency allows drug to accumulate; polypharmacy so unsure which drug may be causing the problem)
Reasons why adverse drug reactions are more common in the elderly
Poor adherence, decreased supervision of patients, increased severity of illness and multiple pathologies at one time, use of drugs with low therapeutic index
5 ways to monitor for adverse drug reactions in the elderly
1) Take thorough drug history
2) START LOW, GO SLOW
3) Plasma level monitoring
4) Simplest regimen
5) Review drug treatment schedule
What does it mean to "start low, go slow" when giving medication to an older adult?
Give a lower dose, and give it slowly (ex - they may get only HALF of a regular adult dose). To accommodate for potentially poor kidney function!
Most important way to monitor for adverse drug reactions in the elderly
Start low, go slow
Ways to promote compliance in older adults
Simple drug regimen, verbal & written instructions, appropriate dosage form, clear labeling, daily reminders, support system, frequent monitoring, have pt carry a list of medications and dosages
Early sign of toxicity in older adults
Altered mental processes
2 lists for meds for older adults
1) BEERS list
2) "Start and Stop" list
Older adults and side effects
Side effects are more commonly reported in older adults
Adverse drug reaction
A noxious, unintended, and undesired effect that occurs at normal drug dosages
Examples of severe or life-threatening adverse drug reactions
Respiratory depression, hemorrhage, neutropenia, hepatic cell injury, anaphylaxis
Examples of minor side effects
Nausea, vomiting, drowsiness, pruritis, rash
Adverse drug reactions are more common in which 2 populations?
1) The very young
2) The very old
Why do infants experience more adverse drug reactions?
Because they have an immature liver (--> poor metabolism of drugs)
Why do older adults experience more adverse drug reactions?
Because of poor absorption in the GI tract, poor metabolism by the liver, and decreased excretion of drugs at the kidney
A nearly unavoidable secondary effect produced at therapeutic drug doses. They are fairly predictable
Are side effects fairly predictable?
Example of side effects
Drowsiness with antihistamines
Adverse reaction caused by an excessive dose
Example of toxicity
>4g acetaminophen in 24hr (elevated LFT's, n/v, jaundice, death)
Another term for an allergic reaction
Another term for a hypersensitivity reaction
An immune response with intensity or severity of the response NOT DEPENDENT on the dose
Examples of allergic reactions
Rash/pruritus after 3 days of administration of a sulfa antibiotic, anaphylaxis
S/s of anaphylaxis
Pruritus, hives, lips/tongue/throat swelling, drop in BP, feeling ill, wheezing, dyspnea, sense of impending doom
5 questions to ask when assessing for a potential allergic reaction
1) Did s/s appear with the new drug?
2) Did s/s resolve with discontinuation of new drug?
3) Did s/s reappear with new drug reinstated?
4) Could the patient's illness cause these s/s?
5) Any other drugs cause the illness?
An uncommon drug response from a genetic predisposition
Example of an idiosyncratic effect
Succinylcholine + halothane - increased length of paralysis occurs in this population
A disease produced by a physician
Example of an iatrogenic disease
Amantidine --> Paksonson's like SE
Patient's body has adapted to drug due to prolonged exposure - will experience withdrawal symptoms if drug is discontinued
Drugs or environmental chemicals can directly cause cancer
Example of a carcinogenic effect
Ex: DES (diethylstilbestrol) given to moms to prevent spontaneous abortion - grown children exposed in utero develop clear cell carcinoma - rare type of vaginal CA; male children unusual urogenital anomalies
Drug-induced birth defect
A chemical capable of causing a birth defect
What body parts ofn the developing fetus are commonly affected by teratogens?
Kidneys, heart, inner ear, liver, limbs, behaviors, mental processes
Lack of limbs
Toxitity of gentamicin affects what?
The inner ear
Toxicity of amphotericin B affects what?
Toxicity of doxorubicin affects what?
Toxicity of amiodarone affects what?
Example of a long QT drug
2 big examples of hepatotoxic drugs
ESPECIALLY THE TWO TOGETHER (?)
Tylenol and liver injury
Tylenol breaks down into a toxic by-product. If only taking Tylenol, liver can metabolize it quickly; if taking other drugs that require the liver to metabolize then the toxic by-product builds up. This causes often irreversible injury to the hepatocytes
Taking Tylenol with other drugs
Can lead to irreversible liver injury
QT interval (on an EEG)
Amount of time it takes for the ventricles to repolarize after each heart beat
What happens if the QT interval is lengthened?
--> dysrhythmia - Torsades de pointes, V-fib and death!
Any preventable event that leads to an inappropriate medication use or patient harm, while the medication is in the control of the HC professional, patient, or consumer.
Types of med errors
Wrong patient, drug, dose, route, time, dosage form, diluent, strength or concentration, infusion rate, technique, deteriorated order, wrong duration of treatment
5 things that may lead to a wrong drug med error
1) Labeling looks similar
2) Packaging looks similar
3) Products with similar names (Adderall / Inderal)
4) Storage of products in close proximity
5) Patients in rooms next to each other with similar problems
5 things that may lead to a wrong technique med error
1) Not thoroughly mixing product in diluent
2) Crushing time-released capsules
3) Not flushing IV line after meds
4) Giving IV med too fast
5) Mixing incompatible drugs causing one to precipitate
10 ways to reduce med errors
1) Organizational commitment to safety
2) Place clinical pharmacists in high-risk areas
3) Eliminate abbreviations
4) High-alert meds (need to be checked by another person)
5) Check verbal orders
6) Computerized order/entry/dispensing
7) Six Patient Rights
8) Infusion pump check list
9) Don't use shortcuts and abbreviations
10) Don't use parenteral syringes for oral meds
When comparing dose calculations with another nurse....
Calculations must be done INDEPENDENTLY, then compare your answers
When to remove the med from the unit dose package
At the time of delivery (at the bedside)
Labeling infusion lines
Label lines with meds flowing (at both points) so can pick out appropriate open ports
Figuring out what medications the patient is taking (at home, OTC, ordered by other doctors, discrepancies between in the hospital and at home, what schedule, etc)
Talking about meds upon discharge
Face to face meeting prior to discharge where meds are discussed with the patient and/or family. Tell them to provide new list of meds to primary care provider and share with pharmacist at local pharmacy
What % of med passes at home or in a skilled nursing facility ends up being a med error?
20% (1 in 5)
What to do when a med error occurs
Inform supervisor and provider STAT. Incident reports, the provider informs the patient and their family of the error.
Incident report for a med error
These are not put in chart, but used for in-house analysis by risk management
How to report a med error
Medication Errors Reporting program, national program (USDHHS), MedWatch form, etc.
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