Pharmacology Ch 1-5
Terms in this set (170)
the desired, therapeutic effect of the drug
what the body does to the drug
the changes that occur to the drug while it is inside the body
the effects of the drug on the body
Contraindications and Precautions
the conditions under which the drug should not be used or must be used carefully with monitoring
the unintended and usually undesired effects that may occur with the use of the drug
the effects that may occur when the drug is given along with another drug, food, or substance
Core Drug Knowledge
Grouping of pharmacologic facts:
contraindications, and precautions,
adverse effects, and
Core Patient Variables
life span and gender
culture and inherited traits
overall health of the patient, Assess functioning of body systems and organs, drug history, cognitive or memory deficits, ability to understand spoken instructions, presence of acute or chronic diseases.
Life Span and Gender
age and gender, developmental level, ability to read and write. Needed to plan patient education on drug therapy.
Life style, diet, and habits
occupation, finances, substance use, exercise
where will the drug be administered
Culture and Inherited Traits
religious beliefes that may hinder the use of pharmacotherapy; ethnic or inherited genetic factors that may influence an individuals response to drug therapy
Anticipated therapeutic and adverse effects of a drug
Nursing Management in drug Therapy
maximizing therapeutic effect
minimizing adverse effects
providing patient and family education
Drug that is representative of a drug class.Typically the first drug of a class
Drug has similar characteristics to all drugs in a class of drugs
Nursing Management of Drug Therapy: Assessment
Determine specific drug and identify core drug knowledge
Assess patient and identify significant core patient variable
Nursing Management of Drug Therapy: Nursing Diagnosis and Outcome Identification
Identify significant interactions between core drug knowledge and core patient variables
Nursing Management of Drug Therapy: Planning
Identify actions to maximize therapeutic effects ad actions to minimize adverse effects
Nursing Management of Drug Therapy: Intervention
Integrate and implement strategies to maximize therapeutic effects and minimize adverse effects
Provide patient and family education
Nursing Management of Drug Therapy: Evaluation
Administration of theophylline to a patient with acute asthma is an example of;
Your patient has a hypertension and is administered minoxidil, an antihypertensive drug. Three months later, the patient notices an increase in the growth of his/her hair, which is an expected effect of the drug. This is an example of the _________ of minoxidil.
You patient, who is 2 months pregnant, has just received a diagnosis of pneumonia. Which of the following areas of core drug knowledge would be most relevant to the selection of drug therapy for this patient?
Contraindications and precautions
Which of the following is an example of adverse effect of a drug?
Lowered white blood cell count after drug therapy of cancer
Which of the following statements/ questions would be included in the nurses assessment of health status?
"Have you ever had an reactions to medications in the past"
Your patient works from midnight to 8 am and experinces insomnia during the day. This is an example of which of the following core patient variables?
Life style, diet, and habits
A history of smoking cigarettes is included in which of the following core patient variables?
life style diet and habits
in assessing the patient core variable of environment, the nurse might include
where the patient keeps his/her medication at home
when conducting a drug history the nurse should as questions to determine
which over the counter drugs are used
which prescription drugs are used
if there are any drug allergies
in providing patient and family education about drug therapy,the nurse should include information on
what to do if a dose is forgotten
hazardous activities to avoid while on the drug
any dietary restrictions or additions and drug food interactions
which of the following is an aspect of the core patient variable - lifestyle diet and habits
use of herbs and vitamins
Three Routes of drug administration
most frequently used method for enteral route is
coating of oral drugs, food, fluids, and other drugs
may affect the absorption and onset of action or oral drugs
Most frequently used parenteral drug administration
onset action is more rapid with
parenteral than enteral route
IM drug administration
consider the patient and drug characteristics when selecting needle, syringe, and intramuscular site
Intravenous Administration of drugs may be
administered by continuous drip, intermittent infusion, or IV push methods
delivered directly into the blood stream, allowing more drugs to reach its highest potential serum drug concentration
applied to the skin and mucous membrane
because they bypass the enteric route, they are technically parental drugs, but they are not most commonly considered a unique form of drug aministration
Topical Drugs produce
localized effect, although some system effects are possible
Drugs administered into the GI tract are given via the ____ route
A good example of an _____ injection is a PPD test
the ___ route circumvents the GI tract
drugs applied directly on the skin are administered via the ___ route
drugs applied topically to the skin or mucous membranes exert a
Drugs that distribute throughout the body exert an
drugs that come as an _____ must be shaken well before administration
a ____ resists the acid environment of the stomach
a solid drug dispersed within a liquid is called a
adminsitration of a drug into the cerebrospinal fluid uses the ___ route
_____ tabelts are placed underneath the tongue
a tablet placed between the cheek and gum in the mouth is an example of the ___ administration
____ is also known as pastille or lozenge
a drug compressed or molded into a specific shape is called a
___ drug administered directly into the blood stream
___ tablet is formulated to release a drug slowly over an extended period
a drug encased ina hard or soft gelatin container is known as a
a ___ is concentrated solution of sugar in water
the technique of instilling drugs into a muscle uses the __ route
__ is a clear hydroalcoholic mixture that is usually sweetened
a ___ medication is administered over a few minutes, where as a ___ medication is administered over 20 to 60 minutes
IV push (may be used for intermittent dosing or for treating emergencies such as cardiac arrest), Piggyback (antibiotics are usually given piggy back)
_____ drugs are administered under the skin into the fat and connective tissues
drugs administered into a joint space are called ___
a ___ drug is administered irectly into the artery
Absorption of enteral drugs occurs most frequently in the pg 32
what type of enteral medications should be avoided in children
the onset of action is rapid after IM administration because
the muscle has a good blood supply
a saline lock is an example of
peripheral access device
which of the following would be affected if an enteric coated tablet were cut in half
to administer a drug by the IM route safely the nurse must consider
physical characteristics of the drug such as viscosity
anatomical landmarks of muscles bones and blood vessels
the age and size of the patient
which of the following is a phase of pharmacokinetics
Precisely describes the drug's atomic and molecular structure
exact chemical name of drug
Nonproprietary name; identifies the drug's active ingredient
Brand or proprietary name
Pure Food and Drug Acts
ensure ingredients are listed on labels (many potent and dangerous drugs on the market)
Federal Food, Drug, and Cosmetics Act of 1938(note
the side effects on all drugs/advertisement)
FDA prohibits the drug to be incompletely tested and stipulated drugs be labeled
Procedure for Drug Development and Approval
studies carried out on animal subjects in a laboratory
are designed to provide basic safety, bioavailability, pharmacokinetic, and initial efficacy data about the drug.
are performed on humans in several phases.
Only about 10% of new drugs that begin clinical trials are approved.
Phase 1 -3 of clinical trails
take place before a new drug is marketed
selected patients (2)
large sample of selected patients (placebo response) (3)
testing is completed after marketing begins.
Importance of Nursing Management of Drug Therapy
Nurses are legally responsible for the drugs they administer.
Safe drug administration requires a thorough understanding of therapeutic drug actions and adverse drug reactions.
In some clinical settings, nurses are allowed to modify drug regimens.
Application of the nursing process to the pharmacologic aspects of patient care is especially important because long-term use of drug therapy is frequently necessary to control chronic disease processes.
Nursing management of drug therapy may be considered an applied science.
classifies the drug by its chemical base
classifies the drug by its effects on a body system
classifies the drug by its use in the therapy
National Formulary United States Pharmacopeia USP
documents that contain the official name for each drug
Canadian Food and Drug Act
laws maintain by the Health Protection Branch of government
system that allows testing of potential new drugs
drug listed according to its abuse potential
group of drugs that share similar characteristics
another term for prescription drug
federal food drug and cosmetics act of 1938
established the food and drug administration as the agency for monitoring and controlling drug manufacturing and marketing
predicts the sensitivity or resistance of an individual patients disease to a specific drug or group of drugs
positive response to any therapeutic intervention
practitioners reporting network
postmarking forum to report problems with prescribed drugs
the study of how genetic variable affect the pharmacodynamics of a drug in a specific patient
which of the following drug names may represent its drug class
a drug manufactured specifically to treat rare or unusual diseases is known as*
which of these statements, if made by a patient receiving a prescription for a schedule 2 controlled substance indicates correct understanding of the nurses discharge instructions
I will make an appointment to see my doctor for a new prescription if I still have pain after the medication is gone
advantages of IV administration
Provides immediate effect
allows administration of a large volume of drug
avoids tissue irritation or injury
use is acceptable when no other route is possible
circumvents impaired cirulation
provides potential for prolonged
continuous administration of solution
disadvantages of IV administration
cannot be retrieved once given
distribution cannot be slowed or stopped
three miscellaneous parenteral delivery routes
the purpose of the enteric coating on a drug
allows the tablet to ressit the acidic environment of the stomach to protect acid-labile drugs, provide a sustained-release dose, or guard against local adverse effects from a drug
how do sustained release capsules slow the delivery of medication
layers of the enteric coating dissolve in response to changes in the pH of fluids.
The drug is released in a steady, controlled manner from a matrix of drug encased in a slowly dissolving substance such as wax.
name the five types of topical drugs
liquid vaginal tablets
which is the preferred site for IM administration of drugs to an infant
Five reasons that enteral drugs may be contraindicated for a patient
patient is vomiting
patient is unable to swallow
or has diffculty swallowing
Patient has trouble swallowing, three strategies to administer enteral medications*
crush the pill and mix with a few mLs of water.
Mix in a tablespoon of jelly, apple sauce, or pudding.
contact the provider to substitute a liquid formulation
administration of medication to a patient with nasogastric tube
verify placement of the tube
elevate the head of the bed, unless contraindications
assess if the drug can be administered in the presence of food (tube feeding)
flush the tube with normal saline
administer the medication
flush the tube again with normal saline
three situations in which topical absorption of a drug may increase
skin is abraded or denuded
drug is added to a specific solvent
skin is covered by an occlusive dressing after the drug is applied
lists the three nursing intervention to maximize therapeutic effects and minimize adverse effects when administering topical drugs
wear gloves when applying topical drugs
use applicator to administer
use sterile technique when the skin is broken or denuded
remove the patch immediately adverse reactions occur
six rights to medication administration
how would the nurse position a patient to administer IM injection in the right vastus lateralis
lying on left side
how can you minimize potential adverse affects
Verify the patient's allergies
Assess for contraindication for the drug therapy
Administer the drug in a manner consistent with standard safety protocols
Monitor the patient and relevant laboratory findings
Discontinue or withhold a drug based on assessment or laboratory findings
Report evidence of adverse effects to the prescriber
Modify administration techniques, when appropriate
Implement appropriate assessment for certain drugs to detect the onset of adverse effects
another term for metabolism
another term for antagonist
Blood brain barrier
selective mechanism that opposes the passage of most ions and large molecular compounds from the blood to the brian tissue
(drugs that are lipid soluble or have a transport system to be effective in the brain)
-reason for it to be hard to treat menigitis
rate of disappearance of the drug molecules from the circulation
the delivery of the drug into any and all body compartments it can penetrate
Three factors; blood flow to the tissues, drugs ability to leave the blood,and the drugs ability to enter cells.
removal of a drug ( or its metabolites) from the body
main organ- kidney
first pass effect
drugs entering the body by the enteral route first go through the portal circulation to the liver before reaching the general circulation
the time needed for the plasma concentration of the drug to be reached by 50%
a combination of affinity and efficacy
conversion of the drug into another substance or substances
mainly controlled by the liver
end product of a chemical change of one drug into another
drug prescribed for a use that has not been approved by the FDA
enzyme system to metabolize drugs
Liver metabolism is predominantly achieved by specific liver enzymes.
These microsomal enzymes are called the cytochrome P-450 system
When a large quantity of one of these enzymes is present, more metabolism can occur through this pathway.
drug that requires conversion into its active form
pharmacotherapeutics (chapter 4)
reason the drug is prescribed
administration rate of a drug equals its elimination rate
At four to five half-lives, steady state is achieved.
relation of ED50 to LD 50
to prevent error when administering any drug*
the nurse checks the drug name at least three times;
and After obtaining the drug
Core Drug Knowledge Teaching
Basics of teaching patient and family about drug therapy
Name of the drug
Reason the drug was prescribed (pharmacotherapeutics)
Intended effect of the drug (pharmacodynamics)
Important adverse effects that may occur
is a specialized area on the cell wall or within the cellular cytoplasm
is a drug that has the ability to initiate the desired therapeutic effect by binding to a receptor
a drug that has affinity for a receptor but does not achieve a response
tendency of a drug to attach to a specific receptor site
the power of a drug to produce a therapeutic response
how well a drug produces its desired effect
an increased rate or dose of a drug to achieve faster steady state
the amount of drug needed to sustain a therapeutic effect
is the movement of the drug from the site of administration into the bloodstream.
Lipid solubility also alters absorption.
pH also affects absorption.
Speeds up with increased blood flow.
Gastrointestinal (GI) tract is used for the ingestion and absorption of drugs.
The most common method of administering drugs
Avoids the GI tract, allowing more drugs to be delivered to the blood stream
Associated with all forms of injections: intramuscular (IM), subcutaneous (SC or SQ), and intravenous (IV)
is a decrease in blood flow that would keep drugs from reaching the site of action
affects the distribution of a drug.
When the drug is bound to protein, it is unable to pass through the capillary walls.
The bonds will dissolve in time, and the drug molecules will become free and active.
Drug dosages are calculated by the drug manufacturer based on the protein-binding characteristics of the drug.
When the patient has a lower-than-expected protein level, the distribution of the drug is altered.
ex. a patient who is malnourished
When a drug and a second drug or element have an effect on each other
This interaction may
Increase or decrease the therapeutic effect of the drugs
Create a new effect
Increase the incidence of an adverse effect
the most serious type of allergic reaction
an unusual, abnormal, or peculiar response to a drug
an interacting effect in which 1 +1=2
An interacting effect in which 1 +1=3
the effect if only one of the two interacting drugs is increased
injury to the nervous system related to drug therapy
Signs and symptoms: drowsiness, auditory and visual disturbances, restlessness, and seizures
injury to the immune system related to drug therapy
injury to the liver related to drug therapy
signs and symptoms: include yellow sclear, nausea and abdominal pain, unsteady gait, hepatitis, jaundice, elevated liver enzyme levels, and fatty infiltration of the liver.
injruy to the kidneys related to drug therapy
Signs and symptoms: decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance, and electrolyte imbalances
injury to the 8th cranial nerve related to drug therapy
Signs and symptoms: tinnitus, hearing loss, light-headedness, vertigo, nausea, and vomiting
injury to the heart related to drug therapy
signs and symptoms: irregularities in cardiac rhythms and conduction, heart failure, and damage to the myocardium.
Common signs and symptoms of an allergic reaction
Identify the classic symptoms of anaphylaxis
cyanosis or pale
List four interactions involving GI absorption
alteration in GI transit time
alteration in gastric pH
presence of food in stomach
Example of a beneficial additive drug-drug interaction
non narcotic analgesic with a narcotic analgesic
what is the difference between potentiation and synergism
Synergism is an interaction in which two "unlike" drugs produce an effect greater than either drugs activity alone; potentiation is an interaction between two "unlike: drugs in which only one of the drugs activity is enhanced.
All drugs have some type of adverse effect(s).
Rationale: All drugs produce some type of adverse effect; some of the effects are mild, and others can be life threatening.
Which of the following is not a symptom of anaphylaxis?
Rationale: Pruritus is itching and is not a sign of anaphylaxis but is considered an allergic reaction
sponsored by the FDA encourages coluntary reporting from health professionals and consumers about adverse effects from drug products or medical devices directly to the FDA
Z track method
to prevent the drug from seeping up from the muscle into the subq tissue.
the subq tissue is displaced to one side before inserting the needle into the muscle.
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