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Pharmacology exam 1 part 1 ch 1-4
Terms in this set (74)
what is the nursing process?
a well established research supported framework for professional nursing practice
what are the five steps of the nursing process
human needs statement (diagnosis)
planning with outcome identification
implementation (including patient education)
what is included in a complete medication history?
any and all drug use
home folk remedies (herbal& homeopathic treatments)
current or past hx of illegal drug use
over the counter meds
family hx of reactions to specific meds
what are the six rights of safe medication administration?
Right Route and Form
what 7 elements are required in a medication order?
date the drug order was written
name of drug(s)
drug dosage amount
drug dosage frequency
route of administration
what is pharmacokinetics?
the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body.
(represents the drugs absorption, distribution, metabolism, and excretion from the body)
what is pharmacotherapeutics?
use of drugs to prevent and treat diseases
(reasons for taking a drug to get benefit, evaluating the appropriateness of a drug used for treating a specific condition)
what is absorption
the movement of a drug from its site of administration into the bloodstream for distribution to the tissues
what is distribution?
the transport of a drug by the bloodstream to its site of action. (first distributed to the areas with extensive blood supply, ex: heart, kidneys, liver and brain)
what is metabolism?
also known as biotransformation, the enzymatic alteration of a drug structure
what is excretion?
removal of drugs from the body
what is the onset of action?
the time is takes for the drug to elicit a therapeutic response (the time the drug starts working)
what is the peak effect?
the time it takes for a drug to reach is maximum therapeutic response in the body (the time the drug is doing the best it can)
what is the duration of action?
the length of time that a drug concentration in the blood or tissues is sufficient to elicit a therapeutic response
what is the minimum effective concentration (MEC)?
the plasma drug level below which therapeutic effects will not occur
what is the therapeutic index/window?
when the amount of the drug in the plasma is above the minimum effective concentration (MEC) and below the toxic concentration
what are sub-therapeutic effects?
blood levels below therapeutic levels due to insufficient dosing
what are toxic effects?
intensification of the effects of the given rug or severe like damaging vital organs
what is the "safe range"
less than minimum dose will be sub therapeutic, more than maximum dose may be toxic
what is the man organ involved in drug metabolism?
how often should LFT's be obtained?
periodically, about every 3 months throughout therapy
which labs monitor the liver functions? (what are their normal ranges)
alk phos: 30-120
what type of juice if taken with certain medications can affects the metabolism and increase the risk of toxicity?
what is the nurses role/responsibility when questioning a medication order?
-inform the health care provider
- record that the provider was informed and record their response
- inform the nursing supervisor
- refuse to carry out that prescription if needed
what is the protocol for taking and documenting a verbal or telephone order for medication?
DO NOT JUST REPEAT BACK
WRITE down the order, READ back to prescriber.
provider must sign within 24 hours of this verbal order
what is the main organ involved in drug excretion?
what las are used to monitor the function of the kidneys, what are their normal ranges?
loading dose vs maintanance dose
loading: large initial dose to achieve a steady state (plateau) (done to get plasma blood level in therapeutic range faster)
maintenance: after high drug levels are obtained, plateau can be maintained by giving these smaller doses (the maintenance doses)
what is pharmacodynamics?
what the drug does to the body.
what is the mechanism of action in pharmacodynamics?
the drugs can produce actions (therapeutic effects) in several ways. once the drug is at the site of action, it can modify (increase or decrease) the rate at which that cell or tissue functions, or it can modify the strength of function of that cell or tissue
-A DRUG CANNOT CAUSE A CELL TO PERFORM A FUNCTION THAT IS NOT PART OF ITS NATURAL PHYSIOLOGY
what is the drug receptor interaction?
the joining of the drug molecule with a reactive site on the surface of a cell or tissue. once the drug binds to the receptor a pharmacologic response is produced. the drug with the best "fit" and strongest affinity for the receptor will elicit the greatest response
what is an agonist?
a drug that binds to and stimulates the activity of one or more receptors in the body
what is an antagonist?
a drug that binds to an inhibits the activity of one or more receptors in the body (also called inhibitors or blockers)
what is the trough serum level?
the lowest level between doses, and occur just prior to administering the next dose. obtained less than 30 minutes before the next dose
what is the peak level?
the highest blood level of a drug, if the peak level is too high, then drug toxicity may occur
what is the generic drug name?
the name given to a drug by the United States Adopted Name Council. also called the nonproprietary name. this name is much shorter and simpler than the chemical name and is not protected by trademark
what is the chemical drug name?
the name that describes the chemical composition and molecular structure of a drug
what is the trade name of a drug?
the commercial name given to a drug product by its manufacturer, also called the proprietary name
what is the brand name for these medications?
what is the rate of absorption fastest to slowest for oral medications?
oral disintegration, buccal tablets, soluble wafers
liquids, elixirs, syrups
enteric coated tablets
describe the purpose for enteric coated tablets and the teaching regarding their use
have a coating that prevents them from being broken down in the acidic pH environment of the stomach and are not absorbed until they reach higher (more alkaline) pH of the intestines. results in slower absorption.
do not crush or alter this tablet
what is bioavailability?
describes how different forms and routes of drugs can affect how quickly a medication will work
contraindication vs precaution
contraindication: indicates it is dangerous to give the patient this medication ex: allergies
precaution: this drug involves risks, drug dosing modification is required
what can opiates cause?
what is the antidote for benzodiazepines (end with -lam or -pam)
what is the antidote for acetaminophen?
what is the antidote for opiates, opiod drugs?
what is the antidote for beta blockers?
how does the number of medications an elderly patient is taking increase the risk for drug interactions?
with 10 drugs there is 100% risk for drug interactions (dose may be 1/2 to 2/3 standard of adult doses)
discuss what happens during the first trimester of pregnancy
the fetus is at the greatest risk for drug induced developmental defects, this is when the mother must take special care to avoid exposure to teratogens
discuss what happens during the last trimester of pregnancy
the greatest percentage of maternally absorbed drug will get to the unknown baby, this is because increased blood flow and lipid solute drugs cross the placenta the easiest here
what is the teratogenic effect?
drugs that cause abnormal fetal development when given to pregnant women
discuss the category A B and C for pregnant women
A: studies indicate that there is no risk to the human fetus
B: studies indicate there is no risk to the animal fetus, no human studies available
C: animal studies with adverse effects reported in fetus, no controlled studies in women
discuss category D and X for pregnant women
D: possible fetal risk in humans has been reported, potential benefit versus risk may warrant treatment in pregnancy women (ex: asthma, hypertension, epilepsy, infection.)
X: absolutely contraindicated. proven risk for fetal abnormality. no possible benefit
describe the factors that effect drug dosing in pediatric patients
skin is thin and more permeable
stomach lacks acid to kill bacteria
lungs have weaker mucous membranes
body temp is less well regulated and dehydration occurs easily
liver and kidneys are immature, drug metabolism and excretion are impaired
how to calculate pediatric dosages
divide patients weight in pounds by 2.2 to get kg (round to the nearest 10th)
describe poly pharmacy and how it relates to adverse drug reactions in the elderly patients
poly pharmacy is the simultaneous use of multiple medications.
poly pharmacy can produce adverse drug events, increase healthcare costs, and noncompliance and non adherence
what is pharmacogenomics?
the study of how certain genetic traits affect drug response
which ethnic groups respond differently to antihypertensive drugs?
which ethnic group response differently to antipsychotic and anti-anxiety drugs?
asians and hispanics
discuss cultural diversity and the use of verb tenses
avoid using: can't, won't, don't.
use words like: cannot, will not, and do not
discuss the common practices among these cultural groups:
asians: opposing forces lead to illness (yin and yang, accupuncture, hot and cold foods)
native Americans: harmony with nature keeping balances within the body, ex: medicine man
African Americans: practice folk medicine, herbs, oils, roots
hispanic: view health as good luck and living right, use spiritualist and curandero
western: increased participation n health care, demand more explanation about disease and prevention of it
what is genetic predisposition?
the presence of certain factors in a persons genetic makeup or genome that increase the individuals likelihood of developing one or more diseases
discuss the individuals in the investigational drug studies in each phases, and what can they all do?
phase I: small numbers of healthy subjects, rather than those who have the disease that the new drug is intended to treat
phase II: small numbers of volunteers who have the disease
Phase III: large numbers of patients who are followed by medical research centers and other types of health care entities
phase IV: studies done by pharmaceutical companies to obtain further proof of the therapeutics and adverse effects of the new drug
-all participants have to sign an informed consent and they can withdraw from the study at any time, NO QUESTIONS ASKED
discuss the three classes of FDA recalls on drugs
class I: most serious, STOP IMMEDIATLY
class II: less severe, use of the drug may results in temporary or medically reversible side effects
class III: least severe, use of the drug is not likely to result in any significant health problems
what is autonomy?
self-determination and the ability to act on one's own
what is beneficence?
the ethical principle of doing or actively doing good, determining how the patient is best served
whaat is confidentiality?
the duty to respect privileged information about a patient, not talking about a patient in public or outside of the health care context
what is justice?
the ethical principle of being fair or equal in ones action, fairness in distributing resources for the care of patients and determining what to treat
what is nonmaleficence?
the duty to do no harm, avoiding doing any deliberate harm while rendering nursing care
what is veracity?
the duty to tell the truth, telling the truth regarding placebos, investigational new drugs, and informed consent
what does the ANA standard for Nursing practice describe?
the scope of practice, function, and role of the nurse. if standards are not met, the nurse becomes liable for negligence and malpractice
what is the purpose of fast tracking of new drugs?
this process allows pharmaceutical manufacturers to shorten the approval process and allowed prescribers to give medications that showed promise during the early phase I and II clinical trials (ex: with AIDS)
describe the 5 categories for controlled substances and give examples of the drugs in each category
C-1: only with approved protocol (heroin, marijuana, methaqualone, mescaline)
c-II: written prescription only, no refills, container must have warning label ( codeine, cocaine, hydrocodone, morphine, amphetamine, oxycodone)
c-III: written or oral prescription that expires in 6 months, container must have warning label (codeine with acetaminophen, pentobarbital rectal suppositories)
c-IV: same as C-III (tramadol, benzodiazepines)
C-V: written prescription or over the counter (meds for relief of coughs, diarrhea, etc)
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