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NUR112 Pharm exam 1

study guide

pharmacodynamics ways in which drugs work to change body function; the study of how drugs work with other medications, enzymes or cell receptor sites in the body
pharmacokinetics the study of how drugs move through the body; mechanism of action drug metabolism
four steps of pharmacokinetics 1. absorption - how it gets into bloodstream 2. distribution - how it gets to target tissue 3. metabolism - how cells convert drug for use 4. elimination - how it is removed from body
pharmaceutics ceutic = magician + pharmakon = drug the science of preparing and dispensing drugs to a patient after he or she has been examined by a licensed HCP
factors affecting absorption where and how much was given
intrinsic drugs chemicals that the body makes; hormones, enzymes, growth factors etc
extrinsic drugs made outside the body, must be taken into the body to change cell, organ or body action
OTC - what must the patient know have less potential for harmful side effects, no prescription required, allow you to control your own health care, can still cause health problems and may interact with prescription drugs
generic name always lower case, USAN creates generic names, some part of all generic names for drugs of one class will be the same (-statin, -olol) once a name is approved it is public and not owned by any one drug company
brand name created by each drug company, always capitalized, will have a TM (trademark) or R (registered) after the name
steady state balancing drug entry with drug elimination
why discuss herbal supplements with pharmacist herbal supplements have cellular effects that can be harmful or can interact with other drugs, people may take large quantities because if a little is good for me then a lot is better for me,
organ of elimination of drugs from the body intestinal tract, kidneys and lungs
2 patient identifiers name and birth date
7 Rights 1. right patient 2. right drug 3. right dose 4. right route 5. right time 6. right documentation 7. right to refuse a drug
SL sublingual
PO oral (per os)
BID twice per day
TID three times per day
standing order an order written when a patient is to receive a drug on a regular basis
High alert drugs P-potassium I-insulin N-narcotics C-chemotherapy agents H-heparin
agonist mimics intrinsic drugs activates receptor site
antagonist blocks receptor sites so intrinsic drugs can not bind, slows or stops the activity; it is similar so that it binds to receptor site but doesn't activate it; competes with intrinsic drug
nonreceptor actions does not use receptors
physiological effect outcome of the mechanism of action of a drug, expected and unexpected response, allergic reaction, personal (idiosyncractic)
side effects mild changes
adverse effects (ADR)harmful side effect more severe than expected toxic or toxicity
bioavailability the amount of drug dose that acturally reaches the bloodstream
percutaneous skin or mucous membrane, must be lipid soluble, a drug placed in lowest 1.5 inches of rectum
enteral GI tract drug placed high in rectum, feeding tubes
parenteral injection, IV drugs are 100% bioavailable
compartments 1st - blood stream or blood volume 2nd - blood volume and interstitial spaces 3rd - blood volume, interstitial spaces and intracellular spaces
hydrophilic drugs limited on entering intracellular spaces
fist-pass loss rapid inactivation or elimination of oral drugs as a result of liver metabolism
when is a drug considered eliminated when less than 10% of the drug remains in the system in general it is 5 half-lives after the last dose
paradoxical effect effect of a drug is opposite expected effect
toddler through adolescent have higher metabolism than an adult, a drug would be given at a lower dose but more often
infants and young children water soluble drugs are eliminated faster due to increased water content and surface area
teratogenic or teratogens drugs that cause birth defects 3rd-8th week is most critical time of embryo development
category A studies show no risk to fetus
category B no studies on humans, animal studies show no risk to fetus
category C no studies have been done on humans or animals
category D human studies show increased risk to fetus
category X studies show risk to fetus DO NOT GIVE TO PREGNANT WOMEN
nurses role administer drug, teach, know desired effects and side/adverse effects
minimum info on written RX date , patient name, name and address of subscriber, generic or brand name of drug, strength, times taken per day, instructions, number of doses to dispense, number of refills, prescriber's signature,
principle of administration of drugs must know the drug know pt drug history, allergies, ADR, lab values and changes in condition be aware of prescribed limitations listen to the patient
enteral drugs Before: check order, wash hands, check identifiers, check wrist band After: document, check pt for side effects, ADR and desired effects
feeding tube (enteral) Before: check about crushing tablets or opening capsules, sit pt upright, withdraw stomach contents with syringe or use end-tidal CO2 detector to make sure tube is in stomach After: flush with 50 mL of water; if suction is used, clamp tubing for 30 mins
Rectal drugs Before: does pt have diarrhea, surgery or trauma to rectum? know history of vasovagal reaction use sims position (left lateral) lubricate suppository insert about 1 inch
Parenteral drugs IV IM intradermal Subcutaneous
interdermal drugs 3/8 inch, 25 guage between layer of skin 15 degree angle, bevel up DO NOT aspirate drug volume - 0.01 to 0.1 mL
subcutaneous 3/8 to 5/8 inch, 25-27 guage between skin and muscle 45 degree angle (90 degree if pt is obese) aspirate for anything except insulin or heparin apply pressure drug volume - 0.5 to 1 mL
IM 1-1.5 inches, 20-22 guage use deltoid, vastus lateralis or dorsogluteal muscles 90 degree angle aspirate drug volume: children no more than 1 mL, adults no more than 3 mL
Z track if drug is irritating or would permantly stain tissue; pull tissue laterally and hold while injecting drug
IV check patency of IV site remove air from tubing document site and flow rate check for infection, extravasation (fluid escaping from vein) and infiltration (fluid collecting in tissues)
Percutaneous drugs absorption affected by size of area, concentration of drug, contact time, condition of skin
topical drugs applied to skin for local effects
transdermal drugs applied to skin but enters blood stream
topical/transdermal drugs clean area,apply in smooth, thin layer, cover area remove old patch, clean site (previous also), rotate sites: for children, place a transdermal patch on back between shoulder blades
mucous membranes includes: buccal, sublingual, eyes, ears, nose, inhaled, vagina
learning to acquire new knowledge that results in a persistent change of behavior
listening the key to know what is taught is actually being learned
cognitive intellectual learning
psychomotor motor skills
affective domain attitudes, values, interests, appreciation and adjustment - helps the pt value information - motivation, longest lasting form of learning
androgogy adult learning
pedagogy child learning
give this info clearly to pt drug name, purpose of drug, how it works, how to take it, special instructions, expected response, side effect, ADR, when to call provider
polypharmacy pt is prescribed many drugs
normal body temp 97-100 F 36.1-37.8 C
Celsius to Fahrenheit (C x 1.8) + 32 round to tenth
Fahrenheit to Celsius (F - 32)/1.8 round to tenth
60 gtt 1 tsp
15 gtt 1 mL
3 tsp 1 TBS
1 tsp 5 mL
2 TBS 1 oz or 30 g or mL
8 oz 240 mL
16 oz (1 pt) 454 g (dry) 500 mL
32 oz (1 qt) 1000 mL
4 qt 1 gallon
mEq used to measure electrolytes: KCl, KPO4, Ca++
Mother killed her dog under duress cause Max made noise (my favorite mnemonic) M K H D U D C M . . M . . N
compared to basic unit K 1000 H 100 D 10 d 0.1 c 0.01 m 0.001 mcg 0.000001 micro gram 0.000000001
drug error most caused due to not following one or more of the rights
pounds to kilograms and vise versa lb / 2.2 kg x 2.2
inch to centimeter inch = 2.54 cm
buccal drugs given between cheek and molar teeth of upper jaw
sublingual placed under tongue
controlled substance Controlled substances are drugs that have some potential for abuse or dependence. These drugs are regulated by the federal Controlled Substances Act (CSA) – this law helps the US Government fight against the abuse of these drugs.
half-life time span needed for half of the drug to be eliminated.
peak and troughs peak=maximum blood drug level: trough= minimal blood drug level
prodrug an inactive substance that is converted to a drug within the body by the action of enzymes or other chemicals.
what factors slow the absorption of drugs affected by anything occurring in the stomach or intestines. diarrhea can move the drug too quickly, calcium can bind with some drugs and keep them from absorbing,
what factors affect drug distribution size and chemical nature of the drug, dehydration, low blood pressure, trapping of the drug in certain tissues (sequestration)
single dose order an order to give a drug once only
PRN order given to the pt as needed
stat order given ASAP, per class notes you have 10 minutes to give a stat order
right time you have a 30 minute window to give ordered drugs in order to stay within the "right time"
sentinel event A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
what drug route is most dangerous IV, 1. the IV may infiltrate. 2. it is expensive and nursing intensive. 3. rapid administration of a drug can lead to toxicity. 4. the patient always has more side effects.
Created by: nursingTSJC2013