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PHARM: Exam 1
| Question | Answer |
|---|---|
| drug | any chemical that can affect living processes |
| pharmacology | the study of physical and chemical properties of drugs and their interaction with living systems |
| pharmacotherapeutics | the use of drugs to diagnose, prevent, treat disease or to prevent pregnancy |
| pharmacology development | FDA responsible for approval, monitoring adverse/toxic affect |
| Pre-FDA phase | in-vitro testing, studies in live animals, applications to the FDA |
| chemical drug nomenclature | indicates its atomic and molecular structure |
| generic or nonproprietary drug nomenclature | r/t official name or active ingredient; given by the US adopted name (USAN) council; not capitalized |
| generic vs brand-name | chemically the same; could have different names, colors and shapes, required by law to be same drug; |
| generic drugs approval | after a drug is approved by the FDA, drug is granted a patent for 10-12 years; after this period these drugs are created by other companies |
| official drug nomenclature | name adopted by governing bodies; same as generic name; not capitalized |
| trade or proprietary or brand name | final name; drug is registered, use is restricted to the owner of that drug |
| over the counter drugs(OTC) | available without a prescription to treat common ailements; 1906- controlling of self-meds; 1972- review of product ingredients to ensure safety, effectiveness, and labeling standards |
| pharmacokinetic | absorption, distribution, metabolism, excretion; BODY to DRUG |
| pharmacodynamic | DRUG TO BODY drug action and effect within body; studies the biochemical and physiologic action and effects of drugs; replace/sub missing chemical; increase/stimulate cellular activity; depress/slow cell activity; interfere with function of foreign cells |
| distribution of drug | through circ system to site of action |
| metabolism of drug | changing drugs into less active chemicals |
| excretion of drug | removal of drug from body |
| half life of a drug | the time required for the body to eliminate 50% of the drug; important for dosing; drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. |
| primary effect | desired or therapeutic effect |
| secondary effect | all other effects; these effects may be desirable or undesirable |
| side effects | nearly unavoidable secondary drug effects produced at therapeutic levels; expected and inevitable; i.e. histamine and drowsiness |
| adverse effects | undesirable responses that may be fatal, life threatening or permanently disabling; black box warnings; allergic reactions; i.e. motrin and hepatitis |
| toxicities | severe drug side effects caused by excessive levels of drug; i.e. resp failure and morphine |
| synergistic | 2 drugs produce an effect greater than the sum of their separate actions (1+1=4) |
| antagonistic | one drug interferes with another, neutralizing the effect(protamine sulfate/heparin) |
| factors influencing drug response | age; weight; gender; pathologic condition/disease; route of admin; genetics and ethnicity; alteration in cell environment; alteration in cell function |
| 8 rights of drug administration | right patient, right med, right dose, right route, right time, right documentation, right to refuse, right education |
| principles of drug administration | verify order, check label(3x), ID patient/allergy, wash hands watch for drugs w sim names never crush w/o pharm never give drug prep by other nurse open dose at pt bedside never remove drug from unlabeled cont observe aseptic technique when using syringes |
| three checks of the label and drug order | when pulling from drawer; when collecting all meds; before giving it to pt |
| the right dose | dont break unscored tablets or divide a single capsule; liquids measured in a container; recheck all calcs with another personnel; be careful using decimal points |
| the right time | number of times a day a drug is to be given; spell out time i.e. every other day not q.o.d; could be equal time intervals, sometimes can be divided over waking hours; have to be given within 30 minutes to an hour of scheduled time |
| the right documentation | only after med administration; |
| the nurse should before med admin | handle and store drugs carefully to maintain the drug's stability and strength; notes a drugs expiration date; remain at bedside until pt takes the med to verify that it was taken as directed and should never leave med at the bedside |
| the nurse should med admin | admin only meds prepared personally or by pharmacist; dont give another nurses drug or one found not labeled in drawer; record obs of pts pos and neg responses to med; look up necessary info; chart after giving |
| standard written orders | applied indefinitely until the prescriber writes another order to alter or discontinue the first one |
| single orders | these order are written for medications that are given only once |
| stat orders | these orders are to be admin immediately for an urgent patient problem |
| P.R.N. orders | for medications that are to be given when needed |
| standing orders/protocol | establish guidelines for treating a particular disease or set of symptoms |
| verbal orders | given orally rather than in writing(document as VO) |
| questioning medication orders | illegible or incomplete, nurse judges order as inaccurate for any reason, nurse must contact prescribing MD to clarify order; |
| if a nurse refuses to administer a medication | nurse must notify the immediate supervisor and document what ensued |
| recording and transcribing orders | orders should be written by the prescriber; TO and VO may be written by nurse, countersigned by the physician ASAP; when taking verbal or telephone the nurse should always read it back for verification |
| drug orders should always include | name of the pt; name of the drug; dose, route and frequency or timing of doses; if any doubt verification must be sought from the prescriber involved |
| reporting a medication error | report immediately and document: clinical observations related to the incident; info on med given; pts reaction; any medical interventions taken to minimize harm to the pt |
| incident report | id what happened; the names and functions of all persons involved; the actions taken to protect the patient after the incident; does not become part of the pts med records |
| the incident report serves 2 purposes | to inform administrators about the incident so they can consider changes that will help prevent similar incidents in the future; to alert admin and the facilities insurance company to potential liability claims and the need for futher investigation |
| united states drug legislation | to protect the public from drugs of poor quality and questionable potency, the federal and state governments have enacted legislation designed to standardize ingredients in medicinal agents- |
| standardizing ingredients in medicinal agents | purity, potency, quality |
| 1906 drug law | food and drug act- purity, potency, quality |
| 1915 drug law | harrison narcotic act/1970 comprehensive drug abuse prevention and control act- sale of narcotic drugs/presciption |
| 1938 drug law | food, drug and cosmetic act- control of manufacture, sale of drugs and safety |
| 970 comprehensive drug abuse prevention and control act | controlled substances act; DEA; strengthened the law enforcement in the control of drug abuse; established a system of drug classification for controlled substances |
| schedule I(C-I) | high abuse potential; heroin, marijiuana, LSD |
| scheudle II(C-II) | high abuse potential w/physical/psychosocial dependence; opioids, stimulants barbituate sedatives, hypnotics; morphine, methamphetamine,pentobarbital |
| schedule III(C-III) | less abuse potential; androgens/anabolic steroids, nonbarbiturate sedatives |
| schedule IV(C-IV) | sedatives/antianxiety; phenobarbital and benzodiazepines |
| schedule V(C-V) | codeine used in antitussives/antidiarrheal |
| malpractice | professionals wrongful conduct, improper discharge of duties, or failure to meet standards of care that causes harm to another; imperative that the nurse be familiar with and to function according to the nurse practice act |
| negligence | form of malpractice; refers to the failure to do something that another person of the same education and experience would do |
| nurses are responsible for their own actions | legally liable for implementing an incorrect order |
| medication errors resulting in malpractice may take two forms | errors of omission(neglect of duty); errors of commission(performing an act) |
| doctrine of respondent superior | an employer is resposible for the acts of his or her employees while they are engaged in service to the employer; does not exempt the practitioner from personal liability |
| placebo | inactive substances used for nonspecific, psychological effects w/o pts immediate knowledge that this is being given; nurses cannot legally admin any med wo an order even with this therapy |
| guidelines for placebo | use only after careful dx; use only inactive substance; answer questions as truthfully as possible; honor pts request not to receive; never given when other treatment is indicated or before exploring all treatment options |
| unit-dose format packaging | a single dose of a drug comes in a labeled container or wrapper |
| bulk format packaging | multiple doses of a drug are packaged in a container, bottle or wrapper |
| solid drug forms | tablets, capsules, enteric coated tablets |
| unscored tablets, enteric-coated tablets, time-released tablets and capsules should never be... | divided |
| liquid drug forms | given parenterally; vials, ampules, self-contained systems or pre-filled syringe, suppositories |
| suppositories | mix of drugs in a soft form; need lubrication to give, due to site given |
| inhalants | powdered or liquid forms of a drug given via the respiratory route and are absorbed rapidly in the lungs; i.e. sprays, atomizers, metered-dose nebulizers |
| other drug forms | sprays, ointments, pastes, lotions, patches, lozenges |
| narcotics admin techniques | stored in a locked cabinet/dispensing device; two nurses count each shift; dispensing device can only be opened by nurse using codes and pt id number |
| oral administration advantages | convenience; economy; the drug does not have to be absolutely pure or sterile; wide variety of dosage forms |
| oral medications include | tablets, capsules, liquids and suspensions |
| oral administration disadvantages | inability of some patients to swallow; slow absorption, partial or complete destruction by the digestive system |
| oral administration | pour meds first into container lid and then into paper cup(med not touched); if pt is NPO double check if pt can have med with a little water; several solids can be combined into the cup |
| for difficulty swallowing solids try | liquid form; crush solid and mix in a small amount of applesauce, jello, pudding, ice cream; sit in an upright position |
| prepare liquid med | pour liquids at eye level, with thumb indicating the meniscus; label should be up so it will not be stained; wipe the lid of the bottle |
| oral admin for infants/toddlers/kids | all are prescribed in liquid form; hold baby with head elevated and instill med in the pocket between gum and cheek |
| can you put medications for a young child in a bottle/formula? | no because they may not finish the bottle and then you wont know how much of the medication they had |
| NG medication | must be crushed or in liquid form; position pt in high-fowlers, confirm placement of NG tube; flush tube with 30 mL of water before and after admin med; allow fluid to flow via gravity in the NG tube |
| parenteral administration definition | not through the GI tract; admin by injection or IV cath for systemic effects; drugs must be sterile; doses usually lower than oral doses |
| why are parenteral doses usually lower than oral doses? | because 100% of injected dose is ultimately absorbed |
| types of parenteral admin | subcu; intradermal; intramuscular; intravenous; intrapsinal |
| subcutaneous admin | agent in injected just below the skins cutaneous layers; i.e. insulin |
| intradermal admin | injected within the dermis; ppd |
| intramuscular admin | drug injected into the muscle; i.e. procaine penicillin G |
| intravenous admin | drug introduced directly into the vein |
| intraspinal admin | drug introduced into the subarachnoid space of the spinal column |
| gauge(diameter) of needles | larger the number, the smaller the gauge is; range from 14 to 28; range from 1/2 in to 2 in |
| IM injection requires.... needle | a long needle; usually 1 1/2 to 2 in |
| viscous substances require.... diameter | larger; usually 20 or 18 gauge |
| parenteral admin | inject a vol of air= volume of drug to be withdrawn; prior to any injection, assess the condition of the site for evidence of tissue damage or poor circulation; rotate injection sites; b4 mix w syringe check compat; aseptic tech; use alcohol to prep site |
| powdered medications must be | reconstituted with the proper diluent |
| common sites for IM | ventrogluteal; dorsogluteal; vastus lateralis; rectus femoris; deltoid |
| ventrogluteal site IM | gluteus minimus; pt is supine, lying on side, sitting or standing; |
| dorsogluteal | gluteus medius; pt is prone or side-lying position; |
| ventrogluteal inection is given | in the center of the triangle between the middle and index finger |
| ventrogluteal landmarks | find greater trochanter, anterior superior iliac spine and the iliac crest |
| dorsogluteal landmarks | crest of the posterior ilium; inferior gluteal fold as lower boundary |
| diagonal lankmark of dorsogluteal | posterior superior iliac spine and greater trochanter of femur |
| when injecting into gluteal region or vastus lateralis avoid | the sciatic nerve; instruct pt to report any pain or burning |
| quadrant lankdmark | divide buttocks into imaginary quadrants; vertical line extends from the crest of the ilium to the gluteal fold; horizontal line extends form the medial fold of the buttock to the lateral aspect of the butt; locate the upper aspect of the upper-outer quad |
| vastus lateralis(lateral thigh) IM | supine, lying on side, standing; one hand's width below the greater trochanter and one's hands width above the knee; give the injection in the lateral thigh |
| rectus femoris(anterior thigh) | supine, lying on side or standing; one hand's width below the greater trochanter and one hand's width above the knee; give injection in middle thigh |
| deltoid IM | sitting or lying down;no more than 2 mL should be injected |
| deltoid landmarks | lower edge of the acromion process and the axilla; injection into the lateral arm between the two points about 2-3 inches below the acromion process |
| IM admin adults | use size 18 to 23 gauge; 1-1/2 inch needle; normally up to 3 mL; max 5 mL |
| IM admin child | 25 to 27 gauge; 1/2 to 1 in; 5/8 for newborn |
| very thin patients IM injection | squeeze skin at injection site and insert needle at 90 degrees |
| IM admin before injecting | aspirate gently to confirm correct needle placement; if blood appears, withdraw the needle and prep another dose for an alternative site |
| Z-track injections | for drugs irritating or staining to the skin; prevent seepage of the med into the needle tract and onto the skin(remove needle and release skin, no massaging) |
| Z-track injection admin | stretch skin to side and hold position; inject med at 90 degrees; aspirate before giving med; count 10 sec after giving injection; removed needle and release the skin at the same time; do not massage the site |
| intradermal administration | injection into the upper layers of the skin to produce local effect; syring with 25 to 27 gauge; 3/8 to 5/8 in needle; limited to ~0.1 mL solution; ventral forearm most common site |
| intradermal admin technique | clean with alochol swab, insert needle at 15 degree angle and with bevel up; med is injected to form a small pocket or wheal; no massage |
| subcutaneous administration | provides slow sustained release of medication and a longer duration of action; used when the total vol injected is small; injection sites should be rotated |
| injection sites(rotate!) for subcu admin | area under scapula; lateral aspect of the upper arms; thighs; abdomen |
| subcu admin tech | needle: 25-27 gauge; 3/8 of 5/8 in; insert needle at 45 or 90 degree and bevel up; amount of solution 2 mL or less; gently massage site to stimulate circ in area except heparin and insulin |
| when admin HEPARIN | injection is given into the lower ad fold at least 2 in from umbilicus; do not aspirate and do not massage the site after injection |
| when admin INSULIN | do not aspirate; mix insulin in one syringe; air into NPH; air into regular(clear); draw regular(clear first); draw NPH |
| sublingual admin | tablet placed on the floor of the mouth |
| buccal admin | tablet placed between gum and cheek |
| sublingual and buccal admin | do not swallow tablet until it is dissolved; no food or liquids until the tablet is dissolved |
| sublingual and buccal admin advantages | drug enters circ without the first pass liver extraction; diminished time required for a drug to begin therapeutic action; rapid absorption into blood stream due to lots of blood vessels |
| rectal admin | left lateral recumbent position(Sim's); moisten w water soluble lub; instruct pt to breathe slowly/deeply; bear down to open anal sphincter; insert lub supposito, tapered end first, approx 2 in; encourage to retain supp for 10-20 min to allow supp to melt |
| ophthalmic(Eyes) drops or ointment | must be sterile and read(eye use only); |
| when admin oinment(Eyes) | gently squeeze into the lower conjunctival sac moving from inner to outer canthus; |
| when admin eye drops | place necessary number of drops into the lower conjunctival sac; apply pressure to pts nasolacrimal duct for 30 to 60 sec(prevents systemic effect) |
| otic (ear) drops | labeled otic or auric; warmed to body temp; lie on unaffected side, straighten the external ear canal by pulling the auricle up and back for adult; pull down and back for children 3 yr or younger |
| nose drops | given as sprays and drops; blow nose gently to clear nasal passageways; sitting or lying down/tilt head back |
| nose drops admin | insert dropper about 1/3 into each nostril; do not touch the nostril and instill med; maintain the position 1 to 2 min; |
| nasal spray | push the tip of the nose up and place the nozzle tip in the nares and spray |
| resp inhaler | must be vaporized or nebulized, water soluble; shake before use; pt exhale place spacer in mouth or hold 1-2 in from mouth w/o touching mouthpiece; press canister to release meds,begin to inhale slowly; hold breath for about 10 sec, then breath out |
| after resp inhaler | rinse mouth; wash spacer |
| dermal(skin) application | used for local effect, except nitroglycerin |
| when admin transdermal disks, patches, pads | skin should be clear, dry and no signs of irritation; clean the area; place on chest, ab, arms, thighs; avoid areas that have hair; remove cover without touching the inside of patch then apply; initial, date and time |
| nitroglycerin(NTG) admin | given via the dermal route for its systemic not local effect; ointment- measure dose in in on the ruled paper that comes w; select a non-hairy site of the trunk; spread on the skin, using ruled paper; do not rub; cover w plastic wrap and tape in place |
| vaginal application | used for topical ab or antifung meds; liquid, cream, supp, ointment, tablet or gel; applicator and water-soluble lub often use; dorsal recumb position; insert 2 in; angled downward and back |
| intrathecal | access device implanted beneath scalp/spinal cord; usually for chemo |
| intra-articular | not common; used with joint inflammation to inject corticosteroids |
| urethral | for local antibiotic or antifungal therapy; liquid med is instilled into the urethra through a small-diameter urinary cath using sterile tech |
| epidural | a cath is placed into the spinal column via a lumbar puncture; commonly used for anesthetics and narcotics |
| before admin any medication determine | safety and need; risk factors; if order relates to pt condition; if drug dose is within safe range; allergies |
| autonomic nervous system | controls involuntary activities in visceral organs |
| sympathetic nervous system | stimulated by physical/emotional stress; fright-flight-fight response; adrenergic receptors= alpha and beta |
| parasympathetic nervous system | resting and maintenance; rest and digest; 75% of nerve fibers in vagus nerve |
| neurotransmitters | acetylecholine(para); norepinephrine(symp) |
| sympathetic NS increases | BP, heart rate, resp rate, blood sugar, pupil dilation |
| alpha receptors | smooth muscle contraction |
| alpha 1 | vasoconstriction; increase BP |
| alpha 2 | vasodilation; decrease BP |
| beta receptors | smooth muscles |
| beta 1 | increases heart rate |
| beta 2 | bronchodilation |
| adrenergic system | emergency response system; increases HR, RR, BP, dilates pupiles; epinephrine/adrenalin |
| adrenergic drug use | emergency; acute cardiovascuar, resp/allergic reaction; hypotension |
| adrenergic drug action | with alpha/beta receptors and mimic the action of neurotransmitters |
| adrenergic drug contraindications | cardiac dysrhythmias, CVA, HTN, narrow-angle glaucoma |
| adrenergic drug adverse effects | hypotension, slows heart rate, slows resp rate, dysrythmias |
| adrenergic agents or sympathomimetics | mimic effects of the SNS neurotransmitters norepinephrine and epinephrine by acting on alpha-adrenergic receptors |
| beta-adrenergic receptors and dopaminergic receptors | drugs effect heart, lungs, blood vessels; receptors are the sites where drugs connect or bind to produce effects |
| epinephrine-adrenergic drug use | cardiac arrest, allergic reaction, airway obstruction |
| epinephrine-adrenergic drug action | stimulates both alpha/beta receptors; needs to work right away--> injection not PO |
| epinephrine-adrenergic drug contraindication | hypersensitivity |
| epinephrine-adrenergic drug adverse effect | restlessness, arrhythmia, tachy, HTN |
| nursing implications of epinephrine-adrenergic drugs | A- allergic disorder, asthma, COPD, angina, HTN; I- administer promptly, monitor 30 min after admin; inhalation teaching; E- observe for increased BP, improved breathing |
| dopamine HCL(intropin) | immediate precursor of norepinephrine; can be given in low, moderate or high doses with varied results because dopamine works on different receptors based on rates |
| low dose dopamine | 1 to 5 mcg/kg/min for renal perfusion; increase urine output |
| low to moderate dose dopamine | 5 to 10 mcg/kg/min for cardiac effects |
| higher doses dopamine | 10 to 30 mcg/kg/min for increased peripheral resistance(constricts), increased BP, cardiac effects, vasoconstriction may cause decreased renal function |
| beta- adrenergic blocking agents | block sympathetic response by competing for beta receptors |
| beta blockers that block beta 1 receptors | decrease BP, block heart stimulation; tx angina pectoris(atenolol) |
| beta blockers that block beta 2 receptors | vasodilation in skeletal muscle arterioles; tx HTN |
| propranolol | hydrochloride; example of a non-specific/non-selective beta blocker that blocks both beta 1 and beta 2 |
| beta- adrenergic blocking agents used to treat | tachyarrhythmias(slow ventricular response); hypertension; angina pectoris; glaucoma; decrease BP, HR and reduce intraocular pressure |
| beta- adrenergic blocking agents side effects | bradycardia; hypotension; bronchospasm; cant be given to asthma pts |
| beta- adrenergic blocking agents nursing implications | assess and monitor VS esp for bradycardia; take apical pulse before drug admin; blood sugar for hypoglycemia; lung sounds for wheezing; the need to increase dosage |
| atenolol/tenormin | beta 1 selective/cardio selective; good choice if someone has respiratory problems; wont affect lungs |
| timolol/blocaderen | eye drop med; glaucoma |
| important beta blockers | atenolol; propanolol; metoprolol; timolol |
| PNS neurotransmitter | acetylcholine |
| PNS body reaction | dilation of blood vessels, bradycardia; constricted pupils(miosis); increased salivation |
| cholinergic drugs | stimulate parasympathetic nervous system; PNS functions are resting, reparative and vegetative; major systems are digestion and excretion; can be direct acting or indirect acting |
| parasympathomimetics actions | decreased HR, vasodilation; increased tone and contractility in GI smooth muscle; relaxation of sphincters; increased salivary gland and GI secretion; increased bladder contraction; increased respiratory secretion; constriction of pupils(miosis) |
| parasympathomimetics common drugs | urecholine; neostigmine/tensilon; aricept; pilocarpine; metoclopramide hydrochloride (reglan) |
| urecholine | urinary retention |
| neostigmine/tensilon | myastenia gravis |
| aricept | alzheimer |
| pilocarpine | glaucoma |
| metoclopramid hydrochloride/ reglan | for gastric reflux, delayed gastric emptying and N/V especially for chemo related side effects |
| cholinergic drugs contraindication | GI/urinary tract obstruction; asthma; CAD |
| cholinergic drugs action | cramps; diarrhea; excessive salivation; muscle weakness; difficulty breathing(s/sx of overdose) |
| cholinergic drugs nursing implications | a- disease specific; I- decreased need for drug, ambu, fluids, rest for MG, wear bracelet; E- atropine |
| cholinergic crisis | overdose of acetylcholinesterase inhibitors or anticholinesterase meds; keep atropine sulfate handy- its that antidote for cholinergic overdoses |
| anticholinergic drugs use | GI, GU, ophthalmic, respiratory |
| anticholinergic drugs action | block acetylcholine at receptor site |
| anticholinergic drugs contraindication | prostatic hypertrophy, MI, glaucoma, tachyarrhythmia |
| anticholinergic drugs adverse effects | dry mouth, decreased gi/gu motility; dilated pupils; dries everything up |
| anticholinergic drugs nursing process | A-bradycardia, dysuria, abd pain, assess for other drugs with anticholinergic effects; I- no otc, prevent heat exhaustion, Tx 3 D's notify MD if urinary retention/constipation |
| anticholinergic drug nursing implications | do not give to pts: with myasthenia gravis (s/sx of MG: eye droop, double vision, weakness, diff swallowing and chewing); acute glaucoma( increase IOP); prostatic hypertrophy(because of urinary rentention) |
| MG needs | acetylcholine to treat; if blocked with cholinergic blocking meds; symptoms increase |
| anticholinergics geri pt | may lead to higher risk for heatstroke due to effects on heat-regulating mechanims; teach pts to limit physical exertion, avoid high temps and strenuous exercise; emphasize importance of adequate fluid and salt intake |
| pediatric considerations for med administration | doses based on weight and body surface area; must consider organ maturity; IM inj given at vastus lateralis(under 3 yo); elixirs, syrups, suspensions(under 5 yo); orders should be for only 1 mL |
| geriatric considerations for med administration | higher risk of drug toxicity and adverse rxns; exacerbaed by disease/chronic disorders; total body water decreased; body fat increased(fat-solubles accumulate= prolonged/toxic effects); sensitive to narcotics; polypharm, noncompliance; physical impairment |
| 1 L | 1000 mL |
| 1 g | 1000 mg |
| 1 kg | 2.2 lbs |
| 1 oz | 30 mL |
| 1 mg | 1000 mcg |
| african americans | harmony with nature; Illness disharmony, punish; evil spirits; Life is a process,can be influenced by other forces; Rely on religious faith; prayer and laying hangs; High risk of HTN & sickle cel; respond better to diuretics, Ca-channel blockers |
| hispanics | good luck; good behavior; illness- weakness, imbalance, misdeed; maintain balance between hold and cold; diseases of the poor- TB, malnutrition, lead poisoning |
| asian americans | balance between fire, earth, metal, water, wood; harmony with nature; yin yang; restore balance= tx illness; hospital food alien; blood drawing invasive |
| native americans | balance of body, mind, enviro; illness caused by spirits, not following tradition, disruption of nature; alcohol abuse common |
| mnemonic for 8 rights of med administration | pet my dog ralph to dance run eat |
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