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PHARM: Exam 1

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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