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3rd Pharmacy Quiz

Multi topic quiz

What are the first steps will you teach to a patient that will use a metered-dose inhaler? 1. Shake canister gently 2. Remove cap, hold upright with thumb and first 2 fingers 3. Tilt head back
What additional steps will you teach to a patient that will use a metered-dose inhaler? 4. Position inhaler 1-2 inches (2 fingers) from mouth 5. Exhale, press down on the inhaler and breathe in slowly and deeply (5 seconds) 6. Hold breath 10 seconds, exhale slowly through pursed lips.
Should second puff be taken immediately after the first one? Pt should wait 20 - 30 seconds before taking the second puff.
Which type of inhaler should be used first? Steroid or bronchodilator? The bronchodilator should be used before the steroid. The bronchodilator will open the airway which will allow in more of the steroid.
What should the patient do after using a steroid inhaler? The patient should rinse out his or her mouth to help prevent the development of a fungal infection.
How soon should the patient wait to use a steroid inhaler if a bronchodilator needs to be used first? The patient should wait 2 - 5 minutes after using the bronchodilator, or use per order directions.
MDI stands for Metered-dose inhaler
Transdermal Patches: steps for administering First few steps 1. Wash hands and put on gloves. 2. Remove old patch and folded in half so that sticky sides are together. 3. Look for skin irritation.
Transdermal Patches: steps for administering 4. Select a new hairless site (free of powder, lotion, etc...) 5. Apply new patch (close to same time as last application). 6. Dispose of old patch per site policy.
Rectal medication administration 1. Wash hands and PUT ON GLOVES! 2. Assess the patient for contraindications: rectal bleeding/irritation. 3. Place patient in left Sim's position.
Rectal medication administration 4. Always lubricate tips to be inserted with water-soluble jelly. 5. Insert suppositories at least 1 inch above the rectal sphincter (along the wall - pt to take deep breaths). 6. Have pt remain on side for 15 - 20 minutes.
Vaginal medication administration 1. Wash hands and PUT ON GLOVES! 2. If possible, administer medication at HS to allow medication to remain in place longer. 3. Place pt in lithotomy (supine) position and elevate hips with a pillow. 4. Be sure to drape pt for privacy and dignity.
Vaginal medication considerations 1. Don't forget to lubricate tip. 2. With suppositories, have pt remain in supine position for 5 - 10 minutes.
Eye medication administration 1. Wash hands and PUT ON GLOVES! 2. Assist pt into supine or seated position. 3. Remove secretions with sterile gloves (wipe inner to outer canthus). 4. Have pt look up, gently pull the lower lid down to expose conjunctival sac.
Eye medication administration 5. DO NOT touch the tip to the pt's eye (dropper or fingers). 6. Drop prescribed amount of drops to the lower conjuntival sac (NEVER APPLY DROPS ONTO THE CORNEA).
Eye ointment administration 1. Gently squeeze a thin strip along the border of the conjunctival sac. 2. Move from inner to outer canthus.
Post administration of eye medications 1. Ask pt to gently squeeze eye(s) closed. 2. A tissue can be used to blot away medication that comes out. 3. Pressure can be applied to the nasolacrimal duct for 3 - 60 seconds to prevent systemic absorption of medication.
Ear medication administration (considerations) 1. Medication should be warmed up prior to administration (if it is refrigerated). 2. For adults and children over 3, pull the pinna up and back. 3. Apply medication along the sides of the ear canal.
Ear medication administration (considerations) 4. Have pt remain on the side for 5-10 minutes. 5. You can massage the tragus to to distribute the medication. 6. Wait 5-10 minutes if medication is ordered in the other ear.
FDA U.S. Federal Drug Administration ** Assures that safe and effective drugs are available to the American people.
DEA U.S. Drug Enforcement Agency Coordinates all activities related to enforcement of laws about narcotics and dangerous drugs.
FDA Which agency provides the official Formulary drug guide? FDA or DEA?
The U.S. Pharmacopeia is also called the National Formulary
1906 saw the creation of the ... National Formulary
1962 saw the creation of the ... Kefauver-Harris Amendments
1906 saw the creation of the ... Federal Pure Food and Drug Act (which established the National Formulary)
The only requirement of the Federal Pure Food and Drug Act in 1906 was Drugs had to be free of adulterants (additives)
First legislation to regulate drug safety through an act by this agency. The Food, Drug and Cosmetics Act in 1938
This was one amendment that demanded that drugs actually be of benefit. Kefauver-Harris Amendments
Kefauver-Harris Amendments Required rigorous testing for new drugs
Kefauver-Harris Amendments were replaced by The Controlled Substances Act of 1970
Defined categories (schedules of drugs) The Controlled Substances Act of 1970
Schedule I drugs No legitimate use in the U.S. Street drugs like heroin
Schedule II drugs Accepted medical use but high abuse/addiction potential (morphine, opioids)
Schedule III drugs Moderate abuse but low addiction potential (Codeine phosphate,Codeine sulfate - Tylenol 3)
Schedule IV drugs Less abuse with addiction potential (Ativan/valium)
Schedule V drugs Small abuse with addiction potential (OTC meds)
Importance of FDA Modernization Act of 1997 Requires that doctors receive a 6 month notification if a drug is no longer produced so an alternative can be found
Limitations of testing The smaller the sample size, the less reliable the results in relation to the population.
CANDO Chemically Addicted Nurse Diversion Option
How should patients be positioned to receive medication via NG tube? Semi-folwers or fowlers position. Pt should remain in this position for 30 minutes to prevent aspiration.
How many medications should pt receive via NG tube at one time? Pt should be given one medication at a time. Each medication administration should be followed by a flush.
What kind of medication is preferred for patients with an NG tube? Liquid medications are preferred.
How much liquid should be used with crushed medications for the NG tube? 15 - 30 mL of warm water, followed by a warm water flush of 30mL.
What is a residual pull? Pulling up some of the stomach contents to see if the patient has digested the food from the previous feeding.
What is another purpose for doing a residual pull? Correct placement of the NG tube can be checked by pulling up some stomach contact and checking the PH of the material to see if it acidic.
What has to be checked repeatedly in regards to the NG tube? The potency of the tube must always be checked.
How do you know when to skip a feeding for a patient with a tube? If 250mL went in and you can pull half back out through the tube, skip the next feeding (be sure to push the food back down through the tube). If less than half comes back out, go ahead with the feeding.
What is the correct Ph that is expected when checking tube placement? A reading of 1-4 is the expected Ph reading.
How much liquid does a 4 ounce cup equal? 120mL's
IMPORTANT!!!! Steps for NG med administration! Placement, patency (flush), med, flush, med, flush, med, flush, etc...
Asthma attack symptoms Coughing, tightness in chest, wheezing, rapid or difficulty breathing, flaring nostrils (accessory muscles), mouth open unusual tiredness
When is there a concern for a patient using opioids? There is concern for patients when the respiration rate falls below 12 respirations per minute.
Opioids can cause Constipation, physical and psychological dependence.
2 liters equal 2000 mL's
People should seek medical care if Medical care should be sought if asthma medication is needed every 2 hours.
With Heparin Check the PTT values. They will be a little elevated.
Heparin does not Dissolve an existing blood clot.
Lovenox is also Enoxaparin (generic)
Arixtra (SQ) This medication does not require regular blood monitoring.
Lab value for Coumadin/Warfarin PT 11.0 to 12.5 seconds
Patients are advised not to eat these foods when using Coumadin. Patients should avoid green foods because of the vitamin K (blood clotting).
Which patients are at risk of contracting TB? Patients that live in crowded settings, homeless, emigrated from areas where TB may be prevalent.
TB is spread via Airborne droplets
TB can remain dormant for years (or life) but can manifest itself during times of stress.
An induration of 5mm or more is considered positive for HIV infected patients, people who are in close contact with people who have TB, people who have abnormal chest x-rays and the general public.
An induration of 10mm or more is considered positive for People who are foreign born, HIV negative but they inject drugs, low income & medically underserved, residents of long-term care facilities, staff of long term care or other health facilities.
An induration of 15mm or more is considered positive for Anyone that does not have any other risk factors.
The Mantoux test is used to Test for TB exposure. Pt is injected with PPD.
TB test must be read Read TB test within 48 - 72 hours.
1st drug used to treat TB isoniazid (INH) - This can also be used as a preventative.
rifampin (generic of Rifadin) A second drug used to treat TB. Urine might be orangish-red in color.
furosemide is the same as lasix
furosemide is a loop diuretic. It inhibits or blocks sodium absorption.
Diuretics May be K depleting. Normal K levels are 3.5 - 5 mEq
One draw-back to the use of diuretics Dehydration. Fluids may need to be limited.
Another side affect of a diuretic is orthostatic hypotension
People using diuretics should Keep a record of their weight, take meds in the morning, keep track of K and Na levels.
Signs of Hypokalemia Weakness, abdominal distension, diarrhea, parathesias (numbness & tingling), bradycardia, headache, postural hypotension.
Patients taking diuretics should consume foods high in K, such as fresh apricots, avocados, bananas, potatoes, prunes, spinach
Loop diruetics Reduces peripheral edema from CHF and hepatic/renal disease.
Symptoms associated with CHF Fatigue, SOB, swollen ankles and legs, weight gain, decreased urination during the day with increased urination at night.
Sputum of people with CHF is pink and frothy.
Digoxin Increases the force of contraction of the heart.
3-D therapy for CHF Diuretics, Digoxin, dilators (to open up arteries to decrease the load on the heart).
Digitalis (cardiac glycocide) Increases the force of ventricular contraction and slows down the heart rate.
Don't give Digitalis if Hold the medication if the pulse rate is below 60.
Before giving Digitalis, make sure to Be sure to check the apical pulse before giving Digitalis. Pulse MUST be ABOVE 60!
Digitalis toxicity symptoms Nausea and vomiting, visual disturbances (might see a ring around a light, see a halo).
Another adverse effect of Digitalis Cardiac arrythmias
Do not take these when taking Digitalis. Liquid antacids, some cholesterol lowering drugs, anti-diarrheals, bulk laxatives.
Normal therapeutic range for people for people to receive Dig 0.5 - 2.0 of Dig in the blood. K levels should also be between 3.5 - 5.0.
Be careful not to confuse Digoxin with Digitoxin!
IDDM Insulin dependent Diabetes Mellitus
3 P's of Type I Diabetes Polyuria, Polydipsia, Polyphagia
Excessive urination Polyuria
Excessive thirst Polydipsia
Excessive hunger Polyphagia
Excessive itching Puritis
A1C Measures the overall blood glucose for the past 2-3 months.
A1C of 8 or less Good control
A1C between 4 - 6% Normal level
Glycosylated Hemoglobin A1C
Humulin R is Regular insulin
Lispro is insulin (Humalog)
Rapid acting Lispro (Humalog)
Onset of Rapid Acting 5 - 15 minutes
Peak of Rapid Acting 1 - 2 hours
Duration of Rapid Acting 4 - 6 hours
Peak of Regular Humulin R 2 - 4 hours
Onset of Humulin R 1/2 - 1 hour
Duration of Humulin R 6 - 10 hours
Short acting Humulin R
NPH Intermediate Acting
Onset of NPH 1 - 2 hours
Peak of NPH 4 - 8 hours
Duration of NPH 10 - 18 hours
Humulin N Intermediate Acting
Do not mix Lantus! It will crystalize.
Long Acting Lantus
5 - 15 minutes Onset of Lispro - rapid acting insulin (Humalog)
1/2 - 1 hour Onset of Humulin R & Novolin - regular short acting insulin
1 - 2 hours Onset of NPH Humulin N - intermediate acting insulin.
THis type of insulin can be given via IV Regular
This type of insulin can not be given via IV Lispro (Humalog)
These insulins can be mixed. Regular and NPH, Novolog and NPH, Lispro and NPH
Causes of Low Blood Sugar Ate too little food, ate too few carbs, delayed or skipped a meal, drank alcohol, too little insulin, exercised harder or longer than usual.
Signs of hypoglycemia Sweating, irritable, tremors, blurred vision, weakness, hunger, cold, clammy.
Cold & clammy Give them candy - hypoglycemic!
Treating hypoglycemic cake icing, a table spoon of honey, glucose tablets. Check numbers after 15 minutes and give the person a snack - protein & carbs.
Hot & dry Sugar high - hyperglycemia
Signs of hyperglycemia flushed, dry skin, headache, elevated blood sugar.
Insulin pumps smoothes out blood glucose swings.
Check insulin pump sites for wound or signs of infection.
NIDDM Non insulin dependent diabetes mellitus.
Metformin - Glucophage Decreases glucose production by the liver.
Combination oral diabetes medication metaglip - metformin & glipizide (glucotrol)
Glipizide (Glucotrol) Causes functioning beta cells to release insulin. A side effect is hypoglycemia.
Narcotics Cause the pupils to constrict
Demerol Causes the pupils to dilate.
Created by: Block 1 Theory