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PatientCare2 Midterm

Define drugs Chemical substances not required for normal sustenance that produce a biologic effect on a organism
Define pharmacokinetics The process that controls absorption, distribution, metabolism, and excretion of drugs by the body
Define pharmacodynamics The study of the response of drugs on normal physiologic body functions, or the response of tissue to a chemical agent
What are the 3 medication classifications? Prescribed, OTC, and controlled
What are the two types of dependence? Physical and physiological
Product packing inserts should include... (name 7) Chemical composition, generic name, trade name, usual dose, indications, contraindications, and side effects
The Food and Drug Act regards... The production, import, export, and transport of food, drugs, contraceptive devices, and cosmetics
The Food and Drug Regulations regard... Standards of composition, strength, potency, purity, quality, and other properties of articles in the Food and Drug Act
The Controlled Drugs and Substances Act regards... Federal laws related to controlled substances in Canada
What phases does not occur for liquid and parentarel drugs? The pharmaceutic phase
What is the pharmaceutic phase? The dissolution of drugs in the body (they must be in a solution to be absorbed)
What is the first stage of the pharmacokinetic phase? Absorption: movement of the drug from site of administration into systemic circulation
How are injected drugs absorbed? Through blood vessels (into muscles, SC tissues, or dermal layers)
How are drugs absorbed in the GI tract? Either by active absorption (carrier molecule moves drug across membrane), passive absorption (diffusion), or pinocytosis (cell engulfs particle)
What drugs do not require absorption? Parenteral
What influences the rate of absorption? Route of administration, solubility, and certain conditions
List the fastest to slowest routes of admission Intravenous, intramuscular, subcutaneous, oral
What is the second stage of the pharmacokinetic phase? Distribution: systemic circulation spreads drug to target sites
What is the third stage of the pharmacokinetic phase? Metabolism (or biotransformation): chemical reaction in which liver enzymes convert drug into metabolites (inactive compounds) to be eliminated
What consideration do patient's with liver disease require? Lower doses
What is the first pass effect? The partial metabolism of oral medication by the liver before it reaches circulation (can be significantly enough to render inactive, in which case alternate route would be necessary
What are risks of slow or fast metabolism? Slow: drug can accumulate. Fast: drug may not have intended affect
What affects rate of metabolism? Age, health, time of day, emotional status, genetic variations, disease status, presence of other drugs
What's the fourth stage of the pharmacokinetic phase? Excretion: removal of drugs (intact or metabolized) from the body, primarily by kidneys through urine
What are less common modes of excretion? Breast milk, lungs, intestines, exocrine glands
What is half life? Time required for body to eliminate 50% of a drug
How many half lives until 98% of a drug is excreted? 5-6
Does contrast media have a short or long half life? Short (excreted within 24 hours)
Define pharmadynamics The actions and effects of drugs within a normally functioning body
What is the primary effect? Secondary? Primary is the desired therapeutic effect. Secondary effects are all others, desirable or not.
At what level are the greatest effects of drugs exerted? Cellular.
Can drugs fundamentally change cellular function? No. Only enhance or diminish it
What are the 3 main drug-receptor interactions? Agonist (binds at receptor site to produce therapeutic effect), antagonist (bonds to receptor site to block therapeutic effect), and partial agonist (partial therapeutic response)
What are the 7 classifications of medication effects? Adverse, allergic/hypersensivity, idiosyncrasy, tolerance, synergistic, cumulative, and toxic
Do all adverse drug reactions appear immediately? No
How is anaphylactic shock treated? Raise BP, improve breathing, restore cardiac function
Define drug idiosyncrasy Unusual or abnormal reaction with unclear cause
Define the drug synergistic effect Responses to combined drugs that differ from their individual effects
What patients are at risk for toxicity from drug accumulation? Those with kidney or liver disease
What classifications of drugs are safe from toxic effects? None
How might a normally safe drug become toxic? Administered in a large dose, inadequate excretion, impaired metabolism, or drug sensitivity exists
Define antidote Drug which treats the toxic effect of another drug
What the the antidote to fentanyl? Naloxone (an opioid receptor antagonist)
Are side effects considered predictable or unpredictable actions? Predictable
What is the most common emergency antihistamine used? How is it administered for adults? Diphenhydramine (Benadryl). 25-50 mg orally, or IV in emergencies
When are adrenergic drugs (epinephrine) used? In cardiovascular, respiratory, and allergic emergencies (including shock and respiratory distress)
What do adrenergic drugs do? Stimulate heart and sympathetic nervous system
How are adrenergic drugs administered? 0.2-1 ml in a 1:1000 solution, via IV, IM, OR SC
What are used as replacement therapy for disease of the adrenal glands, as well as for inflammatory relief, stress relief, and treatment of severe allergic reactions? Glucocorticoids (Cortef)
Antimicrobial contain what categories? Subcategories? Antiseptics (e.g. alcohol for slider boards, Betadine for skin prep) and antibiotics. Subcategories are antibacterial and antifungal
What preventative medication is taken by patients with chronic seizure disorders? Anticonvulsants
What is used in both freezing and to treat cardiac arrhythmia? Lidocaine (xylocaine)
How do controlled analgesics vary from uncontrolled? Controlled depresses the CNS and produce drowsiness, overdose can result in coma or death (ex: opioids/morphine)
Are tranquilizers or sedatives more effective at reducing anxiety and mental tension? Tranquilizers
What dose of valium would be given? 2-20 mg, injected via IV or IM very slowly (extremely painful/burns if gets into SC!)
What's the dosage for ativan? <2 mg, or 0.03 mg/kg for larger patients
What's the dosage for versed? 1-10 mg, with the peak effect being immediate
What sedative can also be used to induce amnesia? Versed
Why would lidocaine be used with epinephrine? Epinephrine constricts adjacent blood vessels, localizing the freezing effect of lidocaine
What hypoglycemic agent is used to control type 2 diabetes? Glucophage (Metformin)
What are the 2 classes of antihypertensives? Angiotensin-converting enzyme (ACE) inhibitors, and Beta blockers
What is an example of an ACE inhibitor? What does it do? Captopril (Capoten), interrupt BP regulation cycle by stimulating adrenal gland to lower BP
What is an example of a beta blocker? What does it do? Propranolol (Inderal), suppresses the sympathetic nervous system by blocking epinephrine and norepinephrine to decrease BP
What should be done if there's a bit of blood in patient's IV line? Nothing, this is normal.
After how many doses of nitroglycerin should you seek help for your patient? 2
Do verbal orders require written confirmation by the attending physician? Yes, but it can be done after the fact
When is a physician's signature not needed? To carry out standing orders
How many times should drug label be checked? When? 3. When taken from storage, before drawing up, and before handing to physician or injecting
Where is iodinated contrast stored? Why? Oven. Makes it less viscous
Who must administer the drug? Whoever prepared it
What are the 6 rights of medication administration? Right dose, right medication, right patient, right time, right route, right documentation
What are the enteral routes? Oral, sublingual, buccal, nasogastric, rectal
When would a drug be given orally? When they're not destroyed by gastric secretions (enteric coating can help) and slow absorption is desired
When is rectal administration contraindicated? Children and unconscious patients
How does rectal absorption affect dose? Bypasses liver so dose is higher
What enteral route is indicated for a local effect? Sublingual or buccal
What route uses droplets, vapor, or gas? Inhalation
What are the different classes of routes of administration? Enteral, inhalation, topical, parenteral,
What topical route allows a constant blood concentration of the drug over a local or systemic area? Transdermal (drug places directly on skin and absorbed slowly)
What needle angles are used in IM, and SC, and ID injections? IM:90°. SC:45°. ID:15°.
What is a common site for IM injection? Why is this important for pediatrics? Vastus lateralis muscle; develops faster than the gluteus maximus in babies and children
How might the flu shot, HBV vaccine, and lidocaine be administered? Intramuscular
What parenteral route places drug directly into an artery? What Guage needle is used? Intra-arterial injection. 18 g (usually followed by a catheter)
What is done to bypass the Blood-Brain Barrier (BBB), directly into the cerebrospinal fluid (CSF)? Intra-thecal injection, places drug into subarachnoid space
What route places drug into a joint? Intra-articular injection
What are two common types of IV flushes? Saline and heparin
Why would a vented IV system be used? Allows fluid to be administered quicker
What is most common needle range? 18-25 g
What needle Guage is most commonly used for an IV? And to draw up contrast? 21 g for IV, 18 g to draw up contrast
What is a salem sump pump? A dual lumen (meaning has 2 ports) system that goes through nose and into stomach to keep it empty
What is a "luer lock"? A corkscrew twist tip on a syringe
What tips are used for a bolus contrast injection via a nasogastric tube? Catheter tip
How long after opening does a vile expire? 24 hours
What is an ampule? Glass container with a single dose of emergency medication within
What are the 2 most commonly stoked IV solutions in DI? Normal saline 9% (0.9% NaCl), and 5% solution of dextrose in water (D5W)
What is extravasation? Escape of fluid from blood vessel into tissue when catheter is in vein
What is infiltration? Escape of fluid into tissues when catheter is out of vein
Should a hot or cold pack be applied if extravasation occurs? Why? Cold. Limits area of involvement and alleviates pain
What thick should a vein be to insert a catheter? Twice the diameter of the catheter
How long should a warm compress be applied to help find a palpable vein? 5-10 minutes
What should go on a catheter label? Date, time, guage, your initials
What is standard IV infusion rate? 15-20 drops per minute
How high should IV bag he above level of vein? Why? 18-20 inches. Too high and hydrostatic pressure becomes a problem, too low and there could be back flow into catheter
What are the 3 types of medication pumps? Patient-controlled, parenteral nutrition, and continuous administration
What one button can we push on med pumps? Silence the alarm
Do we ever recap needles before discarding in sharps container? No
What needs to be charter when meds administered? Date, time, drug name, dose, route of administration, patient's full name
How is contrast media charted? As a medication. Include name and strength of contrast, volume, route, date/time, and signature
Created by: Ewood61