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Pharm Basics Q's
Questions for Exam 1
| Question | Answer |
|---|---|
| What are Adverse Central Nervous System Effects? | Can result from stimulation and depression. Stimulants can cause seizures and should be prepared for. Depression impairs driving, operation of heavy machinery, or other activities. |
| What are Adverse Anticholinergic Effects? | Seen in the eyes, smooth muscle, exocrine glands, and heart. Mostly can be managed by sipping liquids to combat dry mouth, going to the bathroom before taking the medication, and avoiding activities that could lead to overheating due to decreased ability to sweat. |
| What are Adverse Cardiovascular Effects? | Can involve the heart and blood vessels. Medications can cause hypertension and hypotension. Hypotensive patients should sit or lie down if feeling dizzy and move slowly. |
| What are Adverse GI Effects? | Can result from irritation of the GI tract and stimulation of the vomiting center. Take medications that cause irritation with food. |
| What are Adverse Hematologic Effects? | Relatively common and potentially fatal for some groups of medications. Affect blood, bone marrow, and hematopoiesis. Anti cancer meds can cause depression/suppression of bone marrow. Anticoagulants and thrombolytics increase risk of hemorrhaging. Monitor for bleeding, bruising, discolored urine and stool, and petechiae. Notify the provider if you see these immediately. |
| How do you treat angioedema? | Apply oxygen and maintain an open airway. Medication therapy can include corticosteroids, diphenhydramine, and epinephrine depending on the severity. |
| How do you treat Anaphylaxis and Allergy Asthma? | Establish an airway, administer bronchodilators if needed, treat with epinephrine IM or IV, administer diphenhydramine or antihistamine, continue to administer oxygen, monitor blood gases, administer corticosteroids, and watch for fluid overload from IVs. |
| Diazepam and Hydrocodone bitrate 5mg/acetaminophen 500mg Interactions | Adverse interaction, when these medications are used together, the risk of CNS depression increases. |
| Albuterol and Triamcinolone acetonide interactions | Drug-drug interaction, the first medication increases the absorption of the second. |
| Phenytoin and Warfarin Interaction | Therapeutic reduction interaction, the first medication increases the metabolism of the second medication, reducing the blood levels and effect of that medication. |
| Ondansetron hydrochloride and Chemotherapy Interactions | Side/Adverse effect reduction interaction, the first medication reduces the nausea and vomiting side effect of the second medication. |
| Fluconazole and Aripiprazole Interaction | The first medication inhibits hepatic medication metabolizing enzymes that affect the second medication, leading to increase blood levels of that medication. |
| Tyramine (found in aged cheese, cured meats, and fermented products) and MAOIs Interactions | Can lead to a hypertensive emergency. Patients should avoid foods with that compound |
| Vitamin K and Warfarin Interactions | This vitamin is involved in the blood clotting process. It is important to maintain steady levels of the vitamin while taking the medication as taking too little can increase adverse effects (hemorrhaging) and too much can decrease the therapeutic effect. |
| Chelating agent (found in dairy) and Tetracycline Interactions | Can form an insoluble and unabsorbable compound. Patients should be advised not to take the medication within 2hrs of consuming the food products. |
| Grapefruit Juice Interactions | Seems to act by inhibiting medication metabolism in the small bowel, increasing the amount of medication available for absorption of certain oral medications. This can increase the therapeutic and adverse effects of these medications. |
| General food-medication interactions | Food often decreases the absorption of medications. However, for certain medications, it increases absorption. |
| Morphine Contraindication | This drug causes respiratory depression, so it should not be used for patients with asthma or impaired respiratory function. |
| You are preparing to administer an IM dose of penicillin to a patient who has a new prescription. The patient tells you the last time they took penicillin, they developed a rash. What action should you take? | Withhold the medication and contact the provider. |
| What are nurses responsible for knowing in regards to prescriptions? | Federal, state, local laws, and facility policies that govern prescribing and dispensing medications; preparing and administering medications; evaluating patients' responses to medications. |
| What do nurses need to know about the medications they administer? | Up-to-date knowledge of uses, mechanisms of action, routes of administration, safe dosage range, adverse effects, precautions, contraindications, and interactions. |
| How can nurses help reduce adverse effects of medications? | Determining the accuracy of prescriptions, reporting all medication errors, safeguarding and storing medications, following legalk mandates when administering controlled substances, calculating medication doses accurately, and understanding the responsibilities of other members of the health care team regarding medications. |
| Why can new drugs cause problems, despite rigorous testing by the FDA? | They can have unidentified or unreported adverse side effects. |
| Types of Medication Prescriptions | Routine/standing prescriptions, single/one-time prescriptions, stat prescriptions, PRN prescriptions |
| Components of a Medication Prescription | Patient's full name, date and time of prescripton, name of the medication, strength and dosage, route of administration, time and frequency of administration, quantity to dispense and number of refills, signature of the prescribing provider. |
| What is the benefit of medication reconciliation? | Prevents medication errors and adverse drug interactions. |
| When should med reconciliation take place? | At admission of the patient, when transferring the patient between units or facilities, and at discharge. |
| Common Medication Errors | Wrong medication or IV fluids, incorrect dose or drip rate, wrong client, wrong route, wrong time, administration of an allergy inducing medication, omission of a dose or administration of extra doses, incorrect discontinuation of a medication or IV fluid, inaccurate prescribing, inadvertently giving a medication that has a similar name. |
| What should you know to prevent medication errors? | The medications being administered, any conditions the patient has, their baseline vitals. |
| What should you do with a prescription to prevent medication errors? | Check for completeness, make sure you interpret it correctly, ask the provider questions if you are unsure of anything. |
| What kind of dosage change should you question a provider about? | Abrupt and excessive changes. Doses should be increased gradually, not suddenly. |
| Planning to prevent medication errors | Identify the outcomes for administration and set medication priorities. |
| What kind of distractions cause easily avoidable errors? | Interruptions while prepping meds, preparing meds for multiple clients at a time, leaving meds and then coming back. |
| What easy actions can you take to prevent avoidable errors? | Check labels for patient names and concentrations, double check doses with a colleague, only administer meds you prepped yourself. |
| When should you question a dose when preparing a medication? | If a single dose is made up of multiple tablets/vials/etc. Doses are usually 1 or 2 items for a single dose. |
| Do you include or incident reports (notification of error) in a patient's chart? | No |
| Why is it important to report errors? | They relate to system, procedure, product design, or practice flaws. Reporting helps facilities determine what they can change to avoid similar errors in the future. |
| How should you respond when a patient says they don't want to take a medication prescribed to them? | Ask them what their concerns about the medication are. |
| How are medications organized? | By the body system they target and whether they're for pain, inflammation, or infections. |
| When does withdrawal occur? | When a medication a patient is physically and/or psychologically dependent on is stopped. |
| Additive vs. Synergistic Drug Interactions | Additive interactions are when medications that have the same effect contribute their expected part of the therapeutic effect. Synergistic interactions are when medications that have the same effect create an effect greater than what is expected. |
| What should you encourage a patient to do if they experience an adverse reaction to a medication? | You should encourage them to contact their provider and let them know. |
| What is an alternative form of medication for patients who forget to take their medications needed multiple times a day? | An extended or controlled release version of the medication. |
| What demographic are you most likely to see polypharmacy in? | Older adults, because they tend to have more health conditions they need to manage. |
| Why is polypharmacy risky? | Because patients can take medications they no longer need, drug interactions are more likely to occur, and interactions increase the risk of adverse effects. |
| How likely are drug interactions when taking 5 different medications? | They are 50% likely. |
| How likely are drug interactions when taking 10 different medications? | They are 100% likely. |
| How do nurses prevent polypharmacy? | By reconciling a patient's medication list. |
| What should alert you to a medication needing reconciliation? | When the patient has been on it for a long time, especially older patients. |
| What are the 10 Rights of medication administration? | Client, medication, dose, time, route, education, to refuse, assessment, evaluation/response, documentation |
| What are common factors of medication errors? | A lack of knowledge on the medication, bad communication with the patient, a language barrier with the patient, an increased workload for the nurse/understaffing, distractions and interruptions, bad patient records, a lack of standard procedures, and bad communication with the providers. |
| Where should you open, mix, and prepare medications? | When you are at the intended patient's bedside. |
| When can a medication error occur? | Anywhere in the medication process, from when the prescription is written, to when it is processed at the pharmacy, to when the nurse prepares and administers it. |
| What does rate of absorption affect? | How quickly the medication takes effect. |
| What does the amount of medication the body absorbs affect? | How intense the medication's effect is. |
| How does the route of administration affect absorption? | It effects the rate and amount of absorption. |
| Barriers of Oral Absorption | Medications must pass through the layer of epithelial cells that line the GI tract. |
| Oral Absorption Pattern | Varies greatly due to the stability and solubility of the medication, the GI and intestinal pH and emptying time, presence of food in the GI tract, concurrent medications, and the form of the medication. |
| Barriers Sublingual/Buccal Absorption | Swallowing before dissolution allows gastric pH to inactivate the medication. |
| Sublingual/Buccal Absorption Pattern | Quick absorption systematically through the highly vascular mucous membranes. |
| Barriers of Mucous Membrane Absorption | Presence of stool in the rectum or infectious material in the vagina limits tissue contact. |
| Mucous Membrane Absorption Pattern | Easy absorption with both local and systemic effects. |
| Barriers to Inhalation Absorption | Inspiratory effort, airway obstruction, improper technique |
| Inhalation Absorption Pattern | Rapid absorption through alveolar capillary networks |
| Barriers of Intradermal/Topical Absorption | Close proximity of epidermal cells. |
| Intradermal/Topical Absorption Pattern | Slow, gradual absorption. The effects are primarily local, but systemic as well, especially with lipid soluble medications passing through subcutaneous tissue. |
| Barriers to Subcutaneous/Intramuscular Absorption | Capillary walls have large spaces between cells. Therefore, there is no significant barrier. |
| Subcutaneous/Intramuscular Absorption Pattern | Solubility |
| Barriers of Intravenous Absorption | None |
| Intravenous Absorption Pattern | Enters directly into the bloodstream and has immediate effects in the body in its entirety. |
| Factors that affect distribution | Circulation, permeability of the cell membrane, and plasma protein binding. |
| Circulation's effect on distribution | Conditions that inhibit blood flow or perfusion, such as peripheral vascular or cardiac disease, can delay medication distribution. |
| Permeability of the cell membrane's effect on distribution | The medication must be able to pass through tissues and membranes to reach its target area. Medications that are lipid-soluble or have a transport system can cross the blood-brain barrier and the placenta. |
| Plasma binding proteins' effect on distribution | Medications compete for protein binding sites within the bloodstream , primarily albumin. The ability of a medication to bind to a protein can affect how much of the medication will leave and travel to target tissues. Two medications can compete for the same binding sites, resulting in toxicity. |
| Factors that influence the rate of medication metabolism | Age, increase in medication-metabolizing enzymes, first-pass effect, similar metabolic pathways, and nutritional status |
| Age and Medication Metabolism | Infants have a limited medication metabolizing capacity. The aging process can influence metabolism but varies with the individual. In general, hepatic medication metabolism tends to decline with age. Older adults require smaller doses of medication due to the possibility of accumulation of medications in the body. |
| Increase in some medication-metabolizing enzymes | This can metabolize a particular medication sooner, requiring an increase in dosage of that medication to maintain a therapeutic level. It can also cause an increase in the metabolism of other concurrent medications. |
| First-Pass Effect and Medication Metabolism | The liver inactivates some medications on their first pass through the liver. Thus, they require a nonenteral route (sublingual, IV) becuaase of their high first-pass effect. |
| Similar Metabolic Pathways and Medication Metabolism | When the same pathway metabolizes two medications, it can alter the metabolism of one or both. In this way, the rate of metabolism can decrease for one or both medications, leading to medication accumulation. |
| Nutritional Status and Medication Metabolism | Client who are malnourished can be deficient in the factors that are necessary to produce specific medication metabolizing enzymes, thus impairing medication metabolism. |
| Outcomes of Medication Metabolism | Increased renal excretion of medication, inactivation of medications, increase therapeutic effect, activation of pro-medications (also called pro-drugs) into active forms, decreased toxicity when active forms of the medication become inactive forms, increased toxicity when inactive forms of medication become active forms. |
| Kidney Disfunction and Excretion of Medication | Can lead to an increase in duration and intesnsity of a medication's response, so it is important to monitor blood urea nitrogen (BUN) and creatinine levels. Dose adjustments may be needed to prevent toxicity. |
| Medication Dosing | Attempts to regulate plasma levels between the minimum effective concentration (MEC) and the toxic concentration. |
| Monitoring blood medication levels | Nurses should consider the route of administration when monitoring for peak medication levels. |
| When should trough levels be tested? | Immediately before the next medication dose, regardless of the route of administration. |
| Oral or Enteral Administration | Tablets, capsules, liquids, suspensions, elixirs, lozenges |
| Contraindications of Oral Medications | Vomiting, decreased GI motility, absence of a gag reflex, difficult swallowing, and decreased level of consciousness |
| Grapefruit Juice and Oral Medications | Commonly interacts with oral medications. |
| What oral medication should always be swallowed whole? | Enteric coated or time release medications (extended release). Breaking these medications alters their pharmacokinetic properties. |
| Advantages of Oral Medications | Safe, inexpensive, easy, convenient |
| Disadvantages of Oral Medications | Highly variable absorption, inactivation can occur in the GI tract or liver, clients must be conscious and cooperative. |
| Advantages of Buccal and Sublingual Medications | Bypasses the GI tract and liver to get directly to the bloodstream. |
| Buccal and Sublingual Medication Patient Education | Medication must be kept in place until absorption occurs. Cannot eat or drink while medication is in place or until it completely dissolves. |
| Topical Administration | Applied directly to the skin or mucous membranes. Includes powders, sprays, creams, ointments, pastes, oil and suspension based lotions. |
| Advantages of Topical Medications | Painless, limit adverse effects |
| Disadvantage of Topical Medications | Limited mobility of medication. Effects stay local to application area. |
| Nursing Actions with Topical Medications | Wash the skin with soap and water and pat dry before application. Apply with a glove, tongue blade, or cotton tipped applicator. Surgical asepsis is required for applying to open wounds. |
| Transdermal Administration | Medication in a skin patch for absorption through the skin, producing systematic effects. |
| Client Education for Transdermal Medication | Wash skin thorouhgly with soap and water and pat dry before applying a new patch. Apply patches to ensure proper dosing. Apply to a hairless area and rotate sites daily to prevent skin irritation. Cutting patches can affect medication delivery. |
| What actions should nurses take when a obtaining a trough level? | Obtain a blood specimen immediately prior to administering the next dose of medication. |
| How many times should you administer a medication that has a half life of four days? | One |
| What actions should you take when administering eye drops to a patient? | Ask the client to look up at the ceiling, drop the medication into the patient's conjunctival sac (the pocket-like space between the eyelid and eyeball), instruct the patient to close the eye gently after instillation. |
| Why do you need to know what a drug monograph is? | Because you will always refer to it when dealing with medications. |
| What key information should you pay attention to on a drug monograph? | The name of the drug (trade and generic), indications, administration route, formula, maximum dose, dispensed dose, and specific instructions. |
| Why is it good to know all of the medication dose equations? | One calculation may be easier with one equation compared to another, but harder for another calculation. |
| Can you split capsule doses? | No, capsule doses will never be split. |
| Can you split tablet doses? | If the tablet is scored with a line down the middle, you can split the dose in half. Otherwise you will usually leave tablets as is. |
| Where do you round liquid med doses when they exceed 1mL? | You round to the nearest 10th (0.1) |
| Where do you round liquid med doses when they are under 1mL? | You round to the nearest 100th (0.01) |
| Where do you round crystalloid, colloid, blood, and blood products via IV infusion for adults? | You round to the nearest whole number. |
| Where do you round crystalloid, colloid, blood, and blood products via IV infusion for children? | You round to the nearest 10th (0.1) |
| What do you need to know to calculate a med dose? | Key info on the order, key info on the label, and the measuring units of the prescription and dispensed dose. |
| What drug name do you use in a patient's chart? | You always use the generic name. This is because one drug can have more than one trade name. |
| How are liquid medications dosed? | They are dosed by the weight of the medication (g) out of the quantity contained in the product (v). |
| How are insulin and the anticoagulant heparin measured differently than other liquid meds? | They are measured in units instead of weight/volume. |
| Why is it important to check IV compatibility before using it to administer certain products? | Some IV pumps are not designed to administer blood or blood products. |
| Is the concentration of IV fluid used in calculating IV doses? | No. |
| How do you calculate IV administration in mL/hr? | You divide the volume of the solution by the duration of the infusion. |
| How do you round IV rates for adults? | To the nearest whole number. |
| How do you round IV rates for children? | To the nearest 10th (0.1). |
| Where will you find the drop rate factor for an IV solution? | It is indicated on the gravity drip kit you use. |
| Can you calculate drops/min for an infusion pump? | No, it can only take mL/hr measurements. |
| When do you use drops/min calculations? | You use them for gravity drip IV infusions. |
| DRD for 60 drops/mL kit | 1 (x/1) |
| DRD for 20 drops/mL | 3 (x/3) |
| DRD for 15 drops/mL | 4 (x/4) |
| DRD for 12 drops/mL | 5 (x/5) |
| DRD for 10 drops/mL | 6 (x/6) |
| How do you calculate drops/min with DRD? | You find the mL/hr prescribed, then divide that number by the DRD. |
| When can the DRD not be used to calculate an infusion rate? | When the infusion time is under an hour. |
| Equation for drops/min when infusion time is under 1 hour | (total volume to be administered x drops/mL) / administration time in min |
| When recognizing cues (assessing) before medication administration, what questions should you ask? | - Are there any lab results or tests that could influence the effectiveness or safety of this medication? - What client behaviors or statements might suggest misunderstanding or issues about their medications? - What manifestations that may indicate a need for the medication should I monitor for? |
| When analyzing cues before medication administration, what questions should you ask? | - Do the client’s lab values suggest a need for a dosage adjustment or holding the medication? - How do the client’s age, weight, and liver and renal function affect how the medication works, and what adjustments, if any, need to be made to the dose or frequency of the medication? - What trends in the client’s vital signs, manifestations, or lab values over time could indicate that the medication is effective? |
| When hypothesizing before medication administration, what questions should you ask? | - Which clinical information is most critical to consider before administering this medication? - What are the immediate safety concerns related to this medication that must be addressed? - In what order should medications be administered based on the clinical concerns, issues, and urgency of the situation? |
| When generating solutions (planning) before medication administration, what questions should you ask? | - What other medications or dosages could be considered if the current medication is contraindicated or not effective? - What nonpharmacological interventions might mitigate the side effects of the medication? - Who else on the health care team should be consulted in order to optimize the client’s medication treatment plan? |
| When taking action (intervening) during medication administration, what questions should you ask? | - What specific steps should be done to prepare, administer, and document the medication safely? - How will I involve the client to ensure they understand their medications and are taking them correctly? - What immediate actions should be performed if the client experiences an adverse drug reaction? |
| When evaluating during and after medication administration, what questions should you ask? | - What is the desired therapeutic effect of this medication and how will this be determined? - What indicators need to be monitored to evaluate the client’s response to the medication? - How will the client’s response to the medication be documented and communicated with the health care team? |
| Why is weight a factor of determining some drug doses? | Because of variance in physical size, metabolic rate, relative body water content, and maturity of organ systems alters the pharmacokinetic and pharmacodynamic processes of medications. This is particularly important for pediatric and neonatal patients but is used for adults for some medications as well. |
| Clark's Rule Formula | (Pediatric's weight in kg/68kg) x standard adult dose = pediatric dose |
| What DEA drug class is cough syrup in? | Schedule V |
| What DEA drug class is Xanax/Alprazolam in? | Schedule IV |
| What DEA drug class is ketamine in? | Schedule III |
| What DEA drug class is fentanyl in? | Schedule II |
| What DEA drug class is heroin in? | Schedule I |
| What are factors to look for when determining a patient is incompetent? | some of the general key factors for consideration include if the client cannot understand their medical situation and its potential consequences, if the client is unable to state their preferences, or if the client cannot reason through decisions that have the potential to impact their overall health and life. |
| What does patient education and the right to refuse medication ensure? | Patient autonomy |
| What are deflecting questions about medication, administering medication before patient education, and disregarding patient preferences examples of? | Breaches of patient autonomy. |
| Why do some medications need a prescription? | Because they are potentially harmful without the supervision of a prescribing professional. |
Created by:
marinareagankhan