Define: pharmacokinetics ||Pharmacodynamics: the study of what a drug does to the body (example: B1 agonist) Pharmacokinetics: is the study of what the body does to a drug (ex: metabolized by the liver, extreted by kidney, half life)|
|Define: formulary ||List of medications. May include use, dose, side effect, pharmacokinetics, etc.|
|Trade, drug, chemical names for a drug. ASA. Card 1/3. ||Ex: Bayer aspirin, aspirin, acetylsalicylic acid. Patented trade name, generic name assigned by US adopted council, chemical name is used by pharmacists to identify chemical properties.|
|Trade, drug, chemical names for a drug. Tylenol. Card 2/3 ||Ex: Tylenol, acetamenophen, N-(4-hydroxyphenyl)ethanamide
|Trade, drug, chemical names for a drug. MOM. Card 3/3 ||Ex: Phillips milk of magnesia, milk of magnesia, Mg(OH)2|
|Scheduled drug classes ||I - highest abuse potential, illegal in US, ex: heroin.
II - High abuse pot, has medical use, ex: cocaine, morphine.
III - Moderate abuse pot, ex: Lortab. IV lower abuse pot - ex: benzo. V - lowest abuse pot, ex: pseudoephedrine.|
|Pregnancy safety classification ||A- Studies show safe in pregnancy
B- Animal studies show no risk.
C- Some reported risk to fetus, but no studies.
D- Studies show fetal risk.
X- Know cause of birth defects - do not use Ex: Accutane.|
|Transport methods into cell ||Active - moves by transporter protein across cell membrane - requires ATP. Passive - moves down concentration gradient. Pinocytosis - membrane invaginates fluid forms vesicle inside cell "cell drinking"|
|Define: first pass effect ||The effect of liver breakdown of orally ingested substance. Ex: narcotics - 80% is destroyed by first pass effect(liver breakdown of drug).|
|Define: bioavailability ||% of drug that reaches bloodstream, IV=100%. If less, then only a portion of drug is available to reach blood. 80% bioavailable - only 80% absorbed and reaches blood.|
|Factors affecting drug movement ||Tissue affinity, drug solubility, blood flow, protein carrier, barriers (blood brain barrier)|
|Excretion ||Primary site of excretion. Ex: liver, urine.|
|When is renal failure an issue with drug dosing? ||An issue when a drug is exreteted in urine and glomerular filtration rate(GFR_ is low). GFR usu measured in terms of creatinine clearance.|
|Potency vs efficacy ||Potency - how strong a drug is: the amount of drug required for an effect. Efficacy: "effectiveness" of a drug.|
|Define: idiosyncratic drug effect ||drug reactions that occur rarely and unpredictably amongst the population.|
|Define 4 major processes involved in pharmacokinetics - ADME ||Absorption, Distribution, Metabilism, Excretion.|
|Define FDA role ||Oversee the availability of safe and effective drugs.|
|Injection routes, maximum volumes, smallest needle sizes, needle length ||ID - 0.2mL - 27g - 0.5". SC - 1.5mL - 30g - 1". IM - 2mL - 25g - 1 to 1.5".|
|Eye anatomy ||Anterior chamber - part anterior to lens. Aqueous humor - liquid in anterior chamber. Ciliary body - site of aqueous humor production. Canal of Schlemm - site of aqueous humor drainage.|
|Ear anaomy - exernal, middle, inner. ||External - auricle (pinna) and auditory meatus. Middle tympanic membrate malleus, incus, stapes - and Eustacian tube (middle ear vent). Inner cochlea vestibular. Inner = nerve part of ear.|
|Inner ear function ||coclea - sound. vestibular - balance.. CN VIII.|
|Define: Eustacian tube ||Tube that connects middle ear to nasopharynx. Equilizes pressure in middle ear with atomospheric pressure.|
|Define: glaucoma ||Increased intraocular pressure (IOP).|
|Glaucoma causes/risks ||Genetic/trauma/disease/iatrogenic causes.
Risk factors: high blood pressure, migraine headaches, refractive disorders and older age.
A leading causes of blindness.
Blockage aqueous humor flow increases pressure damages optic nerve.|
|Open vs closed angle glaucoma ||Closed-angle: “acute glaucoma”—caused by stress, trauma, or meds -acute glaucoma due iris blocking canal of Schlemm -> extreme pain, blood shot eyes, and blurred vision.
Open-angle “simple glaucoma”—most common type - chronic - canal not blocked.|
|Define: otitis media ||Inflammation of the midle ear—occurs most frequently with upper respiratory infections, allergies, or Eustacian (auditory) tube dysfunction.|
|Define: otitis externa ||External ear infection "swimmer's ear".|
|Define: mastoiditis ||Inflammation of the mastoid sinus—can lead to hearing loss if not treated.
Basic treatment of all “itis” ear infections is antibiotic therapy, may also use pain meds, diuretics, and anti-itch meds. For extreme inflammation may use steroids.|
|Earwax buildup ||If this occurs it can interfere with hearing
The elderly often struggle with this due to the inability to care for themselves.|
|Define: miotics ||Ophthalmic drugs that cause miosis - they constrict the eye. These drugs are cholergic, parasympathomimetic drugs. Used for closed angle glaucoma.|
|Miosis vs mydriasis ||Miosis - pupils small. Mydriasis - pupils big. MYDRIASIS is a bigger word than miosis.|
|Miotics to know ||Cholinergics: Carbachol, pilocarpine. Sympathomimetics: dipivefrin (Propine) apraclonidine. Sympathetic/anticholinergis - mydriasis. Parasympathetic/cholinergis - miosis. A2 agonists are "sympathomimetic" but are inhibitory& act as sympatholytic|
|Prostaglandins to know for glaucoma ||latanoprost (Xalatan).
|B-blockers to know for for glaucoma ||betaxolol (Betaoptic).
|A2 agonist for glaucoma ||Brimonidine tartrate (Alphagan)|
|Carbonic anhydrase inhibitor for glaucoma ||acetazolamide (Diamox)|
|Otic gtt medications to know ||Otitis externa: acetic acid(Domeboro), cipro + hydrocortisone (Cipro HC), polymixin, neomycin & hydrocortisone (Cortisporin).
Analgesic: benzocaine (Auralgan).
Ear wax (cerumen) removers:
Carbamide peroxide (Debrox),
|Pain facts - personal and individualized ||o No 2 people have the same experience with pain.
o Their perception, how it happens, etc. is always different and this is why pain mgmt is so complex. However, it must be effective. It is a standard of care to adequately manage a patient’s pain|
|Pain facts - subjective ||subjective—we can’t see, hear, smell, taste, or feel it!|
|Pain facts - difficult to communicate ||They cannot always tell you how bad it is or how they really feel—you can’t see it which often makes it hard as well.|
|Pain facts - chronic vs acute ||Acute pain: Last only through the expected recovery period.
Chronic pain: lasts beyond the typical healing time period (greater than 3-6 months).|
|Pain facts - a common condition ||~16 mil people have chronic arthritic pain.
>30 million adults report low back pain, 19 mil people have it chronically.
50 mil people are disabled 2nd to pain.
>50% adults have muscle pain each year.
Up to 40% of people w cancer have mod-severe pain.|
|Define: intractible pain ||Persists despite all the interventions that have been done.|
|Define: cutaneous pain ||Originates in the skin or subcutaneous tissue (paper cut).|
|Somatic vs visceral pain ||Somatic - Arises from ligaments, tendons, bones, blood vessels, and nerves.
Visceral - Arises from viscera (notes say: Results from stimulation of pain receptors in the abdominal cavity, cranium, and thorax (obstructed bowel)).|
|Define: Radiating pain ||Perceived at the source of the pain and moves beyond it to the nearby tissues. Example: heart attack pain radiates to left arm.|
|Define: referred pain ||Pain felt in a part of the body that is considerably removed from the tissues causing the pain.|
|Define: neuropathic pain ||Nerve pain. (Notes say: Described as shooting or stabbing and is often severe (diabetics, PVD patients).|
|Define: phantom pain ||Painful sensations perceived in a body part that is missing (i.e. an amputated leg).|
|Define: pain threshold ||Amount of stimulation a person requires in order to feel pain. Some have high threshold and some have low. Again this is subjective and individualized per patient.|
|Define: pain reaction ||Includes the ANS (autonomic nervous system response)—this is when you automatically pull away from something that hurts or is hot—it is also a behavioral type response based on previous experience to pain.|
|Define: pain tolerance ||Maximum amount and duration of pain that an individual is willing to endure. Again this is subjective and individualized per patient.|
|Define: nocioceptors ||The receptors that carry the pain sensation.|
|Define: gate control theory ||Pain messages that are sent spinally can be changed before they reach the brain. Spinal cord synapses can open or close (like gates) to allow things to reach our brain. Message tracks can only handle limited messages, so some messages may block others.|
|Define: preemptive analgesia ||Appropriate before invasive procedures—may need to administer pain med on schedule to prevent those peaks and valleys occurring.|
|Pain assessment rubic: PQRST - (PQ card 1/2) ||PRECIPTATION & PALLIATION -What was going on before the pain started? What makes it better?
QUALITY - What does your pain feel like? (Dull, sharp, aching, throbbing, etc.)|
|Pain assessment rubic: PQRST - (RST card 2/2) ||REGION & RADIATION
Where did it start? Does it radiate to another location in the body?S
How bad is the pain? (Use a pain scale).
When did the pain start and how long did it last?|
|Nonpharmacologic pain management ||Cutaneous stimulation
Transcutaneous electrical nerve stimulation
Non-pharmacological invasive therapies
Also mind-body: distraction, relaxation, imagery, meditation, biofeedback hypnosis, and therapeutic touch|
|Pharmacologic pain management: opiates ||Watch for resp depression (look for over dosage)
Before giving need assess LOC, RR
PCA: Patient-controlled analgesic: Continuous through epidural
Analgesics most effective when scheduled rather than prn. NSAID often co-administered with narcotics|
|Non narcotic adjuvants to opiods ||Aspirin and ibuprofen
Used to decrease inflammation|
|Narcotics to know (opiod agonists) ||mepiridine (Demerol) PO/IV/IM. fentanyl (Duragesic) TD/IM/IV/buccal. hydrocodone/actetamenophen (Lortab) PO. morphine PO/IM/IV/buccal/sc/pr. oxycodone/acetamenophen (Percocet) PO. codeine PO. All come from poppy (opium) plant.|
|NSAIDs to know ||ibuprofen (Motrin). naproxen (Aleve). celecoxib (Celebrex)[COX-2]. ASA. ketorolac (Toradol) [this one is PO/IM/IV.|
|Nonnarcotic non NSAID analgesic ||acetaminophen (this drug is NOT an NSAID).|
|Drugs specifically for headaches ||-triptan. sumitriptan (Imitrex). almatriptan (Axert). For migraine and tension headaches.|
|Reversal agent for narcotics/benzo ||reverse narcotics - naloxone (Narcan), an opiod antagonist - may precipitate acute withdrawl, agitate, incr HR/BP/RR.
reverse benso - flumazenil (Romazicon), benzodiazepine antagonist -may precipitate seizures.|
|Antidote for acetaminophen overdose ||N-acetylcystein (Acetadote)|
|Nusing implications for narcotics ||Monitor RR, LOC, and BP. More symptoms with overdose. Miotic pupil in overdose. Reversal agent = naloxone (Narcan). PO narcotics can cause nausea, take with food. All narcs cause constipation. Morphine may cause hives.|
|Nursing implications for NSAIDs ||All inhibit platelets and may have bleeding side effects. May cause gastritis, PUD, kidney problems. Not used in pregnancy. Avoid with hemophilia. celicoxib (Celebrex) is COX-2 inhibitor - safer for stomach.|
|Acetaminophen nursing implications ||Dosage must not exceed 1g/dose or 4g/24 hours from all combined sources of acetaminophen. Overdose causes liver failure. Do not use if liver disease. Antidote = N acetylcysteine (Acetadote)|
|Actions of NSAIDs ||antiiflammatory, antipyretic, analgesic, antiplatelet.|
|Nursing implications: ASA ||More side effects than other NSAIDs. May cause gastritis, PUD, kidney failure. Platelet effects are long lived. Must hold for days prior to surgery. Avoid if hypersensitivity to salicylates. Do not use in children, flu, gout.|
|Signs/symptoms of ASA overdose ||Tinnitis, hyperventilation -> respiratory alkalosis, N/V, excitability. Severe overdose = metabolic acidosis/seizures.
Toxic dose = 150mg/kg.|
|Isotretinoin ||Accutane. A pregnancy class X drug. Used for refractory acne. Take with fat to increase absorption. Females must have neg preg test monthly and have 2 forms of contraception. Many rules concerning this drug due to its ability to cause birth defects.|
|Narcotic (general) classification,action, uses. ||Classification: opiod agonist. Action: changes perception of and response of pain. Uses: moderate to severe pain.|
|Narcotic (general) side effects ||Confusion, sedation, euphoria, dependence hallucinations, fall risk, dizziness, dry mouth, vision disturbances, hypotension, bradycardia, anorexia, N/V/C, decrease RR. Overdose: apnea, hypotension, comatose, miosis.|
|Narcotic (general) nursing implications ||Caution with EtOH or other sedating drugs. Must monitor LOC and VS. Known intolerance to narcotic agent, elderly, head trauma, undiagnosed abdominal pain.|
|Nursing implications mepiridine (Demerol) ||All (general) narcotics implications + avoid use with liver impairment.|
|Nursing implications morphine ||All (general) narcotics implications + may cause hives (allergic skin rash)|
|NSAID (general) classification, action, uses. ||Classification: nonopiod analgesic - NSAID, action - inhibits prostaglandins and other inflammatory medicators, uses - mild-moderate pain, fever, inhibitor of inflammation.|
|NSAID (general) Side effects ||Inhibit platelet function, bleeding, N/V/C, dyspepsia, PUD, worsening kidney function, headaches. Avoid use in pregnancy or renal insufficiency.|
|-triptan: class, action, use, side effects ||Class: animigraine. Action: selective serotonin agonist. Use: migraines and other headaches. SE: Headache, vertigo, fatigue, myalgias, BP changes|
|-triptan: nursing implications ||Avoid with uncontrolled hypertension, hepatic/renal impairment, pregnancy, CAD, elderly.|
|Vitamin A&D ointment ||Barrier, lubricates and provides Vit A/D for skin repair|
|Benzoyl peroxide ||Peeling agent used for acne. Use on clean face at night. May worsen sun damage to skin. Dries skin.|
|Tretinoin (Retin-A) class, action, use ||Class: Vitamin A derivative anti acne drug. Action: reduces oil production of skin. Uses: acne and some other skin conditions. Side effects: irritated skin, drying of skin, peeling, increases sun irritation to skin.|
|Tretinoin: nursing implications ||Use on cleansed dry face at night. Use small amount of lowest strength. Tolerate this before going to stronger strength.|
|calciprotriene (Dovonex) ||Class: antipsoriatic, vitamin D analog. Action unknown. Use: psoriasis. SE: may thin skin. Nursing implications; - apply only to affected area.|
|minoxidil (Rogaine) ||Class: baldness drug. Action: unknown. Use: alopecia. SE: burning/irritation, unwanted hair growth. Nursing implications: keep head dry 4h after application. Must use indefinitely.|
|calamine ||antipuritic, barrier lotion|
|silver sulfamethazine (Silvadene) AND mafenide acetate (Sulfmaylon) both drugs have similar use and problems. ||Topical antibiotic typically used for burns. Avoid in those with Sulfa allergies. Can cause Stevens Johnson syndrome. May cause skin hypopigmentation.|
|Mydriatics & miotics general info ||miotics: parasympathomimetics, cholinergics. mydriatics: anticholinergics and alpha agonists. May make eye's blurry. Mydriatics may precipitate closed angle glaucoma.|
|Acetic acid & aluminum acetate (Domeboro) ||Acidifies pH of auditory meatus. Used for otitis externa.|