Question | Answer |
4 Specific aspects of pt drug use to be included when performing a pt drug therapy assessment | home remedies
diet
illegal
otc
hormonal
current meds
allergies |
3 physical characteristics to include in drug thereapy | height
weight
chronic illness
muscle mass |
4 psychosocial aspects of drug therapy | age/development
education/ reading
ethnic group
cultural beleifs |
drug info needed to know prior to admin | drug info
use, dosage, route, frequency
mechanism of action
expected therapeutic action
adverse reactions (signs & Sx)
allergic reaction
drug-drug. drug-food interactions
incompatibilities
lab monitoring
nursing actions (v/s pre and post admin) |
required components of med order | pt name
date of order
name of drug
dosage- amount, frequency, number of dose
delivery route
signature |
3 nursing Dx commonly associated with drug therapy | deficient knowledge
risk for injury
noncompliance |
examples: when developing nursing care, pt outcomes related to pt drug therapy | admin tech
storage
purpose
pulse w/i 2 beats |
six rights of meds | right drug
right document
right dose
right pt
right time
right route |
right drug | check name with order and MAR, 3 times |
right dose | check dose w/ pt. & availability |
right time | military time |
right route | enternal, parenteral, topical |
right pt | name, medical record number, dob |
right documentation | prescribers sign. legal and ethical issues |
med error includes | prescribing order, product label, packaging, dispensing, distribution, admin, ed, monitoring |
evaluation of drug therapy (monitoring) | systematic, ongoing, dynamic.
adverse effects, toxic effects, pt ed |
3 principles of pharmacodynamics | where and how it interacts with body
dont create body function, modifies it
no drug has single action |
3 types of names given to each drug & id characteristics | chemical
generic- nonproprietary, US adopted name
trade- proprietary, trade name |
normal length of patent life | 17 years |
drug absorption | enteral, parenteral, topical |
3 most common drug design forms | liquids, powders, capsules, tablets, coated, enteric coated |
4 most common forms of parenteral meds | intradermal, subcutaneous, intramuscular, intravenous |
first pass routes | hepatic arterial
oral
portal venous
rectal * both* |
entero-hepatic crculation onset and duration | onset of 1-2 hours
duration of action is long |
5 factors that may affect absorption of enterally admin drugs in stomach | acidity
foods/liquids
time of day
age
other meds |
3 factors affect absorption of enterally admin drugs in sm. intestine | destruction
surgical removal
diarrhea
concurrent drug therapy
decreased blood flow to Gi: exercise, sepsis, stress responce |
If pt is malnourished, albumin is low. 99% protein bioavailability- what will happen to pt | OD- most common drug cumadin |
primary site and mechanism for drug biotransformation is | liver! cytochrome p-450 |
3 commonly factors that affect liver | age
genetic
disease states
polypharmacy |
microsomal enzyme INDUCER | increase rate of microsomal enzymes |
microsomal enzyme INHIBITOR | decrease rate of microsomal enzymes |
3 common lab test to assess liver function | ALT/SG
ALT/ SGPT
bilirubin
Alkaline phosphatase |
3 primary mechanisms of renal drug excretion | glomerular filtration
active tubular reabsorption
active tubular secretion |
4 common lab test to assess renal function | BUN
creatinine
total protein
electrolytes |
cardiovascular dysfunction
category and metabolism | disease
decrease |
renal insufficiency
category and metabolism | disease
decrease |
obstructive jaundice
category and metabolism | condition
decrease |
slow acetylator
category and metabolism | condition
decrease |
ketoconazole & erythromycin
category and metabolism | drugs (antibiotics) p-450 INHIBITOR
decrease |
fast acetylator
category and metabolism | condition
increases |
barbituates
category and metabolism | drugs
increases |
rigampin & phenytion
category and metabolism | drugs p-450 INDUCER
increase |
when metabolism is decreased, the risk for what is increased | toxicity |
p-450 INDUCER does what to metabolism | increases |
p-450 INHIBITOR does what to metabolism | decreases |
3 basic drug mechanisms of action | receptor
enzyme
nonselective |
agonist | receptor- causes response - morphine (opiods) |
partial agonist- agonist/ antagonist | receptor- causes diminished response- immed withdrawl- oxycotin & talwon |
antagonist | receptor- binds and blocks- beta blockers (narcane) |
enzyme | ace inhibitors- works on enzymes in body, via inhibiting. |
angiotension | vasoconstricts, elevated b/p. enzyme inhibits, therefore it dilates and lowers b/p |
nonselective | do not interact with receptors or enzymes. works on cell wall, destroys itself |
examples of nonselective | penicillin; cephlosprins. cipro, levaquin, erythromycin, chemotherapeutic |
common outcomes of drug therapy | curing disease
elimination or reduction of Sx
prevention of disease or unwanted condition |
6 types of drug therapy | acute
maintenance
supplemental
supportive
prophylactic
empiric
pallitive |
acute | vasopressors |
maintenance | chronic b/p, bc |
supplemental | iron defic, diabetic insulin |
supportive | fluids to prevent dehydration in flu |
prophylactic | cardiac Hx, antibiotics pre dental |
empiric | give meds, test cultures
(wound testing, strep throat) |
palliative care | end of life care. high dose of pain meds |
low therapeutic range | increased risk for toxicity (digoxin) |
high therapeutic range | decreased risk for toxicity |
factors that can cause toxic serum levels | lack of adequate plasma protein, as level of free drug may increase |
common types of drug interactions | additive effects
synergistic effects
antagonistic effects
incompatibility |
additive effects | equal to sum. Tylenol/ codine |
synergistic effects | greater than the sum |
antagonistic effects | less than sum. antibiotic/ antacid |
in pharmacologic reaction, give insulin for high sugar | sugar levels drop too low |
idiosyncratic reaction | give sleeping meds, pt up for 3 days |
3 characteristics of idiosyncratic reaction | occurs unexpect
abnormal responce
usually caused by deficiency |
teratogenic drugs | cross placenta and can harm baby. listed as 'x' in drug cats |
mutagenic | permanent changes in the genetic composition of living. alters chromosome structure, number of chromosomes, or genetic code of DNA |
carcinogenic | cancer causing |
priority for effective Tx of poisoned Pt | first- preserve pt vital functions= maintaining airway, ventilation, and circulation
second= prevent absorption and/or speed elimination |
digoxin (pg 431) | digitals glycosides |
coumadin (1299) | warfarin
coumarins |
lovennox (647) | antithrombotics |
Heparin (644) | antithrombotics |
insulin (707) | pancreatics |