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pharm I final
nursing pharm
| Question | Answer |
|---|---|
| 6 rights of med administration: | Right drug, right dose, right time, right route, right patient; right documentation |
| involves the way in which a nurse gathers, analyzes, organizes, provides, and acts upon data about the patient within the context of prudent nursing care and standards of care | Nursing process and drug therapy: |
| same as bioavailability. Two drugs that have the same bioavailability are said to be this. Refers to distribution within the tissue. A measure of the extent of drug absorption for a given drug and route (from 0-100%). | Bioequivalency: |
| 1.Fast and 2. bybasses the first pass effect (doesn’t have to be metabolized by the liver.) Example: sublingual nitroglycerin (absorbed through the blood vessels) | Parenteral meds: |
| an extension of the drug’s normal effects in the body. Example: takes blood pressure medication, but blood pressure drops too low; antidiabetic medication and they go extremely hypoglycemic. The extreme of the wanted reaction. | Pharmacologic reaction: |
| medications given other than the GI tract; intradermally, subcutaneously, intraarterially, intramuscularly, intrathecally, intraarticularly, intravenously. | Parenteral meds: |
| an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient. Does the opposite of what you want / expect the drug to do. For example: benadril causes drowsiness, but some people get hyper | Idiosyncratic reaction: |
| the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50% -if it is less than 24 hours- give more than once a day | Half life: |
| drug taken enterally and occurs when the drug is taken into the body- usually through the intestines | Absorption- |
| the transport of a drug by the bloodstream to its site of action | Distribution: |
| also known as biotransformation because it involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolize, or a less active metabolite; | Metabolism: |
| next step after absorption and distribution--**primary through liver | Metabolism: |
| the elimination of drugs from the body; usually done via the kidneys, liver, bowel **primarily through kidneys | Excretion: |
| (rapid onset)-get infection and need to be on an antibioitic, nebulizer, something that will treat problem | Types of medication therapy: -acute |
| (HTN meds)-ppl with blood pressure medication, singular or advar | Types of medication therapy:-maintenance |
| (diabetes-insulin), hormone replacement, zynthrodes, think hormone primarily! | Types of medication therapy:-supplemental |
| (hospice)-end of life comfort care | Types of medication therapy:-palliative |
| (used in recovery- fluids—think crisis, short term maintenance), iv fluids to burn patients, fluid and electrolytes to a person with a stomach bug. Will ensure a person gets through illness. Will not fix problem | Types of medication therapy:-supportive |
| (preventative); prevent infection; you have a leaky heart valve and they put you on this before the procedure at the dentist. Example: antibiotics before surgery and after surgery. Ex. Birth control | Types of medication therapy:-prophylactic |
| (prevention- exposed/not exposed; based on clinical probabilities- shown to work so we’re going to give it). | Types of medication therapy:-empiric |
| Someone comes in with suspected strep throat; person is given amoxicillin because it may look like it, so it is given to them even without having the culture back. | Types of medication therapy:-empiric |
| You come in with a suspected UTI will put them on med, and keep them on that med unless they have a drug resistant bacteria. Biaxin for suspected pneumonia | Types of medication therapy:-empiric |
| It is important to REPORT IT. report if error happens right away. double check medication that need to be double checked, i.e heprin, , double check for wasting narcotics **always verify what signing for | Medication errors- |
| not treated same as Rx products; don’t have to prove effective; not good quality control standards in place (not evaluated or regulated by FDA); need to provide list of and % of what is in product; | Regulation of herbal products- |
| dietary and self regulation act (Dietary Supplement Verification program); good manufacturing- demonstrate identity, quality, and purity, and strength of active ingredients—and free form contaminants (microbes, pesticides, and heavy metals). so regulated | Regulation of herbal products- |
| check apical pulse for 1 full minute- must be at least 60+ (if it’s 60 give it), 59 do not. | Digoxin administration- |
| hypokalemia contributes to toxicity- bind to receptors making potassium more abundant | Digitalis toxicity- |
| drug give for digitalis toxicity;antidote | =Digibind = (immune fab)- |
| affects heart rate; negative = dig; that’s why we must make sure apical pulse is at least 60; slows heart rate | Chronotropic effect- |
| affect cardiac conduction (electrical impulse in cells) dig and adenosine= negative | Dromotropic effect- |
| affects cardiac contraction; Positive= increases contractility of the heart ; positive = dig, more power to the pump (heart)- greater strength of contraction, | Inotropic effect- |
| primary adverse effect- dysrhythmias (primarily ventricular); PDI (phosphodiesterase inhibitor); positive inotropes | Milrinone- |
| given with acutely decompensated heart failure**; only used in hospital setting | Nesiritide- |
| 29. Lidocaine- primary use- ventricular dysrhythmias; straight lidocaine given IV (not mixed like rocephin or epinephrine); | Lidocaine- |
| significant adverse effects- CNS toxic effects—twitching, convulsions, confusion; respiratory depression or arrest; and the cardiovascular effects of hypotension, bradycardia, and dysrhythmias | Lidocaine- |
| stops the heart; antidysrhythmic; used with SSVT and PSVT; half life less than 10 seconds- given quickly followed with a flush **rapid IV push given AC (anticubital) IV or closer to heart (as close to the heart as possible) | Adenosine- |
| (Cardizem); primary use- Afib or flutter patients with rapid ventricular response; Class IV drug- CCB (calcium channel blocker); treating dysrhythmias above ventrical; prevent Vfib or Vtach | Diltiazem- |
| take one off before putting other on; don’t touch; wear during day and then take off at night | Topical nitroglycerin- |
| determined by the product of cardiac output (CO) and systemic vascular resistance (SVR); determines arterial blood pressure | Blood pressure- |
| hypotension; male patients warned/ counseled and constantly monitored for sexual dysfunction (impotence)- hard to keep them compliant; cannot take with Viagra (can try to treat by lifestyle changes or HCTZ/diuretics instead to try and avoid side effects | Adverse effects of antihypertensives- |
| used primarily for hypertensive crisis; major adverse effect: can cause cyanide toxicity**; maximum dose- can be on for 10 minutes | Nitroprusside- |
| “pril” family; side effects: dry chronic cough; diabetics benefit most from this b/c it helps vasodilate the kidneys (diabetics do not have to have HTN to take, just cannot be hypotensive) | ACE inhibitors- |
| primary side affect: causes hypokalemia | Loop diuretics- |
| Fluid volume status- best way to assess- | daily weight; can strictly monitor I&O |
| pull water into vasculature to flush out of system; | Osmotic diuretics- |
| main indication: cerebral edema and increased intracranial and intraocular pressure; decreases intraocular pressure | Osmotic diuretics- |
| check expiration date/patient ID, 2 RN need to verify, check unit number- specific delegation of blood, check blood type, monitor vital signs- before, during, and after; monitor if any adverse reactions (In which case STOP IMMEDIATELY) | Blood transfusions- |
| Primary action when person is having adverse reaction is stop it! | STOP IMMEDIATELY. |
| Uses of different blood products- used for acute bleeding | cryoptrcipitate |
| Uses of different blood products- increase clotting factors | fresh frozen plasma (FFP |
| Uses of different blood products- increase oxygen carrying capacity of blood; | packed red blood cells (PRBC)- |
| Uses of different blood products- pts who have lost extreme amount of total blood volume | whole blood- |
| antidote for Warfarin- | Vitamin K |
| labs for Warfarin- | PT/INR |
| only given orally; prevent clot formation- DO NOT break up clots | Heprin and Warfarin |
| antidote for Heprin | protamine sulfate |
| labs for Heprin | aPTT or PTT |
| be given at same time as transition therapy from Heparin to Warfarin; both anticoagualtes, prevent formation of clot, do not break down clot. Warfarin takes lokger to become effective so Heprin will be given first, then warfarin | Heprin and Warfarin |
| clot busters- break down clots; major complication = bleeding (bleeding out) | Thrombolytics- |
| side effects: drowsiness and dry mouth (anticholinergic effects); traditional (benedryl) vs nonsedating (claratin) | Antihistamines- |
| cough suppressants; act on cough centers in brain | Antitussives- |
| IV preparation; xanthine derivative; once metabolized in body turns into caffeine; smoking decreases blood concentration of this(patients who smoke will need increased doses); theophylline = PO preparation | Aminophylline- |
| give bronchodilator before corticosteroids—open up first then steroid will be able to go in and do their job (B before C); no specific amount of time between needed, just B before C | Use of bronchodilators and corticosteroids- |
| get before giving antibiotic | Obtaining cultures- |
| oral contraceptive effectiveness decreased when taking this; anticoagulants increased when used (create higher effects of anticoags when on meds) | Antibiotics and drug interactions- |
| CBC to check effectiveness of this; WBC decreases; reduction of signs and symptoms (such as fever) | Therapeutic responses to antibiotics- |
| when normal flora destroyed and an infections happens after that (example- vaginal yeast infection, thrush—oral candidiasis) | Superinfection- |
| Antiseptics vs disinfectants- (alcohol swab)- living thing (think skin cleaning); | antiseptic- |
| Antiseptics vs disinfectants-nonliving cleaning (think Lysol) | disinfectant- |
| can cause toxicity- monitor peak and trough; infuse slowly b/c can cause hypotension | Vancomycin infusion- |
| Drug of choice to treat MRSA- Vancomycin | Vancomycin |
| Dual therapy with antibiotics-why? | to prevent resistance |
| Drug of choice to treat KPC- (Klebsiella pneumonia carbopenamase)= | colistimethate (Coly-Mycin) |
| Contraindication for antitubercular therapy- | liver failure; noncompliance |
| Length of anti TB therapy- | up to 24 months for treatment (why noncompliance such an issue) |
| Contraindication to antifungal therapy- | drug allergy, liver failure, and kidney failure |
| oral fungal infections; swish and swallow/spit | Nystatin oral preparations- |
| give antipyretic and antihistamines before and check blood pressure before, during, and after; slow infusion; used for severe fungal infections | Amphotericin B considerations when administering and before administering- |
| take before, during, and after going to place where possible interactions with malaria | Malaria prophylaxis- |
| tailored to specific worm (depends on worm for treatment); live primarily in lower intestines; most common route is fecal to oral | Antihelmintics- helminthes = worms- |
| side affect = constipation | Aluminum salts- |
| side effect = diarrhea (strong laxative = maxatrate) | Magnesium containing antacids- |
| (tagament) H2 receptor antagonist/H2 blocker (found in stomach) – reduce production of gastric acid (PPI- stop production all together); smoking decreases effectiveness of medication | Cimetidine- |
| simethicone (Mylicon); chewable or elixir form; used to reduce gas | Antiflatulance meds- |
| Rebound congestion occurs because of | vasodilation. |
| antacid (neutralizes stomach acid); buffer and alkalizer; over use causes metabolic alkalosis and possible rebound acidity | Sodium bicarb- |
| treated with triple therapy = 2 antibiotics and a PPI | H. Pylori- |
| nursing consideration : follow with 8oz glass of water (if not can cause blockage/obstruction); only laxative safe for long term use | Bulk forming laxatives- |
| Complication of laxative use- | can cause dependence; fluid and electrolyte imbalances |
| Long term laxative use- only safe one is | bulk forming laxatives |
| Reglan (metoclopramide); don’t use if intestinal blockage; can cause diarrhea; indications for use: chemotherapy and post-op therapy | Prokinetic drugs- |
| work primarily on central nervous system- blocks nausea impulse in brain; indications for use: chemotherapy | Serotonin blockers- |
Created by:
lalad13
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