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Pharmacology L1
Lecture 1 - 5-19-11
| Question | Answer |
|---|---|
| Drug | Chemical that can affect a living process |
| Pharmacology | Study of drugs and learning about drugs and their interactions with living systems |
| Clinical pharmacology | What drugs are doing to humans |
| Therapeutics | Using drugs to treat a disease or to diagnose or prevent a condition Ex - preventing pregnancy (birth control) |
| Properties of an ideal drug | -There is no such thing as a perfect drug -All drugs don't do only what they were made to do -They all have side effects -Side effects help us determine if the drug is safe -EFFECTIVENESS -SAFETY -SELECTIVITY |
| Effectiveness | Is the drug eliciting a response for the reason we are giving it? Is it effective? Drug companies must prove effectiveness THE MOST IMPORTANT PROPERTY A DRUG CAN HAVE |
| Safety | A safe drug cannot produce harmful side effects There is no such thing as a safe drug (all drugs have side effects) Higher doses and prolonged tx can cause more dangerous side effects |
| Selectivity | The perfect drug Does it illicit ONLY the response we want? |
| Reversibility | Can we give another med to go in and bind it all up? |
| Predictability | It's likely we can predict how a drug will affect the average person, however everyone has different conditions You can't really predict, and it cannot be guaranteed |
| Easily administered (drugs) | Drugs need to be easy to administer so that people will be compliant with meds BEST for out-patient is pills Companies can do this by making time release properties in drugs |
| Free from drug interactions | What are the interactions a drug has with other drugs? Can two or more drugs NOT be taken together? Do they have to be taken on an empty stomach? Drugs can cause others not to work or work less -ex: birth control and antibiotics |
| Chemical stability | Does drug need to be stored in refrigerator Some drugs will degrade when exposed to light Very different for each drug When drugs are similar in structure to our hormones, then we need to watch to make sure everything is still working as it should |
| Easily pronounced generic name | The generic name is much easier for communicating the drug with patients They won't use the chemical name |
| Sources of drug information | People (nurses, poison control), publications (PDR, drug facts), internet (WebMD) |
| PDR | Physicians drug reference |
| Chemical drug names | Nomenclature of chemistry Complex Inappropriate for everyday use |
| Generic drug names | Non-proprietary Less complex than chemical but more complex than trade names Preferable to trade names for general use -ex: Tylenol (trade name), acetaminophen (generic name) |
| Trade drug names | Proprietary/brand name Names under which the drug is marketed -ex: Tylenol (trade name), acetaminophen (generic name) |
| Generic vs. trade drugs | The active portion of the drug must be therapeutically equivalent between the generic and trade -Lots of meds come with diff filler/coatings FDA requires that generic is as safe as trade -Same dose Possible variations in rate & extent of absorption |
| JCAOH | They determine what is safe and they do the major survey of hospital and accreditation |
| What is the order medical terminology is used? | Drug name, dose, abbreviations |
| What is the non proprietary name of the drug? | Generic name |
| Pharmacology objective | Provides maximum benefit (effective) with minimum harm (safe and selectivity) |
| Routine drug orders | Timeline in which you are expected to implement it -Usually 4 hours |
| Types of prescription drug orders | Written, routine, PRN, single, STAT |
| PRN drug orders | Usually a PRN reason -And that reason is the ONLY reason you should give it to pt -If the reason is not listed, ask doctor to clarify |
| Single drug order | Once you've given the drug, there's no other reason to give another dose -It's expired once you give it |
| Parts of a medication order | Name of client Date of order Name of drug Dose Route Frequency Reason Signature of prescriber -Must have all these to be complete -Can't give anything unless it's prescribed |
| A patient has a drug order that reads: "morphine as needed for pain." What kind of medication order is this? | PRN order |
| Goals of safe drug administration | Improve accuracy of patient identification Improve effectiveness of communication among caregivers Improve safety of using meds -Look alike/sound alike meds - be careful Accurately and completely reconcile medications across the continuum of care |
| Reconcile medication | Every time you have contact with patient, you need to find out their up to date list of meds -Check for compliance -When they came in, what were they taking? -When they leave, what has changed? |
| Adverse drug reactions (ADR) | Undesired effect that occurs at normal dose range -mild = intolerance, severe = closing of airway, respiratory depression -Sometimes meds will have a hold for RR Populations at risk - elderly, immunocompromised, and kids |
| Types of ADR | Side effects, toxicity, allergic reactions,carcinogenic effect, idiosyncratic effect, physical dependence, Teratogenic effect, organ specific toxicity |
| Side effects | Unavoidable Some will take time to show up -Nearly unavoidable secondary drug effect produced at therapeutic doses |
| Toxicity | You're taking an excessive dose |
| Allergic reaction | Is it a true allergy? Or is it a side effect? True allergy has immune response (histamine) - May cause anaphylaxis |
| Anaphylaxis | Life threatening BP drops Airway closes |
| Idiosyncratic effect | Uncommon drug response from genetic predisposition -Ex: 2 year old has Benadryl and instead of getting tired, she gets super hyper |
| Physical dependence | State in which the body has adapted to prolong drug exposure (so now you depend on the drug) |
| How does pain med dependence happen? | We have pain med receptors -If we haven't had pain meds, then we have very few receptors -After you've had pain meds a lot, your body adapts and thinks you need more pain receptors so it makes more -Then you need more pain meds to get same response |
| Withdrawal effects | Not usually fatal (except in alcohol withdrawal) |
| Carcinogenic effect | Adverse reaction to good cells |
| Teratogenic effect | Pregnancy related side effects to the fetus |
| Identifying ADR | Determine if there is a relationship between presence of drug and ADR -Ask lots of questions |
| Medication error | Any preventable event that can lead to errors |
| Types of med errors | Wrong patients, wrong dose, wrong time, forgot to give drug at certain times, etc. |
| Strategies to reduce med errors | Institutional culture Infrastructure Clinical practice Technology Adhere to 5 rights Listen to your patient Reporting errors |
| MedWatch | Where you report ADRs to the government -must be done for new drugs |
| Controlled Substance Act | -Passed in 1970 -Regulates manufacture, importation, possession, use, and distribution of certain substances -5 Schedules -Requires an accounting of all controlled drugs on a special record |
| Schedule 1 | High potential for abuse -Marijuana, ecstasy, etc. |
| Schedule 2 | High abuse Medically acceptable -Redline, morphine, oxycodone, cocaine (vasoconstrictor), etc. |
| Schedule 3 | Lower abuse than 1 and 2 -Vicadin |
| Schedule 4 | Low abuse -Zanex |
| Schedule 5 | Less abuse than schedule 4 -cough syrup |
| Controlled substance | Drugs defined and categorized according to their abuse potential and dependence-producing liability -Must be signed by 2 nurses that drug was distributed? -Kept locked and only people with authority have access |
| EBP | Evidence based practice -research -clinically applicable -need to stay clinically up to date |
| Preclinical testing | 1-5 years Done on animals |
| Phase 1 clinical testing | Done on human volunteers (healthy without medical condition) Couple dozen people Measures drug metabolism and effects |
| Phase 2 clinical testing | Couple hundred PATIENTS and some volunteers Testing for therapeutic effects Looking for dose range to see what's safe |
| Phase 3 clinical testing | Application for FDA approval Thousands of people Clinical trial Marketing begins after FDA approval |
| Phase 4 clinical testing | Evaluates general use Post-marketing surveillance (to see if FDA needs to re-evaluate/pull of market) |
| Historical limits to testing | Don't like to test on women of childbearing age so possible fetus isn't harmed Don't like to test on children |
| How are drugs classified? | ?? |
| What is the purpose of placing drugs in classifications? | ?? |
| Identify some advantages and disadvantages to clinical trials | ?? |
| What are some nursing implications related to administering a controlled substance? | ?? |
| What special precautions are required for handling controlled substances? | -All controlled drugs are specially recorded -Only licensed personnel have access to them -Double locks |
| What agency policies should be in place to prevent medication errors? | Institutional culture Infrastructure Clinical practice Technology |
| What will you do as a nurse to prevent medication errors? | Adhere to 5 Rights Listen to your patient Report errors |
| If you know a colleague has done a medication error and how not reported it, what will you do? | Report it |
| Identify some points about safe drug use that should be taught to all patients | ?? |
| As a nurse what will be your biggest safety concern regarding medications? Why? | ?? |
| Contraindication | Pre-existing condition that precludes the use of a particular drug under normal, non-life threatening circumstances -Ex: patient is allergic to an antibiotic, but their infection can only be treated by that one antibiotic |
| Precaution | Pre-existing condition that increases the risk for ADR to a particular drug |
| 5 Rights of Medication Administration | Right drug Right patient Right dose Right time Right route -MUST BE DOCUMENTED |
| Nursing responsibilities | Think critically (know purpose, when to administer, when to hold, common SE, common ADR, pre & post monitoring) Use clinical judgment Role as patient advocate |
| Preadministration assessment(before drug is given) | -Get baseline data -Identify high risk patients -Ability for self-care -Complete drug history |
| Complete drug history | Currently prescribed meds Prescribed dose and route When it was last taken Compliance Why drug is prescribed Reason med was stopped other meds taken in recent past Known allergies, when it occurred and describe OTC |
| Implementation (giving drug) | Administration Patient education Promote therapeutic effects Minimize ADR |
| Patient medication education | Drug names (generic, trade) Purpose Contraindications When to take How to take Duration of tx What to do if dose is forgotten Special lifestyle changes, hazards to avoid Drug-drug/food interactions Storage needs ADRs and what to do Therapeutic |
| Evaluation (after drug is given) | Therapeutic response ADR Compliance Satisfaction |
| What are the 5 Rights of medication administration? | Right drug Right patient Right dose Right time Right route DOCUMENT |
| Listen the steps in the nursing process in medication administration? | -drug administration -patient education -interventions to promote therapeutic effects -interventions to minimize adverse effects |
| What are the parts of a medication order? | Name of client Date of order Name of drug Dose Route Frequency Reason Signature of prescriber |
| What does STAT mean? | Immediately |
| The MOST important property of an ideal drug? | Effectiveness |
| What is the difference between contraindication and precaution? | A precaution is a pre-existing condition that increases risks for ADRs, but a contraindication is a pre-existing condition that makes the use of a particular drug under non life-threatening circumstances IMPOSSIBLE |
| Pharmacokinetics | Determines how much of a dose gets to its site of action IMPACT OF THE BODY ON DRUGS |
| Pharmacokinetic processes | -drug absorption -drug distribution -drug metabolism -drug excretion |
| Pharmacodynamics | Determines the nature and intensity of the response (once a drug reaches its sites of action) IMPACT OF DRUGS ON THE BODY Initial step leading to a response is the binding of a drug to its receptor |
| Most common types of FATAL med errors | Giving an overdose Giving wrong drug Using wrong route |
| Most common causes of FATAL med errors | Human factors (performance or knowledge deficits) Miscommunication (ex: bad handwriting) Confusion caused by similarities in drug names |
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