Term
| 5 Rights of Medication Administration |
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Definition
| Right: Drug, Dose, Time, Route, Patient |
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Term
Pharmacokinetics def.
4 steps in the process |
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Definition
Movement of a drug through the body.
-Absorption
-Distribution
-Biotransformation
-Excretion |
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Term
Absorption def.
affected by:
4 routes into bloodstream: |
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Definition
Movement of drug from the site of administration to bloodstream.
Affected by:
-Stomach acid (pH)
-Food in stomach
-Circulation
-First Pass Metabolism
-Gastric Motillity
Routes:
-ointment on skin to bloodstream
-pill in mouth to bloodstream
-shot in muscle to bloodstream
-IV into bloodstream
**remember low pH hingers absorption |
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Term
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Definition
Given into the GI system.
-Oral
-Gastric tube
**remember by ENTER directly into GI system |
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Term
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Definition
Given by route that advoids GI system.
-IV
-Injection
-Sublingual
-Inhaled |
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Term
| Solubility of med. forms from fastest to slowest |
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Definition
Fastest-->Slowest
Liquids, elixers, syrups
Suspension
Solutions
Powders
Capsules
Tablets |
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Term
Designed for Delay
(EC SR LA SA XR ) |
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Definition
EC- enteric coated
SR- sustained relase
LA- long acting
SA- slow acting
XR- extended release |
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Term
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Definition
| Before entering the blood, enteral meds will pass through the liver and become inactivated; therefore, enteral doses are higher than parenteral in order to survive 1st pass |
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Term
Distribution def.
affected by:
physiological barriers: |
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Definition
Transport of drug from the bloodstream to site of action.
affected by:
-circulation at site of adminstration
-protein binding
barriers: placenta and blood brain |
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Term
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Definition
| Both a physical barrier and system of blood vessels that protect the brain from chemicals, but allows entrance of nutrients. |
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Term
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Definition
| Semi-permeable membrane that limits the kind and amount of material that will cross from mother to fetus. |
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Term
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Definition
| Chemical inactivation of a drug through coversion to a more water soluble compound that can be excreted (metabolite). Occurs primarily in the liver. |
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Term
Elimination def.
organs involved:
routes:
factors that affect: |
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Definition
Process by which drugs and their metabolites are removed from the body.
organs involved:
-Kideys
-Liver (bile)
routes:
-fecal
-urinary
-Respiratory
-Breast Milk
-Sweat, tears, saliva
affected by:
-hepatic and renal function
-urine pH
-genetic factors
-other drugs
-salive, sweat |
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Term
Half-Life def.
which stage?
determines?
important because? |
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Definition
Time required for half of original amount of drug to be excreted.
elimination stage
Determines? the frequency of administration.
If drugs are taken sooner than should be, toxicity can occur. |
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Term
Steady State def.
3 levels |
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Definition
The amount eliminated is equal to the amount absorbed with each dose; desired state for most meds.
toxic level
-----------
therapeutic level
-----------
sub-therapeutic level |
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Term
Drug Window/ Therapeutic Index def.
2 types and examples |
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Definition
Measures sub-therapeutic, therapeutic, and toxic level of drugs.
Narrow index= lesser amount of drug can reach toxic level; dangerous
example: insulin
Wide index= more amount of drug to reach therapeutic level; not dangerous
example: vit.C |
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Term
| What factors affect distribution? |
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Definition
-Circulation
-Protein binding
-Lipid Solubility
-Obesity |
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Term
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Definition
| Action of a drug on the body or mechanisms of action (MOA) |
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Term
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Definition
Ways by which drugs can produce therapeutic effects.
At site of action, drug can modify rates at which cells or tissues function but can not make a cell or tissue perform a function it was not designed to perform. example: liver cell can't function as a kidney cell |
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Term
| What are the ways in which drugs act (MOA)? |
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Definition
-Cell receptors are activated by hormones, neurotransmitters, or other body substances.
-Drugs bind to receptors to cause response.
-Agonists/Antagonists
-Target enzymes.
-Interact with molecules. |
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Term
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Definition
| Desired outcome of therapy; fixing, relieving, stabilizing, eliminating, preventing. |
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Term
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Definition
| Anticipated effects that are not the purpose of giving the drug. |
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Term
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Definition
| Undesirable and unintended effects that are sometimes more severe than side effects. |
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Term
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Definition
Paradoxical- opposite of the intended effects.
Idiosyncratic- unexpected and have no apparent relationship to the reason drug is given.
Hypersensitivity- allergic, due to stimulation of immune system.
Toxic reactions- occur when overdosed with drug. |
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Term
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Definition
Chemical reaction when mixing of drugs, pharmacokinetic, and pharmacodynamic interactions.
Synergistic-combined effect greater.
Reducing- one drug inhibits ability of another drug to act. |
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Term
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Definition
| Induce structural defects in unborn fetus (Accutane). |
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Term
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Definition
| Induce changes in genetic composition of organisms. |
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Term
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Definition
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Term
distribution and protein binding
drugs bind to _______ and can't get thru bloodstream to site of action
less ________ means higher ______ distribution but _______ chance of toxicity. |
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Definition
| albumin: albumin: medication: greater |
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Term
Sulfonamides
drug
broad/narrow spectrum
bacteriostatic/bacteriocidal
MOA
adverse affects
nursing interventions
extra info
nursing interventions |
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Definition
Sulfamethoxazole (Bactrim/Septra)
-Broad spectrum, Bacteriostatic,
-MOA: inhibits folic acid synthesis in bacteria; works well for UTIs b/c it reaches high concentration in kidneys
-AFFECTS: crystalurea, photosensitivity
-INTERVENTIONS: drink at least 2 L fluid, avoid sunlight, use sunscreen
-EXTRA: can be combined with other antibiotics to act synergistically |
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Term
Penicillins
drug(s)
broad/narrow spectrum
bacteriostatic/bacteriocidal
MOA
adverse affects
nursing interventions
extra info |
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Definition
Penicillin G (Bicillin)
Amoxicillin (Amoxil)
-broad spectrum, bacteriocidal
-MOA: disrupts integrity of bacterial cell wall (humans have cell membrane)
-AFFECTS: allergy to PCN, lethargy, N/V/D, decreased effectiveness when given with acidic juices
-INTERVENTIONS: observe for 30 minutes post IM, avoid acidic juices
-EXTRA: two mechanisms of bacterial resistance: inability of PCN to reach targets and destruction of B-lactam ring by B-lactamases |
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Term
Cephalosporins
drug(s)
broad/narrow spectrum
bacterstatic/bacteriocidal
MOA
adverse affects
nursing interventions
extra info |
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Definition
Cefotaxime (Claforan) 3rd generation
Cephalexin (Keflex) 1st generation
Ceftraixone (Rocephin) 3rd generation
-broad sprectrum, bacteriocidal
-MOA: interferes with bacterial cell wall
-AFFECTS: cross-sensitivity (allergy to PCN?)
-INTERVENTIONS: avoid alcohol due to antabuse effects
-EXTRA: divided into 4 generations that determine spectrum: 1st is least effective against gm neg (narrow), 4th is most effective against gm neg (broad) |
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Term
Macrolides
drug(s)
broad/narrow spectrum
bacterstatic/bacteriocidal
MOA
adverse affects
nursing interventions
extra info |
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Definition
Erythromycin (Emycin)
Azithromycin (Zithromax)
-broad spectrum, bacteriostatic and bacteriocidal (dose dependent)
-MOA: inhibits bacterial protein synthesis
-AFFECTS: drug toxicity due to highly protein bound
-INTERVENTIONS: don't give with another highly bound drug!!, good choice for patients who are allergic to PCN, take on empty stomach |
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Term
Tetracyclines
drug(s)
broad/narrow spectrum
bacteriostatic/bacteriocidal
MOA
adverse affects
nursing interventions
extra info |
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Definition
Tetracycline (Achromycin)
Doxycycline (Vibramycin)
-broad spectrum, bacteriostatic
-MOA: inhibits bacterial protein synthesis
-AFFECTS: teeth (fetus in pregnant women and children < 8), retards fetal skeletal development, photo-sensitivity, superinfections, GI irritability, rashes,
-INTERVENTIONS: avoid dairy products, antacids, and iron supplements
-EXTRA: risk for reduced absorption due to binding of calcium, magnesium, aluminum, and iron |
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Term
Aminoglycocides
drug(s)
broad/narrow spectrum
bacteriostatic/bacteriocidal
MOA
adverse affects
nursing interventions
extra info |
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Definition
Gentamicin (Garamycin)
Neomycin (Mycifradin)
Amikacin (Amikin)
-narrow spectrum, bacteriocidal
-MOA: inhibits protein synthesis in aerobic bacteria (not anaerobic b/c requires O2 for transport)
-AFFECTS: nephrotoxicity, ototoxicity, headache, parasthesia, rashes, fever, superinfection
-INTERVENTIONS: monitor urine output ( increased creatinine, BUN), monitor ears (H.L, tinnitus, dizziness), weigh pt. for weight gain, monitor peak and trough levels (for renal function and low level in blood), monitor for edema
-EXTRA: usually not used unless situation is really serious, often used in combination with other antibiotics |
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Term
Flouroquinolones
drug(s)
broad/narrow spectrum
bacteriostatic/bacteriocidal
MOA |
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Definition
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
-broad spectrum, bacteriostatic and bacteriocidal (dose dependent)
-MOA: inhibits enzyme for replication
-no side affects |
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Term
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Definition
bacteria live ON the cell
viruses live INSIDE the cell
nonliving agents
self-limiting (cold, flu)
serious (HIV, Hepatitis)
dormant (mono) |
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Term
Herpes Virus Infections
drug(s)
MOA
forms/uses |
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Definition
Acyclovir (Zovirax)
-MOA:inhibits enzyme for DNA synthesis
-FORMS:
-topical: use gloves, don't mix
-PO: short half life, give around clock
-IV: possible nephrotoxicity, inflammation |
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Term
Influenza-preventative
drug(s)
forms/uses
Influenze-active infections
drug(s)
forms/uses |
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Definition
Amantadine (Symmetrel)
Rimantadine (Flumadine)
-USES: for un-vaccinated pt.s after confirmed outbreak
Eltamivir (Tamiflu)
-USES: new active infections
-must be given 48 hours after onset of symptoms |
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Term
Antivirals/Antiretrovirals
action
uses
side effects
contraindications
possible nursing diagnoses
nursing considerations |
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Definition
ACTIONS:
act by interfering with DNA synthesis that is needed for viral replication
USES:
used for herpes simplex, advanced HIV, encephalitis, varicella
SIDE EFFECTS:
(common) N/V/D, anorexia, vaginitis, headache
(fatal) fatal metabolic encephalopathy, blood dyscrasias, acute renal failure
CONTRAINDICATIONS:
hypersensitivity, immunosuppressed pt.s,
POSSIBLE NURSING DIAGNOSES:
infection, risk for
injury, risk for
knowledge deficit
NURSING CONSIDERATIONS:
-signs of infection, anemia
-I&O ratio, oliguria, fatigue, and weakness may indicate nephrotoxicity
-renal toxicity
-hepatic and blood studies
-bowel monitor
-skin eruptions
-allergies |
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Term
HIV-Antiretrovirals
3 types
patient education
interventions |
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Definition
1. Reverse transcriptase inhibitors
-Zidovudine (Retrovir, AZT)
-inhibits reverse transcriptase
2. Protease inhibitors
-Indinavir (Crixivan)
-block protease so HIV can't mature and leave host cell
3. Fusion inhibitors
-Enfuvtiride (Fuzeon)
-fusion inhibitors block fusion of HIV to CD4 receptor
-will give combination of drugs to confuse virus to slow down conversion to AIDS
-PATIENT EDUCATION:
written schedule of daily meds
-likely side effects
-potential obstacles to adherence
-an offer of adherence supports
-instructions should meds be stopped
-instructions should meds be missed
-INTERVENTIONS:
monitor liver and renal function for toxicity
-if rash occurs, STOP MEDS and NOTIFY
-dont assume anything about pt.
-stress compliance issues-noncompliance |
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Term
fungal infections
onychomycosis
systemic vs topical
drug(s) |
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Definition
*most funal infections are superficial and confined to skin
onychomycosis-fungal infection beneath nailbed
-not superficial, not dangerous
systemic
-can be deadly!!
-occur in immunocompromised ppl
-immunodeficiency syndromes (AIDS)
-taking chemo
-taking immunosuppressants
-poor health
topical
-Nystatin (Mycostatin)
-Miconazole (Monistat)
-Clotrimazole (Lotrimin)
*usually ineffective due to not completing full course of meds or reinfection |
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Term
Systemic Antifungals
drug(s)
MOA
side effects
nursing interventions |
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Definition
1. Amphotericin B (Fungizone) IV route
-causes fungal membrane to become leaky
-fever and chills, hypotension, tachycardia, muscle/joint pain, N/V, renal toxicity, neuro toxicity, hepatic toxicity
-PRE-MEDICATE with tylenol, antihistamine, and antiemetics; take frequent VS, monitor I&O for kidney function and GI distress, monitor fluid/electrolyte imbalance,
2. Fluconazole (Diflucan) Oral route
-causes fungal membrane to become leaky
-N/V/D, jaundice, anorexia, clay colored stool, dark-colored urine
-notify prescriber if occurs |
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Term
Antimalarial
drug
pt. education |
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Definition
Chloroquine (Aralen)
-EDUCATE:
-don't stop med. until GONE
-watch for hearing deficits
-take with food
-possible recurrence of symptoms
-start therapy 2 weeks prior to exposure and continue 8 weeks after |
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Term
Antiprotozoal
drug
MOA
infections
pt. education |
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Definition
Metronidazole (Flagyl)
-MOA: has antibacterial, antiprotozoal, and antihelmintic activity
-INFECTIONS: Amebiasis, Giardiasis, Trichomoniasis
-EDUCATE: alert client that drug may cause metallic taste and dark urine |
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Term
antiseptics
drug(s)
MOA
nursing interventions |
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Definition
Povidone-iodine (Betadine)
Carbolic acid (Chloroseptic)
-MOA: inhibit growth of microorganism, used on living tissue
-INTERVENTIONS:
assess skin (allergies?)
-cleanse skin b/4 application
-pt. educate about med, application, and dressing
-nursing diagnosis
-risk for infection
-knowledge deficit |
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Term
Immunosuppressants
drug
MOA
nursing assessment, diagnosis, plan, implementation |
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Definition
Cyclosporine (Sandimmune)
-MOA: prevent the body from rejecting organ transplants, decrease immune response due to Leukopenia
-ASSESS: complete physical exam with attention to renal and liver function (BUN, creatinine, urinary function, weight)--all tests performed before, during, and after therapy
-DIAGNOSE: risk for infection related to immunosuppressant therapy
-PLAN: pt. exhibits and state symptoms of adverse reaction to therapy or of exacerbation of illness to report to physician
-IMPLEMENTATION: hygiene care, avoid invasive procedures, meticulous mouth care, bath with antibacterial soap, avoid crowds, change dressings daily, protect skin, wear shoes, avoid fresh and uncooked foods, report pain |
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Term
coricosteroids
drug(s)
MOA
adverse affects
indications
contraindications
extra info |
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Definition
-Prednisone (Deltasone) (PO/parental)
-Dexamethasone (Decadron) (PO/parental)
-Hydrocortisone (Cortef) (topical)
-MOA: decrease migration and accumulation of leukocytes, reduce formation of cell-mediated immune responses and T cells
-ADVERSE: weight gain, mood swings, electrolyte imblance, high rish for infection, inactive adrenal glands
-INDICATIONS: chronic disease (long-term), acute exacerbations (short-term), traumatic injuries
-CONTRAINDICATIONS: don't administer with fungal infection, when given to pt. with history of TB steroids can reactivate disease
-EXTRA:steroids affect metabolic functions and should be given only when benefits outweigh risks
-NEVER STOP SUDDENLY in case adrenal glands don't turn back on |
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Term
Glucocorticoids
precautions
adverse effects |
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Definition
PRECAUTIONS:
increase hypertension
worsen peptic ulcers, obesity, osteoporosis, and eye infections
AFFECTS:
adrenal insufficiency
osteoporosis
infection
elevated glucose
fluid and electrolyte changes
adipose tissue redistribution (cushingoid appearance) |
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Term
| nursing diagnosis, plan, interventions, and education for corticosteroids |
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Definition
DIAGNOSIS:
risk for infection r/t immuno-suppression, risk for injury r/t side effects, knowledge deficit
PLAN: pt will exhibit a decrease in symptoms, no sign of infection, verbalize understanding of the drug's action, administration, and side effects
INTERVENTIONS: monitor...
VS, decrease in symptoms, infection,
cushingoid disease symtpoms, blood glucose levels, skin for break in integrity, GI status, serum electrolytes, emotional stability,
potential infections, administer meds as prescribed, administer orals with food
ECUCATION: instruct pt on....
importance of follow-up care
time frame that symptoms should resolve
avoid ppl with infection
report fever, cough, etc
consult w/ dr. b/4 immunizations
never suddenly stop meds
weigh daily, examine skin daily
notify dr of non-healing wounds
mood changes may be expected |
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Term
active immunity def.
examples |
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Definition
YOU ARE DOING IT!!!
-the body is exposed to antigen and develops it's own antibodies
-exposure to antigen thru contact
-antigen injections (immunizations, toxoids)
-long-term, long-lasting immunity |
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Term
passive immunity def.
examples |
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Definition
NOT MADE BY YOU!!
_antibodies manufactured by someone else is given to you
-passed from mother to newborn
-immunoglobulins injections (pre-formed antibodies); when pt. can't produce own antibodies
-temporary immunity |
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Term
| 2 types of active immunizing agents and examples |
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Definition
1) toxoids--made from bacterial exotoxins that are no longer toxic but still contain the antigen so the body develops antibodies
2) vaccines--made from the actual microorganisms which are no longer toxic so that the body develops immunity
common toxoids
-tetanus toxoid,diptheria toxoid
common vaccines
-MMR, flu, hepatitis
common combinations
-diptheria and tetanus toxoids with pertussis vaccine |
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Term
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Definition
examples:
antitoxins
antivenoms
immunoglobulins
good: antibodies are already formed, the pt. doesn't have to be exposed to the possibility of infection
bad: offers only short tern protection |
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Term
problems with vaccines:
major and minor side effects
precautions
treatment |
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Definition
MINOR SIDE EFFECTS
-fever, localized inflammation
MAJOR SIDE EFFECTS
-fever > 103
-difficulty breathing
-CNS effects
-anaphylactic reactions
PRECAUTIONS
never give to immunocompromised pt.
TREATMENT
-acetaminophen for fever, discomfort, and localized symptoms
-warm compresses for increased circulation |
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Term
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Definition
diptheria and tetanus toxoid
h-influenza type b
hepatitis b
influenze virus vaccine
MMR
polio virus vaccine
varicella
hepatitis b immune globulin
rho immune globulin |
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Term
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Definition
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Term
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Definition
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Term
| ZIDOVUDINE (RETROVIR, AZT) |
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Definition
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Term
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Definition
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Term
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Definition
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Term
| CYCLOSPORINE (SANDIMMUNE) |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
| ANTINEOPLASTIC/ANTIBIOTIC |
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Term
| CYCLOPHOSPHAMIDE (CYTOXAN) |
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Definition
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Term
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Definition
ANTIINFECTIVE
AMINOGLYCOCIDE |
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Term
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Definition
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Term
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Definition
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Term
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Definition
ANTIINFECTIVE
CEPHALOSPORIN |
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Term
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Definition
ANTIINFECTIVE
CEPHALOSPORIN |
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Term
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Definition
ANTIINFECTIVE
CEPHALOSPORIN |
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Term
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Definition
ANTIINFECTIVE
FLOUROQUINOLONE |
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Term
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Definition
ANTIINFECTIVE
TETRACYCLINE |
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Term
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Definition
ANTIINFECTIVE
TETRACYCLINE |
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Term
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Definition
ANTIINFECTIVE
AMINOGLYCOCIDE |
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Term
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Definition
ANTIINFECTIVE
FLOUROQUINOLONES |
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Term
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Definition
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Term
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Definition
ANTIINFECTIVE
AMINOGLYCOCIDE |
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Term
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Definition
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Term
| SULFAMETHOXAZOLE (BACTRIM/SEPTRA) |
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Definition
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Term
| TETRACYCLINE (ACHROMYCIN) |
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Definition
ANTIINFECTIVE
TETRACYCLINE |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| AMPHOTERICIN B (FUNGIZONE) |
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Definition
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Term
antiinfectives:
uses
side effects/adverse reactions
contraindications/precautions
possible nursing diagnoses
nursing considerations |
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Definition
USES:
infections of susceptible organisms
SIDE EFFECTS:
N/V/D,
ADVERSE REACTIONS: bone marrow depression, anaphylaxis
CONTRAINDICATIONS/PRECAUTIONS:
hypersensitivity reactions, cross sensitivity, ppl allergic to PCN may also be allergic to cephalosporins
POSSIBLE NURSING DIAGNOSES:
infection, risk for
diarrhea
NURSING CONSIDERATIONS:
-nephrotoxicity (increased BUN, creatinine)
-blood studies (AST, ALT, CBC, HCT, billirubin)
-severe diarrhea
-urine output
-allergic reaction (rash, fever, pruritis, urticaria)
-bleeding gums,hematuria
-overgrowth of infection |
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