Term
| What improves patient outcome and decreases hospital stay? |
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Definition
| Daily Goal sheet. Everyone knows the plan. If your not clear on the goal, how will you know if you've met it. |
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Term
| The Therapeutic Experiment |
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Definition
| Diagnosis-->Therapeutic Goal-->Prescribing Drug--> Drug Received by patient-->Absorption Distribution Metabolism-->Response-->Monitor Response |
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Term
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Definition
| An explicit statement of what we are trying to accomplish with therapy. This goal should be realistically attainable with measurable end-points. It should be established before the initiation of drug therapy so that it can be used as a benchmark to titrate drug therapy. |
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Term
| How should scripts be written? |
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Definition
| Clearly, legibly and unambiguous. Make sure it makes sense, IF NOT LOOK IT UP |
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Term
| PDR/ Phamaceutical Representatives |
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Definition
| Good for looking up dosing of medication and dosing for certain age and organ Failure. Not a good resource for finding a drug for a certain implication. Usually a cheaper better drug for implication. |
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Term
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Definition
| There are many oppurtunities for this to happen during prescription, dispense, administer and Monitor. It is important for the nurse, pharmacist, the physician and the patient to work as a team to minimize the severity. If it doesn't make sense, question it. |
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Term
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Definition
| Prescriptions (current therapy, left over from a previous therapy, borrowed from a patients friend of family member), OTC, health food stores, ligour stores (alchohol and tobacco) and street (illegal drugs) |
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Term
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Definition
| Non-compliance means that the patient is not taking the medication the way you intend. This can result in a drug effect being more, less, or exactly what is expected. It is important to determine the reason for non-compliance so that the appropriate assistance can be given to the patient. |
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Term
| Reasons for Non-compliance |
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Definition
| Not taking it the way you ordered it. confusion about directions, confusion about the importance of taking medications, experiencing side effects, inablility to obtain medications (transportation, economic) or differences in value systems between the patient and the provider. Not taking it the way you ordered it. |
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Term
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Definition
| The drug journey. The study of what happens to the drug molecule. Absorption, distribution of drugs, metabolism and ellimination. |
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Term
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Definition
| Pharmokinetics: Route of administration IV, IM, SC, PO, PR. Some drugs do this faster than others. Completeness and by how much when interacting with another drug. Changes how this works can be done by interactions with other drugs, foods or diseases and age. |
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Term
Absorption in a Premature Infant
Pharmacokinetics
Age |
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Definition
| GI Motility is decreased and ph is high leading to increase absorption of the acid labile drug ampicillin and decreased absorption of the weak acids e.g. phenobarbital (an acid drug in a basic solution is charged; charge molecules are generally not well absorbed.) Absorption from IM site is difficult to predict |
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Term
Absorption in the Elderly
Pharmacokinetics
Age |
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Definition
| Absorption form IM sites is delayed because of decreased blood flow. |
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Term
Distribution
Where does a drug go after it is absorbed? |
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Definition
| Drugs vary in their ability to get into various body compartments (brain,fat,lung,eye, etc.) A drug's specific distribution characteristics affect its dose, route administration and indications. |
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Term
Distribution
Why are drug blood levels often measured even though few drugs work in the blood? |
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Definition
| Since blood is an easily accesible body fluid, blood concentrations are often studied to determine how they relate to drug concentration at the site of ctivity. The DOSE RELATED EFFECTS of a drug are then correlated with a given blood concentration or range of concentrations. Once a relationship has been established, blood concentraions can then be used to monitor therapy. |
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Term
Distribution
THERAPUETIC RANGE |
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Definition
| This term refers to a range of blood concentrations representing the lower and upper boundaries of "desirable" blood concentrations for a drug. The lower limit is established so that enough drug is administered to attain a theraapeutic effect. The upper limit is established to minimize toxicity or unnecessary expense. This is ONLY INTENDED AS A GUIDE; some patients may do very well with blood concentrations lower than the range and more may require more. TREAT THE PAITENT NOT THE LAB VALUE. KNOW YOUR UNITS |
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Term
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Definition
| this is a mathematical concept used to help predict the blood concentraiton of a drug after a given dose. This vlume of distribution doesn't necessarily correspond to the anatomical comparmtent (e.g. blood compartment). Knowing the volumes of distribution for a drug allows you to calculate loading dose needed to achieve a particular blood concentraiton or to predict the blood concentration resulting from a particular loading dose. (NOTE: drugs have different volumes of distribution and the same drug can have a different volume of distribution depending on the patients age or disease. goodman & gillman has a table listing th Vd of various drugs) |
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Term
| concentraiton=amount/volume |
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Definition
volume=amount of a drug/concentration in blood
GO OVER EQUATIONS IN NOTES |
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Term
METABOLISM AND ELIMINATION
What are the two sites responsible for removing most drugs from the body? |
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Definition
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Term
Metablolism and Elimination
LIVER |
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Definition
| When drugs are "eliminated" by the liver, many possibilities exist. 1.The drug can be biotransformed, usually into a compound that is more water-soluble. This metabolite may then reenter he blood circulaiton and be eliminated form the body by the kidneys in to the urine. 2. The drug might be excreted into the bile with or without biotransformation (depending on the drug) Drug or metabolites excreted into the bile would enter to the GI track at which point they might be particularly reabsorbed. Drugs reabsorbed in this manner are said to undergo enterohepatic circulation. |
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Term
Metabolism and Eliminaiton
A drug's metabolite
Liver |
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Definition
| it may be either active or inactive (depending on the drug). If its active it may be therapeutic or toxic. |
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Term
Types of Metabolism
Phase I
Liver |
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Definition
| (Non synthetic) oxidation, reduction, demethylation, hydrolysis. |
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Term
Metabolism
Phase II
Liver |
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Definition
| synthetic. It makes compounds more water soluble, conjugaiton |
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Term
Metabolism and Elimination
KIDNEY |
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Definition
| When a drug is eliminated into the urine, it may leave the body in the urine or be reabsorbed from the glomerular tobules back into the blood. Kidney metabolizes insulin |
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Term
Metabolism
FIRST PASS EFFECT |
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Definition
| This term refers to a situation where a drug that is avidly metabolized by the liver, is given orally. A drug that is absorbed from the intestine is carried by blood flow to the liver. During the drug's first pass through the liver, a large amount of the drug is metabolized so that the amount of the drug escaping into the general circulation is relatively small. When the drug completes its first loop through circulation and returns to the heart, cardiac output carries 30% of the remaining drug to the liver for round of metabolism (30% of the blood from cardiac output is sent to the liver). Unlike the first pass where the liver "sees" 100% of the drug, on subsequent passes the liver only "sees" 30% of the remaining drug. |
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Term
Metabolism
FIRST PASS EFFECT
Can I give a drug orally if it has a high first pass effect? How can I bypass the first pass effect? |
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Definition
Note: just because a drug has a high first pass effect doesn't mean that it can't be given orally. It just means that you have to adjust the dose when converting between oral to parenteral adminitration.
The first pass effect is bypassed when the drug is given sublingually (SL) or parenterally. After administration from these routes, the blood flow bypasses the liver. |
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Term
Metablolism
First Pass Effect
Drugs with High Pass effect |
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Definition
| The parenteral or SL dose is lower that its oral dose. Examples: propranolol, nitrates, narcotics, and calcium channel blockers |
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Term
Metabolism and Elimination
STEADY STATE (IN AND OUT) |
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Definition
A term used to refer to a situation where the amount of drug being administered to the patient is EQUAL to the amount of the drug being eliminated by the patient. When "this" is attained in a patient, blood concentrations remain "STEADY"
Note: Acheiving steady state doesn't necessarily mean that you are in the therapeutic range. Quesiton: If a patient has been taking 0.25 mg daily for 2 months exctly how many mg will the patient eliminate each day? |
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Term
Metabolism and Elimination
Steady State (In=out)
Question:If a patient has been taking 0.25 mg daily for 2 months, exactly how many mg will the patient eliminate each day? |
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Definition
SAME IN As out, after awhile it flattens out, where in=out
- If the patient eliminated less that that, the blood level of the drug would go up
-If the patient eliminated more than never get any drug level |
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Term
Calculating an Estimated Creatinine Clearance
1-18 years old
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Definition
ClCR= 0.48x (Height in CM) x (BSAm2)
serum Creatinine x1.73 |
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Term
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Definition
| How many ml's per blood can the kidney clear per minute. Measurement of the funcitoning of the kidney. 80-120 normal ml/min |
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Term
Creatinine Clearance
Over the age of 18 yo
Crockroft and Gault equation |
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Definition
Crcl (male)= (140-age) x (weight kg)
serum creatinine x72
Crcl (female)=Clcr (male) x 0.85
age, gender, weight...determine your muscle mass. |
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Term
Metabolism and Eliminaiton
HALF-LIFE |
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Definition
| this is the time that it takes for the concentration of a particular drug to drop by one-half in a particular patient. When a patient is given a drug on a regular schedule, the drug will continue to ACCUMULATE until STEADY STATE is achieved. |
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Term
Metabolism and Elimination
How mnay half-lives for a drugto reach steady state? |
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Definition
5 half-lives (not doses)
the time it takes to eliminate half the drug |
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Term
| Half Life of drug in impaired kidneys |
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Definition
| it will take the kidneys longer to excrete the drug, half life is longer |
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Term
How many half lifes does it take a dose to get to steady state when you cut the dose in half?
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Definition
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Term
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Definition
the relationship between blood levels and effect
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Term
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Definition
| At doses used clinically, there is generally a linear relationship between the log of the drug concentration and the response. Therefore, doubling the dose DOSE NOT double the effect. |
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Term
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Definition
This refers to the amount of drug necessary to attain a given effect. If a smaller amount of drug "A" can achieve the same effect as a larger amount of drug "B" then drug "A" is more potent that drug "B"
For example: if 20 mg of drug "A" produces the same effect as a 40 mg of drug "B", drug "A" is said to be twice as potent as drug "B".
The fact that one is more potent than another drug IS NOT NECESSARILY A CLINICAL ADVANTAGE. |
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Term
RESPONSE
Maximum Efficacy |
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Definition
| This refers to the maximum achievable effect of a drug (usually refers to the "good" effect) Once maximum efficacy is achieved, adding more drug will not increase that "particular" good effect but may increase toxic effects |
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Term
MONITORING RESPONSE
Index of therapeutic Effect |
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Definition
1. Used to determine if therapeutic goal is attained
2. Should be discriminating
3. Should be practical to measure.
4.Should be measured in the context of the drug's time course of action
(know what you are monitoring for, so you can pick them up) |
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Term
MONITORING RESPONSE
Index of toxic effect |
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Definition
1. Should be discriminating
2.Should be sensitive to promptly detect and avoid excess toxicity.
3.Should be practical to measure.
4. Should be measured in the context of the drug's time course of action |
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Term
MONITORING RESPONSE
Risk/Benefit ration |
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Definition
1. Amount of "acceptable" toxicity will depend on the severity of disease being treated and the toxicity of alternative therapy
2. Therapeutic Index= Toxic Dose/ Therapeutic Dose |
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Term
| HENDERSON-HASSELBALK PRINCIPLE |
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Definition
| The pH scale denotes the concentration of hydrogen ions and ranges from 1-14. A high pH means the concentration of hydrogen is LOW, and a low pH means that the concentration of hydrogen ion is HIGH (inverse relationship because pH is 1/Hydrogen ion concentration). |
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Term
| When a solution has a pH that is high it is? |
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Definition
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Term
| When a solution has a pH that is low it is ? |
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Definition
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Term
ACID
ACID 1 14 BASIC
0% 100%
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Definition
| If an acid compound is placed into a solution having a pH of 1 , the molecules of that acid compound will not be charged. As the pH of that solution increases, a greater and greater percentage of the molecules become charged until you reach a pH of 14 at which all of the molecules are charged. |
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Term
BASIC
Base 1 14 Acidic
100% 0% |
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Definition
| If a basic compound is placed into a solution having a pH of 1, the molecules of that basic compound will be charged. As the pH of the solution is increased, a greater and greater percentage of the molecules become uncharged until you reach a pH of 14 at which the molecules are not charged. |
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Term
URIC ACID
1 5.5 14
0% 50% (percent charged) 100% |
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Definition
| The pk is the pH at which a particular compound is half charged and half not charged. Every acid and base compound is associated with a particular pKa that is a natural constant of that particular compound. In the case of uric acid, its pKa is 5.5 |
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Term
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Definition
| The magic ph at which the the compound is equal base and equal acid (50%) |
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Term
| If a molecule is charged it is ? |
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Definition
Water Soluble HIGH
Lipid Soluble LOW
Crosses blood brain barrier POORLY
Reabsorbed by the kidneys POORLY |
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Term
| If a molecule is not charged it? |
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Definition
Water solubility LOW
Lipid Solubility HIGH
Crosses blood brain barrier WELL
Reabsorbed by kidneys WELL |
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Term
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Definition
| Acid compound in a Base pH (pH is higher than its pKa) MOSTLY CHARGED |
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Term
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Definition
| Base compound in an Acid pH (pH lower that its pKa) MOSTLY CHARGED |
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Term
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Definition
| Acid compound in a Acid pH (pH higher than its pKa) MOSTLY NOT CHARGED |
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Term
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Definition
| Base compound in a Base pH (pH higher than its pKa) MOSTLY NOT CHARGED. |
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Term
PREGNANCY SAFETY RATINGS
A |
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Definition
ANIMAL DATA: Data showing no problem
HUMAN DATA: Data showing no problem |
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Term
PREGNANCY SAFETY RATINGS
B |
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Definition
ANIMAL DATA: Data showing no Problem OR Data showing a problem
HUMAN DATA: No data OR Data showing no problem
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Term
PREGNANCY SAFETY RATINGS
C |
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Definition
ANIMAL DATA: Data showing a problem or NO data
HUMAN DATA: No data |
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Term
PREGNANCY SAFETY RATINGS
D |
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Definition
ANIMAL:
HUMAN: Data showing a Problem (benefit may outweigh risk) |
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Term
PREGNANCY SAFETY RATINGS
X |
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Definition
ANIMAL DATA:
HUMAN DATA: Data showing a problem (risks outweighs the benefit) |
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Term
| Scaling an Adult Dose for a Child |
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Definition
If you use adult scale dose based on weight, we will under dose the child
If you use the child dose and scale it up to an adult you will overdose the adult. |
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Term
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Definition
This means "many drugs" and is used to indicate the use of more medication than is clinically indicated or warranted.
No specific number of drugs indicated, but in some studies, five or more drugs is defines as polypharmacy.
It is not necessarily inappropriate. |
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Term
| Polypharmacy may lead to... |
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Definition
| 1. More adverse drug reactions. 2. Drud-drug interacitons. 3. decreased medicaiton compliance. 3. Poor quality of life. 4. Unnecessary drug expense. 5. Numbers of errors go up. |
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Term
| Behaviors contributing to polypharmacy. |
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Definition
| 1. Borrow medicines from relatives and friends. 2. Self-medicate with over the counter medicines. 3. Use of herbal, vitamin or mineral preparations. 4. Ordering automatic refils without adequate follow-up |
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Term
| Actions that will help to avoid polypharamcy |
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Definition
| 1. avoid prescribing a drug to treat adverse effects of other drugs. 2. Conduct a brown bag review. 3. Attempt to prescribe a drug that will treat more than one existing problem. 4. Avoid the use of multiple-ingredient preparations. 5. Use single daily dose regimens whenever possible to simplify drug regimens 6. Limit the use of PRN medications and refills 7. Consider all new medicines as a therapeutic trial and discontinue a drug if it is ineffective or intolerable adverse effects occur. 8. Suspect a medication as the cayse of any major or medical or cognitive change. |
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