Shared Flashcard Set

Details

Class 2/PHARM
Pharm cards
46
Nursing
Graduate
09/10/2011

Additional Nursing Flashcards

 


 

Cards

Term
How many medical errors occur a day?
Definition
1% error every day.
Term
While our systems are being made more error tolerant, the are things you can do.
Definition
1. * Be open to advice from others (learn to hear concerns, stop, understand the concern, make sure it is not relevant or is, thank them, creates safe enviroment)  2. Take your time when writing/entering an order. 3. Provide clear communication 4. Listen to others when concerns are expressed. 4. Take rules/policies seriously. (Certainly this silly requirement does not apply to me?)
Term
Orders should be...
Definition
Legible, Complete and Unambiguous.
Term
Medicaiton-Use System
Definition
Get information---> Prescribe---> Send Rx. to pharmacy--->Pharmacist Review--> Prepare medication--> Dispense--->Nurse Review---> Administer medication--> Monitor patient---> repeat
Term
Get Drug information before Prescribing.
Definition
Patient may already be on a medication that causes a side effect that will be doubly bad with the medicaiton you want to prescribe. (example Atrovastatin and voriconazole, both cause hepatotoxicity)
Term
Medicaiton Reconciliation
Definition
Consideration of previous medication therapy while developing or modifying therapeutic plan: What was ordered vs. what was administered (Look at medication administration record), Therapy used by previous care team in the hospital, Therapy used by patient prior to admission.
Term

Medicaiton Reconciliation

Transistions in Care

Definition

Errors can occur when a patient's care is passed from one group to the next.

Medication therapy may be inappropriately: continued, omitted changed or duplicated.

Term

Ordering Medicaitons

Therapeutic Plan-----> Patient Getting Better

What to do before finishing?

Definition

-Entering/Writing an order is a critical step (TAKE YOUR TIME)

-Proof what you type

- Read and consider alerts

-Tell a nurse when a stat order is entered/written

Term

Ordering Medicaitons

Incorrectly writing/entering a medication

Definition

-Legibility

-Name

-Dose

-Dosage form

-Frequency

-Directions

-Your signature/time/date

-Verbal Orders

Term

Be aware of look alike medications

Proper use of decimals

Definition

RIGHT                                  WRONG

0.5 mg                                    .5 mg

5 mg                                      5.0 mg

16 mg                                     15.6 mg

 

Rule: If you can't see the decimal, might an error be made?

Term

Dose

"Take one teaspoon of Tyelenol"

Definition

 Could result in a 500 mg dose instead of 160 mg

Children's liquid                               160mg/5ml

Infant drop                          100 mg/ml (500 mg/5ml)

Adult extra strength                      167 mg/5ml

 

-A Teaspoon contains 2.5-9.7 ml (in practice)

-Use an oral syringe or medication measuring cup/spoon (Syrinfe tips pose a choking hazard)

Term

You will make errors

(Make it easy for someone to know who you are and how to reach you)

 

Definition

-Include your JHH identification number on all orders

-Date and time all inpatient orders

-Date all outpatient prescriptions

(Make it easy for your team members double check you work)

Term
Generic Substitution
Definition
A brand name drug is substituted for a generically equivalant alternative that is bioequivalent
Term
Generically Equivaient=
Definition
same drug
Term
Bioequivalent
Definition

absorbed at same rate and same amount.

-It is established by the FDA

-Potential Problems: Sustained release drugs, Drugs with narrow therapeutic range.

-Inticating "Brand medically necessary" Medical Assistance: include reason, Insurance company may only pay for generic

Term
"Unapproved" Uses of Drugs
Definition

Unapproved or Off- Label Use

Pharmaceutical companies may only advertise drug for FDA approved uses

Practitiioners may use drugs for unapproved uses ( Should be consistent with good medical practice)

Insurance company may not pay for off-label use of drugs

Term

PLACEBO

"I shall please"

Definition

SPECIFIC PILL OR TREATMENT

"any procedure resulting in the improvement in the conditions of a sick person that occurs in response to treatment which is objectively without specific activity for the condition being treated"  This definition hinges on the prescriber's belief involving the "Specific activity" of the treatment being used

Term
The PLACEBO EFFECT
Definition

RESULTS FROM THE INTERPLAY OF THE PATIENT, THE PROVIDER, THE PLACEBO AND THE ENVIROMENT. Be nice and positive with the patient results in positive outcome.

"is a neglected and berated asset to patient care. As a health care deivery systems evolve, it is imperative to recognize the value of the placebo effect so that provisions can be made for its incorporation and proper use. Any health care system that minimizes and fragments the relationship between the physician and the patient will lessen the effects of this asset."

Term
Myth about PLACEBO's
Definition
 Placebo's work 1/3 of the time everytime. Chart shows numbers are all over the place.
Term
CONCEPT OF REGRESSION TO THE MEAN
Definition
Your well being does not reamain constant-- sometimes you feel better than average and sometimes you feel worse than average. When you are down in the dumps-- take heart--- You will feel better soon. If you try a therapy when you are down in the dumps, you are likely to feel better following the therapy regardless of the therapies effectiveness. To guard against this type of bias, it is important to use a control
Term
Giving a placebo vs. doing nothing
Definition

-Giving a placebo is not the same as doing nothing

-Giving Narcan blocks the opiod receptors that would allow our bodies to have natural pain relief.

-Get narcan... don't get placebo effect

Term
Should we ever do sham operations for the benifit of a study/ reasearch?
Definition
Yes
Term
Influence of the provider on the patient.
Definition
Body language, personal bias, confidence helps signal how the patient is going to feel. Care providers can influence how well bronchodilators work. (what you tell them makes them feel better)
Term
If you faith on a drug going to work
Definition
Then it works better.
Term
Influence of the Placebo
Definition

Injections better than oral

Capsules better than tablets

2 more than 1

More expensive better than cheaper

Term

PLACE IN THERAPY

With patients consent

Definition
Maybe indicated in selected cases
Term

PLACE IN THERAPY

Without consent

Definition
Harm to the patient-provider relationship if a patient finds out they were put on a placebo. Almost never justified. Requires other to go along with the "secret/lie".
Term
PLACE IN CLINICAL TRIALS (Need Informed Consent-ALWAYS)
Definition

A placebo in a clinical trial is ethical if: Used in healtht volunteers to differentiate drug and placebo effects.

-If a therapy has been shown to be effective in a particular illness or disease, a placebo might be considered if the value of the information outweighs the risk or discomfort to the patient.

Term
Institutuional Review Board (IRB)
Definition
 Makes the final judgement regarding ethics as it applies to clinical research
Term
Drug Interaction
Definition

is said to occur when one drug modifies the blood concentration, magnitude of effect, or duration of effect of another drug

-They can occur when a drug is added to OR removed from a therapeutic regimen.

Term

Types of Drug Interactions

GI Absorption

Definition

Decreased extent of absorption

1. Antacids reduce the % absorbed of oral digoxin, ciprofloxacin or tetracycline if it is taken at the same time

2. Cholestramine reduces the extent of digoxin absoprtion.

Term

Types of Drug Interactions

Distribution

PROTEIN BINDING

Definition

1. Highly Bound Drug Displaced by 5%

Bound 90%---> 85%

Unbound 10%--->15% (Increase of 50% of circulating drug, going to cause a problem)

2. Not highly Bound Drug- Displaced by 5%

Bound 40%---> 35%

Unbound 60%--->65% (increase of 8%) Not worried

 

Example: This principle can help to explain the increase in phenytoin free fraction caused by uremia and/or hypoalbuminemia and the increased free bilirubin in a an immature infant when a sulfonamide is administered

Term

Types of Drug Interactions

Distribution

Protein Binding

THEATIRCAL ASIDE

How do those percent changes work again?

Definition

-When 10 goes to 15, there is an increase of 50%

-When 15 goes to 10, there is a decreased of 33%

 

Absolute Difference Between The Two Numbers X 100

The Number you start with        

 

= Percent Change

Term

Types of Drug Interactions

Metabolism

Definition
There are many hepatic enzymes that are responsible for the metabolism of drugs. These enzymes were collectively known as P-450 enzymes. The P-450 enzymes are actually a family of enzymes. Examples of family names are: CYP1A4, CYP2C9, CYP2D6, CYP3A
Term

Types of drug Interactions

Metabolism

 

SUBSTRATE

Definition

When drug A is metabolized by an enzyme. Drug A is said to be a _______ of that enzyme.

Term

Types of Drug Interactions

Metabolism

 

INDUCER

Definition

When a drug is able to stimulate the activity of an enzyme: That drug is an _______ enzyme.

Term

Types of Drug Interactions

Metabolism

 

INHIBITOR

Definition

When a drug is able to inhibit (or slow) the activity of an enzyme, that drug is an inhibitor of that enzyme.

Term

Types of Interactions

Metabolism

 *Hepatic Enzyme Induction (increase metabolism)

Increasing metabolism with Decrease half-life

Definition

1. Barbiturates

2. Rifampin

3. Saint Johns Wort

4. Examples: Phenobarbital: INCREASES the metabolism of warfarin (this leads to a DECREASE in warfarin effect)

 

Rifampin INCREASES the metabolism of oral contraceptives (this leads to a DECREASE in the effect or oral contraceptives)

 

St. John's Wort INCREASES the metabolism of cycloporine, protease inhibitors, others.

Term

Types of Drug Interactions

Metabolism

 Hepatic Enzyme Inhibition (decrease metabolism)

Decreasing metabolism will Increase the half-life

Definition

1. Cimetidine

2. Erythromycin

3. Grapefruit Juice

 

Examples: Cimetidine DECREASES the metabolism of theophyline (this leads to AN INCREASE in the effect of theophylline)

 

Erythrimycin DECREASES the metabolism of theophyline (This leads to an INCREASE in the effect of theophyline)

Term

Types of Drug Interactions

 

Elimination

 

Definition

Decreased renal secretion

1. Probenecid decreases the renal elimination of penicillin

Term
Pharmacodynamic Interactions
Definition

Drugs with additive effects

Examples: Benzodiazepines, antihistamines and alcohol all cause drowsiness. When the two or more of these are used in combination, resulting in drowsiness is additive.

Term

*IMPORTANT VARIABLES*

 

Sequence of drugs administered

Examples Used Warfarin and Cimetidine

Definition

1. No apparent drug interaction problem

          (A patient has been stabilized on a drug that inhibits liver enzymes e.g. cimetidine. A hepatically metabolized drug e.g. warfarin is begun and titrated into the therapuetic range.)

 

2. Decreased warfarin effect

        ( The patient described above has cimetidine dicontinued without altering the dose of warfarin)

 

3. Increased warfarin effect

      ( A patient is titrated into the therapeutic range with warfarin. Cimetidine is begun without altering the dose of warfarin)

Term

IMPORTANT VARIABLES

Time Course of interaction

Definition

1. Cimetidine inhibits hepatic enzymes within 24 hours.

2. Erythromycin inhibits hepatic enzymes slowly. When erythromycin is added to a patient taking theophylline, the theophylline level will raise in 3 to 4 days.

Term

IMPORTANT VARIABLES

Some interactions only occur in certain patient subsets

Definition

Digoxin, in 10% of the general population, undergoes significant bacterial degredation in the gut. In these patients, erthromycin will kill GI bacteria (Eubacterium lentum ) resulting in less degredation of digoxin therby allowing more digoxin to be absorbed. If a study was done on the general population, mean levels of digoxin, before and after erythromycin, may fail to show a difference.

Term
Clinical Significance of Drug Reactions
Definition

1. A drug interaction is not necessarily a bad thing.

2. A drug interaction may cause a measureable change in a drug level without causeing measurable change in the patients clinical status.

3. The same drug interaction may be clinically important in one patient and inconsequential in another patient.

4. Personal experience cannot be relaiably used to assess the importance, or lack of importance, of a drug interaction.

Term

Clinical Significance

An example of variable clinical outcomes can be demonstrated by looking at the Theophyline-erythromycin interaction

Definition

-Erythromycin decreases the elimination of theophylline

-In a patient stabalized on theophylline, addition of erythromycin will increase the concentration of theophylline.

- Depending on the blood level of theophylline before erythromycin is begun, the level of theophyline may increase into: a sub-therapeutic range, a therapeutic range or a toxic range.

-Some patients with drug concentrations increased into the "toxic" range may not manifest signs or symptoms of toxcity and some amy become profoundly toxic. If a patient is in the "toxic" range with no signs or symptoms, the situation should be reassessed; are the dose and frequency correct, did organ function deteriorate, was there an error, is compliance an issue etc. etc.

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