Term
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Definition
The study of drugs
Medicinal purposes
Toxic characteristics
Social or recreational use |
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Term
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Definition
| Describes the drug using exact chemical nomenclature to show atomic and molecular structure |
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Term
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Definition
| derived from the chemical name |
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Term
| Trade or Brand naming of drugs |
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Definition
| Provided by the drug manufacturer for ease i pronouncing and remembering. Protected by trademark. |
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Term
| It is the Responsibility of the Nurse to know what in pharmacology? |
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Definition
Generic/trade name
Drug class
Clinical use
Mechanism of action
Side effects
Other specifics (non-pharmacological use, cultural implications, life span implications) |
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Term
| Identify interactions between core drug knowledge and core patient variables to |
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Definition
Maximize therapeutic effects
Minimize adverse effects
Provide patient and family education
Evaluate effectiveness of the drug therapy |
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Term
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Definition
Health Status
Drug History
Medical History
Current Diagnosis
Personal (Diet, lifestyle, habits, typical source of information, support system, financial support) |
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Term
| When giving a nursing diagnosis for pharmacology, remember: |
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Definition
Actual or current diagnosis
Potential or at risk diagnosis
Wellness diagnosis |
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Term
| Potential Pharmacology Nursing Diagnosis's |
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Definition
Knowledge Deficit
Management of therapeutic regimen, ineffective
Alteration in health maintenance
Noncompliance (be careful with this ‘label’)
Alteration in……….
Potential for injury |
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Term
| Planning or Outcomes (NOC) for Pharmacology |
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Definition
Client focused
Resources in the environment
Future but in measurable terms |
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Term
| Implementation (NIC) for Pharmacology: |
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Definition
One of the most important functions
Carries the most legal vulnerability
Continuous assessment
Teaching, teaching, teaching
Monitor diagnostic and lab tests
Proper and timely documentation |
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Term
| Implementation (NIC) for Pharmacology: |
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Definition
One of the most important functions
Carries the most legal vulnerability
Continuous assessment
Teaching, teaching, teaching
Monitor diagnostic and lab tests
Proper and timely documentation |
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Term
| 5 Rights of Safe Handling and Administration |
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Definition
1. Right Drug
2. Right Dose
3. Right Client
4. Right Route
5. Right Time |
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Term
| Evaluation of Pharmacology |
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Definition
Therapeutic response to the drug
Non-therapeutic response to
the drug
Side effects
nearly unavoidable effects
Adverse reactions
unintended & undesirable
Level of clients knowledge
Ability of client to manage the
therapeutic regimen |
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Term
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Definition
| Study of the biological effects of chemicals |
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Term
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Definition
| Use of drugs to treat, prevent or diagnose disease |
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Term
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Definition
| the effects of the drug on the body |
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Term
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Definition
| the effects of genes on drug behavior |
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Term
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Definition
| the effects of the body on the drug |
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Term
| Four phases of Pharmacokinetics |
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Definition
Absorption
Distribution
Metabolism/Biotransformation
Excretion |
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Term
| Drug absorption is dependent upon |
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Definition
Route of administration
Solubility and concentration of the drug
Circulation
Surface conditions
Contact time
pH at the absorption site
Cell membrane transport mechanisms |
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Term
| How drugs move across the cellular membranes |
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Definition
Passage through channels or ports
Passage with aid of transport system
Direct Penetration |
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Term
| Passage through channels or ports |
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Definition
Few move in this manner
Examples: K* or Na* |
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Term
| Passage with aid of transport system |
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Definition
| Active or Passive Transport |
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Term
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Definition
| Increased with lipophilic drug (lipid soluble) |
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Term
| Active Transport requires what from the cell |
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Definition
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Term
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Definition
| Movement of drug molecules against the concentration gradient |
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Term
| In active transport, carriers form... |
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Definition
| complexes with drug molecules on membrane surface |
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Term
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Definition
| Movement of substance from higher concentration to lower until equilibrium obtained |
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Term
| Most drugs use what type of transport system |
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Definition
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Term
| Dose passive transport require energy? |
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Definition
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Term
| Drug movement is dependent on: |
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Definition
Drug flow to the tissues (cardiovascular functions)
Drug’s ability to leave the vascular
system and enter cells (permeability of capillary membranes)
Drug’s lipid affinity (lipophilic) or water affinity (hydrophilic)
Drug’s ability to bind with protein in the blood (protein binding) |
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Term
| An increase in the number of free drug particles (from low protein levels) will |
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Definition
| increase the drug’s effect, even though the dose of the drug is unchanged |
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Term
| An increase in the number of free drug particles (from low protein levels) will |
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Definition
| increase the drug’s effect, even though the dose of the drug is unchanged |
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Term
| Drug particles that are not bound to protein (“free” drug) are |
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Definition
| active and exert an effect |
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Term
| Competition between drugs to bind may |
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Definition
| displace drugs and increase their toxicity |
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Term
| Blood/Brain Barrier allows |
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Definition
| distribution of lipid soluble drugs into brain and CSF |
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Term
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Definition
| Lipid and non-lipid soluble drugs can pass to fetus |
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Term
| Metabolism changes the drug from its |
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Definition
pharmcologically active form to a more
water soluble form to enhance excretion |
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Term
| Most metabolism occurs in |
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Definition
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Term
| The percentage of drug metabolized each time the drug is circulated to the liver |
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Definition
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Term
| When drugs are highly metabolized during the first circulation to the liver (first pass), |
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Definition
| little or no active drug is sent to the general circulation |
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Term
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Definition
| the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved |
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Term
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Definition
| oral drugs are usually absorbed from the small intestine directly into the portal venous system and delivered to the liver which transforms most of the chemicals into metabolites, some of which are deactivated and excreted without reaching the tissue/organ they were intended for |
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Term
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Definition
Drug swallowed
Drug dissolved in gastrointestional fluid (lost in acid)
Dissolved drug reaches intestine (lost in food, acid, digestion)
Drug absorbed in portal system to liver
(biotransformed to noneffective state
Bound to plasma proteins- decrease free drug)
Drug in circulation (Broken down in tissues if not bound)
Drug distributed throughout body (Reaches reactive tissue and ‘does it’s thing’ Excreted by kidneys, lungs, skin, etc.Bound to fat tissue) |
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Term
| Elimination or excretion of drugs occurs in |
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Definition
| the kidneys (primarily), liver, gastrointestinal (GI) tract, lungs, sweat and salivary glands, skin, and breast milk |
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Term
| Pathology of these systems will |
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Definition
| decrease excretion of the drug |
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Term
| Decreased excretion does what to blood levels of the drug |
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Definition
| increases them even though the dose is unchanged |
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Term
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Definition
| General study all the various genes that determine drug behavior |
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Term
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Definition
| study of the genetic material in the cell |
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Term
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Definition
| science of heredity & variations |
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Term
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Definition
| study of inherited variations in drug metabolism and responses |
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Term
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Definition
| appearance of an individual resulting from the effects of both environment and genes |
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Term
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Definition
| genetic constitution of an individual |
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Term
| CYP450 enzymes are essential for |
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Definition
| the metabolism of numerous medications, nutrients, & herbal therapies |
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Term
| System can be inhibited or induced by drugs and may lead to |
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Definition
| altered drug responses (ADR) |
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Term
| In a 1994 report, ADRs accounted for |
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Definition
| more than 2.2 million serious cases & over 100,000 deaths in the U.S. |
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Term
| Pharmacodynamics process includes: |
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Definition
Uptake
Movement
Binding
Interactions of pharmacologically active molecules with their site(s) of action |
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Term
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Definition
| largest effect the drug can produce. The innate ability of the drug to produce a desired effect |
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Term
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Definition
| amount of drug needed to elicit an effect. How many particles of a drug are needed to produce a desired effect |
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Term
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Definition
| usually a larger then standard dose given at the beginning of therapy to raise blood level |
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Term
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Definition
| dose that continues to keep the drug in the desired therapeutic range |
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Term
| Drug-Receptor Interactions |
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Definition
Chemical bond between drugs and specific receptor sites
'Lock and Key effect' |
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Term
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Definition
| Intensity of response proportional to number of receptors occupied |
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Term
| Modified Occupancy Theory |
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Definition
| Involves affinity and intrinsic activity |
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Term
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Definition
| strength of the attraction |
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Term
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Definition
| ability of drug to activate the receptor following binding |
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Term
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Definition
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Term
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Definition
Adrenergic
Cholinergic
Histamine |
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Term
| Examples of Adrenergic Receptors |
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Definition
Alpha 1
Alpha 2
Beta 1
Beta 2
Dopaminergic |
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Term
| Examples of Cholinergic Receptors |
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Definition
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Term
| Examples of Histamine Receptors |
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Definition
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Term
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Definition
Side effects
Adverse reactions
Allergic reactions |
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Term
| Side effects are nearly ____ and are produced at ____ |
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Definition
unavoidable secondary drug effects
therapeutic doses |
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Term
| Adverse reactions are ____ and are produced at___ |
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Definition
Noxious, unintended, and undesirable
normal doses |
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Term
| Allergic reactions are an____ and result from ___ |
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Definition
Immune response
prior sensitization |
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Term
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Definition
| Altered physiologic reactions to a drug that occurs because of a prior exposure to the drug stimulated the immune system to develop antibodies |
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Term
| What is the most serious type of allergic reaction |
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Definition
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Term
| 4 types of allergic reactions |
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Definition
Type I
Type II
Type III
Type IV |
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Term
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Definition
Occurs soon after exposure
Involves IgE |
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Term
| Type II Allergic Reaction |
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Definition
Delayed reaction
Involves IgE & IgG |
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Term
| Type III Allergic Reaction |
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Definition
Delayed reaction
Involves IgE, IgM, and IgG |
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Term
| Type IV Allergic Reaction |
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Definition
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Term
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Definition
| Molecules that activate receptors |
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Term
| When drugs act as agonists, they... |
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Definition
| bind to receptors and mimic the actions of the body's own regulatory molecules |
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Term
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Definition
| prevent receptor activation by endogenous regulatory molecules and drugs |
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Term
| Antagonists produce their effects by... |
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Definition
| preventing the activation of receptors by agonists |
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Term
| FDA Testing Sequence for Investigational Drugs |
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Definition
Part I: Animal Studies
Part II: Human Studies |
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Term
| Part One of the FDA Animal study involves... |
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Definition
Toxicity
Therapeutic Index |
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Term
| Part II of the FDA Human Studies involves... |
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Definition
Phase 1-Initial evaluation
Phase 2-Limited Control
Phase 3-Extended clinical trials |
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Term
| The 8 elements of informed consent |
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Definition
Information about the study
Risks involved
Benefits
Alternatives
Confidentiality
Compensation and Care
Contact information Volunteer's Rights |
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Term
| What is required for consent for investigational drugs? |
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Definition
Informed consent
Nuremberg code
Review boards for research institute (IRBS) |
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Term
| Different Classifications of Drugs |
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Definition
Prescription (legend) Drugs vs. OTCs
CSA Classification (Controlled Substance Act)
Pregnancy Safety Classification |
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Term
| CSA classification is based on... |
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Definition
| The abuse potential and accepted use |
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Term
| Schedule I CSA Classification |
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Definition
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Term
| Schedule II CSA Classification |
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Definition
| Prescription for 6 months with no refills |
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Term
| Schedule III CSA Classification |
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Definition
| Prescription for 5 refills in 6 months |
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Term
| Schedule IV CSA Classification |
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Definition
| Prescription required; accepted medical use |
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Term
| Schedule V CSA Classification |
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Definition
| May not require a prescription |
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Term
| Category A Pregnancy Safety Classification |
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Definition
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Term
| Category B Pregnancy Safety Classification |
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Definition
| Animal studies show no risks but no human studies done |
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Term
| Category C Pregnancy Safety Classification |
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Definition
| Animal studies show adverse effects and no human studies done |
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Term
| Category D Pregnancy Safety Classification |
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Definition
| Human fetal risk reported |
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Term
| Category X Pregnancy Safety Classification |
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Definition
| Fetal abnormalities and fetal risks shown in studies |
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Term
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Definition
Basis for professional status
Nurses' role with Medication
Prescription situations |
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Term
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Definition
| Self determination; the right of individuals to govern themselves according to their own reason |
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Term
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Definition
| Person who is capable of making a decision has freely and voluntarily agreed after receiving the information needed to make a decision |
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Term
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Definition
| Doing good or promoting good |
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Term
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Definition
| Avoiding harm, wrong doing or misconduct |
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Term
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Definition
| Truthfulness; accuracy of statement corresponding with fact or reality |
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Term
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Definition
| Keeping promises; acting in good faith (confidentiality & privacy) |
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Term
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Definition
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Term
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Definition
| Treating people fairly, impartiality, honestly and with equity |
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Term
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Definition
| Quality or state of being of sound moral principle; uprightness, honesty and sincerity |
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Term
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Definition
| Holds that an authority figure knows best and that the individual is obligated to comply with the authority figure; overrides patient autonomy |
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Term
| JCAHO Pain Management Standards- The Fifth Vital Sign |
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Definition
F - First Assess
I - Initiate Intervention
V - Verify effectiveness and document
E - Educate self and patient |
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Term
| Unrelieved pain will do what do the body |
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Definition
Causes unnecessary suffering
Stimulates sympathetic response
Decreases immune function
Weakens already debilitated patients
Increases poor compliance with therapy
Impinges on work, leisure, role in family and society
Diminishes hope |
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Term
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Definition
Inadequate assessment
Patient reluctance to report pain
Patient reluctance to take opioids
Physician reluctance to prescribe opioids
Lack of knowledge |
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Term
| When the patient reports pain relief following a placebo, this means that |
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Definition
| the patient is a malingerer or that the pain is psychogenic |
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Term
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Definition
| Primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. |
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Term
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Definition
| clients that are inadequately treated for pain and as a result, develop a pattern of drug-seeking behaviors to achieve pain control |
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Term
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Definition
| a pharmacologic property causing the occurrence of withdrawal symptoms with abrupt discontinuation or administration of an antagonist. |
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Term
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Definition
| the pharmacologic effect in which, with repeated administration, increasing doses are necessary to provide the same effect |
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Term
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Definition
Physical - sensation of pain involves nerve pathways and brain
Psychological - emotional response to pain |
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Term
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Definition
| sudden onset and subsides with treatment |
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Term
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Definition
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Term
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Definition
| transient flare in pain, occurs in conjunction with persistent pain |
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Term
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Definition
| originates in smooth muscle or sympathetically innerviated organ systems; may be referred pain |
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Term
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Definition
| activation of nociceptors in skeletal muscles, fascia, ligaments vessels or joints; may be more localized |
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Term
| Neuropathic (deafferentation) Pain |
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Definition
| caused by peripheral nerve injury |
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Term
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Definition
Injury causes the release of substances, such as prostaglandines
Nociceptors send pain impulses through myelinated afferent fibers to spinal cord in area of dorsal horn
Activation of nociceptive system up spinal cord to brain
Pain is perceived
Descending pathways suppress pain input |
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Term
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Definition
Mu - mediate supraspinal analgesia, euphoria, respiratory depression, constipation, pruritus, urinary retention, nausea, vomiting, and physical dependence
Kappa - activation at the spinal cord level mediates sedation, miosis, and analgesia |
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Term
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Definition
Tricyclic antidepressants
Anticonvulsants
Muscle relaxants
Benzodiazepines
Corticosteroids |
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Term
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Definition
| morphine-like compound that produces bodily effects including pain relief, sedation, constipation, and respiratory depression |
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Term
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Definition
| compounds that block the opioid analgesics from their receptor sites |
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Term
| Opioid Agonists/Antagonists |
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Definition
| exact mechanism of action is unknown but both act and block the opioid receptors |
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Term
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Definition
| effective for mild to moderate pain and are often combined with opiod analgesics to enhance pain control in cases of severe pain . Also used for antiinflammatory effect |
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Term
| Titration of Opioid Doses |
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Definition
| When titrating opioid doses, increases of 25-50% should be administered until there is either a 50% reduction in the patient’s pain rating on a numerical or visual analog scale or the patient reports satisfactory pain relief |
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Term
| A repeat dose can be safely administered at |
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Definition
| the time of the peak if previous dose is ineffective and side effects are minimal. |
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Term
| For mild to moderate pain increase the dose by |
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Definition
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Term
| For moderate to severe pain, increase the dose by |
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Definition
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Term
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Definition
Around the clock doses are more effective than prn administration for pain that is expected to continue.
Analgesic is more effective if given before pain becomes severe.
Provide analgesia to allow for uninterrupted sleep. |
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Term
| Breakthrough Pain "Rules" |
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Definition
Doses should be equivalent to about 10-15% of the 24-hour total dose
Doses may be given every 2 hours as needed
Doses of immediate-release opioid may be taken at same time as sustained-release opioid
Do not use sustained-release opioid for breakthrough pain |
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Term
| Opioid-Induced Side Effects |
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Definition
constipation
nausea & vomiting
sedation
respiratory depression |
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Term
|
Definition
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Term
| Nursing Interventions for Constipation |
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Definition
Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects.
Stimulant laxatives (ie. Senokot) should be administered routinely if opioid use exceeds 2-3 days, unless contraindicated. |
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Term
| Causes of Nausea and Vomiting |
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Definition
Stimulation of the chemoreceptor trigger zone
Inhibition of GI motility
Vestibular stimulation |
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Term
| Management of Nausea and Vomiting |
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Definition
Tolerance
Change opioids
Multiple antiemetics
Decrease ambulation |
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Term
|
Definition
If respiratory rate is <10/minute, assess level of sedation.
Physical stimulation may be sufficient to prevent significant hypoventilation.
Subsequent doses may need to be decreased by 25-50%.
Initial drowsiness will diminish with continued use. |
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Term
| Fixing Respiratory Depression |
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Definition
If an opioid antagonist is required -- naloxone (Narcan) is the antidote.
Dilute the 0.4-mg ampule of naloxone in 10 ml of 0.9% NaCl and administer 0.5 ml (0.02 mg) by direct IV push every 2 min.
Titrate dose to avoid withdrawal, seizures, and severe pain. |
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Term
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Definition
| CNS depressants issued to induce a loss of sensation, especially the sensation of pain |
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Term
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Definition
| Induces a state of unconsciousness and varying amount of analgesia, amnesia, muscle relaxation, and loss o f reflexes (sensory and autonomic) and is achieved by intravenous or inhalation routes |
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Term
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Definition
| blocks pain sensations in specific areas of the body without loss of consciousness |
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Term
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Definition
| combination of drugs to induce anesthesia with each used for its specific effect |
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Term
| General Anesthetics Stages |
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Definition
Stage 1 – Analgesia
Stage 2 - Excitement
Stage 3 - Surgical anesthesia
Stage 4 – Medullary Paralysis (toxic stage) |
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Term
| Special Considerations for Anesthetic use |
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Definition
Alcoholism – increase liver-metabolizing enzymes and cross-tolerance
Obesity – cardiac and respiratory considerations; avoid fat-soluble anesthetics
Smoking – increased rigidity in arterial vascular system
Pregnancy
Neonate/Child
Elderly |
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Term
| Nursing Considerations for Anesthetics |
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Definition
Preoperative – assessment, informed consent, decrease anxiety, patient teaching
Intraoperative – ensure patient safety and monitor patient’s level of sedation
Postoperative – Assessment:
Airway and breathing
Circulation
Metabolic (skin integrity, temp, I & O)
General – drains, catheters, bowel sounds, status of incision, positioning, LOC, ability to communicate |
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Term
| Postoperative Nursing Responsibilities for Inhalation Anesthetics |
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Definition
Monitor BP, pulse, and temperature
Support respiratory function
Prevent aspiration
Keep the patient warm
Assess for return of normal bowel sounds and urinary output |
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Term
| General Anesthetics: Parental |
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Definition
Barbiturates
Non-Barbiturates
Benzodiazepines
Opioid Analgesia |
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Term
|
Definition
| Nondepolarizing: antagonists to acetylcholine at neuromuscular junction and prevent depolarization of muscle cells |
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Term
| Depolarizing Nerve Block/Regional |
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Definition
| Act as acetylcholine agonist at the neuromuscular junction stimulating the muscle cell and then preventing it from repolarizing |
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