Term
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Definition
Account >60% of all medications used in US
Benefits should outweigh risks
Limited interactions w/ other drug
Low potential for abuse |
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Term
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Definition
Safety and efficacy
Labeling standards
Reclassification
Indication for use
Safety profile
Practical for OTC use |
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Term
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Definition
Dietary Supplement and Health Education Act (DSHEA) of 1994
Herbal products considered “dietary supplements”
No proof of efficacy or safety required
“Natural” does not mean safe
No standards for quality control
May claim effect but do not have to promise a specific cure |
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Term
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Definition
Must carry the legend: “Caution—Federal law prohibits dispensing without a prescription”
May only be sold by a pharmacist when authorized by a written prescription from a medical practitioner |
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Term
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Definition
Right drug: check label 3 times and KNOW why it is ordered for this patient
Right dose: calculate the dose yourself
Right time: prescribed time (+/- 30 min)
Right route: know which route and don’t deviate
Right patient: 2 patient identifiers
Right documentation: RN’s initials on med sheet immediately after administration |
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Term
| Pharmacokinetic considerations across the Life Span |
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Definition
Drugs during pregnancy/breastfeeding
Pediatric patients (mg/kg) - Immaturity of organs
Elderly patients: Decrease in weight,
More sensitive to drugs, Less hepatic metabolism, Less renal excretion |
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Term
During Pregnancy
Greatest danger from medication?
Greatest amount of drug transfer to the fetus? |
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Definition
First trimester is greatest danger from medications = Rapid fetal growth
Greatest drug transfer during third trimester
- Enhanced blood flow to fetus
- Large fetal body surface area |
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Term
| 5 Pregnancy Safety Categories |
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Definition
Category A - Studies indicate no risk to the human fetus.
Category B - Studies indicate no risk to animal fetuses; information for humans is not available
Category C – Adverse effects are reported in animal fetuses; information for humans is not avialable.
Category D – Possible fetal risk in humans is reported; however, consideration of potential benefit versus risk may, in selected cases, warrant use of these drugs in pregnant women.
Category X – Fetal abnormalities are reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. |
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Term
| While Breastfeeding DO NOT TAKE |
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Definition
Nicotine
Psychotropic drugs - Anti-anxiety drugs, antidepressants, and neuroleptic drugs (affect neurotransmitter function)
Silicone implants |
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Term
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Definition
Criteria helps predict Adverse Drug Reactions in elderly outpatients (65+)
severity rating (high vs. low)
Developed using a modified Delphi method to achieve consensus among 12 experts in geriatrics and/or pharmacology
Increase awareness
Nurses, primary care providers and pharmacists may collaborate to optimize individualized medication regimes and provide appropriate clinical monitoring and education.
Not intended to substitute for professional judgment regarding the individualized needs of particular older adults. |
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Term
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Definition
Immature organs (liver, kidney…
Gastric emptying is slowed
Blood-brain barrier immature
More sensitive to many drugs
Can’t safeguard against med errors
May refuse or spit up medicines
Don’t mix with bottle, don’t say “candy” |
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Term
Elderly Patients Defining Age
What happens to their body/organs as they age? |
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Definition
| >65 yrs Declining organ function (kidney, liver, GI) Reduced vision Lack of understanding Multiple prescribers, multiple pharmacies Drug induced problems |
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Term
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Definition
Obtain a full medication history (parents, families, caregivers)
Ask about any adverse medication reactions.
Allergies
Obtain pertinent lab results
Assess risk (Beers criteria) |
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Term
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Definition
- Know about med prescribed (effects, side effects)
- Know why patient is receiving med
- Don’t assume it is correct med or correct dose
- Adhere to hospital policies regarding meds
- Use the “rights method” every time you give a med |
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Term
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Definition
| Oral route is easiest and most desirable |
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Term
| Drug Names: Difference between generic, chemical, and trade names. |
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Definition
Chemical name
- Describes the drug’s chemical composition
Generic name
- Name given by the US Adopted Name Council
Trade name
-The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer) |
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Term
Pharmacologic Principles
- Pharmacotherapeutics
- Pharmacokinetics
- Pharmacodynamics |
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Definition
Pharmacotherapeutics: the use of drugs and the clinical indications for drugs to prevent and treat diseases
Pharmacokinetics: what the body does to the drug
- Absorption
- Distribution
- Metabolism
- Excretion
Pharmacodynamics: what the drug does to the body
The mechanism of drug actions in living tissues |
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Term
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Definition
Affects rate and extent of absorption
Enteral (GI tract): PO, sublingual, NGT (nasal gastric tube)
Parenteral (blood stream): ID, SQ, IV, IM
Topical (body surfaces): skin, eyes, ears, lungs |
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Term
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Definition
| The metabolism of a drug and its passage from the liver into the circulation |
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Term
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Definition
Movement of drug from site of administration into the bloodstream.
Dependent on:
Food or fluids administered with the drug
Dosage formulation
Status of the absorptive surface
Rate of blood flow to the small intestine
Acidity of the stomach
Status of GI motility |
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Term
| Drug Absorption of Various Oral Preparations: What kind of drugs are absorbed faster? (Fastest to Slowest: ) |
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Definition
Fastest to Slowest:
Liquid, Elixirs, and syrups
Suspension Solutions
Powders
Capsules
Tablets
Coated Tablets
Enteric-Coated Tablets |
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Term
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Definition
Why use “combination” meds?
Multiple drugs for simultaneous dosing (one drug may have side effects and combining different drugs to the same dose will allow you to mask the side effects)
Enhance effectiveness of one ingredient |
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Term
| Oral med delivery systems |
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Definition
Immediate release medicines
Extended release capsules ????????
SR (sustained release), SA (slow acting), CR (controlled release), XL (extended release), XT (extended time)
Enteric coated tablets
Protects stomach lining |
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Term
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Definition
Before meals = AC
After meals = PC
With food
Check compatibilities (some meds should NOT be given together) |
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Term
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Definition
Know the action, purpose, safe dose range, potential adverse effects.
Complete assessment BEFORE giving med (pain scale, BP etc.)
Verify ID and allergies
Calculate accurate volume/#of pills and double-check when required
Assess ability to swallow
Remain with patient until medicine has been ingested
DOCUMENT and REASSESS |
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Term
| Administering liquid meds |
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Definition
Pour in medicine cup and draw up into oral syringe
If you overfill the med cup, discard the remainder
Take great care to avoid aspiration (vomit)
Give each med separately—do NOT mix liquids together |
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Term
| Nasogastric Tube Drug Administration |
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Definition
Verify that pill can be crushed using Drug Reference Guide
Use liquid form of medication when available
Keep all medicines separate…administer one at a time. |
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Term
| NG/GT Administration Details: Position of patient and procedures done before administering the drug. |
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Definition
| HOB (head of bed) minimum 30 degrees. Evaluate placement of tube Do NOT add medication to any tube feedings (feeding tubes go into the intestines and nasograstric goes to stomach) Flush NGT with up to 30ml water between each med and when finished |
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Term
Classes of Acid-controlling drugs
What does Magnesium, Aluminum, and Calcium do to your body?
Which one should you not take when you have renal problems? |
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Definition
Antacids neutralize stomach acid to reduce acid-related disorders (peptic ulcer, heartburn)
Side effects:
- Magnesium: Diarrhea
- Aluminum and calcium: Constipation
- Calcium: Kidney stones
Avoid mag and calcium antacids in renal disease |
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Term
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Definition
H2Receptor Agonists are the acid secretion antagonists. Competitively block the H2 receptors of acid producing cells = Reduce acid secretion
Used in GERD, esophagitis, peptic ulcer
Side effects: confusion and disorientation, impotence (weakness), thrombocytopenia (low platelet #)
Smoking decreases effectiveness of these meds |
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Term
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Definition
Proton Pump inhibitors prevents the movement of hydrogen ions out of parietal cells = stops over 90% of all gastric secretion.
Erosive esophagitis, poorly responsive GERD, ulcers |
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Term
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Definition
| (ulcer-adherent) – a cytoprotective drug. Covers and protects the ulcer site. |
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Term
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Definition
| (antiflatulent) – Relieve painful symptoms assoc. with gas |
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Term
| To Crush or Not to Crush…? |
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Definition
Some drugs can block feeding tubes if not dissolved properly
The efficacy of the drug may change once crushed |
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Term
| Distribution: Areas of rapid and slow distribution? |
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Definition
Transport of drug through bloodstream to site of action
Areas of rapid distribution?
- heart, liver, kidney, brain
Areas of slow distribution?
- skin, fat, muscle |
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Term
| What if drug is highly protein-bound? |
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Definition
| - Need more drug and longer time to excrete |
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Term
| Which sites are difficult to reach? Why? |
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Definition
- brain - blood brain barrier
- bones |
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Term
| Metabolism: Organ most responsible for this? And what does that organ do? |
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Definition
| Alteration of the drug Organ most responsible for this? Liver Job done by enzymes (such as_____?) ?????????? |
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Term
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Definition
Elimination of drugs from the body
Organ most responsible for this?
- kidney
(what are the other two organs that help?)
????????????? |
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Term
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Definition
| From the time you give the drug until you notice the therapeutic effects |
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Term
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Definition
| highest therapeutic level |
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Term
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Definition
| the time therapeutic effects are present |
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Term
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Definition
highest/lowest levels in blood stream.
Trough recorded right before you give the medication. |
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Term
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Definition
Receptor interactions: drug attaches to receptor site on cells to elicit or block a physiologic response
Enzyme interactions: the drug either inhibits or enhances enzyme activity
Nonselective interactions: drug either physically interferes with or chemically alters cellular structures or processes.
Example: Some chemo drugs like Cisplatin and Carboplatin work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. |
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Term
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Definition
| therapeutic uses and effects of drugs |
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Term
| Supportive versus Palliative care |
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Definition
Supportive = Maintain body functions while patient is recovering.
Palliative = Make the patient as comfortable as possible at the end stage of disease. |
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Term
Topical
How to apply: Transdermal and Ointment. |
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Definition
| Designed to provide local effect Can have systemic effect if the surface area is large enough. Use gloves to apply ointments, creams Transdermal Patch - Used for slow, systemic absorption usually over 24 hours. - Remove old patch, cleanse site - Rotate sites (hairless) - Do not touch inside of patch Ointment - Remove residual ointment - May need to wash area first - Nitroglycerin BE CAREFUL: do not massage into skin, cover with transparent dressing |
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Term
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Definition
- Patient sidelying (Sims position)
- Nurse wears gloves and lubricates (water soluble) suppository
- Insert suppository past the internal rectal sphincter
- Patient remains supine for 5-10 minutes
- Splitting suppositories not recommended |
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Term
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Definition
Patient lies down or assumes High-fowlers with head tilted back.
Nurse pulls down the skin below eye.
Drops or ointment are instilled into conjunctival sac.
No contact lenses. |
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Term
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Definition
Pull pinna down and back in child
Pull pinna up and back in adult
Patient remains on side for 5 min after drops |
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Term
| Metered Dose Inhalers (MDIs) |
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Definition
Delivers a measured dose with each “puff”
- Spacer
- 1-2 min between puffs
- 2-5 min between different meds
- Rinse mouth after steroid |
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Term
Inhaled Route: Dry Powder Inhalers
(DPI) |
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Definition
- No need to shake canister or use a spacer
- Take deep inhalation and hold breath for 5-10 seconds.
- Requires forceful inhalation to break up the powder
- Difficult for patients younger than 6 years. |
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Term
| Inhalation route: Nebulizer medication |
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Definition
Uses aerosol to suspend medication in particles
When inspired, the medication is deposited throughout the tracheobronchial tree
Used to deliver bronchodilators, mucolytics |
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Term
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Definition
Albuterol
- Stimulate the adrenergic receptors in the sympathetic nervous system which assists in bronchial muscle relaxation = bronchodilation (and cardiac stimulation=tachycardia) |
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Term
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Definition
- ipratropium
- Blocks anticholinergic receptors, which prevents bronchoconstriction. Works well in combo with albuterol |
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Term
| Leukotriene receptor antagonists |
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Definition
- singulair
- Leukotrienes are produced in response to allergens and cause inflammation, bronchial constriction, and ↑mucous.
- Long-term med, not for acute attacks |
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Term
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Definition
pulmicort, beclovent
- Reduce inflammation by stabilizing cell membranes so they don’t release bronchoconstricting substances |
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Term
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Definition
Injecting medication into body tissues
Intradermal = dermis, just below epidermis
Subcutaneous = just below dermis
Intramuscular= into a muscle
Intravenous = into a vein |
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Term
| Insulin vs. tuberculin needles |
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Definition
| Insulin is measured in units while tuberculin is measured in ml. |
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Term
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Definition
Variety of lengths (1/4 – 3 inches) and gauges (18-27)
Depends on size/weight of patient, site, and route
Luer-Lok (screw in needle) versus non-Luer-Lok |
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Term
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Definition
Injected into outer dermal layer
Diagnostic purposes: TB test, allergy tests
1ml syringe
25-28 gauge needle
1/4 – 5/8 inch needle |
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Term
| Contraindications to Tuberculosis skin testing. |
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Definition
| If BCG was given — do NOT do TB skin testing (false positives). |
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Term
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Definition
Max 1ml volume
1-3 ml syringe, 25-27 gauge needle, 3/8-5/8" needle
Inject at 45º or 90º angle
- If 2 inches of tissue can be grasped use 90º
- If 1 inch of tissue can be grasped use 45º
Sites: outer aspect upper arms, abdomen (2" away from umbilicus), upper thighs
- insulin on abdomen |
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Term
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Definition
Faster absorption but many risks
Up to 3ml of volume (1ml for children)
1-3 ml syringe, 21-25 gauge needle, 1-1 ½ inch needle
Inject at 90 degrees
Deltoid for immunizations (adults/children)
Vastus lateralis for infant immunizations
Ventrogluteal for IM meds in adults |
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Term
| Active versus passive immunity? |
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Definition
Active immunity indicates the formation of antibodies through direct exposure to an antigen.
Passive immunity means that antibodies are passed down to a recipient, even without exposure to an antigen. |
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Term
| Toxoids & which two types of toxoids do we use? |
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Definition
| Detoxified exotoxins which stimulate antitoxin antibodies (diphtheria and tetanus caused by toxin-producing bacteria aka: toxic stuff made non-toxic, but can still create immune response and allow the body to recognize and fight real toxins if the body is introduced to toxin. |
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Term
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Definition
| Live, attenuated, or killed microorganisms that stimulate production of antibodies |
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Term
Contraindications & Adverse Effects
What is NOT a contraindication for vaccines? |
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Definition
| Mild illness is NOT a contraindication for vaccines Allergy to the vaccine or its components (eggs) may be a contraindication Minor reactions often occur - Rise in temp, and warm, tender, red skin - May give acetaminophen/ibuprofen (not aspirin), warm compresses |
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Term
| When to call Doctors after receiving an immunization…? |
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Definition
| After receiving an immunization, a patient or parent should call if: - High (>103) or prolonged fever - Rash and/or itching - Shortness of breath or ANY resp involvement |
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Term
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Definition
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Term
How many ml in a teasponn? Tablespoon?
How many tsp in a tbsp?
One ounce? |
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Definition
1 teaspoon = 5ml
1 tablespoon = 3 teaspoons (15ml)
1 ounce = 2 tablespoons (30ml)
1 liter = 1000 ml |
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Term
| Define micro/macro tubing. |
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Definition
“Macro-tubing” = 15 gtts/ml
“Micro-tubing” = 60 gtts/ml |
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