Nursing Pharmacology Semester 1

Intramuscular

1/2-1 1/2 inch needle

Pregnancy Category C

Adverse effects have been demonstrated on animal fetuses, but there are no adequate and well controlled studies in pregnant. The use of these medications during pregnancy may be warranted based on potential benefits/

Pregnancy Category D

Adverse effects have been demonstrated on human fetuses. use may be warranted on potential benefits.

Pharmacokinetic factors specific to children

Decreased gastric acid, slower gastric emptying, decreased first pass metabolism, increased absorption of topical medication, lower blood pressure, higher body water content. Decreased serum protein binding sites until 1 year.

Rapid-acting

Humalog. Onset less than 15 minutes; peak 30min-1hr; Duration 3-4 hours

Medication error

an event that results in a patient receiving inappropriate medication or failing to receive it as prescribed

Morphine (Duramorph)

depresses respiratory function, so it should be used cautiously with asthma or impaired respiratory function.

diabetes insipidous

disorder of the posterior lobe of the pituatary gland that causes excessive thirst and excretion of large volumes of dilute urine

Anticholinergic Effects

(drying effect). Dry mouth, photophobia, urinary retention.

How do you store premixed insulin in syringes?

1-2 weeks, vertical with needle up and should be rotated to mix before administering.

Subcutaneous

1/2-5/8 inch in length needle

How long can premixed insulin be stored?

3 months

intradermal

3/8-5/8 inches in length needle

0.5- 1

A usual starting dose of insulin is between__ unit/kg of body weight per day.

Extrapyramidal symptoms (EPS)

Abnormal body movements such as tremors, rigidity, uncontrolled restlessness, spastic movement of head, neck, eyes, and it can take months to develop. Common with mental disorder meds

Pregnancy Category X

Adverse effects have been demonstrated on animal and human fetuses. The use of these medications are contraindicated during pregnancy because risks outweigh benefits.

Idiosyncratic reactions

An unusual response to a drug. It can manifest as an accelerated, toxic, or inappropriate response to the usual therapeutic dose of a drug

Pharmacogenetics

Area of pharmacology that examines the role of genetics in drug response.

When should patients be instructed to take antacids for optimal effect

At least one hour apart from other medications. They may interfere with absorption of other medications if taken together

How should an opened vial of insulin be stored?

At room temperature; no sunlight or heat and discard after 1 month.

Metabolism

Changes medications into less active forms or inactive forms by enzymes. Primarily happens in the liver.

Diabetes mellitus

Chronic illness that results from an absolue or relative deficiency of insulin, often combined with cellular resistance to insulin's actions.

Components of a prescription

Clients full name, date and time of prescription, name of medication, dosage of medication, route of administration, time and frequency, signature of provider.

Trough Levels

Drawn immediately before the next medication dose, regardless of the route of administration.

Excretion

Elimination of medications from the body. Usually the kidneys but can be liver, lungs, bowel and exocrine glands.

Thiazolidinedionesn (Glitazones)

Increase cellular response to insulin by decreasing insulin resistance.

Immunosuppression

Is a decreased or absent immune response.

Anaphylactic Reaction

Life threatening immediate allergic reaction that causes respiratory distress, severe broncho-spasm, and cardiovascular collapse.

Hepatotoxicity

Liver toxicity due to drug accumulation. most drugs are metabolized in the liver and it is vulnerable to drug-induced injury.

fluid retention

Major side effects in TZD treatment are an increase in adipose tissue and __ ___

Partial Agonists

May act as agonist/antagonist. Limited affinity to receptor site. i.e. nalbuphine acts as an antagonist at mu receptors and an agonist at kappa receptors, causing analgesia at low doses, with minimal respiratory depression.

Antagonist

Medication that can block normal receptor activity regulated by endogenous compounds or receptor activity caused by other medications. i.e. losartin works by blocking angiotensin II receptor blockers on blood vessel, which prevents vasoconstriction. Drug that blocks a response

Agonist

Medication that can mimic the receptor activity regulated by endogenous compounds. i.e. morphine because it activates the receptors that produce analgesia, sedation, constipation, and other effects. drug that produces a response

Toxic Effects

Medications can have specific risks and manifestations of toxicity.

Low Therapeutic Index

Medications have this and they must be monitored by serum medication level monitoring

Long Half Life

Medications leave the body more slowly; more than 24 hours. Greater risk for medication accumulation and toxicity.

lactic acidosis

Meformin can cause __ __ in patients with renal insufficiencies with presenting symptoms; fatigue, unusual muscle pain, difficulty breathing, unusual or unexpected stomach discomfort, dizziness lightheadedness, or irregular heartbeats.

conditions that decrease drug clearance

Metformin is contraindicated in___ ___ __ __ ___ , such as liver disease, alcoholism, or severe congestive heart failure

Kidney disease

Metformin should not be given to anyone with ___ and elevated creatnine levels. most common side effects are abdominal discomfort and diarrhea.

more normal

Mixture of short and intermediate acting insulins produce a__ __ blood glucose response in some patients than does a single dose.

Intermediate-acting

NPH (Humulin N). Onset 1hr; Peak 4-12 hr; duration 18-24 hr.

Diabetic Ketoacidosis

One of the most serious complications of hyperglycemia. Caused by drawing fluid out of the cell into circulation, excreted by kidneys. Results in Polyuria, dehydration & electrolyte imbalance. This increases fat metabolism and ketones, resulting in metabolic acidosis.

Non-parenteral routes of Administration

Oral, sublingual, transdermal, topical, opthalamic, otic, rectal, vaginal, nasal.

mixed insulin

Patients response to__ __ may differ from the response to the same insulins given seperately.

Accumulation

Process which occurs when the rate of drug administration exceeds drug excretion resulting in gradual increase in the blood level of the drug

Metformin (Glucophage)

Reduces production of glucose from the liver by suppression of gluconeogenesis. In a nut shell it prevents glucose from being made and forces body to use what is in storage. used as first medication in diabetes 2 because drug does not induce weight gain or hypoglycemia and has few adverse effects.

Half Life

Refers to period f time needed for the medication in the body to be reduced by 50%

Short-acting

Regular (Humulin R). Onset 30min-1hr; Peak 2-3 hr; Duration 5-7hr

Tolerance

Responsiveness to a medication is reduced and may require higher doses.

Six Rights of Safe Medication Administration

Right Client, Right Drug, Right Dose, Right Time, Right Route, Right Documentation.

Alpha glucosidase inhibitors (Precose, Glyset)

Slows carbohydrate absorption and digestion

Pharmacodynamics

Study of drug concentration and its effect on a living organism

Efficacy

The ability of a drug to produce a specific result, regardless of dosage.

protein, target tissues

The ability of a medication to bind to a ___ can effect how the medication will leave and travel to ___

abdominal discomfort

The most common side effects of Alpha-Glucoidase Inhibitors (Acarbose) include; flatulence, diarrhea, and ___ ___ .

blood glucose

The patients patterns__ __ determines insulin dosage

Bioavailability

The percentage of an administered dose which is absorbed. The rate and extent to which an active drug or metabolite enter the general circulation, permitting access to the site of action.

Adverse Effects

There are undesired, inadvertent, and unexpected dangerous effects of the medication.

Pregnancy Category B

There is no evidence of risk to animal fetus based on studies but there are no adequate and well controlled studies in pregnant women or there is risk in animal fetus but studies in pregnant women show no risk to the fetus

Pregnancy Category A

There is no evidence of risk to the fetus during pregnancy based on adequate and well-controlled studies

Why are inhaled steroids not recommended for acute asthmatic episodes?

They do not produce immediate effects. They are better used for prophylactic measures.

Why are alpha receptor blockers and angiotensin converting enzyme inhibitors less effective in African Americans?

They have abnormally low levels of the enzyme that metabolizes these drugs. Diuretics are more commonly used to treat their hypertension.

How do diuretics lower blood pressure?

They help rid you body of sodium and water. They decrease the amount of fluid by pulling it from the vessels and excreting it through the kidneys. The lesser amount of fluid flowing through the blood vessels decreases the pressure of the blood on arterial walls.

Therapeutic Effect

This is the preferred and expected effect for which the medication is administered to a specific client.

Absorption

Transmission of medication from location of administration to the blood stream.

Distribution

Transportation of medications to site of action by body fluids.

Side Effects

Usually expected and inevitable when a medication is administered at a therapeutic dose.

15 minutes

When rapid acting insulin is mixed with an intermediate acting or long acting, the mixture should be given with ___ __ before a meal.

shorter acting

When rapid acting or short acting insulin is mixed with a longer acting insulin, draw the ___ ___ dose first.

Hepatic First Pass effects

a phenomenon which occurs whereby a drug which has been absorbed by the GI system is extensively metabolized by the liver prior to reaching the systemic circulation

Placebo

a physiological benefit from a compound that may not have the chemical structure of a drug effect

Cross-tolerance

a situation in which the development of tolerance to one drug creates a tolerance to other drugs with similar pharmacological effects

Liver and Kidney Function

are immature in young children and often decreased in older adults.

Hyperglycemic nonketotic syndrome

blood glucose level about 600mg/dl resulting in diabetic coma

Vitamin K

can decrease the therapeutic effects of warfarin (Coumadin) and place clients at risk for developing blood clots.

Tetracycline

can interact with a chelating agent such as milk, and form an insoluble, unabsorbable compound.

Diarrhea

causes oral medications to pass through the GI tract too quickly to be absorbed

Following rectal insertion of suppository

client should remain in a side-lying position for 5-10 minutes

digoxin

clients taking __ should be monitored closely for dysrhythmias. Hyperkalemia places client at higher risk for toxicity

polyuria

excess urination

polyphagia

excessive hunger

polydipsia

excessive thirst and fluid intake

Dawn Phenomenon

fasting hyperglycemia that results from nighttime release of growth hormone. it is managed by providing more insulin for the overnight period.

Liver disease/failure

impairs medication metabolism, which may cause toxicity

How long can unopened insulin be stored and where?

in the fridge until expiration date.

Pharmacokinetic factors specific to older adults

increased gastric pH (alkaline), decreased GI motility and gastric emptying, decreased blood flow through cardiovascular system, liver, and kidneys, decreased hepatic enzyme function, decreased kidney function and glomerular filtration rate, decreased protein binding sites, decrease body water, increased body fat, and decreased lean body mass.

Inadequate gastric acid

inhibits the absorption of medications that require acid to dissolve

Long-acting

insulin glargine (Lantus,Levemir). Onset 1hr; has no peak; duration 24hr

Parenteral Routes of Administration

intramuscular, subcutaneous, intradermal, intravenous, intratracheal, and epidural.

Black Box Warning

is a government designation indicating that a drug has at least one serious side effect and must be used with caution.

lipoatrophy

is a loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin

Insulin

is a small protein that is destroyed by stomach acids and intestinal enzymes. that is why it should be injected

Allergic Reaction

is an immune response to a medication. You have to have been previously exposed and develop antibodies. Can be minor or serious; rash and hives to anaphylaxis.

Lipohypertrophy

is an increased swelling of fat that occurs at the site of repeated insulin injections

vancomycin

is excreted unchanged in the kidneys and should be used cautiously in a client who has renal impairment

Toxicity

is severe or a life threatening condition. It can be caused by excessive dose but can occur at therapeutic levels.

Hypoglycemia acute onset

low blood glucose level. symptoms in include; tachycardia, palpitations, diaphoreses, shakiness

Hypoglycemia gradual onset

low blood glucose level. symptoms include; headache, tremors, weakness,

Safety of insulin therapy in older adults

may be affected by reduced vision, mobility and coordination problems, and decreased memory.

Cardiovascular Effects

may involve blood vessels and the heart. Antihypersensitives can cause orthostatic hypotension.

Nephrotoxicity

may occur with a number of medications, but is primarily the result of antimicrobial agents and NSAIDs. Impaired kidney function may interfere with excretion, leading to accumulation and adverse effects.

Gastrointestinal Effects

may result from local irritation of the GI tract. Stimulation of the vomiting center also results in adverse effects.

Central Nervous System Effects

may result from stimulation or depression of the CNS.

48 hours

metformin should be withheld for __ before and after using contrast material and surgical procedures requiring anesthesia.

sustained release and enteric coated capsules

must be swallowed whole to be effective.

Vascular insufficiency

prevents distribution of medications to affected tissue

Kidney disease/failure

prevents or delays medication excretion, which may cause toxicity.

The purpose of insulin

promote cellular uptake of glucose, converts glucose into glycogen, and moves potassium into cells (along with glucose).

Pharmacokinetics

refers to how medications travel through the body.

Hematologic Effects

relatively common and potentially life-threatening with some groups of medications. Bone marrow depression, anticancer drugs, anticoagulants, thrombolytics.

Grapefruit Juice

seems to act by inhibiting presystemic medication metabolism in the small bowel, thus increasing absorption of certain oral medications such as nifedipine (Procardia) a calcium channel blocker. may cause drug toxicity.

peak drug level

the highest plasma concentration of a drug at a specific time

insulin lipodystrophy

the loss of local fat deposits in patients with diabetes as a complication of repeated insulin injections into the same subcutaneous tissue

Deltoid

the site that is easily accessible but not suitable for repeated injections or injections of more than 2 ml

non-sulfonylurea secretagogue

type of oral anitidiabetic agent that stimulates insulin release; also called glinide

Consuming foods with tyramine

while taking MAOIs can lead to hypersensitve crisis.