Pharmacology

FDA drug approval process

- Preclinical testing - Clinical (human) studies - Investigational drug studies **FDA can recall a med at any time** The goal is provide info about safety, toxicity, efficacy, potency, bioavailability, and purity of drug -Informed consent

migraine

-A common type of recurring headache, usually lasting from 4 to 72 hours -thought to be caused from abnormal dilation of blood vessels in brain from lack of serotonin -Typical features: pulsatile quality with pain that worsens with each pulse -most commonly unilateral but may occur on both side of the head -associated symptoms:nausea, vomiting, photophobia (avoidance of light), and phonophobia (avoidance of sounds) -aura -causes: stress, hypoglycemia, menses, endogenous estrogen (BC pills), exercise; intake of alcohol, caffeine,, cocaine, nitro, aspartame, MSG abortive therapy v preventative.

Ethical nursing considerations and drug therapy

-Adhere to ethical codes and principles -Nurse has the right to refuse to participate in any aspect of patient care that violates the nurse's personal ethics principles -Provide nonjudgemental care -Always act in best interest of the patient -Ethics behind HIPPA -may mix with legal considerations -Know resources available for you when making ethical decisions

Use of herbs

-Approximately 63% of US adults use alternative medicine -Therapeutic agents for treatment and cure of disease -Prophylactic agents for long-term prevention of disease -Proactive agents to maintain health and wellness and "boost" one's immune system

More Prevention

-Assessment -Two patient identifiers -Do not administer if you did not draw up or prepare yourself -Minimize verbal or telephone orders -Repeat order to prescriber -spell drug name aloud -speak slowly and clearly -list indication next to each other

Cultural nursing considerations and drug therapy

-Be aware of cultural differences and performing self- assessment -Maintain current with knowledge about various cultures -Be aware of cultural differences in medication therapy -Be aware of verbal and nonverbal communication -Culturally competency -Be aware of common practices among cultural groups -Use of interpreter

Breastfeeding

-Breastfed infants are at risk for exposure to drugs consumed by the mother -Consider risk to benefit ratio on case by case basis -Amount of exposure depends on volume of milk consumed -Drug levels in breast milk are usually lower than maternal circulation

Pediatrics handle drugs differently than adults, due to??

-Categorized by age -Some meds are contraindicated for peds patients -More susceptible to drug interactions, toxicity, and unusual drug responses.

Possible consequences of errors for nurses AND nursing students

-Consequences vary from institution and severity of incident -malpractice insurance -continuing education -disciplinary action from employer and/or state BON FOR THE STUDENT -notify clinical instructor and provider -if a pattern exists or ADE is serious, disciplinary action (extra clinical hours/ failure of course/ expelled from program)

Salicylates Nursing Implications

-DO NOT GIVE SALICYLATES TO CHILDREN AND TEENAGERS (REYE'S) -Tolerated if taken with food, milk or an antacid to avoid irritation -education about the various adverse effects of NSAIDs and inform them to notify their prescribers if these effects become severe or if bleeding or GI pain occurs -perform GI assessment -assess for contraindications -asminister IM in large muscle mass -advise patients that enteric-coated tablets should not be crushed or chewed -monitor therapeutic effects,, which may not be seen 3-4 weeks -monitor labs -takes 7 days for anti inflammatory effects; 30-60 for analgesia -can cause GI disturbances and decreased platelet aggregation (clotting) which causes bleeding -observe for vomiting, GI discomfort, bleeding, or bruising -bleeding precautions -client teaching

Key aspects to ask regarding medication profile

-Date medication was prescribed -Name of drug(s) -Drug dosage amount -Drug dosage frequency -Route of administration

To ensure correct dosage for peds

-Determine weight in kilograms -use current drug reference to determine drug range for 24 hours in mg per kg -determine safe range per dose and per day contact HCP for concerns

Drug development and approval process

-Development may take up to 17 years -Regulated and monitored by FDA; -Dietary supplements and alternative therapy- national center for complimentary and alternative medicine: most stringent in the world -Developed out of concern for patient safety and drug efficacy.

Nonselective (mechanisms of action)

-Don't work by receptor or enzyme. -Instead, their main target are cell membranes and various cellular processes such as metabolic activities. -These drugs can either physically interfere with or chemically alter cellular structures or processes. -Doesn't care what it affects

What is needed to calculate pediatric dosage?

-Drug order -pediatric weight in kilograms -pediatric dosage per manufacturer/ drug formulary guidelines -Info about available dosage forms

Factors to be considered involving pregnancy

-Drug properties -Fetal gestational age -Maternal factors -FDA Pregnancy safety categories and new subsections.

Acetaminophen Treatment of Toxicity

-Even though available OTC, lethal when overdose (7-10g) -overdose cause hepatic necrosis:hepatotoxicity -Long-term ingestion large doses also causes nephropathy and irreversible hepatotoxicity -obtain serum acetaminophen level 4 hours after

Reporting and Documenting Medication Errors

-Follow HCO policy and procedures on reporting -Fill out incident report and nursing documentation and hotline (if applicable) -Report to prescriber and nursing management -Document only objective, factual, accurate and thorough findings -Health care providers must give full disclosure to patients when errors occur in their care -External reporting -U.S. Pharmacopeia medication error reporting program -medwatch

Pregnancy considerations

-Greatest danger of drug-induced developmental defects happens in first trimester. -Drug transfer to fetus is more likely during last trimester -Transfer of drugs occur by diffusion across placenta. -Maternal conditions like HTN, Epilepsy, DM and infection could endanger mother and fetus.

Older adults: Older than age 65

-High use of medications with increased risk of interactions -Self-medication errors increase -Polypharmacy and prescribing cascade -noncompliance, non adherence -start slow and go low -increased incidence of chronic illnesses -sensory and motor deficits -drug dosage -assess labs

Legal Nursing Considerations and Drug Therapy

-Know your scope of practice, nurse practice act and how to find state board of nursing -Research guidelines from professional nursing groups -Malpractice and neglect -Know state and federal legislation -Know credentialing requirements

Opioids contraindications

-Known drug allergy -determine exact cause and nature of allergy -severe asthma -use with EXTREME CAUTION IN PATIENTS WITH respiratory insufficiency, elevated intracranial pressure, morbid obesity or sleep apnea, myasthenia gravis, paralytic ileus, pregnancy

inflammation

-Localized protective response stimulated by injury to tissues, which serves to destroy, dilute, or wall off (sequester) both the injurious agent and the injured tissues -pain, fever, loss of function, redness, and swelling -mediated by endogenous compounds, including proteins of complement system, histamine, serotonin, bradykinin, leukotrienes, and prostaglandins

FDA

-Mandates manufactures disclose product identity, composition, quality, purity, and strength of active ingredients, free from contaminants

high alert medications

-Meds that are potentially toxic and require special car prescribing, dispensing, and administering. -Meds that have a greater potential for harm (Usually noted with red explanation marks)

Transition of care

-Movement of a patient from one care facility to another facility or home. -Meds are reconciled at point of entry and exit -Ensures no discrepancies between what patient takes at home vs. hospital -Repeated with each admission, status change, patient transfer, and discharge. Three steps: 1. Verification 2. Clarification 3. Reconciliation

Opioids management of toxicity and overdose

-Naloxone (narcan) IV 0.4-2 mg= work to block response at receptor sites and reverse the toxicity; lasts for about one hour; doesn't produce analgesia or respiratory depression; DRUG OF CHOICE -opioid withdrawal or opioid abstinence syndrome occurs manifested as: anxiety, irritability, chills and hot flashes, joint pain,, lacrimation, rhinorrhea, diaphoresis, nausea, vomiting, abdominal cramps, diarrhea, confusion. -prevented with gradual reduction of dose -may need ventilate support -side effects of narcan= hypo/hypertension, dysrhythmias, pulmonary edema, withdrawal symptoms

Nursing assessment for PRESCRIPTION, OTC, HERBAL PRODUCTS, VITAMINS, MINERALS, OTHER DIETARY SUPPLEMENTS

-Obtain thorough medication history, documenting all medications used -Assess level of education and understanding -Assess for information specific to various products. -Assess system functions (especially renal, liver, and cardiac -Assess for conditions that are contraindications -Assess for potential drug-drug, herb-food, and drug-herb interactions

The joint commission standards states patients have a right to appropriate assessment and management of pain, including the following:

-Pain is assessed in all patients -Initial assessment and regular reassessment of pain, taking into account personal, cultural, spiritual, and ethnic belief -Education of all relevant providers in pain assessment and management -Education regarding managing pain and potential limitations and side effects of pain treatments

Ethical Issues regarding med errors

-Patient notification of errors -The nurse is obligated to give full disclosure -Acknowledge and accept responsibility -service recovery

Nursing assessment for OTC

-Previous use of OTCs and patient's response -Assess all medications/substances the client is taking -past and present medical history including allergies -patient knowledge of components of self-administration and level of understanding -assess risk factors for toxicity with OTCs

Nursing implications for OTC

-Provide thorough and individualized patient education -ensure that patients recognize that manufacturers of herbal products and dietary supplements are not required to prove safety and effectiveness -herbal products may not be safe for pregnant or breastfeeding woman, infants, children, or individuals with a chronic illness. -"Natural" does not mean safe -teach patients to monitor themselves for unusual or adverse reactions as well as therapeutic responses. -OTCs and herbs are not without toxicity and side/adverse reactions as well as therapeutic responses -OTCs and herbs are not without toxicity and side/adverse effects -read all labels -provide appropriate and authoritative resources for patient information -teach proper education of substance -inform all HCPs about use of OTCs, dietary supplements, herbs -evaluate therapeutic response

Why do we use the nursing process?

-Research based organizational frame for professional nursing practice. -Ensures the delivery of thorough, Individualized and quality nursing care to patients

Administering Eye Medications

-Standard precautions -Patient to be in sitting or lying position with head tilt back and pull down lower lid -No contact lens should be in the eye -Remove any secretions with a damp, warm washcloth -Administration via or ointment -After instillation •Client should close eye(s) gently •Can use tissue to blot if liquid is out of eye but DO NOT RUB •Apply gentle pressure to nasolacrimal duct for 30-60 sec •Wait several mins for admin of second drug to prevent wash-out •Vision may be blurry for few mins •Document

Opioids

-Synthetic drugs that bind to the opiate receptors to relieve pain moderate to severe pain -often given with adjuvant analgesic drugs to assist primary drugs with pain relief - Titration used to find adequate dosing -opioids are also used for: cough center suppression (codeine), treatment of diarrhea (lomotil), balanced anesthesia. -Examples: hydromorphone, morphine, oxycodone, hydrocodone, fentanyl, methadone, codeine, meperidine -Many type of release forms -Equianalgesia -Route of administration

Methadone

-Synthetic opioid analgesic (schedule II) -opioid of choice for the detoxification treatment of opioid addicts in methadone maintenance -Renewed interest in the use of methadone for chronic (ex. neuropathic) and cancer-related pain -prolonged half-life of the drug: cause of unintentional overdoses and deaths -cardiac dysrhythmias

Receptor (mechanisms of action)

-The joining of the drug molecule with a reactive site on the surface of a cell or tissue. -once a drug binds to and interacts with the receptor, a pharmacologic response is produced. -Drugs interact with receptors in different ways either to elicit or to block a physiologic response -Agonists v. Antagonist

Pharmacokinetics

-The study of what happens to a drug from the time it is put into the body until the parent drug has left the body -Specifically, drug absorption into, distribution and metabolism within, and excretion from the body.

Transdermal Lidocaine

-Topical anesthetic formulated into a patch (lidoderm) and is placed onto painful areas of the skin. - Indicated for the treatment of posttherpetic neuralgia,, local pain relief -Three patches can be used one time -a patch can provide varying degrees of pain relief for 4 to 12 hours -Do not wear for longer than 12 hours a day to avoid potential system toxicity -Side effects: redness or edema to site, and unusual skin sensations may occur. -Nursing: patches are applied only to intact skin with no blisters. Used patches must be disposed of securely.

Antidote for acute treatment of acetaminophen

-acetylcysteine regimen (loading dose and 17 additional doses Q4) within 10 hours of ingestion. -can taste bad and have a foul odor, IV available -long-term toxicity is more likely to be permanent

National Center for Complementary and Alternative Medicine (NCCAM)

-complementary medicine (integrative medicine): simultaneous use of both traditional and alternative medicine -NCCAM classifies complementary and alternative medicine -alternative medical systems, mind-body interventions, biologically based therapies, manipulative and body-based methods -energy therapies

Narcotic counts and witnessing waste

-controlled substances are kept locked in medication dissension system -At beginning/end of shift, 2 nurses count the controlled substances to ensure accuracy -count procedures -used to better manage controlled substance administration -can help decrease criminal activity -improves patient safety -procedure for witnessing waste

Oral meds principles (assessments prior to)

-crush meds to except for which kinds? (crush one pill at a time) -position client in sitting/side lying position -offer full glass of water -powders-> mix in water -Remain with patient until ALL meds have been taken -Document -Sublingual and buccal admin -Orally disintegrating admin

adjuvant therapy

-drugs that have another primary indication other than pain -assist primary drugs with pain -allows for smaller doses of opioids and reduces adverse effects -Examples includes:anticonvulsants (diminishes transmission of pain signals), antidepressants (block reuptake of norepi and serotonin), and gabapentinoids (gabapentin and pregabalin for neuropathic pain) -side effects are specific to type of drug

Nursing implications

-incorporate pharmacological and non pharmacological methods of pain relief -individualize plan of care -administer pain meds BEFORE pain is out of control -oral forms should be taken with foods to minimize gastric upset -ensure safety measures -have emergency med available -withhold dose and contact physician if adverse effects occur -instruct patients to follow directions for administration carefully and to keep a pain diary -side effects management -monitor lab function (ALT/AST) -Patients should be instructed to change positions slowly & fall precautions -check dosages carefully -monitor for and treat adverse effects -monitor for therapeutic effects -be aware of pediatric and older adult considerations -coordinate with physicians for titration -provide community resources for pain management

Over the counter drugs (OTC)

-non prescription drugs -Use for short-term treatment of common minor illnesses -More than 300,000 OTC drugs available -OTC Drug Review (1972) -Safety and efficacy -Appropriate labeling standards -Reclassification

Evaluation

-ongoing part of the nursing process -determining the status of goals and outcomes of care -monitoring the patient's response to drug therapy -expected and unexpected responses -clear, concise documentation.

Acetaminophen Nursing Implications

-perform thorough history and physical; medication assessment -avoid alcohol and hepatotoxic agents -Lab assessment: H/H, RBC, AST, ALT, ALP, BUN, Creatinine -can crush PO except gel tablets and capsules -keep rectal suppository on ice until ready for use -monitor for side effects -cleint education

Goal of treatment

-preserve the patient's vital functions by maintaining the airway, ventilation, and circulation -the second priority is to prevent absorption of the toxic substance and or speed its elimination from the body

Dietary supplement and health education act (DSHEA) of 1994

-provided regulatory framework and define dietary supplements -requires no proof of efficacy and sets no standards for quality control

Saliciylates

-salicylic acid (aspirin) -inhibits platelet aggregation -Daily tablet (81 mg or 325 mg): prophylactic therapy; lower dosage given for those with increased risk of bleeding

migraine abortive therapy

-used to manage migraine during aura phase or when the headache started. -Triptans [sumatriptan (imitrex); almotriptan (axert); eletriptan (relpax); naratriptan (amerge); rizatriptan (maxalt); zolmitriptan (zomig), frovatriptan (froval) are used for servere migraines. -some times caffeine or fioricet -ergot alkaloids (ergotamine); previously used -stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms; reduce the production of inflammatory neuropeptide -used cautiously with cardiovascular disease side effects: vasoconstriction, irritation at injection site, tingling, flushing, congestion, rebound, headache, chest pain; overuse can cause rebound headache Nursing implications: monitor for side effects; contraindication for its with cardiac issues; teach client about injections; available in tablets, SL, SQ, nasal sprays; monitor cardiac status Client education: Teach how to administer med, avoid triggers, keep room dark, keep journal, avoid things that require alertness, contact HCP immediately if chest pain, SOB, palpitations, pain weakness occurs; proper administration

Medication Administration for peds

1. Prepare all equipment and supplies first 2. Have caregivers stay as appropriate 3. Consider developmental stage 4.Assess for comfort methods before, during and after drug administration (infants, toddlers, preschoolers, school-age children, adolescents)

Nurse Practice Act

1. the scope of nursing practice 2. expanded nursing roles 3. educational requirements for nurses 4. standards of care 5. minimally safe nursing practice 6. difference between nursing and medical practice

Nine rights of med administration

1.Right drug 2.Right dose 3.Right time 4.Right route and form 5.Right patient 6.Right documentation 7.Right reason 8.Right response 9.Right of refusal (patient)

Severe treatment of salicylates toxicity/overdose

1.discontinuation of salicylates 2. intensive symptomatic and supportive therapy 3.dialysis if: high salicylate levels, unresponsive acidosis (pH less than 7.1), impaired renal function or renal failure, pulmonary edema, persistent central nervous system symptoms (ex. seizures, coma), progressive deterioration despite appropriate therapy.

Mild treatment of salicylates toxicity/overdose

1.dosage reduction or discontinuation of salicylates 2.symptomatic and supportive therapy

When would you reassess pain level after administering parenteral medication?

30 minutes

when would you reassess pain level after administering oral medication?

60 minutes

The nurse understands that drugs exert their actions on the body by what process? (Select all that apply.) A. Altering metabolic chemical processes B. Interacting with receptors C. Making the cell perform a new function D. Inhibiting the action of a specific enzyme

A. Altering metabolic chemical processes B. Interacting with receptors D. Inhibiting the action of a specific enzyme

The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.) A. Form of drug preparation B. Time of day C. pH of the stomach D. Patient in high-Fowler's position E. Presence of food in the stomach

A. Form of drug preparation B. Time of day C. pH of the stomach E. Presence of food in the stomach

The nurse is giving a medication that has a high first-pass effect. The health care provider has changed the route from IV to PO. The nurse expects the oral dose to be A. Higher because of the first-pass effect B.Lower because of the first-pass effect C. The same as the IV dose D. Unchanged

A. Higher because of the first-pass effect

When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect? A. Increase in the risk of drug-drug interactions B. Hypovolemic shock caused by a low albumin level C. Immediate improvement in the patient's condition D. A short duration of medication action

A. Increase in the risk of drug-drug interactions

When admitting an older adult patient to an acute care setting, which nursing strategy is most appropriate to prevent medication errors? A. Instruct the patient or family to bring in all medications the patient was taking at home. B.Call the primary care physician to verify current medications. C.Ask the patient to provide you with a written list of all medications being taken at home. D.Have the patient's family verify medications the patient was taking at home.

A. Instruct the patient or family to bring in all medications the patient was taking at home.

Which nursing action will increase the absorption of a medication administered intramuscularly (IM)? A. Massage the site after injection. B. Apply ice packs to the injection site. C. Administer the medication via the Z-track method. D. Lower the extremity below the level of the heart.

A. Massage the site after injection.

What information should the nurse chart when documenting medication administration? (Select all that apply.) A. The dosage of medication administered B. The route of administration C. The time of administration D. The patient's age E. Information about an "incident report" in the patient's chart

A. The dosage of medication administered B. The route of administration C. The time of administration

What things should the nurse check when reviewing a prescription before handing the written prescription to the patient? (Select all that apply.) A. The route of administration B. The age of the patient C. The patient's home address D. The patient's emergency contact E. The signature of the prescriber

A. The route of administration E. The signature of the prescriber

A nurse is caring for a client who is taking diphenhydramine for insomnia and reports drowsiness. The nurse should identify that drowsiness indicates which of the following? A. therapeutic effect B. adverse reaction C. contraindication D. precaution

A. Therapeutic effect

What is the term for ratio between a drug's therapeutic effects and toxic effects? A. Therapeutic index B. Cumulative effect C. Affinity D. Tolerance

A. Therapeutic index

A nurse is obtaining a client's health history and discovers that the client takes loratadine, an over the counter drug. The nurse should identify that which of the following is correct regarding over the counter drugs? A. They do not require the supervision of a nurse B. they can interact with other drugs C. they should be included in the client's drug history assessment D. they are less effective than prescription drugs E. they do not cause toxicity

A. They do not require the supervision of a nurse B. they can interact with other drugs C. they should be included in the client's drug history assessment

A nurse is teaching a client who has a prescription for a drug that has a receptor agonist effect. Which of the following information should the nurse include in the teaching? A. This will increase the effect of normal cellular function B. this prevents cells in your body from performing certain actions C. this prevents hormones in your body from attaching to cell receptor sites D. This minimizes the risk that the medications you take will become toxic

A. This will increase the effect of normal cellular function

A nurse is caring for a client who is taking acetaminophen and codeine for pain relief. These analgesic drugs interact with one another to cause an additive effect. The nurse should identify that which of the following are characteristics of additive drug interactions? (select all that apply) A. clients can achieve desired effects with the use of lower dosages B. taking the two drugs together can reduce the effects of one or both drugs C. taking the two drugs together can potentiate the effects of one or both drugs D. the two drugs can produce an action neither would have produced alone E. both drugs have similar actions

A. clients can achieve desired effects with the use of lower dosages E. both drugs have similar actions

A nurse is preparing to teach a client how to take care of a newly created colostomy. The nurse should identify that which of the following factors can decrease the client's ability to learn? (select all that apply) A. impaired cognitive level B. language barrier C. discomfort D. repetition of teaching E. unreadiness to learn

A. impaired cognitive level B. language barrier C. discomfort E. unreadiness to learn

When reviewing a list of drugs in a drug handbook, a nurse can identify the generic name for a drug in which of the following ways? A. it begins with a lower-case letter B. it is listed in parentheses along with the trade name C. There are both letters and numbers in the name D. the chemical name is listed in parentheses before the generic name

A. it begins with a lower-case letter

A nurse is caring for a client who arrived at an emergency department following a bee sting, which of the following findings indicates an anaphylactic reaction? (select all that apply) A. low blood pressure B.wheezing C. bradycardia D. peripheral edema E. difficulty swallowing

A. low blood pressure B.wheezing E. difficulty swallowing

A nurse is providing teaching for a client who has a new prescription for a drug with a high potential for toxicity. Which of the following information should the nurse include? (select all that apply) A. periodic lab test are essential to measure serum drug levels B. monitoring for indications for toxicity is important C. taking the drug with an inducing agent will increase the possibility of toxicity D. taking the smallest effective dose is crucial E. increasing fluid intake is recommended to avoid toxicity

A. periodic lab test are essential to measure serum drug levels B. monitoring for indications for toxicity is important D. taking the smallest effective dose is crucial

A nurse is caring for a client who was prescribed an antidepressant based on its ability to prevent the reuptake of neurotransmitters. The nurse should identify that which of the following terms describes why this drug was prescribed for the client? A. pharmacologic action B. chemical stability C. route D. adverse effects

A. pharmacologic action

A nurse is caring for a client who is postpartum and breastfeeding. The client asks the nurse about the effects that taking over the counter drugs will have on her newborn. Which of the following should the nurse consider when recommending a drug for the client ? (Select all that apply) A. the newborn's weight B. How much breast milk the newborn consumes each day C. Whether or not the benefits to the client outweigh the risks to the newborn D. the properties of the drug E.the route of administration

A. the newborn's weight B. How much breast milk the newborn consumes each day C. Whether or not the benefits to the client outweigh the risks to the newborn D. the properties of the drug

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the nurse's best response to the mother's question? A."Drugs can cross from mother to infant in breast milk, it will depend on the specific drug you are taking." B."All medications pass to infants while breastfeeding." C."You should not take any medication while breastfeeding." D."I will leave the health care provider a message to return your call."

A."Drugs can cross from mother to infant in breast milk, it will depend on the specific drug you are taking."

The nurse is preparing to administer an IM medication using an airlock to prevent leakage of the medication into the subcutaneous space. Which amount of air should the nurse withdraw for the air lock? A.0.2 mL B.0.1 mL C.0.05 mL D.0.3 mL

A.0.2 mL

Which of the following statements regarding African Americans' responses to antihypertensive medication therapy is true? A.African Americans respond better to diuretics than to beta blockers. B.African Americans do not respond to diltiazem. C.Single-drug therapy is effective for African Americans. D.Hypertension is uncommon in the African-American population.

A.African Americans respond better to diuretics than to beta blockers.

While conducting a health history for an older adult patient with heart failure, the patient tells the nurse, "I have chronic constipation." The nurse suspects this gastrointestinal complaint is caused by which class of drugs the patient reports taking? A.Calcium channel blockers B.Potassium-sparing diuretics C.Nonsteroidal anti inflammatory drugs D.Anticoagulants

A.Calcium channel blockers

When calculating pediatric dosages, the nurse understands which method is most accurate for dosing calculations? A. Dosage calculation by body surface area because it takes into account the difference in size for children and neonates B. Medication dosing calculated according to body weight because it is based on maturational growth and development C. Calculated doses based on body weight need to be increased by 10% because of immature renal and hepatic function D. Use of drug reference recommendations based on mg/kg of body weight.

A.Dosage calculation by body surface area because it takes into account the difference in size for children and neonates

When administering ophthalmic eyedrops, the nurse will perform which action? A.Drop the prescribed number of drops into the conjunctival sac. B.Document that a smaller dose was absorbed if the patient blinks during administration. C.Hold the eyedropper 4 to 5 cm above the eye to avoid contamination. D.Place the eyedrops directly on the cornea.

A.Drop the prescribed number of drops into the conjunctival sac.

There are multiple factors that affect medication response. The nurse recognizes which factors have a possible effect on the medication response? (Select all that apply.) A.Level of education B.Body composition C.Use of alternative therapies D.Genetic influences E.Diet and nutrition F.Socioeconomic factors G.Patient compliance with therapy

A.Level of education B.Body composition C.Use of alternative therapies D.Genetic influences E.Diet and nutrition F.Socioeconomic factors G.Patient compliance with therapy

When teaching a patient about the legalities regarding a prescription for methylphenidate (Ritalin), which statement is most accurate? A.Methylphenidate (Ritalin) is a C-II controlled substance that cannot be refilled automatically and can only be filled with a written prescription every month. B.Methylphenidate (Ritalin) is a C-III controlled substance for which a prescription will expire in 6 months. C.Methylphenidate (Ritalin) is a C-I controlled substance that can only be prescribed according to an approved protocol. D.Methylphenidate (Ritalin) is a C-IV controlled substance that is only to be refilled five times per prescription.

A.Methylphenidate (Ritalin) is a C-II controlled substance that cannot be refilled automatically and can only be filled with a written prescription every month.

In which step of the medication process can a medication error occur? (Select all that apply.) A.Prescribing B.Transcribing C.Administration D.Procurement E.Verification

A.Prescribing B.Transcribing C.Administration D.Procurement

The nurse knows that the medication reconciliation process involves which steps? (Select all that apply.) A.Reconciliation B.Reporting C.Verification D.Administration E.Clarification

A.Reconciliation C.Verification E.Clarification

Which are the appropriate landmarks for an IM injection into the dorsogluteal region? A.The dorsogluteal region is no longer recommended for injection; a different site should be selected. B.Below the iliac spine and between the greater trochanter and the iliac crest C.A handbreadth below the greater trochanter and the sacroiliac joint D.A "V" formation between the anterior superior iliac spine and the greater trochanter

A.The dorsogluteal region is no longer recommended for injection; a different site should be selected.

A nurse is reviewing drugs in a drug reference. The nurse should identify that drugs in the same class share which of the following similarities? A.They have similar mechanisms of actions B. they have the same half-life C.they are administered by the same route D. they have similar availability

A.They have similar mechanisms of actions

An emergency department nurse is documenting the medication history of a patient of Asian culture. The patient states, "I am not taking any medications," but the nurse observes a bottle of capsules in the patient's medicine bag. What information would the nurse collect next? A.Use of herbs or over-the-counter medications B.Past use of medicine and home remedies C.Health care provider name D.Vital signs and pulse oximetry

A.Use of herbs or over-the-counter medications

A nurse does not notice that a patient's IV site is swollen, red, painful, and warm to touch nor that the IV has quit infusing properly. This is an example of A.breach of duty. B.duty. C.causation. D.damage.

A.breach of duty.

Before meals (dosage administration abbreviation)

AC, ac

Pharmacotherapeutics: Types of Therapies

Acute, Maintenance, Supplemental, Palliative, Supportive, Prophylactic, Empiric

Standing or routine medication order

Administered until the dosage is changed or another medication is prescribed

Pregnancy Safety Categories: Category C

Adverse effects reported in the animal fetus; information for humans is not available

(Dosage forms) Topical examples

Aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories

Opioids interactions with

Alcohol, antihistamines, barbiturates, benzodiazepines can cause extreme sleepiness, respiratory depression, coma, and death. Monoamine oxidase inhibitors, phenothiazine, CNS depressants. Labs may include: increase in the serum levels of amylase, alanine aminotransferase, alkaline, phosphatase, bilirubin, lipase, creatinine, kinase, and lactate dehydrogenase.

NSAIDs contraindications

Allergy, pregnancy/nursing, bleeding risk, elective surgery in 1 week

Common Herbs

Aloe, feverfew, gingko, goldenseal, St. John's wort, valerian, echinacea, garlic, ginseng, glucosamine, hawthorn, saw palmetto, kava, chamomile, black cohosh, ginger

Drug interaction

Alteration of the action of one drug by another (synergistic/additive v. antagonistic)

Conditions Treated with Herbal Products

Anxiety Colds and cough Depression Headache Insomnia Ulcers Premenstrual syndrome (PMS) Arthritis Constipation Fever Infection Stress Weakness

Drug

Any chemical that affects the physiologic processes of a living organism

Parenteral

Any route of administration other than GI tract (Injection) 3 ways *Intravenously into vein (IV) *Subcutaneously into subcutaneous tissue (Sub-Q) *Intramuscularly into muscle tissue (IM) -Fastest route a drug can be absorbed -Must be absorbed into cells and tissues before they can exert their pharmacologic effect -onset of action is 5-10 min (IV)

Topical

Application of medications to various body surfaces. -All topical routes of drug administration avoid first-pass effects of the liver, with the exception of rectal administration. applied to the skin, eyes, ears, nose, lungs, rectum, or vagina.

A patient is prescribed ibuprofen 200mg PO every 4 hours as needed for pain. The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do? A. Crush the tablets and mix them with applesauce or pudding. B. Call the pharmacy and ask for the liquid form of the medication. C. Call the pharmacy and ask for the IV form of the medication. D. Encourage the patient to try to swallow the tablets.

B. Call the pharmacy and ask for the liquid form of the medication

The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 2100. What will the nurse do first to determine whether the medication was given? A. Call the night nurse at home B. Check the medication administration record C. Call the pharmacy D. Review the nurse's notes

B. Check the medication administration record.

A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the drug has more than one use? A. Adverse effects B. Indications C.Pharmacokinetics D.Nursing implications

B. Indications

What is another term for biotransformation of a drug? A. Absorption B. Metabolism C. Excretion D. Dilution

B. Metabolism

A drug given by which route is altered by the first-pass effect? A. Subcutaneous (subcut) B. Oral C. Intravenous (IV) D. Sublingual

B. Oral

What is the study of physiochemical properties of drugs and how they influence the body called? A. Pharmacokinetics B. Pharmacodynamics C.Pharmacology D. Pharmacotherapeutics

B. Pharmacodynamics

A nurse is reviewing a drug handbook prior to administering a drug to a client who has kidney disease. The handbook states that the drug can be administered but identifies certain risks. Which of the following terms describes these risks? A. Contraindications B.Precautions C.Paradoxical effects D. Adverse effects

B. Precautions

A nurse is preparing to teach a client about a newly prescribed drug. Prior to providing teaching, the nurse should review the precautions section of a drug handbook for which of the following reasons? A. to determine drug-food interactions B. To determine if dosage modification is indicated C. to determine how the drug is absorbed D. to determine availability

B. To determine if dosage modification is indicated

What organization announced implemented regulations requiring bar codes for all prescription and over-the-counter (OTC) medications? A.Drug Enforcement Agency (DEA) B.U.S. Food and Drug Administration (FDA) C.Federal Bureau of Investigation (FBI) D.Department of Health and Human Services (DHHS)

B. U.S. Food and Drug Administration (FDA)

Which statement best describes pharmacokinetics? A. Converts medication into its active chemical substance B. What the body does to the drug after it is administered C. Physiologic interaction between a drug and body cells D. Adverse effects and toxic reactions to medications

B. What the body does to the drug after it is administered

Drug's half-life is defined as the amount of time required for 50% of a drug to? A. exert a response. B. be eliminated by the body. C. be absorbed by the body. D. reach a therapeutic level.

B. be eliminated by the body.

A nurse is preparing to administer a drug to a client. In which of the following sections of a drug handbook should the nurse look to determine if the client can receive the drug? A. adverse effects B. contradiction C. implementation D. black box warning

B. contradiction

New drugs must go through extensive research and testing before approval for use in humans. The nurse knows that the average length of time a medication is researched before being prescribed for humans is how many years? A.14 to 16 B.10 to 12 C.2 to 4 D.6 to 8

B.10 to 12

A nurse working with older adult patients is concerned about the number of medications prescribed for each patient. Which older adult assessment should be of highest priority related to polypharmacy? A.Schedule of medications B.Drug interactions C.Cost of medications D.Nonadherence to drug regimen

B.Drug interactions

What legislation, which was passed in 1996, ensures that the privacy of patient information is protected? A.Durham-Humphrey Amendment B.Health Insurance Portability and Accountability Act C.Medicare Prescription Drug, Improvement, and Modernization Act D.Federal Food, Drug, and Cosmetic Act

B.Health Insurance Portability and Accountability Act

The nurse administers a medication to the wrong patient. Which is the appropriate nursing action following this error? A.Document the medication error. No further action is required. B.Notify the health care provider and document a medication error incident report. C.Assess the patient for an adverse reaction and report if an adverse event occurs. D.Report the error and document the medication on the patient chart.

B.Notify the health care provider and document a medication error incident report.

A pharmaceutical company is voluntarily conducting a postmarketing study to obtain further data to support the therapeutic effects of a new drug. What phase of drug study is this considered? A.Phase III B.Phase IV C.Phase I D.Phase II

B.Phase IV

Which statement about transdermal drugs is true? A.Transdermal drugs are preferred because they exert only a local effect. B.Transdermal drugs provide more consistent blood levels than oral and injection forms. C.For maximum effectiveness, transdermal patches should be reapplied to the same location when reapplied. D.For maximum effectiveness, the skin should not be cleansed with soap once it has been exposed to a transdermal drug.

B.Transdermal drugs provide more consistent blood levels than oral and injection forms.

An 18-year-old has an external ear infection to be treated with eardrops. The nurse correctly instructs the patient to angle the ear A.down and back. B.up and back. C.down and forward. D.up and forward.

B.up and back.

twice each day (abbreviation)

BID

Aloe

Back Ground: Aloe or Aloe Vera is a perennial plant that belongs to the Liliaceae family. Aloe Vera has been used medicinally since 1500 BC primarily for skin integrity and the healing process. Queen Nefertiti and Cleopatra used it daily as part of their beauty regime. Aloe has at least 75 different compounds that include 20 different Amino Acids, 20 minerals, vitamins and water. Medicinal use: Several Studies have shown that Aloe Vera can inhibit a Thromboxane, which is an inhibitor of wound healing. By inhibiting this it greatly increases the wound healing process and reduces inflammation along cuts and burns. There is also Magnesium Lactate that comes from Aloe that can block histamines that trigger itchiness and skin irritation. This can be used to further prevent against skin breakdown such as pressure ulcers. When Aloe is taken, it helps synthesis the collagen in the body by changing its chemical composition to increase the cross-linking effects and increases wound healing. Additionally, mucopolysaccharides along with amino acids and zinc present in Aloe Vera can lead to skin integrity, moisture retention, erythema reduction, and helps to prevent skin ulcers. Dosage routes: Topical, liquid gel capsule, tincture, liquid Positive Effects of Aloe Vera: treats wounds, psoriasis, mouth sores, ulcers, diabetes herpes, bedsore and burn wounds. It is known for its anti-tumor, anti-inflammatory, skin protection, anti-diabetic, anti-bacterial, anti-viral, antiseptic, and wound healing properties Adverse Effects: Hypoglycemia, can sometimes cause stomach cramps and pain, liver problems, Bloody urine, low potassium, weight loss, heart disturbances. Drug Interactions: There are no known drug interactions at this time associated to Aloe Vera. Do not take : if you have GI disturbances (orally), appendicitis (orally), liver/kidney disease (orally) or peptic ulcer disease (orally)

Documentation principles

Be sure to document!! -Medication administered -Actual dose given -Observed changes in client -Prescriber notification and follow up orders -Patient monitoring/ follow up

Educational system issues

Begins in classroom with student nurse errors. most students are sleep deprived, tired, non exposure to meds/exposure.

Sociologic factors

Behavior: disruptive behavior by a physican, and lack of institutional response to it are significant factors into nurse satisfaction and turnover

The nurse answers a patient's call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first? A. Check the orders and give the patient the requested pain medication. B. Provide comfort measures to the patient. C. Assess the patient's pain and pain level. D. Evaluate the effectiveness of previous pain medications.

C. Assess the patient's pain and pain level.

a nurse is caring for a client who has a history of renal insufficiency and is taking lithium. The nurse should monitor the client for which of the following? A. Tolerance to the drug B. Drug interaction C. Drug toxicity D. Dependence on the drug

C. Drug toxicity

A nurse is obtaining a client's health history. The client reports no all allergies but has experienced mild itching while taking amoxicillin in the past. Which of the following responses should the nurse make? A. Itching is an expected adverse effect of amoxicillin B. Itching can indicate amoxicillin toxicity C. Itching can indicate a hypersensitivity to amoxicillin D. Itching can results from dry skin, which is often caused by amoxicillin

C. Itching can indicate a hypersensitivity to amoxicillin

The nurse plans care for a male patient who is 80 years old. The nursing diagnosis is noncompliance with the medication regimen related to living alone, as evidenced by uncontrolled blood pressure. What should the nurse do next? A.Collaborate with the provider on a new medication regimen. B. Assess the impact of home self-management of medications. C. Set up a home care nurse for pharmacotherapy. D. Examine the results of nursing help with the medications.

C. Set up a home care nurse for pharmacotherapy.

A nurse is caring for a client who is receiving nitroglycerin IV and is switching to oral form of the drug. The nurse should identify that the oral dose will be higher than the IV dose for which of the following reasons? A. The IV form crosses the blood-brain barrier B. The oral form has a decreased half-life C. The oral form has decreased bio-availability because of first-pass effect D.The oral form has an increased rate of excretion

C. The oral form has decreased bio-availability because of first-pass effect

The nurse is caring for a client who is having difficulty remembering to take their prescribed drug three times each day. the nurse should identify that which of the following alternate forms of the drug can help to promote adherence to the prescribed dosage? A. liquid suspension B. immediate-release capsule C. extended-release tablet D. powder form

C. extended-release tablet

Which statement best reflects the nurse's understanding of cultural influences on drug therapy and other health practices? A.Regardless of one's cultural background, it is crucial to adhere to recommended medical practices. B.Most cultures are fairly standard in reference to the use of medications during illness. C.Administration of some drugs may elicit varied responses in specific racial/ethnic groups. D.Dietary habits and practices can be of little value to the care of a sick adult.

C.Administration of some drugs may elicit varied responses in specific racial/ethnic groups.

Which nursing intervention is most appropriate when crushing oral medications to administer to a patient with dysphagia? A.Only crush enteric-coated medication. B.Open sustained-release capsules before crushing. C.Crush and administer each medication separately. D.Mix medications together for ease of administration.

C.Crush and administer each medication separately.

Which action by the nurse helps to prevent possible medication errors? A.Ask the patient what condition the medication is for before administering. B.Administer the patient's medications using his or her own supply of medications while in the hospital. C.Encourage the patient to ask questions if the medication ordered is different than expected. D.Administer any medications that the patient had on admission or transfer.

C.Encourage the patient to ask questions if the medication ordered is different than expected.

In which step of the nursing process does the nurse determine the outcome of medication administration? A.Planning B.Assessment C.Evaluation D.Implementation

C.Evaluation

The nurse is teaching a pregnant patient about the effects of medication on fetal development. The nurse understands the greatest risk for negative effects from medications on a developing fetus occurs during which time period? A.Third trimester B.Second trimester C.First trimester D.Birthing process

C.First trimester

Which injection technique will the nurse use when administering a medication subcutaneously? A.Use the landmark between the greater trochanter and superior iliac crest for the vastus lateralis site. B.Aspirate with heparin and insulin injections. C.Insert the needle at a 45- or 90-degree angle, depending on patient size, to administer into the subcutaneous tissue. D.Use a 1- to 1½-inch, 25-gauge needle.

C.Insert the needle at a 45- or 90-degree angle, depending on patient size, to administer into the subcutaneous tissue.

What is the nurse's role in the development of new and investigational drugs? A.Identify patients who receive a placebo drug during Phase III studies. B.Select healthy older adult patients to participate in Phase I studies. C.Monitor and report any adverse effects observed during Phase IV studies. D Inform patients of the specific drug they will receive during Phase II studies.

C.Monitor and report any adverse effects observed during Phase IV studies.

Why are specific medications identified as "high-alert" medications? A.Registered nurses must administer these medications. B.States require that these drugs be on the high-alert list. C.These drugs have increased potential for significant patient harm. D.These medications are responsible for adverse drug events.

C.These drugs have increased potential for significant patient harm.

The nurse will check how many patient identifiers before administering a medication to a patient? A.One B.Four C.Two D.Three

C.Two

The nurse will use a Z-track technique when giving an intramuscular (IM) injection in which situation? A.When massaging the area after medication administration is contraindicated B.With any injection that is given into the ventrogluteal muscle C.With medications that are known to be irritating, painful, or staining to tissues D.When there is insufficient muscle mass in the landmarked area

C.With medications that are known to be irritating, painful, or staining to tissues

A research group is conducting an investigational drug study on a promising new drug for osteoporosis. It has been difficult to find research participants who meet the criteria. Just before the conclusion of the study, four participants approach the researchers and express their desire to withdraw from the study. The researcher should first A.inform them that they waited too long to withdraw from the study. B.explore with them the reasons for withdrawing from the study. C.acknowledge that they can withdraw at any time from the study. D.request that they try to remain with the study until it is completed.

C.acknowledge that they can withdraw at any time from the study.

A nurse has been asked to participate in an elective procedure that violates the nurse's personal ethical principles. The nurse should A.refuse to participate. B.ask to switch assignments with another nurse. C.speak to the manager or supervisor. D.perform the procedure.

C.speak to the manager or supervisor.

COX-2 inhibitors

Celecoxib (Celebrex) -first and only remaining COX-2 inhibitor -inhibitor for OA,RA, acute pain symptoms, ankylosing spondylitis, and primary dysmenorrhea.

Mixing Medications

Check if compatible! If vial & ampule: draw up from vial first If two vials: Draw back enough air for first vial With vial upright inject air without touching fluid Remove needle and draw back air for 2nd vial With 2nd vial upright inject air Then invert vial and draw back medication Remove needle and carefully insert into 1st vial Withdraw dose from 2nd vial Change needle Label syringe

Outcome criteria

Concrete description of patient goals reflect expect and measurable changes in behavior through nursing care and are developed with the patient.

CR

Controlled release

When planning to administer an intradermal medication, the nurse knows which location is the preferred site of injection on the forearm? A.2 to 4 finger widths above the wrist B.Just above the wrist C.Just below the antecubital space D.3 to 4 finger widths below the antecubital space

D. 3 to 4 finger widths below the antecubital space

The patient's medication administration record lists two anti epileptic medications that are due at 0900, but the patient is NPO (nothing by mouth) for a barium study. The nurse's coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do? A. Give the medications PO (by mouth) with a small sip of water. B. Give the medications via the IV route because the patient is NPO C.Hold the medications until after the test is completed D.Call the health care provider to clarify the instructions.

D. Call the health care provider to clarify the instructions

The physiologic changes that normally occur in older adult patients have which implication for drug response? A. Protein binding is more efficient. B. Drug elimination is faster. C. Drug metabolism is quicker. D. Drug half-life is lengthened.

D. Drug half-life is lengthened.

To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route? A. IM B. Intrathecally C. Subcut D. IV

D. IV

The nurse is assessing a patient's culture and race on admission to the hospital. Which concept is important for the nurse to understand regarding drug therapy as it relates to different races of individuals? A. Polypharmacy B.Pharmacokinetics C. Pharmacodynamics D. Polymorphism

D. Polymorphism Drug polymorphism refers to the effect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs.

A nurse makes an error when administering the medications to a patient. Which action by the nurse requires the supervising nurse to intervene? The nurse A. Completes an incident report B. Informs the prescriber of the error C. Documents adverse effects to the medication error D. Records completion of an incident report in the medical chart.

D. Records completion of an incident report in the medical chart. **The nurse should create and incident report but not in the medical chart.

The nurse is preparing to administer a transdermal patch to a patient and finds that the patient already has a medication patch on his right upper chest. What will the nurse do? A. Remove the old medication patch and notify the health care provider. B. Apply the new patch without removing the old one. C. Remove the old patch and apply the new patch in the same spot. D. Remove the old patch and apply the new patch to a different, clean area.

D. Remove the old patch and apply the new patch to a different, clean area.

Which statement is an example of objective data? (Select all that apply.) A. The patient states that she has a headache. B. The patient says that she feels like someone is touching her arm. C. The patient says that she has felt tired for almost a week. D. The patient has clear urine noted by microscopic examination. E. The patient has had a fever for 5 days.

D. The patient has clear urine noted by microscopic examination. E. The patient has had a fever for 5 days.

A nurse is caring for a client who is newly admitted to the facility for chest pain. At which of the following times should the nurse begin teaching about drugs and discharge planning? A. after the client has a definitive diagnosis B. on the day of discharge C. when the client's familiar present D. as soon as possible

D. as soon as possible

A nurse is teaching a client about the adverse effects of digoxin. which of the following statements should the nurse include in the teaching? A. adverse effects are the intended effects of the medication B. adverse effect indicate a serve allergy to the medication C. decrease your medication dose if adverse effect occur D. contact your provider if adverse effect occur

D. contact your provider if adverse effect occur

A nurse is teaching a client about naproxen enteric-coated tablets. Which of the following statements should the nurse include in the teaching? A. drug absorption occurs in the stomach B. you should expect immediate absorption of the drug C. you should allow the tablet to dissolve in your mouth D. do not crush or chew the tablet

D. do not crush or chew the tablet

A nurse is speaking to a client who is taking sertraline and reports drinking grapefruit juice. The nurse explains that grapefruit juice inhibits an enzyme in the liver that is used to metabolize sertraline. The nurse should recognize the client's risk for which of the following? A. reduced drug absorption B. drug dependence C. altered drug distribution D. drug toxicity

D. drug toxicity

A nurse is providing teaching to a pregnant client who is taking captopril, an ACE inhibitor, to treat hypertension. the nurse informs the client that captopril is a teratogenic drug. The nurse should explain that teratogenic drugs can cause which of the following? A. maternal bleeding B. maternal blood clots C. gestational diabetes mellitus D. fetal malformation

D. fetal malformation

A nurse is caring for a client who has a new prescription for a drug. After receiving the first dose of the drug, the client experiences anaphylaxis. The nurse should identify that anaphylaxis represents which of the following results of the drug? A. adverse effect B. paradoxical effect C. therapeutic effect D. toxicity

D. toxicity

Patients with renal failure would most likely have problems with which pharmacokinetic process? A. Distribution B. Metabolism C. Absorption D.. Excretion

D.. Excretion

A nurse is planning to administer an intradermal injection to a patient. Which represents the appropriate technique for this route? A.21-gauge needle at 15 degrees B.20-gauge needle at 90 degrees C.23-gauge needle at 45 degrees D.26-gauge needle at 15 degrees

D.26-gauge needle at 15 degrees

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates the health care provider will perform which action to minimize the risk of toxicity? A. Shorten the time interval between doses. B.Administer the medication intravenously. C.Increase the amount of drug given. D.Decrease the amount of drug given.

D.Decrease the amount of drug given.

The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor? A.Diet of the mother B.Fetal sex C.Maternal blood type D.Drug properties

D.Drug properties

Which position is most appropriate for the nurse to position a patient when administering medications via a nasogastric (NG) tube? A.Trendelenburg B.Supine C.Left side D.Fowler's

D.Fowler's

A patient is complaining of severe pain and has order for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route? A.IV B.IM C.Subcutaneous D.PO

D.PO

A patient is transferred from an intensive care unit (ICU) to a general medical-surgical unit. Which nursing action is most appropriate to prevent a medication error? A.Contact the health care provider to rewrite all drug prescriptions. B.Ask the patient what medications need to be taken while in the hospital. C.Communicate a verbal report face-to-face from the transferring nurse. D.Perform a medication reconciliation of the patient's chart during care transition.

D.Perform a medication reconciliation of the patient's chart during care transition.

What is the professional responsibility of the nurse when the nurses' ethics conflict with the patient? A.Use beneficence, the duty to do no harm to a patient and disregard personal feelings. B.Impose his or her own values on the patient when doing so would help the patient. C.Withhold information from the patient as requested by the family. D.Transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.

D.Transfer care of a patient to another professional nurse if caring for the patient would violate personal ethical principles.

When administering a sublingual medication, which action will the nurse perform? A.Ask the patient to chew the medication so that it will absorb faster. B.Have the patient swallow several times while the tablet dissolves. C.Instruct the patient to drink room temperature water to enhance dissolution. D.Wear gloves to place the tablet under the patient's tongue.

D.Wear gloves to place the tablet under the patient's tongue.

Every day (abbreviation)

Daily

Assessment

Data collection, review and analysis -Objective v subjective data which includes Medication profile, physical exam, allergies, any and all drug use, culture, developmental stage, social history, labs, current and past medical history, compliance and adherence.

Physiology changes in the elderly patient: Renal

Decreased: Blood flow= decreased excretion Decreased: Function= decreased excretion Decreased: Glomerular filtration rate= decreased excretion

Physiology changes in the elderly patient: Hepatic

Decreased: Enzyme production= decreased metabolism Decreased: Blood flow= decreased metabolism

Physiologic changes in the elderly patients: Cardiovascular

Decreased:cardiac output=decreased absorption and distribution Decreased:blood flow= decreased absorption and distribution

Tolerance

Decreasing response to repeated drug dose

Chemical name

Describes the drug's chemical composition and molecular structure

Dosage form

Determines the rate at which drug dissolution (dissolving of solid dosage forms and their absorption) occurs.

Practice standards of care

Determines whether a nurse is acting appropriately when performing professional duties

Nurse's role in medication administration

Determining medications ordered are correct, assessing patient's ability to self-administer, determining whether patient should receive medications at a given time, administering medications correctly, and closely monitoring effects. Cannot be delegated Includes patient teaching

Parenteral administration (disadvantages)

Difficult to administer, risk for infections, and takes time to prepare.

First-pass effect

Drug metabolism by liver/colon before it reaches systemic circulation causing reduced amount entering circulation (occurs with PO meds)

opioid ceiling effect

Drug reaches a maximum analgesic effect Analgesia does not improve, even with higher doses

Antagonists are

Drug that bind with a receptor and either block a response or precipitate less than typical response

Biliary excretion of drugs

Drugs are taken up by the liver, released into the bile, and eliminated in the feces.

DEA Drug schedules (Schedule I)

Drugs substances or chemical are defined as drug with no currently accepted medical use and a high potential for abuse. Are the most dangerous drugs of all the drugs schedule with potentially severe psychological or physical dependence.

Agonists are

Drugs that bind with a receptor and precipitate a greater than typical response

Look alike and sound alike

Drugs with similar spelling or pronunciation

oral administration (PO)

Easiest and most desirable route Food sometimes affects absorption Aspiration precaution Enteral or small-bore feedings -Verify that the tube location is compatible with medication absorption -Use liquid when possible -If medication is to be given on an empty stomach, allow at least 30 minutes before or after feedings -Risk of drug-drug interactions is higher

Drug polymorphism

Effects of patient's characteristics on pharmacokinetics of specific drugs -Environmental and economic (assess to health care, or provider, socioeconomic status) -Cultural factors -Genetic (inherited) factors -variations also occur between ethnic groups with adverse effects

Excretion

Elimination of drugs from the body. -Primary organ for elimination is the kidney, liver and the bowel. -Other routes of elimination are the lungs, sweat, salivary, mammary glands.

What medications CAN NOT be crushed?

Enteric-coated and extended-released drugs can not be crushed.

Opiod Tolerance

Exposure to drug overtime induces change of med to receptors

XL

Extended length

XT

Extended time

Who regulates prescription drug use?

FDA AND DEA

Drug Label

FDA Requires: -purpose and use -specific warnings -when it is appropriate to contact HCP -side effects -substances/activities to avoid -dosage instructions -active/inactive ingredients -storage information

Enteral administration (advantages)

Fast administration, patient can take home, no preparation, available (over the counter)

Pregnancy Safety Categories: Category X

Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women.

Pharmacokinetic changes: Excretion

GFR is decreased (Kidney immature), decreased perfusion to kidney--> reduced excretion of drugs

NSAID adverse effects

GI bleed and GI complications, renal failure, heart failure MI and stroke (except aspirin), hepatotoxicity, sensitivity reactions

Pharmacokinetics changes: Absorption

GI emptying slowed; first-pass is reduced (immaturity of liver); IM absorption is faster and irregular; stomach lacks acid to kill bacteria

Ginseng

Ginseng is an herb that is used in alternative medicine to possibly lower blood glucose level after meals in patients with type 2 diabetes and respiratory infections to prevent cold of flu symptoms. It is not yet proven that ginseng is effective for treating any medical conditions and has not been approved by the FDA. Adverse effects include diarrhea, insomnia, headache, rapid heartbeat, increased or decreased blood pressure, breast tenderness and vaginal bleeding. Since Ginseng has anticoagulant effects, patients should avoid with warfarin (Coumadin) and NSAIDs. Other drug interactions include diabetes medications, antidepressants, immunosuppressants (like azathioprine, cyclosporine, daclizumab, basiliximab, tacrolimus, sirolimus, and prednisone) and other corticosteroids (glucocorticoids). Nursing implications include getting a thorough medication history that includes any prescription, OTC, herbal products, vitamins, minerals, and other dietary supplements to assess for potential drug-drug or drug-herb interactions. Assess heart rate, blood pressure, blood glucose and respirations before and after taking ginseng. Ask patient to report any breast tenderness, vaginal bleeding or insomnia. Increase fluid intake if diarrhea occurs.

PRN medication order

Given when the patient requires it

Echinacea

Herb: Echinacea (herbal supplement) Indications: used as a treatment for common colds, herpes simplex infection (topical), immunostimulant, psoriasis (topical), upper respiratory infection (viral), Urinary Tract Infection, vaginal yeast infection, skin wounds (topical), skin ulcers (topical). Contraindications: autoimmune disorders, HIV/AIDS, leucosis, multiple sclerosis, tuberculosis, collagen diseases; hypersensitivity to Asteraceae/Compositae plants, chrysanthemums, daisies, marigolds, ragweed. Adverse effects: Using echinacea for more than 8 weeks could damage your liver or suppress your immune system. Herbalists do not recommend Echinacea if you are taking medicines known to affect your liver. Possible interference with or counteraction to immunosuppressant drugs and antivirals. Exercise caution with autoimmune disease. Risk of altered fertility, diarrhea, nausea/vomiting. Interactions: Tizanidine: Echinacea may significantly increase pharm actions of Tizanidine. Rasagiline: Echinacea may increase plasma concentrations of rasagiline. Beclomethasone (inhalant). Nursing implementations: The registered nurse should be aware that Echinacea stimulates increased activity of the immune system. Clients with autoimmune disorders should avoid using this. The nurse should encourage the client to tell the health care provider about any other medications or dietary/herbal supplements the client chooses to use. This will help to prevent possible drug interactions. The nurse should also be aware of contraindications for this herbal supplement. The nurse should encourage any female patients to consult their health care provider regarding pregnancy since there is no known information regarding the use of Echinacea during pregnancy or breastfeeding.

Goldenseal

Herb: Goldenseal (Yellow Root) Indications for use (disease it treats and/or prevents): Common cold, respiratory tract infections, allergic rhinitis (hay fever), ulcers, diarrhea, constipation, skin rashes, a mouthwash for sore gums, and an eyewash for conjunctivitis. Adverse effects: *Mainly safe for most adults*, Adults: Those who are pregnant or breast-feeding it is most likely unsafe for the infant. A chemical in the root can cross the placenta and be found in the breast milk which can cause brain damage. Children: Unsafe for newborn babies Interactions: Cyclosporine: will decrease how fast the body breaks down the drug which can result in too much being present in the body. Digoxin: can cause a slight increase in the digoxin levels in the body. Medications changed by the liver: can decrease how quickly the liver breaks down some medications. Medications moved by pumps in cells: can make the pumps less active and increase how much of medication is absorbed. Nursing implications: For dose information: it is by the person's age, health, and other factors. There is not enough information on this herb, further research must be conducted.

DEA Schedule 1 Drug examples

Heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3-4 methylenedioxymethamphetamine (ecstasy), methqualone, and peyote.

Peak Level (drug effect)

Highest blood level of a drug: if the peak blood level is too high, drug toxicity may occur; indicates absorption

St. John's wort

INDICATIONS FOR USE: Depression, anxiety, nervousness, heart palpitations, mood disturbances associated with menopause, Attention Deficit / Hyperactivity Disorder (ADHD), obsessive-compulsive disorders (OCD), Seasonal Affective Behavior (SAD), Pre-menstrual Syndrome (PMS), and Social Phobia. COMMON SIDE EFFECTS: May cause insomnia, vivid dreams, restlessness, dry mouth, dizziness, fatigue, and headaches. ADVERSE EFFECTS: Agitation, irritability, Gastrointestinal discomfort, diarrhea, severe skin rash INTERACTIONS: May decrease effects of alprazolam, amitriptyline, oral contraceptives, cyclosporine, imatinib, irinotecan, NNRTIs, phenytoin, protease inhibitors, tacrolimus, warfarin, benzodiazepines, valproic acid, phenobarbital, immunosuppressants, sympathomimetic amines, tyramine-containing foods, opioids, digoxin, estrogens, HIV drugs, monoamine oxidase inhibitors, zolpidem and other hypnotic drugs, theophylline, triptans, dextromethorphan, loratadine, cetirizine, fexofenadine. May cause addictive serotonergic effects with antidepressants, paroxetine, sertraline, and tramadol. CONTRAINDICATIONS: St. John's Wort is contraindicated in patients with bipolar depression, schizophrenia, Alzheimer's disease, and dementia. NURSING IMPLICATIONS: Do not take St. John's Wort without medical advice if you regularly use other medications. Avoid sun exposure while taking this drug, for product can make you sunburn more easily. This drug can affect fertility. You should avoid taking this drug if you are trying to get pregnant. St. John's Wort may harm an unborn baby. Do not use this product without the medical advice if you are pregnant. This product can also pass through breast milk and cause unwanted effects while breastfeeding. Should not be given to children under the age of 6, but permitted (under medical supervision) for children and teens (6-17 years of age). St. John's Wort should be taken for 4-6 weeks and if condition persists, new evaluation and medications should be considered.

Responding to Medication Errors

Imediate priority is the safety of the patient 1. Check the patient's condition immediately when error is noted Observe for adverse effects related to the error. 2.Notify the nurse manager and primary care provider to SBAR for course of action. 3. Write what error occured on medical record, including remedial steps taken. 4. Complete the form used for reporting errors as dictated by facility.

Pharmacokinetics changes: Metabolism

Immature liver (young), older children have increased metabolism and require higher dosages

Physiological changes in the elderly patients: Gastrointestinal

Increased PH (alkaline gastric secretions)= altered absorption Decrease peristalsis= delayed gastric emptying

Ginger

Indication: relieving nausea, loss of appetite, motion sickness, and pain Adverse effects: increases bleeding, heartburn, diarrhea, mouth, and throat irritation Interactions: May increase the risk for bleeding if taken with anticoagulants and antiplatelets Nursing impactions: must enhance safety, teach clients strategies to prevent adverse, interactions and toxicity. Also, determine the dosage frequency and amount.

Chamomile

Indications for Use: Traditionally chamomile has been used to treat inflammation of the skin and mucous membranes. It can also be used to treat bacterial infections of the skin, colic, croup, diarrhea, and mastitis. Adverse Effects: Some adverse effects of chamomile use can include: anaphylaxis, contact dermatitis, vomiting, and eye irritation. Interactions: Chamomile has been found to interact with sedatives, NSAIDs, anti-platelet drugs, and aspirin. Nursing Implications: Chamomile is not contraindicated for breastfeeding mothers. It is sometimes used as a galactagogue. Galactagogues are believed to increase breastmilk production, though this has not been proven.

Hawthorn

Indications for us it treats/prevents: Hawthorn can be used for countless purposes mainly for treatment. Studies shows that is is used for a disease of the heart, and blood vessels such as congestive heart failure, chest pain, and irregular heartbeat. It can also be used to treat both low blood pressure and high blood pressure, atherosclerosis, and high cholesterol. Hawthorn can also be used for the digestive system, regarding indigestion, diarrhea, and stomach pain. The herb can be used to reduce anxiety and be used as a sedative to increase urine output and for menstrual problems. Hawthorn can also be used to treat tapeworms and intestinal infections. Some people utilize hawthorn and apply it to the skin for boils, sores, and ulcers. Hawthorn is possibly safe for short term use (up to 16 weeks). It is not known if hawthorn has been successful as a long-term use. Adverse effects: Taking hawthorn can cause nausea, upset stomach, fatigue, sweating, headache, dizziness, palpitations, nosebleeds, insomnia, and agitation. Interactions: This herb cannot be taken with digoxin (Lanoxin) because it can increase the effects of digoxin and increase the risks of side effects. It can not be taken with any blood pressure medication because it can cause your blood pressure to decrease. Males can't take hawthorn and any medication for sexual dysfunction because it may cause your blood pressure to go too low. Lastly, this herb can't be taken with any medication that increases the blood flow to the heart (nitrates) because it may increase the chance of dizziness and lightheadedness. Interacting Hawthorn with drugs may lead to toxic levels of cardiac glycosides (e.g., digitalis). Nursing implications: For pregnant and breast feeding: not enough tests have been conducted to know to see the effects of hawthorn during pregnancy or while breastfeeding therefore patient should stay on the safe side and avoid the use. If client has a heart condition and is taking any heart medications avoid the use of hawthorn. Preoperative patients should avoid using this herb 2 weeks before surgery because hawthorn may slow blood clotting and increase the risk of bleeding during and after surgery. Always monitor for any unusual or adverse effects while taking Hawthorn including therapeutic effects.

Garlic

Indications for use: Garlic can be used for many purposes such as, treating or preventing high blood cholesterol, high blood pressure, coronary artery disease, and the common cold, as well as in attempts to prevent cancer (stomach, colon or rectal) and other diseases. Adverse effects: Breath and body odor, burning sensation in the mouth or stomach, heartburn, upset stomach, nausea, vomiting or diarrhea. Interactions: Possible interference with hypoglycemic therapy and anticoagulant Warfarin (Coumadin). Garlic also interacts with Isoniazid, Saquinavir, HIV or AIDS medications, and NSAIDS. Nursing implications: Garlic may pass into breast milk and may harm a nursing baby. Do not use this product without medical advice if breast-feeding a baby. Do not give any herbal/health supplement to a child without medical advice. Garlic taken by mouth in large doses may be harmful to children.

Glucosamine

Indications for use: Glucosamine is most commonly used to provide relief pain and improve joint function for those with osteoarthritis, rheumatoid arthritis, and joint pain. Glucosamine is stated to have further uses but has not been proven with adequate research such as heart disease, knee pain, multiple sclerosis, stroke, jaw pain, glaucoma, interstitial cystitis, temporomandibular joint disorder, and weight loss. Adverse effects: Glucosamine is mostly safe in adults but can cause the following side effects: nausea, heartburn, diarrhea, constipation, drowsiness, skin reactions, headaches, and hyperglycemia. Interactions: Glucosamine has a MAJOR interaction with Warfarin. It may enhance the anticoagulant effects of warfarin. Glucosamine may also cause an increase in insulin resistance, which results in the need for higher dosages of oral hypoglycemics or insulin. Glucosamine may also decrease the effectiveness of chemotherapy medications such as etoposide, teniposide and doxorubicin Lastly, it may decrease the effectiveness of acetaminophen. Nursing implications: Women who are pregnant or breastfeeding should not take glucosamine since there is not enough research to support its safe use. People who are allergic to shellfish should not take glucosamine since the supplement is derived from crabs, shrimps and the shell of lobsters. Stop taking glucosamine at least two weeks before a scheduled surgery as it may impact the body's ability to regulate blood sugar. Monitor pain and range of motion periodically while taking glucosamine.

Valerian

Indications for use: Valerian is an herb sold as a dietary supplement in the United States. It is a native plant to Europe and Asia. Valerian is used to treat sleep disorders such as insomnia. There are other uses that have not been proven by research such as: treatment for attention deficit-hyperactivity disorder, anxiety disorders, depression, restlessness, chronic fatigue syndrome, and tremors. Adverse effects: Headaches, dizziness, and gastrointestinal disturbances are the most common effects reported in clinical trials but similar effects were also reported for the placebo. Interactions: Valerian may have additive therapeutic and adverse effects if taken with Xanax, Valium, Ativan, and Central nervous system depressants. Nursing implications: Women who are pregnant or nursing should not take valerian without medical advice because the possible risks to the fetus or infant have not been evaluated.

Black Cohosh

Indications: To treat the symptoms of menopause, PMS, painful periods, acne, osteoporosis, and starting labor in pregnant women. Other lesser know treatments are anxiety, rheumatism, insect repellent, fever, and cough. Adverse Effects: Possibly safe when taken by mouth by adults for one year. Mild side effects include: upset stomach, cramping, rash, a heavy feeling, vaginal spotting / bleeding, and weight gain. Interactions: Atorvastatin commonly know Lipitor has harmful effects with Black Cohosh. Black Cohosh has the potential to harm the liver, so taking Lipitor might increase the chance of liver damage. However, it's not enough scientific data to know if this is an impact or concern. Please alert your healthcare provider before taking this herb while on Lipitor. Cisplatin also known as Plantinol- AQ is a cancer treating medicine that will lose it effectiveness if taken with Black Cohosh. Any Medicine that is broken down in the liver should not be taken with Black Cohosh. Due to the possibility of liver damage. Some examples are : Elavil, Clozaril, Fentanyl, Zofran, and Tylenol. Nursing: Possibly unsafe for pregnancy and breastfeeding. Since Black Cohosh can act as a female hormone, it increases the risk of mischarges.

Implementation

Initiation and completion of specific nursing actions as defined by the human needs, goals, and outcome criteria. Independent, collaborative and dependent.

(Dosage forms) Parenteral examples

Injectable forms, solutions, suspensions, emulsions, powders for reconstitution

high alert medications examples

Insulin, anti coagulant, chemotherapy, morphine, etc.

Injection degrees

Intramuscular: 90 degrees Subcutaneous: 45 degrees or 90 degrees Intradermal: 15 degrees

Kava Kava

Kava also known as Kava Kava is used for it's herbal use to relieve stress and anxiety and to help boost sleep. Kava is known to have an euphoric effect that compares to drinking alcohol. People can mix Kava with boiled water to create a tea or take the tablet form. Indications for use: Kava is used to encourage sleep and relieve anxiety. Researchers suggest the use of Kava to help treat symptoms or side effects of anxiety disorders. Kava is also used to help induce sleep. Kava has anxiolytic effect and for this reason people use it as an alternative to help with sleep disorders. Adverse effects: Researchers suggest that Kava may cause liver damage. Symptoms include fatigue, nausea, jaundice, abnormal enzyme levels, rash and fever. Long term use of Kava in high doses can cause dry, scaly skin, yellow skin, heart and eye problems. Interactions: Kava interacts with alcohol, consuming both alcohol and Kava could increase a person's risk of developing liver damage. Kava also interacts with other drugs such as benzodiazepines and anti-depressants. For this reason people should consult their doctor's before using Kava. Nursing Implications: Little research has been done on the use of Kava in women who are pregnant. Until more research is conducted, Kava should be avoided in pregnant women. Kava has been banned in several countries not including the U.S. Kava is known to cause possible liver damage so people should try alternative therapies to treat anxiety disorders and improve quality of sleep.

NSAIDS

Large and chemically diverse group of with the following properties: Analgesic, anti-inflammatory, antipyertic, aspirin-platelet inhibitor NSAIDS are also used for the relief of: mild to moderate headaches, fever, dysmenorrhea, myalgia, arthralgia, postop pain, arthritic disorders, gout & hyperuricemia

Loading dose (drug effect)

Large initial dose of drug is given to achieve a rapid minimum effective concentration in the plasma ** in order to give loading dose, must have labs**

Duration of action (drug effect)

Length of time that the drug concentration is sufficient (without more doses) to elicit a therapeutic response.

Trough level (drug effect)

Lowest blood level of a drug: measures excretion

Near miss event

Medical error that is recognized before any harm is done to patient eg. patient prescribed lethal dose of medication but error is caught by pharmacist

Enteral

Medications absorbed through GI tract. Absorbed from the intestinal lumen into the blood system and transported to the liver. Onset action 30-60 mins SL and Buccal (cheek or mouth) forms bypass the liver and still bioavailable

Tramadol

Miscellaneous analgesic -not currently classified as a controlled substance -Indicated for treatment of moderate to moderately severe pain -Absorption is unaffected by food -adverse effects are similar to those of opioids: drowsiness, dizziness, headache, nausea, constipation,, seizures, respiratory depression. -increased risk for serotonin syndrome when tramadol is taken concurrently with SSRIs -Contraindications: drug allergy including opioids. -Available in oral dosage forms, including a combination with acetaminophen -assist with ambulation, injury prevention, constipation and nausea interventions

Opioids side effects

Most side effects are dose related as patient becomes tolerant, the patient tolerates the side effects. -CNS Depression, respiratory depression, nausea and vomiting, overdose, hypotension/bradycardia, dependence (physical and psychological) vs. tolerance, urinary retention, diaphoresis and flushing, pupil constriction (miosis), constipation & N/V, itching

Absorption

Movement of a drug from its site of administration into the blood stream

Preventing Medication Errors

Multiple systems of checks and balances Legible and correct orders Appropriate consultation Check medication order three times "Six Rights" of medication administration

Generic name (nonproprietary name)

Name given by the United States Adopted Names Council Ex: acetaminophen (generic)

Phantom pain

Occurs in the area of body part that has been removed-surgically or traumatically and is often described as burning, itching, tingling, or stabbing.

Enzymes (mechanism of action)

Occurs when the drug chemically binds to an enzyme molecule in such a way that it alters (inhibits or enhances) The enzyme's interaction with its normal target molecules in the body.

Referred pain

Occurs when visceral nerve fibers synapse at a level in the spinal cord close to fibers that supply specific subcutaneous tissues in the body.

central pain

Occurs with tumors, trauma, inflammation, or disease affecting CNS tissues.

Parenteral administration (advantages)

Offers an alternative route for meds that can not be given orally, bypasses first pass effect, faster, good for emergencies, and high bioavailability.

Single (one time) medication order

Order for medication that is given only once at a specified time.

after meals (abbreviation)

PC

Whenever there is a need

PRN

Superficial pain

Pain that originates from the skin or mucous membranes; opposite of deep pain.

How can a nurse monitor the effects of drug therapy?

Patient's reaction, vital signs, pain level, blood level, and clinical data.

herbs

Plant components including bark, roots, leaves, seeds, flowers, fruit of trees, and extracts of these plants that are valued for their savory, aromatic, or medicinal qualities.

Pregnancy Safety Categories: Category D

Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women.

New rules of pregnancy categories require three subsections

Pregnancy: includes information of dosing and potential risk to fetus Lactation: Includes information regarding breast-feeding (amount of drug in breast milk and potential effect on child) Females and Males of reproductive potential: Includes information about contraception, pregnancy testing, and infertility ** New and full effects won't be seen for several years**

pharmacist's role in medication administration

Prepares and distributes medication

Planning

Prioritizes the human needs and specify outcomes including the time frame for their achievement. PATIENT FOCUSED!!

DEA Schedule Drug III Examples

Products containing less than 90 milligrams of codeine per dosage unit (tylenol with codeine), ketamine, anabolic steroids, testosterone

ANA code of ethics for nurses (THE CODE)

Promise of the nursing profession to provide the best care to patients, families, and communities. Guide for ethical professional nursing practice.

Beneficence

Promoting good

Every 4 hours (abbreviation)

Q4H

Every morning, every AM

QAM

every hour (abbreviation)

QH

4 times a day (every 6 hours)

QID, qid, Q6h

Pharmacodynamics

Relates to the mechanisms of drug action in living tissues.

Health Insurance Portability and Accountability Act (HIPAA) of (1991)

Requires ALL HCP, insurance companies, public health, employers and school to maintain privacy regarding protected health information

Idiosyncratic reaction

Response that occurs unexpectedly and that is unknown

Ethics of Care

Rules of conduct for human actions

Pasero Opioid-Induced Sedation Scale

S= Sleep, easy to arouse 1 = awake and alert; no action necessary 2 = occasionally drowsy but easy to arouse; requires no action 3 = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose 4 = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone.

Give immediately (abbreviation)

STAT, stat

Salicylates Side Effects

Salicism Increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, drowsiness, nausea, vomiting, diarrhea, heartburn, GI bleed, Acute Renal Failure, Hepatotoxicity, sweating, thirst, hyperventilation, hypoglycemia or hyperglycemia, metabolic acidosis or respiratory alkalosis

Enteral administration (disadvantages)

Slower response time, and patient can not swallow

Patient-controlled analgesia (PCA)

Specialized pump is used to allow patients to self-administer pain meds by pushing a button IV bolus doses. -Patients who use PCA must be able to understand relationships b/w pain, pressing PCA button, taking the analgesic, and pain relief; must also be cognitively and physically able to use equipment -Morphine and hydromorphone are common used -Dilaudid is SEVEN TIMES more Potent than morphine!! -safety measures (lock outs) prevent overdoses -Need to be monitored closely for response, excessive sedation, respiratory depression, hypotension, and changes in mental status -Follow institutional protocol for set up and use -instruct friends and family to contact nurse if they have concerns about PCA (PCA by proxy) -Patients can receive basal (continuous) rate or demand dose.

SMART

Specific, Measurable, Attainable, Realistic, Timely

Topic administration (advantages)

Specific, high bioavailability, easy to apply and available to the public (over the counter)

Pregnancy Safety Categories: Category B

Studies indicate no risk to the animal fetus; information for humans is not available

Pregnancy Safety Categories: Category A

Studies indicate no risk to the human fetus

SA

Sustained action

3 times a day (every 8 hours)

TID, Q8h

(Dosage forms) Enteral examples

Tablets, capsules, oral soluble wafers, pills, time-released capsules/tablets, elixirs, suspensions, syrups, etc.

Metabolism (biotransformation)

The biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite -Liver is organ responsible for metabolism of drugs. -Other metabolic tissues are skeletal muscles, kidneys, lung, plasma and intestinal mucosa.

Pharmacotherapeutics

The clinical use of a drug to treat or prevent illness and/ or disease

Trade name (proprietary name)

The drug has a registered trademark; use of the name is restricted by the drug's patent owner (usually the manufacturer) Ex. Tylenol (Brand)

Hospital Accreditation Bodies

The joint commission and health care facilities accreditation program

Types of Needles

The larger the gauge number, the smaller the needle!

pain threshold

The level of a stimulus that results in the sensation of pain. example: pen v hammer

Pharmacoeconomics

The study of economic factors impacting the cost of drug therapy.

Pharmaceutics

The study of how dosage FORMS influence how drug affects body.

Toxicology

The study of poisons and unwanted responses to drugs and other chemicals

Pharmacology

The study or science of drugs/medications.

Half life (drug effect)

Time required for one half (50%) of a given drug to be removed from the body: measures elimination: mostly eliminated about 5 cycles : influences drug dosage schedules.

Maintaining Patients' Rights

To be informed about a medication To refuse a medication To have a medication history To be properly advised about experimental nature of medication To receive labeled medications safely To receive appropriate supportive therapy To not receive unnecessary medications To be informed if medications are part of a research study

Distribution

Transport of a drug by the bloodstream to its site of action. Once a drug enters the blood stream, it is distributed throughout the body; it also starts being eliminated by the organs that metabolize and excrete drugs (Primarily the liver and the kidneys)

Salicylates management of toxicity/overdose

Treatment goals include removing salicylate from the gastrointestinal tract and/or preventing its further absorption; correcting fluid, electrolyte, and acid-base disturbances; and implementing measures to enhance salicylate elimination, including hemodialysis

Acetaminophen

Type of nonopioid analgesic Mech of action: blocks peripheral pain impulses; acts on hypothalamus to decrease temp used for mild pain and fever can be administered with opioids can be given PO, rectal and IV can be used in combination with other drugs alternative to aspirin contrindications: allergy,, liver disease, G6PD deficiency

Ethnopharmacology is defined as:

Understanding the specific impact of culture on patient drug response

GINKGO

Used to treat: Ginkgo improves mental function or treating anxiety, dementia, leg pain caused by blood circulation problems, premenstrual symptoms, vision problems caused by glaucoma or diabetes, vertigo (dizziness), or a movement disorder (tardive dyskinesia) caused by taking certain antipsychotic drugs. Adverse Effects: Allergic skin reactions Bleeding disorders Constipation Contact dermatitis (topical use) Diarrhea Dizziness Impaired fertility Headache Nausea/vomiting Palpitations Restlessness Seizures Stomach upset Subdural hematoma Weakness Vertigo (rare) Interactions: Severe interactions of Ginkgo biloba include: There are no known severe reactions from the use of Ginkgo biloba. Serious interactions of Ginkgo biloba include: There are no known serious reactions from the use of Ginkgo biloba. Moderate interactions: Ginkgo Biloba has known moderate interactions with at least 75 different drugs. Contraindications: Hypersensitivity Avoid prior to surgery: may cause bleeding. Attempting conception Nursing Implications: Discontinue 2 weeks prior to surgery. May Cause seizures with overdose. Keep out of reach of children.

Saw Palmetto

Uses-Saw palmetto is a tree use to make medicine. It is mostly used for decreasing symptoms of an enlarged prostate (benign prostatic hypertrophy-BPH). It is also used to prevent complications from prostate surgery and other types of prostate conditions. It has a suggested use for treating baldness in men and women. Research has shown that taking 320 mg of saw palmetto daily for two months before prostate surgery can reduce the time spent in surgery, blood loss, the development of problems during surgery, and the total time spent in the hospital. However, taking 160mg for 5 weeks prior to surgery did not lower the risk for problems. Side effects and Safety-Saw palmetto is likely safe for most people when taken by mouth for up to three years. Some people have reported dizziness, headache, nausea, vomiting, constipation, and diarrhea. Some people have reported that it causes impotence. There is some concern that saw palmetto may cause liver or pancreas problems. However, these side effects do not seem to occur anymore often with saw palmetto than with a sugar pill and not enough information to know if it causes these side effects. Saw palmetto is likely unsafe when taken by mouth during pregnancy or breastfeeding. It acts like a hormone, and this could be dangerous to the pregnancy. Saw palmetto might slow blood clotting. There is some concern that it might cause extra bleeding during and after surgery. Stop using saw palmetto at least 2 weeks before a scheduled surgery. Saw palmetto is possibly safe when administered into the rectum appropriately for up to 30 days. It is not known if its safe to use longer. Interactions- It has a moderate interaction with birth control pills. It may decrease the effectiveness of birth control pills. Some medications that slow blood clotting might increase the chances of bruising and bleeding. These medications include aspirin, clopidogrel (Plavix), diclofenac (Voltaren, Cataflam, etc.), Ibuprofen (Advil, Motrin, etc.), naproxen (Anaprox, Naprosyn, etc.), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, warfarin (Coumadin) and others.

Volume of distribution

Various areas in which drugs may be distributed

Now medication order

When a medication is needed right away, but not STAT

If a drug particles bind to albumin, they become inactive and there is a limited amount of "free" drug in circulation

When there are too many "free" drug concentration, increases drug interactions and drug toxicity.

DEA Drug Schedule IV Examples

Xanax, soma, darvon, darvocet, valium, ativan, talwin, ambien,, tram

Human need statements

a means of communicating and sharing information about the patient and the patient experience. -Three step process example; acute pain related to injury evidence by 10/10 pain, throbbing and worse with movement

What is a contraindication?

a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person. Ex. pregnancy, liver disease, and allergies

Renal excretion of drugs

accomplished through glomerular filtration, active tubular reabsorption and active tubular secretion.

Reye's syndrome

acute, potentially life-threatening condition involving progressive neurologic deficits that can lead to coma and may also involve liver damage.

as desired (abbreviation)

ad lib

Acetaminophen interactions

alcohol, other hepatotoxic agents, phenytoin, barbiturates, warfarin, isoniazid, rifampin, beta blockers, anticholinergics

Indomethacin (acetic acid derivatives)

analgesic, anti-inflammatory, antirheumatic, and antipyretic properties. Uses: RA, OA, Acute bursitis or tendonitis, ankylosing, spondylitis, acute gouty arthritis, and treatment of preterm labor. -oral, rectal, intravenous use

Adverse drug event

broad term for any undesirable occurrence involving medications

Dietary supplement

broad term for orally administered alternative medicines and includes the category of herbal supplement, vitamins, minerals, botanicals, enzymes, etc: used to prevent or treat illness

Cancer pain

can acute or chronic or both. It most often results from pressure of the tumor mass against nerves, organs or tissues.

DEA Schedule II Drug examples

combination products with less than 1.5 milligram of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (demerol), oxycodone (oxycontin), fentanyl, dexedrine, adderall, and ritalin

Topic administration (disadvantages)

cost, takes time to see results

DEA Drug Schedule V Examples

cough preparations with less than 200 milligrams of codeine or per 100 milliliters (robitussin AC), lomotil, motofen, lyrica, parepectolin

DEA Schedule IV

drug, substances, or chemicals are define as drugs with a low potential for abuse and low risk of dependence

DEA Drug schedules III

drugs, substances, or chemicals are define as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than schedule I and schedule II drugs but more than schedule IV

DEA Drug Schedule V

drugs, substances, or chemicals are define as drugs with lower potential for abuse than schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs generally used for antidiarrheal,, antitussive and analgesic purposes

DEA Drug Schedule (Schedule II)

drugs, substances, or chemicals are defined as drugs with a moderate to low potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous

Nonmalefience

duty to do no harm

Teratogens

effects that cause structural defects in a fetus

Ethical dilemmas in healthcare?

end of life (withdrawing care), treating criminals, homeless, homosexuals/LGBQ, abortion (pro-life or pro- choice)

Justice

fairness and equality

veracity

filled with truth and accuracy

STAT medication order

given immediately in an emergency

COX-2 inhibitors adverse effects

headache, sinus irritation,, diarrhea, fatigue, dizziness, lower extremity edema, and hypertension poses a risk for cardiac dysfunction, celecoxib is not be used in patient with known sulfa allergy

Areas of rapid distribution

heart, liver, kidneys, and brain.

chronic pain

is persistent or recurring lasting 3 to 6 months. If often more difficult to treat, b/c changes in the nervous system that often most difficult to treat, because changes occur in the nervous system that often require increase drug dosage.

Acute pain

is sudden and usually when treated. one example of acute pain operative pain

Fidelity

keeping promises and commitments made to others

Salicylates Contraindications

known allergy for salicylates conditions for increased bleeding pregnancy children < 16 with flu-like symptoms (in some cases; increased risk for Reye's) Reye's can be causes from a viral illness or use of aspirin with a viral illness

Medical conditions that affect metabolism (biotransformation)

liver issues and diabetes.

Drug concentration

measures the concentration of the drug in the blood

Therapeutic Index

measures the margin of safety of a drug. It is a ratio that measures the drug's toxic level to the level of therapeutic benefit. - A low therapeutic index means that the difference between a therapeutically active dose and a toxic dose is small leading to toxicity; therefore, its use requires closer monitoring.

Therapeutic drug monitoring (drug effect)

measuring drug levels and allow adjustments to achieve a therapeutic goal

Prescriptions medications order

medication to be taken outside of the hospital

Pharmacokinetics changes: Distribution

more drugs enter the brain (immature BBB), fat content lower, increased total body water

Ibuprofen (motrin, advil) [propionic acid derivatives]

most commonly used uses: analgesic effect in the management of RA, OA, primary demenorrhea, gout, dental pain, musculoskeletal disorders, antipyretic actions

Areas of slower distribution

muscle, skin, fat (based on blood supply)

Organizational issues

no process, lack of technology (ex. system down), overwhelming workload (ex. too many patients to one nurse)

WHO Analgesic Ladder Step 1

nonopioids (with or without adjuvant medications) after the pain has been identified and assessed. If pain persists or increases, treatment moves to

Goals of planning

objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria

Deep Pain

occurs in tissues below skin and mucous membranes. Pain may be appropriately treated when the source of the pain is known.

WHO Analgesic Ladder Step 3

opioids indicated for moderate to severe pain. administer with or without nonopioids or adjuvant medications

WHO Analgesic Ladder Step 2

opioids with or without nonopioids and with or without adjuvants. if pain persists or increases, management then rises to

visceral pain

originates from organs and smooth muscles

Vascular pain

pain that results from pathology of the vascular or perivascular tissues

Patient condition

patient's current disease and medical conditions

opioid naive

person receiving opioids analgesics for the first time and aren't used to its effects

Dependence

physiologic or psychological need for a drug

Medication errors

preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer

What is medical reconciliation?

process used to ensure an accurate list of all meds the patient is taking at every point of transfer. -on admission -when transferring between units -at discharge *essential to medical safety (JCAHO goal #3)

Analgesic Ladder

relieve pain without causing loss of consciousness

Confidentiality

respect privileges information

Naproxen (Propionic Acid)

second most commonly used somewhat better adverse effect profile than ibuprofen fewer drug interactions with ACE inhibitors given for hypertension

Autonomy

self-determination and to act on one's own

Somatic pain originates from

skeletal muscles, ligaments, joints

Acetaminophen adverse effects

skin disorders, nausea/vomiting, blood dycrasias (anemia), nephrotoxicites, hepatotoxicity**, low incidence of GI adverse effects,, does not increase bleeding time

SR

slow release or sustained release

Ketorolac (Toradol) [acetic acid derivatives]

some anti-inflammatory activity without addictive properties. -used primarily for its powerful analgesic effects which are comparable to those of narcotic drugs such as morphine. -Indications: short term use (up to 5 days) to manage moderate to severe acute pain most commonly orthopedic pain -Adverse effect: renal impairment, edema, GI Pain, dyspepsia and nausea

Bioavailability

the amount of active drug that reaches the systemic circulation from its site of administration (Paternal has higher): expressed in percentages

pain tolerance

the amount of pain a person can endure without it interfering with normal function

Pharmacogenetics

the scientific discipline studying how the effect of a drug action varies from a predicted drug response because of genetic factors or hereditary influence

Opioid withdrawal

the signs and symptoms associated with abstinence from or withdrawal of an opioid analgesic when the body has become physically dependent on the substance

Peak effect (drug effect)

time required for a drug to reach its maximum therapeutic response.

Onset of action (drug effect)

time required for the drug to elicit a therapeutic response.

Drug incompatibility

two parenteral drugs/solutions mixed together and a chemical deterioration of one or both drugs or formation of a physical precipitate occurs.

anti-thrombotic effect

used in the treatment of MI and other thromboembolic disorders examples: aspirin, diflunisal (dolobid), choline magnesium trialicylate (trilisate), and salsalate (salsitab)

Preventative therapy for migraines

used to prevent not treat used if migraines occur more than once a week first-line: propranolol, amitriptyline, valporic acid, topiramate second-line: naproxen, CCBs-verapamil, ARBs, ergot alkaloid, avoidance of triggers

herbal medicine

using herbs to heal, promote health, and alleviate illness

Neuropathic pain

usually results from damage to peripheral or CNS nerve fibers by disease or injury but may also be idiopathic (unexplainable)

Preparing for Parenteral Drug Administration

•Administering Injections •Each injection route differs based on the types of tissues the medication enters. •Before injecting, know: •The volume of medication to administer •The characteristics and viscosity of the medication •The location of anatomical structures underlying the injection site •If a nurse does not administer injections correctly, negative patient outcomes may result. •Choose correct size and type of syringe for drug and injection route •Prevention of needle sticks •NEVER recap a used needle!

Administering Medications to the Skin

•Apply to clean, dry skin •Thoroughly remove previous applications using soap and water •If ordered, cover affected area •Use gloves and applicators; clean skin first. •Sterile technique with certain circumstances •Measure nitroglycerin ointment carefully before administration •Transdermal •Remove old patch first and use gloves •Cleanse old patch site thoroughly •Apply new patch in area free from hair and is dry •If need to remove hair, cut DO NOT shave •Apply at the same time each day •Rotate sites •Do not cut patches •Apply a label to the patch if it is difficult to see. •Document removal of the patch as well.

Administering Rectal Meds

•Assess for bleeding or diarrhea (contraindications); have patient defecate before •Position on left side with right leg flexed (Sim's position) •DO NOT palpate if the client had rectal surgery •Lubricate with water-soluble gell (KY jelly) •Insert at least 4 inches •Have patient lie on side for 15-20 min •Educate patient to retain med •Wear gloves & standard precautions •Similar procedure for enema

Removing Medications from Vials & Ampules

•Can be used for single dose or multidose •Fluid must be drawn from vial with a sterile filter or blunt needle (except insulin) •NEVER ADMINISTER MEDS WITH A BLUNT/FILTER NEEDLE! •Remove cap and clean vigorously with alcohol wipe •Inject air first (same amount to be withdrawn) •Invert plunger and Pull back to withdraw prescribed dose •Tap syringe to remove bubbles •Always change needle from blunt/filter to appropriate needle for administration •Ensure sterility

Intramuscular—Deltoid

•Deltoid •Not the first choice for IM b/c muscle may not be fully developed and risk for hitting axillary nerves •Only used for immunizations (except for infants) and small volumes of meds (0.5-1 mL) •Patient can be sitting or lying down •Do not roll up sleeves and have patient relax arm and shoulder •Place three fingers below acromion process and find axilla

Safety in Administering Medications by Injection

•Dispose of sharps in marked containers •Use puncture- and leak-proof containers •Never force needles into receptacle •Never place used needles into wastebaskets, your pockets, or patient's tray or bedside •If full, immediately notify supervisor

Subcutaneous Injections

•Ensure adequate location •If given in abdomen, at least 2 inches from umbilicus •Use 0.5 or 1 mL syringe with a 25-27 gauge needle; ½ to 5/8 in •Inject at 45 (for thin, average, or younger patients) or 90° angle (obese patients) •Pinch skin with non-dominant hand •Do not aspirate! •Apply gentle pressure, but no massage! •Rotate sites •Use insulin needle for insulin! •Use the appropriate insulin syringe (U-100 or U-500) •Clear to cloudy when mixing •Insulin pens •DO NOT expel air bubble from prefilled syringes (ensures whole dose is administered) •Do not administer heparin with insulin syringe!!!!! •Heparin units are not the same as insulin units •Document

Oral Medications for Infants and Children

•Liquids are usually ordered •A plastic disposable syringe is recommended •Nipple can also be used •Head should be slightly elevated to prevent aspiration •Place syringe in mouth, beside the tongue •If crying, wait until they are calmer •Do not add meds to formula •Can mix with 1 tsp of jelly, applesauce, ice cream, or sherbet •Do not mix in an essential food item

Intravenous Piggyback Meds

•May or may not be refrigerated à follow protocol •Ensure compatibility •"Back priming" •But cannot be done if primary infusion is heparin, aminophylline, a vasopressor, or multivitamins •Do not stop drips abruptly! •Use an infusion pump •Needs to hang higher than the primary infusion for gravity •Open clamps during and close when complete •Monitor patient before, during, and after infusion •Infuse at prescribed rate •Flush line as needed per protocol •PCAs •Label all bags with date, time, initial, infusion/drug, patient ID

Parenteral Administration of Medications (Cont.)

•Minimizing Patient Discomfort •Use a sharp-beveled needle in the smallest suitable length and gauge; position patient comfortably. •Select the proper injection site. •Apply a vapocoolant spray or topical anesthetic. •Divert the patient's attention from the injection. •Insert the needle quickly and smoothly. •Hold the syringe steady while the needle remains in tissues. •Inject the medication slowly and steadily.

IV push meds

•Only RNs are allowed to administer •Allow for rapid administration •Can be given in an existing primary IV line, through a saline lock, or directly into vein •Follow manufacturer policy about dilution and consult a pharmacist •Some are NEVER given IV push: dopamine, potassium, some antibiotics •Remove air from syringe •Given over a period of 1-5 minutes (time with your watch) •Observe for IV complications •Monitor patient per protocol •Document

Eye Administration

•Place patient into side-lying position with affected ear up. •Remove excessive cerumen. •If needed, warm medication by setting in out for 30 min. •To administer eardrops, straighten the external ear canal by pulling down (A) on the auricle in children or pulling back on the auricle in adults (B). •Insert medication on the side of ear canal NOT DIRECTLY ON THE EAR DRUM. •Have patient in lying position for 5-10 minutes. •Loosely use cotton ball to stop med from draining out of ear. •Document

Administering via NG or PEG

•Position in Semi-fowlers or Fowlers and leave elevated for 30 min •Give in liquid form if possible; if not crush meds into a fine powder and administer separately •Verify placement and residual •Dilute meds in water •Allow to flow by gravity; manipulate stopcock •Flush after each med administration with water •Remain elevated •Document

Intramuscular Injections

•Select 18-25 (dependent on viscosity) gauge needle, 1 to 1 ½ inch for adults; max given is 3 mL. If greater; two sites needed •Assist to proper position & locate proper site •Palpate for potential sites for hardness/tenderness •Cleanse site appropriately •Grasp with non-dominant and pull skin and inject with dominant hand •Use Ztrack if applicable for irritable meds (iron and hydroxyzine) à reduces pain, irritation, and staining at injection site •Aspirate to make sure there is no blood return •New research... •After injecting, wait 10 seconds and then withdraw while releasing the skin •Apply gentle pressure and bandage •Use Safety device

Administer Inhaled Drugs with spacer

•Shake before use •Ensure no foreign body in inhaler •Attach spacer to mouthpiece •Have patient exhale then press down on inhaler to release med •Breathe in and out slowly for 2-3 sec then hold breath for 10 secs.

Administer Inhaled Drugs with NO SPACER

•Shake before use •Ensure no foreign body in inhaler •Position inhaler 1-2 inches away from mouth (best way) OR place inhaler in mouth with mouthpiece toward back of the throat •Exhale completely then press down to release med •Hold breath for 10 sec and then exhale

Intradermal Injections

•Used for diagnostic testing •Select a 1 mL tuberculin syringe with a 25-27 gauge needle, 3/8 to 5/8 inch •Site selection: 3-4 finger widths below AC area and one hand width above wrist •Avoid areas of bruising, rashes, inflammation, edema, or skin discoloration •Cleanse site •Stretch skin over site with non-dominant hand •Insert needle bevel up at 5-15° angle •Advance at 3 mm in epidermis •Don't aspirate/massage; slowly inject •A bleb shows up •GENTLY pad site •Provide follow up instructions for reading of test •Document

Intramuscular—Vastus Lateralis

•Vastus lateralis •Well developed and not located near major nerves or vessels •Preferred site for immunizations for infants and children •Patient can be sitting or lying down •Place one hand above the knee and one below the greater trochanter of femur •Locate midline of anterior thigh and midline of lateral thigh

Intramuscular: Ventrogluteal

•Ventrogluteal Site •Preferred site for adults and children because the muscle is deep and away from major vessels and nerves •Position the patient on side with knees bent and upper leg slightly ahead of bottom leg •Palpate the greater trochanter at the head of femur and iliac spine with left hand for right injection site and vice versa •Injection site is triangle formed by middle and index fingers