Nursing Pharmacology Semester 1
Intramuscular
1/2-1 1/2 inch needle
Pregnancy Category C
Adverse effects have been demonstrated on animal fetuses, but there are no adequate and well controlled studies in pregnant. The use of these medications during pregnancy may be warranted based on potential benefits/
Pregnancy Category D
Adverse effects have been demonstrated on human fetuses. use may be warranted on potential benefits.
Pharmacokinetic factors specific to children
Decreased gastric acid, slower gastric emptying, decreased first pass metabolism, increased absorption of topical medication, lower blood pressure, higher body water content. Decreased serum protein binding sites until 1 year.
Rapid-acting
Humalog. Onset less than 15 minutes; peak 30min-1hr; Duration 3-4 hours
Medication error
an event that results in a patient receiving inappropriate medication or failing to receive it as prescribed
Morphine (Duramorph)
depresses respiratory function, so it should be used cautiously with asthma or impaired respiratory function.
diabetes insipidous
disorder of the posterior lobe of the pituatary gland that causes excessive thirst and excretion of large volumes of dilute urine
Anticholinergic Effects
(drying effect). Dry mouth, photophobia, urinary retention.
How do you store premixed insulin in syringes?
1-2 weeks, vertical with needle up and should be rotated to mix before administering.
Subcutaneous
1/2-5/8 inch in length needle
How long can premixed insulin be stored?
3 months
intradermal
3/8-5/8 inches in length needle
0.5- 1
A usual starting dose of insulin is between__ unit/kg of body weight per day.
Extrapyramidal symptoms (EPS)
Abnormal body movements such as tremors, rigidity, uncontrolled restlessness, spastic movement of head, neck, eyes, and it can take months to develop. Common with mental disorder meds
Pregnancy Category X
Adverse effects have been demonstrated on animal and human fetuses. The use of these medications are contraindicated during pregnancy because risks outweigh benefits.
Idiosyncratic reactions
An unusual response to a drug. It can manifest as an accelerated, toxic, or inappropriate response to the usual therapeutic dose of a drug
Pharmacogenetics
Area of pharmacology that examines the role of genetics in drug response.
When should patients be instructed to take antacids for optimal effect
At least one hour apart from other medications. They may interfere with absorption of other medications if taken together
How should an opened vial of insulin be stored?
At room temperature; no sunlight or heat and discard after 1 month.
Metabolism
Changes medications into less active forms or inactive forms by enzymes. Primarily happens in the liver.
Diabetes mellitus
Chronic illness that results from an absolue or relative deficiency of insulin, often combined with cellular resistance to insulin's actions.
Components of a prescription
Clients full name, date and time of prescription, name of medication, dosage of medication, route of administration, time and frequency, signature of provider.
Trough Levels
Drawn immediately before the next medication dose, regardless of the route of administration.
Excretion
Elimination of medications from the body. Usually the kidneys but can be liver, lungs, bowel and exocrine glands.
Thiazolidinedionesn (Glitazones)
Increase cellular response to insulin by decreasing insulin resistance.
Immunosuppression
Is a decreased or absent immune response.
Anaphylactic Reaction
Life threatening immediate allergic reaction that causes respiratory distress, severe broncho-spasm, and cardiovascular collapse.
Hepatotoxicity
Liver toxicity due to drug accumulation. most drugs are metabolized in the liver and it is vulnerable to drug-induced injury.
fluid retention
Major side effects in TZD treatment are an increase in adipose tissue and __ ___
Partial Agonists
May act as agonist/antagonist. Limited affinity to receptor site. i.e. nalbuphine acts as an antagonist at mu receptors and an agonist at kappa receptors, causing analgesia at low doses, with minimal respiratory depression.
Antagonist
Medication that can block normal receptor activity regulated by endogenous compounds or receptor activity caused by other medications. i.e. losartin works by blocking angiotensin II receptor blockers on blood vessel, which prevents vasoconstriction. Drug that blocks a response
Agonist
Medication that can mimic the receptor activity regulated by endogenous compounds. i.e. morphine because it activates the receptors that produce analgesia, sedation, constipation, and other effects. drug that produces a response
Toxic Effects
Medications can have specific risks and manifestations of toxicity.
Low Therapeutic Index
Medications have this and they must be monitored by serum medication level monitoring
Long Half Life
Medications leave the body more slowly; more than 24 hours. Greater risk for medication accumulation and toxicity.
lactic acidosis
Meformin can cause __ __ in patients with renal insufficiencies with presenting symptoms; fatigue, unusual muscle pain, difficulty breathing, unusual or unexpected stomach discomfort, dizziness lightheadedness, or irregular heartbeats.
conditions that decrease drug clearance
Metformin is contraindicated in___ ___ __ __ ___ , such as liver disease, alcoholism, or severe congestive heart failure
Kidney disease
Metformin should not be given to anyone with ___ and elevated creatnine levels. most common side effects are abdominal discomfort and diarrhea.
more normal
Mixture of short and intermediate acting insulins produce a__ __ blood glucose response in some patients than does a single dose.
Intermediate-acting
NPH (Humulin N). Onset 1hr; Peak 4-12 hr; duration 18-24 hr.
Diabetic Ketoacidosis
One of the most serious complications of hyperglycemia. Caused by drawing fluid out of the cell into circulation, excreted by kidneys. Results in Polyuria, dehydration & electrolyte imbalance. This increases fat metabolism and ketones, resulting in metabolic acidosis.
Non-parenteral routes of Administration
Oral, sublingual, transdermal, topical, opthalamic, otic, rectal, vaginal, nasal.
mixed insulin
Patients response to__ __ may differ from the response to the same insulins given seperately.
Accumulation
Process which occurs when the rate of drug administration exceeds drug excretion resulting in gradual increase in the blood level of the drug
Metformin (Glucophage)
Reduces production of glucose from the liver by suppression of gluconeogenesis. In a nut shell it prevents glucose from being made and forces body to use what is in storage. used as first medication in diabetes 2 because drug does not induce weight gain or hypoglycemia and has few adverse effects.
Half Life
Refers to period f time needed for the medication in the body to be reduced by 50%
Short-acting
Regular (Humulin R). Onset 30min-1hr; Peak 2-3 hr; Duration 5-7hr
Tolerance
Responsiveness to a medication is reduced and may require higher doses.
Six Rights of Safe Medication Administration
Right Client, Right Drug, Right Dose, Right Time, Right Route, Right Documentation.
Alpha glucosidase inhibitors (Precose, Glyset)
Slows carbohydrate absorption and digestion
Pharmacodynamics
Study of drug concentration and its effect on a living organism
Efficacy
The ability of a drug to produce a specific result, regardless of dosage.
protein, target tissues
The ability of a medication to bind to a ___ can effect how the medication will leave and travel to ___
abdominal discomfort
The most common side effects of Alpha-Glucoidase Inhibitors (Acarbose) include; flatulence, diarrhea, and ___ ___ .
blood glucose
The patients patterns__ __ determines insulin dosage
Bioavailability
The percentage of an administered dose which is absorbed. The rate and extent to which an active drug or metabolite enter the general circulation, permitting access to the site of action.
Adverse Effects
There are undesired, inadvertent, and unexpected dangerous effects of the medication.
Pregnancy Category B
There is no evidence of risk to animal fetus based on studies but there are no adequate and well controlled studies in pregnant women or there is risk in animal fetus but studies in pregnant women show no risk to the fetus
Pregnancy Category A
There is no evidence of risk to the fetus during pregnancy based on adequate and well-controlled studies
Why are inhaled steroids not recommended for acute asthmatic episodes?
They do not produce immediate effects. They are better used for prophylactic measures.
Why are alpha receptor blockers and angiotensin converting enzyme inhibitors less effective in African Americans?
They have abnormally low levels of the enzyme that metabolizes these drugs. Diuretics are more commonly used to treat their hypertension.
How do diuretics lower blood pressure?
They help rid you body of sodium and water. They decrease the amount of fluid by pulling it from the vessels and excreting it through the kidneys. The lesser amount of fluid flowing through the blood vessels decreases the pressure of the blood on arterial walls.
Therapeutic Effect
This is the preferred and expected effect for which the medication is administered to a specific client.
Absorption
Transmission of medication from location of administration to the blood stream.
Distribution
Transportation of medications to site of action by body fluids.
Side Effects
Usually expected and inevitable when a medication is administered at a therapeutic dose.
15 minutes
When rapid acting insulin is mixed with an intermediate acting or long acting, the mixture should be given with ___ __ before a meal.
shorter acting
When rapid acting or short acting insulin is mixed with a longer acting insulin, draw the ___ ___ dose first.
Hepatic First Pass effects
a phenomenon which occurs whereby a drug which has been absorbed by the GI system is extensively metabolized by the liver prior to reaching the systemic circulation
Placebo
a physiological benefit from a compound that may not have the chemical structure of a drug effect
Cross-tolerance
a situation in which the development of tolerance to one drug creates a tolerance to other drugs with similar pharmacological effects
Liver and Kidney Function
are immature in young children and often decreased in older adults.
Hyperglycemic nonketotic syndrome
blood glucose level about 600mg/dl resulting in diabetic coma
Vitamin K
can decrease the therapeutic effects of warfarin (Coumadin) and place clients at risk for developing blood clots.
Tetracycline
can interact with a chelating agent such as milk, and form an insoluble, unabsorbable compound.
Diarrhea
causes oral medications to pass through the GI tract too quickly to be absorbed
Following rectal insertion of suppository
client should remain in a side-lying position for 5-10 minutes
digoxin
clients taking __ should be monitored closely for dysrhythmias. Hyperkalemia places client at higher risk for toxicity
polyuria
excess urination
polyphagia
excessive hunger
polydipsia
excessive thirst and fluid intake
Dawn Phenomenon
fasting hyperglycemia that results from nighttime release of growth hormone. it is managed by providing more insulin for the overnight period.
Liver disease/failure
impairs medication metabolism, which may cause toxicity
How long can unopened insulin be stored and where?
in the fridge until expiration date.
Pharmacokinetic factors specific to older adults
increased gastric pH (alkaline), decreased GI motility and gastric emptying, decreased blood flow through cardiovascular system, liver, and kidneys, decreased hepatic enzyme function, decreased kidney function and glomerular filtration rate, decreased protein binding sites, decrease body water, increased body fat, and decreased lean body mass.
Inadequate gastric acid
inhibits the absorption of medications that require acid to dissolve
Long-acting
insulin glargine (Lantus,Levemir). Onset 1hr; has no peak; duration 24hr
Parenteral Routes of Administration
intramuscular, subcutaneous, intradermal, intravenous, intratracheal, and epidural.
Black Box Warning
is a government designation indicating that a drug has at least one serious side effect and must be used with caution.
lipoatrophy
is a loss of fat tissue in areas of repeated injection that results from an immune reaction to impurities in insulin
Insulin
is a small protein that is destroyed by stomach acids and intestinal enzymes. that is why it should be injected
Allergic Reaction
is an immune response to a medication. You have to have been previously exposed and develop antibodies. Can be minor or serious; rash and hives to anaphylaxis.
Lipohypertrophy
is an increased swelling of fat that occurs at the site of repeated insulin injections
vancomycin
is excreted unchanged in the kidneys and should be used cautiously in a client who has renal impairment
Toxicity
is severe or a life threatening condition. It can be caused by excessive dose but can occur at therapeutic levels.
Hypoglycemia acute onset
low blood glucose level. symptoms in include; tachycardia, palpitations, diaphoreses, shakiness
Hypoglycemia gradual onset
low blood glucose level. symptoms include; headache, tremors, weakness,
Safety of insulin therapy in older adults
may be affected by reduced vision, mobility and coordination problems, and decreased memory.
Cardiovascular Effects
may involve blood vessels and the heart. Antihypersensitives can cause orthostatic hypotension.
Nephrotoxicity
may occur with a number of medications, but is primarily the result of antimicrobial agents and NSAIDs. Impaired kidney function may interfere with excretion, leading to accumulation and adverse effects.
Gastrointestinal Effects
may result from local irritation of the GI tract. Stimulation of the vomiting center also results in adverse effects.
Central Nervous System Effects
may result from stimulation or depression of the CNS.
48 hours
metformin should be withheld for __ before and after using contrast material and surgical procedures requiring anesthesia.
sustained release and enteric coated capsules
must be swallowed whole to be effective.
Vascular insufficiency
prevents distribution of medications to affected tissue
Kidney disease/failure
prevents or delays medication excretion, which may cause toxicity.
The purpose of insulin
promote cellular uptake of glucose, converts glucose into glycogen, and moves potassium into cells (along with glucose).
Pharmacokinetics
refers to how medications travel through the body.
Hematologic Effects
relatively common and potentially life-threatening with some groups of medications. Bone marrow depression, anticancer drugs, anticoagulants, thrombolytics.
Grapefruit Juice
seems to act by inhibiting presystemic medication metabolism in the small bowel, thus increasing absorption of certain oral medications such as nifedipine (Procardia) a calcium channel blocker. may cause drug toxicity.
peak drug level
the highest plasma concentration of a drug at a specific time
insulin lipodystrophy
the loss of local fat deposits in patients with diabetes as a complication of repeated insulin injections into the same subcutaneous tissue
Deltoid
the site that is easily accessible but not suitable for repeated injections or injections of more than 2 ml
non-sulfonylurea secretagogue
type of oral anitidiabetic agent that stimulates insulin release; also called glinide
Consuming foods with tyramine
while taking MAOIs can lead to hypersensitve crisis.