Pharmacology Chapters 1-4

Controlled Substances Act

controls meds that high risk for abuse, defined 5 classifications or schedules of controlled substances. -Schedule 1 -Schedule 2 -Schedule 3 -Schedule 4 Schedule 5

Electronic data bases used for information?

cumulative index of nursing and allied health, Lexi-comp, epocrates, dailymed

excretion in geriatrics

decreased renal blood flow reduced cardiac output loss of glomeruli decreased tubular function serum creatinine levels give estimate of renal function

what is an example of a generic name?

glipizide, these names are not capitalized

most commonly seen adverse drug reactions

rash nausea itching thrombocytopenia vomiting hyperglycemia diarrhea

secondary source

relatives, significant others, medical records, lab reports

An example for fast-tracking is?

smallpox, no treatment so we fast track one to make ready for the public

synergistic effect

the combined effect of two drugs is greater than the sum of the effect of each drug given together ex: aspirin & codeine= much greater analgesic effect

Clinical Research

the stage in which humans are first tested is divided into 3 phases: -phase 1 -phase 2 -phase 3

distribution

drugs are transported throughout the body by body fluids to the sites of action (protein binding and fat solubility affect distribution) organs with largest blood supply receive the distributed drug most rapidly some drugs cannot pass through the blood brain barrier or the placental barrier

X

studies: adequate, well controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal anormalities. the use of the product is contraindicated in women who are or who may become pregnant

what is the foundation for the clinical practice of nursing?

the nursing process

holistic care needs

the nursing process assists the nurse in responding to the changing needs of the patient

evaluating therapeutic outcomes

evaluation procedure for determinging therapeutic outcomes of drug therapy include: assessing pt responses to meds determining signs and symptoms of recurring illness assessing any adverse effects determining the pts ability to reveive education and self administer meds as well as the potential for compliance

assessment

first step in the nursing process comprehensive collection of data, including -physical exam -nursing history -medication history -professional observation assessment is an on going process that starts with admission and continues until the patient is discharged from care

Brand Name

followed by a symbol which indicates that the name is registered, made easier to pronounce, always capitalized

things to remember about absorption

give oral drugs with 8oz water give parental forms properly so they are deposited into the correct tissue reconstitute and dilute as directed heat and massage help absorb faster

planning

identify therapeutic intent and common and serious adverse side affects confirm recommended dosage and route of medication check that scheduling of administration of medicine is based on the providers orders teaching patients -keep written response records -techniques of self administration as needed -proper storage and refilling of meds

New Drug Application Review

investigator submits an NDA(new drug application) to FDA to request approval to market new drug for human use average NDA review takes 17 months

half life of drugs

is the time required for 50% of the drug to be eliminated drugs with a long half life should be administered only once a day is determined by an individuals ability to metabolize and excrete a particular drug in a patient with impaired hepatic or renal function the half life may become considerably longer nurses should be sure to monitor tests for renal and hepatic function

onset of action

is when concentration of a drug at the site of action is sufficient to start a physiologic response

example of a nursing diagnosis for a pt with hyperglycemia

knowledge deficient r/t lack of info about diabetic meds

which form of medication is more easily administered or a toddler who requires a course of antibiotics

liquid

independent actions example

listing to a pts lung sounds after a resp. tx. and monitoring lab values

tertiary source

literature to provide background information, diagnostic tests, diet

factors affecting metabolism in older adults

liver cells decrease, blood flow decreases

Schedule 4

low abuse potential-lowest, script may not be required -lomital, robitussmin AC are examples

Federal Food, Drug and Cosmetic Act

make sure meds are safe before public

Med inserts

manufactors are required to develop a description of a drug and federal laws require it to be approved by the FDA

illness

may alter the rate of absorption distribution, metabolism and excretion

therapeutic drug monitoring

measurements of drug concentration in blood sample to correlate the dosage administered and the level of medicine in the body very essential in neonates, infants, children dosage and frequency of medications can be adjusted to maintain therapeutic level of potentially toxic drugs is routine for conditions such as epilepsy, dysrhythmias, antimicrobial therapy and others to ensure therapeutic levels and to measure if toxicity is present the timing of drugs administration and collection of specimen is crucial. certain medicine require blood to be drawn before and after

medical vs nursing diagnosis

medical diagnosis is a diagnosis of a disease or disorder that impairs normal physiologic function nursing diagnosis refers to the patients ability to function in activities of daily living, it identifies the pts response to the illness

alterations in absorption

most drug interactions that alter absorption take place in the GI tract (antacids increase the gastric pH and can inhibit the dissolution of ketoconazole tablets) many alterations in absorption can be managed by separating the times of administration

NIC

nursing intervention classification- comprehensive research based, standardized classification of interventions that nurses perform

idosyncratic reaction

occurs when something abnormal happens when a drug is first administered. the patient demonstrates and unexpectedly strong response to the action of the drug. results from patients inability to metabolize a drug because of a genetic deficiency of certain enzymes this type of reaction is rare

drug interactions

occurs when the action of one drug is altered by the action of another drug elicited by agents combined increase the action of one or both drugs OR by agents that when combined decrease the effectiveness of one or both drugs

atagonistic effect

one drug interferes with the action of another ex: tetracycline & antacid= decreased absorption of the tetracycline

Postmarketing Surveillance Stage

ongoing review of adverse effects of new drugs

drug actions

onset, peak of action and duration of action

Routes of Absorption and their rates

oral-slowest sub q-slower absorption rate im-more rapidly absorbed iv-most rapidly absorbed

nonprescription drugs

over-the-counter (OTC) drugs sold without a prescription

body weight

overweight may require increase in dosage to attain same therapeutic level. underweight may require lower dosage

risk/high risk diagnosis

patient may be more susceptible to a particular problem

which piece of information obtained during a pt assessment is a subjective finding?

patient states "I have a pain in my abdomen"

dependent actions

performed by a nurse based on health care providers orders

physical drug dependence

person develops withdrawal symptoms if drug is withdrawn

formulating nursing interventions and anticipated outcomes

plan which intervention to use based on anticipated pt behavior

what factors will also affect excretion?

poor kidney function, low creatinine, BUN, GFR, will cause to not have a good blood flow to kidney

Controlled substances (individuals)

possession of controlled substances by individuals without prescriptions is punishable by fine, imprisonment, or losing of nursing license

assessment relies on three sources

primary source secondary source teriary source

priority setting

prioritize nursing diagnosis use maslows heirarcy of needs maslow identified 5 level of needs beginning with physiologic needs and ending with self actualization need

focused assessment

process of collecting additonal data specified to a pt of family that validates a suggested problem or nursing diagnosis the nurse focuses on specific defining characteristics associated with specific nursing

factors affecting metabolism

process whereby the body inactivates medications; primarily occurs in the liver

primary source

produced by patient

Kafaver Harris Drug Amendment 1962

provides greater control and surveillance of the distribution and clinical testing of investigational drugs and requires that a product be proven both safe and effective before release for sale

Prescription Drugs

require an order by a health professional licensed to prescribe drugs

the nurse must remember the seven rights of drug administration

right pt right med right dose right time right route right documentation right to refuse

a clinical judgement that a person is more susceptible to a particular problem than others in the same situation is defined as which type of nursing diagnosis?

risk/high risk

trough

sample is drawn immediately before the next dose to measure the lowest blood level of medicine

nurses prepare the prescribed medications using procedures to ensure patient safety

select correct supplies verify all aspects before preparation collect appropriate data to serve as baseline for later assessments administer meds by correct route document all aspects of administration implement actions to minimize expected side effects educate pt as appropriate

use of monitoring parameters in breastfeeding infants

some drugs are known to enter breast milk and harm the nursing infant discuss all medications with health care provider take medicine immediately after breast feeding or just before infants longest sleeping period

Phase 1 of clinical research

studies drugs pharmacologic properties-pharmacokinetics, metabolism, safe dosage ranges, routes. -the population group used-normal volunteers and those who need the treatment -about 4-6 weeks

Drug classification

Body system classification, Therapeutic use or clinical indications, Physiologic or chemical action

Which name(s) of a drug should the nurse use when teaching a patient with a new prescription?

Generic and trade name so the patient knows they are the same, ease confusion

an example of a brand name?

Glucotrol XL (it would also have the registered symbol behind the name)

excretion

drug metabolites and the drug itself are excreted from the body preterm infants have 15% of the renal capacity of an adult neonates have 35% full adult function occurs at 9-12 months

Agonist

drugs that interact with receptor to stimulate a response

patient with poor kidney function will have what in regards to excretion?

they will have increased action and duration of a drug

metabolic rate

those with higher than average metabolic rate tend to metabolize drugs faster, requiring larger doses and more frequent administration

entral

via the gastrointestinal tract by the oral, rectal or nasogastric routes

factors affecting distribution

ways in which drugs are transported to site of action depends on pH, body water concentration, fat tissues, protein binding, cardiac output and blood flow

drug blood level

when a drug is circulating in the blood and a sample is drawn to determine the amount of drug present is done for certain drugs to ensure the drug blood level is within therapeutic range

tolerance

when person begins to require a higher dosage of medication to provide the same effects of a lower dosage that they were once taking can be caused by psychological dependence or the body may metabolize a drug more rapidly than before

interdependent actions

implemented with the cooperation of a team

Parallel tracking

in an IND may be used for patients who cannot participate in controlled clinical trials when there is no satisfactory standard therapeutic

Phase 3 of clinical research

larger patient population also provides info on proper dosage and safety.

official name of drug

listed by the FDA

interdependent actions example

monitoring a pt heart rate and rhythm while the pt is receiving antidysrhythmic meds

Sources for prescription and nonprescription drugs

package inserts and nursing journals, electronic data base

drug dependence

person is unable to control his/her ingestion of drugs

peak

sample drawn 20-30 minutes after IV dose or 60 min after oral to obtain the highest blood level

An older adult is concerned about the price of his prescribed brand-name medication. He is also reluctant to change to a generic medication, saying "I want that medicine I keep seeing advertised." How can the nurse best educate this patient?

Explain that the brand and generic are the same. The generic goes through the same testing but cheaper because there is no advertising

factors affecting distribution in geriatric patients

total body water content decreases

additive effect

two drugs with similar actions are taken for an increased effect ex: hydrocodone & acetaminophen= added analgesic effect

Illegal or recreational drugs

used for nontherapeutic purposes; obtained illegally

Use of Therapeutic Drugs

used for prevention or treatment of disease

the three parts of a nursing diagnosis

uses a nanda diagnostic label has contributing factors defines characteristics

which is an independent nursing action?

verifies the correct route of medication administration

ex of an outcome statement

within next 8 hrs urine output will greater than 30ml and is the pt oriented realistic and measureable within the appropriate time frame

Polypharmacy

The use of many different drugs concurrently in treating a patient, who often has several health problems.

Food, Drug and Cosmetic Act and stages

This act made the FDA responsible for regulating new drugs. Rules and regulations are divided into 4 stages -preclinical research and development -clinical research and development -new drug applications review -postmarketing surveillance

metabolism

depends on enzyme systems the process whereby the body inactivates drugs primary organ of metabolism is the liver; other sites are GI tract and lungs

responses to drugs

desired effect side effects adverse effects idosyncratic effects allergic reactions teratogen carcinogen

gender and absorption

females: stomach empties more slowly gastric pH greater alcohol absorbed faster

pregnant patients

fetus exposed to substances in mothers blood

Schedule 3

high abuse potential -codeine, lortab, norco are examples

Schedule 2

high abuse potential, accepted for medical use -amphetamines, morphine, vicodin, demerol, adderall are examples

Schedule 1

highest class- not accepted for medical use in the US. -highest abuse potential -heroin, LSD are examples

duration of action

how long the drug has a pharmacological effect

setting priorities

identify problems and prioritize which ones are more important and must be attended to first, depending on patient needs

what is the definition of an adverse drug reaction? what are some common signs and symptoms? what drugs commonly cause adverse reactions?

a noxious, unintended effect from a drug. nausea, diarrhea, vomiting, hyperglycemia, rash, itching antibiotics, anti-inflammatory drugs, cancer chemotherapy agents, analgesics

how does a nursing diagnosis differ from a medical diagnosis?

a nursing diagnosis evaluates a pts response to actual or potential health problems

example of an idosyncratic reaction

a patient with asthma receives a steriod. 30 mins later the patient is agitated and states everyone is out to get me

nocebo effect

a patients negative expectations can result in a less-than- optimal outcome

placebo effect

a patients positive expectations can positively affect the outcome

psychological drug dependence

a person is emotionally attached to a drug

percutaneous

absorbed through the skin and mucous membranes inhalation, sublingual, or topical

Drug Stages after Administration

absorption distribution metabolism excretion (ADME)

factors affecting drug action

absorption premature- slower gastric emptying time may allow increased absorption neonates- IM absorption erratic, reduced gastric acidity infants- topical absorption increased

five types of nursing diagnosis

actual risk/high risk possible wellness syndrome

nursing intervention or implementation

actual process of carrying out the established plan of care nursing actions are suggested -dependent actions -interdependent actions independent actions

A

adequate, well controlled studies in pregnant women have not shown an increase risk of fetal abnormalities

Routes of drug administration

enteral parentral percutaneous

factors affecting metabolism in infants

enzymes take several weeks to a year to develop

potentially inappropriate medications for geriatric patients

includes medications that should be avoided and those that are rarely appropriate (some barbiturates, benzodiazepines, and some narcotics) some are considered appropriate to give only with certain indications but may have potentially adverse reactions

assessing lung sounds

independent

Black Box Warning

indicates a very serious life-threatening problem

which patient has the greatest percentage of body water?

infant

age

infants and the elderly are most sensitive to effects of drugs

factors affecting distribution in infants

infants have a higher total body water content, requiring higher dose on mg/kg basis infants also have lower body fat and reduced protein binding in neonates

Partial agonists

interact with the receptor and stimulate a response but inhibit other response

Pharmacodynamics

interaction between drugs and their receptors

carrying out drs order using NRG judgement

interdependent

Phase 2 of clinical research

involves smaller population of patients who have the condition that the drug is designed to treat. if successful moves to phase 3

Brand or trademark name?

is registered by the manufacturer, capitalized

D

studies: adequate, well controlled or observational; in pregnant women have demonstrated a risk to the fetus. however the benefits of therapy may outweigh the potential risk

genetics

study of how living organisms inherit the traits of their ancestors, including function of metabolic pathways significant differences can occur among racial and ethnic groups

pharmacogenetics

study of ow drug response may vary according to inherited differences

assessment also includes:

subjective findings objective findings

it is important to maintain therapeutic levels of drugs to avoid the complications of being over or undermedicated. if a drug level of 0.5 to 2mg is considered therapeutic, a drug level of 0.45mg is considered to be what?

subtherapeutic or below

possible diagnosis

suspected problems requiring additional data

Drug development

takes 8-15 years and more than 2 billion in research and development costs to bring a new drug to market

displacement

the displacement of the first drug from protein-binding sites by a second drug increases the activity of the first drug because more unbound drug is available ex: warfarin & valproic acid= increased anticoagulant effect

desired action

the expected response

interference

the first drug inhibits the metabolism or excretion of the second drug, thereby causing increased activity of the second drug ex: probenecid & ampicillin= prolonged antibacterial activity of ampicillin b/c probenecid blocks the renal excretion of ampicillin

incompatibility

the first drug is chemically incompatible w/ the second drug, thereby causing deterioration when the drugs are mixed in the same syringe or solution or are administered together at the same site; signs include haziness, formation of a precipitate or a change in the color of the solution when the drugs are mixed. ex: ampicillin & gentamicin= ampicillin inactivates gentamicin

the nursing process

the foundation for the clinical practice of nursing involves: assessment nursing diagnosis planning nursing intervention or implementation evaluating and recording therapeutic outcomes

the nursing process also provides:

the framework for consistent nursing actions and involves use of problem solving instead of an intuitive approach method for evaluating the outcomes of therapy delivered provides scientific method to assign nursing staff to patients and to determine and justify cost of providing nursing care

subjective findings

the nurse makes using physiologic parameters ex: report of pain is subjective b/c people experience it different

what happens when trough levels are ordered?

the nurse should obtain and check the results in a timely manner and notify the prescriber

nursing diagnosis differs from medical because?

the nursing diagnosis indicates a human response the medical pattern indicates a medical condition the nursing diagnosis determines what the nursing interventions will be based on the characteristic gathered from the assessment

which type of topical drug is more readily absorbed by infants?

water-soluble

factors that influence medication response

weight age gender medical condition tolerance

evaluating and recording therapeutic and expected outcomes

all care is evaluated against -nursing dx (goal statement) -nursing interventions -patient responses evaluation process involves pt, family and significant other who provide feedback and help determine goals

Generic Name

also known as a common name

drug response needs to be stated. what is the response after the drug was given? was it the expected response? How can nurses answer these questions?

always do an assessment prior to baseline and after

drug accumulation

Occurs when the next dose is given before the previously given drug has been metabolized or excreted. May result in drug toxicity.

Can therapeutic methods be used in combination?

Yes

Use in Pregnancy categories

a b c d x

independent actions

provided by nurse by virtue of education and license

Definition of Pharmacology

the study of drugs and their actions or effects

peak of action

time which the drug reaches the highest concentration on the target receptor site inducing the max pharmacologic response for the dose given

three reasons for obtaining a drug history?

to evaluate need for medication to obtain current and past use of over the counter meds to identify problems related to drug therapy

Fast tracking

to expedite the development and approval of drugs for the treatment of life-threatening illnesses.

factors affecting distribution gender

total body fat higher in females

drugs that have a complete attachment and response are?

agonist

USAN

contains more than 10,000 drug names

Body System Classifications

cardiovascular, gastrointestinal, etc.

how will liver function affect metabolism

if liver enzymes aren't working will cause a problem

Pharmacokenetics

medications movement through the body

Chemical Name

chemical constitution of a drug

the nurse is caring for a 77 year old woman who has been prescribed IV tobramycin for cellulitis, ketoprofen for pain and lorazepam for anxiety. what are the four basic parameters that the nurse must always consider when administering these medications? what specific nursing interventions related to absorption distribution, metabolism and excretion would be important when a patient receives these drugs?

1. age, gender, weight, metabolism 2. monitor pain, monitor anxiety, monitor infection

How soon do orphan drugs receive approval by the FDA

10-11 months sooner than non-orphan drugs

How long does the entire clinical research phase take?

2-10 years and each completed study is reviewed by the FDA

when the nurse administers a 50mg dose of a drug with a half life of 6 hours, how many milligrams will remain in the body at 24 hours?

3.13

how many years on average does it take for a drug to be brought to market from the time of its conception?

8-15 years

all drugs are processed in the body through pharmacokinetics. what is the correct order that drugs pass through the body?

ADME

what are four factors that influence drug action on the body? What are some additional factors that affect drug action?

ADME

Legislations regarding drug use

Federal Food, Drug and Cosmetic Act & Controlled Substances Act

Physiologic or Chemical Action

Anticholinergics, calcium channel blockers, etc.

Which source of information is best for the nurse to obtain drug information?

Electronic data base

factors affecting absorption in geriatric patients

IM absorption erratic reduced salivary flow makes swallowing difficult transdermal absorption hard to predict timed release/enteric coated tablets cannot be crushed reduced GI acidity affects absorption slower gastric emptying time decreased GI motility and blood flow

Which drug schedule indicates drugs with the highest risk for abuse?

Schedule 1

Resources for Drug Information

The united states pharmacopeia (USP)/ National formulary (NF), electronic data base

psychology

attitude and expectations can play into patients response to treatment and willingness to take meds as prescribed

nursing diagnosis

a clinical judgement about individual, family or community responses to actual or potential health problems/life processes actual nursing diagnosis consists of a three part statement

what are the four stages of a drug goes through after it is administered? describe each stage. what is one factor that affects each of these stages in the entral route?

absorption- the drug is transferred from the site of entry to the body and to the circulation of fluids. distribution- the drug is circulated through fluids throughout the body. metabolism- the body inactivates the drugs excretion-the drug is eliminated from the body a factor that can affect these stages is body problems concerning the GI tract or issues with the liver or kidneys. If a patient has liver enzymes that aren't working then the drug might not metabolism correctly.

Preclinical Research

beings w/discovery, synthesis and purification of a drug. goal is to use lab studies to determine if experimental drug has a therapeutic value and if it is safe in animals IND application is sent to FDA and they have 30 days to determine safety to allow human studies. Only 20% of chemical tested make it to next phase

therapeutic range

between the minimum effective response and the toxic response

what are some signs and symptoms of anaphylactic reaction?

bronchospasms hypotension laryngeal edema

parentral

bypasses the GI tract by using subcutaneous, intramuscular, and intravenous injection

Definition of Drugs

chemical substances that have an affect on living organisms

collaborative problems

different nursing diagnoses when the intervention used is to prevent or treat a problem and is worded with potential complication in the diagnosis evidence based practice uses research to impact nursing practice changes; the interventions used in research findings can be implemented into care plans

Durham-Humphrey Amendment of 1952

divides meds into prescription and non prescription based on safety. Requires caution label that federal law prohibits dispensing without script

pediatric patients

dosage adjustments expected during growth measure liquid medications using mL use appropriate dilution verify dosage prior to giving aspirin use linked with Reye's syndrome allergic reactions occur rapidly in children

alterations in metabolism

drug interactions are caused by an alteration in metabolism, by inhibiting or stimulating the enzymes that metabolize a drug some medications increase another medications actions contributing to toxicity some meds decrease another meds actions, decreasing effectiveness

evidence based practice

goal is to improve pt outcomes by implementing best practices evolved from scientific studies uses best care to improve pt outcomes core measures are measure of care that are tracked to show how often hospitals and health care providers use the care recommendations identified by evidence based practice standards for pt who are being treated for conditions

Controlled Substances in regard to manufactuers & prescribers?

must register with the DEA, requirements must be met to dispense scheduled medications

gender

gender specific medicine-studies the differences in normal function of men and women gender specific medicine is a developing science that looks at how men and women perceive and experience disease, as well as how pharmacokinetics affect each gender

Are brand names or generic name drugs cheaper?

generic name drugs are cheaper and formularies use them

factors affecting metabolism in all ages

genetics, smoking, diet, other medications, liver disorders

USP/NF

sets standards of purity for drugs and lab tests used to determine purity

anaphylactic reaction

severe life threatening reaction that causes respiratory distress and cardiovascular collapse

Which entity is responsible for monitoring drug safety in the United States?

FDA

types of drug interactions

additive effect synergistic effect antagonistic effect displacement interference incompatibility

example of dependent actions

administering an antibiotic q6hr as ordered but can still require the nurses judgement

what are some factors that can affect drug blood level?

age gender weight metabolic rate disease environmental issues

several minutes after starting the infusion of a patients first dose of ampicillin IV, the patients skin becomes flushed, and he says his heart is racing. Red, raised bumps appear on his skin and he reports feeling itchy. What should the nurse suspect? what are the risks to the patient? What should the nurse do? What instructions should the nurse give the patient?

allergic reaction risk would be anaphylactic shock, nurse should stop medication and call doctor and get further orders. Nurse should tell patient to let their doctors know they had a reaction to medicine

drugs known to be teratogenic

androgenic and estrogenic hormones ACE inhibitors, ethanol, tetracycline thalidomide, vitamin A, warfarin Angiotensin II receptor antagonists anticonvulsants, antmanic agents, antithyroid chemotherapy, statins, cocaine

B

animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and well controlled studies in pregnant women or animal studies have shown an adverse effect, but adequate and well controlled studies in pregnant women have failed to demonstrate a risk to the fetus

C

animal studies have shown an adverse effect, and there are no adequate and well controlled studies in pregnant women or no animal studies have been conducted, and there are no adequate and well controlled studies in pregnant women

Therapeutic use or Clinical Indications

antacids, antibiotics, etc.

A drugs chemical bond

forms chemical bond with receptors. the bond can only form if the drug receptors have a similar shape. the relationship is similar to a lock and key, the better the fit the better the response

a patient reports postoperative pain and the nurse administers morphine ( a narcotic analgesic) intravenously to ease the pain. Fifteen minutes later, the nurse notes that the patient is very drowsy, respirations are slow and shallow, and oxygen saturation is low. The nurse administers another drug that decreases the action of the morphine. What is this effect called?

antagonistic

classes of medicine that account for the largest number of ADR's?

antibiotics cardiovascular meds cancer chemotherapy agents analgesics anti-inflammatory agents

adverse effects

any noxious, unintended and undesired effect of a drug which occurs in dosages used in human for prohylaxia, diagnosis or therapy.

objective findings

are clearly measureable and consistently reportable ex: temp, weight, height

a 67 year old man has developed a fever of 103.6 after returning from the recovery room following a carotid endarterectomy. what is the nursing process as it applies to this situation? what are specific medication related issues?

assess, why is there a fever? formulate diagnosis plan care, what meds will he need? something to lower fever? call doc and report it give meds per doctor check vital signs, reassess pt

Antagonist

attach to the receptor but do not stimulate the response

use of monitoring parameters in pregnant women

avoid drugs when taking a womans history, be alert to possibility of pregnancy instruct patient to avoid drugs, alcohol and tobacco try nonpharmacologic treatments before using medicines avoid herbal medicines

actual diagnosis

based on human responses and supported by defining characteristics

phases of planning

four phases of a nursing care plan: -setting priorities -developing measureable goal/outcome statements -formulating nursing interventions -formulating anticipated therapeutic outcomes

wellness diagnosis

clinical judgement about a transition from one level to a higher level

syndrome diagnosis

cluster signs and symptoms to predict certain circumstances or events

geriatric patients

complete a thorough drug history, including prescription, OTC, herbal medications and nutitional status evaluate vision and motor skills to make sure they can read prescriptions and open medicines when evaluating a new symptom, determine whether it was induced by a medication already prescribed start with smaller doses and gradually increase. keep multidrug regimen simple review if any medications can be discontinued assess ability to pay for medications

orders that are written by the provider

dependent

excretion

depends on GI tract and kidneys elimination of drug metabolites and some of the active drug from the body kidneys are the major organ of excretion; some excreted in feces other routes- GI tract, skin, lungs

absorption

depends on route of administration drug is transferred from site of entry into the body to the circulation of fluids of the body to then be distributed around the body. the rate of absorption depends on the route and site of administration, blood flow, and solubility of the drug.

2 part of a risk/high risk nursing diagnosis

diagnostic label from the nanda approved list the risk factors that make the individual more susceptible to development of a problem

Therapeutic approaches to treating illnesses

diet therapy, drug therapy, physiotherapy, psychotherapy

the following should be included in a pt response record

drug name dosage route time of administration all adverse effects dosages misesed and why

liberation

drug released from dosage form and is dissolved in body fluid process of converting oral drug can be influenced by food and water in the stomach

unbound drugs

drugs are bound to proteins in the blood during transportation the more a drug is "bound" to a protein, the less available it is to the circulation some medicines can cause binding or unbinding of another medication, increasing or decreasing its effect

Orphan Drugs

drugs that are developed for rare conditions manufacturers are unable to recover the costs of the research due to the very limited use of the final product. law provides research grants, protocol development assistance, special tax credits for cost of clinical trials and 7 years of exclusive market

teratogens

drugs that cause abnormal development of fetal tissues

measurable goals

goals must be estalished and statements written goals divided into short and long term plans measureable goal statement starts with an action word that is followed by the behavior or behaviors to be performed by the pt all goals and outcomes need to be individualized and based on the pts abilities pt goals rather than nursing goals nursing outcomes classification used to evaluate the effect of nursing interventions on pt care

method to help with nursing diagnosis?

gordons fucntional health patterns model

allergic reaction

hypersensitivity reactions occur in patient who have been previously exposed to a drug and whose immune systems have developed antibodies to the drug. upon re-exposure the antibodies cause a reaction that are usually seen as raised, irregularly shaped patches on skin (hives) which cause sever itching.

which route of administration has the fastest rate of distribution?

intravenous

Controlled substances in hospitals

inventory and dispersion control records

Nursing dx

nurse uses knowledge and skills to analyze data to identify whether certain major and minor defining characteristics relate to a particular problem patient related problems are referred to as nursing diagnosis not all problems are id during assessment-need involvment from multidisiplinary teams nursing dx may vary throughout a course of illness while medical dx tend to stay the same

nursing diagnosis and pharmacology

nursing dx often can be formulated bsed on the pt drug history most commonly associated with drug treatment for a disease or adverse effects from drug therapy also can originate from pathophysiology caused by drug interactions review the drug monographs to identify problems related to medication therapy other factors influencing nursing diagnosis are a pts personal and environmental situations and maturation

developing measurable goal statements

write short and long term goals for the pt to be followed when providing care