Chapters 5-12 Pharmacology
patient, drug, dose, time, route, documentation
"Six Rights" of Medication Administration
Percolation
A process to extract the soluble constituents of a plant with the assistance of gravity. The material is moistened and evenly packed into a tall, slightly conical vessel; the liquid is then poured onto the material and allowed to steep for a certain length of time. A small opening is then made in the bottom, which allows the extract to slowly flow out of the vessel. The remaining plant material may be discarded. Many tinctures and liquid extracts are prepared this way.
Liniment
Extract of a plant added to either alcohol or vinegar and applied topically for therapeutic benefits.
distraction free environment, medication safety zone
Factors to prevent medication errors
excretion
In geriatric pharmacokinetics, the following affect the __________________ stage: •Renal excretion of drugs decreases with age. Changes in kidney function require dosage adjustment, especially if the drug has a narrow therapeutic range.
Infusion
A tea made by pouring water over plant material (usually dried flowers, fruit, leaves, and other parts, although fresh plant material may also be used); the mixture is then allowed to steep. The water is usually boiling, but cold infusions are also an option. May be used therapeutically; hot tea is an excellent way to administer herbs.
Decoction
A tea made from boiling plant material—usually the bark, rhizomes, roots, or other woody parts—in water. May be used therapeutically. Natural dyes are often made this way.
Poulitice
A therapeutic topical application of a soft, moist mass of plant material (such as bruised fresh herbs), usually wrapped in a fine woven cloth
culture of safety
ANA encourages "Just Culture" Individuals should be encouraged to report drug errors, so the system can be repaired and fixed. Risk management departments
Dosage forms
Always consult pharmacist, health care provider, or reliable drug source regarding crushing a drug. Do not crush extended- or sustained-release drugs
Tinctures
An extract of a plant made by soaking herbs in a dark place with a desired amount of either glycerin, alcohol, or vinegar for 2-6 weeks. The liquid is strained from the plant material and then may be used therapeutically.
Essential oils
Aromatic volatile oils extracted from the leaves, stems, flowers, and other parts of plants. Therapeutic use generally includes dilution of the highly concentrated oil.
Astragalus
Boosts immune system, Limits cold and flu symptoms not all species of ______________ are safe for human consumption; some species contain the neurotoxin swainsonine, and others contain toxic levels of selenium.
high alert medications
Can cause significant harm if given in error Examples: Epinephrine, insulin, nitroprusside, potassium chloride injection Simplify storage, preparation, and administration Improve policies and education Limit access Monitor patient's response
Dietary Supplement Health and Education Act (DSHEA)
Ensures products are safe and label information is truthful and not misleading. 1. Name of the supplement 2. Amount of the supplement (net quantity) 3. Nutrition labeling 4. Ingredient list 5. Name and place of the manufacturer, packer, or distributor "This statement has not been evaluated by the US Food and Drug Administration (FDA). This product is not intended to diagnose, treat, cure, or prevent any disease."
Herbal preparations
Decoction, Infusion, Tinctures, Liniment, Poultice, Essential oils, Herb-infused oils, Percolation
Drug reconciliation
Develop an accurate list of patient's medications. Advise patient to always carry current list of personal drug information in the case of emergency. Advise patient to update drug list whenever a change occurs. Advise patient to bring a list of medications to each doctor appointment.
tablet splitting, buying drugs over the internet
Examples of safety risks for medication administration
cannabis use disorder
Drug effects- impairs short-term memory, learning, and ability to focus, and it can cause problems with balance and coordination. In addition,itincreases heart rate and may cause hallucinations, anxiety, panic attacks, and psychosis in some people. Long-term effects-chronic cough, frequent respiratory infections, and exposure to cancer-causing compounds because the smoke has many of the same irritating and lung-damaging properties as tobacco. Ingestion of the drug increases the heart rate for hours, increasing risk for heart attack and stroke.
Opiod use disorder
Effects •Euphoria, tranquility, reduced pain •Drowsiness, confusion •Nausea, constipation Dose-dependent respiratory depression
Disposal of medications
Follow specific information on drug label or insert. Transfer drug from original container to undesirable substance (i.e., kitty litter). Place mixture in container (i.e., sealed plastic bag). Remove all identifying information on label before disposing of empty container. Do not flush drugs down toilet unless specifically instructed. Return drugs to community "drug take-back" program. Consult pharmacist if any questions.
Ginseng
Improves well-being, stamina, and immune system Treats erectile dysfunction, hepatitis C, menopausal symptoms, lowers glucose and blood pressure Side effects include headaches, GI distress, hypertension, hypoglycemia-Diabetics cautioned, breast tenderness, menstrual irregularities.
body fluid composition
In distribution of pediatrics, ______________ describes how Neonates and infants have 75% water, compared with 60% in adults. This increased body fluid proportion results in a lower drug concentration. (MORE WATER)
body tissue composition
In distribution of pediatrics, ______________ describes how Neonates and infants have less body fat.
protein-binding capability
In distribution of pediatrics, ______________ describes how Neonates and infants have less protein and fewer protein receptor sites.
Effectiveness of barriers
In distribution of pediatrics, ______________ describes how Skin-neonates-extremely thin-faster absorption Blood-brain barrier-neonates is relatively immature and allows drugs to pass easily into central nervous system (CNS) tissue, thereby increasing the likelihood for toxicity.
metabolism
In geriatric pharmacokinetics, the following affect the __________________ stage: •decrease in liver size and a reduction in cytochrome P450 (CYP450) enzyme activity, which is responsible for the breakdown of drugs. This can cause decrease first-pass metabolism and can prolong drug half-life, resulting in increased drug levels and potential drug toxicity
distribution
In geriatric pharmacokinetics, the following affect the __________________ stage: •decline in muscle mass and a increase in fat so lipid-soluble drugs have a greater volume of distribution, increased drug storage, reduced elimination, and a prolonged period of action. •reduction in total body water, which affects water-soluble drugs, and a reduction in albumin levels can result in decreased protein binding of drugs and increased free drug available to exert therapeutic effects, but it also increases the risk for drug toxicity.
absorption
In geriatric pharmacokinetics, the following affect the __________________ stage: •decrease in small-bowel surface area, slowed gastric emptying, reduced gastric blood flow, and decrease in gastric acid production
drug dosing and monitoring
In pediatrics, Monitoring for therapeutic effects and adverse reactions Calculations-ALWAYS GET A CURRENT WEIGHT!
drug administration
In pediatrics, this describes: Decreasing pain and anxiety •Distraction, diversion, relaxation, creative imagery Oral administration Intravenous sites, IM injections Eutectic mixture of local anesthetics Utilize, honesty, respect, explanations, least amount of restraint When doing ____________
Pediatric pharmacodynamics
In pediatrics, this includes: Mechanisms of action and effect of a drug on the body Includes the onset, peak, and duration of effect of a medication. Intensity of therapeutic effects and adverse effects
absorption route of administration
In pediatrics, this is affected and includes •Gastric acidity, emptying, motility, surface area, enzyme levels, intestinal flora
absorption IM/subcut
In pediatrics, this is affected and includes •Peripheral perfusion •Effectiveness of circulation
Absorption topical
In pediatrics, this is affected and includes: Childrens skin is thinner than adults
Distribution influencing factors
In pediatrics, this phase of pharmacokinetics includes body fluid composition, body tissue composition, protein-binding capability, effectiveness of barriers
metabolism
In pediatrics, this phase of pharmacokinetics includes influencing factors of: •Maturational level of child •Liver metabolism •Reduced hepatic blood flow and drug drug-metabolizing enzymes •drug-metabolizing enzymes reach an adult level at around 11 years of age •Higher metabolic rate
absorption influencing factors
In pediatrics, this phase of pharmacokinetics is affected and includes: •Child's age, health status, weight, route of administration •Nutritional habits, physical maturity, hormonal differences •Hydration, underlying disease, GI disorders
Excretion
In pediatrics, this phase of pharmacokinetics is affected by: Kidneys. •Infants have decreased -renal blood flow. -glomerular filtration rate. -renal tubular function. •(GFR) in term neonates is roughly 30% that of adults. During infancy, the GFR rises, and by 12 months, it reaches adult levels.
drug administration
In pediatrics, we need to be: Considering developmental and cognitive differences Maintaining safety while ensuring comfort Family-centered care Side effects may be difficult to evaluate when doing ________________
drug administration
In pediatrics, we need to: Teaching is directed toward family or caregivers and patients. Assess pediatric patient for ability to understand the reason for drug. Consider level of knowledge, developmental age, cultural factors, anxiety level, when communicating with pediatric patient and family. Atraumatic care when doing __________________
pharmacodynamics
In the aging population, _______________ describes: Loss of sensitivity in adrenergic receptors Blunting of compensatory reflexes Loss of dopaminergic and cholinergic receptors, neurons, and neural connections in brain Reduced blood flow to brain
Complementary and alternative therapies
Includes botanicals, nutritional products, and herbal supplements. Possess positive and negative effects. Can interact with prescription and OTC drugs
counterfeit drugs
May look like desired drug May have no active ingredient May have wrong ingredient or wrong dose May be improperly package or contaminated Purchase drugs only from licensed pharmacies
Right route
Necessary for adequate absorption. Assess patient's ability to swallow oral medication. Do not crush or mix medications without validation or consultation Offer patient water but not juice (iron may be taken with orange juice). Use aseptic technique
Considerations for adolescents
Need individualized care specific to developmental stage •Physical changes •Cognitive level and abilities •Social, reasoning, and decision-making skill development •Emotional development •Independence from parents •Self-care behaviors •Impact of chronic illness
Right documentation
Record drug administration immediately. Record drug name, dose, route, time, date, nurse's signature or initials according to policy Document patient's response to drug especially analgesics, sedatives, and antiemetics
Chamomile
Relief of anxiety, sleeplessness, digestive complaints, skin conditions, and oral ulcers Side effects include mild allergic reactions to anaphylaxis
neurobiology
Reward circuit-dopamine's effect on the reward system appears to be pivotal to substance use disorder
right drug
Scan medication label Check that order is prescribed by licensed health care provider. Read drug label three times. Be familiar with patient's health record, allergies, lab results, and vital signs. Know why the patient is receiving medication and if correct for patient's diagnosis Check dose calculations Know beginning and ending date of medication
Anabolic-Androgenic Steroids
Short-term effects-headache, acne, fluid retention in the hands and feet, oily skin, yellowing of the skin and whites of the eyes, aggression, extreme mood swings, anger, paranoid jealousy, extreme irritability, delusions, impaired judgment, and infection at the injection site. Long-term effects-kidney damage or failure, liver damage, high blood pressure, enlarged heart, or changes in cholesterol leading to increased risk of stroke or heart attack. Men may experience shrunken testicles, infertility, baldness, development of breasts, and an increased risk for prostate cancer. Women may experience excess facial and body hair, male-pattern baldness, menstrual cycle changes, and deepened voice. Adolescents who use these may experience stunted bone growth and height.
alcohol use disorder
Short-term effects-nausea, vomiting, headaches, slurred speech, impaired judgment, memory loss, hangovers, and blackouts Long-term effects-stomach ailments, heart problems, cancer, brain damage, serious memory loss, immune system compromise, and liver cirrhosis
Tobacco use disorder
Short-term effects-nicotine enters the arterial circulation and moves quickly to the brain and stimulates the release of dopamine, norepinephrine, GABA, glutamate, and endorphins, resulting in stimulation & pleasure and a reduction in stress & anxiety. Long-term effects- These sensations fuel the brain's reward circuit and can result in addiction.
Current Good Manufacturing Practices (CGMPs)
Standards require package labels that declare quality and strength of contents and that product is without contaminants and impurities.
health teaching
The following describes ________________ with the older adult: Use large print and bright colors in teaching aids. Review all medications at each visit. Advise patient to complete vial of life. Instruct patient to take the list of all drugs taken to all health appointments. Encourage a simple dosing schedule.
Health teaching
The following describes ________________ with the older adult: Have patient's senses as sharp as possible. Wearing clean eyeglasses. Make sure that functional hearing aids are in place. Speak in tones such that patient can hear. Face patient when speaking. Limit distractions. Treat patient with respect.
health teaching
The following describes ________________ with the older adult: With onset of confusion or disorientation, suspect recently prescribed medication(s). Encourage the patient to report if new drug is ineffective Consider use of memory aids.
Polypharmacy
The use of many different drugs concurrently in treating a patient, who often has several health problems.
Anabolic-Androgenic Steroids
Treatment for ___________________: •Antidepressants •Behavioral therapy
tobacco use disorder
Treatment for ______________________ •Cognitive behavior therapy •Self-help materials •Telephone-based counseling •Drug-assisted treatment-Nicotine weaning •Water Vapor Electronic Cigarettes
opioid use disorder
Treatment for _________________________ •Non-pharmacological-12 steps, CBT, Rehab •Drug-assisted treatment (Naloxone, Naltrexone, Methadone, Buprenorphine)
Ginko biloba
Treats sexual dysfunction, multiple sclerosis. Side effects include headache, dizziness, nausea, GI upset, increased bleeding, allergic reactions.
Right time
Use health care agency policy. Use of military time reduces errors. Drugs affected by food are given 1h ac or 1h pc Give food with drugs that irritate the stomach Check for scheduled procedures Check expiration date Administer antibiotics at even intervals Hold antihypertensives prior to dialysis if ordered
Valerian
Used for anxiety, headache, insomnia, tremors, depression, irregular heartbeat. Side effects include headache, dizziness, fatigue, stomach upset.
Ginko biloba
Used for asthma, bronchitis, fatigue, tinnitus Used to improve memory, decrease intermittent claudication.
Licorice
Used for bronchitis, sore throat, stomach ulcers, viral hepatitis. High doses can lead to salt and water retention, hypertension, low potassium level.
Echinacea
Used for colds, flu, infections Stimulates immune system Side effects GI effects and allergic reactions, particularly in those who are allergic to ragweed.
Peppermint
Used for headache, cold symptoms, nausea, indigestion, irritable bowel syndrome, muscle and nerve pain. Side effects include heartburn, allergic reaction.
Hawthron
Used for heart disease, digestive issues, kidney disease. Side effects include headache, dizziness, nausea.
Tumeric
Used for heartburn, stomach ulcers, gallstones, inflammation, cancer. High doses may cause nausea, diarrhea.
Garlic
Used for hypercholesterolemia, hypertension, heart disease, preventing stomach and colon cancer Side effects may include heartburn, upset stomach, body odor, decreased blood clotting
Milk thistle
Used for hypercholesterolemia, insulin resistance, chronic hepatitis, cirrhosis, gallbladder disorders Side effects include upset stomach, hypoglycemia, allergic reactions
St. Jon's wort
Used for mental disorders, nerve pain, sleep disorders, malaria, wounds. Side effects include anxiety, dry mouth, dizziness, headache, fatigue, sensitivity to sunlight, GI problems, sexual dysfunction
Ginger
Used for nausea, motion sickness, diarrhea, relieves pain, swelling, arthritic stiffness and gout Side effects may include gas, bloating, heartburn, nausea.
Kava kava
Used for relaxation and anxiety Adverse effects include liver damage; dry, scaly, yellowing skin; eye irritation, heart problems
Saw palmetto
Used for urinary symptoms, chronic pelvic pain, decreased libido, migraines, hair loss Side effects include digestive problems, headache
Cinnamon
Used to treat bronchitis, GI problems, anorexia, diabetes (Blood sugar regulation!), Generally safe without allergic reactions May decrease blood clotting
Right dose
Verify dosage calculation Verify that drug is safe for patient Weigh patient if dose is dependent upon weight Validate dose of certain drugs like insulin and heparin with 2 RNs
right patient
Verify patient with two forms of identification Compare patient's stated name and birthdate with patient's ID band and MAR Scan patient's bar code on their ID band Check color coding on patient's ID band Verify patient's name with family member if present Check for "name-alert" sticker when 2 patients have same name
Physiologic changes
We need to consider the following for the geriatric population: Postural hypotension with antihypertensives Volume depletion & electrolyte imbalance with diuretics Excess bleeding with anticoagulants of antiplatelets Altered glycemic response with antidiabetics GI irritation with NSAIDs
Physiologic changes
We need to consider the following for the geriatric population: Reduction in total body water and lean body mass Reduction in kidney mass and function Reduction in liver mass and blood flow Lower cardiac output is a physiologic change associated with the older adult
Genseng and cinnamon
What are the two herbs that affect blood sugar
Polypharmacy
When doing drug dosing and monitoring for the older adult, we need to consider _______________ which includes risk factors and pharmacotherapy
beers criteria
_______________ describes potential inappropriate drug use in older adults and is based on: Renal dosing of drugs Drug-drug interactions Provide safety information
pain management
_______________for patient with substance use disorder -Treat patient with dignity and respect. -Pain is a higher priority than substance use disorder. -Determine which drug is used and amount
Promethazine (codeine)
cough or cold product that gives effects of euphoria and relaxation
dextromorphan
cough or cold product that is psychoactive in high doses
alcohol toxicity
drinking large amounts of alcohol over a short period of time. The average person can only metabolize 10 g of alcohol (standard drink) per hour.
up and back
for adults, eardrops are administered by pulling the ear which way?
down and back
for children, eardrops are administered by pulling the ear which way?
Anabolic-Androgenic Steroids
have been used to enhance athletic and sexual performance and physical appearance in all age groups
beers criteria
listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults
routes of administration
oral, transdermal, topical, instillation, inhalation, hg and g tubes, suppositories, vaginal, rectal, parenteral
Herb-infused oils
process of extraction in which the volatile oils of a plant substance are obtained by soaking the plant in a carrier oil for approximately 2 weeks and then straining the oil. Resulting oil is used therapeutically and may contain the plants aromatic characteristics.
surgical patients
special needs of patients with substance use disorder: ____________________: High-risk problems •Drug interactions •Postoperative complications •Death Assess for drug use and screen for alcohol misuse •A thorough assessment for any substance use disorder is extremely important. •Don't forget to ask about the abuse of prescription, OTC and/or street/recreational drugs.
surgical patients
special needs of patients with substance use disorder: ____________________: Postoperative period •Monitor for signs and symptoms of drug interactions with pain medications/anesthesia •Monitor for withdrawal. Adverse effects •Delirium, delirium tremens •Seizures •Withdrawal syndrome- tremors, anxiety, gastric distress, and headache, hallucinations, disorientation, tachycardia, hypertension, hyperthermia, agitation, and diaphoresis.
tolerance
the need for a larger dose of a drug to obtain the original euphoria
epigenetics
the study of environmental influences on genetics
alcohol use disorder
treatment for ______________ •Inpatient •Outpatient •Drug-assisted treatment •Nonpharmacologic therapy
risk factors for substance use disorder
•Cognitive development •Family-related risk factors •Social risk factors •Individual risk factors
