Pharmacology Ch. 6 - Challenges to Effective Drug Therapy

Herbal therapies are regulated by the Food and Drug Administration. T/F

False

The Office of Homeland Security educates health care workers regarding signs and symptoms of biologic weapon exposure.

False. The CDC does

What are health consequences of using benzodiazepines?

Health consequences of the use of benzodiazepines include confusion, fatigue, impaired memory, and impaired coordination.

The use of _____________________ can lead to dependence and change the body's response to prescribed medications.

illicit drugs

A client has been prescribed both disulfiram and phenytoin. Based on the interaction of these two medications, the nurse should suggest what adjustment to the medication therapies?

reduced dose of phenytoin Explanation: The client will require a reduced dose of phenytoin because disulfiram interferes with the metabolism of phenytoin. The client will not require more frequent administration of disulfiram. The client will not require a larger dose of disulfiram. The client will not require increased administration of phenytoin.

Cost Considerations

--Finishing antibiotics --Not splitting pills unless advised to do so --Generic drugs --Ordering drugs from the internet, often from other countries

The use of a medication for indications that were not approved by the FDA is called ___________ use.

Off-label

Anthrax is an example of a biological weapon that nurses must be prepared to treat.

True

Media Influence on Drug (mainly presciptions)

--1990s: legal to advertise prescription drugs directly to the public --Federal guidelines: When the advertisement states the indication, it must also include: oContraindications oAdverse effects oPrecautions

Home Care

--Aging population --Increase in teaching needs --Role of the nurse crucial as teacher, assessor, diagnostician, and patient advocate

Drug Abuse and the Opioid Crisis

--Anabolic steroids --Street drugs --Alcohol --Nicotine --Opioid crisis

Alternative Therapies & Herbal Medicine

--Herbal medications of alternative therapies are not controlled or tested by the FDA. --Advertisement for these drugs is not restricted because they are considered dietary supplements. --No regulation by any industry. --The active ingredient has not been tested by the FDA --Incidental ingredients are unknown --Patients do not always mention these therapies to their health care providers --Drug-alternative therapy interactions may occur

Protecting the Environment

--Medications in drinking water --Patients flushing meds, throwing them in garbage --What does it mean for us, animals, crops?

Emergency preparedness

--Risk of exposure to biological and chemical weapons --CDC guidelines for treating exposure to biological weapons are available online.

Cost of Healthcare and Importance of Patient Teaching

--Skyrocketing cost of medical care and drugs --Huge research and equipment requirements to meet consumer demands --Rising cost of health insurance --Earlier discharge from hospitals

OTC Drugs (Over the counter)

--Those "grandfathered in" not tested to the extent that new drugs are today --Can mask the signs and symptoms of disease --Can interact with prescription drugs --Can be taken in greater than the recommended dose, leading to toxicity

Internet Site Evaluation

Address Identification .com, edu, gov, net, org Navigation Is the site easy to access and navigate or confusing? Contributor Who prepared the site and what are his or her qualifications? Is it reviewed, or is it purely commercial? Dates -Is the site updated frequently? Accuracy/Reliability Is the information supported by other sites, accurate, and in agreement with other sources you have reviewed? Are other links listed?

How should the nurse best assess the client for physical dependence on alcohol?

Assess the client for signs and symptoms of alcohol withdrawal.

Emergency preparedness requires that nurses are familiar with the signs and symptoms of ___________ and ____________ weapon exposure.

Biological and Chemical

A client is experiencing acute alcohol withdrawal. What medication does the nurse anticipate the prescriber to order?

Chlordiazepoxide Chlordiazepoxide is a benzodiazepine used for withdrawal from alcohol and central nervous system (CNS) depressants. Varenicline and bupropion are used for smoking cessation. Cannibus is medical marijuana and not used for acute alcohol withdrawal.

Off-Label Uses

Definition oThe use of a drug for an indication not approved by the FDA Occurrence _Commonly done for groups of patients for which there is little premarketing testing _Used with pediatric and geriatric population --May lead to discovery of new use for a drug --Liability issues are fuzzy

The rapidly growing field of ____________________________ requires that patients are able to mange medical regimens at home.

HomeHealth

The nurse admitted a client who overdosed on an unknown drug. The fact that the client appears to be experiencing psychosis should suggest what possible drug to the nurse?

LSD LSD is a hallucinogen. Heroin, fentanyl, and OxyContin are opioids which cause CNS depression, not psychosis.

HMO's and Regulations

Less expensive than traditional insurance, but the tradeoff is loss of choice

What action should the nurse take when identifying that a client regularly self-medicates with herbal supplements?

Notify the healthcare provider of the client's use of herbs. The healthcare provider must be aware of all herbal and over- the- counter medications taken when prescribing medications. Some herbals may or may not have any affect on prescription drugs, so it is the healthcare provider that must make the decision to continue or to hold them. A major concern related to the use of herbal supplements is the potential for interactions with prescription medications, even though the nurse can research them, it is the healthcare provider who must make the decision. Health care providers should identify potential interactions and advise the client accordingly.

_______________are considered safe and effective when used as directed and are available without a prescription.

Over-the-counter medications

Which drug would be classified as a hallucinogen?

PCP PCP is a hallucinogen. Amyl nitrate is a stimulant; heroin is an opioid; and rohypnol is an amnesiac.

When caring for a client with alcohol dependence who is prescribed a benzodiazepine, which side effects is it most important that the nurse monitor for?

Sedation The side effects of benzodiazepines are sedation, confusion, restlessness, bradycardia, tachycardia, urinary retention or incontinence, and drug dependence. The nurse should observe the client for excessive sedation and should use benzodiazepines cautiously in clients with impaired kidney or liver function. Insomnia, increased thirst, and anxiety are common side effects in drugs used in recovery from chemical dependence, but are not most commonly associated with benzodiazepines.

GHB, also known as the "date rape" drug, causes memory loss and somnolence. T/F

True

Over-the-counter medications may interact or interfere with the actions of prescription drugs. True/False

True

True/False Earlier discharge of patients from the inpatient setting is occurring much more than in the past?

True Rationale: Financial pressures have led to the early discharge of patients from health care facilities.

A client, admitted for the treatment of a fracture, has a history of heavy alcohol use. What event should suggest the implementation of pharmacologic treatment for alcohol withdrawal?

signs/symptoms of withdrawal are noted

A client, admitted for the treatment of a fracture, has a history of heavy alcohol use. What event should suggest the implementation of pharmacologic treatment for alcohol withdrawal?

signs/symptoms of withdrawal are noted Treatment with chlordiazepoxide should begin as soon as the clinician identifies that the client is demonstrating signs and symptoms of alcohol withdrawal. It is unsafe to delay treatment of withdrawal. Care for physical injuries is implemented independently.