Pharmacology2

T/F: Pharmacodynamics includes the study of how drugs work

True

Sentinel Events

Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof

Absorption drug interaction

When 1 drug affects the absorption rate of another drug

Metabolism drug interaction

When 1 drug's metabolism affects another drugs (worry about toxicity

potentiation drug interaction

When 1 drug's potency is enhanced when combined with another (synergy)

A nurse is preparing to administer medications to a client via a nasogastric tube. Which of the following nursing interventions are ​appropriate? -Flush the nasogastric tube with 30 mL of water following drug administration. -Stop the feeding for 30 to 60 min before administering medications that are not compatible with the enteral feeding. -Check for placement by aspirating content and verifying pH prior to administration. -Maintain the client​'s position 60 min following medication administration. -Crush a sustained release medication to a very fine powder and mix well with water.

-Flush the nasogastric tube with 30 mL of water following drug administration. -Stop the feeding for 30 to 60 min before administering medications that are not compatible with the enteral feeding. -Check for placement by aspirating content and verifying pH prior to administration. -Maintain the client​'s position 60 min following medication administration.

What is metabolism affected by?

diseases, environment, age & genetic make up

What are the specific items included in the medication order?

drug​ name, dose,​ route, and frequency of administration, signature of HCP Client's name The date and time of the order

Which age group has Increased gastric pH

elderly

Which age group has produces less albumin

elderly

Which drug methods bypass the first pass effect

injections bypass liver and GI

Adverse drug event (ADE)

is "an injury resulting from the use of a drug"

Adverse drug reaction (ADR)

is an unexpected response to a medication—example you give Benadryl for sleep and the patient instead becomes agitated and confused—or a patient has an allergic reaction to a medication.

What is excretion affected by?

kidney function, skin, intestines, lungs & exocrine glands

Antagonist

may be used to block the response of an endogenous substance or reverse adverse effects of a drug overdose.

The Three Checks ...

1. Checking drug when removing it from storage 2. Checking drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to bag 3. Checking drug before administering it to the patient

A nurse is preparing to administer a continuous intravenous​ (IV) infusion. Arrange the steps of the procedure in the correct sequence to ensure safe administration of medication.

1. Check the IV fluid label against the MAR 2. 2 point identification of client 3. Check for allergies 4. Check IV access for patency per policy. 5. Connect the primed IV line to the client's IV access. 6. Set the infusion pump per the IV infusion order. 7. Document

A nurse is preparing to administer an oral medication to the client. Prioritize the​ nurse's actions for safe medication administration by placing the steps in order.

1. Check the medication order against MAR. 2. Check the medication label against the MAR. 3. 2 point identification of client 4. Check for allergies 5. Give med with water 6. Document

Before​ prescribing, the health care provider must​ consider:

- How the drug is​ given; the health care provider must determine if the client can easily​ self-administer the drug. - How frequently the drug has to be​ taken - How the drug is metabolized in the​ body - The cost of the​ drug - Drug/food interactions - Speed of the drug - Effectiveness of the drug - Side effects/adverse rxn - Metabolism/elimination of the drug

In the implementation phase, you will:

1. Receive the medication order 2. Correctly transcribe and communicate the order 3. Accurately calculate the dose if required 4. Accurately administer the medication 5. Document the administration of the medication 6. Determine if the medication is appropriate based on the client's age, weight, and medical condition 7. Monitor the administration of any OTC meds 8. Assess for noncompliance 9. Provide teaching to the client

Antagonistic drug interaction

2 drugs taken at the same time/together (decreases effectiveness of BOTH drugs)

Additive drug interaction

2 drugs with similar therapeutic effect (combined potency)

A nurse is preparing to administer medications to a client. Which of the following medication orders would warrant a call from the nurse to the health care ​provider? Select all that apply. A. Morphine 4 mg IV for pain B. Furosemide 40 mg orally now C. Heparin​ 5,000 units subcut bid D. Guaifenesin syrup orally at bedtime E. Aspirin 81 mg once daily

A. Morphine 4 mg IV for pain (no freq) D. Guaifenesin syrup orally at bedtime (no dose) E. Aspirin 81 mg once daily (no route)

Review of New Drug Application (NDA)

AVERAGE review time = 17-24 months Drug approved - process continues Drug rejected - process suspended

Corticosteroids

Acts on inflammatory cells & mediators to decrease inflammation Used in asthma patients Do not work during acute asthmatic attack Given via inhalation

Precautions for breastfeeding moms

Administer drug after breast-feeding Teach mother to avoid alcohol, illicit drugs, tobacco Drugs with shorter half-lives are preferable Drugs with long half-lives should be avoided Select drugs with high protein-binding ability Avoid all OTC herbal, dietary supplements

Category C

Adverse effects have been demonstrated in animal studies and there are no sufficient studies on pregnant women Should be avoided, if possible, because there is not enough data to support it as safe or unsafe for use

Near Miss:

An error that could have harmed the patient, but serious harm did not occur, aka, a close call.

A nurse is preparing to administer an intravenous medication to a client. Which of the following assessments should the nurse conduct prior to administering the ​medication?

Assess the client​'s understanding of the medication. Check the chart for the client​'s past medications. Check the client​'s most recent vital signs. Inspect and palpate IV insertion site.

Pharm classification

Based on how the drug works in the body (mechanism of action).

Non-Renal Routes of Excretion

Biliary Pulmonary Salivary Mammary Skin/ Dermal Gastrointestinal Genital

Muscarine Agonists

Bind to cholinergic receptors to activating them Activate the parasympathetic nervous system

Trade Name

Capitalized

A nurse is preparing to administer a medication for a client. Which of the following actions should the nurse take prior to administering the​ medication? Administer the medication provided by the family. Administer a buccal medication on the chest area. Administer the medication with applesauce. Check the client​'s chart for any allergies.

Check the client​'s chart for any allergies.

The following are goals and expected outcomes related to medications:

Client and family will understand the medication regime The client will achieve therapeutic effects from the medication The client will be without complications related to drug administration The client will safely administer his/her own medications

Clinical Evaluation

Clinical Phase Trials - 3 different stages LONGEST part of approval process Evaluates HUMAN benefits Tests occur on healthy humans FIRST, then on those with the target illness/disease

Category X

Contraindicated for use in pregnancy because evidence supports risk for causing fetal abnormalities and birth defects

The nurse is caring for a pregnant client who has asthma. Which possible change would the nurse expect the health care provider to make to this client​'s treatment​ regimen?

Decrease dose, because blood flow to the lungs is increased due to progesteron

Beta2adrenergic receptors are activated by

Epi

What are the 4 big physiological changes in elderly that impact PK

Decreased kidney function Decreased liver function Decreased levels of serum albumin Decrease in ratio of lean body mass

Which of the following are physiological changes in the older adult that affect medication ​administration? Administration of multiple medications Decreased number of​ protein-binding sites Decreased gastric motility and decreased gastric acid production Increased liver and kidney function Decreased adipose tissue proportionate to the body mass

Decreased number of​ protein-binding sites Decreased gastric motility and decreased gastric acid production

Adrenergic drugs mimic

Dopamine, Epi, and NE

Factors affecting Absorption

Drug dose drug formula Rate of dissolution route size of drug molecules SA of site digestive motility blood flow lipid solubility of drug gastric pH Ionization Drug interaction

eExplain the first pass effect

Drug is absorbed and enters hepatic circulation where it is converted into an inactive form.

Generic Name

Each drug has one generic name. The United States Adopted Name Council issues these names Lowercase letters Cheaper than trade name drugs The generic drug formula may differ from the brand-name version.

The nurse is caring for a client with pneumonia who is receiving antibiotics. Which factor could influence the client​'s physical response to the​ medication? Cost of the medication Allergy to bee stings Drug classification Gender

Gender

The same ____ is never used for more than one medication

Generic name

A client being evaluated for an infection informs the nurse that she is concerned about taking any medications because she is in the 18th week of pregnancy. Which physiologic changes must be considered when prescribing medications to this​ client?

HCl in the stomach

A nurse is preparing to administer an oral medication for a client. Which of the following is the most appropriate nursing action when a client refuses to take a medication due to​ nausea?

Hold the med and call the HCP

ID vs SC

ID is absorbed easier

Which is the most dangerous method of admin

IV

The pediatric nurse is studying pharmacokinetics of drugs in children. Which factors are recognized as increasing drug toxicity in ​children?

Immature kidney f(x) and liver enzymes Prolonged half life Immature BBB

Preclinical investigation

Involves laboratory research Tests are done on animals/cells Determines drug-dose range Examines adverse effects Results considered inconclusive

Primary site of metabolism

Liver (first pass)

Therapeutic Index

Measure of a drug's safety margin The higher the value, the safer the drug

Factors that affect distribution

Membrane permeability Tissue affinity Volume of distribution Protein binding

Post-marketing Surveillance

Monitor for therapeutic effects and adverse reactions from the drugs Reporting adverse reactions Be aware of drugs that have been recalled or reported dangerous FDA holds annual public meetings FDA will withdraw a drug if serious problem found

Category B

No evidence that the drug causes abnormalities, in animal studies; studies conducted on pregnant females are insufficient Adverse effects have been demonstrated in animal studies; studies conducted on pregnant women have not demonstrated risk to fetus

Category A

No evidence that the drug causes fetal abnormalities, in studies on pregnant women

The​ nurse, seeking the fastest and most consistent​ absorption, would administer drugs by which route to the infant ​client?

Oral, IV, Transfermal

When we study drugs used to prevent, treat or diagnose the diseases processes

Pharmaco-therapeutics

When we study the mechanism of action of drugs within the human body & how drugs produce their effects on the body

Pharmacodynamics

Stages for approval for drugs

Preclinical investigation Clinical investigation Review of new drug application (NDA) Post-marketing surveillance

Pharmacodynamics

Refers to how a drug affects the body

Methylanthines

Results in bronchodilation because of its effect in relaxation smooth muscles of the bronchioles Used in patients with bronchospasms & asthma Do not use in patients with peptic ulcer disease

What are the 6 rights of meds?

Right medication Right dose Right client Right route Right time Right documentation

Any pill with​ _____ in its name is a​ delayed- or​ extended-release form

SR, LA,​ XL, or XR

Category D

Should be avoided, except for a life-threatening or critical scenario, because evidence supports risk for causing fetal abnormalities and birth defects

When do you spike a bag with meds

Spiking the bag of the intravenous medication is part of the implementation phase of the medication administration.

Bronchodilators

Stimulates beta-adrenergic receptors in lung muscles Used in asthma & COPD patients Not given when patient has uncontrolled cardia arrhythmias

Investigational New Drug Application (IND)

Submitted for Phase I clinical trials when SIGNIFICANT THERAPEUTIC BENEFITS are determined Product is REASONABLY SAFE for initial use in HUMANS

Which is faster: systemic or local

Systemic

Telephone orders are recored by the nurse and classified as .... They must be signed within ____ hours by a _____.

Telephone orders are recorded by the nurse and classified as a telephone order in the client's chart; they must be signed by the prescriber within 24 hours.

Chemical Name

The International Union of Pure and Applied Chemistry (IUPAC) assigns these names according to standard nomenclature Complex/hard to memorize

In the evaluation phase of the nursing process, you will evaluate the following:

The client's therapeutic response. The occurrence of adverse effects. Any drug-drug or drug-food interactions.

Medication Reconciliation

The process of tracking a patient's medications as they proceed from one health care provider to another

Therapeutic classification

Why it is being given (i.e. antihypertensives)

What is the primary pharmacokinetic factor determining length of time for drug to produce effect

absorption

4 parts to pharmacokinetics

absorption, metabolism, excretion, and distribution

5 drug interactions

additive antagonistic potentiation absorption metabolism

What is absorption affected by?

affected by route, formulation , stomach contents & blood flow

A therapeutic drug objective is to

assess the patient for adverse side effects

Agonist

mimics or increases the response of an endogenous substance

Digoxin as a narrow therapeutic range so

monitor for toxic effects and monitor drug level

Prototypes

one of the first drugs used in that classification, or because they provide the most benefit.

Movement into blood is __

pharmacokinetics

Therapeutic range

plasma drug concentration between the minimum effective concentration and the toxic concentration

Pharmacokinetics

refers to how the body processes a drug after it is administered.

Root cause analysis (RCA)

seeks to prevent another occurrence by asking what happened and why, and what can be done to prevent it

Absorption is _______ & Distribution is _____ in Older Adults

slower, decreased

What is distribution affected by?

solubility, protein activity/binding & blood flow

Written orders are in ...

the pt chart

Side effects/adverse effects from prototype drugs

usually similar to effects produced by other drugs in the same classification. Knowing the effects of prototypical drugs will help you monitor clients for complications related to drug administration.

Common sites for IM

ventrogluteal, deltoid, dorsogluteal & vastus lateralis

Types of medication orders include

written, computerized, telephone

An experienced nurse has completed a pharmacology review for a new nurse who is caring for clients in a rehabilitation center. Which statement made by the new nurse indicates that further instruction is​ needed? ​"Liquid medications have a slower onset than​ capsules." ​"Taking drugs between meals increases the absorption​ rate." ​"Maintenance dose refers to a dosage administered to keep a preferred drug concentration in the​ blood." ​"A drug that is more potent will produce a therapeutic effect at a lower​ dose, compared to another drug in the same​ class."

​"Liquid medications have a slower onset than​ capsules."