Nursing 112 (Pharmacology) test 1

Efficiency

"How efficient" magnitude of response produced by drug

Potency-

"How much need for a response" more potent drug produces effect at a lower dose than others in that class.

Serum drug level

(Drug plasma concentration): lab measurement of amount of drug in blood at a particular time. Reflects dosage, absorption, bioavailability, half-life, and rates of metabolism and excretion

Sources of drug information

-Pharmacology and textbooks -Drug Reference books -nursing drug guide books(this has everything a nurse needs to know/refer to for safe administration of meds. -reliable internet sites -medical journals -American hospital of formulating services

How do we know when to give meds?

1) check facilities policy 2)check to see when the med works best

Practice Question: what instructions are most important for the nurse to include when teaching pt. how to take Xanax (select all that apply)

1) full meal? 2) light meal?• 3) alcohol? 4) grapefruit? 5)no grapefruit juice? • 6) sodium? 7)low sodium? Correct answers are 2) and 5) also important to know that xanax can NEVER be taken with alcohol

What are the 2 was of obtaining medications?

1) prescribed 2) non- prescribed or "over the counter"

If you have a poisoned patient:

1) stabilize them 2) identify poison 3) find out if there is an antidote

Types of depression:

1. Major depression 2. Mild depression 3. Postpartum 4. Season depression of seasonal affective disorder (SAD)

Review military time in Ogden book

1400-2:00 PM 0100- 1:00 AM 2400- 12:00 AM

By injection SQ (subcutaneous)

5/8 needle, 25 gauge. Tighten skin if obese, pinch skin is normal size. Insert at a 45 to 90° angle will aspirate with some meds and not with others, follow agency policy, never aspirate with heparin and some don't recommend it with insulin

Cardiotoxicity

A few medications damage cardiac muscle cells, affecting the ability of the heart to effectively pump blood to the tissues. The most common cardio toxic drugs belong to chemical class called the anthracyclines Symptoms- excessive fatigue, cough, shortness of breath, weight gain and peripheral Adema

Practice question-

A hospitalized patient is complaining of having difficulty sleeping what do you do first? Provide a restful environment and quietness first, drugs are a last resort

Drug-

A substance used to prevent, cure, or reduce symptoms of a medical condition and there are some that are taken for a feeling of pleasure

Drugs are classic

According to their effects on particular body systems, their therapeutic uses, and their chemical characteristics

Immunizations

Active immunity- body produces its own antibodies in response to exposure Passive immunity- when preformed antibodies are transferred from one person to another

FAS (alcohol)

Acute intoxication impairs thinking, judgment, and psychomotor coordination. These impairments lead to poor work performance, accidents, and disturbed relationships with others. S/S if withdrawal- Agitation, anxiety, tremors, sweating, nausea, tachycardia, confusion, convulsions, and delirium

Polypharmacy

Administration of many drugs together. •the higher the number taken, the higher the risks of interactions and adverse effects •encourage to use 1 pharmacy, pharmacist are aware of what they are taking and be alert for interactions

Agonist vs. Antagonist

Agonist- triggers the response by binding to receptor cell and makes the same response as what normally occurs......."mimics" Antagonist- blocks an action, binds to receptors and blocks normal action that would occur or changes the pharmacokinetics. Ex- opioid antagonized by narcan.

"Cousins" to BENZO

Alprazolam (Xanax)- avoid grapefruit Diazepam (Valium) Temazepam (restoril)- often used for sleep **grapefruit juice should be avoided because they could effect absorption. Especially avoid grapefruit juice with Xanax

Nursing activities in regard to medication administration

Always use military time, always check for allergies, always identify the patient x2, verify orders with MAR Always know contradictions/times to hold Look up unfamiliar meds in drug guide When in doubt clarify

Dose

Amount to be given at one time

Street drugs potential effect on pregnancy

Amphetamines/methamphetamines- premature birth, placental problems, heart defects, cleft lip and after birth withdrawal Marijuana- reduced fertility in men and women, slowed fetal growth, decreases length of pregnancy, after birth withdrawal PCP/LSD/ ketamines- learning and behavior problems Cocaine- miscarriage, premature birth, low birth weight, mental retardation, cerebral palsy and even death. Unborn babies to have stroke, irreversible brain damage, heart attacks, placental problems Heroin- poor fetal growth, premature birth, stillbirth Same with inhalants glues and solvents

Ex of varying responses on cultural groups

Antihypertensives- most African Americans respond better to antihypertensives paired with a diuretic Asians are very slow metabolizes of pain meds like morphine, a high dose could lead to toxicity or overdose

Pharmacotherapy

Application of drug for the purpose of disease prevention and treatment of suffering

Anxiety disorder care plan:

Assessment- suicidal ideation, history of patient's anxiety reaction, determine patients support system, obtain drug history (drug to drug interaction) Evaluation- drug effectiveness and adhering to pt teaching

Drugs alter:

Basic processes in body cells. They can inhibit OR simulate normal cellular function To act on body cells drugs that are given for systematic effects must reach adequate concentration in the blood and other tissues.

If women are pregnant or trying they should

Be advised on meds they are on and risk factors •does the benefit outweigh risks? •tetracycline can stain babies teeth brown •you need to know if they take OTC meds, illegal drugs, and herbal remedies •Tylenol is safe during pregnancy and ibuprofen is not

Nonbenzodiazepines have:

Black box warning- Drugs that can be abused and lead to dependency Contradictions/precautions- respiratory impairment, elderly, hepatic or renal, depression/ suicidal ideation Drug interactions- alcohol opiates, other sedatives Cousins- busparone, May take 2-4 weeks for results

Variables effecting drug action

Blood flow to tissue Drug solubility Tissue storage Drug proteins binding Barriers to drug distribution

100% of IV drugs available because it goes directly into

Bloodstream

Bone marrow toxicity

Bone marrow serves as a nursery for the production of red blood cells, white blood cells, and platelets. Drugs may affect only one of these types of selves or all three. When all three groups are affected drug induced aplastic anemia or pancytopenia occurs Drug most likely to cause- antineoplastics

Drug/food (drug interactions)

Calcium or iron interacts with antibiotics Ex-levoquin with milk •food can either increase or decrease absorption (vitamin K can decrease effects of Coumadin) Drug interactions are impossible to avoid completely

A drug only has 1-

Chemical name. Ex- calcium gluconate, sodium chloride

Drugs have severe names including

Chemical, generic, and trade names

Non-pharmocologic treatment for depression:

Cognitive behavioral therapy- Therapy that helps patients change the negative styles of thought and behavior that are often associated with their depression. Electroconvulsive therapy- The induction of a brief convulsion Bypassing an electric current through the brain as therapy for affective disorder's, especially in patients who have not responded to pharmacotherapy Interpersonal therapy- therapy focusing on the patients disturbed personal relationships that both calls and exacerbate the depression Light therapy or photo therapy- therapy that uses artificial lighting that is 5 to 20 times brighter than usual indoor lighting, it is used to simulate natural sunlight in areas where there is little natural sunlight for several months of the year, such as Alaska and other areas near the north pole Pharmacodynamic therapy- therapy focusing on resolving a patient's internal conflicts repetitive transcranial magnetic stimulation (rTMS) therapy- ineffective somatic therapy, experimental in the United States, that involves a device that administers a train of multiple stimuli per second. The device is a metal coil that is placed on or near the patient's head, allowing the magnetic field to pass through the skull and into specific targeted areas of the brain Vagus nerve stimulation (VNS)- Somatic therapy that involves placing a small generator into the patient's chest, it is attached to electrode with ends wrapped around the left Vegus nerve all the patients deck, the generator is programmed for frequency and intensity of stimulus. The electrical current stimulates the Vagus nerve.

Medical reconciliation

Comparing the patient's medicine order to all meds patient has been taking. -done to avoid omission, duplications, dosage errors, or drug interactions. Had 5 steps: 1)develop a list of current meds 2)list of meds to be prescribed 3)compare 4) make clinical decisions based on findings 5) communicate the new list to appropriate caregivers and the patient.

Pharmacodynamics- what the drug does to the body

Concerned with the mechanism of action and relationship between drug concentration and responses in the body •receptors often describes as a lock into which drug molecules fit as a key and only those drugs able to bond chemically to the receptors in a specific body tissue can produce pharmacological effects

Pharmacoeconomics

Cost of drug therapy that includes cost of purchase, dispensing, storing, administering, and monitoring.

Marijuana

Decreased coordination, red or blood shot eyes

Nicotine

Deposit is characterized by compulsive use and development of tolerance and physical dependence. S/S of withdrawal- anxiety, irritability, difficulty concentrating, restlessness, headache, increased appetite, weight gain, and sleep disturbances. Nursing care- concerned with the use of medications to help quit smoking, either an antidepressant or a drug formulation of nicotine such as patches, gum, inhaler or nasal spray.

Nursing diagnosis

Describe the client problem or needs that diagnosis are based on the assessment of data. They should be individualized according to the clients condition and the medications that they are prescribed. These can be actual or potential. These are used to set goals and plan of care within the practice scope of the nurse

3 med checks: what is checked and when?

Dosage Name of med matches order And when

Dosage and administration factors

Dosage: age, weight, state of health, cardio. function, renal and hepatic function, route of administration. Administration: IV- normally the fastest and most effective IM (intramuscular)- acts within a few minutes Oral- works within 15/30 min Topical- works immediately at the site Sub-lingual- dissolves under the tongue

Signs of overdose

Drowsy, displayed pupils, hallucinating and changes in HR

RN's are the last step in the checks and balances system before

Drug administration

Dermatologic toxicity

Drug reactions affecting the skin or some of the most common types of adverse effects. Rash, the most common cutaneous drug reaction, usually occurs within 1 to 2 weeks of initiation of drug therapy. Antibiotics are most common to cause rash Angeo Adema is a severe drug reaction because the swelling may impair breathing and baby fatal. SJS is another drug induced condition that can be fatal. This syndrome causes severe blistering of the skin usually accompanied by mucous membrane involvement and fever

synthetic drugs

Drugs that are completely derived in a lab.

Nurses should _______ clients about medications they are taking

Educate Ex- old medication patches must be removed before putting a new one on to prevent overdose

A way to combat non-compliance is:

Education- what that are taking, why, purpose behind it and the risks if they don't

Drug/drug (drug interactions)

Effects can be inhibited, enhanced, changed/new response

Hepatotoxicity (Liver)

Effects of hepatotoxic drugs range from minor, transient increases in liver enzyme values to fatal hepatitis

Therapeutic range index

Enough drug to be beneficial but not enough to be toxic- this is the goal of drug therapy

routes of med administration

Enteral drugs- delivered to the GI tract either orally or through the NG or gastrostomy tube Parenteral- administration of drugs by routes other than enteral or topical. Is more invasive. Topical- drug applied to the skin or membrane linings of the eye, ear, nose, respiratory tract, urinary tract, vagina or rectum Also: Otic- ear drops Ophthalmic- eye drops

Nonbenzodiazepines "cousins"

Eszopiclone- long half life Rameloton (rozeren)- melatonin receptors, affects sex hormones

Older adults should bring ALL meds to appointments:

Even OTC and vitamins/supplements

Schedule IV

Even less abuse potential that schedule III (benzodiazepines, phenobarbitol, stadia, and Ambien)

When should the nurse evaluate compliance with the prescribed med regimen?

Every time they are in contact with the patient

Who is at risk for being non compliant?

Everyone, especially illiterate, elderly and poor

Sometimes diets and genetic makeup can effect drug metabolism

Ex- Japanese metabolize meds faster sometimes so they may need higher or more frequent doses

Effects of poisons-

Excessive amounts of a drug may cause reversible or irreversible damage to body tissue Signs may be abdominal cramping, N/V/D, loss of consciousness

Toxic concentration

Excessive level at which toxicity can occur. Can be from single large dose, repeated small ones, or slow metabolism that allows drugs to accumulate in the body

Oral drugs have to

Fight GI tract, bind to protein and other actions deplete they drug level

Assessment

First phase, helps you know what you are dealing with. Collect data about the client and will use it to form the basis of care, identify problems, and help with evaluation. Subjective and objective data are obtained by observing and interviewing the client, family members, the physical assessment, reviewing medical records for lab results and diagnostic test. Learn about what medications they are taking prescription or over-the-counter and herbal may affect their plan of care. Must assess for allergies to medications as well

The rate and extent of absorption are affected by:

Form(tablets, IV, injection) Route GI function Blood flow Presence of food in GI tract Ex- elderly people's GI tract slows down while people with diarrhea have a fast GI tract

Generalized anxiety disorder or:

GAD

What so we need to teach the client about the medication?

General information about the med Why is was prescribed for them How and when to take it Side effects Intended effects and safety measures related to it (dizziness, make sleepy etc.)(need to check blood sugar before, need to check HR before or BP)

Anxiety

Generalized feeling of worry, fear, or uneasiness over a perceived threat •nurses have challenges sorting through etiology of anxiety. •pharmacotherapy May not be the best option, get a comprehensive medical history bc meds may worsen anxiety

Loading dose

Given to get drug into body quickly, larger than normal dose. Ex- if someone had a bad infection you would give IV drugs so it would work more quickly.

Maintenance dose

Given to maintain the drug level after loading does Ex- you would give oral doses after to work with the drug you gave them IV to maintain the drug level.

Malfeasance

Giving the correct drug but by the wrong route that results in the patient's death

Placebo

Have no Active factors they are only "sugar pills", usually helps people to believe they are better. Act more on the psychological side

Pain management of addiction

Have to treat the pain, probably will need higher doses and continual dosing!

Cultural practices

Herbal and homeopathic remedies can inhibit or accelerate drug metabolism and response

Drug/herbal (drug interactions)

Herbal interactions-usually undocumented but they have a significant impact on therapy

Schedule II

High abuse potential with severe dependence liability (codeine, morphine, Demerol, methadone and oxycodone) Must have a written Rx signed by HCP, can't call in refill for these.

Where do drugs come from?

Historically, they were derived from plants, animals and minerals Now, most are manufactured in labs

Nurses must be aware of

How herbal or cultural medicines or treatments react with meds we give. "Be culturally aware"

Inhalants

Huffing

When would the nurse question the pt's compliance?

If the therapeutic outcome is not being seen. You have to determine if taking at all, taking incorrectly, etc If not seeing desired outcome

Med orders

Includes- full name of patient, name of medication, dose, route, frequency, date, time, and signature of prescriber May be- handwritten(what if not legible?) or a computer entry (helps with bad writing but not fail proof) "without a doubt, spell it out l") May have verbal or telephone orders

Prototype drug

Individual drugs that represent groups of drugs, one in which others in that class compare to. Ex- "lols" "cillins" and "statins"

By injection ID and IV

Intradermal Intravenous

Evaluation

Involves evaluating the client status in relation to stated goal and expected outcomes. There is ongoing monitoring of the client for therapeutic as well as adverse effects

Distribution of a drug

Involves transport molecules of drug through the body • depends greatly on adequate blood flow. (If our heart, liver, and kidneys are not working properly it could inhibit distribution because circulation of blood would slow down.") • protein binding important part of drug distribution. (Protein bound medications bind to carrier proteins in order to get to its final destination in the body.) •**only free or unbound parts of the drug can act on body cells. •CNS and blood brain barrier: limit movement of drugs to brain tissue— have to have a carrier protein or be lipid soluble to pass this barrier. (Our normal body response is to protect the brain from foreign cells so it is harder to treat brain infection.)

The nursing process and pharmacology:

Is a systematic way to gather and use information in providing patient care, helps provide holistic care. Will guide care, continuous cycle until med is discontinued or changed because changes will always occur

Trade name

Is designated and patented by the manufacturer. "Brand name" (Tylenol, Advil)

Generic name

Is related to the chemical name and is not related to the manufacture. Often is indicative of its drug group (those ending in "cillin" and penicillins. Generic name typically in lower care letters. Only 1 generic name. (Acetaminophen and ibuprofen)

Pharmacology

Is the study of medications

The elimination half-life of a drug is a pharmacokinetic parameter defined as the time:

It takes for the concentrations of the drug in the plasma or the total amount in the body be reduced 50%. Ex- after 1 half life the concentration of the drug will be half the starting dose. Ex- taking 100mg dose of an intravenous drug with a half life of 15 minutes: •15 min. after admin., 50 mg drug remains. •30 m, 25mg •45m, 12.5mg

Nephrotoxicity (kidneys)

Kidneys are one of the most common organs affected by drugs. This is because these organs filter large volumes of blood, and most drugs are excreted by the renal route. A few obstruct the urinary system and toxicity may manifest as acute symptoms that appear after one or several doses or chronic symptoms that appear after months of pharmacotherapy Identify at risk patients Provide proper hydration and monitor urinary lab values

Hallucinogens

LSD, PCP,— hallucinate, mood swings, HTN, flushed, suspicious

Hinder aces to compliance and learning

Language barrier Hearing loss Poor eyesight May not be able to read Ability to afford medications No way to get Rx from pharmacy Might not be able to open the bottles

Schedule III

Lesser abuse potential (steroids, ketamine, codeine preparations)

When teaching about a medication-

Listen to the patient! This well tell you a lot

With elderly people be sure to check renal function

Many drugs that they are prescribed are harsh in kidneys and kidneys control they excretion part of pharmacokinetics.

(Absorption) Lipids absorbs faster than tablets or capsules Ex-

Medications such as sub lingual or sub buccals absorb very quickly because the membranes in the mouth are thin and easy to permeate

Why do patients take medications?

Meds are usually given for ethereal their local or systematic effects

The nurse is responsible for making sure the patient takes their medications so

NEVER leave drugs at a patients bedside, you have to witness the patient swallow the drugs if they are to be giver orally

Schedule I

NOT approved for medical use; HIGH abuse potential (LSD, Heroin)

Poisons-

Need to know number to poison control When to suspect? Open pill bottle laying next to a person, open bottle of cleaner

Misfeasance

Negligence; giving the wrong drug or drug dose that results in the patient's death

Is there a perfect drug?

No, there are no perfect drugs. We have ideal drugs that we try to pick the right drug with fewer doses, least amount of cost, least amount of side effects, cheapest, and works best to treat the patient's condition.

Good factors for BENZOS

Normally very effective

When giving medications the __________ is legally responsible for safe and accurate administration

Nurse

Drug molecules must-

Occupy a minimal number of receptors to produce their effects. Ex- drug must reach proper receptor to work like a "lock and key"

Nonfeasance

Omission; omitting a drug dose that results in the patient's death

If there is a med order ALWAYS report it and report:

Operator error Incorrect labeling Similarly named medications

FAS (Barbiturates and Benzodiazepines)

Overdoses with these can cause respiratory depression, coma and death S/I- ataxia, belligerence, agitation, anxiety, loss of superficial reflexes, diminished respiratory volume, lethargy, confused or delirious state S/S of withdrawal- anxiety, tremors, muscle twitching, weakness, dizziness, distorted visual perception, insomnia, nightmares, delirium, and seizures Nursing care- concerned with possible injury to self, ineffective breathing pattern, and ineffective coping. Need to provide a quiet environment, maintain frequent contact, and seizure precautions

Drugs can be administered

PO- given by mouth IV- intra venous IM- intramuscular- injected into the muscle SQ- subcutaneous injected right under the skin Inhalation or topically

Bioavailability

Portion of those that reaches systematic circulation and is available to act on body cells. (physiological ability of drug to reach target cell in produce affect)

Side effects

Predictable secondary effects of medication. Usually willing to be tolerated if side effects are serious enough to negate beneficial effect

Benzodiazepines

Preferred drugs for generalized anxiety and short-term therapy for insomnia. (Ativan is the prototype drug) •causes simple relaxation to induce sleep or coma, gaba intensifiers! •available PO, IM, or IV IV doses would be administered for status epilepticus or acute schizophrenia These drugs are HIGH risk for dependency

Cocaine

Produce is strong CNS stimulation. Causes euphoria, increased energy and alertness and sensory of perception, dilated pupils, tachycardia, increased BP, and restlessness. S/S of withdrawal- depression, drowsiness, fatigue, sleep disturbance. Nursing care- same as with amphetamines

Alcohol can not be mixed with CNS depressants, cumulative effect:

Profound sedation

Therapeutic range

Range at which a drug produces the desired therapeutic level

Check to be sure that the elderly pt can-

Read labels, open bottles, they can hear and understand teaching and that they can remember when to take meds, have access to obtain meds and are able to afford them

Meds with a short half life:

Require more frequent dosing but depends on what med it is and why it's being given ex- (epinephrine for low HR)

Phenobarbital (Luminal)

Reserved for emergency situations such as status epileptics (seizures)

What are the effects of poisons?

Results from excessive amounts of a drug and may cause reversible or irreversible damage to body tissue Signs and symptoms- abdominal cramping, loss of consciousness, open container close by Goal of treatment? •suspect when toxicity is present and begin treatment •start treatment ASAP after ingestion, supporting and stabilizing vital functions, preventing further damage by reducing and absorption or increasing elimination and administering antidotes if indicated.

How can you make sure what you have taught has been understood?

Return demonstrations, have them read back instructions to you, asking questions about what has been taught, watch their body language for cues that they are not understanding the info, ask quest about what has been discussed

6 rights of drug administration

Right dose Right patient Right medication Right time Right route Right documentation

Extra "rights" of drug administration

Right reason Right response And right to refuse Right to education and right to assessment

Substance abuse

Rx meds when used as prescribed are rarely a cause for addiction Addiction- destructive compulsive abuse of a substance. With withdrawal,pt will experience opposite of drug effects

Amphetamines

S/I- increase vital signs, heart rate, blood pressure, respiratory rate, and temperature. Dilated pupils, confused mental state, feeling of persecution and anxiety and potential for aggressive or violent behavior also cardiac arrhythmias and anorexia. Nursing care- would include sedation, lowering of temp, administration of antipsychotic meds. A quiet environment, being alert to possible violence, remove harmful objects, monitor cardiac rhythm, and provide clear directions and monitor nutritional status

The nurse has to be knowledgeable about medications and why it is intended for that particular patient in order to:

Safely administer that med and teach the patient about the Rx medication. They need to understand purpose, side effects, when they may need to stop taking it and seek medical assistance, how to know if the medication is working for them.

Which meds can not be refilled? The patient would have to make an appointment with the provider for a new Rx

Schedule II, because they are strong controlled substances

Toxic concentration

Serious adverse effects are seen

Trough

Shows the lowest concentration of the drug - drawn just before next scheduled dose

Neurotoxicity (CNS)

Signs and symptoms of toxicity in the central nervous system include depression, mania, sedation, behavioral changes, suicidal feelings, hallucinations, and seizures Types of drugs- antidepressants, anti anxiety, sedatives and antipsychotics

Skeletal muscle and tendon toxicity

Skeletal muscle is relatively resistant to the effects of drugs despite its extensive blood supply. Chance of drug induced myopathy is low but can be serious when it occurs. Most severe is rhabdomyolysis- characterized by extensive muscle necrosis with the release of muscle enzymes into circulation

Signs and symptoms of anaphylaxis

Skin rash, difficult breathing, nausea, vomiting and shock

Sometimes meds are ordered that are not needed

Someone who had low BP and takes BP meds every day day, but wakes up with a BP of 80/40 and has a BP med scheduled for 8AM. We don't need to give that med because it could drop it dangerously low

Do not study laws in book just know that there are governing agencies for medications

Such as: FDA- who enforce drug laws Public Health Service- regulates vaccines and biologic products. Federal trade commission- suppress misleading advertising DEA or Drug enrichment administration- govern addictive drugs

Institute for Safe Medication Practices (ISMP)

TO/VO - always read back Do not use abbreviations such as: U- unit QD or OQD- every day or every other day MS or MSO4- for morphine sulfate Cc for ml @ could be mistaken for 2 Drug abbreviations

PO

Tablet Capsule Syrup Elixir Lozenges Suspension Sublingual Buccaneers NG

___________ is one of the most important interventions concerning the use of meds.

Teaching

As the drug dose increases

The risk of adverse effects increases

2 basic drug classifications

Therapeutic- "what is being treated by the medication" Pharmacologic- "how the drug acts or produces an effect on the body"

Local effects

These act mainly at the site of application. Ex- ointments and creams.

Why are most drugs manufactured in labs now?

They would be considered completely synthetic and to have completely synthetic drugs is considered safer because you have better control over the medication

Planning/goals

This step involves determining the expected outcomes of prescribed drug therapy (state see expected outcomes of the prescribed drug therapy) goal should be stated in clients behaviors. These must be measurable to help guide nursing interventions

Implementation

This step involves implementing planned activities and includes any tasks performed on the clients behalf- drug administration, teaching about the medications, problem-solving, promoting compliance, identifying barriers to compliance, identifying resources to accomplish the goals or expected outcomes

Why do people take medications?

To treat symptoms of illness or to reduce pain. Medications are used in the treatment of chronic conditions.

Why are drug levels important?

Too much of a drug could lead to toxicity and too little could slow down the healing process

Accidental poisoning is common in young children so-

Try to determine what person has been exposed to And when exposure took place this can help guide specific treatment after speaking with poison control

Often older people will

Underuse- "too expensive" "don't feel bad today" "self adjust" Overuse- "if one works good, 2 will work better" And use erratically

PTSD (Post Traumatic Stress Disorder)

Usually associated with war but also with other traumatic situations/ childhood trauma

Schedule V

Very low potential for abuse of dependence. Contain a moderate amount of controlled substance with another type of medication. (Lomotil, codeine in cough syrup)

Peak

When drug reaches the highest blood plasma concentration. -drawn 30 minutes after IV administration and 1-2 hours after PO administration.

Systematic effects

With this, medications are taken into the body and circulated through the bloodstream to their site of action and then eliminated from the body

Med errors: how do they occur?

Wrong dose, route, person, or wasn't ordered

When taking someone off BENZOS

You can never take them immediately off you must taper doses! Could cause headache, insomnia, restlessness, and pt's condition could return or worsen •monitor for rapid onset of CNS effects hypotension and respiratory distress May cause dizziness, ataxia, blurred vision, sedation or confusion

Trade and generic preparations-

You may have slight differences in their effects due to different "inert" ingredients and fillers

Be aware of look alike meds Ex-

Zantac- Zyrtec Hydroxyzine-Hydralazine

Pharmacokinetics- what the body does to the drug

absorption, distribution, metabolism, excretion

Common drug abbreviations that probably shouldn't be used

ac- before meal gtt- drop h or hr- hour Pc- after meal Stat- immediately Prn- as needed q- every day

minimum effective concentration

amount of drug required to produce a therapeutic effect

OCD (Obsessive Compulsive Disorder)

an anxiety disorder characterized by unwanted repetitive thoughts and/or actions. Can be disturbing if there are any disruptions causing panic to patient

panic disorder

an anxiety disorder that consists of sudden, overwhelming attacks of terror. Ex- spiders, bridges, water Meds may not work so much as a coping mechanism

Nursing process is important because

care is individualized at not "Cookie cutter" care allows us to identify specific patient needs

Carcinogenic

causing cancer

Mutagenic

causing changes, or mutations, in DNA

Combo meds

contain a combination of at least 2 different medications (active ingredients), often see these as "trade" names when Rx and dispensed as well

Semi-synthetic drugs

drugs that are chemically modified in the laboratory after being isolated from natural sources such as plants, animals and minerals.

social anxiety disorder

fear of interacting with others or being in social situations that might lead to a negative evaluation of self.

Dosage

frequency, size, and number of doses

Nursing Practice Act

laws established to regulate nursing practice Every state has its own laws regarding drug administration by nurses. Nurses are held accountable to these standards.

Pregnant women metabolize drugs:

quicker because they are voiding/excreting much more often

Placebo-

something which has a positive mental effect, but no physical effect. A "fake drug" normally a sugar pill used in drug trials.

Teratogenic

structural defects in the fetus

Serum half life

time required for the serum concentration of a drug to decrease by 50%; (it takes 4-5 half lives for the drug to be completely gone)

Adverse effect

unintended, undesirable, and often unpredictable severe responses to medication If severe, discontinue, may cause harm

Idiosyncratic reactions

unpredictable effects in which a patient overreacts or under-reacts to a medication or has a reaction that is different than normal.

By injection IM (intramuscular)

use 1 1/2 needle for most adults and 5/8 to 1 1/2 for children. 22gauge for most meds, viscous use 20 gauge. Given at 90° angle, aspirate and inject, apply pressure Anatomic landmarks- deltoid (shoulder/upper arm) ventrogluteal (side of butt/hip) dorsogluteal, and Vastus lateralus (outside of thigh).

Antidepressants: FLUOXETINE (Prozac)

• First in class SSRI • treats pediatric depression PMDD • available PO only •abrupt withdrawal will lead to dizziness, headache, tremor, anxiety dysphoria and sensory disturbance • black box warning- may cause suicidal thinking in young people • pregnancy: most of the time the benefits outweigh the risks to the fetus "Cousin"- celexa, lexapro, Paxil

VENLAFAXINE (Effexor)

• Is in a atypical depressant classification • need gradual tapering of the dose to prevent withdrawal symptoms if you're discontinue if the medication • given PO • nausea is the most common side effect of Venlafaxine is nausea

Antidepressants

• drugs that enhance or stabilize mood • restores normal neurotransmitters •many patients stop taking them when they feel better without notifying HCP which can cause depression to reoccur or worsen • usually start with low SSRI's normally takes 2-4 weeks to show improvement, if not dosage is increased • antidepressants have fewer side effects than most other drugs but the most common and widely and frequently reported is decreased sex drive or sexual disfunction

Nursing considerations in diagnosing a depressed patient:

• every nurse should be proficient in assessing a possibly depressed patient •rule out other conditions- condition that may be caused by medications or other neurological disorders • a consult they psychiatry may be preformed to confirm diagnosis's

Medication prep

• single-dose vials are preferred over multi use • aseptic technique • One needle for one patient •Use sterile needles for medications •3 med checks done •do not recap needles •use correct device or syringe •label syringes that draw up meds in

AMPHETAMINE (Adderall)

• treats ADHD and narcolepsy • given PO • long term use inhibits growth in children See in text

TRICYCLIC and MOA drugs:

• tricyclic antidepressants-(used for nocturnal enuresis (bed wetting) • Not first line therapy, lowers seizures threshold ect. • table for foods to avoid: Meats, dairy, fruits, vegetables, fish if dried or pickled,alcohol, and protein supplements

LITHIUM CARBONATE (Lithobid)

• used to treat bipolar disorder, controls acute mania • onset of action —> 1-3 weeks • long term therapy- N/V/D, blurred vision, confusion, tremors, toxicity levels > 2.5 mEQ/L —> kidney impairment and dysrhythmias • sodium and fluid levels are important! -cautious on excessively sweating and polyuria -avoid caffeine products- aggravates manic phases -make sure to stop while pregnant

Nonbenzodiazepines

•Became popular for treating anxiety •causes decreased sleep- onset time, number of awakenings, improves length/quality of sleep and is a gaba intensifier Available PO may cause dizziness and diarrhea

Pro drugs (metabolism)

•Benzapril (lotensin) prodrugs are initially inactive and cannot produce an effect until they are metabolized •Enalapril (vasotec)

How does aging affect drug therapy

•CNS changes •liver doesn't function as well •decreases GI secretions and mobility •decreases cardiac output •decreased blood flow to liver and kidneys

Nurses are legally:

•Empowered to give meds that have been ordered by licensed physicians or NP's •responsible for safe and accurate administration •expected to have sufficient knowledge to recognize and question erroneous orders •expected to monitor patients response to drug therapy and teach.

Causes of Depression:

•Imbalanced hormones • genetic make up • environmental circumstances

Things to consider

•Must be using the correct equivalences •Accurately calculating the meds and correct unit of measurement •know how to schedule dosages per the med Rx •read the MAR and HCP orders to make sure they match •that the med is appropriate for your pt. •our goal is to prevent med errors

Nursing responsibilities regarding controlled substances:

•Must have a Rx for that patient in order to administer it •These are kept under lock and key in a secure area •must be "signed out" of the medication dispenser/receptacle •must ensure that "narcotic count" is correct, always count carefully •ensure that the patient actually takes the medication, watch them take it, never leave at bedside •if there is "waste" must be verified/signed by another RN

ADHD: symptoms of impulsive behavior and lack of hypersensitivity

•Often fidgets with hands or feet or squirms in seat • often gets up from seat when remaining in seat is expected • often runs and climbs when it is not appropriate • is often "on the go" or acts "driven by motor" •talks excessively • blurts our answers before questions are finished • has trouble waiting their turn • interrupts or intrudes on others, butts into conversations or games

Pediatric drug therapy

•Pediatric dosages should be double checked for accuracy. Always have another RN to verify you have the correct dose. •safety- if they are taking meds at home be sure the parents/caregivers know to give it, that it's stored out of reach of child and be sure they know correct dosage

Contradictions/precautions for BENZOS

•Should not be withheld if emergent but should try to avoid. •pregnant/lactating •elderly •hepatic(liver)/renal (kidney) disfunction •not established in children bc they cannot pro our well. •Drug interaction- alcohol, opiates, other sedatives, avoid food for better absorption

Medication systems

•Unit does (individually wrapped) is the most common •Medication dispensing system (PIXIS) •floor stock •bar coding •controlled medications kept under lock and key at all times

Proper dosing interval

•With PRN meds verify the last dose given. •reassess after administration of meds •leave meds in original container until at bedside, with injections label syringe when you draw up the med. •DONT leave meds at bedside make sure they are swallowed •document after administration on MAR

Factors affecting drug action

•age •weight- sometimes excess adipose effects dosage •gender- mainly between male and female bc men normally have less adipose but also pregnant women •environmental factors- heat, cold, and outside elements • pathologic states- decreased cardiac output may take longer to reach site of action. Ex- if a person is malnourished or if they vomit we are not sure how much was absorbed. •pathologic factors- sometimes if you think the med will work, it will. ex- when a patient is given a placebo and they claim it gave them desired effect •disease state •time- patient must also care about taking med when prescribed •drug tolerance

Metabolism of a drug

•bio transformation of the drugs, chemically concerting a drug to a form that is usually more easily removed form the body •liver is primary sight for this process. (If the patient has liver disease it will affect the metabolism of the drug because it will not be able to break it down quickly and could lead to toxicity.) •1st pass effect (these drugs travel to the liver first and are broken down and inactivated before they even get to produce an effect) usually this happens with oral drugs so you would need to change the route so it could work properly •sometimes we will have patients with higher metabolisms so they may need higher or more frequent doses •people who would have their low liver function- elderly, infants(because it's not mature), alcoholics and people with hepatitis. Look for signs such as their colors (jaundice, yellowing of eyes and skin) for low liver function.

Assessment of depression:

•change in attitude towards activities • drug and alcohol abuse • older adults are often reluctant to admit • people who are suicidal usually suffer from depression

Documentation

•document on MAR •done AFTER administration •always make sure you are documenting under correct date and the time is correct •if patient refuses, you must document, if not documented it wasn't done

Cultural effects on drug therapy

•nurses must acknowledge and accept the influences of a patient's cultural beliefs, cakes and customs to prevent a conflict from arising between good of nursing/healthcare and dictates of pt's cultural background. •nurses need to be familiar with medications and how culture influences a particular drug response or the way a specific patient uses or responds to a medication

Absorption of a drug

•process occurs between the time the drug enters the body and the time it enters the bloodstream to be circulated

What is depression?

•sad or despondent mood •out of proportion life events • it's the most common mental health disorder

Excretion

•the elimination of drugs from the body (main organ for eliminating a drug is kidneys- this elimination route is through urine) other elimination routes include- feces, sweat, tears, •several rental diseases can lead to an accumulation of some drugs that can cause severe adverse effects if dosage is not decreased •rest for renal functions: creatinine clearance: normal 85-135 ml/min but dose does decrease with age. Ex- if you are taking care of a 80 yo pt. and their levels start with 82 you don't necessarily need to up the dosage. It's normal for things to slow down at that age but also monitor them for signs of toxicity) signs of drug toxicity are specific to each medication. Creatinine levels detect kidney function