Pharm Module 1
A patient receives 10 mg of morphine orally at home for pain management. The patient is in the emergency department and is to receive 4 mg of morphine IV for severe pain. The patient asks the nurse why they are only getting 4 mg of IV morphine when at home they take 10 mg of morphine. What is the best response by the nurse?
"Intravenous medications go directly into the bloodstream while oral medications must first go through the liver and some of the medication is made inactive." Correct answer comments: Oral medication are absorbed through the GI tract and go through the liver before entering the systemic circulation. This is the first pass effect. The liver will often metabolize the drug and make some of the drug inactive during this process. Intravenous drugs are given directly into systemic circulation, and bypass the first pass effect. This increases the bioavalability and most often, the patient will receive a much smaller dose of medication via IV than PO
Drugs are dosed on how what?
"bound" they are to albumin and this is all based on person having normal albumin
The nurse is providing discharge education to an older adult patient who will be on 5 prescription drugs. What physiologic changes in the older adult patient put this patient at risk for drug interactions? Select All That Apply
-Blood flow to the gastrointestinal tract is reduced -Fat content is increased -Protein production by the liver is decreased - Number of working nephrons is decreased -Glomerular Filtration Rate is decreased Physiological changes in the older adult include: Gastric pH is higher (less acidic, more alkaline), Gastric emptying is slowed, movement throughout the GI tract is slower, blood flow to the GI tract is decreased, the absorptive surface are is decreased, total body water is decreased, fat content is increased, protein production by the liver is reduced, the liver is again and decreases metabolism of medications, glomerular filtration rate is decreased, and the number of functioning nephrons is decreased.
Do's of "right documentation"
-check correct medical record before documenting -include: time you gave medication, route, patients response -Do document: only the facts, patient teaching ,precautions/preventative measures -time, message, response when communicating with a healthcare provider -patients refusal to take medication
last trimester
-drug transfer to the fetus is most likely to occur because there is enhanced blood flow to the fetus, increased fetal surface area, and increased amount of free drug in the mothers circulation
first trimester
-greatest risk for teratogenic effects -fetus under goes rapid cell proliferation
In vivo
-living organism -testing allows for some information on toxicity and dosing
To ensure we have the "right drug":
-must have a prescription signed by a prescriber on the patients case --ensure it is the correct drug (generic/brand name) --generic name is preferred on orders to help decrease medication errors --if the order is unclear, contact the prescriber to clarify --**when administering the medications we should be checking the label *MINIMUM OF 3 TIMES to ensure correct medication, dose, and route are being administered
Drugs with low therapeutic index
-will have a small difference between a therapeutic dose and a toxic dose, meaning there is high chance of toxicity. - drug concentrations should be monitored periodically, and the patient should be observed for signs and symptoms of toxicity
What are the four phases of Pharmacokinetics? (ADME)
1. Absorption 2. Distribution 3. Metabolism 4. Excretion
Steady state occurs after how many half lives?
4-5
After how many half lives are most drugs considered to be removed from the body, with 3% of the drug remaining in the system?
5
A member of an investigational drug study team is working with healthy volunteers whose participation will help to determine the optimal dosage range and pharmacokinetics of the drug. The team member is participating in what type of study? a. Phase I b. Phase II c. Phase III d. Phase IV
A
A patient is undergoing major surgery and asks the nurse about a living will. He states, "I don't want anybody else making decisions for me. And I don't want to prolong my life." The patient is demonstrating which ethical term? a. Autonomy b. Beneficence c. Justice d. Veracity
A
During the development of a new drug, which would be included in the study by the researcher to prevent any bias or unrealistic expectations of the new drug's usefulness? a. A placebo b. FDA approval c. Informed consent d. Safety information
A
For accurate medication administration to pediatric patients, the nurse must take into account which criteria? a. Organ maturity b. Renal output c. Body temperature
A
The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs? a. Parenteral drugs bypass the first-pass effect. b. Absorption of parenteral drugs is affected by reduced blood flow to the stomach. c. Absorption of parenteral drugs is faster when the stomach is empty. d. Parenteral drugs exert their effects while circulating in the bloodstream.
A
The nurse is trying to give a liquid medication to a -year-old child and notes that the medication has a strong taste. Which technique is the best way for the nurse to give the medication to this child? a. Give the medication with a spoonful of ice cream. b. Add the medication to the child's bottle. c. Tell the child you have candy for him. d. Add the medication to a cup of milk.
A
The patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet? a.Under the tongue b.On top of the tongue c.At the back of the throat d.In the space between the cheek and the gum
A
The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Which term is used to identify this principle? a. Bioequivalent b. Synergistic c. Prodrugs d. Steady state
A
The patient is to receive oral guaifenesin (Mucinex) twice a day. Today, the nurse was busy and gave the medication 2 hours after the scheduled dose was due. What type of problem does this represent? a."Right time" b."Right dose" c."Right route" d."Right medication"
A
When reviewing the various schedules of controlled drugs, the nurse knows that which description correctly describes Schedule II drugs? a. Drugs with high potential for abuse that have accepted medical use b. Drugs with high potential for abuse that do not have accepted medical use c. Medically accepted drugs that may cause moderate physical or psychologic dependence d. Medically accepted drugs with limited potential for causing physical or psychologic dependence
A
Which activity best reflects the implementation phase of the nursing process for the patient who is newly diagnosed with hypertension? a. Providing education on keeping a journal of blood pressure readings b. Setting goals and outcome criteria with the patient's input c. Recording a drug history regarding over-the-counter medications used at home d. Formulating nursing diagnoses regarding deficient knowledge related to the new treatment regimen
A
patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy? a.Palliative therapy b.Maintenance therapy c.Empiric therapy d.Supplemental therapy
A
P-gylcoprotein
A transporter protein that moves drugs out of cells and into the gut, urine, or bile
Place the phases of the nursing process in the correct order, with 1 as the first phase and 5 as the last phase. (Select all that apply.) a.Planning b.Evaluation c.Assessment d.Implementation e.Nursing Diagnoses
A, B, C, D, E
When giving medications, the nurse will follow the rights of medication administration. The rights include the right documentation, the right reason, the right response, and the patient's right to refuse. Which of these are additional rights? (Select all that apply.) a.Right drug b.Right route c.Right dose d.Right diagnosis e.Right time f.Right patient
A, B, C, E, F
Which statements are true regarding the elderly and pharmacokinetics? (Select all that apply.) a. The levels of microsomal enzymes are decreased. b. Fat content is increased because of decreased lean body mass. c. Fat content is decreased because of increased lean body mass. d. The number of intact nephrons is increased. e. The number of intact nephrons is decreased. f. Gastric pH is less acidic. g. Gastric pH is more acidic.
A, B, E, F In the elderly, levels of microsomal enzymes are decreased because the aging liver is less able to produce them; fat content is increased because of decreased lean body mass; the number of intact nephrons is decreased as the result of aging; and gastric pH is less acidic because of a gradual reduction of the production of hydrochloric acid
Nursing Process
An organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for a patient: assessment, nursing diagnoses, planning (with goals and outcome criteria), implementation of the plan (with patient teaching), and evaluation.
idiosyncratic reaction
An abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.
Two drugs with similar actions, when taken together, cause the equivalent to the sum of the individual effects of the same drugs given alone
Additive effect
Empiric therapy-
Administration of a drug based on high likelihood of occurrence of problem based on patient symptoms- antibiotics administered prior to knowing results of culture and sensitivity.
what is the main blood proteins that binds the drugs?
Albumin 3.5-5.5 grams/dL
Medication Error
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm.
A patient is to receive 50 mg of atenolol at 0800. Prior to administering the medication, the nurse reviews the medical records for past medical history and obtains the patients apical pulse and blood pressure. What phase of the nursing process does this represent?
Assessment Correct answer comments: Gathering assessment data prior to administering medications is part of the assessment phase of the nursing process.
-nurse is gathering data that will be analyzed in order to develop a plan of care -Include: past medical history, surgical history, family history, medication history, allergies, physical assessment -gather data from lab work -asses for compliance with prescription medication and asses for barriers to compliance -data analyzed for human needs statement
Assessment (first step)
non-first pass routes:
Aural (instilled into the ear) Buccal Inhaled Intraarterial Intramuscular Intranasal Intraocular Intravaginal Intravenous Subcutaneous Sublingual Transdermal
An 83-year-old woman has been given a thiazide diuretic to treat mild heart failure. She and her daughter should be told to watch for which problems? a. Constipation and anorexia b. Fatigue, leg cramps, and dehydration c. Daytime sedation and lethargy d. Edema, nausea, and blurred vision
B
During a busy night shift, a new nurse administered an unfamiliar medication without checking it in a drug handbook. Later that day, the patient had a severe reaction because he has renal problems, which was a contraindication to that drug. The nurse may be liable for which of these? a. Medical negligence b. Nursing negligence c. Nonmaleficence d. Autonomy
B
Nurses have the ethical responsibility to tell the truth to their patients. What is this principle known as? a. Justice b. Veracity c. Beneficence d. Autonomy
B
The nurse is asking a patient about his family history as part of an assessment. Which component is included in an effective family history? a. Asking the patient about the current and past health status of the patient's children b. Covering at least three generations of family history c. Obtaining a family history of the patient's spouse d. Asking about the family history for the patient's siblings and parents only
B
The nurse is reviewing facts about pharmacology for a review course. The term legend drug refers to which item? a. Over-the-counter drugs b. Prescription drugs c. Orphan drugs d. Older drugs
B
The nurse will be injecting a drug into the fatty tissue of the patient's abdomen. Which route does this describe? a.Intradermal b.Subcutaneous c.Intramuscular d.Transdermal
B
Amount of drug in the blood after absorption
Bioavailability
Drug transfer to the fetus is more likely during the last trimester of pregnancy for which reason? a.Decreased fetal surface area b.Increased placental surface area c.Enhanced blood flow to the fetus d.Increased amount of protein-bound drug in maternal circulation
C
During discharge patient teaching, the nurse reviews prescriptions with a patient. Which statement is correct about refills for an analgesic that is classified as Schedule C-III? a. No prescription refills are permitted. b. Refills are allowed only by written prescription. c. The patient may have no more than five refills in a 6-month period. d. Written prescriptions expire in 12 months.
C
For which cultural group must the health care provider respect the value placed on preserving harmony with nature and the belief that disease is a result of ill spirits? a. Hispanics b. Asian Americans c. Native Americans d. African Americans
C
The medication order reads, "Give ondansetron (Zofran) 4 mg, 30 minutes before beginning chemotherapy to prevent nausea." The nurse notes that the route is missing from the order. What is the nurse's best action? a. Give the medication intravenously because the patient might vomit. b. Give the medication orally because the tablets are available in 4-mg doses. c. Contact the prescriber to clarify the route of the medication ordered. d. Hold the medication until the prescriber returns to make rounds.
C
The nurse is administering drugs to neonates and will consider which factor may contribute the most to drug toxicity? a. The lungs are immature. b. The kidneys are small. c. The liver is not fully developed. d. Excretion of the drug occurs quickly.
C
The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? a. Laxatives b. Anticoagulants c. Sedatives d. Antidepressants
C
The nurse is aware that confusion, forgetfulness, and increased risk for falls are common responses in an elderly patient who is taking which type of drug? a.Laxatives b.Anticoagulants c.Sedatives d.Antidepressants
C
The nurse is discussing gene therapy in a continuing education class. Which is the best definition of eugenics? a. The use of gene therapy to prevent disease b. The development of new drugs based on gene therapy c. Intentional selection, before birth, of genotypes that are considered more desirable than others d. The determination of genetic factors that influence a person's response to medications
C
The nurse is performing an assessment of a newly admitted patient. Which is an example of subjective data? a.Blood pressure 158/96 mm Hg b.Weight 255 pounds c.The patient reports that he uses the herbal product ginkgo. d.The patient's laboratory work includes a complete blood count and urinalysis.
C
The nurse is preparing to give an injection to a 4-year-old child. Which intervention is age appropriate for this child? a. Give the injection without any advanced preparation. b. Give the injection, and then explain the reason for the procedure afterward. c. Offer a brief, concrete explanation of the procedure at the patient's level and with the parent or caregiver present. d. Prepare the child in advance with details about the procedure without the parent or caregiver present.
C
The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which sentence defines a drug's half-life? a.The time it takes for the drug to cause half of its therapeutic response b.The time it takes for one half of the original amount of a drug to reach the target cells c.The time it takes for one half of the original amount of a drug to be removed from the body d.The time it takes for one half of the original amount of a drug to be absorbed into the circulation
C
The nurse is reviewing the applications of gene therapy. Which drug is manufactured as a result of indirect gene therapy? a. Vitamin K b. Warfarin c. Human insulin d. Heparin
C
When the nurse considers the timing of a drug dose, which factor is appropriate to consider when deciding when to give a drug? a.The patient's ability to swallow b.The patient's height c.The patient's last meal d.The patient's allergies
C
When given an intravenous medication, the patient says to the nurse, "I usually take pills. Why does this medication have to be given in the arm?" What is the nurse's best answer? a. "The medication will cause fewer adverse effects when given intravenously." b. "The intravenous medication will have delayed absorption into the body's tissues." c. "The action of the medication will begin sooner when given intravenously." d. "There is a lower chance of allergic reactions when drugs are given intravenously."
C An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.
Which drugs would be affected by the first-pass effect? (Select all that apply.) a.Morphine given by IV push injection b.Sublingual nitroglycerin tablets c.Diphenhydramine (Benadryl) elixir d.Levothyroxine (Synthroid) tablets e.Transdermal nicotine patches f.Esomeprazole (Nexium) capsules g.Penicillin given by IV piggyback infusion
C,D,F
Increases production of metabolizing enzyme
CYP 450 system Inducer
Increase the risk of toxicity by decreasing drug metabolizing enzymes
CYP 450 system Inhibitor
An African American patient is diagnosed with hypertension and will start therapy to control their blood pressure. Which classification of antihypertensive is most effective in the African American population based on genetic variance?
Calcium channel blockers Correct answer comments: African American patients respond best to calcium channel blockers, especially diltiazem. They also do not do well with monotherapy and do better with a diuretic combined with other antihypertensive medications
Some examples of cultural factors affecting drug therapy:
Cultural Beliefs Religious beliefs Personal and family expectations Previous experience with medications /healthcare system Educational level Participation in alternative medicine practices Environmental Factors
A patient has been selected as a potential recipient of an experimental drug for heart failure. The nurse knows that when informed consent has been obtained, it indicates which of these? a. The patient has been informed of the possible benefits of the new therapy. b. The patient will be informed of the details of the study as the research continues. c. The patient will receive the actual drug during the experiment. d. The patient has had the study's purpose, procedures, and the risks involved explained to him.
D
A patient has just been told that she has the genetic markers for a severe type of breast cancer. After the patient meets with the physician, the patient's daughter asks the nurse, "What did the doctor tell my mother? She seems upset." What is the nurse's best response? a. "I'm sorry, but I'm not allowed to discuss that." b. "The physician will discuss this with you." c. "It seems that your mother has the genetic markers for a type of breast cancer." d. "This is information that your mother will need to discuss with you
D
An elderly patient with a new diagnosis of hypertension will be receiving a new prescription for an antihypertensive drug. The nurse expects which type of dosing to occur with this drug therapy? a. Drug therapy will be based on the patient's weight. b. Drug therapy will be based on the patient's age. c. The patient will receive the maximum dose that is expected to reduce the blood pressure. d. The patient will receive the lowest possible dose at first, and then the dose will be increased as needed.
D
The nurse has been monitoring the patient's progress on a new drug regimen since the first dose and documenting the patient's therapeutic response to the medication. Which phase of the nursing process do these actions illustrate? a.Nursing diagnosis b.Planning c.Implementation d.Evaluation
D
The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic phase? a.Absorption b.Distribution c.Metabolism d.Excretion
D
The nurse is assessing a newly admitted 83-year-old patient and determines that the patient is experiencing polypharmacy. Which statement most accurately illustrates polypharmacy? a. The patient is experiencing multiple illnesses. b. The patient uses one medication for an illness several times per day. c. The patient uses over-the-counter drugs for an illness. d. The patient uses multiple medications simultaneously
D
The nurse is assessing an elderly Hispanic woman who is being treated for hypertension. During the assessment, what is important for the nurse to remember about cultural aspects? a. The patient should be discouraged from using folk remedies and rituals. b. The nurse will expect the patient to value protective bracelets and "root workers" as healers. c. The nurse will remember that the balance among body, mind, and environment is important for this patient's health beliefs. d. The nurse's assessment needs to include gathering information regarding religious practices and beliefs regarding medication, treatment, and healing
D
The nurse is assigned to a patient who is newly diagnosed with type 1 diabetes mellitus. Which statement best illustrates an outcome criterion for this patient? a.The patient will follow instructions. b.The patient will not experience complications. c.The patient will adhere to the new insulin treatment regimen. d.The patient will demonstrate correct blood glucose testing technique.
D
The nurse is explaining the Human Genome Project to colleagues. Which of these is the main purpose of the Human Genome Project? a. The study of genetic diseases. b. The study of genetic traits in humans. c. The discovery new genetic diseases. d. To describe the entire genome of a human being.
D
The nurse is monitoring a patient who is in the 26th week of pregnancy and has developed gestational diabetes and pneumonia. She is given medications that pose a possible fetal risk, but the potential benefits may warrant the use of the medications in her situation. The nurse recognizes that these medications are in which U.S. Food and Drug Administration pregnancy safety category? a.Category X b.Category B c.Category C d.Category D
D
The nurse is reviewing a list of scheduled drugs and notes that Schedule C-I drugs are not on the list. Which is a characteristic of Schedule C-I drugs? a. No refills are permitted. b. They may be obtained over-the-counter with a signature. c. They are available only by written prescription. d. They are used only with approved protocols
D
The nurse is writing a nursing diagnosis for a plan of care for a patient who has been newly diagnosed with type 2 diabetes. Which statement reflects the correct format for a nursing diagnosis? a.Anxiety b.Anxiety related to new drug therapy c.Anxiety related to anxious feelings about drug therapy, as evidenced by statements such as "I'm upset about having to test my blood sugars." d.Anxiety related to new drug therapy, as evidenced by statements such as "I'm upset about having to test my blood sugars.
D
The nurse recognizes that it is not uncommon for an elderly patient to experience a reduction in the stomach's ability to produce hydrochloric acid. This change may result in which effect? a. Delayed gastric emptying b. Increased gastric acidity c. Decreased intestinal absorption of medications d. Altered absorption of weakly acidic drugs
D
The patient is complaining of a headache and asks the nurse which over-the-counter medication form would work the fastest to help reduce the pain. Which medication form will the nurse suggest? a.A capsule b.A tablet c.An enteric-coated tablet d.A powder
D
When administering a new medication to a patient, the nurse reads that it is highly protein bound. Assuming that the patient's albumin levels are normal, the nurse would expect which result, as compared to a medication that is not highly protein bound? a.Renal excretion will be faster. b.The drug will be metabolized quickly. c.The duration of action of the medication will be shorter. d.The duration of action of the medication will be longer.
D
When administering drugs, the nurse remembers that the duration of action of a drug is defined as which of these? a.The time it takes for a drug to elicit a therapeutic response b.The amount of time needed to remove a drug from circulation c.The time it takes for a drug to achieve its maximum therapeutic response d.The time period at which a drug's concentration is sufficient to cause a therapeutic response
D
When discussing dosage calculation for pediatric patients with a clinical pharmacist, the nurse notes that which type of dosage calculation is used most commonly in pediatric calculations? a.West nomogram b.Clark rule c.Height-to-weight ratio d.Milligram per kilogram of body weight formula
D
When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the nurse notes that the patient's blood pressure is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction? a. Adverse effect b. Allergic reaction c. Idiosyncratic reaction d. Pharmacologic reaction
D
When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. Which of these processes describes selective enzyme interaction? a.The drug alters cell membrane permeability. b.The drug's effectiveness within the cell walls of the target tissue is enhanced. c.The drug is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor. d.The drug binds to an enzyme molecule and inhibits or enhances the enzyme's action with the normal target cell.
D
Outcomes
Descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of behaviors related to each nursing diagnosis. These statements are specific while framed in behavioral terms and are measurable.
-human needs statements are developed by registered nurses and are used to communicate and share information about the patient/pateient experience -human needs statements are developed using clinical judgment about the human response to health conditions.
Diagnosis (2nd step)
-occurs after plan of care has been implemented -includes monitoring the fulfillment of outcomes and the patients responses to medications
Evaluation (5th step)
Areas of Liability:
Failure to assess/evaluate Failure to ensure safety Medication Errors
Drug absorption of various oral preparations
Fastest to Slowest: Oral disintegration, buccal tablets, and oral soluble wafers (fastest) 1 Liquids, elixirs, and syrups 2 Suspension solutions 3 Powders 4 Capsules 5 Tablets 6 Coated Tablets 7 Enteric-coated tablets (slowest) 8
The time required for half of an administered drug to be excreted from the body
Half-life
First pass routes:
Hepatic arterial Oral Portal venous Rectal
The process that leads to a larger dose being needed when taken orally versus intravenously
Hepatic first-pass effect
A patient with seasonal allergies takes diphenhydramine at bedtime to help their symptoms. The patient becomes hyperactive and is unable to sleep. What type of reaction is the patient experiencing?
Idiosyncratic reaction Correct answer comments: When a patient experiences an effect that is not a known pharmacologic property of the drug, but instead has an unexpected reaction, this is known as an idiosyncratic reaction.
to ensure "right to refuse":
If a patient refuses a medication, ask why they are refusing it, and re-educate the patient about the medication. If they still refuse, you must notify the prescriber and document the refusal.
what happens if a person with low albumin takes a highly protein bound drug?
If albumin is low, it increases the risk for toxic effects
-action phase of nursing process -teach the patient, administer medications and other treaments. -requires communication and collaboration with the patient and healthcare team -safely administering medications which with include the 9 rights.
Implementation (4th step)
Requires no absorption
Intravenous route of administration
Maternal factors:
Liver and kidney functions can effect amount of drug in the circulation which can increase the amount of drug the fetus is exposed too.
Can lead to toxicity because of the bodys inability to metabolize medications
Liver failure
Will an oral medication work as quickly as an parenteral medication?
No, the oral will take time to disintegrate and form a dissolution. It will go through the liver, this delays the onset of action.
6 major initiatives of QSEN
Patient-centered care Teamwork and collaboration Evidence-based practice (EBP) Quality improvement (QI) Safety Informatics
-once a diagnosis is selected, the nurse will formulate outcomes for the patient -main purpose of phase is to prioritize nursing diagnoses and develop outcomes -outcomes should be objective, measurable, and realistic with an established time frame for their achivement
Planning (3rd step)
Associated with decreased excretion and possible toxicity
Renal dysfunction
What are the nine rights of medication administration? (6 main rights, 3 other rights)
Right Drug Right Dose Right Time Right Route Right Patient Right Documentation Right Reason Right Response Right to Refuse
Clinical Research: Phase 1
Study Participants: 20 to 100 healthy volunteers or people with the disease/condition. Length of Study: Several months Purpose: Safety and dosage Approximately 70% of drugs move to the next phase
Clinical Research: Phase 3
Study Participants: 300 to 3,000 volunteers who have the disease or condition Length of Study: 1 to 4 years Purpose: Efficacy and monitoring of adverse reactions Approximately 25-30% of drugs move to the next phase
Clinical Research: Phase 4
Study Participants: Several thousand volunteers who have the disease/condition Purpose: Safety and efficacy
Clinical Research: Phase 2
Study Participants: Up to several hundred people with the disease/condition. Length of Study: Several months to 2 years Purpose: Efficacy and side effects Approximately 33% of drugs move to the next phase
When two drugs with different actions are taken together and increase the effect
Synergism
Pharamacology
The broadest term for the study or science of drugs
Trade name
The commercial name given to a drug product by its manufacturer; also called the proprietary name.
First-pass effect
The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.
Duration of action
The length of time the concentration of a drug in the blood or tissues is sufficient to elicit a response.
Trough level
The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring.
Peak level
The maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring.
Generic name
The name to a drug by the United States Adopted Names Council. Also called the nonproprietary name. The generic name is much shorter and simple than the chemical name and is not protected by trademark.
Pharmaceutics
The science of preparing and dispensing drugs, including dosage form design.
Pharmacognosy
The study of drugs that are obtained from natural plant and animal sources.
Pharmacoeconomics
The study of economic factors impacting the cost of drug therapy.
Pharmacodynamics
The study of the biochemical and physiologic interactions of drugs at their sites of activity. It examines the effect of the drug on the body
Pharmacogenomics
The study of the influence of genetic factors on drug response that result in the absence, overabundance, or insufficiency of drug-metabolizing enzymes
Pharmacokinetics
The study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacokinetics represent the drug absorption into, distribution and metabolism within, and excretion from the body.
Onset of action
The time required for a drug to elicit a therapeutic response after dosing.
Pharmacotherapeutics
The treatment of pathologic conditions through the use of drugs
Polypharmacy
The use of many different drugs concurrently in treating a patient, who often has several health problems.
Relationship between the drugs lethal dose and effective dose
Therapeutic Index
A desired response from a drug
Therapeutic effect
Undesirable drug response that is related to the dose
Toxicity
Difference between generic and trade names?
Trade name- proprietary name, more expensive/shorter,easier name and will be capalized generic name- nonproprietary name, created after 7 years of patent restriction/names are longer, more difficult and will be lower case
prodrug
a drug that is converted from an inactive form into an active metabolite through biotransformation in the liver
Pharmacogenetics
a general term for the study of the genetic basis for variations in the body's response to drugs, with a focus on variations related to a single gene.
In vitro
a glass or plastic container (a test tube)
Prophylactic therapy-
administered to prevent a common complication (anti-coagulations to prevent VTE while admitted in the hospital, preoperative antibiotics)
Once the therapy is implemented, the nurse should monitor the patient for .
adverse effects and toxic effects
Palliative Therapy-
aims to relieve symptoms and make the patient comfortable, not trying to cure or delay disease. Improve quality of life
topical route
application of medication to various body surfaces. ointments, gels, creams, transdermal route, inhalation.
Objective data
information available through the nurses senses, touch, smell, sight, and hearing (signs)
Pharmacokinetics: Absorption
bioavailability first pass effect routes
To ensure the "right time":
check policy at facility most often hour before or hour after *consider what medications patient is receiving, if it something that can cause harm if not given on time
Kidney function is monitored by what?
creatinine level- less than 1.2 mg/dL for normal kidney function
Half-life
in pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50%
preclinical investigation can be either what?
in vitro or in vivo
An enzyme inducer will do what?
increase metabolism of the drug and result in decreased effects and shorten half-life. Example: nicotine.
An enzyme inhibitor will do what?
decrease metabolism of the drug and result in drug toxicity and prolonged half-life. Example: grapefruit juice
Pharmacotherapeutics and the nursing process: Assessment
drugs the patient has been on past medication history allergies illicit drug use pregnancy/breastfeeding illness that could serve as a contradiction to the prescribed drug therapy
Elements of Liability for Nursing Malpractice
duty, breach of duty, causation, damage
route that is absorbed through the GI mucosa?
enteral
Three basic routes:
enteral parenteral topical
parenteral
fastest route -any route other than the GI tract -normally refers to injection -intravenous injection delivers the medication directly into the bloodstream -highest bioavailability
Drugs with a larger volumes of distribution are usually what?
fat soluble
We also look at creatinine clearance with medications because this can identify how well the medications will be excreted more accurately than creatinine level alone. What is the ideal level?
greater than 30 mL/min
fetal gestational age
helps determine the potential for harmful drug effects to the fetus
A drug that is absorbed through the intestines must first pass through the liver before it reaches the systemic circulation. If a large portion is changed into an inactive metabolite, it is said to have___
high first pass effect
Drugs with a smaller volume of distribution are usually what?
highly water soluble
Drugs are considered highly protein bound if what?
if greater than 90% is bound to protien
To ensure "right documentation"
important for patient safety "sixth right" nurse should document timely and include all pertinent information
Allergic reaction
involve the immune system -has an immune response to the drug which causes the release of chemical mediators (such as histamine). -causes erythema (redness), rash, or be severe and cause life-threatening reactions, such as hypotension, tachycardia, and constriction of bronchial airways
Biotransformation
involves biochemical alterations of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite.
Pharmacogenomics
is the study of how certain genetic traits affect drug response
Maintenance therapy-
it does not eradicate the problem, but aims to delay progression of the disease state. (anti-hypertensives agents, antidiabetic agents)
What is the main site of excretion?
kidneys
The organ most involved in metabolism is the
liver
Administering a larger dose than usual to reach a steady state more quickly
loading dose
Supportive therapy-
maintain body functions (fluid and electrolytes)
transdermal route
medication delivery through adhesive patches used for systemic effect
Two most common adverse drug events (ADE) are
medication errors and adverse drug reactions
As 'unbound' free drug decreases what happens?
more "bound" drug is released from protein to maintain a balance
In order to ensure we have the 'right patient", two patient identifiers must be used:
name date of birth medical record number *new systems allow barcode scanning, must still ask patient to state their name and date of birth
The first pass effect is only for what type of medication?
oral medication
FDA classifies drugs currently based on what?
pregnancy lactation females and males reproductive potential
Supplemental therapy-
provides the body with substances needed to maintain normal function (vitamins)
To ensure the "right dose":
refer to the prescribers order. Use drug reference manual to make sure it is a safe dose for the patient. Calculate dosages based on mg order and form available. Make sure does is in UNITS
to ensure "right response":
refers to evaluating the patients response to a medication, looking for desired and undesired responses
Drug polymorphism
refers to the affect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs. Categorized into environmental (diet and nutritional status), cultural, and genetic factors.
to ensure "right reason":
refers to using appropriate medications to treat patient problems. review the patients history and ask the patient why they are on each medication
Asians and Hispanics: Antipsychotic and antianxiety drugs
response: Asians- need lower dosages of certain drugs such as haloperidol Asians and Hispanics-response better to lowers dosages of antidepressants Chinese-require lower dosages of antipsychotics Japanese-require low dosages of antimanic drugs
African Americans: Antihypertensive drugs
response: better to diuretics than to beta blockers and angiotensin-converting enzyme inhibitors -less effectively to beta blockers -best to calcium channel blockers -less effectively to single drug therapy
undesirable response from a drug that is related to the drugs action
side effect
bioavailability:
term used to express the extent of drug absorption
onset
the amount of time required for therapeutic response
Polypharmacy:
the average older adult takes 4-5 prescription drugs and 2 OTC drugs. This increases the chance of drug interactions. Due to increased cost, noncompliance or nonadherence is reported to occur in about 40% of older adult patients.
trough level
the lowest concentration of the drug, normally drawn prior to the next dose
absorption:
the movement of a drug from its site of administration into the bloodstream for distribution to the tissues
Ethnopharmacology-
the study of the effect of ethnicity on drug responses (absorption, metabolism, distribution, and Excretion), as well as the study of genetic variations to drugs.
peak effect
the time required for a drug to reach its maximum therapeutic response in the body
percentage of drug unbound is "free" drug to act or produce?
therapeutic effect
to ensure "right route and form":
this requires a complete order from a prescriber (if route is not included, contact the prescriber and ask for clarification). Never assume the route.
Between generic and trade names, which is the safest to use?
use of generic drug name is recommended to help avoid a medication error and enhance patient safety.
Dose calculation for pediatrics is based on:
weight
Subjective data
what the patient tells you (symptoms)
Pharmacokinetics in Older Adults: Excretion
•GFR decreased •The number of working nephrons decreased
Lifespan Considerations for the Pediatric Patient: Absorption
•Gastric pH higher (less acidic) until 1-2 years of age •Gastric emptying is slowed •First-pass is decreased because of immature liver •IM absorption is faster and irregular
Pharmacokinetics in Older Adults: Absorption
•Gastric pH is higher (less acidic) •Gastric emptying is slowed-decline in smooth muscle tone •Blood flow to GI tract is reduce r/t decreased cardiac output •Absorption surface area is decreased
Lifespan Considerations for the Pediatric Patient: Excretion
•Glomerular filtration rate and tubular secretion and resorption decreased •Perfusion to kidneys is decreased
Lifespan Considerations for the Pediatric Patient: Metabolism
•Microsomal enzymes are decreased (immature liver) •Older children may have quicker metabolism and require higher doses •Factors affecting metabolism: genetics, liver enzyme production, and substances mother was exposed to during pregnancy
Pharmacokinetics in Older Adults: Metabolism
•Microsomal enzymes decreased-aging liver •Liver blood flow is decreased
Pharmacokinetics in Older Adults: Distribution
•Water 52% males, 46% females in adults older than 60. •Fat content is increased r/t loss of muscles mass •Decreased production of protein by the aging liver
Lifespan Considerations for the Pediatric Patient: Distribution
•Water is 70-80% in full term infants, 85% in premature, and 64% in children 1-12 •Fat content is lower •Decreased protein due to immature liver, decreasing protein binding •More drugs able to enter the brain due to immature blood-brain barrier