Pharmacology Ch 1, 3

A client taking a beta blocker for hypertension tells the nurse he will no longer take the medication because it is causing an inability for him to maintain an erection. What is the best explanation for this issue by the nurse?

"This is an expected adverse effect of the medication, but it is very important that you continue to take it. We can talk about other methods for sexual expression."

Nurse's Responsibility for Administering a drug

* Administering drug *Assesses for adverse drug effects *Intervening to make drug regimen more tolerable *Pt teachings about drug/regimen *Monitoring/Prevention med errors

Steps involved in developing/approving new drug in the U.S

*preclinical *Phase I, II and III studies *Once finish phase III evaluated by FDA *Approved drug given brand name *Phase IV continual evaluation

hypokalemia

- Assessment Finding: Decrease in serum potassium levels - Interventions: Replace serum potassium (IV or oral supplement) and monitor serum levels of potassium

hyperkalemia

- Assessment Finding: Increase in serum potassium level - Interventions: Decrease the serum potassium concentration (Sodium Polystyrene Sulfonate), monitor serum levels of potassium, and monitor cardiac rhythm

General Central Nervous System (CNS) Effects

- Assessment Findings: Altered level of consciousness - Interventions: Prevent injury

auditory toxicity

- Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of balance, and loss of hearing - Interventions: Monitor for hearing loss; discontinue medication as appropriate if a decrease in hearing is noted on assessment.

Atropine-like (Anticholinergic) Effects

- Assessment Findings: Dry mouth, urinary retention, blurred vision - Interventions: Sugarless lozenges to keep mouth moist; have the patient void before administration of the medication

Neuroleptic Malignant Syndrome

- Assessment Findings: Extrapyramidal symptoms - Interventions: Discontinue medication as appropriate

Parkinson-like syndrome

- Assessment Findings: Muscle tremors and changes in gait - Interventions: Discontinue medication as appropriate

occular toxicity

- Assessment Findings: Visual changes - Interventions: Monitor for any visual changes when giving any medication that is known to cause ocular damage; discontinue medication as appropriate.

The nurse is caring for a client receiving an aminoglycoside (antibiotic) that can be nephrotoxic. Which will alert the nurse that the client may be experiencing nephrotoxicity?

A decrease in urine output

A female client has a 12-year history of ETOH abuse. The client is injured in a motor vehicle accident and requires surgery with general anesthesia. What would the nurse expect for this client?

A larger than normal dose of general anesthesia

The nurse should have basic knowledge of drug classifications in order to administer medications safely to clients. What drug information is instrumental in determining nursing actions following drug administration?

Adverse effects

A client is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the client develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is:

An allergic response

The nurse is called to a client's room 15 minutes after the client has received a new medication. The client reports pruritus as well as nausea. The nurse notes that the client appears pale, is sweating, and has begun to cough and wheeze. The nurse determines that the client is experiencing what type of reaction related to the new medication?

Anaphylactic shock

Category C

Animal studies have shown an adverse effect on the fetus. No adequate studies in humans

Category B

Animal studies not demonstrated risk to fetus. No evidence risk in later trimesters

Which drug classification is used to treat superinfections?

Antifungals

The nurse is assessing a new client who states being allergic to nonsteroidal anti-inflammatories (NSAIDs. What subsequent assessment should the nurse prioritize?

Asking the client what is the clients response to taking the NSAIDs

Benefits/Risks of OTC drugs

Benefits: available w/o prescription for self-treatment Risks: could mask signs/sx underlying disease, taking with prescription meds could result in interactions/interfere w/drug therapy, not taking as directed serious overdoses

For several days, a client with hypertension has been inadvertently taking an excessive dose of spironolactone, a potassium-sparing diuretic. The client has presented to the emergency department with signs and symptoms that suggest hyperkalemia. What assessment should the nurse prioritize?

Cardiac monitoring Explanation: Hyperkalemia presents an acute threat to normal cardiac function due to the effect on cardiac action potentials.

Phase One Study

Chemicals tested human volunteers for several months Dropped If: too toxic, unacceptable adverse reactions, lack therapeutic effect in humans

PreClinical Trials

Chemicals tested on lab animals

A client is four months' pregnant. She works in the chemical unit of a research department and is responsible for handling various chemicals. Her gynecologist advised her not to expose herself to chemical or industrial vapors and specific drugs. These restrictions are advised because exposure to industrial vapors could:

Damage the immature nervous system of the fetus.

1970 Controlled Substances Act

Defined drug abuse and classified drugs as to their potential for abuse; provided strict controls over the distribution, storage, and use of these drugs

A client develops a cytotoxic reaction to a drug. What would the nurse expect to do?

Discontinue the drug immediately as ordered

A client who is being treated for cancer developed a serum sickness reaction. The care team has been notified, and the client is being stabilized. What is the nurse's priority action?

Discontinue the drug immediately as ordered

Phase Two Study

Drug tried on informed pt's Dropped if: less effective than anticipated, too toxic, low benefit-to-risk ratio

_______ are chemicals that are introduced into the body to bring about some sort of change

Drugs

who regulates the development and marketing of drugs to ensure safety and efficacy

FDA

what indicates the potential or actual teratogenic effect of drugs

FDA pregnancy categories

The original name assigned to the drug at the beginning of the evaluation process

Generic Drug

A client is diagnosed with hypercholesterolemia and is prescribed a statin by the physician. As part of client education, the nurse should teach the client to avoid eating:

Grapefruit

Many drugs that reach the developing fetus or embryo can cause death or congenital defects. What are examples of congenital defects? (Choose all that apply.)

Heart defects, skeletal and limb abnormalities, CNS alterations

Schedule II Drugs

High abuse potential w/ sever dependence liability (narcotics, amphetamines/barbiturates)

Schedule 1 Drugs

High abuse potential/no accepted medical use (heroin, marijuana, LSD)

Schedule IV Drugs

Less abuse potential than schedule III/limited dependence liability (some sedatives, anti-anxiety agents)

Schedule III Drugs

Less abuse potential/moderate dependence liability (nonamphetamine stimulants, limited amts certain narcotics)

Schedule V Drugs

Limited abuse potential. Small amts of narcotics (codeine) Limited quantities may be purchased w/o prescription.

1938 Federal Food, Drug and Cosmetic Act

Mandated tests for drug toxicity and provided means for recall of drugs; established procedures for introducing new drugs; gave FDA the power of enforcement

A client is receiving an antineoplastic medication for treatment of breast cancer and begins having tonic-clonic seizure activity. What type of toxicity does the nurse recognize that this client is experiencing?

Neurotoxicity Explanation: Neurotoxicity, sometimes referred to as central nervous system toxicity, is a drug's ability to harm or poison a nerve cell or nerve tissue. Signs and symptoms of neurotoxicity include drowsiness, auditory and visual disturbances, restlessness, nystagmus, and tonic-clonic seizures. Neurotoxicity can occur after exposure to drugs and other chemicals and gases.

_______ drugs are available without prescription for the self treatment of various complaints

OTC

what type of drugs are chemicals that have been discovered to have some therapeutic effect but that are not financially advantageous to develop into drugs

Orphan

The nurse is caring for a client with hypertension who was prescribed a loop diuretic one week ago. The client reports malaise and weakness and the nurse's assessment reveals an irregular heart rate. The nurse should prioritize assessment of the client's:

Potassium levels

A client began a new medication four days ago and presents with a temperature of 38.2° C (100.8 °F), dependent edema, and swollen cervical lymph nodes. The nurse has informed the client's provider, who has discontinued the medication. What subsequent intervention should the nurse prioritize?

Provide supportive care to manage fever and inflammation

The nurse is reviewing the laboratory test results of a client receiving drug therapy. What would the nurse suspect if the results reveal an elevation in the blood urea nitrogen level and creatinine concentration?

Renal injury

The nurse is providing care for a client whose most recent laboratory results indicate a potassium level of 6.1 mEq/L (6.1 mmol/L). After completing assessment and informing the provider, the nurse should administer:

Sodium polystyrene sulfonate as prescribed. Explanation: Sodium polystyrene sulfonate is the antidote for hyperkalemia.

Category X

Studies in animals/humans demonstrate fetal abnormalities/adverse reactions/evidence of fetal risk

A client is on antibiotic therapy for an axillary abscess. The client has been outside working in the yard and observes a rash everywhere that is not covered by clothing. What should the client be told about this finding?

The client is having photosensitivity and this can occur even with brief exposure to the sun or UV rays. Explanation: Info on pg. 37

Anaphalactic reaction

This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, including histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that can lead to respiratory distress and even respiratory arrest

cytotoxic reaction

This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days

Serum sickness reaction

This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug

Delayed allergic reacti0n

This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells

DEA controlled substance categories indicate the abuse potential and associated regulation of drugs. T or F

True

Over the Counter OTC

available without a prescription for self treatment of a variety of complaints, deemed to be safe if used as directed

Drugs

chemicals that are introduced into the body to bring about some sort of change

Pharmacotherapeutics

clinical pharmacology-the branch of pharmacology that deals with drugs; chemicals that care used in medicine for the treatment, prevention and diagnosis of disease in humans

Phase Four Study

continual evaluation of a drug after it has been released for marketing

Where can you find information about drugs

drug labels, package insert (prepared by manuf. all chemical/study information leading to approval) reference books (PDR, LNDG), journals and internet sites

Phase Three Study

drug used in vast clinical market for those who have the disesase Dropped if: unacceptable adverse effects/unforeseen reactions

Adverse Effects

drugs effects that are not to the desired therapeutic affects; may be unpleasant or even dangerous

Generic Drugs

drugs sold by their chemical name, not brand or trade name products

Orphan Drugs

drugs that have been discovered but would not be profitable for a drug company to develop; usually drugs that would treat only a small number of people; these orphans can be adopted by drug companies to be developed

Category D

evidence of human fetal risk

FDA

federal agency responsible for the regulation and enforcement of drug evaluation and distribution policies

Teratogenic

having adverse effects on the fetus

Preclinical Trials

initial trial of a chemical thought to have therapeutic potential; uses laboratory animals not human subjects

Brand Name

name given to a drug the pharmaceutical company that developed it; also called a trade name

Chemical Name

name that reflects the chemical structure of a drug

Category A

not demonstrated risk to fetus in 1st trimester/no evidence risk in later trimesters

explain the 3 phases of drug testing

phase 1- studies potential drugs on healthy humans phase 2 studies potential drugs on pt with the disease the drug is designed to treat phase 3-clinical setting to determine any unanticipated effects or lack of effectiveness

what are some of the sources of drugs

plants, animals, inorganic elements, and synthetic preparations

What federal controls are there on drugs that have abuse potential?

prescription, distribution, storage, and use closely monitored by DEA. Each prescriber has DEA # to monitor prescription patterns/possible abuse

Genetic Engineering

process of altering DNA, usually of bacteria, to produce a chemical to be used as a drug

Generic Name

the original designation that a drug is given when the drug company that develops it applies for the approval process

Pharmacology

the study of the biological effects of chemicals