Pharmacology Midterm Exam #1

Module 2 review questions and critical thinking questions

1. What is the difference between therapeutic and pharmacologic classifications? -Therapeutic class is based on therapeutic usefulness in treating particular disease/disorder -Pharmacologic class is the way a drug works at molecular, tissue, body system level 2. Identify the following classification as therapeutic or pharmacologic: beta-adrenergic blocker, oral contraceptive, laxative, folic acid antagonist, antianginal drug. -Beta-adrenergic blocker : pharmacologic -Oral contraceptive : therapeutic -Laxative : therapeutic -Folic acid antagonist : pharmacologic -Antianginal drug : therapeutic 3. What is a prototype drugs, and how does it differ from other drugs in the same class? -well understood drug model which other drugs in it's class are compared. Can use prototype to predict actions/adverse effects of drugs in same class 4. Explain why a patient might seek treatment from an OTC drug instead of a more effective prescription drug? -Don't require healthcare provider order -Obtained more easily -No appointment required -Save time/money *adverse effects still present for OTC 5. A generic equivalent drug may be legally substituted for a trade-name medication unless the medication is on a negative formulary or requested by the prescriber or patient. What advantages does this substitution have for the patient? What disadvantages might be caused by the switch? -Advantages : generic drug saves money, name remains the same regardless of what company makes the drug -Disadvantages : since formularies may be different, ingredients may be somewhat different and therefore may affect the ability of the drug to reach target cell and produce effect 6. What are "biosimilar" drugs? How do they differ from generic drugs? -Chemically synthesized drugs that are closely related to biologic medications that have already received FDA approval -Don't undergo same rigorous preclinical/clinical testing -Biosimilar's must prove to FDA that drug has same route of administration, dosage form, mechanism of action as reference product -The generic name of a drug (infliximab - abda)

Module 4 quiz questions and answers

*Practice math questions, no quiz for module 4

Why does safety matter? (10 questions) chapter 7

-A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer -Medication error index provides a conceptual framework that places medication errors into nine categories based on the extent of harm an error can cause -Factors contributing to medication errors by healthcare professionals include: 1. giving incorrect dose, omitting an ordered dose, giving the wrong drug 2. failure to perform agency system check 3. failure to account for patient variables such as age, body size, and impairment in kidney or liver function 4. giving medication based on verbal orders or phone orders 5. giving medication based on incomplete or illegible order when the nurse is unsure of the correct drug, dosage, or administration method 6. practicing under stressful work conditions -Patients can also be apart of med error by taking drugs prescribed by several doctors, getting prescription filled at more than one pharmacy, not filling or refilling meds, taking meds in incorrect dose or time of day, taking meds that are left over from previous illness -Medication errors are the most common cause of morbidity and preventable death in hospitals -FDA safety info and adverse event reporting program serves two purposes 1. Allows healthcare providers and and member of public to report medication errors. Anyone observing or experiencing an adverse drug event. Mandatory reporting form for healthcare agencies and pharm manufacturers who are required by law to report certain adverse drug events and medication errors 2. Provides up to date clinical info to public about safety issues involving medical products including prescription, OTC, biologics, medical/radiation devices, and nutritional products. -NCC MERP "to maximize the safe use of medications and to increase awareness of medication errors through open communication, increased reporting, and promotion of medication error prevention strategies 1. recommended barcode labels on medications 2. reducing medication errors in non-healthcare settings 3. avoiding medication errors in drug samples 4. promoting the safe use of suffixes in prescription drug names -Documentation in EMR must include specific interventions implemented following error to protect patient safety such as monitory vitals and assessing pt for complications. Failure to report nursing actions implies either negligence or lack of acknowledgment that the incident occurred. -The medication administration record (MAR) is another source that should contain info about what meds was given or omitted -Must include written report "incident report" "occurrence report" of error -Report allows nurse to identify what contributed to error and identify improvement strategies that may need to be implemented -Accurate documentation in medical record and error report is essential for legal reasons to verify the patient's safety was protected and serves as a tool to improve medication administration process -Patient safety event is used to define an incident or condition that could have resulted or did result in harm to a patient -A sentinel event is one that results in an unexpected, serious, or fatal injury following the administration (or lack of administration) of a medication. Physical or psychologic -Not all medication errors result in sentinel events. Serious events are called sentinel because they signal the need for an immediate investigation and response. Because of the grave nature of a sentinel event, they are always investigated and interventions put in place to ensure that the event does not recur. Root-cause analysis is used to identify the causes and required interventions to prevent a recurrence -MOST COMMON errors usually are administering an improper dose, giving the wrong drug, and using the wrong route of administration -Increased risk for error in older adults because they often take numerous medications, multiple doctors -What can the nurse do in the clinical setting to avoid medication errors and promote safe administration? 1. Assessment : allergies to food, meds, health concerns, OTC use, herbal supplements 2. Planning : minimize factors that contribute to medication errors: avoid abbreviations that can be misunderstood, question unclear orders, do not accept verbal orders, follow facility policies 3. Implementation : eliminate potential distractions during medication administration that could result in an error, positively identify each patient w/ two identifiers, use correct procedure and techniques, calc med dose correctly, record medication in record immediately, always confirm the patient took the med and swallowed, be alert for long-acting oral dosage forms with indications such as LA, XL, XR, be alert for drugs names who look alike or sound alike 4. Evaluation : assess the patient for expected outcomes and determine if any adverse effects have occurred -Many older adults are treated by multiple specialists. Patients commonly receive multiple prescriptions, sometimes for the same condition, that have conflicting pharmacologic actions, a condition termed POLYPHARMACY -Due to polypharmacy keep track of multiple medications, their doses, indications, routes, and frequency of administration -MEDICATION RECONCILIATION is the process of tracking medications as the patient proceeds from one healthcare provider to another -Because of lack of medication reconciliation there is a major cause of medication errors!!! Most hospitals have implemented a process for documenting a complete list of the patient's current medications upon admission ***An essential strategy for avoiding medication errors is to educate the patient by providing written age-appropriate handouts, audiovisual teaching aids about the medication, and contact information about whom to notify in the event of an adverse reaction -Having the patient "teach back" to the nurse to confirm that the patient has understood the content is a strategy that assists the nurse to evaluate the teaching ***To minimize the potential for medication errors, the nurse should instruct patient to do the following: -know names of all medications taken, dose, when/how they should be taken -know side effects that need to be reported -read label prior to each drug administration -use med device that comes with it such as spoon -carry list of meds including OTC/herbal/dietary -ASK Qs ***New research trend = electronic health records including e-prescribing (transmission of prescription related info through electronics to pharmacy/provider -Electronic records can check new meds against current meds and prevent potential drug-drug interaction, reduce error from poor writing or misinterpretation ***Second important trend is BARCODE ASSISTED MEDICATION ADMINISTRATION (BCMA) technology used to verify and document medication administration at the point of care usually at bedside -Barcode gives and electronic alert when wrong medication is scanned or wrong dose or wrong time -In larger healthcare organizations they have RISK MANAGEMENT DEPARTMENTS to examine risks, minimize medication error #'s ***The overall goal of reporting medication errors and conduction follow-up assessments such as RCA is safe and effective patient care and patient medication administration

How are drugs administered? (8 questions) chapter 3

-Nurse responsibilities include: 1. what drug ordered 2. name and drug class 3. intended or proposed use 4. effects on body 5. contraindications 6. special considerations (age, weight, fat, patho) 7. side effects 8. why the meds prescribed 9. how meds supplied by pharmacy 10. how meds to be administered 11. what nursing process considerations related to the meds apply to this pt -major goal of pharm is to limit # and severity of adverse drug rx -An adverse event (AE) is any undesirable experience associated with the use of a medical product in a pt -Serious Adverse Event (SAE) defines threat of death or immediate risk of death -Adverse effects warrant either lowering the dosage of the drug or discontinuing the drug -Side effect describes a non-therapeutic reaction to a drug -Allergic reaction is an acquired hyper-response of body defenses to a foreign substance (allergen). allergic and anaphylactic reactions are particularly serious side effects that must be carefully monitored and prevented. -Anaphylaxis is a severe type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life-threatening shock. Acute dyspnea and sudden appearance of hypotension or tachycardia -5 rights of drug administration form the operational basis for the safe delivery of medications 1. right patient 2. right medication 3. right dose 4. right route of administration 5. right time of delivery -also consider the right to refuse medication, right to receive drug education, right preparation, and right documentation -If patient refuses medication, it is the nurse responsibility to educate the patient about drug benefits and risks and to asses for fears and reasons why the patient might refuse the medication -3 checks of drug administration that the nurse uses in conjunction with the 5 rights help to ensure patient safety and drug effectiveness 1. checking the drug with the MAR or the med info system when removing it from the medication drawer, refrigerator, or controlled substance locker 2. checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag 3. checking the drug before administering it to the patient -Adherence is taking a medication in the manner prescribed by the healthcare provider or in the case of OTC drugs, following the instructions on the label -Patients are usually reluctant to admit or report non-adherence to the nurse for fear of being reprimanded or feeling embarrassed -STAT order : refers to any med that is needed immediately and is to be given only once -ASAP order : should be available for administration to the patient within 30 minutes of the written order -SINGLE order : drug that is to be given only once, and at a specific time, such as a preoperative order -PRN is administered as required by the patient's condition -ROUTINE orders carried out within 2 hours of the time the order is written -STANDING order is written in advance of a situation that is to be carried out under specific circumstances -Policy typically states for the orders be reviewed by attending provider within specific time frames usually every 7 days -Prescriptions for narcotics and other scheduled drugs are often automatically discontinued after 72 hours, unless specifically reordered by the provider -Most common system of drug measurement uses the metric system of measurement - Liters, milliliters -cc no longer used because it can be mistaken for the abbreviation for unit and cause med errors -metric weight is kg, g, mg, mcg 1. verify med order and check allergy hx 2. wash hands and apply gloves 3. aseptic technique 4. state full name and check arm band and compare with MAR 5. ask about known allergies 6. inform pt of drug name, expected action, common adverse effects, how it will be administered 7. position pt for appropriate route of administration ENTERAL DRUG ADMINISTRATION TABLETS AND CAPSULES = -drugs given orally, nasogastric or gastrostomy tubes -most common, convenient, least costly -safest since skin barrier not compromised -if overdose can administered induced vomiting -tablet/capsule most common form -do not crush due to possible inactivation -the strongly acidic contents within the stomach can present a destructive obstacle to the absorption of some medications. To overcome tablets may have hard and waxy coating that enables them to resist the acidity -enteric-coated tablets designed to dissolve in alkaline environment of small intestine -SUSTAINED RELEASE tablets or capsules designed to dissolve very slowly to release meds over extended period of time and result in longer duration of action for the meds -certain drugs including proteins are inactivated by digestive enzymes in the stomach and small intestines -Medications absorbed from the stomach and small intestine first travel to the liver where they may be inactivated before they ever reach their target organs and this is called the FIRST PASS EFFECT ENTERAL DRUG ADMINISTRATION SUBLINGUAL AND BUCCAL DRUG ADMINISTRATION -tablet is not swallowed but left in mouth -meds given this way are not subject to destructive digestive enzymes or undergo first pass effect -sublingual route the meds placed under tongue and allowed time to dissolve -rich blood supply under tongue so rapid onset of action -buccal route is places in oral cavity between gum and cheek -buccal is less permeable to most meds so slower absorption -buccal bypass first pass effect ENTERAL DRUG ADMINISTRATION RAPID-DISSOLVING TABLETS AND FILMS -orally disintegrating tablets and oral soluble films are newer drug delivery systems that allow for quick dissolving of medications without the need for an external source of water -less than 30 sec ENTERAL DRUG ADMINISTRATION NASOGASTRIC AND GASTROSTOMY DRUG ADMINISTRATION -usually liquid form -exposed to same physiologic processes as those given orally TOPICAL DRUG ADMINISTRATION -applied locally to skin or membranous linings of eye, ear, nose, respiratory tract, urinary tract, vagina, rectum -dermatologic preparations : applied to skin and most common -instillations and irrigations : into body cavities or orifices -inhalations : to the respiratory tract by inhaler, nebulizer, breathing apparatus -The distinction between topical drugs given for local effects and those given for systemic effects is an important one for the nurse -In the case of local drugs, absorption is undesirable and may cause side effects. For systemic drugs, absorption is essential for the drugs therapeutic action TOPICAL: TRANSDERMAL -nitroglycerin -rate of delivery and dose varied -avoid first pass effect and digestive enzymes TOPICAL: OPHTHALMIC -local conditions of eye and surrounding structures -common indications include excessive dryness, infections, glaucoma, dilation during pupil exam TOPICAL: OTIC -treat local conditions of ear like infection, blockage TOPICAL: NASAL -used both local and systemic -nasal mucosa provides excellent absorptive surface for certain meds -ease of use, avoid first pass effect, avoid digestive enzymes -potential damage to cilia within nasal and irritation, unpredictable mucus secretions -drops and sprays used for local ASTRINGENT EFFECT that is they shrink swollen mucous membranes or loosen secretions and facilitate drainage (relief cold asap) TOPICAL: VAGINAL -treat local infection and relive itching or pain TOPICAL: RECTAL -either local or systemic drug administration -safe and effective for comatose, nausea, vomiting pt -absorption slower than other routes bit it is steady and reliable -first pass avoided PARENTERAL DRUG ADMINISTRATION -delivers drugs via a needle into skin layers, subcutaneous tissue, muscles, veins -invasive, potential for introducing pathogenic microbes directly into blood or body tissues so ASEPTIC technique must be strictly applied PARENTERAL DRUG ADMINISTRATION INTRADERMAL AND SUBCUTANEOUS -delivers drugs to blood vessels -avoid first pass -only small volumes can be administered and injections can cause pain and swelling at the injection site -intradermal is administered into dermis layer, drug more easily absorbed, limited to very small volumes of drug (0.1-0.2 ml) -subcutaneous is delivered to deeper tissue, rapid absorption, small volume doses (0.5-1 ml) PARENTERAL DRUG ADMINISTRATION INTRAMUSCULAR ADMINISTRATION -delivers medication into specific muscles -muscles rich blood supply causes meds to move quickly into BV to produce rapid onset -larger volume of medication -injection site must be located away from bone, large BV, and nerves -Ventrogluteal preferred site, deltoid for well-developed teens and adults less than 1ml, dorsogluteal for adults and children who have been walking for at least 6 months but rarely used due to potential damage of sciatic nerve, and vastus lateralis PARENTERAL DRUG ADMINISTRATION INTRAVENOUS ADMINISTRATION -administered directly into bloodstream and immediately used by body -very very rapid onset of action -bypass enzymatic process and first pass effect 1. large volume infusion : fluid maintenance, replacement, supplementation 2. Intermittent infusion : small amount IV in tandem w/primary large volume infusion, used to instill adjunct medications such as antibiotics/ analgesics over short . 3. IV bolus (push) administration : concentrated dose delivered directly to circulation via syringe to administer single dose meds, given through intermittent injection port or direct IV push -IV routes offer the fastest onset of drug action ***Also the most dangerous because once injected the med cannot be retrieved. If drug solution or needle is contaminated, pathogens have a direct route to bloodstream and body tissues. Patient must be close monitored for adverse rx. Some adverse rx occur immediately after injection and some take hours. Antidotes for drugs that can cause potentially dangerous/ fatal reaction should always be readily available

How are drugs regulated? (3 questions) chapter 2/10

-The first standard commonly used by pharmacists was the formulary, a list of drugs and drug recipes -U.S. Pharmacopoeia-National Formulary (USP-NF) is a resource of public pharmacopoeia standards provided in print and online. USP-NF covers public standards for drugs, excipients (inactive ingredients), and dietary supplements. -USP provides a nationwide database of documented and potential medication errors, as well as their causes. USP labels include drug purity and exact amounts of ingredients found within the container U.S. Pharmacopoeia Medication Errors Reporting Program (USPMERP) provides opportunities for healthcare professionals to search out and report occurrences related to medication safety -The center for drug evaluation and research (CDER) a branch of FDA exercises control over whether prescription and OTC drugs may be use for therapy -FDA created black box warnings for drugs with "special problems" causing death or serious injury. Black box warning is named after the black box appearing around drug safety info in package inserts. This is the primary alert for identifying extreme adverse drug reactions discovered during and after the review process -FDA oversees administration of herbal products and dietary supplements through the center for food safety and applied nutrition (CFSAN). Herbal/ dietary supplements can be marketed WITHOUT prior approval from the FDA. All package inserts and info are monitored once products have gone to market. -Therapeutic drugs and biologics are reviewed in four phases: 1. PRECLINICAL INVESTIGATIONS : extensive testing on human cells, human tissue and animals to evaluate safety and effectiveness of the drug 2. CLINICAL INVESTIGATIONS : longest phase; includes three phases of drug trials, initially a small group of healthy volunteers, progressing to larger groups of volunteers with the particular condition the medication is being tested to treat. 3. REVIEW OF THE NEW DRUG APPLICATION : takes approximately 17 to 24 months and may happen concurrently with Clinical phase III trials. 4. POST-MARKETING SURVEILLANCE : monitors the safety and effectiveness of the drug in the general population. -Controlled substance is drugs that have a significant potential for abuse and are placed into 5 categories called schedules. Scheduled drugs classified according to potential for abuse. Schedule I = highest potential for abuse, restricted for use in situations of medical necessity w/ little or no therapeutic value. Schedule II-IV = may be dispersed only incases in which therapeutic value has been determined. Schedule V = only category in which some drugs may be dispersed without a prescription because the quantities of the controlled drug are so low that the possibility of causing dependence is extremely remote. -Complementary and alternative medicine (CAM) : diverse set of therapies and healing systems outside of mainstream healthcare. Focus on : treating individual person, consider whole person, integration of mind and body, promote disease prevention, self-care, and self healing, recognize spirituality in health and healing -COMPLEMENTARY is when non-mainstream practice is used together with conventional medicine -ALTERNATIVE is when the non-mainstream practice is used in place of conventional medicine -INTEGRATIVE is when traditional and complementary are used in coordinated way to improve wellness -CAM very rarely subject to rigorous clinical and scientific study -Much of value of CAM therapies is ability to reduce the need for medications. Reduction of dose leads to fewer adverse effects and improved compliance. If used appropriately these methods can serve essential roles in healing of patient -Herb is a botanical that does not contain any woody tissue such as stem or bark -Herb and botanical can be used interchangeably now to mean any plant product with some useful application either as food enhancer or medicine -Herbs contain dozens of active chemicals, many of which have not yet been isolated or studied -Americans cannot and SHOULD NOT expect the same quality of standards for herbs and dietary. Regulated far less rigorously since they are not classified as medications they are NOT subjected to the same degree of legal scrutiny as drugs -FDA had the power to remove from the market any product that poses a "significant or unreasonable" risk to the public. They are also required to be clearly labeled by the manufacturer as "dietary supplements" Herbal and Dietary: 1. effectiveness does not have to be demonstrated by the manufacturer 2. does not have to test safety prior to marketing 3. to be removed the government has the burden of proof to show that the supplement is unsafe 4. label must state that the product is not intended to diagnose, treat, cure, prevent disease 5. label may make claims about the product's effect on body structure and function such as : promote healthy immune system, reduces anxiety and stress, maintains cardiovascular function, reduces pain and inflammation -DSHEA does not regulate the accuracy of the label so the product may or may not contain the ingredients listed in the amount claimed -FDA now required manufacturers to evaluate the identity, purity, potency, composition, accurately reflect what is in the product, must be free of contaminants, pesticides, toxins, glass, heavy metals -A patient who substitutes an unproven alternative therapy for an effective medical treatment may delay healing and suffer harmful effect and endanger health -Only a few have recieved the level of scientific scrutiny needed to achieve a consensus recommendation from the medical community including GINKGO BILOBA (treat circulatory disorders and improve memory), ST. JOHNS WORT (treat mild to moderate depression), VALERIAN (induce relaxation or sleep) -Specialty supplements are non-herbal dietary products used to enhance a wide variety of body functions (amino acids, coenzyme Q10, DHEA, fish oil, lactobacillus, vitamin C, etc) generally not harmful but can give false hope -Nurse has OBLIGATION to seek latest medical info on dietary supplements because there is a good possibility that patients are using them to supplement traditional medicines -Following teaching points are important when assessing patient's use of these therapies 1. include questions on CAM when obtaining med hx 2. ask patient why taking supplements 3. advise pt of side effects 4. advise pregnant or lactating women 5. older adults have chronic diseases that increase risk for drug-herb interaction 6. advise caution if serious allergies 7. be skeptical of advertised claims by CAM 8. advise not to take more than dose recommended on product

What is pharmacology? (3 questions)

-The study of medicine -How drugs are administered, where they travel in the body, actual responses produced -Pharmacology is at the core of patient care and is integrated into every step of the nursing process -Therapeutics is concerned with the prevention of disease and treatment of suffering VS -Pharmacotherapy is the application of drugs for the purpose of treating diseases and alleviating human suffering -Biologics are agents naturally produced in animal cells, by microorganisms, or by the body itself. They are large, complex molecules or mixtures of molecules that may be composed of living material. (hormones, monoclonal antibodies, natural blood products, interferons, vaccines) -Biosimilar's are chemically synthesized drugs that are closely related to biologic medications that have already received FDA approval. Biosimilar's are not required to undergo the same rigorous preclinical and clinical testing as their reference products. Biosimilar's must prove to FDA that the drug is safe and effective as the approved reference product. This includes the same route of administration, dosage form, mechanism of action. Do not have generic names. -Complementary and alternative medicine (CAM) therapies involve natural plant, herbs, vitamins, minerals, dietary supplements, etc. Nonconventional. -Therapeutic classification organizes drugs based on their therapeutic usefulness in treating particular diseases or disorders (anticoagulant, antihyperlipidemic, antihypertensive, antidysrhythmic, antianginal). -Pharmacologic classification refers to the way a drug works at the molecular, tissue, or body system level (diuretic, calcium channel blocker, angiotensin-converting enzyme inhibitor, vasodilator). Addresses drug mechanism in action or how produces physiologic effect. More specific and therapeutic and requires more in-depth understanding of biochem/physiology -A prototype drug is the well-understood drug model with which other drugs in its representative class are compared. By knowing the prototype you may be able to predict the action/adverse effects of other drugs in the same class -A generic name of a drug is assigned and less complicated than chemical names. Because there is only one generic name for each drug, using this name has value and students generally must memorize. -A drugs trade name is short and easy to remember and is assigned by the company marketing the drug. A drug developer is given exclusive right to name and market a drug for 17 years after a new drug application is submitted to the FDA -A combination drug contains more than one active generic ingredient. -Trade name is usually more expensive because it is the companies original marketing drug. Pharmacists may routinely substitute a generic drug when the prescription calls for a trade name to save buyer money -Difference between trade name and generic drugs depends on the situation. Despite the fact that the dosages may be identical, drug formulations are not always the same. The two drugs may have different inert ingredients. It is important that the generic medications do not work differently from trade-name medications. -Difference between trade and generic depends on bioavailability (ability of drug to reach target cell and produce effect). Generic drugs, even those with small difference in bioavailability and bioequivalence, could adversely affect patient outcomes in those with critical conditions/illnesses.

Module 7 review questions and critical thinking questions

1. A 22 year old pregnant patient is diagnosed with a kidney infection, and an antibiotic is prescribed. The patient asks the nurse whether the antibiotic is safe to take. What factors are considered when a drug is prescribed for a patient who is pregnant? -Antibiotics sometimes required even if pregnant -Consider fetus gestational age, pregnancy category for drug considered, other factors such as allergies that might contraindicate use 2. An 86 year old male patient who lives with his son and daughter in law at home is confused and anxious, and an anti-anxiety drug has been ordered. What concerns might the nurse have about pharmacotherapy for this patient? -complications in older adults are degeneration multiple organ systems, multiple/severe illness, polypharmacy, unreliable adherence -from absorption to excretion will be altered in this pt -nurse assess presence illness/diseases, if pt on other drugs that might interact, if other fam/caregiver could manage meds at home 3. An 8 month old child is prescribed acetaminophen elixir for management of fever. She is recovering from gastroenteritis and is still having several loose stools each day. The child spits some of the elixir on her shirt. Should the nurse repeat the dose? What are the complications of this child's age and physical condition for oral drug administration? -consult w/pharmacist if should repeat dose -oral elixir absorbed to some degree so may not need to repeat dose -nurse should consider oral syringe to measure/administer meds to infant -syringe tip placed in side of mouth and not forced -gastroenteritis can affect drug absorption due to effect on increasing peristalsis 4. A 72 year old patient with heart disease who has been treated for atrial flutter, a type of cardiac dysrhythmia, is taking the anticoagulant warfarin. The healthcare provider suspects that the patient has a genetic polymorphism that causes the drug to be poorly metabolized. What could the nurse do to assist in monitoring for this effect? Applying the principles of precision medicine, what additional assessment data might be useful? -poorly metabolized = longer periods in body -check lab values to assess continued unexpected drug action -assess for signs of bleeding cuz of anticoagulant -assess patient's diet, nontraditional therapies, herbs that could interfere with warfarin (precision medicine) 5. A 52 year old female patient is admitted to the ED. She developed chest pressure, SOB, anxiety, nausea approximately 4 hours earlier and now has chest pain. She tells the nurse that she "thought she has just overexerted herself gardening." How might her gender have influence her decision to seek treatment? -even though women pay more attention to sx and seek treatment than men this doesn't hold true w/ cardiac conditions -cardiac conditions historically considered disease mainly affected by men therefore women delay seeking treatment for this condition and see sx as unrelated 6. A 19 year old male patient presents at a health clinic for migrant farm workers. In broken english, he describes severe pain in his lower jaw. An assessment reveals two abscessed molars and other oral health problems. Discuss the possible reasons for this patient's condition. -may have limited access to care due to socioeconomic status or due to legal status -even if care provided locally, limited health literacy skills may result in his delay for seeking tx

Module 6 quiz questions and answers

1. Match the following terms with their correct descriptions. -Onset : The amount of time it takes to produce a drug's therapeutic effect -Peak : When the medication has reached it's highest concentration in the bloodstream -Duration : The amount of time a drug maintains its therapeutic effect -Toxic concentration : When the drug is most likely to cause serious adverse effects 2. Which of the following refers to when oral medications reach hepatic circulation before being distributed to other body tissues? -First pass effect 3. Match each response with the correct pharmacokinetic process. -Absorption : The more rapid the dissolution, the faster the onset of drug action -Distribution : Drug-protein binding may limit how much of the drug reaches the target cells -Metabolism : Hepatic microsomal enzymes inactivate drugs to accelerate their removal from the body -Excretion : Those with renal impairment will need a lower dose to avoid renal toxicity 4. An agonist is a drug that produces the same type of response as the endogenous substance and an antagonist is a drug that will prevent the endogenous chemical from acting. -True 5. Absorption is the primary pharmacokinetic factor in determining the length of time it takes a drug to produce its effect. -True

Module 3 quiz questions and answers

1. Medical consensus suggests that Ginger may be effective for the treatment of nausea. -True 2. Match the following branches of the FDA with the correct description. -National Center for Complementary and Integrative Health (NCCIH) : Lead agency for scientific research and information about complementary and alternative medicine -Center for Drug Evaluation and Research (CDER) : Exercises control over whether prescription or OTC drugs can be used for therapy. -Center for Biologics Evaluation and Research (CBER) : Regulates the safe use of serums, vaccines and blood products. -Center for Food Safety and Applied Nutrition (CFSAN) : Monitor dietary supplements after they have gone to market 3. Match the phases of FDA drug approval with the correct description. -Preclinical investigation : Extensive testing on human cells, human tissue and animals to evaluate safety and effectiveness of the drug. -Clinical Investigation : Includes three phases of drug trials, initially a small group of healthy volunteers, progressing to larger groups of volunteers with the particular condition the medication is being tested to treat. -Review of the New Drug Application (NDA) : Takes approximately 17 to 24 months and may happen concurrently with Clinical phase III trials. -Post-marketing Surveillance : Monitors the safety and effectiveness of the drug in the general population. 4. Which of the following is true about the Dietary Supplements? Select all that apply. -The supplement does not have to prove effectiveness before going to market -The supplement is not tested by the FDA for safety prior to going to market -The FDA requires the label be accurate about what the product contains -The FDA may pull a dietary supplement from the market if good manufacturing processes were not followed or the supplement is found to pose a threat to patient safety 5. Potential risks of St. John's Wort include Increased anticoagulation effects and CNS excitation. -False

Module 2 quiz questions and answers

1. Over the counter drugs are generally safer in that they do not typically interact with other drugs. -False 2. Which of the following is true about diphenhydramine. Select all that apply. -It may be sold under the name Allerdryl -It is an antihistamine -It is a generic drug 3. Match the mechanism of action with the drug classification. -Vasodilator : dilates peripheral BV -Calcium channel blocker : blocks heart Ca channels -Angiotensin-converting enzyme inhibitor : blocks hormonal activity -Diuretic : lowers plasma volume 4. Match the drug usefulness with the drug classification. -Antihypertensive : lowers BP -Antihyperlipidemic : lowers cholesterol -Antidysrhythmic : restore normal cardiac rhythm -Anticoagulant : influence blood clotting 5. Learning about azithromycin, an antibiotic, may serve in understanding the macrolide class of antibiotics. In this case, azithromycin is being used as a prototype drug for the macrolide class. -True

Module 5 quiz questions and answers

1. The nurse will use the 3 checks of drug administration in conjunction with the 5 rights of medication administration to avoid medication errors. -True 2. Which of the following are the traditional rights of drug administration? Select all that apply. -Right drug -Right patient -Right time -Right route -Right dose 3. Which of the following is true regarding the topical route of medication administration? Select all that apply. -Systemic absorption of topical drugs is minimal -Inhalers, intranasals and ointments are consider topical medications -Ophthalmic medications are given via the topical route 4. Match the abbreviation with the correct meaning. -ac : before meals -bid : twice a day -pc : after meals -tid : three times a day -qid : four times a day -PO : by mouth 5. The dorsogluteal site is the preferred site for IM injections because it contains no large blood vessels or nerves. -False

Module 7 quiz questions and answers

Can't access until after due date has passed

Module 4 review questions and critical thinking questions

1. A nurse is teaching a young patient's mother about administering liquid medications to her child. The mother expresses concern about the ability to use the small medication cup that comes with the medicine because the printed amounts are hard to read. What might the nurse recommend as alternatives? -Recommend purchasing dosage syringe, drug spoon, other common device -Mom can bring device in and practice w/ nurse to verify ability to measure correct dose -Don't use household utensils cuz amount they hold varies greatly 2. A healthcare provider writes an order for Tylenol PO q3-4h for mild pain. The nurse evaluates this order and is concerned that is is incomplete. Identify the probable concern and describe what the nurse should do prior to administering this medication? -Order does not contain indication for "right dose" or "right time" -It only shows that Tylenol is ordered every 3/4 hours by mouth -Nurse clarify w/prescriber: how many tablets? Amount of liquid administered? Does "q3-4h" refer to routinely around the clock or PRN (as needed) 3. A new nurse does not check an antibiotic dosage ordered by a healthcare provider for a pediatric patient and the order is for a dosage that is too high for the patient's size. The nurse subsequently overdoses a 2-year-old patient, and an experienced nurse notices the error during the evening shift change. Identify each person who is responsible for the error and how each is responsible. -Nurse ultimately responsible because drug handbook check/ dosage calc would have revealed dose is too high -Prescriber responsible for writing wrong dosage -Nurse should have notified provider to correct dosage -Pharmacist responsible for not checking to see if dosage correct for age/weight

Module 6 review questions and critical thinking questions

1. Describe the types of barriers drugs encounter from the time they are administered until they reach their target cells. -Greatest barrier is crossing membranes that separate drug from target cell -To leave bloodstream must cross capillary cells, travel through interstitial fluid, and enter target cell by passing through their plasma membrane -May also need to pass through cellular organelles (nucleus) -Subject to stomach acids -Subject to digestive enzymes 2. Why is a drug's plasma half-life important to nurses? -Plasma 1/2 life is the time required for the concentration of the medication in the plasma to decrease to half its initial value after administration -Important cuz the longer the half-life the longer it takes meds to be excreted = longer effect in body -Determines how often meds will be administered -Kidney/ liver diseases prolong 1/2 life of drugs = increased risk for toxicity 3. Describe how the excretion process of pharmacokinetics may place patients at risk for adverse drug effects. -Eliminating drugs by excretion is mostly though the kidneys -Impaired kidney can alter elimination placing pt at risk for adverse drug effects/toxicity -Gaseous drugs eliminated through respiration so impaired respiration/disease alter experience -Water-soluble forms may be excreted through breast milk, affecting infants who breastfeed 4. Explain why drugs metabolized through the first-pass effect might need to be administered by the parenteral route. -Many drugs will become inactive by hepatic metabolism as the drug passes through that system 5. If the ED50 is the dose required to produce an effective response in 50% of a group of patients, what happens in the other 50% of the patients after a dose has been administered? -The other 50% of the patients did not experience the desired effect from the dose. 6. Great strides are being made in pharmacogenomics and personalized medicine. What are some of the advantages that pharmacogenomics may have for the pharmacologic treatment of patients? -By understanding how a drug works with the unique genetic sequencing in a patient, drugs may be selected to produce more targeted effects and cause less adverse effects

Module 3 review questions and critical thinking questions

1. How does the FDA ensure the safety and effectiveness of drugs? What type of drugs does the FDA regulate or control? -Facilitate availability of safe, effective drugs -Provide clear, easily understandable drug information for safe and effective use -Regulates use of biologics including serums, vaccines, blood products -Control whether prescription/ OTC may be used for therapy 2. What is a black box warning? Why is it important for nurses to consider these when reading drug information materials? -Created to regulate drugs w/ "special problems" -Black box warning is a special alert required by FDA to state if drug/ drug class had potential for serious injury/ death -Identifies extreme/adverse drug reactions discovered during/after review -Nurses must be mindful of standards of care: scanning meds, med reconciliation, special alerts -If nurse had Q they consult healthcare provider before administering 3. Identify opportunities the nurse has in education about, administering, and monitoring the proper use of drugs. -Responsible: safe administration, monitor effects, education to patient -Proper administration and reporting adverse reactions 4. Why are certain drugs placed in schedules? What does the nurse need to know when a scheduled drug is ordered? -They help nurse identify potential for abuse -Require complete records for quantity prescribed -Higher abuse potential = more restriction on prescriber/ refills -When educating the patient, nurse includes abuse potential 5. A nurse is preparing to give a patient a medication and notes that a drug to be given is marked as Scheduled III drug. What does this information tell the nurse about this medication? -Schedule III drug = controlled sub. restricted by Controlled Substance Act and regulated by DEA -Scheduled II has moderate abuse potential, moderate physical dependency, high potential for psychological dependency 6. A 44-year-old breast cancer survivor is placed on tamoxifen (Nolvadex), a drug that may prevent recurrence of the cancer. Since receiving chemotherapy, the patient has not had a menstrual cycle. She is concerned about being menopausal and wonders about the possibility of using a soy-based product as a form of natural hormone replacement. How should the nurse advise the patient? -Natural soy product may interfere with desired action of tamoxifen or other chemo drugs -Patient concerned acknowledged -Warn patient not to consume herb product w/out consulting provider -Nurse can explore patient concerns/ assess sx related menopause, etc. 7. A 62-year-old male patient is recuperating from a myocardial infarction. He is on the anticoagulant warfarin (Coumadin) and antidysrhythmic digoxin (Lanoxin). He talks to his wife about starting to take garlic, to help lower his blood lipid levels, and ginseng, because he has heard it helps in coronary artery disease. Discuss the potential concerns about the use of garlic and ginseng by this patient. -Garlic and ginseng can have drug interaction w/ Coumadin -Ginseng capable of inhibiting platelet activity -Herbal products capable of increased bleeding potential -Ginseng w/ Lanoxin may increase risk of toxicity 8. The patient has been taking St. John's wort for symptoms of depression. He is now scheduled for an elective surgery. What important preoperative teaching should be included? -St. John's had multiple drug interactions -Stop taking drug 3 weeks before surgery -Can potentiate sedation when combine w/ CNS depressants/ opiate analgesics -St. John's can also decrease effects of anticoagulants

Module 5 review questions and critical thinking questions

1. Why do errors continue to occur despite nurses' following the five rights and three checks of drug administration? -Because all members of healthcare team are involved in responsible, safe, accurate administration -Many steps involved in safe administration and there are multiple points where errors can occur 2. What strategies can the nurse use to ensure adherence to drug therapy for a patient who is refusing to take his or her medication? -Formulate individualized plan of cure -Including patient enables them to fully participate and encourages better adherence -Explore reasons patient may refuse meds: cost, unpleasant effect -Seek w/provider for alternatives if not working 3. Compare the oral, topical, IM, subcutaneous, and IV routes. Which has the fastest onset of drug action? Which routes avoid the hepatic first-pass effect? Which require strict aseptic technique? -IV route : fastest cuz meds directly into blood and bypass first-effect -Parenteral meds (IV, intradermal, subcutaneous, IM) : nurse must ensure aseptic technique strictly for ALL 4. What are the differences among a STAT order, an ASAP order, a prn order, and a standing order? -STAT : immediately and only once, usually emergency meds for life-threatening event, usually given within 5 minutes or less after being ordered -ASAP : not as urgent, available for administration within 30 min of written order -PRN : administered as required by patient condition, nurse makes judgement based on assessment -STANDING ORDER : written in advance of a situation that is to be carried out under specific circumstances