NUR 326 Exam One

error

"Any __________ that occurs in medication administration process, whether or not it harms the patient." May be applied to: Misinterpretations, miscalculations Misadministration Handwriting misinterpretation Misunderstanding of verbal orders "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." are most commonly linked to communication issues. Even in an emergency you must know the desired effect, dosage, and route of the prescribed medication. If a medication error is made, it's critical to report and document it in the patient's medical record, and through an Incident Report.

pregnancy

"No prescription drug, OTC medication, herbal product, or dietary supplement should be taken during _______________ unless the physician verifies that the therapeutic benefits to the mother clearly outweigh the potential risks for the unborn."

trade name

(also called proprietary or brand name) The names under which a drug is marketed. These names are created by drug companies with the intention that they be easy for consumers to recall and pronounce. The drug developer has exclusive rights to name and market a new drug for 17 years in the United States. After 17 years, competing companies may sell a generic equivalent drug, sometimes using a different name, which the FDA must approve. A drug may have several trade names it is is capitalized; Example: a trade name for diphenhydramine is Benadryl.

controlled substance act

(also known as Comprehensive Drug Abuse Prevention and Control Act): Restricts the use of drugs with potential for abuse Restricted drugs are placed into one of five schedules Hospitals and pharmacies must maintain complete records of scheduled drugs.

therapeutic effect

=What results are desired? This falls under "Implementation" in the nursing process

loading dose

A higher amount of the drug given to help the plateau be met faster Quickly produces the therapeutic response Patient is then given the maintenance dose, which keeps the plasma-drug concentration in therapeutic range.

lactating patient

A large number of drugs are secreted through breastmilk, however, many are relatively safe. Risk benefit idea is used again to determine the need for a drug. Infants that are premature, neonates, and seriously ill infants may be at greater risk for adverse effects. General recommendations: Postponed and use nonpharmacological therapies. Administer the drug immediately after breastfeeding. Avoiding illicit drug use. Shorter half-life drugs are preferable. OTC herbal products and dietary supplements should be avoided.

I V

A medication's potential for abuse and misuse determines the level of restriction in number and type of providers who may "order" a medication. Drugs that have a significant potential for abuse are placed into five categories called schedules. Schedule ___ drugs have the highest abuse potential, Schedule ___ the lowest.

problems with trade names

A single drug can have multiple trade names Over-the-counter (OTC) products with the same trade name may have different active ingredients Trade names can endanger international travelers

four components of pharmacokinetics

Absorption Distribution Metabolism Excretion

treating the toddler

Ages 1 to 3 years Biggest age group of childhood poisonings Educate parents regarding ways of protecting their children from poisonings. Short, concrete explanations followed by immediate drug administration is most appropriate. Physical comfort or verbal phrase should be offered.

treating the adolescence

Ages 13 to 18 years Educate parents on keeping drugs put away and S/S of illicit drug use. Common pharm: skin problems (acne), menstrual symptoms, eating disorders, contraception, alcohol and tobacco use, and sport-related injury

treating the young adult

Ages 18 to 40 years Common pharm: vitamins, minerals, and herbals, contraception, STD treatment Substance abuse if common in 18 to 24 year olds

treating the preschooler

Ages 3 to 5 years Poisoning safety is still a concern. Understand basics of health and illness Short, concrete explanations followed by immediate drug administration is most appropriate. May use play for the child to better understand the medication.

treating the middle aged adults

Ages 40 to 65 years Health promotion is needed-Rx may be taken for disease that could be improved with lifestyle modifications Common pharm: HTN, cholesterol, obesity, anxiety, cancer, arthritis, erectile dysfunction, antidepressants, and respiratory medications

treating the school-aged child

Ages 6 to 12 More detailed explanation is appropriate, dosing choices and child involvement is appropriate

spores

Bacterium can form __________ _________ can be viable in soil for hundreds or thousands of years Resistant to drying, heat, and some harsh chemicals Found in contaminated animal products such as wool, hair, dander, and bonemeal, but it can also be packaged in other forms

agonist

Bind to receptor and activate a response Produces a response that mimics the response of an endogenous substance

CAM healing therapies

Biologic-based Manual healing Mind-body interventions Spiritual

three checks of drug administration

Checking the drug with the MAR or the medication information system when pulling it from storage Checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag Checking the drug before administering it to the patient

drugs

Chemicals that produce effects by interacting with other chemicals

nurses responsibility in medication administration

Closely monitor patient's status (vital signs) Detect mistakes made by pharmacists and prescribers First member of the healthcare team to observe and evaluate drug responses and intervene if required Must know the response that a medication is likely to elicit Last line of defense for the patient Ethically and legally unacceptable to administer drug that is harmful to the patient-even though the medication has been prescribed by a licensed prescriber and dispensed by a license pharmacist

medication guidelines

Commonly referred to as MedGuides FDA-approved documents Required when the FDA has determined that (1) patient adherence to directions for drug use is essential for efficacy and (2) patients need to know about potentially serious effects when deciding whether to use a drug these were created to teach patients about potentially dangerous drugs

treating the infant

Decimal points matter. The drug guide for the neonatal period is called a neofax. Nursing Interventions: Hold and cuddle the infant while medications are being administered. Use the dropper in the inner check for oral medications, allowing time for swallowing. If rectal suppositories are used the buttocks should be held together for 5-10 minutes. Caution when administering IM or IVE due to little muscle mass. IVs may be used in the feet and scalp.

nurses

Despite six rights and three checks, mistakes still occur. __________ are held accountable for correct administration of drugs, but responsibility also rests on other positions like physician and pharmacist.

questions to reduce adverse drug reactions

Did symptoms appear shortly after the drug was first used? Did symptoms stop when the drug was discontinued? Did symptoms reappear when the drug was reinstituted? Is the illness itself sufficient to explain the event? Are other drugs in the regimen sufficient to explain the event?

evaluation

Did the medication have the desired effect?

median effective dose

Dose that produces therapeutic response in 50% of a group Sometimes called "average" or "standard" dose Many patients require more or less.

things the nurse should teach

Drug name and category Dosage size and schedule Technique of administration Expected therapeutic response and when it should develop Nondrug measures to enhance therapeutic responses Duration of treatment Method of drug storage Symptoms of major adverse effects and measures to minimize discomfort and harm Major adverse drug-drug and drug-food interactions Whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions

genetics

Enzyme breakdowns, changing the function of medications, risk factors

toxic epidermal necrolysis: potentially fatal

Epidermal sloughing Multiple body systems Liver fails to break down a drug normally

education

Every nurse-patient interaction is an opportunity for patient ______________! Small portions given over time are more effective than huge "chunks" of info all at once.

reporting agencies

FDA Safety Information and Adverse Event Reporting Program (MedWatch) Reporting System Up-to-date Clinical Information

surface decontamination

First steps of any emergency triage. remove the patient's clothing and cleanse contaminates from the body flush eyes with water; wash hair with soap and water

reassess

For any nursing intervention we do, we want to evaluate its effectiveness. To do this, we ____________. So, after giving a medication, we need to ____________ to see if the medication we gave was effective.

absorption

For the purposes of pharmacology, you will need to have a working knowledge of any barriers to ______________ for each of the major routes of administration (PO, IV, IM, subQ). Additionally, you will need to know the different types of oral preparations (tablets, enteric-coated, and sustained release).

anthrax spore anthrax

General symptoms associated with almost every form of __________: necrosis, accumulation of exudate, which lead to pain, swelling, restriction of activity __________ bearing diseases are the hardest to treat and eliminate from the environment. These antibiotics are not curative. An __________ vaccine is available, but only recommended for select populations: lab personnel who work with anthrax, military personnel deployed to high-risk areas, those who deal with animal products imported from areas with a high incidence of the disease.

advantages to prescription drugs

Health care provider examines the patient and orders the proper drug. Amount and frequency of drug is controlled. Instructions on use and side effects of drug are discussed.

schedule II drugs

High abuse potential and high potential for physical and psychological dependence May have a therapeutic use with prescription, although some drugs are no longer used Have more restrictions: Need special order form to obtain Orders must be written. Orders must be signed by health care provider. Telephone orders to pharmacies are not permitted. No refills are permitted; patient must see health care provider first. Examples include Morphine, PCP, Cocaine, Methadone, Methamphetamine

sentinel events fatal elderly

Hospitals are graded on the number of ___________ _________ reported by the Joint Commission. One-half of _________ medication errors occurred in clients older than 60 years of age. _____________ are at an increased risk for errors because they often take numerous medications, have multiple HCPs, and experience normal age-related changes in physiology.

excretion

How drugs are removed from the body. The concentration of a drug in the blood stream depends on the excretion rate. The primary site of excretion is the kidney Renal failure diminishes excretion of medications, and drugs are retained for extended times. Dosages must be reduced. Other sites of excretion: respiratory system, glands, biliary system The elderly are usually the population that has a problem excreting drugs.

planning

Involves establishing goals and outcomes, prioritizes diagnoses and interventions, focuses on planning med administration and patient teaching!

treating the older adult

It takes more patience to teach this group. Visual and auditory impairments are common. "Older adult" is defined as someone over 65 years. The majority of medications in the US are given to people over 65. Polypharmacy is when patient's take multiple medications concurrently. It can easily result when a patient visits with multiple physicians or uses different pharmacies. Each MD or pharmacist may not be aware of all the drugs ordered by others. This increases the risk for interactions and side effects. With older adults, there are some predictable physiological and psychosocial ailments, but much variability remains There are more adverse drug events in geriatric patients than any other lifespan population. Adverse drug events in older adults are often related to degeneration of organ systems, multiple/severe illnesses, polypharmacy, unreliable compliance Reminder aids for administration may be used

nurse responsibilities

Know classifications, actions, and side effects of drug Know patient details and why drug was prescribed Know how drug is acquired and pharmacy procedures Know how to prepare and administer drug safely Before drug is administered, the nurse must know all variables of the patient's condition. Be prepared to recognize and react to adverse effects

limitations of the testing procedure

Limited information on women and children Failure to detect all adverse effects

schedule IV drugs

Lower abuse potential; lower potential for physical and psychological dependence Therapeutic use with prescription Examples include: Dextropropoxyphene, Pentazocine, Meprobamate, Diazepam, Alprazolam

schedule V drugs

Lowest abuse potential, lowest physical and psychological dependence Therapeutic use without prescription Examples include OTC cough medicines with codeine

schedule II-V drugs

May be dispersed only in cases where therapeutic value has been determined Some Schedule V drugs may be dispersed without a prescription.

goals for patients receiving medication

May be short-term or long-term Focus on what client will achieve or do, not what the nurse will do Should be patient-centered Discuss and involve the patient and/or caregiver are broad statements that describe a desired change in a patient's condition or behavior. Each _________ is time limited so the health care team has a common time frame for problem resolution. Example: "The patient will express relief from pain by day of discharge." Or, "Patient will be tobacco free within 60 days."

therapeutic index

Measure of a drug's safety Ratio of the drug's LD50 (average lethal dose to 50% of the animals treated) to its ED50 The larger/higher the therapeutic index, the safer the drug. The smaller/lower the therapeutic index, the less safe the drug. is the measure of a drug's safety margin The higher the value, the safer the drug Example: if a drug has a therapeutic index of 4, an error four times the dose would be needed to be lethal The lower the value, the more dangerous the drug. If a drug has a low index, it is a high-alert medication. The margin for optimal response vs. toxic response is often a decimal point.

schedule III drugs

Moderate abuse potential; moderate physical dependence; high potential for psychological dependence Therapeutic use with prescription Examples include Anabolic steroids, Codeine with aspirin or Tylenol, Hydrocodone with aspirin or Tylenol, Some barbiturates

therapeutic effect

Monitor for identified ______________ _________ Reassessing client: Physical condition Vital signs Body weight Lab values Serum drug levels Patient statements

plasma half life

Most common description of a drugs duration is ____________ ______ ______ (t1/2) You look at it to determine how long the drug will stay in someone's system. It helps to determine when you will have to administer medicine. It is the length of time needed to decrease drug plasm by one half. The greater it is, the longer it takes to excrete. Determines frequency and dosages of medications

absorption

Movement from site of administration, across body membranes, to circulating fluids Primary factor in determining the length of time for the effect of the drug to occur What are factors affecting drug absorption? It depends on how you received the drug (orally is slower than IV). Page 40. The size of the drug molecule is a factor in affecting absorption. The dose or the drug formulation affects the absorption. The route the drug is administered. The surface area of the absorption site. The digestive mobility affects the absorption of drugs. Blood flow matters with the absorption of drugs. The lipid solubility affects the absorption. If it is lipid soluble it will be absorbed quicker. Lastly, food or drug interaction can slow down the absorption of a drug.

diagnosis

NANDA nursing diagnosis vs. medical diagnosis; Nsg dx provide basis for establishing goals, outcomes, planning interventions, and evaluating effectiveness

examples of bioterroism

Nerve Agents (i.e. Chemical Warfare agents) Immediate Treatment: Give atropine injection Flush eyes with water Apply sodium bicarbonate or 5% liquid bleach solution to skin Do not induce vomiting Ionizing Radiation (i.e. Nuclear bombs) Immediate Symptoms of Acute Radiation Syndrome: Occur hours or days after exposure Nausea, vomiting, diarrhea

advantages to otc drugs

No health care provider appointment required Often less expensive than prescription drugs

regulated

Not all drugs with abuse potential are _______________! Examples include Tobacco, alcohol, and caffeine

pharmacotherapeutic

Nurses are expected to understand _____________________________ principles for all medications given to each patient.

basic supportive care for toxicity

One of the first elements of toxicity treatment Maintain airway, breathing, and circulation Proper blood glucose levels and arterial blood gases Treatment of any developing seizures Management of acid-base imbalances Agents may be used to facilitate removal of some toxins

spores

Other antibiotics that are effective with __________ Penicillin, vancomycin, ampicillin, erythromycin, tetracycline, and doxycycline

disadvantages to otc drugs

Patient may choose wrong drug. Patient may not know reactions or interactions. Ineffective treatment may result in progression of disease.

skills of a nurse dealing with dose

Patient observation Taking of vital signs Monitoring lab data

7 things to check

Pre-administration assessment- vital signs and check them out Dosage and administration- six rights of administration Evaluating and promoting therapeutic effects- knowing what the drug is going to do Minimizing adverse effects Minimizing adverse interactions Making PRN decisions- if the patient needs it you can give it to them but you have to assess them first Managing toxicity- know reverse

stages of new drug development

Preclinical testing Clinical testing: Phase I Phase II and III Phase IV: post-marketing surveillance

patient teaching

Primary role for nurses Directly related to Knowledge deficit Noncompliance Provide written material to patient Elderly and pediatric clients are special challenge May need to co-teach client's caregiver

antagonist

Produce their effects by preventing receptor activation of endogenous regulator and/or drugs Often compete with agonists for receptor

ciprofloxacin

Prophylaxis—500 mg PO, every 12 hours for 60 days Confirmed case—400 mg IV, every 12 hours

important properties of receptors

Receptors are normal points of control of physiologic processes. Under physiologic conditions, receptor function is regulated by molecules supplied by the body. Drugs can only mimic or block the body's own regulatory molecules. Drugs cannot give cells new functions. Drugs produce their therapeutic effects by helping the body use its preexisting capabilities.

drug selectivity

Receptors make selectivity possible. Each type of receptor participates in the regulation of just a few processes. Lock and key mechanism, but does not guarantee safety. Body has receptors for each: Neurotransmitter Hormone All other molecules in the body used to regulate physiologic processes the more selective a drug is the fewer side effects it will have

dietary supplement health and education act of 1994

Regulatory act for dietary supplements Less rigid than FDA: not required to be proven "safe", don't have to prove "effectiveness", and labels are not monitored for accuracy FDA does have power to remove products

to reach/maintain therapeutic response

Repeated doses of drug are given Drug accumulates in bloodstream. Plateau is reached. Amount administered equals amount eliminated.

disadvantages to prescription drugs

Require a prescription to obtain Need for health care provider appointment

schedule I drugs

Restricted to situations of medical necessity, if allowed at all Little or no therapeutic value; mostly used for research Examples include heroin, LSD, methaqualone

additional properties of drugs

Reversible Action Predictability Ease of Administration Freedom of Drug Interactions Low Cost Chemical Stability Simple Generic Name

six rights of safe delivery of meds to patient

Right patient Right medication Right dose Right route of administration Right time of delivery Right documentation

receptors

Special chemicals in the body that most drugs interact with to produce effects is a part of the cell to which a drug binds to produce its effects.

black box warning

Strongest safety warning a drug can carry and still remain on the market Purpose of this warning is to alert prescribers to: Potentially severe side effects (for example, life-threatening dysrhythmias, suicidality, major fetal harm) Ways to prevent or reduce harm (for example, avoiding a teratogenic drug during pregnancy)

parenteral

Subcutaneous (SubQ, SQ) injection Intramuscular (IM) injection Intravenous (IV) injection

herbs

Technically a botanical without any woody tissue such as stems or bark Meaning has changed to refer to any plant product with some useful application either as a food enhancer or a medicine Documented use for thousands of years

nursing process

The ______________ __________ is used to ensure safe, effective, and individualized medication administration and outcomes for patients.

development

The ____________________ of new drugs is an expensive and lengthy process, often requiring 10-15 years for completion. Rigorous procedures for testing have been established so newly released drugs might be both safe and effective. Although testing can determine effectiveness, it cannot guarantee that a new drug will be safe Significant adverse effects may evade detection during testing, only to become apparent after a new drug has been released for general use

implementation

The action part of administering medication; requires continued assessment and monitoring, and patient teaching!

relative potency

The amount of drug we must give to elicit an effect Rarely an important characteristic of the drug. Can be important if we lack of potency forexes inconveniently large doses. Implies nothing about maximal efficacy - refers to dosage needed to produce effects

reversible

The binding of a drug to its receptor is usually _____________ When a drug binds to a receptor, it will mimic or block the action of the endogenous regulatory molecules This will increase or decrease the rate of physiologic activity normally controlled by that receptor

The ED50 (aka: Median Effective Dose):

The dose that is required to produce a defined therapeutic response in 50% of the population. This can be considered a standard dose, and is frequently the dose selected for initial treatment. Subsequent doses must by "fine tuned" based on the patient's response ED50 in a patient may need to be increased or decreased after the patients' response is evaluated. The dose required to produce a therapeutic response can vary substantially among patients, because people differ from one another. It is not possible to predict how an individual patient will respond to a medication. Each patient must be evaluated to determine his or her own actual response.

maximal efficacy

The largest effect that a drug can produce Match the intensity of the response with the patient's need. Very high is not always more desirable. Don't hunt squirrels with a cannon. The largest effect that a drug can produce (i.e. the maximum degree of pain relief with drug A, when compared with drug B. One drug will have a greater maximal efficacy than another).

post marketing surveillance

The new drug is placed on market and surveyed for harmful effects in larger population FDA holds annual public meetings, and will withdraw a drug if serious problem found Nurses participate most in the drug approval process during the post-marketing surveillance period of Phase IV. All nurses administering medications monitor for therapeutic effects and adverse reactions from the drugs, and are responsible for reporting adverse reactions. This is a very lengthy process.

outcomes for patients receiving medication

The objective measures of a goal Should be specific and measurable Specifically define: What the patient will do Under what circumstance And within a specified timeframe are the specific, measurable criteria used to measure attainment of the selected goals. They are written to include: Subject (usually the patient) Actions required by the subject Under what circumstance The expected performance Specific time frame the subject will accomplish the performance Example: Patient (subject) will demonstrate the injection of enoxaparin (Lovenox; action required by subject), using the preloaded syringe provided (circumstance), given subcutaneously into the anterior abdominal areas (expected performance) one day prior to discharge (specific time frame).

medication reconciliation

The process of "keeping track" of a patient's medications as they proceed from one health care provider to another Many serious medication errors are tracked to this being poor lists all medications a patient is taking to reduce errors. these lists are checked over again when patients are moved to another unit Hospitals are encouraged to document complete lists when patient is admitted

metabolism

The process of converting the drug to a form that can be more easily removed or excreted. The liver is the primary site; kidneys and GI tract are others What are factors affecting metabolism? Liver insufficiency can affect the metabolism. Genetics, liver disease, infants, elderly.

stockpile

The strategic national __________________ is managed by the US Centers for Disease Control and Prevention (CDC). Important data for every nurse to know. Should a chemical or biologic attack occur, it would likely be rapid and unexpected, producing multiple casualties. The local community would be overwhelmed, and shortages of needed drugs, medical equipment and supplies would be needed. Strategic national stockpile addresses this concern.

administer

There are multiple ways to ______________ medications. This is one of your psychomotor tasks you will learn in Fundamentals. Know if your license or hospital allows you to administer through this route.

goldilocks effect

There are so many medications that do almost the same therapeutic action. But each medication dose with each patient is an experiment. Like Goldilocks, each patient needs a nurse who will work to get the results just right for that patient at that moment. No one dug is going to be perfect for everyone.

physiological

There are some ______________________ changes during pregnancy that impact pharmacotherapy: 1. Absorption of drugs -- Abdominal/gastric changes affect absorption; inhaled drugs may be absorbed faster 2. Distribution and Metabolism -- Changes in cardiac output, plasma volume, and regional blood flow change distribution and metabolism 3. Drug excretion rates may increase

pregnant patient

There are two patients during pregnancy: the nurse must consider the effects of the drug on both the mother and on the growing fetus. Some substances readily pass from mother to fetus through the placenta; others are blocked. In general, drugs that are water soluble, ionized, or bound to plasma proteins are less likely to cross the placenta.

dilute

There is a unique physiology to pregnancy: Blood volume, cardiac output increase. This may ____________ some medications so that higher doses are required. An example of this is seizure medications.

FDA pregnancy categories

These guide the health care team & patient in selecting drugs that are least hazardous for the fetus Testing drugs in human subjects to determine teratogenicity is unethical and prohibited by law Most drugs fall under category C

actions reassess

To monitor drug effects, you must know the ___________ of each medication... if you don't know, LOOK IT UP! In our reassessment, if no therapeutic effect was achieved, then we need to ______________ the need for that medication. Is there another medication that would work better? Would a different dose work better?

pharmacokinetics

To understand ____________________________, you also have to understand: How the body handles medication Actions and side effects of drugs Obstacles that a drug faces to reach target cells. The greatest barrier for many drugs is crossing many membranes. For example, in the enteral route, drugs are broken down by stomach acids and enzymes. The organs will attempt to excrete medicines. Phagocytes may attempt to remove medicines seen as foreign.

sentinel events

Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof Always investigated Interventions taken to ensure there is no repeat not all errors are these and not all events occur because of an error

anthrax bacillus anthracis

Used as part of bioterrorist attacks in 2001 Caused by Bacillus anthracis. Can cause serious damage to body tissues is the prototype infectious disease that we will study for this chapter. In the fall of 2001, 5 people died as a result of exposure to ___________. 13 US citizens were infected, including several governmental employees, and it affected the US postal service for several weeks. __________ _____________ normally affects domestic and wild animals (sheep, goats, horses, donkeys, pigs, antelopes) Can be transmitted to humans by exposure to an open wound, through contaminated food, or by inhalation Symptoms usually appear 1-6 days after exposure.

median lethal dose

Used to assess safety of a drug, and is determined in preclinical trials The does that will be lethal in 50% of group of animals Cannot be experimentally determined in humans

stephens johnson sydrome: potentially fatal

Usually within 1 to 14 days after therapy initiation Blister-like lesions

effectiveness safety selectivity

What is the big three of an ideal drug?

FDA

_______ is the Federal coordinator for reporting medication errors. _______'s Division of Medication Error Prevention and Analysis (DMEPA) is responsible for gathering and analyzing data from MedWatch, the NCC MERP and other patient safety organizations. DMEPA then makes recommendations such as changing product names or product labels that may be causing medication errors.

children

_____________ are another vulnerable population due to smaller dosages. ____________ receive their medication dosages based on weight, which increases the possibility of dosage miscalculations. The therapeutic dosages are also much smaller.

stockpile push package vendor

______________ consists of antibiotics, vaccines, and medical, surgical, and client supplies Designed to ensure immediate deployment of essential medical materials in case of biological or chemical attack _______ _____________—first component Supplies and pharmaceuticals for unknown chemical or biological threat. Arrives within 12 hours after attack ____________-managed inventory (VMI) package—second component Supplies and pharmaceuticals for specific chemical or biological agent. Arrives within 24 to 36 hours

environmental and community influences

age distribution, industrial growth, access to healthcare, literacy rate

minimum effective conception

amount of drug required to produce a therapeutic effect (have to get to this point to have any effect at all)

category x

animal and human studies have shown abnormalities. the drug is contraindicated in women who are or may become pregnant.

category B

animal reproduction studies have not shown a fetal risk or adverse effect. risks have not been confirmed in controlled studies with women

adverse drug reaction

any noxious, unintended, and undesired effect that occurs at normal drug does (WHO). Can be mild or life threatening.

assessment

baseline data, subjective/objective data, health history, physical assessment, self-care ability Table 6.1 Assessment Questions

medication error index

classifies medication errors (Figure 7.1) Nurses should know most frequent types of drug errors and severities of reaction Nurse should never administer a medication unless familiar with uses and side effects - PDAs now help with this categorizes medication errors by evaluating the extent of the harm an error can cause

gender influences

compliance, healthcare risk factors, body composition

category A

controlled studies in women fail to show a risk to the fetus and the possibility of fetal harm is unlikely

freedom of interaction

do not want another drug to interact

an effective drug

drug elicits the responses for which it is given. If the drug isn't effective, there is no reason to give it. US law requires that all new drugs be proved effective prior to their release for marketing.

a safe drug

drug is one that cannot produce harmful effects, even if administered in very high doses and for a very long time. All drugs have the ability to cause injury, especially with high doses and prolonged use. The chances of producing adverse effects can be reduced by proper drug selection and drug dosing, however the risk of adverse effects can never truly be eliminated.

a selective drug

drug is one that elicits only the response for which it is given. There truly is no wholly selective drug because all drugs cause side effects.

category c

either studies in animals have revealed adverse effects on the fetus and there is no controlled studies in women or studies in women and animals are not available

activated charcoal

given if poison is carbon based; molecules adhere to activated charcoal and minimize poison from being absorbed; greatest benefit 60 minutes after

chemical warfare agents

have been around since WWI, but few drug antidotes are available. Most were created to cause mass casualties; others designed to cause so much discomfort the soldiers would be unable to continue fighting. Nerve gases can cause paralysis of the neuromuscular junction, severe choking and vomiting, and/or severe blistering. Exposure can cause convulsions and loss of consciousness within seconds; respiratory failure within minutes Atropine is the treatment and works to increase the release of acetylcholine.

mechanism of action

identifies how the drug produces it physiological effect. i.e. lowers plasm a volume (R/T pharmacologic classification)

cultural and ethnic influences

influence beliefs and actions of patients in their medical decisions, dietary considerations, genetic differences in medication effects

preclinical investigation

involves laboratory research. Tests are done on animals to determine toxicity, pharmacokinetics, and possible useful effects. When sufficient data has been gathered, the drug developer may apply to the FDA for permission to begin testing in humans. If approved, the drug is awarded Investigational New Drug status

prototype drug

is a "drug model" that represents a class of drugs. i.e lorazepam (Ativan) = benzos

teratogen

is any substance that produces permanent abnormality in the structure or function of an embryo or fetus, causing growth retardation or death. Fortunately, the number of prescription drugs known/suspected of being teratogenic is relatively small.

generic name

is assigned by the U.S. Adopted Name Council A drug has only one of these names Less complicated and easier to remember Written in lower case, Example: diazepam In many cases, the final syllables of the generic name indicate a drug's pharmacologic class acetaminophen

drugs

is defined as any chemical that can affect living processes. Virtually all chemicals can be considered them then, but we only will focus on drugs that have therapeutic applications.

emergency preparedness

is not a new concept. In fact, nurses have been doing this for about 30 years. The Homeland Security and military coordinate drills with the acute care community. Disaster plans exist for natural disasters (as well as accidents) that could cause multiple casualties. Bioterrorism was most recently added in 1990s. Hospitals are now required to have disaster plans, and these plans have changed recently to include how a health care system might change during a crisis. Cooperation between different health care professionals is essential during a bioterrorist attack.

therapeutic classification

is one name used in classifying a medication that is based upon the usefulness in treating particular diseases or disorders. i.e. anticoagulant (influences blood clotting)

The DEA

is the agency responsible -- along with the Board of Medicine and Nursing in each state -- to regulate who, where, and what can be prescribed by independent licensed healthcare providers. Hospitals and pharmacies must register with _____, and must use an assigned registration number to purchase scheduled drugs Anyone convicted of unlawful manufacturing, distributing, and dispensing of controlled substances faces severe penalties.

duration of drug action

is the amount of time a drug maintains its therapeutic effect.

pharmacology

is the study of drugs and their interactions with living systems. This encompasses the study of the physical and chemical properties of drugs, as well as their biochemical and physiologic effects. Includes knowledge of the history, sources, and uses of drugs, as well as knowledge of drug absorption, distribution, metabolism, and excretion.

therapeutics

is the use of drugs to diagnose, prevent, or treat disease, or to prevent pregnancy. This is also referred to as the medical use of drugs. is our main concern, and as nurses, we need to understand: how drugs produce their effects (both therapeutic and adverse) The reasons for giving a particular drug to a particular patient The rationale underlying selection of dosage, route, and schedule of administration

nursing implications

lacking rigorous research patients may not see these as "drugs" Can reduce reliance on other "generalized" medications

toxic concentration

level of drug that will result in serious adverse effects

gastric lavage and aspiration

must be done within 60 minutes of ingestion; contraindicated if airway protective reflexes are lost

side effect

nontherapeutic reaction to a drug

peak plasma level

occurs when the medication reaches its peak.

enteral

oral

polypharmacy

patients using simultaneous drugs to help something

therapeutic range

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

clinical pharmacology

refers to the study of drugs in humans, which includes the study of drugs in patients as well as healthy volunteers (during new drug development).

pharmacologic classification

refers to the way a drug works at the molecular, tissue, or body system level. i.e Diuretic (lowers plasma volume)

religious and spiritual influences

refusal of medications, blood, surgeries

onset of drug action

represents the amount of time it takes to produce a therapeutic effect after drug administration.

ionizing radiation

results from hundreds of different radioisotopes that are created by nuclear explosion. Nuclear bombs are capable of mass destruction. The greatest number of casualties would be due to the physical blast itself, but survivors would be exposed to high levels of ionizing radiation Some of these radioisotopes can persist in the environment for years Treat patients with potassium iodine and isolate them until they are no longer radioactive.

psychosocial influences

socioeconomic factors, illicit drug use, lifestyle preferences

alternate first pass effect routes

sublingual rectal parenteral routes Oral medications are the only effective route that works with the first pass effect.

agents

syrup of Ipecac with induce vomiting with certain poisonings; contraindicated if the agent was caustic (drain cleaners) burn tissue again as they are vomited

clinical investigation

takes place in three different stages termed clinical phase trials This is the longest part of approval process (2-10 years), but evaluates human benefits Tests are done on healthy volunteers first (Phase I), then on patients with the target disease (Phase II and III) If results of clinical investigation are positive, even if precautions are noted, a New Drug Application is the next step. The average review time 17-24 months. If the drug is approved: process continues; if drug is rejected: process suspended

pharmacokinetics

the study of drug movement throughout the body

pharmacodynamics

the study of what drugs do to the body and how they do it is how drugs produce change in patients and helps predict the difference in patient responses to medications.

distribution

the transport of pharmacologic agents throughout the body. What are factors affecting drug distribution? The simplest factor determining distribution is the amount of blood flow to body tissues. Blood-brain barrier and fetal-placenta barrier: special anatomic barriers that prevent many chemicals and medications from entering Makes brain tumors difficult to treat Fetal-placenta barrier protects fetus; no pregnant woman should be given medication without strong consideration of condition.

category d

there is confirmation of human fetal risk, but the benefits from the use may be acceptable despite the risk

drug formulation variations

they are not the same and there are many variations

chemical name

uses the nomenclature of chemistry to describe its physical and chemical properties (relates to what is actually in the medicine) A drug has only one chemical name Can be complicated, difficult to remember and pronounce Drugs are sometimes classified by a portion of their chemical structure (chemical group name), which can become invaluable to nurses and students! Examples: Cephalosporins, phenothiazines, benzodiazepines N-acetyl-para-aminophenol

reversible reaction

want it to be reversed

bioavailability

what is available to be used by your body

documentation of medication administration

Administration of medication Therapeutic and adverse effects Client statements Objective assessment data Collection of subjective and objective data is needed to evaluate the effectiveness of the medication for the disease. It can be assumed that if it wasn't documented, it wasn't given!

bioterrorism

After 9/11 attacks, awareness of outbreaks and treatments expanded to include __________________ __________________ - intentional use of biologic agents, chemical substances, or radiation to cause widespread harm or illness. is essentially destruction of human life to make a point. Goal: to create public panic and to cause as many casualties as possible

Over the counter drugs

Drugs that can be purchases without a prescription Decision made by the FDA Just because a drug is available like this doesn't necessary mean the drug is considered "safe"

customized drug therapy

End of single-drug, one-size-fits-all policy DNA test before receiving drug Prevention of idiosyncratic responses (unpredictable and unexplained drug reactions) Pharmacogenetics: area of pharmacology that examines role of heredity in drug response

holistic approach to pharmacology

Identity Risk Factors: Age Genetics Biologic characteristics Personal habits Lifestyle Environment

5 common medication errors

Incomplete patient information Unavailable drug information Miscommunication of drug orders Lack of appropriate drug labeling Environmental distractions

NCC MERP

Index for categorizing medication errors