pharmacology

CO3

22-25

One-third of older adult patients report that they are often nonadherent with drug therapy. Which response is given most frequently for nonadherence?

"I didn't have my medicine with me." Thirty-one percent of older adult patients report that they did not take their medication because they did not have it on hand when it was time to take it

The nurse is teaching the patient about a newly prescribed medication. Which statement made by the patient would indicate the need for further medication education?

"If I take more, I'll have a better response."

Which statement by the patient would require more teaching prior to discharge?

"It doesn't matter if the medication works as long as the doctor prescribed it" indicates that the patient is not aware of how to monitor the drug's effectiveness or for its adverse effects, and more teaching is required.

As you enter the room to administer medication, the patient states, "I'm in the bathroom. Please leave the medication on my bedside table, and I will take it when I come out." Which would be the appropriate response?

"Let me know when you are ready, and I will then return with your medicine."

The nurse is teaching the patient about a liquid potassium chloride supplement. Which statement, if made by the patient, indicates that further teaching is necessary?

"Liquid preparations should not be diluted with other fluids."

It is time to give a 3-year-old oral medication. Which comment is most therapeutic?

"Would you like to take your medicine with water or juice?"

Pharmacology in practice (only NP, CNS, PMHNP, CRNA)

- Effective pharmacotherapy depends on nurses understanding of pharmacology - Understanding clinical to nursing practice -Importance to clinical nursing practice cannot be overstated -Most often the nurse is the connection between medication prescription and patients safe use of drug

factors that affect ADME

- Size of drug molecules- smaller past through membrane easier - Ionization of molecule- environmental pH effects absorption - Lipid solubility- highly lipid soluble drugs absorbed more rapidly than low lipid-soluble drugs

Clinical investigation

- Takes place in four different stages termed clinical phase trials - Longest part of approval process - Evaluates human benefits - Tests on healthy humans first, then on those with the target ailment

controlled substance act

- hospitals and pharmacies must register with DEA - must use an assigned number to purchase scheduled drugs - must maintain records of all quantities purchased and sold

Hypotonic

- less tonicity than blood; fluid shifs from ECF to ICF; dehydration treatment

proprietary

- own patient for up to 7 years allows monetary benefit from investing in drug research

Adverse Drug Reactions

-(noxious, unintended, undesired effect that occurs at normal drug doses) -More common in very young and over 65 (50%) -More common with chronically ill and polypharmacy (the use of multiple drugs to treat single ailment)

Which of the following nursing actions should be included in the care plan for a patient receiving normal serum albumin (Albuminar)? (Select all that apply.)

-Document past history of blood transfusion reactions. -Monitor blood pressure and pulse rate. -Measure urinary output hourly

Older adults experience adverse effects more frequently than young adults due to which of the following? (Select all that apply.)

-Excessive prescribing -Multiple-drug therapy -Increased drug sensitivity

Which of the following is considered a gender factor that may influence effective pharmacotherapy? (Select all that apply.)

-Fat-to-muscle ratio -Cerebral blood flow -Limited drug research on females -Health beliefs

When discussing drug use during pregnancy with a group of nursing students, the main topic is the FDA pregnancy drug classifications. The FDA's newly revised Pregnancy and Lactation Labeling Rule (PLLR) will include: (Select all that apply.)

-Helpful information about a medication's risks to the expectant mother, the developing fetus, and the breastfed infant. -Updated information about lactation and the potential for drug effects in the infant. -A subsection that will provide information about pregnancy testing, birth control, and a medication's effect on fertility.

Black box warnings

-Identified special problems and extreme drug reactions -Strong safety warning for drug still on market, alert prescribers to potential harm such as life threatening dysrhythmias, suicidality, and fetal harm and ways to reduce risk

Rights of Medication Administration

-Monitor clients condition before and after use -Seek specific information from clients about OTC/ illicit drug use -Evaluate drug effects -Cost, side effects -Conduct medication reconciliation

Considerations of drug use in pregnancy

-Most drugs cross placenta and secreted in breast milk -Most drugs cause harm in third trimester -90% pregnant take at least one drug during pregnancy -80% take one drug during 1st trimester

Toxicity

-Physiological effects caused by excessive drug dosing -Respiratory arrest, overdose of morphine, severe hypoglycemia, overdose of insulin -Could occur with standard dosing like neutropenia -Abnormalities in drug metabolism and excretion can also lead to increased drug levels

Which factor(s) is/are true regarding the pharmacokinetics in the pediatric population? (Select all that apply.)

-Slower gastric motility in young children will keep the drug in the stomach longer. -Before age 5, the liver may not metabolize drugs as readily as an adult's liver and doses must be adjusted accordingly.

The nurse is monitoring the therapeutic drug level for a patient on vancomycin (Vancocin) and notes that the level is within the accepted range. What does this indicate to the nurse? (Select all that apply.)

-The drug level is appropriate to exert therapeutic effects. -The nurse will need to continue monitoring because each patient response to a drug is unique.

While seeing a postpartum mother who is breastfeeding her 3.2-kg (7-lb) infant daughter, which of the following statements, if made by the mother, indicates that further teaching is necessary? (Select all that apply.)

-When using over-the-counter medication, I should take only the lowest effective dose." -I shouldn't take any drug during breastfeeding, even my prescriptions." -"Medication in liquid form should be avoided since it more readily enters the breast milk."

PK in pregnancy absorption

-effected by estrogen altering absorption -Pressure on the abdomen may slow gastric emptying. -Progesterone increases pulmonary blood flow leading to increased levels of respiratory drugs.

At which stage of fetal development are congenital malformations least likely to occur?

1 to 2 weeks

CO2

35-45

PH

7.35-7.45

Which patient characteristics, if noted in the patient's medical record, should you consider important information that may affect the physiologic response to various types of drug therapy? (Select all that apply.)

82-year-old and female Asian and obese Past medical history of kidney disease Mother and sister with diabetes

The nurse is caring for several patients. Which patient will the nurse anticipate is most likely to experience an alteration in drug metabolism?

A 3-day-old premature infant

Bioavailability

A measure of the extent of drug absorption for a given drug and route (from 0% to 100%).

While completing an initial home assessment of an independent 82-year-old woman recently diagnosed with type 2 diabetes mellitus managed with insulin injections, what action is most appropriate for insulin administration for this patient?

A patient who is functioning independently in all ADLs should be encouraged to take full responsibility for self-administering medications Instruct the patient how to administer the insulin.

prototype drug

Agent to which all other medications in a class are compared Single drug from each class May compare all other medications in the class to the prototype Usually oldest and best understood drug Can be combination of traditional and new drugs

While researching a new drug prior to administration, you see that the drug handbook states that the adverse effects are "dose related," which means that:

As the dose increases, the risk of adverse effects also increases.

Prior to the administration of an antibiotic, the patient informs you that 4 years ago he experienced an allergic reaction. Based on this information, what should you do first?

Ask the patient to describe the reaction further.

In initiating holistic care with a patient who has chronic headaches, which action would the nurse take?

Ask the patient what he or she believes may be contributing to the problem. The nurse understands that multiple contributing factors may contribute to illness and involving the patient helps elicit possible factors.

While administering medication to several patients, you suddenly realize that the wrong medication has been given to a patient. Which would be the first priority action taken?

Assess the patient in order to monitor for adverse effects.

Risk management strategies/considerations

Assessment, planning (verify identity, calculate dose correctly , implementation (confirm patient can swallow, open medication right before giving, record eMAR immediately after administration, evaluation (assess for expected outcomes and ADRs

Which is the most effective method for a nurse to recognize patient-specific genetic influences?

Be cautious with all drugs and observe for individual patient responses.

water in body

Body is 60% water in adult water is found in extracellular fluid, intracellular fluid, interstitial fluid

The patient asks the nurse, "Why are dietary supplements so popular?" The nurse's answer is based on which factors? (Select all that apply.) Herbal supplements:

Can now be purchased in virtually all supermarkets. Are aggressively marketed by the herbal and supplement industry. Cost less than prescription medicines. Appeal to the aging population

Pregnancy Risk Categories

Categorized A safest to X poses most danger A- remote risk of fetal harm B- slightly more risk, animal studies show fetal harm risk C- greater risk, animal studies show fetal harm risk D- proven risk of fetal harm, statement in warning area X- definite risk of fetal abnormality

While using a drug handbook to determine the indications for the drug furosemide (Lasix). The term indications is defined as the:

Conditions for which a drug is approved.

A mother calls the urgent care center and frantically tells you that her toddler drank a bottle of cleaning fluid. Which of the following is the priority instruction that should be given to the parent?

Contact the poison control center.

A patient of Native American descent states, "I will only take medications that are approved by the Shaman." The nurse understands that this statement reflects the patient's:

Cultural beliefs refer to the cumulative ideas of knowledge, experiences, values, attitudes, meanings, and roles acquired by a group of people.

The patient will be receiving 5% dextrose in water (D5W ) intravenous infusion. Which statement is correct about this therapy?

D5W may be used to dilute mixed intravenous drugs

When observing a patient for bone marrow toxicity, you should monitor for:

Decrease in red blood cells, white blood cells, and platelets.: The function of the bone marrow is to produce blood cells. When drugs cause bone marrow toxicity, the condition manifests as a decrease in all blood cell types

Which age-related change in the older patient makes it necessary to reduce drug dosages?

Decrease in renal blood flow: In the older adult, kidney blood flow decreases and excretion of drugs also decreases, requiring dosage or frequency adjustments for many drugs

The healthcare provider orders intravenous magnesium sulfate for a pregnant patient with preeclampsia. The nurse should consult with the prescriber about which patient assessment finding that may affect the drug therapy?

Decreased patellar deep tendon reflexes

The nurse is administering dextran 40 (Gentran 40) to a patient with multiple traumatic injuries following a motor-vehicle crash. The nurse knows that which adverse effect of this medication is toxic?

Dextran 40 interferes with coagulation and reduces blood viscosity. Bleeding, potentially severe, is associated with these effects

first pass effect

Drugs absorbed form the stomach and small intestine travel to the liver, where they may be inactivated before reaching target organ(s)

drug absorption

Drugs are absorbed faster from areas of the body where blood flow is high. IM injections are placed into large muscles because they have a high blood flow that maximizes absorption.

Drugs that are most likely to create drug interactions in pediatric patients are those with:

Extensive protein binding.

While in the clinic, you note that multiple patients had a reaction to the same medication, a drug that has been available for several years. Which action should you take? (Select all that apply.)

File an Adverse Event Report with the FDA. Note the reaction in the patient's chart. Notify the healthcare provider who ordered the drug.

true events

Food decreases the absorption rate of most drugs. Patients should always consult a healthcare provider if unexpected adverse effects develop

While counseling a patient on a medication taken daily which strategy should be included that might prevent a medication error?

Have all prescriptions filled at one pharmacy.

A patient asks why all healthcare providers do not rely on complementary and alternative medicine. When talking to this patient, the nurse knows that many complementary and alternative therapies:

Have not been subjected to rigorous clinical studies.

A pregnant patient asks what factors determine if a drug will cross the placenta. Your response will be based on which of the following principles?

Highly lipid-soluble drugs cross the placental membrane more easily than low lipids.

Pharmacologic classification

How the drug acts Mechanism of the drug or how the drug produces its effect in the body More specific than therapeutic classification Requires understanding of biochemistry and physiology May use drugs chemical name

The experienced pediatric nurse is teaching a new nursing student about injections in the pediatric population. Which statement by the student would indicate that teaching was effective?

Intramuscular (IM) injections in infants are absorbed slowly." IM injections in infants are absorbed slowly due to low blood flow to skeletal muscles.

Preclinical investigation

Involves laboratory research Tests done on cells and animals Determines drug-dose range Examines adverse effects Results considered inconclusive

Various psychosocial variables may influence nonadherence to pharmacotherapy. An example of this would occur when the patient reports that the prescribed drug:

Is too expensive for the patient to afford

In reviewing the patient's medication record, the nurse does not recognize the medication, filgrastimsndz (Zarxio). Consulting a drug guide, it is listed as a "biosimilar" to filgrastim (Neupogen). Which of the following best describes the definition of a biosimilar drug?

It is a drug that is derived from living cells, such as yeast, and has comparable effectiveness and safety to the reference product drug.

Polyherbacy may be of concern in the older adult population. A pharmacokinetic factor for this concern is that the older adult:

May have age-related changes in liver or kidney function.

A patient is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. Which statement made by the patient indicates to the nurse that patient education has been successful?

Medicines taken by inhalation produce a very rapid response."

Symptoms of allergic reactions

Mild reaction: drowsiness, nausea, pruritus,rash Severe reaction: Hepatocellular injury, cardiac dysrhythmias, neutropenia, anaphylaxis, and hemorrhage

Post-marketing surveillance

Monitor for therapeutic effects and adverse reactions from the drugs Reporting adverse reactions Be aware of drugs that have been recalled or reported dangerous FDA holds annual public meetings FDA will withdraw a drug if serious problem found

As a member of an interprofessional team, what key responsibilities does the nurse have to ensure effective pharmacotherapy? (Select all that apply.)

Monitoring the patient's condition before and during pharmacotherapy Teaching the patient about self-administration and any required monitoring of drug effects Frequently conducting a medication reconciliation to verify current medications in use

Hypernatremia

Most common cause - water loss - Early symptoms include thirst, weakness, nausea, and loss of appetite - Severe Symptoms = Altered Mental Status (AMS), muscle twitching + bleeding ir or around brain

Contributing factors

Most common is human factors but Error in patient assessment, inaccurate prescribing, errors in administration, most errors involve one branch of five rights of medication administration Right patient, drug dosage, route, and time

Pharmacokinetics in pregnancy

Most drugs are contraindicated during pregnancy because of their possible adverse effects on the fetus. Drugs known to cause developmental defects are called teratogenic drugs.

passing preclinical

Most potential drugs do not proceed past the preclinical research stage because they are either too toxic or simply not effective. The FDA does not regulate preclinical testing.

A patient with myasthenia gravis has been receiving neostigmine, a cholinergic agonist, for the past 2 years. The nurse is ready to administer benztropine, a cholinergic antagonist. Which result will likely occur when these drugs are combined?

Neostigmine will exhibit a lesser effect: Antagonists bind to receptors and block the effects of an endogenous chemical or another drug by competing with receptor binding sites or inhibiting the drug effect.

What parameters would the nurse use to determine whether the average dose of a medication is effective for a patient? (Select all that apply.)

Physical examination Vital signs Laboratory values Efficacy

When considering pharmacodynamic principles for a patient's drug therapy, the nurse is aware that affinity for a receptor is most closely associated with a drug's:

Potency: Potency is a reflection of a drug's ability to bind to a receptor.

The healthcare provider knows that the pediatric patient and parents will most likely adhere to the medication regimen if the:

Regimen is simple and inexpensive.

It is 2:45 a.m. and the nurse has telephoned the prescriber to report that the patient is experiencing an acute episode of postoperative pain. How can the nurse avoid medication errors when receiving a telephone order from a prescriber?

Repeat the order verbally to ensure accuracy. is critical for the nurse to repeat the order verbatim to the prescriber.

Hyponatremia

SLOWLY correct sodium levels o Too-rapid can cause osmotic demyelination syndrome (ODS) - brain damage

Why would a manufacturer provide additional timeconsuming (and expensive) testing to the FDA so its product could be classified as an interchangeable product instead of a biosimilar?

So that the pharmacist could substitute a biosimilar product for the reference product.

Fluid deficit (dehydration) findings and assessment

State of diminished water volume, deficient of intracellular fluid, causes cells to shrink, decreased amount of water in extracellular fluid

Which health teaching concept should be included in the instructions for a patient taking echinacea?

Take the smallest amount possible when starting herbal therapy.

The nurse cannot read the number of milligrams (mg) to be administered in a drug order written by the healthcare provider. The nurse cannot determine whether 125 mg, 1.25 mg, or 12.5 mg should be administered. What action would be most appropriate to prevent a medication error?

Telephone the healthcare provider about the illegible medication order.

While reviewing a drug manufacturer's package insert, the nurse reads about the dose-response curve. The purpose of the dose-response curve is to illustrate the relationship between:

The amount of a drug administered and the degree of response it produces.

preclinical trail

The goals of this extensive testing on cells and in animals are to determine drug action and to predict whether the drug will cause harm to humans.

chemical name

The name that describes the chemical composition and molecular structure of a drug.

A patient is known to have a genetic variant that causes slow acetylation. If this patient must start on isoniazid (INH), a drug that is metabolized by acetyltransferase, what is a likely outcome?

The patient will be more prone to drug toxicity.

The patient is receiving a medication that causes hepatotoxicity. What symptoms would alert you that this drug-related toxicity has occurred?

The presence of right upper quadrant pain and anorexia are early symptoms often associated with drug-induced liver damage.

Pharmacokinetics

The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. ADME

The patient with a disorder causing metabolic acidosis is being treated with intravenous sodium bicarbonate. The nurse monitors for therapeutic effectiveness by noting which laboratory values?

The serum pH is a measure of alkalinity or acidity in the blood. The administration of bicarbonate neutralizes acidic conditions and causes the patient's serum to become more alkaline.

Most frequent causes of medication error

Top 5 high alert medications by ISMP- insulin, opiates, intravenous potassium, intravenous anticoagulants, sodium chloride solution

topical drugs

Topical drugs placed on the skin have slow absorption due to the poor blood supply to the upper layers of the skin

The nurse is teaching at a community wellness seminar when one participant asks, "How can I be sure that my herbal supplement is pure?" Which of the following labeling marks indicates that the product meets acceptable standards of purity?

USP-verified dietary supplement markay have age-related changes in liver or kidney function.

On physical examination, you observe raised hivelike welts covering the patient's trunk and arms. The patient also reports intense itching after receiving a new medication. You will document which dermatologic adverse effect?

Urticaria or hives

When given a medication, the patient states, "I've never seen this pill before. It's not like the others I take." Which would be the most appropriate action to take?

Verify the order and double-check the drug label.

A patient in her first trimester of pregnancy asks which medications should be avoided during pregnancy. Your response is based on the knowledge that during pregnancy:

When possible, drug therapy is postponed until after pregnancy and lactation.

trade name

a commercial, legal name under which a company does business

concordance

agreement between you and doctor about how and when to take drug

Metabolism PK in pregnancy

altered d/t increased cytochrome p450

Tonicity

amount of solute in solution compared with amount in blood

Sentinel event

an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof

The patient requests that a refill prescription of a Schedule II controlled substance be telephoned to the drug store. When responding to the patient, you would consider which factor? Refills of Schedule II drugs:

are not permitted under federal law Schedule I — drugs with a high abuse risk. These drugs have NO safe, accepted medical use in the United States. Some examples are heroin, marijuana, LSD, PCP, and crack cocaine. Schedule II — drugs with a high abuse risk, but also have safe and accepted medical uses in the United States.

Parenteral

by injection

Combination drug-

contains more than one active generic ingredient

The patient is receiving multiple medications, including one drug specifically used to stimulate gastric peristalsis. The nurse knows that this drug could have what influence on additional oral medications?

decreased absorption

enternal route

delivery of a medication through the gastrointestinal tract

The governmental drug legislation requires the drug manufacturer to prove that a drug is both safe and:

effective for a specified purpose

selectivity in drugs

elicit only intended response

Routes of Administration

enteral, parenteral, topical

In 1992 and in 2012, legislation was passed to allow the FDA to speed up the review and approval of drugs intended to treat serious conditions. When would the following accelerated review processes be applicable

fast track

Hypertonic

greater tonicity than blood; 3% NaCl or IV mannitol; fluid shifs from ICF to ECF; decreased swelling, especially cerebral edema

A drug that is being prescribed "off-label" means that the drug:

has FDA approval for one use but is being prescribed for another purpose

Hyperkalemia

high levels of potassium in the blood, more then 5.2 numbness or tingling muscle cramping, diarrhea, apathy, mental confusion, peaked t waves

The nurse is caring for a patient with hepatitis and resulting hepatic impairment. The nurse would expect the duration of action for most medications to:

increase: Patients with hepatic impairment do not effectively metabolize drugs, which increases the duration of action

PK in pregnancy distribution

increased blood volume can lead to fewer plasma proteins available to bind to drugs leading to higher concentration of "free drugs" with HR for toxicity

excretion PK in pregnancy

increased blood volume r/t hemodilution may increase medication loss - need higher dose of med also increased renal blood flow, GFR, decreased BUN, Cr

Hypernatremia

increased sodium above 145 increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give hypotonic solution.

Therapeutic index

is the ratio between the therapeutic dose of a drug and the toxic dose and is used as a measure of the relative safety of the drug. The higher the therapeutic index, the safer the drug

Managing fluid balance and fluid replacement

isotonic , hypertonic and hypotonic solutions to balance fluid

Hypokalemia

low potassium less than 3.5 anorexia, sluggish bowel, hypotension, (slow symptoms) respiratory alkolosis slow pulse rate, bradycardia slow heart rate

Hyponatremia

low sodium in the blood less then 135 altered mental status headache, lethargy,apathy, muscle cramps and spasms Severe hyponatremia is less than 125

generic name

name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name

The drug research participant with a particular disease is taking part in an investigative study to examine the effects of a new drug. Previously, this drug was tested using healthy volunteers. The next phase of the clinical trial investigation in which the patient will be participating is:

phase 2

Requirements for participation in trials

preclinical investigation, clinical investigation, review of new drug application, post marketing surveillance

The nurse knows that a drug with a high therapeutic index is:

probably safe

hydrostatic pressure

pushing force exerted by water in the bloodstream. hearts pumping action is source of hydrostatic pressure Exerts outward force that pushes water through the capillary membrane pores into the Interstitial and intracellular compartments.

Onset of drug action

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

FDA establishment and role

requires all drugs to be effective before releasing require that it doesnt have any harmful effects adverse drug reaction can be elminated but not reduced

topical route

skin, eyes, ears, nose, lungs, rectum, vagina

adherence

taking medication as prescribed

plasma half life

the length of time required for the plasma concentration of a drug to decrease by one half after administration. Some drugs have a half-life of only a few minutes, whereas others have a half-life of several hours or days.

A research nurse is discussing the of a drug with the other members of the investigation team. On which of the following would the discussion focus?

toxicity This information indicates the dose that will produce a given toxicity in 50% of a group of patients.

Classifcation of drug

what condition is being treated by particular drug

Which patient is most likely to experience drug toxicity while taking dietary supplements?

An 80-year-old with cirrhosis,

Which of the following would indicate a therapeutic classification?

Antihypertensive

scheduled drugs

Drugs considered to have a risk for potential adverse side effects, abuse, or dependency 1 is highest 5 is lowest

Before prescribing medications to a patient who is 32 weeks pregnant, you must consider the following normal physiologic principles associated with pregnancy that will affect drug absorption?

Drugs remain longer in the gastrointestinal tract, leading to extended time for absorption.

membrane

Electrolytes and water move through the cell 'is semi-permeable plasma membrane, but large proteins such as albumin can't pass through. The semipermeable membrane allows some molecules through pores and obstructs others based on size.

Nursing responsibilities

Eliminate medication errors Limit number and severity of adverse drug events Incorporate knowledge updated as lifelong process

The patient is receiving a medication that may cause nephrotoxicity. To decrease the risk of this adverse reaction, the nurse should encourage the patient to:

Increase fluid intake to promote adequate hydration.

In general, drug absorption in the older adult is somewhat slowed. What physiologic changes may account for this? (Select all that apply.)

Increased gastric pH Decreased rate of blood flow to the GI trac

Calcium alkalosis ph down

◦Alkalosis (↓pH ) ◦With fewer H+ to compete for binding sites more calcium binds to albuminà ↓ free, ionized forms of Ca++ = hypocalcemia

calcium acidosis ph goes up

◦H+ compete with Ca++ for binding sites on albumin à ↑ free, ionized forms of Ca++ = hypercalcemia

Potassium Alkalosis

◦in the bloodstream, the decrease H+ can cause K+ to shift into the cells = ↓ K levels (Hypokalemia) ◦In the kidneys, the decrease in H+ can lead to more excretion of K+ = ↓ K levels (Hypokalemia)

Potassium Acidosis

◦in the bloodstream, the excess H+ then moves into the cell and resulting in K+ move out of the cell into the bloodstream = ↑K levels (Hyperkalemia) ◦In the kidneys, the excess H+ is selectively excreted instead of K+ = ↑K levels (Hyperkalemia)