week 1 pharm
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Comprehensive practice flashcards reviewing core pharmacology topics from the transcript, including regulations, controlled substances, pharmacokinetics, safe medication administration, medication errors, and insulin safety.
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114 Terms
What does FDA stand for and what is its primary role?
Food and Drug administration. It regulates medication safety, effectiveness, labeling, manufacturing, and approval
What types of medication does the FDA regulate?
Both prescription and OTC medications
What are two actions the FDA can take when a medication has serious safety concerns?
It can require warnings or labeling changes and can require medication withdrawal
What is Med Watch used for?
It is a system used to monitor adverse drug events/reactions
What is a boxed warning?
The FDAs strongest warning for serious medication risks
What does the DEA stand for and what does it regulate?
Drug Enforcement Administration. It enforces federal laws involving controlled substances and regulates them based on their potential for abuse dependence and medical use
What are important nursing responsibilities regarding controlled substances?
Follow facility policies for storage, administration, documentation, and wasting of controlled substances
Which controlled substance schedule has high abuse potential and currently accepted medical use federally? Example?
Schedule 1; heroin
Which schedule includes medications with high abuse/dependence potential but accepted medical use? Example?
Schedule 2; morphine and fentanyl
Which schedule has lower abuse potential than schedule 1 and 2 and moderate dependence potential?
Schedule 3
Which schedules include diazepam and lorazepam?
Schedule 4
Which controlled substance schedule is the lowest category and may include limited amounts of certain narcotics?
Schedule 5
What does pharmacokinetics mean?
What the body does the the medication
What does ADME stand for?
Absorption, Distribution, Metabolism, and Excretion
What is absorption?
The movement of a medication from the site of administration to the bloodstream
What is the general order of medication absorption speed from fastest to slowest?
IV > IM?SC > oral/enteral
How does increased blood flow affect medication absorption?
Increased blood flow generally results in faster absorption.
How does surface area affect absorption?
A larger surface area generally results in faster absorption
Why does lipid solubility affect absorption?
Lipid soluble medications cross membranes more easily
Why must a medication dissolve before it can be absorbed?
Dissolution must occur before absorption can take place
How can vomiting, diarrhea, or altered GI motility affect oral medications
They can alter orla absorption
What other client factors can alter medication absorption?
Age, disease, and client factors
What is distribution?
The movement of medication through the bloodstream to tissues and the site of action
What factors can affect medication distribution?
Blood flow/ circulation, lipid solubility, body composition, and physiologic barriers
What does protein binding mean in relation to medication effects?
Only the free/unbound medication can leave the blood stream and produce effects
What can happen when a client's protein levels decrease?
There can be ,more free medication, potentially increasing medication effects and toxicity
What is medication metabolism?
The chemical alteration of medication into metabolites
Where does medication metabolism primarily occur?
In the liver
What are several possible results of medication metabolism?
Metabolism can inactivate a medication, activate a medication/ prodrug, make medication easier to excrete, or occasionally produce toxic metabolites.
Which route is the first pass effect most important for?
Oral medications
Describe the path medication takes during the first pass effect
GI → portal circulation → liver → systemic circulation
How can extensive liver metabolism affect an oral medication?
It can reduce the amount reaching systemic circulation, resulting in lower bioavailability
What is excretion?
The removal of medication or metabolites from the body
What is the primary route of medication excretion?
Kidneys
What are other routes of medication extraction?
Liver, GI tract, lungs, skin, breastmilk, and exocrine glands
What can happen when renal function decreases?
Medication may accumulate increasing risk of toxicity
What types of dysfunction can decrease medication clearance?
Kidney, liver, or heart dysfunction can decrease
What is half life?
The time required for the medication concentration to decrease by 50%
How can a short half life affect medication administration?
The medication may need to be given more frequently
How can a long half life affect medication administration?
The medication many only need to be given once daily
How can liver or kidney impairment affect half life?
It can increase half life and increase the risk of toxicity
What is therapeutic range
The blood concentration where the medication provides the desired therapeutic effect without causing toxicity
What is therapeutic drug monitoring?
Measuring medication levels in the blood
When is therapeutic drug monitoring especially important?
For medications with a narrow therapeutic window
What is a peak medication level
The highest medication concentration in the blood
When does the peak usually occur?
Usually after absorption is complete
Why is the peak level important?
It helps determine whether medication levels are becoming excessive or toxic
What is the trough level?
The lowered medication concentration in the blood
When is a trough usually measured?
Immediately before next dose
Why is a trough level important?
It helps determine whether the medication remain therapeutic between doses
What is onset?
When the medication begins producing a therapeutic effect
What is peak effect
The maximum therapeutic effect of the medication
What is duration?
How long the therapeutic effect lasts
What is bioavailability?
The amount or fraction of medication that reaches systemic circulation and is available to produce an effect
Why are IV medication essentially 100% available?
They enter the bloodstream directly
Why do oral medications generally have lower bioavailability than IV medications?
Because of incomplete absorption and the first pass effect
Name factors that can affect bioavailability
Route of administration, first pass metabolism ,age, weight body composition, GI function, blood flow, food, liver and kidney function, protein levels, medication formulations
How can low albumin/ protein levels affect a highly protein bound medication?
They can increase the free fraction of the medication, potentially increasing effect and toxicity
What are the 10 rights of medication administration?
Right client, medication, dose, route, time, assessment, documentation, refusal, education, evaluation
What is required for the right client?
Use two identifiers
What should the nurse verify before the right dose?
Calculation, concentration, weight, age, and condition
What should the nurse assess before administering a medication?
Allergies, vital signs, labs, contradictions, and interactions
When should medication administration be documented?
After the medication is actually administered
What should the nurse do if a client refuses a medication
Investigate the reason, notify the provider, and document
What should medication education include?
Medications purpose, benefits, administration, and adverse effects
What does the right evaluation require?
Assess the clients therapeutic response and adverse effects
When should the nurse perform the three medication checks?
When removing medication, during preparation, and at the bedside immediately before administration
What should be verified during the three checks?
Client, medication, dose, route, and time
What should the nurse do regarding allergies before administering medication?
Check for allergies
What should the nurse review before medication administration?
Relevant labs, vital signs and medication interactions
What should a nurse do with an unclear or incomplete medication order?
Verify the order
Why should interruptions and distractions be avoided during medication administrations?
To promote safe medication administration
SHould medication ever be left unattended at the bedside
No
What technology should be used when available to promote medication safety?
Barcode scanning
What should be followed for high alert medications
Facility policies for an independent double check
What is an important responsibility before administering any medication?
Know the medication before administering it.
What is the nurse's first priority after a medication error occurs?
Assess the client immediately
What should the nurse do after assessing the client following a medication error?
Take appropriate action to protect the client
Who should be notified promptly after a medication error?
The provider
Who else should be notified according to facility policy?
The charge nurse/ Supervisor
What type of report may need to be completed after a medication error?
An incident/event report
What should be documented in the medical record after a medication error?
Objective clinical facts
What should the nurse never do after a medication error?
Hide, alter, or falsify documentation
What is medication reconciliation?
Creating and maintaining the most accurate medication list possible and comparing it with new orders to prevent discrepancies and errors
When should medication reconciliation occur?
At admission, transfers between units/ facilities, changes in level of care, and discharge
What information should be verified for each medication?
Medication name, dose, route, and purpose
What types of medications and products should be included in medication reconciliation
Prescriptions, OTC meds, vitamins, and herbal supplements
What discrepancies should the nurse look for during medication reconciliation?
Omissions, duplications, interactions, incorrect doses, and other discrepancies
What should happen after discrepancies are identified?
Resolve the discrepancy, update the medication list, and communicate the reconciled list to provider
What should happen at discharge regarding medication reconciliation?
The client/ caregiver should receive education
Which groups are at high risk for mediation discrepancies/errors?
Older adults, clients with polypharmacy, clients taking insulin or anticoagulants
What does OTC mean?
Over the counter
What is an OTC medication?
A medication that does not require a prescription and is considered appropriate by the FDA for use without direct prescriber supervision when used according to label
Does OTC mean a medication is risk free?
No
Should ITC medications be included in medication reconciliation?
Yes
What is a prescription medication?
Medication that requires an authorized prescribers order
Why does prescription medication require professional oversight?
Because of potential risk, adverse effects, or the need for monitoring
What does off label use mean?
Using an FDA approved medication for a different indication, age group, route, or condition than the FDA approved labeling specifies
Does off label use automatically mean a medication is unsafe or illegal?
No
What should nurses do when administering an off label medication?
Follow the providers order and facility policy and understand reason for use