NUR 325 Exam 1

Generic names for drugs

name given by the company who developed the drug; not capitalized

Brand names for drugs

drugs commercial name; capitalized

Forms of oral medication

Tablet, capsule, powder, liquid

Rate of oral medication absorption (from quickest to slowest)

liquid, suspension, powder, capsule, tablet, coated tablet, enteric coated tablet

Ways a drug can be delivered parenterally

Intravenously, intramuscular, subcutaneously

What is the most rapidly absorbed drug route

intravenously

Absorption

movement from administration site to various tissues

Factors that affect absorption

Administration route of the drug, food or fluids administered with the drug, dosage formulation, status of the absorptive surface, rate of blood flow to the small intestine, acidity of the stomach, status of GI motility

first pass effect

as the drug passes through the liver some of the drugs effect is deactivated

Factors that affect distribution to different parts of the body

Blood supply, barriers

Metabolism

a change in the drug that may make it more or less potent, soluble, or inactive

where does metabolism primarily take place

liver

Half-life

the time it takes for a drug to decrease in amount by half; affected by liver and kidney function

What must be considered about drug levels in the body if a patient has decreased liver and/or kidney function?

drugs may build up in the body or not be metabolized

Onset

amount of time to demonstrate a therapeutic response

Peak

amount of time to achieve a full therapeutic effect

Duration

Amount of time the drugs therapeutic effects last

Peak levels

the point in time when the medication is at the highest level

trough levels

the point in time when the medication is at the lowest level

When are peak and trough levels important

when you are administering drugs that you must maintain at a therapeutic level in the blood in order for it to be effective

Pharmacokinetics

how medication is moving and working in the body

Pharmacodynamics

the biochemical changes that occur in the body as a result of taking a drug

Adverse drug reactions

occur when a medication is given at the appropriate dose and non therapeutic, unintended, predictable or unpredictable affects occur that can vary in severity

Therapeutic effects

why we are giving a patient a specific medication; one medication can have multiple therapeutic effects

Off label

Using a drug not for the FDA approved reason but another known reason for use

Most severe adverse drug reactions

anaphylaxis

Tolerance

the body's decreased response to a drug over a period of time or repeated use

Cumulative effect (drug sensitivity)

occurs when the body is unable to excrete an existing dose of medication before another dose is administered; may be caused by a metabolic change in the liver/kidney

Toxicity

Excessive doses result in a negative physiologic effect; can be a result of impaired drug excretion/metabolism; important to monitor drug serum levels; may cause irreversible damage; potentially life threatening

Precautions

only use the drug when the benefits outweigh the risk

Contraindications

the potential to cause a serious or life-threatening adverse drug reaction in relation to a specific factor

drug-drug interactions

one drug changes the way another drug affects the body

Additive effect

drugs both work the same together

synergistic effect

drugs work together and make effects more

antagonistic effect

drugs work against each other making effects less

Teratogenic

can cause fetal abnormalities

What physiological factors are important to consider when administering drugs to the aging patient?

aging affects absorption, distribution, metabolism, and excretion of drugs, and may necessitate an adjustment in dosage in older adults

Stress

can be defined as the mental, emotional, or physical response and adaption to real or perceived changes and challenges, can also be defined as a condition in which the body responds to changes affecting its normally balanced state

Physiological/Psychological effects of stress

fight or flight response, general adaptive syndrome (alarm stage, resistance stage, exhaustion stage), decreased immune response

Non-pharmacological interventions to stress

promote effective coping, health, and well-being, maintaining good health and proper nutrition, regular exercise, positive personal relationships and social support networks, preserving positive self-esteem, learning effective preventative coping strategies

Coping strategies

problem-focused coping, emotion-focused coping, meaning-focused coping

Problem-focused coping

treatment

Emotion-focused coping

journaling/meditation

Meaning-focused coping

values/beliefs

Assessment strategies for a client experiencing acute stress

surveys to patients, talking with patients

Defense mechanisms

denial, rationalization, projection, repression, regression, compartmentalization

Denial

refusal to acknowledge or accept reality to avoid the emotional impact

Rationalization

Justify or explain undesirable behaviors to avoid emotional discomfort or save face

Projection

attribute negative or uncomfortable thoughts, feelings, or motives onto someone else

Repression

Conceal unpleasant or painful thoughts, memories, or beliefs in hopes of forgetting about them entirely

Regression

Movement back to a more comfortable developmental time in life

Compartmentalization

Categorize life experiences into segments to avoid facing the anxieties while in that mindset

Factors that can alter a client's stress level

problems with interpersonal relationships, strained family relationships, financial strain, occupational stress, food insecurity, caring for someone with a terminal illness, significant injury or illness, ineffective coping, maladaptive coping

Pain

whatever the experiencing person says it is, existing whenever he says it does; an unpleasant sensory and emotional experience associated with actual or potential tissue damage

Acute pain

sudden, lasting less than 3 months, mild to severe, usually identifies with a precipitating event, decreases overtime and goes away as recovery occurs

Manifestation of acute pain

increase heart rate, respiratory rate, BP, diaphoresis, pallor, anxiety, agitation, confusion, urine retention (sympathetic nervous system)

Chronic pain

gradual or sudden, lasting longer than 3 months, mild to severe, cause may be unknown, typically pain does not go away

Manifestations of chronic pain

flat affects, decrease physical activity, fatigue, withdrawal from social interaction

Effects of untreated pain

fear, anger, depression, anxiety, difficulty maintaining relationships, suicidality, opioid disorder

Nociceptive pain types

somatic, visceral, cutaneous

Nociceptive pain pathway

transduction, transmission, perception, modulation

transduction

noxious stimuli causes cell damage with the release of sensitizing chemical, these substances activate nociceptors and lead to generation of action potential

transmission

action potential continues from site of injury to spinal cord to brainstem and thalamus to cortex for processing

perception

conscious experience of pain

Modulation

neurons originating in the brainstem descend to the spinal cord and release substances to regulate pain levels

Neuropathic pain

somatic sensory; pins and needles

mixed pain syndromes

nociceptive and neuropathic

gate-control theory

non painful irritating stimulation can decrease pain

Risk factors for experiencing pain

infants and children, older adults, gender (women report more chronic pain and lower pain tolerance), social factors, cultural/religion, clients who have substance abuse disorders, chronic conditions, acute or traumatic injury, medical procedures

Pain assessment (patient self-report)

location, intensity, quality, onset and duration, alleviating and relieving factors, effect of pain on function and quality of life, comfort and functional goal

Pain scales

faces, 0-10

Interventions to effectively manage pain

massage, positioning and body alignment, splinting, thermal interventions, mind-body therapies, exercise, transcutaneous electrical nerve stimulation, acupuncture

Pharmacological interventions for pain

review provider order for analgesia, schedule pain interventions as needed, be proactive (it takes less medication to prevent pain than to treat pain), instruct clients to report recurring pain, help client reduce fear and anxiety, create a treatment plan that includes both non-pharmacological and pharmacological measures

Aspirin therapeutic use

inflammation suppression, analgesia for mild to moderate pain, fever reduction, dysmenorrhea, inhibition of platelet aggregation

Aspirin adverse drug reactions

gastric upset, heartburn, nausea, gastric ulceration, bleeding, kidney dysfunction, salicylism, Reye's syndrome, thromboembolic events

Aspirin nursing interventions

monitor signs of GI bleeding, test and treat helicobactor pylori prior to long term therapy, recommend proton pump inhibitor for gastric bleeding, monitor for signs of bleeding, monitor I & Os, monitor rapid increase in BUN and creatinine, monitor for tinnitus, diaphoresis, headache, dizziness, and respiratory alkalosis, recommend acetaminophen for children with viral infections, monitor for signs of MI and CV accident

Aspirin administration

swallow enteric-coated or sustained-release forms whole do not crush or chew

Aspirin client instructions

take with food, milk, or 8 oz of water, avoid alcohol, report gastric irritation and signs of bleeding, report any unusual or prolonged bleeding, report changes in urine output, weight gain, origins of fluid retention such as edema or bloating, report ringing or buzzing in ears, sweating, headache, and dizziness, do not give to children with viral infections, report chest pain or heaviness, shortness of breath, take low dose aspirin once daily to reduce risk of MI or stroke

Aspirin Contraindications

teratogenic, hypersensitivity, peptic ulcer disease, bleeding disorders, children with viral infections, preoperative use prior to coronary artery bypass grafting, quit 1 week before elective surgery

Aspirin precautions

older adults, cigarette smoking, alcohol use disorder, helicobacter pylori infection, heart failure, hypertension, hypovolemia, asthma, chronic urticaria, advanced kidney dysfunction

aspirin interaction

anticoagulants, glucocorticoids and alcohol increase risk of bleeding, ibuprofen decreases the anitplatelet effects of low-dose aspirin, ACE inhibitors and angiotensin receptor blockers increase risk of kidney failure, antihypertensive effects of ACE inhibitors decrease the risk of lithium carbonate and methotrexate toxicity increases

ibuprofen

same as aspirin, recommended only for short period and low dose

Celecoxib therapeutic use

inflammation suppression, analgesia for mild to moderate pain, fever reduction, dysmenorrhea

celecoxib adverse drug reactions

gastric upset, heartburn, nausea, diarrhea, gastric ulceration, kidney dysfunction, CV and cerebrovascular events

celecoxib nursing interventions

monitor for and report gastric upset, heartburn, diarrhea, or GI bleeding, test and treat helicobacter pylori prior to long term therapy, recommend proton pump inhibitor for high risk GI bleeds, monitor I & Os, monitor for rapid rise in BUN and creatinine, recommend drug for short periods and low doses, monitor for signs of MI and CV accident

celecoxib administration

give 2 hr before or after magnesium or aluminum based antacids

celecoxib client instructions

take with food, milk, or 8 oz of water, avoid alcohol, report persistent gastric irritation and signs of bleedings, report changes in urine output, weight gain, or signs of fluid retention, report chest pain or heaviness shortness of breath sudden and severe headache, numbness, weakness, visual disturbances, or confusion

Celecoxib contraindications

pregnancy risks, severe hepatic impairment, advanced kidney disease, children younger than 18, GI bleeding, anemia, pain from coronary artery bypass grafting, allergy to sulfa, sulfonamide, celecoxib

celecoxib precautions

alcohol use disorder, heart failure, diabetes mellitus, hypertension, asthma, history of GI bleeding or peptic ulcer disease, CV disease, mild or moderate liver impairment, renal insufficiency, cerebrovascular accident

Celecoxib interactions

diuretic effects of furosemide decrease, fluconazole increases celecoxib levels, anticoagulant effects of warfarin increase, glucocorticoids and alcohol increase risk of bleeding, antihypertensive effects of ACE inhibitors decrease, risk of lithium carbonate toxicity increases

Acetaminophen therapeutic use

analgesia for mild to moderate pain, fever reduction

Acetaminophen adverse drug reactions

Liver damage (overdose), hypertension (with daily use, particularly women)

Acetaminophen nursing interventions

monitor for early symptoms of overdose/poisoning, liver damage results in 48 to 72 hr following overdose, prepare to administer acetylcysteine orally or IV to contract overdose and reduce liver injury, monitor BP

Acetaminophen administration

orally or rectally, no more than 4g/day, infants and children should be given the manufacturer's recommended dose based on their age

Acetaminophen client instructions

Do not exceed 4 g/day (adults), report any abdominal discomfort, nausea, vomiting, sweating, or diarrhea immediately, have blood pressure checked regularly.

Acetaminophen Contraindications

alcohol use disorder

Acetaminophen precautions

Anemia, immunosuppression, hepatic or kidney disease

Acetaminophen interactions

alcohol increases risk of liver injury, warfarin increases the risk of bleeding, cholestyramine reduces absorption

tramadol therapeutic use

moderate to moderately severe pain

tramadol adverse drug reactions

sedation, dizziness, headache, nausea, vomiting, constipation, respiratory depression, seizures, urinary retention