Pharm Test 1

What are the nurse's responsibilities in medication administration?

Nurses are responsible for precise preparation and administration of medications, comprehensive client safety, meticulous documentation, patient education, ongoing assessment for therapeutic and adverse effects, and maintaining current knowledge of pharmacology, including drug interactions and contraindications.

What are the rights of medication administration?

The '10 Rights of Medication Administration' are fundamental principles to prevent errors, encompassing the Right Client, Right Medication, Right Dose, Right Route, Right Time, Right Documentation, Right Assessment, Right Education, Right Evaluation, and Right to Refuse.

What is a stat prescription?

A stat prescription (from the Latin 'statim' meaning immediately) is a single, emergency dose of medication that must be prepared and administered without delay to address a critical or rapidly worsening client condition.

What is pharmacokinetics?

Pharmacokinetics describes the study of how the body handles a drug. It involves four key processes: Absorption (how the drug enters the bloodstream), Distribution (how it spreads throughout the body), Metabolism (how it's chemically altered, primarily by the liver), and Excretion (how it leaves the body, primarily via kidneys).

What does half-life of a drug mean?

The half-life (t½) of a drug is the specific time interval required for the concentration of a drug in the plasma or the amount of drug in the body to be reduced by 50%. It's crucial for determining dosing frequency and duration of effect.

What is the difference between side effects and adverse effects?

Side effects are predictable, often mild, and expected pharmacological reactions that occur at therapeutic drug doses, not necessarily requiring discontinuation (e.g., drowsiness with antihistamines). Adverse effects are unintended, undesirable, and potentially harmful or dangerous responses to a drug, which can range from severe to life-threatening and may necessitate drug discontinuation.

What is the first-pass effect?

The first-pass effect (or pre-systemic metabolism) is a phenomenon where a significant portion of a drug's dose is metabolized by the liver before it reaches systemic circulation after oral administration. This reduces the drug's bioavailability and its concentration of active form available to target tissues.

How can handling medication errors be prevented?

Preventing medication errors involves a multifaceted approach, including the diligent application of the 10 Rights of Medication Administration, utilizing automated dispensing systems (e.g., Pyxis, Omnicell), implementing barcode scanning at the bedside, employing double-checks for high-alert medications, fostering a culture of safety reporting, and providing continuous staff education.

What is the significance of drug name suffixes?

Drug name suffixes, particularly those for look-alike/sound-alike (LASA) medications, are crucial for patient safety. They often indicate the drug's pharmacological class (e.g., '-pril' for ACE inhibitors, '-olol' for beta-blockers) or formulation, helping healthcare providers differentiate similar-sounding names and thereby prevent medication errors by prompting extra vigilance.

What is the role of the Institute for Safe Medication Practices (ISMP)?

The Institute for Safe Medication Practices (ISMP) is a leading independent, non-profit organization dedicated to preventing medication errors. It accomplishes this by providing education and resources to healthcare professionals and consumers, analyzing medication error reports (through programs like the ISMP Medication Error Reporting Program), and advocating for system-based changes to improve medication safety.

What are the nurse's responsibilities in medication administration?

Nurses are entrusted with critical responsibilities in medication administration to ensure patient safety and therapeutic outcomes. These include precise preparation and administration of medications; ensuring comprehensive client safety through vigilant monitoring; meticulous documentation of all administered drugs and client responses; providing thorough patient education on their medications, including purpose, dosage, and potential side effects; conducting ongoing assessment for both expected therapeutic effects and potential adverse reactions; and maintaining current knowledge of pharmacology, including drug interactions, contraindications, and new medications.

What are the 10 Rights of Medication Administration, and why are they fundamental?

The '10 Rights of Medication Administration' are foundational principles designed to systematically prevent medication errors and ensure patient safety. They encompass verifying the:

1. Right Client: Ensuring the medication is given to the intended patient.
2. Right Medication: Confirming the correct drug is being administered.
3. Right Dose: Verifying the accurate amount of medication.
4. Right Route: Administering the medication via the prescribed path (e.g., oral, IV).
5. Right Time: Giving the medication at the scheduled interval.
6. Right Documentation: Accurately charting the administration and patient response.
7. Right Assessment: Performing appropriate patient assessments before administration (e.g., vital signs, allergies).
8. Right Education: Providing the patient with complete information about their medication.
9. Right Evaluation: Assessing the patient's response to the medication (therapeutic and adverse).
10. Right to Refuse: Respecting the patient's informed decision to decline medication.

What defines a stat prescription, and when is it used?

A stat prescription (from the Latin 'statim' meaning immediately) signifies a single, emergency dose of medication that must be prepared and administered without any delay. It is reserved for situations requiring immediate action to address a critical or rapidly worsening client condition, such as an acute allergic reaction or sudden cardiac event.

Explain pharmacokinetics and its four core processes.

Pharmacokinetics is the study of how the body handles a drug from the moment it is administered until it is completely eliminated. It comprehensively describes the journey of a drug through the body, involving four critical processes:

1. Absorption: The movement of a drug from its site of administration into the bloodstream. Factors like drug formulation, route, and blood flow affect this.
2. Distribution: The reversible movement of a drug from the bloodstream into the interstitial and intracellular fluids and then to target tissues. Influenced by blood flow, tissue-binding, and protein-binding.
3. Metabolism (Biotransformation): The chemical alteration of a drug by the body, primarily occurring in the liver by enzymes (e.g., CYP450 system) to facilitate its excretion or modify its activity.
4. Excretion: The irreversible removal of the drug and its metabolites from the body, chiefly via the kidneys in urine, but also through bile, feces, lungs, or sweat.

What is the half-life (t½) of a drug, and why is it clinically significant?

The half-life (t½) of a drug is the specific time interval required for the concentration of a drug in the plasma or the total amount of drug in the body to be reduced by 50%. This pharmacokinetic parameter is crucial for determining how frequently a drug needs to be administered to maintain therapeutic levels and for estimating the time it takes for a drug to be eliminated from the body (it generally takes about 4 to 5 half-lives for most drugs to be largely excreted).

Differentiate between side effects and adverse effects of medications.

Side effects are predictable, often mild, and expected pharmacological reactions that occur at therapeutic drug doses. They are typically an extension of the drug's known actions but do not necessarily require discontinuation of the medication (e.g., drowsiness with antihistamines, dry mouth with anticholinergics).
Adverse effects (or Adverse Drug Reactions - ADRs) are unintended, undesirable, and potentially harmful or dangerous responses to a drug that are usually unexpected at therapeutic doses. They can range from severe to life-threatening, often necessitating a reduction in dose or complete discontinuation of the drug and may require medical intervention (e.g., liver damage, anaphylaxis, severe gastrointestinal bleeding).

Describe the first-pass effect and its impact on drug administration.

The first-pass effect (or pre-systemic metabolism) is a phenomenon where a significant portion of an orally administered drug's dose is metabolized (inactivated) by enzymes in the liver before it reaches systemic circulation. After absorption from the GI tract, drugs enter the portal venous system and pass through the liver before entering general circulation. This process reduces the drug's bioavailability (the fraction of the administered dose that reaches the systemic circulation unchanged) and its concentration of active form available to target tissues, often requiring higher oral doses compared to other routes.

What multifaceted strategies are essential for preventing medication errors in healthcare settings?

Preventing medication errors requires a comprehensive, multifaceted approach focused on systemic improvements and vigilant practice:

• Diligent application of the 10 Rights of Medication Administration: A fundamental checklist for every drug given.
• Utilizing automated dispensing systems (ADS): Such as Pyxis or Omnicell, which control and track medication access, reducing human error.
• Implementing barcode scanning at the bedside: Verifying the patient, medication, and dose at the point of care.
• Employing double-checks for high-alert medications: Requiring two nurses to independently verify calculations and administration of drugs like insulin, heparin, and opiates.
• Fostering a culture of safety reporting: Encouraging staff to report errors and near misses without fear of punitive action, allowing for system-wide learning.
• Providing continuous staff education: Ensuring healthcare professionals are up-to-date on pharmacology, best practices, and new technologies in medication safety.

What is the significance of drug name suffixes, especially for look-alike/sound-alike (LASA) medications?

Drug name suffixes are critical cues for patient safety, particularly for look-alike/sound-alike (LASA) medications (e.g., Zyrtec/Zyprexa). They often indicate the drug's pharmacological class (e.g., '-pril' for ACE inhibitors like lisinopril, '-olol' for beta-blockers like metoprolol, '-dipine' for calcium channel blockers like amlodipine), its mechanism of action, or occasionally its formulation. Suffixes help healthcare providers quickly identify the drug type, differentiate similar-sounding names, and prompt extra vigilance during prescribing, dispensing, and administration, significantly helping to prevent medication errors.

What is the vital role of the Institute for Safe Medication Practices (ISMP) in medication safety?

The Institute for Safe Medication Practices (ISMP) is a leading independent, non-profit organization globally recognized for its dedication to preventing medication errors and promoting safe medication use. It fulfills this vital role by:

• Providing education and resources to healthcare professionals and consumers on best practices for medication safety.
• Analyzing medication error reports submitted through programs like the voluntary ISMP Medication Error Reporting Program (MERP) to identify trends and systemic vulnerabilities.
• Advocating for system-based changes in healthcare practices, technology, and regulations to improve medication safety at an organizational and national level.

Define pharmacodynamics and its relationship to drug action.

Pharmacodynamics is the study of how drugs affect the body. It explores the biochemical and physiological effects of drugs and their mechanisms of action, focusing on how drugs produce their therapeutic and adverse effects at cellular and systemic levels, often through interaction with specific receptors.

What is an agonist in pharmacology?

An agonist is a drug that binds to a specific receptor and mimics the action of an endogenous substance (like a neurotransmitter or hormone), thereby producing a therapeutic or physiological effect. It activates the receptor to elicit a response.

What is an antagonist in pharmacology?

An antagonist is a drug that binds to a receptor but produces no activation. Instead, it blocks or reverses the effects of agonists or endogenous substances by preventing them from binding to the receptor, thereby inhibiting a physiological response.

Explain the therapeutic index and its significance.

The therapeutic index (TI) is a ratio that quantifies the relative safety of a drug, calculated as the ratio of the median toxic dose (TD{50}) to the median effective dose (ED{50}). A high therapeutic index indicates a wide margin of safety (larger difference between effective and toxic doses), while a low therapeutic index suggests a narrow safety margin, requiring careful monitoring to avoid toxicity (e.g., warfarin, digoxin).

What is the therapeutic range (or window) of a drug?

The therapeutic range or therapeutic window is the range of drug concentrations in the blood plasma that is expected to achieve the desired therapeutic effect with minimal toxicity for most patients. Maintaining drug levels within this window is crucial for effective and safe treatment.

What are peak and trough levels in drug monitoring?

Peak levels are the highest concentration of a drug in the bloodstream, typically measured after administration (e.g., 30-60 minutes after IV infusion). Trough levels are the lowest concentration, measured just before the next scheduled dose. These levels are monitored for drugs with a narrow therapeutic index to ensure efficacy and prevent toxicity.

Define bioavailability in pharmacology.

Bioavailability is the proportion or percentage of an administered drug dose that reaches the systemic circulation in an unchanged form and is therefore available to exert its pharmacological effects at the target tissues. It is greatly influenced by the route of administration, drug absorption, and the first-pass effect.

Differentiate between a drug's onset, peak, and duration of action.

These terms describe the time course of drug action:

• Onset of action: The time interval from administration of a drug to the first observable therapeutic effect.
• Peak action: The time at which the drug reaches its highest concentration in the blood or at the receptor site, correlating with its maximum therapeutic effect.
• Duration of action: The length of time a drug continues to exert a therapeutic effect.

What is a drug-drug interaction, and what are its common types?

A drug-drug interaction occurs when the effects of one drug are altered by the concurrent administration of another drug. Common types include:

• Additive effect: The combined effect of two drugs is equal to the sum of their individual effects (1+1=2).
• Synergistic effect: The combined effect is greater than the sum of individual effects (1+1>2).
• Antagonistic effect: One drug diminishes or neutralizes the effect of another (1+1<2 or 1+1=0).

Provide examples of common drug-food interactions.

A drug-food interaction occurs when food or beverages affect the absorption, metabolism, or excretion of a drug, or when a drug affects nutrient utilization. Examples include:

• Grapefruit juice: Can inhibit drug metabolism (e.g., statins, calcium channel blockers), leading to increased drug levels and potential toxicity.
• Vitamin K-rich foods (e.g., leafy greens): Can antagonize the effect of warfarin (an anticoagulant), reducing its effectiveness.
• Dairy products/Antacids: Can bind with certain antibiotics (e.g., tetracyclines, fluoroquinolones), impairing their absorption.

Define tolerance in pharmacology.

Tolerance is a phenomenon where a patient's response to a given dose of a drug decreases over time, requiring progressively higher doses to achieve the initial therapeutic effect. This can occur with chronic use of many drugs, including opioids and benzodiazepines.

Differentiate between physical dependence and psychological dependence.

Physical dependence: An altered physiological state resulting from chronic drug use, where the body adapts to the drug's presence. Abrupt cessation or reduction of the drug leads to characteristic withdrawal symptoms (e.g., tremors, nausea, seizures).
Psychological dependence: A compulsive need or craving for a drug (often associated with its rewarding effects), characterized by a strong desire to continue drug use despite harmful consequences, to achieve pleasure or avoid discomfort.

What is a drug allergic reaction?

A drug allergic reaction is an unpredictable, adverse immune-mediated response to a drug, occurring in a sensitized individual. It ranges from mild symptoms (e.g., rash, hives, itching) to severe, life-threatening reactions like anaphylaxis, and is independent of the drug's pharmacological action or dose.

Describe anaphylaxis and its nursing management.

Anaphylaxis is a severe, systemic, immediate, and potentially life-threatening allergic reaction. It involves multiple body systems (e.g., respiratory distress like bronchospasm/laryngeal edema, cardiovascular collapse like hypotension, widespread hives). Nursing management includes immediate discontinuation of the offending agent, rapid administration of epinephrine (first-line treatment), maintaining airway, providing oxygen, and administering antihistamines and corticosteroids.

What is an idiosyncratic reaction to a drug?

An idiosyncratic reaction is an unexpected, unpredictable, and often genetically determined adverse drug response that is neither a known pharmacological effect nor an allergic reaction. It occurs in a small percentage of patients and is unusual to the drug's mechanism of action (e.g., paradoxical excitation with a sedative, malignant hyperthermia).

Explain the three types of drug names: chemical, generic, and trade name.

Drugs typically have three types of names:

• Chemical Name: Provides the exact description of the drug's chemical composition and molecular structure, often long and complex (e.g., N-acetyl-para-aminophenol for acetaminophen).
• Generic Name (Nonproprietary Name): The official, internationally recognized name of a drug, simpler than the chemical name, and not capitalized (e.g., acetaminophen, ibuprofen). There is only one generic name for each drug.
• Trade Name (Brand or Proprietary Name): The name given by the pharmaceutical company that markets the drug, capitalized and often trademarked (e.g., Tylenol, Advil). Multiple trade names can exist for one generic drug.

What are controlled substances, and how are they classified?

Controlled substances are drugs with a high potential for abuse or dependence, regulated by federal and state laws (e.g., the Controlled Substances Act in the US). They are classified into Schedules I through V based on their abuse potential, accepted medical use, and safety concerns, with Schedule I having the highest abuse potential and no accepted medical use (e.g., heroin), and Schedule V having the lowest (e.g., certain cough preparations with codeine). Strict regulations govern their prescription, dispensing, and storage.

What essential information must be included on a valid medication prescription?

A valid medication prescription or order must include several key components to ensure safe and accurate dispensing and administration:

• Client’s full name and date of birth
• Date and time the order was written
• Name of the medication (generic or trade)
• Dosage of the medication (e.g., mg, mcg)
• Route of administration (e.g., PO, IV, IM, SubQ)
• Frequency of administration (e.g., BID, Q4h)
• Duration of therapy (e.g., x 7 days) if applicable
• Specific instructions or parameters (e.g., "for pain scale > 5", "hold for HR < 60")
• Signature of the prescribing provider.

What is a PRN prescription?

A PRN (pro re nata, Latin for "as needed") prescription is an order for a medication to be administered only when the patient requires it, based on specific parameters or symptoms. The nurse must assess the patient's need for the medication based on the prescribed criteria (e.g., "morphine 2 mg IV PRN for pain > 6/10 every 4 hours").

Explain a standing order in medication administration.

A standing order is a pre-written, standardized medical order approved by medical staff and nursing leadership, allowing nurses to administer certain medications or perform specific interventions without requiring a direct individual order from a physician each time. These orders apply to specific situations or patient populations (e.g., routine post-operative pain medication protocol, bowel regimen orders).

Define polypharmacy and its risks, especially for older adults.

Polypharmacy refers to the concurrent use of multiple medications by a patient, often more than medically necessary. While sometimes appropriate, it carries significant risks, particularly for older adults, including:

• Increased risk of adverse drug reactions (ADRs).
• Increased potential for drug-drug and drug-disease interactions.
• Higher rates of medication non-adherence.
• Decline in cognitive and physical function.
• Increased healthcare costs and hospitalizations.

What is medication reconciliation, and why is it important?

Medication reconciliation is a formal process of comparing a patient's current medication list against new medication orders at all points of care transition (e.g., admission, transfer, discharge). The goal is to prevent medication errors, unintended omissions, duplications, dosing errors, or drug interactions by creating the most accurate list possible, ensuring patient safety and continuity of care.

What is a teratogenic drug?

A teratogenic drug is a medication that, when administered to a pregnant woman, has the potential to cause developmental abnormalities, birth defects, or functional damage to the fetus. Exposure is most critical during the first trimester of pregnancy when organogenesis occurs (e.g., thalidomide, isotretinoin, certain ACE inhibitors).

What is a maintenance dose?

A maintenance dose is the regular, ongoing dose of a drug administered to maintain its therapeutic concentration within the body's therapeutic range once the desired steady-state plasma level has been achieved (often after a loading dose, if one was used). Its purpose is to balance the rate of drug elimination with the rate of drug administration.

What is a contraindication for a medication?

A contraindication is a specific condition or factor that renders the use of a particular medication or treatment inadvisable or potentially harmful for a patient.

• Absolute contraindication: The medication should never be used (e.g., penicillin in a patient with a known penicillin allergy).
• Relative contraindication: The medication should generally be avoided but may be used with caution if the benefits outweigh the risks (e.g., beta-blockers in patients with asthma).

What are key pediatric considerations in pharmacology for medication administration?

Pediatric pharmacology requires special considerations due to physiological differences in children compared to adults. Key points include:

• Dosage calculation: Based on weight (mg/kg) or body surface area (BSA) due to varying organ maturity and size.
• Variable absorption: Differences in gastric pH, emptying time, and muscle mass affect absorption.
• Immature liver metabolism: Slower drug breakdown, potentially leading to prolonged drug effects or toxicity.
• Immature renal excretion: Slower drug elimination, increasing risk of accumulation.
• Higher body water content/lower fat: Affects drug distribution.
• Increased sensitivity: To CNS effects and adverse reactions.
• Child's developmental stage: Influences route selection and cooperation.

What are key geriatric considerations in pharmacology for medication administration?

Geriatric patients (older adults) often experience age-related physiological changes that significantly impact pharmacokinetics and pharmacodynamics, requiring careful medication management:

• Reduced liver metabolism: Decreased enzyme activity, leading to slower drug inactivation and prolonged effects.
• Reduced renal excretion: Decreased glomerular filtration rate (GFR), causing drugs to accumulate.
• Decreased total body water/increased body fat: Alters drug distribution, potentially increasing fat-soluble drug accumulation.
• Reduced serum albumin: More free drug available, increasing risk of toxicity.
• Increased sensitivity: To CNS depressants and anticholinergics.
• Polypharmacy: High risk of drug interactions and adverse effects due to multiple comorbidities and medications.
• Cognitive and sensory impairments: Affect adherence and ability to manage medications.

What is the importance of a medication safety culture in healthcare?

A medication safety culture is an organizational environment where all healthcare professionals are committed to continuous improvement in medication practices, proactively identify and report errors and near misses, and feel safe to speak up without fear of blame. It emphasizes learning from mistakes, implementing system-level changes, and shared responsibility to minimize the risk of medication errors and enhance patient outcomes.

What does "parenteral route" mean, and what are common parenteral routes?

The parenteral route means administering medication by injection, bypassing the gastrointestinal tract. This route is typically used for drugs that are poorly absorbed orally, inactivated by digestive enzymes, or when a rapid onset of action is required. Common parenteral routes include:

• Intravenous (IV): Directly into a vein (fastest onset).
• Intramuscular (IM): Into a muscle.
• Subcutaneous (SubQ): Into the fatty tissue just under the skin.
• Intradermal (ID): Into the dermis, just beneath the epidermis (e.g., for allergy tests).

Explain the placebo effect.

The placebo effect describes a physiological or psychological response that occurs after receiving an inert substance (a placebo) or a treatment that has no specific therapeutic activity for the condition being treated. This effect is driven by the patient's expectation of benefit, the belief in the treatment, or the ritual of medical care, and can lead to perceived or actual improvements in symptoms.

What is medication adherence (or compliance)?

Medication adherence (or compliance) refers to the extent to which a patient takes their medication as prescribed by their healthcare provider (e.g., correct dose, frequency, timing, and duration). Poor adherence is a significant barrier to effective treatment and can lead to worsened health outcomes, treatment failures, and increased healthcare costs.

A nurse is preparing a client’s medications. The nurse is responsible for gaining and maintaining knowledge about which of the following medication information (SATA)?
A. adverse effects
B. determining dose
C. mechanism of action
D. contraindications
E. insurance coverage

A)adverse effects
C) mechanism of action
D) contraindications

a nurse is preparing to administer digoxin to a client who state, “I don’t want to take that medication. I do not want another pill.” Which of hte following responses should the nurse make?
a. your physician prescribed it for you, so you should take it.
b. well, let’s just get it over with then.
c. okay, I’ll just give you your other medications instead.
d. tell me your concerns about taking this medication.

d. tell me your concerns about taking this medication.

A nurse is assessing a client before administering medications. Which of the following data should the nurse obtain? (SATA)
a. use of herbal products
b. ability to swallow
c. daily fluid intake
d. previous surgical history
e. allergies

a) use of herbal products
b) ability to swallow e) allergies

A nurse is working with a newly licensed nurse who is administering medication to clients. which of the following actions should the nurse identify as an indication that the newly hired nurse understands medication error prevention?
a. taking all medications out of the unit-dose wrappers before entering the client’s room
b. checking the prescription when a single does requires administration of multiple tablets
c. administering a medication, then looking up the usual dosage
d. relying on another nurse to clarify medication prescription

b. checking the prescription when a single does requires administration of multiple tablets

A nurse teaches a client who has a new prescription for a medication with a high potential for toxicity. What's included? (SATA)
a. laboratory tests to measure serum med levels
b. taking med wit an inducing agent
c. taking smallest effective dose
d. increasing fluid intake

a. laboratory tests to measure serum med levels
c. taking smallest effective dose

SATA: A nurse is about to administer a 0800 medication to a patient. Which of the following should they keep in mind?
a. check the ID, name, and DOB with the MAR
b. document the medication after drawing it out of the vial
c. Give the medication between 0700 and 0900
d. ensure that the dosage and the one listed in the script are the same

a. check the ID, name, and DOB with the MAR.
c. Give the medication between 0700 and 0900.
d. ensure that the dosage matches the prescription.

SATA: A client asks a nurse about generic medications. Which of the following are true regarding generic medications?
a. have potential for dependence and abuse
b. have same chemical comp as brand-name
c. may have several brand/trade names
d. may have several generic names

a. have potential for dependence and abuse
b. have same chemical composition as brand-name
c. may have several brand/trade names

what is the movement of a medication by bloodstream to the intended site of action?

distribution

T/F: pharmacodynamics is what the drug does to the body.

True

SATA: Primary care providers prescribe medication dosages for children using which of the following information?
a. age
b. developmental age
c. weight
d. body surface area

a. age c. weight
d. body surface area