Pharmacology Exam 1

What is the 6 Step Nursing Process

What is the 6 Step Nursing Process

CAPPIE

Concept
Assessment
Pt Problems
Planning
Interventions
Evaluation

Patient Problems (Analysis)

3rd step of Nursing Process involving analysis of patient problems and needs. Based on assessment and is individualized

Planning

4th step of nursing process about generating solutions. This includes goals (SMART)
Specific
Measurable
Attainable
Relevant
Timed

Interventions

5th Step of nursing process about implementing planned activities. Involves patient teaching, promoting adherence to drug therapy, solving problems

Evaluation

Final step of nursing process about evaluating the goals. Did they reach their goal? If not why. Reassess, maybe revise plan

What are factors that help promote patient learning

The patients readiness to learn, their investment in learning, timing

What are the 3 core ethical principles in research

Respect for persons (including autonomy), beneficence (risk to benefit), justice (

What is the Controlled Substance Act

Act (passed in 1970) to regulate the manufactures distribution of drugs that may result in dependency. (STOPPING DRUG ABUSE)
It has 5 schedules.. 1 being not for medical abuse and high abuse potential.. and so on

Schedule 1 Drugs

Not approved for medical use, high abuse

Marijuana

LSD

Ecstasy

Heroin

Schedule 2 Drugs

High abuse potential, has medical use

Cocaine

Opium

High grade Morphine

Oxycodone

Methamphetamines (Adderall)

Schedule 3 Drugs

Less dependency then 1 and 2 but can lead to moderate dependence

Low grade Morphine

anabolic Steroids

Ketamine

Certain Codeine Mixtures

Schedule 4 Drugs

Ambien

Valium

Xanax

Rohypnol

Zolpidem

Soma

Darvon

Darvocet

Ativan

Talwin

Schedule 5 Drugs

Cough syrup

Lomotil

Motofen

How do nurses protect controlled substances

Accounting all controlled drugs though Drug counts with other nurses. Verify orders.

Controlled substance log

How do you account for Controlled Substances that are NOT used?

Any wastage must be witnessed by another nurse. If they already did it you CANNOT sign off on it

Who prescribed Controlled Substances stated by Nurse Practice Act

Physicians can only prescribe, nurses cannot administer either without provider order

What is the Chemical Name of a drug?

Describes the drug's chemical structure

What is a drug's Generic Name?

the official, nonproprietary name for a drug. This name is not owned by any drug company and is universally accepted.

nurses must know generic names

What is a drug's Brand Name

known as the proprietary name and is chosen by a drug company and is usually trademarked

ex. Lunesta is a brand name of a drug whose generic name is eszopiclone

Are generic drugs safe compared to brand name?

If the generic drug is found to be bioequivalent to the brand name by the FDA it can be marketed. If there is less than 20% variance in drug absorption, distribution, metabolism, and excretion, a generic drug is considered equivalent to the brand name

What the biggest issue with OTC drugs for Nurses?

Patient side effects when taken with other drugs. Patient teaching with reading drug labels

What is Pharmacokinetics?

The process of drug movement through the body necessary to achieve drug action

what the body does to the drug

What is Drug Absorption? (1/4)

Process of drug transport from the site of administration to the systemic circulation by crossing a biologic membrane

ex- Oral to bloodstream

What factors impact Absorption?

Route, preparation, dosage, digestive motility and enzymes for oral drugs

Blood flow, lipid solubility, degree of ionization, pH, drug-drug, drug-food interactions

What is the route of an Oral Drug

Oral drugs from the GI tract pass from the intestinal lumen to the liver

What is the First-Pass Effect/Metabolism

Oral drugs when in the liver are metabolized to an inactive form and are excreted which REDUCES the amount of active drug available to exert effect

only part of drug reaches systemic circulation

What is Bioavailability

Refers to the percentage of administered drug available for activity. Bioavailability for Oral drugs is always less than 100% due to first pass and IV is always 100%

What are factors that ALTER Bioavailability

Drug form, such as tablet, capsule
Route of Administration- Enteral (gi tract), topical, parenteral
Gastric mucosa and motility
Administration of drug with food or other drugs
Changes in Liver function can increase Bioavailibility

Which drug form is most rapidly absorbed from the GI tract?

Sublingual

What is Drug Distribution? (2/4)

Movement of drug from blood circulation to body tissues. Carried by blood or tissue fluids to sites of action

What factors impact Distribution

Circulation
Tissue affinity
PROTEIN BINDING

What is drug protein binding

As drugs are distributed in plasma many bind with plasma proteins

Highly-bound protein drugs are less active

What are Free Drugs?

The portion that remains of a drug that is free and unbounded from a protein. These are ACTIVE

What happens when two highly protein-bound drugs are administered together

They compete for protein-binding sites resulting in increased free drugs and POSSIBILITY FOR ACCUMULATION AND TOXICITY

What would happen if there were LOW plasma protein levels

The decrease in the # of available binding sites can lead to increase in Free drugs resulting in accumulation and toxicity

What patients would be at risk for Low plasma protein levels?

Patients with Liver or Kidney disease,

What is the most abundant Plasma Protein available for binding?

Albumin

What drugs can get through the Blood Brain Barrier?

Highly lipid soluble and of low molecular weight

What is drug Metabolism? (3/4)

Biotransformation; method of drug inactivation.

PRIMARY SITE IS THE LIVER where drugs are turned into inactive Metabolites

What in the Liver converts drugs to Metabolites?

CYP450 Enzymes in the liver

What is a Pro Drug?

a compound that is metabolized into an active pharmacologic substance

drugs that are only effective when they are turned into metabolites

What is the Half-life of a drug?

Time that it takes for the amount of a drug to be reduced by half.

What is steady state?

Amount of drug administered is equal to the amount being eliminated

What is a Loading Dose?

A large dose given for drugs with long half-lives in order to achieve steady state

What is Drug Excretion? (4/4)

Getting rid of the metabolites from the body. Mainly from the KIDNEYS, can also be eliminated through bile, sweat, lungs.

Reason why kidney function is so important

What factors influence Excretion?

Urine pH, Renal function

What are some Renal Function Tests

Creatinine, BUN, CC (creatinine clearance)

What is Pharmacodynamics?

What the drug does to the body, the effect of the drug

What is a Drugs Primary Effect?

the desirable response from the drug

What is a Drug's Secondary Effect?

a response that may be desirable or undesirable

for example Benadryl with sedation

What is Dose-response Relationship?

the body's physiologic response to changes in drug concentration at the site of action

What does it mean for a drug to have High Potency?

a drug with high potency produces significant therapeutic responses at low concentrations

What is a drug's Maximal Efficacy?

The point when increasing a drug's dosage no longer increased the desired therapeutic response

What is the Therapeutic Index?

ratio of toxic dose to therapeutic dose

therapeutic dose of a drug (ED50) and the toxic dose (TD50). The number referring to the % of the population it effects

TD50 is toxic for 50% of the pop.

what is a drug's Onset?

time it takes for a drug to reach the minimum effective concentration

time it takes for the drug to work

what is a drug's Peak?

when a drug reaches its highest concentration in the blood

what is a drug's Duration of Action?

length of time the drug exerts its therapeutic effect

Where does a drug bind to a receptor?

Ligand-binding domain

What are Side Effects?

expected secondary effects of a drug that may be desirable or undesirable

What is an Adverse Reaction?

Unexpected reaction more severe than side effects, always undesirable.

anaphylaxis, jaundice, seizures, - WBC, kidney damage

What are Additive Drug Interactions

1+1= 2 sum of the effect of 2 drugs is greater than 1

What are Synergistic Drug Interactions

1+1= 3
2 drugs work together extremely well

What is the benefit of Synergistic and Additive drug interactions

You can give less drugs to pts which results in less side effects

What is a common Drug-food combo

Grapefruit juice

It inhibits CYP450 enzyme which alters metabolism

How might Pharmacogenetics affect patients?

Expensive, it can help pts with complex treatments that may be different if someone has genetic variance

What is Ethnopharmacology?

May combines traditional and Western health practices Healing remedies, herbs, powders, teas, etc

Why is Complementary and Alternative Medicine important to nurses

Pt teaching in safety, nurses must also be sensitive to beliefs and practices

What are Ethnohealers?

Folk medicine, traditional medicines, "healers"

Why is research related to Pediatrics limited?

Obtaining informed consent, companies investing less,

Pharmacodynamics is influenced by what in Pediatrics?

differences in body fat, decreased protein, etc.

Variability in organ function, development. and admin issues

what age group does immaturity in organs and systems effect the most in Pharmacokinetics?

Newborns and infants

what is different about Absorption in pediatric pts?

Reduced gastric acidity, irregular gastric emptying,

THINNER SKIN= TOPICALS EASILY ABSORBED

what is different about Distribution in pediatric patients?

More extracellular water/fluid= decreased drug concentration

what is different about metabolism in pediatric patients?

Higher metabolic rate

What is different about Excretion in pediatric patients?

Immature kidneys

How are drugs without pediatric dosing schedules dosed?

Dosing based on child's weight in kg or body surface area (BSA)

what is Family-Centered Care?

Patient teaching is for family and the child. Taking into account their culture. Parents choose involvement level, building rapport with parents

family members/care givers can assist in administration if possible

What is Atraumatic Care?

Care that minimizes the psychological and physical distress experienced by children and families.

Decreasing separation and pain, identifying stressors

What is the most common drug form for Pediatrics?

Oral medications

if IV or IM is needed it should be switched back ASAP

How are Oral drugs given in children under 6

Using oral syringe with exact dosing with possible flavoring

How are Infants given oral drugs

Syringe to the back of the cheek small amounts at a time

droppers, bottle nipples if necessary

Where are Immunizations given to Infants?

Vastus lateralis

How should drugs be administered to Geriatrics?

Start low and go slow

Low dosages first and gradually increase

Physiological Changes that affect Pharm in Older Adutls

increased body fat, reduction in kidney mass and blood flow, reduced clearance of drugs

Reduction in liver size and blood flow, reduced hepatic clearance of drugs

What influences Pharmacodynamics in Geriatric?

decreased receptors, affinity, altered response to drugs, decreased compensatory responses
decreased protein binding sites (free drugs)

What is the significance in Pharmacodynamic changes in Geriatric?

increased risk of adverse reactions
May need a lower dose
may need increase in dosing interval

what is Polypharmacy?

use of more medications than is medically necessary, usually 5 drugs

risk factors- advanced age, female,

Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

document that is used as a guide for safe presciptions

5 types of Adverse Drug Events

adverse reactions
Medication errors
Therapeutic failures
Adverse drug withdrawal events
overdose

Which age group is Adherence to a drug regimen a problem

Older adult geriatric

what are some reasons for Nonadherence to a drug regimen?

Polypharmacy (too many), economic factors, lack of knowledge, lack of symptoms, impairments, cognitive decline

The older adult patient has questions about oral drug metabolism. Information on what subject is most important to include in this patient teaching plan?

First pass effect

What is Substance Use Disorder

when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment

What do drugs do to the Limbic System of the brain?

increase Dopamine for the brain's Reward Circuit making us feel pleasure

what words do you NOT use for Substance Use Disoder?

Abuse and dependency

What is Tolerance?

Requiring a significantly increased amount of a drug to achieve the desired effect

What is remission?

None of the 11 criteria for substance use disorder for at least 3 months

What is Recovery

a process of change through which an individual improves health and wellness, lives a self-directed life, and strives to reach full potential

What is Relapse?

a return to drug use after a period of abstinence, often accompanied by reinstatement of substance use disorder

How is Alcohol absorbed?

It is absorbed mainly through Small Intestines but also in the Stomach