Fundamentals #2 test study guide

Resources if unfamiliar with drug:

MAR, Pamphlet inside box, pharmacopeia, formulary, drug guides, Physician desk reference, Pharmacist

Routs of administration

are dependent on absorption time. Po is taken by mouth and swallowed, has the slowest absorption time. IM is injected straight into tissue. IV is the fastest onset of action. If given local it is like a topical cream. Systemic is absorbed into the blood stream and spreads throughout the body. Enteric coated medication slows absorption, cannot be crushed because cant be broken down by gastric acids. Timed release slows absorption. First pass has to be a PO med. 

Can enteric medication be crushed?

No, Enteric coated medication slows absorption, cannot be crushed because cant be broken down by gastric acids. Timed release slows absorption. First pass has to be a PO med. 

Parenteral medications

is given by injection like IV, IM, SubQ, ID. It bypasses the GI tract. It avoids the first pass effect because it enters the blood stream or tissues directly, it is not metabolized by the liver first. 

Peak

When concentration of dug is the highest in the blood 

Trough level:

Drug at its lowest concentration in the blood 

Half-life:

Amount of time for half the drug to be excreted from the body.

Onset

Time it takes for effects of drug to appear, minimum effective concentration 

Duration of action:

Time period drug produces pharmacological effects

Therapeutic Range:

Range of therapeutic concentration where the drug is effective without being toxic 

Storage systems:

Locked medication carts, refrigerates storage, controlled substance storage with strict documentation, automated dispensing cabinets 

Med errors:

Defined as any inappropriate event. Can be from confusion of similar dug name, lack of knowledge, lack of patient info, equip error, misheard, wrong route. Avoid the errors by 5 rights of admin, error prevention tech, and read telephone orders back. If you commit an error immediately assess the patient first, report findings, foll out incident report. 

Therapeutic range-

range of therapeutic concentration. The serum drug level is minimal

Trough level

Occurs when drug is at its lowest concentration, right before next dose

Absorption

Refers to movement of the drug from site of administration

1: Route- Manufactured to different route all are absorbed at different rates

2: Solubility of drug- ability of a medication to be transformed

3: Blood flow to the area: Absorbed rapidly in areas with greatest blood flo

Pharmacokinetics

how the medication moves throughout the body

Factors that affect pharmacokinetics

Age, weight, sex, pregnancy, environment, route, timing, fluids, pathological states, genetics, enzyme deficiencies, psychological factors

Distribution

The transportation of a drug in body fluids to various tissues and organs of the body

1: Local blood flow: blood supply of target sites affects distribution of a drug

2: Membrane permeability- Drug molecules must leave the blood and cross capillary membranes to reach site of action

Metabolism

Chemical inactivation of a drug through its conversion. Takes place mainly in the liver. Can also take place in kidneys, blood plasma, intestinal mucosa, and lungs

Excretion

 A drug continues to act in the body until it is excreted, kidneys are the primary site of excretion. The liver and GI tract can have some excretion. Lungs can also excrete

Pharmacodynamics

How a drug affects the body

Primary effects of Pharmacodynamics

Pallatative, Supportive, Substituve, Chemotherapeutic, Resotrative

Palliative

Relieve S/S of disease but no effect on disease itself (ex. Morphine for cancer)

Supportive

Support integrity of body functions until other meds or treatments become effective (ex. Pt w/ bacterial infections given acetaminophen to control fever)

Substitutive

Replace body fluids or a chemical required by body for improved functioning (ex: insulin for diabetic, iV fluids)

Chemotherapeutic

Destroy disease producing microorganisms or body cell (ex: antibiotics used to treat infections)

Restorative

Return body to or maintain the body at optimal levels of health (ex: vitamins and minerals in patients recovering from surgery)

Secondary effects of Pharmacodynamics

Side effects, Adverse reaction, toxic reaction, idiosyncratic reaction, cummaltive efects,

Side effects:

Unintended, predictable is common

Adverse effects:

Harmful, unintended unpredictable

Toxic reactions:

Dangerous, damaging effects to an organ tissue. More severe than adverse

Allergic reactions:

Immune system identifies as foreign substance that should be neutralized or destroyed. No problems with 1st dose but after 1st. Watch for anaphylaxis

Idiosyncratic reactions:

Unexpected, abnormal, or peculiar response to a medication

Cumulative effects:

Increase response to repeated doses of drug that occurs when rate of administration is greater than rate of metabolism and excretion.

Drug abuse

is intentional use of a drug for non-medical purposes, inappropriate intake by amount, time, situation, frequency. Like alcohol at work 

Drug misuse

is improper use but not necessarily for the purpose of getting high, often just medication use incorrectly, nonspecific, indiscriminate. Like older adults using laxatives or Benadryl for sleep 

Osmosis

Involves movement of water across a membrane from an area of less concentration, to an area more concentrated. Moves across the membrane to dilute the higher concentration of solutes. Recall that a solute is a substance in body fluid. 

Crystalloids

Solutes that readily dissolve (electrolytes)

Colloids

Larger molecules that do not dissolve readily (proteins)

Osmolality

Concentration of solutes creating pressure in body fluid

Hypotonic

 lower osmolality than blood. Water moves by osmosis from blood stream into cells

Hypertonic

Contains a higher concentration than blood does. Water moves by osmosis from cells. (3% NS increase in blood volume)

Isotonic

Same osmolality as blood. No movement of water happens.

Diffusion

Passive process by which molecules of solute move through a cell membrane from an area of high concentration to low concentration

Filtration

Movement of both water and small particles from an area of high pressure to one of low pressure

Active transport

Molecules move across cell membranes against a concentration gradient. This requires energy expenditure. 

IV Hypotonic solution

lower osmolality than blood. Water moves by osmosis from blood stream into cells

ex: Used for cellular dehydration, diabetic ketoacidosis, and hypernatremia. 0.35 NS. 

Iv Hypertonic solution

Contains a higher concentration than blood does. Water moves by osmosis from cells. (3% NS increase in blood volume)

ex: water moves into blood stream. 3% NS, D5. For cerebral edema, severe hyponatremia. 

Isotonic Iv solutions

Same osmolality as blood. No movement of water happens.

ex:NS, LR. No fluid shift occurs in cells. For dehydration or blood loss.  

how electrolytes work

work in the body as crystalloids they readily dissolve. Nerve signaling, muscle contraction, fluid balance, acid-base balance, heart rhythm. They have an electrical charge.

Intracellular

Contained within cells. Accounts for approximately 40% of body weight and is essential for cell function and metabolism (40% of body weight, essential for cell function and metabolism)

Extracellular

Found outside of cells. Carries water, electrolytes, nutrients, and oxygen to cells and removes waste products of cellular metabolism. Accounts for 20% of body weight and exists in 3 main locations (Interstitial, Intravascular, Transcellular)

Interstitial

lies in spaces between the body cells. Excess fluid within is called edema ( in between tissue)

Intravascular

the plasma within blood. Main function is to transport blood (In blood)

Transcellular fluids-

Includes specialized fluids that are contained in body spaces (CSF)

Kidney

is an organ for electrolyte and fluid balance. You have thirst mechanism, urine, sweating, hormonal regulation like ADH that hands onto water, Aldosterone that hands on to water and NA, RAAS that increase fluid. 

what are cations?

NA, K, Ca, Mg. ICF has potassium and magnesium.

what are anions?

Cl, HCO3, SO4. ICF has phosphate 

Insensible fluid

fluid loss cannot be measured like sweat, exhaled water, breathing, and crying.

Sensible fluid

fluids can be measured like urine, vomiting, and diarrhea

Hypovolemia

• Refers to low blood volume of fluids.  

• Caused by loss of fluids and electrolytes from ECF. Dehydration, hypovolemic shock, urine, seating, breathing, feces, vomiting, asthma, diabetes insipidus, hyperglycemia, increased albumin, nasogastric suction, increased respiration, dementia. 

• S/S: low venous pressure, low BP, weight loss, tachycardia, stroke volume low, poor skin turgor, decreased urine, Increased urine specific gravity, thirst, confusion, high hematocrit, dry membrane, increased serum osmolarity, muscle weakness.  

• You can replace fluids by IV, peripheral vascular device, central line, electrolyte supplement, 

Hypervolemia

• too much fluid in the blood 

• Causes: excessive salt intake, kidney disease or liver, poor pumping heart, excess intake, heart failure, too much ADH, pulmonary edema. 

• S/S: increased venous pressure, tachycardia, decreased serum electrolyte concentration, tachypnea, ascites, weight gain, bounding pulse, muscle weakness, increased BP, cool and pal

Antidiuretic hormone (

ADH) is released from the pituitary gland when blood is too concentrated (so blood volume is low) and tells kidneys to hang onto water.

RAAS 

renin angiotensin-aldosterone system) is activated when blood pressure or kidney perfusion drops. The kidneys release renin, which starts a cascade which results in angiotensin II and aldosterone. Angiotensin II is a strong vasoconstrictor. Aldosterone tells the kidneys to hold onto salt, so between the 2 hormones, blood pressure is increased. 

Thyroid hormone

when pituitary gland senses blood volume is low thyroid stimulating hormone is released, triggering thyroid hormone to be released, which increases cardiac output, which increases glomerular filtration rate and urine output, and increases blood volume/pressure.

Atrial natriuretic peptide (ANP)-

released by the heart’s atria when blood pressure is too high. Causes urine output and vasodilation 

Brain natriuretic peptide (BNP

released by the heart’s ventricles and acts like ANP… but levels increase during heart failure so this is a biomarker that is tested in the blood that helps diagnose heart failure. 

C-type natriuretic peptide (CNP)- 

stimulates long bone growth. (not sure how it regulates blood volume/pressure.) 

How the body regulates fluid: 

ADH, RAAS, Thyroid hormone, ANP, BNP, CNP

S/S of pneumonia

cough, malaise, crackles in lungs, pleural pain from coughing, colored sputum, fever, chills, dyspnea, high WBC count. 

Pneumonia

is an infection of the lungs that causes alveoli to be inflamed with fluid or pus. Signs are SOB, tachypnea, productive cough with yellow/green sputum, crackles in lungs, chest pain, confusion, weakness, cyanosis, low O2.

Hypoxemia

low arterial blood O2 

Hypoxia

inadequate oxygenation of organs and tissues

Treatment for pneumonia

administering oxygen, airway clearance like coughing and incentive spirometry, mobilizing secretions, high fowlers, encourage liquids to thin secretions, immunization for pneumonia and influenza, support smoking cessation, aspiration-like head down when swallow, encourage deep breathings.

Medications for pneumonia

include bronchodilators, anti-inflammatory, nasal decongestants, antihistamines, and cough preparations. Do not take ACE, ARBS, BB, or Opioids. 

Factors that influence pulmonary function (developmental stage) 

• Infants are smaller so there is less gas exchange. Premature are at high risk for RDS which is alveolar collapse because no surfactant. Born at term have small airways, easily obstructable, choking hazards, low CNS and IS. Don’t want too much O2 in babies or else blindness. 

• Toddlers are at risk for upper respiratory tract infection like swollen tonsils and risk for infection 

• Preschool and school age are more mature. Begin with tobacco, asthma, URI, viral infections 

• Adolescents begin nicotine and smoking 

• Older adults have reduced lung expansion, difficulty expelling, decreased ventilation and immune system, kyphosis, GERD, slow chemoreceptors 

Respiratory illness protection 

Vaccines, hand hygiene, no smoking, wear PPE, healthy lifestyle, avoid environmental irritants. 

Physiological changes in the cardiovascular system 

As you get older you have decreased cardiac output, thickening of heart walls, lost elasticity, increased resistance, increased risk of heart diseases. 

Medication for CHF 

• Diuretics like furosemide or hydrochlorothiazide 

• Ace inhibitors ending in pril 

• ARBs ending in sartan 

• Beta blockers 

• Digoxin 

Treatments to promote optional circulatory function 

Promote venous return, promote peripheral arterial circulation by walking and exercise, prevent clot formation, give medications, and reduce anxiety. Elevate legs for venous return. Weight management, diet healthy, 

Circulation

is blood flow to heart and vessels

Perfusion

is blood flow to capillary bed and providing nutrients and O2 to tissue cells 

Treatment to promote optional respiratory function 

Treatment is administering oxygen, airway clearance like coughing and incentive spirometry, mobilizing secretions, high fowlers, encourage liquids to thin secretions, immunization for pneumonia and influenza, support smoking cessation, aspiration-like head down when swallow, early ambulation, encourage deep breathings. Medications include bronchodilators, anti-inflammatory, nasal decongestants, antihistamines, and cough preparations. Do not take ACE, ARBS, BB, Opioids 

Smoking cessation

Once you stop smoking after about 1 week, your lungs begin to repair themselves.

Stock Supply

Medications used most frequently may be kept in stock supply (bulk quantity), labeled, and in a central location. 

Unit-Dose system-

A locked mobile cart is used, with drawers containing separate compartments for each patient’s medications. A unit-dose is the prescribed amount of drug the patient receives at a single time. 

Automated Dispensing System-

An automated dispensing system is a computerized system similar to a unit-dose system. The locked cart contains all the medications frequently used on a particular nursing unit. The computer database contains prescriptions, records, and counts of the medications for each patient on the unit. Each nurse uses a password to access the machine and enters the data about the needed drug, after which the machine dispenses the medication, usually packaged in unit doses. 

Self- Administration

At times while in the hospital, patients may self-administer medications (SAM).