NURS 310 Exam 1

properties of an ideal drug

effectiveness, safety, selectivity

goal of a drug

cause maximum help with minimal harm

four aspects of pharmacokinetics

excretion, absorption, metabolism, distribution

sources of individual variation in drugs

physiologic differences, pathological differences, genetic variance, drug interactions

rights of medication

right med, right patient, right dose, right route, right time

additional rights of medication

right assessment, right documentation, right evaluation, right to education, right to refuse

contraindication

reason to avoid a drug(ex allergy, personal fear, preexisting condition, other drugs)

Nursing process

assess, diagnose, plan, implement, evaluate

three possible effects of drug interactions

Inhibits, amplifies, secret third thing

Mechanisms of drug interaction(4)

direct physical/chemical, pharmokinetic, pharmacodynamic, combined toxicity

Idiosyncratic effect

drug response from genetic predisposition

Paradoxical effect

the opposite effect the drug should have

Iatrogenic disease

drug induced disease

What labs should you watch for liver failure?

ALT and AST

Ginko interactions

Reduces coagulation effects, do not give with anticoagulants

Ginko purpose

improve blood flow, increase memory, prevent dementia

ginger interactions

suppresses coagulation, do not give with anticoagulants

ginger side effects

arrhythmias, lower blood sugar, spontaneous abortion

ginger uses

treat inflammation by inhibiting prostoglandin and leukotriene synthesis, treats nausea by blocking serotonin receptors

fish oil uses

reducing clotting, treating inflammation, regulating rhythm and BP

fish oil side effects

reduces clotting, do not take with anticoagulants

fish oil interactions

taken in small doses can lower triglycerides w/ low fat diet

st john’s wort uses/mechanism

treats depression and pain/inflammation by increasing reuptake of serotonin and dopamine receptors

st john’s wort side effects

skin reaction, GI upset, photophobia, anxiety, agitation

st john’s wort interactions

decrease effects of CYP450 drugs by increasing metabolism, causes excess excretion by increasing P-glycoprotein production, enhances effects of drugs by increasing serotonin transmission(serotonin syndrome)

pharmacodynamic tolerance

loss of sensitivity to a drug over time

metabolic tolerance

the body learning to purge a drug faster

tachyphylaxis

rapid tolerance to a drug developed due to rapid administration in a short period of time

OLDCARTS

onset, location, duration, characteristics, aggravating/alleviating factors, radiation, time/treatment, severity

acteminophen class

nonopiod analgesic

acetominophen action

reduces mild-moderate pain through CNS interaction

acetaminophen route

rectal, oral, IV

acetaminophen adverse effects

chance of hepatotoxicity, check ALT and AST

ibuprofen class

NSAID

ibuprofen subclass

1st gen NSAID

ibuprofen action

blocks COX enzymes from making prostaglandins in the PNS

NSAID route

oral, rectal, topical, IV, intranasal gel

NSAID adverse effects

gastric toxicity, ulceration, hypertension, bleeding, kidney problems

celecoxib class

NSAID

celecoxib subclass

2nd gen NSAIDcele

celecoxib action

blocks selective COX-2 enzymes from making prostaglandins in the PNS

tolerance

getting used to a substance and having less reaction than before

physical dependence

reliance on a drug to function normally

opioid addiction

disease of improper use of opioids resulting in dependence regardless of actively harmful consequences

pseudo addiction

drug seeking behaviors caused by poor pain management that can be seen as addiction

opioid naive

not taken opioids recently

opioid tolerant

the body has adapted to recent opioid use

equianalgesic

the dose a med has to be to produce the same effects of a different drug at a different dose

morphine class

opioid agonist

fentanyl class

opioid agonistmo

morphine subclass

pure opioid agonist

fentanyl subclass

pure opioid agonist

oxycodone class

opioid agonist

opioid agonist action

binds to mu receptors in the CNS

morphine route

PO, rectal, IV, SQ

fentanyl route

everything except PO/rectal

oxycodone route

PO liquid or pill

opioid agonist adverse effects

constipation, nausea, respiratory depression, hypotension, retention, euphoria

naloxone class

opioid antagonist

naloxone action

blocks mu and kappa recptors

naloxone route

IV, IM, SQ, intranasally

opioid agonist-antagonist action

agonist to kappa receptors and antagonist to mu receptorsp

partial opioid agonist action

agonist to mu receptors and antagonist to kappa receptors

opioid nursing considerations

prolonged QT interval, cardiac monitoring especially with preexisting cardiac conditions

tramadol class

non-opioid analgesics

tramadol subclass

non-opioid centrally-acting analgesic

tramadol action

interacts with mu receptors and blocks S/NE reuptake

tramadol nursing considerations

lower seizure frequency

system toxicity symptoms

ringing in ears, irritability, metallic taste, seizures

cardiotoxicity symptoms

tingling, numbness, bradycardia, cardiac collapse, dysrhythmia

sodium normal range

136-145 mEq/L

potassium normal range

3.5-5 mEq/L

calcium normal range

9.5-10.5 mg/dL

chloride normal range

98-106 mEq/L

magnesium normal range

98-106 mEq/L

osmolarity normal level

270-300 mOsm/kg

aldosterone function

sodium and water resorption in the kidneys, excretes potassium

aldosterone origin

secreted by adrenal cortex when ECF sodium is low

vasopressin/ADH function

acts on nephron to reabsorb water into the blood

vasopressin/ADH origin

released from posterior pituitary when blood volume is low

natriuretic proteins origin

secreted from atria and ventricles of the heart

natriuretuc peptides role

released when BP and blood volume is high to reduce both

natriuretic peptide mechanism

binds to the nephron to inhibit sodium resorption and increase urine

parathyroid hormone

increases calcium by breaking down bone, stimulating vitamin d, and inhibiting calcium excretion

thyrocalcitonin

released by thyroid to decrease calcium levels

hyponatremia cellular level

reduced membrane excitability and cellular swelling

hyponatremia s/s

stupor, anorexia, lethargy, tendon reflex, lump muscle, orthostatics, seizures, stomach cramping

hypernatremia s/s

fever, restlessness, increased blood pressure, edema, decreased output, skin flushed, agitation, low-grade fever, thirst

hypokalemia s/s

lethargic, low respirations, lethal dysrhythmias, lots of urine, leg cramps, limp muscles, low blood pressure, lazy bowels

hyperkalemia s/s

muscle weakness, urine output low, respiratory failure, decreased vital signs, early muscle twitches, rhythm changes, shits

hypocalcemia s/s

confusion, reflexes hyperactive, arrhythmias, muscle spasms, positive signs, signs of numbness

hypercalcemia s/s

stones, bones, groans, psychic moans

examples of potassium binders

sodium zirconium and cyclosilicate

-ectomy

removal of

-lysis

destruction of

-orraphy

repair of

-oscopy

looking into

-ostomy

opening creation

-otomy

incision of

-plasty

reconstruction