Pharmacology Exam 1

Rights of medication administration

Right drug, right route, right patient, right dose, right time, right to refuse, right documentation, right response

What should you ask a patient prior to giving the drug to the client?

Identify the patient with two identifiers, if the patient has any questions, if this looks like the right mediation

What contributes to medication errors

miscommunication, illegible orders, getting distracted when preparing a medication, etc.

How can medication errors be prevented

9 rights, checking the label, checking the patient, go over ehr

How should medication errors be reported?

via facility protocol

What are the enteral routs of administration

orally, rectally, NG tube, or gastrostomy tube

What are the parenteral drug routs of administration

intradermal, subcutaneous, intramuscular, intravenous

What are the 4 processed of pharmacokinetics

absorption, distribution, metabolism, excretion

Absorption

when the drug enters the bloodstream

Distribution

transportation via bloodstream

Metabolism

drug changes into a metabolite to perform drug efects

Excretion

elimination of the drug from the body

Plasma half life

the time required for half the drug to be removed from the body

Therapeutic index

ratio of drugs toxic level to level of therapeutic effects

Breastfeeding risks with medication

drugs that the mother consumes can diffuse into the breastmilk

Pregnancy considerations for medications

drugs can cross the placenta by diffusion

Infants and older adults medication condiseration

Gastric pH is less acidic, GI tract is slower to empty, decreased liver function, excretion is impaired, kidney function is decreased

Children dosing consideration

always dose by weight in kilometers

Drug approval step

Phase IV- the drug has been approved and went through clinical trials, ready to distribute to the population, the nurse needs to monitor patients for adverse effects and the black box warning

Why is it important to ask your patients what herbal supplements they’re taking

Certain herbs and certain OTC medicines can make a back side effect when taken together, so a full medication reconciliation is necessary in order to keep the patient safe

Gingko and garlic interactions

increases risk of bleeding when taken with anticoagulants

St. John’s Wort indications

increases risk of serotonin syndrome in patients taking SSRIs

Cranberry and grapefruit juice indications

Causes decreased elimination of drugs that are renally excreted

Anxiolytic drugs MOA

reduce anxiety by reducing overactivity in the CNS

What drugs are anxiolytic drugs?

Benzodiazepines (Buspirone, Alprazolam, Diazepam, Lorazepam)

Benzodiazepine adverse effects

sedation, hypotension, drowsiness, nausea, loss of coordination, dizziness, headache, vomiting, dry mouth, constipation

Buspirone side effects

paradoxical anxiety and blurred vision

Alprazolam considerations

indicated for short term relief of anxiety symptoms

Diazepam considerations

long term relief of anxiety symptoms, management of alcohol withdrawal, reversal of status epilepticus

Lorazepam consdierations

immediate acting long term relief of anxiety symptoms

Antidote for Benzodiazepines

Flumazenil

Mood stabilizing drugs

Lithium

Lithium side effects

cardiac dysrhythmia, drowsiness, slurred speech, seizures, hypotension, involuntary movements of the extremities, disturbances of muscular coordination

Anti-depressant medication types

Tricyclic, MAOIs, SSRIs, and SNRIs

Tricyclic antidepressant

amitriptyline

Amitriptyline side effects

drowsiness, dizziness, orthostatic hypotension, dysrhythmias

Antidote for amitriptyline

activated charcoal

MAOIs considerations

avoid foods that contain tyramine (aged or mature cheeses, red wines, aged meats)

Antipsychotic medication

Haloperidol

Haloperidol side effects

drowsiness, tremors

SSRI and SNRI side effects

insomnia, weight gain, sexual dysfunction

SSRI medication

Citalopram

SNRI medication

Duloxetine

Mood and Behavioral Pharmacologic Therapy Patient Education

patients need 6 weeks for this medication to take full effect, keep an eye out for suicidal ideations

Kava

herbal supplement used for mood and behavioral disorder treatment, interactions with alcohol, barbiturates, and psychoactive drugs

Valerian

herbal supplement to treat mood and behavioral disorders, interacts with CNS depressants, MAOIs, ,alcohol,phenytoin, and warfarin

Hypnotic medication

zolpidem (short acting)

Zolpidem effects

sleep walking

What is a black box warning

one of the primary alerts for identifying extreme adverse drug reactions discovered during and after the review process, always found in drug reference manual

What is the antidote for opioids

Naloxone and Naltrexone

What is the common medication used for alcohol withdrawal

benzodiazepines and disulfiram

How do you assess for pain

rate pain, does the pain move, what type of pain is it, does anything make the pain worse or better

Pain controlling steps

use the nonopioid medication first if applicable, then move to the nonopoids with or without adjuvant meds, then move to the least to strongest opioid medications

Opioid side effects

respiratory depression and constipation

Non-opioid side effects

respiratory depression, constipation, more hepatotoxic than opioids

NSAIDs side effects

heartburn, severe GI bleeding, acute renal failure

Opioids MOA

binds to an opiate pain receptor in the brain and causes an analgesic response

Non-opioid MOA

blocks pain receptors peripherally by inhibiting prostaglandin synthesis

NSAIDs MOA

inhibition of the leukotriene pathway, the prostaglandin pathway, or both. Blocks the chemical activity of the enzyme COX

Sympathetic nervous system neurotransmitters

norepinephrine, epinephrine, dopamine

Sympathetic nervous system function

activated under stress and produces a set of actions called fight or flight response, HR increases, BP increases, liver produces more energy, bronchi dilate, pupils dilate

Parasympathetic Neurotransmitter

Acetylcholine

Parasympathetic nervous system function

activated under normal conditions and produces symptoms called rest and digest. Digestive and urinary responses are increased, HR and BP decrease, bronchi constrict

Stroke

neurological deficits result from a sudden decrease in blood flow to a localized area of the brain

Ischemic stroke

area of brain is deprived from blood

Hemorrhagic stroke

area of brain is bleeding

Thrombotic stroke

blood clot blocks blood flow to other parts of the brain

Embolic stroke

blood clot moves and blocks blood flow

Cerebral hemorrhage

aneurysm in brain

Risk factors for stroke

TIA and hypertension

Medications to treat stroke

Anticoagulants, Antiplatelets, Thrombolytics

Anticoagulant medications

enoxaparin and heparin

Antidote for Heparins (enoxaparin and heparin)

protamine sulfate

Heparin and enoxaparin side effects

bleeding and GI bleeding

Anticoagulant side effects

bleeding, heparin-induced thrombocytopenia, nausea, vomiting, abdominal cramps, thrombocytopenia

Heparin considerations

Monitor aPTT labs

Enoxaparin considerations

used for prevention of stroke treatment, comes in pre filled syringes, don’t expel the air bubble from the syringe

Dabigatran consideration

first oral thrombin inhibitor that is approved for stroke prevention

Thrombolytic drugs

dabigatran and altepase

Antiplatelet drug

aspirin

Alteplase considerations

can cause MI or stroke,

Anticoagulants MOA

Antiplatelet MOA

inhibit platelet aggregation and prevent platelet pluges (decreases stickiness of our platelets)

Thrombolytic drugs MOA

Aspirin considerations

used as an analgesic, anti-inflammatory, antipyretic, and antiplatelet.

Aspirin MOA

Thrombolytic drugs adverse effects

Seizure

brief episode of abnormal electrical activity in the nerve cells of the brain

Cause of seizures

some have no known cause and some are due to trauma, infection, fever, or cerebrovascular disorder

Types of seizures

Tonic-clonic, clonic, tonic, absence, focal onset

Tonic seizure

spasms of the upper body

clonic seizure

contraction and relaxation of the body

Tonic-clonic seizure

muscular contraction throughout the whole body and contraction and relaxation

Absence seizure

brief loss of awareness with rapid blinking for up to 30 secs

Focal onset seizure

originates in localized area of the brain

What medications are used to treat seizures

barbiturates, hydantoins, iminostilbenes, valproic acid, second and third generation antiepileptics

Barbiturate medication

primidone

Barbiturates side effects

sedation

Hydantoin medication

phenytoin

Hydantoins side effects

gingival hyper plasia, osteoperosis