Pharmacology Exam 1 Review

What are the rights of medication administration?

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

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

Name, date of birth, medication history, allergies

Know what contributes to medication errors.

Most medication errors occur as a breakdown in the medication use system, as opposed to being the fault of the individual. Errors can occur during any step of medication process, organizational issues, educational system issues, sociologic factors, use of abbreviations

How can medication errors be prevented?

Reporting the error, reporting of potential errors, non punitive approach to error reporting, follow 9 rights of medication administration. Quiet environment, no distractions, do not give medication you didn’t draw up yourself

How should medication errors be reported?

report to prescriber and nursing management, document error per policy and procedure, factual documentation only.

what are the enteral drug routes of administration?

mouth, nasogastric tube, gastrostomy tube, rectal (take 30-45 minutes to take full effect)

what are the parenteral drug routes of administration?

intradermal (ID), subcutaneous (subcut.), intramuscular (IM), intravenous (IV) (30 minutes -immediately to take full effect)

Intradermal (ID)

dermis layer of the skin (TB test)

Subcutaneous (Subcut.)

* deepest layer of the skin (fatty portion)
* drused for easy access and rapid absorption

Intramuscular (IM)

* delivers medication specifically to the muscle
* more rapid onset of action than with oral, ID, or subcut.
* avoid bone, blood vessels and nerves

Intravenous (IV)

* administered directly into the bloodstream and are immediately available for use by the body.
* fastest drug onset action (but also most dangerous)

What are the four processes of pharmacokinetics?

absorption, distribution, metabolism, excretion

Absorption

* where first pass effect happens
* happens in the liver
* drug is absorbed at the site it was given

Distribution

* transport of a drug by the bloodstream to its site of action
* Albumin is the most common blood protein that carry the drug molecules
* drug is transported to where its site of action is

Metabolism

* drug is transported to the liver to become “inactive”

Excretion

* drug is moved out of the body via exretion - kidney
* elimation of drug from the body
* If PO they will go through first pass effect, if IV, IM, sublingual, buccal- those will bypass first pass effect

What is plasma half life?

time required for half (50%) of a given drug to be removed from the body (amount of time it takes for the drug to get out of the body) (takes about 5 half lifes for drug to be in-affected)

What is therapeutic index?

ratio of drugs toxic level to the level of therapeutic effect (see toxicity if not in the index, too low, not working)

Which drug approval step is important for nurses to be aware about and why?

Phase 4 is important because drug has been approved through all phases, clinical trials, and ready to be distributed for the population (monitor patient for adverse affects) where FDA can pull that drug and do more research on the products.

What is important to ask your patient when taking herbal supplements?

**Obtain thorough medication history**, **documenting all medications used** (prescription, OTC, herbal products, vitamins, mineral, and other dietary supplements). **Assess allergies, assess level of education and understanding, assess for information specific to various products, assess for information specific to various products, assess system functions** (especially renal, liver, and cardiac), **assess for conditions that are contraindications, assess for potential drug-drug and drug-herbal interactions, assess lifespan considerations. (herbal products may not be safe for pregnant or breastfeeding women's, infants or children.**

Antidepressant classes

* **Benzodiapeines**
* Tricyclic antidepressants (TCA)
* Monoamine oxidase inhibitors (MAOIs)


* Second generation antidepressants

what is a HUGE question to ask all our patients who are on psychotherapeutic drugs?

Ask patient if they are experiencing any suicidal thoughts

Benzodiazapines

* decreased CNS activity (sedation)
* hypotension
* drowsiness, dizziness, headaches

Antidote for benzodiazepines

Flumazenil

Benzodiazepine examples

* Alprazolam (short term relief of anxiety symptoms)
* Diazepam (long acting relief of anxiety, alcohol withdrawal)

Tricyclic antidepressant (TCA) side effects

* drowsiness
* dizziness
* orthostatic hypotension
* dysrhythmia

Tricyclic antidepressant (TCA) example

amitriptyline

(if overdose activated charcoal used if ingested within 2 hours)

Monoamine oxidase inhibitors (MAOIs) side effects

* dry mouth
* nausea
* headaches
* drowsiness
* insomnia

What do you not digest when taking MAOIs?

* foods that contain Tyramine
* aged, mature cheese
* processed meet
* red wine

Second generation antidepressant side effects

* insomnia
* weight gain
* sexual dysfunction

What herbal supplement do you avoid when you take second generation antidepressants?

St. Johns wort (increases sarotonin syndrome)

How will you educate your patient on psychotherapeutic drugs?

Provide simple explanations about the drug, its effects, and the length of time before therapeutic effects can be expected, advise patients to avoid abrupt withdrawal, advise patient to change positions slowly to avoid postural hypotension and possible injury. Requires 6 weeks before it takes full effect. High risk of suicide among all age groups.

What are some nonpharmacological measures for treatment for depression?

* psychotherapy
* support groups

Second generation antidepressant examples

* citalopram
* duloxetine

What is a black box warning?

* One of the primary alerts for identifying extreme adverse drug reactions discovered during and after the review process
* Found in drug reference manual
* someone can die from it, educate patient so they know what to look for

Lithium used for bipolar disorder.

Too much sodium can have adverse effects. A sudden decrease of sodium intake, may result in higher serum lithium levels. Sodium levels out of range → check lithium levels.

What is the antidote for opioids?

Naloxone, naltrexone

What is the common medication used for alcohol withdrawal?

* Diazepam
* Lorazepam
* Benzodiazepines:
* Disulfiram - treatment for alcoholism
* Acamprosate - newest treatment

How do you assess pain?

* Ask patient their pain on a scale from 1-10
* O- onset
* L- location
* D- duration
* C- characteristic
* A- aggravating factors
* R- radiation
* T- timing
* S- severity

What are common adverse effect for non-opioid?

ulcers, nausea, vomiting, itching (same as opioid)

What are common adverse effects of opioids?

* CNS depression → respiratory depression
* Constipation

What are common adverse effects for NSAIDs?

* GI: heartburn to severe GI bleeding
* Acute renal failure

What is the MOA of opioids?

bind to opiate receptors to relieve pain (moderate to severe pain)

What is the MOA of non-opioids?

block pain impulses peripherally by inhibiting prostaglandin synthesis (mild to moderate pain relieve)

What is the MOA of NSAIDs?

Inhabitation of the leukotriene pathway, the prostaglandin pathway, or both (reduce inflammation)

What is the antidote for non-opioids?

acetylcysteine regimen

NSAID drugs

* indomethacin
* ibuprofen (most common)
* Naproxen (fewer drug interactions with ACE inhibitors given for hypotension)
* **COX-2-** adverse effects: headache, dizziness, hypertension

What is the sympathetic nervous system?

activated under conditions of stress and produces a set of actions called the fight- or flight response; body produces an immediate response to a potential threat.

What happens during SAS

* pupil dilation
* dry mucus membranes
* Rapid heart beat
* Vasoconstriction (high BP)
* Liver produces more glucose for energy
* bronchi dilate

What is the parasympathetic nervous system?

activated under normal conditions and produces symptoms called the rest- and digest response

What happens during PNS

* heart rate decreases
* blood pressure decreases
* bronchi constrict
* constricted pupils
* stimulates salivation

What are SAS neurotransmitters?

* norepinephrine
* epinephrine
* dopamine

What is the neurotransmitter for PNS?

acetylcholine (Ach)

Is sympathetic nervous system adrenergic or cholinergic?

adrenergic

Is parasympathetic nervous system adrenergic or cholinergic?

cholinergic

What is a stroke?

Neurological deficit results from a sudden decrease in blood flow to a localized area to the brain. Also called a cerebrovascular accident (CVA).

What is an ischemic stroke?

Obstruction blocks blood flow to part of the brain.

What is a hemorrhagic stroke?

Weakened vessel wall ruptures, causing bleeding to the brain.

What is a thrombotic stroke?

Stationary clot that is formed at that specific area

What is an embolic stroke?

moving clot that travels throughout the brain

What are the risk factors for a stroke?

* TIA- brief interruption of blood flow to brain, transient symptoms without lasting/residual effects, warning signs of stroke called “mini stroke” by community, much higher risk for stroke
* HTN (hypertension)- number one preventable risk factor of stroke

What happens when the right side of the brain is damaged?

left body weakness

What happens when the left brain is damaged?

Right body weakness

Symptoms of a stroke on the left side

language

Symptoms of a stroke on the right side

impulsive

What do you not give when a patient is having a hemorrhagic stroke?

anticoagulants, anti-platelet, thrombolytic (because you need to give something that enhances clotting not produces more bleeding)

Anticoagulant

prevents clot formation

Anti-platelet

inhibits platelet aggregation, prevent platelet plug (or adhesion)

Thrombolytic

Breaks down existing clot (ischemic stroke is the only stroke that can be given this drug)

anticoagulant- prevent more clots from forming

Low weight heparin: enoxaparin

heparin

enoxaparin

Important lab to consider with anticoagulants

aPTT- monitoring for bleeding times, this lab is monitored every 6 hours when continuously infusing heparin (if lab values are high → blood is thin, if lab values are low → blood is thick (could cause clots)

What are patients at risk for with anticoagulants?

bleeding

oral anticoagulant that is approved for prevention of strokes (side effect bleeding)

dabigatran

Antiplatelet - aspirin

Recommended for stroke prevention, reduces formations that promote platelet aggregation

Why don’t you give aspirin to kids?

Could cause Reyes syndome

antiplatelet- preventer for stroke, reduces the risk

clopidogrel

Thrombolytic- drug that breaks down performed clot

altiplase (tPa)

What do you not mix with stroke medication?

ginko and garlic because they are at high risk of bleeding

What is a seizure?

syndrome of CNS dysfunction, most common chronic neurological illness

Why do seizures happen?

results from excessive electrical activity of neurons located in superficial areas of the brain (gray matter)

what is a tonic seizure

spasms of the upper trunk, muscles contract

What is a clonic seizure?

looks up, relaxation, contraction

What is a tonic-clonic seizure?

muscular contraction throughout whole body and contraction and relaxation (thrashing, strong abrupt movement)

What is an absence seizure?

brief loss of awareness with rapid blinking for up to 30 seconds. Seen in children. (stops and stares)

What is a focal onset seizures?

originates in a localized area of the brain, problems communicating, stare, smack lips, wander, fidget, unusual behavior.

What medication is used to treat/manage seizures?

Anticonvulsants

* Barbiturates
* Hydantoins
* Iminostilbenes
* Valproic acid

Barbiturate: medication class used for all seizures besides absence seizures

primidone

Hydantoin; seizure medication

phenytoin

Immunostilbenes; medication class that causes auto-induction of hepatic enzymes; affects sodium channels in neurons

Carbamazepine

seizure medication; used for focal seizures

levetiracetam

what is valproic acid used for?

Treatment of generalized seizures, bipolar disorder, and controlling focal seizures.

What are side effects for barbiturates?

sedation

what are common side effects for hydrantoins?

gingival hyperplasia, osteoporosis

what are common side effects for iminosilbenes?

ataxia, drowsiness

What are common side effects for valproic acid?

drowsiness, weight gain, hair loss, hepatotoxicity (toxic to the liver), pancreatitis (inflammation to pancreas)

What are common side effects for levetiracetam?

CNS effects (agitation, anxiety, depression, dizziness, fatigue)

What is the common cold?

virus that invades tissues (mucosa) of upper respiratory tract, causing upper respiratory infection

What is allergic rhinitis?

when the immune system is reacting to an allergen as if its harmful; hay fever and mold, dust allergies

What is asthma?

recurrent and reversible shortness of breath (airways of the lungs become narrow)

What is COPD?

Chronic obstructed pulmonary disease; chronic obstruction of lung airflow that interferes with normal breathing