Pharmacology, Clinical Judgment, and Medication Administration

Comprehensive practice flashcards covering over-the-counter and prescription pharmacology, lifespan dosage adjustments, administration routes, unit conversions, and legal/ethical principles.

How does FDA approval for over-the-counter (OTC) medications differ from prescription medications?

OTC medications receive FDA approval for use by consumers without healthcare provider oversight.

What are the primary safety concerns and complications associated with OTC analgesic overuse?

Risk of side effects, potential drug toxicity, incorrect dosing, and delayed treatment of underlying conditions compared to prescription opioid agonists.

What is the primary function of antacids and what client caution is associated with them?

They neutralize active gastric acid to treat conditions like reflux, but carry risks of drug-drug interactions and systemic complications.

What key client teaching point should be emphasized regarding the timing of Proton Pump Inhibitor (PPI) administration?

Clients should be educated on proper timing of doses, potential adverse effects, and cautions for safe short-term use.

What are the risks associated with the overuse of OTC laxatives?

Chronic overuse can lead to bowel dependency, electrolyte imbalances, and altered bowel function.

What caution should nurses provide to clients taking OTC antidiarrheal medications?

Clients must identify and address the underlying cause of diarrhea and avoid prolonged use to prevent severe complications.

What common adverse effects and precautions are associated with OTC antihistamines?

Central nervous system depression causing drowsiness or sedation, along with potential drug-drug interactions.

What client education should be provided regarding OTC nasal steroid sprays?

Instruct on proper spray administration technique, delayed onset of action, and potential localized or systemic complications.

What serious risks are associated with the misuse of OTC cough suppressants containing dextromethorphan?

Potential for severe central nervous system depression and serotonin syndrome.

What lifestyle recommendation is critical for clients taking cough expectorants?

Maintain high fluid hydration to assist in thinning and loosening respiratory secretions.

What is the role of topical emollients in skin management?

They act as softening or smoothing agents to restore and preserve the skin barrier.

What guideline must be followed when applying OTC topical corticosteroids?

Apply a thin layer as directed to avoid excessive systemic absorption and tissue thinning.

What factors contribute to the misuse of OTC medications by clients?

Overuse and inappropriate usage driven by easy access and the misconception that non-prescription status guarantees absolute safety.

What is the nurse's role in guiding clients who self-select OTC medications?

Assessing appropriate selection, dosage, contraindications, and precautions, educating the client, and informing the healthcare team.

How is polypharmacy defined, and why does it present a clinical risk?

Taking medications for more than one problem; it significantly increases the risk for drug interactions and adverse side effects.

How does co-administering calcium affect the absorption of oral tetracycline?

Giving tetracycline with calcium prevents the intestinal absorption of tetracycline.

How does dehydration impact circulating medication levels in the bloodstream?

Dehydration reduces fluid volume, which can increase medication levels in the blood and lead to drug toxicity.

What is the clinical purpose of the Beers List and the KIDs List?

They provide evidence-based criteria for identifying potentially inappropriate medications in older adults (Beers List) and pediatric patients (KIDs List).

What age-related physiological changes in clients older than $55\text{ years}$ affect drug disposition?

Diminished gastrointestinal function, abdominal wall congestion, and altered liver and kidney function slow absorption and excretion, risking toxic accumulation.

Why are neonates at high risk for adverse medication effects?

Their renal and endocrine systems are immature, drug metabolism and excretion are impaired, and their central nervous system is highly susceptible to medication effects.

Where should intramuscular (IM) injections be administered in infants?

In the vastus lateralis (thigh), because their arm muscles are poorly developed.

How does body composition in men affect drug absorption and distribution compared to women?

Men typically have higher muscle mass relative to fat, allowing medications to be absorbed and distributed more quickly.

Why is the human fetus particularly vulnerable to teratogens in the first and last trimesters?

In the first trimester, vital organ systems are actively forming; in the last trimester, the fetus is prone to accumulating drugs prior to birth.

What defines Pregnancy Safety Category X?

Studies show positive evidence of human fetal risk and abnormalities; these drugs are strictly contraindicated in pregnant women.

According to the Nurse Practice Act, what is mandatory before a nurse administers any medication?

A valid order from an authorized prescriber (except for Advanced Registered Nurse Practitioners).

What are the three required safety checks during medication administration?

Check 1: verify medication against the MAR before preparation; Check 2: check medication against the MAR after preparation; Check 3: check medication against the MAR at the bedside right before administration.

Which solid oral medication forms must NEVER be crushed or broken?

Enteric-coated tablets and time-release (sustained-release) tablets or capsules.

How should a nurse measure liquid oral medication in a calibrated medicine cup?

Place the cup on a flat surface and view at eye level, reading the dose at the lowest point of the concave fluid surface (meniscus).

What distinguishes an elixir from a syrup?

An elixir contains water and about $25\%$ alcohol sweetened with volatile oils, whereas a syrup is an aqueous sugar solution used to mask unpleasant drug tastes.

What position should a client be placed in prior to administering oral solid medications?

High-Fowler's position to prevent aspiration.

How long should a client avoid drinking fluids after receiving a buccal medication?

$15\text{ to }20\text{ minutes}$ to maximize absorption and prevent washing away the drug.

Why do sublingual medications produce a rapid pharmacological effect?

The sublingual mucosal mucosa is highly vascular, allowing rapid absorption directly into the bloodstream while avoiding hepatic first-pass and gastric acid degradation.

What position is required for administering a rectal suppository?

Sims' position (left lateral position with the right hip and knee flexed).

How deep should a rectal suppository be inserted in an adult patient?

Gently pass the suppository beyond the internal sphincter along the rectal wall, approximately $1\text{ to }3\text{ inches}$.

What clinical benefit is provided by using a spacer attached to a Metered-Dose Inhaler (MDI)?

It traps the aerosolized medication in a holding chamber, enabling deeper and more effective delivery into the lungs.

How does a nebulizer deliver inhalation therapy?

It uses compressed air or oxygen to convert liquid drug solution into a fine aerosol mist breathed in through a mask or mouthpiece.

How should the ear pinna be positioned when administering otic drops to an adult versus a child?

For adults, pull the pinna up and back; for children, pull the pinna down and back.

What is the rebound effect caused by frequent use of topical nasal decongestants?

Severe recurrent or increased nasal congestion that occurs as the drug wears off, leading to continuous reliance on the medication.

What mathematical operation converts grams to milligrams in the metric system?

Multiply the number of grams by $1,000$.

What mathematical operation converts kilograms to grams in the metric system?

Multiply the number of kilograms by $1,000$.

What is the conversion factor between kilograms and pounds?

$1\text{ kg} = 2.2\text{ lbs}$.

How many teaspoons (tsp) equal $1\text{ tablespoon (T)}$ in household measurement?

$3\text{ teaspoons}$.

How many fluid ounces (oz) are in $1\text{ cup (c)}$?

$8\text{ fluid ounces}$.

What special legal prescribing rules apply to Schedule II controlled substances compared to Schedule III–V drugs?

Schedule II drugs require a formal written prescription signed by the prescriber (or compliant emergency process) and cannot be refilled.

What requirements must be met to fulfill an emergency verbal prescription for a Schedule II drug?

Quantity limited to the emergency period, immediate documentation by the pharmacist, identity verification of prescriber, and delivery of a written prescription marked 'Authorization for Emergency Dispensing' within $7\text{ days}$.

What is an automatic stop order and why is it implemented?

An order that automatically expires after a set period (e.g., Schedule II/III drugs or antibiotics for $10\text{ days}$) to prevent misuse and dependency.

What required elements must appear on a drug manufacturer's container label?

Medication strength, dosage form, total quantity, LOT number, National Drug Code (NDC) number, manufacturer name, storage instructions, expiration date, and 'Rx only' or schedule designation.

How do the ethical principles of autonomy and beneficence differ in healthcare delivery?

Autonomy respects the client's right to make independent choices regarding their care; beneficence requires acting to promote the best outcome for the client.

What is the nursing ethical definition of nonmaleficence?

The duty to avoid inflicting harm or injury upon the client during care.

What is the application of distributive justice in healthcare nursing?

Ensuring fair, equitable, and unbiased allocation of healthcare resources and care to all clients regardless of status.