NURS 3100 Exam 1 Flashcards

Pharmacology

a branch of medicine, biology, and pharmaceutical sciences concerned with drug or medication action, where a drug may be defined as any artificial, natural, or endogenous molecule which exerts a biochemical or physiological effect on the cell, tissue, organ, or organism.

Therapeutics

The use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy.

Pharmacokinetics

The therapeutic response of a medication is directly related to the medication present in the bloodstream.the application of drugs to treat disease and/or alleviate human suffering.

Classification of drug- Therapetic

focus on disease prevention and treatment and pain. Organizations based on therapeutic usefulness

Over-the-counter

no order/prescription needed, easily obtained

Drug

a chemical agent capable of producing biologic responses within the body. Once administered a drug is a medication.

Biologic

agents which occur naturally either in animal cells, microorganisms, or the human body.

Biosimilar

a chemically created drug closely related to biologic medications which have already received FDA approval.

Complementary and Alternative Medicine (CAM)

therapies-mind/body treatments along with plant extracts, herbs, vitamins, minerals, and dietary supplements. CAM is considered separately from conventional therapeutics.

Therapeutic Classification of Drugs

Organizations based on therapeutic usefulness.

Pharmacologic

organization based on how drug works on molecule, tissue, or body system level

prototype drug

a well understood drug which is used as a representative and comparison drug to all other drugs in the same class

Bioavailability

the physiologic ability of a drug to reach target cells and produce its effect.

Half-life

the time it takes for a drug to decrease in amount by half.

Onset of action

the amount of time it takes a drug to produce a therapeutic response.

Peak

the time it takes for a drug to achieve its full therapeutic effect.

Duration

the length of time the drug's therapeutic effect lasts without additional doses.

Toxic level

amount of a drug which will produce harm in the host

Pharmacoeconomics

deals with the cost and resources associated with a specific drug relative to the drug's effectiveness (or outcome)

risk/benefit ratio.

evaluation of risks relative to benefits

Teratogenic risk

refers to risk of harm to an unborn child/fetus

Prescriptive authority

Legal right to write prescriptions for medications, granted to physicians, veterinarians, dentists, and advanced practice nurses.

Dependance

use of drugs or alcohol that continues even when significant problems related to their use have developed.

controlled substances

drugs that have the potential for abuse and dependency, both physical and psychological

Drug Schedules

Classification of drugs according to their potential for abuse

Pregnancy Risk Categories

A (safest), B, C, D, or X (well established evidence of harm).

Identify principles of drug administration important in professional nursing practice.

The name and drug classification of the medication ordered How the drug is supposed to be used and its effect on the body Contraindications-the potential to cause a serious or life-threatening adverse drug reaction Special considerations (related to age, weight, liver and renal function, etc.) and potential side effects Why the medication has been prescribed for a particular patient How the medication is supplied and administration instructions Nursing process considerations related to the medication ordered for a particular patient.

Enteral

anything put non mouth, or tube into the n=mouth and stomach, or directly into the stomach (G tube) or directly into the large intestine (J)

Parenteral

by injection

topical

applied to the surface of the skin

Identify the five rights of drug administration.

right patient, right meds, right amount of meds, proper route of administration, correct time.

Active transport

a drug actively moves against concentration or electrochemical gradients. Usually, carriers or cotransporters aid in this process. Cellular energy is needed. Large molecule, ionized, and water-soluble agents use active transport.

Diffusion (Passive) transport

a drug moves from areas of high to low concentration. This process requires no cellular energy. Small molecule, nonionized, and lipid soluble drugs diffuse readily across cell membranes. The same is true for small, water-soluble agents.

Absorption

site of administration-through cell membranes-to circulation. Factors that affect absorption include drug formulation/dissolution, dose, route of administration, size of drug molecule, surface area of absorption site, GI motility, blood flow, pH, lipid solubility.

Distribution

transport of medications throughout the body after absorption or injection. Factors that affect distribution include a medication's affinity for certain areas of the body, medications also bind to plasma proteins creating a drug-protein complex. Drug-drug/drug-food interactions occur due to competition for receptor sites; the blood-brain and fetal-placental barriers prevent distribution to the CNS and fetus, respectively.

Metabolism

the biotransformation of medications to a form which is more easily removed from the body. The most important organ in this process is the liver. The hepatic enzyme system, also called cytochrome P450 (CYP450), inactivates drugs and promotes the drug's excretion.

Excretion

the removal of drugs from the body. The rate of excretion determines the concentration of drugs in the bloodstream/tissues and the drug's duration of action. The primary organ involved is the kidney.

Pharmacokinetics

The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.

Loading Dose

a higher dose of the drug initially given in order to jump start therapeutic plasma levels of the drug. gets more medication into the body sooner

Maintenance Dose

given to keep the therapeutic level of medication constant.

Drug's therapeutic Index

range in does b/w the amounts of drug necessary to a cause a therapeutic effect and a toxic effect. The larger the index, the safer the drug

Pharmacodynamics

physical affect of the drug on the Boyd, mechanism of action Medication responses also vary within an individual.The graded dose-response relationship is the patient's response to a drug at different dosages.

partial agonist

drug that has a ceiling, further does beyond that ceiling will not produce additional effects

A partial agonist (agonist/antagonist)

produces a weaker, or less efficacious, response compared to an agonist.

Agonist

a molecule that, by binding to a receptor site, stimulates a response

antagonist

prevents the endogenous substance from (1) acting due to receptor competition or (2) inhibiting the effect of an agonist by changing the pharmacokinetic processes of the agonist. The second action of antagonists likely explains many drug-drug and drug-food interactions.

Identify and describe the steps of the nursing process.

Assessment, Nursing diagnosis Plan, Implementation, Evaluation

Subjective data

anything told to you; feelings, perceptions. Subjective data is obtained from the patient, patient friends or family, or other individuals in the community.

Objective data

includes physical assessment (vital signs), laboratory or other diagnostic test results. Objective data can be measured and validated.

Identify the components of a complete patient/medical history.

History of Present Illness-should include; onset/chronology, position/radiation, quality, quantity, related symptoms, setting, transforming factors (OPQQRST). Past Medical History-should include the following; general state of health/past illnesses/injuries, prior hospitalizations, immunizations, reproductive history, current medications (Rx and OTC), allergies. Social History-should include the following; habits (caffeine, tobacco, alcohol, and drugs), diet, exercise, functional status (ADL), safety (seatbelts, helmets, smoke detectors, guns, sunscreen), pertinent screenings, occupation, hobbies, homelife (relationships/support/violence-abuse/stress), sleep history, sexual history, health beliefs, spirituality/religion, exposures (pets/travel/home-work/STDs), education, military service, financial and legal issues (advance directives, POA, emergency contact). Family History Review of Systems-ROS

Nursing Diagnoses

clinical judgements of a patient's actual or potential health problems that is within the nurses' scope of practice to address.

Differential diagnoses

Differential diagnoses are defined as a process in which a clinician uses prior knowledge alongside unique clinical findings from the patient, to prioritize the list of possibilities into a leading suspicion or working diagnosis, a few potentially active alternatives, and other possibilities that do not merit further consideration because they are not sufficiently likely or serious.

Planning step of the nursing process

Planning involves prioritizing diagnoses, formulating desired outcomes, and selecting nursing interventions to assist patients in achieving an optimal level of wellness. Short- and long-term goals are established, focusing on what the patient will be able to accomplish. Keep in mind, goals should be achievable (realistic) and measurable.

Define the implementation steps of the nursing process.

Implementation is the action phase of the process. Patient teaching is a big nursing intervention. Once interventions have been initiated, evaluation begins. How does the patient's current condition compare with the desired outcomes?

Define the evaluation steps of the nursing process.

monitoring the outcome

List common factors associated with medication errors committed by healthcare providers and healthcare consumers.

Healthcare providers may omit one of the five rights (patient, medication, dose, route, time), fail to consider appropriateness of order or other patient characteristics such as age, weight, or renal/liver function, verbal or telephone orders, incomplete or illegible orders, high stress workplace. Patients may take medications from multiple providers, use more than one pharmacy, not refill or fill a prescription, take medication incorrectly, or take leftover medications.

Identify the major limitation in evaluating data about medication errors in the U.S.'

Data is self reported by patients or hospital systems

Identify strategies for reducing and preventing medication errors.

Verify medication/food allergies with every patient at every medication administration. Obtain an accurate and complete medication history. Double check renal and liver function. Avoid abbreviations, question unclear orders, do not accept verbal orders. Eliminate distractions during medication administration, confirm patient name and DOB, remember the 5 rights, and maintain sterility as appropriate. Calculate doses carefully, double check dosages for drugs with a narrow therapeutic range, record all medications given, confirm patient has swallowed an oral medication, be aware of XR and SR oral meds, be aware of drug names which look or sound alike. Follow the 5 rights, patients, mediation, dose, route of administration, time.

dentify important considerations for medication management in pregnant and lactating patients.

Medications are used very cautiously and judiciously in pregnant women. For women with underlying medical problems such as diabetes, seizure disorders, moderate to severe asthma, or hypertension, stopping these medications during pregnancy can be dangerous for mom and baby. On the other hand, sometimes women on certain medications may need these medications changed during pregnancy. Therefore, preconception counselling is so important for young women considering pregnancy. If diabetes or hypertension begin during pregnancy, treatment is necessary for the health of mom and baby. Antibiotics may be needed to treat an infection.

Describe placental effects important in medication management during pregnancy.

Sometimes a medication will be inactivated by enzymes of the placental membrane, preventing the medication from affecting the fetus-insulin is a good example. Sometimes a medication will be blocked by placental membranes-heparin is a good example. In general, drugs which are water soluble, ionized, or are bound to plasma proteins are less likely to cross the placenta. The way the placenta protects the fetus - multiple types of affects

Preimplantation

weeks 1-2; a teratogen will either have no effect or the embryo will die.

Embryonic period

weeks 3-8; maximum teratogen sensitivity; structural malformation or miscarriage

Fetal period

weeks 9-birth (40 weeks); fetus may receive larger doses of medications taken by mom as well as longer term exposures; growth retardation or impaired organ function is more common after teratogen exposure.

Define the categorization of medications in pregnancy: A

Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities in any trimester of pregnancy. Prenatal vitamins, insulin, folic acid, and levothyroxine are examples.

Define the categorization of medications in pregnancy: B

Animal reproduction studies have failed to demonstrate a risk to the fetus but there are no adequate and well-controlled studies in pregnant women. Or, animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate risk to the fetus in any trimester. Some antibiotics, acetaminophen, ibuprofen are examples.

Define the categorization of medications in pregnancy: C

Animal studies have shown an adverse effect, and there are no adequate, well-controlled studies in pregnant women. Or no animal studies have been conducted, and there are no adequate, well-controlled studies in pregnant women. Most prescription medications are examples.

Define the categorization of medications in pregnancy: D

Adequate, well-controlled or observational studies in pregnant women have demonstrated risk to the fetus. However, the benefits of the drug may outweigh the risk in life-threatening situations or serious disease for which safer drugs cannot be used or are ineffective. Alcohol, ACEI/ARBs, nicotine, NSAIDS, tetracyclines, some seizure medications are examples

Define the categorization of medications in pregnancy: X

Adequate, well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal risk or abnormality. Use is contraindicated and not indicated in pregnancy. Warfarin, methotrexate, statins, OCPs, isotretinoin, misoprostol, testosterone are examples.

Compare and contrast developmental factors important in pediatric medication administration.

Patient's weight. Patient's age. Body surface area. Clinically approved weight-based dosage ranges.

• Are they capable of medication management

Compare and contrast pharmacokinetic variations in pregnant, lactating, pediatric, adult, and older adult populations.

• School aged children (6-12 years) tend to be cooperative. Assisting children in learning to swallow pills is appropriate here. Give choices about taking medications when appropriate options are available. Adolescents (13-18 years); be aware of potential issues such as drug use, nicotine, alcohol, sexual activity (pregnancy & STDs), potential for eating disorders, their need for privacy and control. Adults; young ages 18-40 years, middle ages 40-65 years; tend to be healthy but weight gain and physical inactivity can become problematic. Age-appropriate screenings are important. Issues from adolescence can be a problem.

Define important considerations in holistic pharmacotherapy.

• Psychosocial variables Cultural and Ethnic variables Community and Environmental variables Gender Genetic variables

Ethnicity

biologic and genetic similarities between groups of people.

Culture

refers to beliefs, values, and traditions between groups of people.

Cultural competence

defined as the ability of health care professionals to provide care to individuals of diverse values, beliefs, and behaviors.

pharmacogenetics

Area of pharmacology that examines the role of genetics in drug response. The use of gene mapping/testing to determine the medication that works best with each individual. Pharmacogenetics is an emerging field with significant implications in pharmacology.

Identify the genetic polymorphism that describes normal enzymatic metabolism of medications.

Poor Intermediate Extensive Ultrarapid

complementary medicine

the use of a nonmainstream practice used with conventional medicine.

alternative medicine

the use of a nonmainstream practice instead of conventional medicine.

Integrative medicine

traditional and complementary approaches to treatment used in a coordinated, patient-centered manner. Also referred to as multimodal therapy.

Natural products

include the use of herbs, nutritional supplements, probiotics, and special diets.

Mind-Body Practices

include pet therapy, Ayurvedic medicine (India), biofeedback, Chinese medicine and acupuncture, chiropractic, detoxifying therapies, prayer/faith, guided imagery, homeopathy, hypnotherapy, massage/pressure point therapy, meditation, movement therapies (exercise, dance), Native American medicine, naturopathy, yoga/tai chi/qigong.

Homeopathy

a German medical system; "Like cures like"—the notion that a disease can be cured by a substance that produces similar symptoms in healthy people.

Naturopathy

(naturopathic medicine) includes diet/lifestyle changes, stress reduction, herbs/dietary supplements, homeopathy, manipulations (chiropractic) therapies, exercise therapy, practitioner-guided detox, and psychotherapy/counselling.

Describe the regulatory bodies involved in prescription and over-the-counter medications compared to supplements and herbal products.

The FDA categorizes herbal medicine as food instead of a drug, so alternative medicine isn't heavily regulated or required to meet the same manufacturing, testing, or labeling standards as pharmaceuticals.

Describe the rationale for asking patients about their use of supplements and herbal products.

Herbs can contain multiple chemicals which have not necessarily been identified, measured, isolated, or studied at all. Herbs have the potential to interact with many medications which may result in a wide variety of effects such as increasing the risk of liver or renal toxicity, seizures, bleeding, and sedation. Herbal supplements may also reduce the effectiveness of OCPs, anticoagulants, immunosuppressants, diuretics, and HAART. Hypoglycemia may be potentiated. SSRIs and some herbs can lead to serotonin syndrome.

epidemic

A disease that affects large numbers of people within a community, population, or region.

Pandemic

An epidemic which has spread to multiple countries or continents around the worl

Bioterrorism

The intentional use of infectious biologic agents, chemicals, or radiation to cause widespread harm

List important nursing actions in infection control.

Practice safe environmental infection control techniques. Adhere to safe injection practices. Take proper infection control precautions Manage exposure to support staff Monitor, manage, and train visitors about infection control procedures. The Strategic National Stockpile is a program within the CDC. Materials in this program include antibiotics, vaccines, and medical/surgical support supplies.

Anthrax

A bacterial infection which may be ingested, inhaled, or enter through an open wound. This bacteria forms spores. Treatable with fluroquinolones or tetracyclines. A vaccine is available.

Polio

A viral illness (fecal-oral spread) for which we have a very effective vaccine.

Ebola

A viral illness (blood and body fluids) with a 21-day incubation period and a fatality rate of ~90%. There is currently an experimental vaccine along with convalescent serum, monoclonal antibodies, and a new antiviral medication.

Smallpox

A viral illness (aerosol/droplet spread)with a mortality rate of up to 30%. A vaccine exists and is part of the stockpile at the CDC.

Ionizing radiation

mass exposures may result from a nuclear accident (Chernobyl, Fukushima) or a nuclear bomb.

Radiation sickness

can be acute (N&V&D). Late symptoms include weight loss, fatigue, bone marrow depression, and cancers. Potassium iodide protects the thyroid only. Antidotes exist for exposures to plutonium, curium, cesium-137, and americium.

Identify agents commonly used in bioterrorism events.

Anthrax Polio Ebola Smallpox

Describe and prioritize the medical management of poisonings.

For the most part, poisoning emergencies are managed with supportive care. Many poisoning events are not treated with an antidote because antidotes are not available for many poisons. The principles of supportive care include the following: ABCS of life support Manage seizure activity Surface decontamination Facilitate toxin removal by changing the pH of urine; sodium bicarbonate to excrete acidic drugs (ASA, barbiturates) and ammonium chloride to excrete alkaline drugs (amphetamines, phencyclidine/PCP). Stabilizing ABGS Maintenance of normal blood glucose levels.

Antidotes

used for specific poisonings; vitamin K for warfarin, naloxone for opioids, atropine for cholinergic agonists or acetylcholinesterase inhibitors, acetylcysteine for acetaminophen. There are also antidotes for heavy metal poisonings (iron, lead), benzodiazepine OD, antifreeze, digoxin, and some venoms (snake).

Warfarin

vitamin k

Acetylcysteine

acetaminophen