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TEST 1 STUDY GUIDE

TEST 1 STUDY GUIDE

1. Understand the factors related to drug/medication administration

a. 10 rights of patients in medication administration

  1. Right drug

  2. Right patient

  3. Right dose

  4. Right time

  5. Right route

  6. Right assessment

  7. Right documentation

  8. Right evaluation

  9. Right of patient to education

  10. Right of patient to refuse care

b. Conversions and abbreviations

Liquids

Solids

1 mL = 1 cm3

1,000 mcg = 1 mg

1,000 mL = 1 L

1,000 mg = 1 g

1 ml=1cc

1,000 g - 1 kg

Lbs / 2.2= kg

d. Properties of ideal drugs

  • Effectiveness: Most important property a drug can have

  • Safety: Drug does not produce harmful effects

  • Selectivity: Drug elicits only the response for which it is given

  • Predictability

  • Ease of administration

  • Freedom from drug interactions

  • Low cost

  • Chemical stability

  • Simple generic name

  • However, no drug is ide

2. Medication errors and what causes them

Causes of Medication Errors

  • Of the human factors that can cause errors, performance deficits are the most common, followed by knowledge deficits and the miscalculation of dosage

  • 90% of all errors are due to:

    • Human factors

    • Communication mistakes

    • Drug name confusion

3. Difference between pharmacokinetics and pharmacodynamics

Pharmacokinetics

  • What the body does to the drug

  • 4 processes

    • Absorption- GI tract

    • Distribution- blood

    • Metabolism- Kidney and liver

    • Excretion- bile and urine

Pharmacodynamics

  • What the drug does to the body

Sources of Individual Variation- impt!

  • Physiologic variables

    • Age, gender, and weight

  • Pathophysiology variables

    • kidney , liver damage

    • Acid- base imbalance

    • Altered electrolytes

    • Tolerance

Pharmacodynamics

  • What the drug does to the body

  • Impact of drugs on the body

  • Drug-receptor interaction

  • Patient’s functional state

  • Placebo effects

4. The nurse’s role in safe medication administration process

  • DRUG ALLERGIES

  • Do not administer any drug if you do not understand the reason for its use

  • Promoting patient adherence

    • Also known as compliance or concordance

    • Extent to which a patient’s behavior coincides with medical advice

  • Implementing non drug measures

6. Pharmacokinetic processes

  • Four major pharmacokinetic processes:

    • Drug absorption

    • Drug distribution

    • Drug metabolism

    • Drug excretion

B. Passage of Drugs Across membrane AKA BBB

  • Drug must be lipid soluble or lipophilic OR transport system

  • Plasma albumin is the most abundant and important protein in blood stream

  • METABOLISM- LIVER

7. First pass effect of medications

As you take medicine goes to stomach then to liver, so sometimes it can be less effective. You can bypass this by giving via different routes

8. Terms about pharmacodynamics

a. Therapeutic range- Also known as the therapeutic window, this is the range of drug concentrations in the bloodstream that is effective for treating a particular condition without causing significant adverse effects. It is the range between the minimum effective concentration and the toxic concentration.

b. Therapeutic index: Toxic dose/effective dose (formula for calculating

c. Half life

The half-life of a drug is the time it takes for the plasma concentration of a drug in your body to reduce by half.

It takes 4-5 ‘half-lives’ to reach plateau and 4-5 ‘half-lives’ for drug to be completely eliminated- on test

9. Drug-receptor

Agonist: goes to the receptor to turn it on to: START a Response

  • Antagonist: goes to the receptor and binds with it:

    • Partial agonist: binds to the receptor, weak response

interactions

10. Drug-drug reactions

  • Drugs can interact through four basic mechanisms:

  1. Direct chemical or physical interaction

  • IV’s can precipitate( drugs did not combine well… on next page)

  1. Pharmacokinetic interaction- what the body does to the drug

  • An elevated gastric pH can change absorption

  1. Pharmacodynamic interaction- what the drug does to the body

  • Drugs may compete for receptor sites

  1. Combined toxicity

*Usually caused by drug incompatibility

11. Drug-food reactions

  • Drug metabolism

    • The grapefruit juice effect (not occurring with other citrus fruits or juices)

    • Inhibits the metabolism of certain drugs

    • Raises the drugs’ blood levels

      • Increase in felodipine

      • Others: Lovastatin, cyclosporine, midazolam, and so on

Impact of food on:

  • Drug toxicity

    • Monoamine oxidase inhibitors (MAOIs) and tyramine-containing foods

    • Theophylline and caffeine

    • Potassium-sparing diuretics and salt substitutes

    • Aluminum-containing antacids and citrus beverages

What is considered an empty stomach?

  • 1 hour before meals or 2 hours after eating

13. Drug calculations, drip rage calculations

14. Medication errors- nurse role in prevention

  • Help and encourage patients and their families to be active and informed members of the healthcare team

  • Create an institutional culture that is dedicated to safety

  • Give healthcare providers the tools and information they need to prescribe, dispense, and administer drugs as safely as possible

  • Institute safety checklists for high-alert drugs Institute for Safe Medication Practices High-Alert Medications.

  • About 20 drugs cause 80% of medication error–related deaths

  • Replace handwritten medication orders with a computerized order entry system

  • Have a senior clinical pharmacist accompany physicians on rounds

  • Use a barcode system

  • Do not use error-prone abbreviations

  • Institute for Safe Medication Practices

  • Perform medication reconciliation

15. Drug tolerance and terms related to adverse drug reactions

  • Pharmacodynamic tolerance

    • Associated with long-term administration of drugs such as morphine and heroin

  • Metabolic tolerance

    • Results from accelerated drug metabolism

  • Tachyphylaxis

    • Reduction in drug responsiveness brought on by repeated dosing over a short time - a rapid response, ex. Afrin if you keep using it loses its effect and makes it worse

Terms Related to Adverse Drug Reactions

  • Side effect

  • Toxicity

  • Allergic reaction

  • Idiosyncratic effect- we do not know what caused it

  • Paradoxical effect - benodryal makes kids sleepy but sometimes it can make u hype

  • Iatrogenic disease - thing in medical field causes a problem

  • Physical dependence

  • Carcinogenic effect

  • Teratogenic effect - fetus related

Identifying Adverse Drug Reactions

  • Can be very difficult to determine whether a specific drug is responsible for an observed adverse event

  • Other factors to consider:

    • Underlying illness

    • Other drugs

Boxed Warnings- for the test

  • Also known as black box warnings

  • Strongest safety warning a drug can carry and still remain on the market

  • Purpose of this warning is to alert prescribers to:

    • Potentially severe side effects/adverse effects (eg, life-threatening dysrhythmias, suicidality, major fetal harm)

    • Ways to prevent or reduce harm (eg, avoiding a teratogenic drug during pregnancy)

  • The most dangerous that you can still give to pt, like sertraline has black box warning for suicide

  • Impt things to know: what's going to cause pronblems

  • What can you do as a nurse to prevent those from happen

16. Neuropharmacological drugs

How neurons regulate physiological processes…

  1. Conduction of an action potential along the axon of the neuron

  2. Release of neurotransmitter from the axon terminal and

  3. Binding of transmitter molecules to receptors on the postsynaptic cell

17. Autonomic nervous system- parasympathetic and sympathetic -know difference

  • Somatic motor system – controls movement of voluntary muscles

  • Autonomic nervous system – regulates heart, secretory glands, smooth muscles (involuntary activities)

    • Parasympathetic nervous system: pear

    • Sympathetic nervous system- simp

  • Parasympathetic-”rest and digest”

    • Slowing of heart rate

    • Increased gastric secretions

    • Emptying of bladder

    • Emptying of bowel

    • Focusing of eye for near vision

    • Constriction of pupil

    • Constriction of bronchial smooth muscle

  • Sympathetic “fight or flight”

    • Regulation of cardiovascular system

    • Regulation of body temperature

    • Implementation of “fight-or-flight” reaction:

      • Increased heart rate & BP

      • Bronchodilation

      • Vasodilation in skeletal muscle and heart muscle

      • Vasoconstriction in superficial capillaries

      • Decreased gastric secretions and motility

      • Pupil Dilation

Receptors of the Peripheral NS -know test, understand which are which… cholernergic have three and Adrenergic have 4

  • Cholinergic receptors

    • Nicotinic n

    • Nicotinic m

    • Muscarinic - most cholinergic drugs work here, and activate parasympathetic system

  • Adrenergic receptors - activate sympathetic system

    • Alpha 1

    • Alpha 2

    • Beta 1

    • Beta 2

17. Polypharmacy- taking 5 or more meds

18. If your pt has a high HR bc of meds you call for doctor

19. 2.2 lb =1kg

18. Normal lab values- WBC, RBC, platelets

Formed Elements (leukocytes)

  • Neutrophils, basophils, eosinophils, NO MONO

IMPT on TEST!: If a patient has cancer do not give them erythopoetin!

19. Understand function of WBC, RBC, platelets(Formed Elements)

  • Leukocyte(WBC)- neutrophils, basophils, eosinophils

    • Normal Range 5k-10k

  • Erythrocyte- RBC-

    • Normal Range- 4-6 million

      • Wear out in 120 days eaten by spleen and liver

      • HGB- 12-18 (men higer than women)

      • HCT- 39-50%

  • Platelet

    • Normal range i s150k-400k

    • When you have low (thrombocytopenia) you will be put on bleeding precautions

      • Treatmetn:oprelkin

When taking ertythropoetin HGb should not exceed 12

20. Understand importance of blood types

21. Differentiate the types of anemias-what causes, s/s, treatment, nursing considerations

Oral Defiency Anemia - most common

  • Give oral iron (ferous sulfate) but can cause staining of teeth

Anemia of chronic diseases- like HIV hepatitis

  • Low RBC production

  • Underlying disease first

Megoplastgic Anemia- impaired DNA synthesis

  • Results in large, fragile, defective RBC

  • Treatment: B12 (cobalamin)- caused by pernicious anemia

APLASTIC ANEMIA IS WHEN YOU HAVE RED AND WHITE BLOOD CELLS AND PLATELETS!!!- on test

Aplastic Anemia/ Pancytopenia

  • Decrease in all blood cell types

  • Red blood cells (RBCs)

  • White blood cells (WBCs)

  • Platelets

21. Inheritede Hemorrhagic Diseases

  • Classic hemophilia is factor VIII deficiency (x linked)

  • Manifestations: bleeding in joint, and nose

  • Diagnostic: Lab tests will show low levels of VIII and a prolonged PTT

22. Define homeostasis and why it is important in the body

Equilibrium in body

  • Who contains the highest percentage of water

    • Newborns (70-80)

    • Men have more than women

23. Intracellular fluids vs extracellular fluids

ICF- inside the cell - ⅔ of fluid

EXF- outside of the cell ⅓ od dluid

24. Fluid spacing

  • First spacing: normal distribution of EXF in ICF

  • Second spacing: edema

  • Third spacign : fluid trapped , pleural effusion

25. Fluid movement and disease

From plasma to interstitial

  • Results in edema can be from

    • HF

    • Fluid overload

    • Liver failure

    • Renal disease

    • Trauma

    • Burns

  • Results from intersititual to plasma

    • Medications (mannitol)

    • Compression hose

  • To maintain a stable internal environment the body uses 4 processes

    • Diffusion

    • Facilitated Difusion

    • Osmosis

    • Active Transport

26. Fluid volume deficit vs fluid volume overload- what causes, s/s treatment, nursing considerations

Fluid Volume Imbalance

  • Hypovolemia

    • Isotonic : need isotonic fluids

    • Hypertonic: meed hypotonic fluid

    • Hypotonic: need hypertonic solution

  • Hypervolemia

    • Inreased extracellular fluid (edema)

    • Treat with diuretic or fluid restriction

27. Understand difference between electrolytes and effect on body- normal vs abnormal and how to treat

Electroyltes

  1. Sodium: 135-145 (odd)

  2. Potassium 3.5-5 (pot is ass)

  3. Calcium 9-11 (call 911)

  4. Magnesium 1.5-2.5 (lil maggie is 1.5)

Sodium

  • Neurological and neuromusclar function

  • Signs and Symptoms:

  • Hyper: Thrist, lethargy, dry mouth, sticky mucous, brain damage, disorientationn, hallucination, muscle instability, convulsions

  • Hypo: Headache, confusion, anorexia, SOB with exertion, fatigue, confusion, deliriium, shock, coma

Potassium

  • Neuromuscular and cardiac

  • Signs and Symtoms (most abundant)

  • Hyper: nausea, vomiting, diarhea, weak and flacid muscles, Arrhythmias, v fib/ arrest, T wave heighetens, PR interval prolongs, numbness and tingleness

  • Hypocalemia: Nausea, vomiting, Abd distension, decreased motiility, weakness than flacid, decrease standing BP , syrhithmias, PVCs, twaves lower, Cardiac arrest,

Treatment: Oral forms of K are the safest, never exceeed 10-20 mEQ/hr

ALERT: patients with RENAL FAILURE

Calcium

  • Regulates bones and teeth, nerve impulses, muscle contraction, clotting

  • TETANY- ON TEST- sustained muscle contraction- GIVE ORAL CALCIUM

Magnesium

  • Regulates metabolism, cardiac funciotn, nerve impulses

  • SLOW INFUSION TO AVOID CARDIAC/ RESP ALERT (1.5 ML/MIN OR LESS OF A 10% CONC)

28. Acid-base balance-acidosis vs alkalosis, metabolic vs respiratory

Test:

  • m R acidosisi: increased CO2 (hypoventilaition), R depression- COPD or oversdose

  • R alkalsis is : decreased CO2 (hyperventilation) (anxiety- al is anxious

Food going up ph going up (vomit = alkalosis

Food going down ph going down= acidosis

  • Bufffers are used to maintain acid- base homeostasis

29. ABG interpretation

Normal Arterial Blood Gas Values
(Table 17.15, p. 323 Lewis’s Med/Surg Text , 12th Ed)
*remember these top three

  • pH = 7.35 to 7.45

  • PaCO2 = 35 to 45 mmHg

  • Bicarbonate (HCO3-) = 22-26mEq/L - tells us if it is metabolic

If PH and CO2 are going in same direction its metabolic

If PH and CO are going opposite its respiratory

30. Diuretic functions, side effects, adverse effects, nursing considerations

  • Loop Dieuretic (Fursosemide)

    • Adverse effects: LOWWWWWWW (hyponatremia, hypotensions, HypoKALEMIA)

    • Works in loop of henle

  • Hydrochlorothiazide

    • Most widely used

    • Adverse effects: Hypokalemia

  • Spirnolactorne

    • Adverse effects: HYPERKALEMIA, HYPER, HYPER - tesT!!!

31. Understand/befamiliar with drugs in the drug tables