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205 Cards in this Set
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CHAPTER 1 |
The nursing process and drug therapy |
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Compliance |
Implementation or fulfillment of a prescribers/caregivers prescribed course of treatment or therapeutic plan by a patient |
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Medication Error |
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm |
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Non-compliance |
An informed decision on the part of the patient not to adhere to or follow a therapeutic plan or suggestion |
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Nursing process |
An organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for a patient: adpie |
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Outcomes |
Descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of behaviors related to each patients human needs. These statements are specific while framed in behavioral terms and are measurable |
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Prescriber |
Any healthcare professional licenced by the appropriate regulatory board to prescribe medications |
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Use of the word compliance verses the term adherence acknowledges |
The consideration/acceptance of patient/family/caregiver participation in the use of the nursing process |
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The elements of the nursing process address the _1_, _2_, _3_, _4_, _5_, _6_, and _7_ aspects of a patient |
1.physical 2. Emotional 3.spiritual 4. Sexual 5.financial 6. Cultural 7. Cognitive |
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QSEN and established in |
Quality and safety education for nurses 2005 |
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KSAs |
Knowledge Skills and Attitudes |
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QSEN was developed to |
Address the continued challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) needed to continuously improve the quality and safety of patient care within the healthcare system. |
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The six major initiatives of QSEN |
1. Patient centered care 2. Teamwork and collaboration 3. Evidence based practice (EBP) 4. Quality improvement (QI) 5. Safety 6. Informatics |
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The nursing process ensures the delivery of |
Thorough, individualized, and quality nursing care to patients |
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The nursing process requires |
Critical thinking |
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The nursing process is an |
Ongoing and constantly evolving process |
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Five steps of the nursing process |
Assessment Nursing diagnosis Planning Implementation Evaluation |
ADPIE |
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Assessment consists of |
Data collection, review, and analysis Medication profile |
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Medication profile |
>Any and all drug use >Prescriptions >Over-the-counter medications >Vitamins, herbs, and supplements >Compliance and adherence |
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Methods of data collection revolve around |
Interviewing Direct and indirect questioning Observation Medical records review Head-to-toe physical examination And a nursing assessment |
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Data is categorized into |
Objective and subjective data |
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Objective data |
Any information gathered through the senses or that which is seen, heard, felt, or smelled. |
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Subjective data |
Information shared through the spoken word by any reliable source. Such as the patient, spouse, family member, significant other or caregiver |
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After data about the patient and drug have been collected and reviewed... |
Critically analyze and synthesize the information |
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NANDA-I |
North American Nursing Diagnosis Association International |
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Purpose of NANDA-I |
Increase the visibility of nursings contribution to the care of patients and to further develope, refine, and classify the information and phenomena related to nurses and professional nursing practice |
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Nursing Diagnoses are used to |
Communicate and share information about the patient and the patient experience |
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Common nursing diagnoses related to drug therapy include |
>deficient knowledge >Risk for injury >Non-compliance |
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Three steps in nursing diagnosis |
>Human response to illness, injury, or significant change >Factors related to response >Listing of cues, clues, evidence or other data that support nurses claim for diagnosis |
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Planning is |
Identification of goals and outcome criteria |
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Goals should be |
Objective, measurable, and realistic with an established time period for achievement of the outcomes that are specifically stated in the outcome criteria |
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Outcome criteria |
Concrete descriptions of patient goals |
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The ultimate aim of outcome identification, pertinent to drug therapy, is... |
The safe and effective administration of medications |
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Implementation is the |
Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria |
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Implementation can be |
Independent, collaborative, and dependent |
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Interventions are defined as |
Any treatment based on clinical judgement and knowledge and preformed by a nurse to enhance outcomes |
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Statements of intervention include |
Frequency, specific instructions, and any other relevant information |
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Six rights of medication administration |
Right drug Right dose Right time Right route Right patient Right documentation |
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Current practice standards suggest these additional rights |
Right reason or indication And right to refuse |
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To ensure the correct drug is given, the specific medication order must be checked against the medication label or profile ___ times before giving the medication |
Three |
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All medication orders or prescriptions are required by law to be signed by |
The prescriber involved in the patients care |
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If a verbal order is given, the prescriber must sign the order within _(time)_ |
24 hours |
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Use of a drugs ___ name is now preferred in clinical practice to reduce the risk of medication errors |
Generic |
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Trailing zeros, or zeros following the decimal point are to be |
Avoided because it can easily be mistaken (2.0mg >20mg) |
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For routine medication orders, the standard of care is to give the medication no more than (within time) |
1/2 hour before or after the actual time specified in the prescribers order. (Anytime between 0830-0930 for 0900) |
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Acceptable identifiers of a patient include (5) |
Patient's name Date of birth Home address Social security number Hospital identification number |
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Joint commission national patient safety goals emphasize the use of ___ patient identifiers |
Two |
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Documentation must reflect |
Any improvement in the patients condition, symptoms, or disease process, as well as no change or lack of improvement |
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Document any teaching as well as an assessment on |
The degree of understanding exhibited by the patient |
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Other information that needs to be documented include (3) |
1. If a drug is not given and why 2. Actual time of drug administration 3. Data regarding clinical observations and treatment of the patient if medication error has occured |
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Knowledge of the drugs indication allows understanding of (4) |
What is being treated Catch potential errors Provide thorough explanations to patient/family Decrease challenges to medication reconciliation |
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If refusal of a medication occurs |
Always respect the patients right Document the refusal and reason why |
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Medication errors can be __ or __ |
Patient-related events System-related events |
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Evaluation includes |
Monitoring the fulfillment of outcomes, as well as monitoring the patients response to drug therapy |
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___ is a very important component of evaluation |
Documentation |
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Documentation in evaluation must include any |
Therapeutic effects Adverse effects Toxic effects |
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Chapter 2 |
Pharmacology principles |
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Additive effects |
Drug interactions in which the effect of a combination of two or more drugs with similar actions is equivalent to the individuals effects of the same drug given alone (1+1=2) |
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Adverse drug event |
Any undesirable occurence related to administering or failing to administer a prescribed medication |
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Adverse drug reaction |
An unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosage (as opposed to overdose) |
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Adverse effects |
A general term for any undesirable effects that are a direct response to one or more drugs |
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Agonist |
A drug that binds to and stimulates the activity of one or more receptors in the body |
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Allergic reaction |
An immunologic hypersensitivity reaction resulting from the unusual sensitivity of a patient to a particular medication; a type of adverse drug event |
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Antagonist |
A drug that binds to and inhibits the activity of one or more receptors in the body. Antagonists are also called inhibitors. |
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Antagonistic effects |
Drug interactions in which the effect of a combination of two or more drugs is less than the sum of the individual effects of the same drug given alone 1+1<2. Is usually caused by an antagonizing (blocking or reducing) effect of one drug on another |
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Bioavailability |
A measure of the extent of drug absorption for a given drug and route (from 0%-100%) |
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Biotransformation |
One or more biochemical reactions involving a parent drug; occurs mainly in the liver and produces a metabolite that is either inactive or active. Also known as metabolism. |
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Blood-brain barrier |
The barrier system that restricts the passage of various chemicals and microscopic entities (bacteria, viruses) between the bloodstream and the central nervous system. It still allows for passage of essential substances such as oxygen |
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Chemical name |
The name that describes the chemical composition and molecular structure of a drug |
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Contraindication |
Any condition, especially bone related to a disease state or patient characteristic, including current or recent drug therapy, which renders a particular form of treatment improper or undesirable |
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Cytochrome P-450 |
The general name for a large class of enzymes that plays a significant role in drug metabolism and drug interactions |
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Dependence |
A state in which there is a compulsive or chronic need, as for a drug |
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Dissolution |
The process by which solid forms of drugs disintegrate in the gastrointestinal tract and become soluble before being absorbed into circulation |
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Drug |
Any chemical that affects the physiologic processes of a living organism |
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Drug actions |
The processes involved in the interaction between a drug and body cells (e.g., the action of a drug on a receptor protein); also called mechanism of action |
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Drug classification |
A method of grouping drugs; may be based on structure or therapeutic use |
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Drug effects |
The physiologic reactions of the body to a drug. They can be therapeutic or toxic and describe how the body is affected as a whole by the drug. |
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Drug-induced teratogenesis |
The development of congenital anomalies or defects in the developing fetus caused by the toxic effects of drugs |
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Drug interactions |
Alterations in the pharmacologic or pharmacokinetic activity of a given drug caused by the presence of one or more additional drugs; it is usually related to the effects on the enzymes required for metabolism of the involved drugs. |
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Duration of action |
The length of time the concentration of a drug in the blood or tissues is sufficient to elicit a response |
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Enzymes |
Protein molecules that catalyze one or more of a variety of biochemical reactions, including those related to the body's physiologic processes, as well as those related to drug metabolism |
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First pass effect |
The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream |
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Generic name |
The name given to a drug by the United States Adopted Names Council. Also called the nonproprietary name. The generic name is much shorter and simpler than the chemical name and is not protected by trademark |
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Glucose-6-phosphate dehydrogenase (G6PD) deficiency |
A hereditary condition in which red blood cells break down when the body is exposed to a certain drug |
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Half-life |
In pharmacokinetics, the time required for half of the administered dose of a drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced by 50% |
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Idiosyncratic reaction |
An abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient |
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Incompatibility |
The characteristic that causes two parenteral drugs or solutions to undergo a reaction when mixed or given together that results in the chemical deterioration of at least one of the drugs |
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Intraarterial |
Within the artery |
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Intraarticular |
Within the joint |
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Intrathecal |
Within a sheath (e.g. the theca of the spinal cord) |
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Medication error |
Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or may not cause the patient harm |
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Medication use process |
The prescribing, dispensing, and administering of medications, and the monitoring of their effects |
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Metabolite |
A chemical form of a drug that is the product of one or more biochemical (metabolic) reactions involving the parent drug. Active metabolites are those that have pharmacologic activity of their own, even if the parent drug is inactive. Inactive metabolites lack pharmacologic activity and are simply drug waste products awaiting excretion from the body |
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Onset of action |
The time required for a drug to elicit a therapeutic response after dosing |
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P-glycoprotien |
A transporter protein that moves drugs out of cells and into the gut, urine, and bile |
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Parent drug |
The chemical form of a drug that is administered before it is metabolized by the body into it's active or inactive metabolites. A parent drug that is not pharmacologically active itself is called a prodrug. A prodrug is then metabolized to pharmacologically active metabolites. |
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Peak effect |
The time required for a drug to reach it's maximum therapeutic response in the body |
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Peak level |
The maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring |
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Pharmaceutics |
The science of preparing and dispensing drugs, including dosage form design |
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Pharmacodynamics |
The study of biochemical and physiologic interactions of drugs at their sites of activity. It examines the effect of the drug on the body. |
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Pharmacoeconomics |
The study of economic factors impacting the cost of drug therapy |
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Pharmacogenomics |
The study of the influence of genetic factors on drug response that results in the absence, overabundance, or insufficiency of drug-metablizing enzymes |
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Pharmacognosy |
The study or drugs that are obtained from natural plant and animal sources |
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Pharmacokinetics |
The study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body. Pharmacokinetics represents the drug absorption into, distribution and metabolism within, and excretion from the body |
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Pharmacology |
The broadest term for the study or science of drugs |
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Pharmacotherapeutics |
The treatment of pathologic conditions through the use of drugs |
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Prodrug |
An inactive drug dose from that is converted to an active metabolite by various biochemical reactions once it is inside the body |
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Prototypical drug |
The first form of a drug, or first in a class if drugs. Throughout this book, prototypical drugs will be denoted as "key drug." |
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Receptor |
A molecular structure within or on the outer surface of a cell. Receptors bind specific substances, and one or more corresponding cellular effects (drug actions) occur as a result of this drug-receptor interaction. |
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Steady state |
The physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose |
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Substrate |
Substances on which an enzyme acts |
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Synergistic effects |
Drug interactions in which the effect of a combination of two or more drugs with similar actions is greater than the sum of the individual effects of the same drugs given alone. 1+1> 2 |
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Therapeutic drug monitoring |
The process of measuring drug levels to identify a patient's drug exposure and to allow adjustment of dosages with the goals of maximizing therapeutic effects and minimizing toxicity |
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Therapeutic effect |
The desired or intended effect of a particular medication |
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Therapeutic index |
The ratio between the toxic and therapeutic concentrations of a drug |
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Tolerance |
Reduced response to a drug after prolonged use |
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Toxic |
The quality of being poisonous |
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Toxicity |
The condition of producing adverse bodily effects due to poisonous qualities |
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Toxicology |
The study of Poisons, including toxic drug effects, and applicable treatments |
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Trade name |
The commercial name given to a drug product by it's manufacturer; also called the proprietary name |
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Trough level |
The lowest concentration of drug reached in the body after it falls from it's peak level, usually measured in a blood sample for therapeutic drug monitoring |
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Pharmacology includes several subspecialty areas |
Pharmaceutics, pharmacokinetics, pharmacodynamics, pharmacogenomics, pharmacoeconomics, pharmacotherapeutics, pharmacognosy, and toxicology |
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Knowledge of pharmacology enables the nurse to |
Better understand how drugs affect humans |
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Three basic areas of pharmacology that describe the relationship between the dose of a drug and the activity of that drug in treating that disorder |
Pharmaceutics Pharmacokinetics And pharmacodynamics |
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At times, prescribers may choose to use drugs for non-FDA-approved interactions. This is known as |
Off-label prescribing |
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Oral drugs that are liquids are usually absorbed __ __ than solid dosage forms |
More quickly |
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Enteric-coated tablets absorbed __ __ due to __. Absorbed in__. |
More slowly due to coating that prevents them from being broken down in acidic pH of stomach and are not absorbed until they reach the higher pH of the intestines |
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Extended-release tablets and capsules release drug molecules in the patients __ ___ ___(time)___ |
Gi tract over a prelonged period of time |
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SR |
Slow release or sustained release |
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SA |
Sustained action |
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CR |
Controlled release |
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XL |
Extended length |
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XT |
Extended time |
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Extended-release often require __ daily doses which correlates with __ ___ |
Fewer Patient adherence |
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Entended-release oral dosage forms must not be ___ because __ |
Crushed Could cause accelerated release and possible toxicity |
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Enteric-coated tablets are also not recommended for __. Because |
Crushing Cause disruption of tablet coating designed to protect the stomach lining/ protect the drug from being prematurely disrupted by stomach acid |
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Capsules, powder, or liquid contents can often be |
Added to soft food or dissolved in a beverage |
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Pharmacokinetics Mnemonic |
ADME Absorption Distribution Metabolism Excretion |
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Absorption |
The movement of a drug from it's site of administration into the bloodstream for distribution to the tissues |
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A drug that is absorbed from the intestine must first pass through the __ before it reaches __ __ |
Liver Systemic circulation |
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If a large portion of a drug is chemically changed into inactive metabolites in the liver, then __. Such a drug is said to have a high ___. |
A much smaller amount of the drug will pass into the circulation First-pass effect |
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First-pass effect in relation to bioavailability |
Reduces the bioavailability of the drug to less than 100% |
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Many drugs administered by the mouth have a bioavailability of |
Less than 100% |
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Drugs administered by intravenous route are |
100% bioavailability |
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Enteral route |
In enteral drug administration, the drug is absorbed into the systemic circulation through the mucosa of the stomach and/or small or large intestines |
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Sublingual route |
>Absorbed into the highly vascularized tissue under the tongue >Absorbed rapidly bc tounge has large blood supply >Bypass the liver, yet are systemically bioavailable |
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Parenteral route |
> any route other than GI tract > Most commonly refers to injection |
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Intramuscular and subcutaneous injections absorption rate vs intravenous |
>Absorbed more slowly than those given intravenously >Usually absorbed over a period of several hours |
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Medications given by the parenteral route have what advantage |
Bypassing the first-pass effect of the liver |
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Subcutaneous injections |
Injections into the fatty subcutaneous tissue under the dermal layer |
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Intradermal injection |
Injections under the more superficial skin layers immediately underneath the epidermal layer of skin and into the dermal layer |
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Intramuscular injections |
Injections given into the muscle beneath the subcutaneous fatty tissue |
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Absorption speed of intramuscular vs subcutaneously and why |
Intramuscular are absorbed faster bc muscles have a greater blood supply than the skin |
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How can you increase absorption with subcutaneous or intramuscular injections? |
Applying heat to the injection site or by massaging the site |
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Depot drugs |
Specially formulated long-acting intramuscular dosage forms that have been designed for slow absorption over a period of several days to a few months |
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Topical route |
Involves application of medication to various body surfaces |
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Topically administered drugs can be applied to (7) |
Skin, eyes, ears, nose, lungs, rectum, or vagina |
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Topically application delivers a ____ amount of drug over ___ period effects are usually ___ in their onset and __ ____ in their duration compared to oral or parenteral administration |
Delivers a more uniform amount Over a longer period Effects are slower in onset More prolonged in duration |
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Topical and first-pass effects |
All topical routes of drug administration avoid first-pass effects of the liver, with the exception of rectal administration |
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Rectally administered drugs have (first-pass effect) |
A mixed first-pass and non-first-pass absorption and metabolism |
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Transdermal route + commonly used for |
Delivery through adhesive patches Used for systemic drug effects |
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Transdermal route delvers a ___ amount of drug per ___ __ ___ for a ___ ___ ___ |
Constant amount Per unit of time For a specific time period (25mcg/h for 72 hours) |
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Inhaled route |
>Inhaled drugs are delivered to the lungs as micrometer-sized drug particles >Absorption is fairly rapid |
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Distribution |
Refers to the transport of a drug by the bloodstream to it's site of action |
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Drugs are distributed first to areas with ___ such as (4). |
Extensive blood supply Heart, liver, kidneys, and brain |
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Slower distribution areas include |
Muscle, skin, and fat |
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Drug molecules that can freely distribute to extravascular tissue |
Only drug molecules that are not bound to plasma proteins can freely distribute to extravascular tissues |
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___ is the most common blood protien and carriers the majority of protien-bound drug molecules |
Albumin |
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Certain conditions that cause low albumin levels, such as extensive Burns and malnourished states, result in ___ that can raise the risk of __ |
Larger fraction of free drug Can raise the risk for drug toxicity |
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Hydrophilic drugs will have a ___ volume of distribution and ___ blood concentrations |
Smaller Higher |
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Lipophilic drugs will have ___ volumes of distribution and ___ blood concentrations |
Larger Lower |
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Metabolism is also referred to as |
Biotransformation |
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Metabolism is |
Biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or less active metabolite |
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The organ most responsible for metabolism is the |
Liver |
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The ___ enzymes are responsible for the metabolism of the majority of medications |
P-450 |
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___ acts as a drug transport mechanism, transporting drugs out of the cell |
P-glycoprotien |
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Excretion |
The elimination of drugs from the body |
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The primary organ responsible for elimination is the |
Kidney |
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Drugs that have been metabolized by the liver become more ___ and ___-___. This makes their elimination by the kidneys much easier because |
Polar and water-soluble The urinary tract is water-based |
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The excretion of drugs by the intestines is referred to as |
Biliary excretion |
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Half-life |
Time required for 50% of a given drug to be removed from the body |
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After ____ half-lives, most drugs are considered to be effectively removed from the body |
5 |
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Pharmacodynamics |
The study of what the drug does to the body |
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Drug-receptor interaction is the |
Joining of the drug molecules with a reactive site on the surface of a cell or tissue |
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The degree to which a drug attached to and binds with a receptor is called its ___ |
Affinity |
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Drugs with nonspecific mechanisms of action... |
Do not interact with receptors or enzymes |
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Main targets of nonselective interactions |
Membranes and other various cellular processes such as metabolic activities |
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Pharmacotherapeutics |
The clinical use of drugs to prevent and treat diseases |
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Acute therapy |
>more intensive drug treatment >Implemented in acutely or critically ill >Needed to sustain life or treat disease |
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Maintenance therapy |
>Prevent progression of a disease or condition > Used for the treatment of chronic illnesses |
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Supplemental therapy |
>supplies the body with a substance needed to maintain normal function >Needed because it cannot be made my the body or because it is produced in insufficient quantity |
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Palliative therapy |
>makes patient as comfortable as possible >Relief from symptoms, pain, and stress of serious illness >Used in the end stages of an illness when attempts at curative therapy have faikee |
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Supportive therapy |
>maintains the integrity of body functions while the patient is recovering from illness or trama>Fluids and electrolytes for diarrhea and vomiting ma >Fluids and electrolytes for diarrhea and vomiting |
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Prophylactic therapy |
Provided to prevent illness or other undesirable outcome during planned events |
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Empiric therapy |
>based on clinical probabilities >Involves administration when certain pathological condition has high likelihood based on patients initial presenting symptoms |
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Monitoring |
Make sure the drug did what it was supposed to do |
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A drug with a ___ therapeutic index has a greater likelihood than other drugs of causing adverse reaction, and therefore requires closer monitoring |
Low |
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Tolerance |
Decreasing response to repeated drug |
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Dependence |
Physiologic or phycological need for a drug |
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Physical dependence |
Physiologic need for a drug to avoid physical withdrawal symptoms |
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Psychological dependence |
Also known as addiction and is the obsessive desire for the euphoric effects of a drug |
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Teratogenic effect |
>result in structural defects in the fetus >Fetus is most vulnerable 3week-3month |
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Mutagenic effects |
Permanent changes in genetic composition of living organism |
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Carcinogenic effects |
Cancer causing effects |
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Pharmacognosy |
The study of natural drug sources |
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