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200 Cards in this Set

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What is pharmacology?
Study of the
1. history
2. sources
3. physical
4. chemical properties
of drugs. Also the study of the ways in which drugs affect living systems.
What are drugs, simply speaking?
chemical substances that alter the function of living systems
What are the 6 subdivisions of pharmacology?
1-Pharmacodynamics
2-Pharmacokinetics
3-Pharmacotherapeutics
4-Pharmacognosy
5-Toxicology
6- Pharmacogenetics
The first two are important to nursing.
What is pharmacodynamics?
Study of the biochemical and physiological effects of drugs. Study of drugs’ mechanisms of action. Very important from a nursing perspective.
What's the difference between a biochemical vs. a physiological effect of a drug?
A physiological effect of a drug may be the blood pressure drops, whereas a biochemical effect may be that calcium goes up.
What are the four steps of Pharmacokinetics?
1. absorption
2. distribution
3. biotransformation (metabolism)
4. excretion of drugs.
Very important from a nursing perspective.
Would anything bypass any steps in pharmacokinetics?
Yes, intravenous (IV) drugs or intracardiac (IC) drugs would skip the absorption step by being placed directly into the vascular system.
What is Pharmacotherapeutics?
Study of how drugs may best be used in the treatment of illnesses. Study of which drug would be most appropriate or least appropriate to use for a specific disease; what dose would be required; etc. Specific Drugs for specific illnesses.
What is Pharmacognosy?
The study of drugs derived from herbal and other natural (plant and animal) drug sources. Studying compositions of natural substances helps to gain knowledge for developing synthetic versions. Herbal Medicines not FDA approved.
What is Toxicology?
Study of poisons and poisonings. All drugs have the potential to become toxic.
What is Pharmacogenetics?
How an individual responds to a drug.
What is De Materia Medica?
A list and classification of 600 different plants used for medicinal purposes, prepared by Dioscorides in the first century. It was the first time plants were ever classified.
What are the sources of drugs?

1. Natural sources such as plants and clay
2. semisynthetic sources that are both natural and lab created
3. synthetic sources created in the lab such as HGH.
What are drugs used for?
They are used in healthy and sick people in 6 different ways.
1. Treatment of symptoms
2. Disease prevention
3. Diagnosis such as IVP dye in an angiogram
4. Cure disease such as antibiotics
5. Maintain health such as insulin
6. Contraception
What are the 9 dosage forms?
1. Tablets
2. caplets
3. capsules
4. lozenges
5. suppositories
6. solutions - syrups or elixirs, have alcohol or water
7. suspensions - a solid in a liquid (must shake first)
8. emulsions - fine drops of oil in water (like castor oil)
9. topical - patches, nitro, hormones, pain patches
What is an enteric coating and what is it used for?
It is a coating placed on tablets, made to dissolve in an alkalitic environment (the small intestine, not the stomach). This is for timed or sustained release medication.
Can you take a medication that has an enteric coating with milk or antacids?
No, they are alkaline substances and will cause the medication to break down in the stomach.
Can you crush timed or sustained release tablets?
No, it will cause the tablet to be absorbed well before it's intended to.
What is the benefit of administering a drug sub-lingually or buccally?
The medication is distributed quickly due to the vast amount of capillaries under the tongue and in the cheek.
What is parenteral?
When a medication is administered by some other means than through the digestive system. SC (Sub-cutaneous), IM (Intramuscular) and IV (intravenous) or IC (intracardiac).
What are ampules and vials and what's the difference between them?
Both are parenteral product packaging made of glass or plastic. Ampules typically contain a single dose and vials either have a single or multiple doses.
How many names are given to a drug and what do they stand for?
Three: 1. the chemical name which stands for it's chemical composition and molecular/ chemical structure (1st name given). 2. Generic name given by the US Adopted Names Council which allows it to be marketed and then 3. the brand name given by the company that developed it.
What is the pure food and drug act and when was it enacted?
Required all drugs to meet minimal US standards (legal and safety). It was enacted in 1906.
What is the Federal Food, Drug, and Cosmetic Act and when was it enacted?
Required the drug to be safe before being distributed over state lines. Was enacted in 1938.
What is the Durham-Humphrey Amendment and when was it enacted?
Federal Law prohibits dispensing without prescription” (Legend Drugs – drugs you need a prescription for). Was enacted in 1952.
What is the Comprehensive Drug Abuse Prevention and Control Act and when was it enacted?
Also known as Controlled Substance Act: classified drugs according to their abuse potential. Regulates the manufacture and distribution of drugs causing dependence. Schedule 1-6, low to high. Low being highest potential for abuse. 6 is least addictive. Was enacted in 1970.
Give examples of drugs from each schedule of the Drug Abuse Prevention Act.
Schedule 1: Heroine, LSD, PCP
Schedule 2: Morphine, Cocaine
Schedule 3: Tylenol with Codeine, hydrocodone, Percocet
Schedule 4: Valium
Schedule 5: Robitussin with Codeine
Schedule 6: Marijuana
What are the classifications of drugs?
1. Prescription
2. Non-prescription or OTC (Over the counter)
3. Investigational drugs (clinical studies or chemo)
4. Illicit or street drugs
What are legend drugs?
Drugs prescribed by
1. physician
2. nurse practitioner
3. physician's assistant
4. Dentist
5. Vetrinarian
What are good sources for nurses?
1. PDR (Physician desk reference)
2. Drug interaction book
3. Handbook of non-prescription drugs,
How do drugs work in pharmacodynamics?
They exert a wide variety of effects in the body. They alter existing cellular or chemical functions, not create new ones. Drugs Exert their action by forming a chemical bond with specific receptors within the body.
What is the chemical bond called in pharmacodynamics that bonds with specific receptors within the body?
Lock and key effect.
Give some examples of pharmacodynamics.
Antibiotics alter microbial growth.
Laxatives increase peristalsis.
Antacids alter the chemical fluid in the stomach acid.
In pharmacodynamics, describe the Lock and Key effect.
The better the fit, the better the response, the less amount of drug needed.
What are the principles of drug action?
1. Agonist effect
2. Antagonist effect.
3. Adverse drug effect
4. Therapeutic effect
What is the agonist effect?
Drugs that interact with receptor for effect are agonists – helpful drugs
What is the antagonist effect?
Drugs that have no specific pharmacological action but interact with site to inhibit or prevent the action of the agonist.
Give an example of the antagonist effect.
Heroine and Morphine produce an action= relieve pain or cause euphoria. The nurse gives Narcan to reverse effects of heroine.
What is an adverse drug effect? Give an example.
Unwanted negative side effects. Morphine causes respiratory depression. Antibiotics can cause upset to GI normal flora causing GI upset. Allergies as well.
What is the therapeutic effect?
The desired effect of the drug.
What is drug dependence?
A drug tolerance where a patient develops a drug resistance to narcotics, barbituates or anti-anxiety drugs. There is a Physical vs Psychological dependence.
Describe pharmacokinetics.
The study of How the drug moves through the body. The rate at which it produces wanted effects. Many things effect the concentration of how drugs effect body.
What can effect how a drug works on a patient?
Size of the patient
Other drugs
A full stomach
General Health
Giving fluids
What is absorption?
The first step in pharmacokinetics. Process by which a drug moves from the site of administration into the body's circulation. Drug administered, absorbed, then enters circulation.
What drugs do not need to be first absorbed into the body?
Intravenous or Intracardiac.
What is bioavailability?
A portion of a drug is lost in absorption. The part that is used is the bioavailability.
What are the routes for absorption?
1. Oral, or enteral, which includes Sublingual
2. Parenteral
3. Topical
Describe the oral, or enteral, route.
absorbed through the GI tract before circulated to the action site. Example - a tablet
Describe the sublingual route.
absorbed into the tissue, then into the blood stream Example - nitroglycerin
Describe the parenteral route.
SC (sub-cutaneous) - absorbed in the tissue under the skin is absorbed slower than IM (intra-muscular) because there are more vessels in the muscles.
Describe the topical route.
Absorbed through the skin such as a lotion or cream.
What can affect the parenteral route?
massaging/heat increases absorption. Ice packs decrease.
What is distribution?
The transport of a drug in the body by the bloodstream to its site of action. The more vascular the organ, heart, liver, brain and kidneys, the faster the distribution.
What is biotransformation?
Also known as metabolism, it is the process by which the body changes the chemical structure of the drug, called metabolites. The body attempts to neutralize or detoxify the substance and eliminate it. The alteration or changing of a drug to a more water-soluble medium in preparation for elimination of drug by kidneys.
Where are drugs mainly metabolized?
In the liver.
What happens if the liver isn't functioning properly?
The drugs builds up in the body and the person becomes jaundiced.
Name some reasons why the liver wouldn't function properly.
Liver failure, hepatitis, cirrhosis
What is elimination?
Removal of a drug (or it's metabolites) from the body by kidneys, respiratory tract or bowel.
What is clearance?
Rate of disappearance of the drug molecules from the circulation related to hepatic metabolism & renal excretion.
Who would have altered excretion?
Patients with Chronic renal failure or diabetes mellitus.
What affects the renal excretion of drugs?
The pH of urine. If urine is more acidic, base drugs are better excreted and vice versa.
What is a "half-life"?
The time it takes for one half of the original amount of a drug to be removed from the body.
Give an example of a half-life.
Versed has a half-life of 12 minutes. This means that initially there is 100% in the body. After 12 minutes 50% is gone. After 24 minutes, 25% is left in the system and after 36 minutes only 12.5% is left in the system.
What are the factors that effect pharmacological responses?
Age, sex, weight, BMR (basal metabolic rate), genetics, disease states, pH, among others. AND LIVER FUNCTION
What kind of drugs need serum levels and what is it called to check it?
Aminoglycosides. Peek and trough..
What is peek and trough, how is it administered and why?
Blood will be taken about a 1/2 hour before next dose is given (trough) and then 1/2 hour after the dose is given (peak). This is to be certain that there isn't an unsafe level of the drug in the system.
What is the nursing process?
1. Assessment
2. Nursing Diagnosis
3. Planning
4. Implementation
5. Evaluation
What is nursing assessment?
1. Take a medication history including current use of prescription and OTC agents.
2. Assess the patient's understanding of illness, including past experience.
3. Conduct a physical assessment.
4. Obtain information about social networks and resources.
What is nursing diagnosis and planning?
1. State relevant nursing diagnoses.
2. Idenitfy desired outcomes of nursing intervention.
3. Focus on:
- why drug is needed
- how the drug will be administered
- common indications of adverse effects.
- other nursing measures that will enhance the likelihood of achieving desired outcomes.
What is implementation?
Preparing drugs for administration
1. Ensure cleanliness of hands, work area and supplies
2. Ensure availability of supplies
3. Ensure adequate lighting.
4. Decrease environmental distractions.
What is evaluation?
Evaluating to see if the drug helped.
What are the seven rights of medications?
Right drug
Right dose
Right client
Right time
Right route
Right documentation
Client’s right to refuse
What are the steps to checking the right drug?
1. Check the script
2. Check the med to the script
3. Do not give a med someone else prepared
4. Do not open unit package until at client's bedside
5. Ask if this drug is "right" for client - any allergies?
What are the steps for checking the right dose?
1. Be familiar with measurement conversions.
2. Use appropriate measuring device and read it correctly.
3. Shake all suspensions and emulsions.
4. Always hold dropper vertically and close to cup
5. With multiple-dose vial, inject air equal to amount of fluid to be withdrawn.
6. Do not divide unscored tablets or give tablets broken unevenly
7. Ask if this med is "right" for client. Consider infants, children, or elderly when dosing.
8. Give whole tablets when possible instead of cutting one.
9. If no exact-dose table it available, cut only tablets that break evenly on scored line.
What are the steps for checking the right client?
1. Check tag on client's bed.
2. Check client's ID band
3. Ask client to state their name
4. Ask parents to tell you the child's name
5. Address person by name name before giving meds
6. Double check meds that the client questions. Ask if this the right med.
What are the steps for checking the right time?
1. Meds are scheduled to be given at specified times for maximum therapeutic effectiveness.
2. Adhere to the scheduled times of administration as close as possible.
3. Ask if this is the right time for administering this med.
What are the steps for checking the right route?
1. Be sure to know the prescribed route that the med is to be given.
2. If no route is specified, question the provider.
3. Always gain client's cooperation before giving meds
4. Consider client's developmental level when giving meds.
5. Nurse must know what vehicles may be used with different meds.
6. Plan order that meds are given (considering client)
7. Ask if this is the right route for this med for this client.
What are the steps for the right documentation?
1. Be sure to document the med and time given on appropriate facility document.
2. Document site location after giving intradermal, SC or IM shot.
3. Document if client refuses med, client's reason and reporting of refusal to provider.
What are the steps for the Client's Right to refuse?
1. Be sure to assess client's reason for refusing med
2. If not enough knowledge is client's reason for refusal, explain why med is prescribed, what med does and the importance of med for treatment of client's health alteration.
3. Document if client refuses meds, reason and reporting of refusal to provider.
What are the steps to administering IM medications?
1. Wash hands and use 7 rights
2. Identify anatomical landmarks, check tissue for suitability before making a final site selection.
3. Injection sites should be rotated.
4. The deltoid site may be used for 1 mL or less of clear, nonirritating solutions.
5. Do not use dorsogluteal or ventrogluteal sites in infants or in children who have not been walking for at least one year.
6. The vastus lateralis site is the best choice for children under 3 years.
7. Children should have EMLA or LMX4 cream applied 1-2 hours or 30 min respectively, priot to IM shot.
Describe the needle and angle of IM injection.
An inch to an inch and a half of a 21-23 gauge needle. Use 90° angle for injection.
What are the steps to administering SC medications?
1. Wash hands, use the 7 rights of med administration
2. Insulin, low-molecular-weight herparins and heparin injections are generally administered at a 90° angle.
3. Drugs other than insulin and heparin can be administered at a 45° angle.
4. Some SC meds may be administered continuously.
Describe the needle and angle of SC injection.
Administered mainly in the deltoid or abdomen. A half inch to 5/8 of an inch and 25-28 gauge for heparin or insulin.
What kind of needle is used for an intradermal injection and at what angle is it given?
Very small 1/4 to 3/8 inch 26-27 gauge given at a 10 -15° angle.
What kind of needle is used for IV?
18-24 gauge, 1/2 - 1 1/2 inches (or 16 - the largest)
What are the other Methods of administration?
Vaginal, rectal, Ear, Eye, Nasal, Nasogastric, Epidural, transdermal patches.
What does "gtt" mean?
drops of medication
What does "Qhs" mean?
At bedtime
What does "KVO" mean?
Keep vein open
What does "Stat" mean?
immediately
What does mg mean?
milligrams
What does Gms mean?
Grams
What does mcg mean?
micrograms
Insulin is given in which route?
SC or infusion. Infusion is given under doctor's orders in a hospital setting.
What size does a TB syringe come in and what is it typically used for?
1 mL. Intradermal injections, allergy injections, injectable medications for infants and young children, heparin injections. Situations requiring precise measurement of a small volume of medication (less than 1 mL)
What size does an insulin syringe come in and what is it typically used for?
.3 mL, .5 mL and 1 mL. Administration of insulin of a specified strength.
What size does a general purpose syringe come in and what is it typically used for?
2 - 50 mL. Antibioitics and pain meds
What size does a prefilled single-dose syringe and injector devices come in and what are they typically used for?
1 - 50 mL Administration of meds prefilled into the syringe by the manufacturer.
What is the purpose of IV therapy?
Replace fluids, electrolytes & provide nutrition. Transfuse blood and blood products. Administer medication.
What is the nurse's highest priority during IV therapy?
Maintaining the patency of the IV access. Remembering the "ABCs".
What does it mean to "remember the ABCs".
To always keep "airway, breathing and circulation" at the forefront of the mind.
What is osmosis?
The solvent (water) moving from a lower concentration to a higher concentration.
What is diffusion?
The Solutes (particles, solids) going from a higher concentration to lower concentration .
What is a hypertonic solution?
A highly concentrated solution.
What is a hypotonic solution?
A lower concentration, so fluid is pulled into the cells.
What are some complications of IV therapy?
Infiltration, thrombophlebitis, pain, pyrogenic solutions
What does it mean to prime an IV and why is it important?
Priming an IV means to flush it with water and remove any air. It is important to not allow any air into the veins of clients.
What do you do if an alarm sounds?
Trouble shoot. Flush line. Pump not infusing increases likelihood of blood clot.
How many drops per minute are needed to infuse 1000 ml Lactated Ringers over 8 hours in an IV? The tubing has a drop factor of 10 drops per ml.
1000x10 / 8 x 60min. = 10000 / 480 = 20.8 drops per min.
How many hours are required to administer NS 1000 ml at 200 ml/hr??
1000 / 200 = 5 hours
Give Demerol 25 mg SC. You have Demerol 50 mg/2ml. How many ml would you give?
25 / 50 = .5 .5 x 2ml = 1mL
What is thrombophlebitis?
A blood clot and inflammation which can be caused by an IV.
If you're in doubt about the IV, what do you do?
Stop infusion, disconnect and get another opinion.
How many hours are required to administer NS 1000 ml at 200 ml/hr??
5 hours. 1000/200 = 5 hours
How many drops per minute are needed for 1100 mL to be infused in a 9 hour period, if there are 10 drops per mL. ?
1100mL / 9 hours = 122.22 / 60 min. X 10 drops = 20.4 drops per minute
Who is most susceptible to infection?
1.Young, elderly
2. those often in the hospital
3. those with respiratory issues or skin issues (barrier disruption)
4. those with inadequate immune defenses (AIDS, chemo patients, those who have overused steroids)
5.those with impaired circulation
6. those with poor nutrition.
What are sources of infection?
Bacteria and viruses. Antibiotics are normally given only for bacterial infections.
What is considered when selecting an anti-microbial agent?
1. Location of the infecting organism - UTI, meningitis,etc.
2. Status of the client's organ function - antimicrobial can be nephro or hepatoxic. Do they have renal/ liver failure?
3. Age of the client
4. Are they pregnant or lactating? Medicine may cross the placenta, could be toxic to the fetus or interfere with development.
5. Wether there is overuse of this medication, which can lead to antibiotic resistance.
Name some antibiotic resistant bacterial infections.
MRSA (methylin-resistant Staphylococcus aureus), VRE (vancomycin-resistant Enterococcus) & ORSA (Oxacillin-resistant Staphylococcus aureus).
Describe MRSA and how it's treated.
MRSA is mostly in skin wounds and sputum. Some are treated with Vancomycin.
Describe VRE and how it's treated.
VRE is mostly in urine. It is usually treated with a new antibiotic, zyvoxx.
Describe ORSA and how it's treated.
The newest strain of resistant bacteria. Is usually treated with the latest treatment - Linezolid, the first of a new synthetic antibacterial agent.
How do we prevent antibiotic resistance?
1. Client teaching. Teach the client the importance of taking ALL the medication to be sure the infection is killed.
2. Using universal precautions such as vigilant hand-washing to prevent transmission.
3. The use of 2 or more antibiotics helps prevent resistance to a single drug.
What is bacteriostatic?
An antimicrobial that works on protein synthesis of a bacterial cell. It slows the growth but does not kill the bacteria. Helps the body to fight it.
What is bactericidal?
An antimicrobial that works on the cell wall of bacterial cells. It kills bacterial cells.
Which is better to use; narrow or broad spectrum antibiotics?
If the bacteria is known, it is best to use a narrow spectrum drug. If the infection is not known, it may be necessary to use a broad spectrum. Using a broad spectrum drug can often cause secondary infections because the drug will also kill normal flora and may cause diarrhea, yeast infections or GI symptoms.
What is a superinfection?
Develop another infection secondary to antibiotic therapy.
What are the adverse effects of antimicrobial agents (drugs)?
1. Hypersensitivities
2. Organ toxicity
3. Hematological Disorders
What kinds of hypersensitivities can be caused by drugs?
They range from mild such as hives, nausea, inflammation at injection site to severe such as a tightening of the throat, bronchospasm, anaphylaxis.
What is cross sensitivity?
When the same symptoms appear from a drug of a similar class to that of a drug that symptoms are known to appear.
What is organ toxicity?
High doses of a drug over time can cause nephrotoxicity or hepatotoxicity. There are serious side effects to these.
What are hematological disorders?
Aplastic anemia. A severe case of anemia caused by destruction or depressed functioning of the bone marrow. Can be caused by bone cancer, radiation, chemo or an adverse effect of certain drugs.
What two drugs have a high incidence of adverse effects?
Penicillin and cephalosporin.
Name some different classes of drugs.
Sulfonamides, penicillins, cephalosporins, aminoglycosides, flouroquinolones
Describe sulfonamides.
It was the first group of antibiotics. It is broad spectrum. An example is Bactrim. Nurses should encourage clients to drink at least 1 liter of fluid a day while on sulfonamides, avoid tanning beds and the sun, and be sure they know that they reduce the effectiveness of oral contraceptives. Bacteriostatic
Describe Penicillins.
They are part of a large group of chemically related antibiotics. Has lots of adverse effects. It is bactericidal, inhibits cell wall synthesis. Is not stable in stomach acid. It is good for IV use. Is used for the prevention and treatment of gram + bacteria such as Enterococcus, Strep, staph and pneumococcal bacteria.
What is penicillinase?
Frequent early use of Penicillin caused this bacteria to produce penicillin destroying enzymes. To offset this, Potassium clavulanate is often added to different forms of penicillin. An example is Augmentin.
What are some of the adverse effects of Penicillin?
-Hypersensitivity-Skin symptoms (Uticaria)
-Gastrointestinal symptoms
-Neurotoxicity- in lg. doses
-Renal dysfunction- in lg. doses
-Anaphylaxis in some cases
-Some changes in lytes, NA and K
What is uticaria?
Hives
What other penicillins are commonly used?
Ampicillin given PO, IM and IV which is used sometimes to treat URIs and a high dose for meningitis. And Piperacillin Sodium, which is a very strong drug given IV and IM. It is part of the carbenicillin groups and is better at treating Gram - infections. It is used in conjunction with aminoglycosides for infections such as pseudomonas.
Describe cephalosporins.
Chemically and pharmacologically related to penicillins. Is a bactericidal. Prevents cell wall synthesis like penicillins and is very important to watch for cross sensitivity since they are related to penicillins. There are 4 generations.
What are the 4 generations of cephalosporins?
1. The first had good gram + coverage
2. The second had good gram + coverage and some gram - coverage
3. The third had less gram + coverage and more gram - coverage
4. The fourth had good gram - coverage
A person allergic to penicillin will more likely be allergic to a first or second generation cephalosporin than a fourth.
What are cephalosporins used to treat?
Infections of the skin, bone, heart, respiratory tract, GI tract, and urinary tract
What are the adverse effects of cephalosporins?
-Hypersensitivity, N/V/D (orally) – nausea, vomiting, diarrhea
-Cross-sensitivity reaction to penicillin
-Thrombophlebitis (when given IV)
-Sterile abscess (when given IM)
-Nephrotoxicity
What is important to remember with using cephalosporins and nephrotoxicity?
If a patient is receiving diuretic, ie Lasix and an antibiotic that causes nephrotoxicity.. Red flag...
If a patient is receiving an Aminoglycoside & Cephalosporin.. Higher risk for Nephrotoxicity
Describe aminoglycosides.
It has poor oral absorptions, so it is more commonly given in IV. The only oral forms are neomycin and paromycin, which is rarely seen. It is bacteriostatic, inhibits protein synthesis, but can be bactericidal in higher doses. It is effective on gram - bacteria and some gram +. It is a narrow spectrum drug and needs a peak and trough. These are potent antibiotics with serious toxicities!!
If a client cannot take penicillins, cephalosporins or tetracyclines, what would they be given?
Macrolides.
What are the toxicities seen with aminoglycosides?
Nephrotoxicity (toxic to the kidneys) and ototoxicity (toxic to the vestibulocochlear nerve - hearing and balance). It can also block neuromuscular action, which can lead to respiratory paralysis. Levels need to be monitored with peak and trough, they should be infused in over an hour and clients who are compromised, sick, dehydrated, or on diuretics are more likely at risk for nephrotoxicity.s
What are the most common aminoglycosides used?
Gentamycin, Tobramycin and Streptomycin
Describe Flouroquinolones.
Frequently seen in treatment of UTI’s, URI’s & Pseudomonas but mostly in UTI’s. Most commonly one used is Ciproflaxin, which is available in PO or IV. Classified into generations also. Given to patients who cannot take penicillins and cephalosporins. Phenazopyridine (Pyridium) aids in bladder spasms and turns urine orange.
If a drug ends in "mycin", what does that mean?
That it is an aminoglycoside.
Name some general nursing implications.
- Client teaching - make sure the client takes their medication as prescribed and to not stop taking the medication until it is gone.
- Assess for signs and symptoms of returning infection.
- Obtain cultures from appropriate sites BEFORE beginning therapy.
How are UTIs often treated?
The flouroquinolone, Cipro is often used. Also, the flouroquinolone, pyridium, is used for bladder spasms and turns the urine orange. The sulfonomide, Bactrim, is used. Macrodantin is used and may cause urine to be dark yellow or brown.
When the client complains of pain, what is important?
For the nurse to treat it.
What is pain?
Whatever the experiencing person says it is.
How is pain measured?
In two ways:
1. Pain threshold - the level of stimulus that creates the pain experience (physiological).
2. Pain tolerance - Amount of pain one can withstand without the experience requiring analgesic treatment (pain medication..)
Tissue injury causes the release of what?
- Bradykinin - initiates inflammation response,
- Histamine - neurotransmitter, vasodilates
- Prostaglandins - Antagonized by analgesics
- Seratonin - neurotransmitter
Describe analgesics.
Analgesic drugs relieve pain without causing loss of consciousness. Non-narcotics don't carry a risk of dependency.
List the Non-opiods, non-narcotics.
Most oral forms are:
Tylenol
Motrin
celebrex
naproxen
aspirin
Toradol - only non-narcotic for IV
List the opiods, narcotics.
Risk for physical dependency
Morphine
Fentanyl
Dilaudid
Demerol
Methadone
Oxycontin
Hydromorphone
What is the proper way to select an analgesic?
It is based on 6 factors:
1. Effectiveness of the agent - type of pain
2. Duration of the action of the drug - minor surgery - shorter acting is needed
3. Desired duration of therapy - short term (toothache) to longer term (chronic illness or cancer)
4. The ability to cause drug interactions - Benedryl & opioids can cause resp. depression
5. Hypersensitivity - patient's known allergies
6. Available drug routes - can patient swallow pills
What's the antagonist for opiates?
Narcan
What's the antagonist for sedatives?
Rumazicon.
Describe Opium.
- Been used for thousands of years to alleviate pain.
- Derived from the poppy plant.
- Produces pain relief by attaching to pain receptors.
- Narcotics are derivatives of opium
- Narcotics are strong pain relievers.
- Causes euphoria
What are the uses for opioid analgesics.
To relieve moderate to severe pain.
Also used in cough suppressants (Codiene)
and diarrhea treatment (Lomitil)
What are the effects of opioid analgesics?
- Euphoria
- Nausea & vomiting
- Respiratory depression
- Urinary retention
- Diaphoresis (sweating) & flushing
- Pupil constriction
- Constipation
- With head injury may increase intracranial pressure
What are some nursing implications of administering opioid analgesics?
Oral forms - take with food because it irritates the stomach. Often has enteric coating to help get it through the stomach without being digested until the Small intestine.
Ensure safety measures such as putting up side rails of bed and put in lowest position.
What is physical dependence?
Physiologic adaptation to the presence of an opioid. More of the drug is needed over time.
What is psychological dependence?
A pattern of compulsive drug use when the medication is not needed for physical pain relief.
What are some pain management approaches for nurses?
- Medicate clients before a procedure or activity.
- Medicate clients who are complaining of pain.
- Medicate clients to avoid breakthrough pain.
- Try non-medical measures - back rub, musical therapy, relaxation therapy.
- Rotate sites of IM injections
- Prevent respiratory depression
- Prevent constipation (provide fluid and fiber)
- Provide teaching - take meds as prescribed
What are the considerations when administering a drug?
- Consider the purpose: Short term for day or minor procedures. Fentanyl may be drug of choice for it's short half life. For longer term pain or breakthrough, Morphine or Dilaudid may be used.
- Will the drug effect vital signs? Morphine lowers BP, Fentanyl has no effect on BP
- What is the mental status of the patient? Awake, alert or obtunded. Give meds to an obtunded patient?
Name some commonly seen opioids.
Morphine, Fentanyl, Dilaudid and Demerol.
Describe morphine.
- Comes in IV, IM, SC and sometimes PO
- Used for long term, chronic pain, end of life
- Longer acting
- lowers BP
- Used to treat pain in acute heart attacks
- Watch for respiratory depression
- PO - MS Contin, Liquid - Roxanol & Spinal - Duramorph
Describe Fentanyl.
- Comes in IV, IM and trans-dermal
- Used for short-term treatment, Day procedures/surgery
and conscious sedation
- Shorter acting
- No effect on BP
- Can also be a form of anesthesia with other meds
- Watch for respiratory status
Describe Dilaudid.
- Very potent
- Comes in PO, IV, IM, SC & rectal
- 7 - 10 times more potent than morphine
- Longer acting than morphine
- Given to patients that have built a tolerance to morphine
- less sedation
- more likely to cause respiratory depression
- affects respiratory status more than morphine
Describe Demerol.
- Comes in IM, IV, SC and rarely PO
- Not good for long term pain - better for orthopedic surgeries and injuries.
- Can be nephrotoxic in large doses
- In short term injuries, weened from IV, IM then to PO analgesics
What is the advantage of mixing opioids with non-opioids?
Less of the narcotic is needed to achieve the same effect.
Name some opioids mixed with non-opioids.
- Percocet - Oxycodone & Tylenol
- Vicodin - Hydrocodone & Tylenol
- Hycodan - Hydrocodone & Guaifenesine
- Codeine - Codeine & Tylenol
Others such as:
- Darvocet
- Oxycontin
What are the advantages and disadvantages of mixing opioid agonists with antagonists?
Advantages: Lower risk of dependency and a strong analgesic effect
Disadvantages: Still causes sedation and respiratory depression and can still have withdrawal symptoms.
Name some opioid agonists-antagonists.
Stadol, Talwin, Nubain, Buprenex
Name an opiate antagonist and describe it.
Naloxone (Narcan).
- It is a reversal for narcotics.
- Comes in IV and nasal
- Binds to the opiate receptors and prevents a response
- Used for reversal of opioid-induced respiratory depression
- May put addicted patients into withdrawal
Name some non-opioid analgesic agents/ antipyretics.
Analgesic agents: Salicylates, Acetaminophen, combination drugs with narcotics
Anti-inflammatory analgesic agents: NSAIDS, motrin
Describe aspirin.
- Used for more than 100 years
- It's action is to interfere and block synthesis of prostaglandins
- Treats mild to moderate pain
- Has an antipyretic effect
Side effects
- Causes GI irritation & bleeding
- increase bleeding time
- causes tinnitis over time
- cannot be combined with anti-coagulants
Describe Tylenol.
- Action blocks pain impulses peripherally
- Relieves pain
- Antipyretic
- Weak anti-inflammatory
- minimal effect on CNS
Side effects
- In the first 24 hours, causes Nausea/ vomiting and malaise
- late signs of liver failure in overdoses
- acute overdose causes hepatic necrosis (150mg per kg of weight)
Treatment of O/D: Acetylcysteine (Muco-mist) oral and now in IV
What is an anesthetic?
A group of drugs used to block the transmission of nerve conduction, synaptic responses, so that the sensation of pain is not perceived by the brain. There are two classes: General and Local.
What is a general anesthetic?
Complete or partial loss of consciousness, change in mental status.
What is a local anesthetic?
A nerve block at the site.
Describe General anesthesia.
Has 4 stages ranging from 1, conscious to 4, unconscious. Prevents pain during surgery.
What is balanced anesthesia?
An IV injection is given first then gas (inhalation).
Name some IV anesthetics.
Ketamine
Etomidate
Versed
Propofol
Fentanyl
Describe Ketamine
Usually has to be administered by a physician. Has lots of side adverse effects such as hallucinations, irrational behavior and an increase in BP
Describe Etomidate.
A newer drug, used more often.
Describe Versed.
Used a lot for endoscopic procedures and other procedures requiring conscious sedation. Lowers BP
Describe propofol.
Used a lot as a long term anesthetic for patients in the ICU intubated on a drip and in the OR for short procedures. Big advantage is it has a half life of nearly nothing. Very short.
Describe Fentanyl used in conjunction with other anesthetics.
Usually used with Versed.
What is an adjunct to general anesthesia?
A combo of anesthetics & analgesia's to produce a wanted effect. Four groups are combined.
What are the four groups combined as adjuncts to anesthesia?
1. Sedatives/ hypnotics - no loss of consciousness
2. Opioid analgesics
3. Anticholinergic - diminishes salivation, prevents laryngospasm, and bradycardia, but may cause tachycardia. Very drying (ex. Atropine)
4. Neuromuscular Blocking Agents - paralytics (ex. Succinycholine for short acting and Pavulon for long acting.
What are the nursing implications for administering anesthesia in conjunction with anything else?
Always watch vital signs, watch for respiratory depression, have reversal antagonists ready (Narcan for opioids, Romazicon for benzodiazepines (sedatives), Have bed in lowest position and side rails up.
What is PTT and what does it measure?
Partial Thromboplastin Time. It measures the INTRINSIC coagulation pathway and the common coagulation pathway. It also measures the heparin level in the body. Normal PTT value is 25 to 39 seconds. The clotting factors noted in PTT are I, II, V, VIII, IX, X, XI, XII
What is PT and what does it measure?
Prothrombin ratio. Measures the EXTRINSIC coagulation pathway. Also determines the warfarin levels and vitamin K position. The normal PT value is 11 to 16 seconds. The clotting factors notes are I, II, V, VII and X.