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206 Cards in this Set
- Front
- Back
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buccal
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pertaining to the cheek
placed b/w cheek and upper molar |
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sublingual
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under tongue
quick absorbtion |
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where can you apply topical meds
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vagina, rectum, nose, eye, ear canal and lungs
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how come topical meds are not always absorbed into intact skin
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natural barrier to drug diffusion
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what in topical medication administration called
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percutaneous administration
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problems with topical meds
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messy and difficult to apply
short duration |
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what are the forms of topical medications
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anti-infective(cream, lotion, ointment)
protective anti-inlammatory (steriods) hormone replacement relieve pain |
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what does nitroglycerin treat
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prevent and treat chest pain
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what does nitroglycerin do
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causes vasodilation, increases blood to coronary arteries.
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how is nitorglycerin ordered
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in inches
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what is the most common side effect of nitroglycerin
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headache, and facial flushing
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transdermal rx administration with patches
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disk and patch used for longer intervals
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advantages of patches
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convenience, compliance, and bypasses stomach and liver.
better absorbtion. |
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how is the strength of the patch released
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the strength is the amount released every hour.
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porous membrane of transdermal patch
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regulates release of rx
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drug resevoir of transdermal patch
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contains patch for slow release of rx
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what must eye drops read
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opthalmic use
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do ocular solutions or ocular ointments interfere with vision
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ocular ointments
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where do you place eye medication
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in the lower conjuctival sac
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what don't you pull on for eye drop installation
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upper eye lid
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how long can ocular disks remain in place for
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7 days
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where should a patient look when instilling eye drops
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up
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what do you do after drops are applied
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apply gentle pressure to the inner corner - nasal macramul duct - for one min
should be ordered |
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what are medications for ear drops labled
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otic
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why do you allow otic medication to be warmed to room temp
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to prevent vertigo
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what happens to the auditory canal throughout the lifespan
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the auditory canal changes in size and direction
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how do you straigten the auditory canal for children under the age of 3
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gently pull the earlobe down and back.
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how do you straighten the auditory canal for children over the age of 3 and adults
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gently pull pinna up and back.
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how far do you insert the dropper into the auditory meatus
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0.6 cm
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things to remember for nose drops ans sprays
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shake container
have pt blow nose block one nostril (1cm) have pt remain in postion for 2-3 mins |
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what postition should pt lay in for vaginal meds
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lithotomy
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how far do insert the applicator into the vagina
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2-3inches
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who don't you use a recal suppository on?
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person with rectal, prostatic surgery or trauma
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which side do you place a person in with to apply a rectal suppository
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left side
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which side of the rectal suppository do you insert first
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the tappered end first
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how far do you insert the rectal suppository
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past the anal sphincter, about 7.5 cm or a finger length
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Parenteral
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admin of an RX by any route other than the gastrointestinal. - injectable
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parenteral routes
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ID
SQ IM IV |
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info about parenteral meds
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rapid onset
shorter duration smaller dose greater cost more complete absorbtion |
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why are parenteral meds given
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all of the rx must be absorbed rapidly and completely at a steady and controlled rate.
and because pts are unable to take oral meds |
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what are 4 disadvatages to parenteral meds
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1. trauma @ injection site
2. potential for infection 3. potential for quicker and more severe allergic reaction 5. Rx is irretractable. |
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what are the 3 parts of the syringe
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barrel
plunger tip |
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2 syringe tips
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luer slip and luer lock
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5 syringe types
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glass / plastic
hypodermic TB' Insulin Prefilled |
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glass vs. plastic
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both come in 1,3,5,10,20,50ml
glass = more economical plastic = pre packaged, expensive come w. or w/o needles usually 2 and 3 ml |
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TB syringe
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only holds 1 ml
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hypodermic syringe
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2, 2.5, 3ml
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insulin syringe
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units, specifically calibrated for insulin. Never give insulin w/. a TB syringe
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pre-filled syringe
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one dose of pre-measured med
diposable cartridge-needle unit label special holder saves time and decreases risk for contamination. very expensive, you can not add more meds to it you cannot attach another needle sometimes it comes with more meds then needed. |
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types of prefilled syringes
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insulin pens
epi-pens ( emerg use - pt must go to ECU after injection) certian narcotics |
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3 parts of the needle
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hub - end that sits on syringe
shaft beveled tip |
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needle length
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distance from the tip of needle to hub
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what are longer needles used for
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sq or im
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what are shorter needles used for
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ID or IV
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SQ common adult needles
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25 gauge, 5/8 inch
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IM common adult needle
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22 gauge 1-1.5 inch
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what needle do you use for smaller thinner adults and children
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use a shorter needle
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Needle gauge
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the larger the gauge the smaller the diameter of a needle (INVERSED)
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what do you do if you get stuck with a needle
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wash with soap and water
complete an employee incident report give to nurse manager |
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ampule
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glass container
single dose 1-10ml (can come up to 50) |
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vials
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glass or plastic
self sealing rubber top single or multi dose medication is solution or may be sterile powder vial only good for 24 hours, |
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what kind of a system are vials?
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they are a closed system, so you must put air in to take the meds out.
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what are the two compartments of the mix-o-vial
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lower = powdered drug
upper = solution |
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prefilled syringe
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single dose of med
insert cartridge into reusable holder check med dose in cartridge syringe comes with needle attached. |
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general guidlines for preparing meds
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wash hand
5 rights check order against rx in hand check compatiblity check calculation use aseptic technique check expiration date |
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mixing meds in 1 syringe
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- effective use of supplies, pt only gets stuck once.
meds must be compatible total volume when meds are mixed must be an acceptable volume. both meds are ordered to be given at the same time / route |
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mixing meds from a single dose or multidose vial
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inject air in both vials
draw up from the multidose vial first, then from single dose vial |
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mixing meds from an ampule into a single syringe
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prepare med in vial first
draw up med from vial. |
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If mixing insulin
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always draw up regular (CLEAR) insulin first
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why do you roll cloudy meds inbetween your hands
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for proper equal suspension
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how many meds can you mix in one syringe
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2
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what is absorbed more quickly sq or im and why
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im - muscles have a greater blood supply
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how much fluid can be tolerated in the large muscle masses
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1-4ml of fluid
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how much can be tolerated in sm muscle mass
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0.1-1ml
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how much fluid can children and elderly tolerate
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1-2ml
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syringe size for IM
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2-3ml syringe - usual
5-10ml - rarely |
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needle length for IM
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oil based - 18-25
aqueous - 20-25 it depends apon - injection site, amount of fat, age of client |
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how do you choose an injection site
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type of med
viscosity of med volume of med anatomical landmark pts condition / age |
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what are some possible injections of im injections
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abcess
cellulitis injury to blood vessel, bone, nerve lingering pain tissue necrosis periostitis (inflammation of memebrane covering bones) |
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what is the preferred site for IM injections
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ventrogluteal site
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how do you locate the vetrogluteal site
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place palm on greater trochanter
place index finger pointing toward ant, sup, iliac spine stretch finger toward butt along iliac crest triangle is injection site. |
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vastus lateralis
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good site for peds
site covers large area, can accomodate alot of fluid |
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what is the prefered site for children of all ages
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ventrogluteal
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what is the prefered sit for infants
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vastus lateralis
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what needles do children require for im injections
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5/8inch
22-25 guage needle |
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intradermal injections
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into the dermis layer of skin,
sm volumes - 0.1 - 0.5 |
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what type of syringe do you use for ID injections
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1 ml TB with short 1/4 - 1/2, 26-27 gauge needle
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how do you know that an ID injection is in the right location
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the injected fluid produces a wheal
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what is ID the route of choice for
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allergy, TB testing, desensitization injections, local anesthesia, and vaccinations
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ID sites
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skin should be free of hair
should have little or no clothing friction most common - upper back, scapular, and inner surface of forearms |
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sub Q injection
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injections made into the loose connective tissue below the epidermis and dermis
absorbtion is slower and more sustained then IM |
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what is the most you can inject for a sub q site
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1 ml
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what rx is sub q site used most often for
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insulin and heparin
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sub q syringe size
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0.5 - 2 ml
insulin syringe |
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sub q needle length
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3/8 to 5/8 inch needle
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sub q needle gauge
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25- 30
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why do you rotate sub q sites
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to prevent buildup of fibrous tissue.
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how far away from the previous sub q site do you inject
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one inch
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heparin
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used to treat blood clots
injected into the sq, usually abdomen - 2 in from umbilicus (belt line) |
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What syringe for heparin
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always use TB syringe most accurate
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what do you do when and after injecting heparin
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add two ml of air,
apply gentle pressure |
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Lovenox
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low molecular weight heparin,
into love handles prefilled syringe |
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insulin
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used to control type 1 diabetes
dose adjusted according to blood sugar level. doses calculated in untis |
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what is the normal scale for insulin
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100 units of insulin in 1 ml
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insulin syringe
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3/10 - 1 ml size, 28 - 30 gauge, 5/16th & 1/2
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how do you contact the unit pharmacist
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use paging on intranet homepage
click on location of clinical unit click pharmacy "on call" |
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what do you need to document for insulin
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the time, site, and chemstrip result
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error of omission
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a drug is omitted in error, circle admin time, and initial, but make no comment
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error of commission
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rx was dispensed by mistake and was not ordered, you must write rx, dose, route, and initials.
report error, notify care team coordinator and MD observe pt closely for any adverse side effects. |
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what screen do you use to administer meds
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active worklist
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what screen do you use to verify meds
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med summary
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what screen tells you what date and time rx was given last
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charted list.
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error of omission
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a drug is omitted in error, circle admin time, and initial, but make no comment
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error of commission
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rx was dispensed by mistake and was not ordered, you must write rx, dose, route, and initials.
report error, notify care team coordinator and MD observe pt closely for any adverse side effects. |
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what screen do you use to administer meds
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active worklist
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what screen do you use to verify meds
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med summary
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what screen tells you what date and time rx was given last
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charted list.
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If orders need to be verified
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pink pencil
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discontinued meds
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highlighted yellow
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when do you ask pt for 2 identifiers
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before scanning braclet
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who can verify orders
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rn only
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what do you do when a barcode will not scan green
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get assistance from RN, SN will log of , RN will log on using her numbers
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how does pancrease regulate blood glucose
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beta cells - decrease BG lowers glucose by allowing it to enter cells
alpha cells increase BG by increasing stored glycogen from liver, glycogen turns into glucose. |
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how do you increase blood glucose
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eating
stored glycogen in liver released in times of strees. |
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what does the release of insulin cause
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membrane receptors in cells to allow glucose to enter
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what is negative feedback
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when BG drops, alpha cells release glucogen which stimulates the liver to release glycogen which is changed into glucose
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what happens to the pancreas in type 2 diabetes
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impaired insulin secretion
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s & s of type 2
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cho is metabolized in the blood
BIG 4 - polydipsia (thirst) polyuria (urine) polyphagia (hunger) dehydration |
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s & s of mild hypoglycemia
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nervousness
hunger increased heartbeat sweating |
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ss of moderate hypoglycemia
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confusion
blurred vision nervousness unsteady or imbalanced movement |
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ss of severe hypoglycemia
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headache
confusion unconscious vision problem -doubled or blurred |
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rapid acting insulin
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insulin lispro ( humalog)
insulin aspart (novolog) insulin glulisine (apidra)*5-10mi |
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biguanides and thiazolidediones
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decrease hepatic glucose output
increased peripheral glucose uptake |
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alpha-glucoside inhibitors
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decreased glucose absorption in the GI tract
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sulgonylureas glyizide
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increased insulin secretion
take 30 mins before meals do not use in pregnancy |
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what do dyslipidemic meds do
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manage pts with elevated blood lipids (chelestorol)
reduce morbidity and mortality from CAD and other atherosclerosis related cv disease |
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what are 3 blood lipids
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chelesterol
phospholipids triglycerides (energy in cell) |
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what are blood lipids derived from
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diet or synthesized in the liver and intestine
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how do blood lipids get transported
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in plasma by proteins called lipoproteins
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what do lipoproteins contain
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cholesterol
phospholipids triglyceride bound to protien |
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how do lipoproteins vary
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they vary in the density of protein and lipid components
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HDL
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high density cholesterol
more proteins than lipids |
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LDL
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more lipids than proteins
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dyslipidemia
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aka hyperlipidemia
lipids are out of wack |
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primary dylipidemia
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familial - genetic
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secondary dylipidemia
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dietary habits
disease related (DM hypothyroidism, obesity) |
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dyslipidemia mngmt
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lifestyle changes (very difficult for most pts)
high HDL Low LDL low total cholestorol low triglyceriede level meds (last resort) |
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general characteristics of meds to treat dyslipidemia
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alter : production, absorption, metabolism, or removal of lipids and lipoproteins
initiated only after 6 months of dietary changes |
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HMG - COA reductase inhibitors
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statins
inhibit the enzyme necessary for hepatic synthesis in the liver decrease production of cholesterol and triglycerides lowers LDL and keeps HDL the same or increases it PREGNANCY D CATEGORY |
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bile acid sequestrants
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binds bile acid in the intestinal lumen
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explanation of bile acid sequestrants 3 parts
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1.bile is excreted in feces so it isn't recirculated to the liver
2. lower bile acids to stimulate liver to make more hepatic cholesterol 3. as hepatic cholesterol is used up, serum cholesterol goes to liver to make more bile acids |
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what are bile acid sequestrants used with
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they are mainly used with statins to lower LDLs
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what do bile acid sequestrants do to other drugs
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decrease the absorbtion
you must take one hour before or 4 hours after all other rx's |
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what is an example of a bile acid sequestrant
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questran (cholestryamine)
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what is the most effective rx in lowering serum triglyceride levels
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fibrates
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what do fibrates do
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increase the oxidation of fatty acids in the liver and muscles which * decrease hepatic production of triglycerides
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what is an example of a fibrate
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lopid (gemfibrozil)
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what rx decreases both triglycerides and cholesterol
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niacin
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how does nicain work
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inhibits mobilization of free fatty acids from peripheral tissues
reduces hepatic synthesis of triglycerides increases secretion of vldl, which leads to a decrease of LDL |
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chelesterol absorbtion inhibitor
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acts on sm intestine to inhibit choleserol,
decreases the delivery of intestinal cholesterol to liver reduces helpatic cholesterol stored and increases clearance of cholesterol from blood |
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CAD
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atherosclerotic plaque
narrows lumen of vessels decreases elasticity impairs dilation of coronary arteries |
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what is CAD progression
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from angina to MI
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classic angina
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obstruction of coronary arteries
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how is classic angina relieved
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with rest, nitroglycerin (it usually happens under stress or exertion)
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variant angina
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myocardial spasm, occurs at rest or in cold
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unstable angina
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pt usually has advanced CAD
indicator of possible MI pt will be hospitalized |
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nitrates
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used to treat acute angina
take VS before giving, a drop in BP or systolic above 90 you can give 3 times wait 5 mins b/w |
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beta adrenergic blockers
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treat long term chronic heart pain
Propanolol will decrease pulse and BP |
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Calcim channel blockers
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used when other rx fail always used last!
used for variant heart pain Cardizem (diltiazem) |
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chest pain protocols
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MONA
morphine oxygen NTG asprin |
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Automaticity
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hearts ablility to generate an electrical impulse through the SA node
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Conductivity
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ability of cardiac tissue to transmit electrical impulses for effective contraction
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antidysrhythmics
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cardiac glycosides (lanoxin - digoxin)
Beta blockers (lopressor - metoprolol) Potassium channel blockers (amiodarone hydrochoride) calcuim channel blockers (cardizem - diltiazem) unclassified (adenosine or magnesium sulfate) |
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cardiac glycosides
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lanoxin digoxin -
strenthens heart contraction by pushing blood out and getting more O2 in. |
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What do you do before giving a cardiac glycoside
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you take an apical pulse
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what is something you should note when giving cardiac glycosides
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lanoxin - digoxin
they have a narrow theraputic level, pt can become toxic quickly apical pulse |
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Beta blockers
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lopressor metoprolol
given often - slows sa node down, given to heart attack heart failure pts. |
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potassium channel blockers
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amiodarone hydrochloride
maintains normal sinus rhythm vasodilates |
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calcium channel blockers
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cardizem - diltiazem
blocks calcium from entering myocardial cells. given for a-fib, tachycardia calcium excites the heart |
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adenosine
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short duration of action,
short half life stops the heart, breaks the tachycardia and the heart should restore normal rythym NEED CRASH CART |
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endocrine system
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participates in regulation of all body activities
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what is the master gland
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pituitary gland
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endogenous hormones
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have the exact same sequence as what is in the body. (insulin)
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exogenous hormones
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coming from outside the body (pills)
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target specific hormones
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only affect one or two hormones
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general effect hormones
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hormones effecting the entire body.
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hormonal disorders
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glandular hypofunction (infertility)-inadequate hormone production
glandular hyperfunction - excessive hormone production |
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hormonal meds
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produce widespread theraputic and hormonal effects
synthetic vs. natural sources |
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hypothyroidism
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destruction of thyroid gland causes inadequate prodution of thyroid hormones
cretinism, hashimotos thyroiditis, myxedema |
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Cretinism
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congenital form of hypothyroidism, parent did not have enough dietary iron.
partially funcioning or absent thyroid |
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hashimotos thyroiditis
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own immune system attacks and destroys your gland, auto immune disease
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myxedema
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hypothyroidism
long term fatigue, cold feeling |
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ss of hypothyroidism
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intolerance of cold
fatigue weight loss constipation forgetfulness bradycardia |
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hypothyroid replacement therapy
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adequate dosage to compesate for thyroid defect
exogenous replacement |
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what is the rx of choice for hypothyroidism
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synthroid - levothyroine
lifelong therapy |
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pt education for synthroid -levothyroxine
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take on an empty stomach
take the same time every day do not switch brands limit caffine intake watch meds that stimulate heart avoid antacids, iron, sucralfate |
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hyperthyroidism
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excessive secretion of the thyroid
graves disease, nodular goiter thyroid storm |
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graves disease
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most common hyperthyroidism
eyes popping body is unable to communciate with TSH, it just continues to produce hormones |
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ss of hyperthyroidism
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tachycardy
nervousness insomnia intorlerance of heart weight loss fatigue |
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what is the goal of antithyroid meds
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reduce hormone production, to relieve symptoms, avoid destruction of gland
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thioamides
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stops the synthesis of thyroid hormone
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indications for thioamides
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hyperthyroidism
pe-op thyroidectomy radioactive iodine therapy thyroid storm |
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iodine solutions
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stop the release of hormones
cause accumulation in the thyroid gland |
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indications for use of iodine solutions
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short term rapid response
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examples of iodine solutions
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lugols solutions
saturated solution potassium iodine (sski) - stops release of hormone, must watch K level |
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inderal
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treats symptoms of hyperthiroidism
does not affect thyroid function used to treat CV conditions seen in hyperthyroidism temporary must have thyroidectomy. |
