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121 Cards in this Set
- Front
- Back
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absorption
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process by which drugs are transferred from the site of entry into the body to the bloodstream
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adverse drug effect
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undesirable effects other than the intended therapeutic effect of a drug
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allergic effect
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immune system response that occurs when the body interprets an administered drug as a foreign substance and forms antibodies against the drug
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ampule
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glass flask containing a single dose of medication for parenteral administration
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anaphylactic reaction/ anaphylaxis
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severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse
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antagonist effect
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combined effect of two or more drugs that produces less than the effect of each drug alone
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cumulative effect:
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condition that occurs when the body cannot metabolize a drug before additional doses are administered . The drug is taken in more frequently then it is excreted. Older patients are at risk for this due to impaired hepatic metabolisn and renal clearance
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distribution:
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movement of drugs by the circulatory system to the site of action
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drug tolerance:
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tendency of the body to become accustomed to a drug over time; larger doses are required to produce the desired effects
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ethnopharmacology:
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study of the effect of ethnicity on responses to prescribed medication, especially drug absorption, metabolism, distribution, and excretion
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excretion
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removal of a drug from the body
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generic name
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name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name
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half-life
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the amount of time it takes for half a dose of a drug to be eliminated from the body
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idiosyncratic effect
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unusual, unexpected response to a drug that may manifest itself by overresponse, underresponse, or response different from the expected outcome
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inhalation
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(1) act of breathing in; synonym for inspiration; (2) administration of a drug in solution via the respiratory tract
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intradermal injection
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injection placed just below the epidermis
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intramuscular injection
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an injection into deep muscle tissue, usually of the buttock, thigh, or upper arm
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intravenous route
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injection of a solution into the vein
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medication reconciliation
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look in book |
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metabolism
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(1) chemical changes in the body by which energy is provided; (2) breakdown of a drug to an inactive form; also referred to as biotransformation
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mini-infusion pump
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battery-operated pump for intermittent infusion allowing medication mixed in a syringe to be connected to the primary line and delivered by mechanical pressure applied to the syringe plunger
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official name:
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name by which a drug is identified in official publications
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parenteral:
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outside of intestines or alimentary canal; popularly used to refer to injection route
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peak level
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highest plasma concentration of a drug
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pharmacodynamic
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process by which drugs alter cell physiology and affect the body
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pharmacokinetics:
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movement of drug molecules in the body in relation to the drug’s absorption, distribution, metabolism, and excretion
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pharmacology:
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study of actions of chemicals on living organisms
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pharmacotherapeutics:
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dynamic that achieves the desired therapeutic effect of the drug without causing other undesirable effects
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piggyback delivery system
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look in book |
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placebo:
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Latin word meaning, “I shall please”; an inactive substance that gives satisfaction to the person using it
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subcutaneous injection:
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injection into the subcutaneous tissue that lies between the epidermis and the muscle
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synergistic effect:
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combined effect of two or more drugs is greater than the effect of each drug alone
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teratogenic
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known to have potential to cause developmental defects in the embryo or fetus
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therapeutic range:
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that concentration of drug in the blood serum that produces the desired effect without causing toxicity
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topical application:
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application of a substance directly to a body surface
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toxic effect:
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specific groups of symptoms related to drug therapy that carry risk for permanent damage or death
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trade name:
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drug name selected and trademarked by the company marketing the drug; also calledbrand name or proprietary name
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trough level
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the point when a drug is at its lowest concentration
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vial:
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glass bottle with self-sealing stopper through which medication is removed; may be single or multiple dose
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volume-control administration set:
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ntermittent intravenous medication infusion diluted with a small amount of solution
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Z-track technique
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technique used to administer medications intramuscularly that ensures that the medication does not leak back along the needle track and into the subcutaneous tissue, reducing pain and discomfort
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Prescription meds - advantages
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•Healthcare provider diagnosis and treatment
•Maximizetherapy •Amountis controlled •Patientteaching |
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Prescription meds- disadvantages
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•Appointmentwith health care provider
•Cost •Medicationregime |
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OTC meds – advantages
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•Noorder
•Easy •Noappointment needed |
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OTC meds - disadvantages |
•Maychoose incorrect med
•Mayreact with foods, herbal products, prescription drugs or other OTC drugs •Mayimpair one’s ability to function safely •Selftreating may potentially be harmful |
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•Therapeutic/functional classification
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•Classifiesdrugaccording to the effects it has or the symptoms it relieves•Example:Antidepressant
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•Pharmacological/chemicalclassification |
•Classifiedby chemical makeup•Example:Aminoglycosides
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4 Components of Pharmacokinetics
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•Absorption
•Distribution •Metabolism •Excretion |
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Absorption is affect by: |
•Route of administration
•Ability of med to dissolve •Blood flow to the site of administration •Body surface area •Lipid solubility |
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Distribution is affected by: |
•Circulation
•Membranepermeability •Abilityto pass through tissues and membranes to enter target cells •Barriermembranes •Blood-brainbarrier •Placentalmembrane |
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Distribution Protein binding: |
•Thedegree to which drugs bind to serum protein affects their distribution
•Plasmaalbumin- large molecule- cannot pass through capillary walls •Particlesbound to protein are inactiveParticlesnot bound to protein are active - Protein bound membranes are not available to exert pharmacologic effects |
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Metabolism
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•Metabolizedinto a less active or inactive form•Biotransformationoccurs
•Usuallyoccurs in the liver •Mayalso be metabolized in the lungs, kidneys, blood and intestines |
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Metabolism First pass effect |
•Rapidhepatic inactivation of certain oral drugs•Drugsabsorbed from GI tract to liver via the hepatic portal vein
•Drugconcentration is reduced on its first pass through the liver before it gets tothe circulation |
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Excretion
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•Aftermetabolism, meds exit the body
•Occursmost often in the kidneys •Alsoexits through lungs, bowel, liver and exocrine glands •Lungs-gaseous and volatile compounds•Exocrineglands- lipid soluble meds•Mammaryglands •GItract •Kidneys |
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Pharmacodynamics
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•Biological,chemical and physiological actions of a particular drug within the body and thestudy of how those actions occur.
•Responsiblefor therapeutic and sometimes adverse effects •Canbe affected by the age of the patient. |
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Pharmacodynamics: Recpetors |
Most drugs create their effects in the body by attaching to special sites called receptors
2 kinds of receptors: Agonist: Attaches to a receptor. Stimulates the cell to act Antagonist: Prevents something else from attaching and causing an effect Agonist + receptor= agonist receptor complex = pharmacological response, |
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Drug mechanism of action Therapeutic drug effects |
•expectedresponse |
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Drug mechanism of action Adversedrug effects |
Side effects •Often predictable
•Secondaryeffects produced at a usual therapeutic dose Serious adverse effects Unintended,undesirable, often unpredictable severe reactions •Report,e.g. MedWatch |
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Allergic effect
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Immunologicreaction to a drug
•Canoccur immediately or be delayed•Anaphylaxis] |
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•Drug tolerance
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•Bodybecomes accustomed to drug over time
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Toxic effect
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Due to a prolonged intake of med or med accumulation
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•Idiosyncraticeffect
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Patient overreacts or underreacts to a med or has a reaction different from normal
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Medication interaction
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-Common in patients taking several medications
- Increases or diminishes action - May change the way another med is absorbed, metabolized or eliminated |
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Synergistic effect
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•Combinedeffect is greater than the effect of the meds given separately
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Plasma drug levels |
•Usedto regulate drug responses application
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Plasma drug levels MEC (Minimum Effective Concentration) |
A drug must be present in concentrations at or above the MEC. Therapeutic effects will not occur below this level
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Plasma Drug Levels
Toxic Concentration |
Level at which toxic effects begin
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******Therapeutic Range
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•Rangethat occurs between the minimum effective concentration and the toxicconcentration
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Drug Plateau
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•Goal:to achieve a constant blood level within a safe therapeutic range•Achievedby regular fixed doses of medication
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Loading dose |
•Whenthe plateau must be achieved more quickly, a larger initial dose or Loadingdose isadministered
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•Maintenance doses
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Plateau is maintained with smaller doses or Maintenance doses
EX: The order may read: Give Digoxin (lanoxin) 0.5 mg IV now . Repeat in six hours. Then begin 0.125 mg IV daily. |
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Drug levels:
Onset of action Peak concentration Trough concentration |
Peak concentration – highest levelTrough concentration – lowest level
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Blood sample for peak and trough |
Blood sample for Peak: 30 minutes after completion of IV infusionBlood sample for Trough:Just prior to the next dose....88888
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Drug's half life |
Drug half-life is the time required for the amount of drug in the body to decrease by 50%For example - if a drug’s half life is 8 hours, the amount of drug in the body is as follows:Initially: 100%
After 8 hours: 50% After 16 hours: 25% |
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Drug's half life |
•Thegreater the half-life, the longer it takes for the medication to be excreted•Thehalf-life of the medication will increase if a patient has liver or kidneydisease resulting in possible toxicity•Adrug’s half life determines the dosing interval
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Drug Regulations and Standards card 1
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Federal regulations
Pure Food and Drug Act (1906) Food, Drug and Cosmetic Act (1938) Harris-KefauverAmendments (1962) Response to thalidomide tragedy FDAAmendments Act (2007) State and local regulationsHealth care institutionsState Nurse Practice ActDefine scope of nurses’ professional functions and responsibilitiesControlled Substances Act (1970) |
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Development and Testing of new drugs
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Expensive and lengthy process
Testing of new drugs:Preclinical testingClinical testing |
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Medication Orders
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No medication may be given to a patient without a medication order from a licensed practitioner.When a patient is admitted to the hospital, all home medications are discontinued and new orders written:
•Post-op(after surgery) •Transferto another clinical service •Transferto another health agency |
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Med Reconciliation
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•Processof specifying medications and maintaining a current, accurate list of medications that the patientis receiving•Conductedwhen a patient undergoes a transition in care
•Involvescomparing a list of meds a patient is currently taking with a list of new medsthat are about to be provided |
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Med Reconciliation Steps
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Create a list of current meds
Create a list of meds to be prescribed in new setting Compare the meds on both lists Adjust meds based on the comparison For next transition, provide the updated reconciled list to the patient and new provider |
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Types of orders
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•Standing order •Multiplevitamins daily •Keflex250 mg. PO Q6h x 7 days •PRN order •Morphinesulfate 2 mg IV Q 4h prn incisional pain •Single (one time) orders •Valium10 mg PO at 0900 •STAT orders •Apresoline10 mg IV STAT |
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Now orders
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Medication to be given quickly but not right away
Example: Magnesium sulfate 1 gm IV piggyback now |
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Telephone order
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Write down order, time and name of prescriberRead back and confirm
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Verbal orders
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look in book |
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Components of Medication order
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Patient’s full name
Date and time order is written Medication name Dose Route of administration Time and frequency of administration Signature of health care provider |
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Use of abbreviations
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Can lead to medication errors, especially with written orders
Abbreviations that are associated with a high incidence of errors are on the “Do not Use” list ISMP (Institute for Safe Medication Practices) TJC (The Joint Commission) National Patient Safety goal |
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Rights of med administration
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Right medication
Right reason Right dose, route and preparation Right patient Right time Right assessment data Right education Right documentation Right response Right to refuse |
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Right medication
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Order written by health care provider
-Hand written -CPOE (Computerized Physician Order Entry) -Nurse verification of order -Perform 3 checks |
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Right reason
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•Knowledgeabout medication
•Patientcondition, indications for medication |
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Right dose, route and preparation
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•Thedose ordered needs to be appropriate for the patient •Questionunusually small or large doses •Haveanother nurse check calculated doses •Needsto be prepared safely •Crushing– need to know if a med can be crushed |
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IDC (Independent double check)
****High alert meds***** |
Used for high alert medications
Examples: Anticoagulants, chemotherapeutic agents, insulins and opiodsSecond practitioner independently verifies correct dosage |
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The Right Patient
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•Useat least 2 patient identifiers
•Name,medical record number, birthdate •Pt’sroom number cannot be used •Comparethe patient identifiers on the MAR with the patient’s ID bracelet |
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Right time
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•Knowwhy meds are given at a certain time•Givethe medication at the right frequency and at the time ordered
•Medscan be designated in hospitals to be time-critical or non-time-critical •Time-critical:within 30 minutes of scheduled time •Nontime-critical: within 1-2 hours before or after scheduled time or per agencypolicy |
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Right assessment data
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Collect appropriate assessment data
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Right education
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Assess patient’s level of knowledgeProvide education
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Right documentation
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Document pre-assessment data
Record each medication as soon as you administer the med If medication is not given, record the reason |
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Right response
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Patient’s response to the medication
Laboratory values Education about therapeutic effects and adverse effects |
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Right to Refuse****needs to be answered
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What is the role of the nurse if the patient wants to refuse a medication?
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Controlled Substances
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Have a high potential for addiction or drugs that are frequently abusedControlled under the Controlled Substances Act (CSA)Violations can result in fines, imprisonment and loss of licenseStored in locked, secure cabinet
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Controlled Substances
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Drugs are classified by their potential for abuse, medical use and dependence potentialSchedule I – VDifferent regulations for each schedule
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Controlled Substances
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Drugs are classified by their potential for abuse, medical use and dependence potentialSchedule I – VDifferent regulations for each schedule
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Examples of controlled substances |
Examples:I Heroin, LSDII Morphine, DilaudidIII Vicodin, Tylenol with codeineIV Valium, AtivanV Cough syrup
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Controlled Substances
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Narcotic Count
Special Inventory RecordDiscrepancies DisposalWitness |
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Metric system
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Logically organized in units of 10Units are easy to convert and compute through simple multiplication and divisionBasic units – meter, liter, gram
Safety alert: Errors may occur with the use of fractions and decimal points Two ways to make fractions expressed in decimal points safe: 0.25 not .25 25 not 25.0 |
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Using household equipment for meds |
Familiar to most people
May be inaccurate May be used when more accurate systems of measurement are not required Convenient |
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Metric to household equivalent*** need to know |
1ML= 15 drops (gtt) 5ml=1tsp 15 ml = 1 Tbsp 240 ml = 1 cup |
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Routes of Administration
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Oral /Enteral
Topical – Skin, nasal, eye, ear, vaginal, rectalIntraocular Inhalation Parenteral- IM, SC, ID, Intravenous |
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Advantages of oral administration |
Most convenient
Inexpensive Safer Can be self administered Administration does not cause stress |
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Oral- Disadvantages
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Food may decrease therapeutic effects
Not indicated with alterations of GI function, inability to swallow, gastric suctioning Local irritation |
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Topical/ Intraocular- Advantages
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Local effect or systemic
Painless Limited side effects Potentially may be used when oral meds are contraindicated |
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Topical/ Intraocular – Disadvantages
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Skin abrasions- rapid absorption
Absorbed through skin slowly Can cause embarrassment |
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Inhalation advantages
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Rapid relief
Used for anesthesia |
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Inhalation disadvantages |
Can cause serious systemic effects
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Parenteral- Advantages
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Can administer when oral cannot be given
More rapid absorption than oral or topicalIV- critically ill pt or long term therapy. Route preferred over injections |
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Parenteral – Disadvantages
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Risk of infection, embolism
Can be expensive Pain, anxiety Caution with patients with bleeding tendenciesIM, IV – higher risk of reactions |
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Developmental Considerations: Older Adults
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Physiologic changes
-Altered memory -Decreased visual acuity -Decrease in renal function -orientation |
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physiologic changes in older adults |
Less complete and slower absorption from the GI tract
Increased proportion of fat to lean body massDecreased liver function Decreased organ sensitivity Altered quality of organ responsivenessDecrease in manual dexterity |
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meds: older adults |
May require smaller doses of drugs
Reactions to drugs may be unpredictablePolypharmacy |
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Causes of med errors
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Human factors
Communication Name confusion Packaging, formulations and delivery devicesLabeling and reference materials Clinical practice Education |
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Prevention of med errors***need to elaborate more from book
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Personal
Technology/System Organization |
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Nursing responsibility in med errors
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Assess patient’s conditionContact health care provider Report to supervisor Complete an incident report Continuously monitor the patient for a reaction
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