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95 Cards in this Set
- Front
- Back
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essential parts of a drug order
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1. full name of client
2. date and time order written 3. name of the drug to be administered 4. dosage of the drug 5. frequency of the administration 6. route of administration 7. signature of the person writing the order |
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Oral Route Advantages
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convenient; less expensive; safe-doesn't break skin barrier; administration is less stressful; new oral meds dissolve on the tongue, allowing faster absorption and action
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oral route disadvantages
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contraindicated for nausea, vomiting, low GI mobility, dyphasia, unconscious; may have unpleasant odor or taste; may discolor teeth; can be aspirated or irritate GI mucosa
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sublingual & buccal advantages
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same as oral, plus can be used for local effect; more potent than oral route because drug directly enters the blood and bypasses the liver
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sublingual & buccal disadvantages
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if swallowed the drug could be inactivated by gastric juices; drug must remain umder tongue until dissolved or absorbed which may cause burning or irritation; rapidly absorbed into the bloodstream
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rectal route advantages
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can be used when drug has unpleasant taste or odor; drug released at a slow, steady rate; provides a local, therapeutic effect
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rectal route disadvantages
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dose absorption is unpredictable; perceived as unpleasant to the client; limited use
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vaginal route advantages
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Provides a local effect
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vaginal route disadvantages
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may be messy and soil clothes
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topical route advantages
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few side effects; prolonged systemic effect
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topical route disadvantages
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drug can enter body through abrasions and cause systemic effects; leaves residue on skin that may soil clothes
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Transdermal route advantages
(no disadvantages listed) |
few side effects; avoid GI absorption problems; onset of drug action faster than oral
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Subcutaneous route disadvantages
(no advantages listed) |
involves sterile tech. because breaks skin barrier; more expensive than oral; administer only small volume; slower than IM injection; may irritate tissues and cause pain; produces anxiety; breaks skin barrier
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IM route advantages
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can administer larger volume than sub q; drug is rapidly absorbed
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IM route disadvantages
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can produce anxiety
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ID route advantages
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absorption is slow (good for testing allergies)
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ID route disadvantages
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amount administered must be small; breaks skin barrier
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IV advantages
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rapid effect
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IV disadvantages
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limited to highly soluable drugs; drug distribution inhibited by poor circulation
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Inhalation route advantages
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introduces drug throughout respiratory tract; rapid localized relief; can be administered to unconscious client
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inhalation disadvantages
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drug intended for localized effect can have systemic effect; of use only for the respiratory system
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Pharmacology History
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accidental discoveries and landmark events; began when humans first used a plant to relieve symptoms of disease; the oldest form of healthcare, herbal remedies used for centuries
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Modern Pharmacology
1800's |
began in the early 1800's; isolation of specific substances from complex mixtures (colchicines, curare, cocaine) and other early pharmacological agents from their natural products
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National Formulary
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pharmacological ingredients; 1975 merged with Pharmacopoeia (USP) to form the US Pharmacopoeia-National formulary (USP-NF)
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US Pharmacopoeia
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list of drugs and drug recipes; established in 1820; 1975 merged with National Formulary (NF) to form the US Pharmacopoeia-National formulary (USP-NF)
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Modern Pharmacology
1900's |
drugs were synthesized in laboratory; drug strength and dose could not be controlled with plants, this lab approach saved may lives
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Modern Pharmacology
2000's |
genetic engineering; interferon, human insulin
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Pharmacology
Nurses responsibilities |
nurses are directly involved with patient care and are involved with EDUCATION, MANAGEMENT & MONITORING for the proper use of drugs
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three classifications of therapeutic agents
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drugs or medicines
biologics alternative therapies |
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Drug
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chemical substance that can produce changes within the body
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Medication
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a drug that has been adminstered
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biologics
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1. agents naturally produced in animal cells, by microorganisms or by the body it self 2. any preparation made from living organisms that are used as diagnostic, preventive, therapeutic, insulins, vaccines
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Complimentary and alternative therapies (CAM)
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involve natural plant extracts, herbs, vitamins, minerals, dietayr supplements and may unconventional techiques
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Who can write prescriptions?
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MD, NP, DO, APN, Dentist, PA
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1938 Food, Drug and Cosmetic Act
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1st law preventing the sale of drugs that had not been thoroughly tested before marketing
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1988 Food & Drug Administration (FDA)
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established as an agency of the DHHS
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1994 Dietary Supplement Health & Education Act
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herbal and dietary supplements may be marketed without prior approval of the FDA
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stages of approval for therapeutic and biological drugs
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1. preclinical investigation - extensive laboratory research; animal studies
2. clinical investigation - clinical phase trials; longest part of drug approval 3. review of the New Drug Application - takes about 17-24 months 4. postmarketing surveillance - to survey for harmful effects in a larger population |
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bioterrorism
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deliberate use of a biological or physical agent to cause panic and mass casualties
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2001 new standard for Emergency management
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JCAHO requires all accredited facilities to have plan in place
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potential bioterrorist agents
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Biological - anthrax, viruses (smallpox)
chemical - nerve agents physical - radiation |
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anthrax
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can enter the body by ingestion, inhalation or by cutaneous route (antibiotics can treat if given in time)
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therapeutic drugs
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disease prevention and treatment; based on their therapeutic usefulness in treating particular diseases; clearly states what a particular drug does clinically ("drug used for stroke", Drug used for shock" " antihypertensive"
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pharmacological drugs
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refers to the way an agent works at the molecular, tissue and body system level; addresses how a drug's mechanism of action (how a drug produces its effect in the body (diuretics- lowers plasma volume, calcium channel blocker- blocks heart calcium channels)
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Chemical name
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only one name, the name the chemist knows this drug
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generic name
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only one name
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brand (trade) name
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several different names, given by various manufacturers
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is there a difference between a generic drug or brand name drug?
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key comparison- bioavailability
Physiological ability of the drug to reach its target cells and produce its desired effect; can be affected by inert ingredients and compression |
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Palliative action
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relieves the symptoms of a disease but does not affect the disease itself (morphine sulfate, aspiring for pain)
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curative action
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cures a disease or condition (penicillin for infection
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Supportive action
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supports body function until other treatments or the body's response can take over; norepinephrine for low blood pressure; aspirin for high body remperature
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substitutive action
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replaces body fluids or substances; thyroxine for hypothyroidism
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chemotherapeutic action
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destroys malignant cells; vusulfan for leukemia
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restrative action
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returns the body to health; vitamin, mineral supplements
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controlled substance
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a drug whose use is restricted by the Controlled Substance Act of 1970. drugs classified by abuse potential
schedule one is the highest and schedule five is the lowest |
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Pharmokinetics
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how meds moce through the body; varies by how drugs cross plasma membrane; either diffusion or active transport
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diffusion
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movement of a chemical from an area of higher concentration to and area of lower concentration
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active transport
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movement of a chemical against a concentration of electrochemical gradient (plasma protein and receptor)
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absorption
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where drug moves into the circulating fluids; affects time needed for drug to work; altered by route, amount and individual (acidity of stomach contents can affect absorption of drugs......grapefruit juice
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Metabolism (Biotransformation)
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chemical change so drug can be removed from body; usually takes place in liver;
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First pass effect
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large number of oral drugs are rendered inactive by hepatic metabolic reactions
alternate routes of delivery that bypass the first-pass effect may need to be considered SL, PR or Parental (bioavailability change) |
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Pharmacokinetics
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absorption
distribution metabolism (biotransformation) excretion |
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distribution
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transportation of meds through the body; affected by amout of blood in tissues; affected by physical qualities (poor circulation, fat soluable drugs stored in fatty tissue)
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metabolism (biotransformation)
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chemical change so drug can be removed from body; unsually takes plave in the liver(first pass effect)
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excretion
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removal of drugs from body; main site - kidneys (urine); rate of excretion affects the concentration in the body
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Drug concentration
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minimum; therapeutic; toxic
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minimum effective concentration
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amount of drug required to produce a therapeutic response
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therapeutic range
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plasma drug concentration between minimum effective concentration and toxic concentration
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toxic concentration
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plasma level of drug that wil reuslt in serious adverse affects
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Duration of action
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plasma 1/2 life (increased with renal or liver disease) the longer the 1/2 life, the longer it takes a med to be excreted
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Pharmacodynamics
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how the body changes in response to drugs; statistical calculations from studies of drugs and their effects on the body; means of comparing meds - potentcy, efficacy, agonist, antagonist
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potency
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the dose of meds required to produce a particulare response
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efficacy
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the magnitude of maximal response to the drug
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agonist
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a drug that produces the same type of response as the endogenous substance (as the body would) epi
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antagonist
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prevents the endogenous chemical from acting (antiacid, narcan, etc)
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medication routes
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enteral (GI tract)
parenteral topical |
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Enteral routes
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oral
sublingual buccal rectal |
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oral meds
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tab/caps
powders liquids lozenges |
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infant considerations with liquid meds
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use syringe, dropper or empty nipple; place dropper, syringe, tubing inside mouth between tongue and cheek, in small amounts
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parenteral meds
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IV, IV, IM, ID, sub q, intraarterial
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topical meds
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skin, eyes, ears, nose, lungs, vaginal
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topical meds prep
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know the purpose of the drug
know the prep of the skin wear gloves physicians order lotions, creams, ky |
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5 C's
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Correct pt
Correct med correct dose correct route correct time |
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steps to nursing process
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assessment
nursing diagnosis planning implementation evaluation |
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Assessment
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lab reports, med history, assess pt understanding of meds, phys. exam.
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Drug history
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names of med pt is taking, including otc,
reason for use knowledge of drugs frequency effectiveness or reaction pattern and route admin. allergies, food and meds family history, habits- dietary, alcohol, drugs, tobacco (risk behaviors) socioeconomic- age, education level, occupation, health insurance life style- support system. attitudes towards health |
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nursing diagnosis in regard to meds
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pain (acute)
pain (chronic) constipation diarrhea anxiety knowledge deficit infection (potential) |
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planning (meds)
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focus on
- why pt needs drug - how administered - common indications of adverse effects - determine proper intervention and desired outcome - verify accuracy of the order - know safe dose, allergies, reason for meds |
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implementation
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the actual administration of the medication; patient education (meds, side effects, what to look for and what to report to MD)
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NEVER
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administer a med that someone else has prepared
use meds from an unlabeled container or illegible label leave meds unattended |
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prn med documentation
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reason for med (sharp pain in left shoulder, level 4 on a scale of 1-5)
meds given, include route and if injections, site response to meds |
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evaluation
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compare actual and expected pt outcomes
determine adverse effects, if any pts ability for self- administration What should be changed? |
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patient teaching
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purpose of meds
name and dosage of meds schedule for administration importance of taking meds as directed consequences of not taking it major adverse effects how to handle minor side effects who and when to call for advice |
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patient teaching tips
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physical factors such as hearing/vision affect learning
most effective is if several senses are involved several brief periods may be more beneficial than one long period pt must indicate a willingness to learn geared toward pt's level of understanding |
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reasons why clients may fail to follow medication regimens
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inadequate understanding of illness
dissatisfaction with provider or diaganosis medication cost inconvenient adverse effects forgetfulness |
