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151 Cards in this Set
- Front
- Back
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Identify 5 individual factors that elicit different responses to drugs.
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Age
Gender Body mass Health status Genetics |
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If the drug response is desirable, it is _______.
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therapeutic
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If the drug response is undesirable, it is _______.
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adverse
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After a drug is administered, it is called a _______.
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medication
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biologics
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agents naturally produced in animal cells, by microorganisms, or by the body itself
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Therapeutics is concerned with _______. (2)
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Prevention of disease
Treatment of suffering |
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Identify the function of the Center for Biologics Evaluation & Research.
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Regulates use of serums, vaccines, and blood products
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Identify the function of the Center for Drug Evaluation & Research.
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Keeps unsafe/ineffective drugs off the market
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Identify the 4 stages of approval for therapeutic/biologic drugs by FDA.
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Preclinical investigation
Clinical investigation Review of new drug application (NDA) Postmarketing surveillance |
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preclinical investigation (4)
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-lab research on cells and animals
-determines drug-dose range -examines adverse effects -inconclusive results |
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clinical investigation (4)
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-3 different stages
-long part of approval process (2-10 years) -evaluates human benefits with volunteers -tests done on healthy humans, then on sick |
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NDA review (4)
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-results are positive, precautions noted in application
-safety and efficacy of drug must be noted -drug approved, continues -drug rejected, process suspended |
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post marketing surveillance (3)
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-new drug placed on market
-surveyed for harmful effects in large population -FDA holds public meetings, withdraws drug if problematic |
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Identify the length of time it takes to research and develop a drug before it's submitted to FDA.
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11 years
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Identify the core goal of the FDA.
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Make sure drugs are safe for the public
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Identify the stage of the drug approval process that nurses are most involved and how they're involved.
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Stage 4, post marketing surveillance; they must administer and monitor for therapeutic effects and adverse rxns
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Identify the basic rights of medication administration.
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Right patient
Right medication Right dose Right route of administration Right time of delivery Tip: Pet my dog Rover's tail |
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Identify the two ways drugs are classified and define them. Identify an example of each.
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Therapeutic - based on what drug does clinically, i.e. anticoagulant, antidepressant
Pharmacologic - based on how drug produces its effect or 'mechanism of action', i.e. calcium-channel blockers, diuretics |
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Identify the 3 names a drug can have.
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Chemical
Generic Trade |
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generic name (4)
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-Assigned by U.S. Adopted Name Council
-Used by many organizations, i.e. FDA, WHO, US Pharmacopoeia -Written in lower case -Only 1 generic name |
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trade name (2)
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-Assigned by the company marketing drug
-Capitalized |
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How long does a drug company have exclusive rights to their drug before generics can be made?
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17 years
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DEA
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federal agency responsible for enforcing laws and regulations governing narcotics and controlled substances
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Identify how scheduled drugs are categorized.
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Schedule I drugs have the highest abuse potential and their use is restricted in the U.S.
Schedule V drugs have the lowest potential for abuse. |
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Identify 3 examples of Schedule 1 drugs.
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Heroin
LSD Methaqualone |
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STAT
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immediately within 5 minutes
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PRN
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given when needed/necessary as required for patient's condition
Note: Pro re nata in Latin |
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ASAP
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administered within 30 minutes of written order
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standing order
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written in advance for anticipated outcomes, i.e. post-op or blood products
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routine order
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maintenance drugs, i.e. blood pressure meds or cholesterol meds
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Identify 10 responsibilities the nurse has in regards to a drug prescribed to her patient.
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Must have knowledge and understanding of:
-Drug ordered -Name (generic and trade) and class -Therapeutic use (purpose) -Effects on the body -Side effects -Contraindications -Special considerations (age, weight, risk factors, etc.) -Why this drug has been prescribed for your patient -How the drug is supplied by pharmacy -How the drug is to be administered |
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allergy
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acquired hyperresponse of body defenses to foreign substance (allergen)
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anaphylaxis
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severe massive and systemic release of histamine and other chemicals mediators that can lead to shock
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Identify the 3 additional rights of drug administration.
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-Right to refuse drug
-Right to receive drug education -Right documentation |
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Identify the 5 common signs/symptoms of anaphylaxis.
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Facial and tongue swelling
Throat closure Dyspnea (shortness of breath) Hypotension Tachycardia |
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Identify the 3 checks of drug administration.
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-Checking drug w/ patient's MAR after receiving or removing from machine
-Checking the drug when pouring/preparing -Checking the drug before giving to patient |
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compliance
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taking a medication in the manner prescribed by the health care provider; includes taking at the right time, right route, right schedule, etc.
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Identify 5 factors impacting drug compliance.
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-Cost of drug
-Amount of times drug must be taken -Impairs lifestyle -Annoying side fx -Self-adjustment of doses, i.e. taking 1/2 due to fear of addiction |
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Identify the 3 categories of routes of drug administration.
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Enteral
Parenteral Topical |
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Identify 5 types of enteral routes.
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Oral
Sublingual Buccal Nasogastric Gastrostomy |
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Identify 4 types of parenteral routes.
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Intramuscular (IM)
Intradermal (ID) Subcutaneous (SC) Intravenous (IV) |
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Identify 6 types of topical routes.
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Transdermal patch
Ophthalmic effect Otic Nasal Vaginal Rectal |
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Identify the 4 parts of pharmacokinetics.
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Absorption
Distribution Metabolism Excretion Tip: ADME |
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absorption
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movement of drug from site of administration to the bloodstream
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distribution
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movement of drug throughout the body
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metabolism
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biotransformation of the drug so that it can be excreted by the body; occurs in liver
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excretion
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process of removing drug from the body; mostly done by the kidneys
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Why is it important to know where a drug is metabolized?
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You don't want to give a drug metabolized in the liver to a patient with a malfunctioning liver.
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Identify 4 routes of excretion and which is the most common.
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Kidneys, most common
Breast milk Lungs Bile |
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Identify the role of excretion in pharmacotherapy.
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Determines drug concentration in bloodstream and tissues
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Why is it important to monitor plasma drug levels?
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Therapeutic response and toxicity of most drugs are directly related to levels in plasma.
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first-pass effect
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phenom of metabolism that occurs with orally administered meds (by GI enzymes) that results in a reduction of the amount of metabolized drug
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Why is it hard to treat conditions in the skin, bone, and adipose tissue through the bloodsteam?
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Blood flow to these areas are lower than other areas.
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Identify the 4 areas that get the most blood supply.
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Heart, liver, kidney, brain
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Identify the process of pharmacokinetics that determines the time it takes for drug to reach target site.
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Absorption
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Identify the 4 outcomes of metabolism.
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Increase excretion
Increase effectiveness (of some drugs) Activate prodrugs Convert active drug compounds to inactive form |
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half-life
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time it takes for a drug to be 50% of its originally administered dose
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If half-life of morphine 10 mg is 2 hours, what will be the dose left in the body after 2 hours?
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5 mg
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If a drug has a short half-life, is it given more often or less often?
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More often
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loading dose
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higher amount of drug given to 'prime' the bloodstream
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maintenance dose
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drug dose given to keep plasma drug concentration in therapeautic range
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active transport
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movement against concentration or electrochemical gradient; typically done by large, ionized, water-soluble agents (protein carriers)
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diffusion / passive transport
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movement from high concentration to low concentration; typically done by very small particles (Na, K)
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Most drugs cross membranes via ______.
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direct penetration
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Identify factors affecting absorption.
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Dose, preparation, route, ionization, pH, GI motility, GI enzymes, drug-drug interaction, drug-food interaction, blood-flow to site
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Identify factors affecting distribution. (7)
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Circulating blood flow to the tissues
Lipid solubility Tissues that have high affinity to certain drugs Size (albumin) Drug-protein complex Drug competition for protein binding sites Blood-brain barrier and fetal-placental barrier |
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Identify the process of pharmacokinetics that determines the drug's duration of action.
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Excretion
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Identify how renal failure or liver disease affects excretion.
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Increased duration of drug action in the body
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peak
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highest serum level of free or unbound drug in a patient, based on a dosing schedule, which is usually measured ±1⁄2 hr after an oral dose of a drug
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trough
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point of minimum concentration of a drug or therapeutic agent, measured prior to next scheduled dose
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When is the peak measured?
When is the trough measured? |
Peak - drawn after dose is given
Trough - drawn prior to upcoming dose |
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pharmacodynamics
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how a medication changes within the body
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endogenous regulatory molecules
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molecules of the body
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receptors
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functional macromolecule that binds to endogenous molecules in the body to either mimic action or block action; most are proteins
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therapeutic index (TI)
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describes drug's margin of safety;
Formula = LD-50 / ED-50 |
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ED-50
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50% of the population had a therapeutic response
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LD-50
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50% of the population had lethal dose in animals
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A large therapeutic dose indicates that a drug is _____.
safe/unsafe |
safe
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potency
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drug will produce therapeutic effect at lower dose
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efficacy
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magnitude of maximal response that can be produce from a particular drug
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Which of the following is more important for the patient: potency or efficacy?
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Efficacy because it means relief for the patient
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agonist
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produces same response as endogenous substance
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partial agonist
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mimics response, but a weaker response than agonist
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antagonist
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prevents action on endogenous molecule; occupies receptor and prevents the chemical from acting; competes with agonists for binding sites
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idiosyncratic
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unexplainable and unpredictable drug reactions
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Noncompliance assumes that _____.
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patient has made educated decision about treatment plan
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Identify the 5 steps of the nursing process.
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Assessment
Diagnosis Planning Implementation Evaluating TIP: ADPIE "add pie" |
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assessment
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systemic collection, organization, validation, and documentation data (health history and patient data)
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diagnosis
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selecting NANDA-approved statements that focus on patient needs; includes risk diagnosis and actual diagnosis
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planning (3)
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Prioritize diagnoses, formulate desired outcomes, and select nursing interventions to bring patient back to optimal health
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implementation
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carrying out nursing plan for the patient; the action part of the process that includes med administration, client teaching, and monitoring drug
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evaluation
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compares patient's current health status with desired outcome, according to the nursing plan; after this, restart nursing process
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Once pharmacotherapy is initiated, what is the focus?
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Reaction to the medication, including desired response, adverse effects, and patient capability for self-administration
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How is a medical diagnosis different from nursing diagnosis?
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A medical diagnosis focuses on the disease or condition; a nursing diagnosis focuses on patient's needs
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Identify the 3 main areas of concern in nursing diagnosis.
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Promoting therapeutic drug effects
Minimizing adverse drug effects Maximizing patient ability for self-care |
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When is baseline data gathered and why is important?
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Gathered during assessment to use for comparison in later observations
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goals
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short/long-term goals based on what the patient will achieve or do; prioritized and based on nursing diagnosis
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Goals focus on _______. (3)
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Safe and effective administration
Therapeutic outcomes Treatment of side fx |
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Which of the following is more important: (a) focus on therapeutic outcomes of meds or (b) treatment/prevention of adverse effects?
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(a) focus on therapeutic outcomes of meds
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outcomes
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specific, measurable criteria; objective measure of goals
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Outcomes require ______. (5)
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Subject
Action required by subject Circumstances Expected performance Time frame |
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Identify the 5 actions of implementation.
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Administering medication
Continued assessment of patient Monitoring drug effects Documenting medications Client teaching |
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TRUE/FALSE
Small amounts of info given over a long period is more effective in regards to client teaching. |
TRUE
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Identify the primary intervention in the implementation step of the nursing process.
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Monitoring drug effects
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With respect to pharmacotherapy, what are the main components of the planning step? (2)
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Drug administration and patient teaching
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standards of care (SOC)
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actions that a "reasonable and prudent nurse" with equivalent preparation would do under similar circumstances; guidelines used to determine what a nurse should or shouldn't do
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Identify factors that contribute to medication errors by the healthcare provider. (6)
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• Omitting one of the rights of drug administration
• Failing to perform an agency system check • Failing to take into account for patient variables such as age, body size, and renal or hepatic function • Giving medications based on verbal orders or phone orders • Giving medication based on an incomplete order or an illegible order • Practicing under stressful work conditions |
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Identify factors that contribute to medication errors by the patient. (6)
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• Taking drugs prescribed by several practitioners
• Getting prescriptions filled at more than one pharmacy • Not filling or refilling prescriptions • Taking medications incorrectly • Taking medications that may be left over from a previous illness • Taking medications prescribed for something else |
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Identify possible outcomes that occur due to the intense impact of medication errors. (5)
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• Common cause of morbidity and preventable death in hospitals
• Emotionally devastating to nurse and client • Increased cost to patient and facility, as it may extend client’s stay • Poor reputation for unit or facility, caused by high incidence of errors • Penalizing of administrative staff because of errors |
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What is the acceptable rate of medication errors?
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Zero
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Identify what must be included in the patient's MAR in regards to documenting an error.
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-Specific nursing interventions that were implemented following error in order to protect client
-All individuals notified of error |
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sentinel event
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unexpected occurrences involving death or serious physical or psychological injury, or risk thereof
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Identify methods for reducing medication errors during the following step of the nursing process: assessment. (6)
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• Assess food or medication allergies
• Assess current health concerns • Assess use of OTCs and herbal supplements • Review recent laboratory tests • Review recent physical-assessment findings • Identify need for education of medication regimen |
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Identify methods for reducing medication errors during the following step of the nursing process: planning. (5)
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• Avoid using abbreviations that can be misunderstood
• Question unclear orders • Do not accept verbal orders • Follow specific facility policies and procedures related to medication administration • Ask to client to participate by restating the right time and dose of medication |
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Identify methods for reducing medication errors during the following step of the nursing process: implementation.
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• Be aware of potential distractions during medication administration
• Remove distractions, if possible • Focus on task of administering medications • Practice the rights of medication administration • Positively verify patient using name and birthdate – Use correct procedures for all routes of administration – Calculate medication doses correctly – Open medications prior to administering – Document on MAR immediately after administering • Confirm patient has swallowed medication – Be alert for long-acting oral dosage forms with indicators such as LA, XL, and XR |
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Identify methods for reducing medication errors during the following step of the nursing process: evaluation. (2)
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• Assess client for expected outcomes
• Determine if any adverse effects have occurred |
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Identify the 3 most frequent drug errors.
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Wrong dose
Wrong drug Wrong route |
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Identify the purpose of a medication reconciliation for a patient.
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lists all medications a patient is taking to reduce errors
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Can you anonymously report medication errors to the FDA? If so, how?
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Yes, via telephone or online via FDA MedWatch
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TRUE/FALSE
An incident report is part of the patient's MAR. |
FALSE
It is only used by agency's risk management for quality improvement. |
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addiction
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overwhelming feeling that drives a person to use a drug repeatedly
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anticoagulants
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influence blood clotting
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antihyperlipidemics
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lower blood cholesterol
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antihypertensives
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lower blood pressure
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antidysrhythmics
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restore normal cardiac rhythm
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antianginals
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treats angina
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diuretic
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lowers plasma volume
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calcium channel blocker
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blocks heart calcium channels
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angiotensin-converting enzyme inhibitor
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blocks hormonal activity
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adrenergic antagonist
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blocks physiologic reactions to stress
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vasodilator
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dilates peripheral blood vessels
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Identify 5 examples of drugs in Schedule II.
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PCP
Cocaine Morphine Methadone Methamphetamine |
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TRUE/FALSE
Schedule V can be used therapeutically without a prescription. |
TRUE
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What are a nurse's ABC's?
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Airway
Breathing Circulation |
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What is the number one thing to check when you receive/get medication?
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Expiration date
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How do you treat anaphylaxis?
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Epinephrine 10mg injection
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Is administering drugs via GI tube enteral? If so, identify why.
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Yes, because it still goes through your digestive system.
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Identify the advantages (3) and disadvantages (2) of prescription drugs.
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Advantages
-Healthcare provider will examine pt -Amount/frequency is controlled -Instructions/side fx are discussed Disadvantages -Require prescription to obtain -Required healthcare appt |
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Identify the advantages (2) and disadvantages (3) of OTC drugs.
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Advantages
-No healthcare appt required -Less expensive than prescription drug Disadvantages -May choose wrong drug -May not know reactions/interactions -Ineffective treatment may worsen disease/condition |
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Identify a few examples of complementary and alternative therapies.
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Natural plant extracts
Herbs Dietary supplements Acupuncture Hypnosis Biofeedback Massage |
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negative formulary
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list of trade-name drugs that pharmacists may not dispense as generic-drug substitutes
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Why do some states have negative formularies?
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Claim there are differences in bioavailability between generic and trade- name drugs
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prototype drug
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serves as a model for a drug class; has known action/adverse fx and used to compare other drugs in the same class
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physical dependence vs. psychological dependence
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physical dependence - an altered physical condition caused by the adaptation of the nervous system to repeated drug use; withdrawal symptoms when unavailable
psychologically dependent - little physical discomfort when drug is withdrawn, but intense compelling desire to continue use of substance |
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Identify the indicators for long-acting oral dosage forms. (4)
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LA, XL, SR, and XR
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Identify the 5 abbreviations that need to be avoided as listed in the textbook and what should be used in their place. [Table 3.1]
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q = every
qh = every hour/hourly qd = daily/every day qhs = nightly qod = every other day |
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Identify the meaning for the following abbreviation [Table 3.1]: ac.
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before meals
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Identify the meaning for the following abbreviation [Table 3.1]: Rx.
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take
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Identify the meaning for the following abbreviation [Table 3.1]: pc.
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after meals; after eating
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Identify the meaning for the following abbreviation [Table 3.1]: PM.
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afternoon
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Identify the fastest route for onset of drug action.
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intravenous route
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