Pharmacology Exam #1 Study Cards

Front 1

List the five phases of the nursing process

Back 1

Ch 1
Assessment
Nursing Diagnoses
Planning; Goals and Outcomes Criteria
Implementation; Plan into action
Evaluation

Front 2

Identify the components of the assessment process for pts receiving meds, including collection and analysis of subjective and objective data

Back 2

Ch 1
A comprehensive assessment is completed by gathering data in manners such as completing a physical assessment, looking at the patient, measuring the patient, gathering information from the patient, caregiver, family members, significant others and the patient's chart. Nurse would also collect data regarding a comprehensive medication profile

Front 3

Identify the elements of a comprehensive medication profile

Back 3

1) Any and all drug use;2) use of home or folk remedies, herbal or homeopathic treatments, plant or animal extracts, dietary supplements; 3) intake alcohol, tobacco, and caffeine; 4) current or past history of use of illegal drugs; 5) use of OTC medicals of any sort; 6) hormonal drugs; 7) past and present health history and associated drug regimen; 8) family history, racial, ethnic, and or cultural differences with attention to different responses to medications; 9) history of any unusual responses to medications (including allergic reactions); 10) growth and developmental stages

Front 4

What are the Five Rights of Administration?

Back 4

Ch 1
Right drug; check order, check the label, check for any significant pt history with this medication or potential reactions
Right dose; confirm with order and against patients age and size against normal dosage
Right time; check against hospital policies for standard med admin times and potential conflicts with pts ongoing schedules; is it feasible? would an alternative be better suited
Right route; never assume the route. check against the order
Right patient; check patients identity before giving the meds; ask patient to state name and check badge to confirm name

Front 5

Discuss the related professional responsibility for safe medication practice

Back 5

Nurses are responsible for safe and prudent decision making in the nursing care of their patients, including the provision of drug therapy; in accomplishing this task, they attend to the 5 rights and adhere to legal and ethical standards related to med admin and documentation.

Front 6

Discuss the additional rights of drug administration that are ensured in safe medication practice

Back 6

Patients have the right to an appropriate medication process from start to end; including such aspects as right ordering, dispensing, preparing, administering, and documentation. The nurse must be aware of all facets of med admin process and check the actions of other health care providers. Never assume that all is correct and appropriate

Front 7

List the six elements of a complete drug order

Back 7

Pt name
date order is written
name of medication
dosage
route of delivery
signature of prescriber

Front 8

Other rights of medication administration include:

Back 8

Close consideration of special situations
Prevention and reporting of ME
Patient Teaching
Monitoring for theraputic effects, adverse effects, or toxicity
Refusal of Medication
Constant system analysis
proper drug storage
proper documentation (MAR)
Accurate dosage calculations
accurate dosage preparation
careful checking of transcription (from order to MAR)
Patient safety

Hint 8

Involves every step of the med administration process

Front 9

Pharmacology (define)

Back 9

the study or science of drugs; a drug is any chemical that affects the physiologic processes of a living organism

Front 10

Pharmacology incorporates several interraled areas: name these.

Back 10

pharmaceutics, pharmacokinetics, pharmacodynamics, pharmacotherapeutics, pharmacognosy, and toxicology

Front 11

Define the three names a drug will acquire in the process of development

Back 11

chemical name - describing drug's chemical composition and molecular structure.
generic name - nonproprietary name given to the drug by the USAN Council; shorter simpler name than the chemical name
trade name - proprietary name; drugs registered trademark and indicates that it's commercial use is restricted to the owner of the patent

Front 12

Define: pharmaceutics

Back 12

Ch 2
The study of how various drug forms influence pharmacokinetic and pharmacodynamic activities. The science of preparing and dispensing drugs, including dosage form design (eg tablets, capsules, injections, patches, etc)
Dosage form design affects dissolution

Front 13

Define: pharmacokinetics

Back 13

Ch 2
the study of what the body does to the drug molecules; absorption, distribution, metabolism, excretion
Absorption- The rate at which a drug leaves its site of administration and the extent to which absorption occurs
bioavailability-extent of drug absorption
Bioequivalent- brand name same as generic drug

Front 14

Define: pharmacodynamics

Back 14

Ch 2
the study of what the drug does to the body; the mechanism of a drug actions to the living tissue; involves drug receptor interactions

Front 15

Define: pharmacotherapeutics

Back 15

Ch 2
focuses on the use of drugs and the clinical indications for adminstering drugs to prevent and treat diseases; defines the principles of drug actions; empirical therapeutics (those discovered by accident but action of "how" is not known) and rational therapeutics; the mechanism of how the drug works is known

Front 16

Define: Pharmacognosy

Back 16

Ch 2
the study of natural (vs synthetic) drug sources; plant or animal

Front 17

Define: First pass effect

Back 17

The initial metabolism in the liver of a drug absorbed from the GI tract before the drug reaches systemic circulation through the bloodstream. Drugs administered via IV route do not have the "first pass effect" so should be given in smaller doses.

Front 18

Define: half life

Back 18

in pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body. (aka elimination half life)

Front 19

Define: therapeutic drug monitoring

Back 19

the process of measuring drug peak and trough levels to gauge the level of a pts drug exposure and allow adjustment of dosage with the joint goals of maximizing therapeutic effects and minimizing toxicity

Front 20

Define: therapeutic effect

Back 20

the desired or intended effect of a particular medication

Front 21

Define: Therapeutic index

Back 21

the ratio between the toxic and therapeutic concentration of a drug. If the index is low, the difference between the therapeutic and toxic drug concentrations is small and use of the drug is more hazardous.

Front 22

Define: trough level

Back 22

the lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring

Front 23

Define: peak level

Back 23

the maximum concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring

Front 24

Define: idiosyncratic reaction

Back 24

an abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient

Front 25

Define: contraindication

Back 25

any condition, especially one related to a disease state or other patient charachteristic, including current or recent drug therapy, that renders a particual form of treatment improper or undesirable

Front 26

Define: adverse drug event (ADE)

Back 26

any undesireable occurrence related to administering or failing to administer a prescribed medication

Front 27

Define: Adverse drug reaction (ADR)

Back 27

any unexpected, unintended, undesired, or excessive response to a medication given at therapeutic dosages (as opposed to and OD)

Front 28

Drug: bioavailability

Back 28

a measure of the extent of drug absorption for a given drug and route (0% to 100%)

Front 29

What role does pharmaceutics play in the medication administration process and how is it applied in the nursing process?

Back 29

Pharmaceutics is the study of how different forms of drugs affect the body. For example, drug absorption various for different forms of medication. Liquids, elixirs, and syrups absorb faster than say enteric-coated tablets. In the nursing process, understanding how these different forms affect a patients body is important in determining appropriate dosage, routes and so forth.

Front 30

List the various oral preparations in order from fastest to slowest

Back 30

liquid, elixir, syrups
suspension solutions
powders
capsules
tablets
coated tablets
enteric coated tablets

Front 31

List the three primary dosage forms

Back 31

Enteral - tablets, capsules, pills, timedr released capsules, elixirs, suspensions, syrups, etc

Parenteral - Injectable forms, solutions, suspensions, emulsions, powders for reconstitution, sublinqual or buccal tablets

Topical - aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, suppositories

Front 32

Describe the role of pharmacoKINETICS; (absorption) in medication administration and how it is incorporated in the nursing process

Back 32

Pharmacokinetics is the study of what the BODY DOES TO THE DRUG. It involves the processes of absorption, distribution, metabolism, and excretion.

Absorption is the movement of a drug from it's administration sight into the bloodstream for distribution to the tissues. Absorption is a key factor in the bioavailability of a drug. For example a drug that is absorbed in the intestine must first pass through the liver before it reaches the systemic circulation. The drug's bioavailabity has then been reduced by the "first pass affect." A key part of the nursing process is understanding these and the bioavailability of a PO drug versus a drug administered IV.

Front 33

Describe the role of pharmacoKINETICS; (distribution) in medication administration

Back 33

Distribution is the transport of a drug in the body by the bloodstream to its site of action. The areas to which the drug is distributed first are those that are most extensively supplied with blood. Areas of rapid distribution in clude the heart, liver, kidneys, and brain. Slower distrubtion areas include muscle, skin, and fat.

There are three primary proteins that bind to and carry drugs in the bloodstream through out the body; albumin, alpha1-acid glycoprotein, and corticosteroid binding globulin. Most commonly is the albumin. if a drug binds to plasma proteins as part of it's chemical attributes, there there is only a limited amount of drug that is not bound to protein. This unbound portion is considered pharmacologically active and is a "free" drug versus bound portions which are considered inactivated. Increased levels of unbound drug chemical increases the risk of toxicity.

Front 34

Describe the role of pharmacoKINETICS; (metabolism) in medication administration

Back 34

AKA; biotransformation as it involves biochemical alteration of a drug into an inactive metabolite, a more soluble compound, or a more potent active metabolite. The organ most responsible for metabolism is the liver. Other metabolic tissues include skeletal muscle, kidneys, lungs, plasma, and intestinal mucosa. Delayed drug metabolism can result in the accumulation of drugs; prolonged action of the drugs and increased risk of toxicity

Front 35

Describe the role of pharmacoKINETICS; (excretion) in medication administration

Back 35

The elimination of the drugs from the body. The kidney is the primary organ responsible for elimination. The two other organs that play an important role in this process are the liver and the bowel. Drugs can also be eliminated from the intestines by being taking up into the liver and released into the bile and eliminated by feces. Some certain drugs such as fat soluble drugs, are in the bile and may be reabsorbed into the bloodstream, returned to the liver and again secreted into the bile. This process is known as the enterohepatic recirculation.

Front 36

What are the significant factors associated with enterohepatic recirculation that a nurse must be aware of in the medication administration process.

Back 36

Enterohepatically recirculated drugs persist in the body for much longer periods which must be considered in determining appropriate dosages and frequency of dosing.

Front 37

Label the appropriate areas as shown.....

Back 37

Front 38

Describe the role of pharmacoDYNAMICs in the medication process

Back 38

pharmacodynamics is concernted with the mechanism of drug action in living tissues. Understanding the pharmacodynamic characteristics can aid in assessing the drug's therapeutic affect. A therapeutic effect is a positive change in a faulty physiological system.

Front 39

At what point are most drugs considered to be effectively removed from the body? At what percentage?

Back 39

At approximately 5 1/2 lives 97% of the drug has been eliminated

Front 40

Describe the characteristics of drug effect and relationship to the therapeutic window.

Back 40

In contract to drug actions, drug effects are the physiological reactions of the body to a particular drug. The terms onset, peak, duration, and trough are used to describe drug effects. A drug's onset of action is the time required for the drug to elicit a therapeutic response. A drugs peak effect is the time required for a drug to reach it's max therapeutic response. The duration of action is the length of time that the drug concentration is sufficient to elicit a therapeutic response. The therapeutic window is the time frame between the point in which the minimal effective concentration level has been exceeded but before the toxic level has been reached. There is generally a delay in the "onset of action"; shorter or longer depending on the other pharmacokinetics principles of the drug (i.e. absorption, distribution, etc)

Front 41

Describe the ways drugs produce therapeutic effects

Back 41

Mechanism of actions include three basic ways; through receptors, through enzymes, and through nonselective interactions.

Receptor interaction entails the selective joining of the drug molecule with a reactive site on the surface of a cell or tissue. This binding of the drug molecule to the receptor in turns elicits a biological effect.

Enzyme interactions either inhibit or enhance the action of a specific enzyme. For example, angiotensin-converting enzyme (ACE) causes a chemical reaction that results in the production of a substance known as angiotensin II which is a potent vasoconstrictor.

Nonselective inhibitors act, instead, with the cell membrane and various cellular processes such as metabolic activities (primary target)

Front 42

True or false: A drug can cause a cell to perform a function that it was not designed to perform.

Back 42

False: A drug can modify or strengthen a function of itself but it cannot perform a function that it is not part of it's natural physiology.

Front 43

Discuss the four principles of pharmacotherapeutics to everyday nursing practice as they relate to drug therapy for a variety of patients in different health care settings

Back 43

The four basic principles of pharmacotherapeutics are:
Expected outcome of therapy should be established
Outcome should be specific to the patient with the patients input as well as other members of pts health care team if appropriate
Outcomes should be clearly defined and must be either measurable or observable by the pt or caregiver
Outcomes should be realistic and prioritized

Front 44

List and describe the seven types of therapy:

Back 44

Acute: involves more intensive drug treatment and is implemented in the acutely ill or even critically ill
Maintenance: typically does not eradicate problems the patient may have but does prevent progression of a disease or condition
Supplemental: aka replacement therapy supplies the body with a substance needed to maintain normal function
Palliative: the goal is to make the patient as comfortable as possible; typically at the end stage of illness when curative therapy has been unsuccessful
Supportive: maintains the integrity of body functions while the patient is recovering from illness or trauma
Prophylactic:
therapy provided to prevent illness or other undesired outcome
Empiric:
does not have a scientific basis but instead is based on experience. (i.e. acetaminophen is given to a pt who has a fever b/c it has shown to work but the how is not known)

Front 45

Discuss the influences of the patients age on the effects of drugs and drug responses

Back 45

Ch 3
During the time from the beginning to the end of life, the human body changes in many ways. These changes have a dramatic effect on the four phases of pharmacokinetics: absorption, distribution, metabolism, and excretion. Newborns, pediatric, and elderly patients each have special needs.

Front 46

Identify the drug related concerns during pregnancy and lactaion. Provide explanation of the physiologic basis for these concerns.

Back 46

Ch 3
In pregnancy, the fetus is exposed to many of the same substances as the mother. The first trimester is the period of greatest danger of drug induced developmental defects. During the 1st trimester the fetus undergoes rapid cell proliferation, and the skeleton, muscles, limbs and visceral organs are developing at their most rapid rate.

During the last trimester the greatest % of maternally absorbed drug gets to the fetus. The effects are less severe in that the fetus has undergone most of its in utero development.

During lactation, a wide variety of drugs can easily cross from the mother's circulation to the breast milk and ultimately to the breast feeding baby. However, the primary route for drug excretion is not in breast mild, therefore actual amounts are significantly lower.

Front 47

Discuss the process of pharmacokinetics and associated changes in pediatrics.

Back 47

Ch 3
In neonatal and pediatric patients the following factors should be considered:
Absorption: gastric pH is less acidic, gastric emptying is slowed, and IM absorption is faster and irregular.
Distribution: younger pts have greater TBW % which means lower fat content (faster distribution). They have decreased level of protein binding, and immature blood brain barrier (more drugs enter the brain).
Metabolism: immature liver functions that do not produce enough microsmal enzymes (less breakdown of the drug)
Excretion: kidney immaturity and decreased perfusion rate leading to reduced excretion rates.

Front 48

Discuss the process of pharmacokinetics and associated changes in the elderly patient

Back 48

The following are considerations in drug therapy related to the elderly patient:

Absorption: gastric pH less acidic, slowed gastric emptying, movement thru GI tract is slower, reduced blood flow to the GI tract, reduced absorptive surface area due to flattened intestinal villi
Distribution; TBW % lower, fat content increased, decreased production of proteins by liver (more free drug circulating in the system)
Metabolism: aging liver produces fewer microbial enzymes and reduced blood flow to the liver
Excretion: decreased filtration rates, decreased number of intact nephrons

Front 49

Identify various cultural phenomena affecting health care and use of medications

Back 49

Several historical events have played a significant role in the current legislation of the development, distribution, and regulation of medications on the market today. Not only in the over the counter market but in prescribed and controlled substances. Various legislative inventions have been as a result of large scale tragedies due to unregulated medications. One example is the thalidomide tragedy occuring from the 40-60's when many pregnant women taking the drug for sedative purposes gave birth to severly deformed infants.

Front 50

Briefly discuss the important components of drug legislation at the state and federal levels

Back 50

The first legislative acts were put into place in 1906. More significant acts are as follows:

Durham-Humphrey Amendment which established legend or more widely known as prescription drugs

Kefauver-Harris Amendment which required manufacturers to demonstrate both therapeutic efficiacy AND safety of new drugs

Controlled Substance Act which established schedules for CS and promoted drug addiction, education, research and treatment

Orphan Drug Act which enabled the FDA to research and market organ drugs used to treat rare diseases

Accelerated Drug Review which enabled an expidited process of approval by FDA for drugs to treat life threatening illenesses (prompted by the HIV/AIDS epidemic)

Front 51

Discuss the various drug categories of controlled substances and provide specific drug examples

Back 51

Ch 4
There are five categories of CS with Cat I being the most highly regulated and Cat V being least regulated. Examples of each are as follows:

Cat I - Rarely ever dispensed; ONLY with approved protocol - Most often are not available - Ex: heroine, LSD, Marijuana,

Cat II - written script only (if TO, must have written script in 72 hrs) and NO refills - Ex: Codeine, morphine, oxycodone

Cat III - Written or oral script with expiration in 6 mos - no more than 5 refills; Ex: codeine WITH acetaminophen

Cat IV - same as; Ex: phenobarbital, benxodiazapines

Cat V - Script or OTC depending on the state; Ex: Cough meds, diarrhea, or limited quantities of opioid CS

Front 52

Identify the process involved in the development of new drugs, including the investigational new drug app, phases of investigational drug studies, and process for informed consent

Back 52

Ch 4
A potential drug must go thru the following steps / measure before will be approved for general public use.

Investigational New Drug (IND) application - only after extensive animal testing can a pharmaceutical company submit an application for IND. Companies must have informed consent from all participants

Process then begins in the following steps:
*Preclinical testing
*Phase I - small number of health informed volunteers
*Phase II - small number of informed volunteers; diseased or ailed
*Phase III - large number of pts who are followed by researchers; placebos with blind and double blind studies
*Phase IV - postmarketing studies conducted by the company with potential to recall if significant reactions are discovered

Front 53

Discuss the nurse's role in the development of new and investigational drugs and the informed consent process.

Back 53

Ch 4
Nurse's are the monitor the patient closely and ensure to report any drug reactions that is unusual or abnormal. The nurse's role in the informed consent process is to instruct the patient fully of the purpose and scope and possible outcomes of the study. Nurse should ensure pt is fully educated and informed of the study and study process