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111 Cards in this Set

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What is pharmacokinetics?
- the movement of a drug within the body
- what the body does with a drug
- it determines the intensity and duration of the drug
What is pharmacodynamics?
- mechanism of the drug action
- How the drug affects the body
Do drugs create new responses?
No they just modify existing responses
What is absorption?
The way the drugs are absorbed in to the body
What are factors that influence absorption?
- route
- distribution
- metabolism
- excretion
What is distribution
The way the drug go around in the body
What are factors that influence distribution
- blood flow and volume
- capillary and cellular permeability
- tissue affinity
- plasma protein binding
- age and gender
- special barriers
What are special barriers?
Placenta, brain
What is metabolism
Biotransformation (break down of medicines)
Where does metabolism take place?
Mainly in liver
What is first pass effect
Broken down to metabolites in liver
What is second pass effect
conjugation
How can drugs be metabolized?
- into inactive metabolite: excreted
- active metabolites: pharmacologic action
What are prodrugs
Drugs that do not get active till they are metabolized
What are factors that influence metabolism
- condition of liver
- health of patient
- multiple drug use
- age and gender
- culture and genetics
- diet and other lifestyles
- environment., time
What is excretion
The process of getting rid of the drug
Where does that take place?
Primarily in kidney but also in lungs, GI tract, skin, liver
What are factors that influence excretion
- General health
- Kidney function
- Renal function
- Hydration
Affecting factors in pharmodynamics are
- onset
- peak
- duration
- inter-ethnic influences
What is non-specific mechanism of action?
There is a non-specific cell response, affects all cells alike
What is an example of non specific mechanical?
Sunscreen
What is an example of non specific chemical
Bicarbonate to change PH
What is an example of non specific physiologic?
Chemotherapy
How does specific action work?
The drug mimics a substrate that an enzyme would normally bind to: it inhibits OR stimulates a NORMAL response.
The receptor interaction can result in three different ways:
1. agonist
2. antagonist
3. partial agonist
How does an agonist work
It binds to a receptor, fits well (like key opening a lock) and stimulates a response
How does an antagonist work
It binds to a receptor, fits well enough to block any other normal response
How does an partial agonist work
It binds to a receptor but does not fit well, will stimulate a partial response, but weaker than agonist
What is Onset
The time it takes for the drug to elicit a therapeutic response
What is peak
The time it takes for a drug to reach it maximum therapeutic response
What is duration
The length of time a drug concentration in the blood is enough to elicit a therapeutic response
What is steady state
The physiologic state in which the amount of drug removed via elimination is equal to the amount absorbed with each ndose
What is half life?
The time it takes to remove 50% of the original dose
How many half lives to remove a drug
About 5
Why is half life so important?
It determines how long a drug is active
What is the therapeutic index?
Ratio of effective dose to toxic or lethal dose
What are is plasma protein binding?
Some drug molecules have an affinity for binding to protein molecules in the blood stream
Why is this important?
- it determines how much of the drug is released (if 98 % is bound, only 2% is active)
- It cannot be metabolized when bound
Why can it be dangerous?
If one drug binds easier to protein molecules than others it can replace it and release the original dose in a dose that can be to high for the body.
What is drug interaction?
It is the action of one drug on a second drug creating an increased or decreased effect, a new effect or even an adverse reaction.
What is an additive response?
When two or more like drugs are used together to produce an effect, the outcome is the sum of each individual effect 1+1=2
What is synergism
A synergistic effect: occurs when two unlike drugs are used together and produce a combined effect. 1+1=3
What is potentation
A particular type of synergist interaction in which the effect of only one of two drugs is increased. In other words a drug that has no effect enhances the effect of a second drug
What is an antagonist?
A drug that diminishes or cancels another drug. (opposite if potentation)
What is tolerance?
If you need higher dosage to achieve the desired effect
What is dependence
Physical addiction or psychological habituation
Different adverse reactions can be:
undesired effects like: side effects, toxic effects etc
Some adverse reactions are
- intolerance
- allergy
- idiosyncratic effect
- tolerance
- cumulative effects
- dependency
What is idiosyncratic effect
An abnormal or unexpected susceptibility to medication other than allergy, peculiar to one patient
What happens if drug intake exceeds excretion?
Chance of too much drugs: toxicity and cumulative effect.
Some daily examples of side effects/adverse reactions
- drowsiness
- dulled mental activity
- hangover
- impaired coordination etc
What is iatrogenic ?
a term used to describe illness caused by the medical profession
How do you evaluate the patients response to drugs
- expected effects
- actual response
- document
How can ethnicity change the effect of drugs?
Different ethnic groups can have enzyme deficiencies that change the reaction to drugs.
Keep in mind with children
absorption: Gastric PH is lower until 1-2 years, gastric emptying is slower First-pass effect of liver is reduced .Topical absorption is faster Intramuscular absorption is faster Distribution: Fat content is less, protein binding is decreased More drugs enter the brain (different blood-brain b.)
Metabolism: Levels of microsomal enzymes are decreased, older children may have increased enzyme production, exposure of mother durance pregnancy
Excretion: Filtration and resorption are decreased
Perfusion in liver is decreased
Keep in mind with elderly
absorption: Gastric PH is lower until 1-2 years
Gastric emptying is slower
First-pass effect of liver is reduced
Topical absorption is faster
Intramuscular absorption is faster
Distribution: Fat content is less
Protein binding is decreased
More drugs enter the brain (different blood-brain b.)
Metabolism: Levels of microsomal enzymes are decreased. Older children may have increased enzyme production. Exposure of mother durance pregnancy
Excretion: Filtration and resorption are decreased
Perfusion in liver is decreased
Why do you need blood samples
- to aid in making diagnosis
- to monitor effect of therapy
- to monitor course of a disorder
What do you asses before beginning?
- the patient
- the veins
- the skin
- other stuff: mastectomy etc
What are some nursing diagnosis with venipuncture
- knowledge deficit related to purpose of the blood sample and the procedure
- risk for infection
- anxiety related to the procedure
- impaired tissue integrity: risk for bleeding and hematoma at the side
Equipment needed for venipuncture
- gloves
- alcohol/betadine
- rubber tourniquet
- sterile 2x2 gaze
- band-aid or adhesive tape
- appropriate blood collection tubes
- sharps container
Important with client teaching
Explain, describe, results, instruct, breath deep
Best veins for venipuncture
Basilic vein
Median cubital vein
Cephalic vein
Median antebrachal vein
geriatrics
Veins can roll, skin is thinner, easier bruising/hematoma
pediatrics
Dorsal surface of hand and feed are most frequently used, select site that needs less restraint
Have another nurse assist (not mother)
Scalp veins may be used for neonates/infants
Use topical Transdermal numbing medication 30 minutes before puncture
Tips
Let arm hang for a while
Warm towel
Watch for ‘pop’
Errors
Piercing thru to the other side of vein
Forget to release tourniquet
Sample diluted because of IV fluids
Documentation:
Record time, date, site, complications, test obtained and disposition of specimens
Note clients reaction etc
Responsibility for nurse
- patient must be provided information about every medication they take
- no patient should be allowed to leave the agency without information
- patient must be encouraged to be actively involved in their health care
Factors are:
- readiness to learn
- teaching plan
- implementation
- evaluation
Important is
ethnicity/culture client, age, educational level
Patient response to teaching depends on?
- perceived need to know
- self-concept
- life experience
- impact of illness
- attitude towards illness
- emotional impact of content
So to teach you have to asses
- readiness to learn
- physiological status
- previous knowledge
- cognitive ability to learn
- support system (family)
Geriatric considerations
Asses hearing/vision, memory, cost, etc
Pediatric considerations
Can they learn, age etc.
Some nurses diagnoses related to teaching
Knowledge deficit
Risk for injury: adverse effect
Overuse
under use
3 domains of learning are
cognitive
affective
psychomotor
Methods of presentation
Visual, auditory, combination, psychomotor
IV:
Veins that are suitable are
Round, firm, elastic and engorged
IV sites to avoid
Veins that are sclerosed from old IV’s
Avoid inner side of underarm because of nerves
Phlebitic areas
Thrombosed veins
Mastectomy, edema, legs, feet
Best vein for irritating fluids
Cephalic vein (along lateral side of arm, thumb side)22 to 16 gage
Other good veins
Metacarpal and dorsal veins on top of hands (24 to 20 gauge)
What is isotonic
A fluid with the same mineral ratio as the body: prevents dehydration
What is hypertonic
A fluid with a higher mineral ratio: takes fluids out of cells
What is hypotonic
A fluid with lower mineral ratio: brings fluid into cells
What is leaching?
Pen or other stuff that is written on the bag can contaminate medication
General guidelines for IV’s:
What size for children and elderly
24-22 gauge
For medical and postop. patients
24-22 gauge
For surgical or rapid blood adm
18 gauge
for trauma patients
16 gauge
Why does a bottle need vented tubes?
To let air in (vacuum)
Proper documentation should include
- the length and gauge of the cannula
- insertion site and condition
- date and time
- id of person who inserted iv
- type of fluid/medication
- equipment (pump)
- number of attempts to put IV in (really looking forward to that one!!!)
- response of patient
If an IV is discontinued
Document reason and if you started a new one
What can LPN’s do with IV’s
- calculate rate for unmedicated IV fluids
- regulate rates for unmedicated fluids
- addition of unmedicated IV fluid to existing IV
- inspect
- take care of peripheral short, midline and central iv
- discontinue iv
Complications/problems
- inflammation
- edema
- bruising
- infiltration
MAJOR PROBLEMS
- A COMMON COMPLICATION OF I.V. therapy, infiltration occurs when an I.V. needle or catheter becomes dislodged or the vein wall is disrupted. Nonvesicant I.V. fluid then leaks into the tissue surrounding the insertion site. (When a vesicant leaks into tissue, extravasation occurs.) Watch for signs
- Fluid leaking from an I.V. needle or catheter into the tissue can lead to tissue damage and other serious problems (such as nerve damage), so closely monitor your patient's I.V. site for telltale signs. Here's what to watch for:
- swelling around the I.V. site. As fluid accumulates, tissue around the site swells.
- blanching and cooling of skin. The infusing fluid pooling in the tissue is cooler than body temperature. This cools the skin and causes it to lighten in color.
- slowed infusion rate. When accumulated fluid creates pressure on the catheter (which inhibits fluid from infusing quickly) or the tissue reaches its saturation point, the flow rate slows down and may stop. Confirm infiltration
- If a patient shows any of these signs, assess for infiltration. First, palpate the site to confirm swelling. Then, palpate the area above the catheter tip and rapidly flush the line with 0.9% sodium chloride. (Stop flushing if you meet resistance-the line may be occluded). If fluid is infiltrating, you'll feel bubbling under the skin.
What to document on mar
- most Rx
- route of drug (PO, IM etc)
- Amount of drug
- Time of admin.
- Site of injection
If client refuses medication
Report reason and time
What is important with PRN pain medication
Report what was given and pain scale (1-10)
What is important with PRN anxiety medication
Document behavior of patient, indicating need for medication
What else is important
Report reaction to oral Rx after 30 min-1 hour
Report reaction to IM Rx after 20 min
Report reaction to IV Rx after 10-15 min
Know the expected effect of the drugs and evaluate in what way?
1. asses outcome (heartbeat, BP, EG etc)
2. compare outcome with expected outcome
3. document effectiveness
Why is documentation so important
- legal responsibility
- safety responsibility
- communication with healthcare workers
What to do if a drug was omitted?
Circle the time on the MAR and write reason why
What to do if a drug was given late?
Put actual time on MAR, most agencies require report or form because it can be a drug error
What to do with an error?
Notify supervisor immediately, complete incident report
Safety of patient comes first: monitor for adverse effects (VS etc)
Do not report on nurses notes, fill out separate report
Describe 3 checks
1. check Rx with order on MAR when obtaining med from source
2. check Rx with order on Mar prior to placing it in dispensing container
3. check Rx at clients bedside prior to administering Rx
Parts of MAR
- clients full name
- date and time of order
- drug name
- route
- dosage
- time and freq, of administering
- signature of physician ordering drug
- prescription
- also: allergies, type of drug, therapeutic intent, usual dose, clients tolerance of dose, who to notify if administration is inappropriate.
Renewal order for narcotics
48 hours
Renewal order for ATB
7 days
State practice act:
- LPN must be under supervision of an RN or physician
- RN must have an order from a physician to give ANY drugs
- Nurse practitioners can now have prescribing privileges
Important when preparing Rx
- check name/medication/prescription on mar
- check allergies
- check expiration date
- one patient at a time
- one medication at a time
- verify time and route
- calculate proper dose
- pour/prepare exact
- set up Rx in order of mar