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94 Cards in this Set

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What a holistic approach in regards to pharmacotherapy?

Taking this approach to pharmacotherapy includes considering environmental, genetic, psychosocial, gender, and cultural influences.


Example: when giving a medication for hypertension to a Caucasian man, he may experience greater effects from the medication than an African American man.


Example: Noting any environmental triggers that may be causing the patient's problem or asking them about their lifestyle.

What does psychosocial mean?

A description of one's psychological development in the context of one's social environment.

What is spirituality?

The capacity to love, to convey compassion and empathy, to give and forgive, to enjoy life, and to find peace of mind and fulfillment in living.

What is ethnicity?

It implies that people have biologic and genetic similarities. People who share the same common ancestry and similar genetic heritage.

What is culture?

A set of beliefs, values, and norms that provide meaning for an individual or group. People within a culture have common rituals, religious beliefs, and certain expectations of behavior.

What is cultural competence?

The ability of practitioners to provide care to people with diverse values, beliefs, and behaviors, including the ability to adapt delivery of care to meet the needs of these patients.

Which variables should the nurse keep in mind when treating patients from different ethnic groups?

-Diet: foods may affect metabolism of certain medications and overall pharmacotherapy



-Alternative therapies: CAMs can conflict with various medications (e.g. herb consumption)



-Beliefs about health: Illness may be viewed in different ways and individuals may seek treatment within their own community (e.g. folk healers)

How does the community and environment affect pharmacotherapy?

-Communities can vary in everything from population density, age distributions, socioeconomic levels, occupational patterns, and industrial growth (e.g. lack of sanitation)


-Lack of healthcare or access to healthcare for some individuals


-Literacy issues

What is pharmacogenetics?

The study of genetic variations that give rise to differences in drug response.

What is genetic polymorphism?

Two or more versions of the same enzyme.

What is the role of genetics in regards to pharmacotherapy?

Certain genetic polymorphisms occur within certain ethnic groups that may cause absorption of certain medications to become affected. In some cases absorption occurs but metabolism by the kidneys is hindered and can cause toxic levels of a drug to build up in a person resulting in harm to the individual.

How does gender affect pharmacotherapy?

-Women tend to pay more attention to changes in health patterns and seek health care earlier (except for cardiac problems)


-Alzheimer's disease greater in women


-Drug can have side effects influencing both genders


-Certain drug eliminations can be affected by gender

What are CAM therapies?

Complementary and alternative medicine are a set of therapies and healing systems that are considered to be outside mainstream health care.

Although CAM therapies are diverse, what are their main goals?

-Focus on treating each person as an individual


-Consider the health of the whole person


-Emphasize the integration of the mind and body


-Promote disease prevention, self-care, and self-healing


-Recognize the role of spirituality in health and healting

What are some main concerns in regards to CAM therapies?

Some forms may interfere with the use of medications. (e.g. Herbal therapy usage of garlic (anticoagulant) can interfere with medications that may already produce an anticoagulant effect.


There has been no steady research or EBP to show the usefulness of harm CAMs can do to the body.

Why has there been an increase in the use of herbal therapies?

-Increased availability


-Aggressive marketing


-Natural alternatives


-Renewed interest in preventative medicine

Why are CAM therapies becoming so popular?

They can reduce the needs for medication through alternative and often less expensive methods that also have a lower risk of producing adverse effects as seen with the use of medications.

What are some problems with herbal therapy?

-Active ingredients may be unknown (most contain dozens)


-Potency varies by where the herb was collected, prepared, or even how it was stored

Who regulates the usage and sales of herbs in the United States?

The FDA by way of the Dietary Supplement Health and Education Act of 1994. It is limited in its scope and the FDA only removes the supplement if it harms the user. The act recently forced the producers of supplements to place their address and phone numbers on the containers they sell. It is up to the user of the herb to report adverse effects to the company who in return must report it to the FDA.

What are dietary supplements?

Products intended to enhance or supplement the diet, such as botanicals, vitamins, minerals, or other extracts or metabolites that are not already approved as drugs by the FDA.

What are the two herbal products that have achieved recommendations by the medical community?

Saw palmetto used to treat benign prostatic hyperplasia, and St. John's wort for depression.

What can garlic interfere with?

Aspirin or other NSAIDs, warfarin insulin, or oral hyperglycemic agents resulting in an increased bleeding risk in the individual, or additive hyperglycemic effects.

What are specialty supplements?

Nonherbal dietary products used to enhance a wide variety of body functions. They are obtained from plant and animal sources, and are more specific in their actions. In most cases they are products the body already produces and are used to enhance the body's levels. (e.g. fish oil, vitamin C, amino acids, etc.)

What should patients taking insulin, warfarin (Coumadin), or digoxin (Lanoxin) be warned of?

Never take any herbal products or dietary supplements without first discussing their needs with a health care provider.

Who is at a greater risk for a drug herb interaction?

-Older adults


-Pregnant or lactating women


-Those with serious allergies

As a nurse, what advise can you give to those individuals starting an herbal therapy?

Do not take more than the recommended dose on the product label and always take the smallest amount possible when starting to see if allergies or any adverse effects occur.

What is substance abuse?

The self-administration of a drug in a manner that does not conform to the norms within the patient's own culture and society.

What is addiction for the one millionth time?

An overwhelming compulsion that drives someone to take drugs repetitively, despite serious health and social consequences.
What is substance dependence?

When a person has an overwhelming desire to take a drug and cannot stop. Can be in two forms: Physical and Psychological.
What is physical dependence?


An altered physical condition caused by the adaptation of the nervous system to repeated substance abuse. Over time, the body's cells become accustomed to the presence of the unnatural substance. Withdrawal is a symptom caused by physical dependence.

What is psychological dependence?

A condition in which no obvious physical signs of discomfort are observed after the agent is discontinued. The user, however, will have an overwhelming desire to continue drug-seeking behavior despite obvious negative economic, physical, or social consequences.
What is a withdrawal syndrome?
Symptoms that result when a patient discontinues taking a substance to which he or she was dependent on.
What is used to treat alcohol withdrawal?

A short-acting benzodiazepine oxezepam such as Serax.
What are symptoms associated with alcohol withdrawal?
Tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, and seizures.
What are signs of alcohol toxicity?

Extreme somnolence, severe CNS depression, diminished reflexes, and respiratory depression.
What is tolerance?

A biologic condition that occurs when the body adapts to a substance after repeated administration. Over time, high doses of the agent are required to produce the same initial effect. It is important to remember that this is a natural occurrence of continued drug use and should not be considered evidence of addiction or substance abuse.
What is are important facts about tolerance?


-It does not develop at the same rate for all actions of drugs.


-Immunity and resistance have nothing to do with tolerance

What is cross-tolerance?

When tolerance develops to a substance and then extends to a closely related drug.
What are CNS depressants?


Groups of drugs that cause patients to feel relaxed or sedated. Examples include:


-Barbiturates


-Non-barbiturate sedative-hypnotics


-Benzodiazepines


-Alcohol


-Opioids

Which drug is responsible for the highest cases of substance abuse?

Alcohol.

What are sedatives and what do they include?

Also known as tranquilizers they include barbiturates and non-barbiturate sedative-hypnotics. They are commonly prescribed for sleep disorders or epilepsy. Common forms include:


-Nembutal


-Amytal


-Seconal


-Tuinal


Monitor those using these drugs for cardio pulmonary depression.



What are benzodiazepines?


CNS depressants commonly prescribed for anxiety, the prevention of seizures, or for muscle relaxation. Common forms include:


-Valium


-Xanax


-Restoril


-Halcion


-Versed


Death is rare with this drug even in high doses, unless combined with other drugs (e.g. alcohol or cocaine).

What are opioids?


Narcotic analgesics commonly prescribed for severe pain, persistent cough, and diarrhea. It is derived from the poppy plant in forms of opium, morphine, and codeine. Common forms include:


-Propoxyphene


-Oxycodone


-Fentanyl


-Methadone


-Heroine


-Vicodin


This is one of the most widely abused drugs, monitor for cardio pulmonary depression. Withdrawal of this type of drug produces severe symptoms but not life threatening, sometimes Methadone is used.

What is ethyl alcohol?

The most commonly abused drug, it is a legal substance for adults, and is readily available beer, wine, and liquor. It is a CNS depressant that easily crosses the blood brain barrier causing effects within 5-10 minutes of consumption. Metabolism of this drug occurs in the liver. Overdose produces vomiting, severe hypertension, respiratory failure, and coma.
What is an adverse health effect that results from chronic alcohol consumption?
Cirrhosis of the liver causing an abnormality in the body's blood clotting ability. It also sensitizes the patient to the effect of all medications metabolized by the liver so reduced quantities of medication should always be administered.
What is a DT?

Delirium tremens which occur in individuals who have constantly consumed alcohol for a long period of time. Symptoms are hallucinations, confusion, disorientation, and agitation. Many patients experience anxiety, panic, paranoia, and sensations of something crawling on their skin.
What is Disulfiram?

Also known as Antabuse, it is a drug that is consumed in an attempt to prevent alcohol consumption. A person who has taken Antabuse and consumes alcohol will become violently ill within 5-10 minutes with headache, shortness of breath, nausea, vomiting, and other unpleasant symptoms.
What are hallucinogens?

Schedule I drugs that includes LSD, PCP, Mescaline, Ectasy, DOM, MDA, and Ketamine. These drugs affect the body by raising the body temperature, increasing blood pressure, dilating pupils, and raising the heart rate. Some long term effects includes memory loss or psychosis. In some cases a relapse of the drugs effects may occur weeks, months, or years after it was initially taken.
What are CNS stimulants?


These drugs include:


-Amphetamines and Methlphenidate


-Cocaine


-Caffeine


-In some cases Nicotine

What do CNS stimulants do?

They produce a sense of exhilaration, improve mental and physical performance, reduce appetite, prolong wakefulness, or simply "get high"
What is epilepsy?

Any disorder characterized by recurrent seizures. It is the most common neurological disease and affects more than 2 million Americans.
What is a seizure?

A disturbance in the electrical activity in the brain that may affect consciousness, motor activity, and sensation. They are caused by abnormal or uncontrolled neuronal discharges.
What are convulsions?

Involuntary, violent spasms of the large skeletal muscles of the face, neck, arms, and legs.
What machine is used to diagnose seizures?

EEG or electroencephalogram.
What are the main causes of seizures?


-Infectious diseases (meningitis)


-Trauma (skull trauma)


-Metabolic disorders (hypoglycemia)


-Vascular diseases (hypoxia or carbon monoxide)


-Pediatric disorders (fever)


-Neoplastic disease (tumors)

What are the three classifications of epileptic seizures?

Partial (focal), generalized, and special epileptic syndromes.
What are partial seizures?
Includes both simple and complex.
What is a simple partial seizure?

A seizure that causes olfactory, auditory, and visual hallucinations. It also causes intense emotions, and twitching of the arms, legs, and face.
What is a complex partial seizure?

A seizure that is preceded by an aura and causes a brief period of confusion or sleepiness afterward with no memory of the seizure afterwards. This seizure also causes fumbling with or attempting to remove clothing and patients lack a response to verbal commands.
What are the types of generalized seizures?

Absence (petit mal), Atonic (drop attacks), and Tonic-clonic (grand mal).

What is an absence seizure?
Petit mal, usually lasting only a few seconds. It is most often seen in children (child stares into space, does not respond to verbal stimulation, and may have fluttering eyelids or jerking). This type of seizure is often misdiagnosed as ADD or day dreaming.
What is an atonic seizure?

Also called a drop attack the patient usually falls or stumbles for no reason and it lasts for a few seconds.
What is a tonic-clonic seizure?

Also called a grand mal, it is preceded by an aura followed by intense muscle contraction (tonic phase) followed by intense alternating contraction and relaxation of muscles (clonic phase). Crying occurs at the beginning as air leaves the lungs, loss of bowel/bladder control occurs, and then shallow breathing with periods of apnea. It usually lasts 1-2 minutes and is followed by deep sleep and disorientation (postictal state).
What are the three types of special syndromes?

Febrile seizure, myoclonic seizure, and status epilectus.

What is a febrile seizure?
Occurs in children between 3 months to 5 years. It is a tonic-clonic style seizure that lasts 1-2 minutes followed by a rapid return to consciousness.

What is a myoclonic seizure?
A seizure that causes large jerking movements of a major muscle group, such as an arm. Patients usually fall from a sitting position or drop what they are holding.
What is status epilectus?

A medical emergency due to continuous severe seizure activity that can lead to coma and death.
What is GABA?

Gamma-aminobutyric acid is the primary inhibitory neurotransmitter in the brain. To prevent seizures drugs mimic the action of this acid to stop excessive neuronal activity.
How do benzodiazepines reduce seizures?
They intensify the effect of GABA in the brain by binding directly to the GABA receptor and increasing the influx of chlorine into the cell. It is most commonly used to treat absence seizures and myoclonic seizures. If a patient is given a benzodiazepine via IV monitor respirations every 5 to 15 minutes and have airway and resuscitative equipment accessible. Adverse effects such as cardio vascular collapse, respiratory depression, or coma can occur.
What is Dilantin?

Phenytoin, it is the oldest and most commonly prescribed anti-seizure medication. This medication desensitizes Na channels. This drug must only be mixed with NS and infused at the maximum rate of 50 mg/min. If mixed with other solutions it produces precipitate. Always flush you IV line with NS before administering and using a filtered IV line is recommended. Do not give IM and avoid using hand veins!!!!
What occurs if a person abruptly stops taking seizure medications?

Seizure will occur, to prevent this from occurring, a patient should be slowly weaned from seizure medications. This is also the case when switching from one seizure medication to another.
How do Hydantoin and Phenytoin-like drugs work?

They desensitize sodium channels in the CNS and slow down the influx of sodium.
How do Succinimide drugs work?

They suppress the influx of calcium which causes an increase in the electrical threshold of the cell thus reducing the possibility of an action potential from occurring.
How are other ways seizures may occur?
From drug abuse, as with cocaine, or during withdrawal from alcohol or sedative-hypnotic drugs.
What is nociceptive pain?

Also called somatic pain (sharp, localized sensations) or visceral pain (generalized dull, throbbing, or aching sensations) it is pain produced by injury to a body tissue. This type of pain responds well to conventional pain-relief medications.
What is neuropathic pain?

Pain produced by injury to the nerves typically described as burning, shooting, or numbing.
What is acute pain?

Intense and has a defined period of time (usually short).
What is chronic pain?

Pain that interferes with daily living activities and has a duration of over 6 months.
What are symptoms of opioid analgesics?

They produce stupor like symptoms.
How do opioids work?

They interact with at least four major types of receptors: mu, kappa, delta, and an opioid like receptor called nociception or orphanin FQ peptide.
Patients who are administered opioids should be monitored for what adverse effects?

Severe respiratory depression, cardiac arrest, convulsions, or an anaphylactic reaction.
Patients who are administered Narcan should be monitored for what adverse effects?

Muscle or joint pain, sleep anxiety, headache, nervousness, withdrawal symptoms, and vomiting.

When a patient is given morphine via epidural, what needs to occur?

They must be observed in a fully equipped and staffed environment for at least 24 hours due to the risk of fatal respiratory depression.

What is naloxone (Narcan) used for?

It is an opioid antagonist and is used for the treatment of acute opioid overdose. It works by blocking Mu and Kappa receptors. It should be administered when the respiratory rate is below 10 breaths per minute. Be prepared for symptoms of opioid withdrawal and an increase in BP, tremors, hyperventilation, nausea and vomiting, and drowsiness.
What are signs and symptoms of an opioid overdose?

Sedation or respiratory distress. Cardio pulmonary depressions. It is considered a medical emergency and is most commonly called a drug overdose.
What are nonopioid analgesics?
NSAIDs, acetaminophen, and a few centrally acting drugs. Their roles is more for the treatment of inflammation and fever.
What should people taking nonopioid analgesics be monitored for?

Heartburn, stomach pain, ulceration, GI bleeding, peptic ulcers, constipation, and anemia.
What are examples of NSAIDs?

Aspirin, Ibuprofen, and COX-2 inhibitors.
What is the goal of migraine therapy?

To stop when they occur and prevent migraines from reoccurring.
What should you do to care for a post operative patient after they wake from anesthesia?
Encourage the patient to take deep breaths and move the lower extremities
frequently in the postoperative period. (General anesthetics given by inhalation are
excreted via the lungs. Deep breathing assists in removing the remaining anesthetic.
Early range-of-motion exercises may help prevent venous thrombosis and
complications.) Constantly reorient the patient to prevent confusion.
What is stage I of general anesthesia?

Loss of pain: The patient loses general sensation but may be awake. The stage proceeds until the patient loses consciousness.

What is stage 2 of general anesthesia?

Excitement and hyperactivity: The patient may be delirious and try to resist treatment. Heart rate and breathing may become irregular and blood pressure can increase. IV agents are administered here to calm the patient.

What is stage 3 of general anesthesia?
Surgical anesthesia: Skeletal muscles become paralyzed. Cardiovascular and breathing activities stabilize. Eye movements slow and the patient becomes still.

What is stage 4 of general anesthesia?

Paralysis of the medulla region of the brain (responsible for controlling respiratory and cardiovascular activity): If breathing or heart stops, death could occur. This stage is usually avoided during general anesthesia.