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dietary supplements No real evidence |
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•First trimester is greatest danger from medications. –Rapid fetal growth
•Greatest drug transfer during third trimester –Enhanced blood flow to fetus –Large fetal body surface area
Do not take: Antianxiety, antidepressants, neuroleptic (antipsychotic) – long half lives. |
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always open to the pt, like birth control bc you can keep getting it unless prescriber stops the order. |
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– made in the form it is supposed to be given in
Ex: prefilled syringes |
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the use of drugs and the clinical indications for drugs to prevent and treat diseases |
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what the body does to the drug –Absorption, Distribution, Metabolism, Excretion |
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The mechanism of drug actions in living tissues |
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Remember Abbreviations
Ears, Mouth, Meals |
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Before meals = AC After meals = PC |
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GI tract: PO, sublingual, NGT (nasal gastric tube) |
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blood stream: ID, SQ, IV, IM |
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The metabolism of a drug and its passage from the liver into the circulation – low med availability because it is metabolizes |
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absorbed better with orange juice. |
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Liquids, elixirs, syrups, suspension solutions, powders, capsules, tablets, coated tablets, and enteric-coated |
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Multiple drugs for simultaneous dosing (one drug may have side effects and combining different drugs to the same dose will allow you to mask the side effects) –Enhance effectiveness of one ingredient |
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How do you draw up oral liquids? |
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Pour in medicine cup and draw up into oral syringe |
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HOb 30 degrees Before you flush, you aspirate. Flush 2/ 30ml, give medication, flush w/ 30ml. |
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neutralize stomach acid to reduce acid-related disorders (peptic ulcer, heartburn) •Side effects: –Magnesium: Diarrhea –Aluminum and calcium: Constipation –Calcium: Kidney stones •Avoid mag and calcium antacids in renal disease |
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Competitively block the H2 receptors of acid producing cells = Reduce acid secretion
Used in GERD, esophagitis, peptic ulcer •Side effects: confusion and disorientation, impotence (weakness), thrombocytopenia (low platelet #) •Smoking decreases effectiveness of these meds |
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prevents the movement of hydrogen ions out of parietal cells = stops over 90% of all gastric secretion. •Erosive esophagitis, poorly responsive GERD, ulcers
sucralfate (ulcer-adherent) – a cytoprotective drug. Covers and protects the ulcer site. •simethicone (antiflatulent) – Relieve painful symptoms assoc. with gas |
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(ulcer-adherent) – a cytoprotective drug. Covers and protects the ulcer site. |
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(antiflatulent) – Relieve painful symptoms assoc. with gas |
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Treatment of peptic ulcer disease |
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Caused by H pylori → antibiotics. |
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heart, brain, liver, kidney |
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You need more drug if it is highly protein-bound because proteins can’t leave the blood and won’t be able to go to their sites so you need more available free drugs. → Albumin carries majority of protein bound drugs. |
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alteration of drug, liver, Cytochrome P450 |
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Primary: kidney, Secondary: liver, bowel. |
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highest therapeutic level |
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highest amount of drug in the blood stream. |
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Why therapeutic drug monitoring? |
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◦Verify adequate drug exposure ◦Maximize therapeutic effects ◦Minimize drug toxicity |
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binds but only elicits a small response |
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the drug either inhibits or enhances enzyme activity
–Example: NSAIDs block the COX-2 enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced.
Example: Vancomycin inhibits the enzymes needed for the survival of bacteria. |
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Nonselective interactions |
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: drug either physically interferes with or chemically alters cellular structures or processes. Example: Some chemo drugs like Cisplatin and Carboplatin work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die. |
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What can.. 1) Cure disease 2) Slow progress of disease 3) Prevent a disease 4) Reduce a symptom |
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1) Antibiotics 2) Alzheimers 3) Immunization shots 4) Tylenol |
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Used for slow, systemic absorption usually over 24 hours. ◦Remove old patch, cleanse site ◦Rotate sites (hairless) ◦Do not touch inside of patch |
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Ointment. BE CAREFUL: do not massage into skin, cover with transparent dressing |
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Sims position, gloves, lubrication (water soluble), Insert suppository past the internal rectal sphincter
- Patient remains supine for 5-10 minutes - Splitting suppositories not recommended |
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Patient lies down or assumes High-fowlers with head tilted back.. Nurse pulls down the skin below eye. Drops or ointment are instilled into conjunctival sac. No contact lenses. |
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- Pull pinna down and back in child - Pull pinna up and back in adult - Patient remains on side for 5 min after drops |
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Inhalation route: Why so great? |
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Readily absorbed locally with quick action due to rich vascular capillary network |
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Metered Dose Inhalers (MDIs) |
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Definition
- Delivers a measured dose with each “puff” ◦Propellent ◦Spacer ◦1-2 min between puffs ◦2-5 min between different meds ◦Rinse mouth after steroid |
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- No need to shake canister or use a spacer - Take deep inhalation and hold breath for 5-10 seconds. - Requires forceful inhalation to break up the powder - Difficult for patients younger than 6 years. |
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albuterol ◦Stimulate the adrenergic receptors in the sympathetic nervous system (SNS) which assists in bronchial muscle relaxation=bronchodilation (and cardiac stimulation=tachycardia) + tremors |
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ipratropium
Blocks anticholinergic receptors, which prevents bronchoconstriction. Works well in combo with albuterol |
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Leukotriene receptor antagonists |
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singulair
◦Leukotrienes are produced in response to allergens and cause inflammation, bronchial constriction, and ↑mucous. – stopping leukotriene effects. ◦Long-term med, not for acute attacks |
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pulmicort, beclovent
Reduce inflammation by stabilizing cell membranes so they don’t release bronchoconstricting substances
Works well with albuterol |
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Insulin and Tuberculin syringes |
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Insulin in units.
Tuberculin in ml. |
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1ml syringe, 25-28 gauge needle, 1/4 – 5/8 inch needle, Insert needle at 5º-15º angle up to about 3mm, inject, visualize bleb. Do not massage area
Once a patient has received BCG—do NOT do TB skin testing (false positives). |
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Max 1ml volume, 1-3 ml syringe, 25-27 gauge needle, 3/8-5/8" needle, Inject at 45º or 90º angle. If 2 inches of tissue can be grasped use 90º. If 1 inch of tissue can be grasped use 45º
Sites: outer aspect upper arms, abdomen (2" away from umbilicus), upper thighs |
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Definition
Up to 3ml of volume (1ml for children). 1-3 ml syringe, 21-25 gauge needle, 1-1 ½ inch needle. Inject at 90 degrees
- Deltoid for immunizations (adults/children) - Vastus lateralis for infant immunizations - Ventrogluteal for IM meds in adults |
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- Can offer long-lasting immunity to 20+ infections - May be given SQ, IM (check drug book) |
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Detoxified exotoxins which stimulate antitoxin antibodies (diphtheria and tetanus caused by toxin-producing bacteria) |
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Contraindications to Vaccines |
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Mild illness is NOT a contraindication for vaccines
- Allergy to the vaccine or its components (eggs) may be a contraindication
- Minor reactions often occur ◦Rise in temp, and warm, tender, red skin ◦May give acetaminophen/ibuprofen (not aspirin), warm compresses
- After receiving an immunization, a patient or parent should call if: ◦High (>103) or prolonged fever ◦Rash and/or itching ◦Shortness of breath or ANY resp involvement |
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DO NOT USE abbreviations: |
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U: Unit QD: Every day. QOD: Every other day. |
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have to write out lot number and manufacturer (Lots come in batches, so if it’s not potent enough, they can find the batch and see who’s gotten the rest of the batch). |
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Pt name, date and time, drug name, dose, route, frequency, prescribers signature |
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Common Conversions:
Tsp, Tblsp, ml, oz, kg, lbs |
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1 teaspoon = 5ml 1 tablespoon = 3 teaspoons (15ml) 1 ounce = 2 tablespoons (30ml) 1 kg= 2.2 pounds |
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undesirable effect at therapeutic dose |
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hypersensitivity immune response |
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unexpected in a particular patient |
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How many people died every year from med errors? |
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98,000 90% from IV meds. Insulin: #1 killer. Poor communication 50% of med errors. |
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behavioral choices that create risks. |
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3 steps required for medication reconciliation? |
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1) Verification: Collect patient info 2) Clarification: professional review of meds 3) Reconciliation: investigate discrepancies
On admission, status change, pt transfer, discharge. |
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Your professional responsibility to report Assess the patient situation first Alert the prescriber and the nurse manager Provide follow-up care, testing, or antidotes Complete forms as required documenting the facts: Incident report Unusual occurrence reports |
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