Term
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Definition
*increase or stimulate certain cellular activities
Some drugs interact directly with receptor sites to cause the same activity that natural chemicals would cause at that site. These drugs are called agonists
Ex. insulin reacts with specific insulin-receptor sites to change cell membrane permeability, thus promoting the movement of glucose into the cell. |
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Term
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Definition
*depress or slow certain cellular activities
drugs that react with receptor sites to block normal stimulation, producing no effect.
Ex. Curare occupies receptor sites for acetylcholine, which is necessary for muscle contraction and movement. By blocking the action of acetylcholine at this receptor site, curare prevents muscle stimulation, causing paralysis. |
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Term
| Category/Classification of Narcotics |
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Definition
Schedule I (C-I): High abuse potential and no accepted medical use (heroin, marijuana, LSD)
Schedule II (C-II): High abuse potential with severe dependence liability (narcotics, amphetamines, and barbiturates)
Schedule III (C-III): Less abuse potential than schedule II drugs and moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics)
Schedule IV (C-IV): Less abuse potential than schedule III and limited dependence liability (some sedatives, antianxiety agents, and nonnarcotic analgesics)
Schedule V (C-V): Limited abuse potential. Primarily small amounts of narcotics (codeine/cough syrup)
*lower # higher abuse potential |
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Term
Over the Counter Medications
Benefits vs. Risks |
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Definition
Benefits- safe when taken as directed, no prescription needed
Risks- can mask s/s of underlying disease, can cause drug-drug interactions with prescription meds, not taken as directed can lead to an overdose |
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Term
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Definition
Category A: Adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters.
Category B: Animal studies have not demonstrated a risk to the fetus but there are no adequate studies in pregnant women, or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy, and there is no evidence of risk in later trimesters.
Category C: Animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans; the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks, or there are no animal reproduction studies and no adequate studies in humans.
Category D: There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks.
Category X: Studies in animals or humans demonstrate fetal abnormalities or adverse reactions; reports indicate evidence of fetal risk. The RISK of use in a pregnant woman outweighs the benefit!
*higher the class, the greater the risk |
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Term
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Definition
the actual amount of drug that reaches the body
is affected by
Absorption
Distribution
Biotransformation/Metabolism
Excretion |
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Term
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Definition
Water soluble drugs are filtered through the kidneys
Lipid Soluble drugs are converted to water soluble in the liver
Drugs that have been made water soluble in the liver are often readily excreted from the kidney by glomerular filtration—the passage of water and water-soluble components from the plasma into the renal tubule. Other drugs are secreted or reabsorbed through the renal tubule by active transport systems- need energy. The active transport systems that move the drug into the tubule often do so by exchanging it for acid or bicarbonate molecules. Therefore, the acidity of urine can play an important role in drug excretion.
*more acidic drug requires more alkaline ph of urine to be excreted |
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Term
| Half Life dosing regiment |
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Definition
time required to reduce the plasma concentration to 50% its original value
-will determine dosing interval requirements/how long drug will stay in body
-goal is to create a plateau/steady state |
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Term
| Metabolism/Biotransformation |
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Definition
| The liver is the most important site of drug metabolism, or biotransformation, the process by which drugs are changed into new, less active chemicals. |
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Term
| Peak and Trough: Definition and how to Draw |
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Definition
Trough- 1/2 hour before the next dose
Peak- 1-2 hours after dose
*Labs should be drawn at both points to look for changes in lab values that may indicate toxicity |
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Term
| Pharmacokinetics - Liver metabolism |
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Definition
drugs are changed into new "less active" chemicals in the liver.
The intracellular structures of the hepatic cells are lined with enzymes packed together in what is called the hepatic microsomal system. Because orally administered drugs enter the liver first, the enzyme systems immediately work on the absorbed drug to biotransform it.
Phase I biotransformation involves oxidation, reduction, or hydrolysis of the drug via the cytochrome P450 system of enzymes.
Phase II biotransformation usually involves a conjugation reaction that makes the drug more polar and more readily excreted by the kidneys.
The presence of one drug speeds the metabolism of others, preventing them from reaching their therapeutic levels. Some drugs inhibit an enzyme system, making it less effective. As a consequence, any drug that is metabolized by that system will not be broken down for excretion, and the blood levels of that drug will increase, often to toxic levels. |
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Term
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Definition
| proportion of a drug that enters circulation when introduced into the body and is able to have an active effect |
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Term
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Definition
Most drugs are bound to some extent to proteins in the blood to be carried into circulation. The protein–drug complex is relatively large and cannot enter into capillaries and then into tissues to react. The drug must be freed from the protein’s binding site at the tissues.
*Duration of action of a drug is related to how tightly it is bound to complex. Tightly bound= slow release. Loosely bound= faster release |
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Term
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Definition
| Drugs taken orally are absorbed from the small intestine directly into the portal venous system (the blood vessels that flow through the liver on their way back to the heart). The portal veins deliver these absorbed molecules into the liver, which immediately transforms most of the chemicals delivered to it by a series of liver enzymes. These enzymes break the drug into metabolites, some of which are active and cause effects in the body, and some of which are deactivated and can be readily excreted from the body. As a result, a large percentage of the oral dose is destroyed at this point and never reaches the tissues. |
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Term
Assessment - allergies
Anaphylactic Reaction |
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Definition
This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, including histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that can lead to respiratory distress and even respiratory arrest
Hives, rash, difficulty breathing, increased BP, dilated pupils, diaphoresis, “panic” feeling, increased heart rate, respiratory arrest |
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Term
Assessment - allergies
Cytotoxic Reaction |
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Definition
This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell-> releases K+ in body. This reaction is not immediate but may be seen over a few days
Complete blood count showing damage to blood-forming cells (decreased hematocrit, white blood cell count, and platelets); liver function tests show elevated liver enzymes; renal function test shows decreased renal function |
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Term
Assessment - allergies
Serum Sickness Reaction |
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Definition
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug
Itchy rash, high fever, swollen lymph nodes, swollen and painful joints, edema of the face and limbs |
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Term
Assessment - allergies
Delayed Allergic Reaction |
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Definition
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells
Rash, hives, swollen joints (similar to the reaction to poison ivy) |
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Term
Drug allergies occur when
how to assess pt with a drug allergy |
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Definition
Drug allergies occur when a patient develops antibodies to a drug after exposure to the drug.
*ask additional questions to a patient who states they have an allergy to a medication to determine the exact nature of the reaction they have to a drug. Many people claim they have an allergy to a med when in reality, they are just experiencing a normal side effect of the drug.
-Before administering a drug always ask the pt if they have had the drug before |
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Term
| Client Education on super infections |
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Definition
Several kinds of drugs (especially antibiotics) destroy the normal flora, leading to the development of superinfections, or infections caused by organisms that are usually controlled by the normal flora.
Assessment
Symptoms can include fever, diarrhea, black or hairy tongue, inflamed and swollen tongue (glossitis), mucous membrane lesions, and vaginal discharge with or without itching.
Interventions
Provide supportive measures (frequent mouth care, skin care, access to bathroom facilities, small and frequent meals). Administer antifungal therapy as appropriate. In severe cases, discontinue the drug responsible for the superinfection. |
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Term
| Education: Therapeutic Effects |
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Definition
| .When pt is ordered a drug and they are concerned about side effects explain that the therapeutic effects of the drug outweigh the potential risks. Explain how the drug will help them |
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Term
Adverse effects:
Primary Action
Secondary Action
Hypersensitivity |
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Definition
Primary- side effects from overdose, an extension of the desired effect- ex. anticoagulant/spontaneous bleeding
Secondary- desired effect is achieved with undesired secondary effects ex. drowsiness from antihistamines
Hypersensitivity- underlying problem, kidney unable to excrete drug and it accumulates in the body |
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Term
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Definition
drugs can have an effect on various electrolyte levels in the body. The electrolyte that can cause the most serious effects when it is altered, even a little, is potassium**
Drugs can alter the renal exchange system, causing an imbalance in serum electrolyte levels. The most detrimental electrolyte when imbalanced is Potassium. Symptoms of hypokalemia occur when K is lower than 3.5 and can include: changes in cardiac rhythm, numbness and tingling in extremities, muscle cramps N&V, irregular pulse. Symptoms of hyperkalemia occur when K is higher than 5.0 and can include: slow heart rate, low BP, decreased urinary output, difficulty breathing. |
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Term
| What to tell a woman about drug therapy during pregnancy |
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Definition
| The exact effects of a drug on the fetus may not be known. In some cases a predictable syndrome occurs when a drug is given to a pregnant woman. In any situation, inform any pregnant woman who requires drug therapy about the possible effects on the baby. Before a drug is administered to a pregnant patient the actual benefits should be weighed against the potential risks. All pregnant women should be advised not to self-medicate during pregnancy. Emotional and physical support is needed to assist the woman in dealing with the possibility of fetal death or birth defects. |
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Term
| Drug Therapy: Responsibilities of a nurse (SELECT ALL) |
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Definition
Assessment (PMH, physical exam, HPI-history of present illness, allergies, current meds)
Nursing Diagnosis (statement of pt’s status from the nursing perspective)
Planning (Taking information and prioritizing to plan pt care. Used to ensure effective response to drug, minimize adverse effects, and understand drug regimin.)
Implementation: Nursing interventions aimed at achieving the goals of outcomes determined during planning. Proper administration (drug, storage, route, dose, prep, time, recording), patient, family education, comfort measures
Evaluation: pt continually monitored for therapeutic effects of drug, adverse effects, drug-drug, drug-food, drug-lab test evaluation. Evaluation may lead to change in future assessment, diagnosis, planning and implementation. |
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Term
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Definition
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Term
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Definition
Right patient
Right drug
Right route
Right dose
Right Time
Also, right storage, preparation, and recording |
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Term
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Definition
WBCs
Adults: 5-10
Child <2: 6.2-17
Child >2: 5-10
Newborn: 9-30 |
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Term
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Definition
Adult/Child/Infant/Older Adult: 11-12.5
Pregnant: Slight decrease |
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Term
Lab Values:
INR (international normalized ratio) |
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Definition
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Term
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Definition
All ages: 60-70
Pregnant: Slight Decrease |
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Term
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Definition
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Term
Lab Values:
Total Calcium mg/dL |
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Definition
Adult: 9-10.5
Child: 8.8-10.8
<10 days: 7.6-10.4
10 days-2 yrs: 9-10.6
Umbilical: 9-11.5
Older Adults: Tend to decrease |
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Term
Lab Values:
Chloride mEq/L |
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Definition
Adults: 98-106
Child: 90-110
Newborn: 96-106
Premature Infant: 95-110 |
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Term
Lab Values:
Creatinine mg/dL |
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Definition
Adult Male: 0.6-1.2
Adult Female: 0.5-1.1
Child: 0.3-0.7
Adolescent: 0.5-1
Newborn: 0.2-0.4
Infant: 0.3-1.2 |
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Term
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Definition
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Term
Lab Values:
Potassium mEq/L |
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Definition
Adults: 3.5-5
Child: 3.4-4.7
Infant: 4.1-5.3
Newborn: 3-5.9 |
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Term
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Definition
Adults and Children: 136-145
Infants: 134-145
Newborn: 134-144 |
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Term
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Definition
| A statement of the patient’s status from the nurses perspective. The nurse analyzes information gathered during assessment to arrive at some conclusions that led to a particular goal and set of interventions. A nursing diagnosis shows actual or potential alterations in patient function. Can be diagnosis based on drug therapy effects |
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Term
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Definition
Any time a drug is given the nursing process should be implemented
*High Priority |
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Term
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Definition
Uses of a drug that are not part of the stated therapeutic indications for which a drug was approved by the FDA.
Often drugs are approved for adult use and so they are used off label in children. If off label use is found to be effective, the FDA can approve drug for off label use
Nurse should always be aware of what exactly the drug is being used for. |
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Term
| Aminoglycosides- Pharmacokinetics |
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Definition
"kacin or mycins"
- bactericidial "treat gram - bacterial infections"
Poorly absorbed in the GI Tract
these antibiotics are usually administered IV, IM, Intrathecal, topical or ophthalmic
Widely distributed throughout the body, cross placenta, enters breast milk, excreted unchanged
Adverse Effects- ototoxicity, nephrotoxicity, bone marrow depresion
ex. Gentamycin |
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Term
| Anti-infective activity: Bactericidal (LOW) |
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Definition
Interfere with biosynthesis of the bacterial cell wall
Prevent the cells of the invading organism from using substances essential to their growth and development
Interfere with steps involved in protein synthesis
Interfere with DNA synthesis
Alter the permeability of the cell membrane to allow essential cellular components to leak out
Examples
Antibiotics
Antifungals
Antivirals
Anthelmintics
Antiprotozoans |
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Term
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Definition
Must educate patients on the difference between bacteria and virus
stress that antibiotics cannot be used for viruses
Education on resistance with the overuse of anti infectives (tolerance)
Educate that the full course is needed to treat infection
Allergies can develop overtime
Chicken Noodle Soup Effect
**** |
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Term
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Definition
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Term
| Meropenum Adverse effects/side effects/Education/Assessment (LOW) |
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Definition
| *** Drug Class Carbapenem -used to treat abdominal infections, bacterial meningitis, skin infections Adv effects: anaphlaxis, fatal pseudomembranous colitis, Cdiff, superinfections, seizures, apnea Education: Advise pt to report signs of superinf, notify physician if fever/diarrhea occur or stool contains blood, pus, mucus |
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Term
| Narrow vs Broad Spectrum (LOW) |
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Definition
Broad Spectrum: Anti infectives that can be initiated before results of C&S are available. These are often more toxic and kill normal flora and so superinfections can result.
Narrow Spectrum: Given based on the results of a C&S. More specific to specific microbes and so they are more likely to kill infection without causing superinfections |
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Term
| Allergic Reaction to Antibiotics (HIGH) |
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Definition
Allergies to PCN- penicillin and cephalosporins are common
??? |
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Term
| Isoniazid TB Precautions (LOW) |
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Definition
First line drug for TB (generic)
Used in combination with 2 or more first line drugs to help decrease the emergence of resistant strains
If first line drugs do not work or a pt cannot take more than one, second line drugs are initiated
Long time needed to treat, 6 months to 2 years – Non-Compliant
Hard on LUNGS, GU tract, Bones, and Meninges
ONLY disease that is followed by the Health Dept. AND has a Direct Observation Therapy (DOT), where a nurse watches the client take the med. The client can be legally required to take the medication d/t community at risk.
Precautions: OB lactation |
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Term
| Nursing diagnosis related to antibiotic drug therapy |
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Definition
Nursing diagnosis related to antibiotic drug therapy may include imbalanced nutrition related to GI effects of drug, deficient knowledge of drug, Disturbed CNS functions, GI pain, etc.
Nursing diagnosis related to antibiotic drug therapy will include the potential risks of the antibiotic on the pt |
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Term
| Nursing Process Adverse Effects of Gentamicin |
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Definition
Aminoglycoside
(given IV, eye drops)
Black Box warning: serious risks of ototoxicity (hearing loss) and nephrotoxicity (kidney issues)
Bone marrow suppression- (decrease in erythrocytes, leukocytes-immunity, and thrombosites) |
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Term
| Antiviral lab testing for protease inhibitors (LOW) |
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Definition
Protease inhibitors stop the HIV virus from spreading because the virus cannot mature
Those taking antivirals may suffer from hepatic dysfunction/ abnormal LFT lab results
may develop elevated blood glucose-hyperglycemia
Elevated cholesterol
Steven Johnson’s syndrome |
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Term
| Drug Calculations understanding BID, TID, Daily… (LOW) |
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Definition
Drug Calculations understanding BID, TID, Daily… (LOW)
BID: Twice a day
TID: 3 time a day
?? |
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Term
| Systemic Antifungals: Patient Safety Steps to giving Meds (HI |
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Definition
Patients taking antifungals are typically immunosuppressed- nurses should ensure they are not placed at additional risk for infections
Culture results sbefore administration of antifungal
There are many Drug-drug interactions with antifungal
Liver toxic and toxic to fetus |
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Term
| Antimalarial prophylaxis drug adverse effects (HIGH) |
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Definition
CNS effects: dizziness, vertigo
Fever, shaking, chills, malaise
GI tract- Nausea, vomiting, dyspepsia, anorexia .
Visual Changes
Hepatic dysfunction |
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Term
| Excretion of Drug: Antihelmintic |
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Definition
Mebendazole (Vermox)- Is not metabolized in the body well and most is excreted in feces
Antihelmintic: Praziquantel (Biltricide)
Rapidly absorbed in GI tract, short half life, excreted primarily in urine |
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Term
| Laboratory Test of Antineoplastic Agents (kill neoplastic cells including cancer) |
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Definition
Side effect: Bone Marrow Suppression
Toxic effects on ova and sperm, resulting in infertility
Hematological profile must be constantly assessed when taking these drugs because the drugs can cause toxic levels in blood |
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Term
| Tamoxifen Side Effects (HIGH) |
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Definition
Tamoxifen is a drug used to treat metastatic breast cancer and it acts by competing with estrogen for binding sites in target tissues, such as breasts, a potent antiestrogenic agent
Hot Flashes, stroke, thromboembolism, uterine malignancies, vaginal bleeding, Menstrual abnormalities, pulmonary emboli |
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Term
| African American Ethnic Factors with anti inflammatories (HIGH) |
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Definition
Decreased sensitivity to pain relieving effects of anti-inflammatories
Increased risk of GI adverse effects
Use non drug measures to to decrease pain
Educate A.A’s receiving anti-inflammatories of the signs and symptoms of GI bleeding |
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Term
| Use of Tylenol in Pediatric patients (HIGH) |
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Definition
Safe for use in children
Not an anti inflammatory
Most commonly used drug for the treatment of pain (analgestic) and fever(pyrexia) in children
Liver toxicity with too much** |
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Term
| Immune Modulators: Sex Education (LOW) |
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Definition
Immune Modulators suppress or stimulate immune system
Advise women of childbearing age to use barrier contraceptives while taking these drugs and avoid breastfeeding.
Some drugs impair fertility |
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Term
| Immunosuppressant: Safety to Patients (LOW) |
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Definition
-Block normal effects on the immune system on organ transplantation and autoimmune disorder
Risk for infection related to immune suppression
Risk for imbalanced nutrition related to nausea and vomiting caused by drugs
Use aseptic technique around patients |
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Term
| Measuring Antibodies (LOW) |
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Definition
Vaccines and immune sera stimulate the production of antibodies so body can illicit an immune reaction when exposed to toxin
Serum Titers reflect levels of antibodies to a specific toxin |
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Term
| Measuring Antibodies (LOW) |
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Definition
Vaccines and immune sera stimulate the production of antibodies so body can illicit an immune reaction when exposed to toxin
Serum Titers reflect levels of antibodies to a specific toxin |
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Term
| When not to give a Vaccine to a child (HIGH) |
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Definition
Immune deficiency (vaccine could cause disease and body can not fight it off)
Known allergy to any component of vaccine
Pregnancy (not likely in children)
Pts who have received blood, blood product, or immunoglobulins within the past 3 months
Caution with history of febrile convulsions or cerebral injury |
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