Term
| * What is the normal creatinine clearance |
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Definition
|
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Term
| * If the value is below normal what effect does it have on drugs and the doses |
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Definition
|
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Term
| * What is the half-life of a drug |
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Definition
| o Time required for the serum concentration of a drug to decrease by 50%. |
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Term
| o Drugs with short half lives require |
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Definition
| more frequent administration. |
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Term
| o Drugs with long half lives require |
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Definition
| less frequent dosing, but, may cause toxicity more readily. |
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Term
| o 4-5 half-lives after discontinuing reaches |
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Definition
| an insignificant level in the body. |
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Term
| o 4-5 half- lives while taking the medication reaches |
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Definition
|
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Term
| * Drug x has a half life of 4 hours |
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Definition
| the concentration will decrease by 50% (dose/2) every 4 hours |
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Term
| * How many half-lives do most drugs have to go thru to fall below the MEC |
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Definition
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Term
| * Based on this info: if a person is taking a medication with a three day half-life how long after the drug is stopped would it become essentially inactive |
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Definition
|
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Term
|
Definition
| o Evenly distributed concentrations of a drug in the blood plasma. Administration rate = elimination rate. Dependent on half life |
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Term
| o note: the longer the half life the longer to reach |
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Definition
|
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Term
| * If Digoxin 0.25po every am is ordered and the first dose is administered on Tuesday, January 15, at 8am when should a steady state be reached? |
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Definition
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Term
| * How does protein binding effect the distribution of a drug? |
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Definition
| o If a drug is bound to plasma proteins, the drug-protein complex is generally too large to pass through the walls of blood capillaries into tissues, therefore, the drug can’t reach the intended receptor site |
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Term
| * When two or more drugs are administered at the same time, what role does protein binding play |
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Definition
| o The drugs may compete for binding sites on plasma proteins; b/c of the competition, less of one or both of the drugs binds to the proteins; consequently there is more free, unbound drug which can lead to drug-drug interactions |
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Term
|
Definition
| o A large initial dose- o administered to achieve- o a rapid minimal effective-o concentration (MEC) |
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Term
| * Discuss Bioavailability |
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Definition
| * The percentage of the administered- * Drug that reaches the systemic- * Circulation/blood stream. |
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Term
|
Definition
|
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Term
|
Definition
|
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Term
| * Factors affecting Bioavailability |
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Definition
| * Drug form- * Route of administration- * GI mucosa and mobility- * Food and other drugs- * Rate of absorption- * Hepatic function |
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Term
|
Definition
| * The process by which the drug becomes available to body fluids and tissues |
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Term
| * Distribution Influenced by: |
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Definition
| * Blood flow- * Affinity to the tissues- * Protein binding |
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Term
| * Drug History Components |
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Definition
| * Medical history- * History of allergies- * Current medications- * Include herbals and over-the counter meds- * Diet assessment- * Intake of alcohol, street drugs, tobacco and caffeine- * Growth and Development stage- * Patient’s psychomotor coordination- * Current condition including cognitive status- * Attitude towards drug treatment- * Patient’s understanding their medication regimen- * Patient’s learning needs |
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Term
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Definition
| * May be related to a learning need (Knowledge deficit) or medication side effect. |
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Term
| * Be cautious using the diagnosis of “Non-compliance” |
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Definition
| * May be judgmental- * 50% of adults do not adhere to their medication regimen. |
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Term
| * Health care professionals have to be willing to look into reasons that their patients do not follow their advice. |
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Definition
| * Therapeutic relationship with provider fosters behavior change. |
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Term
|
Definition
| * These are stated as patient in terms of client behaviors not nurse behavior. * Examples: * Client’s blood sugar will be in normal range by _______________. * Client will be able to name prescribed drug (both generic and brand name), its purpose and 3 major side effects by __________________________. |
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Term
|
Definition
| * Safe drug administration is the first nursing priority. Review 5 rights. |
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Term
|
Definition
| * What do you want to know about medications prescribed for you?- * What do you think patients want to know?- * May include safe use of prescription and over the counter medication. - * Monitoring vital signs and lab values. - * Monitor for therapeutic effects.- * Monitor for adverse effect/side effects. |
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Term
|
Definition
| * Evaluate outcomes/goals.- * Evaluate the therapeutic effectiveness of the drug regimen. |
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Term
|
Definition
| o First trimester is the period of greatest danger for drug-induced developmental defects |
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Term
| o Drugs cross the placenta by |
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Definition
|
|
Term
| o During the last trimester the greatest percentage of |
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Definition
| maternally absorbed drug gets to the fetus |
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Term
| * Pregnancy Drug Categories Category A: |
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Definition
| Studies indicate no risk to human fetus |
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Term
|
Definition
| Digoxin, prenatal vitamins |
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Term
| o * Pregnancy Drug Categories Category B: |
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Definition
| Studies indicate no risk to animal fetus; information for humans is not available |
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Term
|
Definition
| Tylenol, Benadryl; penacillan antibiotics |
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Term
| o * Pregnancy Drug Categories Category C: |
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Definition
| Adverse effects reported in animal fetus; information for humans is not available. |
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Term
|
Definition
|
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Term
| o * Pregnancy Drug Categories Category D: |
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Definition
| Possible risk in humans reported; however, consideration of potential benefit vs. risk may, in selected cases, warrant use of these drugs in pregnant women. |
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Term
|
Definition
| Aspirin , antiseizure medications; Valium |
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Term
| o * Pregnancy Drug Categories Category X: |
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Definition
| Fetal abnormalities reported and positive evidence of risks in humans available from animal and/or human studies. These drugs should not be used in pregnant women. |
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Term
|
Definition
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Term
|
Definition
| o Safety issues—lack of research done in children- o Therapeutic dosage ranges may be unclear.- o Long-term effects of drugs may be unknown.- o Dosages are often much smaller than in adults, careful calculations and administration is essential. |
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Term
|
Definition
| o Give smallest effective dose: “Start low, go slow.” |
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Term
| o Teaching the elderly about their medications: |
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Definition
| * Make certain they are wearing hearing aids and/or glasses , if needed.- * Teach someone close to the patient as well.- * Strategize with patient about ways to help them remember to take meds: pill boxes, color coded bottles, turning bottle upside when taken, etc.- * Emphasize safe storage |
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Term
| * New Drug Approval Process |
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Definition
| o Investigational new drug (IND) application |
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Term
|
Definition
| * Involves the careful explanation to the human test patient or research subject of the purpose of the study in which he/she is being asked to participate, the procedures to be used, the possible benefits, and the risks involved |
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Term
| o U.S. FDA Drug Approval Process |
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Definition
| * Preclinical testing- * New drug application- * Investigational drug studies- * Expedited drug approval- o Preclinical investigational drug studies- o Clinical phases of investigational drug studies |
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Term
| o Clinical phases of investigational drug studies |
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Definition
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Term
| * Controlled Substances: Schedule Categories Schedule I |
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Definition
| severe dependency; no medical use; high abuse potential |
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Term
|
Definition
| * Dispensed: * only with approved protocol. |
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Term
|
Definition
|
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Term
| o * Controlled Substances: Schedule Categories Schedule II: |
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Definition
| severe dependency; accepted medical use; high abuse potential |
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Term
| ** Controlled Substances: Schedule Categories Schedule II: Dispensed: |
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Definition
| * written prescription only (if telephoned in, written prescription required w/in 72hrs)- * No prescription refills- * Container must have warning label |
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|
Term
|
Definition
|
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Term
| o * Controlled Substances: Schedule Categories Schedule III: |
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Definition
| moderate to low dependency; accepted medical use; abuse potential less than S-II |
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Term
| * o * Controlled Substances: Schedule Categories Schedule III: Dispensed: |
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Definition
| * Written or oral prescription that expires in 6 months- * No more than five refills in 6 month period- * Container must have warning label |
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Term
| *o * Controlled Substances: Schedule Categories Schedule III: Ex: |
|
Definition
| Anabolic steroids, hydrocodone/codeine preparations |
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Term
| o * Controlled Substances: Schedule Categories Schedule IV: |
|
Definition
| limited dependency; accepted medical use; abuse potential less than S-III |
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Term
| *o * Controlled Substances: Schedule Categories Schedule IV: Dispensed: |
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Definition
| * Written or oral prescription that expires in 6 months- * No more than five refills in 6 month period- * Container must have warning label |
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Term
| * o * Controlled Substances: Schedule Categories Schedule IV: Ex: |
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Definition
| Xanax, Valium, Chloral Hydrate |
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Term
| o* Controlled Substances: Schedule Categories Schedule V: |
|
Definition
| limited dependency; accepted medical use; abuse potential less than S-IV |
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Term
| * o* Controlled Substances: Schedule Categories Schedule V: Dispensed: |
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Definition
| * Written prescription or over the counter (varies w/ state law) |
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Term
| * o* Controlled Substances: Schedule Categories Schedule V: Ex: |
|
Definition
| Lyrica, cough preparations with codeine |
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Term
|
Definition
| inhibits COX-2 production |
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|
Term
|
Definition
|
|
Term
|
Definition
| inhibits both COX-1 and COX-2 production |
|
|
Term
| * * Non-selective—Example: |
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Definition
| Ibuprofen (Motrin) and aspirin |
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Term
|
Definition
| * Relief of mild to moderate pain- * Relieve fever- * Treat inflammation- * Prevent clot formation |
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|
Term
|
Definition
| * GI upset/GI bleeding- * Sodium and water retention- * Sodium and water retention- * Nephrotoxicity- * Bleeding and bruising- * Cardiac arrythmias, heart attack and stroke- * Hepatoxicity- * Tinnitus/hearing loss- * Hypersensitivity |
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Term
| * Nursing Implications for NSAIDs |
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Definition
| * Monitor for GI bleeding- * Administer with full glass of water- * Give enteric coated if GI upset occurs.- * Emphasize importance of not taking higher dosage than prescribed.- * Monitor for drug toxicity- * Teach patient about possible drug interactions |
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|
Term
|
Definition
| o Dimness of vision- o Drowsiness- o Confusion- o N/V, diarrhea- o Sweating/thirst- o Hyperventilation- o Hyperglycemia or hypoglycemia |
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Term
| * Treatment for OD NSAIDs |
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Definition
| o No antidote- o Reduction or discontinuation of aspirin- o Symptomatic and supportive therapy- o Decrease absorption by gastric lavage or activated charcoal- o Increase elimination by diuresis- o Dialysis in severe cases |
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|
Term
| o Acetaminophen (Tylenol) |
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Definition
| * Mild to moderate pain relief and fever reduction |
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|
Term
|
Definition
| * Anorexia- * N/V- * Rash- * Hepatoxicity at high doses (greater than 4gm/day) |
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|
Term
| * Nursing Implications for acetaminophen |
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Definition
| * Monitor for hepatoxicity |
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|
Term
| * Antidote for acetaminophen overdose is acetycysteine (Mucomyst) taken orally or IV |
|
Definition
| o PO—loading + 17 doses- o IV—loading + 2 doses over a period of 21 hours. |
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|
Term
| * Teach patient not to _____________ tylenol |
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Definition
|
|
Term
| * Teach patient to monitor _____________________ as an ingredient. |
|
Definition
| all OTC meds for inclusion of Tylenol |
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|
Term
| 1. An 86 yr old pt is being D/C’d to home on digitalis therapy and has very little info regarding the med. Which of the following statements best reflects a realistic goal or outcome of pt teaching activities? |
|
Definition
| a. The pt and pt’s daughter will state the correct dosing and administration of the drug |
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Term
| 2. What is the most appropriate response to a pt who informs the nurse that he/she does not want to share info about the drugs he/she takes at home? |
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Definition
| a. “The info about the drugs you take at home, including herbal products, is important for safe administration of drugs while you are here and will be kept confidential.” |
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Term
| 3. A pt’s chart includes an order that reads as follows: “Lanoxin 250mcg daily at 0900.” Which statement regarding the dosage route for this drug is correct? |
|
Definition
| a. The dosage route should never be assumed when an order does not specify the route. |
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Term
| 4. Which of the following questions is most helpful in compiling a drug history for a pt? |
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Definition
| a. “When you take your pain med, does it relieve the pain?” |
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Term
| 5. A 77yr old man who has been diagnosed w/ an upper respiratory tract infection tells the nurse that he is allergic to PCN. Which of the following is the most appropriate response? |
|
Definition
| a. “What type of reaction did you have when you took PNC?” |
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Term
| 6. Which of the following factors influencing pharmacokinetics puts the neonatal pt at risk w/ regard to drug therapy? |
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Definition
|
|
Term
| 7. The physiologic differences in the pediatric pt compared w/ the adult pt affect the amt of drug needed to produce a therapeutic effect. One of the main differences is that infants have the following: |
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Definition
|
|
Term
| 8. While teaching a 76 yr old pt about the adverse effects of his meds, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the elderly pt b/c of alterations in pharmacokinetics, such as the following: |
|
Definition
| a. Decreased blood flow to the liver w/ altered metabolism |
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Term
| 9. When the nurse is reviewing a list of meds taken by an 86 yr old pt, the pt notes that she gets “dizzy when I stand up” and has nearly fainted in the afternoon. Her systolic blood pressure drops 15 pts when she stands up. Which of the following types of meds may be responsible for these effects? |
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Definition
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|
Term
| 10. A pt that is at 32 wks gestation has a cold and calls the office to ask about taking an OTC med that is rated as pregnancy category A. Which answer by the nurse is correct? |
|
Definition
| a. “Studies indicate there is no risk to the human fetus, so it is okay to take this med, as directed, if you need it.” |
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Term
| 11. During a home visit, an elderly pt tells the home health nurse that she has been taking six or more aspirin per day for her “bad bones.” The nurse continues w/ a thorough assessment and makes the decision to double the prescribed dose to help minimize the pt’s “bad bones.” Which of the following statements correctly describes this scenario? |
|
Definition
| a. The “right” of the right dosage of the drug is being violated in this situation. |
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Term
| 12. Cultural influences on health care for a 59 yr old female Chinese pt would most likely include which of the following? |
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Definition
| a. The use of heat may be an important practice for this pt. |
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Term
| 13. A pt is being counseled for possible participation in a clinical trial for a new med. After meeting w/ the MD, the nurse is asked to obtain the pt’s signature on the consent forms. This “informed consent” indicates which of the following? |
|
Definition
| a. The pt has been informed of all potential hazards and benefits of the therapy. |
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Term
| 14. A new drug has been approved for use and the drug manufacturer has made it available for sale. During the first 6 months, the FDA receives reports of severe side effects that were not discovered during the testing and considers whether to w/draw the drug. This illustrates which phase of investigational drug studies? |
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Definition
|
|
Term
| 15. A pt of Japanese descent describes a family trait that manifests frequently: she says that members of her family often have “strong reactions” after taking certain meds, but her white |
|
Definition
| a. She may need lower dosages of the meds prescribed. |
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Term
| 16. For best results when treating severe pain associated w/ pathologic spinal fractures related to metastatic bone cancer, which type of dosage schedule should be used? Pain med administered |
|
Definition
| a. Around the clock, w/ additional doses PRN for break-through pain |
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Term
| 17. A pt is receiving an opioid via a PCA pump as part of his post –op pain management program. During rounds, the nurse notices that his respirations are 8 breaths/min and he is extremely lethargic. After stopping the opioid infusion, what should the nurse do next? |
|
Definition
| a. Administer an opiate antagonist per standing orders |
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Term
| 18. Which of the following is a benefit of using transdermal fentanyl patches in the management of bone pain form the spread of cancer? |
|
Definition
| a. More analgesia for longer time period |
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Term
| 19. The nurse suspects that a pt is showing signs of respiratory depression. Which of the following drugs could be the cause of this complication? |
|
Definition
| a. Hydromorphone (Dilaudid) |
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Term
| 20. Several pts have standard PRN orders for acetaminophen as needed for pain. When the nurse reviews their histories and assessments, it is discovered that one of the pts has a contraindication to acetaminophen therapy. Which pt is the one who should receive an alternate med? |
|
Definition
| a. A pt admitted w/ severe hepatitis |
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