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Why is a prototype approach used when learning about medications?Advantages and Disadvantages?

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A drug is a representative of a class or group of drugs. It helps students because it offers a systematic approach to grouping drug data.Method of learning and organizing large amounts of info; No new ideas because too focused on prototype

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Prototype Drug

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Typically the first drug of a class A representative of a class or group of drugs

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Describe three main sources of data used in assessment of drug core variable.

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1. Patient Interview and History - Open ended question to give room for pt explanation. Ex: Health status, lifespan, gender, lifestyle, diet, habits, environment, and culture. 2. Physical Examination - Vital signs, height, weight, skin. Head to toe assessment 3. Medical Record -Lab and diagnostic test results. Provides info on health status, lifespan, gender, lifestyle, diet, habits, environment

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What are 3 sources of assessment data?

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1. Patient Interview 2. Physical Exam 3. Medical Record

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What are the core patient variables?

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1. Health Status - Presence of disease 2. Life Span and Gender - reproductive stage, developmental level 3. Lifestyle, Diet and Habits - Occupations, exercise, resources, sleep, diet, substance abuse 4. Environment - Home setting, living accommodations 5. Culture and Inherited Traits - Religious, ethnic traits

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Three strategies a nurse can implement to maximize therapeutic effects.

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1. Administer the drug in a manner that will promote absorption. Ex. Giving Lovenox/enoxaparin in lateral abdomen because it is best absorbed there. 2. Administer the drug at appropriate time to maintain blood levels of the drug that will promote therapeutic effects. Ex. Antibiotics must be consistent to get rid of infection completely 3. Monitor labs to determine that the prescribed dose achieves therapeutic drug level. Ex. Serum digoxin levels

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List nursing strategies that can be implemented to minimize adverse effects

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1. Verify patient is not allergic nor is it contraindicated for the patient before administration 2. Administer the drug in a manner consistent with standard safety protocols. Ex. IV pump for drugs that need to be admin steady rate 3. Hold/discontinue drug if labs are not in a safe zone 4. Report evidence of adverse effects to prescriber ASAP 5. Modify med. admin. techniques to decrease effects. Ex: give w/ food 6. Implement appropriate techniques for certain drugs to detects onset effects. Ex: Check BP for drug that causes lower BP

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Describe the concept of nursing management of drug therapy.

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The nursing process is used for providing nursing management in drug therapy. The process of planning and implementing actions that will maximize therapeutic effects and minimize adverse effects.

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Nursing Process?

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1. Assessment - Determine specific drug and identify core drug knowledge; assess pt and core patient variables 2. Nursing Diagnosis Interactions between core drug knowledge and pt variables 3. Outcome Identification - Determining desired results 4. Planning - Strategies to max therapeutic effects & min adverse effects 5. Intervention - Performing the plan; physical act of admin and teaching 6. Evaluation

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Nurses responsibility in drug therapy?

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Nurses evaluate effectiveness of drug therapy. Assess pain

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Describe nursing management techniques used during and after med administration

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Safety Check ID Only admin meds that you have prepared Educate Evaluate; Measure patient progress and whether or not pt has achieved desired effect Reassess Identify reasons behind med admin

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Difference between: Chemical Name Generic(nonproprietary) Name Trade/Brand Name

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Chemical - Drugs atomic and molecular structure, exact chemical nomenclature Generic - identifies the drugs active ingredient Trade/Brand - Name my manufacturer

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Define chemical, physiological, and therapeutic classification. Provide example of a drug.

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Chemical - describes chemical base; Morphine is an opioid Physiological - describes its affect on the body; Morphine is classified as a CNS depressant Therapeutic Class - describes the drug by it's use in therapy; Opioid narcotic analgesic

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What are the federal legislation laws regarding drugs?

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The laws protect the public form drugs that are impure, toxic, ineffective, an not tested. It is to ensure safety! Purity Potency Bioavailability Efficacy Safety and Toxicity

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Define key concepts that are relevant to nursing management of pharmacotherapy

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Core drug knowledge Pharmacotherapeutics Pharmacokinetics Pharmacodynamics Contraindications

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Discuss the scope of nursing responsibilities in relation to pharmacology

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Report adverse affects Educate Max therapeutic effects Min. adverse effects

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United States Pharmacopeia (USP)

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Set of drug standards Covers drug categories, prescribing precautions and considerations, side effects, drug action,impact on lifestyle, dosage forms, and labeling data

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Physician's Desk Reference (PDR)

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Provides a more concise monograph of drug info similar to manufacturer package insert

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Example of nursing diagnosis related to pharmacology

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Constipation due to prolonged opiate usage

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Enteral

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Oral; Most Common, Slowest absorption Can be absorbed through oral, gastric mucosa, and intestines Uses the GI tract for ingestion and absorption of drugs. NG and G tubes are included in this type of administration

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Paraenteral

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Avoids the GI tract and is associated with all forms of injections; SQ, IM and IV and other noncommon forms, intradermal, intrathecal Absorbed faster

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Topical

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it is another form of parenteral. Applied directly to skin or mucosa Ex: eyes, ears, nose, vagina, rectum and lungs

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Local Effect

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Drugs that are applied topically that exert their effect at that site

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Systemic Effect

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Distributed all throughout the body. Is able to be transported through the blood and is ditributed

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Tablet and Enteric Coating

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Solid dosage that is prepared by compressing/molding drugs into various ways. Only scored tablets should be cut Wax-like layer that is used on some tablets to bypass stomach acid and disdolve in small intestine

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Sustained-Release

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A drug that is formulated to release drug slowly over an extended period of time Occurs through several methods:Layers of enteric coating and drug is released in response to changes in surrounding pH lvls may be formulated to release in series of pulsations

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Buccal and Sublingual

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Tablets placed between the cheek and gum Tablets placed under the tongue Both a relatively nonirritating, flavorless, and highly water soluble. Highly vascular so drugs are absorbed quickly into the bloodstream and rapid onset occurs. Avoid first pass effect

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Capsules

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Solid dosage forms where the drug is encased in a shell of hard or soft Quickly dissolves in gastric contents gelatin

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Syrups

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A concentrated solution of sugar, such as sucrose, in water. Most syrups that contain 65%+ sucrose are resistant to mold, yeast, and other microbes. Longer shelf life

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Elixir

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A clear hydroalcoholic mixture that is usually sweetened or otherwise pleasantly flavored. Alcohol levels vary but can exceed 25% Alcohol prevents growth of mold and other microbes

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Nursing Management in Enteral Drug Administration

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Core Drug Knowledge - Although oral method is most common, not all can be admin orally. Gastric acids may destroy drugs Assessment - Can patient tolerate an oral drug? vomiting, unconscious, etc. patients are not suited for oral therapy; Environment, oral can be taken at home Planning and Intervention - Maximize; Capsules with sustained release pellets can be sprinkled on food or mixed; Shake suspensions;instill drugs slowly through tubes not with force. Minimize adverse effects; enteric coatings should not be crushed since it can increase effects

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Intramuscular(IM) Administration

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1-4 mL 20-25g OR 18-25g(oil) ; 1-1.5 inch length ; 90º Angle ; Z-Track - aspirate before injecting to make sure you do not hit a vessel -Injecting drugs into the muscle. Muscles have good blood supply so drugs move directly into the bloodstream thus the onset is faster than oral. Water based - Fast absorption into blood Oil based - Deposit is formed in muscle and release slowly -Sites: Ventrogluteal(side)Preferred, deltoid, vastus lateralis, rectus femoris and dorsogluteal(back)

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Subcutaneous Injection

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1-2mL; 25-30g ; 3/8-5/8 inch length 45º-90º angle Administered under skin into fat and connective tissue. Must be highly soluble and nonirritating Distribution is through the capillaries and is less rapid than IM Sites: mid-anterior thigh, abdominal, scapula, lateral posterior arms

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Nursing Management in Parenteral Drug Administration

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Core Drug Knowledge - Route allows drugs to be distributed directly to vascular system without going through GI and liver. If first pass completely metabolizes drug it may be given through parenteral. Assessment - Cannot tolerate oral drug, swallow or GI problems; Muscle mass must be sufficient, teach patients how to inject insulin since their environment will be at home. Planning and Intervention- Selecting appropriate syringe size and location; Follows 5 right, sterile needles, IV should be monitored for adverse effects since it goes straight into blood stream

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4 Phases of Pharmacokinetics

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The effect of the body on the drug. What body does to drug Absorption - Movement of drug from site of administration into the bloodstream Distribution - Movement of drugs into the cells Metabolism - the conversion of the drug into another substance(s) Excretion- removal of drug

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Absorption

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The completeness of absorption is the portion of the drug that is absorbed. Rate of absorption depends on the route of administration Drugs taken orally takes the longest to be absorbed because it needs to be broken down into smaller particles Drugs given parenteral are already dissolved therefor they are absorbed more rapidly Drugs administered SQ orIM are rapidly absorbed into small capillaries IV drugs are placed directly into the bloodstream and are not technically absorbed

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Distribution

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- The distribution of the drug throughout the body depends on 3 factors: blood flow to the tissues, drugs ability to leave the blood, and ability to enter cell- Scar tissue is avascular; adipose has poor blood supply in addition to abscesses and solid tumors- Drug needs to leave the blood and go into the tissues to produce its effect.

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Albumin

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A large protein that most drugs bind to. Drugs are prevented from passing through capillary walls when bound to albumin

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Blood-Brain Barrier

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Prevent toxins and poisons from entering the brain. Only lipophilic and a transport system can pass

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Biotransformation

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Also known as metabolism, changes from original form to a new form. Lipophilic drugs are generally metabolized into hydrophilic drugs so that they can be easily secreted through the renal system. Drugs that are highly metabolized may lose their therapeutic effectiveness more quickly

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Metabolite

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Product of metabolism

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Prodrugs

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inactive drugs until metabolized into an active form

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First-pass effect

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The first time a drug passes through the liver to be metabolized

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P-450 System

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-Microsomal enzymes called cytochrome P-450 System CYP1, CYP2, CYP3 are involved in drug metabolism -Some drugs induce or inhibit the P-450 system altering metabolism of other drugs -Increase of metabolism, decreases the amount of circulating drug Inhibitors: Grapefruit, Tagamet, Benadryl, paxil Inducers:Tobacco, St Johns Wort, seizure meds

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Excretion

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The process of removing a drug or its metabolites from the body. Most common is urine. Other routed include: GI, air, breastmilk, sweat and saliva -Drug excretion can be increased if pH of urine encourages drug to become an ion -Overuse of active transport affects excretion -2 drugs can be given together to slow the rate of excretion

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Half Life

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The time it takes for 1/2 the drug concentration to be eliminated form the body Measures the rate drugs are removed from the body

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Steady State

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The point at which the amount of drug being administered and the amount being eliminated are equal Steady state achieved based on the amount of time required for 4-5 half lives to occur Based on time, not dosage

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Onset, Peak and Duration

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Onset- time it takes to reach minimum effective concentration Peak- time it takes to reach highest blood or plasma concentration Duration- length of time the drug has a pharmacologic effect

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Clearance

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The rate at which drug molecules disappear from circulatory system Renal excretion and hepatic metabolism are the major modes of clearance

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Pharmacodynamics

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Biologic, chemical, and physiologic actions of a particular drug within the body What the drug does to the body Drugs cannot create new response in the body; they can only turn on/off, promote, or block a response that the body is already capable of doing

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Drug-Receptor Interactions

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Most drugs create thei effect At the receptor site, the drug is able to stimulate the cell to act in a way that the cell is designed to act

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Agonist

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Causes the cell to act/turn on They promote a function

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Antagonist

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Is a blocker that prevents something else from attaching to the cell clocking an action

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Variables that influence the dose

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Potency and Efficacy - Lvl of drug needed in the body to produce an effect Maintenance - Daily dose loading doses - Larger than usual does to reach a fast therapeutic effect(Does not affect steady state) Therapeutic Index -difference between and effective dose and toxic dose

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LD50

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Lethal Dose 50% The point at which the dose would be fatal in 50% of the population

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ED50

answer

Effective Dose 50%

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Anaphylaxis

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Allergic reaction that causes constriction of bronchial smooth muscles(bronchospasms), Vasodilation, and increased vascular permeability. hypotension, edema, rash, tachycardia, cyanosis, pale and cool skin

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Idiosyncratic Response

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aka Paradoxical effect Unusual and/or opposite effects Related to an individuals unique response to a drug, considered to be genetically predetermined

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Additive Effect

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Occurs when 2 or more "like" drugs are combined and the result is the sum of the drug effects 1(drug 1) + 1(drug 2) = 2 Ex: Codeine + acetaminaphen work differently to reduce pain, when combined pain reliever is more effective

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Synergistic Effect

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Occurs when 2 or more "unlike" drugs are used together to produce a combined effect and the outcome is a drug effect greater than either drugs activity alone 1(drug 1) + 1(drug 2) = 3 Ex: 2 different anitbiotics to get rid of certain infections; morphine and alcohol both cause CNS depression but together it can be fatal

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Potentiated Effect

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An interaction in which the effect of only one of the two drugs is increased 1/2 +1 = 2 CNS depressant is combined with morphine, morphines pain releiving is increased without increasing dose or increasing effect of other drug

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Antagonistic Effect

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Opposite of synergistic that results in therapeutic effect that is less than the effect of either drug alone because the 2nd drug diminishes or cancels the effects of the 1st drug 1+1=0

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Ototoxicity

answer

8th Cranial Nerve, Structure of the inner ear Tinnitus, hearing loss, light headness, vertigo, and nausea

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Cardiotoxicity

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Heart Heart failure, damage to myocardium, irregular conductions

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Immunotoxicity

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Immune System immunosuppression

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Neurotoxicity

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Central Nervous System Drowsiness, auditory, and visual disturbances and seizures

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Hepatotoxicity

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Liver If liver damage occurs the drug will not be metabolized

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Nephrotoxicity

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Kidneys Signs and symptoms: decreased urinary output, elevated blood urea nitrogen, increased serum creatinine, altered acid-base balance and electrolyte balance

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Bioavailability

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term used to describe the fraction of the administered does that reaches the systemic circulation and produces effects Caries with drug administration route/site IV has 100% bioavailability

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Bioequivalent

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2 drugs that have the same bioavailability (Both drugs are absorbed into circulation in identical amounts with same absorption

Pharmacology Midterm Chapters 1-5 (Drug Therapy Text -Aschenbrenner) – Flashcards

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