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what is a controlled substance?
drug whose use is restricted by the comprehensive drug abuse prevention & control act
how is a scheduled drug classified?
according to potential for abuse and toxicity
What is a schedule I drug? name some examples!
- has highest pontential for abuse
- limited or no theraputic value
- heroin, LSD, GHB, marijuan, psilocybin
what is a schedule II drug?
- high potential for abuse & dependence
- perscription has to be handed in, no ordering over phone
- need to closely monitor
- morphine, oxycodone, meperidine, fentany, pcp, methamphetamine, short acting barbiturates, cocaine
what is a schedule III drug? examples.
- Moderate potential for abuse & dependence
- theraputic with perscription
- codeine, ketamine, hydrocodone+asprin or acetaminophen, buprenorphine, intermediate-acting barbiturates
what is a schedule IV drug? examples.
- Lower abuse & dependence potential
- theraputic with perscription
- benzodiazepines, zolpidem, dextropropoxphene, pentazocine, meprobamate, long-acting barbiturates
what is a schedule V drug? example.
- lowest abuse & dependence potential
- OTC w/ coedine, antidiarrheal w/ opoids
physical/psychological. body adapt & alter pathways. you want to keep using.
you need a bigger amount of the drug to have an effect
does OTC medicine with coedine need to be wasted?
yes! 2nd nurse must watch the wasting.
What restrictions do hospitals and pharmacies place on scheduled drugs?
- must register with the drug enforcement administration (DEA)
- use registration # to purchase sheduled drugs
- must maintain complete records of all quanities purchased & sold
- drugs with higher abuse potential have additional restrictions
What is the broad category name for: diverse group of drugs that cause clients to feel sedated or relaxed? what are the 4 types of drugs that fit under this category?
- CNS depressants
- sedatives, antianxiety agents, alcohol, opiods
what are sedatives used to treat? what are the 2 primary classes? what happens in an overdose?
- prescribed for sleep disorders & certain forms of epilepsy
- 2 classes: barbiturates & nonbarbiturate sedative-hypnotics
- overdose: very dangerous, supress respiratory centers in brain, may stop breathing or lapse into coma
what must be monitored closely for a patient on sedatives?
is a benzodiazepine a stimulant or depressent?
What is Benzodiazepines primary indications?
- sedatives for clients w/ sleep disorders
- seizure disorders
- muscle relaxants
what is an opiod known as? what is it perscribed for? where does it come from? what are some examples.
- aka opiates or narcotic analgesics
- prescribed for: severe pain, anesthesia, persistent cough, life-threatnening diarrhea
- obtained from poopy seeds
- morphine, codeine, heroin, oxycotton, oxycodone, methadone, demoral, fentanyl ect
what type of emotions does a user of opiods experience? how fast does tolerance develop?
- extreme pleasure to slowed body activities, profound sedation, slurred speech, constricted pupils (miosis), increase in pain threshold, respiratory depression
- tolerence develops rapidly- client may require 10 times initial dose to achieve desired effects
what are opiod withdrawl symptoms?
dysphoria, diaphoresis, violent yawning, lacrimation, rhinorrhea, pupil dialation (mydriasis), fever, diarrhea, goose bumps, muscle cramping, tremors
what drug is a heroin addict switched to during detox to help treat withdrawl symptoms?
what does mydriasis mean?
what is the most commonly abused drug? what are consequences of this drug, does it have any health benefits? if so, how much is benefitial for a male or female?
- alchohol (ethanol)
- staggering economic, social & health consequences
- small quanities of alchol consumed on daily basis foudn to reduce the risk of stroke and heart attack
- female= 1-2 drinks
- male= 2-3 drinks
what are side effects of alcohol?
sedation, relaxation, loss of motor coordination, reduced judgment, decreased inhibition, increased diuresis
what should you understand about the alcohol dependent client?
- susceptible to adverse drug effects & drug interactions
- drug doses should be decreased
- serious GI bleeding w/ NSAIDS
- hepatic injury combined w/ acetaminophen
what are some signs of alcohol withdrawl?
- intense agitation
- terrifying hallucinations
- uncontrollable tremors
- panic attacks
- elevate HR/BP
what can alcohol withdrawl lead to? what is it called? what is it? when is peak onset? how long does it last?
- Delirium tremens
- severe alcohol withdrawl
- may be life threatening: increase bp, increase HR= stroke/heart attack
- have to incubate them
- peak onset 48-72 hr
- can last weeks
with an alcohol withdraw patient what is the top priority? how do you care for them? w/o tdx what is the % of death? why use benzodiazepine?
- Treatment of delirium tremens
- administer of benzodiazepine- loraepam (ativan) -diazepam (valum)
- hit same GABA receptors as alchol in CNS
what can you do for a patient who is not in withdrawl but wants to stop drinking? what does this drug do?
- use disulfiram (antabuse)
- discourages relapse, causese violent illness if consumed with alchol
what are antabuse+ alcohol symptoms?
headache, palpations, chest pain, SOB, nausea/vomitting
name 5 drugs that are considered a CNS stimulants?
- club drugs
what might a stiumlant be prescribed for? what can happen with abuse?
- narcolepsy and attention deficit hyperactivity disorder (ADHD)
- with abuse: sense of exhilaration, improves mental and physical performances, reduces appetite, prolonged wakefulness
what are uses for epinephrine? what are uses for noepinephrine?
- epi= allergies/anaphlaxis
- nor-epi= hypotension
what are the effects of increased noepinepthrine? what does overdose lead to?
- tachycardia, increased bp, tachypnea, dilated pupils, sweating, tremors
- seizures, dysrythmias, CVA, cardiac arrest
what stimulant does nor=epi fall under?
what is the added benefit of caffeine + OTC pain relivers?
- increase effectiveness
- rapidly distributed to almost all parts of body
- requires several hours to metabolize and eleminate drug
- pronounced diuretic effect
what are the physical effects of caffeine? what are the s/s of withdrawl?
- dilation of respiratory passages
- increased bp
- increased production of stomach acid
- changes in blood glucose levels
- severe headache
- impaired performance of daily activities
what is nicotine? stimulant? depressent? what are some words associated with it?
- enhances alertness, legal, strongly addictive, high carcinogenic
waht are systemic effects of nicotine? what are psychoactive effects? what are cardiovascular effects?
- promotes the release of epi
- direct stiumlatory effect on reticular activating system of brain
- accelerated HR
- increased Bp
- serious risk in clients taking oral contraceptives
should a female age 35 or over be smoking and taking oral contraceptive? yes or no? why?
no huge risk for blood clots!
how much greater is the risk of heart attack for a smoker?
what are symptoms of nicotine withdrawl?
- impaired concentration
- weight gain + anxiety
- extreme craving of drug
- peaks at 24-48 hours
- continues for several weeks
what are some treatment for smoking withdrawls?
- Nicotine replacement therapy (NRT): based on assumption that blood level of nicotine is what drives people to continue.
- Carenicline (chantix)
what is the mechanism of action and side effects of chantix?
- mechanism of action:
- activates nicotine receptors in brain
- blocks niotine from reaching receptors
- blocks some pleasurable sensation
- Side effects:
- nausea and vomiting
- potential for changes in behavior, agitation, dpressed mood, suicidal ideation, and attempted/completed suicide
whats the most common antidepressent? what happens when its taken during pregnancy?
- Serotonin reputake inhibitors (SSRIs)
- may cause withdrawl symptoms in newborns that include agitation, irritability, trould feeding, and sleep disturbances
what are some changes in pharmacokinetic variables during pregnancy?
- physiologic changes during preg can alter normal pharmacokinetic responses
- most body systems undergo predicatble changes during preg
- some physiologic activities speed up
- some physiologic activites slow down
what does increased proestrone do in a pregnant woman? what about increased estrogen? what about increase progesterone?
- =delayed gastric emptying
- =increased hydrochloric acid production
- =increases pulmonary blood flow, respiratory tidal vol, & min vol 40%
how is distribution affected during pregnancy?
- changes in total body water, may increase over 50%
- leads to greated hemodilution of plasma proteins and drugs
- when plasma proteins diluted fewer are abailabe to bind w/ drugs
- higher concentration of "free" drug in the plasma
what does higher concentration of "free" drug in the plasma do?
increases risk of toxicity
how is metabolism affected during pregnancy?
- least affected during prego
- cyp450 in placenta
- likely contriute to drug metabolism
- placenta and fetal liver contribute to drug metabolism
- incrasing metabolism of certain drugs
how is excretion affectedduring pregnancy?
- enhanced during pregnancy
- results in increased renal elimination of drugs
- dosage of many meds must be adjusted
enhanced excretion during pregnancy increases what?
- renal plasma flow
- glomerular filtration rate (GFR)
- creatine clearance
- renal tubular reabsorption
what is important about the placenta?
- offers protective filtration of maternal blood
- prevents certain harmful substances from reaching fetus
- vitamins, fatty acids, glucose and electrolytes freely pass from mother to fetus
do drugs have to cross placenta to cause fetal abnormalities?
tell me in each of the categories what would cross placenta the easiest:
plasma drug level in mom
solubility of drug
- plasma drug level in mom: higher dose more drug circulates through placenta
- solutility: lipid soluble
- molecular size: small
- protein binding: unbound
- drug ionization: unionized
what is the pregnancy categories used for?
rate medications related to risk to the fetus during pregnancy
what are the 5 risk categories?
what is risk category A?
adequate, well-controlled studies show no increased risk to fetus
what is risk category B?
animal studies have shown no harm to fetus
what is risk category C?
shows adverse effect on animal fetus but may not show on pregnant women
what is risk category D?
demonstrated risk to fetus. benefits may outweight risk
what is category x?
fetal abnormalities and risk shown! should be absolutely avoided!!!
what category do 2/3 of drugs live in?
what are several problems with categories?
- current labeling system gives no specific clinical info on the safety of drug
- system does not indicate how drug should be adjusted during prego or lactaion
waht type of drugs are encouraged during prego?
- multivitamins & iron
- vitamin B9 (folic acid)= helps prevent spinal cord defect
- other A category drugs
Effects of drugs ont he fetus depend on?
Dosage recieved by fetus and stage of fetal dvelopment
whats a teratogen?
substance organism/ physical agent to which the embyro/fetus is exposed that produces permanent abnomrality in structure/function, cuases growth retardation or death
what are potential fetal consequences of teratogens?
- intruterine fetal death
- physical malformation
- growth impairment
- behavioral abnomralities
- neonatal toxicity
is the timing of a drug use important during pregnancy? in regardds to teratogens.
- yes the drug therapy and stage of fetal development is critical
- specific risk is dependent on time in gestation per.
what is thalidomide? what is used for today?
- used in 1950's for morning sickness
- caused severe limb defects
- recently approved to tx some cancers
what determines the amount of drug that is passed to an infant during lactation?
- solubility of drug
- molecular size
- drug t 1/2
waht are some commonly used drugs in peds?
- respriatory meds
tell me about drug absorption for a peds pt?
- increased gastric ph
- delayed gastric emptying- they keep drug longer and its absorbed into stomach and small amounts in intestine
- low blood flow to skeletal muscle- IM avoided because muscle has very little blood flow
- Skin of infants thin and highly permeable- lotion/topical drug absorbed very rapidly; never utilize it!
what are the 3 main factors affecting drug distribution in children?
- proportion of water: 80% newborn body weight is water. 60% body weight water in 1st year
- immature liver function
- underdeveloped blood-brain barrier: not fully developed at birth; assess for toxcity of CNS when give meds to peds pt
what metabolic functions are significantly slower in children?
- reduced clearance rates
- extended half-lives for drugs extensively metabolized by the liver; allows time for metabolism, allow long time between drug dosages
- at years 3-5 their metabolism is similar to an adults
true or false? Young children have mature renal systems with slower renal clearance?
false: young children have immature renal systems w/ slower renal clearance
because young kids have immature renal systems w/ slower renal clearance, what problems may this lead to?
- drugs primarily excreted by kidneys may accumulate and cause nephrotoxicity
- infant able to concentrate urine at about 3-5 months of age
what dovelepmental changes must be considered in giving drugs to peds pt? at what age do you cosnider someone to be a peds pt?
- age, weight, and developmental level
- peds patients are birth to 16 age and weight less than 50 kg
when giving infants medication what is important to keep in mind?
- hold and cuddle while administering meds
- meds administered via droppers into ears, eyes, nose, or mouth
- oral meds directed into inner cheek
- careful w/ IM and IV
what special considerations must be followed when giving an infant a IV or IM med?
- vastus lateralis prefered site for IM injections
- rotate injection sites from one leg to another to avoid over use
- feet and scalp provide good sites for IVs
- use smallest needle!
what should you do when giving toddler medication?
- short concrete explainations
- physical comfort--> verbal praise
- mix unpleasnt meds w/ jam/syrup/fruit puree
- meds may be followed by soda or mint candy
- avoid giving meds with healthy foods so they don't associate the bad experience with the meds with the healthy food
- still use scalp and feet for IV sites
where can you give preschoolers IVs and IMs?
- ventrogluteal site may be used for IM
- don't use dosogluteal site--> potential injury to sciatic nerve
- peripheral IV access
how should you give medications to school-aged clients?
- more detailed explainations
- offer limited choices of dosing alternatives
- praise cooperation
- may take chewable tabs, swallow tabs or caps
- resist injections
- ventrogluteal site preferred for IM injections
how should you give medications to adolescents?
- conformity w/ peers in terms of behavior, dress, and social interaction is important
- strong sense of independence leads teens to self-medicate
- keep medications out of sight
- parents should be taught s/s of drugs abused by teens: marijuana, inhalants, and methamphetamine