NSG 304

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  1. What is bioavailabilty
    -rate and extent to where ingredients are absorbed from the drug product and becomes availbale to produce effect by ingredient and tablet compressor
  2. Name brand vs generic
    -they both can have the same active ingredients but the name brand can be a little more pure then the generic

    -generic can have other filters that may alter the active ingredient causing it to slightly differ then the name brand

    -pros and cons: if generic brand of tylenol takes 5 minutes to reach the target organ and is 10 times cheaper, cost outweighs the benefits

    -name brands are capitalized and generics are not
  3. ways meds can be given

    most common and most safe

    -meds can remain in stomach just in case of overdose, and can be vomitted

    -Disadvantage- pt must be conscious and must be able to swallow
  4. Tablet and capsule
    -most common form of oral

    -hard waxy coating to protect from stomach acid

    -easy to use

    -can be broken down to smaller pieces for smaller dose
  5. liquid

    tablet is kept under tongue until dissolved
  6. liquid

    -slower then sublingual because tissue thicker

    -tablet is kept in side of cheek until dissolved
  7. liquid

    "enteric coating"
    -are design to dissolve in alkaline environment of small intestine
  8. liquid

    -dissolve in mouth
  9. topical (installation)
    -applied in skin or membrous lining of orifices
  10. opthalamic
    -treat eyes for dryness, infection,glaucoma
  11. Otic
    -ear infections, usually no adverse unless have abrasion
  12. intranasal

    -convienant rapid onset and avoid 1st pass effect

    -disadvantages: destroys celia
  13. vaginal
    -local conditions, make sure to empty bladder first
  14. rectal
    -good to use on patient with nausea, vomitting, or bronchial obstruction
  15. nasogastric and gastronomy
    -used if pt has a breathing or feeding tube

    -usually liquid form
  16. nasogastric (flexible)
    -used for short term care
  17. gastronomy
    -used for long term care
  18. crushing meds
    -some meds may be crushed and mixed with water but tend to clog tubes

    -sustained release meds should not be crushed and used for patient with tubes
  19. transdermal patch
    -this route avoids the 1st pass effect in liver and bypass digestive enzyme
  20. parenteral injections
    -if sucutaneous or intramuscular: avoid directly into vein

    -this is why the nurse injects then slightly pulls the syringe back to make sure that its not in a vessel

    -if intravenously, then directly into bloodstream

    -benefit- large volume infusion

    -disadvantage- pathogen from outside body can directly go in
  21. what affects a patient's complience
    -no more symptoms- most common reason

    -too expensive- next most common

    -forgetting meds

    -not approved by insurance

    -adverse affects

    -self adjusting dose

    -inability to dispense safely (misuse)
  22. factors retarding absorbtion of meds
    -food may delay/slow absorption, especiallyhigh fatty foods

    -drug interactions

    -route of administration

    -oral tablets have protective coating, must be broken down in the stomach before it can be absorbed
  23. factors speeding up absorption
    -larger surface area


    -blood flow

    -tissue storage (affinity)
  24. therapeutic range
    -range at which drugs reach its desired therapeutic actions
  25. loading dose
    -pateau may be reached quicker by giving initial big dose

    -often given for first time or second time

    -example:if you had a bad infection, without using a loading dose may take upto 48 hours to reach the therapeutic range whereas if you used a loading dose, therapeutic dose may be reached range
  26. maintenace dose
    -given right before plateu levels drop

    -keeps plasma drug concentration in therapeutic range
  27. maintenance rationale
    -if you had a had a bad migraine, you would take 2 motrin right way

    -the more, the faster and greater the effect, then in 4 hours

    -only take 1 motrin to stabilize the plasma level in order to maintain the therapeutic range
  28. plasma 1/2 life
    -means drug duration

    -length of time required for plasma concentration of a drug to decrease by 1 half after administration

    -some half lives last a few minutes vs. hours vs. days

    -ex: half life of Novocain = 8 minutes. therefor 94% of Novacain would be excreted from your body within 32 minutes (functionally eliminated, but doesn't completely leave your body)
  29. What to do if someone is having an allergic reaction?
    - ensure airways are clear (ABC theory!)

    -document what occurs

    -call provider
  30. Steps to take if medication error occurs

    wrong time

    wrong dose

    wrong med


    -create interventions

    -put intervention into effect

    -call provider
  31. Why do we have 10 rights?

    -ensure that everything is covered
  32. Factors in elders effecting the way medication is metabolized

    "GI absorption"

    -decreases GI motility

    -decrease blood to GI tract

    -Increase in gastric PH (less acidic)
  33. Factors in elders effecting the way medication is metabolized

    -less total body water for dilution

    -increase in fat storage which lowers plasma/increase tissue levels

    -reduce plasma protein levels, therefore fluid tends to leak out

    -due to insufficient blood brain barrier allowing drugs to cross causing symptoms
  34. Factors in elders effecting the way medication is metabolized

    -decreased hepatic (liver) function

    -decrease liver mass

    -less liver blood flow

    -alter in hepatic enzymes
  35. Factors in elders effecting the way medication is metabolized

    -decrease receptors in kidneys

    -urine testing allows for determining creatinine levels correlating to kidney functioning
  36. Ideas that may help geriatric adherence to medication adherence
    -encourage wearing glasses and hearing aides

    -dont necessarily talk so loud

    -face pt and enunciate words allowing them to read your lips

    -use larger print and colorful things to get their attention

    -review their meds on every new encounter

    -follow up with call in case of adverse effects or things that need to be reported
  37. What do cholinergic/parasympathetic drugs mimic?
    -stimulate parasympathetic nervous system

    -agonist that help increase Ach neurotransmitter

    -mimic effects of Ach @ muscarinic receptors

    -stimulate cell to produce response- tone, strength, and secretions

    -increase tone and motility of GI tract

    -contract urinary bladder

    -increase pupillary constriction

    -maintain muscle strength
  38. ACH
    -may stimulate both muscarinic and nicotinic receptors

    -muscarinic/micotinic (cholingeric drugs) are selective in which specific receptors they bond to

    muscarinic/micotinic (cholingeric drugs) stimulate specific nerve terminals to release Ach

    -these 2 mechanisms are considered direct acting, their goal is to activate cholinergic receptors
  39. What effects cholinergic agonists/ parasympathetics in terms of our systems (eyes, cardiac, gut,etc)
    -increase GI motility

    -contract urinary bladder

    -increase pupillary constriction (myosis)

    -Maintain muscle strength

    -increase BP and heart rate

    -CNS alertness
  40. Urecholine/bethanol chloride (direct action)
    -agonist drug taken PO or subcutaneous

    -takes around 30 minutes to produce effect

    -stimulates smooth muscle contraction after anesthesia, restore paralysis,relax sphincter, bladder muscles to contract for urination

    -direct acting

    -does not cross blood brain barrier

    -similiar structure to Ach

    -interacts directly with muscarinic receptors to cause typical parasympathetic stimulation

    -drug is not destroyed by enzyme AchE causing its actions to be prolonged (longer then Ach)

    -increase salivation

    -abdomen cramps



    -blurred vision

    -low BP

    -reflex tachycardia

    -complete heart block or acute bronchospasm

    -dont use if recent GI surgery, suspected bowel obstruction
  41. effects of liver damage from meds
    -medication doses should be reduced

    -reducing meds prevents hepatoxicity

    -damaged liver or smaller less functional liver cannot metabolize meds at normal rate

    -drugs take longer toleave body
  42. Actions of acetylcholenesterase inhibitors (indirect acting)
    -treat alzheimers improving memory and cognition

    -reduce intraocular pressure in glaucoma

    -treat gas poisoning by blocking active site on AchE so toxic agent can not bind

    -inhibits acetylcholinesterase AchE enzyme

    -allows Ach to remain on cholinergic receptors longer prolonging its actions


    -affects all Ach synapses

    -overdose: intense parasympathetic stimulation, miosis, urinary, incontinence, and abdominal cramping

    -Antidote (reverse overdose): Atropine reverses muscarinic effect
  43. direct acting drugs
    -bind directly to receptors or stimulate nerve synapse to release Ach

    -activate receptors to produce effect
  44. AchE inhibitors
    -indirect acting by inhibiting the enzyme AchE preventing it from destroying Ach allowing Ach to remain on the receptors for prolonged action
  45. Neuromuscular blocking
    -drugs used to cause total muscle relaxation

    -inhibit transmission at the neuromuscular junctions on skeletal muscles in the somatic nervous system which provide voluntarycontrol over skeletal muscles

    -example: anesthesia for surgery (pt must be on ventilator)
  46. Epinephrine
    -treats allergic reaction such as anaphylaxis, bronchospasm and cardiac arrest

    -may be applied topically to coagulate blood thus preventing bleeding

    -nonselective adrenergic agonist

    -stimulates both alpha and beta adrenergic receptors throughout the body

    -adverse reactions:nervousness, tremors, tachycardia,dyspnea, headache

    -Contraindications: cardiac arythmia, pregnancy, gluacoma, cerebral arterioscleroisis
  47. Epinephrine Nursing considerations
    -why do we need epinephron

    -does pt have hypertension, angina, other cardiovascular conditions

    -establish vital signs

    -monitor BP closely during first 5 minutes of IV administration

    -take measurements every 3-5 minutes until stable
  48. what meds are safe to give pt with hypertension and asthma?
    -Beta 1 Adrenergic Antagonists (Beta Blockers)

    -Beta blockers are selective (bind sprecifically to certain receptor) and have little effect on Beta 2 receptors in bronchial smooth muscles

    -may be given safely to patients with asthma or COPD

    -very low possibility for bronchospasm
Card Set
NSG 304
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