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  1. medication orders, 6 elements are a must:
    • —
    • 1- patient name
    • 2- date order written
    • 3- name of medication
    • 4- dosage (frequency, amount, # of doses)
    • 5- route
    • 6- signature of prescriber
  2. —Do the 3 check triple check
    • —Educate patient
    • —Document everywhereit is required—
    • Assess allergies before implementation
  3. How can we avoid med errors?
    • —Repeat verbal orders over the phone back to doc
    • —Write clearly
    • —Never assume ANYTHING
    • —5 rights
    • —No trailing zeros (25mg, not 25.0 mg)
    • —Listen to your patient
    • —Assess pt. before, during, and after meds
    • Think critically and be smart
  4. legal and ethical issues:
    • —1906- Pure Food and Drug Act
    • —For the protection of the community – strict rules and regs.
    • —Now- info has to be on the label
    • —What info?
    • -Ingredients
    • -Possible effects, side effects
    • -Contraindications
    • -Addiction possibilities
    • -Risks
  5. —Controlled substances-
    some narcotics, sedatives, tranquilizers, hypnotics (Rx only)
  6. —Legend drugs-
    Rx only- antibiotics, birth control and more
  7. -Benificience





  8. —Physical dependency-
    • physiological need, physical signs and symptoms are manifested, reactions
    • without the drug
  9. —Psychological dependence-
    feelings of stress, anxiety without the medication
  10. —Drug polymorphism-
    effect of the patients age, weight, gender, size, body composition, ethnicity

    -Also consider- diet, genetics, nutritional status
  11. Compliance-
    may depend on cultural beliefs, level of expectations, educational level, family influence
  12. Drug-
    chemical affecting processes of living organism
  13. Pharmaceutics-
    how dosages influence the body
  14. Pharmacokinetics-
    what happens to the drug after entering the body until it leaves the body
  15. Pharmacodynamics-
    study of drug actions in living tissue
  16. Pharmacotherapeutics-
    the outcomes- cure, reduction of symptoms, prevention, life quality improvement
  17. Drug preparations-
    can determine the rate of dissolution and absorption
  18. Dissolution-
    describes how a solid form becomes soluble, disintegrates and get absorbed (from original form)
  19. Enteric coated even slower-
    they are coated so do not dissolve until they get to the lower pH in the lower intestine
  20. size matters:
    • —The larger the particle (say in a capsule)- effects dissolution. You can have two of the same drugs in two different forms, but one may dissolve more quickly
    • —Example- Diabeta and Glynase (same drug = Glyburide) but Glynase is “micronized” and reaches maximum concentration before Diabeta
  21. —Rely on stomach pH for break particles down for absorption into the __ system
    —Rely on stomach pH for break particles down for absorption into the circulatory system
  22. —Once dissolved in stomach mucosa- drug transported to
    —Once dissolved in stomach mucosa- drug transported to site via blood or lymph
  23. enteral forms of absorbtion:
    —Can be absorbed via stomach mucosa, intestine (typically small), or rectum (so this is the rectal route, but still considered “enteral”)
  24. first pass effect
    —Once in the liver- metabolized and passed into circulation
  25. what happens to those with a faulty liver?
    —In the liver- large % of drug metabolized into “inactive metabolites” so a less active form of the drug goes into circulation

    —This drug is known to have a “HIGH FIRST PASS EFFECT”
  26. what happens if the small intestine is damaged or disease?
    —Absorption is altered!

    • —Intestine and stomach are highly vascularized- if blood flow
    • affected here- absorption is affected (SEPSIS can cause a decrease in the blood flow)
  27. opthalmic meds:
    • —Into mucous membrane of the eye (conjunctiva)
    • —Liquid or ointment form
    • —Educate not to rub and careful application- no touching dropper tip to the actual eye
    • —Some opthalmic preps work locally
    • —Some work systemically
    • —This means that a specific eye medication could cause systemic effect like a drop in Bp
  28. parental medications
    —Medications via injection

    • —Solutions made up similar to blood so they can be safely administered
    • —Remember though- veins and capillaries are easily damaged
    • —Parenterals do not have to be absorbed so
    • —Very quickly absorbed and is the fastest route
  29. Onset of action-
    when does it start taking on a therpaeutic effect
  30. Time of peak effect-
    maximum effectiveness
  31. Duration of action-
    how long does the drug actually work
  32. absorption
    —This is the rate at which a drug leaves administration site and the extent at which that occurs
  33. Bioavailability-
    this is the extent of drug absorption
  34. why do PO meds have a bioavailability of <100%?
    Metabolism or excretion of drug in the system- some of the medication is inactivated or diverted before it reaches circulatory system
  35. what affects absorption?
    • —Route
    • —Food and fluids present
    • —Dosage formulations
    • —Rate of blood flow in small intestine
    • —Acidity in the stomach
    • —Gastrointestinal motility
    • —Age
    • —Disease processes
  36. Sublingual (SL)-
    • under the tongue
    • Tissue is highly vascular in the “oral mucosa” so fast absorption
    • No first pass effect b/c they are absorbed at the site
  37. parenteral medications:
    • —Again-this is the fastest route of absorption
    • —IV- goes directly into circ. System
    • —IM (intramuscular) and SC (subcutaneous), slower
    • delivery-can actually take hours to days to start having an effect
    • IV, intraarticular (via the arterial system), intrathecal (via subarachnoid space or spinal cord), intradermal (under the skin), SC, IM
    • —All bypass first pass effect!
  38. —Why ever slow the absorption rate?
    Extravasation- med leaks out of vein into surrounding tissue, cold contains the damage
  39. topical medication:
    • —To body surface (skin, mucous membranes, external/ internal)
    • —Skin, ear, nose, lungs (main areas)
    • —Onset is SLOW
    • —Side effects- we would assume there is a considerable amount of the drug in the system
    • Systemic absorption often unreliable
    • —No first pass effect
    • —Pastes/ointments/creams/lotions/transdermal patch
    • —All go passively into the blood stream
  40. transdermal medications:
    • —Applied to skin- usually in a “patch” form
    • —By passes first pass effect
    • —Examples: Nicotene, Estrogen, Fentanyl
    • —Some patches have specific site placement (Scopalamine)*
    • —Take about 30 minutes or so for onset
    • —Supplies even amount of distribution
    • —Still working after removal!!
    • —Wash with soap and water, dry well and rotate patch
  41. inhalation medications:
    • Med delivery to the lungs in micron-sized particles
    • Enters alveoli for easy absorption
    • Once in the alveolus- comes in contact with capillaries
    • Example- Albuterol (used for breathing difficulties, asthma)
    • There is education required
  42. —Distribution-
    Transport of the drug in the body by the blood stream to site of action

    Once in the blood stream- there is active elimination by the organs that metabolize and excrete
  43. Three proteins:
    —Alpha 1- acid glycoprotein
    • —binding globulins
    • —The most important? ALBUMIN
    • —What happens if the albumin level is low in my patient? (like someone malnourished)
    • You will have free “unbound” drug circulating in the system
    • This can cause toxicity
  44. —Someone is taking more than one drug that is “highly protein bound”?
    —There will be competition for “binding power” and there may be a “drug-drug interaction”
  45. areas of rapid distribution:
    • —Heart
    • —Liver
    • Kidney
    • —Brain
  46. areas of slow distribution:
    • —Muscle
    • —Skin
    • —Fat
  47. volume of distribution- —This is used to describe various areas where drugs are distributed
    • —Blood
    • —Total body water
    • —Fat
    • Highly water-soluble drugs have a small volume of
    • distribution and high blood concentrations
    • These bind more strongly to protein in the blood and are
    • less likely to be absorbed in tissue.
    • The opposite is true for drugs that are highly fat soluble
    • It is a biological transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite (metabolism)
    • Biotransformation takes place after absorption and
    • distribution- this is when metabolism comes in
    • Most common site for metabolism of drugs? LIVER
    • (also kidney, lungs, plasma, intestinal mucosa)
  49. What affects biotransformation?
    • —Disease, especially in the liver
    • —CV dysfunction- slows the process
    • —Renal insufficiency- meds levels can easily become toxic because kidneys do not excrete efficiently
    • —Starvation, obstructions, genetics- can all slow the process (genetics can also quicken the process)
    • —EES and Ketoconozole- slow the process
    • —Barbiturates and Rifampin quicken the process
  50. excretion:
    • —Elimination of the drug from the body
    • —Primary organs of excretions- KIDNEYS
    • —Also liver, bowel
    • —Drugs metabolized by the liver (first pass effect) become very water soluble (polar) making elimination by the kidneys fairly easy
    • —Excretion via the intestine – “biliary excretion”
    • —Many drugs taken up by the liver, released into bile and eliminated via feces
  51. —Less common areas of drug excretion
    • -Lungs
    • -Sweat
    • -Salivary glands
    • -Mammary glands
  52. half life
    • —This is the time it takes for ½ of the original amount of a drug in the body to be removed
    • —This is the measure of the RATE at which a drug is removed from the body
    • —After about 5 half life’s the drug is considered removed by the body
    • —This computation is not anything you will ever be able to measure (as the nurse)
  53. —Steady state blood levels:
    • refers to the state in which the amount of the drug removed via elimination is equal to the amount of drug absorbed with each dose
    • —This happens in about the 4th half life
    • —Once the body has achieved steady state blood levels- there is a consistent level of drug in the body that corresponds with the MAXIMUM THERAPEUTIC EFFECT
  54. Physician will write an order for IV and will include:
    Physician will order type, amount, infusion rate, and duration of the infusion
  55. MACRO- drip tubing-
    larger drops- running at a fast rate- Usually 10, 15 or 20 gtts/mL
  56. MICRO- drip tubing-
    smaller drops- must infuse VERY precisely- to run slowly- Standard is 60 drops/mL
  57. “Phlebitis”-
    “Thrombus” formation-
    “Pulmonary Embolus”-
    “Air Embolus”-
    • “Phlebitis”- inflammation of the vein
    • “Thrombus” formation- stationary blood clot
    • “Pulmonary Embolus”- Blood clot that is capable of traveling to the lung
    • “Air Embolus”- Bubble of air traveling within the vascular system
  58. IV dressings at the insertion site are changed every
    Most IV sites are removed and replaced
    Tubing is changes per protocol also-
    • IV dressings at the insertion site are changed every 24 hours- 72 hours, depending on protocol and appearance of
    • the IV site

    Most IV sites are removed and replaced approximately every 72 hours or as needed at the discretion of the nurse- see protocol.

    Tubing is changes per protocol also- usually every 24-48 hours.
  59. Tubing used for infusion of blood
    and blood products are changed
    AS SOON as the infusion is completed
  60. example of steady stae blood level
    • —Digoxin- —This drug requires frequent labs to assess for maximum therapeutic levels
    • —0.8-2.0 ng/ml
    • —Anything less than 0.8 = non therapeutic
    • —Anything greater than 2.0 = toxicity risks
    • —This is considered a “narrow therapeutic window”
  61. OTC’s- account for __of medications being taken in the US
  62. Classifications:(OTC and HERBALS)
    • 1)Analgesics- Ibuprophen, Ketoprophen, Naproxin Sodium, ASA*
    • 2)Antifungals- Miconozole
    • 3)Histamine Blockers- Cimetadine, Rantadine – often used also for GERD
    • 4)Mast cell stabilizers- Cromolyn Sodium
    • 5)Smoking deterrents- Nicotine patches and gum
    • 6)Topical’s- Hydrocortisone creams, etc..
  63. Nursing Process: Assessment-
    • Assess for all OTC’s the client is taking- NSAIDS
    • – kidney and liver disease
    • - ASA- can cause increased GI bleeding, Reye’s syndrome in children
    • -* may cause hematuria, melena, ologuria, cholestatic hepatitis
    • Caution OTC’s with pregnancy and nursing mothers
    • Caution with the elderly
    • Frequency of use
    • Assess client’s knowledge of side effects, contraindications
    • NO antifungals for the client allergic to PCN or in those with severe bone marrow suppression
    • -Miconozole interacts with ETOH, H2 Blockers, anti-TB meds and antacids
    • Nicotine deterrents- not to be used in the client with heart problems, history of MI, angina, PUD, HTN, diabetes
  64. H2 blockers or “histamine blockers” are used for histamine blocking, but also helps prevent
    gastric acid production in thestomache- can also help to heal gastric ulcers in the GERD client.
  65. Mast cells- play a significant role in the
    inflammatory process and the immediate allergicreaction. They release histamines that act on mucous glands and smooth muscle and connective tissue.It is the release of MastCells that cause nasal inflammation, runny nose, watery eyes, etc… when you geta cold!
  66. SC injections:
    90 degree angle45 degree angle if the patient is emaciatedDO NOT massage heparin given SC
  67. IM injections:
    • 45degree angle
    • (Changethe needles after drawing up meds if the drug is irritating to the SC tissue)
    • Massage lightly after giving an IM injection, unless otherwise contraindicated
    • Airlock method- 0.2 mL air into the syringe after the medication has been drawn up
    • CHILDREN-Rocephin is a common antibiotic given IM once daily for children. It is thick and can be massaged after administration to aid in relievingdiscomfort and in dispersing the medication
  68. ID injections:
    • 5-15degree angle
    • Use atuberculin syringe
    • Support arm at elbow with your hand if there is no flat,firm surface
    • Bevelof the needle stays UP
    • Stretch skin flat with thumb and forefinger
    • Injectmedication slowly, it is normal to feel some resistance- if not, needle is too deep
    • You should see a “bleb”
  69. WHAT is the “Z-track method”?
    Pulling skin taught, prevents the deposit of medication through sensitive tissues while giving an IM injection
  70. WHAT is the “air-lock method”?
    Placing½ to 1 cc of air into the syringe, prevents tracking of medication through SC tissue
  71. When crushing medications, be sure it is not contraindicated to do so. Some meds cannot be crushed
    • Enteric coated and sustained release tabs/caps cannot be crushed!
    • These are the abbreviations you will see on those meds: EC,LA, SA, SR
  72. BUCCAL medications should be place b/t
    the upper molars and the gum and allowedto dissolve before swallowing and liquids should not be taken until medication dissolves
  73. Use ___ to clear NGT and __ after the meds are instilled to clear the tube, unless policy states otherwise
    30 cc, 30 cc
  74. When
    instilling OPTHALMIC medications (ointment)-
    have the patient look upward,lower the conjunctival sac and gently squeeze a thin ribbon of ointment inthe sac starting at the inner canthus working outward. Have the patientclose eye and move eye around to distribute the medication

    Eyedrops- Rest dominant hand on forehead and hold dropper about 1-2 cm aboveconjunctival sac and place drops in as ordered
  75. MDI’s (metered dose inhalers) –
    ShakeinhalerHavepatient tilt head back slightly and breathe out Inhaler into mouth, press down on inhaler and breathe in slowly Holdbreath for about 10 seconds
  76. The SHAFT-
    length of the needle- ranging from about 0.5 to2.5 inches long
  77. The GUAGE-
    • diameter or width of the needle
    • 18-27 gauge is typical for an injection
    • The SMALLER the number, the LARGER the gauge
  78. 1) Ampule-
    2) Vial-
    • 1) Ampule- sealed glass container- break to withdraw the medication
    • 2) Vial- glass or plastic with a self-sealing rubber stopper
  79. ID-
    • Tb skin testing or allergy testingMakesa “wheel”
    • Verysmall volumes are injected- 0.01 to 0.05 mL
    • Usually into the inner aspect of the forearm, the back or the upper chest
    • Tb syringes are often used- holds max. of 1 mL
    • Gauge= 25-17 inch and is about ½ inch long
    • Medicationis instilled shallowly with the bevel of the needle facing UP
  80. SC-
    • Meds are absorbed fairly quickly (about ½ hour afteradmin.)
    • Volume of injection up to 1 mL
    • Insulin and heparin are given SC
    • Sites include the upper arm, back, thigh and abdomen.
    • Insulin as given via an insulin syringe
    • Heparin may come in a prefilled cartridge or can also be drawn up in a Tb syringe 25 gauge needle is most commonly used
    • Most meds given SC are NOT viscous, so the 25 gauge needle can be used without problem
    • Needle lengths vary from ½ to 5/8 inch
    • Given at a 90 degree angle for a heavy person
    • Thin or average client- 45 degrees
    • Holding the skin b/t the thumb and the forefinger before injection is preferred in the thin client and the child/infant
    • Rotate sites for frequent SC injections such as insulin to avoid “lipo-atrophy and “lipo-hypertrophy”
    • Lipo-atrophy- breakdown of SC fat at injection sites
    • Lipo-hypertrophy- build up of SC fat at injection site
  81. Insulin with additives (to delay absorption)
    • tend to separate- roll the insulin to combine- DO NOT SHAKE
    • If given within about 15 minutes of drawing up 2 different insulins- they act as if given separately
  82. HEPARIN Administration:
    • Anticoagulant
    • Prolongs clotting
    • Given SC and IV
    • Small volumes are given
    • The needle must be removed and replaced with a new one after drawing up the medication out of a vial
    • Sites are also rotated to assist in avoidance of bruising
    • You will NOT aspirate
    • Massaging is contraindicated!!
    • Up to 3 mL can be given into one muscle or muscle group
    • Absorption is fairly rapid
    • Irritating medications are given IM b/c there are very few nerve endings in deep muscle
    • DORSOGLUTEAL- upper, outer quadrant of the buttocks (gluteus maximus muscle)
    • Not used in the child under age 3 because the muscle is not developed completely
    • VENTROGLUTEAL- in the hip (gluteus medius and minimus)
    • There are no large nerves or blood vessels in the injection area
    • Safe for children
    • VASTUS LATERALIS- outer thigh (quadriceps group of muscle)
    • Also usually absent of large blood vessels and nerves
    • Good site for infants and small children, and those who may be emaciated
    • Place one hand above the knee and one hand below the greater trochanter at the top of the thigh
    • Needle into the lateral are of the thigh
    • RECTUS FEMORIS- anterior aspect of the thigh- placed into the middle third of the thigh while in sitting position (infants)
    • DELTOID- lateral aspect of the upper arm
    • Smaller group of muscles so it is the least used site (it also gets fairly sore!)
    • ONLY used for adults!
    • Place only 1 mL max solution
    • Palpate lower edge of the acromion process, give b/t that are and the axilla or use the 3 finger process
  84. IM-
    • 22 guage needle is preffered
    • 1.5 to 2 inches in length
    • 3-5 mL syringe is used
    • IM- 90 degree angle
    • Can use Z-track technique to avoid irritating tissues
    • Draw up medications and add a 0.2 mL bubble of air
    • Use the side of the hand to pull the skin at the injection site area taught (this helps seal the drug into that muscle)
    • Aspirate for blood return on ALL IM injections
    • After instilling the med into the muscle- hold taught skin and needle in place for about 10 seconds
    • Withdraw the needle and release the skin
    • Apply pressure
    • DO NOT massage
  85. topical meds
    • Nitro, Scopalamine, Estrogen and pain meds such as Fentanyl to name a few
    • Applied to upper areas of the body- upper arm, chest, shoulder, smaller ones behind the ear
Card Set:
2012-02-16 16:35:46
test pharmacology

pharmacology test 1
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