Pharm_exam1

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Pharm_exam1
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2014-02-06 18:53:34
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  1. ac
    before meals
  2. ad lib
    as desired
  3. BID
    2x/day
  4. gtt
    drops
  5. pc
    after meals
  6. po
    by mouth
  7. q
    every
  8. QID
    4x/day
  9. Rx
    take thou, drug
  10. TID
    3x/daily
  11. SR
    sustained release
  12. XR
    extended release
  13. LA
    long acting
  14. SL
    sublingual, under the tounge
  15. the name that describeds a drug's chemical structure is called:
    chemical drug name

    • rarely used
    • only one chemical per drug name
    • a chemical group name is more often used
    • ex: benzodiazepines
    • ex: cacao
  16. the assigned name of a drug is called:
    generic drug name

    • there is only one generic name per drug
    • generic drug name is NOT capitalized
  17. the drug company name for the drug is called:
    trade/product/propietary/brand name

    • there are many such names for each drug
    • each company producing a drug has its own name for the drug
    • names ARE capitalized
    • all drugs must be FDA approved to avoid sound-alike names or misleading names
  18. drugs that have greater than 1 active ingredient are called:
    combination drugs
  19. a strong desire to use a particular Rx is called:
    addiction
  20. a physiological or pschological need for a substance (not necessarily a drug) is called:
    dependence
  21. a change in fxn caused by the CNS adaption to repeated exposure to a drug is called:
    physical dependence
  22. physical discomfort in a person with drug dependence that is called by stopping the drug is called:
    withdrawal
  23. drugs with potential for abuse are called:

    how are these drugs classifed:
    scheduled drugs

    • classified: according to how high the potential for abuse is
    • Schedule I: greatest potential
    • Schedule V: least potential
  24. a drug that falls under the controlled substance acts is called:
    controlled substance

    the greater the abuse potential of a drug the more sever the consequnces of illegal handling of it
  25. a representative drug from a drug class is called:

    its usually the most studied member of each class and other drugs in that class are noted merely for their differndces when compared to it
    prototype drug
  26. taking a medication as prescribed is called:
    compliance

    with OTC meds: its taking it as per package instructions
  27. a medication order that is to be giving within 5 minutes of the order being written is:
    Stat
  28. a medication order that is to be given within 30 minutes of the order being written is called:
    ASAP
  29. a medication order that is to be given only once is called:
    single drug order

    Stat and ASAP order are usually given as this
  30. a medication order that is to be given as needed/desired/required, to some extent, left to the discretion of the nurse is called:
    PRN
  31. a medication order that is to be given out if a certain type of situation occurs is called:
    standing order
  32. what are the standard measurements by weight or volume for the following:

    Volume:
    weight:
    • volume: ml/l
    • weight: kg/g/mg/mcg
  33. what is the conversion for the following....

    1 tsp:
    1 fluid ounce:
    1 cup:
    2 cups:
    4 cups:
    1 kg:
    • 1 tsp: 5 ml
    • 1 fluid ounce: 2 TBSP = 30 ml
    • 1 cup: 8 fluid ounces= 250 ml
    • 2 cups: 1 pint =500 ml
    • 4 cups: 1 quart = 1 liter
    • 1 kg: 2.2 lbs
  34. meds given by route of administration via mouth is called:
    enteral

    • giving capsules, tabs and liquid: crushing a tablet or opening a capsule is only permitted if the manufacturer says it is acceptable. 
    • some meds are made ineffective as such.
  35. a med that contains a coating resistant to stomach acid and break down in the alkaline small intestines:
    enteric coated tabs

    crushing them renders them useless
  36. meds that dissolve slowly and thus provide slow release of the medication and allow for fewer doses/day:
    • sustained release (SR)
    • extended release (XR)
    • long acting (LA)

    • these medications have improved compliance for many
    • these types of meds usually cannot be crushed
  37. drugs that are absorbed from the stomach/small intestines pass thru the liver before going to general circulation are called:
    first pass metabolism

    • they can greatly decrease the does delivered.
    • usually it is not a good thing
  38. when giving oral meds, keep them in plastic unit dose package until ready to ___________ .

    if its a liquid med, shake the bottle before pouring, and hold the med administration cup at eye level when measuring.   

    Stay with the pt. until they have:
    • when giving oral meds, keep them in plastic unit dose package until ready to: give them to the pt. 
    • Stay with the pt. until they have: swallowed the med
  39. meds that are giving under the tongue are called:

    how do these meds dissolve:

    should these meds be given before or after PO meds?
    sublingual (SL) administration

    • such route eliminates the destructive effects of digestive enzymes and 1st pass metabolism. 
    • these meds dissolve: slowly and usually have a rapid onset of action

    tell the pt. not to chew, swallow the tab, move it around in their mouth, swallow their saliva, eat or drink anything until the tab is completely dissolved.

    • give SL meds after PO meds.
    • stay with the pt. until the SL med is dissolved
  40. a med tab that is placed between the gum and cheek of the mouth is called:

    is this route slower or faster than a SL route?
    buccal administration

    the pt. must not chew, move the tab around in their mouth, eat, drink, or swallow until its dissolved 

    • buccal and SL meds arent interchangeable
    • the buccal route is slower absorption than SL
  41. a tube that has the top in the nose and the bottom ends in the stomach is called:

    a surgically placed tube contained entirely in the abdomen, usually for long term placement is called:
    a tube that has the top in the nose and the bottom ends in the stomach is called: nasogastric tube

    a surgically placed tube contained entirely in the abdomen, usually for long term placement is called: gastric tube
  42. Rx's given via NG and G tube are usually ________, crushed meds put into water usually clog the tube.

    if the pt. is getting a tube feeding, stop it temporarily while giving meds.

    after giving meds thru a tube, keep the HOB _____________ for one hr. to avoid ______.

    restart the feeding tube after flushing the tube with water after done giving meds.
    Rx's given via NG and G tube are usually liquid, crushed meds put into water usually clog the tube.

    after giving meds thru a tube, keep the HOB elevated at 45 degrees for one hr. to avoid aspiration
  43. meds applied to skin, mucous membranes in the eyes, ears, respiratory, GI or GU tract are called:
    topical drugs


    • includes creams, lotions, gels, powder, sprays, instillations, irrigations, and inhalations. 
    • perferred when only a local effect is needed as it produces fewer side effects since the Rx amount reaching the general circulation is minimal

    before you give a a topical, know fi the Rx is given for a local effect or for slow systemic release.

    usually application to abraided or denuded skin is contraindicated
  44. the easiest way to apply such meds is to pull the lower lid down while the pt. has their head titled back and they are looking up:

    let the med drop down into the:
    the easiest way to apply such meds is to pull the lower lid down while the pt. has their head titled back and they are looking up: opthalmic

    let the med drop down into the: conjunctival sac

    if an ointment, squeeze a ribbon into the lower lid from the inner to the outer canthus

    • avoid touching th Rx tube to the eye
    • put pressure afterwards on the nasolacrimal duct for 1-2 minutes to prevent systemic absorption
  45. med administration in which the pt. should have the ear to be medicated in the superior position, clean external ear is called:
    otic

    after putting the Rx in, have the pt. keep their ear up for 10 minutes to prevent the loss of the Rx
  46. med administration in which the pt. should blow their nose before the drops are instilled is called:
    Nasal administration

    • usually given for the topical effect
    • with long term use the pt. can develop mucosal irritation
    • rhinorrhea may decrease Rx absorption
  47. med administration for local or systemic effect if nausea or vomiting or comatose:

    what are the benefits of giving meds this way:
    rectal meds

    benefits: no digestive enzyme action of 1st pass liver effect

    put pt. on their left side to instill
  48. med administration given via needle into skin, soft tissue, muscles, veins, organs, arteries or body cavities:
    parenteral Rx
  49. intrathecal is:
    into the spinal canal

    its invasive so aseptic technique must be used to aviod introducing pathogens into the area
  50. meds administered as injects go into the dermal layer is called:

    what is the usual site for administration:
    intradermal

    only a small amount can be injected via this route, usually only used for allergy testing, TB skin testing, and local anesthesia

    usual site for administration: volar surface of the forearm is used
  51. meds administered into the deepest layer of skin is called:

    what types of meds is this the route for:

    what are the usual sites for this administration:

    what is the usual volume for meds:
    • subcutaneous (SQ)
    • ususal route for: insulin, heparin, some vitamins, and some vaccines.

    • usual sites for admin:
    • outer upper arms above the tricep
    • lateral and anterior thigh
    • middle anterior thigh
    • subscapular area

    usual volume: for SQ injections .05 - 1 ml

    • the needle size varies with the body fat quantity
    • if the regular SQ injections the sites need to be rotated and documented.
    • use the proper syringe (insuline and TB syringes arent interchangeable)
  52. due to a good blood supply to muscles, there's usually quicker absorption and onset of action with this type of med administration:

    what is the usual volume of med per injection:

    what is the max volume of injection into the deltoid or triceps:

    list the sites for injections:
    intramuscular (IM)

    • unless the pt. is very small, give up to 3 ml per injection
    • 1 ml max into the deltoid or tricep

    • sites
    • ventrogluteal
    • deltoid
    • dorsogulteal
    • vastus lateralis
  53. list 3 was intravenous meds can be given:
    • mixed with IVFs
    • given piggyback thru separate IV bag
    • IV push

    because of direct acces into the blood vessels, theres an increased danger from comtamination and Rx error
  54. a description of how drugs change the body is called:
    pharmacodynamics
  55. the range of doses for a large group displaying mathematically how many people repsond to a certain maximum dose is called:
    frequency distribution curve
  56. in general a small person would respone to a smaller dose of a given drug and a larger man would need a larger dose.

    most people fall in the middle of the frequency distribution curve making that quantity of the drug the:
    median effect dose (ED50)

    this is usually the average or standard dose for a drug
  57. the amount of a drug that would kill 50% of pts. who would receive such a dose is called:
    median lethal dose (LD50)
  58. the ED50 (median effective dose) and the LD50 (median lethal dose) are combined to determine the:
    therapeutic index

    • if a drug has a large difference b/w the ED50 and the LD50 the therapeutic range is wide
    • a good thing since a narrow therapeutic index makes for a much more precarious situation as theres a smaller safety margin median toxicity does (TD50)
  59. the amount of a drug that would cause toxiticty in 50% of the population, similar to a leathal dose is called:
    median toxicity dose (TD50)
  60. the relationship between doses and effect is called:

    describe the 3 phases of the relationship:
    • the graded dose-drug relationship
    • phase 1: few target cells have been affected by the drug
    • phase 2: a given increase in response occurs with a given amount of drug
    • phase 3: a plateau is reached - a certain increase in the drug produces no increased therapeutic response but probably will increase the adverse affects
  61. the dose/amount of a drug needed to produce a given effect is called:
    potency

    a potent drug in a given drug class requires a lower dose to produce a given effect than a drug with a low potency
  62. the degree of response you get from a given drug is called:
    efficacy

    ex: morphine has a greater efficacy at relieving severe pain than ibuprofen
  63. many drugs act by interacting with specific receptors on certain cells. 

    when receptors are engaged by a drug one of the ways the drug produces its results is by enacting a series of 2nd messenger events, analogous to tipping over the 1st in a line of dominoes.

    thus certain biochemical events are stopped or started by a drug called:
    mechanisms of action

    • some drugs interact with intracellular receptors including DNA segments (steroids, vitamin D.
    • some drugs act by non-specific cellular responses
  64. a drug that produces the same or greater response as an endogenous substance is called:

    a drug that produces a smaller response that  an endogenous substance is called:
    • a drug that produces the same or greater response as an endogenous substance is called:
    • agonist

    a drug that produces a smaller response that  an endogenous substance is called: partial agonist
  65. a drug that engages a receptor and thus prevents the endogenous chemical from causing its effects is called:
    antagonist

    sometimes an antagonist drug competes with the endogenous chemical for receptor binding sites
  66. list the most common sites for allergic reactions:

    what are anaphylactic-related deaths usually caused by in the hospital:
    • oral cavity (lips and/or tongue swelling)
    • airways (tracheal and/or bronchial muscle constriction with resulting wheezing/respiratory distress
    • GI (vomiting, diarrhea)
    • skin (hives, rashes, eczema)

    • some 500,000 serious allergic rxs occur in U.S hospitals every year
    • 75% of anaphylactic-related deaths are caused by: penicillin 
    • usually no hx of allergic rxn
  67. an abnormal immune response, thus mediated by the immune system:
    allergic rxn

    • there must be prior sensitization for an allergic response to occur
    • the intensity of the rxn is determined chiefly by the degree of sensitization of the immune system, not the drug dose
    • a pts. sensitivity  to a drug can change over time.
  68. the most sever form of an allergic rxn is:
    anaphylacic shock

    • this produces airway restriction 
    • rapid and/or irregular HR
    • wheezing 
    • severe SOB
    • hypotension
    • sense of impending doom
    • n/v/d
    • abdominal cramps
    • hives that are usually preceded by intense itchiness
  69. allergic skin rxns that are typically raised, itchy red areas that often migrate.

    a fixed drug rxn that produces a pink patch on the extremities that is solitary and presistent

    called:
    Hives
  70. Stevens-Johnson syndrome:

    erythema multiform:

    exfoliative dermatitis:
    stevens-johnson syndrome:
  71. any preventable event that may cause or lead to an inappropriate Rx use or client harm while the Rx is in control of the healthcare professional is called:
    Rx (med) error

    categorized errors are based on the harm they can cause
  72. what can cause Rx errors:
    • not going thru the 5 R's:  right person, right med, right route, right dose, right time
    • not determining if an order makes sense for the pt. 
    • not determining if the dose is appropriate
    • not determining the pts weight or renal status
    • not clarifying unclear orders
  73. list ways to help prevent Rx errors:
    • put a zero before values less than 1
    • dont use U, the microgram symbol
    • dont use the following...

    • qd: one a day
    • qod: every other day
    • SC or SQ: subcutaneous 
    • hs: before sleep
    • cc: cubic centimeter
    • AU: each ear or both ears
    • OU: each eye or both eyes
    • AS: left ear
    • OS: Left eye
    • AD: right eear
    • OD: right eye
    • IU: 1 milligram

    dont use drug abbreviations or latin directions
  74. a states definition of its nurses legal scope of practice, enforced by the state board of nursing (usually)  is called:

    what does this include:
    nurse practice act

    • includes:
    • Rx administration
    • standards of card
    • rules of reasonable and prudent action
    • institutions policies and procedures
  75. how should medication errors be reported:
    • incident report: separate from pts chart
    • pts chart: note including additional monitoring, and response to the error
    • note who was notified about the error
    • not should be made in the MAR
  76. what are the 5 R's
    • right pt
    • right time and frequency
    • right dose
    • right med
    • right route
  77. barriers to infection, non-specific so no distinction made as to the type of threat, and the response is always the same is called:

    list the 1st and 2nd lines of defense:
    non-specific infection defenses:

    • 1st and 2nd lines of defense:
    • mucous membranes and their secretions
    • skin- its structures
    • pH
    • fever
    • the clotting system
    • NK cells
    • interferon
    • and inflammation
  78. response that is geared toward one specific foreign protein (an antigen), and carried out primarily by lymphocytes is called:
    the immune response
  79. B lymphocytes:

     T lymphs

    Helper T's

    Cytokines:
    B lymphs: respond indirectly to antigens by producing memory cells and anitbodies; AKA humoral immunity

    T lymphs: attack antigens directly;

    Helper T's: have CD4 receptors and are thus sometimes called CD4s; activate other immune cells, directly kill cancer cells, pathogens and infected cells

    cytokines: poison pathogens and stimulate overall immune response, induce inflammation and/or empower macrophages in response to a pathogen
  80. modified pathogens or their products that stimulate B lymphs to produce specific memory cells and for the disease is called:
    vaccines

    response to a vaccine can be measured via a titer or antibodies
  81. a pts. immune system is stimulated to produce antibodies after exposure in day to day life or via a vaccine:

    preformed antibodies are given to the individual called:
    active immunity

    passive immunity
  82. drugs that suppress the immune response are called:
    immunosuppressants

    • given after a transplant, bc/dontated tissue contains antigens foreign to the recipient
    • also used for those with autoimmune disorders
    • newer immunosuppressants are specific; produce fewer side effects
  83. non specific drugs that suppress the immune response and inflammation are:

    anti-metabolites:
    cyclosporine and tracolimus:
    steroids

    • anti-metabolites
    • sirolimus
    • imuran
    • inhibit lymphocyte replication

    • cyclosporine and tacrolimus
    • prograf
    • bind to the intracellular messanger calcineurin and thus disrupt T cell fxn
  84. prednisone:

    drug class:
    sub-class:
    forms:
    pregnancy category:
    prednisone:

    • drug class: anti-inflammatory
    • sub-class: glucocorticoid
    • forms: PO, IM
    • pregnancy category: C

    • do not stop this abruptly
    • onset: takes 6 hrs to have effect
    • half life: 3.5 hrs
  85. list the contraindication for steriods:
    • active infections
    • side effects: decreased Ca++, K+, decreased thyroxine
    • caused mood swings
    • delayed healing
    • cause an ulcer
    • increased K+ loss

    cushing syndrome: increased blood sugar, muscle weakness, brusing. bleeding
  86. most commonly used anti-inflammatory drug that are appropriate for mild to moderate inflammation are called:
    NSAIDs

    • available OTC: ASA, aleve, ibuprofen, motrin
    • prescribed: indocin and celebrex

    all are anti-inflammatory, anti-pyretic and analgesic
  87. NSAID's

    mechanism of action:
    the decrease prostaglandin formation by inhibiting the production of cyclooxygenase (COX 1 and 2), key enzymes for prostaglanding production, COX 1 aided prostaglandin formation favors normal renal blood flow, helps maintain the stomach lining, aids platelet clumping as needed, and assists in maintenance of smooth muscle tone in bronchi and blood vessles.

    • COX2 is only created after tissue injury and is solely pro-inflammatory
    • COX1 production is ongoing
    • NSAIDS are metabolized in the liver
  88. 2nd generation NSAIDs only inhibit COX2 enzyme production thus sparing COX1 enzyme are called:
    COX2 inhibitors

    • because of this selectivity, its not as hard on the GI mucosa and kidneys 
    • has been found to increase the risk of MI and CVA
  89. NSAIDs that block COX1 and COX2 enzyme production which decrease inflammation (by decreasing COX2 production) but also decreases COX1 production which can cause GI bleeding is called:
    1st generation NSAIDs
  90. COX2:

    COX1:
    • COX2: only create with inflammation
    • COX1: good enzyme, needed for renal fx, neural artery fxn, maintain of stomach lining, and is always being made
  91. contraindications to NSAIDs:
    • should NOT by used by pregnant women
    • avoid by children less than 6 months
    • aspirin (ASA) should not be used by anyone less than 15 y/o
    • PUD (for 1st generation NSAIDs)
    • renal or liver disease
    • bleeding disorders
    • HF
    • HTN
    • caution with LI++
    • HCTZ
    • anti-coagulants
  92. if a pt. will be on NSAIDS long term on a regular basis the contraindications become even more important and baseline renal and liver tests, as well as CBC

    pt care should include:
    • checking for GI bleeding espeically GI bleeding (stomach pain, black or bloody stools)
    • s/sx of hepatitis 
    • nephrotoxicity
    • slicylate toxicity 
    • heart burn
    • rash
    • bronchospasm
  93. ibuprofen...

    mechanism of action:
    drug class:
    indication:
    pregnancy class:
    half life:
    • mechanism of action: inhibits prostaglandin synthesis
    • drug class: NSAIDS
    • indication: mild to moderate pain fever, primary dysmenorrhea, mild to moderate inflammation
    • pregnancy class: B, C in the 3rd trimester
    • half life: 2-4 hrs 
    • duration: 6 hrs

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