Exam 3 Pharmacological Agents

The process by which a medication enters the bloodstream

Any effect other than the therapeutic effect

• A severe allergic reaction that requires immediate medical intervention because it can be fatal
• Treatment includes discontinuing use of the medication and administering epinephrine, IV fluids, steroids, and antihistamines.

Interaction of chemicals by which drug effects decrease

Plant species with medicinal properties

Pertaining to the inside cheek

The name for a medication based on its molecular structure

Drugs that are considered to have either limited medical use or high potential for abuse or addiction

Process by which a drug passes from the circulation of the blood and lymphatic system across cell membranes to a specified tissue

When an intravenous drug precipitates from solutions, or becomes chemically inactive, if mixed with other medications

Process by which a drug or urine is eliminated from the body

A medication’s name that is not owned by a company and is given by the United States Adopted Names Council; it is the drug’s official name throughout its lifetime

Plant species with medicinal properties used to treat illness and disease

Involving administration of a medication into the dermis located just beneath the skin surface

Involving administration of a medication into the muscle layer beneath the dermis and subcutaneous tissue

Involving administration of fluid or medication within a vein

• AKA medication verification
• Important safety procedure during patient handoffs, including new and intermittent clinic visits, emergency room visits, hospital admission, transfers between hospital units, and discharge from one healthcare facility to another or to home, between healthcare providers or agencies

• (1) Chemical reactions in the cells that produce heat as a byproduct
• (2) Breakdown of a drug (usually in the liver) to an inactive form

Medications given by injection or infusion

Study of the physiologic and biochemical effects of a drug on the body

Study of how a medication changes as it passes through the body and undergoes absorption, distribution, metabolism, and excretion (ADME)

Directive written by a physician or other person legally permitted to do so (e.g., nurse practitioner)

Pertaining to the layer of tissue under the dermis

Under the tongue

Medication interaction that increases a drug’s effects

Drugs known to cause birth defects

A medication’s desired and intentional effects

Medication name used by a pharmaceutical company for a 17-year period during which it has the exclusive rights to make and sell the drug

Topical medication that is released through the epidermis and dermis to the blood

A prescribed amount of medication dispensed at a specified time

The routine medication order is one that should be carried out for a specified number of days (e.g., antibiotic) or until another order cancels it. In some healthcare agencies, the standing orders must be reviewed and rewritten within a specified time frame or they are canceled automatically.

A prn order (from the Latin pro re nata) does not indicate a specific time period for administration of a medication. Rather, it states guidelines so that the medication can be administered as needed. Analgesic medications, antiemetic medications, and laxatives are often ordered on a prn basis. Good judgment is essential to determine when a medication is needed and when it is safe to administer the medication. Once administered, evaluation of the effectiveness of the medication is necessary and must be documented.

Standing protocols are written for medications to be administered in specific situations with criteria for administration outlined clearly for patients on a specific unit or service. For example, a standing protocol might be written for a nurse working on a cardiac unit to administer a certain heart medication if the patient develops an irregular rhythm.

The one-time or single order is written for a medication that will be given only once. An order for a preoperative medication to help calm the patient before surgery is an example of a one-time order.

A stat order (from the Latin statim) is a single order for a medication that must be given immediately. An example of this order is “furosemide 20 mg IV stat” for fluid volume excess.

A verbal order is a situation when the provider and the nurse are physically present in the same room. A verbal order is accepted only in emergencies (e.g., cardiopulmonary resuscitation or other lifesaving interventions). The provider gives the order verbally, and the nurse then reads back the order in its entirety to the provider for verification. At all other times, when the provider is present, he or she enters the order into the medical record.

To ensure accuracy when taking telephone orders, always repeat the order to the provider after writing it down. The provider must cosign the order within a specified time, usually 24 hours. Do not take verbal orders except in an emergency situation (code), because the risk for error is very great. Direct the provider to write the order.

• the right patient
• the right medication
• in the right dose
• by the right route
• at the right time
• followed by the right documentation

Minor adverse effects are called side effects. Many side effects are essentially harmless and can be ignored. Some, however, are undesirable and potentially harmful. Especially when a new medication is started or added or when a dose is increased, nurses must be alert for adverse drug reactions or side effects in patients.

Tolerance to a medication occurs when a patient develops a decreased response to it, requiring an increased dosage to achieve the therapeutic effects. Some agents that produce tolerance include nicotine, alcohol, opiates, and barbiturates.

Allergic reactions result from an immunologic response to a medication to which the patient has been sensitized. A foreign substance or antigen has been introduced into the body, and the body responds by producing antibodies. Patients respond to certain medications as they would to this foreign substance and develop symptoms of an allergic reaction. These symptoms range from mild to severe. Mild allergic reactions, commonly manifested by hives (urticaria), pruritus, or rhinitis, can occur within minutes to 2 weeks after medication administration. Skin reactions, including hives, rashes, and lesions, usually improve soon after use of the medication is discontinued, especially with concomitant use of antihistamines. Severe allergic reactions producing symptoms such as wheezing, dyspnea, angioedema of the tongue and oropharynx, hypotension, and tachycardia occur immediately after the medication is given.

• Medication toxicity results from overdose or buildup of medication in the blood due to impaired metabolism and excretion. Careful attention must be given specifically to the dosage and to toxicity monitoring, such as assessing laboratory values of liver and kidney function. Drug levels can be assessed for drugs that have a narrow therapeutic range. Some medications can produce toxic effects almost immediately; others do not produce toxic effects for days or weeks.
• Toxicity can affect, and permanently damage, organ function. Common drug toxicities include nephrotoxicity (kidney), neurotoxicity (brain), hepatotoxicity (liver), immunotoxicity (immune system), ototoxicity (hearing), and cardiotoxicity (heart). Knowledge about potential drug toxicity permits focused nursing assessments for early detection, thus preventing permanent damage.

• ability to swallow
• GI motility
• adequate muscle mass
• adequate venous access
• body system assessment

• Adherence to a medication routine means that the patient takes the medication exactly as prescribed. Lack of adherence can occur in many ways—for example, when the patient:
• Does not take any of the prescribed drug
• Does not take the proper number of doses of the drug
• Takes extra doses of the drug
• Does not follow the dosage schedule as prescribed
• Discontinues the medication prematurely
• Excessively uses a prn order
• Takes medications that were ordered previously for another condition
• Takes a medication that was prescribed for someone else

• Provide brief but practical information about the following topics:
• Name of the medication
• Reason for taking the medication
• How and when to take the medication
• How long to take the medication
• Foods, drinks, and prescription or OTC medications that may affect the medication’s action
• Any activities that may be affected when taking this medication
• Usual adverse effects of the medication and their treatment

Medications injected into the abdomen are absorbed most rapidly, those injected into the arms are absorbed intermediately, and those injected into the thigh and upper buttocks are absorbed most slowly.

• deltoid 1.0 mL
• rectus femoris 2.0 mL
• vastus lateralis 2.0 mL
• ventrogluteal 2.5-3.0 mL

• A. Pull skin and subcutaneous tissue 1 to 1.5 inches to one side of the injection site while injecting medication.
• B. Release traction to allow skin to fall back, sealing medication in site.
• The Z-track method is solely used when administering IM injections. It is never used to administer subcutaneous injections.

Air bubble in the vascular space that may obstruct circulation

• CRBSI
• A blood-stream infection due to an invasive vascular device.
• Definition of catheter-related bloodstream infection: The patient has a microorganism cultured from one or more blood cultures less than 48 hours after admission, and the organism cultured from the blood is not related to an infection at another site

Catheter whose tip is placed in the superior vena cava or at the entrance of the right atrium

Fluids that contain proteins or starch molecules

Fluids that are clear

Interruption of an intravenous infusion for a period of time

• EID
• A drip chamber

When IV solutions inadvertently leak into the subcutaneous tissues

Red blood cell destruction

When a donor’s blood is incompatible with the recipient’s blood, hemolysis occurs as the antibodies in the recipient’s blood quickly react to the donor’s blood cells; symptoms are immediate and include facial flushing, fever, chills, headache, low back pain, tachycardia, dyspnea, hypotension, and blood in the urine

Of greater concentration than in body fluids

Of lower concentration than in body fluids

Abnormal or accidental seepage or deposition of a substance into the tissues; accidental administration of IV fluids into subcutaneous tissues that occurs when the needle or catheter becomes dislodged from the vein

Access with a large-bore rigid needle inserted into the medullary cavity of a long bone for the administration of emergency fluid, medication, or blood if adequate venous access is not available

Infusion of fluid into a vein to treat or to prevent fluid and electrolyte or nutritional imbalances may be used to deliver medications or blood products

Osmotic concentration equal to that of body fluids

Available to provide access to secondary ports on IV tubing or for flushing access; provide an alternative to needles to reduce the risk of injury from contaminated sharps during IV procedures

Concentration of solutes in a solution expressed as milliosmols per liter

• Nutritional elements supplied through an intravenous route, usually into a central vein
• Parenteral nutrition is a form of nutritional support that supplies protein, carbohydrate, fat, electrolytes, vitamins, minerals, and fluids to patients who are unable to assimilate nutrients from the gastrointestinal tract.

• PICC
• Long-line catheter made of soft silicone or Silastic material that is placed peripherally but delivers medications and solutions centrally

Inflammation or infection of a vein, manifested by redness, swelling, and tenderness along the course of the vein

Term used when position changes cause the needle bevel or catheter to rest against a vein wall

An enhanced electronic infusion device that has an embedded computer software program to ensure patient safety

Blood clot that accompanies vein inflammation

• TPN
• Administration of hypertonic solutions containing dextrose, proteins, vitamins, and minerals to provide for nutritional deficits
• TPN constitutes a hyperosmolar solution exceeding 10% dextrose and/or 5% protein. TPN must be administered through a central venous catheter.

• PPN
• contains the same components as TPN except the final concentrations are dextrose 10% or lower and/or protein 5% or lower. This provides a formula that is less than 900 mOsm per liter to prevent thrombosis of the peripheral vein. Because PPN contains a lower concentration of dextrose and protein, it provides fewer calories than does TPN and is used more commonly for supplemental nutrition.

Introduction of whole blood or blood components (packed red cells, plasma, platelets) directly into a patient’s circulatory system

• TRALI
• An adverse response to a blood transfusion thought to occur when donor plasma contains an antibody against the recipient’s leukocyte-specific antigen

• TACO
• can occur if blood components are infused too quickly or too voluminously. Transfusion-associated circulatory overload is more likely in the very young patient or the older adult with poor cardiac or renal function.

Insertion of a needle or catheter into a vein

Highly irritating medication that can cause extensive tissue damage when it leaks into the subcutaneous tissues; examples are chemotherapy and solutions with high or low pH

• Peripheral catheters:
• Advantages: Choice of many sites, Easy to insert and remove, Lower infection rates
• Disadvantages: Short-term use, Infiltration and phlebitis more common, Inability to infuse hyperosmolar solutions, Inability to use for blood draws
• Midline catheters:
• Advantages: Easy to insert and remove, Intermediate use, Lower infection rates, May be used to infuse TPN and for blood draws
• Disadvantages: Thrombosis, phlebitis, air embolism more common than with peripheral lines
• PICC (peripherally inserted central catheter):
• Advantages: Easy to insert and remove, Long-term and home care use, May be used for blood draws
• May infuse all solutions
• Disadvantages: Higher thrombosis rates than tunneled or implanted catheters, Small diameter limits flow rates, Catheter longevity less than tunneled or implanted catheters, Greater incidence of malposition
• Nontunneled CVC (central venous catheter):
• Advantages: Choice of sites, Easy to insert and remove,Multiple lumens available
• Disadvantages: Short term—in-hospital use, Higher risk of complications
• Tunneled CVC:
• Advantages: Lower infection rate than nontunneled CVC, Long-term use, Multiple lumens available
• Disadvantages: More complex insertion and removal
• Implanted port:
• Advantages: Long-term use, No external catheter (Cosmetically attractive, Low maintenance, May swim, shower, bathe), Lower infection rate than tunneled catheters
• Disadvantages: Surgical insertion and removal, More difficult for frequent, repeated access

These catheters are placed into the superior vena cava or the right atrium. They can have one, two, or three lumens that permit simultaneous infusion of fluids, medications, and blood products. They are used in the hospital for short-term therapy.

A long-line catheter inserted in the antecubital area and advanced into a central vessel. An advantage of a PICC is that surgical insertion is not required and it is appropriate for long-term therapy in the hospital or home.

A tunneled catheter is used when long-term therapy is required. The catheter contains a Dacron cuff that causes adhesions to form in the chest, stabilizing the catheter and decreasing the incidence of infection.

A surgically implanted central access port is placed within the chest and into a central vein that can be accessed when needed. An implanted access device is often used for oncology patients so that they can be free from external tubing between treatments.

• flow rate can be calculated and manipulated manually to ensure proper infusion. Tubing is available as macrodrip and microdrip (minidrip). The choice of tubing depends on the nurse’s judgment and which rate is easiest to count. Macrodrip tubing delivers 10, 15, or 20 drops per milliliter, depending on the manufacturer (usually 10 drops per milliliter). Macrodrip tubing generally is used for adult patients, especially when large-volume replacement may be required.
• Microdrip tubing delivers 60 drops per milliliter and is used for small-volume administration. After the administration set is selected, the infusion drip rate can be calculated from the physician’s order using the following formula:
• Drops per minute = total volume identified × dropfactor (drops per mil)

to keep open

keep vein open

• Complication of IV Therapy
• Signs and Symptoms:
• Swelling, coolness, and discomfort at site
• Slowed infusion rate
• Absence of blood return
• Action:
• Discontinue IV and restart in another location.
• Apply warm soaks to decrease swelling.
• Prevention:
• Select a site that is over long bones that act as splint.
• Avoid sites over joints.
• Consider using manufactured stabilization devices.

• Complication of IV Therapy
• Signs and Symptoms:
• Pain, warmth, and redness at site
• Vein may feel hard and cordlike
• Slowed infusion rate
• Action:
• Discontinue IV and restart in another location.
• Apply warm soaks to decrease discomfort. Do not irrigate.
• Prevention:
• Change IV sites every 72 h.
• Use large veins and large-gauge needles rather than catheters.
• Dilute medications well and infuse slowly.
• Use central line for very irritating solutions.

• Complication of IV Therapy
• Signs and Symptoms:
• Local: Redness, warmth, and purulent drainage at the IV site
• Systemic: Fever, chills, malaise, and elevated WBCs
• Action:
• Discontinue IV and restart in another location.
• Culture catheter tip and draw blood cultures.
• Treat with appropriate antibiotics.
• Prevention:
• Maintain strict asepsis when dealing with IVs.
• Use good handwashing.
• Change tubing and dressings every 96 h according to agency protocol.

• Complication of IV Therapy
• Signs and Symptoms:
• Elevated blood pressure, increased pulse and respirations, dyspnea, crackles, neck vein distention, weight gain
• Action:
• Slow IV to “keep open” rate and notify physician.
• Place patient in high or semi-Fowler position.
• Administer oxygen as needed.
• Prevention:
• Monitor rates carefully, especially for high-risk patients (elderly, infants, congestive heart failure, or renal disease).
• Use EID.
• Don’t catch up when IV gets behind for high-risk patients.

• (central venous catheters)
• Complication of IV Therapy
• Signs and Symptoms:
• Pain in chest, shoulder, or back; dyspnea; hypotension; thready pulse; cyanosis; loss of consciousness
• Action:
• Place on left side in Trendelenburg position.
• Notify the physician.
• Monitor vital signs closely.
• Prevention:
• Tape all connectors or use Luer lock connectors.
• Use air-eliminating filters.
• Use EID for all central venous catheters.
• Instruct the patient to use Valsalva’s maneuver when changing tubing or discontinuing a central line.

• Patient-Controlled Analgesia
• PCA devices permit patients to administer opiates intravenously as needed for pain control. A PCA device is programmed electronically to deliver a set amount of pain medication through a prefilled syringe connected to an IV tubing. Specific dosages and time intervals can be programmed into the machine to prevent overdose; medication is delivered when the patient pushes a control button.