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Adequate, up-to-date information about all medications to be administered, including purpose, potential, side effects, cautions, and contraindications, and possible interactions.
Wisdom, and judgement to accurately assess the patient's needs for medications, to evaluate the response to medications, and to plan appropriate interventions as indicated.
Skill in delivery for the medications accurately, in the best interests of the patient, and with adequate documentation.
Patient education to provide the necessary information to the patient and family about why, how and when medications are to be administered and potential side effects and precautions with administeration by the layperson.
Responsibilities of the health care provider
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What to do with medication errors?
Report them, and do no harm.
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What's the purpose of the MedWatch form?
It's a voluntary report that helps the FDA to issue warnings, make labeling changes, required manufacturers to do postmarking studies, and ordered the withdrawl of certain products from the market to help prevent injuries, suffering, disabilities, congenital deformities, and even deaths.
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What are the six rights of medication administration?
- Right medication
- Right amount
- Right time
- Right route
- Right patient
- Right documentation
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What to do when pouring medications?
- Hold the bottle label side up
- Hold the bottle and the cup at eye level
- Pour the medication until the meniscus of the medication hits the proper line
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What's the difference between the NG tube and then G tube?
The NG tube is administered to the nose, and the G tube is administered through the stomach.
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What's the difference between systemic and local effects?
Systemic is that it goes through the whole body, and local is just for a localized area of the body.
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What's sublingual administration?
It's when the medication is placed underneath the tongue.
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What's buccal administration?
It's where medication is placed in the pouch between the cheeck and the gum at the back of the mouth.
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A canister containing a propellant used to deliver a fine mist of a drug into the respiratory system. Often used with a spacer device or reservoir to increase the effectiveness of drug delivery.
Metered Dose Inhaler (MDI)
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Device that creates a fine mist of a drug solution using a gas source (aerosolization). The aerosol is then inhaled via a mouthpiece or mask.
Small Volume Nebulizer (SVN)
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A self-generating device that forms a fine mist from a powdered drug solution that can then be inhaled using a fast, deep breath into the respiratory system.
Dry Powdered Inhaler (DPI)
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Combines administration of an aerosol with a mechanical breather to assist patients who are unable to take a deep breath on their own.
Intermmittent Positive Pressure Breathing (IPPB)
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What are the different transcutaneous, transdermal patches?
- Nitroglycerin-sometimes left in place for 12 hours daily for chronic angina
- Scopolamine-placed behind the ear and left in place for 72 hours for as necessary to prevent motion sickness
- Fentanyl-applied to the skin and changed every 72 hours in the management of chronic pain in patients requiring opiate analgesia
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What is the angle for intramuscular injections?
90 degrees
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What's the angle for subcutaneous injections?
45 degrees
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What's the angle for intradermal injections?
10-15 degrees
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What are short needles used for?
Subcutaneous
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What's regular sized needles used for?
general injection use
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What are the five IM sites for intramuscular injections, and when are each of them used?
- Deltoid-used only in the adult for IM injections because it's easily accessible
- Dorsogluteal-use extreme caution because of the undedrlying sciatic nerve and the major blood vessels of the gluteal trunk, don't use routinely.
- Ventrogluteal-free of major nerves safe to use
- Vastus Lateralis-safe to use in infants less than 7 months old because muscles are well developed at birth, and is also safe for adults.
- Rectus Femoris-safe to use in infants less than 7 months old because muscles are well developed at birth, and is also safe for adults.
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What are needles with small lumens (large gauges) used for?
Aqueous medications that are delivered just under the surface of the skin because the length is usually short.
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What are needles with gauges 27-25 and 5/8 to 7/8" long are commonly used for?
Aqueous SC injections because these needles cause minimal pain and less tissue damage.
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What are larger needles, gauges 23-20 used for?
IM injections of thicker, or viscous, medications
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What's the purpose for vitamin A?
- Resistance to infection
- Proper visual function at night
- Normal growth and development of bones and soft tissue
- Maintaining healthy epithelial tissue
- Healing of wounds
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What's the purpose for vitamin D?
- Good for bones and teeth
- Sunshine vitamin
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What's the purpose for vitamin E?
- Normal metabolism
- Protection of tissues of the eyes, skin, liver, breast, muscles, and lungs
- Protecting RBCs from damage
- Decreasing platelet clumping
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What's the purpose for vitamin K?
Blood clotting
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Chemical elements that occur in nature and in body fluids, and are necessary for homeostasis.
Minerals
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The principal minerals in the extracellular body fluids
Sodium and Chloride
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A principal mineral within cells, and is necessary for acid-base and fluid balance, and normal muscular irritability (heartbeat regulation).
Potassium (K)
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Necessary for strong bones and teeth; contraction of cardiac, smooth, and skeletal muscles; nerve conduction; blood coagulation, capillary permeability, and normal blood pressure.
Calcium
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Mineral found in meat, egg yolks, beans, spinach, enriched cereals, dried fruits, prune juice, and poultry; and it's necessary for hemoglobin formation.
Iron
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Is a component of numerous enzymes and is an essential element in metabolism; and is necessary for wound healing, mineralization of bone, insulin glucose regulation, and normal taste.
Zinc
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Sometimes referred to as "anti-cancer foods" or "natural drugs", and they inhibit cell destruction in damaged or aging tissues.
Antioxidants
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What agency is responsible for dietary supplements?
DSHEA
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What's used to treat scabies and lice?
Scabicides and pediculicides
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What are the eight principal categories for topical skin preparation?
- Antipruritics-relives itching
- Emollients and prtectants-sooth irritation
- Keratolytic agents-loosen epithelial scales
- Enzymatic agents-promote the removal of necrotic or fibrous tissue
- Scabicides and pediculicides-treat scabies or lice
- Antifungals-control fungus conditions
- Local anti-infectives prevent and treat infection
- Agents to treat acne
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For the treatment of scabies in an extended care facility, what is the safest treatment?
Ivermectin
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Treatment for type I acne could NOT include?
Isotretinoin
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Mimic the action of the sympathetic nervous system
Adrenergics
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Can be thought of as the emergency system used to mobilize the body for quick response and actin. Key words to illustrate this action are "fright, fight, and flight".
Sympathetic nervous system
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Can be thought as being automatic, self-governing or involuntary.
Autonomic
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Drugs that block action of the sympathetic nervous system
Adrenergic blockers
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The most commonly used drugs of the adrenergic blockers are?
Alpha-blockers and Beta-blockers
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Drugs that mimic the action of the parasympathetic nervous system.
Cholinergic drugs
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Drugs that block the action of the parasympathetic nervous system.
Anticholinergics, or cholinergic blockers
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What are the adrenergic drugs?
- Adrenalin-epinephrine
- ephedrine
- dopamine
- Isuprel-isproterenol
- Levophed-norepinephrine
- Neo-Synephrine-phenylephrine
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What are the adrenergic blockers?
Inderal-propranlol
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What are the cholinergic drugs?
- Urecholine-bethanechol
- Prostigmin-neostigmine
- Isopto Carpine-pilocarpine
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What are the cholinergic blockers?
- atropine
- Robinul-glycopyrrolate
- Pro-Banthine-propantheline
- Transderm Scop-scopolamine
- Isopto Homatropine-homatropine
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What are the four types of diuretics?
- Thiazides
- Loop
- Potassium-Sparing
- Osmotic Agents
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What are the thiazide and related diuretics?
- Lozol-indapamide
- Microzide-hydrochlorothiazide
- Zaroxolyn-metolazone
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What are the loop diuretics?
- Lasix-furosemide
- Bumex-bumetanide
- demadex-torsemide
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What are the potassium-sparing diuretics?
- Aldactone-spironolactone
- Dyrenium-triamterene
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What are the potassium-sparing and thiazide combination diuretics?
- Aldactazide-spironolactone, hydrochlorothiazide
- Dyazide, Maxide-triamterene, hydrochlorothiazide
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What are the osmotic agents?
Osmitrol-mannitol
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What medications treat gout?
- Uricosuric agents
- Allopurinol
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What medications treat benign prostatic hypertrophy (BPH)?
- Antiandrogens
- Alpha-blockers
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