Intro Pharm Final Study Guide

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cswett
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92237
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Intro Pharm Final Study Guide
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2011-08-08 23:36:47
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Med Math Final Review
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Study Guide For Intro Pharm Final
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  1. Pharmacokinetics
    • The science of drug movement
    • WHAT THE BODY DOES TO THE DRUG

    Absorption - process of entering blood

    Distribution - drug goes to all tissues (not =)

    • Metabolism - drug deactivation, break down
    • - some have enzyme prosess that determines how long drug stays in body
    • -organ problems can effect how long drug stays in body

    Excretion - drug expelled from body (kidney)
  2. Pharmicodynamics
    WHAT THE DRUG DOES TO THE BODY

    Good or bad - therapeutic actions & side effects
  3. Pharmacotherapeutics
    use of drugs in treatment of disease
  4. Classification of Controlled Substances
    Class I - no medical use due to potential for abuse (LSD)

    Class II - High Potential for Abuse (amphetamines, morphine)

    Class III - Moderate to low physical dependence or high psychological dependence (codeine - percocet, percodan)

    Class IV - Low potential limited physical or psycholoical dependence (valium, phenobarbital)

    Class V - Low potential Rx dependent on state reguations (cough Rx w/ codeine, antidiureals
  5. Patients rights in Medicine Administration
    • 1. The right drug
    • 2. The right dose
    • 3. The right patient
    • 4. The right route
    • 5. The right time
    • 6. The right documentation
    • 7. The right to refuse
    • 8. The right to be educated
  6. Written Prescription
    • 1. Patients Full name & date of birth
    • 2. Date (& time)
    • 3. Name of medicaiton
    • 4. Dose of medication
    • 5. Route
    • 6. Time or frequency

    • also can include:
    • Dispensing instructions (Disp #30)
    • Patient instructions
    • refill or special instructions
    • DAW - dispense as written
    • 7. Signature of provider
  7. Parenteral
    by needle
  8. EC
    • Enteric Coated-
    • do not crush enteric coated tablets - or take with antacid
  9. Extended Release
    Do not crush prolonged-release tablets
  10. What is known side effect of all narcotic analgesics?
    narcotic analgesics = pain meds

    Respiratory depression
  11. What is an idiosyncratic reaction to a medicaion?
    Unusual or unexpected reaction to a drug
  12. Documentation on MAR
    MAR = Medication Administration Record

    After nurse give medicaion a line is drawn through the time and initaled

    If medicaion is not taken - the time is circled and intitaled and a reason given why the medication was not given

    Prn meds - not given a scheduled time on MAR - time given is written on MAR and crossed through and initialed
  13. Drug Evaluation
    • Is the desired effect obtained?
    • Is it tolerated well?
    • Are there side effects, adverse effects?
    • Is there a deviation from normal?
  14. JCAHO unsafe abbreviations
    • U - write Units
    • IU - write International Units
    • QD - write every day
    • HS - write at bedtime
    • TIW - write 3 times weekly
    • SC or SQ - write Sub Q
    • D/C - write discontinue
    • cc - use mL
    • AS, AD, AU - write write left ear, right ear, both ears
    • >
    • <
    • trailing 0 (7.0) - decimal could be missed
    • lack of leading zero - (.7) - decimal could be missed
  15. First-pass effect
    Drugs that are administered PO that pass from the intestine to the liver and are partially metabolized before entering the circulation

    • Drug can interact here too - Barbituates make body metabolize drug more rapidly - reduces effects
    • Tylenol block breakdown of PCN in liver - increases effects
  16. half-life
    time it takes for 1/2 of original amount of a drug to be metabolized (broken down) by the body - on 50% remains therapeutic

    frequency of administration is based on half-life
  17. toxicity
    a nontherapeutic effect that may result in damage to tissues or organs
  18. duration of action
    time during which the drug concentration is sufficient to elicit a therapeutic response
  19. therapeutic level
    SI measurment to denote how much of a drug is in the blood to make sure the correct dose is given

    • peak-trough
    • trough measured before dose given to see of drug left in bloodstream
    • peak measured after dose given to make sure dose is high enough
  20. Minimum toxic concentration
    lowest level of a drug plasma level where toxic effects of a drug are observed
  21. Minimal effective concentration
    minimum level of a drug required to elicit a pharmacoligical response
  22. Drug interaction -
    the pharmacological effects of one drug are potentiated or diminished by another drug
  23. When teaching Geriatric patients about medications what should you consider?
    • :they might be drinking alcohol - alcohol consumption & depression
    • -may interact with medications
  24. Dorumentation of a drug given to a client
    • 1. Chart all medications after administration
    • 2. Chart single doses, stat doses, and prn med immediately - note exact time given
    • 3. Chart any nursing actions before adminsitering drugs - blood pressure - apical heart rate
    • 4. If drug refused or withheld write reason in nurses notes or on MAR and contact healthcare provider
    • 5. Evaluate for expected effect of drug -
    • did side effects occur? - note observations
  25. Anaphalaxis
    Signs & Symptoms of Anaphalaxis
    Nurse interventions/ implementations for anaphylaxis
    Anaphalaxis - Type I hypersensitivity between allergenic antigen and IgE

    • Local anaphylaxis - signs & symptoms
    • urticaria (hives)
    • edema
    • warmth
    • erythema (redness of skin)

    • Systemic anaphylaxis
    • urticaria (hives)
    • angioedema (swelling - can cause respiratory distress)
    • flushing
    • wheezing
    • dyspnea
    • increased mucous production
    • nausea and vomiting
    • feelings of generalized anxiety

    • Nursing Interventions
    • protection of airway
    • administration of oxygen
    • IV fluids to support blood pressure
    • dependnet: vasopressors
    • antihistimines
    • swelling of mouth/ tongue
  26. What method of administration offers fastest absorption?
    IV
  27. What method is used for longest term effects?
    Extra Strengh or Exteded Release tablets
  28. What method is used for insulins
    Sub Q
  29. When giving meds PO what is the max # of pills acceptable for each medication?
    3
  30. Medication Errors
    A medication error is... any preventable event which may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of thehealth care professional, patient or consumer....
  31. Most Common Causes of Errors
    • • Incomplete assessment
    • • Unavailable drug information
    • • Miscommunication regarding drugerrors
    • • Poor labeling of drugs
    • • Environmental factors(lighting, fatigue, etc.)
  32. Sentinel Events
    • • Medical errors that DO result inharm to the patient
    • .• Example: Patient dies of pneumonia 2 months after a hospitalization.
    • • They signal a need for immediateinvestigation and response
    • .ex
    • •Suicide in a patient receiving 24-hourcare
    • •Infant abduction
    • •Rape
    • •Hemolytic transfusion reaction
    • •Surgery of the wrong part or on the wrong person
  33. Documentation of a Sentinel event
    • Documentation of a sentinelevent is required ASAP
    • • The healthcare organization is requiredto have a process in place to recognizethe events,
    • • conduct thorough and credible rootcause analyses
    • • that focus on the system or the processin order to improve the process andprevent similar errors.
  34. Root Cause Analysis
    • Determination of human and other factors associated with the event
    • • Analysis of underlying systems andprocesses through a series of why questions
    • • Inquiry into all areas appropriate to thespecific type of event
    • • Identification of risk points
    • • Areas of potential improvement
  35. Incident Reports
    • Florida requires healthcare facilities to have a risk management department
    • • Incident reports are to be submitted to RiskManagement within 3 days of the occurrence
    • • and serious incidents must be reported toAHCA within 24 hours of submission of the incident report
  36. Adverse Incident
    • Florida Law:An event over which healthcare personnel could exercise control and which is associated in whole or in part with medical intervention rather than the condition for which such intervention occurred, and which also satisfies one of the following requirements:
    • Surgery:
    • •wrong patient,
    • • surgical procedure,
    • •wrong site,
    • • unnecessary procedure
    • • Surgery requiring more surgical repair
    • • Surgery requiring removal of previous surgery gauze, etc

    • .• Result in:
    • •Death
    • •Brain or spinal damage
    • •Permanent disfigurement
    • •Fracture
    • •A resulting limitation of neurological, physical, sensory function
    • •Any condition requiring a specialist resulting from an intervention
    • •Any condition requiring the transfer of the patient to another facility for further care.
  37. Near Miss
    • • An error has occurred but therewas NO harm to the patient.
    • • Wrong diet,
    • • wrong medication,
    • • breaking sterile technique but noharm resulted.
  38. What factors affect a patients response to a medication?
    • Factors Influencing DrugDoses and Action
    • • route
    • • time
    • • age
    • • nutritional status
    • • drug absorption and excretion
    • • client healthstatus
    • • gender
    • • client ethnicity /culture
    • • genetics
  39. Error Prevention
    • • decrease reliance on memory
    • • reduce handoffs
    • • decrease multiple entry
    • • eliminate lookalikes, soundalikes
    • • optimize work environment for safety
    • • train
    • • facilitate error reporting
  40. Pharmacokinetic Differences - Peds
    ABSORPTION
    • • Reduced gastric acidity
    • • Slower gastric emptying, irregular peristalsis
    • • Faster topical absorption R/T thinner skinand disproportionate skin surface area
    • • Altered absorption following I.M. injectionR/T changes in peripheral circulation fromenvironmental (temperature) changes
  41. Pharmacokinetic Differences - Peds
    DISTRIBUTION
    • • Greater total body water; children requirehigher doses per kilogram of weight ofwater-soluble medications
    • • Decrease total body fat; fat-solublemedications must be varied
    • • Protein binding decreased R/T immatureliver
    • • Blood-brain barrier immature resulting inmore drugs entering the brain
    • • Smaller muscle mass
  42. Pharmacokinetic Differences - Peds
    METABOLISM
    • • Levels of enzymes decreased
    • • Children (ages 2 - 6 years)increase in metabolic rates
    • • Variables:- status of liver enzymes,
    • - genetic differences,
    • - maternal exposure to harmfulsubstances during pregnancy
  43. Pharmacokinetic Differences - Peds
    ELIMINATION
    • • Immature kidneys- glomerular filtration rate
    • - tubular secretion and reabsorption
    • - perfusion
    • • Lower urine pH and capacity toconcentrate urine decreased;potential for toxicity
  44. ASSESSMENT - Peds
    • • vital signs
    • • height or length (centimeters)
    • • weight (kilograms)
    • • medications history
    • - client allergies
    • - family allergies
    • -medication experience
  45. DIAGNOSES for the pediatric client
    • • Risk for injury RT admin of meds AEB...
    • • Risk for injury RT adverse effects of medsAEB...
    • • Risk for injury RT idiosyncratic reactions dueto young age AEB...
    • • Risk for poisoning RT meds stored incorrectlyAEB...
    • • Risk for altered nutrition RT medicationtherapy AEB...
    • • Knowledge deficit RT meds & safe dose,
  46. IMPLEMENTATION - Peds
    • • Growth and development
    • • Honesty, develop trust
    • • Use easy to understand terms
    • • Information regarding client and family allergies; client history with meds
    • • Avoid mixing in essential foods, liquids
    • • When possible give choices
    • • Never tell child med is candy
    • • Praise cooperation
  47. EVALUATION - Peds
    • • Safe administration
    • • No injury
    • • Change / Improvement in condition
    • • No complications
    • • Client or parents (guardian) understanding of precautions, adverse effects, when to call physician
  48. SAFETY - Pediatric Client
    • • Poisonings: 5 - 7 million annually
    • • Guidance for parents and guardians
    • • Keep meds out of child's reach
    • • Emergency numbers available
    • • Poison Control
    • • MD
    • • Syrup of ipecac
    • • Child proof containers
  49. GERIATRIC DRUG THERAPY
    • • Consume 30% of all prescription drugs in the US
    • • 70% use OTC medications
    • • 32% receive more than 8 different medications daily (an interaction waiting to happen)
    • • Increase chance of drug interactions - estimated to cause 20-25% of hospitalizations in over 65 age group
    • • Complicated by sensory impairment, social isolation, poor nutrition, poverty
  50. Pharmacokinetic Differences - Geri
    ABSORPTION
    • • Reduced gastric acidity
    • • Slower gastric emptying
    • • Use of laxatives and Liquids bran secondary to constipation = reduced absorption
    • • Reduction in blood flow = reduced absorption
    • Thinner skin -- faster topical absorption
    • • Altered absorption -- environmental changes on peripheral circulation
  51. Pharmacokinetic Differences - Geri
    DISTRIBUTION
    • • Decreased total body water =- diminished distribution of some water-solublemeds (& ↑ blood concentration of med)
    • • Increased total body fat =- altered distribution of fat-solublemedications (meds stay in fat longer)
    • • Muscle atrophy =- altered distribution of IM medications
    • • Decrease in protein-binding capability
  52. Pharmacokinetic Differences - Geri
    METABOLISM
    • • Decline in liver function:
    • - decrease in enzyme levels
    • • Decreased liver blood flow
    • :- less able to transform active drugs into inactive metabolites
  53. Pharmacokinetic Differences - Geri
    ELIMINATION
    • • Decrease in blood flow to kidneys
    • • Decrease in kidney function
    • • Accumulation of drugs and increased risk of toxicity
  54. GERIATRIC DRUG THERAPY
    • • Sensory losses
    • • Memory loss
    • • Polypharmacy = increased errors
    • • Sharing
    • • Hoarding
    • • Dietary factors
    • • Communication problems
  55. ASSESSMENT - Geri
    • • Baseline: vital signs, height, weight
    • • Medication and allergy history
    • • Information on sensory functioning,environment, financial concerns,support
    • • Access to medications
  56. DIAGNOSES -Geri
    • • Ineffective Health Maint. RT inability tomanage cost of therapy AEB...
    • • Risk for injury RT self administration of meds AEB...
    • • Noncompliance RT drug regimens AEB...
    • • Knowledge deficit RT med regimen &administration AEB...
    • • Risk for injury RT idiosyncratic responses due to physiological chgs of ageing AEB...
  57. IMPLEMENTATION - Geri
    • • Eight rights
    • • Sit upright
    • • Liquid forms as needed (increase absorption)
    • • Do not rush
    • • Sufficient water
    • • Avoid muscles with decrease in mass
    • • Watch for fluid overload
    • • Teaching
    • - client wear glasses, hearing aid, good lighting
    • - relate previous life experiences
    • - short educational sessions, include others
    • - caution about safety, not sharing meds
  58. EVALUATION - Geri
    • • Demonstrates and communicates understanding of medications and managing medication regime
    • • No injuries
    • • Communicates understanding of when to seek medical attention
    • • Self-care and safe medication Administration
    • • No idiosyncratic responses
  59. What form of medication is best absorbed by an elderly patient (due to lower gastric acidity & slower gastric emptying)?
    Liquid
  60. Similarities of Peds & Geri Patients
    • 1, Absoprtion - reduced gastric acidity
    • 2. slower gastric emptying
    • 3. Increased Topical absoprtion (thin skin)
    • 4. Altered absorption R/T changes in peripheral circulation from environmental changes (temp)
    • 5. Decrease in protein binding capacity
    • 6. Decreased enzyme levels (liver)
    • 7. Decreased Kidney function
    • 8. Increased risk of Toxicity (due to decreased kidney function)
  61. Differences between Peds & Geri Patients
    • Peds = Increased total body water
    • Geri = Decreased total body water

    • Peds = Decreased total body fat
    • Geri = Increased total body fat
  62. What is the maximum injection capacity for:
    A well developed adult
    Very thin adult, elderly adult, large child
    Babies or smaller children
    • Adult: -3mL in Lg muscle (or gluteal Muscle)
    • Thin adult, etc -2mL
    • Babies & small children - 1mL

    If correct dose is more than max then use two syringes & inject in two different sites

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