Pharm Exam 1 Study Guide PDF

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Lecture notes in combination with powerpoint information for exam 1...

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SAFETY AND QUALITY IN MEDICATION ADMINISTRATION Five Plus five rights of medication administration

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Right patient Right drug Right dose Right time Right route

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Right documentation Right assessment Right evaluation Patients right to education Patients right to refuse

Nurses also have rights: ● complete and clean order, ● correct drug route and dose dispersed ● access to information ● Policies and procedures ● Administer them safely and identify safety issues ● Stop, think, and be vigilant when administering meds Safety in administrations ● ANA encourages drug error reporting and individuals should report themselves to repair and fix the system ● The joint commision established National Patient Safety Goals ( removed abbreviations, acronyms, and symbols that can be misread) and focuses on health care safety problems and resolutions ● Incident reports and near misses ● FDA black box warnings Drug Reconciliation ● Patients should be advised to carry a list of current medications, update drug list according to changes, bring list of medications to each doctor appointment High Alert medications ● Cause significant harm if given in error ● Epinephrine, insulin, opium, tincture, nitroprusside, potassium chloride injection, heparin, warfarin ● Drugs that look alike and sound alike ● Require double check Prevent Medical Errors: ● ● ● ● ●

Follow the rights Organization Keps meds separate Avoid distractions Tall man labeling(brings attention

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Check expiration dates Never leave meds unattended Administer only prepared meds Identify pt with 2 patient identifiers Watch pt take all meds Record effectiveness of

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to differences in drug) Check for medication accuracy Check for allergies Prepare only 1 patients meds at a time Calculate meds dose and perform a double check

medication administration

Disposal and Sharps ● Follow instructions on labels and policy and procedures ○ Biohazard, wasting of narcotics, removing label, avoid wasting into water systems ● OSHA needlestick safety and prevention act of 2000 ● Consensus statement and call to action 2012 Questions: The nurse reads the following order: take 1 multivitamin QOD. the nurse will? ● Administer 1 multivit every morning ● Give pt 7 miltivit every other day ● Call prescriber to clarify order ● Refuse to administer the vit and document as not administered Nurse is required to chart the patient's response to all the following groups of medications except? ● Opiods ● Sedatives ● Antimetics ● Antihyperlipidemics

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NURSING PHARMACOLOGY Drugs and medications are substances taken to prevent, cure, or reduce symptoms of a medical condition Interventions need to be prescribed Medications prescribed for more than 1 disease process/ alteration Core ethical principles ○ Respect for persons ○ Beneficence (to do good) ○ Justice NURSING PRACTICE ACTS (look these up)

Understanding Drugs ● No drug that is perfect- safe, effective, w/out side effects, no adverse effect ● Be able to identify drugs side effects and adverse effects ● Issues- cost, scheduling, interactions

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Names ○ Chemical ○ Generic: ibuprofen (lowercase) ○ trade/brand: Advil, Motrin (uppercase) ○ Institution require generic name but pts. Recognize trade ■ Differences in trade vs generic ○ Combination drugs ■ 2+ compounds in them Classification ○ Therapuetic (what is being treated) ○ Pharmacologic (how the drug acts) Prototypes ○ Particular drug that is commonly used ○ Represents action of the class of drug ○ Other drugs are compared to it ○ Other drugs will work similarly but have differences Nursing practice ○ Responsibilities ○ Last check on medications ○ Know six rights: patient, drug, dose, route, time, documentation ○ Five + five rights ○ Allergies, reason, expiration, side effects, adverse effects ○ Look and document FDA Drug schedules ○ Potential for abuse ■ Schedule I is highest potential for abuse (little medical use at this time) ■ Schedule V is lowest potential for abuse ○ Opioids, benzodiazepines, anabolic steroids, barbiturates ○ Controlled substances ■ Restricted prescribing procedures, ie schedule II

Adverse effect and interactions ●

Adverse drug effects ○ Undesirable, potentially harmful events related to medication ○ Causal for medication to be discontinued ○ May cause permanent harm ○ Specific system or multi system: anaphylaxis

Nursing care

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Side Effects ○ Predictable, less serious, tolerable(sometimes) ○ Headache with nitroglycerin related to dilation ○ Individual response- event can be classified as AE or SE

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How do nurses address AE ○ Prevention as much as possible. Dose dependent: antihypertensives in large doses lead to AE or hypotension ○ Others are not able to predict ■ Assessment and connection through critical thinking ■ Knowledge of medication and class ■ Patient teaching (know what and why) ● Allergy to drugs, Not unusual to medications ○ hyper response to the body: mediators of histamine, serotonin, leukotrienes, prostaglandins ○ Can occur with small amounts, symptoms not related to that drug ○ Cross allergic response: drugs from the same class (PCN and cephalosporins) ○ Recognize symptoms over time which can occur immediately or over time ○ Ask pts for specifics when reporting allergies Idiosyncratic response ● Unusual, unexpected response to drug ● Not an allergy ● Ex. G6PD deficiency: aspirin, ibuprofen causes anemia Cancer and birth defects ● Some drugs have long standing adverse effects ● DES daughters and sons ● Risk-benefit ratio ● Some anti cancers have been linked to other cancers ● Immunosuppressants ● Hormones ● Birth defects- teratogens ● Toxicity- AE can cause toxicity which all systems can experience Interactions ● increase/decrease drugs action ○ Drugs, foods, supplements, usually taken concurrent ● Affect organ toxicity and results in (neuro, nephro, oto, hepato, dermalogic, bone marrow, cardio, and skeletal and muscle toxicity) ● Inhibition of drug ● Enhancement of drug- 2 antivirals together ● New response- antabuse with alcohol ● Pharmacokinetics and pharmacodynamic interaction Individual Variations ● Psychosocial-behavior or cognitive interventions prior or in addition to pharmacologic intervention ● Cultural- set of beliefs values and norms ● Ethnic-biologic and genetic variations ● Genetic-hepatic metabolism differs in some groups due to genetic predisposition -protein enzymes differ, receptor drugs differ, or different metabolism for drug ● Gender differences

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Health pattern differences, metabolism and response, slower elimination rates = longer effects Code of Ethics ● Guide designed for carrying out nursing responsibilities ● Nurses in clinical roles are responsible for patients safety and integrity of research protocol Selected drug standards and legislation ● Drug standards- United States Pharmacopeia National Formulary and the International Pharmacopoeia ● FDA to be tougher on distributors, rapid alert system, better informed customers ● Nurse has a role to educate patients ● 2002 FDA standardized OTC labeling ○ Active and inactive ingredients ○ Purpose of product ○ Specific warnings ○ Dosage instructions PHARMACOKINETICS Pharmaceutics ● Oral drugs become liquid/ solution to cross plasma membrane and be absorbed Disintegration: break down of tablet into smaller particles

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Dissolution: is smaller particles dissolve in the GI fluid

Rate of absorption: Time until drug is available to the body after disintegration and dissolution

Enteric coated drugs resist disintegration in the gastric acid and wait to be absorbed in alkaline environment-therefore do not crush Food can increase or decrease absorption Never crush coated capsules--go further into GI tract

Pharmacokinetics ● ● ●

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Movement of drug to achieve action of drug Obstacles: fewer with IV meds than PO PO meds: stomach acid break down drug molecules ○ Liver chemical changes make a drug less active ○ GI plasma membrane may prevent entrance into the bloodstream ○ Drugs go from GI tract to the liver Drugs need to cross plasma membranes to enter cells to produce effect Diffusion Passive, high to low concentration (blood to tissues) Small, nonionized and lipid soluble drugs will pass through most easily. Weak acidic drugs are less ionized so

Active transport Carrier protein or enzyme Proteins are specific for what they will carry ( sodium potassium pumps) Low concentration to high concentration Needs energy

they pass through more quickly, easily Large, ionized(no charge) water soluble drugs cannot pass easily ● 4 phases: absorption, distribution, metabolism, excretion Absorption ● Process of movement of drug particles to body fluids. Movement happens in small intestines ● Absorption doesn't happen for IV meds (already in blood stream) ● Determines onset action and intensity of drugs ● Absorption rate 0-100%. Higher rate= greater effect Routes and Impacts of absorption ● Enteral to GI tract ● Oral to stomach to small intestine for absorption ● Some drugs have enteric coating to protect from gastric acid and be absorbed in the small intestine ● Extended release formulations- absorption over a long period of time. Do not crush! Passive absorption of drugs Facilitated diffusion Carrier protein moves drug from higher to lower

Active absorption Need carrier protein against concentration gradient

Pinocytosis Cells carry drugs across membrane by engulfing drug

Routes ● Sublingual, NG/GT, topical, transdermal, ophthalmic, otic, vaginal, rectal (KNOW) ● Parenteral:uses a needle ○ Intradermal ○ Subcutaneous ○ Intramuscularly- large muscles with blood supply. Rapid onset of action ○ Intravenously- into bloodstream for immediate distribution Factors of absorption ● Concentration: higher dose= faster and greater response ○ Greater concentration gradient for diffusion ● Blood flow ○ Absorption decreases if there's little blood flow ○ Topical patch to a person with decreased circulation ○ Decreased blood flow- decreased absorption ● Surface area- larger SA, faster absorption ● Routes have different absorption time ● GI membrane composed of lipids and fats. Lipid soluble drugs pass through faster. Water soluble drugs need carrier to pass membrane ● Blood flow, pain, stress (slow gastric emptying time) ● Exercise, hunger pH

● IM in areas of increased blood flow ● Subcutaneous: decreased blood flow than muscle Drug Ionization ● Large particles can pass through mucus membrane if nonionized ● charged/ionized particles don’t pass through easily ● Charge depends on environment ● Acidic drugs are absorbed in acidic environments since they are nonionized ● basic/alkaline drugs are absorbed in bases/basic environments since they are nonionized ● Drugs are absorbed better in a matched environment First pass effect, first pass mechanism, hepatic first pass ● Drugs metabolized in liver after GI absorption ○ Intestinal lumen to portal vein to liver ○ Becomes inactive and is then excreted ● Most drugs affected by first pass ● Decrease in liver function= decrease in metabolism=decrease breakdown= a need for a decrease in pt dose Bioavailability ● Percent of drug that reaches systemic circulation and causes effect ● Oral drugs are never 100% Iv are usually 100% (IV dose is lower than oral) ● Factors affecting bioavailability ○ Form of drug, route, food, other drugs ○ Liver status ○ Liver disorders cause less of drug to be available Distribution ● Process of which drug become available to body fluids and tissues ● Influenced by blood flow, drugs affinity to tissues, and protein binding effect ● Areas with highest blood flow have highest exposure to absorbed drugs ○ Heart, kidney, and liver have high exposure ○ Skin, bones, and cells have low exposure ○ Damaged blood cells have lower distribution (necrotic areas or broken bones) Solubility ● Lipid solubility- increased distribution since plasma membranes allow them, pass more easily ● Only unbound or free drugs can reach target cells ● Bound drugs do not have an affect ● Higher protein binding, the less the effect of the drug Tissue Storage ● Decreased distribution with increased affinity ○ Valium is stored in adipose tissue, foseamax is in the bones for 4-7 months Drug protein complexes ● Protein binding effect (albumin, AGP-alpha glycoprotein) ● Some drugs bind to proteins too big to distribute across capillary membranes ○ Bind with protein no longer available to tissues

○ Only unbound free drugs can make an effect Drugs can have different binding effects ○ Highly protein bound ( >89% of drug is bound) ○ Moderately protein bound (30-60%) ○ Low protein bound (89% of drug is bound); 11% is causing an effect - Moderately protein bound:(30-60% of drug is bound) - Low protein bound: (...