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Chapter 2: Beneficence - protect subjects from harm / should be informed about the risk and benefits r/t clinical research Respect for persons - self determination (autonomy) Justice - all people treated fairly Vivo testing - animals Vitro testing - test tubes Drug research in the 1980s only tested ...

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Chapter 2:! •Beneficence - protect subjects from harm / should be informed about the risk and benefits r/t clinical research! • Respect for persons - self determination (autonomy)! • Justice - all people treated fairly! • Vivo testing - animals ! • Vitro testing - test tubes! • Drug research in the 1980s only tested white males! •Phase I - small group of well people given the drug and the drug is evaluated for effectiveness and side effects! •Phase II - a larger group of people and the drug is further evaluated for safety and effectiveness! •Phase III - given to large groups and additional testing is done, comparison of the drug to other common treatments ! • Phase IV - drug continues to be studied, but it has to be marketed! • Generic name - nonproprietary, always capitalized, NOT identical to brand name drugs! • Nurse Practice Act - governs med administration ! • Methadone - schedule II ! • Acetaminophen/codeine - schedule II! • FDA - accurate labeling, effective, tested for harmful effects, 1/10,000 drugs approved ! •FDAM Act of 1997 - review of new drugs accelerated, drug companies must provide info on off-label use of drugs drug companies must offer advanced notice of plans to discontinue drugs! • Good Clinical Practice - design, monitoring and auditing, analyses, reporting! •Proposed informed consent form - description of benefits and risks, ID of related drugs, treatments, and techniques, state of compensation for participants, if any, and description of serious risks! • Counterfeit drugs - variations in packaging, unexpected side effects, different taste! • Controlled Substances Act of 1970 - established treatment and rehab facilities ! ! Chapter 3:! •Pharmacodynamics refers to what the drug does to the body, that is, how it influences cellular physiology.! •Pharmacokinetics is the study of what the body does to the drug and involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.! • Pharmacotherapeutics refers to the study of the therapeutic use of drugs. ! • Pharmacology is the study of drugs.! • Disintegration process - only for oral analgesics ! •Insulin is destroyed in the GI tract by digestive enzymes, must be given parenterally! • Nonionized and lipid-soluble drug molecules slip rapidly across membranes. ! •Ionized, water-soluble, and protein-bound drugs have difficulty moving across membranes. ! • Water soluble drugs require active transport/carrier enzyme/protein! •Blood flow, pain, stress, hunger, fasting, food, and pH affect drug absorption ! • IM is more rapid than subcutaneous (deltoid is greater than gluteal)! • First pass effects - absorbed in portal vein —> GI —> liver! • Bioavailability - % of drug that reaches circulation ! • Tachyphylaxis - low drug response! • Pinocytosis - cells carry solute across membrane! • Low albumin = high drug effects! • Steady state levels occur in 4 half lives! • Sodium bicarbonate alkalizes urine, high excretion of aspirin! • Agonist med - stimulates receptor to produce therapeutic response ! • Digoxin requires a loading dose! • Ciprofloxacin - one hour after / 2 hours before antacids ! • Furosemide - diuretic / low potassium = high digoxin in toxicity! • Hepatic enzyme inducer = high drug metabolisms / warfarin can be increased! • Cimetidine - enzyme inhibitor / low metabolism! • Clavulanate - enzyme inhibitor / inactivates amoxicillin by broadening antibacterial spectrum! •MAO inhibitors cannot be taken with tyramine-rich foods (chz, wine, meat, beer, yogurt, sour cream, bananas)! •Patients with kidney disease may have fewer protein-binding sites and are at risk for drug toxicity! • When drug metabolism rate is decreased - toxicity can occur! • A drug not bound to protein is an active drug! •Rate of absorption can be changed by modifying gastric emptying time, changing gastric pH, forming drug complexes!

•Mechanisms of drug action: stimulation, depression, irritation, replacement, cytotoxic action, antimicrobial action, and modification of immune status! •Opioids slow gastric emptying, allowing more time for drugs to be absorbed in the stomach.!

! ! Chapter 5: • Astragalus - boost immune system (hep, cancer)! • Chamomile - sleep, anxiety, GI upset / side effect: allergic reactions! • Cinnamon - bronchitis, GI problems, anorexia, diabetes! • Echinacea - commonly used for colds, flu, and infections, acne ! •Garlic - treat hypertension and heart disease, cholesterol /cause upset stomach and heartburn/ reduce blood clotting •Ginger - short term use only for nausea with pregnancy, helps arthritic pain / side effects: gas, bloating, heartburn •Ginkgo - helps patients with dementia , increase bleeding risk / helps asthma, bronchitis, fatigue, tinnitus! • USP - identify, potency, purity, labeling accuracy ! •Ginseng - high risk of hypoglycemia, boost the immune system, increase a sense of well-being, increase stamina / used to treat erectile dysfunction, hepatitis C, and menopausal symptoms and to lower glucose ! •Hawthorn - treat heart disease and angina, increase action of hypertensive meds, lowers BP ! • Licorice - avoid when pregnant, increases BP and lowers potassium! • Kava kava - anxiety / side effects: dry scaly yellow skin, eye irritation ! •Milk thistle - cirrhosis, hepatitis, gallbladder, lowers glucose, caution in diabetics ! • Saw palmetto - helps urinary symptoms, migraine, hair loss ! •St. John’s Wort - cause photosensitivity, use sunscreen, helps depression! • GI disorders - chamomile, cinnamon, ginger, peppermint! •Dietary Supplement Health and Education Act (DSHEA) - clarified marketing regulations, reclassified herbs as dietary supplements, stated that herbal products can be marketed with suggested dosages! • Herbal products helps increase blood flow to the extremities ! • Garlic and ginkgo interfere with anticoagulants / prolongs bleeding time! • Dong quai increases the risk of bleeding and should not be taken before surgery! •Valerian has been shown to help anxiety, headache, irregular heartbeat, tremors (insomnia maybe)! • Phytomedicine - therapeutic value of plants! •Turmeric - helps heartburn, stomach ulcers, gallstones, inflammation, cancer, avoid in gallbladder disease ! • Supplement label: name, amount (quantity), nutrition, ingredients, name/place of manufacture ! •Interferes with anticoagulants: bilberry, cats claw, chamomile, dong quai, feverfew, garlic, ginseng, ginger, ginkgo licorice, St. John’s wort! • Interferes with iron: chamomile, peppermint, St. John’s wort ! ! Chapter 9: • Hypertensives reduce volume of fluid in blood to lower BP! • Children must have proper med labels at school, and should not self administer! • Verify patient with 2 identifiers! • DO NOT USE abbreviation “qd”! •The quality and Safety Education for Nurses’ focus on safety is best exemplified by collaborative pt and family care! • Questions about preparing a med - call pharmacy! •The concept of Just Culture encourages organizations to avoid using punitive approaches in reporting drug errors because they focus on punishing individuals for reporting such errors. In a Just Culture, individuals would be encouraged to report drug errors so the system can be repaired and the problem fixed.! ! Chapter 10: • To measure liquid meds, line up bottom of curve with the desired line on spring! • Drug levels fluctuate less with transdermal patches! • Flushing NG tube after giving med ensures it reached stomach ! • Suppository - lie flat or on side, water soluble lubricant should be used! • Intradermal injections - 25 gauge, 1/4-1/2 inch needle, tuberculin syringe! • Z track - lower skin irritation in IM! • IM injection on 5 year old - ventrogluteal! •The vastus lateralis is the preferred site in infants less than 12 months old and/or toddlers who are not walking alone!

•Rotate placement of lidocaine transdermal patch sites, always use gloves applying and removing patch! •Insert the needle at a 45 to 90 degree angle, depending on patient size, to penetrate subcutaneous tissue.! •The intraosseous (IO) method of drug administration involves the infusion of medication directly into the bone marrow! ! Chapter 12: • The major cation of extracellular fluid is sodium.! • The major cation of intracellular fluid is potassium. • Normal osmolality - 275-295 mOsm/kg! •LR solution - replace water and electrolytes, GI losses (isotonic) contraindicated with liver disease! • Hypotonic - increase interstitial and intracellular hydration (0.33% NS)! • Hypertonic - pull water from interstitial space to extracellular fluid (5% dextrose in 0.9% NaCl)! • Colloidal - maintain plasma volume over time (6% Dextran 75 - lower HR, increase BP)! • The TBW of a 70 kg (154 lb) man is approximately 60% (40 L). ! • Neonates are 75% to 80% water, whereas older adults are 45% to 55% water. ! • Do NOT use calcium gluconate with Digitalis! • Calcium gluconate - monitor ECG, report calcium below 2.5! • Hypocalcemia - laryngeal spasms, deep tendon reflexes, mouth twitching! •Hyponatremia (normal levels 136-145) symptoms - tachycardia, hypotension / use NS 0.9% for mild cases (125-135) / use hypertonic saline if sodium is less than 120! •Hypernatremia - instruct pt on seizure precautions, keep appts for lab tests, explain meaning of fluid restriction, instruct pt on how to read food labels / symptoms - flushed skin, increased thirst! • Urine output is low if less than 25mL/h or less than 600mL/d! • Severe hyperkalemia - use Kayexalate / tachycardia, abdominal cramping! •Hypokalemia increases risk of digoxin toxicity, cortisone and licorice / symptoms - irregular pulse, leg weakness! • Potassium infusion rate = 10mEq/h or 200mEq/24hrs ! • Vitamin D enhances absorption of calcium ! • Weight gain of 1kg (2.2lbs) = 1L of fluid! •IV potassium must be diluted with IV fluids and delivered by infusion pump! •Receiving fluid replacement - measure weight every morning, know thirst means mild FVD, monitor I&O daily, review daily electrolyte labs for changes! Chapter 13:! • Folic acid - for pregnancy / prevents neural tube defects ! •Folic acid deficiency is characterized by decreased white blood cell count, decreased clotting factors, anemia, intestinal disturbances, as well as depression.! • Water soluble vitamins are excreted in urine! • Fat soluble vitamins are excreted slowly in urine! •Vitamin A - toxicity can occur - stored in liver for up to 2 years / hair loss, peeling skin! •Vitamin A deficiency is characterized by symptoms of dry skin and night blindness as well as poor tooth development.! •Vitamin B1 deficiency is characterized by sensory disturbances, retarded growth, fatigue, and anorexia.! •Vitamin B12 deficiency is known to produce symptoms such as gastrointestinal disorders, poor growth, and anemia.! •Vitamin B2 deficiency includes visual defects such as blurred vision and photophobia, cheilosis, rash on nose, and numbness of the extremities.! •Vitamin B6 deficiency is characterized by neuritis, convulsions, dermatitis, anemia, and lymphopenia! • Vitamin D - calcium absorption - regulates calcium/phosphorus metabolism ! • Vitamin D is contraindicated with hypercalcemia, a clinical manifestation of hyperparathyroidism! • Vitamin D toxicity - anorexia, nausea, vomiting ! • Long term parenteral nutrition = zinc deficiency! • Vitamin E - prolong prothrombin time, higher risk of bleeding! • Vitamin K1 - for oral anticoagulant overdose, prevents hemorrhage! • Fats increase vitamin A E D and K absorption ! • Thiamine - used for chronic alcohol abuse / Wernicke-Korsakoff syndrome ! •Vitamin B (Riboflavin) deficiency - scaly dermatitis, cracked corners of the mouth, tongue and mouth inflammation • Large dose of niacin - GI irritation, vasodilation (flushing sensation)! • Large dose of Vitamin C - provide symptomatic care (taper down gradually)! • Folic acid deficiency - does not appear for months!...