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Questions and Answers
What is bioavailability, in the context of pharmacokinetics?
What is bioavailability, in the context of pharmacokinetics?
Which process is primarily responsible for the first-pass effect?
Which process is primarily responsible for the first-pass effect?
What is the role of albumin in the distribution of drugs?
What is the role of albumin in the distribution of drugs?
What effect does protein-binding have on a drug's activity in the bloodstream?
What effect does protein-binding have on a drug's activity in the bloodstream?
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What risk is elevated when multiple highly protein-bound drugs are used?
What risk is elevated when multiple highly protein-bound drugs are used?
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Which step of the nursing process involves the collection, review, and analysis of patient data, including medication profiles?
Which step of the nursing process involves the collection, review, and analysis of patient data, including medication profiles?
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A patient is prescribed a new medication. During which phase of the nursing process is the 'route' of administration primarily considered?
A patient is prescribed a new medication. During which phase of the nursing process is the 'route' of administration primarily considered?
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What is the primary purpose of the nursing process?
What is the primary purpose of the nursing process?
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In the planning phase of the nursing process, what characteristic is most important for setting patient goals?
In the planning phase of the nursing process, what characteristic is most important for setting patient goals?
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When a patient requests pain medication, which action should the nurse take FIRST?
When a patient requests pain medication, which action should the nurse take FIRST?
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A patient informs the nurse that they are taking several vitamins and herbal supplements, along with their prescribed medications. During which phase of the nursing process should this information be documented?
A patient informs the nurse that they are taking several vitamins and herbal supplements, along with their prescribed medications. During which phase of the nursing process should this information be documented?
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Outcome criteria are concrete descriptions of patient goals and should include which of the following?
Outcome criteria are concrete descriptions of patient goals and should include which of the following?
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When is it MOST appropriate for a nurse to consult a prescriber regarding a patient's medication?
When is it MOST appropriate for a nurse to consult a prescriber regarding a patient's medication?
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Which route of drug administration results in the fastest delivery into the bloodstream?
Which route of drug administration results in the fastest delivery into the bloodstream?
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A medication administered via the buccal route is absorbed through which anatomical location?
A medication administered via the buccal route is absorbed through which anatomical location?
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Which of the following dosage forms is designed to dissolve at different rates depending on its specific formulation?
Which of the following dosage forms is designed to dissolve at different rates depending on its specific formulation?
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A drug administered via the enteral route must pass through which system?
A drug administered via the enteral route must pass through which system?
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Which of these routes of administration is considered parenteral?
Which of these routes of administration is considered parenteral?
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For a topical drug application, which of these locations is NOT specifically mentioned as a site of use?
For a topical drug application, which of these locations is NOT specifically mentioned as a site of use?
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A patient has an existing transdermal patch on his right upper chest, where should a new patch be applied?
A patient has an existing transdermal patch on his right upper chest, where should a new patch be applied?
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What is the primary focus of the field of pharmaceutics?
What is the primary focus of the field of pharmaceutics?
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A patient is scheduled to receive two antiepileptic medications at 0900 but is NPO for a barium study. A coworker suggests administering the medications intravenously (IV). What is the most appropriate action for the nurse?
A patient is scheduled to receive two antiepileptic medications at 0900 but is NPO for a barium study. A coworker suggests administering the medications intravenously (IV). What is the most appropriate action for the nurse?
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A patient reports to the day shift charge nurse that the night shift nurse did not administer their 2100 medication. What should be the nurse's initial action?
A patient reports to the day shift charge nurse that the night shift nurse did not administer their 2100 medication. What should be the nurse's initial action?
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Which of the following best describes a medication error?
Which of the following best describes a medication error?
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Monitoring the patient’s response to drug therapy, both expected and unexpected, is part of which phase of the nursing process?
Monitoring the patient’s response to drug therapy, both expected and unexpected, is part of which phase of the nursing process?
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A nurse is preparing medications for a patient. Which of the following is NOT one of the ‘Rights’ of medication administration?
A nurse is preparing medications for a patient. Which of the following is NOT one of the ‘Rights’ of medication administration?
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Clear and concise documentation falls under the expectations of which nursing process step?
Clear and concise documentation falls under the expectations of which nursing process step?
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What is a key characteristic of medication errors?
What is a key characteristic of medication errors?
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Beyond administering medication, what else is a crucial component of the evaluation phase of the nursing process?
Beyond administering medication, what else is a crucial component of the evaluation phase of the nursing process?
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A drug is metabolized in the liver and transformed into a less active compound. Which of the following best describes this process?
A drug is metabolized in the liver and transformed into a less active compound. Which of the following best describes this process?
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A medication has a half-life of 4 hours. If a patient has 100mg of the medication in their system, how much will remain after 12 hours?
A medication has a half-life of 4 hours. If a patient has 100mg of the medication in their system, how much will remain after 12 hours?
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A drug that has a high first-pass effect is administered orally. How would the bioavailability of this drug be affected?
A drug that has a high first-pass effect is administered orally. How would the bioavailability of this drug be affected?
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A nurse administers a drug that is an agonist. What is the expected effect of this drug?
A nurse administers a drug that is an agonist. What is the expected effect of this drug?
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What does 'steady state' mean in the context of drug administration?
What does 'steady state' mean in the context of drug administration?
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Two drugs are given together, and the result is a significantly greater effect than either drug given alone. What type of drug interaction is this?
Two drugs are given together, and the result is a significantly greater effect than either drug given alone. What type of drug interaction is this?
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A patient is prescribed an IV medication. What is the main advantage of using the IV route over other routes of administration?
A patient is prescribed an IV medication. What is the main advantage of using the IV route over other routes of administration?
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Which route of administration would result in the slowest onset of action for pain relief?
Which route of administration would result in the slowest onset of action for pain relief?
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Which FDA pregnancy risk category indicates that studies in pregnant women have demonstrated a risk to the fetus, and potential benefits may outweigh the risks?
Which FDA pregnancy risk category indicates that studies in pregnant women have demonstrated a risk to the fetus, and potential benefits may outweigh the risks?
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A drug is categorized as FDA Pregnancy Category X. What does this signify regarding its use during pregnancy?
A drug is categorized as FDA Pregnancy Category X. What does this signify regarding its use during pregnancy?
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During which stage of pregnancy is drug transfer to the fetus most likely to occur?
During which stage of pregnancy is drug transfer to the fetus most likely to occur?
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When considering drug therapy during breastfeeding, what is a key factor to take into account?
When considering drug therapy during breastfeeding, what is a key factor to take into account?
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What effect does an immature liver in neonates and infants have on drug metabolism?
What effect does an immature liver in neonates and infants have on drug metabolism?
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A nurse is explaining pharmacokinetic principles to a new parent. Which statement regarding a neonate's or infant's gastric pH is most accurate?
A nurse is explaining pharmacokinetic principles to a new parent. Which statement regarding a neonate's or infant's gastric pH is most accurate?
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What is a consequence of a neonate's and infant's decreased level of protein binding in drug distribution?
What is a consequence of a neonate's and infant's decreased level of protein binding in drug distribution?
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How does kidney immaturity in neonates and infants impact drug excretion?
How does kidney immaturity in neonates and infants impact drug excretion?
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Flashcards
Nursing Process
Nursing Process
A systematic framework for providing nursing care.
Assessment
Assessment
The first step in the nursing process involving data collection.
Nursing Diagnoses
Nursing Diagnoses
Human needs statements identifying patient problems.
Goals in Planning
Goals in Planning
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Outcome Criteria
Outcome Criteria
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Implementation
Implementation
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Patient Comfort
Patient Comfort
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Evaluation
Evaluation
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NPO
NPO
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Antiepileptic medications
Antiepileptic medications
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Medication Administration Record (MAR)
Medication Administration Record (MAR)
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The Rights of Medication Administration
The Rights of Medication Administration
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Medication Errors
Medication Errors
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Evaluation in Nursing
Evaluation in Nursing
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Right documentation
Right documentation
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Clarifying instructions
Clarifying instructions
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Pharmaceutics
Pharmaceutics
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Dosage forms
Dosage forms
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Enteral Route
Enteral Route
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Sublingual administration
Sublingual administration
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Rectal administration
Rectal administration
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Parenteral Route
Parenteral Route
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Intravenous (IV)
Intravenous (IV)
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Topical Route
Topical Route
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Pharmacokinetics
Pharmacokinetics
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Absorption
Absorption
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Bioavailability
Bioavailability
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First Pass Effect
First Pass Effect
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Distribution
Distribution
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Drug Metabolism
Drug Metabolism
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Inactive Metabolite
Inactive Metabolite
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Renal Excretion
Renal Excretion
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Half-life
Half-life
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Steady State
Steady State
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Pharmacodynamics
Pharmacodynamics
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Synergistic Effects
Synergistic Effects
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Adverse Drug Event (ADE)
Adverse Drug Event (ADE)
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FDA Category X
FDA Category X
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Drug Transfer in Pregnancy
Drug Transfer in Pregnancy
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Breastfeeding Drug Exposure
Breastfeeding Drug Exposure
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Neonatal Absorption Differences
Neonatal Absorption Differences
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Pediatric Drug Distribution
Pediatric Drug Distribution
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Metabolism in Infants
Metabolism in Infants
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Kidney Function in Pediatrics
Kidney Function in Pediatrics
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Skin Permeability in Children
Skin Permeability in Children
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Study Notes
Chapter 1: The Nursing Process and Drug Therapy
- The nursing process is a research-supported organizational framework for professional nursing practice.
- It ensures thorough, individualized, and quality nursing care to patients.
- The process requires critical thinking and is ongoing and constantly evolving.
Five Steps of the Nursing Process
- Assessment: Data collection, review, and analysis, including vital signs, lab values, history, medication profile, any drug use (prescriptions and over-the-counter), vitamins, herbs, supplements, and compliance/adherence.
- Diagnosis: Developing human needs statements (nursing diagnoses).
- Planning: Establishing specific goals and outcomes, including concrete patient goals, and expectations of behavior, related to safe and effective drug administration.
- Implementation: Executing nursing actions related to medication administration, including preparation, dosing, administration, route, patient comfort and understanding, and education. This also includes knowing when to call the prescriber for orders.
- Evaluation: Evaluating the status of the goals and outcomes of care; monitoring the patient's response to drug therapy, including expected or unexpected responses. It also involves clear and concise documentation.
Audience Response Question #1
- The first action a nurse should take when a patient requests pain medication is to assess the patient's pain and pain level.
Audience Response Question #2
- If a patient's medication administration record lists medications due at a time when the patient is NPO for a procedure, the nurse should hold the medications until after the procedure.
The "Rights" of Medication Administration
- Right drug
- Right dose
- Right time
- Right route
- Right patient
- Right documentation
- Right reason or indication
- Right response
- Right to refuse
Three Checks for Medication Safety
- Medication label check #1: Compare the medication label to the MAR as you remove the medication from the storage area.
- Medication label check #2: Compare the medication label to the MAR as you prepare each medication.
- Medication label check #3: Compare the medication label to the MAR at the patient's bedside before you administer each medication.
Audience Response Question #3
- The first action to take when a patient says the night shift nurse didn't give them their medication, is to check the medication administration record(MAR).
Medication Errors
- Any preventable event that may cause or lead to inappropriate medication use or harm.
- This includes patient-related and system-related events.
Evaluation
- Ongoing part of the nursing process.
- Determining the status of the goals and outcomes of care.
- Monitoring the patient's response to drug therapy.
- Evaluating expected and unexpected responses.
- Requires clear and concise documentation.
Chapter 2: Pharmacologic Principles
- Overview: Pharmacology is the study or science of drugs and their effects; it encompasses a variety of topics including lots of vocabulary terms.
- A drug is any chemical that affects the physiologic processes of a living organism.
- Drug Names: Key terms in understanding drug names are chemical name, generic name, and trade name. Chemical name describes the drug's composition and structure. Generic name is used by the United States Adopted Names Council. The drug has a registered trademark as the trade name, used by the manufacturer.
Drug Classifications
- Drugs are grouped based on similar properties.
- Classification categories include structure/mechanism of action (beta-blocker), sub-class (selective), and therapeutic use (antibiotic).
- Prototypical drugs are a major concept that are the first drug in a class of drugs.
Pharmacologic Principles
- Various concepts and related disciplines of pharmocology fall under these headings: Pharmaceutical, Pharmacokinetics, Pharmacodynamics, Pharmacogenomics, Pharmacotherapeutics, Pharmacognosy, Pharmacoeconomics, and Toxicology.
Audience Response Question #1 (Chapter 2)
- If a patient refuses enteric-coated tablets and states they cannot swallow pills, the nurse should call the pharmacy to ask for liquid medication.
Pharmaceutics
- Design for drug form.
- Different dosage forms have different pharmaceutical properties.
- Dissolution rates vary based on the form, this relates to the intended route of administration.
Enteral Route
- Drugs are absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine.
-Oral (PO)
-Sublingual
-Buccal
- Rectal
Parenteral Route
- Includes intravenous, intramuscular, subcutaneous, intradermal, intraarterial, intrathecal, intraarticular, and introseous injections routes. All of these involve injections.
Topical Route
- Treatment applications directly on target tissue.
- Includes skin, eyes, ears, nose, lungs (inhalation), rectum, and vagina.
Audience Response Question #2 (Chapter 2)
- If a patient already has a transdermal patch, the nurse should remove the old patch and apply the new patch in a different location.
Pharmacokinetics
- What the body does to the drug including: Absorption, Metabolism, Distribution, and Elimination(Excretion).
Absorption
- Movement of the drug from the site of administration into the bloodstream.
- Bioavailability- amount of drug available for action in the bloodstream.
- First pass effect- a drug is changed significantly after absorption and before reaching the bloodstream, often by the liver.
First-Pass Metabolism
- The liver metabolizes drugs to make them inactive, reducing bioavailability.
Distribution
- Transport of a drug from the bloodstream to its site of action.
- Albumin- the most common blood protein that carries the majority of protein-bound drug molecules.
Metabolism
- Biochemical alteration of a drug.
- Inactive metabolites
- More soluble compounds, and less active metabolites.
Excretion (Elimination)
- Elimination of drugs from the body.
- Primary organ is renal (kidney).
- Biliary, and bowel function are also involved.
- Half-life- time to remove half of a given drug from the body.
- Clearance rate = absorption rate.
Audience Response Question #3 (Chapter 2)
- If a drug has a high first-pass effect, the IV dose will likely be lower than the PO dose to provide equal therapeutic effect.
Drug Effects
- Onset- the time it takes for a drug to begin working.
- Peak- time when the drug reaches its highest concentration in the blood.
- Trough- time when the drug reaches its lowest concentration in the blood.
- Toxicity- the adverse effects of a drug when consumed in excessive amounts.
Pharmacodynamics
- What the drug does to the body.
- Mechanisms of action.
- Therapeutic effects.
- Drug-receptor relationships: agonist, antagonist, partial agonist.
Pharmacotherapeutics
- Drug interactions can result in additive, synergistic, or antagonistic effects.
- Adverse drug events (ADEs) include medication errors and adverse drug reactions.
Audience Response Question #4 (Chapter 2)
- The slowest route of administering morphine sulfate is the PO (by mouth) route. IV is fastest.
Errors and Adverse Events
- Errors can occur at any stage of the medication use process.
- Adverse drug reactions can include pharmacologic, hypersensitivity (allergic), idiosyncratic, or drug interactions.
- Negative effects can include teratogenic, mutagenic, and carcinogenic effects.
Pharmacotherapeutics (continued)
- Tolerance: decreasing response to repeated drug doses.
- Dependence: physiologic or psychological need for a drug.
Pharmacoeconomics
- Cost-benefit analysis: examines treatment outcomes in relation to costs for therapy with drugs.
Summary (Chapters 1 & 2)
- Understanding pharmacologic principles is essential for quality nursing practice to enable safe and effective drug therapy.
Chapter 3: Lifespan Considerations
- The human body changes from birth to death, and that affects pharmacokinetics.
- Special populations, include: Pregnancy, Newborn, Pediatric, and Older Adults.
Drug Therapy During Pregnancy
- Drugs cross the placenta by diffusion.
- Pregnancy factors and maternal factors affect absorption.
- FDA drug categories (A, B, C, D, X) indicate the potential risks associated with drug use.
- The reference guidelines of FDA should be consulted for drug therapy in regards to pregnancy.
- Nurses should be aware of both female and male reproductive potential when handling or assessing drugs, and consult reference materials when needed.
FDA Drug Risk Categories (Old and New)
- Old categories (A, B, C, D, X) provided risk assessments for different drugs; they did not differentiate between the different trimesters of pregnancy or the different ages of the fetus.
- New categories include additional specific considerations.
Drug Therapy During Breastfeeding
- Breastfed infants are exposed to drugs through breast milk.
- Provider will make consideration of risk-to-benefit ratios when prescribing drugs to mothers who are breastfeeding.
Neonatal and Pediatric Considerations: Pharmacokinetics
- Absorption: Gastric pH less acidic; gastric emptying is slower; first-pass elimination may be reduced; intramuscular absorption is faster.
- Distribution: Higher total body water; lower body fat; immature blood-brain barrier.
- Metabolism: Immature liver; higher doses may be required.
- Excretion: Kidney maturity affects glomerular filtration rate, tubular secretion, and perfusion rate of kidneys.
Pediatric Drug Dosing: Factors to Consider
- Skin is permeable; stomach lacks acid; lungs have weaker mucous barriers; body temperatures and dehydration occurs easily; and liver and kidneys may be immature.
Pediatric Dosage Calculations
- Body surface area method (West Nomogram) is used for dosing.
- Use kilograms for weight; centimeters for height; mg/kg dosing is a common method used in pediatric populations; not pounds.
Peds Medication Administration: Considerations
- Prepare all equipment and supplies first; caregivers need to stay as appropriate; assess for comfort methods before, during, and after drug administration; change method of administration per age if necessary; think about how you may need to change your approach for various ages of children (infants, toddlers, preschoolers, school-age, and adolescents).
Audience Response Question #2 (Chapter 3)
- Pediatric patients are different from adults due to immature liver and kidney function affecting drug dosage.
Older Adults (65+): Common Considerations
- Characteristics include polypharmacy; noncompliance/nonadherence; increased incidence of chronic illnesses; sensory and motor deficits; decline in organ function, resulting in adverse drug effects and toxicity; medications are assessed with caution.
Older Adults: Pharmacokinetics
- Absorption: Reduced gastric acidity; slower gastric emptying; reduced blood flow and surface area in gastrointestinal tract.
- Distribution: Lower total body water; increased fat content; decreased protein production in the liver leading reduced protein binding and increased free drugs.
- Metabolism: Reduced hepatic blood flow, decreased enzyme activity leading to decreased drug metabolism, increased risk of accumulation.
- Excretion: Reduced glomerular filtration rate; decreased number of nephrons; reduced excretion.
Audience Response Question #3 (Chapter 3)
- Older adults have decreased gastric pH reducing acidity; decreased fat content, not increased; and decreased protein productions, and not increased.
Older Adults: Pharmacokinetics (Continued)
- Age-related considerations in older adults can include reduced liver filtration, decreased blood flow to the liver; reduced glomerular filtration rate, decreased number of nephrons, and decreased excretion in kidneys; drugs are cleared less effectively due to these factors.
- Review Table 3.4 with problematic meds in older adult populations.
Back to the Nursing Process...
- This is a transition statement, indicating a return to the nursing process for applying the knowledge gained concerning pharmacological principles to drug administration and evaluation.
Assessment (Review for Older Adults)
- Age and allergies
- Dietary habits
- Sensory and limitations
- Financial status
- List of providers
- Medication list
- Polypharmacy assessment
- Self-medication practices
- Results for laboratory tests
- Alcohol and smoking history
- Risk situations due to drug therapy with older adults.
Planning (Review for Older Adults):
- Human needs statements- to include alteration of fluids and/or nutrients; ineffective perception, risk for altered safety; and/or risk for injury; related to adverse effects, and idiosyncratic reactions.
- Outcomes- outcomes may involve patient, caregiver or legal guardian; individualize the outcomes of care for each patient involved in this consideration.
Implementation (Review for Older Adults)
- Rights of medication administration, including age-appropriate considerations for safe administrations, concealing tastes, age-appropriate terminology, comfort, and appropriate distractions.
- Older adult considerations- drug administration considerations include, taking medication as directed by the prescriber, and not double-dosing or discontinuing therapy without getting approval from the prescriber.
- Safety consideration of other possible reasons, such as safety from polypharmacy, are of consideration in implementing and safely administering medications.
Evaluation (Review for Older Adults)
- Observing and monitoring for therapeutic effects.
- Observing and monitoring for adverse effects.
- Evaluating patient understanding of drug purpose, dose, frequency, adverse effects, and special considerations.
Case Studies
Detailed case studies concerning a patient with pneumonia, involving a six-month-old patient.
- Age-related considerations
- Important data needed to verify drug dose
- Drug calculation using the provided information.
- Audience Response question requiring the nurse's next action; the nurse should immediately contact the prescriber to clarify the dose calculation that exceeds the safe range for the medication to not exceed the limit.
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Description
Test your knowledge on pharmacokinetics, focusing on concepts like bioavailability, protein-binding, and the nursing process stages. This quiz also explores the implications of medication management in patient care. Perfect for nursing students and professionals!
