Pharm Exam 1 Review PDF

PHARM EXAM 1 REVIEW CHAPTER 1: DRUG - Intrinsic drugs: chemicals the body makes REGULATION, ACTIONS, AND - Extrinsic drugs: must be taken into the body to change cell, organ, or RESPONSE body action A drug is administered that wi...

PHARM EXAM 1 REVIEW CHAPTER 1: DRUG - Intrinsic drugs: chemicals the body makes REGULATION, ACTIONS, AND - Extrinsic drugs: must be taken into the body to change cell, organ, or RESPONSE body action A drug is administered that will - Generic name (Trade name) cause the same response as an - Generic name is always lower case, trade name is always intrinsic drug when it binds to the capitalized receptor of a cell. Which term best describes the action of the HIGH ALERT DRUGS - Double check DOSAGE w/ other nurses drug administered? - Potassium a. Intended effect - Insulin b. Side effect - Narcotics c. Adverse effect - Chemo d. Paradoxical effect - Heparin United States Pharmacopeia (USP) A dose of medication is to be - Develops manufacturing standards, purity, strength, packaging, and administered sublingually. Which labeling comment best explains the Food and Drug Administration (FDA) purpose of this route to a patient - Enforces standards set by USP or family member? Drug Enforcement Administration (DEA) → drug police A. “The medication enters the - All prescribers must register with DEA bloodstream via the - Responsible for enforcing drug laws in regard to controlled substances gastrointestinal tract.” and illegal drugs B. “The medication enters the bloodstream via the tissues under the skin.” C. “The medication moves through muscles into the bloodstream.” D. “The medication moves through oral membranes into the bloodstream.” Pharmacodynamics - Mechanism of Action: Exactly how a drug changes cell activity Pharmacokinetics - When the body exerts its effects on a drug - Receptor Agonists - Have the right key to turn on cells ignition - Receptor Antagonists - Block receptors so intrinsic drug can't bind with it Black Box warning: A black box warning is a serious warning issued by the FDA for drugs that carry specific health risks - Allergic Response - Produces inflammation response - Anaphylaxis: severe allergic reaction, can lead to vascular collapse, shock, death - Bioavailability - Amount of drug that makes it to the blood Hepatotoxicity- Liver toxic → LIVER METABOLIZES Nephrotoxic- Kidney Toxic → KIDNEY ELIMINATES Pregnancy - Some drugs cross the placenta and may affect the unborn baby  - Teratogens: can cause defects in fetuses. - Some drugs taken by breastfeeding woman cross into the milk Pediatric dosages Pediatrics can have paradoxical effects (opposite effect of what the drugs is supposed to do) Ex. A drug that's supposed to make you drowsy makes the kids hyper Who can write a prescription: → NOT IN NURSES’ SCOPE OF PRACTICE 1. Physician 2. Advanced Practice Nurse 3. Podiatrist 4. Physician Assistant (PA) 5. Veterinarian CHAPTER 2: SAFELY The eight “rights” PREPARING AND GIVING 1. Right dose DRUGS 2. Right diagnosis 3. Right documentation 4. Right time/frequency 5. Right patient 6. Right drug 7. Right response 8. Right route Requirements for an order: Name of medication Dose Route Frequency The Patient has the Right to Refuse Ear drops (OTIC): Understand why they're refusing. Adult pull UP and BACK Educate them on the consequences of refusal. child pull DOWN and Document the refusal right away. BACK (Ages < 3) ○ Have patient Types of orders: remain on their Standing: on a regular basis. Every 6 hrs. Every 12 hrs. side for 5 minutes - Metoprolol 30 mg PO daily PRN: as needed, not on a regular basis, if not needed, don’t give it. - Dependent upon set parameters such as pain, HR, or BP. - Morphine 2mg IVP every 4 hours as needed for pain Single dose: one dose, one time. - Lorazepam 1 mg IV 30 min prior to the procedure STAT: immediate. SENSE OF URGENCY. Don’t sit on them forever. - Furosemide 40 mg by mouth immediately Reporting drug errors: Assess the patient. → ALWAYS FIRST THING YOU DO. Report it right away. Notify the prescriber.  ABSORPTION: Percutaneous Route: Skin or mucous membranes. - An inhaled medication through the nose - A patch that is applied to the skin - Medication placed under the tongue Enteral Route: Medications given through the GI System. - A tablet that is swallowed through the mouth. Parenteral Route: Injectable medications. - Injection into the fatty tissue below the skin. Enteral Drugs: Oral - Onset of action is slow. - Always give with water and ensure they can swallow. Nasal Gastric or Percutaneous endoscopic gastrostomy - Dilute liquids, or dissolve capsules completely. - Flush with at least 50 mL of water to prevent clogging. - Clamp tube 30 minutes before reattaching to suction Rectal (PR) - Suppositories: absorbed at body temperature. - Enemas: used for constipation. - Assist patient to Left-Sims’ position. - Push into rectum about 1 inch - Remind the patient to remain on side for 20 minutes. Parenteral Drugs: Injected through the skin → DO NOT RECAP NEEDLES - Intradermal: between the layers of skin, needle is 3 ⁄ 8 of an inch, gauge is 25, and 10-15 degrees. - Usually 0.1 mL (inner forearm) - DO NOT MASSAGE → alters absorption of the medication - Intramuscular: deep into the muscle, needle is 1-1.5 inches, gauge is 20-22, and 90 degrees. - 1 - 3 mL (deltoid, hip) → if more than 3 ml, give in TWO DOSES - Use Z-track method if indicated - Subcutaneous: tissue between skin and muscle, needle is 3 ⁄ 8 of an inch, gauge is 25-27, 45 degrees - 0.5 - 1 mL. (upper arm, abdomen, upper back) (insulin) - Intravenous: directly into the vein - Check for infiltration and extravasation. Percutaneous drugs: skin or mucous membrane. - Topical (Lotions, Gel, Patches, Powders) - Sublingual (Under The Tongue) - Buccal (Between gums and cheek) - Inhalation Methods CHAPTER 4: MEDICAL Fahrenheit To Celsius: C = (F-32) x 5/9 SYSTEM OF WEIGHTS AND Celsius To Fahrenheit: F = (C x 9/5) +32 MEASURES 1 Tsp = 5 mL 1 Tbsp = 3 Tsp (15 mL) 1 oz = 30 mL 1 cup = 8 oz (240 mL) 2.2 lb = 1 kg 1 kg = 1000 g 1 g = 1000 mg 1 mg = 1000 mcg CHAPTER 5: DOSAGE CALC. MACRODRIP VS. MICRODRIP AND INTRAVENOUS MICRO: used for pediatric patients SOLUTIONS AND DRUGS - ALWAYS 60 GTTS = 1ML. Drop factor doesn’t change. - Always reassess your math if your drop rate is >60gtts/min - mL per hour = drops per min Infiltration: a condition that MACRO: used for adult patients, drop factor varies (read the label). Bigger occurs when the IV catheter drops. pulls from the vein and begins to leak into the tissue - STOP FLUIDS AND ➗ - CAN BE: 10 gtts/mL,15 gtts/mL, 20 gtts/mL - Volume (mL) time (min) ✖ drop factor = drops per min EVALUATE CATHETER 4 important concepts when giving fluids: - Pain, edema and cold to 1. WHAT TYPE OF FLUID touch 2. HOW MUCH FLUID Extravasation: when the fluid or 3. FOR HOW LONG drug that infiltrates is irritating 4. HOW FAST and leads to tissue damage or loss. Happens when a CALCULATING IV FLUIDS: medication is a VESICANT. - Calculation rate: - BE SURE THAT - Total volume of infusion NEEDLE IS IN THE - Duration of infusion (in hours) VEIN PRIOR TO - Drop factor (on IV package) STARTING MED CHAPTER 9: DRUGS FOR Opioids: PAIN CONTROL MOA: - Bind to opioid receptor sites in the brain, altering the perception of pain. The nurse is teaching a patient S/E: Drowsiness, dizziness, N/V, constipation. about how codeine works in the A/E: Respiratory Depression, addiction, dependance, tolerance, body. Which indicates that withdrawal. teaching was successful? NURSING IMPLICATIONS - a. “All patients obtain pain Check Before: Respiratory Rate (RR), O2 Saturation. relief from codeine” - Normal RR: 12 - 20 BPM b. “Codeine has to be - Normal O2 Sat.: > 92% converted to morphine to Check After: Check RR, O2 Sat. hourly, and bowel patterns. obtain pain relief” PT Teaching: c. “Some patients - Take w/ food metabolize codeine - DO NOT drive or operate heavy machinery rapidly and receive no - Change positions slowly pain relief” - ⬆ fluids, fiber, and activity before using stool softeners or d. “Some patients are poor laxatives metabolizers and have LIFE SPAN CONSIDERATIONS - an increased risk of Pediatrics: Dosage based on age, size (weight in kg), health, and pain toxicity.” severity. Pregnant/ Breastfeeding: Newborn addiction/ withdrawal can occur. If opioids were given during labor, baby may need dose of opioid ASSESS THE PATIENT’S PAIN antagonist. Avoid breastfeeding if mom in is on opioids for more than 2 LEVEL 30 MINUTES AFTER days. GIVING A PAIN CONTROL Older Adults: Increased risk of falling due to low vision. DO NOT give DRUG, THEN HOURLY meperidine (Demerol). ANTIDOTE: NALOXONE (NARCAN) → Given SUBQ, Nasal, IV OPIOID AGONISTS DO NOT CONTRAINDICATION: RESPIRATORY DEPRESSION (