Pharm Test 1 Exam Prep Review FALL 2024 PDF

**Pharm Test 1 Exam Prep Review FALL 2024** **PHARMACOLOGY BASICS** **Chapter 1 -- Drug therapy & Nursing Practice in Canada** - Elements of a legal drug order - Pts name - Date drug order was written - Name of drug(s) - Drug dosage amount and frequency - Rout...

**Pharm Test 1 Exam Prep Review FALL 2024** **PHARMACOLOGY BASICS** **Chapter 1 -- Drug therapy & Nursing Practice in Canada** - Elements of a legal drug order - Pts name - Date drug order was written - Name of drug(s) - Drug dosage amount and frequency - Route of administration - Prescribers signature - Rights of drug administration - Drug - Dose - Time - Route - Patient - Reason - Documentation - Evaluation - Patient education - Refuse - Dispensing - Controlled act - Nurses must demonstrate knowledge, skills, and judgement - Preparation include preparing medication label and transferring appropriate amount of medication administer later - Ensuring that the medication is pharmaceutically and therapeutically appropriate for the intended use and that it will be used properly **Chapter 2 -- Pharmacological Principles** - Pharmacokinetics (ADME) - Pharmacokinetics is what the body does to the drug - A: Absorption -- Bioavailability and first pass effect - D: Distribution -- The movement of the drug in the cardiovascular system to the drugs site of action. Greater blood supply quicker drugs reach these sites kidney, liver, heart, and Brain. Albumin carries most of the Protien-bound drug molecules. Drug binds to albumin only small amount is not bound. The unbound portion is active and considered "free" drug. - M: Metabolism -- Biotransformation = Metabolism. Metabolism includes cytochrome p-450 enzymes, lipophilic (fat loving), hydrophilic (Water loving), substrates (works on enzymes to induce or stop reaction), Enzyme inhibitors, enzyme inducers. - E: Excretion -- The elimination of drug from the body. Primary organ of excretion is Kidneys, Secondary organs include liver and bowels. - Onset, peak, duration of action, Steady State, Half-life - Onset -- First appearance of sign/symptoms of illness - Peak -- when the level of the drug in the patient is at its highest - Duration of Action -- The length of time that particular drug is effective - Steady State -- When the rate of drug availability in the body and elimination from the body equal one another - Half-Life -- The time taken for the plasma concentration of a drug to reduce to its original value. - Pharmacotherapeutics (types of therapy) - The clinical use of drug to prevent and treat disease - Types of therapy's: - Acute - Maintenance - Supplemental (or replacement) - Palliative - Supportive - Prophylactic - Empirical - Therapeutic index - The ratio of drug toxic level to the level that provides therapeutic benefits is referred as the drugs therapeutic index. - Drug interaction effects - Alteration of the action of one drug by another is referred to as drug interactions - Effects: **Chapter 3 -- Ethical & Legal Principles** - Ethical principles and application to practice for pharmacology - Autonomy: The right to choose and refuse medication - Benifence: Should benefit the patient - Nonmaleficence: Should not cause pain and suffering to the patient - Justice: Should be fair, equitable, and appropriate access to drug therapy - Fidelity: being competent - Veracity: Nurse must provide accurate, truthful drug information and honest about mistakes. - DIN and Drug Rx numbers - DIN \# is not confidential, placed on label of prescriptions and OTC medications - Rx \# is specific, also used by a specific pharmacy to identify drug & number of refills, IS CONFIDENTIAL **Chapter 4 -- Patient focused considerations** - Polypharmacy - The use of many different drugs concurrently in treating a patient, often one who has several health problems. - Polymorphism - The ability of solid materials to exists in two or more crystalline forms with different arrangements or conformations of the constituents in the Crystal lattice. - Why drug impact children and older adults differently than adults. - As you get older, your body goes through many changes that influence how substances can affect you and how strong their effects are. For example: your body breaks down substances slower, so they stay in your body for longer **Chapter 6 -- Medication errors** - Factors contributing to drug errors - Similar names, unapproved abbreviations, multiple care gives - Distractions and interruptions, failure to recognize, limited drug knowledge - Strategies to prevent medication errors - Avoid telephone/verbal orders - Avoid distractions by preparing for this in advance **Chapter 7 -- Patient Education & Drug Therapy** - Domains of learning -- teaching to each domain - Affective: The most intangible domain and involves affective behaviours, which is conduct that expresses feelings, needs, beliefs, values, and opinions (feeling domain) - Cognitive: Involves the learning and storage of basic knowledge. Think portion, incorporated a person's pervious experience and perceptions (Learning/think domain) - Psychomotor: Learning a new procedure or skill (Doing domain) - Factors contributing to non-adherence - Age - Time - Organization - Safe practices for discharge teaching - Begin teaching process upon the patients admission - Individualize the teaching session to the patient - Provide positive reward and reinforcement for accurate return demonstration of a producer, etc - Complete medication calendar that include name of drug, dose, and frequency - Use audiovisual aids - Involve family member or significant others - Keep teaching on a level that is most meaningful to the given patient **Chapter 8 -- OTC & NHP** - Criteria for OTC designation - Safety: The drug should have a low potential for misuse and a high margin of safety. - Efficacy: Proven effectiveness for its intended purpose when used according to label directions. - Self-Diagnosable Condition: The condition should be easily recognizable by the patient (e.g., cold symptoms, headache). - Ease of Use: The medication should be simple to use without the need for professional supervision. - Indication for OTC use - Pain Relief (e.g., acetaminophen for headaches, ibuprofen for muscle pain) - Cold and Flu Symptoms (e.g., decongestants, antihistamines - Digestive Issues (e.g., antacids for heartburn, loperamide for diarrhea) - Allergies (e.g., loratadine for seasonal allergies) - Skin Conditions (e.g., hydrocortisone for rashes, antifungals for athlete's foot) - NHP (natural Health Products) interaction with other drug classes - Chamomile: Increased potential for bleeding with anticoagulants - Cranberry: Decreased elimination of many drugs excreted by the kidneys - Echinacea: Possible interference with or counteraction to immunosuppressant drugs and antivirals - Evening primrose: Possible interaction with antipsychotic drugs - Garlic: Can interfere with hypoglycaemic therapy and the anticoagulant, warfare sodium - Ginkgo Biloba: Increases risk of bleeding with use of anticoagulants such as warfin sodium, heparin sodium, and anti platelets drugs such as aspirin, clopidogrel. - Ginger roots: Can interfere with cardiac, antidiabetic or anticoagulants drugs **Chapter 10 - Principles of Drug Administration** - Routes of administration and steps to each - Oral (PO): - Steps: - Verify the medication order and patient's ability to swallow. - Ensure the patient is in an upright position. - Offer a full glass of water unless contraindicated. - Administer the medication and ensure it is swallowed. - Document the administration. - Indications: Common for systemic absorption; slower onset. - Safe Practice Consideration: Avoid crushing enteric-coated or extended-release tablets. - Sublingual/Buccal: - Steps: - Place the tablet under the tongue (sublingual) or between the cheek and gums (buccal). - Instruct the patient not to chew or swallow the medication. - Wait until the medication dissolves completely. - Indications: Rapid absorption into the bloodstream. - Safe Practice Consideration: Do not eat or drink until medication is fully absorbed. - Intravenous (IV): - Steps: - Verify the medication and dose. - Prime the IV tubing (if applicable) to prevent air embolism. - Select and clean the IV site. - Administer the medication at the prescribed rate. - Monitor for immediate reactions. - Flush the line with saline as needed. - Indications: Rapid onset; used for immediate drug effect. - Safe Practice Consideration: Use an infusion pump for accuracy; monitor for phlebitis or infiltration. - Intramuscular (IM): - Steps: - Select the appropriate site (e.g., deltoid, vastus lateralis). - Clean the injection site. - Insert the needle at a 90-degree angle. - Aspirate (pull back slightly) to check for blood return (optional, per institution protocol). - Inject the medication slowly. - Withdraw the needle and apply pressure to the site. - Indications: For medications needing slow absorption or in cases where oral administration is not possible. - Safe Practice Consideration: Rotate sites to avoid muscle damage. - Subcutaneous (Subcut): - Steps: - Choose a site (e.g., abdomen, thigh, upper arm). - Clean the injection area. - Pinch the skin and insert the needle at a 45- to 90-degree angle. - Inject the medication. - Remove the needle and apply gentle pressure. - Indications: Insulin, anticoagulants (e.g., heparin). - Safe Practice Consideration: Rotate injection sites to prevent lipodystrophy. - Topical: - Steps: - Clean and dry the application area. - Apply the prescribed amount of medication evenly. - Avoid touching the medication with bare hands (use gloves). - Document the site and amount applied. - Indications: Localized treatment (e.g., skin conditions). - Safe Practice Consideration: Avoid covering the area unless specified. - Inhalation: - Steps: - Shake the inhaler well (if using an MDI). - Exhale completely, then place the inhaler in the mouth. - Press the inhaler while inhaling deeply and slowly. - Hold breath for 10 seconds, then exhale slowly. - Wait 1-2 minutes between puffs (if a second dose is needed). - Indications: Asthma, COPD management. - Safe Practice Consideration: Rinse mouth after using steroid inhalers to prevent oral thrush. - Rectal: - Steps: - Position the patient in the left lateral position. - Lubricate the suppository. - Insert gently beyond the internal sphincter. - Instruct the patient to remain in position for 5-10 minutes. - Indications: Nausea, constipation, or when oral administration is not feasible. - Safe Practice Consideration: Monitor for rectal bleeding or irritation. - Transdermal: - Steps: - Remove the old patch and clean the area. - Choose a new site (rotate locations). - Apply the patch to dry, intact skin. - Press firmly for 10 seconds. - Indications: Long-term, consistent drug delivery (e.g., pain management). - Safe Practice Consideration: Write date and time on patch; ensure patch removal is documented. - Safe practices - Adherence to the \"Rights of Medication Administration\": - Right patient, right drug, right dose, right time, right route, right documentation, right reason, right response, and right to refuse. - Avoid Distractions: - Implement a "no-interruption" zone when preparing and administering medications. - Use of Standardized Protocols and Checklists: - Follow established protocols for high-risk medications (e.g., insulin, anticoagulants). - Double-Check High-Risk Medications: - Perform independent double-checks for high-alert medications such as heparin, insulin, or chemotherapeutic agents. - Patient Identification: - Use at least two patient identifiers (e.g., full name and date of birth) before drug administration. - Education and Communication: - Educate patients about their medications, including purpose, side effects, and administration instructions. - Use teach-back methods to confirm understanding. - Documentation: - Document immediately after administration, including patient response and any adverse effects. - Monitoring: - Observe for therapeutic effects and adverse reactions, adjusting care as needed. **GI SYSTEM DRUGS** No nutritional supplement questions **Chapter 9 -- Vitamins & Minerals** - Fat soluble & water soluble - Fat soluble : A,D,E and K - Water soluble: B, C - Vitamin K - Vitamin k os blood coagulation factors, converting to Ostecolcin - HIGH ALERT -- the high alert drug in vitamin k the antidote is warfin - Calcium - Most aboundant mineral - Helps maintain strength in teeth and bones - DON'T GIVE CALICUM WITH THESE DRUGS - Tetracyclines - Quinolones - Thyroid replacement medication **Chapter 30 - Fluid & Electrolytes** - Types of IV fluids & indications Crystalloids: - Isotonic (e.g., 0.9% Normal Saline, Lactated Ringer's Solution): - Indication: Used for fluid replacement in patients with fluid loss due to dehydration, surgery, or trauma. - Restores circulating volume without shifting water between compartments. - Hypotonic (e.g., 0.45% Saline): - Indication: Treats intracellular dehydration (e.g., diabetic ketoacidosis). - Causes water to move into cells, increasing cell hydration. - Hypertonic (e.g., 3% Saline, D5NS): - Indication: Corrects severe hyponatremia and cerebral edema. - Pulls water out of cells and into the bloodstream, increasing extracellular volume. - Colloids (e.g., Albumin, Dextran): - Indication: Used to expand plasma volume in hypovolemic shock or burns. - Larger molecules stay in the intravascular space, increasing oncotic pressure. - Blood Products (e.g., Packed Red Blood Cells, Plasma): - Indication: For hemorrhage, severe anemia, or clotting disorders. - Replaces lost components such as red blood cells or clotting factors. - Rehydration and electrolyte replacement least invasive to more invasive - Oral Rehydration: - Indication: Mild dehydration. - Uses oral rehydration solutions (e.g., Pedialyte) to replenish fluids and electrolytes. - Enteral (NG Tube) Rehydration: - Indication: When the patient cannot drink but has a functioning GI tract. - Administers fluids and electrolytes through a nasogastric (NG) tube. - Peripheral IV Fluids: - Indication: Moderate dehydration or electrolyte imbalance. - Isotonic or hypotonic IV solutions to restore fluid volume. - Central IV Fluids: - Indication: Severe dehydration, hypertonic fluids, or rapid electrolyte replacement. - Used for high-risk or long-term infusions. - Parenteral Nutrition: - Indication: Non-functioning GI tract, malnutrition. - Provides nutrition and electrolytes through a central line (e.g., TPN). - Fluid volume excess / fluid volume deficit signs & symptoms - Fluid Volume Excess (FVE): Signs & Symptoms: - Peripheral edema - Weight gain - Jugular vein distention (JVD) - Bounding pulse - Hypertension - Shortness of breath and crackles on lung auscultation - Dilute urine (low specific gravity) - Causes: - Heart failure, renal failure, excessive IV fluid administration. - Fluid Volume Deficit (FVD): - Signs & Symptoms: - Dry mucous membranes - Tachycardia - Decreased skin turgor - Hypotension - Concentrated urine (high specific gravity) - Weak, thready pulse - Weight loss - Increased thirst - Causes: - Vomiting, diarrhea, burns, diuretics, or insufficient fluid intake. - Lab value sodium / Lab value potassium - Sodium --- 135 - 145 - Potassium --- 3.5-5.0 - When is Na / K supplement needed - Sodium : When you are hyponatemia due to vomiting, diametrically, excessive sweating, certain medications (Diuretics) CAN BE ADMINISTERS ORALY OR IV - Potassium : When you are hypokalemia due to poor dietary intake, GI losses, certain endocrine disorders. ORALY FOR MILD CASES, IV FOR SERVE **Chapter 39 -- GI System: Acid Controlling Drugs** - 4 classes of acid controlling drugs: Indications, contraindications, common side effects, assessment, implementation, & patient teaching  **Chapter 40 -- GI System: Anti-diarrheal & Laxative** - 5 classes of laxatives: onset of action, contraindications, assessment, implementation factors, safety considerations, patient teaching **Chapter 41 -- GI System: Anti-emetic** - 6 classes of antiemetic: Indications, contraindications, common side effects, assessment, implementation, & patient teaching - Antihistamine use for children & adults