NURSING 3313 Pharm Exam 1 Review Questions and Answers
1. Define: Therapeutic vs. Pharmacologic classification Therapeutic is usefulness in treating a
... [Show More] particular disease Drug classification- usefulness for cardiovascular function Anticoagulant- influences blood clotting Antihyperlipidemic- lower blood cholesterol Antihypertensive- Lower blood pressure
Antidysrhythmic- Restore normal cardiac rhythm Antiangianal- Treat Angina.
pharmacological classification the way a drug works at the molecular, tissue, and body systems Drug classification- mechanism of action for hypertension
Diuretic- lowers plasma level
Calcium channel blocker- blocks heart calcium channels
Angiotensin converting enzyme blocker (ACE)- blocks hormonal activity Adrenal antagonist- Blocks physiological reactions to stress.
Vasodilators- dilates peripheral blood vessels.
2. Define: Addiction, Dependence, Physical Dependence
Addiction is the overwhelming feeling that drives a person to use a drug repeatedly and
dependence is a physiologic or psychological need for a substance.
Physical Dependence: an altered physical condition caused by the adaptation of the nervous system to repeated drug use. In this case when drug is no longer available the individual expresses physical signs of discomfort known as withdrawal.
3. Controlled substance classification/U.S. Drug Schedule. Recognize the differences between each schedule.
Controlled substance: a drug whose use is restricted by the controlled substances act of 1970 and later revisions. These drugs are frequently abused and have high potential for addiction and dependence. Aka comprehensive drug abuse prevention.
𝗈 U.S Drug schedule: I: Highest abuse potential; Limited or no therapeutic use. (only use in medical necessity if at all allowed or research work) heroin, LSD, marijuana, peyote, ecstasy.
𝗈 II: High abuse and dependence potential; prescription only e.g hydromorphone, oxycodone, methadone, meperidine, fentanyl, amphetamine, cocaine
𝗈 Orders must be written, not called in
𝗈 No refills are permitted
𝗈 III: Moderate abuse or physical dependence; high psychological dependence e.g. ketamine, anabolic steroids, <15mg of hydrocodone or <90mg of codeine
𝗈 IV: Lower abuse potential e.g lorazepam, midazolam, diazepam
𝗈 V: Lowest abuse potential; available without prescription. E.g <200mg codeine/100mL cough syrup.
4. Pregnancy Categories. Recognize the differences between each category.
Teratogenic poses risks to a fetus if taken pregnant.
Category A
Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Category B
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.
Category C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Category D
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women
5. Know dtheesNpuitresep’sorteespnotniasilbirliistyksin. medication administration.
KCnoawtewghoatriys oXrdered, the name and classification
IntSentdueddieusseianndanefifmecatslsonorthhe ubmodayns have demonstrated fetal abnormalities
Coanntradi/nodrictahtieonres
is positive evidence of human fetal risk based on adverse
reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
𝗈 Special Considerations
𝗈 Side effects/adverse effects
𝗈 Why this is prescribed, how it is supplied, how it’s to be administered, safe ranges
𝗈 Nursing considerations
𝗈 NOTE: Special considerations include: how age, weight, body fat, and pathophysiological states
affect the response.
6. Rights of Drug Administration
𝗈 Right patient
𝗈 Right medication
𝗈 Right dose
𝗈 Right route
𝗈 Right time
𝗈 Right to refuse
𝗈 Right to education
𝗈 Right preparation
𝗈 Right documentation
7. Table 3.1 on p. 22 drug abbreviations.
ac- before meals PM- afternoon
ad lib- as desired / as directed PRN-when needed/necessary
AM- Morning qid- four times per day
bid- twice a day q2h-every 2 hrs (even or when first given
cap- capsule q4h- every 4 hrs (even
gtt- drop q6h- every 6 hrs (even
H or hr- hour q8h- every 8 hrs (even
IM- intramuscular q12h- every 12hrs (even
IV- intravenous Rx- take
no-number STAT- immediately; at once
pc- after meals tab- tablet
PO- by mouth * tid- three times a day. *ASAP- available 30mins of written others.
8. Define: Allergic Reaction, Anaphylactic Reaction, Adverse Reaction, Side Effect.
Allergic reaction: an acquired hyperresponse of the body defenses to a foreign substance. signs vary and may include, skin rash, edema, runny nose, reddened eyes with tering, extreme throat closes.
Anaphylactic reaction: severe allergy that involves massive, systemic release of histamine and other chemical mediators that can lead to life-threatening shock. symptoms. acute dyspnea, sudden appearance of hypotension tachycardia ff drug administration.
Adverse Reaction: undesirable reactions of drug therapy. they are usually described in terms of intensity (mild, moderate, severe, life threatening) AE- threat of death.
Side Effect: drug reaction that is expected, not life threatening.
9. Define: Drug Compliance
• drug compliance: Taking a medication in the manner prescribed by the provider or following the instructions on the label. If noncompliant, assess “why”
• factors affecting it: Cost of the drug, Forgetting doses, Annoying side effects, Self- adjusted doses, Fear of dependency.
10. be familiar with abbreviations that we covered in class. Table 3.2 on p. 23
1 teaspoon- 5ml, 1tablespoon- 15.16ml, 1k.g- 2.2lbs
11. Routes of Administration & specific key points for each route.
• Enteral
• Parenteral
• Topical
Enteral: Includes drugs given orally, nasogastric tube, or gastrostomy tube, Includes tablets, capsules, sublingual, and buccal
• tables and capsules most common
o Enteric coated/extended release must be taken whole
• Sublingual is kept in mouth and allowed to dissolve slowly
o Given after oral meds have been swallowed
• Buccal is placed between gum and cheek, allowed to dissolve
• NG tube is soft and flexible, inserted into Nares and ends in stomach
• G tube is surgically placed directly into patient’s stomach
• Both generally use liquid drugs
Topical: when applying topical drug a nurse must wear gloves.
• Intended for local effect (i.e. treatment of skin infections)
• Absorbed slowly, so fewer side effects
• Some are given for systemic effects, with slow absorption
• Dermatologic: applied to skin
• Instillations and irrigations: applied into body cavity or orifice
• Inhalations: applied to respiratory tract by inhalers, nebulizers, or positive pressure breathing
• Transdermal: Patches provide effective means of drug delivery, Rate of delivery and dose may vary, Avoids first-pass effect of liver and enzymes, Full documentation is required
• Ophthalmic administration: Treats local conditions of eye and surrounding structures, Common symptoms of problems: Excessive dryness, redness, drainage (maybe purulent), pruritis
• Otic solutions: (ear drops) Used to treat local conditions of the ear, such as infections, and blockages, Consists of drops or irrigations, Typically for cleaning purposes
• Nasal solutions: ask pt. to blow the nose first. Used for local and systemic effects, Avoids first-pass effect and digestive enzymes, Can be irritating to the mucosa, may cause damage with prolonged use, Typically used for local astringent effect
• Vaginal Medications: Used to treat local infections, relieve pain and/or itching, May be suppositories, creams, jellies, or foam, we must explain the treatment, provide privacy, and maintain patient dignity.
• Rectal medications: Used for local or systemic effect, Typically suppositories, but may be liquid (as with an enema), First-pass effect and digestive enzymes are avoided.
Parenteral Drugs. Also known as injections. Intradermal, subcutaneous, intramuscular, intravenous.*ASEPTIC technique is required, *Nurses must: Know anatomical locations, Know correct equipment, Disposal of hazardous equipment.
Locations:
• Intradermal: dermal layer of skin
• Subcutaneous: deepest layer of skin
• Intramuscular: Specific muscle
• Intravenous: directly into blood stream
• Central line: may deliver directly into body cavity or organs
• Intradermal: Avoids hepatic first-pass effect, Allows only small volumes, Can cause
pain and swelling
• Subcutaneous: Delivered into the deepest layer of skin, Used for easy access and rapid absorption, Injection sites MUST be rotated, Not typically aspirated
• Intramuscular (IM): Delivers medication into specific muscle, More rapid absorption than PO, SQ, or ID, Allows larger volumes, Site is VERY important… must avoid bone, vessels, and nerves.
• Most common sites for IM:
• Deltoid-used for vaccines, aspiration is not necessary (muscle on the shoulder side)
• Ventrogluteal- BEST site for large volumes, void of vessels and nerves. (side butt, top hip) should aspirate i.e. pulling the needle back a little.
• Dorsogluteal- can hold large volumes, sciatic nerve and great vessels run behind this muscle. must aspirate.
• Vastus lateralis- largest muscle in infants and children. must aspirate.
12. Common Protocol for administering medication
• Review order
• Wash hands and apply gloves
• Identify patient and check for allergies
• Inform and provide education to patient
• Position patient, removing from packaging
• Document after administration.
13. Sites of IM injections and specific key points for each route.
• Deltoid-used for vaccines, aspiration is not necessary. e.g. flu
• Ventrogluteal- BEST site for large volumes, void of vessels and nerves. top of hip. should
asirate. i.e pull the needle back a little.
• Dorsogluteal- can hold large volumes, sciatic nerve and great vessels run behind this muscle
• Vastus lateralis- largest muscle in infants and children. must aspirate.
14. Define types of IV infusions
• Large volume infusion: It’s for fluid maintenance, replacement, or supplementation
• Intermittent: small amounts of fluid infusing in tandem with primary large volume
fluids; used for medications such as antibiotics or analgesics, for short period.
• Bolus: concentrated dose delivered quickly via syringe, single dose medications
15. First pass effect: where the concentration of a drug is greatly reduced before it reaches circulation. Bypasses first pass effect and enzymes in parenteral. All enteral medications are subjective to first pass effect. NOTE: Drug is absorbed…enters into hepatic circulation in the liver. Metabolized to inactive form conjugates and leaves the liver. Distributed to general circulation…most are inactive by this first-pass effect
16. Rates of absorption:
* Fastest: Sublingual, IV, or inhalation. *Few cells separate the active drug from systemic circulation
* Slow: PO, IM, or SQ. *Membrane systems in the GI mucosal layers, muscles and skin delay drug passage
* Slowest: Rectal or sustained release.*May take several hours or days to reach peak levels
17. Factors affecting absorption
* Route of administration
* Drug formulation
* Drug dosage
* Digestive motility
* Digestive tract enzymes
* Blood flow at administration site
18. Distribution: involves the Transport of drugs thru the body. it is Affected by the amount of blood flow to body tissues. e.g. the heart, liver, kidneys, and brain receive most blood supply. The Physical properties of the drug influence greatly influence how it moves throughout the body after administration e.g lipid solubility how quickly a drug is absorbed, mixes within the blood stream. Certain tissue has high affinity for certain medications i.e. they accumulate and store drugs after absorption. e.g. bone marrow, teeth, eyes and adipose tissue.
* Drugs and other chemicals compete for plasma protein-binding sites
* Some drugs/chemicals have a higher affinity for protein binding sites
* Displaced drugs can reach high plasma levels…resulting in adverse effects
Barriers for distribution:
Blood-brain: Some drugs, sedatives, antianxiety, and anticonvulsants readily cross. Other drugs, antoneoplastics, antitumor meds do not, making brain tumors difficult to treat.
Fetal-placental: This prevents potentially harmful chemicals from reaching the fetus. Alcohol, cocaine, caffeine, and some Rx easily cross and harm the fetus
19. Metabolism: Also known as biotransformation. It Changes the drug to be excreted easily by the body. Metabolism involves complex biochemical reactions that alter drugs, nutrient, vitamins, and minerals. The liver is the primary site. as biochemical reaction pass through it Includes processes of hydrolysis, oxidation, and reduction. it Conjugates, addition of side chains, make drugs water soluble and more easily excreted.
Metabolism in the liver: Inactivates the drug and accelerates excretion. Some drugs are made into a MORE active state…codeine transforms to morphine. Some drugs (Prodrugs) are inactive until metabolized…Lotensin or Cozaar
20. Excretion: Removal of a drug from the body. Rate determines the concentration of drugs in the bloodstream and tissues. this is important because the concentration of the drugs in the blood stream determines their duration of action. the Primary site is the kidneys aprox. 180 L of blood is filtered each day.
Pathophysiology of excretion: Free drugs and water soluble agents are filtered.* Drug-protein complexes are filtered through renal corpuscle and reabsorbed in the renal tubule.* Nonionized and lipid soluble drugs cross renal tubules and return to circulation. *Ionized and water soluble drugs remain and are excreted.
Factors affecting excretion:
• Liver or kidney impairment
* Blood flow to organs
* Degree of ionization
* Lipid solubility
* Drug-protein complexes
* Metabolic activity
* pH
* Respiratory, glandular, or biliary activity
21. Plasma half-life: Length of time required for plasma concentration to decrease by half after administration.*the longer to be excreted, the greater the half-life.* Drugs with short half-life are typically given more often
22. Define: Loading vs. maintenance dose
Loading: is a higher amount of a drug to “prime” the bloodstream with a sufficient level of the drug. e.g given 2 pills of meds first and then maintenance is taking 1 pill the next day.
Maintenance: smaller doses to keep the plasma drug level in a therapeutic range.
23. Comparing medications: Define: Potency vs. Efficacy
Potency: a more potent drug will produce a therapeutic effect at a lower dose compared to another drug in the same category. For example Morphine and Demerol
Efficacy: magnitude of maximal response that can be produced from a particular drug. efficacy is almost more important than potency
24. Define different types of drug-receptor interactions.
* Agonist: drugs that interact with a receptor. it sometimes produce a greater maximal response than the endogenous chemical. (positive effect)
* Antagonist: drugs that resist or oppose the action of another agent. They compete with agonist for the receptor binding site. May also reverse a drug.
* Partial agonist: drug that produces a weaker response than an agonist less efficacious.
25. Steps of the Nursing process and how it relates to pharmacology
O ASSESSMENT: Systematic collection, organization, validation, and documentation of patient data. Includes: Health history information, Physical Assessment, Lab values, Assessment of medications, Therapeutic effects, Side effects
* Assessment of medications: Assess for desired response
O What is the medication supposed to do for the patient?
O Is the patient responding positively to the medication?
O Monitor for adverse effects
O What are the adverse effects to look for?
O How do you monitor for these?
O Capability of patient to self-administer. *Can the patient read the label?
O Nursing Diagnosis: clinical judgments of a patient’s actual or potential health problem that is within the nurse’s scope of practice to address. Not a medical diagnosis, it provides bases for establishing goals, outcomes, planning, interventions, and evaluating the effectiveness of the care given.
O diagnosis for drug administration : Focus on the patient’s needs, *Areas of Concern,
*Promote therapeutic drug effects, *Minimize adverse drug effects, *Maximize patient ability for self-care.
O Planning: this process prioritizes , diagnoses, formulates desired outcomes, and select nursing interventions that can assist the patient to establish an optimum level of wellness. Goals: focus on: Safe and effective administration, Therapeutic outcome, Treatment of side effects. Goals should be: Specific and measurable, Evaluate degree to which goal is met, Focus on what the client will achieve or do, Discuss with the client or caregiver.
Outcomes: Specific criteria to measure attainment of the goals, Written with a subject, action, circumstances, expected performance, and time frame. Outcomes should be SMART- Specific, measurable, attainable, realistic and time.
O Implementation: Applying the knowledge, skills, and principles of nursing to move the patient toward achieving the goals. Involves the ACTION phase: Patient teaching, Drug administration ( major) Demonstration, Assessing the patient’s response i.e. checking
vital signs, body weight and lab results, objective data.
O Evaluation: Compare the patient’s current health status with the desired outcome. * Did they meet the goal? in relation to pharmacology, it is used to determine whether the therapeutic effects of the drugs were achieved as well as whether the adverse effects prevented.
26. Medications in Pregnancy: Most medications are avoided during pregnancy
Some conditions require treatment during pregnancy
Epilepsy, hypertension, and psychiatric disorders
Antibiotics may be needed to treat infections and STIs
Conditions caused by pregnancy must be treated/managed
Gestational HTN or diabetes. Note: in all cases, health care providers must outweigh the therapeutic benefits of a given medication against its potential adverse effect.
27. Changes in pregnancy and how it affects absorption, distribution, metabolism, and excretion.
Absorption: Hormonal changes as well as expanding the uterus for Blood supply to abdominal organs affect drug absorption. Delayed gastric emptying, gastric acidity is decreased, inhaled drugs are absorbed more because of increased tidal volume and pulmonary vasodilatation….due to progesterone.
Distribution and Metabolism: Increased cardiac output, increased plasma volume, altered blood flow. Increased volume causes dilution of drugs, decreases plasma proteins. Blood flow to uterus, kidneys, and skin is increased, but flow to skeletal muscles is decreased. Lipid levels are altered, changing transport and distribution. Metabolism is increased so higher doses of drugs may be needed…anticonvulsants, hormones such as synthroid. Fat soluble drugs are passed thru breastmilk.
Excretion: By third trimester increased urine output by over 50%, increased filtration and GFR increases excretion and higher doses may be needed and also doses of meds may be adjusted.
28. Key points for medications taken during lactation: Most drugs are secreted in breast milk; however, few cause injury to the infant. *Meds that are completely contraindicated during lactation usually have a safer alternative available.*Medications should only be given if the benefit to the mother clearly outweighs the risk to the infant.
29. Key points for medication administration across the lifespan
-Infants, Toddlers, School age (3-5 vs. 6-12), Adolescence, Young & Middle Adults, Late Middle Age, Older Adults.
Infants: Birth to 12months. IM should be in the vastus lateralis
Volumes <1mL can be given with a TB syringe
Rotation of injection sites (leg to leg) should be done to avoid overuse and prevent inflammation and excessive pain
IV sites can be found in the feet and scalp, and are usually easily accessible
Toddlers: ages 1-3yrs. Give short, concrete explanations and follow immediately with administration
Oral meds can be mixed with small amounts of jam, syrup, or fruit puree…follow with carbonated beverage or mint candy
IM meds should be given in vastus lateralis
IV meds should be given into a patent, secure site. Parent teaching is required to help with adherence.
School children: btwn ages 3-5yrs for preschool and 6-12yrs for school age.
Chewable tablets are easily taken, some may be able to swallow tablets or capsules
IM injections are usually given in ventrogluteal sites.
Adolescence: btwn ages 13-16. Treatment includes teaching parents to maintain meds out of sight and the signs of drug abuse by teens . Concerns during adolescents.
Initiation of sexual activity, avoidance of pregnancy and STIs
Eating disorders- use of laxatives and appetite suppressants
Alcohol, tobacco, and illicit drug use
Need for privacy and confidentiality; state laws differ
Young and middle adults: Ages btwn 18- 24. *Absorption, metabolism, and excretion are at their peak
Little medication is used except for chronic disease
Compliance is usually positive
Substance abuse is more common in the 18-24 ages
Rx (prescription) for treatment of STIs is very common
Late Middle age: btwn 40- 65 yrs Health concerns start to arise: cardiovascular disease, HTN, obesity, arthritis, cancer, and anxiety
Use of drugs to treat these conditions is common
Respiratory disorders related to tobacco use may begin to be common
Older Adults: btwn over 65yrs.Age related physiologic changes alter therapeutic and adverse effects
Treatment of chronic health problems is common and more drugs are used to treat
Polypharmacy is a concern- taking multiple medications concurrently
Using multiple providers and pharmacies can make polypharmacy worse
30. Age effects on drugs:
Absorption: it is slower in older adults due to diminished GI motility and decreased blood flow to digestive organs. Because of increased gastric pH, oral tablets and capsules that require high levels of acid for absorption may take longer to dissolve and therefore take longer to become more available to the tissues.
Distribution: Increased body fat is a storage area for lipid soluble drugs and vitamins…plasma levels are reduced…therapeutic response is less
Dehydration is dramatic due to decreased body water…increased concentration of water soluble drugs
Older liver produces less protein binding plasma, so free drugs circulate
Decreased cardiac output and less efficient circulation slows distribution
Metabolism: Liver produces less enzymes, visceral blood flow is diminished resulting in reduced hepatic metabolism
Excretion: Older adults have Reduced renal blood flow, GFR, tubular secretion, and nephron function decreases excretion by the kidneys…leads to higher serum drug levels and potential for toxicity
Lower dosages and less frequent administration may be helpful
31. Understand influence of psychosocial, spirituality, and religious beliefs on perception of illness & outcomes of therapy.
Psychosocial: social and psychological aspect of a person
Spirituality: incorporates the capacity to love, convey compassion, give and forgive, enjoy life, and find peace and fulfillment
Each overlaps and should be evaluated to provide an affective, holistic plan of care
Spiritual/religious beliefs greatly influence perception of illness and outcomes of therapy
32. Techniques to help establish trusting nurse-patient relationship.
Trivializing the limitations of pharmacotherapy or minimizing potential adverse effects can cause the patient to have unrealistic expectations regarding treatments.
This may jeopardize the nurse-patient relationship.
The patient has an ethical and legal right to receive accurate information regarding the benefits and effects of drug therapy.
33. Gender differences.
Male: Seek care for heart related issues more readily, *Adherence is lessened due to side effects,
i.e. impotence and HTN med.
Female: Pay attention to health patterns,*Seek care earlier, *Disease thought to be mainly women’s issues.
34. Define: Medication Error- Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care provider, patient, or consumer
Error index: categorizes medication errors by evaluating the extent of harm an error can cause.
35. Contributing factors to medication errors. Healthcare providers:
Omit one of the 5 rights…incorrect dose, not the ordered dose, wrong drug
Failing to perform a system check…pharmacist and nurse check the order before administering
Failing to account for variables such as age of patient, body size, renal or hepatic impairment
Giving meds based on verbal orders or phone orders…may be misinterpreted
Giving meds based on an incomplete or illegible order when nurse is unsure.
Practicing under stress or with multiple high acuity patients
Patients:
Seeing multiple providers pharmacies, not sharing complete list of drugs
Not filling or refilling medications
Taking medications incorrectly
Taking leftover meds or something prescribed for another condition
For BINGO in class on Monday be prepared by knowing the following definitions: STAT Pharmacodynamics Pharmacokinetics Deltoid Agonist
Antagonist
First Pass Effect Loading Dose Blood Brain Barrier (BBB) Generic PRN
Enteral Potency Efficacy Medication Error Side effect IV Bolus
Trade Excretion Anaphylaxis Pharmacotherapeutics Addiction
Therapeutic Sustained Release Pharmacologic Class Withdrawal Therapeutic Class
Maintenance Dependence Category D Intradermal Distribution Adverse Effect
Category B [Show Less]