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Pharmacology for Nurses. A Pathophysiologic Approach
Adams - Holland - Urban (Unit 1) Exam With Complete
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Pharmacology - answer Study of medicine; how drugs are administered; where drugs travel in the body, Response that drugs produce. drug - answer A chemical substance that is taken to cause changes in a person's body or behavior medication - answer A substance that is used to treat or prevent disease or relieve pain. biologics - answer agents naturally produced in animal cells, in microorganisms, or by the body itself Mechanism of Action - answer how a drug produces its physiological effect in the body Bioavailability - answer the extent to which the body can absorb and use a nutrient Therapeutic classification of drugs: - answer Based on what the drug does clinically Pharmacologic Classification - answer Based on the drug's mechanism of action, or how the drug produces its effect Most Drugs have three names - answer Chemical, Generic, Trade (CHEMICAL: (1/2)-2-(p- isobutylphenyl) propionic acid; GENERIC: ibuprofen; TRADE: Motrin) Generic vs. Trade-Name Drugs - answer Trade name drugs with exclusive rights cost more. When rights end, competing companies offer generic form cheaper prescription drugs - answer Drugs legally available only with a physician's order. Over the counter drugs (OTC) - answer can be purchased without a prescription Black Box Warnings - answer One of the primary alerts for identifying extreme adverse drug reactions discovered
during and after the review process; 1997 FDA created "Black Box Warnings" Contraindications - answer factors that prevent the use of a drug or treatment why should healthcare professionals be concerned about patients taking herbal medicines? - answer patients could be putting themselves at risk, potential herb-drug interactions U.S. Pharmacopoeia (USP) - answer 1820; 1st comprehensive publication formulary used in the U.S.; drug purity, strength, and directions for synthesis. USP and National Formulary (NF) - answer 1852-1975, two drug standards in the US by the American Pharmaceutical Association (APhA). 1. USP - all drug products. 2. National Formulary (NF) - pharmaceutical ingredients. U.S. Pharacopoeia -National Formulary (USP-NF) - answer 1975 merged into a single publication Biologic Control Act - answer 1902 standardized serum and blood-related products Pure Food and Drug Act - answer 1906 - Established government control (FDA) for labeling medicines Shirley Amendment - answer 1912 - Prohibited drugs labeled with false therapeutic claims Food, Drug, and Cosmetic Act (1938) and amendments - answer 1938- Thorough testing of drug; Proof of safety and efficacy of drug Dietary Supplement Health and Education Act, 1994 - answer 1994-Controls misleading industry claims Four Stages of Approval for Therapeutic and Biologic Drugs - answer 1. Preclinical
Allergic Reactions - answer a condition caused by an overreaction of the body's immune system Anaphylaxis - answer Life threatening allergic reaction Five Rights of Drug Administration - answer 1. Right patient
- Right medication
- Right dose
- Right route of administration
- Right time of delivery Right documentation Three Checks of Drug Administration - answer 1. Checking drug with MAR (medical administration record) or medication information system when removing it from storage
- Checking drug when preparing it
- Checking drug before administering it to the patient Drug Compliance - answer taking a medication in the mannerprescribed by the health care provider ac - answer before meals ad lib - answer as desired/as directed
AM - answer morning bid - answer twice a day cap - answer capsule gtt - answer drop h or hr - answer hour IM - answer intramuscular IV - answer intravenous no - answer number pc - answer after meals, after eating PO - answer by mouth PM - answer afternoon PRN - answer when needed/necessary
- Use aseptic technique when preparing and administering parenteral medications
- Identify patient (two forms of ID)
- Ask patient about known allergies
- Inform patient about drug
- Position patient
- Remove prepackaged drug at bedside
- Unless instructed to do so, do not leave drugs at bedside
- Document administration and pertinent patient responses Pharmacokinetics - answer The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. Four Categories of Pharmacokinetic Processes - answer 1. Absorption -Movement from site of administration, across body membranes, to circulating fluids. Primary pharmacokinetic factor determining length of time for drug to produce effect.
- Distribution - transport of drugs throughout the body. Simplest factor determining distribution is the amount of blood flow to body tissues.Physical properties of drug have great influence. Certain tissues (bone marrow, teeth, eyes, adipose tissue) have a high affinity, or attraction, for certain medications. Many drug molecules form drug protein complexes-binding reversibly to plasma proteins and thus never reach target cells.
- Metabolism (aka -biotransformation) -Chemically converts drug so it can be easily removed from body. Involves complex biochemical reactions. Liver — primary site. Addition of side chains, known as conjugates, makes drugs more water soluble and more easily excreted by the
kidneys.
- Excretion -how drugs are removed from the body. Rate at which medications are excreted determines the concentration of the drugs in the bloodstream and tissues. ** Oral Drugs Enter Hepatic Portal Circulation (First-Pass Effect) - answer 1. Drug is absorbed
- Drug enters hepatic circulation, goes to liver
- Drug is metabolized to inactive form
- Drug conjugates and leaves liver
- Drug is distributed to general circulation
- Many drugs are rendered inactive by first-pass effect Excretion of Medications - answer 1. Primary Site of Excretion of Drugs Is Kidneys
- Free drugs, water-soluble agents, electrolytes, and small molecules are easily filtered
- Drug-protein complexes and large substances are secreted into distal tubule of nephron
- Secretion mechanism is less active in infants and older adults Enterohepatic Recirculation of Drugs - answer Drugs are excreted in bile. Bile recirculates to liver. Percentage of drug may be recirculated numerous times. Prolongs activity of drug Drug Plasma Concentration and Therapeutic Response - answer Concentration of medication at target tissue is often impossible to measure, so it must be measured in plasma minimum effective concentration - answer amount of drug required to produce a
Agonist - answer a molecule that, by binding to a receptor site, stimulates a response partial agonist - answer Medication that produces a weaker, or less efficacious, response than an agonist. Antagonist - answer competes with the agonists for binding at receptor site Pharmacodynamics - answer The process by which a medication works on the body. Therapeutic Index - answer Measure of a drug's safety margin. The higher the value, the safer the drug. The Nursing Process - answer Assessing - Collect data; organize data, validate date, document data Diagnosing -analyze data; identify health problems, risks, and strengths; formulate diagnostic statements Planning - Prioritize problems/diagnoses; formulate goals/desired outcomes; select nursing interventions; write nursing interventions Implementing - Reassess the patient; determine the nurse's need for assistance; implement the nursing interventions; supervise delegated care; document nursing activities.
Evaluating - Collect data related to outcome; compare date with outcome; relate nursing actions to patients goals/outcomes; draw conclusions about problem status; continue, modify, or terminate the patient's care plan Assessment of the Patient - answer 1. Systematic collection, organization, validation, and documentation of patient data
- Health history and physical assessment
- Baseline data gathered; will be compared to later information from observations
- Once pharmacotherapy is initiated, assessment focuses on reaction to medication. Watch for: desired response, adverse effects, patient capability of assuming responsibility for self-administration Nursing Diagnoses for Drug Administration - answer 1. Often most challenging part of nursing
- Focus is on patient's needs, not nurse's
- Three main areas of concerns
- Promoting therapeutic drug effects
- Minimizing adverse drug effects and toxicity
- Maximizing patient ability for self-care (including knowledge, skills, and resources necessary for safe and effective drug administration) Nurse Planning Phase - answer 1. Planning
- Prioritizes nursing diagnosis
- Formulates desired outcomes
- Selects nursing interventions that can assist patient to establish an optimum level of wellness.
- Name (generic trade) & drug classification
- Intended or proposed use
- Effects on the body
- Contraindications
- Special consideration
- Side effects
- Why the medication has been prescribed for this particular patient
- How the medication is supplied by the pharmacy
- How the medication is to be administered, including dosage ranges
- What nursing process considerations related to the medication apply to this patient Drug Administration - answer In order to prepare and administer drugs, it is imperative that you understand and follow the "Six Rights of Medication Administration" • Right dose - In order to avoid medication errors, always complete three checks when preparing medications
- When reaching for the container
- Immediately before preparing the dose
- When replacing or discarding the container • Right Route -Medications must be administered in the form and via the route specified by the prescriber.
Right Time - The prescriber will indicate when and how often a medication should be administered.
- Medications can be ordered once a day (daily), twice a day (b.i.d.), three times a day(t.i.d.), or four times a day (q.i.d.). Right Patient - Before administering any medication, it is essential to determine the recipient's identity. At least two identifiers are required by the Joint Commission
- the patient identification bracelet information
- verbalization of the patient's name by the patient or parent
- patient's hospital number or patient's home telephone number. Right Documentation
- Always document the name and dosage of the drug, as well as the route and time of administration, on the MAR.
- Sign your initials immediately after, but never before, the dose is given and include any relevant information:
- patient allergies to medications
- heart rate (when giving digoxin)
- blood pressure (when giving antihypertensive drugs) Drug Label
- Mycobutin (rifabutin)
Medication orders (drug orders, physician's orders) - answer are directives to the pharmacist for the drugs used in a hospital or other healthcare facility. Orders are written in the sequence: drug name, dose, route, frequency -Written -Verbal -Routine -Standing -PRN -STAT Medication Orders - answer Date and time are necessary when an order is written.
- Many institutions use military time, which is based on a "24 hour clock" that does not use a.m. or p.m. Medical Administration Record - answer The MAR is a form that health care facilities use to document all of the drugs administered to a patient. Patient/Caregiver Factors Contributing to Medication Errors - answer • Taking drugs prescribed by several practitioners
- Getting prescriptions filled at more than one pharmacy
- Not filling or refilling prescriptions
- Taking medications incorrectly •Taking medications that may be left over from a previous illness
- Taking medications prescribed for someone else
Reporting and Documenting Medication Errors - answer • Utilize and incident report
- Documentation in medical record must include specific nursing interventions implemented after the error to protect the patient
- Document all individuals notified of error
- Give details of what medication was given or omitted in medication
- administration record (MAR) Sentinel Events - answer • Unexpected occurrences involving death or serious physical or psychological injury, or risk thereof
- Always investigated
- Interventions to ensure no repetition
- Root cause analysis (RCA) seeks to prevent another occurrence by asking what happened and why, and what can be done to prevent it Holistic Approach - answer ◦ Each person: integrated biological, psychosocial, cultural, communicating whole person ◦ If patient believes treatment is important and beneficial, it often is more effective Ethnicity and Culture - answer - Set of beliefs, values, and norms that provide meaning for an individual or group ◦ Cultural Competence
- Ability to provide care to people with diverse values, beliefs, and behaviors, including ability to adapt delivery of care to meet needs of these patients
Examples of Herbal Supplements - answer ◦ Garlic - hypercholesterolemia ◦ Soy ◦ St. John's wort - Depression ◦ Cranberry ◦ Ginseng ◦ Stevia ◦ Horse chestnut seed extract - chronic venous insufficiency ◦ Plant sterols & stanols - hyperlipidemia ◦ Hawthorn - hypertension ◦ Valerian - insomnia ◦ Devil's claw, white willow bark - Low back pain ◦ Ginkgo biloba - memory impairment ◦ Black cohosh, St. John's wort - menopausal symptoms Dietary Supplement Health and Education Act of 1994 (DSHEA) - answer ◦ Regulatory act for dietary supplements ◦ Less rigid than the Food, Drug, and Cosmetic Act (FD&C Act) ◦ Dietary supplements are exempted from FD&C Act standards ◦ Gives Food and Drug Administration power to remove products considered harmful Food, Drug, and Cosmetic Act - Definition of Dietary Supplements - answer ◦ Products
intended to enhance or supplement the diet ◦ Botanicals ◦ Vitamins ◦ Minerals ◦ Metabolites Dietary Supplement Health and Education Act of 1994 (DSHEA) - answer ◦ Regulatory act for dietary supplements ◦ Less rigid than the Food, Drug, and Cosmetic Act (FD&C Act) ◦ Dietary supplements are exempted from FD&C Act standards ◦ Gives Food and Drug Administration power to remove products considered harmful "Natural" Does Not Always Mean Safer - answer ◦ Some active chemicals are the same as in prescription and OTC medications ◦ Substituting alternative therapy for established medical treatment may prolong condition Nurse Responsibility on herbal supplements - answer ◦ Watch for herbal products with ingredients that interact with prescription drugs ◦ Ask questions and obtain medical histories
