Nur 203 Study Guide 1

1. Explain the interdisciplinary nature of pharmacology to ensure safe medication administration. Use of drugs to diagnose, prevent, or treat disease processes/suffering Medications can either: Improve Quality of Life Produce Devastating Consequences 2. Compare and contrast pharmacology and therapeutics. a. Pharmacology:

The study of medicine. i. Understanding how drugs are administered, to where they travel in the body, to the actual responses produced. b. Therapeutics: branch of medicine concerned with the prevention of disease and treatment of suffering c.Pharmacotherapy: application of drugs for the purpose of disease prevention and the treatment of suffering.

Use of drugs to diagnose, prevent, or treat disease processes/suffering 3. Identify the role of the FDA in U. S. drug regulations and drug approval process. a. Exercises control over prescription and OTC drugs b. Seeks to provide clear information for safe use c. All labs must obtain FDA approval before a drug can be marketed.

d. Testing phases include: i. Preclinical investigation: involves extensive laboratory research. Tests are performed on human and microbial cells cultured in lab.

Important because allows predictions to be made whether drug will harm human. Results are always inconclusive. ii. Clinical investigation: takes place in three different stages termed clinical phase trials. 1st: tests performed on healthy volunteers to determine dosage and assess for adverse effects. 2nd: involve large groups with the disease. 3rd: involve 1,000 to 3,000 patients in hospitols and clinical agencies. iii. Review of the New Drug Application: The drug brand name is finalized. Clinical phase 3 trials may continue depending on the results obtained preclinical testing.

By law, the FDA is permitted 6months to initially review an NDA. If approved, process continues to final stage. If rejected, the process is suspended until noted concerns are addressed by company. iv. Postmarketing surveillance: the final stage of the drug approval process begins after clinical trials and the NDA review have been completed.

Purpose of this stage is to survey for harmful drug effects in a larger population. Some adverse effects takes longer to appear and not identified until a drug is circulated to large number of people. 4. Identify advantages/disadvantages of prescription and over-the-counter medications.

a. Advantages of Prescription: requiring authorization. Physician can examine patient and determine specific diagnosis. Maximize therapy by ordering proper drug for the patients condition, and by conveying amount and frequency of drug. HCP can teach patient proper use of drug and potential side effects.

b. Advantages of OTC: obtained more easily. NO appointment with a physician is required. c. Disadvantages of OTC: choosing proper drug for a specific problem can be challenging. OTC drugs may react with foods, herbal products, prescriptions, or other OTC drugs.

Also OTC drugs can cause impairing to ability to function safely. Self-treatment is sometimes ineffective and the potential for harm may increase if the disease is allowed to progress. 5. Describe the role of the U. S. DEA in management of controlled substances. a. Hospitols and pharmacies must register with the DEA and then use their assigned numbers to purchase scheduled drugs.

Hospitals and pharmacies must keep complete records or all quantities sold and purchased. Drugs with higher abuse potential have more restrictions. The DEA regulates and monitors drug use so no one can abuse controlled substances.

6. Identify chemical, generic, and trade names of medications. a. Chemical: assigned name using standard nomenclature established by the IUPAC. Drug has only one chemical name. Example for diazepam: 7-chloro-1,3-dihydro-1,5-phenyl-2H-1,4-benzodiazepin-2-one. b. Generic name: is assigned by the US adopted Name council. One generic name for each drug.

Health care providers generally use this name. c. Trade name: is assigned by the company marketing the drug. Name is usually short and easy to remember. Product or brand name. Drugs can have multiple trade names. 7.

Describe the application of the nursing process in safe medication administration. Assesment, diagnosis, planning, implementation, evaluation. 8. Describe the application of the 6 rights in medication administration.

Right patient Right medication Right dose Right route Right time of delivery Right documentation 9. Comprehend terminology associated with medication orders. 10. Identify components of pharmacokinetics and influential factors related to absorption, distribution, metabolism, and excretion of drugs. Pharmacokinetics is the enzymatic activity that changes a medication to be less active.

How drugs move within the body. What the body does to the drug. How the body deals with medications Absorption: process involving the movement of a substance from its site of administration, across body membranes, to circulating fluids. Distribution: involves transport of pharmacologic agents throughout the body.

The simplest factor determining distribution is the amount of blood flow to body tissues. The heart liver kidneys and brain receive the most blood supply. Skin bone and adipose receive a lower amount thus it is harder to deliver high concentration of drugs to these areas.

Metabolism: process of chemically converting a drug to a form that is usually more easily removed from the body. Excretion: Drugs are removed from the body by this process. 11. Explain the purpose of loading doses, half-life, and maintenance doses. Loading doses: is a higher amount of drug often given only once or twice to “prime” the bloodstream with a sufficient level of the drug.

The reason for this is so that the plateau may be reached faster. Important for drugs that have prolonged half lives and for situations in which it is critical to raise drug plasma levels quickly.

Maintenance doses: are given to keep the plasma drug concentration in the therapeutic range. Half-life: Time for the serum drug concentration to decrease by 50%, determined by metabolism and excretion 12.

Explain therapeutic safe index. Therapeutic index: median lethal dose LD50/median effective dose ED50. The larger the difference between the two doses, the greater the therapeutic index. The higher the value the safer the medication. So if it has an index of 4. It means that you would have to have 4 times the effective does for it to be lethal. 13.

Discuss practices to safely administer medications to adult and geriatric patients. Polypharmacy: taking of multiple drugs concurrently. Patients visit multiple physicians and use different pharmacies and may not be aware of what else the patient is taking. The nurse should offer the patient the same degree of independence and dignity that would be offered to adults unless otherwise indicated.

Patients need to understand why they are receiving a drug and what outcome are expected. Accomidations should be made is there are hearing or visual impairments. Alarmed pill containers, medicine management boxed.

14. Describe holistic aspects of medication administration. The holistic context to better understand how establish risk factors such as age, genetics, biologic characteristics, personal habits, lifestyle, and environment increase a persons likelihood of acquiring specific diseases. It is important to examine and explain how these tings influence pharmacotherapeutic outcomes.

15. Discuss cultural considerations associated with pharmacology. Dietary considerations, Alternative therapies, Beliefs about health/disease 16. Discuss the role of the nurse in teaching patients about medications. Module 2.

1. Define medication errors -any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. 2. Identify factors that contribute to medication errors. Omitting one of the right of drug administration.

Common errors include given incorrect dose, not ordered dose, and giving wrong drug. Failing to perform an agency system check. Both parmacy and nurses must collabortate on checking the accuracy and appropriateness of drug orders prior to administering drugs to patients.

Failing to account for patient variables such as age body size, and impairment in renal or hepatic function. Giving medications that are not written down but given verbally or over phone. Giving meds based on incomplete or an illegible order. Practicing under stressful work conditions. 3. Discuss the impact of medication errors are the most common cause of morbidity and preventable death within hospitals. Patients stay longer in hospital. Nurse or physician faces embrassement. There is no acceptable rate for medication errors. 4. Identify method to avoid medication errors.

A: ask patient all allergies to food, medications, current health concerns and use of OTC and herbal supplements. Asses kidneys, liver, and other body system functioning. D: P: minimize fat ors that contribute to medication errors: avoid using abbreviations that can be misunderstood, question unclear orders, do not accept verbal orders, and follow specific facility policies. I: be aware of and eliminate possible distractions during medication administration that could result in an error. E: asses the patient for expected outcomes and determine if any adverse effects have occurred. 5.

Identify agencies and Web sites focused on safe medication administration. FDA safety informationi and adverse even reporting system is MedWatch. Institute for Safe Medicine Practices (ISMP). MEDMARX is the US pharmacopeias anonymous medication error-reporting program used by hospitals. 6. Discuss the role of herbal and alternative therapies. —Increased use:::::Natural, media push, self treatment.

The FDA does not have a say in many of these meds 7. Identify components of effective patient teaching related to medications.

8. Explain addiction and dependence. -addiction: is an overwhelming compulsion that drives someone to take drugs repetitively, despite serious health and social consequences. -dependence: —Physical Dependence ?Withdrawal symptoms once substance removed —Psychological Dependence ?Intense craving and desire for substance without withdrawal symptoms —Withdrawal Syndrome ?Symptoms minimized with medications —Tolerance ?

Adaptation to substance after repeated use 9. Discuss considerations needed to safely administer medications to patients with addictions. The nurse must be aware that the patient may have HIV if was addicted to something that was shot up. Also she must disapprove of substance abuse. A list of scocial help should be provided for the patient.

If possible attempt to involve family. Educate patient of long term consequences. 10. Identify medications likely to produce dependence. CNS depressants such as barbiturate, non barbiturate sedative-hypnotic, benzodiazepines-for anxiety, alcohol, and opiods. Sedatives- sleep disorders and forms of epilepsy. 11. Discuss the role of the nurse in emergency preparedness for bioterrorism.

12. Identify treatment for anthrax, viruses, and the role of the CDC in bioterrorism. Ciprofloxacin, doxycycline and penicillin are FDA-approved for the treatment of anthrax in adults and children. 13. 14.

Here are some important tips to remember when converting from one metric unit to another … [mg]-to-[grams], [liters]-to-[ml], [cm]-to-[mm], etc … 1) First thing to ask yourself is … “what is the relationship between the two different units? ” Here …

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1. How were psychoactive drugs defined in the lessons? * Psychoactive drugs: Chemical substances that effect thoughts, emotions and behavior 2. What is pharmacology? * Pharmacology: The study of the mechanisms by which drugs (chemical substances) interact with living systems …

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