1. Define the signs of adverse reactions- iatrogenic and idiosyncratic reactions *Adverse reactions- any unexpected, unintended or excessive response to a medication given at therapeutic dosages (opposed to an overdose) *Latrogenic- an adverse reaction caused by the actions of a prescriber, healthcare professional, or other specific treatment *Idiosyncratic- an adverse reaction that is abnormal/unexpected to a medication (other than an allergic) that is peculiar to the individual 2. Steps of the nursing process- what is done by the nurse in each phase.
*Assessment-Collect data, review, analyze objective (senses)&subjective (patient description) data *Diagnosis-what is wrong with the patient and why(“as evidenced by”) *Planning- goals, outcome criteria, time frame, must be objective and realistic *implementation-Taking steps needed to reach goal set forth by the patient. *Evaluation-Have the goals been met? Evaluation of progress made 3. Factors involved with the timing of drug dosages- with relationship to meals *pay attention to order, medication directions (effects of the drugs in relation to meals), patients current condition, caution to possible interactions 4.
Define terms – * bioavailability- A measure of the extent of drug absorption for a given drug & route (0-100%) *synergistic effect- interactions that effect the combination of 2 or more drugs with similar actions is greater than the effects of the drugs given alone *bioequivalent-2 medications have the same bioavailability &same concentration of active ingredient(generic VS name brand) 5. Define adverse drug reactions with relationship to drug allergies *Adverse drug reaction is an allergic reaction to a drug that involves the patients immune system.
Immunoglobulin’s recognize the drug as a dangerous foreign substance, which trigger an immune response by binding to the drug in an attempt to neutralize it. Also, various chemical mediators (histamine) begin to cause inflammatory response 6. Define and describe the First Pass Effect in relation to the route of medications *First pass effect- the metabolism of a drug & its passage from the liver before reaching the systemic circulation. A drug given orally may be extensively metabolized by the liver before reaching the systemic circulation 7.
Describe factors in drug pharmacokinetics- * absorption- i. enteral route- route in which the drug is absorbed into the systemic circulation through the mucosa of the stomach and/or small/large intestine ii. parenteral route- Route in which the drug is absorbed into the circulation by means OTHER THAN THE GI TRACT ( most common is in the form of injection (IV, IM, subcut, ID, intrarterially, intra-thecally, intra-articularly) iii. topical route- applying the drug to various body surfaces (delivers drug over long period of time (skin, eyes, nose, lungs, rectum, vagina)
* distribution- the transport of a drug by the bloodstream to its site of action. Area with high blood concentration get distribution first. i. albumin is the most common blood protein that carries the majority or protein bound drug molecules. *metabolism-Biochemical alteration of a drug into an inactive metabolite, a more soluble compound or more potent metabolite, or less active metabolite * excretion- the elimination of drugs from the body. Primary organs-kidneys. Others are liver and bowel 8. Define and describe enzyme action and receptor action in pharmacodynamics
*Receptor Action-Selective joining of the drug molecule with a reactive site of a cell or tissue. A drug becomes bound to the receptor through the formation of chemical bonds between receptors on the cell and active sites on the drug molecule.
Agonist- a drug binds to stimulates the activity of one or more receptors in the body Antagonist (inhibitors)- a drug that binds to and inhibits the activity of one or more receptors in the body *Enzyme Action- occurs when the drug chemically binds to an enzyme molecule in such a way that it alters the enzymes’ interaction with its normal target molecules in the body 9. half-life and what it means to the action of the drug in the body.
*Half life- Time required for 50% of a given drug to be removed from body 10. Describe the fetal circulation of medications in the stages of development in the first and last trimester and what it means for the effects of drugs *the fetus is at greatest risk of a drug-induced developmental defects during 1st trimester, because fetus undergoes papid cell proliferation &skeletal,muscle, limb & visceral organ development at the most rapid rate.
*last trimester the greatest % of maternally absorbed drug gets to the fetus 11. What are the drug categories A, B, C, D and X for pregnancy *A- no risk to human fetus *B- no risk to animal fetus, human info NOT available *C- Adverse effects reported in animal fetus, NO human info.
*D- possible fetal risk in humans reported, HOWEVER, consideration of potential benefit VS. risk may warrant drug in pregnant women *X- Fetal abnormalites reported & positive evidence of fetal risk in humans, PREGNANT WOMEN SHOULD NOT USE 12. What are factors in accurate dosages in pediatric patients- age, wt, BSA.
*BSA adult ? BSA child X adult dose= estimated child dose * skin is thinner *Stomach lacks acid to kill bacteria *Body temp is less well regulated and dehydration occurs easily 13. What are geriatric consideration in medication administration- *gastric ph- is less acidic because of a gradual reduction in the production of *hydrochloric acid in the stomach *micosomal enzymes-levels are decreased because the capacity of the gaining liver to produce them is reduced * fat content – is increased because of decreased lean body mass * nephrons-# of intact nephron is decreased.
14. What are the “scheduled” medications in relationship to analgesics *C-II- High abuse potential, accepted medical use, severe physical/psychological dependency potential *C-III-Less abuse potential than CII, Accepted medical use , Mod-Low physical or high psychological dependency potential * C-IV- Less abuse potential than CIII, accepted medical use, limited physical or physiological dependency potential 15. What are the primary cultural practices and considerations in medication administration with : * African-folk medicine, “root workers” as healers.
* Hispanic-view health as a result of luck, use hot/cold remedies *Native American-bad spirits=disease, harmony with nature * Asian- traditional medicine, use herbalists and physician in their healthcare 16. What are the factors in the prevention medication errors-with regard to verbal and telephone orders * minimize the use of verbal& telephone orders.
If used, be sure to repeat the order slowly and clearly 17. ID Erickson’s stages of development- what are their specific developmental task *Infancy(birth-1year):trust vs mistrust. infant learns to trust himself, others & the enviroment, learns to be loved.
*Toddlerhood(1-3yrs)-Autonomy vs shame/doubt. Toddler learns his independence, learns to mast the physical environment & maintains self-esteem *Preschool Age(3-6yrs)Initiative vs Guilt. Preschooler learns basic problem solving; develops conscience and sexual identity, initiates activities as well as imitate *School Age (6-12yr) Industry vs Inferiority. school aged children learns to do things well, develops a sense of self worth *young adult(18-45 yr)intimacy vs isolation. person establishes deep and lasting relationships, learn to make commitment as a spouse/parent/partner.
*Middle adult (45-65yr) Geravity vsStagnation. Adult learns commitment to community and world, productive in career, family and civic interests *Older adult(65+) Integrity s Despair. Older adult appreciates life role and status , deals with loss and prepares for death. 18. Identify adrenergic side effects of, uses of and appropriate nursing diagnosis for albuterol (Proventil)- with regard to vital signs and use in nebulizer and inhaler Brethine (terbutaline) patient teaching, and Serevent (salmeterol) – rescue medication or maintenance medication. **DHB** 19.
Identify the patient teaching and nursing implications for the following medications * Intropin (dopamine)pg. 487- why is it used and what does it do * pseudoephedrine (Afrin)pg. 1281- rebound effect * Arocept (donepezil. 486)- effectiveness –family teaching **DHB** 20. Identify drug used in anaphylactic shock, cardiac and asthma *ANDRENERGIC DRUGS: * ventolin (albuterol) * Primatene (epinephrine) * Serevent (Salmeterol) * Brethine (terbutaline) * Afrin (psuedoephedrine) * Intropin (dopamine) * Adrenalin (epinephrine) * Isuprel (isoproterenol) * Neo-synephrine( phenylephrine).
* Cause bronchodialiation, nasal decongestant/vasoconstriction, opthalmic congestion, very potent cardio-selective or vasoactive sympathomimtic or cardiac stimulation 21. What are catecholamines and what effects do they have in the body *Substances that can produce a sympathomimetic responnse.
They are eitherendogenous catecholamines (IE:epinephrine, norepinephrine and dopamine) or synthetic (ie:dobutamine) 22. What are the uses of Adrenalin (epinephrine) *DHB pg. 537 23. Measures to take if Intropin (dopamine) IV infiltrates – what drug would you use to treat the infiltration?
*area should be infiltrated with 10-15 mL of saline containing phentolamine 5-10 mg (adrenic blocking agent) 24. Contraindications for Erogotamine (Ergostat)- who can not take this drug *CVD, atherosclerosis (=stroke), PVD, CAD, Sepsis, impaired hepatic/renal function, severe HTN, pregnancy 25.
Uses, patient teaching and side effects for betablockers: Tenormin (atenolol)- withdrawal side effect, metoprolol (Lopressor) – patient cautions, and prazosin (Minipress) what time of day is best to take it and what precautions need to be given.
*atenolol-pg125*Metoprolo-pg. 978 *prazosin -pg 1241 26. Uses and side effects for Antilirium (physotigmine)- *pg1199 27. Urecholine (betanechol) what are the effects of this for the patient *pg 173 Mestinon (pyridostigmine) when is it best used. – *pg 1286 28. Patient teaching for Aricept (donepezil) realistic expectations -* pg486 29. Side effects of atropine sulfate- and its effect on the heart- *pg134 DHB, most common – dry mouth, urinary hesitancy, headache, flushing, constipation, heartburn, nausea, vomiting 30.
Patient teaching for Detrol (telerodine) anticholenergic effects in elderly in the heat *cholinergic blocking agent: risk for injury due to loss of normal heat-regulationg mechanism and decrease in sweating which may cause heat stroke 31. Nursing implications for patients on Robinul (glycopyrrolate)- most commonly used in PREOP to reduce saliva and excessive secretion in GI and Respiratory tracts why is it used *peptic ulcer disease, IBS, Gi hyper-secretory states, surgery, anispasmatic, decrease dry secretions from nose, mouth, pharynx, and bronchi.