Koofers

Test 1 Ch 5-12 - Flashcards

Flashcard Deck Information

Class:NURS 360 - Pharmacology
Subject:Nursing
University:Radford University
Term:Fall 2011
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Pharmacodynamics a medicine changes the body
Single patient drug response

Graphically visualizes differences in responses to medications in a single patient

Graded Dose-Response Curve Phase 1

occurs at lowest dose

Few target cells affected by drug

Graded Dose-Response Curve Phase 2

linear relationship

Most desirable range

Linear relationship between amount of drug administered and degree of client response

Generated by Koofers.com
Graded Dose-Response Curve Phase 3

plateau reached

Increasing dose has no therapeutic effect

Increased dose may produce adverse effects

It means because all the receptors for the drug are occupied

Potency

Drug with higher potency produces a same therapeutic effect at a lower dose, compared with another drug in the same class


Agonist

Bind to cellular receptor

Produce same response as endogenous chemical

Sometimes produce greater maximal response of normal activity of the target cell


Antagonist

Occupy cellular receptor

Prevent endogenous chemical from acting

Compete with agonist for receptor

Generated by Koofers.com
SOAPE Assessment

Health-history information (Subject Date)

SOAPE Object

Physical-assessment data (Object)

SOAPE Nursing Diagnosis North American Nursing Diagnosis Association (NANDA) defines and approves nursing diagnoses
SOAPE Planning

Goal and outcomes are developed from the nursing diagnosis

During this phase, prioritizes diagnoses, formulates desired outcomes, and selects nursing interventions that can assist patient to return to an optimum level of wellness

Generated by Koofers.com
SOAPE Implantation

Nurse applies knowledge, skills, and principles of nursing care to patient to promote a therapeutic response toward desired goal and optimal wellness

SOAPE Evaluation

Take steps to ensure success

If the goals are not met, that nursing diagnosis is to be reviewed or  rewritten, goals and outcomes are refined, and new interventions are carried out.

Pre-Implantation Drug Effects

Drugs are less likely to cause congenital malformations during this period because the baby’s organ systems has not yet begun to form

Nicotine can create a negative environment for the embryo and potentially cause intrauterine growth retardation

Embryonic Period Drug Effects

Exposure to teratogens during this phase can lead to structural malformation and spontaneous abortion

Generated by Koofers.com
Fetal Period Drug Effects

Medication will have a prolonged duration of action within the unborn child (fetus has a lack of mature metabolic enzymes)

Exposure to teratogen in this phase à more likely to produce slowed growth or impaired organ function, rather than gross structural malformation

Pregnancy Drug Category A

Adequate well-controlled studies performed with pregnant women

No increased risk of fetal abnormalities shown

Ex.: prenatal multivitamin, insulin, thyroxine, folic acid

Pregnancy Drug Category B

Animal studies have shown no risk to fetus

However, no studies done with pregnant women

OR

Animal studies have shown an adverse effect

But, well-controlled studies with pregnant women showed no risk to the fetus in any trimester

Ex. PCN, cephalosporins, azithromycin, acetaminophen, ibuprofen in the first and second trimester

Pregnancy Drug Category C

Animal studies have shown a risk to fetus

No studies done with pregnant women

OR

No animal studies have been done

No adequate and well-controlled studies in pregnant women

Ex. Most prescription drugs; antimicrobial such as clarithromycin, fluoroquinolones, bactrim, SSRI, corticosteroids, most antihypertensive

Generated by Koofers.com
Pregnancy Drug Category D

Adequate well-controlled studies or observational studies showed a risk to fetus shown

However, if benefits outweigh risk (life-threatening situation or serious disease with no alternative safer drugs available), the use of the drug may be acceptable

ACEI, ARB in second and third trimesters, gentamicin, ibuprofen in the third trimester, tetracyclines, premarin, alcohol, nicotine

Pregnancy Drug Category X

Studies done with animals or pregnant women

Fetal abnormalities shown

The use of the product is contraindicated in pregnant women

Ex. Accutane, misoprostol (Cytotec)

 

Drug Effect In Lactating Women Same guidelines as during pregnancy

Recommends drugs to be avoided during lactation


Pharmacology Approach: Infants

The infant should be held while administering medication

Offer a pacifier if the infant is on fluid restriction caused by vomiting or diarrhea

Oral medication administration- directed to the inner cheek and the child given time to swallow the drug to avoid aspiration

Rectal suppositories

IM site: use vastus lateralis

In this age, the gluteal site is usually contraindicated because of potential damage to the sciatic nerve

IV site: the feet and scalp veins may is more easily accessible and preferred venous access sites.

Generated by Koofers.com
Pharmacology Approach: Toddlers

Short, concise explanations

Provide comfort

Having a parent in close proximity

Safety

Never tell children that medicine is candy

Never leave medication unattended 

Pharmacology Approach: Preschoolers

A brief explanation followed quickly by medication administration is usually the best method.

Pharmacology Approach: School Age Make children fell that they are willing participants in medication administration
Pharmacology Approach: Adolescence

Importance of responsible sexual practices, condom use, other contraceptive methods

Eating disorder: access about their eating habits, use of OTC appetite suppressants or laxatives à can contribute to bulimia or anorexia

Educate about hazards of tobacco and substance abuse

Generated by Koofers.com
Pharmacology Approach: Young Adults

Positive medication compliance

Educate about substance abuse and treatment of sexually transmitted diseases

Pharmacology Approach: Middle Age

Positive lifestyle changes could prevent drug therapy

Emphasize the importance of overall health of lifestyle choices, such as limiting lipid intake, maintaining optimum weight, and exercising

Pharmacology Approach: Older Adults

Reduce the dosage of medication

Monitor drug therapeutic & side effects events in geriatric patients

Human Integration Pyramid

Impacts success of pharmacotherapy

Nurse must focus on holistic approach

Generated by Koofers.com
Human Integration Pyramid: Spiritual or Religious Beliefs

Hope

If client believes treatment is important and beneficial, better Drug Compliance

Human Integration Pyramid: Psychological/Social Dimension

Outcomes of Pharmacotherapy Influenced by

Past experiences with medications

Acceptability of taking medication in social environment

Human Integration Pyramid: Ethnicity and Cultural Dimension

Ethnicity - biologic and genetic similarities

Culture - set of beliefs, values, and norms that provide meaning for an individual or group

Both have profound influence on medication outcomes

Human Integration Pyramid: 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

Generated by Koofers.com
Frequent Drug Errors

Omitting one of the five rights

Failing to perform an agency system check

Failing to take into account client variables such as age, body size, and renal or hepatic function

Giving medications based on verbal orders or phone orders

Giving medication based on an incomplete order or an illegible order

Practicing under stressful work conditions

Medication Errors

Document in patient’s medical record

Documentation should occur in a factual manner: 5W 1H

Documentation in medical record must include specific nursing interventions that were implemented following error in order to protect client

Document all individuals who were notified of error

Medical Reconciliation

Medication reconciliation is a process of “keeping track” of a patient’s medications as they proceed from one health care provider to another

CAM

Considered outside mainstream health care due to lack of research

Rigorous research lacking, though underway for many therapies

Used in several different cultures

Very diverse sets of therapies and healing systems used by many people for disease prevention and self- healing

Generated by Koofers.com
FDA Regulation on Herbal and Dietary Supplements

FDA has the power to remove from the market any product that poses a “significant or unreasonable” risk to the public

Requires these products to be clearly labeled by the manufacturer as “dietary supplements”

Not require safety or efficacy testing prior to marketing.

DSHEA Weakness

Manufacturer not required to prove efficacy or safety

Labels not monitored for accuracy in product amounts or claims of benefits of product

Echinacea

Used for dec. duration of cold; inc. immunity

Interacts with amiodarone and anabolic steroids

Results in possible increased hepatotoxicity

St. John’s Wort

Used for depression treatment

With CNS depressant or opioid à inc. sedation

With warfarin à dec. effect of warfarin

 

Generated by Koofers.com
Feverfew, Ginkgo, and Ginger Interactions:

Aspirin

Heparin

NSAIDs

Warfarin


Anthrax Clinical Manifestations

Cutaneous anthrax

Small skin lesions that turn into black scabs

Gastrointestinal anthrax

Sore throat, difficulty swallowing

Cramping, diarrhea, abdominal swelling

Inhalation anthrax

Initially fatigue and fever

Then persistent cough and shortness of breath

 

Treatment of Anthrax

Ciprofloxacin (Cipro)

Prophylaxis—500 mg PO, every 12 hours for 60 days

Confirmed case—400 mg IV, every 12 hours

Care in Toxicity

ABCs

Check glucose level & arterial blood gas

Seizure control

Remove patient’s clothing

Cleanse any contaminates from the body

Eye should be flushed with water

Hair should be washed with soap and water

Generated by Koofers.com
Syrup of Ipecac: Induces vomiting
Activated Charcoal

In case of ingestion of large carbon-based molecules, it minimizes and prevents poison from absorption

Use within 60 mins of ingestion

Whole-bowel irrigation

Considered for potentially toxic ingestions of sustained release or enteric-coated drugs (iron, lead, illicit drug)

Contraindication bowel obstruction, perforation, compromised airway
Generated by Koofers.com
Efficacy


Magnitude of maximal response  that can be produced from a particular drug


Drug with higher efficacy can have better therapeutic effect

Generated by Koofers.com

List View: Terms & Definitions

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 Pharmacodynamicsa medicine changes the body
 Single patient drug response

Graphically visualizes differences in responses to medications in a single patient

 Graded Dose-Response Curve Phase 1

occurs at lowest dose

Few target cells affected by drug

 Graded Dose-Response Curve Phase 2

linear relationship

Most desirable range

Linear relationship between amount of drug administered and degree of client response

 Graded Dose-Response Curve Phase 3

plateau reached

Increasing dose has no therapeutic effect

Increased dose may produce adverse effects

It means because all the receptors for the drug are occupied

 Potency

Drug with higher potency produces a same therapeutic effect at a lower dose, compared with another drug in the same class


 Agonist

Bind to cellular receptor

Produce same response as endogenous chemical

Sometimes produce greater maximal response of normal activity of the target cell


 Antagonist

Occupy cellular receptor

Prevent endogenous chemical from acting

Compete with agonist for receptor

 SOAPE Assessment

Health-history information (Subject Date)

 SOAPE Object

Physical-assessment data (Object)

 SOAPE Nursing DiagnosisNorth American Nursing Diagnosis Association (NANDA) defines and approves nursing diagnoses
 SOAPE Planning

Goal and outcomes are developed from the nursing diagnosis

During this phase, prioritizes diagnoses, formulates desired outcomes, and selects nursing interventions that can assist patient to return to an optimum level of wellness

 SOAPE Implantation

Nurse applies knowledge, skills, and principles of nursing care to patient to promote a therapeutic response toward desired goal and optimal wellness

 SOAPE Evaluation

Take steps to ensure success

If the goals are not met, that nursing diagnosis is to be reviewed or  rewritten, goals and outcomes are refined, and new interventions are carried out.

 Pre-Implantation Drug Effects

Drugs are less likely to cause congenital malformations during this period because the baby’s organ systems has not yet begun to form

Nicotine can create a negative environment for the embryo and potentially cause intrauterine growth retardation

 Embryonic Period Drug Effects

Exposure to teratogens during this phase can lead to structural malformation and spontaneous abortion

 Fetal Period Drug Effects

Medication will have a prolonged duration of action within the unborn child (fetus has a lack of mature metabolic enzymes)

Exposure to teratogen in this phase à more likely to produce slowed growth or impaired organ function, rather than gross structural malformation

 Pregnancy Drug Category A

Adequate well-controlled studies performed with pregnant women

No increased risk of fetal abnormalities shown

Ex.: prenatal multivitamin, insulin, thyroxine, folic acid

 Pregnancy Drug Category B

Animal studies have shown no risk to fetus

However, no studies done with pregnant women

OR

Animal studies have shown an adverse effect

But, well-controlled studies with pregnant women showed no risk to the fetus in any trimester

Ex. PCN, cephalosporins, azithromycin, acetaminophen, ibuprofen in the first and second trimester

 Pregnancy Drug Category C

Animal studies have shown a risk to fetus

No studies done with pregnant women

OR

No animal studies have been done

No adequate and well-controlled studies in pregnant women

Ex. Most prescription drugs; antimicrobial such as clarithromycin, fluoroquinolones, bactrim, SSRI, corticosteroids, most antihypertensive

 Pregnancy Drug Category D

Adequate well-controlled studies or observational studies showed a risk to fetus shown

However, if benefits outweigh risk (life-threatening situation or serious disease with no alternative safer drugs available), the use of the drug may be acceptable

ACEI, ARB in second and third trimesters, gentamicin, ibuprofen in the third trimester, tetracyclines, premarin, alcohol, nicotine

 Pregnancy Drug Category X

Studies done with animals or pregnant women

Fetal abnormalities shown

The use of the product is contraindicated in pregnant women

Ex. Accutane, misoprostol (Cytotec)

 

 Drug Effect In Lactating WomenSame guidelines as during pregnancy

Recommends drugs to be avoided during lactation


 Pharmacology Approach: Infants

The infant should be held while administering medication

Offer a pacifier if the infant is on fluid restriction caused by vomiting or diarrhea

Oral medication administration- directed to the inner cheek and the child given time to swallow the drug to avoid aspiration

Rectal suppositories

IM site: use vastus lateralis

In this age, the gluteal site is usually contraindicated because of potential damage to the sciatic nerve

IV site: the feet and scalp veins may is more easily accessible and preferred venous access sites.

 Pharmacology Approach: Toddlers

Short, concise explanations

Provide comfort

Having a parent in close proximity

Safety

Never tell children that medicine is candy

Never leave medication unattended 

 Pharmacology Approach: Preschoolers

A brief explanation followed quickly by medication administration is usually the best method.

 Pharmacology Approach: School AgeMake children fell that they are willing participants in medication administration
 Pharmacology Approach: Adolescence

Importance of responsible sexual practices, condom use, other contraceptive methods

Eating disorder: access about their eating habits, use of OTC appetite suppressants or laxatives à can contribute to bulimia or anorexia

Educate about hazards of tobacco and substance abuse

 Pharmacology Approach: Young Adults

Positive medication compliance

Educate about substance abuse and treatment of sexually transmitted diseases

 Pharmacology Approach: Middle Age

Positive lifestyle changes could prevent drug therapy

Emphasize the importance of overall health of lifestyle choices, such as limiting lipid intake, maintaining optimum weight, and exercising

 Pharmacology Approach: Older Adults

Reduce the dosage of medication

Monitor drug therapeutic & side effects events in geriatric patients

 Human Integration Pyramid

Impacts success of pharmacotherapy

Nurse must focus on holistic approach

 Human Integration Pyramid: Spiritual or Religious Beliefs

Hope

If client believes treatment is important and beneficial, better Drug Compliance

 Human Integration Pyramid: Psychological/Social Dimension

Outcomes of Pharmacotherapy Influenced by

Past experiences with medications

Acceptability of taking medication in social environment

 Human Integration Pyramid: Ethnicity and Cultural Dimension

Ethnicity - biologic and genetic similarities

Culture - set of beliefs, values, and norms that provide meaning for an individual or group

Both have profound influence on medication outcomes

 Human Integration Pyramid: 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

 Frequent Drug Errors

Omitting one of the five rights

Failing to perform an agency system check

Failing to take into account client variables such as age, body size, and renal or hepatic function

Giving medications based on verbal orders or phone orders

Giving medication based on an incomplete order or an illegible order

Practicing under stressful work conditions

 Medication Errors

Document in patient’s medical record

Documentation should occur in a factual manner: 5W 1H

Documentation in medical record must include specific nursing interventions that were implemented following error in order to protect client

Document all individuals who were notified of error

 Medical Reconciliation

Medication reconciliation is a process of “keeping track” of a patient’s medications as they proceed from one health care provider to another

 CAM

Considered outside mainstream health care due to lack of research

Rigorous research lacking, though underway for many therapies

Used in several different cultures

Very diverse sets of therapies and healing systems used by many people for disease prevention and self- healing

 FDA Regulation on Herbal and Dietary Supplements

FDA has the power to remove from the market any product that poses a “significant or unreasonable” risk to the public

Requires these products to be clearly labeled by the manufacturer as “dietary supplements”

Not require safety or efficacy testing prior to marketing.

 DSHEA Weakness

Manufacturer not required to prove efficacy or safety

Labels not monitored for accuracy in product amounts or claims of benefits of product

 Echinacea

Used for dec. duration of cold; inc. immunity

Interacts with amiodarone and anabolic steroids

Results in possible increased hepatotoxicity

 St. John’s Wort

Used for depression treatment

With CNS depressant or opioid à inc. sedation

With warfarin à dec. effect of warfarin

 

 Feverfew, Ginkgo, and GingerInteractions:

Aspirin

Heparin

NSAIDs

Warfarin


 Anthrax Clinical Manifestations

Cutaneous anthrax

Small skin lesions that turn into black scabs

Gastrointestinal anthrax

Sore throat, difficulty swallowing

Cramping, diarrhea, abdominal swelling

Inhalation anthrax

Initially fatigue and fever

Then persistent cough and shortness of breath

 

 Treatment of Anthrax

Ciprofloxacin (Cipro)

Prophylaxis—500 mg PO, every 12 hours for 60 days

Confirmed case—400 mg IV, every 12 hours

 Care in Toxicity

ABCs

Check glucose level & arterial blood gas

Seizure control

Remove patient’s clothing

Cleanse any contaminates from the body

Eye should be flushed with water

Hair should be washed with soap and water

 Syrup of Ipecac:Induces vomiting
 Activated Charcoal

In case of ingestion of large carbon-based molecules, it minimizes and prevents poison from absorption

Use within 60 mins of ingestion

 Whole-bowel irrigation

Considered for potentially toxic ingestions of sustained release or enteric-coated drugs (iron, lead, illicit drug)

 Contraindicationbowel obstruction, perforation, compromised airway
 Efficacy


Magnitude of maximal response  that can be produced from a particular drug


Drug with higher efficacy can have better therapeutic effect

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