NURS 323 Final Exam Focus Review Topics; OLD Material (70 items)

NURS 323 Final Exam Focus Review Topics OLD Material (70 items) ATLEAST 12/day Introduction to Nursing Pharmacology (Safety, Nursing Process, Pharmacokinetics, Pharmacodynamics) Know and understand the mechanism of action of drugs on this list 1. Know the principles of pharmacokinetics: absorption, distribution, metabolism and excretion Pharmacokinetics is how drugs move through the body/what the body does to the drug. Dynamic equilibrium is the “pathway” of the drug through the body via pharmacokinetics. 1. Absorption from where the medication is entered via passive or active diffusion such as - By mouth would be GI. - Parental such as IV, IM, SQ, intradermal would be absorbed by the blood. - Rectally, vaginally, sublingual, ears, eyes would be mucous membranes to the blood. - Topical would be through the skin absorption. 2. Distribution to the active site such as getting to an infection in the body i.e. brain infection would need a lipid soluble medication in order for it to be distributed to the site. 3. Metabolism/Biotransformation occurs in the liver and this is where the medication is broken down to be excreted to detoxify the body to less harmful chemicals/levels. - First-pass effect: Medication that is metabolized by the liver during the first time it passes (hence, first-pass) breaks down the drug as much as possible and the rest goes into the body. Eventually, it’ll filter through the liver again. - AST, ALT labs test for liver function. 4. Excretion is the drug finally getting out of the body pretty much via anything the body excretes like saliva, teats, etc. but the kidneys are the main method to excretion. Think: urine drug tests. Grr. 2. Know the difference between loading and maintenance doses - Loading dose is the largest dose to reach therapeutic effect – quick in the body. Think: patient has infection or and Rocephin 1 gm is ordered and is prescribed antibiotics to maintain therapeutic effects OR EpiPen during an asthma attacks; just one of those big doses to make reach therapeutic effects QUICKLY. - Maintaining the levels at therapeutic levels? 3. Why do nurses need to know about pharmacology 4. 5 patient rights of drug administration 1. Right patient – do not want to give to wrong patient. 2. Right med – do not want to give the wrong patient, can cause adverse reaction to wrong medication. 3. Right dose – too much or too little is not beneficial nor therapeutic for the patient. 4. Right time – make sure medication is administered at a certain time because it usually is at the lower therapeutic effect. Pregnancy categories (i.e., C, X, etc.) 5. Right route – can be toxic for a patient or else might not be absorbed. 5. - Category A: no testing shows that there is risk for adverse effects in later trimesters. - Book: Adequate studies on pregnant women have no demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters. - Category B: Studies have been preformed on animals and show adverse effects, but no adverse effects in pregnant women. - Book: Animal studies have no demonstrated a risk to the fetus but no adequate studies in pregnancy women, or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during first trimester of pregnancy, and there is no evidence in later trimesters. - Category C: Animals have been tested and show adverse effects but there have not been enough evidence or studies on pregnant women to determine whether or not they would exhibit any adverse effects. OR no studies have been performed – period/Medication use benefits outweigh the adverse effect. - Book: Animal studies on animals show adverse effect on fetus but no adequate studies in humans the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks, or there are no animal reproduction studies and no adequate studies in humans. - Category D: There are studies that have shown there are fetal risks, but the benefits outweigh the risks and/or are acceptable. - Book: The evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks. - Category X: There are adverse effects and very bad risks, abnormalities have been shown in both animals and humans. The risk of taking this medication outweighs the benefit. - Book: Studies in animals or humans demonstrate fetal abnormalities or adverse reaction report indicted evidence of fetal risk. The risk of use in a pregnant woman clearly outweighs any possible benefit. - All in all, no drug is safe unless it is medically necessary and the benefits outweigh the risk. 6. - Assessment – checking the patient when they are first admitted for their condition. - Diagnoses – nursing diagnosis must have evidence to back up from the assessment. Nursing process and drug administration - Plan – follow up care for patient, rx the patient needs, referrals. - Implementation – Patient needs to follow through and take Rx. Visit as needed. - Evaluation – end goal. 7. Why is evaluation phase important? What are the phases and some possible nursing interventions associated with these phases when administering drugs. - Evaluation is important to know if the patient has any adverse effect or if the medication was effective. ?? - Signs of an anaphylactic reaction 8. Priority actions for nurses to take in the event of a medication error - Assess the patient, document adverse effects, file an incident report ?? 9. - Anaphylactic is something we should be able to assess by swelling, hypertension, SOB, rash, itching, tachycardia, sever, anxiousness. Danger with crushing of extended release medications Schedules of medications (i.e., I, II, III, IV) 10. Teaching about medications during each administration 11. - Administering a bolus which is not indicated for the mechanism of the medication to be effective. Can be too strong got he patient? 12. - DEA is the Drug Evaluation Agency is in control and enforces the Controlled Substance Act of 1970. - Schedule I (C-I) = High abuse protentional and has no medical use that is beneficial such as heroin, LSD, “marijuana”. - Book: High abuse potential and no accepted medical use. - - Schedule II (C-II): High potential for abuse and high level of dependency but it is prescribed such as narcotics, amphetamines, barbiturates. - - Schedule III (C-III): Less abuse potential and less addictive than level II drugs such as nonamphetamine stimulants, nonbarbiturate sedatives, and SOME narcotics). - - Schedule IV (C-IV): Less abuse potential and less addictive than level III drugs such as nonnarcotitis analgesics, antianxiety meds, some sedatives. - - Schedule V (C-V) Limited abuse potential. Does not need prescription or need to be dispensed by pharmacist. 18+ can order with an ID. Think: Target scans card, which is why they scan when we buy Nyquil. Chemotherapeutic Agents 13. Differentiate between narrow-spectrum antibiotics and broadspectrum antibiotics and state when one or the other would be preferred as a therapeutic approach and why - Anti-Infective Activity selectivity types = broad spectrum – positive and negative gram, narrow spectrum = only effective for a few number of organisms/particular gram stain organisms. - Narrow Spectrum of Activity = Effective against only a few microorganisms with a very specific metabolic pathway or enzyme such as only one type of gram stain - Type of bacteria that is difficult to kill = gram-negative due to their 3rd cell wall - Broad Spectrum of Activity = Useful in treating a wide variety of infections in terms of gram staining - We would want a narrow spectrum medications for a medication in which we know the cause of the patient’s infection depending on the specific gram stain and type of pathogen. - We would want broad for treatment of an infection we do not yet know the cause of the infection such as when we are waiting for a urine culture to return. There is a word for this??? 14. Explain the fundamental difference between bactericidal and bacteriostatic drugs. - Bactericidal medications = Aminoglycosides, Carbapenems, Fluoroquinolones, Penicillin. know what this means! It KILLS! -static slows the growth of bacteria. - inhibits the growth of mycobacteria; bacteriostatic. 15. Explain main mechanisms by which microbes develop resistance to antimicrobial drugs. - Natural or acquired resistance = Ability over time to adapt to an anti-infective drug via mutation and evolutionary changes and produce cells that are no longer affected by a particular drug that causes *superbugs*. Know about what are the mechanisms of resistance. - Prevention of resistance/superbugs = take the wh