Complete Exam 1 Study Guide - NUR2474 Pharm

Complete Exam 1 Study Guide-NUR2474 Pharmacology Quiz 1 1. Nursing process as it relates to med administration a. 6 Rights of Med Admin i. Patient ii. Drug iii. Dose iv. Time v. Route vi. Documentation b. Extra rights to med admin i. Assessment ii. Evaluation iii. Patient to education iv. Patient to refuse care c. Biggest medication error is misinterpreting prescriptions i. Do not assume if something is unclear about an order. Clarify with prescriber. ii. TORB and VORB d. Pre- and post- medication administration assessment and interventions i. Pre 1. If patient is complaining of pain 10/10, intervene (prn meds, standing orders, call physician for new orders) then assess. 2. Collection of baseline data to evaluate therapeutic effects and adverse effects 3. Identification of high-risk patients 4. Assessment of the patient’s capacity for self-care 5. Allergies? a) Collect history. What happens during an allergic reaction? b) If patient is having an allergic reaction: primary intervention is to STOP THE MEDICATION THAT IS CAUSING THE REACTION. 6. If patient refuses drug, determine why. INVESTIGATE. ii. Post 1. Therapeutic response 2. Adverse reaction and interaction 3. Adherence to treatment 4. Satisfaction with treatment 2. Patient teaching for medication therapy in general (safety, compliance, etc.) a. Teaching i. Safety 1. If medication causing certain side effects, consult physician. ii. Compliance 1. It is important not to stop or change a medication without consulting the physician. 2. Take medications as prescribed and for the reason they are prescribed. 3. Side effects vs adverse effects vs allergies a. Side effects i. Nausea, vomiting, expected and unavoidable reactions, drug effects produced at therapeutic level. b. Adverse effects lOMoARcPSD| 2 i. Noxious, unintended, and undesired effect that occurs at normal drug doses, harmful at therapeutic level. c. Allergies i. Redness, itching, hives, swelling; A condition in which the immune system reacts abnormally to a foreign substance. 4. Intended effect, teratogenic effect, paradoxical effect, tolerance a. Intended effect i. Maintenance of vital signs within expected limits ii. Decrease in the risk of seizures iii. Decrease in the intensity of withdrawal manifestations iv. Substitution therapy during alcohol withdrawal b. Teratogenic effect i. Drug-induced birth defect ii. Birth defects are not limited to distortions of gross anatomy; they also include neurobehavioral and metabolic anomalies c. Paradoxical effect i. Opposite the intended drug effect ii. Common example 1. Insomnia and excitement that may occur when some children and older adults are given benzodiazepines for sedation. d. Tolerance i. Pharmacodynamic tolerance 1. Reduced responsiveness to a medication that clients take over time. ii. Metabolic tolerance 1. Metabolism of medication increases over time and the effectiveness of the medication declines. iii. Cross-tolerance 1. Become tolerant to a medication that is chemically similar to another medication they became tolerant of. 5. Half-life of medications a. Defined as the time required for the amount of drug in the body to decrease by 50% b. Percentage versus amount c. Determines the dosing interval d. Modafinil (CNS suppressant; narcolepsy) i. about 15 hours e. Phenytoin (Seizures) i. 8-60 hours 1. lower doses: 8 hours 2. higher doses: 60 hours f. Fluvoxamine (SSRI) i. About 15 hours g. Citalopram (SSRI) i. About 35 hours h. Duloxetine (SNRI) i. 12 hours Quiz 2 6. Donepezil (Aricept) therapy in patients with Alzheimer’s disease a. Alzheimer’s Disease i. uncurable, cannot be delayed/slowed, or reversed. However cognitive decline can be slowed down with meds. Cholinesterase inhibitors may cause fainting due to hypotension and bradycardia. lOMoARcPSD| 3 b. Donepezil i. Indicated for mild, moderate or severe AD ii. Affects ACh levels iii. Take acetaminophen (Tylenol) instead of NSAIDs (aspirin or ibuprofen) iv. Inhibition/prevention to breakdown Acetylcholine (ACh) v. Common side effects 1. Nausea/vomiting 2. GI discomfort (diarrhea) 3. dyspepsia (indigestion) 4. headache 5. fainting 6. falls/fall-related fractures vi. Cholinesterase Inhibitors vii. Inhibitors prevent acetylcholinesterase from inactivating ACh (prevents from doing their job.) viii. This causes an increase of ACh, therefore there is a decrease in dopamine. ix. Too much ACh and too little dopamine is Parkinson’s x. Too little ACh and too much dopamine is Alzheimer’s 7. Cholinesterase inhibitors and indications, side effects, cardiac effects a. Cholinesterase inhibitors (donepezil, galantamine, rivastigmine) i. Treatment of AD with these drugs can yield improvement that is statistically significant but clinically marginal. (ex: taking a “weight loss drug” and losing half a pound in 6 months). ii. Goal for AD treatment s to improve symptoms and reverse cognitive decline. iii. Inhibitors prevent acetylcholinesterase from inactivating ACh (prevents from doing their job). Prevent breakdown of ACh. iv. This causes an increase of ACh, therefore there is a decrease in dopamine. b. Indications i. Mild to moderate AD c. Side effects i. Cholinergic side effects 1. Increased sweating 2. Loss of bladder control 3. Muscle weakness, cramps 4. GI upset (diarrhea, N/V, stomach cramps or pain) 5. Bronchoconstriction a) SOB, tightness in chest, wheezing 6. Watering of mouth ii. Fatigue iii. Insomnia iv. Dizziness v. Headache d. Cardiac effects i. Slow or irregular heartbeat ii. Dysrhythmia iii. Hypotension 8. Interferon beta therapy (indications, side effects, etc.) a. Interferon beta i. Multiple Sclerosis ii. Immunomodulators 1. How it works: a) Reduces severity and frequency of attacks lOMoARcPSD| 4 b) Reduces development of brain lesions detectable by magnetic resonance imaging (MRI) c) Delays progression of disease 2. Naturally occurring glycoprotein with antiviral, antiproliferative, and immunomodulatory actions. 3. Immunosuppressive quality a) Inhibits WBC b) Inhibits T-helper cells 4. Does not prevent or cause infection but can make an infection worse. 5. May cause FLU-LIKE symptoms, not actually cause the flu. 6. Injection reactions a) No warm or cold compress i. Do not change the temperature of the tissue b) Benadryl if needed c) Hydrocortisone cream if needed d) Rotate injection sites to avoid injection site reactions and skin break down 7. Can cause depression and suicidal thoughts 8. Allow 48 hours between injections 9. Start with low dose then increase too more. b. Indications i. Multiple sclerosis 1. Immune system attacks itself 2. Inflammation and destruction of myelin in CNS c. Side effects i. Flu-like reactions ii. Hepatotoxicity iii. Myelosuppression iv. Injection-site reactions v. Depression vi. Suicidal thoughts vii. Neutralizing antibodies viii. Drug interactions 9. Baclofen therapy a. Therapeutic uses: i. MS, spinal cord injury, and cerebral palsy ii. Not used with stroke! iii. Decreases flexor and extensor spasms iv. Suppresses resistance to passive movement v. No direct effect on skeletal muscle vi. Centrally Acting Muscle Relaxer for Spasticity vii. May mimic the action of GABA on spinal neurons. b. Adverse effects i. Withdrawal ii. GI symptoms (nausea, constipation) iii. Urinary retention iv. Miss one dose, cause seizures! c. Considerations: There is no antidote for an OD. It is a CNS depressant. Withdrawal needs to be gradual or there is a risk of serious complication. Do not use with alcohol! d. Caution: seizure patients and renal impairment. e. May take with food to avoid GI upset. 10. Levodopa/Carbidopa in PD (action, side effects, interventions for side effects) lOMoARcPSD| 5 a. Levodopa/Carbidopa (dopaminergic agent) i. Parkinson’s Disease 1. Incurable, cannot be slowed down, chronic degenerative disease