NSG 120 Final Study Guide TI Pharm 1

NSG 120 Final Study Guide TI Pharm 1 • What are generic drugs? Orphan drugs? Over-the-counter drugs? generic drug is the official or nonproprietary name of the United State adopted name council gives a medication. each medication has only one generic name. Orphan drugs u Drugs to treat ‘rare diseases u (200,000 in US) u Not profitable for Pharm companies u ‘Orphan Drug Act’ u Government $ incentives • Remember to use the nursing process to guide your decisions about how to proceed with nursing situations • Assessment • be knowledgeable about the medications administered Use appropriate resource provide, including nurses, physicians, and pharmacist • obtain information about medical diagnosis and conditions that affects medication administration (ability to swallow, allergies, heart, liver, and kidney disorders0 • obtain necessary pre administration data (heart rate, blood pressure, blood levels) to assess the appropriateness of the medication and to obtain baseline data for evaluating the effectiveness of medications • omit od delay doses as necessary due to client’s status determine whether the medication prescription is complete • interpret the medication prescription accurately. the institute for safe medication practice Error prone abbreviation list high number of error confused medication name list : sound-a like and look- alike medications names • high-alert medication list • questions the provider if the prescription is unclear or seems inappropriate for the client. refuse the medication if it seems unsafe, and notify the charge nurse or superior • providers usually make dosage changes gradually • planning • identify client outcomes for medications administration • set priorities which medications to give first or before specific treatment or procedure implementation avoid distruction during the medication preparations (poor lighting, ringing phones). interrupt can increase the risk of error. prepare medication for one client at a time check the labels for the medication’s name and concentration measures doses accurately and double check dosage of high alert medication (heparin and insulin) with a collegue follow the right. medication administration follows all laws and regulations for preparations and administering controlled substances do not leave medication at the bedside Evaluating Evaluate the client’s responses to medications and document and report them • Don’t mix meds (liquid, powder, or crushed) into large quantity of food or liquid – May not finish • Don’t give injection first, oral med second (esp kids) • DON’T GIVE AN INJECTION THAT YOU DID NOT DRAW UP (OR WATCH DRAWN UP) • What do the A-B-C-D-X categories mean for drugs and pregnancy The FDA’s pregnancy Risk categories (A, B, C,D,X) have previously classified medications according to their potential harm during pregnancy. A is being the safest and the Category X is the most dangerous. Teratogenesis from unsafe medications is the most likely occur in first trimester. u Pregnancy safety u A (no risk to baby) u B-D (potential to definite risk) u X (do not use!!) u Teratogenic u Damages developing fetus u Most danger in 1st trimester (3 months) • Interpret simple ABGs and why they happen • pH 7.35-.45 • pCO2 35-45 • Bicarb 22-26 • PaO2 80-100 • SaO2 90-100% • pH below 6.9 or higher than 7.8 is usually fatal Imbalanced pH affects drug effects, hormone shape, excitability of cell membranes etc • Ability of blood to carry/release O2 back up system • The lungs – First line compensation – Begins in seconds – Hyperventilation • Blow off CO2 – Hypoventilation • Retain CO2 • The kidneys – Second line compensation – Begins in hours-days – Stronger but slower – Puts more bicarb in blood – Gets rid of bicarb • Metabolic acidosis: – pH 7.35 – Bicarbonate low (22 mEq/L) – Respiratory acidosis: – pH 7.35 – PaCO2 high ( 45) fixing metabolic acidosis • Hydration – Make sure all cells are getting blood/O2 • Drugs: – Insulin to treat DKA – Antidiarrheal drugs – Bicarbonate only if serum bicarbonate levels are low Respiratory Acidosis • Retention of CO2:Respiratory depression, Inadequate chest expansion, Airway obstruction, Atelectasis post op, Reduced alveolar-capillary diffusion • fixing respiratort acidosis • Maintain a patent airway, and enhance gas exchange • Drug therapy – Bronchodilators? Pulmonary hygiene, Ventilation supportPrevent complication – Cardiac arrest is an example of a problem leading to combined metabolic and respiratory acidosis • Metabolic alkalosis: – pH 7.45 – Bicarbonate high ( 26 mEq/L) Base excess • Too much antacids – Acid deficit • prolonged vomiting • NG suctioning – Stop giving antacid – Give antiemetics – Change diuretic – – Respiratory alkalosis: – pH 7.45 PaCO2 low ( 35 – Hyperventilation • anxiety, fear • Didn’t study enough • stimulation of central respiratory center due to fever CNS lesion fixing respiratory alkalosis • Slow down breathing • Paper bag? • Anxiolysis • Treat pain • *important point: try to understand the why before you intervene • Nursing teaching for antihypertensive drugs- safety For beta-blocker therapy • Teach patients that they shouldn’t suddenly stop therapy. Because of the risk of rebound tachycardia and hypertension, a healthcare provider should monitor the cessation of beta-blocker therapy. • Beta blockers can cause transient increases in serum lipid and glucose levels. • Because beta blockers inhibit the sympathetic nervous system response, they also hide the symptoms of hypoglycemia and can be dangerous in patients with diabetes who use insulin. • Some older beta blockers such as propranolol and high doses of beta1 blockers can block the beta2 receptors in the pulmonary vasculature, resulting in bronchoconstriction and asthma symptoms. • Carefully assess patients with asthma or chronic lung disease for an exacerbation of their symptoms during beta-blocker therapy. • Check for common adverse effects of beta blockers, such as dizziness, slowing of the pulse, fatigue, and hypotension. For alpha-blocker therapy • Warn patients about the risk of orthostatic hypotension, which can cause falls. • Teach patients to take their first dose at bedtime and to move slowly from a sitting to a standing position. For Calcium channel blockers • Tell patients to report dizziness and symptoms of an irregular heart rate. • Teach your patients to avoid grapefruit juice because it inhibits the hepatic metabolism of calcium channel blockers and may lead to increased blood drug levels and increased pharmacologic effects. • All calcium channel blockers should be used cautiously in patients with heart failure. • Drugs that inhibit cytochrome P450 isoenzymes, such as erythromycin, inhibit the metabolism of amlodipine and may result in a stronger antihypertensive effect. o Measure BP prior to therapy (document arm, position), BP lying, sitting, standing; regular checks to evaluate therapy o Do not stop suddenly, can cause unsafe rise in BP o Use cautiously in patients who have diabetes, liver, thyroid or respiratory dysfunction (asthma) o Do NOT take calcium channel blockers (CCB) w/grapefruit juice ▪ Don’t stop suddenly can lead to rebound hypertension ▪ may cause cardio side effects (hypotension), change position carefully ▪ energy issues (tired, insomnia) ▪ neuro issues (nightmares, depression, sexual dysfunction) ▪ Be alert for non-adherence r/t sexual dysfunction ▪ Do not give prazosin if patient has renal disease ◦ Care considerations: ◦ Measure BP prior to therapy ◦ Document arm, position ◦ BP lying, sitting, standing ◦ Regular checks to evaluate therapy • Side effects of ACE inhibitors