Pharmacology Final Exam Review

Pharmacology Final Exam Review Nursing Process & Drug Therapy Pharmacology Final Exam Review  In a prescription what must you have: o nameofthemed o route- (no route call the Dr. and verify it) o date/time o dose o time/frequency of med o Dture  If you don’t understand the prescription: o hold med & call the Dr.  Types of meds that cannot be crushed: o Enteric coated (EC) o Long acting (extended release) o Sustainedaction(SA) o SustainedRelease(SR)  If crushed it loses the effect, it will also dissolve sooner than it is supposed to increasing toxicity. DO NOT CRUSH!!  Do a pre assessment: o Whatmedicationsisthepatienttaking o Baselineofmedication o Allergies o OTCmedscurrentlytaking o If taking Digoxin- check the Apical HR (60-100); if HR less than 60 CANNOT give Digoxin; also check Digoxin level & K+ (if K+ level is high, it decreases the effect of Digoxin; if the potassium level is low, increases the effect of Digoxin) o ForBetaBlockers-checkifpulseislessthan60(Iflessthan60donotgivebeta blocker), after the med is given you always Assess o Diuretics- always give in the A.M (check K+ level, electrolyte levels, vital signs *mostly BP, weight the pt, intake/output of pt)  Purpose of 9 rights of drug administration: o to avoid medication error of OD (Safety of drug administration) o rightmed,righttime,rightpatient,rightdose,righttorefuse,rightroute,right documentation, right reason, & right response to med o use2identifierstocheckpt o read medication level 3 times! o newborn-checkthemother’sidentifier/olderchildren-checktheparent’sidentifiers o elderly-2identifiers;ifconfused(donotaskptforthename) o give med 30 min before or 30 min after the due time (right time) o TID:3times/day;BID:2times/day;QID:4times/day;DONOTuseQD(writetheword Daily)  Pharmacokinetics: o What the body does to the drug o Four Principles of Pharmacokinetics:  Absorption (Route) depends on the site:  Parenteral goes 1st because- it bypasses 1st pass effect, so it has a bioavailability of 100%, IV has more effect than oral  Oral: has the 1st pass effect, the bioavailability is 80%  Sublingual: under the tongue because of increase in vascularity bypasses the 1st pass effect 100% bioavailability  Buccal: between the cheeks & the upper/lower molar & rotate, with vascularity you also will bypass the 1st pass effect 100% bioavailability  Distribution- also depends on the site (high/more vascularity = more distribution of the med)  Plasma protein affects distribution of meds (Albumin)  Albumin meds are highly protein bound so it attaches to the receptor & once attached they remain in the bloodstream & the rest of meds are free to go  2 meds together compete & can cause toxicity  Metabolism AKA (Biotransformation)- the main organ is the Liver  Is the process by which the body inactivates drugs  If you have liver problems- higher chances of toxicity because medication cannot be broken down  Elderly & Newborns are at higher risk due to immature liver  Excretion- the main organ is the Kidney  If patient has renal failure cannot excrete the drugs so higher chances of toxicity to occur; also newborns have immature kidneys so they as well are at higher risk of toxicity o Half-LifeofaDrug:  Is the time required for 1 half of the medication to be removed from the body  EX: 800mg, half-life is every 8 hrs. Within 24 hrs. how much of the drug will be left/remain? 1st half life is 400; 2nd is 200; 3rd is 100 so the half-life is 100 o Pharmacodynamics:  Is what the drug does to the body  Can have receptor on receptor binding  It can have enzymes- it can break down or enhance the effect (agonist action- mimics receptor actions, so it binds to it)  Antagonist actions- blocks the reaction  Partial agonist- blocks & enhances at the same time (partial reaction) o Synergistic Effects:  When TWO drugs are given- 1 of the drug enhances the effect of the other drug o AntagonistReaction:  One medication blocks the other medication (Blocks the reaction)  Categorize a Drug:  Which drugs can be used for pregnant women:  Category A- No risk for human fetus  Category B- No risk for animal fetus; NO info in human fetus  Category C- Risk in animal fetus; NO info in human fetus  Category D- Possible fetal risk in Humans BUT in selected cases potential benefit vs risk may warrant use of these drugs in Pregnant woman (depends what is more beneficial to the patient)  Category X- CANNOT give to pregnant women (fetal abnormalities) o Medication reconciliation:  Every time a patient comes in to the hospital or transfer from a unit to another unit nurse reconcile all meds together to know which one’s patient will use or no longer use  It is Safety mechanism o Standards of Care when administering meds:  DO NOT recap needles, put them in a sharp container  Type of medication that we are giving: never crush enteric coated or long acting  Less than 5 ml must be given in a syringe  For children must be given in calibrated syringe (#’s are on top of syringe)  Nasal Gastrostomy Tube:  Do Not give enteric coated meds; must call pharmacy to obtain liquid form  Put the patient in Semi Fowlers Position/High Fowler Position  Before you give G tube meds- You must check for Tube placement; flush before/after you give med with warm water, when medication is complete you flush with 30-60 ml of warm water; meds must go through gravity (so you hold tube and put the med); leave head bead elevated for 30 min to avoid aspiration o ParenteralMeds&Angles:  Subcutaneous- (45-90) degree angle (depending on size of patient) if patient is obese 90; if patient is thin/child 45; average adult 90; Use a 25-gauge needle; for Heparin & Insulin 1/8 to 1 inch the needle DO NOT MASSAGE THE SITE, DO NOT ASPIRATE  Intradermal- (5-15) degree angle, a bleb after injection is Normal; TB; 0.01-0.1ml of solution can be given; 25-27gauge needle must be used (remember the bigger the gauge # the smaller the needle is)  Intramuscular- you go all the way down to the muscle (90 degrees); Use the Z track method, mostly for (IRON); Ventrogluteal site for adults; vastus lateralis for children (MUST ASPIRATE to make sure there is no blood); 22-27 needle size  Insulin- Unit syringe; Regular & NPH can be mixed in same syringe; 1st draw Regular Insulin (clear), and 2nd draw the NPH (cloudy) insulin  Long Acting Insulin cannot be mixed together  IV Medication- IV locks must be flushed before/after each use either Heparin or Saline flush is used; (saline lock is usually for short term medications or peripheral line); To mix- you put medication into port & you will mix it gently; after mixing hang & label the IV with the name of the patient, what’s there, & the time given; Tubing must be labeled as well depending on type of medication (if giving antibiotic which is a secondary bag via IV must change every 24 hrs.; if using a primary bag up to 96 hrs. to change tubing port)  Ear Drops- o Patient has to lie on the unaffected side (remain in this position for 2-3 minutes) o For children younger than 3 yrs.- Pull Pinna Down & Back o For adult or older child- Pull Pinna Up & Back  Eye Drops- o Place medication in lower conjunctival sac & instruct pt to blink 1 or 2 times, then keep eyes closed for several minutes o To Prevent Systemic Absorption Gently Press on the Nasolacrimal Duct  Inhaler & Rectal Suppositories- o Inhaler- have patient open his/her mouth, position inhaler 1- 2in away from mouth; have patient exhale, then press down once on inhaler, have patient breathe slowly/deeply for 5 seconds; if second inhalation is prescribed wait 1-2 min before administering it. o Rectal Suppositories- place patient on Left side or Sim’s position, lubricate suppository with a small amount of water soluble lubricant, have patient remain laying on his side for 15- 20 minutes to allow absorption of med. o Extrapyramidal Symptoms:  Serious movement disorders  Caused by 1st Generation Antipsychotic Drugs (FGA)  Reversible/Early Extrapyramidal Symptoms:  Acute Dystonia- painful muscle spasms (severe spasm of tongue, neck, face, or back) – can cause Oculogyric (eye popping) this is a crisis situation  Parkinsonism- bradykinesia (slow), tremors  Akathisia- distressing motor restlessness (unable to stand/sit still, pacing & agitated)  Irreversible/Late Extrapyramidal Symptoms:  Tardive Dyskinesia (NOT REVERSIBLE)- involuntary movements of tongue & face (lip smacking which can cause speech/eating disturbances)  Neuroleptic Malignant Syndrome (may be FATAL if not treated fast)- high fever, muscle rigidity (leap pipe), myoglobinuria, autonomic instability o DepolarizingNeuromuscularBlockingDrugs:  Used for skeletal muscle paralysis to facilitate controlled ventilation during surgical procedures  Succinylcholine- the only available drug in NMBDs  Most commonly used to facilitate endotracheal intubation  Adverse Effect:  Malignant Hyperthermia  Signs/Symptoms: Muscle Rigidity, Increased temperature  Administer: Dantrolene IV o MAOIs:  Are 1st generation antidepressant drugs (They are rarely use as antidepressant, MOSTLY used for Parkinson’s disease  Cause Hypertensive Crisis when taken with tyramine foods  Patient on MAOIs: cannot consume aged cheese, smoked/pickled meats, red wine  Ex of the meds: Isocarboxazid, Phenelzine, Tranylcypromine (nonselective of MAO type A Type B)  SELEGILINE is (Selective MAO-B); in Oral form it is used for Parkinson’s Disease  Rasagiline o AntiparkinsonDrugs:  CARBIDOPA-LEVODOPA (dopamine replacement)  Carbidopa alone is NOT used as therapy  Carbidopa is Used in combination with LEVODOPA (to reduce the adverse effect of Levodopa, allows smaller dose of Levodopa to be used)  Contraindicated: in patients with angle-closure glaucoma, history of melanoma, concurrent use of MAOIs  Common Adverse Effect of Carbidopa/Levodopa: palpitations, hypotension, urinary retention & Dyskinesia (difficulty in performing voluntary movements)  AMANTADINE (dopamine modulator)  Is an antiviral drug, also treats mild-moderate Parkinson’s Disease  ENTACAPONE (COMT inhibitor)  Is taken with Levodopa & is effective from the 1st dose  It can be used to reduce on-off effect  They prolong the duration of action of Levodopa  SELEGILINE & RASAGILINE is (Selective MAO-B); in Oral form it is used for Parkinson’s Disease o Antiepileptic Drugs:  Traditional AED:  Phenobarbital & Primidone (barbiturates)-  Phenobarbital has the longest half-life of all AED’s  Adverse Effect of barbiturates: paradoxical restlessness, lethargy, GI upset, osteomalacia)  Phenytoin- (hyndatoins)  Adverse Effect of Phenytoin: Nystagmus, Gingival Hyperplasia, ataxia, thrombocytopenia, agranulocytosis  Phenytoin via IV: is given only with Normal Saline; must be given slowly no more than 50mg/min in adults; the patient must be monitored for Bradycardia & decrease BP  *Therapeutic Level of Phenytoin 10-20 mcg  Make sure patient has a good oral hygiene (to avoid gingival hyperplasia)  Carbamazepine- (iminostilbenes)  Adverse Effect: visual change, unusual eye movement, behavioral changes)  Valproic Acid Adverse Effect: weight gain, hepatotoxicity)  Diazepam- drug of choice for Status Epilepticus o Autonomic Nervous System (ANS): Is an Involuntary type of system (breathe on your own); divided into the SNS & PNS  SNS: