Pharm Exam 1 - PowerPoint Red Notes/ NURS 4445 Pharm Study Outline Exam 1
Pharm Exam 1 - PowerPoint Red Notes Feel free to add anything I missed, or add comments in the margins (“add comment” button) if you have questions and hopefully someone will come along and answer them! - Heidi Hey guys! It’s Kahla! I made a quizlet with all of the red notes and turned them into questions so here is the link for that: “Intro to Drugs” o Nurses study the aspect of pharmacology that deals with Impact of drugs on the body Body’s response to a drug Adverse and anticipated drug effects o All medications, in this country, undergo rigorous scientific testing controlled by the Food and Drug Administration (FDA) Safety during pregnancy - FDA categories indicate the potential or actual teratogenic effects of a drug. Consider the population of young women. Generic drugs - An important concept to consider is the bioavailability of the drug because the way the body breaks down and uses the generic drug may differ from that of the brand-name product {i.e., Furosemide is the generic name for Lasix} o Pharmacokinetics how drugs travel through the body Hypoalbuminemia will result in more available free drug Critical concentration = is the amount of drug that is needed to cause a therapeutic effect on the reactive tissues o range of plasma drug concentration that produce efficacy without toxicity o Drug absorption is influenced by: Amount of food or acidity in stomach Route o Biotransformation (metabolism) Drugs do not metabolize the same in all people. Expect an alteration in drug metabolism/biotransformation in patients with liver disease o Excretion Excretion generally declines with age Monitor BUN and creatinine levels To prevent accumulation of a drug in the kidneys, the nurse should ensure the patient stays well hydrated o Half-life determines the time interval between the doses and duration of a drug’s effect Time it takes for an amount of drug in the body to decrease to one half or 50% of the peak level it previously achieved Helps in predicting dosing schedules and duration of effects Ex: If a patient takes 20 mg of a drug with a half-life of 2 hours, 10 mg of the drug will remain 2 hours after administration. Two hours later, 5 mg will be left; in 2 more hours, only 2.5 mg will remain o Factors influencing drug effects Elderly patients are at higher risk for drug-related complications due to: o Taking multiples pills from different prescribers o Presence of chronic diseaseo Decline in renal function Toxicity in pediatric patients o Altered by age/weight for children o Interactions Drug-drug o One drug affects the efficacy of another Drug-food o Some foods affect the efficacy of a drug o Ex: Grapefruit juice affects liver enzymes, thus changing serum drug levels Drug-lab test o Drug Allergies Categories: (see table 3.1, pg 36) o Anaphylactic o Cytotoxic o Serum sickness o Delayed Patients should specifically state how they respond when they take the drug Photosensitivity o patient should receive instructions to wear sunglasses, and cover exposed skin, and wear a hat If a medication is mistakenly prescribed to a patient with a known allergy, hold the medication and notify the physician Patients having an anaphylactic reaction may present with increased heart and respiratory rates o Drug-induced Tissue/Organ damage Superinfections o infections caused by organisms (bacteria, viruses, fungi, etc.) that are usually controlled by the normal flora Blood Dyscrasia o bone marrow suppression caused by drug effects o Interventions - monitor WBCs, platelets, and hemoglobin; provide rest, protection from exposure to physical injury, avoidance of activities that might result in injury or bleeding, and protect from infection o Medication Error Prevention: Nurse’s Role When torn or soiled labels are noted, discard the entire med and obtain a new one Drug orders must include: name, dose, route, frequency o Ex: Ibuprofen 400 mg PO Daily 6 rights of drug administration: o right patient o right drug o right dose o right route o right time o right documentation o Remember: Patients Do Drugs Round The Day o Medication Error Prevention: Patient’s Role Should keep record of all current meds Ask the patient if they are taking OTC and herbal supplements o Herbal agents interact with prescription drugs o Body may convert herbs to unsafe chemicals o Standard Drug Times Daily – once a day BID – twice a day (0900, 1700) TID – three times a day (0900, 1300, 1700) QID – four times a day (0900, 1300, 1700, 2100) Q6 – every 6 hours (0000, 0600, 1200, 1800) Q12 – every 12 hours (0900, 2100) Q24 – every 24 hours “Drugs that Affect Immune Responses” o Analgesic: compounds with pain-blocking properties o Anti-inflammatory agents: drugs that block the effects of the inflammatory response o Antipyretic: blocking-fever o Drugs Salicylates Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Related agent: Acetaminophen (Tylenol) o Salicylates Aspirin (ASA) – most widely used o Use in children with fever is contraindicated because of Reye’s Syndrome o Contraindications: bleeding, kidney impairment, pregnancy (caution), allergy o Monitor patients with rheumatic disease for tinnitus (Rheumatic disease affects the muscles and joints as a result of wear and tear) o NSAIDS Ibuprofen o Contraindications: cardiac impairment, renal/hepatic dysfunction, hypertension, pregnancy (caution), allergy o The nurse should counsel the patient to obtain regular kidney function tests and stool tests for blood o Acetaminophen Used in place of Salicylates/NSAIDs Adverse effects o Hepatotoxicity with overuse o Evaluate patients taking large doses of Tylenol for hepatic function o Antidote (in event of overdose): acetylcysteine o Immune Modulators modulators are used to modify the actions of the immune system stimulants are used to energize the immune system when it is exhausted o Interferons (naturally produced and released by human cells that have been invaded by viruses or in other stimuli, such as cytotoxic T-cell activity) and Colony-Stimulating Factors (stimulate bone marrow to produce more WBCs in situations where the level of the cells are very low and the patient is at serious risk for infection) suppressants are used to block the normal effects of the immune system (organ transplantation/autoimmune disorders) o T and B cell suppressors (cyclosporine most commonly used) Cautions Patients receiving an immunosuppressant should be protected from exposure to infection Interventions for bone marrow suppressive drugs include: Protection from infection Protection from physical injury Monitoring WBC, platelet, hemoglobin o Vaccines and Sera Immunization o Patients should receive instructions that the immunization may cause pain, redness, and swelling at the site of injection (this is NOT an allergic reaction) LIVE vaccines are contraindicated for people who are immunosuppressed Mumps, vissels,…… review “Anti-Infective Agents” O are drugs designed to target organisms that have invaded and infected the body Narrow spectrum - effective against a small group of pathogens Broad spectrum - effective against many pathogens antibiotic treatment may not always begin with narrow-spectrum drugs Patients on broad-spectrum anti-infective agents should be monitored for destruction of normal flora o Bactericidal - causes death of the cells they affect o Bacteriostatic - interferes with the ability of the cells to reproduce or divide o Resistance Develops when: o Mutant organisms that do not respond to the anti-infective become the majority of the pathogen population o Pathogen develops enzymes to block the anti-infectives Dosing intervals at the patient’s convenience contributes to the emergence of resistant microorganisms o Vancomycin antibiotic that interferes with cell wall synthesis in susceptible bacteria This drug is reserved when no other drug will work against the infection Can cause “red man syndrome” (sudden/severe hypotension, fever, chills, paresthesia, erythema, redness of neck and back) o Anti-infective therapy Patients should not stop taking their medications before completion; Patients are encouraged to continue taking the full prescription even when symptoms start to go away o Antibiotic therapy antibiotics may be given prophylactically to prevent infection prior to invasive procedures or surgery culture test – performed to identify causative organism and determine which antibiotic will effectively interfere with its specific proteins and enzyme systems Gram+ bacteria = associated with infections of respiratory tract/soft tissues (pneumonia) Gram- bacteria = associated with infections of genitourinary or GI tract (E coli) Aerobic bacteria = depend on oxygen Anaerobic bacteria = do not use oxygen Gentamycin o Monitor for renal dysfunction o Peak & trough Monitor for IM & IV Peak 30min to hour after administration Trough right before next dose Gentamicin Aminoglycosides chapter 8 Cephalexin and Cefaclor: Bactericidal and bacteriostatic – (gram negative and gram positive strains) – Interfere with the cell wall–building ability of bacteria when they divide o Adverse effects: n/v, diarrhea, rash, superinfection, bone marrow depression, risk for pseudomembranous colitis **************************CONTINUES****************************
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nurs 4445pharm study outline exam 1
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pharm exam 1 powerpoint red notes
