Term
| acetaminophen (Tylenol) - which is the generic name & which is the trade name? |
|
Definition
| generic name=acetaminophen, the not capitalized one assigned by the USAN council. The trade name=Tylenol, it is capitalized in parantheses, is the drug's registered trademark, use restricted to the owner. |
|
|
Term
| __________ is the science of preparing & dispensing drugs, including what design the dosage is in. ie. capsules, tablets, injections, patches.<-- it is the dissolution of a drug, the disintegration of dosage form. |
|
Definition
|
|
Term
| _____________ is the rate of drug distribution among various body components after a drug has entered the body. It is what the body really does to the drug. It is the: Absorption, Distribution, Metabolism and Excretion. |
|
Definition
|
|
Term
| ____________ is the study of the biochemical and physiological interactions of drugs at their sites of activity. This examines the physiochemical properties of drugs & their pharm interactions with body receptors. It is what the drug does to the body... the drug-receptor reaction. |
|
Definition
|
|
Term
| _________________ is the pharm interactions with body receptors. The treatment of pathological conditions through the use of drugs. It is the effect or specifically what disorder it is used to treat. |
|
Definition
|
|
Term
| Absorption (which is part of pharmacokinetics) is the movement of a drug from where it is administered to the _______________ where it is distributed to tissues. |
|
Definition
|
|
Term
| The measure of the extent of drug absorption for a given drug route refers to what term? It is how much of it is actually left to be used. |
|
Definition
|
|
Term
| What is the initial metabolism in the liver of a drug absorbed from the GI tract before the drug reaches systemic circulation through the blood stream? |
|
Definition
|
|
Term
| WHy is the 1st pass effect so important when giving a drug amount? |
|
Definition
| Because a drug that has a 1st pass effect, like an orally swallowed pill, will pass through the liver (reducing its bioavailability) while the same drug can be injected IV and will be a significantly less amount needed b/c it goes directly into the blood stream. |
|
|
Term
| What routes are effected by the 1st pass effect? |
|
Definition
| hepatic arterial, oral, portal venous, rectal |
|
|
Term
| If 2 drugs are 'bioequivalent' what does that mean? |
|
Definition
| If 2 drugs have the same BIOAVAILABILITY and they have the same CONCENTRATION of an active ingredient - then they are considered bioequivalent (eg. brand name drug = the same generic drug) |
|
|
Term
| what factors affect the rate of absorption? |
|
Definition
| the presence of food or fluid digested with the drug, the dosage formulation, the status of the absorptive surface, the rate of blood flow to the small intestine, the acidity of the stomach, the GI motility and how the drug is administered (which route) will all affect the rate of absorption. |
|
|
Term
| Looking at a clients med profile, you see: Digoxin=77% unbound, Phenytoin: 13% unbound, Diazepan: 4% unbound, Warfarin: 0.8% unbound. What message is important to understand concerning drugs binding to proteins? |
|
Definition
| Drugs bind & compete to bind to proteins. When 2 or more highly bound protein drugs are given together, it is hard to predict their effect. |
|
|
Term
| Distributiion (part of pharmacokinetics) is the transport of a drug by bloodstream to its site of action. Where are these slow distribution areas? |
|
Definition
| Muscle, Skin & Fat will slowly distribute drugs. |
|
|
Term
| Where are the fast distribution areas? |
|
Definition
| heart, liver, kidneys and brain (those areas most extensively supplied with blood). |
|
|
Term
| We know that drugs may bind to proteins. Drugs can be freely distributed to extravascular tissue ONLY if they are NOT bound to: ________ ___________. |
|
Definition
|
|
Term
| If a drug is bound to protein, it is generally too LARGE to pass into tissues. Unbound portion of drug is pharmacologically active and considered " ____ ." Whereas, a protein bound drug is pharmacologically _______. |
|
Definition
|
|
Term
| THere are some sites in the body that are difficult to distribute a drug, such as |
|
Definition
| sites with poor blood supply, (like bone), or those that have physiological barriers that don't allow drugs through - like the brain b/c of the blood/brain barrier. |
|
|
Term
| Metabolism can also be referred to as "bio___________." |
|
Definition
|
|
Term
| Metabolism "biotransformation" refers to the biological transformation of a drug into an ________ metabolite, a more soluble compound, or a more ______ metabolite. |
|
Definition
|
|
Term
| What organ is responsible for metabolism? |
|
Definition
|
|
Term
| What are the enzymes involved in hepatic transformation and they aid in drug metabolism? |
|
Definition
|
|
Term
| What factors influence the rate of metabolism of a drug? |
|
Definition
| Genetics, Renal insufficiency, Cardiovascular dysfunction, Starvation, Jaundice and the Use of Barbiturates or other drugs at the same time. Overall, know that Genetics, disease and the concurrent use of other drugs will effect the metabolism of a drug. |
|
|
Term
| Elimination of drugs from the body as parent, active, or inactive compounds is __________. |
|
Definition
|
|
Term
| Our bodies primarily excrete by the kidney, but also by the _____ and _____. |
|
Definition
|
|
Term
| Excretion by the kidney is called _____________________. Drugs taken up by the liver, secreted into bile, and excreted in ____________. |
|
Definition
| "biliary excretion, feces |
|
|
Term
|
Definition
| It is the time required for 1/2 of the given amount of drug in the body to be removed. It is a measure of the rate which the drug is eliminated from the body. It is important to know b/c it tells us the appropriate timing of the drug. |
|
|
Term
| How is the 1/2 life of Ibuprofen different then the 1/2 life of Digoxin? |
|
Definition
| Ibuprofen's 1/2 life is about 2 hours. So, you can take it again in 4-6 hours. Digoxin's 1/2 life is 33-44 hours. It is common to take too much & OD b/c of its long half life. You only take Digoxin once a day, at 1 pm. Ex/little old lady comes into the ER w/ a really low HR...? Often she has taken too much Digoxin. It is going to take a long time - put her on a heart monitor. |
|
|
Term
| Most drugs are removed after about __ half-lives |
|
Definition
|
|
Term
|
Definition
| With regard to blood levels of a drug it refers to the physiological state in which the amount of a drug removed via elimination (renal clearance) is equal to the amt of drug absorbed with each dose. It's a "physiological plateau" that usually occurs after 4-5 half-lives of the drug. |
|
|
Term
| The __________________ is the time it takes for the drug to elicit a therapeutic response. |
|
Definition
|
|
Term
| ___________________ is the time it takes for a drug to reach its maximum therapeutic response. |
|
Definition
|
|
Term
| _____________________ is the time that drug concentration is sufficient to elicit a therapeutic response. |
|
Definition
|
|
Term
|
Definition
| the drug is at the highest blood level. (don't want it to go any higher then the peak b/c they could becomes toxic.) |
|
|
Term
|
Definition
| it is at the LOWEST blood level of a drug. We don't want it any lower b/c we want it to work. We need to look at both peak & trough to prevent toxicity. |
|
|
Term
| Pharmacodynamics is what the drug does to the body biochemically and physiologically. What are the 3 general mechanism of actions for pharmacodynamics? |
|
Definition
| 1. RECEPTOR INTERACTION 2. ENZYME INTERACTION 3. NONSELECTIVE INTERACTION |
|
|
Term
| explain "Receptor Interactions"? |
|
Definition
| drugs may use receptor interactions - they involve the selective joining of the drug with a reactive site on the surface of a cell or tissue. Usually it is a protein & by binding to it, the drug starts a biological effect of some kind. |
|
|
Term
| explain "Enzyme Interaction" |
|
Definition
| enzymes catalyze reactions in our cells. Drugs produce effects by interacting with these enzyme systems. Drugs either inhibit or enhance the specific action of an enzyme by binding to it, and changing its normal interaction with target molecules in the body. This process is called "selective interaction." |
|
|
Term
| explain "Nonselective Interaction" |
|
Definition
| these drugs do not react with receptors or enzymes, they target cell membranes or metabolic activities instead. These drugs will physically interfere with or chemically alter these cellular structures or processes. These drugs cause defects in cell walls. Also cause death/lysis or stop cells energy production causing cell starvation & death. |
|
|
Term
| Pharmacotherpautics is, again, the tratment of pathological conditions through the use of drugs... the effect or specifically what disorder it is used to treat. Medications are administered for what? |
|
Definition
| All the types of therapy talked about next... |
|
|
Term
|
Definition
| it is intensive drug treatment, used to treat acute illness or critically ill needed to sustain life or disease. For example, vasopressers after open heart surgery. |
|
|
Term
| What is maintenance therapy? |
|
Definition
| It does NOT get rid of problems that the patient has, but it does prevent progression of the disease or condition. Ex/ need maintenance therpay to treat conditions like HTN or oral contraceptive use. |
|
|
Term
| What is supplemental therapy? |
|
Definition
| Supplemental therapy supplies the body with a substance needed to maintain normal function. These substances are needed b/c the body can't make the substances or can't make enough of them. Ex/ insulin for type 1 diabetics,iron to iron anemics |
|
|
Term
| What is palliative therapy? |
|
Definition
| The goal of palliative therapy is to make the patient as comfortable as possible. Used in the end stages of an illness or trauma. Ex/ high dose opioid analgesics to relieve pain in final stages of cancer. |
|
|
Term
| What is supportive therapy? |
|
Definition
| maintains the integrity of body functions while the patient is recovering from illness or trauma. Example of supportive therapy is giving fluid & electrolyes to prevent dehydration while person is vomiting or diarrhea. |
|
|
Term
| What is prophylactic therapy? |
|
Definition
| It is provided to prevent an illness or other undesireable outcome. Prophylactic therapy is based on scientific knowledge and observation. |
|
|
Term
| a patient has been treated for hypothyroidism for 10 yrs after having his thyroid gland removed d/t cancer. What kind of therapy is this? |
|
Definition
| Supplemental b/c it is supplying his body with a substance needed to maintain normal function. |
|
|
Term
| A pt has a history of depression and has been taking bupropion for 8 months, with improvement in symptoms noted. What kind of therapy is this? |
|
Definition
| Maintenance b/c the depression is being treated to prevent progression, but it is not intended to get rid of the disease. |
|
|
Term
| A pt who is in her 28th wk of pregnancy is experiencing premature labor and is given an IV infusion of terbutaline sulfate to stop the contractions. What kind of therapy is this? |
|
Definition
| acute therapy, b/c she is only in her 7th month of pregnancy and the drug is an intensive drug treatment designed to sustain life. |
|
|
Term
| A pt is scheduled for abd surg. Prior to the surg, he is given a dose of an intravenous antibiotic. What kind of therapy is this? |
|
Definition
| Prophylactic b/c it is provided to prevent illness or other undesireable outcome (infection most likely). |
|
|
Term
| A pt with terminal cancer is receiving a high dose of morphine sulfate. What kind of therapy is this? |
|
Definition
| Palliative b/c it is a pain med (designed to make as comfortable as possible) used in end stages of cancer. |
|
|
Term
| We call the 'unintended' predictable adverse drug reactions.... |
|
Definition
|
|
Term
| The ratio of a drug's toxic level to the level that provides therapeutic benefits is called their... |
|
Definition
|
|
Term
| If the difference between a therapeutically active dose compared to the toxic dose is small (therefore a greater likelihood of causing adverse rxn's) then we say it has a... |
|
Definition
|
|
Term
| Why is it important to know the drug concentration? |
|
Definition
| it's an imp tool for evaluating the pt's response to drug therapy. If liver or kidney fx declines, toxic drug levels may be seen and adjust the dose. |
|
|
Term
| Why is it so important to know the patients condition? |
|
Definition
| Because a pt's response to a drug will be altered by disease, infection, cardio and GI function. |
|
|
Term
| When a patient shows a decreasing response to repeated drug doses (aka a patient on the same pain med over time needs more of the med to feel relief) this is _____________. |
|
Definition
|
|
Term
| A physiological or psychological need for a drug and has withdrawal symptoms is showing ___________. |
|
Definition
|
|
Term
| The more drugs a pt receives, the more likely a drug interaction will occur. This is esp a problem with elderly. Why? |
|
Definition
| Elderly typically have an increased sensitivity to drug effects and are receiving several meds (polypharmacy). Elderly often have altered metabolism and absorption with decreased excretion rates. |
|
|
Term
| What is the effect that is caused when 2 drugs with similar actions are given together? |
|
Definition
|
|
Term
| When 2 drugs are given together and the result is an effect even greater than the sum of effects for each drug given alone is __________________. |
|
Definition
|
|
Term
| When 2 drugs are given together results in an effect less than the sum of effects of each drug given alone is a ___________________. |
|
Definition
| Antagonistic Drug Interaction |
|
|
Term
| 2 parenteral drugs/solutions mixed together resulting in chemical deterioration of 1 or both drugs refers to ___________________. It can produce a precipitate or haziness. (we always want to make sure our drugs are compatible together) |
|
Definition
|
|
Term
| Are med errors preventable? Are adverse drug effects preventable? |
|
Definition
| Med errors are preventable (they can occur in any stage of drug therapy), but adverse drug effects are not necessarily preventable. |
|
|
Term
| A pharmacologic reaction is... |
|
Definition
| just an extension of the drugs normal effects in the body. For example, a drug that is used to lower BP in a patient with HTN causes a pharmacologic ADR when it lowers the BP to the point at which the pt becomes unconscious. Pharmacologic rxn's also include adverse effects... their occurence is related to the dose, and are predictable in frequency and intensity. |
|
|
Term
| What is an allergic (hypersensitivity reaction)? |
|
Definition
| it involves the patients immune system, immunoglobulins bind to the drug to neutralize it. responses can be milk (like a rash) or severe (constriction of the airways). |
|
|
Term
| A ___________ reaction is one where there is no reason for these rxn's to occur. It is an abnormal response to a normal dose. |
|
Definition
|
|
Term
| __________ effects result in structural defects in the fetus. |
|
Definition
|
|
Term
| ____________ effects are permanent changes in the genetic code, DNA and/or # of chromosomes. |
|
Definition
|
|
Term
| __________ effects are the cancer-causing effects of drugs, chemicals, radiation and viruses. |
|
Definition
|
|
Term
| Do pediatric patients have as much of a first pass effect as adults? |
|
Definition
| No b/c of the immaturity of their liver |
|
|
Term
| When is the greatest danger for drug-induced developmental defects? |
|
Definition
|
|
Term
| What is the fetal risk for "category A" vs "X"? |
|
Definition
| category A = no risk to fetus. X = positive evidence of human fetal risk. |
|
|
Term
| Can drugs pass from mom's circulation via breastmilk to her child? |
|
Definition
| Yes, a great number of drugs can cross from mom's circulation into breast milk |
|
|
Term
| Are drug levels higher or lower then in mothers circulation? |
|
Definition
|
|
Term
| are all drugs more toxic in children than adults? |
|
Definition
| No, some are more toxic & some are less toxic to kids than they are to adults. |
|
|
Term
| Do we always give a lower dose to children? |
|
Definition
| No, not necesarily. Some drugs are more toxic in kids & some drugs are less toxic than they are in adults. |
|
|
Term
| Whether or not to give a drug to an age group and at what dose, is under the category of pharmaco_________. |
|
Definition
| dynamics. (because this is what the drug does to the body) |
|
|
Term
| Many drugs commonly used in adults have not been studied in children, and therefore are administered on an empirical basis. Dose calculations using ____________________________ are the most accurate. |
|
Definition
| Body Surface Area (BSA) nomogram |
|
|
Term
| Elderly is defined as more then _____ years old. |
|
Definition
|
|
Term
| Drug therapy in elderly is more likely to result in.... why? |
|
Definition
| adverse effects, toxicity d/t polypharmacy, physiologic changes, pharmacokinetics. Elderly have decreased absorption, distribution, metabolism and excretion. |
|
|
Term
| What happens to absorption, distribution and metabolism in elderly? |
|
Definition
| all are decreased. (excretion is reduced d/t decreased GFR) |
|
|
Term
| Will implementing the 5 rights prevent all medication errors? |
|
Definition
|
|
Term
| Med Errors are potentially __________ and are caused by who? |
|
Definition
| preventable, caused by all HC workers. There are organization issues and there are SO many people involved. In 2003 a stuedy showed that 1/2 of all preventable ADRs occured when? in the prescribing stage. |
|
|
Term
| What can reduce med errors? |
|
Definition
| Technology, such as EMAR (electronic medical administration record). We scan med & scan pt's arm band. |
|
|
Term
| How does the educational system contribute to medication errors? |
|
Definition
| HC professional have a tendency to feel denial, fear or shame when wrong. NO QUESTION is a stupid question! |
|
|
Term
| The quality of the nurse and physician's ______________ is a strong predictor of patient outcomes related to medication errors. |
|
Definition
|
|
Term
| ____________ ______________ is procedure that seeks to prevent medication errors through the ongoing assessment and updating of every patient's list of medications throughout the HC process and timely communication of such info to both patients and their providers. |
|
Definition
| medication reconciliation |
|
|
Term
| What 3 steps should be repeated at each stage of HC delivery? |
|
Definition
| Verification, Clarification and REconciliation. |
|
|
Term
| What is an example of a med error? a. pt refuses their morning meds. b. pt recieves a dbl dose of a med b/c the nurse did not cut the pill in half c. a pt. develops hives after starting an IV 24 hrs ago |
|
Definition
| B. forgetting to cut a pill in 1/2 is a medication error |
|
|
Term
| When giving a scheduled med, the pt. states they've never seen that pill before. What's the best nurses reaction? |
|
Definition
| I'll check the order first, before you take it |
|
|
Term
| If your best friend nurse comes up with your med drawn, do you administer it? |
|
Definition
| No! never give a med you didn't draw up & triple check yourself |
|
|
Term
| Same med (nitroglycerin for angina in a pt) given different routes. Ms. A, age 88, takes 9 mg BID to prevent angina. How is this med given? |
|
Definition
|
|
Term
| Same med (nitroglycerin for angina in a pt) given different routes. Mr. B, age 63, takes a form that delivers 0.2 mg/hr to prevent angina. How is this likely given? |
|
Definition
| Patch (Not IV because it is "preventing") |
|
|
Term
| Same med (nitroglycerin for angina in a pt) given different routes. Ms. C, age 58, takes 0.4 mg only if needed for severe chest pain. How is this given? |
|
Definition
| sublingual (very vascular, gets in the blood stream faster) |
|
|
Term
| Same med (nitroglycerin for angina in a pt) given different routes. Mr. D, age 62, is in the hospital with severe, unstable angina and is receiving 20 mcg/hr. |
|
Definition
| IV (b/c dosage is much less with mcg) |
|
|
Term
| What would happen if Ms. A chewed her nitroglycerin dose instead of swallowing? |
|
Definition
| The effects would be a lot faster and would not last as long. She would likely get a BIG headache b/c it dilated the vessels in her head fast too. |
|
|
Term
| What would happen if Ms. C chewed her dose when she was supposed to put it sublingually? |
|
Definition
| It would be slower, onset of action would get affected by the 1st pass. |
|
|
Term
| What is insulin's onset, peak and duration times? |
|
Definition
| Onset: 5-15 minutes, Peak (max. effect): 1-2 hrs, Duration (therapeutic effect ends): 4-6 hours |
|
|
Term
| What is a sd effect of opioids? |
|
Definition
|
|
Term
| Morphine sulfate & demerol are both __________. |
|
Definition
|
|
Term
| morphine sulfates sd effect is _________. |
|
Definition
|
|
Term
| Why do we have to be careful using Demerol? (test question) |
|
Definition
| Demerol can actually cause serizures |
|
|
Term
| What are the other sd effects of Demerol? |
|
Definition
| CNS respiratory depression (anything less then 12 resp/min), constipation, urinary retention, itching or rash! |
|
|
Term
| What is the antidote for opioids (it reverses opioids)? |
|
Definition
|
|
Term
| What do you need to remember about naolxone (Narcan's) 1/2 life? How is it given? |
|
Definition
| the 1/2 life of Narcan is a lot less then the opioid, so you ne to redose & do not forget that! It is given IV, IM and sub-q. |
|
|
Term
| Teacher said opioids are used for: postop, severe pain, cancer pain. non opioids are used for... |
|
Definition
| moderate headaches & fever (Tylenol). |
|
|
Term
| What is the most widely used nonopioid analgesic? |
|
Definition
|
|
Term
| The MOA of nonopioid analgesics is this... The MOA of acetaminophen.. it blocks peripheral pain impulses by inhibition of _____________ ______________. |
|
Definition
|
|
Term
| acteominophen (Tylenol) is an antipyretic, what does that mean? |
|
Definition
| it lowers the body temperature by acting on the hypothalmus (brain structure that regulates body temperature). |
|
|
Term
| In contrast to NSAIDs, acetaminophen has only weak antiinflammatory effects, what's this mean? |
|
Definition
| acetaminophen (Tylenol) is not used to treat inflammation. |
|
|
Term
| If somebody has an acute OD of acetaminophen (Tylenol) what organ do you affect? What about with a chronic OD? |
|
Definition
| acute OD=hurts the LIVER, chronic OD=hurts the kidneys |
|
|
Term
| What is the max daily dose of Tylenol? How many mg are in one Tylenol usually? |
|
Definition
| 4000 mg/day = 4g/day. Usually 500 mg/tab. Often it is take 2 every 6 hrs. Problem is, Tylenol is in a lot of things: Therflu, Midol, Excedrin, Sinutab... so need to be careful |
|
|
Term
| What is the antidote for acetaminophen (Tylenol)? What is key to know about this drug? |
|
Definition
| Acetylcestine, it smells like rotten eggs - you're going to need to disguise it. |
|
|
Term
| What is the #1 problem if you give too much narcotics? |
|
Definition
|
|
Term
| What are NSAIDs mechanism of action? they inhibit ______________ pathway so we don't get inflammation. |
|
Definition
|
|
Term
| What are some of the things prostaglandins do? (That we would be blocking with NSAIDs, so its adverse effects?) |
|
Definition
| Prostaglandins transmit pain, increase blood flow to kidneys, protect the lining of the stomach and dilate small vessels. |
|
|
Term
| Sd Effects of NSAIDs (prostaglandin inhibitors) are: |
|
Definition
| GI distress (ulceration & bleeding), Renal Faiure, Bleeding |
|
|
Term
| One of the most common adverse effects of NSAIDs? |
|
Definition
|
|
Term
| What are 2 of the key drugs for NSAIDs and what are their sd effects? |
|
Definition
| celecoxib (Celebrex): can cause cardiac problems (increased risk of stroke & heart attack from Celebrex), cycloxygenase (Cox 2) inhibitor: taken for osteoarthritis. |
|
|
Term
| What is important patient teaching in regard to NSAIDs? |
|
Definition
| Teach them to protect their stomachs - take NSAIDs with food, milk or an antacid to prevent GI irritation. |
|
|
Term
| What happens when you drink alcohol with NSAIDs? |
|
Definition
| get an additive effect -> increased bleeding |
|
|
Term
| What happens when you take anticoagulants with NSAIDs? |
|
Definition
| platelet inhibition -> increased bleeding tendencies |
|
|
Term
| What happens when you take an aspirin + NSAIDs? |
|
Definition
| get decreased absorption, additive GI toxicity -> increased GI toxicity, with no therapeutic advantage |
|
|
Term
| What is the disease in the great toe that usually results from inappropriate uric acid metabolism build-up? |
|
Definition
|
|
Term
| What is the key antigout med to know? |
|
Definition
| colchicines - it reduces the inflammatory response |
|
|
Term
| What are the sd effects of colchicines (antigout med)? |
|
Definition
| Leukopenia, GI bleeding, renal failure. it is used for acute attacks only! |
|
|
Term
| What NSAID is commonly prescribed for rheumatoid arthritis? (rheumatoid arthritis has an autoimmune element - the body is fighting itself) |
|
Definition
| sulfasalazine (Azulfidine) - it is a disease modifying antirheumatic, meaning it tries to prevent the progression of the disease. |
|
|
Term
| What are prostaglandins good effects and bad effects? |
|
Definition
| Good effects=increase blood flow to kidneys and protects the lining of the stomach. Bad effects=transmits pain and allows us to have inflammation. NSAIDs therefore work by: decreasing blood flow to kidneys, unprotects stomach (why we have to eat & take med), stop pain transmission and decrease inflammation. |
|
|
Term
| What is to understand about equal analgesics? |
|
Definition
| need to understand in clinicals that 30 mg IV and 30 mg PO do not work the same, need to be really careful to give equal analgesics & follow charts thoroughly. |
|
|
Term
| Your patient is recovering from abd surgery... he's groggy, but complaining about pain during incision. What is most important for the nurse to consider? His temperature, resp rate or appearance of incision? |
|
Definition
| Respiratory rate is most imp! |
|
|
Term
| A pt will be discharged with a 1 wk supply of opioid analgesic for abd pain following surgery. The nurse should include what info? |
|
Definition
|
|
Term
| a 78 y.o. pt is in the recovery room after hip surgery. As he's gradually awakening, he wants pain meds. 10 minutes later he's lethargic with only 9 resp/min. The nurse should expect to give him at this time....? |
|
Definition
| naloxone (Narcan) - an antidote that reverses opioids. |
|
|
Term
| What 3 things to remember if question is on opioids? |
|
Definition
| constipation, drowsiness, N & V |
|
|
Term
| a 38 y.o. male comes to the ER, severe hip pain and fell from a ladder at work. Says he took many pills over the last hour, but doesn't remember how many. He hands you an empyty bottle of Tylenol. What is the most serious sd effect of acute acetaminophen OD? |
|
Definition
| Liver effects (hepatic, nephropathy <- refers to damage or to disease of the kidney) |
|
|
Term
| A pt is to receive acetylcestine (antidote for Tylenol) for an OD. What action is most appropriate? |
|
Definition
| Disguise it in some juice or some drink b/c it smalls & tastes really bad, like rotten eggs |
|
|
Term
| If a pt is treated for lung cancer and the opioid isn't helping much... they need more meds for the same pain relief. As a nurse, you know she's experiencing opioid __________. |
|
Definition
|
|
Term
| Which of the following are possible therapeutic sd effects of NSAIDs? a) antianxiety b) diuretics c) antipyretics d) antimicrobial |
|
Definition
| c) antipyretics (antifever) - and they're also antiinflammation drugs |
|
|
Term
| a 75 y.o. woman has RA (rheumatoid arthritis - so it's systemic) the nurse is aware that which med could have an interaction with this NSAID? |
|
Definition
|
|
Term
| a 6 y.o. with chk pox has fever of 102. What should the nurse suggest to reduce the fever? what do we never give kids? |
|
Definition
| Tylenol, we never give kids Aspirin b/c they are at risk for Reye's Syndrome which is rare but deadly. |
|
|
Term
| Drugs that depress the CNS (includes the brain + spinal cord) are referred to as ___________ or ___________. |
|
Definition
|
|
Term
| Sedative hypnotics can either be, in general, ________________ or ________________. which ones older and which ones newer? |
|
Definition
| Barbiturates (older) or Benzodiazepines (newer drug, that's more safe) |
|
|
Term
| Barbiturates were first introduced for insomnia, but they had bad sd effects of... |
|
Definition
| being habit forming, depriving one of REM sleep and enzyme induction (they are highly metabolized by the liver, so it increases drug metabolism and breakdown). |
|
|
Term
| The key barbiturate is ____________ which is still used for seizures. It can be used as a sedative hyponotic by reducing nerve impulses to the brain, but remember the bad sd effects previously (they're habit forming, they deprive one of REM sleep and enzyme induction - they're highly metabolized in the liver so it increases drug metabolism and breakdown.) |
|
Definition
|
|
Term
| ___________ reduce nervousness, excitability, and irritability without causing sleep. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| _____________ are very commonly prescribed for helping you sleep or reducing anxiety. |
|
Definition
|
|
Term
| What happens if you OD on benxodiazepines? |
|
Definition
| it's benign, causes little more then sedation |
|
|
Term
| What is zolpidem (Ambien) used for? how long? Does it interfere with REM sleep? |
|
Definition
| sleep, short term insomnia (7-10 days, up to 2 weeks) it is intended for short-term treatment and is used UNDER THE DIRECTION OF A PHYSICIAN. It does not interfere with REM sleep, but it DOES interfere with sleep. It is not normal to take drugs to sleep and a lot of people will have a hangover th e day after they take Ambien. |
|
|
Term
| Why would a physician choose benzodiazepine over a barbiturate? |
|
Definition
| In short, b/c they're SAFER... an OD on a benzodiazepine causes little more then sedation. They are also not habit forming and do not interfere with REM sleep. |
|
|
Term
| What are the consequences of long-term use of barbiturates? |
|
Definition
| They're habit forming, deprive one of REm sleep, can have rebound nightmares, increases a drugs metabolism & breakdown, can get agitated (inability to deal with normal stress). |
|
|
Term
| What interactions should the patient be told about when they're using Ambien? |
|
Definition
| Alcohol (when you mix a CNS depressant, Ambien, with another CNS depressant, alcohol, you get = an additive effect, all sd effects are more intensive!) |
|
|
Term
| What other patient teaching is important for someone prescribed with Ambien? |
|
Definition
| The patient still needs 8-10 hours of sleep. It is only short-term treatment. Also, we don't know how they will respond the first time they take it (might want to take it on the weekends)... there are tons of non-pharm ways to deal with insomnia, might want to try one of those. |
|
|
Term
| Who is often getting prescriptions of muscle relaxants? |
|
Definition
| when people get an injury, a lot of people who injure their back or spinal cord, get muscle relaxants. |
|
|
Term
| key drugs that are muscle relaxants are what? |
|
Definition
| cyclebenzaprine (Flexeril) and baclofen (Atrofen) |
|
|
Term
| Would a patient with back pain be prescribed the cyclebenzaprine (Flexeril) or the baclofen (Atrofen)? |
|
Definition
| the cyclebenzaprine (Flexeril) is prescribed for people with back pain. |
|
|
Term
| Would a patient with a spinal cord injury or cerebal palsy be prescribed the cyclebenzaprine (Flexeril) or the baclofen (Atrofen)? |
|
Definition
| baclofen (Atrofen) is more likely to be prescribed for spinal crod injury or cerebral palsy, it can be administered introfecally via pump. |
|
|
Term
| Do the muscle relaxants discussed, cyclebenzaprine (Flexeril) or the baclofen (Atrofen), act on the CNS to relax muscles or irectly on the muscle tissue? |
|
Definition
| They both act on the CENTRAL NERVOUS SYSTEM to relax - these do not have a direct effect on the muscle tissue! |
|
|
Term
| What are the SD effects of cyclebenzaprine (Flexeril) or the baclofen (Atrofen) muscle relaxants? |
|
Definition
| Cause drowsiness & light headedness |
|
|
Term
| If you're taking care of someone on muscle relaxants, with SD effects of drowsiness & light headedness, what are you worried about? |
|
Definition
| Falls, especially with the elderly population |
|
|
Term
| The terms convulsion, seizure and epilepsy are often used interchangably, but they do not have the same meaning. Which one is characterized by involuntary spasmodic contractions of any or all voluntary muscles throughout the body? |
|
Definition
|
|
Term
| The terms convulsion, seizure and epilepsy are often used interchangably, but they do not have the same meaning. Which is a brief episode of abnormal electrical activity in the nerve cells in the brain? |
|
Definition
|
|
Term
| The terms convulsion, seizure and epilepsy are often used interchangably, but they do not have the same meaning. Which is a chronic, recurrent pattern of seizures? |
|
Definition
|
|
Term
| How do antiepileptic (convulsion, serizure, epilepsy) drugs work? |
|
Definition
| They decrease excitability/responsiveness of the neurons that are firing. We are NOT exactly sure how these drugs even work though. |
|
|
Term
| What kind of seizure disorder is a life-threatening emergency? |
|
Definition
| status epilepticus - have tonic-clonic convulsions that occur in successive order. Tonic-clonic seizures were formerly called grand mal seizures. |
|
|
Term
| What is the prototypical benzodiaszepine used to treat status epilepticus? |
|
Definition
|
|
Term
| What are the sd effects of diazepam (Valium)? |
|
Definition
| Antiepileptic Drugs (AED's) are plagued by many side effects, DROWSINESS is common and they need to AVOID ALCOHOL. Patient teaching is important b/c it is very important for the patient to understand that it is a life-long treatment and they they cannot abruptly stop it, they need to taper off & start a new AED. |
|
|
Term
| phenytoin (Dilantin), carbamazepine (Tegretol) and diazepam (Valium) are all what kinds of drugs? |
|
Definition
| Antiepileptics - for seizures & antiepilepsy. |
|
|
Term
| What are the therapeutic levels for phenytoin (Dilantin) and carbamazepine (Tegretol)? |
|
Definition
| It also has a therapeutic level and the PATIENTS BLOOD LEVELS NEED TO BE MONITORED for many AED's. Tegretol=3-14 mcg/mL and Dilantin=10-20 mcg/mL. |
|
|
Term
| What are the adverse effects of phenytoin (Dilantin)? |
|
Definition
| GINGIVAL HYPERPLASIA (hypertrophy of their gums when they're on Dilantin for a long time), get ACNE, girls get MALE HAIR PATTERN LIKE BEARDS.. |
|
|
Term
| most antiepileptics needs to be __________ monitored. |
|
Definition
|
|
Term
| What 3 categories are within ANTIPARKINSON'S? |
|
Definition
| MAOI, Dopaminergic and Anticholinergic |
|
|
Term
| How do the 3 categories within Antiparkinson's work? Need to know this!! |
|
Definition
| MAOI's = inhibit the breakdown of dopamine, DOPAMINERGIC = increase the amount of breakdown, ANTICHOLINERGIC = block the effects of acetylcholine. They have nothing to do with dopamine. |
|
|
Term
| What kind of drug is selegiline (Eldepryl)? |
|
Definition
| MAOI (monoamineoxidase inhibition) |
|
|
Term
| There is something called the "________ ________" in MAOI (so with selegiline Eldepryl)... what does this mean? |
|
Definition
| Cheese Effect - need to avoid cheese, yogurt, red wine, beer... otherwise will get HYPERTENSION <--- will be on the test |
|
|
Term
| MAOI's can be selective & nonselective, what does that mean? |
|
Definition
| If the amount you give exceeds the amount recommended then it will becomes nonselective (don't have a specific neuron you're going to) and you're at risk for the cheese effect. There will probably be a patient teaching question on this info. |
|
|
Term
| What kind of drug is levodopa-carbidopa (Sinemet)? |
|
Definition
| Dopaminergic (increases the amt of dopamine). |
|
|
Term
| How does levodopa-carbidopa (Sinemet) work? |
|
Definition
| Levodopa is an exogenous precursor of dopamine. Exogenous dopamine can't cross the blood brain barrier though. However, levodopa can cross the blood-brain barrier, but it breaks down in the body really fast when taken by the mouth. So you will need very large amounts then. Carbidopa prevents breakdown of Levodopa and protects it, thus, allowing it to cross the blood/brain barrier/ |
|
|
Term
| What kind of drug is benztropne mesylate (Cogentin)? |
|
Definition
| Anticholinergic - which blocks the effects of acetylcholine, has nothing to do with dopamine. |
|
|
Term
| Parkinsons patients get increased muscle rigidity b/c of __________ build-up. What med would you prescribe for this & what are its side effects? |
|
Definition
| acetylcholine. Prescribe: benzoptropne mesylate (Cogentin). Has horrible sd effects though: you can't pee, can't see, can't spit, can't shit. It fixes the muscle rigidity and acetylcholine build-up, but causes these horrible sd effects. |
|
|
Term
| Why are CNS stimulants often called "sympathel memetics?" |
|
Definition
|
|
Term
| CNS stimulants work for what 3 categories? |
|
Definition
| ADHD/Narcolepsy, Obesity and Migraines |
|
|
Term
| Why would you prescribe methyphenidate (Ritalin)? |
|
Definition
|
|
Term
| What are the unfortunate sd effects of methphenidate (Ritalin) |
|
Definition
| look at "methyl" - it has a strong ADDICTION potential. Also, strong potential for TOLERANCE. It speeds up body systems and you get an increased HR. |
|
|
Term
| What drug will you prescribe for obesity? |
|
Definition
| sibutramine (Meridia): which will suppress the appetite and make them feel full. It increases dopamine, norpipinephrine & serotonin activity in the brain. |
|
|
Term
| What would the drug sumatriptan (Imitrex) be prescribed? |
|
Definition
| for treating (not preventing!!) Migraines. It vasal constricts the cerebral arteries... be careful that it doesn't speed up the BP more then you want it to. |
|
|
Term
| If you are a nurse in a busy ped's office and the physician wrote a prescription to J.J. an 8 y.o. boy with ADHD for Ritalin. What is your teaching plan? When/how do you take meds and what do you need to worry about while he's taking them? |
|
Definition
| Ritalin needs to be taken in the morning. Worry about other CNS stimulants... could get an additive CNS effect - don't give them caffeine, sugar. Watch for addiction and weight loss (get a baseline weight). Might need to offer them frequent snacks, make sure they're getting good nutrition and when they come in make sure they're growing right. |
|
|
Term
| What is the AE of phenytoin (Dilantin)? |
|
Definition
|
|
Term
| What antiparkinsonian agent is associated with the "cheese effect"? |
|
Definition
| MAOIs - means it can interact with cheese, yogurt, red wine, beer.. what will happen? Hypertension |
|
|
Term
| What is the cornerstone in treatment of Parkinsons Disease? |
|
Definition
|
|
Term
| Which type of CNS depressants deprive clients of REM sleep? |
|
Definition
|
|
Term
| Which benzodiazepine is indicated for short-term treatment of insomnia? |
|
Definition
|
|
Term
| Phenoarbital is a ___________ |
|
Definition
|
|
Term
| Baclofen is a ______________ |
|
Definition
|
|
Term
| Phenytoin is an _________________. |
|
Definition
|
|
Term
| Which drug is used in the treatment of ADHD? |
|
Definition
|
|
Term
| Most drug-drug interactions involving barbiturates are secondary to their interactions on what? |
|
Definition
|
|
Term
| What is an example of a muscle relaxant used in the management of spasticity associated with cerebral palsy? |
|
Definition
|
|
Term
| What is the term for drugs that have a small difference between safe & Toxic levels? |
|
Definition
| they have a "Narrow Therapeutic Index (NTI) drugs" |
|
|
Term
| ____________ are for psychosis & agitation. They are the foundation of treatment for serious long term mental disorders, such as schizophrenia. |
|
Definition
|
|
Term
| You must know that antipsychotic meds have serious sd effects that can be lethal... like what? |
|
Definition
| extrapyramidal side effects (EPS), neuroleptic malignant syndrome (NMS), agranulocytosis (clozaril), photosensitivity & cardiac problems (geodon - QT prolongation). |
|
|
Term
| Older antipsychotic meds have _____ sd effecs and block dopamine. Newer "atypical" antipsychotics have ____ sd effects and regulate serotonin, norepinephrine, and dopamine to various degrees depending on the med. |
|
Definition
|
|
Term
| Why is it more difficult to assess patients sd effects with antipsychotics? |
|
Definition
| psychotic pt's often have difficulty communicating |
|
|
Term
|
Definition
| usually occurs early in treatment, it is primarily muscle spasms or contractions of the neck, jaw, back area |
|
|
Term
|
Definition
| severe body restlessness, compulsion to move. Make sure they're not just feeling anxious. With akithisia they're not really in control of what they're doing. |
|
|
Term
| What is a drug induced movement disorder where they don't swing their arms as much, have stooped posture, bradykinesia (slow movement. Often they tolerate sd effects & think it's part of what's wrong with them. |
|
Definition
|
|
Term
| What is tardive dyskinesia? |
|
Definition
| It's very serious b/c this sd effect is potentially irreversible to the patient. The patient has involuntary movements that start often with the jaw. |
|
|
Term
| Older antipsychotics are also called: |
|
Definition
| "conventional" or "typical" antipsychotics |
|
|
Term
| What do the older antipsychotics help? |
|
Definition
| they decrease hallucinations & delusions (known as "positive" symptoms) but do not help apathy, social withdrawal ("negative" symptoms) and sometimes make these worse. |
|
|
Term
| What is a high potency older antipsychotic? |
|
Definition
| Haldol. Tends to have more EPS, less sedation |
|
|
Term
| What is a low potency antipsychotic that was introduced more then 50 years ago? |
|
Definition
| Thorazine - causes orthostatic hypotension, more sedation, decreased gag reflex. |
|
|
Term
| What are the newer, atypical antipsychotics? |
|
Definition
| clozapine (Clozaril), olanzapine (Zyprexa) |
|
|
Term
| Older antipsychotics (Haldol & Thorazine) block ___________. |
|
Definition
|
|
Term
| Newer antipsychotics (Clozaril & Zyprexa) affect ___________, __________ and/or dopamine. |
|
Definition
| serotonin, norepinephrine |
|
|
Term
| Side effects of antipsychotics in general (more with older antipsychotics) are extrapyramidal side effects d/t dopamine blockade. What are these? |
|
Definition
| Dystonia, akathisia, pseudoparkinsonism, tardive dyskinesia. |
|
|
Term
| Do the newer, atypical antipsychotics (Cloazaril, Zyprexa) have ______________ EPS. |
|
Definition
|
|
Term
| What medications are used to treat EPS? |
|
Definition
| Cogentin (is an anticholinergic, antiparkinsonian med) or benadryl (if dystonia is severe and cannot swallow then IM) |
|
|
Term
| Vitamin ___ may help but not cure tardive dyskinesia. |
|
Definition
|
|
Term
| The best way to prevent tardive dyskinesia is through screening with the _____ _______ performed on a regular basis. Note tremors, shuffling gait, cogwheel rigidity, restlessness since easy to observe. Vermicular (worm like) tongue movements are an early sign of tardive dyskinesia (TD). |
|
Definition
|
|
Term
|
Definition
| neuroleptic malignant syndrome: rare, but can be lethal. Monitor VS, assess for lead pipe rigidity of limbs, muteness, incontinence, increased/fluctuating VS, increased BP, fever, confusion. Hold meds; notify the on call immediately. |
|
|
Term
| What is agranulocytosis? <--sd effect of antipsychotics |
|
Definition
| Rare, but can be lethal. Note infection, sore throat, fever, and notify primary care provider immediately. Monitor WBC lab biweekly for agranulocytosis. |
|
|
Term
| What are the sd effects of antipsychotics? |
|
Definition
| Extrapyramidal sd effects (dystonia, pseudoparkdinsonism, TD, akathisia) Neuroleptic Malignant Syndrome (NMS), Agranulocytosis, Photosensitivity, Orthostatic Hypotension, Sedation, Anticholinergic effects, Substantial weight gain, Seizures, Prolactin Levels can increase |
|
|
Term
| Why do people taking antipsychotics need to stay out of the sun? |
|
Definition
| They have PHOTOSENSITIVITY as a sd effect, which means it can be lethal if they get a severe sunburn. Use sunscreen (15+) and protective clothing. |
|
|
Term
| Antipsychotics sd effects put them at risk for sedation. Advise not to mix with ________ or another sedating drug. |
|
Definition
|
|
Term
| Anticholinergic Effects are a sd effect of antipsychotics... explain them... |
|
Definition
| They're a serious problem. Note constipation, urinary retention, dry eyes, mouth. The treatment for EPS (cogentin, an anticholinergic itself) can lead to additional anticholinergic effects on top of those caused by antipsychotics. Severe impaction and urinary retention can be huge problems. Even anticholinergic psychosis can occur. Good dental care needed to prevent decay. Use sugarless candy, push fluids, bulk in diet, monitor well. |
|
|
Term
| Antipsychotics cause the sd effect of weight gain or weight loss? |
|
Definition
| weight gain: most of the newer meds cause this d/t markedly increased appetite. A high percentage (up to 40%) become obese and/or diabetic. |
|
|
Term
| Additional to obesity, Antipsychotics, can cause prolactin to increase - causing ________ enlargement. |
|
Definition
|
|
Term
| Antidepressants are obviously for depression, but what else? |
|
Definition
| panic, PMS, social phobia, addictions. |
|
|
Term
| What are the 4 basic types of Antidepressants? |
|
Definition
| SSRI's, atypical others, tricyclics, MAOI's. |
|
|
Term
| ____ are used most and have few sd effects that are troubling except for sexual problems. |
|
Definition
|
|
Term
| Tricyclics & MAOI antidepressants are rarely used b/c of sd effects any more. What sd effects do each of those have? |
|
Definition
| Tricyclics=cause CARDIAC DYSRHYTHMIAS, orthostatic hypotension, sedation, anticholinergic effects, and rarely some EPS and OD IS LETHAL! MAOI's require a low tyramine level diet to prevent hypertensive crisis. These could be lethal for a suicide patient. All of these take about a month to really work, although some effects may be seen in 2 weeks. Do NOT MIX MAOI and SSRI. Separate by at least 2-5 weeks. |
|
|
Term
| WHy is it SO important to not mix SSRI & MAOI antidepressants? They need at least 2-5 weeks inbetween.. |
|
Definition
| Combining them could cause SEROTONIN SYNDROME and be lethal. There are new "black box" warnings r/t possible suicidal impulses on SSRIs. |
|
|
Term
| What are the commonly prescribed SSRI antidepressants? |
|
Definition
| fluoxetine (Prozac) & sertraline (Zoloft) |
|
|
Term
| What are the SD effects of the SSRI antidepressants Prozac & Zoloft? How do SSRI's work? |
|
Definition
| All can cause HA, insomnia, tremors, sedation, wt. loss/gain, sexual problems. The "SSRI" says it = selective serotonic reuptake inhibitor, means inhibits reuptake of serotonin. |
|
|
Term
| The tricyclic antidepressant we need to know is called _______. What are its sd effects? |
|
Definition
| Elavil - cardiac problems, orthostatic hypotension, sedation, anticholinergic effects. |
|
|
Term
| What is the MAOI antidepressant we need to know? what are its specifications/sd effects? |
|
Definition
| Nardil - need to be on a LOW TYRAMINE diet: nothing pickled, aged, fermented, plus a few others. many chesses, wines, beers are out. Hypertensive crisis: stiff neck, high BP, severe HA. Requires emergency treatment! |
|
|
Term
| The other antidepressant we need to know is _________. It is used for nicotine addiction. We do not use this drug with patients who have seizures or anorexia though. |
|
Definition
| Wellbutrin (also known as Zyban) |
|
|
Term
| _______________________ are used with bipolar disorder and other mood disorders. |
|
Definition
| Mood stabilizers/antimanics |
|
|
Term
| The mood stabilizer/antimanics used with bipolar disorder and other mood disorders is _________. It requires good renal fx, close monitoring of lithium levels, and essential fluid balance and normal salt intake. Dehydration will lead to lithium toxicity which could lead to seizures, coma and death. |
|
Definition
|
|
Term
| Lithium levels should be around ____. |
|
Definition
| 1.0. Range is 0.8-1.2 in most books. Getting toxic around 1.5. |
|
|
Term
| What are the sd effects & risks for Lithium as a mood stabilizer? |
|
Definition
| mild side effects of increased thirst, urination. Diarrhea + N & V which could lead to dehydration & toxicity. SEVERE TOXICITY risk: decrease urine output, seizures, confusion, coma, death. Patient should report problems early, avoid diuretics and dehydration in summer and DO NOT restrict salt. Monitor levels a few times a week on input and every 3-6 months for output. |
|
|
Term
| What is the anticonvulsant + mood stabilizer drug? |
|
Definition
|
|
Term
| What do we watch with Tegretol? |
|
Definition
| monitor blood levels and for blood dyscrasias with Tegretol |
|
|
Term
| Antianxiety/anxiolytics are used for anxiety, detox and sleep. Are they safe? |
|
Definition
| They're safe when they're not overused, mixed with alcohol or other sedating drugs. Major withdrawal symptom seiures which can occur up to a week later. Can cause drowsiness, ataxic gait, slurred speech. They are addictive for addicts. Withdrawing from them causes anxiety, insomnia. It is important to incorporate other coping methods before going straight to meds like exercise, relaxing techniques, calling someone, music, taking a bath, etc... |
|
|
Term
| There are 2 antianxiety meds we need to know and they're called: |
|
Definition
| lorazepa, (Ativan) and chlodiazepoxide (Librium) |
|
|
Term
| Ativan & Librium are both ____________ that are effective for detox & anxiety. |
|
Definition
|
|
Term
| Antianxiety meds work on ____ and increase it. |
|
Definition
|
|
Term
| What is the problems with antianxiety meds? |
|
Definition
| withdrawal symptoms and addiction.. do not give them to people with addictive tendencies. |
|
|
Term
| What drug would you use for alcohol detox? |
|
Definition
| Antianxiety - like Ativan or Librium... we use them for anxiety. They are safe and hard to OD on. EXCEPT if you mix them with other downer drugs (any other sedating drugs/psychotics/alcohol and will cause problems). So you need to teach them about that. Want to use them short term. |
|
|
Term
| Benzodiazepines (ativan and Librium) cause problems if you ___________________. |
|
Definition
|
|
Term
| SSRI's work on increased ____________ levels. |
|
Definition
|
|
Term
| What levels do we need to watch with Lithium? |
|
Definition
| their fluid & salt balance... make sure they don't get dehydrated, check their renal function - make sure it's good before you start them on it. Could get HYPOTHYROIDISM: can destroy their kidneys, will get a goiter. |
|
|
Term
| Tegretol is a much safer mood stabilizer. However, they can get ______ - check blood levels, can get weight gain. Can get blood dyscranias. |
|
Definition
|
|
Term
| When do you want to draw blood levels (to check their lithium levels)? |
|
Definition
| 12 hours past their last dose |
|
|
