Drug orders
Concept relevant to Pharmacokinetics

Name the 2 absorption drug effects?

Local- at the site- inhaler, SL, buccal

Systemic- in bloodstream- PO, IV,


What is the supportive drug effect?

Supportive- supports integrity of body function ex. Tylenol for fever

Palliative- relieves s/s of disease with no effect on disease itself- Ex morphine

Substitutive- replace either body fluids or chemical ex- Synthroid

Chemotherapeutic? destroys disease producing microorganisms-  Ex Chemo, Abx

Restorative- return the body to or maintain optimal level Ex Vitamins


Differentiate between chemical, generic and brand name of a drug?

Chemical= chemical composition

Generic= nonproprietary name

Brand= proprietary name, drug company registered trademark


Name types of technology that prevents errors

Barcode of medication, Smart pumps, Automated dispensing cabinets, Computerized prescriber order entry


Acetaminophen 650 p.o. every 6 hours prn temperature 101.5

Is drug order complete?

No, missing mg


What is potency?

Amount of drug needed to elicit a specific physiologic effect

Drug response

Therapeutic effect

Maximal efficacy


The nurse checks the mediation at least how many times prior to administrtaion?

3  Before you pour, after you pour and at the bedside


What is biotransformation?

Change or break down of medication into a less active/potent form or inactive form

Done by liver enzymes- First Pass effect PO meds


A physiological drug effect which is unintended but is predictable.  Primary reason patients stop a mediation

Side effect

Primary or Secondary (ex diphenhydramine)


How many control substance categories are there and define?

5,  I High potential for abuse, unsafe/illegal (ectasy, LSD, Heroin)

II- high abuse potential, severe dependence (Morphin, Ritalin, Oxycodone, Cocaine, Methadone)

III less potential for abuse, moderate dependence (Codeine, hydrocodone, anabolic steroids, testosterone)

IV- Low abuse, limited dependence (lorazepam, tramadol, temazepam- sleep nerve pills)

V Lower abuse, limited dependence  Cough med, diarrheal meds iwth opiod


Give some examples of why errors occur?

Confusion of similar drug names, lack of knowledge, faulty communication, equipment error, drug calc error, Pt ID not checked, Nurse bypass safety protocols (2 RN insulin), Nurse fatigue, distraction or interruption 


Atropine 5 mg IV Stat,   

Is this order complete, and when do you give it

yes, Immediately

Now is within 90 minutes

Occurs when drug concentration is at its highest blood concentration?

Peak action

Onset of action- time needed for drug concentration to reach a high enough blood level to cause physiological effect

Duration of action-Length of time a drug exerts a pharmacologic effect--  HALF LIFE

Therapeutic range- relationship between therapeutic dose and toxic does-   Narrow or wide index


Six Rights

Patient, drug, dose, route, time, documentation


Factors effect Absorption??

Route of administration, Drug solubility (XL, Enteric coated, lipid vs water soluble), Acid vs alkaline environment.

Stress, hunger, pain, fasting, presence or absence of food/stool, Food texture, fat content and temperature


Drug level exceeds therapeutic range and may cause a damaging effect to organs or tissues. 

Toxic effect or Drug toxicity


Stock supply or unit dose?

Stock= Bulk quantity, central location, cost effective

Unit dose= individually packaged, client specific


Drugs that appear on these 2 lists are meds the nurse should use with precaution in the elderly?

High Alert Meds (heparin, insulin, hypnotics) and BEERS Criteria

Black Box Warning= strongest form of warning issued about a drug


After the nurse takes a telephone order from a healthcare provider the nurse has to preform what next?

Read back and verify the order  R?V


When is a trough lever drawn?

30 to 60 minutes prior to next scheduled dose of medication


When should the nurse give a patient an oral medication?

Pt N&V, lack of gag reflex, Decrease LOC, Dysphagia until speech therapy evals (risk for aspiration), NPO status,


factors which effect excretion include:

Kidney function, Age, other drugs, urinary PH, half-life


3 Causes of drug toxicity

Overdosing, Accumulation of drug in tissues, Abnormal sensitivity or allergic response


Differentiate between prescription and OTC drug?

Prescribed require health care provider to write it

OTC- go to CVS Walgreens


DOPamine    DOBUTamine

Tall man lettering

Look Alike  Sound Alike Drug Names


Flagyl 10 mg po ac 

When do you administer ibis medication?

Yes, give prior to meals


A drug is given once a day if it has a short or long half life?



Principles of transdermal patch

Rotate sites, Date, initial and time patch, Do not cut. Remove old before apply new,  Provides consistent blood level, Avoids GI upset, Clean area prior to application

Wash hands wear gloves


Factors effect distribution?

Circulatory system function, Membrane permeability (blood brain and placenta), protein binding sites,  Free drug


Signs of anaphylactic shock

Wheezes, tachycardia, hypotension, rash/hives, cough, dyspnea, swollen eyes, lips or tongue, Edema of phyrnx and larnyx


Regulates medication before and after market


Identifies the most accurate medication list on admission, Compare patient's medication orders to home medications, Done to avoid errors, omission, dosing errors and drug interactions

Medication Reconcillation

Example of a scheduled BID mediation 

1000 and 2200

0900 and 2100


A medication dose used when immediate drug response is desired, large, safe initial dose?

Loading dose


Name 4 herbs that decrease platelet aggregation potentially causing bleeding

Garlic, Ginkgo biloba, Ginger

Ginseng- watch with DM and hypoglycemia

Kava Kava- liver toxicity

Saw Palmetto- interfere with enlarged prostate meds

St John's Wart- watch for interaction with mental health drugs

Valerian- Mild sedative like valium

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