Intro to Pharm
What type of PO medication cannot be crushed and why?
Extended release (enteric coated, XR, ER)
There is a coating that is meant to protect the medication from being broken down by the stomach acids
What are objective signs of pain and what are subjective signs of pain?
Objective: VS and blood sugar changes, grimacing, guarding, immobility, anxiety, agitation, shallow breathing, fatigue, insomnia
Subjective: OLDCAARTS
What medication is also used as an antipyretic?
Tylenol (acetaminophen)
Motrin (ibuprofen)
Aspirin
Naproxen (Aleve)
What routes can we administer an opioid?
PO, IV, topical, patches, rectal
Elderly, CKD, hepatic impairment, and narrow therapeutic ranges may result in what when taking medications?
Toxicity
The liver, kidney, and lungs are responsible for portion of ADME
Metabolism
What is drug tolerance?
Tolerance: Long term medication usage resulting in the need for a higher dose to achieve the intended effect
What are some side effects and adverse effects of prednisone?
SE: Increased blood sugars, fluid retention resulting in weight gain and HTN, insomnia, buffalo hump, moon face, acne, facial hair, striae
AE: Adrenal gland suppression, impaired immune system, delayed wound healing
You are administering an opioid, what are assessing before administration and why?
RR because they can cause respiratory depression and result in an OD
BP because they can lower the BP resulting in poor perfusion and increase risk for falls
LOC because they can sedate a person and result in an OD
What are some reasons that the absorption, distribution, metabolism, and elimination would be affected? BE SPECIFIC!
Absorption: Bioavailability
Route IV (high absorption), enteral (low absorption)
Distribution: Protein bound vs. Lipid Soluable
Metabolism: Hepatic and renal impairment, age, diet
Elimination: Renal impairment, motility disorders, respiratory disorders
What type of reactions can a patient experience to a medication, what are their symptoms, and which ones are life threatening?
Allergic Reaction: pruritis, hives, redness, swelling
Anaphylaxis: Swelling of the face, mouth, tongue, or throat resulting in difficulty breathing, anxiety, chest pain, tachycardia, low SPO2
Angioedema: Face, hands, abdomen, genitalia, and feet become severely swollen
What is the difference between dependence and addiction?
Dependence: The body adjust to having a certain medication in it's system and when it is stopped or drastically reduced the body will go through withdrawal
Addiction: The psychological craving for a medication to produce a high
Your patient with RA is placed on rheumatrex what medication class is this and what education would you provide?
DMARDS
SE: HA, nausea, injection site reaction
AE: Compromised immune system, bone marrow suppression, HF, and allergic reactions
Your patient who has pancreatitis is yelling in pain and grabbing at her lower stomach, which is new for her and not related to her pancreatitis. What 2 potential side effects would we want to assess for?
Constipation and urinary retention
You administer hydrocodone to your patient and find that they start experiencing an uptick in their pain rating roughly 4 hours after administration. What could we assume has started to occur to the medication?
The half life of the medication has been reached/half of the medication has been excreted from the body
What are we assessing before administering a medication to the patient?
Allergy: what happened when they took it? Is there an allergic cross reaction to the medication being administered?
Is this drug appropriate for the diagnosis?
How does the medication work?
What are the side effects?
What are the adverse effects?
What are the contraindications?
How do I know if the medication was effective?
Your patient comes to the urgent care complaining of low back pain. During your questioning you find that she has been taking Tylenol every 3 hours. What do we need to educate her on?
Tylenol is hepatoxic and you should not be taking more than 4000mg/day. The more tylenol you take does not equate to more pain relief, which is referred to as an analgesic ceiling. The more medication you take the more harm you are causing to your liver
Your patient comes into the ER with dilated pupils, has a fever of 101.2, and is very sedated. When looking over her skin you find what appears to be a bee sting. What is the likely cause of her symptoms?
Antihistamine OD
Benadryl
You walk into your cancer patients room, who is prescribed fentanyl, at shift change and find that her respiratory rate is 10 breaths per minute, her eyes are 2mm bilaterally, and she is somnolent. What do you administer and why?
Narcan (naloxone) because she is presenting with an OD and naloxone will boot the opioids off the opioid receptor and reverse the OD
Your patient is requesting Ofirmev (IV tylenol) to be given rather than PO tylenol because it has a quicker onset. What part of pharmacokinetics is the cause of this?
Absorption
What is missing on this prescription?
DOB
Frequency
Instructions on how to take
# of refills
Contact the MD or notify your supervising RN that the patients pain is not being managed and that you would recommend the patient be placed on a scheduled dose of Tylenol to prevent breakthrough pain or to trial a different opioid to see if that helps them more
Your patient who has a known history of asthma comes into the ER complaining of hot flashes and chest pain. Results from the xray come back showing a PE. What medication class do you want to assess the patient for taking?
Leukotriene Inhibitors
Singulair
The same patient comes out of her OD state after receiving narcan, but 2 hours later you go back in to assess the patient and find that she appears to have OD'd again. When you check the MAR you find, what could be the potential cause of the repeated OD as something had not been charted. What do you want to assess?
Is there a patch still on her skin releasing medication
Your patient who is actively having an MI was administered Aspirin in the field. Upon arriving to the ER the RN takes report and finds out that the patient has developed wheezes and is unable to talk because of it. The RN delegates you to look through the patients chart. What are you looking for?
Allergies to NSAIDS and history of asthma