CUMMULATIVE PORTION
What is the definition of Adverse effects?
Side effects, also known as adverse reactions are unwanted undesirable effects that are possibly related to a drug.
What does Category X signify and to what pt population?
--Known danger!! Fetal abnormalities reported in pregnant women!
What organ causes the "First Pass" effect?
Liver
What route of medication administration is effected by "First pass" effects?
PO
What organ is most often responsible for the excretion of medications?
Kidneys
What is the difference between the onset of action and peak action?
--Onset: time required for drug to have a therapeutic response
--Peak: time required for drug to reach the maximum therapeutic response
What is Palliative therapy?
-- Tx given to help relieve the symptoms and reduce the suffering caused by cancer or other life-threatening diseases
What is Prophylactic therapy?
--Prevents or protects
What should a nurse think about when giving medication to an elderly pt?
-- Polypharmacy
-- Kidney/liver function
-- Physiologic change
-- Financial issues
Why is the "First pass" phenomenon important?
-- Rate of drug absorption based on the route the drug takes to the blood stream
What is pharmacokinetics?
--Study of what happens to the drug while it's in the body
- Absorption= 1st pass, bioavailability
- Distribution= getting to the site of action
- Metabolism= biochemical alteration of drug, often the liver
- Excretion= elimination of drug from the body
Why are the Cytochrome P-450 enzymes important to medication administration?
-- Drug metabolism via the Chrotochrom P-450 system has emerged as an important determinant in the occurrence of several drug interactions that can result in drug toxicities, reduced pharmacological effects, and adverse drug reactions.
What opioid antagonist is used in overdoses?
-- Naloxone (Narcan)
What level of pain is appropriate for the use of opioids?
-- Moderate to severe
How should we educate elderly pts taking an opioid?
-- Start low, go slow
-- Monitor respirations
-- Know where naloxone is located
What cell receptors are involved in pain?
-- Mu receptors in the dorsal horn
-- Kappa
-- Delta
What are the S/S's of opioid overdoses?
-- Coma (Unresponsive)
-- Resp. depression
-- Pinpoint pupils (miosis)
What does it mean to be "opioid naive?"
A pt who has not used opioids for more than 7 consecutive days during the previous 30 days
What is the difference between drug tolerance and drug dependence?
-- Drug tolerance: a state in which a larger dose is required to produce the same response that could formerly be produced with a smaller dose
-- Physical dependence: a state in which an abstinence syndrome will occur if drugs use is stopped abruptly
(1) What should the nurse recognize about the major differences between giving a PO med and an IV medication?
(2) How quickly would you push IV morphine?
(3) When would you expect pain relief when giving IV morphine?
(1) Smaller doses with IV and onset of action is quicker
(2) Slow!!
(3) Onset: 5-10 mins. Peak: 30 mins
What is the difference between an agonist and an antagonist?
-- Agonist: binds to receptor, alters the function of the receptor, TRIGGERS A PHYSIOLOGICAL RESPONSE for that receptor
-- Antagonist: binds to receptor, FAILS TO ACTIVATE A PHYSIOLOGIC RESPONSE
What are the major AE's of opioids?
-- Resp. Depression
-- CNS depression
-- Constipation
-- N/V
-- Strong abuse potential
-- Itching, rash, wheal formation
-- Orthostatic hypotension
-- Miosis
What is the major AEs of morphine that the nurse should monitor for?
-- Resp. depression
-- Sedation
-- Physical dependance
-- GI motility
What are important teaching points for Fentanyl patches?
-- Do not expose your fentanyl patches to heat. This can cause accelerated release of fentanyl.
-- Do not throw used patches away. Dispose of them by flushing down the toilet.
-- Keep patches away from children
-- Change your patch every 72 hours after removing the old patch, alternating locations
-- Periodically check that the patch has n to fallen off and is not a potential safety hazard
(1) When is fentanyl most appropriately used?
(2) How often can you dose Naloxone?
(1) Chronic pain (cancer)
(2) Repeat as necessary every 2-8 mins