PN Pharm EX 1

All About Pharm

100

OTC use of medications is nearly 60% of all drugs on the market. The FDA regulates these as these are the requirements (Indication for use and Safety profile).

Consumer must be able to easily:
-Diagnose condition
-Monitor effectiveness
-Benefits must outweigh risks

Drug should have:
-Limited interaction with other drugs
-Low potential for abuse
-High therapeutic index

200

OTC use of both medications and drugs are common in patients. What is the difference between these two?

300

What is the nursing process in regards to medication administration? What is involved with each step?

Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation

400

List the 9 rights of medication administration

*Note* These are limited to the resources you have. Some say there are only 5 rights, some say 9.

500

Identify this prescription: 

cetirizine/Zyrtec 10 mg PO prn daily

cetirizine/Zyrtec 10 mg tablet by mouth as needed daily

600

Med error reporting is crucial to the safety of our patients and nurses. Define each one of these for me: Actual errors, Near misses, and Close call

Actual Errors: Giving a patient the WRONG medication/dose

Near Misses: event or situation that did not produce injury but only b/c of chance. NO patient injury due to luck.

Close Call: an event or situation or error that took place but was identified and captured prior to reaching the patient. Error was found prior to reaching the patient.

Pharm Terms

100

We see polypharmacy ALOT in medicine, what is this term and who do you see it often with?

Polypharmacy-The concurrent use of multiple medications (typically 5 or more); typically seen with elderly patients. 

Often times additional medications are to treat the side effects of initial medications prescribed.

200

What is the difference between Pharmacokinetics and Pharmacodynamics?

Kinetics (korpse-what the body does to the drug)

Dynamics (drug-what the drug does the body)

300

What is an agonist and what does the antagonist do?

Agonist interacts with a receptor to produce a response

Antagonist has no specific pharmacological action of its own, but interacts with receptor to prevent the action of an agonist

400

What are indicated with NARROW therapeutic indexes?

Window/Index can be very narrow=doesn't work vs toxic

Peak concentration(highest level predicted)

Trough concentration (lowest, drawn before drug is administered)

500

Define the following: Subtherapeutic, Minimum Effective Concentration, Minimum Toxic Concentration, and Therapeutic (desired dose) 

Minimum Effective Concentration (MEC): dose and interval to permit the plasma level to be above the minimal level required to elicit a pharmacological response" Just enough"

Minimum Toxic Concentration (MTC): The dosage and interval must permit the plasma level to be below the minimum toxic concentration.

Subtherapeutic: symptoms are still present and the current dose is not effective. Goal is to increase the dose or change the drug (per provider).

Therapeutic dose: The expected outcome of the drug that is optimized in the way we expect/want it to for the patient. 

 

600

Define the following effects of medications: side effects, adverse effects, toxic effects, idiosyncratic, and additive effects

Side effects: effects of the drug that is not intended, can be predicted

An adverse outcome of drug therapy in which a patient is harmed in some way. Some adverse drug reactions are classified as side effects: Expected, well-known reactions that result in little or no change in patient management and Predictable frequency. The effect's intensity and occurrence are related to the size of the dose

Toxic effects- related to the dose of drug administered. All drugs are capable of producing toxic effects.

Idiosyncratic reaction are the result of abnormal reactivity to a drug caused by genetic differences between the client and nonreacting individuals

Additive Effects: potential of increased side effects

Controlled Substances Schedule

100

What is a schedule V drug?

Schedule V - Lowest potential for abuse:

Robitussin AC with codeine, lyrica, Lomotil (treats diarrhea) -has morphine derivative that helps with nerve pain

200

What is a Scheduled IV drug? 

Schedule IV - Low potential for abuse: 

Xanax, Valium, Ativan, Ambien, Tramadol

300

What is a scheduled III drug?

Schedule III- Lower potential for abuse than Schedules I and II: 

Tylenol with codeine, ketamine, anabolic steroids, testosterone

400

What is a scheduled II drug? 

Schedule II - High potential for abuse but currently has an accepted medical use in the U.S: 

meperidine, morphine, cocaine, oxycodone, methadone, secobarbital, codeine, amphetamines, Vicodin,, fentanyl, Adderall, ritalin

500

What is a scheduled I drug? 

Schedule I - High potential for abuse & NO accepted medical use in the U.S.: 

heroin, LSD, marijuana, peyote, hashish, ecstacy

600

Scheduled drugs are enforced by which agency? And which schedule is not allowed refills on the script?

Drug Enforcement Agency (DEA): 

The DEA regulates who can write prescriptions, manages refills for scheduled medications (Schedule II med refills are not allowed), Schedule II Meds must be hand written or electronically sent to pharmacy through DEA software (Cannot call in); ePDMP

Pharmaco-Kinetics

100

What are all the steps involved with Pharmacokinetics?

Absorption: The rate at which a drug leaves its site of administration and enters the bloodstream for distribution to body tissues.

Distribution: The transport of a drug in the body by the bloodstream to its site of action

Metabolism: 

The biologic transformation of a drug into: an inactive metabolite, a more soluble compound, a more potent metabolite

Elimination: The elimination of drugs or metabolites from the body

200

What organs are involved with Metabolism?

Liver (main organ), skeletal muscle, kidneys, lungs, plasma, intestinal mucosa

300

What organs are involved with Elimination and who do we consider dosing adjustments for? 

Kidneys, respiratory tract, breast milk, saliva, and sweat

Renal dosing: adults and young children

400

What is a half life and steady state of a drug? What if the half life of a drug was 5 hours, when would I expect the steady state?

Drug Half Life: The time it takes for one half of the original amount of a drug in the body to be removed. A measure of the rate at which drugs are removed from the body. 

Steady State: After approximately five half-lives, most drugs are considered to be effectively removed from the body. Physiologic state in which the amount of drug removed via elimination is equal to amount of drug absorbed with each dose.

5 hours=100%
10 hrs=50%
15 hrs=25%
20 hrs=12.5%
25 hrs=6.25%

500

What are factors that affect Distribution? 

Protein-binding: "carriers" to their jobsite to work

Water vs fat soluble: water soluble= highly protein bound (slow) vs. fat soluble=poor protein bound (faster)

Blood-brain barrier: Water soluble drugs enter slowly

Organs: heart, liver, kidneys, brain vs. muscle, skin, fat

600

What are all the factors that affect absorption? 

Routes: Enteral, Parenteral, SQ, IM, IV Topical.

Foods: empty vs full (delay)

Dose/formulation: EC, controlled released

Absorptive surface

Blood flow to Small Intestine

GI motility

Infection

100

What are signs and symptoms of infection?

•Fever

•Chills

•Sweats

•Redness

•Pain

•Swelling

•Fatigue

•Weight loss

•Increased White Blood Cell (WBC) Count

•Pus

200

What are the differences in these types of therapies? Empiric, Definitive, and Prophylactic

Empiric therapy: Broad spectrum vs narrow spectrum antibiotics

Definitive therapy: Most narrow spectrum, least toxic drug to meet culture/sensitivity results

Prophylactic therapy: Prevent

300

How do you fight antibiotic resistance? (Don't be like Christy's mom.)

•Vaccinate

•Prevent conditions that lead to infections

•Get the unnecessary devices out

•Know when to say “no” to antibiotic use

•Treat infection ONLY

•Finish full course of prescribed antibiotic(s)

•Isolate the pathogen – Use isolation precautions

•Perform hand hygiene, perform hand hygiene, perform hand hygiene

400

What are the general teaching points as a nurse for antibiotic use?

•Assess for ALLERGIES!

•The most COMMON side effects of antibiotics are nausea, vomiting, and diarrhea.

•Assess for potential drug and/or food interactions.

•All oral antibiotics are absorbed better if taken with at least 6 to 8 ounces of water.

•Take antibiotics AROUND THE CLOCK for best results.

•Back up method of oral contraception

500

How do antibiotics work? (Hint: there are 2 ways)

Bactericidal: Kill bacteria

Ex) Cephalosporins, polymxin and vancomycin

Bacteriostatic: Inhibit growth of bacteria that eventually leads to their death

Ex)Sulfonamides, erythromycin and lincomycin

600

Fluoroquinolones like Cipro are often used for skin infections, what are the adverse effects to watch for as well as teaching aspects for your patient?

Adverse Effects: SEIZURES, Dizziness, headache, insomnia, DYSRHYTHMIAS: Prolongs QT interval, Pseudomembranous colitis, STEVEN’S JOHNSON SYNDROME, Abdominal pain, diarrhea, nausea, Peripheral neuropathy, Photosensitivity

Edu: Fluid intake, avoid dairy as it can decrease absorption, renal labs will be obtained and monitored, as well as use sunblock/protective clothing. We may monitor for hypoglycemia and warfarin if indicated. 

Anti-biotics

100

Sulfonamindes like Bactrim are effective for UTIs and ear infections, what potential side effects and teaching aspects do you provide to your patient?

SE: diarrhea, nausea, vomiting; crystalluria, toxic nephrosis; anemia, thromboycytopenia; Stevens-johnson syndrome, photosensitivity

Edu: 

•Should be taken with at least 2000-3000 mL of fluid
per day, unless contraindicated.

•Due to photosensitivity, avoid sunlight and
tanning beds.

•These agents reduce the effectiveness of
oral contraceptives.

•Take with food to decrease GI upset

200

Penicillins are often combined with beta-lactamase to create a stronger antibiotic. What potential adverse and side effects do you look for as well as educate your patient with?

Adverse & Side Effects:

•Nausea, vomiting, diarrhea, abdominal pain, superinfections, colitis

•Allergic Reactions: common = urticaria, pruritus, & angioedema

•Idiosyncratic reactions occur, i.e. Stevens-Johnson Syndrome

Edu: 

•Any patient taking a penicillin should be carefully monitored for an allergic reaction for at least 30 minutes after its administration.

•The effectiveness of oral penicillins is decreased when taken with caffeine, citrus fruit, cola beverages, fruit juices, or tomato juice.

•Alternate form of oral contraception

300

There are 5 generations of Cephalosporins. What other antibiotic class are you considering?

Penicillins

400

Macrolides like azithromycin is often used for STIs. What side effects do you consider along with teaching aspects?

SE: 

•Chest pain, hypotension, palpitations, prolongs QT interval

•Abdominal pain, diarrhea, nausea, vomiting

•Hepatotoxicity, jaundice, anorexia

•Superinfections: vaginitis, stomatitis, thrush, c-diff

Edu: The absorption of oral macrolides is enhanced when taken on an empty stomach, but because
of the high incidence of GI upset, many agents
are taken after a meal or snack.

500

Tetracyclines can target both gram positive and negative pathogens. This class of antibiotics has very specific contraindications and interactions. How do you educate your patient?

Interaction: Strong affinity for calcium

Contraindications: pregnancy and children under 8 years old. Hepatic and renal disease as well. 

Edu: Contact the office if pregnancy is considered, use alt. form of contraceptive, avoid dairy products, and take on an empty stomach.

600

Aminoglycosides like gentamicin are known to be very potent with serious toxicities, which toxicities are of a concern and what are the contraindications? 

Nephrotoxicity (renal failure)

Ototoxicity (auditory impairment and vestibular impairment [eighth cranial nerve])

Contraindications: hypersensitivity, renal disease, and pregnancy/breastfeeding

TB and Fungal

100

TB is a slow growing bacteria that may become dormant. You can diagnose a patient with TB through these exams.

1.TB skin test

2.If skin test is positive, then chest x-ray

3.If chest x-ray shows signs of TB, then culture of sputum or stomach secretions is obtained

200

What treatment is utilized in TB?

Multidrug Therapy:

•4 antibiotics administered at the same time

•Often 24 months of drug therapy

•Adherence to drug regimen

•Around the clock

Primary Agents: 

•Isoniazid (INH)

•Rifampin

•Ethambutol or streptomycin

•PZA (pyrazinadmide)

300

What are adverse effects and teaching consideration for TB treatments INH and Rifampin?

Isoniazid

•Pyridoxine deficiency

•Peripheral neuropathy

•Liver toxicity

Rifampin

•Red-orange-brown discoloration of urine, tears, sweat, & sputum

•May decrease effectiveness of oral contraceptives

Edu: Coloring of secretions, Supplementation of VB6, oral contraceptive alternatives.

400

Antifungal drugs are used to treat fungal infections, these can often occur as a superinfection if the normal human flora has been adjusted by antibiotics. What classes of medications are utilized.

•Polyenes: Amphotericin B and nystatin

•Imidazoles: Ketoconazole, miconazole, clotrimazole

•Antimetabolic antifungal: Flucytosine

•Antiprotozoal agents: atovaquone

500

What is the education you would provide to your patient about the differences in Nystatin versus Amphotericin? 

Nystatin-Topical infection like candidiasis

Amphotericin-Systemic infection given IV for progressive and fatal fungal infections.
-SE: fever/chills, nausea/vomiting, allergic reactions

600

Anti-Virals are utilized to treat viral illnesses but are often quite difficult to eradicate because viruses can duplicate/mutate. What are some viral infections we can treat?

Smallpox, poliomyelitis, chickenpox, mumps, rabies and influenza, hepatitis, herpes simplex, herpes zoster