Intro to Nursing Pharmacology

Exam 1 Study Guide Intro to Nursing Pharmacology ● ● ● Pharmacokinetics ○ Absorption : movement of a drug from site of administration into the blood rate determines how quickly effect will begin ○ Distribution: Drug movement from blood to interstitial space of tissues, LIPOPHILIC (FAT LOVING) ○ Metabolism: Chemical alteration of drug structure ○ Excretion: Removal of the drug from the body (urine, bile, sweat, breast milk, expired air) 5 Rights of Drug Admin (nursing process) ○ Right drug ○ Right person ○ Right dose ○ Right time ○ Right route Drug names ○ Chemical, Brand, and Generic ○ Each drug can have many brand names but ONLY ONE GENERIC NAME ○ Brand names can be different depending on the country ○ EX: tylenol = brand, acetaminophen = generic ○ Chemical names are inappropriate to use bc they are too long and complex ○ Brand names must be approved by FDA Pharmacologic Principles ● ● ● Most common errors ○ Human factors ■ Performance & knowledge deficits ○ Communication mistakes ■ Oral and written orders ■ Poor handwriting ○ Name confusion ■ Read-back system ○ Packaging, Formulations and Delivery Devices Ideal Drug characteristics ○ Effectiveness: elicits a response for which is given (MOST IMPORTANT) ○ Safety: a drug that cannot produce a harmful effect ○ Selectivity: should only elicit a response for which it is given Types of drug effects (ie: teratogenic effect, placebo effect, etc) ○ Idiosyncratic effect: uncommon drug response resulting from a genetic predisposition ○ ○ ○ ○ ○ ○ Placebo effect: component of a drug response that is caused by psychologic factors and not by the biochemical or physiologic properties of the drug Teratogenic effect: drug-induced birth defect Paradoxical effect: an effect is the opposite of the intended drug response Allergic reaction: immune reaction that occurs after prior sensitization of the immune system and reexposure triggers an allergic response Toxicity: degree of detrimental physiologic effects caused by excessive drug dosing Carcinogenic effect: ability of medications and environmental chemicals to cause cancers Antiseptics/disinfectants ● ● ● Which infectious microbes are not best treated with alcohol hand rubs? Why? What is the best practice for these? ○ C. Diff, B. anthracis, Other spore forming bacteria ○ Why? Because Alcohol based hand rubs DON’T KILL SPORES ○ Washing hands with soap and water is best practice Wound care and topical antiseptics ○ Topical agents used in the past ○ Systemic anti-infective drugs now the treatment of choice. They are more effective than topical agents and do not damage inflamed/ abraded tissue Hydrogen peroxide use ○ Is a great disinfectant but useless antiseptic Childhood Immunizations ● ● How to minimize discomfort when giving a 4-year-old a shot ○ Sitting child upright ○ Applying topical anesthetic ○ Providing tactile stimulation ○ Doing IM injections rapidly w/ out prior aspiration ○ Saving most painful vaccine for last Varicella – what is it? Why get vaccinated? What are we preventing in the short term? Long term? ○ Also known as chickenpox; causative organism is varicella-zoster virus ○ Common, highly contagious and potentially serious disease of childhood ○ Symptoms include: lesions on face, scalp, or trunk, fever, malaise, loss of appetite ■ Among children, most common complications are bacterial suprainfection and acute cerebellar ataxia ■ Among adults, most common serious complication is varicella pneumonia ○ Hospitilization is 10x more likely in adults and death 20x more likely ○ Adverse effects ■ None to the vaccinated ■ ● ● ● Temporarily avoid close contact w/ susceptible, high-risk individuals (i.e. neonates, pregnant women, immunocompromised people) ○ Injection: subcutaneous in upper arm or anterolateral thigh ○ Schedule: 2 shots ■ Never had chickenpox: ● 12-15 months ● 4-6 yrs ■ Never had chickenpox and > 12 yrs old: 2 doses & 28 days apart ○ Preventing Short term: s/s mentioned above^ ○ Preventing Long term: Shingles develops in 15% if people after chickenpox has been resolved; caused by reactivation of varicella zoster virus that had been dormant in sensory nerve roots. Starts with neurologic pain that persists for month or in some cases, years and Blister-like lesions within 3-4 days which disappear 2-3 weeks later. Expected initial reactions after a vaccine. ○ Mild reactions can happen ○ Local reactions: Discomfort, swelling erythema, fever ○ Rare effects: anaphylaxis (MMR), acute encephalopathy (diptheria, tetanus, pertussis), vaccine associated paralytic poliomyelitis (Oral poliovirus vaccine) Should we give acetaminophen before a shot? Why or why not? ○ Giving acetaminophen and ibuprofen prior or shortly after can help reduce immune response ○ Prophylactic administration of antipyretics (i.e acetaminophen) does not significantly reduce the incidence of fever or pain. Accordingly, routine prophylactic use of these drugs to prevent pain and/or fever should be discouraged BUT is still condoned Contraindications ○ HIV or leukemia (immunocompromised) ○ Allergy to neomycin ○ Taking corticosteroids