Test #1 Pharmacology

Test #1 Pharmacology: Module 1: Compare and Contrast “Prescription” vs. “NonPrescription” Define “Generic” Define “Trade Name” Define “Pharmacokinetics” Define “Pharmacodynamics” Compare and Contrast Pharmacokinetics and Pharmacodynamics Explain the following chart: Onset Peak Duration Parenteral Enteral Topical Transdermal Absorption Distribution Excretion Metabolism Half-life Peak Level Trough Level-also, when do you draw it? Agonist Antagonist Expected Pharmacological Action Therapeutic Response Adverse Drug Reaction Tolerance Cumulative Effect Toxicity Precautions Contraindications Drug/Drug Interactions Drug Food Interactions Additive Drug/Drug Interactions Synergistic Drug/Drug Interactions Client Instructions Side Effect Allergy -Define: -Please note that if a medication has a half-life of 5 hours, then it is often given every five hours. -Please note that if I give 10 mg (if the half-life is five) then ten hours later it will be 2.5 mg that is left, theoretically. Define: What types of non-pharmacologic techniques can be used to reduce the side effect of nausea with many oral medications? Why is it important to stop a medication if a client develops a rash? (Stop and call the provider). What is meant by “cholinergic effects?” Did we learn about medications that have these? What is meant by “anticholinergic effects?” What type of symptoms do we see? Did we learn about medications with these effects? What is neuroleptic malignant syndrome? What meds did we learn about that could cause this? What medication is used to treat this? A side effect or adverse effect is listed in the drug guide so that nurses “monitor for them.” Look up a side/adverse effect of any drug and think about how you would monitor for that negative effect (apply it). Side effects that involve liver or kidney damage are to be closely monitored for older adults. If it is a problem with a drug, the elderly will be especially and closely tested before and during administration of such a drug. Why? What are the rights of administration? What if they are not all included in the order? Who would you clarify an incomplete or illegible order with? What if we ask you about the “most important” side effect? Which is “most important?” Explain. A client declines a medication. Why is it important that the nurse investigates why. Why is a good therapeutic communication technique to ask the patient to “tell you more” about it? Why is a person with kidney or liver failure more prone to side/adverse effects and toxicity? Explain the nursing process and how it may be used to administer a medication. At what point do you develop outcomes in the nursing process. Know this chart: Know the following definitions: Drug (Also known as: Medication)   Full Definition: Any chemical that can affect living processes within the human body (Burchum & Rosenthal, 2019).Note: The term drug and medication can and will be used interchangeably throughout this course. Simple Definition: Any substance that has a physiological effect on the body Pharmacology   Full Definition: The study of drugs and their origin, nature, properties, and effects on living organisms (Venes, 2013). Simple Definition: The study of drugs and their effects on the body Therapeutics (Also known as: Pharmacotherapeutics)   Full Definition: The use of drugs to diagnose, prevent, or treat disease.Note: The phrase "therapeutic effect" refers to the drug's effect on the body to diagnose, prevent, or treat disease (Burchum & Rosenthal, 2019). Simple Definition: Beneficial or useful effects of a drug Side effect   Full Definition: Responses in the body where the drug's effects are neither needed nor wanted that cause problematic, but not harmful, symptoms (Smith, 2016). Simple Definition: Undesirable effects that are bothersome, but not harmful to the client Adverse effect   Full Definition: Responses in the body where the drug's effects are both undesirable and harmful (Smith, 2016). Simple Definition: Harmful undesirable effects Pharmacokinetics   Full Definition: The study of the metabolism and action of drugs with particular emphasis on the time required for absorption, duration of action, distribution in the body, and method of excretion (Venes, 2013). Simple Definition: What the body does to drugs Pharmacodynamics   Full Definition: The molecular interactions of a drug with specific biological receptors on or in the body's cells, which lead to a desired therapeutic response (Smith, 2016). Simple Definition: What drugs do to the body Module 2: The Original 5 Rights 1. Give the right drug 2. ...to the right client 3. ...in the right dose 4. ...by the right route 5. ...at the right time. 6. Documentation (we put this one as #6) Common examples of additional rights include:      Right assessment Right documentation Right evaluation The client's right to education The client's right of refusal Limitations of the rights    The Rights only ensure that the medication will be administered as prescribed. As future professional nurses, it is imperative that you practice to the fullest extent of your education and training. This means you will need to begin thinking of medication administration as much more than simply The Rights. You must recognize that important additional interventions are required both before and after a medication is given to ensure it will do the most good with the least harm. An in-depth understanding of pharmacology is therefore required of the modern professional nurse in order to ensure the overall therapeutic goals are accomplished for your client. Checks and Balances Remember that The Rights only ensure that the medication is given as prescribed. But what if a mistake?was made by the pharmacist or the prescribing clinician.   Strict adherence to The Rights is important, but it is not going to prevent a mistake from reaching the client. Does that mean the nurse has no responsibility in preventing mistakes? The answer is NO - nurses indeed, have a responsibility to detect and prevent upstream errors from reaching the client. Nurses spend the most time directly with the client, and therefore often know the client's health status best. The closeness of this nurse-client relationship allows the nurse to:   observe how the medication is affecting the client and intervene if needed. anticipate how a particular medication and or dosage will affect the client if given. The nurse is the last line of defense against medication errors. Applying your Pharmacology Knowledge A good way to break down the responsibilities of the nurse as it pertains to pharmacology is to think about it in the two primary spheres of influence the nurse has related to medications: 1. Pharmacology knowledge as it pertains to the direct client care you provide 2. Pharmacology knowledge as it pertains to client education Pharmacology Knowledge: Direct Client Care The use of pharmacology in client care focuses on the following eight aspects of medication therapy: 1. Preadministration assessment - Collecting data and analyzing that data 2. Dosage and administration - The Rights 3. Promoting therapeutic effects - Examples, using an analgesic with nonpharm comfort measures; using asthma meds with breathing exercises 4. Minimizing adverse effects - This requires knowledge of what to look for and how to intervene 5. Minimizing adverse interactions - This requires knowledge of how different drugs interact with each other when given concurrently to the same client 6. Making “as needed” or PRN decisions - This requires good nursing judgement 7. Evaluating responses to medications - Is the drug doing what it was supposed to, is not effective, or is causing having harmful adverse effects 8. Managing toxicity - This requires knowledge The common thread throughout all these aspects is "you could never know too much about the medications you are giving your clients". Pharmacology Knowledge: Client Education Nurses play an important role in educating clients about their medications. When educating clients, it is important to give the client the following information: 1. The name of the drug and what it is for in simple terms 2. Dosage - how much to take with each dose 3. Dosing schedule - how often to take it 4. Route and technique of administration - PO versus sublingual versus subcutaneous 5. What the expected response should be an when they should expect it 6. Nondrug measures to enhance their response (e.g. exercise for hypertension) 7. Duration of the treatment 8. How to store it 9. Symptoms of major adverse effect and how to cope with them 10. Major drug-drug and drug-food interactions 11. Who to call with issues Module 2: Prototype Medication Name Medication Class For Each of these prototypes, you will need to know the following: a. b. c. d. e. f. Classification Brand and Generic Name(s) Therapeutic use How does it work Adverse/Side Effects Interventions Where to find the information. g. h. i. j. k. l. Administration Client Instructions Contraindications Precautions Interactions Identify if there are any CNS depressants on this list or CNS stimulants. Additional questions may also need to be answered for each drug, as seen below. What is this medication used for? ATI: Pharmacology 4.0 The Neurological System, Levodopa/Carbidopa Dopaminergic Drugs Why does increasing salt and water work to alleviate the dizziness one may feel if Part 1 they are experiencing orthostatic hypotension with this medication? ATI: Pharmacology 4.0 Donepezil Cholinesterase Inhibitors The Neurological System, Part 1 ATI: Pharmacology 4.0 Memantine NMDA Receptor Antagonists The Neurological System, Part 1 Interferon beta Immunomodulators ATI: Pharmacology 4.0 The Neurological System, Why might a person use an antipyretic, like acetaminophen or ibuprofen, while taking this? Part 1 Why is it important to alert the provider about depression and suicidal ideology in clients taking this medication? Phenytoin Normal Phenytoin Level? ATI: Pharmacology 4.0 What is meant when it is stated that there are “teratogenic effects?” The Neurological System, Traditional Antiepileptic Agents Part 1 **Normal Levels Found in Lab Guide ATI: Pharmacology 4.0 Oxcarbazepine Traditional Antiepileptic Agent The Neurological System, Part 1 Normal Valproic Acid Level? ATI: Pharmacology 4.0 The Neurological System, Valproic Acid Traditional Antiepileptic Agent Part 1 **Normal Levels Found in Lab Guide Phenytoin Newer Antiepileptic Agents Normal Levels? *Drug Guide ATI: Pharmacology 4.0 Sumatriptan (Imitrex) Serotonin Agonists The Neurological System, Part 1 Baclofen Centrally Acting What does withdrawal look like (symptoms)? ATI: Pharmacology 4.0 dantrolene Amphetamine sulfate Methylphenidate Muscle Relaxer for Spasticity The Neurological System, Mostly Peripherally Just know what this one is for: Acting Muscle Relaxer for Localized Muscle Spasm ATI: Pharmacology 4.0 Part 1 The Neurological System, Part 1 What time of day is best for this drug? Why? Amphetamines (CNS Why can’t a teenager drink “Monsters” while on this medication? Stimulant) Are parents responsible for this medication? ATI: Pharmacology 4.0 Amphetamine-like Drugs (CNS Stimulant) What time of day is best for this drug? Why? ATI: Pharmacology 4.0 Why can’t a teenager drink “Monsters” while on this medication? The Neurological System, Are parents responsible for this medication? Part 1 The Neurological System, Part 1 Lisdexamphetamine Amphetamines (CNS Explain physiologically why this medication can cause shortness of breath and why Stimulant) it is so dangerous. Lamotrigine AED *Drug Guide ATI Neuro Part 1 Phenobarbital Know These Terms: Dystonia, Akathisia, Parkinsonism, and Tardive dyskinesia, hepatic, Labs to know: Lab Normal levels (and units) Therapeutic Level What does it mean when it is high? What symptoms may be What does it mean when it is assessed and what interventions may be initiated. Creatinine Phenytoin Levels Valporic Acid Levels LFTs Phenytoin Level Lithium Level Valproic Acid Level xxx low? What symptoms may be assessed and what interventions may be initiated. xxx xxx Module 3: Prototype Prototype Medication Medication Name Class For Each of these prototypes, you will need to know the following: a. b. c. d. e. f. g. h. i. j. k. l. Classification Brand and Generic Name(s) Therapeutic use How does it work Adverse/Side Effects Interventions Administration Client Instructions Contraindications Precautions Interactions Identify if there are any CNS depressants on this list or CNS stimulants. Where to find the information. Additional questions may also need to be answered for each drug, as seen below. Chlorpromazine Haloperidol Traditional Antipsychotics Why would it not be good to give a traditional antipsychotic to someone with Parkinson’s disease? (low-potency) ATI: Pharmacology 4.0 First Generation Part 2 The Neurological System, Traditional Antipsychotics This one works quickly. Why is this beneficial? Why would an eventual switch to a *Drug Guide (high-potency) second generation be beneficial? First Generation ATI: Pharmacology 4.0 Risperidone (Risperdal) The Neurological System, Atypical Antipsychotics Part 2 ATI: Pharmacology 4.0 The Neurological System, Selective Serotonin Fluoxetine (Prozac) Reuptake Inhibitors …also be able to name the other medications from the SSRI classification that Part 2 were listed as prototypes in ATI. Make generalizations from this drug for the other SSRIs. Why is it important that the gradual withdrawal be done with the provider? Venlafaxine Serotonin/ Norepinephrine Reuptake Inhibitors ATI: Pharmacology 4.0 The Neurological System, Part 2 ATI: Pharmacology 4.0 Amitriptyline and Imipramine Tricyclic Antidepressants Adverse Effects? The Neurological System, Part 2 ATI: Pharmacology 4.0 Phenelzine (Nardil) Monoamine Oxidase Inhibitors The Neurological System, Dietary Restrictions? Why? This is related to the side effects that these medications are famous for. Part 2 ATI: Pharmacology 4.0 Bupropion (Wellbutrin) The Neurological System, Atypical Antidepressants Part 2 ATI: Pharmacology 4.0 Lithium The Neurological System, Mood Stabilizers What is the relationship between sodium and lithium? Is it inverse? What does that mean? What are signs you may assess if lithium is too high? Part 2 ATI: Pharmacology 4.0 Valproic acid Mood Stabilizers The Neurological System, Part 1 & 2 ATI: Pharmacology 4.0 Carbamazepine Mood Stabilizers The Neurological System, Part 1 & 2 ATI: Pharmacology 4.0 The Neurological System, What is a typical onset for a benzodiazepine? Does that have anything to do with Part 2 why we give it for acute anxiety and acute status epilepticus? Explain. Diazepam, Alprazolam, Lorazepam, clonazepam Why is it important to taper down under the direction of your provider? Benzodiazepines What are symptoms of sudden withdrawal? Explain what it means if someone develops a “tolerance.” Why are these used for alcohol withdrawal? These can be used as short-term sleep aids. What are the risks of using them with elderly patients? Zolpidem tartrate Benzodiazepine-like Drugs (Ambien) *Drug Guide ATI: Pharmacology 4.0 Buspirone NonbenzodiazepineNonbarbiturates The Neurological System, Part 2 Olanzapine Lab *Drug Guide Atypical Antipsychotic Normal levels (and units) Therapeutic Level What does it mean when it is high? What symptoms may be assessed and what interventions may be initiated. What does it mean when it is low? What symptoms may be assessed and what interventions may be initiated. Lithium Levels Phenytoin Levels Valporic Acid Levels LFTs Sodium Levels xxx Reversal Agent: Flumazenil (Romazicon): Therapeutic use, Side Effects, What does it reverse?nti Anticholinergics: As a reversal agent for First Generation Antipsychotics (What side effects are they used for?) Why do we use a medication like activated charcoal with many seizure med overdoses, like phenobarb, etc…? Antipsychotics (esp. first generations are known for EPS). Complete the following chart: EPS Side Effect Define this side effect Is there a reversal (you may need the Lehne textbook for this) Parkinsonism Dystonia Akathesia Tardive Dyskinesia Dosage Calculation Is it permanent? Explain.      Medication Administration Safe Dosage Oral Medications “Commonly used conversions” “Commonly used abbreviations.”