Unit 1 Safe Medication Administration 1. What agency(ies) is(are) responsible for control over prescription or OTC drugs?

The Food and Drug Administration 2. What are 2 advantages of over-the-counter (OTC) over prescription drugs? They are cheaper and it is easier to access them 3. What is a drug formulary? The list of drugs and drug recipes 4. What is meant by prototype drug? The well understood drug model with which other drugs in a pharmacological class are compared. 5. Are generic and trade name drugs the same? Not always. Some absorb differently but for the most part they are the same. 6. What are 4 different pharmacological ways that drugs might be classified? Therapeutic Use- What does it treat Pharmacological- Why it works on a molecular level Mechanism of action- How it produces an effect in the body Schedule use- Authority from state board of nursing 7. From what authority does the nurse receive the right to administer medications? The state in which that nurse is licensed. 8. What are 4 regulations designed to decrease abuse of Schedule II drugs? Special order form must be obtained, orders must be written and signed by health care provider, Telephone orders are not permitted and refills are not permitted. 9. What are 3 ways nurses should secure controlled substances? Keep in locked cabinets (accudose, omnicell, ect.), Account for all controlled substances, wasting must be witnessed by another person. 10. What are the 6 rights of drug administration? The right client, medication, dose, route of administration, time of delivery, and documentation. 11. How many times should the nurse check rights before administration to the patient? Three times 12. What is the correct process for taking verbal/telephone orders from a provider? Write it as the physician ordered it then read it back and wait for the provider to confirm. 13. How can the nurse promote drug compliance in his/her clients? The nurse should use the nursing process to formulate a personalized plan of care that will best enable the client to become an active participant in his or her care. Educate the client about the certain medication to be given. 14. What is meant by the term pharmacokinetics? The study of drug movement throughout the body. How the body handles medications. 15. Which type of molecules are most easily transported into cells by diffusion? Drug molecules that are small, nonionized, and lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cell.

16. How does ionization affect the distribution of a drug? The drug will not be as likely to be absorbed. How does it affect elimination? The drug will remain in the filtrate for excretion. This is also true for water-soluble drugs. 17. What are the 4 phases of pharmacokinetics? Absorption, distribution, metabolism, and excretion 18. What factors influence absorption of drugs? Blood flow, PH, stress, GI motility, age and disease. 19. What factors influence distribution of drugs? Blood flow, protein binding, nutrition, tissue affinity (renal failure, drug with high concentration to kidneys), anatomic barriers (blood-brain barrier BBB), solubility. 20. ***A client has a therapeutic level of phenytoin (Dilantin), a highly protein-bound drug, for a seizure disorder. He develops a blood clot and requires the anticoagulant, warfarin (Coumadin), another highly protein-bound drug. What concern should the nurse have when a protein-bound drug is added to a second protein-bound drug that is at therapeutic level? When a protein bound drug is given to a patient at therapeutic level, it makes more of each drug bioavailable and puts the patient at risk for toxicity of both drugs and need to be reduced in both drugs. What concern should the nurse have if warfarin is to be withdrawn? As warfarin is removed dilantin needs to be increased due to increased risk of bleeding. 21. What are factors influencing metabolism of drugs? Route of administration and the liver and kidney function. 22. ***Drug A and B are both metabolized by the same hepatic enzyme system. Drug A is an inducer of that enzyme. What will happen to the level of drug B if Drug A is added? Drug A will make drug B metabolize faster. You may need to increase drug B to get up to therapeutic level. 23. What will happen to drug B if drug A is an inhibitor? Less of drug B will be needed. There is a risk of toxicity so you will need to monitor closely. 24. How does the scenario in question #22 change if Drug A is a pro-drug? More of drug B will be needed 25. What factors influence elimination of drugs? Blood flow, protein binding, organ integrity (liver and kidney function), and ionization. 26. What is the significance of drug half-life? Determines dosing schedule to maintain a therapeutic level. 27. What is the difference between a maintenance dose and a loading dose? Loading dose- High dose used to get to the therapeutic level (Dilantin, Digoxin, Antibiotics). Maintenance dose- Maintains a steady concentration on the blood. 28. What is meant by the term selectivity?

Having only one effect. If the drug is more selective it decreases the risks of adverse effects. 29. What is meant by the term pharmacodynamics? The study of the biochemical and physiological effects of drugs and their mechanism of action. It is the interaction between the drug and target cell. 30. What is the significance of therapeutic index? Ratio of a drugs lethal dose to its effective dose . 31. What is the difference between potency and efficacy? Potency is the strength of a drug at a specified concentration or dose Efficacy is the ability of a drug to produce a desire response 32. What is an agonist? Agonist is a drug that is capable of binding with receptors to induce a cellular response What is a partial agonist? Partial agonist is a medication that produces a weaker, or less efficacious, response that an agonist 33. What is an antagonist? Antagonist is a drug that blocks the response of another drug 34. What is meant by carcinogenic? Carcinogens are numerous factors that have been found to cause cancer or to be associated with a higher risk for acquiring a disease 35. What is meant by teratogenic? Teratogen drug or other agent that causes developmental birth defects What are the classification stratifications that delineate drug safety for fetuses? The FDA has developed drug pregnancy categories that classify medications according to their risks during pregnancy: A, B, C, D, X A-adequate, well-controlled studies to pregnant women have not shown an increased risk of fetal abnormalities B-Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate, well-controlled studies in pregnant women OR animal studies have shown an adverse effect, but adequate, well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus C-animal studies have shown an adverse effect, and there are no adequate, wellcontrolled studies in pregnant women OR no animal studies have been conducted, and there are no adequate, well-controlled studies in pregnant women D-Studies either adequate or well controlled or observational in pregnant women have demonstrated a risk to the fetus; however, the benefits of therapy may outweigh the potential risk X-studies either adequate and well controlled or observational in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant. 36. What is nurses role when a medication error is made? Document in the medical record include specific nursing interventions that were implemented following the error to protect client safety, such as monitoring vital signs and assessing the client for possible complications. Document all individuals who were notified of the error. Write an incident report. It is always the nurses legal and ethical responsibility to report all occurrences. The FDA requires that nurses and other healthcare providers report medication errors for its database that is used to assist other professionals in avoiding similar mistakes.

Medication errors, or situations that can lead to errors, may be reported in confidence directly to the FDA by telephone at 1-800-23-ERROR or NCC MERP at 1-800-822-8772 37. What processes may prevent the nurse from making medication errors? Nurses can reduce medication errors by adhering to the four steps of the Nursing Processassessment, planning, implementation, and evaluation. Keeping up to date on pharmacotherapeutics and knowing common error types are instrumental to safe medication administration. 38. What is an idiosyncratic reaction? Unpredictable and unexplained drug reaction 39. What are the most common side effects of drugs? Cant find just one answer.n/v, restlessness, HA 40. What is meant by the term(s) addition? Additive effect is the term used when two or more drugs are taken at the same time and the action of one plus the action of the other results in an action as if just one drug had been given. This could be represented by 1+1= 2. An example would be a barbiturate and a tranquilizer given together before surgery to relax the patient. Synergism? synergism is similar to potentiation. If two drugs are taken together that are similar in action, such as barbiturates and alcohol, which are both depressants, an effect exaggerated out of proportion to that of each drug taken separately at the given dose may occur. This could be expressed by 1+1= 5. An example might be a person taking a dose of alcohol and a dose of a barbiturate. Normally, taken alone, neither substance would cause serious harm, but if taken together, the combination could cause coma or death. Potentiation? Potentiation occurs when two drugs are taken together and one of them intensifies the action of the other. This could be expressed by a +b= B. As an example, Phenergan(R), an antihistamine, when given with a painkilling narcotic such as Demerol(R) intensifies its effect, there by cutting down on the amount of the narcotic needed.

Enteral Therapies

1. How is tube placement verified for enteral feedings or enteral medication administration? Color/pH of residual, listen for air bubbles when air injected, x-ray verification. 2. How much fluid should precede/follow enteral medication administration? 15-30ml before and after, 5-10 ml between each med. 3. How long should suction be discontinued after enteral medications are administered? 2030 minutes

4. Can enteral drugs be mixed? Some electrolytes may be mixed with enteral nutrition, but other than that, drugs should be given separately, and the feeding tube should be irrigated with 5-10 ml water between each. Dermatologic Therapies pg 752 1. What drug class is most likely to be used for inflammatory conditions of the skin? Topical anesthetic like Benzocaine (solarcaine, others) 2. What properties make this class a good choice? Immediate onset, low toxicity, overdose unlikely, anaphylaxis rare, works locally. 3. What primary risk is associated with topical use of this class of drugs? Possible anaphylaxis/hypersensitivity. 4. ***What important education points should be included for clients using isotretinoin (Accutane)? Take with meals, do not use if hx of severe depression or suicidal ideation. Pregnancy category X. contraindicated in clients who have leucopenia or neutropenia or who are hypersensitive to the drug. 5. How will topical therapies be affected by inflamed or broken skin? 6. Which antibiotics are most likely to be given topically for dermatologic conditions? Doxycycline (vibramycin), tetracycline (Achromycin), and erythromycin. 7. What adverse effect is associated with all topical therapies? 8. What is the correct process for placing transdermal medication patches? Obtain transdermal patch, read instructions Use gloves Remove previous patch and clean area If using ointment, apply ordered amount in an even line directly on the premeasured paper that accompanies the medication tube Press patch or apply paper to clean dry hairless skin rotate sites Label patch with date, time, initials 9. When is the best time of day to dose a suppository for a vaginal infection? Before bed? 10. What classes of medications might be used to treat urticaria? Anti-histamines urticaria :skin condition that is caused by an allergic reaction and is characterized by raised red patches on the skin accompanied by itching, hives 11. How can nurses most effectively manage intractable urticaria? 12. What mineral may be most effective as a keratolytic in dandruff, seborrhea, or psoriasis and is often found in OTC products to treat these conditions? 13. What systemic risk is associated with use of topical antiparasitic agents, like lindane and permethrine? CNS adverse effects. 14. Why are topical antibiotics often combined with systemic antibiotics in burn patients? What are these antibiotics? 15. How does DuoDERM promote wound healing?

Otic / Ophthalmic 1. What must be verified before administering MOST otic preparations? If there is a perforation in the ear drum. 2. What direction is the pinna moved when administering otic preparations in adults? Up and back In children? Back and back. 3. What are the differences between narrow-angle glaucoma and open-angle glaucoma? Narrow-Angled glaucoma: Caused by normal thickening of the lens and mat develop continually over several years. Usually unilateral and may be caused by stress, impact injury, or medications. Open-angled glaucoma: Bilateral, with intraocular pressure building up over years. The iris does not cover the trabecular meshwork; it remains open. 4. Why should HR and BP be checked before using timolol (Timoptic) drops for glaucoma? Because hypotension or dysrhythmias can occur. It is not common but it can be absorbed systemically. 5. What other classes of drugs are used to treat glaucoma? Prostaglandins, - Adrenergic blockers, 2 -Adrenergic Agonists, carbonic anhydrase inhibitors, cholinergic agonists, nonselective sympathomimetics, and osmotic diuretics. 6. In what part of the eye anatomy should an eye drop be deposited? The conjuctival sac. 7. For what common side effects should clients using eye drops be prepared to expect? Stinging, temporary blurred vision. Be sure to review: Guidelines for needle length/gauge Drug calculations