nur 304 study guide for unit 1 test

8/7/2019 NUR 304 Study Guide for Unit 1 Test

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NUR 304: Study Guide for Unit 1 Test

Chapter 1:

Understand the following processes/terms:

F irst-pass effect

Process in which the drug passes to the liver FI RST(hepatic 1 st pass)

Protein-binding Effect (distribution) primarily albumin

D rug dose is prescribed according to the percentage in which the drug binds to protein

H ighly protein bound drugs (89% +)

Moderately protein bound drugs (61-89 %)Low protein bound drugs (30 60 %)

Peak/trough; therapeutic range of drugs

Peak drug Level

H ighest plasma concentration of drug at a specific timeIndicates the rate of absorption

Trough D rug Level

Lowest plasma concentration of a drugMeasures the rate at which a drug is eliminated

Therapeutic Range of D rugs (therapeutic window) ED 50 & LD50 close to ratio 1 toxic

Concentration range in plasma should be between M INIMUM effectiveconcentration in plasma for obtaining desired drug action and the M INIMUMTOXIC concentration ( protein bound & free)

Narrow range-monitor to avoid drug toxicityWide range- not considered highly toxic


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Pharmacokinetics

Process of drug movement to achieve drug action.Ab sorption

P assive Ab sorption (Lipid solu b le) D iffusion

o Lipid &nonionized faster than water a b sorption

Active Ab sorption (water solu b le)o N eed carrier

D istri b ution (protein b inding effect) V olume of drug distri b ution is dependent on drug dose & its concentration

in b ody

Meta b olism ( b iotransformation) Liver (primary site and GI tract)

Excretion Main route Kidney b ut also b ile, feces, lungs, saliva, sweat, b reast milk

Pharmacodynamics

The study of drug concentrations and its effects on the body

Primary effect response is desirableSecondary effect response may be desirable or undesirable

Ex. Benadryl: prim (symp of allergies)/Sec (drowsiness; bad id driving auto)

Onset of action- time to meet min. effective concentrationPeak Action- H ighest plasma concentrationD uration of Action- length of pharmacological effect

Loading doseWhen immediate drug response is desired, a large initial dose is given to achieve arapid minimum effective concentration in the plasma.


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Absorption of different drug preparations

Blood flow, pain, stress, hunger, fasting, food, & p H affect drug absorption

Pain, stress, & solid, hot, fatty, foodsslow gastric emptying timeExercise: decr bl flow to G I tract (more bl to peripheral muscle)D rugs that lipid soluble and non-ionized are absorbed faster than water soluble &ionized drugs

Onset, peak, duration of action

Onset of action- time to meet min. effective concentrationPeak Action- H ighest plasma concentrationD uration of Action- length of pharmacological effect

Chapter 2:

H ow to develop educational goals; what constitutes a good goal

RUMBA stands for Relevance ,Understandable, Measurable,Behavioral and AttainableEffective Goal setting Qualities

Client centered; Clearly states expected changeAcceptable to both Client & NurseRealistic & MeasurableShared with other H ealth Care ProvidersRealistic D eadlinesIdentifies Components for Evaluation


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Steps of the nursing process and how they relate to teaching about drug therapy

Assessment (incl Nursing Diagnosis)

Subjective D ata Prescription, OTC, herbs, Vitamins

Objective data ROM, F ine Mtr Control, Visual impairment affect taking meds Identify H igh risk clients for Adverse Reactions Probs w/ compliance; cost, forgetfulness, trust, value systems

Includes Nursing D iagnosis Cultural/lamguage barriers Pain/fear of addiction Ineffective H ealth maintenance (not having preventive care) Ineffective regimen management Noncompliance related to forgetfulness/costs Risk for Injury/side effects

Planning/goalsClient centered; Clearly states expected changeAcceptable to both Client & NurseRealistic & MeasurableShared with other H ealth Care ProvidersRealistic D eadlinesIdentifies Components for EvaluationExamples

Client will independently adm prescribed dose of Insulin by end of 4 th session of instructions

Client will prepare a medication recording sheet that correctly reflectsprescribed meds schedule within 3 days

Implementation

Client Ed & teaching very important in this stage.In practice settings, adm of drugs assessment of drug effectiveness areimportant nursing responsibilities.


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Chapter 5:

Schedules of drugs

Schedule I (labeled C-I) D rugs with high Abuse potential. NO ACCEPTE D MED ICAL USE

H eroin, H allucinogenics (Lsd, Marijuana(except presc), mescaline,peyote, psilocybin)

Sch II thru Sch V have accepted med use (dep decr as you move down)

Schedule II (labeled C- II )H igh potential for abuse. ACCEPTE D MED ICAL USE. Can lead to strong physical

dependence& Psychological dependence D emerol, Morphine, H ydrocodone, H ydromorphine, Methadone,

Oxycodone, Codeine, Amphetamines, Secobarbital, Pentobarbital

Schedule III (labeled C- III )Medically accepted D rugs. Potential for abuse is less than I or II . May causedependence

Codeine preparations, Paregoric, nonnarcotic drugs-Pentazocine,Propoxyphene

Schedule IV (Labeled C- IV)Medically Accepted D rugs. May cause dependence

Phenobarbital, Benzodiazepines (diazepam, oxazepam, lorazepam,chlordiazepoxide), Chloral H ydrate, Meprobamate

Schedule V (labeled C-V)Opioid-controlled substances for diarrhea & cough (eg codeine in coughpreparations)

Example: Codeine is a sch II drug but when added to acetaminophen, it becomes a sch III drug and

when in combination with cough preparations, it becomes a sch V drug


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Pregnancy categories

F D A developed a classification system related to the effects of drugs on the unbornchild (fetus). A preg category is indicated on most drugs

Pregnancy Categories:

CATEGORIES A& B are considered to be within SA F E LIM ITS, esp. during 1 st Tri-semester A- No risk to F etus (studies have shown no evidence) B- No risk in Animal Studies and well controlled studies in pregnant

women are not available. It is ASSUMED there is little or no risk C- Animal Studies indicate a risk to the F etus. Control studies on

pregnant women are not available. Risk VS Benefit of the drug must

be determined. D -A Risk to the H uman F etus has been Proved. Risk VS Benefit of the

drug must be determined. It could be used in L IF E TH REATENINGCOND ITIONS

X- A Risk to the H uman F etus has been Proved. Risk outweighs theBenefit and drug should be avoided during pregnancy

Chapter 7:

General guidelines as to the use of OTC drug preparations

Category I D rugs judged to be both safe & effective

Category II D rugs judged to be either unsafe or ineffective; these drugs should not beincluded in nonprescription products

F D A recommends drugs in CAT II be reformulated to be incl. in CAT I orremoved from the market

Category III D rugs for which there insufficient data to judge safety or efficacy


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Chapter 9:

General guidelines as to the use of herbal medications/preparationsD o not take if pregnant or attemptingD o not take if nursingD o not take a lge quantity of any one herbal preparationBuy only preparations that have the plant & their quantities listed; noguarantee of safetyContact H CP before stopping use of prescription medStore in a cool dry dark place; dark glass containers preferredUse only herbs that are bought currently and are freshD o not delay seeking care for severe or persisting symptomsAdvise against belief in unsubstantiated claims of miracle cures

Consumers need to think of herbs as medicine MORE IS NOT BETTERH erbs are not placebosMost less potent than conventional medsConventional meds fasterLabeling of herbal products important

Scientific name & parts of plantMfg name & addressBatch & Lot #D ates ogmfg&exp; many have short shelf life


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Chapter 11: p 199

General nursing implications for medication use in the elderly client

The # of drugs taken , drug interactions&physical health are factors assoc with drug

effectsy H ypnotics- Benzodiazepines ( low doses w/short term therapy suggested) y Anthypertensives- Start low/grad incr as per needs y Anticoagulents- ck PT , INR y Antibacterial- reduced doses/reduced clearance/prolonged t y Antidepressants- reduce 30-50 % & incr as per need

AbsorptionD ecr gastric acidity alters absorp of weak acids such as aspirinD ecr Bl flow in G I tract (40-50%less) is caused by decr cardiac output andabsorp is slowedReduction in G I motility rate (peristalsis) may delay onset of actionReduction in Gastric emptying time occursAmt of oral dose that is absorp is not affected by age (just longer)

D istributionBecause of decr body H 2O, water soluble drugs are concentratedBecause if incr F at to water ratio, fat- soluble drugs are stored &accumulateD ecr in circ serum protein (fewer protein binding sites) there is morefree drug available to body tissue at receptor sites

MetabolismD ecr in H epatic Enzyme production, hepatic Bl flow, Total LiverF unctioncause a reduction in drug metabolism

o With reduction in metabolic rate, t life INCREASES and drugaccumulation can result

ExcretionD ecr in RENAL BLFLOW/GLOM FI LTR at 40 t0 50 %D ecr renal function causes decr drug excretions and accumulation canresult. Poss. drug toxicity


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Chapter 14:

Nursing implications of your prototypes

Vitamins

Assessmento Ck client for Vit deficiencies before start & regularly thereaftero Obtain 24 & 48 hr diet history analysis

Nursing interventionso Adm vitamins w/ food to promote absorptiono If drop form, use the calibrated dropper for accurate dosingo Adm IM to clients unable to take PO(GLmalabsorptionsyndrome)

o Vit A-To avoid risk for hemolytic anemia recognize need for Vit Esupplements for infants receiving Vit A

o Vit A-Monitor Vit A serum levels (80-300 int l units/ml)

o Vit C Abrupt withdrawal can result in rebound deficiencyo Vit C decr effects of oral anticoagulantso Vit C-smoking & Oral contraceptives decr levelso Vit C- megadoses taken w/aspirin or sulfamides may cause

crystal formation in urine (crystalluria)

o Iron-incr amt needed during 1 st trimestero Iron-Megadoses cause teratogenic effect on fetuso Iron-iron Toxicity serious cause of poisoning in childreno Iron-hemorrhage due to ulcerogenic effects of unbound iron

leads to shock


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B12 D eficiency uncommon unless there is a disturbance in the intrinsicfactor & intestinal absorptionPernicious Anemia (lack of intrinsic factor) major cause of deficiency

Vitamin CScurvy

Know the purpose of all vitamins/minerals that have a significant impact onillness/disease processes

Vitamin A

Purposeo Essential for bone growth & the maintenance of epithelial

tissues, skin, eyes & hairUsed F or:

o Treats Vitamin D eficiencies Biliary tract or pancreatic disease, colitis, cirrhosis, celiac

dis., sprue

Skin disorders (acne) Night Blindness

Vitamin D

Purposeo Major role (calcitriol) in regulating calcium & phosphorus

metabolism and needed for calcium absorption from smallintestines (if Ca levels low, more Vit D activated, when Canormal, Vit D is decr)

Used F or:


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Vitamin E

Purposeo

Antioxidant properties that protect cellular components (fattyacids, RBCs from hemolysis). Promotes functioning of RBCs,muscles & tissues

Used F or:o 400-800 Int l units per day reduces # of Myocardial Infarctions

(M I)o 200 Int l units a day reduce CA D o Prolongs PT; monitor

Vitamin K

Purposeo Needed for synthesis of Prothrombin and clotting factors V II , IX,

XUsed F or:

o Antidote for oral anticoagulant overdoseo To prevent & treat hypoprothombinemia of Vit K deficiencyo Newborns Vit K deficiency

Vitamin B 1 Thiamine

Purposeo It functions as a coenzyme during carbohydrate metabolism. It is

essential for the functioning of heart, muscles and nerves Used F or:

o Treatment of Wernicke-Korsakoff Syndrome

Vitamin B 2 Riboflavin

Purposeo It promotes carbohydrate and protein metabolism. Riboflavin is

necessary for healthy skin, nerves and oral mucosaUsed F or:

o Treat Migraine headaches/dermatological concerns


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Vitamin B 3 Niacin

Purposeo maintains good mental health, digestive tract and healthy skin.

Used F or:o Reduce Cholesterol levelso Alleviates Pellagra & hyperlipidemia

Vitamin B 6 Pyridoxine

Purposeo Essential building block of nucleic acids, RBC formation &

synthesis of hemoglobin; maintains NS integrity (myelin)Used F or:

o Treat Vit B 6D ef o Neonates w/seizures refractive to traditional therapy

Vitamin C

Purposeo Aids in absorption of IRON and conversion of F OLIC ACID ; plays a

role in the metabolism of connective tissue, collagen fibersynthesis and production of strong skin. It increases theresistance of the body to fight infections and also keeps theteeth, gums and joints healthy

Used F or:o Treat D eficiency of vitamin C that results in scurvy

Folic Acid (folate)

Purposeo Essential for body growth; D NA synthesis; w/out there is a

disruption in cellular division

Used F or:o F olic acid def in 1 st trimester


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Iron

Purposeo Vital for hemoglobin regeneration (RBC development)o

O2 transport via hemoglobin

Used F or:o Prevent & treat Iron deficiency

Copper

Purpose

o F ormation of RBCs and Connective tissues & production of neurotransmitters Norepinephrine & epinephrine

ZincPurpose

o Important to enzymatic reactions; essential for normal growthand tissue repair; wound healing and taste & smell

Used for:o Poss. alleviate common cold

Chromium

Purposeo Control of type II diabetes by helping to normalize Bl glucose bt

incr the effects of insulin on the cells

Selenium

Purposeo Cofactor for an antioxidant enzyme that protect protein and

nucleic acids from oxidative damageUsed F or:

o Works w/ Vit E and thought to have Anticarcinogenic effect


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Chapter 15:

Know the various types of IV solutions and the uses of each

Crystalloid ( crystals mixed in solution)

Replacement and maintenance of fluid therapyEx. D extrose, Saline, Lactated Ringers

Colloids (draw fluids in )

Volume ExpandersEx. D extran solutions; dextran 40-interfere w/platelet functionEx. Amino AcidsEx. H etastarch- isotonic (310 mOsm/l) decr platelet & H ctEx. Plasmanate- Comm l prepared protein product (inst of alb or plasma)

Blood & Blood Products

Whole Bloodo 1 unit -Elevates H gb by 0.5 to 1.0

Packed RBCs-o 1 unit-Elevates H ct by 3o decr chance of Circ overload/less antigen reaction

PlasmaAlbumin

Lipids

A fat emulsion solution which is usually indicated in IV therapy that lastslonger than 5 daysAdds balance to nutritional needs


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Safety issues associated with electrolyte replacement

Monitor vital signsMonitor Urine OutputMeasure wt. dailyCk for signs & symptoms of F luid Vol. deficitCk for signs & symptoms of F luid Vol. OverloadMonitor lab resultsMonitor types fluid client receivingCk IV injection site for infiltration or phlebitisSevere vomitingMeaning of thirst /old /young

Various types of crystalloids and how they work/issues associated with their tonicityWith fluid Volume loss, Isotonic solution Indicated ( similar osmolality to ECF & ICF )

D extroseD 5W-isotonic- 250 mOsmIn water becomes hypotonic ( 3 L +)

Normal Saline0.9 % NaCl- isotonic- 310 mOsm

Lactated RingersIsotonic- 275 mOsm

Ringers Solution

Isotonic- 310 mOsm

H ow do you know if a client is adequately responding to fluid replacement vs havingside effects/adverse effects

Electrolytes would be within their narrow rangesMagnesium 1.5 - 2.5 mg/dLCalcium (total) 8 - 11 mg/dLChloride 96 - 112 mEq/LPhosphorus 2.2 - 4.8 mg/dLPotasssium 3.5 - 5.5 mEq/LSodium 135 - 148 mEq/L


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H ct ( H ct (Male) 39 - 54%) and BUN ( BUN 6 - 23 mg/dL ) are Normal

If both values elevated, indicates F lVol deficit (dehydration)BUN > 60 mg/dl indicates Renal F ailure

Urine Output would be normalNormal output > 35 ml/hr or 1000-1200 ml per dayReport < 25 ml/hr or < 600ml per day

Urine Specific Gravity (SG) would be normal

Normal 1.005 to 1.030> 1.030 indicates H ypovolemia (dehydration)

Ck types of IV fluids

Report Continuous use of D 5W/promotes hypo-osmolality

Signs & symptoms of F luid Over load

Constant irritated cough; Neck Vein Engorgement; hand Vein Engorgement

Moist Rales in Lungs

Sign & Symptoms of F luid D eficit

Excess Thirst (mild Thirst ), Marked Thirst: D ry Mucous membranes, poor skinturgor , decr urine output, tachycardia, Slight decr in Systolic Blood Press


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Chapter 16:

Compare and contrast the uses, complications, side effects, and which clients arecandidates for enteral vs. parenteral nutrition therapy

Enteral Nutrition Therapy (preferred method) 1st Choice-less risk of sepsis/maintains GI integrity/less costly

Route for adm nutritional support orally(can swallow) or by feeding tubes(cannot swallow)

o Nasogatric tube (gastrostomy) S H ORT TERMo Nasoduodenal/nasojejunal/jejunostomy (small Intestinal) LONG TERM

Enteral Solutions- Carbs/protein/fat o Blenderized (liq that pass thru tube)o Polymeric (milk based & lactose free) Supplement/Ensureo Elemental or Monomeric (partial G I tract dysfunction)

Methods for D eliveryo Bolus- 2 50-400ml rapidly o Intermittent- every 3-6 hrs over 30 to 60 minuteso Continuous (critically ill/in intestine) slow rate over 24 hrso Cyclic(continuous) 8-16 hrs

Complications/side effectso D ehydration-if not enough water is given( some hyperosmolar)o D iarrhea: caused by rapid adm/corrected by decr rate of infusiono Ck residual:


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COMPLICATIONS o Result from catheter insertion & TPN infusion o Pneumothorax/hemothorax/hydrothorax/air

embolism/infection/hyperglycemia/fluid overload

ValsalvaManeuver prevents air embolism H yperglycemia when infusion rate too rapido TPN excellent medium for organism growth

Chapter 17-25:

In these chapters guys , you are responsible for primarily the classes and prototypes . For each, you

should b e familiar with mechanism of action , selectivity , safety concerns , client teaching , side effects ,adverse reactions , issues with dosing (times, preparation, anything the book highlights) , antidotes ,and relevant nursing assessments . I assure you that anything you are tested on is important and a b igdeal. This test O V ER ALL is very general.... b ut there are a few specific things pulled out that we definitelywent over in class...and E V ERYT H IN G ON T H E TEST COMES STR AIGH T FR OM YOUR BOOK!!

Chapter 17

CLASS:Adrenergics-agonists (Sympatheomimetics/adrenomemetics)

D rugs that stimulate the SYMPAT H TIC NERVOUS SYSTEMMimic SNS

Act on Adrenergic Receptors (cells of muscles: heart,Bronchioles, G I, Urinary bladder,cilary eye muscles

Alpha 1 Receptor: When stimulatedArterioles&venules CONSTR ICT incr peripheral resistance &bl return toheart(BP incr)

Alpha 2 Receptor: When stimulatedInhibits the release of Epinephrine leading to decr invasoconstriction(BP decr)


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Beta 1 Receptor: When stimulatedIncreases MyocardialContractibility and H eart Rate (smooth muscle)

Beta 2 Receptor: When stimulatedCauses relaxation in smooth muscles in lungsIncr Blood flow to skeletal musclesRelaxation of Uterine muscles

D opaminergic Receptor; When stimulatedVessels dilate & blood flow increases

Adrenergic Blockers (antagonist) SYMPAT H OLYTICS

D rugs that block the effects of adrenergic neurotransmitters , alpha/beta, bydirectly occupying the alpha/beta receptors or indirectly inhibiting the releaseof the neurotransmitters Norepinephrine & epinephrineEffects of Adrenergic Blocker at Receptors

Alpha 1 o causes VASO D ILATION; decr BP; reduce smooth muscle

contractionBeta 1

o D ecr H R; reduces force of contractionsBeta 2

o Constricts Bronchioles, Contracts Uterus; inhibit Glycogenolyisis(decr bl sugar)

Alpha-Adrenergic Blockers

PROMOTE VASOD ILATION & D ECR BPBlock or inhibit a response at the alpha adrenergic receptor siteSelective alpha blockers-Alpha1 onlyNonselective- Alpha1 & Alpha2


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Beta-Adrenergic BlockersD ECRH R; D ECR BPF OLLOWS;

Nonselective blocking Beta 1 & 2 o

caution COPD

(bronchiole constriction &H

R)Selective Beta 1 o Good for decr H r& BPo Atenolol

Adrenergic Neuron Blockers (sub of Adrenergic Blockers)Blocks the release of Norepinephrine to D ECR BP

Chapter 18

Cholinergics (parasympathomimetics) AGON IST

Mimic PNS neurotransmitter Acetylcholine (Ach)Cholinergic Receptors

o Muscarinic receptorStimulate smooth muscle & slow heart rate

o Nicotinic receptorsAffect skeletal muscles

D irect Acting Cholinergic D rugso Act on the receptors to activate a tissue responseo Primarily selective to Muscarinic receptors but are nonspecific because

receptors are located on smooth muscle-G I,GU, glands, hearto BethanecholCholride (Urecholine) Increases urination

Indirect Acting Cholinergic D rugs (anticholinesterase/Cholinesteraseinhibitors)

o Inhibit the action of the enzyme Cholinesterase (ChE)(Acetylcholinesterase) by forming a chemical complex, thus permittingacetylcholine to persist and bind to the receptor


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o Primary use to treat Myasthenia Gravis, Glaucomao Reversible Cholinesterase Inhibitors

Pupil constriction (Glaucoma) Incr muscle strength (Myasthenia Gravis)

o Irreversible Cholinesterase

I

nhibitors o Permanent

AntiCholinergics (Parasympatholytics) Antagonisto D rugs that inhibit the actions of acetylcholine by occupying the acetylcholine

receptorso By blocking PNS, the SNS (adrenergic) dominateso Major response is decr G I motility , decr salivation, decr pupils (mydraisis), incr

pulse rateo Can act as an antidote to Cholinesterase inhibitors/organophosphate ingestiono Atropine- Preoperative med to decr salivation, H R, dilate pupils

Anti Parkinson/Anticholinergic D rugso Trihexyphenidyl H CL

D ecr involuntart symptoms of Parkinson or drug induced Parkinson(pseudo)

Blocks cholinergic (muscarinic) receptors

nur 304 study guide for unit 1 test

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