NR 293 Exam 1 Study GuideNR 293 Exam 1 Study Guide, Study Guides, Projects, Research of Nursing

Download NR 293 Exam 1 Study GuideNR 293 Exam 1 Study Guide and more Study Guides, Projects, Research Nursing in PDF only on Docsity! 1 NR 293 Exam 1 Study Guide Chapter 2 • Define the common terms used in pharmacology o Pharmacokinetic- the study of what the body does to the drug; involves the processes of absorption, distribution, metabolism, and excretion; the study of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body; represent the drug absorption into, distribution and metabolism within, and excretion from the body o Pharmacodynamics- the study of what the drug does to the body; involves drug– receptor relationships. o First-pass effect- initial metabolism in the liver of a drug absorbed from the GI tract before the drug reaches systemic circulation through the bloodstream; reduces the bioavaibility of less than 100%, whereas drugs administered by the intravenous route are 100% bioavailable o Bioavaibility- a measure of the extent of a drug absorption for a given drug and route (from 0% to 100%) o Protein-binding o Onset of action- time required for a drug to elicit a therapeutic response after dosings o Peak Effect – the time required for a drug to reach its max. therapeutic response o Duration of action- the length of time the concentration of a drug in the blood or tissues is sufficient to elict a response o Half-life – in pharmacokinetics, the time required for half of an administered dose of drug to be eliminated by the body, or the time it takes for the blood level of a drug to be reduced o Therapeutic index- ratio btwn toxic and therapeutic concentrations of a drug o Trough level- lowest blood level; the lowest concentration of a drug reached in the body after it falls from its peak level, usually measured in blood sample for therapeutic drug monitoring o Peak level- highest blood level; done usually at 12th level after 3rd dose; the max. concentration of a drug in the body after administration, usually measured in a blood sample for therapeutic drug monitoring 2 o Agonist- drug that binds to and stimulates the activity of one or more receptors in the body o Antagonist- drug that binds to and inhibits the activity of one or more receptors in the body; also called inhibitors • Type of therapy: o Acute therapy- often involves more intensive drug treatment and implemented in acutely ill (those with rapid onset of illness) or critically ill; often needed to sustain life or treat disease ▪ Ex: vasopressors to maintain BP and cardiac output after open heart surgery ▪ Ex: intensive chemotherapy for pt with newly diagnosed cancer o Maintenance therapy- doesn’t eradicate problems the pt may already have but will prevent progression of a disease or condition; used for treatment of chronic illnesses ▪ Ex: HTN it will maintain the pt’s BP within given limits which prevents certain end-organ damage ▪ Ex: oral contraceptives for birth control o Supplemental therapy- or replacement therapy; supplies body with a substance needed to maintain normal function; substance may be needed bc it cannot be made by the body or bc it is produced in insufficient quantity ▪ Ex: administration of insulin to diabetic pt’s ▪ Ex: iron to pts w/ iron-deficiency anemia o Palliative therapy- make pt as comfortable as possible; focuses on providing pts w/ relief from symptoms, pain, and stress of a serious illness; goal is to improve quality of life for both pt and family; typically used in the end stages of an illness when attempts at curative therapy have failed; it can be provided along with curative treatment ▪ Ex: use of high dose opioid analgesics to relieve pain in the final stages of cancer o Supportive therapy- maintains integrity of body functions while the pt is recovering from illness/trauma ▪ Ex: provision of fluids and electrolytes to prevent dehydration in a pt w/ influenza who is vomiting and has diarrhea ▪ Ex: administration of fluids, volume expanders, or blood products to a pt who lost blood during surgery o Prophylactic therapy- drug therapy provided to prevent illness or other undesirable outcome during planned events 5 and viruses 6 Chapter 3 • Major drug related concern during the pregnancy and lactation o First trimester of pregnancy is generally period of greatest danger of drug-induced developmental defects. o Fetal gestational age is an important factor in determining potential for harmful drug effects to the fetus. o Maternal factors also play a role in determining drug effects on the fetus. Any change in mother’s physiology can affect the amount of drug to which the fetus may be exposed. Maternal kidney and liver function affect drug metabolism and excretion. Impairment in kidney or liver function can result in higher drug levels or prolonged drug exposure which leads to increased fetal transfer. o Avoid breastfeeding/pump and dump o Pregnancy Safety Categories CATEGORY DESCRIPTION Category A Studies indicate no risk to human fetus Category B Studies indicate no risk to animal fetus; information for humans is not available Category C Adverse effects reported in the animal fetus; information for humans is not available Category D Possible fetal risk in humans has been reported; however, in selected cases consideration of potential benefit vs risk may warrant use of these drugs in pregnant women. Category X Fetal abnormalities have been reported and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not o be used in pregnant women • Pharmacokinetic change in the life span o Polypharmacy o Everything decreases as you age Chapter 7 • What do we need to teach the patient about OTC medications and herb 7 o OTC medications treats symptoms only o Herbs are not FDA regulated o Herbs are not considered medications Chapter 38 & 39, Major Concepts: • Antiseptics- one of two types of topical antimicrobial agents; a chemical that inhibits the growth and reproduction of microorganisms without necessarily killing them; aka static agents • Disinfectants- one of two types of topical antimicrobial agents; a chemical applied to nonliving objects to kill microorganisms; aka cidal agents Antiseptics Disinfectants Where Used Living Tissue Nonliving Objects Potency Lower Higher Activity against organisms Primarily inhibits growth (bacteriostatic) Kills (bactericidal) • Subtherapeutic- generally refers to blood levels below therapeutic levels due to insufficient dosing. Also refers to antibioitic treatment that is ineffective in treating a given infection; possible causes include inappropriate drug therapy, insufficient drug dosing, and bacterial drug resistance • Superinfection- 1. An infection occurring during antimicrobial treatment for another infection, resulting from overgrowth of an organism not susceptible to the antibiotic used. 2. A secondary microbial infection that occurs in addition to an earlier primary infection, often due to weakening of the pts immune system function by the first infection • Empiric therapy- administration of antibiotics based on the practitioner’s judgment of the pathogens most likely to be causing an apparent infection; it involves the presumptive treatment of an infection to avoid treatment delay before specific culture information has been obtained • Definite therapy- the administration of antibiotics based on known results of culture and sensitivity testing identifying the pathogen causing infection • Prophylactic antibiotic therapy- antibiotics taken before anticipated exposure to an infectious organism in an effort to prevent the development of infection • Bactericidal antibiotics- antibiotics that kill bacteria • Bacteriostatic antibiotics- antibiotics that do not actually kill bacteria but inhibit their growth 10 • Take oral doses with food • Betalactam: o Penicillins “cillin” ▪ Mechanism of Action- Penicillins enter the bacteria via the cell wall, bind to penicillin-binding protein- normal cell wall synthesis is disrupted. Result: bacteria cells die from cell lysis. Penicillins do not kill other cells in the body ▪ Indications - Prevention and treatment of infections caused by susceptible bacteria, such as: Gram-positive bacteria, including Streptococcus spp., Enterococcus spp., Staphylococcus spp. ▪ Adverse effects • Allergic reactions to the penicillins occur in 0.7% to 4% of treatment courses o Urticaria, pruritus, angioedema • Those allergic to penicillins have an increased risk of allergy to other beta- lactam antibiotics • Only those patients with a history of throat swelling or hives from penicillin should not receive cephalosporins • Common adverse effects- Nausea, vomiting, diarrhea, abdominal pain • Other adverse effects are less common ▪ Contraindications - known drug allergy ▪ Interactions • NSAIDs • Oral contraceptives • Warfarin • Others ▪ Nursing Implications • Take oral doses with water (not juices) as acidic fluids may nullify drug’s antibacterial action • Monitor patients taking penicillin for an allergic reaction for at least 30 minutes after administration o Cephalosprins “cef” “ceph” ▪ Mechanism of Action- bacteriocidal -> same as penicillin ▪ Indications- 11 ▪ Adverse effects • Similar to penicillins- Mild diarrhea, abdominal cramps, rash, pruritus, redness, edema • Potential cross-sensitivity with penicillins if allergies exist ▪ Contraindications ▪ Interactions- alcohol, antacids, iron, oral contraceptives ▪ Nursing Implications • Assess for penicillin allergy; may have cross allergy • Give orally administered forms with food to decrease GI upset, even though this will delay absorption • Some of these drugs may cause a disulfiram (Antabuse)-like reaction when taken with alcohol • Macrolides “thromycin” : Erythromycin/Azithromycin o Mechanism of Action ▪ Prevent protein synthesis within bacterial cells ▪ Considered bacteriostatic ▪ Bacteria will eventually die ▪ In high enough concentrations, may also be bactericidal o Indications ▪ Strep infections- Streptococcus pyogenes (group A beta-hemolytic streptococci) ▪ Mild to moderate URI and LRI- Haemophilus influenzae ▪ Spirochetal infections- Syphilis and Lyme disease ▪ Gonorrhea, Chlamydia, Mycoplasma ▪ azithromycin and clarithromycin- Approved for Mycobacterium avium- intracellulare complex infection (opportunistic infection associated with HIV/AIDS) ▪ Clarithromycin- Recently approved for use in combination with omeprazole for treatment of active ulcer disease associated with Helicobacter pylori infection o Adverse effects ▪ GI effects, primarily with erythromycin- Nausea, vomiting, diarrhea, hepatotoxicity, flatulence, jaundice, anorexia ▪ Azithromycin and clarithromycin: fewer GI adverse effects, longer duration of action, better efficacy, better tissue penetration o Contraindications - known drug allergy 12 o Interactions- These drugs are highly protein-bound and will cause severe interactions with other protein-bound drugs o Nursing Implications ▪ The absorption of oral erythromycin is enhanced when taken on an empty stomach, but because of the high incidence of GI upset, many drugs are taken after a meal or snack • Tetracyclines “cycline” o Mechanism of Action - Bacteriostatic- Inhibit protein synthesis. Stop many essential functions of the bacteria. In high enough concentrations, may also be bactericidal o Indications- Wide spectrum ▪ Gram-negative and gram-positive organisms, protozoa, Mycoplasma, Rickettsia, Chlamydia, syphilis, Lyme disease, acne, others ▪ Demeclocycline is also used to treat SIADH by inhibiting the action of ADH o Adverse effects ▪ Strong affinity for calcium- Discoloration of permanent teeth and tooth enamel in fetuses and children, or nursing infants if taken by the mother ▪ May retard fetal skeletal development if taken during pregnancy ▪ Alteration in intestinal flora may result in: • Superinfection • Diarrhea • Pseudomembranous colitis • Vaginal candidiasis ▪ Other effects--photophobia o Contraindications - Should not be used in children under age 8 or in pregnant/lactating women because tooth discoloration will occur if the drug binds to the calcium in the teeth o Interactions ▪ Bind (chelate) to Ca+++ and Mg++ and Al+++ ions to form insoluble complexes ▪ Dairy products, antacids, and iron salts reduce oral absorption of tetracyclines o Nursing Implications 15 as stated previously for interacting drugs. ▪ Enteral tube feedings can also reduce the absorption of quinolones. ▪ Oral anticoagulants are to be used with caution in patients receiving quinolones because of the antibiotic-induced alteration of the intestinal flora, which affects vitamin K synthesis. o Nursing Implications ▪ Monitor for cardiac dysrhythmias especially if the patients are taking antidysrhythmic medications ▪ Do not take with antacids, zinc, iron, multivitamins, calcium due to impaired absorption ▪ Monitor for joint pain and inflammation • Vancomycin (Vancocin) o Mechanism of Action o Indications ▪ Treatment of choice for MRSA and other gram-positive infections ▪ Oral vancomycin is indicated for the treatment of antibiotic-induced colitis (C. difficile) and for the treatment of staphylococcal enterocolitis o Adverse effects ▪ Ototoxicity ▪ Nephrotoxicity ▪ Red man syndrome may occur • Flushing/itching of head, neck, face, upper trunk • Antihistamine may be ordered to reduce these effects ▪ Additive neuromuscular blocking effects in patients receiving neuromuscular blockers ▪ Hypotension if infused too quickly (should be infused over 60 min) o Contraindications ▪ Known drug allergy ▪ Impaired renal function ▪ Impaired hearing 16 ▪ Elderly and newborns o Interactions o Nursing Implications ▪ Must monitor blood levels to ensure therapeutic levels and prevent toxicity • Clindamycin ( Cleocin) o Used for chronic bone infections, GU infections, intraabdominal infections, other serious infections o May cause pseudomembranous colitis (also known as antibiotic-associated colitis, Clostridium difficile diarrhea, or C. difficile infection) o Potential interaction with vecuronium • Linezolid (Zyvox) o New class: oxazolidinones o Used to treat vancomycin-resistant Enterococcus faecium (VREF, VRE), hospital- acquired, and skin structure infections, including those with MRSA o May cause hypotension, serotonin syndrome if taken with SSRIs, and reactions if taken with tyramine-containing foods • Metronidazole (Flagyl) o Used for anaerobic organisms o Intraabdominal and gynecologic infections o Protozoal infections o Several drug interactions • Nitrofurantoin ( Microdantin) o Primarily used for urinary tract infections (UTIs) (E. coli, Staphylococcus aureus, Klebsiella spp., Enterobacter spp.) o Use carefully if renal function is impaired o Drug concentrates in the urine o May cause fatal hepatotoxicity Chapter 40 Antiviral Drugs • Antivirals (Non HIV) • Acyclovir (Zovirax) o Synthetic nucleoside analog o Used to suppress replication of HSV-1, HSV-2, VZV 17 o Drug of choice for treatment of initial and recurrent episodes of these infections o Oral, topical, parenteral forms • Ganciclovir o Synthetic nucleoside analog o Used to treat infection with cytomegalovirus (CMV) o Oral, parenteral forms o CMV retinitis o Ophthalmic form surgically implanted (Vitrasert) o Bone marrow toxicity • Oseltamivir (Tamiflu) Zannamivir ( Relenza) • Active against influenza types A and B • Reduce duration of illness • Oseltamivir: causes nausea and vomiting • Zanamivir: causes diarrhea, nausea, sinusitis • Treatment should begin within 2 days of influenza symptom onset • Antiretrovirus (HIV) o Zidovudine Zidovudine (Retrovir), also known as azidothymidine or AZT, is a synthetic nucleoside analogue of thymidine that has had an enormous impact on the treatment and quality of life of patients who have AIDS. It was the very first and, for a long time, the only anti-HIV medication. Zidovudine, along with various other antiretroviral drugs, is given to HIV-infected pregnant women and even to newborn babies to prevent maternal transmission of the virus to the infant. Chapter 41 Antitubercular Drugs • Isoniazid o Drug of choice for TB o Resistant strains of Mycobacterium emerging o Metabolized in the liver through acetylation—watch for “slow acetylators” o Used alone or in combination with other drugs o Contraindicated with liver disease o Adverse effects: Peripheral neuropathy, hepatotoxicity o Perform liver function studies in patients 20 ▪ Renal toxicity, potassium loss, hypomagnesemia ▪ Pulmonary infiltrates ▪ Fever, chills, headache, nausea, occasional hypotension, gastrointestinal upset, anemia o Nursing implications ▪ To reduce the severity of the infusion-related reactions, pretreatment with an antipyretic (acetaminophen), antihistamines, antiemetics, and corticosteroids may be given ▪ Use IV infusion pumps and the most distal veins possible ▪ Follow manufacturer’s directions carefully for reconstitution and administration ▪ Monitor vital signs of patients receiving IV infusions every 15 to 30 minutes ▪ During IV infusions, monitor I&O to identify adverse effects • Fluconazole o Mechanism of Action - Inhibit fungal cell cytochrome P-450 enzymes, resulting in cell membrane leaking. Result: altered cellular metabolism and fungal cell death o Adverse effects ▪ Nausea, vomiting, diarrhea, stomach pain, ▪ Increased liver enzymes ▪ Use with caution in patients with renal and liver dysfunction o Contraindications ▪ Liver failure ▪ Renal failure ▪ Drug allergy o Interactions-Many antifungal drugs are metabolized by the cytochrome P-450 enzyme system. Coadministration of two drugs that are metabolized by this system may result in competition for these enzymes, and thus higher levels of one of the drugs • Nystatin o Adverse effects: ▪ Nausea 21 ▪ Vomiting ▪ Anorexia ▪ Diarrhea ▪ Rash o Nursing Implications: ▪ Nystatin given as an oral lozenge or troche should be slowly and completely dissolved in the mouth (not chewed or swallowed whole) ▪ Nystatin suspension should be swished thoroughly in the mouth as long as possible before swallowing ▪ Monitor for therapeutic effects • Easing of symptoms of infection • Improved energy levels • Normal vital signs, including temperature ▪ Monitor carefully for adverse effects Chapter 45, 46 (focusing on nursing implications relate to the toxicity) Antimetabolite: methotrexate (MTX) • Mechanism of action o Antimetabolites: Folic acid antagonism- Interferes with the use of folic acid as a result, DNA is not produced, and the cell dies • Indications o Used in combination with other drugs to treat various types of cancer, such as solid tumors and some hematologic cancers ▪ Acute and chronic lymphocytic leukemias ▪ Leukemias (several types) ▪ Colon, rectal, breast, stomach, lung, pancreatic cancers 22 o Methotrexate is also used to treat severe cases of psoriasis and rheumatoid arthritis • Adverse effects o Hair loss, nausea and vomiting, myelosuppression o Neurologic, cardiovascular, pulmonary, hepatobiliary, GI, genitourinary, dermatologic, ocular, ottic, and metabolic toxicity o Tumor lysis syndrome o Palmar-plantar dysesthesia (also called hand-foot syndrome), Stevens-Johnson syndrome, toxic epidermal necrolysis • Antidote o Leucovorin “rescue” is prescribed to reduce the bone marrow suppression that is associated with high-dose methotrexate therapy. Alkylating drugs (cisplatin) • Mechanism of action o Work by preventing cancer cells from reproducing o Alter the chemical structure of the cells’ deoxyribonucleic acid (DNA) o Bifunctional or polyfunctional • Indications- Used in combination with other drugs to treat various types of cancer o Recurrent ovarian cancer o Brain tumors o Lymphomas o Leukemias o Breast cancer o Bladder cancer o Others • Adverse effects o Dose-limiting adverse effects ▪ Nausea and vomiting, myelosuppression o Alopecia o Nephrotoxicity, peripheral neuropathy, ototoxicity o Hydration can prevent nephrotoxicity 25 ▪ Leaking of an antineoplastic drug into surrounding tissues during IV administration ▪ Can result in permanent damage to nerves, tendons, muscles; loss of limbs ▪ Skin grafting or amputation may be necessary ▪ Several specific antidotes can be used ▪ Prevention is essential ▪ Continuous monitoring of the IV site is essential ▪ If suspected, stop the infusion immediately and contact the prescriber, but leave the intravenous catheter in place ▪ Aspirate any residual drug and/or blood from the catheter ▪ Consult guidelines or the pharmacist regarding antidotes, application of hot or cold packs and/or sterile occlusive dressings, and elevation and rest of the affected limb ▪ Thoroughly document the extravasation incident ▪ Consult facility protocol and guidelines • Nursing implication o Assess baseline blood counts before administering antineoplastic drugs o Follow specific administration guidelines for each antineoplastic drug o Remember that all rapidly dividing cells (both normal and cancer cells) are affected ▪ Mucous membranes ▪ Hair follicles ▪ Bone marrow component o Monitor for effects on these tissues or complications o Monitor for complications ▪ GI mucous membranes: stomatitis, altered bowel function with high risk for poor appetite, nausea, vomiting, diarrhea, and inflammation and possible ulcerations of GI mucosa ▪ Hair follicles: loss of hair (alopecia) ▪ Bone marrow components: dangerously low (life-threatening) blood cell counts o Monitor for adverse effects specific to the type of antineoplastic drug given o Implement measures to monitor for and prevent infection in patients with neutropenia or leukopenia 26 o Implement measures to monitor for and prevent bleeding in patients with thrombocytopenia and anemia o Keep in mind that anemia may result in severe fatigue o Monitor for stomatitis (oral inflammation and ulcerations), and implement measures to reduce the effects if it occurs o Anticipate nausea and vomiting, and implement measures to reduce these effects o Antiemetics often work better if given 30 to 60 minutes before chemotherapy is started o Women of childbearing age will need to use a nondrug form of contraception during therapy o In addition to physical measures, keep in mind the need for emotional support during this time for both the patient and family o Monitor for therapeutic responses to antineoplastic therapies and the many possible adverse effects o Monitor closely for anaphylactic reactions ▪ Keep epinephrine, antihistamines, and antiinflammatory drugs on hand o Monitor closely for complications associated with bone marrow suppression ▪ Anemia, thrombocytopenia, neutropenia o Cytoprotective drugs may be used to reduce toxicities ▪ IV amifostine to reduce renal toxicity associated with cisplatin ▪ IV or PO allopurinol to reduce hyperuricemia o Monitor for oncologic emergencies ▪ Infections ▪ Pulmonary toxicity ▪ Allergic reactions ▪ Stomatitis with severe ulcerations ▪ Bleeding ▪ Metabolic aberrations ▪ Bowel irritability with diarrhea ▪ Renal, liver, cardiac toxicity • Bleomycin? Cant find this one on the ppt 27 Please use this study guide as a reference only. Reading the book, PPTs and Quia games are important for the exam. There are about 50 questions in the first exam with 200 points. The test questions may not be limited in this study guide.