Summary NURS 472A NURSING PHARMACOLOGY EXAM STUDY GUIDE 2024 UPDATE
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Course
NURSING PHARMACOLOGY
Institution
NURSING PHARMACOLOGY
Pharmacology Exam 1 Guide
Nursing Process and Drug Therapy
● IPEC: Interprofessional Education Collaboration
○ Goal to develop core competencies for practice and improve health outcomes
● 5 steps of nursing process
○ Assessment
■ Data collection of both objective and subjective natu...
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Pharmacology Exam 1 Guide
Nursing Process and Drug Therapy
● IPEC: Interprofessional Education Collaboration
○ Goal to develop core competencies for practice and improve health outcomes
● 5 steps of nursing process
○ Assessment
■ Data collection of both objective and subjective nature
■ Medication reconciliation
■ General: always check allergies before giving meds
■ Specific: ie check vitals applicable to the med antihypertensive check bp
○ Human Need Statement / Diagnosis
■ Complements medical diagnosis
■ Ensure medication matches pt problem
■ Ex: a) problem b) etiology of problem c) evidence of problem d) prioritize
response
○ Planning
■ SMART goals: specific measurable, achievable, realistic, timely
■ Outcome criteria: concrete descriptions of pt goals, expectations for
behavior; for meds that the outcome is safe and effective administration of
meds
○ Implementation (includes pt education)
■ Rights -> drug, dose, time, route, pt, documentation, (and) reason,
response, right to refuse
■ Initiate and complete specific nursing actions as defined by nursing dx,
goals, outcome criteria
○ Evaluation (see impact)
■ Ongoing part of nursing process
■ Determine status of goals and outcomes of care (intended vs unintended
outcomes)
■ Monitor pt response
■ Clear, concise documentation
Pharmacokinetics (what body does to drug: ADME)
● Absorption
○ Bioavailability-> % active drug reaching bloodstream
■ All drug bioavailability is influenced by route and pharmaceutics
● Route: enteral (GI tract), parenteral (injections), misc
○ Enteral: oral, sublingual/buccal, suppositories
■ For sublingual and buccal, swallowing medication
may inactivate it (unable to handle pH of stomach)
○ Parenteral: IV 100%, IM/SQ/ID, epidural
○ Misc: inhalation, topical/transdermal, instillation
(eye,ear,nose, drops, sprays)
■ IV route is 100% bioavailable
,■ Oral route bioavailability is influenced by
● pH of GI tract - acidic vs basic envt
○ pH influenced by time, food, meds, age (neonates +
geriatrics have less acid), diseases ie GERD, PUD
● Taking w other meds, food
○ Drugs can adhere to each other
○ In general, take meds on empty stomach w full glass of
water (30min-1hr before or 2 hours after food)
○ When in doubt, separate administration of multiple drugs
■ Drug formulation
●
● Enteric coated protects it from pH of stomach so that it gets
absorbed in SI, made to protect gastric mucosa from irritation
■ P-glycoproteins
● Located in bbb, GI tract
● Efflux pumps designed to pump out xenobiotics
● Resulting in less absorption of oral drugs into general circulation
● This gets undone by grapefruit juice and other drugs/foods,
resulting in more drug getting absorbed than intended -> can lead
to toxicity
■ First pass effect
● Oral drugs are swallowed, enter GI tract, get absorbed into GI
mucosa, then it all goes to liver via portal vein, liver metabolizes it,
then metabolized drug enters general circulation
, ●
● Distribution
○ Permeability of cell membrane
■ Lipophilic, nonpolar gets through easily while hydrophilic, polar does not
■ Bbb, placenta are things nonpolar drugs can get into easily since they can
pass through cell membrane via passive diffusion
■ While water soluble drugs need to bind to receptors to enter cells; they
remain in highly vascularized spaces and can easily leave via urine
○ Protein binding of drugs
■ Free vs bound
● Free (active) is unrestricted and all of it is able to bind to receptors
and distribute into extravascular tissue to its intended target
● Bound (inactive) restricts how much of the drug is actually
available in bloodstream, ie albumin binding to phenytoin makes
only 10% active ie available
● Albumin is most common blood protein that preferentially binds
drugs to it, those drugs are then stuck in bloodstream
● Complications of highly bound drugs: deficiency in protein will then
increase concentration of drug and can lead to toxicity;
competition can also lead to toxicity
○ Circulation/ blood supply
■ Rapid - vital organs
■ Slow - muscle, skin, fat
■ Diseases
● Poor perfusion -> PVD, heart diseases
● Drugs go where there is more blood flow, so concerns come in to
pt w perfusion problems
● Metabolism
○ Not all drugs go through metabolism, sometimes you may eliminate them
untouched by liver
○ Metabolites can be stronger or weaker than initial drug, active or inactive
○ Liver is primary organ, secondary are skeletal muscles, kidney, lung, plasma,
intestinal mucosa
, ■ P450 liver enzymes target substrates that are lipophilic and nonpolar so
that they can convert them to hydrophilic polar in order to excrete them
more easily
○ CYP450 liver enzymes
■ Any alteration will alter rate of metabolism of drugs: other drugs, certain
foods ie grapefruit, smoking/alcohol
■ Other influences: diseases, genetics, age (geriatrics have less enzyme
activity while infants have fewer liver enzyme)
■ Pro drug: inactive drug that becomes active as a metabolite from the liver;
ex: valacyclovir (Valtrex) and codeine; can help improve bioavailability
■ Enzyme inducer: ie phenytoin, inDucer, drop levels of other drug since
metabolism is sped up
● CORPPSS (many of these are seizure drugs)
○ Carbamazepine
○ Oxcarbazepine
○ Rifampin
○ Phenytoin
○ Phenobarbital
○ Smoking
○ St John’s Wort (OTC herb)
■ Enzyme inhibitor: ie fluconazole, inHibitor, higher levels of other drug
since it slows metabolism
● PACMAN loves Grapefruit Juice
○ Protease inhibitor (HIV)
○ Azole antifungal (fluconazole, ketoconazole)
○ Cimetidine (H2RAs)
○ Macrolides (ACE, azithromycin, clarithromycin,
erythromycin)
○ Amiodarone
○ Non-DHP Ca2+ channel blockers (diltiazem, verapamil)
○ Grapefruit juice
● Describe the first pass effect and identify methods to bypass the first pass effects
(Metabolism)
○ Oral route drugs have first pass effect where they get metabolized in liver before
entering systemic circulation
○ Bypass it by taking drugs another route and that will impact its bioavailability
● Identify common lab values, signs and symptoms of hepatic impairment (especially drug
induced liver injury- DILI) (Metabolism)
○ S/s of impaired liver function
■ Dark urine (bilirubin is in)
■ Jaundice (yellow eyes, liver doesn’t filter bilirubin from blood)
■ Swelling abdomen (no longer making sufficient albumin)
■ Bruise, bleed (lack of clotting factors)
■ Fatigue
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