Pharm Final

• Factors that may require alteration in drug administration


  • African Americans
  • Age
  • Gender
  • Illness
  • Kidney/liver functions
  • Metabolism
  • Genetics-Pharmacogenetics
  • Site of administration
• Nurse responsibilities with medications


  • Safety and error prevention
  • Reporting and documentation
• Methods of administering medications


  • Enteral: oral, sublingual, buccal, NG, G-tube, J-tube. Tablets, capsules, pills
  • Topical: ophthalmic-eye, otic-ear, nasal, inhaled, transdermal- meds to skin, rectum, vagina. inhalants, topical ointments, pastes, transdermal patches
  • Parenteral: subcutaneous, IM, intradermal, IV
• Filter needles


  • For ampules so that no glass is in med
• Two meds one syringe


  • Clear first, cloudy second
• 1. track method


  1. Apply downward pressure to skin

  2. Inject as usual

  3. When ready to withdraw needle, withdraw and release traction on skin
• Order must include: med, dose, time, frequency, route
• Drawing up meds from vial

  1. Remove cap

  2. Cleanse rubber seal with alcohol wipe, allow to dry

  3. Draw up air equal to amount of med to be withdrawn and inject into vial

  4. Invert vial, withdraw correct amount of med

  5. Dislodge bubbles and eject from vial

  6. Recap(scoop), change needle if indicated

  7. Label syringe
• The 5 rights of medication administration


  • Right Patient
  • Right Reason
  • Right Time
  • Right Drug
  • Right Dose
  • Right Route
  • Right Documentation
• Prescribers help to prevent drug abuse by


  • Less refills
  • Less pills given per refill
• Generic name


  Not capitalized, cheaper
• Trade name


  Capitalized, restricted to owner, easier to spell, pronounce and remember
• Antidotes


  • Acetaminophen: acetylcysteine (Mucomyst)
  • Tramadol: naloxone
  • Digoxin: digoxin immune fab (DigiFab or DigiBind)
  • Warfarin: Vitamin K
  • Benzodiazepine: flumazenil
  • Heparin: protamine sulfate
  • Narcotics: Naloxone and naltrexone
• Cholinergic effects


  • Acetylcholine increase
  • Parasympathetic nervous system
  • Rest and digest
  • Contract smooth muscles (Organs)
  • Dilate muscles
  • Pressure goes down, low BP
  • Increased secretions
  • Decreased HR
  • SLUDGE (salivation, lacrimation, urination, defecation, GI distress, emesis)
• Anticholinergic effects


  • Acetylcholine decreases
  • Block PNS, less rest and digest
  • Decreased secretions
  • Urinary retention
  • Increased HR
  • Constricts vessels
  • Increased BP
• Metabolism


  The change that occurs in a drug into a more/less potent form of the drug, more soluble form, or an inactive form of drug. Liver is the main spot of metabolism of drugs.
• Absorption


  Movement of drug from site of administration to various tissues of the body
• Excretion


  The elimination of a drug or its metabolite through various parts of the body
• Distribution


  Movement of drugs by circulatory system to intended site of action
• Peak drug level


  The time it takes the drug to demonstrate its full therapeutic effect
• Onset of action


  The amount of time it takes for the drug to demonstrate a therapeutic response
• Trough drug level


  The point when the drug is at its lowest level in the body
• Duration of action


  The length of time the drug's therapeutic response lasts w/o additional doses
• Agonist


  Drugs that interact with a receptor to stimulate a desired response
• Antagonist


  Drugs that attach to a receptor but do not stimulate a response or block a response. Often prevents binding of agonists.
• Antihypertensive drug classes


  • RAAS Suppressants
  • Calcium Channel Blockers
  • Sympatholytics (Antiadrenergics)
  • Direct-Acting Vasodilators
• RAAS Suppressants


  • Renin-angiotensin-aldosterone mechanism is affected
  • Types: ACE inhibitors, angiotensin 2 receptor blockers (ARBs), Aldosterone antagonists, direct renin inhibitors
• ACE inhibitors


  • Block angiotensin-converting enzyme from converting angiotensin I to angiotensin II which is a powerful vasoconstrictor
  • Dilate vessels
  • Increase renal blood flow
  • Can be used alone or in combination with diuretic
• Examples of ACE inhibitors


  • Captopril (Capoten)
  • lisinopril (Prinivil)
  • enalapril (Vasotec)
  • Fosinopril (Monopril)
• Adverse effects of ACE inhibitors


  • Hypotension (especially after first dose)
  • Dry nonproductive cough
  • Rash
  • Metallic taste in mouth
  • Hyperkalemia
  • Neutropenia (puts them at risk for infection)
  • Angioedema (swelling of mouth, throat)
• ACE inhibitors are contraindicated in those with renal disease
• Considerations for ACE inhibitors


  • Hold medication/contact prescriber if systolic BP < 100 mm Hg
  • Decreased absorption if taken with food
  • African Americans may not respond well
• Angiotensin II Blockers (ARBs)


  Bind to angiotensin II receptor sites and block the vasoconstrictor from binding to receptor sites in target organs
• Examples of ARBs


  • Losartan potassium (Cozaar)
  • Valsartan (Diovan)
  • Irbesartan (Avapro)
  • Candesartan (Atacand)
• Uses of ARBs


  • Alone or in combination with other antihypertensives to reduce blood pressure
  • African Americans may not respond well to therapy with an ARB only
• Adverse effects of ARBs


  • Angioedema
  • Headache
  • Dizziness
  • Hypotensions
  • Insomnia
  • Hyperkalemia
  • Birth defects
• Aldosterone Antagonists


  Treat HTN
• Examples of Aldosterone Antagonists


  • Eplerenone (Inspra)
  • Spironolactone (Aldactone)
• Adverse effects of Aldosterone Antagonists


  • Hyperkalemia
  • Lithium toxicity
  • Caution in meds that affect K+
• Direct Renin Inhibitors


  Treat HTN