physical/psychological. body adapt & alter pathways. you want to keep using.
define Tolerance?
you need a bigger amount of the drug to have an effect
does OTC medicine with coedine need to be wasted?
yes! 2nd nurse must watch the wasting.
What restrictions do hospitals and pharmacies place on scheduled drugs?
must register with the drug enforcement administration (DEA)
use registration # to purchase sheduled drugs
must maintain complete records of all quanities purchased & sold
drugs with higher abuse potential have additional restrictions
What is the broad category name for: diverse group of drugs that cause clients to feel sedated or relaxed? what are the 4 types of drugs that fit under this category?
CNS depressants
sedatives, antianxiety agents, alcohol, opiods
what are sedatives used to treat? what are the 2 primary classes? what happens in an overdose?
prescribed for sleep disorders & certain forms of epilepsy
what drug is a heroin addict switched to during detox to help treat withdrawl symptoms?
methadone
what does mydriasis mean?
pupil dialation
what is the most commonly abused drug? what are consequences of this drug, does it have any health benefits? if so, how much is benefitial for a male or female?
alchohol (ethanol)
staggering economic, social & health consequences
small quanities of alchol consumed on daily basis foudn to reduce the risk of stroke and heart attack
female= 1-2 drinks
male= 2-3 drinks
what are side effects of alcohol?
sedation, relaxation, loss of motor coordination, reduced judgment, decreased inhibition, increased diuresis
what should you understand about the alcohol dependent client?
susceptible to adverse drug effects & drug interactions
drug doses should be decreased
serious GI bleeding w/ NSAIDS
hepatic injury combined w/ acetaminophen
what are some signs of alcohol withdrawl?
intense agitation
confusion
terrifying hallucinations
uncontrollable tremors
panic attacks
paranoia
elevate HR/BP
perspiration
what can alcohol withdrawl lead to? what is it called? what is it? when is peak onset? how long does it last?
Delirium tremens
severe alcohol withdrawl
may be life threatening: increase bp, increase HR= stroke/heart attack
have to incubate them
peak onset 48-72 hr
can last weeks
with an alcohol withdraw patient what is the top priority? how do you care for them? w/o tdx what is the % of death? why use benzodiazepine?
Treatment of delirium tremens
administer of benzodiazepine- loraepam (ativan) -diazepam (valum)
35%
hit same GABA receptors as alchol in CNS
what can you do for a patient who is not in withdrawl but wants to stop drinking? what does this drug do?
use disulfiram (antabuse)
discourages relapse, causese violent illness if consumed with alchol
changes in total body water, may increase over 50%
leads to greated hemodilution of plasma proteins and drugs
when plasma proteins diluted fewer are abailabe to bind w/ drugs
higher concentration of "free" drug in the plasma
what does higher concentration of "free" drug in the plasma do?
increases risk of toxicity
how is metabolism affected during pregnancy?
least affected during prego
cyp450 in placenta
likely contriute to drug metabolism
placenta and fetal liver contribute to drug metabolism
incrasing metabolism of certain drugs
how is excretion affectedduring pregnancy?
enhanced during pregnancy
results in increased renal elimination of drugs
dosage of many meds must be adjusted
enhanced excretion during pregnancy increases what?
renal plasma flow
glomerular filtration rate (GFR)
creatine clearance
renal tubular reabsorption
what is important about the placenta?
offers protective filtration of maternal blood
prevents certain harmful substances from reaching fetus
vitamins, fatty acids, glucose and electrolytes freely pass from mother to fetus
do drugs have to cross placenta to cause fetal abnormalities?
no
tell me in each of the categories what would cross placenta the easiest:
plasma drug level in mom
solubility of drug
molecular size
protein binding
drug ionization
plasma drug level in mom: higher dose more drug circulates through placenta
solutility: lipid soluble
molecular size: small
protein binding: unbound
drug ionization: unionized
what is the pregnancy categories used for?
rate medications related to risk to the fetus during pregnancy
what are the 5 risk categories?
A,B,C,D,X
what is risk category A?
adequate, well-controlled studies show no increased risk to fetus
what is risk category B?
animal studies have shown no harm to fetus
what is risk category C?
shows adverse effect on animal fetus but may not show on pregnant women
what is risk category D?
demonstrated risk to fetus. benefits may outweight risk
what is category x?
fetal abnormalities and risk shown! should be absolutely avoided!!!
what category do 2/3 of drugs live in?
category C
what are several problems with categories?
current labeling system gives no specific clinical info on the safety of drug
system does not indicate how drug should be adjusted during prego or lactaion
Dosage recieved by fetus and stage of fetal dvelopment
whats a teratogen?
substance organism/ physical agent to which the embyro/fetus is exposed that produces permanent abnomrality in structure/function, cuases growth retardation or death
what are potential fetal consequences of teratogens?
intruterine fetal death
physical malformation
growth impairment
behavioral abnomralities
neonatal toxicity
is the timing of a drug use important during pregnancy? in regardds to teratogens.
yes the drug therapy and stage of fetal development is critical
specific risk is dependent on time in gestation per.
what is thalidomide? what is used for today?
used in 1950's for morning sickness
caused severe limb defects
recently approved to tx some cancers
what determines the amount of drug that is passed to an infant during lactation?
solubility of drug
molecular size
ionization
drug t 1/2
waht are some commonly used drugs in peds?
NSAID
acetometaphin
benadryll
antibiotic
respriatory meds
tell me about drug absorption for a peds pt?
increased gastric ph
delayed gastric emptying- they keep drug longer and its absorbed into stomach and small amounts in intestine
low blood flow to skeletal muscle- IM avoided because muscle has very little blood flow
Skin of infants thin and highly permeable- lotion/topical drug absorbed very rapidly; never utilize it!
what are the 3 main factors affecting drug distribution in children?
proportion of water: 80% newborn body weight is water. 60% body weight water in 1st year
immature liver function
underdeveloped blood-brain barrier: not fully developed at birth; assess for toxcity of CNS when give meds to peds pt
what metabolic functions are significantly slower in children?
reduced clearance rates
extended half-lives for drugs extensively metabolized by the liver; allows time for metabolism, allow long time between drug dosages
at years 3-5 their metabolism is similar to an adults
true or false? Young children have mature renal systems with slower renal clearance?
false: young children have immature renal systems w/ slower renal clearance
because young kids have immature renal systems w/ slower renal clearance, what problems may this lead to?
drugs primarily excreted by kidneys may accumulate and cause nephrotoxicity
infant able to concentrate urine at about 3-5 months of age
what dovelepmental changes must be considered in giving drugs to peds pt? at what age do you cosnider someone to be a peds pt?
age, weight, and developmental level
peds patients are birth to 16 age and weight less than 50 kg
when giving infants medication what is important to keep in mind?
hold and cuddle while administering meds
meds administered via droppers into ears, eyes, nose, or mouth
oral meds directed into inner cheek
careful w/ IM and IV
what special considerations must be followed when giving an infant a IV or IM med?
vastus lateralis prefered site for IM injections
rotate injection sites from one leg to another to avoid over use
feet and scalp provide good sites for IVs
use smallest needle!
what should you do when giving toddler medication?
short concrete explainations
physical comfort--> verbal praise
mix unpleasnt meds w/ jam/syrup/fruit puree
meds may be followed by soda or mint candy
avoid giving meds with healthy foods so they don't associate the bad experience with the meds with the healthy food
still use scalp and feet for IV sites
where can you give preschoolers IVs and IMs?
ventrogluteal site may be used for IM
don't use dosogluteal site--> potential injury to sciatic nerve
peripheral IV access
how should you give medications to school-aged clients?
more detailed explainations
offer limited choices of dosing alternatives
praise cooperation
may take chewable tabs, swallow tabs or caps
resist injections
ventrogluteal site preferred for IM injections
how should you give medications to adolescents?
conformity w/ peers in terms of behavior, dress, and social interaction is important
strong sense of independence leads teens to self-medicate
keep medications out of sight
parents should be taught s/s of drugs abused by teens: marijuana, inhalants, and methamphetamine
