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Agonist drugs do what to receptors?: stimulate them
Antagonist drugs do what to receptors?: inhibit them
What is the mechanism by which drugs produce chemical and physiological changes in the body?: pharmacodynamics
What is the movement of drugs into the systemic circulation?: pharmacokinetics
What are 4 ways drugs move through the body?: absorption, distribution, metabolism, excretion
What is adsorption?: movement of a drug from the site of administration into the systemic circulation
What is distribution?: the movement of the drug from the systemic circulation into the tissues
What is metabolism?: alteration of drug to more or less active form, usually in the liver
What is excretion?: the elimination of the drug from circulation
The rate and degree of absorption depends on:: a. administration route
b. patients age
c. physical condition
d. lipid or water solubility of the drug
e. any potential drug interaction with other drugs or foods
Distribution of a drug from the systemic circulation may be affected by:: a. blood brain barrier
b. cardiac output
c. body composition
d. blood supply to tissue
e. degree of vessel constriction or dilation
f. degree to which the drug binds to plasma proteins
What determines a drugs dosing schedule?: the drugs pharmacokinetic properties
What is considered when establishing dosing schedules?: a. route of administration
b. onset of action
c. peak concentration level
d. duration of action
e. half life
What is the area of the body where the drugs absorption will take place?: route of administration
What is the time when a drug effects first become noticeable?: onset of action
What is the maximum blood concentration level achieved through absorption at this level most of the drug reaches the site of action and provides the therapeutic response?: peak concentration level
What is the lenght of time a drug acts on the body?: duration of action
What is the time required for a drugs plasma concentration to decrease by 50%?: half life
What are 5 ways that excretion of a drug can occur?: a. by the kidneys via urine
b. by the liver via bile and into feces
c. by the lungs via exhaled air
d. into breastmilk
e. through saliva, tears, sweat
What is pharmacotherapeutics?: the use of drugs to treat a specific disease or produce a desired effect
In pharmacotherapeutics what are the therapeutic steps ? (6): a. assessing the nature and extent of the problem
b. assessing the options
c. selecting the type of therapy
d. implementing the therapy
e. monitoring effectiveness of the therapy
f. reassessing the problem
What are 8 factors that affect the response to a drug?: 1. disease or disorder
2. route of administration
3. patients body size
4. patients weight
5. patients gender
6. past medical history
7. tolerance or dependence
8. psychological and emotional factors
What are the measures of drug efficacy?: vital signs, body weight, easing of symptoms
What is a loading dose?: this refers to administration of one or more doses at the onset of therapy to quickly reach the therapeutic blood level and thereby hasten a therapeutic effect
What is adverse reaction?: refers to the unwanted or potentially harmful effects of a drug
What is dose related reaction?: may be reactions to the drugs primary effect or a secondary effect
What is sensitivity reaction?: occurs when a patient is hypersensitive or allergic to a drug or one of its components
What is toxicity?: reaction when drug levels exceed therapeutic range
What is idiosyncrasy?: reaction that is unexpected or peculiar
What are three types of interactions?: 1. incompatibilities
2. pharmacokinetic interactions
3. pharmacodynamic reactions
What is imcompatibilities?: chemical or physical reaction between two or more drugs
When might incompatibilities occur?: 1. when preparing an IV admixture
2. administering medications in IV bolus or piggyback
3. mixing medications in a syringe
What are sontrolled substances?: drugs that have potential for abuse or physical and psycholoical dependence
What is additive effect?: combining 2 or more drugs to cause an effect equal to the sum of their separate effects
What is synergism effect?: combining 2 or more drugs to cause an effect greater than the sum of their separate effects
What is potentiation effect?: occurs when 1 of 2 or more drugs are combined and one of the drugs exerts an action greater than if it was given alone
What is antagonistic effect?: conbining 2 ot more drugs to produce an effect less than the sum of their separate effects
What does a medication order have to have?: patients full name, date, time, drug name, dosage form, dose amount, route, schedule, prescribers signature
How many times should you check a drug against the drug label?: 3 times
Why are most medications administered via oral route?: safe, convenient, least expensive
What is buccally administered medications?: medications that are placed between the cheek and the teeth
What is sublingually administered medications?: medications that are placed under the tongue
Buccally and sublingually administered drugs bypass the ___________ and are immediatily absorded into the _________________.: digestive tract

systemic circulation
What are 4 methods of parenteral administration?: intravenous, intramuscular, subcutaneous, intradermal
What type of administeration gives immediate action?: IV
What type of administration is given in a muscle?: IM
What type of administration is given in the fatty tissue?: SC
What type of administration is given in dense vascular tissue?: ID
What type of drug is applied directly to the skin and includes lotions, creams, ointments and transdermal patches?: topical
What are ophthalmic drugs used for?: their local effects within the eye
Why would you use an otic drug?: treat local infection or inflammation, soften cerumen, provide local anesthesia
When appling ear drops to an adult you pull? to a child you pull?: ADULT CHILD
P O
W
N
How is a topical medication delivered into the respiratory tract for local and systemic effects?: inhaled medications
What absords the inhaled medications?: muscosal lining of the lungs
What two ways can drugs be administered into the respiratory tract?: inhaler, nebulizer
What route of administration would you use if other routes were not available?: rectal
Drugs that are given rectally are absorded where?: large intestine
What can cause an increased absorption of topical drugs in children?: thin epidermis
What may delay metabolism in infants?: immaturity of the liver
What may delay excretion in infants?: immaturity of the kidneys
Cholinergic agonists directly stimulate what?: cholinergic receptors
Cholinergic agonists mimis what action?: the action of acetylcholine
Where is cholinergic agonists metabolized?: in the plasma and the liver
What metabolizes cholinergi agonists?: cholinesterases at teh muscarinic and nicotinic receptor sites
How is cholinergic agonists excreted?: urine
What is the pharmacokinetics of cholinergic agonists?: ABSORPTION: varies widely
DISTRIBUTION: widely distributed, binding primarily to muscarinic receptors
METABOLISM: by cholinesterases at the muscarinic and nicotinic receptor sites, in the plasma and the liver
EXCRETION: urine
Why is cholinergic agonists rarely given IM or IV?: because they are subject to immediate breakdown by cholinesterases
How is cholinergic agonists usually given?: orally or SUB-Q
What are 4 reasons you would give a cholinergic agonists?: *glaucoma
*bladder/intestinal function
stimulation
*nonobstruction urine
retention
*neurogenic bladder
When would you not use a cholinergic agonists?: *prostate enlargement
*possible urine/GI
obstruction
*hypertension
*bradycardia/atrioventricular
conduction defect
*asthma
*pregnancy
What are some side effects of cholinergic agonists?: *hypotension
*headache
*flushing
*sweating
*increased salvia
*abdominal cramps
*nausea/vomiting
*diarrhea
*blurred vision
*bronchial constriction
When administering bethanechol chloride which is a cholinergic agonist drug you would base your evaluation on what?: increased bladder tone and function
When given bethanechol chloride which is a cholinergic agonist drug you would assess the patients what?: urinart status
Cholingeric agonist drug: If toxicity occurs while giving bethanechol chloride what is the antidote?: atropine
What are the key nursing responibilites when giving bethanechol chloride which is a cholinergic agonist drug?: *evaluate
*assess
*observe patient for 20-60
minutes after given SUB Q
*monitor for s/s of toxicity
CHOLINERGIC What 2 drugs are used to diagnosis myasthenia gravis?: edrophonium and neostigmine
CHOLINERGIC What drug is used to promote muscle contractions and are used to treat myasthenia gravis?: neostigmine

ambenonium/pyridostigmine
CHOLINERGIC What drug is used to prevent or treat postoperative ileus/distention and treat nonobstructive urine retention?: neostigmine
CHOLINERGIC What drugs are used to reverse the effects of nondepolarizing neuromuscular blockers?: edrophonium and neostigmine
CHOLINERGIC How would the drugs edrophonium and neostigmine be excreted?: excreted in urine
CHOLINERGIC What are edrophonium and neostigmine metabolized by?: plasma esterases
CHOLINERGIC When would you not use neostigmine and edrophonium?: possible urinary or GI odstruction
CHOLINERGIC What are the nursing actions when giving neostigmine and edrophonium?: *assess neuromuscular status before and after therapy
*monitor for drug toxitiy
*monitor vital signs
*monitor breath sounds every 4 hours
*take seizure precautions
Anticholinergics block the action of what?: acetylcholine at muscarinic receptors in the parasympathetic nervous system
What are some cholinergic drugs?: *neostigmine (prostigim)
*edrophonium (tensilon)
*urecholine (bethanechol)
What are some anticholinergic drugs?: *atropine
*cogentin (benztropine)
*pro-banthine (propantheline)
What is the pharmacokinetics for anticholinergic drugs?: ABSORPTION: in GI tract, mucous membranes, skin, and eyes
DISTRIBUTION: does not cross blood brain barrier
METABOLISM: hydrolyzed in the GI tract and liver
EXCRETED: in the feces and urine
why are anticholinergics used?: *to reduce saliva
*to reduce gastric secretions
*to reverse a heart block
*to induce mydriasis
*to treat parkinsons disease
*to treat GI spasms
*to treat motion sickness
*to treat enuresis
What are anticholinergics?: parasympatholytics: cholinergic blocker
What drugs are used to treat bradyarrhythmias, arrhythmias, and sinus arrest?: atropine which is a anticholinergic drug
What drug is used to treat dyskinesia, extrapyramidal reactions, and parkinsonism?: benztropine which is an anticholinergic drug
What drug is used to treat peptic ulcer and bowel spasms?: propantheline which is an anticholinergic drug
What drug is used to induce mydriasis?: atropine which is an anticholinergic drug
What drug is used to decrease saliva and bronchial secretions before surgery?: atropine which is an anticholinergic drug
What are the ophthalmic side effects when using topical application of atropine which is an anticholinergic drug?: blurred vision, conjunctivitis, and photophobia
What are the the systemic adverse effects of atropine which is an anticholinergic drug?: tachcardia, constipation, dry mouth, urinary hesitancy or urine retention
What decreases absorption of parasympatholytic drugs?: antacids
What are the nursing responsibilities when giving anticholinergic drugs?: *assess relief of symptoms
*monitor for side effects
*educate patient
*monitor patients intake and output
*watch for s/s of urine retention
When should you give an anticholinergic drug when giving to reduce GI motility?: 30 minutes before meals and at bedtime
When giving anticholinergic drugs educate the patient to reduce dry mouth by?: using ice chips, hard candy, or gum
When giving anticholinergic drugs educate the patient to reduce constipation by?: exercising and increasing fiber/fluid intake
What is classification?: a family or group of drugs that are used to treat a clinical condition or a group of drugs that affect a body system
Classification of drugs are often sub classed based on what?: the site of action
What is phototype?: a drug in each classification that is typical of how the class of drugs work. this is usually the most commonly used drug or drug that fits the class action/use.
What is primary use?: the clinical indication of the drug. some drugs will have more than one use
Perioperative includes 3 phases:: 1. preoperative
2. intraoperative
3. postoperative
five purposes of surgery: 1.diagnostic
2.curative
3.restorative
4.palliative
5.cosmetic
If a patient is having diagnostic surgery what is this: to determine origin and cause of disorder or cancer
if a patient is having curative surgery what is this: to resolve a problem
if a patient is having restorative surgery what is this: to improve clients sunctional ability
if a patient is having palliative surgery what is this: to releive symptoms
if a patient is having cosmetic surgery what is this: to alter or enhance personal appearance
five surgical categories: 1. elective
2. urgent
3. emergent
4. required
5. optional
what is elective surgery: failure to have surgery not catastrophic planned for correction of a non acute problem
what is urgent surgery: requires prompt intervention can be life threatening is no interventions in 24-48 hours
what is emergent surgery: requires immediate intervention because of life threatening consequences
what is required surgery: requires surgery within few weeks or months
what is optional surgery: personal perference
what is an example of an elective surgery: repair of a scar
simple hernia
what is an example of aurgent surgery: acute cholecystits
kidney stones
what is an example of emergent surgery: severe bleeding
bladder or intestinal obstruction
fractured skull
gunshot or stab wound
extensive burns
what is an example of a required surgery: cataracts
what is an example of optional surgery: cosmetic surgery
what is the degree of risk with minor surgery: without significant risk
local anesthetic
what is the degree of risk with major surgery: greater risk
long and intense
when does preoperative phase begin: with the decision for surgical intervention
when does preoperative phase end: wtih the transfer to operating room
what are some responsiblities of the nurse in preoperative phase: preadmission testing
admission to unit
holding area
preop assessment
surgical history
informed consent
the responsibility to provide appropriate information for consent belongs to who: physician
type and cross match is good for how long: 72 hours
where is the signed consent form placed: on the patients chart and accompanies the patient to the operating room
what is appropirate covering for an elderly patient who is being transfered to and from the operating room: a light weight cotton blanket
a nutritional deficit needs to be corrected before surgery why: so that enough protein is available to promote healing
a mild fluid volume deficit can be corrected when: during surgery
chronic alcoholics suffer from: malnourishment
systemic problems
increase surgical risk
tobacco use increases the risk of surgery how: increase risk of pulmonary complications
substance abuse can alter the response to: anesthia and pain medication
while taking a medical history the nurse is told the patient has diabetes what might be needed: more extensive bowel prep
while taking a medical history the nurse is told that the patient has lupus (SLE) what might be needed: drugs to off set the stress of surgery
while taking a medical history the nurse is told that a patient has an infection what might be needed: the infection might need to be treated before surgery
in the cardiovascular status the goal is to have a functioning CV system that will meet what needs during the peroperative phase: oxygen
fliud
nutritional
a patient with CV diseases may experience what: 1. impaired ability to withstand homodynamic changes
2. alter response to anesthesia
3. increase risk in surgery
a patient with CV requires greater than normal nursing attention during which phase: all phases
patients who smoke are urged to stop 2 months before surgery but most will not however they must stop how long before: 24 hours
what are some adverse effects associated with smoking: 1. increased airway reactivity
2. decreases mucociliary
3. physiologic changes inthe cardiovascular and immune systems
the goal in respiratory status is: optimal respiratory function
why is optimal function of the liver and urinary systems a goal: so anesthetics, medications, waste, and toxins can be processed and removed from body
the goal in endocrine function is what: to maintain blood glucose less than 200mg/dl
a patient with blood glucose problems is at risk for: hypo or hyperglycemia
a patient who is hypoglycemia is at risk postoperative from: inadequate CHO
excessive insulin
if a patient is hyperglycemia they are at risk for: wound infection that may be from stress of the surgery
the use of corticosteroid use must be reported to the anesthesiologist and the surgeon why: increased risk of infection
steroids increase blood sugar
if the patient is immunosuppresion then you must look for what postoperative: any symptoms FEVER 100.5
what disorders place a patient in the immunosuppresion category: corticosteriod therapy
renal transplant
radiation
chemotherapy
AIDS
if a patient is allergic to shellfish they will also be allergic to: iodine
if a patient is allergic to bananas they will also be allergic to: latex
if a patient is receiving surgery to the neck, oral, or facial area then the nurse will look for what sings of complications after surgery: airway complications
if a patient is receiving surgery to the chest or high abdominal area the nurse will look for what complications after surgery: pulmonary complications
if the patient is receiving surgery inthe abdominal area the nurse will look for what complications after surgery: paralytic ileus
DVT
preoperative testing is usually done when: 24 hours to 28 days before surgery
when is teaching ideal: during the laboratory assessment
the preoperative education is taught to whom: patient
spouse
parents
guardians
what will children fear the most in the operation room: the mask
when patient is in the doctors office the teaching needs to be started what might be taught at this time: date and time of procedure
NPO status
medications to take or not to take
how does the nurse find out who to teach: ask the patient
when does the intraoperative phase begin: with transfer to the operating room table
when does the intraoperative phase end: with transfer to postanesthia care
what are some responsibilties fo the nurse during intraoperative phase: safety maintenance
physiologic monitoring
psychological support
who marks the site where the incision is to be: patient
when do you verify the patients name and purpose of surgery: on floor
during holding
in surgery room before doctor starts
when would you transfer patient to holding area: 30-60 minutes before surgery
the surgical team consists of who: surgeon
anesthia provider
nurses and surgical techs
patient
what is the role of the holding room nurse: manage care
reviews medical record
checklist and consent
assess patients physical and emotional condition
answer questions
document on preioperative record
what is the role of the circulating nurse: manages the OR
monitors traffic in OR
ensures sterile asepsis
communicates with surgeon
communicates with family
documents
what is the role of the scrub nurse or surgical tech: set up sterile feild
scrub surgical site
prepare equipment
counts needles, sponges, instruments
labels all specimens and give to circulator to send to lab
may not be a nurse just specially trained
when is family called while patient is in surgery: before the surgery starts
every 45 minuted to 1 hour after surgery starts
then after surgery starts
who monitors vital signs during surgery: anesthesiologist
why are surgical nurses hands cultured regularly: for nosocomial infections
what is the foundation for preventing surgical site infections: surgical asepsis
the surgical scrub is done for how many mintues: 3-5 minutes
in what direction should the water run in a surgical scrub: straight off not up or down
when is the surgical scrub done: after masking
befoer sterile gown and gloves
after the sterile srcub is done what are the steps in entering the OR: enter with hands higher than elbow
dry from tips to elbow
the surgical gown is sterile where: 2 inches down from neck to wasit area
from elbow to wrist area
what are the three sedation levels: minimal
moderate
deep sedation
what is minimal sedation level: drug induced state
patient can respond normally
ventilation not affected
cardiovascular not affected
cognitive function impaired
coordination impaired
what is moderate sedation level: intravenously
depressed level of consciouness
does not impair airway
can respond
what is the goal for moderate sedation: calm
tranquil
amnesic
what is deep sedation: can not be easily aroused but can respond purposely after repeated stimulation
what is the difference between sedation and anesthesia: anesthesized patients can not be aroused
during anesthesia the patient loses the ability to maintain: ventilatory function
general anesthesia is used for what types of surgery: head, neck, upper torso and abdomen
analgesia is used for: pain relief or suppression
amnesia is used for: memory loss of surgery
unconsciousness is used for: loss of muscle tone and reflexes
what is the 1 stage of general anesthesia: analgesia, sedation, relaxation stage
when does stage 1 of general anesthesia begin: with introduction of medication
when does stage 1 of general anesthesia end: with loss of consciousness
hearing during stage 1 of general anesthesia is: exaggerated
what is the nursing care of a patient in stage 1 of general anesthesia: close doors
sim lights
control traffic
secure patient
talking to minimum
what is stage 2 of general anesthesia: excitement
delirium
when does stage 2 of general anesthesia start: with loss of conciousness
when does stage 2 of general anesthesia end: with relaxation, regular breathing, loss of eyelid reflex
during stage 2 of general anesthesia a patient may have: irregular breathing
increased muscle tone
involuntary movements
during stage 2 of general anesthesia a patient is susceptible to what type of stimuli: external
what is the nursing care for stage 2 of general anesthesia: avoid auditory stimuli
avoid physical stimuli
protect extremities
assist with suction
asist with restraining
stay with client
what is stage 3 of general anesthesia: operative or surgical anesthesia
when does stage 3 of general anesthesia start: with generalized muscle relaxation
when does stage 3 of general anesthesia end: with loss fo reflexes and depression of vital functions
what type of hearing and sensation is the patient experiencing at stage 3 of general anesthesia: none
what are the nursing responisibilities suring stage 3 of general anesthesia: assist with intubations
place patient in position
prep site
during anesthesia the most reliable guide of patients condition somes from: responses of pupils
repiratory status
blood pressure
cardiac status
what are 2 methods of administration of general anesthesia: inhalation
intravenous
what is conscious sedation: IV deliveried medication to reduce the level of conciuosness but allow the patient to maintain a patent airway and to respond to verbal commands
during conscious sedation what areas are monitored: airway
oxygen saturation
V/S q 15 to 30 minutes
level of consciuosness
ECG status
what are some common types of skin closures: sutures
staples
glue
when does the postoperative phase begin: with admission to PACU recovery
when does the postoperative phase end: with follow up evaluation in clinical setting or home
what are some of the nurses responsibilities during the postoperative phase: assessment
maintain patent airway
monitor hemorrhage
monitor hypotension and shock
documentation
when is patient discharged from PACU: fully recovered
stable vital signs
oriented to person, place and time
uncompromised pulmonary function
stable oxygen saturation
UOP at least 30ml/hr
N/V under control
minimal pain
what nurse gets the supplies needed for patient going to floor: floor nurse
who should be taught how to use and when to use PCA pump: patient, family should not push for patient
what are some pain releif measures: positioning
distractions
back rub
cool towel for N/V
what is a general rule for outpatient surgery when can a patient be discharged: eat
drink
not throw up
pee
what is the typical diet pattern for a patient who has had surgery: NPO
clear
full
soft
regular
what is the normal range for fliud output: 30cc an hour if less call doctor
what is a normal pattern of bowel function for a patient that has had surgery: bowel sounds
passing flatus
bowel movement
(patient will not come back from surgery with bowel sounds)

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