PHARMA MIDTERMS:

 NURSING PROCESS-The problem-

(CHAPTER 4)
NURSING PROCESS:
1. ASSESSMENT- Information
gathering regarding the current
status of a particular patient,
including evaluation of past
history and physical examination.
Provides a baseline of information
and clues to effectiveness of
theraphy.
2. EVALUATION- Part of the nursing
process, determining the effects of
the interventions that were
instituted for the patient and
leading to further assessment and
intervention.
solving process used to provide
efficient nursing care, it involves
gathering information,
formulating a nursing diagnosis
statement, prioritizing the
diagnoses, developing goals and
desired outcomes for the patient,
carrying out interventions, and
evaluating the process.
 NURSING; ART AND SCIENCE –
nursing is a unique and complex
science, as well as nurturing and
caring art.
 NURSING PROCESS;
ASSESSMENT
(PAST HISTORY AND
PHYSICAL EXAMINATION)

3. IMPLEMENTATION- Actions
undertaken to meet a patient’s
needs, such as administration of
drugs, comfort measures, or NURSING DIAGNOSIS
patient teaching.

4. NURSING DIAGNOSIS- Statement

of an actual or potential problem,
based on the assessment of a PLANNING
particular clinical situation, which
directs needed nursing
interventions.
IMPLEMENTATION
5. PLANNING- The process of (INDEPENDENT, DEPENDENT,
prioritizing the information INTERDEPENDENT)
gathered in assessment and using
the established nursing diagnosis,
to develop goals and desired
outcomes for the patient. EVALUATION

 NURSING- The art of nurturing

and administering to the sick,
combined with the scientific
application of chemistry, anatomy,
physiology, biology, nutrition,
psychology, and pharmacology to
the particular clinical situation.
 Nurses use the nursing process to
provide a framework for
organizing the information that is
needed to provide safe and
effective patient care.
 The nursing process are
constantly being repeated to meet
the ever changing needs of the
patient.
 The nursing process provides an
effective method for handling all
of the scientific and technical
information as well as the unique
emotional, social, and physical
factors that each patients brings
to a given situation.
 The patient history is important
element of assessment related to drug
theraphy because his/her past
experiences and illnesses can
influence a drug’s effect. Knowledge
of this important information before
beginning drug theraphy will help to
promote safe and effective use of the
drug and prevent adverse
effects,clinically important drug-
drug,drug-food, or drug alternative
theraphy interactions, and
medications errors.
 Chronic conditions can affect the
pharmacokinetics and
pharmacodynamics of a drug. For
example, the patient has certain
conditions such as heart disease and it
may be contraindications to the use of
a drug.
 A patients history of allergies can
affect drug therapy.
 Level of education and
understanding of the patients.
 Social supports involves referral to
appropriate community resources.
 Financial supports for example the
drug may be too expensive so the
nurse will advice the less expensive
drug. And the nurse may offer to the
patient appropriate resources for
financial assistance.
 Pattern of healthcare Knowing how
a patient seeks healthcare provides
the nurse with valuable information to
include when preparing the patient’s
teaching plan. Example; Does this
patient routinely seek follow up check
up? Or does she/he wait for
emergency situations and etc….
 It is important to assess the patient’s
physical status/Physical
Examination before beginning drug
therapy to determine if any conditions
exist that would be contraindications
or cautions for using the drug and to
develop a baseline for evaluating the
effectiveness of the drug and the
occurrence of any adverse effects.
 A patient’s weight will helps to
determine whether the recommended
drug dose is appropriate because the
recommended dose typically is based
on 150lb adult man, patient’s who are
much lighter or much heavier often
need a dose adjustment.
 Age patients at the extremes of the
age spectrum children and older
adults often require dose adjustments
based on the functional level of the
liver and kidneys and the
responsiveness of other organs.

 Physical Parameters Related to
Disease or Drug Effects for
example; if a patient is being treated
for chronic pulmonary disease, his/her
respiratory status and reserve need to
be assessed especially if a drug is
being given that is known to affect the
respiratory tract.
 Proper Drug Administration the
nurse must consider 8 points or 8
rights to ensure safe and effective
drug administration.
- Right drug and patient, right
storage of drug, right and most
effective route, right dose, right
preparation, right timing, and
right recording of administration.
 Comfort Measures nurses are in a
unique position to help the patient
cope with the effects of drug therapy.
A patient is more likely to be
compliant with a drug regimen if the
effects of the regimen are not too
uncomfortable.
 Placebo effect The anticipation that
a drug will be helpful (placebo effect)
has proven to have tremendous
impact on the actual success of drug
theraphy. Therefore the nurse’s
attitude and support can be a critical
part of drug theraphy. For example;
back rub, kind word, positive
approach may be helpful.
 Managing Adverse Effects
Interventions can be directed at
promoting patient safety and
decreasing the impact of the
anticipated adverse effects of drug.
Such interventions include
environmental control (temperature,
light) safety measures (Avoiding
driving, Avoiding the sun, Using side
rails) and physical comfort measures
(skin care, laxatives, frequent meals)
 Lifestyle Adjustment Some
medications and their effects require
that a patient make changes in
his/her lifestyles. Example; patients
who take diuretics may have to
rearrange their day so as to be near
toilet facilities when the drug action
peaks.
 Patient and Family Education with
patients becoming increasingly
responsible for their own care, it is
essential that they have all of the
information necessary to ensure safe
and effective drug theraphy at home.
 Drug Education Program
1. Name, dose, and action of drug:
Ensure that patients know this
information.
2. Timing of administration. (when to
take the drug with respect to
frequency, other drugs, and meals)
3. Special storage and preparation
instructions. (inform patients the
special storing of the drug. Some
drugs may require refrigeration)
4. Specific OTC drugs or alternative
therapies to avoid.
5. Special comfort measures. ( teach
patients how to cope with
anticipated adverse effects to ease
anxiety)
6. Safety measures. ( instruct the
patients to keep drugs out of reach
of children)
7. Specific points about drug toxicity.
(give patients a list of warning
signs of drug toxicity)
8. Specific warnings about drug
discontinuation.
 Medication Errors with the increase
in the older adult patient population,
 the increase in the number of
available drugs and OTC and
alternative therapy preparations, and
the reduced length of hospital stays
for patients, the risk for medication
errors is ever increasing.
 Nurse’s Role the monumental task of
ensuring medication safety with all of
the potential problems that could
confront the patient can best be
managed by consistently using the
“RIGHTS” of medication
administration.
1. Right patient Make sure that you
are giving the drug to the correct
patient.
2. Right drug To prevent medication
this is to reduce the risk of medication
errors, always check to make sure
errors in the home setting:
the drug you are going to
administer is the one that was
prescribed.
3. Right storage Be aware that
some drugs require specific
storage environments. Example;
Ref, protection from light.
4. Right route Determine the best
route of administration;
5. Right dose always double check
calculations and always do the
calculations if the drug is no
available in the dose ordered.
6. Right preparation know the
specific preparations required
before administering any drug.
Example; Oral drugs may need to
be crushed or shaken.
7. Right time When drugs are
studied and evaluated, a
suggested timing of administration
is established. This timing takes
into account all aspects of
pharmacokinetics to determine a
dosing schedule that will provide
the needed therapeutic level of the
drug.
8. Right recording always document
drug administration. If it isn’t
written, it didn’t happen.
 The patient’s role only patient really
knows what is being taken and when,
and only the patient can report the
actual as opposed to the prescribed
drug regimen being followed. Patient
and family education plays a vital role
in the prevention of medication errors.
1. Keep a written or electronic list of
all medications you are taking
including prescription, otc, and
herbal nedications.
2. Know what each of your drugs is
being used to treat.
3. Read the labels and follow the
directions.
4. Store drug in a dry place, away
from children and pets.
5. Speak up.
(CHAPTER 6)

 ALTERNATIVE THERAPHY-
includes herbs and other “natural”
products as often found in ancient
records: these products are not
controlled or tested by the FDA
and are considered to be dietary
supplements; however they are
often the basis for discovery of an
active ingredient has it later
developed into a regulated
medication.
- Herbal therapies can produce
unexpected effects and toxic
reactions, can interact with
prescription drugs and can contain
various unknown ingredients that
alter their effectiveness and
toxicity.
 BIOLOGICAL WEAPONS- so called
germ warfare; use of bacteria,
viruses, and parasites on a large
scale to incapacitate or destroy a
population.
 COST COMPARISON- comparison
of the relative cost of the same
drug provided by different
manufacturers to determine the
costs to the consumer.
 INTERNET- the worldwide digital
information system accessed
through computer systems.
 OFF-LABEL USES- uses of a drug
that are not part of the stated
therapeutic indications for which
the drug was approved by the
FDA; off label uses may lead to a
new indications for a drug.
 SELF-CARE – patients self-
diagnosing and determining their
own treatment needs.
 STREET DRUGS- nonprescription
drugs with no known therapeutic
use; used to enhance mood or
increase pleasure. EX; ALCOHOL,
NICOTINE ETC….
 CONSUMER AWARENESS – access
to information has become so
broad over the last decade that
consumers are often overwhelmed
with details, facts, and choices
that affect their healthcare.
 MEDIA INFLUENCE- the last 25
years have seen an expolsion of
drug advertising in the mass
media. It became legal to
advertise prescription drugs
directly to the public in the 1990’s,
and it is now rare to watch
televisions, listen to the radio, or
flip through a magazine without
encountering numerous drug
advertisements. The goal behind
the wide advertising of
prescription drugs was to open a
good discussion between the
patient and the healthcare
provider to improve patient-
centered care.
 OTC DRUGS – it allow people to
take care of simple medical
problems without seeking advice
from their healthcare providers.
- “Grandfathered in”
- Have been deemed safe when use
as directed and do not require a
prescription or advice from a
healthcare provider.
- Can mask the signs and symptoms
of disease.
- Otc drugs need to avoid while
taking prescribe drugs.
 PATIENTS WHO TAKE
ANTIBIOTICS MUST BE REMINDED
TO TAKE FULL COURSE AND NOT
 TO STOP THE DRUG WHEN THEY
FEEL BETTER.
 DRUGS CAN BE ADVERTISED IN
THE MASS MEDIA ONLY IF ;
ADVERSE EFFECTS AND
PRECAUTIONS ARE STATED IF THE
USE IS STATED.
 HERBAL TREATMENTS AND
ALTERNATIVE THERAPIES; ARE
CONSIDERED DIETARY
SUPPLEMENTS AND NOT
REGULATED BY THE FDA.
 THE HOME HEALTHCARE
INDUSTRY IS BOOMING BECAUSE;
PATIENTS ARE GOING HOME
SOONER AND BECOMING
RESPONSIBLE FOR THEIR OWN
CARE SOONER THAN IN PAST.
SIGNS AND SYMPTOMS. MANY OF
THESE PRODUCTS INTERACT WITH
TRADITIONAL PRESCRIPTION
DRUGS.
 A NURSE IS CARING FOR PATIENT
WHO HAS BEEN DIAGNOSED WITH
TYPE 2 DIABETES. THE PATIENT
HAS REPORTED THAT HE OR SHE
FREQUENTLY USES HERBAL
REMEDIES. BEFORE
ADMINISTERING ANY
ANTIDIABETIC MEDICATIONS,
THE NURSE SHOULD CAUTION THE
PATIENT ABOUT THE USE OF
WHICH OF THE FF HERBAL
THERAPIES? ; GINSENG, JUNIPER
BERRIES, AND GARLIC.

 THE COST OF DRUG THERAPY IS A

MAJOR CONSIDERATION IN MOST
AREAS BECAUSE; THE HIGH COST
OF DRUGS COMBINED WITH MORE
FIXED-INCOME CONSUMERS PUTS
CONTRAINTS ON DRUG USE.

 AN OFF-LABEL USE OF A DRUG

MEANS THAT THE DRUG ; IS
BEING USED FOR AN INDICATION
NOT LISTED IN THE APPROVED
INDICATIONS NOTED BY THE FDA.

 WHEN TAKING A HEALTH

HISTORY, THE NURSE SHOULD
INCLUDE SPECIFIC QUESTIONS
ABOUT THE USE OF OTC DRUGS
AND ALTERNATIVE THERAPIES.
THIS IS AN IMPORTANT ASPECT
OF THE HEALTH HISTORY
BECAUSE ; PATIENTS OFTEN DO
NOT CONSIDER THEM TO BE
DRUGS AND DO NOT REPORT
THEIR USE. THESE PRODUCTS CAN
(CHAPTER 7)
MASK OR ALTER PRESENTING
 CELL CYCLE- life cycle of a cell,
which includes the phases
GO,G1,S,G2 and M. during M
phase, the cell divides into two
identical daughter cells.
 CELL MEMBRANE- Lipoprotein
structure that separates the
interior of a cell from the external
environment; regulates what can
enter and leave a cell.
 CYTOPLASM- lies within the cell
membrane; contains organelles
for producing proteins, energy,
and so on.
 DIFFUSION- movement of solutes
from an area of high concentration
to an area of low concentration
across a concentration gradient.
 ENDOCYTOSIS- the process of
engulfing substances and moving
them into a cell by extending the
cell membrane around the
substance.
 ENDOPLASMIC RETICULUM- Fine
network of interconnected
channels known as “cisternae”
found in the cytoplasm. It is site
of chemical reactions within the
cell.
 GENES- sequences of DNA that
control basic cell functions and
allow for cell division.
 GOLGI APPARATUS- a series of
flattened sacs in the cytoplasm
that prepare hormones or other
substances for secretion and may
produce lysosomes and store
other synthesized proteins.
 HISTOCOMPATIBILITY ANTIGENS-
Proteins found on the surface of
the cell membrane,they are
determined by the genetic code
and provide cellular identity as a
self-cell. (cell belonging to that
individual)
 LIPOPROTEIN- structure
composed of proteins and lipids,
the bipolar arrangement of the
lipids monitors substances passing
in and out of the cell.
 LYSOSOMES- encapsulated
digestive enzymes found within a
cell; they digest old or damaged
areas of the cell and are
responsible for destroying the cell
when the membrane ruptures and
the cell dies.
 MITOCHONDRIA- rod-shaped
organelles that produce energy
within the cell in the form of
adenosine triphosphate. (ATP)
 MITOSIS- cell division resulting in
two identical daughter cells.
 NUCLEUS- the part of a cell that
contains the DNA and genetic
material, regulates cellular protein
production and cellular properties.
 ORGANELLES- distinct structures
found within the cell cytoplasm.
 OSMOSIS- movement of water
from an area of low solute
concentration to an area of high
solute concentration.
 RIBOSOMES- membranous
structures that are the sites of
protein production within a cell.
 CHEMOTHERAPEUTIC DRUGS- are
used to destroy both organisms
that invade the body. (ex;
bacteria, viruses, parasites,
protozoa, fungi) and abnormal
cells within the body.
 CELL- the basic structural unit of
the body. The cells that make up
living organisms, which are
arranged into tissues and organs,
all have the same basic structure.
 NUCLEOLUS- a small spherical
mass within the nucleus.
 RECEPTOR SITES – embedded in
the cell membrane are a series of
peripheral proteins with several
functions. Type of protein located
on the cell membrane. This protein
reacts with specific chemicals
outside the cell
 IDENTIFYING MARKERS- other
surface proteins are surface
antigens or genetically determined
identifying markers. These
proteins are called
histocompatibility antigens or
human leukocyte antigens, which
the body uses to identify a cell as
a self-cell
 CHANNELS- or pores within the
cell membrane are made by
proteins in the cell wall that allow
the passage of small substances in
or out the cell.
 CELL PROPERTIES- cells have
certain properties that allow them
to survive.
- ENDOCYTOSIS- the process
of engulfing substances and
moving them into a cell by
extending the cell
membrane around the
substane.
- PINOCYTOSIS- engulfing of
specific substances that
have reacted with a receptor
sites on the cell membrane.
 This process allows cells
to absorb nutrients,
enzymes, and other
materials.
 WATERRRR ///
FLUIDS/// LIQUID
- PHAGOCYTOSIS- a similar
process; it allows the cell,
usually a neutrophil or
macrophage, to engulf a
bacterium or a foreign
protein and destroy it within
the cell by secreting
digestive enzymes into the
area.
 Eliminating particles
larger than 0.5 diameter.
- EXOCYTOSIS- removal of
substances from a cell by
pushing them through the
cell membrane.
 HOMEOSTASIS – the main goal of
the cell is to maintain
homeostasis, which means
keeping the cytoplasm stable
within the cell membrane.
 PASSIVE TRANSPORT- it happens
without expenditure of energy and
can occur across any
semipermeable membrane. It has
3 types of passive transport.
Diffusion, osmosis, and facilitated
diffusion.
 DIFFUSION- is the movement of
substance from a region of higher
concentration to a region of lower
concentration.
 OSMOSIS- a special form of
diffusion, is the movement of
 water across a semipermeable
membrane from an area that is
low in dissolved solutes to one
that is high in dissolve solutes.
 If a red blood cell placed
in HYPERTONIC
SOLUTION it will shrink
and shrivel up as water
moves out of the cell.
 If red blood cell placed in
ISOTONIC SOLUTION it
will become stable and
will retain its shape.
 If a red blood cell placed
in hypotonic solution it
will swell and burst as
water moves into the cell.
 FACILITATED DIFFUSION-
sometimes the substance cannot
move freely on it’s own in or out
of a cell. Does not require energy,
just the presence of carrier.
 ACTIVE TRANSPORT- requires
energy.
 G2 PHASE- after the DNA has
doubled in preparation for
replication, the G2 phase begins.
Another gathering phase. The cell
produces all of the substances
required for the manufacture of
the mitotic spindles.
 M PHASE- after the cell has
produced all of the substances
necessary for formation of a new
cell, or daughter cell, it undergoes
cell division or mitosis.
(CHAPTER 8)
 BACTERICIDAL – substance that
causes the death of bacteria.
Usually by interfering with a cell
membrane stability or with
proteins or enzymes necessary to
maintain the cellular integrity of
the bacteria.

 BACTERIOSTATIC- substance that

prevents the replication of
 G0 PHASE- resting phase, the cell
bacteria, usually by interfering
is stable. It is not making any
with proteins or enzyme systems
proteins associated with the cell
necessary for reproduction of the
division and is basically dormant
bacteria.
as far as reproduction goes.

 G1 PHASE- when a cell stimulated

 CULTURE- sample of the bacteria
to emerge from its resting phase,
to be grown in a laboratory to
it enters what is called the G1
determine the species of bacteria
phase or gathering phase. Which
that causes an infection.
lasts from the time of stimulation
from the resting phase until the
 PROPHYLAXIS- treatment to
formation of DNA. During this
prevent an infection before it
period, the cell synthesizes
occurs, as the use of antibioticsto
substances needed for DNA
prevent bacterial endocarditid in
formation.
high-risk patients.

 S PHASE – or synthesis phase,

 RESISTANCE- ability of pathogens
involves the actual synthesis of
over time to adapt to an
DNA, which is an energy-
antiinfective to produce cells that
consuming activity.
 are no longer affected by a
particular drug.
 SELECTIVE TOXICITY- the ability
to affect certain proteins or
enzyme systems that are used by
the infecting organism but not by
human cells.
 SENSITIVITY TESTING –
evaluation of pathogens obtained
in a culture to determine the
antiinfectives to which the
organisms are sensitive and which
agent would be appropriate for
treatment of particular infection.
 SPECTRUM- range of bacteria
which an antibiotics is effective.
 SUPERINFECTION- infections that
occur when opportunistic
pathogens that were kept in check
by the “normal’ bacteria have the
opportunity to invade tissues and
cause infections because the
normal flora bacteria have been
destroyed by antibiotic theraphy.
 DRUG LIST FOR ANTIBACTERIA;
BACITRACIN, GENTAMICIN,
MEROPENEM, POLYMYXIN B,
VANCOMYCIN
 ANTIINFECTIVE AGENTS- are
drugs designed to target foreign
organisms that have invaded and
infected the body of a human host.
 CHILDREN – use
antiinfectives with
caution; early exposure
can lead to early
sensitivity.
 ADULTS- often demand
antiinfectives for a “quick
cure” of various sign and
symptoms.
 OLDER ADULTS- often do
not present with the
same signs and
symptoms of infection
that are seen in younger
people.
 THERAPEUTIC ACTIONS-
antiinfective agents may act on
the cells of invading organisms in
several different ways. The goal is
interference with the normal
function of the invading organism
to prevent it from reproducing and
to cause cell death without
affecting host cells.
 HUMAN IMMUNE RESPONSE- the
goal of antiinfective theraphy is
reduction of the population of the
invading organism to a point at
which the human immune
response can take care of the
infection.
 VANCOMYCIN DRUG FOR
ALLERGIC TO PENICILLIN.
 ACQUIRING RESISTANCE –
microorganisms develop
resistance in a number of ways,
including the; producing enzyme,
changing cellular permeability,
altering binding sites on
membranes or ribosomes,
producing chemical that acts as an
antagonist to the drug.
 PREVENTING RESISTANCE-
because the emergence of
resistant strains of microbes is a
serious public health problem that
continues to grow, healthcare
providers must work together to
prevent the emergence of
resistant pathogens.
 IDENTIFICATION OF THE bound for transfer
PATHOGEN- is done by culturing a through cardiovascular
tissue sample from the infected system.
area.  SUPERINFECTIONS.

 SENSITIVITY TESTING - on the  NARROW SPECTRUM

cultured microbes to evaluate and ANTIBIOTICS – target a few types
determine which drugs are of bacteria.
capable of controlling the  BROAD SPECTRUM ANTIBIOTICS-
particular microorganism. target many types of bacteria.

 COMBINATION THERAPHY- a
combination of a two or more
types of drugs effectively treats
the infection.

 PROPHYLAXIS- to prevent
infections before they occur.
(mainom na ning bulong para dai
na mag kaigwa or mahawaan)

 ADVERSE REACTIONS TO
ANTIINFECTIVE THERAPHY
 KIDNEY DAMAGE - it
occurs most frequently
with drugs that are
metabolized by the
kidney and then
eliminated in the urine.
 GI TOXICITY- very
common with many
antiinfectives. Have toxic
effects on the cells lining
the GI tract, causing
nausea, vomiting etc..
 NEUROTOXICITY- some
antiinfectives can damage
or interfere with the
function or nerve tissue.
 HYPERSENSITIVITY
REACTIONS- protein