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Pharmacology mind map, A student nurse is required to abide by all laws…
Pharmacology mind map
Aspirin
Indications for administration: Aspirin in low doses, is used as a mild blood thinner to help prevent blood clots forming. It belongs to the anti-platelet family of medications. From the salicylates family.
Normal dosage ranges: 325-650mg per day.
Contraindications: Can be contraindicated with other NSAIDS or tartrazine (type of dye). Bleeding abnormalities can be created due to a change in platelet aggregation.. Due to this, stopping aspirin prior to surgery is recommended.
Mechanism of action: Inhibits the synthesis of prostaglandins. Platelet aggregation is also inhibited by blocking thromboxane A2.
Interactions: Due to being a salicylate it can interact with other protein binding drugs. Other medicines could be displaced from binding and this in turn could lead to hypoprothrominaemia. Before a new drug is added, this interaction should be considered.
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Side effects: Can cause hepatic impairment. Uncontrolled hypertension. Excessive bleeding/bruising.
Route: Oral administration
Metformin
Indications for administration: Used in type 2 diabetes to decrease the amounts of glucose created by the liver. Can be used with gliclazide. Also recommended to be used in conjunction with a change in diet and exercise.
Normal dosage ranges: 500-850mg, increased to 1.5 g- 2g per day as tolerated. Creatinine clearance to be measured to adjust dose accordingly.
Contraindications: Include ketoacidosis, metabolic acidosis, renal disease, chronic heart failure.
Route: Oral administration.
Side effects: Lactic acidosis, hypoglycaemia, GI upset, nausea, diarrhoea, anorexia, heartburn, irritating the skin.
Interactions: Caution should be used when taking with diuretics, corticosteroids and some anti-psychotic drugs. Caution should also be taken when consuming alcohol as the risk for lactic acidosis is increased due to symptoms of hypoglycemia can not be as easily recognized.
Mechanism of action: Increases the peripheral use of glucose while decreasing the hepatic glucose production. Intestinal absorption of glucose is decreased. Insulin production is also increased.
Quetiapine
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Indications for administration: Used to treat psychosis often found in patients who suffer from schizophrenia or bi-polar disorder,
Normal dosage ranges: Dosage needs to be titrated when commencing medication in first instance. Once fully titrated, dose can be between 300-450 mg per day for schizophrenia, 400-800mg per day for mania or bipolar, or 300 mg per day for treatment of depression associated with bi polar.
Contraindications:comatose states; CNS depression; phaeochromocytoma.
Route: Oral administration.
Side effects: CNS depressor, can cause tachycardia, sexual dysfunction, temperature regulation disruption, constipation, blurred vision, drowsiness, headache, confusion, weight gain and diabetes.
Interactions: Domperadone, histamines, hydroxazine, haloperidol. Take into consideration any heart medications, CNS medications also.
Mechanism of action: It is a dopamine D1 & D2, Histamine 1, alpha1-adrenoreceptor antagonist. It blocks the effects of dopamine on the brain.
Gliclazide
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Indications for administration: Used in type 2 diabetes to encourage increased insulin production in the pancreas.
Normal dosage ranges: 40-160 mg per day
Route: Oral administration
Side effects: Hypoglycemia, GI distress, nausea, vomiting, anorexia (if this occurs it needs to be monitored closely) heartburn. Increases risk of cardiovascular mortality.
Interactions: Due to gliclazide being a second generation sulfonylureas, they have less interactions with other protein bound drugs.
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Contraindications: If known drug allergy to sulfonylureas need to avoid Gliclazide. Complicated by trauma, fever severe infection, kidney disease, ketoacidosis or renal disease.
Mechanisim of action: Stimulates insulin release from the beta cells based in the pancreas. Also improves insulin binding to insulin receptors on cells
Lactulose
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Indications for administration: Given to aid in softening bowel motions or given as a prophylactic to prevent constipation from occurring due to other medications that create constipation as an undesired side effect.
Normal dosage ranges: 15-30 ml per dose as required for short term treatment of constipation.
Contraindications: Only contraindicated when a person has allergies to any of the components of the drug. People who suffer from acute abdominal disorders such as diverticulitis caution should be used to prevent hypersensitivity. Caution should also be used when giving lactulose to people with heart block, CAD or debilitation due to risk of electrolytes becoming imbalanced, Further precautions are advised when using in pregnancy.
Route: Oral administration
Side effects: Stomach upset, diarrhea, abdominal discomfort. CNS side effects include dizziness, weakness and headaches
Interactions: Advisable to not take laxatives with other prescribed medications due to increased GI tract motility. This could mean that the other drugs move through the GI tract to quickly and they are not fully absorbed. Laxatives should be separated by 30 minutes when giving other medications.
Mechanism of action: Bulk stimulants aid in drawing water into the bowel to increase the bulk matter. This creates a chain reaction of improving GI tract motility, which then causes local stretch receptors to be activated allowing bowel motions to pass through.
Acts and legislation
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Therapeutic products bill: Potentially going to replace the medicines act
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Medicines act 1981
Section 1 states that a prescription medicine may be administered to any person only in accordance with the directions of the authorised prescriber who prescribed the medicine or a standing order.
Every person who contravenes section 1, commits an offence against this act.
Authorised prescribers are stated in this act to be a practitioner, registered midwife or designated prescriber.
Authorised prescriber means a person other than a practitioner or registered midwife who belongs to a class of registered health professionals who are authorised by completing requirements relating to competence, specific training and qualifications.
Misuse of drugs act 1975
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Due to health professionals having readily available access to drugs, some of which may be controlled drugs, there could be a risk of conviction if an offence occurs. If a controlled drug is stolen and conviction occurs, the misuse of drugs act 1975 section 11(1) states that a person who commits an offence (steals a controlled drug) against the act is liable on conviction for imprisonment for a term not exceeding 7 years.
Misuse of drugs regulations 1977
Regulation 29 states that prescriptions for controlled drugs must be in accordance with all regulations. Date, prescriber and signature, person who it has been prescribed for, route and required dosage.
In an emergency some medications can be accessed and given by specific healthcare professionals
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Health Practitioners Competence Assurance Act 2003
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This act provides a framework for the regulation of healthcare professionals. This helps to provide protection for the general public against the risk of harm from professional practice.
Standing order
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Scope and role of an RN
Medication administration and role of RN,
Must understand all legal, professional and ethical issues associated with medication administration.
An RN must report concerns regarding the risks of giving medication to the prescriber and/or management
Complies with employers policies regarding medication administration
Must comply with employers policies regarding preparation, storing and checking of medications.
When requesting other EN and HCA to complete medication administration, the RN must ensure it is within their scope. Furthermore the RN will still be held accountable for the administration and should follow up with the delegated staff members.
Scope of practice in relation to medication administration.
In an obstetric setting, the RN will be under the guidance of the midwife.
Verbal and telephone orders must be given by the correct prescriber and confirmed by a 2nd RN who has also listened to the verbal order.
Role of an RN
Prior to drug administration
Preparation of drugs
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According to prescription
As per MIMs or injectable drugs
Last dose given within acceptable timeframes
Prepared according to work areas protocols
Patient rights
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Right person, right time, right route, right drug, right to refuse
Allergies
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While administering
Monitoring reaction to drug
Anaphylaxis
After administration
Documentation
Competencies for registered nurses
Domain two: management of nursing care
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Domain four: interprofessional health care and quality improvement
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Domain one: Professional responsibility
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Professional responsibilities
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Remain up to date with current legislation
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Remain up to date with current workplace policies
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Taking ownership of any delegated medication tasks and following up regarding these.
Patient situation: Patient lives alone, traumatic history, alcohol dependency, history drug use, onset of mental health symptoms during drug induced psychosis during early 20s. Medical history of patient: Type 2 diabetes mellitus, Paranoid schizophrenia, Personality disorder, hypertension. Age: 49. Gender: Female. Ethnicity: Maori.
Reason for admission: Presenting primary symptom of constipation. Patient queries if this is in relation to the mental health drugs they are taking. Secondary to the constipation, patient states they also have watery diarrhea once the constipation passes through the bowels. Patient further states that they take laxatives for three days when they begin to "feel blocked up". Patient states that they buy laxatives from pharmacy directly, not on prescription. They were unable to specify what laxative they were taking.
Social aspects, background to admission/visit: Patient often presents to clinic due to paranoia/feeling unwell. History of traumatic abuse and psychosis/mental health. Lower socioeconomic status. Currently unemployed
A student nurse is required to abide by all laws and legislation relevant to registered nurses scope of practice. Further to that they are also required to abide by school policies such as not giving specific controlled drugs and also regarding intravenous drugs.
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