Pharmacology '

what leads to an accumulation of some drugs that can cause severe adverse effects if dosage is not decreased

Severe renal disease

Drug

a substance that is taken to prevent, cure, or reduce symptoms of medical conditions and some taken for pleasure

DEA

charged with enforcing controlled substance act. Persons that handle controlled substances have to be registered with them, keep accurate records of transactions, and have secured storage

Drugs have several names including:

chemical, generic, and trade name

Trade name

designated and patented by the manufacturer. "Brand name".

pediatric dosages should be_______ _______ for accuracy

double checked; (make sure drug is safe for the tiny person)

Nurses should __________ clients about meds they are taking.

educate

FDA

enforces drug laws

Therapeutic range and therapeutic index

enough of drug to be beneficial but not enough to be toxic. ****this is the goal of drug therapy!!!

Schedule IV drugs

even less potential for abuse (benzos -lorazepam &diazepam, phenobarbitol, stadol, ambien

Liquids absorb _______ than tablets or capsules

faster

Malfeasance

giving the correct drug but by wrong route that results in death

Why are drug levels important?

if things aren't working right then there might be a higher level and may become toxic

Prototype drug

individual drugs that represent groups of drugs, one in which others in that class are compared to. Ex: "lols", "cillins", "statins"

Placebo

inert ingredients

Pharmacoeconomics

involves the costs of drug therapy. Includes cost of dispensing, storing, administering, monitoring, and losses due to expirations

Serum drug level (drug plasma concentration):

lab measurement of amount of drug in blood at a particular time. Reflects dosage, absorption, bioavailability, half-life, and rates of metabolism and excretion.

Nurses are ___________ for safe and accurate administration

legally resonsible

Schedule III drugs

lesser abuse potential than schedule II (anabolic steroids, ketamine, codeine preparations)

The receptor often described as a ______ into which drug molecules fit as a ______ and only those drugs able to bond chemically to the receptors in specific body tissue can produce pharmacologic effects.

lock; key

Safety

make sure they know how to store safely and how to give the medicine

Why is pharmacology important?

meds have an impact on healthcare, the nurse is the last person to catch an error before administration, you're responsible for understanding drugs, must understand drugs to know what the outcomes you should expect and what adverse reactions there could be

Meds with short half life require

more frequent dosing but depends on what med it is and why being given

Misfeasance

negligence- giving wrong dose or drug that results in death

Is there a perfect drug?

no, but strive to be the best: safe, lowest effective dose, fewest side effects, fewer doses a day, least amount of cost, fewer interactions with foods or other meds

Drug molecules must

occupy a minimal number of receptors to produce their effects.

Nonfeasance

omission- omitting a drug dose that results in death

When would you suspect a poisoning?

open pill bottle lying beside person, open bottle of cleaners, etc. Accidental poisoning common in young children. Try to determine what person has been exposed to (but not always possible to do this) and when exposure took place—this can help guide specific treatment after speaking with poison control!!!

Public health services

regulates vaccines and other biologic products

Generic name

related to the chemical name and is not related to the manufacturer. Often is indicative of its drug group (those ending in "cillin" are penicillins. Generic name typically in lower case letters. Only have 1 generic name

Trough

shows the lowest concentration of the drug. - Drawn just before next scheduled dose is given.

Pharmacology

study if drugs (chemicals)that alter functions of living organisms. Study of biological active compounds, how they react in the body and how the body reacts to them

What is the most important interventions concerning the use of meds?

teaching

Eliminate is determined by

the blood flow through the kidneys

Metabolites

the broken-down parts of the drugs that have been metabolized

What are the 2 basic classifications of drugs?

therapeutic and pharmacologic

Local effects

these act mainly at the site of application: impaled (inhaler, local in lungs), ointments, burn creams, etc

Serum half-life

time required for serum concentration to decrease by 50%.

Why do people take drugs?

to improve quality of life, stop progression of disease, prevent diseases

Agonist

triggers a response by binding to receptor cell and makes the same response as what normally occurs...."mimics"

Schedule V drugs

very low potential for abuse/dependence. Contain a moderate amount of controlled substance with another type of med. (lomotil, codeine cough syrup)

How does age of the child influence the absorption, distribution, metabolism, and excretion of medications?

very young have immature metabolisms, goes very slow and changes pharmacometrics

Pharmacodynamics

what the drug does to the body

Peak

when drug reaches the highest blood and plasma concentration - Drawn 30 minutes after IV administration and 1-2 hours (normally) after PO administration

passive immunity

when preformed antibodies are transferred from one person to another

Systematic effects

with this, medications are taken into the body and circulated through the bloodstream to their site of action and then eliminated from the body (PO- mouth, IV, etc.)

Why are drugs now derived in a lab?

you have more control over them but they aren't as effective but are more consistent in their effectiveness, there is also semi-synthetic like antibiotics

What affects how medications will work?

¨ Absorption ¨ Distribution ¨ Metabolism ¨ Excretion

Metabolism

¨ Biotransformation of the drugs; chemically converting a drug to a form that is usually more easily removed from the body. ¨ Liver is primary site of this process. (liver disease will affect the breakdown of drugs; slows down the drug)

Distribution

¨ Involves the transport of drug molecules within the body. • Depends greatly on adequate blood flow (heart, liver, kidneys -> key players in distribution) ¨ Protein binding important part of drug distribution. (meds need help from carrier protein; cross membranes and throughout parts they can't alone); two highly protein bound will fight each other ¨ ***only free or unbound parts of drugs can act on body cells. (protein bound drugs will not produce an effect)

How can drugs be administered?

¨ PO (mouth), IV (bloodstream), IM, SQ, inhalation (going directly where it needs to), topically, (sublingual is under tongue and absorbs quickly)

Absorption

¨ Process that occurs between the time a drug enters the body and the time it enters bloodstream to be circulated ¨ The rate and extent of absorption affected by: form(how its supplied; tablet, inhaled, etc.), route (oral, IV), GI function (elderly, pregnant have slower; someone with diarrhea has it going faster), blood flow, presence of food in GI tract, etc.

Excretion

¨ The elimination of drugs from the body. ¨ Most drugs are excreted by the kidneys and eliminated through urine.

Polypharmacy

¨ an increase of medication that they are taking and has higher risk of issues

Prodrugs

¨ cannot produce an effect until metabolized (ex. Benazapril (Lotensin), Enalapril (Vasotec))

Test for renal function

¨ creatinine clearance: normal 85-135 ml/min but does decrease with age

Toxic concentration

¨ excessive level at which toxicity can occur. Can be from single large dose, repeated small doses, or slow metabolism that allows drug to accumulate in body. Blood work is a good indicator but if exhibiting toxic signs then they should not have any more

CNS and blood brain barrier

¨ limits movement of drugs to brain tissue—have to have carrier or be lipid soluble to pass this barrier (protective mechanism); lipid is easier to transport but harder to excrete

1st pass effect

¨ meds are absorbed from the GI tract after going to the liver and are inactivated before they can produce an action (usually in oral drug, need to change routes)

Bioavailability

¨ portion of dose that reaches systemic circulation and is available to act on body cells (physiologic ability of drug to reach target cell and produce effect)

Efficacy

"how efficient", magnitude of response produced by drug

Potency

"how much need for a response", more potent drug produces effect at lower dose than others in that class

Pharmacologic

"how the drug acts/produces an effect in the body"

Therapeutic

"what is being treated by the medication"

Cultural practices

(herbal and homeopathic remedies)-these can inhibit or accelerate drug metabolism and their response

Factors that Affect Drug Action:

-Age -Weight -Gender -Environmental factors -Pathologic states(hypertension, kidney and liver issue, etc) -Psychological factors (believing med will work) -Disease state -time -drug tolerance

What are the nursing responsibilities regarding controlled substance?

-Must have Rx -Keep in a locked/ secured area -must be "signed out" -make sure "narcotic count" is correct -ensure patient actually takes med -"waste" needs to be verified and signed off by another RN

Drugs are classified according to:

-effects on particular body system -their therapeutic uses -chemical characteristics

How do attitudes and expectations influence the use of a placebo?

-has no active therapeutic effect but some believe it is working

What is a placebo?

-pill without working ingredients

Why do clients take medications?

-taken for acute and chronic health conditions -acute: pain and infection are treated with drugs that provide immediate relief -chronic: problems such as HTN, DM, HIV require meds over an extended period of time (long term therapy) to move signs and symptoms and help slow the progression of the disease

How can nurses help prevent noncompliance?

Educate pt at every encounter to inc. compliance, build trusting relationships

Why are nurse Practice Acts important?

Every state has its own laws regarding drug administration by nurses. Nurses are held accountable to these standards

Who is at risk for being noncompliant?

Everyone....especially illiterate, elderly, poor

What do we need to teach the client?

General info about the med, why is was Rx for them, how and when to take it, side effects, intended effects, and safety measures related to it (cause dizziness, make sleepy, etc./need to check blood sugar before, check HR before or BP, etc.)

loading dose

Given to get drug into body quickly, larger than normal dose

Maintenance dose

Given to maintain the drug level after loading dose

Schedule II drugs

High potential for abuse and dependence -MUST have WRITTEN Rx signed by HCP -NO refills or telephone orders (codeine, morphine, demerol, methadone, oxycodone)

Barriers to adequate healthcare for culturally diverse patients:

Language, poverty, access, beliefs, etc

How can you make sure that what you have taught has been understood?

Return demonstrations, have them read back instructions to you, ask them questions about what has been taught, watch their body language for cues that not understanding the info, ask them questions about what have been discussing.

Meds are usually given for their:

Local and systematic effects

What are hindrances to compliance and learning>

Might be language barrier, might not be able to hear, might not be able to see/see well, ability to read, ability to afford medications, no way to get Rx from pharmacy, might not be able to open the bottles, etc

What are the nurse practice acts?

Misfeasance, nonfeasance, malfeasance

Schedule I drugs

NOT approved for medical use (LSD, Heroine, Marijuana)

Chemical name

a drug only has 1 of these names ex: calcium gluconate, sodium chloride

Goal of treatment for poisons?

Suspect when toxicity is present and begin treatment Start treatment ASAP after ingestion, supporting and stabilizing vital functions, preventing further damage by reducing and absorption or increasing elimination, and administering specific antidotes if indicated

Where do drugs come from?

Were historically derived from plants, animals, and minerals. Now, most are synthetic compounds that are manufactured in labs

Pharmacokinetics

What the body does to the drug (med) (how the body handles the drug)

Polypharmacy

administration of many drugs together. The higher the # taken—the higher the risk for interactions and adverse effects

Minimum effective concentration (MEC):

amount of drug that must be present before drug can exert its therapeutic effect (desired effect)

Pharmacotherapy

application of drugs for the purposes of disease preventions and treatment of suffering

Federal trade commission

can suppress misleading advertisements of nonprescription drugs

Developmental considerations:

can they follow directions, how to get it in them, band aid on baby doll, etc

Antagonist

blocks an action; binds to receptor and blocks normal action that would occur or changes the pharmacokinetics. Ex: opioid antagonized by Narcan

How can accidental poisonings be prevented?

› Keep things out of reach!!!

Examples of varying responses of different drug classifications on cultural groups:

›Antihypertensives (African Americans do better when they have a combo of meds for BP) ›Antipsychotics and antianxiety meds (Hispanic and Asian pop. Do better with lower dose)

How does aging affect drug therapy?

›CNS changes ›Liver doesn't function as well ›Decreased GI secretions and motility ›Decreased cardiac output ›Decreased blood flow to liver and kidneys

What are the effects of poisons?

›Results from excessive amounts of a drug and may cause reversible or irreversible damage to body tissues.

Signs and symptoms that may be seen for poisons

›abdominal cramping, N/V/D, loss of consciousness, open container close by

active immunity

›body produces its own antibodies in response to exposure