Lehne Chapters 1-11

FDA Pregnancy Risk Factors A, B, C, D, X

A: Safest B: more dangerous than A C: more dangerous than A and B D: more dangerous than A, B, & C X: most dangerous, can cause fetal harm

Partial agonist

Agonist that has only moderate intrinsic activity - Maximal effect that a partial agonist can produce is lower than that of a full agonist

drug

Any chemical that can affect living processes

adverse drug reaction

Any noxious, unintended, and undesired effect that occurs at normal drug doses Can be mildly annoying to life threatening

Phase IV (clinical testing)

Drug is released for general use permitting observation of its effects in a large population

enteral

GI tract

Parenteral

IV (faster, but harder to stop once it is in the system), IM (painful), Subcutaneous

predictability (additional property of ideal drug)

It is very helpful to know before drug administration, the certainty of how a given patient will respond

medication reconciliation

Joint Commission requirement compare medications through transitions

agonist

Molecules that activate receptors. Drug agonists simply bind to receptors and mimic the actions of the body's own regulatory molecules. EX) neurotransmitters, hormones

individual variation

No two patients will respond identically to the same drug regimen Tailor drug therapy to the individual

paradoxical effect

Opposite of the intended drug response

Antagonist

Produce their effects by preventing receptor activation by endogenous regulatory molecules and drugs pharmacologic effect - preventing the activation of receptors by agonists

QT Interval Drugs

Refer to the ability of some medications to prolong the QT interval on the electrocardiogram, thereby creating a risk of serious dysrhythmias -cause altered cardiac function

Hepatotoxic Drugs

Some drugs undergo metabolism by the liver and are converted to toxic products that can injure some liver cells (injury to liver) Drugs are the leading cause of acute liver failure in US

pharmacology

The study of drugs and their interactions with living systems

therapeutics (pharmacotherapeutics)

The use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy The medical use of drugs

Freedom from Drug Interactions (additional property of ideal drug)

When a patient is taking two or more drugs, the drugs can interact - The interactions can augment or reduce drug responses

loading dose

a large initial dose which is administered to reach a plateau more quickly and get the serum levels up

side effects

a nearly unavoidable secondary drug effect produced at therapeutic doses most likely to occur, mild

carcinogenic effect

ability of certain medication and environmental chemicals to cause cancers

evaluation (nursing process)

accomplished by analyzing data collected following implementation identify interventions to be continued and discontinued

factors that determine the intensity of drug responses

administration, pharmacokinetics, pharmacodynamics

placental drug transfer

all drugs can cross the placenta some can cross more easily than others

Half-life

amount of time it takes for half of the chemical to degrade *longer half-life=fewer doses

allergic reaction

an immune response for allergic reaction to occur, there must be prior sensitization of the immune system. Re-exposure to that drug can then trigger an allergic response

idiosyncratic effect

an uncommon drug response resulting from a genetic predisposition

medication error

any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the healthcare professional, patient, or consumer

nursing process (5)

assessment, analysis, planning, implementation, and evaluation

safety (property of ideal drug)

cannot produce harmful effects EVEN when administered in very high doses and for a very long time

three types of drug names

chemical, generic, trade

assessment (nursing process)

collect data about the patient methods: patient interview, medical and drug use histories, observation, physical exam, lab test

pharmacokinetics (factor of drug response)

determine how much of an administered dose gets to its sites of action

iatrogenic disease

disease that occurs as the result of medical care or treatments ex) by drugs

four major processes of pharmacokinetics

drug absorption drug distribution drug metabolism drug excretion

administration (factor of drug response)

drug dosage, route, and timing of administration are important determinants of drug responses

teratogenic effect

drug induced birth defect

therapeutic range

drug should be at a therapeutic range otherwise it will be ineffective or toxic

Properties of an ideal drug (3 main)

effectiveness, safety, and selectivity

selectivity (property of ideal drug)

elicits only the response for which its given

Absorption routes (pharmacokinetic process)

enteral Parenteral

Possession of a Simple Generic Name (additional property of ideal drug)

generic names are preferable to trade names, so an ideal drug should have a generic name that is easy to recall and pronounce

IV disadvantages

high cost, difficulty, inconvenience, danger because of irreversibility, potential for fluid overload, infection and embolism

Low cost (additional property of ideal drug)

ideal drug is easy to afford

Ease of Administration (additional property of ideal drug)

ideal drug should be simple to administer the route should be convenient, and the number of doses per day should be low can enhance patient adherence

Chemical stability (additional property of ideal drug)

ideal drug would retain its activity indefinitely

IM, subcutaneous disadvantages

inconvenience, discomfort

reversible action (additional property of ideal drug)

it is important that effects be reversible - you want drug actions to subside within an appropriate time (for most drugs)

effectiveness (property of ideal drug)

most important property elicits the responses for which it is given

analysis (nursing process)

nurse analyzes the information in the database to determine actual and potential health problems which can be physiologic, psychologic, and sociologic each problem stated in the form of a nursing diagnosis- PES

planning (nursing process)

nurse describes specific interventions directed at solving or preventing the problems identified in analysis

Phase II and III (clinical testing)

o Drugs tested in patients o Objective: determine therapeutic effects, dosage range, safety, and effectiveness o 500-5000 patients receive drug - few hundred take it for more than 3-6 months o apply to FDA for conditional approval of New Drug Application-if conditional approval -> Phase IV can begin

Phase I (clinical testing)

o Usually conducted in healthy volunteers o If the drug is likely to have severe side effects (anticancer drugs) then, the trial is done in volunteer patients who have the disease under consideration o Three goals: evaluating drug metabolism, pharmacokinetics, and biologic effects

Clinical testing

occurs in four phases and take 2-10 years to complete

teratogenesis

process by which congenital anomalies are produced in an embryo or fetus

The Therapeutic Objective

provide maximum benefit with minimal harm

IV advantages

rapid onset, precise control over amount of drug entering blood

first pass effect

refers to the rapid inactivation of some oral drugs as they pass through the liver after being absorbed

Dose-response relationship

right amount of drug to get the right effect

Rights of Drug Administration

right drug right patient right dose right route right time right documentation right to refuse right reason

maintenance dose

smaller dose/amount to maintain plateau

physical dependence

state in which the body has adapted to drug exposure in such a way that an abstinence syndrome will result if drug use is discontinued

IM, subcutaneous advantages

suitable for insoluble drugs and depot preps

toxicity

the degree of detrimental physiologic effects caused by excessive drug dosing

pathophysiology

the disordered physiological processes associated with disease or injury

pharmacodynamics (factor of drug response)

the impact of drugs on the body biochemical and physiological effect(s) of the drug pharmacodynamic processes determine the nature and intensity of the response

clinical pharmacology

the study of drugs in humans

pharmacogenomics

the study of how genetic variations can affect individual responses to drugs

adverse effect

unintended effect occurring at normal drug doses, usually more serious

plateau

when the amount of drug eliminated between doses equals the dose administered, average drug levels will remain constant and plateau will have been reached