NUR 378 Exam One
RAAS system
renin-angiotensin-aldosterone system
Pharmacokinetics
what the body does to the drug (absorption, distribution, metabolism, excretion)
Pharmacodynamics
what the drug does to the body drug-response relationship drug-receptor interactions drug response w/out receptors interpatient variability (not comparable between pt's) Therapeutic index Dependent on receptors
Interactions
when a drug changes the effects of another drug. Can increase or decrease drug levels/effects
prescription or medication order (from any prescriber) must be checked for the following seven elements:
(1) patient's name (2) date the drug order was written (3) name of drug(s) (4) drug dosage amount (5) drug dosage frequency (6) route of administration (7) prescriber's signature.
Hypertension
(high blood pressure) A common, often asymptomatic disorder in which systolic blood pressure persistently exceeds 150 mm Hg and/or diastolic pressure exceeds 90 mm Hg in patients over 60 years of age and 140/90 for patients younger than 60 and those who have chronic kidney disease or diabetes.
Medications and Conditions Requiring Special Considerations in the Older Adult Patient
Bladder flow obstruction - Anticholinergics, antihistamines, decongestants, antidepressants Clotting disorders - NSAIDs, aspirin, antiplatelet drugs Chronic constipation - Calcium channel blockers, tricyclic antidepressants, anticholinergics Chronic obstructive pulmonary disease - Long-acting sedatives or hypnotics, opioids, beta blockers Heart failure and hypertension - Sodium, decongestants, amphetamines, over-the-counter cold products Insomnia - Decongestants, bronchodilators, monoamine oxidase inhibitors Parkinson's disease - Antipsychotics, phenothiazines Syncope, falls - Sedatives, hypnotics, opioids, CNS depressants, muscle relaxants, antidepressants, antihypertensives
metabolism affect pharmacokinetics
Enzymes inactivating the drug occurs in Liver, skeletal muscle, kidneys, lungs, plasma, intestinal mucosa
excretion affect pharmacokinetics
Excretion: Elimination of drugs from the body. occurs in kidneys(urine), liver, bowel, sweat, lungs, salivary and mammary glands All drugs eventually must be removed either whole or as active or inactive metabolites.
Summarize client and family teaching of Antihypertensive
Importance/purpose, proper administration, move slowly when getting up, adverse effects and when to report, ow salt diet, limiting alcohol intake, monitor their blood pressure, exercise, smoking cessation, stress management, Assess client/family understanding and encourage them to ask any additional questions. Proper education helps ensure medication safety.
compliance
Implementation or fulfillment of a prescriber's/caregiver's prescribed course of treatment or therapeutic plan by a patient. Use of compliance versus the term adherence acknowledges the consideration/acceptance of patient/family/caregiver participation in the use of the nursing process.
pharmacologic principles summaries
Pharmacokinetics- things the body does to the drug. absorbs, distributes, metabolizes and eliminates drugs. Half-life- time it takes for concentration of a drug to be reduced by 50%. Pharmacodynamics- what the drug does to the body. Onset, peak, and duration- the time for the drug to take effect (onset), reach the maximum (peak), the total time the drug was active (duration) Metabolism- Interactions- when a drug changes the effects of another drug. Can increase or decrease drug levels/effects. Adverse effects- Contraindications- Administration- Storage-
Antagonist (pharmacodynamics)
drug binds to a receptor and there is no response. Drug prevents agonist binding to the site what is an agonist? type of drug or ligand that binds to a specific receptor and activates it to produce a biological response
Partial agonist (pharmacodynamics)
drug binds to a receptor causing a diminished response compared to the agonist response
Agonists (pharmacodynamics)
drug binds to a receptor causing a response, the reaction progresses
Noncompetitive antagonist (pharmacodynamics)
drug combines w/ different parts of the receptor (changes shape of receptor) and inactivates it causing the agonist then have little to no effect
Competitive agonist (pharmacodynamics)
drug competes w/ the agonist for receptor site. If the competitive agonist is able to bind in to the same receptor as the agonist, the agonist is likely to interfere with the type of response the competitive agonist has
peak
drug reach the maximum impact
topical drugs
drugs that are applied to the skin: patches, lotions, ointments, powders - eye drops - eye ointment - ear drops - Inhaled Drugs (inhaler) - Nebulizers - Nasal Drops - Nasal sprays - Vaginal Medications: Creams, Foams, or Gels Applied With an Applicator, Suppositories or Vaginal Tablets
gene therapy
experimental technique that uses genes to treat or prevent disease. It allows doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery. Researchers are testing several approaches to gene therapy, including: • Replacing a mutated gene with a healthy copy of the gene • Introducing a new gene into the body to help fight a disease • Inactivating a mutated gene that is functioning improperly
How does a half-life impact drug dosing?
if the drugs 1/2 life is 36 hours they will only be taking it once a day. So its lasting effect in the body determines how many times a person would take it.
why do pediatric patients handle drugs much differently than adult patients
immaturity of vital organs
adherence
implying more collaboration and active role between patients and their providers
Assessment (nursing process)
initial assessment phase of the nursing process, data are collected, reviewed, and analyzed from patient, family, group, and/or community sources.
Pediatric patients
premature: Younger than 38 weeks' gestation Neonate/Younger than 38 weeks' gestation: is defined as between birth and 1 month of age. Infant: is between 1 and 12 months of age. child: is between 1 and 12 years of age.
Ethnopharmacology
study of the effect of ethnicity on responses to prescribed medication, especially drug absorption, metabolism, distribution, and excretion
Dabrafenib (Tafinlar)
targets BRAF V600ED mutation treats melanoma driven by a mutated BRAF gene.
Drug polymorphism
the effect of a patient's age, gender, size, body composition, and other characteristics on the pharmacokinetics of specific drugs
Pharmacogenomics
the study of how genetic inheritance affects the body's response to drugs genetic variations influence drug metabolism, transport, and action in the body.
Onset
the time for the drug to take effect
duration
the total time the drug was active
half-life
time it takes for concentration of a drug to be reduced by 50%.
Vacaftor (Kalydeco)
treats a genetic defect that causes cystic fibrosis.
why do older adult patients handle drugs physiologically differently from younger adult patients.
decline in organ function that occurs with advancing age
Trade name
Brand name; capitalized Ex: Tylenol
Parenteral drugs
- Given by a route other than the GI tract - Drugs administered by injectable routes - Means "excluding the intestines" - Administered by needle and syringe - I.V. - I.M.
Implementing patient education about medications involves:
- instructions in writing and verbally - Using pamphlets, pictures, videos, or other aids - multiple short teaching sessions as needed - Matching teaching methods to the patient's learning needs and priorities - Accommodating age-related changes in cognition, senses, etc. - Providing medication aids like calendars, reminder stickers, pill boxes - Documenting doses taken to avoid errors - The goals are to ensure the patient understands: - What the medication is, what it treats -How and when to take it properly - Expected effects and potential side effects - What to do about missed doses or other issues - Effective patient education leads to proper medication use, adherence, and improved outcomes.
Nine Rights of Medication Administration (prevents medication errors)
1) Right drug 2) Right dose 3) Right time 4) Right route/form 5) Right patient 6) Right documentation 7) Right reason (indication) 8) Right response 9) Right of patient to refuse
Medical errors
A broad term used to refer to any errors at any point in patient care that cause or have the potential to cause patient harm.
biosimilars
A drug that has the same clinical effect as a generic drug but a different chemical composition. generic drug copy of an authentic biological product
narcotic
A legal term established under the Harrison Narcotic Act of 1914. The term is currently used in clinical settings to refer to any medically administered controlled substance and in legal settings to refer to any illicit or "street" drug; also referred to as opioid.
Medication reconciliation
A procedure to maintain an accurate and up-to-date list of medications for all patients between all phases of health care delivery.
Human needs statement (nursing process)
Human need statements are subsequently developed by professional nurses and are used as a means of communicating and sharing information about the patient and the patient experience.
Pharmacokinetic Changes in older adults
Absorption: Reduced gastric acidity Delayed gastric emptying Slower GI motility Decreased GI blood flow Reduced absorptive surface area Distribution: Decreased total body water Increased body fat Reduced protein binding Metabolism Reduced liver enzyme activity Decreased hepatic blood flow Excretion Decline in glomerular filtration Loss of nephrons Decreased renal clearance
absorption affect pharmacokinetics
Absorption: The movement of a drug from the site of administration into the bloodstream for distribution to the tissues.
Pharmacokinetics and adherence issues that affect pharmacotherapy in Infants and Children (how the body affects the clinical use of a drugs in an infant and child)
Absorption: rate are slower due to gastric pH less acidic, Slow gastric emptying, Immature liver, Intramuscular absorption is fast & irregular - Gastric pH is less acidic because acid-producing cells in the stomach are immature until approximately 1 to 2 years of age. - Gastric emptying is slowed because of a slow or irregular peristalsis. - First-pass elimination by the liver is reduced because of the immaturity of the liver and reduced levels of microsomal enzymes. - Intramuscular absorption is faster and irregular. Distribution: water composition of body varies, Low fat content • Total body water is 70% to 80% in full-term infants, 85% in premature newborns, and 64% in children 1 to 12 years of age. • Fat content is lower in young patients because of greater total body water. • Protein binding is decreased because of decreased production of protein by the immature liver. • More drugs enter the brain because of an immature blood-brain barrier. Metabolism: decreased enzymes, Increased metabolism (faster metabolism) • Levels of microsomal enzymes are decreased because the immature liver has not yet started producing enough. • Older children may have increased metabolism and require higher dosages once hepatic enzymes are produced. • Many variables affect metabolism in premature infants, infants, and children, including the status of liver enzyme production, genetic differences, and substances to which the mother was exposed during pregnancy. Excretion: decreased filtration rate, Decreased perfusion to kidney • Glomerular filtration rate and tubular secretion and resorption are all decreased in young patients because of kidney immaturity. • Perfusion to the kidneys may be decreased, which results in reduced renal function, concentrating ability, and excretion of drugs.
Type of OTC Drug
Acid-controlling drugs (histamine-2 blockers), antacids, and proton pump inhibitors - famotidine (Pepcid AC), aluminum- and magnesium-containing products (Maalox, Mylanta), calcium-containing products (Tums), esomeprazole (Nexium 24), lansoprazole (Prevacid-24), omeprazole (Prilosec-OTC) Antifungal drugs (topical) - clotrimazole (Lotrimin), miconazole (Monistat), terbinafine (Lamisil AT) Antihistamines and decongestants - brompheniramine (Dimetapp), cetirizine (Zyrtec), chlorpheniramine (Theraflu), diphenhydramine (Benadryl), fexofenadine (Allegra), guaifenesin (Robitussin), loratadine (Claritin), pseudoephedrine (Sudafed) Eyedrops - artificial tears (Moisture Eyes) Hair growth drugs (topical) - minoxidil (Rogaine) Analgesics - acetaminophen (Tylenol) Nonsteroidal antiinflammatory drugs - aspirin, ibuprofen (Advil, Motrin), naproxen sodium (Aleve) Nasal steroids - fluticasone (Flonase), triamcinolone (Nasacort) Smoking deterrents - transdermal nicotine patches, nicotine gum
Brief Review of Common Practices Among Selected Cultural Groups
African - Common Health Beliefs and Alternative Healers: Practice folk medicine; employ "root doctors" as healers, spiritualists Use herbs, oils, and roots - Verbal and Nonverbal Communication; Touch/Time: Asking personal questions of someone met for the first time seen as intrusive and not proper, such as when nurse meets patient Direct eye contact seen as rude Present oriented - Family: Have close, extended family ties Women play important key role in making health care decisions - Biological Variations: Keloid formation, sickle cell anemia, lactose intolerance, skin color Asian - Common Health Beliefs and Alternative Healers: Believe in traditional medicine; hot and cold foods; herbs/teas/soups; use of acupuncturist, acupressurist, and herbalist; Tai Chi; QiGong -Verbal and Nonverbal Communication; Touch/Time: High respect for others, especially individuals in positions of authority Not usually comfortable with custom of shaking hands with those of opposite sex Present oriented - Family: Have close extended family ties; family's needs more important than individual needs - Biological Variations: Many drug interactions, lactose intolerance, skin color, thalassemia Hispanic - Common Health Beliefs and Alternative Healers: View health as a result of good luck and living right; see illness as a result of doing a bad deed Heat, cold, and herbs used as remedies; Use curandero, spiritualist -Verbal and Nonverbal Communication; Touch/Time: Expressing negative feelings seen as impolite Avoiding eye contact seen as respectful and attentive Touching acceptable between two persons in conversation - Family: Have close extended family ties; all family members involved in health care decisions Past cultural experiences in the family with illness and healing practices holds significant value Strong adherence to cultural practice - Biological Variations: Lactose intolerance, skin color Native American - Common Health Beliefs and Alternative Healers: Believe in harmony with nature and ill spirits causing disease Use medicine man -Verbal and Nonverbal Communication; Touch/Time: Speak in low tone of voice Light touch of a person's hand is preferred versus a firm handshake as a greeting Present oriented - Famil
nursing assessments and interventions required for safe and effective administration of Older adult patient
Age Allergies (drug and food) Dietary habits Sensory, visual, hearing, cognitive, motor-skill deficits Financial status and limitations List of all health care providers Past and present medical history Medications: past/present, prescription/OTC, herbals, supplements, vitamins, home remedies. Any polypharmacy?Self medication practices. Lab results, esp. Renal and liver function Smoking and alcohol use
nursing assessments and interventions required for safe and effective administration of Pediatric patient
Age, age related concerns about organ function, age-related fears, allergies to drugs and food, baseline vitals, head-to-toe physical assessment findings, height in feet/inches + cm, weight in kg and lbs, level of growth and development and related developmental tasks Medication history (prescription and OTC), current medications, patient's tolerance Anxiety of patient or family Usual response to medications
Allergic reaction
An immunologic reaction resulting from an unusual sensitivity of a patient to a certain medication; a type of adverse drug event and a subtype of adverse drug reactions.
how to prevent Adverse Reactions
Anticipating adverse drug reactions (ADRs) can help minimize them. This allows timing intervention to minimize harm. Monitor functions of the target organs if the drug is toxic to a specific organ. Individualizing therapy, balancing the drug's benefits vs. risk medication Guides read box Warnings
idiosyncratic reaction
Any abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient.
Medication errors
Any preventable adverse drug events involving inappropriate medication use by a patient or health care professional; they may or may not cause the patient harm.
Adverse drug event (definition)
Any undesirable occurrence related to administration of or failure to administer a prescribed medication.
Nursing Process
Assessment Human needs statements Planning Implementation Evaluation
Nursing assessments and interventions for safe Administration for Antihypertensive
Assessments: health history - note previous response to antihypertensives, other cardiac conditions, renal function, etc. vital signs before administration - blood pressure, heart rate, respiratory rate Assess for symptoms of hypotension before each dose - dizziness, lightheadedness, syncope Monitor for signs of electrolyte imbalances - weakness, muscle cramps, irregular heartbeat Interventions: -Educate patient on potential side effects, importance of compliance -Have patient take dose at same time each day and consistent relation to meals -Ensure proper patient positioning - sitting or lying down during administration -Check vital signs 15-30 minutes after initial doses or dose increases -Hold medication and contact provider for very low blood pressure, dizziness, syncope -Encourage compliance with dietary modifications - low salt, potassium intake -Document effects and report any adverse reactions to provider
Adverse Drug Events
Augmented: Severity of the reaction increases with increasing dose. Bizarre: Occur through unknown mechanisms, not related to dose. Chronic: Occur with prolonged use of drug, related to both dose and time. Delayed: Occur a period of time after drug use, related to time rather than dose. End of use: Occur after stopping the drug following prolonged use. (Withdrawal) Failure: Drug is ineffective for the condition being treated. Idiosyncratic Effect: Unpredictable reactions in susceptible individuals, not dose-related. Paradoxical Effect: Effects opposite of the expected therapeutic effect. Latrogenic Effect: Caused by medical treatment or diagnostic procedures. Physical Dependence: Adaptive physiological response to repeated drug use. Carcinogenic Effect: Can cause cancer. Tetrogenic Effect: Can cause fetal malformations.
Non-First Pass Routes
Aural (instilled into the ear) Buccal Inhaled Intraarterial Intramuscular Intranasal Intraocular Intravaginal Intravenous Subcutaneous Sublingual Transdermal Considered 100% bioavailable. meaning it is able to go wherever it needs to go when introduced into the body and able to have an active effect.
FDA Pregnancy Categories
Category Description Category A - Studies indicate no risk to the human fetus. Category B - Studies indicate no risk to the animal fetus; information for humans is not available. Category C - Adverse effects reported in the animal fetus; information for humans is not available. Category D - Possible fetal risk in humans has been reported; however, in selected cases consideration of the potential benefit versus risk may warrant use of these drugs in pregnant women. Category X - Fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available from animal and/or human studies. These drugs are not to be used in pregnant women. In June 2015, the FDA ruled the following: Drugs currently on the market are being phased in to the new categories, but the transition is not complete. This information will ultimately replace the A to X categories. Note: This textbook will continue to use the letter categories until the transition is complete. The student is referred to individual drug package inserts for the most current information. - Three detailed subsections on "Pregnancy," "Lactation," and "Females and Males of Reproductive Potential"
risks posed by medications to reproductive potential.
Diffusion across the placenta. Not all drugs can diffuse. Three factors that contribute to safety or potential harm: - Drug properties: drug chemistry, dosage, concurrently administered drugs - Fetal gestational age: First trimester is the greatest danger of drug-induced developmental defects d/t rapid cell proliferation in first trimester. During the third trimester, drugs can most easily cross the placenta to fetus d/t inc. blood flow. - Maternal factors: any change in mother's physiology can affect amount of drug the fetus is exposed to. Impairment of kidneys or liver may result in higher drug levels/prolonged drug exposure -> inc. fetal transfer
distribution affect pharmacokinetics
Distribution: from the bloodstream to wherever it needs to go. Volume of distribution used to describe where the drug is theoretically going to be distributed: blood intravascular space, total body water, body fat, body fat, other specific tissues or organs
Considerations for safe pharmacotherapy during pregnancy
Drug properties that have an impact on drug transfer to the fetus include the drug's chemistry, the dosage, and concurrently administered drugs Fetal gestational age is an important factor in determining the potential for harmful drug effects to the fetus Maternal factors also play a role in determining drug effects on the fetus. Any change in the mother's physiology can affect the amount of drug to which the fetus may be exposed. Maternal kidney and liver function affect drug metabolism and excretion. Impairment in either kidney or liver function may result in higher drug levels and/or prolonged drug exposure and thus increased fetal transfer. Maternal genotype may also affect how certain drugs are metabolized (pharmacogenomics). The lack of certain enzyme systems may result in adverse drug effects to the fetus when the mother is exposed to a drug that is normally metabolized by the given enzyme. Without drug therapy, maternal conditions such as hypertension, epilepsy, diabetes, and infection could seriously endanger both the mother and the fetus, and the potential for harm far outweighs the risks of appropriate drug therapy. so outweigh potential harm of not taking medication and risks of taking medication
Areas of Potential Liability for Nurses
Failure to assess/evaluate • See significant changes in patient's condition after taking a medication • Report the changes in condition after medication • Take a complete medication history and nursing assessment/history • Monitor patient after medication administration Failure to ensure safety • Lack of adequate monitoring • Failure to identify patient allergies and other risk factors related to medication therapy • Inappropriate drug administration technique • Failure to implement appropriate nursing actions based on a lack of proper assessment of patient's condition Medication • Clarify unclear medication order • Identify and react to adverse drug reactions • Be familiar with medication before its administration • Maintain level of professional nursing skills for current practice • Identify patient's identity before drug administration • Document drug administration in medication profile Fraud • Falsification of documentation on the medication profile or patient's record • Failure to provide the nursing care that was documented
current and reliable drug information:
Generic name: made by pharmaceutical company Trade name: Brand name; capitalized Biosimilars: generic drug copy of an authentic biological product Drug patents: last 17 years - 7 of them being profitable Current: Try to use resources dated within the last 3 years Physician's Desk Reference, Mosby's Drug Consult, Drug manufacturers' inserts, drug handbooks, and/or licensed pharmacists, Journals Reliable online sources: US Pharmacopeia (USP), US Food and Drug Administration (FDA)
Herbs and Dietary Supplements and Their Possible Drug Interactions
Herb or Dietary Supplement Chamomile - Increased risk for bleeding with anticoagulants Cranberry - Decreased elimination of many drugs that are renally excreted Echinacea - Possible interference with or counteraction to immunosuppressant drugs and antivirals Evening primrose - Possible interaction with antipsychotic drugs Garlic - Possible interference with hypoglycemic therapy and the anticoagulant warfarin (Coumadin) Gingko - May increase risk for bleeding with anticoagulants (warfarin, heparin) and antiplatelets (aspirin, clopidogrel) Ginger root - At high dosages, possible interference with cardiac, antidiabetic, or anticoagulant drugs Grapefruit - Decreases metabolism of drugs used for erectile dysfunction, estrogens, and some psychotherapeutic drugs. Increases risk for toxicity of immunosuppressants, HMG-CoA reductase inhibitors, and some psychotherapeutic drugs Increases intensity and duration of effects of caffeine Hawthorn - May lead to toxic levels of cardiac glycosides (e.g., digitalis) Kava - May increase the effect of barbiturates and alcohol Saw palmetto - May change the effects of hormones in oral contraceptive drugs, patches, or hormonal replacement therapies St. John's wort - May lead to serotonin syndrome if used with other serotonergic drugs (e.g., selective serotonin reuptake inhibitors [see Chapter 16]). May interact with many drugs, including antidepressants, antihistamines, digoxin, immunosuppressants, theophylline, and warfarin. Valerian - Increases central nervous system depression if used with sedatives
Antihypertensive drug
Mechanism of action: blocks binding of angiotensin II to receptor sites; inhibiting effects of angiotensin II reduce blood pressure (ACE inhibitor) -vasodilator therapeutic use: Hypertension management, treats nephropathy (kidney failure) in type II diabetes, reduces risk of stroke, hypertension and left ventricular hypertrophy adverse effects: dizziness, fatigue, headache, insomnia, malaise, angioedema, hyperkalemia, hyponatremia interactions: ACE inhibitors, aliskiren, other ARBs, lithium,NSAIDS, Potassium foods, supplements, diuretics that are potassium sparing labs: Potassium levels and renal function should be monitored regularly. Blood pressure should also be routinely checked.
Antihypertensive Drugs: doxazosin (alpha1 blocker); amlodipine; beta blocker losartan (ARB)
Mechanism of action: blocks binding of angiotensin II to receptor sites; inhibiting effects of angiotensin II reduce blood pressure Therapeutic use: Hypertension management, treats nephropathy in type II diabetes, reduces risk of stroke, hypertension and left ventricular hypertrophy Adverse effects: dizziness, fatigue, headache, insomnia, malaise, angioedema, hyperkalemia, hyponatremia Interactions: ACE inhibitors, aliskiren, other ARBs, lithium,NSAIDS, Potassium foods, supplements, diuretics that are potassium sparing Nursing assessments and interventions: Always check BP prior; Hold for systolic less than 100 and diastolic less than 90. Education: Avoid potassium containing salt substitutes, potassium supplements/foods as they may increase risk of hyperkalemia. Move slowly through position change
adherence issues that affect pharmacotherapy in infants and children
Mix medication in non-essential food because child may develop a dislike for the food item. Don't add drugs to fluid in a cup because you can't calculate if the pt doesn't consume full amount. Document special techniques so others can benefit from suggestion. Avoid calling the med "candy" for child's safety. Ask parent/caregiver for tips.
Acute pain
Pain that is sudden in onset, usually subsides when treated, and typically occurs over less than a 6-week period.
Chronic pain
Persistent or recurring pain that is often difficult to treat. Includes any pain lasting longer than 3 to 6 months, pain lasting longer than 1 month after healing of an acute injury, or pain that accompanies a nonhealing tissue injury.
Identify the pharmacological (use, effects and actions of a drug) and social factors uniquely affecting pharmacotherapeutics (clinical use of a drug) in the older adult.
Social factors : money, multiple drugs with multiple prescribers, mental status Physiological factors - changes associated with aging affect the action of many drugs. Physiologic Changes in the Older Adult Patient: Cardiovascular ↓ Cardiac output = ↓ absorption and distribution ↓ Blood flow = ↓ absorption and distribution Gastrointestinal ↑ pH (alkaline gastric secretions) = altered absorption ↓ Peristalsis = delayed gastric emptying Hepatic ↓ Enzyme production = ↓ metabolism ↓ Blood flow = ↓ metabolism Renal ↓ Blood flow =↓ excretion ↓ Function = ↓ excretion ↓ Glomerular filtration rate = ↓ excretion
how to collect human needs statement?
Subjective and objective data
types of enteral drugs
Sublingual and Buccal Medications - allow for rapid absorption into the bloodstream through the oral mucous membranes. Orally Disintegrating Medications - tablet or medicated strip form, dissolve in the mouth without water within 60 seconds. - on the tongue, not under the tongue - absorption through the oral mucosa - allow the medication to dissolve on the tongue and not to chew or swallow the medication or take it with fluids. Liquid Medications - usually for Infants and Children because they cannot swallow pills or capsules - oral-dosing syringe is recommended for measuring small doses of liquid medications. Drugs Through a Nasogastric or Gastrostomy Tube - semi-Fowler's or Fowler's position, and leave the head of the bed elevated for at least 30 minutes afterward to reduce the risk for aspiration -fluid restriction or fluid overload is a concern. It will be necessary to give water along with the medications to flush the tubing. - Check to see if it is recommended for the drug to be given on an empty or full stomach Rectal Drugs -Position the patient on his or her left side, unless contraindicated - Do not insert the suppository into stool. - Remove the wrapping from the suppository and lubricate the rounded tip with water-soluble gel - insert the suppository into the rectum, against the rectal wall, at least 4 inches beyond the internal sphincter - remain lying on the left side for 15 to 20 minutes to allow absorption of the medication. Age-related considerations: With children, it may be necessary to gently but firmly hold the buttocks in place for 5 to 10 minutes until the urge to expel the suppository has passed. Older adults with loss of sphincter control may not be able to retain the suppository.
Considerations for safe pharmacotherapy during Breastfeeding
The primary drug characteristics that increase the likelihood of drug transfer via breastfeeding include fat solubility, low molecular weight, and high concentration. Drug levels in breast milk are usually lower than those in the maternal circulation. The actual amount of exposure depends largely on the volume of milk consumed. The ultimate decision as to whether a breastfeeding mother takes a particular drug depends on the risk/benefit ratio. The risks of drug transfer to the infant in relation to the benefits of continuing breastfeeding and the therapeutic benefits to the mother must be considered on a case-by-case basis.
Metabolism
This is how the body chemically modifies the drug through enzymatic reactions. The liver is the major site. Metabolism transforms the drug into forms that are more easily excreted. It also can increase or decrease the drug's pharmacological activity.
current drug information
Try to use resources dated within the last 3 years
reliable online sources
US Pharmacopeia (USP), US Food and Drug Administration (FDA)
Adverse drug reactions
Unexpected, unintended, or excessive responses to medications given at therapeutic dosages (as opposed to overdose); one type of adverse drug event.
Roles of receptors in pharmacodynamics
When a drug binds to its specific receptor, it can activate or block the receptor, triggering a cascade of cellular mechanisms that lead to the drug's pharmacological effects.
dietary supplements
broad term for orally administered alternative medicines and includes the category of herbal supplements. Dietary supplements are products that are intended to augment the diet and include vitamins, minerals, herbs or other botanicals, amino acids, and enzymes. Dietary supplements may be produced in many forms, such as tablets, capsules, liquids, and powders.
Older Adult Patients
a person who is 65 years of age or older.
influence of ethnicity and genetics adherence
adherence may vary depending on the patient's cultural beliefs, experiences with medications, personal expectations, family expectations and influence, and level of education. Prescribers must be aware that some patients use alternative therapies, such as herbal and homeopathic remedies, which can inhibit or accelerate drug metabolism and therefore alter a drug's response.
drug patents can last:
last 17 years - 7 of them being profitable
Generic name
made by pharmaceutical company Ex: Acetaminophen
doxazosin (alpha1 blocker)
mechanism of action: Decreases BP by inhibiting alpha1-adrenergic receptors in the sympathetic nervous system, causes peripheral vasodilation and reduced peripheral vascular resistance. Relaxes smooth muscle of bladder neck, prostate, and prostate capsule, reducing urethral resistance and increasing urinary outflow. therapeutic use: Manages hypertension and benign prostatic hyperplasia. adverse effects: dizziness, first-dose orthostatic hypotension, palpitations, peripheral edema, sinus tachycardia, dyspnea Interactions: diuretics, other antihypertensives, enhanced hypotensive effects Explain the nursing assessments and interventions required for the safe and effective administration of: do not give to hypotensive patients, Cardura XL not for female pts and is not to be used to treat hypertension. Use cautiously in pts with liver disease (normal dosage can cause exaggerated effects) and in elderly pts (hypotensive response may be more pronounced) Summarize client and family teaching of: Cardura XL Extended release tablets to be taken with food and swallowed whole. Change positions SLOWLY. Avoid exercising, hot weather, and alcohol; this may worsen orthostatic hypotension
Hydralazine
mechanism of action: Exerts a vasodilating effect on vascular smooth muscle . - dilates arteries, not veins. Increases cardiac output, HR, and left ventricular ejection fraction. therapeutic use: Manages essential hypertension. adverse effects: Angina, edema, orthostatic hypotension, tachycardia, dyspnea Interactions: Do not take w/ other antihypertensives, risk of severe hypotension. NSAIDs decrease the effects of hydralazine. All foods may possibly increase bioavailability of hydralazine. Explain the nursing assessments and interventions required for the safe and effective administration of: Monitor BP and HR regularly, weigh pt daily during therapy. Check orthostatic BP watch for signs of orthostatic hypotension Summarize client and family teaching of: Do not take w/ food, may increase incidence of adverse effects. Change position slowly, especially in the morning. Hot showers may increase hypotension. Notify the provider if fever, joint/muscle pain, sore throat occur. Report numbness or tingling in limbs, may require treatment w/ another drug.
Planning (nursing process)
planning phase begins/ setting goals setting goals and outcomes and determining interventions.
Implementation (nursing process)
preceding phases/ Education process The nurse carries out the interventions outlined in the care plan. This is where the actual "hands-on" nursing care is provided.
Medications and Conditions Requiring Special Considerations in the Older Adult Patient
medication common complaints for older adults Opioids - Confusion, constipation, urinary retention, nausea, vomiting, respiratory depression, falls Nonsteroidal antiinflammatory drugs (NSAIDs) - Edema, nausea, gastric ulceration, bleeding, renal toxicity Anticoagulants (heparin, warfarin) - Major and minor bleeding episodes, many drug interactions, dietary interactions Anticholinergics - Blurred vision, dry mouth, constipation, confusion, urinary retention, tachycardia Antidepressants - Sedation and strong anticholinergic adverse effects (see above) Antihypertensives - Nausea, hypotension, diarrhea, bradycardia, heart failure, impotence Cardiac glycosides (e.g., digoxin) - Visual disorders, nausea, diarrhea, dysrhythmias, hallucinations, decreased appetite, weight loss Central nervous system (CNS) depressants (muscle relaxants, opioids) - Sedation, weakness, dry mouth, confusion, urinary retention, ataxia Sedatives and hypnotics - Confusion, daytime sedation, ataxia, lethargy, increased risk for falls Thiazide diuretics - Electrolyte imbalance, rashes, fatigue, leg cramps, dehydration
first pass effect
medications first pass through the liver became inactivated. that means these medications need to be administered another way instead of the GI tract.
Enteral drugs
medications that enter the body through the digestive tract, like oral medications such as pills or liquids
medication errors (opposite from rights of administering meds)
misinterpretation of the prescriber's orders, avoid abbreviations. Medication errors include giving a drug to the wrong patient confusing sound-alike and look-alike drugs administering the wrong drug or wrong dose giving the drug by the wrong route giving the drug at the wrong time.
social factors in the older adult.
money, multiple drugs with multiple prescribers, mental status
Antianginal Drugs
nitroglycerin diltiazem insulin effects
Evaluation (nursing process)
occurs after the nursing care plan has been implemented but also needs to occur at each phase of the nursing process. how effective the interventions were in achieving the desired outcomes. The nurse may need to modify the care plan if goals were not met. Evaluation sets the stage for the next round of the nursing process.
Warfarin
oral anticoagulant drug that is used to prevent blood clots (blood thinner) inhibits vitamin K-dependent clotting factors. people with specific gene variations (CYP2C92, CYP2C93, or VKORC1) need lower doses. - Too much warfarin raises their risk of bleeding. This is especially common in Asians. Labs: monitoring of INR
First Pass Routes
oral, hepatic arterial, portal venous, rectal Considered less than 100% bioavailable. meaning it only sometimes able to go wherever it needs to go when introduced into the body and able to have an active effect.
Heparin
parenteral anticoagulant activating antithrombin to inhibit clotting factors Labs: requires monitoring of aPTT
