Pharmacology

Bethanechol

-Direct cholinergic agonist -Activates bowel and bladder smooth muscle -Used in postoperative and neurogenic ileus -Resistant to AChE

Older Adult Considerations: Absorption

-Gastric pH less acidic -Gastric emptying slowed -Movement through GI tract slowed because of decreased muscle tone and activity -Blood flow to GI tract reduced -Absorptive surface of GI tract reduced

Types of Prescriptions

-Time critical (within 30 min) -Non time critical (within 2 hours or BID/ TID meds within 1 hours) -One time or single dose -STAT (immediately) -PRN. Ex pain or nausea -Standing order. Ex Hypoglycemia med

non-competitive inhibitor

A substance that reduces the activity of an enzyme by binding to a location remote from the active site, changing its conformation so that it no longer binds to the substrate.

The nurse is providing discharge education for a parent whose child will be receiving a prescription at home. Which statement by the parent requires correction? A. I will be the only person administering the prescription. B. I am going to create a medication administration time chart. C. The full dose needs to be re administrated if my child spits some out. D. I will have you watch me administer this prescription before we leave.

C. The full dose needs to be re administrated if my child spits some out. Parents will be instructed to estimate the amount of medication lost and to re administer that amount, rather than the full dose.

CO formula

CO = HR x SV

3 medication checks

Check MAR/order. Check when you pull the medication. Check at the patient bedside.

Scheduled medications

Classification of medications with potential for abuse and misuse

Prednisone

Corticosteroids help reduce inflammation.

Sympathetic drugs

Drugs that affect the NE and E alpha and beta receptors

Fastest to slowest absorption

Fastest: IV Medium: Sub-Q, IM Slow: Oral

Reversal agent for benzodiazepines

Flumazenil (Romazicon)

Factors that affect absorption

Food, age, GI motility, pH level

common herbal interactions

Ginger, Garlic, Gingko, St John's Wort, Valerian, Saw palmetto.

Routes of administration that go through first pass effect?

Hepatic arterial, oral, portal venous, rectal *Rectal has both first pass and non first pass effects

Meds ending in -statin

Hyperlipidemic drug

Reversal agent for calcium channel blockers

IV calcium

examples of time critical medications

Anti coagulation, insulin, antibiotics

Non-First Pass Routes

Aural (instilled into the ear) Buccal Inhaled Intraarterial Intramuscular Intranasal Intraocular Intravaginal Intravenous Subcutaneous Sublingual Transdermal

Older Adult Considerations: Distribution

Lower total body water percentages Increased fat content Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs)

MONA for MI

M - morphine O - oxygen N - nitroglycerin (vasodilator) A - aspirin

Reversal agent for opioids

Naloxone (Narcan)

9 rights of medication administration

Right drug Right dose Right time Right route Right patient Right documentation Right reason Right response Right to Refuse

scheduled drugs

Schedule I: Marijuana, ecstasy, heroin, LSD, and peyote. (Highest potential for abuse) Schedule II: Methamphetamine, cocaine, fentanyl, Vicodin, oxycodone, and Adderall. Schedule III: Anabolic steroids, testosterone, and ketamine. Schedule IV: Xanax, Ambien, Ativan, and Valium. Schedule V: Cough suppressants. (lowest potential for abuse, but still has potential for abuse)

Herbal contraindications for St John's Wort

Schizophrenia, Bipolar depression, Alzheimer's

Acetaminophen dosing

Should not exceed 3 to 4 grams a day.

List of medications should include.

OTC and herbal supplements

Acetaminophen consideration

OTC cold medications

slow acetylators

People known as slow acetylators, for instance, take a longer time than fast acetylators to clear certain drugs from the liver. *Higher risk of development of drug-induced toxicity

reversal agent for warfarin

Vitamin K

partial agonist

a drug that binds to a receptor and causes a response that is less than that caused by a full agonist.

Agonist

a molecule that, by binding to a receptor site, stimulates a response

Reversal agent for acetaminophen

acetylcysteine

meds ending in -olol

beta blockers (blood pressure)

Competive antagonist

bind to receptors at the same binding site (active site) as the endogenous ligand or agonist, but without activating the receptor.

Reversal agent for magnesium sulfate

calcium gluconate

lead poisoning

chelation therapy

Dexcom monitor

continuous monitoring of glucose

Insulin (beta cells of pancreas)

decreases blood glucose levels

In an aging adult, absorption _______ due to pH level ______.

decreases, increasing.

Parasympathetic drugs

drugs that affect the muscarinic and nicotinic receptors

Which drugs cannot be crushed?

enteric-coated slow release extended release sustained release

Synthetic opioids include

fentanyl, methadone, tramadol, dilaudid, meperidine **Stronger than natural opioids

Reversal agent for beta blockers

glucagon

Glucagon (alpha cells of pancreas)

increases blood glucose levels

Parental routes of administration

intradermal, subcutaneous, intramuscular, intravenous

Where does first pass occur?

liver

Fast acetylators

metabolize isoniazid rapidly and have low blood drug levels. *Increased risk of treatment failure

Natural Opioid Analgesics

morphine and codeine

cholinergic receptors

parasympathetic

Acetylcholine

parasympathetic neurotransmitter

Herbal contraindications for ginseng

pregnancy

exocrine function of pancreas

produces digestive enzymes such as lipase and amylose.

reversal agent for heparin

protamine sulfate

Reversal agent for tricyclic antidepressants

sodium bicarbonate

Antagonist receptor

substances or drugs that attach to receptors and prevent them from being activated.

Somatostatin (delta cells)

suppresses secretion of glucagon and insulin

Factors that affect absorption for transdermal medications

sweat, hair, wounds

half-life

time required for 50% of drug to be removed from body.

Enteral route of administration

via GI tract

Pharmacodynamics

what the drug does to the body

When must telephone orders be signed?

within 24 hours and must be repeated to provider for confirmation

Older Adult Considerations: Excretion

•GFR decreased •The number of working nephrons decreased

Fastest to slowest drug absorption

1. oral disintegration, buccal tablets, & oral soluble wafers 2. liquids, elixirs & syrups 3. suspension solutions 4. powders 5. capsules 6. tablets 7. coated tablets 8. enteric-coated tablets

Meds ending in -pril

ACE inhibitors. It works by inhibiting the formation of angiotensin II and blocks release of aldosterone.

Non-opioid analgesics

Acetaminophen NSAIDs (aspirin, ibuprofen, naproxen) Cox inhibitors

BP formula

BP= CO x SVR

Older Adult Considerations: Metabolism

Decreased hormone levels Decreased enzymes Decreased liver function

Reversal agent for digoxin

Digoxin antibodies

first pass effect

The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream.

Pharmacokinetics

The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. (what the body does to the drug)

Pharmacoeconomics

The study of economic factors impacting the cost of drug therapy.

Pharmacogenomics

The study of the influence of genetic factors on drug response that result in the absence, overabundance, or insufficiency of drug-metabolizing enzymes.