Pharmacology Exam 1
assessment of adverse drug effects and allergic reactions: e.g. "if the client is demonstrating an allergic reaction, what should the nurse assess?"
-ABC -When did the symptoms appear? -Did the symptoms diminish or disappear when the drug was stopped? -Did the symtoms return whan the drug was resumed? -Has the patient experienced this before? -Does the underlying illness account for the symptoms? -Is there an interaction with other drugs?
Drug therapy across the lifespan (elderly) and how it influences principles of pharmacokinetics. "If the client is an elderly person, how might the client's drug dosages need to change?"
-Absorption: altered GI absorption is not a major factor; percentage of an oral dose that is absorbed does not change with age; rate of absorption may be slowed; delayed gastric emptying and reduced splanchnic blood flow occur; reduced acidity -Distribution: increased percentage of body fat (storage depot for lipid-soluble drugs and drugs can then be released in abnormal ways); decreased percentage of lean body mass; decreased total body water (distributed in smaller volumes); reduced concentration of serum albumin (fewer buses, especially if malnourished so increased level of free drugs); decreased CO -Metabolism: hepatic metabolism declines with age; reduced hepatic blood flow, reduced liver mass, and decreased activity of some hepatic enzymes occur; half-life of some drugs may increase, and responses are prolonged; responses to oral drugs (those that undergo extensive first-pass effect) may be enhanced bc not as many of the enzymes -Excretion: renal function undergoes progressive decline beginning in early adulthood; reductions in renal blood flow, GFR, active tubular secretion, and number of nephrons; drug accumulation (secondary to reduced renal excretion) is the most important cause of adverse drug reactions in the elderly -higher dosages of drug in the bloodstream
agonists and antagonists
-Agonist (mimicking): drug attaches to a receptor to cause a response; affinity (attraction) and intrinsic activity (ability to activate a response) -Antagonist (blocking): drug attaches to a receptor to block a response; affinity but no intrinsic activity -noncompetitive antagonist: binds irreversibly to receptors; prevents receptor activation aka agonist can't bind -competitive antagonist: binds reversibly to receptors; competition with agonists; can competitively knock off another drug but must give a lot -partial agonist: can acts as an agonist or antagonist; some moderate intrinsic activity, and only reach partial maximum effect -chart on slide 15 of 3rd pwpt is very helpful
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" BRAIN/NERVOUS SYSTEM
-Assess for LOC and mental status changes
Minimum effective concentration (MEC) and minimum toxic concentration (MTC)
-MEC: least amount of drug that is required to exert a therapeutic effect. Plasma drug levels below which therapeutic effects will not occur. Usually start here and titrate up as needed. -Toxic concentration: plasma level at which we see toxic effects; need to keep dose low enough so we don't see toxic effects
Absorption and factors that influence absorption
-Moving drugs from the site of administration into the blood -Rate of absorption influences how soon the drug will take effect and amount of absorption influences the intensity of the drug response. -Rate/amount is influenced by: route of medication delivery (parenteral or enteral), surface area for absorption (better if larger), blood flow (important esp. with cardiac pts), lipid solubility (enhances movement of drug, higher solubility = faster absorption), pH partitioning (acidic/alkalinic things affect blood pH)
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" HEART/QT interval
-QT interval drugs -QT interval: the measure of the time required for the ventricles to repolarize after each contraction -QT drugs have the ability to prolong the QT interval on ECG; with this prolongation comes a serious risk of life-threatening dysrhythmias -susceptible pts: women, elderly, pts with bradycardia, CHF pts, congenital QT prolongation, low K+, low Mg+ -do not use two QT drugs concurrently -Torsades de Pointes (twisting of QRS complex around isoelectric baseline) associated with prolong QT syndrome, causing decrease in CO, sudden drop in BP, dizziness, syncope, can lead to Vfib
Therapeutic range
-Range of doses for therapeutic responses -wider therapeutic range -> more safe the drug is and less precise the dosage needs to be -narrow therapeutic range -> less safe the drug is and more precise dosing and monitoring needs to be -range refers to dose size, index refers to window of safety
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" BONE MARROW
-WBC count -RBC count -platelet count
Metabolism and factors that affect metabolism
-ability to change a drug biologically from its original form into a water-soluble form (able to be excreted from kidneys) -also called biotransformation of drugs -driven by enzyme activity that alters drug structure -primary site of metabolism - LIVER -metabolites produced which can then be excreted -factors influencing metabolism: age, adequacy of blood flow (liver disease causes decreased blood flow to liver so decreased metabolism of drug so potential for toxicity), poor nutrition, other drugs
how to prevent adverse drug effects with the elderly
-adverse drug reactions are way more likely in order adults bc of: altered pharmacokinetics, organ degeneration, polypharmacy, greater severity of illness and comorbidities, greater use of drugs with low TI, and problems with adherence -majority of ADE are dose related, not idiosyncratic -to reduce ADRs: take thorough drug history, consider pharmacokinetic and pharmacodynamic changes due to age, monitor clinical response/plasma drug levels, use the simplest regimen possible, monitor for drug-drug interactions, periodically review the need for continued drug therapy, encourage pts to dispose of old meds, and promote adherence and avoid drugs on the beers list
Transbuccal
-against inside of cheek
types of adverse drug effects
-allergic reaction: the body's immune response ; could be mild itching, a severe rash, or anaphylaxis; determined primarily be degree of sensitization of the immune system; body recognizes drug as a foreign antigen and produces antibodies -idiosyncratic effect -paradoxical effect (opposite of intended) -iatrogenic disease -physical dependence -carcinogenic effect (cancer causing) -teratogenic effect (drug-induce birth defect)
drug safety and potentially fatal drug errors
-an error of commission or omission -risk for errors in hospitals is high, especially overdose, wrong drug, and wrong route -90% of all errors due to human factors, communication mistakes, and name confusion -high-alert medications: drugs that have a heightened risk of causing significant harm when used in error; many safeguards (institute checklists)
Topical medication
-application to body surface (even if med injected into cather to be absorbed by bladder) -safe -onset slow, effect prolonged
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" IMMUNE SYSTEM
-assess WBC count and for symptoms of infection
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" CARDIOTOXICITY
-assess for dysrhythmias and damaged muscle
how to counsel pregnant women in relationship to drug therapy
-avoid unnecessary drug use (alcohol, cocaine) -identify details of exposure -ultrasounds
what information is critical to know to effectively dose a pediatric client
-body surface area
Drug binding to proteins in distribution
-bonds are reversible, the drug hitches a ride to a protein and unattaches to reach target tissues -when bound, the drug is inactive -when unbound, drug is freely distributed and interacts with receptors -ability to bind varies from drug to drug and influences the intensity of the response -theorized that 1 drug can cause another drug to become unbound, causing increased action of the unbound drug (could be toxic)
pregnancy risk categories for drugs and what the categories mean
-category A: remote risk of fetal harm; a guess, never seen any problems -category B: slightly more risk than A; can use -category C: greater risk than B; try and avoid, professional decision; might want to check with provider if prescribed--does benefit outweigh the risk? -category D: proven risk of fetal harm; in a life threatening situation, may need to use -category X: proven risk of fetal harm--contraindicated; DO NOT USE BC ABSOLUTE FETAL HARM -category X drugs include: chemo drugs, immunosuppressants, antiseizure drugs, sex hormones, aspirin and NSAIDS?, cholesterol lowering drugs (some are X some are D)
Factors influencing oral drug absorption
-characteristics of the GI tract (presence or lack of food, stomach acidity, gastric emptying time, surface area for absorption) -chemical properties of a drug (tablets, enteric coated, sustained release, suspensions and syrups)
grapefruit interactions - increased or decreased plasma drug levels?
-chemicals found in grapefruit products can interfere with enzymes that metabolize drugs, causing increased drug levels and side effects -know which drugs should not be taken with grapefruit
developmental/physiological characteristics of infants and children and how they influence principles of pharmacokinetics
-classification of peds patients: neonates (first 4 postnatal weeks), infants (weeks 5-52), children (1 to 12 years), adolescents (12-16 years) -respond differently to drugs. They are more sensitive to drugs (mainly bc of organ system immaturity-liver can't metabolize as well) and so increased risk for ADE -dosage is most commonly based on BSA
drug-food interactions and nursing implications
-decrease absorption: slows down the rate causing a delayed onset of action; interference with extent of absorption (drugs can bind with food) causing a reduced absorption and therefore a decreased therapeutic response -increase absorption: drugs may increase the extent of absorption
Tolerance vs dependence
-dependence: develops during long-term use of certain drugs (e.g. opioids); a state in which the body has adapted to drug exposure in such a way that withdrawal will result if the drug is discontinued -tolerance: decreased responsiveness to a drug as a result of repeated administration -pharmacodynamic tolerance: morphine, minimum effective concentration increased -metabolic tolerance: drugs induce hepatic drug-metabolizing enzymes; increase metabolism so need higher dosing -tachyphylaxis: reduction in responsiveness due to repeated dosing over a short time; having to intermittently apply a nitro patch
drug incompatibilities and other potential interactions?
-direct chemical or physical interaction: interfere with pharmacologic activity, formation of precipitate or change in color -pharmacokinetic interaction: altered ADME and interactions that involve P-glycoprotein 1. altered absorption: elevated gastric pH (antacids causing decreased ionization of basic drugs), laxatives (make drug not absorb as much), drugs that depress peristalsis, drugs that induce vomiting, adsorbent drugs, and drugs that reduce regional blood flow 2. altered distribution: competition for protein binding, alteration of extracellular pH 3. altered metabolism: most important and complex mechanism of drug interaction, attachment of inducing or inhibiting agents to enzymes (inducers increase metabolism of other drugs and cause those other drugs to have sub-therapeutic effects; inhibitors impair metabolism of other drugs causing those other drugs to have prolonged effects and increased side effects 4. altered renal excretion: drugs can alter filtration (if there is decreased CO), reabsorption (if urine pH is altered), and active secretion (which can decrease renal excretion of both drugs) -pharmacodynamic interaction: at the same receptor site (almost always inhibitory) or at separate sites (may be potentiative or inhibitory) -combined toxicity: drugs with overlapping toxicities should not be used together
SQ administration and absorption
-drug into fatty layer of tissue -hurts, risk for infection, inconvenient -sustained release (gradual absorption over time)
therapeutic index and drug safety
-effective dose (ED 50): dose that produces a therapeutic response in 50% of the studied population -"Standard dose" is where we start -therapeutic index = LD50/ED50 -therapeutic index is a measure of the drug's safety -LD50 is the average lethal dose (lethal to 50% of animals treated) -a high index is preferred, it means a drug has a good safety profile; would need a much higher dose to reach toxicity -small TI? monitor.
What type of patients are most apt to develop adverse side effects
-elderly -very young -polypharmacy: taking many meds -limited health literacy
Modified occupancy theory of drug-receptor interaction
-explains why drugs have different potency and efficacy -affinity: strength of attraction between drug and receptor (potency) -intrinsic activity: ability of a drug to activate the receptor once is is attached (efficacy)
genetic and gender differences in drug responses
-genetics: may result in increased or decreased therapeutic and/or adverse effects, most commonly alter metabolism, may also alter drug targets and immune responses to drugs -gender: alcohol is metabolized more slowly by women than be men; certain opioid analgesics are much more effective in women than in men
Sublingual medications
-given under the tongue -absorbed into vascular tongue tissue -rapid absorption into bloodstream
Mechanisms via the kidneys
-glomerular filtration: filtration moves drugs from blood to urine. Protein-bound drugs are not filtered. -passive reabsorption: lipid-soluble drugs move back into the blood. Polar and ionized remain in the urine. -active transport: tubular "pumps" for acids and bases move drugs from blood to urine
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" LIVER
-hepatotoxic drugs: leading cause of liver failure in US; during metabolism, drugs are converted into toxic products causing liver injury; combining hepatotoxic drugs may increase risk for liver damage; at risk for inadequate metabolism which could lead to toxicity; clients at risk include pts with diseased liver and impaired blood flow to liver; monitor AST and ALT for liver injury and watch for S/Sx of liver injury and educate patient (jaundice, dark urine, light-colored stools, nausea, vomiting, malaise, abdominal discomfort, loss of appetite)
Half life
-how long it takes for one-half of the drug dose to be eliminated (usually in percentages) -dependent on metabolism and excretion
iatrogenic and idiosyncratic drug effects
-idiosyncratic effect: an uncommon drug response resulting from a genetic predisposition -iatrogenic disease: sometimes called drug-induced disease, symptoms essentially identical to naturally occurring pathology
Inhibitor drugs
-impairs metabolism of other drugs, causing increased therapeutic effects and risk of toxicity
Inducer drugs
-increase metabolism of other drugs, causing decreased therapeutic effects of those other drugs because less in the system
Drug therapy across the lifespan (infant) and how it influences principles of pharmacokinetics. "If the client is an infant, how might the client's drug dosages need to change?"
-increased sensitivity due to: 1. drug absorption (gastric emptying is more variable and not as acidic), variations in intramuscular, and at risk of OD when transdermally administered bc thinner skin 2. drug distribution: albumin carries billirubin and there is lots of billirubin produced in the first part of life, billirubin is kicked off the bus if given highly protein bound drugs bc protein binding sensitive, but this puts billirubin in the bloodstream (kernicterus). bilirubin moves from bloodstream to brain tissue. Also as far as the blood-brain barrier, there are loose junctions in the brain so other drugs can go in that are NOT small, uncharged, and lipid-soluble -intense and prolonged drug effects
types of drug interactions
-indifference (what we want): therapeutic effects are unaltered -intensification of effects (potentiative actions): increased therapeutic and adverse effects -reduction of effects (inhibitory): reduced therapeutic and adverse effects -creation of a unique response: rarely; and example would be drugs and alcohol causing vomiting
Drug delivery methods and absorption
-influences the rate and extent of absorption -route is determined by the drug properties and desired onset of action -parenteral is quicket onset bc right into bloodstream -enteral, some drug is lost because of first-pass effect (goes through liver).
Simple occupancy theory of drug-receptor interaction
-intensity of a response is related to the number of receptors taken up by the drug -the maximal response occurs when all receptors are taken up by the drug
Importance of lipid solubility of drug to penetrate cell membranes, also to cross blood brain barrier
-lipid-soluble readily passes through membranes
physiologic changes in the elderly and how they influence principles of pharmacokinetics
-look at previous similar question!!!! -pharmacodynamic changes in the elderly: alterations in receptor properties may underlie altered sensitivity to some drugs, causing either more intense effects or less intense effects
measures to promote medication compliance with elderly clients
-many think med regimens won't work, not needed, don't want to spend money on, don't want the side effects -to promote: simplify the regimen, tailor regimen to pts routine, organize the dispensing of the drugs, educate both pt and pts fam, periodic review of meds, assess pts ability to pay, monitor for therapeutic response and ADE, clearly labeled and easy-to-open containers, and daily reminders
Potency vs efficacy
-maximal efficacy: largest effect that a drug can produce -potency: how much drug we must give to get a response -can have same efficacy but different potency
Inhaler
-mist
Oral administration and absorption
-most common method of drug administration -noninvasive so no increased risk for infection, safest, easiest -increased variability in absorption -bioavailability is a concern because of first-pass effect (some of the oral drug is lost after passing through the liver) -drug swallowed, must disintegrate into small particles, then dissolve in the GI fluid, transported to intestine, drug absorbed across the membrane of the intestinal lumen, drug enters portal vein and is transported to liver, liver metabolizes drug, and drug is transported to systemic circulation
IV administration and absorption
-most common parenteral -fastest absorption -drug delivered directly into circulation -rapid onset and tight controls, but expensive and risk of infection and inconvenient
Drug therapy across the lifespan (children) and how it influences principles of pharmacokinetics. "If the client is a child, how might the client's drug dosages need to change?"
-most pharmacokinetic paramaters are similar to those in adults -drug sensitivity is more like that for adults than for children less than 1 year -one important difference: metabolize drugs faster than adults; markedly faster until 2 years of age, then a gradual decline; sharp decline at puberty and reaches adult level -they are vulnerable to unique AE related to organ immaturity and ongoing growth and development
Distribution and factors that affect distribution
-movement of drugs throughout the body -transport of a drug in the body by the bloodstream to the site of action (to cells and tissues) -drugs can form reversible bonds with proteins (albumin) -inhibited by the blood brain barrier -Factors that effect distribution: blood flow to tissues, ability to exit vascular system, ability to enter cells
Education necessary when administering enteric coated or sustained release medications
-must be swallowed whole to maintain a therapeutic drug level -could be toxic if crushed -should not be dissolved in liquid
Drug therapy across the lifespan (breastfeeding) and how it influences principles of pharmacokinetics. "If the client is breastfeeding, how might the client's drug dosages need to change?"
-nearly all drugs pass into breast milk: small, lipid-soluble more likely to go in -concentrations should be 1-2% of the maternal dose -drugs can be excreted in breast milk and effects can occur in the infant
toxic effects of drugs on organs and symptoms of toxicity e.g. "if the drug is toxic to the liver (heart, kidneys, bone marrow), what should the nurse assess for?" KIDNEYS
-need to monitor: UO, BUN, creatinine, GFR, UA -Patients with renal disease: concerns with high drug accumulation (half-life of drug may be much longer bc body excreting at lower rate) and adverse side effects, carefully monitor renal function, assess for the development of renal failure, individualize dose regimen, careful drug selection
Ceiling effect
-occurs in the third phase of the dose-response relationship -phase 1 the dose is so low there is no measurable response -phase 2 the increase in dose causes an increased response -phase 3 the dose reaches a level in which no higher response can be achieved. This is the ceiling effect - can't see any more returns. -Morphine does not have a ceiling effect (watch for adverse effects while titrating up)
Transdermal medication
-patch
physiologic changes in pregnancy and how they influence principles of pharmacokinetics
-physiologic changes of pregnancy can alter pharmacokinetics -absorption: decreased tone and motility, so there is a delayed onset of action -distribution: increased blood volume and total body water, so decreased drug concentrations; increased CO, so increased delivery to tissues; decreased serum albumin, so increased free drug; basically just very unpredictable. -metabolism and excretion: both increased, more blood is put through the kidneys so more excretion. There is a shortened duration of drug action. -during the third trimester, renal blood flow is double and renal excretion is accelerated; tone and mobility of the bowel is decreased and there is prolonged transit and increase in total absorption
Drug therapy across the lifespan (pregnant) and how it influences principles of pharmacokinetics. "If the client is pregnart, how might the client's drug dosages need to change?"
-placental drug transfer -can adversely affect both mom and baby -drug use should be minimized or avoided -drugs ingested by the mom may affect the fetus, some being fetotoxic -to prevent drug problems during pregnancy: obtain a thorough medical history, obtain a complete drug history including OTCs and herbs and birth control, and encourage the pt to notify HCP of problems with drugs bc may require dosage changes
Plasma drug monitoring: peak and trough levels
-plasma drug levels are taken for therapeutic drug monitoring, especially when drugs have a narrow therapeutic index -plasma drug level is the amount of drug present in the bloodstream, and it is predictive of therapeutic and toxic responses -peak plasma level is the highest level achieved by a drug (this is dictated by the route of administration) -trough level is the lowest plasma concentration (drawn 30 minutes prior to the next scheduled dose - if high, will not give next dose) -used for determination of dosing schedules
Drug plateau and number of half-lives to reach a plateau
-plateau: the point at which repeated drug dosing causes a steady level of drug to be achieved -usually reached in approximately 4 half lives -time to reach plateau is independent of dosage size
Assessing kidney function in the elderly
-poor kidney function is evident with higher creatinine levels. -elderly should have creatinine on the lower side bc not as much is produced -look at GFR estimate too (for anyone--this changes how much dosage we would give to a pt)
Sustained release medications
-prolonged, steady release of a drug -DON'T GIVE WITH FOOD -has layers
Enteric coated medication
-protects the drug from gastric enzymes -protects the stomach from the drug -coating slowly wears away and after passing through the stomach is ready to be absorbed
receptors (how they work, what they do, how they interact with drugs)
-receptors are activated by interactions with hormones, neurotransmitters, regulatory molecules and a response is created -these same receptors are places for drugs to work; drugs will either mimic or block -a drug can modify cell function or rate of function, but cannot stimulate a new function or make a cell or tissue perform a function is was not intended to do -drugs are selective and so combine with certain receptors (if highly selective, less adverse effects)
IM administration and absorption
-regulated onset time -usually more sustained release (gradual absorption over time) -hurts, risk for infection, inconvenient
Pharmacodynamics
-study of what drugs do to the body and how they do it -drugs can mimic/block what already happens in the body; can't create something new to happen
critical times during fetal gestational development that abnormalities can occur
-teratogenesis is a concern; to minimize the risk, avoid unnecessary drug use -conception through week 2: either damage so severe that miscarriage occurs or no damage at all -embryonic period (weeks 3 to 8): gross malformations produced by teratogens (structural) -fetal period (week 9 to term): functions disrupted with teratogen exposure; fetus has all parts; functional damage such as intelligence level, seizures, liver function
Bioavailability
-the ability of a drug to reach systemic circulation after administration -the extent to which a drug's active ingredient is absorbed and transported to the site of action -different brands of drugs have different bioavailability, causing a different onset and/or intensity of effects
Excretion and factors that affect excretion
-think KIDNEYS -removal of drugs from the body -drugs need to be hydrophilic (water soluble). If still lipid soluble, will readily pass through cell membrane and go back into system -dependent on adequate renal function -other sources: drugs excreted into bile, breast milk, feces, exhaled
loading dose
-this is used when a drug has a long half-life -give a large initial dose, then follow by maintenance dose -use large loading dose to reach what plateau level would be for maintenance (smaller doses to maintain) -this gets us to the plateau level quicker
nursing interventions to avoid adverse drug interactions
-to avoid chemical or physical incompatibilities: do not administer an IV if you see precipitate, never combine drugs in the same container without establishing compatibility, and flush with saline before and after -assessment: drug history -knowledge of drugs and their interactions -awareness of susceptible patients -adjust drug doses when needed if metabolizing inducers or inhibitors are added or deleted -adjust the timing of administration to minimize interference with absorption -monitor for early signs of toxicity -be vigilant if patient is taking drug with narrow therapeutic range
how to counsel breast-feeding mothers who need to be taking meds
-to decrease risk to an infant: take drugs immediately after breast-feeding, avoid drugs that have a long half-life, choose drugs that tend to be excluded from milk and are least likely to affect the infant, avoid drugs that are known to be hazardous, and do take the lowest dose for the shortest period of time -drugs contraindicated during breast-feeding: controlled substances, anti-cancer drugs, immunosuppressants, and some antiseizure and psych drugs
P-glycoproteins (PGP)
-transport protein -transmembrane protein, transports drugs out of cells -drugs can induce protein and increase PGP functioning (causing reduced drug absorption from the intestine, increasing drug movement from fetal circulation to maternal to reduce fetal drug exposure, increasing drug export from brain tissue into the blood to protect the brain, and increasing drug elimination
How should you instruct patients to take medications on empty stomach?
-usually drugs better absorbed on empty stomach, unless drugs irritate gastric mucosa or cause nausea then give with food. -give drug 1 hour before meals and 2 hours after
Suppository
-vaginal and rectal mucosa
Physiologic factors that influence drug response
1. Administration - dosage, route, timing 2. Pharmacokinetics - absorption, distribution, metabolism, excretion 3. Pharmacodynamics - binding to receptors -> event 4. Individual variations - gender, race, morbidities
Use of the nursing process in drug therapy
1. Assessment for side effects (labs to monitor) - sources of data: patient interview and history, physical examination, lab findings, diagnostic tests - History: allergies, medical history, dietary habits, personal/lifestyle/beliefs, sensory deficits, other drugs, capacity for self-care - baseline data: helps determine effectiveness of drug and adverse effects 2. Diagnosis/Analysis - identify actual and potential health problems - related to side effects of drugs -starting piece for a care plan 3. Planning/Client medication teaching - collaborative process between nurse and patient; involve family - directed at problems identified in analysis -maximizing therapeutic effects and minimizing adverse effects - define goals - insure adherence: client-HCP relationship, nature of the therapeutic regimen (complexity, cost, adverse side effects, disruption in routine) 4. Implementation/Administration of drugs - administering drug - patient education (more in depth in powerpoint) - promoting therapeutic effects and minimizing adverse - the doing phase 5. Evaluation of drug effectiveness - therapeutic response - achievement of outcomes - adverse drug reactions/interactions - patient satisfaction, documentation
Similarities and differences between brand name vs. generic drugs
1. Brand name - trade name or proprietary name - multiple names for drug - more expensive - different trades might work differently because of different fillers 2. Generic name - nonproprietary name - only one name/drug - this is what we remember, the first name given to a drug 3. Similarities - contains the same dose of the drug - generic formulations could differ based on rate and extent of absorption - OTC products with the same Brand-Name may have different active ingredients
Major properties of an ideal drug
1. Effectiveness - this is the most important property of any drug; does the drug do its job? 2. Safety - no such thing as a safe drug; all drugs can cause adverse effects (unintended); side effects (anticipated) 3. Selectivity - want this to be high. How likely will the drug do its job? Other: reversibility, predictability, ease in administration, decreased drug interactions, cost, chemical stability, simple name
Influence of pathophysiologic health problems (e.g. heart, liver, kidney failure) and their influence on drug pharmacokinetics/pharmacodynamics
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placebo effect
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Principles of pharmacokinetics
Absorption, distribution, metabolism, excretion
Prodrugs
Drugs that are inactive when given and activated after metabolism
Most important property of drugs
EFFECTIVENESS
Why is dosing different when switching between oral and parenteral medications?
First-pass effect
What concept largely accounts for differences in dosing schedules between medications?
Half-life
If a second drug induces metabolism what happens? How should the schedule or dose be changed to maintain therapeutic effects?
If a second drug (Drug A) induces metabolism of drug B, then less drug B in the system so less therapeutic effect. Would need an increased dose of drug B to be effective.
Drug approval process: know what defines the four phases, expedited approval
Phase I: normal, healthy volunteers - testing metabolism and biological effects Phase II: small number of volunteers with the disease/illness - therapeutic utility and dosage range Phase III: larger number of volunteers with disease/illness - clinical effectiveness and safety Phase IV: continued surveillance Expedited approval -shortens the drug approval process - drugs for serious and life-threatening health problems such as therapies for Ebola, HIV, and other healthcare crises
Pharmacokinetics definition
Study of drug movement through the body. What happens to a drug from when it enters to the point where it leaves the body.
First pass through the liver: dosing and clinical implications
Will need to increase the dosage because some of the med will be lost since metabolized by the liver before reaching systemic circulation