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.