Pharmacology For Nurses Week 1

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  • a detailed lecture - yet very simple. I highly recommend this to student nurses
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  • Pharmacology
  • Exact starting date thought to begun in the early 1800s. If applied properly drugs can dramatically improve the quality of life
  • Covers traditional and, biological drug categories
  • Cover alternative drug therapy
  • In the early 1900, the U.S. developed and enforced tougher drug legislation to protect the public.
  • Refer to the book for other regulatory acts, legislation, standards and organizations., ,
  • The concerned addressed are is the drug effective, worsens other medical condition, does it interact safely with other medication, or affect one type of a pt. more than others.
  • The Prescription Drug User Fee Act and the FDA Modernization Act . have accelerated the approval process and required drug and biologic manufacturers to provide yearly product user fees
  • Drugs may be organized by their therapeutic or pharmacologic classification. . Two ways to classify drugs are by therapeutic classification and pharmacological classification. The fields of pharmacology and therapeutics are closely connected. Both areas are at the core of the nursing profession.
  • Drugs may be described by More practically classified by a portion of their chemical structure known as the chemical group name.
  • Some say generic are less effective
  • The term propriety suggest ownership
  • Conjugated used to describe a double chemical bond separated by a single bond.
  • Dependence- is a related term, often defined as a physiological or psychological need for a substance. When the drug is no longer available, the individual expresses physical signs of discomfort known as withdrawals
  • OTC drugs may have serious adverse effects (teaching ROY), they may react with food, other drugs and impair their ability to function safely and the potential for harm may increase if the disease is allowed to progress.
  • The “five rights” and “three checks” are guidelines to safe medication administration, they offer guidelines to be used during preparation, delivery and administration. Documentation of the time of administration and any associated side effects should be placed in the medical record.
  • For pharmacologic compliance, the patient must understand and personally accept the value associated with the prescribed drug regimen. Understanding the reasons for noncompliance can help the nurse increase the success of pharmacotherapy
  • Used in conjunction with the five rights and include checking. The fourth check is at the bedside when you tell the patient what you are giving them whether they can respond or not
  • The nurse must know the many abbreviations used to indicate dosing information. Agency policy often dictates the actual times that medications are given.
  • Per JACHO
  • ASAP- Usually within1 hours, STAT- usually twenty-thirty minutes or less. Single doses usually within 2hrs.
  • There are established orders and time schedules by which medications are routinely administered The nurse must understand factors which decrease compliance such as expense, annoying side effects and self-dosing with the medication.
  • Hs (noc) or hour of sleep
  • Prn orders do not follow this time schedule instead start from the time the medication is given
  • The nurse must have a comprehensive knowledge of the actions and side effects of drugs before they are administered. This understanding takes into account the actions and side effects of the drug as well as the physical and emotional needs of each patient.
  • Three broad categories , each has advantages and disadvantages
  • Sublingual route not suitable for extended release
  • NGT is soft and flexible advanced through the nostril into the stomach. GT is surgically into the stomach for patients who need long term care. Both require a functioning G.I. Tract. Other forms of oral (enteral) drug administration include syrups, elixirs, emulsions and suspensions( drugs consisting of 2 chemical agents that separate rapidly, therefore be sure to shake to mix thoroughly
  • Medication may taste nasty, liquid medicine may cause nausea, pills maybe hard to swallow
  • Mucous membranes are the eyes, ears, nose, respiratory tract, urinary tract, vagina, and rectum
  • Landmarks: 2 finger widths down from the acromion process; the bottom edge is at an imaginary line drawn from the axilla.
  • Landmarks: Draw an imaginary line between the greater trochanter and the posterior superior iliac spine; at the middle of the imaginary line, go up about one inch Safe but poses greatest danger for irritation of the sciatic nerve Avoid areas that look inflamed, edematous, or irritated and areas that contain moles, birthmarks, scars or other lesions.
  • Landmarks: With thumb toward the umbilicus, place palm of hand on the greater trocanter, index finger on the anterior superior iliac spine, and the middle finger on the iliac crest.
  • Landmarks: Place one hand below the greater trocanter and one hand above the lateral femoral condyle; mid-lateral thigh.
  • Hold firm pressure with one hand, watch the veins pop out
  • One of the most dangerous once the drug is given it cannot be retrieved. Has potentional for prolonged, contentious administration. Avoids tissue irritation or injury resulting from SQ or IM administration.
  • Parenteral administration results in a rapid onset of drug action. Because of the possibility of introducing microbes directly into the body, Parenteral routes are considered invasive and require aseptic technique. IV administration offers the fastest onset of action and is the most dangerous
  • Pharmacokinetics is the way that the body deals with a drug - how drug moves throughout the body. Pharmacodynamics explains how drugs produce changes in the body.
  • Physiological relating to the way that living things function, rather than to their shape or structure
  • Diffusion – flow, circulation, transmission. (example NA+ normal level 135-140) pt level 157 (high, give D5W (if not diabetic) at 100cc/hr (lower concentration) the sodium moves from it’s higher site toward the dextrose and water the lower concentration. Gradient –slope, incline, grade. Electrochemical -studies chemical change associated with electrons and electricity
  • Interspersed – mix together, intermingle, scatter, sprinkle, spread.
  • pH partitioning Drugs will accumulate on which-ever  side of a membrane that favors their ionization .  So keeping in mind that an acid will ionize in an alkaline environment, and a base will ionize in an acidic environment  we can determine in which environment a drug will accumulate. The processes involved in pharmacokinetics must be considered when choosing the most effective dose, route and schedule for a drug's use.
  • Lipid solubility is an important characteristic, because it determine how quickly a drug is absorbed, mixes within the bloodstream, crosses membranes and becomes localized in body tissues Ionization process by which an atom or molecule loses or gains electrons ,acquiring and electric charge or changing an existing charge. The blood-brain and fetal-placental barriers represent areas in the body where drug distribution may be limited. Lipid-soluble and non- ionized drugs easily cross these barriers; water-soluble and ionized drugs do not.
  • Physiological factors that may affect blood flow include
  • Avoided by Parenteral administration of drugs that undergo rapid hepatic metabolism many drugs absorbed across the intestinal tract are routed directly to the liver, which deactivates them before they can be distributed to body tissues. Usually require higher doses
  • Primary site of excretion are the kidneys. Water- soluble drugs may be secreted into saliva, sweat, and breast milk. As a drug moves through the body, it must cross membranes
  • Several important pharmacokinetics principles can be illustrated by measuring serum drug levels
  • Plasma half –life is an essential pharmacokinetic variable. Drugs with short half-lives must be given more frequently than those with long half-lives.
  • which is the “average” or standard dose of a medication. ED 50 represents the dose required to produce a therapeutic response in 50% of a specific population of patients. The lethal dose is determine in per- clinical trials as part of the drug development process. The therapeutic index offers the nurse practical information on the safety of a drug
  • The higher the potency, the less dose is needed to produce a response. The higher the efficacy, the greater the response
  • Responses to medications are caused by drug-receptor interactions
  • At receptors, drugs mimic or block the action of the body's own regulatory molecules
  • It is hoped that responses that have labeled idiosyncratic can someday be avoided through DNA testing. The very nature of pharmacology requires that the practitioner consider the specifics of age, growth, development, and weight in relation to pharmacokinetics and pharmacodynamics It is hoped that responses that have labeled idiosyncratic can someday be avoided through DNA testing. The very nature of pharmacology requires that the practitioner consider the specifics of age, growth, development, and weight in relation to pharmacokinetics and pharmacodynamics
  • In order to contribute to safe and effective pharmacotherapy, it is essential for the nurse to comprehend and apply fundamental concepts of growth and development. Nurses must possess an understanding of what is considered normal, in terms of growth and developmental patterns, so that deviations from the norm can be identified and health pattern impairments can be appropriately addressed.
  • Infants require special treatment due to their small size and their immature physiologic and biochemical processes.
  • Because liver and kidney are immature drugs will greater impact due to prolong duration of action
  • Giving medication to this age group can be challenging. Avoid placing medication in milk, O.J., or cereal. Oral medication that taste bad should be placed in jam, syrup, or fruit puree if possible.
  • In general, principles of medication administration that oretain to toddlers apply to this age group.
  • Health status of younger adults is generally good; absorption, metabolic, and excretion mechanism are at their peak
  • Because adults are living longer
  • The American Nurses Association publishes a list of ethical principles that nurses can use to guide their decision making. Nurse practice acts are enacted by every state to define the scope of practice of professional nursing and to protect the public
  • The State nursing practice acts, define what a nurse can and cannot do. Check the physician’s orders against the MAR to be certain the correct drugs have been administered.
  • Causes may include omission of one of the “five rights” or giving medications based on verbal, illegible or incomplete orders
  • Use of the nursing process can help reduce the number of medication errors. Nurses should work and collaborate with others on the healthcare team to develop agency policies for the storage and handling of medicines.
  • Subjective what the patient says or perceives, objective- gathered through physical assessment, lab tests, and other diagnostic sources
  • After analyzing the assessment data, the nurse formulates patient-specific nursing diagnoses appropriate for the medications used. Diagnoses will form the basis for the other steps in the Nursing Process
  • Knowledge deficit and non-compliance are the diagnosis used most often. The goal of pharmacotherapy is safe administration with the best therapeutic outcome possible
  • Systems of measurement used in pharmacology include the metric, apothecary, and household systems
  • Rarely used
  • D5W Must know normal dosage for the medication given in %
  • To convert grains to grams divide grains by 15 or 16, to convert grams to grain multiply grams by 15 or 16, to convert minims to milliliters divide minims by 15 or 16
  • 1000mg, 15ml & 3tsp, 1000g & 2.2lb, 1ml
  • Quick review
  • Pharmacology For Nurses Week 1

    1. 1. Pharmacology for Nurses Nur30 Mount Saint Mary’s College Associate Degree in Nursing Program Maggie Davis-Kendrick, RN,MSN
    2. 2. Core Concept in Pharmacology <ul><ul><li>Characterization of: Pharmacology </li></ul></ul><ul><ul><ul><li>Is The Study of Medicine </li></ul></ul></ul><ul><ul><ul><li>Derived from two Greek words </li></ul></ul></ul><ul><ul><ul><ul><li>Pharmakon – medicine drug </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Logos – study </li></ul></ul></ul></ul>
    3. 3. Core Concept In Pharmacology <ul><li>Concepts </li></ul><ul><li>Is a discipline devoted to patient therapy through the use of drugs </li></ul><ul><li>Pharmacology utilizes concepts from human biology, pathophysiology, and chemistry </li></ul>
    4. 4. HX. Of Pharmacology <ul><li>One of the oldest form of healthcare, practiced in virtually every culture dating to antiquity </li></ul><ul><li>Applying products to relieve suffering has been recorded throughout history by virtually every culture </li></ul><ul><li>Modern pharmacology began in the early 19th century through the isolation of specific active agents from their complex mixtures </li></ul>
    5. 5. Regulations and Standards <ul><li>Created to protect the public from drug misuse </li></ul><ul><li>Regulatory agency are responsible for ensuring that drugs and medical devices are safe and effective </li></ul><ul><li>The regulatory agency responsible for ensuring that drugs and medical devices are safe and effective is the Food and Drug Administration (FDA) </li></ul>
    6. 6. Regulations and Standards <ul><li>Laws and other standards formed the basis of modern drug regulation used by agencies and organizations such as the FDA and the U.S. Pharmacopoeia-National Formulary </li></ul><ul><ul><li>Formulary – first standard commonly used by pharmacists </li></ul></ul><ul><ul><li>Pharmacopoeia – medical reference summarizing standards of drug purity, strength and direction for synthesis </li></ul></ul>
    7. 7. The FDA <ul><li>Branch of the U.S. Department of Health and Human Services </li></ul><ul><li>Primary agency responsible for regulating drug safety </li></ul><ul><li>Three branches control policies regarding drug therapies </li></ul>
    8. 8. Branches of the FDA <ul><li>The Center for Drug Evaluation and Research (CDER ) </li></ul><ul><ul><li>Exercises control over whether prescription drugs and OTC maybe used for therapy </li></ul></ul><ul><li>The Center for Biologics Evaluation and Research (CBER) </li></ul><ul><ul><li>Regulates use of biologics including serums, vaccines, and blood products </li></ul></ul>
    9. 9. Branches of the FDA <ul><li>The Center for Food Safety and Applied Nutrition (CFSAN ) </li></ul><ul><ul><li>Regulates administration of herbal products and dietary supplements </li></ul></ul><ul><li>Drug regulations were created to protect the public from drug misuse </li></ul><ul><li>The first drug laws were created by Congress to protect clients from wrongful therapeutic claims </li></ul>
    10. 10. Drug Legislation <ul><li>1902- Biological Control Act to help standardize- the quality of serum and other blood-related products </li></ul><ul><li>1906 - Pure Food and Drug Act, gave the government power to control labeling of medicine </li></ul><ul><li>1912- Sherley Amendment prohibited the sale of drugs labeled with false therapeutic claims that were intended to defraud the consumer </li></ul>
    11. 11. Drug Legislation <ul><li>1938 – Food, Drug, and Cosmetic Act, first law preventing the sale of drugs that had not been thoroughly tested before marketing </li></ul><ul><li>1994 – Dietary Supplement Health and Education Act passed in an attempt to control misleading industry claims </li></ul>
    12. 12. Stages of Drug Approval <ul><li>There are four stages of approval for therapeutic and biologic drugs </li></ul><ul><ul><li>Pre-clinical investigation – involves extensive laboratory research on humans and microbial cells cultured in the laboratory </li></ul></ul><ul><ul><li>Clinical investigation – takes place in three different stages termed clinical phase trials </li></ul></ul>
    13. 13. Stages of Drug Approval <ul><li>Stage II Clinical Phase Trials </li></ul><ul><ul><li>Longest part of drug approval process </li></ul></ul><ul><ul><li>Essential component of drug evaluation </li></ul></ul><ul><ul><li>Tests performed on healthy volunteers to determine proper dosage and assess for adverse effects </li></ul></ul>
    14. 14. Clinical Phase Trials <ul><li>Large group of selected patients with the particular disease are given the medicine </li></ul><ul><li>Clinical investigators from different medical specialists address concerns, if drug appears effective without serious side effects, maybe used immediately in special cases with careful monitoring </li></ul>
    15. 15. Stages of Drug Approval <ul><li>New Drug Application (NDA) with review </li></ul><ul><ul><li>Third stage </li></ul></ul><ul><ul><li>FDA permitted six months to initially review a NDA </li></ul></ul><ul><ul><li>Average review time 17-24 months </li></ul></ul><ul><ul><li>Process suspended if rejected until concerns are addressed by the pharmaceutical company </li></ul></ul>
    16. 16. Stages of Drug Approval <ul><li>Post Marketing Surveillance </li></ul><ul><ul><li>Final stage of drug approval process </li></ul></ul><ul><ul><li>Begins after clinical trials and the NDA are completed </li></ul></ul><ul><ul><li>Purpose is to survey for harmful drug effects in a large population </li></ul></ul><ul><ul><li>Weighs therapeutic benefits versus its identified risks </li></ul></ul>
    17. 17. Classification of Drug <ul><li>Therapeutic </li></ul><ul><ul><li>Clearly states what the drug does clinically </li></ul></ul><ul><ul><li>Is the discipline dealing with the treatment of suffering and the prevention of disease </li></ul></ul><ul><li>Pharmacologic –refers to the way an agent work at the molecular, tissue, and body system </li></ul><ul><ul><li>Addresses a drug mechanism of action </li></ul></ul><ul><ul><li>More specific than therapeutic </li></ul></ul><ul><ul><li>Requires understanding of biochemistry and physiology </li></ul></ul><ul><li>Pharmacotherapy or Pharmacotherapeutics </li></ul><ul><ul><li>Is the application of drugs for the purpose of disease prevention and treatment of suffering </li></ul></ul>
    18. 18. Classification of Drug <ul><li>Prototype - used to compare drugs within the same classification </li></ul><ul><ul><li>Original prototype not most widely used </li></ul></ul><ul><ul><li>Newer drugs in same class maybe more effective </li></ul></ul><ul><ul><li>Have more favorable safety profile and longer duration of action </li></ul></ul>
    19. 19. Drug Names <ul><li>Three basic drug names </li></ul><ul><ul><li>Chemical </li></ul></ul><ul><ul><ul><li>Helpful in predicting a substances physical and chemical properties </li></ul></ul></ul><ul><ul><ul><li>Often complicated and difficult to remember or pronounce </li></ul></ul></ul><ul><ul><ul><li>Chemical name for diazepam: 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one </li></ul></ul></ul>
    20. 20. Drug Names <ul><li>Generic </li></ul><ul><ul><li>Name is assigned by the U.S. Adopted Names Council </li></ul></ul><ul><ul><li>Less complicated and easier to remember </li></ul></ul><ul><ul><li>Only one generic name for each drug </li></ul></ul><ul><ul><li>Less expensive </li></ul></ul>
    21. 21. Drug Names <ul><li>Trade </li></ul><ul><ul><li>Assigned by company marketing the drug </li></ul></ul><ul><ul><li>Sometimes called proprietary, product or brand name </li></ul></ul><ul><ul><li>May have multiple names </li></ul></ul><ul><ul><li>Selected to be short and easy to remember </li></ul></ul>
    22. 22. Drug Names <ul><li>Generic substance </li></ul><ul><ul><li>Aspirin </li></ul></ul><ul><ul><li>Diphenhydramine </li></ul></ul><ul><ul><li>Ibuprofen </li></ul></ul><ul><li>Brand Name </li></ul><ul><ul><li>Anacin, Bayer, Excedrin </li></ul></ul><ul><ul><li>Benadryl, Caladryl, Allerdryl </li></ul></ul><ul><ul><li>Advil, Motrin, Midol </li></ul></ul>
    23. 23. Generic/Brand Names <ul><li>Generic Name </li></ul><ul><li>Conjugated Estrogen </li></ul><ul><li>Digoxin </li></ul><ul><li>Levothyroxine Sodium </li></ul><ul><li>Wafarin </li></ul><ul><li>Brand Name Equiv . </li></ul><ul><li>Premarin </li></ul><ul><li>Lanoxin </li></ul><ul><li>Synthroid </li></ul><ul><li>Coumadin </li></ul>
    24. 24. Classification of Therapeutics <ul><li>General categories </li></ul><ul><ul><li>Traditional Drugs - chemical agent capable of producing biological responses within the body (therapeutic or adverse) RAM </li></ul></ul><ul><ul><li>Biologics - agents naturally produced in animals cells, microorganisms, or by the body itself </li></ul></ul><ul><ul><li>Alternative Therapies - herbal supplements and certain techniques </li></ul></ul>
    25. 25. Controlled Substances <ul><li>Drugs that have potential for abuse or physical and psychological dependence </li></ul><ul><li>Use restricted by the Control Substance Act </li></ul><ul><li>A special order form needed to obtain schedule II drugs </li></ul><ul><li>There are five drug schedules of controlled substances </li></ul>
    26. 26. Schedule of Controlled Substance <ul><li>Schedule/Abuse Potential </li></ul><ul><ul><li>I/carries highest risk </li></ul></ul><ul><ul><li>II/carries high potential </li></ul></ul><ul><ul><li>III/moderate abuse risk </li></ul></ul><ul><ul><li>IV/low abuse risk </li></ul></ul><ul><ul><li>V/least abuse potential </li></ul></ul><ul><li>Therapeutic Use/ Example </li></ul><ul><li>Limited or no use/heroin, LSD, Marijuana </li></ul><ul><li>With prescription/MS, PCP, Cocaine </li></ul><ul><li>With prescript./Codeine, ASA, Tylenol </li></ul><ul><li>With prescript/Darvon, Librium, Valium </li></ul><ul><li>Without prescription OTC </li></ul>
    27. 27. Methods of Dispensing Drugs <ul><li>Two major methods </li></ul><ul><ul><li>Purchase of prescriptions drugs with a physician’s order </li></ul></ul><ul><ul><li>Purchase of over the counter (OTC) drugs which do not require a physician’s order </li></ul></ul><ul><ul><li>There are advantages and disadvantages to both methods of dispensing </li></ul></ul>
    28. 28. Principles of Drug Administration <ul><li>Rights of Drug Administration </li></ul><ul><ul><li>Right patient </li></ul></ul><ul><ul><li>Right medication </li></ul></ul><ul><ul><li>Right dose </li></ul></ul><ul><ul><li>Right route </li></ul></ul><ul><ul><li>Right time </li></ul></ul><ul><ul><li>Right documentation </li></ul></ul>
    29. 29. Principles of Drug Administration <ul><li>Additional Rights </li></ul><ul><ul><li>Right to refuse </li></ul></ul><ul><ul><li>Right to receive medication education </li></ul></ul><ul><ul><li>Right preparation </li></ul></ul>
    30. 30. Principles of Drug Administration <ul><li>Three Checks of medication administration </li></ul><ul><ul><li>Checking the medication with the medication administration record (MAR) when removing it from its stored location </li></ul></ul><ul><ul><li>Checking the medication when preparing it </li></ul></ul><ul><ul><li>Checking the medication before administering it to the patient. </li></ul></ul>
    31. 31. Principles of Drug Administration <ul><li>Abbreviations </li></ul><ul><ul><li>Table 4.1, Pg. 31 text </li></ul></ul><ul><ul><li>Front cover pg. Drug Calculation book </li></ul></ul><ul><ul><ul><li>ac before meal </li></ul></ul></ul><ul><ul><ul><li>Po or per os – by mouth </li></ul></ul></ul><ul><ul><ul><li>pc – after meals </li></ul></ul></ul><ul><ul><ul><li>mEq – milliequivalent </li></ul></ul></ul><ul><ul><ul><li>gtt - drop </li></ul></ul></ul><ul><ul><ul><li>hs – hour of sleep, at bedtime </li></ul></ul></ul>
    32. 32. Principles of Drug Administration <ul><li>Do not use </li></ul><ul><ul><li>U or u </li></ul></ul><ul><ul><li>IU </li></ul></ul><ul><ul><li>q.d. or QD </li></ul></ul><ul><ul><li>q.o.d. or QOD </li></ul></ul><ul><ul><li>MS </li></ul></ul><ul><ul><li>MSO4 </li></ul></ul><ul><ul><li>Zero after decimal point (1.0) </li></ul></ul><ul><li>Use instead </li></ul><ul><ul><li>Unit </li></ul></ul><ul><ul><li>International Unit </li></ul></ul><ul><ul><li>Daily </li></ul></ul><ul><ul><li>Every other day </li></ul></ul><ul><ul><li>Morphine </li></ul></ul><ul><ul><li>Morphine sulfate </li></ul></ul><ul><ul><li>1 </li></ul></ul>
    33. 33. Principles of Drug Administration <ul><li>Do not use </li></ul><ul><ul><li>MgSO4 </li></ul></ul><ul><ul><li>mg </li></ul></ul><ul><ul><li>TIW or tiw </li></ul></ul><ul><ul><li>AS </li></ul></ul><ul><ul><li>AD </li></ul></ul><ul><ul><li>AU </li></ul></ul><ul><ul><li>No zero before decimal dose (0.5mg) </li></ul></ul><ul><li>Use instead </li></ul><ul><ul><li>Magnesium Sulfate </li></ul></ul><ul><ul><li>Micro gram </li></ul></ul><ul><ul><li>Three times weekly </li></ul></ul><ul><ul><li>Left ear </li></ul></ul><ul><ul><li>Right ear </li></ul></ul><ul><ul><li>Both ears </li></ul></ul><ul><ul><li>.5mg </li></ul></ul>
    34. 34. Principles of Drug Administration <ul><li>Time Schedule </li></ul><ul><ul><li>ASAP – as soon as possible </li></ul></ul><ul><ul><li>STAT – immediately </li></ul></ul><ul><ul><li>Single – one time dose </li></ul></ul><ul><ul><li>Routine – daily dose </li></ul></ul><ul><ul><li>Standing – parameters left to follow </li></ul></ul><ul><ul><li>PRN – when needed </li></ul></ul><ul><li>Drug Orders </li></ul><ul><ul><li>Clonidine .2mg po twice daily, hold for SBP<100 </li></ul></ul>
    35. 35. Principles of Drug Administration <ul><li>Drug Orders </li></ul><ul><ul><li>Vancomycin 750mg IV stat, followed by Gentamycin 1gm IV </li></ul></ul><ul><ul><li>Lasix 40mg IV now and daily PO </li></ul></ul><ul><ul><li>Tylenol 650mg po or pr, q 4hr prn temp. > 101 or mild pain </li></ul></ul>
    36. 36. Principles of Drug Administration <ul><li>Time Schedules (military time) </li></ul><ul><ul><ul><li>Daily or q am 0900 </li></ul></ul></ul><ul><ul><ul><li>Twice daily 0900 1700 </li></ul></ul></ul><ul><ul><ul><li>Three times daily 0900 1300 1700 </li></ul></ul></ul><ul><ul><ul><li>Four times daily 0900 1300 1700 2100 </li></ul></ul></ul><ul><ul><ul><li>Every pm 1700 </li></ul></ul></ul>
    37. 37. Principles of Drug Administration <ul><li>Time Schedules (military time) </li></ul><ul><ul><ul><li>Every hs (noc) 2200 </li></ul></ul></ul><ul><ul><ul><li>Every 4 hours 0001 0400 0800 1200 1600 2000 </li></ul></ul></ul><ul><ul><ul><li>Every 6 hours 0001 0600 1200 1800 </li></ul></ul></ul><ul><ul><ul><li>Every 8 hours 0001 0800 1600 </li></ul></ul></ul><ul><ul><ul><li>Every 12 hours 0600 1800 </li></ul></ul></ul>
    38. 38. Principles of Drug Administration <ul><li>Documentation </li></ul><ul><ul><li>If medication refused or omitted and reason </li></ul></ul><ul><ul><li>Any assessment </li></ul></ul><ul><ul><li>Dosage and time administered </li></ul></ul><ul><ul><li>Medication name and your signature </li></ul></ul><ul><ul><li>Example: Tylenol 650mg pr (rectally) given for temp. 101.6 orally at 1600. M. Davis-Kendrick RN </li></ul></ul>
    39. 39. Principles of Drug Administration <ul><li>Nursing Management </li></ul><ul><ul><li>Assumes great responsibility for drug administration </li></ul></ul><ul><ul><li>Firm knowledge of drug </li></ul></ul><ul><ul><ul><li>Name and classification </li></ul></ul></ul><ul><ul><ul><li>Intended or proposed use </li></ul></ul></ul><ul><ul><ul><li>Effects on body </li></ul></ul></ul><ul><ul><ul><li>Contraindication/special consideration </li></ul></ul></ul><ul><ul><ul><li>Side effects </li></ul></ul></ul>
    40. 40. Principles of Drug Administration <ul><li>Nursing Management </li></ul><ul><ul><li>Why prescribed for this patient </li></ul></ul><ul><ul><li>How supplied by pharmacy </li></ul></ul><ul><ul><li>How is medication to be administered with dosage ranges </li></ul></ul><ul><ul><li>What nursing process consideration related to medication apply to this particular patient </li></ul></ul>
    41. 41. Routes of Drug Administration <ul><li>Enteral </li></ul>
    42. 42. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><li>Includes drugs given orally and those administered through nasogastric or gastrostomy tubes </li></ul></ul><ul><ul><li>The sublingual and buccal routes are less commonly used enteral routes, dissolved directly into blood stream </li></ul></ul><ul><ul><li>Is the most common, convenient, and usually, the least costly of all the routes </li></ul></ul>
    43. 43. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><li>Tablets </li></ul></ul><ul><ul><ul><li>Maybe formulated to release the drug in a steady controlled manner </li></ul></ul></ul><ul><ul><ul><li>Maybe scored for individual dosage, </li></ul></ul></ul><ul><ul><ul><li>Maybe enteric-coated (EC) to dissolve in alkaline environment of sm. intestines </li></ul></ul></ul><ul><ul><ul><li>Sustained- Release also called extended –release (XR), long acting (LA), or slow-release (SR) </li></ul></ul></ul><ul><ul><ul><li>Do not crush EC or slow releasing tablets </li></ul></ul></ul>
    44. 44. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><li>Capsules </li></ul></ul><ul><ul><ul><li>Drug encased in shell of hard or soft gelatin </li></ul></ul></ul><ul><ul><ul><li>Also comes extended release </li></ul></ul></ul><ul><ul><ul><li>Extended-release capsules must not be opened </li></ul></ul></ul><ul><ul><li>Sublingual </li></ul></ul><ul><ul><ul><li>Placed under tongue and allowed to dissolve </li></ul></ul></ul><ul><ul><ul><li>Result in a rapid onset of action </li></ul></ul></ul>
    45. 45. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><li>Buccal </li></ul></ul><ul><ul><ul><li>Placed in oral cavity between gums and cheeks </li></ul></ul></ul><ul><ul><ul><li>Mucosa less preamble than sublingual </li></ul></ul></ul><ul><ul><ul><li>Slower absorption than sublingual </li></ul></ul></ul><ul><ul><ul><li>Preferred over sublingual for sustained release </li></ul></ul></ul>
    46. 46. Routes of Drug Administration <ul><ul><li>Troches (lozenge) </li></ul></ul><ul><ul><ul><li>Commonly used to achieve local effect </li></ul></ul></ul><ul><ul><ul><li>Held within the mouth until dissolved </li></ul></ul></ul><ul><ul><li>NGT/GT </li></ul></ul><ul><ul><ul><li>Useful if patient unable to swallow </li></ul></ul></ul><ul><ul><ul><li>Medication is crushed or dissolved </li></ul></ul></ul>
    47. 47. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><ul><li>Do not crush sustained release drugs or EC </li></ul></ul></ul><ul><ul><ul><li>If tube connected to suction, hold for 30 minutes after giving medication </li></ul></ul></ul><ul><ul><ul><li>If drug interferes with tube feeding hold feeding for 1 hour before and 2 hours after </li></ul></ul></ul>
    48. 48. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><li>Advantages </li></ul></ul><ul><ul><ul><li>Safe </li></ul></ul></ul><ul><ul><ul><li>Convenient </li></ul></ul></ul><ul><ul><ul><li>Least expensive </li></ul></ul></ul><ul><ul><li>Disadvantages </li></ul></ul><ul><ul><ul><li>Patient must be alert and able to swallow </li></ul></ul></ul><ul><ul><ul><li>Need to stay until medicine is taken </li></ul></ul></ul><ul><ul><ul><li>Greater chance for refusal and non compliance </li></ul></ul></ul>
    49. 49. Routes of Drug Administration <ul><li>Enteral </li></ul><ul><ul><li>Nursing Consideration </li></ul></ul><ul><ul><ul><li>Assess patient level of consciousness </li></ul></ul></ul><ul><ul><ul><li>Assess allergies </li></ul></ul></ul><ul><ul><ul><li>Monitor vital signs or lab result </li></ul></ul></ul><ul><ul><ul><li>Perform the 5 rights of administration and </li></ul></ul></ul><ul><ul><ul><li>The three checks before administering medication </li></ul></ul></ul><ul><ul><ul><li>Documentation </li></ul></ul></ul>
    50. 50. Routes of Drug Administration <ul><li>Topical </li></ul><ul><ul><li>Application </li></ul></ul><ul><ul><ul><li>Instillations and irrigations –applied into body cavity or orifices </li></ul></ul></ul><ul><ul><ul><li>These include the eyes, ears, nose bladder, rectum and vagina </li></ul></ul></ul><ul><ul><ul><li>Inhalations – drugs applied to the respiratory tract by inhalers, nebulizers, or positive pressure breathing machines </li></ul></ul></ul>
    51. 51. Routes of Drug Administration <ul><li>Topical </li></ul><ul><ul><li>Transdermal </li></ul></ul><ul><ul><ul><li>Effective way of delivering specific amounts of medications </li></ul></ul></ul><ul><ul><ul><li>Patches are changed/rotated on a regular basis </li></ul></ul></ul><ul><ul><ul><li>Slow release and absorption </li></ul></ul></ul><ul><ul><li>Ophthalmic </li></ul></ul><ul><ul><ul><li>Used to treat local conditions of the eye and surrounding structure </li></ul></ul></ul><ul><ul><ul><li>Available in the form of irrigation, drops, ointments, and medicated disks </li></ul></ul></ul>
    52. 52. Routes of Drug Administration <ul><li>Topical </li></ul><ul><ul><li>Otic </li></ul></ul><ul><ul><ul><li>Used to treat local conditions of the ear and auditory canal </li></ul></ul></ul><ul><ul><ul><li>Includes eardrops and irrigations </li></ul></ul></ul><ul><ul><ul><li>Perform carefully on infants and young children to avoid injury to sensitive structures of the ear </li></ul></ul></ul><ul><ul><li>Nasal </li></ul></ul><ul><ul><ul><li>Used for both local and systemic drug administration </li></ul></ul></ul><ul><ul><ul><li>Drops or sprays often used for their local astringent effect which is to shrink swollen mucous membranes </li></ul></ul></ul>
    53. 53. Routes of Drug Administration <ul><li>Topical </li></ul><ul><ul><li>Vaginal </li></ul></ul><ul><ul><ul><li>Used to treat local vaginal infections, and to relieve pain and itching </li></ul></ul></ul><ul><ul><ul><li>Inserted in suppositories, creams, jellies, or foam </li></ul></ul></ul><ul><ul><li>Rectal </li></ul></ul><ul><ul><ul><li>Used for either local or systemic administration </li></ul></ul></ul><ul><ul><ul><li>Normally in suppository form </li></ul></ul></ul><ul><ul><ul><li>Slowest rate of absorption </li></ul></ul></ul>
    54. 54. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Dispensing of medications via a needle </li></ul></ul><ul><ul><li>Usually into the skin layers, subcutaneous tissue, muscles or veins </li></ul></ul><ul><ul><li>Advance deliveries include into arteries, body cavities and organs </li></ul></ul><ul><ul><li>Aseptic technique must be strictly applied </li></ul></ul>
    55. 55. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Intradermal (ID) </li></ul></ul><ul><ul><ul><li>ID administered into the dermis (1 st layer of skin) </li></ul></ul></ul><ul><ul><ul><li>Easily absorbed because of more blood vessels </li></ul></ul></ul><ul><ul><ul><li>Usually for allergies, TB, anesthetic, or prior to IV insertion </li></ul></ul></ul><ul><ul><ul><li>Limited to small volumes (0.1 to 0.2ml) </li></ul></ul></ul><ul><ul><ul><li>Use only 25 or 27 gauge needle </li></ul></ul></ul><ul><ul><ul><li>Inject into non-hairy skin surfaces (inner forearm ) </li></ul></ul></ul>
    56. 56. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Subcutaneous (sub-q, SC, SQ) </li></ul></ul><ul><ul><ul><li>Administered into fatty tissue </li></ul></ul></ul><ul><ul><ul><li>Less absorption than IM, distributed through capillaries </li></ul></ul></ul><ul><ul><ul><li>Insulin, heparin, vitamins, some vaccines and narcotics </li></ul></ul></ul><ul><ul><ul><li>Sites used are upper, lateral arms, anterior thigh, abdomen and mid back </li></ul></ul></ul><ul><ul><ul><li>Doses small in volume (0.5 – 1cc) per injection </li></ul></ul></ul>
    57. 57. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Subcutaneous (sub-q, SC, SQ) </li></ul></ul><ul><ul><ul><li>Not necessary to aspirate </li></ul></ul></ul><ul><ul><ul><li>Rotate sites </li></ul></ul></ul><ul><ul><ul><li>TB and Insulin syringes are not interchangeable </li></ul></ul></ul><ul><ul><ul><li>Use 5/8 inch needle </li></ul></ul></ul><ul><ul><ul><li>Size of individual determines angle of injection (45 vs. 90 degree angle) </li></ul></ul></ul>
    58. 58. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Intramuscular (IM) </li></ul></ul><ul><ul><ul><li>Delivers medication injected into a certain muscle </li></ul></ul></ul><ul><ul><ul><li>Onset of action more rapid than SQ because of rich blood supply </li></ul></ul></ul><ul><ul><ul><li>Many are dry power and must be reconstituted before administration </li></ul></ul></ul>
    59. 59. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Intramuscular (IM) </li></ul></ul><ul><ul><li>Most common sites </li></ul></ul><ul><ul><ul><li>Deltoid </li></ul></ul></ul><ul><ul><ul><li>volume not to exceed </li></ul></ul></ul><ul><ul><ul><li>2 ml </li></ul></ul></ul><ul><ul><ul><li>Small volume vaccines </li></ul></ul></ul><ul><ul><ul><li>1” needle </li></ul></ul></ul>
    60. 60. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Intramuscular (IM) Most common sites </li></ul></ul><ul><ul><ul><li>Dorsogluteal </li></ul></ul></ul><ul><ul><ul><li>Up to 3ml/injection </li></ul></ul></ul><ul><ul><ul><li>1-1.5” needle </li></ul></ul></ul><ul><ul><ul><li>Aspirate </li></ul></ul></ul><ul><ul><ul><li>Inject slow & smooth </li></ul></ul></ul>
    61. 61. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Intramuscular (IM) </li></ul></ul><ul><ul><li>Ventrogluteal </li></ul></ul><ul><ul><ul><li>Preferred site </li></ul></ul></ul><ul><ul><ul><li>Contains no large </li></ul></ul></ul><ul><ul><ul><li>vessels or nerves </li></ul></ul></ul><ul><ul><ul><li>Suitable for children </li></ul></ul></ul><ul><ul><ul><li>and infants over seven </li></ul></ul></ul><ul><ul><ul><li>months </li></ul></ul></ul>
    62. 62. Routes of Drug Administration <ul><li>Parenteral </li></ul><ul><ul><li>Intramuscular (IM) </li></ul></ul><ul><ul><ul><li>Rectus femoris </li></ul></ul></ul><ul><ul><ul><ul><li>Used for infants </li></ul></ul></ul></ul><ul><ul><ul><li>Vastus lateralis </li></ul></ul></ul><ul><ul><ul><ul><li>Middle third used for injection </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Used most often in children </li></ul></ul></ul></ul>
    63. 63. Routes of Drug Administration <ul><li>Intravenous </li></ul>
    64. 64. Routes of Drug Administration <ul><li>Intravenous Administration (I.V.) </li></ul><ul><ul><li>Direct delivery into systemic </li></ul></ul><ul><ul><li>circulation, bypasses absorption </li></ul></ul><ul><ul><li>process </li></ul></ul><ul><ul><li>Rapid onset of action </li></ul></ul><ul><ul><li>Allows large volumes to be given </li></ul></ul><ul><ul><li>Acceptable when no other route </li></ul></ul><ul><ul><li>possible </li></ul></ul>
    65. 65. Routes of Drug Administration <ul><li>Intravenous Administration (I.V.) </li></ul><ul><ul><li>Three Basic Types </li></ul></ul><ul><ul><ul><li>Large volume infusion </li></ul></ul></ul><ul><ul><ul><ul><li>For maintenance, replacement or supplement </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mixture of compatible drugs </li></ul></ul></ul></ul><ul><ul><ul><li>Intermittent infusion </li></ul></ul></ul><ul><ul><ul><ul><li>Intravenous Piggy Back (IVPB) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Used to instill adjunct medication (analgesic, antibiotics ) </li></ul></ul></ul></ul>
    66. 66. Routes of Drug Administration <ul><li>Intravenous Administration (I.V.) </li></ul><ul><ul><li>Three Basic Types </li></ul></ul><ul><ul><ul><li>IV Bolus or IV Push </li></ul></ul></ul><ul><ul><ul><ul><li>Concentrated dose delivered via syringe </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Monitor closely for adverse reaction </li></ul></ul></ul></ul><ul><ul><ul><ul><li>May take several minutes depending on the drug </li></ul></ul></ul></ul>
    67. 67. Pharmacokinetics/ Pharmacodynamics <ul><li>Molecules </li></ul><ul><li>Receptor Sites </li></ul>
    68. 68. Pharmacokinetics <ul><li>Derived from the root words </li></ul><ul><ul><li>Pharmaco – medicine </li></ul></ul><ul><ul><li>Kinetics – movement or motion </li></ul></ul><ul><li>Focuses on the movement of drugs throughout the body after they are administered </li></ul><ul><li>Deals with how the body metabolizes and excretes drugs </li></ul>
    69. 69. Pharmacokinetics <ul><li>Describes the barriers that drugs must penetrate to achieve therapeutic success </li></ul><ul><li>Physiological properties of plasma membranes determine movement of drugs throughout the body </li></ul>
    70. 70. Pharmacokinetics <ul><li>Drugs primarily use two processes to cross body membranes </li></ul><ul><ul><li>Diffusion or Passive transport </li></ul></ul><ul><ul><ul><li>Movement of chemical from area of higher concentration to lower concentration </li></ul></ul></ul><ul><ul><li>Active transport </li></ul></ul><ul><ul><ul><li>Against a concentration or electrochemical gradient </li></ul></ul></ul>
    71. 71. Pharmacokinetic s <ul><li>Diffusion </li></ul>
    72. 72. Pharmacokinetics <ul><li>Plasma membrane consist of lipid bilayer with proteins and other molecules interspersed in the membrane </li></ul><ul><ul><li>This lipophilic membrane is relatively impermeable to large molecules, ions, and polar, molecules </li></ul></ul><ul><ul><li>Drugs that are small, uncharged, and lipid soluble are distributed more completely than those that are large, ionized, and water-soluble </li></ul></ul><ul><ul><li>These physical characteristic have direct application on pharmacokinetics </li></ul></ul>
    73. 73. Pharmacokinetics <ul><li>The Processes of Pharmacokinetics </li></ul><ul><ul><li>Absorption </li></ul></ul><ul><ul><ul><li>Movement of the drug from it’s administration site into systemic circulation </li></ul></ul></ul><ul><ul><ul><li>Many factors affect drug movement </li></ul></ul></ul><ul><ul><ul><ul><li>Rate of Dissolution- how fast the drug dissolve </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Surface Area- larger surface area = faster absorption </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Blood Flow: Greater blood flow = faster absorption </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lipid Solubility- High lipid solubility = faster absorption </li></ul></ul></ul></ul><ul><ul><ul><ul><li>pH Partitioning - ionize in the blood and not at the site of administration </li></ul></ul></ul></ul>
    74. 74. Pharmacokinetics <ul><li>Pharmacokinetics Processes </li></ul><ul><ul><li>Distribution </li></ul></ul><ul><ul><ul><li>Represents how drugs are transported throughout the body </li></ul></ul></ul><ul><ul><ul><li>Variables affecting distribution </li></ul></ul></ul><ul><ul><ul><ul><li>Lipid solubility </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Degree of ionization </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Plasma protein binding </li></ul></ul></ul></ul><ul><ul><ul><ul><li>The blood-brain barriers </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fetal-placental barrier </li></ul></ul></ul></ul>
    75. 75. Pharmacokinetics <ul><li>Pharmacokinetics Processes </li></ul><ul><ul><li>Distribution </li></ul></ul><ul><ul><ul><li>Amount of blood flow to body tissue is the main factor determining distribution </li></ul></ul></ul><ul><ul><ul><ul><li>Cardiac output </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Body composition( amt. of adipose tissue) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Presence and degree of vessel constriction or dilatation </li></ul></ul></ul></ul>
    76. 76. Pharmacokinetics <ul><li>Pharmacokinetics Processes </li></ul><ul><ul><li>Metabolism (Biotransformation ) </li></ul></ul><ul><ul><ul><li>Is a process that changes a drug’s activity and makes it more likely to be excreted. </li></ul></ul></ul><ul><ul><ul><li>Alters drug structure usually in the liver </li></ul></ul></ul><ul><ul><ul><li>First-Pass Effect- Hepatic inactivation of certain oral drugs </li></ul></ul></ul><ul><ul><ul><li>Metabolic enzymes in the liver are less active in infants and geriatric patients </li></ul></ul></ul>
    77. 77. Pharmacokinetics <ul><li>Processes </li></ul><ul><ul><li>Excretion </li></ul></ul><ul><ul><ul><li>Elimination of drug from circulation </li></ul></ul></ul><ul><ul><ul><li>The main organ involved with excretion is the kidney </li></ul></ul></ul><ul><ul><ul><li>Drugs are eliminate from the body by </li></ul></ul></ul><ul><ul><ul><ul><li>Kidney via the urine </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Lungs via exhaled air </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Sweat glands via perspiration </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Tears via crying </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Mammary glands via breast milk and </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Biliary system </li></ul></ul></ul></ul>
    78. 78. Pharmacokinetics <ul><li>Plasma Concentration </li></ul><ul><ul><li>The therapeutic response of most drugs are related to their plasma concentration </li></ul></ul><ul><ul><ul><li>Minimum – amount required to produce therapeutic effect </li></ul></ul></ul><ul><ul><ul><li>Therapeutic -lies between the minimum effective level and the toxic level. </li></ul></ul></ul><ul><ul><ul><li>Toxic – result in serious adverse effects </li></ul></ul></ul>
    79. 79. Pharmacokinetics <ul><li>Plasma Concentration </li></ul><ul><ul><li>Plasma half-life </li></ul></ul><ul><ul><ul><li>Represents the duration of action for most drugs </li></ul></ul></ul><ul><ul><ul><li>The length of time the body takes to reduce the plasma level of a drug to 50% of its peak value </li></ul></ul></ul><ul><ul><li>Loading dose </li></ul></ul><ul><ul><ul><li>Higher amount of drug </li></ul></ul></ul><ul><ul><ul><li>Given once or twice to </li></ul></ul></ul><ul><ul><ul><li>Quickly induce a therapeutic response </li></ul></ul></ul>
    80. 80. Pharmacokinetics <ul><li>Plasma Concentration </li></ul><ul><ul><li>Equilibrium state </li></ul></ul><ul><ul><ul><li>The amount of drug administered is equal to the amount excreted </li></ul></ul></ul><ul><ul><ul><li>Equilibrium state may be reached faster through the use of loading doses </li></ul></ul></ul><ul><ul><li>Maintenance dose </li></ul></ul><ul><ul><ul><li>Given to keep plasma concentration in therapeutic range </li></ul></ul></ul>
    81. 81. Pharmacodynamics <ul><li>Is comprised of the root words </li></ul><ul><ul><li>Pharmco – medicine </li></ul></ul><ul><ul><li>Dynamics – change </li></ul></ul><ul><ul><li>! </li></ul></ul><ul><ul><li>Pharmacodynamics – the mechanism by which drugs produce biochemical and physiologic changes in the body </li></ul></ul><ul><li>The differences in patient responses to medications </li></ul>
    82. 82. Pharmacodynamics <ul><li>Frequency Distribution Curve </li></ul><ul><ul><li>Represents drug action in a specific patient population </li></ul></ul><ul><ul><li>The middle of the curve represents a drug’s median effective dose </li></ul></ul><ul><ul><li>Used to represent safety of a drug </li></ul></ul><ul><li>Therapeutic Index </li></ul><ul><ul><li>Is a value representing the margin of drug safety </li></ul></ul><ul><ul><li>Equals median lethal dose divided by median effective dose </li></ul></ul><ul><ul><li>Larger the difference the greater the therapeutic index </li></ul></ul>
    83. 83. Pharmacodynamics <ul><li>Potency and Efficacy </li></ul><ul><ul><li>Potency - the dose of medication required to elicit a particular response </li></ul></ul><ul><ul><li>Efficacy - the magnitude of maximal response to a drug </li></ul></ul><ul><ul><li>Efficacy of a drug is more important to the patient and nurse than the potency </li></ul></ul>
    84. 84. Pharmacodynamics <ul><li>Drug Receptor Interaction </li></ul><ul><ul><li>Used to explain the mechanism of action of many medications </li></ul></ul><ul><ul><li>Majority of receptors are proteins located on the plasma cell membrane </li></ul></ul><ul><ul><li>Some drug responses are nonspecific and do not involve direct receptor interaction </li></ul></ul>
    85. 85. Pharmacodynamics <ul><li>Drug Receptor Interaction </li></ul><ul><ul><li>Drugs compete with endogenous substances and other medications for cellular receptors </li></ul></ul><ul><ul><ul><li>Agonist - are drugs that bind to a receptor and cause effects that mimic normal cell activities . </li></ul></ul></ul><ul><ul><ul><li>Partial agonist – produces a weaker or less efficacious, response than an agonist </li></ul></ul></ul><ul><ul><ul><li>Antagonist - are drugs that bind to a receptor and inhibit normal cell activity </li></ul></ul></ul>
    86. 86. Pharmacodynamics <ul><li>Pharmacology of the Future </li></ul><ul><ul><li>Likely be customized to match the genetic make-up of each patient </li></ul></ul><ul><ul><li>Pharmacogenetics - application of genetics to pharmacology with the objective of individualizing therapy </li></ul></ul>
    87. 87. Pharmacotherapy across the Lifespan <ul><li>Pregnancy </li></ul><ul><ul><li>Conducted only when the benefits to the mother outweigh the potential risks to the fetus </li></ul></ul><ul><ul><li>Pregnancy Categories guide the practitioner in prescribing drugs for these patients </li></ul></ul><ul><ul><li>Pregnancy Categories have been developed by the FDA to assess potential risk to the fetus </li></ul></ul>
    88. 88. Pharmacotherapy across the Lifespan <ul><li>Pregnancy </li></ul><ul><ul><li>Drugs and other substances can appear in breast milk and affect infants </li></ul></ul><ul><ul><li>Refer to FDA Pregnancy Categories (table 7.1 pg.69 text) </li></ul></ul><ul><li>Infancy (birth 12 months) </li></ul><ul><ul><li>Directed toward safety </li></ul></ul><ul><ul><li>Administer oral medication slowly </li></ul></ul>
    89. 89. Pharmacotherapy across the Lifespan <ul><li>Infancy (birth 12 months) </li></ul><ul><ul><li>For suppositories hold buttocks together for 5-10 minutes </li></ul></ul><ul><ul><li>Vastus lateralis preferred site for IM injection </li></ul></ul><ul><ul><li>Medication prescribed in milligrams per kilogram per day (mg/kg/24h) </li></ul></ul>
    90. 90. Pharmacotherapy across the Lifespan <ul><li>Infancy (birth 12 months) </li></ul><ul><ul><li>Alternate method for calculating dosage is to use the infants body surface area (BSA ) </li></ul></ul><ul><ul><ul><li>BSA refers to the total area exposed </li></ul></ul></ul><ul><ul><ul><li>Derived from height and weight </li></ul></ul></ul><ul><ul><ul><li>Two formulas used </li></ul></ul></ul><ul><li>Formula using metric system </li></ul><ul><li>Weight (kg) x Height (cm) </li></ul><ul><ul><li>3600 </li></ul></ul>
    91. 91. Pharmacotherapy across the Lifespan <ul><li>Infancy (birth 12 months) </li></ul><ul><li>B. Formula using pounds and inches </li></ul><ul><li>Weight (lb) x Height (in ) </li></ul><ul><li>3131 </li></ul><ul><ul><li>BSA written in square meter (m2) </li></ul></ul><ul><ul><li>Maybe used to double check orders for safe dosage </li></ul></ul>
    92. 92. Pharmacotherapy across the Lifespan <ul><li>Toddlers (1-3) </li></ul><ul><ul><li>Major concern, sense of curiosity </li></ul></ul><ul><ul><li>Can swallow liquid, maybe able to solid medication </li></ul></ul><ul><ul><li>IM injection given in the vastus lateralis </li></ul></ul><ul><ul><li>IV may use scalp or feet </li></ul></ul>
    93. 93. Pharmacotherapy across the Lifespan <ul><li>Preschool (3-5) </li></ul><ul><ul><li>Dorsogluteal site used for IM after 1 year of walking </li></ul></ul><ul><ul><li>Peripheral veins used for IV injections </li></ul></ul><ul><ul><li>Often resist medication </li></ul></ul><ul><li>School Age (6-12) </li></ul><ul><ul><li>Begin to realize the benefits of medications and the reasons why medications are needed </li></ul></ul>
    94. 94. Pharmacotherapy across the Lifespan <ul><li>School Age (6-12) </li></ul><ul><ul><li>Give the child a sense of control over drug administration </li></ul></ul><ul><ul><li>At the same time be firm and giving the child praise for cooperation </li></ul></ul><ul><ul><li>Can take chewable tablets, may swallow tablets or capsules </li></ul></ul><ul><ul><li>Ventrogluteal site preferred for IM </li></ul></ul>
    95. 95. Pharmacotherapy across the Lifespan <ul><li>Adolescence </li></ul><ul><ul><li>Respect need for independence and privacy </li></ul></ul><ul><ul><li>Concerned with physical appearance and peer approval </li></ul></ul><ul><ul><li>Indications for pharmacotherapy </li></ul></ul><ul><ul><ul><li>Skin conditions </li></ul></ul></ul><ul><ul><ul><li>Headaches </li></ul></ul></ul><ul><ul><ul><li>Menstrual irregularities </li></ul></ul></ul><ul><ul><ul><li>Sports injuries </li></ul></ul></ul>
    96. 96. Pharmacotherapy across the Lifespan <ul><li>Young (18-40) and Middle (40-65) Adulthood </li></ul><ul><ul><li>Generally need little pharmacotherapy </li></ul></ul><ul><ul><li>Complications associated with pregnancy are of major concern </li></ul></ul><ul><ul><li>Cardiovascular concerns become important </li></ul></ul><ul><ul><li>Use of antidepressants and antianxiety agents are prominent in the over-50 population </li></ul></ul>
    97. 97. Pharmacotherapy across the Lifespan <ul><li>Older Adults </li></ul><ul><ul><li>Take more medications (polypharmacy) and experience more adverse drug events than any other age group </li></ul></ul><ul><ul><li>Must make accommodations for age-related changes in physiological and biochemical functions </li></ul></ul><ul><ul><li>With numerous physical challenges, which become targets for pharmacotherapy </li></ul></ul>
    98. 98. Pharmacotherapy across the Lifespan <ul><li>Older Adults </li></ul><ul><ul><li>Changes in liver and kidney function make pharmacotherapy more risky </li></ul></ul><ul><ul><li>Cardiovascular disease becomes a major indication for pharmacotherapy </li></ul></ul><ul><ul><li>For drug therapy to be successful must make accommodations for age-related changes in physiological and biochemical functions </li></ul></ul>
    99. 99. Legal and Ethical Issues <ul><li>Ethics </li></ul><ul><ul><li>Branch of philosophy dealing with the moral principles that guide a person’s behavior or conduct </li></ul></ul><ul><ul><li>Are learned early in life through religious affiliations, family, role models, and peers </li></ul></ul>
    100. 100. Legal and Ethical Issues <ul><li>Moral </li></ul><ul><ul><li>Principles such as beneficence, non-maleficent behavior, veracity, autonomy, justice, and fidelity are necessary in medication administration </li></ul></ul><ul><ul><li>When making ethical decisions in clinical practice, the nurse uses fundamental moral principles </li></ul></ul>
    101. 101. Legal and Ethical Issues <ul><li>Three most important principles </li></ul><ul><ul><li>Beneficence - promote the most good for the patient </li></ul></ul><ul><ul><li>Non-maleficent – obligation not to harm the patient </li></ul></ul><ul><ul><li>Autonomy - allowing the patient the informed right to choose the course of their care </li></ul></ul>
    102. 102. Legal and Ethical Issues <ul><li>Legal </li></ul><ul><ul><li>Nurse Practice Act </li></ul></ul><ul><ul><ul><li>Defines the scope of practice for professional nursing </li></ul></ul></ul><ul><ul><ul><li>Defines the standard of care for practicing nurses </li></ul></ul></ul><ul><ul><ul><li>State the minimum competency for proficiency in nursing </li></ul></ul></ul><ul><ul><li>Documentation of medication administration, including any errors, should be completed immediately </li></ul></ul>
    103. 103. Legal and Ethical Issues <ul><li>Legal </li></ul><ul><ul><li>Medication Errors </li></ul></ul><ul><ul><ul><li>A preventable error that may cause or lead to an adverse reaction </li></ul></ul></ul><ul><ul><ul><li>can result in serious injury to the patient and litigation for the nurse and healthcare agency </li></ul></ul></ul>
    104. 104. Legal and Ethical Issues <ul><li>Legal </li></ul><ul><ul><li>It is the ethical and legal responsibility of the nurse to report any medication errors </li></ul></ul><ul><ul><li>Documentation necessary for patient safety </li></ul></ul><ul><ul><li>Finding strategies to prevent of medication errors involves many different processes, including the nursing process </li></ul></ul>
    105. 105. Nursing Process <ul><li>Is a systematic method of problem-solving and consists of clearly defined steps </li></ul><ul><ul><li>Assessment </li></ul></ul><ul><ul><ul><li>First step in the nursing process </li></ul></ul></ul><ul><ul><ul><li>Baseline data gathered (subjective, objective) </li></ul></ul></ul><ul><ul><ul><li>Assessment includes health history information, physical assessment data, lab values and other measurable data </li></ul></ul></ul><ul><ul><ul><li>Includes an assessment of medication effects: therapeutic, side or adverse effects </li></ul></ul></ul>
    106. 106. Nursing Process <ul><li>Nursing Diagnosis </li></ul><ul><ul><li>Are developed after an analysis of the assessment data </li></ul></ul><ul><ul><li>Diagnoses are focused on the patient’s problems or potential problems </li></ul></ul><ul><ul><li>Begin by addressing problems that pose immediate threats to the patient’s health </li></ul></ul>
    107. 107. Nursing Process <ul><li>Goal </li></ul><ul><ul><li>Developed from the nursing diagnoses </li></ul></ul><ul><ul><li>Focus on what the patient will be able to do or achieve </li></ul></ul><ul><li>Outcomes </li></ul><ul><ul><li>Objective measures of goals </li></ul></ul><ul><ul><li>Define what the patient will do </li></ul></ul><ul><ul><li>Under what circumstances and time frame </li></ul></ul><ul><li>Goals and outcomes are prioritized to address immediate need first </li></ul>
    108. 108. Nursing Process <ul><li>Goals and outcomes may be developed for short-term or long-term, depending on the specific situation </li></ul><ul><li>Planning </li></ul><ul><ul><li>Links strategies or interventions to goals and outcomes </li></ul></ul><ul><li>Interventions </li></ul><ul><ul><li>Aimed at returning the patient to an optimum level of wellness and limiting adverse effects </li></ul></ul>
    109. 109. Nursing Process <ul><li>Interventions </li></ul><ul><ul><li>Key components of implementation include monitoring and documentation of drug effects, and patient education </li></ul></ul><ul><ul><li>Monitoring drug effects is a primary intervention </li></ul></ul><ul><ul><li>Patient teaching is a vital component( considered primary role </li></ul></ul><ul><ul><li>Documentation of both therapeutic and adverse effects is complete during this phase </li></ul></ul>
    110. 110. Nursing Process <ul><li>Evaluation </li></ul><ul><ul><li>Final step of the nursing process </li></ul></ul><ul><ul><li>Considers the effectiveness of interventions at meeting goals and outcomes </li></ul></ul><ul><ul><li>Evaluation begins a new cycle as new assessment data is gathered and analyzed </li></ul></ul><ul><ul><li>Nursing diagnoses are reviewed or rewritten, goals and outcomes refined, and new interventions are implemented </li></ul></ul>
    111. 111. System of Measurement <ul><li>Include the metric, apothecary, and household systems </li></ul>
    112. 112. System of Measurement <ul><li>Metric </li></ul><ul><ul><li>Preferred system of measurement </li></ul></ul><ul><ul><li>Also known as the International System of Units (SI) </li></ul></ul><ul><ul><li>Basic unit of mass (weight) is the gram </li></ul></ul><ul><ul><li>Basic unit of volume (capacity) is the liter </li></ul></ul><ul><ul><li>Milliliter (mL) and cubic centimeter (cc) are used interchangeably </li></ul></ul>
    113. 113. System of Measurement <ul><li>Metric </li></ul><ul><ul><li>Equivalents frequently used (memorize ) </li></ul></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><ul><li>1mg (milligram) = 1000mcg (microgram) </li></ul></ul></ul><ul><ul><ul><li>1g (gram) = 1000 mg (milligrams) </li></ul></ul></ul><ul><ul><ul><li>1 kg (kilogram) = 1000 g or Gm (grams) = 2.2 lbs </li></ul></ul></ul><ul><ul><li>Volume </li></ul></ul><ul><ul><ul><li>1L (liter) = 1000cc or 1000 ml (milliliters) </li></ul></ul></ul>
    114. 114. System of Measurement <ul><li>Apothecary </li></ul>
    115. 115. System of Measurement <ul><li>Apothecary </li></ul><ul><ul><li>Apothecary means “Pharmacist” </li></ul></ul><ul><ul><li>Imprecise, old English system of measurement </li></ul></ul><ul><ul><li>Grain, basic unit of weight </li></ul></ul><ul><ul><li>Basic unit of volume is the minim, which = one drop (gtt) </li></ul></ul>
    116. 116. System of Measurement <ul><li>Apothecary </li></ul><ul><ul><li>Abbreviation or symbol usually written before amount or quantity –ex gr 60 = 1 dram </li></ul></ul><ul><ul><li>Measures based on the minim </li></ul></ul><ul><ul><ul><li>Fluidram (fl. dr.) </li></ul></ul></ul><ul><ul><ul><li>Fluid ounce (fl. Oz.) </li></ul></ul></ul><ul><ul><ul><li>Pint (pt.) </li></ul></ul></ul><ul><ul><ul><li>Quart (qt.) </li></ul></ul></ul>
    117. 117. System of Measurement <ul><li>Household </li></ul>
    118. 118. System of Measurement <ul><li>Household </li></ul><ul><ul><li>Least accurate system of measurement </li></ul></ul><ul><ul><li>Measurements approximate </li></ul></ul><ul><ul><li>Becoming increasingly more important with the trend toward home health care </li></ul></ul>
    119. 119. System of Measurement <ul><li>Household </li></ul><ul><ul><li>Household Measures </li></ul></ul><ul><ul><ul><li>Tablespoon (Tbs or T) </li></ul></ul></ul><ul><ul><ul><li>Teaspoon (tsp or t) </li></ul></ul></ul><ul><ul><ul><li>Drop (gtt) </li></ul></ul></ul>
    120. 120. System of Measurement <ul><li>Units of Measurements </li></ul><ul><ul><li>Measures drugs in terms of their action </li></ul></ul><ul><ul><li>Vitamins, antibiotics, insulin and heparin are measured in units </li></ul></ul><ul><ul><li>Label indicates units per ml </li></ul></ul><ul><ul><li>No conversion exists for units </li></ul></ul>
    121. 121. System of Measurement <ul><li>Milliequivalent (mEq) </li></ul><ul><ul><li>Measures chemical combining power of electrolytes such as potassium (K+) </li></ul></ul><ul><ul><li>Specific to medication used </li></ul></ul><ul><ul><li>Has no conversion to another system </li></ul></ul>
    122. 122. System of Measurement <ul><li>Dosage measured in percentage </li></ul><ul><ul><li>Commonly used in IV solutions </li></ul></ul><ul><ul><li>D5W, D5 ½ NS, D10, .45NS, 0.9 NS </li></ul></ul><ul><ul><li>Often used with metric measures </li></ul></ul><ul><ul><li>Means part per hundred or number of grams of drug per 100ml of solution </li></ul></ul><ul><ul><li>Often no conversion is necessary (give 10ml of 10% calcium gluconate ) </li></ul></ul>
    123. 123. System of Measurement <ul><li>Metric House </li></ul><ul><li>1ml 15-16gtts </li></ul><ul><li>4-5cc 1tsp or </li></ul><ul><li>15-16ml 1Tbs or </li></ul><ul><li>30-32ml 2Tbs </li></ul><ul><li>240-250 1gl or cup </li></ul><ul><li>500ml 2gls or cups </li></ul><ul><li>1L 1qt, or </li></ul><ul><li>Apothecary </li></ul><ul><ul><li>15-16minims </li></ul></ul><ul><ul><li>1 fluid dram </li></ul></ul><ul><ul><li>4 fluid ounces </li></ul></ul><ul><ul><li>8fl. dr or 1oz </li></ul></ul><ul><ul><li>8 oz or ½ pt. </li></ul></ul><ul><ul><li>1pint </li></ul></ul><ul><ul><li>32ounces or 1qt </li></ul></ul>
    124. 124. System of Measurement <ul><li>Metric </li></ul><ul><ul><li>1mg </li></ul></ul><ul><ul><li>60-64mg </li></ul></ul><ul><ul><li>300-325mg </li></ul></ul><ul><ul><li>1kg =2.2lbs </li></ul></ul><ul><ul><li>1gram </li></ul></ul><ul><li>Apothecary </li></ul><ul><ul><li>1/60 gr </li></ul></ul><ul><ul><li>1gr </li></ul></ul><ul><ul><li>5grs </li></ul></ul><ul><ul><li>15-16grs </li></ul></ul>
    125. 125. System of Measurement <ul><li>Conversion between and within systems </li></ul><ul><ul><li>1 g = 1000mg 1000mcg 2.2lbs </li></ul></ul><ul><ul><li>1T = 0.5L 15mL 3tsp </li></ul></ul><ul><ul><li>1kg = 1000g 1dr 2.2lb </li></ul></ul><ul><ul><li>1cc = 500mL 1L 1mL </li></ul></ul>
    126. 126. References <ul><li>Adams, M, Josephson, D. & Holland, L. (2005). Pharmacology for Nurses: A pathophysiologic approach, Pearson Prentice Hall, New Jersey </li></ul><ul><li>Aschenbrenner,D & Venable, S (2006). Drug Therapy in Nursing. 2 nd Edition, Lippincott Williams & Wilkins, </li></ul><ul><li>Brown, M & Mulholland, J. (2004). Drug Calculations: Process and Problems for clinical Practice 7 th Edition , Mosby, St. Louis , Missouri </li></ul>
    127. 127. References <ul><li>(2004).Straignt A’s in Pharmacology, Lippincott Williams & Wilkins </li></ul><ul><li>(2005).Dosage Calculations Made Incredible Easy, 3 rd Edition, Lippincott Williams & Wilkins </li></ul><ul><li>(2005).Nursing Pharmacology Made Incredible Easy, Springhouse </li></ul><ul><li>www.crnasomeday.com/pharmacology.htm </li></ul>

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