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This is for Week 1

This is for Week 1

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  • Polypharmacy_
  • The metabolism of a drug and its passage from the liver into the circulation – A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation (high first-pass effect) – The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation
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    • 1. Pharmacology Rosalie C. Villora MSN, RN
    • 2. Objectives
      • Identify principles of pharmacology that relate to nursing care.
      • Explain absorption, excretion, desired effect.
      • Describe the 5 steps of the nursing process.
      • Explain how nursing process is used in the administration of medications
      • Identify elements in a patient drug history
      • Identify common elements in a variety of hospital medication records
      • Discuss charting do’s and don’ts
      • Discuss confidentiality issues as they apply to medication administration
    • 3. Pharmacologic Principles
      • Pharmacology - study or science of drugs
      • Pharmaceutics - study of how various drug forms influence pharmacokinetic and pharmacodynamic activities
      • Pharmacokinetics - study of what the body does to the drug
        • Absorption
        • Distribution
        • Metabolism
        • Excretion
      • Pharmacodynamics - study of what the drug does to the body, i.e. mechanism of drug actions in living tissues
    • 4. Pharmacologic Principles cont’d
      • Pharmacotherapeutics - use of drugs and clinical indications for drugs to prevent and treat diseases
        • Empirical therapeutics – effective, but mechanism of action is unknown
        • Rational therapeutics – specific evidence has been obtained for the mechanisms of drug action
      • Pharmacognosy - study of natural (plant and animal) drug sources
    • 5.
    • 6. Pharmacokinetics: Absorption
      • The rate at which a drug leaves its site of administration, & the extent to which absorption occurs
        • Bioavailability – measure of the extent of drug absorption in the body (0% to 100%)
        • Bioequivalent – two drugs have the same bioavailability and same concentration of active ingredients
      • Factors That Affect Absorption
      • Food or fluids administered with the drug
      • Dosage formulation
      • Status of the absorptive surface
      • Rate of blood flow to the small intestine
      • Acidity of the stomach
      • Status of GI motility
    • 7. Neonatal and Pediatric Considerations: Pharmacokinetics
      • Absorption
        • Gastric pH less acidic
        • Gastric emptying is slowed
        • Intramuscular absorption faster and irregular
      • Distribution
        • The younger the person, the greater the % of total body water
        • Greater TBW means fat content is lower
        • Decreased level of protein binding
        • Immature blood-brain barrier—more drugs enter the brain
    • 8. Neonatal and Pediatric Considerations: Pharmacokinetics
      • Metabolism
        • Liver immature, does not produce enough microsomal enzymes
        • Older children may have increased metabolism, requiring higher doses than infants
      • Excretion
        • Kidney immaturity affects glomerular filtration rate and tubular secretion
        • Decreased perfusion rate of the kidneys may reduce excretion of drugs
    • 9. The Elderly
      • Elderly: older than age 65
        • Healthy People 2010: older than age 55
      • Use of OTC medications
      • Increased incidence of chronic illnesses
      • Polypharmacy - “prescribing cascade”
    • 10. The Elderly: Pharmacokinetics
      • Absorption
        • Gastric pH less acidic
        • Slowed gastric emptying
        • Movement through GI tract slower
        • Reduced blood flow to the GI tract
        • Reduced absorptive surface area due to flattened intestinal villi
      • Distribution
        • TBW percentages lower
        • Fat content increased
        • Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (& increased circulation of free drugs)
    • 11. The Elderly: Pharmacokinetics
      • Metabolism
        • Aging liver produces fewer microsomal enzymes, affecting drug metabolism
        • Reduced blood flow to the liver
      • Excretion
        • Decreased glomerular filtration rate
        • Decreased number of intact nephrons
    • 12. Pharmaceutics
      • Dosage form design affects dissolution
    • 13. First-Pass Effect
      • The metabolism of a drug and its passage from the liver into the circulation
      • – A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation (high first-pass effect)
      • – The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation
    • 14.
    • 15.
      • Distribution
      • Protein-binding
      • Water soluble vs. fat soluble
      • Blood-brain barrier
      • Areas of rapid distribution: heart, liver, kidneys, brain
      • Areas of slow distribution: muscle, skin, fat
      • Metabolism (Biotransformation)
      • Liver (main organ)
      • Skeletal muscle
      • Kidneys
      • Lungs
      • Plasma
      • Intestinal mucosa
    • 16.
      • Factors that metabolism
      • Fast acetylator
      • Barbiturate therapy
      • Rifampin therapy
      • Delayed drug metabolism results in:
      • Accumulation of drugs
      • Prolonged action of the drugs
      • Factors that metabolism
      • Cardiovascular dysfunction
      • Renal insufficiency
      • Starvation
      • Obstructive jaundice
      • Slow acetylator
      • Erythromycin or ketoconazole drug therapy
    • 17. Excretion
      • The elimination of drugs from the body
      • Kidneys (main organ)
      • Liver
      • Bowel
        • Biliary excretion
        • Enterohepatic recirculation
    • 18. Half-life
      • The time it takes for one half of the original amount of a drug in the body to be removed
      • A measure of the rate at which drugs are removed from the body
      • Most drugs are considered to be effectively removed after about five half-lives
      • Steady state
    • 19. Onset, Peak, and Duration
      • Onset
      • The time it takes for the drug to elicit a therapeutic response
      • Peak
      • The time it takes for a drug to reach its maximum therapeutic response
      • Highest blood level
      • Trough Level
      • Lowest blood level
      • Duration
      • The time a drug concentration is sufficient to elicit a therapeutic response
    • 20.
    • 21. Pharmacodynamics: Mechanisms of Action
    • 22. Pharmacotherapeutics: Types of Therapies
      • Acute therapy
      • Maintenance therapy
      • Supplemental/replacement therapy
      • Palliative therapy
      • Supportive therapy
      • Prophylactic therapy
      • Empiric therapy
    • 23.
      • Contraindication - a ny characteristic of the patient, especially a disease state, that makes the use of a given medication dangerous for the patient
      • Intended therapeutic action (beneficial)
      • Unintended but potential adverse effects (predictable, adverse reactions)
      • Therapeutic index - ratio between a drug’s therapeutic benefits and its toxic effects
      • Tolerance - a decreasing response to repeated drug doses
      • Dependence - a physiologic or psychological need for a drug
    • 24.
      • Drug interactions: the alteration of action of a drug by other prescribed drugs, over-the-counter medications, & herbal therapies
      • Drug interactions
        • Additive effect
        • Synergistic effect
        • Antagonistic effect
        • Incompatibility
    • 25.
      • Adverse drug reactions:
        • Pharmacologic reactions, including adverse effects
        • Hypersensitivity (allergic) reaction
        • Idiosyncratic reaction
        • Drug interaction
      • Adverse effects
      • Predictable, well-known reactions that result in little or no change in patient management
      • Predictable frequency
      • Occurrences are related to the size of the dose
      • Usually resolve when the drug is discontinued
    • 26. Other Drug-Related Effects
      • Teratogenic – results in structural defects in the fetus
      • Mutagenic – permanent changes in the genetic composition and chromosome structure of living organism
      • Carcinogenic – cancer-causing effects of drugs
    • 27. Pharmacology & The Nursing Process
    • 28. The Nursing Process
      • A research-based organizational framework for professional nursing practice
      • Central to all nursing care
      • Encompasses all steps taken by the nurse in caring for a patient
      • Flexibility is important
      • Critical thinking
      • Ongoing and constantly evolving process
    • 29. The Nursing Process (cont’d)
      • Assessment
      • Nursing diagnosis
      • Planning
      • Goals
      • Outcome criteria
      • Implementation
      • Evaluation
    • 30. The Nursing Process (cont’d)
      • Assessment
      • Data collection
        • Subjective, objective
      • Medication history
        • Prescriptions
        • OTCs
        • Herbals
        • Responses to medications (therapeutic & adverse responses)
    • 31. The Nursing Process (cont’d)
      • Nursing diagnosis
      • Decision about the need/problem (actual or at risk for) of the patient
      • Critical thinking, creativity, and accurate data collection
      • NANDA format
    • 32. The Nursing Process (cont’d)
      • Nursing diagnosis
      • Three steps
      • Human response to illness (actual or risk)
      • “ related to”
      • “ as evidenced by”
      • Planning
      • Identification of goals and outcome criteria
      • Time frame
      • Prioritization
    • 33. The Nursing Process (cont’d)
      • Goals
      • S- specific
      • M- measurable
      • A- attainable
      • R- realistic
      • T- time frame specified
      • Outcome Criteria
      • Specific standard(s) of measurement
      • Patient oriented
    • 34. The Nursing Process (cont’d)
      • Implementation
      • Initiation and completion of the nursing care plan as defined by the nursing diagnoses and outcome criteria
      • Follow the “Six Rights” of medication administration
    • 35. The Six Rights of Medication Administration
      • Right drug
      • Right dose
      • Right time
      • Right route
      • Right patient
      • Right documentation
    • 36. Other “Rights” (cont’d)
      • Close consideration of special situations
      • Prevention and reporting of medication errors
      • Patient teaching
      • Monitor therapeutic effects, adverse effects, and toxic effects
      • Refusal of medication
    • 37. Six Elements of a Drug Order
      • 1. Patient's name
      • 2. Date order is written
      • 3. Name of medication
      • 4. Dosage (size, frequency, & number of doses)
      • 5. Route of delivery
      • 6. Signature of the prescriber
    • 38. Evaluation
      • Ongoing part of the nursing process
      • Determining the status of the goals and outcomes of care
      • Monitoring the patient’s response to drug therapy
        • Expected and unexpected responses

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