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Presentation1 A Pharmacology
 

Presentation1 A Pharmacology

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  • 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
  • Intrathecal – intraspinal Intraarticular- joint
  • Acute- rapid onset Maintenance – for treatment of chronic illness, e.g. hypertension Supplemental – due to insufficient quantity e.g. insulin, iron Palliative – comfort the end of treatment, e.g. opioid analgesics in cancer, O2 in end-stage pulmonary disease Supportive – fluids Prophylactic- antibiotic prior to surgery Empiric – based on previous experience with the drug. E.g. acetaminophen for fever with unknown cause.
  • Pregnancy- First trimester is the period of greatest danger for drug-induced developmental defects. Drugs cross the placenta by diffusion During the last trimester the greatest percentage of maternally absorbed drug gets to the fetus. FDA pregnancy safety categories BREASTFEEDING - Breast-fed infants are at risk for exposure to drugs consumed by the mother Consider risk-to-benefit ratio
  • Polypharmacy_

Presentation1 A Pharmacology Presentation1 A Pharmacology Presentation Transcript

  • Pharmacology Rosalie C. Villora, MSN, RN
  • Objectives
    • Identify principles of pharmacology that relate to nursing care.
    • Describe the 5 steps of the nursing process.
    • Explain how nursing process is used in the administration of medications
    • Explain absorption, excretion, desired effect.
    • Identify elements in a patient drug history
    • Identify common elements in a variety of hospital medication records
    • Discuss charting dos and don’ts
    • Discuss confidentiality issues as they apply to medication administration
  • Terminology
    • Drug - any chemical that affects the physiologic processes of a living organism
    • Pharmacology - the study or science of drugs
    • Chemical name - describes the drug’s chemical composition and molecular structure
    • Generic name (nonproprietary name) - name given by the United States Adopted Name Council
    • Trade name (proprietary name) - each drug has a registered trademark; use of the name restricted by the drug’s patent owner (usually the manufacturer)
  •  
  • Pharmacologic Principles
    • Pharmaceutics - the study of how various drug forms influence pharmacokinetic and pharmacodynamic activities
    • Pharmacokinetics - the study of what the body does to the drug
      • Absorption
      • Distribution
      • Metabolism
      • Excretion
    • Pharmacodynamics - the study of what the drug does to the body, i.e. the mechanism of drug actions in living tissues
  •  
  • Pharmacologic Principles cont’d
    • Pharmacotherapeutics - The use of drugs and the 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 - The study of natural (plant and animal) drug sources
  • Pharmaceutics
    • Dosage form design affects dissolution
  • Pharmacokinetics: Absorption
    • The rate at which a drug leaves its site of administration, & the extent to which absorption occurs
      • Bioavailability – a 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
  • Routes
      • Enteral (GI tract)
        • Oral
        • Sublingual
        • Buccal – oral mucosa between the cheek and gum
      • Parenteral
      • Topical
  • 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
    • Drugs to be taken on empty stomach
      • alendronate sodium
      • risedronate sodium
    • Drugs to be taken with food
      • Carbamazepine
      • Iron
      • Hydralazine
      • Lithium
      • Propanolol
      • Spironolactone
      • Theophylline
    • Parenteral Route
    • Intravenous (fastest delivery into the blood circulation)
    • Intramuscular
    • Subcutaneous
    • Intradermal
    • Intrathecal
    • Intraarticular
    • Topical Route
    • Skin - transdermal patches
    • Eyes
    • Ears
    • Nose
    • Lungs (inhalation)
    • Rectum
    • Vagina
    • 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
  •  
    • Factors that metabolism
    • Fast acetylator
    • Barbiturate therapy
    • Rifampin therapy
    • Factors that metabolism
    • Cardiovascular dysfunction
    • Renal insufficiency
    • Starvation
    • Obstructive jaundice
    • Slow acetylator
    • Erythromycin or ketoconazole drug therapy
    • Delayed drug metabolism results in:
    • Accumulation of drugs
    • Prolonged action of the drugs
    • Stimulating drug metabolism causes:
    • Diminished pharmacologic effects
    • Cytochrome P-450 enzymes
    • Also known as microsomal enzymes
  • Excretion
    • The elimination of drugs from the body
    • Kidneys (main organ)
    • Liver
    • Bowel
      • Biliary excretion
      • Enterohepatic recirculation
  •  
  • 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
  • The Movement of Drugs Through the Body
    • Drug actions
    • The cellular processes involved in the drug and cell interaction
    • Drug effect
    • The physiologic reaction of the body to the drug
  • 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
  •  
  • Pharmacodynamics: Mechanisms of Action
    • Receptor interactions
    • Enzyme interactions
    • Nonspecific interactions
  •  
  • Pharmacotherapeutics: Types of Therapies
    • Acute therapy
    • Maintenance therapy
    • Supplemental/replacement therapy
    • Palliative therapy
    • Supportive therapy
    • Prophylactic therapy
    • Empiric therapy
    • 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 - t he 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
    • 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
    • Adverse Drug Events
    • Medication errors
    • 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
  • 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
    • Pharmacognosy
    • Four main sources for drugs
    • Plants
    • Animals
    • Minerals
    • Laboratory synthesis
    • Toxicology
    • The study of poisons and unwanted responses to drugs and other chemicals
  • Life Span Consideration
    • Pregnancy
    • Breast-feeding
    • Neonatal and Pediatric
    • Elderly
  •  
  • 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
  • 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
  • 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”
  • 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 (and increased circulation of free drugs)
  • 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
  • Pharmacology & The Nursing Process
  • 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
  • The Nursing Process (cont’d)
    • Assessment
    • Nursing diagnosis
    • Planning
    • Goals
    • Outcome criteria
    • Implementation
    • Evaluation
  • The Nursing Process (cont’d)
    • Assessment
    • Data collection
      • Subjective, objective
    • Medication history
      • Prescriptions
      • OTCs
      • Herbals
      • Responses to medications (therapeutic and adverse responses)
  • 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
  • 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
  • The Nursing Process (cont’d)
    • Goals
    • S- specific
    • M- measurable
    • A- attainable
    • R- realistic
    • T- time frame specified
    • Outcome Criteria
    • Specific standard (s) of measure
    • Patient oriented
  • 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
  • The Six Rights of Medication Administration
    • Right drug
    • Right dose
    • Right time
    • Right route
    • Right patient
    • Right documentation
  • Another “Right”—Constant System Analysis
    • A “double-check”
    • The entire “system” of medication administration
    • Ordering, dispensing, preparing, administering, documenting
    • Involves the physician, nurse, nursing unit, pharmacy department, and patient education
  • 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
  • Six Elements of a Drug Order
    • 1. Patient's name
    • 2. Date order is written
    • 3. Name of medication
    • 4. Dosage (includes size, frequency, and number of doses)
    • 5. Route of delivery
    • 6. Signature of the prescriber
  • 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