Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

7351039 Pharma Gapuz Intro

1,104 views

Published on

Published in: Health & Medicine, Business
  • Be the first to comment

7351039 Pharma Gapuz Intro

  1. 1. <ul><li>PHARMACOLOGY </li></ul><ul><li>(ANTONIO B. CRUEL, RMT, RN, MSPH) </li></ul><ul><li>PHARMACODYNAMICS: </li></ul><ul><li>what drugs do to the body </li></ul><ul><li>Drug Effects: </li></ul><ul><li>1. DESIRED =therapeutic effect </li></ul><ul><li>2.SIDE = unintended/predictable </li></ul><ul><li>3. ADVERSE = harmful/severe </li></ul><ul><li>4. TOXIC= pathologic/> 1 st drug </li></ul><ul><li>5. IDIOSYNCRATIC=unpredictable </li></ul><ul><li>6. CUMULATIVE=> response RT repeated dose,<metab,<excretion </li></ul>
  2. 2. <ul><li>ALLERGIC= drug: Ag </li></ul><ul><li>ANAPHYLAXIS= > allergic rxn: bronchial vc, LE causing airway obstruction </li></ul><ul><li>TOLERANCE= <effect RT rpt dose; reqr > </li></ul><ul><li>TACHYPHYLAXIS= rapid devt of tolerance to drug </li></ul><ul><li>DEPENDENCE=driving needs: drug use </li></ul><ul><li>*HABITUATION: PSYCH </li></ul><ul><li>*PHYSICAL: ADDICTION </li></ul><ul><li>ABUSE= inappropriate drug intake (un/prohibited) </li></ul>
  3. 3. <ul><li>DRUG INTERACTION=mod of drug effect: </li></ul><ul><li>ANTAGONISM= opposing 1 + (-1)=0 </li></ul><ul><li>SUMMATION= combined(=) 1 + 1= 2 </li></ul><ul><li>SYNERGISM= combined(>) 1 + 1= 3 </li></ul><ul><li>POTENTIATION= 1 drug enhanced by etc. </li></ul><ul><li>1 drug alone (0) </li></ul><ul><li> 1 + 1= 1x,2x,3x effect </li></ul>
  4. 4. <ul><ul><li>PHARMACOKINETICS= body does to drugs </li></ul></ul><ul><ul><li>ABSORPTION </li></ul></ul><ul><ul><li>=site of admin to bloodstream </li></ul></ul><ul><ul><li>>in: IV, >absorbing surface, liquid/lipid soluble form, good blood flow </li></ul></ul><ul><ul><li><in: PO (RT food, >GI motility, acid pH </li></ul></ul><ul><ul><li>2. DISTRIBUTION </li></ul></ul><ul><ul><li>=from site of absorption to action </li></ul></ul><ul><ul><li>>in: >BF, >PPB (drugs inactive if bound in albumin for transport), >volume of distribution (edema), > membrane perm. </li></ul></ul><ul><ul><li><in: <albuminemia(<PPB=>free drug), dehydr </li></ul></ul>
  5. 5. <ul><li>METABOLISM </li></ul><ul><li>=chemical events (in/activates drug) </li></ul><ul><li>*Biotransformation=using enz, drugs are made more H20-soluble (excreted in liver) </li></ul><ul><li>*1 st -pass effect= oral meds are metab in liver via portal circ before distributed </li></ul><ul><li>>in: Drug-drug interaction (>Cytochrome P450) </li></ul><ul><li><in: infants, elderly, disease (liver, malnut) </li></ul>
  6. 6. <ul><li>ELIMINATION/EXCRETION </li></ul><ul><li>=excreted via kidnys, intestines, bile duct, lungs, sweat, mammary glands </li></ul><ul><li>=affected by DD interaction, organ elim, blood% levels, renal status. </li></ul><ul><li>Renal excretion= filtration+secretion=reab </li></ul><ul><li><renal fxn=<excretion=>toxicity </li></ul><ul><li>Excretes only H20-sol,unbound metabolite </li></ul><ul><li>Modified by acid/alkalinizing urine </li></ul><ul><li>(carbonic anhydrase inh alkalizes urine > UA excretion) </li></ul>
  7. 7. <ul><li>DRUG ADMINISTRATION </li></ul><ul><li>Principles: </li></ul><ul><li>1. 7 Rights: DR. CAT </li></ul><ul><ul><li>*DRUG </li></ul></ul><ul><ul><li>*DOSE </li></ul></ul><ul><ul><li>*ROUTE </li></ul></ul><ul><ul><li>*RECORD </li></ul></ul><ul><ul><li>*CLIENT </li></ul></ul><ul><ul><li>*APPROACH </li></ul></ul><ul><ul><li>*TIME </li></ul></ul>
  8. 8. <ul><li>2. Verify all new or questionable orders with physician or nurse. </li></ul><ul><li>3. Use meds in clearly labeled containers, check it 3X (pharmacy/cabinet, before, after prep) </li></ul><ul><li>4. Check expiry date, changes:clarity,odor </li></ul><ul><li>5. Aseptic tx:wash hand,caps upside down </li></ul><ul><li>6. Meds id with correct client </li></ul><ul><li>7. Check for allergies: ANST </li></ul><ul><li>8. Inform client: meds, tx, purpose </li></ul>
  9. 9. <ul><li>9. Stay with clients until meds taken </li></ul><ul><li>10. Report to Dr: client vomits </li></ul><ul><li>11. Record admin of drug asap: chart any omission, initial, give rationale </li></ul><ul><li>12. For meds errors: report asap </li></ul><ul><li>13. For safety, give only meds YOU prep. </li></ul>
  10. 10. <ul><li>COMMON DOSAGE FORMS: </li></ul><ul><li>CAPLET= solid for oral use, shaped like a capsule and coated for ease of swallowing </li></ul><ul><li>CAPSULE=solid, meds in powder, liq, oil encased by gelatin shell </li></ul><ul><li>ELIXIR=clear fluid c water/ROH;PO; usually c sweetener </li></ul><ul><li>ENTERIC TAB= tablet coated with materials that dissolves in intestine </li></ul><ul><li>EXTRACT= concentrated form made by removing active portion of meds from its other components </li></ul>
  11. 11. <ul><li>GLYCERITE= soln of meds combined c glycerine(50%) for external use. </li></ul><ul><li>INTRAOCULAR DISK= small, flexible oval if moistened by ocular fluid, releases meds up to 1 week. </li></ul><ul><li>LINIMENT=prep c ROH, oil, soapy emolient applied to skin </li></ul><ul><li>LOTION= MEDS IN LIQUID SUSPENSION APPLIED EXT TO PROTECT SKIN </li></ul><ul><li>OINTMENT= semisolid, externally applied prep, c 1 or more meds </li></ul>
  12. 12. <ul><li>PILL= solid form,1 or > meds, shaped into globules, ovoids, oblong </li></ul><ul><li>SOLUTION= liquid, used PO, IV, externally, instilled c body </li></ul><ul><li>SUPPOSITORY= pellet-shaped solid c gellatin for insertion into body cavity </li></ul><ul><li>SUSPENSION= fine frugparticles dispersed in liq medium w/c settles on standing, shake </li></ul><ul><li>SYRUP=meds dissolved in concentrated sugar solution </li></ul>
  13. 13. <ul><li>TABLET= powder pressed into disk or cylinders, contains binders (adhesive), disintegrators (for tab dissolution), lubricants, fillers (for convenient tab size) </li></ul><ul><li>TINCTURE= ROH or H20 meds soln. </li></ul><ul><li>TRANSDERMAL PATCH= meds in semi-permeable membrane disk or patch absorbed thru skin </li></ul><ul><li>TROCHE/ LOZENGE= flat & round form, dissolves in mouth to release meds, contains mucilage, sugar and flavoring </li></ul>
  14. 14. <ul><li>ROUTES OF ADMINISTRATION </li></ul><ul><li>VIA MOUTH </li></ul><ul><li>1.ORAL </li></ul><ul><li>=take c 50-100 ml of cold fluid unless CI </li></ul><ul><li>CI: GI dysfxn (vomiting), unconscious or unable to swallow, NPO per/post-op </li></ul><ul><li>DisAdv: GI irritation, inactivation by gastric acid, unpleasant taste/odor, teeth discoloration. </li></ul><ul><li>Remember: Sit client upright to enhance swallowing </li></ul>
  15. 15. <ul><li>When preparing solid meds: </li></ul><ul><li>Only scored tablets may be broken </li></ul><ul><li>Crush tab only when appropriate (children,elderly,dysphagia) </li></ul><ul><li>For enteric-coated tabs:don’t crush, give c antacid,milk </li></ul><ul><li>When preparing liquid meds: </li></ul><ul><li>Shake suspensions and pour away from label to prevent dirtying it </li></ul>
  16. 16. <ul><li>Read amount at meniscus and at eye level </li></ul><ul><li>Wipe lip and neck of bottle before re-capping </li></ul><ul><li>Evaluate client’s response to meds after 30 min. If client vomits after taking meds, inform physician. Do not give again. </li></ul><ul><li>2. SUBLINGUAL </li></ul><ul><li>Place meds under tongue until it dissolves. Do not swallow or take with fluid. (gastric acid deactivate meds) </li></ul><ul><li>Fast absorption thru blood vessels under the tongue </li></ul>
  17. 17. <ul><li>BUCCAL </li></ul><ul><li>Place meds against mucous membranes of the cheek. </li></ul><ul><li>Also not swallow or taken with fluid </li></ul>
  18. 18. <ul><li>TOPICAL MEDICATIONS (SKIN, NOSE, EYE, EAR, VAGINA, RECTUM) </li></ul><ul><li>1. VIA SKIN </li></ul><ul><li>Use gloves, gauze or sterile applicator </li></ul><ul><li>Cleanse skin with soap & warm water to remove encrustation that blocks contact & absorption of new meds. </li></ul><ul><li>Remember: </li></ul><ul><li>Lotion & creams: applied gently, not rubbed </li></ul><ul><li>Liniment: rubbed into skin gently but firmly </li></ul>
  19. 19. <ul><li>Powder: dusted lightly to cover affected area thinly </li></ul><ul><li>Transderm patches: remove backing and place patch in area with little hair, use gloves to avoid drug absorption </li></ul><ul><li>NTG patch: take BP before & after application </li></ul><ul><li>2. VIA NOSE </li></ul><ul><li>Have client blow nose, lie supine and breathe thru mouth </li></ul><ul><li>Position head as follows for 5 min to ensure absorption </li></ul>
  20. 20. <ul><li>Posterior pharynx: head tilted backward </li></ul><ul><li>Ethmoid & sphenoid sinus: head hyperextended, tilted over HOB (Parkinson’s position) </li></ul><ul><li>Frontal & Maxillary sinus: Hyperextended & side wards (Proetz) </li></ul><ul><li>Place dropper 1 cm above nares & squeeze quickly, not to touch nose with applicator </li></ul><ul><li>Client may wipe but not blow nose </li></ul>
  21. 21. <ul><li>Meds may produce unpleasant taste or coughing </li></ul><ul><li>CI: to decongestants (most common nasal meds): HPN, heart disease </li></ul><ul><li>3. VIA EYE </li></ul><ul><li>Gently clean eyelid of crusts or discharge using gauze in saline. Wipe from inner-outer canthus. </li></ul><ul><li>For Eyedrops: Client looks up, use thumb/forefinger to pull down cheekbone & pull up lid exposing lower conjunctiva. </li></ul><ul><li>Drop prescribed meds & ask client to blink/close eys </li></ul>
  22. 22. <ul><li>For Eye Ointment </li></ul><ul><li>Squeeze thin stream along inner edge of lower conjunctiva from inner to outer canthus. Don’t touch eye with container, twist tube to break stream. </li></ul><ul><li>Client closes eyes, then lightly rub lid in circular motion. </li></ul><ul><li>4. VIA EAR </li></ul><ul><li>With client side-lying, straighten ear canal by pulling ear </li></ul><ul><li>Assess for eardrum perforation or DC. </li></ul><ul><li>Warm meds in hands (avoids vertigo). Hold dropper 1 cm above ear & instill meds, Maintain for 2-3 min. </li></ul>
  23. 23. <ul><li>For irrigation: place towel under client’s head. Irrigate with 50 ml of fluid. </li></ul><ul><li>5. VIA VAGINA </li></ul><ul><li>Privacy, void 1 st </li></ul><ul><li>Position: dorsal recumbent, over bedpan if for irrigation </li></ul><ul><li>Use gloves, then retract labia with non-dominant hand </li></ul><ul><li>For suppositories: With dominant hand, apply water-based lubricant on rounded end of suppository and insert 3-4 inches down. </li></ul>
  24. 24. <ul><li>Store suppositories in ref to avoid melting </li></ul><ul><li>For creams, jelly, irrigating solutions (douche) </li></ul><ul><li>Insert applicator 2-3 inches down & deposit meds. </li></ul><ul><li>Client remains in position for 15-20 min. </li></ul><ul><li>6. VIA RECTUM </li></ul><ul><li>Sim’s, breathe slowly thru mouth </li></ul><ul><li>Apply lubricant, insert tapered end past internal anal sphincter (kids: 2”) & hold buttocks togeter as client may expel suppository. </li></ul>
  25. 25. <ul><li>INHALANT MEDS: METERED DOSE INHALERS </li></ul><ul><li>These clients depend on meds for adequate control of airway obstruction & must learn self-admin. </li></ul><ul><li>Position:upright (sitting or standing) </li></ul><ul><li>Shake inhaler then have client inhale & exhale deeply </li></ul><ul><li>3-point/lateral hand position: client holds inhaler, thumb at bottom of mouthpiece & index & middle finger at the top. </li></ul>
  26. 26. <ul><li>Place inhaler in mouth or 1-2 “ away if c spacer </li></ul><ul><li>Client inhales deeply, presses canister </li></ul><ul><li>Hold breath for 10 sec then exhale thru pursed lips. </li></ul><ul><li>PARENTERAL MEDS (NEEDLE/INJXN) </li></ul><ul><li>AMPULE PREP: </li></ul><ul><li>Tap neck to move fluid down ampule then snap off neck towards self. Hold ampule upside down, quickly draw meds s needle touching rim </li></ul>
  27. 27. <ul><li>Keep tip of needle under fluid to avoid aspirating bubbles. If aspirated do not expel air in ampule </li></ul><ul><li>To expel bubbles, tap syringe to move bubbles up & draw back plunger slightly then push to expel air. </li></ul><ul><li>VIAL PREP (SOLUTION) </li></ul><ul><li>Multi-dose vials: Wipe off rubber stopper with ROH pledget </li></ul><ul><li>S contaminating plunger, draw up air in equal to amt of meds needed & inject air into vial. This prevents (-) pressure buildup </li></ul>
  28. 28. <ul><li>Insert needle thru center of rubber seal. Keep tip below fluid level & allow pressure in vial to fill syringe </li></ul><ul><li>Before injecting, change dulled needle </li></ul><ul><li>VIAL PREP (POWDER FOR RECON) </li></ul><ul><li>Prepare diluent & inject into vial. Remove needle & roll vial in palms. Don’t shake </li></ul><ul><li>Use filter needle when drawing up recon meds. </li></ul>
  29. 29. <ul><li>Mixing Meds </li></ul><ul><li>2 vials=Inject air into vial A & withdraw needle (tip must not touch soln) </li></ul><ul><li>Inject air into vial B & withdraw meds. Change needle. </li></ul><ul><li>Inject new needle into vial A and withdraw meds. </li></ul><ul><li>VIAL TO AMPULE: Draw meds from vial-ampule </li></ul>
  30. 30. <ul><li>ADMINISTERING INJECTIONS </li></ul><ul><li>Select appropriate site avoiding bruised / tender areas & rotating sites AMAP. </li></ul><ul><li>Clean site with ROH swab. Use gloves to prevent contact with client blood. </li></ul><ul><li>Insert needle quickly, bevel up, then release hold to < pain. </li></ul><ul><li>Aspirate for blood. Re-insert if with blood unless it IV </li></ul><ul><li>Inject slowly. Press swab over site before removing needle. </li></ul><ul><li>Massage area except Z track or heparin injxn </li></ul>
  31. 31. <ul><li>Airlock IM Tx: for interferon, DPT vaccine </li></ul><ul><li>Most common site of heparin injxn: abdomen </li></ul>
  32. 32. Z track IM: < irritation Hold like dart. Insert. Inject 10-20 sec G:21-23 L:1” (K) 1 1/2 “ (A) K:.5-1ml A:2-3 ml Gluteus, A&M thigh, deltoid IM Don’t aspirate or massage for heparin or insulin injxn Pinch skin to form fold, dart palm down. 45/90 G:25-27 L:3/8 5/8 1/2 K: 0.5-1ml A: 1-3ml LUA, anterior thigh, abdomen SQ Don’t massage Stretch skin, insert needle 10-15 2-3mm deep G: 26 L:3/8 5/8 0.1-1 ml Ventral upper arm, scapula, chest ID Remarks Method Needle Syringe Site
  33. 33. <ul><li>INTRAVENOUS ADMINISTRATION </li></ul><ul><li>Microtubing: 60 gtts/ml, rates >12 h </li></ul><ul><li>Macrotubing: all other rates </li></ul><ul><li>VENIPUNCTURE </li></ul><ul><li>1. Prepare infusion set. Place roller clamp 1-2 inches below drip chamber & move to off position. Insert spike into fluid bag. </li></ul><ul><li>2. Prime fill drip chamber & tubing (up to adapter) c solution. </li></ul><ul><li>3. Remove any air bubbles by tapping tubings </li></ul><ul><li>4. Apply tourniquet & select a vein </li></ul>
  34. 34. <ul><li>5. Use the most distal site in non-dominant arm </li></ul><ul><li>6. Dilate vein:close-open fist </li></ul><ul><li>7. Cleanse site then anchor vein using thumb & stretch skin opposite the direction of insertion </li></ul>
  35. 35. <ul><li>Types IV Admin: </li></ul><ul><li>1. IV push via hep lock </li></ul><ul><li>a. 2 ml saline: flush </li></ul><ul><li>b. admin meds </li></ul><ul><li>c. 2 ml saline: flush </li></ul><ul><li>d. 10-100 U heparin: flush </li></ul><ul><li>2. IV push via existing line </li></ul><ul><li>Occlude primary IV line by pinching tubing just above injxn port closest to pt, give meds & release tubing </li></ul>
  36. 36. <ul><li>3.IV infusion </li></ul><ul><li>Inject meds thru port thru port in IV bag with rubber stopper not thru air vent or port for IV tubing. </li></ul><ul><li>4. Piggyback/Add med solution bag to an existing line </li></ul><ul><li>*connect IV tubing to meds bag. Hang med bag higher than primary bag if piggyback </li></ul>
  37. 37. <ul><li>DOSAGE CALCULATION </li></ul><ul><li>A. DRUG DOSAGE= D x Q </li></ul><ul><li>S </li></ul><ul><ul><li>eg: erythromycin 250 mg PO, stock: 125mg/5ml </li></ul></ul><ul><ul><li>250mg/125 mg X 5 ml= 10 ml </li></ul></ul><ul><ul><li>For drugs that need dilution: </li></ul></ul><ul><ul><li>IM=2 cc </li></ul></ul><ul><ul><li>IV < 500= 5 cc </li></ul></ul><ul><ul><li>IV >500= 10 cc </li></ul></ul><ul><ul><li>Eg 5 FU 259 mg IV; stock: 500 mg vial </li></ul></ul><ul><ul><li>250 mg/500 mg X 5 cc dil=2.5 cc </li></ul></ul>
  38. 38. <ul><li>PEDIA DRUG DOSAGE </li></ul><ul><li>1. BSA (M2)=sq rt WEIGHT (kg) x HT (cm) </li></ul><ul><li>3600 </li></ul><ul><li>Child’s dose = child’s BSA X AD </li></ul><ul><li>Adult’s BSA (1.73 m2) </li></ul><ul><li>3 yo weighs 15 kg, ht of 92 cm is to be given Demerol; AD for Demerol is 100 mg/dose </li></ul>
  39. 39. <ul><li>Based on body weight </li></ul><ul><li>= mg/kg/dose X wt (kg) X Q </li></ul><ul><li>S </li></ul><ul><li>eg: Paracetamol 15 mkd for child weighing 20 kg. Stock: 250 mg/5 ml </li></ul><ul><li>Based on Age </li></ul><ul><li>Fried’s: birth-12 months </li></ul><ul><li>Infant’s dose= age in months X AD </li></ul><ul><li> 150 </li></ul>
  40. 40. <ul><li>Young’s= (1-12 years) </li></ul><ul><li>Child’s Dose= age in years X AD </li></ul><ul><li>age in yrs + 12 </li></ul><ul><li>Clark’s Rule= </li></ul><ul><li>Child’s Dose= wt of child in lbs X AD </li></ul><ul><li>150 lb </li></ul>

×