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Pharmacology For Nurses Week 1
- 1. Pharmacology for Nurses Nur30 Mount Saint Mary’s College Associate Degree in Nursing Program Maggie Davis-Kendrick, RN,MSN
Editor's Notes
- 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