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

    1. 1. Pharmacology Rosalie C. Villora, MSN, RN
    2. 2. Objectives <ul><li>Identify principles of pharmacology that relate to nursing care. </li></ul><ul><li>Describe the 5 steps of the nursing process. </li></ul><ul><li>Explain how nursing process is used in the administration of medications </li></ul><ul><li>Explain absorption, excretion, desired effect. </li></ul><ul><li>Identify elements in a patient drug history </li></ul><ul><li>Identify common elements in a variety of hospital medication records </li></ul><ul><li>Discuss charting dos and don’ts </li></ul><ul><li>Discuss confidentiality issues as they apply to medication administration </li></ul>
    3. 3. Terminology <ul><li>Drug - any chemical that affects the physiologic processes of a living organism </li></ul><ul><li>Pharmacology - the study or science of drugs </li></ul><ul><li>Chemical name - describes the drug’s chemical composition and molecular structure </li></ul><ul><li>Generic name (nonproprietary name) - name given by the United States Adopted Name Council </li></ul><ul><li>Trade name (proprietary name) - each drug has a registered trademark; use of the name restricted by the drug’s patent owner (usually the manufacturer) </li></ul>
    4. 5. Pharmacologic Principles <ul><li>Pharmaceutics - the study of how various drug forms influence pharmacokinetic and pharmacodynamic activities </li></ul><ul><li>Pharmacokinetics - the study of what the body does to the drug </li></ul><ul><ul><li>Absorption </li></ul></ul><ul><ul><li>Distribution </li></ul></ul><ul><ul><li>Metabolism </li></ul></ul><ul><ul><li>Excretion </li></ul></ul><ul><li>Pharmacodynamics - the study of what the drug does to the body, i.e. the mechanism of drug actions in living tissues </li></ul>
    5. 7. Pharmacologic Principles cont’d <ul><li>Pharmacotherapeutics - The use of drugs and the clinical indications for drugs to prevent and treat diseases </li></ul><ul><ul><li>Empirical therapeutics – effective, but mechanism of action is unknown </li></ul></ul><ul><ul><li>Rational therapeutics – specific evidence has been obtained for the mechanisms of drug action </li></ul></ul><ul><li>Pharmacognosy - The study of natural (plant and animal) drug sources </li></ul>
    6. 8. Pharmaceutics <ul><li>Dosage form design affects dissolution </li></ul>
    7. 9. Pharmacokinetics: Absorption <ul><li>The rate at which a drug leaves its site of administration, & the extent to which absorption occurs </li></ul><ul><ul><li>Bioavailability – a measure of the extent of drug absorption in the body (0% to 100%) </li></ul></ul><ul><ul><li>Bioequivalent – two drugs have the same bioavailability and same concentration of active ingredients </li></ul></ul><ul><li>Factors That Affect Absorption </li></ul><ul><li>Food or fluids administered with the drug </li></ul><ul><li>Dosage formulation </li></ul><ul><li>Status of the absorptive surface </li></ul><ul><li>Rate of blood flow to the small intestine </li></ul><ul><li>Acidity of the stomach </li></ul><ul><li>Status of GI motility </li></ul>
    8. 10. Routes <ul><ul><li>Enteral (GI tract) </li></ul></ul><ul><ul><ul><li>Oral </li></ul></ul></ul><ul><ul><ul><li>Sublingual </li></ul></ul></ul><ul><ul><ul><li>Buccal – oral mucosa between the cheek and gum </li></ul></ul></ul><ul><ul><li>Parenteral </li></ul></ul><ul><ul><li>Topical </li></ul></ul>
    9. 11. First-Pass Effect <ul><li>The metabolism of a drug and its passage from the liver into the circulation </li></ul><ul><li>– A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation (high first-pass effect) </li></ul><ul><li>– The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation </li></ul>
    10. 12. <ul><li>Drugs to be taken on empty stomach </li></ul><ul><ul><li>alendronate sodium </li></ul></ul><ul><ul><li>risedronate sodium </li></ul></ul><ul><li>Drugs to be taken with food </li></ul><ul><ul><li>Carbamazepine </li></ul></ul><ul><ul><li>Iron </li></ul></ul><ul><ul><li>Hydralazine </li></ul></ul><ul><ul><li>Lithium </li></ul></ul><ul><ul><li>Propanolol </li></ul></ul><ul><ul><li>Spironolactone </li></ul></ul><ul><ul><li>Theophylline </li></ul></ul>
    11. 13. <ul><li>Parenteral Route </li></ul><ul><li>Intravenous (fastest delivery into the blood circulation) </li></ul><ul><li>Intramuscular </li></ul><ul><li>Subcutaneous </li></ul><ul><li>Intradermal </li></ul><ul><li>Intrathecal </li></ul><ul><li>Intraarticular </li></ul><ul><li>Topical Route </li></ul><ul><li>Skin - transdermal patches </li></ul><ul><li>Eyes </li></ul><ul><li>Ears </li></ul><ul><li>Nose </li></ul><ul><li>Lungs (inhalation) </li></ul><ul><li>Rectum </li></ul><ul><li>Vagina </li></ul>
    12. 14. <ul><li>Distribution </li></ul><ul><li>Protein-binding </li></ul><ul><li>Water soluble vs. fat soluble </li></ul><ul><li>Blood-brain barrier </li></ul><ul><li>Areas of rapid distribution: heart, liver, kidneys, brain </li></ul><ul><li>Areas of slow distribution: muscle, skin, fat </li></ul><ul><li>Metabolism (Biotransformation) </li></ul><ul><li>Liver (main organ) </li></ul><ul><li>Skeletal muscle </li></ul><ul><li>Kidneys </li></ul><ul><li>Lungs </li></ul><ul><li>Plasma </li></ul><ul><li>Intestinal mucosa </li></ul>
    13. 16. <ul><li>Factors that metabolism </li></ul><ul><li>Fast acetylator </li></ul><ul><li>Barbiturate therapy </li></ul><ul><li>Rifampin therapy </li></ul><ul><li>Factors that metabolism </li></ul><ul><li>Cardiovascular dysfunction </li></ul><ul><li>Renal insufficiency </li></ul><ul><li>Starvation </li></ul><ul><li>Obstructive jaundice </li></ul><ul><li>Slow acetylator </li></ul><ul><li>Erythromycin or ketoconazole drug therapy </li></ul>
    14. 17. <ul><li>Delayed drug metabolism results in: </li></ul><ul><li>Accumulation of drugs </li></ul><ul><li>Prolonged action of the drugs </li></ul><ul><li>Stimulating drug metabolism causes: </li></ul><ul><li>Diminished pharmacologic effects </li></ul><ul><li>Cytochrome P-450 enzymes </li></ul><ul><li>Also known as microsomal enzymes </li></ul>
    15. 18. Excretion <ul><li>The elimination of drugs from the body </li></ul><ul><li>Kidneys (main organ) </li></ul><ul><li>Liver </li></ul><ul><li>Bowel </li></ul><ul><ul><li>Biliary excretion </li></ul></ul><ul><ul><li>Enterohepatic recirculation </li></ul></ul>
    16. 20. Half-life <ul><li>The time it takes for one half of the original amount of a drug in the body to be removed </li></ul><ul><li>A measure of the rate at which drugs are removed from the body </li></ul><ul><li>Most drugs are considered to be effectively removed after about five half-lives </li></ul><ul><li>Steady state </li></ul>
    17. 21. The Movement of Drugs Through the Body <ul><li>Drug actions </li></ul><ul><li>The cellular processes involved in the drug and cell interaction </li></ul><ul><li>Drug effect </li></ul><ul><li>The physiologic reaction of the body to the drug </li></ul>
    18. 22. Onset, Peak, and Duration <ul><li>Onset </li></ul><ul><li>The time it takes for the drug to elicit a therapeutic response </li></ul><ul><li>Peak </li></ul><ul><li>The time it takes for a drug to reach its maximum therapeutic response </li></ul><ul><li>Highest blood level </li></ul><ul><li>Trough Level </li></ul><ul><li>Lowest blood level </li></ul><ul><li>Duration </li></ul><ul><li>The time a drug concentration is sufficient to elicit a therapeutic response </li></ul>
    19. 24. Pharmacodynamics: Mechanisms of Action <ul><li>Receptor interactions </li></ul><ul><li>Enzyme interactions </li></ul><ul><li>Nonspecific interactions </li></ul>
    20. 26. Pharmacotherapeutics: Types of Therapies <ul><li>Acute therapy </li></ul><ul><li>Maintenance therapy </li></ul><ul><li>Supplemental/replacement therapy </li></ul><ul><li>Palliative therapy </li></ul><ul><li>Supportive therapy </li></ul><ul><li>Prophylactic therapy </li></ul><ul><li>Empiric therapy </li></ul>
    21. 27. <ul><li>Contraindication - a ny characteristic of the patient, especially a disease state, that makes the use of a given medication dangerous for the patient </li></ul><ul><li>Intended therapeutic action (beneficial) </li></ul><ul><li>Unintended but potential adverse effects (predictable, adverse reactions) </li></ul><ul><li>Therapeutic index - t he ratio between a drug’s therapeutic benefits and its toxic effects </li></ul><ul><li>Tolerance - a decreasing response to repeated drug doses </li></ul><ul><li>Dependence - a physiologic or psychological need for a drug </li></ul>
    22. 28. <ul><li>Drug interactions: the alteration of action of a drug by other prescribed drugs, over-the-counter medications, & herbal therapies </li></ul><ul><li>Drug interactions </li></ul><ul><ul><li>Additive effect </li></ul></ul><ul><ul><li>Synergistic effect </li></ul></ul><ul><ul><li>Antagonistic effect </li></ul></ul><ul><ul><li>Incompatibility </li></ul></ul>
    23. 29. <ul><li>Adverse Drug Events </li></ul><ul><li>Medication errors </li></ul><ul><li>Adverse drug reactions: </li></ul><ul><ul><li>Pharmacologic reactions, including adverse effects </li></ul></ul><ul><ul><li>Hypersensitivity (allergic) reaction </li></ul></ul><ul><ul><li>Idiosyncratic reaction </li></ul></ul><ul><ul><li>Drug interaction </li></ul></ul><ul><li>Adverse effects </li></ul><ul><li>Predictable, well-known reactions that result in little or no change in patient management </li></ul><ul><li>Predictable frequency </li></ul><ul><li>Occurrences are related to the size of the dose </li></ul><ul><li>Usually resolve when the drug is discontinued </li></ul>
    24. 30. Other Drug-Related Effects <ul><li>Teratogenic – results in structural defects in the fetus </li></ul><ul><li>Mutagenic – permanent changes in the genetic composition and chromosome structure of living organism </li></ul><ul><li>Carcinogenic – cancer-causing effects of drugs </li></ul>
    25. 31. <ul><li>Pharmacognosy </li></ul><ul><li>Four main sources for drugs </li></ul><ul><li>Plants </li></ul><ul><li>Animals </li></ul><ul><li>Minerals </li></ul><ul><li>Laboratory synthesis </li></ul><ul><li>Toxicology </li></ul><ul><li>The study of poisons and unwanted responses to drugs and other chemicals </li></ul>
    26. 32. Life Span Consideration <ul><li>Pregnancy </li></ul><ul><li>Breast-feeding </li></ul><ul><li>Neonatal and Pediatric </li></ul><ul><li>Elderly </li></ul>
    27. 34. Neonatal and Pediatric Considerations: Pharmacokinetics <ul><li>Absorption </li></ul><ul><ul><li>Gastric pH less acidic </li></ul></ul><ul><ul><li>Gastric emptying is slowed </li></ul></ul><ul><ul><li>Intramuscular absorption faster and irregular </li></ul></ul><ul><li>Distribution </li></ul><ul><ul><li>The younger the person, the greater the % of total body water </li></ul></ul><ul><ul><li>Greater TBW means fat content is lower </li></ul></ul><ul><ul><li>Decreased level of protein binding </li></ul></ul><ul><ul><li>Immature blood-brain barrier—more drugs enter the brain </li></ul></ul>
    28. 35. Neonatal and Pediatric Considerations: Pharmacokinetics <ul><li>Metabolism </li></ul><ul><ul><li>Liver immature, does not produce enough microsomal enzymes </li></ul></ul><ul><ul><li>Older children may have increased metabolism, requiring higher doses than infants </li></ul></ul><ul><li>Excretion </li></ul><ul><ul><li>Kidney immaturity affects glomerular filtration rate and tubular secretion </li></ul></ul><ul><ul><li>Decreased perfusion rate of the kidneys may reduce excretion of drugs </li></ul></ul>
    29. 36. The Elderly <ul><li>Elderly: older than age 65 </li></ul><ul><ul><li>Healthy People 2010: older than age 55 </li></ul></ul><ul><li>Use of OTC medications </li></ul><ul><li>Increased incidence of chronic illnesses </li></ul><ul><li>Polypharmacy - “prescribing cascade” </li></ul>
    30. 37. The Elderly: Pharmacokinetics <ul><li>Absorption </li></ul><ul><ul><li>Gastric pH less acidic </li></ul></ul><ul><ul><li>Slowed gastric emptying </li></ul></ul><ul><ul><li>Movement through GI tract slower </li></ul></ul><ul><ul><li>Reduced blood flow to the GI tract </li></ul></ul><ul><ul><li>Reduced absorptive surface area due to flattened intestinal villi </li></ul></ul><ul><li>Distribution </li></ul><ul><ul><li>TBW percentages lower </li></ul></ul><ul><ul><li>Fat content increased </li></ul></ul><ul><ul><li>Decreased production of proteins by the liver, resulting in decreased protein binding of drugs (and increased circulation of free drugs) </li></ul></ul>
    31. 38. The Elderly: Pharmacokinetics <ul><li>Metabolism </li></ul><ul><ul><li>Aging liver produces fewer microsomal enzymes, affecting drug metabolism </li></ul></ul><ul><ul><li>Reduced blood flow to the liver </li></ul></ul><ul><li>Excretion </li></ul><ul><ul><li>Decreased glomerular filtration rate </li></ul></ul><ul><ul><li>Decreased number of intact nephrons </li></ul></ul>
    32. 39. Pharmacology & The Nursing Process
    33. 40. The Nursing Process <ul><li>A research-based organizational framework for professional nursing practice </li></ul><ul><li>Central to all nursing care </li></ul><ul><li>Encompasses all steps taken by the nurse in caring for a patient </li></ul><ul><li>Flexibility is important </li></ul><ul><li>Critical thinking </li></ul><ul><li>Ongoing and constantly evolving process </li></ul>
    34. 41. The Nursing Process (cont’d) <ul><li>Assessment </li></ul><ul><li>Nursing diagnosis </li></ul><ul><li>Planning </li></ul><ul><li>Goals </li></ul><ul><li>Outcome criteria </li></ul><ul><li>Implementation </li></ul><ul><li>Evaluation </li></ul>
    35. 42. The Nursing Process (cont’d) <ul><li>Assessment </li></ul><ul><li>Data collection </li></ul><ul><ul><li>Subjective, objective </li></ul></ul><ul><li>Medication history </li></ul><ul><ul><li>Prescriptions </li></ul></ul><ul><ul><li>OTCs </li></ul></ul><ul><ul><li>Herbals </li></ul></ul><ul><ul><li>Responses to medications (therapeutic and adverse responses) </li></ul></ul>
    36. 43. The Nursing Process (cont’d) <ul><li>Nursing diagnosis </li></ul><ul><li>Decision about the need/problem (actual or at risk for) of the patient </li></ul><ul><li>Critical thinking, creativity, and accurate data collection </li></ul><ul><li>NANDA format </li></ul>
    37. 44. The Nursing Process (cont’d) <ul><li>Nursing diagnosis </li></ul><ul><li>Three steps </li></ul><ul><li>Human response to illness (actual or risk) </li></ul><ul><li>“ related to” </li></ul><ul><li>“ as evidenced by” </li></ul><ul><li>Planning </li></ul><ul><li>Identification of goals and outcome criteria </li></ul><ul><li>Time frame </li></ul><ul><li>Prioritization </li></ul>
    38. 45. The Nursing Process (cont’d) <ul><li>Goals </li></ul><ul><li>S- specific </li></ul><ul><li>M- measurable </li></ul><ul><li>A- attainable </li></ul><ul><li>R- realistic </li></ul><ul><li>T- time frame specified </li></ul><ul><li>Outcome Criteria </li></ul><ul><li>Specific standard (s) of measure </li></ul><ul><li>Patient oriented </li></ul>
    39. 46. The Nursing Process (cont’d) <ul><li>Implementation </li></ul><ul><li>Initiation and completion of the nursing care plan as defined by the nursing diagnoses and outcome criteria </li></ul><ul><li>Follow the “Six Rights” of medication administration </li></ul>
    40. 47. The Six Rights of Medication Administration <ul><li>Right drug </li></ul><ul><li>Right dose </li></ul><ul><li>Right time </li></ul><ul><li>Right route </li></ul><ul><li>Right patient </li></ul><ul><li>Right documentation </li></ul>
    41. 48. Another “Right”—Constant System Analysis <ul><li>A “double-check” </li></ul><ul><li>The entire “system” of medication administration </li></ul><ul><li>Ordering, dispensing, preparing, administering, documenting </li></ul><ul><li>Involves the physician, nurse, nursing unit, pharmacy department, and patient education </li></ul>
    42. 49. Other “Rights” (cont’d) <ul><li>Close consideration of special situations </li></ul><ul><li>Prevention and reporting of medication errors </li></ul><ul><li>Patient teaching </li></ul><ul><li>Monitor therapeutic effects, adverse effects, and toxic effects </li></ul><ul><li>Refusal of medication </li></ul>
    43. 50. Six Elements of a Drug Order <ul><li>1. Patient's name </li></ul><ul><li>2. Date order is written </li></ul><ul><li>3. Name of medication </li></ul><ul><li>4. Dosage (includes size, frequency, and number of doses) </li></ul><ul><li>5. Route of delivery </li></ul><ul><li>6. Signature of the prescriber </li></ul>
    44. 51. Evaluation <ul><li>Ongoing part of the nursing process </li></ul><ul><li>Determining the status of the goals and outcomes of care </li></ul><ul><li>Monitoring the patient’s response to drug therapy </li></ul><ul><ul><li>Expected and unexpected responses </li></ul></ul>