Upload
tracy-wells
View
221
Download
0
Tags:
Embed Size (px)
Citation preview
1
INTRODUCTION TO PHARMACOLOGYN402 Pharmacology
Los Angeles Pierce College
2
“PHARMACOLOGY” IS COMPLEX….
Purpose
Site of Action
Precautions
Intended outcome
Delivery methods
3
MASTERING PHARMACOLOGY REQUIRES APPLICATION OF KNOWLEDGE FROM OTHER FIELDS
Pharma-cologyAnatomy
Physiology
Chemistry
Micro-biology
Psycho-Social
Nursing
4
CLASSIFICATION OF THERAPEUTIC AGENTS
Drug
Chemical agent able to produce biologic responses; “medication” after administration
Biologic
Naturally produced by animal cells, microorganisms, or by the body
“CAM”
Complementary and alternative medicine therapies
5
ADVANTAGES OF PRESCRIPTION MEDICATIONS
Patient is examined before medication initiated Diagnosis is obtained Proper amount is recommended Dosing instructions provided Description of correct use and potential side
effects
6
FUNCTIONS OF THE FDA(U.S. FOOD AND DRUG ADMINISTRATION)
Assure that foods are safe, wholesome, sanitary, properly labeled Ensuring that human and veterinary drugs,
vaccines, biological products, and medical devices are safe and effective
Protect the public from electronic product radiation
Assure cosmetics, dietary supplements are safe and properly labeled
Regulate tobacco products Facilitate product innovation to advance public
health
7
BLACK BOX WARNING
Identification of extreme adverse reactions Potential to cause death or serious injury
8
WHAT IS A “PROTOTYPE DRUG?”
A well-understood drug within a specific classification
Other drugs within the class are compared to the prototype drug Knowing the prototype will allow you to predict actions and adverse effects of other drugs in the class
9
CLASSIFICATIONS OF DRUGS
The number of drugs available grows every day
Impossible to know everything about every one
Drugs are classified to facilitate understanding of individual drugs
Therapeutic Classification determined by the drug’s intended use in treating disease
Pharmacologic Classification determined by the drug’s effects at the molecular, tissue, and body system level
Pharmacologic Classification provides the student and practitioner with greater ability to understand individual drugs within the class
10
DRUG NAMES
Chemical name is unique to that compound Generic name assigned by the US Adopted
Name Council, used by a variety of entities Trade name is assigned by the company
marketing the drug A drug company has exclusive rights to a
new drug for 17 years After 17 years, other companies may market
the drug A generic drug may have several trade
names
11
TRADE NAME VS GENERIC DRUGS
Generic generally less expensive May be slight differences in drug formulation Inert ingredients may affect bioavailability Some drugs may take longer than others to
become effective
12
DRUGS WITH POTENTIAL FOR ABUSE OR ADDICTION
Such drugs are identified by one of 5 classes:
13
WHAT THE REGISTERED NURSE MUST KNOW BEFORE GIVING DRUGS…
What drug is ordered Drug classification Intended use Effects on body Contraindications Patient anthropomorphics Side effects Indications How supplied Administration considerations Assessment strategies
14
YOUR GOAL IS TO CARE FOR AND PROTECT YOUR PATIENT
The purpose of understanding Pharmacology is to limit adverse drug events
You CANNOT know if the drug or dose is appropriate unless you know your patient
Therefore…. You CANNOT give a medication until you have performed your physical assessment!
15
THE EXPECTED DRUG EFFECT IS INTENDED;OTHER EFFECTS CAN OCCUR
Drug effect
Allergic
Side effect
Adverse
event (exp)
Adverse
event (unexp
)
16
ADVERSE DRUG EVENTS/EFFECTS AND THE ELDERLY PATIENT
Can be influenced by non-drug factors: Cognitive impairment Depression Motor dysfunction Complex drug regimen Polypharmacy Fear of adverse drug reaction
17
SIX RIGHTS (OR 10, OR 11, OR MORE!)
18
CHECK DRUG 3 TIMES
Check with MAR
Check when pouring, preparing, or connecting
Check before administering
19
CAUSES OF MEDICATION ADMINISTRATION
Inadequate patient information Inadequate drug information/knowledge Miscommunication of drug orders Improper labeling Distraction by outside influences
20
ENTERAL DRUG ADMINISTRATION—ORAL
Use only if patient is fully alert Patient must have ability to swallow Hand patient the cup with drug and provide
water Stay with patient until drug is swallowed May require asking patient to open his mouth
the verify drug has been swallowed
21
ENTERAL DRUG ADMINISTRATION--SUBLINGUAL
Make sure patient is fully alert and able to follow your directions
Place tablet under the tongue Instruct the patient to allow drug to dissolve
and not to swallow Remain with patient until fully dissolved Offer water afterward
22
ENTERAL DRUG ADMINISTRATION—BUCCAL
Make sure patient is fully alert and able to follow your directions
Place tablet between gum line and the cheek Instruct the patient to allow drug to dissolve
and not to swallow or move the table with his tongue
Remain with patient until fully dissolved Offer water afterward
23
ENTERAL DRUG ADMINISTRATION—NASOGASTRIC AND GASTROSTOMY
Give liquid forms or crushed and mixed with at least 30 ml warm water
Enteric coated or extended release cannot be crushed
Verify tube placement Turn off feeding Aspirate stomach contents to see that there is less than 100 mL Return residual, flush with water Pour drug into syringe and allow to flow by gravity Keep HOB elevated Flush with at least 30 mL water
24
TOPICAL DRUG ADMINISTRATION—TRANSDERMAL
Use gloves Label patch with initials, date, time Remove previous patch Place on clean, dry hairless skin Rotate sites
25
TOPICAL DRUG ADMINISTRATION—OPHTHALMIC
Instruct patient to tilt head back Pull lower lid down with nondominant hand Keep dispenser ¼ to ⅛ inch above
conjunctival sac Instill drops in center of pocket Instill thin line of ointment along inner lid
margin Instruct to blink gently Provide with tissue
26
TOPICAL DRUG ADMINISTRATION—OTIC
Instruct patient to lie on opposite side Hold dropper ¼ inch from ear canal Instill drops to side of ear canal Pull pinna up on adult, down on child Once instilled, apply intermittent pressure to
tragus 3 or 4 times Have patient remain side lying for 10
minutes
27
TOPIC ADMINISTRATION—NASAL
Ask patient to blow nose first, tilt head back Have patient open mouth and breathe
through mouth Hold dropper just above nostril Direct drops along side or back of nostril so
drug does not go down eustachian tube
28
VAGINAL ADMINISTRATION
Have patient lying down after emptying bladder
Provide for privacy Medication should be placed against the
cervix
29
RECTAL ADMINISTRATION
Used when patient is comatose or experiencing nausea and vomiting
May require use of lubricant
30
INTRADERMAL ADMINISTRATION
Use TB syringe or other 1mL syringe with 26-27 gauge needle
Spread skin taut with nondominant hand; swab antiseptically
Insert with bevel up until entire bevel under skin
Slowly inject to form small wheal Do not massage after removing needle
quickly Draw circle around site
31
SUBCUTANEOUS ADMINISTRATION
Use 23 to 25 gauge syringe Chose appropriate site; swab antiseptically;
allow to dry Rotate sites; bunch skin with nondominant
hand Insert at 45º to 90º angle depending on
patient size Inject slowly, remove needle quickly Massage site with antiseptic swab unless
medication is an anticoagulant
32
INTRAMUSCULAR ADMINISTRATION
Prepare using a 20-23 gauge needle Clean site antiseptically with swab Form a V with the nondominant hand above
the site Inject into the skin at the angle of the V Aspiration before injection is not required Inject slowly; remove needle quickly Apply pressure and massage gently
33
PHARMACOKINETICS VS PHARMACODYNAMICS
34
ADME… DETERMINES THE EFFICACY OF THE DRUG
Distribution:Blood flowMolecular sizeBind to serum protein?
Metabolism:Breakdown by liverCompound converted tometabolites
Excretion:Removal of compound and metabolitesKidney, gut, lungsIf incomplete → toxicity
Drug Performance
35
PLASMA CONCENTRATION ANDTHERAPEUTIC RANGE
During absorption, time is required for drug to reach minimum effective concentration (MEC)
Drug remains in therapeutic range and reaches peak
Drug continues to be effective during excretion decreases the drug’s concentration
Drug continues to be excreted after passing below minimum effective concentration
36
LOADING DOSE AND MAINTENANCE DOSE
A loading dose is larger than usual dose intended to quickly bring the drug to therapeutic range
Maintenance doses follow Maintenance doses are given at regular
intervals to keep the drug in therapeutic range and to prevent complete elimination
37
THERAPEUTIC INDEX
A comparison of drug that causes a therapeutic effect to the amount of that drug that causes toxicity or death
Toxic dose is divided by the effective dose The larger the ratio, the larger the therapeutic index The smaller the ratio, the smaller the therapeutic index and the greater the chance for toxic effects
38
AGONISTS AND ANTAGONISTS
Agonist—produces the same effect as a natural
chemical at the receptor site Antagonist—binds to receptor site to prevent a sub- stance from binding at that receptor site
39
THE NURSING PROCESS AND MEDICATION ADMINISTRATION—ASSESSMENT
Your assessment focuses on the patient, not on the task
Obtain or review health history Physical assessment of the patient’s
condition Assessment of:
Patient’s baseline understanding of the drug Indication and need for specific drug Potential allergies/adverse reactions The patient’s ability to participate in the medication process (compliance)
40
NURSING DIAGNOSIS
Major areas of concern:
Promote therapeutic
effects of drug
Maximize patient self-care
Minimize ADE and toxicity
41
ESTABLISHING DESIRED OUTCOMES
Describes the intended state of the patient after the care plan is performed
Often focuses on enhanced self-care abilities Self-care is promoted through education by
the nurse Administration skills (e.g., how to give self
insulin) Knowledge of desired effects (what the drug will
do) What to report to provider (nausea, changes in
VS) Special considerations for effective dosing (e.g.,
grapefruit inhibits the metabolism of statins)
42
IMPLEMENTATION
In addition to actually giving the medication, includes…
Ongoing assessment Monitoring drug effects Large component is patient education
Use of the drug Monitoring side effects Medication administration
43
EVALUATION
Compare the patient’s current status with the desired outcome
Were the therapeutic effects achieved? Requires documentation, continuation, or
revision of plan
44
ESTABLISHING PRIORITIES IN MEDICATION ADMINISTRATION
Safety first…safety second…safety always! Consider each encounter as thoroughly as your
first Validate allergies, identity Ask and assess regarding potential side effects or
adverse reactions Whether giving medications or providing any other
care, always identify: “What is my patient’s most immediate need?”
Think: Circulation Airway Breathing Then, everything else….
45
REPORTING AND DOCUMENTING MEDICATION ERRORS
Each facility has its own procedure Documentation should be objective Statement of events and facts Does not include description of contributing
factors Document exactly what was given or what
was omitted In-house incident or occurrence reports
provide forum for describing contributing factors objectively
46
STRATEGIES TO REDUCE MEDICATION ERRORS
Assess and question your patient Act only on clear orders and question unclear ones Eliminate distractions Use at least 2 identifiers each encounter Follow prescribed procedures and techniques Validate patient has taken in the drug Calculate correctly and precisely Record drug administration immediately Recognize that many drugs when crushed are
toxic Guard against easily confused and different drugs Always observe for expected and unexpected
outcomes
47
PREGNANCY RISK CATEGORIES
48
GUIDELINES FOR DRUGS DURING BREAST FEEDING
Large number of drugs are secreted into breast milk in varying amounts
Infants vary in their ability to metabolize small amounts of drug
Best to postpose pharmacotherapy until after baby is weaned
If drugs are necessary, give immediately after breast feeding
Drugs with shorter half-life are preferred OTC products should also be avoided
49
PHARMACOTHERAPY ACROSS THE LIFESPAN—SPECIAL CONSIDERATIONS
Rate of metabolis
m
Understanding and
inquisitiveness
Potential for abuse
or overdose
Dosing variations
Individual physical health
50
FACTORS CONTRIBUTING TO POLYPHARMACY
Defined as taking 4 or more drugs Multiple medications for many diseases Elderly purchase 40% of OTC drugs and use
twice as much herbals Going to multiple healthcare providers Using different pharmacies
51
EFFECTIVE PHARMACOTHERAPY REQUIRES CONSIDERATION OF MULTIPLE FACTORS
Holistic
model
Cultural influence
s
Environ-mental factors
Genetics Gender
Psycho-socialfactors
52
CHALLENGES OF COMPLEMENTARY AND ALTERNATIVE MEDICINE
The use of CAM is increasing among adults and children
More likely when client cannot afford conventional care
Such products are not standardized; therefore, effects cannot be predicted
Manufacturer is not required to demonstrate a product’s effectiveness or to prove its safety
Actual toxicity of certain products may not be known because effects are not reported
53
NURSING RESPONSIBILITIES REGARDING CAM
Include OTC, herbal preparations, dietary supplements, and performance (sports) supplements in your questioning during health and medication history
Be alert to documented herb-drug and supplement-drug interactions
Ask the patient why he or she is taking such products to identify potential health risks or concerns
54
PATIENT EDUCATION AND CAM
Instruct regarding potential serious side effects
Advise pregnant women to inform physician of CAM use
Older adults at greater risk for drug-herb interaction
Inform patients with allergies that such products have multiple components
Educate regarding unrealistic advertising claims
Caution not to exceed suggested doses
55
NOW, A REAL PROBLEM….
Potential for Abuse
Conventional Drug Therapy
OTC ProductsCAM
56
SOME TERMS RELATED TO CONTROLLED SUBSTANCES
Substance abuse: patterned use of a drug in amounts harmful to the user or others Substance dependence: an adaptive state
that develops from repeated drug use Substance addiction: compulsive, out-of-
control drug use despite negative consequences
Withdrawal: symptoms that occur after abruptly stopping a drug upon which one has become dependent
57
PHYSICAL VS PSYCHOLOGICAL DEPENDENCE
Physical
Adaptation of the nervous system to repeated
substance use
Withdrawal results when substance is discontinued
Psychological
Overwhelming desire to continue drug seeking behavior, regardless of
consequences
No obvious physical signs of discomfort when substance is
discontinued
58
“WITHDRAWAL SYNDROME”
Also known as “discontinuation syndrome” Risk of withdrawal syndrome increases with
dosage and length of time Symptoms are specific to drug withdrawn,
e.g.: Opioids: inner restlessness, chills, cramping,
dizziness, ↑heart rate Cannabinoids: hallucinations, myocardial
infarction SSRIs: Flu-like symptoms, vertigo, dysphoria
59
IN SUMMARY…
The Registered Nurse is the coordinator of all patient care The RN has the best access to determining
competency and appropriateness of the patient’s drug therapy
The RN matches the patient discovered on physical assessment to the medication treatment plan ordered
Omissions, duplications, and unnecessary drugs are identified and reconciled
After appropriate drug administration, careful continuous assessment is performed
The patient is assessed uniquely and independently