Pharmacology Part 1 Final Version Student Pp 2010

8/9/2019 Pharmacology Part 1 Final Version Student Pp 2010

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Nursing ConceptsPharmacology 2010

Tara Kay Race MSN, RN, CNS,

CCRN


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MEDICATIONS

What Should a NURSE Know??

Specific Uses

Dosages UsedModes of Administration Side Effects Possible Adverse Reactions Possible InteractionsWays to Monitor Effectiveness in Treating

Specific Disease Processes


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BEFOREYou Give

Medications

5 Questions to AskYourself..


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Question # 1

What is the ScientificRationale for

Administering theMedication??


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Question #2

When Should theAdministration of the

Medication beQuestioned??


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Question #3

How Can the NurseEnsure the Safety of

the MedicationAdministration??


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Question #4What are the possible

Side Effects and Possible

Adverse Reactions

Associated with a SpecificMedication??


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Question #5

How can theEffectiveness of the

Medication beMeasured??


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Overview of Pharmacology

Define

Branches of PharmacologyDrug Sources

Drug Related Terms

Drug Nomenclature (Name) Legal Regulations and Standards

Drug References


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Definition of Pharmacology

The study of drugs and their

interactions with livingsystems Clinical Pharmacology- the study of

drugs in humans


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Pharmaco-therapeutics

Definition: The use of drugs todiagnose, prevent and treat

disease or to prevent pregnancy


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Characteristics of Drugs

3 Most Important:

Effectiveness

Safety

Selectivity


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IDEAL DRUG

NO SUCHTHING!!!!


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Therapeutic Objective

Maximum Benefit

Minimal Harm


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Intensity of Drug Response

Determined by:

Administration

Pharmacokinetics

Pharmacodynamics Individual Variations


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Determination of Drug Responses


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DRUG Administration is a

NURSING Responsibility

Nurses are the Last Line of

Defense in prevention ofmedication errors

Follow the 6 RIGHTS!!

Know your responsibilities!!


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Pharmacology in Patient Care

Pre-Administration Assessment

Dosage and Administration Evaluate and Promote Therapeutic Effects

Minimize Adverse Effects

Minimize Adverse InteractionsMaking PRN decisions

Managing Toxicity

Patient Education


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Administration Factors

Dosage Size

Route

Timing


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PharmacokineticsDefinition:How much of a drug gets to its

sites of action. 4 Major Processes:

Absorption

Distribution

Metabolism Excretion


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Pharmacokinetics


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Absorption

Definition:

Rate of Absorption: Influential Factors:

Route of Administration

Dissolution

Blood Flow to the site of Administration.

Body Surface Area

Lipid Solubility


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Trans-dermal Absorption


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Oral

per os: Latin forby way of the mouth

2 Barriers to Cross:

1. Layer of Epithelial Cells that line the

GI Tract

2. The Capillary Wall.


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Variables Affecting

ORAL Absorption

Solubility and Stability of the DrugGastric and Intestinal pH

Gastric Emptying Time

Food in the GutCo-administration with Other Medications

Special Coatings on the Drug Preparations.


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GI Absorption


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Disadvantages to Oral Administration

Variability of Absorption

Inactivation of some medications by digestiveenzymes

In-activation of the medication as it passes

through the liver(First Pass Effect)

Requires a conscious cooperative patient.

Local Irritation


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Intra-muscular Administration

Barriers Capillary Wall

Advantages

Disadvantages


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Subcutaneous Administration

Barriers Capillary Wall

Advantages

Disadvantages


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Other Routes of Absorption

Other Routes Allow for Systemic or Local effects Topical

Trans-dermal Inhalation

Suppositories

Injection Directly into a Site

Joints

Heart

Nerve

CNS


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Distribution

Definition: The movement of drugs

throughout the body to their specificsite of action Depends on:

Physical and Chemical Properties of the Medication and theIndividual Receiving the Medication .

Factors influencing: Blood flow to the Tissues Ability of the Drug to Exit the Vascular System Ability of the Drug to Enter the Cells


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Drug Movement Across Capillaries


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Protein Binding for Transport


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Protein Bound Drugs


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Blood Brain Barrier

Can the Drug Cross into the Central Nervous

System?? The Blood-Brain Barrier Prevents many drugs

from crossing to the Central Nervous System.

Body Protective Mechanism.


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Metabolism

Definition: Biotransformation or the

enzymatic alteration of a drug structure.LIVER most responsible

Hepatic Microsomal Enzyme System

P450 System- Cytochrome P450


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Excretion

Definition: Removal of the Drugs from the Body

Kidneys most Responsible via Urine

Other Routes of Drug Exit:

Liver Bile Intestines Feces

Exhaled via Lungs

Exocrine GlandsSweat, Breast Milk, Saliva


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Organ of Excretion..The Kidney!!


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Pharmaco-dynamicsDefinition:The impact of drugs on the

body- What drugs do and how they do it.

Determines the nature and intensity of the

drugs response on the body Drug-Receptor Interaction

Drug Dose Relationships Plasma Drug Levels


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Individual VariationsEvery individual body is

UNIQUE! Physiological Variables

Pathological Variables

Genetic Variables


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Drug Dose Responses

GOAL: Constant Blood Level with in a Safe

Therapeutic Range

Terms: Minimal Effective Concentration (MEC)

Toxic Concentration

Therapeutic Range


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Therapeutic Index


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Serum Half-Life

Definition: The time required for the amountof drug in the body to decrease by 50%.

Determines the dosing interval


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Dose Responses Continued.

Onset:Peak:Trough:

Duration:Plateau:


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Effects of Drugs on Fetal Development


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Pharmaco-therapeuticsDefinition: Using Drugs to diagnose, prevent

or treat a disease or to prevent pregnancy

YOU MUST KNOW WHY YOUR

PATIENT IS TAKING AMEDICATION!!!!!


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Type of Medication Action

What is the drug supposed to do???

The same drug can have many Therapeutic

Effects/Actions

Example: Aspirin (ASA): Inflammation

Fever Reduction

Pain

Anti-platelet Aggregation

Why is your patient taking it???


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Adverse Reactions to Medication

Definition: Un-intended, un-desired effectwhen the drug is given at normal doses.

More common in the elderly and very young

patients

Range: Mild (itching) to SEVERE (coma orDEATH!!)


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Adverse Drug Reactions

Side Effects:

Toxicity:

Allergic Reaction:


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Allergic Reaction Immune (antigen-antibody) response to a

drug to which the patient was previously

exposed or sensitized

Mild to SEVEREcan result in DEATH!!

Required immediate intervention.


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Physical DependenceDefinition: The state in which the body

has adapted to prolonged drugexposure in such a way that an

abstinence syndrome (WITHDRAWAL)

will result if the drug is discontinued.


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ToleranceDefinition: Experiencing a

decreased response to a drug as aresult of repeated drug

administration


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Psychological Dependence

Definition: The desire for the

effects of a drug.


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Carcinogenic EffectsDefinition: The ability of certain

medications and environmentalchemicals to alter body cells and

cause a variety of cancers


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Other Drug Adversities

Teratogenicity

Iatrogenicity

Hepatotoxicity

Nephrotoxicity

Hematologic Effects Idiosyncrasy


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Individual Variation:

EVERY BODYis DIFFERENT

Age

Gender

Race

Body Weight and Composition

Pathophysiology Liver Disease

Kidney Disease

Acid Base Balance

Electrolyte Imbalance


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Renal Insufficiency Effects


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pH Effects on Plasma Drug Levels


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Medication InteractionsDrug-Drug Interactions: When one

medication alters the effects of another

medication

Drug-Food Interactions: Food can increase

or decrease the rate of drug absorption.


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Drug-Drug Interactions

Additive Effects

Synergism or Potentiating Interference

Displacement

Antagonism

Incompatibility


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FOOD-DRUG Interactions

Food slows the absorption of most Drugs

Thyramine/MAO Inhibitors

Vitamin K containing Foods/Warfarin (Coumadin)

Tetracycline/Dairy Products

Grapefruit Juice/ Many Drugs esp. Calcium

Channel Blockers Iron/Acidic Foods

Herbs and Food Supplements


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Legislation and Regulations

Federal Drug Administration (FDA):

Federal Pure Food and Drug Act of 1906 Food Drug and Cosmetic Act of 1938

Harris-Kefauver Amendments to the Food,

Drug and Cosmetic Act in 1962

Controlled Substances Act of 1970


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Legislation and Regulations

Continued

1992- FDA Permits accelerated approval of Drugs for

AIDS and Cancer

1992-The Prescription Drug User Fee Act 1997- Food and Drug Administration Modernization Act

2002- The Best Pharmaceuticals for Children Act

2003- Pediatric Research Equity

2007- FDA Amendments Act


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New Drug Development

Expensive

Lengthy Process6-12 yearsRandomized Control Trials

Most reliable and objective way to assess drugs

Use of Controls

Randomizations Blinding


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Whats in a NAME???

Chemical Name

Generic Name Non-proprietary

Trade name:

Trademarked the medications name(Tylenol)


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Nursing Responsibilities!!

ACCURATELY COMMUNICATE!!!! Know the compound names being referred to by

the Generic and Trade Names. .

Be able to recognize names of medications

and interrelate them.


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Drug Resources

How and Where Do I get myInformation?? Published Information: Clinicians and Pharmacists- call the Pharmacy

--DO NOT BE AFRAID TO CALL! Poison Control Centers Pharmaceutical Sales Representatives:

Remember they may be biased; They areSALES people NOT educators; may not tellthe negatives


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End PharmacologyPart I

Thank you!!!

Any Questions????

Documents

Pharmacology Part 1 Final Version Student Pp 2010