what is pharmacology?
study of drugs and their actions on living organisms
what are drugs used for?
- prevent, treat, or cure disease or disorders (vaccines)
- restore or maintain body system function (insulin)
- relieving symptoms (ibuprofen)
- aid in diagnosing disease (dye)
what is the nurse responsible for when administering a medication?
- understanding how medication works
- correct administration (safe dose, route, pt, time)
- therapeutic effects, side effects, contraindications
- questioning an order that is unclear or may contain an error
- following the 6 rights of administration
- pt and family education
- correct documentation
- evaluation of effectiveness
what meds can chronic lung patients not have?
beta blockers; can be detrimental
how are OTC & prescription drugs similar?
- can be as effective as the other one
- can have as many side effects as the other
- can be as safe as the other
what are the drug categories?
- curative
- prophylactic
- diagnostic
- palliative
- replacement
- destructive
when asking a pt about their medications, what do we need to know?
ALL their meds: OTC, prescription, & any herbals
routine & PRN
what are the different names of drugs?
- generic
- trade
the official and nonproprietary name approved by the USAN Council; there is only ONE for each drug; always lowercase
generic name
registered name; are always capitalized; may be more than one
trade/brand name
why is it important to get information from patients about all of their medications?
because of the risk for drug-drug interaction
who regulates drugs?
United States Pharmacopeia (USP)
assures that drugs have met high standards for therapeutic use, pt safety standards, quality, purity, strength, packaging safety, and dosage form by the U.S. Pharmacopeia National Formulary
United States Pharmacopeia (USP)
the USP designation does not indicate
FDA approval
ensures drugs are labeled correctly
Food and Drug Administration (FDA)
all drug administration laws are initiated, implemented, and enforced by
FDA
requires drug companies to study their products in children for safety and efficacy to be marketed for pediatric use
Pediatric Research Quality Act
when pediatric studies are required, they must be conducted with
the same drug and for the same use for which they were approved in adults
identifies and regulates the manufacture and sale of narcotics and dangerous drugs
Controlled Substance Act (1970)
which drugs have the highest abuse potential?
I and II
which drugs have the lowest abuse potential?
IV and V
examples of schedule I drugs?
- heroin
- LSD
- peyote
- ecstasy
examples of schedule II drugs?
- morphine
- hydromorphone
- methadone
- meperidine
- oxycodone
- fentanyl
- adderall
- ritalin
- cocaine
examples of schedule III drugs?
- tylenol w/ codeine
- steroids
- ketamine (requires new prescription after 6 months or 5 refills)
examples of schedule IV drugs?
- tramadol
- talwin
- benzos
- zolpidem
- phentermine
examples of schedule V drugs?
- lyrica
- lomotil
- robitussin AC
what can cocaine be used to treat?
nose bleeds
where can we, as nurses, find reliable and up-to-date drug information?
- Micromedex
- Hospital Formulary
- Facts and Comparisons
- Physicians Desk Reference (PDR)
- Package Inserts
- FDA
- Drug Books
the study of how drugs are processed in the body (how medications travel through the body)
pharmacokinetics
the process of pharmacokinetics begins and ends when?
from administration to elimination
What is the process of pharmacokinetics?
ADME
- Absorption
- Distribution
- Metabolism
- Excretion
the first step in which a drug enters the body
absorption
what are the ways to introduce and administer drugs into the body?
- enteral
- topical
- inhalation
- parenteral
enteral
oral, SL, buccal
topical
transdermal, eye, ear, nose, rectal, vaginal
inhalation
MDI
parenteral
IV, IM, ID, SQ, IO, epidural
certain medications have to be given by certain means because
of the way drugs are absorbed
why must insulin be given SQ as opposed to PO?
if it was taken PO, by the time it would reach the small intestine, digestive enzymes from the GI tract would destroy the insulin, and it would no longer function
what is the primary site for GI absorption of a drug?
small intestine
what are some factors that could affect the absorption of drugs in the small intestine?
Crohn's, small intestine surgery
the process of a drug going from the bloodstream to tissues from circulating body fluids (bloodstream) to receptor sites
distribution
what affects distribution of drugs?
- blood flow (too little): PVD, CVD, hypovolemia, hypotension
- plasma protein binding (albumin-taxi cab)
- blood-brain barrier
- body weight/distrubution (muscle mass and fat composition)
what does albumin do?
carries molecules to the sites they need to go to
if albumin level is low, what can happen?
problems related to distribution
is the process of changing medications into less active or inactive forms by the action of enzymes
metabolism
where are most drugs metabolized?
liver
what can inhibit enzyme action (metabolism) resulting in excess drug accumulation in the body?
- liver disease (hepatitis, cirrhosis)
- liver failure
** this would increase the drugs effect and can lead to toxicity
if a pt has high liver enzymes, how might we alter the medication dose?
decrease it
process by which a drug is removed or eliminated by the body
excretion
drugs are eliminated either
unchanged or as metabolites in the urine
what is the primary organ involved in excretion?
kidneys
what labs would you follow to ensure safe medication administration and excretion?
BUN & Creatinine
if above labs are elevated, what should you do as a nurse?
call MD & suggest decreasing dose or changing to a medication that is not excreted by the kidneys
what can impair excretion causing drugs to accumulate?
- kidney disease
- kidney failure
- decreased blood flow to the kidneys (hypotension)
what are some factors affecting pharmacokinetics? "ADME"
- age-elderly changes (GI system, GU system, decreased body weight)
- body composition
- liver and kidney conditions
- polypharmacy
- inadequate blood flow (hypotension, PVD, CAD)
- nutritional status
what are some issues seen in the elderly?
- delayed emptying
- decreased blood flow to liver and kidneys
- decreased lean body weight & increased SQ fat
The registered nurse is providing care for a pt with a brain tumor. Which nursing action helps to prevent cerebral edema?
Administering glucocorticoids to the pt
a pt is started on low molecular wt heparin (LMWH). what complications should the nurse monitor for?
thrombocytopenia
what is an example of an ototoxic medication that can cause damage to the sensitive structures of the ear, with prolonged or overuse?
furosemide
what medication may cause patients to develop a dry, nonproductive cough
angiotensin-converting enzyme inhibitor
a pt reporting chest tightness arrives at the hospital. on assessment, the nurse noted wheezing, cough, elevated BP, and pulse rate. the primary healthcare provider prescribes corticosteroids, which is the most likely outcome of the prescribed therapy?
decreases the inflammation of the airway
what is true regarding herbal remedies' impact during surgery?
they can decrease the effectiveness of anesthesia
what is it called when a pt takes six or more medications?
polypharmacy
the pt with systemic lupus erythematosus (SLE) is experiencing pancytopenia. what would be the cause of this?
immunosuppression
which test measures the amount of glucose that binds to RBC's in a nonpregnant adult patient?
Hemoglobin A1c
what is true regarding long acting insulin?
it is a dose of basal insulin used in combination with rapid acting or short acting
which is true of the action of proton pump inhibitors (PPIs) in treating gastroesophageal reflux disease?
they block gastric acid production
The nurse is assessing a patient with a history of angina. The patient states that "I usually experience chest pain while climbing the stairs or after walking for 5 minutes." What question should the nurse ask next?
"If you rest, does the pain subside?"
Rationale: This question will help to determine if the angina is stable or unstable.
The nurse is admitting a patient in the emergency department with new onset of confusion. The laboratory report shows Na 120 mEq/L; K 5 mEq/L; urine specific gravity 1.038. Which intervention is the highest priority?
Pad the siderails of the bed.
Rationale: The sodium level is very low and the risk for seizures is very high. Implementing seizure precautions is the priority.
While caring for a patient who underwent surgical repair of a fracture, the nurse finds edema in the area where the surgery occurred. Which should the nurse assess next based on these findings?
Distal pulses
Rationale: Edema in the area of the surgery may be the cause of impaired perfusion.
involves the interactions between medications and target cells-the drugs actions and effects "lock and key"
pharmacodynamics
primary effect of pharmacodynamics is called
therapeutic effect
what are receptror sites?
proteins on the surface of cells that are capable of recognizing a specific molecule
drugs that combine with a specific receptor site to cause a pharmacologic response; the drug action will begin once it attaches to receptor sites
agonists
drugs that prevent a receptor response or block a normal cellular response
antagonist
act both as agonists and antagonists with limited affinity to receptor sites; act differently depending on the receptor site that is used
partial agonists
time it takes for drug to reach an effective blood level and to initiate a response (depends on the route of administration)
onset
when drug achieves its highest blood concentration
peak
length of time the drug has a pharmacologic effect
duration
amount of time needed for elimination process to decrease original blood concentration by 50%
half-life
how the drug works
mechanism of action
the patient's response to drug action
therapeutic effect
ability of a drug to produce maximal effects
efficacy
amount of drug required to produce 50% of maximal response possible for that drug
potency
affects the time that a drug stays in the body and can also have an effect upon the drug's efficiency
plasma protein binding (PPB); it affects both pharmacodynamics and pharmacokinetics
the most common plasma protein that drugs are bound to is
albumin
the part of the medication that is bound to the protein is
inactive
what are some things that increase the risk of having interactions:
- drug-drug
- food-drug
- chronically ill (polypharmacy)
- seeing several specialists
- multiple pharmacies
- taking OTC, prescription, & herbals
highest concentration of a drug in the patient's bloodstream
peak
lowest concentration of a drug in the pt's bloodstream
trough
the difference between average toxic and therapeutic doses
therapeutic index
rapidly achieving a higher level of a drug into the patients system to quickly achieve a therapeutic effect
loading dose
maintaining the drug level within a therapeutic range
maintenance dose
examples of medications that may require a loading dose
- azithromycin
- digoxin
- diltiazem
- amiodarone
how a drug produces its response
pharmacodynamics
what affects pharmacodynamics?
- age
- body composition/weight
- genetics
- ethnicity
- disease conditions
- psychosocial conditions
- nutritional status
relationship between a person's genetic make-up and response to medication
pharmacogenetics
effects that occur when the actions of one drug are affected by another drug; example: antacid and abx
drug-drug interactions
when 2 drugs with similar actions are taken together and the additive effect increases the sum of the effects; example: ASA and codeine
additive effect
when 2 drugs together cause a greater response than each drug given individually; example: lisinopril and furosemide (BP responds much better)
synergism
the action of one drug increases the effect of the second drug; example: warfarin and ASA (causes increase in bleeding potential)
potentiation
drug not a suitable composition to be combined or mixed with another agent or substance, results in an undesirable reaction including chemical alteration or destruction
drug incompatibility
what puts a client at risk for drug interactions?
- chronic health conditions
- polypharmacy
- more than one provider
- supplement use
- OTC use
- use of more than one pharmacy
anticipated effects, usually mild (opioids-nausea, constipation_
side effects
pt becoming sensitized to drug, producing antibodies against drug creating antigen-antibody reaction (rash, hives, itching)
allergy
severe allergic rxn (bronchospasm, angioedema, etc.)
anaphylaxis
unusual or unexpected response; opposite the desired effect (diphenhydramine should induce sleepiness, however, if it causes hyperactivity, restlessness-that would be this rxn)
idiosyncratic effect
harmful, undesired effects of the possibility of organ damage
toxic effect
...
hepatotoxicity
...
nephrotoxicity
...
ototoxicity
drugs that cause birth defects
teratogenic effect
sociological factors affecting medication administration
socioeconomic status, housing, marital status/children, season, religious beliefs, finances, transportation
psychological factors affecting medication administration
ethics/cultural beliefs, cognitive functioning, food preferences
physiological factors affecting medication administration
health, senses, chronic disease processes, medication use, dental health
what are the rights of medication administration
- patient
- drug
- time
- route
- dose
- documentation
- some consider technique
what is the most common medication error?
incorrect dosage of drug
_________________ people are injured annually by medication errors in the U.S. according to the CDC. Medication errors cause at least one death every day.
1,300,000
through absorption from GI tract
enteral
parenteral
by injection: ID, SQ, IM, IV
percutaneous administration routes?
- transdermal
- ophthalmic
- otic
- nasal
- vaginal
- rectal
what organs must be carefully considered in pediatric medication administration?
liver and brain b/c they are not fully developed in pediatric patients
elderly population-specific information R/T pharmacology
- body processes slow down
- decrease blood flow to liver and kidney therefore decreasing the effectiveness (which are responsible for metabolizing and eliminating excess medication from body)
- decreased albumin levels
- doses may need to be decreased
females of childbearing age-specific information R/T pharmacology
- could be pregnant, medication could be potentially harmful to fetus (teratogenic)
1 c is ____ mL
240
1 tbsp is ____ tsp
3
1 unit is __________ milliU
1,000
requires lifelong learning and ability to acquire relevant experiences
critical thinking
what are the levels of critical thinking?
- basic
- complex
- commitment
an inner sensing that facts do not currently support something; should spark the nurse to search the data to confirm or disprove the feeling
intuition
a nurse trusts the experts and thinks concretely based on the rules
basic critical thinking
the nurse begins to express autonomy by analyzing and examining data to determine the best alternative
complex critical thinking
the nurse expects to make choices without help from others and fully assumes the responsibility for those choices
commitment
what are the components of critical thinking?
- knowledge
- experience
- competence
- attitude
- standards
information that's specific to nursing and comes from:
-basic nursing education
-use of evidence-based practice
-continuing education courses
-advanced degrees and certification
knowledge
decision-making ability derived from opportunities to observe, sense, and interact with clients followed by active reflection
experience
cognitive processes a nurse uses to make nursing judgments
competence
mindsets that affect how a nurse approaches a problem
attitudes
model for comparing care to determine acceptability, excellence, and appropriateness
standards