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General Pharmacological Principles

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1 General Pharmacological Principles
Module A

2 Objectives The student will be able to: List three sources of drugs.
List the components of a proper medication order. Define the commonly used abbreviations. List the routes of medication delivery. Define "parental administration" and list three types of parental administration. List the four routes of medication delivery via inhalation. List three types of nebulizers used to deliver respiratory medication. Given a route of administration, explain the safety requirements associated with drug administration.

3 Objectives The student will be able to:
Explain two ways to confirm proper patient identification prior to giving a medication. State the change in pulse rate needed to terminate a respiratory treatment. Describe how the effectiveness of bronchodilators can be objectively measured? List the items that should be documented in the patients chart following each treatment. Describe the procedure you would follow in the event of an adverse reaction. Define terms typically found on a package insert for a drug. Describe how most drugs are metabolized and excreted.

4 Web Site Animations Videos Updates
Glossary & Drug Pronunciations Extended Concepts Chapter Quiz Reference & Additional Readings

5 Definition of Pharmacology
Pharmacology - The study of drugs (chemicals) including their origins, properties, and interactions with living organisms.

6 Are these drugs? Aspirin Mint Vodka Vitamins Black Cohosh

7 Drug Sources Chemical synthesis Animal Plant Mineral Most common
Recombinant DNA Animal Plant Mineral

8 FDA Federal agency Regulates drug testing Approves new drugs

9 Drug Approval Can take up to 12 years and over 200 million dollars.
Only 1 in 10,000 chemicals are approved.

10 Steps for Drug Approval
Identify the chemical structure Animal studies – toxicology studies Investigational New Drug Approval Phase I: Healthy volunteers Phase II: Volunteers who have the disease Phase III: Large multi-center study New Drug Application – NDA is filed with the FDA and upon approval it is released for general use. Reporting system in place for 6 months

11 Source of Drug Information
PDR – Physician Desk Reference USP – United States Pharmacopoeia National Formulary Hospital Formulary FDA Website!

12 Study of Drugs Generic and Trade Names Classification Indications
Actions Adverse reactions (side effects) Contraindications Dosage

13 Naming Drugs Chemical Name: Reflects the chemical structure.
4-(5-cyclopentyloxy-carbonylamino 1-methyl-indo-3 ylmethyl) Code Name: Name assigned by a manufacturer to an experimental chemical that shows potential as a drug (SCH 1000).

14 Naming Drugs Generic Name: Based on the drugs chemical structure.
Assigned by the USAN Council Example: isoproterenol Trade Name: Name given by the manufacturer. A generic drug can have 2 or more trade names. Also called brand name. Example: Isuprel

15 Trade Names Beta Blockers Neuromuscular blocking agents
propranolol atenolol metoprolol Neuromuscular blocking agents pancuronium vecuronium atracurium Names of drugs contains clues Slo-Bid Nasalcort DuoNeb

16 Prescriptions for Medication Orders
Patient’s Name Date Name of the drug Dosage of drug and amount Concentration if appropriate Route of administration (delivery device) Frequency or Schedule Number of days if appropriate Any additional instructions Peak flows before and after therapy Monitor tidal volume during IPPB treatment Signature of Physician

17 Examples: John Smith 12/23/89
IPPB therapy with 0.25 mL of 1% Bronkosol and 3 mL Normal Saline four times a day x 3 days. Dr. James Jones Jack Doe 3/30/99 SVN therapy with 0.3 mL of 5% Alupent and 2 mL of Normal Saline every four hours around the clock. Peak flow before and after treatment. Dr. James Jones

18 Example Karen Johnson 4/28/96
MDI Proventil 2 puffs three times a day. Administer with spacer Dr. James Jones

19 Abbreviations Lots of changes over the last few years.
Due to errors in prescribing, many abbreviations have been eliminated based upon JCAHO recommendations (handout). Many institutions have specific rules that go beyond JCAHO recommendations (handout).

20 Frequency Abbreviations
BID: Twice a day TID: Three times a day PRN: When necessary, as needed STAT: Immediately

21 Eliminated Frequency Abbreviations
Some others that have been eliminated: QOD: Use “Every other day” QD: Use “daily” QID: Four times a day Q4: Every four hours Q3: Every three hours Q2: Every two hours Q4 ATC: Every four hours around the clock Q4 WA: Every four hours while awake Q4 PRN: Every four hours as needed H.S: Use at “bedtime”

22 Other commonly used abbreviations:
NS: Normal Saline : With : Without a.c.: Before Meals p.c.: After Meals mL: Milliliters gtt: drop qs: Quantity sufficient (as much as required) PO: By mouth, orally

23 Other commonly used abbreviations:
MDI: Metered Dose Inhaler IPPB: Intermittent Positive Pressure Breathing SVN: Small Volume Nebulizer SPAG: Small Particle Aerosol Generator Rx: Prescription or “take” IM: Intramuscularly IV: Intravenous DPI: Dry Powder Inhaler Tx: Treatment

24 Other commonly used abbreviations:
NPO: Nothing by mouth OTC: Over the Counter FDA: Food and Drug Administration PDR: Physician Desk Reference BS: Breath Sounds PF: Peak Flow PEFR: Peak Expiratory Flow Rate

25 Other Eliminated Abbreviations
D/C: (eliminated) Discontinued cc (eliminated): Cubic Centimeters

26 5 “Rights” Right Drug Right Dose Right Patient Right Time Right Route
Patient’s wrist band Right Time Right Route Also Expiration Date Allergies Timely documentation

27 Routes of Medication Delivery
Oral (Enteral) Route Tablet Capsule Pill Powder Solutions Elixirs Syrups Emulsions/gels

28 Routes of Medication Delivery
Parenteral Route (route comprising routes that bypass the alimentary tract, i.e. injectable) Intradermal Subcutaneous Intramuscular Intravenous Intra-arterial Intra-spinal Intraosseous (into the tibia or sternum)

29 Routes of Medication Delivery
Topical Transdermal Creams and gels Sublingual (under the tongue) Enteral Rectal Inhalation MDI Aerosol (SVN, USN) DPI IPPB

30 Routes of Medication Delivery
Aerosol Therapy Small volume nebulizers Ultrasonic nebulizers Large volume nebulizers SPAG Heart Nebulizer IPPB Metered Dose Inhalers Dry Powder Inhalers




34 Continuous Nebulization
Occasionally, the nebulized medication must be administered over an extended period of hours instead of minutes. A nebulizer can be adapted to other oxygen delivery equipment to facilitate this process.

35 Advantage of Aerosolized Agents
Dosage is smaller. Less side effects and less severe side effects. Rapid Onset. Drug delivery is targeted to the respiratory system. Painless, safe and convenient. Patients can administer medication themselves.

36 Medications Given by RCP
Bronchodilators Mucolytics Steroids Non-Steroidal Anti-inflammatory Mast Cell Stabilizers Leukotriene Inhibitors Anti-Infective Agents

37 Medications given by RCP
Nicotine Replacement Therapy Artificial Surfactants Topical Anesthetics Lidocaine Gases Oxygen Nitric Oxide He/O2 (Heliox) Morphine (?)

38 Objectives State the change in pulse rate needed to terminate a respiratory treatment. Describe how the effectiveness of bronchodilators can be objectively measured? List the items that should be documented in the patients chart following each treatment. Describe the procedure you would follow in the event of an adverse reaction. Define terms typically found on a package insert for a drug. Describe how most drugs are metabolized and excreted.

39 What is the difference between Q4 PRN, Q4 WA, and PRN?
Q4 PRN: Every four hours as needed Q4 WA: Every four hours while awake PRN: When necessary, as needed

40 Drug Metabolism and Excretion
Pharmacokinetics: The movement (kinesis) of the drug throughout the body. Absorption Limited by disintegration Bioavailability: The amount of drug that has been absorbed into the circulation. Distribution Metabolism Liver Elimination Kidney GI Tract (feces), Skin, Pulmonary System


42 Definition of Terms Selectivity – The extent to which a drug acts at one specific site or receptor. When binding occurs: Ion channel open/closed Biochemical messengers are activated. Normal cellular function is turned on or off.

43 Definition of Terms Racemic – A drug which contains two isomers (same chemical components, only bonded differently). Agonist – A drug or chemical that binds to a corresponding receptor and initiates a cellular effect or response – Example: b2 agonist Agonists have an affinity for a receptor site. Antagonist - A drug which binds with a receptor but do not cause activation of the receptor. Explains why some drug’s action is less effective or blocked in the presence of another drug.

44 Definition of Terms Drug Affinity – A measure of the tendency of a drug to combine with a particular receptor site. Drug Potency – The amount of drug required to produce the response desired. A more potent drug would require a lower dose to proved a desired effect. Drug Efficacy – The peak or maximum biologic effect.


46 Definition of Terms Tolerance - Increasing amounts of drug are needed to produce the same effect. Loss of effectiveness. Tachyphylaxis - A rapidly decreasing response to a drug following administration of the initial doses. Desensitization - Loss of tissue responsiveness that can occur with drug exposure. Placebo - An inactive substance resembling a medication that may be given experimentally or for its psychological effects

47 Definition of Terms Additive – The sum of the effects of two drugs given together is equal to each of them given separately but at the same time (1+1 = 2). Synergism – The joint effect of two drugs is greater than the algebraic sum of their individual effects (1+1 = 3). albuterol + ipratropium bromide Potentiation - The effect of two drugs given together where one drug has no effect but increases the response of the other drug (1 + 0 = 2)

48 Definition of Terms Half Life of a drug – The time required to eliminate 50% of the drug from the body after absorption and distribution are complete. Loading Dose – Administration of an initial higher level of the drug to facilitate a steady state (maximal saturation of the receptors in the body). Maintenance Dose – Additional drug which is administered after the loading dose that is used to maintain the steady state.


50 Definition of Terms Side Effect – Unwanted symptoms which occur after drug administration Also called adverse drug reaction (ADR) Cumulation – Occurs when a drugs rate of removal or inactivation is slower than the rate of administration. This can result in toxicity. Emetic - A substance that induces vomiting. Activated Charcoal – Used to decrease absorption. Teratogenicity – A drug’s potential to damage a fetus in utero when given to a pregnant women.

51 Definition of Terms Systemic Effect - Throughout the body
Local Effect - Restricted to a specific area (drugs given by aerosol to the lungs)

52 Definition of Terms Therapeutic Index = LD50 ED50
LD “Lethal Dose 50” The dose that is lethal to 50% of the test population of animals ED 50 – “Effective Dose 50” The dose that is therapeutically effective in 50% of the test population of animals

53 Therapeutic Index The higher the therapeutic index, the safer the drug. The lower the therapeutic index, the greater the chance of toxicity. theophylline, lidocaine and digitalis all have low therapeutic indexes. LD mg = 2 ED mg

54 Safety Requirements for Drug Administration
Always check the patient’s chart. Always check the patient’s name band for proper identification. Check the medication label before preparing medication. Check dates on the medication for expiration date.

55 Safety Requirements for Drug Administration
Check medication color for change. Check the dosage of medication ordered and know the normal and safe range. Always wash hands before preparing and giving a medication. Check previous notes to determine the patients previous response to the medication.

56 Safety Requirements for Drug Administration
Document the HR before, during and after the therapy. If the heart rate increases more than 20 beats from the baseline, STOP THE TREATMENT and notify your clinical instructor/preceptor. Document patient assessment findings (breath sounds, respiratory pattern, use of accessory muscles, peak flows if using a bronchodilator) before an after therapy. Assure patient safety before leaving the room. Bedrails up, patient restraint, call button in patient’s reach. Document clearly, concisely and accurately.

57 Safety Requirements for Drug Administration
If you make an error when documenting: Put one line through the charting. Initial. Write “error”. Continue to chart correct information. Never use white-out!

58 Nosocomial Infection Hospital Acquired Infection Hand Washing #1!!

59 Adverse Reaction Stop the treatment immediately.
Stay with the patient and notify the nurse. When the patient is out of immediate danger, contact your Clinical Instructor or Preceptor. Document the adverse reaction, the patients vital signs at the time you left the room, personnel you contacted and any order change by the physician.

60 Adverse Reaction If the physician changed the medication order or therapy, document all changes on the respiratory therapy treatment sheet. Report the incidence at change of shift; discuss with next therapist taking care of the patient.

61 What To Do With an Improper Order
As a student Contact your clinical instructor/preceptor The clinical instructor or preceptor will then follow the steps outlined below. As a therapist Contact the physician Contact the department supervisor Contact the department manager Contact the medical director of the RC department

62 Take Home Message SAFETY!
Remember: “To Err is human,” but to err in drug administration can be very dangerous!

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