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给 药 ( 一 ) 中国医科大学护理学院 王健. Medications (one) A medication is a substance administered for the diagnosis, cure, treatment, mitigation (relief), or prevention.

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Presentation on theme: "给 药 ( 一 ) 中国医科大学护理学院 王健. Medications (one) A medication is a substance administered for the diagnosis, cure, treatment, mitigation (relief), or prevention."— Presentation transcript:

1 给 药 ( 一 ) 中国医科大学护理学院 王健

2 Medications (one)

3 A medication is a substance administered for the diagnosis, cure, treatment, mitigation (relief), or prevention of disease. In the health care context, the words medication and drug are generally used interchangeably. The term drug also has the connotation of an illicitly obtained substance such as heroin, cocaine, or amphetamines.

4 In the United States and Canada, medications are usually dispensed on the order of physicians and dentists. In some US states, specially qualified nurse-practitioners and physician ’ s assistants may prescribe drugs. The written direction for the preparation and administration of a drug is called a prescription. In the United States and Canada, medications are usually dispensed on the order of physicians and dentists. In some US states, specially qualified nurse-practitioners and physician ’ s assistants may prescribe drugs. The written direction for the preparation and administration of a drug is called a prescription.

5 One drug can have as many as four kinds of names: its generic name, official name, chemical name, and trademark or brand name. The generic name is given before a drug becomes official. The official name is the name under which it is listed in one of the official publications (eg, the United States Pharmacopeia). One drug can have as many as four kinds of names: its generic name, official name, chemical name, and trademark or brand name. The generic name is given before a drug becomes official. The official name is the name under which it is listed in one of the official publications (eg, the United States Pharmacopeia).

6 The chemical name is the name by which a chemist knows it; this name describes the constituents of the drug precisely. The trademark, or brand name, is the name given by the drug manufacturer. Because one drug may be manufactured by several companies, it can have several trade names. The chemical name is the name by which a chemist knows it; this name describes the constituents of the drug precisely. The trademark, or brand name, is the name given by the drug manufacturer. Because one drug may be manufactured by several companies, it can have several trade names.

7 Medications are often available in a variety of forms. They are aerosol spray or foam, aqueous solution, aqueous suspension, caplet, capsule, cream, elixir, extract, gel or jelly, liniment, lotion, lozenge(troche), ointment (salve, unction), paste, pill, powder, suppository, syrup, tablet, tincture, transdermal patch. Medications are often available in a variety of forms. They are aerosol spray or foam, aqueous solution, aqueous suspension, caplet, capsule, cream, elixir, extract, gel or jelly, liniment, lotion, lozenge(troche), ointment (salve, unction), paste, pill, powder, suppository, syrup, tablet, tincture, transdermal patch.

8 Pharmacology is the study of the effect of drugs on living organisms. Pharmacy is the art of preparing, compounding, and dispensing drugs. The word also refers to the place where drugs are prepared and dispensed. Drugs are prepared by a pharmacist, a person licensed to prepare and dispense drugs and to make up prescriptions. Pharmacology is the study of the effect of drugs on living organisms. Pharmacy is the art of preparing, compounding, and dispensing drugs. The word also refers to the place where drugs are prepared and dispensed. Drugs are prepared by a pharmacist, a person licensed to prepare and dispense drugs and to make up prescriptions.

9 A clinical pharmacist is a specialist who often guides the physician in prescribing drugs. A pharmacy technician is a member of the health team who in some states administers drugs to clients. A clinical pharmacist is a specialist who often guides the physician in prescribing drugs. A pharmacy technician is a member of the health team who in some states administers drugs to clients.

10 DRUG STANDARDS Drugs may have natural (eg, plant, mineral, and animal) sources or they may be synthesized in the laboratory. For example, digitalis and opium are plant derived, iron and sodium chloride are minerals, insulin and vaccines have animal or human sources, and the sulfonamides and propoxyphene hydrochloride (the analgesic Darvon) are the products of laboratory synthesis. DRUG STANDARDS Drugs may have natural (eg, plant, mineral, and animal) sources or they may be synthesized in the laboratory. For example, digitalis and opium are plant derived, iron and sodium chloride are minerals, insulin and vaccines have animal or human sources, and the sulfonamides and propoxyphene hydrochloride (the analgesic Darvon) are the products of laboratory synthesis.

11 Drugs vary in strength and activity. Drugs derived from plants, for example, vary in strength according to the age of the plant, the variety, the place in which it is grown, and the method by which it is preserved. Drugs must be pure and of uniform strength if drug dosages are to be predictable in their effect. Drugs vary in strength and activity. Drugs derived from plants, for example, vary in strength according to the age of the plant, the variety, the place in which it is grown, and the method by which it is preserved. Drugs must be pure and of uniform strength if drug dosages are to be predictable in their effect.

12 Drug standards have therefore been developed to ensure uniform quality. In the United States, official drugs are those so designated by the Federal Food, Drug, and Cosmetic Act. These drugs are officially listed in the United States Pharmacopeia (USP) and described according to their source, physical and chemical properties, tests for purity and identity, method of storage, assay, category, and normal dosages. Drug standards have therefore been developed to ensure uniform quality. In the United States, official drugs are those so designated by the Federal Food, Drug, and Cosmetic Act. These drugs are officially listed in the United States Pharmacopeia (USP) and described according to their source, physical and chemical properties, tests for purity and identity, method of storage, assay, category, and normal dosages.

13 A Pharmacopoeia (also spelled pharmacopeia) is a book containing a list of products used in medicine, with descriptions of the product, chemical tests for determining identity and purity, and formulas and prescriptions. The United States ’ National Formulary lists drugs and their therapeutic value and can include drugs that may still be used but not listed in the USP. A Pharmacopoeia (also spelled pharmacopeia) is a book containing a list of products used in medicine, with descriptions of the product, chemical tests for determining identity and purity, and formulas and prescriptions. The United States ’ National Formulary lists drugs and their therapeutic value and can include drugs that may still be used but not listed in the USP.

14 Pharmacopoeias and formularies are invaluable reference sources for nurses and nursing students. Nurses not only administer thousands of medications but also are responsible for assessing their effectiveness and recognizing unfavorable reactions to drugs. Since it is impossible to commit to memory all pertinent information about a very large number of drugs, nurses must have a reliable reference readily available. Pharmacopoeias and formularies are invaluable reference sources for nurses and nursing students. Nurses not only administer thousands of medications but also are responsible for assessing their effectiveness and recognizing unfavorable reactions to drugs. Since it is impossible to commit to memory all pertinent information about a very large number of drugs, nurses must have a reliable reference readily available.

15 LEGAL ASPECTS OF DRUG ADMINISTRATION The administration of drugs in both the United States and Canada is controlled by law. Nurses need to (a) know how nursing practice acts in their areas define and limit their functions and (b) be able to recognize the limits of their own knowledge and skill. To function beyond the limits of nursing practice acts or one’s ability is to endanger clients’ lives and leave oneself open to malpractice suits.

16 Under the law, nurses are responsible for their own actions regardless of whether there is a written order. If a physician writes an incorrect order (eg, Demerol 500 mg instead of Demerol 50 mg), a nurse who administers the written incorrect dosage is responsible for the error. Therefore, nurses should question any order that appears unreasonable and refuse to give the medication until the order is clarified. Under the law, nurses are responsible for their own actions regardless of whether there is a written order. If a physician writes an incorrect order (eg, Demerol 500 mg instead of Demerol 50 mg), a nurse who administers the written incorrect dosage is responsible for the error. Therefore, nurses should question any order that appears unreasonable and refuse to give the medication until the order is clarified.

17 Another aspect of nursing practice governed by law is the use of controlled substances. In hospitals, controlled substances are kept in a locked drawer, cupboard, medication cart, or computer-controlled dispensing system. Agencies have special forms for recording the use of controlled substances. Another aspect of nursing practice governed by law is the use of controlled substances. In hospitals, controlled substances are kept in a locked drawer, cupboard, medication cart, or computer-controlled dispensing system. Agencies have special forms for recording the use of controlled substances.

18 The information required usually includes the name of the client, the date and time of administration, the name of the drug, the dosage, and the signature of the person who prepared and gave the drug. The name of the physician who ordered the drug may also be part of the record. The information required usually includes the name of the client, the date and time of administration, the name of the drug, the dosage, and the signature of the person who prepared and gave the drug. The name of the physician who ordered the drug may also be part of the record.

19 Included on the record are the controlled substances wasted during preparation. In most agencies, counts of controlled substances are taken at the end of each shift. The count total should tally with the total at the end of the last shift minus the number used. If the totals do not tally, the discrepancy must be reported immediately. In facilities that use a computerized dispensing system, manual counts are not required, because the dispensing system runs a continuous count; however, discrepancies must be accounted for. Included on the record are the controlled substances wasted during preparation. In most agencies, counts of controlled substances are taken at the end of each shift. The count total should tally with the total at the end of the last shift minus the number used. If the totals do not tally, the discrepancy must be reported immediately. In facilities that use a computerized dispensing system, manual counts are not required, because the dispensing system runs a continuous count; however, discrepancies must be accounted for.

20 EFFECTS OF DRUGS 1.The therapeutic effect of a drug, also referred to as the desired effect, is the primary effect intended, that is, the reason the drug is prescribed. For example, the therapeutic effect of morphine sulfate is analgesia, and the therapeutic effect of diazepam is relief of anxiety. The kinds of therapeutic actions are as follows: palliative, curative, supportive, substitutive, chemotherapeutic and restorative.

21 2.A side effect, or secondary effect, of a drug is one that is unintended. Side effects are usually predictable and may be either harmless or potentially harmful. For example, digitalis increases the strength of myocardial contractions (desired effect), but it can have the side effect of inducing nausea and vomiting. Some side effects are tolerated for the drug ’ s therapeutic effect; more severe side effects, also called adverse effects, may justify the discontinuation of a drug.

22 3.Drug toxicity (deleterious effects of a drug on an organism or tissue) results from overdosage, ingestion of a drug intended for external use, and buildup of the drug in the blood because of impaired metabolism or excretion (cumulative effect).

23 Some toxic effects are apparent immediately; some are not apparent for weeks or months. Fortunately, most drug toxicity is avoidable if careful attention is paid to dosage and monitoring for toxicity. An example of a toxic effect is respiratory depression due to the cumulative effect of morphine sulfate in the body. Some toxic effects are apparent immediately; some are not apparent for weeks or months. Fortunately, most drug toxicity is avoidable if careful attention is paid to dosage and monitoring for toxicity. An example of a toxic effect is respiratory depression due to the cumulative effect of morphine sulfate in the body.

24 4.A drug allergy is an immunologic reaction to a drug. When a client is first exposed to a foreign substance (antigen), the body may react by producing antibodies. A client can react to a drug as to an antigen and thus develop symptoms of an allergic reaction.

25 Allergic reactions can be either mild or severe. A mild reaction has a variety of symptoms, which are skin rashes, pruritus, angioedema, rhinitis, lacrimal tearing, nausea, vomiting, wheezing and dyspnea, diarrhea. An allergic reaction can occur anytime from a few minutes to 2 weeks after the administration of the drug. Allergic reactions can be either mild or severe. A mild reaction has a variety of symptoms, which are skin rashes, pruritus, angioedema, rhinitis, lacrimal tearing, nausea, vomiting, wheezing and dyspnea, diarrhea. An allergic reaction can occur anytime from a few minutes to 2 weeks after the administration of the drug.

26 A severe allergic reaction usually occurs immediately after the administration of the drug; it is called an anaphylactic reaction. This response can be fatal if the symptoms are not noticed immediately and treatment is not obtained promptly. The earliest symptoms are acute shortness of breath, acute hypotension, and tachycardia. A severe allergic reaction usually occurs immediately after the administration of the drug; it is called an anaphylactic reaction. This response can be fatal if the symptoms are not noticed immediately and treatment is not obtained promptly. The earliest symptoms are acute shortness of breath, acute hypotension, and tachycardia.

27 5.Drug tolerance exists in a person who has unusually low physiologic activity in response to a drug and who requires increases in the dosage to maintain a given therapeutic effect. Drugs that commonly produce tolerance are opiates, barbiturates, ethyl alcohol, and tobacco.

28 A cumulative effect is the increasing response to repeated doses of a drug that occurs when the rate of administration exceeds the rate of metabolism or excretion. As a result, the amount of the drug builds up in the client ’ s body unless the dosage is adjusted. Toxic symptoms may occur. A cumulative effect is the increasing response to repeated doses of a drug that occurs when the rate of administration exceeds the rate of metabolism or excretion. As a result, the amount of the drug builds up in the client ’ s body unless the dosage is adjusted. Toxic symptoms may occur.

29 An idiosyncratic effect is unexpected and individual. Underresponse and overresponse to a drug may be idiosyncratic. Also, the drug may have a completely different effect from the normal one or cause unpredictable and unexplainable symptoms in a particular client. An idiosyncratic effect is unexpected and individual. Underresponse and overresponse to a drug may be idiosyncratic. Also, the drug may have a completely different effect from the normal one or cause unpredictable and unexplainable symptoms in a particular client.

30 6.A drug interaction occurs when the administration of one drug before, at the same time as, or after another drug alters the effect of one or both drugs. The effect of one or both drugs may be either increased (potentiating or synergistic effect) or decreased (inhibiting effect).

31 Drug interactions may be beneficial or harmful. For example, probenecid, which blocks the excretion of penicillin, can be given with penicillin to increase blood levels of the penicillin for longer periods (potentiating effect). Two analgesics, such as aspirin and codeine, are often given together because together they provide greater pain relief (additive effect). Drug interactions may be beneficial or harmful. For example, probenecid, which blocks the excretion of penicillin, can be given with penicillin to increase blood levels of the penicillin for longer periods (potentiating effect). Two analgesics, such as aspirin and codeine, are often given together because together they provide greater pain relief (additive effect).

32 In addition, certain foods may interact adversely with a medication. See Table 44-1. In addition, certain foods may interact adversely with a medication. See Table 44-1.

33 7.Iatrogenic disease (disease caused unintentionally by medical therapy) can be due to drug therapy. Hepatic toxicity resulting in biliary obstruction, renal damage, and malformations of the fetus as a result of specific drugs taken during pregnancy are examples.

34 DRUG MISUSE 1.Drug misuse is the improper use of common medications in ways that lead to acute and chronic toxicity. Both over-the-counter drugs and prescription drugs may be misused. Laxatives, antacids, vitamins, headache remedies, and cough and cold medications are often self-prescribed and overused. Most people suffer no harmful effects from these drugs, but some people do. A persistent cough may go undiagnosed until the underlying problem becomes serious and advanced. DRUG MISUSE 1.Drug misuse is the improper use of common medications in ways that lead to acute and chronic toxicity. Both over-the-counter drugs and prescription drugs may be misused. Laxatives, antacids, vitamins, headache remedies, and cough and cold medications are often self-prescribed and overused. Most people suffer no harmful effects from these drugs, but some people do. A persistent cough may go undiagnosed until the underlying problem becomes serious and advanced.

35 2.Drug abuse is inappropriate intake of a substance, either continually or periodically. By definition, drug use is abusive when society considers it abusive. For example, the intake of alcohol at work may be considered alcohol abuse, but intake at a social gathering may not. Drug abuse has two main facets, drug dependence and habituation.

36 Drug dependence is a person ’ s reliance on or need to take a drug or substance. The two types of dependence, physiologic and psychologic, may occur separately or together. Drug dependence is a person ’ s reliance on or need to take a drug or substance. The two types of dependence, physiologic and psychologic, may occur separately or together.

37 a.Physiologic dependence is due to biochemical changes in body tissues, especially the nervous system. These tissues come to require the substance for normal functioning. A dependent person who stops using the drug experiences withdrawal symptoms.

38 b.Psychologic dependence is emotional reliance on a drug to maintain a sense of well-being, accompanied by feelings of need or cravings for that drug. There are varying degrees of psychologic dependence, ranging from mild desire to craving and compulsive use of the drug.

39 Drug habituation denotes a mild form of psychologic dependence. The individual develops the habit of taking the substance and feels better after taking it. The habituated individual tends to continue the habit even though it may be injurious to health. Drug habituation denotes a mild form of psychologic dependence. The individual develops the habit of taking the substance and feels better after taking it. The habituated individual tends to continue the habit even though it may be injurious to health.

40 3.Illicit drugs, also called street drugs, are those sold illegally. Illicit drugs are of two types: (a) drugs unavailable for purchase under any circumstances, such as heroin (in the United States), and (b) drugs normally available with a prescription that are being obtained through illegal channels. Illicit drugs often are taken because of their mood- altering effect; that is, they make the person feel happy or relaxed.

41 Thank you !


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