1. 1 Week 1: Seminar Overview, Basic Concepts

2. Course Policies and Procedures References Books - must be current... Published within the last 2 years Websites - these 3 are very useful...  www.rxlist.com www.rxlist.com  www.webmd.com www.webmd.com  https://online.epocrates.com/ https://online.epocrates.com/  manufacturer’s website when information about a specific brand name drug product is needed, (for example... go to Lilly.com for detailed info on Prozac)

3. Course Policies and Procedures References Must be reputable Must be sited  Take the Plagiarism Policy very seriously!  Any drug-information you turn in that you had to look up... Must be referenced using APA format Unsure how to reference?  Seek help by going to the ‘Writing Center’

4. Chapter 2 critical thinking case of Basics of Pharmacology Yvette, a new patient, has been diagnosed by the physician as hypertensive. The physician has prescribed two new medications for her to take. Yvette is also taking several other medications for osteoarthritis and allergies; these were prescribed by another physician, but she cannot remember all of the names. What can you do to make certain you have all the right information about Yvette’s new medications so that they will not cause any adverse or toxic reactions?

5. What is a Drug? a chemical used for a therapeutic application Drug Indications  Therapeutic  Diagnostic  Replacement  Supplemental  Preventative/Prophylactic  Curative  Maintenance  Supportive

6. Traditional Medication Indications Therapeutic = to relieve symptoms Diagnostic = to diagnose a disease, or the disease’s progression Replacement = to replace missing chemicals needed by the body... Example: thyroid preparations; hormones

7. Traditional Medication Indications (cont.) Supplemental = to prevent deficiencies Example: Vitamins Preventative = example: Vaccines Palliative = reduce symptoms, but no ‘cure’ Example: pain medications

8. Traditional Medication Indications(cont.) Curative = Example: antibiotics Maintenance = to maintain health that has been put at risk Example: medicine for high blood pressure Supportive  Maintain body in “homeostasis” until disease process can be resolved Asthma rescue inhaler

9. Drug Components Active ingredient  pure, undiluted form of chemical having an effect on body function Inert ingredient  little or no effect on body function  adds flavor, bulk, color Vehicle  inactive agent carrying an active medicinal ingredient

10. Pharmacognosy—The Origins of Drugs Historically, drugs came from...  plants  animals  minerals  synthetic substances (chemicals) Recently,...  recombinant DNA technology (gene splicing) is being used to create drugs

11. Pharmacokinetics: How the Body Processes Drugs Involves four processes (A-D-M-E):  Absorption—movement of a drug from its administration site into the blood  Distribution—movement of a drug from the blood into tissues and cells  Metabolism—physical and chemical alteration of a drug in the body  Excretion—removal of waste products from the body

12. Absorption = ‘A’ Medications are administered by three routes. Modified from Leahy, JM, Kizilay, PE (1998). Foundations of nursing practice. Philadelphia: Saunders.

13. Physical Properties and Absorption Rates Solubility—tendency of a drug to dissolve pH—acidic drugs are easily absorbed in the stomach Absence or presence of food in stomach— food slows absorption rate Fat solubility—medications high in fat are easily absorbed in the stomach

14. Length of Contact Topical drugs’ absorption depends on:  Length of time in contact with skin  Skin thickness  Composition/medium-ointment, cream, lotion Topical medications can be dangerous in elderly patients, because their skin may be so thin that absorption is greater than desired.

15. Distribution = ‘D’ Drug is delivered to tissues through blood vessels and capillaries. Drug’s effect takes place in tissues, not blood vessels. Modified from Leahy, JM, Kizilay, PE (1998). Foundations of nursing practice. Philadelphia: Saunders.

16. Drug Blood Level Amount of drug circulating in bloodstream Physicians monitor blood levels with therapeutic drug level test

17. Synergism Two drugs taken together boost each other’s effect more than either alone could accomplish Drug A   Drug B

18. Antagonism One drug counteracts, or reduces the effect of another drug when the two are taken together Drug A   Drug B

19. Summation, Cumulation, Tolerance Summation - two drugs given together result in expected effect of combination, for example...  Summation: 1+1 = 2, vs. Synergy: 1+1= >2 Cumulation/accumulation - occurs when the drug administered is still residing in the body when another dose is given (can lead to toxicity) Tolerance - occurs after long-term use of some drugs... results in less than expected effects (sub- therapeutic?)

20. Metabolism (Biotransformation)= ‘M’ Series of chemical reactions altering a drug by converting it into a water-soluble compound for excretion Modified from Leahy, JM, Kizilay, PE (1998). Foundations of nursing practice. Philadelphia: Saunders.

21. Excretion (Elimination) = ‘E’ May occur through... respiration, perspiration, urination, and/or defecation Modified from Leahy, JM, Kizilay, PE (1998). Foundations of nursing practice. Philadelphia: Saunders.

22. Effects of Drugs Desired effect—intended response to a medication, for example... –Amoxil (an antibiotic) clears up Kyle’s strep throat. Side effect—mild, undesirable response to a medication, for example... –Amoxil causes Kyle to become slightly nauseated

23. Unwanted Effects of Drugs Adverse reaction—unintended, undesirable, often unpredictable effects causing unwanted symptoms, for example... – Amoxil causes Kyle to have recurring episodes of diarrhea. Allergic reaction—”hypersensitivity” to a drug, often after just one dose, for example... –Amoxil causes Kyle to break out in a rash.

24. Anaphylaxis-the most dangerous type of allergic reaction Severe, potentially fatal, allergic response Occurs a short time after the drug is taken, for example... Shortly after Kyle takes his first dose of Amoxil, his mouth and throat begin to swell, and he has difficulty breathing.

25. Drug Nomenclature (naming) Chemical name-based on molecular-structure  Ex: 2-(4-isobutlyphenyl)propionic acid Generic/nonproprietary name - always in lowercase, easier than chemical name  Ex: ibuprofen Trade/Brand/proprietary name - owned by the original manufacturer, who holds the Patent rights for 20yrs after FDA approval(given a registered trademark ®)  Ex: Motrin®, Advil®

26. Tablets —Dried Compressed Powder Unscored Scored (for division) Layered (to allow incompatible drugs to be given in one medication)

27. Enteric-Coated Tablets Special coating to allow drug to dissolve in intestines rather than stomach Prevent inflammation of gastric mucosa Always swallowed whole Example: enteric-coated aspirin(EC-ASA)

28. Various Tablet Forms Chewable—Sugared or flavored (antacids, antiflatulents, children’s medications) Sublingual(SL)—dissolve under tongue for rapid absorption, - ex: nitroglycerin tabs Buccal—place between cheek and gum *** Instruct patients taking SL or buccal tablets... Do NOT: 1. take with H 2 O – too quickly absorbed 2. Chew or Swallow tablet – not as effective

29. Capsules Small, cylindrical gelatin containers Two pieces fit together Used when medication has unpleasant taste, odor Can pull apart and add to food

30. Sustained-Release Capsules Medication released over period of time Tiny beads designed for release or disintegration at different times Swallow whole Also called time-release or delayed-action Never open— overdose may occur due to altered absorption rates

31. Gelcaps Soft gelatin shells made in one piece Hold a liquid form of medication Do not chew!—medicine often tastes unpleasant Can squeeze into oral cavity, following physician’s advice May stick to inside of mouth if mouth is dry

32. Troche or Lozenge Hard medications (flat tablet or ‘disc’) Candy or fruit base Dissolve in mouth for local effect Examples: cough drops, sore throat lozenges

33. Liquid Oral Preparations Active ingredients in liquid medium Two major categories –Solutions—active ingredient dissolved in liquid –Suspensions—medication particles suspended in liquid (Shake Well!)

34. cont. -- Liquid Preparations Syrups—water based, sweetened with sugar or sugar substitutes Elixirs—contain sweetener, alcohol, and water –use with caution in diabetics and patients taking Antabuse (Disulfarim reaction) Extracts—highly concentrated preparation achieved through evaporation of a solution

35. Percutaneous Medications Lotions—free-flowing liquids or suspensions in water base –treat skin conditions (calamine lotion) Creams—semisolids in water base –corticosteroid cream Ointments—semisolids in oil base –triple antibiotic ointment

36. 36 Questions