1. AMA 109 Pharmacology

2. Drug Names Chemical Name: describes the drug’s molecular structure – i.e. Chemical Name: describes the drug’s molecular structure – i.e. 2-(N,N-dimethylcarbamimidoyl)guanidine 2-(N,N-dimethylcarbamimidoyl)guanidine Generic Name: is the drug’s official name (lower case, can be made by more than one pharmaceutical company) i.e. metformin Generic Name: is the drug’s official name (lower case, can be made by more than one pharmaceutical company) i.e. metformin Trade or Brand Name: registered by patent and protected for 17 years – i.e. Glucophage Trade or Brand Name: registered by patent and protected for 17 years – i.e. Glucophage

3. Legal Regulations Food and Drug Administration (FDA) Food and Drug Administration (FDA) - regulates manufacture and distribution of drugs and food products Drug Enforcement Agency (DEA) Drug Enforcement Agency (DEA) - strong regulatory control over all controlled substances Controlled Substances Act Controlled Substances Act Schedule I – highest potential for abuse - Opium Schedule II – high potential for abuse - Morphine Schedule III – limited potential for dependence - Fiorinal Schedule IV – lower potential for abuse - Valium Schedule V – lowest potential for abuse - Lomotil

4. Storage and Handling Store in original containers Store in original containers Keep in locked cabinet Keep in locked cabinet Follow special handling i.e. refrigeration, freezing, keep in dark place, etc.. Follow special handling i.e. refrigeration, freezing, keep in dark place, etc.. Drug labels indicate proper handling, always read! Drug labels indicate proper handling, always read! Always label drawn up medication! Always label drawn up medication! Keep medications for internal use separate from those for external use Keep medications for internal use separate from those for external use Always check expiration dates! Always check expiration dates! Read the label 3 times! Read the label 3 times!

5. Parts of a Prescription

6. Medication Label Medication Name Medication Name Medication Strength Medication Strength Medication Use Medication Use Expiration Date Expiration Date Manufacturer Manufacturer Medication Information Medication Information

7. Dosage Calculations Ratios: 3:4 = 1:2 multiply the means and the extremes Ratios: 3:4 = 1:2 multiply the means and the extremes (4) (1) means (3) (2) extremes (4) (1) means (3) (2) extremes Solve for X 30mg : 1cc = 60mg : x 30mg : 1cc = 60mg : x 1cc x 60mg = 30mg x x 1cc x 60mg = 30mg x x 60 = 30x 60 = 30x 60/30 = x 60/30 = x 2 = x give 2cc or 2mL 2 = x give 2cc or 2mL Formula Method: Dose ordered X Quantity = Amount to give Formula Method: Dose ordered X Quantity = Amount to give Dose on hand Dose on hand Ordered: 40mg Demerol / On hand: 80mg X Quantity: per 1mL Ordered: 40mg Demerol / On hand: 80mg X Quantity: per 1mL 40/80 x 1mL = 0.5mL(cc) 40/80 x 1mL = 0.5mL(cc) Children’s Dosages by BSA (Body Surface Area): Children’s Dosages by BSA (Body Surface Area): BSA of Child x Adult Dose = Child’s Dose BSA of Child x Adult Dose = Child’s Dose 1.7 1.7 0.7 (40 inches tall, weight 38 pounds) x 50mg Demerol(adult dose) = child dose 0.7 (40 inches tall, weight 38 pounds) x 50mg Demerol(adult dose) = child dose 1.7 1.7 0.41 x 50 = 20.6mg Demerol for the child 0.41 x 50 = 20.6mg Demerol for the child * Then go to formula method to determine what is on hand to determine cc’s to give…

8. Medical Uses for Drugs Medical uses for drugs: Therapeutic: used in treatment such as antihistamine for allergies Therapeutic: used in treatment such as antihistamine for allergies Diagnostic: used in radiology such as barium for x-rays Diagnostic: used in radiology such as barium for x-rays Curative: used to kill the causative agent in a disease such as antibiotics Curative: used to kill the causative agent in a disease such as antibiotics Replacement: used to replace substances normally found in the body such as hormones Replacement: used to replace substances normally found in the body such as hormones Preventative or Prophylactic: used to lessen severity or ward off disease such as immunizations Preventative or Prophylactic: used to lessen severity or ward off disease such as immunizations Ways to handle drugs: Prescribe: licensed practitioner gives a written prescription to be filled later Prescribe: licensed practitioner gives a written prescription to be filled later Dispense: to give medication ordered by the practitioner to be taken at another time Dispense: to give medication ordered by the practitioner to be taken at another time Administer: to give medication by mouth, injection, etc… right then as ordered by the practitioner Administer: to give medication by mouth, injection, etc… right then as ordered by the practitioner

9. Drug Actions In general drugs may be grouped as follows: those that act directly on one or more tissues of the body; those that act on microorganisms; and those that replace body chemicals. Certain drugs have selective action: such as stimulants which increase cell activity and depressants, which decrease cell activity. Other drugs may have what is known as: Local Action – the drug acts on the area to which it is administered, i.e. ointment for a rash Local Action – the drug acts on the area to which it is administered, i.e. ointment for a rash Remote Action – a drug affects a part of the body that is distant from the site of administration, i.e. chemotherapy Remote Action – a drug affects a part of the body that is distant from the site of administration, i.e. chemotherapy Systemic Action – the drug is carried via the bloodstream throughout the body, i.e. antibiotics Systemic Action – the drug is carried via the bloodstream throughout the body, i.e. antibiotics Synergistic Action – one drug increases or counteracts the action of another, i.e. HIV meds Synergistic Action – one drug increases or counteracts the action of another, i.e. HIV meds

10. FACTORS THAT AFFECT DRUG ACTION The four principal factors that affect drug action are: absorption, distribution, biotransformation, and elimination. These factors depend on the individual patient, the form and chemical composition of the drug and the method of administration. Absorption is the process whereby the drug passes into the body fluids and tissues. Absorption is the process whereby the drug passes into the body fluids and tissues. Distribution is the process whereby the drug is transported from the blood to the intended site of action, site of biotransformation, site of storage and site of elimination. Distribution is the process whereby the drug is transported from the blood to the intended site of action, site of biotransformation, site of storage and site of elimination. Biotransformation is the chemical alteration that a drug undergoes in the body. Biotransformation is the chemical alteration that a drug undergoes in the body. Elimination is the process whereby the drug is excreted from the body. Elimination occurs via the gastrointestinal tract, respiratory tract, skin, mucous membranes and mammary glands. Elimination is the process whereby the drug is excreted from the body. Elimination occurs via the gastrointestinal tract, respiratory tract, skin, mucous membranes and mammary glands.

11. Undesirable Actions of Drugs Side Effect: undesirable action that may limit usefulness Side Effect: undesirable action that may limit usefulness Drug Interaction: one drug potentially increases or diminishes the action of another, (drugs may also interact with food, alcohol, etc…) Drug Interaction: one drug potentially increases or diminishes the action of another, (drugs may also interact with food, alcohol, etc…) Adverse Reaction: unfavorable or harmful unintended action such as allergic reaction Adverse Reaction: unfavorable or harmful unintended action such as allergic reaction

12. Routes and Administration Direct Application: lotions, creams, transdermal Direct Application: lotions, creams, transdermal Sublingual: under the tongue, tablets, liquid, drops Sublingual: under the tongue, tablets, liquid, drops Buccal: in the cheek, tablets Buccal: in the cheek, tablets Rectal: suppositories, ointments Rectal: suppositories, ointments Vaginal: suppositories, creams, etc… Vaginal: suppositories, creams, etc… Inhalation: inhalers, oxygen, sprays Inhalation: inhalers, oxygen, sprays Instillation: liquid, drops (eyes and ears) Instillation: liquid, drops (eyes and ears) Parenteral: injections Parenteral: injections

13. Emergency Medications and Supplies – Medication Errors Some examples of emergency drugs and their use: Adrenalin: anaphylactic shock (vasoconstrictor) Adrenalin: anaphylactic shock (vasoconstrictor) Albuterol: asthma (bronchodilator) Albuterol: asthma (bronchodilator) Benadryl: allergic reaction (antihistamine) Benadryl: allergic reaction (antihistamine) Compazine: relieves nausea and vomiting (antiemetic) Compazine: relieves nausea and vomiting (antiemetic) Dextrose: hypoglycemia Dextrose: hypoglycemia Hydrocortisone: suppresses swelling and shock (antiinflammatory) Hydrocortisone: suppresses swelling and shock (antiinflammatory) Insulin: diabetic coma Insulin: diabetic coma Narcan: drug overdose (antidote) Narcan: drug overdose (antidote) Nitroglycerin: angina (vasodilator) Nitroglycerin: angina (vasodilator) Oxygen: respiratory difficulties Oxygen: respiratory difficulties When an error occurs: Recognize Recognize Stay calm Stay calm Report Report Follow orders Follow orders Document Document

14. “6 Rights” – Check the Label x 3! Right Drug Right Drug Check the label 3 times!! Check the label 3 times!! 1) when removing from storage area 1) when removing from storage area 2) when removing from container 2) when removing from container 3) when returning to storage or before discarding 3) when returning to storage or before discarding empty container empty container Right Dose Right Dose Right Route Right Route Right Time Right Time Right Patient Right Patient Right Documentation Right Documentation

15. Patient Education Take medication exactly as directed for the prescribed duration; do not stop unless you ask provider Take medication exactly as directed for the prescribed duration; do not stop unless you ask provider Inform the Provider of any unusual or adverse reactions Inform the Provider of any unusual or adverse reactions Do not take other meds unless you ask the provider; never take another person’s medication Do not take other meds unless you ask the provider; never take another person’s medication Store away from children Store away from children Discard properly; always check expiration date Discard properly; always check expiration date Heed warning labels; always check label of prescribed meds at pharmacy to be sure it is correct Heed warning labels; always check label of prescribed meds at pharmacy to be sure it is correct Be sure you understand what you are taking; ask for explanation if needed Be sure you understand what you are taking; ask for explanation if needed Enroll in education classes if you are taking lifelong drug therapy Enroll in education classes if you are taking lifelong drug therapy

16. References http://www.drugs.com/top200.html http://www.drugs.com/top200.html http://www.drugs.com/top200.html http://www.rxlist.com/script/main/art.asp?articlekey=79509 http://www.rxlist.com/script/main/art.asp?articlekey=79509 http://www.rxlist.com/script/main/art.asp?articlekey=79509 http://home.sc.rr.com/nurdosagecal/ http://home.sc.rr.com/nurdosagecal/ http://home.sc.rr.com/nurdosagecal/ http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Paren teral%20Medications http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Paren teral%20Medications http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Paren teral%20Medications http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Paren teral%20Medications http://nursesaregreat.com/articles/drugcal.htm http://nursesaregreat.com/articles/drugcal.htm http://nursesaregreat.com/articles/drugcal.htm http://www.cdc.gov/Nip/recs/child-schedule.htm http://www.cdc.gov/Nip/recs/child-schedule.htm http://www.cdc.gov/Nip/recs/child-schedule.htm