Download presentation
Presentation is loading. Please wait.
1
UNIT 1 INTRODUCTION TO PHARMACOLOGY
Reference: Mosby Foundations Chapter 23 pg 696 01/10 ES
2
Study of drugs and their action on the living body
PHARMACOLOGY Study of drugs and their action on the living body 01/10 ES
3
MEDICATION / DRUG Medicinal agent that modifies body function Used:
To prevent ds. or pregnancy To aid in dx or tx To restore or maintain functions 01/10 ES
4
DRUG SOURCES Animals Plants Vitamins Minerals Synthetics
Animals: Thyroid extracts; pork, beef insulin; hormones, cortisone, adrenalin Plants: purple foxglove – lanoxin; white poppy – morphine, codiene; kelp – iodine; mold – PCN; roots; bark; flower; seeds Vitamins: Minerals: K+, Ca++, Iron Synthetics: today this is the more common, less expensive, more pure, decreased side effects and decreased adverse reactions 01/10 ES
5
Sources Animals Insulin Adrenalin Cortisone Thyroid Hormones 01/10 ES
5
6
Sources Plants Synthetics Foxglove Poppy Kelp Mold Roots Bark Seeds
Less expensive, more pure 01/10 ES 6
7
NURSE’S ROLE Knowledge of: Drug Action What is the expected response
Therapeutic Effect Will this med achieve it’s goal Possible Adverse Effects Patient Teaching With every med There is no excuse for administering a drug without full knowledge 1st : DO NO HARM Knowledge of: Drug action – what is the expected response Therapeutic effect – will this medication achieve the goal Possible adverse effects – side effects Pt teaching – with EVERY med pass THERE IS NO EXCUSE FOR ADMINISTERING A DRUG WITHOUT FULL KNOWLEDGE 01/10 ES
8
NURSING PROCESS: ASSESSMENT
When discussing pharmacology and medication administration the nurse must utilize the nursing process to understand what components their thoughts, plans and actions fall under. Assessment is the first step – our data collection component (Reinforce that the Nursing Process IS ‘how we think as nurses’ – we are always assessing, planning, implementing and evaluating) 01/10 ES
9
ASSESSMENT OBJECTIVE SUBJECTIVE Physical assessment including:
V.S. Weight Skin color Diagnostic tests Drug levels in body (Dilantin, Dig) PT/INR LABS (BS/K) SUBJECTIVE Allergy history (What kind of reaction) Complaints (?Pain) Objective assessment data are those elements that are observed by the nurse that are factual, such as; an increase or decrease in blood pressure values, pulse, temp Diagnostic tests: drug levels in blood (Dilantin) clotting studies (PT/INR or PTT) lab values to check (BS, K) Subjective assessment data are those elements the patient “reports” or “states” Allergy Hx – ask what kind of reaction occurs make sure pt is wearing a red armband Complaints – pain 01/10 ES
10
NURSING PROCESS PLANNING
Planning is the second step in the nursing process This is where we sort through and analyze our data to develop our actual plan for the patient 01/10 ES
11
PLANNING Sorting and analyzing the data to develop the plan of care and goals What are you going to do based on your findings? Planning pt / family teaching What needs to be taught?, When? Do you need handouts? Sorting/analyzing data: Setting long term and short term goals; Plan what you are going to do based upon your assessment findings Pt teaching: planning what needs to be taught best time to teach gathering reference info – pamphlets, handouts, video, education channel 01/10 ES
12
IMPLEMENTATION
13
This is execution of nursing actions
IMPLEMENTATION This is the third step in the nursing process and is when we actually take actions that we planned. This is execution of nursing actions Implementation is the third step in the nursing process This is where we actually take the actions that we planned Execution of nursing actions 01/10 ES
14
IMPLEMENTATION Preparing and administering drugs
Always follow the six rights Assessment of V.S. prior to administration Actually check the VS, BS Patient teaching Actually doing the teaching Preparing/administering drugs: ALWAYS follow the SIX RIGHTS Assessment of VS: put plan into action – actually check the BP check the BS Pt teaching: actually ‘doing’ the teaching DOCUMENTATION is under implementation as this is the action we take to record what nursing care we rendered 01/10 ES
15
NURSING PROCESS EVALUATION
The final step of the nursing process is to evaluate what impact our nursing actions had on the patient. 01/10 ES
16
EVALUATION How the pt is responding to the intervention Was goal met?
Reassessment of V.S., Pain level, etc. Did BP respond? Did pain decrease? Response to intervention: r/t goal, was goal met? was intervention effective? do we need to revise goals? Or interventions? Reassessment: did BP respond to tx did pain decrease? Temp F Tylenol 650 mg PO E) Temp decreased to 99.6 F 01/10 ES
17
PATIENT TEACHING Most dramatic change in recent years
Patient has a right to know what med was given, they have right to refuse, and they have the right to generics One of our most important roles Provide written material, reinforce key points, document Dramatic change: Pt has a right to know AND should know: why med is given right to refuse right to generics Provide written materials: Repeat, repeat, repeat; Reinforce; short sessions, handouts, audiovisuals 01/10 ES
18
DRUG LEGISLATION 1906 Federal, Food, Drug and Cosmetic Act
Began federal regulation Established safety guidelines; required labeling, prohibited false claims and regulated advertising National standards for drugs – USP (United States Pharmacopeia) Purity / Safety Concerns Purity/Safety: Established safety and purity guidelines; required labeling; prohibited false claims and regulated advertising USP: United States Pharmacopeia – defined standards for medication approval 01/10 ES
19
1938 – added FDA to enforce laws
1914 Harrison Narcotic Act First narcotic control 1938 – added FDA to enforce laws 1945, 1952, 1962 Amendments to Federal Food, Drug and Cosmetic Act 01/10 ES
20
FDA - Food and Drug Administration
part of Dept. Health and Human services Federal agency to enforce federal drug laws including: Purity, labeling, testing, dispensing, safety, advertisement FDA determines safety of drugs before marketing, monitors development of new drugs 01/10 ES 20
21
1970 CONTROLLED SUBSTANCE ACT
Strict controls on manufacture and distribution of habit-forming drugs Established 5 schedules of habit-forming drugs Required gov’t programs to promote prevention & tx of drug dependence Schedule 1 not accepted in US Page 700 and table on page 702 Strict control: Nurse’s responsibility to maintain accurate count of all controlled substances Established 5: Schedules in Davis Drug Guide Know difference in categories i.e. – Schedule 1 not accepted in US Schedule 2 - Morphine 01/10 ES
22
Schedule I Drugs Schedule I Drugs Schedule I drugs have a high tendency for abuse and have no accepted medical use. This schedule includes drugs such as Marijuana, Heroin, Ecstasy, LSD, and GHB. Recent activists have tried to change the schedule for Marijuana citing the possible medical benefits of the drug. Pharmacies do not sell Schedule I drugs, and they are not available with a prescription by physician. 01/10 ES
23
Schedule II Drugs Schedule II Drugs Schedule II drugs have a high tendency for abuse, may have an accepted medical use, and can produce dependency or addiction with chronic use. This schedule includes examples such as Cocaine, Opium, Morphine, Fentanyl, Amphetamines, and Methamphetamines. Schedule II drugs may be available with a prescription by a physician, but not all pharmacies may carry them. These drugs require more stringent records and storage procedures than drugs in Schedules III and IV. 01/10 ES
24
Schedule III Drugs Schedule III Drugs Schedule III drugs have less potential for abuse or addiction than drugs in the first two schedules and have a currently accepted medical use. Examples of Schedule III drugs include Anabolic steroids, Codeine, Ketamine, Hydrocodone with Aspirin, and Hydrocodone with Acetaminophen. Schedule III drugs may be available with a prescription, but not all pharmacies may carry them. 01/10 ES
25
Schedule IV Drugs Schedule IV Drugs Schedule IV drugs have a low potential for abuse, have a currently accepted medical use, has a low chance for addiction or limited addictive properties. Examples of Schedule IV drugs include Valium, Xanax, Phenobarbital, and Rohypnol (commonly known as the "date rape" drug). These drugs may be available with a prescription, but not all pharmacies may carry them. 01/10 ES
26
Schedule V Drugs Schedule V Drugs Schedule V drugs have a lower chance of abuse than Schedule IV drugs, have a currently accepted medical use in the US, and lesser chance or side effects of dependence compared to Schedule IV drugs. This schedule includes such drugs as cough suppressants with Codeine. Schedule V drugs are regulated but generally do not require a prescription. 01/10 ES
27
Illegal to possess controlled substances without rx
Formed Drug Enforcement Agency (DEA) to enforce 01/10 ES
28
DRUG NAMES Generic Name Trade / Brand Name
May be used by other manufacturers, less costly, not capitalized Trade / Brand Name Usually short Easy to spell Capitalized Name given by manufacturer followed with “R” Copyright name (Tylenol, Advil, Demerol) Generic: “common name” may be used by other manufacturers less costly – not capitalized i.e.; acetaminophen, ibuprofen, meperidine Trade: usually short name easy to spell capitalized $$ name given by manufacturer followed by symbol R copyright name i.e.. Tylenol R, Advil R, Demerol R 01/10 ES
29
DRUG REFERENCES USP / NF (FDA) U.S. DISPENSATORY
United States Pharmacopeia – standard for drugs updated every 5 years with formulas & standards for preparation & dispensation of drugs National Formulary – drugs of established usefulness U.S. DISPENSATORY Publication of description and composition of medicines PDR – published annually Physicians Desk Reference – divided into color coded sections 01/10 ES 29
30
DRUG REFERENCES NURSING DRUG HANDBOOKS FACTS AND COMPARISONS
Handbooks: Davis Drug Guide, Saunders etc. FACTS AND COMPARISONS listed by body system ALSO – each HCF has it’s own ‘hospital’ formulary – cannot carry every drug; may see substitutions 01/10 ES 30
31
PHARMACOKINETICS References: Mosby pg 696 ATI pg 1-2 01/10 ES
32
PHARMACOKINETICS Use of drug by body
Process that affect drug from time it enters the body to time it leaves Divided into 4 phases Absorption Distribution Biotransformation Excretion Use of: processes that affect drug from time it enters the body to time it leaves 01/10 ES
33
ABSORPTION Passage of drug from site of entry to bloodstream
What is the most common site of entry? What factors affect absorption? Passage: Ask students what is most common site of entry – GI tract (PO) Factors: Route of administration & conditions at absorptive site Drug form – enteric coated; sustained release; liquid Gastric emptying & gastric motility Timing – presence of food, other drugs – esp. antacids REFER to ATI text pg 1-3 – Great reference! 01/10 ES
34
Absorption Factors Route of administration & conditions at absorptive site Drug form – enteric coated; sustained release; liquid Gastric emptying & gastric motility Timing – presence of food, other drugs – esp. antacids 01/10 ES
35
DISTRIBUTION What factors affect distribution?
Progress or transportation from bloodstream to particular site of action (receptor sites) Receptor sites or target tissue where drug chemically bonds to cells What factors affect distribution? Circulation, cardiac output, blood supply to site of drug action Binding of drugs to Plasma Protein Albumin & Tissue binding Level of plasma proteins (albumin) For PO drugs, amt of drug metabolized by liver before reaching systemic circulation Blood – Brain Barrier prevents many drugs from entering CNS 01/10 ES 35
36
BIOTRANSFORMATION Metabolism
Degradation or breakdown of drug for excretion Process by which drug is detoxified or inactivated What factors affect biotransformation? Metabolism: degradation or breakdown of drug for excretion Process by: or inactivated Factors: Condition of liver – most drugs detoxified by liver – need to check LFT’s “First Pass” thru liver is why oral drugs are given in higher doses – REFER to ATI book Chemicals or drugs that stimulate production of transforming enzymes = decreased drug effect Chemicals or drugs that decrease production of transforming enzymes = increased drug effect, cumulative effect, increased adverse reactions Discuss metabolism & cumulative effect REFER ATI pg 4 01/10 ES
37
Biotransformation Factors: Condition of liver – most drugs detoxified by liver – need to check LFT’s “First Pass” thru liver is why oral drugs are given in higher doses Chemicals or drugs that stimulate production of transforming enzymes = decreased drug effect Chemicals or drugs that decrease production of transforming enzymes = increased drug effect, cumulative effect, increased adverse reactions 01/10 ES 37
38
EXCRETION Elimination of the drug from the body
What factors affect excretion? Kidney – condition of kidney as this is the main excretory organ Other excretory – respiration, perspiration, defecation REFER to ATI pg 5 Factors: Kidney – condition of kidney as this is the main excretory organ Other excretory – respiration perspiration defecation 01/10 ES
39
BLOOD LEVELS Amount of drug in circulating fluid is often measured
Drug half life – amount of time for serum concentration to decrease by 50% Commonly done with Antibiotics, Lanoxin, AED’s Drug half life – amount of time for serum concentration to decrease by 50% 01/10 ES
40
Medication Actions and Interactions
LOCAL – affects only area drug is placed, not absorbed into blood stream SYSTEMIC – absorbed into bloodstream REFER Mosby pg 697 Local: not absorbed into bloodstream Systemic: absorbed into bloodstream Ask for examples 01/10 ES
41
TERMS Therapeutic Effect Agonist Antagonist Additive
Synergistic / Potentiating REFER to Mosby pg 697 Therapeutic: desired or intended effect Agonist: drug that produces a response, stimulates a response Antagonist: drug that blocks the action of another drug, opposing effect sometimes desired – Narcan sometimes undesired – Antibiotics & BCP’s REFER to ATI pg 3 Additive: drugs with similar actions sum of their effects 1+1=2 (alcohol + sedatives) Synergistic: 2 drugs with different actions produce greater effects 1+1=3 (Codeine + ASA) 01/10 ES
42
Therapeutic: desired or intended effect
Agonist: drug that produces a response, stimulates a response Antagonist: drug that blocks the action of another drug, opposing effect sometimes desired – Narcan sometimes undesired – Antibiotics & BCP’s Additive: drugs with similar actions sum of their effects 1+1=2 (alcohol + sedatives) Synergistic: 2 drugs with different actions produce greater effects 1+1=3 (Codeine + ASA) 01/10 ES 42
43
Anaphylactic (Allergic) Cumulative Adverse Effect / Side Effect
Incompatibility Idiosyncratic Anaphylactic (Allergic) Cumulative Adverse Effect / Side Effect REFER to ATI pg 3 / Mosby pg 697 Incompatibility: drugs that do not combine chemically with other drugs, don’t mix compatibility charts – refer to student drug book (Davis pg 1243) REFER to ATI pg 4 / Mosby pg 697 Idiosyncratic: unusual or unexpected + highly individualized Anaphylactic: Hypersensitvity; antigen/antibody reaction – can be severe, life threatening Be careful to check allergies Cumulative: drugs that build up in the body, may be d/t increased dose, poor circulation, metabolism or excretion REFER to ATI pg 39 Adverse Effect: undesired action – usually classified by body system are considered adverse but can be helpful in some situations i.e. Pt has angina& HTN, Nitrates vasodilate + also lowers B P 01/10 ES
44
Idiosyncratic: unusual or unexpected + highly individualized
Incompatibility: drugs that do not combine chemically with other drugs, don’t mix, compatibility charts on nursing units Idiosyncratic: unusual or unexpected + highly individualized Anaphylactic: Hypersensitivity; antigen/antibody reaction – can be severe, life threatening Be careful to check allergies Cumulative: drugs that build up in the body, may be d/t increased dose, poor circulation, metabolism or excretion Adverse Effect: undesired action – usually classified by body system are considered adverse but can be helpful in some situations i.e. Pt has angina& HTN, Nitrates vasodilate + also lowers B P 01/10 ES 44
45
DRUG FORMS Liquids Solids Oral, parenteral, topical, instillation
Tablets, caplets, capsules, powder, zydis DRUG FORMS: Ask for ideas first and list Liquids: Parenteral: other than GI ( IM, SC, ID, IV, inhalation) Instillation: eyedrops Solids: Powder: often mixed with liquids (diluent) Zydis: on tongue + dissolves 01/10 ES
46
Liquids: Parenteral: other than GI ( IM, SC, ID, IV, inhalation) Instillation: eyedrops, eardrops, other examples Solids: Powder: often mixed with liquids (diluent) Zydis: on tongue + dissolves 01/10 ES 46
47
Semisolids Inhalers Transdermals Suppositories Ointments, Pastes
Metered dose decreases systemic effects Transdermals Semisolids: Suppositories: melt at body temp, absorbed thru mucosa Ointments: NTG paste Inhalers: MDI – metered dose inhalants Transdermals: controlled amount, paste, patches, - NTG, Duragesic, Nicoderm, Estrogen 01/10 ES
48
DRUG DOSAGE Factors to be considered: Age Weight Physical Health
Psychological Status REFER Mosby pg 698 Age: young & old do not tolerate large doses; young: underdeveloped renal / liver elderly: decreased liver & kidney function + less body water often leads to decreased metabolism of drug – cumulative effect REFER to table 23-1 pg 699 Mosby Weight: kg wt overweight may require increased dose underweight may require decreased dose in children: meds calculated by mg/kg Physical: People in poor health do not tolerate average doses as well Disease process alter dosage requirements eg. Renal Hepatic Cardio GI Psych: personality & culture, difference in pain threshhold agitation, anxiety, stress, pt’s attitude toward doctor, nurse, hospital 01/10 ES
49
More Factors Environmental Temp. Gender Amount of food in stomach
Dosage forms Environ: Heat may increase metabolism of drug (vasodilation) Cold may decrease metabolism of drug (vasoconstriction) Some meds sensitive to light & temperature Gender: women have increased fat – may accumulate fat soluble drugs men have increased body water Discuss breastfeeding & pregnancy + affects of baby & fetus Amount of food: empty stomach reach bloodstream faster irritating drugs may be given with or after meal so they won’t irritate GI tract Dosage: IV, IM – act more rapidly 01/10 ES
50
DOSAGE CONSIDERATIONS
Therapeutic dose Minimal dose Loading dose Maximal dose Toxic dose Lethal dose REFER Mosby pg 697 Therapeutic: usual dose for most clients Minimal: smallest amt necessary to give therapeutic effect Loading: initial dose is larger than the usual continuing dose Maximal: largest amt safely given Toxic: poisoning, overdose, toxicity *emphasize age-related changes + decreased body water may increase toxicity of water soluble drugs Lethal: = death 01/10 ES
51
MEDICATION ORDERS Who can write a prescription? Written orders
Verbal orders Standing orders Stat orders REFER Mosby pg 698 and pg 700 Box 23-3 Who: MD, DO, DDS, ARNP, CNM, DVM, PA (depends on the state) Written: common, safest, decreased errors Verbal: V.O. T.O. = Increased errors repeat order for verification Standing: standardized orders ie – sliding scale, heparin (PTT), post op Stat: Now; immediately 01/10 ES
52
PARTS OF A PRESCRIPTION
Pt Name Date, Time Name of Drug Dose of Drug Time / Frequency Method / Route HC Provider Signature DOB Special Instructions Book has NINE (adds DOB & special instructions) KNOW these (fill in on TQ) ***SHOW VIDEO - Understanding Medication Guidelines 01/10 ES
Similar presentations
