1. Pharmacology 3 Safety and Effectiveness in Medicines Administration Applying the Evidence Base

2. Recap from Pharmacology 1 and 2 Pharmacokinetics what the body does to the drug Pharmacodynamics what the drug does to the body Desired effects? Adverse effects? Evaluating effects-ongoing monitoring

3. Pharmacokinetics What are the key considerations with patients? Ability of the liver to metabolise drugs Ability of the liver to excrete drugs

4. Pharmacodynamicss Drug Effects on the body They can be used to Depress activity Stimulate activity Destroying cells (cytotoxicity) Irritate – produce adverse effects Replace substances Diagnose Key considerations: Desired activity Undesirable effects Therapeutic window

5. Therapeutic Window Blood level of the drug ResponseResponse

6. Recap Case 1 Co-codamol (BAN) is a non-proprietary name used to denote a compound analgesic, a combination of codeine phosphate and paracetamolBANproprietarycompound analgesic codeineparacetamol Co-codamol tablets are used for the relief of mild/moderate (or in the case of 30/500mg - severe) pain. pain Side effects can include of this drug can include: constipation, skin rashes, dizziness, sedation, shortness of breath, hypersensitivity reaction, fainting (syncope or near syncope), nausea and/or vomiting, confusion, loss of short-term memory, drowsiness, changes in blood, allergic reactions, euphoria, dysphoria, abdominal pain, pruritus (itching), easy bruising and bleeding gums (BNF 55) constipationskin rashesdizzinesssedationhypersensitivityfaintingnauseavomiting confusionshort-term memorydrowsinessbloodeuphoria dysphoriapruritus bruisinggums

7. Use the BNF Check the side effects- Co-Codamol Go to http://www.bnf.org/bnf/index.htmhttp://www.bnf.org/bnf/index.htm Create a login

8. BNF work Check the side effects- Co-Codamol Side effects of this drug can include: Constipation, Skin rashes, Dizziness, Sedation, fainting (syncope or near syncope), euphoria, dysphoria, confusion, loss of short-term memory, drowsiness, Shortness of breath, Hypersensitivity reaction, Nausea and/or vomiting, Blood dyscrasias (thrombocytopenia and agranulocytosis ), Allergic reactions, Abdominal pain, Pruritis (itching), Easy bruising and bleeding gums (BNF 61)

9. Compare EMC http://www.medicines.org.uk/EMC/ Undesirable effects: Codeine can produce typical opioid effects including constipation, nausea, vomiting, dizziness, light-headedness, confusion, drowsiness and urinary retention. The frequency and severity are determined by dosage, duration of treatment and individual sensitivity. Tolerance and dependence can occur, especially with prolonged high dosage of codeine. Adverse effects of paracetamol are rare but hypersensitivity including skin rash may occur. There have been reports of blood dyscrasias including thrombocytopenia and agranulocytosis, but these were not necessarily causally related to paracetamol. Regular prolonged use of codeine/DHC is known to lead to addiction and tolerance. Symptoms of restlessness and irritability may result when treatment is then stopped. Prolonged use of a painkiller for headaches can make them worse. Very rare occurrence of pancreatitis.

10. Reviewing Case Example 1 Mrs Powell (age 45years) was prescribed Co-codamol 15-500 (whilst in hospital) to treat her arthritic pain. She had been taking this medication for one month and her pain relief did improve. Her side effects were : Feeling drowsy and felt a little nauseated in the first 3 weeks of taking these. WHY and WHEN WOULD THIS RESOLVE WHYFeeling drowsy and felt a little nauseated in the first 3 weeks of taking these. WHY and WHEN WOULD THIS RESOLVE WHY Constipated WHY HOW could this be MANAGED.Constipated WHY HOW could this be MANAGED.

11. She was considering a change in Pain relief PARACETEMOL IBUPROFEN

12. BNF – Look up Ibuprofen http://www.medicines.org.uk/EMC/medicin e/10849/SPC/Brufen+400+mg+Tablets/http://www.medicines.org.uk/EMC/medicin e/10849/SPC/Brufen+400+mg+Tablets/

13. Some Clinical Practice Considerations She asked: Can I take my other tablets (OTC medication) with the medicine I have been prescribed? (mentioning. Ibuprofen, mixes of Aspirin and Paracetamol (‘Anadin Extra’) and paracetamol alone ) What can be mixed? Does it matter if I take the tablets at varying time intervals? The nurse must be able to give the patient accurate information, to ‘empower’ the patient to be able to safely self medicate (NMC 2008).

14. ‘Errors’ The nurse with knowledge and understanding of pharmacology will be more confident in drug administration Who is responsible for ‘correct dose administration ’ with respect to medication? What professional principles are relevant? What ethical principles can be applied to the issue of patients getting the right dose?

15. ‘Errors’ The nurse with knowledge and understanding of pharmacology will be more confident in drug administration Who is responsible for ‘health education’ with respect to medication? What professional principles are relevant? What ethical principles can be applied to the issue of patients understanding side effects?

16. Development of Knowledge and Skill with Medicine Administration Knowledge and understanding of pharmacology will generate more confidence in drug administration Nurses are responsible for ‘correct dose administration ’.