Introduction to Pharmacology & Applied Therapeutics Flashcards
Critical Thinking
The ability to reason and think rationally in order to understand, solve problems, and make decisions; a major component of the nursing process, often considered the foundation on which to provide the best possible patient care, supported by current best evidence
Adverse Drug Effects
general term for any undesirable effects that are a direct response to one or more drugs
Allergic Reaction
An immunological hypersensitivity reaction resulting from the unusual sensitivity of a patient to a medication; a type of adverse drug event
Adverse Drug Reaction
Any unexpected, unintended, undesired, or excessive response to a medication given in therapeutic dosages
Drug Classification
A method of grouping drugs; may be based on structure or therapeutic use
Contraindications
Any condition, especially one that is a result of a disease state or patient characteristic, including current or recent drug therapy, that renders a form of treatment improper or undesirable
Drug Induced Teratogenesis
The development of congenital anomalies or defects in the developing fetus that are caused by the toxic effects of the drug
Idiosyncratic reaction
An abnormal and unexpected response to a medication, other than an allergic reaction, that is peculiar to an individual patient
Side Effects
Unwanted undesirable effects that are possible related to a drug
Generic Name
The medicines active ingredient that makes it work
ie., Acetaminophen
Brand Name/Trade Name
Name from the pharmaceutical company that markets the medicine
ie., Tylenol
Nursing Process and Medication Administration:
Assessment
- Subjective and Objective data collection
- Collection of specific information about prescribed, OTC, and natural health products or complementary and alternative drug use, with attention to the drugs actions; signs and symptoms of allergic reaction; adverse effects; dosages and routes of administration; contraindications; drug incompatibilities; drug to drug, drug to food, and drug laboratory test interactions; and toxicities and available antidotes
- Gather data about the patient and a given drug by asking yourself these simple questions:
What is the patient’s oral intake?
Tolerance of fluids?
Swallowing ability for pills, tablets, capsules, and liquids? - What are the laboratory results and other diagnostic tests related to organ functioning and drug therapy? What are the kidney function studies? What are the results of the liver function tests? Etc.,
What should the order from a prescriber be checked for? (6)
1) Patient’s Name
2) Date the drug order was written
3) Name of the drug
4) Drug dosage amount and frequency
5) Route of Administration
6) Prescriber’s Signature
Nursing Process and Medication Administration: Diagnosis
- Inadequate knowledge
- Risk of injury
- Nonadherence
- Various disturbances, deficits, excesses, or impairments in bodily functions; and other problems or concerns related to drug therapy
Nursing Process and Medication Administration: Planning
- Goals and expected patient outcome criteria of the medications
- Medication administration:
These outcomes may address special storage and handling techniques, administration procedures, equipment needed, drug interactions, adverse effects, and contraindications - There needs to be a timeframe in mind (is it a quick goal or an overarching goal)
- Do you have all of your supplies needed to give this medication?
- Do you need to review a procedure prior to doing something?
- Objective, measurable, realistic goals
Nursing Process and Medication Administration: Implementation
- Nursing interventions or actions may be independent, collaborative, or dependent upon a prescribers order
- Statements of interventions include frequency, specific instructions, and any other pertinent information
- Constant communication and collaboration
- Implementation is based on the nurse’s clinical judgment and knowledge
- The principles of informed consent and choice should underpin medication administration
- Nurses must adhere to safe administration practice to prevent errors
- *The Ten Rights of Medication Administration
Nursing Process and Medication Administration: Evaluation
- Includes monitoring the fulfillment of goals and outcome criteria, as well as the patient’s therapeutic response to the drug and its adverse effects and toxic effects
- Documentation is also an important component of evaluation
What are the 10 Rights of Medication Administration?
1) Right Drug
2) Right Dose
3) Right Time
4) Right Route
5) Right Patient
6) Right Reason
7) Right Documentation
8) Right Evaluation (or right assessment) - ie., Blood Pressure, Lab results, pulse rate etc.,
9) Right Patient Education
10) Right to Refuse
What are Pharmaceutics?
Study of how various dosages forms influence the way in which a drug affects the body
ie., Tablet, Capsule or liquid (these are all broken down differently)
Controlled release, sustained release. Can I crush this medication? When is the onset?)
What is Pharmacokinetics?
Study of what the body does to the drug (Absorption, Distribution, Metabolism, Excretion)
Pharmacokinetics: Absorption
The drug moves from its site of administration into the bloodstream for distribution into the tissues
If a drug is absorbed in the intestine, it must first pass through the liver before it reaches systemic circulation
Is dependent on the route of administration (ie., Enteral route (PO meds, SL), Parenteral route (any other administration that is not through the gastrointestinal tract ie., SC, Intradermal, IM, IV
Topical route
Inhalation route
Pharmacokinetics: Distribution
The transport of the blood by the bloodstream to its site of action
What is an area of slow distribution for meds?
Areas of slower distribution include muscle, skin and fat
What are the areas that drugs are distributed to first?
Drugs are distributed first to those areas with extensive blood supply such as the heart, liver, kidneys and the brain
What is an area that is difficult for the distribution of a medication to occur?
There are some sites in the body which are difficult to distribute a drug such as those with poor blood supply like bone or have physiological barriers that make it difficult to pass through such as the blood brain barrier
What is the role of Albumin in the distribution of medications? (Pharmacokinetics)
Albumin is the most common blood protein and carries the majority of protein bound drug molecules
If a medication is given it binds to albumin, only a limited amount of the drug is not bound. This unbound portion is pharmacologically active and is considered “free” drug whereas “bound” drug is pharmacologically inactive - this can raise the risk of drug toxicity
Pharmacokinetics: Metabolism
Medication is broken down into its primary components
Intersectionality considerations: genetics, ethnicity (liver enzymes)
Pharmacokinetics: Elimination
The elimination of the drug from the body
What is the primary organ for medication elimination?
Primary organ for elimination is the kidney - Kidney’s (labs- assess the kidney function such as Crea, GFR, Urea), assess their urine output
What is the primary organ where drugs are metabolized?
Liver
However…drugs are also metabolized by the
- Integumentary system
- Respiratory System
- Gastrointestinal Tract
Pharmacodynamics
Relationship between drug concentration and pharmacological response (Mechanism of Action)
Relationship between drug concentration and pharmacological response - There needs to be a certain “level” in our bloodstream for it to have its effects. We look at therapeutic concentrations and critical concentrations (ie., Vancomycin Trough)
Drug induced changes in normal physiological functions are explained by the principles of pharmacodynamics
A positive change is called a therapeutic effect
Pharmacotherapeutics
Clinical use of drugs to prevent or treat
Pharmacotherapeutics: Acute Therapy
Often involves more intensive drug therapy and is implemented for patients who are have a rapid onset of illness
Ex. vasopressors to maintain Blood Pressure and cardiac output
Pharmacotherapeutics: Maintenance Therapy
Typically does not eradicate problems the patient already has but does prevent the progression of a disease or condition
Used for the treatment of chronic conditions such as blood pressure medications to treat hypertension. Oral contraceptives for birth control
Pharmacotherapeutics: Supplemental Therapy
Supplemental or replacement therapy supplies the body with a substance needed to maintain normal function
Ex. administration of insulin to patients with diabetes and iron to patients with iron-deficiency anemia
Pharmacotherapeutics: Palliative Therapy
The goal to make the patient as comfortable as possible
The goal is to improve quality of life for both the patient and the family
Ex: opioid analgesics for pain management
Pharmacotherapeutics: Supportive Therapy
Maintains the integrity of bodily functions while the patient is recovering from illness or trauma
Ex: fluids and electrolytes to prevent dehydration in a patient with influenza who is vomiting and has diarrhea, IV therapy or blood products to a patient who has lost lots of blood during surgery
Pharmacotherapeutics: Prophylactic Therapy and Empirical Therapy
Drug therapy provided to prevent illness other undesirable outcome during planned events
Ex: administering disease specific vaccines to individuals
Pharmacotherapeutics: What is the therapeutic index?
The ratio of the drugs toxic level to the level that provides therapeutic benefits
Pharmacotherapeutics: What are some components of monitoring with pharmacotherapeutics?
- Drug Concentration
- Patient’s Condition
- Tolerance and Dependence
- Interactions
- Adverse Drug Events
What is important to keep in mind regarding pharmacotherapeutics?
Outcomes need to be clearly defined - the desired therapeutic outcome for the patient
Examples include curing a disease, eliminating or reducing pre-existing symptoms, arresting or slowing a disease process, preventing a disease or other unwanted conditions, or otherwise, improving quality of life
What is a carcinogenic reaction to medications?
Cancer causing (ie., Immunotherapy)
What is an example of an Adverse Drug Reaction?
Anaphylaxis
4 Clinical Phases of New Drug Development: Phase 1
Trial where individuals are healthy and do not need this medication, clinical setting, the individual will keep a journal of their symptoms with this medication.
Less than 100 people
What is the optimal range? (what is lowest or highest dose we can do?)
Pharmacokinetics
We look to make sure there are no life threatening reactions
4 Clinical Phases of New Drug Development: Phase 2
Involves a large amount of individuals, with individuals who have the disease or a disease , adverse effects/reactions are monitored here, the the dosage is changed here based off of effects
4 Clinical Phases of New Drug Development: Phase 3
Lots of people such as 1000 people reaching out to medical research centers. Looking for infrequent or rare adverse reactions
Placebo is introduced here to prevent bias
4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)
This medication is deemed to be safe
Pharmaceutical companies are going to follow this medication for a couple years
Documentation
Recalls due to being available to a lot of people
4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)
What is a class I recall?
The medication is DONE
4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)
What is a class II recall?
the adverse drug reactions are temporary or reversible (black box on the med label)
4 Clinical Phases of New Drug Development: Phase 4
(recalls class I, II, or III)
What is a class III recall?
Warning on the medication
