Pharm ch 1 - 3 Flashcards
assessment
objective (concrete data, test results), subjective (complaints) and human needs statement ( Diaphoresis is the medical term used to describe excessive, abnormal sweating in relation to your environment and activity level)
planning phase
outcomes are objective, measurable, and realistic
Outcomes are
objective, measurable, and realistic with an established time frame for their achievement.
PO
by mouth
redox
an addition of H or removal of O
ADE
adverse drug event
ADR
adverse drug reaction
neonate
between birth and 1 month of age
infant
between 1 and 12 months
child
between 1 and 12 years of age
younger than 38 weeks gestation
premature
younger than 1 month
neonate
prescribing cascade
give potassium to counteract potassium loss from diuretics
Outcomes are
objective, measurable, and realistic with an established time frame for their achievement.
The ninth right is that of the right of the patient to
refuse
Knowledge of the drug’s indication allows the nurse, prescriber, members of the health care team, patient and/or family members to
understand what is being treated.
If there is a medication error
complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, do not record completion of an incident report in the medical record.
following information needed:
following information: date and time of medication administration, name of medication, dose, route, and site of administration
Other factors must be considered in determining the right time, such as
multiple-drug therapy, drug-drug or drug-food compatibility, scheduling of diagnostic studies, bioavailability of the drug
Include in your three checks…
the frequency of the ordered medication, the time to be administered, and when the last dose of medication was given
Always confirm that the dosage amount is appropriate for the patient’s
age and size
Grounded theory was used to identify the
essence of medication safety.
If a verbal order is given, the prescriber must
sign the order within 24 hours or as per guidelines within a health care setting
Statements of interventions include
frequency, specific instructions, and any other relevant information
The study of natural (versus synthetic) drug sources (i.e., plants, animals, minerals) is called
pharmacognosy (nature is cognizant)
The study of the adverse effects of drugs and other chemicals on living systems is known as
toxicology
Pharmacotherapeutics (also called therapeutics) focuses on the
clinical use of drugs to prevent and treat diseases. It defines the principles of drug actions
Pharmacokinetics is the study of what the (kinetic energy is dope)
body does to the drug.
Pharmacodynamics involves (dynamic between drug and receptor)
drug-receptor relationship
Pharmaceutics is the study of
various dosage forms influence the way in which the drug affects the body
Drugs can be classified by their
structure (e.g., beta-adrenergic blockers) or by their therapeutic use (e.g., antibiotics, antihypertensives, antidepressants).
Pharmacology includes the following several subspecialty areas:
pharmaceutics, pharmacokinetics, pharmacodynamics, pharmacogenomics (pharmacogenetics), pharmacoeconomics, pharmacotherapeutics, pharmacognosy, and toxicology
Oral dosage forms rely on
gastric and intestinal enzymes and pH environments to break the medication down into particles that are small enough to be absorbed into the circulation
Topical
Aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories
Parenteral
Injectable forms, solutions, suspensions, emulsions, powders for reconstitution
Enteral
Tablets, capsules, oral soluble wafers, pills, timed-release capsules, timed-release tablets, elixirs, suspensions, syrups, emulsions, solutions, lozenges or troches, rectal suppositories, sublingual or buccal tablets
Dosage form determines the
rate at which drug dissolution (dissolving of solid dosage forms and their absorption, e.g., from the gastrointestinal [GI] tract) occurs
Metabolism is also referred to as
biotransformation. It involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite (as in the conversion of an inactive prodrug to its active form), or a less active metabolite
Typically a drug that is highly water-soluble (hydrophilic) will have a smaller volume of
distribution and high blood concentrations. In contrast, fat-soluble drugs (lipophilic) have a larger volume of distribution and low blood concentrations
A theoretical volume, called the volume of distribution, is sometimes used to describe the
various areas in which drugs may be distributed. These areas, or compartments, may be the blood (intravascular space), total body water, body fat, or other body tissues and organs.
A drug-drug interaction occurs when the
presence of one drug decreases or increases the actions of another drug that is administered concurrently (i.e., given at the same time).
Only drug molecules that are not bound to plasma proteins can
freely distribute to extravascular tissue (outside the blood vessels) to reach their site of action.
Areas of rapid distribution include the (BLK H)
heart, liver, kidneys, and brain
Transdermal drug delivery through adhesive patches is an elaborate topical route of drug administration that is commonly used for (transdermal has a system)
systemic drug effects
All topical routes of drug administration avoid
first-pass effects of the liver, with the exception of rectal administration.
Muscles have a greater blood supply than does the skin; therefore drugs injected intramuscularly are
absorbed faster than drugs injected subcutaneously
Injections into the fatty subcutaneous tissues under the dermal layer of skin are referred to
subcutaneous injections
The time until onset of action for the PO form is
30 to 60 minutes; for the IV form, this time is 5 minutes.
Intramuscular injections are indicated/used with drugs that are poorly soluble which are often given in
“depot” preparation form and are then absorbed over a prolonged period
Medications given by the parenteral route have the advantage of
bypassing the first-pass effect of the liver.
Intraarterial, intrathecal, or intraarticular injections are usually given by
physicians
The parenteral route is the f
fastest route by which a drug can be absorbed, followed by the enteral and topical routes
Drug absorption may be altered in patients who have had
portions of the small intestine removed because of disease. This is known as short bowel syndrome
Taking an enteric-coated medication with a large amount of food may cause it to be
dissolved by acidic stomach contents and thus reduce intestinal drug absorption and negate the coating’s stomach-protective properties.
Once the drug is in the liver
hepatic enzyme systems metabolize it, and the remaining active ingredients are passed into the general circulation.
three basic routes of administration
enteral (GI tract), parenteral, and topical.
First-pass effect reduces the bioavailability of the drug to
less than 100%.
If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then
a much smaller amount of drug will pass into the circulation (i.e., will be bioavailable). Such a drug is said to have a high first-pass effect
Bioavailability is the term used to express the
extent of drug absorption
Absorption is the
movement of a drug from its site of administration into the bloodstream for distribution to the tissues
Specifically, the combined processes of pharmacokinetics include
drug absorption into, distribution and metabolism within, and excretion from the body represent.
Pharmacokinetics is the study of
what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body
Drugs with nonspecific mechanisms of action do not
interact with receptors or enzymes. Instead, their main targets are cell membranes and various cellular processes such as metabolic activities.
For a drug to alter a physiologic response in this way
it may either inhibit (more common) or enhance (less common) the action of a specific enzyme. This process is called selective interaction
Noncompetitive antagonist
Drug combines with different parts of the receptor and inactivates it; agonist then has no effect.
Competitive antagonist
Drug competes with the agonist for binding to the receptor. If it binds, there is no response.
Antagonist
Drug binds to the receptor; there is no response. Drug prevents binding of agonists.
Partial agonist (agonist-antagonist)
Drug binds to the receptor; the response is diminished compared with that elicited by an agonist.
Agonist
Drug binds to the receptor; there is a response.
Drugs can exert their actions in three basic ways
: through receptors, enzymes, and nonselective interactions.
Teratogenic effects of drugs or other chemicals result in
structural defects in the fetus.
An idiosyncratic reaction is not the result of a
known pharmacologic property of a drug or of a patient allergy, but instead occurs unexpectedly in a particular patient
Medication errors occur during the
prescribing, dispensing, administering, or monitoring of drug therapy. These four phases are collectively known as the medication use process.
Toxic drug levels are typically seen when
the body’s normal mechanisms for metabolizing and excreting drugs are compromised. This commonly occurs when liver and kidney functions are impaired or when the liver or kidneys
drug with a low therapeutic index has a greater likelihood than other drugs of
causing an adverse reaction, and therefore requires closer monitoring.
The ratio of a drug’s toxic level to the level that provides therapeutic benefits is referred to as
the drug’s therapeutic index
Empiric therapy is based on
]clinical probabilities. It involves drug administration when a certain pathologic condition has a high likelihood of occurrence based on the patient’s initial presenting symptoms.
Prophylactic therapy is
drug therapy provided to prevent illness or other undesirable outcome during planned events
Maintenance therapy does not eradicate preexisting problems the patient may have, but will prevent
progression of a disease or condition.
Acute therapy often involves
more intensive drug treatment and is implemented in the acutely ill (those with rapid onset of illness) or the critically ill
The source of all early drugs was
nature, and the study of these natural drug sources (plants and animals) is called pharmacognosy.
Impairment in either kidney or liver function may result in
higher drug levels and/or prolonged drug exposure, and thus increased fetal transfer.
During the last trimester, the greatest percentage of
maternally absorbed drug gets to the fetus.
Drug properties that impact drug transfer to the fetus include
the drug’s chemistry, dosage, and concurrently administered drugs
Transfer of both drugs and nutrients to the fetus occurs primarily by
diffusion across the placenta, although not all drugs cross the placenta
The first trimester of pregnancy is generally the period of
greatest danger of drug-induced developmental defects
older age
Skin is thinner and more permeable.• Stomach lacks acid to kill bacteria.• Lungs have weaker mucous barriers.• Body temperature is less well regulated, and dehydration occurs easily.• Liver and kidneys are immature, and therefore drug metabolism and excretion are impaired.
Drug therapy in the older adult is more likely to result in
adverse effects and toxicity.
The simultaneous use of multiple medications is called
polypharmacy
Kidney function is assessed by measuring
serum creatinine and blood urea nitrogen levels. Creatinine is a by-product of muscle metabolism. Because muscle mass declines with age, serum creatinine level may provide a misleading index of renal function.
Liver function is assessed by testing the blood for
liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT). These laboratory values can help in assessing the ability to metabolize and eliminate medications and can aid in anticipating the risk for toxicity and/or drug accumulation.
Therefore the concentrations of highly water-soluble (hydrophilic) drugs may be higher in older adults because
they have less body water in which the drugs can be diluted.
The transformation of active drugs into inactive metabolites is primarily performed by
the liver. The liver loses mass with age and slowly loses its ability to metabolize drugs effectively due to reduced production of microsomal (cytochrome P-450) enzymes
Anticoagulants (heparin, warfarin)
Major and minor bleeding episodes, many drug interactions, dietary interactions
The brown-bag technique requires
the patient/caregiver to place all medications used in a bag and bring them to the health care provider.
MOA
mechanism of action
narrow drugs ex
digoxin and dilantin
Describe the physiochemical processes mediating drug
action.
Describe the physiochemical processes mediating drug
action.
Explain the client variables that influence the rate
and extent of Absorption, Distribution, Metabolism,
and Elimination
Explain the client variables that influence the rate
and extent of Absorption, Distribution, Metabolism,
and Elimination
Explain current theories of drug action:
- drug receptor interaction
- drug-enzyme interaction
- nonspecific drug interaction
Explain current theories of drug action:
- drug receptor interaction
- drug-enzyme interaction
- nonspecific drug interaction
Use Nursing Assessments to identify unusual
and adverse effects of drug therapy
Use Nursing Assessments to identify unusual
and adverse effects of drug therapy
Drugs do not confer any new functions on a
tissue or organ in the body
they only modify
existing functions.
● Drugs in general exert multiple actions rather
than a
single effect.
Drug action results from a
physiochemical
interaction between the drug and a
functionally important molecule in the body
pharmaceutics - Different drug dosage forms have
different
Pharmaceutical (medicinal) properties.
Dosage form determines the rate of drug
dissolution (dissolving of solid dosage forms and
their absorption from the GI tract).
Enteric-coated tablets
🞑 Extended-release forms
4 parts of pharmacokinetics
Absorption
- Distribution
- Metabolism
- Excretion
pharmacokinetics - A drug’st ime to
Onset of action, time
to Peak effect, and Duration of action
Study of what happens to a drug from
the time it is put into the body until the
parent drug and all metabolites have left
the body
pharmacokinetics absorption
Movement of a drug from its site of administration into the bloodstream for distribution to the 🞑 Bioavailability 🞑 First-pass effect
routes
A drug’s route of administration affects the rate and extent of Absorption of that drug 🞑 Enteral (GI tract) 🞑 Parenteral 🞑 Topical
enternal route
The drug is absorbed into the systemic circulation
through the oral or gastricmucosa or the small
intestine
- Oral
-Sublingual
-Buccal
-Rectal (can also be topical)
parenteral route
Intravenous (fastest delivery into the blood circulation) Intramuscular Subcutaneous Intradermal Intraarterial Intrathecal Intraarticular
topical route
Skin (including transdermal patches) Eyes Ears Nose Lungs (inhalation) Rectum Vagina
distribution
The transport of a drug by the bloodstream to its
site of action
Protein-binding
Water-soluble vs. Fat-soluble
Blood-brain barrier
Areas of rapid distribution: Heart, Liver, Kidneys, Brain
Areas of slow distribution: Muscle, Skin, Fat
distribution - a loading dose
is administered to reach a
therapeutic response level rapidly. Maintenance
doses are administered at prescribed intervals to
maintain a therapeutic drug response.
metabolism/biotransformation
*The biochemical alterationof a drug into aninactive metabolite, a more soluble compound, a morepotent active metabolite, or a lessactivemetabolite Liver(main organ) Skeletal muscle Kidneys Lungs Plasma Intestinal mucosa
Factors that decrease metabolism
Factors that decrease metabolism
Cardiovascular dysfunction
Renal insufficiency
Starvation
Obstructive jaundiceYellow skin, eyes,, Liver CA, blocked Bile
Slow acetylatorLiver can’t detoxify becomes toxic
Ketoconazole therapy- tx for fungus or yeast infections
metabolism - Factors that increase metabolism
-Fast acetylator
-Barbiturate therapy
CNS depressant, Tx Sz, Anesthesia
- Rifampin therapy- TB
-Phenytoin therapy- Sz
excretion
The elimination of drugs from the body Kidneys (main organ) Liver Bowel 🞑 Biliary excretion 🞑 Enterohepatic recirculation Biliary recycling
half life
The time it takes for one half of the original
amount of a drug to be removed from the body…
A measure of the rate at which a drug is
removed from the body
Most drugs considered to be effectively removed
after about five half-lives
Steady state- constant drug level- 2, 4, 5X 1/2L
bioavailability
Refers to the percentage of active drug
substances absorbed and available to reach the
target tissues following drug administration
movement through the body - drug actions
The cellular processes involved in the
drug and cell interaction
Drug effect
Drug effect
The physiologic reaction of the body to the drug
Includes onset, peak, and duration of action
Onset
The time it takes for the
drug to elicit a therapeutic
response
Peak
The time it takes for a drug to reach its maximum
therapeutic response
Duration
The time a drug concentration is sufficient to elicit a
therapeutic response
therapeutic drug monitoring
Peak level = Highest blood level
Trough level = Lowest blood level
therapeutic idex
Pharmacotherapeutics / Pharmaceutics ❑ Therapeutic index represents the ratio between two factors: ▪Lethal dose (LD50) ▪Effective dose (ED50) TI = LD50/ED50
drugs w/ narrow therapeutic index
- Aminoglycosides (Gentamicin®)
- Digoxin (Lanoxin®)
- Lithium (Lithobid®)
- Phenytoin (Dilantin®)
- Valproic Acid (Depakote®)
- Warfarin (Coumadin®)
pharmacodynamics - mechanisms of action
Receptor interactions reactive site on cell surface or inside cell
Enzyme interactions catalyst most biochemical rx in cell
Nonselective interaction No Rx with receptors or
enzymes.
agonists
Mimics action of the receptor
• A drug that has high affinity and intrinsic activity-
(ability of drug to be bound to receptor)
• Affinity -> promotes binding (level of degree
drug attaches or binds with receptor)
• IntrinsicActivity -> allows the
bound agonist to activate the
receptor
antagonists
Blocks action of the receptor • Acts to prevent receptor activation by endogenous (internal origin) regulatory molecules and agonist drugs • High affinity but no intrinsic activity
pharmacotherapeutics - types of therapies
Acute therapy- CC
Maintenance therapy- Prevent progression of disease, tx;HTN, BC
Supplemental/replacement therapy-replace substance needed, tx;
Insulin, thyroid
Palliative therapy- EOL, C/care
Supportive therapy-recovery post Op or trauma, bldafter surgery
Prophylactic therapy- prevent illness, vaccines
Empirictherapy- clinical problem- ex: antibxfor sepsis
contraindications
Any characteristic of the patient, especially a
disease state, that makes the use of a given
medication dangerous for the patient
It is important to assess for contraindications!
monitoring
Evaluating the clinical response of the patient to the treatment One must be familiar with the drug’s: • Intended therapeuticaction(beneficial) • Unintendedbut potential adverseeffects (predictable, adverse drug reactions)
monitoring 2
Therapeuticindex- ratio TI=LD50/ED50
Drugconcentration
Patient’s condition-infection/CV/GI/Stress/ depression/anxiety
Tolerance and dependence-I
is physiological or psychological response to repeated doses
Drug interactions (additive effect, synergistic
effect, antagonistic effect, incompatibility)- action
of one drug by another
Adverse drug events-
( Additive effect= 1+1=2, Synergistic effect= 1+1>2, Antagonis
monitoring - adverse drug reactions
Pharmacologic reactions, including adverse effects-
(drug too effective dec BP)
Hypersensitivity (allergic) reaction
Pt immune sys, histamines cytokines rash- airway
Idiosyncratic reaction- unexpected rx
Drug interaction2 or more drugs together in
other drug-related effects
Teratogenic Structural defects to Fetus Mutagenic Permanent change to genetic DNA: Radiation/virus/chemicals Carcinogenic Cancer causing
drug effect
Side Effects
• AdverseEffects
• Allergic Effects
• Drug Induced Reactions
Side effects are usually
predictable secondary
effects such as anorexia, nausea, vomiting,
dizziness, drowsiness, dry mouth, abdominal gas
or distress, constipation, and diarrhea.
Adverse effects are
unintended, undesirable, and
often unpredictable drug effects that range from
mild to fatal.
drug-induced reactions look up
Tolerance Tachyphylaxis Cumulative effect Idiosyncrasy Drug dependence Drug interaction Drug antagonism Summation Synergism Potentiation
cultural considerations
Influenceof ethnicity on genetics and drugresponse
Drugpolymorphism-various drug resistance d/t ptage, gender,
size, body composition
Compliance level with therapy
Environmental and economic considerations
Barriers to adequate health care for culturally diverseLanguage, poverty, access, pride, belief in medicine, need for
Cultural Assessment
cultural assessment
Languages spoken Health beliefs and practices Past uses of medicine Herbal treatments, folk remedies, home remedies Over-the-counter drugs and treatment Usual response to illness Responsiveness to medical treatment Religious practices and beliefs Support from the patient’s cultural community Dietary habits
legal considerations
tate and federal legislation- FDA, DEA, CA Board of Nursing, DPH
Nurse practice acts
o Scope of nursing practiceo Expanded nursing roles
o Educational requirements
o Standards of care
o Minimally safe nursing practice
o Differencesbetween nursing and medical practice
(Nursing= Caring Medical= Curing)
Only MD, APN, NP, OD, Dentist, Pod
legal considerations 2
Guidelines from professional nursing groups
Institutional policies and procedures, state and
federal hospital licensing
Case law or common law- relies on records of similar
situations/status d/t no official legal code to apply to the
case.
HIPAA- Privacy Lay for Healthcare records
ethical considerations
American NursesAssociation (ANA) - Codeof Ethicsfor Nurses- www.nursingworld.org International Council of Nurses (ICN) - Code of Ethics for Nurses Duty Breach of Duty Causation Damage ( Book, page 58
Tachyphylaxis
refers to a quickly developing tolerance that occurs after repeated
administration of a drug. (NTG in chest pain)
Cumulative effect occurs when
the body cannot metabolize one dose of a drug
before another dose is administered. (1+1 = 1.5)
Summation (addition or additive effect) occurs when
the combined effect of two
drugs produces a result that equals the sum of the individual effects of each
agent. (1+1 =2)
Tolerance refers to a
decreased physiologic response that occurs after repeated
administration of a drug or a chemically related substance
Drug Dependence is the term preferred over
the previous terminology of
“habituation” and “addiction” can be physical or psychological
Synergism describes a drug interaction in which the
combined effect of drugs is
greater than the sum of each individual agent acting independently. (1+1 =3)
Idiosyncrasy is any
abnormal of peculiar response to a drug which may manifest by
itself by
1)overresponse or abnormal susceptibility to a drug
2) under response, which demonstrates abnormal tolerance
3) a qualitatively different effect from the one expected, such as excitation after the
administration of a sedative
4) unpredictable and unexplainable symptoms. often from genetic enzymatic
deficiencies.
Potentiation refers to the
concurrent administration of two drugs in which one drug
increases the effect of the other drug. (PI booster in HIV therapy)
