Week 1; Basics Flashcards
What are the nursing responsibilities of pharmacology?
Administering drugs, assessing drug effects, intervening to make the drug regimen more tolerable, Providing teaching about drugs and drug regimens, monitor the overall patient care plan to prevent medication errors, must be knowledgeable about changing landscape of medical treatment and rely on up-to-date and comprehensive drug and treatment guidelines.
Chemical name; generic name; trade name
- The name that reflects the chemical structure of a drug; 2.Name given by the United States adopted name council; 3.The drug has registered trademark; use of the name restricted by the drug’s owner
Phase I studies
Uses human volunteers to test the drugs. These studies are more tightly controlled than preclinical trials and are performed by specially trained clinical investigators. At the end of phase I studies, many chemicals are dropped from the process for the following reasons: they cause unacceptable adverse effects, they are highly teratogenic, they are too toxic, they lack evidence of potential therapeutic effect in humans
Phase II studies
Allows clinical investigators to try out the drug in patients who have the disease that the drug is designed to treat; performed at various sites across the country and are monitored by representatives of the pharmaceutical company studying the drug. May be removed from study because: It is less effective than anticipated, it is too toxic when used with patients, it produces unacceptable adverse effects, it has a low benefit-to risk ratio, meaning that the therapeutic benefit does not outweigh the risk of potential adverse effects.
Phase III studies
Involves the drug in a vast clinical market. Prescribers are informed of all the known reactions to the drug and precautions required for its Sade use. Prescribers observe patients very closely, monitoring them for an adverse effects. A drug that produces unacceptable adverse effects or unforeseen reactions in usually remove from further study by the drug company.
DEA schedule I drugs
Highest abuse potential (heroin, LSD, Marijuana, psilocybin); no accepted use for medicine, limited use for research purposes
DEA schedule II drugs
High abuse potential; morphine, PCP, cocaine; accepted use with restrictions
Pharmacodynamics
Study of what the drug does to the body
Pharmacokinetics
The study of what the body does to the drug; Absorption, distribution, ,metabolism, excretion
Pharmaceutics
The study of how various drug forms influence pharmacokinetic and pharmacodynamic activities
Pharmacotherapeutics
The use of drugs and the clinical indications for drugs to prevent and treat disease
In what ways do drugs work in the body
Replaces or act as a substitute for missing chemicals, to increase or stimulate cellular activities, to depress or slow cellular activities, to interfere with the functioning of foreign cells
Absorption
The rate at which a drug leaves its site of administration and the extent to which absorption occurs
Bioavailability
enough available drug to be absorbed from the body
Bioequivalent
establishes that the generic drugs have the same absorption and desired effects are the same as the trade drug
actors that affect absorption
Administration route of the drug, food or fluids administered with the drug, food or fluids administered with the drug, dosage formulation, status of the absorptive surface, rate or blood flow to the small intestine, acidity of the stomach, status of GI motility
Routes of admin
A drugs route of administration affects the rate and extent of absorption of the drug
enteral, parenteral, topical
Enteral
Absorbed through the oral or gastric mucosa; oral, sublingual, buccal, rectal
First pass effect
The metabolism of a drug and its passage from the liver into the circulation; the liver has a high metabolism rate which leads to a low or less therapeutic effect
Routes that bypass the liver
sublingual, buccal, rectal, intravenous, intranasal, transdermal, vaginal, intramuscular, subcutaneous, inhalation
Parental route
intravenous, intramuscular, subcutaneous, intradermal, intrathecal, intraarticular
Topical route
skin, eyes, ears, nose, lungs, vagina
Distribution
The transport of a drug in the body by the bloodstream to its site of action
What is distribution of drugs affected by
water-binding, water soluble vs fat soluble, blood brain barrier, areas of rapid distribution (heart, liver, kidneys, brain), areas or flow distribution (muscle, skin, fat
Metabolism
The biological transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite; done by liver, kidneys, lungs, lungs, plasma intestinal mucosa, pro-drug a drug that is activated after it is metabolized
Factors that decrease metabolism
Cardiovascular dysfunction, renal insufficiency, starvation, obstructive jaundice, slow acetylator, erythromycin or ketoconazole drug therapy
Factors that increase metabolism
Fast acetylator, barbiturates, rifampin therapy
What does delayed drug metabolism result in
Accumulation of drugs, prolonged action of the effects of the drug
What does stimulating drug metabolism cause
Diminished pharmacological effects
Excretion and routes
The elimination of drugs from the body; kidneys, liver, bowel
Therapeutic index
The ratio between a drug’s therapeutic benefits and its toxic effects
What are the kinds of drug therapies
Acute, empiric, maintenance, palliative, prophylactic, replacement, supportive, supplemental
Monitoring
Effectiveness of the drug therapy must be evaluated which is why nurses must be familiar with the drugs intended therapeutic effects
How do adverse effects occur
Drug effect on the body (potentiation), patient sensitivity (patient sensitivity), drugs action may cause other responses (secondary effects)
Challenges to effective therapy
Media influence/internet, OTC drugs, alternative therapies and herbal medicines, off-label uses, cost considerations, importance of patient teaching, street drugs
Tolerance
A decreasing response to repetitive drug doses
Dependence
A physiologic or psychological need for a drug
What are some things that commonly cause drug interactions
Other prescribed drugs, OTC meds, herbal therapies
Drug allergy reactions
Anaphylactic reaction, cytotoxic reaction, serum sickness reaction, delayed allergic reaction
Anaphylactic reaction
Causes immediate reaction; leads to respiratory distress- s/s are hives, rash, panic, dilated pupils, increased BP
Cytotoxic reaction
Attacks the cell sites of the drug that cause cell death, not immediate but seen over several days. S/s include decreased HCT, elevated AST/ALT, decreased renal function
Serum sickness reaction
Causes damage to the tissues by depositing in blood vessels, may occur up to 1 week after exposure. s/s include itchy rash, high fever, swollen lymph nodes, painful joints.
Delayed allergic reactions
Can occur several hours to days after exposure and involves antibodies bound to specific WBC. s/s rash, hives, swollen joints
Teratogenic
Hurts fetus
Mutagenic
Causes mutations
Superinfections
Secondary infection is super imposed on a previous one; usually caused by antibiotic affects on natural biome
Blood dyscrasias
Blood disorders especially with the bone marrow; can cause anemia or some deficiency in blood
Category X
Adequate well-controlled or observational studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. The use of the product is contraindicated in women who are or may become pregnant.
Category D
Adequate well-controlled or observational studies in pregnant women have demonstrated a risk to the fetus. However, the benefits of therapy may outweigh the potential risk.
Distribution in older adults
Lower total body water percentages, increased fat content, decreased production of proteins by the liver, resulting in decreased protein binding of drugs
Metabolism in older adults
Aging liver produces fewer microsomal enzymes, affecting drug metabolism, reduced blood flow to the liver
Excretion
Decreased glomerular filtration rate, decreased number of nephrons
Older adult med administration considerations
Age, allergies to drugs and food, dietary habits, sensory, visual, hearing, cognitive, and motor-skill deficits, financial status and any limitations, list of all health-related care providers, listing of medications, existence of poly pharmacy, self-medication practices, lab test results, history of smoking and use of alcohol, risk situations related to drug therapy identified by the beers criteria
Types of med errors
Wrong dose, choice, drug, time, frequency, technique, route; missed dose, known allergy, drug-drug interaction, extra dose, failure to act on test, equipment failure, inadequate monitoring, preparation error
Medications that are commonly involved in errors
Meds that have similar names or similar packaging, meds that are sometimes not commonly used or prescribed, meds that are commonly associated with allergies, meds that require testing to ensure proper therapeutic levels are maintained
10 rights of medication
drug, dose, time, route and form, patient, documentation, reason, response, refuse, education
