Week 2 Flashcards
Pharmacodynamics pediatric
Differences in body comp
Variability in body water, fat stores, protein amounts
Pharmacokinetics pediatrics
Immaturity of organs and systems
Greatest effect in newborns and infants
Absorption peds
Reduced gastric activity
Irregular gastric emptying
Thinner skin - topical easily absorbed
Distribution peds
More body water = Lower drug concentration
Metabolism peds
Higher metabolic rates
Excretion peds
Immature kidneys
Infants administration and dosages
Methods: dropper, oral syringe or bottle nipple, inner aspect of cheek
Dosages: variations, immaturity of liver and kidneys, immunizations
WEIGHT BASED DOSAGES
Toddlers - meds & doses
Curiosity, mobility, safety, educate parents on keeping them safe
Administration - minimal choices, simple & short explanations, adult needs to control administration
Preschooler admin
Play acting, allow some choice/control
Give meds with food they like, before or after snacks
School age admin
Developmental issues, provide more detail of their meds, offer choices, don’t want others to know why they had to go to the nurses office
Adolescents admin
Developmental issues, privacy & control, self care, self medication (only if they understand), parents need to control and double check
When a child needs an injection, what way can the child cope with getting it?
Child can sit in moms lap, don’t look at needle, talk to her, hide needle but explain what is happening
Geriatric pharmacology
Physiologic changes: GI, CV, hepatic, renal
Polypharmacy: lots of meds mixed together
Decreased dietary intake, hearing , ADLs, motility, cardio
Geriatric pharmacokinetics
A = low acidity, motility, & blood flow
D = low protein binding sites, body water, high body fat
M = low liver function
E = low kidney function
Geriatric pharmacodynamics
Low receptors, affinity, compensatory responses, altered response to drugs r/t CNS changes
Significance? Higher risk of ADR, may need smaller doses but more dosing intervals
Hypnotics
Insomnia, short term therapy only
Diuretics/antihypertensives
Lower doses, risk for falls
Cardiac glycosides
Careful monitoring
Anticoagulants
Warfarin highly protein bound, low albumin levels lead to high free drug
GI drugs
Anti-ulcer agents (avoid tagamet)
Laxatives
Antidepressants
Start low and go slow
Reasons for med no adherence
Polypharmacy Economic factors Lack of knowledge Lack of symptoms Physiologic impairments Cognitive decline
Drug abuse
Substance abuse - overuse of any kind of drug, can interact w meds in bad ways
Craving, dependence, tolerance, withdrawal syndrome, stimulants, depressants, hallucinogens
Common abused drugs
Heroin, alcohol, cocaine, meth, ecstasy, LSD, marijuana, nicotine, caffeine
Alcohol
Absorbed in blood stream, most in small intestines & stomach
Metabolized by liver
Excreted by urine, breath and sweat
Alcohol pharmacology
CNS depressant
Affects GABA, glutamate, dopamine, opioid, enhances inhibitory effects of GABA
Alcohol on frontal lobe
Judgement and reasoning altered
Alcohol and midbrain
Pleasure, loss of emotional control
Alcohol and cerebellum
Loss of coordination and balance
Alcohol and hippocampus
Alters long term memory formation
Alcohol toxicity
Can’t communicate Irregular/slow HR Hypothermia Respiratory depression Coma Death
Dangerous in combination
Physiological effects of cocaine
Last 1-2 hrs Increased energy and motor activity Increased HR & BP Euphoria Decreased appetite Mental alertness Increased body temp Dilated pupils
Cocaine toxicity
Rapid heart beat Hallucinations Paranoid delusions Tremors and convulsions Respiratory failure Heart attack or heart failure Stroke
Physiologic effects of meth
Lasts 8-12 hours Similar to cocaine effects Irritability and aggression Anxiety/paranoia/nervousness Increased wakefulness Tremors/convulsions Decreased appetite Insomnia High HR & BP
Meth toxicity
Neurotoxic: serotonergic & dopaminergic neurons Permanent psychosis Hyperthermia (high body temp) Kidney failure Coma Stroke Heart attack
Special needs of drug abusing patients
Surgical patients & pain management
Rights of the nurse
Right to avoid distraction Right to not give a med = detrimental to patient Right to control prn = patient wants med sooner than ordered Assessment Documentation Education Evaluation Refuse
High alert meds
More serious if error occurs
Many classes/categories
Optimize safety - standardizing order, storage, prep, admin, access to info, limited access to meds, automated alerts, redundancies
Look alike and sound alike names
Pregnancy FDA classification
A - no risk to fetus
B - no risk in animal studies
C - animal studies indicate risk = risk vs. benefit
D - risk to fetus proved = might be used in life threatening condition
X - risk to fetus proved = risk outweighs benefit
Characteristics of drugs
Effectiveness: elicit the appropriate and intended response
Safety: not only be effective, but also safe for the patient (including drugs that require high & prolonged uses)
Selectivity: only eliciting response for which it is given
Reversible action:
Appropriate start and end time
Effects of drug will wear off
Antibiotics should NOT have a reversible action
Ease of admin
Simple admin = patient compliance
Freedom from drug interactions
Causing drugs to become more or less potent because of one another
Low cost
Producing affordable meds, because meds can be a financial burden
Chemical stability
Drugs can lose effectiveness during storage
Pharmacotherapeutics
Studies therapeutic use of a drug to prevent/treat a disease, or to prevent a pregnancy.
Influenced by the body’s cell response to chem aspects of a med
Drug classification
Grouping of drugs w similar effects on the body
Clinical pharm
Study of drugs in humans
Application of drugs in the real world, from discovery & development -> effects on people
Pharmacodynamics
What a drug does to the body once at the target site(s)
Actions receptor binding, enzymes, no selective interactions
Can only change strength/rate of a cell but cant make the cell perform a different function out of its normal physiology
Establish baseline measurement
Parameters the dug is being used to modify need to be determined to evaluate whether or not this response in achieved
Anticipate adverse effects
Have ability to produce side or adverse effects. They are usually known. Baseline measurements can help identify if effect has occurred
Identify high risk patient
Individual characteristics may put patient at higher risk of having side/adverse effects. Characteristic predisposed to an effect depends on drug
Determine self care capacity
Patient must be willing and able to self administer the med as prescribed. If unable make arrangements
Objective
Obtaining vitals
Subjective
How patient feels
Info from family or friends
Drug interaction
Interaction b/w drug & substance that effects the performance of the drug
Increase action of drug
Drug less effective
Produce a new response
Drug-drug
Altered/modified action or effect of drug bc of interaction w mult. Drugs
Maybe intended OR unintended
Direct chem or physical interaction, combined toxicity, pharmacokinetics interaction, pharmacodynamics interaction
Pharmacokinetic interactions
A = 2 drugs at the same time, rate of absorption of drugs can change. - drug can block, decrease or increase absorption by in or de gastric emptying time, changing gastric pH, forming drug complexes
D = altered by competition for protein building or alteration of extra cellular pH
M = occur w induction, inhibition of hepatic microsomal systems. Can in metab of other by stimulating liver enzymes = produce a cascade effect in drug function
E = filtered through glomeruli and excreted in urine. Some drugs are excreted in bile, passes in intestines. Can in or de Neal excretion and have effect on excretion of others
De cardinal output > de blood to kidneys > de blood flow > de glomerular filtration rate > de drug excretion
Pharmacodynamics interactions = additive effect (summation)
2 drugs = sum of effect of drugs taken separately. Due to the drugs acting on the body in the same way
Synergistic effect
2 drugs together > than separate effects
Antagonistic effect
2 drugs < than separate effect, 1 drug decreases or blocks effect of other drug
Drug to food
When a food or beverage in or de absorption
In absorption: heightened peak effect & potential toxicity - grapefruit juice, inhibit metab, in blood levels
De absorption: de drug absorption, delays onset of effects but doesn’t alter peak effects. Reducing absorption de in intensity of peak effect. Therapeutic effectiveness of drug diminishes. Interaction be ca+ containing foods and tetracycline antibiotics
Drug supplement
Vitamins, minerals, amino-acids, herbs/botanicals may lead to toxicity or reduction in response
Drug-lab
Interference w enzymes, altering chem rxns, cross reaction with antibodies
Lab results may be misinterpreted or invalidated and unnecessary repeat or additional tests and missed or erroneous diagnoses
Allergic rxn
Immune response, releasing histamines
Can by mild (rash) or severe (anaphylaxis)
Idiosyncratic rxn
Time related and occur w consistent exposure over time
Teratogens - birth defects
Carcinogenic - cancer
Paradoxical rxn
Body responds in opposite manner than what’s expected
Minimizing adverse effects
Producing safe drugs Limit # of drugs taken Pro/cons of prescribing Know ADRs Educate patients on signs of ADRs
Med guides
Educational tool to de risk and potential harm from certain meds. Has description of drug, adherence to therapy and side effects
Boxed warnings
Black box, when drug can cause serious or life threatening ADRs. Potential benefits of drug. Strongest safety warning
Risk eval and mitigation strategy (REMS)
Minimizing harm associated w certain meds. Involves patients, prescribers and pharmacists
Reporting ADRs
50% of all drugs have serious ADRs that aren’t revealed during phase 2&3 trials. Important to check post evals
New symptoms = check post evals
New unknown symptoms = medwatch
Documentation of ADRs
Use of EHR prevent ADRs. Easy to create, update, maintain active med lists. Alerted when new med is prescribed
Human errors
Performance deficits Knowledge deficits Improper prep or admin Computer error Stocking error Transcription error Stress Fatigue/lack of sleep Dosage miscalc
Communication errors
Poor handwriting 15.8%
Poor comm on home meds leads to wrong prescriptions
Name confusion
Meds w look/sound alike names
Packaging, formulations, delivery
Formulations = tabs/caps that look similar but have different drug/strengths; inappropriately packaged; malfunctioning delivery device
Labeling and reference materials
Meds labeled on dispensed products; inaccurate, misleading and outdated info
Med reconsiliation
Process that new meds are compared to meds already being taken. Avoid errors, duplication, omission, dosage, interactions, transition in care
Just culture
Don’t blame and tries to come up with a better way to avoid that error
