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NRS110Lectures4 6NursingPharmacology
NRS110Lectures4 6NursingPharmacology
Pharmacology in
Nursing
Pharmacologic
Principles
Drug Names
Chemical name
Describes the drugs
chemical composition and
molecular structure
Generic name
(nonproprietary name)
Name given by the United
States Adopted
Name Council
Trade name (proprietary
name)
The drug has a registered
trademark; use of the name
restricted by the drugs
patent owner
(usually the manufacturer)
Drug Names
(cont'd)
Chemical name
(+/-)-2-(p-isobutylphenyl)
propionic acid
Generic name
ibuprofen
Trade name
Motrin, Advil
Figure2-1 The
chemical, generic, and
trade names for the
common analgesic
ibuprofen are listed
next to the chemical
structure of the drug.
Pharmacological
Concepts:
Classification
Classification- Nurses
learn to categorize
meds with similar
characteristics by their
class
Medication
classification indicates
the effect of the med on
the body system, the
symptom the med
relieves, or the meds
desired effect (e.g. oral
hypoglycemics)
Pharmacological
Concepts:
Classification
A medication may
also be part of more
than one class
Aspirin is an
analgesic,
antipyretic, antiinflammatory, and
anti-platelet
Medications are
Pharmacological available in a variety of
Concepts:
forms and preparations
Medication
The form of the med will
Forms
determine its route of
administration
Composition of med is
designed to enhance its
absorption &
metabolism
Many meds are
available in several
forms
Medication
Forms
Tablet
Capsule
Elixir
Enteric-coated
Suppository
Suspension
Transdermal patch
Pharmacologic
Principles
Pharmaceutics
Pharmacokinetics
Pharmacodynamics
Pharmacotherapeuti
cs
Pharmacognosy
Pharmaceutics
Pharmacokineti
cs
Pharmacodynami
cs
Pharmacotherapeuti
cs
Pharmacognosy
Pharmacokinetics:
Absorption
Factors That
Affect
Absorption
Administration route of
the drug
Ability of Med to Dissolve
Food or fluids
administered with the
drug
Body Surface Area
Status of the absorptive
surface
Rate of blood flow to the
small intestine
Lipid Solubility of Med
Status of GI motility
Routes of
Administration
A drugs route of
administration
affects the rate and
extent of absorption
of that drug
Enteral (GI tract)
Parenteral
Topical
Enteral Route
Drug is absorbed
into the systemic
circulation through
the oral or gastric
mucosa, the small
intestine, or rectum
Oral
Sublingual
Buccal
Rectal
First-Pass Effect
The metabolism of a drug
and its passage from the
liver into the circulation
A drug given via the oral
route may be extensively
metabolized by the liver
before reaching the systemic
circulation (high first-pass
effect)
The same druggiven IV
bypasses the liver,
preventing the first-pass
effect from taking place, and
more drug reaches the
circulation
Parenteral
Route
Intravenous (fastest
delivery into the
blood circulation)
Intramuscular
Subcutaneous
Intradermal
Intrathecal
Intraarticular
Topical Route
Skin (including
transdermal
patches)
Eyes
Ears
Nose
Lungs (inhalation)
Vagina
Distribution
The transport of a drug in
the body 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
Metabolism
(Also Known As
Biotransformation)
The biologic
transformation of a drug
into
an inactive metabolite, a
more soluble compound,
or a more potent
metabolite
Metabolism/Biotransformati
on (cont'd)
Delayed drug
metabolism results
in:
Accumulation of drugs
Prolonged action of the
drugs
Stimulating drug
metabolism causes:
Diminished
pharmacologic effects
Excretion
The elimination of
drugs from the body
35 - 34
Study of the
Pharmacodynami
mechanism of drug
cs
actions in living
tissue
Drug-induced
alterations to normal
physiologic function
Positive changeTherapeutic effectGoal of therapy
Mechanism of
Action
Mechanism of
Action
Receptor Interaction
Enzyme Interaction
Non-Specific
Interaction
Receptor
Interaction
Receptor
Interaction
Affinity- degree to
which a drug binds with
a receptor
The drug with the best
fit or affinity will elicit
the best response
Drug can mimic bodys
endogenous substances
that normally bind to
receptor site
Drugs that bind to
receptors interact with
receptors in different
ways to either block or
elicit a response
Receptor
Interaction
Agonist-Drug binds
to receptor-there is a
response (Adrenergic
Agents)
Antagonist-drug
binds to receptor-no
response-prevents
binding of agonists
(Alpha & Beta
Blockers)
Enzyme
Interaction
Non-Specific
Interaction
1. IV
2. IM
3. SC
4. PO
Type of
Medication
Action
Therapeutic Effect
Side Effects
Adverse Effects
Toxic Effect
Idiosyncratic Reactions
Allergic Reaction
Medication Interactions
Iatrogenic Response
Therapeutic
Effect
The expected or
predictable
physiological
response a
medication causes
A single med can
have several
therapeutic effects
(Aspirin)
It is important for the
nurse to know why
med is being
prescribed
Side Effects
Unintended secondary
effects a medication
predictably will cause
May be harmless or
serious
If side effects are serious
enough to negate the
beneficial effect of meds
therapeutic action, it
may be D/Cd
People may stop taking
medications because of
the side effects
Adverse Effects
Undesirable response of
a medication
Unexpected effects of
drug not related to
therapeutic effect
Must be reported to FDA
Can be a side effect or
a harmful effect
Can be categorized as
pharmacologic,
idiosyncratic,
hypersensitivity, or
drug interaction
Adverse Effects
Adverse Drug
Reactions (ADR)
Toxic Effect
Idiosyncratic
Reactions
Allergic
Reaction
Unpredictable response
to a medication
Makes up greater than
10% of all medication
reactions
Client may become
sensitized
immunologically to the
initial dose, repeated
administration causes
an allergic response to
the med, chemical
preservative or a
metabolite
35 - 59
Other Drug
Reactions
TeratogenicStructural effect in
unborn fetus
(thalidomide)
Carcinogenic-Causes
cancer
Mutagenic- Changes
genetic composition
(radiation,
chemicals)
Drug
Interactions
Iatrogenic
Responses
Unintentional adverse
effects that occur during
therapy
Treatment-Induced
Dermatologic-rash,
hives, acne
Renal DamageAminoglycoside
antibiotics, NSAIDS,
contrast medium
Blood DyscrasiasDestruction of blood
cells (Chemotherapy)
Hepatic Toxicity-Elevated
liver enzymes (hepatitislike symptoms)
Synergistic
Effect
Effect of 2 meds
combined is greater than
the meds given
separately
Alcohol &
Antihistamines,
antidepressants,
barbiturates, narcotics
Not always undesirable,
physician may combine
meds to create an
interaction that will have
beneficial effects
(Vasodilators & diuretics
to control high BP)
Medication
Dose Responses
Medication
Dose Responses
Serum Half-Life:Time it
takes for excretion
processes to lower the
serum medication
concentration by
Regular fixed doses must
be given to maintain
therapeutic concentration
Dosage schedules set by
institutions (TID, q8h, HS,
AC, STAT, PRN)
Peak & Trough levels
Therapeutic drug
monitoring
Half-life
Onset, Peak,
and Duration
Onset
Peak
Duration
Pharmacotherapeutics: Types
of Therapies
Acute therapy
Maintenance therapy
Supplemental
therapy
Palliative therapy
Supportive therapy
Prophylactic therapy
Empiric therapy
Monitoring
The effectiveness of
the drug therapy
must be evaluated
One must be familiar
with the drugs:
Intended therapeutic
action (beneficial)
Unintended but
potential side effects
(predictable, adverse
reactions)
Monitoring
(cont'd)
Therapeutic index
The ratio between a
drugs therapeutic
benefits and its toxic
effects
Monitoring
(cont'd)
Tolerance
A decreasing
response to repetitive
drug doses
Monitoring
(cont'd)
Dependence
A physiologic or
psychological need
for a
drug
Monitoring
(cont'd)
Monitoring
(cont'd)
Drug interactions
Additive effect
Synergistic effect
Antagonistic effect
Incompatibility
Monitoring
(cont'd)
Medication
misadventures
Adverse drug events
Adverse drug
reactions
Medication errors
Monitoring
(cont'd)
Adverse Drug
Reaction
An adverse outcome
of drug therapy in
which a patient is
harmed in some way
Pharmacologic
reactions
Idiosyncratic reactions
Hypersensitivity
reactions
Drug interactions
Teratogenic
Mutagenic
Carcinogenic
Toxicology
Table2-9 Common
Poisons and
Antidotes
The Nursing
Process (cont'd)
Assessment
Nursing diagnosis
Planning (with
outcome criteria)
Implementation
Evaluation
The Nursing
Process
An organizational
framework for the
practice of nursing
Orderly, systematic
Central to all nursing
care
Encompasses all
steps taken by the
nurse in caring for a
patient
Flexibility is important
The Nursing
Process (cont'd)
Assessment
Data collection
Subjective, objective
Data collected on the
patient, drug,
environment
Medication history
Nursing assessment
Physical assessment
Data analysis
The Nursing
Process (cont'd)
Nursing diagnosis
Judgment or
conclusion about the
need/problem
(actual or at risk for)
of the patient
Based upon an
accurate assessment
NANDA format
The Nursing
Process (cont'd)
Planning
Identification of
goals and outcome
criteria
Prioritization
Time frame
The Nursing
Process (cont'd)
Goals
Objective,
measurable, realistic
Time frame
specified
Outcome criteria
Specific standard(s)
of measure
Patient oriented
The Nursing
Process (cont'd)
Implementation
Initiation and
completion of the
nursing care plan
as defined by the
nursing diagnoses and
outcome criteria
Follow the five rights
of medication
administration
The Five
Rights
Right drug
Right dose
Right time
Right route
Right patient
Another RightConstant
System Analysis
A double-check
The entire system of
medication
administration
Ordering, dispensing,
preparing,
administering,
documenting
Involves the physician,
nurse, nursing unit,
pharmacy department,
and patient education
Other
Rights
Other
Rights
(cont'd)
Close consideration
of special situations
Prevention and
reporting of
medication errors
Patient teaching
Monitoring for
therapeutic effects,
side effects, toxic
effects
Refusal of medication
Evaluation
nursing process
Determining the
status of the goals
and
outcomes of care
Monitoring the
patients response to
drug therapy
Expected and
unexpected responses
Life Span
Considerations
Life Span
Considerations
Pregnancy
Breast-feeding
Neonatal
Pediatric
Geriatric
Pregnancy
Table 3-1
Pregnancy safety
categories
Breast-feeding
Breast-fed infants
are at risk for
exposure to drugs
consumed by the
mother
Consider risk-tobenefit ratio
Pediatric Considerations:
Pharmacokinetics
Absorption
Pediatric Considerations:
Pharmacokinetics (cont'd)
Distribution
TBW 70% to 80% in
full-term infants, 85%
in premature newborns,
64% in children 1 to
12 years of age
Greater TBW means fat
content is lower
Decreased level of
protein binding
Immature blood-brain
barrier
Pediatric Considerations:
Pharmacokinetics (cont'd)
Metabolism
Liver immature, does
not produce enough
microsomal enzymes
Older children may
have increased
metabolism, requiring
higher doses
Other factors
Pediatric
Considerations:
Pharmacokinetics
(cont'd)
Excretion
Kidney immaturity
affects glomerular
filtration rate and
tubular secretion
Decreased perfusion
rate of the kidneys
Summary of
Pediatric
Considerations
Methods of Dosage
Calculation for Pediatric
Patients
Body weight dosage
calculations
Body surface area
method
Geriatric
Considerations
Use of OTC
medications
Polypharmacy
Geriatric Considerations:
Pharmacokinetics
Absorption
Gastric pH less acidic
Slowed gastric emptying
Movement through GI
tract slower
Reduced blood flow to
the GI tract
Reduced absorptive
surface area due to
flattened intestinal villi
Geriatric Considerations:
Pharmacokinetics (cont'd)
Distribution
TBW percentages
lower
Fat content increased
Decreased production
of proteins by the
liver, resulting in
decreased protein
binding of drugs
Geriatric Considerations:
Pharmacokinetics (cont'd)
Metabolism
Aging liver produces
less microsomal
enzymes, affecting
drug metabolism
Reduced blood flow
to the liver
Geriatric Considerations:
Pharmacokinetics (cont'd)
Excretion
Decreased glomerular
filtration rate
Decreased number of
intact nephrons
Geriatric Considerations:
Problematic Medications
Analgesics
Anticoagulants
Anticholinergics
Antihypertensives
Digoxin
Sedatives and
hypnotics
Thiazide diuretics
Legal, Ethical,
and Cultural
Consideration
s
U.S. Drug
Legislation
U.S. Drug
Legislation
(cont'd)
1951: DurhamHumphrey
Amendment (to the
1938 act)
1962: KefauverHarris Amendment
(to the 1938 act)
1970: Controlled
Substance Act
U.S. Drug
Legislation
(cont'd)
New Drug
Development
Investigational new
drug (IND)
application
Informed consent
Investigational drug
studies
Expedited drug
approval
investigational drug
studies
Clinical phases of
investigational drug
studies
Phase I
Phase II
Phase III
Phase IV
Ethical Nursing
Practice
American Nurses
Association (ANA)
Code of Ethics for
Nurses
Cultural
Considerations
Cultural
Assessment
Cultural
Assessment
(cont'd)
Usual response to
treatment
Responsiveness to
medical treatment
Religious practices
and beliefs
Dietary habits
Medication
Errors:
Preventing
and
Responding
Medication
Misadventures
Medication errors
(MEs)
Adverse drug events
(ADEs)
Adverse drug
reactions (ADRs)
Medication
Misadventures
(cont'd)
By definition, all
ADRs are also ADEs
But all ADEs are not
ADRs
Two types of ADRs
Allergic reactions
Idiosyncratic
reactions
Medication
Errors
Preventable
Common cause of
adverse health care
outcomes
Effects can range from
no significant effect to
directly causing
disability or death
Preventing
Medication Errors
Minimize verbal or
telephone orders
Repeat order to prescriber
Spell drug name aloud
Speak slowly and clearly
Preventing
Medication Errors
(cont'd)
Preventing
Medication Errors
(cont'd)
Preventing
Medication
Errors (cont'd)
ALWAYS use a
leading zero for
decimal dosages
Do not use .25 mg;
use 0.25 mg
.25 mg may be
misread as 25 mg
.25 is sometimes
called a naked
decimal
Preventing
Medication Errors
(cont'd)
Check medication
order and what is
available while using
the 5 rights
Take time to learn
special administration
techniques of certain
dosage forms
Preventing
Medication Errors
(cont'd)
Medication
Errors
Possible consequences to
nurses
Reporting and responding
to MEs
ADE monitoring programs
USPMERP (United States
Pharmacopeia Medication
Errors Reporting Program)
MedWatch, sponsored by
the FDA
Institute for Safe
Medication Practices (ISMP)
Notification of patient
regarding MEs
35 - 138
35 - 139
Medication
Administration
Preparing for
Drug
Administration
Oral Route
Easiest, most
commonly used
Slower onset of
action
More prolonged
effect
Preferred by clients
Sublingual
Administration
Buccal
Administration
Enteral
Drugs
Parenteral Route
Injecting a
medication into body
tissues
Subcutaneous (SQ)
Intramuscular (IM)
Intravenous (IV)
Intradermal (ID)
Advanced
techniques
Parenteral
Drugs
Parenteral
Drugs
(cont'd)
Removing
medications from
ampules
Removing
medications from
vials
Disposal of used
needles and syringes
Injections
Injection
Techniques
Intradermal
injections
Subcutaneous
injections
Insulin administration
Heparin
administration
Injection
Techniques
(cont'd)
Intramuscular
injections
Ventrogluteal site
(preferred)
Vastus lateralis site
Dorsogluteal site
Deltoid site
Preparing
Intravenous
Medications
Needleless systems
Compatibility issues
Expiration dates
Mixing intravenous
piggyback (IVPB)
medications
Labeling intravenous
(IV) infusion bags when
adding medications
Intravenou
s
Medication
s
Adding medications to
a primary infusion bag
IVPB medications
(secondary line)
IV push medications
(bolus)
Through an IV lock
Through an existing IV
infusion
Intravenous
Medications
(cont'd)
Volume-controlled
administration set
Using electronic
infusion pumps
Patient-controlled
analgesia (PCA)
pumps
Topical
Drugs
Eye medications
Drops
Ointments
Ear drops
Adults
Infant or child younger
than 3 years of age
Topical
Drugs
(cont'd)
Nasal drugs
Drops
Spray
Inhaled drugs
Metered-dose
inhalers
Small-volume
nebulizers
Topical
Drugs
(cont'd)
Administering
medications to the
skin
Lotions, creams,
ointments, powders
Transdermal patches
Vaginal medications
Creams, foams, gels
Suppositories