PHARMACOKINETICS

the study of the time course of drug absorption,

distribution, metabolism, and excretion.
Clinical pharmacokinetics is the application of
pharmacokinetic principles to the safe and
effective therapeutic management of drugs in an
individual patient.

The Four Cornerstones

of Pharmacokinetics:
1. Absorption
2. Distribution
3. Metabolism
4. Excretion

Physiological Factors Affecting Oral Drug

Absorption. Gastrointestinal Motility.
Decreased stomach emptying slows drug
absorption can be decreased by food, disease,
drugs (opioids) Gastrointestinal Blood Flow
Removes drug from site of absorption
(conc. gradient) Limiting factor for highly
absorbed drugs (e.g. ethanol)Surface area Approximately
250m 2 (adult male); 1000x > stomach Most drug
absorption occurs in small intestine (esp. duodenum)
Metabolism and Efflux Many drugs are metabolized in
the intestinal wall Many drugs are effluxes from
enterocytes to gut lumen by transport proteins Changes
in pH of Gastrointestinal Tract Affects polarity of drug
Can be altered by food, disease, other drugs (e.g.
antacids).

Bioavailability refers to the rate and extent

of absorption of a drug from dosage form.
It is a measure of the fraction (F) of
administered dose of a drug that reaches
the systemic circulation in the unchanged form.
Major Factors Affecting Drug Bioavailability
• First-Pass Metabolism (liver and intestine)
• Efflux from enterocytes (active drug transporters)
• Physiochemical properties of drug that affect
absorption (polarity, size, etc)
• Nature of drug formulation (binders, solubilizers,
etc) IV administration circumvents these factors.
Distribution Process by which a drug reversibly
leaves the site of administration and distributed
throughout the tissues of the body. A prerequisite for
most drugs to reach target organs in therapeutic
concentrations Drugs, once again, must overcome
physiological barriers, simple capillary endothelial
barrier, simple cell membrane barrier, Blood-brain
barrier, Blood-placental barrier, CSF barrier, Blood-testis
barrier.
10 RIGHTS OF DRUG ADMINISTRATION
Nurses are primarily involved in the
administration of medication across various
settings. Nurses are also involved in both
dispensing and preparation of medication.
Research on medical administration errors
(MAEs) shows an error rate of 60%, 34
mainly in the form of wrong time, wrong rate,
or wrong dose. There are many ways to prevent
medication errors and one way of which is
understanding the 10 “rights” of drug
administration.
1. Right patient
 Check the name on the prescription and
wristband.
 Ideally, use 2 or more identifiers and ask the
patient to identify themselves
2. Right medication
 Check the name of the medication, brand names
should be avoided.
 Check the expiry date.
 Check the prescription.
 Make sure medications, especially antibiotics,
are reviewed regularly.
3. Right dose
 Check the prescription
 Confirm appropriateness of the dose using the
BNF or local guidelines.
 If necessary, calculate the dose and have another
nurse calculate the dose as well
4. Right route
 Again, check the order and appropriateness of
the route prescribed.
 Confirm that the patient can take or receive the
medication by the ordered route.
5. Right time
 Check the frequency of the prescribed
medication.
 Double-check that you are giving the prescribed
at the correct time.
 Confirm when the last dose was given.
6. Right patient education
 Check if the patient understands what the
medication is for.
 Make them aware they should contact a
healthcare professional if they experience side-
effects or reactions.
7. Right documentation
  Ensure you have signed for the medication
AFTER it has been administered.
 Ensure the medication is prescribed correctly
with a start and end date if appropriate.
8. Right to refuse
 Ensure you have the patient consent to
administer medications.
 Be aware that patients do have a right to refuse
medication if they have the capacity to do so.
9. Right assessment
 Check your patient actually needs the
medication.
 Check for contraindications.
 Baseline observations if required.
10. Right evaluation
 Ensure the medication is working the way it
should.
 Ensure medications are reviewed regularly.
 Ongoing observations if required.