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PHARMACOLOGY (ANTONIO B. CRUEL, RMT, RN, MSPH) PHARMACODYNAMICS: what drugs do to the body Drug Effects: 1. DESIRED =therapeutic effect 2.SIDE = unintended/predictable 3. ADVERSE = harmful/severe 4. TOXIC= pathologic/> 1st drug 5. IDIOSYNCRATIC=unpredictable 6. CUMULATIVE=> response RT repeated dose,<metab,<excretion

• ALLERGIC= drug: Ag • ANAPHYLAXIS= > allergic rxn: bronchial vc, LE causing airway obstruction • TOLERANCE= <effect RT rpt dose; reqr > • TACHYPHYLAXIS= rapid devt of tolerance to drug • DEPENDENCE=driving needs: drug use • *HABITUATION: PSYCH • *PHYSICAL: ADDICTION • ABUSE= inappropriate drug intake (un/prohibited)

• DRUG INTERACTION=mod of drug effect: ANTAGONISM= opposing 1 + (-1)=0 SUMMATION= combined(=) 1 + 1= 2 SYNERGISM= combined(>) 1 + 1= 3 POTENTIATION= 1 drug enhanced by etc. 1 drug alone (0) 1 + 1= 1x,2x,3x effect

PHARMACOKINETICS= body does to drugs 2. ABSORPTION =site of admin to bloodstream >in: IV, >absorbing surface, liquid/lipid soluble form, good blood flow <in: PO (RT food, >GI motility, acid pH 2. DISTRIBUTION =from site of absorption to action >in: >BF, >PPB (drugs inactive if bound in albumin for transport), >volume of distribution (edema), > membrane perm. <in: <albuminemia(<PPB=>free drug), dehydr

• METABOLISM • =chemical events (in/activates drug) • *Biotransformation=using enz, drugs are made more H20-soluble (excreted in liver) • *1st-pass effect= oral meds are metab in liver via portal circ before distributed • >in: Drug-drug interaction (>Cytochrome P450) • <in: infants, elderly, disease (liver, malnut)

• ELIMINATION/EXCRETION • =excreted via kidnys, intestines, bile duct, lungs, sweat, mammary glands • =affected by DD interaction, organ elim, blood% levels, renal status. • Renal excretion= filtration+secretion=reab • <renal fxn=<excretion=>toxicity • Excretes only H20-sol,unbound metabolite • Modified by acid/alkalinizing urine • (carbonic anhydrase inh alkalizes urine > UA excretion)

• DRUG ADMINISTRATION • Principles: • 1. 7 Rights: DR. CAT

• 2. Verify all new or questionable orders with physician or nurse. • 3. Use meds in clearly labeled containers, check it 3X (pharmacy/cabinet, before, after prep) • 4. Check expiry date, changes:clarity,odor • 5. Aseptic tx:wash hand,caps upside down • 6. Meds id with correct client • 7. Check for allergies: ANST • 8. Inform client: meds, tx, purpose

• 9. Stay with clients until meds taken • 10. Report to Dr: client vomits • 11. Record admin of drug asap: chart any omission, initial, give rationale • 12. For meds errors: report asap • 13. For safety, give only meds YOU prep.

• COMMON DOSAGE FORMS: • CAPLET= solid for oral use, shaped like a capsule and coated for ease of swallowing • CAPSULE=solid, meds in powder, liq, oil encased by gelatin shell • ELIXIR=clear fluid c water/ROH;PO; usually c sweetener • ENTERIC TAB= tablet coated with materials that dissolves in intestine • EXTRACT= concentrated form made by removing active portion of meds from its other components

• GLYCERITE= soln of meds combined c glycerine(50%) for external use. • INTRAOCULAR DISK= small, flexible oval if moistened by ocular fluid, releases meds up to 1 week. • LINIMENT=prep c ROH, oil, soapy emolient applied to skin • LOTION= MEDS IN LIQUID SUSPENSION APPLIED EXT TO PROTECT SKIN • OINTMENT= semisolid, externally applied prep, c 1 or more meds

• PILL= solid form,1 or > meds, shaped into globules, ovoids, oblong • SOLUTION= liquid, used PO, IV, externally, instilled c body • SUPPOSITORY= pellet-shaped solid c gellatin for insertion into body cavity • SUSPENSION= fine frugparticles dispersed in liq medium w/c settles on standing, shake • SYRUP=meds dissolved in concentrated sugar solution

• TABLET= powder pressed into disk or cylinders, contains binders (adhesive), disintegrators (for tab dissolution), lubricants, fillers (for convenient tab size) • TINCTURE= ROH or H20 meds soln. • TRANSDERMAL PATCH= meds in semipermeable membrane disk or patch absorbed thru skin • TROCHE/ LOZENGE= flat & round form, dissolves in mouth to release meds, contains mucilage, sugar and flavoring

• • • • •

ROUTES OF ADMINISTRATION VIA MOUTH 1.ORAL =take c 50-100 ml of cold fluid unless CI CI: GI dysfxn (vomiting), unconscious or unable to swallow, NPO per/post-op • DisAdv: GI irritation, inactivation by gastric acid, unpleasant taste/odor, teeth discoloration. • Remember: Sit client upright to enhance swallowing

• When preparing solid meds: • Only scored tablets may be broken • Crush tab only when appropriate (children,elderly,dysphagia) • For enteric-coated tabs:don’t crush, give c antacid,milk • When preparing liquid meds: • Shake suspensions and pour away from label to prevent dirtying it

• Read amount at meniscus and at eye level • Wipe lip and neck of bottle before re-capping • Evaluate client’s response to meds after 30 min. If client vomits after taking meds, inform physician. Do not give again. • 2. SUBLINGUAL • Place meds under tongue until it dissolves. Do not swallow or take with fluid. (gastric acid deactivate meds) • Fast absorption thru blood vessels under the tongue

• BUCCAL • Place meds against mucous membranes of the cheek. • Also not swallow or taken with fluid

• TOPICAL MEDICATIONS (SKIN, NOSE, EYE, EAR, VAGINA, RECTUM) • 1. VIA SKIN • Use gloves, gauze or sterile applicator • Cleanse skin with soap & warm water to remove encrustation that blocks contact & absorption of new meds. • Remember: • Lotion & creams: applied gently, not rubbed • Liniment: rubbed into skin gently but firmly

• Powder: dusted lightly to cover affected area thinly • Transderm patches: remove backing and place patch in area with little hair, use gloves to avoid drug absorption • NTG patch: take BP before & after application • 2. VIA NOSE • Have client blow nose, lie supine and breathe thru mouth • Position head as follows for 5 min to ensure absorption

• Posterior pharynx: head tilted backward • Ethmoid & sphenoid sinus: head hyperextended, tilted over HOB (Parkinson’s position) • Frontal & Maxillary sinus: Hyperextended & side wards (Proetz) • Place dropper 1 cm above nares & squeeze quickly, not to touch nose with applicator • Client may wipe but not blow nose

• Meds may produce unpleasant taste or coughing • CI: to decongestants (most common nasal meds): HPN, heart disease • 3. VIA EYE • Gently clean eyelid of crusts or discharge using gauze in saline. Wipe from inner-outer canthus. • For Eyedrops: Client looks up, use thumb/forefinger to pull down cheekbone & pull up lid exposing lower conjunctiva. • Drop prescribed meds & ask client to blink/close eys

• For Eye Ointment • Squeeze thin stream along inner edge of lower conjunctiva from inner to outer canthus. Don’t touch eye with container, twist tube to break stream. • Client closes eyes, then lightly rub lid in circular motion. • 4. VIA EAR • With client side-lying, straighten ear canal by pulling ear • Assess for eardrum perforation or DC. • Warm meds in hands (avoids vertigo). Hold dropper 1 cm above ear & instill meds, Maintain for 2-3 min.

• For irrigation: place towel under client’s head. Irrigate with 50 ml of fluid. • 5. VIA VAGINA • Privacy, void 1st • Position: dorsal recumbent, over bedpan if for irrigation • Use gloves, then retract labia with nondominant hand • For suppositories: With dominant hand, apply water-based lubricant on rounded end of suppository and insert 3-4 inches down.

• Store suppositories in ref to avoid melting • For creams, jelly, irrigating solutions (douche) • Insert applicator 2-3 inches down & deposit meds. • Client remains in position for 15-20 min. • 6. VIA RECTUM • Sim’s, breathe slowly thru mouth • Apply lubricant, insert tapered end past internal anal sphincter (kids: 2”) & hold buttocks togeter as client may expel suppository.

• INHALANT MEDS: METERED DOSE INHALERS • These clients depend on meds for adequate control of airway obstruction & must learn self-admin. • Position:upright (sitting or standing) • Shake inhaler then have client inhale & exhale deeply • 3-point/lateral hand position: client holds inhaler, thumb at bottom of mouthpiece & index & middle finger at the top.

• Place inhaler in mouth or 1-2 “ away if c spacer • Client inhales deeply, presses canister • Hold breath for 10 sec then exhale thru pursed lips. • PARENTERAL MEDS (NEEDLE/INJXN) • AMPULE PREP: • Tap neck to move fluid down ampule then snap off neck towards self. Hold ampule upside down, quickly draw meds s needle touching rim

• Keep tip of needle under fluid to avoid aspirating bubbles. If aspirated do not expel air in ampule • To expel bubbles, tap syringe to move bubbles up & draw back plunger slightly then push to expel air. • VIAL PREP (SOLUTION) • Multi-dose vials: Wipe off rubber stopper with ROH pledget • S contaminating plunger, draw up air in equal to amt of meds needed & inject air into vial. This prevents (-) pressure buildup

• Insert needle thru center of rubber seal. Keep tip below fluid level & allow pressure in vial to fill syringe • Before injecting, change dulled needle • VIAL PREP (POWDER FOR RECON) • Prepare diluent & inject into vial. Remove needle & roll vial in palms. Don’t shake • Use filter needle when drawing up recon meds.

• Mixing Meds • 2 vials=Inject air into vial A & withdraw needle (tip must not touch soln) • Inject air into vial B & withdraw meds. Change needle. • Inject new needle into vial A and withdraw meds. • VIAL TO AMPULE: Draw meds from vialampule

• ADMINISTERING INJECTIONS • Select appropriate site avoiding bruised / tender areas & rotating sites AMAP. • Clean site with ROH swab. Use gloves to prevent contact with client blood. • Insert needle quickly, bevel up, then release hold to < pain. • Aspirate for blood. Re-insert if with blood unless it IV • Inject slowly. Press swab over site before removing needle. • Massage area except Z track or heparin injxn

• Airlock IM Tx: for interferon, DPT vaccine • Most common site of heparin injxn: abdomen







Ventral upper arm, scapula, chest

0.1-1 ml

G: 26 L:3/8 5/8
G:25-27 L:3/8 5/8 1/2
G:21-23 L:1” (K) 1 1/2 “ (A)

Stretch skin, insert needle 10-15 23mm deep
Pinch skin to form fold, dart palm down. 45/90 Hold like dart. Insert. Inject 10-20 sec

Don’t massa ge


LUA, anterior thigh, abdomen
Gluteus, A&M thigh, deltoid

K: 0.5-1ml A: 1-3ml

Don’t aspirate or massage for heparin or insulin injxn


K:.5-1ml A:2-3 ml

Z track IM: < irritation

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INTRAVENOUS ADMINISTRATION Microtubing: 60 gtts/ml, rates >12 h Macrotubing: all other rates VENIPUNCTURE 1. Prepare infusion set. Place roller clamp 1-2 inches below drip chamber & move to off position. Insert spike into fluid bag. • 2. Prime fill drip chamber & tubing (up to adapter) c solution. • 3. Remove any air bubbles by tapping tubings • 4. Apply tourniquet & select a vein

• 5. Use the most distal site in non-dominant arm • 6. Dilate vein:close-open fist • 7. Cleanse site then anchor vein using thumb & stretch skin opposite the direction of insertion

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Types IV Admin: 1. IV push via hep lock a. 2 ml saline: flush b. admin meds c. 2 ml saline: flush d. 10-100 U heparin: flush

• 2. IV push via existing line • Occlude primary IV line by pinching tubing just above injxn port closest to pt, give meds & release tubing

• 3.IV infusion • Inject meds thru port thru port in IV bag with rubber stopper not thru air vent or port for IV tubing. • 4. Piggyback/Add med solution bag to an existing line • *connect IV tubing to meds bag. Hang med bag higher than primary bag if piggyback

eg: erythromycin 250 mg PO, stock: 125mg/5ml 250mg/125 mg X 5 ml= 10 ml For drugs that need dilution: IM=2 cc IV < 500= 5 cc IV >500= 10 cc Eg 5 FU 259 mg IV; stock: 500 mg vial 250 mg/500 mg X 5 cc dil=2.5 cc

• PEDIA DRUG DOSAGE • 1. BSA (M2)=sq rt WEIGHT (kg) x HT (cm) • 3600 • Child’s dose = child’s BSA X AD • Adult’s BSA (1.73 m2) • 3 yo weighs 15 kg, ht of 92 cm is to be given Demerol; AD for Demerol is 100 mg/dose •

• Based on body weight • = mg/kg/dose X wt (kg) X Q • S • eg: Paracetamol 15 mkd for child weighing 20 kg. Stock: 250 mg/5 ml Based on Age Fried’s: birth-12 months Infant’s dose= age in months X AD 150

• Young’s= (1-12 years) • Child’s Dose= age in years X AD • age in yrs + 12 • Clark’s Rule= • Child’s Dose= wt of child in lbs X AD • 150 lb

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