AMA 109 PharmacologyAMA 109 Pharmacology

Drug NamesDrug Names

Chemical Name:Chemical Name: describes the drug’s describes the drug’s molecular structure – i.e. molecular structure – i.e.

2-(N,N-dimethylcarbamimidoyl)guanidine 2-(N,N-dimethylcarbamimidoyl)guanidine

Generic Name:Generic Name: is the drug’s official name is the drug’s official name (lower case, can be made by more than one (lower case, can be made by more than one pharmaceutical company) i.e. metforminpharmaceutical company) i.e. metformin

Trade or Brand Name:Trade or Brand Name: registered by patent registered by patent and protected for 17 years – i.e. Glucophageand protected for 17 years – i.e. Glucophage

Legal RegulationsLegal Regulations Food and Drug Administration (FDA)Food and Drug Administration (FDA)

- regulates manufacture and distribution of drugs and food - regulates manufacture and distribution of drugs and food productsproducts

Drug Enforcement Agency (DEA)Drug Enforcement Agency (DEA)- strong regulatory control over all controlled substances- strong regulatory control over all controlled substances

Controlled Substances ActControlled Substances ActSchedule I – highest potential for abuse - OpiumSchedule I – highest potential for abuse - OpiumSchedule II – high potential for abuse - MorphineSchedule II – high potential for abuse - MorphineSchedule III – limited potential for dependence - Schedule III – limited potential for dependence - FiorinalFiorinalSchedule IV – lower potential for abuse - ValiumSchedule IV – lower potential for abuse - ValiumSchedule V – lowest potential for abuse - LomotilSchedule V – lowest potential for abuse - Lomotil

Storage and HandlingStorage and Handling Store in original containersStore in original containers

Keep in locked cabinetKeep in locked cabinet

Follow special handling i.e. refrigeration, freezing, keep in dark Follow special handling i.e. refrigeration, freezing, keep in dark place, etc..place, etc..

Drug labels indicate proper handling, always read!Drug labels indicate proper handling, always read!

Always label drawn up medication!Always label drawn up medication!

Keep medications for internal use separate from those for external Keep medications for internal use separate from those for external useuse

Always check expiration dates!Always check expiration dates!

Read the label 3 times!Read the label 3 times!

Parts of a PrescriptionParts of a Prescription

Medication LabelMedication Label Medication Name Medication Name

Medication Strength Medication Strength

Medication Use Medication Use

Expiration Date Expiration Date

Manufacturer Manufacturer

Medication InformationMedication Information

Dosage CalculationsDosage Calculations Ratios:Ratios: 3:4 = 1:2 multiply the means and the extremes 3:4 = 1:2 multiply the means and the extremes (4) (1) (4) (1) means means (3) (2)(3) (2) extremes extremesSolve for X Solve for X 30mg : 1cc = 60mg : x30mg : 1cc = 60mg : x 1cc x 60mg = 30mg x x1cc x 60mg = 30mg x x 60 = 30x60 = 30x 60/30 = x60/30 = x 2 = x give 2cc or 2mL2 = x give 2cc or 2mL

Formula Method:Formula Method: Dose ordered Dose ordered X Quantity = Amount to give X Quantity = Amount to give Dose on handDose on hand Ordered: 40mg Demerol / On hand: 80mg X Quantity: per 1mLOrdered: 40mg Demerol / On hand: 80mg X Quantity: per 1mL 40/80 x 1mL = 0.5mL(cc)40/80 x 1mL = 0.5mL(cc)

Children’s Dosages by BSA (Body Surface Area):Children’s Dosages by BSA (Body Surface Area):

BSA of ChildBSA of Child x Adult Dose = Child’s Dose x Adult Dose = Child’s Dose 1.71.7 0.7 (40 inches tall, weight 38 pounds)0.7 (40 inches tall, weight 38 pounds) x 50mg Demerol(adult dose) = child x 50mg Demerol(adult dose) = child

dosedose 1.7 1.7 0.41 x 50 = 20.6mg Demerol for the child0.41 x 50 = 20.6mg Demerol for the child

* Then go to formula method to determine what is on hand to determine cc’s to give…* Then go to formula method to determine what is on hand to determine cc’s to give…

Medical Uses for DrugsMedical Uses for Drugs

Medical uses for drugs:Medical uses for drugs: Therapeutic:Therapeutic: used in treatment such as antihistamine for allergies used in treatment such as antihistamine for allergies Diagnostic:Diagnostic: used in radiology such as barium for x-rays used in radiology such as barium for x-rays Curative:Curative: used to kill the causative agent in a disease such as antibiotics used to kill the causative agent in a disease such as antibiotics Replacement:Replacement: used to replace substances normally found in the body used to replace substances normally found in the body

such as hormonessuch as hormones Preventative or Prophylactic:Preventative or Prophylactic: used to lessen severity or ward off used to lessen severity or ward off

disease such as immunizationsdisease such as immunizations

Ways to handle drugs:Ways to handle drugs: Prescribe:Prescribe: licensed practitioner gives a written prescription to be filled licensed practitioner gives a written prescription to be filled

laterlater Dispense:Dispense: to give medication ordered by the practitioner to be taken at to give medication ordered by the practitioner to be taken at

another timeanother time Administer:Administer: to give medication by mouth, injection, etc… right then as to give medication by mouth, injection, etc… right then as

ordered by the practitionerordered by the practitioner

Drug Actions Drug Actions In general drugs may be grouped as follows:In general drugs may be grouped as follows: those that those that act act

directlydirectly on one or more tissues of the body; those that on one or more tissues of the body; those that act on act on microorganismsmicroorganisms; and those that ; and those that replace body chemicalsreplace body chemicals..

Certain drugs have selective action:Certain drugs have selective action: such as such as stimulantsstimulants which which increase cell activity and increase cell activity and depressantsdepressants, which decrease cell , which decrease cell activity.activity.

Other drugs may have what is known as:Other drugs may have what is known as: Local ActionLocal Action – – the drug acts on the area to which it is the drug acts on the area to which it is

administered, i.e. ointment for a rashadministered, i.e. ointment for a rash

Remote ActionRemote Action – a drug affects a part of the body that is distant – a drug affects a part of the body that is distant from the site of administration, i.e. chemotherapyfrom the site of administration, i.e. chemotherapy

Systemic ActionSystemic Action – the drug is carried via the bloodstream – the drug is carried via the bloodstream throughout the body, i.e. antibioticsthroughout the body, i.e. antibiotics

Synergistic ActionSynergistic Action – one drug increases or counteracts the – one drug increases or counteracts the action of another, i.e. HIV medsaction of another, i.e. HIV meds

FACTORS THAT AFFECT DRUG FACTORS THAT AFFECT DRUG ACTIONACTION

The four principal factors that affect The four principal factors that affect drug action are: absorption, drug action are: absorption, distribution, biotransformation, and elimination. These factors distribution, biotransformation, and elimination. These factors depend on the individual patient, the form and chemical depend on the individual patient, the form and chemical composition of the drug and the method of administration. composition of the drug and the method of administration.

AbsorptionAbsorption is the process whereby the drug passes into the body is the process whereby the drug passes into the body fluids and tissues. fluids and tissues.

Distribution Distribution is the process whereby the drug is transported from is the process whereby the drug is transported from the blood to the intended site of action, site of biotransformation, the blood to the intended site of action, site of biotransformation, site of storage and site of elimination.site of storage and site of elimination.

BiotransformationBiotransformation is the chemical alteration that a drug is the chemical alteration that a drug undergoes in the body.undergoes in the body.

EliminationElimination is the process whereby the drug is excreted from the is the process whereby the drug is excreted from the body. Elimination occurs via the gastrointestinal tract, respiratory body. Elimination occurs via the gastrointestinal tract, respiratory tract, skin, mucous membranes and mammary glands. tract, skin, mucous membranes and mammary glands.

Undesirable Actions of Undesirable Actions of DrugsDrugs

Side Effect: Side Effect: undesirable action that may limit undesirable action that may limit usefulnessusefulness

Drug Interaction: Drug Interaction: one drug potentially one drug potentially increases or diminishes the action of another, increases or diminishes the action of another, (drugs may also interact with food, alcohol, etc…)(drugs may also interact with food, alcohol, etc…)

Adverse Reaction: Adverse Reaction: unfavorable or harmful unfavorable or harmful unintended action such as allergic reactionunintended action such as allergic reaction

Routes and AdministrationRoutes and Administration Direct Application: Direct Application: lotions, creams, transdermallotions, creams, transdermal

Sublingual: Sublingual: under the tongue, tablets, liquid, drops under the tongue, tablets, liquid, drops

Buccal: Buccal: in the cheek, tabletsin the cheek, tablets

Rectal: Rectal: suppositories, ointmentssuppositories, ointments

Vaginal: Vaginal: suppositories, creams, etc…suppositories, creams, etc…

Inhalation: Inhalation: inhalers, oxygen, spraysinhalers, oxygen, sprays

Instillation: Instillation: liquid, drops (eyes and ears)liquid, drops (eyes and ears)

Parenteral: Parenteral: injectionsinjections

Emergency Medications and Supplies – Emergency Medications and Supplies – Medication ErrorsMedication Errors

Some examples of emergency drugs and their use:Some examples of emergency drugs and their use: Adrenalin: Adrenalin: anaphylactic shock (vasoconstrictor)anaphylactic shock (vasoconstrictor) Albuterol: Albuterol: asthma (bronchodilator)asthma (bronchodilator) Benadryl: Benadryl: allergic reaction (antihistamine)allergic reaction (antihistamine) Compazine: Compazine: relieves nausea and vomiting (antiemetic)relieves nausea and vomiting (antiemetic) Dextrose: Dextrose: hypoglycemia hypoglycemia Hydrocortisone: Hydrocortisone: suppresses swelling and shock suppresses swelling and shock

((antiinflammatory) antiinflammatory) Insulin: Insulin: diabetic comadiabetic coma Narcan: Narcan: drug overdose (antidote)drug overdose (antidote) Nitroglycerin: Nitroglycerin: angina (vasodilator)angina (vasodilator) Oxygen: Oxygen: respiratory difficultiesrespiratory difficulties

When an error occurs:When an error occurs: RecognizeRecognize Stay calmStay calm ReportReport Follow ordersFollow orders DocumentDocument

““6 Rights” – Check the Label x 6 Rights” – Check the Label x 3!3!

Right DrugRight Drug Check the label 3 times!! Check the label 3 times!! 1) when removing from storage area1) when removing from storage area 2) when removing from container2) when removing from container 3) when returning to storage or before 3) when returning to storage or before

discardingdiscarding empty containerempty container Right DoseRight Dose Right RouteRight Route Right TimeRight Time Right PatientRight Patient Right DocumentationRight Documentation

Patient EducationPatient Education Take medication exactly as directed for the prescribed duration; Take medication exactly as directed for the prescribed duration;

do not stop unless you ask providerdo not stop unless you ask provider

Inform the Provider of any unusual or adverse reactionsInform the Provider of any unusual or adverse reactions

Do not take other meds unless you ask the provider; never take Do not take other meds unless you ask the provider; never take another person’s medicationanother person’s medication

Store away from childrenStore away from children

Discard properly; always check expiration dateDiscard properly; always check expiration date

Heed warning labels; always check label of prescribed meds at Heed warning labels; always check label of prescribed meds at pharmacy to be sure it is correctpharmacy to be sure it is correct

Be sure you understand what you are taking; ask for explanation if Be sure you understand what you are taking; ask for explanation if neededneeded

Enroll in education classes if you are taking lifelong drug therapyEnroll in education classes if you are taking lifelong drug therapy

ReferencesReferences http://www.drugs.com/top200.htmlhttp://www.drugs.com/top200.html

http://www.rxlist.com/script/main/art.asp?articlekey=79509http://www.rxlist.com/script/main/art.asp?articlekey=79509

http://home.sc.rr.com/nurdosagecal/http://home.sc.rr.com/nurdosagecal/

http://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Pahttp://classes.kumc.edu/son/nurs420/clinical/basic_review.htm#Parenteral%20Medicationsrenteral%20Medications

http://nursesaregreat.com/articles/drugcal.htmhttp://nursesaregreat.com/articles/drugcal.htm

http://www.cdc.gov/Nip/recs/child-schedule.htmhttp://www.cdc.gov/Nip/recs/child-schedule.htm