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8/9/2019 Pharmacology Part 1 Final Version Student Pp 2010
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Nursing ConceptsPharmacology 2010
Tara Kay Race MSN, RN, CNS,
CCRN
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MEDICATIONS
What Should a NURSE Know??
Specific Uses
Dosages UsedModes of Administration Side Effects Possible Adverse Reactions Possible InteractionsWays to Monitor Effectiveness in Treating
Specific Disease Processes
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BEFOREYou Give
Medications
5 Questions to AskYourself..
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Question # 1
What is the ScientificRationale for
Administering theMedication??
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Question #2
When Should theAdministration of the
Medication beQuestioned??
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Question #3
How Can the NurseEnsure the Safety of
the MedicationAdministration??
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Question #4What are the possible
Side Effects and Possible
Adverse Reactions
Associated with a SpecificMedication??
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Question #5
How can theEffectiveness of the
Medication beMeasured??
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Overview of Pharmacology
Define
Branches of PharmacologyDrug Sources
Drug Related Terms
Drug Nomenclature (Name) Legal Regulations and Standards
Drug References
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Definition of Pharmacology
The study of drugs and their
interactions with livingsystems Clinical Pharmacology- the study of
drugs in humans
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Pharmaco-therapeutics
Definition: The use of drugs todiagnose, prevent and treat
disease or to prevent pregnancy
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Characteristics of Drugs
3 Most Important:
Effectiveness
Safety
Selectivity
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IDEAL DRUG
NO SUCHTHING!!!!
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Therapeutic Objective
Maximum Benefit
Minimal Harm
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Intensity of Drug Response
Determined by:
Administration
Pharmacokinetics
Pharmacodynamics Individual Variations
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Determination of Drug Responses
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DRUG Administration is a
NURSING Responsibility
Nurses are the Last Line of
Defense in prevention ofmedication errors
Follow the 6 RIGHTS!!
Know your responsibilities!!
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Pharmacology in Patient Care
Pre-Administration Assessment
Dosage and Administration Evaluate and Promote Therapeutic Effects
Minimize Adverse Effects
Minimize Adverse InteractionsMaking PRN decisions
Managing Toxicity
Patient Education
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Administration Factors
Dosage Size
Route
Timing
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PharmacokineticsDefinition:How much of a drug gets to its
sites of action. 4 Major Processes:
Absorption
Distribution
Metabolism Excretion
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Pharmacokinetics
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Absorption
Definition:
Rate of Absorption: Influential Factors:
Route of Administration
Dissolution
Blood Flow to the site of Administration.
Body Surface Area
Lipid Solubility
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Trans-dermal Absorption
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Oral
per os: Latin forby way of the mouth
2 Barriers to Cross:
1. Layer of Epithelial Cells that line the
GI Tract
2. The Capillary Wall.
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Variables Affecting
ORAL Absorption
Solubility and Stability of the DrugGastric and Intestinal pH
Gastric Emptying Time
Food in the GutCo-administration with Other Medications
Special Coatings on the Drug Preparations.
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GI Absorption
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Disadvantages to Oral Administration
Variability of Absorption
Inactivation of some medications by digestiveenzymes
In-activation of the medication as it passes
through the liver(First Pass Effect)
Requires a conscious cooperative patient.
Local Irritation
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Intra-muscular Administration
Barriers Capillary Wall
Advantages
Disadvantages
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Subcutaneous Administration
Barriers Capillary Wall
Advantages
Disadvantages
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Other Routes of Absorption
Other Routes Allow for Systemic or Local effects Topical
Trans-dermal Inhalation
Suppositories
Injection Directly into a Site
Joints
Heart
Nerve
CNS
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Distribution
Definition: The movement of drugs
throughout the body to their specificsite of action Depends on:
Physical and Chemical Properties of the Medication and theIndividual Receiving the Medication .
Factors influencing: Blood flow to the Tissues Ability of the Drug to Exit the Vascular System Ability of the Drug to Enter the Cells
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Drug Movement Across Capillaries
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Protein Binding for Transport
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Protein Bound Drugs
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Blood Brain Barrier
Can the Drug Cross into the Central Nervous
System?? The Blood-Brain Barrier Prevents many drugs
from crossing to the Central Nervous System.
Body Protective Mechanism.
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Metabolism
Definition: Biotransformation or the
enzymatic alteration of a drug structure.LIVER most responsible
Hepatic Microsomal Enzyme System
P450 System- Cytochrome P450
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Excretion
Definition: Removal of the Drugs from the Body
Kidneys most Responsible via Urine
Other Routes of Drug Exit:
Liver Bile Intestines Feces
Exhaled via Lungs
Exocrine GlandsSweat, Breast Milk, Saliva
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Organ of Excretion..The Kidney!!
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Pharmaco-dynamicsDefinition:The impact of drugs on the
body- What drugs do and how they do it.
Determines the nature and intensity of the
drugs response on the body Drug-Receptor Interaction
Drug Dose Relationships Plasma Drug Levels
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Individual VariationsEvery individual body is
UNIQUE! Physiological Variables
Pathological Variables
Genetic Variables
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Drug Dose Responses
GOAL: Constant Blood Level with in a Safe
Therapeutic Range
Terms: Minimal Effective Concentration (MEC)
Toxic Concentration
Therapeutic Range
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Therapeutic Index
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Serum Half-Life
Definition: The time required for the amountof drug in the body to decrease by 50%.
Determines the dosing interval
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Dose Responses Continued.
Onset:Peak:Trough:
Duration:Plateau:
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Effects of Drugs on Fetal Development
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Pharmaco-therapeuticsDefinition: Using Drugs to diagnose, prevent
or treat a disease or to prevent pregnancy
YOU MUST KNOW WHY YOUR
PATIENT IS TAKING AMEDICATION!!!!!
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Type of Medication Action
What is the drug supposed to do???
The same drug can have many Therapeutic
Effects/Actions
Example: Aspirin (ASA): Inflammation
Fever Reduction
Pain
Anti-platelet Aggregation
Why is your patient taking it???
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Adverse Reactions to Medication
Definition: Un-intended, un-desired effectwhen the drug is given at normal doses.
More common in the elderly and very young
patients
Range: Mild (itching) to SEVERE (coma orDEATH!!)
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Adverse Drug Reactions
Side Effects:
Toxicity:
Allergic Reaction:
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Allergic Reaction Immune (antigen-antibody) response to a
drug to which the patient was previously
exposed or sensitized
Mild to SEVEREcan result in DEATH!!
Required immediate intervention.
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Physical DependenceDefinition: The state in which the body
has adapted to prolonged drugexposure in such a way that an
abstinence syndrome (WITHDRAWAL)
will result if the drug is discontinued.
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ToleranceDefinition: Experiencing a
decreased response to a drug as aresult of repeated drug
administration
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Psychological Dependence
Definition: The desire for the
effects of a drug.
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Carcinogenic EffectsDefinition: The ability of certain
medications and environmentalchemicals to alter body cells and
cause a variety of cancers
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Other Drug Adversities
Teratogenicity
Iatrogenicity
Hepatotoxicity
Nephrotoxicity
Hematologic Effects Idiosyncrasy
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Individual Variation:
EVERY BODYis DIFFERENT
Age
Gender
Race
Body Weight and Composition
Pathophysiology Liver Disease
Kidney Disease
Acid Base Balance
Electrolyte Imbalance
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Renal Insufficiency Effects
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pH Effects on Plasma Drug Levels
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Medication InteractionsDrug-Drug Interactions: When one
medication alters the effects of another
medication
Drug-Food Interactions: Food can increase
or decrease the rate of drug absorption.
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Drug-Drug Interactions
Additive Effects
Synergism or Potentiating Interference
Displacement
Antagonism
Incompatibility
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FOOD-DRUG Interactions
Food slows the absorption of most Drugs
Thyramine/MAO Inhibitors
Vitamin K containing Foods/Warfarin (Coumadin)
Tetracycline/Dairy Products
Grapefruit Juice/ Many Drugs esp. Calcium
Channel Blockers Iron/Acidic Foods
Herbs and Food Supplements
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Legislation and Regulations
Federal Drug Administration (FDA):
Federal Pure Food and Drug Act of 1906 Food Drug and Cosmetic Act of 1938
Harris-Kefauver Amendments to the Food,
Drug and Cosmetic Act in 1962
Controlled Substances Act of 1970
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Legislation and Regulations
Continued
1992- FDA Permits accelerated approval of Drugs for
AIDS and Cancer
1992-The Prescription Drug User Fee Act 1997- Food and Drug Administration Modernization Act
2002- The Best Pharmaceuticals for Children Act
2003- Pediatric Research Equity
2007- FDA Amendments Act
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New Drug Development
Expensive
Lengthy Process6-12 yearsRandomized Control Trials
Most reliable and objective way to assess drugs
Use of Controls
Randomizations Blinding
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Whats in a NAME???
Chemical Name
Generic Name Non-proprietary
Trade name:
Trademarked the medications name(Tylenol)
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Nursing Responsibilities!!
ACCURATELY COMMUNICATE!!!! Know the compound names being referred to by
the Generic and Trade Names. .
Be able to recognize names of medications
and interrelate them.
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Drug Resources
How and Where Do I get myInformation?? Published Information: Clinicians and Pharmacists- call the Pharmacy
--DO NOT BE AFRAID TO CALL! Poison Control Centers Pharmaceutical Sales Representatives:
Remember they may be biased; They areSALES people NOT educators; may not tellthe negatives
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End PharmacologyPart I
Thank you!!!
Any Questions????