pharma drugs
Post on 14-Apr-2018
216 Views
Preview:
TRANSCRIPT
-
7/29/2019 PhaRMA DRUGS
1/171
Introduction to
Pharmacology in
Nursing
Donna Penn RN MSN CNE
-
7/29/2019 PhaRMA DRUGS
2/171
Nurses need to haveknowledge about the
actions and effects ofmedications
To safely and
accurately administermedications nursesneed to have anunderstanding ofpharmacologicprinciples
-
7/29/2019 PhaRMA DRUGS
3/171
Pharmacologic
Principles
-
7/29/2019 PhaRMA DRUGS
4/171
Drug Names Chemical name Describes the drugs chemical
composition and molecular
structureGeneric name (nonproprietary
name)
Name given by the United
States AdoptedName Council
Trade name (proprietary name) The drug has a registered
trademark; use of the namerestricted by the drugs patentowner(usually the manufacturer)
-
7/29/2019 PhaRMA DRUGS
5/171
Drug Names
(cont'd)
Chemical name (+/-)-2-(p-isobutylphenyl)
propionic acid
Generic name ibuprofen
Trade name Motrin, Advil
-
7/29/2019 PhaRMA DRUGS
6/171
Figure 2-1 The chemical,
generic, and trade names
for the common analgesic
ibuprofen are listed next tothe chemical structure of
the drug.
-
7/29/2019 PhaRMA DRUGS
7/171
Pharmacological
Concepts:
Classification
Classification- Nurses learnto categorize meds withsimilar characteristics bytheir class
Medication classificationindicates the effect of the
med on the body system,the symptom the medrelieves, or the medsdesired effect (e.g. oral
hypoglycemics)
-
7/29/2019 PhaRMA DRUGS
8/171
Pharmacological
Concepts:
Classification
A medication may alsobe part of more than
one class Aspirin is an analgesic,
antipyretic, anti-
inflammatory, and anti-platelet
-
7/29/2019 PhaRMA DRUGS
9/171
Pharmacological
Concepts:
MedicationForms
Medications are availablein a variety of forms andpreparations
The form of the med willdetermine its route ofadministration
Composition of med isdesigned to enhance itsabsorption & metabolism
Many meds are available inseveral forms
-
7/29/2019 PhaRMA DRUGS
10/171
Medication Forms Tablet
Capsule
Elixir Enteric-coated
Suppository
Suspension
Transdermal patch
-
7/29/2019 PhaRMA DRUGS
11/171
-
7/29/2019 PhaRMA DRUGS
12/171
-
7/29/2019 PhaRMA DRUGS
13/171
Pharmacologic
Principles
Pharmaceutics
Pharmacokinetics
Pharmacodynamics Pharmacotherapeutics
Pharmacognosy
-
7/29/2019 PhaRMA DRUGS
14/171
Pharmaceutics The study of how variousdrug forms influencepharmacokinetic andpharmacodynamic activities
-
7/29/2019 PhaRMA DRUGS
15/171
Pharmacokinetics The study of what thebody does to the drug
Absorption Distribution
Metabolism
Excretion
-
7/29/2019 PhaRMA DRUGS
16/171
Pharmacodynamics
The study of what thedrug does to the body
The mechanism of drugactions in living tissues
-
7/29/2019 PhaRMA DRUGS
17/171
Figure 2-2 Phases of Drug Activity. (From
McKenry LM, Salerno E: Mosbys
pharmacology in nursingrevised and
updated, ed 21, St. Louis, 2003, Mosby.)
-
7/29/2019 PhaRMA DRUGS
18/171
Pharmacotherapeutics
The use of drugs and theclinical indications for
drugs to prevent andtreat diseases
-
7/29/2019 PhaRMA DRUGS
19/171
Pharmacognosy The study of natural(plant and animal) drug
sources
-
7/29/2019 PhaRMA DRUGS
20/171
Pharmacokinetics: Absorption
The rate at which adrug leaves its site ofadministration, and the
extent to whichabsorption occurs
Bioavailability
Bioequivalent
-
7/29/2019 PhaRMA DRUGS
21/171
Factors That Affect
Absorption Administration route of the
drug Ability of Med to Dissolve
Food or fluidsadministered with the drug
Body Surface Area Status of the absorptive
surface
Rate of blood flow to thesmall intestine
Lipid Solubility of Med
Status of GI motility
-
7/29/2019 PhaRMA DRUGS
22/171
Routes of
Administration
A drugs route ofadministration affects
the rate and extent ofabsorption of that drug
Enteral (GI tract)
Parenteral Topical
-
7/29/2019 PhaRMA DRUGS
23/171
Enteral Route Drug is absorbed intothe systemic circulation
through the oral orgastric mucosa, thesmall intestine, orrectum
Oral
Sublingual
Buccal
Rectal
-
7/29/2019 PhaRMA DRUGS
24/171
First-Pass Effect
The metabolism of a drug and
its passage from the liver intothe circulation
A drug given via the oral routemay be extensively metabolized
by the liver before reaching thesystemic circulation (high first-pass effect)
The same druggiven IVbypasses the liver, preventingthe first-pass effect from takingplace, and more drug reachesthe circulation
-
7/29/2019 PhaRMA DRUGS
25/171
-
7/29/2019 PhaRMA DRUGS
26/171
Box 2-1 Drug Routes and First-Pass Effects
-
7/29/2019 PhaRMA DRUGS
27/171
Parenteral Route Intravenous (fastestdelivery into the blood
circulation) Intramuscular
Subcutaneous
Intradermal Intrathecal
Intraarticular
-
7/29/2019 PhaRMA DRUGS
28/171
Topical Route Skin (includingtransdermal patches)
Eyes Ears
Nose
Lungs (inhalation) Vagina
-
7/29/2019 PhaRMA DRUGS
29/171
Distribution
The transport of a drug in thebody by the bloodstream toits 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
-
7/29/2019 PhaRMA DRUGS
30/171
-
7/29/2019 PhaRMA DRUGS
31/171
Metabolism(Also Known As Biotransformation)
The biologic transformationof a drug intoan inactive metabolite, a
more soluble compound, or amore potent metabolite Liver (main organ)
Kidneys
Lungs Plasma
Intestinal mucosa
-
7/29/2019 PhaRMA DRUGS
32/171
Metabolism/Biotransformation
(cont'd)
Delayed drug metabolismresults in:
Accumulation of drugs
Prolonged action of thedrugs
Stimulating drugmetabolism causes:
Diminished pharmacologiceffects
-
7/29/2019 PhaRMA DRUGS
33/171
Excretion The elimination of drugsfrom the body
Kidneys (main organ) Liver
Bowel
Biliary excretion
Enterohepatic circulation
-
7/29/2019 PhaRMA DRUGS
34/171
1. You are caring for a client who has diabetes complicatedby kidney disease. You will need to make a detailed assessmentwhen administering medications because this client mayexperience problems with:
A. Absorption
B. Biotransformation C. Distribution
D. Excretion
35 - 34
-
7/29/2019 PhaRMA DRUGS
35/171
Pharmacodynamics Study of the
mechanism of drug
actions in living tissue Drug-induced
alterations to normal
physiologic function Positive change-
Therapeutic effect-Goalof therapy
W i hi h d
-
7/29/2019 PhaRMA DRUGS
36/171
Mechanism of Action Ways in which a drug
can produce atherapeutic effect
The effects that aparticular drug hasdepends on the cells ororgan targeted by the
drug Once the drug hits its
site of action it canmodify the rate at
which a cell or tissuefunctions
-
7/29/2019 PhaRMA DRUGS
37/171
Mechanism of Action Receptor Interaction
Enzyme Interaction
Non-Specific
Interaction
l
-
7/29/2019 PhaRMA DRUGS
38/171
Receptor Interaction Drug structure is essential
Involves the selectivejoining of drug moleculewith a reactive site on thecell surface that elicits abiological effect
Receptor is the reactive siteon a cell or tissue
Once the substance bindsto and interacts with thereceptor, a pharmacologicresponse is produced
Affi it d t hi h
-
7/29/2019 PhaRMA DRUGS
39/171
Receptor
Interaction
Affinity- degree to which adrug binds with a receptor
The drug with the best fit
or affinity will elicit thebest response Drug can mimic bodys
endogenous substancesthat normally bind to
receptor site Drugs that bind to
receptors interact withreceptors in different ways
to either block or elicit aresponse
-
7/29/2019 PhaRMA DRUGS
40/171
Receptor
Interaction
Agonist-Drug binds toreceptor-there is a
response (AdrenergicAgents)
Antagonist-drug binds
to receptor-noresponse-preventsbinding of agonists(Alpha & Beta Blockers)
-
7/29/2019 PhaRMA DRUGS
41/171
E b
-
7/29/2019 PhaRMA DRUGS
42/171
Enzyme Interaction Enzymes are substances
that catalyze nearly everybiochemical reaction in a
cell Drugs can interact with
enzyme systems to alter aresponse
Inhibits action of enzymes-enzyme is fooled intobinding to drug instead oftarget cell
Protects target cell fromenzymes action (ACEInhibitors)
N t i l i t
-
7/29/2019 PhaRMA DRUGS
43/171
Non-Specific
Interaction
Not involving a receptorsite or alteration in enzymefunction
Main site of action is cellmembrane or cellularprocess
Drugs will physically
interfere or chemically altercell process
Final product is alteredcausing defect or cell death
Cancer drugs, Antibiotics
-
7/29/2019 PhaRMA DRUGS
44/171
-
7/29/2019 PhaRMA DRUGS
45/171
The nurse is giving a medication that has a
high first-pass effect. The physician has
changed the route from IV to PO. The nurseexpects the oral dose to be:
1. Higher because of the first-pass effect.
2. Lower because of the first-pass effect.
3. The same as the IV dose.
4. Unchanged.
-
7/29/2019 PhaRMA DRUGS
46/171
. A patient is complaining of severe pain
and has orders for morphine sulfate. The
nurse knows that the route that would
give the slowest pain relief would bewhich route?
1. IV
2. IM3. SC
4. PO
Th i Eff
-
7/29/2019 PhaRMA DRUGS
47/171
Type of Medication
Action
Therapeutic Effect
Side Effects
Adverse Effects Toxic Effect
Idiosyncratic Reactions
Allergic Reaction
Medication Interactions
Iatrogenic Response
Th t d
-
7/29/2019 PhaRMA DRUGS
48/171
Therapeutic Effect The expected or
predictablephysiological responsea medication causes
A single med can haveseveral therapeutic
effects (Aspirin) It is important for the
nurse to know whymed is being prescribed
U i t d d d
-
7/29/2019 PhaRMA DRUGS
49/171
Side Effects
Unintended secondaryeffects a medicationpredictably will cause
May be harmless or serious
If side effects are seriousenough to negate the
beneficial effect of medstherapeutic action, it maybe D/Cd
People may stop taking
medications because of theside effects
Undesirable response of a
-
7/29/2019 PhaRMA DRUGS
50/171
Adverse Effects Undesirable response of amedication
Unexpected effects of drug
not related to therapeuticeffect
Must be reported to FDA
Can be a side effect or aharmful effect
Can be categorized aspharmacologic,idiosyncratic,hypersensitivity, or druginteraction
Ad Eff Ad D E t
-
7/29/2019 PhaRMA DRUGS
51/171
Adverse Effects Adverse Drug Events
Adverse DrugReactions (ADR)
M d l ft
-
7/29/2019 PhaRMA DRUGS
52/171
Toxic Effect May develop after
prolonged intake or whena med accumulates in the
blood because of impairedmetabolism or excretion, orexcessive amount taken
Toxic levels of opioids cancause resp.depression
Antidotes available toreverse effects
Idios ncratic U di t bl ff t
-
7/29/2019 PhaRMA DRUGS
53/171
Idiosyncratic
Reactions
Unpredictable effects-overreacts or under reactsto a medication or has a
reaction different fromnormal
Genetically determined
abnormal response Idiosyncratic drug
reactions are usuallycaused by abnormal levels
of drug-metabolizingenzymes (deficiency oroverabundance)
Unpredictable response to
-
7/29/2019 PhaRMA DRUGS
54/171
Allergic Reaction Unpredictable response to
a medication
Makes up greater than 10%
of all medication reactions Client may become
sensitized immunologicallyto the initial dose, repeated
administration causes anallergic response to themed, chemical preservativeor a metabolite
Medication acts as an
-
7/29/2019 PhaRMA DRUGS
55/171
Allergic Reaction Medication acts as an
antigen triggering therelease of the bodys
antibodies May be mild or severe
Among the differentclasses of meds, antibiotics
cause the highest incidenceof allergic reaction
Severe reaction-Anaphylactic reaction
Mild reaction-hives, rash,pruritis
-
7/29/2019 PhaRMA DRUGS
56/171
-
7/29/2019 PhaRMA DRUGS
57/171
-
7/29/2019 PhaRMA DRUGS
58/171
-
7/29/2019 PhaRMA DRUGS
59/171
2. A postoperative client is receiving morphine sulfate via aPCA. The nurse assesses that the clients respirations aredepressed. The effects of the morphine sulfate can be classifiedas:
A. Allergic
B. Idiosyncratic C. Therapeutic
D. Toxic
35 - 59
Teratogenic Structural
-
7/29/2019 PhaRMA DRUGS
60/171
Other Drug
Reactions
Teratogenic-Structuraleffect in unborn fetus
(thalidomide) Carcinogenic-Causes
cancer
Mutagenic- Changesgenetic composition(radiation, chemicals)
D Occurs when one med
-
7/29/2019 PhaRMA DRUGS
61/171
Drug
Interactions
Occurs when one medmodifies the action ofanother
Common in peopletaking severalmedications at once
One med may
potentiate or diminishthe action of another oralter the way it isabsorbed, metabolized
or eliminated Warfarin and
Amiodarone
Iatrogenic Unintentional adverse
-
7/29/2019 PhaRMA DRUGS
62/171
Iatrogenic
Responses
Unintentional adverseeffects that occur duringtherapy
Treatment-InducedDermatologic-rash, hives,acne
Renal Damage-Aminoglycoside
antibiotics, NSAIDS,contrast medium
Blood Dyscrasias-Destruction of blood cells
(Chemotherapy) Hepatic Toxicity-Elevatedliver enzymes (hepatitis-like symptoms)
Synergistic Effect of 2 meds combined
-
7/29/2019 PhaRMA DRUGS
63/171
Synergistic
Effect
Effect of 2 meds combinedis greater than the medsgiven separately
Alcohol & Antihistamines,antidepressants,barbiturates, narcotics
Not always undesirable,
physician may combinemeds to create aninteraction that will havebeneficial effects
(Vasodilators & diuretics tocontrol high BP)
Medication Dose Except when administered
-
7/29/2019 PhaRMA DRUGS
64/171
Medication Dose
Responses
Except when administeredIV, meds take time to enterbloodstream
The quantity & distributionof med in different bodycompartments changeconstantly
Goal is to keep constant
blood level within a safetherapeutic range
Repeated doses arerequired to achieve a
constant therapeuticconcentration of a medbecause a portion of med isalways being excreted
Medication Dose Serum Half-Life:Time it
-
7/29/2019 PhaRMA DRUGS
65/171
Medication Dose
Responses
Serum Half Life:Time ittakes for excretionprocesses to lower the
serum medicationconcentration by
Regular fixed doses mustbe given to maintain
therapeutic concentration Dosage schedules set by
institutions (TID, q8h, HS,AC, STAT, PRN)
Peak & Trough levels Therapeutic drug
monitoring
Half life The time it takes for one
-
7/29/2019 PhaRMA DRUGS
66/171
Half-life The time it takes for onehalf of the original amountof a drug in the body to be
removed A measure of the rate at
which drugs are removed
from the body
Onset Peak and
-
7/29/2019 PhaRMA DRUGS
67/171
Onset, Peak, and
Duration
Onset The time it takes for the drug
to elicit atherapeutic response
Peak The time it takes for a drug
to reach its maximumtherapeutic response
Duration The time a drug
concentration is sufficient toelicit a therapeutic response
Pharmacotherapeutics: Types of
-
7/29/2019 PhaRMA DRUGS
68/171
Pharmacotherapeutics: Types of
Therapies
Acute therapy Maintenance therapy
Supplemental therapy
Palliative therapy Supportive therapy
Prophylactic therapy
Empiric therapy
Monitoring The effectiveness of the
-
7/29/2019 PhaRMA DRUGS
69/171
Monitoring The effectiveness of thedrug therapy must be
evaluated One must be familiarwith the drugs:
Intended therapeuticaction (beneficial)
Unintended butpotential side effects
(predictable, adversereactions)
Monitoring (cont'd) Therapeutic index
-
7/29/2019 PhaRMA DRUGS
70/171
Monitoring (cont d) Therapeutic index
The ratio between adrugs therapeuticbenefits and its toxiceffects
Monitoring (cont'd) Tolerance
-
7/29/2019 PhaRMA DRUGS
71/171
Monitoring (cont d) Tolerance
A decreasing responseto repetitive drug doses
Monitoring (cont'd) Dependence
-
7/29/2019 PhaRMA DRUGS
72/171
Monitoring (cont d) Dependence
A physiologic orpsychological need for adrug
Monitoring (cont'd) Interactions may occur
-
7/29/2019 PhaRMA DRUGS
73/171
Monitoring (cont d) Interactions may occurwith other drugs or food
Drug interactions: thealteration of action ofa drug by:
Other prescribed drugs
Over-the-countermedications
Herbal therapies
Monitoring (cont'd) Drug interactions
-
7/29/2019 PhaRMA DRUGS
74/171
Monitoring (cont d) Drug interactions
Additive effect
Synergistic effect Antagonistic effect
Incompatibility
Monitoring (cont'd) Medication
-
7/29/2019 PhaRMA DRUGS
75/171
Monitoring (cont d) Medicationmisadventures
Adverse drug events
Adverse drug reactions
Medication errors
Monitoring (cont'd) Some adverse drug
-
7/29/2019 PhaRMA DRUGS
76/171
Monitoring (cont d) Some adverse drugreactions are classifiedas side effects
Expected, well-knownreactions that result in littleor no change in patient
management Predictable frequency
The effects intensity and
occurrence are related tothe size of the dose
Adverse Drug An adverse outcome of
-
7/29/2019 PhaRMA DRUGS
77/171
Adverse Drug
Reaction
An adverse outcome ofdrug therapy in whicha patient is harmed insome way
Pharmacologic reactions
Idiosyncratic reactions
Hypersensitivity reactions
Drug interactions
Other Drug-Related Teratogenic
-
7/29/2019 PhaRMA DRUGS
78/171
Other Drug Related
Effects
e atoge c
Mutagenic
Carcinogenic
Toxicology The study of poisons
-
7/29/2019 PhaRMA DRUGS
79/171
Toxicology y pand unwantedresponses totherapeutic agents
-
7/29/2019 PhaRMA DRUGS
80/171
Table 2-9 Common
Poisons and Antidotes
The Nursing
-
7/29/2019 PhaRMA DRUGS
81/171
Process (cont'd) Assessment
Nursing diagnosis Planning (with outcome
criteria)
Implementation Evaluation
The Nursing An organizational
-
7/29/2019 PhaRMA DRUGS
82/171
g
Process
gframework for thepractice of nursing
Orderly, systematic
Central to all nursing
care Encompasses all steps
taken by the nurse incaring for a patient
Flexibility is important
The Nursing Assessment
-
7/29/2019 PhaRMA DRUGS
83/171
Process (cont'd) Data collection
Subjective, objective
Data collected on the patient,drug, environment
Medication history
Nursing assessment Physical assessment
Data analysis
The Nursing( )
Nursing diagnosis
-
7/29/2019 PhaRMA DRUGS
84/171
Process (cont'd)g g
Judgment or conclusion
about theneed/problem (actualor at risk for) of thepatient
Based upon an accurateassessment
NANDA format
The Nursing
( )Planning
-
7/29/2019 PhaRMA DRUGS
85/171
Process (cont'd)g
Identification of goals
and outcome criteria Prioritization
Time frame
The Nursing Goals
-
7/29/2019 PhaRMA DRUGS
86/171
Process (cont'd) Objective, measurable,
realistic Time frame specified
Outcome criteria
Specific standard(s) ofmeasure
Patient oriented
The NursingI l t ti
-
7/29/2019 PhaRMA DRUGS
87/171
Process (cont'd) Implementation
Initiation and completion
of the nursing care planas defined by the nursingdiagnoses and outcome
criteria Follow the five rights of
medication
administration
The Five
-
7/29/2019 PhaRMA DRUGS
88/171
The Five
Rights Right drug
Right dose Right time
Right route
Right patient
Another RightConstant
-
7/29/2019 PhaRMA DRUGS
89/171
Another Right Constant
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 Proper drug storage
-
7/29/2019 PhaRMA DRUGS
90/171
g p g g
Proper documentation
Accurate dosagecalculation
Accurate dosage
preparation Careful checking of
transcription of orders
Patient safety
Other Rights Close consideration of
-
7/29/2019 PhaRMA DRUGS
91/171
g
(cont'd) special situations
Prevention andreporting of medicationerrors
Patient teaching Monitoring fortherapeutic effects, sideeffects, toxic effects
Refusal of medication
Evaluation Ongoing part of the
-
7/29/2019 PhaRMA DRUGS
92/171
nursing process
Determining the statusof the goals andoutcomes of care
Monitoring thepatients response todrug therapy
Expected and
unexpected responses
-
7/29/2019 PhaRMA DRUGS
93/171
The day shift charge nurse is making rounds. Apatient tells the nurse that the night shift nurse
never gave him his medication, which was due at
11 PM. What should the nurse do first to
determine whether the medication was given?
1. Call the night nurse at home.
2. Check the Medication Administration Record.
3. Call the pharmacy.
4. Review the nurses notes.
-
7/29/2019 PhaRMA DRUGS
94/171
The patients Medication Administration Recordlists two antiepileptic medications that are due at
0900, but the patient is NPO for a barium study.
The nurses coworker suggests giving the
medications via IV because the patient is NPO.
What should the nurse do?
1. Give the medications PO with a small sip of water.
2. Give the medications via the IV route because the
patient is NPO.3. Hold the medications until after the test is
completed.
4. Call the physician to clarify the instructions.
-
7/29/2019 PhaRMA DRUGS
95/171
Life Span
Considerations
Life Span Pregnancy
-
7/29/2019 PhaRMA DRUGS
96/171
Considerations Breast-feeding
Neonatal Pediatric
Geriatric
Pregnancy First trimester is the
-
7/29/2019 PhaRMA DRUGS
97/171
period of greatestdanger for drug-induced developmentaldefects
Drugs diffuse across the
placenta FDA pregnancy safety
categories
-
7/29/2019 PhaRMA DRUGS
98/171
Table 3-1 Pregnancy
safety categories
Breast-feeding Breast-fed infants are at
-
7/29/2019 PhaRMA DRUGS
99/171
risk for exposure todrugs consumed by themother
Consider risk-to-benefitratio
-
7/29/2019 PhaRMA DRUGS
100/171
Table 3-2 Classification of
young patients
Pediatric Considerations:
-
7/29/2019 PhaRMA DRUGS
101/171
Pharmacokinetics
Absorption Gastric pH less acidic Gastric emptying is
slowed
Topical absorption fasterthrough the skin
Intramuscular
absorption faster andirregular
Pediatric Considerations:
-
7/29/2019 PhaRMA DRUGS
102/171
Pharmacokinetics (cont'd)
Distribution TBW 70% to 80% in full-
term infants, 85% inpremature newborns, 64%in children 1 to 12 yearsof age
Greater TBW means fatcontent is lower
Decreased level of proteinbinding
Immature blood-brainbarrier
Pediatric Considerations:
Ph ki i ( 'd)
-
7/29/2019 PhaRMA DRUGS
103/171
Pharmacokinetics (cont'd)
Metabolism
Liver immature, doesnot produce enough
microsomal enzymes Older children may have
increased metabolism,requiring higher doses
Other factors
Pediatric Considerations:
-
7/29/2019 PhaRMA DRUGS
104/171
Pharmacokinetics (cont'd)
Excretion
Kidney immaturity
affects glomerularfiltration rate andtubular secretion
Decreased perfusion rate
of the kidneys
Summary of Pediatric
Considerations
-
7/29/2019 PhaRMA DRUGS
105/171
Considerations Skin is thin and permeable
Stomach lacks acid to killbacteria
Lungs lack mucus barriers
Body temperatures poorlyregulated and dehydrationoccurs easily
Liver and kidneys areimmature, impairing drugmetabolism and excretion
Methods of Dosage Calculation
for Pediatric Patients
-
7/29/2019 PhaRMA DRUGS
106/171
for Pediatric Patients
Body weight dosagecalculations
Body surface areamethod
Geriatric
C id ti
Geriatric: older than65
-
7/29/2019 PhaRMA DRUGS
107/171
Considerations age 65
Healthy People 2010:older than age 55
Use of OTCmedications
Polypharmacy
-
7/29/2019 PhaRMA DRUGS
108/171
Table 3-4 Physiologic changes in the geriatric patient
Geriatric Considerations:
Ph ki ti
-
7/29/2019 PhaRMA DRUGS
109/171
Pharmacokinetics
Absorption Gastric pH less acidic
Slowed gastric emptying
Movement through GItract slower
Reduced blood flow to theGI tract
Reduced absorptivesurface area due toflattened intestinal villi
Geriatric Considerations:
-
7/29/2019 PhaRMA DRUGS
110/171
Pharmacokinetics (cont'd)
Distribution
TBW percentages lower
Fat content increased
Decreased production ofproteins by the liver,resulting in decreased
protein binding of drugs
Geriatric Considerations:
Ph ki ti ( t'd)
-
7/29/2019 PhaRMA DRUGS
111/171
Pharmacokinetics (cont'd)
Metabolism
Aging liver producesless microsomal
enzymes, affecting drugmetabolism
Reduced blood flow to
the liver
Geriatric Considerations:
-
7/29/2019 PhaRMA DRUGS
112/171
Pharmacokinetics (cont'd)
Excretion Decreased glomerular
filtration rate
Decreased number ofintact nephrons
Geriatric Considerations: Problematic
Medications
-
7/29/2019 PhaRMA DRUGS
113/171
Medications
Analgesics
Anticoagulants
Anticholinergics
Antihypertensives Digoxin
Sedatives and
hypnotics Thiazide diuretics
-
7/29/2019 PhaRMA DRUGS
114/171
Legal, Ethical,and Cultural
Considerations
U.S. Drug
L i l ti
1906: Federal Food andDrug Act
-
7/29/2019 PhaRMA DRUGS
115/171
Legislation Drug Act
1912: SherleyAmendment (to theFederal Food and DrugAct of 1906)
1914: Harrison NarcoticAct
1938: Federal Food,Drug, and Cosmetic Act(revision of 1906 Act)
U.S. Drug Legislation
(cont'd)
-
7/29/2019 PhaRMA DRUGS
116/171
(cont d) 1951: Durham-
HumphreyAmendment (to the1938 act)
1962: Kefauver-HarrisAmendment (to the1938 act)
1970: ControlledSubstance Act
U.S. Drug Legislation
(cont'd)
-
7/29/2019 PhaRMA DRUGS
117/171
(cont d)
1983: Orphan Drug Act
1991: Accelerated drugapproval
-
7/29/2019 PhaRMA DRUGS
118/171
-
7/29/2019 PhaRMA DRUGS
119/171
New Drug
Development
Investigational newdrug (IND) application
-
7/29/2019 PhaRMA DRUGS
120/171
Development drug (IND) application
Informed consent
Investigational drugstudies
Expedited drugapproval
U.S. FDA Drug
Approval Process Preclinical
-
7/29/2019 PhaRMA DRUGS
121/171
Approval Process Preclinicalinvestigational drug
studies
Clinical phases ofinvestigational drug
studies Phase I
Phase II
Phase III Phase IV
Ethical Nursing
Practice
American NursesAssociation (ANA)
-
7/29/2019 PhaRMA DRUGS
122/171
Practice Association (ANA)Code of Ethics for
Nurses
Cultural
Considerations
-
7/29/2019 PhaRMA DRUGS
123/171
Considerations Assess the influence of a
patients cultural beliefs,values, and customs Drug polymorphism Compliance level with
therapy Environmental
considerations Genetic factors
Varying responses tospecific agents
Cultural
Assessment
Health beliefs andpractices
-
7/29/2019 PhaRMA DRUGS
124/171
Assessment practices
Past uses of medicine
Folk remedies
Home remedies
Use of nonprescriptiondrugs and herbalremedies
OTC treatments
Cultural Assessment
(cont'd)
-
7/29/2019 PhaRMA DRUGS
125/171
( )
Usual response to
treatment Responsiveness to
medical treatment
Religious practices andbeliefs
Dietary habits
-
7/29/2019 PhaRMA DRUGS
126/171
MedicationErrors:
Preventingand
Responding
Medication
Misadventures
Medication errors(MEs)
-
7/29/2019 PhaRMA DRUGS
127/171
Misadventures (MEs)
Adverse drug events(ADEs)
Adverse drug reactions(ADRs)
Medication
Misadventures (cont'd)
-
7/29/2019 PhaRMA DRUGS
128/171
By definition, all ADRs
are also ADEs But all ADEs are not
ADRs
Two types of ADRs Allergic reactions
Idiosyncratic reactions
Medication Errors
-
7/29/2019 PhaRMA DRUGS
129/171
Preventable Common cause of
adverse health care
outcomes Effects can range from no
significant effect to
directly causing disabilityor death
Box 5-1 Common classes of medications involved
in serious errors
-
7/29/2019 PhaRMA DRUGS
130/171
Preventing Medication
Errors
-
7/29/2019 PhaRMA DRUGS
131/171
Minimize verbal ortelephone orders Repeat order to prescriber
Spell drug name aloud
Speak slowly and clearly
List indication next toeach order
Avoid medical shorthand,including abbreviationsand acronyms
Preventing Medication
Errors (cont'd)
-
7/29/2019 PhaRMA DRUGS
132/171
Never assume anything
about items not specified ina drug order (i.e., route)
Do not hesitate to question
a medication order for anyreason when in doubt
Do not try to decipherillegibly written orders;contact prescriber forclarification
Preventing Medication
Errors (cont'd)
NEVER t ili
-
7/29/2019 PhaRMA DRUGS
133/171
NEVER use trailing
zeros with medicationorders
Do not use 1.0 mg; use
1 mg 1.0 mg could be
misread as 10 mg,resulting in a tenfolddose increase
Preventing
Medication Errors
-
7/29/2019 PhaRMA DRUGS
134/171
(cont'd) ALWAYS use a
leading zero fordecimal dosages
Do not use .25 mg; use0.25 mg
.25 mg may be misreadas 25 mg
.25 is sometimes
called a nakeddecimal
Preventing Medication
Errors (cont'd)
-
7/29/2019 PhaRMA DRUGS
135/171
Check medication order
and what is availablewhile using the 5 rights
Take time to learn specialadministrationtechniques of certain
dosage forms
Preventing Medication
Errors (cont'd) Always listen to and
-
7/29/2019 PhaRMA DRUGS
136/171
honor any concerns
expressed by patientsregarding medications
Check patient allergiesand identification
MedicationReconciliation
Medication Errors
Possible consequences to
-
7/29/2019 PhaRMA DRUGS
137/171
qnurses
Reporting and responding toMEs
ADE monitoring programs
USPMERP (United StatesPharmacopeia MedicationErrors Reporting Program)
MedWatch, sponsored by theFDA
Institute for Safe MedicationPractices (ISMP)
Notification of patient
regarding MEs
-
7/29/2019 PhaRMA DRUGS
138/171
3. Nurses are legally required to document medications that
are administered to clients. The nurse is mandated to document:
A. Medication before administering it
B. Medication after administering it
C. Rationale for administering the medication
D. Prescribers rationale for prescribing the medication
35 - 138
-
7/29/2019 PhaRMA DRUGS
139/171
4. If a nurse experiences a problem reading a physiciansmedication order, the most appropriate action will be to:
A. Call the physician to verify the order.
B. Call the pharmacist to verify the order.
C. Consult with other nursing staff to verify the order.
D. Withhold the medication until the physician makesrounds.
35 - 139
-
7/29/2019 PhaRMA DRUGS
140/171
Medication
Administration
-
7/29/2019 PhaRMA DRUGS
141/171
Preparing for Drug
Administration
-
7/29/2019 PhaRMA DRUGS
142/171
Check the 5 rights
Standard Precautions:Wash your hands!
Double-check if unsureabout anything
Check for drug allergies
Prepare drugs for onepatient at a time
Check three times
Preparing for Drug
Administration (cont'd)
-
7/29/2019 PhaRMA DRUGS
143/171
Check expiration dates Check the patients
identification Give medications on time
Explain medications to thepatient Open the medications at
the bedside
Document the medicationsgiven before going to thenext patient
Drug Routes &
First Pass Effects
First Pass Routes- Oral,Rectal
-
7/29/2019 PhaRMA DRUGS
144/171
Non-First Pass Routes-Aural, Buccal, Inhaled,Intraarterial,
Intramuscular,Intranasal, Intraocular,Vaginal, Intravenous,Subcutaneous,
Sublingual,Transdermal
Oral Route
Easiest, mostcommonly used
-
7/29/2019 PhaRMA DRUGS
145/171
y
Slower onset of action
More prolonged effect
Preferred by clients
SublingualAdministration
Buccal Administration
-
7/29/2019 PhaRMA DRUGS
146/171
Enteral
Drugs
-
7/29/2019 PhaRMA DRUGS
147/171
Drugs Giving oral medications
Giving sublingual or buccalmedications
Liquid medications
Giving oral medications toinfants
Administering drugsthrough a nasogastric or
gastrostomy tube Rectal administration
Parenteral Route Injecting a medicationinto body tissues
-
7/29/2019 PhaRMA DRUGS
148/171
Subcutaneous (SQ)
Intramuscular (IM)
Intravenous (IV)
Intradermal (ID) Advanced techniques
Parenteral
Drugs
Never recap a usedneedle!
-
7/29/2019 PhaRMA DRUGS
149/171
Drugs
May recap an unusedneedle with the scoopmethod
Prevention ofneedlesticks
Filter needles
Parenteral
Drugs
Removing medicationsfrom ampules
-
7/29/2019 PhaRMA DRUGS
150/171
Drugs
(cont'd) Removing medicationsfrom vials
Disposal of usedneedles and syringes
Injections Needle angles forvarious injections
-
7/29/2019 PhaRMA DRUGS
151/171
Intramuscular (IM)
Subcutaneous (SC or SQ)
Intradermal (ID)
Z-track method for IMinjections
Air-lock technique
Injection
Techniques
Intradermal injections
-
7/29/2019 PhaRMA DRUGS
152/171
Techniques
Subcutaneous injections Insulin administration Heparin administration
-
7/29/2019 PhaRMA DRUGS
153/171
-
7/29/2019 PhaRMA DRUGS
154/171
-
7/29/2019 PhaRMA DRUGS
155/171
Injection
Techniques
Intramuscularinjections
-
7/29/2019 PhaRMA DRUGS
156/171
Techniques
(cont'd)
Ventrogluteal site
(preferred) Vastus lateralis site
Dorsogluteal site
Deltoid site
-
7/29/2019 PhaRMA DRUGS
157/171
Preparing
Intravenous
-
7/29/2019 PhaRMA DRUGS
158/171
Intravenous
Medications Needleless systems Compatibility issues
Expiration dates
Mixing intravenouspiggyback (IVPB)medications
Labeling intravenous (IV)infusion bags whenadding medications
-
7/29/2019 PhaRMA DRUGS
159/171
-
7/29/2019 PhaRMA DRUGS
160/171
Intravenous
Medications Adding medications to a
-
7/29/2019 PhaRMA DRUGS
161/171
Medications gprimary infusion bag
IVPB medications(secondary line)
IV push medications(bolus) Through an IV lock
Through an existing IVinfusion
-
7/29/2019 PhaRMA DRUGS
162/171
-
7/29/2019 PhaRMA DRUGS
163/171
Intravenous
Medications
( t'd)
-
7/29/2019 PhaRMA DRUGS
164/171
(cont'd) Volume-controlledadministration set
Using electronicinfusion pumps
Patient-controlledanalgesia (PCA) pumps
-
7/29/2019 PhaRMA DRUGS
165/171
Topical
Drugs
-
7/29/2019 PhaRMA DRUGS
166/171
Drugs
Eye medications Drops
Ointments
Ear drops
Adults
Infant or child youngerthan 3 years of age
-
7/29/2019 PhaRMA DRUGS
167/171
Topical
Drugs
Nasal drugs
Drops
-
7/29/2019 PhaRMA DRUGS
168/171
g
(cont'd)
Spray
Inhaled drugs
Metered-dose inhalers
Small-volume nebulizers
-
7/29/2019 PhaRMA DRUGS
169/171
Topical
Drugs
Administeringmedications to the skin
L ti
-
7/29/2019 PhaRMA DRUGS
170/171
g
(cont'd)
Lotions, creams,
ointments, powders Transdermal patches
Vaginal medications Creams, foams, gels
Suppositories
-
7/29/2019 PhaRMA DRUGS
171/171
top related