pharmacology for nurses week 1
DESCRIPTION
Introduction toTRANSCRIPT
Pharmacology for Nurses
Nur30Mount Saint Mary’s CollegeAssociate Degree in Nursing ProgramMaggie Davis-Kendrick, RN,MSN
Core Concept in Pharmacology
CharacterizationCharacterization of: Pharmacology• Is The Study of Medicine
• Derived from two Greek words
– PharmakonPharmakon – medicine drug– LogosLogos – study
Core Concept In Pharmacology
Concepts• Is a discipline devoted to patient therapy through the use
of drugs
• Pharmacology utilizes concepts from human biology, pathophysiology, and chemistry
HX. Of Pharmacology
One of the oldest form of healthcare, practiced in virtually every culture dating to antiquity
Applying products to relieve suffering has been recorded throughout history by virtually every culture
Modern pharmacology began in the early 19th century through the isolation of specific active agents from their complex mixtures
Regulations and Standards
Created to protect the public from drug misuse
Regulatory agency are responsible for ensuring that drugs and medical devices are safe and effective
The regulatory agency responsible for ensuring that drugs and medical devices are safe and effective is the Food and Drug Administration (FDA)
Regulations and Standards
Laws and other standards formed the basis of modern drug regulation used by agencies and organizations such as the FDA and the U.S. Pharmacopoeia-National Formulary
FormularyFormulary – first standard commonly used by pharmacists
PharmacopoeiaPharmacopoeia – medical reference summarizing standards of drug purity, strength and direction for synthesis
The FDA
Branch of the U.S. Department of Health and Human Services
Primary agency responsible for regulating drug safety
Three branches control policies regarding drug therapies
Branches of the FDA
The Center for Drug Evaluation and Research (CDER)• Exercises control over whether prescription drugs and
OTC maybe used for therapy
The Center for Biologics Evaluation and Research (CBER) • Regulates use of biologics including serums, vaccines, and
blood products
Branches of the FDA
The Center for Food Safety and Applied Nutrition (CFSAN)• Regulates administration of herbal products and dietary
supplements
Drug regulations were created to protect the public from drug misuse
The first drug laws were created by Congress to protect clients from wrongful therapeutic claims
Drug Legislation
1902- Biological Control Act to help standardize- the quality of serum and other blood-related products
1906 - Pure Food and Drug Act, gave the government power to control labeling of medicine
1912- Sherley Amendment prohibited the sale of drugs labeled with false therapeutic claims that were intended to defraud the consumer
Drug Legislation
1938 – Food, Drug, and Cosmetic Act, first law preventing the sale of drugs that had not been thoroughly tested before marketing
1994 – Dietary Supplement Health and Education Act passed in an attempt to control misleading industry claims
Stages of Drug Approval
There are four stages of approval for therapeutic and biologic drugs
• Pre-clinical investigationPre-clinical investigation – involves extensive laboratory research on humans and microbial cells cultured in the laboratory
• Clinical investigationClinical investigation – takes place in three different stages termed clinical phase trials
Stages of Drug Approval
Stage II Clinical Phase Trials • Longest part of drug approval process
• Essential component of drug evaluation
• Tests performed on healthy volunteers to determine proper dosage and assess for adverse effects
Clinical Phase Trials
Large group of selected patients with the particular disease are given the medicine
Clinical investigators from different medical specialists address concerns, if drug appears effective without serious side effects, maybe used immediately in special cases with careful monitoring
Stages of Drug Approval
New Drug Application (NDA) with review• Third stage
• FDA permitted six months to initially review a NDA
• Average review time 17-24 months
• Process suspended if rejected until concerns are addressed by the pharmaceutical company
Stages of Drug Approval
Post Marketing Surveillance• Final stage of drug approval process
• Begins after clinical trials and the NDA are completed
• Purpose is to survey for harmful drug effects in a large population
• Weighs therapeutic benefits versus its identified risks
Classification of Drug TherapeuticTherapeutic
• Clearly states what the drug does clinically• Is the discipline dealing with the treatment of suffering
and the prevention of disease Pharmacologic Pharmacologic –refers to the way an agent work at
the molecular, tissue, and body system • Addresses a drug mechanism of action• More specific than therapeutic• Requires understanding of biochemistry and physiology
Pharmacotherapy or PharmacotherapeuticsPharmacotherapy or Pharmacotherapeutics• Is the application of drugs for the purpose of disease
prevention and treatment of suffering
Classification of Drug
Prototype - used to compare drugs within the same classification
• Original prototype not most widely used
• Newer drugs in same class maybe more effective
• Have more favorable safety profile and longer duration of action
Drug Names
Three basic drug names• Chemical
– Helpful in predicting a substances physical and chemical properties
– Often complicated and difficult to remember or pronounce
– Chemical name for diazepam: 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one
Drug Names
Generic• Name is assigned by the U.S. Adopted Names
Council
• Less complicated and easier to remember
• Only one generic name for each drug
• Less expensive
Drug Names
TradeTrade• Assigned by company marketing the drug
• Sometimes called proprietary, product or brand name
• May have multiple names
• Selected to be short and easy to remember
Drug Names
Generic substance• Aspirin
• Diphenhydramine
• Ibuprofen
Brand Name• Anacin, Bayer,
Excedrin
• Benadryl, Caladryl, Allerdryl
• Advil, Motrin, Midol
Generic/Brand Names
Generic Name
• Conjugated Estrogen
• Digoxin
• Levothyroxine Sodium
• Wafarin
Brand Name Equiv.
• Premarin
• Lanoxin
• Synthroid
• Coumadin
Classification of Therapeutics
General categories• Traditional DrugsTraditional Drugs - chemical agent capable of
producing biological responses within the body (therapeutic or adverse) RAM
• BiologicsBiologics - agents naturally produced in animals cells, microorganisms, or by the body itself
• Alternative TherapiesAlternative Therapies - herbal supplements and certain techniques
Controlled Substances
Drugs that have potential for abuse or physical and psychological dependence
Use restricted by the Control Substance Act
A special order form needed to obtain schedule II drugs
There are five drug schedules of controlled substances
Schedule of Controlled Substance
Schedule/Abuse Potential • I/carries highest risk
• II/carries high potential
• III/moderate abuse risk
• IV/low abuse risk
• V/least abuse potential
Therapeutic Use/ Example
• Limited or no use/heroin, LSD, Marijuana
• With prescription/MS, PCP, Cocaine
• With prescript./Codeine, ASA, Tylenol
• With prescript/Darvon, Librium, Valium
• Without prescription OTC
Methods of Dispensing Drugs
TwoTwo major methods
• Purchase of prescriptions drugs with a physician’s order
• Purchase of over the counter (OTC) drugs which do not require a physician’s order
• There are advantages and disadvantages to both methods of dispensing
Principles of Drug Administration
Rights of Drug Administration• Right patient
• Right medication
• Right dose
• Right route
• Right time
• Right documentation
Principles of Drug Administration
Additional Rights
• Right to refuse
• Right to receive medication education
• Right preparation
Principles of Drug Administration
Three Checks of medication administration
• Checking the medication with the medication administration record (MAR) when removing it from its stored location
• Checking the medication when preparing it
• Checking the medication before administering it to the patient.
Principles of Drug Administration
Abbreviations• Table 4.1, Pg. 31 text• Front cover pg. Drug Calculation book
– ac before meal– Po or per os – by mouth – pc – after meals– mEq – milliequivalent– gtt - drop– hs – hour of sleep, at bedtime
Principles of Drug Administration
Do not use• U or u• IU• q.d. or QD• q.o.d. or QOD• MS• MSO4• Zero after decimal point
(1.0)
Use instead• Unit• International Unit• Daily• Every other day• Morphine• Morphine sulfate• 1
Principles of Drug Administration
Do not use• MgSO4• mgmg• TIW or tiw• AS• AD• AU• No zero before decimal
dose (0.5mg)
Use instead• Magnesium Sulfate• Micro gram• Three times weekly• Left ear• Right ear • Both ears• .5mg
Principles of Drug Administration
Time Schedule• ASAP – as soon as possible• STAT – immediately • Single – one time dose• Routine – daily dose • Standing – parameters left to follow• PRN – when needed
Drug Orders• Clonidine .2mg po twice daily, hold for SBP<100
Principles of Drug Administration
Drug Orders• Vancomycin 750mg IV stat, followed by
Gentamycin 1gm IV
• Lasix 40mg IV now and daily PO
• Tylenol 650mg po or pr, q 4hr prn temp. > 101 or mild pain
Principles of Drug Administration
Time Schedules (military time)• Daily or q am 0900
• Twice daily 0900 1700
• Three times daily 0900 1300 1700
• Four times daily 0900 1300 1700 2100
• Every pm 1700
Principles of Drug Administration
Time Schedules (military time)• Every hs (noc) 2200
• Every 4 hours 0001 0400 0800 1200 1600 2000
• Every 6 hours 0001 0600 1200 1800
• Every 8 hours 0001 0800 1600
• Every 12 hours 0600 1800
Principles of Drug Administration
Documentation• If medication refused or omitted and reason• Any assessment• Dosage and time administered• Medication name and your signature
• Example: Tylenol 650mg pr (rectally) given for temp. 101.6 orally at 1600. M. Davis-Kendrick RN
Principles of Drug Administration
Nursing Management• Assumes great responsibility for drug administration
• Firm knowledge of drug– Name and classification– Intended or proposed use– Effects on body– Contraindication/special consideration– Side effects
Principles of Drug Administration
Nursing Management• Why prescribed for this patient
• How supplied by pharmacy
• How is medication to be administered with dosage ranges
• What nursing process consideration related to medication apply to this particular patient
Routes of Drug Administration
Enteral
Routes of Drug Administration
Enteral • Includes drugs given orally and those administered
through nasogastric or gastrostomy tubes• The sublingual and buccal routes are less commonly
used enteral routes, dissolved directly into blood stream
• Is the most common, convenient, and usually, the least costly of all the routes
Routes of Drug Administration
Enteral• Tablets
– Maybe formulated to release the drug in a steady controlled manner
– Maybe scored for individual dosage, – Maybe enteric-coated (EC) to dissolve in alkaline
environment of sm. intestines– Sustained- Release also called extended –release (XR),
long acting (LA), or slow-release (SR) – Do not crush EC or slow releasing tablets
Routes of Drug Administration
Enteral• Capsules
– Drug encased in shell of hard or soft gelatin– Also comes extended release – Extended-release capsules must not be opened
• Sublingual – Placed under tongue and allowed to dissolve– Result in a rapid onset of action
Routes of Drug Administration
Enteral• Buccal
– Placed in oral cavity between gums and cheeks
– Mucosa less preamble than sublingual
– Slower absorption than sublingual
– Preferred over sublingual for sustained release
Routes of Drug Administration
• Troches (lozenge)– Commonly used to achieve local effect
– Held within the mouth until dissolved
• NGT/GT– Useful if patient unable to swallow
– Medication is crushed or dissolved
Routes of Drug Administration
Enteral– Do not crush sustained release drugs or EC
– If tube connected to suction, hold for 30 minutes after giving medication
– If drug interferes with tube feeding hold feeding for 1 hour before and 2 hours after
Routes of Drug Administration
Enteral• Advantages
– Safe– Convenient – Least expensive
• Disadvantages– Patient must be alert and able to swallow– Need to stay until medicine is taken– Greater chance for refusal and non compliance
Routes of Drug Administration
Enteral• Nursing Consideration
– Assess patient level of consciousness – Assess allergies– Monitor vital signs or lab result– Perform the 5 rights of administration and– The three checks before administering medication– Documentation
Routes of Drug Administration
Topical• Application
– Instillations and irrigationsInstillations and irrigations –applied into body cavity or orifices
– These include the eyes, ears, nose bladder, rectum and vagina
InhalationsInhalations – drugs applied to the respiratory tract by inhalers, nebulizers, or positive pressure breathing machines
Routes of Drug Administration
Topical• Transdermal
– Effective way of delivering specific amounts of medications
– Patches are changed/rotated on a regular basis – Slow release and absorption
• Ophthalmic– Used to treat local conditions of the eye and
surrounding structure– Available in the form of irrigation, drops, ointments,
and medicated disks
Routes of Drug Administration
Topical• Otic
– Used to treat local conditions of the ear and auditory canal
– Includes eardrops and irrigations– Perform carefully on infants and young children to
avoid injury to sensitive structures of the ear
• Nasal – Used for both local and systemic drug administration– Drops or sprays often used for their local astringent
effect which is to shrink swollen mucous membranes
Routes of Drug Administration
Topical• Vaginal
– Used to treat local vaginal infections, and to relieve pain and itching
– Inserted in suppositories, creams, jellies, or foam
• Rectal– Used for either local or systemic administration– Normally in suppository form– Slowest rate of absorption
Routes of Drug Administration
Parenteral• Dispensing of medications via a needle • Usually into the skin layers, subcutaneous tissue,
muscles or veins• Advance deliveries include into arteries, body
cavities and organs• Aseptic technique must be strictly applied
Routes of Drug Administration
Parenteral• Intradermal (ID)
– ID administered into the dermis (1st layer of skin)– Easily absorbed because of more blood vessels– Usually for allergies, TB, anesthetic, or prior to IV
insertion – Limited to small volumes (0.1 to 0.2ml)– Use only 25 or 27 gauge needle
– Inject into non-hairy skin surfaces (inner forearm)
Routes of Drug Administration
Parenteral• Subcutaneous (sub-q, SC, SQ)
– Administered into fatty tissue– Less absorption than IM, distributed through
capillaries– Insulin, heparin, vitamins, some vaccines and narcotics– Sites used are upper, lateral arms, anterior thigh,
abdomen and mid back – Doses small in volume (0.5 – 1cc) per injection
Routes of Drug Administration
Parenteral• Subcutaneous (sub-q, SC, SQ)
– Not necessary to aspirate– Rotate sites– TB and Insulin syringes are not interchangeable– Use 5/8 inch needle– Size of individual determines angle of injection
(45 vs. 90 degree angle)
Routes of Drug Administration
Parenteral• Intramuscular (IM)
– Delivers medication injected into a certain muscle– Onset of action more rapid than SQ because of
rich blood supply– Many are dry power and must be reconstituted
before administration
Routes of Drug Administration
Parenteral• Intramuscular (IM) • Most common sites
– DeltoidDeltoid– volume not to exceed
2 ml– Small volume vaccines– 1” needle
Routes of Drug Administration
Parenteral• Intramuscular (IM) Most common sites
– DorsoglutealDorsogluteal – Up to 3ml/injection– 1-1.5” needle– Aspirate– Inject slow & smooth
Routes of Drug Administration
Parenteral• Intramuscular (IM) VentroglutealVentrogluteal
Preferred siteContains no large
vessels or nervesSuitable for children
and infants over seven
months
Routes of Drug Administration
Parenteral• Intramuscular (IM)
– Rectus femorisRectus femoris Used for infants
– Vastus lateralisVastus lateralisMiddle third used for injectionUsed most often in children
Routes of Drug Administration
Intravenous
Routes of Drug Administration
Intravenous Administration (I.V.)• Direct delivery into systemic
circulation, bypasses absorption
process• Rapid onset of action• Allows large volumes to be given• Acceptable when no other route
possible
Routes of Drug Administration
Intravenous Administration (I.V.)• Three Basic TypesThree Basic Types
– Large volume infusionFor maintenance, replacement or supplementMixture of compatible drugs
– Intermittent infusion Intravenous Piggy Back (IVPB)Used to instill adjunct medication (analgesic,
antibiotics)
Routes of Drug Administration
Intravenous Administration (I.V.)• Three Basic TypesThree Basic Types
– IV Bolus or IV Push
Concentrated dose delivered via syringe
Monitor closely for adverse reaction
May take several minutes depending on the drug
Pharmacokinetics/ Pharmacodynamics
Molecules Receptor Sites
PharmacokineticsDerived from the root words
• Pharmaco – medicine • Kinetics – movement or motion
Focuses on the movement of drugs throughout the body after they are administered
Deals with how the body metabolizes and excretes drugs
PharmacokineticsDescribes the barriers that drugs
must penetrate to achieve therapeutic success
Physiological properties of plasma membranes determine movement of drugs throughout the body
PharmacokineticsDrugs primarily use two processes to cross
body membranes • Diffusion or Passive transport
– Movement of chemical from area of higher concentration to lower concentration
• Active transport– Against a concentration or
electrochemical gradient
Pharmacokinetics
Diffusion
PharmacokineticsPlasma membrane consist of lipid bilayer
with proteins and other molecules interspersed in the membrane• This lipophilic membrane is relatively
impermeable to large molecules, ions, and polar, molecules
• Drugs that are small, uncharged, and lipid soluble are distributed more completely than those that are large, ionized, and water-soluble
• These physical characteristic have direct application on pharmacokinetics
PharmacokineticsThe Processes of Pharmacokinetics
• Absorption – Movement of the drug from it’s
administration site into systemic circulation– Many factors affect drug movement
Rate of Dissolution- how fast the drug dissolve
Surface Area- larger surface area = faster absorption
Blood Flow: Greater blood flow = faster absorption
Lipid Solubility- High lipid solubility = faster absorption
pH Partitioning - ionize in the blood and not at the site of administration
PharmacokineticsPharmacokinetics Processes
• Distribution – Represents how drugs are
transported throughout the body – Variables affecting distribution
Lipid solubility Degree of ionizationPlasma protein binding The blood-brain barriersFetal-placental barrier
PharmacokineticsPharmacokinetics Processes
• Distribution– Amount of blood flow to body tissue is
the main factor determining distribution
Cardiac outputBody composition( amt. of adipose
tissue)Presence and degree of vessel
constriction or dilatation
PharmacokineticsPharmacokinetics Processes
• Metabolism (Biotransformation)– Is a process that changes a drug’s
activity and makes it more likely to be excreted.
– Alters drug structure usually in the liver
– First-Pass Effect- Hepatic inactivation of certain oral drugs
– Metabolic enzymes in the liver are less active in infants and geriatric patients
PharmacokineticsProcesses
• Excretion – Elimination of drug from circulation– The main organ involved with excretion
is the kidney – Drugs are eliminate from the body by
Kidney via the urine Lungs via exhaled airSweat glands via perspiration Tears via cryingMammary glands via breast milk and Biliary system
PharmacokineticsPlasma Concentration
• The therapeutic response of most drugs are related to their plasma concentration
– MinimumMinimum – amount required to produce therapeutic effect
– TherapeuticTherapeutic -lies between the minimum effective level and the toxic level.
– ToxicToxic –result in serious adverse effects
PharmacokineticsPlasma Concentration
• Plasma half-life– Represents the duration of action for
most drugs – The length of time the body takes to
reduce the plasma level of a drug to 50% of its peak value
• Loading dose– Higher amount of drug– Given once or twice to– Quickly induce a therapeutic response
PharmacokineticsPlasma Concentration
• Equilibrium state – The amount of drug administered is
equal to the amount excreted – Equilibrium state may be reached faster
through the use of loading doses
• Maintenance dose– Given to keep plasma concentration in
therapeutic range
PharmacodynamicsIs comprised of the root words
• Pharmco – medicine
• Dynamics – change !
Pharmacodynamics – the mechanism by which drugs produce biochemical and physiologic changes in the body
The differences in patient responses to medications
PharmacodynamicsFrequency Distribution Curve
• Represents drug action in a specific patient population
• The middle of the curve represents a drug’s median effective dose
• Used to represent safety of a drug Therapeutic Index
• Is a value representing the margin of drug safety
• Equals median lethal dose divided by median effective dose
• Larger the difference the greater the therapeutic index
PharmacodynamicsPotency and Efficacy
• Potency - the dose of medication required to elicit a particular response
• Efficacy - the magnitude of maximal
response to a drug
• Efficacy of a drug is more important to the patient and nurse than the potency
PharmacodynamicsDrug Receptor Interaction
• Used to explain the mechanism of action of many medications
• Majority of receptors are proteins located on the plasma cell membrane
• Some drug responses are nonspecific and do not involve direct receptor interaction
PharmacodynamicsDrug Receptor Interaction
• Drugs compete with endogenous substances and other medications for cellular receptors
– AgonistAgonist - are drugs that bind to a receptor and cause effects that mimic normal cell activities.
– Partial agonistPartial agonist –produces a weaker or less efficacious, response than an agonist
– AntagonistAntagonist - are drugs that bind to a receptor and inhibit normal cell activity
PharmacodynamicsPharmacology of the Future
• Likely be customized to match the genetic make-up of each patient
• Pharmacogenetics - application of genetics to pharmacology with the objective of individualizing therapy
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespanPregnancyPregnancy
• Conducted only when the benefits to the Conducted only when the benefits to the mother outweigh the potential risks to mother outweigh the potential risks to the fetusthe fetus
• Pregnancy Categories guide the Pregnancy Categories guide the practitioner in prescribing drugs for practitioner in prescribing drugs for these patientsthese patients
• Pregnancy Categories have been Pregnancy Categories have been developed by the FDA to assess developed by the FDA to assess potential risk to the fetuspotential risk to the fetus
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
PregnancyPregnancy• Drugs and other substances can Drugs and other substances can
appear in breast milk and affect appear in breast milk and affect infants infants
• Refer to FDA Pregnancy Categories Refer to FDA Pregnancy Categories (table 7.1 pg.69 text)(table 7.1 pg.69 text)
Infancy (birth 12 months)Infancy (birth 12 months)• Directed toward safetyDirected toward safety• Administer oral medication slowlyAdminister oral medication slowly
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
Infancy (birth 12 months)Infancy (birth 12 months)• For suppositories hold buttocks For suppositories hold buttocks
together for 5-10 minutestogether for 5-10 minutes
• Vastus lateralis preferred site for IM Vastus lateralis preferred site for IM injectioninjection
• Medication prescribed in milligrams Medication prescribed in milligrams per kilogram per day (mg/kg/24h)per kilogram per day (mg/kg/24h)
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
Infancy (birth 12 months)Infancy (birth 12 months)• Alternate method for calculating dosage is Alternate method for calculating dosage is
to use the infants body surface area (BSAto use the infants body surface area (BSA))
– BSA refers to the total area exposedBSA refers to the total area exposed– Derived from height and weightDerived from height and weight– Two formulas usedTwo formulas used
A.A.Formula using metric systemFormula using metric system Weight (kg) x Height (cm)Weight (kg) x Height (cm)
36003600
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespanInfancy (birth 12 months)Infancy (birth 12 months)
B. B. Formula using pounds and inchesFormula using pounds and inches
Weight (lb) x Height (inWeight (lb) x Height (in))
31313131
– BSA written in square meter (m2) BSA written in square meter (m2) – Maybe used to double check orders Maybe used to double check orders
for safefor safe dosagedosage
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespanToddlers (1-3)Toddlers (1-3)
• Major concern, sense of curiosity Major concern, sense of curiosity
• Can swallow liquid, maybe able to Can swallow liquid, maybe able to solid medication solid medication
• IM injection given in the vastus IM injection given in the vastus lateralislateralis
• IV may use scalp or feetIV may use scalp or feet
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
Preschool (3-5)Preschool (3-5)• Dorsogluteal site used for IM after 1 Dorsogluteal site used for IM after 1
year of walkingyear of walking• Peripheral veins used for IV injectionsPeripheral veins used for IV injections• Often resist medicationOften resist medication
School Age (6-12)School Age (6-12)• Begin to realize the benefits of Begin to realize the benefits of
medications and the reasons why medications and the reasons why medications are neededmedications are needed
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
School Age (6-12)School Age (6-12)• Give the child a sense of control over Give the child a sense of control over
drug administrationdrug administration • At the same time be firm and giving At the same time be firm and giving
the child praise for cooperationthe child praise for cooperation • Can take chewable tablets, may Can take chewable tablets, may
swallow tablets or capsulesswallow tablets or capsules• Ventrogluteal site preferred for IMVentrogluteal site preferred for IM
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
AdolescenceAdolescence• Respect need for independence and Respect need for independence and
privacyprivacy
• Concerned with physical appearance Concerned with physical appearance and peer approvaland peer approval
• Indications for pharmacotherapyIndications for pharmacotherapy
– Skin conditions Skin conditions – Headaches Headaches – Menstrual irregularitiesMenstrual irregularities– Sports injuriesSports injuries
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
Young (18-40) and Middle (40-65) Young (18-40) and Middle (40-65) AdulthoodAdulthood• Generally need little pharmacotherapyGenerally need little pharmacotherapy• Complications associated with pregnancy Complications associated with pregnancy
are of major concernare of major concern • Cardiovascular concerns become Cardiovascular concerns become
important important • Use of antidepressants and antianxiety Use of antidepressants and antianxiety
agents are prominent in the over-50 agents are prominent in the over-50 populationpopulation
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
Older AdultsOlder Adults• Take more medications (polypharmacy) Take more medications (polypharmacy)
and experience more adverse drug and experience more adverse drug events than any other age group events than any other age group
• Must make accommodations for age-Must make accommodations for age-related changes in physiological and related changes in physiological and biochemical functionsbiochemical functions
• With numerous physical challenges, With numerous physical challenges, which become targets for which become targets for pharmacotherapypharmacotherapy
Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan
Older AdultsOlder Adults• Changes in liver and kidney function make Changes in liver and kidney function make
pharmacotherapy more riskypharmacotherapy more risky
• Cardiovascular disease becomes a major Cardiovascular disease becomes a major indication for pharmacotherapyindication for pharmacotherapy
• For drug therapy to be successfulFor drug therapy to be successful must make must make
accommodations for age-related changes in accommodations for age-related changes in physiological and biochemical functions physiological and biochemical functions
Legal and Ethical Issues
Ethics • Branch of philosophy dealing with the
moral principles that guide a person’s behavior or conduct
• Are learned early in life through religious affiliations, family, role models, and peers
Legal and Ethical Issues
Moral • Principles such as beneficence, non-
maleficent behavior, veracity, autonomy, justice, and fidelity are necessary in medication administration
• When making ethical decisions in clinical practice, the nurse uses fundamental moral principles
Legal and Ethical Issues
• Three most important principles • BeneficenceBeneficence - promote the most good
for the patient
• Non-maleficentNon-maleficent – obligation not to harm the patient
• AutonomyAutonomy - allowing the patient the informed right to choose the course of their care
Legal and Ethical Issues
Legal• Nurse Practice Act
– Defines the scope of practice for professional nursing
– Defines the standard of care for practicing nurses
– State the minimum competency for proficiency in nursing
• Documentation of medication administration, including any errors, should be completed immediately
Legal and Ethical Issues
Legal• Medication Errors
– A preventable error that may cause or lead to an adverse reaction
•can result in serious injury to the patient and litigation for the nurse and healthcare agency
Legal and Ethical IssuesLegal
• It is the ethical and legal responsibility of the nurse to report any medication errors
• Documentation necessary for patient
safety
• Finding strategies to prevent of medication errors involves many different processes, including the nursing process
Nursing ProcessIs a systematic method of problem-solving
and consists of clearly defined steps• Assessment
– First step in the nursing process– Baseline data gathered (subjective, objective)– Assessment includes health history information,
physical assessment data, lab values and other measurable data
– Includes an assessment of medication effects: therapeutic, side or adverse effects
Nursing ProcessNursing Diagnosis
• Are developed after an analysis of the assessment data
• Diagnoses are focused on the patient’s problems or potential problems
• Begin by addressing problems that pose immediate threats to the patient’s health
Nursing ProcessGoal
• Developed from the nursing diagnoses • Focus on what the patient will be able to do or
achieve Outcomes
• Objective measures of goals• Define what the patient will do• Under what circumstances and time frame
Goals and outcomes are prioritized to address immediate need first
Nursing ProcessGoals and outcomes may be developed for short-
term or long-term, depending on the specific situation
Planning• Links strategies or interventions to goals and
outcomes Interventions
• Aimed at returning the patient to an optimum level of wellness and limiting adverse effects
Nursing ProcessInterventions
• Key components of implementation include monitoring and documentation of drug effects, and patient education
• Monitoring drug effects is a primary intervention
• Patient teaching is a vital component( considered primary role
• Documentation of both therapeutic and adverse effects is complete during this phase
Nursing ProcessEvaluation
• Final step of the nursing process• Considers the effectiveness of interventions at
meeting goals and outcomes• Evaluation begins a new cycle as new
assessment data is gathered and analyzed • Nursing diagnoses are reviewed or rewritten,
goals and outcomes refined, and new interventions are implemented
System of Measurement
Metric • Preferred system of measurement
• Also known as the International System of Units (SI)
• Basic unit of mass (weight) is the gram
• Basic unit of volume (capacity) is the liter
• Milliliter (mL) and cubic centimeter (cc) are used interchangeably
System of MeasurementMetric
• Equivalents frequently used (memorize)• Weight
– 1mg (milligram) = 1000mcg (microgram)
– 1g (gram) = 1000 mg (milligrams)
– 1 kg (kilogram) = 1000 g or Gm (grams) = 2.2 lbs
• Volume – 1L (liter) = 1000cc or 1000 ml
(milliliters)
System of Measurement
Apothecary
System of Measurement
Apothecary• Apothecary means “Pharmacist”
• Imprecise, old English system of measurement
• Grain, basic unit of weight• Basic unit of volume is the minim,
which = one drop (gtt)
System of Measurement
Apothecary• Abbreviation or symbol usually written
before amount or quantity –ex gr 60 = 1 dram
• Measures based on the minim– Fluidram (fl. dr.)– Fluid ounce (fl. Oz.)– Pint (pt.)– Quart (qt.)
System of Measurement
Household• Least accurate system of
measurement
• Measurements approximate
• Becoming increasingly more important with the trend toward home health care
System of Measurement
Household• Household Measures
– Tablespoon (Tbs or T)
– Teaspoon (tsp or t)
– Drop (gtt)
System of Measurement
Units of Measurements• Measures drugs in terms of their
action
• Vitamins, antibiotics, insulin and heparin are measured in units
• Label indicates units per ml
• No conversion exists for units
System of Measurement
Milliequivalent (mEq)
• Measures chemical combining power of electrolytes such as potassium (K+)
• Specific to medication used
• Has no conversion to another system
System of Measurement
Dosage measured in percentage• Commonly used in IV solutions
D5W, D5 ½ NS, D10, .45NS, 0.9 NS • Often used with metric measures
• Means part per hundred or number of grams of drug per 100ml of solution
• Often no conversion is necessary (give 10ml of 10% calcium gluconate)
System of Measurement
Metric House• 1ml 15-16gtts • 4-5cc 1tsp or• 15-16ml 1Tbs or• 30-32ml 2Tbs• 240-250 1gl or cup• 500ml 2gls or
cups• 1L 1qt, or
Apothecary • 15-16minims• 1 fluid dram• 4 fluid ounces• 8fl. dr or 1oz• 8 oz or ½ pt.• 1pint• 32ounces or 1qt
System of Measurement
Metric• 1mg• 60-64mg• 300-325mg • 1kg =2.2lbs• 1gram
Apothecary• 1/60 gr• 1gr• 5grs
• 15-16grs
System of Measurement
Conversion between and within systems• 1 g = 1000mg 1000mcg 2.2lbs
• 1T = 0.5L 15mL 3tsp
• 1kg = 1000g 1dr 2.2lb
• 1cc = 500mL 1L 1mL
References• Adams, M, Josephson, D. & Holland, L.
(2005). Pharmacology for Nurses: A pathophysiologic approach, Pearson Prentice Hall, New Jersey
• Aschenbrenner,D & Venable, S (2006). Drug Therapy in Nursing. 2nd Edition, Lippincott Williams & Wilkins,
• Brown, M & Mulholland, J. (2004). Drug Calculations: Process and Problems for clinical Practice 7th Edition, Mosby, St. Louis , Missouri
References• (2004).Straignt A’s in Pharmacology,
Lippincott Williams & Wilkins
• (2005).Dosage Calculations Made Incredible Easy, 3rd Edition, Lippincott Williams & Wilkins
• (2005).Nursing Pharmacology Made Incredible Easy, Springhouse
• www.crnasomeday.com/pharmacology.htm