Pharmacology
Scientific study of the origin, nature, chemisty, effects and use of drugs
Pharmacodynamics
What the medication does to the
... [Show More] body
Pharmacokinetics
What the body does to the medication
Pharmacotherapeutics
How the medication helps with the pathophysiology
Nonprescription/ OTC med examples
Herbal meds, vitamins, tylenol. ASK PATIENTS SPECIFICALLY IF THEY TAKE THESE
Generic name
most cases derived from chemical name but shorter (offical name). have to adhere to naming "rules"
Trade name
brand name selected by the company
What should you check on the MEDS before giving them?
The expiration date. Check date on cardex and computer also.
What should you do if the meds are expired?
Get them reordered
What needs to be listed when meds are ordered?
Route, name, how often, time
Can you take verbal orders?
NO
Is "daily" an acceptable time?
NO
Absorption, distribution, metabolism, excretion are apart of what?
Pharmacokinetics
Factors affecting absorption
body surface area
Blood flow
Pain and stress (negatively)
Drug soluability (ph of stomach and GI motility)
Enteral
mouth or rectal
small intestines
(absorption depends on when peak and concentration levels are reached)
Parental
Injection (rapid absorption)
vein, arteries, muscle (intermediate absorption)
Topical
skin and mucous membranes
(absorption is slow)
What is the fastest route of absorption?
Parental
What can cause physiological changes that affect drug metabolism?
Diseases
What is the ability to change a drug biologically from original to water soluable form
Drug metabolism
Why would you get a 24 hour urine?
To look at by products serum drug levels
(too high-toxicity)
(too low-not therapeutic)
How can drugs be eliminated?
Through the lungs, exocrine glands, kidneys, liver, skin, and GI tract.
What is a half-life?
Time the total amount is dimished by 1/2
It helps determine the drug frequency
Onset
time when the drug is sufficiently absorbed to reach an effective blood level and distributed to elicit a therapeutic response
Peak
when the body absorbs more drug, blood concentration rises, more drug reaches the site of action, therapeutic response increases. (BS is low)
Duration
Length of time a drug concentration is sufficient in the blood to produce a therapeutic response
Bioavailability
Refers to the extent to which a drugs active ingredient is absorbed and transported to its site of action
Why are blood concentration levels measured?
To help determine whether the dosing has achieved therapeutic goals
What is drug ACTION??
Interaction at the cellular level between a drug and cellular components.
What is drug EFFECT??
The response resulting from drug action which may affect total body function
What is the PRIMARY job of the nurse?
SAFETY.
After that is monitor for adverse and therapeutic effects AND documenting the findings!
Drug interactions may occur between drugs, between drugs and herbs, or between.....
drugs and food
The more drugs a patient recieves, the greater risk for...
drug interaction
What happens if you drip an antibiotic in too fast?
TOXICITY
What happens if you give the medication at the wrong time?
CONFLICT
What happens in you push a med too fast?
INFILTRATION
What happens if you forget to give a med?
LEVELS DROP. Report this!
What happens if you give an antibiotic late?
BACTERIA GROWS
Nursing responsibilites for meds
Check dose
Ordered correctly? Clients weight correct?
Monitor before giving drug (BP, HR)
Monitor AFTER giving drug (BP, HR)
Teach about drug (DONT ASSUME; ask why they are taking it)
If you give a med as ordered and it wasnt right, are you liable?
YES
If you give a med as ordered and the order was for too much, are you liable?
YES
How much of the population is older adults? What percentage are on meds?
13%
30% prescribed meds
40% OTC meds
90% take atleast 1 prescribed med
12% use ten or more per week
Who takes the most meds?
Women, multiple health conditions, frail elderly, nursing home residents
Meds used most commonly in the community
analgesics, diuretics, CV, sedative-hypnotics
Meds used most commonly in nursing homes
antipsychotics, sedative hypnotics, dieurtetics, antihypertensives, analgesics, CV, antiboitics
What question do you have to ask when giving a patient meds?
Do the potential benefits outweigh the potential risks for this patient
Example of drug-drug interaction
Aspirin and coumadin
Aspirin is an antiplatelet, but will cause more bleeding if combined with coumadin. It interferes with clotting cascade and slows clotting down.
What else can interfere with drugs?
Food, a physical condition, alcohol
How do drug interactions occur?
Drug may affect the amount of a substance in the body which then affects the way another drug is processed
Drug interactions can also occur from an increase or decrease is what?
Absorption, distribution, metabolism, elimination
If total body water decreases,
Increases serum concentration of water-soluable drugs
Patient will have a prolonged half life if they have...
more body fat
If you have slow circulation,
it may delay drugs getting to liver and kidneys (which affects the time it takes for these meds to break down and leave body)
Issues with med use and older adults
Mutiple medical conditions, multiple physicians, multiple pharmacies, underuse, cost, noncompliance, lack of research (we just dont know)
Drug effects appear to be unpredictable which may be asummed as....
another health problem or just "old age". DONT ASSUME
It is harder for the elderly to..
process and metabolize medications
Side effect
An action of a drug other than the one for which it is being used
Adverse drug event (ADE)
injury resulting from the medical use of a drug
Preventable ADE
those that result from a med error in prescribing, dispensing, administering, or monitoring
Nonpreventable ADE
an injury resulting from the medical use of a drug where NO error is involved
Anaphylactic reaction
A severe allergic reaction that can be life-threatening
(small dose first and MONITOR)
Primary thing to assess with Anaphylactic reaction
AIRWAY
Penicillin
related antibiotics are the number 1 most common. These allergies kill 400 people in the US every year
Symptoms of ADE
confusion, nausea, decreased balance, change in bowel pattern. sedation, ortho hypotension (measure BP lying, sitting, standing)
Significant ADE
Falls w/o fractures, oversedation, rashes, hemorrhages not requiring transfusion or hospitalization without hypotension
Serious ADE
Delirium, falls WITH fractures, hemmorhages REQUIRING transfusions or hospitalizations WITHOUT hypotension
Life-threatening ADE
Hemorrhage with associated hypotension, liver failure, hypoglycemia (low BS) encephalopathy (brain disorder)
Most at risk for ADE's
new residents, 80+, multiple conditions, multiple meds, psychoactive meds, opioids, anti-infective drugs
What errors lead to ADEs?
Prescribing. monitoring, patient adherance
OTC pain relievers
Analgesics, antipyretics, NSAIDS, acetaminophen (toxic in high doses)
What should you review on any drug being considered
ACTIVE INGREDIENTS
MAIN POINT The important question to ask yourself as the nurse before giving meds
Do the potential benefits outweigh the potential risks for this patient
If you miss a dose, can you double up on the next dose?
NO
Can you bring medicine into the hospital when you are admitted?
YES
Are OTC meds always safe to take?
NO
Do herbal products interact with prescription or OTC meds?
YES
Medication Reconciliation
Process of identifying the most accurate list of all meds a patient is taking including name, dose, frequency, and route. Comparing the patients current list of meds against the physicians admission, transfer, and/or discharge orders.
What causes 50% of all med errors and 20% of ADE?
LACK OF COMMUNICATION
(everytime a pt moves facilities, HCP should reconcile)
Pharmacogenomics
Genetic polymorphisms
Personalized medicine
Medication Administration Record
Legal documentation that the nurse uses to sign off meds that are given.
First-pass effect
The metabolism of a drug before its systemically available, and it reduces the bioavailability (becomes available to the target tissue) of the drug
High alert meds can cause
significant patient harm.
What do you need to do for high alert meds before giving?
Check with a second RN
(these meds may be on a different med cart) [Show Less]