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242 Cards in this Set
- Front
- Back
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what is pharmacology
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study of medicines
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synthetic drug source
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drugs chemically made
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natural drug source
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derived from roots, lleaves, or bark of plants; animal sources;microbial sources and mineral sources
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medications elicit different responses depending upon...
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client age, sex, body mass, health status, and genetics
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pharmacotherapy
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is the application of drugs
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Therapeutics
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Branch of medicine dealing with prevention of disease and treatment of suffering
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Drug
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a chemical agent capable of producing biological responses. A drug is a drug until it is given....then it is a medication.
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Biologic
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An agent naturally produced in animal cell, by microorganisms or by the body itself. Ex..hormones
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CAT
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Comlementary and Alternative medicines....unconventional
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Prescription
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requires an order from an healthcare provider
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Drug
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a chemical agent capable of producing biological responses either therapeutic or adverse, within the body. A drug is a drug til it is given..then it is considered a medication
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biologic
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an agent naturally produced in animal cells, by microorganisms, or by the body itself...Ex: hormones
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CAT
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Complementary alternative therapies....Unconventional....ex: Acupunture
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Formualry
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1st standard used by pharmacists...List of drugs and drug recipes
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FDA
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Food Drug Administration...
Keep drugs available safe.... Regulates the use of biologics "authority" |
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therapuetic classification
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What a drug does?
Usefullness....Effect |
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Pharmacalogical classificatio
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How does the medication work?
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Mechanism of action
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How the drug produces and its effect in the body?
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Prototype Drug
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well understood drug model with which other drugs in a pharmacological class is compared.
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Example of a Prototype drug?
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Morphine
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3 basic Types of drugs names
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chemical
trade generic |
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chemical name
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complicated name
one name only |
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generic name
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all lower case
less complicated one generic name |
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trade name
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many brands and trades
ex: tylenol and advil |
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combination drug
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a drug that contains more than one active ingredient
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Bioavailabilty
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Ability of the drug to reach its target cells to produce the effect.
Length of time it takes to exert its effect |
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Controlled substances
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narcotics
abuse potential |
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Dependance
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is a psychological or physiological need of the drug
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Physical Dependence
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refers to the altered physical condition caused by the adaption of the nervous system to repeated drug use. when this happens withdraws occur
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Withdrawal
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the is no longer available and the individuals express physical sign of discomfort
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Psychological dependence
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exhibits few signs of physical discomfort with drug withdrawal, but does feel an intense compelling desire to continue drug use. Having an addicition but showing no signs of it
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Schedule drugs
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classified according to their potential for abuse though not all drugs with an abuse potential are regulated
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Before the nurse gives any drug she must know:
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What drug is ordered?
Name and class of drug. Intended use. Effects on the body. Contraindications Side Effects Nursing Process |
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Adverse reactions
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an unexpected or dangerous reaction to a drug
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allergic reaction
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an aquired hyperresponse of body defenses to a foreign substance
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Allergic reactions cause...
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skin rash
urticaria(hives) edema runny nose teary red eyes |
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Anaphylaxis
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a severe type of allergic reaction that can lead to death
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5 rights of drug admnistration
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right patient
right drug right dose right route right time |
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3 checks of drug admnistration
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1. checking the drug with the MAR when removing it from the med drawer, refriderator, or controlled substance locker.
2. checking the drun when preparing it. taking it out, or connectiong it to the IV tubingto the bag 3. checking the drug before giving it to the pt. |
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Compliance
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taking a medication in the manner prescribed by teh practitioner, or with OTC drugs, following the instructions on the label.
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3 routes of drug administration
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Enteral
topical parental |
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3 types of IV administration
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Large volume infused
Intermittent infusion IV bolus |
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Large volume infused
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Normal saline...fluid maintenance, replacement, or supplementation
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Intermittent infusion
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antibiotics, analgesics...small amounts arranged tandem with or piggy backed to teh primary large volume infusion
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IV bolus
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concentrated dose deliveered to the blooodstream...IV push
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pharmacokinetics
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the study of drug movements throughout the body. How the body handles the drug...
How easy the drug can pass |
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For drugs given the enteral route....
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stomach acids and digestive enzymes often act to break down the drug molecules
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Enzymes in the liver and other organs may....
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chemically change the drug molecules to make it less active
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phagocytes may...
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attempt to remove the drug or trigger an immune response, if the body views the drug as foreign
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4 processes of pharmacokintics
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Absorption
Distribution Metabolism Excetion |
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Much of how the body moves medication throughout it depends upon....
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the ability of the drug to move across the plasma membrane
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2 processes to cross the plasma membrane
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1. diffusion or passive transport
2. active transport |
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Diffusion
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Lipid soluable enzyme...the movement from a chemical agent from an area of higher concentration to an area of lower concentration
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Active transport
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Large Ionized.....drugs that are water soluable
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absorption
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the PRIMARY pharmacokinetic FACTOR determining the length of time it takes a drug to produce its effect
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drugs can be absorbed thru...
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the skin and mucous membranes...
Lining of the GI or respiratory tract. |
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the more rapid absorption...
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the faster the onset action
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distribution
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involves the TRANSPORT of pharmacologic agents throughout the body and is mostly influenced by the amount of blood flow to the body tissues
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Distibution depends on....
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the blood flow
proteins available medication solubility |
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organs that receive the most blood supply....
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heart
liver kidneys brain |
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.....recieve a lower blood flow
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skin
bone and adipose tissue |
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affinity
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the ability to accumulate and store drugs after absorption.
examples....bone marrow, teeth, eyes, and some tissues |
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drug protein complexes
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is formed when some drugs bind reversibly to plasma proteins, particularly albumin
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drug protein complexes are...
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too big to cross capillary membranes therefore the drug is not available for distribution to body tissues
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blood brain barrier and fetal placental barrier...
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inhibit many chemicals and meds from entering. most anti-tumor drugs do not easily cross, making brain tumors difficult to treat.
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metabolism
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alson known as biotransformation.....is the process of CONVERTING the drug to a form that makes it easier to excrete.
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Primary site of drug metabolism...BREAKS DOWN
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the liver
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conjugates
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side chains that make drugs more water soluable and more easily exctreted out of the kidneys during metabolism
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P-450
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Enzyme that helps with the breakdown and inactivates drugs and speeds up excretion
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enzyme induction
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the ability to increase metabolic activity in the liver. the drug increases the rate of its own metabolism, therefore requiring higher doses of medications to be given to the pt. to achieve optimal therapuetic effect.
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first pass effect
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a phenonmenon of drug metabolism whereby a drug with a high pass effect will render inactive.
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alternative routes of delivery to bypass first pass effect...
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sublingual
rectal parental |
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excretion
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Process in which drugs are removed from the body
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duration of action
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determines the rate at which meds are excreted and thier concentration in the bloodstream and tissues.
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diseases that effect excretion
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renal diseas
liver disease renal failure |
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kidneys
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primary site for excretion
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easily excreted and filtered at the glomerulus are....
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free drugs
water soluable agents electrolytes small molecules |
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too large to filter due to their size are....
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protiens
blood cells drug protein complexes |
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therapuetic range
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the plasma drug concentration between the minimum effect concentraton and the toxic concentration.
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the amount of meds that give the intended benefit while minimizing or avoiding side effects
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therapuetic effect
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the most common description of a drugs duration of action is....
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plasma half life (t 1/20
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half life
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the length of time required for the plasma concentration of a medication to decrease by half after admninstration.(time it needs for the med to leave your system)
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the greater the half life....
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the longer it takes for the medication to be excreted
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the shorter the half life....
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the more often the drug must be taken
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name to 2 plasma drug levels
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minimum effective concentration
toxic concentration |
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minimum effective concentration
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the amount the ddrug is required to produce a therapeutic effect.
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toxic concentration
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the level the drug will result in serious adverse reactions
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a plateau is reached when the level of drug is....
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mainitained continuiously within the therapeutic range, resulting in equilibrium....Goal is to keep the patient pain free
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how many half lives does it take to reach equilibrium?
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4
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a plateau can be reached by....
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adding a loading dose
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loading dose
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a higher amount of the drug, often given only once or twice, that is administered to PRIME the bloodstream with a level sufficient to quickly induce a thereapeutic response.
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maintenance dose
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intermittent doses given to keep the plasma drug concentration in the therapeutic range
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serum drug levels are monitored....
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by drawing a lab speciman and measuring the level of the drug in the serum
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to ensure therapeutic ranges are maintained...
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certain medications such as antibiotics, digoxin and warfarin are monitored and tested for thier serum drug levels
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trough level
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point at which the drug is at its lowest concentration. the specimen is contained in the 30 minute interval before the next dose
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The peak level is the highest plasma concentration and should be measured ....
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when absorption is complete
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pharmacodynamics
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the process by which drugs alter cell physiology and effect the body
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frequency distribution curve
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graphical represention of the number of clients responding to a drug action at different doses
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median effective dose
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the dose required to produce a specific therapeutic response in 50% of a group of pts. (ED50)
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median lethal dose
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the dose of drug that will be lethal in 50% of animals treated in preclinical trials (LD50)
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therapeutic index
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the ratio of a drugs median effective dose and its median lethal dose. the larger the index the greater the therapuetic index
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the therapeutic index is a measure of a drugs safety margin:
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the higher the value, the safer the medication
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median toxicity dose
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dose measured in a clinical setting that will produce a given toxicity in 50% of a group of patients...this is tested in humans (TD50)
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graded dose response relationship
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measures a clients respnse to a drug at different doses
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3 phases of the graded dose respose relationship
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1st phase..lowest dose
2nd phase..straightline portion of the curve 3rd phase...plateau is reached |
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2 fundamnetal ways to compare drugs within the same therapeutic and pharmacological class
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potency and efficacy
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potency
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a drug that is more potent will produce a therapeutic effect at a lower dose, compared with another drug int he same class
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efficacy
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the magnitude of maximal response that can be produced form a particular drug
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cellular receptors
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are cellular macromolecules to which medications bind to initiate its effect
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3 types of drug receptor interactions
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agonists
partial agonists antagonists |
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agonists
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a drug that produces the same type of response as the endogenous substance sometimes Producing A Greater Maximal Response than the endogenous chemical.
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partial agonist
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a drug that produces a weaker response than an agonist....it is less effacious
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antagonist
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a drug will occupy a receptor and PREVENT the endogenous chemical from acting...will compete with the agonist for the receptor binding site
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adverse drug effects
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the undesireable effects other than the intended therapeutic effect
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types of adverse drug effects
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allergic effect and analphylaxsis
drug tolerance toxic effect cummalative effect idiosyncratic effect tachyphylaxis |
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drug tolerance
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body becomes accustomed to the effects of a particular drug over a period of time
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toxic effect
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toxicities that carry risk for permanent damage or death
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cummulative effect
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occurs whe the body cannot metabolize one dose of a drug before another dose is administered
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idiosyncratic effect
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an UNUSUAL RESPONSE to s drug that may manifest itself by over-response, or even opposite the expected response
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tachyphylaxis
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an acute tolerance
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antagonist effect
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the combined effect of 2 or more drugs acting simutanelously to produce an effect that is less than that of each drug alone.
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synersistic effect
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the effect when 2 or more drugs acting simutaneously produce an effect greater than that of each drug alone
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Factors affecting drug action
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developmental considerations:cause birth defects
weight: the weight of person is largely based on the action of drug Gender: distribution of body fat and fluids has s ome effect..women ave more body fat than men genetic and cultural factors: religious restrictions psychological factors: pts expectation of the drug pathology: presense of disease affects drug action environment: sensory deprivation or overload timing of administration: food decreases absorption |
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Placebo
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a pharmacologically inactive substance
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nurse is resposible....
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for knowing if the drug is working or not.
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nursing process
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a systematic method for problem solving...nurses deliver care to patients
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5 steps of the Nursing Process
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Assessment
Nursing diagnosis Goal and outcomes Implementation Evaluation |
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Assessment
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1st step in the nursing process that includes ...
Health history Intitial nursing assessmnet ongoing assessments helps evaluate the outcomes of the medication use. |
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key components of pts. health history
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allergies
past medical history past and present meds use of alcohol, drugs,caffeine and tobacco health risks reprductive health |
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What the physical assessment entails...
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objective vs. subjective data....what you see and what the pt. tells you
vital signs weight and height head to toe physical assess. lab data |
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Ongoing assessment
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an assessment that includes systematic monitoring and observation relating to specific problems. Allows the nurse to broaden the database or to confirm the validity of the data obtained during the initial assessment.
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what is asked during the ongoing assessment?
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are the therapeutic benefits of the med being experienced? if not/why?
Review dosages, scheduling of meds, and serum drug levels ability to self administer? understnds the meds medication storage at home? any difficulty with administration can the med be obtained or afforded? |
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NURSING DIAGNOSIS
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a statement that describes the patients actual or potential response to a health problem that the nurse is licensed and competent to treat.
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Goals and outcomes between the nurse and the pt.
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goals focus on what the client should be able to achieve and do, based on the nursing diagnosis established from the assessment data
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key interventions
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are the interventions aimed at returning the client to the optimum level of wellness and limiting adverse effects related to the clients medication diagnosisor condition.
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key interventions that nurses monitor...
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therapeutic effect
side effects adverse effects teaching..CLIENT TEACHING REGARDING MEDICATION ADMIN. IS CRUCIAL!! documentation |
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Evaluation
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the final step in the nursing process...the process comes full circle as the nurse reassures the client, reviews the nursing diagnosis, makes necessary changes, reviews and rewrites goals and outcomes, and carries out further interventions to meet the goals and outcomed.
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Growth
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the term that characterizes the progressive increase in physical size.
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Development
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functional changes in the physical, psychomotor, and cognitive capabilities of a living being.
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polypharmacy
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concurrent use of multiple medications.
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Elderly and drug dosages
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elderly have less body water making effects of dehydration more; increasing the risk for drug toxicity.
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Elderly require less...
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smaller doses and it is up to the nurse to slowly increase the amount to a safe level. because of aging liver
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metabolism in the older client...
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because of decreased liver mass...function of the first pass effect is reduced
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Excretion of the older client
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elderly have reduced renal blood flow...reduced glomerula filtration rate....and reduced nephron function decreases excretion in drugs eliminated by the kidneys.
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Human integration pyramid
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provides a basic framework of the functional environment and interrelationships in which human beings exist.
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levels of the human integration pyramid
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Age Corollaries
Gender Determnants Generic Predispositions Community-Environment Factors Cultural and ethnic perpspectives psychological-social-spiritual dimension |
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all levels of the human integration pyramid are....
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important and interconnected
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Issues that can have a great impact on wellnesss and preferred methods of medical treatment, nursing care and pharmacotherapy are...
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Suffering
Loneliness Despair Death Hope |
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A better drug compliance....
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if the client believes the treatment is important and beneficial.....clients who are convinced that thier treatment is improtant and beneficial to thier well being will demonstrate better compliance with drug therapy.
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obstacles to access to health care...
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Inadequate health insurance
cost of treatment and drugs limited medical care in rural areas |
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polymorphisms
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single based mutation in DNA
amno acid change in enzyme enzyme function change |
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Enzyme change
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Increases metabolism of certain drugs..
decreases metabolism of certain drugs... depends on the disease |
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Pain
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is the physical suffering or distress as due to injury, illness, etc...
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non opioid analgesics
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steroid antiflammatory drugs
NSAIDS tylenol |
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narcotic/opiod analgesics
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all controlled substances
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narcotic
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used to describe morphinelike drugs that produce analgesia and CNS depression..
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Inflammation
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the body's protective response to injury
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"itis"
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inflammation
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acute inflammation
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resolves with in 8-10 days
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chronic inflammation
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may continue for months or years
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When injury occurs what is released?
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inflammatory mediators
Ex...histamines...leukotriunes |
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Mediators in inflammation cause...
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vasodilation
capillary permeability stimulation of the nociceptors |
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nociceptors
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free nerve endings strategically located throughout the body
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neuropathic pain
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pain due to the injury to the nerves
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nociceptor pain
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pain die to the injury of the tissues
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Somatic pain
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sharp pain
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visceral pain
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dull, throbbing pain
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subtance P
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a neurotransmitter resposible for CONTINUING the pain message, although other neurotransmitter candidates have been proposed
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endogenous ipioids
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endorrphins, dynorphins, and enkaphalins
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Analgesics
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meds to RELIEVE pain
opioids and non opioids |
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narcotics
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opiods that produce numbness and stuporlike symptoms
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opiates
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natural substances
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opioid antagonist
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blockers of opioid activity
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narcan
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used to reverse the symptoms of opioid toxicity or overdose....opioid antagonist
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methadone maintenance
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therapy used to give as a substitute to avoid withdrawals from another drug that the pt. has an addiction to
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5 sign of inflammation
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Heat
Edema Loss of function Pain Redness |
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Bradykinin
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present in an inactive form in plasma and mast cells; vasodilator that causes pain; effects are similar to those of histamine
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prostaglandins
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present in most tissues and stored and released by mast cells; increase capillary permeability; attract white boold cells to site of inflammation and cause pain
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histamine
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stored and released by mast cells; cause dilation of blod vessels, smooth muscle constriction, tissue swelling and itching
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mast cells
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detect foreign agents or injury and respond by releasing histamine, which initiates the inflammatory response within seconds
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steriod anti-inflammatory drugs
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decrease production of prostaglandins and histamine release, inhibits WBC function
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Short acting corticosteroid..
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cortisone
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Intermediate acting corticosteroid...
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prednisone
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long acting corticosteriod...
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decradron
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do not administer corticosteroids to pts with...
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active infections such as viral, bacterial and fungal infections. caution to pts with HIV, TB and cancer. cause potential serious adverse effects
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side effects to corticosteroids in the CNS
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mood changes, depression, euphoria, restlessness and irritability
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side effects to C.steroids in the CVS..
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blood clots
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side effeccts to C steriods in the GI...
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ulcers, bleeding, increased appetite
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Non systemic corticosteriods..
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nasal
inhaled topical opthalmic |
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systemic corticosteroids
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Oral
IV IM |
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side effects to c.steroids in the DERM...
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susceptibilty to infection, bruising, delayed wound healing, acne, and thinning of the skin
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side effects to c. steroids in the ENDO....
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hyperglycemia (high blood sugar), adrenal supression
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Cushings Syndrome
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side effect to c. steroids....causes...buffalo hump, moon face, central obesity, facial hair and acne
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C. steroids nursing implications.....
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Monitor for side effects!!!! taper dose as ordered
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taper dose
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when pts. symptoms are being resolved
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Patient teaching for C. steroids
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Take with food
If ordered daily take in am do not d/c abruptly Monitor BP Monitor Blood sugars |
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NSAIDS
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Non steroidal anti-inflammatory drugs
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types of NSAIDS
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aspirin
ibuprofen Cox 2 inhibitors |
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ASA
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aspirin
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Aspirin
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an analgesic, anti inflammatory and antipyretic
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action of aspirin
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inhibits prostaglandin synthesis
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contraindications of aspirin
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hypersensitivity (pts with asthma increase risk)
reyes syndrome bleeding disorders |
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reyes syndrome
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an uncommon, severe disorder occurring primarily in children after a viral illness, as influenza or chickenpox, and associated with aspirin usage, involving swelling of the brain and liver and affecting other organs: symptoms include fever, projectile vomiting, confusion, and, sometimes, respiratory arrest
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adverse reactions to aspirin
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GI most common...GI bleed, nausea, dyspepsia(indigestion),abd. pain
Long term can cause neuropathy |
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nursing implications for aspirin
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Pre- op...usually d/c 7-10 days before pre-op
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pt teaching for aspirin,,
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not for children
take with food avoid etoh do not take with tylenol or other NSAIDS for for than 3 days: can cause neuropathy |
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adverse effects of Ibuprofen
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GI most common (abd. pain, N/V, GI bleed)
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Pt. teaching with Ibuprofen
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take with full glass of h2o
do not exceed greater thana 3,600 mg a day Signs of GI bleeding Avoid taking with ASA avoid etoh |
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cox 2
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ex: Celebrex
inhibits the enzyme cox1 that converts arachidonic acid into prostaglandins |
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contraindications of cox2
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if allergic to NSAIDS and ASA , may also be allergic to cox 2 inhibitors
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adverse reactions for cox 2
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diarrhea, abd pain, GI bleed, risk of CVA/MI, renal impairment
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Nursing implications for cox 2 inhibitors
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assess ROM, swelling and joint pain, GI bleed ( abd. pain, black tarry stool), edema, unexplained weight gain
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Pt teaching for cox 2 inhibitors
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same as Ibuprofen
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Tylenol
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acetaminophen (APAP)
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hidden doses in tylenol
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cold meds
cough syrup opioid meds |
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action of tylenol..
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weakly inhibits prostagladins synthesis and acts on the hypothalamus to decrease fever
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indications of Tylenol..
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relief of mild- moderate pain and fever....tylenol has NO ANTI INFLAMMATORY EFFEC!!!!
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overdose of tylenol causes....
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liver failure and toxic dose= DO not exceed 4 grams/day (adult)
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Treatment of tylenol overdose...
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mucomyst (acetylcysteine)
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Fever
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increase in body temperature, comonly caused by infectious agent
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antipyretics
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medications that decrease fever
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3 types of antipyretics
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NSAIDS
Tylenol ASA |
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schedule I narcotic..
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highest abuse potential, unacceptable...
Ex..LSD, Heroin |
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Schedule II narcotic..
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high abuse/ physical and psychological dependancy potential..
--RX in writing: no refils Ex..Demerol..methadone..morphine and percocet |
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Schedule III narcotic
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intermediate abuse/ dependancy
--telephone orders accepted: may have up to 5 refils Ex: Lortab, hydrocodone, codeine combo drugs (tylenol 3) |
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schedule IV narcotics
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lesser abuse/ dependency potential
ex: darvocet |
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Schedule V narcotics
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lowest abuse potential
Ex: cough medicine with codeine |
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controlled substances
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narcotics
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morphine sulfate
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binds to opioid receptors in the CNS where they act as agonists of endogenously occuring opioids
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indications of morohine sulfate
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relief of moderate to severe pain (acute, chronic and terminal)
--preoperative sedation --also used for severe diarrhea and cough |
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morphine sulfate dosage..
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varies..depending ont he wieght of the pt.
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adverse effects of morphine sulfate
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Resp- respiratory depression and cough supression
CVS- decreased BP, orthostatic hypotension, brardycardia GI- constipation, N/V ( stimulates chemoreceptor trigger zone) CNS- sedation, confusion |
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Diaphoresis
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sweating
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medications prescribed along with morphine to treat side effects...
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antihistamine-itching
laxative- constipation antiemetic- N/V |
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nursing implications for morphine
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Goal: adequate pain mgt. with lowest dose
Use non pahrm therapies whenever possible adjuvent (assist in prevention) Elderly more prone to side effects make sure V/S are monitored (hold if RR is <12/min) |
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mursing implications with morphine..
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turn, cough, deep breath...prevent atelectasis (collapsed lung)
--prevent constipation..give stool softener if >2-3 days of use |
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when giving morphine doses the nurse must always....
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be witnessed!!
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pt teaching with morphine..
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PRN
PCA pumps do not crush SR's constipation |
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clinical descision making when resp. depression is preceded by sedation...
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1-awake and alert..no action required
2-occasionally drowsy. easy to arouse..no action required 3-frequently drowsy, drifts off to sleep during conversation=decrease dose and or frequency 4- sleeping w/little or no response to stimuli= D/C med or administer Narcan per dr. order. |
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Fear of addiciton...
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main reason pt is undermedicated.
misunderstood by pts, md's nurses true addiction is psychological in orgin |
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s/s of physical dependance
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start 6-8 hours after D/C'd
anxiety,chills, irriatability, hot flashes,joint pain, sweating, vomiting easily avoided by weaning |
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prodrug
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drug that becomes more active after it is metabolized
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