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67 Cards in this Set

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Drug
Any chemical that can affect living processes.

Any substance that alters physiologic function with the potential of affecting health.
Medication
A drug administered for its therapeutic effects.
Pharmacology
The study of drugs and their interactions with living systems
Clinical Pharmacology
The study of drugs in humans
Therapeutics (Pharmacotherapeutics)
The use of drugs to diagnose, preven ot treat disease or to prevent pregnancy
Properties of an ideal drug
1. Effectiveness (elicits the response for which it is given)
2. Safety (Cannot produce harmful effects)
3. Selectivity (elicits only the response for which it is given (no side effects)
4. Reversible Action (Any chemical that can affect living processes)
5. Predictability
6. Ease of administration
7. Freedom from drug interaction
8. Low cost
9. Possesses a simple generic name
The therapeutic objective of drug therapy
To provide maximum benefit with minimum harm
Federal pure food and drug act of 1906
Required drugs to be free of adulterants (free of bacteria)
Food and Drug cosmetic act 1938
Regulated drug safety
Harris-Kefauver amendment, 1962
Required proof of effectiveness before marketing the drug
Controlled Substance Act of 1970
Categorized drugs based on potential abuse and medical usefulness:

Schedule 1 drugs: no acceptable medical use, high potential for abuse. eg. marijuana, heroin, coccaine

Schedule II drugs: acceptable medical use, also high potential for abuse, no RX refills allowed, expires 6 months eg. morphine, oxycodin

Schedule III: acceptable medical use, high potential for abuse, 34 day supply, RX req., no more than 5 refills in 6 months. eg. opiates

Schedule IV: Acceptable med. use, high potential for abuse, RX req. nor more than 5 refills in 6 months. eg. Valium

Schedule V: potential for abuse significantly less, may req. RX, no limits on refills, RX expire 12 month. eg. cough syrups
Food and drug admin modernization act of 1997
*fast tract approval for dugs for serious illness
*pt. notification prior to cease manufacture
*test drugs in children
*manufactures may provide physicians with journal articles about off label use - medication can be used on trial basis for purposes other than main use.
Drug Testing
*Pre-clinical testing usually takes 1-5 yrs.
*Clinical testing: four phases

1. Phase I: normal volunteers, evalueates drug metabolism and determines effects.

Phase II & III: tested in patients, determines therapeutic effects, dosage and safety

Phase IV: durg released for general use permitting observation in large population
Drug Testing : Limitations
Limited data in wome and children

Small numbers of patients in trials

patients carefully selected and may not represent the general population

Drug trials over a shor period of time
Pharmacodynamics
The physiologic and biochemical effects of a drug on the body
Information found on Drug labels
*NDC # - a # used by pharmacist to identify the drug and the method of pkg.

*Total amt. in container
*Trade name = brand name. The trade name is followed by manufactures name. Som meds. have TM after the trade name which stands for trade mark

*Generic name = acceptable name of the drug

*Strength of the drug: amount of meds. per unit of measure

*Form of the drug : type of preparation available

*Usual Dosage

*Route of admin: describes how meds. is administered


*Storage: req. conditions so drug does not lose potency


*Manufacture name

*Expiration date

*Lot number

*Additives
8
Pharmacokinetics
Processs by which a drug moves through the body and is eventually eliminated.
Processes Involved in Pharmacokinetics
Absorption
Distribution
Metabolism
Excretion
Absorption
Movement of a drug from its site of administration into the blood. i.e. Osmosis, Diffusion, Filtration

Rate will determine how effect will begin
Factors affecting absorption
*Rate of dissolution: quicker dissove, faster onset

*Suface Area: the larger the surface area, faster absorption

*Blood flow: more rapidly from sites where blood flow is high

*Lipid solubility: highly soluble drugs are more rapidly absorbed.
Distribution
Movement of drugs throughout the body

Three major factors
-Blood flow to the tissue
-Amount of amedication bound to protein
-Tissue specificity to the drug
Transportation
Way in which the dug is transported from the blood to the site of action

Some drugs bind to protiein and have to compete with other drugs for this storage site.
Metabolism
The enzymatic alteration of drug structure.

Most metabolism occurs in the liver

Consequence
-Drug inactivation
-Increased therapeutic action
-Activiation of produgs
-Increassed or decreased toxicity
Excretion
Removal of drugs from the body

May exit through unirn, bile sweat, saliva, breast milk and expired air, intestines, lungs.

Most drugs are excreted through the kidney
Factors modifying renal drug excretion
Age

Renal function

pH dependen ionization: by manipulating urinary pH, may promote ionization of a drug and hasten excretion.

Competition between drugs
Metabolism specical consideration
Aging process and/or disease state affects how medications are metabolized
Plasma Drug Levels
Minimum effective concentraion: drug level below which therapeutic effects will not occur

Toxic concentaritions: levels at which toxic effects begin

Therapeutic range:
-Peak levels: Highest 30-60 min. after medication administered
-Trough levels: Lowest: drawn just before a drug is administered
Drug Attachments
Receptor Site: When the drug forms a chemical bond at a specific site in the body

Agonist: Drug attaches at the receptor site and activates the reeptor; the drug has a similar action to the body's own chemical. Response is usually good.

Antagonist: Drug attaches at drug receptor site, but then remains chemically inactive; no chemical drug response.

Partial agonist: Drug attaches at drug receptor site, only a slight chemical action is produced.
Drug Interactions
May intensify the effects or reduce the effects (both therapeutic and side effects)

May be drug/drug interaction or food/drug interactions

Food frequently decreases the rate of drug absorption and can decrease the extent of absorption

Importance in time drug adminstration in relation to meals.
Principles of Drug Action
Pharmacodynamics: the physiologic and biochemical effects of a drug on the body.

Adverse effects: any effect other than the therapeutic effect.
-side effects
-Tolerance
-Allergic reactions
-Toxicity

Interactions:
*occurs when medication effects are altered by concurrent presence of other medication of food
**Synergism -increases drug effects
**Antagonism -decreases drug effects
Types of Medication Action
Therapeutic Effects- is the expected or predictable physiological response a medication causes

eg. Aspirin: analgesic, antipyretic, anti-inflammatory, antiplatelet aggregation

**It is important for the nurse to know for which therapeutic effect a medication is prescribed
Types of Medication Action

(Side Effects)
Are the unintended, secondary effets a medication predictably will cause. (Predicatable Effects)

They may be harmless or injurious
Types of Medication Action

(Adverse Effects)
Any effect other than the therapeutic effect. Severe response to a medication.

eg. a client may become comatose when a drug is taken.
Types of Medication Action

(Toxic Effects)
May develop after prolonged intake of a medication

Or when a meication accumulates in the blood because of impaired metabolism.

eg. toxic levels of Morphine may cause severe respiratory depression & death.
Types of Medication Action

(Hypersensitive Reaction)
Client is unusually sensitive to medications therapeutic or secondary effects
Types of Medication Action

(Tolerance)
Client develops decrease response to meds requiring increased dosage to achieve therapeutic effects
Types of Medication Action

(Idiosyncratic Reactions)
When a client over reacts or under reacts to a medication or has a reaction different from normal

eg. when a child after receiving Benadryl may become extremely agitated instead of drowsy
Types of Medication Action

(Allergic Reactions)
Another unpredicatable response to medication that make up 5% to 10% of all medication reactions.

Allergic symptoms vary depending on the individual & the medication.
Types of Medication Actions

(Medication Interactions)
When one medication modifies the action of another

A medication may potentiate or diminish the action of another medication

Or may alter the way in which another medication is absorbed, metabolized, or eliminated from the body.
Types of Medication Actions

(Synergistic Effect)
The effect of the two medications combined is greater than the effect of the medications when given separately.

eg. Alcohol is a CNS (control nervous system) depressant that has a synergistic effect on antihistamines, antidepressants, barviturate & narcotic analgesics.
Individual Variations in Drug Response
*Body weight and composition BSA

*Age: sensitiviy varies w/ age

*Gender: Very little testing in women

*Pathophysiology: renal or liver disease

*Tolerance: decrease response with repeated doses

*Failure to take a prescribed

*Diet: example some antibiotics are boind to protein and can be affected by protein in the diet.
System of Medication Distribution
Unit dose - involves pharmacy/manufactures and is in prepackaged and prelabel for indiv. client dose

Automated medication dispension system - machine contains meds. frequently used in a unit

Self Administered - supplies client w/ prescribed doses & quant. for a given period

Bar Code medication Administration - light weight handheld laser, laptop computer attached to med. cart and barcodes
Oral Medications
Tablets
Capsules
Syrups
Elixers
Sublingual
Buccal
Parenteral
Intravenous - faster absorp.
Intramuscular
Subcutaneous
Intradermal
Topical Preparations
Solutions
Creams
Lotions
Ointment
Transdermal - patch 24- 72hrs.
Routes of Medication
Instillation - medication is introduce in liquid form into a body cavity, where the medication dissolves at body temperature

Inhalation - medication is administered into the respiratory tract

Intranasal - instillation of medication into the nose

Topical - medication is applied to the external surface of the skin.
**Six Righst of Medication Administration**
Right client, Right medication, Right dose, Right time, Right route, Right documentation

**Check pt. ID bracelet, Medical Record #, Dr.'s order
The seven parts of a drug order
Name of the client

Date drug was ordered

Name of the drug

Dosage

Route of administration and nay special rules of administration

Time and frequency the drug should be administered
Signature of individual ordering the drug
Types of Drug Orders
Routine Orders
-drug is administered daily, at dosing intervals until it is discontinued
-know hosp. stop policy
-7 days for antibiotic
-48 hours for narcotics

PRN Orders
-given on an as needed basis
-usually antipyretics are ordered prn
-given only once

*Telephone or drug orders
Medication Assessment
During init. assess, obtain:
-Medication History
1.name, dose, schedule, purpose of medication
2. use of OTC meds.

-Allergies and Intolerance (food and drug)
-Medical History
-Pregnancy and lactation status
Before Medication Administration check the following
Medication Record
Diet and fluid orders
Lab Values
Physical Assessment -ability to swallow, GI Motility, VS, Body systems assessment, adequate venous access, adequate muscle mass
Medication Administration
**Never administer and unfamiliar medication

*Before giving any drug
-understand the conditio of the client for whom the medication is ordered

*Know the following
-dosage ranges
-the expected therapeutic effects
-possible adverse action or interaction with other meds.

*Be prepared to teach the client the meds. purpose
*Be ready to answer questions about meds. use
*Information souces: Drug handboood, PDR, pharmacist.
Client Rights
Right o expec t safe and appropriate drug administration by the nurse

Right to refuse to take meds.
-the nurse should explain to the client the importance of taking the medication
-attempt to clarify the client's concern about the meds.
-notify the prescriber, including info. about client's concern
Safe Medication Administration
**Accurately interpret the prescriber's order
*Accurately calculate the amount of drug to give for the prescribed dose
*Develop a systmatic and safe procedure using the "Five Rights" for drug admin.
*Document med. admin. according to agency policy
Medication Errors
*When a med. is not admin. as order.
*Med. admin. as ordered, but ordered is not appropriate for pt.
*Improper Documentation
*Violation of the five rights
Routes of Medication
Instillation - medication is introduce in liquid form into a body cavity, where the medication dissolves at body temperature

Inhalation - medication is administered into the respiratory tract

Intranasal - instillation of medication into the nose

Topical - medication is applied to the external surface of the skin.
**Six Righst of Medication Administration**
Right client, Right medication, Right dose, Right time, Right route, Right documentation

**Check pt. ID bracelet, Medical Record #, Dr.'s order
The seven parts of a drug order
Name of the client

Date drug was ordered

Name of the drug

Dosage

Route of administration and nay special rules of administration

Time and frequency the drug should be administered
Signature of individual ordering the drug
Types of Drug Orders
Routine Orders
-drug is administered daily, at dosing intervals until it is discontinued
-know hosp. stop policy
-7 days for antibiotic
-48 hours for narcotics

PRN Orders
-given on an as needed basis
-usually antipyretics are ordered prn
-given only once

*Telephone or drug orders
Medication Assessment
During init. assess, obtain:
-Medication History
1.name, dose, schedule, purpose of medication
2. use of OTC meds.

-Allergies and Intolerance (food and drug)
-Medical History
-Pregnancy and lactation status
Before Medication Administration check the following
Medication Record
Diet and fluid orders
Lab Values
Physical Assessment -ability to swallow, GI Motility, VS, Body systems assessment, adequate venous access, adequate muscle mass
Medication Administration
**Never administer and unfamiliar medication

*Before giving any drug
-understand the conditio of the client for whom the medication is ordered

*Know the following
-dosage ranges
-the expected therapeutic effects
-possible adverse action or interaction with other meds.

*Be prepared to teach the client the meds. purpose
*Be ready to answer questions about meds. use
*Information souces: Drug handboood, PDR, pharmacist.
Client Rights
Right o expec t safe and appropriate drug administration by the nurse

Right to refuse to take meds.
-the nurse should explain to the client the importance of taking the medication
-attempt to clarify the client's concern about the meds.
-notify the prescriber, including info. about client's concern
Safe Medication Administration
**Accurately interpret the prescriber's order
*Accurately calculate the amount of drug to give for the prescribed dose
*Develop a systmatic and safe procedure using the "Five Rights" for drug admin.
*Document med. admin. according to agency policy
Medication Errors
*When a med. is not admin. as order.
*Med. admin. as ordered, but ordered is not appropriate for pt.
*Improper Documentation
*Violation of the five rights
Medication Errors

(How to handle)
*Report med. admin. errors immediately
*Complete a medication incident reprot
*If you find an error in a medication order (questionable route or dose), must question and clarify the order.
*If you do not understand the handwriting, questtion the order
Medication Safety
*Medication safey is part of the National Patient Safety Goal mandated by JCAHO
*Do not use abbreviations
*Mediaiton Reconciliation
*Removal of concentrated Electrolyte
*Separation of Sound alike-look alike medication
*Use patient identifiers