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54 Cards in this Set

  • Front
  • Back
Pharmacology
Greek for poison, or drug, or medicine, ology study of
Drug
any chemical substance other than those required for normal sustenance which produces a biological effect.
Pharmacokinetics
how the body interacts with the drug.
Pharmacodynamics
how drugs interact with cells, tissues, organs
Pharmacotherapeutics
the use of drugs to treat diseases
Toxicology
the study of adverse effects of drugs and other chemicals.
Nurses Role
Nurse is the last line of defense for giving medications!
Role of Nurse
* Administer medications
* Detecting drug related problems, primarily drug to drug interactions
* supervision of drug therapy
* Understanding the theraputic uses of and potential for injury with prescription, over the counter, herbal/complementary, and illicit drugs.
1906
the first us law passed to protect the public from altered drugs The Pure Food and Drug Act
1938
Mandate for testing of all drugs for harmful effects and accurate labeling.
1952
Clearer definition of prescription drugs, non-prescription, and drugs that cannot be refilled (narcoditics).
1962
Tightened controls over safety issues.
1970
categorized controlled substances on the basis of their relative potential for abuse.
1978
drug investigation process shortened to release drugs sooner to the public.
FDA
regulation and approval of all Rx drugs. Adverse drug reporting program.
PHS

Public Health Service
regulation of biological products: serums, viral preparations, antitoxins, anything used for the prevention, treatment, or cure of diseases. (in charge of H1N1 vaccine)
Product Liability
a state by state doctrine that holds manufacturers liable for injuries caused by defects in their products.
FDA approval process
1. animal studies
2. human studies
1. phase I - intial evaluation (prisioners)
2. phase II - limited controlled evaluation
3. phase III - extended clinical evauation
animal studies ascertain
* 3 levels of toxicity, acute, sub acute, and chronic
* therapeutic index
* modes of absorption, distribution, metabolism, and excretion
Phase I
a small # of human subjects to determine the pharmacokinetics of the drug
Phase II
administered to individuals with targeted disease.
Phase III
determines clinical effectiveness, safety, establishes tolerated dosage or range.
Legal administration
3 conditions need to exist for an RN to administer a drug


* the medication order must be valid
* the prescriber must be licensed by the state
* the nurse must know the purpose, actions, effects, and major side effects and toxic effects of the drug as well as the teaching required to enable the client to self administer the drug safely and accurately.
Nursing responsibility
* Need to know the physical characteristics of the drug
* need to know most common side effects
* look it up if it is new to you
* the nurse is responsible for every drug the administer. even if it is labeled wrong by the pharmacist.
Valid Orders
Leave no room for doubt (includes: dosage, route, dosing interval, prescribers name and signature)

worded in a way that is correct, complete, legible, and appropriate for the situation.
The six rights of administration
1. Right medication
2. Right Client (triple check: i.e. arm band)
3. Right dose
4. Right route (form of the drug, administration technique)
5. Right time
6. Right for patient to refuse the medication
Code of ethics
* promote health
* prevent illness
* restore health
* alleviate suffering (physical, emotional, psychological, financial)
* Principles of non malfeasance and beneficence (do no harm)
Principles of drug actions
* effectiveness
* safety
* selectivity
* plus: reversible, predictable, easy to give, no interactions, low cost, stable chemically, simple generic name
general properties of drugs
* drugs do no bring a new function only modify the existing function.
* Drugs exert multiple actions rather than a single effect.
* Drug action results from interaction with an important molecule in the body (almost always a receptor).
Naming of Drugs
* Chemical name - N-acetyl-para-aminophenol
* Generic name - acetaminophen
* Trade name - Tylenol
3 phase process
1. phase I - pharmaceutical
2. phase II - pharmacokinetic
3. phase III - phrmacodynamic
phase I pharmaceutical
* disintegration and dissolution of drug form
* drug becomes available for absorption
phase II pharmacokinetic
* absorption
* distribution
* metabolism
* excretion
phase III pharmacodynamic
drug receptor interaction
4 primary factors
1. absorption - parental vs enteral
2. distribution - transport to tissue
3. metabolism - primarily liver
4. excretion - primarily kidneys
absorption
* depends on route of administration
* absorbing surface (passive transport = faster)
* blood flow to the site (rich blood flow enhances)
* solubility of the drug (pH- acid in acid faster base in base slower)
* concentration (the more concentrated = faster)
Distribution
the amount of space in the body a particular drug has to fill up in order to provide blood levels that are measurable and meaningful.
Distribution variables
* blood flow to tissues
* ability of drug to exit vascular system
* body fat
* protein binding (albumin is #1 protein that medications adhere to)
* blood brain barrier
metabolism:

Biotranformation
* Hepatic transformation (CYP450)
* purpose is to remove foreign chemicals from body:
o increasing h2o solubility for elimination in urine
o inactivating chemical
o converting chemical for elimination through gut
* resulting in:
o inactivation
o change in active metabolite
o activation of a pro drug to an active substance
o activation to a toxic metabolite
Clinical implications of CYP450
* drugs either induce or inhibit other drug actions when they meet at P450
* induction can enhance the metabolism of other drugs taken concurrently. results - prevent effectiveness of drug therapy
* inhibit - block enzymes that metabolize other drugs leading increase concentrations of second drugs. results - toxicity.
factors effecting metabolism
* age - infants vs geriatrics (start low go slow)
* health - liver or renal disease
* environment - chemical inducers
* lifestyle - dietary, smoking, drinking (how much? what kind? how big?)
* genetics
elimination or excretion
* removal of drug from the body
* primarily in kidney in 3 step process:
o glomerular filtration
o passive re-absorption
o active secretion/transport
* other sites: lungs, sweat or salivary glands, mammary glands, hemodialysis.
Pharmacodynamics
* how drugs exert their action: 2 principles
o activate a series of cellular events creating a biological effect or
o the bind to receptors without stimulating, but block the effects of other chemicals that might act on that receptor
affinity
the degree of attraction between drug and receptor
efficacy
(intrinsic activity) the ability of a drug to initiate biologic activity as a result of binding to a given receptor (how effective)
agonist
a drug which gas both affinity and intrinsic affinity (e.g. - B-agonists, albuterol)
antagonist
a drug which has affinity, but no intrinsic activity (e.g. - beta blocker, metoprolol)
Maximal efficacy
the largest effect that a drug can produce
relative potency
the amount of drug that must be given to elicit an effect
tolerance
a change in the responsiveness to drugs
Biologic half-life
it is the time for the amount of drug in the body to decrease by 50%
Therapeutic Index (TI)
* The ratio between lethal dose LD50 and effective dose ED50 (want a wide index)
* A narrow TI - less safe the drug, usually requires drug blood levels to monitor effectiveness and prevent toxicity
predictors for adverse reactions
* age - infant and older adults
* body mass - too much or too little can be a factor
* pathological state (how sick are they)
* time of administration
* genetic factors
* psychological state
critical thinks concepts a guide to use
* purpose: what am i trying to accomplish?
* information: what do i need to settle the question?
* conclusions: how did i reach this conclusion and is there another way to interpret the information? (know all reasons!)
* concepts: what is the main idea here?
* assumptions: what am i taking for granted? (pharmacists labels correctly?)