decrease the metabolism rate causing excess drug Then you will have success if you are careful

to to toxicity accumulation which can leadobserve the decrees and laws

that the LORD gave Moses for Israel. Be strong and courageous. Do not be afraid or discouraged.

1 Chronicles 22:13

Fundamentals of Pharmcology
Pharmacokinetics is the process of drug movement to achieve drug action. The 4 process are absorption, distribution, metabolism/biotransformation, and excretion/elimination Pharmacodynamics is the study of drug concentration and its effects in the body Drugs that are lipid soluble and non-ionized are absorbed faster than water soluble and ionized drugs Excipients are fillers and inert substances are used in drug preparation to allow the drug to take on particular size and shape and enhance drug dissolution Generally, drugs are both disintegrated and absorbed faster in acidic fluids with a pH of 1 or 2 rather than in alkaline fluids Most oral drugs are absorbed in the surface area of small intestine through the action of the extensive mucosal villi. Absorption is reduced if the villi are decreased in numbers Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, than in those that have fewer blood vessels. SubQ tissue has fewer vessels, so absorption is slower in such tissue Bioavailability of the drug is the percentage of administered drug dose that reaches the systemic circulation. The percentage of bioavailability for the oral route is always less than 100%, but for the IV route, it is usually 100% The process in which the drug passes to the liver first is called first pass effect, or hepatic first pass. Some drugs do not go directly into the systemic circulation following oral absorption but pass from the intestinal lumen to the liver via the portal vein. The portion of the drug that is bound is inactive because it is not available for the receptors and the portion that remains unbound is free, active drug. Only free drugs are active and can cause pharmacologic response When two highly protein bound drugs are given concurrently, they compete for protein-binding sites, thus causing more free drug to be released into the circulation The liver is the primary site of metabolism. Liver diseases such as cirrhosis and hepatitis can The half life (t) of a drug is the time it takes for one-half of the drug concentration to be eliminated. Metabolism and elimination affect the half-life of the drug The main route of drug elimination is through the kidneys (urine) The kidneys filter free, unbound, water soluble drugs and drugs that are unchanged. Protein bound drugs cannot be filtered through the kidneys. The urine pH influences drug excretion. Acid urine promotes elimination of weak base drugs, and alkaline urine promotes elimination of weak acid drugs, like aspirin. The most accurate test to determine renal function is creatinine clearance (CLcr). Creatinine is a metabolic byproduct of muscle that is excreted by the kidneys. A decrease in GFR results in increase creatinine level and decrease in urine creatinine clearance Drug response can cause a primary or secondary physiologic effect or both. Dipenhydramine (Benadryl) has the primary effect to treat symptoms of allergy, and the secondary effect is a CNS depression that causes drowsiness Onset of action is the time it takes to reach the minimum effective concentration (MEC) after a drug is administered Peak action occurs when the drug reaches its highest blood or plasma concentration Duration of action is the length of time the drug has a pharmacologic effect Most receptors, protein in structure are found on cell membranes. Drug binding sites are primarily on proteins, glycoproteins, proteolipids and enzymes Drugs that produce a response are called agonists, and drugs that block a response are called antagonists Almost all drugs, agonists and antagonists, lack specific and selective effects. Drugs that affect various sites are non specific drugs. Drugs that affect various receptors are non selective drugs Categories of drug action includes: o Stimulation or depression, which increases or decreases the rate of cell activity or secretion from a gland o Replacement drugs, such as insulin replace essential body compounds - 1 -

NURSING FACTS IN BRIEF

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Drugs that inhibit or kill organisms interfere with bacterial cell growth Drugs that act by the mechanism of irritation, like laxatives irritate the inner wall of the colon, thus increasing peristalsis and defecation

Idiosyncratic reactions are the result of abnormal reactivity to a drug caused by genetic differences between the patient and non reacting individual Drug tolerance occurs when a client develops a decreased response and requires higher dose. Drug tolerance to a frequently repeated administration of a certain drug is known as tachyphylaxis Pharmacogenetics is the effect of a drug action that varies from a predicted drug response because of genetic factors or hereditary influence A placebo effect is a physiologic benefit from a compound that may not have the chemical structure of a drug effect The traditional five rights are (1) the right client (2) the right drug (3) the right drug (4) the right time and (5) the right route The five additional rights are (1) the right assessment (2) the right documentation (3) the clients right to education (4) the right evaluation (5) the clients right to refuse The right client can be ensured by checking the clients identification bracelet and by having the client stating his/her name. A telephone order (TO) or verbal order (VO) for medication must be cosigned by the prescribing health care provider within 24 hours To avoid drug error, the drug label should be read three times: (1) at the time of contact with the drug bottle or container, (2) before pouring the drug, and (3) after pouring the drug Check that the medication order is complete and legible. If the order is not complete or legible, notify the nurse manager and physician In the traditional stock drug method, the drugs are dispensed to all clients from the same containers. In the unit dose method, drugs are individually wrapped and labeled for single doses Calculate the drug dose correctly. When in doubt, the drug dose should be recalculated and checked by another nurse When the drug has a long half-life (T), the drug is given once a day. Drugs with a short half life are given several times a day at specified intervals Administer drugs that are affected by foods, such as tetracycline, before meals. Administer drugs that can irritate the stomach, such as potassium and aspirin, with food to decrease GI discomfort Assess he clients ability to swallow before administration of oral medications. Do not crush or mix medications with foods or beverages or other substances before consultation with a pharmacist. Do not mix medications in an infants formula feeding The right assessment requires that appropriate data be collected before administration of the drug - 2 -

The therapeutic index (TI) estimates the margin of safety of a drug through the use of a ratio that measures the effective dose (ED) in 50% of persons or animals and the lethal dose (LD) in 50% of animals. The closer the ration is to 1, the greater the danger of toxicity Drugs with a low therapeutic index have a narrow margin of safety. Drugs with a high therapeutic index have a wide margin of safety and less danger of producing toxic effects The therapeutic range (therapeutic window) of a drug concentration in plasma should be between the minimum effective concentration in the plasma for obtaining desired drug action and the minimum toxic concentration, the toxic effect Peak drug level is the highest plasma concentration of drug at a specific time. The trough level is the lowest plasma concentration of a drug, and it measures the rate at which the drug is eliminated When immediate drug response is desired, a large initial dose known as the loading dose, of drug is given to achieve a rapid minimum effective concentration in the plasma Side effects are physiologic effects not related to desired drug effects. These are essentially harmless and can be ignored Adverse reactions are more severe than side effects. Adverse reactions are always undesirable and must always be reported Toxicity results from over-dosage or build up of medication in the blood due to imbalanced metabolism and excretion When two drugs with similar action are administered, the drug interaction is called an additive effect and is the sum of the effects of the two drugs When two or more drugs are given together, one drug can potentate or have synergistic effect on the other drug When two drugs are combined that have opposite, or antagonistic effects, the drugs cancel each others drug effect Allergic reactions are not a result of the pharmacological effects of the drug but rather a response of the patients immunological system to the presence of the drug. Prior sensitization to the drug is generally required Photosensitivity is a skin reaction caused by exposure to sunlight. It is caused by the interaction of a drug and exposure to UV light, which can cause cellular damage.

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The right documentation requires that the nurse immediately record the appropriate information about the drug administered The right to education requires that the client receive accurate and thorough information about the medication and how it relates to his/her particular situation The right evaluation requires that the effectiveness of the medication be determined by the clients response to the medication The client has the right to refuse the medication. When a medication is refused, this refusal must be documented immediately. According to JCAHO, the following abbreviation, acronyms and symbols must not be used: U (for unit), IU (for international unit), QD (for everyday), QOD (for every other day); trailing zero and lack of leading zero; MS and MSO4 Oral medications are not given to clients who are vomiting, lack a gag reflex, or who are comatose. Clients may need a brief rest before proceeding with further intake of medications Enteric coated and timed release capsules must be swallowed whole to be effective. Crushing would alter the place and time of absorption of the drug Advise client not to eat fatty food before ingesting an enteric coated tablet because fatty foods decrease absorption rate Drugs given sublingually or buccally should remain in place until fully absorbed. No foods or fluids should be taken while the medication is in place Pour liquid at eye level. The meniscus is at the line of desired dose Persons with diabetes should not be given elixirs or syrups that contain sugar Discard unused solutions from ampules. Appropriately store unused stable solutions from open vials Administer only drugs that you have prepared. Do not prepare medications to be administered by another Offer ice chips to numb taste buds when giving bad-tasting drugs. When possible, give bad tasting medications first, followed by pleasant tasting liquids. Administer no more than 2.5 to 3 ml of solution intramuscularly at one site. Infants receive no more than 1 ml of solution intramuscularly at one site When administering drugs to a group of clients, give drugs last to clients who need extra assistance Record amount of fluid take with medications on input and output chart Oral medications can be administered through a nasogastric tube but should not be mixed with the entire tube feeding solution

If the drug is embedded in a matrix patch and diffuses into the skin, the drug is diffused over the entire surface of the patch and probably may be cut If the drug is pooled in a reservoir patch and is released via a semi permeable membrane, the patch must not be cut Remember to remove foil-backed patches before Magnetic Resonance Imaging (MRI) is performed to prevent burns A nurse should never apply a topical medication without first protecting his/her own skin Do not double dip gloves and applicators that come in contact with a client should not be reinserted into the container To administer eye drops, gently pull down the skin below the eye to expose the conjunctival sac. Medication place directly in the cornea can cause discomfort or damage To administer eardrops in children, pull down and back on the auricle. In adults, pull up and back on auricle. After 3 years of age, same as adults Vaginal suppositories are inserted into the vagina with the client in lithotomy position Preferred areas for intradermal injections are lightly pigmented, thinly keratinized, and hairless, such as the ventral midforearm, clavicular area of the chest, and scapular area For tuberculin testing, measure only the indurated area; do not include redness in the measurement Aspirate subcutaneous injections, except with heparin Locations for Subcuteneous injections includes the abdomen, upper hips, upper back, lateral upper arms and lateral thighs Gently massage area of subcutaneous injections unless contraindicated, as with heparin Apply gentle pressure to the SubQ injection site if the client is on anticoagulant therapy to prevent bleeding or oozing into the tissue and subsequent bruising and tissue damage Insulin syringe measured in units for use with insulin only. Use the tuberculin syringe for amounts less than 0.5 ml Intramuscular drugs are used for more rapid effect of drug than with the SubQ route. Used for irritating drugs, aqueous suspensions and solutions in oil Locations of IM injections in pediatrics includes ventrogluteal, dorsogluteal, deltoid, and vastus lateralis - 3 -

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Clients with low weight should be evaluated for sites with adequate muscle. The ventrogluteal muscle is the preferred site for adults and infants older than 7 months Do not use the dorsogluteal site for IM injections in children, for infants younger than 7 months, the vastus lateralis is preferred The z-track injection technique prevents medication from leaking back into the subQ tissue. It is frequently advised for medications that cause visible and permanent skin discoloratios (e.g. iron dextran) Drugs administered by IV act more rapidly than those by mouth, subQ, and IM. Acccessible peripheral veins (e.g. cephalic or cubital vein of the arm) are preferred. When possible, ask the client of his/her preference In newborns, the veins of the feet, lower legs, and head may be used after the previous sites have been exhausted If the IV rate is to infuse at 100 ml/hr or more, the macrodrip set is usually used. If the infusion rate is less than 100 ml/hr, or the client is a child, the microdrip set is preferred Drugs should be added to the IV bag or bottle immediately before administering the IV fluid. Inject the drug into the rubber stopper and rotate the bag several times to ensure that the drug is dispersed throughout the solution Do not add the drug while infusion is running unless the IV bag is rotated Inject medications slowly to minimize tissue damage. Do not administer injections if sites are inflamed, edematous or lesioned Rotate injection site to enhance absorption of the drug (e.g. insulin) Document the injection site Key aspects of pediatric medication administration: (1) honesty is a priority; (2) careful attention to vocabulary; (3) forceful restraint should never be used; (4) praise and positive reinforcement, (5) the child should not be threatened or shamed into taking a medication Developmental needs of Pediatric clients with administrations of medications: o Stranger anxiety (infant): maintain a nonthreatening approach and move slowly o Hospitalization, illness or injury may be viewed as a punishment (3-6 year olds): allow control where appropriate, encourage positive relationships and expression of feelings o Fear of Mutilation (3-6 year olds): explain the procedures carefully; use less intrusive routes such as oral route, play Physiological factors which may affect drug action in the pediatric patients includes: o reduced gastric acidity, small muscle mass, thin stratum corneum, high proportion of water in body, reduced protein-binding capability, unpredictable hepatic enzyme production and immature renal system

reduced gastric acidity, prolonged gastric emptying time, diminished muscle tone and motor activity in the lower GI, reduced blood supply to major organs, diminished proportion of water in the body, diminished protein-binding capability, increased proportion of fat in the body, reduced hepatic and renal function and impaired homeostatic responses

The metric system is a decimal system based on the power of 10. The apothecary system uses Roman numerals instead of Arabic numbers to express the quantity. The household system of measurement is not as accurate because of the lack of standardization of spoons, cups and glasses. Drugs have several names. The chemical name of the drug describes the drugs chemical nature The generic name is the official or non proprietary name for the drug. This name is not owned by any pharmaceutical company and is universally accepted The brand (trade) name, also known as proprietary name is chosen by the drug company and is usually a registered trademark owned by that specific manufacturer Over-the-counter (OTC) drugs are drugs that are available without prescription, are found in most households. Drug abuse generally refers to an overindulgence of a chemical substance that results in a negative impact on the psychologic, physical or social functioning of an individual Chronic abuse of drug may lead to addiction. Drug addiction is a complex disease of the CNS characterized by compulsive, uncontrolled craving for and dependence on a substance to such a degree that cessation causes severe emotional, mental or physiologic reactions Physical dependence is altered physiologic state from prolonged substance use; regular use is necessary to prevent withdrawal syndrome Psychologic dependence is compulsive need to experience pleasurable response from the substance Craving is subjective need for a substance, usually experienced after decreased use or abstinence. Cue-induced craving is stimulated in the presence of situations previously associated with drug taking Republic Act No. 9502 Cheaper medicines act of 2008 Republic Act No. 9165 Comprehensive Dangerous Drugs Act of 2002 Republic Act No. 8203 - Special Law on Counterfeit Drugs Republic Act No. 6675 - Generics Act of 1988 Republic Act No. 6425 - Dangerous Drugs Act of 1972 Republic Act No. 5921 Pharmacy Law

Physiological factors which may affect drug action in geriatric patients includes: DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

"The whole world steps aside for the man who knows where he is going."
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