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Presented by Wesley Jackson, ARNP

Welcome and introduction to pharmacology

Unit 1:Pharmacology Basics

The Nursing Process & Drug Therapy


Assessment Nursing Diagnosis Planning Implementation Evaluation

Assessment
Collect data that used to identify the patients needs Analysis of data Data collected through interviews, observations, lab reports, other sources

Nursing Diagnosis
Nursing Diagnosis: A statement that describes the human response (health state or actual/potential altered interaction pattern) of an individual or group which the nurse can legally identify and for which the nurse can order the definitive interventions to maintain the health state or to reduce, eliminate or prevent alterations

Diagnosing

Planning
Establish priorities Determine appropriate interventions Set expected patient outcomes

Implementation
Carry out plan that was developed in the planning stage

Evaluation
Evaluate patients response to interventions and re-work plan when necessary

Definitions: Pharmacology Drug-

Pharmacologic Principles

Pharmacogenetics Toxicology-

Definitions: Pharmaceutics-

Pharmacologic Principles

DOSAGE FORMS-1
Tablets: Scored EC: SR: ER: XR:

DOSAGE FORMS-2
Capsules: Colace- soft shell temazepam-hard shell

Drug concentration in plasma after a single oral administration of drug

DOSAGE FORMS-3
Troches (lozenges)-solid dosage forms, usually disc shaped, dissolved slowly in mouth -- designed to release medication that exerts antiseptic or anesthetic effect on mouth tissues or throat, e.g. zinc or Cepacol lozenges

DOSAGE FORMS-4
Suppositories: dosage form to be inserted in external body orifices, e.g. rectum, vagina, or urethra --effects may be localized or systemic --suppositories are usually coated with cocoa butter

DOSAGE FORMS-5
Solutions: clear liquid preparation containing one or more solvents --syrups: --elixirs: --tinctures: --douche:

DOSAGE FORMS-6
Suspensions: liquid dosage forms that solid drug particles are suspended in suitable liquid medium -- usually administered orally or topically e.g. milk of magnesia

Measuring Liquid In A Cup

DOSAGE FORMS-7
Emulsions: dispersions of fine droplets of an oil in water or water in oil --e.g.---

DOSAGE FORMS-8
Semisolids: used primarily for skin --e.g. creams and gels, petrolatum Topical Patches: nitroglycerin, estrogen, clonidine, fentanyl, scopolamine, nicotine --medication is released slowly Implants: capsule-like object is surgically implanted, e.g. Norplant

Pharmacokinetics: Study of: - Absorption - Distribution - Metabolism - Elimination

Pharmacologic Principles

History of Drugs
Natural Products Foxglove plant

Chemical: 7 chloro, 1,3 dihydro, 1 methyl, 5 phenyl, etc Generic: diazepam Brand name: Valium Function: sedation Body system: Nervous Chemical/Pharmacological

Classification of Drugs

Types of Therapy
Acute Maintenance Supplemental Palliative Supportive Prophylactic

Systemic vs local effects Oral/Enteral Topical Parenteral - subcutaneous - Intramuscular - Intradermal - Intravenous

Routes of Administration

Intramuscular injection

Administration of medication through a nasogastric tube

Subcutaneous Injection

Routes of Administration (cont.)


Mucus membranes - Sublingual - Buccal - Inhalation - Eye, ear, nose, rectal

Passive Diffusion

How Drugs Enter the Cells

Carrier Mediated Diffusion Osmosis

Factors Affecting Drug Absorption


Solubility Route of administration - Bioavailability - First pass phenomenon Blood Flow

Factors Controlling Drug Distribution


Protein Bound Blood-brain Barrier Placenta

Protein-bound drug molecules

Factors Controlling Drug Metabolism


Biotransformation - the chemical changes a substance undergoes in the body

Factors Controlling Drug Elimination


Feces Urine

Renal excretion of drugs

Drug concentration in plasma after a single oral administration of drug

Pharmacodynamics
-- study of biochemical and physiologic interactions of drugs -- examine physiochemical properties of drugs and their pharmacologic interactions with suitable body receptors

How Drugs Act


Receptor sites - Affinity - Efficacy - Agonist - Antagonist Enzyme Interaction Non-specific Interaction

Drug-receptor interaction

Drug Action
Dose Response Curve Half-life Recommended Dose Therapeutic Index Therapeutic Blood Levels

Time Course of Drug Action


Onset Peak Duration Half Life Plateau Principle Loading Dose

plasma after a single intravenous (bolus) administration of drug

Drug concentration in plasma after multiple oral administrations of drugs

Unwanted Effects
Side Effects Adverse Reactions Predictible Unpredictible -Idiosyncratic - Allergic - Anaphylactic

Additive Interaction Synergism Potentiation Antagonistic Interference Incompatibilities Food

Drug Interactions

Contraindications -Absolute -Relative Dependence Tolerance Potency

Other Considerations

Other Factors Affecting Drug Responses


Body Weight Age Illness Culture

Drug Moving Through The Body

Drug therapy during pregnancy

Life Span Considerations

Drug Therapy During Breast Feeding

Neonatal & Pediatric Considerations

Legal, Ethical & Cultural Considerations

Federal Food & Drug Act of 1906 Shirley Amendment of 1912(amended the FF&D Act of 1906) Harrison-Narcotic Act of 1914 Federal Food, Drug, & Cosmetic Act of 1938 (amended the 1906 Act) Durham-Humphrey Amendment of 1951 Kefauver-Harris Amendment of 1962 (amended the FFD&C Act of 1938) Controlled Substance Act of 1970 Orphan Drug Act of 1983 1991: Accelerated Drug Approval

Laws & Amendments

Regulation of Drugs
Food and Drug Administration (FDA) Drug Testing - informed consent - Investigational New Drug

New Drug Development


Investigational New Drug Application Informed consent Placebo Preclinical investigational drug studies Clinical phases of investigational drug studies -Phase 1 -Phase II -Phase III -Phase IV

Legal Classifications
Prescription Non-prescription (OTC) Controlled Substances
-Class 1 -Class 2 -Class 3 -Class 4 -Class 5

Legislation in Administering Drugs Nurse Practice Act Pharmacy Act

Legal & Ethical Issues


Autonomy Benefience Confidentiality Justice Nonmaleficence Veracity

Cultural Considerations
African Asian Hispanic European Native American Western

General impact of medication errors Nursing measures to prevent medication errors Consequences of medication errors to nurses Preventing and responding to errors Notification of patient regarding errors An ounce of prevention

Medication Errors: Preventing & Responding

Right Right Right Right Right Right Right

Rights of Administration
drug route dose time patient documentation to refuse

Medication orders must have: - name of patient - date order was written - name of drug - Dosage including size, frequency, # of doses - Route of delivery - signature of prescriber

Administration of Drugs

Types of Orders - Standing - Single - PRN - STAT

Administration of Drugs

Medication Misadventures

Patient Education & Drug Therapy


Nursing diagnoses appropriate to drug therapy Planning related to learning needs and drug therapy Implementation related to drug therapy Evaluation related to drug therapy

Over-the-Counter Drugs and Herbal Products

OTC drugs
-Food, Drug, & Cosmetic Act (1938-Durham-Humphrey Amendments (1951) -Kefauver-Harris Amendments (1962) -OTC Drug Review (1972)

Herbal Products
Herbs Safety & Education Epidemiology

Opiods
Opiod analgesics Morphine Codeine Heroin

Stimulants
Amphetamines Cocaine

Depressants
Benzodiazepines Barbiturates

Alcohol (ETOH)
Beer Wine Whiskey Rum Champagne

Nicotine
Cigarettes Tobacco