NURS 198 Pharm lecture Unit 1 Complete

NURS 198 Pharm lecture Unit 1 Scoring- the line in the middle identifies that the tablet was scored which is done by manufacture to break it in half with equal distribution in each half - If it does not have the line you are not guaranteed you will have half of each medication Pharmacology- is the study of the biological effects of chemicals Drugs- chemical that are introduced into the body to cause some sort of change - Health care providers focus on how chemicals act on living organisms - Some drugs effects are therapeutic or helpful but other are undesirable or potentially dangerous (adverse effects) Adverse effects- drug effects, sometimes called side effects, that are not the desired therapeutic effects; may be unpleasant or even dangerous Pharmacotherapeutics- clinical pharmacology—the branch of pharmacology that deals with drugs; chemicals that are used in medicine for the treatment, prevention, and diagnosis of disease in humans - Nurses deal with pharmacotherapeutics or clinical pharmacology ( nurses go to school to be nurse ad are not responsible for clinical pharmacology) Disintegration- when the stomach breaks down the tablet Dissolution- the smaller particles (when they become powder into a smaller component to then be absorbed) (orally) Nurses responsibility 1) Administering drugs- a lot falls on the nurses so it’s our responsibility to make sure the meds are correct - We are the last person to administer medication to the patient 2) Assessing drug effects- what effects the medications have and are Ex- blood pressure by checking the patients blood pressure first it will show if the medication is working 3) Intervening to make the drug regimen more tolerable- Ex- if the medication requires a full stomach or to be taken with food you will give the patient food before or while they take the medication so they do not have an upset stomach - There are many different type of ways to administer medications - Injectables, eye drops, swallowing orally, intramuscular injection, patch (absorbed through the skin) and under the tongue that melts then gets absorbed. - 99% is by mouth (orally) - 1% is injection and patch 4) Providing patient teaching about drugs and the drug regimen 5) Monitoring the overall patient care plan to prevent medication errors Sources of drugs A) Natural sources-Chemicals that might prove useful as drugs can come from many natural sources, such as plants, animals, or inorganic compounds. To become a drug, a chemical must have a demonstrated therapeutic value or efficacy without severe toxicity or damaging properties. - Organic in nature - synthetic= inorganic 1) Plants - Synthetic version of the active chemical found in a plant - Main component of the growing alternative therapy- - Ex- ricinus communis which is used in caster oil Digitalis used in cardiac medication (cardiac glycoside which is used for heart failure) - Papaver (poppy seeds)- give off morphine - Teas that are brewed for certain condition like lavender teas for people that have a hard time sleeping 2) Animal products - Used to replace human chemicals that are not produced because of disease or genetic problems - Genetic engineering - Many of these preparations are now created synthetically - People whom have diabetes type 1 need insulin injections so people would use animals - Ex- horse,pig and cow pancreas to get insulin for diabetics *** this may cause cultural beliefs because some cultures do not eat pork or pork products which may not allow them to get insulin from pig pancreas****** 3) Inorganic compounds - Salts of various elements can have therapeutic effects in the human body - Ex magnesium salts (epsom salt) people use this to soak their feet when in pain 4) Synthetic sources - Genetic engineering alter bacteria to produce chemicals that are therapeutic and effective which generate good and bad bacteria (normal flora) - Good bacteria- keeps bad bacteria low - GI tract bacteria helps to synthesis vitamins like vitamin D - Original prototypes Drug examples: Inorganic - Compounds we need for survival - Aluminum- decrease gastric acidity and management of hyperphosphatemia - Fluorine- prevention of dental cavities (In our tooth paste and add to our local water supply) - Gold- treats rheumatoid arthritis - Iron- treats iron deficiency anemia Drug Evaluation (process medications need to go through to get on the market) Preclinical Trials: Chemicals tested on laboratory animal 1) To determine whether they have the presumed effects in living tissue 2) To evaluate any adverse effects. Animal testing is important because unique biological differences can cause very different reactions to the chemical - These can only be found in living organisms, so computer generated models alone are often inadequate Some chemicals are discarded to the following reasons ● The chemical lacks therapeutic activity when used with living animals. ● The chemical is too toxic to living animals to be worth the risk of developing into a drug. ● The chemical is highly teratogenic (causing adverse effects to a fetus). ● The safety margins are so small that the chemical would not be useful in the clinical setting. Phase I Studies: Chemicals tested on human volunteers - Usually the volunteers are young men and often women - Pregnant women are not good candidates because the chemical may exert unknown and harmful efforts on a womens ova, too much risk is involved in taking a drug that might destroy or alter the ova Phase II Studies: Drug tried on informed patients with the disease Phase III Studies: Drug used in vast clinical market - Used around the world on thousands of people to get reports on drug FDA Approval: Drug evaluated by FDA; if approved, may be marketed - FDA (food drug administration) - The FDA regulates the development and marketing of drugs to ensure safety and efficacy. - FDA pregnancy categories indicated the potential or actual teratogenic effects of a drug; these categories are being replaced by risk categories related to pregnancy, lactation, and fertility. Phase IV Studies: Continual evaluation of the drug Question #1- true or false TRUE - Groups of similar drugs, all of which are derived from an original prototype, are available today because of technological advances that make a particular drug more desirable in a specific situation. - Ex- antibiotics Safe use of drugs in the Institutional setting - Administering - evaluating patients for toxic effect - monitoring patients for drug effects - educating patients/families about drugs Controlled Substances #1 The Controlled Substances Act of 1970 - Control over the coding of drugs and the enforcement of these codes to the FDA and the Drug Enforcement Agency (DEA), a part of the U.S. Department of Justice. - Prescription, distribution, storage, and use of these drugs are closely monitored. - Local policies and procedures might be even more rigorous. DEA - The prescription, distribution, storage, and use of controlled substance drugs are closely monitored by the DEA in an attempt to decrease substance abuse of prescribed medications. - Each prescriber has a DEA number, which allows the DEA to monitor prescription patterns and possible abuse. - A nurse should be familiar with not only the DEA guidelines for controlled substances but also the local policies and procedures, which might be even more rigorous. Controlled Substances #2 DEA Schedules of Controlled Substances I: High abuse potential, no accepted medical use (heroin, marijuana, LSD) - marijuana may be deregulated because of the medicinal use for cancer patients because they are sick they don't eat enough. But marijuana allows for the munchies and helps patients eat II: High abuse potential, severe dependence liability (morphine, narcotics, amphetamines, and barbiturates) III: Less abuse potential than schedule II, moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics) IV: Less abuse potential than schedule III, limited dependence liability (some sedatives, antianxiety agents, and nonnarcotic analgesics) V: Limited abuse potential. Primarily small amounts of narcotics (codeine) used as antitussives or antidiarrheals. Under federal law, limited quantities of certain schedule V drugs may be purchased without a prescription directly from a pharmacist. Purchasers must be at least 18 years of age and must furnish suitable identification. All such transactions must be recorded by the dispensing pharmacist. Brand name- benadryl that owns the patent until expired - trade name by the pharmaceutical company that developed it. Generic Drugs a) Chemicals that are produced by companies involved solely in the manufacturing of drugs b) Bioavailability of the drug may be different than brand name - Sometimes when generic brand use certain fillers is does not allow the medications to agree with the patient - The medication may not have the desired effect C) “Dispensed as written” - They have to give the real brand name not generic. Follow whats written D) Important in drugs that have narrow safety margins E) A patent ensures that only the brand name company can make that medication until the patent has expired Generic- drugs are chemicals that are produced by companies involved solely in the manufacturing of drugs. - the name of the drug but another company's version - a drug is the original designation that the drug was given when the drug company applied for the approval process - Many states require that a drug be dispensed in the generic form if one is available. This requirement helps to keep down the cost of drugs and healthcare. Chemical names- are names that reflect the chemical structure of a drug. Some drugs are known by all three names. It can be confusing to study drugs when so many different names are used for the same compound. Ex- p-isobutylhydratopic Orphan Drugs - Drugs that have been discovered, but are not financially viable and therefore have not been “adopted” by any drug company - The Orphan Drug Act of 1983 OTC Drugs Over-the-Counter Drugs- Products that are available without prescription for self-treatment of a variety of complaints. (meds over the counter for specific illnesses) - Some of these agents were approved as prescription drugs. - A lot of medications over the counter have high abuse potential - Later were found to be very safe and useful for patients. - Many of these drugs were “grandfathered.” *** Nurses should consider several problems related to OTC drug use: - Taking these drugs could mask the signs and symptoms of underlying disease, making diagnosis difficult. - OTC drugs can impact other medications your taking - Taking these drugs with prescription medications could result in drug interactions and interfere with drug therapy. - Not taking these drugs as directed could result in serious overdoses. - Always ask your patient if they are taking OTC drugs if so How often and how are they taking them Sources of Drug Information Drug Label - Drug labels have specific information that identifies a specific drug (they can be very small but have to be read) - Understanding how to read a drug label is essential ( very important to know how to take medications) Package Inserts - Prepared by the manufacturer - Contains all of the chemical and study information that led to the drug’s approval - Difficult to understand and read Reference Books - Physician’s Drug Reference (PDR) - Drug Facts and Comparisons AMA Drug Evaluations - Lippincott’s Nursing Drug Guide (LNDG) Journals and Internet Question #2 (B) Drug labels are a source of information. What information might a drug label provide? A. The manufactured date B. The expiration date C. When the patent expires D. The binding properties of the drug Pharmacodynamics - is the study of the interactions between the chemical components of living systems and foreign chemicals that enter those systems. - When new chemicals (drugs) enter the system, other effects occur in cell functioning. Drug Actions Different actions for medications Ex- parkinson's medications speed up cellular processes - Replace or act as a substitute for missing chemicals - Increase or stimulate certain cellular activities - Depress or slow cellular activities (ex seizure disorder) - Interfere with the functioning of foreign cells Receptor Sites- specific areas on cell membranes that react with certain chemicals to cause an effect within the cell - Receptor sites react to certain chemicals to cause an effect within the cell. - Agonists, Drug-enzyme interactions, Selective toxicity Pharmacodynamics - Receptor theory Agonists- Helps promote a response to happen - Two drug agonists attach to the receptor site. - The drug agonist that has an exact fit is strong= strong agonist and more biologically active - Then the weak agonist binds weakly= weak reaction and binds very tightly= strong reaction vs. Antagonists- helps block a certain response Nonspecific drug effect- one specific receptor all over the place or body - Cholinergic receptors are located in the bladder, heart, blood vessels, stomach, bronchi and eyes Nonselective drug effect- acting on multiple (3) receptors that are located on different organ systems - Epinephrine affects three different receptors: alpha, beta 1 an beta 2 Pharmacokinetics-the way the body deals with a drug, including absorption, distribution, biotransformation, and excretion - The study of absorption, distribution, metabolism (biotransformation), and excretion of drugs - Biotransformation (break down of medication) passive diffusion: movement of substances across a semipermeable membrane with the concentration gradient; this process does not require energy - Directly into the cell no atp (energy) active transport: the movement of substances across a cell membrane against the concentration gradient; this process requires the use of energy - Transporter molecule needs atp to bring meds in - Ex potassium sodium pump Pinocytosis- cell membrane pinches a portion of itself to allow medications in Pharmacokinetics Onset of drug action - Food in our stomach will make the medication take longer to work Drug half-life - Amount of medications that become half its dosage- less strength - the time it takes for the amount of drug in the body to decrease to one half of the peak level it previously achieved Timing of the peak effect