pharmacology related edapt week1 notes

Pharmacokinetics, pharmacodynamics, pharmacogenomics, and pharmacotherapeutics are fundamental to working with patients. Understanding these concepts enables the nurse to utilize the nursing process to better assess, diagnose, plan, intervene, and evaluate for pharmacology related problems. NURSING ASSESSMENT: Noticing key factors about a patient including their allergies and medications enables the nurse to look for clues that may generate question needing more information. This is the nursing assessment process. In pharmacology, an initial grasp of the medications, the context of how they relate to the age, diagnosis, and situation, will help the nurse to identify patterns they may require further clinical decision-making. Consider the following information you’ve learned so far about pharmacodynamics, pharmacogenomics, pharmacokinetics, and pharmacotherapeutics. IV: Advantages  Complete absorption  100% bioavailability  Precise control of dosing  Quick dilution of irritating drugs Disadvantages  Irreversible administration  Drug concentration, formulation, and rate of injection sensitivity  Risks of overloading body fluid volume, infection, and embolism IM Advantages  The use of poorly water-soluble drugs  The use for depot drug formulation (e.g., Penicillin G) Disadvantages  Discomfort and inconvenience  Local tissue injury caused by chronic administration  Risk of nerve damage because of improper injection  Moderate to low bioavailability TRANSDERMAL: Advantages  Good control of drug release (e.g., nitroglycerin and contraceptive hormones)  Convenient to use (e.g., patch and ointment) Disadvantages  Inconvenient administration for liquid formulation of drug SUBLINGUAL: Advantages  The use of poorly water-soluble drugs  The use for depot drug formulation Disadvantages  Discomfort and inconvenience  Local tissue injury caused by chronic administration  Risk of nerve damage because of improper injection  Moderate to low bioavailability ORAL: Advantages  Convenient and inexpensive  Higher safety of administration Disadvantages  Variability of drug absorption and difficulty of drug concentration control  Inactivation of certain drugs because of acidic environment of the stomach (e.g., Penicillin G) and/or the liver “first-pass” effect (nitroglycerin)  Patients consciousness requirement  Local irritation of the GI tract to cause vomiting and nausea IMPLEMENTATION AND EVALUATION: Once planning is completed, it is time for the nurse to take action and evaluate how those actions work. This is the implementation and evaluation part of the nursing process. This can include administering, holding, or changing medication. It also includes working collaboratively with other healthcare personnel to reflect and identify further outcomes and goals. ADVERSE EFFECTS: As a health care provider, you gain knowledge by assessing a particular medication (i.e. drug) prior to safe drug administration. Take the time to review pharmacodynamics, as it refers to the drug’s response from the drug action. Safety in medication administration includes understanding the drug’s response (i.e. drug effect). Remember that a drug can modify cell function or the rate of function, but it can’t make the cell do something new. Drugs can produce multiple effects, not just the desired effect. Sometimes these effects can be adverse. An adverse effect is a general term for undesirable effects that are a direct response to one or more drugs (Lilley et. al, 2020). As a health care provider, recognizing potential hazards, unfavorable effects, and potential life-threating effects of medications is essential. You, as the health care provider, will use assessment skills, think critically, and use clinical judgement to identify and prioritize the adverse effects of a drug’s response. A patient’s response to a drug can greatly differ, depending on factors such as the following:  Age  Cardiovascular function  Diet  Exercise  Gender  GI function  Hepatic function  Infection  Renal function  Other drugs (individuals may be taking more than one drug at a time = drug-drug interaction) In your drug guide, recognize and highlight adverse drug effects that are “high alert” therefore potentially life-threatening! CONTRAINDICATIONS: As a health care provider, you gain knowledge by assessing a particular medication (i.e. drug) prior to safe drug administration. Safety in medication administration includes understanding contraindications. Contraindication is a general term for any condition (related to a disease state or patient characteristic), which renders a particular form of treatment improper or undesirable (Lilly et al, 2020). In other words, a contraindication is any condition or factor that serves as a reason to withhold a certain medication due to harm it would cause. Contraindication is the opposite of indication for use. Indication for use is the reason to use a certain medication. Health care providers use knowledge of the drug(s) with information about the patients’ medical and social history to indicate if any contraindications exist. Common contraindications for use include the following:  Drugs currently used (prescription, OTC, herbal, illicit or street drugs)  Pregnancy status  Breastfeeding  Concurrent illness(es)  Age-appropriate considerations Pay careful attention to these assessment indicators to ensure an optimal therapeutic plan. Safety = Understand Contraindications DRUG INCOMPATIBILITIES: As a health care provider, you gain knowledge by assessing a particular medication (i.e. drug) prior to safe drug administration. Safety in medication administration includes understanding drug incompatibilities. Drug incompatibility is an undesirable reaction that occurs between a drug and a solution, container, or another drug. The result is a chemical deterioration of one or both of the drugs and can formulate a physical precipitate, haziness, or color change in the solution. It is a term most commonly used to describe parenteral drugs. Before medication administration, inspect the medication vial or IV solution for precipitate and/or color changes. As a resource, contact the pharmacist if you have any questions or concerns regarding the physical characteristics of a medication, to include a solution. Often in the clinical environment, you may see a drug compatibility chart located in the medication dispensing room for quick reference. Always use your learning resources to check drug compatibility prior to medication administration. TEST 1. ondansetron and lorazepam NO 2. furosemide and ondansetron NO 3. morphine and furosemide NO 4. phenytoin and morphine sulfate NO 5. linezolid and magnesium sulfate YES DRUG-DRUG, DRUG-FOOD INTERREACTION: As a health care provider, you gain knowledge by assessing a particular medication (i.e. drug) prior to safe drug administration. Safety in medication administration includes understanding drug-drug and drug-food interactions. Drugs may interact with other drugs or foods we eat. A drug interaction can either increase or decrease the action of one or both of the drugs. Monitoring drug therapy includes understanding these interactions. Review pharmacokinetics and examples of drug interactions and their effects on pharmacokinetics. It is common that patients may take more than one medication, and the more medication once receives, the greater chance a drug interaction (drug-drug or food-drug) may occur. This is especially true with older adults who take several medications and may have an increased sensitivity to drug effects. Children also are susceptible to multiple drug effects. OTC and herbal medications can significantly interact with prescribed medications. Taking a detailed medication history, to include any OTC and herbal remedies is essential. Common Food and Drug Interactions Food Drug Interaction Outcome Leafy green vegetables Warfarin (anticoagulant) Decreased anticoagulant effect Dairy products Ciprofloxacin (antibiotic) Decreased chemical binding of the drug = decreased effect Grapefruit juice Atorvastatin (antilipidemic) Decreased metabolism and increased drug effect Aged cheese, wine Monoamine oxidase inhibitor (MAOIs) (antidepressants) Increased in blood pressure (hypertensive crisis)