NSG 251 Pharmacology PHARM EXAM 1 BLUE PRINT

PHARM EXAM 1 BLUE PRINT EXAM 1 NOTES - Pharmacology: Study / Science of Drugs - Drugs: any chemical that affects the physiological (function) process of a living organism - Pharmacokinetics: drug movement “pharma” = drug “kinetic” = movement of in the body - Pharmacodynamics “pharma” = drugs “dynamics” =effects - Pharmogenetics: study of genetic factors that influence an individual’s response to specific drugs - Safety: condition of being safe form undergoing or causing hurt, injury, or loss (6 Rights ) o Right patient o Right drug o Right dose o Right route o Right time o Right documentation - QSEN= Quality and Safety Education for Nurses (organizations) Standards to follow - The Joint Commission o Accrediting body for health care organizations and programs o Est. National Patient Safety Goals is to improve patient safety and how to solve - Nurse Responsibility o “6 Rights” to medication and administration o Check vitals (BP [ don’t want to high/low], HR, RR, lungs, o Do focused assessment (episodic, specific) o Verify orders o Allergies/ and how they affect them o Current medication list (prescription, over the counter, herbal CAMS) = drug reconciliation o Clarify orders o Clean/clear environment o 2 patient identifiers (Name, date of birth) o Scanning system o Check Medications at bedside - Drug Names o Chemical Name  Describes the chemical structure of the drug  Ex. NoaceTYL-p-aminophenol o Generic Name (non-business name)  Official, nonproprietary nameEx. Acetaminophen o Brand *Trade* name (business name)  Proprietary name Ex. Tylenol - Generic Drugs (non-business) o Approved by FDA o Same active ingredients (main medicine component) as Name Brand Drugs o Inert or inactive (provide in forming the shape, color) (don’t have to do with the function of the drug) o Less expensive o Products that help in providing the shape of tablets and controls the timing of release in the body o Must be stated on the prescription if it is generic or name brand by the health care provider - Over- The- Counter (OTC) o Safe and appropriate for use without the supervision of the health care provider o Nurse needs to be aware of the OTC drugs o Can go buy in the store (not necessarily good) - Drug Labels o Active and inactive/inert ingredients o Dosage o Purpose and use of product o Specific warnings o Dosage instructions or directions Complementary and Alternative Therapies (CAM’s) - No regulatory agencies - Includes botanicals, nutritional products, and herbal supplements - National Center for Complementary and Integrative Health (NCCIH) - Dietary Supplement Health and Education Act (DSHEA) o Ensure that products are safe and label information is truthful and not misleading - Current Good Manufacturing Practices (CGMPs) o Standards require package labels that declare quality and strength of the contents and that it is without contaminants and impurities - Herbal Preparations o Decoction o Infusions o Tinctures o Liniment o Poultice o Essential oils o Herb-infused o Percolations - Potential Hazards o Natural substances are not always safe o Not all compounds are safe in all intake routes o Collect complete list of herbals use o Can affect lab results o Interfere with absorption, breakdowns, and excretion of anesthetics, anticoagulants and other drugs in surgery (about 2-3 weeks before surgery) - DO’s and DON’T’s o Don’t give to the pregnant, nursing mothers o Don’t give to children o Don’t take in large sums o Follow the labels o Stop if the side effects are disturbing and contact health care provider Drug Administration - Forms and routes o Sublingual (under tongue), buccal (check) o Oral (mouth) (by tablets, capsules, liquids, suspensions, elixirs)  PO – per oral (the medial abbreviation) o Transdermal (on the skin) (cream, ointment), topical o Instillation (drops, sprays) o Nasogastric (nose to stomach) and gastrostomy tubes (straight to the stomach) o Suppositories (rectal) (abbreviation: PR, per rectal) o Parenteral (injection) - Tablets and Capsules o Extended release- never crushed or cut  Want it to take a while and not released at the same period of time o Administer irritating drugs with food to decrease GI upset o Administer foods on empty stomach if food interfered with medication absorption - Tablets o Sublingual (under tongue) o Buccal (between Cheek and gum) o Via sublingual or buccal need to remain in place till fully absorbed  No food/ liquid to be taken while meds are in place - Liquid o Elixirs o Emulations o Suspensions - Transdermal o Patched on the skin and absorbed through the skin o Little as 12 hours to 7 days o Preventing of breakdown by moving patch sites - Topicals o Applied to skin - Instillations o Eye drops o Eye ointments o Ear drops o Nose drops and sprays - Inhalations o Meter-dosed inhalers  Handheld device to deliver asthma and bronchitis drugs to lower respiratory track o Spacers  Device used to enhance the delivery of medication from the MDI o Nebulizer  A device that changes liquid medication into a fine mist or aerosol that has the ability ti reach the lower, smaller airways - NG and Gastrostomy tubes o Soft, flexible tube inserted int the nasopharynx with the tip lying in the stomach o GI tube- tube surgically placed directly into the patient’s stomach - Suppositories o Solid medical preparation that is:  Cone/ spindle shaped – rectum  Globular/ egg shaped – vagina  Pencil shaper- urethra  Useful route in. babies, uncooperative patients, and in cases of vomiting or digestive system problems - Parenteral Administrations of medications o Intradermal (ex. TB skin test) o Subcutaneous (to the fatty layer) o Intramuscular (in muscle) o Intravenous (in blood stream) o Intraosseous (into the bone) (emergency situation with no iv access and need to have medication or fluids) Drug Calculations - Metric System o Gram, Liter, Meter o Household systems:  1 teaspoon= 5ml 3teaspoon = 1 tablespoon 2 tablespoon= 1 oz - Gtt= drops gtts = drops - Right of the Decimal place: o Tenths, hundredths, thousandths - General rule: rounds to the tenths place: - Drops rounding round to the nearest whole number - Tablet rounding: if there is a score it can be rounded to the nearest half - If it cannot be split, or if it is an extended, controlled release or enteric coated tablet - Liquids: rounded to the nearest 10ths place Measuring Body weight - Convert the pounds to kilograms - Round the kg to the nearest 10th FIRST before continuing on to the additional calculations - BODY WEIGHT (kg) * DESIRED * 1 DAY OR DOSE TOPIC 2: Pharmacokinetics, Pharmacodynamics, Pharmacogenetics (Ch. 2-3, 11) Drug Phases: - Pharmacokinetic phases: MOVEMENT OF DRUGS WITHIN THE BODY o Absorption o Distribution o Metabolism o Excretion - Pharmacodynamic phases o Receptor binding o Post receptor effect o Chemical reaction  Describe the FDA pregnancy/lactation categories: o Category A: no risk to the human fetus o Category B: no risk to the animal fetus; info for humans is not available o Category C: adverse effects reported in the animal fetus; info for humans is not available o Category D: possible fetal risk in humans has been reported. Potential benefit versus risk may warrant use of these drugs in pregnant women. o Category X: fetal abnormalities have been reported, and positive evidence of fetal risk in humans is available. Those drugs are not used for pregnant women.  A: Safest B: animal studies show no risk C: potential risk, drugs may be used D: evidence of fetal risk, but potential benefit to mother may be acceptable X: fetal harm, outweighs any benefit  FDA pregnancy risk, clinical considerations and data  FDA lactation section is divided into: o 1. risk summary 2. clinical consideration: method to prevent exposure 3. data of studies that form EBM  FDA female& Male: reproductive potential  Describe the drug approval process:  FDA regulates the process by which drugs are researched and released to the population; 1st animal studies the human studies (4 phases)  Phase I: Small # of healthy to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity they test drugs on healthy people  Phase II: Small number volunteers test drugs on a few subjects with the target disease and compare to results from healthy subjects  Phase III: large double-blind studies are conducted with a placebo  Phase IV: drugs become marketable to general use; still in research but now the manufacturer is monitoring and reporting the drug effects (if too many/severe adverse effects come to light drugs can be taken off the market) Describe the categories for controlled substances: Schedule categories  C-I: drugs with no currently accepted medical use, and high potential for abuse.  Ex: Heroin, lysergic acid, Marijuana  C-II: drugs with medical use and high potential for abuse.  Ex: Codeine, Cocaine  C-III: drugs with moderate to low potential for physical and psychological dependence.  Ex: codeine with selected medications  C-IV: drugs with low potential for abuse and low risk of dependence  EX: written or oral prescription that expires in 6months. Phenobarbital  C-V: drugs with lower potential for abuse than C-IV  Ex: written prescription or OTC. Coughs or diarrhea - Pharmacokinetics o Drug absorption  Drug movement from GI track into the bloodstream  IV bypass and GI track go straight into the blood stream o Disintegration  Breakdown of oral drugs form into small particles o Dissolution  Process of combining small drug particles with liquid to form a solution o Absorption methods:  Passive transport  Diffusion & facilitated diffusion  Active transport  Energy and a carrier substance (enzymes)  Pinocytosis  Cell carries drug across membrane by engulfing drug particles o Factors affecting absorption:  Blood circulation  Slow circulation is less effective because it takes longer to have its effectiveness  Pain, stress  Interstitial mobility  Food, food texture, fat content, temperature  Dissolves better in hot water  PH in stomach  Route of administration o Drug movement from GI tract to Liver  Via portal vein  First pass effect  In which drug goes to the liver or hepatic  Some drugs pass multiple times before going to blood stream for use  Bioavailability  Percentage that actually gets to the blood stream o Oral medication: none are 100% because it goes through the liver multiple times o Factors affecting bioavailability  Drug form (pill, IV)  Route of administration  Gastric mucosa and motility (how fast it gets to the liver)  Administration with food and other drugs and other interactions  Changes in liver metabolism and the labs o Drug Distribution  Protein binding- high protein bound or not  If it’s able to combine to a protein and then go to a receptor to get through  Free Drugs  Floating in the blood stream because it can’t get to the ite of action yet and can cause toxicity (life threatening)  Prevention: clarify with the physician and ask to stager the times that they are given because protein binding will be to high  Volume of drug distribution  How much is going into the blood  Blood Brain Barrier (BBB)  Not many pass the BBB (about 98% because BBB is thicker and harder to cross)  MEDICATIONS NOT SAFE TO TAKE DURING PREGNANCY OR BREASTFEEDING  If oral medication, visocal, womb on the feet; effects the distribution most. o Drug Metabolism  Half-life (t1/2)- how long it takes for half the drug concentration to be eliminated from the body  Metabolism by the LIVER  Elimination by the KIDNEY  Loading dose- bigger dose than normal that you give as the initial does so that it can reach the minimum concentration level to start faster and then follow the other doses as normal  Minimum concentration minimum therapeutic effects  Maintain at a therapeutic level after loading dose  Liver function test (LFT) (the A’s)  Aspartate transaminase (AST)  Alanine Aminotransferase (ALT)  Alkaline phosphate (ALP) o Drug Excretion (kidney/liver determine effectiveness of drug)  Kidneys  Creatinine Clarence- Low= holding on to Creatinine and Creatinine= High  BUN  Glomerular filtration rate  Liver bile  Feces  Lungs  Sweat, saliva, breast milk (can get to the baby)  LOW ALBUMIN levels= takes longer for the drug to work because there isn’t that many proteins to bins and more Free drugs  Factors affecting drug excretion  Drugs that affect renal excretion  Drugs decreasing cardiac output (anything affecting HR decreases the circulation through the body and decreases amount at the kidneys  Use of diuretics (excretes to fast)  Competition with other drugs using the same rout of excretion  Change in urine pH  Patients with decrease renal (kidney) or hepatic (liver) function  Function of kidneys through lab work, urine studies, flank pain, low/ no urinary output  LABS: o Kidney- Creatinine and Blood Urea Nitrogen (CR & BUN)  NOT FILTERED OUT BYKIDNEYS CAN CAUSE TOXICITY IN THE BODY - Pharmacodynamics (effects of the drugs within the body) o Study of the way the drugs affec