Legal and Ethical Issues
Chapter 3
What is a drug? – any substance or mixture of substances manufactured, sold, or
represented for use in:
a. the diagnosis, treatment, mitigation or prevention of a disease, disorder,
abnormal physical state, or its symptoms, in human beings or animals.
b. restoring, correcting, or modifying organic functions in human beings or
animals.
c. disinfection in premises in which food is manufactured, prepared, or kept.
Drug products-
- Include prescription and non-prescription pharmaceuticals, and products
with disinfectant claims.
- Health Canada assesses safety (are downsides significant), efficacy (how
effective is it), and quality of drug products.
Three types of drug names-
1. Chemical name: based on chemistry
2. Generic name: less complex name assigned by drug developer
3. Trade name: brand/marketing name
Canadian drug legislation:
1953: Canadian Food and Drugs Act (has been revised)
- 2003: food and drug regulations
- Drugs approved for use
- Prescription vs non-prescription (prescription drug list)
1996: Controlled Drugs and Substances Act (CSDA)
- Medications not addressed in the food and drugs act
- Drugs that affect mental processes- majority are prescription
- Contains schedules (categories) of drugs
National Drug schedule - 4 categories of drugs that determine public access:
Schedule I - requires prescription
Schedule II - behind desk at pharmacy, no prescription required
Schedule III - in pharmacy, but self-selection
, Schedule IV - available for sale in any retail outlet
Ethical Nursing Practice - Canadian Nurses Association (CNA)
2017: Code of Ethics for Registered Nurses
- Promoting safe, compassionate, competent and ethical care
- Promoting health and well-being
- Promoting and respecting informed decision-making
- Honouring dignity
- Maintaining privacy and confidentiality
- Promoting justice
- Being accountable
Ethnocultural Considerations
- Assess the influence of a patient’s cultural beliefs, values, and customs
- Drug polymorphism
- effect of client’s age, sex, size, body composition etc on individual’s
absorption and metabolism of a drug
- Environmental (diet and nutrition), ethnocultural and genetic (inherited)
factors
- Adherence to therapy
Ethnocultural Assessment
- Health beliefs and practices
- Past uses of medicine
- Folk remedies – eating mud; milk poultice
- Home remedies- vinegar on wounds
- Use of nonprescription drugs and natural health remedies
- Responsiveness to medical treatment
- Religious practices and beliefs
- Dietary habits
Identify related legislation in Canada.
Recognize drug schedules, and the narcotic and controlled drug schedules.
Recognize ethnocultural factors influencing medication treatment.
Identify principles of ethical decision making.
,Principles of Pharmacology
Chapters 4 and 5
Memory
Short term
1. Sensory memory
- Info coming in
- Lasts 3-4 seconds
2. Working memory
- Gateway to long term memory
- Paying attention = activation of working memory
- Phonological loop - verbal/text
- Visuospatial sketchpad - visual/images
Long term
3. Episodic memory
- Phono/visuo bound together
- Consolidate during sleep
4. Semantic memory
- Memory of facts and information
- Episodic - specific - transferable to situations
*key to long term memory - memorise in “chunks” and sleep
Drug Administration - A drug’s route of administration affects the rate and
extent of absorption of that drug
Excipients- non-medicinal ingredients such as fillers, antioxidants,
disintegrants, colourants and coatings, flavourings and sweeteners
Routes of Administration
★ Enteral: drug absorbed through the GI tract (between mouth and rectal)
○ Oral (PO)
- By mouth
Benefits- easiest, safest and cheapest. No need for drug to be sterile
Drawbacks- acid-sensitive and protein drugs are unstable, patient must be
conscious and cooperative, variable absorption and bioavailability,
possible upper GI tract irritation
- Absorption depends on disintegration/solubility, acidity of the GI tract,
stability of the drug (destroyed by acid or digestive enzymes?), gastric
emptying and motility, and GI blood flow
First Pass Metabolism Effect- most drugs given orally first pass through the
liver before entering systemic circulation. Drug concentration can drop
dramatically after liver as it is the major site of drug metabolism
, ○ Sublingual (SL)
- Drug placed under tongue
Benefits- relatively rapid absorption , no first-pass effect (direct entry into
systemic circulation), suitable for acid-sensitive drugs (mouth pH is ~7), fast,
easy and cheap
Drawbacks- many drugs taste bad
○ Rectal (PR)
- Absorption is through the rectal mucosa
Benefits- rapid absorption, cheap and easy, useful when patients can’t or
won’t swallow, less first pass effect (fewer rectal veins enter liver)
Drawbacks- absorption often incomplete, many drugs cause irritation of
mucosal lining
*Formulations for Enteral Administration
- Tablets
- Capsules (powder in gelatin coating) - faster absorption
- Caplets (capsule shaped tablets) - more easily swallowed
- Liquids - even faster absorption - can be aqueous (dissolved
in water) suspensions, or emulsions
★ Parenteral: drug bypasses GI tract in absorption
○ Intravenous (IV)
- Drug injected directly into vein either as rapid bolus (IV push) or
continuous infusion (IV drip)
Benefits- rapid distribution and onset of action, very close to 100%
bioavailability, large drug volumes
Drawbacks- requires skilled administration and close monitoring, drug
must be sterile, greater cost
○ Intramuscular (IM)
- Drug injected into skeletal muscle
Benefits- can be into a large muscle mass, easy self administration,
absorption into systemic circulation can be controlled (oil based
formulations allow slower absorption)
Drawbacks- can be painful
Chapter 3
What is a drug? – any substance or mixture of substances manufactured, sold, or
represented for use in:
a. the diagnosis, treatment, mitigation or prevention of a disease, disorder,
abnormal physical state, or its symptoms, in human beings or animals.
b. restoring, correcting, or modifying organic functions in human beings or
animals.
c. disinfection in premises in which food is manufactured, prepared, or kept.
Drug products-
- Include prescription and non-prescription pharmaceuticals, and products
with disinfectant claims.
- Health Canada assesses safety (are downsides significant), efficacy (how
effective is it), and quality of drug products.
Three types of drug names-
1. Chemical name: based on chemistry
2. Generic name: less complex name assigned by drug developer
3. Trade name: brand/marketing name
Canadian drug legislation:
1953: Canadian Food and Drugs Act (has been revised)
- 2003: food and drug regulations
- Drugs approved for use
- Prescription vs non-prescription (prescription drug list)
1996: Controlled Drugs and Substances Act (CSDA)
- Medications not addressed in the food and drugs act
- Drugs that affect mental processes- majority are prescription
- Contains schedules (categories) of drugs
National Drug schedule - 4 categories of drugs that determine public access:
Schedule I - requires prescription
Schedule II - behind desk at pharmacy, no prescription required
Schedule III - in pharmacy, but self-selection
, Schedule IV - available for sale in any retail outlet
Ethical Nursing Practice - Canadian Nurses Association (CNA)
2017: Code of Ethics for Registered Nurses
- Promoting safe, compassionate, competent and ethical care
- Promoting health and well-being
- Promoting and respecting informed decision-making
- Honouring dignity
- Maintaining privacy and confidentiality
- Promoting justice
- Being accountable
Ethnocultural Considerations
- Assess the influence of a patient’s cultural beliefs, values, and customs
- Drug polymorphism
- effect of client’s age, sex, size, body composition etc on individual’s
absorption and metabolism of a drug
- Environmental (diet and nutrition), ethnocultural and genetic (inherited)
factors
- Adherence to therapy
Ethnocultural Assessment
- Health beliefs and practices
- Past uses of medicine
- Folk remedies – eating mud; milk poultice
- Home remedies- vinegar on wounds
- Use of nonprescription drugs and natural health remedies
- Responsiveness to medical treatment
- Religious practices and beliefs
- Dietary habits
Identify related legislation in Canada.
Recognize drug schedules, and the narcotic and controlled drug schedules.
Recognize ethnocultural factors influencing medication treatment.
Identify principles of ethical decision making.
,Principles of Pharmacology
Chapters 4 and 5
Memory
Short term
1. Sensory memory
- Info coming in
- Lasts 3-4 seconds
2. Working memory
- Gateway to long term memory
- Paying attention = activation of working memory
- Phonological loop - verbal/text
- Visuospatial sketchpad - visual/images
Long term
3. Episodic memory
- Phono/visuo bound together
- Consolidate during sleep
4. Semantic memory
- Memory of facts and information
- Episodic - specific - transferable to situations
*key to long term memory - memorise in “chunks” and sleep
Drug Administration - A drug’s route of administration affects the rate and
extent of absorption of that drug
Excipients- non-medicinal ingredients such as fillers, antioxidants,
disintegrants, colourants and coatings, flavourings and sweeteners
Routes of Administration
★ Enteral: drug absorbed through the GI tract (between mouth and rectal)
○ Oral (PO)
- By mouth
Benefits- easiest, safest and cheapest. No need for drug to be sterile
Drawbacks- acid-sensitive and protein drugs are unstable, patient must be
conscious and cooperative, variable absorption and bioavailability,
possible upper GI tract irritation
- Absorption depends on disintegration/solubility, acidity of the GI tract,
stability of the drug (destroyed by acid or digestive enzymes?), gastric
emptying and motility, and GI blood flow
First Pass Metabolism Effect- most drugs given orally first pass through the
liver before entering systemic circulation. Drug concentration can drop
dramatically after liver as it is the major site of drug metabolism
, ○ Sublingual (SL)
- Drug placed under tongue
Benefits- relatively rapid absorption , no first-pass effect (direct entry into
systemic circulation), suitable for acid-sensitive drugs (mouth pH is ~7), fast,
easy and cheap
Drawbacks- many drugs taste bad
○ Rectal (PR)
- Absorption is through the rectal mucosa
Benefits- rapid absorption, cheap and easy, useful when patients can’t or
won’t swallow, less first pass effect (fewer rectal veins enter liver)
Drawbacks- absorption often incomplete, many drugs cause irritation of
mucosal lining
*Formulations for Enteral Administration
- Tablets
- Capsules (powder in gelatin coating) - faster absorption
- Caplets (capsule shaped tablets) - more easily swallowed
- Liquids - even faster absorption - can be aqueous (dissolved
in water) suspensions, or emulsions
★ Parenteral: drug bypasses GI tract in absorption
○ Intravenous (IV)
- Drug injected directly into vein either as rapid bolus (IV push) or
continuous infusion (IV drip)
Benefits- rapid distribution and onset of action, very close to 100%
bioavailability, large drug volumes
Drawbacks- requires skilled administration and close monitoring, drug
must be sterile, greater cost
○ Intramuscular (IM)
- Drug injected into skeletal muscle
Benefits- can be into a large muscle mass, easy self administration,
absorption into systemic circulation can be controlled (oil based
formulations allow slower absorption)
Drawbacks- can be painful
