NUR 318 Exam 1

Main goal of U.S drug legislation?

protect the public by ensuring that drugs marketed are safe and effective

FDA

ensures public medication safety

Comprehensive Drug Abuse Prevention and Control Act

enforces and regulates narcotics and substances of abuse

Controlled Substances Act

gives authority to the Drug Enforcement Agency to regulate the sale and use of drugs and places those drugs into a class schedule

Schedule I

most addicting, most strict

• no accepted medical use and high abuse potential

• ex. LSD, ecstasy, heroin

Schedule II

Used medically with a high abuse potential

• requires a handwritten provider's prescription

• Opioid analgesics, CNS stimulants, & barbituate sedative-hypnotics

• ex. Morphine, Oxycodone

Schedule III

Less potential for abuse, but may lead to dependence

• Androgens, steroids, some depressants

Schedule IV

Accepted medical use in US but has some potential for abuse

• benzodiazepines

Schedule V

Less addicting, least strict

• may be dispensed by pharmacist but some restrictions apply

Phase 1 of Research

New drug that is given to very few healthy people (guinea pigs)

Phase 2 of Research

drug given to a very small group of people who have the certain condition/disease trying to treat

Phase 3 of Research

drug given to different populations

• Double Bind Research to test effectiveness

• Placebo Effect

Phase 4 of Research

FDA approval

• drug given to a large population

• data still being collected

What are Black Box Warnings?

Warnings on the medications about serious side effects

Over the Counter Drugs

• no prescription needed

• gives more autonomy

Advantages to OTC drugs

• easy access (autonomy)

• helps decrease healthcare visits

Disadvantages to OTC drugs

• People ignore S/S of illness with OTC (Masking symptoms rather than treating the problem)

• Inaccurate self-diagnosis

• Interaction with other medications

Are OTC drugs regulated?

YES, more highly regulated by FDA due to wrong reason/way

What are the Right’s to medication administration?

Right:

• drug

• dose

• patient

• route

• time

• reason

• documentation

• education

• evaluation

• to refuse

What is the organization “Quality and Safety Education for Nurses Project (QSEN” for?

Focused on the needed knowledge, skills, and attitudes required for the preparation of future nurses

What is the organization “Joint Commission” for?

• targeted high risk activities

• Contains the “Do Not Use’ list of abbreviations

What is Beers Criteria?

• medications that should be avoided in older patients due to adverse effects

• for older patients or patients with comorbidities

Herbal Supplements

• can negatively interact with other drugs

• most have not been studied, tested, or FDA approved

Most drugs are given for _____________ effect

systemic (travels through bloodstream)

What is pharmacokinetics?

The drug movements through the body

What are the four specific processes involved in pharmacokinetics?

1. Absorption - what route (PO vs. IV0

2. Distribution - where it’s going

3. Metabolism - How it’s broken down

4. Excretion - How does it leave

Absorption process

The time the medication enters the body to the time it enters the bloodstream

• Onset of drug action is determined by the rate of drug absorption

What are some factors that affect the rate and extent of drug absorption?

• Dosage form & route of administration

• Administration site blood flow & GI function

• The presence of food or other drgs

What route of drug takes longest to absorb?

PO drugs

Why do PO drugs take so long to absorb?

pass through stomach and small intestines

What drug/s has the highest bioavailability (100%)?

IV and Buccal (sublingual)

Why do IV/buccal drugs have highest bioavailability?

They go straight into the bloodstream - no first pass effect

What factors influence oral absorption?

• food

• stomach acidity

• other drugs

What factor impacts IM/SubQ absorption?

Adequate blood circulation

Distribution Process

Drugs are carried by blood and tissues to:

• action sites

• metabolism sites

• excretion sites

What does distribution depend on?

Adequacy of blood circulation

Distribution process affected by: Protein Binding

Some drugs are highly bound drugs which have a longer duration of action due to their size

• albumin usually acts as a carrier for the drugs

Distribution process affected by: Blood Brain Barrier

acts as a guard to the brain and limits the movement and amount of drugs to the brain tissue

Metabolic Process

The method by which drugs are inactivated or biotransformed by the body

• drugs are most often changed from active to inactive metabolites and then excreted

What are some locations metabolizing enzymes are located within?

• Kidneys

• Liver

• RBC/plasma

• Gastrointestinal mucosa

What organ is most commonly associated with drug metabolism?

liver

Factors affecting metabolsim

• Age (very old/young)

• Medication metabolizing enzymes (genetics affect the way meds are metabolized)

• First pass (travel through kidneys)

• nutritional status

First Pass Effect

Affects oral drugs that are carried to the liver to be metabolized, then go to the bloodstream and take effect

• Travel through the kidney and then to the bloodstream leading to less concentration of the drug

Excretion Process

Elimination of a medication from the body

Excretion requires adequate function of what organs?

• circulatory system

• Kidneys/Bowel

• Lungs

• Skin

What organ is most commonly associated with drug excretion?

kidneys

What will happen to the excretion process if a person has bad kidney function?

There will be decreased secretion from the kidneys = toxicity (due to not being able to fully excrete the drug)

What happens if drugs are not excreted from the body?

drug accumulation and toxicity

What is serum drug level?

A laboratory measurement of the amount of a drug in the blood at a particular time

What do serum drug levels determine?

• bioavailability

• half-life

• dosages

• pharmacokinetics

• rates of metabolism & excretion

Minimum Effective Concentration

the minimum amount of drug required to produce a therapeutic effect

What is toxic concentration?

Excessive levels of drug in the bloodstream - causes adverse effects on the body

What is toxic concentration (toxiology) caused by?

• single large dose

• repeated small doses to frequently

• slow metabolism of medication

How does excretion play a part in toxicology?

If a drug is not properly excreted, it can accumulate in the body causing overdose

What are some treatments to toxicity (AKA overdose)?

• stabilization efforts

• activated charcoal (can interfere with PO absorption)

• Antidotes for IV

  • Common antidote: Narcan for opioid overdose

Onset

initial concentration needed for the drug to start working

Peak

highest concentration of drug in the body - has the most effect on the body

Duration

How long the drug is working in the body for

Trough

lowest concentration of a drug in the patients bloodstream

When should we collect a trough level?

right before giving the next dose of drug when the previous dose is at its lowest concentration

small therapeutic level

a small window where a drug works without becoming toxic and without losing its therapeutic effect

What is a serum half-life?

Length of time required for a drug's concentration to drop by 50%

• AKA: elimination of half-life

Short half-life

• Medications that leave the body quickly

• Short dosing intervals to ensure constant blood levels

• drugs leave the body quickly

• can be given more frequently (multiple doses/day)

Long half life

• Take more time to breakdown

• drug remains in the body longer (24+ hours)

• given less frequently

• Greater risk of toxicity and accumulation

Pharmacodynamics (think mechanism)

How the drug works & what it does to the body

• AKA mechanism of action

What are the two ways medications interact with cells?

Agonist and Antagonist

Agonist

Mimics receptor activity (makes it better to activate receptors)

Example of Agonist

Morphine:

• Activates the receptors that produce analgesia, sedation, constipation, etc.

Antagonist

Blocks normal receptor activity

Example of Antagonist

Losartan:

• works by blocking angiotensin II receptors on blood vessels to prevent vasoconstriction

What are some patient-related affects of pharmacodynamics (mechanism of action)?

• Age/body weight (may need to increase dose)

• Genetics/ethnicity/sex

• Pathologic conditions (ex. GI disorders)

• Psychological considerations (ex. placebo effect)

• Tolerance and cross-tolerance

What is tolerance?

decreased response to a drug

What are adverse effects?

Undesired response to drug administration

Adverse effects are more likely to occur/more severe with…

• higher doses (more med = more at risk for SE)

• Older age

• Polypharmacy (multiple meds)

What is cumulative effect?

Poor excretion of drugs

• can lead to toxcicity

What are some common medication errors?

• wrong medication

• incorrect dose

• wrong client, route, or time

• administration of known allergic medication

• omission of dose

• incorrect discontinuation of medication

• similar medication names getting mixed up

What are some ways to prevent med errors?

• Bar coding

• limiting the use of abbreviations

• Med reconciliation

• correct dosage calculation

• prepare 1 patient’s med at a time

• don’t leave meds at the bedside

What information is required for medication orders?

• Full patient name

• Name of the drug (preferably generic)

• Dose

• Route

• Frequency

• Date, time, and signature of provider

Routes of administration

• Oral

• GI (NG or gastrstomy)

• Topical

• Injections

  • SubQ

  • IM

  • IV

Assessment

• gather data

• physical assessment

• subjective - what pt says

• objective - observed

Diagnosis

Describes patient problems or needs

• ND specific to drug therapy [y:

  • deficient knowledge r/t drug thera[y regimen

  • risk for injury r/t adverse drug effects

  • noncompliance rt overuse/underuse

Planning

Expected goals/outcomes of prescribed drug therapy

• must be measured and observable

• stated in terms of patient behavior

  • Example: Pt will self-administer morning insulin dosage per protocol

Intervention

Implementing planned activities (teaching)

• example: teaching a patient how to administer insulin dosage

Evaluation

Determining the patient’s response to drug

• observe for therapeutic and adverse effects

• reassess with subjective and objective data

Why do we use evidence based practice?

maximize outcomes in an efficient, effective, and ethical manner using backed RESEARCH

How might absorption be impacted by young age?

• decreased gastric emptying and intestinal motility

• Increased Skin permeability:

  • skin is thinner = increased absorption = increased risk for toxicity

How might metabolism/excretion be impacted by young age?

• immature liver and kidney function

• reduced GFR

• Slow renal clearance

How might drugs negatively impact older adults?

Reduced amount of receptor sites leads to increased adverse effects

• watch for polypharmacy

How might older age impact absorption?

• Changes in the GI tract:

  • Increased PH = stomach acid is more alkaline & meds don’t get broken down as much

• decreased muscle mass and increased body fat

• decreased blood flow

How might older age impact distribution?

decreased blood circulation and cardiac output

• DRUGS STAY IN SYSTEM LONGER = TOXCICITY

How might older age impact metabolism/excretion?

Decreased liver and kidney function (assess BUN and creatinine clearance)

How might pregnancy impact drug use?

drugs can reach fetus through the maternal-placental-fetal circulation

Teratogenic drugs

cause abnormal embryonic/fetal development and should never be used during pregnancy

What should pregnant women avoid?

• Live vaccines

• Herbals

• Alcohol

• Smoking

• Caffeine

Drug classification pregnancy risk categories (5 categories)

Categorized A (safest) to x (known danger)

1. A drugs

2. B drugs

3. C drugs

4. D drugs

5. X drugs

   • D and X are known to cause risk to the fetus (teratogenic)

Category A drugs

well-controlled studies have shown these have no risk to the fetus

Category B drugs

animal studies show these have no risk to the fetus

Category C drugs

animal studies show these can have adverse effects on the fetus

Category D drugs

there is evidence of human risk to the fetus

• The benefits may outweigh the risks in certain situations

Category X drugs

there is strong evidence of fetal abnormalities with these drugs, and should not be taken while pregnant