Path&Pharm Pt.2

What is stress?

A response to a stressor that challenges the body's ability to maintain balance.

What body systems does stress activate

Increased heart rate, Increased blood pressure, increased alertness, Increased energy availability

What system does physical activity affect

Physical activity affects the cardiovascular system, musculoskeletal system, and respiratory system, promoting overall health and well-being.

Immobility

Everything slows down and the body's systems become less efficient

What is pharmacology?

The study of the biological effects of chemicals.

What is pharmacotherapeutics?

The study of the therapeutic uses and effects of drugs.

Nurse's Medication Responsibilities

• Administers medications

• Assesses drug effects

• Helps make medication regimens tolerable

• Educates the patient

• Monitors care to prevent medication errors

Drug Development

Animals → Volunteers → Patients → Large group → Keep watching

What law regulates controlled substances?

Controlled Substances Act of 1970

What agencies are involved in controlled substances?

FDA and DEA

Controlled substances are closely monitored for:

• Prescription

• Distribution

• Storage

• Use

What are major concerns with OTC medications?

otc does not automatically mean safe; They can mask symptoms of an underlying disease; They can interact with prescription medications; Excessive use can cause toxicity/overdose

What is pharmacokinetics?

What the body does to the drug.

What does the A in ADME stand for

Absorption: Drug enters the bloodstream/body.

What does the D in ADME stand for

Distribution: Drug moves to tissues.

What does the M in ADME stand for

Metabolism: Drug is broken down, primarily by the liver.

What does the E in ADME stand for

Excretion: Drug leaves the body, primarily through the kidneys.

How long it takes for PO(by mouth drugs) to start working in the body

20-30 min

How long it takes for IN(sprayed or wicked into the nose) to start working in the body

5-10 min

How long it takes for IV(injected into veins) to start working in the body

5 min

What is the first-pass effect?

Medication taken orally passes through the gastrointestinal system and liver, where some of the drug can be metabolized before reaching systemic circulation.

What is half-life?

The time it takes for the amount of drug in the body to decrease by one-half of the peak level.

What is critical concentration?

The amount of drug needed to produce a therapeutic effect.

What is a loading dose?

A higher initial dose used to get the drug level up more quickly.

What does an agonist do?

Stimulates/activates a receptor to produce an effect.

What does an antagonist do?

Blocks/interferes with a receptor's action.

What is a drug allergy?

An immune response that occurs after exposure to a drug and may become stronger with reexposure.

FIRST EXPOSURE

BODY LEARNS

REEXPOSURE

REACTION

GI Irritation

STOMACH/BOWEL PROBLEMS

What is hepatotoxicity?

Drug-related damage to the liver.

What is nephrotoxicity?

Drug-related kidney damage.

Anticholinergic Effects

• Dry mouth

• Urinary retention

• Blurred vision

What causes superinfection?

Destruction of normal flora.

What can cause blood dyscrasia

Bone marrow suppression.

Ocular Toxicity

Drug-induced damage affecting the eyes.

Signs:Visual changes

Auditory Toxicity

Signs:

• Tinnitus

• Dizziness

• Loss of balance

• Hearing loss

Dermatological Reactions

An adverse drug reaction involving the skin:

• Rash

• Hives

• Red areas

• Blisters

What is stomatitis?

Inflammation of the mucous membranes of the mouth.

What are extrapyramidal symptoms?

Medication-related movement disorders.

Neuroleptic Malignant Syndrome

A serious neurological/adverse drug reaction.:

• Hyperthermia—>Abnormally high body temperature

• Fever

• Tachycardia—>Rapid heart rate

• Neurologic symptoms

• Autonomic disturbances

What is teratogenicity?

Harm caused to a developing embryo/fetus by a drug or other exposure

Why should nurses ask about herbal/alternative therapies?

They may have unknown ingredients, may not have been adequately tested, and can interact with medications.

What is off-label medication use?

Using a medication for an indication that has not been approved by the FDA.

ADPIE

Assess → Diagnose → Plan → Implement → Evaluate

MEDICATION RIGHTS

Before giving medication ask:

WHO? WHAT? HOW MUCH? HOW? WHEN? DID I DOCUMENT?

PATIENT EDUCATION

Patients should:

• Keep a medication list

• Know why they take each medication

• Read labels

• Follow directions

• Store medications safely

• Ask questions

• Tell providers about other medications/herbals

Hypoglycemia

LOW SUGAR = BRAIN + BODY STRUGGLE

Hyperglycemia

HIGH SUGAR = PEE + THIRST

Hypokalemia

Low serum potassium concentration:

• Weakness

• Muscle cramps

• Nausea

• Vomiting

• Diarrhea

Hyperkalemia

High serum potassium concentration:

• Weakness

• Muscle cramps

• Diarrhea

Receptor Sites

React to certain chemicals to cause an
effect within the cell

Biotransformation

Helps to prevents medications from causing adverse
effects on the body

Adverse Drug Reaction

Undesired effects that may be unpleasant or even
dangerous

Primary Actions

Overdose; extension of the desired effect

Secondary Actions

Undesired effects produced in addition to the
pharmacologic effect

Hypersensitivity Reactions

Excessive response to primary or secondary effect of
drug

Acute Stress

Response to intermittent stimuli

Chronic Stress

Prolonged activation of stress response

Eustress

Stress that stimulates a person positively

Distress

Stress that stimulates a person negatively

Selye's Stress Response Theory

The theory that the body adapts to stressors to maintain homeostasis.

General Adaptation Syndrome (GAS)

The body's general stress response involving neural, endocrine, and immune systems.

Alarm stage

The initial stress response in which the sympathetic nervous system and stress hormones are activated.

Sympathetic nervous system (SNS)

Activates the fight-or-flight response during stress.

Norepinephrine

An SNS hormone/neurotransmitter involved in the fight-or-flight response.

Three stages of General Adaptation Syndrome

Alarm, resistance, and exhaustion

Effects of SNS activation

Increased alertness, heart rate, respiratory rate, vasoconstriction, pupil dilation, bronchodilation, blood flow to muscles, and sweating

What happens to GI blood flow during SNS activation

It decreases.

What happens to genitourinary blood flow during SNS activation?

It decreases.

Why does blood flow increase to muscles during stress

The body is preparing for the fight-or-flight response.

Vasoconstriction

Narrowing of blood vessels that occurs during the stress response.

Pupil dilation during stress

Increases as part of the fight-or-flight response.

Bronchodilation

Widening of the airways during the stress response

CRF

Corticotropin-releasing factor released by the hypothalamus.

ACTH

Adrenocorticotropic hormone released by the anterior pituitary.

Cortisol

Hormone released by the adrenal cortex during the stress response

Stress hormone pathway

Hypothalamus releases CRF → anterior pituitary releases ACTH → adrenal cortex releases cortisol.

Main effect of cortisol on blood glucose

Increases blood glucose.

Short-term effect of cortisol on the immune system

Immune activation.

Long-term effect of cortisol on the immune system

Immune suppression.

Adrenal medulla

Releases epinephrine and norepinephrine during the stress response.

Epinephrine

Released by the adrenal medulla as part of the stress response.

ADH

Antidiuretic hormone is released from the posterior pituitary in response to stress

Effect of ADH

Decreases urine output and increases blood volume.

Resistance stage

The stress response continues during this time-limited stage.

What happens if the stressor abates during resistance?

The parasympathetic nervous system induces relaxation.

PSNS

Parasympathetic nervous system; induces relaxation when the stressor abates.

What happens if the stressor does not abate?

The body's ability to respond lessens over time.

Exhaustion stage

The stress response can no longer be maintained and the stress overwhelms the body.

What happens during exhaustion?

The person becomes rundown, overwhelmed, and unable to cope

Chronic stress during exhaustion

Can adversely affect overall health.

Long-term cortisol effect

Suppresses the immune system.

Long-term immune suppression

Increases risk for infection

McEwen's Stress Response Theory

Theory developed in the 1990s describing how frequent stressors can change physiological balance.

Allostasis

A dynamic state of balance.

Effect of frequent stressors on allostasis

Frequent stressors can change physiological balance and create a new setpoint.

Allostatic load

Wear and tear on body systems caused by stress

What contributes to allostatic load?

Both the stressor and the individual's ability to respond.

Causes of allostatic load

Repeated stressful experiences, inability to adapt, prolonged reaction, or inadequate response.