N221

Clinical pharmacology

study of drugs to use to treat and cure

pharmacotherapeutics

using drugs for treatment

pharmaceutics

determines dosage and form

pharmacy

place of storage and distribution of drugs

pharmacokinetics

energy and movement of drugs in the body

pharmacodynamics

how the body processes and interacts with the drugs

toxicology

study of appropriate consumption of drugs before its toxic to the body

pharmacoeconomics

purchasing of drugs, keeping it low cost

acute dose

a large dose used for critical condition-life sustaining (ICU, OR)

loading dose

higher than usual dose to create critical concentration sooner. establishes presence; sensitive, only under supervision at hospital

maintenence

chronic condition-prevent progression or occurrence. small; recommended dosage, can be continued at home

supplement

lack of/inadequate production by body, support normal function-insulin, iron

palliative

relief from symptoms of serious illness (end-stage) to improve quality of life, to alleviate stress from condition

supportive

used during illness recovery/trauma to maintain body function - fluid/dehydration, blood loss/transfusion

prophylactic

prevention of disease/undesirable outcome (ex. antibiotics before surgery)

empiric

prevention of disease based on high clinical chance of pathology related to symptoms (infection)

goal of pharmacokinetics

to reach critical concentration needed for therapy within the safe dose range

components of pharmacokinetics (4)

absorption, distribution, metabolism, and excretion

In pharmacokinetics the GI ________ the PO medication

absorbs

In pharmacokinetics the liver _____________ the medication

metabolizes

In pharmacokinetics, the heart ___________ the medication

distributes

In pharmacokinetics, the kidneys ___________ the medication

excretion

what are ways to directly introduce medication into the circulation (3)

injection, inhalation, and topical medication

what are ways the body excretes medication

bile, feces, lungs, and kidney

What are factors that can affect drug absorption (4)

how the drug is administered, patients disease condition, how the drug is formulated, and what other drugs are taken (interaction)

factors to consider in drug distribution

drug status, drug condition, brain structure (blood brain barrier), environment, hydration status, circulation structure, and genetics

ctyochrome P450 enzyme

in the liver and helps breakdown of drugs. Some works well with this enzyme, others not so much

first pass effect

reduced concentration after passing through certain parts of metabolism

bioavailability

what remains after the liver metabolizes the drug

factors affecting metabolism of medication

disease, drug w/ p-450, genetics, other (tabacco), food items (ex. grapefruit juice)

half life

the time required for one-half of a given drug to be removed from the body

steady state

the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed with each dose

Pharmacokinetic pre-pregnancy considerations

fetus exposure

pharmacokinetic pregnancy considerations

1st trimester, last trimester, and breastfeeding

pharmacokinetic pediatric considerations

immature organs, disease

pharmacokinetic older adult considerations

aging process, polypharmacy, adherence, patient with disease

pharmacokinetic principles

onset of action, duration of action, half-life of a drug, bioavailability, steady-state, and lifespan

mechanism of actions include

receptors, enzymes, and non-selective drugs

affinity

degree of attachment of drug to receptor site to illicit greater response

agonist

fit in receptor to cause change

antagonist

fits in receptor to stop change

enzymes can either

inhibit or enhance a drug

potency

how powerful to be effective

efficacy

high maximal and low maximal. how well drug works for certain conditions

possible results of drug interaction

delayed effect, decrease expected effect, enhance expected effect, and unexpected side effect

impacts of adverse drug events

no effect, mild, moderate and severe effect, life-threatening effect, disfigurement/disability, death

Possible causes of drug reaction

change in drug therapy, initiation of supportive treatment, complication of disease process, interaction with other therapy

idiosyncratic reaction

unexpected response to normal drug dose peculiar to a patient due to genetic predisposition

possible signs and symptoms of adverse drug reaction

hives, swelling, redness, itching , pain, level of conciousness

General sources of medication errors

manufacturer, system weakness, provider, dispenser, administration, other staff, and patient

two types of human errors

omission and commission

omission error

forgetting to give medication at scheduled time (unless patient refused or contraindications which you should document)

commission error

giving medications but something is wrong with 6 rights

6 rights

is it the right
dose, route, date/time, drug, documentation, patient

shift change events that can lead to medication error

patient transfer to different department, and incomplete shift reports

distractions that can effect medication administration

phone calls, unrelated conversations, call lights, change in patient condition

BCMA

bar code medication administration

medication reconciliation

process in which medications are reconciled at all points of entry and exit to/from a health care entitiy

points of reconciliation

on admission, status change, patient transfer, and discharge

steps of medication reconciliation

verification, clarification, and reconciliation

BCMA process

prepare med, inform patient, scan patient ID (2 checks), scan medication, administer medication (ensure patient swallowed), and document by clicking accept

basic drug information you should know (11)

Name, SDR, category, purpose (MOA), pharmacokinetics, pharmacodynamics, side effects, interactions, contraindications, nursing implications, patent education

Where to report medication error

your facility, med-watch, joint commission, institute for safe medication practices, united stated pharmacopeia medication medication errors reporting system

goals of medication reconciliation

prevent error by assessing and updating medication info throughout the healthcare process. preventing poorly communicated medical information as the cause of up to 50% of medication errors. Fulfil required obligation by Medicare and joint commission

how to report error (nursing student)

assess patient first, report error on time, provide objective information about error, ask your CI and Nurse about "incident reporting" protocol at your facility. and review/complete USF incident reporting in your student portal/handbook

performance errors include

wrong patient, drug, dose, route, time, omitted dose, wrong dosage form diluent, concentration, infusion rate, technique, duration, expired dose, and incorrect documentation

value of drug classification

tells us expected information, nursing education/care, provides information on overdose, anticipate adverse effects, drug to drug interactions, and reduce duplication of therapy

3 ways to classify drugs

pharmacologic, therapeutic and chemical structure classification

groups drugs by their similar.... (4)

attributes, mechanism of action, interaction, and adverse effects

therapeutic classification

is a way to categorize drugs by the way they act against disease or disorders. On a particular area of the body or on a particular condition

antacids

treats hyperacidity

anticonvulsants

treats seizures

narcotics schedule

levels for potential habit forming/abuse

legend drugs

prescription

orphan drugs

treats rare diseases like Ebola. Is expensive to develop and typically government sponsored

Acetaminophen/tylneol PO or Ofirmev IV

antipyretics and non-opiod analgesic

acetylsalicylic acid (aspirin) PP is classified as

salicylates

therapeutic effects of acetylsalicylic acid (aspirin) PO

antipyretic, non-opioid analgesic, anti-inflammatory

drug classification on pregnancy safety

category A, B, C, D, X

Category A drugs

drugs that demonstrate no risk to the fetus

category B drugs

no risk in animal studies, with no adequate studies in humans

category C drugs

Risk cannot be ruled out. No satisfactory studies in pregnant women, but animal studies demonstrate a risk to the fetus. potential benefits of the drug may outweigh the risks

category D drugs

evidence of risk to fetus, but potential benefits of the drug may outweighh the risks

category X drugs

contraindication; studies show risk to fetus, leading to fetal abnormalities. Risk of drug outweigh potential benefits

Antidote for acetaminophen

mucomyst

antidote for coumadin

vitamin K

antidote for heparin

protamine sulfate

antidote for opiod

naloxone

Broad class of drugs used for diseases causing by organisms

anti-infection agents

bactericidal

kill germs/bacteria

bacteriostatic

inhibit growth of germs/bacteria

subclasses of anti-infective agents

based on source of infection. Anti-viral, anti-fungal, anti0bacterial, other

broad class for infection treatment

antibiotics

examples of anibiotics

penicillin (augemntin), sulfonamides (sulfamethoxazole-trimethoprim), tetracyclines (doxycycline, tetracycline)

class of drugs for angiotensin converting enzymes

anti-hypertensives

ACE inhibitor

angiotensin converting enzymes inhibitor

examples of antihypertensies

benazepril (lotensin), captopril, lisinopril (Prinivil, Zestril), enalapril (Vasotec), quinapril (accupril)

subclass of anti-hypertensives

beta blocker (LOL medication) and calcium chanel blockers (pine)

selective beta blocker (+ examples)

beta 1, metoprolol (Lopressor, Toprol-XL), atenolol (tenormin)

nonselective beta blockers (+examples)

target beta-1, and beta-2. carvedilol (Coreg, Coreg CR, labetalol), propranolol (Inderal LA), nadolol (corgard)