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drug
chemicals that are introduced into the body to cause some sort of change; any chemical that affects the physiology of a living organism
plants, genetic engineering, animals, inorganic compounds
possible sources of ingredients for drug
prescription drug
drugs made legally available to consumers with written prescription
-food and drug administration drug development approval required
otc drug
no prescription needed
-used for minor ailment
-used for short term symptoms treatment
-FDA determines safety and effectiveness criteria
convenient, effective self treatment, possible cost savings
advantages of OTC (3)
may delay serious treatment, potential abuse, limited insurance coverage, potential adverse event
disadvantages of OTC (4)
therapeutic care, prophylactic care, nutrition, proactive care
herbal dietary supplements general use (4)
chamomile
interact with anticoagulation drug
cranberry
affect drug excretion from kidney
echinacea
interacts w antiviral and immunosuppressant drugs
garlic
interact with diabetic (hypo), anticoag (bleed) drugs
ginger
interact with cardiac, diabetes, and anticoag drugs
ginko
bleeding risk
grapefruit
affects metabolism of drugs
SIR drugs
nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure
-ex: cocaine
pharmacology
the study of biological effects of chemicals; the study of or the science of drugs
clinical pharmacology
application of concepts and principles of pharmacology to properly evaluate and manage drug therapy for patients in clinical setting
acute
what kind of drug therapy is critical condition-life sustaining
loading dose
higher than the usual dose to create critical concentration sooner
manintenance/treatment
drug therapy: chronic condition-prevent progression/occurrence
supplement
lack of/inadequate production by body, support normal function
ex: insulin, iron
palliative
relief from symptoms of serious illness (end stage) to improve quality of life
supportive
used during illness recovery/trauma to maintain body function
ex: fluid, blood transfusion
prophylactic
prevention of disease/undesirable outcome
empiric
prevention of disease based on high clinical chance of pathology related to symptoms (infection)
pharmacokinetics
what happens to a drug from the time it is introduced to the body until it reaches the circulating fluids and tissues
absorption, distribution, metabolism, excretion
ADME
PO, injection, inhalation, topical
routes of drug administration
absorption
how drug is administered, patient’s disease condition, how drugs are formulated, what other drugs are taken, blood flow, enzymatic breakdown, pH can all affect drug _________
liquids, elixirs, and syrups
fastest drug absorption
enteric coated tablets
slowest drug absorption
drug distribution
the transport of a drug by the bloodstream to its site of action
distribution
drug status, disease condition, brain structure, environment, hydration status, circulation structure, and genetics are all factors to consider in drug ______
drug metabolism/biotransformation
the biochemical alteration of a drug into an inactive metabolite, a more soluble compound
cytochrome p450 enzymes
enzymes in the liver used for drug metabolism/biotransformation
first pass effect
when the drug is absorbed and it goes through the liver, the liver metabolizes it, and sends it through the main circulation, some of the main particles have been lost, less amount of drug circulating
-especially PO drugs
high first pass effect
drug is highly metabolised = don’t get full benefit of drug
bioavailability
amount of drug remaining after metabolism
drug excretion
the elimination of drugs from the body
kidney
main organ used for drug excretion
amount of drug/plasma concentration
volume of distribution equation
volume of distribution
measure of drug in circulation and rate of elimination
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
half life
the time required for one-half (50%) of a given drug to be removed from the body
pharmacodynamics
is the study of what the drug does to the body. mechanism of drug action in living tissue
-what the drug does to the body processes
drug MOA
drug actions or how drug works; effects
MOA
receptors, enzymes, non-selective
receptors
MOA: 1. reactive protein (plasma protein) sites of the cell enable the metabolites to make contact with the cells 2. affinity (fit): degree of attachment of drug to receptor site to illicit greatest response-agonist
enzymes
can inhibit or enhance drug MOA
non-selective process
drug MOA: 1. disrupts the cellular structure involved in the disease process 2. alter the metabolic process of problems caused by an organism
pharmacotherapeutics
using drug for treatment
pharmacy
place where drugs are kept
toxicology
the aspect of pharm that studies what happens when we take too much of a specific drug that becomes detrimental to us
efficacy
how well drug treats what it says it will treat
onset of action
when does the drug begin to work
duration of action
how long does drug work in body
peak effect
once initially absorbed into system, the level of drug in system is very high
trough level
after PK drug has travelled through body and is at its lowest level.
therapeutic index
relationship b/w drug treating condition vs causing tocicity
adverse drug event
broad term for any undesirable occurrence involving medication
drug reaction
any reaction to a drug that is expected and undesirable and occurs at therapeutic dose
delay effect, decrease expected effect, enhance expected effect, unexpected side effect
possible results of drug interaction
anaphylactic reaction
deadly reaction to a drug
idiosyncratic drug reaction
opposite reaction of what everybody else presents
tolerance effect
after a while, body doesn’t react to drug much anymore
-need to find different drug for patient
allergic reaction
an unusual unpredictable immunologic hypersensitivity reaction to a drug
anaphylactic reaction
vasodilation of blood vessels, constriction of bronchioles, increased hr, decreased bp, possible death are all signs of an
idiosyncratic reaction
unexpected response to normal drug dose peculiar to a patient due to genetic predisposition
adverse drug reaction
hives, swelling, redness, itching, pain, LOC changes are all possible signs and symptoms of an
interaction
how to prevent drug ____: learn about drug, read drug labels, take the drug as ordered, keep the drug in the original container, keep a list of all drugs/prescription/otc/herbs, check with provider, use one pharmacy
pharmaceutics
the aspect of pharmacology concerned with dosage form design
pharmaceutics dosage forms
the medium used to carry drug molecules to the site of action in the body
polypharmacy
taking five or more medications simultaneously
laxatives
_____ are the most reported drugs in polypharmacy among older adults
polypharmacy effect
poor/non adherence to treatment plan, drug-drug interaction, adverse drug reaction, hospitalization, cost
non-adherence to polypharmacy
LOC, physical body function, cost, associated symptoms are all reasons for
role of nurse in polypharmacy
learn about the drugs, assess patient/drug, assist patient in organizing drug, educate patient about drugs, provide other general information
administration responsibilities
safety/contamination/infection prevention, patient assessment/nursing care, medication administration process are all general medication _____ _______
do not
…. ….. administer any medication you have not reviewed, activate incomplete order, leave medication at bedside, administer any drug you did not prepare, prepare medication for more than one patient at a time
special drug considerations for infant/child
growth/developmental stage, special devices, technique, communication, safety
drug dosing considerations for older adults
polypharmacy/adherence, health impairments, aging/body size, abilities/special devices, drug reactions, and interaction
the 3 check principle
check drug 1. pulling out of drawer, 2. opening drug package, 3. after pouring and before giving to patient
right patient, right drug, right dose, right route, right time, right documentation
name the 6 rights
enteral route
PO (through mouth)
parenteral route
injections
other route
topicals
do not crush
controlled release, long acting, slow/sustained action, slow/sustained release, double strength, enteric coated, capsule
administering liquid drug
shake bottle as needed, use proper indicated measuring, pour/aspirate at eye level, protect drug label, mouth rinse as needed
checks patient’s armband
the first check during drug administration occurs when the nurse
enteric
intestinal obstruction, malabsorption syndrome, paralytic ileus, intractable vomiting, and diarrhea are all contradictions of the ___ route
opthalmic
eye
otic
ear
nasal
nose
ophthalmic route goals
prevent infection, prevent injury, prevent systemic absorption
inner corner
where do eye drops go?
swipe across towards outer eye
where does eye ointment go
otic route
soften wax, pain management, local anesthesia, infection treatment, foreign object are all uses of
pull ear lobe up and back
otic: for adult and children over 3 years old
pull ear lobe down and back
otic: children under 3 years
topical route-skin
assess skin site, remove old treatment, clean site, place new treatment/new site, date, time, initial, prevent contact with med site