nurs 116 lecture 3

categories undesirable drug effects

non-deleterious (side effects)

deleterious (toxic)

what must you always assess after admin a drug?

side effects and adverse effects

categories undesirable drug effects

non-deleterious (side effects)

deleterious (toxic)

what must you always assess after admin a drug?

side effects and adverse effects

polypharmacy

too many drugs

common in seniors

pregnancy category A

no risk (ex. hydrophilic vitamins like vitamin C)

pregnancy category B

animal research suggests safety/human studies show safety

pregnancy category C

R v B

insufficient human study/animal studies show problems

pregnancy category D

R v B

show fetal risk but drug is important to treat some women

pregnancy category X

fetal risks, no situations where R v B justifies use

general pregnancy effects

altered GI fx (delayed GI emptying)

decreased acidity

higher blood volume (50x)

• higher HR=more distribution

• higher GFR

• decreased PPB

• high blood flow to uterus

pregnancy effects on pharmacotherapy

drugs take longer to absorb

most drugs cross into placenta & breastmilk (ex. ibuprofen, opioids)

avg pediatric blood volume

80mL/kg of body weight

renal function for pediatrics

neonates & young infants have lower renal functions

rate of decline of renal function with age

1%

most common toxicities (drugs) → “all the old bats are coming around”

ASA

tylenol (acetaminophen)

opioids (oxycodone, fentanyl, isotonitazene)

benzodiazepam

alcohol

cocaine

antidepressants

most common medication errors + how to fix

-wrong dose

-crushing enteric-coated tablets

-crushing sustained-release tablets

how to fix? check your 10 rights

clinical procedure in toxicity

Airway - patency (ability to breathe)

Breathing (oxygenation & ventilation)

Circulation (organ perfusion, CO + BP)

Disability - assess dysfunction (VS, pupils, ECG - coma, seizure, cardiac arrhythmias) & treat

Exposure - identify the drug/substance, initiate tx to decrease activity

why is the throat an anatomical deadspace?

no gas exchange

ASA toxidrome signs

confusion, tachycardia, tachypnea, hyperthermia

acetaminophen toxidrome signs

abd pain

loss of appetite

nausea/vomiting

opioids toxidrome signs

bradypnea/apnea

pupils constricted

cocaine (+ stimulants) toxidrome signs

agitation/tremors

tachycardia

tachypnea

hyperthermia

pupils dilated

CBD vs THC

cbd: calming

thc: narrow TI, CNS boost, VS instability

cannabis admin potency: inhalation vs. PO

inhalation has higher overall potency but PO overdoses more (ppl assume it isn’t working and take more)

somnolence

drowsiness

labs for cannabis

urine toxicology

serum levels

tx of cannabis toxidrome

-seizures —> benzodiazepines

-hypertension —> antihypertensives

-resp depression —> ET

-psychosis tx —> antipsychotics

adsorption

binding of drug to decrease its absorption (using activated charcoal)

how does activated charcoal work? how much can you admin?

binds to its surface carbons

enteral route

eliminated via stool

dose: 0.5-2g/kg (max 100g)

drug tx of toxidrome (induce metabolism) example

acetaminophen (1) —> NAPB/NAPQI (toxic) —> NAC (n-acetylcysteine) increases glutathione (2) —> nontoxic conjugates

what metabolizes ETOH?

dehydrogenase —> depletes vitamin B which supports cellular function

CNS effects of alcohol

GABA binding-inh (high affinity) + less glutamate-excit = sedation

what does alc inhibit?

ADH which causes diuresis —> dehydration

what happens in tolerance of ETOH?

GABA receptors # increase —> need more alc for same effect

tx for alc toxidrome (drug, elimination)

metadoxine, IV —> induces alc dehydrogenase fx (faster clearance)

you can also wait (zero order kinetics)

general elimination tx for toxidrome

GI tract: activated charcoal —> intestinal elimination of charcoal-bound drug

renal: alkalization to induce excretion, sodium bicarbonate (ionizes acidic substance like ASA)

hemodialysis: activate removal from venous circulation