Pharm final - SG

Generic name

Generic name

Not owned by a specific agency and is the official name of the frug and is given to a drug that can be made or marketed by any company.

Trade name

Selected by a specific company producing the drug for marketing purposes. Followed by the trademark symbol.

Controlled substance scedules

• Schedule I: illegal ex: heroin, marijuana, ecstasy

• Schedule II: prescribed with great caution for potential addiction ex: opiods’s, hydrocodone, fentanyl, morphine

• Schedule V: Limited abuse potential ex: small amounts of opioid, antitussives, antidiarrheals

Pharmokinetics processes

Absorption —> Distribution —> metabolism —> excretion

Absorption

The process by which a drug is made available for use in the body

First pass effect

Oral drug is absorbed and carried directly to the liver, where it is inactivated by enzymes before it enters the general bloodstream

Distribution

When a drug moves from circulation to body tissue or a target site

Metabolism

The body changes a drug to a more or less active form that can be excreted

Excretion

Removal of drug by kidneys or intestine

Half-life

The time required for the body to eliminate 50% of a drug.

Adverse drug reaction

undesirable effects (ex: nausea)

Allergic reaction

A hypersensitive response of the immune system ex: itching, skin rash, hives

Anaphylactic shock

An extremely serious allergic drug reaction that usually occurs shortly after the administration of the drug

Drug idiosyncrasy

An unusual or atypical reaction to a drug ex: drug given for sleep causes wakefulness

Drug tolerance

A decreased response to a drug, requiring in an increase in dosage to achieve desired effect

Cumulative Drug Effect

When the body is unable to metabolize and excrete one dose of a drug before the next dose is given

Toxic Reactions

Toxic levels build up when a drug is administered in doses that exceed normal level or if the client’s kidneys are not functioning properly and cannot excrete the drug.

Additive Drug Reaction

When the combined effects of 2 drugs is equal to the sum of each drug given alone. 1 + 1 = 2

Synergistic drug reaction

When drugs interact with each other and produce an effect that is greater than the sum of their separate actions. 1 + 1 = 3

Antagonistic drug reaction

When one drug interferes with the action of another, causing a neutralization or a decrease in the effect of the drugs. 1 - 1 = 0 ex: protamine and heparin

What factors affect drug action?

• Age

• Weight

• Sex

• Disease

• Route of administration

What are the 5+ rights of drug administration

1. Right client

2. Right drug

3. Right dose

4. Right route

5. Right time

6. Right documentation

What are the 5 steps of the nursing process?

• Assess

• Diagnose

• Plan

• Implement

• Evaluate

Name the 3 components of good health communication

• Health literacy

• Cultural competency

• Identifying limited English proficiency (LEP)

Health literacy

• The ability to understand information about disease and then use the information to make decisions about health care

• Assessment is required to determine a patient’s ability to understand health concepts and carry out health care instructions

Cultural Competency

• The ability to interact with people from different cultures

• Respect other people’s traditions, norms, and other traits

• Learn other cultural norms and behaviors

Identifying limited English proficiency (LEP)

• Provide teaching resources for clients with LEP

• Use written instructions that have been translated into familiar language when teaching LEP clients

• Use professional interpreter services to relay oral interactions

ANS is divided into

SNS and PNS

CNS contains

brain and spinal cord

Sympathetic =

adrenergic

“Fight or flight”

• Sympathetic/ adrenergic

Primary neurotransmitter for SNS

Norepinephrine —> epinephrine

Parasympathetic =

cholinergic

Rest and digest

Parasympathetic/ cholinergic

PNS neurotransmitter

acetylcholine

Common ADR of adrenergic drugs

• cardiac arrhythmias

• headache

• nausea/ vomiting

• Increased BP

Nursing considerations when administering Levophed/ norepinephrine

• Potent vasopressor

• Extravasation injury

• Administer via central or PICC

• Continuous BP monitoring

Epi-Pen administration

• Hold epi-pen into fist with tip pointing downward toward thigh

• Swing and push auto-injector firmly until it “clicks”

• Hold in place 3 seconds

• Remove from thigh

Alpha-adrenergic blocking drug uses

• HTN caused by pheochromocytoma

• HTN preoperatively

• Reduce ocular pressure during laser surgery

• Extravasation injury

Alpha-adrenergic blocking ADR

• weakness

• orthostatic hypotension

• arrhythmias

• hypotension

• tachycardia

Alpha-adrenergic blocking drug prototype

Phentolamine

Beta- adrenergic blocking drug prototype

Metoprolol and propanolol

Beta- adrenergic blocking uses

• HTN

• Arrhythmia

• Migraines

• HF

• Angina pectoris

• Glaucoma

Beta- adrenergic blocking ADR

• Orthostatic hypotension

• Hypotension

• Bradycardia

• Blood glucose changes (hyperglycemia - propranolol)

• Bronchospasm (propranolol)

Alpha/ Beta adrenergic blocking drug uses

• HTN

• HF

• Labetalol- gestational HTN

Alpha/Beta blocker prototype

Labetalol

Alpha/Beta blocker ADR

• Hypotension

• Bradycardia

• Skin rash

• Dyspnea

Central/ Peripheral acting adrenergic blocking uses

• HTN

• Arrhythmias

• BPH

Central/peripheral anti-adrenergic ADR

• Peripherally acting —> hypotension, bradycardia

• Centrally acting —> dry mouth, drowsiness, sedation, anorexia, rash, weakness

Central/peripherally acting anti-adrenergic prototypes

• Central- clonidine

• Peripheral- Tamsulosin

Cholinergic Drug Uses

• Urinary retention

• MG

• Neurogenic bladder

Cholinergic drug ADR

• Muscle weakness

• Arrhythmias

• Salivation

• Flushing of skin

• Nausea, diarrhea, abdominal cramps

Direct acting cholinergic uses

• Acute, non-obstructed urinary retention

• Neurogenic atony of bladder with urinary retention

Direct-acting cholinergic prototype

Bethanechol

Indirect acting cholinergic use

MG

Indirect- acting cholinergic prototypes

• Guanidine - MG

• Pyridostigmine - Myathenic syndrome (Eaton- lambert disease)

Difference between direct and indirect acting cholinergics

• Direct acting acting on the PNS

• Indirect acting act on the enzyme acetylcholinesterase

What is the antidote for a cholinergic overdose

Atropine

Use of cholinergic blocking drugs

• Maintenance treatment of asthma and COPD

• Ureteral or biliary colic and bladder overactivity

• Pylorospasm and peptic ulcer

• Vagal-nerve induced bradycardia

Cholinergic- blocking ADR

• Cardiovascular: palpitations, tachycardia

• CNS: headache, flushing, nervousness, drowsiness, weakness, insomnia, nasal congestion, fever

• GI and GU: dry mouth, N/V, dysphagia, heartburn, constipation, dysuria, urinary hesitancy and retention

• Other: decreased sweat production and urticaria

oxybutynin use

overactive bladder

Scopolamine uses

motion sickness, preanesthetic sedation

Prehypertension

BP is 120-129/ below 80, and pt. should engage in health promoting lifestyle modifications to reduce risk for hypertension

Hypertension

A blood pressure of 130/80. unchecked it can lead to kidney disease, HF, or stroke

HTN risk factor

Age, gender, family history, ethnic group/race, increased weight, increased dietary intake of sodium, chronic and alcohol consumption, lack of physical activity, smoking, stress, socioeconomic status

Non-medication management of hypertension

Weight loss, stress reduction, regular aerobic exercise, smoking cessation, moderation of alcohol consumption, change diet (decrease salt intake)

Beta-blocker action

• Decreases or blocks stimulation of SNS

• Decreases heart excitability

• Dilates blood vessels

• Decreases cardiac workload and oxygen consumption

ARB prototype

Losartan

ARB action

Blocks the binding of angiotensin II at receptor sites found in smooth muscle and adrenal gland which blocks the vasoconstrictive effects of the RAAS

ARBS ADR

• Angioedema

• URI

• Cough

CCB action

• Inhibits the movement of calcium ions across cell membranes of cardiac and arterial muscle cells

• Effects on heart slowing the conduction velocity of the cardiac impulse

• Depression of myocardial contractility

• Dilating coronary arteries and arterioles increases oxygen to tissue

CCB uses

• Anginal pain associated with certain forms of angina

• Chronic stable angina

• HTN

CCB prototype

Verapamil

CCB ADR

• CNS: dizziness, lightheadedness, headache, nervousness, fatigue

• GI: Nausea, constipation, abdominal discomfort

• Cardiovascular: peripheral edema, hypotension, arrhythmias, bradycardia

• URI: Nasal congestion, cough

• Skin reactions: rash, flushing

ACEIs action

• Prevents the angiotensin-converting enzyme, which converts angiotensin I to angiotensin II, a powerful vasoconstrictor

What is the “First Dose Effect”

Significant drop in BP after the 1st dose of the drug

What are some interventions to manage the “First Dose Effect”

• Smaller initial dose ordered by HCP

• After first dose of an ACEI, monitor BP every 15-30 minutes for 2 hours afterward until BP is stable for 1 hour

• Increase to therapeutic dose slowly

• Sit or lay supine don’t stand

• Take medication at bedtime

What are some ways to prevent orthostatic hypotension

• Place items close to bed

• Change position slowly

• Exercise calf muscles before getting out of bed

• Sit at edge of bed or chair before standing

• Avoid bending at waist to pick up items

• Drink adequate fluids

Why should a patient not abruptly stop taking antihypertensive drugs

It can cause severe rebound hypertension

Patient education for antihypertensive drugs

• skipping doses —> severe rebound HTN

• Check with HCP before taking prescription drugs

• Rise from lying or sitting position slowly

• If drowsy avoid hazardous tasks such as driving

• Monitor BP and keep a record

• Notify HCP if unexplained weakness, fatigue, or sudden BP increase

Sublingual drugs

under tongue

Buccal drugs

• Between cheek and gum OR between upper lip above incisors. allow it to dissolve.

• Dry mouth decreases reabsorption

• May rinse mouth first

• May cause burning or tingling in mouth

• Do NOT swallow or chew

What should be included in pt. education when administering nitroglycerin metered spray?

• Metered aerosol spray canister to abort an acute angina OR prophylactically 5-10 minutes before engaging in activity

• Spray metered dose under tongue

• Do NOT shake or inhale

• Instruct pt. to call HCP if pain is not relieved in 3 doses given 5 minutes for 15 minutes

What should included in nurse and pt. education when administering a nitrate ointment topically

• Obtain BP and pulse before administration

• Dose measure in in, mm, cm

• Compare BP and P with baseline and previous vital signs

• If BP is lower or pulse rate higher contact HCP before applying

• Rotate application sites

• Do not rub ointment into skin

What should be included in nurse and patient education when administering a nitroglycerin transdermal patch? What are some benefits of the patch?

• Drug absorbed through skin

• Drug impregnated in a pad

• Drug released at a constant rate and maintains plasma level

• Prone to developing tolerance to vascular and anginal effects of nitrates

• Patch applies (9 am) for 12 than removes (9 pm) 12 hours until next am dose

• Site needs to be dry, free of hair, not subject to rubbing or movement

• Sites: chest, abdomen, thighs

• Remove patch to new site

What are some interventions to prevent tolerance of nitrates from developing?

8-12 hours of nitrates

What are the primary actions of decongestants? What effect can this have on BP?

• Sympathomimetic: produce localized vasoconstriction of the small blood vessels of the nasal membranes similar to adrenergic drugs, reduce swelling in nasal cavity and sinuses

• Raise BP

Decongestant Use

• Common cold

• Hay Fever

• Sinusitis

• Allergic Rhinitis

Decongestant ADR

• Tachycardia

• Nervousness, restless

• Insomnia

• Blurred Vision

• N/V

1st generation antihistamines

• Bind non-selectively to central and peripheral H1 receptors

• may result in CNS stimulation or depression (sedation)

2nd generation Antihistamines

Selective for peripheral H1 receptors and are less sedating

What is the effect on intranasal steroids on Rhinitis? When does this effect occur?

• Act by inhibiting the response of a number of cells, including mast cells and WBC

• Inhibits mediators such as histamine which reduces the inflammatory response

• Do NOR get immediate results; takes time for effectiveness

Intranasal corticosteroids uses

• Rhinitis caused by non-allergens

• Nasal polyps

• Chronic sinusitis

Intranasal corticosteroids ADR

• unpleasant tase or smell

• drying of nasal passages

• Epistaxis

• Fungal infections- rare

Intranasal corticosteroids proper method

• Topically

• Insert nasal applicator into nostril. Lean forward and aim nozzle slightly up and outward tear duct

• Spray without sniffing or sniff gently

Antitussive prototype

• Codeine: opioid

• Dextromethorpan: non-opioid

Antitussive uses

• Relieve non-productive, dry hacking cough

• Depress cough center in the brain

Expectorant prototype

Guaifenesin

Expectorant Uses

• Help bring up respiratory secretions

• Thin respiratory secretions

Mucolytics prototype

Acetylcysteine