1: Intro to Drugs (Rx, OTC, SIR)

Nurses Responsibilities in Drug Administration

-Knowledge: correct drug, dose, administration technique

-Assessment

-Promote therapeutic effects

-Minimize adverse effects

-Minimize adverse interaction

-Make as-needed decisions

-Evaluate medication responses from patients

-Manage toxicity

-Patient education

Drug Definition

-Chemicals that are introduced into the body to cause some sort of change

-Any chemical that affects the physiology of a living organism

Properties of Ideal Drug

Safe

Effective

Selective

Reversible action

Predictability

Easy administration

Low cost

Chemically stable

Simple generic name

General Drug Effects

-Positive: prevent illness, diagnose diseases, treat conditions, antidote

-Negative: teratogenic (kills fetus of pregnant woman), mutagenic (causes mutations), carcinogenic (causes cancer), drug/food interaction

Sources of Ingredients for Drugs

-Plants

-Animals

-Genetic engineering (synthetic)

-Inorganic compounds (calcium, iron)

Samples of Drugs Derived From Plants & Flowers

Nicotine

Morphine

Atropine

Capsaicin

Cocaine

Codeine

Digoxin

Quinine

Samples of Drugs Derived From Animals

-Heparin: pig, ox liver

-Insulin: pig, ox pancreas

-Penicillin: microorganism

-Thyroxin: pig, ox thyroid gland

Samples of Drugs Derived From Inorganic Salts

Magnesium

Sodium chloride (salt)

Calcium

Potassium

Iron salt

Lithium

Iodine

Samples of Drugs Derived From Synthetic Preparation

Ampicillin

Salicylates (anti-platelet effects)

Amoxicillin

Doxycycline

Sources of Written Drug Information

-Text-books

-Drug labels

-Package inserts

-Drug reference books

-Recognized internet sites

> Organizations: WHO

> Government sites: CDC, FDA

> Professional health care sites

Drug Names

1. Chemical structure name

2. Trade/brand name (proprietary)

3. Generic name (non-proprietary)

Examples of Drug Names

1. Chemical structure name: acetyl-p-aminophenol

> Trade/brand name: panadol, fevadol, adol

> Generic name: paracetamol (UK), acetaminophen (US)

2. Trade/brand name: claritin

> Generic name: loratadine

-DAW: dispense as written

Drug Availability to Consumers

-Prescription (Rx)

-Over the counter (OTC)

> herbal/dietary supplement

-Street /illicit/recreational drugs (SIR)

Prescription (Rx) Drug

-Drugs made legally available to consumers with written prescription

-Food & Drug Administration (FDA) drug development approval required

Over the Counter (OTC) Drug Characteristics

-No prescription needed

-Used for a common minor ailment

-Used for short-term symptoms treatment

-FDA determines safety and effectiveness criteria

Determining Criteria for OTC Drug Status

-Safety profile

-Practical use

-Indication for use

Advantages of Using OTC Drugs

-Convenient

-Effective self treatment of minor illness

-Possible cost savings

Disadvantages of Using OTC Drugs

Safety issues

-May delay treatment for serious illness

-Potential misuse/abuse

-Limited insurance coverage

-Potential interaction, adverse event, toxicity

OTC Safety/Effectiveness Requirements

-Drug information

-Active ingredient/purpose

-Use

-Warning: before, during, pregnancy, child, overdose

-Directions: when, how, frequency

-Other information: precautions, storage

-Inactive ingredient

-!OTC drugs can only claim symptom management, not cure!

OTC Manufacturing Practice Requirements

-Data

-Product identity

-Composition

-Quality

-Purity: microbes, metal, pesticides

-Strength of active ingredient

HERBAL/DIETARY SUPPLEMENTS (HDS)

General Use

-Therapeutic care: treatment

-Prophylactic care: prevention

-Nutrition: food & nutrients

-Proactive care: maintain health & wellness

Sources of HDS

Herb: plant source of ingredient used to maintain health

Bark

Berries

Roots

Leaves

Gums

Seeds

Stems

flowers

Common Available Forms of Herbal Products

Teas

Syrup

Oils

Extract

Tincture

Pills

Capsules

Common Names of Herbal Products

Aloe

Echinacea

Feverfew

Garlic

Ginkgo

Ginseng

Goldenseal

Hawthorn

Saw palmetto

St john's wort

Valeria

Body Systems Treated with Herbal Products

Integumentary (skin)

Neurological

Cardiac

Gastrointestinal

Genito-urinary

Musculoskeletal

Common Conditions Treated with Herbal Products

Anxiety

Arthritis

Cold/cough

Constipation

Depression

Fever

Headache

Infection

Insomnia

Stress

Ulcers

PMS

Weakness

Possible Herbal Supplement/Food Interaction

-chamomile

-cranberry

-echinacea

-garlic

-ginger

-ginkgo

-grapefruit

chamomile

interact with anticoagulation drug (counteracts)

cranberry

affect drug excretion from kidney

echinacea

interacts with antiviral and immunosuppressant drugs

garlic

interact with diabetic (hypo), anticoagulant (clot) drugs

ginger

interacts with cardiac, diabetes, and anticoag drugs

ginkgo

bleeding risk (anticoag-warfarin, antiplatelet-asprin)

grapefruit

affects metabolism of drugs

Street/Illicit/Recreational (SIR) Drugs

-Nonprescription drugs with no known therapeutic use; used to enhance mood or increase pleasure

-A drug (such as cocaine, marijuana, or methamphetamine) used without medical justification for its psychoactive effects often in the belief that occasional use of such a substance is not habit-forming or addictive

Sample Names of SIR Drugs

Amphetamine

anabolic steroids

barbiturates

benzodiazepines

cannabis

cocaine

fentanyl

heroin

morphine

oxycontin

Health Effects of SIR Drugs

Stimulant

Depression

Analgesic

Hallucinogen

Amnesiac

Disadvantages of OTC drug use includes all except:

-Possible cost savings

-May delay treatment for serious illness

-Potential misuse/abuse

-Potential interaction, adverse event, toxicity

Possible cost savings

All except which of the following can be harmful to a patient who is at risk for bleeding?

-Chamomile & cranberry

-Cranberry & echinacea

-Garlic & ginkgo

-Ginger & chamomile

Cranberry & echinacea

Case Study 1:

A patient tells the nurse, “I have high blood pressure and hardening of my arteries. I go to the doctor and take prescription pills, but I have added some Herbal Supplements because they are natural and totally safe.”

Nursing Care:

Understanding possible effects of herbal products in patients with

cardiovascular disease what should the Nurse do?

Figure out what patient is taking, see how supplement affects patient

Case Study 2:

A patient who is getting blood clot prevention therapy tells the nurse that she

would like to start taking Ginkgo.

Nursing Care:

Before starting this herbal product, it is most important for the nurse to ask if

the patient is taking which type of medication? Why?

Understanding the possible effects of herbal products in patients with

cardiovascular disease, what should the nurse do?

Ask about medication because ginkgo has a bleeding risk