pharm week1+2

med name 3

chemical- chemical structure used during drug development; generic- assigned by us, cheaper; trade(brand)- given by pharmcuetrical company more expensive

pharmacokinetic

what human body does to medication as it passes thru body; can be affected by many factors: water soluability, fat etc.

4 main components of pharmokinetics

absorption- how will it get taken in; distribution- transport moves thru tissues; metabolism- changed to form that can be extreted, how liver breaks it down; excretion- removed from body kidney

absorption

how med enters blood stream after administration, dependent on route of adminstration; affects how quickly med will have an effect. extent of absorption is called bioavablibity

bioavailibility

how quickly + how much a drug reaches its intended site of action. drug form + route of administration, gastric musosa, administration w drugs+/or food changes in liver metabolism. Absorption ranges from 0-100% Iv enters bloodstream first

how drug works

taken in; in stomach peptides destroyed by gastric enzymes then intestine, absored thru small intestine then hepatic portal vein to liver- hepatic vein to heart- then rest of body

less bioavailibity vs more

less- capsules, tablets, coated tablets; more- buccal tablets, liquids, syrups, powder

variables (how formulation can influence what happens after u take medication)

enteric coated pills(cant crush/chew)- special coating doesnt dissolve in stomach, later in large intesine- protects stomach from drug or drug from acid

micronized/nonmicronized(how finely drug is ground)- micronized- particles extremely small which allow the drug to dissolve + can be absorbed more quickly or consitnely; nonmicronized- larger particles may dissolve more slowly, particle size can therefore affect how much + how quickly gets to bloodstream

combination drug- single pill contains 2 or more active medications. reduce # of pills someone has to take

extended release(should not be crushed or chewed can relese too much)- release meication gradually over longer period allowing less frequent dosing

immediate release- released medication quickly after u take it

distribution (from bloodstream into body tissues)

process when medication exits bloodstream + enters cells to excret the effect; affected by BF, blood brain barrier, protein binding

bound drug or free exit bloodstream to tissues

bound(stuck in blood unactive)- bound to plasma protein (albumin) inactive/cant leave bloodstream + enter tissues easily. highly protein bound if >80% binds to protein

free (free to move in tissues + act/ active)- not attached/unbound, can leave bloodstream enter tissues and reach site of action

low albumin levels (burns malnutriton)

low albumin- less protein binding INCREASE in free/unbound drug, free drug INCREASES drug effect risk of toxicity

drug on drug interaction

presence of one drug can decrease/increase the action of another drug when administered tg- compete for binding sites on albumin- more free-unbound drug RESULT= unpredicted drug response

drug ability to cross a cell membrane dependant on water/lipid soluability

lipophilic/lipid/fat soluable Increasing volume of distribution travels thru tissues lower blood concentration- easily cross thru cell membranes including blood-brain barrier, large volume of distriution +less drug stays in blood (lower blood concentration)

hydophilic/water soluble increasing blood concentration drug stats in blood decreasing small volume of distribution- harder time crossing cell membranes; small volume of distribution; more drug stays in blood higher concentration

metabolism

breakdown of medication (liver) to inactive form; biotransformation- bodys ability to change drug from dosage form fat soluable to move water soluable so easily excreted thru urine (fat to water) affected by diseases (liver, CV disease, renal), genetics stress, age

drugs metabolized by enzymes in liver

CYTOCHROME P-450 enzymes changes drug to metabolites; can effect drug on drug interactions; targets lipophilic drugs (helps convert them. itno water soluable substances)

first pass effect

drug goes small intestine to liver before circulation; liver may metabolize the drug before it enters circulation which is known as first pass; liver metabolism may inactive the drug and lower the amount of active drug released into circulation; if this occurs need to higher the dose

half life of a drug

time it takes plasma concentration of a drug to fall to HALF its original value OR time it takes for HALF of the drug to be eliminated by the body; absorption, metabolism, and excretion affect half life. approximately 4-5 half lives to be effectively rid of a drug- meaning not enough drug to cause an effect (97% of drug elimanted)

half life

how long it takes for amount of drug in ur body to decrease by half (50%) (short half life)- leaves body quickly may need to take more; (long half life)- stays in body longer need to take less 4-5 half lives- 94-97% of drug has been elimnated

steady state

amount of drug entering the body equal amount leaving body; occurs after 4-5 half lives

excretion- kidney(remove drugs from blood and put in urine)

glomerular filtration; normal 80-130ml/minute, free or unbound water soluable drugs + metabolites

drug effects

onset- starts at drug administration and ends when theraputic effect starts, route dependent; peak- absorption rate>elimnation rate(STRONGEST) duration- how long

peak, trough, toxicity, therapeutic drug monitoring, clinical pharamacist

peak level- highest amount of drug in blood (highest); trough- lowest amount of drug in blood; toxicity- peak level too high; therapuic drug monitoring- peak and trough blood levels making sure it works without being toxic

pharmacodynamics

what medication does to body; drug works by binding to receptors to enhance or suppress actions the body would tyoicallt do

3 effects of pharmacodynamics

agonists- activites/enhance receptor +increase endogenous actions; antagonists- block/deactivate endogenous actions; partial agonists- enhance an endognous action but with lesser intensity

standard dose= starting/average dose but may need to be adjusted for individual; for each med stablished

avergage dose expected to work for most people- 50% of people will get desired therpautic effect from dose; other 50% may need higher or lower

therpautic index

ratio between lethal dose and the average effective dose, wider ranges are safer drugs. large gap between effective dose and dangerous dose

mechanism of action- how a drug works in the body

change how cells or tissues work by mkaing their activity stronger, weaker, etc.

pharmacotherapeutics (clinical pharmacology)- using medications to help pts

treat diseaes, prevent diseases, diagnose diseases. 2 things to look at: pharmacodynamics- what med does to body, pharmacokinetics- body does to drug

med errors and prevention

nurses later stop; medication reconciliation; computered systems; only approved abbreivations

med reconciliation

checking pts medicaitons to make sure safe and correct; helps missin meds, duplicates, incorrect dosgaes, etc.

rights and checks- verify order 3 times prior to administration

follow 6 rights- right med, right client, right dose, right route, right time, right documnation

adverse drug effects vs side

adverse- unintended pharamcologic events that occur when medication is adminstered correctly, harmful unexpected; side effect- unwanted but mild effect

adverse drug reaction catergpries

pharmacologic- exaggerated version of normla effect (BP gets too low from bp medication); hypersensitivty/aggeric reaction- immune system reacts to drug bc it sees as forgein, immunoglobins bind to neutralize, chemical mediators released mild to severe reactions; idiosyncratic reaction- unnusal or unexpected reaftion to drug that is diff from what normally happens pharmacogenomics- genes can make a drug work diff from person-person; drug interaction- 2 or more drugs interact cause an unwated effect or change how drugs work

physical dependce vs psychologic dependence

physical- physiologic need for drug to prevent withdrawal symptoms; psychological- obsessive desire for euhporia from drug addiction. narcotics are most concern.

schedule 1- highest potential for abuse and lack any acceptal medical use

herion, weed, ectasy

drug abuse

withdrawal- body reacts and cause withdrawl symptoms; narcotics(opiods) higher risk for dependce and abuse

special considerations- genetics pharmacogemics

persons genes affect how respond to medications- poor metabolizer- breaks drug down slowly- build up need lower dose; ultra rapid metabolizer- break down very quickly may not work/last; slow metabolizers WARFARIN may have too ,uch high risk for bleeding need to lower fose

special considerations age peds

peds- still developing; at risk for toxicity and sensitiy. slow stomach emptying can increase absorption of oral; thin skin topical meds can absorb faster; blood brain not developed; kidneys not developed. pedatric doses based on weight and body surface area

special considerations- geri

slowley; increase risk of buildup and toxicity. check lab values, serum drug levels, use lower doses. polypharmacy=taking many medications. more med= grater chance of drug on drug interactions.

speical considerations preg

some meds can cross placenta and reach fetus this can harm baby. teratogenesis= ability of something to cause birth defects. some can pass thru breast milk thru lactation. few studies on pregnany avoid NSADS tylenol ok

adherence- how well a peeson follows their med instructions

culutral beliefs; past experiences; person expecations; family influence; educaiton. herbal and homeopathic products- can slow down drug metabolim or speed up.

patient teaching

starts with admission- first encounter; teaching needs to be individualized, include family/support team, provide feedback, make sure u are talking at their level

PA Drug Monitoring Program (PDMP)

helps prevent prescirption drug abuse; collects info on all filled prescirtiopns for controlled substances, intergration with EHR and systems in PA, shares data with 17 other states and washingotn DC; contirnugn education avaibe. nurses as delegates

controlled substances levels

sch 1- high abuse potential w no accepted mecial use- herion, weed, LSD sch2- high abuse w severe dependce

nursing process

assessment- collect key data to administer meds safely; diagonse- indenity actual + potential stuff; planning- develop plans priorities and intervations; implentaiton- administraiton of drug and intervations developed in planing phase; eveulation- effectiness of reginment side effects

dosage forms

enteral- using gi tract, oral, rectal suppositories; parenteral- injections, solutions; topical- ointments, creams, powders, gels, inhalers,