Pharm final

pharm final

Pharmacology

Study of drugs that alter functions of living organisms. Pharmacokinetics and pharmacodynamics.

Ex: natural and synthetic drugs

Best practice for giving medications (Pharm practicum)

-login to EHR

-verify pt ID (name, DOB, allergies)

-review history and physical (verify 6th right)

-review active orders (verify correctly written med orders)

-review eMSR (identify meds to be given now)

-use FOC sheet for schedules meds (D,R,F,R)

-gather info/cross checking (vitals/labs/etc)

-close EHR

-go to med cart/pyxis (verify pt, label plastic bag w/ pt initials and DOB)

-pull out meds and check expiration dates

-1st check: compare meds against the eMAR (one med at a time) do the 6 rights

-note special assessments on FOC sheet for meds

-2nd check: dump bag and repeat

- clean area/take meds to pt

-enter room (hand hygiene)

-introduce self, provide privacy, explain process and purpose

-identify pt (open chart to verify name and DOB, click on the eMAR, scan ID )

-assess allergies (confirm verbally, ensure allergy band is present)

-scan all meds

-complete special assessments

-3rd check of rights

-explain each med to pt

-administer ( pain meds first, injections next, PO last)

4 major concepts that assist in understanding pharmacology.

Core drug knowledge

Core patient variables

Nursing management of drug therapy

Medications

Core drug knowledge

Pharmacotherapeutics

Pharmacokinetics

Pharmacodynamics

Precautions/Contraindications

Drug interactions

Adverse effects

Pharmacokinetics

What the body does to the drug. Changes that occur to the drug while its inside the body.

Absorption

Distribution

Metabolism

Excretion

Pharmacodynamics

What the drug does to the body. The action of the drug and its effects on the body.

(adverse effects/side effects)

Core patient variables

Health status, lifespan and gender, lifestyle, diet, habits, environment, culture, and inherited traits.

Assessment of core patient variables

Interview

Physical assessment

Chart review

How to maximize therapeutic effects?

-Administer drug in a manner that will promote absorption

-Administer at appropriate time

-Monitor lab values

How to minimize adverse effects?

Allergies, contraindications , administer safely, monitor patient, monitor labs and patient, report adverse effects, withhold drugs based on assessments/lab findings, modify administration techniques (crushing pills), implement appropriate assessment to detect onset of adverse effects

What is the USP-NF?

United States pharmacopeia- set of drug standards used in the US. Revised every 5 years. Not a government agency.

Drug standards that are controlled/enforced by federal government.

Purity, potency, efficacy, safety/toxicity and bioavalibility.

Therapeutic classification

Antidepressant, antihypertensives

Pharmacologic classification

Drugs MOA

Chemical classification

Adrenergics

Generic name

Chemical or official name of the drug that is independent of the manufacturer and often indicates the drug group. More affordable (lowercased)

Brand name

Designated and patented by the manufacturer. Indicates disease or body part to be treated. More expensive.(capitalized)

Error reduction strategies

Always ID patient

Give only meds you prepared

Give only as desired

Educate patient

Pharmacotherapeutics

The desired, therapeutic effect of the drug. Indication for use/reason why drug is being taken.

1906 Pure Food and Drug Acts

Established official standards and requirements for accurate labeling.

1912 Shirley Amendment

Strengthened the 1906 law- prohibiting fraudulent therapeutic claims of drug effectiveness.

Food, Drug, and Cosmetics Act of 1938

Required that drugs meet standards of purity and strength. Labeling requirements established (penalties for fraud claims and misleading labels). FDA established and charged with enforcing law. Gave FDA control over drug safety.

1951 Durham-Humphrey Amenterm-41dment

Designated drugs that MUST be prescribed by a licensed HCP and dispensed by a pharmacist.

1962 Kefauver-Harris Amendment

Increased control on drug safety. More extensive testing on new drugs required. Manufacturers must prove safety and efficacy. Authorized FDA to establish official names for uniformed nomenclature. Gave federal government authority to standardize drug names.

1970 Comprehensive Drug Abuse Prevention and Control Act

Regulated distribution of narcotics and categorized narcotics according to therapeutic usefulness and potential abuse. Ex: schedule 1 is not appropriate for hospital settings; includes LSD, heroin ,etc.

1993 NIH Revitalization Act

Requires inclusion of women and minorities in NIH-funded research studies.

2005 Combat Methamphetamine Epidemic Act

Established federal law that regulates OTC sale of ephedrine, pseudoephedrine, and phenylpropanolamine due to their use in manufacturing methamphetamine.

High alert medications

Medications that have a high risk of causing patient harm when used in error.

Ex: digoxin and insulin

Needs 2 nurses to verify dose

Beers criteria

List of medications that are considered inappropriate for the geriatric population (65 yo and up). Pros outweigh the cons; these meds are still used just monitored.

5 beers criteria drugs

Ibuprofen

Insulin

lorazepam

digoxin

meperidine. aspirin

Precautions

Drug must be carefully monitored.

Contraindications

Drug should not be used at all.

Adverse effects

Unintended and usually undesired effects that may occur.

Too much therapeutic response.

All drugs have adverse effects

Ex: anaphylactic shock from vaccine

Side effects

More common/predictable.

Ex: headaches, nausea, constipation

Synthetic drugs

Made in a lab. Less likely to cause allergic reactions. More consistent in side effects.

Semisynthetic drugs

Naturally occurring substances that have been chemically modified

Ex: antibiotics

Prototype drug

An individual drug that represents groups of drugs. Similar characteristics to all medications within that same classification.

What information about drugs should be included during patient education?

Name of drug

Reason drug was prescribed (pharmacotherapeutics)

Intended effect of the drug (pharmacodynamics)

Important adverse effects that may occur

Who can administer drugs (has prescriptive authority)

HCPs such as NP, PA, MD, dentist, and dermatologist

Enteral route

Oral route

PO(most common), sublingual, gastric tube, rectal

Enters through GI tract and absorbed in small intestine

Oral mucosa, gastric mucosa, and small/large intestine