Pharmacodynamics
The study of what the drug does to the body
Pharmokinetics
the method by which drugs are absorbed, distributed, metabolized, and eliminated or excreted by the body
loading dose
use of a higher dose than what is usually used for treatment to allow the drug to reach the critical concentration sooner
critical concentration
The amount of a drug that is needed to cause a therapeutic effect
Distribution
movement of drugs by the circulatory system to the site of action
protein binding
Many drugs bind to proteins in the blood and go inactive. They reactivate when levels of that drugs, in the body, decrease. This creates a prolonged effect (CR, LA, ER)
blood brain barrier
highly lipid soluble drugs are more likely to pass through and reach CNS
first pass effect
The initial metabolism in the liver of a drug absorbed from the gastrointestinal tract before the drug reaches systemic circulation through the bloodstream. DRUG IS NOT EFFECTIVE may need higher dose PO
factors influencing drug effect
Weight Age Gender Physiological Factors Pathological Factors Genetic Factors Immunological Factors Psychological Factors Environmental Factors Drug Tolerance Cumulative Effect
oral drugs are best in an
empty stomach - usually
superinfection
overgrowth of normal microbiota that is resistant to antibiotics
fever , diarrhea, vaginal discharge *antifungal meds may need to DC drug responsible
Hypersensitivity
an exaggerated response by the immune system to a particular substance
Anaphalactic reaction
an immediate, severe reaction to a substance to which an individual is allergic that can be life threatening
symptoms of Anaphalactic reaction
hives rash difficulty breathing, high bp, anxious
treatment of Anaphalactic reaction
epinephrine
cytotoxic reaction
Antibodies attack antigens bound to cell receptors, leading to cell death
Blood dyscrasias, elevated liver enzymes, decreased renal function
shown on CBC - decreased hematocrit and WBC DC drug *notify hcp
delayed allergic reaction
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells. DC drug *notify hcp
Loop Diaretics
can cause hypokalemia bc it can cause low potassium levels
serum sickness reaction
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 wk or more after exposure to the drug
symptoms serum sickness reaction
rash, hives, swollen lymph nodes DC drug *notify hcp
Anticholinergic drugs
drugs that interrupt or reduce the function of the parasympathetic system
Anticholinergic effects
dry mouth constipation photophobia blurred vision Tachycardia
cell nucleus
A part of the cell containing DNA and RNA and responsible for growth and reproduction
cell membrane
lipoprotein structure the semipermeable membrane surrounding the cytoplasm of a cell.
lipoproteins of cell membrane
phospholipids, glycolipids, cholesterol can have receptor sites via proteins - reacts with specific chemicals
identifying markers
surface antigens
important in the role of cellular immunity
histocompatibility proteins that allow for self-identification
the body's immune system recognizes these proteins and acts to protect self-cells and to destroy non-self cells
channels
Pores in the membrane that allow passage of specific substances, such as ions
Cytoplasm
Site of cellular metabolism
mitochondria
ATP production
endoplasmic reticulum
production of protein, phospholipids and cholesterol
Golgi apparatus
A system of membranes that modifies and packages proteins for export by the cell
Lysosomes
An organelle containing digestive enzymes
Diffusion
Movement of molecules from an area of higher concentration to an area of lower concentration.
Osmosis
Diffusion of water through a selectively permeable membrane
facilitated diffusion
Movement of specific molecules across cell membranes through protein channels
active transport
Energy-requiring process that moves material across a cell membrane against a concentration difference
Endosytosis
occurs when the cell membrane invaginates and engulfs material to bring it into the cell
Exocytosis
a process by which the contents of a cell vacuole are released to the exterior . hormones, neurotransmitters, and enzymes are excreted thru this
G0
a resting phase in which a cell is not preparing for the cell division cycle
G1
Cell growth and gathering phase
S phase
The synthesis phase of the cell cycle; DNA has DOUBLED
G2 phase
Last substances are gathered for division produces mitotic spindeles
m phase
mitosis and cytokinesis cell division occurs, produce 2 identical daughter cells
primary actions
overdose, extension of the desired effect
secondary action
Undesired effects produced in addition to the pharmacologic effect
Hypersensitity
an exaggerated response by the immune system to a particular substance
drug allergy
formation of antibodies to a drug or drug protein; causes an immune response when the person is next exposed to that drug
anaphylactic
cytotoxic
serum sickness -delayed reactions
hydrocortisone
stop itching
stomatitis
sores in the mouth and tongue inflammation of mucous membranes *nystatin - coats mouth
blood dyscrasia
bone marrow suppression fever chills weakness
protective isolations, monitor CBC
assesing for liver injury
fever, jaundice, change in urine color or stool, elevated liver enzymes DC med
assesing renal injury
change in urinary pattern, High BUN and creatine levels
notify hcp may DC meds
poisoning
overdose of a drug that causes damage to multiple body systems and has the potential for fatal reactions
hypogylcemia
fatigue, drowsiness, hunger, anxiety, headache
restore glucose
hypergycemia symptoms
fatigue, polyuria, polydipsia, nausea, THIRTSY
admin. insulin to decrease glucose level
Hypokalemia
deficient potassium in the blood
replace serum K+ level
Hyperkalemia
excessive potassium in the blood
monitor cardiac rhythm, lower K+ levels
ocular damage
visual changes, blurring of vision, color vision changes
monitor, DC as appropriate
auditory damage
Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of balance, and loss of hearing
Interventions: Monitor for hearing loss; discontinue medication as appropriate if a decrease in hearing is noted on assessment.
General CNS effects
Assessment: altered level of consciousness
Interventions: prevent injury
atropine- like (antichollergenic) effect
dry mouth, urinary retention , blurry vision
sugarless losange, have pt void beofre admin
parkinson like syndrome
muscle trmors, change in gait
DC med
nueroleptic malignant syndrome-
nero symptoms - fever, muscle rigidity
DC as appropriate , check pupils
teratogenicity
Any drug that causes harm to the developing fetus or embryo
advise woman possible effects on baby
weight benefits and risk -NURSE BABY FIRST THEN TAKE MEDS
narrow spectrum
effective against few organisms
broad spectrum antibiotics
affect a broad range of gram-positive or gram-negative bacteria
anticfective therapy
reduction of the population of invading organism
preventing drug resistance
limit drug use, proper drug use, narrow range antibiotics, multiple drug treatments
sensitivity testing
evaluation of pathogens obtained in a culture to determine the anti-infectives to which the organisms are sensitive and which agent would be appropriate for treatment of a particular infection
combination therapy
The administration of two or more antimicrobial medications simultaneously to prevent the growth of mutants that might be resistant to one of the antimicrobials
smaller dosage of each drug
Prophalaxis
preventative treatment
Kernicterus
billirubin in CSF
gram postive
stain purple; thick peptidoglycan
gram negative
pink, more complex cell wall structure
beta lactam
Penicillins Cephalosporins Carbapenems Monobactams
Aminoglycides drug names
amikacin gentamycin neomycin streptomycin tobramycin
Aminoglycosides MOA
inhibit bacterial protein synthesis rapidly absorbing via IM Primarily against aerobic gram(−) infections Poorly absorbed from the GI tract cross placenta but not BBB
Neomycin
Aminoglycoside Given PO for preop bowel cleanse
Pharmacotherapeutics for aminglycosides
gram neg. bacteria noscociomal infections UTI CNS infection eye infection
Aminoglycosides drug interactions
Synergistic with cephalosporins/penicilins. Avoid combining with diuretics. neuromuscular blockade (succylcholine) to avoid inc. muscle relax. and resp. distress toxicity to kidneys warfarin - increase risk of bleeding loop diuretic- inc. risk ototoxicity
Nursing Considerations aminoglycides
allergy history
baseline vitals
asses drig interac. rotate IM sites gentamycin- draw blood after 1 hour
Penicilins MOA
MOA -Bactericidal -Bacterial infection caused by susceptible organisms -More effective in gram + -rapid cell destruction
Pharmokinetics of penicilin
absorbed thru duodenum and jejunum factors that effect - acidity, presence of food in gi
well distributed in body liver inactivates metabolites
pencillins that can be used regardless of food intake
amoxicilin penicillin V augmenten
Pharmacotherapeutics penicilin
wide spectrum of antimicrobial activity given IM when cannot be given PO Penicilin g. - insoluble - IM
penincilin drug interactions
probenicid -increase plasma concentration of pen.
methotrexate toxicity
tetracyclines reduce effect hormonal contraceptives decreased
decrease vitamin K - increase bleeding -hypo/hypernatremia penicillin can inactivate amino-glycosides an dincrease its own functions
adverse reactions penicilin
hypersensitivity serum sickness drug fever rash oral candidis diarhea lethargy
nursing consid. penicilin
allergy history obtain c&s vitals monitor platelet count clarify route dont mix another drug with iv
cephalosporins MOA
broad spectrum
Bactericidal
used to treat wide range of bacterial infections.
Gram + or gram-, the new the more gram-
Cross sensitivity to penicillin (1%)
Administered IV or IM bc many not absorb thru GI tract
1 Gen Cephalosporins
cefazolin, cephalexin gram positive
2 Gen Cephalosporins
cefaCLOR, cefoteTAN CROSS BBB gram neg
3rd generation cephalosporins
ceftriaxone, cefotaxime, ceftazidime CROSS BBB for influenza, streptococci, vatarhalis
4th generation cephalosporins
-Cefepime -Use: gram-negative organisms, and gram-positive organisms.
5th generation cephalosporins
ceftaroline *** only cephalosporin that covers MRSA PENETRATE CSF
Pharmokinetics cephalosporins
-parenterally 1st and 2nd gen arent well distributed thru CNS
not metalobolized at all - excreted thru kidneys unchnged
Drug interactions cephalosporins
dont mix with alcohol uricosurics- relives gout drug can reduce kidneys ability to excrete cephalosporins. proton pump - pepcid can decrease effect
nursing consideration cephalosporins
warfarin may need to be adjusted' hypersensitivity is most common monitor renal and platets do not admin to a pt with penicilin allergy
Tetracylines
bacteriostatic vibramycin and minocycline
effective against gram neg and pos
Tetracylines MOA
Bacteriostatic inhibitor of protein synthesis broad spectrum CROSS PLACENTA excreted in feces enterohepatic recirculation - drug is reabsorbed
pharmacotherapeutucs Tetracylines
rocky mountain spotted fever q fever lyme disease acne anthrax