Introduction to Pharmacology

FDA (Food & Drug Administration)

Evaluates for:

Safety

Effectiveness

Governs:

Marketing

Drug Distribution

Medication Process in a Healthcare facility

1. Ordered

2. Verified

3. Dispensed

4. Withdrawn

5. 5 (6) Rights

Phases of Drug Activity

Phases during which drugs undergo:

Absorption

Distribution

Metabolism

Excretion

Absorption

movement of the drug from the site of administration into the bloodstream

Determinants of absorption

Route

Solubility: water soluble vs. lipid-soluble.

Enteric coated

Distribution

transportation in the body fluids to the tissues and organs.

Determinants of distribution

Blood flow

Permeability

Protein-binding

Metabolism

process by which the body chemically alters a drug

Determinants of metabolism

Genetics

Drug interactions

Health/Age/Diet

Physicochemical Properties

Excretion

drug and metabolites are removed from the body

Determinants of excretion

Organ fuction

Drug properties

Patient-specific factors

Drug Excretion

•Medications or their metabolites

Urine

Stool

•Others:

⚬Respiratory* (LUNGS)

⚬Breast Milk*

⚬Sweat*

Drug Forms

1.Solids

2.Semi-solids

3.Liquids

4.Gasses

Side-Effects:

Unintended but usually PREDICTABLE

Immediately or delayed.

Eg: Benadryl feeling very drowsy.

Adverse Reactions:

Extremely HARMFUL and LIFE-THREATENING!

Discontinue the medication.

Eg: Morphine - patient is extremely sensitive and respirations decrease to less than 8 a minute.

Nursing interventions when administering medications:

6 RIGHTS

Oral medications:

Choking

Cheeking

Parenteral (IV) meds:

Assess IV site

Topical medications:

Assess the skin

6 Rights of Medication Administration:

Right Drug

Right Patient

Right Dose (IV rate)

Right Route

Right Time

Right Documentation

Random Blood Glucose Test

>= 200

Urine Test

Renal Threshold

Not enough insulin

Break down fats for energy -> liver converts to ketones -> metabolic acidosis

Increase in glucagon & cortisol -> severe hyperglycemia -> diuresis

Clinical Manifestations

3 P's, Dehydration, Electrolyte imbalance

Emergency

Hypotensive, tachycardic, fruity smell, lethargy, coma

Treatment

Fluids, electrolytes, IV insulin

DM Complications - Hypoglycemia

CNS needs glucose

< 65 mg/dL

DM Complications - Hypoglycemia Reason

Too much insulin or oral medication

Renal insufficiency

Decreased nutritional intake

Increased exercise

Clinical Manifestations (SNS) Hypoglycemia

Anxiety

Hunger

Palpitations

Circumoral paresthesia

Sweating

Shakiness

Irritability

Effect if clinical manifestations of hypoglycemia are not treated

If not treated

Confusion / slurred speech

Dizziness/ weakness

Fatigue / sleepiness

If not treated

Seizures

Coma

Treatments for hypoglycemia

Oral Glucose

Recheck in 15 minutes

Eat a meal

IV Dextrose

IM/nasal Glucagon (N/V)

DM Complications

Microvascular disease and microvascular disease

Microvascular disease

Neuropathy (loss sensation, pain, foot ulcers)

Nephropathy (renal failure)

Retinopathy (vision impairment, blindness)

Macrovascular Disease

Atherosclerosis CAD, HTN, stroke

Impaired Immune function (infection, delayed wound healing)

Peripheral Vascular Disease (gangrene, neuropathy)

Managing Diabetes at Home

Carbs 45-60 gm/meal

Protein 15-20% of daily food

Fiber 25-50 gm/day

Fat < 30% of daily food

Limit alcohol

Exercise

Insulin (DM1) or Oral agents (DM2)

Medication Diabetes - Insulin

Class: Insulin

Indication of Insulin

Diabetes, Hyperglycemia

MOA of insulin

Unlocks cells for glucose to enter

Side effects of insulin

Hypoglycemia

RN insulin

Check BG before giving

Contraindications of insulin

Hypoglycemia

Patient Education Isulin

Follow orders; know which type of insulin & when

TYPES OF INSULIN

Rapid

Short acting

Intermediate

Long acting

Rapid-Acting (Humalog, Aspart)

Appearance: Clear

Onset: 10 - 30 minutes

Peak: 1 - 1.5 hours

Duration: 2 - 5 hours

Short-Acting (Regular, "R")

Appearance: Clear

Onset:30 - 60 minutes

Peak: 2 - 5 hrs

Duration:5 - 8 hrs

Intermediate-acting (Humulin N, NPH)

Appearance: Cloudy

Onset: 1-2 hours

Peak: 4-12 hrs

Duration: 18-24 hrs

Long-acting--Insulin detemir (Levemir), Insulin glargine (Lantus)

Appearance: Clear

Onset:1-2 hours

Peak: No peak

Duration: 24 hours

Metformin

Class: Biguanides

Indication Metformin

DM2; pre diabetes

MOA of metformin

Decrease glucose production in liver

Side Effects of metformin

Hypoglycemia

RN Metformin

HgbA1c, daily BG checks

Contraindication of metformin

Hypoglycemia

Patient education of metformin

Take at same time of day; do not take if N/V and cannot eat

Glipizide

Class: sulfanylurea

Indication of glipizide

DM2

MOA of glipizide

Hypoglycemia

RN of glipizide

Be aware of daily BG checks

Contraindication

Hypoglycemia

Patient Education for Glipizide

Take at same time of day; do not take if N/V and cannot eat

Glucagon

Class: antihypoglycemic

indication of glucagon

Hypoglycemia

MOA of glucagon

Causes glucose to be released from the liver's glycogen stores

Side Effects of Glucagon

hyperglycemia

RN glucagon

Check blood sugar. Administer IV or IM if BS if unable to swallow

Contraindications of Glucagon

BS >65

Patient education

How to administer PO; teach family how to administer IM

Athletes

Increases uptake of glucose by muscles

Insulin still required

Sensitivity to insulin is increased

Timing is important

Eat complex CHO w/ Protein just prior

BG should be >100 mg/dL

Monitor BG frequently following extended exercise