NSC 330 - Clinical Drug Therapy

NSC 330 - Clinical Drug Therapy: The Basics

Part 1

  • Instructor: Brigette Holleran, DNP, APRN, FNP

Pharmacotherapy Overview

  • Definition of Pharmacotherapy:
    • Use of drugs to prevent, diagnose, or treat disease.

Nursing Process in Drug Therapy

  • Nursing Diagnosis:
    1. Knowledge deficit related to medication management.
    2. Potential for injury due to improper drug administration or understanding.
    3. Non-compliance with medication regimen.

Importance of Patient Instruction in Drug Therapy

  • Instructions given by healthcare providers are critical for patient understanding and adherence to medication regimens. The mode of communication should be tailored according to the patient’s needs.

Sources of Drugs

  • 1. Plant-derived drugs:

    • Examples:
    • Theophylline (from tea leaves)
    • Caffeine (from coffee)
    • Nicotine (from tobacco)
    • Morphine (from poppy plant)
    • Codeine (from poppy plant)
    • Cocoa (from cocoa beans)

  • 2. Animal-derived drugs:

    • Example:
    • Insulin sourced from cow and pig pancreas.

  • 3. Synthetic chemical compounds:

    • Example:
    • Antibiotics like cephalosporins.

  • 4. Genetically-engineered chemicals:

    • Example:
    • Human insulin via cloning.

Drug Nomenclature

  • Understanding the different names of drugs:
    • Prototype: The standard or original model for a class of drugs.
    • Generic Name: The official name of the drug not tied to a specific manufacturer.
    • Brand Name: The trade name in uppercase tied to the manufacturer, which may change over time.

Pharmacodynamics and Pharmacokinetics

  • Ibuprofen:
    • Classification: Nonsteroidal anti-inflammatory drug (NSAID).
    • Effects on the Body:
    • Physiological effects include anti-inflammatory, analgesic (non-narcotic).

Federal Drug Laws

  • Relevant Legislation:
    • Pure Food and Drug Act of 1906: Requires accurate labeling of drug products.
    • Food, Drug and Cosmetic Act (1938): Mandates proof of safety for new drugs prior to marketing, ensuring both safety and effectiveness.
    • Food and Drug Administration (FDA): Oversees drug development and sale, assuring safety and reliability.
    • Federal Trade Commission (FTC): Responsible for suppressing misleading advertisements for non-prescription drugs.

Clinical Trials Overview

  • Phases of Drug Approval:
    • Phase 0:
    • Initial phase involving animal testing and small human groups, often double-blind.
    • Emergency Use Authorization:
    • Example noted for the COVID-19 vaccine that allows medications to be used before full approval under certain circumstances.

Controlled Substance Laws

  • Comprehensive Drug Abuse Prevention and Control Act (1970):
    • Enforcement by DEA.
    • Drug Schedules:
    • Schedule I:
      • Not approved for medical use; high potential for abuse. Examples include heroin and LSD.
    • Schedule II:
      • High potential for abuse; provides medical benefits under severe restrictions.
    • Schedule III:
      • Lower potential for abuse compared to I & II. Examples include buprenorphine/naloxone and codeine/acetaminophen.
    • Schedule V:
      • Contains moderate amounts of controlled substances; may be dispensed by pharmacists without a prescription—examples include Phenergan with codeine and gabapentin (varies by state).

Nursing Management of Controlled Substances

  • Recommended practices for handling controlled substances include:
    1. Use of automated systems for tracking.
    2. Secure storage in double-locked cabinets.

Routes of Drug Administration

  • Types:
    1. Enteral: Refers to administration via the gastrointestinal tract.
    2. Parenteral: Involves administration via injections or infusions outside the gastrointestinal tract.
    3. Topical: Application on skin or mucous membranes.
  • Factors Influencing Route Choice:
    • Drug characteristics, client characteristics, and desired therapeutic responses (local vs systemic).

Enteral Administration

  • Common Methods:

    • Oral (PO) is the most prevalent.
    • Alternative methods include NG (nasogastric) or G (gastrostomy) tubes.

  • Disadvantages of Enteral Administration:

    1. Delayed onset of action.
    2. Gastrointestinal upset may occur.

  • Types of Oral Medications:

    • Tablet: Standard pill form.
    • Sustained-release: Cannot be crushed.
    • Sublingual: Placed under the tongue for quick absorption.
    • Buccal: Placed in the cheek pouch for absorption.

Learning Check Example

  • Question: Which of the following is considered topical administration of a medication?
    • A. Nitro-glycerin 0.4mg SL
    • B. Ketorolac 60mg IM
    • C. Albuterol inhaler, 2 puffs via lungs
    • D. Piperacillin 1gm IV