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Questions and Answers
What does Category C signify regarding drug usage during pregnancy?
What does Category C signify regarding drug usage during pregnancy?
Which schedule of controlled substances has the least abuse potential?
Which schedule of controlled substances has the least abuse potential?
What is a characteristic of Schedule I controlled substances?
What is a characteristic of Schedule I controlled substances?
What does Category D indicate about a drug's use during pregnancy?
What does Category D indicate about a drug's use during pregnancy?
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What is the main difference between Schedule II and Schedule III drugs?
What is the main difference between Schedule II and Schedule III drugs?
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What is a key responsibility of nurses in medication administration?
What is a key responsibility of nurses in medication administration?
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Which of the following best describes a prototype drug?
Which of the following best describes a prototype drug?
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Which classification type is NOT used for drugs?
Which classification type is NOT used for drugs?
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What is the primary difference between generic and brand name drugs?
What is the primary difference between generic and brand name drugs?
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Which of the following statements about drug sources is accurate?
Which of the following statements about drug sources is accurate?
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What is a significant effect of using morphine as an analgesic?
What is a significant effect of using morphine as an analgesic?
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Which statement regarding drug evaluation is incorrect?
Which statement regarding drug evaluation is incorrect?
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How are brand name drugs primarily designated?
How are brand name drugs primarily designated?
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What is the most accurate source of drug information that is continually updated?
What is the most accurate source of drug information that is continually updated?
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Which of the following describes how drugs can interfere with the function of foreign cells?
Which of the following describes how drugs can interfere with the function of foreign cells?
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What type of drug interaction occurs when a substance binds to a receptor site and produces an effect?
What type of drug interaction occurs when a substance binds to a receptor site and produces an effect?
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What is not considered a reliable source of drug information?
What is not considered a reliable source of drug information?
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Which of these options describes the interaction of receptors and chemicals as a 'lock and key' mechanism?
Which of these options describes the interaction of receptors and chemicals as a 'lock and key' mechanism?
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What effect do competitive antagonists have on receptor sites?
What effect do competitive antagonists have on receptor sites?
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What is the primary focus of pharmacodynamics?
What is the primary focus of pharmacodynamics?
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What is one way that drugs can influence enzyme systems?
What is one way that drugs can influence enzyme systems?
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What is selective toxicity in pharmacology?
What is selective toxicity in pharmacology?
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Which component of pharmacokinetics refers to how medications are processed in the body?
Which component of pharmacokinetics refers to how medications are processed in the body?
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What is the significance of knowing the half-life of a drug in clinical practice?
What is the significance of knowing the half-life of a drug in clinical practice?
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What factor can influence the absorption rate of intramuscular injections?
What factor can influence the absorption rate of intramuscular injections?
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What is critical concentration in pharmacology?
What is critical concentration in pharmacology?
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Why might some drugs need to be administered via injection instead of orally?
Why might some drugs need to be administered via injection instead of orally?
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What does a higher therapeutic index indicate about a drug?
What does a higher therapeutic index indicate about a drug?
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What route of administration is considered the fastest for drug absorption?
What route of administration is considered the fastest for drug absorption?
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What role does protein binding play in drug action?
What role does protein binding play in drug action?
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How does the Blood-brain barrier affect drug distribution?
How does the Blood-brain barrier affect drug distribution?
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What is the First-Pass Effect?
What is the First-Pass Effect?
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Which organ is primarily responsible for drug excretion?
Which organ is primarily responsible for drug excretion?
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What impact does liver dysfunction have on drug metabolism?
What impact does liver dysfunction have on drug metabolism?
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What is the role of the CYP-450 system in drug metabolism?
What is the role of the CYP-450 system in drug metabolism?
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What factors can influence drug effects?
What factors can influence drug effects?
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What does a shorter half-life indicate about a drug?
What does a shorter half-life indicate about a drug?
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What can happen if drugs are not properly metabolized in the liver?
What can happen if drugs are not properly metabolized in the liver?
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What are adverse effects of drugs?
What are adverse effects of drugs?
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What is a potential consequence of drug exposure due to hypersensitivity?
What is a potential consequence of drug exposure due to hypersensitivity?
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Which of the following can indicate hepatotoxicity?
Which of the following can indicate hepatotoxicity?
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What adverse effect is specifically characterized by inflammation of mucous membranes?
What adverse effect is specifically characterized by inflammation of mucous membranes?
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Which factor can lead to hypoglycemia?
Which factor can lead to hypoglycemia?
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Which drug effect is associated with the destruction of normal flora?
Which drug effect is associated with the destruction of normal flora?
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What effect does nephrotoxicity have on renal function?
What effect does nephrotoxicity have on renal function?
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Which side effect might result from drug-induced hypokalemia?
Which side effect might result from drug-induced hypokalemia?
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Which of the following can indicate a risk of teratogenicity?
Which of the following can indicate a risk of teratogenicity?
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What is a characteristic of neuroleptic malignant syndrome?
What is a characteristic of neuroleptic malignant syndrome?
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Which of the following is primarily an adverse effect of certain antibiotics?
Which of the following is primarily an adverse effect of certain antibiotics?
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Which alteration occurs due to the first-pass effect in drug metabolism?
Which alteration occurs due to the first-pass effect in drug metabolism?
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What is included in patient education regarding drugs?
What is included in patient education regarding drugs?
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Which medication error occurs if the right dose is not provided?
Which medication error occurs if the right dose is not provided?
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Study Notes
NUR 320 Module 1B: Introductory Topics for Pharmacology
- This module covers introductory topics in pharmacology for nursing students
- The instructor is Mary Rose Gaughan, PhD, RN, CNE at D'Youville University.
Agenda
- Terminology and guidelines for drug order interpretation and transcription
- Legal and ethical implications related to drug administration
- Principles of drug action
- Developmental and cultural (ethnic) considerations
Today's Objectives
- Describe the concepts and principles of drug action
- Identify developmental and cultural considerations of pharmacology and drug administration
- Understand terminology and guidelines related to pharmacology
Pharmacology
- The study of biological effects of chemicals
- Drugs are chemicals introduced to the body to cause a change
- Herbals and non-pharmaceuticals can also cause changes to the body
- Pharmacotherapeutics uses drugs to prevent, diagnose, or treat disease processes
- Pharmacotherapy uses drugs to prevent, diagnose, or treat symptoms and disease processes
What does this mean to nursing practice?
- Nursing guidelines require safe practice when administering medications
- Drugs can have many effects - some helpful, some undesirable or harmful
- Responsibilities include: administration of drugs, assessing drug effects, intervening to make the drug regimen more tolerable, providing patient teaching, monitoring the overall care plan to prevent medication errors
Sources of Drugs
- Natural sources: plants, animals, inorganic compounds
- Synthetic sources: genetic engineering, improving established medications
Classification of Drugs
- Classified according to effects on a particular body system, therapeutic use, and chemical characteristics
- Drugs fit into many groups because of their effects on the human body
- Example: morphine – CNS depressant and an opioid analgesic
Prototype
- Often the first drug of the class to be developed
- The standard to which newer drugs are compared to
- Example: Morphine is the prototype analgesic
- Some groups lack a universally accepted prototype
- Some prototypes are replaced over time with newer, more commonly utilized drugs
Generic and Brand Names
- Generic: related to the chemical or official name, independent of manufacturer, presented in lowercase letters
- Brand Name: also known as trade name, designated and patented by the manufacturer, presented with a capital letter
- US Adopted Names Council assigns generic names
- Generic names are required to be therapeutically equivalent and less expensive than brand names
- Monitored by FDA
Drug Evaluation
- U.S. Food and Drug Administration (FDA) has tight control
- Regulates development and sale of drugs
- Ensures safety and reliability of drugs
- Several stages of development to determine if benefits outweigh the known and potential risks of the medication
- Pre-clinical trials, phase I, II, and III studies
- Orphan drugs – discovered but not financially viable, have not been 'adopted' by a drug company
- May be useful in treating rare diseases or have potentially dangerous adverse effects
FDA Trials and Studies
- Pre-clinical trials: do not use humans (use animals) to test drug potential, determine whether the drug has effects in living tissue, evaluates adverse effects
- Phase I studies: human volunteers to test safety and dosage; healthy volunteers with the condition the medication is designed to help; informed consent
- Phase II studies: more patients who have the disease the drug is intended to treat; performed across the country; if unacceptable adverse effects are detected, the drug is removed from testing
- Phase III studies: larger sample of population; determine treatment benefit and monitor side effects; participants keep journals and record symptoms
- FDA approval (Phase IV): continual evaluation after approval for marketing
FDA Labels and "Off-Label" Uses
- Prescribing information from studies is refined and "labelled".
- Label lists the approved uses, risks, and benefits of medication based on clinical trials
- "Off-label" uses of a drug are not part of the stated therapeutic indications the drug was approved for
Legal Regulation of Drugs
- FDA regulates development and sale of drugs
- Local laws further regulate distribution and administration of drugs
- Vary from state to state, and within a state
- Federal legislation affects clinical use of drugs
Safety in Pregnancy
- Category A: Adequate studies not demonstrated a risk to the fetus in any study
- Category B: Animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant people
- Category C: Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans
- Category D: Evidence of human fetal risk, but potential benefits may be acceptable
- Category X: Studies in animals or humans demonstrate fetal abnormalities or adverse reactions
Controlled Substances
- Schedule I: high abuse potential, no accepted medical use (heroin, LSD)
- Schedule II: high abuse potential, severe dependence liability (narcotics, amphetamines, barbiturates)
- Schedule III: less abuse potential than Schedule II, moderate dependence liability, certain narcotics
- Schedule IV: less abuse potential than Schedule III, limited dependence liability, sedatives, antianxiety agents
- Schedule V: limited abuse potential, small amounts of narcotics (codeine)
Sources of Drug Information
- Drug labels: name, dosage, expiration date, warnings
- Package inserts: by manufacturer, all chemical and study information, most accurate source
- Reference books: compilation of package inserts
- Journals: new drugs/classes, specific treatment protocols
- Internet information: government and association websites
Pharmacodynamics
- Study of interactions between chemical components of living systems and foreign chemicals (drugs)
- Drugs work in one of four ways:
- Replacing missing chemicals
- Increasing or stimulating cellular activities
- Depressing or slowing cellular activities
- Interfering with foreign cells (e.g., microorganisms or neoplasms)
Receptor Sites
- Specific areas on cell membranes that react with certain chemicals
- "Lock and key" analogy
- Key = specific chemical
- Lock = receptor site
- Interactions: Agonists, competitive antagonists and non-competitive antagonists
Drug-Enzyme Interactions
- Drugs can cause effects by interfering with enzyme systems
- Enzyme systems work in a cascade fashion, with one enzyme activating another one
Selective Toxicity
- Ability of a drug to attack only those systems found in foreign cells
Pharmacokinetics
- Study of how medications travel through the body
- Includes absorption, distribution, metabolism (biotransformation), excretion
- In clinical practice, nurses must consider: onset of drug action, drug half-life, timing of peak effect, duration of drug effects, site of excretion
Critical Concentration and Therapeutic Index
- Critical concentration: amount of drug needed for a therapeutic effect
- Therapeutic index: ratio of blood concentration where a drug becomes toxic to concentration where it is effective
- Loading dose: higher dose than usual to reach critical concentration sooner
Absorption
- Time from drug introduction until it reaches circulating fluids and tissues
- Sites of absorption, rate and amount absorbed (e.g., IV fastest, bypasses barriers, PO non-invasive)
- Influencing factors: chemical instability, injection methods, intestinal issues
Distribution
- Movement of drug into body tissues
- Factors: blood circulation, cell membrane permeability, plasma protein binding
- Bound drug = longer duration of action
- Unbound drug = quicker action, excretion
Biotransformation (Metabolism)
- Liver is the primary site
- Changes drugs into new chemicals
- First-pass effect: drugs taken by mouth can be significantly reduced by metabolism in the liver before reaching the circulatory system
- Factors for metabolism: site, route, prior condition
Biotransformation (Metabolism)
- Hepatic Enzyme System (CYP-450): abundant in the liver, metabolizes drugs
- Drugs can increase or decrease CYP-450 activity, affect metabolism of other drugs
- Liver disease and other factors affect drug metabolism
Excretion
- Kidneys play the most important role in excretion
- Drugs made water-soluble during metabolism readily excreted by the kidney, others secreted or reabsorbed
- Kidney dysfunction can lead to toxicity due to the inability to excrete the drug.
Pharmacokinetics Recap
- Description of drug movement through the body
- Drugs dissolved, lost in stomach/intestines, absorbed across intestinal wall
- Drug in liver, biotransformed → non-effective state (bound to plasma proteins), drug in circulation
- Broken down in tissues, reaching reactive tissues → excretion
Half-life
- Time when drug in the body reduces to half of its peak level
- Short half-life = more frequent dosing
- Liver/kidney dysfunction can lengthen half-life
Factors Influencing Drug Effects
- Interactions: when two or more drugs taken together can cause adverse effects
- Factors: weight, age, sex, physiological factors, pathological factors, genetic factors, immunological factors, psychological factors, environmental factors, drug tolerance, drug accumulation, interactions
Adverse Effects
- Primary actions: effects that are extensions of desired actions
- Secondary actions: effects not related to therapeutic effect
- Drugs cause effects in the body.
- Drug allergies/hypersensitivity can happen when patient develops antibodies.
- Adverse effects can include: dermatological reactions, GI irritation, superinfection, blood dyscrasia.
Drug-Induced Tissue & Organ Damage
- Adverse effects can include rashes, hives, Stevens-Johnson syndrome, stomatitis, GI irritation, nausea, vomiting, constipation, diarrhea, superinfections, and blood dyscrasia
Toxicity
- Hepatotoxicity: liver cell damage
- Nephrotoxicity: kidney damage
- Poisoning: overdose damaging multiple body systems
Alterations in Glucose Metabolism
- Hypoglycemia: low blood glucose
- Hyperglycemia: high blood glucose
Electrolyte Imbalances
- Hypokalemia: altered renal exchange system causing potassium loss (e.g., loop diuretics)
- Hyperkalemia: potassium retention and increased serum potassium (e.g., anti-neoplastic drugs)
- Other imbalances: hypercalcemia, hypocalcemia, hypernatremia, hyponatremia, hypermagnesemia, hypomagnesemia
Sensory Effects
- Ocular damage: drug deposits cause inflammation, leading to blindness
- Auditory damage: tiny vessels/nerves in auditory nerve easily irritated, may lead to ringing in ears
Neurological Effects
- General CNS effects: alterations in electrolyte and glucose levels, CNS stimulants/depression
- Anticholinergic effects: blockage of cholinergic receptors, many cold and anti-histamines cause these
- Extrapyramidal symptoms: dopamine levels affected, Parkinsonian symptoms, antipsychotic/neuroleptic drugs cause these
- Neuroleptic Malignant Syndrome: general anesthesia can cause this, high fever, potentially fatal
Teratogenicity
- Drugs that reach a developing fetus or embryo can cause death and congenital defects
- Defects include skeletal abnormalities, CNS alterations, heart defects
Nursing Process
- Assessment, nursing conclusions, planning, intervention, evaluation; obtaining medication history
- Application of the nursing process ensures safe, efficient, scientifically based quality, holistic care
Comfort Measures
- Managing adverse effects
- Lifestyle adjustment (e.g., alterations in activities, diet)
- Placebo effect (anticipation of drug's helpfulness)
Patient and Family Education
- Drug education needs to include: drug name, action, dose, timing, storage precautions, specific OTC drugs, special comfort measures, safety measures, and toxicity warning signs.
- Medication errors must be reported according to the policy of the healthcare facility.
Medication Errors
- Nurse's Role: right patient, right drug, right dose, right route, right time, right preparation, right recording, encouraging patient autonomy, provide health teaching.
- Patient's Role: keeping an accurate record, knowing what each drug is used for, reading labels, following directions, speaking up when necessary, using safe devices.
Reporting Medication Errors
- Errors must be reported at the national and institutional level
- Compiling reports to prevent recurrence
- Issuing HCP warnings
- Suggesting ways to avoid errors in the future
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Description
This quiz explores the classifications of controlled substances and their implications for drug usage during pregnancy. It covers topics such as the significance of different categories and schedules of drugs, focusing on abuse potential and safety for expectant mothers.
