Podcast
Questions and Answers
Why is it especially important to be vigilant when giving medications to children?
Why is it especially important to be vigilant when giving medications to children?
What is one of the challenges of administering medications to children?
What is one of the challenges of administering medications to children?
Why does the need for small volumes of fluid limit the flushing between drugs in children?
Why does the need for small volumes of fluid limit the flushing between drugs in children?
What is recommended by The Joint Commission and the World Health Organization regarding patient safety?
What is recommended by The Joint Commission and the World Health Organization regarding patient safety?
Signup and view all the answers
Why do many drugs marketed for adults require additional preparation when given to children?
Why do many drugs marketed for adults require additional preparation when given to children?
Signup and view all the answers
What is a significant challenge when giving medications to children according to the text?
What is a significant challenge when giving medications to children according to the text?
Signup and view all the answers
Why have most drugs not been tested in children according to the text?
Why have most drugs not been tested in children according to the text?
Signup and view all the answers
What is a common issue when administering adult medications to children?
What is a common issue when administering adult medications to children?
Signup and view all the answers
Why does the need for small doses in children often require additional steps during medication administration?
Why does the need for small doses in children often require additional steps during medication administration?
Signup and view all the answers
What limits the ability to flush between drugs when administering medications to children?
What limits the ability to flush between drugs when administering medications to children?
Signup and view all the answers
Why is it crucial for nurses and healthcare institutions to maintain up-to-date medication administration skills?
Why is it crucial for nurses and healthcare institutions to maintain up-to-date medication administration skills?
Signup and view all the answers
What does patient safety entail according to The Joint Commission and the World Health Organization?
What does patient safety entail according to The Joint Commission and the World Health Organization?
Signup and view all the answers
Why might undesirable interactions with other drugs and IV solutions occur when administering medications to children?
Why might undesirable interactions with other drugs and IV solutions occur when administering medications to children?
Signup and view all the answers
What complicates the preparation and administration process when giving medications to children?
What complicates the preparation and administration process when giving medications to children?
Signup and view all the answers
Why must health care institutions ensure internal and external reporting requirements for adverse drug events in children?
Why must health care institutions ensure internal and external reporting requirements for adverse drug events in children?
Signup and view all the answers
What is a key reason for the high risk of medication errors when giving medications to children?
What is a key reason for the high risk of medication errors when giving medications to children?
Signup and view all the answers
Why is it challenging to administer adult medications to children?
Why is it challenging to administer adult medications to children?
Signup and view all the answers
What limitation do children have that impacts the administration of IV drugs?
What limitation do children have that impacts the administration of IV drugs?
Signup and view all the answers
Why does the need for small fluid volumes limit flushing between drugs in children?
Why does the need for small fluid volumes limit flushing between drugs in children?
Signup and view all the answers
What is essential for healthcare institutions regarding internal and external reporting of medication errors?
What is essential for healthcare institutions regarding internal and external reporting of medication errors?
Signup and view all the answers
Why are most drugs not tested in children according to the text?
Why are most drugs not tested in children according to the text?
Signup and view all the answers
What contributes to the complexity of medication administration to children?
What contributes to the complexity of medication administration to children?
Signup and view all the answers
How does children's limited sites for IV administration affect medication delivery?
How does children's limited sites for IV administration affect medication delivery?
Signup and view all the answers
What poses a challenge when preparing and administering medication to children?
What poses a challenge when preparing and administering medication to children?
Signup and view all the answers
Why is it important for healthcare professionals to maintain up-to-date skills in medication administration?
Why is it important for healthcare professionals to maintain up-to-date skills in medication administration?
Signup and view all the answers
What is a primary reason for the high risk of medication errors when giving medications to children?
What is a primary reason for the high risk of medication errors when giving medications to children?
Signup and view all the answers
Why are many drugs marketed in dosage forms and concentrations suitable for adults a challenge when administering to children?
Why are many drugs marketed in dosage forms and concentrations suitable for adults a challenge when administering to children?
Signup and view all the answers
How does the limited sites for administration of IV drugs in children impact medication delivery?
How does the limited sites for administration of IV drugs in children impact medication delivery?
Signup and view all the answers
What contributes to the complexity of medication administration in children?
What contributes to the complexity of medication administration in children?
Signup and view all the answers
Why does the need for small volumes of fluid limit flushing between drugs in children?
Why does the need for small volumes of fluid limit flushing between drugs in children?
Signup and view all the answers
What is a significant challenge when preparing and administering medication to children?
What is a significant challenge when preparing and administering medication to children?
Signup and view all the answers
Why have most drugs not been tested in children, according to the text?
Why have most drugs not been tested in children, according to the text?
Signup and view all the answers
What is the main goal of thrombolytic therapy?
What is the main goal of thrombolytic therapy?
Signup and view all the answers
Where does metabolism of alteplase predominantly occur?
Where does metabolism of alteplase predominantly occur?
Signup and view all the answers
Which drug class is given following thrombolytic therapy to decrease reformation of a thrombus?
Which drug class is given following thrombolytic therapy to decrease reformation of a thrombus?
Signup and view all the answers
How does alteplase work to dissolve unwanted blood clots?
How does alteplase work to dissolve unwanted blood clots?
Signup and view all the answers
In which condition is alteplase considered first-line therapy?
In which condition is alteplase considered first-line therapy?
Signup and view all the answers
What is the primary action of plasmin, generated by thrombolytic drugs?
What is the primary action of plasmin, generated by thrombolytic drugs?
Signup and view all the answers
Where does excretion of alteplase take place?
Where does excretion of alteplase take place?
Signup and view all the answers
What happens to more than 50% of alteplase after discontinuation of infusion?
What happens to more than 50% of alteplase after discontinuation of infusion?
Signup and view all the answers
Why are anticoagulant drugs given following thrombolytic therapy?
Why are anticoagulant drugs given following thrombolytic therapy?
Signup and view all the answers
What is the main adverse effect of alteplase as mentioned in the text?
What is the main adverse effect of alteplase as mentioned in the text?
Signup and view all the answers
What is the pharmacokinetic administration route for alteplase?
What is the pharmacokinetic administration route for alteplase?
Signup and view all the answers
What age group should exercise caution when considering the use of alteplase?
What age group should exercise caution when considering the use of alteplase?
Signup and view all the answers
In which patient population is alteplase contraindicated due to an increased risk of bleeding?
In which patient population is alteplase contraindicated due to an increased risk of bleeding?
Signup and view all the answers
What is essential to check before initiating thrombolytic therapy with alteplase?
What is essential to check before initiating thrombolytic therapy with alteplase?
Signup and view all the answers
Where is administration of alteplase carried out according to the text?
Where is administration of alteplase carried out according to the text?
Signup and view all the answers
What should be measured two or three hours after starting thrombolytic therapy with alteplase?
What should be measured two or three hours after starting thrombolytic therapy with alteplase?
Signup and view all the answers
Which thrombolytic agents are used mainly in acute myocardial infarction to dissolve clots obstructing coronary arteries?
Which thrombolytic agents are used mainly in acute myocardial infarction to dissolve clots obstructing coronary arteries?
Signup and view all the answers
Why should alteplase not be shaken during reconstitution according to the text?
Why should alteplase not be shaken during reconstitution according to the text?
Signup and view all the answers
'Administration is IV as a bolus injection or infusion' means that alteplase should be administered:
'Administration is IV as a bolus injection or infusion' means that alteplase should be administered:
Signup and view all the answers
What is the most common adverse effect associated with the use of Reteplase and tenecteplase as mentioned in the text?
What is the most common adverse effect associated with the use of Reteplase and tenecteplase as mentioned in the text?
Signup and view all the answers
Study Notes
Drug Variables
- Dosage refers to the frequency, size, and number of doses
- Dosage depends on reason for use, potency, pharmacokinetics, route of administration, dosage form, and recipient
- Loading dose: a larger dose at the beginning of drug therapy to attain a rapid blood level of the drug
- Maintenance dose: quantity of drug needed to keep blood levels and/or tissue levels at a steady state
Route of Administration
- Affects drug actions and patient responses
- Rapid response: IV (injected directly into the bloodstream) and IM (produces a fast effect)
- Slow response: Oral (due to first-pass effect)
- Absorption and action vary on drug formulation
Drug-Diet Interactions
- Used therapeutically to decrease food absorption in the intestinal tract
- Examples: Orlistat (Xenical) decreases the absorption of fats from food, and ezetimibe (Zetia) decreases absorption of cholesterol from food
- Undesirable interactions: food often slows absorption of oral drugs, and certain foods react with drugs (e.g., MAO inhibitors, warfarin, vitamin K, dairy, and grapefruit)
Drug-Drug Interactions
- Increase or decrease therapeutic or adverse effects
- Types of interactions:
- Additive effects: two drugs with similar pharmacological actions (e.g., ethanol and sedative drugs)
- Synergism: two drugs produce greater effects when taken together (e.g., acetaminophen and codeine)
- Interference: intensify effects of the second drug
- Displacement: a drug exchanges with another, increasing the effect of the second drug
- Antidote: given to antagonize the toxic effects of another drug
- Decreased intestinal absorption of oral drugs when combined with other drugs
Preparations and Dosage Forms
- Vary according to drug's chemical characteristics, reason for use, and route of administration
- Types of dosage forms:
- Liquids
- Tablets
- Capsules
- Suppositories
- Transdermal and pump delivery systems
Medication Administration Process
- Follow the "rights" associated with medication administration consistently
- Learn essential information about each drug to be given
- Interpret the prescriber's order accurately
- Question the prescriber if any information is unclear
- Calculate doses accurately
- Verify the identity of all patients before administering medications
Clopidogrel
- Antiplatelet effects similar to aspirin
- Reversibly blocks the ADP receptor on platelet cell surface
- Indications for use: reduction of myocardial infarction, stroke, and vascular death in patients with atherosclerosis
- Specific uses: prevention of vascular ischemic events, acute coronary syndrome, and thrombosis following placement of an intracoronary stent
Prasugrel and Ticagrelor
- Other ADP receptor antagonists
- Similar to clopidogrel but with different mechanisms and effects
- Uses: reduction of thrombotic cardiovascular events, including stent thrombosis
Heparin
- Pharmaceutical preparation of the natural anticoagulant
- Prototype anticoagulant
- Antidote: protamine sulfate
- Pharmacokinetics: given intravenously or subcutaneously
- Action: combines with antithrombin III to inactivate clotting factors
- Uses: prophylactic prevention of DVT and pulmonary embolism, management of acute thromboembolic disorders, and disseminated intravascular coagulation (DIC)### Heparin Administration
- Heparin therapy requires platelet counts before therapy begins and every 2-3 days during therapy
- If platelet count falls below 100,000 platelets per microliter of blood or to less than half the baseline value, heparin should be discontinued
- Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening complication of heparin administration
Contraindications and Administration
- Contraindications include GI ulcerations, intracranial bleeding, dissecting aortic aneurysm, blood dyscrasias, severe kidney or liver disease
- aPTT (activated partial thromboplastin time) should be maintained at approximately 1.5 to 2.5 times the control or baseline value
Pharmacokinetics and Pharmacodynamics
- Absorption: the process by which a drug enters the body and reaches the bloodstream
- Distribution: the transport of drug molecules within the body to their sites of action, metabolism, and excretion
- Metabolism: the method by which the body inactivates drugs
- Excretion: the elimination of a drug from the body
Pharmacodynamics
- Receptors: proteins located on the surfaces of cell membranes or within cells that bind to drug molecules
- Agonist effect: drugs that produce effects similar to those produced naturally occurring hormones, neurotransmitters, and other substances
- Antagonist effect: drugs that inhibit cell function by occupying receptor sites
Serum Half-life
- Serum half-life: the time required for the serum concentration of a drug to decrease by 50%
- Half-life is determined by the drug's rate of metabolism and excretion
- Four to five half-lives are required to achieve steady-state concentrations and to develop equilibrium between tissue and serum concentrations
Drug-Related Variables
- Dosage: the frequency, size, and number of doses; a major determinant of drug actions and responses
- Route of administration: affects drug actions and patient responses
- Drug-drug interactions: may be increased or decreased
- Drug-diet interactions: used therapeutically to decrease food absorption in the intestinal tract or undesirable because food often slows absorption of oral drugs
Dosage Forms and Drug Preparations
- Dosage forms of systemic drugs include liquids, tablets, capsules, suppositories, and transdermal and pump delivery systems
- Controlled-release tablets and capsules maintain more consistent serum drug levels and allow less frequent administration
Medication Administration Process
-
The nurse adheres to the following principles: follow the "rights" associated with medication administration consistently, learn essential information about each drug, interpret the prescriber's order accurately, and calculate doses accurately### Adenosine Diphosphate (ADP) Receptor Antagonists
-
ADP receptor antagonists, including clopidogrel, prasugrel, and ticagrelor, have antiplatelet effects similar to aspirin and inhibit the ADP receptor on platelet surfaces.
-
Clopidogrel has three shortcomings: delayed onset of action, irreversible inhibitory effects on platelets with no reversing agent or antidote, and significant individual variability in platelet response.
Pharmacokinetics of Clopidogrel
- Clopidogrel is rapidly absorbed after oral administration and undergoes extensive first-pass metabolism in the liver.
- It is converted to its active form by hepatic CYP2C19 and CYP3A4 enzymes.
- Platelet inhibition may occur 2 hours after a single dose, but the onset of action is slow, so an initial loading dose is usually administered.
- The drug has a half-life of about 8 hours and is excreted in the urine and feces.
Action of Clopidogrel
- Clopidogrel irreversibly blocks the ADP receptor on platelet cell surfaces.
- Effective dose-dependent prevention of platelet aggregation can be seen within 2 hours of a single oral dose.
- Platelet inhibition essentially lasts for the lifespan of the platelet (7-10 days).
Use of Clopidogrel
- Indications for use include reduction of myocardial infarction, stroke, and vascular death in patients with atherosclerosis and in those after placement of coronary stents.
- Specific uses include prevention of vascular ischemic events in patients with symptomatic atherosclerosis or with acute coronary syndrome (with or without ST-segment elevation).
- People with atrial fibrillation who are unable to take vitamin K antagonists take clopidogrel instead.
Safety and Precautions of Clopidogrel
- Older adults are more likely than younger ones to experience bleeding and other complications of antiplatelet drugs.
- Clopidogrel may accumulate in people with hepatic impairment.
- Caution is necessary for people with variant forms of CYP2C19, who may be poor or ultrarapid metabolizers of clopidogrel.
Adverse Effects of Clopidogrel
- The most common adverse effects associated with clopidogrel are pruritus, rash, purpura, and diarrhea.
- Thrombotic thrombocytopenic purpura, hemorrhage, and severe neutropenia have also occurred.
Prasugrel and Ticagrelor
- Prasugrel demonstrated improved cardiac outcome compared with clopidogrel for acute coronary syndromes involving percutaneous coronary intervention.
- Ticagrelor is the latest ADP receptor antagonist, used to reduce the rate of cardiovascular death, myocardial infarction, and stroke in patients with a history of myocardial infarction or acute coronary syndrome.
- Ticagrelor differs from clopidogrel and prasugrel in that receptor blockade is reversible.
Heparin
- Heparin is a prototype anticoagulant, used to prevent and treat thromboembolic disorders.
- It combines with antithrombin III to inactivate clotting factors IX, X, XI, and XII, inhibit the conversion of prothrombin to thrombin, and prevent thrombus formation.
Pharmacokinetics of Heparin
- Heparin is administered intravenously or subcutaneously, as the gastrointestinal tract does not absorb the drug.
- After IV injection, the drug acts immediately; after subcutaneous injection, heparin acts within 20-30 minutes.
- Metabolism takes place in the liver and the reticuloendothelial system, and excretion occurs in the urine.
Use of Heparin
- Prophylactically, patients at risk for certain disorders take low doses of heparin to prevent DVT and pulmonary embolism.
- Heparin is used to manage acute thromboembolic disorders, such as DVT, thrombophlebitis, and pulmonary embolism.
- Another use is in disseminated intravascular coagulation (DIC), a life-threatening condition characterized by widespread clotting.
Adverse Effects of Heparin
- Hemorrhage is a major adverse effect of heparin.
- Heparin-induced thrombocytopenia (HIT) is a potentially life-threatening complication of heparin administration, leading to a decrease in platelet count and detectable HIT antibodies.
Contraindications of Heparin
- Contraindications include GI ulcerations, intracranial bleeding, dissecting aortic aneurysm, blood dyscrasias, severe kidney or liver disease.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Explore different drug delivery systems including oral tablets, transdermal patches, and pump delivery systems used for administering various medications. Learn about the formulations and drugs commonly delivered through each system.
