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What does pharmacodynamics refer to?
First-pass metabolism occurs when drugs are administered intravenously.
False
What is the term for how the body bio-transforms a drug to aid in its excretion?
Metabolism
The _____ is primarily responsible for the excretion of drugs from the body.
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Match the following pharmacology terms with their definitions:
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Which of the following is NOT one of the R's of Drug Administration?
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Bioavailability is only concerned with the amount of the drug that is left in the body after excretion.
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What is the main purpose of excretion in pharmacology?
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What is the primary purpose of nebuliser administration?
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Subcutaneous injections have a faster absorption rate than intramuscular injections.
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What is the recommended oxygen flow rate for nebuliser administration?
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Injections should be avoided in areas of ______ tissue, bruises, infections, or broken skin.
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Match the injection type with its property or characteristic:
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Which injection site is typically used for intramuscular administration?
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It is necessary to wipe the injection site for a healthy patient.
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What angle is the needle usually inserted at for subcutaneous injections?
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In the procedure for injections, the nurse should hold the syringe in their ______ hand.
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What is a potential risk of gluteal injections?
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Which patient characteristic can lead to a faster elimination of medication?
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Adverse effects of medication are always benign.
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What is the primary site of drug absorption for orally administered medications?
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The ______ is the latest possible date at which a medication can be safely administered.
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Match the following routes of drug administration with their characteristics:
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What can cause a delay in drug elimination in elderly patients?
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Food interactions can impact the efficacy of a drug.
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What must be calculated for pediatric drug dosages?
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Drug ______ refers to how it works to create the desired effect.
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Match the following drug preparations with their examples:
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Which method of drug administration avoids first-pass metabolism?
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Volume and dose refer to the same quantity in medication.
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What does contraindication mean in medication administration?
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Intraosseous administration delivers drugs directly into the ______.
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Study Notes
Pharmacology
- The study of drugs: their uses, effects, and modes of action.
Pharmacokinetics
- How the body affects a drug (absorption, distribution, metabolism, and excretion).
Pharmacodynamics
- How a drug affects the body.
Absorption
- How a drug enters the body (route of administration).
Distribution
- Where a drug goes in the body and where it accumulates.
Metabolism
- How the body bio-transforms a drug to remove it.
- Involves chemical alteration of drug molecules to make them more water-soluble for excretion.
Elimination
- The process of a drug being bio-transformed from an active state to inactive metabolites.
Excretion
- The removal of drugs from the body, either as metabolites or unchanged drugs.
- Primarily performed by the kidneys.
Half-Life
- The time it takes for the concentration of a drug in the plasma or the total amount in the body to be reduced by 50%.
First Pass Metabolism
- Drugs administered orally are metabolized in the gut or liver before reaching systemic circulation.
Bioavailability
- The extent and rate at which the active drug or metabolite enters systemic circulation and reaches the site of action.
The R's of Drug Administration
- Right drug
- Indications and contraindications
- Appearance of the drug
- Right route
- Correct pathway for drug administration
- Right patient
- Age, other diseases, allergies, and potential side effects of the drug
- Right dose
- Drug calculations
- Right time
- Scheduled administration, rate of administration, and time for effect
- Right to refuse
- Consent if appropriate
- Action if incorrect drug administration is suspected
- Right response
- Desired outcome of medication administration
- Right documentation
- Accuracy records
- Right to question, advice, and knowledge
- Confirm with partner
- Advise patient of possible side effects
Patient Characteristics Affecting Medications
- Age
- Children have less developed liver function, leading to quicker drug elimination.
- Elderly may have compromised organ function or multiple co-morbidities, resulting in slower drug elimination.
- Body weight
- Higher body weight require higher doses for effect due to changes in drug clearance.
- Pathophysiology
- Disease, infection, and inflammation can decrease drug metabolism, affecting the duration of drug effect.
- Genetics
- Impact on drug metabolism.
- Drug or food interactions
- Certain drugs may be contraindicated if taken with other drugs, over-the-counter medications, or herbs.
Important Definitions
- Dose: The amount of medication to be given.
- Weight: The physical weight of the active dose of the medication.
- Volume: The physical volume of the fluid containing the medication.
- Expiry date: The latest date for safe administration of the medication.
- Route of administration: How the drug enters the body.
- Actions: The desired effect of the drug.
- Mechanism of action: How the drug works to create the effect.
- Indications: Conditions for which the medication is appropriate.
- Contraindications: Conditions where the medication is unsafe.
- Precautions: Conditions requiring close monitoring or cautious administration.
- Adverse effects: Negative or undesired effects of the medication.
- Side effects: Benign effects of the medication unrelated to its therapeutic effects.
Drug Dose & Volume
- Dose refers to the mass of drug required, regardless of preparation or form.
Paediatrics
- Paediatric drug dosage is based on patient weight.
- Three calculations for paediatric drug administration:
- Patient weight
- Drug dose based on weight
- Volume based on drug dose
Calculating Doses
- Three formats for calculating drug doses:
- mg/kg
- µg/kg
- mL/kg
Calculating Volume
- Drug preparation refers to the dosage and volume in the ampoule.
- Factors involved in volume calculation:
- Volume of drug preparation required
- Dosage (mass) of drug required
- Concentration of the preparation provided
Drug Administration
Enteral Methods
- Drug is placed directly into the GI tract.
- Sublingual: Under the tongue
- Oral: Swallowed
- Rectal: Administered as a suppository
Parenteral Methods
- Drug is delivered into systemic circulation bypassing the intestinal mucosa.
- Topical: Used externally on skin, nose, eyes
- Intradermal: Into the skin
- Subcutaneous: Under the skin
- Intramuscular: Into the skeletal muscle
- Intravenous: Directly into the bloodstream
- Endotracheal: Administered endotracheally through an ET tube
- Intraosseous: Directly into bone marrow
- Intranasal: Administered through nasal structures
- Inhalation: Through airways and into alveoli
- Vaginal: Administered into the vagina
Oral Administration
- Most common route in community settings.
- Primary drug absorption site: small intestine.
- Bioavailability is influenced by the first-pass effect.
- Examples: paracetamol, ibuprofen, aspirin
Sublingual Administration
- Under the tongue for absorption through the mucous membranes of the mouth.
- Bypasses first-pass metabolism, leading to higher bioavailability.
- Examples: glyceral trinitrate (GTN), anginine
Intranasal Administration
- Aerosol medication applied through the nose.
- Advantages: easily accessible and highly vascular.
- Contraindications:
- Suspected nasal fractures
- Obstructed nasal passage
- Complications:
- Underdose if not administered properly
- Mild, short-lasting discomfort (typically burning)
Nebuliser administration
- Converts liquid medication into an aerosol mist for inhalation.
- Rapidly absorbed across the respiratory tract epithelium.
- Administered through a mask with an oxygen flow rate of 6-8 L/min.
- Patient must be sitting.
Subcutaneous Injection
- Delivery of medication into the fat layer between the skin and muscle.
- Slower absorption than intramuscular route.
- Example: insulin, heparin
- Factors affecting absorption:
- Exercise
- Environmental temperature
- Contraindications:
- Injection into scar tissue, bruises, infection, or broken skin.
- Precautions:
- Pain
- Bleeding
Intramuscular Injection
- Administration of medication into the muscle.
- Rapid setup and administration.
- Commonly used sites: deltoid muscle (shoulder) and vastus lateralis (outer side of thigh).
- Contraindications:
- Evidence of infection or trauma at the injection site.
- Precautions:
- Pain
- Bleeding
- Abscess
- Cellulitis
- Tissue necrosis
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