Introduction to Pharmacology PDF Notes

INTRODUCTION TO PHARMACOLOGY notes by Kemi Peterside  PHARMACOLOGY notes by Kemi Peterside THE NURSING PROCESS KEY TERMS Assessment - recognize cues Drug - chemical that affects Diag...

INTRODUCTION TO PHARMACOLOGY notes by Kemi Peterside  PHARMACOLOGY notes by Kemi Peterside THE NURSING PROCESS KEY TERMS Assessment - recognize cues Drug - chemical that affects Diagnosis - identify problems physiological process of the body Planning - outcome identification Medication error - preventable adverse Implementation - includes patient drug event education Generic name - name given by the Evaluation - includes documentation united states adopted name council Trade name - name given by the 9 RIGHTS OF MEDICATION manufacturer Right drug Pharmacokinetics - study of what the Right dose body does to medication Right time First pass effect - drug metabolism in Right route liver Right patient Bioavailability - drug available for use Right documentation after absorption Right indication Prodrug - inactive form of drug to Right response active Right to refuse Pharmacodynamics - what drugs do to the body PRINCIPLES OF PHARMACOKINETICS ABSORPTION - from site of administration of drug to the bloodstream. The rate of administration affects drug absorption. ADMINISTRATION ROUTES - Enteral: GI tract (PEG, Buccal, Oral, Rectal, Sublingual) drugs go through first pass effect - Parenteral: IV, Subcutaneous, Intramuscular. Fasted delivery for drugs - Topical: Inhaler, Rectal, Patches, ointment, eye, nasal, & ear drops, cream. Can be used for systemic or local treatments. FACTORS AFFECTING ABSORPTION —> age, pH of stomach, food or fluids, site of administration, low blood flow, low peristalsis  ~ notes by Kemi Peterside DISTRIBUTION - from bloodstream to site of action. Areas of rapid distribution are the brain, heart, kidneys, and liver due to high blood circulation.Areas of slow distribution are fat, muscle, and skin due to low blood circulation. FACTORS AFFECTING DISTRIBUTION —> low fat, low water & blood volume, low albumin (burns & malnutrition) unbound/active drug: distribute freely to METABOLISM - is altering drug to tissues make it usable. Main organ for Bound/inactive: too large to penetrate metabolism is the liver. capillary wall FACTORS AFFECTING METABOLISM Low metabolism —> toxicity - hepatic disease. - jaundice High metabolism —> low bioavailability - renal insufficiency - starvation P-450 enzymes metabolize drugs in liver - cardiovascular dysfunction EXCRETION - drug eliminated from the body, mostly takes place in the kidneys (also bowels & liver), if elimination is not done properly it can lead to toxicity FACTORS AFFECTING EXCRETION —> kidney problems, constipation, age, dehydration KEY TERMS Duration - how long drug elicits Agonist - drug binds to receptor to produce therapeutic response a response Peak - maximum therapeutic effect Antagonist - binds to receptor to prevent Trough - minimum therapeutic effect agonist from binding Side effect - expected effect Pharmacotherapeutics -use of drug to treat Toxicity - poisonous level of drug in conditions blood Drug interaction - two drugs or substance Tolerance - decreased response to a (food) cause effects when taken together repeated drug Half life - time it takes for half a drug to Dependence - need for a drug be removed from the body. It takes 5 half Therapeutic index - ratio of drug toxic lives for a drug to reach a steady state. Onset - time required for drug to reach level to therapeutic benefit therapeutic state Therapeutic effect - intended action of drug  ~ notes by Kemi Peterside TYPES OF THERAPY DRUG EFFECTS Acute therapy - for critically ill Adverse effect - unexpected effect patients that can cause harm Maintenance therapy - prevent Additive effects - unintended progression of a condition additional effect Supplemental therapy - supplies Synegistic effect -working together body with substance needed to Antagonistic effect - one drug maintain function doing one thing, other doing the palliative therapy - make patient as opposite comfortable as possible Pharmacognosy - study of drugs Supportive therapy - maintains made from plant and animals integrity of body function while Pharmacogenomics - how genes patient is recovering affect drug Prophylactic therapy -to prevent illness PREGNANCY SAFETY Empiric therapy - based on CATEGORY probability of illness based on Category A - no harm to fetus patient presenting symptoms Category B - no harm to animal fetus Category C - adverse effect in animal LIFESPAN CONSIDERATIONS fetus INFANTS Category D - possible fetal risk in - liver, kidney, blood brain barrier are humans not fully developed so infants are at Category X -fetal abnormalities & risk of toxicity evidence of fetal risk in humans - oral medication can be given as long as infant is awake and can swallow ANTIDOTES - fat soluble medications can pass Opioids - naloxone through breastmilk Acetaminophen - acetylcysteine OLDER ADULTS Benzodiazepines - flumazenil - low pH affect absorption - low peristalsis affect excretion - low blood volume & high body fat affect distribution - low albumin & enzymes in liver affect metabolism  ~ notes by Kemi Peterside ANALGESICS They relieve pain without causing loss of consciousness. TYPES OPIOID ANALGESIC (moderate - severe pain) MECHANISM OF ACTION Agonist - bind to receptor to produce a response Antagonist - bind to receptor but does not provide a response CLASS - Mild opioid agonist - codeine & hydrocodone - Strong opioid agonist - oxycodone, fentanyl, morphine, hydromorphone, meperidine, methadone - Opioid antagonists/antidotes - naloxone & naltrexone - Opioid agonist-antagonist - buprenorphine, pentazocine, butorphanol, nalbuphine INDICATIONS —> cough, diarrhea, anesthesia CONTRAINDICATIONS —> allergy, hypersensitivity, pregnancy, severe asthma, sleep apnea, obesity, liver disease, paralytic ileus, older adults, history of opioid addiction, undiagnosed abdominal pain ADVERSE EFFECTS —> CNS depression, Respiratory depression, Constipation, Itching, nausea, vomiting, flushing, bradycardia, hypotension, urinary retention WITHDRAWAL SYMPTOMS —>nausea, vomiting, chills, anxiety, irritability, hot flashes DRUG INTERACTIONS —> alcohol, other opioids, CNS depressants, barbiturates, benzodiazepines, dipherihydramine, MAOI  ~ notes by Kemi Peterside NON OPIOID ANALGESIC (mild - moderate pain) ACETAMINOPHEN/TYLENOL: pain & antipyretic (fever) - similar to salicylates - blocks pain impulses peripherally by blocking prostaglandin (cause pain & inflammation response) synthesis ROUTES —> IV, oral, rectal HIGHEST DOSE OF TYLENOL —> 3000mg/day, 2000mg/day for older adults or people with liver disease. CONTRAINDICATIONS —> liver failure, liver disease, allergy, G6PD (cause RBC to breakdown in response to certain medications) ADVERSE EFFECTS —> nausea, vomiting, liver toxicity, renal failure, stevens johnson syndrome OVERDOSE SIGNS —> jaundice, NORMAL LAB VALUES abdominal pain, nausea, vomiting - BUN - 12 -20 - Creatine - up to 1.1 - Potassium - 3.5 - 5 - Hemoglobin 12 - 16 (F) 14 - 18 (M). - ALT & AST - < than 40 MISCELLANEOUS ANALGESIC (moderate - moderately severe) TRAMADOL: central acting, inhibits seratonin & norepinephrine. CONTRAINDICATIONS —> hypersensitivity, alcohol, CNS depression, sedatives, opioids, breastfeeding, GI obstruction, respiratory depression, children younger than 12yrs SIDE EFFECTS —> drowsiness, dizziness, nausea, vomiting, constipation, headaches, risk of seizures, respiratory depression OTHERS NSAID —> over the counter cold medication, non steroids, anti inflammatory drugs e.g advil & motrin ADJUVANT DRUGS —> taken in combination with other medication e.g antidepressants, anticonvulsants, corticosteroids. * amitriptyline - used for depression & migraines  ~ notes by Kemi Peterside ENDOCRINE DRUgS Hypothalamus communicates to the pituitary glands to release hormones through negative feedback loop to promote homeostasis. ANTERIOR PITUITARY DRUGS COSYNTROPIN: stimulates the secretion of cortisol. INDICATION —> HIV infection associated wasting syndrome, diagnosis of adrenocortical insufficiency CONTRAINDICATION —> hypersensitivity ADVERSE EFFECTS —> edema, hypertension, congestive heart failure SOMATROPIN: acts like growth hormone , promotes skeletal growth INDICATIONS —> HIV associated wasting syndrome, growth hormone deficiency e.g dwarfism & Turner’s syndrome CONTRAINDICATION —> hypersensitivity, diabetes ADVERSE EFFECTS —> hyperglycemia, muscle/joint pain, hypothyroidism, renal calculi DRUG INTERACTION —> GLUCOCORTICOIDS (hyperglycemia) OCTREOTIDE: inhibits release of growth hormone INDICATION —> acromegaly, esophageal varices, severe diarrhea, flushing, hypotension CONTRAINDICATION —> diabetes, renal impairment, hypersensitivity ADVERSE EFFECTS —> hypo/hyperglycemia, joint pain(arthralgia), fatigue, headache, impaired gallbladder function, liver enzymes impairment, prolonged QT syndrome DRUG INTERACTION —> Ciprofloxacin  ~ notes by Kemi Peterside POSTERIOR PITUITARY DRUGS VASOPRESSIN & DESMOPRESSIN: increase sodium & water retention in kidneys INDICATIONS (VASOPRESSIN) —> hypotensive emergencies, diabetes insipidus, pulseless cardiac arrest, stop bleeding from esophageal varices INDICATION (DESMOPRESSIN) —> nocturnal enuresis, blood disorders CONTRAINDICATIONS —> coronary artery disease, renal impairment ADVERSE EFFECTS —> edema, hypertension, nausea, headache, myocardial infarction DRUG INTERACTIONS —>Lithium, Alcohol, Norepinephrine, Fludrocortisone THYROID & ANTITHYROID DRUGS HYPOTHYROIDISM: low thyroid hormone INDICATION —> goiter, constipation, weight gain, cold intolerance, slow metabolism TREATMENT —> LEVOTHYROXINE (taken before breakfast) CONTRAINDICATION —> myocardial infarction, thyrotoxicosis (thyroid storm) ADVERSE EFFECTS —> cardiac dysrhythmias, angina, hyperthyroidism effects DRUG INTERACTION —> Soy, Anti ulcer medications HYPERTHYROIDISM: high thyroid hormone, caused by graves disease, multi nodular disease, plummer’s disease, thyroid storm TREATMENT —> PTU, Methimazole, Iodine, Surgery (total/partial) INDICATIONS —> hyperthyroidism, graves disease, block thyroid hormone, thyroid storms CONTRAINDICATIONS —> pregnancy, lactation, bone marrow depression, liver disease, immunosuppression ADVERSE EFFECTS —> hypothyroidism symptoms, liver toxicity, bone marrow toxicity, leukopenia CONSIDERATIONS —> avoid foods high in iodine e.g tofu, seafood, iodine salt, soy sauce