Introduction to Pharmacology PDF

Introduction to Pharmacology Key Concepts and Definitions  Requirements Read the following textbook chapters: Prefixes, suffixes, and abbreviations, pp xxiv-xxxv. Chapter 1, pp 1-6 You should be able to answer the following chapter ques...

Introduction to Pharmacology Key Concepts and Definitions  Requirements Read the following textbook chapters: Prefixes, suffixes, and abbreviations, pp xxiv-xxxv. Chapter 1, pp 1-6 You should be able to answer the following chapter questions: 1, 2, 3, 4, 5, 6. Chapter 4, pp 52-66 You should be able to answer the following chapter questions: 1, 3, 6, 10, 15. Watch the following video on medication administration: 8 Rights of Medication Administration (3:23) Watch the following video on medication safety: Dr. Francois deWet turns “physician’s worst nightmare” into opportunity for improvement (11:15)  Objectives Define the following terms: Drug, medicine, pharmacology, pharmacognosy, pharmaceutics, medication error, adverse drug event, adverse drug reaction, List the sources of medications. Identify common abbreviations used in pharmacology. You must be able to identify all the abbreviations found in the table on slide 6 of this presentation. Explain the stages of new drug testing, identify orphan drugs, and explain black box warnings. Explain the paramedic’s role in medication handling, storage, and management. Detail the components of a drug monograph. Discuss sources of medication error and mitigation strategies. Define and give examples of the 6 rights of medication administration.  Pharmacology Definitions Drug A drug is a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.1 Pharmacology The branch of medicine concerned with the uses, effects, and modes of action of drugs. 1 Pharmaceutics The branch of pharmacology concerned with the preparation, use, or sale of medicinal drugs. 1 Medicine Drugs used in a medical setting. Pharmacognosy The study of natural sources of drugs.  Common Pharmaceutical Abbreviations Abbreviatio Meaning Abbreviatio Meaning Abbreviatio Meaning n n n AMA Against medical Td Transdermal QHs Before sleep advice Amp Ampule SL Sublingual (T)KVO (To) keep vein open ASA Aspirin PO By mouth (orally) OTC Over the counter D/C Discontinue PR By rectum tab Tablet Dx Diagnosis PRN As needed BHP Base hospital physician Rx Medication IN Intranasal MDSO Medical directive and standing order Tx Treatment SC or SQ Subcutaneous mg Milligram ET Endotracheal QD Every day mcg Microgram ETT Endotracheal tube BID Twice daily Kg Kilogram gtt Drop(s) TID Three times daily L Liter IM Intramuscular QID Four times daily mL Milliliter IV Intravenous NPO Nothing by mouth h Hour IVP Intravenous push QAM Every morning min Minute IO Intraosseous QPM Every evening / per Sources of Medication Syntheti Plant c Mineral Animal  New Drug Testing Phase 1 Testing is performed to determine a new medication’s pharmacokinetics, toxicity, and safe dosing. Tests are done on a small number of healthy volunteers. Phase 2 Tests are performed to determine therapeutic levels, longer-term toxicity potential, and side effects. Tests are done on a small number of volunteers with the disease. Phase 3 Tests are performed to refine therapeutic dosing and potential side effects. Tests are done on a large group of patients with the disease at several research centers. The results of this phase are evaluated by government oversight bodies. Phase 4 Post-marketing analysis of therapeutic dosing and side effects on the general population with the disease. Occurs after conditional government approval.  New Drugs and Special Labeling Orphan drugs Drugs developed to treat rare diseases. Side effects may be significant, or the drug may have a high risk of adverse reaction. Costs of development cannot be recouped so the cost to the patient is often inaccessible, requiring government subsidization. Off-label use Government approval of a drug is for the disease or condition listed in Phases 2 and 3 of the drug trial. Sometimes the pharmacology of the drug suggests it may be of benefit in other conditions. Use in these other conditions is not approved (“off label”), has not been proven effective or safe, and may not be covered by insurance. Black box warnings After a drug has been released to the general population (Phase 4) it may become apparent that the drug causes a previously-undetected harmful effect resulting in serious injury or death to some patients. If the risk can be minimized and the drug made safe for general use, a “black box” warning may be added to packaging.  Drug Storage and Handling Medications have specific storage and handling requirements. Temperature parameters: Many drugs must be stored between 5-25˚C and do not tolerate freezing. Some drugs must be kept refrigerated up to use or have a limited shelf-life once at room temperature. Exposure to light: Many drugs must be protected from UV rays. Some will be individually packaged to protect the drug from light, but some, such as salbutamol nebules, come in a multi-dose package where the individual nebules are clear. Reconstitution: Some drugs are packaged as a powder as they have a limited shelf life once dissolved in a liquid. These drugs must be reconstituted prior to parenteral administration. Expiry dates: It is possible for drugs to degrade over time. This can alter the effectiveness of the drug. Sometimes the drug is rendered less potent, sometimes it is made more potent. It is important to check the drug expiry date prior to administration. Drug monograph Names (generic and trade) Classification (drug category) Mechanism of action Indications Pharmacokinetics Side effects/adverse reactions Contraindications Dosage How supplied Special considerations Medication Safety  Medication error Medical error is the “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” 1 Medication misadventure is any iatrogenic incident or hazard associated with medication. Medication misadventures include medication errors, adverse drug reactions, and adverse drug events. 2 Adverse drug event encompasses any harm resulting from medication, including harm from the drug at a standard dose and harm due to inappropriate dosage or overdose.2 Adverse drug reaction is a harmful, unintended reaction to a medication occurring at normal treatment doses. 2 Sentinel event is "an unexpected occurrence involving death, serious physical or psychological injury, or the risk thereof.“ 2  Medication errors ISMP Canada analysis of 60 medication events showed half of all events were related to medication administration 1. The most common incident types were: Dose omissions Incorrect infusion rate or frequency of drug administration Incorrect drug Dosing or mixing errors.  Medication error Clinical Drug prep and Communicatio Medication assessment administration n storage  System Failures Poor Unavailable or Failure to ask interprofession inaccurate Increased about allergies al patient workload communication information Inadequate Interruptions Inaccurate naming and A language and order labeling, of barrier distractions transcription medicines Lack of training or inadequate knowledge  Potential pitfalls Verbal orders Speak slowly, use common language (no short-hand), read-back the orders Patient consent Administration “Rights” of administration Documentation Use charting rules, document consent and the “rights”.  High-alert medications Medications that, if given inappropriately, have great potential for harm. Especially important to watch when administering to pediatrics. Use of “tall man” lettering to differentiate look-alike/sound-alike medications: DOPamine vs DOBUTamine diphenhydrAMINE vs dimenhyDRINATE  Medication safety case A local paramedic service would like to improve medication safety in the way they store their drug. Have a look at the following photos: What do they do well? Where could they improve?  Patient Documentatio Medication n THE “RIGHTS” OF MEDICATION RIGH ADMINISTRATION T Time Dose Route The “rights” of medication administration R I G H T PAT IE N T R I G H T M E D I C AT IO N Does your patient meet the indications for Verify you have pulled out the the medication? correct medication. Underlying pathology or complaint. Age Weight Read the labels at every stage of the Clinical condition requirements process. This includes any packaging AND the vial or ampule Does your patient have any absolute within the packaging. contraindications to administration? Underlying pathology or complaint Age or medical history Verify: Allergies Medication name Co-ingestion or home medications Concentration Does your patient have any relative Expiry date contraindications to administration? Evaluate the risk vs benefit for each The appearance of the administration medication Packaging and safety seal integrity The “rights” of medication administration R I G H T D O SE RIGHT ROUTE Confirm the dose or dosage range Confirm the routes of administration recommended by the medical directive or recommended by the medical by the base hospital physician. directive or by the base hospital Confirm the dose appropriate for your physician. specific patient. Verify the most appropriate route of Calculate a weight-based dose for administration for your specific pediatrics. patient. Consider titrated doses based on patient Route availability condition. Patient comfort, cooperation, and Consider lowering the dose or increasing preference. the time between doses in elderly patient Contraindications or those with significant co-morbidities. Consider the pharmacokinetics of Determine the VOLUME of drug to be the drug and route. administered. The “rights” of medication administration R I G H T T IM E R I G H T D O C U M E N TAT IO N When should the patient receive the Have you labeled all bags and syringes medication? with the drug name, concentration, and Consider what assessments, interventions, and dose? information is required BEFORE the medication Are you documenting each dose as you should be administered. administer it? What is the dosing interval recommended? Consider marking the event on your Consider patient factors such as age, health monitor. status, comorbidities, coadministration. Is someone available to chart dosing on Is the medication given by scheduled dosing or busy calls? on an as needed basis? Document the true time, dose, and What is the rate of administration? method of administration on the ePCR, even if it doesn’t align with your MDSO. Slow push, fast push, infusion? Consider the desired onset time and route of Documentation must include name, dose, administration. time, route, location of injection and results from drug administration.  Independent Double Check (IDDC) Each of the 6 “rights” MUST be independently verified by your partner or another competent person PRIOR to administering any medication. All drug calculations MUST be performed by each paramedic independently. It is good practice to double check yourself at each step of the process. REGARLESS OF YOUR LEVEL OF CARE, EACH PARAMEDIC IS RESPONSIBLE FOR PERFORMING MEDICAL MATH AND MEDICATION SAFETY.  Questions? [email protected]