สรุป Midterm Pharmacy .pdf

Drug-drug interaction during metabolism Principle of pharmacology - Enz. inducer drug Induced + i...

Drug-drug interaction during metabolism Principle of pharmacology - Enz. inducer drug Induced + induced => less/no effect Drug = substance diagnosis, cure เยียวยา , treat, protect disease - Enz. Inhibitor drug Medical pharmacology: substances used to prevent, diagnose, and Induced + enz.inhibit => actionชา + Toxic dose treat disease. Drug excretion = removal of drugs 1. Pharmacokinetics = how to body move and effect a drug Urine , bile , saliva Drug Adsorption : delivery into blood circulation Kidney drug excretion Factor * - - GFR increases => excrete increase 1. Physical + Chemical - passive tubular reabsorption - drug formulation รูปแบบของยา จะ adsorption ตางกัน Urine pH Tablet, capsule, suppository, patch, **solution Adsorption the best Acid excrete => weak base drug ~ Ammonium chloride - molecular weight low => Adsorption well Base excrete => weak base drug ~ NaHCO3 - lipid solubility/lipophilic การละลายไขมัน - Active tubular secretion lipid solubility increases => Adsorption increase 2. Rout + patients Pharmacokinetic = how drugs affect the body on a chemical and psychological level - Route of administration : the best IV, I/O The half-life ; decline 50% Sublingual, inhalation, Supp, oral Buccal, Transdermal slowest Volume of distribution = ปริมาณการกระจายยาในรางกาย Oral route Onset = เริ่มใหยา > ยาออกฤทธิ์ - Drug interaction : food-drug, drug-drug Duration of action = ยาออกฤทธิ์ > หมดฤทธิ์ - The pH of stomach : Acid (stomach) , Base (intestine) * Loading dose = ขนาดยาที่ใหครั้งแรก - Pathology of GI : Diarrhea => moved thoughts quickly C max , T max = ความเขมขนในเลือด , ะยะเวลาตั้งแตให - Physiology + Mood : หลังกินยา ใหทาลําตัวตรง ทั้งนั่งและยืน Area under the curve Drug distribution = delivery drug from blood to target organ Factors - Blood flow High : heart, lungs , liver, kidneys, brain *well distribution Slow : skin , bone , depot fat - lipid solubility increases => distribution increases * - plasma protein binding increases => distribution decreases Free from => distribution increases - Capillary permeability: BBB => lipid solubility increases ผานได - Accumulation at other site : muscle , fat , bone, teeth 2. Pharmacodynamic Drug metabolism = biotransformation drug effect on body **Liver , GI tract, lung,kidney,skin Without receptors Mechanism of drug activation : การออกฤทธิ์ของยา drug effect - chemical action e.g. Mg(OH)2 neutralize stomach acid Terminate/ inactivate of drug action : การเปลี่ยนสภาพใหยาหมดฤทธิ์ - physical action osmotic laxative ขับถาย , osmotic diuretic Hydrophiliac , Ionize form, polar compound งายตอการขับออกทางไต ขับปสสาวะ Phase I : NADPH-Cytochrome P450 , CYP3A4 - Physiochemical action e.g. inhalation anesthetic ยาสลบ Phase II : molecules drug + endogenous compounds in liver Change move of ion Glucolonic acid, Sulfuric acid, Acetic acid With receptor = determine drug action selectivity * Factor: Genetic factor, Age **เด็กและผูใหญ , Disease โรคไต , diet Receptor = Protein , function = selective choosing bind drug and environmental, Drug-drug interaction during metabolism Type Agonist : จับ receptor เกิดฤทธิ์สัมพันธกับขนาด S = special controlled ยาควบคุมพิเศษ e.g. Steroid, Antagonist : ลดฤทธิ์ agonistชอบขึ้น Anti /ลงทาย blocker D = Dangerous Drugs e.g. hypotension drug , cardiovascular Partial agonist = drug with intrinsic activity higher * than 0% and lower than 100%? NDD = non dangerous drugs - full agonist condition จะทําหนาที่เปน antagonist E-D = external use dangerous drugs - no agonist จะทําหนาที่ agonist แตฤทธิ์ไมเต็ม 100% E = external use-non dangerous drugs T = traditional drugs Pharmacodynamic parameter Affinity = ความสามารถของยาในการจับ receptor PLLR drug category 2015 Efficacy = ประสิทธิภาพในการรักษา 1. Pregnancy includes Labor + Delivery Potency = ความแรงของการออกฤทธิ์ของยา Risks Summary of using Disease-associated Dose adjustments ใชนอย ประสิทธิภาพเยอะ 2. Lactation includes Nursing Mother Therapeutic index Effects on the breast-fed child + milk production Save 3. Females + Males of Reproductive potential Effect on fertility or pregnancy loss High = save drugs Low = Dangerous Drug responsiveness Idiosyncratic ; don’t occur in most pt. E.g. genetic Hypersensitivity (Allergic reaction) ; ตอบสนองมากกวาปกติ Tolerance; ดื้อยา well as they did at first dose Placebo effect ; ยาหลอก e.g. ใชยาแกปวดนาน เลยใชยาแปเาง แทน แตผลเหมือนกัน 3. Thai FDA medicines classification Modern drugs household remedies No license e.g. antacid gel Ready-packed sold by nurses/ medical professionals Dangerous drugs Specially controlled drugs Traditional drugs Control and registration are less strict Thailand FAD Drug category P2 = Psychotropics substances 2 e.g Ketamine , Ephedrine P3 = psychotropics substances 3 อันตรายนอยกวา2 E.g. pentazocine , pentobarbital P4 = psychotropic substance 4 อันตรายนอยกวา 3 E.g. Lorazepam , Phenobarbital N2 = Narcotic drug 2 ยาเสพติด ประเภท e.g. morphine N3 = first grade pharmacist report submitted to FDA  Rational drug use RdU Pt. receive medication appropriate in dose own individual requirements and the lowest cost WHo,1985 Important RDU : avoiding preventable adverse drug effects maximizing outcome and minimizing the cost of drug PROCEDURES AND CONCEPTUAL FRAMEWORKS FOR RATIONAL DRUG USE indication ขอบงชี้ : take medicine when needed Efficacy ประสิทธิภาพ : truly benefit to the pt. Rick : safety is the main priority cost : sufficient and cost Dose method of administration วิธีใหยาที่ถูกตอง frequency of dose PERFORMANCE OF RATIONAL DRUG USE ACCORDING TO THE ROLE Duration of treatment ระยะเวลาในการใหยา OF PROFESSIONAL NURSES pt. Compliance ความสะดวกสบาย : explain information to pt. to 1. Able to assess pt. Problem may be related to drug understand 2. Able considering the appropriate drugs selection E.g. inappropriate drug use 3. Allow pt. to make informed decision on medication based respect 1. Laxative ยาระบาย use as diet pills the pt. (Reach a share decision) 2. Take paracetamol every day more than 5 days 4. Administer medication correctly (administer safety) 3. Injection to get rid of it MANAGEMENT OF HIGH-RISK DRUGS 4. self-administered or adjusted the medication หยุดกินเอง ปรับยาเอง Prevent and reduce of medications errors caused by high risk drugs 5. overdose do antibiotic when have diarrhea sore throat Able guideline for use of high risk medications ensure pt. Safety 6. Skin whitening injections as gluta vit. C drug administration 1. check drug name , amount before mixing / giving to pt. The Role of nurse in RDU 1. การซักประวัติเกี่ยวของกับการใชยาอยางสมเหตุสมผล 2. Check how to use the drug Identify data ขอมูลทั่วไป 3. Check counting the number of pills Reliability ความเชื่อถือของขอมูล 4. Assess pt. Before administering the drug Chief complaint 5. Check the expiration date Present illness 6. Use 6R guidelines Past history medication IV Family history Control flow consistently and accurately Personal and social history => lifestyle evaluation of medication outcomes Review of symptoms 1. The drug must be monitored for adverse reactions 2. Principles of RDU 2. Intravenous drug check Vital signs, EKG every 1 hour Using 10 R 3. Pt. Have adverse reactions from drug correction and follow-up the guidelines guidelines for prescribing high risk drugs - medication order คัดลอกคําสั่งใชยา 1. Review drug order to understand the name drug, dosage การให ยา and methods 2. Copy the doctor’s order into prescription completely avoid use of abbreviation คํายอ aren’t universal  - drug recheck and dispensing การตรวจสอบและจายยา 1. check of the patient's name, drug type, dosage, and drug delivery method at least 2 times before dispensing 2. Check exp. Date 3. Correct preparation 4. Avoid receiving medication order over the phone - drug administration 1. Prepare medication 2. Give medication correct according to 6 R 3. Evaluate the response to the drug observed ADR from drug - Medication stores 1. Stores medication are suitable for type e.g. keep in refrigerator, photoprotection in tea-colored sachet protected from light 2. group of drugs should be separated from drugs that have a similar to reduced error 3. Attach a red sticker to the medicine container. to be clear and increase caution in the use of more drugs  Drugs used in autonomic nervous system ANs 1. Cholinergic Drug Cholinergic antagonist drugs ( Anticholinergic drug) Cholinergic agonist drugs 1) Muscarinic antagonists Drugs (Antimuscarinics) Natural alkaloid : Nicotine , Ach , muscarine * Hyoscine , Atropine Synthetic analog : Ach , Bethanechol , pilocarpine Action : competitive antagonist at M receptor ADR ** Bronchoconstriction , sweating, Urinary urgency Clinical uses : * Therapeutic uses Antispasmodic (GI): Hyoscine (Buscopan) => Relief abdominal cramp and - urinary retention ; Bethancol pain induced by gastrointestinal spasms # - Xerostomia ; Pilocarpine Antiasthma : Ipratopium bromide - close angle glaucoma Antidiarrhea Enzyme cholinesterase inhibitor Parkinson’s disease 1) Alcohol : Edrophonium ADR : tachycardia, blurred vision, facial flushing Diagnosis => Myasthenia gravis 2) Neuromuscular blocking agents ADR ; high bronchial secretion , hypersensitivity => rash Depolarizing : Succinylcholine 2) Carbamate Duration ; 5-10 min Neostigmine , Pyridostigmine , physostigmine Clinical use ; general anesthesia ยาชา * ADR ; Lacrimation , Miosis , Bronchi secretions, salivation facilitate tracheal intubation = skeletal m. Relax during surgery Therapeutic ADR ; myalgia , Bradycardia , Hyperkalemia * - myasthenia gravis - Alzheimer’s disease - Urinary retention 3) Organophosphate _ Parathion, Malathion Organophosphate +cholinesterase => increased +excessive Ach => Cholinergic crisis Anti cholinesterase overdose => Cholinergic crisis -Antitosthma Antidote : Pralidoxime , Atropine ** Oral , respiratory , skin => Miosis , Lacrrimation , 2. Adrenergic Drugs Salivation , pulse increase , BP decrease, HR decrease Adrenergic agonist drug Enzyme Cholinesterase activator Epinephrine, Adrenaline Pralidoxime == Antidstama, chlinergic crisis Low dose ; beta 2 Vasodiate => TPR & BP decrease Therapeutic use * beta 2 Bronchodilate - muscle weakness, respiratory depression มีความอากาศตํ่า High dose ; Alpha vasoconstriction => TPR & BP increase ADR ; Cardiac arrest, Tachycardia, Hypertension, Blurred Beta 1 => HR increase vision * ADR : cardiac arrhythmias, hypertension, pulmonary edema Inhibit release of ACh Therapeutic use Botulinum toxin A / Botox - Cardiac arrest Onset : 3-7 day - Anaphylactic shock ภูมิแพรุนแรงเฉียบพลัน Duration action : 3-4 m. - stop bleeding (packing) Decreased winkle ADR : swelling / bruising ฟกชํ้าดําเขียว, headaches total peripheral resistance : TPR ผลรวมแรงตานของหลอดเลือดทั้งหมดในรางกาย  Norepinerphine , NE Levophed => A HR Low dose ; beta 1 => HR increase High dose ; alpha => vasoconstriction => TPR & BP increase ADR : cardiac arrhythmias, bradycardia Therapeutic use - septic shock - cardiogenetic shock - severe hypertension Dopamine , DA Low dose ; vasodilate Intermediate dose ; beta 1 => HR increase High dose ; alpha 1 => vasoconstriction TPR & BP increase Pulmonary vascular resistance increase ADR : palpitations ใจสั่น , tachycardia, gangrene high dose Therapeutic use - adjunct in treatment of shock Alpha 1 agonists drug ; pseudoephedrine use in nasal congestion ADR ; hypertension, blurred vision Alpha 2 agonist drug ; clonidine use in hypertension ADR ; bradycardia, drowsiness, dry mouth Beta 1 ; Dobutamine ; hypotension , cardiac arrest ADR ; palpitations, Tachycardia, Arrhythmias * Beta 2 ; salbutamol use in *Asthma, relax uterine Adrenergic antagonist drug Alpha antagonist drug Prazosin , Doxazosin Therapeutic use -hypertension ADR ; nasal congestion, postural hypotension, syncope Beta antagonists drug propranolol ADR ; dizziness, fatigue, bradycardia, insomnia Therapeutic use - hypertension - Treat congestive heart failure - hyperthyroidism * Assess before give the peta plocher = 1 AstUMA  Drugs used in respiratory systems Drug use in common cold = upper respiratory tact Non- narcotic antitussive ไมเสพติด 1. Antihistamines H1 Allergic inflammation Dextromethorphan ; nonproductive cough Mechanism : block effects of histamine H1 receptor Action; depresse the cough Decreasing the allergic response ADR; dizziness, drowsiness * DROWSY A Nursing interventions assess respiration Not taken longer than recommended # 4. Expectorants ยาขับเสมหะ Increased cough to clear the airway Therapeutic use Ammonium carbonate - allergic rhinitis จมูกอักเสบ, conjunctivitis Guaifenesin (Glyceryl guaiacolate) เจอบอย! Pharmacokinetics; we’ll absorb in liver excrete in urine and faces Production cough ADR in first gen ; Drowsiness Action ; reduced adhesive nests and surface tension of fluid Avoid driving a motor vehicle until stabilized on the drug ADR; nausea, dizziness, rash 2. Decongestants ยาบรรเทาอาการคัดจมูก guaifenesin => loose bronchial secretion so coughing can eliminate Dilation of nasal blood vessels causing inflammation,infection , them Alpha- Adrenergic receptor 5. Mycolytics ยาละลายเสมหะ Pseudoephedrine, ephedrine Liquefy and loosen thick Mechanism ; stimulate alpha -Adrenergic receptor producing Acetylcysteine **Acetaminophen antidote Vasoconstriction => shrinking mucous membrane and reduced # Action; break down mucous runny nose Indication; **pt. Tracheotomy Therapeutic use ; discomfort of nose Anticholinergic : Ipratopium Drug use to treat Asthma and COPD Inhibit action of acetylcholinergic 1. Bronchodilator ขยายหลอดลม Intranasal Glucocorticoid Beta - Adrenergic agonists Treat allergic rhinitis = > anti-inflammatory action Mechanism : increased cAMP causing dilatation do ADR : CNS depression (insomnia), Tachycardia bronchioles **contraindication ; Hypertension , *Closed-angle glaucoma Non-selective; Epinephrine (Adrenaline) administration in *** frequent use nasal spray can tolerance and rebound nasal emergency congestion Selective beta-Adrenergic agonist; Terbutaline , Albuterol Nursing interventions use in Asthma Monitor vital signs Contraindication ไมควรใชกับ Caution shouldn’t use drugs longer than 7 days Drug allergy, High risk for stroke Limit use of the drug 5-7 days prevent rebound nasal congestion ADR; Insomnia, tachycardia, Cimetidine , Ciprofloxacin Avoid caffeine Nursing interventions monitor respiratory Lung sound e.g. wheezing Observe lip and fingernail for cyanosis Observe side effects Monitor Liver function Aminophylline should monitor : Increased heart rate. Teach pt. alert HCP of tachycardia before the next dose 2. Non-bronchodilator Leukotriene receptor antagonist Increased in eosinophil mucous production => bronchoconstriction Use in asthma and prevent exercise induced bronchochonstriction * Corticosteroids Use in respiratory disorder => anti-inflammatory action If pt. Has asthma attacks while on the maximum dose of Theophylline Key point Swelling Slow onset Sugar increases Sores in mouth *Maybe *fungal infection Prevent => rinsing the mouth after using spacer don’t swallow water Washing the apparatus Antineoplastic (Anticancer), Immunosuppressant & Acne-Psoriasis drug **Extravasation Antineoplastic ( Anticancer) drugs/ = leakage of infection drug out of the blood vessels Chemotherapeutic agents stop administration do I fluid Clod compression every 4 hr. Prevent vasoconstriction c Hot compression : Viscritine , Vinblastine Don’t compression of rupture vessels immunosuppressive drug Use in organs transplants, treatment of autoimmune disorders corticosteroids e.g. prednisolone ADR.; **infection rate high, high blood sugar, osteoporosis 1. Alkylating and alkylating-like agents Cytotoxic drug e.g. Azathioprine Anti-proliferative ; Inhibit DNA formation Use in Rheumatoid arthritis , Renal transplantation E.g. Cyclophosphamide , mitomycin-C, ADR; Low platelets, Nausea vomiting , hepatotoxicity ADR: bone marrow toxicity, Anemia, Neutropenia Cyclosporine: calcineurin inhibitors e.g. cyclosporine 2. Anti-microtubule agents Use in rheumatoid arthritis Inhibit mitosis in M phase ADR; nephorotoxicity , Hirsutismภาวะขนดก,hyperlipidemia E.g. taxanes, paclitaxel immunosuppressive antibodies Plant alkaloids ; vinca alkaloids ชอบขึ้นตน vin 1. Monoclonal antibodies ADR : peripheral neuropathyปลายมือปลายเทาชา , 2. Small molecule inhibitors Phlebitis หลอดเลือดดําอักเสบ Use in rheumatoid arthritis, renal transplantation 3. Antimetabolites Nursing interventions Disrupts DNA/RNA interruption S phase of cell assess range of motion rheumatoid arthritis E.g. Methotrexate (block เนนที่ nucleus ) Reject transplantation => macupapular rash ADR; bone marrow toxicity, Aphthous Ulcer, Urinary/ Advice side effects renal toxicity Monitor LAB 4. Antitumor antibiotics agents interference with DNA synthesis S phase Acne treatment E.g. Doxorubicin *cardiac toxicity Non inflammation: comedone สิวไมอักเสบ ADR; hyperglycemia , heart rate 1. closed comedone 5. Hormone-based 2. Open comedone สรางสภาพแวดลอมที่ไมเหมาะแกการสรางเซลลมะเร็ง Inhibit Inflammation acne estrogens receptor Propionibacterium acne (p.acne) E.g. Tarnoxifen, letrozole ADR; hot flashes รอนวูบวาบ , bleeding per vagina Nursing interventions monitor vital signs before & after LaB blood count, BuN ,creatinine , alkaline Intake-output Assess dehydration,body weight Nursing interventions hands washing before applying Use cotton bud Don’t use in eyes & mouth Aseptic technique Avoid UV **Retin A don’t use in pregnancy Psoriasis treatment topical treatment 1. Steroids: betamethasone 2. Vitamin D : calcipotiol cream 3. Coal tar systemic treatment 1. Aciteretin 2. Immunosuppressant 3. UV radiation Side effects topical treatment 1. Skin sensitivity 2. Atrophy 3. Dry skin 4. Hypopigmentation systemic treatment Acitretin ; high cholesterol & triglyceride Immunosuppressant : lipidmia UVA UVB: itching , redness Nursing interventions assess lesion Review history allergy Adivice Monitor LAB ; cholesterol & triglycerides ***Acitretin avoids alcohol 2 m. Food low fat, carb, sugar PUVA : avoid UV Psoralen takes with meal or milk  Drugs Acting on The Gastrointestinal Tract neutralize that a reduce pepsin act pantacid Drugs used in acid-related diseases Cause of peptic ulcer Nursing interventions antiuler drug Adequate drugs - H.pylori infection Ensure therapeutic of other medications - NSAIDs Perform diagnosis testing - stress ulcers Prevent imbalance Antacids => neutralize stomach Institute a bowel program Aluminum Ensure adequate nutrition Therapeutic Pour dietary habits causes of constipation == - heartburn Laxative and Antidiarrheal Agents - GERD เรงการขับถาย เกิดจากทองผูก - gastritis Bulk forming laxative ADR ; constipation ทองผูก , diarrhea, nausea and vomiting Psyllium เมล็ดเทียนหอย, Methyl cellulose Antisecretory ADR : Abdominal distention เกิดลมในลําไส 1. Histamine-2 antagonists = block H2 receptor Hyperosmotic agents Prevent release gastrin Hor. Decrease Pepsin & - น อนอาหาร เกิดแรงดันนํ้า ลําไสเคลื่อนที่ Saline laxative Cimetidine , Ranitidine , formotidine lactulose , Magnesium ~ Therapeutic ; GERD หามใชกับเด็กตํ่ากวา 1ป ADR ; breast enlargement/ gynecomastia ชายนมโต Lubricant laxative dizziness, drowsiness คนไขริดสีดวง , ผาตัดชองทอง 2. Proton pump inhibitor => inhibit No Image Encourage bowel movement ยาที่มีประสิทธิภาพสูงสุด Mineral oil *Omeprazole , PantoprZole , Lampnsoprazole ร Use for Therapeutic : Acid reflux, GERD - during pregnancy - Examination/ surgery Cytoprotective drug ลดกรดออกฤทธิ์ปกปองเยื่อกระเพาะ Emollient laxative Antisepticgent คนไขไสเลื่อน , โรคหัวใจ Sucralfate Docusatesodium ADR : constipation stimulant laxative, chemical stimulants prostaglandin analog Bisacodyl , Sean , Castor oil Misoprost Soap suds enema ADR: Diarrhea, Abdominal pain Clear bowel before medical procedure หามใชในคนทอง!!! Sodium …, Macrogols with electrolytes Bismuth compound ADR ; Bismuth sodium phosphate oral solution : cramps ,irritation around the anus ADR ; black stool Macrogole : Anaphylaxis, cardiac arrest , difficulty breathing Eradication กําจัดเชื้อ H.pylori PPI, ranitidine, bismuth + amoxicillin, clarithromycin, metronidazole ก่ กิ  Nursing interventions หามใชยาระบายในผูปวยทองผูกและมีอาการปวด * nexium ไมควรใชยาระบายเปนประจํา ไมควรใชเปนยาลดนํ้าหนัก => Medication กินยาระบายกอนนอน ฤทธิ์ออก 6 ชม ถาสวนยา ออกฤทธิ์ภายใน 30 นาที Recrease S หามใชยาที่มี Magnesiumกับ คนไข โรคไต หัวใจ กลามเนื้อ หามใชยามีการกระตุนกะบเด็กตํ่ากวา 6 ป และ คนทอง stomalU หามใช lactulose & lactitol กับคนเบาหวาน acid secretion กินกลวยสุก มะละกอสุก เพิ่มกากากใย ยาบรรเทาอาการเกร็งกลามเนื้อ Antimuscarnic drug ลดการหลั่งกรด ลดการบีบตัว ของกระเพาะ Hyoscine -N- Butylbromide , Dicycloverine HCL ADR ; Sore throat , tachycardia, obstipation , vision **caution! : Accumulation => Anticholinergic syndrome ยา Mebeverine side effects: insomnia, Heat rate decreases Antidiarrheals and oral electrolyte replacers ถายเหลวมากกวา 3 ครั้งตอวัน ORS, elemental zinc Treat of acute diarrhea หามใชเกิน 2 วัน หามใชในคนมีไขสูงและเด็ก อายุตํ่ากวา 3 ขวบ Antidiarrheals drug decrease peristalsis movement ลดการเคลื่อนไหวของลําไส Loperamide HCL, Diphenoxy+HCL treat the symptoms of acute diarrhea, chronic diarrhea rocontrol mersede vomiting Antiemetic and Emetic Agents ยาตานอาเจียน * Metoclopramide (Plasil) : increases muscle contractions in the upper digestive tract, Domperidone : does not pass the blood–brain barrier Ondansetron (Zofran) : used alone or with other medications to prevent nausea and vomiting ↳ ใชระงับอาการอาเจียนจากการรับยาเคมี Side effects : tiredness, chills Antagonist at 5- HT3 receptOrS Histamine; H1 antagonists : drug that inhibits the H1 receptor used as demonstrations, lectures, speeches, reports, and more. Nursing interventions Avoid using drugs. Metoclopramide in epileptic patients and Parkinson's disease