NCM 106 Pharmacology PDF

NCM106 ​ Tolerance: A decreasing response to repetitive drug doses LESSON 1: INTRODUCTION TO PHARMACOLOGY Pharmacology...

NCM106 ​ Tolerance: A decreasing response to repetitive drug doses LESSON 1: INTRODUCTION TO PHARMACOLOGY Pharmacology Basic Concepts of Pharmacology -​ the science of drugs including their origin, ​ Pharmacokinetics: is about how the body deals composition, pharmacokinetics, therapeutic use, with drugs. and toxicology ​ Pharmacodynamics: is the effect of drugs on the -​ the properties and reactions of drugs especially body. with relation to their therapeutic value ​ Pharmacotherapeutics: is a clinical use of -​ the study of drugs (Chemicals) that alter functions drugs. of living organisms ​ Pharmacognosy: The study of natural (plant and animal) drug sources. Drug -​ According to the WHO, a drug is a substance that Branches of Pharmacology / Science of Pharmacology can change how a living organism works. ​ Pharmacognosy - Origin -​ chemical entities both endogenous and foreign ​ Pharmacokinetics - Movement through Body that are capable of reacting with biological system. ​ Pharmacodynamics - Effect ​ Pharmacotherapeutics - Use/Purpose Terminology ​ Toxicology - Side Effects ​ Pharmacology: is a science that studies the effect of the drugs on the body. Drug Classification ​ Pharmacopeias: are the total of all authorized Drug can be classified by its chemical activity or drugs available within the country. by the condition that it treats. In general, drugs are ​ Medication: is a substance administered for classified based on: diagnosis, cure, treatment, mitigation or a.​ Therapeutic classification prevention. b.​ Pharmacologic classification (based on ​ Prescription: the written direction for the mechanism of action and mode of action) preparation and the administration of the drug. c.​ Chemical classification ​ Therapeutic effect: is the primary effect intended d.​ Legal classification (Controlled Substances, Drug that is the reason the drug is prescribed such as Schedules, and Teratogenic Risks) morphine sulfate is analgesia. ​ Side effect: secondary effect of the drug is one 1.​ Therapeutic classification that unintended, side effects are usually -​ is defined as organizing drugs based on predictable and may be either harmless their therapeutic usefulness in treating ​ Drug toxicity: harmful effect of the drug on an particular diseases. organism or tissue, result from overdose or external use. 2.​ Pharmacologic classification ​ Drug allergy: is immunological reaction to a drug. -​ refers to the way a drug works at the ​ Drug interaction: occur when administration of molecular, tissue, and body system levels. one drug before or after alter effect of one or both -​ the pharmacologic classification drug. addresses a drug’s mechanism of action, ​ Drug misuse: Is the improper use of common or how a drug produces its physiological medications in way that lead to acute and chronic effect in the body. toxicity for example laxatives ​ Drug abuse: is an inappropriate intake of 3.​ Chemical classification substance either continually or periodically. 3 basic types of drug names: ​ Drug dependence: is a persons reliance on or a.​ Chemical name need to take drug or substance there are two type b.​ Generic name of dependence: c.​ Trade name ​ Physiological dependence: is due to Chemical name biochemical changes in the body tissue these -​ is assigned using standard nomenclature tissue come to require substance for normal established by the International Union of Pure and function. Applied Chemistry (IUPAC). ​ Psychological dependence: is emotional -​ A drug has only one chemical name, which is reliance on a drug to maintain a sense of well helpful in predicting a substance’s physical and being accompanied by a feeling of need. chemical properties. ​ Drug habituation: denotes a mild form of -​ Example: Chemical name for aspirin is psychological dependence. 2-acetoxybenzoic acid. ​ Illicit drug: also called street drug are those sold Generic name illegally. -​ name approved by the medical association of ​ Dose :The aim to give patient a dose of the drug pharmaceutical in the original country of that achieves the desired effect without causing manufacture harmful side effect. -​ Generic names are less complicated and easier to ​ Therapeutic index: is a measure of the danger of remember than chemical names poisoning and the higher it is safer of drug is. For -​ The Food and Drug Administration (FDA), the example: Aspirin (3.5), digoxin (2) official Pharmacopoeia, and the World Health ​ Bioavailability: Means that the drug has reached Organization (WHO), routinely describe a the circulation and is therefore available for all the medication by its generic name tissues. Trade name  -​ is assigned by the company marketing the drug. -​ is a substance that has the potential to cause a -​ Name is usually selected to be short and easy to defect in an unborn child during pregnancy. remember. -​ A small number of drugs have been shown to be -​ The trade name is sometimes called the teratogenic, either in humans or in laboratory proprietary or product or brand name. animals. -​ Classification of teratogenic risk places drugs into Chemical Classification (Example) categories A, B, C, D, and X. Trade name: Biogesic Generic Name(S): Phenyltoloxamine-Acetaminophen Pregnancy Categories Chemical name: N-acetyl-p-aminophenol ​ Cat. A- studies in pregnant women failed to show Chemical formula: C8H9NO2. risk to the fetus ​ Cat. B- animal studies have failed to show a risk to the fetus but there are no adequate studies in Chemical Name Generic Name Trade Name women 7-chloro-1,3-dihy diazepam Valium ​ Cat. C- animal studies have shown an adverse dro-1-methyl-5 effect on the fetus, no adequate human studies, phenyl 2H-1, benefits may outweigh risks 4-benzodiazepin ​ Cat. D- positive evidence of human fetal risk 2-one ​ Cat. X- animal or human studies have shown fetal Ethyl 1-methyl meperidine Demerol abnormalities or toxicity 4-pheyli-sonipec otate hydrochloride acetylsalicylic aspirin Ecotrin 5. Anatomical Therapeutic Chemical Classification System with Defined Daily Doses (ATC/DDD) ​ The purpose of the ATC/DDD system is to serve as a tool for drug utilization research in order to improve quality of drug use. ​ In the ATC classification system, the drugs are 4. Legal Classification : Controlled Substances, Drug divided into different groups according to the Schedules, and Teratogenic Risks organ or system on which they act and their ​ Some drugs are frequently abused or have a high chemical, pharmacological and therapeutic potential for addiction. According to law, drugs that properties. have a significant potential for abuse are placed into five categories called schedules. What are drugs made of? ​ These scheduled drugs are classified according to 1.​ Minerals their potential for abuse: -​ Many mineral substances found in nature -​ Schedule I drugs have the highest are used in drugs. potential for abuse -​ Examples: iodine, zinc oxide, and -​ Schedule V drugs have the lowest magnesium sulfate (Epsom salt). potential for abuse 2.​ Plant -​ Certain drugs are derived from vegetables Categories of Controlled Substances and plants. ​ Schedule I— not approved for medical use and -​ Examples: digitalis, morphine, and senna have high abuse potentials; LSD, heroin, peyote, pod extract ecstasy (3,4 methyenedioxy-methamphetamine) 3.​ Animal ​ Schedule II— used medically. High abuse -​ The organs, tissues, and body fluids of potential (methadone, meperidine, cocaine, animals (including man) are the source of pentobarbital, Tylox) some drugs. ​ Schedule III- less potential for abuse than I and II -​ Examples: hormones, antitoxic serums, but may lead to psychological or physical and gamma globulin from human blood dependence (Vicodin, Tylenol with codeine) 4.​ Synthesis ​ Schedule IV- drugs have some potential for -​ Synthesis is the artificial building up of a abuse (Valium, Dalmane, Klonopin) chemical compound by the union of its ​ Schedule V- contain moderate amounts of elements. controlled substances. An example is Lomotil -​ Drugs such as epinephrine that were once (atropine and diphenoxylate) available only from natural sources can now be artificially reproduced through Teratogenic Risks synthesis.  -​ Other drugs such as the sulfonamides Example: hydrochlorothiazide (official name). were originally created through synthesis. Esidrex (brand name) 5.​ Microorganisms -​ Chemical substances produced by Drug Sources microorganisms such as fungi and ​ Plants: such as digitalis, vincristine. bacteria are also sources of drugs. ​ Human and animals: such as epinphrine, insulin -​ Examples: penicillin, tetracycline, and and adrenocoticotrpoic hormone. vaccines. ​ Minerals: as iron, iodine and zinc 6.​ Human ​ Synthetic and chemical substance: as sodium bicarbonate Drug Preparations ​ Drugs are compounded into various types of preparations, depending upon each drug's Drug Classifications physical characteristics, the purpose for which it is 1.​ Pharmacologic Classification intended, and the method by which it is to be ​ Similar Characteristics administered. Some drugs are prepared in more ​ Similar Chemical Make up than one form so they may be administered ​ Examples: Beta Blockers, Diuretics several ways ​ To give them bulk or form, drugs may be mixed 2.​ Therapeutic Classification with other substances which have no action or ​ Used for similar effect medicinal value. These substances are called ​ May not have similar chemical make up vehicles. ​ Examples: Antihypertensives, Antibiotics ​ For a drug in aqueous solution, water is the vehicle; for a drug in an ointment, fatty substances Drug Action Across Lifespan such as petrolatum or lanolin are used as the ​ Drug administration during pregnancy vehicle. 1.​ Solid Preparations ​ Drug administration during childhood a.​ Capsule - A drug placed in a gelatin container ​ Drug administration during adulthood b.​ Tablet - A drug compressed or molded into a flat disk or other shape. Drug Therapy during Pregnancy and Breast-Feeding c.​ Pill - A powdered drug molded into a ​ Must balance risks vs benefits of drugs during sphere. The word "pill" as a general term pregnancy used for tablets is a misuse of the word -​ Affect fetus more than mother? d.​ Lozenges - A drug preparation in a flat -​ Teratogenic effects disk which is to be held in the mouth until -​ Mother’s health affects fetus— dissolved. ​ Chronic asthma is more dangerous to the fetus e.​ Suppository - A drug which is molded than the drugs used for treatment (mother’s who into shape for insertion into a body do not take medication for asthma the incidence of opening other than the mouth. Its vehicle, stillbirths is doubled!!) such as cocoa butter, melts at body ​ Pregnancy alters drug disposition and excretion temperature and the drug is released. processes f.​ Ointment - A drug suspended in a ​ By 3rd trimester renal blood flow is doubled with semi-solid base such as petrolatum. an increase in glomerular filtration and elimination g.​ Powder - A drug which is ground up and of drugs increases (therefore will need an used in powder form increased dosage of drug to compensate) Tablets or pills may be “scored” ​ Tone and motility of intestines (peristalsis) Some dosage forms prepared for oral decrease in pregnancy (more time for drugs to be administration are enteric coated with a special coating absorbed) that resists the action of the stomach juices but dissolves All drugs can cross the placenta in the intestine. This helps prevent nausea, irritation of the ​ Lipid soluble cross more easily stomach lining, or destruction of the drug. Scored tablets ​ Ionized, highly polar or protein bounds cross with are marked with an indented line across the surface so difficulty that they can be broken in half, if half a tablet is the dose ​ Nicotine (smaller babies) required. Drugs prepared with flavored coatings or in ​ Alcohol (dependence) flavored vehicles are exceptionally hazardous to children if ​ Cocaine/heroine/morphine (addictive to fetus) left where they have access to them. ​ Bacterial and viral infections 2. Fluid preparations Teratogenesis ​ Oral -​ The process by which congenital malformations ​ Injectable or IV are produced in an embryo or fetus. -​ Cleft palate LESSON 2: PHARMACOLOGY -​ Hydrocephalus Drug Names -​ Spina bifida ​ The generic name: is given for the drug to being -​ Behavioral and biochemical anomalies official name. 3 stages of embryonic development ​ The chemical name: is the name by which the 1.​ Pre-implantation (conception to week 20) chemist knows it. 2.​ Embryogenic period (week 3 to week 8) ​ The trade mark or brand name (proprietary 3.​ Fetal period (week 9 to term) name) : is name given by the drug manufacture  – During pre-implantation and embryonic stages and adverse responses, and the regime must be the teratogen acts in an all-or-none response, i.e. , is dose adjusted accordingly” is high enough the fetus will die, if dose is sublethal fetus will recover Geriatric patients will vary quite a lot from one patient to – Gross malformations produced by exposure to another: teratogens during the embryonic period (1st trimester) ​ Physically fit patients respond differently than out – Exposure during the 2nd and 3rd trimesters of shape usually results in organ dysfunction rather than gross ​ Absorption- percentage of absorption DOES NOT malformations usually change with age, but rate may be slowed (drug response may be delayed) Few drugs considered to be teratogenic: hard to prove ​ Gastric acidity may be increased in aged affecting -​ Incidence of congenital anomalies is low absorption of certain drugs -​ Animal test may not be applicable ​ Distribution- in aged there is: -​ Prolonged exposure may be necessary -​ Increased body fat- reduces plasma levels -​ Teratogenic effects may be delayed of lipid soluble drugs -​ Behavioral effects are hard to document -​ Decreased total body water- increases -​ Controlled experiments cannot be done in humans concentration of water soluble drugs and intensity of response To prove a drug is a teratogen: -​ Reduced concentration of serum albumin- -​ Drug must cause a characteristic set of malnourishment decreases albumin and malformations results in increased drug levels -​ It must act only during a specific window of Metabolism: vulnerability (weeks 4 through 7 of gestation) -​ hepatic functions decrease in elderly and drug -​ Incidence of malformations should increase with levels increase (amount of dysfunction variable) increasing dosage and duration of exposure Excretion: decline of renal function in elderly (variable) Drug Therapy during Breast Feeding therefore increase drug levels in plasma ​ Drugs get through breast milk and can affect ​ Determine renal function by creatinine clearance infant rates ​ Lipid soluble drugs are in higher concentration ​ Pharmacodynamic Changes: alterations in Things That Can Minimize Risk: receptor levels may change on a number of cells. -​ Dose after breast feeding ​ Decreased affinity of receptors -​ Take drugs with short half life -​ Take drugs that are not found in breast milk LESSON 3: PHARMACOLOGY IN NURSING -​ Avoid drugs known to be hazardous Variables that affect drug actions Drug Therapy in Pediatric Patients ​ Dosage ​ Patients who are young or old respond differently ​ Route to drugs than do middle aged people ​ Drug-diet interactions. Food may slow Pediatrics- all patients under age 16 absorption or foods may actually interact with ​ Pre-mature infants (< 36 weeks gestation) certain medications (tyramine and MAO inhibitors; ​ Full-term infants (36-40 weeks gestational age tetracycline and milk products; ingestion when ​ Neonates (1st 4 weeks post-natal) taking certain antihypertensive medications) ​ Infants (5-32 weeks postnatal) ​ Children (1-12 years) Variables affecting drug actions ​ Adolescents (12-16 years) ​ Drug-drug interactions Very Young Patients ​ Antidote—drug can be given to antagonize the -​ At risk for prolonged and intense responses toxic effects of another drug Response of Infants due to differences in: Variables that affect drug actions ​ Drug absorption- absorption of drugs IM is greater ​ Age in infants than neonates and adults ​ Pregnancy ​ Renal drug excretion (reduced in infants) ​ Body weight ​ Hepatic drug metabolism (low in new born) ​ Gender-hormonal effects ​ Protein binding of drugs (albumin lower in infants) ​ Pathologic conditions ​ Exclusion of drugs from CNS by blood-brain ​ Placebo response barrier (not sully developed in infancy making infant much more susceptible to drugs) Toxicology—Drug Overdosage – By one year- pharmacokinetic response similar to adult General management ​ CPR Drug Therapy in Geriatric Patients ​ ETT ​ Elderly more sensitive to drugs and exhibit more ​ IV variability in response ​ Check blood sugar, drug screen, liver and kidney ​ Altered pharmacokinetics (organ degeneration) function ​ Multiple and severe illnesses ​ Antidotes ​ Multiple drug therapy and usage ​ Poor compliance General Principles of Accurate Drug Administration ​ “Individualization of treatment is essential: each Six Rights patient must be monitored for desired responses ​ Right patient ​ Right drug  ​ Right dose ​ Vaginal ​ Right route ​ Right time Sites for injections ​ Right documentation ​ Sub q- abdomen, thighs, back and upper arms ​ IM- deltoid, dorsogluteal, ventrogluteal and vastus General Principles lateralis muscles ​ Follow the ‘rights’ consistently ​ IV- antecubital, hands, arms, external jugular ​ Learn essential information about each drug ​ Others: intradermal, intra-articular, intra-arterial ​ Interpret prescriber’s orders correctly and intrathecal ​ Read labels for right medication and concentration Drug Administration Cardinal Rules Drug Administration ​ Wash hands before giving meds ​ Minimize the use of abbreviations ​ Read MAR carefully. If ever in doubt, check the ​ Calculate dosages correctly original order ​ Measure doses accurately ​ Never give medications you are uncertain of ​ Use appropriate anatomic landmarks to identify unless you have looked them up or have sites of IM injections-follow manufacturers consulted with pharmacy recommendations ​ Never give more than 3cc per IM injection ​ Verify client identity ​ Wear gloves with all injections Seek information about the client’s medical diagnoses and ​ For sub q injections, use 25G, 5/8” needles condition in relation to drug administration ​ Do not give oral meds if patient is vomiting, -​ Be especially vigilant with children to avoid errors sedated, NPO or is unconscious ​ Follow narcotic protocol for signing out of Legal Responsibilities narcotics -​ Nurse is legally responsible for safe and accurate administration of medications Nursing Process in Drug Therapy -​ Nurse is expected to have sufficient drug -​ Is a systematic way of gathering and using knowledge to recognize and question erroneous information to plan and provide individualized orders client care and to evaluate the outcomes of care -​ Unit dose wrappings of oral drugs should be left in -​ Five steps of the nursing process are: place until the nurse is in the presence of the assessment, nursing diagnosis, planning, client and ready to administer the medication interventions and evaluation Medication Orders General Principles of Drug Therapy ​ Include the full name of the patient ​ Expected benefits should outweigh potential ​ Generic or trade name of the drug adverse effects ​ The dose, the route and frequency of ​ Drug therapy should be individualized administration ​ Drug effects on quality of life should be ​ Date, time and signature of the prescriber considered in designing a drug therapy regiment Common Abbreviations Drug selection and dosage ​ PO - Per Orem IM - Intramuscular ​ Use as few drugs as possible ​ IV - Intravenous ST - Speech Therapy ​ Fixed dose combinations increase compliance ​ SL - Sublingually SQ - Subcutaneous ​ Lowest dose with therapeutic effect ​ OD - Once a day BID - Two times a day ​ Follow guidelines but dosages must be ​ TID - Three times a day QID - Four times a day individualized ​ AC - Before meals PC - After meals ​ Drugs with long half-lives may require loading ​ HS - At bed time Q15 - Every 15 mins doses then titrated lower maintenance doses ​ Q30 - Every 30 mins Q1 - Every hour ​ Q2 - Every 2 hours Q4 - Every 4 hours Drug Therapy in Special Populations-Pediatrics ​ Q6 - Every 6 hours Q12 - Every 12 ​ Pediatrics- all aspects must be guided by the ​ Qshift - Every shift PRN - As needed child’s age, weight and level of growth and ​ Stat - Immediately RTC - Round the clock development ​ Safe therapeutic ranges are less well-defined Drug Dosages ​ Choice of drug is restricted because many drugs ​ Cc used in adults have not been sufficiently ​ Gtt investigated ​ Uggt ​ mL Pediatric Physiologic Characteristics Affecting ​ L Pharmacokinetics ​ Oz ​ Thin, permeable skin – increased absorption of ​ Tsp topicals ​ Immature blood-brain barrier— increased Routes of Administration distribution into the CNS until age 2 ​ Oral ​ Altered protein binding until age 1 ​ Via GI tube ​ Decreased activity of metabolizing enzymes in ​ Parenteral- IM, IV and SQ infants, increased in children ​ Topical ​ Rectal Pediatric Physiologic Effects ​ Otic, ophthalmic, nasal ​ Increased percentage of body water  ​ Decreased GFR until one year of age ​ Assess patient’s ability to perform self-care ​ Assess patient’s understanding and attitude Pediatrics regarding medication regimen ​ Oral route for meds is preferable ​ Inquire if patient is taking any herbal preparations ​ For injections, may wish to use EMLA (eutectic ​ Inquire if patient is taking any OTC meds mixture of lidocaine and prilocaine, local ​ Assess environment for safety anesthetics) ​ Educate patient and caregiver indication, proper ​ Site selection for injections—infants, use thigh administration and side effects of administered muscles; older than 18 months of age, use deltoid; medications older than 3, use ventrogluteal muscle ​ Between visits, maintain contact with patient to monitor progress and serve as a resource Drug Therapy in Older Adults Physiologic Characteristics and Pharmacokinetic Impact LESSON 4: PHARMACOKINETICS AND ​ Decreased GI motility— slower absorption PHARMACODYNAMIC ​ Decreased cardiac output— slower absorption from site of administration, decreased distribution Pharmacokinetics to sites of action in tissues -​ Involves drug movement through the body to ​ Decreased blood flow to liver and kidneys-delayed reach sites of action, metabolism, and excretion metabolism and excretion -​ Specific processes are absorption, distribution, metabolism and excretion Drug Therapy in Older Adults ​ Decreased total body water and lean body Liberation mass-fat soluble meds stay with patient longer, -​ The first step in the process by which medication water soluble drugs are distributed in smaller enters the body and liberates the active ingredient area, greater risk for toxicity that has been administered. ​ Decreased blood flow to liver-slowed metabolism -​ The release of the active ingredient into the GI and detox of drugs tract ​ Decreased albumin- decreased availability of protein for binding and transporting. Will also have Absorption higher concentration of free active drug. -​ Process that occurs from the time a drug enters ​ Decreased blood flow to kidneys— impaired drug the body to the time it enters the bloodstream to excretion, potential toxicity be circulated -​ Factors affecting absorption include: dosage form, Older Adults route of administration, blood flow to the site of Renal Impairment administration, gastrointestinal function, presence ​ Know baseline renal function of food or other drugs ​ Tailor dosages ​ Avoid nephrotoxic medications Bioavailability ​ Be aware of need for additional dosing if patient is -​ is the portion of a dose that reaches the systemic receiving renal replacement therapy circulation and is available to act on body cells -​ IV administration is 100% bioavailable Hepatic Impairment -​ Subcutaneous administrations has more rapid ​ Those with cirrhosis, hepatitis, receiving absorption than does the oral route hepatotoxic drugs, have heart failure, are -​ Mucous membranes allow for rapid and direct undergoing major surgery or have had trauma are absorption into the bloodstream at higher risk for toxicities r/t medications ​ Know drug effects on hepatic function Distribution ​ Reduce dosages on medications that are -​ Involves the transport of drug molecules within the extensively metabolized by the liver such as: body cimetidine, phenytoin, ranitidine, theophylline -​ After the drug is absorbed into the bloodstream, it is carried by the blood or tissue fluids to its sites of Critical Illnesses pharmacologic action, metabolism and excretion ​ Be aware that all medications may have variable -​ Drug distribution into the CNS is limited because effects in this scenario of the blood-brain barrier ​ Know the actions, usual dosages and side effects -​ Blood-brain barrier is composed of capillaries with of medications tight walls which limits movement of drug ​ Closely monitor renal and liver function tests molecules into brain tissue ​ Monitor serum protein and albumin levels -​ Drug distribution during pregancy and lactation is ​ Most drugs will be given IV-for this reason, unique as most drugs cross the placenta or in the medications may have faster onset case of lactation, pass into breastmilk ​ Many factors may interfere with drug effects if given orally Metabolism ​ Considerations when giving medications via -​ Method by which drugs are inactivated or feeding tube biotransformed by the body ​ Appropriate scheduling very important -​ Some drugs yield metabolites that are also active and exert effects on the body until they are Drug Therapy in Home Care excreted ​ On patient’s turf -​ Most drugs are lipid soluble which aids their ​ Schedule visit at convenient time for patient and passage across the cell membrane caregiver  -​ Excretion usually is by kidneys. Need to be water 4.​ Replacement - drugs may be used for soluble for this to occur. Thus, one function of replacement when there is deficiency of natural metabolism is to convert fat soluble medications to substances like hormones, metabolites or water soluble ones. nutrients, e.g insulin in diabetes, iron in anemia, -​ Hepatic drug metabolism or clearance is a major vitamin C in scurvy mechanism for terminating drug action and 5.​ Anti-infective or cytotoxic action - drugs may eliminating drug molecules from the body act by specifically destroying infective organisms, e.g penicillin, cytotoxic effect on cancer cells Excretion 6.​ Modification of the immune status - vaccines -​ Refers to the elimination of a drug from the body and sera act by improving our immunity while -​ Most are excreted by the kidneys although some immunosuppressants act by depressing immunity, are excreted in the feces e.g glucocorticoids Routes Of Administration Agonist 1.​ Parenteral -​ A substance that binds to the receptor and -​ IV produce a response -​ IM -​ SQ Antagonist 2.​ Enteral -​ A substance that binds to the receptor and -​ Rectal prevents the action of agonist on the receptor -​ Oral > When two or more drugs are given concurrently, the Absorption effect may be additive, synergistic or antagonistic -​ The process by which drug proceeds from the site of administration to the site of measurement a.​ Additive Effect (blood stream) within the body. -​ The effect of two or more drugs get added up and -​ Necessary for the production of a therapeutic total effect is equal to the sum of their individual effect. actions, e.g Ephedrine with theophylline in -​ Most drugs undergo gastrointestinal absorption. bronchial asthma This is extent to which drug is absorbed from gut lumen into portal circulation b.​ Synergism -​ Exception: IV drug administration -​ Action of one drug is enhanced or facilitated by another drug, the combination is synergistic. IV vs Oral -​ The total effect of the combination is greater than 1.​ IV Drug the sum of their independent effect -​ Immediately -​ Often called “potentiation” or “supra-additive -​ Completely effect” 2.​ Oral Drug -​ E.g acetylcholine + physostigmine -​ Delayed -​ Incomplete c.​ Antagonistic 1.​ Chemical Antagonism Distribution -​ Two substances chemically interact to -​ The movement of drug from the blood to and from result in inactivation of the effect, e.g the tissues Antacid like aluminum hydroxide neutralize gastric acid Excretion 2.​ Physiological Antagonism -​ Main process that body eliminates “unwanted” -​ Two drugs act at different sites to produce substances opposing effect, e.g Insulin and glucagon -​ Most common roue - renal have opposite effects on the blood sugar -​ Other routes - Lung (through exhalation), skin level (through perspiration) Efficacy Pharmacodynamics -​ A maximal effect (Emax) an agonist can produce. -​ Study of action of the drugs on the body and their -​ It can be measured with a graded dose-response mechanism of action, i.e to know what drugs do curve only. and how they do it -​ Drugs produce their effects by interacting with the Potency physiological system of the organisms. By such -​ The amount of the drug needed to produce a interaction drugs can only modify the rate of given effect. function of various systems. -​ Potency is determined by the affinity of the Drugs act by: receptor for the drug. 1.​ Stimulation - the highest in activity of the specialized cells, e.g adrenaline stimulates the heart LESSON 5: LEGAL ASPECTS OF PHARMACOLOGY 2.​ Depression - the lowest in activity of the specialized cells, e.g quinidine depresses the ROLE IN NURSING CARE heart 1.​ Prevention 3.​ Irritation - occur on all types of tissues in the -​ First level body and may result in inflammation, corrosion -​ Health impact of environment and necrosis of cells  -​ Health aspects of social, medicinal and illegal drug abuse 4.​ Unit Dose System -​ Single unit packages of drugs 2.​ Early Detection Of Disruption In A Healthy -​ Dispensed to fell each dose required Client -​ Individual packages placed in individual -​ Second level labelled drawers kept in -​ Case finding and referral -​ Refilled every 24 hours and large unit -​ Seeks evidence of habituation, toxicity dose cabinet; 3 to 7 days in long term addiction and untoward side effects facilities 3.​ Care Needed For Clients With Acute Health Narcotic Control System Needs ​ Within hospitals -​ Third level ​ It is a standard policy that controlled substances -​ Institutional setting are issued in single unit packages and are kept in -​ Administering drugs to acutely ill patients separate locked cabinet in each nursing unit ​ Head nurse designated individuals is responsible 4.​ Rehabilitation And Resumption Of Normal for the key Living ​ When controlled substances are issued to a -​ Fourth level nursing unit -​ Focus education and assistance -​ Long term use of drugs necessary Drug Orders 1.​ STAT Pharmacology In Nursing Education -​ emergency doses -​ Integrated in curriculum -​ meds given ASAP but ONCE only Pharmacology In Research 2.​ Single Order ​ Drug research -​ Administration at a certain time only but ​ Considerations in drug research: once > Nurse - Fully informed > Information available to physician 3.​ Standing Order > Research and pharmacist -​ Meds given for a specific number of doses > Recommended dosage > Route of administration 4.​ PRN (pro re nata) > Desired therapeutic effects -​ As needed > Adhere to the study protocol -​ Allows nurse to practice judgement to when a medication should be Ethical Principles administered ​ Respect for person -​ Individuals are independent meaning they Verbal Orders are capable ​ of making ​ Should be avoided decisions ​ Physician should co-sign and date the order in 24 ​ BENEFICENCE – duty to do good hours ​ NON-MALEFICENCE - to do no harm ​ JUSTICE – social benefits can be allocated Responsibilities In Drug Therapy objectively and that those with equivalent RIGHT circumstances should be treated equally 1.​ Patient 2.​ Drug Principles Of Drug Administration 3.​ Time ​ Nurse should understand professional 4.​ Dose responsibilities 5.​ Route ​ Medical administrations 6.​ Documentation ​ Medication delivery systems ​ Drug orders Legal And Ethical -​ Practice under professional license Drug Distributions System 1.​ Floor Stock Patient’s Chart -​ All medications are stocked at nursing -​ Primary source of information station, except dangerous drugs -​ Utilized in small hospitals, government THE NURSING PROCESS hospitals 1.​ ASSESSMENT ​ Subjective and objective 2.​ Individual Prescription Order System ​ Prescriptions -​ Medications dispensed from pharmacy ​ OTCs -​ Receipt prescription or drug order ​ Herbals ​ Responses to medications 3.​ Computer-Controlled Dispensing System -​ Drug order sent to pharmacy 2.​ NURSING DIAGNOSIS -​ Encode order to a computer system ​ Decision about the needs/problems of -​ Nurse with the use of security code and patient password access the system  ​ Critical thinking, creativity and accurate 8.​ Drug Enforcement Administration Of The Doj data ​ charged with the role of being the nation’s 3.​ PLANNING sole legal drug enforcement agency ​ Goals and outcome criteria ​ Specific and measurable 9.​ Drug Regulation Reform Act 1978 ​ Patient-centered ​ Shortened the time in which new drugs ​ Time-frame could be developed and marketed ​ Prioritization 4.​ IMPLEMENTATION 10.​ Drug Relations Act 1992 ​ Initiation and completion of nursing plans ​ The regulations were change to increase the approval rate of drugs used to treat AIDS and cancer LEGAL REGULATIONS OF PHARMACOLOGY ​ Pharmaceutical companies pay a user fee 1.​ Us Pharmacopeia (Usp) at the time they file the application for the ​ Drug standard revised every 5 years new drug ​ Drugs have high standards for therapeutic use 11.​ The Food And Drug Administration ​ International Pharmacopoeia first Modernization Act 1997 published in 1951 ​ Five Provisions a.​ Review and use of new drugs is 2.​ Federal Legislation accelerated ​ Public protected from drugs that are b.​ Drugs can be tested in children impure, toxic, ineffective or not tested before marketing prior to public use c.​ Clinical trial data are necessary for experimental drug use for 3.​ Food, Drug And Cosmetic Act 1938 serious or life-threatening health ​ To monitor and regulate the manufacture conditions and marketing of drug d.​ Drug companies are required to ​ It is FDA’s responsibility to ensure that all give information on “off-label” drugs are tested for harmful effects have drugs and their uses and costs label with accurate information, an e.​ Drug companies that plan to enclose with drugs packaging detailed discontinue drugs must inform literature that explains adverse effects health professionals and clients at least 6 months before stopping 4.​ Durham-Humphrey Amendment 1938 (1952) drug production ​ Distinguishes between drugs that are solid with or without prescription and 12.​ Health Insurance Portability And those that should not be refilled without Accountability Act (HIPPA) 2003 new prescription ​ Sets the standards for the privacy of individually identifiable health information 5.​ Kefauver-Harris Amendment Of 1938 (1962) as of 2003 ​ Taken during first trimester Babies were ​ Gives clients more control over their born with extreme limb deformities health information, including boundaries on the use and release of health records 6.​ Comprehensive Drug Abuse Prevention And ​ Limitations on access to information from Control Act the pharmacy ​ Categorize substances into schedules ​ Pharmacist must provide a private are for consultation with the client and have all 7.​ Controlled Substances Act clients sign a statement that they have ​ Designed to remedy the escalating received a copy of the privacy statement problem of drug abuse, included several provisions 13.​ Pediatric Research Equity Act 2003 ​ Promotion of drug education and research ​ FDA is authorized to require testing of into the prevention and treatment of drug drugs and biologic products for safety and dependence effectiveness in children by drug ​ Strengthening of enforcement authority manufacturers ​ Establishment of treatment and ​ One must not assume that children are rehabilitation facilities small adults ​ Designation of schedules or categories for controlled substances according to abuse 14.​ Medicare Prescription Drug Improvement And liability Modernization Act 2003 ​ Serves to provide financial assistance to Controlled Substances seniors to purchase needed prescription SCHEDULE I- not approved for medical use, medications abuse potential and extent of physical and psychologic dependence are greater with schedule I. Philippine Laws SCHEDULE II to V- have accepted medical use 1.​ National Drug Policy 1987 SCHEDULE V- limited potential and extent of ​ Ensures drugs are safe, effective and physical and psychologic dependence essential ​ Reasonable and affordable  ​ Components -​ Quality assurance of drugs 𝐷 -​ Rational use of drugs by health A= 𝑆 (Q) professionals and consumers -​ Self reliance and self sufficiency A = Amount -​ Targeted drug procurement by D = Desired dose (mg or g), found in doctor’s order government in support for the 1st S = Stock Dose (available dose, packaging or ampule) of 3 pillars Q = Quantity (amount of stock) 2.​ Generic Act Of 1988 (Ra 6675) ​ Identifies by their scientific and 24 ℎ𝑟𝑠 internationally recognized active Frequency = 𝐼𝑛𝑡𝑒𝑟𝑣𝑎𝑙 ingredients 𝑎𝑚𝑜𝑢𝑛𝑡 𝑝𝑒𝑟 𝑑𝑜𝑠𝑒 ​ Advantages Amount per day = 𝑓𝑟𝑒𝑞𝑢𝑒𝑛𝑐𝑦 -​ Decreases prices -​ Ensures adequate drug supply -​ Promote safety *Basis of conversion depend on stock dose -​ For scientific basis use of drugs * If amount in mL, one decimal place ​ Disadvantages -​ May have some variation in action Pediatric Dosage Calculations or response 1.​ Young’s Rule -​ Too long and difficult to -​ Age in years pronounce -​ Child from 1 to 12 years old 3.​ Senior Citizen Act 𝑎𝑔𝑒 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 ​ Provision in which senior citizen will be PD = 𝑎𝑔𝑒 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 + 12 (𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒) given 20% discount 4.​ Ra 9502- Universally Accessible Cheaper And 2.​ Fried’s Rule Quality Meds Act Of 2008 -​ Age in months ​ Effective September 2008 -​ Child less than 12 months ​ Lowering of drug prices thru free competition and better access to 𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠 affordable brand PD = 150 (𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒) ​ Generic forms to test, produce and register generic versions of patented drugs 3.​ Clark’s Rule ​ Prohibits the patent of newly discovered -​ Regardless of age uses of unknown drugs -​ Weight in lbs 𝑊𝑒𝑖𝑔ℎ𝑡 (𝑙𝑏𝑠) Legal Aspects - Generic Act of 1988 PD = 150 (𝐴𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒) ​ R.A. 6675- An act to promote, require and ensure the production of an adequate supply, distribution, *Use bar line for repeating numbers use and acceptance of drugs and medicines *If dosage, 2 decimal places identified by their generic names. ​ June 01- August 31, 1989- monitoring of Generic Act. Compliance. mg/day = (weight in kg) ​ September 01, 1989- full implementation of (recommended dose/kg/day) generic Act. ​ Pharmacy Act R.A. 5921- all prescription contain the following info.: name of the prescriber, office 𝑚𝑔/𝑑𝑎𝑦 address, PR #, PTR#, client name, age, sex, and mg/dose = 𝑓𝑟𝑒𝑞𝑢𝑒𝑛𝑐𝑦 date of prescription. ​ R.A. 3720 - food , drugs, and devices and cosmetics act. IVF Calculations ​ R.A. 2382 - Philippine medical act of 1957, define -​ To avoid overload, avoid delay of care the practice of medicine in the Philippines. -​ For replacement of fluids and electrolytes in the ​ R.A.6425 - dangerous drug act of 1972, article ll, body sec. 4 states that sale, administration, delivery, -​ Answer is in range if there is a decimal point distribution, and transportation of prohibited drugs -​ gtts/min = drops per minute are punishable by law. The penalty of -​ ugtts/min = microdrops per minute imprisonment ranging from 12 years and 1 day to 20 years and fine ranging from 12 thousand to 20 𝑇𝑉 𝐷𝐹 𝑇𝑉 𝑥 𝐷𝐹 thousand pesos shall be imposed. 𝑡 (ℎ𝑟𝑠) 𝑥 60 ; 𝑡 (𝑚𝑖𝑛𝑠) ​ Philippine Nursing Act of 1991 Section 28 - TV = Total volume (mL) administration of intravenous injections, special t = Time (hrs); Time (mins) training shall be required according to protocol 60 = constant established. DF = drop factor (varies on the infusion set, no. of drops/ml) LESSON 6: DRUG CALCULATIONS gtts/min, macroset: ​ Third Trimester: 22.4 mg/day 𝑇𝑉 20 Ferrous Sulfate = 𝑡 𝑥 60 -​ It replaces iron stores needed for RBC development. It treats or prevents ugtts/min, microset, soluset: iron-deficiency anemia. Foods rich in iron 𝑇𝑉 60 = 𝑡 𝑥 60 include lean red meat, beans, nuts, asparagus, oatmeal, and dried peaches. 2.​ Folic Acid 𝑇𝑉 cc/hr = 𝑡 ​ It is recommended that women who are planning pregnancy should take a supplement containing 0.4 mg to 0.8 mg of folic acid, one month before and for the 𝑇𝑉 𝑇𝑉 𝐷𝐹 t= 𝑐𝑐/ℎ𝑟 ;t= 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 𝑥 60 first two to three months after conception. ​ All women of childbearing age should ingest 400 mcg of folic acid daily for birth defect prevention. Expected time (count the number ​ Folic Acid Deficiency can result in of hrs) = given time + no. of hrs spontaneous abortion or birth defects, specifically neural tube defects, a failure of the embryonic neural tube to close properly, leading to spina bifida or skull and brain malformations. ​ Side effects are not common but include allergic bronchospasm, rash, pruritus, erythema and general malaise. Multiple Vitamins: -​ Prenatal vitamins preparations are routinely recommended for pregnant women. -​ These preparations supply vitamins A, D, E, C, B Complex, Iron, Calcium and other minerals. -​ Vitamins are used most effectively by the body when taken with meals. -​ Megadoses of vitamins and minerals may cause harm to the pregnant patient, the fetus, or both 3.​ Vitamin A ​ Pregnant: 800 ug ​ Lactation: 1,300 ug SEMI FINALS ​ Functions: Normal vision, maintenance of skin and mucous membrane, promote LESSON 7: DRUGS USED FOR REPRODUCTIVE bone and teeth growth SYSTEM (DURING PREGNANCY) ​ Food sources: Fish oil, egg yolk, yellow and green fruits and vegetables Drugs Most Commonly Ingested During Pregnancy -​ It is estimated that half the medications taken by 4.​ Vitamin D pregnant patients are over-the-counter (OTC) ​ Pregnant: 10 ug drugs. This includes iron supplements and ​ Lactation: 12 ug vitamins, antiemetics, antacids, stool softeners, ​ Functions: Promotes calcium absorption, nasal decongestants, mild analgesics, and bone and teeth absorption antibiotics. Pregnant patients should be ​ Food sources: Milk, liver, egg yolk and discouraged from using OTC medications until exposure to sunlight they consult with their healthcare provider. 5.​ Vitamin E 1.​ Iron ​ Pregnant: 10 ug ​ During pregnancy, approximately 27 ​ Lactation: 12 ug mg/day of iron is needed to meet fetal and ​ Functions: Prevention of hemolytic maternal daily requirements. anemia and enhances immune system ​ Supplementation of iron is not generally ​ Food sources: Vegetable oils, nuts, green necessary until the second trimester, leafy vegetables when the fetus begins to store iron, the goal is to prevent maternal Iron Deficiency 6.​ Vitamin B1 (Thiamine) Anemia, not to supply the fetus. ​ Pregnant: 1.5 mg ​ Side effects include nausea, constipation, ​ Lactation: 1.6 mg black tarry stools, gastrointestinal ​ Functions: Carbohydrate metabolism, irritation, epigastric pain, vomiting, normal nerve function, promotes appetite discoloration of urine and diarrhea. ​ Food sources: Glandular organs, egg ​ First Trimester: 6.4 mg/day yolk, legumes, meat ​ Second Trimester: 18.8 mg/day  7.​ Vitamin B2 (Riboflavin) Magnesium-based antacids are not ​ Pregnant: 1.6 mg administered in patients with renal ​ Lactation: 1.8 mg disease. ​ Functions: Carbohydrate, protein and fat metabolism, healthy eyes and skin, tissue 2.​ Nausea and Vomiting maintenance -​ It is the major complaint for most pregnant ​ Food sources: Milk, meats, poultry, fish, patients but Hyperemesis Gravidarum, a enriched breads, cereals severe nausea and vomiting that may require hospitalization for hydration and 8.​ Vitamin B6 (Pyridoxine) nutrition occurs with much lower ​ Pregnant: 2.2 mg incidence. ​ Lactation: 2.1 mg -​ Nonpharmacologic measures include ​ Functions: Protein metabolism and eating crackers, avoiding high-fat foods, absorption eating small, frequent meals, drinking ​ Food sources: Meat, liver, whole grains, fluids between meals, eating high-protein green leafy vegetables bedtime snack, stop smoking and taking an iron supplement at bedtime. 9.​ Vitamin B12 (Cyanocobalamin) Drugs for Nausea and Vomiting ​ Pregnant: 2.2 mg a.​ PYRIDOXINE (B6) ​ Lactation: 2.6 mg ​ Coenzyme for various metabolic functions ​ Functions: Maturation of RBC, prevent including metabolism of proteins, Megaloblastic anemia, normal nerve carbohydrates and fats. function ​ Side effects are rare and include ​ Food sources: Red meat , milk, nuts headache, nausea, somnolence and legumes, eggs, green leafy vegetables sensory neuropathy. b.​ ANTIHISTAMINES 10.​ Vitamin C (Ascorbic Acid) ​ Blocks CTZ, which acts on vomiting ​ Pregnant: 70 mg center, available OTC. Sites of action ​ Lactation: 95 mg include labyrinth and CNS. ​ Functions: Promotes iron absorption, ​ Side effects include dizziness, tissue integrity, resistance against drowsiness, dry mouth and nose, blurred infection, and promotes healing vision, urinary retention, rash and ​ Food sources: Citrus fruits, tomatoes, headache. strawberries, cabbage, broccoli c.​ TRIMETHOBENZAMIDE (Tigan, T-Gen) ​ It does not inhibit direct impulse to the Drugs for Minor Discomforts of Pregnancy vomiting center. It is contraindicated in -​ The average prenatal patient uses three drugs patients with cardiac dysrhythmias, during pregnancy, two of which are vitamin and narrow angle glaucoma, asthma, and mineral supplements. pyloroduodenal obstruction. -​ Drug ingestion is most likely during the first and ​ Side effects include drowsiness, third trimesters, when the discomforts of headache, blurred vision, diarrhea, pregnancy tend to be the most bothersome. depression, hypotension, muscle cramps, 1.​ Heartburn (Pyrosis) allergic reactions, extrapyramidal -​ It is a burning sensation in the epigastric symptoms and blood dyscrasias and sternal regions that occurs with reflux d.​ ONDANSETRON (Zofran) of acidic stomach content. ​ It is a serotonin 5-HT3 receptor antagonist -​ It is common when a pregnant patient sits used for the prevention of nausea and or lies down soon after eating a normal vomiting. Side effects include headache, meal, only to have her gravid uterus exert constipation, diarrhea, malaise/fatigue. upward pressure on her stomach, causing ​ It is used as scheduled, not PRN. Use increased reflux activity and the with caution in patients who have perception of hyperacidity. congenital/medical conditions that cause Drugs for Heartburn prolonged QT interval. a.​ ALUMINUM HYDROXIDE (Amphojel) e.​ PHENOTHIAZINES ​ Used for heartburn and neutralizes gastric ​ Blocks postsynaptic mesolimbic acidity. dopaminergic receptors in brain; exhibits ​ Side effects include constipation, adverse strong alpha-adrenergic blocking effect reactions include dehydration, and depresses release of hypothalamic hypophosphatemia, GI obstruction and hypophyseal hormones, competes b.​ MAGNESIUM HYDROXIDE AND ALUMINUM with histamine for H1 receptor. HYDROXIDE WITH SIMETHICONE ​ Side effects include dizziness, ​ It neutralizes gastric acidity and is drowsiness, excitation, fatigue, insomnia, antiflatulent. photosensitivity reactions, and ​ Aluminum-based antacids may cause constipation. It is contraindicated in constipation, while magnesium-based patients with hypersensitivity to drug or combination antacids have a laxative any component, CNS depression or coma effect. f.​ ANTICHOLINERGICS ​ Aluminum and magnesium-based ​ Side effects include confusion, combination antacids are given to balance drowsiness, headache, fatigue, dry skin, the constipation and laxative effects. constipation, vomiting, bloated feeling. In  cardiovascular side effects include term basis for its analgesic and antipyretic orthostatic hypotension, ventricular effects. fibrillation, tachycardia and palpitations. b.​ ASPIRIN ​ It is contraindicated in patients with ​ A salicylate, classified as a mild hypersensitivity to drug or any analgesic. Aspirin is a pregnancy category components and those with narrow-angle C drug (which changes to category D if glaucoma, acute haemorrhage, GI or GU full-dose aspirin is used in the third obstruction, tachycardia secondary to trimester). cardiac insufficiency, and myasthenia ​ It is a prostaglandin synthetase inhibitor gravis. with antipyretic, analgesic, and g.​ PROKINETIC AGENTS (Metaclopramide) antiinflammatory properties. Teratogenic ​ Blocks dopamine receptors in CTZ of effects have not been shown conclusively, CNS; causes enhanced motility and but the risk for anomalies is perceived to accelerated gastric emptying without be small. stimulating secretions. c.​ IBUPROFEN ​ Side effects include restlessness, ​ It is classified as a pregnancy Category C drowsiness, diarrhoea, weakness, and drug (which changes to Category D if insomnia. used in the third trimester). ​ It is contraindicated in patients with ​ If taken late in pregnancy, it may cause hypersensitivity to drug or any premature closure of the ductus component, GI obstruction, perforation, or arteriosus. haemorrhage; pheochromocytoma; or ​ It is a prostaglandin synthetase inhibitor history of seizure disorder. with antipyretic, analgesic and anti-inflammatory properties 3.​ Constipation -​ It is a frequent occurrence during Antidepressant Drugs pregnancy. -​ Exposure to antidepressant drugs and depressive -​ Its cause may be related to hormonal disorders have both been associated with adverse changes, specifically progesterone, which birth outcomes. decreases GI motility. -​ Use of selective serotonin reuptake inhibitors Drug for Constipation (SSRIs) in pregnancy is associated with low birth a.​ METAMUCIL weight and small for gestational age infants ​ This medication is used to treat -​ POOR NEONATAL ADAPTATION – a term for constipation. It increases the bulk in stool, transient symptoms like tachypnea, irritability, an effect that helps to cause movement of hypoglycemia, and week cry, has been reported in the intestines. neonates exposed to SSRIs in late pregnancy b.​ DOCUSATE SODIUM -​ Options for treatment for pregnant patients include ​ Docusate is a medication used for psychotherapy alone or in conjunction with managing and treating constipation. pharmacologic therapy as determined by the ​ It reduces the surface tension of the oil health care provider. and water interface within the stool, facilitating the passage of water and lipids 1.​ Citalopram is used to treat depression. It may into the stool mass. The goal is for the improve your energy level and feelings of stool to become softer and move through well-being. Citalopram is known as a selective the intestinal tract more easily serotonin reuptake inhibitor (SSRI). This medication works by helping to restore the 4.​ Pain balance of a certain natural substance (serotonin) -​ Through week 26 of pregnancy, in the brain. headaches resulting from hormonally 2.​ Sertraline is a medication used to manage and induced body changes, sinus congestion, treat major depressive disorder, or eye strain are quite common. obsessive-compulsive disorder, panic disorder, -​ It is not unusual for the pregnant patient to post-traumatic stress disorder, premenstrual experience backaches, joint pains, round dysphoric disorder, and social anxiety disorder. It ligament pain and pain from minor is in the SSRI class of medications. injuries. -​ Nonpharmacologic pain relief include rest, TERATOGENS (TERATOWA) - TERATOGENIC DRUGS calming environment, relaxation -​ Teratogen is a substance that has the potential to exercises, alteration in routine, mental cause a defect in an unborn child during imagery, ice packs, warm heat, postural pregnancy changes, correct body mechanics and 1.​ Thalidomide changes in footwear. ​ Used to treat erythema nodosum Drugs for Pain leprosum, a painful skin disease a.​ ACETAMINOPHEN (Tylenol) associated with leprosy. ​ It is a para-aminophenol analgesic and a ​ Prescribed for pneumonia, colds, and flu, pregnancy category B drug. It is the most for relieving the symptoms of nausea commonly ingested nonprescription drug (morning sickness) during pregnancy. ​ Birth defects that may be caused when ​ It may be used during all trimesters of taking thalidomide: pregnancy in therapeutic doses on a short -​ Very short or missing arms and legs  -​ Missing parts of the ears ​ There is an increased risk of minor birth -​ Deafness defects in children whose mothers take -​ Missing or small eyes norethindrone acetate during the first 4 -​ Paralysis of the face months of pregnancy: -​ mild masculinization of the 2.​ Epileptic Drugs external genitalia of the female ​ Use to treat epilepsy, a chronic disorder of fetus the central nervous system (sudden and -​ hypospadias in the male fetus recurrent seizures) ​ Antiepileptic drugs may cause birth 7.​ Warfarin defects such as: ​ It helps to treat blood clots and to prevent -​ Neural tube defects further blood clots from forming. -​ Cleft lip ​ Warfarin is not recommended during -​ Heart abnormalities pregnancy as it can sometimes cause -​ Delay in developing speech and birth defects and bleeding problems for language the baby. -​ Problems with memory and ​ Birth defects of Warfarin: attention -​ Hypoplastic Nose -​ Stippled Epiphyses 3.​ Retinoid -​ Skeletal Abnormalities -​ It is a man-made form of vitamin A that is used to treat various skin conditions or 8.​ Alcohol skin diseases. ​ It is a beverage that contains ethanol -​ Pregnant mothers taking retinoids can (ethyl alcohol), a substance that can make cause physical birth defects to their baby people intoxicated or drunk when or abnormalities to their facial structures consumed. These drinks include beer, such as microtia where the baby has wine, and spirits (liquor). low-set ears and stenosis which is having ​ Alcohol use during pregnancy can cause a narrow ear canal. birth defects and developmental disabilities. It can also cause other 4.​ ACE inhibitors pregnancy problems, such as ​ Angiotensin-converting enzyme inhibitor is miscarriage, stillbirth, and prematurity. used to treat high blood pressure. It can ​ Birth Defects: also be used to treat problems with the -​ Hearing Loss heart and kidneys. -​ Heart Problems ​ During the first trimester, there is no -​ Cleft Lip proven risk of birth defects but when the mother is in the second and third Sexually Transmitted Infected trimesters, it can cause a low level of -​ Spread predominantly by unprotected sexual amniotic fluid which can lead to problems contact. Some STIs can also be transmitted such as: during pregnancy, childbirth and breastfeeding -​ poor lung development and through infected blood or blood products. -​ poor growth STIs have a profound impact on health. -​ poor development of the skull -​ How STIs are treated: bone ​ The only person who can determine the -​ birth defects appropriate treatment for a sexually -​ problem with kidney transmitted infection (STI) is a healthcare provider. A prescription medication is typically in order, and what you need depends on the type of infection you 5.​ Third element (Lithium) have. ​ Lithium is a medication that has been used to treat bipolar disorder and other Common STIs caused by bacteria: conditions. ​ Syphilis - disease caused by the bacterium ​ Some studies suggest that taking lithium Treponema pallidum. This bacterium causes in the first trimester is associated with infection when it gets into broken skin or mucous birth defects: membranes, usually of the genitals. -​ small increased chance of heart ​ Chlamydia - is a common sexually transmitted defects infection (STI) caused by the bacterium -​ Ebstein’s anomaly - abnormal Chlamydia trachomatis. You can get chlamydia placement of one of the valves from intercourse, anal sex or oral sex. that controls blood flow ​ Gonorrhea - caused by infection with the Neisseria gonorrhoeae bacterium. N. gonorrhoeae 6.​ Oral contraceptives/hormones infects the mucous membranes of the ​ used to prevent pregnancy. reproductive tract, including the cervix, uterus, and ​ Progestin-only (norethindrone) oral fallopian tubes in women, and the urethra in contraceptives are a very effective women and men. method of birth control, but they do not ​ Herpes - The herpes simplex virus (HSV) causes prevent the spread of AIDS and other genital herpes. Genital herpes can often be sexually transmitted diseases. spread by skin-to-skin contact during sexual  activity. Some people infected with the virus may 1.​ Vitamin K: The recommended dosage is typically have very mild symptoms or no symptoms. 0.5 to 1 milligram (mg) of vitamin K1. Newborns ​ Human papillomavirus (HPV) - causative agent are often administered vitamin K shortly after birth of this infection is the human papillomavirus; It is to help prevent bleeding problems. Vitamin K most commonly spread during vaginal or anal sex. deficiency is relatively common in newborns due It also spreads through close skin-to-skin touching to their immature liver function during sex. 2.​ Eye ointment (Erythromycin or Tetracycline): ​ HIV - is the virus that causes acquired Oral dosage (erythromycin base or stearate) immunodeficiency syndrome (AIDS). HIV neonates 10 mg/kg/dose PO every 6 hrs for 5-14 weakens your immune system by destroying your days. To prevent eye infections, newborns are T-cells until you are unable to fight off even minor typically given antibiotic ointment or drops in their illnesses eyes shortly after birth. 3.​ Hepatitis B vaccine: Administer single antigen Prescriptions hepatitis B vaccine 0.5 ml intramuscular. -​ Antibiotics used to treat bacterial STIs may be Newborns may receive the first dose of the administered as a single injection or pill or a hepatitis B vaccine shortly after birth. This vaccine course of pills taken over several days. helps protect against hepatitis B virus infection. -​ The antibiotic prescribed typically depends on the 4.​ Antibiotics: Given via cannula (IV) inserted 15 bacteria behind the infection. Here are common mg in the vein of the baby. In certain situations, antibiotics prescribed for different infections: newborns may be given antibiotics if there is a ​ Chlamydia: Zithromax (azithromycin), suspected or confirmed bacterial infection. This Vibramycin (doxycycline) may include intravenous antibiotics if the infection ​ Gonorrhea: ceftriaxone, cefixime, is severe. ciprofloxacin, ofloxacin 5.​ Pain relief: 160 mg/5 mL oral suspension. If a ​ Syphilis: penicillin—doxycycline or newborn undergoes a painful medical procedure, tetracycline only if allergic to penicillin such as circumcision or certain medical ​ Herpes: Acyclovir, famciclovir, valacyclovir interventions, pain relief medications may be ​ Human Papillomavirus (HPV): Podofilox, administered. Common options include imiquimod, sinecatechins acetaminophen (paracetamol) or local ​ HIV/AIDS: Antiretroviral medications are anesthetics. used to treat HIV and AIDS. The proper 6.​ BCG: This vaccine is an intradermal injection of medication for you will depend on the 0.05 mL. The BCG vaccine is typically stage of your condition. Prescriptions administered as an intradermal injection, usually used to treat HIV and AIDS include on the upper arm. It is not an oral or topical enfuvirtide (T20), emtricitabine, tenofovir, medication.The vaccine contains weakened form abacavir, rilpivirine, etravirine, efavirenz, of the bacteria Mycobacterium bovis, which dolutegravir, elvitegravir, tipranavir, stimulates the immune system to provide lopinavir/ritonavir, darunavir, maraviroc, protection against TB and ibalizumab. LESSON 8: CARDIOVASCULAR DRUGS IMMUNIZATIONS Cardiac Glycosides -​ Cardiac glycosides are found in a number of Digitalis plants, including Digitalis called