NCMA216 PRELIM.pdf

Bachelor of Science in Nursing 2YA NCMA216: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 Coverage for Prelim: Acacia leaves – to treat internal bleeding. Basic Concepts of Pharmacology...

Bachelor of Science in Nursing 2YA NCMA216: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 Coverage for Prelim: Acacia leaves – to treat internal bleeding. Basic Concepts of Pharmacology 4) Pharmacologia sen Manuductio and Materia Medicum Pharmacokinetics - First recorded reference to the word pharmacology. Pharmacodynamics 5) Early 1800s Pediatric Drug Computation - Chemists isolates specific substances from complex Nursing Process in Pharmacology mixtures Autonomic Nervous System - Pharmacologists then study their effects in animals - Fredrich Serturner (first isolated morphine from opium, BASIC CONCEPTS OF PHARMACOLOGY injected himself and three other friends with huge doses Discussed by Prof. Marivic Ilarde (100mg) Pharmacology - Tiningnan nila kung yung morphine is makakatanggal ng - Is the study of drugs and its origin, chemical structure, pain preparation, administration, action, metabolism and excretion. - They study the effect of substances in animals (aalamin ang tungkol sa drug, kung saan nangaling, - John Jacob Abel ingredients nung gamut, how they are prepared, paano Father of American Pharmacology gagamitin, effect ng gamut sa tao, at paano sila e a absorb and (Foundation of the 1st pharmacology – department in ilalabas kase hindi sila pwede mag stay dahil magiging toxic; University of Michigan in 1890) inc. level of chemical comp. in the body lead toxicity) - The study of drugs that alter functions of living organisms. Hopkin’s first professor of pharmacology Pharmacy The early focus of his work was on isolation and - Art of preparing, compounding (we mix medication for characterizing the hormones of the endocrine system, personalized medication), and dispensing drugs. It also refers especially adrenaline and insulin to the place where drugs are prepared and dispensed. Basic Concepts of Pharmacology (e.g, Mercury; sila din nag mi mix ng mga drugs- Drug compounding) - Are chemicals that alter physiochemical processes in body cell. Pharmacist - They can stimulate or inhibit normal cellular functions. - A person licensed to prepare and dispense drugs to make up - Used interchangeably with medicines. prescriptions. Drug Definition - Nurses can also dispense drugs but not allowed to mix - A substance recognized by an official pharmacopoeia or medications formulary - A substance intended for the use in the diagnosis, cure, History of Pharmacology mitigation, treatment, or prevent diseases (vaccines or healthy - Begun when humans used plants to relive symptoms food). - Dahil hindi pa uso ang medication dati mga tapal tapal pa mga - A substance or (other than food) intended to affect the ginagamit noong sinauna) structure or any function of the body 1) Babylonians Drug Classification - Earliest surviving “prescriptions” on clay tablets in 3000 Chemical Structure B.C. - pertain to the molecular arrangement of atoms in a - (Herbs or mga dahon) molecule and the chemical bonds that holds the atom 2) Chinese together - Recorded the Pen Tsao (great herbal) – a 40-volume Mechanical of Action (MOA) compendium of plant remedies dating to 2700 B.C. - refers to the specific biochemical interaction through - Herbal plants which a drug substance produces its pharmacological - They are still using herbs until now to cure illness effect such an enzyme or receptor 3) Egyptians - Archives of remedies on a document known as Eber’s Mode of Action (Moa) (Erb’s) Papyrus in 1500 B.C. - describes a functional or anatomical change resulting - Sa Erb’s Papyrus nakasulat ang mga iba’t ibang medicinal from the exposure of a living organism to a substance plants, anatomy of the body and diseases of plants and Drug Information - also referred to a medication information or drug informatics animals. - range from discovery, use, and management of information in - Ex. Aloevera - to treat burns or skin diseases. the use of medication J.A.K.E 1 of 32  PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - covers from drug identification, pharmacokinetics to dosage Drug Action and adverse effects. 1) Therapeutic Effect Drug Names - Also referred as the desired effect (primary effect 1) Generic or Nonproprietary Name intended) - Name approved by the Medical or Pharmaceutical - Binibigyan ang anti-biotic to slow down growth of bact. Associations in the original country of manufacture and is to kill the bacteria adopted by all countries 2) Side Effect - Ex. paracetamol - also referred as the secondary effect (unintended effect) - (kung saan nanggagaling yung drugs or na manufactured - ex. Side effect of anti-biotic is diarrhea, nausea, and yung drugs) vomiting. 2) Brand Name or Trade Name - adverse effect (severe side effect) kaya dpt i-reevaluate pt. - Name given by the manufacturer of the drug (ex. adol or - not all pare pareho ang effect kaya need talagang e panadol or biogesic pareho lang ang effects, same lang evaluate ang pt lagi para if may mga effects ma heads up ang effect) agad ang Doctor 3) Chemical Name 3) Drug Toxicity - Name that describes the atomic or chemical structure. - deleterious effects of a drug resulting from over dosage, - Ingredients like N-acetyl-p-aminophenol ingestion of external use drug, and accumulation on the Examples of Generic, chemical, and brand names: blood stream Brand - pwedeng ma overdose ang pt kapag mali ang computation Generic name Chemical name name (halimbawa ang ibibigay sa baby is.5 kaso ang nabigay is N-methyl-3phenyl- 5mL so nagkulang ng point you can overdose the pt) Fluoxetine HCI Prozac propylamine - Nagkakaroon ng auto toxicity dahil kapag may mga sakit Acetaminophen 4-hydroxyacetanilide Tylenol kunwari sinisipon lang inom agad ng gamot, nagkaubo 2-p-isobutylphenyl-propionic lang inom agad gamot, masama pakiramdam umiinom Ibuprofen Motrin agad ng gamut tapos lahat nung ininom mong gamut acid merong paracetamol so it will cause problem - Signs of drug toxicity: Generic Name - Hepatotoxic- liver damage; necrotoxic- kidney damage; Route of high blood and etc. Brand Name medication - like in pregnant woman who have hypertension tapos bingyan ng magnesium sulfate malalaman kung nag ka Dosage/ content Action of vial drug toxicity sya kung bumaba bp, pulse, respiration at absent na ung patellar reflex so dpt mabigyan siya ng calcium gluconate sa bed side ng pt. usually nakalagay lang sa chart is observe for drug toxicity. 4) Drug Allergy - immunologic reaction to drug or hypersensitivity - should have skin test for IV drugs - should ask patient for allergy in oral drugs - if the pt. have many food allergy then ask the doc. 5) Drug Tolerance - exists in person with unusually low physiologic response to a drug - may mga taong mababa tolerance sa mga substances at ung iba nmn dhil usual silang uminom ng pain reliever tumataas pain tolerance nila Drug Regulation & Mandates Food and Drug Administration of the Philippines or FDA - created under the Department of Health or DOH to license, monitor, and regulate the flow of food, drugs, cosmetics, medical devices, and household hazardous waste in the Philippines J.A.K.E 2 of 32  PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - FDA’s main goal is to ensure the health and safety of the food o Medication nurse- focus on pt. get direct care to pt. and drugs made available to the public and give medications and check pt. chart to check - (sila ang nagbibigay ng lisensya sa mga drugs. Tinitingnan bago umuwi nila kung may mga ibang substances pa sa drugs. Kapag - When error is made, assess the patient first and report to meron tine terminate nila yung drugs kase magkakaroon ng MD immediately. bad effect yun sa katawan ng tao) (there is no room for error because it is cause life of - Govt. doctors- write generic name not the brand name patient so you should focus on what you are doing) Republic Act No.3720 Correct Identification of the Patient: - known as the Food Drug, and Cosmetic Act. - ID band or ID bracelet (Kozier) - An act to ensure the safety and purity of foods, drugs, - Ask the patient’s name. and cosmetics being made available to the public by - Avoid: calling the client in Name because they may creating the food and drug administration which shall answer “Yes” to the wrong Name. administer and enforce the laws. Observe the Ten Rights: Republic Act No. 8203 1) Right medication - Otherwise known as the special law on counterfeit - Means that the client receives the drug that was drugs. prescribed - “Unregistered and imported drug product” as - Medication orders may be prescribed by: distinguished from counterfeit drug defined under o Physician Section 3 of RA…shall refer to unregistered o Dentist counterpart brand in the Philippines o Podiatrist- treat infection in foot and lowerlimb - (Ito yung nagche check if totoo or peke yung product) o License health care provider such as advance Republic Act No.7394 practice registered nurse - Consumer Act of the Philippines o With authority from the state to order medication - Protects the interest of the consumer, promotes - Components of Medication Prescription: general welfare and to establish standards of conduct o Component of drug order for business and industry o Date and time the order is written - Protection against deceptive, unfair, and o Drug name: BN and GN unconscionable sales acts and practices. o Drug dosage: 500mg Republic Act No.9165 o Route of administration - Comprehensive Dangerous Drugs Act of 2002 the o Frequency and duration of administration Philippine Drug Enforcement Agency (PDEA) o Any special instructions for withholding or - Created for the efficient and effective law adjusting dosage based on nursing assessment, enforcement of all the provisions on dangerous drugs drug effectiveness, or laboratory result and or precursor and essential chemicals as provided o Physician or other health care provider signature in R.A or name if TO or VO - Two of the most used and valuable illegal drugs in o Signature of license practitioner taking TO or the country are “methamphetamine hydrochloride VO known as shabu and marijuana” - Categories of Drug Order: o Standing- maintenance medications or taken for Principle of Drug Administration several days like anti biotics. Give cephalexin Are substances administered for the diagnosis, cure, treatment, 5mg 1 cup 3x a day for 7 days or relief of symptom or prevention of disease. o One time- diphenhydramine 50mg IV prior to Practice Guidelines: blood transfusion. - RNs are responsible for own actions, illegible order o PRN / when necessary- some doc. Don’t indicate should be questioned or clarified. prn. Paracetamol 500mg 1 tab every 4 hours for - RNs should be knowledgeable about the medication. temp. 38.5 and above. So ang basehan dito ay - If the RN is uncertain about the calculation, ask another temp. kase walang prn. Ibibigay kada 4hrs nurse to double check. tuwing may lagnat na ang temp ay 38.5 pataas. - What you prepare, you administer. 8am-12pm walang lagnat wag ibigay, 2pm may - Do not leave medications at bedside. lagnat ibigay ang gamot. - If the client vomits, report to charge nurse, MD, or both. o STAT/immediately/now- demerols IM stat, so o Charge nurse- does the charting and carry out doc. ibigay na agad kahit may ginagawa ka pa iwan Order mo ginagawa mo balikan mo na lang J.A.K.E 3 of 32  PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 2) Right dose - Right dosage of the medicine that will be given to the client 3) Right route - Is necessary for adequate or appropriate absorption - Common routes are the following: o Oral o Sublingual o Buccal o Inhalation o Topical o Inhalation o Instillation- ex. eyedrops 8) Right to refuse o Suppository, etc. - Client can and do refuse to take medication 4) Right time - It is the nurses’ responsibilities to determine when - the time at which the prescribed dose should be possible, the reason for refusal and to take reasonable administer. measure to facilitate the client taking the medication - Daily drug dosages are given at specified time during - Should have waiver signed by the pt. a day such as: 9) Right assessment o Twice a day b.i.d - Requires the appropriate data be collected before o Three time a day t.i.d administration of drugs. o Four times a day q.i.d. 10) Right evaluation o Every 6hrs q6h - Requires that the effectiveness of the medication be o HS: hour of sleep determined by the client response to medication 5) Right client - (you must observe the first 5 rights) - Can be measured by checking the client identification bracelet by having and by having the client state her or his name. - Tanungin ang name but do not call the name of the client let the client speak her/his name - Some client answers to any name or unable to respond, so client identification should verify each time of medication administered. - In the event of missing identification bracelet, the nurse must verify the client identity before any drug Date prescription was Prescriber’s Info. administration. written 6) Right client education Patient’s Info. Inscription: - Requires that the client received accurate and Medication Prescribed thorough information about the medication an d how Superscription: it relates to his or her situation “Recipe” Quantity of - Client teaching also includes therapeutic purpose, Medication Sigma: Directions possible side effect of the drugs, any dietary for Patient restriction or requirements skills administration, and Instruction to the pharmacy laboratory monitoring Physician’s License 7) Right documentation and PTR Number Physician’s signature - Requires that the nurses immediately record the appropriate information about drug administered - Rx- from latin word recipe means to take. Called include the ff: superscription Name of the drug - Inscription- medication prescribe Dose - Sigma- direction for pt. on how to take the medication Route - PTR-yearly kumukuha sa munisipyo Time and date - S2 no.- used for prescribing drugs that cause addiction like Demerol Nurse initial or signature J.A.K.E 4 of 32  PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 Oral Medications Parenteral Medications - Most common route Intradermal - Contradictions: Site Angle Gauge Length Max cc Client is vomiting - Inner lower Almost 25, 26, 27 3/8”, 5/8”, ½” 0.1 to 0.2 Client with intestinal or gastric suction arm parallel to mL Unconscious client - Upper the skin chest 10-15 O Inability to swallow - Anterior - Unsafe actions chest Do not crush enteric coated or gel coated tablets (to - Upper back prevent form gastric juice) beneath the Do not crush long-acting tablets (slowly inaabsorb scapula gamot) - Perfect wheel should have right angle and hawak sa syringe, if Do not try to open sealed capsules (wag itry buksan if no wheel means malalim ang pag inject mahigpit) Do not crush contents of spansule with beads or pellets Do not give sublingual formulations orally Do not crush sublingual formulations Do not give oral medications sublingually - Safe actions Scored tablets may be split (no scoring wag hatiin) Subcutaneous Chewable medications can be crushed safely Site Angle Gauge Length Max cc If a capsule opens easily, powder from the capsules can be - Outer aspect 45-degrees 25, 26, 27 3/8”, 5/8”, 1-3 mL mixed with food or liquid of the upper (1 inch of ½” Liquid filled capsule contents can be (a) squeezed out, or arms tissue can - Anterior be grasped) (b) aspirated then mixed with food or liquid thighs A sublingual formulation can still be given ever if client is - Abdomen 90-degrees NPO - Upper back (2 inches of Beads from readily opened capsules can be sprinkled over - Ventroglutea tissue can soft food, but should not be chewed. l be grasped) - Tablets or Capsule: - Dorsogluteal Difficulty in swallowing Crush and mix with small amount of water - Avoid Crushing: Sustained-action Enteric coated Buccal and sublingual tablets - Liquid Medication: Mix before pouring Place medication cup on flat surface at eye level Fill the cup with the desired level using the bottom of the meniscus Intramuscular Site: - Ventrogluteal  1y/o and adult  No large nerve or blood vessels  Sealed off by bone  Contains less fat than buttock J.A.K.E 5 of 32  PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021 - Vastus lateralis - Hairless  Site of choice for 1 y/o - (+) hair (CLIP, do not shave) and younger - Not subject to excessive movements or wrinkling  Infants with poorly Avoid: developed gluteal - cuts, burns, abrasions, distal extremity muscles 2) Ophthalmic medications - Dorsogluteal Preparation:  For adults and children - Clean the eyelid and lashes with well-developed from inner to outer canthus gluteal muscles Instruction before administration:  Contradicted: For - Look up adults and children Where and how much to apply: with well-developed - Liquid: instill correct number gluteal muscles of drops  Increased risk of - Outer third of the lower striking the sciatic nerve - Ointment: discard the first - Deltoid bead  Small muscle, very - Squeeze 2cm on the lower conjunctival sac close to the radial Instruction after installation: nerve and artery - Do punctual occlusion for 30 seconds  Rapid absorption - Close but not squeeze the eyelid for adults 3) Otic medications  Cannot administer Preparations: more than 1 mL - Clean the pinna and the  Recommended site for Hepa B vaccine meatus of the ear canal administration - Warm the medication: In - Rectus femoris  Can be used for self- between hands administration - Place in warm water  Disadvantage: causes Straighten the auditory canal: discomfort - Adult (>3 years old): Pull the pinna upward and Angle: backward  90-degrees - Child (