Nursing Pharmacology (2023-2024) - Week 1 & 2 PDF

WESLEYAN UNIVERSITY PHILIPPINES- COLLEGE OF NURSING NURSING PHARMACOLOGY School Year: 2023-2024 (2nd Semester) GERALD M. PAGDANGANAN, RPh, MSc, LPT Professor Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES GENERAL OBJECTIVES At the end of the course, the students are expected to demonstrate understanding of the different fields of Nursing Pharmacology as applied in the prevention and treatment of different diseases as well as nursing intervention. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES COURSE STUDY GUIDE In order for you to successfully accomplish this course, the following primary guidelines, tips and rules must be followed: 1. Plan- focus is essential in learning, therefore set time for each course you enrolled in, for tasks to be done, and arrange tasks according to importance in your daily schedule. Write down notes in your to-do list and study calendar e.g, Assignments, Activities etc. 2. Eliminate distractions- avoid doing multiple things all at the same time e.g. Using facebook while doing answering questions in the course homepage. Do not procrastinate. 3. Effective balance-make sure you take some rest (study breaks), relaxation and enough sleep. Take regular breaks (stretch arms and legs and avoid eye strain from computer use) Do not over work otherwise you’ll get burned out. Prioritize both your school work and personal life. Above all, stay healthy. 4. Use online resources- gather information from various online library sources wisely. Look into scholarly works such as journals, encyclopedias etc. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES COURSE STUDY GUIDE 5. Take Notes- jot down important information. This will help you remember. 6. Efficient reading- read carefully and understand well each unit. Follow the set of instructions given to you. Read in advance some literatures that will help you understand the topics and enhance your knowledge. 7. Engage- connect and interact with your virtual classmates or peers. Participate in the online discussions. Cooperative learning is fun when enjoyed with other students. Exchange of point of views by talking to other students. 8. Ask Questions -seek for assistance from the course facilitator. Do not be afraid to ask for help. Your professor will guide you all throughout the course. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ON COMPLETION AND SUBMISSION OF STUDENT OUTPUTS 25 % deduction for a day late submission of outputs 50% deduction for TWO days late submission of outputs Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ETHICAL USE OF INTERNET AND ETIQUETTE ON ONLINE POSTING FOR ACADEMIC DISCUSSIONS Ethical considerations on use of internet can be found below. Pappas (2015) tips for online discussions are also enumerated: (Refer to link: https://elearningindustry.com/10-netiquette-tips-online-discussions) A. Use of proper language L. Do not harm others and steal information B. Be precise M. Respect human rights, property and diversity C. Check accuracy and reliability of source N. Control temper D. Avoid emoticons and “texting” writing O. Related/Relevant post E. Explain and justify your point of view P. Use internet for communication and academic F. Safeguard your username and password purposes G. Read before submitting Q. Be Credible and Cite your sources H. Be alert and aware of risks associated to internet use I. DO NOT PLAGIARIZE J. Tone down your language K. Get permission from owner of copyrighted materials Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TITLE A/An ________________________ Submitted to the faculty of College of Nursing Wesleyan University Philippines In Partial fulfillment of the Requirements For the course Nursing Pharmacology Submitted by: Name of Student Course & Year Submitted to: Name of Faculty Professor Date of Submission Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASSROOM RULES AND REGULATIONS 1. Come to class prepared to learn 2. Don't ever cheat. 3. Always be on time (15 minutes grace period) 4. Be attentive 5. Dress appropriately 6. No phones are allowed unless the instructor permits you. 7. All examinations and quizzes must be taken in the University 8. Assignments MUST be handwritten except for the cover page Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES WEEK 1: INTRODUCTION TO NURSING PHARMACOLOGY Learning Targets: At the end of discussion, Student Nurses will be able to: 1. Know the salient terminologies in Pharmacology. 2. Differentiate the Pharmacokinetic and Pharmacodynamic in relation to the practice of nursing. 3. Importance of receptor families in the effects of drugs. 4. Know the importance of drug interactions, and 5. Learn the different calculations of dosing. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACOLOGY is the study of the BIOLOGICAL effects of chemical. In Clinical practice, healthcare providers focus on chemicals act on living organisms. Nurses deal with PHARMACOTHERAPEUTICS, or CLINICAL PHARMACOLOGY. Wherein, it is a BRANCH of pharmacology that deals with the USES OF DRUGS, to PREVENT, TREAT and DIAGNOSE disease. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SALIENT TERMINOLOGIES ▪ DRUG- any article intended for USE IN DIAGNOSIS, MITIGATION, CURE, PREVENTION AND TREATMENT of diseases in man and animals. ▪ EXCIPIENT- INACTIVE INGREDIENT present in dosage form. ▪ API- ingredient of drug products that PRODUCES PHARMACOLOGIC EFFECT. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SALIENT TERMINOLOGIES SIDE EFFECTS- An effect of a drug or other type of treatment that is in ADDITION TO OR BEYOND ITS DESIRED EFFECT. ADVERSE EFFECTS- response to a drug which is NOXIOUS AND UNINTENDED and which occurs at doses normally used in man for prophylaxis, diagnosis, or therapy of disease or for the modification of physiologic function. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SALIENT TERMINOLOGIES TOXIC EFFECTS OR TOXICITY- When the DRUG LEVEL EXCEEDS the therapeutic range, toxic effects are likely to occur from overdosing or DRUG ACCUMULATION. PHARMACOGENETICS- is the scientific discipline studying how the effect of a DRUG ACTION VARIES from a predicted drug response because of GENETIC FACTORS or hereditary influence. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SALIENT TERMINOLOGIES TOLERANCE refers to a DECREASED RESPONSIVENESS over the course of therapy. PLACEBO EFFECT is a psychological benefit from a compound that MAY NOT HAVE the chemical structure of a DRUG EFFECT. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SALIENT TERMINOLOGIES LOADING DOSE- when IMMEDIATE DRUG RESPONSE IS DESIRED, a large initial dose, known as the loading dose, of drug is given to achieve a rapid minimum effective concentration in the plasma. After a large initial dose, a prescribed dosage per day is ordered. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SOURCES OF DRUGS Plants Sources Synthetic Sources Animal Sources Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES DRUG APPROVALPROCESS Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES 1938: FOOD, DRUG, AND COSMETIC ACT The Food, Drug, and Cosmetic Act of 1938 empowered the FDA to ensure drug safety by monitoring and regulating the manufacture and marketing of drugs. It is the FDA’s responsibility to ensure that all drugs are tested for harmful effects, have labels with accurate information, and enclose detailed literature in the drug packaging that explains adverse effects. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES 1970: THE CONTROLLED SUBSTANCES ACT In 1970, Congress passed the Controlled Substances Act (CSA) of the Comprehensive Drug Abuse Prevention and Control Act, Title II. This act, designed to remedy the escalating problem of drug abuse, included several provisions: (1) promotion of drug education and research into the prevention and treatment of drug dependence; (2) strengthening of enforcement authority; (3) establishment of treatment and rehabilitation facilities; and (4) designation of schedules, or categories, for controlled substances according to abuse liability. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES DRUG SCHEDULING AND CLASSIFICATIONS Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES MAIN BRANCHES OF PHARMACOLOGY PHARMACOKINETIC PHARMACODYNAMIC Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACOKINETIC PHASE ABSORPTION DISTRIBUTION METABOLISM EXCRETION Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACOKINETIC PHASE ABSORPTION- the movement of drug particles from the GI tract to body fluids by passive absorption, active absorption, or pinocytosis. Most oral drugs are absorbed into the surface area of the small intestine through the action of the extensive mucosal villi. Absorption is reduced if the villi are decreased in number because of disease, drug effect, or the removal of small intestine. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES 2 GENERAL METHODS: Passive Transfer Facilitated Transport ❑ Facilitated diffusion ❑ Active Transport ❑ Endocytosis Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACOKINETIC PHASE DISTRIBUTION- is the process by which the drug BECOMES AVAILABLE TO BODY FLUIDS AND BODY TISSUES. Drug distribution is influenced by blood flow, the drug’s affinity to the tissue, and the PROTEIN-BINDING EFFECT Volume of Distribution -Protein binding BOUND UNBOUND Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACOKINETIC PHASE METABOLISM-is the process by which the body inactivates or biotransforms drugs. Drugs can be metabolized in several organs; however, THE LIVER IS THE PRIMARY SITE OF METABOLISM. Factors affecting bioavailability Physical properties Gastric emptying rate Health of GIT First pass effect. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES HALF-LIFE (t12) of a drug is THE TIME IT TAKES FOR ONE HALF of the drug concentration to be ELIMINATED. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACOKINETIC PHASE EXCRETION- main route of drug ELIMINATION is through the KIDNEYS (URINE). Other routes include bile, feces, lungs, saliva, sweat, and breast milk. Creatinine Clearance - Rate by which a known volumetric clearance plasma is cleared from the drug. - affected by the liver and kidney function. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PHARMACODYNAMIC PHASE DOSE RESPONSE AND MAXIMAL EFFICACY DOSE RESPONSE is the relationship BETWEEN THE MINIMAL VERSUS THE MAXIMAL AMOUNT OF DRUG DOSE needed to produce the DESIRED DRUG RESPONSE. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES RECEPTOR THEORY Drugs act through receptors by binding to the receptor to produce (initiate) a response or to block (prevent) a response. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FOUR (4) RECEPTOR FAMILIES 1. KINASE-LINKED RECEPTORS- The ligand-binding domain for drug binding is on the cell surface. The drug activates the enzyme (inside the cell), and a response is initiated. 2. LIGAND-GATED ION CHANNELS- The channel spans the cell membrane and, with this type of receptor, the channel opens, allowing for the flow of ions into and out of the cells. The ions are primarily sodium and calcium. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FOUR (4) RECEPTOR FAMILIES 3. G PROTEIN–COUPLED RECEPTOR SYSTEMS- There are three components to this receptor response: (1) the receptor, (2) the G protein that binds with guanosine triphosphate (GTP), and (3) the effector that is either an enzyme or an ion channel. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FOUR (4) RECEPTOR FAMILIES 4. NUCLEAR RECEPTORS- Found in the cell nucleus (not on the surface) of the cell membrane. Activation of receptors through the transcription factors is prolonged. With the, first three receptor groups, activation of the receptors is rapid. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES AGONISTS and ANTAGONISTS Drugs that produce a response are called agonists, and drugs that block a response are called antagonists. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FACTORS INFLUENCING DRUG EFFECTS 1. Weight 2. Age 3. Gender 4. Pathological Factors 5. Immunological Factors 6. Psychological Factors Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NURSING CARE PROCESS ASSESSMENT Take patient history to identify factors that may affect drug pharmacokinetics. Examine the patient’s history to identify factors that may affect pharmacodynamics Collect a medication history. Perform a physical exam to identify problems that may affect pharmacodynamics (e.g., elevated BP, dysrhythmias, or other abnormal findings may be an indication for drug therapy). Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NURSING CARE PROCESS NURSING INTERVENTIONS Advise patient not to eat high-fat food before ingesting an enteric coated tablet, because high-fat foods decrease absorption rate. Report to the health care provider if drugs with a long half-life (i.e., greater than 24 hours) are given more than once a day. Some drugs with a long half-life (e.g., the anticoagulant warfarin [Coumadin]) can be more dangerous than others and must be monitored frequently. Monitor the therapeutic range of drugs that are more toxic or have a narrow therapeutic range (e.g., digoxin). Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NURSING CARE PROCESS CULTURAL CONSIDERATIONS Be aware that individuals of some ethnic or racial heritage metabolize drugs differently than the general population. Assess for adverse effects that may result from this variation in metabolism. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NURSING CARE PROCESS EVALUATION Evaluate the determinants that affect drug therapy Assess for signs and symptoms of drug toxicity when giving two drugs that are highly protein-bound. The drugs compete for protein- binding sites, and displacement of drugs occurs. More free drug is in circulation because there are not enough protein-binding sites. Too much of a free drug can result in drug toxicity. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES DRUG INTERACTIONS A drug interaction is A REACTION BETWEEN TWO (OR MORE) DRUGS OR BETWEEN A DRUG AND A FOOD, BEVERAGE, OR SUPPLEMENT. Taking a drug while having certain medical conditions can also cause a drug interaction. (National Institute of Health, 2021) Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TYPES OF DRUG INTERACTIONS 1. DRUG-DRUG INTERACTIONS When two or more drugs are taken together, there is a possibility that the drugs will interact. Drug-drug interactions can occur in the following situations: At the site of absorption During Distribution During Excretion At the site of action Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TYPES OF DRUG-DRUG INTERACTIONS 1. DUPLICATION This refers to the potential of effect when 2 drugs with the same active ingredient or with the same action are taken at the same time. Ex: Taking a cold remedy with a phyenylpropanolamine HCl and paracetamol combination separately with an antipyretic preparation containing paracetamol. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TYPES OF DRUG-DRUG INTERACTIONS 2. ANTAGONISM This refers to the reduction of efficacy when 2 drugs with opposing actions are taken together. Ex: NSAIDs may cause the body to retain salt and fluids. Taking this together with a diuretic may result in reduced efficacy of the diuretic Propanolol (antihypertensive) is a beta blocker opposing the action of albuterol (anti-asthma) which is a beta-adrenergic stimulant. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TYPES OF DRUG INTERACTIONS 2. DRUG-FOOD INTERACTIONS Certain food can interact with drugs in much same way that drugs can interact with each other. This interaction occurs when the drug and the food are in direct contact in the stomach. Ex: 1. Levofloxacin (Levaquin), Ciprofloxacin (Cipro), Tetracycline (Take 1 hour before or 2 hours after calcium, magnesium, and iron supplements or milk and dairy products. 2. Metronidazole (Flagyl)—Do not drink alcohol during, and 72 hours after, therapy. The combination can cause flushing, headache, nausea, vomiting, sweating, and rapid heart rate. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TYPES OF DRUG INTERACTIONS 3. DRUG-LDISEASE INTERACTIONS 1.The worsening of a disease because of a drug 2.The alteration of the effect of a drug because of a disease 3.Manifestation of side effects because of interaction between the drugs and a disease other than the one for which the drug is being taken Ex: Indomethacin causes confusion and dizziness Chlorpropramide causes prolonged hypoglycemic effects Reserpine causes depression and erectile dysfunction Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES TYPES OF DRUG INTERACTIONS 4. DRUG-HERB INTERACTIONS Herbs can increase or decrease a prescription drug's expected activity, leading to either unwanted adverse effects or therapeutic failure. Active ingredients in the herbs can alter remarkably the pharmacokinetic and pharmacodynamic properties of a drug. Ex: Ginger, Ginkgo, Ginseng + Warfarin = Increase risk of bleeding Grapefruit + Drug = Decrease effect of drugs Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES DOSAGE CALCULATIONS Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES MEASURING SYSTEMS METRIC SYSTEM- most widely used system of measure. HOUSEHOLD SYSTEM- measuring system found in recipe book. APOTHECARY SYSTEM- system developed by Pharmacists, much harder to use that the metric system. AVOIRDUPOIS SYSTEM- mostly used in compounding system. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ORAL DOSING (Tablets and Capsules) 1. An order is written for 0.05 g Spironolactone (Aldactone) to be given orally. The available dose is 25 mg. How many tablets would you have to give? 2. An order is written for 320 mg of Aspirin to be given orally. The available dose is 80 mg. How many tablets would you have to give? Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES INTRAVENOUS DOSING (Drops per minute) mL of solution prescribed per hour x drops delivered per ML Drops/minutes = 60 minutes / 1 hour Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES INTRAVENOUS DOSING (Drops per minute) 1. An order is written for a patient to received 400 mL of 5% dextrose in water (D5W) over a period of 4 hours in a standard microdrip system (60 drops/mL). Calculate the correct setting (drops/ minute) 2. Calculate the same order an IV set that delivers 15 drops, mL Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PEDIATRIC DOSING Pediatric patients experience unique differences from the adult population in pharmacokinetic parameters and, consequently, require individualized dosing. Medications useful in pediatric medicine often lack a therapeutic indication and dosing guideline for this population. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PEDIA: pertaining to children(0-18y/o) Stages: -babies(0-2years old) infants/neonates(0-28 days) -Toddlers/Pre-schoolers(2-5 years old) -School Age (6-12 years old) -Adolescence/Teen age(13-18 years old) PEDIATRICS : a branch of medicine dealing with the development, care, and diseases of children Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FORMULAS IN COMPUTING PEDIATRIC DOSE FRIED’S RULE (FOR INFANT 0-12 MONTHS OLD): Infants dose = age (mo,) x adult dose 150 YOUNG’S RULE (FOR CHILDREN 2-12 YRS OLD): Child’s dose = age (yrs.) x adult dose Age (yrs) + 12 Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FORMULAS IN COMPUTING PEDIATRIC DOSE COWLING’S RULE (AGE NEXT BIRTHDAY): Child’s dose = age (in yrs on next birthday) x adult dose 24 DILLING’S RULE : Child’s dose = age in years x adult dose 20 Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES FORMULAS IN COMPUTING PEDIATRIC DOSE CLARK’S RULE Child’s dose = Weight of child (pounds) 150 pounds x adult dose Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES WEEK 2: DRUG THERAPY: ANTI INFECTIVE AGENTS Learning Targets: At the end of discussion, Student Nurses will be able to: 1. Explain what is meant by selective toxicity 2. Differentiate between broad-spectrum and narrow spectrum drugs. 3. Define bacterial resistance to antibiotics. 4. Explain three ways to minimize bacterial resistance 5. Describe common adverse effects associated with the use of antibiotics. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CHEMOTHERAPEUTIC AGENTS SELECTIVE TOXICITY - destroy the infecting organism without damage to the host by exploiting basic biochemical and physical differences between the two organisms ANTIBIOTICS -Produced by microorganisms that in small amount can inhibit other microorganisms. - Can be BACTERICIDAL or BACTERIOSTATIC Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES MECHANISM OF ACTIONS 1. Bacterial and fungal cell wall – synthesizing enzymes ( Beta-lactams and Antifungals) 2. Bacterial ribosomes (Macrolides and Aminoglycosides) 3. Enzymes required for nucleotide synthesis and DNA replication (Sulfas and Quinolones) 4. Machinery of viral replication (Anti-viral drugs Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES The goal is to the reduction of the invading organisms to a point at which human immune response can take care of the infection Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NARROW SPECTRUM vs BROAD SPECTRUM ACTIVITY Narrow-spectrum antibiotics target a few types of bacteria. Broad-spectrum antibiotics target many types of bacteria. Both types work well to treat infections. But using broad-spectrum antibiotics when they're not needed can create antibiotic-resistant bacteria that are hard to treat. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SOURCES OF ANTIBIOTICS Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ANTIBIOTIC RESISTANCE: A PHENOMENON IN WHICH FORMERLY EFFECTIVE MEDICATIONS HAVE LESS AND LESS IMPACT ON BACTERIA. happens when microorganisms (such as bacteria, fungi, viruses, and parasites) change when they are exposed to antimicrobial drugs (such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics). (WHO) Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES SOME STRATEGIES IN THE WAR AGAINST DRUG RESISTANCE Education Patients should never pressure clinicians to prescribe antimicrobial agents It is important that clinicians not allow themselves to be pressured by patients. Clinicians should prescribe an inexpensive, narrow spectrum drug whenever the laboratory results demonstrate that such a drug effectively kills the pathogen. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES Patients must take their antibiotics in the exact manner in which they are prescribed. It is critical that clinicians prescribe the appropriate amount of antibiotic necessary to cure the infection. Patients should always destroy any excess medications and should never keep antibiotics in their medicine cabinet. Unless prescribed by a clinician, antibiotics should never be used in a prophylactic manner—such as to avoid “traveler’s diarrhea” when traveling to a foreign Country. Healthcare professionals must practice good infection prevention and control procedure. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ADVERSE REACTION TO ANTI INFECTIVE THERAPY 1.KIDNEY DAMAGE- occurs most frequently with drugs that are metabolized by the kidney and eliminated in the urine. Ex: amiNOglycosides (Gentamicin, amikacin, tobramycin, neomycin, and streptomycin. 2. GASTROINTESTINAL TOXICITY- Common side effects of antibiotics include nausea, diarrhea, and stomach pain. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ADVERSE REACTION TO ANTI INFECTIVE THERAPY 3. NEUROTOXICITY- Neurotoxicity is common among many groups of antibiotics in at-risk patients and can range from ototoxicity, neuropathy and neuromuscular blockade to confusion, non-specific encephalopathy, seizures and status epilepticus. 4. HYPERSENTIVITY REACTION- Cross sensitivity reaction. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES PROPHYLAXIS Antibiotics are sometimes given as a precaution to prevent, rather than treat, an infection. This is called antibiotic prophylaxis. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NOSOCOMIAL INFECTION Mutant strains of organisms have developed, thus increasing their resistance to antibiotics that were once effective against them. Infections acquired while patients are hospitalized are called nosocomial infections. GOOD TO KNOW! Enterococcus faecium, Staphylococcus aureus Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Enterobacter species. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASS OF ANTIBACTERIALS PENICILLIN a natural antibacterial agent obtained from the mold genus Penicillium. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASS OF ANTIBACTERIALS Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASS OF ANTIBACTERIALS CEPHALOSPORINS In 1948, a fungus called Cephalosporium acremonium was discovered in seawater at a sewer outlet off the coast of Sardinia. This fungus was found to be active against gram- positive and gram- negative bacteria and resistant to beta- lactamase (an enzyme that acts against the beta-lactam structure of penicillin). Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASS OF ANTIBACTERIALS CEPHALOSPORINS SIDE EFFECTS: Nephrotoxicity, Alteration of blood clotting time, GI disturbances (Nausea, Vomiting, Diarrhea) DI: Drug interactions can occur with certain cephalosporins and alcohol. For example, alcohol consumption may cause flushing, dizziness, headache, nausea, vomiting, and muscular cramps while taking cefamandole, or cefoperazone. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASS OF ANTIBACTERIALS MACROLIDES are active against most gram-positive bacteria and moderately active against some gram-negative bacteria. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES CLASS OF ANTIBACTERIALS TETRACYCLINES isolated from Streptomyces aureofaciens in 1948, were the first broad-spectrum antibiotics effective against gram-positive and gram-negative bacteria and many other organisms—mycobacteria, rickettsiae, spirochetes, and chlamydiae, to name a few. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NURSING CARE PROCESS ASSESSMENT: Assess for allergy to penicillin or cephalosporins. The patient who is hypersensitive to amoxicillin should not take any type of penicillin products. NURSING DX: Risk for infection related to invasion of bacteria through surgical incision PLANNING: Patient’s infection will be controlled and later eliminated. NURSING INTERVENTION: Obtain sample (e.g., swab, blood, sputum) for laboratory culture and antibiotic sensitivity testing of infective organism (also known as C&S) before antibiotic therapy is started. EVALUATION: Evaluate effectiveness of antibacterial agent by deter- mining whether infection has ceased and whether any side effects, including superinfection, have occurred. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ANTIVIRALS and ANTIMALARIALS ANTIVIRAL DRUGS are used to prevent or delay the spread of a viral infection. They inhibit viral replication by interfering with viral nucleic acid synthesis in the cell. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ANTIVIRALS and ANTIMALARIALS ANTIMALARIAL DRUGS Treatment of malaria depends on the type of Plasmodium and the organism’s life cycle. Quinine was the only anti- malarial drug available from 1820 until the early 1940s. Synthetic antimalarial drugs have since been developed that are as effective as quinine and cause fewer toxic effects. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES DRUGS FOR URINARY TRACT INFECTION ❑Upper Urinary Tract Infections: Pyelonephritis ❑Lower Urinary Tract Infections: Cystitis Urethritis Prostatitis Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES ❑Most common pathogens for cystitis, prostatitis and pyelonephritis: ▪ Escherichia coli ▪ Staphylococcus saprophyticus ▪ Proteus mirabilis ▪ Klebsiella ▪ Enterococcus ❑Most common pathogen for urethritis ▪ Chlamydia trachomatis ▪ Neisseria gonorrhea Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES URINARY ANTISEPTICS/ANTIINFECTIVES AND ANTIBIOTICS Nitrofurantoin (Macrodantin) was first prescribed to treat UTIs in 1953. Nitrofurantoin is bacteriostatic or bactericidal, depending on the drug dosage, and is effective against many gram-positive and gram-negative organisms, especially E. coli. It is used to treat acute and chronic UTIs. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES URINARY ANTISEPTICS/ANTIINFECTIVES AND ANTIBIOTICS Trimethoprim and Trimethoprim-Sulfamethoxazole Trimethoprim (Proloprim) can be used alone for the treat- ment of UTIs, although it is usually used in combination with a sulfonamide, sulfamethoxazole (the combined preparation is generically called TMP/SMZ), to prevent the occurrence of trimethoprim-resistant organisms. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES URINARY ANALGESICS Phenazopyridine Phenazopyridine hydrochloride (Pyridium), an azo dye, is a urinary analgesic (relieves urinary pain and burning) that has been available for almost 40 years. It is used to relieve the pain, burning sensation, and frequency and urgency of urination that are symptomatic of lower UTIs. Nursing Pharmacology PHINMA WESLEYAN ARAULLO UNIVERSITY UNIVERSITY- PHILIPPINES- COLLEGECOLLEGE OF ALLIED OFHEALTH NURSING SCIENCES NURSING CARE PROCESS ASSESSMENT: Obtain a history from patient of clinical problems with UTI, incontinence, or other urinary tract disorders. NURSING DX: Acute pain related to inflammation in the urinary tract PLANNING: Patient will be free of signs and symptoms of UTI within 10 days. NURSING INTERVENTION: Monitor patient’s urinary output and urine specific gravity. Careful attention to output is required when administering urinary antiseptics to patients with anuria and oliguria. Report promptly any decrease in urine output. EVALUATION: Evaluate the effectiveness of the urinary anti-infectives in alleviating the UTI. Patient is free of side effects and adverse reactions to drug. Nursing Pharmacology

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