Pharmacology and Venipuncture PDF

[PHARMACOLOGY AND VENIPUNCTURE] CONTENT  Earliest people used to treat diseases by some  Drug Principles unconventional methods, using plants, animal  Uses and Impact of Drug Categori...

[PHARMACOLOGY AND VENIPUNCTURE] CONTENT  Earliest people used to treat diseases by some  Drug Principles unconventional methods, using plants, animal  Uses and Impact of Drug Categories products and minerals, of them plants were given  Beam Attenuation and Pharmacologic Profile priority  Rights of Drug Safety PHARMACOLOGY Pharmacon  A “medicine” or a “drug” Logos or Logia  A “science” or the “study of”  It is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function “actions of drugs on living system” Drug  Despite having wider differences in their principles of treatment, they agree upon the point that disease is due to imbalance within the constituents of the body and that the aim of treatment is to restore the balance with the help of herbs BRANCHES OF PHARMACOLOGY  Pharmacodynamic  Pharmacokinetic  Taken from the French word “DROGUE” which  Therapeutic Chemotherapy means Dry Herb, strongly suggests that earliest  Toxicology drugs were taken out from plant sources  Clinical Pharmacology Can produce harmful as well as beneficial effects  Pharmacy Decisions about when and how to use  Pharmacognosy them therapeutically always involve the  Pharmacoeconomics balancing of benefits and risks  Pharmacogenetics The availability of drugs for medical use is  Pharmacogenomics regulated by law  Comparative Pharmacology  Posology  Animal Pharmacology  Pharmacoepidemiology Therapeutic  The branch of pharmacology that deals with the art and science of treatment of disease For the prevention and cure of the disease Chemotherapy  Refers to the treatment of diseases by chemicals that kill the cells, especially those of microorganisms and neoplastic cells RRT 2023 CUTIE | 1 [PHARMACOLOGY AND VENIPUNCTURE]  Two (2) Divisions:  Conducted in three ways: Antibiotics A. Observational cohort studies Antineoplastic B. Case control studies C. Phase trials Toxicology  Includes the study of adverse effects of drugs on Comparative Pharmacology the body. It deals with the symptoms,  Dealing with the comparison of one drug to mechanisms, treatment and detection of another belonging to the same or another group. poisoning caused by different chemical substances The main criterion is the DOSE Posology NOTE  Deals with the dosage of drugs Essential medicines are poisons in high doses and some poisons are essential medicines in low doses Animal Pharmacology  Deals with the different properties of drugs in Clinical Pharmacology animals  The scientific study of drugs in man  A vast variety of animals are utilized including Pharmacodynamics rabbits, mice, guinea pigs, and etc Pharmacokinetic  Drugs are given to the animals and all parameters  The main objectives are: (their behavior, activities, vital signs, etc.) are 1. Maximize the effect of drug recorded. Any change is noted down 2. Minimize the adverse effects  If found to be useful in animals, then the drug is 3. Promote safety of prescription tested on humans  Aims include: 1. Generate optimum data for use of drugs PHARMACODYNAMIC 2. Promote usage of evidence based  The branch of Pharmacology that deals with the medicine mechanism of action of a drug and the relation Pharmacy between the drug concentration and its effect WHAT THE DRUG DOES TO THE BODY?  The branch of Pharmacology is the art and science of compounding by dispensing drugs, preparing PHARMACOKINETICS suitable dosage forms for administration to man  Derivation: and animals Pharmacon meaning “drug” and kinetics meaning “putting in motion” Pharmacognosy  The branch of pharmacology that deals with the  The identification of drugs by just seeing or absorption, distribution, metabolism and excretion smelling them of drugs and their relationship with the onset,  It is a crude method no longer used. Basically it duration and intensity of the drug effect deals with the study of properties of drugs from WHAT THE BODY DOES TO THE DRUG? natural sources or identification of new drugs obtained from natural sources PHARMACOKINETICS Pharmacogenetic or Pharmacogenomic  Dealing with the genetic variations that cause differences in drug response among individuals or population  Field of research that studies how a person's genes affect how he or she responds to medications. Its long- term goal is to help doctors select the drugs and doses best suited for each person Pharmacoepidemiology  Deals with the effects of drugs on a large population. The effects may be good or harmful RRT 2023 CUTIE | 2 [PHARMACOLOGY AND VENIPUNCTURE] Absorption  Derived from ATP  The movement of drugs from the site of  When ATP undergoes hydrolysis to ADP, there is a administration to systemic circulation high energy that comes from breaking of  Four (4) different ways of absorption of drugs phosphate bond Passive Diffusion Facilitated Diffusion Endocytosis Active Transport Endocytosis Passive Diffusion  Drugs of very large size get transported via ENGULFMENT by cell membrane REMEMBER Absorption is not exactly that straightforward It’s a variable process still depending on pH,  Most drug is absorbed by passive diffusion surface area and blood flow  Simply move from the area of higher to lower concentration Bioavailability  Water soluble – move with the help of channel or pore  Lipid soluble – move with any help; effortless Facilitated Diffusion  Distribution  Movement of particles from high to low  The disbursement of an unmetabolized drug as it concentration using PROTEIN or CARRIER PROTEIN moves through the body's blood and tissues 1. Lipophilicity Active Transport 2. Blood flow 3. Capillary permeability 4. Plasma and Tissue binding 5. Volume of distribution Volume of Distribution  Is the theoretical volume that would be necessary to contain the total amount of an administered drug at the same concentration that it is observed in the blood plasma RRT 2023 CUTIE | 3 [PHARMACOLOGY AND VENIPUNCTURE]  The larger the volume of distribution, the more likely that the drug is found in the tissues of the body  The smaller the volume of distribution, the more likely that the drug is confined to the circulatory system  Elimination  The removal of an administered drug from the body. It is accomplished in two ways, either by Important route of elimination however, there is also two excretion of an unmetabolized drug in its intact metabolic reactions form or by metabolic biotransformation followed  Phase 1 by excretion  Phase 2  The removal of an administered drug from the body or simply the clearing of drugs from the Liver Detoxification Pathways body.  TOTAL BODY CLEARANCE - CLt  Cltotal = Cl(hepatic) + Cl(renal) + Cl(biliary) + Cl(others) ➔ First Order Kinetic or Zero Order Kinetic FIRST ORDER KINETIC ZERO ORDER KINETIC Amount of drug eliminated over Amount of drug eliminated is time is directly proportional to independent of drug the concentration of drug in the concentration in the body body Cytochrome Family Enzyme Essential for the Metabolism 1000mg ---> 840mg ---> 706mg --- 1000mg ---> 800mg ---> 600mg --- > 593mg > 400mg of Drugs  Cytochrome P450 “the amount of eliminated each “The amount of DRUG eliminated time period will be different but is the same per each time period CYP 3A4/5 the fraction will be constant” but the fraction or percentage is CYP 2D6 different” CYP 2C8/9 CYP 1A2  Inducers (PCRAB) Phenytoin Carbamazepine Rifampin Alcohol (Chronic) Barbiturates St. John’s Wort Steady State  Inhibitors (G-PACMAN)  “High enough to be effective but not high enough Grapefruit to be toxic” Protease Inhibitors  Goal: To maintain STEADY STATE concentration Azole Antifungals within therapeutic range Cimetidine RRT 2023 CUTIE | 4 [PHARMACOLOGY AND VENIPUNCTURE] Macrolides (except Azithro) Enzyme Linked Receptor Amiodarone Non-DHP CCBs PHARMACODYNAMICS Four (4) Types 1. Ligand-Gated Ion Channels 2. G-Protein Coupled Receptors 3. Enzyme-Linked Receptors  Are a second major type of cell-surface receptor 4. Intracellular Receptors  They were recognized initially through their role in responses to extracellular signal proteins that Ligand-Gated Ion Channels promote the growth, proliferation, differentiation, or survival of cells in animal tissues. Intracellular Receptors  The easiest or simplest among out of the four  Ligand – refers to some molecule or ion  Receptor – bind drugs and mediate its pharmacological actions  These are receptor proteins found on the inside of the cell, typically in the cytoplasm or nucleus G-Protein Coupled Receptor rather than outside the cell or the cell membrane. USES AND IMPACT OF DRUG CATEGORIES Drug Category  A group of medications with certain similarities. Three dominant methods are used to classify them  Mechanism of action Specific changes they cause in your body  Physiologic effect How your body responds to them  Chemical structure What they’re made of “Drugs are classified by how they work, what they treat, and their chemical structure” The Purpose of Drug Classification  The aim of drug classification is to make sure you use a drug safely and get the greatest possible benefit. Every time you take a drug, your body  Also known as the “Seven Transmembrane chemistry changes Receptor”  Medications are meant to help but they can also  Passes through the cell membrane SEVEN (7) times make side effects more severe Are the largest and most diverse group of  By noting the class of a drug, we can understand membrane receptors in eukaryotes what to expect from it. That includes the risks and These cell surface receptors act like an which other drugs you can switch to inbox for messages in the form of light  Classification also helps identify drug-drug energy, peptides, lipids, sugars, and interactions and the potential for drug resistance proteins RRT 2023 CUTIE | 5 [PHARMACOLOGY AND VENIPUNCTURE] Drug – Drug Interaction The vast majority of these agents  The action of one drug can make another drug less are nonionic monomers, which means they do not dissociate in effective. They may change the way your body water, allowing for lower LOCM absorbs or uses the drug osmolality. they also have fewer nephrotoxic reactions and  When classified by mechanism of action, an improved intravascular interaction that affects one drug will usually affect tolerability others in the same class IOCM Still under study Doubling - Up Ionicity  Sometimes, combining drugs makes them too Ionic agents dissociate in water effective into anion and cation  For instance, non-steroidal anti-inflammatory IONIC components, which increases inherent osmolality; thus, ionic drugs (NSAIDs) like ibuprofen or aspirin increase agents tend to fall into the high- your bleeding risk. Anticoagulants (blood thinners) osmolar category like Coumadin (warfarin) keep your blood from Nonionic agents do not dissociate clotting. Taking them together can lead to in water, resulting in lower dangerous excessive bleeding osmolality and fewer adverse effects  It’s often dangerous to take two drugs from the same class, such as two NSAIDs. Doubling up often NON-IONIC Nonionic agents encompass both LOCM and IOCM preparations doubles the risk or severity of side effects. Nonionic agents are used almost exclusively for examinations RECAP requiring intravascular injection  Drugs are classified for safety and effectiveness reasons. It helps limit side effects, predict your Viscosity response to it, and choose a replacement drug  Viscosity or thickness of an agent is an important when one doesn’t work. You shouldn’t take property that can impact iodine delivery multiple drugs from a single class or that affect the  In many exams, a delicate balance between timing same organ system. Some classes of drugs and risk for adverse reactions is required to deliver shouldn’t be used together a sufficient amount of iodine to the site being imaged, and viscosity is an important Drug Resistance consideration  Medications for chronic infections work in a 6 RIGHTS OF DRUG SAFETY specific way. If used incorrectly or for a long time, Six (6) R’s the infection can become resistant to it. That  Right Patient means the drug won’t work as well. Other drugs of the same class may also be ineffective  Right Medication  Right Dose Contrast Media  Right Time  To avoid this complication, metformin must be  Right Route withheld after the administration of the contrast  Right Documentation agent for 48 hours, during which the contrast- induced renal failure becomes clinically apparent. Right Patient If renal function is normal at 48 hours, the  Some facilities have differing protocols however it metformin can be restarted is imperative that the nurse verifies the name on the patient's armband prior to administering any CONTRAST MEDIA PHARMACOLOGIC PROFILE medications Osmolality  As osmolality moves closer to that of blood, or Right Medication close to “iso-osmolar,” the tolerability and safety  Read the medication label carefully! Be sure to profile improves compare the strength, concentration and type of medication to the order. Considerations include Associated with higher rates of HOCM only administering a medication that you prepared adverse reactions RRT 2023 CUTIE | 6 [PHARMACOLOGY AND VENIPUNCTURE] yourself and being generally familiar with the  Section 3 medication They shall provide patient care, without discrimination, by reason of age, race, Right Dose creed, sex, socio-economic status,  Be cautious as many medications come in different religious, or political belief, or nature of strengths based on route and a mistake could disease or illness prove fatal  Section 4  Low-osmolar contrast agents are widely used in They shall possess such degree of clinical practice, with an observed mean technical knowledge and skills, reflective administered volume ranging from 30 to 140 mL of their competence in the field  Section 5 Right Route They shall advocate the best interests and  Method of delivery of medications can safety of the patient as well as of the substantially alter the effects of the drug entire health care team by ensuring that  Broad classifications include enteral, through the the radiation exposure is kept at a digestive system, and parenteral, directly to the minimal tissues and topical which is applied to the skin, and  Section 6 IV via veins They shall uphold the principle of informed consent Right Documentation  Section 7  Proper documentation of your medication They shall hold in confidence all administration is very important to avoid mistakes information obtained in the course of and any unnecessary interactions during their professional practice and shall only administration disclose such information in accordance  This also includes time, assessment record and with the law and principles of medical other subjective or objective reactions observed ethics INTRAVENOUS CONTRAST MEDIA AND MEDICATION  Section 8 They shall only provide services for which ADMINISTRATION they are qualified by virtue of their Basic consideration education, training, and experience  Allergy  Asthma ROUTE OF ADMINISTRATION  Renal Insufficiency  Oral  Anxiety  Intravenous (IV)  Subcutaneous Legal, Ethical, and Professional Responsibility  Intramuscular (IM)  Transdermal  Rectal  Inhalation  Sublingual Intravenous (IV) ARTICLE II. Responsibility to Patients  Advantages  Section 1 Immediate effect Radiologic Technologists and X-ray Dose increased Technologists shall provide care in Suitable for irritating substances accordance with the accepted Used in emergency situations professional and ethical standards Ideal for high molecular weight proteins  Section 2  Disadvantages They shall respect the dignity, privacy, Unsuitable for oil substances and right to self-determination of the May result in adverse effects patients Must be slowly injected RRT 2023 CUTIE | 7 [PHARMACOLOGY AND VENIPUNCTURE] Strict aseptic technique needed Sublingual  Erratically or incompletely absorbed Subcutaneous  Systemic absorption  Aqueous solution  Rapid Prompt  Advantages  Depot preparation Bypasses first-pass effect Slow and Sustained Bypasses destruction by stomach acid  Advantages Drug stability maintained Suitable for slow-release drugs Immediate pharmacological effects Ideal for some poorly soluble suspensions  Disadvantages  Disadvantages Limited to certain types Pain or necrosis Limited to drug Unsuitable for large doses May lose part of the drug VENOUS – ANATOMY AND CORRECT CIRCULATORY Intramuscular (IM)  Aqueous solution PHYSIOLOGY Prompt  The venous system of the upper limb drains  Depot preparation deoxygenated blood from the arm, forearm and Slow and Sustained hand. It can be subdivided into the superficial system and the deep system.  Advantages If drug volume is moderate Suitable for oily vehicles Preferable to IV if patient must self- administer  Disadvantages Affect certain lab tests Can be painful Intramuscular hemorrhage Transdermal  Slow and Sustained  Advantages Bypass the first-pass effect Painless Ideal for drugs that are Lipophilic Superficial Vein Ideal for drugs that are quickly eliminated  They are located within the subcutaneous tissue of  Disadvantages the upper limb. Allergic to patches Highly Lipophilic Basilic Vein Delay delivery of drugs  The basilic vein originates from the dorsal venous Limited to drug network of the hand and ascends the medial aspect of the upper limb Rectal  At the border of the teres major, the vein moves  Erratic and Variable deep into the arm. Here, it combines with the  Advantages brachial veins from the deep venous system to Bypass first-pass effect form the axillary vein Bypass destruction by stomach acid No vomiting Cephalic Vein  Disadvantages  Also arises from the dorsal venous network of the May irritate the rectal mucosa hand. It ascends the antero-lateral aspect of the Not well-accepted route upper limb, passing anteriorly at the elbow RRT 2023 CUTIE | 8 [PHARMACOLOGY AND VENIPUNCTURE]  At the shoulder, the cephalic vein travels between Implement the deltoid and pectoralis major muscles (known  Provide care and treatment as the deltopectoral groove), and enters the axilla  Diagnostic tests region via the clavipectoral triangle. Within the axilla, the cephalic vein empties into the axillary Evaluate vein  Evaluate outcomes  The cephalic and basilic veins are connected at the  Interpret results elbow by the median cubital vein.  Assess compliance Deep Vein  Situated underneath the deep fascia. It is formed by paired veins, which accompany and lie either side of an artery. In the upper extremity, the deep veins share the name of the artery they accompany  The brachial veins are the largest in size, and are situated either side of the brachial artery. The pulsations of the brachial artery assist the venous return. Veins that are structured in this way are known as vena comitantes  Perforating veins run between the deep and superficial veins of the upper limb, connecting the two systems. IV ADMINISTRATION OF CONTRAST MEDIA  Avoid placing it near a flexing joint and make sure you fixate the catheter  Always flush with saline to verify it is in the vein and to clean the catheter  Always consider the purpose of placing the IV catheter and assess the patient’s blood vessels carefully, never use a larger catheter size than necessary  Again, assess the blood vessels carefully, use your eyes and fingertips  Look for as straight veins as possible and palpate for good elasticity and filling. Try to avoid stiff or very thin veins, also veins under sore skin  Always fixate the IV catheter carefully to keep it in place and in a stable position  Always make it as comfortable as possible for the patient ACCEPTABLE UNIVERSAL PRECAUTION TECHNIQUE AND PERTINENT PATIENT ASSESSMENT Assess  EMR review  Patient assessment Plan  Plan care  Review orders RRT 2023 CUTIE | 9