NCM 106A Pharmacology (Preliminary) PDF

NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM PROPERTIES OF AN IDEAL DRUG INTRODUCTION TO PHARMACOLOGY By: Ms. Anna Alejandria Agudo, RN...

NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM PROPERTIES OF AN IDEAL DRUG INTRODUCTION TO PHARMACOLOGY By: Ms. Anna Alejandria Agudo, RN 1) EFFECTIVENESS PHARMACOLOGY An effective drug is one that elicits the The study of the biological effects of chemicals responses for which it is given. In clinical practice, health care providers focus Effectiveness is the most important property that on how chemicals act on living organisms a drug can have. WHAT ARE DRUGS? 2) SAFETY Chemicals that are introduced into the body to A safe drug is defined as that cannot produce cause change. harmful effects- even if administered in very high doses and for a very long time. PHARMACOTHERAPEUTIC/CLINICAL PHARMACOLOGY 3) SELECTIVITY A branch of pharmacology that uses drugs to A selective drug is defined as one that elicits treat, prevent, and diagnose disease. only the response for which it is given. 2 KEY CONCERNS ADDITIONAL PROPERTIES OF AN IDEAL DRUG 1. The drugs effects on the body 2. Body’s response to the drug 1) REVERSIBLE ACTION *Drugs can react differently to people, depending on how It is important that drug effects are reversible; we the body reacts to the medication want drug actions to subside within an appropriate time. FOUR BASIC TERMS 2) PREDICTABILITY 1) DRUG The certainty just how a given px should A drug is defined as any chemical that can affect respond. living processes. 3) EASE OF ADMINISTRATION 2) PHARMACOLOGY Should be simple to administer; the route should The study of drugs and their interactions with be convenient, and the number of doses per day living systems. should be low. Encompasses the study of the physical and chemical properties of drugs as well as their 4) FREEDOM FROM DRUG biochemical and physiologic effects. INTERACTIONS Includes knowledge on the history, sources, and uses of drugs as well as drug absorption, When the px is taking 2 or more drugs, those distribution, metabolism, and excretion. drug interactions may augment or reduce drug responses. 3) CLINICAL PHARMACOLOGY 5) LOW COST The study of drugs in humans. The study of drugs in patients as well as in An ideal drug should be easy to afford. healthy volunteers. 6) CHEMICAL STABILITY 4) THERAPEUTICS Some drugs lose effectiveness during storage. Also known as pharmacotherapeutics. Others may be stable on the shelf, and can Use of drugs to diagnose, prevent, or treat rapidly lose effectiveness when put into solution. disease or to prevent pregnancy. Because of chemical instability, stocks of certain The medical use of drugs drugs must be periodically discarded. Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM PROPERTIES OF AN IDEAL DRUG DRUG-ENZYME INTERACTIONS ADMINISTRATION Drugs can also cause their effects by interfering with the enzyme systems that act as a catalyst for various chemical reactions. Dosage size and the route and timing of administration are important determinants of drug responses. SELECTIVE TOXICITY Poor px compliance and medication errors by hospital staff can result in major discrepancies. The ability of a drug to attack only those systems found in foreign cells. 1. INTRAVENOUS ROUTE (IV) Affects an enzyme unique to bacteria, causing bacterial cell death without disrupting normal human cell functioning. IV drugs reach their full strength at the time of administration. PHARMACOKINETICS 2. INTRAMUSCULAR ROUTE (IM) What the BODY does to the DRUG Involves the study of absorption, distribution, Absorbed directly into the the capillaries in the metabolism (biotransformation), and excretion of muscle and sent into circulation drugs. In clinical practice, pharmacokinetic 3. ORAL ROUTE considerations include the onset of drug action, drug half-life, timing of the peak effect, duration of drug effects, metabolism or biotransformation Is the most frequently used drug administration of the drug, and the site of excretion. route in clinical practice. Non invasive Less expensive 4 MAJOR PHARMACOKINETICS PROCESS Safest way to deliver drugs 1. Drug Absorption Fastest to Slowest Route of Drugs: 2. Drug Distribution - to systems 1. Intravenous 3. Drug Metabolism - liver 2. Intramuscular 4. Drug Excretion - kidney 3. Subcutaneous 4. Oral CRITICAL CONCENTRATION 5. Topical *Non-invasive - does not involve the bloodstream. The amount of drug that is needed to cause a *Males can absorb medications faster than females. therapeutic effect PHARMACODYNAMICS LOADING DOSE What the DRUG does to BODY. Some drugs that take a prolonged period to The science dealing with interactions between reach a critical concentration; if their effects are the chemical components of living systems and needed quickly, a loading dose is recommended. the foreign chemicals. Example: ○ Digoxin (Lanoxin), a drug used to increase the strength of heart DRUG ACTIONS concentrations. ○ Xanthine bronchodilators used to treat Drugs work in one of four ways: asthma attacks are often started with a 1. To replace or act as substitutes for missing loading dose to reach the critical chemicals. concentration. 2. To increase or stimulate certain cellular The critical concentration is then maintained by activities. using the recommended dosing schedule 3. To depress or slow cellular activities 4. To interfere with the functioning of foreign cells, DYNAMIC EQUILIBRIUM such as invading microorganisms or neoplasms (chemotherapeutic drugs) The actual concentration that a drug reaches in the body results from a dynamic equilibrium RECEPTOR SITES involving several factors: 1. Absorption from the site of entry. Drugs act at specific areas on cell membranes 2. Distribution to the active site. called RECEPTOR SITES. Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM 3. Biotransformation (metabolism) in the BIOTRANSFORMATION liver. 4. Excretion from the body. Enzymes in the liver. Lining of the GI tract. ABSORPTION Refers to what happens to a drug from the time EXCRETION it is introduced to the body until it reaches the circulating fluids and tissues. The removal of a drug from the body. Drugs can be absorbed from many different Skin, saliva, lungs, bile, and feces are some of areas in the body; the routes to excrete drugs. 1. Through the GI tract (orally or rectally KIDNEYS - play the most important role in drug administered). excretion; drugs that have been made water 2. Through mucous membranes. soluble in the liver are often readily excreted 3. Through the skin. from the kidney by the glomerular filtration. 4. Through the lungs. 5. Through muscles or subcutaneous HALF-LIFE tissues. The time it takes for the amount of drug in the DRUGS CAN BE ABSORBED INTO CELLS body to decrease to one-half of the peak level it THROUGH VARIOUS PROCESSES: previously achieved. E.g., if a px takes 20mg of a drug with a half life 1) PASSIVE DIFFUSION of 2 hours, the 10 mg of the drug will remain 2h after administration. 2h later, 5mg will be left, in 2 more hours, only 2.5 mg will remain. Major process through which drugs are ○ The longer the half life, lesser the absorbed into the body. withdrawal symptoms, the shorter the Occurs across a concentration gradient; when half life the more addictive there is a greater concentration of drug on one side of a cell membrane moves to an area of lower concentration. PEAK 2) ACTIVE TRANSPORT Refers to maximum concentration of medication in the body and the client shows evidence of greatest therapeutic effect A process that uses energy to actively move a molecule across a cell membrane. Often involved in drug excretion in the kidney. DURATION 3) FILTRATION Refers to the length of time the medication produces its desired therapeutic effect. Example: the duration of oral acetaminophen is Commonly used in drug excretion. 4-6 hours, at which time the client will likely Involves movement through pores in the cell require an additional dose of pain. membrane. either down a concentration gradient or as a result of the pull of plasma proteins. ONSET OF MEDICATION FIRST-PASS EFFECT Refers to when the medication first begins to take effect. Happens when the drug is taken per orem. A large percentage of the oral dose is destroyed at this point and never reaches the tissues. MECHANISM OF ACTION BLOOD BRAIN BARRIER Term used to describe how a drug or other substance produces an effect in the body. Course of mechanism in your body. A protective system of cellular activity that keeps substances away from the CNS. Drugs that are not lipids soluble are not able to pass the BBB. SIDE EFFECTS PLACENTA AND BREAST MILK Undesirable expected effects of the drug The nurse must always check the the ability of a Three common side effects: NVD drug to pass into the breast milk when giving a 1. N - Nausea drug to a breat-feeding mother 2. V - Vomiting 3. D - Diarrhea Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM Liver ADVERSE EFFECTS Injury renal injury Poisoning Undesired unexpected effects that may be unpleasant or dangerous. They can occur for BLOOD DYSCRASIA many reasons including: 1. The drug may have other effects on the body besides the therapeutic effect. Bone marrow suppression caused by drug 2. The px is sensitive to the drug being given. effects. 3. The drug's action on the body causes other Any abnormality in the blood. responses that are undesirable. Example: 4. The px is taking too much or too little of the drug ○ Pancytopenia - low level of all blood leading to adverse effects cells (RBCs, WBSs, platelets) ○ Neutropenia - low level of neutrophils ○ Leukopenia - low white blood cell count 1. PRIMARY ACTION The desired therapeutic effect. NURSING PHARMACOLOGY 2. SECONDARY ACTION NURSING RESPONSIBILITIES Primary effect + beneficial or harmful effect 1. Administering drugs. hypersensitivity. 2. Assessing drug effects. 3. Intervening to make the drug regimen more tolerable. HYPERSENSITIVITY 4. Providing px teaching about drugs and the drug regimen. Some pxs have an unusually strong reaction to 5. Monitoring the overall px care plan to prevent a drug. medication errors. Can depend on the dosage of the drug; the higher the dose, the more susceptible you are to hypersensitivity. SOURCES AND EVALUATION OF DRUGS ○ Develops rash, urticaria SOURCES OF DRUGS DRUG ALLERGY Chemicals that might prove useful as drugs can come from many natural sources, such as The body's immune system reacts to a specific plants, animals, or inorganic compounds, or they drug. may be developed synthetically. Involves immune system, allergic since birth. 1) PLANTS TYPE OF DRUG ALLERGIES Plants and plant parts have been used as 1. Anaphylactic Reaction medicines. 2. Cytotoxic Reaction - immune system ○ e.g., Digitalis products used to treat 3. Serum Sickness Reaction - involves tissues cardiac disorders ; Opiates used for 4. Delayed Allergic Reaction sedation Drugs may also be processed using a synthetic version of the active chemical found in a plant ADVERSE EFFECTS ○ e.g., Marijuana leaf; a synthetic version allows for an accepted form to achieve DERMATOLOGICAL REACTIONS the desired the therapeutic effect in cancer patients Rash Hives 2) ANIMAL PRODUCTS Stomatitis - singaw Used to replace human chemicals that are not SUPERINFECTIONS produced because of disease or genetic problems. The normal flora that protects the body from ○ e.g., Insulin as tx for diabetes (from invasion of bacteria, viruses, fungi, etc. is pancreas of cows and pigs) destroyed. (antibiotics) GENETIC ENGINEERING - the process of altering the TOXICITY DNA to produce a substance. Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM 3) INORGANIC COMPOUNDS PHASE 2 STUDIES Salts of various elements can have therapeutic Allow clinical investigators to try the drug in pxs effects in the human body. who have the disease that the drug is meant to e.g., treat. 1. Aluminum - decrease gastric acidity. Reasons chemicals are dropped from the 2. Fluoride - prevention of dental cavities, process: prevention of osteoporosis. 1. It is less effective than anticipated. 3. Iron - tx of iron deficiency anemia. 2. Too toxic when used with patients. 4. Gold - tx of rheumatoid arthritis. 3. Produces unacceptable adverse effects. 4. Has a low benefit-to-risk ratio. SYNTHETIC SOURCES PHASE 3 STUDIES Scientists use genetic engineering to alter bacteria to produce chemicals that are therapeutic and effective. Prescribers observe px very closely for any Alter chemicals with proven therapeutic adverse effects. effectiveness to make it better. Prescriber's ask pxs to keep journals and record any symptoms they experience. Prescribers then evaluate the reported effects to DRUG EVALUATION determine whether they are caused by the disease or by the drug. PRECLINICAL TRIALS Information are collected and shared with the FDA. Chemicals may have therapeutic value and are tested on animals. TWO PURPOSES: 1. To determine whether they have the presumed effects in living tissue. 2. To evaluate any adverse effects. AT THE END OF CLINICAL TRIALS, CHEMICALS ARE DISCARDED FOR THE FOLLOWING REASONS: 1. The chemical lacks therapeutic activity when used with living animals. 2. The chemical is too toxic to living animals to be worth the risk of developing into drugs. 3. The chemical is highly teratogenic (harmful to the fetus). 4. The safety margins are so small that the chemical would not be useful in the clinical setting. DRUG EVALUATION PHASE 1 STUDIES TWO Use healthy human volunteers to test the drugs. Trials are performed by specially trained clinical investigators reasons chemicals are dropped from the the process: 1. They lack therapeutic effects in humans. 2. They cause unacceptable adverse effects. 3. They are highly teratogenic. 4. They are too toxic. 11 Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM NURSING PROCESS IN PHARMACOLOGY By: Ms. Christine Epilepsia, MSN, RN NURSES TIME ALLOCATION ON COMMUNICATION: HANDS ON TASKS AND LOCATIONS On average, in a 4 hour observations, nurses spent: 1. Communication: a. With patients (29.99 mins) b. Other nurses (26.68 mins) 2. Hands-on Tasks: a. Charting in HER - electronic health record (31.63 mins) b. Reviewing EHR (21.51 mins) c. Medication administration (15.70 mins) d. Getting medications (8.15 mins) e. Speeding on delegable tasks (13.52 mins) 3. Locations: a. Nurses at the patient's room (60.17 mins) b. Nursing station (53.55 mins) Summary: it's hard to be a nurse so you have to master communication in order to be diligent. QSEN (Quality Safe Education for Nurse) GOAL: SAFE, TIMELY DELIVERY OF DRUG ADMINISTRATION 1. ASSESSMENT Illness and drug regimen - medication, health problems, lifestyle: ○ Current history (health assessment, labs) & family history ○ Swallowing problems ○ s/s (signs and symptoms) ○ Concerns: side effects, OTC remedies, contraceptives, attitudes & belief ○ Allergies ○ Financial barriers ○ Dietary barriers ○ Caregiver needs and support (order, prepare, organize) Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM 4. IMPLEMENTATION OF NURSING INTERVENTION Education, Drug administration and Patient care 1. Assessment of Drug Effectiveness 2. Education/ Teaching a. Timing.... What is the best time to learn b. Barriers to learn c. Educational level i. Consistency to adherence (are they really listening) ii. Dose is adjusted iii. Pregnancy iv. Added supplement/ OTC meds v. Side effects vi. Self-administration (eye/ nose/ oral buccal/ suppository, SQ, Inhaler (return demo) 3. Patient Care a. Drug box b. Recording sheet/ Alarm reminder device 5. EVALUATION Determining if goals are met Ongoing assessment Revision of objective, plans , intervention If met, document successful attainment of Nursing plan of care 2. NURSING DIAGNOSIS Examples: Pain (Acute or Chronic) related to surgery Confusion, acute, related to adverse reaction to medication Knowledge, deficient related to effects of anticoagulants Noncompliance related to forgetfulness (especially on the elderly) (knowledge deficit) 3. PLANNING Patient-centered (Collaboration of patient and family) SMART (Specific, Measurable, Attainable, Realistic, Time-bound) Examples: The patient will independently administer the prescribed dose of 4 units of regular insulin by the end of the 3rd session of instructions The patient will prepare a 3 - day medication recording sheet that correctly reflects the prescribed medication schedule at the end of the second session of instructions. Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM MEDICATION ADMINISTRATION By: Ms. Christine Epilepsia, MSN, RN Usually the brand name has an encircled letter ‘R’ raised in the end (ex. Pretendmed); the one that doesn't have is the generic name (ex. Fauxpharmoide). When asked for the dosage strength answer 250mg per capsule or if syrup 2mg/5ml (stated in the medication). PRINCIPLES IN ADMINISTERING MEDICATION Observe the "10 Rights" of drug Administration. Practice asepsis. Nurses who administer medications are responsible for their own actions. Be knowledgeable about the medications that you administer (Never give an unfamiliar medication, not clearly labeled containers). Use only medications that are in clearly labeled containers (Re-labeling of drugs is the responsibility of the pharmacist. Return liquid that is cloudy in color to the pharmacy. Before administering the medication, Identify the client correctly. Do not leave the medication at the bedside. Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM The nurse who prepares the drug administers DERMATOLOGIC it. If the client vomits after taking the meds, report this to the nurse in-charge or physician. Includes lotions, liniments & ointments Pre-op meds are usually discontinued during Wash & pat dry area well before application to post-op periods. facilitate absorption Narcotics kept are locked. Use surgical asepsis when an open wound is When the meds are omitted for any reason, present record the fact together with the reason. Remove previous —- When the meds error is made, report Apply only a thin layer of meds to prevent immediately to the nurse in-charge / physician. systemic absorption Use gloves when applying the meds over a large surface ROUTE OF DRUG ADMINISTRATION INSTILLATIONS Oral Sublingual Buccal Liquid medications usually administered as Topical drops, ointments or sprays: Rectal ○ Eyedrops Parenteral ○ Eye ointments ○ Ear drops ○ Nose drops and sprays EYE DROPS OINTMENTS Position client (sitting or lying) Instill eye drops into lower conjunctival sac Avoid dropping a solution onto the cornea directly, it causes discomfort Instruct the client to close the eyes gently 1-2 mins Position client & explain to help not to blink Squeeze strip of ointment (about ¼) onto conjunctival sac Close eyes 2-3 min Instruct for blurred vision for a short time Never crush enteric-coated or sustained release tablets can cause mucositis or OTIC gastric irritation (bc its absorption is fast). Higher than expected initial level of meds & a Includes instillations & irrigations shorter that expected duration of action. INSTILLATION ○ To soften earwax ○ To reduce inflammation & treat infection SUSTAINED RELEASE TABLETS ○ To relieve pain IRRIGATION Mucositis or gastric irritation. ○ To remove cerumen or pus Higher than expected initial level of meds. ○ To apply heat Shorter than expected duration of action. ○ To remove foreign body EARDROPS Affected on the top TOPICAL ROUTE OF DRUG ADMINISTRATION Ensure drugs at room temp Sit up, head tilted toward the unaffected side Dermatologic Straighten the ear canal: Ophthalmic ○ 0-3 years old: pull pinna downward & Otic backward Nasal ○ Older than 3: pull pinna upward & Inhalation backward Vaginal Instill ear drops on the side of the auditory canal Press gently but firmly a few times in the tragus Remain in side lying for about 5 min Insert a small piece of cotton fluff loosely Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM Irrigating container should be 30 cm (12 inches) above Ask the client to remain in bed for 5-10 minutes following administration of vaginal suppository, NOSE DROPS OR SPRAYS cream, foam, jelly or irrigation Advice to blow nose RECTAL Tilt head back for drops to reach the frontal sinus and tilt the head to the affected side Administer ordered # of drops or sprays w/o Insert the suppository, pointed end first, about touching tip to nasal passages 1/2 to 1 inch in infants and 1 inch in adults Spray to sinuses, instruct to close one nostril, Refrigerate suppository position head, looking down at the feet with the breathe through the mouth (so that the sphincter spray tip aimed toward the eye will relax) Remain in lateral position 20 mins after administration INHALATION PARENTERAL Use of nebulizers, metered-dose inhalers (MDI) Shake the canister several times Types of Injection Routes: Instruct client to hold breath for 10 seconds Intradermal Administer bronchodilator before other inhalation Subcutaneous meds Intramuscular Instruct client to rinse mouth, if steroid had Intravenous been administered to prevent oral fungal Intraarterial infection intraosseous SUPPOSITORIES GENERAL PRINCIPLES IN PARENTERAL MEDICATION ADMINISTRATION: Drug order VAGINAL Respect Asepsis DRUG FORMS: Materials Tablet Techniques Liquid (douches) Documentation Cream Jelly INTRADERMAL (ID) Foam Suppository - Use of applicator or sterile gloves for The administration of a drug into the dermal vaginal administration of medications. layer the skin beneath the epidermis Solid /oval shaped are stored in refrigerator Creams and jellies inserted with an applicator The sites are the inner lower arm, upper chest & back, & Placed in lithotomy position beneath scapulae: Remain in bed for 5-10 minutes Indicated for allergy & tuberculin testing & for vaccinations ADVANTAGES Use left arm for tuberculin tests & right for all Provides local therapeutic effect other tests Use the needle gauge 25, 26, 27 DISADVANTAGES ○ Needle length 3/8", 5/8" or ½/2" Has limited use Needle at 10-15 degree angle, bevel up Use left arm for tuberculin tests & right for all other tests VAGINAL IRRIGATION Inject a small amount of drug slowly over 3-5 seconds to form wheal or bleb. The washing of the Vagina by a liquid at low Do not massage the site of injection pressure Also called douche SUBCUTANEOUS (SC) Empty the bladder before the procedure Position & drape the client Drugs administered subcutaneously are as follows: INSTILLATION: back-lying position with knees flexed & ○ Vaccines hips rotated laterally IRRIGATION: back-lying position with the hips higher than the shoulders (use bedpan) ○ Preoperative meds Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM ○ Narcotics DORSOGLUTEAL SITE ○ Insulin ○ Heparin Use the gluteus medius muscle The sites are: Position of the client is similar to Ventrogluteal ○ The outer aspects of the upper arms, site ○ Interior aspect of the thighs Site should not be used for infants & under 3 ○ Abdomen years ○ Scapular areas of the upper back Locating this site is to divide the buttocks into ○ Ventrogluteal areas four quadrants ○ Dorsogluteal areas The upper outer quadrant is the injection site Only small doses of meds should be injected via Palpate the crest of the ilium to ensure that the SC route (0.5 to 1 ml) site is high enough Rotate sites of injection to minimize tissue ○ Avoid hitting the sciatic nerve, major damage blood vessel or bone by locating the site Needle length & gauge are the same as for ID properly injections Use 5/8" needle for adults when the injection is administered at 45 degree angle, ½2" is used to VASTUS LATERALIS a 90 degree angle For thin patients: 45 degree angle Recommended site for injection for infants For obese patients: 90 degree angle Located at the middle third of the anterior lateral For heparin injection, don't aspirate & massage aspect of the thigh For insulin injection, don't massage & inject to Assume back-lying or sitting position 90 degree angle ○ Middle 3rd of the thigh Adjust the length of the needle depending on the size of the client for insulin administration RECTUS FEMORIS SITE For other meds, aspirate before injection of meds to check if blood vessels had been hit. Located at the middle third, anterior aspect of ○ Added note: Insulin syringe can be used with the thigh a 90° or 45° angle for it has a shorter needle. INTRAMUSCULAR (IM) Z-TRACK TECHNIQUE Into the muscle (IM) Used for parenteral iron preparation Best site: Upper outer quadrant and left buttocks Retract the skin laterally, inject the meds slowly Needle is 1”, 1 1⁄2”, 2” – to reach the muscle Hold the retraction of skin until the needle is layer withdrawn Use needle gauge 20, 21,22 & 23 – depending Do not massage the site injection on the viscosity of meds Clean the injection site with alcohol swab Inject, Aspirate (to check for blood) and Inject INTRAVENOUS (IV) the meds slowly to allow the tissues to accommodate the volume Direct IV, IV push and IV Infusion Most rapid route of absorption of meds SITES FOR IM INJECTION: Predictable, therapeutic Blood levels of meds Ventrogluteal site can be obtained Dorsogluteal site The route can be used for patients with Vastus lateralis site compromised GI function or peripheral Rectus femoris site circulation Deltoid site (most common) Larger doses of meds can be administer VENTROGLUTEAL SITE (von Hochstetter’s site) Use gluteus medius which lies over the gluteus minimus muscle The area contains no large nerves or BV & less fat Farther from the rectal area, less contaminated Position the client in prone /side lying – relaxes the gluteus muscles ○ Prone ○ Curl the toes inward ○ Side-lying ○ Flex the knee & hip Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM DRUG CALCULATION By: Ms. Christine Epilepsia, MSN, RN 3. IV flow rates Calculating fluid volume received hr KULANG APPROXIMATE EQUIVALENT 1 G = gr xv 1 gr = 60 mg 1 dram = 1 tsp = 4-5 ml = 4-5 cc 1 ounce = 30 ml 1 qt = 1000 ml 1mL = 15-16 minims = 15-16 gtts 1G = 1mL Insulin: Insulin injections: Order: Units 60 NPH SC qd If insulin, just aspirate using injection Important: Regardless of the source of an error, if you CALCULATING FLOW RATE administer the wrong dosage you are legally responsible. 3 step method: 1. cc/hr = total fluid divided by # of hours Never assume what an order states!......Clarify an order 2. cc/min = cc/hr divided by 60 min/hr when in doubt 3. FR (gtt/min) = cc/min x drop factor CALCULATIONS OF ORAL MEDICATIONS Formula method Shortened method Desired —------- X quantity = amount of Have Convert to same weight (or unit) of measurement Estimate dose 1. Order: Cloxacillin sodium 0.25 g Stock: 125 mg per 5 ml = 250 divided by 125 mg x 5 ml 2. Order: Furosemide 24 mg po qd Stock: 10mg/mL = 24/ 10 x ano ang quantity Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM UNDERSTANDING NEUROPHARMACOLOGY: ★ ANS MEDICATIONS Exploring the ANS, PNS, and CNS By: Ms. Yedda Nobelle B. Villaruel, RN, USRN Regulation of the heart, regulation of secretory glands (salivary, sweat, gastric bronchial glands), regulation of Nervous System - complex of networks from brain to smooth muscles (bronchi, blood vessels, urogenital, GI system. tract). Sympathomimetics (Adrenergic Agonists) ★ (mimics sympathetic), increases epinephrine Parasympathomimetics (Cholinergic Agonists) ★ (mimics parasympathetic) Sympatholytics (Adrenergic Antagonists) Parasympatholytics (Anticholinergics) ★ Lytic (inhibit) Agonist - Bida Antagonist - Kontrabida MIMICS EACH SYSTEM SYMPATHOMIMETIC PARASYMPATHOMIMETIC (Adrenergic Agonist (Cholinergic drugs) releases drugs) - Epinephrine & Acetylcholine that is Norepinephrine) = responsible to activate the muscarinic receptors Treatment for Shock, Hypotension and Asthma Exacerbation DOBUTAMINE PYRIDOSTIGMINE = Tx for DOPAMINE Myasthenia Gravis NOREPINEPHRINE Myasthenia Gravis is a EPINEPHRINE decrease in Acetylcholine: BETA 2 ADRENERGIC Cholinergic Fibers in Post AGONISTS ganglionic membranes Sensory - to the brain | Motor - away from the brain Side effects: ⬆ ALL HIGH Side effects: ⬇ ALL LOW except GIT/ GUT except GIT/ GUT Memorize this: “Sympa” - stimulates adrenergic fibers. “Para” - stimulate cholinergic fibers. SYMPATHETIC PARASYMPATHETIC (Fight or Flight) (Rest and Digest) Hypertension Bronchoconstriction Bronchodilation Bradycardia Tachypnea Urinary urgency Increase adrenaline Diarrhea Pupil dilation (Mydriasis) Hypersalivation Decreased saliva production Lacrimation Slows digestion Increases digestion Parasympathetic (P is Pahuway) - all is low except GIT & GUT Increased alertness Resting Sympathetic (S is Stress) - all is high except GIT & GUT Ejaculation Erection Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM Para Effect Thinking SYMPATHOMIMETICS (Adrenergic Agonists) PARASYMPATHOMIMETICS Stimulate the Adrenergic receptors (alpha & beta receptors) (Cholinergics) System that releases Acetylcholine that activates muscarinic ) receptors Mechanism of Action: Treatment for Shock, PRODUCE 3S SECRETIONS Hypotension and Asthma Exacerbation Side effects: 1. Lacrimation (SEE / Teary eye) ALPHA BETA 2. Hypersalivation - Secretory glands (SPIT) Alpha-1 Agonists: Beta-1: cardiac function, 3. Increase Urinary frequency & Bowel Function contraction of smooth muscle increasing heart rate and (SHIT) in blood vessels and contractility. increased systemic vascular resistance. ADVERSE EFFECTS Alpha-2 Agonists: acts on Beta-2: affects the bronchial Hypotension the central nervous system to smooth muscle, leading to Bradycardia reduce sympathetic outflow, bronchodilation, and can also Cholinergic toxicity - DOB (difficulty of resulting in decreased blood affect uterine and vascular breathing), decrease HR and excessive tearing pressure and heart rate. smooth muscle. and sweating Phenylephrine (a1 agonist) Contraindications: not given with genitourinary - increases BP and nasal Dobutamine (b1 agonist) - and gastrointestinal obstruction, asthma, copd, decongestant increase heart contractility parkinsons and seizures Epinephrine (a1,a2,b1 and Dopamine (b1 agonist) - NURSING CONSIDERATIONS b2) - increases HR & BP and increase BP and renal bronchodilators perfusion Review Laboratories - urinalysis and fecalysis Assess urinary status Norepinephrine (a1 & b1) - Albuterol (Salbutamol) (b2 Increase fluid intake and empty every 4 hours increase BP & cardiac output agonist) - acute asthmatic Teach the patient about common side effects like attacks diarrhea, urinary frequency, bradycardia Side Effects: ⬆ ALL HIGH Side effects: ⬇ ALL LOW SYMPATHETIC PARASYMPATHETIC except GIT/GUT “Fight or Flight” “Rest and Digest” except GIT/ GUT ⬆ ALL HIGH except ⬇ ALL LOW except GIT/GUT GIT/GUT CONTRAINDICATIONS Sympathomimetic effect: Parasympathomimetic Hypertensive patients Epinephrine effect: Pregnant and breastfeeding mothers Adrenaline Pyridostigmine Those with coronary artery disease Ephedrine Tachyarrhythmias Anticholinergic (DRY) Cholinergic (WET) Ventricular Fibrillation Angina Pectoris Ex. Atropine - tx of Ex. Pilocarpine - tx of bradycardia and glaucoma pre-anesthetic to prevent INTERACTIONS salivation during surgery Rivastigmine Donepezil Combining sympathomimetics leads to Scopolamine - tx of motion Galantamine sympathomimetic toxicity and cardiac problem sickness, nausea, and - tx of Alzheimer’s disease vomiting - Acetylcholinesterase (increase ACETYLCHOLINE NURSING CONSIDERATIONS Oxybutynin - tx of levels) overactive bladder Monitor Hemodynamic Status Titration of doses Benztropine - tx of Monitor Side effects parkinson's symptoms STIMULATES (by Acetylcholine) INHIBITS EACH SYSTEM Muscle Movement Muscle Memory Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM SYMPATHOLYTIC PARASYMPATHOLYTIC 3. MAOI (Monoamine Oxidase Inhibitor) (Adrenergic Agonists) - (Anticholinergic) - paRnate (Tranylcypromine) blocks the release of stops/blocks the release of naRdil (Phenelzine) Norepinephrine Acetylcholine = Tx for Asthma & COPD maRplan (Isocarboxazid) = Tx for Hypertension & R in the middle Anxiety WOF: Hypertensive Crisis BETA BLOCKERS Airway: Ipratropium for Avoid TYRAMINE FOODS: (ABC) Ex. Propranolol (Bronchodilation) of the lungs Aged Cheese/Avocado Atropine: Increases HR and Beer/Banana dilation of pupils after surgery Canned foods/Chocolates Side effects: ⬇ HR, BP, Side effects: ⬆ HR, Pupil & Bronchoconstriction Dilation after surgery ANTIPSYCHOTICS / NEUROLEPTICS / MAJOR TRANQUILIZERS 1. TYPICAL (Old Generation) ★ CNS MEDICATIONS azine/ peridol ○ Haloperidol Antidepressants ○ Droperidol Antipsychotics Anxiolytics Mood Stabilizers 2. ATYPICAL (New Generation) Stimulants Substance Abuse: Uppers and Downers done/ pine Antiepileptics ○ Clozapine Anti-Parkinson's ○ Clozapine Sedatives & Hypnotics ○ Quetiapine (seroquel) ○ Risperidone ANTIDEPRESSANTS Side effects Are a type of medicine used to treat clinical depression, OCD and PTSD. EPS (Extrapyramidal Syndrome) (APAT) 1. SSRI - Selective Serotonin Reuptake ○ Acute Dystonia (Twitching or Twisting of Inhibitor (-ine) extremities) ○ Pseudoparkinsonism (Mimics signs and Zoloft (Sertraline) symptoms of Parkinson’s diseases) Prozac (Fluoxetine) ○ Akathisia (Restlessness) Paxil (Paroxetine) ○ TardiveDyskinesia(Repetitive movements especially in the mouth, eyes, etc.) Side effects Adverse Effects (starts with S) 1. Sexual Dysfunction 2. Seizure NMS (Neuroleptic Malignant Syndrome or 3. Serotonin Toxicity Malignant Hyperthermia) (FEVER) ○ Fever 2. TCA - Tricyclic Antidepressants ○ Elevated: (-triptyline/pyramine) VS (vital signs) Enzymes Clomipramine (Anafranil) ○ Risk for Seizure Elavil (Amitriptiline) Desipramine (Norpramin) Tofranil (Imipramine) ANXIOLYTICS / BENZODIAZEPINES Ana, ami, nora, imi pam/ zolam/ zepine ○ Diazepam (Valium) Side effects ○ Alprazolam (Xanax) (TCA - starts with C) ○ Lorazepam (Ativan) 1. Cardiotoxicity ○ Clonazepam (Rivotril) (elderly) 2. Cardiac Arrhythmias ○ Midazolam (Versed) (Tubed patients) Baldevieso, Ballaret, Geanga, Lim, Perpetua, Lozada, Artus, Aviador , Jimenez, Bajade, Julleza, De la Paz  NCM 106A - PHARMACOLOGY BSN 2 | 1st Semester - PRELIM Side Effects ○ Dizziness ○ Drowsiness ○ Confusion ○ Hypotension Nursing Responsibilities ○ Do not drive ○ Take before meals ○ Taper the dose to prevent withdrawal symptoms: Coarse tremors,Seizures and delirium ○ Taper the dose for 2 weeks ○ Withdrawal symptoms: Tremors, Seizure and Delirium Antidote: Flumazenil Taper the dose for 2 weeks Withdrawal symptoms: Tremors, Seizure and Delirium MOOD STABILIZERS / ANTI MANIC Lithium/ Eskalith ○ Therapeutic Level: 5 --1.2 mEq/L ○ Elderly: