Pharmacology Unit 1 TL 9-8-2024 2 PDF

Section 1 Introduction to Nursing Pharmacology Prof. LaFlam Chapters 1-8 1 Pharmaceutic, Pharmacokinetic, Pharmacodynamic A tablet or capsule taken by mouth goes thru 3 phases – Pharmaceutic, Pharmacokinetic, Pharm...

Section 1 Introduction to Nursing Pharmacology Prof. LaFlam Chapters 1-8 1 Pharmaceutic, Pharmacokinetic, Pharmacodynamic A tablet or capsule taken by mouth goes thru 3 phases – Pharmaceutic, Pharmacokinetic, Pharmacodynamic  Pharmaceutic  drug becomes a solution so that it can cross the biologic membrane (breakdown); this phase occurs in the GI tract-oral medications  Pharmacokinetics  how medications travel through the body  composed of absorption, distribution, metabolism, excretion  Pharmacodynamics  biologic or physiologic result occurs (intended)  IM/SC/IV = no pharmaceutic phase – WHY? 3  Pharmaceutic  Disintegration and dissolution 2 Pharmaceutic Phases Are Disintegration and Dissolution.  Drug absorption  Drug movement from GI tract into bloodstream  Disintegration  Breakdown of oral drug form into small particles  Dissolution  Process of combining small drug particles with liquid to form a solution 4  Absorption  Processes of drug absorption GI tract, muscle, skin, mucous membranes, subcutaneous tissue to bloodstream Most common routes of administration are enteral (through GI tract) & parenteral (by injection)  Water-soluble & lipid-soluble drugs dissolve in water, such as antihypertensive atenolol, tend to stay within blood & fluid that surrounds cells dissolve in fat, such as antiseizure drug Dilantin, tend to concentrate in fatty tissues 3 Major Processes for Drug Absorption Through GI Membrane Are Passive Absorption, Active Absorption, & Pinocytosis  Affected by drug form, route of administration, GI mucosa & motility, food & other drugs, & changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow 5  Distribution  Transportation of drugs to sites of action by bodily fluids Plasma protein binding: Drugs compete for protein binding sites within bloodstream, primarily albumin. Permeability of cell membrane: Ability of drug to bind to protein can Medication must be able to pass affect how much of drug will leave & through tissues & membranes to travel to target tissues. reach its target area. 2 drugs can compete for the same Lipid-soluble drugs or have a binding sites, resulting in toxicity. transport system can cross the Drug Crossing the Placenta. blood-brain barrier & placenta. Drug Movement Across the Blood-Brain Barrier. 6  Metabolism (Biotransformation)  Biotransformation  changes medications into less active or into inactive forms by the action of enzymes  occurs primarily in LIVER also takes place in kidneys, lungs, intestines, & blood  Half-life (t½) refers to time for drug in body to drop by 50% Liver & Kidney function affect half‑life It takes 4 half‑lives to achieve a steady blood concentration (medication intake = medication metabolism & excretion) SHORT HALF‑LIFE  Drugs leave the body quickly (4 - 8hr) LONG HALF‑LIFE  Drugs leave body more slowly: over >24hr  A greater risk for drug accumulation & toxicity  Excretion  Elimination of drugs from body  Primarily through KIDNEYS Creatinine clearance  also takes place through liver, lungs, intestines, & exocrine glands (breast milk)  Kidney dysfunction can lead to an increase in duration & intensity of drug’s response, so it is important to monitor serum BUN & creatinine levels. 8  Pharmacodynamics  Study of the way drugs affect the body interactions between medications & target cells, body systems, & organs to produce effects  Primary effect is desirable.  Secondary effect may be desirable or undesirable. 9  Pharmacodynamics-the effects of drugs  Dose response & maximal efficacy  Onset, peak, & duration of action Time-Response Curve Evaluates 3 Parameters of Drug Action. (1) Onset (2) Peak 10 (3) Duration  Pharmacodynamics Receptor theory  Agonists & Antagonists Agonists  drugs that bind to or mimic receptor activity that endogenous compounds regulate  Morphine is an agonist b/c it activates receptors that produce analgesia, sedation, constipation. (Receptors are the drug’s target sites on or within the cells) Antagonists  drugs that can block usual receptor activity that endogenous compounds regulate or the 2 Drug Agonists Attach to the Receptor Site. receptor activity of other medications The drug agonist that has an  Losartan, angiotensin II receptor blocker, is an exact fit is a strong agonist & is antagonist. It works by blocking angiotensin II more biologically active than receptors on blood vessels, which prevents the weak agonist. vasoconstriction. 11 11  Pharmacodynamics (Cont.)  Nonspecific drug effect- can be beneficial or have adverse effect Cholinergic Receptors Are Located in Bladder, Heart, Blood Vessels, Stomach, Bronchi, and Eyes.  Nonselective drug effect- affect tissues or organs they were not intended to effect Epinephrine Affects 3 Different Receptors: Alpha1, Beta1, Beta2. 12  Therapeutic Index Therapeutic Index measures the margin of safety of a drug. It is a ratio that measures the effective therapeutic dose and the lethal dose. Low Therapeutic Index Drug Has a Narrow Margin of Safety. The drug effect should be closely monitored. High Therapeutic Index drug has a wide margin of safety & carries less risk of drug toxicity. 13  Peak & Trough Levels Peak drug level  Highest plasma concentration of drug at a specific time.  Indicates rate of absorption.  Blood sample should be drawn at the proposed peak time, according to the route of administration. Trough drug level  Lowest plasma concentration of a drug.  Measures rate at which drug is eliminated.  Blood sample are drawn immediately before next dose of drug is given, regardless of route of administration. 14  Loading Dose  Used when immediate drug response is desired  Large initial 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.  Digoxin (Lanoxin, Digitek, Lanoxicaps): Digitalization  Cardiac glycoside Decrease heart rate 15  Side Effects Adverse Reactions  Physiologic  More severe than side effects effects not related  Range of untoward effects to desired drug (unintended & occurring at effects normal doses) of drugs that cause mild to severe side  All drugs have effects Anaphylactic Shock desirable or  Anaphylaxis symptoms: Swelling of face, mouth, undesirable side throat Difficulty breathing effects. Rapid HR, Low BP  Are always undesirable Cardiac arrest  Difference terms  Must always be reported & side effects & documented b/c they represent adverse reactions variances from planned therapy 16  Toxic Effects, or Toxicity  Identified by monitoring plasma (serum) therapeutic range of the drug  Wide therapeutic index– therapeutic ranges are seldom given  Narrow therapeutic index– therapeutic ranges are closely monitored (digoxin, aminoglycoside antibiotics & anticonvulsants)  Drug level exceeds the therapeutic range– toxic effects are likely to occur from overdosing or drug accumulation 17  Pharmacogenetics  Scientific discipline studying how the effect of a drug action varies from a predicted drug response because of genetic factors or hereditary influence  African Americans do not respond as well as Caucasians to some classes of antihypertensive medications, such as ACE inhibitors 18  Tolerance & Tachyphylaxis  Tolerance a decreased responsiveness over the course of therapy  Tachyphylaxis rapid decrease in response to the drug Drug categories that can cause tachyphylaxis include narcotics, barbiturates, laxatives, & psychotropic agents 19 3 Phases of Drug Action 20 Determinants That Affect Drug Therapy 21  Nurse’s Role in Medication Safety Rights of Medication Administration 1. Right drug 2. Right patient 3. Right dose 4. Right route 5. Right time 6. Right reason 7. Right documentation 22 22 Drug Approval Process 23 23  Drug Standards & Legislation  Brief history of pharmacology  Nurse Practice Act- nurses can be prosecuted for med errors  Drug standards and legislation  Drug standards United States Pharmacopeia National Formulary (USP-NF) The International Pharmacopeia  Federal legislation 1938: Food, Drug, and Cosmetic Act 1952: Durham-Humphrey Amendment to the 1938 Act 1962: Kefauver-Harris Amendment to the 1938 Act  The Controlled Substances Act of 1970  1978: Drug Regulation Reform Act  1992: Drug Relations Act  1997: Food & Drug Administration Modernization Act  2003: Health Insurance Portability and Accountability (HIPAA)  2003: Pediatric Research Equity Act  2003: Medicare Prescription Drug Improvement & Modernization Act (MMA)  2007: Food and Drug Administration Amendments Act  2009: Family Smoking Prevention & Tobacco Control Act  2010: Patient Protection and Affordable Care Act  2012: Food and Drug Administration Safety and Innovation Act (FDASIA) 24  Legislation  Nurse Practice Act  Misfeasance Negligence-improper action – Giving the wrong drug, route, or dose that results in patient’s harm or death (unintentional)  Nonfeasance Omission – Omitting a drug dose or not administering meds at prescribed time; an adverse reaction due to delayed treatment  Malfeasance Giving correct drug via wrong drug, route or dose that results in harm or death which is considered medical malpractice due to negligence or non-action (this could be intentional) 25  Drug Names  Chemical names  describes chemical properties  Generic names  official, nonproprietary name for the drug  is not owned by any drug company & is universally accepted Ibuprofen acetaminophen  Brand (trade) names  AKA the proprietary name  is chosen by the drug company & is usually a registered trademark ® symbol owned by that specific company  Brand names must be capitalized. Motrin Tylenol 26 26  Nursing Process  Assessment  Assess cultural & racial background  Planning  Collaborate w/ patient to reduce high-risk health behaviors  Nursing interventions  Incorporate nonharmful traditional practices w/ biomedical prescriptions  Patient teaching  Involve family in teaching about prescriptive therapies  Evaluation  Patient correctly demonstrates understanding of prescriptive 27 therapies & treatments. 27  Drug Interactions & Over-the-Counter (OTC) Drugs 28  Drug Interactions  Altered or modified action or effect of a drug as a result of interaction with 1 or multiple drugs  Adverse drug reaction  Undesirable drug effect that ranges from mild untoward effects to severe toxic effects *hypersensitivity reaction & anaphylaxis  Drug incompatibility  Chemical or physical reaction that occurs among 2 or more drugs “outside the body” –the reaction would occur with 2 drugs inside a syringe or IV bag 29  Pharmacodynamics  Additive drug effect 2 similar drugs to achieve same therapeutic effect while reducing specific adverse effect of a particular drug  Synergistic drug effect or potentiation interaction of 2 or more drugs when their combined effect is greater than the sum of the effects seen when each drug is given alone  Antagonistic drug effect stops the action or effect of another substance  Drug-food interactions  Food is known to increase, decrease, or delay drug absorption  Food can bind w/ drugs causing less or slower drug absorption  Grapefruit should be avoided w/ statins (atorvastatin) which will lead to higher levels & more side effects. 30 30 Drug Interactions (cont.)  Drug-laboratory interactions  Drug-induced photosensitivity  Over-the-counter (OTC) drugs  OTC drug categories  cold & cough remedies  sleep aids  Category I: Safe & effective  weight-control drugs  Category II: Unsafe & ineffective  Category III: Insufficient data to judge 31 31  Cautions with Use of OTC Medications  OTC drugs may cause delay in professional diagnosis and treatment SAFER  Symptoms may be masked. Speak up  Be sure to read labels carefully. Ask questions Find the facts  Consult health care provider before use. Evaluate choices  Inactive ingredients may cause adverse Read the labels reactions.  Be aware of potential for overdose.  Polypharmacy increases risk for drug- drug interactions (especially in the elderly) 32 Herbal Therapies 33  Herbs  Herbs  Plant or plant part used for its scent, flavor, or therapeutic properties (example: Gingkgo biloba-always  Dietary Supplement Health check with provider 1 ) st and Education Act of 1994  National Center for (DSHEA) Complementary and Alternative  Ensure products are safe and label information is Medicine (NCCAM) truthful and not misleading.  Current Good  Herbal Monographs Manufacturing Practices  Therapeutic monographs contain information on use, dosage, side (CGMPs) effects, & contraindications.  Standards require package  Qualitative monographs have labels that declare quality information on areas such as and strength of contents and compliance with compounding that product is without guidelines & standards of purity. contaminants and impurities. 34 34   Astragalus  Boosts immune system Herbal  Limits cold and flu symptoms Preparations  St. John’s Wort  Antidepressant and antiviral  Dried herbs For depression, anxiety, sleep disorders; effects in 4 to 8 weeks  Extracts  Drug interactions  Fresh herbs May cause serotonin syndrome when taken with other antidepressants; decreases INR  Oils  Salves  Licorice root  Used for bronchitis, sore throat, stomach  Teas ulcers, viral hepatitis.  Tinctures  High doses can lead to salt & water retention, HTN, low potassium level  Syrups  Valerian  Mild sedative Sleep-inducing agent “Herbal valium” “Dirty socks” odor 35 6  Aloe Vera  Green tea  External: relief of pain; promotes  Improves mental alertness, burn healing relieves headache  Internal: constipation; may cause  Protects against heart disease arrhythmias, neuropathies, & cancer, promotes weight loss edema  Adverse effects include liver dysfunction  Chamomile  Relief of digestive complaints,  Echinacea anxiety, sleeplessness, skin  Stimulates immune system conditions  For colds, flu, recurrent  May have sedative effects respiratory & UTIs  Rare allergic reactions of urticarial & bronchoconstriction if allergic to daisy or ragweed  Garlic  Used to lower cholesterol & BP  Cinnamon & heart disease, preventing  Used to treat bronchitis, GI stomach & colon cancer problems, anorexia, diabetes  Side effects may include  Generally safe without allergic heartburn, upset stomach, reactions body odor, decreased blood  May decrease blood clotting clotting 36 7  Ginger  Ginseng  Stimulates digestion  Improves well-being,  Used for nausea, motion sickness, stamina, and immune diarrhea, relieves pain, swelling, system arthritic stiffness.  Treats erectile dysfunction,  Side effects include gas, bloating, hepatitis C, menopausal heartburn, nausea symptoms, lowers glucose  Decreases platelet aggregation and blood pressure  Side effects include  Ginkgo biloba headaches, GI distress,  Used for asthma, bronchitis, fatigue, HTN, hypoglycemia, breast tinnitus tenderness, menstrual  Used to improve memory in an irregularities, allergic aging person, prevent progression of reactions Alzheimer disease  Decrease intermittent claudication.  Peppermint  Treats sexual dysfunction  Internal: stimulates appetite  Side effects include headache, & aids in digestion dizziness, nausea, GI upset,  External: relief of tension HA increased bleeding, allergic reactions when rubbed on forehead  Decreased platelet aggregation 37 11  Turmeric  Hawthorn  Used for heartburn, stomach  Used for heart disease, ulcers, gallstones, inflammation, digestive issues, kidney cancer. disease.  High doses may cause nausea,  Side effects include diarrhea headache, dizziness, nausea  Milk thistle  Saw palmetto  Used for hypercholesterolemia,  Used for urinary symptoms insulin resistance, chronic from benign prostatic hepatitis, cirrhosis, gallbladder hypertrophy, chronic pelvic disorders pain, decreased libido,  Side effects include upset migraines, hair loss stomach, hypoglycemia, allergic  Side effects include reactions digestive problems, headache  Kava kava-effects similar to ETOH  Use: relaxation, anxiety, insomnia  Adverse effects include liver damage; dry, scaly, yellowing skin; eye irritation, heart problems 38 11  Potential Hazards of Herbs  Selected Herb-Drug Interactions  No preparations safe in all situations  Anticoagulants  Contamination  Antidiabetics  Interaction with prescription &  Antihypertensives OTC drugs  Many products may interfere  Digoxin with absorption, breakdown, and excretion of anesthetics,  Corticosteroids anticoagulants, and other drugs used in surgery Discontinue herbal therapy 2 to 3 weeks before surgery 39 16  Tips for Herb Use  Do not take if pregnant or if nursing.  Do not give herbs to infants or young children.  Do not take a large quantity of any herbal preparation.  Do not delay in seeking care from HCP for persistent/severe symptoms.  Buy only products with contents & quantity listed on label.  Contact HCP before stopping prescription medication.  Store product in cool, dry place; dark glass containers are preferred.  Use only current products.  Advise against belief in “miracle cures.”  Herbs are not placebos.  There is increased risk of reactions when prescription and OTC medications with similar actions are combined with herbs. 40  Nursing Process  Assessment  Obtain baseline of pt’s use of unconventional therapeutic agents & practices.  Identify complete product information.  Identify all prescription and OTC drugs.  Interventions  Monitor pt’s response to prescription, OTC, and herbal products.  Consult with dietitian & others as appropriate.  Continue with same brand; discuss w/ HCP before changing or starting product.  Patient teaching  General  Diet  Side effects  Self-administration-empowers the patient  Evaluation 41 21 Geriatric Pharmacology 42  Geriatric Pharmacology  Polypharmacy  Aging population  Use of multiple medications  Multiple & chronic conditions  Adverse reactions  Physiologic changes  Unintended & harmful  Reduction in total body water & response to a drug lean body mass; fat to water ratio  Reduction in kidney mass & function  Reduction in liver mass & blood flow  Loss of protein-binding  Postural hypotension with sites antihypertensives  Volume depletion & electrolyte  Decline in hepatic first- imbalance with diuretics pass metabolism  Excess bleeding with anticoagulants of antiplatelets  Altered glycemic response with  Prolonged half-life of drug antidiabetics because of decreased  GI irritation with NSAIDs liver & kidney function 43  Geriatric Pharmacology (Cont.)  Pharmacodynamics  Lack of affinity to receptor sites  Age-related changes in the central nervous system (CNS)  Changes in the number of drug receptors  Changes in the affinity of receptors to drugs  Compensatory response to physiologic changes is decreased.  Effects of selected drug groups on older adults  Hypnotics  Diuretics and antihypertensives  Cardiac glycosides  Anticoagulants  Antibacterials  Gastrointestinal drugs  Antidepressants  Opioid analgesics  Adherence/nonadherence 44  Education (daily contact, insurance, therapeutic effect) 44  Generic Name Trade Name Beers List carisoprodol Soma diazepam Valium  Beers list identifies potentially flurazepam Dalmane inappropriate medications (PIMs) that hydroxyzine Vistaril, Atarax should be used with caution or should ketorolac Toradol be avoided in older adult. lorazepam Ativan meperidine Demerol  Drug references may identify a PIM by digoxin Lanoxin including wording such as “Appears on secobarbital Seconal Beers list” or “On Beers list” as part of the drug information.  Listing of some PIMs based on American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults: Example Aprazolam 45  Geriatric Pharmacology (Cont.)  Hypnotics  Diuretics & antihypertensives  Insomnia  HCTZ low dose  Low doses of benzodiazepines  Nonpharmacologic methods to reduce blood pressure  Flurazepam HCl (Dalmane)  Quazepam (Doral)  Calcium blockers, angiotensin-  Temazepam (Restoril) converting inhibitors, & A-II blockers  Triazolam (Halcion) commonly used  Estazolam  Lorazepam  Alpha1 blockers or antagonists  Oxazepam (prazosin, terazosin) & centrally acting alpha2 agonists (methyldopa, clonidine, guanabenz, guanfacine) are infrequently prescribed for older adults b/c of orthostatic hypotension 46  Geriatric Pharmacology (Cont.)  Cardiac glycosides  Anticoagulants  Digoxin (Lanoxin)  Warfarin (Coumadin)  Narrow therapeutic range  Decreased serum albumin (0.5 to 2 ng/mL)  PT and INR level 2.0 – 3.0  Possibility of digitalis toxicity  With close monitoring of  Risk for falls serum digoxin levels, creatinine clearance tests, &  Drug interactions HR >60/min), digoxin is considered safe for older adult. 47 47  Geriatric Pharmacology (Cont.)  Antibacterials  Gastrointestinal drugs  Histamine (H2) blockers,  Penicillins, cephalosporins, sucralfate, famotidine tetracyclines, & (Pepcid), & nizatidine (Axid) sulfonamides: Considered used to treat peptic ulcer safe for older adult disease  Aminoglycosides, fluoroquinolones  Cimetidine (Tagamet): Not for (quinolones), & older adults vancomycin: Not frequently prescribed for patients >  Laxatives 75 years old Enteric coated Meds-why? 48  Geriatric Pharmacology (Cont.)  Antidepressants  Opioid Analgesics  Tricyclic antidepressants Side effects include dry mouth,  Dose-related adverse tachycardia, constipation, & reactions urinary retention. Tricyclic antidepressants can  Hypotension also contribute to narrow-angle  Respiratory depression glaucoma.  Constipation  Fluoxetine (Prozac) Bicyclic antidepressant  Monoamine oxidase inhibitors (MAOIs): Not often prescribed for older adults 49  Nursing Process  Assessment  Nursing Interventions  Monitor lab results  Common potential nursing such as liver function diagnoses tests & serum  Ineffective health maintenance r/t creatinine lack of transportation  Nonadherence r/t lack of  Patient teaching insurance  General  Self-administration  Planning  Diet  The older adult will take the  Side effects prescribed medications as  Cultural considerations ordered.  The drug therapy will be effective  Evaluation with no or few side effects.  Monitor patient closely for signs of increased drug effect 50 50 Drugs of Abuse 51  Alerts and Warnings: Controlled Substances Controlled substances are drugs or therapeutic agents that have the potential for abuse & addiction and may lead to physical & mental harm; Schedule II highest potential for abuse with an accepted medical use Controlled Substances Schedule Schedule I High potential for abuse, unsafe (illegal) Schedule II High abuse potential, severe dependence risk Less potential for abuse, moderate Schedule III dependence Schedule IV Low abuse potential, limited dependence Schedule V Lower abuse potential, limited dependence 52  Alerts and Warnings: Controlled Substances (continued)  RN routinely administers controlled substances in clinical area  Identify controlled substance by letter “C” and Roman numeral (I to V) next to the drug name on drug label. letter “C” indicates that the drug is a controlled substance Roman number signifies under which schedule the drug is categorized 53  Context of Drug Abuse  Cultural considerations  Terminology of Drug Abuse  Definitions  Tolerance  Drug misuse  Craving  Drug abuse  Cue-induced craving  Drug addiction  Abstinence  Dependence  Relapse  Physical dependence 54 54  Neurobiology of Addictive Drugs  Mesolimbic system “pleasure center” or brain reward system, an ancient system that creates the sensation of pleasure for certain behaviors necessary for survival, such as eating & sexual behavior 55 55  Overview of Addictive States  Intoxication  state of being influenced or affected by a drug or other toxic substance  Detoxification  treating intoxicated patient to diminish or remove drugs or their effects from the body  Withdrawal syndrome  group of signs & symptoms that occurs in physically dependent persons when drug use is stopped  symptoms are often opposite the effects the drug produced before it was withdrawn  Cessation and maintaining abstinence  treatment with other drugs may be used to decrease craving & prevent withdrawal syndrome. 56 56  Types of Substance Use Disorders  Alcohol use disorder  Opioid use disorder  Alcohol toxicity  Effects Euphoria, tranquility, reduced  Treatments pain Inpatient or Outpatient Drowsiness, confusion Drug-assisted treatment Nausea, constipation Dose-dependent respiratory  Tobacco use disorder depression  Treatment  Treatment Drug-assisted treatment Cognitive behavior therapy  Naloxone Self-help materials  Naltrexone Drug-assisted treatment  Methadone Electronic cigarettes  Buprenorphine  Cannabis use disorder  Cough & cold products  Drug effects  Dextromorphan Psychoactive in high doses  Long-term effects  Promethazine-codeine  Limited benefits Effects: euphoria, relaxation 57 57  Stimulants  Nicotine  Most rapidly addicting of drugs of abuse Side effects/adverse reactions:  Marked cardiovascular stimulation  increased myocardial oxygen consumption  general CNS stimulation  increased respiratory rate & tremors  increased alertness & arousal  increased GI secretions & smooth- muscle tone  promotion of relaxation & relief of anxiety 58  Nicotine  Psychological dependency  Withdrawal symptoms may occur within 1st few hours after stopping smoking, peak in 24 to 48 hours, & last from a few weeks to several months.  Treatment: nicotine replacement therapy  After withdrawal (NRT) or other smoking subsides, cue-induced cessation agents are craving may cause recommended for all tobacco smoking relapse. users in addition to behavioral and support therapies. 59 59  Nicotine Replacement Smoking Cessation Agents  Bupropion (Zyban)  Gum  atypical (heterocyclic) antidepressant  Lozenges  Varenicline (Chantix)  Patch  Nortriptyline (Aventyl,  Nasal spray Pamelor)  Inhaler  clonidine (Catapres) 60 60  Cocaine  Schedule II drug under the Controlled Substances Act  Side effects/adverse reactions: At usual doses, cocaine produces euphoria & increased energy & alertness  Cocaine psychosis as well as peripheral  Acute cocaine toxicity adrenaline-like actions.  Emergency management  Cognitive-behavioral  Chronic use: therapies Impairment of concentration  Disulfiram (Antabuse) & memory, irritability & mood  Modafinil (Provigil) swings, paranoia, &  Topiramate (Topamax) depression  Ondansetron (Zofran) 61 61  Amphetamines  Synthetic drugs  Side effects/adverse reactions  Schedule II drug of the Initial effects of increased Controlled Substance Act alertness, improved performance, relief of  May be used fatigue, anorexia, & therapeutically as CNS increased HR & BP stimulants  Long-term use  More often initially used a irritability, anxiety, paranoia, & hostile & violent behaviors cheaper alternative to cocaine  Toxic reactions  Effects  “Bath salts”  Drug interactions  Treatment 62 62  Caffeine  Most widely used psychoactive substance in the world  Used to promote alertness & to alleviate fatigue  Safe in most people  “Energy” drinks  Side effects/adverse reactions: Insomnia, irritability, anxiety, muscle twitching, confusion, chest pain, tachycardia, dysrhythmias63 63  Depressants  Alcohol  Most widely consumed substance of abuse in USA  Side effects/adverse reactions: Wernicke’s encephalopathy, Korsakoff’s psychosis  Alcohol withdrawal: use chlordiazepoxide (Librium) or lorazepam (Ativan)  Rehabilitation and sustained abstinence: disulfiram (Antabuse), naltrexone (ReVia, Depade), naltrexone extended release (Vivitrol), acamprosate (Campral), ondansetron (Zofran), topiramate (Topamax) 64 64  Depressants (Cont.)  Opioids  Effects: analgesia, drowsiness, slurred speech, & detachment from the environment  Signs of overdose of opioids: pinpoint pupils, clammy skin, depressed respiration, coma, & death, if not treated  Treatment Overdose  naloxone (Narcan)-ANTAGONIST Withdrawal symptoms  methadone (Dolophine), clonidine (Catapres), buprenorphine (Buprenex)-AGONISTS Opioid antagonist  Naltrexone (oral ReVia, injectable Vivitrol) & naloxone 65 65  Basic Ethical Principles  Autonomy  Promotion of individual autonomy  Respect for person  Beneficence  Protection of patients and subjects from harm; ensuring risks/benefits are clearly defined in research studies  Justice  Avoidance of fraud and duress in health care;  fairness in equality of benefits/burdens in research research studies  Veracity  Encouragement for health care professionals to  Truth telling be thorough and clear in communicating information  Promotion of patient-educated decision making  Informed consent & right to self-determination 66 67