Pharmacology: Quality and Safety PDF Chapter 1

Chapter 1 The Foundation of Pharmacology: Quality and Safety Chapter 1 The Foundation of Pharmacology: Quality and Safety Chapter 1 The Foundation of Pharmacology: Quality and Safety  Is the following statement True or False? Question #1 Pharmacology is the use of...

Chapter 1 The Foundation of Pharmacology: Quality and Safety Chapter 1 The Foundation of Pharmacology: Quality and Safety Chapter 1 The Foundation of Pharmacology: Quality and Safety  Is the following statement True or False? Question #1 Pharmacology is the use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes. 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #1 Rationale: Pharmacology is the study of drugs that alter functions of living organisms. Loading… 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  Pharmacology: study of drugs that alter functions of living Pharmacology and organisms Drug Therapy #1 Pharmacotherapy (drug therapy): use of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes Medications: drugs given for therapeutic purposes 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Effects of medications Pharmacology and oLocal: act mainly at the site of application Drug Therapy #2 oSystemic: taken into the body, circulated via the bloodstream to sites of action, and eventually eliminated from the body Loading… 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Plants Drug Sources Animals Minerals Synthetic compounds 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Classifications Drug Classifications oClassified according to effects on and Prototypes #1 Particular body systems Therapeutic uses Chemical characteristics 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  Prototypes Drug Classifications Individual drugs that represent groups of drugs and Prototypes #2 Often the first drug of a particular group to be developed Morphine (represents opioid analgesics) Penicillin (represents beta-lactam antibacterial drugs) 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Most common Drug Names Generic name (chemical or official) Brand (trade) name May be prescribed and dispensed by either name Using different drug names (i.e., generic or trade names) increases confusion and the risk of misuse. 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Over-the-counter medications are not regulated by law. 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #2 Rationale: Over-the-counter medications are regulated by various drug laws. Loading… 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Two routes of access to therapeutic drugs Prescription and oPrescription Nonprescription Drugs Written by a licensed healthcare provider, such as a physician, dentist, or nurse practitioner oOver-the-counter (OTC) Do not require prescription Regulated by various laws 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Which law (and its amendments) requires that official Question #3 drugs meet standards of purity and strength? A. Durham-Humphrey Amendment B. Comprehensive Drug Abuse Prevention and Control Act C. Food, Drug, and Cosmetic Act of 1938 D. Controlled Substances Act 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  C. Food, Drug, and Cosmetic Act of 1938 Answer to Question #3 Rationale: The Food, Drug, and Cosmetic Act of 1938 requires that official drugs meet standards of purity and strength as determined by chemical analysis or bioassay. The Durham-Humphrey Amendment designates which medications must be prescribed by a healthcare professional; the Comprehensive Drug Abuse Prevention and Control Act regulates the manufacturing and distribution of controlled substances; and the Controlled Substances Act categorizes controlled substances according to therapeutic usefulness and potential for abuse. 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Passed in 1970 Comprehensive Drug Title II: Controlled Substances Act Abuse Prevention and oRegulates manufacturing and distribution of Control Act Narcotics, depressants Stimulants, hallucinogens Anabolic steroids 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Schedule I Categories of Schedule II Controlled Substances Schedule III Schedule IV Schedule V 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Enforces Controlled Substances Act Drug Enforcement Registers individuals and companies legally empowered Administration (DEA) to handle controlled substances Regulates documentation and handling of controlled substances 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  FDA’s CDER: Approval of oApproves new prescription drug annually Prescription and oApproves drugs for OTC availability Nonprescription Drugs oDetermines need for clinical trails 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  Responsible for ensuring safety and efficacy of drugs U.S. Food and Drug before they can be marketed Administration (FDA) Since 1962, specific testing standards must be applied. #1 Clinical trials oPhases 1 to 4 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Approves many new drugs annually U.S. Food and Drug oBoth prescription and OTC Administration (FDA) May change status from prescription to OTC #2 oPotential advantages and disadvantages 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Rights off Medication Administration Safety in Drug Quality and Safety Education for Nurses (QSEN) Administration National Patient Safety Goals o“Do Not Use” list of unacceptable abbreviations oTargeted High-Risk Activities The Institute for Safe Medication Practices (ISMP) oHigh-Alert Medications oPregnancy Categories for Safety oBeers Criteria 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Pharmacology and textbooks Sources of Drug Drug reference books Information Journal articles Internet sites 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  American Hospital Formulary Service Authoritative Sources Drug Facts and Comparisons Less authoritative oPhysicians’ Desk Reference (PDR) 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Concentrate on therapeutic classifications and their Strategies for Studying prototypes. Pharmacology #1 Connect new drug information to known similar drugs or prototypes. Focus on drugs’ main characteristics. Use own words when taking notes or writing drug information cards. 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  Keep an up-to-date drug reference readily available. Strategies for Studying Write notes, answers to review questions, definitions of Pharmacology #2 new terms, and trade names of medications directly into your pharmacology textbook. 25 Copyright © 2025 Wolters Kluwer. All rights reserved. Chapter 2 Basic Concepts and Processes  Cells are dynamic “factories” that Cellular Physiology #1 oTake in raw materials oManufacture products required to maintain bodily functions oDeliver those manufactured products to the appropriate destination within the body oDiffer from one tissue to another 2 Copyright © 2025 Wolters Kluwer. All rights reserved. Cellular Physiology #2 Loading… 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 While all cells differ from one tissue to another, they share certain common characteristics. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #1 Rationale: While all cells differ from one tissue to another, they share common characteristics, including the ability to exchange materials from their immediate environment, obtain energy from nutrients, synthesize complex molecules, reproduce, and communicate with one Loading… another via biologic chemicals. 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Cells can Cellular Physiology #3 oExchange materials with immediate environment oObtain energy from nutrients oReproduce oCommunicate with one another via biologic chemicals 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drugs must reach and interact with or cross the cell Drug Transport membrane to stimulate or inhibit cellular function. Through Cell Membranes #1 Most drugs are given for systemic effect. Transport pathways and mechanisms move drug molecules through the body. 7 Copyright © 2025 Wolters Kluwer. All rights reserved. Drug Transport Through Cell Membranes #2 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Define pharmacokinetics. Pharmacokinetics oDrug movement through the body Specific processes involved oAbsorption oDistribution oMetabolism oExcretion 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Absorption process Absorption oOccurs from time drug enters body to time it enters bloodstream to be circulated oOnset of drug action is largely determined by the rate of absorption. oFactors that affect rate and extent of drug absorption Dosage form, route of administration Administration site blood flow, GI function The presence of food or other drugs 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Distribution process Distribution #1 oTransport of drug molecules within body oDrugs are carried by blood and tissue fluids to Action sites Metabolism sites Excretion sites Loading… oDepends largely on adequacy of blood circulation 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Distribution process affected by Distribution #2 oProtein binding oBlood–brain barrier oPregnancy oLactation 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Metabolic process (biotransformation): Metabolism #1 oMethod by which drugs are altered from their original form into a new form (biotransformed) by the body oDrugs changed to Inactive metabolites (excreted) Active metabolites Prodrugs (exert effects when metabolized) 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug-metabolizing enzymes are located within Metabolism #2 oKidneys oLiver oRed blood cells, plasma oLungs oGastrointestinal mucosa 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Factors that affect drug metabolism Metabolism #3 oEnzyme induction (accelerates) oEnzyme inhibition (decreased or delayed) 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Excretion Excretion oElimination of a medication from the body oRequires adequate function of Circulatory system Organs of excretion (kidneys, bowel, lungs, and skin) 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Absorption is the transport of drug molecules within the body. 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #2 Rationale: Distribution is the transport of drug molecules within the body. Absorption is the process that occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated. 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  Serum drug level Serum Drug Level #1 oLaboratory measurement of the amount of a drug in the blood at a particular time oReflects Dosage Absorption Bioavailability Half-life Rates of metabolism Excretion 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Minimum effective concentration (MEC) must be present Serum Drug Level #2 for efficacy. Toxic concentration: excessive level of medication in bloodstream; caused by oSingle large dose oRepeated small doses oSlow metabolism of medication 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drugs exert their effects by chemically binding with Receptor Theory of receptor cells through: Drug Action oActivation, inactivation, or alteration of intracellular enzymes oChanges in the permeability of cell membranes to one or more ions oModification of the synthesis, release, or inactivation of neurohormones oAgonists and antagonist drugs 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Relatively few drugs do not act on receptor sites. These Nonreceptor Drug few drugs include Actions oAntacids oOsmotic diuretics oSeveral anticancer drugs oMetal chelating agents 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Dosage Drug-Related Variables oFrequency, size, number of doses #1 Route of administration oInfluences absorption and distribution Drug–diet interactions Drug–drug interactions 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Interactions that can increase therapeutic or adverse Drug-Related Variables effects include #2 oAdditive effects oSynergism oInterference oDisplacement 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  Interactions in which drug effects are decreased include Drug-Related Variables oAntidote medication #3 oDecreased intestinal absorption of drugs oIncreased metabolism rate of drugs 25 Copyright © 2025 Wolters Kluwer. All rights reserved.  Age, body weight Patient-Related Pharmacogenomics, genetics, ethnicity, gender Variables Pharmacogenetics Preexisting pathologic conditions Psychological considerations Tolerance and cross-tolerance 26 Copyright © 2025 Wolters Kluwer. All rights reserved.  Adverse effects Adverse Effects of oAny undesired responses to medication administration Drugs All drugs can produce adverse effects. Can occur with usual therapeutic dosing More likely to occur or be more severe with high dosing Especially likely to occur with specific drugs and in older adults who take multiple drugs Boxed warnings, pregnancy categories 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Also called poisoning or overdose Toxicology: Drug Overdose #1 Results from excessive amounts of medication May damage body tissues Common problem in both adult and pediatric populations 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  May result from Toxicology: Drug oSingle large dose Overdose #2 oProlonged ingestion of smaller doses May involve alcohol, prescription, OTC, or illicit drugs Loading… Can be a medical emergency, regardless of location 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  Main goals of treatment Toxicology: Drug oStarting treatment soon after ingestion Overdose #3 oSupporting and stabilizing vital function oPreventing further damage by Reducing absorption Increasing elimination Administering antidotes whenever possible 30 Copyright © 2025 Wolters Kluwer. All rights reserved. Chapter 3 Medication Administration and the Nursing Process of Drug Therapy “Rights” of Medication Right drug Right reason Administration Right dose Right to refuse Right patient the medication Right assessment Right Right route documentation Right time Right patient education Right evaluation 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Follow “rights” consistently. Accurate Drug Learn essential information about medications to be Administration given. Principles #1 Interpret the prescriber’s orders accurately. Patient ! oWrite down or enter into computer and read back verbal autonomy or phone orders. Read medication labels carefully. your 3 am , can't Loading… Use only approved abbreviations use to prevent errors.. responsibility distinguish an Think about what environment orderr... can help you administer Call the doctor !! safely meds Verify Verify , , Verify Copyright © 2025 Wolters Kluwer. All rights reserved. 3  Calculate doses accurately. Accurate Drug Measure doses accurately. Administration Use correct procedures and techniques for all Principles #2 administration routes. Learn about the patient’s diagnoses and condition in relation to medication administration. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Verify identity of all patients before administering Accurate Drug medications. Assess patient! Administration Omit or delay doses as indicated by the patient’s condition Principles #3 and document accordingly. meds Be especially careful when administering medication to Don't give children due to high risk of medication error. if assessment Maintain up-to-date drug administration skills and deems it not Loading… knowledge. ! necessary 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Nurses’ legal responsibilities include Legal Responsibilities oSafe, accurate medication administration oRecognizing and questioning erroneous orders oRefusing to administer unsafe medications oDelegating in compliance with the law 6 Copyright © 2025 Wolters Kluwer. All rights reserved. Question #1 Is the following statement True or False? O It is the legal responsibility of a nurse to administer medications exactly as the prescriber has written it, without question. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  False. Answer to Question #1 Rationale: It is the legal responsibility of a nurse to recognize and question erroneous orders. Additionally, if the nurse considers the administration of any medication unsafe, the nurse must refuse to give the drug. 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Medication errors can result in Medication Errors #1 oSerious illness Page 37 oConditions that prolong hospitalization or require additional treatment 5 1 Figure. oDeath 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Common medication errors include Medication Errors #2 oGiving an incorrect dose oNot giving an ordered medication oGiving an unordered medication Medications often associated with errors include oInsulin, heparin, and warfarin * includes barcodes, safety , but computer systems , you still must verify and use. clinical judgement 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Systems vary by health care facility and include Medication Systems Unit dose system Computerized, locked cabinets Additional security for controlled substances Changes to prevent medication errors CPOE Loading… Bar coding Point of care Limiting use of abbreviations Medication reconciliation 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Must include Medication Orders oThe patient’s full name oName of the medication (preferably generic) oDose, route, frequency of administration oDate, time, signature of the prescriber 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Typed into computer (preferred method) Medication Order Handwritten on an order sheet Transcription Verbal orders Document all oSigned by the transcriber, countersigned by the prescriber you do in Epic. Telephone orders oSigned by the transcriber, countersigned by the prescriber 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Which of the following is the preferred method of order Question #2 transcription? A. Telephone order B. Verbal order C. Handwritten order D. Computer entry 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  D. Computer entry Answer to Question #2 Rationale: Telephone and verbal orders must be signed by the transcriber and the prescriber; handwritten orders must be signed by the prescriber. Both types can involve interpretation and/or transcription errors. Direct computer- entry orders are the preferred method of order entry. Chicken scratch ? Call Doc and have them Verify it 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Nurses must know commonly used abbreviations. Medication Order Routes, dosages, and times of administration Interpretation “Do not use” abbreviations Due to frequent misinterpretation Illegible, seemingly erroneous orders must be clarified before administration. Look up PDF 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  IM: Intramuscular Abbreviations: Routes IV: Intravenous of Drug Administration PO: By mouth, oral SL: Sublingual - Buccel Sub-Q: Subcutaneous Parenteral medication routes Im , IV Sub-Q , 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  Medications may be available in various forms. Drug Preparation and Dosage Forms Systemic medication forms include oLiquids oTablets, capsules oSuppositories, transdermals oInjections 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  Pump delivery systems Medication Delivery Systems #1 By mouth (PO) oTablets oCapsules oSublingual 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Controlled release Medication Delivery Timed-release, sustained-release, extended release Systems #2 Names usually include CR, SR, XL Enteric coated (to prevent stomach upset) Maintains more consistent serum drug levels Allows less frequent administration More convenient for patients disolve in some drugs Stomach metabolized other drugs are in the small intestine 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Controlled release (cont.) Medication Delivery Tablets, capsules Systems #3 Contain high amount of drug Intended to be absorbed slowly over prolonged period of time Should never be broken, open, crushed, chewed 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Transdermal Medication Delivery Systems #4 froute ormulation - Systemic absorption through skin foodod Pump delivery systems A absorption ita External or implanted binding Refillable or long-acting without refills ~ M metabolism Insulin, opioid analgesics, anticancer medications enzymes (antineoplastics), and other drugs excretion bioavailability %! 100 E removal IV drugs directly - are administered and are not digested 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  & & Pharmacokinetics · · u ⑧ morphine. - agonist 6 Absorption I mir mir - ⑳ mu analgesia- Distribution I paint anagement - endorphins Narcan - metabolism - antagonist excretion - Receptor Theory of Drug Action Toxic ! M in ↓ Theraputic overdose ? Range * no way to tell where in cycle patient is in dose Minimum Effective Dose  that affect variables drug Actions ! Dosage route of administration , , Drug-diet interactions dosage , , Drug-drug interaction age weight, , , Pharmacogenomic Variations !  Topical Medication Delivery oSolutions Systems #5 oCreams oSuppositories oFrequently used for local treatment 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Accuracy is of utmost importance. Calculating Medication Involves Dosages #1 oSystem of measurement oMathematical calculations oKnowledge of common units of measurement oKnowing how to use data in performing calculations 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  D=X Calculating Medication H V Dosages #2 D = desired dose (dose ordered, often in mg) H = available dose (on drug label, often in mg per tablet/capsule/mL) X = unknown (number of tablets/capsules/mL) V = volume or unit 25 Copyright © 2025 Wolters Kluwer. All rights reserved. Equivalents 26 Copyright © 2025 Wolters Kluwer. All rights reserved.  Oral (by mouth) Routes of Parenteral (injected) Administration oSubcutaneous (Sub-Q) oIntramuscular (IM) oIntravenous (IV) Topical (applied to skin or mucous membrane) 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #3 The parenteral route of medication administration involves applying medication directly to the skin or mucous membrane. 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #3 Rationale: The parenteral route of medication administration involves injecting medication into a blood vessel, muscle, or spinal column. The topical route involves applying medication directly to the skin or mucous membrane. Loading… 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  Must be prepared, packaged, and administered Medications for maintaining sterility Injection Typical medication containers oVials (single or multiple dose) oAmpules oPrefilled syringes with attached needles 30 Copyright © 2025 Wolters Kluwer. All rights reserved.  Sterile needles Equipment for oVarious gauges (lumen size) Injections #1 Larger number = smaller lumen oVarious lengths, use depends on Route of administration Thickness (viscosity) of solution Size of the patient 31 Copyright © 2025 Wolters Kluwer. All rights reserved.  Needleless systems Equipment for oDeveloped to prevent injury and the spread of blood- Injections #2 borne pathogens Syringes oMade of plastic (disposable) oCalibrated to measure doses accurately oInsulin, tuberculin syringes for small doses 32 Copyright © 2025 Wolters Kluwer. All rights reserved.  Sub-Q common sites Injection Sites oUpper arms, abdomen, back, thighs IM common sites oDeltoid, ventrogluteal, vastus lateralis muscles IV common sites oBack of hands, forearms 33 Copyright © 2025 Wolters Kluwer. All rights reserved. Sub-Q Injection Sites 34 Copyright © 2025 Wolters Kluwer. All rights reserved. IM Injection Sites: Deltoid 35 Copyright © 2025 Wolters Kluwer. All rights reserved. IM Injection Sites: Ventrogluteal 36 Copyright © 2025 Wolters Kluwer. All rights reserved. IM Injection Sites: Vastus Lateralis 37 Copyright © 2025 Wolters Kluwer. All rights reserved. IV Injection Sites 38 Copyright © 2025 Wolters Kluwer. All rights reserved.  Nurses may perform Less Common Injection oIntradermal (into layers of skin) Sites oIntra-arterial (into arteries if established arterial line is present) Physicians must perform oIntra-articular (into joints) oIntrathecal (into spinal fluid) 39 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True orE False? Question #4 Nursing process is rarely used in drug therapy. 40 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #4 Rationale: Nursing process, a systematic way of gathering and using information to plan, provide, and evaluate individualized care, is instrumental in effective drug therapy. ADpie! 41 Copyright © 2025 Wolters Kluwer. All rights reserved. Nursing Process Assessment AAPIE Nursing diagnosis & Planning/establishing goals Interventions Evaluation 42 Copyright © 2025 Wolters Kluwer. All rights reserved.  take Assessment: Medication So important to ! History #1 comprehensive medical history -Look intofurther eave Swallow problems ing Assess for allergies that causes Anything a makes you feel sensitivity or off? Copyright © 2025 Wolters Kluwer. All rights reserved. 43 Assessment: Medication History #2 caffiene-weed 44 Copyright © 2025 Wolters Kluwer. All rights reserved.  Current medication orders Medication History The patient’s knowledge regarding current medications Questions History of allergic reactions Can the patient swallow medications? Communicate verbally? Patient’s pathological condition that might influence drug therapy History of herbal/dietary supplement use 45 Copyright © 2025 Wolters Kluwer. All rights reserved.  Promoting health General Nondrug Preventing/decreasing need for drug therapy Interventions Using nondrug measures to enhance therapeutic effects or decrease adverse effects Patient teaching Individualizing care Administering drugs Observing patient responses 46 Copyright © 2025 Wolters Kluwer. All rights reserved.  Promoting healthful lifestyles regarding nutrition, fluids, Specific Examples of exercise, rest, and sleep Nondrug Interventions Conscientiously performing hand hygiene, infection prevention Ambulating, positioning, exercising Assisting to cough and deep breathe Applying heat or cold Scheduling activities to promote rest or sleep Recording vital signs, I&O, and other data 47 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #5 All drug therapy goals should be stated in terms of the nurse’s behavior. 48 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #5 Rationale: All drug therapy goals should be stated in terms of the patient’s behavior. 49 Copyright © 2025 Wolters Kluwer. All rights reserved.  Progress toward stated outcomes Drug Therapy oRelief of symptoms Evaluation Criteria Accurate administration Avoidance of preventable adverse effects Patient adherence Specific parameters measured to evaluate response to particular medications 50 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #6 Most drug administration outcomes will be evaluated over hours or days, not minutes. 51 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #6 Rationale: The nurse monitors responses to drug therapy, both therapeutic and adverse. 52 Copyright © 2025 Wolters Kluwer. All rights reserved.  Evidence-based nursing practice Evidence-Based Requires a conscientious and continuing effort to Practice and Nursing provide high-quality care to patients Process Obtaining and analyzing best scientific evidence from research oScientific evidence is integrated with the nurse’s clinical expertise and the patient’s preferences and values to yield best practice. 53 Copyright © 2025 Wolters Kluwer. All rights reserved.  Questionable safety due to unknown effect on humans, Herbal/Dietary nonstandardized ingredients Supplement Concerns Use of supplements may keep the patient from seeking medical care. Supplements may interact with prescription medications to decrease therapeutic effect or increase adverse effects. Use of supplements not communicated to the health care provider 54 Copyright © 2025 Wolters Kluwer. All rights reserved.  Cells are dynamic “factories” that Cellular Physiology #1 oTake in raw materials oManufacture products required to maintain bodily functions oDeliver those manufactured products to the appropriate destination within the body oDiffer from one tissue to another 2 Copyright © 2025 Wolters Kluwer. All rights reserved. Cellular Physiology #2 Loading… 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 While all cells differ from one tissue to another, they share certain common characteristics. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #1 Rationale: While all cells differ from one tissue to another, they share common characteristics, including the ability to exchange materials from their immediate environment, obtain energy from nutrients, synthesize complex molecules, reproduce, and communicate with one Loading… another via biologic chemicals. 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Cells can Cellular Physiology #3 oExchange materials with immediate environment oObtain energy from nutrients oReproduce oCommunicate with one another via biologic chemicals 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drugs must reach and interact with or cross the cell Drug Transport membrane to stimulate or inhibit cellular function. Through Cell Membranes #1 Most drugs are given for systemic effect. Transport pathways and mechanisms move drug molecules through the body. 7 Copyright © 2025 Wolters Kluwer. All rights reserved. Drug Transport Through Cell Membranes #2 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Define pharmacokinetics. Pharmacokinetics oDrug movement through the body Specific processes involved oAbsorption oDistribution oMetabolism oExcretion 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Absorption process Absorption oOccurs from time drug enters body to time it enters bloodstream to be circulated oOnset of drug action is largely determined by the rate of absorption. oFactors that affect rate and extent of drug absorption Dosage form, route of administration Administration site blood flow, GI function The presence of food or other drugs 10 Copyright © 2025 Wolters Kluwer. All rights reserved.  Distribution process Distribution #1 oTransport of drug molecules within body oDrugs are carried by blood and tissue fluids to Action sites Metabolism sites Excretion sites Loading… oDepends largely on adequacy of blood circulation 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  Distribution process affected by Distribution #2 oProtein binding oBlood–brain barrier oPregnancy oLactation 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Metabolic process (biotransformation): Metabolism #1 oMethod by which drugs are altered from their original form into a new form (biotransformed) by the body oDrugs changed to Inactive metabolites (excreted) Active metabolites Prodrugs (exert effects when metabolized) 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drug-metabolizing enzymes are located within Metabolism #2 oKidneys oLiver oRed blood cells, plasma oLungs oGastrointestinal mucosa 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Factors that affect drug metabolism Metabolism #3 oEnzyme induction (accelerates) oEnzyme inhibition (decreased or delayed) 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Excretion Excretion oElimination of a medication from the body oRequires adequate function of Circulatory system Organs of excretion (kidneys, bowel, lungs, and skin) 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Absorption is the transport of drug molecules within the body. 17 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #2 Rationale: Distribution is the transport of drug molecules within the body. Absorption is the process that occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated. 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  Serum drug level Serum Drug Level #1 oLaboratory measurement of the amount of a drug in the blood at a particular time oReflects Dosage Absorption Bioavailability Half-life Rates of metabolism Excretion 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Minimum effective concentration (MEC) must be present Serum Drug Level #2 for efficacy. Toxic concentration: excessive level of medication in bloodstream; caused by oSingle large dose oRepeated small doses oSlow metabolism of medication 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Drugs exert their effects by chemically binding with Receptor Theory of receptor cells through: Drug Action oActivation, inactivation, or alteration of intracellular enzymes oChanges in the permeability of cell membranes to one or more ions oModification of the synthesis, release, or inactivation of neurohormones oAgonists and antagonist drugs 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Relatively few drugs do not act on receptor sites. These Nonreceptor Drug few drugs include Actions oAntacids oOsmotic diuretics oSeveral anticancer drugs oMetal chelating agents 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Dosage Drug-Related Variables oFrequency, size, number of doses #1 Route of administration oInfluences absorption and distribution Drug–diet interactions Drug–drug interactions 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Interactions that can increase therapeutic or adverse Drug-Related Variables effects include #2 oAdditive effects oSynergism oInterference oDisplacement 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  Interactions in which drug effects are decreased include Drug-Related Variables oAntidote medication #3 oDecreased intestinal absorption of drugs oIncreased metabolism rate of drugs 25 Copyright © 2025 Wolters Kluwer. All rights reserved.  Age, body weight Patient-Related Pharmacogenomics, genetics, ethnicity, gender Variables Pharmacogenetics Preexisting pathologic conditions Psychological considerations Tolerance and cross-tolerance 26 Copyright © 2025 Wolters Kluwer. All rights reserved.  Adverse effects Adverse Effects of oAny undesired responses to medication administration Drugs All drugs can produce adverse effects. Can occur with usual therapeutic dosing More likely to occur or be more severe with high dosing Especially likely to occur with specific drugs and in older adults who take multiple drugs Boxed warnings, pregnancy categories 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Also called poisoning or overdose Toxicology: Drug Overdose #1 Results from excessive amounts of medication May damage body tissues Common problem in both adult and pediatric populations 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  May result from Toxicology: Drug oSingle large dose Overdose #2 oProlonged ingestion of smaller doses May involve alcohol, prescription, OTC, or illicit drugs Loading… Can be a medical emergency, regardless of location 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  Main goals of treatment Toxicology: Drug oStarting treatment soon after ingestion Overdose #3 oSupporting and stabilizing vital function oPreventing further damage by Reducing absorption Increasing elimination Administering antidotes whenever possible 30 Copyright © 2025 Wolters Kluwer. All rights reserved. Chapter 15 Inflammation, Infection, and the Use of Antimicrobial Agents  Used to treat or prevent infections caused by pathologic Antimicrobial organisms such as bacteria, fungi, viruses, and parasites Medications Are necessary when host defense mechanisms are Homeostasis = inadequate to ward off infection Balance use when mounted immune isn't h. response enoug % 2 Copyright © 2025 Wolters Kluwer. All rights reserved. Question #1 Is the following statement True or False? O Antimicrobial medications are used to treat all microorganisms. Loading… 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #1 Rationale: Antimicrobial medications are used to prevent or treat infections caused by pathogens. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Microorganisms attach to host cell receptors. Microorganisms and oInvade tissues Infections oMultiply oProduce infection Biological adaptations protect microbes from host defense mechanisms and antimicrobials. Loading… 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Bacteria alive Microorganism - Classifications Viruses -not alive Fungi - alive Parasites - alive 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Body areas that are colonized with microorganisms that Normal Microbial Flora protect host #1 oSkin oUpper respiratory tract oColon - antibiotics kill off good bacteria If normal flora is suppressed via antimicrobial therapy: oPotential pathogens may thrive. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  Normal flora can cause disease in certain conditions. Normal Microbial Flora oOlder adult patients #2 oDebilitated patients oImmunosuppressed patients 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Involves the presence of pathogen plus clinical signs and Infectious Diseases symptoms of infection oMicrobes are usually spread by Direct contact with Infected person Contaminated hands, food, water, objects 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Usually, normal endogenous or environmental flora and Opportunistic nonpathogenic Pathogens oBecome pathogenic under conditions that favor their (over)growth Severe burns, CA, HIV infection Indwelling IV or urinary catheters Antibiotic or corticosteroid therapy oBacterial infections are usually serious and life threatening Caused by drug-resistant microorganisms 10 Copyright © 2025 Wolters Kluwer. All rights reserved. Question #2 E Is the following statement True or False? Opportunistic infections are likely to occur in patients with impaired defense mechanisms. Loading… 11 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #2 Rationale: Opportunistic infections are likely to occur in patients with impaired defense mechanisms, such as those with severe burns, CA, HIV infection, IV or urinary catheters, or antibiotic or corticosteroid drug therapy. 12 Copyright © 2025 Wolters Kluwer. All rights reserved.  Laboratory tests can identify Crystal Violet Laboratory Gramine tained w/ a tire grampositive oBacteria Identification of Gram stain Pink Pathogens #1 Identifies microscopic appearance Culture Growing microbes in the laboratory 13 Copyright © 2025 Wolters Kluwer. All rights reserved.  Laboratory tests can identify (cont.) Laboratory oSerology Identification of IDs infectious agent via antibody levels Pathogens #2 oPolymerase chain reaction (PCR) Detects the presence of microbial DNA in sampling 14 Copyright © 2025 Wolters Kluwer. All rights reserved.  Increasingly prevalent in human pathogens Antibiotic-Resistant Infections caused by resistant pathogens Microorganisms #1 oRequire more toxic and expensive medications oLead to prolonged illness or hospitalization oIncrease mortality rates No defense against superbugs. 15 Copyright © 2025 Wolters Kluwer. All rights reserved.  Grow, multiply when susceptible organisms (including Antibiotic-Resistant normal flora) Microorganisms #2 oAre suppressed by antimicrobials oNormal host defenses are impaired by Immunosuppressive disorders Immunosuppressive medications oEmerge during or after antimicrobial therapy 16 Copyright © 2025 Wolters Kluwer. All rights reserved.  Mechanisms of development Antibiotic-Resistant oBroad-spectrum antibiotics suppresses normal flora. Microorganisms #3 oResistant organism becomes predominant strain. Cause superinfection oInterruption of/inadequate antimicrobial treatment 17 Copyright © 2025 Wolters Kluwer. All rights reserved. Question #3 O Is the following statement True or False? Infections often associated with high rates of antimicrobial resistance include lower respiratory tract infections. 18 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #3 Rationale: Infections often associated with high rates of antimicrobial resistance include lower respiratory tract age foleys infections and infections associated with cystic fibrosis or meds -11 osteomyelitis. The infections are often difficult to treat Oport Surgery - disease because they tend to reoccur, involve multiple organisms, impairs etc. sleepy - 11 immune auto immune ↓ response mal hygiene nutrition 19 Copyright © 2025 Wolters Kluwer. All rights reserved.  Production of enzymes that inactivate medications Microbial Mechanisms Modification of antibiotic target sites of Resistance Production of alternate enzyme to bypass antibiotic activity Changing cell wall permeability Acquiring/increasing ability to pump medications out of the cell Modification of antibiotic binding target 20 Copyright © 2025 Wolters Kluwer. All rights reserved.  Intact skin and mucous membranes Host Defense Various anti-infective secretions Mechanisms Mechanical movements oCoughing, swallowing, peristalsis Phagocytic cells Immune processes Inflammatory processes 21 Copyright © 2025 Wolters Kluwer. All rights reserved.  Breaks in skin and mucous membranes Host Defense oTrauma, inflammation, open lesions Mechanism oInsertion of prosthetic devices, tubes, catheters Impairments #1 Impaired blood supply Neutropenia, other blood disorders Malnutrition 22 Copyright © 2025 Wolters Kluwer. All rights reserved.  Poor personal hygiene Host Defense Suppression of normal flora via antimicrobials Mechanism Suppression of immune system, inflammatory response Impairments #2 Diabetes mellitus, other chronic diseases Advanced age 23 Copyright © 2025 Wolters Kluwer. All rights reserved.  Terms Characteristics of oAnti-infective and antimicrobial include Antimicrobial Drugs #1 Antibacterials Antivirals Antifungals oAntibacterial and antibiotic (ATB) Medications used in bacterial infections 24 Copyright © 2025 Wolters Kluwer. All rights reserved.  Terms (cont.) lot of bacteria oBroad spectrum -Treats Characteristics of a Antimicrobial Drugs #2 oNarrow spectrum -killer oBactericidal kills bacteria - Culture oBacteriostatic it in it's track stops - -collecting date slows Penicilling bump the pil Fear the Sun Fluoroquinoens 25 Copyright © 2025 Wolters Kluwer. All rights reserved.  Acts on specific target in pathogen Antimicrobial oInhibition of bacterial wall synthesis Mechanisms of Action oInhibition of protein synthesis or production of abnormal #1 bacterial proteins oDisruption of microbial cell membranes oInhibition of reproduction of organisms oInhibition of cell metabolism and growth 26 Copyright © 2025 Wolters Kluwer. All rights reserved. Antimicrobial Mechanisms of Action #2 27 Copyright © 2025 Wolters Kluwer. All rights reserved.  Goal of treatment Principles of oEradicate causative microorganism Antimicrobial Therapy oReturn host to full physiologic function Rational use of antimicrobials oMost frequently used medications worldwide oMuch overuse, misuse, abuse leading to adverse drug effects, healthcare costs, drug-resistant infections 28 Copyright © 2025 Wolters Kluwer. All rights reserved.  Cost Antimicrobial Therapy oUse older, more cost-effective drug if it meets criteria for Use Guidelines #1 selection Combination therapy of antimicrobials to treat oInfections caused by multiple microbes oHospital-acquired infections oSerious infections Loading… 29 Copyright © 2025 Wolters Kluwer. All rights reserved.  Administration Antimicrobial Therapy oOrally or IV for systemic infections Use Guidelines #2 oDependent on patient condition Location, severity of infection Ability to take oral medications oAvailable medication dosage forms 30 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #4 A community-acquired infection is contracted while one is within a healthcare facility. 31 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #4 Rationale: Hospital-acquired infections are acquired while within a healthcare setting and may be more severe and difficult to manage because they often result from drug- resistant microbes and occur in those who are immunocompromised. 32 Copyright © 2025 Wolters Kluwer. All rights reserved.  Duration of therapy Antimicrobial Therapy oVaries, depending on reason for use Use Guidelines #3 Single dose (prophylactically) 7 to 10 days or until the patient has been afebrile and asymptomatic for 48 to 72 hours Acute infection 33 Copyright © 2025 Wolters Kluwer. All rights reserved.  Perioperatively Antimicrobials in Children Special Populations Older adults Abnormal kidney function Hepatic impairment Critical illness Home care 34 Copyright © 2025 Wolters Kluwer. All rights reserved.  Avoid using antibacterial drugs to treat viral infections. Guidelines to Promote Give antibacterial drugs only for significant bacterial Appropriate infections or when there is an established indication for Antimicrobial Drug Use prophylaxis. #1 Use a narrow-spectrum antibacterial drug instead of a broad-spectrum drug, whenever possible. Collect specimens for culture and Gram stain before giving the first dose of an antibiotic 35 Copyright © 2025 Wolters Kluwer. All rights reserved.  Minimize antimicrobial drug therapy for fever unless Guidelines to Promote other clinical manifestations or laboratory data indicate Appropriate infection. Antimicrobial Drug Use Follow CDC recommendations for prevention and #2 treatment of infections. Consult infectious disease/infection control specialists about local patterns of drug-resistant organisms and treatment of complicated infections. 36 Copyright © 2025 Wolters Kluwer. All rights reserved. Chapter 16 Drug Therapy to Decrease Pain, Fever, and Inflammation  Chemical mediators found in most body tissues Prostaglandins oAssist in regulating many body functions oParticipate in the inflammatory response oAre formed when cellular injury occurs oExert various and opposing effects on various body tissues 2 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #1 Prostaglandins are chemical mediators found in the central nervous system. Loading… 3 Copyright © 2025 Wolters Kluwer. All rights reserved.  False Answer to Question #1 Rationale: Prostaglandins are chemical mediators found in most body tissues. 4 Copyright © 2025 Wolters Kluwer. All rights reserved.  Inhibit prostaglandin synthesis in CNS and PNS NSAIDs’ Mechanism of Action #1 Inhibit COX-1 and COX-2 enzymes oRequired for prostaglandin production Relieve pain by acting centrally and peripherally to block pain impulse transmission Loading… 5 Copyright © 2025 Wolters Kluwer. All rights reserved.  Relieve fever by decreasing hypothalamic response and NSAIDs’ Mechanism of resetting “thermostat” at a lower level. Action #2 Aspirin and nonselective NSAIDs also have antiplatelet effect. Acetaminophen is not an NSAID nor does it have anti- inflammatory properties or inhibit platelet aggregation. 6 Copyright © 2025 Wolters Kluwer. All rights reserved.  Is the following statement True or False? Question #2 Body temperature is controlled by a regulating center in the hypothalamus. 7 Copyright © 2025 Wolters Kluwer. All rights reserved.  True Answer to Question #2 Rationale: Body temperature is controlled by a regulating center in the hypothalamus. 8 Copyright © 2025 Wolters Kluwer. All rights reserved.  Act both centrally and peripherally to block the Salicylates: Aspirin transmission of pain impulses oReduce fever by acting on the hypothalamus oDiminish inflammation oSuppress platelet aggregation oLow dose indicated to manage Ischemic stroke, transient ischemic attack, angina, and acute myocardial infarction See Table 16.4. 9 Copyright © 2025 Wolters Kluwer. All rights reserved.  Does not cause nausea, vomiting, GI bleeding, or interfere Acetaminophen #1 with blood clotting Equal to ASA in analgesic and antipyretic effects oLacks anti-inflammatory activity Metabolized in the liver; sm