Study Guide_ Pharm Week PDF

I. Introduction to Pharmacology Definition: Pharmacology is the branch of medicine and biology that studies the effects of drugs on living organisms. It involves understanding how drugs interact with biological systems to produce therapeutic effects. II. Key Concepts 1.Pharma...

I. Introduction to Pharmacology Definition: Pharmacology is the branch of medicine and biology that studies the effects of drugs on living organisms. It involves understanding how drugs interact with biological systems to produce therapeutic effects. II. Key Concepts 1.Pharmacodynamics: - Focuses on how drugs interact with their targets (receptors, enzymes, ion channels) in the body to produce physiological responses. -Key Terms: -Agonists: Drugs that activate receptors to produce a response. -Antagonists: Drugs that block receptors, preventing a response. -Partial Agonists: Drugs that partially activate receptors, causing a moderate response. 2.Pharmacokinetics: - Deals with the movement of drugs within the body (absorption, distribution, metabolism, excretion). -Key Processes: -Absorption: How a drug enters the bloodstream from its site of administration. -Distribution: How a drug is transported to various tissues and organs. -Metabolism: The process of breaking down drugs, primarily in the liver, into metabolites. -Excretion: The elimination of drugs and their metabolites from the body, mainly through urine or bile. III. Drug Categories and Mechanisms of Action** 1.Drug Targets: -Receptors: Specific proteins that drugs bind to, leading to a cellular response. -Enzymes: Proteins that catalyze biochemical reactions, which drugs can inhibit or activate. -Ion Channels: Proteins that control the flow of ions across cell membranes, which can be modulated by drugs. 2.Common Drug Classes: -Antibiotics: Inhibit the growth of or destroy bacteria. -Antidepressants: Treat depression and mood disorders. -Antihypertensives: Lower blood pressure. -Antipsychotics: Manage symptoms of schizophrenia and bipolar disorder. -NSAIDs: Reduce inflammation, pain, and fever. -Diuretics: Increase urine production to remove excess fluid. IV. Opioid Receptors and Function** 1.Types of Opioid Receptors: -Mu (μ) Receptors: Involved in pain relief, euphoria, and respiratory depression. -Delta (δ) Receptors: Modulate mood and analgesia. -Kappa (κ) Receptors: Mediate pain relief and dysphoria. 2.Function: Opioid receptors reduce pain by inhibiting neurotransmitter release, decreasing neuronal excitability, and reducing the perception of pain. V. Important Drug Classe 1.ACE Inhibitors: -Function: Block the enzyme responsible for producing angiotensin II, leading to vasodilation and lower blood pressure. -Examples: Lisinopril, Enalapril. 2.Statins (HMG-CoA Reductase Inhibitors): -Function: Lower cholesterol production in the liver, reducing LDL ("bad" cholesterol) levels. -Examples: Atorvastatin, Simvastatin. 3.Calcium Channel Blockers: -Function: Relax and widen blood vessels by blocking calcium entry into cells, lowering blood pressure. -Examples: Amlodipine, Verapamil. 4.Warfarin: -Function: Anticoagulant that inhibits the use of vitamin K in clotting factor production, reducing the risk of blood clots. -Usage: Treat or prevent DVT, PE, atrial fibrillation. 5.Heparin: -Function: Rapid anticoagulant that inhibits clotting factors, used in acute settings like surgery. -Administration: Intravenous or subcutaneous injections. 6.Nitroglycerin: -Function: Treats angina by dilating blood vessels, increasing blood flow to the heart. -Administration: Sublingual tablets or spray for rapid relief. 7.Corticosteroids: -Function: Mimic adrenal hormones to reduce inflammation and suppress the immune system. -Uses: Treat inflammatory conditions, autoimmune diseases, and allergic reactions.  8.Bronchodilators: -Function: Relax airway muscles to increase airflow in conditions like asthma and COPD. -Administration: Inhalers, nebulizers, oral tablets, or injections. VI. Adverse Effects and Drug Naming 1.Adverse Effects: Unintended, sometimes harmful effects of a drug, also known as side effects. 2. Drug Naming: -Brand Name: The name given by the pharmaceutical company (e.g., Tylenol). -Generic Name: The original designation of the drug (e.g., Acetaminophen). -Chemical Name: Reflects the chemical structure of the drug. 3. Regulation: -FDA: The Food and Drug Administration oversees drug approval and distribution in the U.S. -Generic Drugs: Less expensive versions of brand-name drugs with the same active ingredients. VII. Special Drug Categories 1. Orphan Drugs: Drugs developed to treat rare diseases; often not profitable but crucial for small patient populations. 2.Over-the-Counter (OTC) Drugs: Medications available without a prescription for self-care. Chapter 2: 1. Response of Body Cells to Drugs -Receptor Binding:Drugs often bind to specific receptors on cell surfaces, initiating a series of intracellular reactions that lead to a cellular response. -Enzyme Inhibition or Activation:Some drugs inhibit or activate enzymes, altering cellular processes. -Altered Gene Expression:Drugs can modify gene expression, affecting protein synthesis and overall cell function. -Cellular Signaling:Drugs may influence signaling pathways within cells, leading to changes in cellular behavior. -Cellular Damage or Death: Certain drugs can cause cell damage or induce cell death, often through apoptosis. 2. Changes in Dynamic Equilibrium of Drug Concentration -Absorption:The process by which a drug enters the bloodstream from its site of administration. Factors like route of administration (oral, IV, etc.) and the presence of barriers (e.g., stomach acid) influence absorption. -Distribution: The dispersion of the drug throughout the body’s tissues. It depends on factors like lipid solubility, ionization, and perfusion of the target tissue. -Metabolism: The process of biotransformation where the drug is broken down, usually in the liver, into metabolites. This can either activate or deactivate the drug. -Excretion: The elimination of the drug from the body, primarily through the kidneys. Other routes include the skin, lungs, and feces. 3. Clinical Implications of Drug Therapy and Half-Life Calculation -Dosage and Frequency: The half-life of a drug helps determine how often it should be administered to maintain therapeutic levels. -Patient-Specific Factors: Age, weight, liver and kidney function, and genetic factors all affect drug metabolism and efficacy. -Drug Half-Life: The time it takes for the drug concentration to reduce by half. Important for determining dosing schedules. 4.Risk Factors Influencing Drug Effectiveness -Genetic Factors:Genetic differences can influence how individuals metabolize and respond to drugs. -Age: Drug metabolism varies with age; children and the elderly may metabolize drugs differently. -Organ Function: Impaired liver or kidney function can slow down metabolism and excretion. -Drug Interactions: Concomitant use of other drugs can alter the effectiveness or cause adverse effects. -Compliance: Adherence to prescribed regimens is crucial for drug efficacy. 5. Interactions Involving Drugs -Drug-Drug Interactions:Can occur at various stages (absorption, distribution, metabolism, excretion) and affect efficacy or safety. -Drug-Alternative Therapy Interactions:Herbal supplements or other alternative therapies can interact with conventional drugs. -Drug-Food Interactions:Foods can affect drug absorption, metabolism, or excretion. For example, grapefruit juice can inhibit the metabolism of certain drugs. -Drug-Laboratory Test Interactions: Drugs may alter lab test results, leading to potential misinterpretations. Key Terms - Absorption: The process from when a drug enters the body to when it reaches the bloodstream. - Active Transport:Movement of substances across cell membranes using energy. - Chemotherapeutic Agents:Drugs used to kill or inhibit the growth of foreign cells, often used in cancer treatment. - Critical Concentration: The minimum concentration of a drug needed to achieve the desired therapeutic effect. - Distribution: The dispersion of the drug throughout the body's tissues. - Enzyme Induction:An increase in enzyme activity due to the presence of a specific chemical, affecting drug metabolism. - Excretion:The process of eliminating drugs from the body. - First-Pass Effect:The reduction in drug concentration after it passes through the liver, affecting orally administered drugs. - Half-Life:The time required for the concentration of a drug in the body to reduce by half. - Pharmacodynamics:The study of how drugs affect the body. - Pharmacokinetics:The study of how the body processes drugs (absorption, distribution, metabolism, excretion). - Placebo Effect:The beneficial effect of a treatment due to the patient's belief in its efficacy. - Receptor Sites:Specific locations on cell membranes where drugs bind to exert their effects. - Selective Toxicity:The ability of a drug to target specific cells or systems without affecting others. - Therapeutic Index:The ratio between the toxic dose and the effective dose of a drug. Pharmacodynamics -Drug Actions: - Replace or substitute for missing chemicals. - Stimulate or increase cellular activities. - Depress or slow cellular activities. - Interfere with the function of foreign cells. -Receptor Sites: - Drugs may act as agonists (stimulate receptors) or antagonists (block receptors). - Selective Toxicity: Drugs target foreign cells without harming healthy cells. Pharmacokinetics - Absorption:The process of a drug entering the bloodstream from the site of administration. -Distribution:The spread of the drug throughout the body. -Metabolism (Biotransformation):The conversion of the drug into different chemical forms. -Excretion: The removal of the drug from the body. Factors Influencing Drug Effects -Weight, Age, Sex, Physiological and Pathological Factors, Genetics, Immunological Factors, Psychological Factors, Environmental Factors, Tolerance, and Accumulation. Drug Interactions Drug-Drug Drug-Food Drug-Alternative Therapy Drug-Laboratory Test Interactions. Chapter 3: Adverse Drug Reactions and Drug-Induced Tissue Damage Adverse Drug Reaction (ADR) -Definition: An ADR is an unintended, harmful response to a medication occurring at normal doses used for treatment or prevention. -Clinical Significance: ADRs can cause patient harm, require additional treatment, prolong hospital stays, and increase healthcare costs. Effective identification and management are vital for patient safety and therapeutic success. Types of Allergic Responses to Drug Therapy 1.Type I (Immediate Hypersensitivity): -Mechanism: IgE-mediated reaction. -Examples: Anaphylaxis, urticaria (hives), angioedema. -Symptoms: Hives, swelling, difficulty breathing. 2.Type II (Cytotoxic Reactions): -Mechanism: IgG or IgM antibodies target cells, leading to their destruction. -Examples: Hemolytic anemia, thrombocytopenia. 3.Type III (Immune Complex-Mediated Reactions): -Mechanism: Formation of immune complexes that deposit in tissues. -Examples: Serum sickness, vasculitis. 4.Type IV (Delayed-Type Hypersensitivity): -Mechanism: Cell-mediated response involving T lymphocytes. -Examples: Contact dermatitis, drug-induced lupus. Common Examples of Drug-Induced Tissue Damage 1.Hepatotoxicity: -Cause: Drugs like acetaminophen. -Effects: Liver failure, jaundice. 2.Nephrotoxicity: -Cause: Certain antibiotics, NSAIDs. -Effects: Acute kidney injury, decreased urine output. 3.Cardiotoxicity: -Cause: Drugs like doxorubicin. -Effects: Heart failure, arrhythmias. 4.Pulmonary Toxicity:  -Cause: Drugs like amiodarone. -Effects: Interstitial lung disease. 5.Dermatotoxicity: -Cause: Drugs like allopurinol. -Effects: Rashes, severe skin reactions (e.g., Stevens-Johnson syndrome). Poison -Definition: A substance that can cause harm or death when absorbed by the body by disrupting normal physiological functions. Nursing Process in Drug Toxicity Situations 1.Assessment: Evaluate symptoms, medical history, exposure to toxins, and monitor vital signs. 2.Diagnosis: Identify toxicity type and impact on health. 3.Planning: Create a plan to manage and mitigate toxicity, including possible discontinuation of the drug. 4.Intervention: Implement the plan, administer treatments, and provide symptomatic relief. 5.Evaluation: Assess intervention effectiveness, modify care strategies, and monitor patient responses. Key Terms -Blood Dyscrasia: Bone marrow suppression due to drug effects, leading to low blood cell levels. -Dermatological Reactions: Skin reactions to drugs, ranging from mild rashes to severe exfoliative dermatitis. -Drug Allergy: Immune response to a drug after forming antibodies, leading to various allergic reactions. -Poisoning: Overdose causing damage to multiple body systems, potentially leading to fatal reactions. -Stomatitis: Inflammation of mucous membranes, often caused by toxic drugs, leading to nutritional and dental issues. -Superinfections: Infections that occur due to the destruction of normal flora by antibiotics, allowing other pathogens to grow uncontrollably. Types of Adverse Effects 1.Primary Actions: Overdose or exaggerated therapeutic effects (e.g., excessive bleeding with anticoagulants). 2.Secondary Actions: Unintended effects in addition to therapeutic effects (e.g., drowsiness from antihistamines). 3.Drug Allergy: Immune-mediated response to drugs, varying from mild irritation to severe reactions. Drug-Induced Tissue and Organ Damage  1. Dermatological Reactions -Assessment: Rashes, hives, other lesions. -Interventions: Discontinue drug in severe cases; notify provider. 2. Stomatitis -Assessment: Swollen gums, inflamed mouth, red tongue. -Interventions: Frequent mouth care, nutrition evaluation, dental consultation. 3. Gastrointestinal Irritation -Mechanism: NSAIDs can decrease mucosal protection by inhibiting prostaglandin production. -Assessment: Nausea, vomiting, heartburn, abdominal pain. -Interventions: Administer with food, use of motility stimulants. 4. Superinfections -Mechanism: Destruction of normal flora leads to overgrowth of pathogens. -Assessment: Fever, diarrhea, black or hairy tongue. -Interventions: Supportive measures, antifungal therapy, discontinue drug if necessary. 5. Blood Dyscrasia -Mechanism: Bone marrow suppression, especially with drugs causing cell death. -Assessment: Fever, chills, sore throat, weakness. -Interventions: Monitor blood counts, supportive measures, discontinue drug if needed. Toxicity 1.Hepatotoxicity: Look for jaundice, elevated liver enzymes; discontinue drug if needed. 2.Nephrotoxicity: Monitor BUN/creatinine levels, reduce or stop drug. 3.Electrolyte Imbalances: -Hypokalemia: Replace potassium, monitor levels. -Hyperkalemia: Administer drugs to lower potassium, monitor cardiac rhythm. Sensory Effects 1.Ocular Damage: Monitor vision changes; discontinue drug if necessary. 2.Auditory Damage: Look for tinnitus, hearing loss; discontinue drug if necessary. Neurological Effects 1.CNS Effects: Confusion, delirium, insomnia; provide safety measures, discontinue drug if needed. 2.Anticholinergic Effects: Dry mouth, urinary retention; provide supportive measures. 3.Extrapyramidal Symptoms: Muscle tremors, rigidity; discontinue drug if necessary. 4.Neuroleptic Malignant Syndrome: Hyperthermia, autonomic disturbances; discontinue drug, reduce temperature. Teratogenicity -Definition: Drugs that cause harm to a developing fetus. -Prevention: Advise pregnant patients of risks, weigh benefits against risks, and avoid self-medication. Key Points - Adverse drug effects can include skin reactions, superinfections, blood dyscrasias, and stomatitis. - Toxicity from drugs can affect multiple organs, requiring specific interventions and monitoring. - Safety in drug administration involves careful assessment, planning, and evaluation to prevent and manage adverse effects. Chapter 4 - Nursing: Art and Science 1. Nursing as an Art and Science -Increasing Responsibilities: Nurses take on more responsibilities in patient care, requiring broad knowledge and skills. -Holistic Care: Focus on the whole patient, including physical, emotional, social, and spiritual needs. -Key Health Care Professional: Nurses are central to the healthcare team, coordinating care and providing direct patient care. - Integration of Multiple Disciplines: -Basic Sciences: Biology, chemistry, and anatomy. -Social Sciences: Psychology, sociology, and anthropology. -Education: Teaching patients, families, and communities. -Other Disciplines: Collaboration with other healthcare professionals. 2. Nursing Process Application -Assessment #1: Past History: -Chronic Conditions: Understanding long-term health issues. -Drug Use: Current and past medications. -Allergies: Allergic reactions to medications or substances. -Education & Understanding: Patient’s knowledge of their disease and treatment. -Social & Financial Supports: Resources available to the patient. -Health Care Pattern: Regularity and type of healthcare accessed. -Assessment #2: Physical Examination: -Weight & Age: Important for dosing and understanding patient needs. -Physical Parameters: Specific to the disease state or drug effects. 3. Nursing Conclusions and Planning -Patient Status: Evaluate the patient’s condition from a nursing perspective. -Analysis of Information: Synthesize data collected to prioritize patient care. -Setting Goals: Develop desired patient outcomes, focusing on: - Effective drug therapy response. - Minimizing adverse effects.  - Ensuring patient understanding of their drug regimen. 4. Intervention -Achieving Goals: Implement nursing interventions to meet planned outcomes. -Types of Interventions: -Drug Administration: Safe and effective medication delivery. -Comfort Measures: -Placebo Effect: Utilizing psychological benefits. -Managing Adverse Effects: Minimizing and addressing side effects. -Lifestyle Adjustment: Assisting patients in making necessary life changes. -Patient and Family Education: Ensuring understanding and adherence to care plans. 5. Evaluation -Ongoing Process: Continuously assess and adjust the patient’s care plan. -Evaluating: - Patient response to interventions. - Effectiveness of interventions. - Success of education programs. 6. Medication Errors -Increasing Risk: Medication errors are a growing concern in healthcare. -To Err is Human: Recognizing the prevalence of human error in healthcare. -Error Prevention: Implementing checks throughout the drug regimen process. 7. Nurse’s Role in Safe Medication Administration -Seven Rights: 1. Right Patient 2. Right Drug 3. Right Storage 4. Right Route 5. Right Dose 6. Right Preparation 7. Right Time 8. Right Recording 8. Patient’s Role in Medication Safety -For Adults: - Keep a current list of all medications. - Understand the purpose of each drug. - Follow label instructions and store drugs safely. - Ask questions and communicate with healthcare providers. -For Children: - Use appropriate dosages and measuring devices. - Keep medications out of children’s reach.  - Never use adult medications for children. - Seek medical advice if adverse effects occur. 9. Reporting of Medication Errors -Reporting Programs: -National Level: ISMP Medication Error Reporting Program, FDA MedWatch Program. -Institutional Level: Follow policies and procedures at your workplace. Sample Question Question: What needs to be included in a provider’s order for a patient so the nurse can use the “rights of safe administration”? -Answer: C. Patient’s name -Rationale: The provider’s order must include the correct patient information to ensure safe and effective medication administration according to the seven rights