Week-1-Intro-to-Pharma-Part-1.pptx

Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar Web: http://uep.edu.ph Email: [email protected] Introduction to Pharmacology Rules and Regulations Schedule of Class (Fused Sec B) Monday 7:00AM – 10:00AM All students shou...

Republic of the Philippines UNIVERSITY OF EASTERN PHILIPPINES University Town, Northern Samar Web: http://uep.edu.ph Email: [email protected] Introduction to Pharmacology Rules and Regulations Schedule of Class (Fused Sec B) Monday 7:00AM – 10:00AM All students should join on time and REGULARLY. Students Attendance are checked every meeting. Note: Excuse letter should be presented 3 days from the day that the student has been absent. No excused letter automatically considered unexcused absent. Assessment Task Week Percentage 1 Quizzes TBA/Anytime 30 % 2 Reporting/Recitation TBA/Anytime 10% 3 Attendance 1st – 15th week 10% 4 Midterm/Finals 9th/18th week 40% Examination 5 Project/Assignments TBA 10 % Total 100% Contact Email: [email protected] PHARMACOLOGY  Is a science that study the effects of drugs within the living system.  It deals with all legal and illegal drugs used in society today.  In Nursing Practice, it applies knowledge from many different disciplines including anatomy physiology, microbiology, chemistry , mathematics and psychology and others. Pharmaceutical - any kind of drug used for medicinal purposes, like cough syrup or sleeping pills When about to give medicine, the nurse must have? Understanding to any medication before giving to a client Knowledge in the usual dosage, route of administration Indication Significant adverse effect Major drug interaction Contraindication Nursing responsibilities Definition of Terms: Pharmacopeia- is the list of all authorized drugs available within a country :it contains descriptions, recipes, strengths, standards of purity, and dosage forms for the drugs Medication - substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of disease. Drug - same as medication – a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body..Non-prescription or Over-the-counter drug- drug that can be purchased without prescription. Prescription - the written direction for the preparation and administration of a drug. Generic name – the name used throughout the drug’s lifetime. Trade (brand) name - given by the drug manufacture and identifies it as property of that company. Official name – this is the name which the drug is listed in the official publications. Chemical name – is the name by which a chemist knows it; describes the constituents of the drug precisely.  The therapeutic effect: is the primary/desired effect intended that is the reason the drug is prescribed such as morphine sulfate is analgesia. Side effect: secondary unwanted effects that occurs due to drug therapy. Adverse effect: are unintended pharmacologic effects that occur when the medication is administered correctly. - May justify the discontinuation of a drug. - The nurse should report this to the health care provider.  Drug toxicity: harmful effect of the drug on an organism or tissue, result from overdose or external use drug, or buildup of drug in blood. Drug allergy: is immunological reaction to a drug. - Mild allergic reaction - Severe allergic reactions (anaphylaxis) – this response can be fatal. Drug interaction: occurs when administration of one drug before or after alter effect of one or both drug. Drug misuse: Is the improper use of common medications in a way that lead to acute and chronic toxicity for example laxative, antacid and vitamins. Drug abuse: is an inappropriate intake of substance either continually or periodically.  Drug dependence: is a person’s reliance on or need to take drug or substance. Psychological dependence: is emotional reliance on a drug to maintain a sense of well-being accompanied with feeling of need. Drug habituation: denotes a mild form of psychological dependence. Illicit drug: also called street drugs that are those sold illegally.  Dose :The aim to give patient a dose of the drug that achieves the desired effect without causing harmful side effect. Tolerance: A decreasing response to repetitive drug doses  Basic Concepts of Pharmacology Pharmacognosy: the branch of knowledge concerned with medicinal drugs obtained from plants or other natural sources. Pharmacokinetics: the branch of pharmacology concerned with the movement of drugs within the body. Study of absorption, distribution, biotransformation, and excretion of drugs. This is how the body reacts to the drug. Pharmacodynamics: the effect of drug on the body. This is how the drug acts in the body. Pharmacotherapeutics: is the clinical purpose or indication for giving a drug. Branches of Pharmacology Pharmacognosy - Origin Pharmacokinetics - Body’s reaction Pharmacodynamics - Effect Pharmacotherapeutics - Use/Purpose Toxicology -Side Effects  Drugs are substances that are used or intended to be used in the diagnosis, prevention, treatment or cure of diseases.  In early times, these substances were derived from natural sources, of which plants took up the major share.  With the introduction of technology, most drugs today are manufactured synthetically in the laboratory. D e p Sources of drugs a t m 1. Plants and plant parts e n - plants are important chemicals that develop o into drugs. A number of plants have medicinal qualities N u and have been used for centuries as drugs or drug sources. Although the earliest plant si source for drugs was the leaf, other parts of n plants (e.g., barks, fruits, roots, stem, wood, g seeds, blossoms, bulb etc.) were also later exploited for drug extraction. Where the product is used without further processing. Sources of drugs 2. Animal Products - are used to replace human chemicals that are not produced because of disease or genetic problems. Many important drugs are derived from animal source. In most instances, these medicinal substances are derived from the animal’s body secretions, fluid or glands. Insulin, heparin, adrenaline, enzymes, and antitoxins sera are some examples of drugs obtained from animal sources. D e p a Sources of drugs t m e - Insulin for treating diabetes is exclusively n obtained from cow pancreas tissue. o - now genetic engineering – the process of N u altering DNA – permits scientist to produce human insulin by altering E. coli bacteria. si n g D e p a Sources of drugs t m e 3. Microbial sources n Several life-saving drugs have been historically o derived from microorganisms. Examples include streptomycin from Streptomyces N u griseus, chloramphenicol from Streptomyces venezuelae. si n g Sources of drugs 4. Marine source Bioactive compounds from marine flora and fauna have extensive past and present use in the prevention, treatment or cure of many diseases. Coral, sponges, fish, and marine microorganisms produce biologically potent chemicals with interesting anti-inflammatory, anti-viral, and anticancer activity. For example, discodermolide from marine sponge Discodermia dissoluta, show potent anti-tumor activity. Sources of drugs 5. Mineral sources Minerals (both metallic and non-metallic minerals) have been used as drugs since ancient times. Our body requires trace elements of minerals in order to maintain homeostasis. Patients lacking an adequate level of these materials may take specific mineral- based drugs to raise the level of minerals. Examples include ferrous sulfate in iron deficiency anemia; magnesium trisilicate, aluminum hydroxide and sodium bicarbonate as antacids for hyperacidity and peptic ulcer, selenium as anti-dandruff.  Sources of drugs 6. Synthetic/chemical derivative A synthetic drug is produced using chemical synthesis, which rearranges chemical derivatives to form a new compound. The synthetic sources of drugs evolved with human skills in the laboratory and advanced knowledge and understanding of phytochemical investigation. At present, majority of drugs used in clinical practice are exclusively prepared synthetically in pharmaceutical and chemical laboratory. One of the earliest synthetic drugs was sulphonamide, which began with the synthesis of prontosil dye. D e p a Sources of drugs t m e 7. Semi-synthetic Sources n Semi-synthetic drugs are neither completely o natural nor completely synthetic. They are a N hybrid and are generally made by chemically u modifying substances that are available from si natural source to improve its potency, efficacy n and/or reduce side effects. g Examples of semi-synthetic medicine include heroin from morphine, homatropine from atropine, ampicillin from penicillin etc. Sources of drugs 8. Biosynthetic sources (genetically engineered drugs) This is relatively a new field which is being developed by mixing discoveries from molecular biology, recombinant DNA technology, DNA alteration. Examples include recombinant Hepatitis B vaccine, recombinant insulin and others. Controlled substances Fentanyl Heroin Hydromorphone Cannabis Cocaine Dihydrocodeine Codeine Ketamine Methadone Methamphetamine Methaqualone Morphine Opium Legal and Ethical Aspect of Medication Medical Prescriptions 1. It is not permissible to prescribe restricted drugs except by authorized doctors, and the restrictions related to these drugs should be followed. 2. The healthcare practitioner should not write a prescription only for pleasing his/her patient or the patient’s relatives. 3. The prescription should be written in clear handwriting, with the healthcare practitioner’s name, signature, the name of the institution he/she works in, date of the prescription, patient’s information, diagnosis, drug dose, its pharmacological form, daily dose, and duration of treatment. This all must also be reported in the patient’s record. Note: it is prohibited for a pharmacist to dispense any medication without a prescription issued by a physician licensed to practice. See the Law of Practicing Healthcare Professions Doctor prescription Components of prescription need to assessed Client Date Medication Dosage and frequency Route Legal Requirements need to be met before administer a drug 1. The Medication order must be valid 2. The physician/ prescriber and the nurse must be licensed. 3. The nurse must know the purpose, action, effects and major adverse effects of the drug, and the teaching required to enable the client or caregiver to self administer the drug safely and accurately. Six Rights of Medication Administration 1. The Right Medication( the one that was prescribed and one that is not contraindicated) 2. The Right Client(not someone else medication by mistake, nor the medication of the person in the next bed) 3. The Right dose as prescribed and appropriate (this may involve simple mathematical computation 4. The Right route, form of the drug, and administration technique prescribed 5. The Right time for the dose (usually within 30 mins of the time indicated and at beneficial intervals as ordered) 6. The Right documentation 12 RIGHTS OF DRUG ADMINISTRATION 12 RIGHTS OF DRUG ADMINISTRATION Factors Affect Drug Absorption 1. Nature of the absorbing surface (cell membrane) through which the drug must cross. 2. Blood flow to the site of administration 3. Solubility of the drug 4. pH – acidity vs alkalinity 5. Molecular weight- Vancomycin has large molecular weight administered IV when administered orally is minimally absorbed into systematic circulation in treating C. difficile diarrhea 6. Dosage form D e p FACTORS CAN ALTER AN INDIVIDIAL’S a RESPONSE TO DRUG THERAPY t m e 1. Age – n Infants immature body system o Children-dosage adjustment usually necessary N Older adult-depressed hepatic and renal u system si 2. Body Mass index n g - The greater the volume of distribution of the drug in body mass, the lower the concentration of the drug in the body compartment. D e p FACTORS CAN ALTER AN INDIVIDIAL’S a RESPONSE TO DRUG THERAPY t m e 3. Gender n Woman smaller than men; definite difference during pregnancy and in relative proportion of fat and o water; drugs and vary by water or fat soluble N 4. Environmental Milieu u Mood and behavior modified by si Drug itself n g Personality of the user Environment of the user Interaction of these three factors D e p FACTORS CAN ALTER AN INDIVIDIAL’S a RESPONSE TO DRUG THERAPY t m e 5. Time of administration n Present or absence of food o Biologic rhythms- sleep-wake cycle, N u circadian 24 hours cycle in si absorption and urinary excretion n g Insufficient fluid intake with solid dosage form D e p FACTORS CAN ALTER AN INDIVIDIAL’S a RESPONSE TO DRUG THERAPY t m e 6. Pathological State n Pain intensifies the need of opioids o Anxiety may resist to large dose of N u tranquilizing drugs si Presence of circulatory, hepatic and n g renal dysfunction interfere physiologic process of drugs. D e p FACTORS CAN ALTER AN INDIVIDIAL’S a RESPONSE TO DRUG THERAPY t m e 7. Genetic Factors n - genetic differences can sometimes explain o patients’ varied/ different responses to a given drug. N u - some people lack enzyme systems necessary for metabolizing a drug. si n g 8. Psychological Factors - The patients attitude about a drug has been shown to have an effect on how the drug works. D e p FACTORS CAN ALTER AN INDIVIDIAL’S a RESPONSE TO DRUG THERAPY t m - A drug is more likely to be effective e n if the patient thinks it will work than if the patient believes it will not o work. This is called the Placebo N effect. u si n g Different Characteristic of Drug Response 1. Tolerance refers to adecrease physiologic response that occurs after repeated administration of a drug or a chemically related substance. 2. Tachyphylaxis refers to a quickly developing tolerance that occurs after repeated administration of a drug. 3. Cumulative effect occurs when the body cannot metabolize one dose of a drug before another dose is administered. Different Characteristic of Drug Response 4. Idiosyncrasy is any abnormal or peculiar response to a drug which may manifest itself by ;  Overresponse or abnormal susceptibility to adrug  Under response, which demonstrate abnormal tolerance  A qualitatively different effect from the one expected such a excitation after administration of a sedative  Unpredictable and unexplainable Different Characteristic of Drug Response 6. Drug dependence is the term preferred over the previous terminology of “habituation” and “addiction” it maybe physical or psychological. 7. Drug Interaction occurs when the effects of one drug are modified by the prior or concurrent administration of an other drug, thereby increasing or decreasing the pharmacologic action of each. 8. Drug antagonism occur when the combination effects of two drugs is less than the sum of the drugs acting separately. Different Characteristic of Drug Response 9. Summation (addition or additive effect) occurs when the combined effect of two drugs produces a result that equals the sum of the individual effects of each agent. Written as 1+1=2 Example codeine and aspirin both acts as analgesic when given together they provide greater pain relief than when either one used alone Different Characteristic of Drug Response 10. Synergism describes a drug interaction in which the combined effect of drugs is greater than the sum of each individual agent acting independently written as 1+1=3 or greater 11. Potentiate refers to the concurrent administration of two drugs in which one drug increase the effect of the other drug. Various Types of Drug Orders 1. Standing Order - it may or may not have a termination date. - it may be carried out indefinitely until an order is written to cancel it or maybe carried out on a specified number of dates. – Example: Demerol 100 mg. IM every 4 hours for 5 days. – Example: Multivitamins 1 tablet daily. 2. PRN orders (as –needed) given at the client’s need and nurse’s judgment concerning need and safety. Example : Hyoscine butylbromide 20 ml. prn. 3.One time or single order- given once and usually at a specific time Example pre operative medication. Seconal 100 mg. hs before surgery 4. Stat orders- given once immediately as a single dose – Example: Nubain 10 mg. IM stat. Indicators for Evaluating the Administration of Medication The drug is administered in the ordered dose The drug is administered by the ordered route The drug is administered by the ordered site The drug is administered at the ordered rate The drug is administered in the ordered drug form The drug is administered in the ordered schedule The drug is administered using the correct technique REQUIREMENT 1 RA 9165 THE COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002 Write the highlights of this law. ANSWER THE FOLLOWING QUESTIONS: 1. What is the importance of such law as a nursing student and as a citizen of the country? 2. How can you contribute to the implementation of the law as a health care provider? Cite examples in the community and hospital setting. 3. How can you apply this RA to your self as a citizen? References: McKenry, Tessier, Hogan. “Mosby’s Pharmacology Nursing ”. Mosby USA. Edition 22 Jones & Bartlett Learning (2011). “Nurse Hand Book” Kevin Sullivan. USA. Karch, Amy M. (2011). “Focus on Nursing Pharmacology”. Lippincott. USA. Department of Nursing QUESTIONS???