Wk1 Pharm PDF - Learning Objectives

1Learning Objectives, Chapter 1, The Foundation of Pharmacology: Quality and Safety 1. Define a prototype drug. Is individual drugs that represent groups of drugs Often the first drug of a particular group to be developed Ex: Morphine (represents opioid analgesics), Penicillin (represents beta-la...

1Learning Objectives, Chapter 1, The Foundation of Pharmacology: Quality and Safety 1. Define a prototype drug. Is individual drugs that represent groups of drugs Often the first drug of a particular group to be developed Ex: Morphine (represents opioid analgesics), Penicillin (represents beta-lactam antibacterial drugs), in drug literature presented in lowercase 2. Distinguish between generic and trade names of drugs. Generic- is Related to the chemical or official name, often indicates drug group ex: “cillin” are penicillins, in drug literature presented in lowercase Trade names – presented in capitalized letters, designated and patented by the manufacture 3. Describe the five categories of controlled substances in relation to therapeutic use, potential for abuse, and regulatory requirements. Schedule I- NO medical use highly addictive ex: heroin Schedule II-used medically high abuse potential ex oxy/morphine/pentobarbital Schedule III- less abuse potential, but can lead to dependence, ex androgens and anabolic steroids, some depressants, some CNS stimulants and mixtures containing sm amounts of controlled substances. Schedule IV- some potential abuse but accepted with medical use in the US, benzos, sedatives, appetite stimulants Schedule V- products that contain moderate amounts of controlled substances but no physicians prescription needed ex: cough suppressants with codeine, anti diarrheal 4.Identify the multiple Safeguards and laws that are in place to promote drug safety in drug research, packaging, and approval processes. The DEA controls this, Enforces Controlled Substances Act Registers individuals and companies legally empowered to handle controlled substances Regulates documentation and handling of controlled substances 5. Recognize initiatives designated to enhance safe drug administration. Rights of Medication Administration 11 rights: dose/drug/pt/documentation/assessment/route /education/time/reason/evaluation/the right to refuse Quality and Safety Education for Nurses (QSEN) National Patient Safety Goals “Do Not Use” list of unacceptable abbreviations Targeted High-Risk Activities The Institute for Safe Medication Practices (ISMP) High-Alert Medications Pregnancy Categories for Safety Beers Criteria dest to avoid drugs in older adults 6. Develop personal techniques for learning about drugs and using drug knowledge in patient care. The joint commission is also concerned with drug safety, make sure following the 11 rights to drug administration and have a drug handbook handy and know what the drug is for 7. Identify authoritative sources of drug information. American Hospital Formulary Service Drug Facts and Comparisons Less authoritative Physicians’ Desk Reference (PDR) Learning Objectives, Chapter 2, Basic Concepts and Processes 1. Describe the main pathways and mechanisms by which drugs cross biologic membranes and move through the body. 3 main pathways 1Direct penetration (most common) by lipid soluble drugs most of these are systematic 2. passage through protein channels that go all the way through the cell membrane 3.carrier protiens that transport molecules from one side of the cell membrane to the other they are specific on what they will carry so the drugs chemical structure determines which carrier will transport it Mechanisms: once drug is absorbed in the body drugs are transported to and from target cells by passive diffusion, facilitated diffusion and active diffusion Passive diffusion the most common movement of a drug from higher concentration to lower concertation Facilitated diffusion is similar to passive but the drug molecules combine with a carrier substance such as an enzyme or other protein Active transport drug molecules are moved from an area of lower concentration to a higher concentration. This process requires a carrier substance and the release of cellular energy 2. Explain each process of pharmacokinetics. Pharmacokinetics- Drug movement through the body Specific processes involved: Absorption- process that occurs from the time the drug enters the body to the time it enters the bld stream to be circulated Distribution -in the transport of drug molecules with in the body Metabolism - the method in which the drugs are altered from there original form into a new form Excretion- the elimination of the drug from the body. 3. Recognize individual differences in patient drug responses related to genomic variations. 4. Discuss the clinical usefulness of measuring serum drug levels. Serum drug level Laboratory measurement of the amount of a drug in the blood at a particular time Reflects Dosage Absorption Bioavailability Half-life Rates of metabolism Excretion Minimum effective concentration (MEC) must be present for efficacy. Toxic concentration: excessive level of medication in bloodstream; caused by Single large dose Repeated small doses Slow metabolism of medication 5. Describe major characteristics of the receptor theory of drug action. Pharmacodynamics- “what a drug does to the body”, drug actions on target cells and the resulting alterations in cellular biochemical reactions and functions Drugs mimic normal physiologic substances such as hormones/neurotransmitters and chemically bind with receptors at the cellular level When drug molecules binds with receptor molecules it causes a psychochemical reaction that stimulate or inhibit normal cellular functions 6. Differentiate between agonist drugs and antagonist drugs. Agonist: drug that produces effects similar to those produced by naturally occurring hormones, neurotransmitters and other substances Antagonist: drug that inhibits cell function by occupying receptor sites 7. Discuss mechanisms and potential effects of drug–drug interactions. Action of the drug can increase or decrease its effect on the body, it alters the drug metabolism 8. Explain drug-related and patient-related variables that affect drug actions. Patient related variables: age/body wt/pharmacogenomic/genetics/ethnicity/sex/pre existing conditions/psychological factors Drug related variables: dosage/route of administration/drug-diet interactions/drug to drug interactions 9. Identify signs and symptoms that may occur with adverse drug effects on major body systems. Things we dont expect to happen CNS effects stimulation (agitation)or depression (sedation) GI effects (N/V/D) Hematologic effects bone marrow depression , excessive bleeding, anemias. Hepatic effects hepatitis liver dysfunction/failure, Nephrotoxicity nephritis abnormal kidney function Hypersensitivity allergy Drug fever Idiosyncrasy unexpected reaction to a drug with first time given Drug dependence dependence might be psychological or physilogical Carcinogenicity causes cancer Teratogenicity causes abnormal fetal development 10. Discuss initial management considerations related to drug overdose and toxicity. Poisening or overdose If pt collapsed or not breathing call 911 If alert call poison control for further instructions Start treatment as soon as possible with antidote, support vital organs and minimize damage of organs. Results from excessive amounts of medication May damage body tissues Common in pediatrics and older adults May result from single dose or overtime or with a large amount this includes alcohol, prescription, over the counter medications or illicit drugs 11. Discuss selected drug antidotes. Acetaminophen- acetylcysteine Anticholinergics (atropine)- physostigmine Warfin-Vit K Tricyclic antidepressents- sodium bicarbanate Thrombolytics- aminocaproic acid Phenothiazine- diphenhydramine Opioid analgesic- naloxone (narcan) Lead- dimercaptosuccinic acid Isoniazid- pyridoxine (vit d) Iron-deferoxamine Heparin-protamine sulfate Digoxin-digoxin immune fab Cholinergics – atropine Calcium channel blockers- calcium gluconate 10% Beta-adrenergic blockers- glucagon Benzodiazepines- flumazenil Learning Objectives, Chapter 3, Medication Administration and the Nursing Process of Drug Therapy 1. Apply the rights of medication administration in the care of a patient. dose/drug/pt/documentation/assessment/route education/time/reason/evaluation/the right to refuse 2. Illustrate knowledge needed to administer medications to a patient. Follow “rights” consistently. Learn essential information about medications to be given. Interpret the prescriber’s orders accurately. Write down or enter into computer and read back verbal or phone orders. Read medication labels carefully. Use only approved abbreviations use to prevent errors. Calculate doses accurately. Measure doses accurately. Use correct procedures and techniques for all administration routes. Learn about the patient’s diagnoses and condition in relation to medication administration. 3. Identify and interpret drug orders for medication administration. Verify identity of all patients before administering medications. Omit or delay doses as indicated by the patient’s condition and document accordingly. Be especially careful when administering medication to children due to high risk of medication error. Maintain up-to-date drug administration skills and knowledge. Common medication errors include Giving an incorrect dose Not giving an ordered medication Giving an unordered medication Medications often associated with errors include Insulin, heparin, and warfarin Must include The patient’s full name Name of the medication (preferably generic) Dose, route, frequency of administration Date, time, signature of the prescriber 4. Demonstrate the ability to calculate drug dosages accurately. 5. Apply the steps of the nursing process in the administration of medications. Oral (by mouth) Parenteral (injected) Subcutaneous (Sub-Q) Intramuscular (IM) Intravenous (IV) Topical (applied to skin or mucous membrane) Sub-Q common sites Upper arms, abdomen, back, thighs IM common sites Deltoid, ventrogluteal, vastus lateralis muscles IV common sites Back of hands, forearms : Nursing process, a systematic way of gathering and using information to plan, provide, and evaluate individualized care, is instrumental in effective drug therapy. Assessment Nursing diagnosis Planning/establishing goals Interventions Evaluation 6. Demonstrate safe and accurate administration of medications. 7. Apply evidence-based practice research in the administration of medications. Evidence-based nursing practice Requires a conscientious and continuing effort to provide high-quality care to patients Obtaining and analyzing best scientific evidence from research Scientific evidence is integrated with the nurse’s clinical expertise and the patient’s preferences and values to yield best practice. 8. Identify alternative or complementary therapy that may potentiate, negate, or cause toxicity with prescribed medications. Questionable safety due to unknown effect on humans, nonstandardized ingredients 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 Learning Objectives, Chapter 15, Inflammation, Infection, and the Use of Antimicrobial Agents 1. Describe the characteristics of inflammation. Cellular response of the body to tissue damage and injury, red warm to the touch,pain 2. Describe, in general, the groups of drugs used to treat inflammation. NSAIDS, Aspirin, corticosteroids 3. Identify the common microorganisms that cause infection and their key characteristics. Bacteria- single celled microorganisms without a nuclei can be areobic or anaroebic viruses- parisite that only survives in living tissue Fungi- plantlike microorganisms that live as parasites on living tissue or as saprophytes on decaying matter. Parasites- micro organisms in the animal kingdom that infect other animals (human- arthropods, protozoa, helminths 4. Discuss the characteristics of infection and methods of infection control. 5. Discuss ways to minimize emergence of drug-resistant microorganisms. Take all antibiotics use antibiotics targeted at the organism 6. List ways to increase the benefits and decrease the risks associated with antimicrobial drug therapy. 7. Apply the nursing process in the care of patients receiving antimicrobial therapy. Learning Objectives, Chapter 16, Drug Therapy to Decrease Pain, Fever, and Inflammation 1. Discuss the role of prostaglandins in the etiology of pain, fever, and inflammation. Chemical mediators found in most body tissues Assist in regulating many body functions Participate in the inflammatory response Are formed when cellular injury occurs Exert various and opposing effects on various body tissues 2. Identify the major manifestations of fever and inflammation. 3. List and describe two common disorders that specifically produce inflammation. 4. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for the salicylates. 5. Identify the action, use, adverse effects, contraindications, and nursing implications for acetaminophen. 6. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for the propionic acid derivatives. 7. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for the oxicam derivatives. 8. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for the acetic acid derivatives. 9. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for the selective COX-2 inhibitors. 10. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for the mitotic agent. 11. Identify the prototype and describe the action, use, adverse effects, contraindications, and nursing implications for uricosuric medications. 12. Implement the nursing process in the care of patients undergoing drug therapy for pain, fever, and inflammation. Learning Objectives, Chapter 17, Drug Therapy With Corticosteroids 1. Understand the physiologic effects of endogenous corticosteroids. Important in metabolic/ inflammatory and immune processes naturally higher in the body in the morning 2. Identify the characteristics of adrenal cortex disorders. 3. Describe the action and the clinical indications for use of exogenous corticosteroids. 4. Understand the contraindications and adverse effects of corticosteroids as well as the nursing implications of their use. 5. Analyze how other drugs and substances as well as other factors may affect the need for corticosteroids. 6. Apply the nursing process when a patient is administered a corticosteroid. Glucocorticoid – ant-inflammatory Mineral corticoid- aldosterone Gonad corticoid- androgen/estrogen