Week 3 - Pharmacology (PDF)

WEEK 3-Pharmacology 2. Parental - Injection Medication - Subq (45deg) - Are substances prescribed by the - IM (90deg) client’s...

WEEK 3-Pharmacology 2. Parental - Injection Medication - Subq (45deg) - Are substances prescribed by the - IM (90deg) client’s prescribing practitioner to - IV (15-20deg) help in the treatment, relief, or cure - ID (15 deg–bevel of the cause of the client’s health up–wheal form) alterations or in the prevention of - Local such alterations - Subq and IM are on the - Medication management requires same side (deltoid the collaborative efforts of many muscle–right forearm, vastus health care providers lateralis–right inner thigh, - Once prescribed, pharmacists are abdomen and buttocks) DO licensed to prepare and dispense NOT FORGET TO medications ASPIRATE! –if there is blood - Nurses are responsible for backflow, remove and administering medications prepare another one 3. Dermal Types of medication action - Epidermic Therapeutic effect - Instillation ○ The desired effect intended - Irrigation for that medication - Otic drops ○ If px complaining pain–to - A: Upward, have no pain backward Side effect - P: Downward, ○ This are the unintended backward effect of the medication, and 4. Inhalation the effect that we are to - Vaporization monitor with client after - Gas inhalation taking the medication - Nebulizer ○ Expected 5. Transdermal Adverse effect - Patch ○ This are the severe side - Microneedle effect that are fatal to the client Drug Nomenclature and Classification ○ Unexpected - Nomenclature implies that there are several names that can be used to Routes of drugs administration identify a drug. Drugs have 3 1. Enteral different names: - Oral A. Chemical name - Buccal - Is given when a new - Sublingual chemical entity (NCE) is - Rectal developed; it is useful for - Ocular chemist as it provides an  exact arrangement of atom/atomic groups as it Non proprietary name: provides in the molecule - Approved name: (BAN) Paracetamol - Chemicals found in the med - Official name: (USAN) B. Non-proprietary name Acetaminophen - Given to a drug that is not Proprietary name: Panadol, Calpol, Adol subject for proprietary rights; should be concise and A. Classification based on chemical nature meaningful; used for 1. Inorganic drugs discussions and textbooks - Metals and their salts (Ferrous Sulfate and Zinc 2 classes: Sulfate, Magnesium Sulfate) 1. Approved name - Non-metals (Sulfur) - Given by bodies like the 2. Organic drugs United States Adopted Name - Alkaloids (Atropine, Council (USAN) and British Morphine, Strychnine) Approved Name (BAN) soon - Glycosides (Digitoxin, after its introduction. Digoxin) Sometimes referred to as - Proteins (Insulin, Oxytocin) generic name, however used to designate a chemical B. Classification Based on Source or pharmacologic class such 1. Natural source as Sulfonamide or Penicillin a. Plants (Morphine, Atropine, 2. Official name Digitoxin) - Name approved by a b. Animals (Insulin) National Pharmacopoeia c. Microorganism (Penicillin) Commission; it must be d. Mineral (Sodium) identical to the approved e. Synthetic source name (Sulfonamide, Procaine) - Umbrella of the legisting or f. Non-synthetic source commission bodies of the (Amoxicillin, Amoxicillin, medication Doxycycline) g. Bio-synthetic source C. Proprietary name (Recombinant human - Given by the pharmaceutical erythropoietin) firm which sells drugs. Written with capital initial C. Classification Based on Target Organ letter distinguished by 1. Drug Acting on CNS (Diazepam, superscript Phenobarbital) 2. Drug Acting on Respiratory system Example: (Bromhexine) PARACETAMOL 3. Drug Acting on CVS (Digitoxin, Chemical name:N-(4-hydroxyphenyl Digoxin) acetamide) 4. Drug Acting on GIT (Omeprazole)  5. Drug Acting on Urinary System any patient in clearly defined (Magnesium, Sulfate, Furosemide) circumstances without the 6. Drug Acting on Reproductive need to initially notify a System (Oxytocin, Estrogen) provider ○ Example: patients visiting an D. Classification Based on Mode of Action urgent care clinic reporting 1. Inhibitor of bacterial wall synthesis chest pain is to immediately (Penicillin) administer four chewable 2. Inhibitor of bacterial protein aspirin, establish intravenous synthesis (Tetracycline) (IV) access, and obtain an 3. Calcium channel blockers electrocardiogram (ECG) (Verapamil, Nifedipine) Single or one-time order ○ Is a prescription for a medical E. Classification based on therapeutic use to be administered only once 1. Antimicrobials/antibiotic (Penicillin, ○ An example of a one-time Streptomycin, Quinolones, order is a prescription for an Macrolides) IV dose of antibiotics to be 2. Antihypertensives (Beta-blocker, administered immediately CCB, Nitrates, Diuretics) prior surgery 3. Antidiarrheals (Loperamide) ○ Routine order 4. Antiemetics (Domperidone, ○ Is a prescription that is Metoclopramide) followed until another order cancels it F. Classification based on physiologic ○ An example of a routine system order is “Lisinopril 10 mg PO 1. Sympathomimetics (Adrenaline, daily” Noradrenaline) ○ Compare to stat order this 2. Parasympathomimetics (Pilocarpine, can be delay Neostigmine) PRN order (pro re nata) 3. Neuromuscular blockers ○ Is a prescription for (Suxamethonium) medication to be administered when it is G. Classification based on physical effects requested by, or as needed, 1. Emollients (Lanoline, Vaseline) by the patient 2. Caustics (Silver Nitrate) ○ PRN orders are typically 3. Demulcents (Zinc, Oxide, Tannic administered based on acid) patient symptoms, such as pain, nausea, or itching TYPES OF MEDICATION ORDER ○ An example of a PRN order Standing order (continuous) for pain medication is ○ Referred to in practice as an “Acetaminophen 500 mg PO “order set” or a “protocol” every 4-6 hrs as needed for ○ Standardized prescriptions pain” for nurses to implement to  Nurse can write a prescription (OPD and BEDSIDE nurse) when doctor STAT order requested to write a medication–get ○ Is a one time order that is it from doctors order administered without delay due to the urgency of the TERMINOLOGIES circumstances Pharmacotherapeutic ○ An example of a STAT order ○ Is the clinical purpose or is “Benadryl 50 mg PO stat” indication for giving a drug for a patient having an ○ Good effect allergic reaction ○ Cure, alleviate the discomfort and prevent the major Prescription/Doctor’s order complication - The written direction for the Pharmacokinetic preparation and administration of a ○ KB–kilobyte (what the body drug do to the drug) - Important information in a doctor’s ○ Is the effect of the body on order the drug. It is made up of 4 - Name of the patient phases: - Age or date of birth Absorption- is the - Date and time of the order movement of the drug - Drug name from the site of - Dose, frequency and route administration (e.g - name/signature of the orem-mouth) prescriber Distribution- is - Weight of the patient to movement of the drug facilitate dose when through the applicable (note that dose bloodstream and calculation are based on eventually into the metric weight: kilograms for cells children/adults or grams for Metabolism- refers to newborns) the changing of the - Dose calculation drug into another requirements, when substance/s (i.e applicable metabolites) - Exact strength or Excretion- is the concentration when removal of the drug or applicable its metabolites from - Quantity and/or duration of the body. Metabolism the prescription, when and excretion are applicable considered together - Specific instructions for use, as elimination of a when applicable drug Pharmacodynamics  ○ (sometime describe as what aware of what medication a drug does to the body) is can be crushed and those the study of the biochemical, that cannot be crushed. physiologic, and molecular - Name, dosage/stock, route, effects of drugs on the body and expiration date and involves receptor binding 3. Right dose (including receptor - Ensures the dosage of the sensitivity), postreceptor medication matches the effects, and chemical prescribed dose, verifies the interactions correct dosage range for the age and medical status of the 10 RIGHTS IN GIVING MEDICATIONS patient, and also confirms 1. Right patient that the prescription itself - Acceptable patient identifiers does not reflect an unsafe include, but are not limited to, dosage. For example, the patient’s full name, an medication errors commonly identification number occur in children, who assigned by the hospital, or typically receive a lower dose date of birth. A patient’s room of medication than an adult. number must never be used Medication errors also as an identifier because a commonly occur in older patient may change rooms patients who have existing identifiers must be confirmed kidney or liver disease and by the patient wristband, are unable to metabolize or patient identification card, excrete typical doses of patient statement (when medications possible), or other means 4. Right time and frequency outlined in the agency policy - Drug timing is important, 2. Right drug/medication especially with some drugs - The nurse ensures the like antibiotics, to achieve medication to be cure and prevent resistance. administered to the patient Some drugs must be given matches the order and on an empty stomach. (e.g checks your patient's allergy antituberculosis drugs;and status. Also, check the some after meal) expiration date of the 5. Right route medication. Beware of - Nurses must administer look-alike and sound-like medications via the route medication names, as well indicated in the order. If a as high-alert medications that nurse discovers an error in bear a heightened risk of the order or believes the causing significant patient route is unsafe for a harm if they are used in error. particular patient, the route The nurse should also be must be clarified with the  prescription provided before patient is a minor, the parent administration (IV,IM,SQ,ID, may depending upon the Inhalation etc.) circumstances 6. Right documentation 10. Right of refusal - After administering - After providing education medication, it is important to about the medication, the immediately document the patient has the right to refuse administration to avoid to take medication in potential errors from an accordance with the nursing unintended repeat code of ethics and respect dose/medication/errors. for the individual patient 7. Right history and assessment autonomy - Nurses should be aware of - Secure a waiver (name and the patient’s allergies, as well sign) as any history of any drug interactions. Additionally, If a patient refuses to take the medication nurses collect appropriate after proper education has been performed, assessment data regarding the event should be documented in the the patient’s history, current patient chart and the prescribing provider status, and recent lab results notified to identify any contraindications for the Documentation: transcribing doctor’s patients to receive the orders prescribed medication 8. Right drug interactions UNIVERSAL FORMULA - Patient’s history should be D/HxQ=dose reviewed for any potential interactions with medications previously given or with the patient’s diet. It is also important to verify the medication’s expiration date before administration 9. Right education and information - Information should be provided to the patient about the medication, including the expected therapeutic effects. As well as the potential adverse effects. The patient should be encouraged to report suspected side effects to the nurse and/or prescribing provider. If the