module-1-Pharmacology-AY2024-2025-FS.pdf

NUPC 107 NURSING PHARMACOLOGY COURSE MODULES Monica Jane Marzan Modesto Noble CCHAMS Faculty  2024 COURSE DESCRIPTION, EXPECTATION, and INTRODUCT...

NUPC 107 NURSING PHARMACOLOGY COURSE MODULES Monica Jane Marzan Modesto Noble CCHAMS Faculty  2024 COURSE DESCRIPTION, EXPECTATION, and INTRODUCTION rolled into 1 If you’re too busy to read this boring introduction, busy with Mobile Legends or Coin Master, or with other subjects to have the time to go through an introduction that uses pretentious or highfalutin terms and endless dull paragraphs to get to the point. So let’s cut the chase! Here’s why this subject is so terrific and essential in your nursing career! It will teach you all the important things you need to know about nursing pharmacology. (And it will leave out all the fluff that wastes your time as you practice your profession safely.) It will help you remember what you’ve learned to become a responsible and prudent nurse. It will make you smile as it enhances your knowledge and skills. (hopefully) COURSE REQUIREMENTS To pass this course, you must: 1. Have PATIENCE. You need a lot of patience in reading the whole Pharmacology course 2. Read and comprehend the entirety of the modules and attend the face-to-face meeting when required. 3. Answer all the print-based discussion activities. 4. Take the graded written quizzes. 5. Accomplish the Midterm and Final Evaluation/Exams. If you need assistance during the course of your study, you may contact me thru messenger, google classroom, email, or request for zoom meeting. GRADING SYSTEM Class Standing = 60% Learning Activities Summative Tests Projects Midterm/Final Exam = 40% Midterm Grade = Class Standing (60%) + Midterm Exam (40%) Final Term Grade = Class Standing (60%) + Final Exam (40%) FINAL GRADE = 40% of Midterm Grade+ 60% of Final Term Grade  COURSE CONTENT MODULE 1 FUNDAMENTALS OF NURSING PHARMACOLOGY LESSON 1 Overview LESSON 2 Drugs and its Forms LESSON 3 DOH Approved Herbal Medications LESSON 4 Medication safety LESSON 5 Nursing Process & Drug Administration REFERENCES Books: Pharmacology for Nurses by Blaine Templar Smith & Diane F. Pacitti; Second Edition 2019 Nursing 2020 Drug Handbook by Walters Kluwer; Philippine Edition 2020 Davis’s Drug Guide for Nurses by Judith Hopper Deglin, et al, Thirteenth Edition, 2015 Essentials of Pharmacology for Nurses by Paul Barber & Deborah Robertson Third Edition, 2015 Nurses! Test yourself in Pharmacology by Katherine M.A. Rogers & William N. Scott, Faculty of Nursing Chiangmai Univeristy, 2014. Karch A.,(2011)Focus on Nursing Pharmacology 5th Edition. Lippincott Williams and Wilkins. Adam, M.P., L,N. Bostwick, P. (2007). Pharmacology for Nurses: A Pathophysiologic Approach 2nd Edition. Pearson Education Inc. Clayton, Bruce D. and Y. Stock, Basic Pharmacology for Nurses Websites: http://nursingcrib.com/practice-tests/ http://nursingcrib.com/category/nursing-notes-reviewer http://nursing crib.com/category/nclex-cgfns/ http://nurseslabs.com http://www.nursingschoolhub.com/top-10-blogs-nursing-students/  Module 1 INTRODUCTION TO NURSING PHARMACOLOGY Module Outcomes When you complete Module 1, you’ll learn ♦ pharmacology basics ♦ key concepts of pharmacokinetics, pharmacodynamics, and pharmacotherapeutics ♦ key types of drug interactions and adverse reactions ♦ basics in medication safety ♦drug computation and morphology ♦ and the nursing process. LESSON 1. Overview 1.A. PHARMACOLOGY BASICS Pharmacology is the scientific study of the origin, nature, chemistry, effects, and uses of drugs. This knowledge is essential to providing safe and accurate medication administration to your patients. 4’s This chapter reviews the three basic concepts of pharmacology: Pharmacokinetics—the absorption, distribution, metabolism, and excretion of drugs by the body Pharmacodynamics—the biochemical and physical effects of drugs and the mechanisms of drug actions Pharmacotherapeutics—the use of drugs to prevent and treat diseases. Pharmacognosy- branch of pharmacology dealing with natural drugs & their constituents, as well as sources, procurement & chemistry of natural products. In addition, it discusses other important aspects of pharmacology, including: how drugs are named and classified how drugs are derived how drugs are administered how new drugs are developed. Naming and classifying drugs Drugs have a specific kind of nomenclature—that is, a drug can go by three different names: The chemical name is a scientific name that precisely describes the drug’s atomic and molecular structure. The generic, or nonproprietary, name is an abbreviation of the chemical name. The trade name (also known as the brand name or proprietary name) is selected by the drug company selling the product. Trade names are protected by copyright Drugs may have many different tradenames. To avoid confusion, refer to a drug by its generic name. The symbol ® after a trade name indicates that the name is registered by and restricted to the drug manufacturer. To avoid confusion, it’s best to use a drug’s generic name because any one drug can have a number of trade names.  A pharmacologic class groups drugs by their shared characteristics. A therapeutic class groups drugs by their therapeutic use. Making the DRUG official In 1962, the federal government mandated the use of official names so that only one official name would represent each drug. The official names are listed in the United States Pharmacopeia and National Formulary. Class act Drugs that share similar characteristics are grouped together as a pharmacologic class (or family). Beta-adrenergic blocker is an example of a pharmacologic class. A second type of drug grouping is the therapeutic class, which categorizes drugs by therapeutic use. Antihypertensive is an example of a therapeutic class. Where drugs come from (ORIGIN) Traditionally, drugs were derived from natural sources, such as: plants animals minerals Today, however, laboratory researchers have used traditional knowledge, along with chemical science, to develop synthetic drug sources. One advantage of chemically developed drugs is that they’re free from the impurities found in natural substances. Also, researchers and drug developers can manipulate the molecular structure of substances such as antibiotics so that a slight change in the chemical structure makes the drug effective against different organisms.The first-, second-, third-, and fourth-generation cephalosporins are an example. Here’s a List of Sources of Drugs as product of Research I. NATURAL SOURCES A. Plants  parts of plants are processed to become Crude Drugs which are considered as Active Principles such as: 1. ALKALOIDS o are a diverse group of bitter-tasting, organic, basic substances found in plants o generally given names that end in “INE” Examples: Morphine Cocaine Atropine Quinine Nicotine Caffeine 2. GLYCOSIDES o compounds that consist of sugar units, usually glucose, & a nonsugar component called AGLYCONE Example: Digitalis – Digoxin 3. VOLATILE OIL o may be used as aromatics & as flavoring agents like peppermint, menthol, and cinnamon o wintergreen oil used as antiseptic & for rubs (like vicks vaporub) 4. RESINS o are complex substances of plant origin that are amorphous in structure & insoluble in water but mostly soluble in alcohol Example: Podophyllum (mandrake) – used as laxative Peruvian balsam– astringent used in Hemorrhoidal prep  5. GUMS o these are translucent, amorphous, hydrocolloidal masses Ex: karaya, agar, carrageenan –used as bulk laxatives 6. TANNINS o Tannic Acid – used as antiseptic & astringent for bed sores, to stop bleeding, treat rashes and alleviate other conditions of soreness o However, their presence in many herbal teas as well as ordinary tea has been linked to occurrence of esophageal cancer. B. Animals - liver - thyroid - insulin - cortisone C. Mineral Products 1. Elementary substances a) oxygen b) iodine c) iron 2. Free acids a) Boric acid b) Hydrochloric Acid 3. Metallic hydroxide a) Aluminum hydroxide 4. Salts a) Magnesium sulfate o Epsom salt o as a cathartic b) Magnesium trisilicate o gastric antacid II. SEMI-SYNTHETIC  derived by chemical modification of natural substances  Genetic Engineering – a new method of drug production based on recombinant DNA technology III. SYNTHETIC  Drug is made in the laboratory and mainly composed of pure chemicals  Medicinal Chemistry – branch of the pharmaceutical science most directly concerned with the synthesis of new drug substances. Examples: hematropine barbiturates sulphonamides Sowing the seeds of drugs The earliest drug concoctions from plants used everything: the leaves, roots, bulb, stem, seeds, buds, and blossoms. As a result, harmful substances often found their way into the mixture. Reaping the rewards of research As the understanding of plants as drug sources became more sophisticated, researchers sought to isolate and intensify active components while avoiding harmful ones. The active components of plants vary in character and effect: Alkaloids, the most active component in plants, react with acids to form a salt that’s able to dissolve more readily in body fluids. The names of alkaloids and their salts usually end in “- ine”; examples include atropine, caffeine, and nicotine. Glycosides are naturally occurring active components that are found in plants and have both beneficial and toxic effects. They usually have names that end in “-in,” such as digoxin.  Gums give products the ability to attract and hold water. Examples include seaweed extractions and seeds with starch. Resins, of which the chief source is pine tree sap, commonly act as local irritants or as laxatives and caustic agents. Oils, thick and sometimes greasy liquids, are classified as volatile or fixed. Examples of volatile oils, which readily evaporate, include peppermint, spearmint, and juniper. Fixed oils, which aren’t easily evaporated, include castor oil and olive oil. Aid from animals The body fluids or glands of animals are also natural drug sources. The drugs obtained from animal sources include: hormones, such as insulin oils and fats (usually fixed), such as cod-liver oil enzymes, which are produced by living cells and act as catalysts, such as pancreatin and pepsin vaccines, which are suspensions of killed, modified, or attenuated microorganisms. Many minerals Metallic and nonmetallic minerals provide various inorganic materials not available from plants or animals. Mineral sources are used as they occur in nature or they’re combined with other ingredients. Examples of drugs that contain minerals are iron, iodine, and Epsom salts. Laboratory processed Today, most drugs are produced in laboratories. Examples of such drugs include thyroid hormone (from natural sources) and cimetidine (from synthetic sources). DNA paving the way Recombinant deoxyribonucleic acid (DNA) research has led to another chemical source of organic compounds. For example, the reordering of genetic information enables scientists to develop bacteria that produce insulin for humans. The process of Genetic Engineering. I.B. FORMS/PREPARATIONS OF DRUGS A. TOPICALS 1. CREAMS – are water soluble in preparation and are usually applied by rubbing into the skin; often used as moisturizer 2. OINTMENT – drugs in oily or fatty suspension - most commonly used ointment bases are petrolatum & lanolin - not easily washed away by water or sweat 3. PASTES – ointments that are especially thick & viscous & that don’t soften substantially from body heat 4. GELS - aqueous suspensions of hydrated particles 5. LOTIONS – aqueous suspensions of drugs & should be dabbed, not rubbed 6. LINIMENTS - thinner than ointment, consisting of fluid mixture of drugs w/ water, oil, soap & other constituents -applied by rubbing 7. PLASTERS – drugs that comes in solid dosage forms and have usually have a rubber mixture as their base 8. POWDERS – usually consist of fine mineral dusts, such as talc & are applied by dusting. -used to absorb moisture from the skin thereby altering conditions favorable to growth of microbes. 9. PATCHES – used to provide gradual transfer of drug from the patch to the skin, usually for drugs that’ll be absorbed through the skin to provide systemic effects Example: nitroglycerine patch, salonpas, nicotine patch 10. TINCTURES – solutions of drugs in alcohol form; often applied by fainting 11. AEROSOLS – used for topical application of drugs to both the skin & the respiratory tract. It consist of liquids applied under air pressure as sprays 12. FOAMS – aerated semisolid preparation applied under pressure in a manner similar to aerosol. 13. BATHS & SOAKS – provide thorough & direct contact of the skin w/ water or other fluids for a limited time period B. DRUGS or MEDICATIONS USED in MUCOSAL MEMBRANES - ointment, creams, drops - used or administered in the urethra, vagina, conjunctiva, nose, throat, rectum and mouth - the medication is readily absorbed both locally & systemically 1. GARGLES – oral membrane (betadine garle, listerine gargle, bactidol gargle) 2. LOZENGES – a flat disk containing a medicinal agent in a suitable flavoured base - held in the mouth to be dissolved slowly (example: Strepsils) 3. VAGINAL SUPPOSITORY - is usually supplied with an applicator to facilitate easy & effective insertion - make sure to wipe away excessive vaginal discharges & always observe sterile technique. Instruct patient lie flat for 15 minutes. C. INHALATION/INSUFFLATION 1. INHALATION - drugs that can be administered to the Respiratory tract for either topical or systemic purpose. - both liquid & gases can be administered. 2. INSUFFLATION - fine powders administered to the Respiratory tract by blowing or spraying into the nose. D. OCULAR INSTILLATION 1. DROPS – solutions, or suspensions, that are instilled in the eye by the use of a dropper. Make sure to observe sterile technique. 2. OINTMENT – usually placed on the inner mucosal surface of the lower eyelid or in the conjunctival sac in the inner canthus E. EAR DROPS 1. DROPS – labelled as OTIC F. ENTERAL ADMINISTRATION - medication or drug is administered in the alimentary tract with systemic effect - it may be in oral, rectal, sublingual or buccal routes F1. ORAL ROUTE- the most convenient and frequently used route a) TABLETS – dried powdered drug that has been compressed into small disks. Some tablets are “scored” to aid in subdividing them. (scored meaning divisions for you to easily divide the tablet. If the tablet is not scored, you cannot divide it split it into half. - some are “enteric coated” enteric coated tablets resist dissolution in the acid medium of the stomach be sure to instruct your patient not to chew or crush or even split it into half. b) CAPSULES – consist of powders or liquids in a gelatin container. Capsules don’t require color or additives to improve taste c) TIMED-RELEASE CAPSULE- granules w/in the capsule dissolve at different rates d) SOLUTIONS – consist of substances dissolve in water e) SYRUPS – are sugar solutions used as vehicles for various drugs f) SUSPENSIONS – consist of fine drug particles suspended in a liquid vehicle. Make sure to shake well to ensure thorough mixing g) EMULSIONS – consist of a lipid substance dispersed in water by the action of an emulsifying agent h) MAGMAS – often called milk. These are thick suspensions of white particles in water ex. Milk of magnesia (MOM) i) GELS – aqueous suspensions of hydrated particles j) ELIXIR – are vehicles containing alcohol, sugar, & water - used primarily when the drug will not dissolve in water k) SPIRITS – alcohol solutions of volatile substances  l) TINCTURES – consist of drugs dissolved in alcohol or alcohol & water F2. SUBLINGUAL/BUCCAL ADMINISTRATION a) NITROGLYCERIN –medication is placed under the tongue → which results to rapid disintegration →drug is absorbed thru thin epithelium into the blood the vessels F3. RECTAL SUPPOSITORY - mixture of drugs in a base, e.g. cocoa butter, that is solid at room temp. but which melts at body temp & dissolves in the body fluids. - suitable substitute for oral administration of medications in comatose patients - make sure to evacuate the rectum by enema before administration BOUGIES – small suppository inserted into the urethra G. PARENTERAL ADMINISTRATION 1. AMPULES – glass containers that usually contain a single dose of medication ◼ may be scored or have a darkened ring around neck 2. VIALS – are glass containers that contain 1 or more doses of a sterile medication - may be a solution or it may be a sterile powder to be reconstituted or diluted before the time of administration 3. MIX-O-VIALS – glass containers with 2 compartments - lower chamber contains the solute; upper chamber contains a sterile diluent. - in between the chambers is a rubber stopper 4. PREFILLED SYRINGE - these are premeasured amount of meds in a disposable cartridge-needle unit - the cartridge is in a sealed unit and drug name, concentration, & volume are clearly printed in the cartridge - it time saving and there is diminished chance of contamination of drugs 1.C. HOW DRUGS ARE ADMINISTERED A drug’s administration route influences the quantity given and the rate at which the drug is absorbed and distributed. These variables affect the drug’s action and the patient’s response. Buccal, sublingual, and translingual Certain drugs, such as nitroglycerin, are given buccally (in the pouch between the cheek and teeth), sublingually (under the tongue), or translingually (on the tongue) to prevent their destruction or transformation in the stomach or small intestine. Gastric The gastric route allows direct administration of a drug into the GI system. This route is used when patients can’t ingest the drug orally. Intradermal In intradermal administration, drugs are injected into the skin. A needle is inserted at a 10- to 15-degree angle so that it punctures only the skin’s surface. This form of administration is used mainly for diagnostic purposes, such as testing for allergies or tuberculosis. Intramuscular The IM route allows drugs to be injected directly into various muscle groups at varying tissue depths. This form of administration provides rapid systemic action and allows for absorption of relatively large doses (up to 3 mL). Aqueous suspensions and solutions in oil as well as drugs that aren’t available in oral forms are given IM. Intravenous The IV route allows injection of drugs and other substances directly into the bloodstream through a vein. Appropriate substances to administer IV include drugs, fluids, blood or blood products, and diagnostic contrast agents. Administration can range from a single dose to an ongoing infusion that’s delivered with great precision. IV administration puts substances right into the bloodstream. Oral Oral administration is usually the safest, most convenient, and least expensive route. Oral drugs are administered to patients who are conscious and able to swallow. Rectal and vaginal Suppositories, ointments, creams, or gels may be instilled into the rectum or vagina to treat local irritation or infection. Some drugs applied to the mucosa of the rectum or vagina can also be absorbed systemically. Respiratory Drugs that are available as gases can be administered into the respiratory system through inhalation. These drugs are rapidly absorbed. In addition, some of these drugs can be selfadministered by devices such as the metered-dose inhaler.The respiratory route is also used in emergencies—for example, to administer some injectable drugs directly into the lungs via an endotracheal tube. Subcutaneous In subcutaneous administration, small amounts of a drug are injected beneath the dermis and into the subcutaneous tissue, usually in the patient’s upper arm, thigh, or abdomen. This allows the drug to move into the bloodstream more rapidly than if given by mouth. Drugs given by the subcutaneous route include nonirritating aqueous solutions and suspensions contained in up to 1 mL of fluid, such as heparin and insulin. Topical The topical route is used to deliver a drug via the skin or a mucous membrane. This route is used for most dermatologic, ophthalmic, otic, and nasal preparations. Talk about going with the flow! IV administration puts substances right into the bloodstream Specialized infusions Drugs may also be given as specialized infusions. These are given directly to a specific site in the patient’s body. Specific types of infusions include: epidural—injected into the epidural space intrapleural—injected into the pleural cavity intraperitoneal—injected into the peritoneal cavity intraosseous—injected into the rich vascular network of a long bone intra-articular—injected into a joint. 1.C. NEW DRUG DEVELOPMENT In the past, drugs were found by trial and error. Now, they’re developed primarily by systematic scientific research. The Food and Drug Administration (FDA) carefully monitors new drug development, which can take many years to complete. Only after reviewing extensive animal studies and data on the safety and effectiveness of the proposed drug does the FDA approve an application for an Investigational New Drug (IND).(See Phases of new drug development.) Drugs are primarily developed by systematic scientific research conducted under FDA guidelines. On the FDA fast track Although most INDs undergo all four phases of clinical evaluation mandated by the FDA, a few can receive expedited approval. For example, because of the public health threat posed by acquired immunodeficiency syndrome (AIDS), the FDA and drug companies have agreed to shorten the IND approval process for drugs to treat the disease. This allows doctors to give qualified AIDS patients “Treatment INDs” that aren’t yet approved by the FDA. Sponsors of drugs that reach phase II or III clinical trials can apply for FDA approval of Treatment IND status. When the IND is approved, the sponsor supplies the drug to doctors whose patients meet appropriate criteria. Cheaper and easier In the past, only a few drugs for acute conditions (such as headaches and colds) were available without prescription. Now, however, the Food and Drug Administration approves more drugs for over the- counter use, making the drugs more easily accessible and much less expensive to consumers. Some examples include GI medications (such as ranitidine and cimetidine) and antihistamines (such as loratadine). ✰Pharmacokinetics The term kinetics refers to movement. Pharmacokinetics deals with a drug’s actions as it moves through the body. Therefore, pharmacokinetics discusses how a drug is: absorbed (taken into the body) distributed (moved into various tissues) metabolized (changed into a form that can be excreted) excreted (removed from the body). This branch of pharmacology is also concerned with a drug’s onset of action, peak concentration level, and duration of action. Absorption Drug absorption covers the progress of a drug from the time it’s administered, through the time it passes to the tissues, until it becomes available for use by the body. How drugs are absorbed On a cellular level, drugs are absorbed by several means—primarily through active or passive transport. ✓ No energy required Passive transport requires no cellular energy because the drug moves from an area of higher concentration to one of lower concentration (diffusion). It occurs when small molecules diffuse across membranes. Diffusion stops when the drug concentrations on both sides of the membrane are equal. Oral drugs use passive transport; they move from higher concentrations in the GI tract to lower concentrations in the bloodstream. ✓ Get active Active transport requires cellular energy to move the drug from an area of lower concentration to one of higher concentration. Active transport is used to absorb electrolytes, such as sodium and potassium, as well as some drugs, such as levodopa. ✓ Pinocytosis Pinocytosis is a unique form of active transport that occurs when a cell engulfs a drug particle. (just like taking a bite of its particles) Pinocytosis is commonly employed to transport the fat-soluble vitamins (A, D, E, and K). Factors affecting absorption Various factors—such as the route of administration, the amount of blood flow, and the form of the drug—can affect the rate of a drug’s absorption. Fast and furious-- If only a few cells separate the active drug from systemic circulation, absorption occurs rapidly and the drug quickly reaches therapeutic levels in the body. Typically, drug absorption occurs within seconds or minutes when administered sublingually, IV, or by inhalation. Slow but steady-- Absorption occurs at slower rates when drugs are administered by the oral, IM, or subQ routes because the complex membrane systems of GI mucosal layers, muscle, and skin delay drug passage.  At a snail’s pace-- At the slowest absorption rates, drugs can take several hours or days to reach peak concentration levels. A slow rate usually occurs with rectally administered or sustained-release drugs. Intestinal interference-- Several other factors can affect absorption of a drug. For example, most absorption of oral drugs occurs in the small intestine. If a patient has had large sections of the small intestine surgically removed, drug absorption decreases because of the reduced surface area and the reduced time the drug is in the intestine. Liver-lowered levels-- Drugs absorbed by the small intestine are transported to the liver before being circulated to the rest of the body. The liver may metabolize much of the drug before it enters circulation. This mechanism is referred to as the first-pass effect. Liver metabolism may inactivate the drug; if so, the first-pass effect lowers the amount of active drug released into the systemic circulation. Therefore, higher drug dosages must be administered to achieve the desired effect. Watch out for the first-pass effect! It lowers the amount of active drug released into the systemic circulation. More blood, more absorption-- Increased blood flow to an absorption site improves drug absorption, whereas reduced blood flow decreases absorption. More rapid absorption leads to a quicker onset of drug action. For example, the muscle area selected for IM administration can make a difference in the drug absorption rate. Blood flows faster through the deltoid muscle (in the upper arm) than through the gluteal muscle (in the buttocks). The gluteal muscle, however, can accommodate a larger volume of drug than the deltoid muscle. More pain, more stress, less drug absorbed-- Pain and stress can also decrease the amount of drug absorbed. This may be due to a change in blood flow, reduced movement through the GI tract, or gastric retention triggered by the autonomic nervous system’s response to pain. Food you eat….Whatcha eatin’?-- High-fat meals and solid foods slow the rate at which contents leave the stomach and enter the intestines, delaying intestinal absorption of a drug. Watch what your patient eats. High fat meals and solid food can delay intestinal absorption of a drug. Form factors-- Drug formulation (such as tablets, capsules, liquids, sustained-release formulas, inactive ingredients, and coatings) affects the drug absorption rate and the time needed to reach peak blood concentration levels. For example, enteric-coated drugs are specifically formulated so that they don’t dissolve immediately in the stomach. Rather, they release in the small intestine. Liquid forms, however, are readily absorbed in the stomach and at the beginning of the small intestine.  Combo considerations-- Combining drug with another drug or with food can cause interactions that increase or decrease drug absorption, depending on the substances involved. Example: Pritor plus An antihypertensive drug (combination of Telmisartan & Hydrochlorothiazide) Telmisartan is classified as ARBs (Angiotensin Receptor Blocker ) which is also a drug that lowers blood pressure Hydrochlorothiazide is a diuretic (“pampaihi”) which also helps in lowering blood pressure Distribution Drug distribution is the process by which the drug is delivered to the tissues and fluids of the body. Distribution of an absorbed drug within the body depends on several factors, including: blood flow solubility protein binding. Go with the flow-- After a drug has reached the bloodstream, its distribution in the body depends on blood flow. The drug is distributed quickly to those organs with a large supply of blood, including the heart, liver, and kidneys. Distribution to other internal organs, skin, fat, and muscle is slower. Breaching the barrier-- The ability of a drug to cross a cell membrane depends on whether the drug is water- or lipid- (fat-) soluble. Lipid-soluble drugs easily cross through cell membranes, whereas water-soluble drugs can’t. Lipid-soluble drugs can also cross the blood-brain barrier and enter the brain. Binding-- As a drug travels through the body, it comes in contact with proteins, such as the plasma protein albumin. The drug can remain free or bind to the protein. The portion of a drug that’s bound to a protein is inactive and can’t exert a therapeutic effect. Only the free, or unbound, portion remains active. A drug is said to be highly protein-bound if more than 80% of it binds to protein. Metabolism Drug metabolism, or biotransformation, refers to the body’s ability to change a drug from its dosage form to a more water-soluble form that can then be excreted. Drugs can be metabolized in several ways: Although most drugs are metabolized in the liver, metabolism can also occur in the plasma, kidneys, and intestines.  Most commonly, a drug is metabolized into inactive metabolites (products of metabolism), which are then excreted. Some drugs can be converted to active metabolites, meaning they’re capable of exerting their own pharmacologic action. These metabolites may undergo further metabolism or may be excreted from the body unchanged. Other drugs can be administered as inactive drugs, called prodrugs, and don’t become active until they’re metabolized. Biotransformation: Where the magic happens-- Most drugs are metabolized by enzymes in the liver; however, metabolism can also occur in the plasma, kidneys, and membranes of the intestines. Some drugs inhibit or compete for enzyme metabolism, which can cause the accumulation of drugs when they’re given together. This accumulation increases the potential for an adverse reaction or drug toxicity. Factors that can affect metabolism Metabolism busters—. Certain diseases can reduce metabolism. These include liver disease, such as cirrhosis, and heart failure, which reduces circulation to the liver. In the genes--Genetics allow some people to be able to metabolize drugs rapidly, whereas others metabolize them more slowly. Environmental effects-- Environment, too, can alter drug metabolism. For example, if a person is surrounded by cigarette smoke, the rate of metabolism of some drugs may be affected. A stressful environment, such as one involving prolonged illness or surgery, can also change how a person metabolizes drugs. Age alterations-- Developmental changes can also affect drug metabolism. For example, infants have immature livers that reduce the rate of metabolism, and elderly patients experience a decline in liver size, blood flow, and enzyme production that also slows metabolism. Excretion Drug excretion refers to the elimination of drugs from the body. Most drugs are excreted by the kidneys and leave the body through urine. Drugs can also be excreted through the lungs, exocrine glands (sweat, salivary, or mammary glands), skin, and intestinal tract. Half in and half out-- The half-life of a drug is the time it takes for the plasma concentration of a drug to fall to half its original value —in other words, the time it takes for one-half of the drug to be eliminated by the body. Factors that affect a drug’s half-life include its rates of absorption, metabolism, and excretion. Knowing how long a drug remains in the body helps determine how frequently a drug should be taken. A drug that’s given only once is eliminated from the body almost completely after four or five half-lives. A drug that’s administered at regular intervals, however, reaches a steady concentration (or steady state) after about four or five half-lives. Steady state occurs when the rate of drug administration equals the rate of drug excretion. A drug’s half-life is the time it takes for its plasma concentration to drop to half its original value. Onset, peak, and duration-- In addition to absorption, distribution, metabolism, and excretion, three other factors play important roles in a drug’s pharmacokinetics: onset of action peak concentration duration of action. How long ‘til we see some action?-- Onset of action refers to the time interval that starts when the drug is administered and ends when the therapeutic effect actually begins. Rate of onset varies depending on the route of administration and other pharmacokinetic properties. When will it reach peak performance?--As the body absorbs more drug, blood concentration levels rise. The peak concentration level is reached when the absorption rate equals the elimination rate. However, the time of peak concentration isn’t always the time of peak response. How long will it last?--The duration of action is the length of time the drug produces its therapeutic effect. Have water or bladder break. Quick review: Pharmacokinetics involves the processes of -Absorption -Distribution -Metabolism -Excretion ✰Pharmacodynamics Pharmacodynamics is the study of the drug mechanisms that produce biochemical or physiologic changes in the body. The interaction at the cellular level between a drug and cellular components, such as the complex proteins that make up the cell membrane, enzymes, or target receptors, represents drug action. The response resulting from this drug action is called the drug effect. A drug’s action refers to the interaction between the drug and the body’s cellular components. Fooling with function A drug can modify cell function or the rate of function, but a drug can’t impart a new function to a cell or target tissue. Therefore, the drug effect depends on what the cell is capable of accomplishing. A drug can alter the target cell’s function by: modifying the cell’s physical or chemical environment interacting with a receptor (a specialized location on acell membrane or inside a cell). Stimulating response An agonist is an example of a drug that interacts with receptors. An agonist drug has an attraction, or affinity, for a receptor and stimulates it. The drug then binds with the receptor to produce its effect. The drug’s ability to initiate a response after binding with the receptor is referred to as intrinsic activity. Preventing response If a drug has an affinity for a receptor but displays little or no intrinsic activity, it’s called an antagonist. The antagonist prevents a response from occurring. Antagonists can be competitive or noncompetitive: A competitive antagonist competes with the agonist for receptor sites. Because this type of drug binds reversibly to the receptor site, administering large doses of an agonist can overcome the antagonist’s effects. A noncompetitive antagonist binds to receptor sites and blocks the effects of the agonist. Administering large doses of the agonist can’t reverse its action. Not so choosy If a drug acts on a variety of receptors, it’s said to be nonselective and can cause multiple and widespread effects. Potent quotient Drug potency refers to the relative amount of a drug required to produce a desired response. Drug potency is also used to compare two drugs. If drug X produces the same response as drug Y but at a lower dose, then drug X is more potent than drug Y. Observe the curve As its name implies, a dose-response curve is used to graphically represent the relationship between the dose of a drug and the response it produces. (See Dose-response curve.) On the dose-response curve, a low dose usually corresponds with a low response. At a low dose, an increase in dose produces only a slight increase in response. With further increases in dose, there’s a marked rise in drug response. After a certain point, an increase in dose yields little or no increase in response. At this point, the drug is said to have reached maximum effectiveness. From desired effect to dangerous dose Most drugs produce multiple effects. The relationship between a drug’s desired therapeutic effects and its adverse effects is called the drug’s therapeutic index. It’s also referred to as its margin of safety. The therapeutic index usually measures the difference between: an effective dose for 50% of the patients treated the minimal dose at which adverse reactions occur The lowdown on a low index A drug with a low or narrow therapeutic index has a narrow range of safety between an effective dose and a lethal one. On the other hand, a drug with a high therapeutic index has a wide range of safety and less risk of toxic effects. Factors affecting patient response to a drug Because no two people are alike physiologically or psychologically, patient responses to a drug can vary greatly, depending on such factors as: ✓ age, ✓ cardiovascular function, ✓ diet, ✓ disease, ✓ drug interactions, ✓ gender,  ✓ GI function, ✓ hepatic function, ✓ presence of infection and ✓ renal function. ✰PHARMACOTHERAPEUTICS Pharmacotherapeutics is the use of drugs to treat disease. When choosing a drug to treat a particular condition, health care providers consider the drug’s effectiveness as well as such factors as the type of therapy the patient will receive. TYPES The type of therapy prescribed depends on the severity, urgency, and prognosis of the patient’s condition. Therapy types include: ▪ acute therapy, if the patient is critically ill and requires acute intensive therapy ▪ empiric therapy, based on practical experience rather than on pure scientific data ▪ maintenance therapy, for patients with chronic conditions that don’t resolve ▪ supplemental or replacement therapy, to replenish or substitute for missing substances in the body ▪ supportive therapy, which doesn’t treat the cause of the disease but maintains other threatened body systems until the patient’s condition resolves ▪ palliative therapy, used for end-stage or terminal diseases to make the patient as comfortable as possible. Personalized A patient’s overall health as well as other individual factors can alter his response to a drug. Coinciding medical conditions and personal lifestyle characteristics must also be considered when selecting drug therapy. (See Factors affecting patient response to a drug.) Decreased response… Certain drugs have a tendency to create drug tolerance and drug dependence in patients. Drug tolerance occurs when a patient has a decreased response to a drug over time. The patient then requires larger doses to produce the same response. Tolerance differs from drug dependence, in which a patient displays a physical or psychological need for the drug. Physical dependence produces withdrawal symptoms when the drug is stopped, whereas psychological dependence is based on a desire to continue taking the drug to relieve tension and avoid discomfort. ✰DRUG INTERACTIONS Drug interactions can occur between drugs or between drugs and foods. They can interfere with the results of a laboratory test or produce physical or chemical incompatibilities. The more drugs a patient receives, the greater the chances are that a drug interaction will occur. Potential drug interactions include: additive effects potentiation antagonistic effects decreased or increased absorption decreased or increased metabolism and excretion. Adding up An additive effect can occur when two drugs with similar actions are administered to a patient. The effects are equivalent to the sum of the effects of either drug administered alone in higher doses. Giving two drugs together, such as two analgesics (pain relievers), has these potential advantages: Lower doses of each drug can be administered, which can decrease the probability of adverse reactions because higher doses increase the risk of adverse reactions. Greater pain control can be achieved than from administration of one drug alone (most likely because of different mechanisms of action). When a drug is said to be potentiated by another drug, the results are more potent—the drug goes beyond its original potential. EMPOWERING EFFECTS A synergistic effect, also called potentiation, occurs when two drugs that produce the same effect are given together and one drug potentiates (enhances the effect) of the other drug. This produces greater effects than either drug taken alone WHEN TWO ISN’T BETTER THAN ONE An antagonistic drug interaction occurs when the combined response of two drugs is less than the response produced by either drug alone. ALTERED ABSORPTION Two drugs given together can change the absorption of one or both of the drugs. For example, drugs that change the acidity of the stomach can affect the ability of another drug to dissolve in the stomach. Other drugs can interact and form an insoluble compound that can’t be absorbed. Sometimes, an absorption interaction can be avoided by separating drug administration by at least 2 hours. For some drugs, you can avoid absorption interactions by separating their administration times by at least 2 hours. BINDING BATTLES After a drug is absorbed, blood distributes it throughout the body as a free drug or one that’s bound to plasma protein. When two drugs are given together, they can compete for proteinbinding sites, leading to an increase in the effects of one drug as that drug is displaced from the protein and becomes a free, unbound drug. TOXICITY Toxic drug levels can occur when a drug’s metabolism and excretion are inhibited by another drug. Some drug interactions affect excretion only. FOOD FACTOR Food can alter the therapeutic effects of a drug as well as the rate and amount of drug absorbed from the GI tract, affecting bioavailability (the amount of a drug dose available to the systemic circulation). Dangerous interactions can also occur. For example, when food that contains tyramine (such as aged cheddar cheese) is eaten by a person taking a monoamine oxidase inhibitor, hypertensive crisis can occur. Also, grapefruit can inhibit the metabolism of certain drugs and result in toxic blood levels; examples include fexofenadine, statin drugs, and albendazole. ELEVATING ENZYMES Some drugs stimulate enzyme production, increasing metabolic rates and the demand for vitamins that are enzyme cofactors (which must unite with the enzyme in order for the enzyme to function). Drugs can also impair vitamin and mineral absorption. ADVERSE DRUG REACTION A drug’s desired effect is called the expected therapeutic response. An adverse drug reaction, on the other hand (also called a side effect or adverse effect), is a harmful, undesirable response. Adverse drug reactions can range from mild reactions that dis- appear when the drug is stopped to debilitating diseases that become chronic. Adverse reactions can appear shortly after start- ing a new drug but may become less severe with time. FACTORS Adverse drug reactions can be classified as dose-related or patient sensitivity–related. Most adverse drug reactions result from the known pharmacologic effects of a drug and are typically dose- related. These types of reactions can be predicted in most cases. ▪ Dose-related reactions. Dose-related reactions include: ✓ secondary effects ✓ hypersusceptibility ✓ overdose ✓ iatrogenic effects. ▪ Secondary effects. A drug typically produces a major therapeutic effect as well as secondary effects that can be beneficial or adverse. For example, morphine used for pain control can lead to two undesirable secondary effects: constipation and respiratory depression. Diphenhydramine used as an antihistamine is accompanied by the secondary effect of sedation, which is why the drug is also sometimes used as a sleep aid. ▪ Hypersusceptibility. A patient can be hypersusceptible to the pharmacologic actions of a drug. Even when given a usual therapeutic dose, a hypersusceptible patient can experience an excessive therapeutic response. Hyper-susceptibility typically results from altered pharmacokinetics (absorption, metabolism, and excretion), which lead to higher-than-expected blood concentration levels. Increased receptor sensitivity can also increase the patient’s response to therapeutic or adverse effects. ▪ Overdose. A toxic drug reaction can occur when an excessive dose is taken, either intentionally or accidentally. The result is an exaggerated response to the drug that can lead to transient changes or more serious reactions, such as respiratory depression, cardiovascular collapse, and even death. To avoid toxic reactions, chronically ill or elderly patients commonly receive low drug doses. ▪ Iatrogenic effects. Some adverse drug reactions, known as iatrogenic effects, can mimic pathologic disorders. For example, such drugs as antineo- plastics, aspirin, corticosteroids, and indomethacin commonly cause GI irritation and bleeding. Other examples of iatrogenic effects include induced asthma with propranolol and induced deafness with gentamicin. Allergic reactions to drugs can range from a mild rash to life-threatening anaphylaxis. Get some help! Stat! Patient sensitivity–related adverse reactions aren’t as common as dose-related reactions. Sensitivity-related reactions result from a patient’s unusual and extreme sensitivity to a drug. These adverse reactions arise from a unique tissue response rather than from an exaggerated pharmacologic action. Extreme patient sensitivity can occur as a drug allergy or an idiosyncratic response. Allergic reaction A drug allergy occurs when a patient’s immune system identifies a drug, a drug metabolite, or a drug contaminant as a dangerous foreign substance that must be neutralized or destroyed. Previous exposure to the drug or to one with similar chemical characteristics sensitizes the patient’s immune system, and subsequent exposure causes an allergic reaction (hypersensitivity). A shock to the system An allergic reaction not only directly injures cells and tissues, but also produces broader systemic damage by initiating cellular release of vasoactive and inflammatory substances. The allergic reaction can vary in intensity from a mild reaction with a rash and itching to an immediate, life-threatening anaphylactic reaction with circulatory collapse and swelling of the larynx and bronchioles. Idiosyncratic response Some sensitivity-related adverse reactions don’t result from the pharmacologic properties of a drug or from an allergy but are specific to the individual patient. These are called idiosyncratic responses. A patient’s idiosyncratic response sometimes has a genetic cause. A B Before proceeding with the next top topic, let me check first if you are a certified Plantito or a Plantita. Guess what herbal plant that is seen in the picture. Do not turn to the next page unless you are done answering. GOODLUCK! C  D E F G H ANSWERS: A. NIYOG-NIYOGAN B. YERBA BUENA C. SAMBONG D. TSAANG GUBAT E. LAGUNDI F.BAWANG G. ULASIMANG BATO H.AKAPULKO Scoring If you answered all eight plants correctly, fantastic! Obviously you’re a Certified Plantito. Keep it up! If you answered five plants correctly, terrific! You can clearly identify DOH Approved herbal plants. If you answered fewer than three plants correctly, don’t be discouraged. You can improve your learning by planting knowledge and cultivating your mind with constant reading. Herbal Plant Indication/ Use Lagundi a. Asthma, cough & fever (Vitex Negundo) b. Dysentery, colds and pain in any part of the 5 leaves chaste tree body as in influenza. c. Skin diseases (dermatitis, scabies, and ulcer eczema) and wounds. d. Headache e. Rheumatism, sprain, contusions, insect bites. f. Aromatic bath for sick patients.  Yerba (Hierba) Buena (Mantha a. For pain (headache, stomach-ache). Cordifelia) b. Rheumatism, arthritis, and headache. Peppermint c. Cough and colds. d. Swollen gums. e. Tooth-ache. f. Menstrual and gas pain. g. Nausea and fainting. h. Insect bites. i. Pruritis Sambong (Blumea balsamifera) a. Anti-edema-diuretic Camphor b. Anti-urolithiasis Tsaang Gubat (Carmona retusa) a. Diarrhea Kalimunog, Talibunog, Tsa, Taglokot b. Stomach ache (TAG) Niyug-Niyogan (Quisqualis indica L.) a. Anti-helminthic Burma creeper, Chinese honey *should not be given to children below 4 years suckle old. Bayabas (Psidium guajava) a. Used to wash wounds Guava b. For diarrhea. c. Used as a gargle to relieve toothache. Akapulko (Cassia, alata L.) a. Anti-fungal Ringworm bush or shrub Ulasimang Bato (Peperonia pelluida) a. Lowers uric acid (rheumatism and gout). Pansit-pansitan Bawang (Alium sativum) a. Hypertension- lower cholesterol level in Garlic blood b. Toothache Ampalaya (Mamordica charantia) a. Lowers blood sugar level. Balsam apple, Balsam pear, Bitter b. DM (Mild non-insulin dependent) Gourd 1.C. HERBAL PLANTS Approved by Department of Health (DOH)  Other names or English name Medication safety Medication therapy is the primary intervention for many illnesses. It greatly benefits many patients and yet is involved in many instances of patient harm from either unintended consequences of therapy (adverse drug reactions) or medication-related errors (adverse drug events). In 2005, The Patient Safety and Quality Improvement Act (PL 109-41) authorized the creation of patient safety organizations (PSOs) to improve the quality and safety of U.S. health care delivery. One of these PSOs, the Institute for Safe Medication Practices (ISMP), is a nonprofit organization entirely dedicated to preventing medication errors and using medications safely. In addition, The Joint Commission has established National Patient Safety Goals and standards to improve the safe use of medications in its accredited facilities. CAUSES OF MEDICATION ERRORS The National Coordinating Council for Medication Error Reporting and Prevention (nccmerp.org) defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use.” Traditionally, teaching nurses to administer drugs safely focused on the individual nurse’s practice and the application of the “rights” of safe medication administration. (See The TEN “rights” of medication administration.) Although individual nursing practice is still considered an extremely important part of safe drug administration, the focus has widened. After medication errors had been systematically studied by numerous organizations who shared data, it became apparent that medication errors are complex events with multiple factors and are most often caused by failures within systems. As a result of these findings, research has shifted to preventing medication errors by identifying their root causes and then developing and validating evidence-based strategies. Organizational processes, management decisions, inadequate medication administration protocols, staffing shortages, environmental conditions, poor communication, inadequate drug knowledge and resources, and individual mistakes or protocol violations may all contribute to drug errors. The medication administration process Medication errors can occur from medication administration process problems within any one or within more than one of the five stages of the process. Because up to 40% of a nurse’s time may be spent in medication administration, and nursing practice intersects multiple stages, nurses may often be involved in medication errors. Here are some of the types of errors that have been reported in each stage. These are sample errors in each stage. Be aware and mindful not to commit these errors in your nursing practice. Stage 1: Ordering and prescribing Prescriber’s orders are incomplete or illegible. Contraindicated drugs (such as drugs to which the patient is allergic) are prescribed. The prescriber specifies the wrong drug, dose, route, or frequency.  Drugs are prescribed using inappropriate or inadequate verbal orders. Stage 2: Transcribing and verifying An incorrect drug, dose, route, time, or frequency is transcribed into the medication administration record (MAR) by the pharmacist or nurse. Drug verification and documentation in the MAR by the pharmacist or nurse are inadequate. Stage 3: Dispensing and delivery The prescribed drug is filled incorrectly. Failure to deliver the right drug to the right place for the right patient occurs. Stage 4: Administering The wrong drug is given to the wrong patient. The wrong dose is calculated and given or infused. The right drug is incorrectly prepared (such as crushing a drug that shouldn’t be crushed). DRUG DISTRIBUTION SYSTEM 1. Floor or Ward System all but the most dangerous or rarely used medications are stocked at the nursing station in stock containers this system has been used most often in a very small hospital & hospitals where there are no charges directly to the patient for medications. Advantages:  ready availability of most drugs  fewer inpatient prescription orders  minimal returns of medications Disadvantages:  increased potential for medication errors  increased danger of unnoticed drug deterioration  need for larger stocks & frequent total drug inventories  storage problems on the nursing units in many hospitals 2. Individual Prescription System in this system, medications are dispensed from the pharmacy on receipt of a prescription or drug order on individual patient Advantages: - provides greater patient's safety - less danger of drug deterioration - easier inventory control Disadvantage: time consuming procedures used to schedule, prepare, administer, control & record the drug distribution & administration process. 3. Computer-controlled Dispensing System is the safest & most economical method of drug distribution in hospitals & long- term care facilities today. the system provides detailed listing of all medications administered to a patient & charges the patient for the medication as well. controlled drug are kept in this cart, & the system provides a detailed record of the controlled substance dispensed including date, time, & by whom it was accessed. 4. Unit-dose System use single packages of drugs dispensed to fill each requirement as it is ordered. each package is labelled with generic & brand name, manufacturer, & expiry date. ✰THE NURSING PROCESS & DRUG ADMINISTRATION One of the most significant advances in nursing has been the development of the nursing process. This problem-solving approach to nursing care provides a systematic method of determining the patient’s health problems, developing a care plan to address those problems, implementing the plan, and evaluating the plan’s effectiveness. The nursing process guides nursing decisions about drug administration to ensure the patient’s safety and to meet medical and legal standards. The five steps of the nursing process are dynamic, flexible, and interrelated. The goal of the Nursing Process is to alleviate, minimize, or prevent actual & potential health problems which include: assessment, nursing diagnosis, planning, implementation, evaluation. 5 SEQUENCIAL & CYCLICAL PHASES 1. ASSESSMENT  the collection of relevant information that defines the current health situation for the particular client  it encompasses the client’s medical & drug history, physical examination, psychological, social, cultural, & environmental factors, laboratory tests & current drug & nondrug orders & interventions 2. ANALYSIS/ NURSING DIAGNOSIS  the critical study of the assessment data for the purposes of studying the client’s needs & establishing nursing goals.  includes the determination of appropriate nursing diagnoses & identification of requirements for referral to other health care practitioners (HCP)  NURSING DIAGNOSES – are those problems for which nurses can legally prescribe interventions independently Ex. Anxiety related to insufficient knowledge regarding surgical experience 3. PLANNING  the designing of strategies, in cooperation with the client or those responsible for the client, that will help to achieve the established the nursing goals.  includes setting priorities & determining nursing interventions  plans are individualized to the unique requirements & capabilities of each client  plans are also dynamic –-- it requires frequent adjustments as the client condition changes. 4. IMPLEMENTATION  is the initiation & completion of the strategies developed during the planning stage 5. EVALUATION  is the process of determining the effects of the plan of care, both the extent to which the goals have been achieved & the occurrence of any unfavorable consequences.  nurses observe & measure the extent to which a client is responding to drug treatment, any side effects the client may be experiencing, & any changes in physiological or psychological functioning 10 RIGHTS in ADMINISTERING MEDICATIONS 1. Right Assessment  before any medication is administered to the client, it is important for the nurse to conduct a thorough assessment of the client. a). take a medication history - prescription, over-the-counter (otc, herbals, alcohol - adverse drug effects experienced b). assess the client’s understanding about illness, including past experience - What do you believe to be the cause of your illness? - What do you know about your condition? c). conduct a physical assessment - provides baseline info on height, weight, BP, temp., PR, RR - also provides general health & nutrition & about physical condition. d). obtain information about social networks & resources o these factors influence whether individuals will have prescriptions filled & will comply with the treatment program. Nursing Diagnosis a number of nursing diagnoses may be useful in guiding planning & implementation. These may include: state relevant nursing diagnoses a) ineffective health maintenance b) risk for injury c) noncompliance r/t drug regimens d) deficient knowledge (illness & its treatment) e) ineffective mgt of the therapeutic regimen Planning once the assessment has been completed & the nursing diagnoses made, the nurse engages in identifying desired outcomes of nursing intervention & in planning appropriate nursing actions to achieve these outcomes focus on: (a) Why the drug is needed (b) How the drug will be administered (c) Common indications of adverse effects (d) other nursing measure that will enhance the likelihood of achieving desired outcomes Implementation in preparing to administer medications, it is important for the nurse to ensure cleanliness of all materials used ensure availability of supplies ensure adequate lighting decrease environmental distractions verify the prescription for the medication to be administered (date, time, drug name, dosage, route, frequency, & duration of administration, & required signature by the prescriber NOTE: prescription must always be written except in some emergency situations. Once emergency has been controlled, written prescription must be obtained. 2. The Right Drug - read label 3x (non- unit dose) a) when taking the container from its location b) when removing the drug from its container c) when returning the container to its storage place ✓ three checks be carried out (unit dose) a) when removing it from its location in the drawer/refrigerator b) when comparing it with the client’s medication administration record c) before administering it NOTE: - carefully check the prescription - check the medication against the prescription - do not administer a medication someone else has prepared - if using a unit dose system, do not open the unit packaging until you are at the client’s bedside. - ask if this drug is “right” for the client. (e.g. drug allergy) - never leave medications unattended ABBREVIATIONS THAT ARE FREQUENTLY SEEN IN PRESCRIPTIONS aa of each ad lib freely, as desired a.c. before meals  b.i.d, BID twice a day c with caps. capsule dl, dL deciliter elix. elixer ext. extract g gram gr grain gtt drop h hour H.S., h.s. at bedtime or hr of sleep ID intradermal Im intramuscular inj. by injection IV or I.V. intravenously IVPB intravenous piggyback kg kilogram kvo keep vein open L liter mcg microgram mEq milliequivalents mg milligram ml, mL milliliter NGT nasogastric tube O.D. right eye OCTOR on call to operating rm. O.S. left eye o.u. both eyes p after p.c. after meals p.o, by mouth p.r.n., PRN as the occasion rises, q every q.h. every hour q2h every 2 hours q.s. a sufficient quantity q.i.d 4x a day s without S.C., sub q subcutaneously S.L. sublingually sol. solution ss one-half stat immediately susp. suspension tab’ tablet TID three times a day TPN total parenteral nutrition tr. tincture tsp. teaspoon 3. In the Right Dose a) be familiar with the various measurement systems & the conversion from one system to another b) always use the appropriate measuring device & read it correctly c) shake all suspensions & emulsions d) when measuring drops of medication with a dropper, always hold the dropper vertically & close to the medication cup e) when removing a drug from a multiple –dose vial, inject an amount of air equal to the amount of fluid to be withdrawn f) do not attempt to divide unscored tablets & do not administer tablets that have been broken unevenly along the scoring 4. To the Right Client a) check the tag on the client’s bed b) check the client’s ID band c) ask the client to state his name d) ask parents to tell you the name of their child e) always double-check a prescription that the client questions. 5. At the Right Time a) to achieve maximum therapeutic effectiveness, medications are scheduled to be administered at specific times b) the nurse should adhere, as closely as possible. to the scheduled time of administration NOTE: as a general rule, the nurse should always be certain that a medication is administered within half an hour of the time it is ordered to be given 6. By the Right Route - the method by which a drug is administered affects such factors as the absorption, speed of onset, dose, side effects & adverse effects a) be sure you know the prescribed route by which a medication is to be given b) if no route is specified in the health care provider’s prescription, the MD should be questioned about the intended route c) always gain the client cooperation before attempting to administer a dosage of drug d) consider the client’s developmental level during administration of medications e) the nurse must know what vehicles may be used with various drugs f) to achieve maximum effectiveness & client well-being, it is important to plan the order in which meds are administered Correct Sequence of Oral Medications 1. drugs that require special assessments such as those for which an apical pulse or BP is required 2. other tablets & capsules 3. liquid preparations except for syrups intended for local soothing or anesthetic actions 4. sublingual preparations 5. antacids & liquid preparations intended for local soothing or anesthetic actions that are given with instructions not to eat or drink fluids for 20-30mins. 7. Right Documentation a) be sure to document the medication & time administered on appropriate facility document. b) document site location after administering ID, SC, or IM injection c) document if client refuses medication, client’s reason, & reporting of refusal to health care provider Right documentation is not only a legal requirement, but also a safety responsibility of the nurse. ALWAYS REMEMBER!!!  ‘if it isn’t documented, it wasn’t done”  an inappropriate & illegal practice is for the nurse to “borrow” a drug from client ”A” to give to client “B” with the intent of replacing it later. 8. Client’s Right to Refuse a) be sure to assess client’s reason for refusing medication b) if knowledge deficit underlies client’s reason for refusal, provide appropriate explanation for why medication is prescribed, what medication does, & the importance of medication for treatment of client’s health alteration.  c) Document refusal 9. Right Evaluation Is the comparison of actual client outcomes with expected outcomes. Includes assessing the effectiveness of the medication in alleviating s/s of illness, determining adverse effects that result from the use of the drug, & determining the client’s ability to self-administer medication 10. Right Education The following general teaching guidelines will help ensure that the patient receives the maximum therapeutic benefit from his medication regimen and help him avoid adverse reactions, accidental overdose, and harmful changes in effectiveness. a) Instruct the patient to learn the brand names, generic names, and dosages of all drugs and supplements (such as herbs and vitamins) that he’s taking. b) Tell the patient to notify the pharmacist and prescriber about everything he takes, including prescription drugs, over-the-counter drugs, and herbal or other supplements, and about any drug allergies. c) Advise the patient to always read the label before taking a drug, to take it exactly as prescribed, and never to share prescription drugs. d) Warn the patient not to change brands of a drug without consulting the prescriber, to avoid harmful changes in effectiveness. For example, certain generic preparations aren’t equivalent in effect to brand-name preparations of the same drug. e) Tell the patient to check the expiration date before taking a drug. f) Show the patient how to safely discard drugs that are outdated or no longer needed g) Caution the patient to keep all drugs safely out of the reach of children and pets. h) Advise the patient to store drugs in their original container, at the proper temperature, and in areas where they won’t be exposed to sunlight or excessive heat or humidity. Sunlight, heat, and humidity can cause drug deterioration and reduce a drug’s effectiveness. i) Encourage the patient to report adverse or unusual reactions to the prescriber, and teach him proper techniques to monitor his condition (for example, how to obtain a resting heart rate before taking digoxin). j) Suggest that the patient have all prescriptions filled at the same pharmacy so that the pharmacist can warn against potentially harmful drug interactions. k) Tell the patient to report his complete medication history to all health care providers he sees, including his dentist. l) Instruct the patient to call the prescriber, poison control center, or pharmacist immediately and to seek immediate medical attention if he or someone else has taken an overdose. m) Tell the patient to keep emergency numbers handy at all times. n) Advise the patient to make sure he has a sufficient supply of drugs when traveling. He should carry them with him in their original containers and not pack them in luggage. Also, recommend that he carry a letter from his prescriber authorizing the use of a drug, especially if the drug is a controlled substance. Using the Drug Monographs The following components are described in the order in which they appear in the monographs. All components may not appear in each monograph but are represented where appropriate and when information is available. 1. Drug Name: The generic drug name is the first item in the name block  2. Phonetic Pronunciation: Pronunciation guide for generic name to assist in mastering often complex names. 3. Classifications: Defines the type of drug or the class under which the drug is listed. A classification or descriptor is provided for each drug name. 4. Pregnancy Category: List the FDA pregnancy category (A, B, C, D, or X) assigned to the drug. 5. Trade name: Trade names are identified as Rx (prescription) or OTC (over the counter, no prescription required). If numerous forms of the drug are available, the trade names are identified by form. 6. Controlled Substance: If the drug is controlled by the U.S Federal Controlled Substances Act, the schedule in which the drug is placed follows the trade name listing (C-1, C-11, C-111, C-1V, and C-V). 7. Combination Drug: The heading at the top of the name block indicates that the drug is a combination of two or more drug in the same product. 8. General Statement: Information about the drug class and/or anything specific or unusual about a group of drugs is presented. Information may also be presented about the disease(s) or condition(s) for which the drugs are indicated. 9. Action/ Kinetics: Critical information about the rate of drug absorption, distribution, time for peak plasma levels or peak effect, minimum effective serum or plasma level, duration of action, metabolism, and excretion route(s). Metabolism and excretion routes maybe important for clients with systemic liver disease, or both. 10. Uses: Approved therapeutic uses for the drug are listed. 11. Contraindications: Disease states or conditions in which the drug should not be used are noted 12. Special Concerns: When appropriate, the FDA Black Box Warning is included. Considerations for use with pediatric, geriatric, pregnant, or lactating clients. Situations and disease states when the drug should be used with caution are also listed. 13. Side Effects: Listed by the body organ or system affected. Usually presented with the most common side effects first in descending order of incidence. If potentially life-threatening, the side effect is bold – italic. 14. Overdose Management: Symptoms observed following an overdose or toxic reaction and treatment approaches and/or antidotes for the overdose. 15. Drug Interactions: Alphabetical listing of drugs and herbals that may interact with the drug. Laboratory Test Considerations: The manner in which the drug may affect laboratory test values is presented as increased values ( ), false positive values ( + ), decreased values ( ), or false negative values ( -). Also included, when available, are drug-induced changes in blood or urine levels of endogenous substances. 16. How Supplied: Dosage forms and amounts of the drug in each of the dosage forms. One dosage form may be more appropriate for a client than another. This information also allows the user to ensure the appropriate dosage form and strength is being administered. 17. Dosage: The dosage form and/or route of administration is followed by the disease state or condition (in italics) for which the dosage is recommended. 18. Nursing Considerations: Guidelines to help the practitioner in applying the nursing process to pharmacotherapeutic s to ensure safe practice and patient safety. 19. Sound Alike Warnings 20. Administration Storage: Guidelines for preparing medications for administration, administering the medication, and proper storage and disposal of the medication. Guidelines for administration by IV are indicated by an icon IV. 21. Assessment: Guidelines for monitoring/assessing client before, during, and after prescribed drug therapy. 22. Client/Family Teaching: Guidelines to promote education, active participation, understanding, and adherence to drug therapy by the client and/or family members. Precautions about drug therapy are also noted for communication to the client/family. 23. Outcomes/Evaluate: Desired outcomes of the drug therapy and client response. 24. Interventions (For selected Drugs): Guidelines for specific nursing actions related to the drug being administered. Activity 1-2: Explain in no more than 150 words how the principles of Pharmacokinetics work. (30points)  Activity 1-3: Principles of Drug Action MODIFIED IDENTIFICATION. Identify the term that is being described for each number. You can choose your answer from the box of concepts provided below. (1 point each) Pharmacotherapeutics Pharmacokinetics Pharmacodynamics Half life Adverse reaction Distribution Hepatic First-Pass Effect Side effect Absorption Symptoms Pharmacology Toxicology 1. science that deals with the origin, nature, chemistry, effects & uses of drugs 2. the study of the movement of drugs in the body, including the processes of absorption, distribution, localization in tissues, biotransformation, & excretion 3. the study of the biochemical & physiological effects of drugs & the mechanisms of their actions, including the correlation of their actions & effects with their chemical structure. 4. treatment of diseases with medicines 5. the act of the drug being transported via circulation to the tissues 6. act of the drug reaching the circulating fluids & tissues from outside of the body 7. the time it takes for the amount of drug in the body to be decreased to ½ of the peak level it previously achieved 8. newly absorbed substances initially pass to the liver before entering the systemic circulation thru enterohepatic portal circulation 9. are predictable Adverse reaction that occur within the normal range of therapeutic doses for a given drug 10. undesirable effects of drugs Goodluck!!! Prepared by: Recommending Approval: Approved: MODESTO N. NOBLE MONICA JANE MARZAN SALVADOR P. LLAVORE GABRIEL O. BACUNGAN Instructor Program Chair, Nursing Dean Date: Date: Date: