Introduction To Pharmacology PDF

INTRODUCTION TO  happens in the mucosal lining of the small intestine PHARMA...

INTRODUCTION TO  happens in the mucosal lining of the small intestine PHARMACOLOGY  example of a solid form of drug is a tablet tablets or capsules taken by mouth  tablets are not 100 drugs undergo EXCIPIENTS A. PHARMACOKINETICS (ADME)  feelers and inert substances 1. such as simple syrup, vegetable 2. gums and aromatic powders 3.  used in drug preparation to 4. allow the drug to take a particular size and shape and to B. PHARMACODYNAMICS enhance drug dissolution   EXAMPLE: ▪ Ion potassium in penicillin potassium  drug should be in solution form to cross the ▪ Sodium in penicillin sodium biologic membrane of the cell  when parental administration (Subcutaneous, → increase the absorbability of intramuscular or intravenous routes); no need for it the drug to be converted to a solution → penicillin is poorly absorbed in a GI tract because of gastric acid → by adding potassium or A. pharmacokinetics sodium salts penicillin can - process of drug movement be absorbed throughout the body that is necessary to achieve drug action DISINTEGRATION  tablet has to be broken down 4 PROCESSES into small particles before it is 1. ABSORPTION absorbed  refers to the movement of drug into the DISSOLUTION bloodstream after  small particles must combine administration with a liquid to form a solution Clavecillas, Krixie Claire NOTE:  Most oral drugs enter the  drugs are both disintegrated bloodstream following absorption and dissolved faster in acidic across the mucosa lining of the fluids (pH 1 or 2) than alkaline small intestine fluids The epithelial lining of a small  alkaline drugs would become intestine is covered with villi ionized and have difficulty finger- like protrusions that crossing the cell membrane by increases the surface area years available for absorption  Young and older adults have less gastric acidity ➔ drug absorption is slower (For those drugs primarily absorbed in the stomach)  Enteric coated drugs are meant to be absorbed in a small intestine Nursing Implication: do not crush the medication otherwise, the medication  Absorption is reduced if the villi will not be absorbed in the intended are decreased in number side because of:  Ex. of Enteric coated medication o Disease o drug effect o removal of some or all of the small intestine  Absorption happens in the mucosal lining of the small intestine through: 1. PASSIVE TRANSPORT  Ex. of Ordinary tablet  Does not require energy a. Diffusion  drug moves across the cell membrane from an area of higher concentration to lower concentration Clavecillas, Krixie Claire  b. Facilitated Diffusion 3. PINOCYTOSIS  relies on a carrier protein  cells carry a drug across their to move the drug from an membrane by engulfing the area of higher drug particles into a vesicle concentration to lower concentration 2. ACTIVE TRANSPORT  requires energy  Mucous membrane that lines  requires a carrier such as an the GI tract is composed of enzyme or a protein lipids, fats and protein such that (To move drug against a concentration lipid soluble drugs can pass medium) rapidly through the mucous membrane  water-soluble drugs need a carrier either an enzyme or a protein to pass through the mucous membrane REMEMBER:  That drugs in liquid form are more rapidly absorbed than solid drugs  Pain, stress and foods that are solid, hot or high in fat cause drugs to remain in the stomach Clavecillas, Krixie Claire  longer due to slow gastric available to exert a emptying time pharmacologic effect  poor circulation to stomach → most oral drugs are hampers absorption can be due affected to some degree to shock, vasoconstrictor drugs by first past metabolism or diseases  drugs given rectally are EXAMPLE: absorbed slower than drugs Lidocaine administered by mouth some Nitroglycerines (Due to composition of the suppository-based drug affects the absorption) → are not given orally because they have extensive first  There are drugs that do not pass metabolism and most pass GIT due to their route of of the drug is inactivated administration; ▪ ▪ WHY not given orally? ▪  because if the lidocaine and nitroglycerine will be given orally  INTRAMASCULAR (IM) drug nothing will be used by the body absorbed faster in muscles that because it will be inactivated by the have increased blood flow like liver deltoid than those that do not like don't use maximus  Bioavailability  SUBCUTANEOUS has decreased → refers to the percentage of blood flow compared to muscle administered drug available ▪ absorption rate is for activity lower → for orally administered drugs bioavailability is affected by Following absorption of oral drugs absorption and first past from the GI tract they pass from the metabolism intestinal lumen to the liver via the portal vein. Bioavailability of; ➔ PO drugs  First- pass effect or first-pass Is always less than metabolism 100% → in LIVER, some drugs are based on the rate of first metabolized to an pass metabolism inactive form and are ➔ Intravenous or IV drugs excreted thus reducing 100% the amount of drug Clavecillas, Krixie Claire  plasma proteins like albumin FACTORS THAT ALTER and lipoproteins BIOAVAILABILITY: (DRAGC) Highly protein-bound drugs  drugs that are 90 % drug form bound to protein route of administration Weakly protein-bound drugs gastric mucosa and motility  drugs that are less administration with food and than 10 % bound to other drugs protein changes in liver metabolism  due to liver  The portion of the drug that is dysfunction or bound to the protein is inactive inadequate hepatic  because it is not blood flow available to interact with tissue receptors  a decrease in liver function or a decrease in hepatic blood flow  therefore, unable to exert can increase the bioavailability a pharmacologic effect of a drug but only if the drug is metabolized by the liver  The portion that remains unbound is free active drug  less drug is destroyed by  free drug can exit blood hepatic metabolism in the vessel and reach their site presence of a liver disorder of action causing a pharmacologic response  patients with: kidney disease liver disease 2. DISTRIBUTION malnourished → have lower albumin  refers to the movement of the levels drug from the circulation to body tissues NURSING IMPLICATION  check patients’ protein and  influenced by the rate of the albumin levels when blood flow to the tissue, drugs administering drugs affinity to the tissue and protein binding Protein Binding ➔ as drugs are distributed in the plasma; many binds with Clavecillas, Krixie Claire  pharmacologic ILLUSTRATION: effect ILLUSTRATION:  BLUE particle  protein ONLY ONE drug in the  GREEN particle  drug (FREE bloodstream = represented by DRUG) the green particle  FREE DRUG; this drug is not bound to protein  BLUE W/ GREEN particle  protein-bound drug  drug is already attached to the protein 2 DRUGS in the bloodstream = represented by the green and the  the drug is already yellow particles inactivated  why? because the drug cannot interact with the receptors anymore only the free drug can interact with the receptors in order to take a Clavecillas, Krixie Claire ILLUSTRATION: Another factor that may alter protein binding is the; Low Plasma Protein Level  potentially decreases the number of available binding sites  can lead to an increase in the amount of free drug available  resulting in drug accumulation and toxicity  May have significantly lower albumin level:  when two highly protein-bound  with liver diseases drugs are administered together  kidney diseases they compete for protein binding  Malnourished sites  Older adults  in which drug  are more likely to accumulation may have occur and toxicity hypoalbuminemia will result particularly if they  WHY? have multiple because the more chronic illnesses highly protein- bound drug could displace the other ’ from its binding site  patients with kidney  liver disease  DURING PREGNANCY  malnourished drugs can cross the may have lower albumin levels which placenta as much as they means that there are only few proteins can cross other available for the drugs to bind and; membranes these affects both the  that's why you need to monitor fetus and the mother them closely for drug accumulation or toxicity their albumin level has to be considered in deciding for the dosage of the medication to be administered Clavecillas, Krixie Claire   the liver is a primary site of DRUGS TAKEN DURING: metabolism  1st trimester  May cause spontaneous abortion Liver enzymes ➔ collectively referred to as  2nd trimester cytochrome P450 of drug  May cause spontaneous metabolizing enzymes convert abortion, teratogenesis or drugs to metabolites other subtler defects  a large percentage of drugs are  3rd trimester lipid soluble  May alter fetal growth and development  thus, the liver metabolizes the lipid-soluble drug substance to  The risk benefit ratio must be a water-soluble substance for considered before any drugs are renal excretion given during pregnancy  however, some drugs are transformed into active  DURING BREASTFEEDING metabolites causing an drugs can pass into increased pharmacologic breast milk response which can affect infant Liver diseases such as cirrhosis and nurses must teach women who hepatitis altered drug metabolism by breastfeed to consult their inhibiting drug metabolizing enzymes in health care provider prior to the liver taking any drug whether over the counter or prescribed Decreased drug metabolism  excess drug accumulation can occur 3. DRUG METABOLISM   metabolism or TOXICITY biotransformation  process by which the body chemically changes drugs into a form that can be excreted Clavecillas, Krixie Claire Drug half-life NOTE: ➔ time it takes for the amount of ➔ takes about 4 half-lives for a drug into the body to be reduced steady state to be achieved by half the amount of drug administered the amount of remaining drug in the body from previous doses metabolism elimination  may affect the half-life of a drug EXPLANATION: Example:  supposing a patient receives If with liver kidney dysfunction and 500mg of a medication less drug is metabolized and eliminated  its dosage will decrease to 50% due to half-life ➔ by knowing half-life, you can  leaving 250mg of the medication determine time of drug to reach into the body and the other 250mg steady state is excreted EXAMPLE: REMEMBER: A 500mg paracetamol was administered  steady state is achieved when the at 0800H. The medication has a half-life amount of medication of 4 hours. administered is equal to the amount of the medication 0800H  500mg eliminated 1200H  250mg 0400H  125mg  in this case the amount of the 0800H  62.5mg medication administered are 1200H  31.25mg 500mg and the amount of the And so on……. medication excreted is 250mg (The two figures are not even close) Steady state at this point the drug is still in its 50% steady state ➔ amount of drug being administered is the same amount  with another dose of 500mg of drug being eliminated administered the total amount of ➔ a steady state of drug is necessary medication in the body becomes to achieve optimal therapeutic 750mg benefit Clavecillas, Krixie Claire   whereas in the sixth row still the REMEMBER: amount of medication  that a medication amounting to administered is 500mg; now look 250mg was left in the body and at the amount of the medication added with another 500mg for the eliminated 492.1875mg second dose  thus, the total amount of the medication inside the body is now 750mg  but this amount will be reduced to its 50% which is 375mg after the which is very close to the amount of second half-life medication administered  at this point the steady state is 75%  with a 3rd dose and 3rd half-life a Loading dose steady state of 88% is reached ➔ administration of a large initial  however, with the 4th dose a steady dose of a medicine used to ensure state of 94% is already reached a quick therapeutic response  with a 5th dose a steady state of ➔ given for a short period before 97% is reached therapy continues with a lower  with a 6th dose a steady state of maintenance dose 98% is reached ➔ this is applicable in the case of drugs with long half-lives NOTICE: ➔ Example:  noticed the amount of medication phenytoin eliminated for AMOUNT EXRETED  the half-life of phenytoin is COLUMN, it is already close to approximately 22 hours 500mg of  if all doses of the drugs will the medication administered and a steady be the same; state has been reached  steady state will not be achieved for about three and a half days  however, by giving a large initial dose that is significantly higher than the maintenance dose therapeutic effects can be obtained while a  take a look the medication steady state is administered was 500mg and the reached amount eliminated is 468.75mg in the 4th dose; Clavecillas, Krixie Claire  REMEMBER:  purpose of loading dose is to achieve a quick therapeutic REMEMBER: response and take note the optimal Loading Dose to achieve a quick therapeutic benefit from the therapeutic response medication is only achieved when steady state is reached DIFFERENTIATE STEADY STATE AND LOADING DOSE 4. DRUG EXCRETION ➔ main route of drug excretion is the kidneys ➔ drugs are also excreted through:  first table the dose given from the  bile 1ST to the 6TH dose is consistently  lungs 500mg  saliva  whereas, in the second table the  sweat initial or the 1ST dose is 750mg  breast milk which is higher than its succeeding ➔ urine pH influences drug doses excretion NOTE:  acidic urine promotes that in the first table a steady elimination of weak based state of 94% is achieved after the drugs 4TH half-life  alkaline urine promotes elimination of weak acid  but in the second table were in the drugs 1ST or the initial dose is higher compared to its succeeding dose  the steady state of 94% is achieved Condition affect Drug Excretion as early as 3RD half-life  Prerenal  that is why during emergency  the problem is a situations and when the profusion of the blood medication has a long half-life towards the kidney loading dose of the medication is Ex: dehydration or hemorrhage administered  reduce blood flow to the kidneys and results in reduced glomerular filtration rate Clavecillas, Krixie Claire   Intrarenal  the problem is within the kidneys or the formation of urine Ex: glomerulonephritis and chronic kidney disease  affect glomerular filtration and tubular secretion and reabsorption  Postrenal  the problem is the outflow of urine from the kidneys Ex: prostatic hypertrophy, stones and urogenic bladder  adversely affects glomerular filtration If any of these are present, drug accumulation may occur resulting in adverse drug reactions ➔ CREATININE and BLOOD UREA NITROGEN (BUN) used to determine renal function CREATININE more reliable test for kidney function → because it is not altered by bodily processes ➔ it is important for nurses to know their patient’s kidney function to ensure correct dosage of the medication Clavecillas, Krixie Claire B. PHARMACODYNAMICS POTENCY  amount of drug needed to ➔ study of the effects of drugs elicit a specific physiologic in the body response to a drug ➔ drugs act within the body to mimic the actions of the  High potency body's own chemical messengers  produced a significant therapeutic response Drug Response at low concentration can cause a PRIMARY or Medication that are given at low SECONDARY physiologic concentration even if they're effect or both only given at 5mg can already elicit a therapeutic response  PRIMARY EFFECT Desirable response  Low potency  SECONDARY EFFECT  produces minimal Maybe desirable or therapeutic response undesirable at low concentrations Example of a drug with a primary and Medications that have to be secondary effect: administered in 500mg  need to increase diphenhydramine the dosage of the antihistamine medication to feel DRUG: diphenhydramine the therapeutic PRIMARY EFFECT: effect  to treat the symptoms of allergy SECONDARY EFFECT:  central nervous system MAXIMAL EFFICACY depression that causes  the point at which drowsiness increasing the drug's  undesirable when the patient dosage no longer drives a car increases the desired  desirable when at bedtime therapeutic response  because it causes mild  even if you double the dose sedation of the medication, you can no longer increase the effect of the medication TERMS RELATED TO PHARMACODYNAMICS THERAPEUTIC INDEX  is the difference between the toxic and  is the body's therapeutic doses physiologic response  describes the to changes in drug relationship between concentration at the the therapeutic dose of site of action the drug (𝑬𝑫𝟓𝟎 ) and  the toxic dose of the Receptor Theory drug ( 𝑻𝑫𝟓𝟎 ) a. Therapeutic Dose (𝑬𝑫𝟓𝟎 )  dose of a drug that produces a therapeutic response in 50% of the population b. Toxic Dose (𝑻𝑫𝟓𝟎 )  dose of a drug that produces a toxic response in 50% of the population Ligand REMEMBER:  is a drug molecule that binds to a receptor if the therapeutic and toxic doses are close, the drug is said to have a Enzyme linked receptor narrow therapeutic index   it is where the ligand will requires close monitoring to bind ensure patient safety The four receptor families: ONSET, PEAK, and DURATION of 1. Cell membrane embedded Action enzymes Onset The ligand binding Prerenal  is a time it takes for a drug to domain for drug binding is reach the minimum on the cell surface effective concentration after  the drug activates the administration enzyme inside the cell and the response is initiated Peak  drug reaches its highest 2. Ligand-gated ion channels concentration in blood  The channel crosses the cell membrane Duration of Action  when the channel  Length of time the drug opens ions flow into exerts a therapeutic effect and out of the cells  drugs take effect in the body  this primarily affects by binding into a receptor sodium and calcium ions and activate it 3. G protein-coupled receptor system  Needs 3 component:  Receptor  G-Protein  Effector   either an enzyme or an ion channel Antagonists  How the system works?  are drugs that prevent  the drug activates the receptor activation and blocks receptor a response  then the receptor will activate the g-protein  then the g- protein will Nonspecific drug affect the effector  when the drug affects protein multiple receptor sites  then a response will be  it affects only one type of initiated receptor but of various or multiple receptor sites  only one type of receptor is 4. Transcription factors activated but it affects  receptor site is found inside multiple receptor sites the nucleus  it only affects the cholinergic  ligands that can pass receptors however, in various through the cellular sites like eyes, heart, blood membrane enters the cell vessels etc.  after entering the nucleus, it binds to intracellular receptor  this can alter the transcription of DNA within a cell  activation of receptors through transcription factors regulates protein synthesis and is prolonged  with the first three receptor Nonselective Drug groups activation the receptors  when the drug affects is rapid now multiple receptors  it affects multiple types of receptors  already affects multiple receptor types  like the alpha receptor and beta receptor RELATED TERMS IN NURSING PHARMACOLOGY Agonist  are drugs that activate receptors and produce a desired response  Drug Toxicity  occurs when drug levels exceed the therapeutic range  toxicity may occur secondary to overdose or drug accumulation Tolerance  decreased responsiveness to a drug over the course of therapy  an individual with drug tolerance requires a higher dosage of drug to achieve the same therapeutic effect Side Effects Tachyphylaxis  secondary effects of drug  acute, rapid decrease in therapy response to a drug  can be desirable and undesirable Drug Interaction undesirable  it can be a  altered or modified action or reason for a client to stop effect of a drug as a result of taking the medication interaction with one or more multiple drugs Nursing Implication Nurse must include health Drug-Nutrient Interaction teaching and side effects  food increases, decreases or this is to encourage the client delays the body’s from a to continue taking the pharmacokinetic response to medication drug Example: Adverse reaction taking an iron supplement  are unintentional, unexpected together with milk reactions to drug therapy that can occur at normal drug that should not happen , why? dosages  because the milk will  mild or severe hamper the absorption  Always undesirable of the iron  iron is best absorbed in NOTE: that adverse reactions are an empty stomach or always undesirable you can take it together with an ascorbic acid   to enhance its activity of the antibacterial absorption and not agent with milk Antagonistic drug effect Additive drug effect  One reduces or blocks the  when two drugs are effect of another administered in combination  response is increased beyond Example: Antidote what either could produce alone  A patient who takes heparin,  sum of the effects of the two experiences over dosage; so, in drugs order to counteract that  can be desirable or  The medication undesirable protamine sulfate will be given DIURETIC and PROTAMINE SULFATE as an ANTIHYPERTENSIVE antidote Desirable additive drug effect  occurs when a diuretic and a beta blocker are administered Pharmacogenetics for the treatment of  the study of genetic factors that hypertension influence an individual's response to specific drugs  in combination these two drugs use different mechanisms to Placebo effect have a more pronounced blood  is a drug response not pressure lowering effect attributed to the chemical properties of a drug Synergistic drug effect or Potentiation Ethnopharmacology  when two or more drugs are  a subdivision of ethnomedicine given together, one drug can and focuses on the use of have a synergistic effect on herbs powder teas and another animal products as healing  the clinical effect of the 2 drugs remedies given together is substantially greater than that of either drug alone Example: Co-Amoxiclav  a combination of the antibiotic together with the clavulanic acid  which inhibits bacterial enzyme activity  and enhances the effect or broadens the spectrum of  NCM 106: Pharmacology Introduction to Pharmacology: Part your job to know what side 3 effects might result from the medicines you are taking. OVER-THE-COUNTER Because every person is DRUGS different, your response to the - Are drugs that have been found medicine may be different than to be safe and appropriate for another person’s response. use without the direct OTC medicines often interact supervision of a health care with other medicines, and with provider food or alcohol, or they might - Available for purchase without a have an effect on other health prescription in many retail problems you may have. locations If you do not understand the - Take note: other over-the- label, check with the counter drugs just like pharmacist. pseudoephedrine and Do not take medicine if the emergency contraception are package does not have a label available with some restrictions on it. and must be kept behind the Throw away medicines that pharmacy counter have expired (are older than the - Prior to dispensing patient age date on the package). and identity are verified and Do not use medicine that education is provided belongs to a friend. NURSING IMPLICATIONS: Buy products that treat only the The nurse needs to emphasize symptoms you have. that many of these drugs are If cost is an issue, generic OTC potent and can cause moderate products may be cheaper than to severe side effects, brand name items. especially when taken with Avoid buying these products other drugs. online, outside of well-known Internet insurance company Nursing Considerations Related sites, because many OTC to Over-the-Counter Drugs preparations sold through the Nurses should advise patients of the following when over-the-counter (OTC) Internet are counterfeit drugs are considered: products. These may not be what you ordered and may be Always read the instructions on dangerous. the label. Do not take OTC medicines in Parents should know the following higher dosages or for a longer special information about using time than the label states. OTCs for children: If you do not get well, stop Parents should never guess treating yourself and talk with a about the amount of medicine to health care professional. give a child. Half an adult dose Side effects from OTCs are may be too much or not enough relatively uncommon, but it is to be effective. This is very true Yuson, Drea  NCM 106: Pharmacology of medicines such as immune status of a person acetaminophen (Tylenol) or (modification of immune status) ibuprofen (Advil), in which 1. A drug that stimulates repeated overdoses may lead to (stimulation) poisoning of the child, liver destruction, or coma. - Enhances intrinsic activity like If the label says to take 2 adrenergic drugs which teaspoons and the dosing cup increases heart rate, sweating, is marked with ounces only, get and respiratory rate another measuring device. Example: epinephrine Don’t try to guess about how much should be given. 2. Depressant drugs Always follow the age limits - Decrease neural activity and listed. If the label says the bodily functions product should not be given to a child younger than 2 years, do Example: barbiturates which causes not give it. CNS depression Always use the child-resistant 3. Drugs that irritate cap, and relock the cap after use. - Have noxious effect Throw away old, discolored, or Example: Laxatives (bisacodyl and expired medicine or medicine senokot) that has lost its label instructions. These are considered as irritant because it irritates the sensory Do not give medicine containing alcohol to children. nerve endings in the intestinal mucosa MECHANISMS OF DRUG 4. Replacement drugs ACTION (how the drugs produce an - Such as insulin replace effect in the body) essential body compounds in Drugs can either: the case of a person with diabetes mellitus, the problem is - Stimulate (stimulation) there could be inadequate - Depress (depression) number of insulin in the body - Irritate cells inside our body That’s why the person (irritation) needs to receive an - Can also replace certain exogenous source of chemicals in our body insulin (replacement) - Can also produce cytotoxic and 5. Cytotoxic drugs antimicrobial actions (cytotoxic - Selectively kill invading action) parasites or cancers - Also possible for the medications to modify the Yuson, Drea  NCM 106: Pharmacology Example: Chemotherapeutic drugs or Category (old) FDA Drug risk also called as antineoplastic classification in pregnancy medications A Controlled studies in women fail to show a risk to the fetus and the 6. Antimicrobial medications possibility of fetal harm appears unlikely - Drugs that prevent, inhibit, or kill B Animal-reproduction studies have infectious organisms not shown a fetal risk or adverse Example: Co-amoxiclav (basically an effect. Risks have not been confirmed in controlled studies in antibiotic) women. 7. Drugs that modify the immune C Either studies in animals have revealed adverse effects on the status fetus and there are no controlled - Modify, enhance, or depress the studies in women and animals are not available. immune system D There is confirmation of human fetal Example: Corticosteroids risk, but the benefits from use in pregnant women may be When this medication is taken acceptable despite the risk. for a long time, it may make the X Animal and human studies have shown fetal abnormalities. The drug person immunocompromised is contraindicated in women who Another example: Chemotherapeutic are or may become pregnant. drugs in which if a person receives that - If a medication is under type of drugs, the person will also pregnancy category A that become immunocompromised means the medication is completely safe for the pregnant PREGNANCY CATEGORIES OF woman DRUGS - If the medication is under NOTE: During pregnancy, drugs can pregnancy category X then the cross the placenta as much as they pregnant woman should not can cross the other membranes and take the medication as it will these affects both the fetus and the certainly cause fetal mother. That harmful medications can abnormalities cause spontaneous abortion, New Pregnancy and Lactation congenital defects, and alter fetal Labeling of Drugs *effective June 30, growth and development 2015* - This old FDA drug risk classification in pregnancy is presented just in case you will encounter this then you would know whether the medication is safe for the pregnant woman or not. Yuson, Drea  NCM 106: Pharmacology - Changes were made to assist or pregnancy lost will be health care providers in provided when available assessing benefit vs risk in subsequent counselling of FORMS AND ROUTES FOR pregnant women and nursing DRUG ADMINISTRATION mothers who need to take Tablets and Capsules medication - Thus, allowing them to make - A tablet is the most common informed and educated form of oral medication decisions for themselves and children 8.1 Pregnancy (includes Labor and Delivery) - This subsection will provide information about dosing and potential risks to the developing fetus and registry information that collects and - Inside a capsule, it may be a maintains data on how liquid or the powder form of a pregnant women are affected medication when they use the drug or biological products 8.2 Lactation (includes Nursing Mothers) - This subsection will replace a nursing mother subsection of the old label - Information will include: drugs that should not be used during breastfeeding, known human or animal data - Time-released capsule or also regarding active metabolites called as Spansule in milk as well as clinical There are small beads effects on the infant within it - Other information may The medication will be include: pharmacokinetic data released in small like metabolism or excretion, amounts over time a risk and benefits section as well timing of breastfeeding to minimize infant exposure 8.3 Females and Males of Reproductive Potential - Relevant information on pregnancy testing or birth control before, during, or after drug therapy and a medication’s effect on fertility Yuson, Drea  NCM 106: Pharmacology - Enteric-coated medication Remember: do not crush crush the medication because the coating is designed to hold the tablet together in the stomach and the medication will be 3. Sublingual released in small - Place the medication under the intestine tongue Take note: Tablets are not only administered orally there are also types of medication in which it’s still in tablet form but the medication will be administered intravaginally or rectally. Thus, you Routes of Administration of must read the physician’s order Tablets and Capsules: properly. Liquids 1. Oral - Medication will be swallowed by the patient 1. Elixir - liquid containing a medicinal drug with syrup, glycerin, or alcohol added to mask its unpleasant taste 2. Suspension 2. Buccal - consists of undissolved particles - Place the medication between of one or more medicinal agents the cheek and the gum mixed with a liquid vehicle for oral administration - Take note: Shake it before using Yuson, Drea  NCM 106: Pharmacology 3. Emulsion - Mixture of two or more liquids that are normally immiscible or unmixable ROUTES 1. Eye drops 2. Eye ointment 3. Nasal spray 4. Ear drop or optic drops 1. Transdermal INHALATIONS - A patch is used in the transdermal route 2. Topical - A cream is used in the topical route - Topical compounds only minimally penetrate the skin layer which is its decide intent 1. Metered-Dose Inhaler (MDI) While all topical and transdermal compounds are applied in the skin, (with spacer) only the transdermal formulation are - A spacer may be attached to a designed to penetrate through the skin metered-dose inhaler to layer and exert their effects on deeper facilitate the inflow of medicine or more distant tissues. into the lungs INSTALLATIONS 2. Nebulizer Drug installation also known as medication installation NASOGASTRIC AND GASTRONOMY TUBES - The administration of a medicine generally in liquid form either drop by drop or with a catheter into a body space or cavity - In NGT routes or nasogastric tube route, a tube is inserted Yuson, Drea  NCM 106: Pharmacology through the nose until the PARENTERAL MEDICATION stomach - In gastronomy route, a tube is inserted to the stomach through the abdominal wall - In both routes, the medicines will be administered through the tubes SUPPOSITORIES - Parenteral drug administration is defined by the USFDA as a drug administration by injection, infusion, and implantation or by some other route other the alimentary canal - In administering parenteral medications, remember that the length of needle and angle of - A suppository is a solid medical insertion matter preparation that is cone or spindle-shaped for insertion 1. In intradermal route into the rectum - The needle is inserted 10 to 15 - Globular or egg-shaped degree angle further use in the vagina - Pencil-shaped for insertion into 2. Subcutaneous route the urethra - 45 degrees - Suppositories are made from glycerinated gelatine or high 3. Insulin Syringe molecular weighted - Though the desired route is polyethylene glycols and are subcutaneous, it has to be more common vehicles for a inserted at 90 degrees because variety of drugs of the short needle length - A suppository is a useful route in babies who are 4. Intramuscular uncooperative patients and in - The needle will be injected at 90 cases of vomiting or certain degrees digestive disorders TECHNOLOGICAL ADVANCES 1) Insulin - Old/current system: Insulin is commonly administered subcutaneously - UPDATE: there is already a pain-free delivery of insulin through a transdermal patch Yuson, Drea  NCM 106: Pharmacology 3 Infusion Pumps - Old/current system: programming of the infusion pumps are done manually Used in the delivery of intravenous fluids - UPDATE: intelligent infusion technology that programs IV infusion based on scanned information 2) Serum Glucose - Old/Current system: Monitoring of serum glucose is done manually with the use of glucometer Meaning, before a person receives an insulin, he has to check his glucose first 4. Antibiotics - UPDATE: insulin pupms deliver insulin based on monitoring of - Old/Current system: antibiotics serum glucose level are either administered orally, parenterally or topically - UPDATED: topically through spray as aerosolized antibiotics were already created 5. Herbal plants - Old/current system: limited use of herbal plants and without extensive research - UPDATE: expanding use of medicinal plants in medicine 6. Antineoplastic medication - Old/current system: the nurse of the pharmacist personally prepares antineoplastic medication - UPDATE: robotic mixing of antineoplastic drugs Yuson, Drea  NCM 106: Pharmacology Yuson, Drea PART 4: PHARMACOLOGY → cultural dietary barriers → patient’s home safety needs NURSING PROCESS: PATIENT - → care giver needs and support system CENTERED COLLABORATIVE CARE  Objective data - refers to what the nurses directly observes about the I. Assessment patient’s health status. It involves II. Diagnosis collecting the patient’s health III. Planning information by using the senses: IV. Implementing seeing, hearing, smelling, and V. Evaluation touching.  Examples: → Physical health assessment I. ASSESSMENT → Laboratory and diagnostic test results  The nurse gathers data from the → Data from Physician’s notes patient about the patient’s health and → Measurement of vital signs life style. → The patient’s body language  Assessment phase is paramount because the nurse will use the II. DIAGNOSIS information gathered to form a basis  It is made based on analysis of the of the patient’s plan of care which assessment data includes drug administration.  It determines the type of care the  The nurse will gather both subjective client will receive. data and objective data.  Subjective data - refers to the data III. PLANNING that are covert or those that you  The nurse uses the data collected to couldn’t observe and know unless an set goals or expected outcomes and interview is conducted to the patient. interventions.  Example: - goals or expected outcomes should → current health history including family address the problem in the patient’s history nursing diagnosis. → dysphagia - goals are patient-centered, it → s/s (signs and symptoms) of illness as describes specific activity and it must verbalized by client include a time frame for achievement and → current concerns about the patient re-evaluation. - patient’s knowledge about medication and side effects, over the IV. IMPLEMENTATION counter remedies, nutritional supplements,  Is a part of nursing process in which herbal remedies and contraceptives. the nurse provides education, drug - knowledge of side effects, attitude administration, patient care, and other and beliefs about taking the medication. interventions necessary to assist the → allergies patient in accomplishing established → financial barriers goals. → use of tobacco, alcohol, and caffeine PATIENT TEACHINGS: 3. SELF - ADMINISTRATION - it is essential to the patients recovery. It - teach the patient the proper way of allows the patient to become informed taking the medication. about his or her health problems and to - include a return demonstration when participate in creating interventions that appropriate. can lead to good health outcomes thus nurses have a primary role in teaching 4. DIET both patients and families about drug - advise a patient about food to administration. It is important that all include their diet or avoid. teachings be tailored to the patient’s educational level and that the patient 5. CULTURAL CONSIDERATIONS trusts the nurse for learning to begin. - you should be culturally sensitive When you impart health teaching to your - you should be mindful of your body patient you should avoid medical jargons language so that your patient will better understand what you are teaching. V. EVALUATION  The nurse determines whether the IMPORTANT PRINCIPLES OF PATIENT goals and teaching objectives and TECAHINGS: being met. 1. GENERAL - general instructions like telling them DOCUMENTATION FORMS to take the drug as prescribed. - you may also provide a simple written instruction to the patient with a doctor and pharmacy names and telephone numbers. - you may also give them instruction on when to notify the health care provider. For instance, the dose, frequency, or time of the drug is adjusted. - general instructions about medication administration, teach the patient about side effects. 2. SIDE EFFECTS - you may advise the patient of any expected changes in the color of your venous tool. - counsel the patient who has dizziness caused by orthostatic hypotension, to rise slowly from a sitting to a standing position.  SAFELY and QUALITY in appropriate absorption PHARMACOTHERAPY  Ordered by the health care provider FIVE plus FIVE” of Medication Example: Administration → we need to assess the patient’s ability to swallow before administering or OBSERVE: medications. → we need to administer drugs at the 1. Right Patient appropriate site based on the route.  Right patient determine is essential, the joint commission requires 2 forms 6. Right Assessment of identification before drug  Requires the collection of appropriate administration. baseline data before administration of  You may ask the patient to state his drug. or her full name and birth date. Then, compare these with the patient’s 7. Right Documentation identification ban and the patient’s  Requires a nurse to record medication administration record. immediately the appropriate information about the drug 2. Right Drug administered.  Nurse must accurately determine the right drug prior to medication 8. Right to Education administration.  Requires the patient receive accurate  Check the medication at least 3x prior and thorough information about the to the actual giving to the patient. drugs they are taking and how each drug relates to their particular 3. Right Dose condition.  Refers to verification by the nurse that the dose administered is the amount 9. Right Evaluation ordered and that is safe for the patient  Determines the effectiveness of the for whom it is prescribed. drug based on the patient’s response  Based on the patient’s physical to the drug evaluation. status.  Right weight = right dose 10. Right to Refuse  Patient has the right to refuse the 4. Right Time medication  Refers to the time the prescribed  Nurses responsibility to determine the dose is ordered to be administered. reason for the refusal  Right time when you know when is  Explain to the patient the risks the best time to administer the involved with refusal and reinforce the medication. important benefits and the reasons for taking the medication. 5. Right Route  When a medication is refused, the  It is necessary for adequate and refusal must be documented  immediately.  Follow-up is always required. NURSES RIGHTS WHEN ADMINISTERING MEDICATION 1. Right to a complete and clear order 2. Right to have the correct drug route (form) and dose dispensed 3. Right to have access to information 4. Right to have policies to guide safe medication administration 5. Right to administer medications safely and to identify problems in the system 6. Right to stop, think and be vigilant when administering medications. PART 5: CULTURE OF SAFETY Culture of Safety  during medication administration, drug administration is a vulnerable area where the possibility of error is high.  in a true culture of safety everyone in the organization is committed and driven to keep patient from harm.  American Nurses Association (ANA) - supports the concept of just culture and it  it is defined as a process of identifying the encourages organization to avoid punitive most accurate list of all medications that a approaches in reporting drug errors. patient is taking a transition in care.  in a just culture individuals will be INCLUDES: encouraged to report drug errors so the  admissions and discharges from a hospital system can be repaired and the problem to another health care setting such as fixed. long-term care.  Just Culture - does not hold the individual  this prevents discrepancies that can cause practitioners responsible for a failing drug error. system, although it does not tolerate disregard for a patient or gross misconduct. THE JOINT COMMISSION  is an independent not-for-profit group in DRUG RECONCILIATION the united states that administers voluntary accreditation programs for hospitals and  is an important component of the culture of other healthcare organizations. safety.  they have taken steps to support safety and quality care in the workplace. NATIONAL PATIENT SAFETY GOALS:  established two (2) important goals that already become standards are the “do not use” abbreviations and the list of acceptable abbreviations.  Black box warning by the US FDA  this is an example of a black box warning  these are the acceptable abbreviations for drug measurement and drug forms route of medication administration and time of administration set by the joint commission.  to keep our home and workplace safe at all times we must practice safe disposal of medications.  these are the do not use abbreviations set  to avoid inadvertent intake of expired by the joint commission organization medications and to keep it from the children at home.  in relation to sharp safety all hospitals provide a tamper-resistant container where you can dispose your sharps.  what they do in order to give a caution to the  sharps are not meant to be thrown in an nurse regarding high alert medication is that ordinary trash bean it has to be in a they place a red or an orange flag on the high tamper-resistant container. alert medication.  in some hospitals are already using these syringes with safety features in order to 10 MEDICINAL PLANTS IN THE PHILIPPINES prevent needle stick injury among its ENDORSED BY DOH: employees.  Jet Injector - which is a medical injecting 1. AKAPULKO (Cassia alata) - used to treat syringe used for a method of drug delivery tinea infections, insect bites, ringworms, known as jet injection in which a narrow eczema, scabies and itchiness. high pressure stream of liquid penetrates 2. AMPALAYA (Momordica charantia) - found without the use of needle. to be effective in the treatment of diabetes (diabetes mellitus), hemorrhoids, coughs, COUNTERFEIT DRUGS burns and scalds, and being studied for  these drugs look like the desired drug but anti-cancer properties. may have no active ingredient the wrong 3. BAWANG or GARLIC ( Allium sativum) - active ingredient.  Used to treat infection  report counterfeit drugs immediately  With antibacterial, antiinflammatory, anti- cancer and anti-hypentensive properties. HIGH ALERT MEDICATIONS  It is widely used to reduce cholesterol level  these are drugs that can cause significant in blood. harm to the patient. 4. BAYABAS or GUAVA (Psidium guagua) - used  examples of high alert medications are as antiseptic, anti-inflammatory, anti- Epinephrine, oxytocin, promethazine, insulin spasmodic, antioxidant hepatoprotective, anti- and etc. allergy, antimicrobial, and antigenotoxic in  strategies to reduce the risk of errors folkloric medicine. 5. LAGUNDI (Vitex negundo) - used to treat 1. simplify the storage preparation and cough, colds and fever. administration of high alert drugs. - it is also used as a relief for asthma and 2. write policies concerning safe administration. pharyngitis, rheumatism, dyspepsia, boils, and 3. improve information and education diarrhea. 4. limit access to high alert medications 6. NIYOG-NIYOGAN (Quisqualis indica L.) - 5. use labels and automated alerts used to eliminate intestinal parasites. 6. use redundancies or (automated or 7. SAMBONG (Blumea balsamifera) - used to independent double checks) treat kidney stones, wounds and cuts, 7. closely monitor the patient's response to the rheumatism, anti-diarrhea, antispasms, colds medication and cough and hypertension.  in some of our affiliated hospitals 8. TSAANG GUBAT (Ehretia microphylla Lam.) - 13. ST. JOHN”S WORT - mental disorders and used to treat skin allergies including eczema, nerve pain. scabies and itchiness wounds in childbirth. 14. TURMERIC - heartburn, stomach ulcer, 9. ULASIMANG BATO / PANSIT - PANSITAN gallstones, inflammation and cancer. (Peperomia pellucida) - used in treating arthritis. 15. VALERIAN - insomnia, anxiety headache, 10. YERBA BUENA (Clinopodium douglasii) depression, irregular heartbeat, and tremors.  As analgesic to relieve body aches and pain due to rheumatism and gout.  It is also used to treat coughs, colds and DRUG STANDARD AND LEGISLATION insect bites.  The Philippine National Drug Formulary COMMONLY USED HERBAL REMEDIES:  Aims to make quality essential drugs available, accessible,efficacious, safe and 1. ASTRALAGUS - used as an adjunct to boost affordable. immune system.  It provides the list of medicines 2. CHAMOMILE - for sleepness, anxiety, registered with FDA or the Pharmacopoeia. stomach and intestinal ailments.  http://caro.doh.gov.ph/wp- 3. CINNAMON - bronchitis, GI problems, content/uploads/2018/04/PNF-8th- anorexia and diabetes. edition.pdf 4. ECHINACEA - for colds, flu and infection. 5. GARLIC - used to lower cholesterol, blood  Philippine National Formulary or the pressure and reduce heart disease. Pharmacopeia looks like: 6. GINGER - nausea, motion sickness and diarrhea. 7. GINGKO - asthma, bronchitis, fatigue and tinnitus. 8. GINSENG - used to boost the immune system, increase a person’s sense of well-being and increase stamina. 9. HAWTHORN - for treatment of heart diseases. 10. LICORICE ROOT - used to treat stomach ulcer, bronchitis, sore throat, and viral hepatitis. 11. MILK THISTLE - cirrhosis, chronic hepatitis  RA#9711 or Food and Drug Administration and gall bladder disorders. Act of 2009 12. PEPPERMINT - nausea, indigestion, irritable  is an act strengthening and rationalizing bowel syndrome, colds, headaches, muscle and the regulatory capacity of the BFAD by nerve pain. establishing adequate testing laboratories in field offices, upgrading its equipment,  augmenting its human resource  Tablet - is the form of the medication complement, giving authority to retain its  333 milligrams - is a dosage of the income, renaming it to FDA. medication  Abbott laboratories - represents the  RA#9502 or Universally Accessible Cheaper manufacturer of this medication. and Quality Medicines Act of 2008  Expiration date - in which you need to  is a law which states that it is a policy of check this one before administering the the state to protect public health and when medication to your patients, that is to public interest or circumstances of extreme ensure safety. urgency so require it shall adopt  Lot number - signifies that the product is appropriate measures to promote and part of a particular production batch. ensure access to affordable quality drugs and medicines for all.  It is important that we know how to interpret doctor's orders this is to make  RA#6675 Generics Act of 1988 sure that we administer the correct  is an act to promote require and ensure medication to our patients. production of an adequate supply distribution use and acceptance of drugs Sample of a Doctor's Order and medicines identified by their generic  which reads administer co-amoxiclove names. augmentin 625 milligrams per cap one cap now then BID PO. INTERPRETING DRUG LABEL Sample of a drug label:  Co-amoxiclove here is a generic name of the medication.  Augmenting is a brand name or the trade name of the medication.  625 milligrams per cap is the dosage of the medication.  The error tab (ERY-TAB) - represents the  one cap is the amount of medication you brand or the trade name of the medication. need to administer per dose  Erythromycin - is the generic name of the medication.  Timing or the Frequency  BID- this means that the first dose of the medication should be administered now and  Amount calculated to be given to the will be administered twice a day patient subsequently  Desired Dose - is a dose ordered by the  the route of the medication for this order is physician PO or PER OREM  Drug on hand - refers to the drug available or the amount of drug available SYSTEMS OF MEASUREMENTS  Vehicle - refers to the volume of a drug form available aside from the basic formula 2. Ratio & Proportion, Fraction Equation Drug on Hand : vehicle : : desired dose : x  Multiply the drug on hand and the x so this is the extreme and we also have the vehicle and the desired dose so this is the mean so again you will multiply the Drug on hand to the x and the vehicle to the desired dose. 3. Dimensional Analysis Amount to administer = vehicle x desired dose Drug on hand x  in order to determine the amount to administer so this is the formula for this Different Formulae: one amount to administer equals vehicle over drug on hand times desired dose over 1. Basic Formula x. Amount to administer = desired dose x vehicle  Multiply the numerator to the numerator, Drug on hand denominator to the denominator  YOUNG’S RULE: Child’s Dose =age in years x average adult dose Child’s age in years + 12 CLARK’S RULE: Child’s Dose = weight of child in lbs x average 150 adult dose FRIED’S RULE: 4. Body Weight Infant’s Dose=Infant’s age in months x average Patient’s Dose = Drug Dose x Body Weight 150 months adult dose 5. Body Surface Area  Most precise CALCULATING INTRAVENOUS FLOW RATE  MICRODRIP = 60gtt/ml (with needle)  MACRODRIP = 10gtt/ml = 15gtt/ml SPECIAL CONSIDERATIONS = 20gtt/ml  Pediatric considerations = without needle  Less developed absorption in neonates and infants must be considered in dosage administration.  Drugs for pediatric patient are ordered based on their weight or body surface area.  Dosing of medication must consider the child’s status including age, organ function, health and route of administration.  Atraumatic care principles should be used when possible.  Nurses may need to crush pills or dissolve the contents of capsule  When injection or venipuncture is necessary, topical anesthetic protocols may be followed  IV infusion sites must be protected  GERIARTRIC CONSIDERATIONS  Aging can significantly alter drug distribution  Renal excretion decreases with age  Nurses must have a general understanding of drug classifications that require dosage adjustment in patients with chronic kidney disease →BANDD CAMP WEBINARS RELATED TO PHARMACOLOGY EXAMPLE OF WEBINAR:  SYSTEMS OF MEASUREMENTS: TABLE 11A.1 Metric and English Units of Measurements UNITS EQUIVALENT UNITS OF MEASUREMENT Weight 1 kilogram (kg,Kg) = 1000 g = 2.2 lb 1 gram (g, gm, G, Gm) = 1000 mg 1 milligram (mg) = 1000 mcg 1 microgam (mcg) = 1000 ng (nanograms) Volume 1 liter (L) = 1000 mL (milliliters) Length 1 kilometer (km) = 1000 m 1 meter (m,M) = 100 cm 1 centimeter (cm) = 10 mm 2.54 cm = 1inch 25.4 millimeters (mm) = 1 inch TABLE 11A.2 Household Equivalents 1 measuring cup 8 oz or 240 mL (1 oz = 30 mL) 1 medium-size glass (tumbler size) 8 oz or 240 mL 1 ounce (oz) 2 tablespoons or 30 mL 1 tablespoon (T) 3 teaspoons or 15 mL 1 teaspoon (t) 60 drops (60 gtt)  ACCEPTABLE ABBREVIATIONS Abbreviation Meaning DRUG MEASUREMENTS AND DRUG FORMS Cap Capsule Elix Elixir ER Extended Release G Gram Gtt Drops Kg Kilogram L Liter M2 Square meter Mcg Microgram mEq Milliequivalent Mg Milligram mL Milliliter NKA No Known Allergies NKDA No known drug allergies Oz Ounce SR Sustained release One-half table Half-tablet Supp Suppository Susp Suspension Tbsp, tbs, or T Tablespoon Tsp Teaspoon ROUTES OF MEDICATION ADMINISTRATION ID Intradermal Inj Injection IM Intramuscular IV Intravenous IVPB Intravenous piggyback KVO Keep vein open PO By mouth Sub0, subcut, subcutaneous Subcutaneous Subling Sublingual (under tongue) TKO To keep open Vag Vaginal TIMES OF ADMINISTRATION PRIOR USAGE CURRENT USAGE ā Before Ac Before meals Ad lib As desired Bid (twice a day) Bid c̅ With Hr (hour) Hr or hrs Hs Bedtime NP (nothing by mouth) NPO Pc After meals PCA (patient-controlled analgesia) PCA Per (through, by [route]) PCA Prn (as needed) PRN q Every or each qh or q1h Every hr or every 1 hr qid (four times a day) qid Q2h, q4h, etc. Every 2 hrs, every 4 hrs, etc s̅ (without) Without Stat Immediately, at once Tid (three times a day) Tid DO NOT USE ABBREVIATIONS Abbreviation Preferred q.d., Q.D. Write daily or every day q.o.d or Q.O.D. Write every other day U Write unit IU Write international Unit MS, MSO4 Write morphine sulfate MgSO4 Write magnesium sulfate.5 mg Use a zero before a decimal point when the dose is less than a whole unit (e.g., write 0.5 mg) 1.0 mg Do not use a decimal point or a zero after a whole number (write 1 mg)