Pharmacology Module 1-6 PDF

Module 1: Regulations and Ethics Pertaining to Medication Readings - Chapter 1, 2, 9, 10 Food and Drug Act (FDA): primary legislation that monitors the sale of food, drugs, medical devices and cosmetics FDA – your role is to follow their recommendations based on the most current data on food and dr...

Module 1: Regulations and Ethics Pertaining to Medication Readings - Chapter 1, 2, 9, 10 Food and Drug Act (FDA): primary legislation that monitors the sale of food, drugs, medical devices and cosmetics FDA – your role is to follow their recommendations based on the most current data on food and drugs. This will allow you to deal with patients health issues that is safe and in the most effective way Canadian Controlled Drugs and Substances Act: Outlines controlled drugs and mandatory minimum sentences related to trafficking and possession Canadian Council for Practical Nurse Regulators: Responsible for the regulation of LPN’s Law governs all aspect of drug approval, labeling, marketing, manufacturing and distribution - therapeutics : drugs or medicine - Biologics : Hormones, blood products, produced in an animal/cell - Natural : Vitamins, minerals, herbals, supplements Hierarchical Order of Governing Bodies 1. Government of Alberta - Health Professions Act (HPA) - Legislation governing LPN practice in Alberta ( they provide a framework for governance, registration, restricted activities, discipline and continuing competence – It defines the requirements that regulated health professions in Alberta (like, nurses, doctors, physiotherapists, etc) need to follow to provide safe and competent care) 2. Legislation Administered by Alberta Ministry of Health - Government representative “ensure” Albertans receive the right health care service 3. LPN Regulation - developed by CLPNA, reviewed by stakeholders, approved by the government. - regulates the registration and practice of the profession (they take the recommendations and regulations made by the HPA) 4. College of Licenced Practical Nurses of Alberta (CLPNA) - entry level competencies standards of practice code of ethics continuing competence conduct process approve PN programs maintain database of LPNs licensed to practice in Alberta 5. LPN Bylaws, LPN standards of Practice LPN Code of Ethics Restricted Activities would require advance education in order to practice one specific practice - Responsibility to the Public Responsibility to Clients - Responsibility to the Profession - Responsibility to Colleagues - Responsibility to Oneself Restricted Activities: ​“Restricted activities are high risk activities performed as part of providing a health service that require specific competencies and skills to be carried out safely. Restricted activities are not linked to any specific health profession and a number of regulated health practitioners may perform a particular restricted activity.” Drug Order, and what is the Nurses role in medication administration: ● Name (Generic & Trade) ● Pharmacological Classification ● Therapeutic Classification ● Intended use ● Effects on the body ● Contraindications ● How pathophysiological states affect pharmacotherapeutic response ● Side and adverse effects ● 10 rights ● Teachings ● Advocacy ● Nursing process considerations Physicians: provide signed medication orders Pharmacists: dispenses medications and provides resources. Monitors medication incompatibilities. Can also prescribe Schedule II medications. Nurse Practitioner (NP): Prescribe medications within their scope of training Licensed Practical Nurses (LPN’s): Administer medication prescribed by the above as outlined in CLPNA practice guidelines Medication Rights 1. Right drug 2. Right client 3. Right dose 4. Right route 5. Right time and frequency 6. Right documentation 7. Tight history and assessment 8. Right drug-interaction and evaluation 9. Right education and information 10. Right to refuse (according to CLPNA 2022) Medication administration must be performed in accordance with legislation, regulatory standards and policy documents, and employer policy - The LPN must have education, knowledge, and competence to: - Accept and transcribe medication orders according to best practice; - Safely prepare, initiate, administer, monitor, titrate, discontinue medications Pass and Bridge Medications - When pharmacy is not available to dispense a drug, an LPN can dispense with a written order - Pass medications are given when a patient leaves an inpatient area for a brief period but will be coming back. (Remain Admitted) - Bridge medications are given out of the hospital ‘stock’ to maintain coverage of a medication until a pharmacy is open to get medications. “Generally, the legal authority to dispense a medication falls within the responsibility of the pharmacy (pharmacist or pharmacy technician). An LPN is authorized to dispense medications incidental to the practice of practical nursing, according to the Standards of Practice on Restricted Activities and Advanced Practice. When a pharmacy is not available to dispense the drug and dispensing of the medication is required to meet the needs of the patient, there must be a patient specific order in place from an authorized prescriber. Pass medications are used in practice when the patient is leaving an inpatient unit and will need to take medications while they are out on pass.” Schedule I Available only by prescription and provided by a pharmacist including the following: ● All prescription drugs ● Drugs with less potential for abuse: Schedule F ● Controlled Drugs: Schedule G Schedule II Available only from a pharmacist; must be retained in an area with no public access (Behind the Counter) Schedule III Available via open access in a pharmacy area (Over the Counter) Unscheduled (U) Can be sold in any store without professional supervision Role in medication Delivery: 1. Active failure: prescribing error 2. Patient Monitoring (Medication use process and safety systems) 3. Patient education and communication (Medication use process and safety systems) 4. Nurse order review (Medication use process and safety systems) 5. Pharmacist order review 6. Adverse drug event Strategies for Preventing medication incidents: 1. Assessment - Ask about allergies to food or medications 2. 3. - Ask current health concerns and assess current renal and liver function Ask if they’re taking any other medications/supplements Planning Minimize factors that contribute to med errors Question unclear orders - only use verbal orders when the agency policy allows Prepare medications within the appropriate timing Have clients demonstrate their understanding of the goals of therapy Implementation When engaged in medication-related task, focus entirely on the task, keep a quiet environment if possible - Ensure you’ve considered the 10 rights before administration 4. Evaluation - Recheck any medications the patient may says “looks different” (different color, size) Module 2: Medication Action and Administration Chapter - 2, 3, 4, 6, 25 Acute/Empirical - to treat an acute disease Maintenance - for chronic conditions Supportive - treat symptoms resulting from the underlying disease until the disease is resolved Supplemental/Replacement - to replenish something the body needs or makes normally Palliative - to maintain comfort at the end of life Pharmacokinetics - How a drug moves through the body (how it is absorbed, distributed, metabolized and excreted) - Repeat four processes A, D, M, E Absorption - how will it get in? ● The process of moving a drug from its site of administration, across body membranes and into circulating fluids ● Drugs can be administered in more than 10 different routes Slow Absorption Fast Absorption Tablets (Stomach) Elixir Enteric Coated Syrup Inhalation Absorption is the primary factor that determines the onset of action; For any given drug the percentage of the drug that is absorbed is 0-100%. Higher the absorption rate the more effective the response. Factors that affects Absorption of Medications Area of absorptive surface Gastric pH Enzymes GI motility Blood Flow Physical form of the drug Presence of other substance Distribution - Where will it go? ● How pharmacological agents are transported throughout the body after they are absorbed or injected Factors affecting the distribution of medications Blood Flow to Tissues Drug Solubility Tissue Storage Protein Binding Metabolism - How is it broken down? ● The process that changed a drugs form (water soluble) and makes it more likely to be excreted ● Chemical conversion of a drug to aid in excretion ● Live is the primary site of drug metabolism ● Kidneys and cells of intestinal tract also have a high metabolic rate ● Sometimes a metabolite may exhibit a greater therapeutic action than the original drug = prodrug (Codeine ● When a drug is metabolized it can become one of the three: 1. Inactive metabolite - no longer able to work in the body 2. Active metabolite - metabolized but still able to work in the body 3. Pro Drug (a drug that doesn’t become active until it is metabolized, requires enzymes to become active Factors that affect Metabolism: Liver Failure Age Environmental/Other drug Factors Genetics Excretion - how does it leave? ● The process in which drugs are eliminated from the body ● Most drugs are excreted by the kidneys and leave the body through the urine ● A small amount of drugs can be excreted through saliva, skin, sweat, breast milk or GI Factors that Affects Excretion of Medications Kidney Disease/Failure Protein Binding Urine pH Urine Flow Pharmacodynamics - How a drug affects the body Pharmacotherapeutics - The use of a drug to prevent and treat diseases Onset - how long it takes for the drug to achieve minimal effect Peak - How long it takes for the drug to achieve full effect Duration - How long it takes for the drug to stay active in the body Changing the route or fromm of the drug can dramatically affect the onset, peak and duration of the drug Drug Half Life - Drug half life is the amount of time required for the drug concentration to be reduced to exactly half its initial concentration in the blood - Half life of drugs increase with age, decreased liver and kidney function - Half life is useful in determining the dosing frequency - Many variable that affect half life Loading and Maintenance Dosing - Loading doses can be given when the therapeutic effect is needed faster Endogenous - Natural occurring chemical Agonist - drugs that produce the same response as the endogenous substance Antagonist - drugs that block the endogenous chemical from acting Therapeutic effect - the desired effect of the medication Side effect - a documented effect other than the desired effect Adverse effect - a side effect that can cause serious harm Contraindication - a drug should not be used as it may cause harm Additive effect - similar drugs given together to give a total effect. (percocet) Synergistic effect - different drugs given together to increase the action of one or both drugs (antibiotics) Antagonistic effect - when two drugs compete for absorption or protein binding sites resulting in a less than desired therapeutic effect for one or both drugs (narcan) Physical Dependance - an altered physical condition cause by the NS adapting to repeated substance use Psychological Dependance - produces no signs of physical discomfort after the medication or agent is discontinued Misuse - inappropriate use of prescription drugs in a way not to be used Abuse - A pattern of using any drug in such a way that it negatively affects a person's psychological and physiological well being Tolerance - when someone requires increased dosage to achieve the same therapeutic effect Dependance - when someone require a drug to maintain a state of psychological and/or physical well being Idiosyncratic Effect - Non documented drug effect, likely due to individual genetics Allergic reaction - the patient's immune system recognizes the drug as a threat Aaphylactice reaction - severe allergic reaction that can be life threatening High Alert Medications Hazardous Medications Module 3: Medication Classification and Research Chapter 2, 5, Davis Drug’s Guide What’s in a Name? Chemical Name - The scientific name that describes the drugs structure (atomic/molecular) Generic Name - An abbreviation of the chemical name Trade Name - The name assigned to the drug by the manufacturer/drug company N-Acetyl-P-Aminophenol is a chemical name, acetaminophen is a generic name and Tylenol is the trade name for the same drug Drugs are classified by therapeutic and pharmacological classification, they are “sorted” according to chemical similarities or similar therapies Therapeutic Classification - Related to therapeutic usefulness for treatment - Drugs with similar chemical properties Pharmacologic Classification - The way a drug works at the molecular, tissue, and body system level - The effect the drug aims to have on the body Generic Name Trade/Brand Therapeutic Class Pharmacological Metoprolol Lopressor Antihypertensives Antianginals Beta blockers Lebetalol Trandate Antihypertensives Antianginals Beta blockers Nifedipine Adalat Antihypertensives Antianginals Calcium channel blockers Mechanism of Action - How a drug produces its effects - Drugs typically enhance or inhibit existing physiological and biochemical process - Most drugs produce their actions by activation or inhibiting specific cellular receptors Research - What do we need to know before we give a medication - Where do we find this information - What resources are available - The nursing process is problem solving. What problems are we solving regarding pharmacology SBAR - Situation, background, assessment, recommendation Module 4: Complementary and Alternative Medicine Chapter 11, 37 What is CAM? ● Set of therapies and healing systems “outside” of mainstream health care CAM systems share the following: ● ● ● ● ● ● ● Focus on treating each person as an individual Consider the health of the whole person Emphasize integration of body and mind Promote disease prevention, self-care and self-healing Acknowledge the role of spirituality of health and healing In pharmacology, often involves the use of Natural Health Products (NHPs) Canadians spend more than $9 billion on CAM each year CAM in Pharmacology Natural Health Product (NHP) ● Herbal therapies: ○ ○ ● A plant-based substance with useful application as a medicine One of the earliest recorded use of plant products as a prescription was garlic in 3000 BCE ○ Now widely available for purchase in most grocery stores and online ○ The gradual aging of the population has led people to seek alternative for managing chronic conditions (anxiety, depression, hormone replacement therapy, prostate difficulties) ○ Ex: Aloe vera leaves for minor skin irritation and burns; Cranberry to prevent UTIs; Flaxseed oil to reduce blood cholesterol or to use a laxative Specialty Supplements ○ Non-herbal dietary products to enhance a wide variety of body functions ○ Plant or animal sources ○ Ex: Carnitine to enhance energy and memory; Coenzyme Q10 to prevent heart disease; DHEA to boost immune and memory functions; Vitamin C to prevent colds Why do people choose NHP? - Increase in focus on “wellness” disease prevention and healing Recognition of connection between the mind and the physical body Perceptional of “natural” being safer than chemically prepared pharmaceuticals How Can a Nurse Best Support a Patient Using NHP ● ● ● ● Be non-judgemental, discuss reasons for use with the patient/client Be aware of any bias the nurse may hold towards the use of NHP Become educated on the products and/or treatments being used Present both advantages and limitations about the treatment to the patient/client Regulation of NHP in Canada ● ● ● Natural Health Products Regulations of the Canada Food and Drugs Act The Natural and Non-prescription Health Products Directorate defines NHPs, determines licensing requirements, labelling standards, manufacturing practices, adverse event reporting, quality control To be licensed, an NHP must have some efficacy and be relatively safe at the recommended dosage Regulations ● No number, no health claims are made and the product has not been evaluated by Health Canada ● Natural Product Number (NPN), the product has been approved for sale by the NNHPD; a health claim is supported by evidence ● Drug Identification Number (DIN), the product has been evaluated by the Therapeutic Products Directorate of Health Canada Standardization of herbal remedies ● ● ● Intention is to guarantee that the consumer is getting a product in which the chemistry (amount of active ingredient) is consistent from batch to batch. Active ingredient extract ○ Standardized amount of biologically active substances in the herb (ex: saw palmetto’s active ingredient is fatty acids so standardization is based on amount of fatty acids present) Marker extracts: ○ Standardize the potency of the herb based on a common substance in the WHOLE herb that may not be the active ingredient (ex: ginseng is standardized on percent of ginsenosides in the extract) *A standardization does not guarantee safety or effectiveness* Herb-drug Interactions ● ● ● True extent of interactions is unknown – few studies have looked at herb-drug interactions Wide variation is products available make it challenging to know the exact amount of an herb a patient is taking Some herbal products may contain ingredients that act as agonists or antagonists to prescription drugs Insulin Is a hormone secreted by the pancreas in response to rising blood sugar levels. It is given exogenously (external source) when a patient is unable to produce insulin (Type 1) Warfarin Is an anticoagulant (prevents platelets from clumping together) that results in increased bleeding time Digoxin Medication used in treatment of heart failure; increases cardiac contractility, increased cardiac output and slows HR Fish Oil Reduces cholesterol levels, enhances brain function, increases visual acuity. May decrease risk of heart diseases Glucosamine and Chondroitin Reduce the pain of arthritis and other joint conditions Lactobacillus acidophilus/probiotic Maintain intestinal health Melatonin Reduce daytime sleepiness and jet-lag during travel Vitamin Therapy Necessary for metabolic functions, tissue growth and healing Fat Soluble Vitamins - Metabolized slowly Stored in fatty tissue, liver and muscle Excreted in urine slowly Importance of Vitamins Vitamin A, D, E, and K will help you feel good - A helps the eyes, skin, and hair to grow D helps calcium to be absorbed E helps your blood and cells to be safe K helps out to not bleed out of the face Water Soluble Vitamins - Vitamin B12, B complex, vitamin C, folic acid Not usually toxic unless taken in extreme amounts Not stored in the body, readily excreted in urine Vitamin c: strawberries, tomatoes, broccoli, sweet potatoes, white potatoes Vitamin B12: eggs, meat, poultry, fish, milk products Vitamin B12 - Helps in the formation of red blood cells Maintenance of the CNS which keeps nerves working properly Essential for DNA synthesis Relies on gastric cells to be absorbed B Complex Made up of: B1 (Thiamine) - new cell formation B2 (Riboflavin - antioxidant B3 (Niacin) - Good Cholesterol B5 (Pantothenic Acid) B6 (Pyridoxine B7 (Biotin) - Beauty Vitamin B9 (Folate Vitamin C - Necessary for normal growth and development - Aids in absorption of iron Folic Acid - Needed for DNA synthesis Essential for CNS development of a fetus Aids in the production of RBC’s Module 5: Antineoplastic Medications Chapter 60 Neoplasm or Tumor - An abnormal enlargement or mass of tissue that serves no useful purpose and may harm the host organism Can be benign or malignant Cancer Cell Characteristics - Usually grows rapidly Infiltrate surrounding tissue Poorly differentiated and too abnormal to perform any physiological function Metastases common Always harmful to host Will cause death unless treated Causes of Cancer 1. 2. 3. 4. Carcinogens Physical factors Viruses Genetics Cancer Treatment - Surgery Radiation Chemotherapy - destroys cancer cells or slows down how fast they grow Hormone therapy Bone marrow transplantation Targeted therapy Immunotherapy Categories of Medications used to treat Cancer: - - Alkylating Agents - First alkylating Agents were nitrogen mustards, which were used as chemical warfare in WWII - Most common class of drugs used in chemotherapy - Affect cancer cells via DNA - Cannot be copied or replicated properly - Most common adverse effect is bone marrow suppression (cyclophosphamide or Cytoxan) - Blood cells are very sensitive. Within days erythrocytes, leukocytes, and platelets decline Changes shape of the DNA, prevent cell division - Hormone antagonist having antineoplastic activity Biological response modifiers (BRMs) Antitumor Hormone - Adds or removes hormones to slow or stop the growth of some cancers Used in larger doses that the amount normally presents in the body Usually used with combinations of other cancer treatments Mechanism of action is unknown (Tamoxifen - Apo-Tamox) Antineoplastic Drugs-Biological Response Modifiers - Natural or engineered substances used to stimulate, boost or act like body’s immune system Enhance body’s response to destroy cancer cells by changing their behavior Slow growth of cancer cells Lessen the spread (Imatinib Mesylate - Gleevec) Common Adverse Effects of Anticancer Drugs - Changes in the blood: anemia, leukopenia, thrombocytopenia Changes to the GI tract: anorexia, bleeding, diarrhea, N/V Other Effects: Alopecia, fatigues, fetal death/birth defects, opportunistic infections Nursing COnsiderations ● Baseline: ○ Vital signs ○ CBC: RBC, WBC, Platelets ○ Kidney function ○ Liver function ○ Ins and Outs ○ Weight ○ Pregnancy Category D-X ○ Emotional Well being ○ Benefit risk ratio ○ Therapeutic goals Module 6: Autonomic Nervous System Agents Chapter 12, 13, 14, 15 Somatic - controls voluntary movements Autonomic - controls involuntary control or movement Sympathetic - fight or fly Parasympathetic - rest and digest The Autonomic Nervous system has 2 primary neurotransmitters. - - Norepinephrine (NE) = sympathetic Alpha or Beta Receptors (Adrenergic receptors) - Constricts blood vessels (vasoconstriction) - Dilates pupils - Increased HR - Inhibits smooth muscle Acetylcholine (Ach) = parasympathetic Muscarinic or Nicotinic receptors (cholinergic receptors) - Stimulation of smooth muscle - Stimulation of gland secretions - Decreased HR SYMPATHETIC Classification of Drugs - Adrenergics = sympathomimetics = adrenergic agonists (produces the fight or flight response) - Antiadrenergic = adrenergic antagonists (suppresses fight or flight) producing the opposite reaction PARASYMPATHETIC Classification of Drugs - Cholinergics = parasympathomimetics = cholinergic agonists (produce the rest and digest response) - Anticholinergics = cholinergic antagonist (suppresses rest and digest response) produces the opposite reaction Adrenergic Antagonists - Block alpha and beta receptor sites Indirectly inhibit release of norepinephrine and epinephrine Most widely prescribed autonomic drugs (used in treatment of hypertension, myocardial infarction, angina, heart failure; also used in treatment of benign prostatic hyperplasia by increasing urine flow). - Beta receptors are further divided into beta 1, beta 2 and beta 3. We will not be discussing beta 3. Some adrenergics are specific to certain beta receptors, others - attach to all 3. We will learn more about this in module 7. Gs – G-protein coupled transmembrane proteins (Gs = stimulatory) cAMP – cyclic adenosine monophosphate – a secondary messenger used for intracellular signal transduction, such as transferring the effects of hormones like adrenaline – which can't get through cell membrane Alpha 1 - Smooth Muscle Contraction Alpha 2 - Presynaptic Nerve Terminals Adrenergic Agonists - Mimics sympathetic neurotransmitters (epinephrine and norepinephrine) Acts on Adrenergic receptor sites: - - Alpha 1 = treatment of nasal congestion or hypotension, induces mydriasis (dopamine intropin) Alpha 2 = treatment of hypertension (centrally-acting by inhibiting release of norepinephrine) (Clonidine - Catapres) Beta 2 Agonist = asthma, causes bronchodilation Adrenergic Antagonist/Blocker - Alpha 1 Blockers: - Orthostatic hypotension - Syncope Beta 1 Blockers: - Dizziness, drowsiness, or light headedness Cholinergic Agonists - mimics the parasympathetic neurotransmitter acetylcholine Acts on cholinergic receptor sites Two subclasses: Direct-acting (muscarinic agonists): increases smooth muscle tone - Monitor intake and output Monitor for blurred vision (cholinergic effect) Monitor for orthostatic hypotension Indirect-acting (acetylcholinesterase inhibitors): inhibit AChE - Monitor for muscle weakness Schedule other meds around mealtime Indirect- acting cholinergic will aid in chewing and swallowing Excessive accumulation of acetylcholine (ACh) at the neuromuscular junctions and synapses causes symptoms of both muscarinic and nicotinic toxicity. These include cramps, increased salivation, lacrimation, muscular weakness, paralysis, muscular fasciculation, diarrhea, and blurry vision Anticholinergics - Acts by occupying acetylcholine receptors, therefore blocking the action of acetylcholine. Inhibit parasympathetic impulses; induces fight or flight response. Therapeutic uses: - GI disorders: decrease secretion of gastric acid in peptic ulcer disease; slow intestinal motility in IBS - Ophthalmic procedures: cause mydriasis or cycloplegia during eye procedures - Accelerates heart rate for patients with bradycardia - Preanesthetic: decrease respiratory secretions and reverse bradycardia d/t anesthetics (Scopolamine) - Dilates bronchi (asthma) (Atrovent)