Principles of Pharmacology Outline PDF

Alanis Leite Nursing 101 11/7/2024 Principles of Pharmacology Outline Responsibilities in New Jersey ○ Prescriber Orders the medication (prescription) ○ Pharmacist Responsible for preparing the...

Alanis Leite Nursing 101 11/7/2024 Principles of Pharmacology Outline Responsibilities in New Jersey ○ Prescriber Orders the medication (prescription) ○ Pharmacist Responsible for preparing the meds ○ Nurse Responsible for administration of those meds ○ Checks and balances in place to keep from error If an error is made The pharmacist & nurse has time to note that ○ If pharmacy makes the error the nurse can note it with the 7 rights FDA Process ○ Pre Clinical Phase Development of the drug Animal Testing (Looking @ Toxicity) & Sponsoring of the drug ○ Investigational Phase New Drug Application Application is sent to the FDA once it’s met that criteria  ○ Clinical Phase New Drug Tested on small groups of people Larger groups: People with diseases for that drug and usually some placebos Largest group: Patients will be taking the med and further studying of effectiveness and safety ○ New Drug Review Application Process FDA Final Review application process and marketing Testing on Human Beings ○ Approvations Nursing Process of Med Administration ○ Assessment Med History Medication Reconciliation - it’s a process of questions to know what meds the pt is on, why, when they are taken, when did pt start taking it. ○ Usually this questioning is done in the ED Patient Assessment (Ongoing or After Administration) Vitals & Head to Toe ○ Some medication has special instructions/limitations to give medications  I.e BP Meds, Heart Rate Meds, Lasix, Meds that Require Labs ○ Nursing Diagnosis Developed by assessment data gathered ○ Patient Centered Outcomes Evaluated after implementation of some type of plan of care Medicine/Med Identifiers ○ Generic v.s. Trade Generic The name that identifies the drugs active ingredient or chemical name (Universally Accepted **NOT OWNED BY ANY DRUG COMPANY) ○ I.e. acetaminophen Trade (Referred as NAME BRAND) selected by the pharmaceutical company that sells the actual drug ○ Protected by trademark (can have several trade names) I.e Benadryl, Tylenol ○ Form of the Drug Form in which the drug is prepared is going to determine the route of administration I.e Tablet, injection, transdermal patch, cream A lozenge or a cough drop is also called a TROCHE ○ Slow or Continuous Release Some tablet are enteric coated (prevent stomach irritation)[Extended Release -> ER] Allows for slow and continuous release (large intestine) ○ 12 Common Identifiers NDC# National Drug Code number used to identify a specific drug Generic Name Brand Name Drug Dose Dose available in this product Warnings Specific drug warning Administration Some labels indicate route and dosage Prescription Status Indicates drug is prescription only Drug Manufacturer Pharmaceutical house that produce the drug Quantity Amount of the drug in this package Storage Information Lot number  Specific Drug batch from which this drug was produced ○ Important for recall information Expiration Date Indicates date after which the drug was produced ○ Onset, Peak, & Duration Onset of Action The time it takes to reach the minimum effective concentration after drug is given Peak action Occurs when the drug reaches its highest blood concentration Duration The length of the time the drug has its effect It's important to understand the length to understand dosage and where exactly it will effect ○ Documentation Name of med Dosage Route & Time of Administration Nurse initials Intentional or inadvertently omitted drugs Refused Drugs Medication Errors Factors that affect drug action  ○ Developmental considerations ○ Weight ○ Biological sex ○ Culture & genetic factors Religious restrictions ○ Psychological Factors Pt expectations, compliance ○ Pathology Presence of disease that can affect the drug ○ Environment Sensory deprivation/overload, O2 deprivation, nutrition ○ Time of administration Present of food could delay or food will help irritation Side Effect vs. Adverse Effect (Interactions) ○ Side Effects Non-therapeutic reaction to a drug, the effect could be desirable or undesirable I.e percocet = falling asleep ○ Adverse Effect Pharmacological event that is not expected [considered a dangerous reaction] unpredictable, occurs less than side effects ** ○ Drug Interactions Patient can be sensitive to the drug  Drug can cause some other type of response Patient taking too much or too little dose Hypersensitivity Allergic effect Pharmacokinetics vs. Pharmacodynamics ○ Pharmacokinetics The effect that the body has on a drug Absorption Factor ○ The process by which a drug is transferred from its site of entry Influencing Factor Route of Administration Lipid Solubility (absorbed more readily and pass more easily) pH (well absorbed in the stomach) Blood Flow (Increased flow increased absorption) Location Condition of Site of Administration (different conditions = different absorption abilities) Drug Dose Distribution  ○ After a drug has entered into blood stream, transported throughout the body the drug molecules take action Depends on: Person's ability to circulate blood Protein Binding capacity (drugs ability to leave the bloodstream or storage areas) Selectively permeable blood brain barrier of CNS (protects CNS and drugs from entering) Metabolism ○ The change of an active drug from its original form to an inactivated or a new form Liver is primary source GI Tract, Lungs, and kidneys have a role in metabolism of meds Excretion ○ Occurs when the drug is broken down (removing the drug from the body) Kidney is the main route for excretion Lungs excrete gaseous substances/meds Factors that affect Impaired renal function can = toxicity in body (bad)  Aging, diseases, etc ○ Pharmacodynamics The process of drugs acting in specific or target cells resulting in a change in cellular function and reaction Drug Orders ○ Standing Order (a.k.a Routine Order) Carried out until canceled by another order Specific Instructions/limitations ○ PRN - As Needed Received when requested by patient or required by physician when the specifics of the orders are met Clinical Parameters or timing btwn doses ○ I.e every 4 hours if patient has a pain level between 5-7 ○ Usually Pain, nausea, & sleep meds ○ Stat order - immediate order, one time order carried out at once Seven Parts of a Med Order ○ Patient Name ○ Date & Time order is written ○ Name of drug to be administered ○ Dosage of the drug ○ Route by which the drug is to be administered ○ Frequency of admission of the drug ○ Signature of person writing the order  9 Rights of Medication Administration ○ Right Med ○ Right Patient ○ Right Dose ○ Right Route ○ Right Time ○ Right Reason ○ Right Assessment ○ Right Documentation ○ Right Response Med Checks ○ 3 Med Checks When the nurse reaches for the unit dose package After retrieval from the drawer and compared with the MAR Before giving the unit dose medication to the patient Controlled Substances ○ Record should be kept of each narcotics that is administered to the patient ○ The amount of a C.S. on hands is counted and must be accounted for administrative records ○ Needs to be checked daily Usually each off-going shift must complete a count of all controlled substances ○ A witness (another nurse) when counting and wasting (throwing out) a narcotic  Common Medical Errors & Prevention ○ Common Medical Errors Inappropriate prescribing of the drug Extra omitted, or wrong doses Administration of drug to wrong patient Administration of wrong route or rate Failure of give medication on within prescribed time Incorrect preparation of a drug Improper technique when administering drug Giving a drug that has expired or deteriorated If this happens: Check patient for adverse effects Advise nurse manager and physician Write description of the error in EMR and quality assurance documentation (incident report) ○ Prevention Drug Regamin Process Avoid interruption & distraction Series of Checks ○ Nurse ○ Patient Reporting Medication Errors NEVER LEAVE PREPARED DRUGS UNATTENEDED  Bar-code Medication System Patient has own identifiers (ID, Stickers) Nurse has a unique barcode ○ Get in the Omnicell, MAR, COW Drug has a unique barcode ○ Barcode Identifies the drug form, dosage ○ NDC -> Natural Drug Code Nurse scans patient ID first, than the drug: ○ If it is right it will allow you to continue administering the medication ○ If it is wrong the system will tell you and not let you continue Patient Teaching ○ Describe the medication and what it does to the patient in an understanding language This is done before administration so the patient know what is being given ○ Topics of teaching Name of the drug Dose of the drug Action of the drug The frequency How to store/prepare (discharge)  What OTC and holistic, alternative, therapies should be avoided Comfort and Safety Measures ○ Make sure the patient can restate the information perfectly to know that they understand