103 terms

Pharm - Overview Week 1

STUDY
PLAY
Medication order components
Date and time of order
drug name
drug dosage
route of admin
freq and duration
any special instructions
HCP signature
RN sig taking the order
Traditional 5 Rights
Right Client
Right drug
Right dose
Right time
RIght route
Additional 5 Rights
Right assessment
Right documentation
Clients right to education
Right evaluation
Clients right to refuse
Drug Admin Guidelines
Wash hands
Check allergies
Use at least 2 patient identifiers
Assess patient
Check order
Check label 3 times
Check expiration date
REcheck drug calculation
make sure pt. takes the drug and
Document
Errors of Omission
Not prescribed
Not dispensed
Not administered
Not taken
Errors of Commission
Wrong drug
Wrong dose
Wrong drug substitute
Wrong patient
Wrong route
Allergic reaction
Drug - food interaction
Errors of Commission - Communication
Illegible handwriting
Incomplete order
Vague instructions
Prescription not recognized
Unknown or illeligble HCP
Failure to follow policy
Filure to follow drug specific instructions
Drug overuse without therapeutic benefit
Drug labels
Brand - trade name
Generic name
dosage strength per drug form
form of drug
expiration date
lot number
name of manufacturer
Pharmaceutics
Art and science of dispensing drugs and medicines
Pharmacokinetic
Quantitative study of how drugs are taken up, biologically transformed, distributed, metabolized and eliminated from the body
Pharmacodynamics
Quantitative study of DRUG ACTION
Factors affecting drug absorption
Route of admin
Blood flow and supply
Pain and stress
GI motility
Exercise
Food and other drugs
PH
First pass effect
Drug passes through liver before entering systemic circulation
Bioavailability
Percent of drug that reaches systemic circulation
PO drugs always - under 100%
IV drugs usually 100%
Distribution
Process by which drug becomes available to body fluids and tissues
Plasma protein bound drugs
Bound drug portion is INACTIVE
2 high protein drugs can create toxicity
Free unbound drugs
ONly free drugs are ACTIVE
hypoalbuminemia - excess free drug can cause toxicity
Distribution
Abscesses, exudate and glands decrease distribution

Check clients protein and albumin levels
Liver
Primary site of drug metabolism and inactivation
Sometimes processed in GI tract and liver
Liver disease can SLOW metabolism = excess drugs can lead to toxicity
Half life
time it takes for 1/2 drug concentration to be eliminated.
Metabolism and elimination effect half life
liver or kidney dysfunction prolong half life
Three to 5 half lives saturates biological system
Excretion and elimination
Kidneys - main route
Liver, bile, feces, lungs, saliva, sweat and breast milk other routes.
Kidneys filter FREE unbound drugs, water soluble drugs and UNCHANGED drugs.
Protein bound drugs CANNOT be excreted via the kidneys
Urine PH
Acid urine excretes weak based drugs
Alkaline urine excretes weak acid drugs
Creatinine clearance
Most accurate renal test
Creatinine is a metabolic byproduct of muscle excreted by kidneys
less muscle mass - lower value - in women and elderly
85-135 ml/min - NORMAL
Pharmacodynamic pharse
study of drug concentration and its effects on the body
Primary physiologic effect
desirable
Secondary physiologic effect
may be desirable or undesirable
Time response curve
plasma or serum level too low - may lead to inadequate dose.
Too high - can lead to toxicity
Therapeutic index
Low - NARROW margin of safety
High : Wide margin of safety
Peak
TIme of highest plasma drug concentration and shows rate of absorption - blood drawn at prescribed time
Trough
Lowerst plasma drug concentration and shows rate of excretion
- Blood work drawn just before net dose of drug and should be documented
Loading dose
large initial dose
Adverse reactions
more severe than side effects
always undesirable
can be mild to severe
Placebo effect
psychological benefit from a compound without chemical structure of a drug effect.
Kinase linked receptor
ligand binding domain on cell surface
Drug activates enzyme inside cell initiating effect
Ligand gated ion channels
Drug spans cell membrane, ion channels - Na and Ca open initiating effect
G protein
coupled receptor systems drug activates receptor which activates G protein which activates effect
Nuclear receptors
effect is achieved through in and through the function of the cell nucleus by means of a transcription process. Actiivation is prolonged
1970 Controlled Substance Act
I - High abuse potential - no medical use - heroin
II High abuse potential - accepted medical use - morphone
III - medically accepted - potential abuse - possible dependance - codeine
IV - medically accepted - possible dependence -
V - 5 - Medically accepted - limited potential dependence - opioids for cough and diarrhea
Misfeasance
negligence - wrong drug / dose - results in death
Nonfeasance
Omission results in death
Malfeasance
Correct drug by wrong route - causes death
FDA Pregnancy Categories
Classifies drug risks to fetus
Categories, ABCDX
A and B considered safe during pregnancy - especially during 1st trimester
FDA Categories
A - Studies show no fetal risk
B - No fetal risk in animal studies - no risk assumed in humans
C - Fetal risk in animal studies - weight risk vs. benefit
D - PRoven fetal risk - weigh risk vs. benefit if life - threatening
X = Proven fetal risk - MORE than benefit - avoid in pregnancy
Drug interaction - Additive effects
Sum of the effects
two drugs with similar actions sum their effects -
may be desirable or undersirable
Synergism or potentiation
Clinical effect is greater than simply the combined effect of the two.
TWo drugs with different mechanisms of action produce greater effects
Drug interference
One creates a difference in the other.
One drug increases or decreases the metabolism or excreation of the other.
Displacement
One takes the place of the other.
Two drugs compete for binding sites on plasma proteins
Antagonism
One cancels the effect of the other
Basis for antidotes to toxic effects of another drug or chemical
Incompatibility
one cannot exist with the other.
Interaction of 2 drugs interferes with action of at least one drug.
Basis for drugs that bind / inactivate another toxic drug in GI tract
Drug abuse
defined as drug use inconsistent with medical or social norms - negative impact on psychologic and social functioning
Drug - Food interactions
Food slows most drug absorption but NOT drug actions
beer, wine, cheese yeast create HTN with MAO's
Vit K - bananas, fish, green vegs - Coumadin create greater anticoagulation
Dairy products impair absorption of tetracycline
Grapefruit juice and calcium channel blockers - lower BP and possible toxic
Chamomile
GI complaints
Echinacea
Immune system enhancer
Garlic
Lower cholesterol and Triglycerides
Lower blood pressure and blood clotting
Ginger
Boost immune system
Gingko
Improve memory
Ginseng
Lowers stress and boosts evergy and digestion
St Johns Wart
Antidepressant
Potential hazards of herbs
Unregulated by FDA
not be used by pregnant women or nursing
by infants or small children
with chemotherapy
in large quantities
Dopamine
movement, attention, learning , reward and reinforcement of addictive drugs
Serotonin
Role in mood, sleep rhythms and arousal
Epinephrine and Norepinephrine
Vigilence
Fight or flight response
Acetylcholine
Muscular movement
GABA
Regulation of anxiety
Psychotic disorders -
Imbalance of dopamine
delusions
hallucination
incoherence
catatonia
agressive / violent behavior
delusion
A false belief in which one's own thought feeling or fears cannot be distinguished from reality - persecution gradeur or conrtol
hallucination
a false perception having no relation to reality - may be visual, auditory, tactile olfactory or gustatory
Schizophrenia
Chronic
exaggeration of normal function
hallucinations
loss in function - social withdrawl or poverty of speech content
Antipsychotics
neuroleptics - taking a hold of the brain
psychotropics - acting upon the mind
Antipsychotics - most common

Drugs that modify psychotic behavior - taken consistently
need time for full therapeutic response
Largest group of drugs for mental illness
NOT used to treat depression or anxiety
Antipsychotics
Given PO IM Or IV
Liquid preferred
Peak serum in 2-3 hours
Highly protein bound
Drug excretion SLOW
Pinkish to red - brown urine
Full effect may take 3-6 weeks
Therapeutic response 7-10 days
Start low in older adults
Antipsychotics Action
Block dopamine receptors - so there is excess dopamine in the system = regulate emotional responses and cognition
excess dopamine helps restore balance
All block D2 receptors
Typical antipsychotics
traditional -
Phenothizaines
Nonphenothiazines
Strong affinity for the D2 receptors - increased incidence of EPS - Extra pyramidal symptoms
Atypical Antipsychotics
Effective for treating schizophrenia and other psychotic disorders - unresponsive to typical antipsychotics
Weak affinity for D2 receptors - Decreased incidence of EPS
Antipsychotics Side effects
**Drowsiness
Anticholinergic effects
Dry mouth
Increased HR
Urinary retention
Constipation
Pseudoparkinsonism
Occurs within 5-30 days
From typical antipsychotics
Prolixin and Thorazine
Acute dystonia
occurs within DAYS of taking the drug
Treat with antichollinergic or antiparkinsonism drug - Cogentin or Ativan - Benzos
Akathisia
Early treatment
Treat with Ativan - Benzos
Beta Blockers - Inderal - propanolol
Tardive dyskinesia
Typically 1 year after drug
Drug should be STOPPED
In older adults
Treat - bensoz
Calcium channel blockers or beta blockers
High doses of Vitamin E
Adverse reactions with atypicals
Diabetes - hyperglycemia
Dyslipidemia
Hypertension
Neuroleptic Malignant Syndrome
RARE
Sudden high fever
BP Fluctuations
Tachycardia
Muscle rigidity
Altered mental status
Seizures
Tx
Immediate withdrawl of meds
hydration
blankets
muscle relaxants
Kava Kava
May increase risk of dystonic reaction with phenothiazines
or fluphenazine - prolixin
Phenothiazines
Typical - Thorazine - strong sedative effect lowers BP
Atypical - nonphenothiazines - Haldol - haloperidol
smaller doses but increases Qt time = contractions
Atypical Antipsychotics
Effective in treating positive and negative symptoms of illness (typical ineffective for negative sx)
Doesn't cause EPS or tardive
May cause metabolic syndrome
Abilify, Seroquel, Risperdal, Geodon
Antipsychotic Interventions
Check VS - orthostatic hypertension
Food and milk
Give IM by Z track
Observe for EPS
Assess for neuroleptic malig syndrome
Check urine output
Monitor serum glucose - Atypicals -
Antipsychotic client education
wear ID
stop smoking
6 week or more for full effect
labs
photosensitivity
eye exam - atypical - cause cataracts
orthostatic hypotension
Anxiolytics
Treat anxiety and insomnia
Benzos major group - better than barbituates
Primary - NOT caused by medical condition or drug use
Secondary - related to drug use or medical psych disorder
- not usually given for second -
Long term use discouraged
Tolerance in weeks or months
- nonpharm - warm baths, removal from stress, quiet surroundings
Benzodiazepines
Anticonvulsants
Sedative hypnotics
Preop drugs
Anxiolytics
For prolonged or severe anxiety
Ativan
Valium
** Kava Kava will have increased sedative effect
Lorazepam - Ativan
Increases GABA effects -
Binds to benzo receptors
inhibits rapid neurotransmissions
decreases anxiety
HI Protein Binding 90%
T1/2 - 10-20 hours
Excreted in urine
Rapid GI absorption
Ativan side effects
Drowsiness
Weakness
Blurred vision
Anorexia
Nausea and vomiting
Hallucination
Restlessness

Adverse Rx
Hypertension
Hypotension
Taper off use
Depression
Reactive - sudden onset after event - may last for months
Major - loss of interest in life - deep depression
Primary - not related to health problems
secondary - related to health problems
Bipolar affective disorder - btw mania and depression
Herbal supplements for mild depression
St john wart
gingko biloba
should discontinue 2-3 weeks before surgery
Tricyclics TCA's
Major depression - Elavil
Blocks uptake of norepinephrine and serotonin
less expensive than SSRI's
Elevate mood - increase interest in ADL and lowers insomnia
Given at night - sedative effect
Tricyclics Side effects
Orthostatic hypotension
Sedation
Anticholinergic effects
Cardiac Toxicity
Seizures
Interact with
Alcohol
hypnotics
sedatives
barbituates
MAOIs
SSRI
Block reuptake of serotonin and enhance transmission
Do not block dopamine or norepinephrine
DO NOT bloack cholinergi and alpha 1, adrenergic receptors
Major depressive disorders and migraines
Prozax
SSRI
hepatically metabolized - LIVER
more costly than TCA's
Insomnia
nervousness
nausea
anorexia
diarrhea
sexual dysfunction

*** Feverfew may interfere with SSRI - Prozac
St john Wort - interferes - dizziness, headache, sweating, agitation
Atypical antidepressants
2nd generation
Major depression, reaction depression and anxiety
Affect 1 OR 2 of the neurotransmitters
Wellbutrin
MAOIs Monoamine Oxidase Inhibitors
MAO A and MAO B - inactivates norepinephrine dopamine and epinephrine
NONSELECTIVE - Inhibit both MAO A and B
Increase levels of neurotransmitters which relieves symptoms
taken by 1%
used when unresponsive to TCA's
Parnate
MAO Interactions
Any CNS stimulant or sympathomimetics = HTN crisis
Tyramine food - HTN crisis - Sympathomimetic - like effects
Tyramine Foods -
Cheese
Bananas, raisins
jPickled foods
red wine, beer
cream, yogurt
Chocolate, coffee
Italian green beans
Liver
yeast
soy sauce
Antidepressants - cultural
Asians and hispanics may need lower dose
Mood stabilizer
Lithium
Antidepressant to treat bipolar disorder
Controls manic phase
narrow therapeutic range - 0.5 - 1.5 mEg/L - 1.5 and above are toxic
Depletes serum sodium levels - must monitor NA
Lithium Side effects
Dry mouth
Thirst
Up in urination
weight gain
bloating
metallic taste
edema of feet and ankles
Lithium Toxicity
Nausea
Vomiting
Cardiac dysrhythmias
Circulatory collapse
NO NSAIDS
Monitor thyroid function
or cardiovascular problems.