Pharmacology Ch. 1-6

A nurse working in radiology administers iodine to a patient who is having a CT scan. The oncology nurse administers chemotherapy to patients who have cancer. The Public Health Department nurse administers an MMR vaccine to a 14 month old child. Which branch of pharmacology best describes the action of all 3 nurses?

A. Pharmacoeconomics
B. Pharmacotherapeutics
C. Pharmacodynamics
D. Pharmacokinetics
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A nurse working in radiology administers iodine to a patient who is having a CT scan. The oncology nurse administers chemotherapy to patients who have cancer. The Public Health Department nurse administers an MMR vaccine to a 14 month old child. Which branch of pharmacology best describes the action of all 3 nurses?

A. Pharmacoeconomics
B. Pharmacotherapeutics
C. Pharmacodynamics
D. Pharmacokinetics
B. Pharmacotherapeutics

Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease.
A physician ordered IM injections of morphine, a narcotic, every 4 hours PRN for pain for a MVA victim. The nurse is aware this drug has high abuse potential. Which drug category would morphine be listed?

A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
B. Schedule II

-Schedule I: Narcotics with high abuse potential and no accepted medical use (heroin, LSD)
-Schedule II: High abuse potential but with accepted medical use. (narcotics, amphetamines', barbiturates)
-Schedule III: Lesser abuse potential than schedule II and accepted medical use are schedule III (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics)
-Schedule IV: Low abuse potential and limited dependence liability (some sedatives, anti anxiety agents, nonnargotic analgesics)
-Schedule V: limited abuse potential. Can be purchased without Rx directly from pharmacist if 18 or older and the transaction is recorded.
When involved in phase III drug evaluation studies, what responsibilities would the nurse have?

A) Working with animals who are given experimental drugs
B) Choosing appropriate patients to be involved in the drug study
C) Monitoring and observing patients closely for adverse effects
D) Conducting research to determine effectiveness of the drug
C. Monitoring and observing patients closely for adverse effects

Preclinical- animal participants
Phase I- tested on healthy human volunteers
Phase II- participants have the disease that the drug is intended to treat
Phase III- use of a drug in a vast clinical population in which patients are asked to record any symptoms they experience while taking the drugs
FDA approval- drugs that finish Phase III trials are evaluated by the FDA; if approved, may be marketed
Phase IV- continued evaluation
DAW means:
dispense as written

drug cannot be substituted for generic or another form of drug. Important in drugs with narrow safety margins.
Teratogenic:
causes adverse effects to the fetus
Pharmacokinetics
The process by which drugs are absorbed, distributed within the body, metabolized, and excreted.
-what the body does to the drug
Pharmacodynamics
The process by which a medication works on the body.
- what the drug does to the body
The 4 Drug Actions:
1. replace or act as a substitute for missing chemicals
2. increase or stimulate certain cellular activities
3. depress or slow cellular activities
4. interfere with the functioning of foreign cells, such as invading microorganisms or neoplasm, leading to cell death
Agonist:
drugs that interact directly with the receptor sites to cause the same activity that natural chemicals would
- insulin, thyroid hormone
Competitive antagonist:
Drug competes with the agonist for binding to the receptor. If it binds, there is no response.
-react with receptor sites to block normal stimulation, producing no effect
-blocks "key" from going in "lock"
Noncompetitive Antagonist:drug combines with different parts of the receptor and inactivates it; agonist then has no effect -blocks the effect, but doesnt act directly on the same receptor siteDrug enzyme interaction:drugs can cause their effect by interfering with the enzyme systemSelective toxicity:the ability of a drug to attack only those systems found in foreign cellsOnset of a drug action:How long it takes to see the beginning of the drugs therapeutic effectsHalf life:Time it takes for the drug potency to be half of what it wasTiming of Peak Effect:How long it will take to see the maximum effect of the drugDuration of drug effects:How long the patient will experience the effects of the drugBiotransformation:the metabolism of the drugSite of excretion:Where the drug exists the body (skin, urine, feces)Critical concentration:the amount of drug that is needed to cause a therapeutic effectLoading dose:A higher dose than that usually used for treatmentDynamic equilibrium: What is it affected by:-the actual concentration that a drug reaches in the body. -absorption, distribution, biotransformation, excretionAbsorption:what happens to a drug from the time it enters the body until it enters the circulating fluid and tissuesFactors affecting absorption: -IV: -IM: -SubQ: -PO: -PR: -Mucous membrane: -Topical: -Inhalation:IV: none, goes directly into bloodstream IM: perfusion/blood flow to muscle, fat content, temperature SubQ: perfusion/blood flow to the tissue, fat content, temp PO: stomach acidity, length of time in stomach, blood flow to GI tract, presence of food that interact with drugs PR: perfusion/blood flow to the rectum, lesions, length of time retained for absorption Mucous membrane: perfusion/blood flow, integrity of mucous membrane, presence of food or smoking, length of time in retained area Topical: perfusion/blood flow, integrity of skin Inhalation: perfusion/blood flow, integrity of lung lining, ability to admin. correctlyHow does temperature affect absorption:Hot= vasodilation = increased absorption Cold= vasoconstriction = decreased absorptionPassive diffusion:movement of solutes across the cell membrane to equalize their concentration; moves to area of lower concentration; requires no energyActive Transport:uses energy to actively move a molecule across a cell membraneFiltration:movement rhough pores in the cell membrane, either down a concentration gradient or as a result of the pull of plasma protiens -for example: drug excretionProtein binding:Most drugs are bound to some extent to proteins in the blood to be carried into circulation -some are more tightly bound to proteins than others and are released more slowly- longer duration of actionBBB:drugs that are lipid soluble are more likely to pass through the BBB and reach the CNSBiotransformation:metabolism. process of drugs being changed into new, less active chemicals LIVER is the single most important organ for biotransformationFirst Pass Effectconcentration of an oral drug is grealy reduced before it reaches the systemic circulation due to rapid uptake and metabolism by the liver immediately after absorptionHepatic enzyme systemcytochrome P450- alters drug and starts biotransformationWhat are dosages usually based off of:150lb maleDrug Food interactionsoccur when a drug reacts with a food -grapefruit can enhance the reaction of a drugAdverse effects:undesired effects that may be unpleasant or even dangerousAdverse effect; Primary actionoverdose, extension of desired effectAdverse effect; secondary actionundesired effects produced in addition to the pharmacologic effectAdverse effect; Hypersensitivityexcessive response to the primary or secondary effect of the drugDrug Allergy:body forms antibodies to particular drug causing immune response when person is re-exposed (only get a reaction if you have taken drug before unless you get a cross allergy to drug in same class)Anaphylaxis:antibody reacts with specific sites in the body to cause the release of chemicals including histamine. Immediate reaction is produced. Could lead to respiratory distress or even arrestCytotoxic reaction:antibodies circulate in the blood and attack antigens on cell sites, causing death of cellSerum sickness:systemic injury initiated by antigen-antibody complexes that circulate in the bloodDelayed allergy reaction:reaction occurs several hours to days after exposure and involves antibodies that are bound to specific WBCSuperinfection:destruction of the body's normal floraRashes and Hives Assessment: Intervention:-abnormalities in the skin, red area, blisters - may need to D/C medication in severe casesStomatitis Assessment: Intervention:-inflammation of mucous membranes of the mouth -frequent mouth careSuperinfections Assessment: Intervention:-diarrhea, fever, vaginal discharge -supportive care (mouth and skin care), antifungals/bacterials, may need to stop drug responsible for superinfectionBlood Dyscrasia Assessment: Intervention:[bone marrow suppression caused by drug effects] -fever, chills, sore throat, weakness, backpain, dark urine, pancytopenia (decrease in all cells) -monitor blood counts, protective isolationLiver Injury Assessment: Intervention:-fever, malaise, nausea, jaundice, change in urine or stool color, abdominal pain, elevated liver enzyme -D/C medicationRenal Injury Assessment: Intervention:-change in urinary pattern, elevated BUN and creatinine -notify physician, may need to D/C medication or decrease dosagePoisoningOverdose of a drug damages multiple body systems -damage to multiple systems can have fatal reaction -treatment varies with each drugHypoglycemia Assessment: Intervention:-fatigue, drowsiness, hunger, anxiety, headache, cold and clammy skin, increased heart rate and BP... etc -administer glucoseHyperglycemia Assessment: Intervention:-fatigue, polyuria (increased urine), polydispia (increased thirst), deep respirations (Kussmauls respirations), restlessness, nausea, fruity acetone odor to breathe, etc -administer insulin therapyHypokalemia Assessment: Intervention:-low serum K+ levels, weakness, numbing, tingling of extremities, nausea, vomiting, diarrhea, muscle cramps, irregular pulse, etc. -replace K+ and monitor levelsHyperkalemia Assessment: Intervention:-high serum K+ levels, weakness, muscle cramps, diarrhea, numbness and tingling, slow HR, etc -decrease K+ levels with sodium polystyrene sulfonate, monitor levels, monitor heart rhythmOcular Damage Assessment: Intervention:-visual changes, blurry vision, color vision changes -monitor for visual changes when giving medication that has those known side effects, D/C medication as appropriateAuditory Damage Assessment: Intervention:-dizziness, ringing in ears (tinnitus), loss of balance, loss of hearing -monitor for hearing loss, D/C medication as appropriateCNS effects Assessment: Intervention:-confusion, delerium, insomnia, drowsiness, bizarre dreams, numbness, tingling, etc. -prevent injury, consult with provider to D/C medication or decrease dosageAtropine-like (Anticholinergic) Effects Assessment: Intervention:- dry mouth, urinary retention, blurred vision -sugarless lozenges to keep mouth moist, have the patient void before administration of medicationParkinson like syndrome Assessment: Intervention:[drugs that directly or indirectly affect dopamine levels in the brain can cause a syndrome that resembles Parkinson's disease] -muscle tremors, drooling, changes in gait, rigidity, etc -D/C medication as appropriateNeuroleptic Malignant Syndrome Assessment: Intervention:[a generalized syndrome that includes high fever and if not treated quickly, could be fatal- caused by general anesthetic agents] -neurological symptoms; slow refleces, fever, rigidity, involuntary movements, hypertension, elevated HR -D/C medication as appropriateThe Nursing Process:Assessment Diagnosis Planning Implementation Evaluation8 rights of Drug Administration:Right Patient Right Drug Right storage Right route Right dose Right preparation Right time Right recording1 pint = ____ tbsp3260 drops (gtt) = ___ tsp1Drops / minute =(mL of solution per hour or drops per mL) / 60 minTBSA calculation=(surface area [m^2] / 1.73) x average adult doseMost accurate calculation from childs drug dose:TBSAWhen drug advertisements state the indication, it must also include:contraindications, adverse effects, precautionsOTC drugs are important to note because:-they can mask the signs and symptoms of disease, making it difficult to arrive at accurate diagnosis -can interact with Rx drugs -can be taken in greater than recommended dose, leading to toxicity (Percocet is oxy + acetaminophen, if you take Percocet and tylenol, can lead to toxicity)T/F: herbal medications of alterntive therapies are not controlled or tested by the FDATrueAdvertising herbal medicine cannot include what:claims to cure, treat, diagnose, or prevent specific disease -does allow for nondisease claimsT/F: Active ingredients in alternative therapy/herbal medicine has been tested by the FDAFalseOff label use:use of a drug that was not approved by the FDAWhat is a factor that lead to an increase in home health:financial pressures to discharge a patient earlier than they would beforeWhat is the most rapidly growing response to the changes of cost in medical care deliveryHome health careRole of the nurse in response to home health care:teacher, assessor, diagnostician, patient advocateWhy should you not stop your antibiotics early to save them for the future:could lead to resistant drugsProper drug disposal:- take unused drugs out of their original containers -mix Rx with undesirable products (used coffee grounds, kitty litter, etc.) -throw these closed containers in the trash -flush them down the toilet ONLY if the drug description says so -Safest route: return them to a pharmaceutical take back locationHow are parenteral drugs administered?by injectionPeripheral IV site care-Flush the IV with normal saline using push pause method -flush atleast every 12 hours -monitor for skin reactionsWhat two fluids are used in resuscitations, and what is their tonicity?Normal Saline and Lactated Ringer -isotonicNaCl % of Normal Saline0.9%Osmosis:diffusion of water across a membrane from low solute to high solute concentration to balance solute concentrationOsmolalityhow many solutes are in that compartmentIsotonic:same solute concentration as the plasmaTonicity:the ability of a surrounding solution to cause a cell to gain or lose water (all the osmolality)Hypotonic:less solute concentration as the plasma (water move into the cell)Hypertonic:more solute concentration than the plasma (water moves out of the cell)What does D5W mean?dextrose 5% in waterWhy should topical agents not be applied to open sores or breaks in the skin?break in the skin means direct access to blood vessels, which could be toxic if its absorbed systemicallyHow do you apply topical agents?sparingly!!!How long should you wait between applications when using different solution or drops? [ophthalmic agents]5 minutesHow long should you wait between applications when using different ointments? [ophthalmic agents]10 minutes