Nursing Concepts

Pharmacology 2010

Tara Kay Race MSN, RN, CNS,

CCRN
MEDICATIONS…
What Should a NURSE Know??
 Specific Uses
 Dosages Used
 Modes of Administration
 Side Effects
 Possible Adverse Reactions
 Possible Interactions
 Ways to Monitor Effectiveness in Treating
Specific Disease Processes
5 Questions to Ask
Yourself…..
BEFORE
You Give
Medications
Question # 1
What is the Scientific
Rationale for
Administering the
Medication??
Question #2
When Should the
Administration of the
Medication be
Questioned??
Question #3
How Can the Nurse
Ensure the Safety of
the Medication
Administration??
Question #4
What are the possible
Side Effects and Possible
Adverse Reactions
Associated with a Specific
Medication??
Question #5
How can the
Effectiveness of the
Medication be
Measured??
Overview of Pharmacology

 Define
 Branches of Pharmacology
 Drug Sources
 Drug Related Terms
 Drug Nomenclature (Name)
 Legal Regulations and Standards
 Drug References
What are DRUGS????

Definition:
– Any chemical that can affect Living
Processes
– ALL Chemicals can be considered
drugs
Definition of Pharmacology

The study of drugs and their

interactions with living
systems
– Clinical Pharmacology- the study of
drugs in humans
Pharmaco-therapeutics

Definition:The use of drugs to

diagnose, prevent and treat
disease or to prevent pregnancy
Characteristics of Drugs

3 Most Important:
– Effectiveness
– Safety
– Selectivity
IDEAL DRUG
NO SUCH
THING!!!!
Therapeutic Objective

Maximum Benefit
Minimal Harm
Intensity of Drug Response
Determined by:
– Administration
– Pharmacokinetics
– Pharmacodynamics
– Individual Variations
Determination of Drug Responses
DRUG Administration is a
NURSING Responsibility

Nurses are the Last Line of

Defense in prevention of
medication errors
– Followthe 6 RIGHTS!!
– Know your responsibilities!!
Pharmacology in Patient Care

 Pre-AdministrationAssessment
 Dosage and Administration
 Evaluate and Promote Therapeutic Effects
 Minimize Adverse Effects
 Minimize Adverse Interactions
 Making PRN decisions
 Managing Toxicity
 Patient Education
Administration Factors
Dosage Size
Route
Timing
Pharmacokinetics
 Definition: How much of a drug gets to its
sites of action.
 4 Major Processes:
– Absorption
– Distribution
– Metabolism
– Excretion
Pharmacokinetics
Absorption

 Definition:
 Rate of Absorption:
 Influential Factors:
– Route of Administration
– Dissolution
– Blood Flow to the site of Administration.
– Body Surface Area
– Lipid Solubility
Trans-dermal Absorption
Oral

per os: Latin for “by way of the mouth”

2 Barriers to Cross:
1. Layer of Epithelial Cells that line the
GI Tract
2. The Capillary Wall.
Variables Affecting
ORAL Absorption

 Solubilityand Stability of the Drug

 Gastric and Intestinal pH
 Gastric Emptying Time
 Food in the Gut
 Co-administration with Other Medications
 Special Coatings on the Drug Preparations.
GI Absorption
Disadvantages to Oral Administration

 Variability of Absorption
 Inactivation of some medications by digestive
enzymes
 In-activation of the medication as it passes
through the liver (“First Pass Effect”)
 Requires a conscious cooperative patient.
 Local Irritation
Intra-muscular Administration

 Barriers
– Capillary Wall
 Advantages

 Disadvantages
Subcutaneous Administration

 Barriers
– Capillary Wall
 Advantages
 Disadvantages
Other Routes of Absorption

 Other Routes Allow for Systemic or Local effects

– Topical
– Trans-dermal
– Inhalation
– Suppositories
– Injection Directly into a Site
 Joints
 Heart
 Nerve
 CNS
Distribution

 Definition: The movement of drugs

throughout the body to their specific
site of action
– Depends on:
 Physical and Chemical Properties of the Medication and the
Individual Receiving the Medication .
– Factors influencing:
 Blood flow to the Tissues
 Ability of the Drug to Exit the Vascular System
 Ability of the Drug to Enter the Cells
Drug Movement Across Capillaries
Protein Binding for Transport
Protein Bound Drugs
Blood Brain Barrier

 Canthe Drug Cross into the Central Nervous

System??
– The Blood-Brain Barrier Prevents many drugs
from crossing to the Central Nervous System.
– Body Protective Mechanism.
Metabolism

 Definition:Biotransformation or the
enzymatic alteration of a drug structure.
 LIVER most responsible
– Hepatic Microsomal Enzyme System
P450 System- Cytochrome P450
Excretion

 Definition: Removal of the Drugs from the Body

 Kidneys most Responsible via Urine
 Other Routes of Drug Exit:
– Liver Bile Intestines Feces
– Exhaled via Lungs
– Exocrine Glands—Sweat, Breast Milk, Saliva
Organ of Excretion..The Kidney!!
Pharmaco-dynamics
 Definition:The impact of drugs on the
body- What drugs do and how they do it.
 Determines the nature and intensity of the
drugs response on the body
– Drug-Receptor Interaction
– Drug Dose Relationships
– Plasma Drug Levels
Individual Variations
Everyindividual body is
UNIQUE!
– Physiological Variables
– Pathological Variables
– Genetic Variables
Drug Dose Responses

 GOAL: Constant Blood Level with in a Safe

Therapeutic Range
 Terms:
– Minimal Effective Concentration (MEC)
– Toxic Concentration
– Therapeutic Range
Therapeutic Index
Serum Half-Life

 Definition: The time required for the amount

of drug in the body to decrease by 50%.

 Determines the dosing interval

Dose Responses Continued….

Onset:
Peak:
Trough:
Duration:
Plateau:
Effects of Drugs on Fetal Development
Pharmaco-therapeutics
 Definition: Using Drugs to diagnose, prevent
or treat a disease or to prevent pregnancy

YOU MUST KNOW WHY YOUR

PATIENT IS TAKING A
MEDICATION!!!!!
Type of Medication Action

 What is the drug supposed to do???

 The same drug can have many Therapeutic
Effects/Actions…
 Example: Aspirin (ASA):
– Inflammation
– Fever Reduction
– Pain
– Anti-platelet Aggregation
Why is your patient taking it???
Adverse Reactions to Medication

 Definition:Un-intended, un-desired effect

when the drug is given at normal doses.
 More common in the elderly and very young
patients
 Range: Mild (itching) to SEVERE (coma or
DEATH!!)
Adverse Drug Reactions

Side Effects:
Toxicity:
Allergic Reaction:
Allergic Reaction
 Immune (antigen-antibody) response to a
drug to which the patient was previously
exposed or sensitized
 Mild to SEVERE—can result in DEATH!!
 Required immediate intervention.
Physical Dependence
Definition: The state in which the body
has adapted to prolonged drug
exposure in such a way that an
abstinence syndrome (WITHDRAWAL)
will result if the drug is discontinued.
Tolerance
Definition: Experiencing a
decreased response to a drug as a
result of repeated drug
administration
Psychological Dependence

Definition: The desire for the

effects of a drug.
Carcinogenic Effects
Definition:The ability of certain
medications and environmental
chemicals to alter body cells and
cause a variety of cancers
Other Drug Adversities

 Teratogenicity
 Iatrogenicity
 Hepatotoxicity
 Nephrotoxicity
 Hematologic Effects
 Idiosyncrasy
 Individual Variation:
EVERY BODY is DIFFERENT

 Age
 Gender
 Race
 Body Weight and Composition
 Pathophysiology
– Liver Disease
– Kidney Disease
– Acid Base Balance
– Electrolyte Imbalance
Renal Insufficiency Effects
pH Effects on Plasma Drug Levels
Medication Interactions
 Drug-Drug Interactions: When one
medication alters the effects of another
medication

 Drug-Food Interactions: Food can increase

or decrease the rate of drug absorption.
Drug-Drug Interactions

 Additive Effects
 Synergism or Potentiating
 Interference
 Displacement
 Antagonism
 Incompatibility
FOOD-DRUG Interactions

 Food slows the absorption of most Drugs

 Thyramine/MAO Inhibitors
 Vitamin K containing Foods/Warfarin (Coumadin)
 Tetracycline/Dairy Products
 Grapefruit Juice/ Many Drugs esp. Calcium
Channel Blockers
 Iron/Acidic Foods
 Herbs and Food Supplements
Legislation and Regulations

 Federal Drug Administration (FDA):

 Federal Pure Food and Drug Act of 1906
 Food Drug and Cosmetic Act of 1938
 Harris-Kefauver Amendments to the Food,
Drug and Cosmetic Act in 1962
 Controlled Substances Act of 1970
Legislation and Regulations
Continued…

 1992- FDA Permits accelerated approval of Drugs for

AIDS and Cancer
 1992-The Prescription Drug User Fee Act
 1997- Food and Drug Administration Modernization Act
 2002- The Best Pharmaceuticals for Children Act
 2003- Pediatric Research Equity
 2007- FDA Amendments Act
New Drug Development

 Expensive
 Lengthy
Process—6-12 years
 Randomized Control Trials
– Most reliable and objective way to assess drugs
– Use of Controls
– Randomizations
– Blinding
What’s in a NAME???

Chemical Name
Generic Name
– Non-proprietary
Trade name:
– Trademarked the medication’s name
(Tylenol™)
Nursing Responsibilities!!

 ACCURATELY COMMUNICATE!!!!
 Know the compound names being referred to by
the Generic and Trade Names. .
 Be able to recognize names of medications
and interrelate them.
Drug Resources

 How and Where Do I get my

Information??
– Published Information:
– Clinicians and Pharmacists- call the Pharmacy
--DO NOT BE AFRAID TO CALL!
– Poison Control Centers
– Pharmaceutical Sales Representatives:
Remember they may be biased; They are
SALES people NOT educators; may not tell
the negatives
End Pharmacology
Part I

Thank you!!!
Any Questions????