introduction to pharmacology in nursing

INTRODUCTION TO PHARMACOLOGY  DEFINITION:  Pharmacology is the science that deals with the study of drugs and their interaction with the living systems.  The word Pharmacology is derived from Greek – pharmacon means drug and logos means study.  DRUG:  Drug is a substance used in the diagnosis ,prevention or treatment of disease.  PHARMACOKINECTICS:  Pharmacokinectics is the study of the absorption distribution ,metabolism and excretion of drugs,i.e what the body does the drug (in greek kinesis = movement).
3. INTRODUCTION TO PHARMACOLOGY  DEFINITION:  PHARMACODYNAMICS :  Pharmacodynamics is the study of the effect of the drugs on the body and their mechanism of action ,i.e what the drug does the body.  THERAPEUTICS:  Therapeutics deals with the use of drugs in the prevention and treatment of disease.  TOXICOLOGY :  Toxicology deals with the adverse effect of the drug and also the study of poisons,i.e detection ,prevention and treatment of poisoning.(Toxicon =poison in greek.
4. INTRODUCTION TO PHARMACOLOGY  CHEMOTHERAPHY :  Chemotheraphy is the use of chemicals for the treatment of infections.the term now also includes the use of chemical to treate malignancies.  PHARMACY :  Pharmacy is the science of identification , compounding and dispensing of drugs .It also includes collection , isolation, purification , synthesis and Standardization of medical substances.   
5. SOURCES OF DRUGS  The sources of drugs could be natural or synthetic ,  NATURAL SOURCES:  1.PLANTS,e.g Atropine ,Morphine ,Quinine ,digoxine,pilocarpine,physostigmine.  2.ANIMALS e.g . Insulin ,heparin ,gonadotrophins and antitoxic sera.  3.MINERALS,Magnesium sulphate , Aluminium hydroxide ,iron ,sulphur and radio active isotopes.  4.MICROORGANISMS ,Antibacterial agents are obtained from some bacteria and fungi.we thus have pencillins,cephalosporins,tetracycline and other antibiotics.
6. SOURCES OF DRUGS  5.HUMAN: some drugs are obtained from man ,e.g  Immunoglobulin from blood,growth hormone from anterior pituitary and chorionic gonadotrophins from the urine of pregnant woman.  SYNTHETIC :  Most drugs are now synthesized .e.g quinolones,omeprazole,sulfonamides,pancuronium,neostigmi ne.  Many drugs are obtained from cell culture ,e.g urokinase from cultured kidney cells.  some are now produced by recombinant DNA technology ,e.g human insulin, tissue plasmogen activator and some drugs by Hybridoma technique, e.g monoclonal antibodies.
7. ROUTES OF DRUG ADMINISTRATION  Drugs may be administered by various routes .the choice of the route in a given patient depends on the properties of the drug and the patients requirements.A knowledge of advantage and disadvantage of the routes of drug administration is essential.  The route can be broadly divided into:  Enteral  Parenteral  Local
8. ENTERAL ROUTE (ORAL INGESTION )  This is the most common ,oldest and safest routes of drug administration. the large surface area of the GI ,the mixing of its content

1. MS VARSHA S. Ass. Professor

2. Objective Upon completion of the topic the health care professionals understands the importance of safe administration of medications and appreciate the kn o w led g e about th e actio n s and ef f ects of medications to safely and accurately administer medicati o n s and unders tands about pha r ma c ol o gic principles.

3. Co n t e n ts Introduction to pharmacology Definitions Sources T er m i n olo g y used Route of drug administration Types: Classification Pharmacodynamics: Actions, therapeutic Adverse, toxic Pharmacokinetics : absorption, distribution, metabolism, interaction, excretion Review: Routes and principles of administration of drugs Indian pharmacopoeia : Legal issues Rational use of drugs Principles of therapeutics

4. Introduction Pharma c ol o g y i s th e st u d y of drug s i n cludin g their origins, history, uses, and properties. The word pharmacology comes from the Greek words pharmakos , meaning medicine or drug, and logos , meaning study. Drug therapy plays a major role in the treatment of patients. It involves the use of drugs to prevent, diagnose or cure disease processes or to relieve signs and symptoms without curin g th e unde rl y i n g disease.

5. Definitions Pharmacology is the scientific study of the effects of drugs and chemicals on living organisms where a drug can be broadly defined as any chemical substance, natural or synthetic, which affects a biological system . Pharmacology is the science that deals with the study of drugs and their interactions with the living system . Pharmacology is the science that deals with drugs, their sources, nature and properties.

6. TERMINOLOGY DRUG: Any substance, which is synthetic, semisynthetic, natural or biotechnological used for diagnosis, prevention, treatment or cure of a diseases or disorder is known as drug. Pharmacodynamics: it is a branch of pharmacology, which deals with the effects of drugs on the different body system and includes mechanism of action of drugs at the molecular, cellular and organ level. Pharmacokinetics : it is a branch of pharmacology, which deals with the journey or movement of drug in, through and out from the body. Pharmacy: It is a branch of medical science, which deals with compounding and dispensing of drugs. Its includes collection, identification, purification, isolation, synthesis, standardization and quality control of medicinal substances.

7. SOURCES OF DRUGS 1 Natural Sources - Plants - Animals and human Microorganisms Heavy metals, minerals and mineral oils 2. Synthetic and Semi-Synthetic Sources 3.Engineered Sources/ Biosynthetic sources

8. Sources of drugs Drugs are substances that are used or intended to be used in the diagnosis, prevention, treatment or cure of diseases. The major sources of drugs can be grouped into the following; 1. Plant Sources plant source for drugs are the leaf and other parts of plants (e.g., barks, fruits, roots, stem, wood, seeds, blossoms, bulb etc.) Pl a nt part Leaves Fl ow ers Fruits Seeds R oots B a r k S t em Drugs Digoxin, digitoxin (from Digitalis purpurea /foxglove plant); atropine (from Atropa belladonna ) Vincristine, vinblastine (from Vinca rosea ) Physostigmine (from Physostigma venenosum /calabar bean) Strychnine (from Nux vomica ); physostigmine (from Physostigma venenosum /calabar bean) Emetine (from Cephaelis ipecacuanha ); reserpine (from Rauwolfa serpentina ) Quinine (from Cinchona ); atropine (from Atropa belladonna ) Tubocurarine (from Chondrodendron tomentosum )

9. 2. Animal Sources Medicinal substances are derived from the animal’s body secretions, fluid or glands. Insulin , heparin, adrenaline, t h y r o xin , c od l i v er oil, m usk , b ees w ax, enzy m e s , and antitoxins sera are some examples of drugs obtained from animal sources . 3. Microbial sources Several life-saving drugs have been historically derived from microorganisms. Examples include penicillin produced by Penicillium chrysogenum , streptomycin from Streptomyces griseus , .

10. 4. Marine source Bioactive compounds from marine flora and fauna have extensive past and present use in the prevention, treatment or cure of many diseases. Coral , sponges, fish, and marine microorganisms produce biologically potent chemicals with interesting anti-inflammatory, anti-viral, and anticancer activity . 5. Mineral sources Minerals (both metallic and non-metallic minerals) have been used as drugs since ancient times. Examples include ferrous sulfate in iron deficiency anemia; magnesium sulfate as purgative ; M agnesium trisilicate, aluminum hydroxide and sodium bicarbonate as antacids for hyperacidity and peptic ulcer; Z inc oxide ointment as skin protectant, in wounds and eczema; G old salts (solganal, auranofin) as anti- inflammatory and I n rheumatoid arthritis; selenium as anti-dandruff.

11. 6. Synthetic/chemical derivative A synthetic drug is produced using chemical synthesis, which rearranges chemical derivatives to form a new compound. E x amples i n clud e a c et y lsali c y lic acid (as p ir i n or ASA), oral antidiabetics, antihistamines, thiazide diuretics, chloroquine, chlorpromazine, general and local anaesthetics, paracetamol , phenytoin etc.

12. 7. Semi-synthetic Sources Semi-synthetic drugs are neither completely natural nor completely synthetic. They are a hybrid and are generally made by chemically modifying substances that are available from natural source to improve its potency, efficacy and/or reduce side effects. Examples of semi-synthetic medicine include heroin from morphine, bromoscopolamine from scopolamine, homatropine from atropine, ampicillin from penicillin etc.

13. 8. Biosynthetic sources (genetically engineered drugs) This is relatively a new field which is being developed by mixing discoveries from molecular biology, recombinant DNA technology, DNA alteration, gene splicing, immunology, and immune pharmacology. Drugs developed using living organisms with the help of biotechnology or genetic engineering are known as biologics, biopharmaceuticals, recombinant DNA expressed products, bioengineered, or genetically engineered drugs Examples include recombinant Hepatitis B vaccine, recombinant insulin and others.

14. SYSTEM OF MEASUREMENT APOTHECARY SYSTEM METRIC SYSTEM HOUSEHOLD SYSTEM

15. APOTHECARY SYSTEM It is the oldest system of measurement. This system was based on arbitrary units and later on replaced by metric system. METRIC SYSTEM Invented in France. It includes gram and liter as basic units. Arabic numerals, fraction and decimal were also included.

16. Household system This is household methods for measuring liquid item. The accuracy is not established for measuring medicine and other products but it is still in use.

17. Medication Forms Solid : Powders Tablet Granules Capsule s Cachets Pills Lozenges Suppositories Poultices

18. Solid form Powders : it contains finelty divided particles in micron size of drugs Tablet: it contains medicaments with or excipients Granules: aggregate of particles of drugs Capsules: drugs enclosed with cylindrical gelatin containers, which alter the taste of drug . Cachets: drugs enclosed with wafer sheet of rice Pills : small t ablet containing excipients Lozenges : it contain sugar and gum used to medicate mouth and throat . Suppositories : it contain medicament with suitable suppository base that inserted into the body cavities . Poultices : solid dosage form converted to paste like prepration used externally in the skin to reduce inflammation.

19. Medication Forms Semisolid Solid : Ointments Creams Paste Gels Poultices

20. Semisolid Solid : Ointments : semisolid dosage forms for external use containing with or without medicaments with suitable ointment base. Creams: semisolid dosage forms external use containing with or without medicaments with suitable fatty base. Paste: semisolid dosage forms for external use containing high proportion of powered medicaments with suitable fatty base. Gels: transparent semisolid dosage forms for external use containing hydrophillic and hydrophobic base with gelling agents Poultices: for external use containing medicaments applied to the skin to hold the dressing and protective.

21. Medication Forms Liquid dosage: Collodions Droughts Exlixirs Emulsions Suspensions Enemas Gargles Gels Linctuses Liniments Mixtures Mouth washes

22. Liquid dosage : Collodions : liquid prepration for external use having nitro cellulose used to protect the skin. Droughts : liquid preparation for oral containing medicaments available in single dose or multiple doses. Exlixirs ; Emulsions Suspensions Enemas Gargles Gels

23. Medication Forms Liquid : Nasal drops Paints Solutions Syrups Gaseous 1 Aerosol 2. Inhalations 3. Sprays

24. Pharmacological Concepts: Classification A medication may also be part of more than one class Aspirin is an analgesic, antipyretic, anti-inflammatory, and anti-platelet

25. Pharmacological concepts: Medication forms Medications are available in a variety of forms and preparations The form of the med will determine its route of administration Composition of med is designed to enhance its absorption & metabolism Many meds are available in several forms

26. ROUTE OF DRUG ADMINISTRATION

27. Pharmacologic Principles Pharmaceutics Pharmacokinetics Pharmacodynamics Pharmacotherapeutics Pharmacognosy

28. Pharmaceutics The study of how various drug forms influence pharmacokinetic and pharmacodynamic activities

29. Pharma c okin e tics Th e s t u d y of w hat t h e bo d y doe s t o t h e dr u g Absorption Distribution Metabolism Excretion

30. Pharmacokinetics: Absorption The rate at which a drug leaves its site of administration, and the extent to which absorption occurs Bioavailability Bioequivalent

31. Factors That Affect Absorption A dminist r ation r ou t e of th e drug Ability of Med to Dissolve Food or fluids administered with the drug Body Surface Area Status of the absorptive surface Rate of blood flow to the small intestine Lipid Solubility of Med Status of GI motility

32. Routes of Administration A drug’s route of administration affects the rate and extent of absorption of that drug Enteral (GI tract ) (oral): Drug is absorbed into the systemic circulation through the oral or gastric mucosa, the small intestine, or rectum Subcutaneous : the drug are deposited in the vicinity of capillaries and absorption occur through the large paracellula r space around the capillaries. large molecule of drug not absorb through capillaries

33. Conti… Intramuscular : the absorption Is faster than sc and more consistent. The muscular exercise and application of heat at the site increase the rate of absorption. Intravenous : here the drug is directly put into the circulation and within no time the drug circulate throughout the body.

34. Di s tribution The transport of a drug in the body by the bloodstream to its site of action Protein-binding W a t er so l ubl e v s . fat so l uble Blood-brain barrier Areas of rapid distribution: heart, liver, kidneys, brain Areas of slow distribution: muscle, skin, fat

35. The distribution of drug depends upon the following factors. Lipid solubility Lipid water partition coefficient Ionization at physiological pH extent of binding to plasma and tissue proteins Differences in regional blood flow Diseases renal failure, liver failure, heart failure.

36. Metabolism/Biotransformation (cont'd) Delayed drug metabolism results in: Accumulation of drugs Prolonged action of the drugs Stimulating drug metabolism causes: Diminished pharmacologic effects

37. Metabolism (Also Known As Biotransformation) The biologic transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite Liver (main organ) Kidneys Lungs Plasma Intestinal mucosa

38. EFFECTS OF METABOLISM Inactivation of the active drugs: drug are made inactive or less active. Ex : Paracetamol Activation of inactive drug: some drugs needs conversion in the body to active form and are inactive as such drug called prodrug . EX : Acyclovir- Acyclovir triphosphate Active metabolites formation from an active drug: some drugs are active even after their conversion to their metabolites. These metabolism can also act as the original drug. These are called active metabolites.

39. Types of metabolism reactions Non-synthetic/ phase I reactions: A functional group is generated or exposed metabolite may be active or inactive. The non-synthetic reaction involve oxidations, reduction, 2. Synthetic / phase I reactions: here the drug or its phase I metabolites are conjugated with an endogenously derived substrate to form an easily excretable substance. This reaction requires energy. Its involve: glucuronide conjugation, acetylation, methylation.

40. Excretion The elimination of drugs from the body Kidneys (main organ) Liver Bowel Bilia r y e x c r et i on Enterohepatic circulation

41. Pharmaco dynamics The study of what the drug does to the body – The mechanism of drug actions in living tissues

42. Figure 2-2 Phases of Drug Activity. (From McKenry LM, Salerno E: Mosby’s pharmacology in nursing—revised and updated, ed 21, St. Louis, 2003, Mosby.)

43. Pharma c othe r apeut i cs The use of drugs and the clinical i n dicat i o n s f or drug s t o p r e v ent and treat diseases

44. Pharmacognosy The study of natural (plant and animal) drug sources

45. Pharmacodynamics Study of the mechanism of drug actions in living tissue Drug-induced alterations to normal physiologic function Positive change-Therapeutic effect-Goal of therapy

46. Mechanism of Action Ways in which a drug can produce a therapeutic effect The effects that a particular drug has depends on the c ells or o r gan ta r g e t ed b y th e drug Once the drug hits its “site of action” it can modify the rate at which a cell or tissue functions

47. Mechanism of Action Receptor Interaction Enzyme Interaction Non-Specific Interaction

48. Receptor Interaction Drug structure is essential Involves the selective joining of drug molecule with a reactive site on the cell surface that elicits a biological effect Receptor is the reactive site on a cell or tissue Once the substance binds to and interacts with the receptor, a pharmacologic response is produced

49. Receptor Interaction Affinity- degree to which a drug binds with a receptor The drug with the best “fit” or affinity will elicit the best response Drug can mimic body’s endogenous substances tha t normal l y bin d t o r e c ep t or si t e Drugs that bind to receptors interact with receptors in different ways to either block or elicit a response

50. Receptor Interaction Agonist-Drug binds to receptor-there is a response (Adrenergic Agents) Antagonist-drug binds to receptor-no response- prevents binding of agonists (Alpha & Beta Blockers)

51. Enzyme Interaction Enzymes are substances that catalyze nearly every biochemical reaction in a cell Drugs can interact with enzyme systems to alter a response Inhibits action of enzymes-enzyme is “fooled” into binding to drug instead of target cell Protects target cell from enzyme’s action (ACE Inhibitors)

52. Non-Specific Interaction Not involving a receptor site or alteration in enzyme function M ain si t e of a c tio n i s c ell m e mb r ane or c ellular process Drugs will physically interfere or chemically alter cell process Final product is altered causing defect or cell death Can c er drug s , Antibiotics

53. The nurse is giving a medication that has a high first-pass effect. The physician has changed the route from IV to PO. The nurse expects the oral dose to be: Higher because of the first-pass effect. Lower because of the first-pass effect. The same as the IV dose. Unchanged.

54. Type of Medication Action Therapeutic Effect Side Effects Adverse Effects T o xi c Ef f e c t Idiosyncratic Reactions Allergic Reaction Medication Interactions Iatrogenic Response

55. Therapeutic Effect The expected or predictable physiological response a medication causes A sin g le me d ca n h a v e se v e r al the r a p eu t i c ef f ects (Aspirin) It is important for the nurse to know why med is being prescribed

56. Side Effects Unintended secondary effects a medication predictably will cause May be harmless or serious If side effects are serious enough to negate the beneficial effect of meds therapeutic action, it may be D/C’d People may stop taking medications because of the side effects

57. Adverse Effects Undesirable response of a medication Unexpected effects of drug not related to therapeutic effect Must be reported to FDA Can be a side effect or a harmful effect Can be categorized as pharmacologic, idiosyncratic, hypersensitivity, or drug interaction

58. Adverse Effects Adverse Drug Events Adverse Drug Reactions (ADR)

59. Toxic Effect n May develop after prolonged intake or when a med accumulates in the blood because of impaired metabolism or excretion, or excessive amount taken Toxic levels of opioids can cause resp.depressio Antidotes available to reverse effects

60. Idiosyncratic Reactions Unpredictable effects-overreacts or under reacts to a medication or has a reaction different from normal Genetically determined abnormal response Idiosyncratic drug reactions are usually caused by abnormal levels of drug-metabolizing enzymes (de f ic i e n c y or o v e r ab u nda n c e)

61. Allergic Reaction Unpredictable response to a medication Makes up greater than 10% of all medication reactions Client may become sensitized immunologically to the initial dose, repeated administration causes an allergic response to the med, chemical preservative or a metabolite

62. Allergic Reaction Medication acts as an antigen triggering the release of the body’s antibodies May be mild or severe Among the different classes of meds, antibiotics cause the highest incidence of allergic reaction Severe reaction-Anaphylactic reaction Mild reaction-hives, rash, pruritis

63. Other Drug Reactions Teratogenic-Structural effect in unborn fetus (thalidomide) Carcinogenic-Causes cancer Mutagenic- Changes genetic composition (radiation, chemicals)

64. Drug Interactions Occurs when one med modifies the action of another Common in people taking several medications at once O n e me d m a y p o t entia t e or dimi n is h th e action of another or alter the way it is absorbed, metabolized or eliminated Warfarin and Amiodarone

65. Iatrogenic Responses U nin t entional a d v erse ef f e c t s tha t o c c ur during therapy Treatment-Induced Dermatologic-rash, hives, acne Renal Damage-Aminoglycoside antibiotics, NSAIDS, contrast medium Blood Dyscrasias- Destruction of blood cells (Chemotherapy) Hepatic Toxicity-Elevated liver enzymes (hepatitis- like symptoms)

66. Synergistic Effect Effect of 2 meds combined is greater than the meds given separately Alcohol & Antihistamines, antidepressants, barbiturates, narcotics Not always undesirable, physician may combine meds to create an interaction that will have beneficial effects (Vasodilators & diuretics to control high BP)

67. Medication Dose Responses Except when administered IV, meds take time to enter bloodstream The quantity & distribution of med in different body compartments change constantly Goal is to keep constant blood level within a safe therapeutic range Repeated doses are required to achieve a constant therapeutic concentration of a med because a portion of med is always being excreted

68. Medication Dose Responses Serum Half-Life:Time it takes for excretion processes to lower the serum medication concentration by ½ Regular fixed doses must be given to maintain therapeutic concentration Dosage schedules set by institutions (TID, q8h, HS, AC, STAT, PRN) Peak & Trough levels Therapeutic drug monitoring

69. Half-life The time it takes for one half of the original amount of a drug in the body to be removed A measure of the rate at which drugs are removed from the body

70. Onset, Peak, and Duration Onset The time it takes for the drug to elicit a therapeutic response Peak Th e tim e i t ta k es f or a dru g t o r ea c h i t s maximum therapeutic response Duration The time a drug concentration is sufficient to elicit a therapeutic response

71. Pharmaco therapeutics: Types of Therapies A cu t e the r a p y Maintenance therapy Supplemental therapy Palliative therapy Supportive therapy Prophylactic therapy Empiric therapy

72. Moni t oring The effectiveness of the drug therapy must be evaluated O n e m u st b e famil i ar with th e drug ’ s: In t en d ed the r apeutic action (be n e f icial) Unintended but potential side effects (predictable, adverse reactions)

73. Monitoring (cont'd) Therapeutic index – The ratio between a drug’s therapeutic be n e f it s and it s t o xi c ef f e c ts

74. Monitoring (cont'd) Tolerance – A decreasing response to repetitive drug doses

75. Monitoring (cont'd) Dependence – A p h y sio l ogic or p s y chologica l n e ed f or a drug

76. Monitoring (cont'd) Interactions may occur with other drugs or food Drug interactions: the alteration of action of a drug by: Other prescribed drugs Over-the-counter medications Herbal therapies

77. Monitoring (cont'd) Drug interactions A ddit i v e ef f e c t S yn e r gis t i c ef f e c t Anta g onistic ef f e c t Incompatibility

78. Monitoring (cont'd) Medication misadventures A d v erse dru g e v ents A d v erse dru g r eact i o n s Medication errors

79. Monitoring (cont'd) Some adverse drug reactions are classified as side effects Expected, well-known reactions that result in little or no change in patient management Predictable frequency The effect’s intensity and occurrence are related to the size of the dose

80. Adverse Drug Reaction An adverse outcome of drug therapy in which a patient is harmed in some way Pharmacologic reactions Idiosyncratic reactions Hypersensitivity reactions Drug interactions

81. Other Drug-Related Effects Teratogenic Mutagenic Carcinogenic

82. Toxicology The study of poisons and unwanted responses to therapeutic agents

83. e 2 9 mon Poisons and Antidotes

84. INDIAN PHARMACOPOEIA The Indian Pharmacopoeia (IP) is a compilation of official standards for drugs manufactured in India. Standards in the IP are expressed in the form of spe c i f ic a tio n s a n d t est method s f or de t ermi n i n g c ompl i an c e with such standa r d s . The pharmacopoeias or formularies contain a list of drugs and other related substances regarding their source, descriptions, standards, tests, formulae for preparing the same, action and uses, doses, storage conditions etc

85. Indian Pharmacopoeia (IP) is published by the Indian Pharmacopoeia Commission (IPC) on behalf of the Ministry of Health & Family Welfare, Government of India in fulfillment of the requirements of the Drugs and Cosmetics Act, 1940 and Rules 1945 there under. IP is recognized as the official book of standards for the drugs being manufactured and/or marketed in India. IP contains a collection of authoritative procedures of analysis and specifications of drugs for their identity, purity and strength. The standards of the IP are authoritative in nature and are en f o r c ed b y th e r eg ula t o r y authori t i es f or ensur i n g the q uality of dru gs i n In d ia . Dur i n g q uality assu r an c e and at the time of dispute in the court of law the IP standards are legally acceptable.

86. 1946- Indian Pharmacopoeial List was published by Govt. of India. 1955 -First edition of Indian Pharmacopoeia was published. 1960 -Supplement of IP 1955 was published. 1966 - Second edition of IP was published. 1 9 7 5 -Su p p l e m e n t of IP 1 96 6 w as p u blished. 1985- Third edition of IP was published. 1989 -Addendum-I to IP 1985 was published. 1991 -Addendum-II to IP 1985 was published. 1996 -Fourth edition of IP was published followed by its addendum 2000, supplement 2000 for Veterinary Products, addendum 2002 and addendum 2005; Indian Pharmacopoeia 2007 - Fifth edition, followed by addendum 2008; Indian Pharmacopoeia 2010 - Six edition with DVD followed by its addendum 2012; Indian Pharmacopoeia 2014 – Seventh edition with DVD followed by its addendum 2015 and addendum 2016; Indian Pharmacopoeia 2018 with DVD - Eighth edition

87. Medication Misadventures Medication errors (MEs) Adverse drug events (ADEs) A d v erse dru g r eactio n s (ADRs)

88. Medication Misadventures (cont'd) By definition, all ADRs are also ADEs B ut all AD E s a r e no t ADRs T w o type s of ADRs Alle r g i c r eact i o n s Idiosyncratic reactions

89. M e • P d r e i v c e a n t t a b i l o e n Er r o r s Common cause of adverse health care outcomes Effects can range from no significant effect to directly causing disability or death

90. Box 5-1 Common classes of medications involved in serious errors

91. Preventing Medication Errors M i n i mi z e v e r ba l or t elepho n e o r ders Repeat order to prescriber Spell drug name aloud Speak slowly and clearly List i n di c ati o n n ext t o each o r der Avoid medical shorthand, including abbreviations and acronyms

92. P r e v e n ting Medi c a tion Er r o r s (cont'd) N e v er assu m e a n ythin g about i t ems n o t specified in a drug order (i.e., route) Do not hesitate to question a medication order f or a n y r eason w hen i n doubt Do not try to decipher illegibly written orders; c o n tac t p r escr i be r f or clar i f ic a tion

93. P r e v e n ting Medi c a tion Er r o r s ( c o n t'd) NEVER use “trailing zeros” with medication orders Do not use 1.0 mg; use 1 mg 1.0 mg could be misread as 10 mg, resulting in a tenfold dose increase

94. P r e v e n ting Medi c a tion Er r o r s (cont'd) ALWAYS use a “leading zero” for decimal dosages Do not use .25 mg; use 0.25 mg .25 mg may be misread as 25 mg “.25” is sometimes called a “naked decimal”

95. Preventing Medication Errors (cont'd) Check medication order and what is available while using the “5 rights” Take time to learn special administration techniques of certain dosage forms

96. Preventing Medication Errors (cont'd) Always listen to and honor any concerns expressed by patients regarding medications Check patient allergies and identification Medication Reconciliation

97. Medication Errors Medication error has the potential to lead to harm to the patient. It is the leading cause of threatens trust in the healthcare system, induce corrective therapy, and prolong patients’ hospitalization, produces extra costs and even death. P ossible c o n seq u en c es t o nurses Reporting and responding to MEs ADE monitoring programs USPMERP (United States Pharmacopeia Medication Errors Reporting Program) MedWatch, sponsored by the FDA Institute for Safe Medication Practices (ISMP) Notification of patient regarding MEs

98. Administer medications safely