NURSING PHARMACOLOGY Introduction only..

Nursing pharma

1. NURSING PHARMACOLOGY Irene Cheeries A. Enriquez, RN, MN

2. Introduction Nurses need to have knowledge about the actions and effects of medications „To safely and accurately administer medications, nurses need to have an understanding of pharmacologic principles Irene Cheeries A. Enriquez

3. Pharmacology Basics „Pharmacology is the scientific study of the origin, nature, chemistry, effects, and uses of drugs. „ „This knowledge is essential to providing safe and accurate medication administration to your patients. Irene Cheeries A. Enriquez

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5. Naming and Classifying Drugs 8 Drugs have a specific kind of nomenclature—that is, a drug can go by three different names: • The chemical name is a scientific name that precisely describes the drug’s atomic and molecular structure. • The generic, or nonproprietary, name is an abbreviation of the chemical name. • The trade name (also known as the brand name or proprietary name) is selected by the drug company selling the product. Irene Cheeries A. Enriquez

6. Trade names are protected by copyright. The symbol ® after a trade name indicates that the name is registered by and restricted to the drug manufacturer. To avoid confusion, it’s best to use a drug’s generic name because any one drug can have a number of trade names. Irene Cheeries A. Enriquez

7. Naming and Classifying Drugs Chemical name „Describes the drug’s chemical composition and molecular structure Generic name (nonproprietary name) „Name given by the BFAD (Bureau of Food and Drug) Trade name (proprietary name) „The drug has a registered trademark; use of the name restricted by the drug’s patent owner (usually the manufacturer) Irene Cheeries A. Enriquez

8. Example: Irene Cheeries A. Enriquez Chemical name (+/-)-2-(p-isobutylphenyl) propionic acid Generic name Ibuprofen Trade name Motrin®, Advil®

9. Naming and Classifying Drugs „Drugs that share similar characteristics are grouped together as a pharmacologic class (or family) or the mechanism of action or what the drug does on the molecular level . „A second type of drug grouping is the therapeutic class, which categorizes drugs by therapeutic use or the physiological changed induced by the drug. Irene Cheeries A. Enriquez

10. Pharmacologic Class - describes the specific thing the drug does on the molecular level in order to illicit the physiological effect „Beta-adrenergic blockers – inhibit proteins that receive epinephrine (adrenaline) which slows heartbeat and lowers blood pressure Irene Cheeries A. Enriquez

11. Naming and Classifying Drugs Therapeutic Classification „Anticoagulants – help prevent blood clots „Antihyperlipidemics – lower blood-cholesterol levels „Antihypertensives – lower blood pressure „Antidysrhythmics/antiarrhythmics – treat an abnormal heart beat Describes the clinical purpose or physiological change induced by the drug and does not describe anything about the way the drug achieves this change. Irene Cheeries A. Enriquez

12. Pharmaceutics Pharmacokinetics Pharmacotherapeutics Pharmacodynamics Pharmacognosy Irene Cheeries A. Enriquez The study of how various drug forms influence pharmacokinetic and pharmacodynamic activities The study of what the body does to the drug: Absorption, Distribution, Metabolism, Excretion The interaction at the cellular level between a drug and cellular components, such as the complex proteins that make up the cell membrane, enzymes, or target receptors, represents drug action. The response resulting from this drug action is called the drug effect. When choosing a drug to treat a particular condition, health care providers consider the drug’s effectiveness as well as such factors as the type of therapy the patient will receive. The study of natural (plant and animal) drug sources

13. Enteral vs Parenteral Irene Cheeries A. Enriquez

14. „Gastric The gastric route allows direct administration of a drug into the GI system. This route is used when patients can’t ingest the drug orally. Irene Cheeries A. Enriquez

15. Intradermal In intradermal administration, drugs are injected into the skin. A needle is inserted at a 10- to 15-degree angle so that it punctures only the skin’s surface. This form of administration is used mainly for diagnostic purposes, such as testing for allergies or tuberculosis Irene Cheeries A. Enriquez

16. Intramuscular The IM route allows drugs to be injected directly into various muscle groups at varying tissue depths. This form of administration provides rapid systemic action and allows for absorption of relatively large doses (up to 3 mL). Aqueous suspensions and solutions in oil as well as drugs that aren’t available in oral forms are given IM Irene Cheeries A. Enriquez

17. Subcutaneous In subcutaneous (subcut) administration, small amounts of a drug are injected beneath the dermis and into the subcutaneous tissue, usually in the patient’s upper arm, thigh, or abdomen. This allows the drug to move into the bloodstream more rapidly than if given by mouth. Drugs given by the subcutaneous route include nonirritating aqueous solutions and suspensions contained in up to 1 mL of fluid, such as heparin and insulin. Irene Cheeries A. Enriquez

18. The IV route allows injection of drugs and other substances directly into the bloodstream through a vein. Appropriate substances to administer IV include drugs, fluids, blood or blood products, and diagnostic contrast agents. Administration can range from a single dose to an ongoing infusion that’s delivered with great precision. Intravenous Irene Cheeries A. Enriquez

19. Specific types of infusions include: epidural—injected into the epidural space intrapleural—injected into the pleural cavity intraperitoneal—injected into the peritoneal cavity intraosseous—injected into the rich vascular network of a long bone intra-articular—injected into a joint. Irene Cheeries A. Enriquez

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21. „Medications are available in a variety of forms and preparations „The form of the medication will determine its route of administration „Composition of medication is designed to enhance its absorption and metabolism „Many medicines are available in several forms Tablet Capsule Elixir Enteric-coated Suppository Suspension Topical Transdermal patch Inhalation Irene Cheeries A. Enriquez

22. Buccal tablets Effervescent tablets Chewable tablets Coated tablets Compressed tablets Conventional tablets Throat lozenge Convertible tablets Tablet triturates Uncoated tablet Irene Cheeries A. Enriquez

23. There are two main types of capsules: hard shelled and soft gel Irene Cheeries A. Enriquez

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27. Irene Cheeries A. Enriquez • Hand-held pressurized containers deliver a measured dose of medication with each “puff.” • Dosing may require two “puffs”—patient should wait 1 minute between “puffs.” • A spacer device may be used to increase the delivery of medication and to decrease medication deposited in mouth and throat. Pediatric patients often require the spacer. • Requires “hand-lung coordination”—patient should exhale and, on beginning of inhalation, activate the MDI. • Patient should hold his or her breath for approximately 10 seconds after inhalation. Metered-Dose Inhaler (MDI)

28. Irene Cheeries A. Enriquez • Each medication comes with a delivery system. Medication should be administered only with delivery system provided. No aerosol propellant is used. • Capsules and tablets are to be administered by inhalation only; medications are not to be taken by mouth. • Delivery system crushes medication to a fine powder to be inhaled. • After system is loaded, teach patient to cover mouthpiece and inhale deeply. • Compared with MDIs, medication delivery is significantly more efficient. Dry Powder Inhaler

29. Irene Cheeries A. Enriquez • A small machine converts a medication solution to a nebulized or mist form. • Prescribed amount of medication is added to a nebulizer cup or container and attached to the machine. • Determining whether a diluent needs to be added to the medication to facilitate the delivery is important. • Most effective method of delivery is via mouthpiece; however, medication may also be delivered via face mask. Small-Volume Nebulizers

30. PHILIPPINE DRUG LAWS Irene Cheeries A. Enriquez

31. Irene Cheeries A. Enriquez As a regulatory agency under the Department of Health, the Food and Drug Administration, created under Republic Act No. 3720, series of 1963, as amended by Executive Order 175, series of 1987, otherwise known as the “Food, Drugs and Devices, and Cosmetics Act”, and subsequently Republic Act No. 9711 otherwise known as “The Food and Drug Administration Act of 2009”, is mandated to ensure the safety, efficacy or quality of health products which include food, drugs, cosmetics, devices, biologicals, vaccines, in-vitro diagnostic reagents, radiation-emitting devices or equipment, and household/urban hazardous substances, including pesticides and toys, or consumer products that may have an effect on health which require regulations as determined by the FDA.

32. Irene Cheeries A. Enriquez Among others, the FDA is also mandated to enforce the provisions of the following laws: RA 9502, or The Universally Accessible Cheaper and Quality Medicine Act of 2008 RA 6675, or The Generics Act Of 1988, RA 10918, or The Pharmacy Law, RA 8172, or The ASIN Law, RA 9165, or The Comprehensive Dangerous Drugs Act EO No. 51, or The Milk Code of the Philippines

33. Irene Cheeries A. Enriquez RA 9165 Comprehensive Dangerous Drugs Act of 2002 It is the policy of the State : to safeguard the integrity of its territory & the well-being of its citizenry, particularly the youth, from the harmful effects of dangerous drugs on their physical & mental well-being, and 2. to defend the same against acts or omissions detrimental to their development and preservation

34. Irene Cheeries A. Enriquez RA 9165 Comprehensive Dangerous Drugs Act of 2002 It is the policy of the State : to safeguard the integrity of its territory & the well-being of its citizenry, particularly the youth, from the harmful effects of dangerous drugs on their physical & mental well-being, and 2. to defend the same against acts or omissions detrimental to their development and preservation

35. DRUG ADMINSTRATION PRINCIPLES Irene Cheeries A. Enriquez

36. Irene Cheeries A. Enriquez 1.Only administer medications you have prepared. 2.Read medication label carefully; not all formulations of parenteral medications are appropriate for IV administration (e.g., insulin for IV use). 3.Know your medications. • Why is this patient receiving this medication? • What nursing observations will tell you the desired medication action is occurring? • What are the nursing implications specific to this medication? 4. Do not leave medications at the bedside. 5. Check medication compatibility if administering IV.

37. Irene Cheeries A. Enriquez 1.Only administer medications you have prepared. 2.Read medication label carefully; not all formulations of parenteral medications are appropriate for IV administration (e.g., insulin for IV use). 3.Know your medications. • Why is this patient receiving this medication? • What nursing observations will tell you the desired medication action is occurring? • What are the nursing implications specific to this medication? 4. Do not leave medications at the bedside. 5. Check medication compatibility if administering IV.

38. Irene Cheeries A. Enriquez 6. Medications prepared for one route may differ in concentration for another different route (e.g., epinephrine SC is concentrated, whereas IV preparation is dilute). • Administering a SC epinephrine preparation IV could be fatal because of an overstimulation of the cardiac system. 7. Use at least two identifiers to determine the correct patient before administering any type of medication (e.g., armband with barcode and date of birth). 8. Have another nurse check medication calculations. 9. IM injections: • Do not inject more than 3 mL at one time. • Use the smallest gauge needle necessary to administer medication correctly.

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40. Orphan Drug Irene Cheeries A. Enriquez Drugs that are not developed by the pharmaceutical industry for economic reasons but which respond to public health need.

41. Irene Cheeries A. Enriquez GET ½ Crosswise !!!!

42. How a drug is absorbed or excreted is called: A.pharmacodynamics. B.pharmacotherapeutics. C.pharmacokinetics. D.drug interactions. Irene Cheeries A. Enriquez Part I

43. 2. What type of drug interaction occurs when two drugs that produce the same effect are given together? A.Additive effect B.Potentiation C.Increased absorption D.Decreased effect Irene Cheeries A. Enriquez

44. 3. Expected outcomes are defined as: A. goals the patient and family ask you to accomplish. B. goals that are above the level the patient can realistically reach. C. goals that were met by the patient in the past. D. goals the patient should reach as a result of planned nursing interventions. Irene Cheeries A. Enriquez

45. 4. Pharmacology is the study of: a) Drug interaction b) Pharmacodynamics c) Drug metabolism d) Pharmacokinetics Irene Cheeries A. Enriquez

46. 5. The process by which a drug is absorbed, distributed, metabolized, and excreted by the body is known as: a) Nursing care techniques b) Disease prevention strategies c) Drug actions and interactions d) Surgical procedures Irene Cheeries A. Enriquez

47. 6. Which of the following statements best defines a "generic name" for a medication? a) It is the brand name given by the manufacturer. b) It indicates the drug's chemical composition. c) It is a shorter and simpler name for the drug. d) It is the name assigned by the Food and Drug Administration (FDA). Irene Cheeries A. Enriquez

48. 6. Which of the following statements best defines a "generic name" for a medication? a) It is the brand name given by the manufacturer. b) It indicates the drug's chemical composition. c) It is a shorter and simpler name for the drug. d) It is the name assigned by the Food and Drug Administration (FDA). Irene Cheeries A. Enriquez

49. 7. The route of drug administration that involves applying the medication to the skin is called: a) Intravenous b) Intramuscular c) Topical d) Sublingual Irene Cheeries A. Enriquez

50. 8. Which of the following terms refers to the physiological movement of a drug from the site of administration to the bloodstream? a) Absorption b) Distribution c) Metabolism d) Excretion Irene Cheeries A. Enriquez

51. 9. The term "half-life" of a drug refers to: a) Range of doses that are safe and effective b) Range of doses that cause severe side effects c) Range of doses that are used in clinical trials d) Range of doses that require close monitoring Irene Cheeries A. Enriquez

52. 10. The therapeutic range of a drug is the: a) Range of doses that are safe and effective b) Range of doses that cause severe side effects c) Range of doses that are used in clinical trials d) Range of doses that require close monitoring Irene Cheeries A. Enriquez

53. 11. Which government agency is responsible for regulating the approval and safety of medications in the United States? a) Centers for Disease Control and Prevention (CDC) b) National Institutes of Health (NIH) c) Food and Drug Administration (FDA) d) Environmental Protection Agency (EPA) Irene Cheeries A. Enriquez

54. 12. The "off-label use" of a medication refers to: a) Using the medication without a prescription b) Using the medication for a purpose not approved by the FDA c) Using the medication only for pediatric patients d) Using the medication exclusively in emergency situations Irene Cheeries A. Enriquez

55. 13. The term "adverse effect" in pharmacology refers to: a) The main therapeutic action of a drug b) A mild and expected side effect of a drug c) An unintended and potentially harmful response to a drug d) The beneficial outcome of a drug interaction Irene Cheeries A. Enriquez

56. 14. The process of a drug being broken down into simpler substances by the body is known as: a) Metabolism b) Absorption c) Distribution d) Excretion Irene Cheeries A. Enriquez

57. 15. The "placebo effect" refers to: a) The tendency of a drug to cause placebo-like effects b) The use of placebos instead of actual medications c) The phenomenon where a patient experiences benefits from an inactive substance due to psychological factors d) The administration of medications without the patient's knowledge Irene Cheeries A. Enriquez

58. 1. Pharmacology 2. Drug 3. Medicine 4. Pharmacokinetics 5. Pharmacodynamics 6. Pharmacotherapy 7. Pharmacologic 8.Therapeutic 9. Generic name 10. Trade/Brand name 11. Side effects 12. Adverse effects 13. Receptors Agonist Antagonist Part II Irene Cheeries A. Enriquez

59. 1. ac 2. pc 3. PO 4. PRN 5. Gtts 6. STAT 7. Caps 8. mg 9. ml 10.OD 11.BID 12.TID 13.QID 14.NPO 15. od 16. os 17. ad 18. as 19. IV 20. NGT Part III Irene Cheeries A. Enriquez

60. THANK YOU! Irene Cheeries Apal Enriquez RN, MN