Patho/Pharm week 1
Patho/Pharm week 1 28127
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This 10 page Class Notes was uploaded by Grace Mendel on Friday September 11, 2015. The Class Notes belongs to 28127 at Indiana University Purdue University - Indianapolis taught by in Fall 2015. Since its upload, it has received 36 views. For similar materials see Pathophysiology and Pharmacology in Nursing and Health Sciences at Indiana University Purdue University - Indianapolis.
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Date Created: 09/11/15
Study Questions for 1 De ne pharmacotherapeutics pharmacokinetics and pharmacodynamics Pharmacotherapeutics is the achievement of the desired therapeutic goal from drug therapy Pharmacotherapeutics is the study of the clinical purpose the indication for giving a drug The desired pharmacotherapeutics can be to induce a cure or prevent a problem Pharmacokinetics The changes that occur to the drug while it is inside the body Refers to how medications travel through the body 1 absorption 2 distribution 3 metabolism 4 Excretion Pharmacodynamics the effects of the drug on the body the biologic chemical and physiologic actions of a particular drug within the body The pharmacodynamics of a drug are responsible for its therapeutic effects and sometimes its adverse effects Drugs cannot create new responses in the body they can only turn on turn off promote or block a response that the body is inherently capable of producing Describe how patient variables can affect drug therapies 67 Nurses assess the current health status of the patient and gathers data on other core patient variables life span amp gender lifestyle diet habits environment culture inherited traits to identify those that are relevant to the individual patient This allows the nurse to predict future needs of the patient Health status what drugs they are taking conditions they have allergies Life span amp gender can they read and write developmental level for drug educann Lifestvle diet habit level of exercise potential fooddrug interactions sleep patterns street drug use economic factors Environment home setting or living environment sunlight exposure air pollution environment where the drug needs to be administered Culture amp inherited traits religious or cultural practices genetic variations ldentify patient variables that can affect patient teaching regarding drug therapies 6 Life span and gender can effect patient teaching The nurse determines patient s developmental level the ability to read and write and the ability to understand directions This information is needed to plan patient education on drug therapy including the nurse s approach and teaching methods Identify methods that can be used to evaluate drug therapy 12 Measures the patient s progress Was goal achieved Was the nursing management effective Consider whether the drug achieved the desired effect Outcomes that are not achieved Reassess to identify barriers to success Must identify the reason behind any treatment failure Steps to achieve desired results effectively 5 Identify four main sources of drugs and biological products 1516 Plants ex Morphine Drugs that come from plants are classi ed by their physical and chemical properties alkaloids glycosides gums ois resins Animals ex Insulin pituitary hormones some vitamins antibiotics and biologic agents Synthetic chemicals most drugs today are either partially or wholly synthetic chemical compounds that have been produced in a lab unaffected by pharmacodynamics changes Ex Penicillin Genetically engineered chemicals drugs developed with DNA technologies Genomics the study and identi cation of genes and gene function Proteomics study of protein structure and function Transcriptomics the study of transcriptome the complete set of RNA transcripts produced by the genome at any one time Metabonomics the study of metabolic responses to drugs environmental changes and diseases Pharmacogenomics the application of the quotomicsquot technology for the prediction of the sensitivity or resistance of an individual patient s disease to a speci c drug or a group of drugs Pharmacogenetics the study of how genetic variables affect the pharmacodynamics of a drug in a speci c patient 6 Describe how drugs are named and its signi cance in identifying drugs 16 Drugs are known by 3 names Chemical name Precisely describes the drug s atomic and molecular structure Generic name Nonproprietary name identi es the drug s active ingredient Trade name Brand or proprietary name So Why is drug nomenclature important to us as nurses 16 Accurately transcribing drug orders Administering the drugs correctly and documenting patient s response Drugs are ordered by the generic name but may be referred to by the trade name Sound alike drugs and TALL man letters Double and triple check drug names Pharmacy bar code systems 7 Explain the signi cance of drug classi cations 17 Because there are thousands of drugs available today drugs that share similar characteristics are classi ed as a pharmacologic group or family Classi ed by chemical composition physiologic effect and therapeutic uses 8 Identify key sources of drug information 1718 United States Pharmacopeia USP and USP Dispensing Information USPDI National Formulary NF Pharmaceutical Package lnserts American Hospital Formulary Service Physician s Desk Reference PDR AHFS Drug Information PDR for Nonprescription Drugs Facts and Comparisons Electronic databases Food and Drug Administration FDA Drug Bulletin 9 Describe the nursing s role in the management of drug therapies There are six steps of the nursing process for drug therapy 1 Assessment Core drug knowledge identify drugs the patient is taking along with knowledge about that drug and core patient variables interview and history physical exam medical records 2 Diagnosis re ect a current actual problem or the risk for developing a problem related to a drug therapy Diagnosis may re ect the effects of drugs 3 Outcome identi cation determine desired results based on data collected are speci c to the patient s drug regimen 4 Planning identifying interventions necessary to reach desired outcomes maximize therapeutic effects and minimize adverse effects de nes what needs to be done to achieve outcomes Interventions performing plan and carrying out the interventions Interventions are related to the physical act of giving the drug and patient and family education about the drug Evaluation measures patient s progress considers whether the drug achieved the desired effect outcomes that are not achieved must be reassessed must identify the reason behind any treatment failures So 10 Why is Nursing Management of Drug Therapy important 27 You are legally responsible for the drugs you administer To be safe giving a drug you must understand therapeutic drug actions and adverse drug reactions Standing orders or protocols may allow nurses to adjust some drug regimens Applying your nursing process to each and every patient with each and every drug you give is necessary because our patients with chronic conditions are requiring long term drug therapy to control their diseases Nurses are the last line of defense for our patients Identify three routes of medication administration 30 Enteral route Gastrointestinal GI tract is used for the ingestion and absorption of drugs First pass metabolism The most common method of administering drugs Parenteral route Avoids the GI tract Avoids rst pass metabolism Associated with all forms of injections intramuscular IM subcutaneous SC or SQ and intravenous IV Topical route Drugs administered topically are applied to the skin or mucous membranes 11 Describe how the route of administration affects the delivery of the medication 3031 The route of administration affects the rate and the amount of absorption Routes Absorption rate Oral Varies greatly due to Stabilitysolubility of medication GI pH and emptying time Presence of food in stomach Forms of medications SuanguaVBuccal Absorbed quickly through highly vascular mucous membranes Other mucous membranes rectal vaginal Easily absorbed with both local and systemic effects Inhalation via mouth or nose Absorbed rapidly through alveolar capillary network Topical Slow and gradual absorption Subcutaneous intramuscular Absorption is determined by Solubility of medication Blood perfusion at the site of injection Immediate and complete absorption 12 Describe nursing interventions used to maximize therapeutic effects 9 o Administer the drug in a manner that will promote its absorption Use the appropriate administration technique for the desired route 0 Administer the drug at the appropriate time to maintain blood levels of the drug that will promote therapeutic effects 0 Monitor lab values when appropriate to determine that the prescribed dose achieves the a therapeutic drug level 13 What are some strategies used to minimize adverse reactions with drug therapies 9 Betf39iOTF e initiating drug therapy verify that the patient is not allergic to the drug and that the is not contraindicated for this patient for same reason Ad minister the dm 9 in a manner cansistent with standard safety protocels Manitor the patient and relevant Iaboratary ndings Closeisy for evidence 0f known adverse effeCts from drug therapy Discontinue for withhold a drug if the lab ninvgs warrant doing so Notify the prescriber of the ndings and your actions Report evidence of adverse effects to the prescriber ASAP Modify administration techniques appropriate to dec rease the incidence of adverse effects lm p leme t a ppm priatie techniques for certafi n drugs to detect the onset Of adverse effect 14 Describe how the chemical makeup of a drug affects a drugs ability to cross a cellular membrane Drugs that are more lipid soluble usually are absorbed more rapidly than others because they are able to cross lipid cell membranes easily Only drugs that are lipophilic or that have a transport system can penetrate the bloodbrain barrier and get to the other side Any drug that can pass through a membrane can pass through the placenta lipophilic not ionized and not protein bound 15 Identify factors that may alter drug metabolism Age and gender An increase in certain medicationmetabolizing enzymes this can cause a particular medication to be metabolized sooner requiring an increase in dosage of that medication to maintain a therapeutic level Firstpass effect some oral medications are inactivated on their rst pass through the liver and may require a higher dose to achieve a therapeutic effect or must be given by a nonenteral route because of their high rstpass effect These medications are usually given by alternate routes such as IV or sublingual Similar metabolic pathways when 2 medications are metabolized by the same pathway they can interfere with the metabolism of one or both of the medications In this way the rate of metabolism can be decreased for one or both of the medications leading to medication accumulation Nutritional status a malnourished patient may be de cient in the factors that are necessary to produce speci c medicationmetabolizing enzymes Consequently medication metabolism may be impaired Diet and Habits diet and exposure to things like cigarette smoke or pesticides Environmental amount of light altitude level pollutants 16 Describe how drug modules are excreted from the body Drugs are primarily excreted through the kidneys via urine bile in the GI tract expired air through lungs breast milk sweat from skin and saliva Pharmacotherapeutics Pharmacotherapeutics is the achievement of the desired therapeutic goal from drug therapy Pharmacotherapeutics is the study of the clinical purpose the indication for giving a drug The desired pharmacotherapeutics can be to induce a cure or prevent a Pharmacodynamics The effects of the drug on the body The pharmacodynamics of a drug are responsible for its therapeutic effects and sometimes its adverse effects Drugs cannot create new responses in the body they can only turn on turn off problem promote or block a response that the body is inherently capable of producing Pharmacokinetics the changes that occurs to the drug while it is in the body Refers to how medications travel through the body 1 absorption 2 distribution 3 metabolism 4 excretion Drug classi cations Drugs that share similar characteristics can be classi ed by Chemical composition Physiological effects Therapeutic uses Health status The presence of disease illness and allergy chronic conditions causing system or organ dysfunction diminished memory or mental capacity Pharmacogenomics a biotechnological science that combines the techniques of medicine pharmacology and genomics and is concerned with developing drug therapies to compensate for genetic differences in patients which cause varied responses to a single therapeutic regimen Contraindications and precautions Conditions under which the drug should not be used or must be used carefully with monitoring Pharmacogenetics the study of the interrelation of hereditary constitution and response to drugs Adverse effects Undesired inadvertent and unexpected dangerous effects of the medication Steady state a state or condition of a system or process as one of the energy states of an atom that does not change in time Therapeutic index TI The ratio of a drug39s toxic level to its therapeuti 0 level which is calculated as the relation of lethal dose LD to effective dose ED Tl ED LD Medications with a high Tl have a wide safety margin Therefore there is no need for routine serum medication level monitoring Medications with a low Tl should have serum medication levels monitored closely Agonist A medication that can mimic the receptor activity regulated by endogenous compounds A drug that is capable of binding with cellular hormonal neurotransmitters or molecular receptors to induce a cellular response Drug interactions Effects that may occur when the drug is given along with another drug food or substance Antagonist A medication that can block normal receptor activity regulated by endogenous compounds or receptor activity cause by other medications Drug Response the anticipated therapeutic and adverse effects Prototype drug Typical of a group of drugs within a drug class P450 Set of enzymes in the liver that metabolize drugs Therapeutic range A dose that that places the drug concentration above the minimum effective concentration MEC but below the level at which adverse effects occur Loading dose a large initial dose of a substance or series of such doses given to rapidly achieve a therapeutic concentration in the body Maintenance dose The dose that is chosen and administered consistently over time Blood brain barrier a naturally occurring barrier created by the modi cation of brain capillaries as by reduction in fenestration and formation of tight celltocell contacts that prevents many substances from leaving the blood and crossing the capillary walls into the brain tissues Generic Name The of cial of nonproprietary name that is given by the United States Adopted Names Council Each medication only has one generic name identi es the drug s active ingredient Ex Ibuprofen Adverse Effects vs Anaphylaxis Undesired inadvertent and unexpected dangerous effects of the medication Adverse effects that are not predictable or dose related are caused by allergic or idiosyncratic responses Anaphylaxis The most serious allergic response Constriction of bronchial smooth muscles Vasodilation Increased vascular permeability Symptoms acute respiratory distress marked hypotension edema rash tachycardia cyanosis and pale coo skin Treatment administration of vasopressor agents to increase the blood pressure bronchodilators to open the airway antihistamine to block the effects of the released histamine corticosteroids to reduce swelling oxygen therapy to treat cyanosis and IV uids to help support blood pressure