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Patho/Pharm week 2

by: Grace Mendel
Grace Mendel
Pathophysiology and Pharmacology

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Here are the study questions for week 2!
Pathophysiology and Pharmacology
Class Notes
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This 7 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 27 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
Core Patient Variables and the Nurse Patient Relationship Part I Adverse Effects Nontherapeutic effects of a medication Known effects may be mild to severe Mild adverse effects may not require a medication adjustment Example Omnicef turns poop orange Moderate to severe may require adjusting the treatment plan or discontinuing the medicine Example A patient gets a yeast infection while on an antibiotics and needs an antifungal ExampleA patient on a blood pressure medicine develops hypotension and must come off the med Adverse Effects Allergic response Anaphylaxismost severe Idiosyncratic responses Toxicities Neurotoxicity Hepatotoxicity Nephrotoxicity Ototoxicity Cardiotoxicity Immunotoxicity Black Box Warning Way of agging important safety information It is the most serious medication warning required by the FDA Used when the medication can cause serious undesirable effects compared to the potential bene t from the drug Indicates need for extra precautions MedWatch What is the purpose of MedWatch What is reported to MedWatch httpwwwfdaqovSafetvMedWatch Drug Interactions Interactions affecting absorption Drug A may bind with another substance in the GI tract and there is less drug available Interactions affecting distribution Competitive protein binding Altered extracellular pH Interactions affecting metabolism P450 Interactions affection excretion Interactions affection pharmacodynamics May happen with food supplements minerals or other drugs Sometimes interactions increase therapeutic effect Steroid decreases in ammation so antibiotic can reach target Sometimes they decrease therapeutic effect Antibiotics reduce efficacy of oral contraceptives Risks for Drug Interactions Immature physiologic processes Chronic disease or aging organ systems Malnutrition recent weight changes Alcohol abuse Certain modi ed diets high fat Multiple drugs Rx or OTC use Drugs instilled into a feeding tube Drug Incompatibilities Chemical incompatibilities Physical incompatibilities Interactions before Medications Reach Body Usually occur when substances are in direct physical contact ie in delivery device Example Calcium phosphate precipitates in TPN solution Interactions That Affect Bioavailability 1 Foods may prevent absorption 2 Drugs may modify enzyme activity 3 Protein 4 Complex binding may occur Modi ed Enzyme Activity Heme containing enzymes known as CYP450 enzymes oxidizemetabolize many medications Examples of CYP450 enzymes CYP1A2 CYP2C9 CYP2C19 CYP2D6 CYP3A4 CYP2C8 Medications metabolized these enzymes are SUBSTRATES Examples of CYP3A4 substrates Calcium channel blockers felodipine nisoldipine and nicardipine Benzodiazepines diazepam midazoIam and triazolam Statins simvastatin and lovastatin Immunosuppressive cycosporine INHIBITORS decrease activity CYP450 enzymes Oral bioavailability increases dramatically Increases drug levels Risk of increased side effects amp drug toxicity Example Grapefruit juice INDUCERS increase enzyme CYP450 activity Cause drugs to clear the system more rapidly Decrease bioavailability and therapeutic effect Example st John39s Wort Complex in the Patient Binding Makes insoluble compounds Bioavailability of tetracycline is reduced 57 when taken with food 65 with dairy products 81 with iron supplements Same interaction with many uroquinolones like cipro oxacin To prevent Separate drug doses from foods and tube feedings containing these minerals by 1 to 3 hours Interaction During Distribution Occur after the substances have reached the systemic circulation Additive effect Synergistic effect Potentiated effect Antagonistic effect Drug Incompatibilities Chemical Physical Core Patient Variables of the Patient Receiving Drug Therapy Health status Life span amp gender Lifestyle diet and habits Environment Culture amp Inherited traits The Biggest Offenders Grapefruit juice Food CYP450 inhibitor Warfarin Drug CYP450 substrate Known to interact with approximately 250 different drugs Interactions can increase or decrease the international normalised ratio INR St John s wort Supplement CYP450 inducer Interacts with 60 of drugs on market Supplement Use Compared to prescription medications herbal supplements are relatively low in cost easy to obtain 70 of patients neglect to tell their healthcare provider that they are taking an herbal supplement Natural does not always mean quotsafequot They may contain unknown ingredients and may interact with medication Reasons Patients Don t Tell Providers about Supplements Do not feel the supplements are medicines Feel that because the supplements are natural they must be safe Are not asked if they are taking any supplements by their provider Fear of disapproval Regulation of Dietary Supplements Food and Drug Administration FDA Regulates food OTC and Rx drugs Manufacturer must prove safety before marketing the product Under DSHEA Dietary Supplement Health Education Act of 1994 Must have truth in advertising an not overtly claim to treat diseases FDA must prove product unsafe or labeled in a misleading ma n ner after product is marketed Areas of Concern Lack of standardization Potency varies with Part of plant used Growing processing storage conditions Research cannot prove worth if components uncertain Many instances of incorrect ingredients Contamination with dangerous substances Pharmaceuticals Heavy metals mercurylead More Concerns Interactions with other drugs Increased risk if botanical intake not disclosed to healthcare provider Anesthesiologists advise discontinuing many herbal products 2 to 3 weeks before surgery Difficulty obtaining reliable information Consider the source often seller of product Scienti c information is scarce Nursing Implications Ask about all treatments a person uses in a nonjudgmental way Avoid using only the word quotmedicinequot Consider the following information for all supplements a patient is using What if any are the supplements therapeutic effects What are the supplement s adverse reactions Are there pregnancy or breastfeeding consideration What are the adverse interactions with other supplements or medications Does bioavailability very greatly with the supplement Web Resources NIH Web sites NICCAM httpnccamnihdovhealth Office of Dietary supplements httpodsodnihgov Natural Medicines Comprehensive Database wwwnaturadatabasecom rates effectiveness based on evidence FDA lists warnings and safety information on dietary supplements as they become available wwwcfsanfdagovdmsdswarnhtml Overview of Common Herbs amp Supplements from NCCAM St John s work Ginko biloba Garlic Ginger Glucosaminechondroitin Fish oils Echinacea Valerian Kava Ephedra Greatest Risk for DrugDietary Supplement Interactions Children The elderly People with chronic diseases or impaired organ function Persons taking many medications Individuals with genetic variants in drug metabolism Cultural Consideration Everyone has a culture What is yours Cultural sensitivity Now preferred term over competence Teaching competence sometimes lead to sterotyping lncludes eliciting patient preferences ie ask Don t assume World views amp values Health beliefs Family involvement Acceptable treatments Role of Genetics Pharmacogenetics variations in drug response based on speci c genes Some related to race amp some are individual variations Pharmacogenomics variations in drug responses based entire inherited gene sequencegenome FDA lists drugs with known genetic variations as quotgenomic biomarkersquot Extremely important in treating cancer Known Variations in Drug Responses Treating hypertension ACE inhibitor amp beta blockers work better in whites than blacks Thiazide diuretics amp calcium channel blockers work better in blacks than whites Asians need lower doses of beta blockers than whites Treating mental health problems Black react more quickly and have more adverse effects to tricyclic antidepressants than white Hispanics need lower doses traditional antipyschotics than whites From Munoz amp Hildenberg 2005 References Aschenbrenner D S amp Venable S J 2012 Drug therapy in nursing 4th ed Philadelphia PA Wolters KuwerLippincott Williams amp Wilkins


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