Unit 1: Basic Concepts of Pharmacology questions and answers

Unit 1: Basic Concepts of Pharmacology questions and answers Phases of the Nursing Process 1. Assessment 2. Diagnosis 3. Outcome Id & planning 4. implementation 5. Evaluation Nursing process phase #1: Assessment Data is collected, reviewed, and analyzed from patient, family, group, and/or community sources. Objective Data any information gathered through the senses or that which is: seen heard felt or smelled Objective Data may also be obtained from: Nursing Physical Assessment Nursing History Past and Present Medical History Results of Laboratory Tests, Diagnostic Studies or Procedures Measurement of Vital Signs Weight and Height Medication Profile Subjective Data includes information shared through the spoken word by any reliable source such as the Patient Spouse family member significant other or caregiver Components of a prescription/medication Order: Seven Elements: 1. Patient's name 2. Date the drug order was written 3. Name of drug(s) 4. Drug dosage amount 5. Drug dosage frequency 6. Route of administration 7. Prescriber's signature (example in powerpoint) Assessment about the specific drug involves the collection of specific information about prescribed, OTC, and herbal/complementary/alternative therapeutic drug use, with attention to the: drug's action signs symptoms of allergic reaction adverse effects dosages and routes of administration contraindications drug incompatibilities drug-drug interactions drug-food interactions drug-laboratory test interactions toxicities available antidotes WHATS'S WRONG? WHAT WOULD YOU DO? Date of order: 9/13/15 Patient: John Doe Physician: Dr. A. Jackson, M.D. Order: Acetaminophen (Tylenol), 2 Tablets PO, every 4 hours as needed for fever Missing the dose Clarify temperature Call and get it clarified NEVER assume Nursing process phase #2: Diagnoses are the result of clinical judgement about a human response to health conditions and/or life processes, critical thinking, creativity, and accurate collection of data regarding the patient as well as the drug. Describes symptoms (notes) Diagnoses-Problems pertaining to Drug Therapy: Knowledge deficit Risk for injury Noncompliance - disturbances - deficits - excesses - impairments of bodily functions Formulation of nursing diagnoses: Part one of statement The human response of the patient to illness, injury, or significant change. May be: actual problem increased risk of developing problem opportunity to improve the human response by the patient, family, group, or community Formulation of nursing diagnoses: Part two of statement Defining characteristics and identifies the factor(s) related to the response, with more than one factor often named. connection between factor(s) and response (not necessarily cause-and-effect) Formulation of nursing diagnoses: Part three of statement Contains a listing of clues, cues, evidence, signs, symptoms, or other data that support the nurse's claim that this diagnosis is accurate Assessment-Data Collection: Drug data Patient data Prescription/Medication order Nursing diagnosis does not equal Medical diagnosis Shortness of breath does not mean someone has COPD Nursing process phase #3: Planning Includes identification of outcomes The major purpose of the Planning phase: Prioritize the nursing diagnoses Specify outcomes including the time frame for their achievement Patient outcomes are _______ based. and may be categorized into... behavior based Physiologic Psychological Spiritual Sexual Cognitive Motor and/or other domains Outcomes are... Objective measurable realistic with an established time frame for the patient's achievement Define Outcome the changes you expect to see after you intervene (opposite of the diagnosis/problem) Nursing Process Phase #4: Implementation Doing/active/intervening phase Nine Rights of Medication Administration 1. Right drug 2. Right dose 3. Right time 4. Right route and form 5. Right patient 6. Right documentation 7. Right reason 8. Right response 9. patient Right to refuse To check if you are giving medication to the right patient you must have them.... repeat their name and date of birth Intervention define: any treatment based on clinical judgement and knowledge and performed by a nurse to enhance outcomes To ensure the right drug is given, the specific medication order must be checked against the medication label or profile.... three times before giving the medication. Always confirm that the dosage amount is appropriate for the patient's... age and size For routine medication orders, the standard of care is to give the medications no more than 1/2 hour before or after the actual time specified in the prescriber's order. Prescriber define: Any health care professional licensed by the appropriate regulatory board to prescribe medication. Outcomes define: Descriptions of specific patient behaviors or responses that demonstrate meeting of or achievement of behaviors related to each nursing diagnoses. These statements are specific while framed in behavioral terms and are measureable. Nursing process define: An organizational framework for the practice of nursing. It encompasses all steps taken by the nurse in caring for the patient. Compliance define: Implementation or fulfillment of a prescriber's or caregiver's prescribed course of treatment or therapeutic plan by a patient. Medication error define: Any preventable adverse drug event involving inappropriate medication use by a patient or health care professional; it may or my not cause the patient harm. Noncompliance define: An informal decision on the part of the patient not to adhere to or follow a therapeutic plan or suggestion. Do not record completion of an incident report in the... medical chart. Right reason: Confirm the rationale for use of medication through... researching the patient's history while also asking the patient the reason he or she is taking the drug (Rights of Med administration) Right response: Drug and its desired response Nursing Process Phase #5: Evaluation Occurs after the nursing care plan has been implemented but also needs to occur at each phase of the nursing process. Nursing Process Evaluation includes: Monitoring the fulfillment of outcomes Monitoring the patients therapeutic response to the drug Monitoring the patients adverse effects response to the drug Monitoring the patients toxic effects response to the drug DOCUMENTATION Nursing Process Evaluation Monitoring Effectiveness: Example: Diuretic Were outcomes met? Is the patient responding to the drug(s)? See if drug is working, Patient should be peeing The nursing process, as it relates to drug therapy involves: the way in which a nurse gathers analyzes organizes provides and acts upon data about the patient within the context of prudent nursing care and standards of care. Drug: Any chemical that affects the physiological process of a living organism. Pharmacology: The broadest term for the study or science of drugs. Chemical name: Complex terminology of chemical structure. Generic name: Universally accepted, less complicated terminology, most commonly used. (lower case) Trade name: Assigned by the company marketing the drug. Drug classification Grouped together based on properties (NSAIDS) and therapeutic use (analgesics, antipyretics). Pharmaceutics: The study of how various dosage forms influence the way in which the drug affects the body. Pharmacokinetics: Involves the processes of... The study of what the body does to the drug. absorption distribution metabolism excretion Pharmacodynamics: Involves... The study of what the drug does to the body. drug-receptor relationships Pharmacotherapeutics: Focuses on the clinical use of drugs to prevent and treat diseases. drug actions: The processes involved in the interaction between a drug and body cells (like the action of a drug on a receptor protein); a.k.a. mechanism of action. toxicology: The study of the adverse effects of drugs and other chemicals on living systems. Toxic: The quality of being poisonous (injurious to health or dangerous to life). Pharmacognosy: The study of drugs that are obtained from natural plant and animal sources. Pharmacoeconomics: The study of economic factors impacting the cost of drug therapy. Three Phases of Drug Activity: (Pharmacology Principles) Dose of formulated drug Administration 1st Pharmaceutical Phase: Disintegration of dosage form; dissolution of drug in body. Drug available for absorption 2nd Pharmacokinetic Phase: Absorption, distribution, metabolism, excretion. Drug available for action 3rd Pharmacodynamic Phase: Drug receptor interaction. Effect Pharmaceutics Drug form impacts how quickly the onset of action occurs Drug Absorption of Various Oral Preparations: FASTEST--------------> SLOWEST FASTEST Oral disintegration, buccal tablets, and oral soluble wafers Liquids, elixers, and syrups Suspension solutions Powders Capsules Tablets Coated tablets Enteric-coated tablets SLOWEST *liquids absorb quicker *food impacts drug absorption Enteric Coated Tablets are not meant to break down in the stomach could be toxic if broken down in the stomach or... could possibly not work at all if broken down in the stomach Pharmacokinetics ABSORPTION: Movement of drug from the administration into the blood stream. Pharmacokinetics ABSORPTION ROUTE SLOWEST-------------> FASTEST SLOWEST Enteral: absorbed through GI tract (oral, SL, buccal, rectal) • tablets, capsules, elixirs, syrups, suppositories, etc. • First pass effect: liver breaks down drug before it reaches blood steam Topical: application/absorption through skin, eyes, ears, nose, lungs, vagina, rectum • aerosols, ointments, creams, pastes, inhalers, suppositories Parenteral: Injections (IV, IM, Subcutaneous) • solutions, suspensions, emulsions, powder for reconstituting FASTEST Will absorption take longer with a Pill or IV? A PILL Pill: has to go through liver Injection: does not go through liver Stomach-----> Liver METABOLIZED 30 mg of oral morphine equals how many mg of IV morphine? 10 mg of IV morphine *10 mg of oral morphine does not equal 10 mg of IV morphine Pharmacokinetics DISTRIBUTION: The transport of a drug by the bloodstream to its site of action. Heat and Ice v.s. Blood Vessels Heat: Dialates Blood Vessels Ice: Constricts Blood Vessels Distribution cont.: Protein-binding Water vs. fat affinity Blood supply -rapid distribution to * heart * liver * kidneys * brain (major organs) -slow distribution to *muscle *skin *fat More Albumin binding to drug means... less dosage of drug for destination organ Less Albumin binding to drug means... more dosage of drug for destination organ Drug attaches to Albumin and what's left over... goes to the destination organ Pharmacokinetics METABOLISM: biochemical alternation of a drug into a inactive metabolite, or a more/less potent active metabolite. Metabolism Organs: Liver (primary) kidneys muscle lungs Intestines ***Cytochrome P-450 Enzymes: aid in liver metabolism of fat-soluble drugs Enzyme inhibitors: drugs that delay metabolism Enzyme inducers: drugs that stimulate metabolism Substrates: Drugs that are specifically targeted by enzymes Factors that decrease metabolism: Cardiovascular dysfunction Renal insufficiency Starvation Obstructive jaundice Genetics (Slow acetylator) P-450 enzyme inhibitors Drugs Factors that increase metabolism: Genetics (Fast acetylator) Drugs (Barbiturate therapy) P-450 enzyme inducer Pharmacokinetics EXCRETION: The elimination of drugs from the body. Organs involved in excretion: Kidneys (major organ) Liver- Bile Bowel Half-Life: Time it takes for one half of the drug to be removed from the body. *5 half-lives for removal Example: What is the half-life of the following? 100 mg @ 0800 50 mg @ 1200 What time and mg would the next two half-lives be? 4 hours 25 mg @ 1600 12.5 mg @2000 Narrow Therapeutic Window: Small range from being therapeutic to being toxic. Wide Therapeutic Window: Would have to take a lot to be toxic. Therapeutic Range ONSET: The time it takes for the drug to elicit a therapeutic response. Therapeutic Range PEAK: The time it takes for a drug to reach its maximum therapeutic response. Therapeutic Range DURATION: The time a drug concentration is sufficient to elicit a therapeutic response. Therapeutic Drug Monitoring PEAK LEVEL: Highest concentration of drug in blood Therapeutic Drug Monitoring TROUGH LEVEL: Lowest concentration of drug in blood PHARMACODYNAMICS Mechanisms of drug action in tissues Natural chemical + Receptor site = Normal response Agonist drug + Receptor site = Mimicked response Natural chemical + Antagonist drug + Receptor site = Blocked response Example: Heart & Adrenalin If body is low on natural drug... 1. Agonist would: 2. Antagonist would: 1. (drug that takes place of enzyme) Make heart beat faster 2. Blocks receptor site (blocks bodies natural response from occurring) *EX: beta blocker makes heart slow Pharmacotherapeutics: Clinical use of drugs to prevent or treat disease/illness Pharmacotherapeutics types ACUTE THERAPY: Treatment for quick onset of illness Pharmacotherapeutics types MAINTENANCE THERAPY: Prevents chronic progression of illness Pharmacotherapeutics types SUPPLEMENTAL/REPLACEMENT THERAPY: Supplies substance to body to maintain function Pharmacotherapeutics types PALLIATIVE THERAPY Comfort from symptoms Pharmacotherapeutics types SUPPORTIVE THERAPY: Maintains body function during illness Pharmacotherapeutics types PROPHYLACTIC THERAPY: Prevents illness/outcome of planned event