Pharmacology Exam 1
Drug Names and Classifications
Names
- Chemical: structure
- Generic: original name for common understanding
- Trade (brand) name: assigned by pharmaceutical company
o Fillers/binders differ between brand and generic – may alter bioavailability
Classifications
- Therapeutic: based on usefulness in treating diseases or disorders
o Analgesics, antihypertensives
- Pharmacologic: how drug produces physiological effect at molecular/tissue level
o Calcium channel blocker
Sources of Medications
Natural Sources
- Plants
o Active chemical found in a plant (ex: Digitalis)
- Animal products
o Replace human chemicals not produced because of disease or genetic issues
o Genetic engineering (ex: insulin, thyroid)
- Inorganic compounds
o Salts of various elements (ex: iron, fluoride)
Synthetic Sources
- Most drugs produced synthetically
Food and Drug Administration
Protects public health by ensuring safety, efficacy, and security of drugs, biological products and medical devices
Ensure safety of nation’s food supply, cosmetics, and products that emit radiation
Drug approval process tightly controlled by FDA
- Takes several years
- Several phases
Preclinical Investigational Studies
- Tested on laboratory animals
Phase I Studies
- Tested on healthy human volunteers (dose, range, and pharmacokinetics)
,Phase II Studies
- Tested on clients with disease (therapeutic effects, adverse effects)
Phase III Studies
- Large sample size; placebo and/or binded studies (effectiveness, safety, dose)
- Submission of new drug application; approved by FDA and given name; patent 5-7 years
Phase IV Studies
- Post marketing studies (2+ years); new or severe effects, black box
Legal Regulation of Drugs: Drug Enforcement Agency (DEA)
Controlled Substances Act of 1970
- Regulates manufacturing, distribution, and dispensing of drugs with known abuse potential (controlled)
- Anyone convicted of unlawfully manufacturing, distributing, or dispensing of controlled substances faces
severe penalties
Controlled drugs divided into five DEA schedules
- Based on potential for abuse/physical and psychologic dependence
Physicians and dispensing pharmacists must be registered with DEA
Nurses must be familiar with regulations and standard of practice
Schedule Controlled Substances
Schedule I (heroin, LSD)
- High abuse potential and no accepted medical use
Schedule II (narcotics, amphetamines, barbiturates)
- High abuse potential with severe dependence liability
Schedule III (nonamphetamines stimulates, nonbarbiturates sedatives)
- Less abuse potential and dependence liability than II (moderate)
Schedule IV (antianxiety agents, some sedative)
- Less abuse potential and dependence liability than III (moderate)
Schedule V (codeine)
- Limited abuse potential
Over the Counter (OTC) Drugs
No prescription required
Many originally approved as prescriptions; found safe used as directed
- Ex: loratadine (Claritin); fluticasone (Flonase); ibuprofen (Advil)
Problems with OTC use:
- Delay seeking treatment from healthcare provider
- Masks s/s of disease
- Drug-drug interactions
- Overdose/toxicity (acetaminophen)
- Abuse (pseudoephedrine, Robitussin)
Nurse – always ask patient about OTC, herbs, supplement
Assessment: Gather Information
, Health History
- Allergies (ask reaction – true allergy vs. adverse effect)
- Past medical history
- Medications (current and recent past, OTC, herbals, supplements)
- Diet, alcohol, drug use
- Education level (understanding on disease and therapy)
- Reproductive history (Pregnancy/nursing)
Physical Assessment
- Baseline VS, head to toe; cognition, weight, height, age
- Lab tests and other diagnostics
Diagnosis: Determine the Problems
Most problems related to adverse effects, toxicities, drug-drug interactions, medication error, ineffective self-care
Examples:
- Fluid imbalance related to diuretic medication
- Nausea related to opioid medication
- Risk for falls related to sedating effects of medication
- Ineffective health maintenance related to inappropriate dosing of medication
Planning: Goals/Expected Outcomes
Client will maintain a blood pressure within normal range
- Address therapeutic effect of medication
Client will maintain normal gas exchange and remain free from respiratory depression
- Addresses potential adverse effect
Client will demonstrate correct administration of medication
- Demonstrates adequate teaching/learning for self-care
Client will explain 3 adverse effects of medication
- Demonstrates adequate teaching/learning for self-care
Implementation
Administer medication
- Right drug
- Right dose
- Right route
- Right time
- Right patient
- Right documentation
High alert medications
Look-alike, sound alike drugs
Interventions
Drug Names and Classifications
Names
- Chemical: structure
- Generic: original name for common understanding
- Trade (brand) name: assigned by pharmaceutical company
o Fillers/binders differ between brand and generic – may alter bioavailability
Classifications
- Therapeutic: based on usefulness in treating diseases or disorders
o Analgesics, antihypertensives
- Pharmacologic: how drug produces physiological effect at molecular/tissue level
o Calcium channel blocker
Sources of Medications
Natural Sources
- Plants
o Active chemical found in a plant (ex: Digitalis)
- Animal products
o Replace human chemicals not produced because of disease or genetic issues
o Genetic engineering (ex: insulin, thyroid)
- Inorganic compounds
o Salts of various elements (ex: iron, fluoride)
Synthetic Sources
- Most drugs produced synthetically
Food and Drug Administration
Protects public health by ensuring safety, efficacy, and security of drugs, biological products and medical devices
Ensure safety of nation’s food supply, cosmetics, and products that emit radiation
Drug approval process tightly controlled by FDA
- Takes several years
- Several phases
Preclinical Investigational Studies
- Tested on laboratory animals
Phase I Studies
- Tested on healthy human volunteers (dose, range, and pharmacokinetics)
,Phase II Studies
- Tested on clients with disease (therapeutic effects, adverse effects)
Phase III Studies
- Large sample size; placebo and/or binded studies (effectiveness, safety, dose)
- Submission of new drug application; approved by FDA and given name; patent 5-7 years
Phase IV Studies
- Post marketing studies (2+ years); new or severe effects, black box
Legal Regulation of Drugs: Drug Enforcement Agency (DEA)
Controlled Substances Act of 1970
- Regulates manufacturing, distribution, and dispensing of drugs with known abuse potential (controlled)
- Anyone convicted of unlawfully manufacturing, distributing, or dispensing of controlled substances faces
severe penalties
Controlled drugs divided into five DEA schedules
- Based on potential for abuse/physical and psychologic dependence
Physicians and dispensing pharmacists must be registered with DEA
Nurses must be familiar with regulations and standard of practice
Schedule Controlled Substances
Schedule I (heroin, LSD)
- High abuse potential and no accepted medical use
Schedule II (narcotics, amphetamines, barbiturates)
- High abuse potential with severe dependence liability
Schedule III (nonamphetamines stimulates, nonbarbiturates sedatives)
- Less abuse potential and dependence liability than II (moderate)
Schedule IV (antianxiety agents, some sedative)
- Less abuse potential and dependence liability than III (moderate)
Schedule V (codeine)
- Limited abuse potential
Over the Counter (OTC) Drugs
No prescription required
Many originally approved as prescriptions; found safe used as directed
- Ex: loratadine (Claritin); fluticasone (Flonase); ibuprofen (Advil)
Problems with OTC use:
- Delay seeking treatment from healthcare provider
- Masks s/s of disease
- Drug-drug interactions
- Overdose/toxicity (acetaminophen)
- Abuse (pseudoephedrine, Robitussin)
Nurse – always ask patient about OTC, herbs, supplement
Assessment: Gather Information
, Health History
- Allergies (ask reaction – true allergy vs. adverse effect)
- Past medical history
- Medications (current and recent past, OTC, herbals, supplements)
- Diet, alcohol, drug use
- Education level (understanding on disease and therapy)
- Reproductive history (Pregnancy/nursing)
Physical Assessment
- Baseline VS, head to toe; cognition, weight, height, age
- Lab tests and other diagnostics
Diagnosis: Determine the Problems
Most problems related to adverse effects, toxicities, drug-drug interactions, medication error, ineffective self-care
Examples:
- Fluid imbalance related to diuretic medication
- Nausea related to opioid medication
- Risk for falls related to sedating effects of medication
- Ineffective health maintenance related to inappropriate dosing of medication
Planning: Goals/Expected Outcomes
Client will maintain a blood pressure within normal range
- Address therapeutic effect of medication
Client will maintain normal gas exchange and remain free from respiratory depression
- Addresses potential adverse effect
Client will demonstrate correct administration of medication
- Demonstrates adequate teaching/learning for self-care
Client will explain 3 adverse effects of medication
- Demonstrates adequate teaching/learning for self-care
Implementation
Administer medication
- Right drug
- Right dose
- Right route
- Right time
- Right patient
- Right documentation
High alert medications
Look-alike, sound alike drugs
Interventions
