Nur 641E Final

NUR 641E FINAL


Pharmacokineticsooinvolvesoo-ans--
absorption,oodistribution,oometabolismooandooelimination).

Absorption:oo-ans--
absorptionoofromootheooadministrationoositeooeitheroodirectlyooorooindirectlyoointoootheooblo
od/plasma.

Distribution:oo-ans--
reversiblyooorooirreversiblyoomoveoofromootheoobloodstreamoointoootheoointerstitialooandooi
ntracellular

Metabolism:oo-ans--biotransformedooviaoohepaticoometabolismoooroobyoootherootissues.

Elimination:oo-ans--
tissues.oolastly,ootheoodrugooandooitsoometabolitesooareooeliminatedoofromootheoobody.

routeooofooadministrationoowithootheoohighestoobioavailabilityoo-ans--
intravenous;ooputtingooentireoodoseoointoooaoopatient'sooveinooandoobypassingooabsorptio
n.

avoidsoofirst-passoometabolismoo-ans--Intravenousooroute

administrationoohasoovariableooandooerraticooabsorption.oonoo-ans--Rectalooadministration

4.ooSteadyoostateoo(SS)oo-ans--absorption.oonooisoousuallyooreachedoowithinoo4-5oohalf-
livesooofoodrug.

Half-lifeooofooaoodrugooisoo-ans--
howoolongooitootakesooforoohalfootheoodrugootooobeooexcretedoofromootheoobody.ooDetermin
esoohowoofrequentlyootheoodrugoomustoobeooadministered.ooPredictsoohowoolongootoxicooe
ffectsoocanoolast.isooconstantoowithoofirst-orderoopharmacokineticsooofooaoodrug.

Zero-orderoo(nonlinear)oopharmacokineticsoo-ans--
meansooaoodrugooisoometabolizedooatooaooconstantoorateooperoounitootime.

CYP3A4oosubstrateoodrugsoo-ans--
mayoohaveooenhancedooactivityooifooanyooCYP3A4ooinduceroodrugsooareoousedooalongoow
ithooit.

,DrugoodevelopmentooprocessooinvolvesootheseoostepsooaccordingootoootheooFDA:oo-ans--
Discovery:oolaboratoryooresearchootooodevelopootheoonewoodrug.ooPreclinicalooresearchoo
withooanimalootestingooforoosafetyoo(PhaseooI).ooClinicalooresearchooonoohumanoosubjects
ooforoomedicationoosafetyoo(PhaseooII).ooClinicalooresearchooinoohumansoocomparingoothe
oonewoodrugootoooacceptedoomedicationsooplacebooodependingooonootheoostudyoo(Phaseo
oIII).ooFDAooreviewooofootheooresultsootooodetermineooapproval.ooPostoomarketingoostudyoo
toooidentifyooadverseooeffectsoonotoofoundooinooearlierooclinicaloostudiesoo(PhaseooIV)

2.ooMedicationoosafetyooorganizationsoo-ans--
TheooInstituteooforooSafeooMedicationooPracticesoo(ISMP)ooTheooInstituteooofooMedicineoo
(IOM)ooTheooJointooCommissionooTheooNationalooCoordinatingooCouncilooforooMedication
ooErrorooReportingooandooPreventionoo(NCCooMERP)ooFoodooandooDrugooAdministrationo
o(FDA)ooSafeooUseooInitiative


TwooobasicootypeooofooADRS:oo-ans--pharmacologicalooandooidiosyncratic.

85%ootooo90%ooofooADRSoo-ans--areoopharmacological.

Adverseoodrugooreactionsooareoousuallyoopreventable,oo-ans--
frequentlyoooccurooinooaoohospitaloooroonursingoohomeoosetting,ooandooincludeoomedicatio
nooerrors,ooadverseoodrugooeffects,ooandooallergicooidiosyncraticootypeooreactions.

ADRSooareoonotoocommonlyooreported;oo-ans--
theooFDAoodoesoonotoomandateoothatooADRSoobeooreported.

Polypharmacyoo-ans--
involvesoousingoomultipleoohealthoocareooprovidersooforoocare,oousingoomultipleoomedicati
ons,ooandoousingooseveraloopharmaciesooprescriptionoofilling.

Angiotensinooconvertingooenzymeooinhibitorsoo(ACEIS):oo-ans--
lisinopril,oocaptopril,ooenalapril,ooramipril,oobenazepril,oofosinopril.

ACEISooreduceoobloodoopressureooenzyme.oo-ans--
byoosuppressingootheooreleaseooofooangiotensin-convertingooenzyme.

ImportantoosideooeffectsooofooACEooinhibitorsoo-ans--
Importantooincludeoocoughooandooangioedema;oodiscontinueootheooACEIooifooangioedem
aoooccurs.

AngiotensinooIIooreceptorooblockingooagentsoo(ARBS):oo-ans--
Icandesartanoo(Atacand),ooeprosartanoo(Teveten),ooirbesartanoo(Avapro),oolosartanoo(Co
zaar),ootelmisartanoo(Micardis)ooandoovalsartanoo(Diovan).

ARBSooreduceoobloodoopressureoo-ans--byooblockingooangiotensinooIIooreceptors.

, Essentialoo(primary)oohypertensionoo-ans--
Essentialoo(primary)ooaccountsooforoo90%ooofoocases;oosecondaryoohypertensionoomayoo
causedoobyoochronicoorenaloofailure.

Nitroglycerinoo-ans--
NitroglycerinooisooaoonitrateoodrugoothatoocanoobeooadministeredooIV,ooSL,ooaootopicaloooin
tmentooandooasooaootransdermaloopatch.

Nitratesooareoocontraindicatedoo-ans--withooPDE-
5ooinhibitorsoo(e.g.,oosildenafilooandoovardenafil)

Amiodaroneooisootheooantiarrhythmicoo-ans--
Ofoochoiceoowhenoothereooisoocoexistingooheartoofailure;oocanoocauseoothyroidooandoopul
monaryootoxicity.

Alpha-1ooadrenergicoostimulationoo-ans--
resultsooinoovasoconstrictionooandooincreasedoobloodoopressure.

Alpha-1ooadrenergicooblockadeoo-ans--
resultsooinoovasodilationooandooreducedoobloodoopressure.

Beta-1ooadrenergicoostimulationoo-ans--
byoobetaooagonistsoo(e.g.,ooisoproterenol)ooresultsooinooincreasedooheartoorate,ooincrease
doobloodoopressure,ooandooincreasedoocardiacoooutput.

Beta-1ooadrenergicooblockadeooresultsoo-ans--
inooreducedooheartoorate,ooreducedoobloodoopressure,ooandooreducedoocardiacoooutput.

Leftooheartoofailureoo-ans--
causesooreducedoodeliveryooofoooxygenatedoobloodootoootheoobodyootissues.

Rightooheartoofailureoo-ans--
isooassociatedoowithoopulmonaryoodiseaseooandooincreasedoopulmonaryoovascularooresist
ance.

drugoothatoorelievesooheartoofailureoosymptomsoobutoodoesoonotooreduceoomortalityoo-
ans--furosemide.

Loopoodiureticsoolikeoofurosemideoo-ans--
areoopotentoodiuretics,oocanoocauseoodiureticooresistanceooandoohypokalemia,ooandoowor
kooonooreceptorsooinootheoothickooascendingoorenalooloopooofooHenle.

Loopoodiureticsooinhibitoo-ans--
reabsorptionooofoosodiumooandoochlorideooatoothisoositeooinootheookidney.

Potassium-sparingoodiuretics:oo-ans--spironolactone,ootriamterene.