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Chapter 1 Drugs/Agents and Factors Affecting Their Action Pharmacology Study of the history, sources, and physical and chemical properties of drugs Also looks at the ways in which drugs affect living systems Various subdivisions of pharmacology have evolved 1-2 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacodynamics Study of the biochemical and physiological effects of drugs Study of drugs’ mechanisms of action 1-3 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacokinetics Study of the absorption, distribution, biotransformation (metabolism), and excretion of drugs Four steps Absorption Distribution Metabolism Excretion 1-4 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacotherapeutics Study of how drugs may best be used in the treatment of illnesses Study of which drug would be most appropriate or least appropriate to use for a specific disease; what dose would be required; etc. 1-5 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacognosy The study of drugs derived from herbal and other natural (plant and animal) drug sources Studying compositions of natural substances helps to gain knowledge for developing synthetic versions 1-6 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Toxicology Study of poisons and poisonings All drugs have the potential to become toxic. 1-7 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. History of Pharmacology Ancient Egypt: the cradle of pharmacology These medical sources listed over 700 different remedies for different ailments. First century: Dioscorides prepared De Materia Medica: Listed and classified 600 different plants used for medicinal purposes; first time plants were ever classified 1-8 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Sources of Drugs Drugs derived from: Natural sources Semisynthetic sources Synthetic sources 1-9 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Drug Uses Symptomatic treatment Prevention Diagnostic drugs Curative Health maintenance Contraception 1 - 10 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Dosage Forms 1 - 11 Tablets Timed or sustained release Tablets or controlled release Capsule Troches Suppositories (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Dosage Forms Solutions Douche Suspensions Emulsions Topicals Patches Drug implants 1 - 12 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Parenteral Product Packaging Ampules Sterile Sealed glass or plastic container Contain a single liquid dose Vials: either single or multiple dose Glass or plastic container Sterile liquid dose Sealed with a rubber diaphragm 1 - 13 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Drug Names Chemical name The drug’s chemical composition and molecular structure Generic name (nonproprietary name) Name given by the United States Adopted Names Council Allows the drug to be marketed 1 - 14 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Brand Name Also called trade name (proprietary name) The drug has a registered trademark; use of the name is restricted by the drug’s owner (usually the manufacturer) Allows the drug to be commercially distributed The superscript ® is registered by the U.S. Patent Office and approved by the FDA (Food and Drug Administration) 1 - 15 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Drug Names: Examples Chemical name Generic name (+/-)-2-(p-isobutylphenyl) propionic acid Ibuprofen Trade name Motrin 1 - 16 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. U.S. Drug Legislation Pure Food and Drug Act of 1906 Federal Food, Drug, and Cosmetic Act of 1938 1 - 17 Required all drugs to meet minimal standards Required the drug to be safe before being distributed over state lines (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) U.S. Drug Legislation 1970: Comprehensive Drug Abuse Prevention and Control Act Also known as Controlled Substance Act: classified drugs according to their abuse potential Regulates the manufacture and distribution of drugs causing dependence 1 - 18 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Controlled Substances Schedules Schedule I High potential for abuse No medical use Heroin LSD Schedule II High potential for abuse Accepted medical use Morphine Demerol Schedule III Lower potential for abuse Accepted medical use Librium, Valium, hydrocodone, Tylenol with codeine Schedule IV Lower potential for abuse Accepted medical use Librium Valium Schedule V Lowest potential for abuse Accepted medical use Lomotil Robitussin A-C 1 - 19 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Prescription Drugs Prescription drugs = legend drugs Drugs prescribed by: Physician Nurse practitioner Physician’s assistant Dentist Veterinarian Others 1 - 20 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Principles of Drug Action Drugs Alter existing cellular or chemical functions Exert their action by forming a chemical bond with specific receptors within the body 1 - 21 Referred to as a lock and key effect (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Drug receptor interaction. Binding with specific receptors occurs only when the drug and its receptors have a compatible chemical shape. 1 - 22 (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Principles of Drug Action Receptors 1 - 23 The better the fit, the stronger the drug’s affinity, thus Drug effect occurs at lower doses (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Principles of Drug Action Agonist effect Antagonistic effect Adverse drug effect Therapeutic effect 1 - 24 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacokinetics: Absorption Routes Oral Parenteral Topical 1 - 25 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Metabolism: First-Pass Effect The metabolism of a drug and its passage from the liver into the circulation Metabolism occurs in the liver Liver enzymes react with the drug Increases the dosage requirement The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation. 1 - 26 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacokinetics: Distribution The transport of a drug in the body by the bloodstream to its site of action 1 - 27 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Elimination/Excretion The elimination of drugs from the body 1 - 28 Kidneys (main organ) Liver Bowel (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Renal excretion of drugs. Note sites where drugs are secreted and reabsorbed. 1 - 29 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pharmacokinetics: Measuring Drug Action Half-life The time it takes for one half of the original amount of a drug to be removed from the body 1 - 30 Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Chapter 2 Principles and Methods of Drug Administration Nursing Process Assessment Nursing diagnosis Planning Implementation Evaluation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Administering Medication Assessment Nursing diagnosis Planning Implementation Evaluation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. The Five (or Seven) Rights of Medications 1. 2. 3. 4. 5. 6. 7. Right drug Right dose Right client Right time Right route Right documentation Client’s right to refuse Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Parenteral Medications Intramuscular administration Subcutaneous administration Intradermal administration Intravenous administration Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Additional Methods of Administration Vaginal Rectal Ear Eye Nasal Nasogastric Epidural Transdermal patches Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Chapter 3 Nursing Clients Receiving Drugs Intravenously Intravenous Administration Collect materials needed. Select IV tubing. Select IV needle. Explain the procedure. Prepare the site. Secure the site. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Complications Infiltration Extravasation Thrombophlebitis Pain Fluid overload Pyrogenic reactions Tissue necrosis Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Calculations Total number of milliliters to be infused = Time in hours mL/hr mL/hr = mL/min time in minutes mL/min x SDF = gtt/min Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. IV Administration at Home Home care/client teaching Home health nurses Provide written guidelines Teach IV complications Teach when to call the nurse Teach dressing change guidelines Teach how to heparinize and flush a catheter Have the client return demonstrate skills Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Chapter 5 Drug Therapy for Pediatric Clients Pediatric Drug Therapy Approximately 75% of all prescription drugs in the U.S. lack full approval by the FDA because most drugs are not studied on children. Studying the effects of drugs in children is a problem. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Absorption Gastric acid (hydrochloric acid) secretion in infants Choosing the intramuscular injection site Topical drug absorption Intravenous drug administration Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Distribution Dependent upon the amount of water and/or fat present in the child, as well as plasma affinity of the drug and protein-binding activity Water-soluble drugs effectively utilized Protein binding capacity is less Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Metabolism Difficult to predict Maternal drug history is important Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Excretion Kidney maturation Excretion increases as the kidney matures Drug toxicity decreases as the kidney matures Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pediatric Drug Sensitivity Central nervous system drugs Barbiturates and morphine Depressant effects are exaggerated Lowering body temperature Acetaminophen • Becomes toxic easily with large doses Salicylates • Do not give to children under the age of 12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pediatric Dosages Determined by using a nomogram Nomograms are generally accurate after the attainment of mature liver and kidney function. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Rights to Follow Allow adequate time for drug administration. Gain the child’s trust. Never lie to the child. Consider the child’s developmental level. Prevent choking. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Administration Methods Liquid medications are administered using an infant dropper, syringe without a needle, or a small spoon Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Parenteral Medications Explain the procedure to the child and to the parents. Use additional materials such as: Booklets Coloring books Puppets Dolls IV setup with colored water Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Painful Procedures Allow the parents to stay. Painful procedures should be done in a separate room designated as the “owie” room. Use a firm positive manner. Assemble equipment first. Maintain the child’s safety. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Intramuscular Injections Vastus lateralis is the preferred site for children under the age of 3. Ventrogluteal site is the preferred site for children over the age of 3. The child should be walking. (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Anterior view of the location of the vastus lateralis muscle in a young child. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Final Step in Administering Drugs Evaluate drug action Remember Children are vulnerable. Be kind and patient. Enjoy the children; you will receive more than you give. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Chapter 28 Anxiolytics and Other Agents Used to Treat Psychiatric Conditions Psychotherapeutics Treatment of emotional and mental disorders Commonly prescribed drugs Used when a person’s ability to cope with his or her environment is seriously impaired Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Treatment Drug agents used for treatment of: Anxiety Mental and emotional disorders Psychoses Psychosis and affective disorders Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Anxiolytic Groups Four groups of anxiolytics (antianxiety) drugs used in the U.S. Barbiturates Carbamates Antihistamines Benzodiazepines Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Affective Disorders Two classes of agents used to treat affective disorders Antidepressant agents Antimanic agents Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Anxiolytics Barbiturates The oldest drugs to be used as anxiolytic agents Depress the CNS Suppress REM sleep Carbamates Depress the CNS Similar to barbiturates Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antihistamines and Benzodiazepines Antihistamines Used as anxiolytics Cause sedation Benzodiazepines First line of drugs used for anxiety disorders Produce sedation and muscle relaxation Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Anxiolytics: Side Effect/Adverse Effects Usually safe Sedation Relaxation Check vital signs Dangerous when taken with: Other sedating medications Alcohol Respiratory arrest Check kidney and liver labs Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antipsychotic Agents Treat mood disorders Schizophrenia Organic psychoses Manic phase of bipolar affective disorders (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Antipsychotic Agents Clients with psychotic disorders show symptomatic improvement Action Inhibit or alter the dopamine-mediated response in the brain Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Side Effects/Adverse Effects Extrapyramidal symptoms Tardive dyskinesia Impaired temperature regulation Lower the seizure threshold Endocrine changes Dermatological changes Photosensitivity Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Clozapine (Clozaril) An example of an antipsychotic drug agent Very effective Produces fewer side effects and adverse effects Agranulocytosis Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Antidepressant Agents Cyclic antidepressants Tricyclics Work by correcting an imbalance in the norepinephrine transmitter Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Tricyclic Antidepressants Used to treat Depression Chronic pain Bedwetting Examples: amitriptyline and imipramine Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Cyclic Antidepressants Adverse/side effects Orthostatic hypotension, extrapyramidal effects, sedation, weight gain, dry mouth, tachycardia, urinary retention, tremors, sexual dysfunction Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Monoamine Oxidase Inhibitors (MAOIs) Inhibit monoamine oxidase Monoamine oxidase Normally inactivates neurotransmitters such as serotonin and dopamine Dangerous side effects Hypotension Hypertension Death Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Newer Agents Sertraline HCl (Zoloft), Fluoxetine HCl (Prozac), Paroxetine HCl (Paxil) Action: act in a similar fashion to the tricyclic antidepressants Produce fewer sedative and anticholinergic effects Adverse effects and side effects • Nausea, dry mouth, headache, and dizziness Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Pediatric Considerations Higher risk for side effects, especially extrapyramidal symptoms Lithium, an antimanic agent, may lead to: Decreased bone density Decreased bone formation Children are very sensitive to these agents. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Geriatric Considerations The elderly process these agents much slower Side effects Toxic effects Orthostatic hypotension, sedation, and anticholinergic side effects Increased anxiety is associated with the use of tricyclic antidepressants (continues) Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. (continued) Geriatric Considerations May experience higher incidence of cardiac dysfunction such as a myocardial infarction Lithium is more toxic in elderly clients; lower doses are necessary. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Chapter 38 Agents Used in Obstetrical Care Agents Used in Obstetrical Care This presentation focuses on the following drug agents: Uterine stimulants Uterine relaxants Lactation suppressants Abortion inducers Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Oxytocin Stimulates the uterus and the mammary glands Affects the smooth muscle of the uterus to promote childbirth Increases frequency and force of uterine contractions Forces milk into mammary sinuses for the to infant Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Uterine Relaxants Prevent premature labor Ritodrine HCl A beta-adrenergic stimulant Relaxes the uterus Terbutaline sulfate (Brethine) Stimulates beta2 receptors Relaxes the uterus Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Lactation Suppressants Bromocriptine mesylate (Parlodel) A nonhormonal ergot derivative Estrogen is no longer used. High risk for thromboemboli and cancer of the reproductive tract Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. Abortion Inducers First trimester Suction curettage Second trimester Intra-amniotic injection of hypertonic (20%) NaCl Oxytocin Prostaglandins Most useful Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved.