1. introduction to nursing pharmacology.ppt

8/19/2019 1. INTRODUCTION TO NURSING PHARMACOLOGY.ppt

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I. OVERVIEW

• What is PHARMACOLOGY?


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I. OVERVIEW

• Pharmacology is the study of drugs !he"i!a#s$

that a#ter fu%!tio%s of #i&i%g orga%is"s.

• Drug therapy, a#so !a##ed 'har"a!othera'y( is theuse of drugs to 're&e%t( diag%ose( or treat sig%s(

sy"'to"s( a%d disease 'ro!esses.

• )rugs gi&e% for thera'euti! 'ur'oses are usua##y!a##ed medications.


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PHARMACOTHERAPEUTC!

• is the *ra%!h of 'har"a!o#ogy that uses

drugs to treat( 're&e%t a%d diag%ose.


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PHARMACODYNAMICS

• +tudy of *io!he"i!a# a%d 'hysio#ogi!a#

effe!ts of drugs, study of drugs

"e!ha%is" of a!tio%.


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PHARMACO"#ETC!

• +tudy of the a*sor'tio%( distri*utio%( a%d

*iotra%sfor"atio% "eta*o#is"$ a%d

e-!retio% of drugs.


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PHARMACO$#O!%

• +tudy of drugs deri&ed fro" her*a# a%d

other %atura# sour!es.


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TO&CO'O$%

• +tudy of 'oiso%s a%d 'oiso%i%g.


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SOURCES OF DRUGS

• P#a%ts

• A%i"a#s• Mi%era#s

• +y%theti! !he"i!a#


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DRUG CLASSIFICATIONS

• )rugs are !#assified a!!ordi%g to their

effe!ts o% 'arti!u#ar *ody syste"s(

their thera'euti! uses.


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A. PRE!CRPTO# DRU$!

• Are those that ha&e o% their #a*e#s the

'res!ri'tio% #ege%d.

• May *e 'res!ri*ed *y the 'hysi!ia%s(de%tists( &eteri%aria%s( or other #ega##y

authoried hea#th 'ra!titio%er as 'art of

their s'e!ifi! 'ra!ti!e.


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(. #O#)PRE!CRPTO# DRU$!

• /he drugs that "ay *e #ega##y a!0uired

*y the !#ie%t 1ithout the 'res!ri'tio%

order.• A#so 2%o1% as o&er the !ou%ter drugs

O/C$


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C. #*E!T$ATO#A' DRU$!

• A %e1 drug 1hi!h a "a%ufa!turer 1ishes

to "ar2et.

• Must fu#fi## the re0uire"e%ts of 3)A.


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D. ORPHA# DRU$

• Are drugs that ha&e *ee% dis!o&ered *ut

are %ot fi%a%!ia##y &ia*#e a%d therefore

ha&e %ot *ee% 4ado'ted5 *y a%y drug!o"'a%y.


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E. E''CT DRU$

• a.2.a. 4street6 drugs are those 1hi!h are

used a%d7or distri*uted i##ega##y.


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Legal Regulation of Drugs

• A. 3)A Preg%a%!y Categories

• 8. Co%tro##ed +u*sta%!es


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A. 3)A Preg%a%!y

Categories


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Category A

• Ade0uate studies i% 'reg%a%t 1o"e%

ha&e #OT de"o%strated a ris2 i% the

fetus i% the first tri"ester of 'reg%a%!ya%d there is no e+idence o ris- i% #ater

tri"ester.


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Category (

• A%i"a# studies ha&e #OT demonstrated a

ris- or the etus *ut there are #o adeuate

studies in pregnant /omen, or animalstudies ha&e sho1% a% ad&erse effe!t( *ut

ade0uate studies i% 'reg%a%t 1o"e% ha&e %ot

de"o%strated a ris2 to the fetus duri%g thefirst tri"ester( a%d there is %o e&ide%!e of ris2

o% #ater tri"ester.


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Category C

• A%i"a# studies ha&e sho/n an ad+erse

eect o% the fetus *ut there are no adeuate

studies in humans, the *e%efits fro" the useof the drug i% 'reg%a%t 1o"e% "ay *e

a!!e'ta*#e des'ite the 'ote%tia# ris2s( or there

are %o a%i"a# re'rodu!tio% studies a%d %oade0uate studies i% hu"a%s.


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Category D

• /here is e+idence o human etal ris- (

*ut the 'ote%tia# *e%efits fro" the use of

the drug i% 'reg%a%t 1o"e% "ay *ea!!e'ta*#e des'ite of its 'ote%tia# ris2s.


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8. Co%tro##ed

+u*sta%!es


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Schedule I

• )rugs that are %ot a''ro&ed for "edi!a#

use a%d ha&e high a*use 'ote%tia#s9

heroin, lysergic acid diethylamide0'!D1, peyote, mescaline,

tetrahydrocanna2inol, mari3uana.


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Schedule II

• )rugs that are used "edi!a##y a%d ha&e higha*use 'ote%tia#s9 opioid analgesics eg(

!odei%e( hydro"or'ho%e( "ethado%e(

"e'eridi%e( morphine, o-y!odo%e(o-y"or'ho%e 1, central ner+ous system 0C#!1

stimulants eg( !o!ai%e( "etha"'heta"i%e(

"ethy#'he%idate$( a%d 2ar2iturate sedati+e)hypnotics a"o*ar*ita#( 'e%to*ar*ita#(

se!o*ar*ita#$.


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Schedule III

• )rugs 1ith #ess 'ote%tia# for a*use tha% those

i% +!hedu#es I a%d II( *ut a*use "ay #ead to

'sy!ho#ogi!a# or 'hysi!a# de'e%de%!e9 an)drogens and ana2olic steroids, some C#!

stimulants eg( *e%'heta"i%e$( a%d

"i-tures !o%tai%i%g s"a## a"ou%ts of!o%tro##ed su*sta%!es eg( !odei%e(

*ar*iturates %ot #isted i% other s!hedu#es$.


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Schedule IV

• )rugs 1ith so"e 'ote%tia# for a*use9

2en4odia4epines 0eg, dia4epam,

lora4epam, tema4epam1, other sedati&e:hy'%oti!s eg( 'he%o*ar*ita#( !h#ora# hydrate$(

a%d so"e 'res!ri'tio% a''etite su''ressa%ts

eg( "ai%do#( 'he%ter"i%e$.


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Schedule V

• Produ!ts !o%tai%i%g "oderate a"ou%ts of

!o%tro##ed su*sta%!es. /hey "ay *e

dis'e%sed *y the 'har"a!ist /ithout a physician5s prescription *ut 1ith so"e

restri!tio%s regardi%g a"ou%t( re!ord 2ee'i%g(

a%d other safeguards. I%!#uded area%tidiarrhea# drugs( su!h as dipheno6ylate

and atropine 0'omotil1.


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CLASSIFICATIONS

• A%ti'yreti!

• A%a#gesi!s

• A%ti*ioti!s

• A%tide'ressa%ts• a%ti:hy'erte%si&es

• a%ti:dia*eti!

•A%tihista"i%e• A%titussi&e

• !ho#i%ergi!s

• )e!o%gesta%ts

• )iureti!s

• E"eti!s

• E-'e!tora%ts• Hy'%oti!s

• La-ati&es

• +edati&es

• /ra%0ui#iers• A%ti'sy!hoti!• PHARMACOLOGY;PHARMACOLOGY

+O


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DRUG NAMES

• I%di&idua# drugs "ay ha&e se&era#

differe%t %a"es( *ut the t1o "ost

!o""o%#y used are the $E#ERC#AME a%d the TRADE #AME a#so

!a##ed the *ra%d or 'ro'rietary %a"e$.


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• /he $E#ERC #AME eg( amoxicillin$is re#ated to the !he"i!a# or offi!ia# %a"e

a%d is i%de'e%de%t of the "a%ufa!turer.

• )iffere%tiated fro" /rade


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• /he TRADE #AME is desig%ated a%d'ate%ted *y the "a%ufa!turer.

• CAPTA'7ED 9R!T 'ETTER• 3or e-a"'#e( a"o-i!i##i% is "a%ufa!tured

*y se&era# 'har"a!euti!a# !o"'a%ies(

so"e of 1hi!h assig% a s'e!ifi! trade%a"e eg( Amoxil, Trimox$


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• CHEMCA' #AME is the e-a!t "o#e!u#ar

for"u#a of the drug, usua##y a #o%g( &ery

diffi!u#t %a"e to 'ro%ou%!e a%d of a #itt#e!o%!er% to the hea#th !are 1or2er.


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• O99CA' #AME is the %a"e of the drug

as it a''ears i% the offi!ia# refere%!e( the

>+P7


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GENERIC NAME TRADE NAME

i*u'rofe% Ad&i#

#orae'a" Ati&a%

di'he%hydra"i%e 8e%adry#

!a'to'ri# Ca'ote%


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GENERIC NAME TRADE NAME

!#o%idi%e Cata'res

!e#e!o-i* Ce#e*re-

"etfor"i% G#u!o'hage

"iso'rosto# Cytote!


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PRESCRIPTION AND

NONPRESCRIPTION DRUGS

• Lega##y( !o%su"ers ha&e t1o routes of a!!ess to

thera'euti! drugs.

• O%e route is *y PRE!CRPTO# or order fro" a#i!e%sed hea#th !are 'ro&ider( su!h as a

'hysi!ia%( de%tist( or %urse 'ra!titio%er.

• /he other route is *y O*ER)THE)COU#TER O/C$ 'ur!hase of drugs that do %ot re0uire a

'res!ri'tio%.


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DRUG APPROVAL PROCESSES

• /he 9DA 09ood and Drug

Administration1 is res'o%si*#e for

assuri%g that %e1 drugs are safe a%deffe!ti&e *efore a''ro&i%g the drugs

a%d a##o1i%g the" to *e "ar2eted.


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Testin an! Clinical Trials

• /he testi%g 'ro!ess *egi%s 1ith

animal studies to deter"i%e

'ote%tia# uses a%d effe!ts.


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• I% Phase , a fe1 doses are gi&e% to a

fe1 hea#thy &o#u%teers to deter"i%e safe

dosages( routes of ad"i%istratio%(a*sor'tio%( "eta*o#is"( e-!retio%( a%d

to-i!ity.


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• I% Phase ( a fe1 doses are gi&e% to a

fe1 su*e!ts 1ith the disease or sy"'to"

for 1hi!h the drug is *ei%g studied( a%dres'o%ses are !o"'ared 1ith those of

hea#thy su*e!ts.


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• I% Phase , the drug is gi&e% to a #arger

a%d "ore re'rese%tati&e grou' of

su*e!ts.


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• I% phase *, after a drug is a''ro&ed for

"ar2eti%g( it e%ters a 'hase of !o%ti%ua#

e&a#uatio%.


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INDICATIONS

• A #ist of "edi!a# !o%ditio%s or diseases

for 1hi!h the drug is "ea%t to *e used.


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ACTIONS

• A des!ri'tio% of the !e##u#ar !ha%ges that

o!!ur as a resu#t of the drug.


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CONTRAINDICATIONS

• A #ist of !o%ditio%s for 1hi!h the drug

shou#d %ot *e gi&e%.


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SIDE EFFECTS an! ADVERSE

REACTIONS

• A #ist of 'ossi*#e u%'#easa%t or

da%gerous effe!ts( other tha% the desired

effe!ts(


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INTERACTIONS

• A #ist of other drugs or foods that "ay

a#ter the effe!ts of the drug a%d usua##y

shou#d %ot *e gi&e% duri%g the sa"e!ourse of thera'y.


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Basic Concepts and

Processes


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• Ho1 do syste"i! drugs rea!h(

i%tera!t 1ith( a%d #ea&e *ody !e##s?

• Ho1 do 'eo'#e res'o%d to drug

a!tio%s?


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CELLULAR P"#SIOLOG#

• Ce##s are dy%a"i!( *usy( 4fa!tories5

• /hat is( they ta2e i% ra1 "ateria#s(

"a%ufa!ture &arious 'rodu!ts re0uiredto "ai%tai% !e##u#ar a%d *odi#y fu%!tio%s(

a%d de#i&er those 'rodu!ts to their

a''ro'riate desti%atio%s i% the *ody.

DRUG TRANSPORT T"ROUG"


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DRUG TRANSPORT T"ROUG"

CELL MEM$RANES

• Most drugs are gi&e% for effe!ts o% *ody

!e##s that are dista%t fro" the sites of

ad"i%istratio% ie( syste"i! effe!ts$. /o"o&e through the *ody a%d rea!h their

sites of a!tio%( "eta*o#is"( a%d e-!retio%

drug "o#e!u#es "ust !ross %u"erous !e##"e"*ra%es.


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P"ARMACO%INETICS

• Phar"a!o2i%eti!s i%&o#&es drug

"o&e"e%t through the *ody ie(

:/hat the 2ody does to the drug;1to rea!h sites of a!tio%( "eta*o#is"(

a%d e-!retio%.• PHARMACOLOGY;VI)EO+;Phar"a!o2i%eti!s @ What the 8ody )oes to a )rug."'=


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&' A$SORPTION

• A2sorption is the 'ro!ess that

o!!urs fro" the ti"e a drug e%ters

the *ody to the ti"e it e%ters the*#oodstrea" to *e !ir!u#ated.

• PHARMACOLOGY;A


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PH%!CA' 9ACTOR! #9'UE#C#$

A(!ORPTO#

:*#ood f#o1 to the intestine is "u!hgreater tha% the f#o1 to the sto"a!h,

thus a*sor'tio% fro" the i%testi%e is

fa&ored o&er that fro" the sto"a!h.


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?. TOTA' !UR9ACE AREA a+aila2le or

a2sorption>

: *e!ause the i%testi%e has a surfa!eri!h i% "i!ro&i##i( it has a surfa!e area a*out


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. CO#TACT TME at the a2sorption

surace>

: a%ythi%g that de#ays the tra%s'ort ofthe drug fro" the sto"a!h to the i%testi%e

delays the rate of a*sor'tio% of the drug.


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BIOVAILABILITY

• Is the fra!tio% of ad"i%istered drug that

rea!hes the syste"i! !ir!u#atio%.

• E-9 if B"g of drug is ad"i%istered ora##y

a%d D"g of this drug is a*sor*ed

u%!ha%ged( the *ioa&ai#a*i#ity is D .


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(' DISTRI$UTION

• Distri2ution i%&o#&es the transport of

drug "o#e!u#es 1ithi% the *ody.

• O%!e a drug is i%e!ted or a*sor*ed i%tothe *#oodstrea"( it is !arried *y the *#ood

a%d tissue f#uids to its sites of

'har"a!o#ogi! a!tio%( "eta*o#is"( a%d

e-!retio%


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• )istri*utio% de'e%ds #arge#y o% the

adeuacy o 2lood circulation.

• )rugs are distri*uted ra'id#y to orga%sre!ei&i%g a #arge *#ood su''#y( su!h as

the li+er, heart, and -idneys.


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• )istri*utio% to other internal organs,

muscle, at, and s-in is usually

slo/er.

• PHARMACO'O$%BPharmacology Meds Distri2ution.mp


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• Protein 2inding a##o1s 'art of a drug dose

to *e stored a%d re#eased as %eeded.

• +o"e drugs a#so are stored i% "us!#e( fat(

or other *ody tissues a%d re#eased gradua##y 1he% '#as"a drug #e&e#s fa##. /hese storage

"e!ha%is"s "ai%tai% #o1er( "ore e&e%

*#ood #e&e#s a%d redu!e the ris2 of to6icity


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• )rug distri*utio% i%to the central

ner)o*s s+stem CNS- is limite!

*e!ause the *#oodF*rai% *arrier( 1hi!h is!o"'osed of !a'i##aries 1ith tight 1a##s(

#i"its "o&e"e%t of drug "o#e!u#es i%to

*rai% tissue


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• )rug distri*utio% duri%g .renanc+ a%d#a!tatio% is a#so u%i0ue.

• )uri%g .renanc+, "ost drugs !ross the placenta a%d "ay affe!t the fetus.

• )uri%g lactation( "a%y drugs e%ter

*reast "i#2 a%d "ay affe!t the %ursi%gi%fa%t.


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/' META$OLISM

• Meta2olism is the "ethod *y 1hi!h drugs arei%a!ti&ated or 2io transormed *y the *ody.

• Most ofte%( a% a!ti&e drug is !ha%ged i%to o%e or

"ore i%a!ti&e "eta*o#ites( 1hi!h are the%e-!reted.

• +o"e a!ti&e drugs yie#d "eta*o#ites that are a#so

a!ti&e a%d that !o%ti%ue to e-ert their effe!ts o%*ody !e##s u%ti# they are "eta*o#ied further ore-!reted.


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• Most drugs are lipid solu2le( a !hara!teristi!

that aids their "o&e"e%t a!ross !e##"e"*ra%es.

• Ho1e&er( the 2id%eys( 1hi!h are the 'ri"ary

e-!retory orga%s( !a% e-!rete o%#y /ater)

solu2le su2stances. /herefore( o%e fu%!tio%

of "eta*o#is" is to con)ert 0at1sol*2le drugsi%to 3ater1sol*2le meta2olites.


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• Whe% drugs are gi&e% orally, they are

a*sor*ed fro" the GI tra!t a%d !arried to the#i&er through the 'orta# !ir!u#atio%.

• +o"e drugs are e-te%si&e#y "eta*o#ied i%

the li+er, 1ith o%#y 'art of a drug doserea!hi%g the syste"i! !ir!u#atio% fordistri*utio% to sites of a!tio%. /his is !a##ed the

irst)pass eect or 'resyste"i! "eta*o#is".• PHARMACOLOGY;VI)EO+;3irst Pass Meta*o#is" : Phar"a!o#ogy Le!t

."'=


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• /he '*ER is the "aor site of

"eta*o#is"( *ut s'e!ifi! drugs "ay

u%dergo *iotra%sfor"atio% i% othertissues.


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4' E5CRETION

• E6cretion refers to elimination of a drug

fro" the *ody.

• Effe!ti&e e-!retio% re0uires ade0uatefu%!tio%i%g of the !ir!u#atory syste" a%d

of the orga%s of e-!retio% 6i!ne+s,

2o3el, l*ns, an! s6in-'


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• Most drugs are e6creted *y the -idneys

a%d e#i"i%ated u%!ha%ged or as"eta*o#ites i% the urine.

• +o"e drugs or "eta*o#ites are e-!reted i%

2ile( the% e#i"i%ated i% eces

• others are e-!reted i% *i#e( rea*sor*ed

fro" the s"a## i%testi%e( retur%ed to the#i&er !a##ed enterohepatic recirculation$(


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• /he lungs "ai%#y re"o&e &o#ati#e

su*sta%!es( su!h as anesthetic gases.

• /he s-in has "i%i"a# e-!retory fu%!tio%.

• PHARMACOLOGY;A


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RE


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+eru" )rug Le&e#s

• A serum drug level is a #a*oratory

"easure"e%t of the a"ou%t of a drug i%

the *#ood at a 'arti!u#ar ti"e.• It ref#e!ts dosage( a*sor'tio%(

*ioa&ai#a*i#ity( ha#f:#ife( a%d the rates of

"eta*o#is" a%d e-!retio%.


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• A to6ic concentration is a% e-!essi&e

#e&e# at 1hi!h to-i!ity o!!urs.

• /o-i! !o%!e%tratio%s "ay ste" fro" asi%g#e #arge dose( re'eated s"a## doses(

or s#o1 "eta*o#is" that a##o1s the drug

to a!!u"u#ate i% the *ody.


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• 3or "ost drugs( seru" #e&e#s i%di!ate the

onset, pea-, and duration o drug

action.


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• /he drug #e&e# !o%ti%ues to !#i"* as

"ore of the drug is a*sor*ed( u%ti# it

rea!hes its highest !o%!e%tratio% a%d'ea2 drug a!tio% o!!urs. /he%( drug

#e&e#s de!#i%e as the drug is e#i"i%ated

ie( "eta*o#ied a%d e-!reted$ fro" the*ody.


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S l0 i0


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Ser*m "al01Li0e

• !erum hal)lie, a#so !a##ed elimination

half-life, is the ti"e re0uired for the seru"

!o%!e%tratio% of a drug to decrease 2yF@G. It is deter"i%ed 'ri"ari#y *y the drug6s

rates of "eta*o#is" a%d e-!retio%. A drug

1ith a short ha#f:#ife re0uires "ore fre0ue%tad"i%istratio% tha% o%e 1ith a #o%g ha#f:#ife.

P"ARMACOD#NAMICS


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P"ARMACOD#NAMICS

• Pharmacodynamics i%&o#&es drug

a!tio%s o% target !e##s a%d the resu#ti%g

a#teratio%s i% !e##u#ar *io!he"i!a#rea!tio%s a%d fu%!tio%s 0ie, :/hat the

drug does to the 2ody; 1.

• As 're&ious#y stated( a## drug a!tio%s

o!!ur at the !e##u#ar #e&e#.

VARIA$LES T"AT AFFECT


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VARIA$LES T"AT AFFECT

DRUG ACTIONS

• E-'e!ted res'o%ses to drugs are #arge#y

*ased o% those o!!urri%g 1he% a

'arti!u#ar drug is gi&e% to hea#thy adu#t"e% 0


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• Ho1e&er( other groups o people eg(

1o"e%( !hi#dre%( o#der adu#ts( differe%t

eth%i! or ra!ia# grou's( a%d !#ie%ts 1ithdiseases or sy"'to"s that the drugs are

desig%ed to treat$ re!ei&e drugs a%d

respond dierently tha% hea#thy adu#t"e%.

D R l t ! V i 2l


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Dr*1Relate! Varia2les

• Dosage

Fdose i%di!ates the a"ou%t to *e gi&e%

at o%e ti"e a%d dosage refers to thefre0ue%!y( sie( a%d %u"*er of doses.


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• Dosage is a "aor deter"i%a%t of drug a!tio%s

a%d res'o%ses( *oth thera'euti! a%d ad&erse.• If the a"ou%t is too small or ad"i%istered

inreuently ( %o 'har"a!o#ogi! a!tio% o!!urs

*e!ause the drug does %ot rea!h a% ade0uate

!o%!e%tratio% at target !e##s.

•If the a"ou%t is too large or ad"i%istered tooofte%( to6icity 'oiso%i%g$ "ay o!!ur.


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• M#MUM DO!E F a s"a##est a"ou%t of a

drug that 1i## 'rodu!e a thera'euti! effe!t.

• MA&MUM DO!E F #argest a"ou%t of a

drug that 1i## 'rodu!e a desired effe!t

1ithout 'rodu!i%g sy"'to"s of to-i!ity.


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• 'OAD#$ DO!E F i%itia# high dose used to

0ui!2#y e#e&ate the #e&e# of the drug i% the *#ood

ofte% fo##o1ed *y a series of #o1er doses$

• MA#TE#A#CE DO!E F dose re0uired to

2ee' the drug *#ood #e&e# at a steady state i%order to "ai%tai% the desired effe!t.


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• TO&C DO!E F a"ou%t of drug that 1i##

'rodu!e har"fu# effe!ts or sy"'to"s of

to-i!ity.

• 'ETHA' DO!E F dose that !a% !ause death.

• THERAPEUTC DO!E) dose that is

!usto"ari#y gi&e%, adusted a!!ordi%g to&ariatio%s fro" the %or".

ROUTE O9 ADM#!TRATO#


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ROUTE O9 ADM#!TRATO#

• /here are t1o "aor routes of drug

ad"i%istratio%,

• ENTERAL

• PARENTERAL


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ENTERAL


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ENTERAL


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• 9R!T PA!! "eta*o#is" *y the i%testi%e

or '*ER #i"its the effi!a!y of "a%y

drugs 1he% ta2e% ora##y.

• PHARMACOLOGY;VI)EO+;3irst Pass Meta*o#is" : Phar"a!o#ogy

Le!t ."'=


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?. !U('#$UA'

: '#a!e"e%t u%der the to%gue.


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. RECTA'

: *oth the su*#i%gua# a%d the re!ta#

ha&e the additio%a# ad&a%tage that they pre+ent the destruction of the drug *y

intestinal en4ymes or lo/ pH i% the

sto"a!h.

PARENTERAL


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PARENTERAL

1. 3or ra'id drug a!tio% a%d res'o%se(

the * 0ntra+enous1 route is "ost

effe!ti&e *e!ause the drug is i%e!teddire!t#y i%to the *#oodstrea".


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2. 3or so"e drugs( the M

0ntramuscular1 route a#so 'rodu!es

drug a!tio% 1ithi% a fe1 "i%utes*e!ause "us!#es ha&e a #arge *#ood

su''#y.


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. !U(CUTA#EOU!

It re0uires a*sor'tio% a%d is

so"e1hat slo/er tha% the IV route.

OT"ERS


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OT"ERS

1. INHALATION

. INT!ANA"AL

#. INT!ATH$CAL%. &A'INAL

(. T!AN")$!*AL+. TOPICAL


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• A*sor'tio% a%d a!tio% of to.ical drugs&ary a!!ordi%g to the drug for"u#atio%(

1hether the drug is a''#ied to s2i% or"u!ous "e"*ra%es( a%d other fa!tors.

Drug Diet nteractions


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DrugDiet nteractions

• 9ood "ay a#ter the a*sor'tio% of ora# drugs. I%"a%y i%sta%!es( ood slo/s a2sorption *y

s#o1i%g gastri! e"'tyi%g ti"e a%d a#teri%g GI

se!retio%s a%d "oti#ity.• Whe% ta*#ets or !a'su#es are ta2e% 1ith or soo%

after food( they disso#&e "ore s#o1#y, therefore(

drug "o#e!u#es are de#i&ered to a*sor'ti&e sites i%the s"a## i%testi%e "ore slo/ly


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• 3ood a#so "ay decrease a*sor'tio% *y!o"*i%i%g 1ith a drug to for" a%

i%so#u*#e drugFfood !o"'#e-.


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• I% other i%sta%!es( ho1e&er( !ertai%

drugs or dosage for"s are *etter

a*sor*ed 1ith !ertai% ty'es of "ea#s.

Drug Drug nteractions


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DrugDrug nteractions

• /he a!tio% of a drug "ay *e increased ordecreased *y its i%tera!tio% 1ith a%other

drug i% the *ody. Most i%tera!tio%s o!!ur

1he%e&er the i%tera!ti%g drugs are 'rese%ti% the *ody, so"e( es'e!ia##y those

affe!ti%g the a*sor'tio% of ora# drugs( o!!ur

1he% the i%tera!ti%g drugs are gi&e% at or%ear the sa"e ti"e.

ncreased Drug Eects


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ncreased Drug Eects

• I%tera!tio%s that !a% i%!rease thethera'euti! or ad&erse effe!ts of drugs

are as fo##o1s9

Additive effects


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Additive effects

• Additive effects o!!ur 1he% t1o drugs 1ith si"i#ar 'har"a!o#ogi! a!tio%s are

ta2e%.• $ample etha%o# sedati&e drug

increased sedation

"ner/ism or potentiation


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"ner/ism or potentiation

• !ynergism or potentiation o!!urs 1he% t1odrugs 1ith differe%t sites or "e!ha%is"s of

a!tio% 'rodu!e greater effe!ts 1he% ta2e%

together tha% either does 1he% ta2e% a#o%e.

• $ample a!eta"i%o'he% %o%:o'ioid

a%a#gesi!$ !odei%e o'ioid a%a#gesi!$increased analgesia

Interference


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Interference

• ntererence *y o%e drug 1ith the "eta*o#is"or e#i"i%atio% of a se!o%d drug "ay resu#t i%

i%te%sified effe!ts of the se!o%d drug.

• $ample !i"etidi%e i%hi*its CYP BA( JC( a%d

KA drug:"eta*o#ii%g e%y"es i% the #i&er a%d

therefore i%terferes 1ith the "eta*o#is" of

"a%y drugs


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111/140

Decreased Drug Eects


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Decreased Drug Eects

• I%tera!tio%s i% 1hi!h drug effe!ts arede!reased are grou'ed u%der the ter"

antagonism.• E-a"'#es of su!h i%tera!tio%s are as

fo##o1s9

I it ti d th t i ifi tid t


113/140

• I% so"e situatio%s( a drug that is a s'e!ifi! antidote

is gi&e% to antagoni4e the to-i! effe!ts of a%other

drug.

• $ample %a#o-o%e a %ar!oti! a%tago%ist$

"or'hi%e a %ar!oti! or o'ioid a%a#gesi!$ relie

o opioid induced respiratory depression.


114/140

• )e!reased i%testi%a# a*sor'tio% of ora# drugso!!urs 1he% drugs !o"*i%e to 'rodu!e

%o%a*sor*a*#e !o"'ou%ds.

• $ample a#u"i%u" or "ag%esiu" hydro-ide

a%ta!ids$ ora# tetra!y!#i%e a% a%ti*ioti!$

*i%di%g of tetra!y!#i%e to a#u"i%u" or

"ag%esiu"( !ausi%g decreased a2sorptionand decreased anti2iotic eect o tetracycline


115/140

• A!ti&atio% of drug:"eta*o#ii%g e%y"es i% the

#i&er i%!reases the "eta*o#is" rate of a%ydrug "eta*o#ied 'ri"ari#y *y that grou' of

e%y"es. +e&era# drugs eg( 'he%ytoi%(

rifa"'i%$( etha%o#( a%d !igarette s"o2i%g are2%o1% en0me indcers.

• $ample 'he%o*ar*ita# a *ar*iturate$

1arfari% a% a%ti!oagu#a%t$ decreased

eects o /ararin


116/140

• I%!reased e-!retio% o!!urs 1he% uri%ary 'His !ha%ged a%d re%a# rea*sor'tio% is *#o!2ed.

• $ample sodiu" *i!ar*o%ate

'he%o*ar*ita# i%!reased e-!retio% of

'he%o*ar*ita#. /he sodiu" *i!ar*o%ate

a#2a#i%ies the uri%e( raising the num2er o2ar2iturate ions in the renal iltrate.

Client1Relate! Varia2les


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Client Relate! Varia2les

• Age

• /he effe!ts of age o% drug a!tio% are "ost

'ro%ou%!ed i% %eo%ates( inants, and olderadults. n children( drug a!tio% de'e%ds

#arge#y o% ae an! !e)elo.mental stae.

)uri%g pregnancy ( drugs !ross the placenta a%d "ay har" the fetus.


118/140

• )rug distri*utio%( "eta*o#is"( a%d e-!retio%differ "ar2ed#y i% %eo%ates( es'e!ia##y're"ature i%fa%ts( *e!ause their orga%

syste"s are not ully de+eloped .• O#der i%fa%ts B "o%th to B year$ rea!h

a''ro-i"ate#y adu#t #e&e#s of 'rotei% *i%di%g

a%d 2id%ey fu%!tio%( 2ut li+er unction andthe 2lood2rain 2arrier are still immature.


119/140

• Children 0< to


120/140

• I% older adults 0IF years and older1,'hysio#ogi! !ha%ges "ay a#ter a##

'har"a!o2i%eti! 'ro!esses. Cha%ges i% the

$ tract include decreased gastric acidity,

decreased 2lood lo/, and decreased

motility . )es'ite these !ha%ges( ho1e&er(there is #itt#e differe%!e i% a*sor'tio%.


121/140

• (ody =eight

• 8ody 1eight affe!ts drug a!tio% "ai%#y i%

re#atio% to dose. /he ratio *et1ee% thea"ou%t of drug gi&e% a%d *ody 1eight

i%f#ue%!es drug distri*utio% a%d

!o%!e%tratio% at sites of a!tio%.


122/140

• I% ge%era#( 'eo'#e hea+ier than a+erageneed larger doses( 'ro&ided that their

re%a#( he'ati!( a%d !ardio&as!u#arfu%!tio%s are ade0uate. Re!o""e%ded

doses for "a%y drugs are #isted i% ter"s

of gra"s or milligrams per -ilogram of*ody 1eight.


123/140

• /o#era%!e to 'har"a!o#ogi!a##y re#ated drugs is


124/140

' g y g

!a##ed cross)tolerance.

• 3or e-a"'#e( a 'erso% 1ho regu#ar#y dri%2s

#arge a"ou%ts of a#!oho# *e!o"es a*#e to

i%gest e&e% #arger a"ou%ts *efore *e!o"i%g

i%to-i!ated@ this is tolerance to alcohol . If

the 'erso% is the% gi&e% sedati&e:ty'e drugs or

a ge%era# a%estheti!( larger)than)usual doses

are re0uired to 'rodu!e a 'har"a!o#ogi! effe!t@this is cross)tolerance.

ADVERSE EFFECTS OF DRUGS


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ADVERSE EFFECTS OF DRUGS

• the ter" ad+erse eects refers to a%y

u%desired res'o%ses to drug

ad"i%istratio%( as o''osed totherapeutic eects, 1hi!h are desired

res'o%ses.


126/140


127/140

• +o"e ad&erse effe!ts o!!ur 1ith usua#thera'euti! doses of drugs ofte% !a##ed

si!e e00ects$, others are "ore #i2e#y too!!ur a%d to *e "ore se&ere 1ith high

doses.

• Common or serio*s a!)erse e00ectsincl*!e t7e 0ollo3in9


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Co""o% or serious ad&erse

effe!ts

CN" effects


129/140

• CN" effects "ay resu#t fro" C


130/140

Hematolo/ic effects


131/140

/

• Hematolo/ic effects *#ood !oagu#atio% disorders(*#eedi%g disorders( *o%e "arro1 de'ressio%(

a%e"ias( #eu2o'e%ia( agra%u#o!ytosis(

thro"*o!yto'e%ia$ are re#ati&e#y !o""o% a%d'ote%tia##y #ife threate%i%g. E6cessi+e 2leeding is

"ost ofte% asso!iated 1ith a%ti!oagu#a%ts a%d

thro"*o#yti!s, *o%e "arro1 de'ressio% is usua##yasso!iated 1ith a%ti%eo'#asti! drugs.

Hepatotoicit


132/140

p

• Hepatotoicit he'atitis( #i&er dysfu%!tio% orfai#ure( *i#iary tra!t i%f#a""atio% or o*stru!tio%$ is

'ote%tia##y #ife threate%i%g. 8e!ause "ost drugs

are "eta*o#ied *y the #i&er( the #i&er is es'e!ia##ysus!e'ti*#e to drug i%du!ed i%ury. )rugs that are

hepatoto6ic i%!#ude a!eta"i%o'he% /y#e%o#$(

iso%iaid I


133/140

p

• Nephrotoicit %e'hritis( re%a# i%suffi!ie%!y orfai#ure$ o!!urs 1ith se&era# a%ti"i!ro*ia#

age%ts eg( ge%ta"i!i% a%d other

a"i%og#y!osides$( %o%steroida#a%tii%f#a""atory age%ts eg( i*u'rofe% a%d

re#ated drugs$( a%d others.

Hpersensitivit


134/140

p

• Hpersensitivit or aller/ "ay o!!ur 1itha#"ost a%y drug i% sus!e'ti*#e !#ie%ts. It

is #arge#y u%'redi!ta*#e a%d u%re#ated todose. It o!!urs i% those 1ho ha&e

're&ious#y *ee% e-'osed to the drug or a

si"i#ar su*sta%!e a%tige%$ a%d 1ho ha&ede&e#o'ed a%ti*odies

)r/ fever


135/140

/

• )r/ fever is a fe&er asso!iated 1ithad"i%istratio% of a "edi!atio%. )rugs !a%

!ause fe&er *y se&era# "e!ha%is"s(

i%!#udi%g a##ergi! rea!tio%s( da"agi%g *ody

tissues( i%!reasi%g *ody heat or i%terferi%g

1ith its dissi'atio%( or a!ti%g o% thete"'erature regu#ati%g !e%ter i% the *rai%.

)r/ dependence


136/140

/ p

• )r/ dependence "ay o!!ur 1ith "i%d:a#teri%g drugs( su!h as o'ioid a%a#gesi!s(

sedati&e:hy'%oti! age%ts( a%tia%-iety

age%ts( a%d C


137/140

Terato/enicit


138/140

/

• Terato/enicit is the a*i#ity of a su*sta%!eto !ause a2normal etal de+elopment

1he% ta2e% *y 'reg%a%t 1o"e%. )rug

grou's !o%sidered teratoge%i! i%!#ude

a%a#gesi!s( diureti!s( a%tie'i#e'ti! drugs(

a%tihista"i%es( a%ti*ioti!s( a%tie"eti!s(a%d others.

Toxic E00ects o0 Dr*s


139/140

• Dr* toxicit+ a#so !a##ed 'oiso%i%g(o&erdose( or i%to-i!atio%$ resu#ts fro"

e-!essi&e a"ou%ts of a drug a%d "ay

!ause re&ersi*#e or irre&ersi*#e da"age

to *ody tissues.


140/140

F I% so"e !ases( the 'atie%t or so"eo%ea!!o"'a%yi%g the 'atie%t "ay 2%o1 the

to-i! age%t eg( acci!ental o)er!ose o0 a

t7era.e*tic !r*, *se o0 an illicit !r*, as*ici!e attem.t-'

1. introduction to nursing pharmacology.ppt

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