Winter 2013Winter 2013 11Winter 2013

04/19/23 Winter 2013Winter 2013 22

INSTRUCTORINSTRUCTORJOAN SAALWAECHTER MSN, RNJOAN SAALWAECHTER MSN, RN

04/19/23 Winter 2013Winter 2013 33

CONTACTING MECONTACTING ME

PHONE – 303-292-0015 X3629PHONE – 303-292-0015 X3629CELL – 303-726-0692CELL – 303-726-0692OFFICE – 2OFFICE – 2ndnd floor #210 floor #210 j.saalwaechter@denverschoolofnursing.eduJUPITER GRADESJUPITER GRADESOFFICE HOURS – IN SYLLABUSOFFICE HOURS – IN SYLLABUS

33

04/19/23 Winter 2013Winter 2013 44

SUGGESTED MATERIALSSUGGESTED MATERIALS

EVERY BOOK YOU HAVE THAT EVERY BOOK YOU HAVE THAT RELATES TO HEALTH CARERELATES TO HEALTH CARE

PLUSPLUS

THE INTERNET !!THE INTERNET !!

44

04/19/23 Winter 2013Winter 2013 55

CLASSROOM RULESCLASSROOM RULES

BE NICEBE NICESHARESHARE

DON’T DISTURB YOUR DON’T DISTURB YOUR NEIGHBORNEIGHBOR

IF YOU ARE TALKING, YOU IF YOU ARE TALKING, YOU ARE NOT LISTENINGARE NOT LISTENING

55

TIPS FOR STUDYINGDON’T READ THE BOOK LIKE A NOVEL – USE IT TO

INVESTIGATE THE DRUGS and CONCEPTS WE DISCUSS IN CLASS

WORK BOOK

TIPS OUTLINED IN TEXT

BOXES, DRUG PROFILES, TABLES, LIFESPAN CONSIDERATIONS,

HERBAL THERAPIES, CRITICAL THINKING ACTIVITIES, POINTS TO

REMEMBER, PATIENT TEACHING TIPS, NCLEX REVIEW

QUESTIONS, CASE STUDIES, VOCABULARY

EVOLVE STUDENT SITE HESI PRACTICE EXAM

NCLEX REVIEW BOOK04/19/23 6Winter 2013

IMPORTANT !!!

KNOW THE VOCABULARY

THIS IS A NEW LANGUAGE THAT YOU ARE LEARNING

LOOK UP THE WORDS THAT YOU DO NOT KNOW

04/19/23 Winter 2013 7

04/19/23 Winter 2013Winter 2013 88

Resources Resources for Drug Drug informationinformation

LilleyLilleyDavis drug guideDavis drug guideOther texts and drug referencesOther texts and drug referencesInternetInternet

04/19/23 Winter 2013Winter 2013 99

Inside the World of a Drug BookInside the World of a Drug BookClassificationsClassificationsIV compatibility chartIV compatibility chartTall Man ListTall Man ListDrug picturesDrug picturesDrugs, generic names in alphabetical Drugs, generic names in alphabetical

orderorderPink boxesPink boxes

Trade namesTrade namesPregnancy categoriesPregnancy categoriesClassificationClassification

04/19/23 10Winter 2013

Drug ClassificationsPINK BOXES IN DRUG BOOKPINK BOXES IN DRUG BOOK

Therapeutic Based on the therapeutic response

expected from the drugExample: Antidepressant

Pharmacologic A description of the chemical action of the

drug. Example: Selective Serotonin Reuptake

Inhibitor

04/19/23 11Winter 2013

Drug ClassificationsDrug ClassificationsDrugs are grouped or categorized Drugs are grouped or categorized

according to their effect on the body, according to their effect on the body, the condition they are treating or their the condition they are treating or their chemical characteristicschemical characteristics CNS depressantsCNS depressants AntidepressantsAntidepressants AdrenergicsAdrenergics

Some drugs fit into more than one Some drugs fit into more than one categorycategory

04/19/23 Winter 2013Winter 2013 1212

CNS DEPRESSANTS

OPIOIDS SEDATIVES HYPNOTICS MUSCLE RELAXANTS

DIRECT ACTING

CENTRAL ACTING

04/19/23 13Winter 2013

Drug NamesChemical name

Describes the drug’s chemical composition and molecular structure

Generic name (nonproprietary name)

Name given by the United States Adopted Name Council

Trade name (proprietary name)

The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer)

04/19/23 14Winter 2013

Naming of DrugsNaming of DrugsChemical name

(+/-)-2-(p-isobutylphenyl) propionic acid

Generic nameIbuprofen

Trade nameMotrin, Advil

04/19/23 Winter 2013Winter 2013 1515

04/19/23 Winter 2013Winter 2013 1616

Naming of drugs, cont.Naming of drugs, cont.

Chemical nameN-acetyl-para-aminophenol (APAP)

Generic name acetaminophen

Trade name (Proprietary name)Tylenol

LET’S TALK ABOUT LET’S TALK ABOUT DRUG CARDS AND DRUG CARDS AND WEEKLY QUIZZESWEEKLY QUIZZES

04/19/23 17Winter 2013

Generic & Brand Name

Student namecefazolin sodium (Ancef; Kefzol)

Classification Antibiotic, cephalosporin class – First generation

Action Inhibits cell wall mucopeptide synthesis

IndicationsFirst 10

Infection of bone, joint, respiratory tract, skin and skin structure, urinary tract, genital tract, biliary tract; septicemia; prostatitis; endocarditis; epididymitis, surgical prophylaxis. Active against the following organisms in vitro and in clinical infections: S. Aureus (including Penicillinase-producing strains); S. epidermidis; Streptococcus pneumoniae, Escherichia col, Proteus mirabilis, Klebsiella sp. Enterobacter aerogenes, Haemophilus influenzae

Dosing RangeAdult only

Adults: Mild-severe infections: 500 mg – 1.5 grams IM/IV every 6-8 hrs. Maximum 12 grams/day. Renal dosing considerations required.Adult Prophylaxis: 1 gram IV or IM administered 0.5-1 h prior to the start of

surgery.

04/19/23 18Winter 2013

Adverse Effects

MOST COMMON

Diarrhea, oral candidiasis (oral thrush), vomiting, nausea, stomach cramps, anorexia and pseudomembranous colitis. Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment. Anaphylaxis, eosinophilia, itching, drug fever, skin rash, Stevens-Johnson syndrome. Neutropenia, leukopenia, thrombocytopenia, thrombocythemia. Genital and anal pruritus.

Contraindications/PrecautionsNo more than 10 +

life-threatening

Known allergy to cephalosporins; Caution if impaired renal function, may have cross-allergenicity to penicillins; history of antibiotic-associated colitis; seizure disorder; if also receiving nephrotoxic drugs. Transient rise in ALT, AST, and alkaline phosphatase levels has been observed. As with other cephalosporins, reports of hepatitis have been received. Pregnancy category B

Drug-Drug, Drug-Herbal Interactions

10 only

Probenecid may decrease renal tubular secretion of cephalosporins when used concurrently, resulting in increased and more prolonged cephalosporin blood levels.

DON’T FORGET TO CHECK HERBAL INTERACTIONS

Nursing Interventions/

Patient Teaching

Check allergies. Monitor BUN and creatinine. May be associated with a fall in prothrombin activity. Prothrombin time should be monitored in patients at risk and exogenous vitamin K administered as indicated. Drug should be taken exactly as directed. Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by cefazolin sodium or other antibacterial drugs in the future.

04/19/23 19Winter 2013

04/19/23 Winter 2013Winter 2013 2020

CONCEPTS AND PRINCIPLES OF CONCEPTS AND PRINCIPLES OF PHARMACOLOGYPHARMACOLOGY

Chapter TwoChapter Two

04/19/23 Winter 2013Winter 2013 2121

WHAT IS PHARMACOLOGY?WHAT IS PHARMACOLOGY?THE STUDY OF DRUGS THE STUDY OF DRUGS

(CHEMICALS) THAT ALTER THE (CHEMICALS) THAT ALTER THE FUNCTION OF LIVING FUNCTION OF LIVING ORGANISMSORGANISMS

04/19/23 Winter 2013Winter 2013 2222

Drug PrototypesDrug PrototypesIndividual drugs that represent groups

of similar drugsSometimes the original drug in a class

Penicillin Aspirin Digoxin

Pharmacologic PrinciplesPharmaceutics

PharmacokineticsPharmacodynamicsPharmacotherapeuticsPharmacognosy

04/19/23 23Winter 2013

PharmacokineticsThe study of what the body does to

the drugAbsorptionDistributionMetabolismExcretion

04/19/23 24Winter 2013

PharmacodynamicsThe study of what the drug does to

the bodyThe mechanism of drug actions in

living tissues

04/19/23 25Winter 2013

PharmacotherapeuticsThe use of drugs and the clinical

indications for drugs to prevent and treat diseasesEmpirical therapeuticsRational therapeutics

04/19/23 26Winter 2013

Pharmacokinetics: Absorption

The rate at which a drug leaves its site of administration, and the extent to which absorption occursBioavailabilityBioequivalency

04/19/23 27Winter 2013

Factors That Affect Absorption

Absorption characteristics vary according to the dosage form and route

Food or fluids administered with the drug Dosage formulation Status of the absorptive surface Rate of blood flow to the small intestine Acidity of the stomach Status of GI motility

04/19/23 28Winter 2013

Routes A drug’s route of administration

affects the rate and extent of absorption of that drugEnteral (GI tract)ParenteralTopical

04/19/23 29Winter 2013

04/19/2304/19/23 Winter 2013Winter 2013 3030

PharmacokineticsAbsorption

Route of delivery effects bioavailability IV – Drug 100% available, fastest absorptionPO – Less than (<)100% because of passage

through liver (first pass effect) IM – 100% Available, quick absorptionSC – 100% Available, slower absorption ID – 100% Available, minimal absorptionTopical – (skin, mucus membranes, inhalation,

Intra-nasal) consistent absorption, longer duration of action

04/19/23 31Winter 2013

First-Pass Effect The metabolism of a drug and its passage from

the liver into the circulation

A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation (high first-pass effect)

The same drug—given IV—bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation

04/19/23 32Winter 2013

Parenteral RouteIntravenous (fastest delivery into the blood

circulation)IntramuscularSubcutaneousIntradermalIntraarterialIntrathecalIntraarticular

04/19/23 33Winter 2013

Topical RouteSkin (including transdermal patches)EyesEarsNoseLungs (inhalation)RectumVaginaTransdermal

04/19/23 34Winter 2013

DistributionThe transport of a drug in the body by the bloodstream to its site of action

Protein-binding

Water soluble vs. fat soluble

Blood-brain barrier

Areas of rapid distribution: heart, liver, kidneys, brain

Areas of slow distribution: muscle, skin, fat

04/19/23 35Winter 2013

04/19/23 36Winter 2013

Metabolism/BiotransformationThe biochemical transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite

Liver (main organ) Skeletal muscle Kidneys Lungs Plasma Intestinal mucosa

04/19/23 37Winter 2013

Metabolism/Biotransformation

Prodrugs Drugs that are inactive then become active after they are changed by metabolism

04/19/23 38Winter 2013

Metabolism/Biotransformation (cont’d)

Delaying drug metabolism causes:

Accumulation of drugs

Prolonged action of the drugs drug toxicity

Stimulating drug metabolism causes:

Diminished pharmacologic effects

04/19/23 39Winter 2013

ExcretionThe elimination of drugs from the bodyKidneys (main organ)LiverBowel

Biliary excretionEnterohepatic recirculation

04/19/23 40Winter 2013

Half-lifeThe time it takes for one half of the

original amount of a drug to be removed from the body

A measure of the rate at which a drug is removed from the body

Most drugs considered to be effectively removed after about five half-lives

04/19/23 41Winter 2013

Onset, Peak, and Duration of Action

OnsetThe time it takes for the drug to elicit a

therapeutic responsePeakThe time it takes for a drug to reach its

maximum therapeutic response DurationThe time a drug concentration is sufficient to

elicit a therapeutic response

04/19/23 42Winter 2013

04/19/23 Winter 2013Winter 2013 4343Winter 2013

Therapeutic Drug Monitoring

Peak levelHighest blood level

Trough levelLowest blood level

04/19/23 44Winter 2013

Serum Drug LevelsSerum Drug Levels

The amount of drug in the blood at a single point The amount of drug in the blood at a single point in timein timeReflects dosage, absorption, bioavailability, Reflects dosage, absorption, bioavailability,

half-life, and rates of metabolism and excretionhalf-life, and rates of metabolism and excretionMinimum effective concentration (MEC) must Minimum effective concentration (MEC) must

be present for the drug to be effectivebe present for the drug to be effective

454504/19/23 Winter 2013

Ways Drugs Produce Therapeutic Effects

Once the drug is at the site of action, it can modify the rate (increase or decrease) at which the cells or tissues function

A drug cannot make a cell or tissue perform a function it was not designed to perform

04/19/23 46Winter 2013

Pharmacodynamics:

Mechanisms of Action (what the drug does to the body)

Receptor interactionsEnzyme interactionsNonselective interactions

04/19/23 47Winter 2013

04/19/2304/19/23 Winter 2013Winter 2013 4848

Receptor Theory of Drug Receptor Theory of Drug ActionAction

Agonist – Substance (hormone, neurotransmitters) binds to a receptor site on a cell and causes a cellular function

Antagonist – Substance (hormone, neurotransmitter) binds to a receptor site on a cell and inhibits a cellular function

04/19/23 Winter 2013Winter 2013 4949

Winter 2013Winter 2013 5050

Non-receptor Drug actionsNon-receptor Drug actionsAntacids (generally speaking)Osmotic diureticsSome anticancer drugsMetal chelating agents

Chemical inactivation of a substance (drug, metal) rendering it harmless

04/19/23

Pharmacotherapeutics: Types of Therapies

Acute therapyMaintenance therapySupplemental/replacement

therapyPalliative therapySupportive therapyProphylactic therapyEmpiric therapy

04/19/23 51Winter 2013

ContraindicationsAny characteristic of the patient, especially

a disease state, that makes the use of a given medication dangerous for the patient

It is important to assess for contraindications!

04/19/23 52Winter 2013

MonitoringThe effectiveness of the drug therapy

must be evaluatedOne must be familiar with the drug’s:

Intended therapeutic action (beneficial)Unintended but potential adverse

effects (predictable, adverse reactions)

04/19/23 53Winter 2013

Monitoring (cont’d)Therapeutic index

Ratio of a drug’s toxic level to the level that provides therapeutic benefits

ToleranceDecreasing response to repeated

drug dosesDependence

Physiologic or psychological need for a drug

04/19/23 54Winter 2013

Monitoring (cont’d)

Interactions may occur with other drugs or food A drug interaction is the alteration of a drug’s action by:

Other prescribed drugs Over-the-counter medications Herbal therapies

04/19/23 55Winter 2013

Monitoring (cont’d)

Drug interactionsAdditive effect

1+1=2Synergistic effect

1+1=3Antagonistic effect

1+1=0Incompatibility

1+1=04/19/23 56Winter 2013

Monitoring (cont’d) Adverse drug events

Medication errors Adverse drug reactions

04/19/23 57Winter 2013

Why Learn about Adverse Drug Why Learn about Adverse Drug Reactions (ADR)?Reactions (ADR)?

Over 2 MILLION serious ADRs are reported yearly

100,000 DEATHS yearlyADRs 4th leading cause of death ahead of

pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths

Nursing home patients ADR rate – 350,000 yearly

Institute of Medicine, National Academy Press, 2000

04/19/23 Winter 2013Winter 2013 5858

Adverse EffectsCNS

Confusion, headache, agitation, seizures

GINausea, vomiting, diarrhea

Hematologic effectsCoagulation disorders

Hypersensitivity / allergic reactionItching, hives, bronchospasms

04/19/23 Winter 2013Winter 2013 5959

04/19/23 Winter 2013Winter 2013 6060

Adverse ReactionsAdverse Reactions

Davis Drug GuideIn RED and CAPITAL letters indicates a life-

threatening reactionUnderlined indicates most common side

effectsPrentice Hall Nurse’s Drug Guide 2008

Underlined effects are life threateningCommon adverse effects are in Italics

AngioedemaAngioedema

04/19/2304/19/23 Winter 2013Winter 2013 6161

04/19/23 Winter 2013 62

Monitoring (cont’d)Adverse drug reactions Pharmacologic reactions,

including adverse effects Hypersensitivity (allergic) reaction Idiosyncratic reaction Drug interaction

04/19/23 63Winter 2013

Other Drug-Related Effects

TeratogenicMutagenicCarcinogenic

04/19/23 64Winter 2013