NUR 119 Mod 1

C. the time required after absorption for half of the drug to be eliminated

D. poor circulation, pain, stress, hunger, fasting

Tired organs

Accumulate drugs dur to age

Use smallest effective dose

Use shortest effective time

e.g. Start low, go slow

Try non-drug measures first

Keep in mind their vision and tactile abilities

Stop all herbal therapies 2-3 weeks before surgery.

Less depression

Similar to Prozac (increases serotonin in the brain)

Inhibits metabolism of many drugs

Extra energy and increased mental alertness

May depress or stimulate the CNS.

May cause hypertension, palpitations.

May increase the risk of bleeding.

Decreases blood glucose and cholesterol (again is this too much?).

Decreases BP, BS & lipids

May increase the risk of bleeding.

May decrease glucose and cholesterol (too much?)

Good for the common cold.

Stimulates the immune system, may aggravate autoimmune disorders.

Hepatoxic.

It has a calming effect...

May increase the risk of bleeding.

• Enteric: designed to be absorbed in SI not stomach
• Anything ER, SR, XR or XL: Results in a faster release of drug for distrubution that designed
• Capsules: Same reason as above.

Nose - (head back, maintain 2 -3 minutes)

• 0: Wash hands, don gloves
• 1: Into conjunctival sac
• 2: Press lacrimal duct for 1-2 min to prevent systemic absorption.
• 3: Pt eyes closed for 1-2 min to promote absorption

Vitamin K

Narcan

Protamine sulfate (1 mg per 100 units of heparin that had been given over the past four hours) has been given to counteract the anticoagulant effect of heparin.

Digibind - the specific antidote is antidigoxin (antibody fragments against digoxin, trade names of Digibind and Digifab).

Mucomyst also known as N-acetylcysteine or N-acetyl-L-cysteine (abbreviated NAC).

The antidote to acetaminophen overdose, N-acetylcysteine (NAC), is most effective when taken within eight-hours of an overdose.

Sodium Bicarbonate

Tolerance after only a few doses

Larger doses needed.

Must be taken with foods

Many anticancer drugs, e.g. Cyclopamine, are paradoxically carcinogenic in healthy individuals

Harmful to the developing fetus

Any of the C-II through C-IV drugs,

Unbexpected with 1st time dose.

Motrin

• Tylenol (acetominophen)
• Thorazine
• MAO inhibitors
• Dilantin
• aspirin

Phenytoin sodium is a commonly used antiepileptic.

Has been suggested that phenytoin causes a reduction in folic acid levels, predisposing patients to megaloblastic anemia.

• Nausea
• vomiting
• diarrhea
• bleeding

Stimulation or depression

• A: Adverse reactions
• B: Undesirable.

The study of drug responses that may be unique to an individual due to social, cultural and biologic phenomena.

Photoallergy & Phototoxicity

Photoallergy is immune-based and is only related to previous exposure.

Phototoxicity may be dose-based and resaults in damage (serious sun burn) to skin where exposed.

• 1: SPF 15 or greater and
• 2: Avoid sunlight and
• 3: Wear protective clothing

Each drug's actions nullify the other drugs actions with a net 0 result.

Narcan nullifys the actions of drugs.

If the binding sites of one drug are "used up" by a 2 drug, this increases the effects of the displaced drug as the displaced drug is circulating in unbound orfree form

e.g. aspirin * Coumadin = increased anticoagulant effect

Intensified effects of 2nd drug due to lst drug interfering with its metabolism and excretion

e.g. Tagament interferes with many drugs

Because they have different sites of action: Tylenol + Codeine = increased pain relief

Per the book, their "clinical effect is substantially better than the combined effect of the two."

Can be desirable or not.

Sedative + alcohol = increased sedation.

Beta blocker + diuretic = better treatment of hypertension.

• With digoxin and
• Decreased serum potassium and
• Decreased serum magnesium or
• Increased serum calcium level,
• Digitalis toxicity may result.

Drugs from the thiazide diuretic group can cause abnormal electrolyte concentrations.

• An example is hydrochlorothiazide (HydroDIURIL), which can
• Decrease serum potassium, magnesium, and sodium levels and
• Increase the serum calcium level.

Hydrochloro-thiazide promotes potassium loss, and low serum potassium results in an increase in the uptake of digoxin by myocardial tissue.

This sensitization of the myocardium to digoxin increases the risk of digitalis-induced arrhythmias.

When digoxin and hydrochlorothiazide are taken together, the nurse should observe the client for digitalis toxicity.

Symptoms are nausea, vomiting, bradycardia, and stated visual problems, e.g. "yellow vision".

Clients on long-term therapy should have regular digoxin levels drawn to detect earlytoxicity.

• Pro - with food: beta blocker metoprolol (Lopressor)
• Con - without food: Levothyroxine

Dairy products can interfere with the antibiotic effects of tetracycline.

Vitamin K found in green leafy vegetables will inactivate the blood thinning effects of Coumadin.

• If monoamine metabolism is compromised by the use of monoamine oxidase inhibitors (MAOIs) and
• Foods high in tyramine are ingested, then
• A hypertensive crisis can result,
• As tyramine can cause the release of stored monoamines, such as dopamine, norepinephrine and epinephrine.

• Beer
• Wine
• Cheese
• Yeast products
• Chicken livers
• Pickled herring

Neutralize hydrochloric acid

Increase osmolarity of the plasma and pull water out of the tissues into the blood, e.g. Manitol for head injuries

Similar to nutrients / incorporated into body

Combine with toxic metals for excretion

• Different types - mainly proteins
• Number of sites available affects extent of drug action
• Drugs chemical structure affects ability of the drug to reach tissues
• Drug reaction with receptors causes agonism or antagonism
• Receptors may increase or decrease in their sensitivity

• Stimulation or inhibition of cell function
• Changes in cell permeability
• Involvement of neurohormones (i.e. acetylcholine, norepinephrine, serotonin)

It is the site on the receptor at which drugs bind.

• Kinase-linked receptors: The ligand-binding domain for drug binding is on the cell surface.
• Ligand-gated ion channels: The channel spans the cell membrane and, with this type of receptor, the channel opens, allowing for the flow of ions into and out of the cells.
• G protein-coupled receptor systems: There are three components to this receptor response: (1) the receptor, (2) the G protein that binds with guanosine triphosphate (GTP),and (3) the effector that is either an enzyme or an ion channel.
• Nuclear receptors: Found in the cell nucleus (not on the surface) of the cell membrane.

• 1: Kinase-linked receptors
• 2: Ligand-gated ion channels
• 3: G protein-coupled receptor systems
• 4: Nuclear receptors.

Minimum Toxic Concentration

• 4 to 5 half-lives of administration to...
• Reach steady state or to...
• Drop below MEC

At "steady state" the intake = metabolized & excreted.

• The first adverse symptoms that occur at a particular dose.
• Affects on metabolism and toxicity are interrelated.
• Toxicity is more prevalent in persons with liver or renal impairment or in the very young or old Pt.

Minimum Effective Concentration, i.e. just at the therapeutic level.

Amount of drug in the blood at a particular time.

• Renal dysfunction either in older adults or as a result of kidney disorders, drug dosage usually needs to be decreased.
• When creatinine clearance is decreased, drug dosage likewise may need to be decreased.
• Continuous drug dosing according to a prescribed dosing regimen without evaluating creatinine clearance could result in drug toxicity.
• Normal creatinine clearance is 85 to 135 mL/min.
• Older adult clients may have a creatinine clearance of 60 mL/min.

• 1: Excreted in the bile
• 2: Reabsorbed by the SI
• 3: Returned to the liver
• 4: Excreted by the kidney

When they are bound to proteins

• Drug elimination is most often via the kidney, although elimination may also take place via the [7 factors?]
• 1: liver
• 2: bile
• 3: feces
• 4: lungs
• 5: saliva
• 6: sweat
• 7: breast milk

• Steroids
• High protein diets
• Enzyme inducers
• Anticonvulsant drugs
• Cigarette smoke
• Tagamet (antiulcer) is an enzyme inhibitor, so it would NOT "INC Metabolism"!

Increases drug action by reducing availability of enzymes for metabolism. (more often the case)

In this case, smaller doses of the drug are needed because of slower drug metabolism.

Most often decreases drug action, that is increased activated (induced) enzymes will more rapidly metabolize drugs into non-active forms for secretion.

However, enzyme may be responsible for metabolizing a pro-drug into a drug, which can increase drug action

• Most often metabolism refers liver enzymes changing a lipid soluable drug into a water-sol for excretion by kidneys.
• Some times though the liver can change a drug into something more potent than the drug itself.
• The old (decreased liver func) and the young (imature liver func) are more suseptible to drugs.

Only those that are free, that is not bound to any proteins

It all depends on vasculature. So, fat - slow; muscle - fast, at least for injections.

• blood flow
• affinity to the tissue
• drug dosage
• drug concentration in the body

• blood flow
• pain
• stress
• hunger
• fasting
• food
• pH
• method of administration

mucous membranes - faster than IV per Maddie

Lungs can quickly take in drugs to the blood supply because of its great area 70 m² (25' x 35') and lungs are also an

• Drugs must get to systemic circulation to be utilized.
• Oral meds may be affected by vomiting or diarrhea.
• IM will be faster than SQ because of greater vasculature.

• 1: the drug form (e.g., tablet, capsule, sustained-release, liquid, transdermalpatch, rectal suppository, inhalation)
• 2: route of administration (e.g., oral, rectal, topical, parenteral)
• 3: Gl mucosa and motility
• 4: food and other drugs
• 5: changes in liver metabolism caused by liver dysfunction or inadequate hepatic blood flow

Percentage of drug that reaches systemic circulation.

For oral drugs that have a high rate of liver metabolism (20-40%), 3 to 5 times the dose ca be required po to match to bioavailability of an IV dose which usually has bioavailability of 100%.

The GI membrane of the SI is mostly lipid and protein, so lipid soluable drugs can pass across the membrane via passive diffusion.

Water soluable drugs require a carrier - protein or enzyme - to cross and energy.

Lipid soluable (and non-ionized) drugs are absorbed faster than water-soluable and/or ionized drugs.

It applies only to oral meds and it is the dissolution of the pill, i.e. oral "liquids" are already in solution.

Fillers are called excipients

• A: No risk to fetus
• B: No risk in animal studies; well-controlled studies in pregnant women are not available
• C: Animal studies indicate a risk to the fetus. Risk-v-benefit?
• D: A risk to the human fetus has been proved; Risk-v-benefit? life-threatening conditions
• Z: A risk to the human fetus has been proved. Risk outweighs the benefit

• Harrison Narcotics Tax Act
• Regulated importation, taxation and distribution of opium
• It also stated that docs could write Rx for narcotics for treatment, but not for treatment of addiction

• 1914
• Regulated importation, taxation and distribution of opium
• It also stated that docs could write Rx for narcotics for treatment, but not for treatment of addiction

1 hour before or 2 hours after a meal.

The study of effects of chemical subtsances on living tissues

The official or nonproprietary name of a drug. It is not owned by any drug company.

• 1938
• Empowered FDA
• Regulate manufacture & marketing of drugs
• Tested for harmful effects
• Labels with accurate information
• Only safe by FDA approved marketing

• Food, Drug, and Cosmetic Act
• Empowered FDA
• Regulate manufacture & marketing of drugs
• Tested for harmful effects
• Labels with accurate information
• Only safe by FDA approved marketing

• 1952
• With or w/o Rx
• Refilled only w/ new Rx

• Durham - Humphrey Amendment
• With or w/o Rx
• Refilled only w/ new Rx

• 1962
• Thalidomide tragedy of the 1950s
• European infants limb deformities
• Adverse reactions & contraindications labeled

• Kefauver -Harris Amendment
• Thalidomide tragedy of the 1950s
• European infants limb deformities
• Adverse reactions & contraindications labeled

• 1970
• Prevention & treatment drug dependence
• Categories: I thru V

• Controlled Substances Act
• Prevention & treatment drug dependence
• Categories: I thru V

• 1997
• Review & use accelerated
• Tested in children bef marketing
• Clinical data necessary for serious
• Discontinue drugs 6 months notification

• FDA Modernization Act
• Review & use accelerated
• Tested in children bef marketing
• Clinical data necessary for serious
• Discontinue drugs 6 months notification

• 2003
• Privacy of individually identifiable health information

• HIPPA
• Privacy of individually identifiable health information

• 2003
• Financial assistance to seniors

• Medicare Prescription Drug Improvement and Modernization Act
• Financial assistance to seniors

• High potential for drug abuse.
• No accepted medical use.
• Labeled C-I.

• heroin
• LSD
• mescaline

marijuana [except when prescribed with cancer treatment], peyote, psilocybin)

• High potential for drug abuse.
• Accepted medical use.
• Can lead to strong physical and psychological dependency.
• Labeled C-II

• meperidine (Demerol) this drug is not used because it causes seizures
• morphine
• methadone
• hydrocodone
• hydromorphone
• oxycodone
• codeine
• amphetamines
• secobarbital
• pentobarbital

• Medically accepted drugs.
• Less potential for abuse is less than that for schedules I and II.
• May cause dependence.
• Labeled C-lll.

• codeine preparations
• androgens, i.e. anabolic steroids
• paregoric
• nonnarcotic drugs (pentazocine, propoxyphene)

• Medically accepted drugs.
• Some potential for abuse.
• May cause dependence.
• Labeled C-IV.

• phenobarbital
• benzodiazepines (diazepam, xanax, oxazepam, lorazepam, chlordiazepoxide)
• chloral hydrate

Key examples of drugs in a category

• e.g. Morphine as a narcotic analgesic
• Used to relieve pain
• CNS depression (drowsiness to depression)
• Major adverse effect: respiratory depression
• High potential for abuse
• Caution for those with respiratory depression or decreased respirations.

• Medically accepted drugs.
• Very limited potential for dependence.
• Labeled C-V.

opioid-controlled substances for diarrhea and cough

In some states a nurse who gives a drug w/o a doc's order violates the nurse practise act and can lose license.

Since lopressor is a drup to treat hypertension, the Pt should not have low BP when given.

Giving the correct drug but by the wrong route that results in the client's death

Omission; omitting a drug dose that resultsin the client's death

Negligence; giving the wrong drug or drug dose that results in the client's death

The MAR "parameter", e.g. Hold for HR less than ...

FDA evaluates and allows marketing for further study.

Much larger sample using controls, i.e. double-blind with placebos

Give to a small group of those with symptons or disease for which drug is intended

Doses to healthy volunteers

If Pt has visitors, you need to ask Pt if it is OK to talk about their drugs.

• 1: Unrestricted by social or economic status, personal attributes, or the nature of health problems
• 2: Primary commitment to patient, whether individual, family, group, or community
• 3: Advocates rights of patient
• 4: Appropriate delegation of tasks
• 5: Same duties to self; Continue professional growth
• 6: Health Care environment
• 7: Advancement of the profession
• 8: Collaborates with other health professionals
• 9: Articulating nursing values

• A: GI tract
• B: liver

• blood flow
• affinity to the tissue
• drug dosage
• drug concentration in the body

• blood flow
• pain
• stress
• hunger
• fasting
• food
• pH
• method of administration

• A: Pinocytosis
• B: engulfing

against a concentration gradient

diffusion

• A: Absorption
• B: passive - most common
• C: active - or active transport, which requires a carrier and energy
• D: pinocytosis

Also "facilitated diffusion" which requires a carrier, but no energy.

Active transport moves against the concentration grad - low to high

• A: pharmacokinetics
• B: absorption
• C: distribution
• D: biotransformation
• E: elimination

• A: Pharmaceutic
• B: parenteral

pharmacodynamics

• A: pharmacodynamics
• B: different aspects of drug action.

• 3/8 - 5/8
• 1 inch if obese

• 24 - 26
• 26 - 30 for insulin

0.5 - 1.0 mL

1 inch

23 - 25

0.5 - 1.0 mL

• 1 1/2
• 2 inch if obese

20 - 22

Up to 3.0 mL

1/4 - 5/8

25 - 27

up to 0.1 mL

• 1. Acromion Process
• 2. Top of axilla

• 1. Posterior superior iliac spine (note: towards the spine)
• 2. Greater trochanter (note: lateral side of leg)

• 1. Greater trochanter
• 2. Anterior superior iliac spine (note: towards umbilicus)
• 3. Iliac crest (note: lateral leg above greater trochanter)

• 1. Greater trochanter
• 2. Lateral femoral condyle

• 1. Acromion process (hand breath below)
• 2. Elbow (hands breath above)

B. absorption, distribution, metabolism, excretion

• 1. 2 inches away from umbilicus
• 2. Above level of iliac crest