Pharm

• RN must do Read back–
• Mustbe cosigned by the licensed health care provider that gave order w/in 24 hrs

Cannot be refilled automatically. Must have new prescription if extended.

Allergies

1.Right client

2.Right drug

3.Right dose

4.Right time

5.Right route

Additional 5 “Rights”

1.Right assessment

2.Right documentation

• 3.Client’s right to
• education

4.Right evaluation

• 5.Client’s right to
• refuse

• 1) Wash Hands
• 2) Double check allergies
• 3) 2 pt ID ( check arm band)
• 4) Assess Pt
• 5) Check order
• 6) Check Label 3 times
• 7) Check Expiration Date
• 8) Make sure pt takes med

—Do not be distracted, “safe/quiet zones”

—Do not give drugs poured by others

—Do not transfer drugs to another container

—Do not give poorly labeled drugs

—Do not leave drug with patient

—Do not call name to identify patient

—Do not give drug if allergic

units or international units

Every day/daily or every other day

morphinesulfate

magnesiumsulfate

19%

of that  more than 40% is due to administration errors

—Errors of Omission

◦Not prescribed

◦Not dispensed

◦Not administered

◦Not taken

—Errors of Commission

◦Wrong drug

◦Wrong dose

◦Wrong drug substitute

◦Wrong patient

◦Wrong route

◦Allergic reaction

• ◦Drug-food-therapy
• interaction

◦Communication failures

• ◦Failure to follow
• policy

• ◦Failure to follow
• drug specific instructions

• ◦Drug overuse without
• therapeutic benefit

• Order incomplete
• Pt having adverse Rx
• Dosage seems incorrect

—Advantages

◦Always available

◦Cost efficiency

—Disadvantages

◦More errors

◦–Poured by many

◦Drug expiration may be missed

—Advantages

◦Fewer errors

◦Saves time

◦Correct dose without calculation

◦Billed for specific # doses

—Disadvantages

◦Time delay to get drug

◦Not readily replaceable if damaged

The art and science of preparing and dispensing drgs and medicines

Quantitative study of how drugs are taken up, bilogically transformed, distributed, metabolized, and eliminated from thebody

Quantitative study of drug action

• —Primary: Desired physiologic effect
• Ex: Benedryl and decreased histamine response

• —Secondary: Physiologic effect that may be desirable or undesirable.
• Ex: Benedryl and Drowsiness

Route of administration

Blood flow & supply

Pain & Stress

GI motility

Exercise

Food or other drugs

pH

Is the amount of the drug that reaches systemic circulation and also known as the fraction absorbed

The process where liver enzymes inactivate a fraction of the ingested drug; anydrug that exhibits signficiant first-passmetabolism must be administered in a quantity sufficient to ensure that an effective concentration ofactive drug exits the liver into the systemic circulation, from which it can reach the target organ

Always less than 100%

100%

Process by which drug becomes available to body fluids & tissues. Influenced by blood flow, the drug’s affinity to the tissue, and the protein-binding effect.

Bound drug portion is inactive. Beware of toxicity esp if two PB drugs are given together.

Active Drugs. Hypoalbuminemia (lack of protein) can lead to drug toxicity.

Protein binding

Plasma protein & albumin levels

Abscesses, exudates, glands, & tumors decrease distribution

Drugs that accumulate in fat, bone, liver, muscle, & eye tissue negatively effect drug distribution.

• Metabolism
• Elimination
• Kidney Liver D/O

Done by kidneys.

Protein bound drugs can not be excreted via the kidneys

◦Most accurate renal function test

• ◦Creatinine is the metabolic
• byproduct of muscle tissue that is excreted by kidneys

◦Less muscle mass = lower values (women & elderly)

◦Normal is 85 to 135 ml/min

Relation between minimum vs max dose needed for desired effect.

Plasma or serum level too low may lead to inadequate dose. Too High: Toxicity.

Therapeuti index estimates the margin of safety of a drug through the use of a ratio that meassures the effective (therapeutic or concentration) dose (ED) in 50% of persons or animals  and the lethal dose in 50% animals

Narrow Margin of Safety. Dose typically monitored via blood tests.

Lowest plasma drug concentration

Shows rate of excretion.

Typically blood work done just prior to next dose

Time of highest plasma drug concentration & shows rate of absorption

Large initial dose. Helps saturate biologic system earlier.

Side effects can be desirable.

Adverse reactions are never. They tend to be more severe.

Ligand binding domain on cell surface. Drug activates enzyme inside cell.

Drug spans cell membrane, ion channels (Na and Ca) open initiating effect.

Drug activates receptor which activates G-protein which activates effect

Achieved by entering nucleus of cell by means of a transcription (reading and coding)process.  Activation is prolonged.

High abuse potential

No medical use (heroin)

• High abuse potential
• Accepted medical use (morphine)

• Medically accepted
• Less potential abuse
• Possible dependence (codeine)

• Medically accepted
• Possible dependence (phenobarbital)

• Medically accepted;
• Limited potential dependence
• (opioids for diarrhea & cough)

Negligence (wrong drug/dose) results in death

Error of omission results in death

Correct drug by wrong route causes death

Studies show no fetal risk

• No fetal risk in animal studies; no risk
• assumed in humans.

• Fetal risk in animal studies; weigh risk
• vs. benefit.

D.  Established/Proven fetal risk; weigh risk vs. benefit if life-threatening

Established/Proven fetal risk; risk more tahn benefit; avoid in pregnancy

Determines human drug dosage in healthy subjects

Demonstrate drug safety & efficacy subjects with disease

Demonstrate drug safety & efficacy in wide client population & collect long term data

• 1+1= 2
• Beneficial/ Or Non

• ◦Hydralazine + Nitroglycerin=
• > Hypotension (requires caution and patient knowledge)

◦Beta blocker + diuretic = < BP (desired)

—Two drugs with different mechanisms of action that produce greater effects together

—i.e., 1+1=3

—Examples:

• ◦Codeine + ASA = >
• pain relief

• ◦Ampicillin + Sulbactam =>therapeutic
• effect

—One drug increases or decreases the metabolism or excretion of another

Two Drugs compete for binding sites

Ex: antinflammatory and anticoagulants

• —Effects of two drugs that cancel each other
• 1+1=0

• ◦Naloxone (Narcan) prevents opiates
• from binding to CNS receptor sites (caution not to push the Narcan all at once)

• —Interaction of 2 drugs interferes w/action of at least 1 drug
• Ex: Mixing drugs in IV can cause crystalization

• —Food slows most drug absorption, but not
• drug actions EXCEPT:

• ◦Tyramine foods (beer, wine,
• cheese, pickled herring, yogurt, liver and yeast extract) + MAO inhibitors =
• severe HTN

• ◦Vit K foods (green leafy
• veggies, broccoli, bananas, fish) + warfarin (Coumadin) = < anticoagulation

• ◦Dairy
• products impair absorption of tetracycline

• ◦Grapefruit
• juice + calcium channel blockers = < BP & possible toxicity

—Abnormal plasma or serum electrolytes can affect certain drug therapies

Ex: Hypokalemia & Lasix

• Psuedoparkinsonism (5-30 days After)
• Acute Dystonia (May be within days)
• Akathisia (May be early)
• Tardive Dyskinesia (Usually after a year)

• Stooped Posture
• Shuffling Gait
• Rigidity
• Bradykinesia
• Termors At Rest
• Rolling Motion of Hand

• Protrusion & Rolling of Tongue
• Sucking and smacking movements of lips
• Chewing Motion
• Facial Dyskinesia
• Involuntary Movements of Body and Extremities

• Restless
• Trouble standing still
• Paces the floor
• Feet in constant motion

• Facial grimacing
• Involuntary upward eye movement
• Muscle spasms of the tongue, face, neck, and back.
• Laryngeal Spasms

• Dilates Pupils
• Dilates Bronchioles
• Increases HR
• Constricts Blood Vessels
• Relaxes Smooth Muscle of GI
• Relaxes Bladder
• Relaxes Uterus

• Constricts Pupils
• Constricts Bronchioles and Increases Secretions
• Dilates Blood Vessels
• Increases Peristalsis
• Constricts Bladder
• Increases Salivation

• Sudden Death
• Prolonged QT time (time between contractions)
• Diabetes, Hyperglycemia, Dyslipidemia, Hypertension
• Neuroleptic Malignant Syndrome

Immediately withdraw anti-psychotics

• Sudden high fever
• BP Fluctuations
• Muscle Rigidity
• Altered Mental Status
• Tachycardia
• Dysrhythmias
• Seizures
• Rhab

• Compliance issues
• 6 weeks for full effect
• No Alcohol or smoking
• Lab work needed
• Possible Photosensitivity
• Eye Exams necessary
• Orthostatic Hypotension possible.

• V/S
• Compliance
• Give w/ Food
• Deep IM by Z Track
• Monitor for EPS, NMS
• Check Urine Output
• Serum glucose

• GABA effects
• Decrease Anxiety
• High PB
• T 1/2= 10-20hrs
• Excreted in urine

Can cause Drowsiness, confusion restlessness, hallucinations

Adverse: either hypo/hyper tension

Do not D/C Abruptly: withdrawls

• Tricyclics
• Tyramine Foods

• SSRI
• Do not block dopamine or NE, Cholinergic and Alpha 1 receptors
• Used for Depression, Anxiety and Migraines.

Common side effect: Insomnia/ Nervousness, Sexual Dysfunction

Drug interference with St. Johns wart

MAOI given when unresponsive to others

SSRI more expensive, less side effects, more used

TCAs block NE and Serotonin removal compared to SSRI which only block Serotonin