Medication

any substance that modifies body fx when taken into the body. They are chemicals that are introduced into the body to cause some type of change.

the study that deals w/chemicals that affect the body's fxing. Biological effect of the drug.

a person licensed to prepare and dispense drugs.

physicians, dentists, psychiatrists, podiatrists, physician assistants, and advance practice nurses have prescriptive authority. Prescriptive authority for advance practice nurses (clinical nurse specialists, nurse practitioners, certified nurse anesthetists, nurse midwives) and physician assistants varies in the degree of independence and the meds that may be prescribed from state to state. Nurses must be familiar with the laws relative to prescriptive authority in their state of practice.

the prescriber conveys med plans to others by an order called a prescription

info about specific drugs are available this way. comp programs and electronic databases are available for up-to-date med info.

is a precise description of the drug's chemical composition. the chemical name identifies the drug's atomic and molecular structure using exact chemical language and terminology.

which identifies the drug's active ingredient, is the name assigned by the manufacturer that first develops the drug. Often, the generic name is derived from the chemical name. Are no longer protected by a patent and can be produced by companies other than the one that developed it.

is the name by which the drug is identified in the official publications, U.S. Pharmacopeia and National Formulary (USP and NF). The official name is often the generic name.

also referred to as the brand name/proprietary name, is selected by the drug company that sells the drug and is protected by trademark. A drug can have several trade names when produced by different manufacturers.

drugs are available in many forms

the form in which the drug is prepared may determine the route of administration, which can be oral, topical, and parenteral administration. Some drugs may be prepared in only one form to be administered by a certain route. Others may be supplied in several preparations, allowing them to be given through various routes. One type of preparation may be desirable in a given situation.

or drug classes, are groups of drugs that share similar characteristics. Drugs are classified in several ways. For example, they may be classified by body systems (e.g., drugs that affect the respiratory system/cardiovascular system), by chemical composition, or by the clinical indication for the drug/therapeutic action (e.g., analgesic, antibiotic). Knowledge r/t the class of drug can be applied to individual drugs in that class.

the effect of the body on the drug. It's the movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion.

the process by which a drug is transferred from its site of entry into the body to the bloodstream. Absorption of a drug is influenced by many factors, such as rate of absorption (depending on route of administration), whether its lipid soluble, its pH, blood flow, local conditions at the site of administration, and drug dosage.

depends on the route of administration. Drugs given orally take the longest to be absorbed. Injected meds are usually absorbed more rapidly than oral meds. Drugs administered intravenously are placed directly into the bloodstream and thus technically are not absorbed and take effect quickly.

cell membranes have a fatty acid layer. a drug that is more lipid soluble can be absorbed more readily and pass more easily through the cell membrane.

Acidic drugs are well absorbed in the stomach. Drugs that are basic remain ionized/insoluble in an acid environment. These drugs are not absorbed before reaching the small intestine.

absorption is increased with increased blood flow. Pts with impaired circulatory fx absorb drugs less rapidly than do pts with normal circulatory fx.

powder/gel form of an active drug enclosed in a gelatinous container; may also be called liquigel

med in a clear liquid containing water, alcohol, sweeteners, and flavor

a tablet/pill coated to prevent stomach irritation

preparation of a med that allows for slow and continuous release over a predetermined period

med mixed w/alcohol, oil, or soap, which is rubbed on the skin.

drug particles in a sol for topical use

small oval, round, or oblong preparation containing a drug in a flavored/sweetened base, which dissolves in the mouth and releases the med; also called troche

semisolid preparation containing a drug to be applied externally; also called an unction

mixture of a powdered drug w/a cohesive material; may be round/oval

single/mixture of finely ground drugs

a drug dissolved in another substance

an easily melted med preparation in a firm base such as gelatin that is inserted into the body (rectum, vagina, urethra)

finely divided, undissolved particles in a liquid medium; should be shaken before use

med combined in a water and sugar solution

small, solid dose of a med, compressed/molded; may be any color, size, or shape; enteric-coated tabs are coated w/a substance that is insoluble in gastric acids to reduce gastric irritation by the drug

unit dose of med applied directly to skin for diffusion through skin and absorption into the bloodstream.

For example, a pt with burns would have poor absorption form an IM injection. Food in the stomach can delay the absorption of some meds or enhance the rate of absorption of other drugs. Drug absorption can be manipulated w/sustained-release preparations/enteric-coated preparations. Enteric-coated preparations are resistant to the digestive action of the stomach.

or a larger than normal dose, is usually given when a pt is in acute distress and the maximum therapeutic effect is desired as quickly as possible.

a lower dosage that becomes the usual/daily dosage. Pts who receive digoxin/phenobarbital, for example, may receive loading doses when therapy is initiated.

The goal of drug dosing is to give a dose that achieves the desired therapeutic effect of the drug w/o causing other undesirable effects (adverse effects). Effect of the drug on the body.

it's not a barrier like the BBB. Drugs readily move across the placenta, and many drugs produce harmful effects in the fetus. These factors must be considered when planning and implementing drug therapies. Any concern about the safe use of a med during preg can be ID in a pharmacology text, through consultation w/a pharmacist, or from a comp resource.

depends on the blood flow to the tissues, the drug's ability to leave the bloodstream, and the drug's ability to enter the cells. Certain other factors may also influence distribution. The drug may bind to plasma proteins, which causes unequal distribution and prevents the drug from reaching its intended site of action. Another factor that affects distribution is the BBB.

is a structure made up of tightly packed capillary walls that supply blood to the brain. It prevents toxins and poisons from reaching the brain. Unfortunately, many drugs cannot penetrate the barrier, obviously influencing distribution. Some drugs fail to penetrate the tissues of the CNS as readily as others.

or biotransformation, is the change of a drug from its original form to a new form. The liver is the primary site for drug metabolism. Various processes and enzymes are involved in metabolism. Physiologic changes associated w/ aging, the presence of liver dz, or other factors that impair the fxing of the liver decrease the ability of the liver to metabolize drugs. Other tissues, such as those of the GI tract, lungs, kidney, and skin, have a role in drug metabolism.

after the drug is broken down to an inactive form, excretion of the drug occurs,. It's theprocess of removing a drug or its metabolities (products of metabolism), from the body. The kidneys excrete most drugs. The lungs are the primary route for the excretion of gaseous substances, such as inhalation anesthetics. Many drugs are excreted through bile in the GI tract. The sweat, salivary, and mammary glands are also routes of drug excretion. Some meds may be contraindicated, or dosages may need to be adjusted, if renal excretion is impaired. Changes associated w/ aging, dz, or the presence of other factors that impair the fxing of the kidneys can decrease their ability to excrete drugs.

products of metabolism

Drugs act at the cellular lvl to achieve the desired effect. The process by which drugs alter cell physiology and affect the body. How the drug affects the body. Is the science dealing w/interactions between the chem components of living systems and the foreign chemicals, including drugs, that enter those systems. All living orgs fx by a series of complicated, continual chem reactions. When a new chem enters the system, mult changes in and interferences w/cell fxing may occur. To avoid such probs, drug development works to provide the most effective and least toxic chems for therapeutic use. Drugs usually work in 1 of 4 ways: 1. To replace/act as a substitutes for missing chems, 2. To incr/stimulate certain cellular activities, 3. to depress/slow cellular fx, 4. to interfere w/the fxing of foreign cells, such as invading microorgs/neoplasms (drugs that act in this way are called chemotherapeutic agents)

Drugs turn on, turn off, promote, or block responses that are part of the body's processes. One mechanism of drug action is a drug-receptor interaction, which the drug interacts w/one or more cellular structures to later cell fx.

Specialized structures where the drug  fits the receptor as a key fits a lock. Drugs may also combine w/ other molecules in the body to achieve their effect. For example, a drug may combine w/ an enzyme to achieve the desired effect, which is referred to as a drug- enzyme interaction. Other drugs act on the CM or alter the cellular environment to achieve their effect.

some drugs interact directly w/receptor sites to cause the same activity that natural chems would cause at that site. These drugs are called agonists. For ex, insulin reacts w/specific insulin-receptor sites to change CM permeability, thus promoting the movement of glucose into the cell.

is a receptor antagonist that binds to a receptor but does not activate the receptor. The antagonist will compete with available agonist for receptor binding sites on the same receptor.

Although therapeutic effect is the desired outcome in med administration, sometimes secondary undesirable effects occur. Undesirable effects other than the intended therapeutic effect of a drug are known. Some are predictable and may be tolerable as part of the therapy. For example, morphine, a narcotic agonist, is used to treat moderate to severe and chronic pain. A known adverse effect w/morphine use is constipation. However, the benefit of pain relief usually outweighs the adverse effect of constipation, so that often, the adverse effect is accepted and managed with stool softeners and laxatives.

defined as an action that's life threatening, requires intervention to prevent death/permanent impairment, and/or leads to death, hospitalization, disability, or congenital anomaly. RNs and HC professionals are encouraged to complete a form that provides info on a med/medical product that they suspect either has caused harm and submit the form to the MEDWATCH prog. Provides a national report of all serious adv drug reactions. Reporting is necessary for corrective action to take place to protect pts. This info is used to revise drug labels, add warning to HC providers, create pt med guides, or withdraw a drug from the market.

an immune system response that ocurs when the body interprets the administered drug as a foreign substance and form antibodies against the drug. Drug allergies can be manifested in a variety of symptoms ranging from minor to serious. The reaction can occur immediately after the pt receives the med or be delayed for hrs to days. Symptoms may become more severe each time the drug is introduced into the body. Some of the s/s of the drug allergy are rash, urticaria, fever, diarrhea, nausea, and vomiting.

the most serious allergic effect. Is life threatening and results in respiratory distress, sudden severe bronchospasm, and CV collapse. This reaction is treated w/bronchodilators, vasopressors, corticosteriods, oxygen therapy, IV fluids, and antihistamines.

occurs when the body becomes accustomed to the effects of a particular drug over a period of time. Larger doses of the drug must be taken to produce the desired effect. For example, pts using morphine for an extended period of time become tolerant to the drug's therapeutic effects and eventually need higher and higher doses to control their pain.

are specific groups of symptoms r/t drug therapy that carry risk for permanent damage/death.. The organ/system affected by the toxicity is used to name the toxicity, as in hepatotoxicity, or damage to the liver. Toxicities can occur from cumulative effect.

occurs when the body cannot metabolize one dose of a drug before another dose is administered. The drug is taken in more frequently than is excreted, and each new dose increases the total quantity in the body.

(sometimes called paradoxical effect) is any unusual/peculiar response to a drug that may manifest itself by over response, under response, or even the opposite of the expected response. Idiosyncratic effects are r/t a pt's unique response to a drug and are thought to be the result of genetic enzyme deficiencies that lead to an abnormal mechanism of drug breakdown. Older pts often have unpredictable or erratic response to meds.

occur when one drug is affected in some way by another drug, a food, or another substance that is taken at the same time. Drug interactions may be advantageous when, for example, a med is given to decrease the adverse effects of a drug or increase its therapeutic effects. Other drug interactions are not beneficial: for example, interactions that decrease the therapeutic effect and/or increase the adverse effects.

the combined effects of 2 or more drugs acting simultaneously produces an effect either less than that of each drug alone (antagonist effect) or greater than that of each drug alone (synergistic effect). Alcohol and barbituates, for example, when taken together create an unbeneficial synergistic effect w/ the potential for significantly increased CNS depression. It's important to be knowledgeable about, and alert for, drug interactions and the effects of drug therapy.

combined effect of two or more drugs that produces less than the effect of each drug alone

combined effect of two or more drugs is greater than the effect of each drug alone

developmental considerations, pt's body weight, pt's gender, genetic and cultural factors, psychological factors, pathology, environment, and timing of med administration.

certain drug, referred to as teratogenic, are known to have the potential to cause developmental defects in the embryo/fetus and are definitely contraindicated. Examples of teratogenic drugs include cocaine, alcohol, phenytoin (Dilantin, an anticonvulsant), and isotretinoin (Accutane, a med used to treat severe acne). Some drugs cross into breast milk, so breastfed infants are also at risk for adverse effects from drugs in the mother's circulation.

the study of the effect of ethnicity on responses to prescribed med, esp drug absorption, metabolism, distribution, and excretion. It includes pharmacogenetics.

the study of genetic variations in response to drugs. Differences in the responses of pts receiving the same med may result from genetic differences, such as genetic variations in certain enzymes that may cause differing drug response. Ethnicity influences response to certain meds. Certain ethnic groups have more of these variations than do others. Nurses need to know about meds that may produce vaired repsonses in pts from different ethnic groups. Specifically, there may be important variations in the therapeutic dose and/or incidence of adverse effects; some pts in certain ethnic groups obtain therapeutic responses at lower doses than those usually prescribed, while other pt groups experience less effect or more effect from prescribed meds than expected.

a pharmacologically inactive substance. In clinical drug trials, one group of pts receives the active drug, whereas another group receives a placebo to study the drug's effects. Some pts appear to have the same response w/ the placebo as w/ the active drug.

the concentration of drug in the blood serum that produces the desired effect w/o causing toxicity.

or highest plasma concentration, of the drug should be measured when absorption is complete. The peak level may be affected by factors that affect drug absorption as well as the route of administration.

the point when the drug is at its lowest concentration and this specimen is usually drawn in the 30-minute interval before the next dose. The dosage schedule, as well as the half-life of the drug, can modify the trough lvl.

is the amount of time it takes for 50% of the blood concentration of a drug to be eliminated from the body. Monitoring these lvls ensures that therapeutic ranges are obtained w/o reaching toxic lvls.

• - acquire basic info about health beliefs and practices of various cultural groups in your HC setting. This provides a basis for assessing pt's beliefs and practices. Recognize, however, that within all cultures and ethnic groups, there are members who do not hold all the values of the group.
• - Be alert to atypical drug responses/unexpected adverse effects that may occur in certain ethnic groups. This knowledge helps you direct assessment questions as appropriate.
• - Ask specifically about the use of folk or home remedies prescribed by a nontraditional healer.
• - Ask specific questions about possible adverse effects, rather than asking general questions or waiting for the pt to voice concerns. For example, do not ask, "Are you having any problems w/your medicine?" Instead, ask, "Have you noticed any unusual, involuntary movements?"
• - Consider culture when teaching pts and families. Ask, "What do you think caused your health problem?" and "what treatment do you think will help?" Include culturally sensitive info in all basic health teaching.
• - Determine the pt's lang preferences for spoken and written communication
• - Use printed/audiovisual info that is in the language spoken by your pts
• - Encourage cultural sensitivity in HC workers in your particular setting
• - Recognize that diversity exists within cultural groups. For example, the Hispanic population includes Mexicans, Cubans, Puerto Ricans, and other Latino groups
• - Emphasize threads/messages in health teaching that are common to all cultures (e.g., concern about family, faith, and home.)
• - Help culturally diverse pts to value and understand the importance of communicating concerns and asking questions about prescribed meds. Pts and families needs to know how to ID major adverse effects of the meds they are taking and the appropriate person(s) to contact if these effects are noted.

• - deltoid: 20 to 25 gauge needle between 1" and 1 1/2" in length; for children, 5/8" to 1 1/4" in length. 1 to 4 mL and 1 to 2 mL in less developed muscles in elderly and children.
• - ventrogluteal: 1 1/2" in length; 20 to 25 gauge needle. Meds in oil-based sol should be admin with an 18 to 25 gauge needle.
• - vastus lateralis: 5/8" to 1" length needle with 20 to 25 gauge.

72 degrees or 90 degrees

90 degrees or 45 degrees

5-15 degrees

• Infants: vastus lateralis
• Toddlers and children: vastus lateralis/deltoid
• Adults: ventrogluteal/deltoid
• Hep B/Rabies: deltoid
• meds that are known to be irritating, viscous, or oily sol: ventrogluteal

the shorter 3/8" needle should be inserted at a 90 degree angle and the longer 5/8" needle is inserted at a 45 degree angle. With a 25 to 30 gauge. No more than 1mL of sol is given subcut.

1/4" to 1/2" length, 26 or 27 gauge needle is used. Dosage is small, usually 0.5 mL.

reduce N/V

expand the airways of the resp tract, which promotes air exchange and easier resp

aka laxatives, induces defecation

antibiotics precipitates it from prolong use

decr freq/intensity of cough

decr pain/discomfort

incr the flow of resp secretions promoting mucous removal from the lungs

incr urinary secretion of water and electrolytes (Na, K, Ca, Cl)

contribute to postural hypotension because of actions such as peripheral vasodilation, decr peripheral resistance, and decr in HR

Drugs are available from varied sources, both natural and synthetic. Natural sources include plants, animals, and inorganic compounds.

After a chem that might have therapeutic value is ID, it's put through a series of scientific tests to evaluate its actual therapeutic and toxic effects, tightly controlled by the FDA. The stgs include: preclinical trials, phase I, phase II, phase III. Phase IV study is when it enters a phase of continual evaluation, after a drug is approved for marketing.

prevented the marketing of adulterated drugs; required labeling to eliminate false/misleading claims.

Mandated tests for drug toxicity and provided means for recall of drugs; est procedures for introducing new drugs; gave FDA the power of enforcement. The drug "elixir of sulfanilamide" was distributed in a vehicle of ethylene glycol that had never been tested in humans. Turns out it was toxic and hundreds of people died and many people became ill, and that led to this act.

Tightened control of certain drugs; specified drugs to be labeled "may not be distributed w/o a prescription."

Tightened control over quality of drugs; gave FDA regulatory power over the procedure of drug investigations; stated that efficacy as well as safety of drugs had be est. When reviewing the various legislation r/t drug therapy, use of thalidomide as a sleeping agent for preg women led to the enactment of this Act.

defined drug abuse and classified drugs as to their potential for abuse; provided strict controls over the distribution, storage, and use of these drugs (DEA)

Provided incentives for the development of orphan drugs for treatment of rare dz.

• - category A: adequate studies in preg women have not demonstrated a risk to the fetus in first trimester of preg, and there's no evidence of risk in later trimesters.
• - category B: animal studies have not demonstrated a risk to the fetus but there are no adequate studies in preg women/animal studies have shown ADR, but adequate studies in preg have not demonstrated a risk to the fetus during the first trimester of preg and there is no evidence of risk in later trimesters.
• - category C: animal studies have shown an ADR on the fetus but there are no adequate studies in humans; the benefits from the use of the drug in preg women may be acceptable despite its potential risks, or there are no animal reproduction studies and no adequate studies in humans.
• - category D: There's evidence of human fetal risk but the potential benefits from the drug in preg women may be acceptable despite its potential risks.
• - category X: studies in animals/humans demonstrate fetal abnomalities/ADR indicate evidence of fetal risk. The risk of use in a preg woman clearly outweighs any possible benefit.

• -schedule I (C-I): High abuse potential and no accepted medical use (heroin, marijuana, LSD)
• -schedule II (C-II): High abuse potential w/severe dependence liability (narcotics, amphetamines, and barbiturates)
• -schedule III (C-III): Less abuse potential than schedule II drugs and moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics).
• -schedule IV (C-IV): Less abuse potential than schedule III and limited dependence liability (some sedatives, antianxiety agents, and non-narcotic analgesics)
• -schedule V (C-V): Limited abuse potential. Primarily small amounts of narcotics (codeine) used as antitissives/antidiarrheals. Under federal law, limited quantities of certain schedule V drugs may be purchased w/o a prescription directly from a pharmacist. The purchaser must be 18 yrs or older and must furnish suitable ID. All such transactions must be recorded by dispensing pharmacist.

the brand name of the drug must be dispensed.

regulates the development and sale of drugs