The nurse must advise patients to report any differences in _____ or ______ of a drug or in its ______.
taste
appearance
packaging
To combat drug counterfeiting (make a copy with intent to deceive), the patient should do this (3) practices.
Be alert to slight variations in packaging or labeling.
note any unexpected side effects.
Buy drugs from reputable sources.
Describes a drugs chemical structure.
Uses nomenclature of chemistry.
chemical name
This is known as the nonproprietary name (not owned by any company);known also as the most common drug name where the drug manufacturer uses for a drug.
generic name
It is known as the proprietary or trade name or the name for the drug manufactured by one of the company often by the symbol ®.
Brand name
True or false
Many brand name can exist for a single generic name.
True
Eventually generic drugs have the same ingredients as the brand- name drugs but usually less expensive because manufacturers do not have to do extensive testings. Though they are clinically tested for safety and efficacy by the former pharmaceutic company this drugs may have inert fillers and binders that may alter the drugs effectiveness.
Some generic drugs are sold to branded manufacturers where they give improve it and goes different trials and testing and give it a new name.
The study of drug responses that may be unique to an individual owing to social,cultural, and biologic phenomena.
Ethnopharmacology
That is why it is necessary for nurses to use knowledge and research from the social sciences as well as the biologic and physical sciences to provide holistic nursing care.
Integrates the study of pharmacokinetics,pharmacodynamics, and variations of the predicted response to a drug due to genetic factors.
pharmacogenetics
Sets of learned behavior and ideas that human beings acquire as members of a community.
culture
Cluster of individuals who function as a group to attain cultural universals.
Community
_______ are designed to meet the community’s survival needs and common goals such as the obtainment of food and other practices that maintain the group.
Cultural universals
Numerous cultural groups engage in the use of traditional health practices, which may include use of: (7)
teas, herbs, spices, and special foods as well as homeopathic remedies, poultices, and ointments.
Traditional health practices can have _____, ____ or ______ effects on patient's health.
neutral
beneficial
deleterious
Because traditional health practices have various effects to patient's health, the nurse must _______ to determine all the pharmacotherapeutic agents the patient is using.
obtain a thorough health history
_________ usually have some practical knowledge of human anatomy and physiology, pharmacology, and pharmaceutical substances.
Traditional healers
Occurs when a less powerful group changes its ways to blend in with the dominant cultural group. Adults who immigrate to a new region usually take longer to assimilate than do younger people.
Assimilation
The process by which a group adjusts to living within a dominant culture while at the same time maintaining its original identity.
acculturation
Combine traditional beliefs and mainstream health practices.
Complementary health practices
When a dominant groupadopts health practices from a nondominant group.
Alternative Health Practices
Refers to the general study of all the different genes that determine drug behavior.
Pharmacogenomics
______ suggests that all culture have (6) phenomena flowing from a culturally unique individual.
The Ginger and Davidizar Transcultural Model
The Transcultural model by Giger and Davidhizar has (6) components mainly the:
☑communication
☑space - the amount of space around the body
☑social organization -family or groups
☑time - difference between nurses perspective and that of the patient
☑environmental control- the desire to control nature to facilitate the need of human beings.
☑biological variations
What must the nurse keep in mind with regards to communicating to patients?
Nurse must be aware of the verbal or nonverbal cues a patient may be exhibiting, as well as the language (proper use of translator), and the differences in greeting and communication style.
Cultures can have a different interpretation.
True or false
All cultures have taboos regarding touch.
True.
This depends on cultures as well.There are also added consideration when patients is of different gender than the nurse.
An altered or modified action or effect of a drug as a result of interaction with one or multiple drugs.
Drug interaction
An undesirable drug effect that ranges from mild untoward effects to severe toxic effects, including hypersensitivity reaction
and anaphylaxis.
Adverse effect
Is a chemical or physical reaction that occurs among two or more drugs in vitro. In other words, the reaction occurs between two or more drugs within a syringe, IV bag, or other artificial environment outside of the body.
Drug incompatability
Two categories of drug interaction.
Pharmacokinetic interaction
Pharmacodynamic interactions
Changes that occur in the absorption, distribution, metabolism and excretion of one or more drugs.
Pharmacokinetic interaction
Pharmacodynamic interactions result in _______,_____, and ______ drug effect.
additive,synergistic, or antagonistic
It is the sum of the effects of the two drugs administered together.
additive drug effect
A drug reaction where two drugs can potentiate ( increase the effect) the clinical effect to be greater than the combined effect of the two.
Synergistic drug effect
When two drugs have the opposite effect are administered together and each drugs cancels the effect of the other.
Antagonistic drug effect
_____ interaction is known to increase, decrease, or delay drug absorption.
Drug- food
Food can bind with drugs, causing less or slower drug absorption.
Abnormal plasma or serum electrolyte concentrations can affect certain drug therapies.
Drug-laboratory interaction
Data from lab test of patients must be read carefully to identify the proper amount of drug dosage to avoid any adverse effects.
A skin reaction caused by exposure to sunlight. It is caused by the interaction of a drug and exposure to ultraviolet A (UVA) light, which can cause cellular damage.Usually the skin area that is exposed is affected.
Drug-induced photosensitivity
What are the two types of photosensitivity?
Photoallergy
Phototoxicity
This type of photosensitivity allergy has a delayed hypersensitivity reaction.
Photoallergy
Because it takes time to develop antibodies
This type of photosensitivity is not immune-mediated and can be rapid to cause erythema.
phototoxicity
How long can phototoxicity persist?
2-6 hours
What is the difference between both the photosensitivity reaction?
Both type of reaction are results of light exposure but they differ according to the wavelength of light and the photosensitive drug.
Geriatric Pharmacokinetic
Physiological changes in the Body composition. (5)
Decreased total body water
Deacred lean body mass
Increased body fat
Decreased plasma albumin
Increased alpha 1 acid glycoprotein
Geriatric Pharmacokinetic
Physiological changes in the Body composition. (3)
Decreased GFR, renal blood flow and tubular secretion
Geriatric Pharmacokinetic
Changes in pharmacokinetic parameter (absorption)
(2)
(1)Decreased first-pass metabolism that increases bioavailability of propranolol & morphine.
(2)Decreased absorption by sublingual route d/t reduced blood supply to oral mucosa.
Geriatric Pharmacokinetic
Changes in pharmacokinetic parameter (distribution)
(4)
Decreased serum albumen that increases drug conc. of acidic drug
Increased alpha-1 acid glycoprotein that decreases free fraction of basic drugs
Decreased volume distribution Vd of water soluble drugs
Increased Vd of lipid soluble drugs
Geriatric Pharmacokinetic
Changes in pharmacokinetic parameter (metabolism) (3)
Decreased drug clearance and increased half life of oxidative metabolized drugs. (diazepam, piroxicam, theophylline quinidine)
Phase 2 metabolism of drugs like oxazepam, lorazepam is unaffected.
Geriatric Pharmacokinetic
Changes in pharmacokinetic parameter (excretion) (4)
Decreased renal clearance of drugs
Increased half-life
Creatinine clearance as guide to dose adjustment
Decreased respiratory capacity
Increased incidence of pulmonary disease use of IV rather than inhiation anaes
_______ slower in infancy, but absorption from _______ is faster
GI absorption (slower)
intramuscular (faster)
Infant skin is thin and __________ can cause systemic toxicity
percutaneous absorption
_______ content in infants low, _____ content is high
body fat (low)
water (high)
Compare the geriatric and pediatric distribution of fat soluble drugs.
Geriatric Vd of lipid soluble drugs are increased
Pediatric lower Vd of fat soluble drugs
True of false
Neonates have high protein binding level.
False
There is decrease plasma protein binding of drugs in neonates
due to lower levels of plasma proteins like albumin and alpha-1-acid glycoprotein, which are responsible for drug binding, along with the immaturity of their liver and kidneys affecting drug metabolism and distribution.
True or false?
Blood-brain barrier is more permeable in neonates and young children, leading to and increase risks of CNS adverse effects
True
In pediatric patients; at birth, _____________ is relative immature particularly in preterm infant but after first four weeks it matures rapidly.
the hepatic microsomal enzyme system- plays a central role in the metabolism of drugs and other compounds in the liver.
True or false?
Hepatic drug metabolism increased in older infants and children.
True
Because their organs are continuously developing
True or false
Phenobarbitone drug (a medication primarily used as an antiepileptic (anti-seizure) metabolism faster in adults than in children because they can metabolize it faster.
false
It is faster in children than in adults
All renal mechanisms (filtration,secretion and reabsorption) are
reduced in both _______ and _______.
neonates and new born
_______when given to pregnant women near term, can induce (can cause a rise) fetal hepatic enzymes responsible for glucuronidation of bilirubin.
Phenobarbital
________ can produce grey baby syndrome in neonates.
chloramphenicol
What is the GOLDEN RULE FOR DRUG THERAPY in ELDERLY
smallest number of drugs
in lowest possible dose
for shortest possible time
in simple possible regimen
IMPORTANT ADVERSE EFFECT IN CHILDREN
causes reye's syndrome
aspirin
IMPORTANT ADVERSE EFFECT IN CHILDREN
causes increased hepatotoxicity hepatotoxicity i young children
valproate
IMPORTANT ADVERSE EFFECT IN CHILDREN
Causes dystonias more frequently than in adults.
metoclopramide
IMPORTANT ADVERSE EFFECT IN CHILDREN
damage growth cartilage
fluoroquinolone (ciprofloxacin)
IMPORTANT ADVERSE EFFECT IN CHILDREN
staining and occasionally dental hypoplasia
IMPORTANT ADVERSE EFFECT IN CHILDREN
inhibit growth
chronic corticosteroid use
The Pharmacodynamic changes in geriatric patients. (6)
☑️Greater sensitivity to medications affecting CNS
☑️More confusion with cimetidinde
☑️Increased incidence of postural hypotension
☑️Reduce clotting factor synthesis: require reduced dose of warfarin
☑️Increased toxicity from NSAIDS
☑️Increased incidence of allergic reactions
Give atleast 5 principles of prescribing in children.
☑️Calculate doses for drugs base on weight of patient
☑️use well establishes drugs
☑️give proper instruction to parents
☑️keep all drugs out of reach of children
☑️use antibiotics sparingly and only when required
☑️avoid prolonged treatment with drugs that have delayed complications (steroids)
☑️use suitable dosage forms
☑️Keep in mind the PK (Pharmacokinetic) & PD (Pharmacodynamic) differences
Give atleast 5 principles of prescribing in elderly.
☑️Calculate doses for drugs base on weight of patient
☑️use well establishes drugs
☑️give proper instruction to parents
☑️keep all drugs out of reach of children
☑️use antibiotics sparingly and only when required
☑️avoid prolonged treatment with drugs that have delayed complications (steroids)
☑️use suitable dosage forms
☑️Keep in mind the PK (Pharmacokinetic) & PD (Pharmacodynamic) differences
Give atleast 5 principles of prescribing in elderly.
☑️Think about the necessity for drugs
☑️Avoid drugs with negligible or doubtful benefit
☑️Think about the dose
☑️Think about drug formulation
☑️Assume any new symptoms may be due to drug side-effects.
