-
any chemical that can affect living processes
drug
-
the study of drugs and their interactions with living systems
pharmacology
-
the study of drugs in humans (patient's and healthy volunteers)
clinical pharmacology
-
the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy
therapeutics or pharmacotherapeutics
-
What are the 3 major properties of an ideal drug?
- effectiveness (most important)
- safety
- selectivity
-
What are some additional properties of an ideal drug?
- reversible action
- predictability
- ease of administration
- low cost
- freedom from drug interaction
- chemical stability
- possession of a simple generic name
-
What factors determine the intensity of a drug response?
- administration (route, amount of dosage, timing)
- pharmacokinetics
- pharmacodynamics
- individual variation (physiology-age, gender, weight, genetics, pathphysiology)
-
What are sources of drugs?
- plants
- animals/humans
- minerals
- chemicals
-
What are the types of drug therapy?
- prescription drugs-healthcare provider must write
- nonprescription drugs-OTC drugs
- controlled drugs-regulated by the federal, state and local government
- recreational drugs-people obtain by illegal means
-
What are the different names fo drugs?
- chemical name
- generic name
- brand/trade name
-
What are some sources of drug information?
- U.S. Pharmacopeia (USP)
- National Formulary-Supplement to the USP
- PDR
- Nursing Drug Handbooks
- Internet
- Pharmaceutical companies
-
What does the USP provide regarding drug information?
- drug must be of high standard to be listed
- drugs are reviewed every 5 years
- info.: strength, quality, purity, packaging, safety, labeling, dosage form
-
What does the PDR provide regarding drug information?
- list pharmaceutical companies
- color pictures of medications
- drug action
- recommended dosage
- indications for use
- side effects
-
What does the Nursing Drug Handbook rpovide with regards to drug information?
- generic and trade names
- indication for use and recommended doses
- action & pharmacokinetics
- side effects & nursing implications
- teaching tips
-
first federal law protecting the public from mislabed and dangerous products, developed by the USP
Pure Food and Drug Act of 1906
-
legislative act that required pharmaceutical companies to test products for safety before selling them
Food, Drug, and Cosmetic Act of 1938
-
legislative act that defined prescription v. nonprescription drugs
1952: Durham-Humphrey Amendment of the 1938 Act
-
legislative act resulting from the thalidomide tragedy, required safety and efficacy testing of drugs
1962: Kefauver-Harris Amendment of the 1938 Act
-
legislative act to fast track drugs anf allow off-label uses of drugs
Food and Drug Administration Modernization Act (1997)
-
law that allowed the testing of drugs already on the marker
Best Pharmaceuticals for Children (2002)
-
law that required the testing of all drugs to be used on children
Pediatric Research Equity Act of 2003
-
What are the regulatory agencies for drugs?
FDA, CDC, DEA, ANA, state board of nursing
-
What is involved in the pre-clinical testing of new drugs?
- extensive animal studies
- submit Investigation New Drug (IND) application
- application reviewed by FDA & is approved then clinical testing may begin
-
What is involved in the clinical testing of a new drug?
- human studies
- phase 1-studies the effects of the drug on a small group of healthy volunteers
- phase 2-studies the effects of the drug on a small number of individuals with the disease, looks at effectiveness and side effects
- phase 3-studies the effects of the drug on a large number of individuals with the disease
- submit a new drug application (ND) to FDA, hsa to be apporved in order to marker the drug
- phase 4-post market studies, volunteer basis
-
rights of human subjects to be protected in medical research
nuremburg code
-
What is the purpose of informed consent in research?
- describes the study in detail
- hazards, risks, and benefits of study
- payment
- study termination
- confidentiality
-
What are the basic tasks for giving informed consent?
- decision making capacity
- information/education
- understanding
- free-choice
- obtain informed consent
- documentation
-
What are the nursing responsibilities that are specific to drug therapy?
- goals of drug therapy
- mechanism of drug action
- expected effects
- proper administraiton techniques
- contraindications
- assess responses
- client education
-
What is the purpose of assessment in the nursing process with regards to drug therapy?
- gather data: subjective & objective
- assess learning needs
- verify & cluster
-
What is the purpose of nursing diagnosis in the nursing process with regards to drug therapy?
- formulate nursing diagnosis (NANDA list)-identify health care needs of clients within the realm of nursing practice
- nursing diagnosis related to drug therapy-knowledge deficit, noncompliance, or a diagnosis related to side effects
-
What is the purpose of planning in the nursing process with regards to drug therapy?
establish goals-patient oriented, use action verbs, MEASURABLE, time limited
-
What is the purpose of interventions in the nursing process with regards to drug therapy?
- education-why are you taking it? intended therapeutic response? how often? side effects and which to report?
- medications orders
- administration of medications
- documentation: date, time, med, dose, route
- w/holding medication: pt refuses, side effects. notify physician
-
What is the window for administering a medication?
30 minutes
-
What are the 5 rights of medication administration?
- right patient
- right drug
- right dose
- right route
- right time
-
What are the components of a drug order?
- date & time
- patient name & hospital #
- drug, dosage, route, frequency, lot #
- MD name
- nurses name & title
-
What are the types of drug orders?
- written orders v. fax orders
- phone orders v. verbal orders
- standing order
-
What is the purpose of evaluation in the nursing process with regards to drug therapy?
- effectiveness of meds for therapeutic & non-therapeutic responses (30 minutes to 1 hour)
- determine the extent to which goals of care have been achieved
- compare client response to outcome and document responses
- analyze reasons for results and conclusions
- modify care plan
-
What are the 3 phases of drug action?
- pharmakinetic phase-MUST occur first
- pharmacodynamic phase
- pharmacotherapeutic phase
-
the mechanisms by which drugs interact, on a molecular level, with constituents of cells or cellular environments to produce biochemical and/or physiological changes in cells, tissues, organs, and ultimately patients
pharmacodynamics
-
In order for a drug to have pharmacologic effects, it must be capable of?
influencing some functioning of some cells
-
The ultimate objective is to select drugs that have a _____ and ______ .
- very narrow
- well-defined target or very specific action in the body
-
The narrower the action of a drug, the ____ widespread damage/adverse effects
less
-
What are the 3 theories of drug action?
- nonspecific theory
- drug enzyme theory
- drug receptor binding
-
produce dynamic effects by influencing the environment of cells, does not require interaction b/t tje drug & cell
nonspecific theory
-
What are the 5 mechanisms of the nonspecific drug theory?
- alteration of body chemistry
- aborption of toxins, electrolytes, bile salts, and other drugs in the intestinal tract
- imposition of a physical barrier
- lubrication
- alteration of surface tension
-
What is the mechanism of the nonspecific theory of drug action that alters body chemistry and an example?
- alters gastric or extracellular pH
- extracellular osmotic pressure
- composition of extracellular electrolytes
- example: antacids are used to alter gastric pH
-
What is the mechanism of the nonspecific theory of drug action that involves the absoprtion of toxins, electrolytes, bile salts, and other drugs in the intestinal tract and an example?
- drugs have an irreversible bond in the intestinal tract which prevents absorption
- example: activated charcoal binds to (absorbs) other orally ingested drugs & toxins, preventing their absorption
-
What is the mechanism of the nonspecific theory of drug action that involves the imposition of a physical barrier and an example?
- block injury to cells from their exterior
- example: sunscreens coat the skin cells blocking UV radiation injury from the sun
-
What is the mechanism of the nonspecific theory of drug action that involves lubrication and an example?
- by decreasing mechanical injury to the cells, they perform a protective function
- example: mineral oil decreases friction b/t colonic wall and stool, allowing easier defecation
-
What is the mechanism of the nonspecific theory of drug action that alters surface tension and an example?
- allows solids and liquids to mix, liquid becomes solid
- example: stool softeners alter the surface of hard stool allowing water from the colonic lumen to enter the stool, making it softer
-
What are the 2 forms of drug-enzyme interaction with regards to the drug enzyme theory of drug action? What are examples of each?
- drug may bind to the same physical location on the enzyme, preventing the enzyme from functioning normally (digoxin)
- drug may interact with an enzyme target changing the physical structure of the enzyme and disrupting its integrity (ACE inhibitors)
-
mimic actions of the body, can cause a response when they bond to the receptor
agonist
-
What are the 2 types of agonists and example of each?
- agonist I-bind to the same receptor site as endogenous biomediator (epinephrine, opiates)
- agonist II-bind to a different site on the receptor, but enhances the natural effect of the endogenous biomediator on its own receptor (thyroid hormone, benzodiazepines)
-
blocks the actions of the body, has no intrinsic activity of their own
antagonist
-
What are the 3 types of antagonist and example of each?
- antagonist I-bind to the same site and inhibit or block the action of the natural compound (atropine, H2 receptor blockers)
- antagonist II-bind to a different molecular extracellular site from the endogenous biomediator and partially inhibit the action of the natural compound (calcium channel blockers)
- antagonist III-translocate and inhibit receptor's signal on the inside of the cell, either at the internal part of the receptor or some other secondary messenger mechanims inside the cell (Viagra)
-
s-shaped curce that demonstrates the dosage rance that produces the desired response for each drug
log-dose drug response curve
-
the average dose that produces half of the desired response on most patients (recommended dose)
effective dose-ED 50
-
How is the ED 50 defined?
- objective measurements-single patient measurement
- subjective symptoms-100's of subjects required
-
produces death in one half of test animals
lethal dose-LD 50
-
measurement of a drug's safety/toxicity
- therapeutic index
- TI = LD50/ED50
-
The wider the curves (further away the LD50 & ED 50 curves) on a graph, the ______
The narrower the curves, ______
safer the drug
more toxic the drug
-
the measurement of the amount of active ingredient of the drug
relative potency
-
the drug with the least amount of active ingrediant producing its ED50 is the most _____
potent
-
the ability of a drug to produce an effect
maximal efficacy
-
What are the different types of drug therapies and examples of each?
- acute-new or immediate problem (appendicitis)
- maintenance-maintains current functions, does not prevent progression (insulin, BP meds)
- supplemental-maintains normal functions (vitamins)
- supportive-maintains body function integrity (IV fluids)
- prophylatic-preventive care (antibiotics prior to surgery)
- palliative-end of life care, comfort measures (pain meds)
-
What is a Type A adverse drug reaction?
- intrinsic adverse drug reaction
- direct extension of the known pharmacodynamic actions
- most common type of ADR-60-70% of all known ADR's
- predictable
- dose-dependent
-
What is a Type B adverse drug reaction?
- idiosyncratic adverse drug reaction
- uncommon, unpredictable DR that is not explained by pharmacodynamics
- 20-30% of ADR's
- independent of the size of the dose of drug administered
- may be genetically linked
-
What are the different types of type A intrinsic ADR's?
toxic reaciton, tachyphylaxis, tolerance, dependence (physical and psychological), additive/synergist effects, antagonist effects
-
What are the different typess of type B idiosyncratic ADR's?
- allergic reaction/anaphylaxis
- idiosyncratic or paradoxial response
- carcinogenic effect
- teratogenic effect
- extrapyramidal effect
- serum sickness
- fetal alcohol syndrome
- iatrogenic reaction
-
drug poisoing or an overdose
toxic reaction
-
tolerance occurs very rapidly to a drug with just a few doses
tachyphylaxis
-
decrease responsivenesss to a drug as a result of repeated drug administration
tolerance
-
physical symptoms from withdrawing from a drug
physical dependence
-
intense cravings for a drug
psychological dependence
-
combining 2 drugs which increases their effects
additive/synergistic effects
-
blocking the effects of a drug
antagonistic effects
-
results from an immune response, must have previously been exposed
allergic reaction/anaphylaxis
-
an effect that is opposite of what is expected
idiosyncratic or paradoxial response
-
the ability of certain medications and environment chemicals to cause cancers
carcinogenic effect
-
a drug-induced birth defect
teratogenic effect
-
mimick's Parkinson's disease
extrapyramidal effect
-
a delayed reaction that occurs about a week after the administration of a drug
serum sickness
-
caused by a mother drinking alcohol during pregnancy which leads to congenital defects in the fetal body
fetal alcohol syndrome
-
a healthcare induced ADR
iatrogenic reaction
-
sensitivity or an abnormal reaction to light
photosensitivity
-
mixing 2 substances which turns the substances a chalky consistency
incompatible
-
taking 8+ drugs, including OTC drugs
polypharmacy
-
therapeutic effects with inactive substances
placebo
|
|
