NUR 117 Overview of Pharmacology Copyright 2011

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Количество слайдов: 38

Pharmacology • Pharmacology is the study of the biological effects of chemicals. • Nurses deal with pharmacotherapeutics, or clinical pharmacology. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nurse’s Responsibility • Administering drug • Assesses for adverse drug effects • Intervening to make the drug regimen more tolerable • Providing patient teachings about drugs and the drug regimen • Monitoring and prevention of medication errors Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drug Nomenclature • Chemical name—identifies drug’s atomic and molecular structure • Generic name—assigned by the manufacturer that first develops the drug (Acetaminophen) • Official name—name by which the drug is identified in official publications USP and NF (Often the same as Generic) • Trade name—brand name copyrighted by the company that sells the drug (Tylenol) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drug Legislation • In 1938 the Federal Food, Drug and Cosmetic Act, prohibiting adulterated or mislabeled drugs from being made available. • The (FDA) Food and Drug Administration enforces this law. • The Controlled Substance Act was passed in 1970 this law regulates distribution of narcotics and other drugs of abuse. Control over the coding of drugs and the enforcement of these codes to the FDA and the Drug Enforcement Agency (DEA), a part of the U. S. Department of Justice. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sources of Drug Information • Drug Label – Drug labels have specific information that identifies a specific drug – Understanding how to read a drug label is essential • Package Insert – Prepared by the manufacturer – Contains all of the chemical and study information that led to the drug’s approval – Difficult to understand read Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sources of Drug Information (cont. ) • Reference Books – Physician’s Drug Reference (PDR) – Drug Facts and Comparisons – The United States Pharmacopeia-National Formulary (USP-NF) – Lippincott’s Nursing Drug Guide (LNDG) • Journals • Internet (reliable sources) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drug Preparations • Oral – Capsule, pill, tablet, extended release, elixir, suspension, syrup • Topical – Liniment, lotion, ointment, suppository, transdermal patch • Injectable Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Medication Orders • Standing order—carried out until cancelled by another order • PRN order—as needed • Stat order—carried out immediately Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Parts of the Medication Order • Patient’s name • Date and time order is written • Name of drug to be administered • Dosage of drug • Route by which drug is to be administered • Frequency of administration of the drug • Signature of person writing the order Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

7 Rights of Medication Administration • Right medication • Right patient • Right dosage • Right route • Right time • Right reason • Right documentation Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medication Supply Systems • Stock supply • Individual unit dose supply • Medication cart • Computerized automated dispensing system • Bar code–enabled medication cart Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drug Classifications • Effect on body system (example: antihypertensive) • Chemical composition • Clinical indication or therapeutic action Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mechanisms of Drug Actions • Drug-receptor interaction—drug interacts with one or more cellular structures to alter cell function • Drug-enzyme interaction—combines with enzymes to achieve desired effect • Acting on cell membrane or altering cellular environment Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Factors Affecting Drug Absorption • Route of administration • Lipid solubility • p. H • Blood flow • Local conditions at site of administration • Drug dosage Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Variables Influencing Effect of Medications • Developmental considerations • Weight • Sex • Genetic and cultural factors • Psychological factors • Pathology • Environment, timing of administration Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pharmacokinetics • Absorption—drug is transferred from site of entry into bloodstream • Distribution—drug is distributed throughout the body • Metabolism—drug is broken down into an inactive form • Excretion—drug is excreted from the body Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Systems of Measurement • Metric—meter (linear), liter (volume), gram (weight) • Metric is most commonly used and has been adopted internationally. It is proven to be safer for measuring drug dosages • Apothecary—less convenient and concise; basic unit or weight is grain • Household—least accurate system; teaspoons, tablespoons, teacup, and glass used Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical Record Documentation • Name of the medication • Dosage • Route and time of administration • Nurse’s initials • Intentional or inadvertently omitted drugs • Refused drugs • Medication errors Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Type of Medication Errors • Inappropriate prescribing of the drug • Extra, omitted, or wrong doses • Administration of drug to wrong patient • Administration of drug by wrong route or rate • Failure to give medication within prescribed time • Incorrect preparation of a drug • Improper technique when administering drug • Giving a drug that has deteriorated Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medication Errors • Check patient’s condition immediately; observe for adverse effects. • Notify nurse manager and physician. • Write description of error and remedial steps taken on medical record. • Complete special form for reporting errors. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Three Checks of Medication Administration • Read the label: – When the nurse reaches for the container or unit dose package – After retrieval from the drawer and compared with the CMAR, or compared with the CMAR immediately before pouring from a multidose container – When replacing the container to the drawer or shelf, or before giving the unit dose medication to the patient Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Administration of Oral Medications • Oral Route—having patient swallow drug • Enteral route—administering drug through an enteral tube • Sublingual administration—placing drug under tongue • Buccal administration—placing drug between tongue and cheek Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Administration of Parenteral Medications • Subcutaneous injection—subcutaneous tissue • Intramuscular injection—muscle tissue • Intradermal injection—corium (under epidermis) • Intravenous injection—vein Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sites for Intramuscular Injections • Ventrogluteal site • Vastus lateralis site • Deltoid muscle site • Dorsogluteal site is no longer recommended Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Criteria for Choosing Equipment for Injections • Route of administration • Viscosity of the solution • Quantity to be administered • Body size • Type of medication Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Topical Administration of Medications • Skin applications • Eye instillations and irrigations • Ear instillations and irrigations • Nasal instillations • Vaginal applications • Rectal instillations Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Patient Teaching • Review techniques of medication administration. • Remind the patient to take the medication as prescribed for as long as prescribed. • Instruct the patient not to alter dosages without consulting a physician. • Caution the patient not to share medications. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Drug Calculation • Order: Give Demerol 10 mg IM. • You have a vial with a label that reads: Demerol 25 mg/ml. • What happens if the order is written in grams? • For example : Give Demerol 0. 01 grams IM? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

BREAK TIME • Take a 15 break and return to your desk for testing. • Students are expected to clear all desks of all objects other than test, pencil and calculator. • Spread out or move so that each of you are separated to a minimum of every other seat. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins