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Grouping of Drugs
Names may reflect the conditions for which they are used (e.g. antidepressants) May reflect their chemical characteristics (benzodiazepines) May reflect the effects on body systems (central nervous system depressants)
Prototype Drugs
Individual drugs that represent groups of drugs are called Prototypes May be the first drugs of this group to be developed (e.g., penicillin for antibiotics, morphine for opioid analgesics)
Drug Names
Generic Name is related to the chemical name and is independent of the manufacturer (e.g., sertraline) Trade name is designated and patented by the manufacturer (e.g., Zoloft)
Pregnancy Categories
Cat. A-studies in pregnant women failed to show risk to the fetus Cat. B- animal studies have failed to show a risk to the fetus but there are no adequate studies in women Cat. C-animal studies have shown an adverse effect on the fetus, no adequate human studies, benefits may outweigh risks
Pharmacokinetics
Involves drug movement through the body to reach sites of action, metabolism, and excretion Specific processes are absorption, distribution, metabolism and excretion
Pharmacokinetics
Absorption-process that occurs from the time a drug enters the body to the time it enters the bloodstream to be circulated Factors affecting absorption include: dosage form, route of administration, blood flow to the site of administration, gastrointestinal function, presence of food or other drugs For many medications, food in the stomach slows absorption
Bioavailability
Is the portion of a dose that reaches the systemic circulation and is available to act on body cells IV administration is 100% bioavailable Subcutaneous administrations has more rapid absorption than does the oral route Mucous membranes allow for rapid and direct absorption into the bloodstream
Distribution
Involves the transport of drug molecules within the body After the drug is absorbed into the bloodstream, it is carried by the blood or tissue fluids to its sites of pharmacologic action, metabolism and excretion Protein binding is an important factor in drug distribution
Distribution cont.
Drug distribution into the CNS is limited because of the blood-brain barrier Blood-brain barrier is composed of capillaries with tight walls which limits movement of drug molecules into brain tissue Only drugs that are lipid soluble or have a transport system can cross the blood-brain barrier and reach therapeutic concentrations in brain tissue
Distribution cont.
Drug distribution during pregancy and lactation is unique as most drugs cross the placenta or in the case of lactation, pass into breastmilk
Protein binding
Most drugs form a compound with plasma proteins, mainly albumin, which act as carriers Only the free or unbound portion of a drug acts on body cells As unbound drug acts on cells, the decrease in plasma drug level causes some of the bound drug to be released Protein binding allows a part of a drug dose to be stored and released as needed
Metabolism
Method by which drugs are inactivated or biotransformed by the body Some drugs yield metabolites that are also active and exert effects on the body until they are excreted (normeperidine) Most drugs are lipid soluble which aids their passage across the cell membrane
Metabolism cont.
Excretion usually is by kidneys. Need to be water soluble for this to occur. Thus, one function of metabolism is to convert fat soluble medications to water soluble ones. Hepatic drug metabolism or clearance is a major mechanism for terminating drug action and eliminating drug molecules from the body
Metabolism cont.
Most drugs are metabolized by the cytochrome P450 enzymes in the liver Liver contains complex system of enzymes, three of which are key in the metabolism of medications/drugs
Cytochrome p450
CYP enzymes catalyze the chemical reactions which ultimately metabolize the medications With chronic administration (greater than 1-3 weeks), some drugs stimulate hepatocytes to produce larger amounts of drug metabolizing enzymes (inducers). Enzyme induction accelerates drug metabolism. Result is that larger doses of the drug may be need for therapeutic effects.
Cytochrome p450
Enzyme inhibition may occur with concurrent administration of two or more drugs that compete for the same metabolizing enzymes (e.g., Dilantin, EES, Tagamet) Oral meds are generally absorbed by the GI tract and carried to the liver. Drug may undergo extensive metabolism leaving little for systemic use. This is called the first pass effect.
Excretion
Refers to the elimination of a drug from the body Most are excreted by the kidneys although some are excreted in the bile then the feces
Pharmacodynamics--Receptors
Involves drug actions on target cells and the resulting alterations in cellular biochemical reactions Most drugs chemically bind with receptors at the cellular level Drug-receptor complex initiates physiochemical reactions that stimulate or inhibit cellular functions
Pharmacodynamics-receptors
Receptors vary in type, location, number and functional capacity When drug molecules chemically bind with cell receptors, pharmacologic effects result from agonism or antagonism
Pharmacodynamics-receptors
Agonists-are drugs that produce effects similar to those produced by naturally occurring hormones, neurotransmitters and others. Agonists may accelerate or slow normal cellular processes depending on the type of receptor activated. Antagonistsdrugs that inhibit cell function by occupying receptor sites. Not all drugs act on receptors. Examples include: antacids, osmotic diuretics, chelators.
ToxicologyDrug Overdosage
1. 2. 3. 4. 5. 6. 7. General management CPR ETT IV Check blood sugar, drug screen, liver and kidney function Charcoal Narcan or possibly antidotes May alkalinize the urine to prevent kidney damage
Antidotes cont.
Benzodiazepinesflumazenil Cholinergics-atropine Calcium channel blockerscalcium gluconate
Drug Administration
Minimize the use of abbreviations Calculate dosages correctly Measure doses accurately Use appropriate anatomic landmarks to identify sites of IM injections-follow manufacturers recommendations Verify client identity
Drug Administration
*****Seek information about the clients medical diagnoses and condition in relation to drug administration Be especially vigilant with children to avoid errors
Legal Responsibilities
Nurse is legally responsible for safe and accurate administration of medications Nurse is expected to have sufficient drug knowledge to recognize and question erroneous orders Unit dose wrappings of oral drugs should be left in place until the nurse is in the presence of the client and ready to administer the medication
Medication Orders
Include the full name of the patient Generic or trade name of the drug The dose, the route and frequency of administration Date, time and signature of the prescriber
Common abbreviations
PO IM IV SL Sub q
Drug Dosages
cc g Gr gtt mL oz Tsp tbsp
Routes of Administration
Oral Via GI tube Parenteral-IM, IV and sub q Topical Rectal, ophthalmic Otic vaginal
Equivalents
Metric Apothecary Household (see p. 37)
Pediatrics
Oral route for meds is preferable For injections, may wish to use EMLA (eutectic mixture of lidocaine and prilocaine, local anesthetics) Site selection for injectionsinfants, use thigh muscles; older than 18 months of age, use deltoid; older than 3, use ventrogluteal muscle
Questions