Concepts of the first test material of nursing pharmacology. The information here is as deep as I think that they will test on, but I am sure that this is not an inclusive list of information that will be asked about. Supplement this material with the pharm book and reading the slides. Happy studying!
Pharm study guide 1:
Special population considerations
- Elderly – they can have multiple chronic conditions, polypharmacy, adherence issues, functional limitations, use 31% of the drugs even though they represent 12% of population. Issues in All parts of ADME
- A: ↓ GI motility and gastric emptying, ↑ gastric pH
- D: ↑ body fat %, ↓ body H2O, Lean body mass, albumin
- M: ↓ hepatic (Liver) mass, blood flow, and metabolism.
- E: Renal issues will cause excretion issues and can lead to toxicity and negative drug effects
- African population responds poorly to ACE inhibitors, but responds better to calcium channel blockers and Diuretics.
- Kiddos, but I did not find information about this population in the slides except do not recommend over the counter cough meds to a child less than 6 yo. (per the American Academy of Pediatrics)
Scheduled vs. legend drugs
- Legend drug is a drug that is illegal to have without a prescription
- Schedule drugs are regulated more and are in 5 schedules
- Schedule 1: High abuse potential and no medical use
- Schedule 2: High abuse potential and accepted medical use
- Schedule 3: Potential for abuse and accepted medical use
- Schedule 4: Low potential for abuse and accepted medical use
- Schedule 5: Lowest potential for abuse and accepted medical use
- (t ½ )The amount of time it takes for the body to eliminate half of the drug.
Pregnancy categories (old and new) Davis Drug Guide for Nurses Appendix I.
- A: have not shown an increased risk of fetal abnormalities
- B: Studies in animals show no negative effects, but there are no studies in pregnant women, or there are animal studies that show adverse effects and studies in pregnant women are not adequate
- C: animals have shown adverse effect, and there are no adequate and well-controlled studies in pregnant women, OR no animal studies have been conducted and there are no adequate and well controlled studies in pregnant women
- D: studies, adequate well-controlled or observational, in pregnant women have demonstrated a risk to the fetus. however, the benefits of therapy may outweigh the potential risk.
- X: Studies, adequate well-controlled or observational, in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. the use of the product is contradicated in women who are or may be pregnant.
Concepts of potentiation and interference in CYP 450 system
- System overview: 12 channels, 50 isoenzymes, 90% of drugs go through 6 channels. If 2 or more drugs need one channel there can be interference.
- Interference: one drug can increase or decrease the excretion or metabolism of another drug.
- ex. Erythromycin taken w/ increases serum digoxin levels, and increases action of Coumadin
- potentiation: when two similar drugs have an effect that adds on one another.
- ex. Coumadin + aspirin can = excessive bleeding
- ex. sedatives + ETOH can = excessive sedation
How other organ system issues impact drug dosing (i.e. renal)
- The renal system if not working well or in a disease state, will cause drug accumulation. this is an extremely important and common cause of toxicity and adverse med effects.
- a drug is competing to bind a protein in the blood and will end in a “drug reservoir” and allows accumulation to occur.
- the drug must be unbound to be useful or work.
- the most common protein that a drug binds to is albumin
- two similar drug molecules will have compete for binding sites on serum proteins
- is a ratio between the lethal dose and the effective dose. TI=LD/ED
- Therapeutic range: the area between the ED and LD, so effective but not lethal or toxic.
First pass effect
- for most oral or enteral drugs will be metabolized by the liver on the first pass through the liver.
- Some drugs could be 90% metabolized on the first pass.
Nursing interventions to reduce adverse effects
- Monitor for drug interactions
- know pt allergies history
- monitor patient for s/s
- interference – one drug stops or slows the action of a second drug.
- cyp450 system
- can be used on purpose
- HIV meds: ritonavir inhibits metabolism of lopinavir so the second drug can be effective.
- Potentiation: similar meds have effects that add to each other
- displacement is when two drugs are fighting for the same binding sites and only one can win. this leads to a drug with a higher affinity for the site or higher serum levels to displace the lesser drug.
Different forms of meds and how fast into the system
- Oral: swallowed, sublingual, buccal: 30 mins to and hour?
- enternal: NG, gastric tubes, rectal:
- Parental: SC, IM, IV, intrathecal, epidural:
- from slow to fast: ID, SC, IM, IV (IV is almost instantaneous in some cases)
- Pulmonary: gas, mist:
- fast due to the large amount of capillaries
- topical: local effect usually, must be lipid soluble.
- initial dose that is larger than maintenance dose that brings the levels of the drug up to the desired range.
Duration of action and minimal effective concentration
- measurable action of the drug from the beginning to end
- lowest serum levels that produce the desired effect.
BBB and drugs
- the Blood-brain barrier is a barrier that is harder to pass through than normal endothelial cells. this is due to the fatty sheath that covers the endothelial columns
- only lipid soluble meds can pass through (also drugs that are compatible with specific active transport site but this was not covered in class soooo)
What is ADME?
- Absorption, Distribution, Metabolism, Excretion
- This is all a part of pharmacokinetics
What is included in patient education?
- How, when, why, how much, how long, for what reason, diet, when not to take it, side effects, adverse effects, s/s of toxicity, when to notify HCP
Emergency care (Appendix T) of Davis Drug Guide for Nurses Appendix T.
- Early management of anaphylactic reactions
- Stop the administration of the drug
- Maintain airway: bronchodilators and Aminophylline may be needed to keep the airways open in severe resp. distress.
- Administer epinephrine:
- IM, SubQ; adults 0.3-0.5 mg q5-15 mins, Kiddos 0.01mg/kg or 0.1 q5-15 mins
- IV: Adults 0.1mg over 5mins or 1-4 mcg/min infusion, Kiddos 0.01mg/kg or 0.1-0.2 mg over 5 mins q 30 mins, infusion 0.1-1.5 mcg max/ kg/min
- Administer antihistamines: diphenhydramine (Benadryl) IM, IV: 50-100 mg initial, kiddos 5mg/kg/day divided into doses q6-8hr do not exceed 300mg/day (so child >15kg should not get the maximum dose)
- Support BP w/ fluids and vasopressors
- Administer corticosteroids: hydrocortisone (Sulo-cortef) IV 100-1000mg mg followed by 7mg/kg/day IV for 1-2 days
- Document the reaction in medical reaction and have the pt/family to carry ID
Side effects of anti-HTN meds and digoxin
- Thiazides cause a shift of K out of the body causing Digoxin toxicity
- Furosemide can cause ototoxicity
- Spironolactone (K sparing diuretic) will increase the half life of digoxin
Inotrope, chronotrope, dromotrope
- Cardiac drug effects
- inotropic ↑ contractility
- Chronotropic ↑ HR
- dromotropic ↑ conduction velocity of the heart
Selecting a BP medication
- Step I: A diuretic, calcium channel blocker, or ACE inhibitor
- Step II: increase dose of the first med, or ad another
- Step III: Pick another drug from a different class
- Step IV: Add another one or two meds, three or four total.
Labs and HTN meds
- Urinalysis for kidney function, lipid panel, electrolytes, Basic metabolic panel
- Meds: Beta blockers, ACE inhibitors, Diuretics
Disclaimer: This is for studying purposes only and is not for practice in a hospital setting or personal setting. Full disclaimer is under the main home page and can be found by searching “disclaimer” in the search bar.
Deglin, J., Vallerand, A., & Sanoski, C. (2015). Davis’s drug guide for nurses (14th ed.). Philadelphia, Pennsylvania: F.A. Davis.
Robinson PhD, FNP, M., & Gilbert DNP ARNP-BC, M. (2015, September 1). Pharmacokinetics & Pharmacodynamics. Lecture presented in Anschutz Medical campus, Aurora.
Robinson PhD, FNP, M., & Gilbert DNP ARNP-BC, M. (2015, September 8). Antihypertensives and Diuretics. Lecture presented in Anschutz Medical campus, Aurora.
Robinson PhD, FNP, M., & Gilbert DNP ARNP-BC, M. Nino, T. (2015, September 15). Respretory Pharmacology Fall 2015 Updates. Lecture presented in Anschutz Medical campus, Aurora.