Post on 22-Dec-2015
PHARMACOLOGYLisa H. Young, RN, BSN, MA Ed.
Daymar College
HOW TO USE DRUG BOOK
http://www.youtube.com/watch?v=Jh_U8V9-Htw
http://www.youtube.com/watch?v=9mcqPJFB3UE
Controlled Substances Availability Uses and Unlabeled Uses Action and Therapeutic Effect Contraindications and Cautious
Use Route and Dosage Administration
Classifications and Prototype Drugs (Pr) Intravenous Drug Administration
Adverse Effects Diagnostic Test Interference Interactions Pharmacokinetics Clinical Implications Therapeutic Effectiveness Pregnancy Category
• PharmacodynamicsThe study of the action of drugs on living tissue
• Pharmacokinetics The study of the processes of drug absorption, distribution, metabolism, and excretion
• Pharmacotherapeutics The study of the use of drugs in treating disease
• Pharmacy The science of preparing and dispensing medicines
MAJOR AREAS OF PHARMACOLOGY
• Posology The study of the amount of drug that is required to produce therapeutic effects
• Toxicology The study of the harmful effects of drugs on living tissue
DRUG FORMS
Drugs come in various dosage forms:The physical and chemical properties of a drug usually determine what form will be most effective.
Some common dosage forms include tablets, capsules, syrups, and injectables.
• Therapeutic Effect
Desired Effects
• Side Effect• Adverse
Effect• Toxic Effect
Undesired
Effects
DRUG EFFECTS
DRUG NOMENCLATURE
• Drugs have three different names:ChemicalGenericBrand or Trade
• Drugs are also divided into the following classifications:
PrescriptionNonprescription (OTC)
ROUTES OF ADMINISTRATION
Drugs can enter the body several different ways.
Two common routes are orally and parenterally.
PHARMACOKINETIC PHASES
There are four pharmacokinetic phases: Absorption Distribution Metabolism Excretion
http://connect.mheducation.com/connect/hmEBook.do?setTab=sectionTabs
HALF-LIFE & BLOOD DRUG LEVELS
Half-life Half-life is the amount of time it takes for the blood concentration to drop by half of the original amount.
Blood drug levelsThe intensity of a drug effect is determined mainly by the concentration of drug in the blood.
BIOAVAILABILITY
Bioavailability is the percentage of drug that is actually absorbed into the bloodstream.
There are several factors that influence bioavailability.
DRUG INTERACTIONS
Drug interaction refers to one drug affecting the actions of another drug.There are several types of drug interactions:
Incompatibility Additive Effects Summation Synergism Antagonism
CHRONIC DRUG USE & ABUSE
Tolerance Decreased drug
effect with repeated administration
Two main types are metabolic and pharmacodynamic.
Dependence Reliance on drug
becomes ever more vital to the well-being of the patient
The two types are physical and psychological.
PHARMACOLOGIC PRINCIPLES
Prescription OrdersPatient Name (superscription)AddressDrug name (inscription)Drug doseRoute (subscription)Frequency of administrationNumber to be dispensedNumber of refills allowedDEA #MD Name/signatureMD addressMD Phone number
http://www.youtube.com/watch?v=Mhqe12Aj1dE
READING PRESCRIPTION LABELS
http://www.youtube.com/watch?v=S0oqYJp9t2ohttp://www.youtube.com/watch?v=hRdGLzylovM
MEDICATION ADMINISTRATION
Ten Rights Right patient name Right drug Right dosage Right route & technique Right time Right documentation Right client education Right to refuse Right assessment Right evaluation
http://www.youtube.com/watch?v=cm7GexPKNOc&list=PLxdOP8vuQhz9SNJLTWjTGzh3yOTsEsd6l
http://www.youtube.com/watch?v=yhHq-pV6HOw
DRUG USE IN THE ELDERLY
With an aging population comes an increase in geriatric prescriptions.
It is not uncommon for some elderly patients to have 3 or more prescriptions.Aging affects all four phases of pharmacokinetics.
As one ages, the following changes alter drug absorption:Decrease in the blood flow to the intestinesDecrease in gastric acid secretions
As one ages, the following changes alter drug distribution:Decrease in lean body massDecrease in total body waterIncrease in body fat
DRUG USE IN THE ELDERLY
• Altered drug metabolism• Decrease blood flow to liver• Decrease production of metabolizing
enzymes• Increased drug duration of action
• Altered drug excretion• Decrease in blood flow to kidneys• Decrease in all areas of renal function• Increased blood plasma concentrations • Need for reduced dosages
EFFECTS OF AGE ON DRUG RESPONSE
Several factors associated with aging affect drug response:
Nutritional statusDisease statesChanges in pharmacodynamic responses
DRUG COMPLIANCE IN THE ELDERLY
• Elderly patients can be confused about their medications.
• They may need a change in dosage form to allow for easier administration.
• Polypharmacy is a concern as well.
IMMUNIZATION SCHEDULE
Website addresses for current immunization schedules• American Academy of Pediatrics• http://www.aap.org
• American Academy of Family Physicians• http://www.aafp.org
• American College of Obstetricians and Gynecologists• http;//www.acopg.org
• Advisory Committee on Immunization Practices• http://www.cdc.gov/vaccinesacip
DOSAGE CALCULATIONS
A ratio is the relationship of one number to another number:
2:7 or 2/7A proportion expresses the equality between two ratios
3:4 = 12:16
SYSTEMS OF MEASUREMENT
There are different measuring systems used in pharmaceutical calculations and dosages:
Metric Apothecary Household
APOTHECARY SYSTEM
gr = grain gal = gallondr = dram qt iii = 3 quartsoz = ounce ix = 9lb = pound qt i = 1 quartm = minims gr ½ = ½ grainfl dr = fluid drams pt iiiss = 3 ½ pintsfl oz = fluid ounce 1 grain = 60 mgpt = pintqt - quart
RULES OF CONVERSION
Apothecary Metric
1 fluid oz 30 mL or cc
1 quart 1000 mL or cc
1 grain 0.065 gram
15 grains 1 gram
2.2 pounds 1 kilogram
Household Metric
1 drop 0.06 mL
1 tsp 4-5 mL
1 T 15-16 mL
1 cup 250 mL
2 cups 500 mL
DOSAGE DEFINITIONS
• Dosage unit
• Dosage strength
• Dosage ordered
• Desired dose
• Dose on hand Amount to administer
DOSAGE CALCULATIONS
Metric Conversion Value Chart
Kilo – Hecto-Deka-Base-Deci-Centi-Milli-X-X-Micro Gram Liter Meter
45.2 grams = 45200.0 milligrams
1cubic centimeter (cc) = 1 milliliters (ml)
http://www.youtube.com/watch?v=2QR9yCkAEpE
DOSAGE CALCULATIONS
Drug Calculation: Formula Method
Ordered Dose X Available Amount
Available Dose Amount to give
Ordered dose: 500 mgAvailable dose: 1000 mgAvailable amount: 1 ml
500 mg X 1 ml = 0.5 or ½ ml 1000mg ?
http://www.youtube.com/watch?v=b69Wr008dzMhttp://www.youtube.com/watch?v=BMDOk3RAHC4http://www.youtube.com/watch?v=Wa9Zi64_HJk
ROUNDING MEDICATION DOSAGES
Rounding 1.75 to the nearest tenth.If the number in question is 5 or greater, add 1 to the last number, and drop all the numbers to the right of the changed number.
1.75 → 1.8
If the number in question is less than 5, do not change the last number, but drop all the numbers to the right of that number 1.74 → 1.7
POUNDS TO KILOGRAMS
Divide the weight by 2.2 = weight in kilograms
32 pounds / 2.2 = 14.5454545kg
Round answers to the nearest hundredth
14.5454 = 14.55 kg
Weight in pounds and ounces, convert ounces to a decimal before dividing by 2.2 14 pounds and 6 ounces = 14.50 pounds Divide 4 by 16 = 0.50
BODY WEIGHT METHOD DOSAGE CALCULATION
1. Convert weight in pounds into kilograms 20 lbs / 2.2 = 9.09 kilograms or 9 kilograms
2. Multiply the amount of medication (mg) by the kilograms
Example: 20 lb child Give 5 mg/kg of medication. calculation: 5mg X 9 kg = 45 mg of medicationAvailable dose: 100mg/ml45 mg/100mg X 1ml/?ml = 0.45 ml = 0.46 ml
http://www.youtube.com/watch?v=AQaeAON4GUM
PEDIATRIC DOSAGE CALCULATIONS
Single-Dosage DrugsIntended to be given once or p.r.n.Multiply the recommended mg by the patient’s kg weight for
each dose.
Calculate one dose: ordered dose/available doseX dose unit
Single-Dosage-Range-DrugsSingle-dosage medications indicate a minimum and maximum range or a safe dosage range.
PEDIATRIC DOSAGE CALCULATIONS
Routine or Round-the-clock DrugsDosages intended to produce a continuous effect on the
body over 24 hours.
Total daily dose then divided by ordered divided doses
Daily-Dosage-Range DrugsMany medications are recommended by a minimum and
maximum mg/kg range per day, to be divided into some number of doses.
PHARMACOLOGY ABBREVIATIONS
ac before meals alt. h.alternate hours
bid twice a day fl.fluid
HS at bedtimecaps capsulePRN whenever this is needed dil.
diluteQ2h every 2 hours gtt
dropQ4h every 4 hours inj
injectionQ6h every 6 hours kg
kilogramQ8h every 8 hours L
literTID three times daily liq.
liquidQID four times daily noct.
nightSTAT give immediately R or PRrectally/per rectumAd lib as desired c
withH hour s
withoutpc after meals tab
tabletpo oral
tsp. teaspoonIM intramuscular ung
ointment
READING & INTERPRETING ORDERS
Procanbid 500 mg p.o. b.i.d.
Give 500mg of Procanbid orally twice daily.
Phenytoin 100mg p.o. t.i.d.
Give 100mg of Phenytoin orally three times daily
CHARTING MEDICATION ADMINISTRATION
Six Cs of Charting
Client’s own words Clarity Completeness Conciseness Chronological Confidentiality
http://www.youtube.com/watch?v=mYGf0AdhhI4
http://www.youtube.com/watch?v=SDcmXqSvP7A
GUIDELINES FOR CHARTING
• Date/time of entry• Legible handwriting• Permanent black ink • Proper terminology, correct spelling and correct grammar• Document in sequence • Be concise• Correct errors • Sign every entry
http://www.youtube.com/watch?v=pe2TQJKXZIshttp://www.youtube.com/watch?v=GMVwoR0YU-Ihttp://www.youtube.com/watch?v=Bkoic2dLFmY
CHARTING EXAMPLES
A. 9/1/12 9:00 a.m. nitroglycerin, 1 tab, sublingually. Written instructions given to pt. Precautions explained. Told to call office at 1:00p.m. today to report progress of his condition….M. Richards, CMA (AAMA)
B. 1/19/12 11:00 a.m. B 12 vitamin, 10000mcg given IM to left deltoid muscle without complications and band aid applied to injection site. Pt tolerated injection well. Pt. given written instructions for possible side effects and considerations. Pt to return in one monthly to receive monthly B 12 injections as ordered……L.Young, CCT.
C. 10/10/2012 1:00 p.m. Mantoux test, 0.01 ml. Tuberculin Purified Protein Derivative, Left forearm, subcutaneous, small wheal noted. Pt. instructed not to rub or cover the are and to return for reading on 10/12/12…..M. Richards, CMA (AAMA)
PATIENT EDUCATION
• Assessment• Plan• Implementing• Document• Evaluate• Special Needs• Noncompliance
http://www.youtube.com/watch?v=1HQHdpAov-I
PROFESSIONALISM
• Cultural Considerations
• The Life Span
• In the Workplace
• The Law
• Understanding and knowledgeable about medication
Skeletal Muscle Relaxants
OPIOID ANALGESICS
NONOPIOID ANALGESICS, NONSTEROIDAL ANTIINFLAMMATORIES, AND ANTIGOUT DRUGS
Antiinflammatory Drug Action
Nonopioids
Salicylates
Acetaminophen
NSAIDs
Drug Interactions
Preferred Therapy
ANTIANGINAL DRUGS
DIURETICS
ANTIHYPERTENSIVE DRUGS
NUTRITION AND THERAPY
RESPIRATORY PHARMACOLOGY
THERAPY OF GASTROINTESTINAL DISORDERS
ANTIBACTERIAL AGENTS
ANTISEPTICS & DISINFECTANTS
IMMUNOPHARMACOLOGY