Pharmacology Day 1

Elizabeth Keele, RN/BSN

Course Objective #2

• Describe the dynamic process between the giver and the receiver of medications, which promotes positive medication compliance.

“Dynamic Process”

• dy·nam·ic• dīˈnamik/• adjective• 1. ( process or system) characterized by

constant change, activity, or progress.

“Dynamic Process”

• Giver • Receiver

“Mutual process”

• Key characteristics:–Knowledge– Teaching–Communication–Observation skills– Evaluation skills

Turn to your neighbor and take turns…

• Describing the dynamic process between the giver and the receiver of medications, which promotes positive medication compliance. • (Course objective #2)

Course Objective #1

• Identify limitations/deficits commonly seen in D.D. clients that prevent them from asking questions or reporting adverse effects regarding medications they receive.

Limitations to “mutual process” of medication administration

• Understanding• Communication• Awareness

• Knowledge• Teaching• Communication• Observation• Evaluation

Limitations to “mutual process” of medication administration

• The NURSE must “account and compensate” for these limitations

Medication Administration is…

• Invasive• Risk to benefit

Turn to your neighbor and take turns

• Identify limitations/deficits commonly seen in D.D. clients that prevent them from asking questions or reporting adverse effects regarding medications they receive.

• (Course objective #1)

Course Objective #3

• Describe the importance of patient teaching with regard to prescribed medication regimen.

Why is patient teaching important?

Teaching / Learning Process

• Teaching– Interactive process

• Learning– Acquiring new

knowledge• Motivation– Desire

3 Domains of Learning

• Cognitive– Intellectual activities

• Affective–Attitudes & beliefs

• Psychomotor–Physical skills

Turn to your neighbor and…

• Describe the importance of patient teaching with regard to prescribed medication regimen.

• (Course objective #3)

Course Objective #4

• Describe the electrochemical processes of the central nervous system, which allow CNS drugs to cause their desired effects.

Course objective #12

• Explain how chemicals and electrical impulses interact to make up the electrochemical properties of the nervous system.

The nervous system consists of:

• Divided system– Central Nervous System (CNS)• Brain & Spinal Cord

– Peripheral Nervous System (PNS)• Nerves (peripheral & Cranial)

Nervous System

• Controls and coordinates the body

• By transmission of electrical impulses (Electrical-chemical system)

Nerve Impulse

• The nervous system is powered by electrical and chemical energy– K+– Na+– Cl-– (Ca+)

Course objective #9

• Differentiate between afferent and efferent neuron.

Neuron

• Basic functional unit– Afferent neuron

• Sensory• Carry info from PNS CNS

– Efferent neuron• Motor• Carry into from CNS PNS

Neuron structure

• Cell body/ Soma– Nucleus– Neurotransmitters synthesized

• Dendrites– Carry impulses toward the cell

body

• Axons– Carry impulses away from the

cell body

Cool Fact Damaged Neuron

• CNS = – Irreversible

• PNS = –will repair itself if

the cell body is not destroyed

Course Objective #10

• Describe the role played by neurotransmitters in nerve impulse transmission within the synapse.

Synaptic Junction

• Neuron connect to each other end to end

• Where two neurons come together– Synaptic junction– Synapse– Inter-neuron space

Anatomy of the NS

• Synapse = the space between one neuron & the next

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Pre-synaptic neuron

Post-synaptic neuron

Synaptic Junction

• Terminal end of Axon = Pre-Synaptic Vesicles

• Nerve impulse reaches the vesicle release substance neurotransmitters (nt) into the synaptic junction

• Nerve impulses must have a receptor site

Synaptic events

• Electrochemical message received• Vesicle opens• NT are released into synapse• NT finds its receptor site that it fits into on the next

neuron• Activation of receptor nerve impulse in post-

synaptic vessel • Re-uptake of NT

– MAO action

Neurotransmitters

• Synthesized in the soma • Special Properties

– Excitability – Inhibitory

• 30+ neurotransmitters

Course objective #11

• Describe the role played by monoamine oxidase in nerve impulse transmission within the synapse.

Monoamine oxidase (MAO)

• ENZYME • Released into the synaptic space• Action–breakdown or inactivates NT

• Result–i NT levels

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Course Objective #5

• Differentiate between the following neurotransmitters:– Acetylcholine– Norepinephrine– Dopamine– Serotonin– Gamma-aminobutyric acid– Glycine

Neurotransmitters

• Synthesized in the soma • Special Properties

– Excitability – Inhibitory

• 30+ neurotransmitters

Excitatory Neurotransmitters

• Serotonin– Sleep– Sensory perception– Temperature– Mood– Inhibits pain

Excitatory Neurotransmitters

• Dopamine– Subconscious

movement– Fine motor skills– Emotional responses

Excitatory Neurotransmitters

• Norepinepherine– Maintains arousal – Overall activity– Mood

• Acetylcholine– Vital for short term

memory

Inhibitory Neurotransmitters

• Cholinergic– Stabilizers

Inhibitory Neurotransmitters

• Gammaamniobutyricacid• GABA– #1 – h concentration in • brain

– Stop/slow firing of neurons

• Glycine– h concentration in • Spinal Cord

Inhibitory Neurotransmitters

• Dopamine– Basal Ganglia– Dopamine &

Acetylcholine are opposites which work together to create homeostasis

Course Objective #6

• Identify psychiatric disorders that appear to be related to the body’s inability to regulate the availability of neurotransmitters.

h or i Neurotransmitters

• Imbalance disease or disorder

Schizophrenia

• h dopamine

Depression

• i Serotonin

Alzheimer’s Disease

• i acetylcholine

Generalized Anxiety Disorder

• Norepinephrine • Serotonin

ADHD(Attention deficit hyperactivity disorder)

• Imbalance–Norepinephrine–Dopamine

Drug Addictions

• Affects dopamine areas of the brain

Alcohol

• Interacts with GABA receptors

Course Objective #7

• Describe the ‘principle of opposition’ between the operation of the sympathetic and parasympathetic branches of the autonomic nervous system.

The nervous system consists of:

• Divided system–Central Nervous System

(CNS)• Brain & Spinal Cord

–Peripheral Nervous System (PNS)• Nerves (peripheral &

Cranial)

Nervous System

CNS PNS

Autonomic Nervous System

Somatic Nervous System

Peripheral Nervous System

PNS comprised of Cranial and Spinal Nerves

Somatic Nervous SystemProcess: VoluntaryFunction: Respond to changes in external environmentEffector site: skeletal muscle

Autonomic Nervous systemProcess: InvoluntaryFunction: Respond to changes in the internal environmentEffector sites: Internal organs

Sympathetic NS Parasympathetic NS

Autonomic Nervous System

Sympathetic Nervous System

• Chemical process:– Adrenergic

• Function– Energize

Parasympathetic Nervous System

• Chemical Process– Cholinergic

• Function– Stabilize

Sympathetic NS Parasympathetic NS

Rate Heart rateDilates Vessels of

Skeletal muscles

0

Dilates Bronchi Constricts secretions Lung

secretions secretions

Peristalsis

Salivary secretions

Sympathetic NS Parasympathetic NS

Closes Anal sphincter Opens

Relaxes Bladder Contracts

Closes Urinary sphincter

Opens

Dilate Pupil Constrict

far vision Eye accommodatio

n

near vision

secretions Pancreas secretions

Release glucose Liver 0

secretions Adrenal Medulla

0

Principle of Opposition

Sympathetic Parasympathetic“Fight or Flight” “Rest & Digest”Energizes StabilizesAdrenergic Cholinergic(Adrenal gland) Epinephrine Norepinephrine

Acetylcholine

Adrenergic vs. Cholinergic Agents

Adrenergic CholinergicSympathetic N.S. Parasympathetic N.S.Norepinephrine / Epinephrine

Acetylcholine

Adrenergic Agent Cholinergic AgentDrug that mimicsSympathetic stim.

Drug that mimicsParasymathetic stim.

Course Objective #8

• Differentiate between an agonistic drug and an antagonistic drug.

Agonist

• Bind with receptor • Enhances response

Antagonist

• Binds with receptor • Blocks response

Course objective #13

• Describe the variable responses seen depending on the fit of drugs to receptor sites.

Drug Action

• “Target” cells

Drug Action

• Rx fits / “binds” receptor site • Influences

reaction• Mimics natural

body chemicals

• “BIND”– Similar shape–Closer the fit Stronger the effect

Types of Antagonists

Competitive• “Push off” agonist• h dose • Block action of agonist

Non-competitive• Does not “push off an

agonist from receptor

• h dose …