Download Introduction: Foundations for Drug Therapy

B261
Pathophysiology and
Pharmacology
The study of common diseases
and their medication treatments
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Agenda for Week 1, Day 1
• Introduction to the Course
• Review of Activities
• Lectures
• Case Studies
• Review of Assignments for Evaluation of Learning
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Open-book Quizzes in Canvas
Proctored Examinations in ATI
ATI Pharmacology Practice Examination
Electronic Medication Notebook
In-class Learning Activities and/or Homework
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Introduction:
Foundations for Drug
Therapy
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Core Drug Knowledge:
DEFINITIONS
• Pharmacotherapeutics:
• The desired, therapeutic effect of the drug
 Pharmacokinetics:
 The changes that occur to the drug while it is inside
the body
 Pharmacodynamics:
 The effects of the drug on the body
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Definitions (cont’d)
 Contraindications and precautions
 The conditions under which the drug should not be
used or must be used carefully with monitoring
 Side Effects
 The unintended and usually undesired effects that
may occur with the use of the drug
• Serious Adverse effects:
– Serious side effects that may be dangerous,
cause permanent harm or be lethal
 Drug interactions
 The effects that may occur when the drug is given
along with another drug, food, or substance
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Core Patient Variables
• Health status: overall health of the patient
• Life span and gender: age and gender
• Lifestyle, diet, and habits: occupation, finances,
substance use, exercise
• Environment: where will the drug be administered
• Culture and inherited traits: cultural beliefs &
practices
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Goals of Nursing Management of Drug
Therapy
• Maximize the therapeutic effects of a
drug
• Minimize the adverse effects of a drug
• Provide patient and family education
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Medication Usage in the United States
• Approximately 45% of the population
receives one drug in any given month.
• Prescription drug use increases with each age
group.
• Approximately 85% of adults aged 65 and
older are receiving one prescription per
month.
• Almost 50% of adults aged 65 and older
receive three or more prescriptions a
month.
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Prototype Drug
• Typical of a medication within a drug class
• Often the first drug of a class
• Drug has similar characteristics to all drugs in
a class of drugs
• Provides a systematic way to increase
knowledge of medications
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Interventions to Maximize Therapeutic
Effects of Medications
• Administer the drug in a manner that
will promote its absorption
• Administer the drug at the appropriate
time
• Monitor relevant laboratory values
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Interventions to Minimize Adverse
Effects
• Verify the patient’s allergies
• Assess for contraindication for the drug
therapy
• Administer the drug in a manner consistent
with standard safety protocols
• Monitor the patient and relevant laboratory
findings
• Discontinue or withhold a drug based on
assessment or laboratory findings
• Do Patient education
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Minimizing Adverse Effects (cont.)
• Report evidence of adverse effects to the
prescriber
• Modify administration techniques, when
appropriate
• Assessment to detect the onset of adverse
effects
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Core Drug Knowledge
• Understand the drug’s behavior
• Basics of teaching patient and family about
drug therapy
– Name of the drug
– Reason the drug was prescribed
(pharmacotherapeutics)
– Intended effect of the drug
(pharmacodynamics)
– Important adverse effects that may occur
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Core Patient Variables
• Health status
– Activities that must be performed while the
patient receives the drug
– Pre-existing health conditions
• Life span and gender
– Adverse effects on a developing fetus
– Effects on infants and children
– Effects on the elderly
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Core Patient Variables (cont.)
• Lifestyle, diet, and habits
– Changes the patient may need to make
during drug therapy
• Environment
– To promote effective self-managed drug
therapy
• Culture and inherited traits
– Consider cultural issues and modify content
or presentation accordingly
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Evaluation of Medication Interventions
• To measure the patient’s progress
• Consider whether the drug achieved the
desired effect
• Evaluate for side/adverse effects
• Reassess to identify barriers to success
for outcomes that are not achieved
• Identify the reason behind any
treatment failure
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Sources of Drugs
• Plants
• Animals
• Synthetic chemicals
• Genetically engineered
chemicals
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Animal Sources for medications
• Includes agents such as insulin (from pork) or
estrogen (from pregnant horses).
• Today, genetically engineered hormones are
rapidly replacing animal-based drugs.
• The advantage of genetically engineered drugs
is their purity
• More similar to the human animal.
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Synthetic Chemicals
• Most drugs used today are either partially or
wholly synthetic chemical compounds.
• A partially synthetic agent contains a
derivative of a natural substance combined
with a pure chemical.
• Wholly synthetic drugs are pure chemicals.
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Genetically Engineered Drugs
• Genetically engineered drugs are drugs
developed using DNA technologies.
• Genomics is the study and identification of genes
and gene function.
• This new knowledge has enabled researchers to
manipulate the chemical formulas of drugs to
produce more specifically targeted drugs with
fewer adverse effects.
• Especially useful in chemotherapy for cancer
or HIV
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Drug Nomenclature (Names)
• Chemical name
– Precisely describes the drug’s atomic and
molecular structure
– e.g. acetyl-salicylic acid
• Generic name
– Nonproprietary name; identifies the drug’s
active ingredient
– e.g. Aspirin
• Trade name
– Brand or proprietary name
– e.g. Bayer, Excedrin, Equate
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Implications for Nursing
• A drug should be learned by the generic
name.
• Trade names can vary by region
• Many trade names sound alike.
• The nurse should check the drug name
at least three times.
• Pharmacy bar code systems help
to reduce errors
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Drug Classifications
• Drugs that share similar characteristics are
classified as a pharmacologic group or family.
• Allows for increased understanding of
medications
• Drugs that share similar characteristics can be
classified by
– Chemical classification
– Physiologic classification
– Therapeutic classification
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New Drug Development and Approval
• The first step is in the discovery of a potential
new drug molecule.
• Preclinical trials are designed to provide basic
safety, bioavailability, pharmacokinetic, and
initial efficacy data about the drug.
• Clinical trials are performed on humans in
several phases.
• Only about 10% of new drugs that begin clinical
trials are approved.
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Controlled Substances (I, II, III, IV, V)
• The prescribing, dispensing, and storing of
controlled substances is subject to
governmental control.
• Procedures are defined by law for every step,
from manufacture to administration to wasting
or discarding.
• Many hospitals use an automated system to
electronically track the use of stock drugs.
• Indiana has an online controlled substance
prescription monitoring system called
“INSPECT”
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Effect of Legal and Institutional
Controls on Nursing Management of
Drug Therapy
• Drug laws and nurse practice acts vary from state
to state.
• Nurses must be familiar with the current
regulations in their states and in their practice
settings.
• Nurses must adhere to established drug control
laws and protocols.
• Nurses cannot provide drug therapy without
proper authorization.
• Nurses are responsible for drug security and safe
administration.
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Importance of Nursing Management
of Drug Therapy
 Nurses are legally responsible for the
drugs they administer.
 Don’t administer a drug that you
don’t know!
 Safe drug administration requires a
thorough understanding of therapeutic
drug actions and adverse drug
reactions.
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CHALLENGE QUESTIONS
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Question
______________ are the changes that occur to the
drug while it is inside the body.
– A. Pharmacotherapeutics
– B. Pharmacokinetics
– C. Pharmacodynamics
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Question
Pharmacokinetics are the changes that occur
to the drug while it is inside the body.
– A. Pharmacotherapeutics
– B. Pharmacokinetics
– C. Pharmacodynamics
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Question
What percentage of the population in the
United States takes at least one
medication in a month?
– A. 10%
– B. 25%
– C. 33%
– D. 45%
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Question
What percentage of the population in the
United States takes at least one
medication in a month?
– A. 10%
– B. 25%
– C. 33%
– D. 45%
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Question
Objective data are the data collected from
the patient’s story.
– A. True
– B. False
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Question
Objective data are the data collected from
the patient’s story.
– A. True
– B. False
Objective data are the data the nurse
collects by completing a physical
examination of the patient.
Subjective data are what the patient
tells the nurse
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Question
The advantage of genetically engineered
drugs over those made from animals is
less drug reactions.
– A. True
– B. False
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Question
The advantage of genetically engineered
drugs over those made from animals is
less drug reactions.
– A. True
– B. False
Genetically engineered drugs are
considered to be purer, thereby causing
fewer negative drug reactions.
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Question
For the drug furosemide (Lasix), furosemide is the
_____ name of the drug.
– A. Chemical
– B. Trade
– C. Generic
– D. Therapeutic class
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Question
For the drug furosemide (Lasix), furosemide is the
generic name of the drug.
– A. Chemical
– B. Trade
– C. Generic
– D. Therapeutic class
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Question
As a new nurse, what would be the most
appropriate action to take when you administer a
medication you are unfamiliar with?
– A. Go ahead and give the drug in an
emergency situation and look the drug up
later
– B. Ask a co-worker to give the medication
– C. Ask the patient why he or she is taking
the medication
– D. Look up the drug prior to administration
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Question
As a new nurse, what would be the most
appropriate action to take when you administer a
medication you are unfamiliar with?
– A. Go ahead and give the drug in an
emergency situation and look the drug up
later
– B. Ask a co-worker to give the medication
– C. Ask the patient why he or she is taking
the medication
– D. Look up the drug prior to
administration
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