Download Unit 20 Self Needs Analysis: Date……………….

Unit 20 Self Needs Analysis: Date……………….
Prior Level of Knowledge
and Comprehension
Learning outcomes
Evidence of
knowledge
(*score A, B)
Pharmacology 1
1. Briefly discuss professional principles
relevant to drug administration
2. Briefly discuss ethical principles
applied to drug administration
3. Explain the nurses roles in ‘health
education’ related to medication
4. Define Pharmacology
5. Define Pharmacotherapuetics
6. Define Pharmacokinetics
7. Define Pharmacodynamics
8. Define the words drug and medicine
9. Outline the history of drug
development
10. State four sources of drugs, giving
one example from each source
11. Explain drug names- giving one
example from the BNF
12. State three different ways in which
drugs work (pharmacodynamics) giving
examples of drugs from each group.
13. Briefly explain what is meant by
therapeutic range
14. Briefly explain why side effects may
occur in addition to ‘desired’ effects
15. Define and outline types of adverse
drug reactions
16. State the role of the MHRA
17. List three types of drug interaction
18. Outline the stages of clinical trials
Pharmacology 2
19. Explain how drugs may cross cell
membranes
20. Describe factors affecting drug
absorption
distribution
metabolism
excretion
21. Explain modes of drug interaction
22. Explain the meaning of half life and
factors affecting this
23. Describe the concept of a
therapeutic window
24. Outline the process dynamic
equilibrium that determines the actual
concentration of drug in the body.
*Evidence of Knowledge and Understanding:
 A: Previous education undertaken
 B: Documented evidence of Knowledge
Needs
revision
tick if
appropriate
Date……………….
Post Study Analysis
following self testing
Totally
Evidence of
lacking
knowledge
Knowledge (*score A, B)
tick if
appropriate
Needs
revision
tick if
appropriate
Totally
lacking
Knowledge
tick if
appropriate
Action Plan
Learning outcomes of the unit that
need revision
Resources that you plan to
use
Timescale
for achieving
outcomes for this
unit
Unit 20 Pharmacology
INTRODUCTION TO PHARMACOLOGY (NURSING)
Outcomes
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Briefly discuss professional principles relevant to drug
administration
Briefly discuss ethical principles applied to drug administration
Explain the nurses roles in ‘health education’ related to medication
Define Pharmacology
Define Pharmacotherapuetics
Define Pharmacokinetics
Define Pharmacodynamics
Define the words drug and medicine
Outline the history of drug development
State four sources of drugs, giving one example from each source
Explain drug names- giving one example from the BNF
State three different ways in which drugs work (pharmacodynamics) giving examples
of drugs from each group.
Briefly explain what is meant by therapeutic range
Briefly explain why side effects may occur in addition to ‘desired’ effects
Define and outline types of adverse drug reactions
State the role of the MHRA
List three types of drug interaction
Outline the stages of clinical trials
Cases
1.
Lauren (age 21years) was prescribed Clozapine whilst in hospital to treat her
schizophrenia. She has been taking this medication for one year now and her mental health
has improved considerably. She has been discharged from hospital (under Section 25) and
is living in supported accommodation near her mother. Since staring on the medication she
has experienced a number of side effects. She feels tired much of the time, has gained 4
stone in weight, is always constipated and has excessive saliva production (hyper salivation)
(she is too embarrassed to stay overnight at a friend‟s home). Since she is feeling a lot
better mentally, and is getting really fed up with the side effects of her medication, she
decides to stop taking the Clozapine. She intends to discuss this with her CPN when he next
visits her (he is off sick at present and they have been too short staffed to send anyone
else!).
2.
Helen (a student nurse) was on her first clinical placement and had been on the ward
for a few days. She was asked by the nurse in charge to give a patient (Mr Y) a suppository,
as he was complaining of constipation. She was instructed to use the „PR‟ tray from the
clinical room. She followed the correct procedure (as taught by the clinical teacher) with
respect to inserting the suppository (e.g. maintaining patient dignity, ensuring correct patient
position and effective communication). The suppository was inserted and the patient advised
to ring for the nurse as soon as he needed the toilet. Half an hour passed and the patient
expressed concern that the suppository had not worked (at all) and this had never been the
case previously. It transpired that the usual suppository („glycerin‟) was not on the PR tray
and the student had used one called „aminophylline.
3.
Mr Edwards (age 67) has had NIDDM for more than 15 years. Initially, his condition
was controlled with diet alone but for the last 5 years he has needed oral hypoglycaemic
agents. He attends all his GP and diabetic clinic appointments and seems to be complying
with both diet and medication regimes. He is a keen gardener lost confidence in going to his
garden alone as he has had a number of episodes of nausea, sweating, tremors, dizziness
and palpitations that occur mostly in the late morning. His prescription drugs have not been
changed for a number of years and he is not feverish, has no pain, nor is he exhibiting any
signs of illness other than these worrying episodes. His main concern is that these
symptoms will occur when he is driving.
4.
Mr Edwards (Age 67 and with a diagnosis of NIDDM) also has been medically
managed for his hypertension for the last 15 years has hypertension. He was taking an ACE
inhibitor to control his Hypertension was had now been prescribed a Diuretic as well. He
returned to talk to the practice nurse to complain that his dizziness had returned, particularly
when he stood up and he had actually stumbled with this a couple of times. The Practice
nurse reviewed his Blood pressure (lying and standing) and noticed that at there was a
difference. Discuss the advice you would offer Mr Edwards.
5.
Doctor Thomas was deputising for a colleague who was on leave. After a
particularly demanding night, he was asked, in the early hours of the morning, to see a
premature infant with congestive heart failure. He was not normally responsible for the care
of premature infants but he requested Digoxin to be given intramuscularly and calculated (by
mental arithmetic) that the dose should be 0.6 mg. Just as he settled down for a restorative
nap, the nurse phoned to ask whether the dose shouldn‟t be 0.06 mg as she had had to
open two ampoules. Without thinking he told her to “give it as I ordered”. An hour later, he
was called to the ward because the baby had suffered a cardiac arrest.
‘Justification for study’
The nurse with knowledge and understanding of pharmacology will be more
confident in drug administration
Who is responsible for ‘health education’ with respect to medication?
What professional principles are relevant?
What ethical principles can be applied to the issue of patients being educated about
their medication?
Some Clinical Practice Considerations
The patient may ask:
How quickly will the drug work? (E.g. analgesic)
Do I take the tablets with food or on an empty stomach? (E.g. antibiotics)
Can I take my other tablets (OTC medication) with the medicine I have been prescribed?
(E.g. aspirin)
Does it matter if I take the tablets at different times? (E.g. antibiotics)
The nurse needs to be able to give the patient accurate information and ‘empower’ the
patient to be able to self medicate
King RL (2004) Nurses’ perceptions of their pharmacology educational needs Journal of
Advanced Nursing45 (4), 392–400
Background:
Lack of science teaching in nurse education
Theory–practice gap in this area of the curriculum
Findings:
Limited understanding of the subject
Dissatisfaction with the teaching of pharmacology, Resulting anxiety on qualifying
Conclusion:
Nurses have a limited understanding of pharmacology
They recognize the need for pharmacology knowledge in practice.
Improved pharmacology teaching might increase nurses’ confidence in: drug administration
+ patient education, and decrease anxieties related to these roles
Latter S Rycroft-Malone J Yerrell P Shaw D (2000)
Evaluating educational preparation for a health education role in practice: the case of
medication education, current health care policy highlights the importance of nurses
contributing to educating patients about medication.
Findings (of the study) highlighted the importance of:
* sufficient taught pharmacology
* an evidence-based curriculum
* practice-based learning
(J Adv Nurs. 2000 Nov; 32(5):1282-90)
The NMC (2008) Medicine Management guidelines direct us all to address our
……………………………………………………………………………………………………………
The impact of Drug Errors
Patients, their relatives and professionals can experience considerable trauma and there can
be a substantial additional cost to the NHS (Armitage 2004)
Appropriate (and inappropriate) use of drugs
Drugs are used to:
* Cure or Arrest ………………...
* Relieve ………………...
* Obtain a ………………...
* ………………... disease occurring
Nurses need knowledge of pharmacology to:
Obtain drug ..........................
..........................patients taking drugs
..........................drugs
..........................patients
.........................., record, evaluate and
..........................patient responses to drugs
AND … counsel patients having drug rehabilitation
Some situations when they
should NOT be used:
To make the patient „easier to
manage‟!
When they will do more harm
than good
Science of Pharmacology
………………………………= Science (logos) of drugs (pharmakon)
……………………………….= use of drugs to treat disease
Involves -
Assessment
Implementation
Monitoring and
Reassessment/evaluation
………………………………= Absorption, distribution, metabolism & excretion of drugs (what
the body does to the drug)
………………………………= Biochemical & physical effects of drugs; Mechanisms of drug
action (what the drug does to the body)
………………………………= toxicity & adverse effects of drugs
Drugs and Medicines
A DRUG is any chemical (except food) that will bring about a response in the body
* All drugs are ……………………. (potentially)
* All drugs produce ………………………………………………..
* Interactions can occur between drugs (or between drugs and food)
A …………………………….. is a drug that has been ‘modified’ so that it is suitable
for administration
The (very brief!) History of Pharmacology
Oldest Science (originally a brand of magic!)
Opium used for thousands of years
Samuel Dale (London) catalogued existing knowledge of
drugs  Descriptive
Pharmacopoeia
Early in 19th Century began experiments to establish WHY drugs worked (beginning of real
pharmacology)
Discoveries of the 19th Century include:
1842 ether 1847 chloroform
Some key discoveries of the 20th Century:
…………. Insulin
………….Penicillin (first treatment)
………….Chlorpromazine
………….Benzodiazepine derivatives
………….Haloperidol
………….Levodopa
Add some more drug discoveries of interest to you
Sources of drugs / medicines
Plant products or Plants
Fox Glove
……………………..
Poppy
……………………..
Belladonna
……………………..
Coffee
……………………..
Tobacco
……………………..
Animal products
Premarin (conjugated Oestrogen) from Pregnant Mares
Insulin from pigs & cows
Heparin from pigs & cows
Inorganic compounds
(Compounds with no Carbon)
Zinc + Sulphate ions  ……………………..
Aluminium +Hydroxyl  ……………………..
KCl
Synthetic sources
Drugs made in ……………………..
Most drugs today made in labs = ……………………..
Many drugs are synthetic copies of naturally occurring substances e.g.
…………………
Insulin (biosynthetic human insulin / recombinant or DNA-derived insulin)
Draw a diagram to represent how cells may be engineered to produce human insulin
Drug Names
Chemical
Generic
Brand Name
Describes actual
Official Medical
Name chosen by
Compound
name for active
manufacturer
substance
?
……………………..
VALIUM
?
……………………………....
EPILIM
Pharmacodynamics
Involves study of the
……………………………………………………………………..
……………………………………………………………………………………………..
What Drugs Do
……………………..natural body substances
E.g. thyroxine, insulin
Act against ……………………..cells or invading ……………………..
E.g. chemotherapeutic agents, antibiotics
Interfere with cell ……………………..
Act at ……………………..
 intensifying cell activity (……………………………) or
 reducing activity (………………………..………)
 (Clozapine administration was found to produce dopamine2 (D-2) and
serotonin2 (5-HT2) receptor blockade‟ )
Inhibit ……………………………
 neostigmine inhibits cholinesterase
Draw a graph / diagram and include a brief explanation of what is meant by therapeutic
range
Side Effects
A drug, once absorbed to the circulation, will be distributed throughout the body  affecting
other parts  ……………………………
Examples
Drug
Side effect
Clozapine
Hyper salivation, ……………………………
Iron
Nausea, ……………………………
Codeine
……………………………
Morphine
……………………………
Adverse Reactions
„Any response to a drug which is noxious, unintended and occurs at doses used in man for
prophylaxis, diagnosis or therapy‟
 …………………………………………………(WHO)
Adverse reactions:
* may be due to ……………………………or ……………………………absence of
specific enzymes
* may be predictable or …………………………
* may be …………………………… (causing embryonic deformities)
* are …………………………… (caused by practitioners)
The Medicines and Healthcare products Regulatory Agency (MHRA)
The Medicines and Healthcare products Regulatory Agency (MHRA) is the government
agency which is responsible for ensuring that medicines and medical devices work, and are
acceptably safe.
The MHRA website http://mhra.gov.uk
SUSPECTED ADVERSE DRUG REACTIONS
If you are suspicious that an adverse reaction may be related to a drug or combination of
drugs please complete this Yellow Card.
 PATIENT DETAILS
 SUSPECTED DRUG(S)
 SUSPECTED REACTION(S)
 OUTCOME
 OTHER DRUGS (including self-medication & herbal remedies)
 Additional relevant information
The MHRA
 Controlled substances
Opiates
 Generic / proprietary drugs
Paracetamol
 Orphan drugs
Rare diseases/small populations
 Over-the-counter (OTC) drugs
Paracetamol
 Prescription Only Medicines (POM)
Warfarin
 Nurse Prescriber’s Extended Formulary
Minor ailments, minor
injuries, health promotion & palliative care
Drug Interactions
These interactions may be beneficial or harmful and include:
Alterations in ……………………………
Altered ………………………………of other drugs
Competition for ……………………………
 Some important interactions: Oral anticoagulants and aspirin
Development of new drugs
Preclinical trials
New drugs or treatment approaches: often tested first on animals (or live
human cells in test tubes).
Scientists identify an approach that is most likely to succeed, and then carry
out preliminary research into safety and effectiveness.
Phase 1 studies: Early Clinical Trials
These first trials usually involve a small number of individuals (less than
100) who are healthy.
However …there are times when the new compound is tested first in people
who have the condition that the drug is meant to treat (especially when the
drug is meant to treat a very serious disease and is likely to have serious
side effects).
The objective= to find out if the new drug is safe.
Phase 2 Continuing Clinical Trials
If the new compound is considered safe on animals, testing is expanded to
see if it is effective,
Trials include people who have the disease or condition against which the
researchers think a new compound will be effective.
Phase 3 studies
A drug is tested in several hundred to several thousand subjects.
This large-scale testing provides more information about:
*the drug's effectiveness,
*possible side effects, and
*safety in a broader range of people.
Drug Trials
Six men were treated in intensive care after experiencing a serious reaction to a drug taken
during a clinical drugs trial in north-west London in 2006
The six healthy men, all under 40 years of age, had volunteered to take part in a trial of an
anti-inflammatory drug, to treat conditions such as rheumatoid arthritis and leukaemia, being
tested at an independent research unit based at Northwick Park Hospital.
The six suffered multiple organ failure, and two were said to be critically ill. Another two men,
who had been given a dummy version of the drug in the trial, did not fall ill.
The trial was stopped as soon as the men fell ill.
http://news.bbc.co.uk/1/hi/england/london/4807042.stm
Accessed 20/08/2012
‘Homework’!
Check the ingredients of four or five different OTC drugs for comparison and to familiarize
yourself with the difficulty a layperson may encounter while trying to find this information.
Give rationale for why some drugs need to be kept under lock and key on the hospital unit.
Discuss this with your mentor.
Familiarize yourself with 4 or 5 drugs that are often prescribed & administered in your
placement setting.
Outline the role of the nurse in the safe administration of these drugs.
(Discuss this with your mentor & your clinical teacher.)
Pharmacology 2: Pharmacokinetics
Outcomes
•
•
•
•
•
•
Explain how drugs may cross cell membranes
Describe factors affecting drug
– absorption
– distribution
– metabolism
– excretion
Explain modes of drug interaction
Explain the meaning of half life and factors affecting this
Describe the concept of a therapeutic window
Outline the process dynamic equilibrium that determines the actual concentration of
drug in the body
Pharmacokinetics
The study of drug
–
A………………………
–
D………………………
–
M………………………
–
E………………………
Crossing Lipid Bilayers
For drugs given by all routes other than the intravenous route,
several lipid cell membrane barriers will have to be passed before
the drug reaches the circulation.
Oral drugs have to cross for e.g. mucous membranes of the GI
tract and walls of small blood vessels surrounding the GI tract
These barriers are
....................................................................................................
Draw a diagram representing the phospholipid bilayer
Phospholipids are arranged so that the membrane serves as a barrier separating two watery
environments. „Lipid soluble‟ substances will get through (General Anaesthetics are very lipid
soluble).
Transport mechanisms
Four major transport mechanisms exist to facilitate this process:
*
*
*
*
Passive and Active transport
............................... transport:
Molecules move down concentration gradient - no energy required (most
drugs pass through membranes by passive transport)
............................... transport:
Used if molecules have to move against concentration gradients or if molecules
are large - requires energy (involved in drug excretion in kidney)
Simple Diffusion
................................................. membrane
....... concentration
....... concentration
Simple Diffusion through a phospholipid bilayer
Small, uncharged
molecules
Large uncharged,
molecules
Ions
Facilitated diffusion across cell membranes
Molecules (which includes drug molecules) move from areas of high concentration to areas
of low concentration without requiring energy but
using a
..............................................................
Rate of diffusion faster if molecule:
.......................................................
.......................................................
Image used with permission- fleshandbones
Active transport example: Pinocytosis
Write brief notes on pinocytosis
Drug now inside
cell membrane
..................................................................
.................................................................
..................................................................
Fat soluble vitamin
entering cytoplasm
..................................................................
Image used and abridged with permission- fleshandbones
Fat soluble
vitamins enter the
cell in this way
Pharmacokinetics: Absorption
Mostly, for drugs to have the desired effect they must enter the
..................................................
What happens to the drug from when it is introduced into the body until it reaches
circulating fluid and tissues = .................................................
How quickly and how much of a drug reaches its target site of action =
.................................................
Factors influencing absorption
ADMINISTRATION METHOD
e.g.
................................................................................................
DRUG PROPERTIES
e.g.
.........................................................
.........................................................
.........................................................
.........................................................
PHYSIOLOGY of the person taking the drug
e.g.
.........................................................
.........................................................
Sites for Administration of Drugs (look up absorption times)
Site
Absorption time?
Topical – SKIN, EYES
…………..
Oral – MOUTH
…………..
Nasal - NOSE
…………..
Rectal (PR) - RECTUM
…………..
Vaginal - VAGINA
…………..
Injections – IV
…………..
Injections – IM
…………..
Injections – S/C
…………..
Inhalers - Lungs
…………..
Drug properties and lipid solubility
....................................drugs will not pass through from the gut to the bloodstream
(E.g. gentamycin must be given..............................................................)
Lipid solubility is a function of:
Size of molecule (Large or Small?)
Electrical charge (Cation or Anion or
Uncharged)
Insert cation and anion symbols below
Drug properties and size of particles
..................... molecules move more easily than
...................................molecules across biological membranes
Drug properties and electrical charge
Molecules can be:
......................... (without an electrical charge)
or
......................... (one part has a - ve charge while another part has a + ve charge but the
molecule as a whole is neutral) – most drugs belong to
Drug properties and ionized or un-ionized?
Ions
•
are electrically charged particles
•
can have a positive charge e.g.
•
can have a negative charge e.g.
Positively charged particles have ................... an electron
Negatively charged particles have ......................an electron
Ionized molecules (including drugs)
..................................................................
Acids and Bases

An acid is a substance that ........................................................

Acid molecules ............................................to form ions e.g.
HCl  ...........................................
H2CO3  ...........................................
(A base is a substance that accepts H+ ions)
Strong acids dissociate more than weak acids e.g.
...................
......................
this group
Which acid is more ‘ionised’?
pH value
= strong acid (Lots of H+ ions)
= weak acid
= neutral (e.g. Water)
= weak base
= strong base (Very few H+ ions)
Drug properties and pH in Digestive Tract
Stomach pH = ..........
Duodenum pH = .........
Small intestine pH = .........
Drug properties and pH of the Environment
Most drugs are either ............................ acids or weak bases
In acid environments like the stomach weak acid drugs remain largely ............................
Aspirin is a weakly acidic drug - in the acid stomach aspirin will be ............................
favouring diffusion through the .......................................................
In basic (alkaline) environments like the small intestine weak acid drugs are
more likely to
dissociate ...............................
Drug properties and pH
Briefly describe the absorption of aspirin in stomach
Morphine is a weakly basic drug - these drugs in the basic environment of the lower GI
tract will be less ionized, favouring diffusion through the ............................
Drug properties and pH in the stomach
Stomach cavity
Physiology affecting
•
Stomach lining
Absorption
STOMACH ................................................ (E.g. how long the stomach takes to
empty)
•
SURFACE ...................... (E.g. absorption reduced if small intestine surgically
removed)
•
TRANSIT ...................... (E.g. Diarrhoea will decrease transit time and so decrease
absorption)
•
...................... (Increased SNS activity will reduce blood flow to the gut)
Absorption from the GI tract also affected by factors that reduce blood flow to the GI
tract e.g.
Hypovolaemia / Shock (What are the clinical signs of shock?)
Absorption - Oral drugs
Surface area of the small intestine ............. surface area
of the stomach
 Most oral drugs are absorbed from the
……………………..
•
Only a proportion (or possibly none) of the drug
will reach the circulation
•
This is due to factors relating to:
...................................................and / or
.......................................................
[IV Drugs - .................will reach circulation!]
Absorption: ‘First pass’ effect
The majority of drugs given ORALLY are absorbed
across the gastro intestinal epithelium into the
..................................................................................................
Draw a flow chart representing the First Pass Effect
The metabolism of orally administered drugs by gastrointestinal and hepatic enzymes
resulting in a significant reduction of the amount of unmetabolized drug reaching the
systemic circulation is called the first pass effect.
In the liver the drug is ‘transformed’ and ‘detoxified’ (made less active and more easily
eliminated from the body)
So, a substantial proportion of orally administered doses may be
deactivated before reaching the site of action (dose for oral drugs
higher than dose for parenteral drugs)
This is very significant for some drugs
e.g. Opioids - after a single dose,
....................................................................................................
Drug administration and absorption
Oral
Commonest, cheapest, safest
Drug diffuses from gut  blood vessel (high  low concentration)
Barriers –
…………………………………………………………………………..
Problem solving –
……………………………………………………………………..
Absorption time =
Sublingual
Enters blood stream quickly  onset of action rapid
Enters chiefly by …………………………………………………
Avoids the acid medium and digestion process of stomach
Absorption time =
Absorption of drugs in an infant
Gastric Cells are immature
 ………………………………………..
Slow / irregular peristalsis
 ………………………………………..
Increased body surface + thin skin layers
 ………………………………………..
Lack of muscle maturity
 ………………………………………..
Absorption of drugs in an elderly adult
Reduction in gastric cells
 ………………………………………..
Decline in muscle tone
 ………………………………………..
Peristalsis is slowed
Decreased C.O. and decreased blood flow
 ………………………………………..
Villi in gut become ‘blunt’
 ………………………………………..
Pharmacokinetics: Distribution
•
After absorption, drugs are distributed to tissues and organs i.e.
………………………………………..
•
This process involves the transportation of the drug to the
………………………………………..
Factors influencing distribution
Lipid Solubility e.g. ……………………only allows lipid soluble drugs
to pass
Protein Binding e.g. drug bound to protein forms a
…………………………….…… that cannot leave blood stream
Perfusion e.g. person with ................................... prescribed antibiotics
a leg wound infection
Lipid solubility and volume of distribution
Water soluble  ........................... blood concentration and ........................... volume of
distribution
for
Lipid soluble  ...........................blood concentration and ............................volume of
distribution
Women have more fat cells  fat soluble anaesthetics may have
.......................................................
Volume of distribution
•
The smaller the volume of distribution, the more likely that the drug is
........................................... ..............................................................................
•
The larger the volume of distribution, the more likely that the drug is
.................................................
•
The volume of distribution (VD) is a theoretical volume that a drug would have to
occupy (if it were uniformly distributed), to provide the
.....................................................................................................
Protein Binding
Proportion of drug bound to .......................................................... (albumin and globulin) –
drug can be up to 99% bound (only the ‘unbound’ portion is
........................................................... and exert an effect)
Reduced protein binding in: ..................................................................
....................................................................
Distribution of drugs in an infant
………………………..Total Body Water + ……………………….. Fat content
………………………..Protein binding (less protein produced in immature liver)
Blood brain barrier immaturity means that
…………………………………………………………………..………
Distribution of drugs in an elderly adult
………………………..Total Body Water + ………………………..Fat content
 …………………………………………………..
 …………………………………………………..
………………………..Protein binding (less protein produced in ageing liver)
Pharmacokinetics: Metabolism
In the ……………many drugs are metabolised by a series of
………………………..  only a proportion of the dose absorbed
reaches the circulation (e.g. .................... is rendered almost inactive if
swallowed)
Enzyme induction
Some drugs .............................. enzyme activity  rate of metabolism of that drug and also
other drugs is increased  ......................................... (morphine needs to be taken in
...............................for same effect)
Enzyme inhibition
Some drugs ……………………….. enzyme activity  making other drugs
………………………..
Liver Disease Reduces drug metabolism  ………………………………………....
Metabolism of drugs – infant
Immaturity of liver and Reduced liver Enzymes 
………………………………………………………………………………………………………..…
……………………………………………………………………………………………………………
Metabolism of drugs - Elderly adult
The ageing liver is less able to produce microsomal enzymes + liver blood flow is decreased
by 1.5% per year after the age of 25 years 
………………………………………………………………………………...
Pharmacokinetics: Excretion (removal of drugs from body)
Sites for drug elimination:
* ...........................................
* ...........................................
* ...........................................
* ...........................................
Renal drug excretion
For drug excretion to occur drug metabolite must be:
...........................................
........................................... (in aspirin O/D alkalisation of urine with HCO3- will speed up
elimination of the drug in the urine)
Water Soluble drugs excreted by glomerular
filtration
Other drugs may be secreted by active transport processes
(Kidney dysfunction .....................................................................)
Excretion of drugs – infant
Immaturity of kidneys  ...........................................
……………………………………………………..
Excretion of drugs - Elderly adult
Renal excretion is ………………………………. as GFR is reduced and number of nephrons
decreases
Elimination: Drug half life
Time taken for amount of drug in the body to reduce to ..........................................(important
in determining.........................................................................)
Therapeutic Window
Write brief notes on the meaning of ‘therapeutic
window’.
...............................................................................
...............................................................................
...............................................................................
...............................................................................
...............................................................................
...............................................................................
...............................................................................
Add detail to the graph and write brief notes to
explain this diagram.
................................................................................
................................................................................
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Dose of drug and frequency of administration
Need to consider:
* Rate of METABOLISM via the .....................
* Rate of EXCRETION via the ..............................
Therefore, dose of drug and frequency of administration may vary in:
*
*
*
Laboratory test of organ function
Kidney Function Tests
Urea (Blood urea nitrogen - BUN)
Normal Range = 2.5 – 6.6mmol/L
Creatinine clearance – blood creatinine
levels are compared to creatinine in the
urine
Liver Function Tests
Measure various enzymes
Measures Albumin levels
Side Effects
A drug, once absorbed to the circulation, will be distributed throughout the body  affecting
other parts  SIDE EFFECTS
Drug
Side effect
Clozapine
...........................................................
Iron
..........................................................
Codeine
..........................................................
Morphine
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Beta blocker
..........................................................
Adverse Reactions
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Antibiotics can develop antibodies to antibiotics  allergic reactions can occur on second
exposure (Rash  Anaphylaxis  Death)
Drug Interactions related to pharmacokinetics
These interactions may be beneficial or harmful and include:
1. Alterations in ..............................................................
2. Competition for ............................................................
3. Altered ..........................................................................
Names of Medicines
Two systems in place for generic / approved drug names:
International Non-proprietary name (rINN)
–
E.g. Dosulepin
British Approved name (BAN)
–
E.g. Dothiepin
(Proprietary / Brand = Prothiaden)
Generally, drugs should be prescribed by the ............................................................
List examples for generic vs. brand names
Generic name
Brand name
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Post study Action plan for Unit 20
Action points arising in relation to your ability to apply knowledge and understanding
to practice.
Remaining areas of weakness.
Strategy for developing a deeper understanding and
enhancing your ability to apply this theory to nursing
practice.