DSN Kevin Dobi MS APRN Copyright 2014 by Mosby an imprint of Elsevier Inc Chapter 2 Drug Any chemical that affects the physiologic processes of a living organism Pharmacology Study or science of drugs ID: 737951
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Pharmacologic PrinciplesDSN Kevin Dobi, MS, APRN
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Chapter 2Slide2
DrugAny chemical that affects the physiologic processes of a living organismPharmacology
Study or science of drugs
Pharmacologic Principles
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Chemical name
Describes the drug’s chemical composition and molecular structure
Generic name
(nonproprietary name)
Name given by the United States Adopted Names Council
Trade name
(proprietary name)
The drug has a registered trademark; use of the name is restricted by the drug’s patent owner (usually the manufacturer)
Drug Names
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Chemical, Generic, and Trade names and Chemical Structure of Ibuprofen
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PharmaceuticsPharmacokineticsPharmacodynamicsPharmacotherapeutics
PharmacognosyPharmacoeconomics
Pharmacologic Principles
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The study of how various drug forms influence the way in which the drug affects the body
Pharmaceutics
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The study of what the body does to the drugAbsorptionDistribution
MetabolismExcretion
Pharmacokinetics
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Classroom Response QuestionCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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The nurse is giving a medication that has a high first-pass effect. The health care provider has changed the route from IV to PO. The nurse expects the oral dose to be
higher because of the first-pass effect.
lower because of the first-pass effect.
the same as the IV dose.
unchanged
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The study of what the drug does to the bodyThe mechanism of drug actions in living tissuesDrug-receptor relationships
Pharmacodynamics
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Phases of Drug ActivityCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Classroom Response QuestionCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route?
IV
IM
Subcut
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The clinical use of drugs to prevent and treat diseases
Defines principles of drug actions—the cellular processes that change in response to the presence of drug molecules
Drugs are organized into pharmacologic classes
Pharmacotherapeutics
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The study of natural (versus synthetic) drug sources (i.e., plant, animals, minerals)
Pharmacognosy
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Different drug dosage forms have different pharmaceutical properties.Dosage form determines the rate of drug dissolution (dissolving of solid dosage forms and their absorption from the GI tract).
Enteric-coated tabletsExtended-release forms
Pharmaceutics
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Classroom Response QuestionCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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A patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain. The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do?
Crush the tablets and mix them with applesauce or pudding.
Call the pharmacy and ask for the liquid form of the medication.
Call the pharmacy and ask for the IV form of the medication.
Encourage the patient to try to swallow the tablets.Slide16
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A drug’s time to onset of action, time to peak effect, and duration of actionStudy of what happens to a drug from the time it is put into the body until the parent drug and all metabolites have left the body
Pharmacokinetics
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Movement of a drug from its site of administration into the bloodstream for distribution to the tissuesBioavailabilityFirst-pass effect
Pharmacokinetics: Absorption
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A drug’s route of administration affects the rate and extent of absorption of that drugEnteral (GI tract)
ParenteralTopical
Routes
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The drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestineOral
SublingualBuccalRectal (can also be topical)
Enteral
Route
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Intravenous (fastest delivery into the blood circulation)Intramuscular
SubcutaneousIntradermal
Intraarterial
Intrathecal
Intraarticular
Parenteral
Route
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Skin (including transdermal patches)EyesEarsNoseLungs (inhalation)Rectum
Vagina
Topical Route
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Classroom Response QuestionCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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The nurse is preparing to administer a transdermal patch to a patient and finds that the patient already has a medication patch on his right upper chest. What will the nurse do?
Remove the old medication patch and notify the health care provider
Apply the new patch without removing the old one
Remove the old patch and apply the new patch in the same spot
Remove the old patch and apply the new patch to a different, clean areaSlide24
The transport of a drug by the bloodstream to its site of action Protein-binding Water-soluble vs. fat-soluble
Blood-brain barrier Areas of rapid distribution: heart, liver, kidneys, brain
Areas of slow distribution: muscle, skin, fat
Distribution
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Protein Binding of DrugsCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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The biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite, or a less active metabolite
Liver (main organ) Skeletal muscle
Kidneys
Lungs
Plasma
Intestinal mucosa
Metabolism/Biotransformation
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Drug Transport in the BodyCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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Factors that decrease metabolismCardiovascular dysfunctionRenal insufficiency
StarvationObstructive jaundice
Slow acetylator
Ketoconazole therapy
Metabolism/Biotransformation (cont’d.)
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Factors that increase metabolismFast acetylatorBarbiturate therapyRifampin therapy
Phenytoin therapy
Metabolism/Biotransformation (cont’d)
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The elimination of drugs from the bodyKidneys (main organ)Liver
BowelBiliary excretionEnterohepatic recirculation
Excretion
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Renal Drug ExcretionCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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The time it takes for one half of the original amount of a drug to be removed from the bodyA measure of the rate at which a drug is removed from the bodyMost drugs considered to be effectively removed after about five half-lives
Steady state
Half-life
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Drug actionsThe cellular processes involved in the drug and cell interaction
Drug effectThe physiologic reaction of the body to the drug
Includes onset, peak, and duration of action
The Movement of Drugs
Through the Body
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Onset
The time it takes for the drug to elicit a
therapeutic response
Peak
The time it takes for a drug to reach its maximum therapeutic response
Duration
The time a drug concentration is sufficient to elicit a therapeutic response
Onset, Peak, and Duration
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Peak level
Highest blood level
Trough level
Lowest blood level
Therapeutic Drug Monitoring
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Receptor interactionsEnzyme interactionsNonselective interactions
Pharmacodynamics:
Mechanisms of Action
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Acute therapyMaintenance therapySupplemental/replacement therapy
Palliative therapySupportive therapyProphylactic therapy
Empiric therapy
Pharmacotherapeutics
:
Types of Therapies
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Any characteristic of the patient, especially a disease state, that makes the use of a given medication dangerous for the patient It is important to assess for contraindications!
Contraindications
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Evaluating the clinical response of the patient to the treatmentOne must be familiar with the drug’s:Intended therapeutic action (beneficial)
Unintended but potential adverse effects (predictable, adverse drug reactions)
Monitoring
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Therapeutic indexDrug concentrationPatient’s conditionTolerance and dependence
Drug interactions (additive effect, synergistic effect, antagonistic effect, incompatibility)Adverse drug events
Monitoring (cont’d)
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Adverse drug reactionsPharmacologic reactions, including adverse effects
Hypersensitivity (allergic) reactionIdiosyncratic reaction
Drug interaction
Monitoring (cont’d)
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TeratogenicMutagenicCarcinogenic
Other Drug-Related Effects
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Four main sources for drugsPlantsAnimals
MineralsLaboratory synthesis
Pharmacognosy
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The study of poisons and unwanted responses to drugs and other chemicals
Overlaps with pharmacotherapeutics
Toxicology
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The EndCopyright © 2014 by Mosby, an imprint of Elsevier Inc.
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