Week 1 By Renee McCroskey BSN RN Pharmacology Fundamentals Chapters 14 Things to think about What drug is ordered Name generic and trade and drug classification Mechanism of action ID: 774772
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Slide1
Pharmacology Fundamentals and the Autonomic Nervous System
Week 1
By Renee
McCroskey
BSN, RN
Slide2Pharmacology Fundamentals
Chapters 1-4
Slide3Things to think about…
What
drug is ordered
Name (generic and trade) and drug classification
Mechanism of action
Therapeutic action (intended use)
Side effects
Adverse effects
Contraindications
Special considerations (effect of age or weight)
How the medication is supplied (IV, tabs, caps, cream,
etc
)
How the medication should be administered (
po
, NG, topical,
etc
)
Dosage ranges
Nursing process considerations related to this medication
Use of OTC and herbal preparations and how they interact with prescribed
medications
Slide4Whose responsibility is it?
The doctor writes for the appropriate medications
The pharmacist checks for interactions and allergies
You are accountable for preparing and administering the
medications
Slide51-5
Major Areas of Pharmacology
Pharmacodynamics
The study of the action of drugs on living tissue
Pharmacokinetics
The study of the processes of drug absorption, distribution, metabolism, and excretion
Slide6Pharmacokinetic Phases
There are four pharmacokinetic phases: Absorption Distribution Metabolism Excretion
2-
6
Slide71-7
Drug Sources
Where do drugs come from? Plants AnimalsSynthesized in a LabChemistryBiotechnology
Slide8Different types of therapy
Traditional drug therapies
(chemicals made in a lab)
Biologics
(naturally produced by the body, in animal cells, or in microorganisms- includes hormones and vaccines)
Natural alternatives
(includes herbs, extracts, vitamins, minerals or dietary supplements)
Slide91-9
Basic Concepts in Pharmacology
Site of Action
Location where drug exerts its effect
Mechanism of Action
How a drug produces its effects
Slide101-10
Basic Concepts in Pharmacology
Receptor SiteSite on a cell where a drug exerts its effectsAgonists produce drug action.Antagonists inhibit drug action.
Slide11FDA approval process
4 stages of research
Preclinical investigation is basic research in lab and animal models
Clinical investigation (3 phases) involves human volunteers
Submission of new drug application with review
Post-marketing research- drug is approved by FDA, but testing is continued to look for long term safety and side
effects
Slide12Drugs Have More Than One Name
Generic Name-
assigned by US Adopted Name Council
Before parentheses and lower case
Trade Name-
assigned by company marketing the drug
Short and easy to remember
Name in parentheses and is capitalized
Example- acetaminophen (Tylenol
)
Slide13OTC vs Prescription drugs
OTC
drugs have a wide margin of safety and do not require a prescription
Prescription drugs
must have an MD (or NP) order
Potential problems with OTC drugs- may not work, take more than recommended, drug interactions
Slide14Routes of Administration
Drugs can enter the body several different ways.Two common routes are orally and parenterally.
2-14
Slide15Enteral routes of Administration
PO
Sublingual or buccal
NG tube
G tube
Slide16Topical routes of administration
Dermatologic preparations (transdermal)
Instillations and irrigations
Transdermal
Ophthalmic
Otic
Nasal
Vaginal
Rectal
Inhalations
Slide17Parenteral routes of administration
Intradermal
Subcutaneous
Intramuscular
Intravenous
Slide18Half-Life and 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.
2-
18
Slide19Bioavailability
Bioavailability is the percentage of drug that is actually absorbed into the bloodstream. There are several factors that influence bioavailability.
2-
19
Slide20Factors of Individual Variation
2-20
AgeWeight Sex Genetic Variation Emotional State
Placebo Effect Disease State Patient Compliance
Slide21Pediatric Considerations
FDA Pregnancy Categories
2-21
Slide22Drug Schedules
I
Highest abuse potential
II
High abuse potential
III
Moderate abuse potential
IV
Lower abuse potential
V
Lowest abuse
potential
Slide23Chronic Drug Use and Abuse
2-23
Decreased drug effect with repeated administration Two main types are metabolic and pharmacodynamic.
Reliance on drug becomes ever more vital to the well-being of the patient The two types are physical and psychological.
Tolerance
Dependence
Slide24Medication Administration
Six R’s
What are they?
3 checks of drug administration
Check drug with MAR or med info system when obtaining it
Check drug when preparing it
Check drug before administering it to the patient
Slide25Types of orders
STAT
ASAP
Single order
PRN
Standing orders
Slide26Abbreviations
bid
ac
pc
hs
q and q4h, q2h,
qid
prn
po
Slide27Compliance
Pts may not take as prescribed
Factors that decrease compliance
???
Often don’t tell MD or nurse they aren’t taking them
Self adjust doses
Slide28Drug 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.
3-
28
Slide29Drug Calculations
Will be on each test and quiz
It is important to be accurate in your dosing!
Slide30Need to know conversions
5ml is _______ tsp?
3 tsp is ________ml and ______ tbsp?
1kg is ________ lbs?
1 grain is _______ mg?
Slide31Calculation Practice
Your patient has been prescribed:
Solumedrol 100mg IV q 4 hours around the clock. The available vial contains 125mg/2ml. How many mls will you give per dose?
Slide32Calculation Practice
How many mls would be given in a 24 hour period?
Slide33Calculation practice
Your patient is ordered Vancomycin 125mg po BID. Available form is 250mg/10ml. How many mls would you give?
Slide34So…
That would equal ________ tsp.
Slide35What about a wt based med?
Your client weighs 22 lbs. The PDR states that the usual dose range for Lasix for her age is 50 to 100mg/kg/day in equally divided doses 4x/day. What is the dose range for each individual dose for this patient?
Slide36Question #1
Gentamicin (Garamycin) 60 mg IM is ordered for a client. Available is a multidose vial with 40 mg/ml. What is the correct amount to give?
A. 1.5 mls
B. 1.25 mls
C. 2.0 mls
D. 1.75 mls
Slide37Question #2
To ensure that the right medication was being given, the first step for the nurse would be:
A. Check the client’s ID band
B. Read the information insert for directions as to correct administration
C. Check the order with the medication administration sheet
D. Check the expiration date on the medication
Slide38Question #3
What physiological changes in the older adult should be given the greatest consideration when administering medication?
A. Increased cardiac output
B. Increased peristalsis
C. Reduced fat to water ratio
D. Reduced liver function
Slide39Question #4
The nurse pours a dose of medication and then finds that the client no longer needs the dose. What action should the nurse take?
A. Record the dose as taken to keep the count correct
B. Charge for the dose because the dose must be paid for
C. Record the medication as “not taken” and waste the poured dose
D. Pour the medication back into the container
Slide40Question #5
A dose of indomethacin (oral suspension) 50 mg qid is ordered for a client. The unit has oral suspension 25 mg/5 ml. How much would the nurse give per dose?
Answer__________
Slide41The Autonomic Nervous System
Chapters 5-7
Slide42Nervous System Organization
The nervous system is divided into two parts:Central Nervous System (CNS)Peripheral Nervous System (PNS)
5-
42
Slide43Nervous System Organization
The peripheral nervous system is also divided into two divisions:Somatic DivisionVisceral Division (Autonomic Nervous System)
5-
43
Slide44Overview of the ANS
The autonomic nervous system is further divided into two sections:Sympathetic DivisionAdrenergic NerveParasympathetic Division Cholinergic Nerve
5-
44
Slide45Cholinergic and Adrenergic Nerves
5-45
The nerves of the ANS release different neurotransmitters.
Cholinergic
nerves release acetylcholine (ACH).
Adrenergic
nerves release norepinephrine (NE).
Slide46Cholinergic and Adrenergic Receptors
5-
46
Slide47Sympathetic Division
Fight or flight
Dilates pupil,
mydriasis
Inhibits salivation
Inhibits digestion/peristalsis and secretion
Accelerates heart rate
Increases heart’s contractility
Vasoconstricts
(increases BP)
Bronchodilates
Stimulates release of glucose
Conversion of glycogen to glucose
Relaxes bladder (inhibits urination)
Inhibits sex organs
Slide48Parasympathetic division
Rest and digest
Constricts pupils,
miotic
Stimulates salivation
Stimulates peristalsis/digestion
Slows heart (bradycardia)
Decreases heart’s contractility
Vasodilates
(decreases BP)
Bronchoconstricts
Contracts bladder (stimulates urination)
Stimulates sex organs
Slide49ANS Activation Comparison
5-
49
Slide50Adrenergic Receptors
Drugs that affect the sympathetic nervous system:SympathomimeticsAKA Adrenergic AgentsStimulate the sympathetic systemSympatholytics AKA Adrenergic BlockersAntagonize the sympathetic system
6-
50
Slide51Usages
Used primarily for their effects on the:
Heart
Bronchial tree
Nasal Passages
Slide52Alpha-Adrenergic Agents
n
orepinephrine (
Levophed
)
p
henylephrine (Neo-
Synephrine
)
p
seudoephedrine (Sudafed)
Slide53Slide54Beta-Adrenergic Agents
a
lbuterol (Proventil)
d
obutamine
(
Dobutrex
)
i
soproternol
(
Isuprel
)
Slide55Alpha-Adrenergic Blocking Drugs
Alpha-blockers compete with NE and EPI at alpha-adrenergic receptors.They are used in the treatment of hypertension.Adverse effects include decrease blood pressure and decrease heart rate, constriction of the pupils, nasal congestion, and increased GI activity.
6-
55
Slide56Alpha-Adrenergic Blocking Drugs
6-56
d
oxazosin
(Cardura)
p
razosin
(
Minipress
)
t
amulosin
(Flomax)
t
erazosin (
Hytrin
)
Slide57Beta-Adrenergic Blocking Drugs
Beta-blocking drugs antagonize the beta effects of EPI and NE.There are two types of beta-blockers:NonselectiveSelectiveBeta-blockers are used in the treatment of angina pectoris and cardiac dysrhythmias.
6-
57
Slide58Slide59Beta-Adrenergic Blocking Drugs
a
tenolol (Tenormin)
m
etoprolol
(Lopressor)
propranolol
(
Inderal)
t
imolol
(
Timoptic
)
Slide60Adrenergic Receptors
Drugs that affect the parasympathetic nervous system:ParasympathomimeticsAKA Cholinergic AgentsStimulate the parasympathetic systemIndirect acting cholinergic agents can be acetylcholinesterase inhibitorsParasympatholytics AKA Cholinergic Blockers or AnticholinergicsAntagonize the parasympathetic system
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60
Slide61Cholinergic Drugs
Cholinergic drugs mimic the actions of ACH.Also called parasympathomimetics. Cholinergic drugs are divided into two groups:Direct-actingIndirect-acting
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61
Slide62Duration of Action for Cholinergic Agents
Older cholinergic agents
Extremely short duration of action
Do not stay in the patient’s system very long
Newer cholinergic agents
Have a longer duration of action
Stay in the patient’s system longer
Slide63Cholinergic Agents
Direct-acting cholinergic drugs bind to the cholinergic receptor and produce the following responses:Increased GI secretions and motilityIncreased urinary tract functionPupillary constriction
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63
Slide64Cholinergic Agents
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64
Slide65Indirect Acting Cholinergic Agents
Same effect as direct acting but different mechanism of action
neostigmine (
Prostigmin
)
Primarily aid in the treatment of myasthenia gravis, postoperative ileus, urinary retention; antidote to excessive cholinergic
blockade
pyridostigmine
(
Mestinon
)
primarily aid in the treatment of myasthenia gravis
-they increase ACH levels and increase skeletal muscle tone and strength
Slide66Anticholinergic Drugs
The cholinergic blocking drugs that bind to the muscarinic receptors are referred to as the anticholinergic, or parasympatholytic, drugs. They act by competitive antagonism of ACH: ACH is unable to bind to the cholinergic receptors to produce an effect.
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66
Slide67Anticholinergics
Atropine
To dry secretions prior to anesthesia
To increase HR
To dilate pupils
Ipratropium (
Atrovent
)
To treat asthma
Scopolamine (Hyoscine)
To treat IBS
Motion sickness
Slide68Anticholinergic Drugs
The adverse effects of anticholinergic drugs include:Dry mouthVisual disturbances/blurred visonConstipationUrinary retention (esp in men with prostate disorders)TachycardiaHypertension
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68
Slide69Preferred Treatment
Urinary Retention—cholinergic drugs or cholinesterase inhibitorsMales with Benign Prostatic Hyperplasia—alpha-blockersOveractive Bladder or Urge Incontinence—anticholinergic drugs
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69
Slide70Preferred Treatment
Intestinal Stasis or Postoperative Ileus—cholinergic drugsIrritable Bowel Syndrome—anticholinergic drugsMyasthenia Gravis—indirect acting cholinergic agent
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70
Slide71Question #1
An adrenergic blocker is MOST DIRECTLY related to which of the following?
A. Stimulation of the sympathetic nervous system
B. Inhibition of the parasympathetic nervous system
C. Stimulation of the parasympathetic nervous system
D. Inhibition of the sympathetic nervous system
Slide72Question #2
Pseudoephedrine has been ordered for a patient with nasal congestion. The nurse knows the drug can give which of the following side effects?
A. Hypertension, insomnia, and tachycardia
B. Drowsiness and dry mouth
C. Increased heart rate and abdominal cramps
D. Dilated pupils and orthostatic hypotension
Slide73Question #3
How does propranolol (Inderal) exert its effects?
A. Stimulates cholinergic receptors
B. Blocks cholinergic receptors
C. Stimulates alpha receptors
D. Blocks beta receptors
Slide74Question #4
Scopolamine (Transderm-Scop) is an anticholinergic agent. Which of the following is LEAST likely to be a side effect of this drug?
A. Dry mouth
B. Bradycardia
C. Tachycardia
D. Urinary retention
Slide75Question #5
Beta adrenergic blockers should be used with extreme caution in patients with:
A. Hypertension
B. Raynaud’s
C. Emphysema
D. Cardiac dysrhythmias
Slide76References
Hitner
, H. and Nagle, B. Pharmacology An Introduction 6
th
Edition. (2012). New York, NY: McGraw Hill.
Zerwekh
, J. and
Claborn
, J. Memory Notebook of Nursing. (2012). Ingram, TX: Nursing Education Consultants.