Pharmacology review (med safety)

• Drug: any chemical that affects the physiological process of living organisms
• Pharmacology: Study/ science of drugs
• 10 Rights

  1. Drug
  2. dose
  3. time
  4. route
  5. patient
  6. reason
  7. documentation
  8. evaluation
  9. education
  10. refuse
• Pharmacodynamics: The study of the effects of drugs on the body

  • Behavior of medication at cellular level and adverse/therapeutic effects
• Pharmacotherapeutics: The clinical use of the drugs to prevent and treat diseases
• Pharmacokinetics: Movement of drugs in the body

  • Absorption, Distribution, Metabolism, and Excretion

  Affected by pregnancy/lactation, age, weight, body surface, and body composition
• Teratogenic: can cause birth abnormalities/ harm to baby
• Carcinogenic: A substance that can causes cancer
• Mutagenic: A substance that increases the rate of mutation in a cell (genetic changes)
• Interprofessional Medication Process

  1. Prescribing
  2. Dispensing
  3. Administering
  4. Monitoring
• The major site for drug metabolism is at the liver
• The major site for drug excretion is at the kidneys
• Pharmacokinetics (Absorption): How drug enters the body
• Bioavailability: Measures how much of the drug administered is delivered unchanged to the system circulation
• First-Pass Effect: Initial metabolism in the liver of drug absorption from the GI tract before it reaches the systemic circulation
• Enteral routes: Absorption through mucous of stomach, small intestine, or large intestine

  Oral, sublingual, buccal, and rectal
• Tropical routes: Skin, eyes, ears, nose, lungs, (also rectum), vagina
• Parenteral routes of administration include IM, IV, SC, and IV push

  • Intravenous: fastest due to direct delivery into the blood circulation
• Pharmacokinetics (Distribution): Transport of a drug by the bloodstream to the drug's site of action. Drug distributed first to areas with extensive blood supply. (heart, liver, kidneys, and brain)
• Pharmacokinetics (Metabolism): Biochemical alteration of a drug into any of the following

  • inactive metabolite, more soluble compound, more potent metabolite (inactive to active), less active metabolite
• Pharmacokinetics (Excretion): Elimination of a drug from the body

  • Primary organ is the kidney
  • Liver and bowels also play a role
  • Renal excretion and Biliary excretion
• Onset of action: time required for a drug to elicit a therapeutic response after dosing
• Half-life: Time required for half of a drug to be removed from the body
• Peak level: Highest blood level of a drug
• Trough level: Lowest blood level of a drug
• Duration of action: How long the drug has an effect in the body
• Toxicity: Occurs if the peak blood level of the drug is too high

  • Can cause adverse effects, may need reversal agent or decrease dose
• Factors that affect safe medication administration include

  • Drug properties, fetal gestational age, maternal factors, and breastfeeding
• Medication safety factors affecting Pediatric patients include

  • Skin is thin and permeable (tropical medication)
  • Body water: increase distribution of water-soluble drugs and lower fat content
  • Stomach lacks acid to kill bacteria
  • Lungs have weaker mucus barrier
  • Body temperatures less regulated, dehydration occurs easily (may need to encourage hydration with meds to reduce kidney damage)
  • Liver and Kidneys are immature, impairing drug metabolism and excretion
• Teaching should include

  • Why drug is needed
  • What the child will experience
  • What is expected of the child
  • How the parents can participate and support their child
• Nursing process to promote safety includes (ADPIE)

  Assessment, Diagnosis, Planning, Implementation, and evaluation
• Medication reconciliation should happen at admission, status change, patient transfer, and discharge.
• Near miss: did not reach patient, results in no harm
• No harm event: Reaches patient but, results in no harm
• Medication error: Causes harm to patient
• Critical Incident: Results in serious harm to patient