pharm

• Therapeutic


  Prevention of disease
• Unit 1


  • Pharmacokinetics
  • Pharmacodynamics
• Pharmacokinetics


  Study of what happens to a drug from the time it's put into the body, time to onset of action, time until peak effect, time of duration of action, and time until the parent drug and all metabolites have left the body
• Movement of a drug within the body

  • 2 processes to cross body membranes:
  • Active transport: need energy, movement of chemical against concentration gradient
  • Diffusion or passive transport: movement of a chemical from high concentration to low concentration (no energy)
• Pharmacodynamics


  The study of what the drug does to the body
• Pharmacodynamics does NOT change with age
• Duration of action


  The length of time a drug in the blood or tissues is sufficient to elicit a response
• Evaluating client teaching


  Teaching needs to begin at diagnosis or admission and is ongoing
• Rights of medication administration

  • Dose
  • Route
  • Person
  • Documentation
  • Time
  • Right to refuse
  • Right to receive education
  • Right preparation
• STAT order


  Any med needed immediately (given 5 minutes or less)
• ASAP order


  As soon as possible (given 30 minute)
• Routine orders


  STAT, ASAP, NOW, PRN
• Standing order


  Written in advance that is to be carried under specific circumstances
• Inflammation


  • Adrenal glands produce cortisol to suppress inflammation
  • Hypothalamus stimulate pituitary gland to release ACTH
  • Acth stimulate release of aldosterone
• Inflammation


  • Natural, nonspecific defense mechanism
  • Occurs in response to injury, antigen, toxic chemicals, extreme heat, invading microorganisms, or death of cells
  • Limits spread of injury or antigen by containing the injury and destroying microorganism
• Types of Inflammation


  • Acute
  • Chronic (6+ months)
• Signs of Inflammation


  • Pain
  • Swelling
  • Warmth
  • Redness
• Causes of Inflammation


  • Infection
  • Mechanical damage
  • Ischemia
  • Nutrient deprivation
  • Temperature extremes
  • Radiation
• Chemical mediators of inflammation

  • Histamine
  • Prostaglandins
  • C-Reactive Protein
  • Cytokines
• Acute Inflammation


  1. Vasodilation

  2. Vascular Permeability (edema)

  3. Cellular Infiltration (pus)

  4. Thrombosis (clots)

  5. Stimulation of nerve endings (pain)
• Strategies for Treating Inflammation

  • Identify and treat the underlying cause
  • Usually self-limiting
  • Use ice packs and rest for mild symptoms
  • Topical agents for inflammation of skin and mucous membranes
• Goal of inflammation treatment

  Prevent or decrease the intensity of the inflammatory response and reduce fever
• NSAIDS


  • Primary drug for treatment of mild to moderate inflammation (all NSAIDS have about the same efficacy)
  • Analgesics and antipyretics
  • Acetaminophen is not an NSAID!
• Primary use of NSAIDS

  For musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis, mild to moderate pain, reduction of fever, primary dysmenorrheal pain
• Adverse effects of NSAIDS

  • Nausea
  • Heartburn
  • Epigastric pain
  • Dizziness
• Cyclooxygenase-1 (COX-1)


  • Present in all tissues
  • Reduces gastric acid secretion, promotes renal blood flow, promotes platelet aggregation
  • Inhibition of COX-1 results in bleeding, gastric upset, and reduced renal function
  • Work to maintain homeostasis
• Cyclooxygenase-2 (COX-2)


  • Formed only after tissue injury
  • Promotes inflammation, sensitizes pain receptors, mediates fever in brain
  • Inhibition of COX-2 results in suppression of inflammation
  • Results in inflammation, pain, fever
• Aspirin & ibuprofen blocks COX-1 and COX-2
• COX-2 Inhibitors


  • Newest and most controversial class
  • Celecoxib only cox 2
  • No inhibition of COX-1
  • Does not affect blood coagulation or irritate the digestive system
  • Was the treatment of choice for moderate to severe inflammation, then they were found to increase heart attack and stroke risk, and only Celecoxib is still on the market.
• Systemic Corticosteroids


  • Effective in treating severe inflammation
  • Naturally released from adrenal cortex
  • Suppress histamine and prostaglandins
  • Can inhibit immune system to reduce inflammation
• Serious adverse effects of Systemic Corticosteroids

  • Suppression of adrenal gland function
  • Hyperglycemia
  • Mood changes
  • Cataracts
  • Peptic ulcers
  • Electrolyte imbalances
  • Osteoporosis
• Systemic Corticosteroids can mask infections
• Systemic Corticosteroids are contraindicated in active infections
• Long-term treatment with Systemic Corticosteroids

  • Keep dose as low as possible
  • Use alternate-day dosing
  • Cushing syndrome may result
  • Discontinue gradually
• Treating Fever with Antipyretics

  • Treat underlying cause of fever
  • Aspirin, ibuprofen, acetaminophen
• Pharmacotherapy With Anti-Inflammatory and Antipyretic Drugs

  1. Assessment- baseline assessment prior to administration

  2. Assessment throughout administration
• Baseline assessment prior to administration

  • Obtain a complete health history and drug history, including allergies, current prescription and O T C drugs, herbal preparations, caffeine, nicotine, and alcohol use. Be alert to possible drug interactions.
  • Obtain baseline vital signs and weight.
  • Evaluate appropriate laboratory findings (e.g., complete blood count (C B C), coagulation panels, bleeding time, electrolytes, glucose, lipid profile, liver or kidney function studies).
• Assessment throughout administration


  • Assess for desired therapeutic effects (e.g., temperature returns to normal range, pain is decreased or absent, signs and symptoms of inflammation such as redness or swelling are decreased).
  • Continue periodic monitoring of C B C, coagulation studies, bleeding time, electrolytes, glucose, lipids, and liver and kidney function studies.
  • Assess vital signs and weight periodically or if symptoms warrant. For patients on corticosteroids, obtain weight daily and report any weight gain over 1 k g (2 l b) in a 24-hour period or more than 2 k g (5 l b) in 1 week.
  • Assess for and promptly report adverse effects: symptoms of G I bleeding (dark or "tarry" stools, hematemesis or coffee-ground emesis, blood in the stool), abdominal pain, severe tinnitus, dizziness, drowsiness, confusion, agitation, euphoria or depression, palpitations, tachycardia, H T N, increased respiratory rate and depth, pulmonary congestion, or edema.
• Absorption


  • Movement of a drug from site of administration to the bloodstream
  • Bioavailability is the portion or amount of drug that is able to have an effect on the body
  • First-pass effect is the amount of drug metabolized before it enters general circulation and reaches its site of action
  • Factors that effect: drug formulation, dose, route, size of drug molecule, SA, digestive motility, blood flow, lipid solubility
  • The more rapid the dissolution (how drug disintegrates into a simpler form), the faster the drug absorption and faster the onset of the drug is
• Distribution


  • Amount of blood flow determines it
  • Addition: add
  • Synergism: stronger effect
  • Antagonism: blocks
  • Displacement: shift