Pharm Final

• 1+1=2 additive


  Combination of two drugs results in an effect equal to the sum of their individual effects
• 1+1=3 synergistic


  Combination of two drugs results in an effect greater than the sum of their individual effects
• 1+1=<2 antagonistic


  Combination of two drugs results in an effect less than the sum of their individual effects
• Drug interactions


  Alteration in pharmacologic or pharmacokinetic activity of a given drug
• Compatibility


  Capable of harmonious coexistence; said of two or more medications that are suitable for simultaneous administration without nullification or aggravation
• Incompatibility


  Chelation (chemical breakdown)
• Enzyme interaction


  Inhibits/ promotes action of enzyme
• Half Life


  Time it takes one half of the original amount of drug to be removed from the body. Most drugs considered removed after about five-half lives
• Laws regarding nursing


  Legislation dictates boundaries for nurse practice at the state and federal level
• State Nurse practice acts

  Defines the scope and role of the nurse, education requirements, standard of care, safe practice and differentiates nursing and medicine, legal framework
• U.S Drug Legislation


  Determines what drugs are safe; FDA
• Nurse Practice Act


  Defines what we are allowed to do with drugs
• Routes of drug administration

  • Enteral (GI tract): Oral, Sublingual, Buccal, Recall (also topical); First pass effect
  • Parenteral: IV, IM, SubQ, ID, Intraarterial, intrathecal, intraarticular, Transdermal
  • Topical: Skin, Eyes, Ears, Nose, Lungs, Rectum, Vagina
• Pharmacokinetics


  The study of what the body does to the drug: Absorption, Distribution, Metabolism, Excretion
• Alterations in blood flow


  Will influence absorption
• Distribution depends on the drug and the physiology of the person
• All medications bind to protein to some extent
• If a liver is diseased


  A medication may be eliminated more slowly
• If a patient has kidney disease

  He/she may need a smaller dose of medication
• Absorption


  Rate in which leaves its site of admin: Bioavailability: how much usable makes to target: Bioequivalent: going in and out of body at same rate
• Absorption affected by route, ability to dissolve, blood flow to area, body surface area, lipid solubility
• Distribution affected by circulation, metabolism, Excretion
• Agonist


  Binds to receptor resulting in response
• Antagonist


  Prevent binding of agonist
• Herbal interactions with other medications need to be known
• Understanding safe doses (knowing when an order is too much)
• Tylenol


  Normal 4000 mg/day; elderly 2000mg/day
• Levothyroxine


  No > 200mcg
• Beta blocker


  Lower heart rate but can also relax blood vessels
• Analgesics


  Relieve pain
• Antipyretic


  Reduce fever
• Anti-inflammatory


  Reduce inflammation
• Anti-emetic


  Prevent nausea, vomiting
• ACE-inhibitor


  Relax blood vessels
• Rights of drug administration

  • Right Person
  • Right Med
  • Right Dose
  • Right Route
  • Right Time
  • Right Documentation
• Patient education (every class)

  1. Reason for med

  2. Dose

  3. Frequency

  4. Route

  5. Side effects

  6. When to call provider
• Validate whether learning has occurred


  1. Questions

  2. Return demonstration

  3. Behavior (adherence)
• Adverse effects of stimulants


  • Palpations
  • Tachycardia
  • Hypertension
  • Angina
  • Dysrhythmias
  • Nervousness
  • Vomiting and diarrhea
  • Dry mouth
  • Urinary frequency
  • Increased metabolic rate
• Amphetamines (Methylphenidate/Ritalin)


  Used for ADHD, Narcolepsy
• Adverse effects of stimulants

  • Stimulate sympathetic nervous system
  • Cause growth suppression
  • Speed everything up