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With pregnancy what are physiologic changes due to?
- Hormonal Influences
- Growth of fetus
- Mother's physical adaptation to changes
What changes occur in ABSORPTION with pregnancy?
- Delayed stomach emptying
- Prolonged intestinal transit time
- Enhanced absorption of lipid-soluble meds
- GI PH: morning sickness, OTC antacids
- ^ absorption of IM's
- Placenta allows transfer of substances between mother and fetus - as placental flow ^ so does drug transfer.
During pregnancy there is increased body fat & total body water, how does this change drug distribution?
it ^ distribution of fat soluble drugs & <bloodstream concentration = prolonged 1/2 life.
During pregnancy plasma albumin (protein) levels fall, how does this affect drug distribution?
^free drug = unbound drugs reach the fetus
How does pregnancy affect the metabolism?
- ^level of liver enzyme activity = ^liver clearence of drug = shortened 1/2 life
- Fetus relies on maternal processes to metabolize drugs
How does pregnancy change elimination?
- ^GFR: ^excretion of drugs
- Fetal kidneys rapidly excrete water-soluble drugs
- Fetus effect: prolonged exposure to drugs & metabolites.
- Fat-soluble drugs diffuse back across placental membranes.
What is Tetratogenicity?
The ability of a substance to interfere w/fetal development.
Explain the Pregnancy Catagories.
- A - No risk to fetus
- B - No risk in animal studies, assumed no risk to fetus.
- C - Animal studies indicate risk, determine risk vs. benefit
- D - Risk to fetus has been proved, determine risk vs. benefit (life/death conditions)
- X - A risk to fetus has been proved. DO NOT GIVE.
Ethnopharmacology integrates what 3 pharm drug actions?
What does Transcultural Nursing include?
- Traditional health practices: teas, herbs, spices, etc.
- Complementary health practices
- Alternative health practices
- Mainstream health practices
What does Autonomy mean & how does it apply to nursing?
Independence or freedom, nurses must respect another persons rights to make their own independent decisions.
What are basic Ethical Principles?
- Respect for a person: Autonomy
- Beneficence: active goodness/kindness
- Truth Telling
For drug research there why are there basic ethical principles?
- Protect individual autonomy
- Protect clients & subjects from harm
- Avoid fraud & duress in health care
- Encourage professionals to be thorough & clear in communicating information
- Promote client-educated decision making
- Promote self-determination of client
Human Clinical Experimentation has 4 phases of purpose, what are they?
- Phase I: to determine human dosage range based on healthy subjects & identify pharmacokinetics.
- Phase II: to demonstrate safety & efficacy of drug in subjects w/disease to be treated
- Phase III & IV: to demonstrate safety & efficacy of drug for well client population; to incluce long-term data if a chronic regimen.
Some Nursing responsibilities of a clinical trial?
- Recruit & assess study subjects
- Thorough understanding of protocols
- Validity & reliability of measurement instruments
- Communication & teamwork w/other HCP & sponsors.
- Knowledge of HIPPA requirements
- Budget negotiations