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. What would you like to do?
What is the nursing process?
Nurse's Role with Medications
- Assess pt
- store meds
- reassess pt
What are the categories of controlled drugs
- 1- not approved for medical use
- 2. narcotic analgesic-opiates/barbituates
- 3. Sedatives, Anabolic Steroids
- 4. Sedative-Hypnotic
- 5. Paritally Controlled
Off label use
medication designed for a specific use but is used for another
Name characteristics of therapeutic effects
body becomes more effective at breaking down medication
b/c of tolerance to another drug, a drug that is broken down by the same enzymes will be tolerated better
What are the Teratogenicity drug categories?
- A-no risk-studies on people
- B: No risk- animal studies
- c: Potential Risk- Animal Studies
- D: Evidence of Risk
- X: DO NOT USE
What do you look for in your assessment?
- REc. Rx
- OTC Rx
- Body Size
Prototype for Opioid Analgesics
Physiology of Pain-What vasodilates?
What is exogenous vs. endogenous pain relief
- exogenous is something you take to relieve pain
- endogenous is something your body produces to relieve pain
Describe exogenous pain relief
- binds to opiate MU receptors in CNS
Describe endogenous pain relief
- system of opioid peptides: endorphins, seratonin, GABA
- activated by exercies , meditation etc
localized in one area
hurts in an area of the body, non distint
sharp shooting pain
3 categories for pain management
- 1. Opiates/opoids
- 2. non opiates; acetaminophen, ASA, NSAIDs
- 3. Adjuvant: Benzodiazepine, TCA, Corticosteroids
What is the therapeutic effect of opiates (morphine)
interferes with pain impulses, lowers pain
What are the 4 ADE of opiates (morphine)
- Depresses CNS
- Depresses GI Tract
- Alters psychological response to pain
- produces euphoria
What is the ROA (route of administration) for Opiates (Morphine)
- Patch (slow release)
- PCA (Patient Controlled Analgesia)
What are the common clinical uses of Opiates (morphine)?
- Severe-Moderate/Pain relief
- Acute Pulmonary Edema
- Severe non-productive cough (Codeine, Antitussive)
You should use opiates (morphine) cautiously when...
- resperatory depression is present
- Chronic Lung Disease
- Kidney/Renal disease
- Increase Intracranial Pressure
What are opiates (morphine) infrequently used for?
- Invasive diagnostic tests
- pre-op sedation
What is important to watch for when giving an opiate (morphine)
more than 1 CNS depressant taken
What is the prototype for Opiate Antagonist
What is the purpose of an opiate antagonist (Naloxone, Narcan)
- Counter act opiates
- Binds to opiate receptors so opiates cannot
What is the prototype for Agonist/Antagonist Opiate?
When is it deemed that opiates are being abused?
when used for mind-altering purposes
What are the treatments for Opiate (morphine) abuse?
- Bupienorphine (Suboxone)
What is Pharmacodynamics?
effects of drug on the body
movement of drug through the body
clinical therapeutic use of a drug
amount of drug needed for a therapeutic effect vs. amount of drug for a harmful event
How do drugs cross membranes?
- Transport Systems
- Direct Penetration of membrane
what is ADME
The path of drug throughout the body
What does ADME stand for?
Another word for metabolism is...
How are drugs excreted?
urine or bile
What happens via metabolism when a drug is administered via IV
bypasses the liver
What is enteral?
absorbed via GI tract
- Not absorbed via GI tract
- ex. Stomach
What are the 3 things that affect Pharmacokinetics( movement of drug throughout the body)
- Lipid Solubility
- Protein Binding
What occurs with a lipid soluble drug?
- it's uncharged/non-polar
- Crosses membrane easily
What occurs with a Ionized drug?
- it's charged, either acidic or basic
- Like crosses membranes in like substances
- Affects where the drug is absorbed
What occurs with Protein Binding Drugs?
- Binds to plasma protein in blood (albumin)
- when bound it is unavailable for distribution
- effects rate of DME
What is first pass effect?
a lot of drugs get metabolized through the first time
What artery feeds the liver?
What is the level of toxicity?
concentration in blood is harmful
What is bioavailability?
how much drug is available in the blood
What is titration
giving small doses until desired effect is achieved
Describe a subcutaneous administration
- Can be prompt or slow
- depends on vascularity of area
What is a contraindication with intramuscular administration?
if a pt is on anticoagulants, it can enhance bleeding from the site
What are the 2 types of factors that affect drug distribution?
What physiological factors affect drug distribution?
- CO, regional blood flow, capillary permeability
- Anything that affects blood flow
What are some physiochemical factors affecting drug distribution
lipid solubility, pH, drug binding to plasma proteins
drugs gets taught in adipose tissue or bone and can redistribute later on
What is the main Superfamily responsible for drug metabolism?
Cytochrome P-450 Superfamily
Define fundamental Tenet?
relationship exists between effect of drug vs. blood concentration
What are 4 important parameters of blood concentration?
- Bioavailability: how much is needed to obtain a certain blood concentration
- Volume of distribution: How much space does the drug take up?
- Clearance: Body's effiiciancy at eliminating the drug
- Elimination Half-Life: how long it takes to decrease blood concentration by half
What is bioavailability
How much drug is needed to obtain a certain level of blood concentration
What is volume of distribution?
How much space does the drug take up?
What is clearance?
Body's Efficiancy at eliminating the drug
What is Elimination Half-Life?
How long it takes to decrease the blood concentration of a drug by half
What is a loading dose?
A large initial dose
What is therapeutic drug monitoring?
making sure the blood concentration stays within the therapeutic index
What is enzyme induction?
liver will make more enzymes to metabolize medications
What is enzyme inhibition?
Stops metabolism of drugs
What does a short half-life indicate?
The drugs frequency will be higher
What occurs after arachidonic Acid is produced?
COX I and COX II are produced
What is COX I
What is COX II
What does COX I do?
Maintains GI Tract, Renal functioning, smooth muscle, blood clotting
What does COX II do?
- Release of cytocines
What blocks both COX I and COX II
ASA, Acetaminophen, NSAID
What blocks just COX II?
COX II Inhibitors
What is the prototype for ASA?
What are the therapeutics effects of ASA (Aspirin)
- Mild analgesic (1-3)
- Anti pyretic (affects hypothalamus)
- Anti-Thrombotic (inhibits platelet aggregation-can also be and ADE)
What does platelet aggregation mean?
platelets stick together
What are ADE of ASA (Aspirin)?
- Reye's Syndrome (children w/viral infection)
- GI System
- Pregnancy- prolongs gestation/labor/hemorrhage
- ASA Sensitive Asthma
What age should a child NOT take aspirin (ASA)
What are the signs/symptoms of Salislate poisoning?
- mental Confusion
- Diaphoresis (Vasodilation)
- Hyperventilation (causes metabolic acidosis, helps bring pH back to normal)
What is the prototype of NSAID?
What are the therapeutic effects of NSAID (Ibuprofen, advil)
- Mild Analgesic
- Anti-thrombotic (only binds for duration of drugs within the system)
What are the ADEs of NSAIDs (Ibuprofen, Advil)
- CNS depressant-drowsiness
- Eyes- blurring
- Category B
- GI System- N/V, ulcer
- Renal-Kidney Necrosis
What are drug interactions for NSAIDs (Ibuprofen, Advil)
- Oral anticoagulants
- Oral hypoglycemic
when should you stop taking NSAIDs or Aspririn pre-op?
1 week before surgery
What is the brand name of Acetaminophin?
What are the therapeutic uses of Acetaminophin (Tylenol)
- Mild Analgesic
- NO ANTI-INFLAMMATORY
What are some ADEs of Acetaminophen (Tylenol)
- Hepatoxicity (lg doses, used with alcohol)
- Renal Toxicity
- Contraindicated liver or kidney disease
What occurs during Acetaminophen induce hepatotoxicity
- 1-24 hours: N/V, diaphoresis, Malaise
- 24-48 hrs: decreased UA, pain in RUQ
- 2-6 days: ecchymosis, jaundice, increased bilirubin, renal failure
What is the antidote for acetaminophen hepatotoxicity?
- Acetylcystein ( mucomyst)
- must be given within 24 hours
What is the prototype for COX II Inhibitors
What are the therapeutic uses of COX II inhibitors (Celecoxib, celebrex)
- Mild Analgesic
What are ADE of COX II Inhibitors?
- BLACK BOX WARNING
- increased risk of MI
- CVA because it increases platlet activitiy
what is the purpose of an anti-anxiety/sedatives
What is the purpose of hypnotics?
What occurs when you take a lg dose of anti-anxiety
you get sleepy
What occurs when you take a sm dose of hypnotics?
What is the prototype for Barbituates?
What is the purpose of barbiturates (phenobarbital)
designed to be a short aciting, medium acting, and/or long acting anti-anxiety
What is an ADE of Barbiturates?
interferes with REM sleep
What is the prototype for benzodiazepine
What is the action of benzodiazepine
- enhances GABA
- ETOH w/draw
What are the actions of barbituates/Benzos/Misc
- Depresses CNS
- -Skeletal muscle relaxation
- -sedative effect
What are the therapeutic actions of barbituates/benzo/misc?
- Promote sleep/rest
- cerebral palsy spasticity
- tx Status-epilepticus
- Decrease Muscle Spasm
- Diagnostic Procedures
- Acute ETHOL w/draw
- adjuvant drug w/ pain relief
What are the contraindications of barbituates/benzo/mic?
- decreased resp rate
- severer liver and kidney
- hx of allergies
- hx of drug abuse
- potentially addictive
What are the ADE of barbituates/benzo/misc
- paradoxical reaction
- ataxia (unsteady gait)
What is pt teaching for barbituates/benzo/misc
- no alcohol
- dont drive until you know how it will affect you
- take only as prescribed
- increase fluid intake and fiber
- C and DB q2hr
- store in secure place
What occurs during a barbituate/benzo/misc overdose?
- resp support
- fluids and diuretics
- NG Lange
- Flumazenil (romazicon)
What are the two systems in the Autonomic nervous system
- Sympathetic > Adrenergic > Neurepinephrine
- Parasympathetic >Cholinergic > Acetylcholine
Define Adrenergic Agonist
Stimulates or mimics sympathetic
What is the adrenergic prototype?
Define Adrenergic Blocker
blocks the SNS system
Adrenergic Alpha blocker prototype
Adrenergic beta blockers prototype
What is the protottype for adrenergic?
What is the prototype for Cholinergic
What do cholinergic blockers do?
What is the prototype of anti-cholinergic
What is inotropic?
force of contraction
What is dromotropic?
What would you like to do?
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