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Fall Week 1 & 2 - Introduction to Pharmacology.pdf

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Janet O' Connell

Fall Week 1/2 - Introduction to Pharmacology September-10-10 10:14 PM Chapter 1: Nursing Practice in Canada and Drug Therapy Overview • Patient care is getting more complexin Canada. • Nurses expected to keep up-to-date with rising use of intricate pharmacologicaltherapies. • Knowledge of drugs, their adverse effects, and interactions is critical for nurses to provide safe, competentcare. • Greater accountability expected of nurses with increased attention focused on safe medication practices. • Nursing process: a frameworkfor professional nursing practice. Five step process:(1) assessment; (2) nursing diagnosis; (3) planning; (4) implementation;and (5) evaluation. ○ Ensures delivery of thorough, individualized care Assessment Importance of Critical Thinking to the Nursing Process • Major componentof the nursing process. • Underpinning to provide the best possible care. • Using the mind to develop conclusions, make decisions, draw inferences, and reflect on all aspects of the patient. Assessing the Patient and Drugs • During the assessmentphase, data is collected, reviewed, and analyzed. • Assessmentallows the nurse to formulate a nursing diagnosis related to the patient's needs and needs related to drug administration. • Data categorized as objective and subjective. • A comprehensivemedication profile should include (not limited to): ○ Drug use; ○ Natural health products; ○ Alcohol, tobacco, and caffeine; ○ Use of OTC meds; ○ Hormonal drugs; ○ Past & present Hx; ○ Family history and background; ○ Any unusual responses to meds; ○ Growth and developmentalstages related to age and med use. • Assessmentof drug is also important; specific informationshould be collected (dosage, peak times, contraindications, etc). Use reliable sources: nursing textbooks,drug manufacturer's insert, drug handbooks, licences pharmacist, reliable online resources. • Data gathering about patient & drug may be done by asking simple questions. • Prescription from doctor must be checked for six elements 1. Patient's full name; 2. Date & time order was written; 3. Generic/tradename of drug; 4. Dosage of the drug (includes size, frequency, and number of doses); 5. Route of administration; 6. Signature of the prescriber. Analysis of Data • Once nurse has received and reviewed all data, the nurse must analyze and amalgamatethe information. Info should be verified and documented. • Sum of info on patient and drug are used to make a nursing diagnosis. Nursing Diagnoses • Used as a means of communicatingand sharing information about the patient and patient experience. • A result of critical thinking, creativity, and accurate data collection. • Nursing diagnoses related to drug therapy will most likely develop out of data associatedwith the • Nursing diagnoses related to drug therapy will most likely develop out of data associatedwith the following: ○ Deficient knowledge; ○ Risk of injury; ○ Nonadherence; ○ Various disturbances, deficits, excessesor impairments in bodily functions and other problems or concerns. • 3-step process: 1. Human response of the patient to illness, injury or change.  This can be a problem, which may lead to the developmentof another problem or an opportunity to increase health. 2. Identifying the factor(s) related to the response.  Not necessarily cause/effect,but indicating a relationship between factors and responses. 3. List of cues, clues, evidence, or other data that supports the nurse's claim that this diagnosis is accurate. Example: (1) Risk for injury from (2) erroneous medication, due to (3) decreased vision loss. Planning • Includes identification of goals and the outcomecriteria. • Major purpose is to prioritize the nursing diagnoses and specify the goals and outcomecriteria, including time frames for achievement. Goals and Outcome Criteria • Goals are objective,measurable, and realistic, with an established time period for achievementof the outcomes. • Patient goals reflect expected changes through nursing care. • The outcome criteria are concrete descriptions of the patient's goals. They should be concise, well thought-out, and patient-focused. ○ Should include expectations of behaviour (which can be changed) that are met by certain deadlines. ○ Ultimate aim is the safe and effective administration of medications. ○ Should relate to each nursing diagnosis and guide implementationof nursing care. ○ May address special storage and handling techniques, administration procedures, equipment needed, drug interactions, adverse effects, and contraindications. ○ Patient-orientedoutcomecriteria must apply to any medicationsthe patient will receive. Implementation • Involves the use of nursing interventions to activatethe plan and is guided by preceding phases of the nursing process (assessment,nursing diagnosis, planning) • Requires constant communicationand collaborationwith patient and members of healthcare team. • Based on nurse's clinical judgement and knowledge. • Must adhere to safe administration practices to prevent errors (The five "rights" of medication administration): 1. Right drug; 2. Right dose; 3. Right time; 4. Right route; 5. Right patient. • Additional rights: 1. Right reason: ensuring the drug ordered is being given for the right reason. 2. Right documentation:ensuring documentationof the medication administration is done after drug has been administered, not before. 3. Right evaluation:ensuring that any special assessment requirements have been made prior to drug administration (i.e. Pulse rate and BP readings). 4. Right to refuse. • Check three times for safe medicationadministration. Evaluation • Occurs after the collaborative plan of action has been implemented. • Systematic,ongoing and dynamic part of the nursing process as related to drug therapy. • Systematic,ongoing and dynamic part of the nursing process as related to drug therapy. • Includes monitoringthe patient's therapeutic response to the drug and its adverse and toxic effects. Chapter 2: Pharmacological Principles Overview • A drug is any chemical that affects the processes of a living organism. The study or science of drugs is called pharmacology. • The study of pharmacologyincludes absorption, biochemical effects, biotransformation,distribution, drug history, drug origin, drug receptor mechanisms,excretion, mechanismsof action, physical and chemical properties, physical effects, therapeutic (beneficial) effects, toxic (harmful) effects. ○ Knowledge of these areas enables the nurse to better understand how drugs affect humans. • Throughout its development,a drug will acquire at least three different names: ○ The chemical name, describing the drug's chemical compositionand molecular structure. ○ The generic name (or nonproprietary name), is given to the drug and approved by Health Canada. Usually shorter and simpler than the chemical name. ○ The trade name (or proprietary name) indicates the drug has a registered trademark. • Three basic phases of drug activity - pharmaceutics, pharmacokinetics,and pharmacodynamics - describe the relationship between the dose of a drug given to a patient and the effectivenessof that drug in treating the patient's disorder. ○ Pharmaceutics (disintegration of dosage form, dissolution of drug): how different dosage forms (i.e. Injection, capsule, controlled-releasetablet) influence the way in which the drug affects the body. ○ Pharmacokinetics (absorption, distribution, metabolism,excretion): what the body does to the drug molecules. Onset of action, peak effect and duration of action of a drug are all part of its pharmacokinetics.  A metabolite is the product of one or more biochemical (metabolic)reactions involving the parent drug (the original drug administered).  A parent drug that is not pharmaceuticallyactive is called a prodrug. Prodrug is then metabolized into pharmaceutically active metabolites.  Inactive metabolites lack pharmacologicalactivity and are simply drug waste products awaiting excretion from the body. ○ Pharmacodynamics (drug-receptor interaction): what the drug does to the body.  Examines physicochemicalproperties of drugs and their pharmacological interactions with drug receptors in the body.  Receptors are specialized protein molecules embedded in the outer surfaces of cells or within cells to which drug moleculesbind to exert their effects. ○ Pharmacotherapeutics (a.k.a therapeutics) focuses on the use of drugs to prevent and treat diseases.  Defines the principles of drug actions - the cellular processes that change in response to the presence of drug molecules.  Empirical therapeutics refers to drug therapy that is effectivebut for which the mechanism of drug action is unknown (receptor protein unknown, cellular processes unknown, etc)  Rational therapeutics is drug therapy in which specific evidence has been obtained for the mechanisms of drug action. ○ The study of adverse effects of drugs and other chemicals on living systemsis known as toxicology. ○ An adverse effect is a direct response to one or more drugs that results in an undesirable effect. Effects generally minor by are expected to occur in a percentage of the population receiving a given drug. ○ Pharmacognosy is the study of natural (vs. Synthetic) drug sources. (A Closer Look at) Pharmaceutics • Different drug dosage forms have different pharmacologicalproperties. • Dosage form design determines the rate at which a drug undergoes dissolution (dissolving of solid dosage forms and their absorption) Example: Drug ingested orally may be taken in either a solid form (i.e. tablet, capsule or ○ Example: Drug ingested orally may be taken in either a solid form (i.e. tablet, capsule or powder), a liquid form (i.e. a solution). Oral drugs that are liquids (i.e. syrups) are already dissolved and are absorbed more quickly than solid dosage forms. ○ Enteric-coateddrugs have a coating that prevent them from being broken down in an acidic pH environment(i.e. The stomach)and usually don't dissolve until they reach a more alkaline environment(i.e. the intestines). This results in a slower dissolution. Liquids, elixirs and syrups Fastest Suspension solution Powders Capsules ↓ Tablets Coated tablets Enteric-coatedtablets Slowest • Sometimesthe size of the particles inside a capsule can make different capsules containing the same drug dissolve at different rates. • A variety of dosage forms exist to provide more accurate and convenientdrug delivery systems. ○ Conveniencein administration correlates strongly with medication adherence. ○ Example: extended-releaseoral dosage forms are more convenientbecause they often require fewer daily doses. • Specific characteristics of different dosage forms (i.e. fast-acting, injected subcutaneously, etc) have a large impact on how and to what extent drug is absorbed. ○ If a drug is to work at a specific part of the body, it must be applied either directly at the site in an active form or have a way of getting to that site.  Enteric (systemic)administration refers to drugs administered via GI tract (i.e. Oral
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