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Pharm 1 EXAM 1 Notes Pharmacological Basis For Nursing Interventions I (Nova Southeastern University)

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Introduction to Pharmacology: Basic Concepts Related to Medication Administration Nursing Process   

An organizational framework for the practice of nursing. It encompasses all steps taking by the nurse in caring for a patient: assessment, nursing diagnosis, planning, implementation, and evaluation. The nursing process ensures the delivery of through, individualized, and quality nursing care to patient regardless of age, gender, medical diagnosis or setting. Through use of the nursing process combined with knowledge of skills, the nurse will be able to develop effective solutions to meet patient’s needs.

Assessment   

Data are collected, reviewed and analyzed. Information about the patient may come from the patient, family, caregiver or significant other, and the patient’s chart Methods of data collection revolve around interviewing, direct or indirect questioning, observation, medical records review, head to toe physical examination and nursing assessment.

Objective Data

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Any information gathered through the senses or that which is seen, heard, felt or smelled. May be obtained through a nursing physical assessment, nursing history, past and present medical history, lab results, diagnostic studies or procedures, vital signs, weight and height, and medication profile. A holistic assessment includes not only gathering information regarding medical concerns but spiritual, socioeconomically, etc.

Subjective Data

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Information shared through the spoken words of any reliable source.

Nursing Diagnosis 

NANDA Approved Nursing Diagnosis R/T Drug Therapy: o Deficient Knowledge, Risk for Injury, Noncompliance, Various disturbances, Deficits, Excesses, Impairment in bodily functions and/or other problems or concerns as R/T drug therapy.

A nursing diagnosis is composed of three parts:   

Human response of the patient to illness, injury, or significant change. May be actual problem or risk for developing a problem. Defining characteristics and identified factors R/T the response (it doesn’t have to be a cause and effect) Contains a listing of clues, cues, evidences, S/S, or other data that support the nurses’ claim that the diagnosis is accurate (as E/B evidenced by...)

Planning (Outcome Identification)      

The major purpose is to prioritize the nursing diagnosis and specific outcomes including the time frame for their achievements. Outcomes are objective, measurable and realistic with an established time frame for their achievements. Patient outcomes are behavior based and may be categorized into physiologic, psychological, spiritual, sexual, cognitive, motor, and/or other domains. Individualized for each patient. Outcomes need to reflect each nursing diagnosis and serve as a guide for the implementation phase. Provide a standard for measuring movement toward goals.

Implementation    

Requires constant communication and collaboration with the patient and family members, as well as with the health care team involved in the patient’s care, Implementation if nursing actions may be independent, collaborative or dependent upon a prescriber’s order. Intervention: Any treatment based on clinical judgement and knowledge and performed by a nurse to enhance outcomes. In relation to medication administration, you need to know and understand all the info about the patient and about each medication prescribed.

Nine Rights of Medication Administration         

Right drug Right dose Right time Right route and form Right patient Right documentation Right reason Right response Right to refuse o Respect the patient’s right to refuse. o Determine the reason why.

o Take appropriate action including notifying the HCP. o Document refusal and the reason why. o Document any furthers action such as vital signs and /or system assessment. *If anything is missing from the order, do not proceed with the medication administration and call HCP to clarify. Medication Errors 

Any preventable event that may lead or cause inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer.

Evaluation   

Occurs after the nursing care plan has been implemented but also needs to occur at each phase of the nursing process. It concludes monitoring the fulfillment of outcomes, as well as monitoring patient’s therapeutic response to drug and its adverse effects and toxic effects. Documentation!

What is pharmacology?  Pharmacology is the study or science of a drug. This helps the nurse understand how the drug affects humans.  Study of drugs  Study of agents that alter functions of living organisms  A “drug” is any chemical that affects the process of a living organism Nurses rule o Education o Remember nurses have to educate we talked about telling the patient the reason why there getting the drug, any side effects, what lab works they need to assess. So you have to educate. o If you ever watch a nurse go into a room they tell the patient everything as in what’s going on before they administer the medication to them. o Nurses should use resources. It is very complicated; we cannot remember every drug that’s why we use our drug guides, our resources. o Its not just education to the patient, our own knowledge if were not knowledgeable we would not know what to do. We have to have knowledge ourselves; we have to have a good understanding of how the drugs affect humans. o The golden rule is if we don’t know what the drug is or what it does than you don’t give it. You have to know what you’re giving. o Knowledge also helps to provide education to the patient, that’s what we do we educate ourselves before we go to the patients room. If it’s a new

drug we have never given before we go to our drug resource look up the information than we go to the patients room and we give them back that information that we just picked up. That’s what we do as nurses. It’s no shame having a resource and just giving the patient information right in the patient’s room. What does it encompass?  Different topics such as: o Therapeutic effects, side effects, contraindication -> that you should never take that drug, if its saying the drug is contraindicated means that you should never take it. For example if your allergic to a medication they will say the drug is contraindicated meaning that if you have an allergy your not suppose to take tat drug. However some drugs may not be contraindicated some drugs they may say use with caution, if it says use with caution that means its not contraindicated. Contraindicated means do not take and use with caution means yes the patient can still get the drug however the nurse will have to monitor it really have to monitor that medication the patient is getting. o How drugs are absorbed o How drugs are metabolized o How drugs are excreted o How drugs are distributed/administered o Look at drug history and toxic effects/chemical effects  We know that patients overdose, if its overdosed that means that is a toxic effect.  When were looking at toxic effects we look at the type of patients that you’re giving these medications to. If you have a patient with hepatic or renal dysfunction you have to pay attention to that because of excretion. If the drug cannot be excreted properly it’s going to accumulate and therefore the patient can be toxic. o Pharmacoeconomics -> focuses on the economic aspects of drug therapy. Description of the outcomes. How the drugs are absorbed, metabolized, distributed and excreted. Drugs are used to  Prevent o Vaccines o Birth control  Cure o No longer have the disease and will no longer have it again; should not come back o Antibiotics, Antifungal, and chemotherapy DO NOT CURE  Diagnose o PPD  If its positive its saying you have been exposed o Given contrast before a procedure to help show organs

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 Contrast dyes Alleviate o If you take an anti-hypertensive medication to alleviate what happens?  It lowers it but it can come back o Medication that is given to decrease the symptoms at that time; doesn’t completely solve the problem (decrease symptoms) o Inhaler for an asthma attack o Anti-hypertensive medications  Blood pressure medications Relieve o (Make something go away) o Pain medication o Analgesics o Usually if you take a necrotic most of the time the pain goes away o Tylenol

The effects of drugs The effect depends on the location (method and route)  Local o Area where you apply it (topical)

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o Some local medications could have a systemic effect Ex. Nitro Patches, Edema localized in one area o Affects the site of administration o Limited to certain locations o If I were giving a topical drug where would I feel the effect?  You would feel it at the point of administration, wherever you’re putting that. Systemic o Throughout systemic circulation o The drug must enter the blood stream. o It affects the enter system. o It affects the distance from the site of administration. o Main routes -> oral, IV o Bloodstream to different areas of the body. Ex. Heart Failure o Examples: Bee sting (localized) or Hives (systemic)

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Prescription or medication order (from any prescriber) must be checked for the following six elements: o Patient’s name o Date the drug order was written

o Name of drugs o Drug dosage amount and frequency of Route of administration o Prescriber’s signature. Sources of drugs  Plants o Morphine  Animals o Insulin/heparin (older forms) o Premarin  Minerals o Iron, ASA  Synthetic o NaHCO3  Semi-synthetic o Most antibiotics Drug Classifications (what category of drug is this)  Actions o How the drug will help the patient o What does the drug do o Patients are going to ask you how can this drug help me o The mechanism of action  Affected body system o How the drug will affect that system o How does the drug affect that particular body system o For example: the nurses administering the medication should already know how that drug could affect that particular body system. o For example: you are giving Atrivent -> respiratory drug given to (inhaler for patient with asthma or respiratory complications) – need to know how this medication will affect some of the body system. Atrivent can increase the patient’s heart rate  You give this kid Atrivent by nebulizer all of a sudden the kids heart rate has increased, the kid is bouncing off the wall, from all this extra energy you should already know that you should not be coming back and calling the doctor and telling the doctor that something is wrong with this kid. Because now the kids pulse rate is way higher than what it was before you should already know how that drug is going to affect that system.  Symptom relieved o We have to evaluate to make sure it is relieved o Every time we give a drug depending on what were giving the drug for we have to evaluate to make sure that it is relieved.

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o Like hospitals if your going to give pain management you have to go back and check until that patient says they are comfortable whatever there number is. o If you give a medication for a temperature the hospital says the pain you have to continue to check until the patient does not have a fever anymore. o If your checking for blood pressure and your giving blood pressure medication you are suppose to continue to monitor the patients blood pressure until it is back to normal (some patients never have a normal blood pressure, but what is normal for them and what is trending, always go back and look at the trend). Chemical characteristics o NaHCO3 o Want to know what category does this medication fall in o Whether is it analgesic, antidiarrheal, antihypertensive o How we group them  You can say analgesics, antidiarrheal, etc.  The patient was receiving an anti-hypertensive medication and I’m not telling you the name of the drug and its not every drug and the category all going to react the same, they have different side effects, therefore you have to look at the drug itself with these categories. What is a prototype? o An original or initial thing, and then something subsequent happens o Morphine is a prototype of an opioid derivative o The first of its kind {NOTE CARDS: DRUG GUIDE} {The drug, the classification, the mechanism of action=what the drug is going to {do, indication for use=what is this medication used for/how will it help/ {Why are we using it/giving it to the patient?, side effects, and adverse effects. {Example of mechanism of action: looking up narcotics in drug book, it will not {tell you it will decrease the patient pain. But you put it into simple terms for the {patient and say it will help to decrease their pain. Always tell the patients the {mechanism of action: “I am giving you this blood pressure medication to help {decrease or normalize your blood pressure. {Patient education: you know everything you need to know about the drug and {information you need to educate the patient about

Naming of Drugs  Chemical (in pharmacy) o Relates to chemical composition o Describes the drug’s chemical composition o Example: N-acetyl-para-aminophenol  Generic (in hospital and NCLEX/tests) [non-proprietary]

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o Similar to chemical name o Assigned by United States Adopted Name Council (USANC) o Example: acetaminophen (not capitalized) o Generic is the same but not equal to the real drug; that is why it is cheaper Trade (in hospital) [proprietary-assigned by hospital] o Assigned by manufacturer o Has a registered trademark; use of the name restricted by the drug’s owner (usually the manufacturer) o Example: Tylenol (capitalized)

Sources of drug information  Pharmacology textbook  US Pharmacopeia  PDR  Nursing drug reference  Drug package inserts  Pharmacists (last resort) o If it’s a new drug and they cannot find it in there drug guide, the micro medics, when you got o the pixies you can look stuff up. If they can’t find it than your responsibility is calling the pharmacist and asking them to send you the drug information. o Call the pharmacists as the last resort and let them send you the literature that you’re seeing it for yourself.  Credible Internet Sources o Lexicomp o HPD library o Docucare  CDC & NIH updates o www.CDC.gov  Healthcare providers, nurses, administration, we look at CDC for all of our updated stuff for vaccinations  Anytime they put out new stuff that is what we follow as nurses, if they put up new recommendations all the healthcare providers follow the CDC recommendations. o www.NIH.gov Federal Drug Laws and Standards  1906 Federal Food, Drug & Cosmetic Act  1914 Harrison Narcotic Act  1938 Federal Food, Drug & Cosmetic Act  1952 Durham-Humphrey Amendment  1962 Kefauver-Harris Amendment  1970 Controlled Substances Act  1978 Drug Regulation & Reform Act  1983 Orphan Drug Act

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o Lets say you have a disease and if they consider it to be a rare disease have a large percentage of the population that has the potential for this disease these drug companies are not investing any money, they try to come up with medications. o Enabled the FDA to promote research and marketing of orphan drugs used to treat rare diseases o Pharmaceutical companies do not want to make drugs for diseases that they think they wont be able to sell the drugs for o Example: Sickle cell disease – there are no drugs made specifically for sickle cell disease, but a lot of other drugs have proven useful for sickle cell disease. There is a cancer drug that is widely used for patients with sickle cell disease (hydroxy)  Sickle cell disease is like an orphan disease in the USA, because we do not have to report if someone has sickle cell disease. If we don’t report it, we do not know any true statistics on the amount of patients in the USA that have sickle cell disease.  Because of that, if pharmaceutical companies made drugs they cant cell that will become a problem  Any disease they consider a rare disease, you will find that pharmaceutical companies do not want to get involved 1991 Accelerated Drug Approval

US FDA Drug Approval Process  Pharmaceutical companies cannot just start making a drug for a specific disease, and just put it on the market.  Preclinical investigational studies o Tested on animals, then if it is safe on the animals that go to the humans with pre-clinical investigational drug studies done in different phases o This is how we come up with certain medications and than after they go through clinical phases.  Clinical phases of investigational drug studies o Phase 1  Primary focus: safety of the drug in humans  Have to look at pharmacokinetics: has to do with absorption, distribution, metabolism, and excretion of the drug.  Tested on a small population of healthy people, rather than on people who actually have the disease  Look at a small number of healthy people o Phase 2  Involves a small number of people who have the disease  Trying to explore the effectiveness of the drug.  There looking to determine what is the best dose  What are the short term side effects  Depending on what they discover they move on the phase three.

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Clinical studies in this phase are inspecting the effectiveness of the drug over a range of dosages to determine the common short term side effects  If everything goes well in this phase, then they go on to phase 3  When they look at side effects, every side effect has to be noted o Phase 3  Large number of participants  The purpose of this larger sample size is to provide information about infrequent or rare adverse effects that may not yet have been observed during previous smaller studies (phase two)  Objective here is to determine clinical effectiveness, safety, and dosage range.  Large population of people to get more information about the drug/ side effects; give true representation  The objective here is to determine whether the drug was effective and whether the dosages they came up with are safe  When drugs are put on the market and patients start having all these side effects or complication, they pull them off the market o Phase 4  Start marketing the drug, because they have gone through all these phases and see that the drug is fine.  The dosages they are putting are safe; they have side effects, but every drug has side effects  Pharmaceutical reps focus on the HCP offices, because they are going to give samples and if the drugs are effective, the next time they want the HCP to give a prescription so patients can start buying the drugs  In this phase, drugs are compared to other drugs on the market. They also look at some of the adverse reactions while looking at the side effects.  If they are having a bunch of problems in this phase, then they would have to pull the drug off the market Scheduled for Controlled Substances (how dangerous they are)  Controlled substances are LEGAL drugs such as narcotics that are highly addictive o Always locked up o Nurses have to count the controlled substances in the morning and night o Pyxis password is a fingerprint instead of user ID and password o Red flags in Pyxis if taking out too many controlled substances  Schedule I o High abuse potential o Not legally approved o No currently accepted medical use and a high potential for abuse o Street drugs  Schedule II

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o As above with accepted use o They have a high abuse potential however there approved to be used. o Medical use and a high potential for abuse. Schedule III o Lower abuse potential o Drugs with a moderate to low potential for physical and psychological dependence. Schedule IV o Still lower abuse o Drugs with a low potential for abuse and low risk for de...