Ch1. Intro to Drugs

adverse effects:
drug effects that are not the desired therapeutic effects; may be unpleasant or even dangerous

brand name:
name given to a drug by the pharmaceutical company that developed it; also called a trade name

chemical name:
name that reflects the chemical structure of a drug

generic name:
the original designation that a drug is given when the drug company that developed it applies for the approval process

genetic engineering:
process of altering DNA, usually of bacteria, to produce a chemical to be used as a drug

over-the-counter (OTC) drugs:
drugs that are available without a prescription for self-treatment of a variety of complaints; deemed to be safe when used as directed

pharmacology:
the study of the biological effects of chemicals

pharmacotherapeutics:
clinical pharmacology—the branch of pharmacology that deals with drugs; chemicals that are used in medicine for the treatment, prevention, and diagnosis of disease in humans

phase I study:
a pilot study of a potential drug done with a small number of selected, healthy human volunteers

phase II study:
a clinical study of a proposed drug by selected physicians using actual patients who have the disorder the drug is designed to treat; patients must provide informed consent

phase III study:
use of a proposed drug on a wide scale in the clinical setting with patients who have the disease the drug is thought to treat

phase IV study:
continual evaluation of a drug

teratogenic:
having adverse effects on the fetus

Pharmacokinetics
How the body acts on the drug (what does the body do to the drug once its inside the body)

Pharmacodynamics
How the drug affects the body

Efficacy
the ability to produce a desired or intended result

Dynamic Equilibrium
Absorption (stomach)
Distribution (circulation)
Biotransformation (metabolism) (liver)
Excretion (kidneys)

Pharmacokinetics Absorption
Process by which a drug is transferred from its site of entry into the body to the bloodstream (circulating fluids) and tissues

Oral meds-
most frequently used, longest to start working, acid in stomach is involved, food stimulates more acid and prolongs gastric emptying.

Injected Meds-
faster than oral, IM is absorbed into the muscles then into the bloodstream.

Pharmacokinetics Distribution
Movement of drug to the body’s tissues

Influences on drug distribution
Blood flow to tissues
Lipid solubility and ionization
Protein binding- drug binding to proteins in the plasma in the circulation prevents the drug from reaching its
Blood-brain barrier- a structure that is protective made of tightly spaced capillary walls that supply’s blood to the brain. Preventing toxins and poisons to effect the brain.
Placenta and lactation- most drugs readily move across the placenta, try to not administer drugs to a pregnant woman unless the benefit outweighs the risk.

Pharmacokinetics Biotransformation
(metabolism)
Change of a drug from its original form to a new form
Occurs in many tissues
Liver primary site where metabolism occurs.

Liver metabolism
Inactivated by the liver and broken down into something that is inert

First pass effect
(Orally) Goes first to the liver where it is being transformed by the liver and transformed into other things so it can be excreted. Doesn’t’t happen with Intra muscular Injections or IV.
Oral drugs are increased in size when compared to IV or IM.

Hepatic enzymes
The interaction of some drugs increase the reaction of liver enzymes. Speeding up the metabolism of the drug. Some drugs cant be given together because some speed up the metabolism of the liver enzymes or slow down the liver enzymes which can cause the drug to linger.

Pharmacokinetics Excretion
Excretion
process of removing a drug or its metabolites from the body
Occurs in several tissues
Kidneys primary site

Before distributing a drug we must know the pt’s kidney functions/problems.

Critical Concentration and Onset of Action-
amount of drug needed to cause a therapeutic effect.

Loading Dose-
higher dose than used for normal treatment to initiate a quicker onset of action

Peak Effect-
highest concentration of blood after which declines

Half-life-
time it takes the drug to decrease to one half of the peak. (part of dosage)

Duration of Effect-
the length of time that the drug is effective.

Factors Affecting Drug Action
Weight- determines drug dosing
Age (developmental factors)
Gender
Illness
Genetic and Cultural factors
Ethnopharmacology- the study of response to drugs based on ethnicity.
Pharacogenetics-people that have genetic variations that indicate the pt might be more receptive to the drug
Psychological patients expectations
Environmental

Tolerance-
higher dose needed to cause the same effect.
Cross tolerance- b/c u have a tolerance to one drug u might be tolerant to another that is similar one as well.

Allergic Effect-
hypersensitivity, body interprets drug as a foreign invaded and builds antibodies against it.
Anaphylaxis-respiratory distress, life threatening.

Interactions
Drug-drug- something happens between taking two drugs together. Getting unanticipated effects.
Drug-food- could inhibit or enhance absorption
Drug-laboratory test- some drugs interfere in laboratory tests

Toxic Effect
Hepatotoxicity- liver damage
Nephrotoxicity-kidney damage
Cardiotoxicity-heart damage
Cumulative effect- cant metabolize the drug before the next dose is given.

Idiosyncratic-
occurs unexpectedly usually after the first time the person is given the drug.

Carcinogenicity-
drugs that have adverse effects that can cause cancer

Teratogenicity-
drugs that can cause abnormal fetal development.

Black Box Warning
Potential to cause serious or life-threatening adverse effect
Added after significant serious adverse effects have occurred
Strongest warning

Nursing Responsibilities and Drug Therapy
Knowledge
Therapeutic effect Drug-drug interactions
Indication Lifespan and cultural considerations
Contraindication Nursing Considerations
Adverse effect Relevant patient education

Administer drugs
Prevent medication errors
Assess for therapeutic and adverse drug effects
Act to make the drug regimen more tolerable/increase compliance
Provide patient teaching about drug and regimen

Nursing Process in drug therapy to ensure that the patient receives the best, safest, most efficient, scientific and evidence-based holistic care.

Challenges to Effective Drug Therapy
Consumer Awareness
OTCs
Alternative Therapies and Herbals
Financial Considerations

Weight-based Drug Calculation
Pediatric Dosing
Wide variations in size
Adult Dosing
Small margin of safety
High potential for toxicity
Safe Range
Specified amount of drug for each unit of weight

Drug Evaluation
Regulated by FDA
Preclinical Trials
Chemicals tested on laboratory animals
Phase I Studies
Chemicals tested on human volunteers
Phase II Studies
Drug tried on informed patients
Phase III Studies
Drug used in vast clinical market

Drug Regulation
FDA – U.S. Food and Drug Administration
Regulation of development of drugs
Regulation of sale of drugs
Drug approval for marketing and use
Stages of Development

Sources for Drugs
Natural
Plants, animals, inorganic compounds

Synthetic
Manufactured
Genetic engineering

Nursing Responsibilities and Pharmacotherapeutics
Knowledge about drugs
Administer drugs
Prevent medication errors
Assess for therapeutic and adverse drug effects
Act to make the drug regimen more tolerable/increase compliance
Provide patient teaching about drug and regimen

Pharmacotherapeutics (clinical pharmacology) –
branch of pharmacology that uses drugs to treat, prevent, and diagnose disease.

Key concerns:
the drug’s effects on the body
the body’s response to the drug

Importance for nursing:
Apply to clinical setting
Patients often have complex drug regimens and receive potentially toxic drugs
Drug can have many effects and need to know which ones may occur when administering a drug
Some drug effects are therapeutic, meaning helpful, others are undesirable or potentially dangerous

Pharmacology
The science of drugs including their origin, composition, pharmacokinetics, therapeutic use, and toxicology (Merriam Webster)

The study of the biological effects of chemicals (Karch)
Chemicals = drugs
Drugs are chemicals introduced into the body to cause some sort of change

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