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Pharmacology Final

Surface Pharm 1

The therapeutic objective of drug therapy to provide maximum benefit with minimum harm
ED50 the dose that is required to produce a defined therapeutic response in 50% of the population
Potency refers to the amount of drug we must give to elicit an effect
Pharmacodynamics study of the biochemical and physiological effects of drugs and the molecular mechanisms by which those effects are produced – what drugs do to the body and how they do it.
Maximal efficacy the largest effect the drug can produce
General properties of drugs 1 - Drugs do not confer any new functions, they only modify existing functions. 2 - Drugs exert multiple actions. 3 -Drug action results from a physicochemical interaction between the drug and a functionally important molecule in the body
Ways to minimize adverse drug reactions Educate patients and family members to watch for signs of and alert physician. Anticipate ADRs. Monitor organs of known toxicity of certain drugs. Individualize therapy.
Side effects a nearly unavoidable secondary drug effect produced at therapeutic doses.
Pharmacokinetics 4 phases: absorption, distribution, metabolism, and excretion. All involve drug movement into cells through cell membranes
Larger therapeutic index Safest drugs
Mechanisms of drug action To produce its optimal effect, a drug must reach the appropriate concentrations at its site of action
Concentration of the drug at its site of action is influenced by 3 phases of drug activity: pharmaceutical, pharmacokinetic, and pharmacodynamic
Adverse reactions Can occur in all patients, more common in elderly and infants.
Nomogram Surface area of child in m2 Child’s dose = _______________________ X Adult dose 1.7 m2
Full renal function develops by 6 to 12 months.
Drugs excreted through the kidneys have a half-life aprox. 50% longer in infants than adults.
Infant’s urine slightly less acidic than adults and may decrease elimination of drugs that require acidic urine to be excreted.
Most accurate drug dosage calculations for peds based on the body surface area of the child’s body relative to that of an adult.
In general, any IV drug or fluid can be safely given by intraosseous route
IM injections over 18 months Deltoid muscle, Ventrogluteal site, Dorsogluteal site–not recommended for <3 years, Vastus lateralis muscle
IM injections under 18 months Vastus lateralis muscle
For Children under Age 3: Eardrop administration Gently pull the outer flap of the affected ear DOWNWARD and backward to straighten the ear canal. Look for the ear canal to open.
For Children over Age 3: Eardrop administration Gently pull the outer flap of the affected ear UPWARD and backward to straighten the ear canal. Look for the ear canal to open.
Liquid medications to infants Give liquid medicine along the side of the mouth, about halfway down. Make sure your child is standing or sitting up at least a 45-degree angle when taking any medicine.
Aspirin This should not be given to children with viral infections due to possibility of causing Reye's disease
Phase 1 Clinical testing small number of human volunteers, used to determine pharmacokinetic
Phase 3 Clinical testing extended clinical evaluation; tested in various centers in US in larger numbers of individuals. Goals: 1) determine clinical effectiveness, 2) determine drug safety, 3) establish tolerated dose or range
Phase 2 Clinical testing limited controlled evaluation; in selected individuals with the targeted disease; closely monitored for side effects and effectiveness
Generic names assigned by the United States Adopted Names Council. Has only one generic name. AKA nonproprietary names.
Trade names AKA proprietary or brand names, are the names under which a drug is marketed. Created by drug companies, approved by the FDA.
Requirements for drug administration 1) the med order must be valid, 2) the prescriber and the nurse must be licensed (nonphysicians by state law), 3) the nurse must know the purpose, actions, effects, and major adverse effects, and the teaching required
Changing a med order by modifying any part of it without consultation is Illegal.
Controlled Substances Act of 1970 categorized controlled substances on the basis of their potential for abuse. Schedule I-V.
Telephone order This verbal order is "called" into the pharmacy by a physician or agent. know your legal role in your state
Prescription drugs Prescribed by a doctor. Bought at a pharmacy. Prescribed for and intended to be used by one person
OTC drugs Drugs that do NOT require a doctor's prescription. Bought off-the-shelf in stores
Opioid classification agonists, partial agonists, or agonist-antagonist
Agonist binds to the receptor(s) to produce the maximum response of the individual receptor
Partial agonist produces a partial response
Agonist-antagonist produces mixed effects, acting as an agonist at one type of receptor and as a competitive antagonist at another
Meperidine (Demerol, Pethidine) the least potent of the common opioid analgesics. Uses - acute asthma, biliary colic, and pancreatitis
Naloxone hydrochloride (Narcan) PO is not active, but if dissolved and injected will block the effects of the pentazocine.very effective parenterally. Onset 21-2 min (IV); 2-5 min (IM,SQ)
Morphine indications severe pain; drug of choice for CA. Small doses can depress cough center; useful in pulmonary edema, useful with MI, and peripheral vasodilation; also has antidiarrheal effects
Morphine side effects most common are vertigo, faintness, and light-headedness. Others are fatigue, sleepiness, N, V, sweating, constipation, hypotension.
Morphine action altering the perception of and emotional responses to pain because the receptors are widely distributed in the CNS, especially in the spinal and medullary dorsal horn, limbic system, thalamus, hypothalamus, and midbrain
Primary opioid receptors in the CNS mu, kappa, delta, and sigma. Analgesia is associated with the first 3. Research on delta receptors is limited, therefore the primary analgesic receptors at this time are mu and kappa
Factors affecting pain management Fear of inducing addiction, tolerance, or physical dependence. Fear of inducing respiratory depression
COX 1 VS COX 2 inhibitors COX-1 (good) and COX-2 (bad). COX-1 is found in practically all tissues. COX-2 is found primarily at sites of tissue injury, where it catalyzes the synthesis of prostaglandin, which promote inflammation and sensitize receptors to painful stimuli
NSAID contraindications children and teens suspected of having influenza or chickenpox. Pregnancy, Hypersensitivity: asthma, hay fever, chronic urticaria, or nasal polyps. If allergic to ASA, do not give other NSAIDs.
NSAID risks Kidney damage. NSAIDs are cleared from the blood stream by the kidney. Stomach problems. NSAIDs may also cause stomach upset or possibly ulcers
Mydriatic eye drops Anticholinergic actions include dilated pupils
Eye drop administration Place nondominant hand on cheekbone and expose lower conjunctival sac by pulling on cheek. Instruct the patient to look up and drop the drops into center of conjunctival sac
IOP treatment Treatment consists of a cholinomimetic drug, a carbonic anhydrase inhibitor, epinephrine, and an osmotic diuretic. Same as CAG treatment
Fluorescein sodium a nontoxic water-soluble dye, can be applied to the cornea. Stains denuded areas of epithelium such as scratches as a bright green color; foreign bodies are surrounded by a green ring. Areas having a loss of conjunctiva are stained yellow
Closed angle glaucoma Characterized by the iris bulging up to shut off access to the aqueous humor to the anterior chamber. This creates an emergency because the buildup of IOP may rapidly become severe,
CAG Tx cholinomimetic drug, a carbonic anhydrase inhibitor, epinephrine, and an osmotic diuretic. Same as IOP treatment
NSAIDS (flurbiprofen sodium, suprofen, diclofenac sodium, ketorolac tromethamine) decrease prostaglandin concentrations in the eye which may decrease itching and inflammation. Have analgesic, antipyretic, and anti-inflammatory properties
Dilantin range Narrow therapeutic range (10-20 mcg/ml). Nystagmus. Toxic > 30 mcg/ml.
Dilantin administration PO with meals to decrease GI distress, IM not recommended (painful, erratic absorption, crystallizes causing necrosis), never subcu. Highly alkaline. IV not greater than 50 mg/min (elderly 5-10 mg/min)
Phenobarbital Therapeutic range: 15 – 45. PO or IV (not more than 60 mg/min IV to avoid respiratory depression.
Anti epileptic Teaching (1-3) 1. Take medication exactly as prescribed. 2. Keep seizure frequency chart – date, time, and nature of all seizure events. 3. CNS depression is common with all meds – avoid driving and hazardous activities.
Anti epileptic teaching (4-6) 4. Never discontinue drug without consulting doctor. 5. Travel – carry extra medication with you. 6. No ETOH or other CNS depressants.
Primary defense mechanisms against infection intact skin and mucous membranes, the chemical composition and pH of specific body secretions, phagocytic cells, mechanical movements of certain cells or tissues, and the inflammatory process
Prophylactic use of antibiotics surgery, bacterial endocarditis, neutropenia, recurrent UTI, rheumatic carditis, STDs.
Alternatives for penicillin allergy erythromycin, vancomycin
Peak and trough trough level is the lowest level that a medicine is present in the body. It should be contrasted with a "peak level", which is the highest level of the medicine in the body
Meds requiring peak and trough Vancomycin, and aminoglycosides
Antibiotic contraindications pregnancy, lactation, infants under 2 yo, allergy, blood dyscrasias, uric acid kidney stones, renal impairments
Selective toxicity ability to injure a target cell or target organism without injuring other cells or organisms that are intimate contact with the target
Nosocomial infections that have been caught in a hospital and are potentially caused by organisms that are resistant to antibiotics
Suprainfection new infection that occurs during the course of treatment for a primary one
Vancomycin uses Principal indications for C Difficile (PO only), MRSA, MRSE
Aminoglycosides parenteral only, bactericidal, narrow-spectrum, ineffective against anaerobes, uses: serious systemic infections, prepare GI tract for surgery, TB in combo with other drugs.
Tetracycline Valuable for treating several uncommon infections.bacteriostatic. absorption is decreased with compounds containing magnesium, calcium, aluminum, iron (antacids, dairy products, iron). Decrease effects of oral contraceptives
Amphotericin B adverse effects Infusion reactions—fever, chills, rigors, N, HA—from release of cytokines from monocytes and macrophages. Symptoms start in 1-3 hours, persist 1 hour. Mild reactions can be reduced by premedicating with diphenhydramine (Benadryl) and ASA or acetaminophen
Amatadine side effects CNS (dizziness, nervousness, insomnia, difficulty concentrating), CV (CHF, orthostatic hypotension), teratogenic
Amatadine uses Parkinson drug, used for prophylaxis and treatment of influenza A
Acyclovir agent of first-choice for herpes simplex and varcella-zoster
Flucytosine almost always given with amphotericin B.
Interferon alfa Depression; suicide has occurred. Antidepressants may help or dosage reduction or cessation is required
1 Teaspoon - t 5 ml
1 Tablespoon - T 15 ml
1 Ounce - oz 30 ml
15 Grains - gr 1 g
1 kg 2.2 lb
Created by: mwgilacab