Core Concepts in Pharmacology
Introduction to Pharmacology
History of Pharmacology
John Jacob Abel, considered the father of American pharmacology for his many contributions in the field, founded the first department of pharmacology in the United States at the University of Michigan in 1890. The 20th century saw an increase in the pace of change in all areas. of medicine continued exponentially. Current pharmacological practice is extremely complex and advanced compared to its early, primitive history.
The nurse who consults with a pharmacist in the use of pharmacological agents and other health.
Pharmacology: The Study of Medicines
Many drugs are prescribed for more than one disease and most produce multiple effects within the body. For example, patients with liver or kidney impairment may experience enhanced responses due to reduced clearance of drugs from the body.
Pharmacology and Therapeutics
Classification of Therapeutic Agents as Drugs, Biologics, and
Due to their great popularity, herbal and alternative therapies are mentioned throughout this text wherever they show promise in treating a disease or condition.
Therapeutic and Pharmacologic Classification of Drugs
The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its physiological effect in the body. By learning the properties of the prototype drug, students can predict the actions and adverse effects of other drugs in the same class. For example, by knowing the effects of penicillin V, students can extend this knowledge to the other drugs in the penicillin class of antibiotics.
Newer drugs in the same class may be more effective, have a more favorable safety profile, or have a longer duration of action.
Chemical, Generic, and Trade Names for Drugs
Since there is only one generic name for each drug, the use of this name is useful and students should generally remember it. Since it takes several years for a drug to be approved, the time taken for approval is usually the same. Trade names can be challenging for students to learn because of the dozens of products that contain similar ingredients.
The rule of thumb is that the active ingredients in a drug are described by their generic name.
Prescription and Over-the-Counter Drugs
Differences Between Trade-Name Drugs and Their Generic Equivalents
Public information often focuses on generic drugs that have the same active ingredients but colors, flavors, and some other filler ingredients. Since there is a lag time before generic products appear in the Orange Book, first-time generic drug approvals can also be requested online at the FDA website. The key to comparing brand-name drugs and their generic equivalents may lie in measuring the bioavailability of the two preparations.
The bioavailability of the drug will depend on the dosage form and the amount that actually reaches the target location.
Decisions Relative to Proper Drug Choices
The Centers for Disease Control and Prevention (CDC) and FDA participated in a series of public discussions that began with the Ebola outbreak in March 2014. The numbered key concepts provide a concise summary of important points from the corresponding numbered section within the section. What is a prototype drug and how does it differ from other drugs in the same class.
Pridobljeno s http://psqh.com/january- february- 2014/healthcare-analytics-patient-engagement-what-can-we-learn-from- other-industries.
Drug Approval and Regulation
Drug Regulations and Standards
All medicines were covered by the USP; pharmaceutical ingredients fell under the NF. Since the beginning of the 21st century, the cost of drug invention in the United States has increased dramatically, while the number of drugs developed has decreased. Thus, this reform will likely continue to increase the volume of prescription drugs used in the US.
To protect the public in the early 1900s, the United States began to develop and enforce stricter drug laws.
The Role of the Food and Drug Administration
The FDA oversees the administration of herbal products and dietary supplements through the Center for Food Safety and Applied Nutrition (CFSAN). Herbal products and dietary supplements are regulated by the Dietary Supplements Health and Education Act of 1994. For example, herbal and dietary supplements may be marketed without prior FDA approval; however, all package inserts and.
In 1998, the National Center for Complementary and Alternative Medicine (NCCAM), now called the National Center for Complementary and Integrative Health (NCCIH), was established as the federal government's lead agency for scientific research and information on complementary and alternative medicine (CAM) therapies.
Phases of Approval for Therapeutic and Biologic Drugs
Clinical researchers from various medical specialties address concerns such as whether the drug is effective, worsens other medical conditions, and interacts with each other. If the drug seems promising but precautions are taken, the trial is postponed until the pharmaceutical company addresses the concerns. The New Drug Application (NDA) review is the third phase of the drug approval process.
If the FDA discovers a serious problem, it will order the drug withdrawn from the market.
Changes to the Drug Approval Process
Special populations require careful assessment of the patient's ability to understand or make informed decisions about research. While providing information is beyond the scope of most nursing practice, the patient will often ask questions of the nurse, and the nurse can relay these questions to the health care provider. Although the dollar amount varies from year to year, the gap occurs when coverage for allowable drugs paid by the patient and the prescription plan reaches a certain limit.
Upon reaching the limit, the patient bears the cost of the drugs, until the upper limit is reached.
Nurses, the Drug Approval Process, and the Need for Effective Safety
Controlled Substances, Drug Schedules, and Teratogenic Risks
In the United States, a controlled substance is a drug whose use is restricted by the Controlled Substances Act of 1970 and subsequent revisions. These Schedule drugs are ranked by abuse potential: Schedule I drugs have the highest potential for abuse, and Schedule V drugs have the lowest potential for abuse. Refills of Schedule II medications are not permitted: patients must first see their healthcare provider.
Birth defects are most likely in the first trimester; nurses must therefore be aware of the various drug risks during this time.
Principles of Drug Administration
Medication Knowledge and Understanding
They may require intervention by a nurse, although they are generally perceived as acceptable. It is characterized by widespread peeling of the epidermis, which is caused by extensive breakdown of the upper layer of the skin and mucous membrane. Generalized vesicular lesions appear within a few days and desquamation may occur on 10% of the body.
The boundaries for such decisions are often based on the respective policies and guidelines of regulatory agencies, health care providers, and the mutual consent they provide.
The Rights of Drug Administration
If a patient refuses medication, it is the responsibility of the nurse to inform the patient about drug benefits and risks, and to assess for fears and reasons why the patient may refuse the medication. The nurse must notify the health care provider and document all information related to these additional rights. The three checks of drug administration that the nurse uses along with the five rights help ensure patient safety and drug effectiveness.
The nurse following institutional policy and procedure during scanning correctly checks the five rights three times.
Patient Compliance and Successful Pharmacotherapy
In many situations, the nurse remains the last line of defense to prevent a medication error from occurring. Before administering the medication, the nurse should use the nursing process to create a personalized care plan that best suits the patient's needs. In the care plan it is important to include essential information that the patient needs to know about the prescribed medications.
Patients are usually reluctant to admit or report a nurse's noncompliance for fear of being reprimanded or embarrassed.
Drug Orders and Time Schedules
The time between writing the order and administering the medicine must be 5 minutes or less. Although not as urgent, an ASAP (as soon as possible) order must be available for administration to the patient within 30 minutes of the written order. Grapefruit juice should be consumed at least 2 hours before or 5 hours after taking a medication that may interact with it.
Sildenafil (Viagra) is unique in that it must be taken 30 to 60 minutes before expected sexual intercourse to achieve an effective erection.
Systems of Measurement
After the medications are administered, the nurse must correctly document that the medications have been given to the patient. Because Americans are very familiar with the teaspoon, tablespoon, and cup, it is important for the nurse to be able to convert between the household and metric measurement systems. If a discharged patient is ordered to drink 2400 mL of fluids per day, the nurse can.
Likewise, when a child is to have a drug administered in elixir form, the nurse must explain that 5 mL of the drug is approximately the same as 1 teaspoon.
Enteral Drug Administration
For the sublingual route, the medication is placed under the tongue and allowed to dissolve slowly. The patient must be instructed not to move the substance with the tongue, nor to eat or drink anything until the medicine has completely dissolved. Assess that the patient is alert and has the ability to hold the medication under the tongue.
Assess that the patient is awake and has the ability to hold the medication between the gum and the cheek.
Topical Drug Administration
Antineoplastic agents can be introduced into the bladder via a catheter to treat bladder mucosal tumors. Corticosteroids are sprayed into the nostrils to reduce inflammation of the nasal mucosa due to allergic rhinitis. The ophthalmic route is used to treat local conditions of the eye and surrounding structures.
Instruct the patient to remain in the supine position or to lie supine to prevent expulsion of the suppository.
Parenteral Drug Administration
Injection into the skin delivers drugs to the blood vessels that supply the different layers of the skin. Apply pressure to the site with a dry, sterile 2 × 2 gauze and massage to promote absorption of the medication in. Before administering medications via the enteral route, the nurse should assess which of the following.
The order reads: "Lasix 40 mg IV STAT." Which of the following actions should the nurse take?
Pharmacokinetics
- Pharmacokinetics: How the Body Handles Medications
- The Passage of Drugs Through Plasma Membranes
- Absorption of Medications
- Distribution of Medications
The pH of the local environment directly affects drug absorption through its ability to ionize the drug. The physical properties of the drug greatly influence its movement throughout the body after administration. Drug-protein complexes are too large to cross capillary membranes; thus, the drug is not available for distribution to body tissues.
Some drugs, such as the anticoagulant warfarin (Coumadin), are strongly bound; 99% of the drug in the plasma is bound in drug-protein complexes and is unavailable to reach target cells.
