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BS Nursing (BSN)
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Drug introduced to the body target cell
Potassium chloride
Pharmacodynamics
Action of drug to the body
Pharmacology
Study of biological effects of chemicals
“pharmaco” = medicine/drug
Drugs o Chemicals o Introduced into the body changes in the body occur o Example: Paracetamol - Chemical - Oral, IV, rectal - Relieve pain and lower the temperature
Also, the study of drug history, names, biochemical effects, physiological effects, and toxicity
Branches of Pharmacology
Pharmacodynamics
finds the enters through a receptor changes in the body occur Likened to a “key and lock” o Receptor = lock o Drug = key
Pharmacokinetics
Body’s response to the drug “Kinetics” = movement Types of movement Liberation Absorption Distribution Metabolism Excretion
Pharmacology
TOPRANK REVIEW
- RIGHTS OF DRUG ADMINISTRATION
o Right Medication/Drug Check the drug at least 3 times When you are about to get it from the stock cabinet When preparing the medication When you are about to administer “Medication error is the number 1 problem of hospitals.”
o Right Dose To achieve a therapeutic effect Therapy = cure o Right Patient Ask patient’s name and birthday o Right Time To achieve a therapeutic effect o Right Route incorporated in in IV fluid/infused, NOT IV push IV = dangerous because there is no coming back o Unlike PO which can be reversed through vomiting, gastric lavage o Right Documentation For the nurse’s protection o Right Client Education o Right to Refuse o Right Assessment o Right Evaluation
Example:
o Replace a missing substance - DM insulin insufficiency o Insulin - Cortisol for Addison’s Disease - T4, T3 for hypothyroidism
o Depress cellular activities Example:
o Interfere with the growth a foreign cell Example:
- Drug actions may be through: o Receptors
stimulated to release acetylcholine receptors in muscle of effector cells
Neostigmine: for myasthenia gravis
o SSRI administration serotonin reuptake is blocked
o Increase cellular activities Example: - Epinephrine
Beta blockers
Anti-cancer drugs
Antibiotics
Drug-Receptor Interactions - Types of Interactions o Agonists: stimulate receptor sites Epinephrine Digoxin o Antagonists= “block” Competitive Antagonist: binds to a same receptor Potency of agonist is reduced Diazepam Flumazenil Non-Competitive Antagonist: binds to a different receptor Prevents binding of agonist Epinephrine Phenoxybenzamine (adrenergic agent alpha blocker)
- Autonomic Drugs o Alpha receptors Alpha 1 Alpha 2 o Beta receptors Beta 1 Beta 2
o Enzymes and pumps Drug-Enzyme Interactions
- Normal physiology: o Interaction between neurons and muscle Nerve stimulation Electrical impulse axon terminal is
ACH binds to contraction cholinesterase is released ACH is metabolized /broken down muscle relax
- Drug involvement o Example: Cholinesterase inhibitors
No ACH breakdown occurs muscle does not relax Inhibiting Pumps
- Example: Reuptake inhibitors
- Normal physiology: o Nerve stimulation Electrical impulse stimulated to release 5HT ( hydroxytryptamine) – a serotonin
axon terminal is
binds to nerve receptors impulse transmission stimulation of effector cells 5HT is reuptaken
- Drug involvement: SSRI (Selective Serotonin Reuptake Inhibitor) – antidepressant o Block reuptake of serotonin o Depression Biogenic Amine Theory Depression is caused by imbalance of norepinephrine, dopamine, and 5HT (serotonin). Goal of care is to increase amount of NE, Dopa, and 5HT using antidepressants
serotonin levels are
Excretion: waste products/unnecessary substances are eliminated
Recommended dose: 500mg q T ½: 8 hours It would take 4-5 days before the drug is totally removed from the body
Blood thinner Operations must not be done while on aspirin Discontinue aspirin for about 5 days before operation
IV drugs bypass the first pass effect metabolism is skipped concentration is 100% Liver damage patients oral drug dose is reduced because the liver cannot metabolize drug properly
- Kidneys
- Feces
- Lungs
- Skin
Dose: the amount of drug to be administered Schedule: frequency, how many doses per day Recommended Dose: right amount and right schedule (time) To reach the critical concentration therapeutic effect cure Critical Concentration: level of drug in the blood which produces therapeutic effect Therapeutic Effect: favorable response after a treatment of any kind Loading Dose: initial dose, immediate response, usually higher than the recommended dose, usually given in emergency cases Half Life: time it takes for a drug to become half of its previously peaked level Example: - Amoxicillin
- Aspirin/ASA for hypertension risk for clot
risk for bleeding
half-life must be eliminated
NOTE: Half-life is usually the drug frequency - Example: Azithromycin – 1 tab OD for 3-5 days (5 days for COVID) Underdose not achieved due to low doses
critical concentration is
- Physiology of nerve impulse transmission o Parts: Neuron – functional unit of nervous system Presynaptic nerve – neuron that transmits the impulse Synapse (Synaptic Cleft) – space between neurons
o Process: Presynaptic neuron receives impulse from neuron before it through the neuron and reaches its end neurotransmitter is released into the synaptic cleft binds to the receptors on post-
o Layered: contains 2 or more chemicals Example: Neozep Can be crushed o Enteric-coated: liberation in an alkaline environment (small intestine) Shiny surface Liberation is not in the stomach stomach irritation Do NOT crush Swallow whole
Can be crushed
Slow absorption Longer duration of action Do NOT crush Swallow whole
Note: Do not put powder over wounds
Tablet
Anus Vagina
Cream
Liquid
o Dosage Forms of Drugs Solid
Postsynaptic nerve – neuron that receives neurotransmitters Impulse – contains the information, message Effector Cell – cells that act based on the impulse received from neurons - Muscle – contracts - Gland – releases hormones - Nerve – transmits impulses to other neurons
impulse travels
neurotrans- mitter synaptic neuron effector cells func- tion based on impulse received
o Scored: tablet with line in the center so it can be divided Can be crushed
does not cause
o Chewable
o Sustained-Release
Capsule o Hard gel: contains powder inside
o Soft gel: contains liquid
Lozenges o Has antiseptic= inhibits growth of bacteria o Has anesthetic action= relieve pain
Suppository o Inserted into the external orifice (opening)
Syrup o Usually sugar-based o Flavored but CLEAR/TRANSPARENT Suspension o Usually bought in powder form mixed with water o Chemicals do not mix with the water o Shake before administration
Topical Ointment o Oil-based o Use for dry lesions
o Water-based o Used for wet lesions Lotion o Used for an extensive lesion
Ganglia: nerve bodies outside the central nervous system
- Spinal nerves end in ganglia
o Anxiolytic – blocks anxiety o Mucolytic – lysis mucus o Thrombolytic – dissolves clot o Tocolytic – blocks tone of (uterine) muscle
o NOTE: Preganglionic & Postganglionic
nerves from ganglia innervate organs
Preganglionic Nerves: before the ganglia
Postganglionic Nerves: after the ganglia
Parasympathetic = PSNS – cholinergic
Antagonist – block
Lytic – block, destroy, dissolve
for premature contraction
- Sympathetic = SNS – adrenergic
- Agonist – stimulate
- Mimetic – copy, mimic
- NOTE:
o Give Atropine (anticholinergic) in OR before surgery to decrease salivation decrease risk for aspiration o Give Haloperidol (antipsychotic/neuroleptic) to patient with schizophrenia Side effect: - NMS (Neuroleptic Malignant Syndrome) - EPS (Extrapyramidal Sydrome) - Pseudoparkinsonism - Tardive Dyskinesia
Phenylephrine (decongestant) blood flow
o BP = HR x SV x Total Peripheral Resistance (SVR) o Vascular effects increase TPR
- Akathisia
- Anticholinergic Side Effects Clozapine is an atypical antipsychotic
o ANTIPSYCHOTICS ARE ANTICHOLINERGIC o Nursing care Expect constipation - Increase OFI - Increase fiber in diet
Expect urinary retention - Void first - Schedule voiding Expect dryness of the mouth - Increase OFI - Oral care - Ice chips - Sugarless candy
- Alpha receptors o Alpha Urinary bladder sphincter – urinary retention Blood vessels – vasoconstriction Iris – mydriasis o Drug Involvement: vaso constriction decrease oxygen to the cells cell shrink - Side effect: Increased BP
increased BP o NOTE: Sinupret decongestant that does not increase BP
Phenylephrine is also used during eye exam Midodrine used for orthostatic hypotension
Vasoconstriction increases TPR increases BP
o Alpha Found in the CNS (nerve membrane) decrease norepine- phrine release Pancreas decreased insulin hyperglycemia o Drug Involvement Clonidine (Catapres) affect nerve membrane in CNS decrease nor- epinephrine release weakens SNS activation of PSNS decrease BP
Methyldopa
Antihypertensive
Used in pregnancy and postpartum
Beta receptors o Beta1 receptors Lungs bronchodilation Uterus relaxation Blood vessels of heart, lung, skeletal muscles vasodilation Liver glycogenolysis hypergly cemia Drug Involvement - Albuterol/Salbutamol short- acting bronchodilator treat asthma & COPD o Side effect Tremors Palpitations Rationale: Albuterol has beta1 affinity - Terbutaline (Bricanyl) o Bronchodilator used for asthma and COPD o Can enter the uterus used for premature contraction tocolytic
Ciliary body produces aqueous humor >> humor leaves the iridocorneal angle Problems: - Open: Increase aqueous humor >> decrease production of humor - Close: Obstruction of flow
Side effects: o Bradycardia o Hypotension o Bronchoconstriction o Hypoglycemia o Erectile Dysfunction (Impotence)
Intervention: o Monitor HR, BP, RR o Hold if HR <60 bpm o Hold if BP <90/60 mmHg o Instruct client to move slowly, sit, dangle feet first before standing (for orthostatic hypotension) o May mask hypoglycemia >>caution in clients with DM
Muscarinic o M CNS Gastric Parietal Cells Autonomic Ganglia
o M Heart o M Smooth muscle (airway) o M CNS o M CNS
- Nicotinic o N1 or Nm NMJ (Neuromuscular Junction)
o N2 or Nn Autonomic Ganglia CNS Adrenal Medulla
OTHER DISORDERS
MYASTHENIA GRAVIS - Autoimmune >> antibody formation >> attack antigen (normally) o For MG, antibodies attack acetylcholine receptors >>acetylcholine does not reach effector cells - Paralysis happens when no receptors are present o Weakness if there are remaining receptors - More common in women 20-40 years old, unknown cause or idiopathic - Descending muscle weakness o Ptosis – initial sign Check palpebral fissure o Diplopia – double vision o Mask like facial expression o Dysphagia >> increased risk for aspiration o Weakening of laryngeal muscles >> hoarseness of voice o Respiratory muscle weakness >> difficulty breathing >> respiratory arrest Prepare at bedside tracheostomy set
o Extreme muscle weakness (especially in the morning) o NOTE: Opposite of MG is GBS >> ascending paralysis
Turning schedule:
- NURSING PRIORITIES
o AIRWAY o ASPIRATION o IMMOBILITY
Drug Involvement o Anticholinesterase – to prevent the breakdown of acetylcholine >> cholinergic effect Neostigmine - Treatment Pyridostigmine - Treatment Physostigmine - Treatment Edrophonium Chloride - Diagnostic >> short acting (~ 5 min)
CRISES o Myasthenic crisis S/S – weakness, paralysis Cause – underdose of cholinergic drug Treatment – cholinergic drug (neostigmine)
o Cholinergic crisis S/S – weakness, paralysis Cause – overdose of cholinergic drug Treatment – anticholinergic drug (atropine)
- DIAGNOSIS o Tensilon Test Strengthening of muscles for 5- minutes Use edrophonium chloride – IV (because it is a crisis) Myasthenic Crisis >> temporary relief of paralysis (Positive Tensilon Test) Cholinergic Crisis >> worsen the paralysis (Negative Tensilon Test)
- NURSING MANAGEMENT
o Maintain patient airway and adequate ventilation by Assisting on mechanical ventilation Monitoring pulmonary function test
o Monitor vital signs, I&O, neuro check, muscle strength or Motor Grading Scale (4/5, 5/5, etc.) o Side rails – for safety o Prevent complications of immobility
- Adult – q
- Elderly – qhourly
o NGT feeding o Pharmacotherapeutics Cholinergics or anticholinesterase agents - Long term - Increase acetylcholine - Side effects: o Peripheral nervous system effects Corticosteroids o Monitor for 2 types of crisis Myasthenic Crisis Cholinergic Crisis o Slow IV administration o Assist in surgical procedure o Assist in plasmaparesis o Prevent complications
5-pharmacology-nursing-notes compress
Course: BS Nursing (BSN)
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