Introduction to Pharmacology

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Introduction to Pharmacology

• Presented by
• Cynthia Bartlau, RN, PHN, MSN

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Introduction to Pharmacology

• The science of drugs, their properties, use and
  effects
• Medicinal drugs do not include
• Non-prescription
• Nicotine
• Alcohol
• Illegal Drugs

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Pharmacology Definition

• Study of the effect of chemical substances on
  living tissue
• The study of medicinal drugs
• The study of chemicals and toxic properties
• The study of the use of chemicals for
  psychotropic or social purposes

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History of Drugs

• Primitive
• Herbal Remedies
• Arrow Poisons
• Mood altering foods
• Opium
• Cocoa

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History of Drugs (cont.)

• Ancient
• Preservation substances (Egyptian Mummification)
• 100 A.D. 600 substances listed in the Roman
  Materia Medica

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History of Drugs (cont.)

• Medieval
• Plants and herbs are classified
• Relationship of dose to toxicity is recognized
• Use of poisons for homicide prevalent

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History of Drugs (cont.)

• 17th and 18th Century
• Increased knowledge of drugs and shared with
  world as increase in world travel continued
• Widely accepted by physicians and lay persons

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History of Drugs (cont.)

• 19th Century
• The beginning of the modern science of
  pharmacology
• Problems Recognized
• Dose effect relationship
• Processes involved in absorption/excretion
• Localization of the site of action of a drug
• Specific mechanisms of drug action
• Relation between chemical makeup biologic
  activity of substances

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History of Drugs (cont.)

• Developed
• Anesthetics
• Injection technique
• Antipyretics (Aspirin)

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History of Drugs (cont.)

• Modern Medicine
• Complex science Big business
• Virtually every body function can be enhanced,
  suppressed, or manipulated by chemical means
• Problem with drug abuse worldwide
• Chemical technology
• Herbicide
• Insecticide
• Fuel/solvents
• Poison affecting our health and environment
• We need to use this new technology wisely
  without poisoning ourselves and environment

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Drug Laws

• Drug Standards
• Drugs of the same name must have the same
  strength, quality, and purity
• Federally approved requirements for safety of
  consumer
• Three major acts that provide consumer safety

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Drug Laws (cont.)

• 1906 Pure Food Drug Act
• Empowered federal government to enforce standards
  set by US Pharmacopoeia and National Formulary
• Drugs must meet standards of strength purity
• Type amount of narcotics must be listed on
  label of opiate mixture
• 1912 Sherley Amendment to FFDCA prohibits
  fraudulent therapeutic claims

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Drug Laws (cont.)

• 1914 Harrison Narcotic Act
• Legally defines the term narcotic
• Regulates manufacture, import, sale, and use of
  cocaine and opiates
• Revision to Harrison Act regulates the use of
  marijuana and synthetic opiates

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Drug Laws (cont.)

• 1938 Food, Drug and Cosmetic Act
• Requires drugs products be tested for harmful
  effects
• Drug labels and literature must be complete
  accurate, setting dose, manufacturers name
  address, names amounts of potentially harmful
  ingredients, a warning if habit forming,
  direction for use, and contraindications
• Medical devices must be safe effective and
  cosmetics must be safe

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Drug Laws (cont.)

• 1952 Durham-Humphrey Amendment
• Distinguishes between prescription and over the
  counter medication
• A prescription for narcotics, hypnotic,
  habit-forming drugs, and potentially harmful
  drugs can be refilled only with a new
  prescription, and requires that the label state
  this fact

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Drug Laws (cont.)

• 1962 Kefauver-Harris Act
• Allows FDA to evaluate the testing methods of
  drug manufacturers
• Requires manufacturers to prove that a drug is
  effective, not just nontoxic

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Drug Laws (cont.)

• 1970 Controlled Substance Act
• Controls substances (narcotics, tranquilizers,
  barbiturates, amphetamines) into 5 categories
  (schedules) based on drugs potential for abuse
  medical effectiveness
• Limits the number of RX refills for controlled
  substances each 6 months
• Lists drugs that can be called into pharmacy
  (prescriber must register with DEA)
• Symbol for schedule C

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Drug Laws (cont.)

• 1984 Drug Price Competition and Patent Term
  Restoration Act
• Makes it possible for generic drugs of
  bioequivalent equals to be marketed without
  duplicating clinical trials
• Gives longer patent protection to companies
  introducing new drugs

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Drug Laws (cont.)

• 1992 Prescription Drug User Fee Act
• Allowed FDA to collect user fees from pharm
  companies (with new drug apps) to shorten review
  time
• Specified a review time of 12 months for standard
  drugs/6 mos for priority drugs

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Drug Laws (cont.)

• 1997 FDA Modernization Act
• Updated regulation of biologic products
• Increased client access to experimental drugs and
  medical devices
• Accelerated review of important new drugs
• Allowed drug companies to disseminate info about
  off-label (non-FDA approved) uses and costs of
  drugs
• Extended user fees

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Drug Laws (cont.)

• FDA (Federal Drug Administration)
• General safety standards
• Approval removal of products on market
• DEA (Drug Enforcement Administration)
• Controlled substances
• Only enforces laws against illegal drug use
• Monitors need for changing schedules of abused
  drugs

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Controlled Substances

• Groups of medications that have potential for
  abuse or physical psychological dependence
• Proper handling of controlled substances is
  essential
• Violations may result in suspension of your
  nursing license
• 5 Schedules

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Controlled Substances (cont.)

• Schedule I - CI
• Highest risk for abuse
• Not acceptable for prescription use
• May be available for investigational use
• Includes
• Cannabinols (marijuana)
• Hallucinogens (LSD, heroin, mescaline)

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Controlled Substances (cont.)

• Schedule II - CII
• Medically useful, but carry high potential for
  abuse and may lead to physical psychological
  dependence
• Includes certain barbiturates, narcotics
  (opiates), and stimulants (MS, codeine,
  meperidine)
• Prescriptions may not be refilled
• Medically useful drugs with high abuse potential
• Includes pure preparations of narcotics (opiates)
• Includes stimulants (uppers)
• Includes stimulants (uppers) used for treatment
  of hyperactive children

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Controlled Substances (cont.)

• Schedule III - CIII
• Lesser abuse potential that schedule I or II
• Includes nonbarbiturate sedatives, narcotics in
  combination with other drugs, stimulants,
  anabolic steroids paregoric (Tylenol with
  codeine)

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Controlled Substances (cont.)

• Schedule IV - CIV
• Low potential for abuse, with psychological
  dependence more common that physical dependence
• Includes benzodiazepines, propoxyphene (Darvon),
  and chlordiazepoxide (Librium)

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Controlled Substances (cont.)

• Schedule V - CV
• Least abuse potential
• Have a small amount of narcotic combined with an
  antitussive or antidiarrheal

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Controlled Substances (cont.)

• Scheduled Drugs in Hospital Nrsg. Home
• II, III, and IV
• Nurses
• All are signed for with patients name, date,
  time, reason, nurses signature.
• While student, controlled substances must have a
  second signature of licensed nurse.
• All are counted at change of work shift, with two
  nurses leaving and arriving
• Records and signatures may be written or on
  computer.
• Locked with two different keys, either actual
  or virtual

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Controlled Substances (cont.)

• Scheduled Drugs in Hospital Nrsg Home
• II, III, and IV
• Doctors and nurses
• Schedule II drug prescriptions/orders in effect
  only 72 hours
• Schedule III drug prescriptions/orders in effect
  for up to one month
• Nurses must not give drug if order is out of date
• Nurses remind doctors with regular visit
• Rules change

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Controlled Substances (cont.)

• Five pregnancy categories established by FDA

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Controlled Substances (cont.)

• Cat A
• No demonstrated risk to fetus in first trimester
  of pregnancy
• No evidence of risk in second and third trimester

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Controlled Substances (cont.)

• Cat B
• Animal studies have not demonstrated risk to
  fetus or have demonstrated adverse effect, but
  adequate studies on pregnant women have not
  demonstrated a risk to fetus during 1st, 2nd, or
  3rd trimesters

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Controlled Substances (cont.)

• Cat C
• Animal studies have shown adverse effects on
  fetus, but there are no adequate studies on humans

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Controlled Substances (cont.)

• Cat D
• Evidence indicates a risk to the human fetus
• Potential benefit from use of drug may outweigh
  the risk to the fetus

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Controlled Substances (cont.)

• Cat X
• Studies in animals and humans demonstrated fetal
  abnormalities or reports indicate evidence of
  fetal risk

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Nursing Process in Medication Administration

• The nurse is the primary member of the health
  care team responsible for the timely, safe, and
  accurate administration of drugs
• Using the nursing process can minimize drug
  errors or omissions

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Nursing Process (cont.)

• Assessment (collection of data about patient)
• Allergies?
• Current medications?
• Why is the patient taking RX or OTC drugs?
• Condition of the patient skin?
• Current level of use of tobacco, alcohol, etc.
• Amount of coffee, tea, cola use?
• Known problems with drug metabolization?
• Physical or mental problem affecting ability to
  take med?
• Learning need, language, literacy level?
• Nursing history?

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Nursing Process (cont.)

• Diagnosis
• Consists of 3 elements
• Problem
• Its etiology
• Signs and symptoms
• Address problems that post immediate threats
• Knowledge deficit
• Risk for injury
• Ineffective management of therapeutic regimen
• Noncompliance

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Nursing Process (cont.)

• Planning
• Establishing short long term goals objectives
  for care
• Take into consideration patients physical,
  psychological, and sociocultural life-style needs
• Following three teaching sessions, patient will
  identify the reasons for delaying the eating and
  drinking of milk products for at least 2 hours
  after taking tetracycline.

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Nursing Process (cont.)

• Implementation
• Follow the 5 rights of drug administration
• Administer meds as prescribed
• Monitor for therapeutic effect
• Evaluate for adverse reaction
• Provide patient teaching
• Consider legal aspect associated with drug
  therapy
• Complete med order, question any handwriting
  difficult to read, unclear dosages, or if drug is
  incompatible

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Nursing Process (cont.)

• Evaluation
• The nurse to determine whether the goals have
  been met

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Nursing Process (cont.)

• Patient Teaching and Medication Therapy
• Name of medication
• Purpose of medication
• How and when to take medication
• How to monitor med effectiveness
• Drugs that may interact with prescribed meds
• Any required dietary changes
• Possible adverse effects
• Signs symptoms to bring to MD attention
• Required follow-up procedures

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Nursing Process (cont.)

• Documentation
• Serves as a way to communicate with other members
  of health care team

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Nursing Process (cont.)

• Legal responsibilities regulated by SNPA
• To administer medication safely and accurately
  (5Rs)
• Must be familiar with the pharmacologic profile
  of the drug to eliminate or decrease errors
• Common Errors dose amount, dosing interval,
  inappropriate route
• Accurate recording of all drugs given
• Nurse might be found liable for not
• recognizing and reporting adverse reaction

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Read, Study, Take Notes

• Strategies for studying pharmacology
• CD math practice and NCLEX review questions
• Complete chapter exercises
• Lecture notes
• Math help Tech Center at PCC and Nursing and
  Health Technology Learning Center at LAC
• Study techniques

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Questions???