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Introduction to Basic Pharmacological Principles

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Any chemical substance that affects living systems by ... 3 Buccal. 4 Rectal. 5 Vaginal. 6--Topical. 41. Still More Routes of Administration. 7 Transdermal ... – PowerPoint PPT presentation

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Title: Introduction to Basic Pharmacological Principles


1
Introduction to Basic Pharmacological Principles
2
What is a Drug???
  • Any chemical substance that affects living
    systems by changing their structure or function

3
6--Subdivisions of Pharmacology
  • 1Pharmacology
  • History, sources, and physical and chemical
    properties of different drugs
  • How drugs affect living systems
  • 2Pharmacodynamics
  • Biochemical and physiological effects of drugs
  • Drugs mechanisms of action

4
6--Subdivisions of Pharmacology
  • 3Pharmacokinetics
  • Absorption, distribution, biotransformation
    (Metabolism), and excretion
  • Effected by route used, concentration of the
    drug, time, etc.
  • 4Pharmacotherapeutics
  • How drugs are used in the treatment of illnesses

5
6--Subdivisions of Pharmacology
  • 5Pharmacognosy
  • Drugs derived from herbal and other natural
    sources
  • 6Toxicology
  • Poisons and poisoningsToxic effects on living
    organisms

6
History of Drugs
  • As old as history, Important for survival,
    Disease Great superstition
  • Ancient Egypt is credited as being the cradle of
    pharmacologylisted over 700 different remedies
    to treat specific ailments
  • Greece first systematic dissections of the
    human body to study the functions of organs.
  • Paracelsus a Swiss scientist, advocated the use
    of single drugs. Father of Pharmacology.

7
History of Drugs Cont
  • 17th century demonstrated the circulation of the
    blood in the body and introduced a new way of
    administering drugsIV
  • Lister and Semmelweis introduced antiseptics to
    prevent infection during surgery
  • Ehrlichs discovery of antibiotics
  • Banting and Best for insulin
  • the Golden Age of Pharmacology

8
4--Sources of Drugs
  • 1--Natural Sources
  • Examples Pancreas of animalsinsulin
  • Nature claysKaopectate
  • PlantsDigoxin, Metamucil
  • 2Semi Synthetically
  • Examples Prepared by chemically modifying
    substances that are available from natural source
  • Animal insulin changed to be like human insulin

9
4--Sources of Drugs
  • 3Synthetic Means
  • Examples Formed by chemical reactions in a lab.
    Synthroid. Greater purity than nature.
  • 4Gene splicing involves the process of
    manipulating genes. The aim is to introduce new
    characteristics or attributes
  • Examples can include the production of human
    insulin through the use of modified bacteria

10
6 Major Uses for Drugs
  • 1Symptomatic
  • Relieve disease symptoms. Aspirin, Tylenol.
  • 2Preventative
  • To avoid getting a disease. Hepatitis B vaccine,
    Flu vaccine.
  • 3Diagnostic
  • Help determine disease presence. Radioactive
    dyes.

11
6 Major Uses for Drugs
  • 4Curative
  • Eliminate the disease. Antibiotics.
  • 5Health Maintenance
  • Help keep the body functioning normally.
    Insulin.
  • 6Contraceptive
  • Preventative

12
Dosage Forms
  • 1Tablet Most popular and easiest to
    administer. Does not break the skin or mucous
    membranes
  • --Scored tablets easiest to divide
  • --Enteric-coated (EC) designed to carry drugs
    that irritate the stomach. Dissolve best in
    neutral or alkaline PH environment. AVOID
    administering antacids, milk, or other alkaline
    substances coating will dissolve. NEVER crush
    or chew.
  • --Timed or Sustained Release Tablets permits
    drugs to be released from tablets in a controlled
    fashion. Eg Slow K crystals of potassium
    chloride embedded in a wax.
  • IMPORTANT TO TAKE/GIVE THE METHOD ORDERED

13
Dosage Forms Cont
  • 2--Capsule, Pill Enclosed in either a hard or
    soft soluble shellusually gelatin. 10-20 minutes
    average time. NEED TO KNOW IF CAN OPEN
    CAPSULES TO MIX WITH LIQUIDS, FOOD Soft
    gelatin capsules--Usually encapsulate medicinal
    liquids
  • 3--Troches, Lozenges Dissolve slowly in mouth.
    Usually exerts an antiseptic or anesthetic effect
    on the tissues of the oral cavity or throat.

14
Dosage Forms Cont
  • 4Suppository Can be inserted into one of the
    external body orifices (vaginal, rectal)
  • 5Solution Clear liquid preparation. Easy
    administration. Often flavored.
  • --Syrups sweetened solutions to mask the taste.
  • --Elixir Solutions that contain alcohol and
    water. Used to dissolve drugs that do not
    dissolve in H20.
  • --Tincture Solutions that contain alcohol as
    primary solvent. May be for external or internal
    use. Carefully check label

15
More Dosage Forms
  • 6Suspensions Liquid dosage forms that contain
    solid drug particles that are suspended in a
    suitable liquid medium. Mostly oral but may be
    lotions, liniments or injections. Never IV Shake
    thoroughly to mix
  • 7Emulsion Dispersions of fine droplets of an
    oil in water or water in oil. SHAKE THOROUGHLY
    TO MIX
  • 8Topical Patches applied to skin surface
    allows the drug to pass through the skin and into
    the bloodstream where they exert systemic
    effects. Examples Nitroglycerin, Nicotine, etc.

16
Still More Routes
  • 9Implants For extended periods of timeeg 5
    years for Norplant. Surgically implanted
    subdermally, often in upper arm region. Are
    small flexible capsules made of a Silastic
    polymer.
  • 10--Parenteral Products either IV or injection
  • --Ampules sterile, sealed glass or plastic
    containers usually containing only a single dose
  • --Vials Either single-or multiple-dose glass or
    plastic containers that are sealed with rubber
    diaphragm
  • --Prefilled syringes by prescription

17
3 Different Names for Drugs
  • 1 Chemical While under investigation, a drug
    is known this way usually in a code name of
    letters and numbers. Example??
  • 2Trade/Brand or Proprietary Name
  • Protected by patent given 17 years of exclusive
    rights Federal Trade-mark protected. Example??
  • 3Generic Name assigned when drug went to
    market. Example??

18
Drug Substitution
  • 1Patent generics are the same drug just have
    different fillers and binders.
  • 2--Chemical equivalent similar concentrations of
    the drug
  • 3--Biological equivalent blood/tissue
    concentrations of the drug will be similar
  • 3--Therapeutic equivalent drugs must be proven
    to be biologically equivalent before marketing
  • Careful assessment is neededif any variations
    are made Some persons may have different
    reaction to generic or brand name if not been
    using that type

19
Federal Regulatory Agencies
  • FDA Determines which drugs will be marketed in
    the US. More stringent than comparable agencies
    in other countries. Thalidomide
  • FTC Regulates trade practices of drug companies
    and prohibits false advertising.
  • DEA Administers the controlled substance act of
    1970. Regulates the manufacture, distribution of
    drugs that have the potential for abuse
    narcotics, ANS stimulants and sedative-hypnotics.
  • Omnibus Budget Reconciliation Act Requires RPh
    to counsel pts regarding drugs
  • HIPAA Health Insurance Portability and
    Accountability Act (Privacy of pt information)

20
Prescription Forms
  • What are the 8 pieces of information that should
    be included on the prescription forms?
  • 1. 5.
  • 2. 6.
  • 3. 7.
  • 4. 8.
  • Check answers next slide

21
Prescription Forms
  • 1Client information
  • 2Date prescription was written
  • 3The Rx symbol
  • 4Name and dosage strength of the medication
  • 5Dispensing instructions for the pharmacist
  • 6Directions for the client or SIGNA
  • 7Refill and/or specialized labeling instructions
  • 8Prescribers signature, address, and telephone

22
Legend Drugs
  • Legend Drugs Labeled with Federal law
    prohibits dispensing without prescription.

23
Storage of Medications
  • Nurse needs to ensure the correct method for
    storage of medications. If not possible loss of
    potency stability
  • Most are stable at room temperature but some may
    need refrigeration or be kept frozen
  • Drug may become unstable or lose potency if it is
    not stored correctly
  • Expiration Dates Pharmaceutical Co. cannot
    guarantee drug potency/stability/efficacy must
    be discarded
  • Controlled Substances must be kept in double
    locked storage cabinets with accurate records of
    the disposition of all drugs received/used during
    each shift

24
Controlled Substances Schedules
  • Controlled Substance Act of 1970 Comprehensive
    drug abuse prevention and controlled substances
    act of 1970. This act also regulates the
    manufacture and distribution of drugs that may
    cause dependence
  • Schedule I High potential for abuse and no
    accepted medical use in the US. EG LSD, heroin
  • Schedule II High potential for abusebut have a
    currently accepted medical use in the US. Abuse
    could lead to severe psychological or physical
    dependence. EG meperidine, morphine, cocaine

25
Controlled Substances Schedules Cont
  • Schedule III Have accepted medical uses in the
    US. Lower potential for abuse than drugs in 1
    or2. EG Tylenol with Codeine, hydrocodone.
  • Schedule IV Low potential for abuse than even
    Sch. 3 drugs. Abuse may lead to limited physical
    or psychological dependence. EG Librium, Valium
  • Schedule V Lowest abuse potential of the
    controlled substances. Limited quantities of
    certain narcotic drugs. EG Lomotil, Robitussin
    A-C.

26
Over the Counter (OTC) Drugs
  • Prescription is not needed.
  • Safe if used as directed, but could be toxic if
    not following label or physician directions
  • Use caution with different combinations of OTC
    drugs or with certain medical conditions
  • Many contain Tylenol, decongestants, or
    antihistamines. May mask symptoms. May antagonize
    symptoms of certain medical conditions (eg. High
    BP, heart problems, diabetes, etc)

27
FDA Medical Products Reporting Program
  • Intranet site look up for greater understanding
  • http//www.fda.gov/medwatch/
  • Purpose MedWatch allows healthcare professionals
    and consumers to report serious problems that
    they suspect are associated with the drugs and
    medical devices they prescribe, dispense, or use.
    Reporting can be done on line, by phone, or by
    submitting the MedWatch 3500 form by mail or fax.

28
Principles of Drug Action
  • Most common way that drugs work on bodyform a
    chemical bond with specific receptors within the
    body (Like a lock and key)
  • Better the fit the stronger the drugs affinity
    and lower the dose needed.
  • Agonist Drug which interact with a receptor to
    produce a response.
  • Antagonist Inhibits or prevent the action of an
    agonist.
  • Agonist-Antagonist Exert some of both responses.
    EG Morphine and Talwindepressant action
    reduced but some of the narcotic action will be
    evident.

29
Drug Action Characterization
  • Drug Any chemical substance used for the
    diagnosis, prevention or treatment of disease or
    to prevent pregnancy.
  • Action
  • Biochemical chemical processes and
    transformations in living organisms (blood sugar
    lowering drugs)
  • Physiologic Something that helps normalize the
    body or body systems (anti-hypertensives)
  • Organ system Involved in controlling or
    altering an organ system (CNS stimulants)

30
Terms to Know
  • 1Potency Strength of the medicine. Power.
  • 2--Ceiling dose Maximum intensity of effect or
    response that can be obtained with a drug---No
    increased medicinal effects but MORE side
    effects.
  • 3Route of Administration
  • Passage across bodily membranes affects
    Absorption Distribution Mechanism of action
    Metabolism Excretion

31
Terms to Know (Cont)
  • 4--Side Effects Result because of a lack of
    specificity of action by the drug -- Acts not
    only on the tissues with which intended but also
    on other tissues (eg. antihistamines causing
    drowsiness/dizziness)
  • 5Drug Toxicity predictable adverse drug
    effectUsually dose related
  • 6Adverse Drug EffectsAnaphylaxis Less
    frequent than predictable side effects but more
    serious
  • 7Teratogenic drug that will cause a congenital
    defect in an infant whose mother took the drug
    while pregnant.

32
Terms to Know (Contd 2)
  • 8Drug Tolerance Client develops a resistance to
    the effects of a drug. Characterized by the need
    for an increased dose or frequency.
  • 9Physical Drug Dependence Body becomes
    accustomed to a drug and body cannot function
    normally unless drug is present.
  • 10Psychological Drug Dependence Drug is the
    center of a persons thoughts, emotions, and
    activities.

33
What is Pharmacokinetics???
  • Study of the The absorption, distribution,
    biotransformation (Metabolism), and excretion of
    drugs
  • 1Liberation
  • Rate at which the solid drug is dissolved in
    gastric or intestinal fluids before it can be
    absorbed into the bloodstream. Fluids will
    increase rate. Each tablet or capsule varies.

34
What is Pharmacokinetics???
  • 2Absorption
  • Process by which a drug passes from its site of
    administration into the fluids of the body that
    will carry it to its site(s) of action.
  • A-- Presence of food, B--Acidity of the stomach,
    C--Amount of circulation
  • 3Distribution
  • Drug is carried from its site of absorption to
    its site of action.

35
What is Pharmacokinetics???
  • 4--Biotransformation (Metabolism) Converts drugs
    to more water-soluble form.
  • Also permits the body to inactivate a potent drug
    before it accumulates and produces toxic effects.
  • Location for Most Liver Liver enzymes.
  • End product is than metabolites.

36
What is Pharmacokinetics???
  • Who would have impaired Liver function???
  • A-Prematue infants/Neonates, B-Aged, C- Liver
    damage (Alcoholic)
  • 5Elimination Several different ways. Kidney,
    feces, exhaled, breast milk, saliva, and/or
    sweat.

37
Kidneys Role in Elimination
  • 2 Ways Drugs are excreted by Kidneys
  • 1Through the glomerulus
  • Most common way.
  • The drug which enters the tubule in this manner
    may be partially reabsorbed through the wall of
    the tubule back into the bloodstream.
  • 2Through the walls of the tubules
  • Secreted directly through the walls of the
    tubule. More rapid elimination.

38
Common Pharmacokinetic Terms
  • 1Onset The time after administration when the
    body initially responds to the drug.
  • 2Peak Plasma Level The highest plasma level
    achieved by a single dose when the elimination
    rate of a drug equals the absorption rate.
  • 3Drug Half-Life (Elimination half-life) The
    time required for the elimination process to
    reduce the concentration of the drug to one-half
    what it was at initial administration.

39
Common Pharmacokinetic Terms
  • 4Plateau A maintained concentration of a drug
    in the plasma during a series of scheduled doses.
  • 5Loading Dose Bolus is administered to bring
    blood levels up to the therapeutic level quickly.

40
Routes of Administration
  • 1--Oral
  • 2Sublingual
  • 3Buccal
  • 4Rectal
  • 5Vaginal
  • 6--Topical

41
Still More Routes of Administration
  • 7Transdermal
  • 8Subcutaneous
  • 9Intramuscular
  • 10Intradermal
  • 11Intravenous
  • 12Inhalation
  • 13Intrathecal An injection into the space
    around the spinal canal

42
Monitoring Drug Therapy Results
  • GOAL To achieve a therapeutic response
  • 1 Assess patient Observe the client for
    desired effect and undesired toxic effects
  • 2 Measure biochemical changes - Lab tests
  • 3 Measure plasma concentrations of the drug
  • Peak Greatest concentration of drug in body (30
    min after drug given IV)
  • Trough Lowest level of drug concentration (30
    min. before next dose of drug to be given)

43
Factors that Affect Response of Drug
  • 1Age Extremes of age. Greater variations in
    drug absorption, distribution, biotransformation,
    and elimination.
  • 2Gender Different body compositions
  • 3Body weight More weighthigher dose needed.
  • 4Body metabolic rate BMI to figure dosage
  • 5Disease states may affect absorption,
    distribution, biotransformation, and excretion.
  • 6Genetic factors

44
More Factors
  • 7Placebo effect Belief that therapy will work
  • 8Time of administration Menstrual cycle, time of
    day, empty stomach
  • 9Tolerance Considerable tolerance differences
  • 10Environmental factors
  • 11Idiosyncratic responses Unexpected and
    individual responses. Eg Drug not work or small
    amount is toxic.

45
Drug Interactions and Incompatibilities
  • All drugs are capable of reacting with other
    substances.
  • Synergistically response greater that would be
    expected
  • Antagonistically One drug diminishes the action
    of another
  • Use compatibilities chart
  • See Appendix 5pages 883

46
Herbal/Botanical Medicine
  • 1Not regulated by the FDA
  • 2Are chemicals and have an influence on the
    body.
  • 22--of pre-surgical clients reported using.
  • Women and clients aged 40-60 years old were the
    most likely to use herbals
  • Assess the patients use of herbs and document

47
Teratogenic Effects of Agents
  • Many drugs can have a teratogenic effect on an
    unborn fetus.
  • Each drug has a pregnancy classification attached
    to it A through X
  • Any good drug handbook will give the pregnancy
    classification of a drug and what each
    classification means.
  • As a nurse it is important to check out the
    pregnancy classification of a drug before
    administering it to a woman of child-bearing age
  • One of the nursing standards is do no harm

48
Pregnancy Classifications
  • ANo risk demonstrated to the fetus in any
    trimester
  • BNo adverse effects in animalsno human studies
  • COnly given after risks to the fetus
    consideredanimal studies show adverse reactions
  • DDefinite fetal risks. Only given in life
    threatening situations
  • XAbsolute fetal abnormalities

49
Equivalents
  • 60mg 1 grain
  • 1 gram 1000 mg
  • 1mcg 0.001 mg
  • 1 tsp 5 ml
  • 1 Tbsp 15 ml
  • 1 kg 2.2

50
Formula for Med Math
  • Dosage Desired
  • ________________ x Quantity X
  • Dosage on Hand
  • 300 mg/100mg X 2 ml _____ ml

51
Abbreviations
  • Be careful know but JACHO says to no longer use
    abbreviations -- should write out
  • ac
  • pc
  • bid
  • c
  • cap
  • disp

52
More Abbreviations
  • g or gm
  • gr
  • gtt
  • h
  • hs

53
Still More Abbrevations
  • po
  • prn
  • q
  • qid
  • s
  • sig
  • stat

54
Just a Few More..
  • tab
  • tid
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