General Pharmacological Principles

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General Pharmacological Principles

• Module A

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Objectives

• The student will be able to
• List three sources of drugs.
• List the components of a proper medication order.
• Define the commonly used abbreviations.
• List the routes of medication delivery.
• Define "parental administration" and list three
  types of parental administration.
• List the four routes of medication delivery via
  inhalation.
• List three types of nebulizers used to deliver
  respiratory medication.
• Given a route of administration, explain the
  safety requirements associated with drug
  administration.

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Objectives

• The student will be able to
• Explain two ways to confirm proper patient
  identification prior to giving a medication.
• State the change in pulse rate needed to
  terminate a respiratory treatment.
• Describe how the effectiveness of bronchodilators
  can be objectively measured?
• List the items that should be documented in the
  patients chart following each treatment.
• Describe the procedure you would follow in the
  event of an adverse reaction.
• Define terms typically found on a package insert
  for a drug.
• Describe how most drugs are metabolized and
  excreted.

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Web Site

• www.prenhall.com/colbert
• Animations
• Videos
• Updates
• Glossary Drug Pronunciations
• Extended Concepts
• Chapter Quiz
• Reference Additional Readings

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Definition of Pharmacology

• Pharmacology - The study of drugs (chemicals)
  including their origins, properties, and
  interactions with living organisms.

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Are these drugs?

• Aspirin
• Mint
• Vodka
• Vitamins
• Black Cohosh

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Drug Sources

• Chemical synthesis
• Most common
• Recombinant DNA
• Animal
• Plant
• Mineral

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FDA

• Federal agency
• Regulates drug testing
• Approves new drugs
• http//www.fda.gov/

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Drug Approval

• Can take up to 12 years and over 200 million
  dollars.
• Only 1 in 10,000 chemicals are approved.

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Steps for Drug Approval

• Identify the chemical structure
• Animal studies toxicology studies
• Investigational New Drug Approval
• Phase I Healthy volunteers
• Phase II Volunteers who have the disease
• Phase III Large multi-center study
• New Drug Application NDA is filed with the FDA
  and upon approval it is released for general use.
  Reporting system in place for 6 months

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Source of Drug Information

• PDR Physician Desk Reference
• USP United States Pharmacopoeia
• National Formulary
• Hospital Formulary
• FDA Website!
• http//www.fda.gov/

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Study of Drugs

• Generic and Trade Names
• Classification
• Indications
• Actions
• Adverse reactions (side effects)
• Contraindications
• Dosage

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Naming Drugs

• Chemical Name Reflects the chemical structure.
• 4-(5-cyclopentyloxy-carbonylamino 1-methyl-indo-3
  ylmethyl)
• Code Name Name assigned by a manufacturer to an
  experimental chemical that shows potential as a
  drug (SCH 1000).

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Naming Drugs

• Generic Name Based on the drugs chemical
  structure.
• Assigned by the USAN Council
• Example isoproterenol
• Trade Name Name given by the manufacturer.
• A generic drug can have 2 or more trade names.
• Also called brand name.
• Example Isuprel

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Trade Names

• Beta Blockers
• propranolol
• atenolol
• metoprolol
• Neuromuscular blocking agents
• pancuronium
• vecuronium
• atracurium

• Names of drugs contains clues
• Slo-Bid
• Nasalcort
• DuoNeb

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Prescriptions for Medication Orders

• Patients Name
• Date
• Name of the drug
• Dosage of drug and amount
• Concentration if appropriate
• Route of administration (delivery device)
• Frequency or Schedule
• Number of days if appropriate
• Any additional instructions
• Peak flows before and after therapy
• Monitor tidal volume during IPPB treatment
• Signature of Physician

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Examples

• John Smith 12/23/89
• IPPB therapy with 0.25 mL of 1 Bronkosol and 3
  mL Normal Saline four times a day x 3 days. Dr.
  James Jones
• Jack Doe 3/30/99
• SVN therapy with 0.3 mL of 5 Alupent and 2 mL
  of Normal Saline every four hours around the
  clock. Peak flow before and after treatment. Dr.
  James Jones

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Example

• Karen Johnson 4/28/96
• MDI Proventil 2 puffs three times a day.
  Administer with spacer Dr. James Jones

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Abbreviations

• Lots of changes over the last few years.
• Due to errors in prescribing, many abbreviations
  have been eliminated based upon JCAHO
  recommendations (handout).
• Many institutions have specific rules that go
  beyond JCAHO recommendations (handout).

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Frequency Abbreviations

• BID Twice a day
• TID Three times a day
• PRN When necessary, as needed
• STAT Immediately

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Eliminated Frequency Abbreviations

• Some others that have been eliminated
• QOD Use Every other day
• QD Use daily
• QID Four times a day
• Q4 Every four hours
• Q3 Every three hours
• Q2 Every two hours
• Q4 ATC Every four hours around the clock
• Q4 WA Every four hours while awake
• Q4 PRN Every four hours as needed
• H.S Use at bedtime

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Other commonly used abbreviations

• NS Normal Saline
• ? With
• ? Without
• a.c. Before Meals
• p.c. After Meals
• mL Milliliters
• gtt drop
• qs Quantity sufficient (as much as required)
• PO By mouth, orally

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Other commonly used abbreviations

• MDI Metered Dose Inhaler
• IPPB Intermittent Positive Pressure Breathing
• SVN Small Volume Nebulizer
• SPAG Small Particle Aerosol Generator
• Rx Prescription or take
• IM Intramuscularly
• IV Intravenous
• DPI Dry Powder Inhaler
• Tx Treatment

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Other commonly used abbreviations

• NPO Nothing by mouth
• OTC Over the Counter
• FDA Food and Drug Administration
• PDR Physician Desk Reference
• BS Breath Sounds
• PF Peak Flow
• PEFR Peak Expiratory Flow Rate

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Other Eliminated Abbreviations

• D/C (eliminated) Discontinued
• cc (eliminated) Cubic Centimeters

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5 Rights

• Right Drug
• Right Dose
• Right Patient
• Patients wrist band
• Right Time
• Right Route
• Also
• Expiration Date
• Allergies
• Timely documentation

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Routes of Medication Delivery

• Oral (Enteral) Route
• Tablet
• Capsule
• Pill
• Powder
• Solutions
• Elixirs
• Syrups
• Emulsions/gels

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Routes of Medication Delivery

• Parenteral Route (route comprising routes that
  bypass the alimentary tract, i.e. injectable)
• Intradermal
• Subcutaneous
• Intramuscular
• Intravenous
• Intra-arterial
• Intra-spinal
• Intraosseous (into the tibia or sternum)

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Routes of Medication Delivery

• Topical
• Transdermal
• Creams and gels
• Sublingual (under the tongue)
• Enteral
• Rectal
• Inhalation
• MDI
• Aerosol (SVN, USN)
• DPI
• IPPB

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Routes of Medication Delivery

• Aerosol Therapy
• Small volume nebulizers
• Ultrasonic nebulizers
• Large volume nebulizers
• SPAG
• Heart Nebulizer
• IPPB
• Metered Dose Inhalers
• Dry Powder Inhalers

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SMALL VOLUME NEBULIZER (SVN)
LARGE VOLUME NEBULIZER
SMALL PARTICLE AEROSOL GENERATOR (SPAG)
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DRY POWDER INHALER (DPI)
METERED DOSE INHALER (MDI)
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Continuous Nebulization

• Occasionally, the nebulized medication must be
  administered over an extended period of hours
  instead of minutes.
• A nebulizer can be adapted to other oxygen
  delivery equipment to facilitate this process.

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Advantage of Aerosolized Agents

• Dosage is smaller.
• Less side effects and less severe side effects.
• Rapid Onset.
• Drug delivery is targeted to the respiratory
  system.
• Painless, safe and convenient.
• Patients can administer medication themselves.

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Medications Given by RCP

• Bronchodilators
• Mucolytics
• Steroids
• Non-Steroidal Anti-inflammatory
• Mast Cell Stabilizers
• Leukotriene Inhibitors
• Anti-Infective Agents

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Medications given by RCP

• Nicotine Replacement Therapy
• Artificial Surfactants
• Topical Anesthetics
• Lidocaine
• Gases
• Oxygen
• Nitric Oxide
• He/O2 (Heliox)
• Morphine (?)

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Objectives

• State the change in pulse rate needed to
  terminate a respiratory treatment.
• Describe how the effectiveness of bronchodilators
  can be objectively measured?
• List the items that should be documented in the
  patients chart following each treatment.
• Describe the procedure you would follow in the
  event of an adverse reaction.
• Define terms typically found on a package insert
  for a drug.
• Describe how most drugs are metabolized and
  excreted.

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• What is the difference between Q4 PRN, Q4 WA, and
  PRN?

• Q4 PRN Every four hours as needed
• Q4 WA Every four hours while awake
• PRN When necessary, as needed

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Drug Metabolism and Excretion

• Pharmacokinetics The movement (kinesis) of the
  drug throughout the body.
• Absorption
• Limited by disintegration
• Bioavailability The amount of drug that has been
  absorbed into the circulation.
• Distribution
• Metabolism
• Liver
• Elimination
• Kidney
• GI Tract (feces), Skin, Pulmonary System

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Definition of Terms

• Selectivity The extent to which a drug acts at
  one specific site or receptor.
• When binding occurs
• Ion channel open/closed
• Biochemical messengers are activated.
• Normal cellular function is turned on or off.

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Definition of Terms

• Racemic A drug which contains two isomers (same
  chemical components, only bonded differently).
• Agonist A drug or chemical that binds to a
  corresponding receptor and initiates a cellular
  effect or response Example b2 agonist
• Agonists have an affinity for a receptor site.
• Antagonist - A drug which binds with a receptor
  but do not cause activation of the receptor.
• Explains why some drugs action is less effective
  or blocked in the presence of another drug.

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Definition of Terms

• Drug Affinity A measure of the tendency of a
  drug to combine with a particular receptor site.
• Drug Potency The amount of drug required to
  produce the response desired.
• A more potent drug would require a lower dose to
  proved a desired effect.
• Drug Efficacy The peak or maximum biologic
  effect.

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Definition of Terms

• Tolerance - Increasing amounts of drug are
  needed to produce the same effect.
• Loss of effectiveness.
• Tachyphylaxis - A rapidly decreasing response to
  a drug following administration of the initial
  doses.
• Desensitization - Loss of tissue responsiveness
  that can occur with drug exposure.
• Placebo - An inactive substance resembling a
  medication that may be given experimentally or
  for its psychological effects

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Definition of Terms

• Additive The sum of the effects of two drugs
  given together is equal to each of them given
  separately but at the same time (11 2).
• Synergism The joint effect of two drugs is
  greater than the algebraic sum of their
  individual effects (11 3).
• albuterol ipratropium bromide
• Potentiation - The effect of two drugs given
  together where one drug has no effect but
  increases the response of the other drug (1 0
  2)

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Definition of Terms

• Half Life of a drug The time required to
  eliminate 50 of the drug from the body after
  absorption and distribution are complete.
• Loading Dose Administration of an initial
  higher level of the drug to facilitate a steady
  state (maximal saturation of the receptors in the
  body).
• Maintenance Dose Additional drug which is
  administered after the loading dose that is used
  to maintain the steady state.

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Definition of Terms

• Side Effect Unwanted symptoms which occur after
  drug administration
• Also called adverse drug reaction (ADR)
• Cumulation Occurs when a drugs rate of removal
  or inactivation is slower than the rate of
  administration. This can result in toxicity.
• Emetic - A substance that induces vomiting.
• Activated Charcoal Used to decrease absorption.
• Teratogenicity A drugs potential to damage a
  fetus in utero when given to a pregnant women.

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Definition of Terms

• Systemic Effect - Throughout the body
• Local Effect - Restricted to a specific area
  (drugs given by aerosol to the lungs)

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Definition of Terms

• Therapeutic Index LD50
• ED50
• LD 50 - Lethal Dose 50
• The dose that is lethal to 50 of the test
  population of animals
• ED 50 Effective Dose 50
• The dose that is therapeutically effective in 50
  of the test population of animals

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Therapeutic Index

• The higher the therapeutic index, the safer the
  drug.
• The lower the therapeutic index, the greater the
  chance of toxicity.
• theophylline, lidocaine and digitalis all have
  low therapeutic indexes.
• LD50 400 mg 2
• ED50 200 mg

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Safety Requirements for Drug Administration

• Always check the patients chart.
• Always check the patients name band for proper
  identification.
• Check the medication label before preparing
  medication.
• Check dates on the medication for expiration date.

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Safety Requirements for Drug Administration

• Check medication color for change.
• Check the dosage of medication ordered and know
  the normal and safe range.
• Always wash hands before preparing and giving a
  medication.
• Check previous notes to determine the patients
  previous response to the medication.

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Safety Requirements for Drug Administration

• Document the HR before, during and after the
  therapy.
• If the heart rate increases more than 20 beats
  from the baseline, STOP THE TREATMENT and notify
  your clinical instructor/preceptor.
• Document patient assessment findings (breath
  sounds, respiratory pattern, use of accessory
  muscles, peak flows if using a bronchodilator)
  before an after therapy.
• Assure patient safety before leaving the room.
• Bedrails up, patient restraint, call button in
  patients reach.
• Document clearly, concisely and accurately.

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Safety Requirements for Drug Administration

• If you make an error when documenting
• Put one line through the charting.
• Initial.
• Write error.
• Continue to chart correct information.
• Never use white-out!

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Nosocomial Infection

• Hospital Acquired Infection
• Hand Washing 1!!

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Adverse Reaction

• Stop the treatment immediately.
• Stay with the patient and notify the nurse.
• When the patient is out of immediate danger,
  contact your Clinical Instructor or Preceptor.
• Document the adverse reaction, the patients vital
  signs at the time you left the room, personnel
  you contacted and any order change by the
  physician.

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Adverse Reaction

• If the physician changed the medication order or
  therapy, document all changes on the respiratory
  therapy treatment sheet.
• Report the incidence at change of shift discuss
  with next therapist taking care of the patient.

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What To Do With an Improper Order

• As a student
• Contact your clinical instructor/preceptor
• The clinical instructor or preceptor will then
  follow the steps outlined below.
• As a therapist
• Contact the physician
• Contact the department supervisor
• Contact the department manager
• Contact the medical director of the RC department

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Take Home Message

• SAFETY!
• SAFETY!
• SAFETY!
• Remember To Err is human, but to err in drug
  administration can be very dangerous!