Pharmacology Made Easy
Florence Nightingale:, Nursing has been limited to little more than the administration of medicines and the application of poultices. Times Have Changed
The administration of drugs is an integral part of the nurses role.
The study of pharmacology includes 3 areas:
Pharmacokinetics-the study of how drugs are absorbed, distributed, metabolized, and excreted Pharmacodynamics-the study of how the drug is used by the body Pharmacotherapeutics-the study of how the client responds to the drug
Lets look at abbreviations:
Dur=Duration SR=Sustained Release CR=Continuous Release SA=Sustained Action Contin=Continuous LA=Long Acting Bid=twice per day Tid=Three times per day
The clients mother contacts the clinic regarding medication administration stating, my daughter cant swallow this capsule, it is too large.Investigation reveals that the medication is a capsule marked S-R. The nurse should instruct the mother to:
A. open the capsule and mix the medication in ice cream. B. crush the medication and administer with eight ounces of liquid. C. call the pharmacist and request an alternate preparation of the medication. D. stop the medication and inform the the physician at the followup visit.
The nurse is expected to use the five rights when administering medications to the client.
right client right route right drug right amount right time
All medication errors that are made are related to omission of one or more of these.
The nurse is responsible for teaching the client and / or the family.
The nurse is responsible for supervising others in the administration of medications.
The nurse collaborates with the health care team to formulate a plan of care that includes pharmacologic agents.
The Federal Food and Drug Administration is responsible for insuring the purity and efficacy of pharmacologic agents.
Whats in a name?
chemical name-1-[(2S)-3-mercapto-2-methylproplonyl]-Lproline[MW217.29] generic name-captopril
trade name-Capoten official name -captopril
Many drugs have more than one trade name.
Its much safer to learn the generic name since trade names may differ.
Building a Professional Knowledge Base
Nurses are expected to utilize their knowledge of pharmacology to :
recognize common uses and side effects of the clients medication challenge medication errors meet the clients learning needs.
What medications will the new nurse be giving?
The medications the nurse is expected to administer depends on: Area of practice Assigned clients
RN
Most new graduates work within the hospital setting with medical/surgical clients.
Remembering the Drugs by Classifications
First look at the generic name. Then look at the trade name.
Lets look at some examples:
Drugs that affect the cardiovascular system.
Examples of Commonly Administered Cardiovascular Medications
ACE Inhibitors Antiarrythmics Anticholinergics Anticoagulants Calcium Channel Blockers Inotropic Agents (Digitalis) Beta Blockers Antilipidemics Thrombolytic Agents
Remembering side effects and nursing implications of similar drugs is made easier by looking for commonalities within the generic name.
Examples of Heart Medications (Antihypertensives) [angiotensin converting agents]
benazepril (Lotensin) captopril (Capoten) enalapril (Vasotec) fosinopril (Monopril) moexipril (Univas) quinapril (Acupril) ramipril (Altace)
Action/Use For Antihypertensives
ACE inhibitors act by blocking the sympathetic vasomotor centers response. This action reduces sympathetic nervous system response thereby lowering the blood pressure, pulse rate, and cardiac output.
Side Effects/Adverse Reactions:
hypotension bradycardia tachycardia headache nausea/vomiting respiratory symptoms
Nursing Considerations
Lab : monitor platelet and neutrophil counts Lab : monitor creatinine levels Physical Changes : respiratory, circulation
Teach the client to:
Rise slowly (postural hypotension) Report a rash, fever, urticaria Monitor urinary output Report swelling in feet or hands
Beta Adrenergic Blockers
Selective beta-1 receptor blockers acebutolol (Monitan,Rhotral,Sectral) atenolol (Tenormin, Apo-Atenol, Nova-Atenol) esmolol (Brevibloc) metaprolol (Alupent) propanolol (Inderal)
Beta-Adrenergic Blockers
Act by blocking sympathetic vasomotor response Lower blood pressure Lower pulse rate Lower cardiac output
Side Effects/Adverse Reactions
orthostatic hypotension bradycardia nausea/vomiting diarrhea congestive heart failure blood dyscrasias
Nursing Considerations
Monitor the client for changes in lab values (protein, BUN, creatinine) that indicate nephrotic syndrome. Monitor clients blood pressure, heart rate and rhythm. Monitor client for signs of edema.
Teach the client to:
rise slowly report bradycardia, dizziness, confusion, depression, fever taper off the medication
Antiinfectives ( Aminoglycosides)
gentamicinGaramycin,Alcomicin,Genoptic kanamycin- Kantrex neomycin -Mycifradin streptomycin- Streptomycin tobramycin - Tobrex,Nebcin amikacin-Amikin
Antiinfectives
Interfere with protein synthesis of the cell causing the bacteria to die.
Side Effects/Adverse Reactions
Ototoxicity Nephrotoxicity Seizures Blood dyscrasias Hypotension Rash
Nursing Considerations
Monitor intake and output. Monitor vital signs during infusion. Maintain patency of IV site. Monitor for therapeutic levels . Peak level drawn at 30-60 minutes after the third or fourth IV dose or 60 minutes after third or fourth IM dose. Trough level drawn 30 minutes before next dose. Monitor for signs of nephrotoxicity. Monitor for signs of ototoxicity.
Teach the client to:
report signs of allergic reaction. report changes in renal function. report changes in hearing. report sign of superinfection, ie, fever,malaise, redness pain, swelling, perineal itching, diarrhea, stomatitis, change in cough, sputum.
Lets look at some other drug names. What can you tell from the name?
Benzodiazepines
(Anticonvulsants/Sedative/Antianxiety)
Clonazepam-Klonopin Diazepam-Valium Chlordiazepoxide-Librium Lorazepam-Ativan
Phenothiazines
(Antipsychotic/Antiemetic)
Chlopromazine-Thorazine Prochlorperazine-Compazine Trifluoperazine-Stelazine Promethazine-Phenergan Hydroxyzine-Vistaril
Glucocorticoids
prednisolone prednisone betamethasone dexamethasone cortisone hydrocortisone methylprednisolone triamcinolone
Taper off these medications to prevent CHF and Addisonian Crises. May cause fluid retention, weight gain, insomnia, nervousness and depression.
Protease inhibitors
acyclovir ritonavir saquinovir indinavir
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Diabetic Medications
Metformin-(Glucophage) (biguanide)-increases insulin sensitivity acarbose (Precose)-inhibits the enzyme alphaglucosidase in theGI tract (If the client has a hypoglycemic reaction give glucose source (glucotrol) not orange juice.)
Well have fun a learn a lot!
Cholesterol Lowering Agents
atorvastatin (Lipitor) cerivastatin (Baycol) fluvastatin (Lescol) Lovastatin (Mevacor) pravastatin (Pravachol) simvastatin (Zocar)
Register by calling 662-728-4622 visit our web site at www.nclexreview.net
Searching the Web:
www.micromedex.com Nurses on the web ring Virtual Nurse www.medscape
