General Pharmacological
Principles
Module A
Objectives
• The student will be able to:
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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.
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.
Web Site
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www.prenhall.com/colbert
Animations
Videos
Updates
Glossary & Drug Pronunciations
Extended Concepts
Chapter Quiz
Reference & Additional Readings
Definition of Pharmacology
• Pharmacology - The study of drugs
(chemicals) including their origins,
properties, and interactions with living
organisms.
Are these drugs?
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Aspirin
Mint
Vodka
Vitamins
Black Cohosh
Drug Sources
• Chemical synthesis
• Most common
• Recombinant DNA
• Animal
• Plant
• Mineral
FDA
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Federal agency
Regulates drug testing
Approves new drugs
http://www.fda.gov/
Drug Approval
• Can take up to 12 years and over 200
million dollars.
• Only 1 in 10,000 chemicals are approved.
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
Source of Drug Information
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PDR – Physician Desk Reference
USP – United States Pharmacopoeia
National Formulary
Hospital Formulary
FDA Website!
• http://www.fda.gov/
Study of Drugs
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Generic and Trade Names
Classification
Indications
Actions
Adverse reactions (side effects)
Contraindications
Dosage
Naming Drugs
• Chemical Name: Reflects the chemical
structure.
• 4-(5-cyclopentyloxy-carbonylamino 1-methylindo-3 ylmethyl)
• Code Name: Name assigned by a
manufacturer to an experimental chemical
that shows potential as a drug (SCH 1000).
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
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
Patient’s 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
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
Example
• Karen Johnson 4/28/96
MDI Proventil 2 puffs three times a day.
Administer with spacer Dr. James Jones
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).
Frequency Abbreviations
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BID: Twice a day
TID: Three times a day
PRN: When necessary, as needed
STAT: Immediately
Eliminated Frequency Abbreviations
• Some others that have been eliminated:
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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”
Other commonly used
abbreviations:
c
• NS: Normal Saline
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: 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
Other commonly used
abbreviations:
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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
Other commonly used
abbreviations:
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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
Other Eliminated Abbreviations
• D/C: (eliminated) Discontinued
• cc (eliminated): Cubic Centimeters
5 “Rights”
• Right Drug
• Right Dose
• Right Patient
• Patient’s wrist band
• Right Time
• Right Route
• Also
• Expiration Date
• Allergies
• Timely documentation
Routes of Medication Delivery
• Oral (Enteral) Route
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Tablet
Capsule
Pill
Powder
Solutions
Elixirs
Syrups
Emulsions/gels
Routes of Medication Delivery
• Parenteral Route (route comprising routes
that bypass the alimentary tract, i.e.
injectable)
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Intradermal
Subcutaneous
Intramuscular
Intravenous
Intra-arterial
Intra-spinal
Intraosseous (into the tibia or sternum)
Routes of Medication Delivery
• Topical
• Transdermal
• Creams and gels
• Sublingual (under the tongue)
• Enteral
• Rectal
• Inhalation
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MDI
Aerosol (SVN, USN)
DPI
IPPB
Routes of Medication Delivery
• Aerosol Therapy
• Small volume nebulizers
• Ultrasonic nebulizers
• Large volume nebulizers
• SPAG
• Heart Nebulizer
• IPPB
• Metered Dose Inhalers
• Dry Powder Inhalers
SMALL VOLUME NEBULIZER (SVN)
SMALL PARTICLE
AEROSOL
GENERATOR (SPAG)
LARGE VOLUME NEBULIZER
DRY POWDER INHALER (DPI)
METERED DOSE INHALER (MDI)
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.
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.
Medications Given by RCP
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Bronchodilators
Mucolytics
Steroids
Non-Steroidal Anti-inflammatory
• Mast Cell Stabilizers
• Leukotriene Inhibitors
• Anti-Infective Agents
Medications given by RCP
• Nicotine Replacement Therapy
• Artificial Surfactants
• Topical Anesthetics
• Lidocaine
• Gases
• Oxygen
• Nitric Oxide
• He/O2 (Heliox)
• Morphine (?)
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.
• 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
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
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.
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 drug’s action is less effective or
blocked in the presence of another drug.
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.
Definition of Terms
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Tolerance - Increasing amounts of drug are
needed to produce the same effect.
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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
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 (1+1 = 2).
• Synergism – The joint effect of two drugs is
greater than the algebraic sum of their
individual effects (1+1 = 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)
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.
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 drug’s potential to damage a
fetus in utero when given to a pregnant women.
Definition of Terms
• Systemic Effect - Throughout the body
• Local Effect - Restricted to a specific area
(drugs given by aerosol to the lungs)
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
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
Safety Requirements for Drug
Administration
• Always check the patient’s chart.
• Always check the patient’s name band
for proper identification.
• Check the medication label before
preparing medication.
• Check dates on the medication for
expiration date.
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.
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 patient’s
reach.
• Document clearly, concisely and accurately.
Safety Requirements for Drug
Administration
• If you make an error when
documenting:
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Put one line through the charting.
Initial.
Write “error”.
Continue to chart correct information.
• Never use white-out!
Nosocomial Infection
• Hospital Acquired Infection
• Hand Washing #1!!
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.
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.
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
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Contact the physician
Contact the department supervisor
Contact the department manager
Contact the medical director of the RC
department
Take Home Message
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SAFETY!
SAFETY!
SAFETY!
Remember: “To Err is human,” but to err
in drug administration can be very
dangerous!