Rinehart and Associates

1. Rinehart and Associates Pharmacology Made Easy

2. Florence Nightingale:, “Nursing has been limited to little more than the administration of medicines and the application of poultices.” “Times Have Changed”

3. The administration of drugs is an integral part of the nurse’s role.

4. 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

5. Let’s 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

6. The client’s mother contacts the clinic regarding medication administration stating, “my daughter can’t 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 follow-up visit.

7. 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.

8. The nurse is responsible for teaching the client and / or the family.

9. The nurse is responsible for supervising others in the administration of medications.

10. The nurse collaborates with the health care team to formulate a plan of care that includes pharmacologic agents.

11. The Federal Food and Drug Administration is responsible for insuring the purity and efficacy of pharmacologic agents.

12. What’s in a name? • chemical name- -1-[(2S)-3-mercapto-2-methylproplonyl]-L-proline[MW217.29] • generic name- -captopril • trade name- -Capoten • official name -captopril

13. Many drugs have more than one trade name. It’s much safer to learn the generic name since trade names may differ.

14. Building a Professional Knowledge Base Nurses are expected to utilize their knowledge of pharmacology to : • recognize common uses and side effects of the client’s medication • challenge medication errors • meet the client’s learning needs.

15. What medications will the new nurse be giving? The medications the nurse is expected to administer depends on: • Area of practice • Assigned clients RN

16. Most new graduates work within the hospital setting with medical/surgical clients.

17. Remembering the Drugs by Classifications First look at the generic name. Then look at the trade name.

18. Let’s look at some examples: Drugs that affect the cardiovascular system.

19. ACE Inhibitors Antiarrythmics Anticholinergics Anticoagulants Calcium Channel Blockers Inotropic Agents (Digitalis) Beta Blockers Antilipidemics Thrombolytic Agents Examples of Commonly Administered Cardiovascular Medications

20. Remembering side effects and nursing implications of similar drugs is made easier by looking for commonalities within the generic name.

21. Examples of Heart Medications (Antihypertensives)[angiotensin converting agents] • benazepril (Lotensin) • captopril (Capoten) • enalapril (Vasotec) • fosinopril (Monopril) • moexipril (Univas) • quinapril (Acupril) • ramipril (Altace)

22. Action/Use For Antihypertensives ACE inhibitors act by blocking the sympathetic vasomotor center’s response. This action reduces sympathetic nervous system response thereby lowering the blood pressure, pulse rate, and cardiac output.

23. Side Effects/Adverse Reactions: • hypotension • bradycardia • tachycardia • headache • nausea/vomiting • respiratory symptoms

24. Nursing Considerations • Lab : monitor platelet and neutrophil counts • Lab : monitor creatinine levels • Physical Changes : respiratory, circulation

25. Teach the client to: • Rise slowly (postural hypotension) • Report a rash, fever, urticaria • Monitor urinary output • Report swelling in feet or hands

26. Beta Adrenergic Blockers Selective beta-1 receptor blockers • acebutolol (Monitan,Rhotral,Sectral) • atenolol (Tenormin, Apo-Atenol, Nova-Atenol) • esmolol (Brevibloc) • metaprolol (Alupent) • propanolol (Inderal)

27. Beta-Adrenergic Blockers Act by blocking sympathetic vasomotor response • Lower blood pressure • Lower pulse rate • Lower cardiac output

28. Side Effects/Adverse Reactions • orthostatic hypotension • bradycardia • nausea/vomiting • diarrhea • congestive heart failure • blood dyscrasias

29. Nursing Considerations • Monitor the client for changes in lab values (protein, BUN, creatinine) that indicate nephrotic syndrome. • Monitor client’s blood pressure, heart rate and rhythm. • Monitor client for signs of edema.

30. Teach the client to: • rise slowly • report bradycardia, dizziness, confusion, depression, fever • taper off the medication

31. Antiinfectives ( Aminoglycosides) • gentamicin- Garamycin,Alcomicin,Genoptic • kanamycin- Kantrex • neomycin -Mycifradin • streptomycin- Streptomycin • tobramycin - Tobrex,Nebcin • amikacin-Amikin

32. Antiinfectives Interfere with protein synthesis of the cell causing the bacteria to die.

33. Side Effects/Adverse Reactions • Ototoxicity • Nephrotoxicity • Seizures • Blood dyscrasias • Hypotension • Rash

34. 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.

35. 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.

36. Let’s look at some other drug names. What can you tell from the name?

37. Benzodiazepines (Anticonvulsants/Sedative/Antianxiety) • Clonazepam-Klonopin • Diazepam-Valium • Chlordiazepoxide-Librium • Lorazepam-Ativan

38. Phenothiazines (Antipsychotic/Antiemetic) • Chlopromazine-Thorazine • Prochlorperazine-Compazine • Trifluoperazine-Stelazine • Promethazine-Phenergan • Hydroxyzine-Vistaril

39. Glucocorticoids Taper off these medications to prevent CHF and Addisonian Crises. May cause fluid retention, weight gain, insomnia, nervousness and depression. • prednisolone • prednisone • betamethasone • dexamethasone • cortisone • hydrocortisone • methylprednisolone • triamcinolone

40. Protease inhibitors • acyclovir • ritonavir • saquinovir • indinavir Join us

41. Diabetic Medications We’ll have fun a learn a lot! 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.)

42. 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

43. Searching the Web: • www.micromedex.com • Nurses on the web ring • Virtual Nurse • www.medscape

44. Join Us MS, La, TN, Al, Ky, Fl, Ga To register call: Rinehart and Associates 662-728-4622 or e-mail us at wrinehar@tsixroads.com. Visit our web site at www.nclexreview.net . You can pass the NCLEX-RN. We can help.