Pharmacology Fundamentals and the Autonomic Nervous System

Pharmacology Fundamentals and the Autonomic Nervous System

PHARMACOLOGY FUNDAMENTALS AND THE AUTONOMIC NERVOUS SYSTEM Week 1 By Renee McCroskey BSN, RN PHARMACOLOGY FUNDAMENTALS Chapters 1-4 THINGS TO THINK ABOUT

What drug is ordered Name (generic and trade) and drug classification Mechanism of action Therapeutic action (intended use) Side effects Adverse effects Contraindications Special considerations (effect of age or weight) How the medication is supplied (IV, tabs, caps, cream, etc) How the medication should be administered (po, NG, topical, etc) Dosage ranges Nursing process considerations related to this medication Use of OTC and herbal preparations and how they interact with

prescribed medications WHOSE RESPONSIBILITY IS IT? The doctor writes for the appropriate medications The pharmacist checks for interactions and allergies You are accountable for preparing and administering the medications MAJOR AREAS OF PHARMACOLOGY Pharmacodynamics The

study of the action of drugs on living tissue Pharmacokinetics The study of the processes of drug absorption, distribution, metabolism, and excretion 1-5 PHARMACOKINETIC PHASES There

are four pharmacokinetic phases: Absorption Distribution Metabolism Excretion 2-6 DRUG SOURCES Where do drugs come from? Plants

Animals Synthesized in a Lab Chemistry Biotechnology 1-7

DIFFERENT TYPES OF THERAPY Traditional drug therapies (chemicals made in a lab) Biologics (naturally produced by the body, in animal cells, or in microorganisms- includes hormones and vaccines) Natural alternatives (includes herbs, extracts, vitamins, minerals or dietary supplements)

BASIC CONCEPTS IN PHARMACOLOGY Site of Action Location where drug exerts its effect Mechanism How of Action

a drug produces its effects 1-9 BASIC CONCEPTS IN PHARMACOLOGY Receptor Site Site on a cell where a drug exerts its effects Agonists produce drug action.

Antagonists inhibit drug action. 110 FDA APPROVAL PROCESS 4 stages of research Preclinical investigation is basic research in lab and animal models Clinical investigation (3 phases) involves human volunteers Submission of new drug application with review Post-marketing research- drug is approved by

FDA, but testing is continued to look for long term safety and side effects DRUGS HAVE MORE THAN ONE NAME Generic Name- assigned by US Adopted Name Council Before parentheses and lower case Trade Name- assigned by company marketing the drug Short and easy to remember Name in parentheses and is

capitalized Example- acetaminophen (Tylenol) OTC VS PRESCRIPTION DRUGS OTC drugs have a wide margin of safety and do not require a prescription Prescription drugs must have an MD (or NP) order Potential problems with OTC drugsmay not work, take more than recommended, drug interactions

ROUTES OF ADMINISTRATION Drugs can enter the body several different ways. Two common routes are orally and parenterally. 214 ENTERAL ROUTES OF

ADMINISTRATION PO Sublingual NG tube G tube or buccal TOPICAL ROUTES OF ADMINISTRATION

Dermatologic preparations (transdermal) Instillations and irrigations Transdermal Ophthalmic Otic

Nasal Vaginal Rectal Inhalations PARENTERAL ROUTES OF ADMINISTRATION Intradermal Subcutaneous Intramuscular Intravenous HALF-LIFE AND BLOOD DRUG LEVELS

Half-life Half-life is the amount of time it takes for the blood concentration to drop by half of the original amount. Blood drug levels The intensity of a drug effect is determined

mainly by the concentration of drug in the blood. 218 BIOAVAILABILITY Bioavailability is the percentage of drug that is actually absorbed into the bloodstream. There are several factors that influence bioavailability.

219 FACTORS OF INDIVIDUAL VARIATION Age Weight Sex Genetic Variation Emotional State

Placebo Effect Disease State Patient Compliance 220

PEDIATRIC CONSIDERATIONS FDA Pregnancy Categories 221 DRUG SCHEDULES I Highest II

High abuse potential abuse potential III Moderate IV Lower

V abuse potential abuse potential Lowest abuse potential CHRONIC DRUG USE AND ABUSE Tolerance

Decreased Dependence drug effect with repeated administration Two main types are metabolic and pharmacodynamic.

Reliance on drug becomes ever more vital to the wellbeing of the patient The two types are physical and psychological. 223 MEDICATION ADMINISTRATION

Six Rs What are they? 3 checks of drug administration Check drug with MAR or med info system when obtaining it Check drug when preparing it Check drug before administering it to the patient TYPES OF ORDERS STAT ASAP

Single order PRN Standing orders ABBREVIATIONS bid ac pc hs

q and q4h, q2h, qid prn po COMPLIANCE Pts may not take as prescribed Factors that decrease compliance ??? Often dont tell MD or nurse they

arent taking them Self adjust doses DRUG COMPLIANCE IN THE ELDERLY Elderly patients can be confused about their medications. They may need a change in dosage form to allow for easier administration.

Polypharmacy is a concern as well. 328 DRUG CALCULATIONS Will It be on each test and quiz is important to be accurate in your dosing!

NEED TO KNOW CONVERSIONS 5ml is _______ tsp? 3 tsp is ________ml and ______ tbsp? 1kg is ________ lbs?

1 grain is _______ mg? CALCULATION PRACTICE Your patient has been prescribed: Solumedrol 100mg IV q 4 hours around the clock. The available vial contains 125mg/2ml. How many mls

will you give per dose? CALCULATION PRACTICE How many mls would be given in a 24 hour period? CALCULATION PRACTICE Your patient is ordered Vancomycin 125mg po BID. Available form is 250mg/10ml. How many mls would

you give? SO That would equal ________ tsp. WHAT ABOUT A WT BASED MED? Your client weighs 22 lbs. The PDR states that the usual dose range for Lasix for her age is 50 to

100mg/kg/day in equally divided doses 4x/day. What is the dose range for each individual dose for this patient? QUESTION #1 Gentamicin (Garamycin) 60 mg IM is ordered for a client. Available is a multidose vial with 40 mg/ml. What is the correct amount to give?

A. 1.5 mls B. 1.25 mls C. 2.0 mls D. 1.75 mls QUESTION #2 To ensure that the right medication was being given, the first step for the nurse would be:

A. Check the clients ID band B. Read the information insert for directions as to correct administration C. Check the order with the medication administration sheet D. Check the expiration date on the medication QUESTION #3 What physiological changes in the older adult should be given the greatest consideration when administering medication?

A. Increased cardiac output B. Increased peristalsis C. Reduced fat to water ratio D. Reduced liver function QUESTION #4 The nurse pours a dose of medication and then finds that the client no longer needs the dose. What action should the nurse take?

A. Record the dose as taken to keep the count correct B. Charge for the dose because the dose must be paid for C. Record the medication as not taken and waste the poured dose

D. Pour the medication back into the container QUESTION #5 A dose of indomethacin (oral suspension) 50 mg qid is ordered for a client. The unit has oral suspension 25 mg/5 ml. How much would the nurse give per dose? Answer__________

THE AUTONOMIC NERVOUS SYSTEM Chapters 5-7 NERVOUS SYSTEM ORGANIZATION The nervous system is divided into two parts: Central Nervous System (CNS)

Peripheral Nervous System (PNS) 542 NERVOUS SYSTEM ORGANIZATION The peripheral nervous system is also divided into two divisions: Somatic

Division Visceral Division (Autonomic Nervous System) 543 OVERVIEW OF THE ANS The autonomic nervous system is

further divided into two sections: Sympathetic Division Adrenergic Nerve Parasympathetic Cholinergic Nerve

Division 544 CHOLINERGIC AND ADRENERGIC NERVES Cholinergic nerves release acetylcholine The nerves of the ANS release (ACH).

different Adrenergic neurotransmitte nerves release rs. norepinephrine (NE). 545 CHOLINERGIC AND ADRENERGIC RECEPTORS

546 SYMPATHETIC DIVISION Fight or flight Dilates pupil, mydriasis Inhibits salivation Inhibits digestion/peristalsis and secretion Accelerates heart rate Increases hearts contractility Vasoconstricts (increases BP) Bronchodilates

Stimulates release of glucose Conversion of glycogen to glucose Relaxes bladder (inhibits urination) Inhibits sex organs PARASYMPATHETIC DIVISION Rest and digest

Constricts pupils, miotic Stimulates salivation Stimulates peristalsis/digestion Slows heart (bradycardia) Decreases hearts contractility Vasodilates (decreases BP) Bronchoconstricts Contracts bladder (stimulates urination) Stimulates sex organs ANS ACTIVATION COMPARISON 549

ADRENERGIC RECEPTORS Drugs that affect the sympathetic nervous system: Sympathomimetics AKA Adrenergic Agents Stimulate the sympathetic system Sympatholytics AKA Adrenergic Blockers Antagonize the sympathetic system

650 USAGES Used primarily for their effects on the: Heart Bronchial tree Nasal Passages

ALPHA-ADRENERGIC AGENTS norepinephrine (Levophed) phenylephrine (NeoSynephrine) pseudoephedrine (Sudafed) BETA-ADRENERGIC AGENTS albuterol (Proventil) dobutamine (Dobutrex)

isoproternol (Isuprel) ALPHA-ADRENERGIC BLOCKING DRUGS Alpha-blockers compete with NE and EPI at alpha-adrenergic receptors. They are used in the treatment of hypertension. Adverse

effects include decrease blood pressure and decrease heart rate, constriction of the pupils, nasal congestion, and increased GI activity. 655 ALPHA-ADRENERGIC BLOCKING DRUGS doxazosin (Cardura) prazosin (Minipress)

tamulosin (Flomax) terazosin (Hytrin) 656 BETA-ADRENERGIC BLOCKING DRUGS Beta-blocking drugs antagonize the beta effects of EPI and NE. There are two types of betablockers: Nonselective

Selective Beta-blockers are used in the treatment of angina pectoris and cardiac dysrhythmias. 657 BETA-ADRENERGIC BLOCKING DRUGS atenolol (Tenormin) metoprolol (Lopressor)

propranolol (Inderal) timolol (Timoptic) ADRENERGIC RECEPTORS Drugs that affect the parasympathetic nervous system: Parasympathomimetics AKA Cholinergic Agents Stimulate the parasympathetic system Indirect acting cholinergic agents can be acetylcholinesterase inhibitors

Parasympatholytics AKA Cholinergic Blockers or Anticholinergics Antagonize the parasympathetic system 660 CHOLINERGIC DRUGS Cholinergic drugs mimic the actions of ACH. Also

called parasympathomimetics. Cholinergic drugs are divided into two groups: Direct-acting Indirect-acting 761 DURATION OF ACTION FOR CHOLINERGIC

AGENTS Older cholinergic agents Extremely short duration of action Do not stay in the patients system very long Newer cholinergic agents

Have a longer duration of action Stay in the patients system longer CHOLINERGIC AGENTS Direct-acting cholinergic drugs bind to the cholinergic receptor and produce the following responses: Increased GI secretions and

motility Increased urinary tract function Pupillary constriction 763 CHOLINERGIC AGENTS 764 INDIRECT ACTING CHOLINERGIC AGENTS Same

effect as direct acting but different mechanism of action neostigmine (Prostigmin) Primarily aid in the treatment of myasthenia gravis, postoperative ileus, urinary retention; antidote to excessive cholinergic blockade pyridostigmine primarily (Mestinon)

aid in the treatment of myasthenia gravis -they increase ACH levels and increase skeletal muscle tone and strength ANTICHOLINERGIC DRUGS The cholinergic blocking drugs that bind to the muscarinic receptors are referred to as the

anticholinergic, or parasympatholytic, drugs. They act by competitive antagonism of ACH: ACH is unable to bind to the cholinergic receptors to produce an effect. 766 ANTICHOLINERGICS Atropine

To dry secretions prior to anesthesia To increase HR To dilate pupils Ipratropium (Atrovent) To treat asthma Scopolamine (Hyoscine) To treat IBS Motion sickness ANTICHOLINERGIC DRUGS The

adverse effects of anticholinergic drugs include: Dry mouth Visual disturbances/blurred vison Constipation Urinary retention (esp in men with prostate disorders) Tachycardia Hypertension 768 PREFERRED TREATMENT Urinary

Retentioncholinergic drugs or cholinesterase inhibitors Males with Benign Prostatic Hyperplasiaalpha-blockers Overactive Bladder or Urge Incontinenceanticholinergic drugs

769 PREFERRED TREATMENT Intestinal Stasis or Postoperative Ileus cholinergic drugs Irritable Bowel Syndrome anticholinergic drugs Myasthenia

Gravisindirect acting cholinergic agent 770 QUESTION #1 An adrenergic blocker is MOST DIRECTLY related to which of the following? A. Stimulation of the sympathetic nervous system B. Inhibition of the parasympathetic nervous system C. Stimulation of the parasympathetic nervous system

D. Inhibition of the sympathetic nervous system QUESTION #2 Pseudoephedrine has been ordered for a patient with nasal congestion. The nurse knows the drug can give which of the following side effects? A. Hypertension, insomnia, and tachycardia B. Drowsiness and dry mouth C. Increased heart rate and abdominal cramps D. Dilated pupils and orthostatic hypotension

QUESTION #3 How does propranolol (Inderal) exert its effects? A. Stimulates cholinergic receptors B. Blocks cholinergic receptors C. Stimulates alpha receptors D. Blocks beta receptors

QUESTION #4 Scopolamine (Transderm-Scop) is an anticholinergic agent. Which of the following is LEAST likely to be a side effect of this drug? A. Dry mouth B. Bradycardia C. Tachycardia D. Urinary retention

QUESTION #5 Beta adrenergic blockers should be used with extreme caution in patients with: A. Hypertension B. Raynauds C. Emphysema D. Cardiac dysrhythmias

REFERENCES Hitner, H. and Nagle, B. Pharmacology An Introduction 6th Edition. (2012). New York, NY: McGraw Hill. Zerwekh, J. and Claborn, J. Memory Notebook of Nursing. (2012). Ingram, TX: Nursing Education Consultants.

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