ADPIE

assesment

diagnosis

plan

implement

evaluate

at least when walking possibly 2-3

Schedule I

Schedule II

Schedule III

Schedule IV

Schedule V

I- no acceptable med use-marijuana, LSD

II- high abuse and dependance narcotics, barbituates

III- mod. dependence sedatives, stimulants-Ritalin, Ambien

IV- less abuse potentials sedatives, non-narcotic analgesic

V-  limited potential for abuse, no rx but >18yo with ID-otc (behind counter)-cough syrup Terpenhydrate

FDA Drug approval process

preclinical-

PH 1-

PH2

PH3-

PH4-

informed consent required for all four phases!

preclinical-lab animals

1.  healthy humans

2.  informed pt(they fully know drug may either kill or save them)

3. clinical implementation- wide spread use

4. continued evaluation-drug approved and used widespread

8 med rights

normally 6

right patient

right drug

right storage*

right prep*

right dose

right time

right route

right charting

high alert meds

SALAD or LASA-sound alike and look alikes

can you use trailing zeros?

10.0

can you use leading zeros?

0.35

never use trailing zeros

10

always use leading zeros

0.35

process that seeks to prevent med. errors through the ongoing assessment and updating of information on patients' meds throughout the healtcare process and the timely communication of this information to pts and their prescribers.

JCAHO requirement-automatic

NO

think about Quality, Quanity, Purity

can interact with prescribed meds

toxicity

binding

criteria for drug to have over-the-counter status

 indications for use-consumer must be able to easily diagnose condition, monitor effeciveness, benefits must outway risks

safety profile- drug should have favorable adverse event profile, limited interaction with other drugs, low potential for risk, high theraputic index

Practicality-easy to use, easy to monitor

dietary supplements

system functions-esp. renal, liver, cardiac

conditions that are contraindicated

potential drug-drug and drug-herb interactions

oral-treat constipation, cause bowel evacuation

can take up to 10hrs to work

monitor for deydration

topical-burns and skin irritation

oral (or tea)-restlessness, anxiety, motion sickness, D, indigestion

if allergic to ragweek family-may see anaphylaxis

not for use during pregnancy

amy increase anicoagulant effects

topical-inflammation, wound healing, burns

UTI prophylaxix or treatment

prevent renal calculi

use unsweetened for to prevent bacteria from adhering to bladder wall

used to prevent and treat common cold

supportive therapy, not replace antibiotic

prevent and treat migraines

hot flashes and menstral problems

rheumatoid arthritis

asthma

avoid use in pregnancy (abortifacient)

increase bleeding with anticoagulants or antiplatieltets

do not stop abruptly, tension headaches, insomnia, joint stiffness and pain, lethargy

dec. cholesterol and triglyceride levels

age related vasc. changes

prevent GI CA

coughs, cold, fevers, sore throat

increase bleeding time if on anticoagulants

may have odor to breath/skin

raw form see more reaction

not use in diabetes, insomnia, pemphigus, rheumatoid arthritis, organ transplants

nausea, motion and morning sickness

GI upset (Flatulence, colic, indigestion)

High cholesterol, liver toxicity

burns, ulcers, depression

Inc. risk of bleeding, nosebleeds, bruising

caution in pregnancy and with other drugs

used as a memory improver

Alzheimer's , dementia, cerebral insufficiency

Intermittent Claudication

Tinnitius, HS

use for 6-8 wks, no longer than 3 mos

standardized:if at least 24% flavonoid glycosides and 6% terpene lactones

inc. effects of anticoagulants

50 seeds see seizure

fatigue, improve concentration

atherosclerosis, strengthen resistance

inc. effects of anticoagulants

sided effects with lg. doses (diarrhea, nervousness, hypertension, edema, and rash, increased motor activity)

treat hyperlipidemia, prevent cancer

HA, mild diuretic, CNS stimulant

inc. effect of anticoagulants

causes restlessness, insomnia, palpitations, vertigo, HA,

milk decreases adverse effects

stress, anti-anxiety, restlessness,

HA, seizures, colds

do not take with CNS depressants, MAOI, levodopa, antiplatelets, ETOH, anxiolytics

causes drowsiness

effects should be evident within 2 days

contraindicated in pregnancy and lactation

not use with st johns wart

mild to mod. depression, anxiety

sciatica, viral infections

interacts with many drugs-not use if taking antidepressants or anit-anxiety meds

takes several weeks to be effective

stop if no response after 4-6 weeks

pms

take with water in the am

may take several cycles to ee action

aphrodisiac for impotence

causes CNS excitation, tremor, anxiety, inc BP and HR,

avoid if renal or hepatic toxicity

science of drugs, any chemical that affects the physiologica processs of a living organism

study of biological effects of chemicals

drugs trigger a change

theraputic

helpful

undesirable

dangerous

the study of natural (plant and animal) drug sources

plants

animals

minerals

laboratory synthesis

iron tablet and

mylanta-aluminum

chemical name

generic name

trade name

chemical name-chemical make up

generic name-nonpatented name-given by US Adopted Name Council

Trade name-proprietory name- registered trademark name, patent, usually by manufacturer

the study of how  various drug forms influence pharmokinetics and pharmocodynamic activities

The science of preparing and dispensing drugs, including dosage from design

type affects what it does in the body

processing of drugs in the body

what body does to to drug

absorption

distribution

metabolism

excretion

actual concentration drug reaches in body

affected by absorbtion, distribution, biotransformation, excretion

basic actions of drugs

4 things

•

Replace or act as substitute for missing

chemical

•

Increase or stimulate certain cellular

activities

•

Depress or slow cellular activities

•

Interfere with functioning of foreign cells

dynamic equilibrium

a measure of the extent of drug absorbtion for a given drug and route (0-100%)-ex. what is left after passes through stomach, liver, etc.  (first pass)

drugs given IV are 100% bioavailable- they bipass the liver,

if 2 drugs have the same concentration of active ingredients, they are equivalent

ex. generic vs. brand name drugs are often this

Food or fluids administered with the drug

Dosage formulation

Status of the absorptive surface

Rate of blood flow to the small intestine

Acidity of the stomach

Status of GI motility-ex. diarrha, constipation

the drug is absorbed into the systemic circulation through the oral or gastric mucosa or the sm. intenstine

oral

sublingual-under the tongue

buccal-cheek

rectal-(can also be topical)-enema, suppository, prep. H

by IV,

intra arterial (fastest del. into circulation)

intramuscular

subcutaneous-

intradermal

intrathecal-spinal

intraarticular

transdermal (can be considered parenteral)-on skin

intramuscular-

subcutaneous

intramuscular (IM)-  into muscle, below subcutaneous fat

subcutaneous-into  fatty subcutaneous tissues, under dermal layer of skin

intradermal-

intrathecal

intraarticular-

intradermal-  injections under the more superficial skin layers immediately underneath the epidermal layer(TB test)

intrathecal-  into the spinal chord(within a sheath)-subarachnoid space

intraarticular- within a joint

skin, eyes, ears, nose, lungs, rectum, vagina(a little more acidic environment)

movement of drug to body tissues

affected by solubility, ionization, perfusion

large, complex, cannot enter capillaries

if tightly bound are released slowly

if loosly bound act quickly

certain drugs compete with each other at site

drugs bind with the albumin mostly

only unbound drugs can leave the vascular system

water loving-hydrophilic are more easily metabolized

fat loving- lipophilic are difficult to eliminate

barrier there to protect the CNS,

most drugs do not cross, ex. most antibiotics are not lipid soluble,

only lipids are more likely to cross

which type of meds are better for distribution, H2o sol or fat?

areas of body with rapid distribution of drugs...

slow....

rapid....heart, liver, kidneys, brain

slow...muscle, skin, fat

onset

peak

duration

onset- the time it takes for a drug to elicit a theraputic response

peak- the time it takes for a durg to reach its max. theraputic response

duration-the time a drug is conc. is sufficient to elicit a theraputic response

water soluble drugs are excreted by the process of _______ 

all other drugs are removed by________

water soluble-glomerular filtration

others-active transport

Science of dealing with interactions

between living organisms and foreign

chemicals

What a drug does to the body
Mechanism of drug actions in living tissues

liver-primary

skeletal muscle

kidneys

lungs

plasma

intestinal mucosa

factors that decrease metabolism

increase?

decrease-  cardiovascular dysfunction

renal insufficiency

starvation

obst. jaundice

slow acetylatory

erythromycin or ketoconazole drug therapy

increase-  fast acetylator

barbituate therapy

rifampin therapy(for TB)

accumulation of drug in body

prolonged action of the drug-toxicity!

peak-highest blood level

trough-lowest blood level

can increase or decrease

rate at which cells or tissues function

but cannot make cell or tissue perform a function it was not designed to perform

1.  emperical therapeutics

2.  rational theraputics

using shared knowledge to begin therapy before test results are positive

2.  waiting for confirmation-ex. chemotherapy

any characteristic of pt., esp. a disease state that makes use of a given medication dangerous

teratogenic

mutagenic

teratogenic- fetus danger

mutagenic-cellular danger

pts on narcotics may build up a ____ to the drug

pts on sleeping pills may develop a ____ to the drug

Narcotics-tolerance

sleeping pills-dependence

additive effect

synergistic effect

antagonistic effect

additive  1+1=2 (they are both equal together or seperate)

synergistic  1+1>2  (the combined effect is greater than each individual)

antagonistic  1+1< 2 (the combined effect is less than each individual, they block or reduce each other)

side effect

verses

adverse effect

side effect-expected from studies and experience

may be tolerable and may subside

reason some people stop, but benefits may outweight the side effects

adverse effect-undesired, may be sudden and severe, need to stop medication immediately

1.  cytotoxic reaction

2.  serum sickness reaction

1.  death of cells, break down

2.  horse syrum reaction to protein

inflamation of mucous membranes

mouth, gut

see in antibiotics and chemo drugs

if hypoglycemic do what?

hyperglycemic?

hypo- low, administer foood or glucose

hyper- insulin

nutritional and vitamin deficiencies (B vit)

see physical changes, esp. nerve

hospitalize,

high BP, high temp, insomnia, high HR

tremors

agitation

ICU!

benzo's -Diazapam(Valium), lorazapam (Ativan), chlordiazepoxide (Librium)

Disulfiram (Antabuse)-causes vomiting if drink alcohol