Define the term adverse drug reaction. They are rarely used in anxiety management. Edinburgh: Churchill Livingstone. However, it targets a different type of virus, the cytomegalo virus. Enzymes Enzymes are biological catalysts that increase the rate of chemical reactions in the body. You should be familiar with the units in Box 1.2 as they are the most common encountered in drug calculation. Aciclovir should not be given in pregnancy as it could cause chromosomal mutations to occur. After that, there may be other problems (e.g. Brenner, G.M. Philadelphia, PA: Lippincott Williams & Wilkins. She has bedside nursing experience in medical neurology and the neuroscience ICU. Edinburgh: Churchill Livingstone. The Misuse of Drugs Act (1971), which supersedes the Dangerous Drug Act (1967), prohibits certain activities in relation to controlled drugs in relation to manufacture, supply and possession. Significant first pass effect occurs in the liver, and therefore subcutaneous, intramuscular or intravenous injections are usually given. There are three categories of drugs that affect blood clotting and the formation of thrombosis: 1 drugs that affect fibrin formation; 2 drugs that affect platelet function; 3 drugs that affect dissolving of the clot. National Institute for Health and Clinical Excellence (NICE) (2006) Clinical Guideline 36: Atrial Fibrillation. Used to treat fungal infection of the nails and skin. Karch, A.M. (2008) Focus on Nursing Pharmacology, 4th edn. Many deteriorate and suffer dementia. Once inside the host cell the nucleic acid centre of the virus starts to use the host cell’s machinery to help it replicate more of its kind (viral replication). c) The following day after surgery? However, this tends to be limited to treating 48 Beta-lactam antibiotics Penicillins The first penicillin was the naturally occurring benzylpenicillin, and is still used today. If you are involved in a drug error or if you see a drug error being made you must report it. the shape of them. The reflective analysis allows you to revisit the situation and to explore your reasons for the course of action you took. These antibodies in turn attach themselves to a type of tissue cell called a mast cell. Product packaging The elderly or those with manual dexterity problems can often have trouble with product packaging. We accept that not all these incidents involved the giving of medication but what these statistics highlight is the importance of thoroughly checking the identity of a patient. Some prostaglandins in the COX1 pathway have an effect on the pressure of blood flow through the kidneys. Nurses need to have an understanding of pharmacology at a level which will allow them to inform and educate the patients in their care. The use of these drugs has been related to significant long-term problems. However, in asthma these cells are responsible for releasing a group of substances called prostaglandins and platelet-activating factors which sustain the bronchial hyperactivity. Block sodium channels in the neurone. The form of seizure that the person suffers from usually depends on the part of the brain affected. This mechanism has an onward effect which facilitates an increase in mood and makes Fluoxetine and drugs similar to it good antidepressants. Chronic inflammation. The _____ name is the name under which the drug is listed by the United States Food and Drug Administration, who by federal law names the drug for human use in the United States. Click Download or Read Online button to get Basic Pharmacology For Nurses book now. Other problems that can result from taking this medication are itching of the skin, gastrointestinal disturbances and inhibition of adrenocorticoids and testosterone. The NICE guideline on the management of depression (2004) recommends the use of SSRIs. a) They make the nociceptors more sensitive b) They directly stimulate the nociceptors c) They stimulate the release of bradykinin d) They only act on receptors in the central nervous system 2 Local anaesthetic agents work by a) Opening potassium channels b) Opening sodium channels c) Blocking potassium channels d) Blocking sodium channels 3 Why are some local anaesthetics given with adrenaline? Opioid drugs are a class of natural, synthetic and semi-synthetic agents and are used for their analgesic, anti-tussive (stop you coughing) and anti-diarrhoeal properties. Introduction Medicines that are prescribed but not taken by patients represent a large loss in drug and prescribing costs and an enormous waste of expensive health professionals’ time. Discuss legal and professional dilemmas concerning giving a medicine in a covert manner. Karch, A.M. (2008) Focus on Nursing Pharmacology, 4th edn. Simonson, T., Aarbakke, J., Kay, I., Coleman, I., Sinnott, P. and Lyssa, R. (2006) Illustrated Pharmacology for Nurses. Beckwith, S. and Franklin, P. (2007) Oxford Handbook of Nurse Prescribing. It is particularly important for formation of factors II, VII, IX and X. Courts have also accepted that doctors may treat patients without their consent if it is seen to be in the best interests of that patient. D decongestant: a drug used to unblock the upper respiratory tract. Main classes of drugs are thiazide, diuretics, beta-adrenoreceptor antagonists, angiotensinconverting enzyme inhibitors, calcium antagonists or blockers and alpha-adrenoreceptor antagonists. Intracranial bleeding in the baby may occur during delivery. Phenytoin also increases enzymes into the liver that can affect the breakdown (metabolism) of other drugs that the patient may be taking. Morphine is the gold standard by which other opioids are measured. Nursing and Pharmacology Pharmacology is the study of the actions of drugs, incorporating knowledge from other interrelated sciences, such as pharmacokinetics and pharmaco-dynamics. Vitamin K is used clinically in a range of situations, for example, overdose with Warfarin, in babies to prevent haemorrhagic disease and in diseases which cause Vitamin K deficiency. It is estimated that one in five patients who suffer from asthma run the risk of having a severe reaction to the drug. For mild to moderate pain it is usually given at a dose of 300 to 600mg four times a day. Seizures can range from brief lapses in attention to full-blown convulsive fits which may last up to several minutes. This group of medicines can all be given in tablet form. g 85 Chapter 5 Anti-inflammatory drugs f 7 A child weighing 30kg is prescribed 80mg per kg per day of paracetamol to be given every six hours. The clot dissolves more slowly than it was built. Types of virus include DNA, RNA and retrovirus. The dose has to be given at a rate of 1ml every 30 seconds: how long with each dose last? There are six main classifications of anxiety disorders: 1 panic disorder; 2 social phobia; 3 generalized anxiety disorder; 132 An understanding of the physiological mechanisms thought to be involved in the development of pathological anxiety is vital to ensure appropriate treatment of anxiety disorders. The patient should then place the open end of the mouthpiece into their mouth and avoid covering the drug outlet piece with their tongue. 96 g Chapter 6 Anticoagulant therapy f Ø Vitamin K naturally occurs in plants. Metabolism Children metabolize drugs differently to adults, especially in the first few weeks of life. Specific tissues may take up certain drugs (e.g. Demonstrate an understanding of what unwanted effects antibiotics have on humans. As these blood cells protect us from infection it is important that the level does not drop significantly. Unlike osteoarthritis, which tends to occur as we get older, rheumatoid arthritis can develop at any age, but usually starts in the middle adult life, around the ages of 40 to 60. Drugs used in chronic conditions 7 Chapter contents Learning objectives Introduction Asthma Pathological changes in asthma Drugs used in treating asthma Beta 2 adrenoreceptor agonists Methylxanthines Muscarinic receptor antagonists Ipatropium Inhaled corticosteroids Cromoglicate Diabetes Medicine management of diabetes Insulin Treatment with insulin Short-acting insulins Intermediate insulins Long-acting insulins Side-effects Oral hypoglycaemic agents Metformin Sulfonureas Meglitinides Thiazolidinediones (glitazones) Alpha-glucosidase inhibitors Hypertension Thiazide diuretics Beta-adrenoreceptor antagonists Angiotensin-converting enzyme inhibitors Calcium antagonists Alpha-adrenoreceptor antagonists Parkinson’s disease Levodopa Selegiline Dopamine receptor agonists Acetylcholine antagonists Epilepsy Partial seizures Generalized seizures Inhibition of sodium channel function Phenytoin Inhibition of calcium channels Ethosuximide Enhancement of GABA action Sodium valproate Vigabatrin Case studies Key learning points Calculations Multiple choice questions Recommended further reading 101 Chapter 7 Drugs used in chronic conditions Learning objectives After studying this chapter you should be able to: Describe the basic pathology involved in asthma, diabetes, hypertension, Parkinson’s disease and epilepsy. Calculate the rate of the infusion in ml per hour 7 You need to give 1mg of vitamin K orally. C chemotaxis: the movement of white cells towards an area of inflammation. Second, it increases the sensitivity of muscle cells to insulin. They are thought to be safer than lithium but are still associated with serious side-effects. The foundation is now secured for the next process to begin. These cells are very important in defending the body and are linked to the immune response. The doctor has prescribed her another SSRI and she asks you to explain how it works. Edinburgh: Churchill Livingstone Elsevier. Azoles This group of drugs is manufactured synthetically. and Stevens, C.W. It is thought that through their action they moderate the firing of neurones in an area of the brain called the thalamus. Medicine management of depression Ø Tricyclic antidepressants affect the re-uptake of noradrenaline and serotonin. New medicines are being introduced daily and it is the nurse’s responsibility to gain knowledge regarding the medicines they are dealing with. a) Pergolide b) Benzatropine c) Selegiline d) Carbidopa 8 Parkinson’s disease is caused by a lack of which substance? In anxiety management they are used in doses much lower than would be needed for their antipsychotic effects. Formation of a platelet plug Damage to the wall of a blood vessel exposes proteins within the vessel wall. Examples are Ketoconazole and Fluconazole. Basic formula There is more than one way to do a drug calculation, but the simplest and most widely used method is the basic formula show here: D6Q=X H Where: D = desired dose H = strength available Q = quantity or unit of measure (for tablets Q =1, for liquids Q can vary) X = dose to be determined/amount to be given The steps for using the basic formula method are as follows: first, memorize the formula; remember to convert all the units to same system and size; place all of the unit information into the correct position within the basic formula; calculate your answer; label all answers (e.g. The factors which affect drug distribution are taken into consideration by drug companies when developing and formulating medications. How many ml would you give? Wolfe, S. (2006) Respiratory nursing: treatment of allergic rhinitis and asthma, Nursing Times, 102(20): 49–52. 14 Gatford, J.D. What information from Mrs Asamoah’s assessment could you now obtain which would help you identify factors influencing the absorption and distribution of the medication she is taking? Fortunately, deficiencies in clotting factors rarely happen. intercostals) or deep (e.g. Aspirin Ø Aspirin alters the fine balance between thromboxane and prostacyclin. Anticoagulant therapy For example, people who have developed fatty plaques, who are physically immobile or who are being treated with certain contraceptives are more at risk of developing thrombosis. While these factors are of interest, the nurse’s role in monitoring drug distribution is mainly in monitoring the onset of the effect of, or the response to, the medication. This fluid is called acute inflammatory exudate and its presence is detected by looking for the cardinal signs of inflammation discussed earlier. The mode of action is complex and not fully understood. Antibiotics are often described as being bactericidal: in other words, they kill bacteria, usually very rapidly. When applied to the eye the patient should be warned that it may cause a short-lasting stinging sensation. Downie, G., Mackenzie, J. and Williams, A. There are four types of opioid receptor and they are designated by the Greek letters m (mu), k (kappa), s (sigma) and d (delta). Giving replacement steroids causes atrophy of the adrenal gland. The pharmacy will have a copy of that person’s signature which helps them to decide to dispense the drug or not. One track carries information from the A delta fibres and the other from the C fibres. Finally, the patient has trouble in initiating and coordinating movement. A number of disease processes and other drugs can potentiate or inhibit its action. However, certain drugs do not dissolve into small enough particles to ensure rapid absorption. It is important that the disease is diagnosed and treated early as intervention, be it pharmacological or non-pharmacological, can reduce the risk of much cardiovascular disease associated with hypertension. Entamoeba histolytica is the cause of amoebic dysentery, an infection of the gastrointestinal system. Pharmacokinetics is the effect the body has on the drugs. However, inhaled corticosteroids are now a regular therapy in asthma management. a. Lomotil b. Adhesion of the platelets to themselves and the site of the injury is further helped by one of the plasma clotting factors called factor VIII. Shorter-acting medicines may cause flushing and headaches and if used over a long period of time can cause ankle swelling. Philadelphia, PA: Saunders Elsevier. Mechanisms that seem to be involved affect the extracellular fluid volume and expand the circulating blood volume. ix About the Authors Paul Barber Dr Deborah Robertson Paul Barber (MSc Practitioner Research, BSc (Hons) Nursing, Dip N (Lond), Cert Ed, RNT, SRN, RMN) commenced his nursing career in 1974 as a cadet nurse, where he completed both his Registered Mental Nurse and State Registered nurse training. Chloramphenicol should only be given to babies with extreme caution as they do not have the capacity to metabolize and excrete the drug. Think of alcohol effects on liver Think about the effects of smoking on the systems of the body Consider the effects of surgery on the movement of the intestine Check the fluid balance Check the urinary output Calculations 1 2 3 4 2000 micrograms 0.6g 1200mg 1g in 10,000 is the weakest 1 2 3 4 5 6 7 8 9 10 360ml 2 tablets 2 tablets A A D C B B D B D A Chapter 2 Case study j, Marek Brodzki Your responsibilities regarding the antibiotics are: This may be a mild allergy Needs to be closely monitored No treatment necessary, although may give antihistamines Report rash to doctor The rash may become a more severe reaction Your responsibilities regarding recording the incident are: Record extent of the rash, when first noticed: is it becoming worse, how irritant is it? They may well cause sedation and stop motion sickness, but they will also produce other central nervous system side-effects that are less useful, for example, Chapter 5 Anti-inflammatory drugs dizziness, tinnitus and tiredness. You are helping him to dress when you notice a red pinprick rash all over his upper body. Examples are methotrexate, penicillamine and gold. Fluoroquinolones The most common antibiotic in this group is called ciprofloxacin, which is a broad spectrum antibiotic. Basingstoke: Palgrave Macmillan. Drugs used in chronic conditions weight. The doctor has prescribed 0.05g. Arterial pressure is regulated by the performance of the heart (measured as cardiac output) and the diameter of the arterioles (total peripheral resistance). May cause menstrual irregularities. Check BNF for any interactions between drugs that may affect absorption and distribution Case study k, Mr Mambety The following factors may influence Mr Mambety’s ability to metabolise and excrete drugs during his post-operative recovery. This may be due to a major change in lifestyle. The main problem is child-proof caps on medicine bottles, but some blister packs can prove difficult to get into. This is called proviral DNA. This allows pharmacovigilance and builds up a fuller profile of the drugs. The Misuse of Drugs Regulations (2001) define the classes of person who are authorized to supply and possess controlled drugs in a professional capacity and under set conditions. Limit prostaglandin E effects on the nociceptors. This side-effect is rare but can occur in low doses in some individuals. However, although rare, liver disturbances such as hepatitis can occur. Define what is meant by the word histamine. The bronchodilator effect begins after approximately 45 minutes and lasts for about three to five hours. How many tablets will you give? Effect metabolism of fats, carbohydrates and proteins. The body’s analgesic system As with other sensory systems in the body, the pain pathway has a descending mechanism (see Figure 3.6). The patient may have to be treated with antifungal lozenges. (2000) Clinical Pharmacology for Nurses, 16th edn. Taking medication at the same time as an antacid preparation. London: NMC. The chapter is only introductory and is not intended as comprehensive coverage of all chronic conditions and their pharmaceutical management. You have a patient with swallowing difficulties. You will find that all hospitals have their own medicines policy which usually contains information on crushing or tampering with medicines. This effect should wear off after the patient has been taking the medicine for a while. How much do you draw up? 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