. Medications - My
1. Discuss drug legislation in the US
- In 1906, the Pure Food and Drug Act designated the United States Pharmacopeia and the National Formulary as the official drug standards in the United States,
- in 1938 the Federal Food, Drug and Cosmetic Act prohibited adulterated or mis...
28. Medications - My
1. Discuss drug legislation in the US
- In 1906, the Pure Food and Drug Act designated the United States Pharmacopeia and
the National Formulary as the official drug standards in the United States,
- in 1938 the Federal Food, Drug and Cosmetic Act prohibited adulterated or mislabeled
drugs from being made available.FDA enforces this law. Extensive testing of new drugs
is required before marketing.
- in 1952 The Durham-Humphrey amendment to the Federal Food, Drug and Cosmetic
Act distinguished prescription drugs from nonprescription (over-the-counter) drugs and
provided directions for dispensing prescription drugs.
- The Kefauver-Harris Amendment of 1962 increased controls on drug safety, requiring
tighter testing of drugs and written inclusion in the drug literature of adverse reactions
and contraindications for approved drugs.
- The Comprehensive Drug Abuse Prevention and Control Act, also known as the
Controlled Substances Act, was passed in 1970. This law regulates the distribution of
narcotics and other drugs of abuse.
- In 1983, the Drug Enforcement Administration (DEA), a part of the Department of
Justice, was identified as the nation’s sole legal drug enforcement agency.
- More current drug-related legislation= the Food and Drug Administration
Modernization Act of 1997 provides for accelerated review and use of new drugs and
approves drug testing in children before marketing.
- In 2003, the Pediatric Research Equity Act was signed into legislation. This act
authorizes the FDA to require testing by drug manufacturers of drugs and biologic
products for their safety and effectiveness in children
- Also in 2003, Congress approved the Medicare Prescription Drug Improvement and
Modernization Act (MMA). This legislation provides financial assistance to seniors to
purchase needed prescription medications.
2. Describe basic principles of pharmacology, including drug nomenclature and types of
drug preparations.
- chemical name is a precise description of the drug’s chemical composition, identifying
the drug’s atomic and molecular structure using exact chemical language and
terminology.
- generic name, which identifies the drug’s active ingredient, is the name assigned by the
manufacturer that first develops the drug
- official name is the name by which the drug is identified in the official publications,
United States Pharmacopeia and National Formulary (USP and NF). The official name is
often the generic name.
- trade name, also referred to as the brand name or proprietary name, is selected by the
pharmaceutical company that sells the drug and is protected by trademark.
,→ Nurses should be familiar with a drug’s generic and trade names.
● TABLE 28-1 Common Types of Drug Preparations
PREPARATIO DESCRIPTION
N
Capsule Powder or gel form of an active drug enclosed in a gelatinous container;
may also be called liquigel
Elixir Medication in a clear liquid containing water, alcohol, sweeteners, and
flavor
Enteric coated A tablet or pill coated to prevent stomach irritation
Extended release Preparation of a medication that allows for slow and continuous release
over a predetermined period;
Liniment Medication mixed with alcohol, oil, or soap, which is rubbed on the
skin
Lotion Drug particles in a solution for topical use
Lozenge Small oval, round, or oblong preparation containing a drug in a flavored
or sweetened base, which dissolves in the mouth and releases the
medication; also called troche
Ointment Semisolid preparation containing a drug to be applied externally; also
called an unction
Pill Mixture of a powdered drug with a cohesive material; may be round or
oval
Powder Single or mixture of finely ground drugs
Solution A drug dissolved in another substance (e.g., in an aqueous solution)
Suppository An easily melted medication preparation in a firm base such as gelatin
that is inserted into the body (rectum, vagina, urethra)
Suspension Finely divided, undissolved particles in a liquid medium; should be
shaken before use
Syrup Medication combined in a water and sugar solution
Tablet Small, solid dose of medication, compressed or molded; may be any
color, size, or shape; enteric-coated tablets are coated with a substance
, that is insoluble in gastric acids to reduce gastric irritation by the drug
Transdermal Unit dose of medication applied directly to skin for diffusion through
patch skin and absorption into the bloodstream
3. Develop an understanding of basic principles of pharmacology, including mechanisms of
drug action, adverse drug effects, and factors affecting drug action.
A. Pharmacokinetics = the effect of the body on the drug, once the drug enters the body.
● ABSORPTION = process by which a drug is transferred from its site of entry
into the body to the bloodstream, influenced by the following factors.
❏ Route of Administration (orally usually take the longest, injected
medications are usually absorbed more rapidly)
❏ Lipid Solubility (Cell membranes have a fatty acid layer. A drug that is
more lipid soluble can be absorbed more readily and pass more easily
through)
❏ pH (Acidic drugs are well absorbed in the stomach)
❏ Blood Flow (Absorption is increased with increased blood flow)
❏ Local Conditions at the Site of Administration (The more extensive the
absorbing surface, the greater the absorption of the drug and the more
rapid the effect. Contact time also affects absorption)
❏ Drug Dosage
i. A loading dose, or a larger than normal dose, is usually given
when a patient is in acute distress and the maximum therapeutic
effect is desired as quickly as possible.
ii. A maintenance dose is a lower dosage that becomes the usual or
daily dosage.
● DISTRIBUTION = drug is distributed throughout the body, becoming available to body
fluids and body tissues, depending on blood flow to the tissues, the drug’s ability to
leave the bloodstream, and the drug’s ability to enter the cells
- drug may bind to plasma proteins, which causes unequal distribution and prevents the
drug from reaching its intended site of action.
- blood–brain barrier prevents toxins and poisons from reaching the brain. Unfortunately,
many drugs cannot penetrate the barrier, obviously influencing distribution.
- The placenta, on the other hand, is an ineffective barrier. Drugs readily move across the
placenta, and many drugs produce harmful effects in the fetus.
● METABOLISM (biotransformation) = the change of a drug from its original form to a
new form. The liver is the primary site for drug metabolism
, - First-pass effect (Drugs move from the intestinal lumen to the liver by way of the portal
vein and DO NOT go directly into the systemic circulation following oral absorption)
● EXCRETION = the process of removing a drug, or its metabolites (products of
metabolism), from the body. The kidneys excrete most drugs. The lungs are the primary
route for the excretion of gaseous substances, such as inhalation anesthetics. Many drugs
are excreted through bile in the gastrointestinal tract. The sweat, salivary, and mammary
glands are also routes of drug excretion.
- Some medications may be contraindicated, or dosages may need to be adjusted, if renal
excretion is impaired.
- Manufacturers are required by law to include specific information regarding implications
for geriatric patients on the package inserts of certain drugs. This law affects
psychotropic drugs, nonsteroidal anti-inflammatory agents (NSAIDs), oral hypoglycemic
agents, anticoagulants, certain broad-spectrum antibiotics, and cardiac drugs.
B. Pharmacodynamics = process by which drugs alter cell physiology and affect the body is
called pharmacodynamics
- Drugs act at the cellular level to achieve the desired effect
- Mechanism of drug action is a drug–receptor interaction, The drug fits the receptor as a
key fits a lock.
- A drug may combine with an enzyme to achieve the desired effect, which is referred to
as a drug–enzyme interaction.
- Other drugs act on the cell membrane or alter the cellular environment to achieve
their effect.
C. ADVERSE DRUG REACTIONS:
a. Some are predictable and may be tolerated as part of the therapy. (Eg: A known
adverse effect with morphine use is constipation)
b. It can be severe and may require discontinuation of the drug, depending on whether
the benefit of the drug outweighs the harm from the adverse effect.
c. Development of an iatrogenic disorder caused unintentionally by drug therapy. (Eg:
Neutropenia caused by chemotherapy
d. Allergic Effect = an immune system response that occurs when the body interprets the
administered drug as a foreign substance and forms antibodies against the drug. S&S
rash, urticaria, fever, diarrhea, nausea, and vomiting. The most serious allergic effect is
called an anaphylactic reaction (anaphylaxis).
e. Drug Tolerance = occurs when the body becomes accustomed to the effects of a
particular drug over a period of time. Larger doses of the drug must be taken to produce
the desired effect.
f. Toxic Effect = occur from a cumulative effect. A cumulative effect occurs when the
body cannot metabolize one dose of a drug before another dose is administered. The drug
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