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Pharmacological and Parenteral Therapies 1

Pharmacology Terms and Responsibilities
1. Medication nomenclature

Chemical name - description of a medication's chemical elements
Generic name - simpler version of the chemical name, never changed and used in medical terminology (always lower case)
Trade name - manufacturer's name for medication; is capitalized and shown in parentheses if it follows generic name (always capitalized)

Pharmacokinetics
1. Absorption
2. Distribution
3. Metabolism
4. Excretion
5. Serum half-life
Effects of medications
1. Therapeutic effect: desired primary effect for which the medication was given
2. Adverse effect: undesired responses to drug administration
3. Side effect: adverse effect that occurs with usual therapeutic dose of drug
4. Toxic effect or toxicity: extension of primary action carried to an extreme
5. Cumulating effect: body holds more of the medication because it excretes or metabolizes less of it.
6. Hypersensitivity/allergy: anaphylaxis, urticaria, etc.
7. Tolerance: body becomes accustomed to drug so that larger doses are needed to produce same effects
8. Dependence: medication needed long-term, possibly leading to abuse
  1. psychic dependence
  2. physical dependence
9. Subtherpeutic:insufficient dosage
10. Peak-trough
  1. done with antibiotics
  2. trough- just prior to giving a dose
  3. peak- one hour after infusion is complete
Variables affecting drug action
1. Drug-related
  1. dosage
  2. route
  3. drug-diet interaction
  4. drug-drug interaction
2. Client-related
  1. age
  2. weight
  3. genetic and ethnic characteristics

Nursing responsibilities when administering medications:
1. Determine if the medication order is correct
2. Know the usual dosage of the medication, usual route, expected therapeutic effects and side effects
3. Determine if medication is compatible with others that the client is taking
4. Exercise independent judgment before give a medication
  1. consider client needs, adverse effects, etc.
  2. use appropriate administration technique
  3. monitor amount of medication in the body (such as its levels in blood)

Major Routes of Administration
1. Oral (P.O.)
2. Intramuscular (IM) (illustration )
3. Subcutaneous (Subq)
4. Intravenous (IV)
  1. Methods of IV administration
    1. iv push
      1. use
        
        for quick response
        
        replace IM injects for patient comfort
        
        to administer loading doses
      2. nursing interventions
        
        first, check that medication, dose and route are correct
        
        assess patency of IV line
        
        determine compatibility with infusing IV liquids
        
        monitor how client reacts to medication
    2. infusion control devices
      1. use to administer a fluid volume accurately
      2. nursing interventions
        
        know how the device works
        
        double check the flow rate
        
        monitor client closely for complications such as inflammation, infiltration or infection at insertion site
        
        explain purpose of infusion device to client
    3. heparin lock
      1. use - administer periodic IV medication without continuous IV therapy
      2. nursing interventions
        
        monitor for inflammation, infection or infiltration at insertion site
        
        follow your facility's policy to maintain patency

venous access devices (illustration )
1. uses
  - long-term intravenous therapy
  - iv therapy in the home
2. nursing interventions
  - monitor for cardiac irregularities, which may show central catheter placed too deeply and extending into right atrium
  - monitor for inflammation, infiltration, and infection at insertion site
    1. purposes
      - manage pain at a consistent level
      - client self administers
    2. protocol
      - prepare infusion and attach to IV
      - medication is delivered in loading dosage as ordered
      - teach client how to use PCA
  - intravenous therapy
    1. use - replace fluid, electrolytes and other nutrients for clients who cannot eat or drink adequately
    2. types of IV therapy solutions
      - osmotic pressure similar to that of plasma
      - examples: normal saline 0.9%; lactated Ringer's solution; 5% dextrose in water
    3. hypotonic

exerts less osmotic pressure than plasma
examples: 2.5% dextrose in water; half strength normal saline 0.45%

hypertonic
- exerts higher osmotic pressure than plasma (draws water out of the cells)
- examples: 5% dextrose in normal saline 0.9%; 5% dextrose in lactated Ringer's solution

Other

Sublingual (SL)
Intraocular
Intrathecal

Classification of Medications by Body Systems
1. Managing cardiac disease

Cardiac glycosides

Antihypertensives

Thrombolytics

Lipid-lowering agents

Antianginals

Hypotension and shock

Anticoagulants

Antidysrhythmics

Cardiac glycosides
1. action: makes heart beat slower but stronger
  1. improves pumping ability of heart
  2. increases force of heart's contraction
  3. decreases rate of contraction
  4. increases cardiac output
2. examples
  1. digitoxin (Crystodigin)
  2. digoxin (Lanoxin)
3. use
4. contraindications
  1. ventricular tachycardia
  2. ventricular fibrillation
  3. second and third degree heart block
5. adverse side effects
  1. gastrointestinal effects such as nausea and vomiting, diarrhea, and anorexia
  2. bradycardia
  3. xanthopsia
  4. muscle weakness
  5. dysrhythmia
6. nursing interventions
  1. before giving glycoside, check apical pulse and heart rhythm. Report if < 60 bpm
  2. establish baseline data such as vital signs, electrolytes, clinical symptoms, creatinine clearance test
  3. monitor for drug toxicity
    - in children - cardiac arrhythmias
    - in adults - visual disturbances, nausea and vomiting, anorexia
    - older clients more prone to toxicity
  4. monitor drug levels
    - therapeutic range 0.8 to 2.0 ng/ml
    - toxic range > two ng/ml
    - diuretics may increase chance of toxicity
7. monitor intake and output
8. client teaching
  1. take medication as prescribed
  2. teach client how to take and record pulse daily
  3. identify and report signs of toxicity
    - for atrial fibrillation: take pulse and report if below 60 or above 100 or changes in rhythm
    - daily weights: report two pound increase

Antihypertensives

action: dilates peripheral blood vessels
examples
1. hydralazine HCL (Apresoline)
2. enalapril maleate (Vasotec)
3. reserpine (Serpasil)
4. prazosin HCL (Minipress)
5. methyldopa (Aldomet)
6. clonidine (Catapres)

use: hypertension
contraindications
1. heart block
2. children
adverse side effects
1. orthostatic hypotension
2. dizziness
3. bradycardia
4. tachycardia
5. sexual dysfunction
6. deterioration in renal function
7. agranulosis
nursing interventions
1. monitor vital signs and blood pressure, sitting and standing
2. monitor for hearing changes, renal functioning
3. if hypotension, closely monitor client
4. encourage intake of foods high in vitamin B
5. teach client
  - low sodium diet
  - change positions slowly
  - take medication as instructed
  - avoid hazardous activities
  - protect medication from heat and light

Thrombolytics
1. action: binds with plasminogen to dissolve thrombi (clots) in coronary arteries within four to six hours of myocardial infarction. Activates conversion of plasminogen to plasmin. Plasmin is able to break down clots (fibrin).
2. examples
  1. streptokinase (Streptase)
  2. urokinase (Abbokinase)
3. uses
  1. myocardial infarction
  2. deep venous thrombosis
  3. pulmonary emboli
4. contraindications
  1. active bleeding
  2. cerebral embolism/thrombosis/hemorrhage
  3. recent intraarterial diagnostic procedure or surgery
  4. recent major surgery
  5. neoplasms of the CNS
  6. severe hypertension
5. adverse side effects
  1. bleeding
  2. allergic reactions:urticaria, itching, flushing, headache (illustration )

nursing interventions

monitor for bleeding
monitor coagulation studies
monitor for allergic reactions
keep available: aminocaproic acid (fibrinolysis inhibitor)

Lipid-lowering agents (antilipemic)
1. action and use: lower LDL levels by reducing the synthesis of cholesterol and/or triglycerides. Use: primary hypercholesterolemia
2. examples
  1. cholestyramine (Questran)
  2. atorvastatin (Lipitor)
  3. colestipol (Colestid)
  4. nicotinic acid (Niacin)
3. contraindications:
  1. hypersensitivity
  2. pregnancy/lactation
  3. active liver disease
4. adverse side effects
  1. skin flushing
  2. gastric upset
  3. niacin: temporary, intense flushing of face, neck and ears
  4. reduced absorption of fat-soluble vitamins
  5. disruption of liver function
  6. muscle tenderness or weakness (rhabdomyolysis)
5. nursing interventions
  1. monitor cholesterol levels
  2. monitor liver function tests
  3. teach client
    - blood work and eye exams will be necessary during treatment
    - to report blurred vision, severe GI symptoms, or headache
    - about low-cholesterol high-fiber diet
    - to report muscle weakness or tenderness
  4. with cholestyramine, colestipol: Give other medications (e.g., such as thiazide diuretics, digoxin, warfarin, and certain antibiotics) one hour before or four hours after administration of cholestryramine and colestipol, so that they will not react with bile-acid-binding resins

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