Ch.1&2

Nursing Management of Drug Therapy

Chapter 1

Pharmacotherapeutics Pharmacokinetics Pharmacodynamics Contraindications / Precautions Adverse effects Drug Interactions “ Prototype”

Core Drug Knowledge: Facts Relevant to Every Drug

Must know about the patient that will receive the drug

Factors that may interact or affect drug therapy for that particular person

Core Patient Variables:Facts Relevant to Every Patient

Health Status Life span Gender Lifestyle, diet , habits Environment Culture ( Inherited traits)

Core Patient Variables

Awareness of all drugs the patient is taking …Prescription and OTC ( over the counter) as well as herbal preparations

Utilization of current drug references to gain knowledge of the medication prior to administration or teaching of a patient

Assessment of Core Drug Knowledge

Patient Interview Patient History Patient Physical Exam Use of the Medical Record

Assessment of Core Patient Variables

Nursing Diagnoses / Outcome Identification

Terms given to the identified interactions between the core drug knowledge and core patient variables

Nursing Management of Drug Therapy:

Core Pt. Variables + Core Drug Knowledge =

( Knowledge of unique Pt. variables)

Utilization of the Nursing Process: ( RN determines what significant interactions

may occur) Planning Intervention Evaluation

Nursing Management of Drug Therapy:

Common protocols used for certain drugs Standard of care for all patients receiving

a particular therapy Uses an interdisciplinary approach Utilized in conjunction with continued

nursing assessment : not instead of Not an automatic recipe ! Inclusion of: Core patient variables + Core drug

knowledge always

CLINICAL PATHWAY

How does the nurse assess core patient variables ?

Why does the RN need to assess the core drug knowledge of each drug a pt. receives?

How does learning core drug knowledge about “prototype” drugs help the RN?

How do the core pt. variables affect the pt. education that will be provided ?

REVIEW

Pharmaceuticals: Development

Safeguards

Delivery

Chapter 2

Where do drugs come from ?

Plants – alkaloids, glycosides, gums, oils, resins Animals Synthetic Chemicals Genetically Engineered Chemicals- pharmacogenomics

pharmacogenetics

Sources of Drugs

Chemical name ( p-isobutylhydratropic acid)

Generic name (Official name) -ibuprofen

Trade name ( Advil, Motrin, Motrin IB, Nuprin)

Drug Nomenclature

Classifying by similar characteristics:

Chemical

Physiologic

Therapeutic

A drug may belong to more than one class of drugs depending on the classification system used

Drug Classifications

Official Pharmacopeia

U.S. Pharmacopeia ( USP) National Formulary (NF) British Pharmacopeia (BP) The International Pharmacopeia

Sources of Drug Information

Unofficial Compendia: American Hospital Formulary Service British National Formulary FDA Bulletin USP Dispensing Information Pharmaceutical Package Inserts Physician’s Desk Reference ( PDR) Electronic databases PDA’s

Other Sources of: Drug Information

Pure Food and Drug Act of 1906 ( Shirley Amendment -1912 )

Federal Food Drug and Cosmetic Act ( FFDCA) 1938 (Kefauver-Harris Amendment 1962)

Legislation for Drug Safety and Efficacy

Clinical Trials Pre-clinical ( conducted on animals)

Clinical ( conducted on humans) Occurs in 4 phases Takes about 5 – 9 yrs for completion Med Watch program –

www.fda.gov/medwatch

Drug Development and Approval

Harrison Narcotic Law 1914

Controlled Substance Act 1970

Legislation: Controlled Substances

Important nursing responsibility

Health care facility must use automated system or “double lock system”

Violation of the Controlled substance act can result in:

fine, imprisonment, or both.. loss of nursing license

Nursing Management of Controlled Substances

Durham- Humphrey Amendment – 1952 ( to the Federal Food Drug and Cosmetic Act -

FFDCA) Separated drugs into two classifications: legend – prescription drugs- must have

inscription: Caution Federal Law prohibits dispensing without a prescription

non- prescription drugs

Ryan Haight Internet Pharmacy Consumer Protection Act of 2005

Bill introduced into Congress – to amend the FFDCA with respect to the purchase of sales on internet

Legislation : Drug Distribution

Canadian Food and Drug Act

Canadian Narcotics Control Act

Similar Legislation to the U.S.

Familiar with : Institutional policy Laws Professional regulations ( nurse practice

act) Cannot administer medication without an

order Patient education important safety

concern

Nursing Management of Drug Therapy

1. What is the purpose of the USP and NF ? 2. What is the purpose of the omics

technologies? 3. Explain how drugs are named ? 4. How are drugs classified? Why is this

done? 5.Discuss the purpose and intent of the

Food, Drug, Cosmetic Act and Durham – Humphrey amendment .

Review

6. Explain the purpose of clinical trials. Discuss advantages and disadvantages

7. What are controlled substances ?Nursing responsibilities/ special precautions

when administering these? 8. Safe drug use to be taught to patients?

Review