Pharmacology Basics

Pharmacology Basics

First rule of thumb:
NEVER EVER ADMINISTER A DRUG YOU ARE UNFAMILIAR WITH
* Ancient vs. Modern Pharmacology
o Pharmekos-study of medicine/drug
o Ology-study
* Studies effects of drugs/how they exert their effects

Therapeutic Purposes of Medications
* Prevent disease
* Diagnose disease
* Cure disease
* Relief of symptoms

Drugs
* A drug may be defined as:
o Any substance taken by mouth; injected into a muscle, blood vessel, or cavity of the body; inhaled, or applied topically to treat or prevent a disease or condition.
* Drug- any substance that alters physiologic function w/potential for affecting health
* Drug interaction
* Adverse drug reaction-undesirable drug effect

Sources of Drugs
* Plants
* Animals
* Minerals or mineral products
* Synthetic chemical compounds
* Biotechnology

Drug Nomenclature
Drug Classification Indicates
Forms or Preparations of Drugs
* Liquid (solution, elixir, emulsion, spirit, syrup, suspension)
* Solid (tablet, capsule, powder, granules)
* Suppository (rectal, vaginal)
* Creams or lotions
* Aerosol
Sources of Drug Information
* Pharmacology textbook
* Pharmacists
* Internet sources
* Journal articles
* Drug reference books

Drug Standards Ensure
* Strength or potency
* Purity
* Efficacy
* Safety
* Bio-availability

Federal Drug Laws in the USA
Categories of Controlled Substances
* Schedule I - not approved for medical use and have high abuse potential
* Schedule II - used medically and have high abuse potential
* Schedule III - less potential for abuse but may lead to physical or psychological dependence
* Schedule IV - some potential for abuse
* Schedule V - contain mod. amounts of controlled substances, limited abuse potential

Scope of Management
Medication Assessment
Name of Medication
Include Generic & Brand Name Classification
Ordered Dose & Route
Is Dose Safe?
Standards of Practice
* Information for Administering Medications
o Generic Name/Trade Name/Classification
o Clinical Uses/Safe Dosage
o Mechanism of Action
o Side Effects/Adverse Effects
o Contraindications/Precautions
o Significant Drug Interactions
o Monitoring Needs/Client Teaching
o Evaluation of Effectiveness

N.C. Nursing Practice Act
Routes of Administration
Three Phases of Action
Pharmaceutics
Pharmacokinetics
Factors Which Influence Drug Absorption
Factors Which Influence Drug Distribution
Protein Bound Drugs
Highly protein bound drugs
First Pass Effect
Serum Half-Life
Pharmacodynamics
Time Intervals of Drug Action
Therapeutic Index
Drug interactions:
Drug Effects
Non-therapeutic Drug Use
Common or Serious Side Effects
Drug Related Variables Affecting Drug Actions
Client Variables Affecting Drug Actions
Nursing Process
Assessment
Planning
Implementation
Evaluation

Pharmacology Basics.ppt

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Antiretroviral Therapy

Antiretroviral Therapy: Adherence, Drug Interactions, and Safety Among Women
Presentation by: Melissa D. Johnson, PharmD, MHS

Objectives
* Identify adherence barriers and motivators specific to women
* Discuss several drug-drug interactions of particular interest among women with HIV
* Describe mechanisms of gender differences antiretroviral pharmacokinetics and the potential implications of this on toxicity

Factors contributing to poor adherence among women
HIV-infected women have higher incidence of:
o Depression
o Emotional stress
o Fatigue and anxiety
o Physical and sexual abuse
o Stigma, rejection, and isolation
o Hiding diagnosis

Barriers to adherence among HIV-infected women
Factors influencing adherence
* Treatment experiences
* Support from provider and others
* Health care environment and material factors
* Informational resources

Factors influencing adherence
Beliefs, attitudes and behaviors regarding adherence among women
Motivators of adherence
o Physician
o Quasi-scientific rationale
o Belief that the drugs work
o Religiosity and faith (support from God)
o Family members (mom)
o Secular popular cultural prescription
o Television talk shows
o The body instinct (my body tells me when I need it)
o Friends
o Self (I know when I need it)
o The belief in the power of positive thinking
o Individual responsibility

African-American women in an inner city clinic, cited sources encouraging adherence:
Approaches to improve adherence
* Motivational interviewing/group workshops
* Positive life skills programs
* Modified directly observed therapy
* Cognitive-behavioral therapy for substance abuse
* Customized telephone calls
* Buddies/peer support

Approaches to improve adherence
KHARMA project
Motivational Interviewing principles:
* Expressing empathy and building rapport, through reflective listening and acceptance
* Highlighting the discrepancy between current behavior and it’s effect on the patient’s life goals
* Avoiding conflict by using a positive approach and avoiding negating and direct confrontation
* Assisting patients in exploring options, as a means of overcoming ambivalence or resistance to change
* Supporting self-efficacy and encouraging patients to consider and choose personal options, and to develop belief in their own power to make changes

Schema of KHARMA Workshops
Summary & Termination: Putting it all Together with Goals and Values
Disclosure of HIV Status: To tell or Not to Tell
Risk Reduction behavior: Balance & Negotiation
Risk Reduction behavior: Knowledge & Skills
Sharing successes & ART Strategies
ART Adherence: Change & Exploring Goals
ART Awareness: The Good Things and the Not so Good Things
Introduction, Group Guidelines, Exploration of Lifestyles

Resources
* United Nations
o UNIFEM Gender and HIV/AIDS Web Portal
http://www.genderandaids.org/index.php
* South Africa HIV and AIDS Information Dissemination Service
o Women’s treatment literacy toolkit:
http://www.safaids.org.zw/viewpublications.cfm?linkid=47
* DHHS
o HIV/AIDS Bureau
http://hab.hrsa.gov/publications/womencare05/WG05chap2.htm
http://hab.hrsa.gov/publications/womencare05/WG05chap5.htm

Approved Antiretroviral Agents 1987-2008

Non-nucleoside RTI
Protease Inhibitor
Fusion Inhibitor
Nucleoside RTI
Common Drug Interactions
Drug Interactions: Methadone
Decrease Methadone levels
NNRTIs
* Efavirenz
* Nevirapine
PIs
* Amprenavir/fosamprenavir
* Nelfinavir
* Ritonavir
* Lopinavir/ritonavir
* Saquinavir/ritonavir

Methadone effects on other agents:
Drug Interactions: OCs
Recommendations
Interaction
At risk for pregnancy
Mechanisms of differential PK
Lower hepatic p-glycoprotein in women
CNS effects
Toxicity
Concentrations in Women vs. Men
Toxicity in Studies of PIs
HAART including at least one PI
Toxicity in women vs. men
Focusing on Safety
Summary

Antiretroviral Therapy.ppt

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Food/Drug Interactions

Food/Drug Interactions
Presentation by:M. Burns, PhD, RD

Drug therapy
* Long-term care
* Numerous drugs
* Therapeutic side effects
* Alters nutritional status

JCAHO
* Joint
* Commission
* Accreditation
* Healthcare
* Organizations

Drug-induced malnutrition
* Numerous meds at one time
* Sudden increased need
* Genetics
* Body composition

High-risk Groups
* Developing fetus, infants
* Pregnant women
* Elderly
* Chronically ill

What is a drug?
* Chemical that interacts with a living organism to produce physiologic response
What is bioavailability?
* Proportion of drug that passes into the circulation
* Reflects both ABSORPTION and METABOLIC USE

Remember...

with increased meds there is an increased chance for drug-nutrient interactions.

Commonly affected nuts
* Calcium
* Folate
* Pyridoxine
* Vitamin A
Effects on Nut’l Status
* Dietary intake
* Affects nutrient absorption
* Affects nutrient metabolism
* Include meds in SOAP note
* Assess nut’l status in regards to interactions

Appetite -- Table 18.1 and 18.3
Dysgeusia -- change taste sensation
Hypogeusia -- reduce acuity of taste
Aftertaste -- Table 18.2
Cravings -- duiretics crave salty foods
Absorbed in small intestine, therefore, FNI are common here…
Transit time -- laxatives, diuretics
Bile acid -- affects fat absorption, chol, ADEK
GI environment -- antacids changes pH
Mucosal lining -- laxatives
Antivitamins -- used in chemo tx, rheumatoid arthritis
MAO inhibitors -- monoamine oxidase, calls for tyramine-restricted diets
Anticonvulsants -- phenobarbital -- low folate, biotin and VD
Oral conceptives -- folate and B6
Anti-inflammatory -- Ca absorption reduced and excretion increased can cause GI bleeding leading to Iron deficiency and protein loss
Anti-hypertensives -- Diuretics affect mineral metabolism (K, Ca, Mg, Zn)

Food / Drug Interactions.ppt

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