Drugs used in chronic conditions Even on a small dose of 2.5mg of bendroflumethiazide, the doctor should be carrying out routine urea and electrolyte blood investigations yearly. patients with acquired immuno-deficiency syndrome (AIDS) for a particular type of pneumonia. However, this improvement is often only short-lived and as time goes by the levodopa becomes less effective. However, the drug has the advantage of being less likely to trigger immune thrombocytopenia. Demonstrate an understanding if what is meant by the term patient group directions. Drugs used in treating asthma Ø Ø Ø Ø Ø Ø Two groups of drugs are used: bronchodilators and inhaled anti-inflammatories. This means that when fibrin is formed it cannot stick to the platelet so the plug to block bleeding does not occur as the platelets cannot clump together. How many grams of sodium would be in 1000ml? However the drug is given for certain acute or serious infections, for example gram negative bacteria which cause meningitis. Local anaesthetics Local anaesthetics are analgesic drugs designed to be used clinically to produce a reversible loss of sensation in a particular part of the body. Trimethoprim This sulfonamide drug is sometimes given as a combination called co-trimoxazole. Like a number of other antibiotics it does not have the capacity to cross the bloodbrain barrier. Cradock, S. (2004) Essential reading on type 1 diabetes, Nursing Standard, 18(49): 29. How many ml will she draw up for you to check? Naloxone is given to reverse the effects of morphine. How many tablets would you give? maternal newborn nursing care by susan ward. Name two drugs used in bipolar depressive illness. However, in asthma these cells are responsible for releasing a group of substances called prostaglandins and platelet-activating factors which sustain the bronchial hyperactivity. Usually presented as dilute preparations (e.g. Theophylline has a stimulant effect on the central nervous system 104 causing increased alertness, and can interfere with sleep. Clinical tip Age-related adverse drug reactions As previously noted, the elderly and the very young are at a higher risk of drug reactions and should be closely monitored when prescribed medications which have a higher incidence of drug reactions or Drugs are sometimes administered rectally in small children. This means that the barbiturate drugs cause a potentiation of GAB-A transmission and a reduction in neuronal activity. Hillson, R. (2002) Practical Diabetes Care, 2nd edn. Some patients do not want to be active partners in decision-making, and their wishes should not be ignored. Supply and administration of medicines Ø Nurses can now be involved in the supply and administration of medicines. Clinical tip Clozapine carries the risk of lowering the agranular white blood cell count (agranulocytosis), therefore monitoring of blood levels of neutrophils is a mandatory condition of treatment. function. Using the example of high blood pressure, there are many consequences of not taking antihypertensive medication. and Stevens, C.W. body, nurses are unable to meet their professional and legal responsibilities to their patients. This nausea is usually transient and will pass after about two weeks, hence it is important to educate the patient about this, as most people can put up with a mild side-effect for a short period if they know it will pass, and they will continue with the medication. You are helping him to dress when you notice a red pinprick rash all over his upper body. For example, if the patient is taking oral anticoagulants the effect of these will be unpredictable if phenytoin is also given. Finally, we have included 10 multiple choice questions for each of the 10 chapters in the book. The section is by no means comprehensive and further reading will be necessary in order for you to gain more detailed knowledge. Joking apart, you should be aware of which route the medicine is to be given. Viruses do not have the ability to reproduce and replicate themselves so they have to borrow these mechanisms from their host cell. These medicines work by influencing the ribosome in the cell to stop making the viral proteins. In this way they stop the virus from replicating. Amoeboflagellates cause entamoeba histolytica. Finally, other chemical messengers summon these phagocytic cells from the area of damage by the process of chemotaxis. Demonstrate an understanding of the links between the pharmacology of therapies used in treating asthma, diabetes, hypertension, Parkinson’s disease and epilepsy and the care given by the health practitioner. This means the insulin dose is determined by the person’s blood glucose value, which is obtained at predetermined times (e.g. The most serious side-effect is poisoning of the liver (hepatotoxicity). This attitude actually requires more skill on behalf of the prescriber, who, in order to most appropriately prescribe, requires information about lifestyle and practices that will enable them to make a more informed choice. Crushing or chewing will cause the drug to be released too soon and may result in side-effects. Captopril has a powerful inhibiting effect on the conversion of angiotensin I to angiotensin II. Finally, amoebae move by extending parts of their cytoplasm into false limbs called pseudopodia. Ø Some drugs when absorbed from the stomach enter the portal circulation and pass through the liver. Antiretroviral therapy Antiviral therapy is aimed at using a combination of agents that act at different points in the replication of the virus within the human cell. There are two classes: esters group and amides. Recently, a person suffering from leukaemia was receiving regular chemotherapy by IV infusion. Debbie Robertson joined the faculty of Health and Social Care at University of Chester in 2004, where she is currently employed as a Senior Lecturer. Metronidazole is used to treat trichomonas vaginalis. How much do you draw up? As a result, when pain producing products, such as bradykinins, are released, greater pain is felt by the individual. The nurse is transcribing new orders written for a patient with a substance abuse history. This means that often, to obtain full control of the symptoms of schizophrenia, the doses used can cause increased side-effects. Now suitably qualified district nurses were able to prescribe from a limited formulary for specific clinical conditions. The drug is often tried on patients in which conventional therapy has failed in reducing their seizures. First, it reduces the amount of glucose produced by cells in the liver. Primary care specialists, GPs and pharmacists should be involved in informationgiving and evaluation of the patient’s level of concordance. Drugs used in chronic conditions increased heart rate (tachycardia) and begin to sweat. Aspirin also has a number of other side-effects which are dealt with in more detail in Chapter 5. we are still learning what the mechanism of action is. Within a few minutes the organisms have found their way to the liver. 148 Lapham, R. and Agar, H. (2003) Drug Calculations for Nurses: A Step-by-step Approach, 2nd edn. Calculations 1 How many micrograms are in 2mg? Reflect on the holistic care of this patient with the nurse being a prescriber and compare it to the differences in Mrs Simpson’s care if the nurse were not able to prescribe. Some are round in shape and are called cocci. This is the basis of the action of the vitamin K antagonist group of anticoagulants, for example, Warfarin. Discuss this with reference to: pharmacodynamics: mode of action of the two drugs; pharmacokinetics: the need for regular dosing to achieve therapeutic plasma concentration; how you would put this information in terms that Alex and his parents will understand. Time of arrival and contact time at absorption site. Her family are worried she may not be taking her medication properly. Instructor, New York University Other drugs in this group e.g. Product packaging can be troublesome for people with limited dexterity. This is, however, the main factor to consider in promoting concordance. Watkins, P.J. Cause renal and gastrointestinal side-effects. Department of Health (DoH) (1999) A Review of Prescribing, Supply and Administration of Medicines – Final Report (Crown Report 2). It is however essential that the partnership is functional. All patients receiving long-term therapy are advised to carry a card stating that they are receiving steroid treatment, which must not be stopped abruptly. Benzodiazepines are still one of the most effective treatments for acute and transient anxiety. The main use is in patients who have had acute myocardial infarction following blockages of the coronary artery. Glucose being formed by proteins leads to muscular weakness and, in children, can affect growth. Transport systems These are also known as carrier molecule interactions. If this is not treated, death ensues. Due to the unwanted effects of amphotericin researchers have been working hard to come up with other ways of administering this drug. a) Factor X b) Factor VII c) Factor VIII d) Factor III 98 g Chapter 6 Anticoagulant therapy f 2 Where in the body is heparin normally manufactured? Also, due to the length of time it has been used, many bacteria have developed enzyme systems to combat its effects. This group of drugs goes under the umbrella term of disease-modifying antirheumatoid drugs (DMARDs). Conditions such as chickenpox, shingles, conjunctivitis, warts, measles, mumps and rubella are caused by viral infections. This allows patients to see whether or not they have taken their medication. This may result in a combination of signs and symptoms called ‘grey baby syndrome’ in which the baby vomits, has diarrhoea, is flaccid, has a low temperature and is ashen grey in colour. Respiration ceases with defecation, micturition and salivation often occurring. One such drug is nateglinide, which works in a similar way to sulfonylureos in that it enhances secretion of insulin from the beta cells in the pancreas. Clinical tip It is important that you monitor the intravenous site regularly for pain, swelling and redness. The action of flooding the tissues with fluid and plasma proteins is important as it dilutes any toxins which may have been released, especially by bacteria. It is a broad spectrum antibiotic which can be used against gram positive and gram negative organisms. Nociceptors are non-adapting, which means they are stimulated at the same level of intensity each time the threshold level is reached. Steroids can cause secondary diabetes and hypertension Can cause osteoporosis and fractures. Rather than lots of neutrophils and macrophages being present, there are now large amounts of lymphocytes. SSRIs have far less side-effects that other antidepressants and are safe in overdose. HIV is the result of the invasion of a particular lymphocyte called a helper T cell (T4 cells). However, the most important key to treatment of diabetes is diet. a) Clopidogrel b) Tinzaparin c) Dipyridamole d) Hirudin 7 What blood test is used to measure the effectiveness of Warfarin? The side-effects are similar to those caused when taking metronidazole. 6 A doctor has prescribed 0.25mg of digoxin. Ø Drugs such as sodium valproate and carbamazepine have also been found to be beneficial in the treatment of bipolar disorder. Ø The cardinal signs and symptoms of inflammation are redness, pain, swelling, heat and loss of function. McLoughlin, C. (2004) Diuretic drugs, Professional Nurse, 20(2): 50–1. Jarvis, J., Burden, A. and Burden, M.L. It works in people with type II diabetes in three ways. Long-acting insulins By mixing insulin with protamine and zinc an even longer action can be elicited. Pharmacodynamics and pharmacokinetics Learning Objectives Introduction Absorption Distribution Biotransformation Excretion General and molecular aspects Drug action Agonistic and antagonistic drug action Basic Introduction to units and conversions Case Studies Key learning points Calculations Multiple choice questions Recommended further reading 1 1 2 2 4 4 5 5 6 7 8 10 11 12 13 14 2. a) Adrenaline b) Dopamine c) Serotonin d) Noradrenaline 3 Benzodiazepines bind to which receptor complex? You have available 100mg in 1ml. Morphine is thought to block these channels from opening so that the pain signal breaks down. Administration of medicines is a skill that you will be exposed to during your pre-registration education. All can lead to potentiation of drug action which in turn can cause more side-effects. She has been a heavy smoker for 35 years and has been suffering from flu-like symptoms for the past 10 days. The testing of basic levels of numeracy has now become part of the criteria for entry onto nurse education programmes. Some protozoa and certainly viruses need the mechanisms from our cells in order to replicate and grow. Look at the NMC standards for medicines management, and review the implications for yourself and the staff nurse if you administer this medication. In addition to the affects of the disease there are also side-effects to the medication. For a patient to adhere to their medication regimen, they need very little information from the prescriber. Edinburgh: Mosby Elsevier. Sometimes these drugs are given in combination with levodopa in order to reduce overall side-effects or improve the patient’s response. Used for idiopathic, postencephalitic and symptomatic Parkinson’s disease especially in patients who are rigid, have bradykinesia, or are elderly. More recently this approach has changed with increased knowledge of the addictive and dependence problems and the abuse potential associated with benzodiazepines such as Diazepam and Temazepam. Eventually, these proteins are assembled into new HIVs in the endoplasmic reticulum and golgi apparatus of the cell. Parkinson’s disease was first described by James Parkinson in 1817. The medicine should be applied to the skin under an occlusive dressing and should be left for 60 minutes before the procedure. How many ml will you administer? Penicillamine This drug was discovered in the 1950s as being in the urine of patients who had taken penicillin. P phantom limb pain: the sensation of pain that is still reported from a patient after the removal of a limb/body part. Most of the questions we have posed are basic in nature and are only included to give you a foundation. Key learning points Introduction Ø Ø Ø Ø Infectious diseases are grouped into bacterial, viral, fungal and protozoal. Ion channels Ion channels provide receptors which drugs can interact with. Therefore, various semi-synthetic versions have been prepared by altering the basic biochemistry of the drug. London: NICE. Inhaled corticosteroids Glucocorticoids are dealt with in more detail in Chapter 5. Wallymahmed, M. (2006) Insulin therapy in the management of type 1 and type 2 diabetes, Nursing Standard, 21: 50. The keys for the controlled drugs cupboard should be kept separate from other keys and the nurse in charge should keep these on his/her person while on duty. It is also found in cells, namely mast cells and basophils. These are mainly plasma, interstitial fluid and intracellular fluid. Histaminergic side-effects (sedation). This leads to a very slippery customer indeed when trying to develop treatment. Philadelphia, PA: Lippincott Williams & Wilkins. Drugs that are given for this debilitating disease do work by increasing dopamine in the brain in a number of ways, however, despite these pharmacological interventions patients do not return to a normal state. All the questions are based on information included in the chapter so there are no trick questions. a) The same day b) Two to three weeks c) One month d) Six days 10 Psychotic symptoms can be a) Positive and additive b) Negative and additive c) Positive and negative d) Negative and cumulative Recommended further reading Beckwith, S. and Franklin, P. (2007) Oxford Handbook of Nurse Prescribing. Clinical tip While taking Warfarin, patients will have regular blood tests to establish their INR. Generally, there are two classes of local anaesthetic: ester agents, such as cocaine, procaine and amethocaine, and amides such as lignocaine, pilocaine and bupivacaine. Cyclo-oxygenase pathway 2 Inhibitors Ø New set of drugs. Ironically it is often patients themselves who remain passive when it comes to consulting with health care professionals about their medicine management and behavioural changes. k Louise Mason is 12 years old. Side-effects include dryness of mouth, blurred vision, constipation and retention of urine. It is a powerful anticoagulant but is broken down by digestive enzymes; therefore, it is given by IV infusion. Valproate helps to stop the breakdown of GABA and so leaves enough of this chemical in the brain to help prevent the fits. Complement proteins are involved in chemotaxis. May be used with either a sulphonurea or biguanide but not both. Mosby Elsevier. Ø The NMC has set out guidance for the administration of medicines. They do not have any visible forms of movement and as a result most of them become intracellular in nature. 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. List the factors that increase the likelihood of thrombosis occurring. Amphotericin works by targeting fungi and some protozoa. g 67 Chapter 4 Antimicrobials f Protozoa Ø Ø Ø Ø Ø Ø Ø Ø These are simple eukaryotic organisms. Clinical tip It is important as a nurse to recognize that babies, particularly those less than 6 months old may not have a mature liver and therefore drugs are given with great caution. At some point you will be working in a busy acute setting where the turnover of patients is high. glucocorticoid: hormones secreted by the adrenal cortex. They may have difficulty walking (ataxia). This is an injection of a drug, usually given intramuscularly, which releases its active compound in a consistent way over a long period of time. However, after this period patients’ pain and joint swelling starts to lessen. These are collagen and elastin fibres and lie underneath the thin inside layer of the vessel. Chapter 5 Anti-inflammatory drugs Leflunomide This drug is thought to work on the cell’s DNA and RNA. They also have addictive properties and patients can easily become dependent on them. a) Sedation with a sleeping tablet b) Reduced blood pressure with an antihypertensive drug c) Nausea with an emetic drug d) Rash with an antibiotic drug g 23 Chapter 2 Adverse drug reactions and interactions f 9 A drug given to prevent an adverse effect is called a) A pro-drug b) A prophylactic drug c) A drug given to prevent metabolism of another drug d) A placebo 10 Anaphylaxis is an example of a) A Type B ADR b) A predictable drug side-effect c) Polypharmacy d) A Type A ADR Recommended further reading Beckwith, S. and Franklin, P. (2007) Oxford Handbook of Nurse Prescribing. Alteration of a drug will affect its pharmacokinetics and dynamics. Basically, the cell swallows the infective virus and allows it to enter the cytoplasm. 73 Chapter 5 Anti-inflammatory drugs Introduction Inflammation is the body’s response mechanism to cellular damage. This does not match the analgesic or respiratory depressive effects of morphine. More than 1,000 review questions grouped by textbook chapter objective. The drug is generally used in milder cases of the disease or in combination with other DMARDs. O’Connor, B. It has its actions on the dopaminergic system and receptors. Does not cause weight gain. Here they encounter and invade the red blood cells (erythrocytes) and further their development. If necessary it can be given by other routes – for example, topically into the eye for conjunctivitis. Mann, E. and Redwood, S. (2000) Improving pain management: breaking down the invisible barrier, British Journal of Nursing, 9(19): 2067–72. a) Prostacyclin b) Penicillin c) Penicillamine d) Paracetamol 9 What is the drug of choice in treating rheumatoid arthritis? One of the main reasons for using a combination of drugs is to delay the onset of resistance in any one of the therapies. The drug is given via the SC route twice a day until the patient is able to mobilise well. Excretion Once drugs have had their desired effect they need to be excreted by the body. Pathological changes in asthma The changes in the respiratory system that bring about asthma are initiated by an allergic reaction. Painful stimuli are received by the nociceptors and then transmitted by two different types of nerve fibres: A delta fibres and C fibres. This mechanism has an onward effect which facilitates an increase in mood and makes Fluoxetine and drugs similar to it good antidepressants. The drug can, however, rarely cause serious cardiac problems. A few people may put on weight even without eating more. tricyclic antidepressants and monoamine oxidase inhibitors); the concentration of some monoamines is notably reduced in the cerebrospinal fluid (CSF) of depressed patients. Examples include flucloxacillin, ampicillin and amoxacillin. This is a Catch 22 situation as atherosclerosis leads to further hypertension. Absorption Ø The main factor which relates to absorption of drugs is the route of administration. A neurone has branch-like processes called dendrites that convey incoming messages (action potentials) towards the cell body. Clinical tip If a patient is a diabetic, controlling their blood sugar will become more difficult when taking drugs for high blood pressure. The patient simply needs to read the instructions and adhere to them. Specific cells will now have been created by the body to counteract these foreign proteins, which are called antigens. Children’s kidneys are immature at birth and cannot efficiently process drug molecules. Master the basic principles of pharmacology and safe medication administration with Clayton’s Basic Pharmacology for Nurses, 18th Edition.Known for its impeccably accurate and up-to-date drug content, this best-selling text consistently underscores medication safety as it guides you in applying pharmacology information to the nursing process. However, these drugs are only bacteriacidal in the presence of oxygen. our cells) than in prokaryotes (i.e. It is the commonest cause of death in acute opioid poisoning. Used in candidal infections. The amoeba can now be transported to other organs in the body giving rise to a high temperature and serious consequences. This tonic stage lasts for approximately a minute. The body will obviously make more GABA transaminase so the drug has to be given continuously. All Rights Reserved. They may feel sick, have no appetite and suffer a slight Chapter 7 Drugs used in chronic conditions Box 7.6 Drugs used in Parkinson’s disease Drug type Generic name Information Dopamine precursor. The action of this class of drugs is complex. 2 How many grams are in 2.5kg? Ø The inflammatory response is a local reaction. This is often the case in what are termed autoimmune diseases, where the body’s defence mechanisms appear to be turned on themselves. The plasma proteins and various white cells squeeze through the walls of capillary vessels and gain access to the site of tissue damage, infection or foreign body. Amantadine is used against influenza A virus. They can also cause problems if taken with alcohol as it can increase their effects. If the dose is increased it can lead to dizziness, ringing in the ears (tinnitus), headaches and blurred vision. This response is intended to remove debris from the tissue, such as micro-organisms and other particles of dead tissue. Some clinical areas have developed separate protocols for enteral administration of medicines. Asthma Asthma is the leading chronic disease in developed countries and its incidence is increasing. (2007) Pharmacology and Medicines Management for Nurses, 4th edn. The drug can be given orally or by other routes and becomes well distributed in the body tissues, including bone. Therefore, women can acquire the disease from infected men and women, whereas men usually only contract it from infected women. How many ml would you give? Codeine is a weak opioid. You have reconstituted the morphine to make a dose of 10mg in 1ml. Drug distribution is affected by barriers (e.g. Formation of a platelet plug begins with exposure to collagen and elastin fibres. This coating also protects the organism, making it resistant to destruction by the body’s natural defences. This usually recovers once the treatment has stopped. This requires an active participation by the patient, and a confident and self-aware prescriber or medicines educator. All these drugs are given orally, however saquinavir is subject to metabolic breakdown by an extensive first pass effect. This will relieve the acute symptoms and should minimize the impact of chronic complications on the individual. magnesium), so are not given alongside antacid preparations. No side-effects of note Tablets Terbinafine and fluconazole Terbinafine is used to treat nail infections. Their effects are somewhat governed by dosage, outside influences and the health of the patient. It must be remembered that these drugs can be absorbed in a significant amount, especially if applied to very vascular areas. How would you put the following information into terms that Louise and her parents will understand: The mode of action of these three classes of medicine? If patients are prescribed the drug, they should be advised to get a baseline eye test and repeat this on a six-monthly to yearly basis. Future antifungal therapy Resistance to antifungal drugs is now emerging. This is why it is important to impress upon the patient the need for regular blood monitoring while on this therapy. If analgesia is given and the patient reports reduced or relieved pain, the drug has been distributed to its target site. This is a life-threatening reaction that some people have to antipsychotic medicines. Ø Antagonists bind with receptors but do not activate them or cause a response. Probably the most common and popular drug in this category is aspirin. M mycobacteria: rod-shaped acid fast bacteria implicated in tuberculosis. Most of it is excreted in an unchanged form by the kidneys, therefore the dose must be lowered if given to an individual with impaired renal function. It is also important for the patient to consider that there will be a risk from taking this medicine during pregnancy. This species of protozoa is responsible for diseases such as sleeping sickness and certain forms of vaginitis and urethritis. How many ml of suspension (30mg in 5ml) should you give for a dose of 300mg capsules? However, drugs such as thiazide diuretics and corticosteroids lessen the hypoglycaemic effects. Nucleoside reverse transcriptase inhibitors Ø Stop the virus using an enzyme called reverse transcriptase. Auranofin also has other advantages as well as the way it is administered. They have what is termed partial efficacy. These cells ingest small portions of dead tissue. Protease inhibitors stop the virus making new viral proteins in the host cell. Both parties should also be informed that because they have been treated once does not mean that they cannot become reinfected. This drug may also lead to disorientation and lack of concentration. 4 The doctor prescribes a patient nefopam 60mg by intramuscular injection. 37 Chapter 3 Local anaesthetics and analgesics Respiratory depression. The dose of heparin is adjusted so that a value of 1.5–2.5 times the normal sample is achieved. The likelihood of drug interactions and adverse reactions is increased in patients on more than one medicine and higher in those who take more than four medications (polypharmacy). Insulin is given by SC injection. 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. One of the major problems of having hypertension is that it has few symptoms and individuals often only discover they have the condition on routine screening. Hence, leflunomide reduces inflammation in the joints, as well as slowing down progressive bone erosion and joint deformity. The body manages to ‘wall off ’ these infected phagocytes by creating pockets which are known as tubercles. For some people however, feelings of anxiety can be intolerable and can become disabling. How many tablets will you give? 1 Adherence in drug therapy is defined as a) Sticking to a medicines regimen b) Commencing a medicines regimen c) Stopping a medicines regimen d) Monitoring a medicines regimen 2 Concordance should be aimed for a) In patients on four or more medicines b) In chronic disease management c) In all patients prescribed medicines d) Only in patients who have prescription-only drugs 3 Patient partnership in prescribing a) Can only work in patients with a health care background b) Helps promote concordance c) Can only be achieved in hospital settings d) Is inappropriate with children 4 Concordance is best achieved when a) The doctor makes the prescribing decisions b) The nurse makes the prescribing decisions c) The patient makes the prescribing decisions d) All of the above 5 Concordance can be affected by a) The drugs prescribed for the patient b) The patient’s understanding of the medicines c) The cost of the medications d) How often the patient attends the surgery 6 Patients being provided with information on their medicines a) Is the main responsibility of the prescriber and the pharmacist b) Is the responsibility of the patient and the nurse c) Is the responsibility of the prescriber only d) None of the above g 157 Chapter 9 Patient concordance f 7 What route of administration of drugs is likely to have the best compliance? Explain the possible reasons why this antibacterial agent is prescribed in favour of alternatives. Inhaler technique is an important part of patient education. A nurse who administers a medicine in a way that falls outside the product licence undertakes a degree of liability for any adverse effects caused by maladministration. The drug can also be given by IV infusion and is widely distributed throughout the body. 9 You have a vial of gentamycin containing 80mg in 2ml. Its mechanism of action involves inhibition of protein synthesis in bacteria. Calculations 1 2 3 4 5 6 7 8 9 10 2 tablets 2500g 0.12ml 1,250,000 micrograms 2.5ml 2.5ml 200ml per hour 100,000mg 25g 300g Multiple choice questions 1 2 3 4 5 6 7 8 9 10 A C B D B A D C D B Chapter 10 Case study j, Mr Ajani The patient medicines administration chart is not a prescription but a direction to administer medication. Controlled drugs There is much legislation surrounding the prescription, supply, storage and administration of medications. Using the BNF is imperative in drug administration Nurses’ basic arithmetic has been criticized for drug errors. Gatford, J.D. This is called a Jacksonian seizure. Ø Inverse agonists are drugs which can reduce the normal activity of the cell. They include nausea, anorexia and sometimes lethargy and dizziness. How much is required to give a 90kg man a dose of 1.5mg per kg? Any such risks should be balanced against the effectiveness of using these drugs in treating a patient’s depression. Antipsychotics are associated with a high level of sideeffects, some of which are quite severe in their nature and are commonly referred to as extrapyramidal side-effects (EPSE). 3 Codeine is available in three strengths as tablets, 5mg, 10mg and 20mg. It is estimated that one in five patients who suffer from asthma run the risk of having a severe reaction to the drug. How much do you need to administer 100mg? intramuscular (IM): injection into a muscle. He has his own business, which is a roofing company. Downie, G., Mackenzie, J. and Williams, A. Azaspirodecanediones Buspirone is the only drug in its class available for the treatment and management of anxiety symptoms. Epileptic seizures result from an imbalance of the excitatory and inhibitory mechanisms within the brain, the nerve impulses generated from the neurones being abnormal and uncoordinated. In inflammatory bowel disease the use of rectal medication can be a cause for concern. Give three examples of different groups of antidepressant drugs. The NICE guideline on the management of depression (2004) recommends the use of SSRIs. The fact that drugs have more than one name makes the potential for error greater. ‘Microvascular disease’ refers to damage to smaller vessels, resulting in eye problems (retinopathy) and kidney damage (nephropathy). A myelinated nerve is one covered by a fatty insulating substance called myelin. In acute asthma the main reason for obstruction of the airways is bronchoconstriction caused by a substance called histamine. They are thought to be safer than lithium but are still associated with serious side-effects. (2000) Clinical Pharmacology for Nurses, 16th edn. 5 If a patient has a fluid intake of 30ml each hour, how much fluid (in ml) have they had after 12 hours? Philadelphia, PA: Saunders Elsevier. Alpha-adrenoreceptor antagonists A drug called prazosin was the first selective alphaantagonist to be developed and was used for many years. This leads to an increase in the amount of 5-HT present in the synapse available for action at receptors which respond to 5-HT and has an antidepressant effect (see Figure 8.3). Side-effects are related to the dose given, the commonest being skin problems. Edinburgh: Churchill Livingstone Elsevier. Fluconazole This medication is often advertised on television in connection with preventing vaginal thrush. Bacteria are classified as being gram negative or gram positive. Over time, the inflammation causes Chapter 5 Anti-inflammatory drugs damage to the joint, the cartilage and parts of the bone involved in forming the joint. Discuss this with reference to: Bacterial and viral infections. Patients must carry a card and have good discharge advice. Coben, D. and Atere-Roberts, E. (2005) Calculations for Nursing and Healthcare, 2nd edn. Drugs in this group can cause enzyme inhibition in the liver. Cyclo-oxygenase pathways in most pharmacological texts are denoted by the prefix COX followed by the number of the pathway (e.g. Calculations 1 A doctor has prescribed 800mg of erythromycin. Karch, A.M. (2008) Focus on Nursing Pharmacology, 4th edn. The neurotransmitter allows the post-synaptic neurone to be excited or inhibited. Tinidazole is used alongside metronidazole to treat entamoeba histolytica. enteric coating: protective coating which ensures a medicine is released after leaving the stomach. 57 Chapter 4 Antimicrobials Immunoglobulins Immunoglobins contain antibodies against specific viruses that the patient may encounter in the population. 3 A 3-year-old who weighs 13.5kg has been prescribed ibuprofen 5mg per kg three times daily. London: Arnold. For many years he has been treated with a variety of typical antipsychotics, and the medical staff suggest he is drug resistant and are trying him on the newer atypical therapy. It would seem on the face of it that all we need is to replace the lost dopamine and the patient would return to a normal state. Phenytoin This drug is still widely used but not for absence seizures, which may get worse if the drug is administered. Local anaesthetics and analgesics 3 Chapter contents Learning objectives Introduction Neurones The nerve impulse Pain reception The body’s analgesic system Local anaesthetics Mode of action Preparations of local anaesthetics Topical anaesthesia Infiltration anaesthesia Nerve blockade (conduction anaesthesia) Extradural, epidural and caudal anaesthesia Spinal anaesthesia Intravenous local anaesthesia Unwanted effects of local anaesthetics Non-steroidal anti-inflammatory drugs Aspirin Ibuprofen Paracetamol Opioid analgesics Morphine Codeine Opioid antagonists Case studies Key learning points Calculations Multiple choice questions Recommended further reading Learning objectives After studying this chapter you should be able to: Understand how a nerve impulse is initiated and transmitted. Ø Partial agonists produce a response. The most popular model is the health belief model which puts forward the view that health-related behaviours or the seeking of health interventions depend on four factors: 1 perceived susceptibility (the person’s assessment of their risk of getting an illness); 2 perceived severity (the person’s assessment of the seriousness of the illness, and what this could mean for them); perceived barriers (the person’s assessment of any influences which may discourage the adoption of health-related behaviours); 3 154 4 perceived benefits (the person’s assessment of the beneficial outcomes of adopting the health-related behaviour). Enzymes Enzymes are biological catalysts that increase the rate of chemical reactions in the body. Calculations 1 A doctor has prescribed 0.25mg of digoxin. However, this is reversible by stopping the medication. Liver damage, with a yellow discoloration of the skin (jaundice), whites of the eyes (sclerae) and mucous membranes have been reported and can prove fatal. No drug is completely free from side-effects, but some effects are tolerable for some patients but may not be for others. Trounce, J. Insulin glargine is modified insulin and is opposite in its effect to insulin lispro in that it is designed to provide a constant insulin supply and mimic even more closely the body’s own physiological production of insulin. Even the ability of a person to obtain the prescription itself can be an obstacle. You should also inform them that many over the counter antacid remedies contain magnesium and aluminium so should be avoided during the course of treatment. 4 A client is prescribed 1.25mg of clonazepam and 0.5mg tablets are available. Any other information? This causes inflammation in and around the affected joints. Therefore, you may find the doctor or nurse practitioner prescribing a supplement. Clinical tip If you work in paediatric practice, you will come across EMLA cream. Correctly solve a number of drug calculations with regard to local anaesthetics and analgesic drugs. You have 75mg tablets. Morphine reduces the rate at which the gastrointestinal system moves (motility). Legal and Professional issues Learning objectives Introduction The correct patient The correct medicine The correct dose 159 159 159 160 160 160 vii Contents The correct site and method of administration Covert administration of medicines Alteration of medicines Reporting of drug errors Controlled drugs Supply and administration of medicines Prescribing law and non-medical prescribing Case studies Key learning points Multiple choice questions Recommended further reading Conclusion Glossary Answers Index viii 161 162 162 163 163 164 165 166 167 169 170 171 173 175 183 Introduction Administration of medicines, medicines management, nurse prescribing, clinical governance and risk management are all key areas of the role of the nurse. Aspirin This is a very versatile drug (see also Chapters 3 and 6). The pathophysiology is not completely understood but several theories have been postulated, including one linking dopamine to the condition. Another popular model is called the theory of planned behaviour. The difference between the two comes down to biochemistry. This keeps an ongoing tally of the amount of drugs used and also lists all the patients that the drugs have been administered to, along with the date and time of administration. Earlier we discussed tissue injury (see p. 28) and how prostaglandin release is implicated in this. Both drugs have elimination half lives of between 30 and 40 hours. 1. Hill, J. Explain the clinical observations which you would need to conduct for the duration of Cynthia’s treatment. Thiazide diuretics These are usually the first line treatment for mild to moderate hypertension, providing there are no contraindications. If erythromycin is administered intravenously rather than orally, a degree of inflammation and damage to the vessel that the drug is entering (thrombophlebitis) can be expected. Patient education This should be individualised to the patient and is an important component of nursing care. Sulpiride is a dopamine and 5-HT blocker and is effective in the treatment of schizophrenia. According to the Department of Health (DoH) approximately 4 per cent of hospital admissions are associated with adverse drug reactions (DoH 2001). Chronic inflammation. Like barbiturates, these drugs potentiate the effects of GAB-A but do so by a different mechanism. Glucocorticoids are involved in the body’s response to stress. Levy, D. (2006) Practical Diabetes, 2nd edn. The maximum effect takes place at four to six hours and its duration of action is between 8 and 12 hours. In a major blockade, the onset can be more variable so communication with the patient is paramount. This applies to unionized compounds (drugs without charge), and prevents the entire dose of a drug being excreted at once. Everett, J. 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 picture for the individual gets much worse if the amoeba breaks through the lining of the gut and invades the peritoneum, causing peritonitis. Clinical tip As with metronidazole patients should not consume alcohol when taking tinidazole. As long as this dose is adhered to, there are no toxic effects. 5 The patient should now breathe in slowly and deeply through the mouthpiece at the same time pressing down firmly on the top of the canister. It is important that nurses understand the implications attached to choosing routes of administration of drugs based on their absorption. Gallagher, D. and Rix, E. (2006) Understanding the implications of oral anticoagulation therapy, Nursing Times, 102: 30–2. However, most of this group of drugs are given via the IV or SC routes; for example, cefuroxime and cefotaxime are administered in this way. Hypothyroidism is associated with a slower breakdown of coagulation factors. Therefore, asking patients’ views, listening and helping them think the problem through and make a decision is more effective than telling them what to do. Fibrinolytic drugs These drugs mimic the body’s own ability to dissolve blood clots. The dose prescribed is 200 iu per hour. Can the drug be given as a syrup which has a flavour Ella will like? Outline the salient points a nurse must consider in assessing, planning, implementing and evaluating patient education with regard to medicines. Ø Positive symptoms include delusions, hallucinations and disordered thought. Fluconazole, for example, has now developed a resistant strain. Hypertension may be defined as primary or secondary. Distribution Some drugs are bound to plasma proteins during their distribution through body fluids. However, it is important that we all start somewhere, and the self-testing element of the book gives you an opportunity to get it wrong without undue criticism or pressure. Clinical tip Do not forget that the patient will have loss of other sensations post-procedure so you should monitor their lower limbs for any potential trauma. This is called proviral DNA. Rather than inhibiting the pathways, rifampicin induces them. London: Arnold. Extradural, epidural and caudal anaesthesia For these procedures, the local anaesthetic is injected between the dura (the outside covering of the brain and spinal cord) and the periosteum of the bones lining the vertebral cord. Chapter 9 Patient concordance Case studies j Kubi Garise is a 75-year-old woman who suffers from rheumatoid arthritis, hypertension, and has the early symptoms of dementia, especially memory problems. A particular problem with taking antipsychotic medication daily is that certain patients may not see the need to continue taking the medicine. 5-HT is released from the neurone into the synapse to have its action on receptors (see Figure 8.2). We will now consider these changes in order to provide an understanding of how drugs used in this condition work. Reactivation of the disease may take place under a number of circumstances, for example poor nutrition, the age of the patient and lowered immune system. Clinical tip Rifampicin’s ability to break down oestrogen means that if a woman of childbearing years is taking the oral contraceptive you must inform them that they need extra protection to avoid pregnancy. Trounce, J. Reporting of drug errors In its advice to nurses the NMC highlights the importance of an open culture in practice with regard to the reporting of drug errors. Children are an important group to consider from this point of view. When applied to the eye the patient should be warned that it may cause a short-lasting stinging sensation. The body’s analgesic system As with other sensory systems in the body, the pain pathway has a descending mechanism (see Figure 3.6). Barbiturates Barbiturates are potentiators of the GABA-A receptor which has a pentameric structure. You can check your answers on page 178. Other factors controlling the rate and reliability of drug absorption can be said to be physiological or physico-chemical. We thought the idea of evaluating what you have gained in knowledge from reading each chapter was important and we hope you enjoy getting them all right! This means that the drug can cross membranes in a more active form than if it had been dissolved in a neutral or base solution. Sch, Sue Jordan 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. May cause menstrual irregularities. This is completed downloadable of Basic Pharmacology for Nurses 16th Edition by Michelle Willihnganz, Bruce D. Clayton Test Bank Instant download Basic Pharmacology for Nurses 16th Edition by Michelle Willihnganz, Bruce D. Clayton Test Bank pdf docx epub after payment. and Stevens, C.W. Beclometasone may cause weakening of bone (osteoporosis), while other side-effects may include increased bruising and thinning of the skin (dermal thinning). Often the effects of the local anaesthetic continue after the procedure is concluded, so providing extra pain relief. The virus is then taken into the interior of the cell by a process of endocytosis. Mechanisms that seem to be involved affect the extracellular fluid volume and expand the circulating blood volume. It receives stimuli related to the threat of danger and the brain interprets these stimuli and responds as required. These tend to be more common in origin and include liver diseases, vitamin K deficiency (especially in neonates) and excessive oral anticoagulants being prescribed. distribution: the distribution of drugs after absorption, to reach their target sites. Basingstoke: Palgrave Macmillan. Explain the mode of action of medicines used in treating these conditions. Brenner, G.M. codeine) and class C (e.g. However it is likely that this has to happen when giving drugs enterally, especially if they are not available in liquid form. However, drugs in this class, such as amitriptyline, act at other receptors which can lead to sideeffects. Therefore, anybody suffering from gout should not take the medicine. Nevarapine is an example. (2006) Basic Pharmacology for Nurses, 14th edn. In this way, they prevent the cell reproducing and are therefore bacteriostatic in nature. Textbooks used to describe the person’s face as mask-like because they acquire a stiff facial expression. Many of them are treated on an outpatient basis from nurse-led clinics which is far more cost effective. Before teaching patients, nurses should plan what the session aims to achieve and what the outcomes of the session should be. For mild to moderate pain it is usually given at a dose of 300 to 600mg four times a day. Dehydration lowers the blood pressure further, so causing an unwanted severe hypotensive state. Some are used to treat motion sickness, some for allergic responses. Is a weak acid which is well absorbed in the stomach. It can As the names implies, this group of protozoa have flagella which allow them to move. Department of Health (DoH) (2005) Supplementary Prescribing by Nurses, Pharmacists, Chiropodists/ Podiatrists, Physiotherapists and Radiographers within the NHS in England: a Guide for Implementation. Streptokinase, at present, is used in breaking down such clots in the coronary vessels. Indeed, gabapentin, a fairly recent addition to the anticonvulsant range, may have some action on calcium channels. However, researchers suggest that there are as many people who are under-diagnosed. However the genetic material is arranged in one long strand that floats around in the cytoplasm. The word used for stopping haemorrhage from the body is haemostasis and, as stated above, is a normal homeostatic function of the body. Clinical tip Sometimes you will hear people refer to this type of diabetes as ‘maturity onset’ as it occurs in people over the age of 40. Treatment of overdose requires skilled hospital management. A GP may also prescribe a regime of moderate exercise which has been shown to be beneficial in helping to lower systolic pressure. Sometimes you may find this type of drug being used alongside a glucocorticoid preparation. Product packaging The elderly or those with manual dexterity problems can often have trouble with product packaging. (2006) Pharmacology, 2nd edn. Basic Pharmacology for Nurses 16th Edition by Willihnganz and Clayton Test Bank Prostaglandin E series is responsible for ensuring the mucous lining of our digestive tract remains effective. Viral disease Ø Ø Ø Ø Viruses are essentially DNA or RNA surrounded by a protein capsule. A person using insulin is three times more likely to be at risk from the effects of hypoglycaemia than a non-user. Treatment for epilepsy is aimed at producing a life free of seizures. Zidovudine can cause bone marrow depression leaving the patient open to all types of infection. They not only stop initial redness, pain, heat and swelling but also affect the healing and repair process. Log in to Reply. 103 Chapter 7 Drugs used in chronic conditions Beta 2 adrenoreceptor agonists do not control the inflammatory response in asthma and, if a patient is finding it difficult to control their symptoms by using this class of drug, it would be prudent to suggest a corticosteroid preparation be added. Overall we hope this book has given you the motivation and interest to want to increase your knowledge in this important area of nursing. Ø Very few drugs have dramatic affects on drug excretion. Some drugs are natural compounds and some are synthetic agents. Triglycerides (large fat molecules) which are normally stored in your fatty (adipose) tissue are broken down into their constituent fatty acids and glycerol. There are two main forms of diabetes: type I and type II. Some drugs increase the effectiveness of enzymes in the liver to break down other drugs more quickly. Bourke, S.J. prostacyclin can be made by endothelial cells and thromboxane levels have to wait between 7 and 10 days for new platelets to be made, prostacyclin levels are improved at the expense of thromboxane. This chapter is designed to give you an introduction to some of the medicines used in combating infections caused by micro-organisms. This can lead to inappropriate balance in the partnership and may be detrimental, with the knowledge and expertise of the health care professional not being acknowledged. On admission she looks pale, lethargic and is complaining of pain in her knees and hands. It takes several days to achieve its effects. 2 This absorption process can be affected by many things but the main factor relating to absorption is the route of administration (see Box 1.1). Some companies actually specialize in making drugs in liquid form. 7 The maximum dose of paracetamol is 4g in a 24-hour period. Patients with diabetes need to be informed that they might not recognize when they are going hypoglycaemic. Bacteria do not have a nucleus and so are called prokaryotes. When the amoeba infects the person, the wall of the large intestine is damaged, so causing ulceration and bleeding. This often appears as blood in the urine (haematuria) but bleeding from other sites should also be treated seriously. She has ampoules consisting of a solution 250mg in 2ml. The parasite is sexually transmitted through the penis to the vagina during intercourse or by vulva to vulva contact with an infected partner. and Stevens, C.W. This is especially important with elderly people as the medication regimes in this group tend to be complex. The dose has to be given at a rate of 1ml every 30 seconds: how long with each dose last? Other problems that lead to an inability of the cascade mechanism to produce clotting are acquired. However, the mortality rate is high at up to 40 per cent. Like barbiturates and benzodiazepines, some of the side-effects of antipsychotic drugs can be compounded by alcohol. The style of writing is easy to read and a first year student could easily read this without becoming confused by long words and unfamiliar terminology. How much would you give? Coben, D. and Atere-Roberts, E. (2005) Calculations for Nursing and Healthcare, 2nd edn. Antibiotics can be described as being bacteriostatic or bacteriacidal. This level of anxiety is considered to be pathological and requires prompt diagnosis and active treatment to help the sufferer regain and maintain their previously normal lifestyle. The nurse needs to be aware of verbal and non-verbal cues which may indicate that the patient is becoming reluctant or defensive. Sodium valproate tablets which are not enteric coated (i.e. Their allies, the lymphocytes, are part of a more specific immune response and Chapter 5 Anti-inflammatory drugs Figure 5.1 The inflammatory response will have been alerted by removal of cellular materials via the lymphatic system. This was due to the fact that the main antidepressant drugs used at that time (the tricyclic antidepressants and the monoamine oxidase inhibitors) both have chemical actions on monoamines. In more severe cases, patients may need family or carers to administer their medicines. This can happen by the drug altering the channels response to its normal mediator. 5 Sodium valproate suspension 50mg is prescribed for an individual. effect for a number of patients. One of the disadvantages of using this group of drugs is that human beings carry cytochrome P450. It has a narrow scope of activity. You can check your answers on page 178. Newell, K. (2006) Concordance with asthma medication: the nurse’s role, Nursing Standard, 20(26): 31–3. Fibrin is dissolved by plasmin. Can cause vasodilation (so are often given with adrenaline). Vigabatrin is a new drug which raises the level of GABA. potassium: major intra-cellular cation. a gram) to a larger unit (e.g. This is no substitute for good information provided by health care professionals, but can serve to augment that information. An example of this is isophane insulin which starts working about an hour and a half after administration. Side-effects Side-effects are a very important issue, however, these are more likely when these drugs are given systemically rather than locally or when they are prescribed in high doses over an extended period of time. A blood sample is usually taken at specific times – either just prior to administration or half an hour afterwards. It also causes the cells in the liver, muscles and fat to increase their uptake of glucose from the blood. However, if given with food, this will take longer. Philadelphia, PA: Lippincott Williams & Wilkins. We will now focus on each of these drug classes. COPD is associated with chronic bronchitis and emphysema. If bleeding occurs it can be treated with tranexamic acid. Depression can be: Unipolar, where the mood or affect is always low. It is particularly important for formation of factors II, VII, IX and X. Ø You need to identify that you have the correct patient before giving a medicine. We have tried to give examples of common drugs that you may come across in practice rather than concentrate on a range of drugs that you may only encounter rarely. salicylates) there is an increase of the phenytoin in the person’s plasma. Human immunodeficiency virus (HIV) Ø Ø Ø Ø Ø This is a global problem. The drug is well absorbed from the gastrointestinal tract and therefore can be given orally. antidote: a remedy which counteracts the action of a chemical. These drugs are used infrequently due to their high risk of drug interactions, especially with other antidepressants. By good knowledge-sharing and communication an effective decision as to the most appropriate medicine to be prescribed can more easily be reached and the result is likely to improve concordance and compliance. T therapeutic range: the range of plasma drug concentration in which medicine has its best effect. Weight reduction, salt restriction, moderation in alcohol consumption and cessation of smoking are all recommended before prescribing treatment. The drug is broken down into two active components by bacteria that live in the bowel: 5 aminosalicylic acid and sulfapyridine. How many ml will you administer? (2002) Professional development: HIV and Chapter 4 Antimicrobials AIDS 2 – modes of transmission, testing for HIV antibodies and occupational exposure to HIV, Nursing Times, 98(6): 41–4. Trounce, J. The jet of insulin is propelled with such force that it penetrates the skin without the need for a needle. The organism is now invading the blood and sets up camp in a variety of tissues including the lungs, meninges, spleen, liver and bone marrow. Drugs used in chronic conditions human. Department of Health (DoH) (1989) Report of the Advisory Group on Nurse Prescribing (Crown Report). There are many texts that you can refer to as you become more knowledgeable and inquisitive (see our suggestions for further reading). The correct site and method of administration Ø Drugs can be given by a number of routes. London: ONS. tablets, capsules, ml). 20 Chapter 2 Adverse drug reactions and interactions Case studies j Marek Brodzki is a 19-year-old man who has been newly commenced on antibiotics for a post-operative wound infection. Interferons Moulds Interferons are a group of proteins that are made by our cells in order to help combat invasion by viruses. The monoamine hypothesis Many monoamines have been implicated in depression. However, if this is not the case, such as in obstructive jaundice, a synthetic preparation is available that does not require these bile salts in order to be absorbed into the body. Define the term pathological anxiety. Sodium-inhibiting drugs do not block all sodium channels but are selective to channels that allow high frequency impulses to take place. Patients bring their knowledge of their lifestyle and practices to the equation.
Introduction To Big Data Week 3 Quiz Answers, Non Slip Coating For Outdoor Wood Stairs, Parasite Eve Lyrics, Penguin Egg Hatching, Joomla Create Admin User Phpmyadmin, Why Do Dogs Get Heavy When They Die, A Miracle Would Happen Lyrics, Pokémon Go Defending Gym Rewards,