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Pharmacology for AN423

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Pollyanna Kellett

on 29 September 2016

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Transcript of Pharmacology for AN423

62
ECG
bpm
Thank You!
Pharmacodynamics
the effect that drugs have on the body cells to produce their action.
Drugs can exert their effect in many ways..........
Why do we need to understand pharmacology?
it is an important part of our role:
we can inform the patient what we are giving
why
what it will do to them
what they need to look out for eg side effects and interactions with other drugs or diet
Mechanisms of drug action
chemical action eg antacid (combines with & neutralises stomach acid)
physical action eg an osmotic diuretic eg manitol
enzyme inhibition eg statins which inhibit enzyme function in liver
fitting into receptors (most drugs)
Receptors
Plasma membrane of a cell (a bi layer of phospholipids and protein molecules) is selectively permeable so it controls what moves in and out of cell. The proteins (called receptors) perform different functions eg the reception of nutrients. Ligands (molecules binding to these receptors) have different functions eg hormones and neurotransmitters and drugs.
The binding is converted to a signal that the cell understands and responds to in some way eg adrenaline binding to receptors in the heart muscle increases the strength of cardiac contraction.
(Richards 2012, Barber and Robertson 2012)
Pharmacokinetics
Pollyanna Kellett
Pharmacology
Pollyanna Kellett
AN423 & PGDip stage 1

Learning objectives:
1) Understand why nurses need to know how medications work, the student's role in learning about pharmacology and how students can relate this Lead Lecture to seminars, skills and clinical practice.
2) Understand what is meant by pharmacodynamics and pharmacokinetics
3) Pharmacokinetics:
*Describe aspects of absorption, distribution, metabolism and excretion of medication.
*Understand different routes and the pros and cons of each
4) Pharmacodynamics:
* describe the actions of drugs on the body and relate to workbook to gain more in-depth knowledge of drug groups
Extension learning objectives (years 2 & 3 and PGDip):
5) Understand legislation surrounding prescription, supply, storage and administration of controlled drugs
6) Understand, describe and be able to differentiate Patient Group Direction (PGD) from non-medical prescribing.
7) Describe how to recognize adverse reactions and what clinical actions and reporting systems are indicated

Pharmacokinetcis
the way in which drugs move through the body
Agonist + receptor = response
Antagonist + receptor = no response
Affinity = ability of substance to bind to a receptor
Efficacy = ability, once bound, to produce an effect
Potency = the strength of a drug

Workbook - focuses on drug actions on key body systems eg respiratory, GI & cardiac systems but also additional medications used for pathophsyiology related to these systems.
Start now! Add to it each placement, after each seminar or skills session and each biology session.
How the body handles a drug depends on 4 factors:
Absorption of the drug
Distribution of the drug molecules
Metabolism of the parent drug
Excretion or elimination of the drug & its metabolites

First Pass Metabolism
Drug Action - we need to have an effect within a specific time frame
Time of onset affected by: route, rate of absorption and manner of distribution. Duration of effect defines dosing schedule - on drug chart/electronic record
Latin abbreviations for prescribing scheduled times
od (once a day)
bd (twice a day)
tds (three times a day)
qds (four times a day)
nocte (at night)
mane (in the morning)
stat (immediately)
Drug Actions:
Affinity, Efficacy, Agonists and Specificity

Drugs have an
affinity
for their receptors (chemical targets) ie how well they can combine with it. The binding converts to a signal and the cell responds eg adrenaline binding to receptors in cardiac muscle increases strength of cardiac contraction.
Efficacy
is the ability of the drug, once bound, to produce an effect.
Potency
is the strength of the drug.

Receptors can
up
or
down
regulate.
Agonists
= substances that stimulate the receptor to cause a response eg adrenaline
Antagonists
= bind (block) a receptor so no response is caused eg beta blockers ( eg atenolol)

Specificity - drugs are specific for intended target areas
Legislation

Medicines Act 1968 - defines the three legal categories of medicines (P, POM, GSL) Most medicines can only be supplied and sold in a pharmacy under care of pharmacist (P).
GSL's can be sold at other shops (if pre-packed and the premises can be closed to exclude the public) and there are limits to size and strength eg only upto 16 paracetamol, and only 200mg ibuprofen. POM's must be prescribed by GP (or nurse, dentist or pharmacist).
Standards for Medicines Management (NMC 2008) - outlines responsibilities and guidance for all qualified nurses
Misuse of Drugs Act 1971 - prohibits certain activities in relation to controlled drugs (CD) in terms of manufacture, supply and posession. Outlines 3 classes of CD:
class A (eg morphine)
class B (eg codeine)
class C (eg buprenorphine)
Misuse of Drugs Regulations (2001) - defines who can authorize supply and possession of CD's for import and export, production, supply, possession, prescribing and record keeping. Has 5 schedules 1-5.
eg schedule 1 eg cannabis - possession and supply prohibited unless under Home Office rule
eg schedule 2 eg morphine - full controlled drug restriction, register required.
Trust and local hospital policies.
Prescribing timeline
1986:Non-medical prescribing suggested Baroness Cumberlege
1986:Neighbourhood Nursing: a Focus for Care
1992: The Medicinal Products: Prescription by Nurses Act
1994: Nurse prescribing legalised
1999: Review of Prescribing, Supply and Administration of Medicines (DH)
2001: The Health and Social Care Act - prescribing rights for other healthcare professionals
2006: DH reviews to allow nurses and pharmacists to prescribe independently of a clinical management plan
Responsible for assessment, diagnosis and treatment for patients whose clinical conditions is within competence.
Allows: flexibility, patient choice, efficient and timely access to medications for patients.
Must: an identified prescribing role within their practice, 3 years post-registration, achieved approved training.
Allows additional registration with NMC as nurse prescriber
Adverse Drug Reactions (ADR's)
= unwanted or unintended effect of a drug that happens during proper use
Report online or yellow card via BNF
Type A: (Augmented) predictable, low mortality
Type B: (Bizarre) unpredictable, unrelated to expected effects, rare, high mortality eg anaphylaxis
Predisposing factors: polypharmacy, age, co-morbidity
Examples: rash, nausea & vomiting, diarrhoea, blood disorders, arrhythmia

Adverse Drug Events (ADE's)
= actual or potential damage resulting from medical intervention related to medicines (errors). Preventable events that may cause patient harm.
Usually resulting from human failure or system failure.

Relate to 5 Rights and NMC Standards for medication administration (standard 8)


Age related ADR's

Neonates, infants & older people have reduced amount of plasma proteins -
consider age
Neonates & infants have immature livers therefore cannot metabolize drugs so well therefore given in lower doses - consider hepatic immaturity &/or disease
Renal function at all ages is first sign of renal insufficiency - consider renal disease
Older people more likely to take more +/- 4 drugs - consider polypharmacy
Children have thinner skin (absorb quicker); have longer transit time through GI tract (greater contact of drug with absorbtion site); have trouble swallowing tablets; often do not tolerate liquid drugs well
Learning objectives:
1) Understand why nurses need to know how medications work, the student's role in learning about pharmacology and how students can relate this Lead Lecture to seminars, skills and clinical practice.
2) Understand what is meant by pharmacodynamics and pharmacokinetics
3) Pharmacokinetics:
*Describe aspects of absorption, distribution, metabolism and excretion of medication.
*Understand different routes and the pros and cons of each
4) Pharmacodynamics:
* describe the actions of drugs on the body and relate to workbook to gain more in-depth knowledge of drug groups
Extension learning objectives (years 2 & 3 and PGDip):
5) Understand legislation surrounding prescription, supply, storage and administration of controlled drugs
6) Understand, describe and be able to differentiate Patient Group Direction (PGD) from non-medical prescribing.
7) Describe how to recognize adverse reactions and what clinical actions and reporting systems are indicated

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