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basic pharmacology for nurses 16th edition pdf

Chronic inflammation. 5 A client is prescribed 20mg of haloperidol decanoate by intramuscular injection and 50mg in 1ml of liquid for IM injection is available. Nociceptors are non-adapting, which means they are stimulated at the same level of intensity each time the threshold level is reached. and Phillips, N. (2006) Nursing Calculations, 7th edn. Liver disease, thyrotoxicosis and fever may all interfere with the natural manufacture by the body of clotting factors. Psychostimulants, used in demotivation. She has suffered from rheumatoid arthritis for many years and takes co-codamol with moderate effect. In other words, drugs such as Warfarin, glucocorticoids, opiates, oral hypoglycaemic agents and oestrogen are all broken down more rapidly. For those people whose blood sugar is not controlled by diet alone there are a range of medicines available. Examples of SSRIs in common use for anxiety are: fluoxetine and sertraline are licensed to treat anxiety symptoms accompanying depression and for OCD; fluvoxamine is licensed for the treatment of OCD; citalopram is licensed for the treatment of panic disorder; paroxetine is licensed for the treatment of social phobia, panic disorder, OCD and mixed anxiety and depression. Conversely, neurones carrying messages out of the central nervous system to the muscles, glands and internal organs are called motor (efferent) neurones. 63 Chapter 4 Antimicrobials Irritation and itching of the vulva are also indications of infection. Asthma symptoms are thought to be caused by what doctors describe as hyper-reactivity or hyperresponsiveness of the cells lining the air passages. Spinal anaesthesia This is a specialised procedure which anaesthetises the lower half of the body and does not maintain leg strength: the patient is unable to move their legs. As a result, a new breed of azoles is now being developed as are drugs which act on fungal protein synthesis. Eventually the liver stores are exhausted and the reactive byproduct starts to damage the liver tissue itself. Management of these side-effects is often necessary by prescription of other drugs to reduce their severity. Isoniazid causes enzyme inhibition in the liver. As the body is made up of a large amount of water, drugs can dissolve readily. Sulpiride is a dopamine and 5-HT blocker and is effective in the treatment of schizophrenia. The patient develops a persistent tremor, even at rest and quite often there are head-nodding and pill-rolling movements of the fingers. chlorpromazine). Extent of plasma protein binding. The nature of acute inflammation is characterized by its rapid onset and short duration. Clarithromycin 550mg BD is commenced orally for seven days. (2007) Pharmacology and Medicines Management for Nurses, 4th edn. The problems of this type of administration becoming unlawful stem from tampering with the medicine but not informing the prescriber of this practice. Coben, D. and Atere-Roberts, E. (2005) Calculations for Nursing and Healthcare, 2nd edn. The drug can also lead to the development of a type of anaemia due to its affects on folate. How many grams of glucose will you have in 50ml? Coben, D. and Atere-Roberts, E. (2005) Calculations for Nursing and Healthcare, 2nd edn. Not all people who require a large number of medicines get help in paying for them. The risk of this type of diabetes is also higher if it runs in the family or if the patient is overweight. our cells) than in prokaryotes (i.e. This information must be documented on the prescription chart and in the nursing records. Patients who metabolise isoniazid more slowly are more at risk of side-effects if they are dosed too often. Specific tissues may take up certain drugs (e.g. 8 Finally ask the patient to replace the protective cap on the inhaler. These are then transported to the liver where they are used to fuel certain metabolic pathways. pharmacology for nurses audio test bank. This is referred to as malignant hypertension and is usually triggered by kidney disease arising from essential hypertension or other causes. Problems such as cleft palate were increased more than in the general population, therefore if a woman falls pregnant while taking the medication she should seek professional advice immediately. This method of application numbs a small area of skin so is ideal for relieving pain from sunburn, minor burns and insect bites. It is important that the patient avoids dehydration as this will increase the risk of lithium toxicity. However, if damage occurs to this delicate lining, collagen fibres come into contact with blood products and the clotting mechanism commences. For a child who is prescribed antibiotics three or four times per day and is well enough to attend school, necessitating dosing during school hours, this can be problematic. Reporting of drug errors Ø Ø Ø Ø An open no-blame culture is important in the reporting of drug errors. How many ml will you administer? Infiltration anaesthesia This technique is used to provide anaesthesia for minor surgical procedures such as dental work. A group of antibiotics called sulfonamides exploit this difference between bacterial and mammalian cells. g 40 Chapter 3 Local anaesthetics and analgesics f Opioid analgesics Ø Ø Ø Ø Ø Ø Ø Ø Ø Ø Given for moderate to severe pain. Second, it may inhibit ‘repetitive firing’ of neurones. The spectrum of these medicines is wide and they are effective against both gram negative and gram positive bacteria. Discuss with reference to: The mode of action of the two medicines. Some should be taken with food, others after food and still others before food, so it is important that the patient takes their medicines exactly as prescribed to ensure optimum effect. As a result there is a large range of medicines in this group that can be prescribed for infections. penicillins and cephalosporins Interference with protein synthesis controlled by the ribosomes e.g. Hypertension may be defined as primary or secondary. It is important that patients are fully aware of the need to take their medication. Weight reduction, salt restriction, moderation in alcohol consumption and cessation of smoking are all recommended before prescribing treatment. Amoeboflagellates cause entamoeba histolytica. a) Gold compounds b) Methotrexate c) Sulfasalazine d) Chloroquine 10 What is the mode of action of DMARDs? Access Free Pharmacology For Nurses 16th Edition Test Bank the information on the site. k You are accompanying a district nurse on a patient home visit. This leads to rapid absorption of the drug, reducing its effect. Changes in legislation and the extension of health professionals’ roles has seen this change in recent years. It is thought that this class of drug interferes with COX2 but has the disadvantage of interfering with COX1. These ionized compounds are actively excreted by the kidney and are ‘pushed’ out into urine. It is also advisable to tell the patient to take the whole course of treatment and if they miss a dose to take the next one but not to double up on the tablets if they forget a dose. The patient may also need to have blood tests from time to time to make sure that the dose of valproate is enough and not too much or too little for them. On the ward you only have 5,000 iu of heparin in 1ml. benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress. Paperback. Certain viruses also carry the mechanisms to reproduce (replicate) inside the host cell without using the host cell’s machinery to help them. Relaxation and biofeedback are also techniques that are advisable prior to drug therapy. These drugs also have troublesome side-effects that can lead to glaucoma and urinary retention in an elderly person. The correct site and method of administration You will probably have heard the one about the student nurse being asked to give a patient an aminophylline suppository to help their breathing. a) IV b) IM c) Sublingual d) Oral 8 Which of the following is a plasma protein? The commonest method of administration is by the SC route. Sometimes the antifungal cream is combined with a mild steroid preparation e.g. 96 g Chapter 6 Anticoagulant therapy f Ø Vitamin K naturally occurs in plants. Dizziness can also be a troubling side- Some patients may develop a number of serious adverse effects to gold compounds that may require the therapy to be stopped. What volume of heparin and saline would be required to prepare the syringe? 8 You have a bottle of amoxicillin syrup containing 250mg in 5ml. 24 Downie, G., Mackenzie, J. and Williams, A. Following a discussion with her daughter, you learn that she has recently commenced a course of trimethoprim to treat a urinary tract infection but has been reluctant to take it as she claims that she has too many tablets to take and they tend to get stuck when swallowing. What are they? Before performing many drug calculations you will need to convert the numbers you use in the Chapter 1 Pharmacodynamics and pharmacokinetics Box 1.2 Equivalencies of weight UNIT SYMBOL EQUIVALENT SYMBOL 1 kilogram kg 1000 grams g 1 gram g 1000 milligrams mg 1 milligram mg 1000 micrograms mcg or mg 1 microgram mcg 1000 nanograms ng Ø Ø To convert from a smaller unit to the next higher unit divide by 1000 To convert from a larger unit to a smaller unit multiply by 1000 calculation so that they all appear in the same units. glucocorticoid: hormones secreted by the adrenal cortex. Lack of energy. 6 20,000 iu of heparin is added to 500ml of 0.9 per cent saline. Other problems that lead to an inability of the cascade mechanism to produce clotting are acquired. Altering the delivery system of a medicine is outside its licence. a) 1 b) 2 c) 4 d) 10 g 13 Chapter 1 Pharmacodynamics and pharmacokinetics f 7 What route should drugs subject to first pass metabolism not be given by? Many children under the age of 10 have great difficulty in swallowing tablets, so liquid medicine is the preferred choice. These sections deliberately repeat the key texts in this field for your ease of reference, and in addition include works specific to the chapter’s topic. 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. Absorption is better if they are given on an empty stomach as they can be absorbed erratically and this is not helped by the presence of food. Nevertheless, try to get involved in the administration of this category of medicine to gain a full understanding of the procedure and the nurse’s role. Clinical tip The main risk with streptokinase is the risk of haemorrhage. Insulin lispro is a special form of human insulin which works more rapidly than actrapid but for a shorter period of time. Education and information is the key in patient empowerment. Ø Type B ADRs require prompt detection and rapid action. It could lead to the child being kept off school, the parent missing work or the antibiotics being taken inappropriately. Edinburgh: Churchill Livingstone Elsevier. An increase in exercise and cessation of smoking are advisable in order to reduce high blood pressure (hypertension) and high fat content in the blood (hyperlipidaemia). Patients at risk of developing oral candidiasis are those being treated with antibiotics and steroids and it is important that when applying nystatin orally to these individuals you are aware whether they have dentures. The focus of your career is nursing and it is important that any science subject is applied to that discipline. Tricyclic antidepressants Tricyclic antidepressants (TCAs) are powerful drugs which block the re-uptake of two major monoamines, noradrenaline (NA) and serotonin, also know as 5-hydroxytryptamine (5-HT). (2000) Clinical Pharmacology for Nurses, 16th edn. Ø Sometimes have serious side-effects due to prostaglandin inhibition. 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). Macrophages are a type of bacteria-engulfing cell or phagocyte which are protective in function. 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. The elderly often have changes in sensitivity to drugs due to: reductions in drug binding sites; impaired organ function (liver/kidneys); altered metabolizing enzyme systems in the liver. 9 You have a vial of gentamycin containing 80mg in 2ml. 3 If the patient is using the inhaler for the first time or has not used it in the last three days, get them to prime it by pressing down on the canister to release two sprays into the air, away from their face. They may be administered directly into joint spaces (intra-articularly) or into the lungs by means of an aerosol. Condition: Very Good. Demonstrate an understanding of the unwanted effects of medicines used in treating these conditions. Oxford: Oxford University Press. You can check your answers on page 177. It has a relatively short half life as it is quickly metabolised by the liver. They can be divided into two broad categories: co-analgesic drugs and drugs that are used to relieve the side-effects of analgesics. some bronchodilators may have an Drugs used in chronic conditions effect on inflammatory cells. It also affects chemotactic agents and prevents an important protein called collagen from maturing. (2006) Pharmacology, 2nd edn. Adverse drug reactions and interactions Learning Objectives Introduction Main Mechanisms of drug interactions Adverse drug reactions Clinical significance of drug interactions to the patient Major groups of drugs involved in adverse drug reactions Steps in minimizing the effects of adverse drug interactions Age-related adverse drug reactions Case studies Key learning points Multiple choice questions Recommend further reading 15 15 16 16 17 18 18 19 19 21 21 22 24 3. List the principal routes of drug administration. Crushing or chewing will cause the drug to be released too soon and may result in side-effects. Explain to her the benefits of preventative use of her steroid inhaler and the necessity of using her salbutamol to prevent severe asthma attack. In addition, infections by micro-organisms not sensitive to penicillin can take place. You can check your answers on page 179. Amantadine is well absorbed orally and so is usually given in tablet form in a dose of up to 200mg daily. Ø It occurs mainly in the liver and is therefore often called hepatic metabolism. However, before we plunge headlong into the classification of local anaesthetics and analgesics, we need to remind ourselves of the basic principles of, first, the initiation and conduction of nerve impulses, and second, the body’s pain pathways and analgesic system. Ø All Type B and many Type A ADRs should be reported via the yellow card found in the BNF. London: DoH. In other words, it is our inbuilt analgesic system. This occurs from a tendency of the blood to clot. London: Arnold. As a result their use is usually confined to treating side-effects of drugs given as neuroleptic agents (e.g. Local anaesthetics and analgesics Clinical tip You may find that the anaesthetist wants to keep the anaesthesia topped up. Within a few minutes the organisms have found their way to the liver. Ø There are some 450 million people worldwide with a mental health problem. Flucystosine acts on the fungal DNA. Often these models are adopted by nurses and others in an attempt to empathise with the patient and to ensure a positive outcome to health education. however be given via the IV route if the patient is very ill. Clinical tip Quinine has a depressant effect on cardiac muscle, so therefore cannot be given as a large one-off dose (bolus). How much do you need to give 125mg? The anaesthetic agent infiltrates the tissues below the level of the blood pressure cuff. Steroids Steroid hormones include a group known as glucocorticoids. Azoles are fungistatic in nature and have a broad spectrum of activity. The fact that Mrs Simpson is eligible for free prescriptions. Hypertension involves an increase in either cardiac output or the peripheral resistance. Pupillary constriction. Patient should drink plenty of water when taking the medication. More serious illnesses can occur that can cause inflammation of the lining of the heart (endocarditis) and in some cases these fungi can have fatal consequences – for example in cases of septicaemia. Non-adherence to medication regimens can have serious consequences, depending on the medication being prescribed. This may be due to deliberate or accidental overdose or to the Warfarin interacting with other drugs which leads to an increase in its anticoagulant effect. As these blood cells protect us from infection it is important that the level does not drop significantly. This is a Catch 22 situation as atherosclerosis leads to further hypertension. They attend a consultation and present the prescriber with a problem or symptom. Brenner, G.M. Even though Mrs Simpson could, in theory, buy paracetamol over the counter, you should bear the following in mind: Her ability to go shopping. Every person with mental capacity has a right to refuse medication if they so wish. They should also inform their dentist of their treatment. As with the other antibiotics in this section macrolides inhibit protein synthesis in the bacterium. some cheeses, red wine, pickled herring and others). This book has introduced you to the knowledge necessary when engaging in these skills. 6 A doctor has prescribed 0.25mg of digoxin. Renal function is also affected so ibuprofen should be used cautiously in patients who already have a degree of renal impairment or congestive cardiac failure. Box 8.3 Drugs used in the treatment of psychosis Typical Atypical Chlorpromazine Sulpiride Promazine Clozapine Flupentixol Olanzapine Haloperidol Quetiapine Trifluoperazine Risperidone Typical antipsychotics Typical antipsychotics are associated with more side-effects despite their good antipsychotic action, due to their actions at the D2 receptors. Opioid antagonists As discussed above, respiratory depression is a side-effect of opiates. It cannot be given orally. Chronic inflammation occurs when noxious substances are not removed by the acute phase. 90 The essential end point of this process is an insoluble protein called fibrin which will plug the tear in the vessel wall. Her mother is struggling to get her to take the medicine the doctor has prescribed as she does not like the taste. This can lead to extensive long-term therapies being instigated to treat traumatic injuries. This process is called enzyme induction. London: Arnold. Finally, retroviruses work by copying a viral blueprint onto a piece of DNA. This assists the diagnosis and categorization of the depression. Some examples of drugs from this class are zidovudine, abacavir and lamividine. basic pharmacology for nurses text and study guide package 16e Sep 25, 2020 Posted By Clive Cussler Library TEXT ID 762f063b Online PDF Ebook Epub Library study guide package basic pharmacology for nurses text study guide package 16th edition by bruce d clayton bs pharmd rph author michelle willihnganz author 48 out of 5 The usual dose for minor aches and pains, including painful periods and a high temperature, is 200 to 400mg every four to six hours. They have what is termed negative efficacy. Some drugs are not fully absorbed from the stomach if they are taken at the same time as an antacid preparation. Parkinson’s disease Ø Ø Ø Ø Progressive disorder of movement. g 66 Chapter 4 Antimicrobials f Non-nucleoside reverse transcriptase inhibitors Ø Ø Ø Ø Ø Ø Have the same mode of action as the nucleoside drugs. 25 Chapter 3 Local anaesthetics and analgesics Introduction Pain is a sensation that lets us know about damage occurring to our tissue. The nurse is transcribing new orders written for a patient with a substance abuse history. An example of this is isophane insulin which starts working about an hour and a half after administration. This issue should be thoroughly explored with the patient before treatment is prescribed. For a person to give consent, they need to have the mental capacity to understand an explanation, be able to make some form of choice and be able to communicate. The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable . This has significant advantages: for example, these drugs are more predictable than their larger cousin, which means that blood tests such as the activated partial thromboplastin time test do not need to be monitored and the dosage does not need to be adjusted. Neutrophil activity is limited, however, because they do not have the ability to make and store more of this enzyme. Edinburgh: Churchill Livingstone. This can have one of two effects: 1 2 Enzyme inducer: this is where the drug increases the effectiveness of the enzyme and metabolizes more quickly. Non-steroidal anti-inflammatory drugs Ø Ø Ø Ø Ø Ø Ø Ø Used for mild to moderate pain. This section of the chapter will briefly outline some of the most common protozoal infections. Buy Basic Pharmacology for Nurses-Study Guide 16th edition (9780323087001) by Bruce D. Clayton for up to 90% off at benzhexol, procyclidine). If in doubt over how the medicine can be given please consult your pharmacist. The first question that you might ask is whether the individual has the capacity to consent. How many tablets would you give? London: DoH. However, today it is almost entirely 109 Chapter 7 Drugs used in chronic conditions Clinical tip An example of soluble insulin is actrapid. Case studies j Joseph Olita, a 30-year-old man, has been on salbutamol inhaler and inhaled steroids for many years. Sodium aurothiomalate is administered by deep IM injection whereas auranofin is given orally. It is usually given intravenously and its effects are immediate. He lives on his own but has a wide circle of friends. The problem with this product is the difficulty in extracting commercial amounts. Patient concordance Learning objectives Introduction Adherence, compliance and concordance Factors influencing effective medicine use and concordance Patient empowerment in chronic disease management Case studies Key learning points Calculations Multiple choice questions Recommended further reading 149 149 149 150 150 152 155 155 156 157 158 10. An average time from diagnosis of HIV to death from AIDS is about two years in an untreated patient. Like many of the immunosuppressant DMARDs, leflunomide can mask infections. Compared to bacterial treatment with antibiotics it is very difficult to produce antiviral drugs because viruses live within our own cells. It is also involved in learning not to do dangerous things, therefore allowing future avoidance of anxiety-provoking situations. These drugs can be given orally in a number of forms (tablet, syrup and suspension). plasminogen: inactive plasma protein. One reasonably promising development has been to deliver it in little spheres of lipid so that it is in a protected form until it binds with the fungal membrane. Absent seizures are characterized by a brief alteration in consciousness which is sometimes very difficult to see. The usual maintenance dose of these drugs is in the range of 200–800 micrograms per day, usually given in two to four doses. Ø Steps in minimizing the effects of drug interactions should be taken (e.g. This controls the virus and buys the immune system time to deal with the initial infection. They work by stimulating the beta cells in the pancreas to secrete the hormone insulin. Refer to Chapter 8 for more on drugs that are used in mental health. A drug that is used commonly is bendroflumethiazide. Again these mainly occur in individuals whose immune systems have been compromised in some way. Ø Haemostasis is divided into four processes: constriction of blood vessel, formation of platelet Ø Ø Ø Ø Ø Ø Ø plug, formation of fibrin clot and dissolving of the clot. It has also been noted that this group of diuretics has an effect on blood vessels, causing them to vasodilate and lower blood pressure. Further reviews by the Department of Health enabled nurses and pharmacists to prescribe independently of a CMP from 2006. Additive effects of drugs with similar actions. A number of psychological models have been developed in order to understand health behaviours relevant to compliance. We both remember, as students, sitting and trying to come to terms with scientific language and almost falling asleep in an attempt to unravel the intricacies of mathematical formulae and biochemical presentations of molecular function. These drugs work in the same way as penicillin in that they affect the production of the peptidoglycan wall of the bacterium. They found the formulary restrictive and in some cases were not able to prescribe appropriately for the patients in their care. It reduces the manufacture of a range of clotting factors. In this report, Neighbourhood Nursing: A Focus for Care (Department of Health and Social Security 1986) it was concluded that much of a district nurse’s time was being wasted in obtaining prescriptions for basic dressings and appliances required for patient care. All other drugs need to be distributed throughout the body. 71 Anti-inflammatory drugs 5 Chapter contents Learning objectives Introduction Acute inflammation Chronic inflammation Non-steroidal anti-inflammatory drugs Cyclo-oxgenase pathway 2 inhibitors Aspirin Adverse effects Overdose Paracetamol Histamine Antihistamines Steroids Administration Side-effects Antirheumatoid drugs Sulfasalazine Gold compounds Penicillamine Methotrexate Choloroquine Leflunomide Case studies Key learning points Calculations Multiple choice questions Recommended further reading Learning objectives After studying this chapter you should be able to: Describe acute and chronic inflammatory processes. How many ml will she draw up for you to check? calcium and sodium). Beckwith, S. and Franklin, P. (2007) Oxford Handbook of Nurse Prescribing. The section is by no means comprehensive and further reading will be necessary in order for you to gain more detailed knowledge. Covert administration of medicines Ø Covert administration of a medicine to a capable adult is seen as a trespass in law. Malden, MA: Blackwell. Euphoria. Rosiglitazone may produce side-effects such as water retention. List three common drugs which are frequently implicated in drug reactions. Steroids can cause secondary diabetes and hypertension Can cause osteoporosis and fractures. New York: Churchill Livingstone. One treatment is given per year. This may continue for a period of time and can become life-threatening. The medical staff have decided to change her analgesia from opioids to non-steroidal anti-inflammatory medication as she is four days post-surgery. Local anaesthetics and analgesics The blockage of the cyclo-oxygenase pathway is useful in terms of the amount of pain we feel; however, it also produces side-effects. Molecular targets for drugs are found in these areas. and Stevens, C.W. A dose of 75mg daily is sufficient to achieve anticoagulation, in comparison to a dose of 300mg daily which would be prescribed in aspirin’s role as an analgesic. As a result, the tissue will be repaired by scar tissue. Second, it increases the sensitivity of muscle cells to insulin. Coben, D. and Atere-Roberts, E. (2005) Calculations for Nursing and Healthcare, 2nd edn. They do not bring about bronchodilatation and are not given as an immediate response to the trigger factor. When giving a controlled drug a particular procedure must be followed. The correct site and method of administration Ø Drugs can be given by a number of routes. Basingstoke: Palgrave Macmillan. buprenorphine). Warfarin which is 99 per cent bound to plasma proteins). Abciximab interferes with this process. The usual dose is 100mg daily for the first three days, then 20mg daily, or 10mg if side-effects appear. Older patients also need special consideration, as the kidney does not perform as well as we get older, resulting in a lower glomerular filtration rate. 15 Chapter 2 Adverse drug reactions and interactions Introduction The aim of this chapter is to introduce you to the concepts of adverse drug reactions and drug interactions and side-effects. This is often the case in what are termed autoimmune diseases, where the body’s defence mechanisms appear to be turned on themselves. Other contraindications are also associated with aspirin. 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. Nystatin Amphotericin This drug was first used over 50 years ago and is a macrolide antibiotic (which means it inhibits protein synthesis in the bacterial cell) and is very complex in its biochemical structure. First line drugs will be discussed and include isoniazid, rifampicin and pyrazinamide. Campbell, S. (2004) Management of HIV/AIDS transmission in health care, Nursing Standard, 18(27): 33–5. You suspect this has been caused by the antibiotics. Protease inhibitors If the viral RNA manages to make a copy of its genetic blueprint onto DNA, then this is carried into the nucleus of the human cell. A junior doctor, by error, decided to give the medication into the person’s epidural space and subsequently killed them. Therapy involves using a combination of drugs. A second side-effect associated with this drug group is called the ‘on-off ’ effect. Ø Consent is an important area of drug administration. The drug is usually given orally in a seven-day course of treatment. Most drugs undergo phase I oxidation followed by phase II conjugation. However, after this period patients’ pain and joint swelling starts to lessen. Inflammation can be classified as either acute or chronic. Earlier we discussed tissue injury (see p. 28) and how prostaglandin release is implicated in this. 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. (2000) Clinical Pharmacology for Nurses, 16th edn. 81 Chapter 5 Anti-inflammatory drugs Aurothiomalate has the ability to control symptoms better than its oral counterpart but comes at a price to the patient’s biological systems. Tolbutamide comes as a tablet and is usually taken twice or three times a day. The combination of drugs now given for HIV has dramatically improved the prognosis (see Figure 4.2). The arachidonic acid acts by triggering two vitally important pathways, the cyclo-oxygenase pathway and lipoxygenase pathway. Used in patients who are immunocompromised. 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. Identify at least six drugs that act on the clotting cascade. Medication can also be supplied in easy-to-open packs. All Type B and many Type A ADRs should be reported to the Medicines & Healthcare Products Regulatory Agency (MHRA) via the yellow card found in the back of the BNF or online. Terbinafine This drug is given orally for tinea infections of the skin and nails. This 110 Chapter 7 Drugs used in chronic conditions Box 7.3 Types of insulin Rapid acting analogue (clear) Onset: 10–15 minutes Peak: 60–90 minutes Duration: 4–5 hours Fast acting (clear) Onset: 0.5–1 hour Peak: 2–4 hours Duration: 5–8 hours Intermediate acting (cloudy) Onset: 1–3 hours Peak: 5–8 hours Duration: Up to 18 hours Long acting (cloudy) Onset: 3–4 hours Peak: 8–15 hours Duration: 22–26 hours Extended long acting analogue Onset: 90 minutes Duration: 24 hours Premixed (cloudy) Presented as a single vial which contains a fixed ratio (a percentage of rapid/fast acting to a percentage of intermediate/long acting) Oral hypoglycaemic agents These are drugs that are usually given for type II diabetes. Find out where it is kept and make use of it during your placements. the placenta and the blood-brain barrier). Brenner, G.M. Durham, S.R. Learn Basic Pharmacology Nurses Clayton with free interactive flashcards. Further significant obstruction of the airways is brought about by inflammatory changes in the mucosa which bring 102 about an increase in mucous production, more epithelial cells being shed and swelling of the tissues within the respiratory passages. It is contraindicated in patients in whom it may cause bleeding, for example, patients with peptic ulcers. It is due to this effect that morphine should be avoided in people suffering from biliary colic due to gallstones: if morphine is given it might actually increase the pain rather than lessen it. Risperadone has a higher affinity for 5-HT than dopamine and a lower incidence of sedation and extrapyramidal side-effects at low doses than other neuroleptics. To do this an enzyme is needed to uncoil parts of the supercoiled material. The whole area of damage becomes flooded with fluid, plasma proteins and phagocytic cells. This is an important area to consider. (2006) Pharmacology, 2nd edn. There are two main drugs in this family: nevirapine and efavirenz. Skin rashes and fever are common contraindications; much more serious is acute anaphylactic shock. Unwanted effects are not common. It is given intravenously and usually is only indicated in high risk patients undergoing certain invasive procedures, for example, coronary angioplasty. Multiple choice questions Try answering these multiple choice questions to test what you have learned from reading this chapter. Antidepressants The tricyclic antidepressants (TCAs) have a positive effect in generalized anxiety disorder and panic disorder, although many of these drugs are not licensed for such indications. In order to trigger the sensation of pain, the inside of the neurone must become positively charged as compared to the outside. The main side-effects are depression and psychotic disturbances. function. Nystatin cream should be applied to the glans penis three times a day for a similar period of time. S salicylates: group of drugs including aspirin which are acidic and given as analgesics. Multiple choice questions Try answering these multiple choice questions to test what you have learned from reading this chapter. (2007) Pharmacology and Medicines Management for Nurses, 4th edn. Clinical tip Aspirin Personnel must always be alert to the possibility of accidental injection into veins and arteries. According to the Department of Health (DoH) approximately 4 per cent of hospital admissions are associated with adverse drug reactions (DoH 2001). This specificity is thought to occur as the drug likes a substance called ergosterol. Side-effects The main problem of giving insulin is that the blood sugar may be lowered too much, a state we call hypoglycaemia, which can cause brain damage. How many 5mg prednisolone tablets is equivalent to a dose of 100mg of hydrocortisone? 64 Minor gastrointestinal and central nervous symptoms have been reported. Morphine is thought to block these channels from opening so that the pain signal breaks down. For a patient to adhere to their medication regimen, they need very little information from the prescriber. Sometimes the first indicator of renal insufficiency is a change in urinary output. London: Arnold. 2 A client is prescribed 300mg of promazine and 100mg tablets are available. Courts have also accepted that doctors may treat patients without their consent if it is seen to be in the best interests of that patient. The bacteria is engulfed by phagocytic cells in our lungs. This hypertrophy both in the heart and vessels leads to cardiac failure as a muscle cannot restore its normal contractility. a) Clopidogrel b) Tinzaparin c) Dipyridamole d) Hirudin 7 What blood test is used to measure the effectiveness of Warfarin? Let us now return to our discussion concerning the cyclo-oxygenase pathway. This section will focus on two main treatment groups: antifungal antibiotics and synthetic antifungal agents. If you have seen an error occurring you must report it. Pharmacies are limited to a maximum 32-tablet pack and shops are limited to packs of 16. Some of these drugs act better on the heart muscle (e.g. All can lead to potentiation of drug action which in turn can cause more side-effects. These symptoms do not become apparent on initial infection, but usually occur between seven and nine days after the host has been bitten by the mosquito. (2006) Basic Pharmacology for Nurses, 14th edn. and Stevens, C.W. London: NICE. Some people can maintain normoglycaemia with diet alone, others need oral hypoglycaemic drugs and some may require insulin eventually Usual age of onset Less than 20 years 40–60 years Control by oral hypoglycaemics No Yes; certainly in the first instance Control by insulin Yes Not at the beginning of treatment but may be required as the disease progresses or if the patient remains unresponsive to therapy Symptoms Symptoms appear rapidly: frequent micturition; extreme hunger; extreme thirst; extreme weight loss; weakness and tiredness; feeling edgy and mood changes; nausea; vomiting; blurred vision Symptoms appear slowly (the person may not feel any symptoms at all): increased thirst; increased micturition; feeling tired; feeling edgy; nausea; loss of weight; slow wound healing; recurrent infections of the skin, gums, vagina/penis and bladder; blurred vision; tingling or loss of sensation in hands or feet Complications Diabetic coma or ketoacidosis from hyperglycaemia; hypoglycaemia; nephropathy; blindness; myocardial infarction; cerebrovascular accident; peripheral vascular disease; neuropathy Diabetic coma from hyperglycaemia; hypoglycaemia; nephropathy; blindness; myocardial infarction; cerebrovascular accident; peripheral vascular disease; neuropathy Treatment Carbohydrate controlled healthy diet; exercise; daily insulin; regular monitoring of blood glucose levels; monitoring of urine Carbohydrate controlled healthy diet; exercise; regular monitoring of blood glucose levels; monitoring of urine Chapter 7 Medicine management of diabetes The overall aim of the treatment of diabetes is to maintain blood glucose levels within the normal range (normoglycaemia). Certain neurones in part of the brain called the basal nuclei degenerate and this leads to a lack of a neurotransmitter called dopamine. Where a patient lacks capacity, the law in England does not currently allow others, for example relatives, to give consent on someone’s behalf. a) Anticoagulant therapy b) Morphine c) Steroid medicines d) Angiotensin converting enzyme inhibitors 10 Amphoteracin could be described as being a) A newly-developed medicine b) A synthetic antifungal agent c) A harmless medicine d) An antifungal antibiotic Recommended further reading Adler, M.W. (2003) ABC of Diabetes, 5th edn. 5 Chapter 1 Pharmacodynamics and pharmacokinetics Receptors The plasma membrane of a human cell is selectively permeable in that it helps control what moves in and out of the cell. Male impotence can be caused by thiazide diuretics in about 20 per cent of individuals. The analgesic system is a descending system. Despite its effectiveness it is not used as a first line treatment but rather a third or fourth line option. Basically, they are heparin but broken into smaller parts. Gastrointestinal disturbances, itching, headaches and muscle pains have been reported. amphetamines, cocaine). Naloxone, therefore, quickly reverses the effects of opioid drugs. Clayton, B.D. and Phillips, N. (2006) Nursing Calculations, 7th edn. Adverse reactions to this family of drugs are not pleasant. Phenytoin has also been responsible for malformations in babies born to women taking the drug. (2001) Inhaler devices: compliance with steroid therapy, Nursing Standard, 15(48): 40–2. This often extends to their carers and can be detrimental to their close relationships. F: failure of therapy. The dose he can have for each drug is: ibuprofen, 200mg every 6–8 hours; paracetamol, 500mg every 4–6 hours, maximum 2g in 24 hours. Phenytoin, ethosuximide and carbamazepine can all be increased in the plasma if given with isoniazid. After being absorbed, cephalosporins are widely distributed in the tissues of the body. As the person’s ability to fight infection is compromised, infection can go undetected. Downie, G., Mackenzie, J. and Williams, A. Rifampicin can cause orange discoloration of saliva, tears and sweat. Pharmacology Matthews, E. (2004) Reflective practice: concordance with pain medication, reflection on an adverse incident, British Journal of Nursing, 13(9): 551–5. However, this is reversible by stopping the medication. Most drugs in this category are given orally as they are well absorbed by the body. O’Connor, B. The cell body houses the nucleus and therefore is the metabolic centre. These symptoms are not good news if you happen to be diabetic and have HIV. Crushing or splitting of tablets can affect how they are absorbed by the body. How many ml of heparin would you give? Valproate helps to stop the breakdown of GABA and so leaves enough of this chemical in the brain to help prevent the fits. Details of such licences (for reprographic reproduction) may be obtained from the Copyright Licensing Agency Ltd of Saffron House, 6-10 Kirby Street, London, EC1N 8TS. Levy, D. (2006) Practical Diabetes, 2nd edn. (2006) Pharmacology, 2nd edn. Clinical tip It is good practice to advise patients to drink plenty of water when taking aciclovir orally to avoid over-concentration of the drug (six to eight pints of water per day). Aspergillus causes an allergic reaction in the tissues of the lung. Formation of a platelet plug Damage to the wall of a blood vessel exposes proteins within the vessel wall. Examples of oral hypoglycaemics are metformin, glipizede, nateglinide and rosiglitazone.

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