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Documenti di Professioni
Documenti di Cultura
Generic name
• ibuprofen
Trade name
• Motrin®, Advil®
Figure 2-1 The chemical,
generic, and trade names
for the common
analgesic ibuprofen are
listed next to the
chemical structure of the
drug.
Pharmacologic • Pharmaceutics
Principles • Pharmacokinetics
• Pharmacodynamics
• Pharmacotherapeutics
• Pharmacognosy
Pharmaceutics The study of how various
drug forms influence
pharmacokinetic and
pharmacodynamic activities
Pharmacokinetics • The study of what the
body does to the drug
– Absorption
– Distribution
– Metabolism
– Excretion
Pharmacodynamics
• Excretion
– Kidney immaturity
affects glomerular
filtration rate and
tubular secretion
– Decreased perfusion rate
of the kidneys
Summary of Pediatric
Considerations
• Skin is thin and permeable
• Stomach lacks acid to kill
bacteria
• Lungs lack mucus barriers
• Body temperatures poorly
regulated and dehydration
occurs easily
• Liver and kidneys are
immature, impairing drug
metabolism and excretion
Methods of Dosage Calculation
for Pediatric Patients
• Body weight dosage
calculations
• Distribution
– TBW percentages lower
– Fat content increased
– Decreased production of
proteins by the liver,
resulting in decreased
protein binding of drugs
Geriatric Considerations:
Pharmacokinetics (cont'd)
• Metabolism
– Aging liver produces
less microsomal
enzymes, affecting drug
metabolism
– Reduced blood flow to
the liver
Geriatric Considerations:
Pharmacokinetics (cont'd)
• Excretion
– Decreased glomerular
filtration rate
– Decreased number of
intact nephrons
Geriatric Considerations: Problematic
Medications
• Analgesics
• Anticoagulants
• Anticholinergics
• Antihypertensives
• Digoxin
• Sedatives and
hypnotics
• Thiazide diuretics
Legal, Ethical,
and Cultural
Considerations
U.S. Drug • 1906: Federal Food and
Legislation Drug Act
• 1912: Sherley
Amendment (to the
Federal Food and Drug
Act of 1906)
• 1914: Harrison Narcotic
Act
• 1938: Federal Food,
Drug, and Cosmetic Act
(revision of 1906 Act)
U.S. Drug
Legislation (cont'd)
• 1951: Durham-
Humphrey
Amendment (to the
1938 act)
• 1962: Kefauver-Harris
Amendment (to the
1938 act)
• 1970: Controlled
Substance Act
U.S. Drug
Legislation (cont'd)
• 1983: Orphan Drug Act
• Preventable
• Common cause of
adverse health care
outcomes
• Effects can range from no
significant effect to
directly causing disability
or death
Box 5-1 Common classes of medications
involved in serious errors
Preventing
Medication Errors
• Minimize verbal or
telephone orders
– Repeat order to prescriber
– Spell drug name aloud
– Speak slowly and clearly
• List indication next to
each order
• Avoid medical shorthand,
including abbreviations
and acronyms
Preventing
Medication Errors
(cont'd)
• Never assume anything
about items not specified in
a drug order (i.e., route)
• Do not hesitate to question
a medication order for any
reason when in doubt
• Do not try to decipher
illegibly written orders;
contact prescriber for
clarification
Preventing Medication
Errors (cont'd)
• NEVER use “trailing
zeros” with medication
orders
• Do not use 1.0 mg; use
1 mg
• 1.0 mg could be
misread as 10 mg,
resulting in a tenfold
dose increase
Preventing
Medication Errors
(cont'd) • ALWAYS use a
“leading zero” for
decimal dosages
• Do not use .25 mg; use
0.25 mg
• .25 mg may be misread
as 25 mg
• “.25” is sometimes
called a “naked
decimal”
Preventing Medication
Errors (cont'd)
• Check medication order
and what is available
while using the “5 rights”
• Prevention of
needlesticks
• Filter needles
Parenteral • Removing medications
Drugs from ampules
(cont'd)
• Removing medications
from vials
• Disposal of used
needles and syringes
• Needle angles for
Injections various injections
– Intramuscular (IM)
– Subcutaneous (SC or SQ)
– Intradermal (ID)
• Air-lock technique
Injection • Intradermal injections
Techniques
• Subcutaneous injections
– Insulin administration
– Heparin administration
Injection • Intramuscular
injections
Techniques – Ventrogluteal site
(cont'd) (preferred)
– Vastus lateralis site
– Dorsogluteal site
– Deltoid site
Preparing
Intravenous
Medications • Needleless systems
• Compatibility issues
• Expiration dates
• Mixing intravenous
piggyback (IVPB)
medications
• Labeling intravenous (IV)
infusion bags when
adding medications
Intravenous
Medications • Adding medications to a
primary infusion bag
• IVPB medications
(secondary line)
• IV push medications
(bolus)
– Through an IV lock
– Through an existing IV
infusion
Intravenous
Medications
(cont'd) • Volume-controlled
administration set
• Using electronic
infusion pumps
• Patient-controlled
analgesia (PCA) pumps
Topical
Drugs
• Eye medications
– Drops
– Ointments
• Ear drops
– Adults
– Infant or child younger
than 3 years of age
Topical • Nasal drugs
– Drops
Drugs
– Spray
(cont'd)
• Inhaled drugs
– Metered-dose inhalers
– Small-volume nebulizers
Topical • Administering
medications to the skin
Drugs – Lotions, creams,
(cont'd) ointments, powders
– Transdermal patches
• Vaginal medications
– Creams, foams, gels
– Suppositories