Pharmacology And Medications: A Comprehensive Guide

Types of medications and their schedules

1.

Nurse must be registered (Nursing and Midwifery Board of Australia, 2017)

Nurses are aware about the medication dosage, their use and side-effects (Nursing and Midwifery Board of Australia, 2017)

Schedule 2: Pharmacy medicine

Schedule 3: Pharmacist only in medicine

Schedule 4: Pescription only in medicine

Schedule 8: Controlled drug

(Australian Government Depart of Health, 2017)

4.

Name	Handled	Administered	Stored
Capsules	Out of direct sunlight	Orally	Room-temperature
Drops	Out of the reach of children	Internally (nasal or eye drops)	Room temperature or 4 degree centigrade
Inhalants	Out of the reach of children	Internal via mouth	Room temperature, away from light
Liquid medication	Out of the reach of children. Liquid antibiotic requires expert handling	Orally (cough syrup or liver tonics) Intravenously (antibiotics)	Cough syrup or liver tonics: room temperature Liquid antibiotic: 0 to 4 degree Centigrade
Lotion or creams	Away from sunlight and children	Locally or externally, over skin	Room temperature
Ointments	Away from sunlight and children	Locally or externally, over skin	Room temperature
Patches	Strict hand hygiene required	Locally or externally, over skin	Room temperature
Powder	Away from sunlight and children	Locally or externally, over skin	Room temperature
Tablets	Away from sunlight in an air tight manner inside glass bottles	Orally	Room temperature
Wafers	Away from the reach of children. Does not require expert handling	Orally. Majority are mouth dissolved and do not require water	Room temperature
Suppositories	Suppositories should not be handled long with hands as it can melt	Through the rectum	Cool and dark place

(Source: Shargel, Andrew & Wu-Pong, 2015)

5.Pharmacodynamics: Branch of pharmacology that deals with the mechanism of action of drugs and subsequent effect on the body

Pharmacokinetics: A branch of pharmacology that deals with the kinetics of drug mechanism inside the body

Pharmaco-therapeutics: It is a branch of pharmacology that deals with the study of therapeutic usage of drugs and is possible effects

(Shargel, Andrew & Wu-Pong, 2015)

Polypharmacy: Use of multiple or numerous combination of medication by a patient is known as polypharmacy. The concept of polypharmmacy is mostly common among the elderly people especially the people with intellectual disabilities. Polypaharmacy leads to adverse drug reactions along with the generation of antibiotic resistance (Shargel, Andrew & Wu-Pong, 2015).

7.

First Pass Effect: It is a phenomenon of drug metabolism where the concentration of the administered drug is significantly reduced before it reaches to the systemic circulation. This loss of concentration of drug occurs via absorption effect coming from liver and the gut wall. First Pass Effect is also known as First Pass Metabolism. This loss of concentration of drugs via the heaptic system or the gut tissue is termed as excretion (Shargel, Andrew & Wu-Pong, 2015).

Example: Nitroglycerine, Morphine, marijuana, propranolol.

8.The duration of action of a drug is known as its half-life. Half-life of the drug is calculated by means of how quickly a drug is eliminated from blood plasma. More is the half-life less is the dosage. The half-life of the drug varies with the mode of drug administration life intravenous, intramuscular, parenteral and orally. Based on the required of the drug dosage or its half-life, the mode of administration is determined (Shargel, Andrew & Wu-Pong, 2015).

9.Transportation of drug inside the body can take place via two ways, active transport and passive transport.

Passive transport
Passive diffusion	Pore transport	Ion-pair transport	Facilitated or receptor medicated diffusion
Active transport
Symport (co-transport)	Anti-port (counter transport)

(Source: Newton, Hickey & Brant, 2016) 

10. Bioavailability: One of the principal pharmacokinetic properties of a drug is belong under a sub-category of absorption. It is defined as the fraction of administered drug dose of unchanged drug form reaches systemic circulation Newton, Hickey & Brant, 2016).

Oral Dosage form (decreasing order to bioavailbility)

Solution

Suspension

Capsule

Tablet

Coated Tablet

(Source: Newton, Hickey & Brant, 2016)

Pharmacodynamics, Pharmacokinetics, and Pharmaco-therapeutics

Receptors are membrane bound macromolecular protein that helps in the transportation of drugs towards the effector molecules.

Types of receptors:

Type 1: Ligand gates ion channels

Type 2: G-protein coupled receptors

Type 3: Kinase linked receptors

Type 4: Nuclear receptors,

Agonist: Agonists are the drug which when binds with is receptors cause receptor activation.

Antagonist: Antagonists are the drugs which when binds with the receptors cause receptor deactivation.

(Perry, Potter & Ostendorf, 2015)

12.

• Drug toxicology: It is used to measure the toxic effect of drugs inside the body.
• Anaphylactic reaction: Life threatening allergic reactions that belong under type 1 hypersensitivity reaction.
• Adverse reaction: Thenegative effects of drugs
• Contraindications: It is specific situation or a condition of the body where a particular drug or a procedure or surgery cannot be used as it may prove to be harmful for the person.
• Precautions: The measures taken in order to avoid any adverse reactions prior to drug administration.
• Side-effects: Therapeutic adverse effect of a drug

(Perry, Potter & Ostendorf, 2015)

8 rights of medication administration

1. Right medication (drug, medication, medicines)

• Checking medication level
• Checking the order

1. Right dose

• Confirming appropriateness of the dose
• Checking the medication order

1. Right route

• Checking order and appropriateness of the route administration route
• Checking the last route of administration of last dose

1. Right time

• Frequency or ordered medication
• Checking the prescribed time of medication administration

1. Right person

• Asking patient to identify himself
• Use of two identifiers

1. Right expiration date
2. Right to refuse

• Documentation of refusal

1. Right prescription (documentation)

• Using proper method of recording the medical records

(Perry, Potter & Ostendorf, 2015)

Oral: Through mouth;  

• Sublingual: placing drug under tongue; cardiovascular drugs
• Buccal: Placing drug in between gums; psychiatric drug
• Dry Powder inhalers: breath through inhaler via mouth; asthmatic medication
• Metered dose inhalers: short burst of aerosolized medicine via inhalation; respiratory disease (asthma)
• Nebulisers: inhaled directly into lungs; pneumonia
• Oxygen therapy: Administered via nasal canulla; Chronic obstructive pulmonary disease
• Subcutaneous injections: Beneath the skin; insulin
• Intramuscular injections: Inside the muscle; Tetanus
• Z – track injections: type of intramuscular injection, used to prevent leakage t the mediciane in the subcutaneous layer.; used in elderly patient with decreased muscle mass
• Enteral administration – percutaneous gastrostomy (peg) as well as nasogastric tubes: gastrointestinal tract; Liquid medications: elixirs and suspensions
• Intranasal, including nebulised medications: via nose: nebulizers
• Ocular:  topical administration of medicine via eyes (subconjunctival, intravitreal, retrobulbar, intracameral)
• Rectal: Rectum as a route of administration; Glycerine suppository
• Sub-cutaneous injection using pre-loaded syringes or pens: beneath the skin; clexane (low molecular weight heparine)
• Topical, including transdermal: application over body surface, skin ointment for allergy
• Vaginal: Antifungal (cloritmazole)
• Ventrolateral injection technique: type of intramuscular injection at the junction between spine and hair region on the ventrolateral aspect of the hedgehog’s flank

(Perry, Potter & Ostendorf, 2015)

15.

Paracetamol

Chemical name: n-(4-hydroxyphenyl)ethanamide

Trade name: Capol

Generic name: Paracetamol

(Perry, Potter & Ostendorf, 2015)

Name of medicine	Name of medicine	Rationale of administration	Route of administration	Mode of action	Side-effects	Nursing intervention
BETA- BLOCKERS	Mepindolol	Used to treat glaucoma	Oral	beta-adrenergic blocking agents	Dizziness	Regular check-up of blood pressure
CALCIUM CHANNEL BLOCKERS	Diltiazem	High blood pressure	Oral	Relaxation of smooth muscle	Headache	Regular check-up of blood pressure
ANTI-HYPERTENSIVE		Hypertension	Oral	Diuretics (water pills)	diarrhoea	Regular check-up of blood pressure
DIURETICS	hydrochlorothiazide	Help kidney to get rid of extra-water	Oral	Blocks reabsorption of sodium in nephron	Low sodium level	Maintain electrolyte balance
ANTI-CHOLESTOR	simvastatin (Zocor)	Harmful effect of cholesterol	Oral	Blocks cholesterol absorption	Stomach ache	Easy to digest diet
ANTI-CLOTHING	warfarin	used to prevent blood clots	oral	Reduction in the production of blood clotting factor	severe bruising	Prevention of wounds
SEDATIVES	clonazepam (Klonopin)	Helps to induce sleep	oral	enhancement of gamma-aminobutyrate (GABA)-mediated mechanisms in the CNS	constipation	Monitoring of sleep
ANTIDEPRESSANTS	amoxapine	Helps to prevent depression	oral	Selective serotonin reuptake inhibitors (SSRI)	nausea	Monitoring psychotic action
ANTIPSYCHOTICS	· aripiprazole (Abilify)	Prevention of psychosis	oral	blockage of dopamine D2 receptors in the dopaminergic pathways brain	nausea	Monitoring of mental condition via counselling
ANTIBIOTICS	penicillin	Prevention of bacterial infection	Oral or intravenous	Bactericidal works via disruption bacterial cell membrane (gram negative)	Multi-drug resistance	Monitoring the bacterial load in blood
VITAMINS/MINERALS	Vitamin B12	Prevention of pernicious anaemia	oral	Water soluble vitamin, mix directly with blood	Vitamin overdose (staining of teeth)	Monitoring vitamin and mineral levels in blood
ANTI-REFLUX	esomeprazole (Nexium)	Prevention of acid reflux	Oral suspension	Proton-pump inhibitor	constipation	Regular and periodic intake of food
ANTI-EMETICS	Cyclizine	Prevention of vomiting and nausea	oral	H1 histamine receptor antagonists	gastrointestinal disturbanc	Regular and periodic intake of food
ORAL HYPOGLACEMICS	Sulfonylureas – glimepirid	Anti-diabetic medication	oral	Stimulates insulin secretion from pancreatic beta cells	Weight gain	Monitoring blood glucose level
APERIENCES	laxative	induce bowel movements	oral	Competitive antagonist at opioid receptors	constipation	Intake of liquid food
INHALED MEDICATIONS	Inhalers (salbutamol)	Treatment of COPD	nasal	relaxation of bronchial smooth muscles	Headache	Guiding patient to take inhaler
ANALGESICS	Codeine (nonsteroidal anti-inflammatory drugs (NSAIDs)	Pain relief	oral	Inhibition of the synthesis of prostaglandins	Drowsiness	Regulating proper dose
RESPIRATORY MEDICATIONS	Bronchodilators	Treatment of asthma	oral	relaxation of bronchial smooth muscles	Headache	Checking partial pressure of oxygen
ANTI-INFLAMATORY	aspirin	Fever and mild pain	oral	Inhibits the synthesis of prostaglandins and thromboxanes	black, bloody, or tarry stools	Regulating proper dose
ANESTETICS	Ketamine	Maintenance of anaesthesia	intravenous	Blockage of NMDA (N-methyl-D-aspartate) receptors	blurred vision	Checking the consciousness of the patient and other cardiac condition before application of medicine
ANTI-VIRAL	· Rapivab (peramivir)	Viral fever	Intra-venous	Inhibit viral replication	Renal impairment	Not suitable for patients with renal impairment
OPHTALMIC	ofloxacin	Bacterial infection of eyes	Eye drop	bactericidal	dizziness	Guiding the patients after giving medication while suffering from blurred vission
ANTI- PARKINSONS	Dopamine agonists	Treatment of Parkinson disease	oral	activates dopamine receptors	Hallucinations	Checking the hand tremor if any
ANTI-EPILEPTIC	benzodiazepines	Treatment if seizures	oral	Modifying neurotransmitter gamma-aminobutyric acid (GABA)	Development of habit of medicine	Protect patient from injury coming from seizures
CONTRACEPTIVE MEDICATIONS	Elinest	Prevention of pregnancy	oral	nhibition of ovulation	changes in vaginal bleeding	Birth control

(Source: Perry, Potter & Ostendorf, 2015; Kizior & Hodgson, 2017) 

As the patient has been suffering from 6 by 10 pain scale which reflects a moderate to severe pain the patient will need a functional or target it pain medication. Although the patient had been taking metoclopramide which can have severe drug interactions Side Effects if any narcotic pain medication is taken. Has the patient will need to take a non narcotic pain medication such as toradol (Chen et al., 2011).

Oxycodone is opoid based analgesic and it is orally administered usually. It is mainly administered with HCl solution and mm is needed to be very carefully measured by the Healthcare professionals before administering it to the patient. The patient will show  significant indications of pain relief and it can be measured through the facial pain scale measurement tools. Along with that some non pharmacological pain medication techniques can also be administered to the patient to help relieve the pain (Elvir-Lazo & White, 2010).

Paracetamol belongs to the class of analgesics. Can be stored at room temperature.

Oxycodon belongs to the opoid. Should be stored at temperature within 68 to 77F.

Metoclopramide is a dopamine-2 receptor antagonist. Should be stored in a temperatire within 68 to 77 F.

The drugs need to be administered with the right drug : mediation ratio, in this case as I have faced shortage I would ask the doctor to prescribe another medication of the same composition or i will reduce the amount of mediation stock so that the ratio of drug and mediation remains the same and administer to the patient at extreme urgency. 

It has to be mentioned that cellulitis is a very common bacterial infection but there are many side effects associated with the disease. Not taking the medication for the patient has many implications and there are various complications that can occur if the cellulitis is not managed and prevented by the treatment. Not taking the medication can delete the infection spreading throughout the body and entering lymph nodes and bloodstream. This can cause blood infection, bone infection, inflamed lymph vessels, and even tissue death for the patient (Kilburn et al., 2014).

Polypharmacy and Adverse drug reactions

Patient education plays a major role in motivating and providing the patience to fall in line with the treatment plants and provide can send to their progress of the treatment. In this case the patient has stopped taking medication because he was not feeling well and he was feeling depressed. In such cases engaging the patient in ICU therapeutic conversation encouraging him to understand the severity of the Healthcare adversity is going through and how he can control his progress by cooperating with the treatment plan can help. Hence I will attempt to interact with the patient (Karppelin et al., 2010).

As the patient is allergic to penicillin, and amoxicillin belongs to the penicillin class of drugs, the nursing professional will lead to discuss with the Iron if amoxicillin can be replaced by any non penicillin antibiotic as taking amoxicillin can be harmful for the patient (Kilburn et al., 2014). 

Diabetes is concerned with high blood sugar levels and can lead to many health complexities like coronary heart diseases, renal diseases, and hypertension. The patient will need to keep your body weight and BMI in control. The various ways that the patient can maintain healthy weight is with regular exercise, low fat diet, and regular checkups. The medications include alpha glucosidase inhibitor, biguanides, dopamine antagonists, DPP4 inhibitors, incretin mimetics, and thiazolidinediones. As the blood glucose levels of the patient is very high insulin will be included in the medication plan for the patient, the patient funny to be very careful about the tools and the injection sites. Rotating injection site will help in avoiding an infection or soreness. The dietary plan of for the patient will include high carbohydrate and fibres. 50% of his meals will need to include green vegetables. Along with that one fourth of his meal choice should include starch based foods and the rest must include milk and fruits. Occasionally he might indulge in lean meat like chicken or fish, but the amount has to be very limited. The patient family has to be involved in the plan in case of hyperglycemia attacks in which case the patient must be administered 15 grams of carbohydrate, preferably sugars. The risk factors include low blood glucose, weaknesses, fatigue, and diabetic foot ulcers. The patient will need to consult with cardiac specialist and dietitian for better management of the disease (Inzucchi et al., 2012).

Gentamycin can be prescribed to the patient for conjunctivitis. Although the precautions include allergic reactions, and can even cause temporary blurred vision. It can be stored in room temperature within 15 to 30 degree Celsius (Ley et al., 2014).

Yes, as the blood glucose is much higher than the normal levels, I will administer insulin and I will administer 15 units of insulin, preferably Actrapid (Inzucchi et al., 2012). 

References

Chen, W. H., Liu, K., Tan, P. H., & Chia, Y. Y. (2011). Effects of postoperative background PCA morphine infusion on pain management and related side effects in patients undergoing abdominal hysterectomy. Journal of clinical Anesthesia, 23(2), 124-129.

Elvir-Lazo, O. L., & White, P. F. (2010). The role of multimodal analgesia in pain management after ambulatory surgery. Current Opinion in Anesthesiology, 23(6), 697-703.

Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., … & Matthews, D. R. (2012). Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 55(6), 1577-1596.

Karppelin, M., Siljander, T., Vuopio?Varkila, J., Kere, J., Huhtala, H., Vuento, R., … & Syrjänen, J. (2010). Factors predisposing to acute and recurrent bacterial non?necrotizing cellulitis in hospitalized patients: a prospective case–control study. Clinical Microbiology and Infection, 16(6), 729-734.

Kilburn, S. A., Featherstone, P., Higgins, B., Brindle, R., & Severs, M. (2014). Interventions for cellulitis and erysipelas. Cochrane Database Syst Rev2010, 16.

Kizior, R. J., & Hodgson, B. B. (2017). Saunders Nursing Drug Handbook 2018-E-Book. Elsevier Health Sciences.

Ley, S.H., Hamdy, O., Mohan, V. and Hu, F.B., 2014. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet, 383(9933), pp.1999-2007.

Newton, S., Hickey, M., & Brant, J. (2016). Mosby’s Oncology Nursing Advisor E-Book: A Comprehensive Guide to Clinical Practice. Elsevier Health Sciences.

Nursing and Midwifery Board of Australia – Home. (2017). Nursingmidwiferyboard.gov.au. Retrieved 15 February 2018, from https://www.nursingmidwiferyboard.gov.au/

Perry, A. G., Potter, P. A., & Ostendorf, W. (2015). Nursing Interventions & Clinical Skills-E-Book. Elsevier Health Sciences.

Satoskar, R. S., Rege, N., & Bhandarkar, S. D. (2015). Pharmacology and Pharmacotherapeutics-E-Book. Elsevier Health Sciences.

Scheduling basics. (2017). Therapeutic Goods Administration (TGA). Retrieved 15 February 2018, from https://www.tga.gov.au/scheduling-basics

Shargel, L., Andrew, B. C., & Wu-Pong, S. (2015). Applied biopharmaceutics & pharmacokinetics (pp. 119-120). McGraw-Hill Medical Publishing Division.