MODULE II 3.

Opioids

HERBAL THERAPY Pharmacokinetics and pharmacodynamics

Republic Act No. 9711 Effects and use Treatment
Food and Drug Administration (FDA) Act of 2009”. Overdose: naloxone (Narcan)
Withdrawal symptoms: methadone (Dolophine),
- AN ACT STRENGTHENING AND clonidine (Catapres)
RATIONALIZING THE REGULATORY Opioid antagonist: naltrexone (Trexan, ReVia)
CAPACITY OF THE BUREAU OF FOOD AND Anesthetic agents has prolonged sedative effect with liver
DRUGS (BFAD) BY ESTABLISHING ADEQUATE dysfunction
TESTING LABORATORIES AND FIELD Increase dose of analgesics if dependent on opioids
OFFICES, UPGRADING ITS EQUIPMENT,
AUGMENTING ITS HUMAN RESOURCE OTHER DRUGS:
COMPLEMENT, GIVING AUTHORITY TO Cannabis
RETAIN ITS INCOME, RENAMING IT THE Inhalants
FOOD AND DRUG ADMINISTRATION (FDA), Volatile solvents
AMENDING CERTAIN SECTIONS OF Aerosols
REPUBLIC ACT NO. 3720, AS AMENDED, AND Anesthetic agents
APPROPRIATING FUNDS THEREOF. Nitrites
DRUG ABUSE
CULTURAL CONSIDERATIONS Chemical Impairment in Nurses
Moslem Middle East, Christian & Mormons – alcohol Serious concern
or mind-altering drugs – ABUSE - 10 to 20% of nurses have substance abuse problem
European – alcohol part of social gathering 3 to 6% demonstrate impaired practice because of drugs
American Indians – Psychedelic agents - Alcohol most common followed by other CNS acting
White Americans – alcohol & amphetamines drugs (Demerol, Valium & Oxycodone)
African Americans & Hispanics – heroine & cocaine
Contributing factors:
TERMINOLOGY OF DRUG ABUSE Stressors – chronic fatigue, illness, responsibility for
Drug misuse – indiscriminate use other than indicated clients’ responses to illness & dying, professional
Drug abuse – drug use inconsistent with medical & social dissatisfaction, access to drugs & others
norms - Changes in personality & behaviors, job performance &
Drug addiction – Complex disease of CNS with attendance
compulsive uncontrolled craving for & dependence on a
substance CONTROLLED SUBSTANCES AND SCHEDULES
CONTROLLED SUBSTANCE
DEFINITIONS: -Drugs whose general availability is restricted; any one of
Brain reward system – mesolimbic system a number of drugs or other substances which are strictly
Tolerance – decrease effect regulated or outlawed because of their potential for abuse
Craving – subjective need or addiction.
- Such drugs include those classified as narcotics,
- Drug craving stimulants, depressants, hallucinogens, and cannabis.
- known as "drugs" or "dope"
Cue - induced craving (persuade)
Relapse – return to abuse during abstinence SCHEDULED DRUGS
-the classification of drugs according to their potential for
abuse
STIMULANTS – make a person feel awake
1. Nicotine SCHEDULE I - are the drugs that have the highest
- Nicotine Replacement Agents potential for abuse and dependence but have little or no
Gum, Lozenge, Patch, Nasal spray, Inhaler therapeutic value or are intended for research only.
2.Cocaine Example: Heroin, marijuana, methaqualone
Amphetamines
3.Caffeine SCHEDULE II – has high abuse potential and physical
and psychological dependency.
DEPRESSANTS – slows down brain activity Example: Morphine, cocaine, methamphetamine Hcl
1. Alcohol [shabu]
Wernicke’s encephalopathy
Korsakoff’s psychosis SCHEDULE III – has moderate abuse potential and
Drug therapy for alcohol withdrawal physical dependency but high psychological dependency.
Rehabilitation and sustained abstinence Example: Anabolic steroids, codeine, hydrocone with
2.Sedative-hypnotics
aspirin or Tylenol, some barbiturates. POOR MEDICATION ABSORPTION
A. hormonal differences
SCHEDULE IV – has lower abuse potential and B. changes in physical maturity
dependency. C. Poor nutritional habits, and
Example: Darvon, Valium. D. Gastric and Intestinal conditions in the stomach and
intestine affect the absorption of the drug.
SCHEDULE V – has the lowest abuse potential and
dependency. It is the only category in which some drugs First-pass elimination is reduced due to of immaturity of
maybe dispensed without a prescription because the the liver and reduced levels of microsomal enzymes.
quantities of the drug are low that the possibility of causing Delayed emptying in children reduces the peak
dependence is extremely remote. concentration of medications
Example: OTC cough medications with codeine are used
therapeutically without prescriptions. Pediatric Considerations
- Conditions that change perfusion such as dehydration in
NOTE: Drugs under schedule 2-5 maybe dispensed only infants, cold temperature and alterations in cardiac status
if therapeutic value has been determined. may impede absorption of medications at the tissue level.
Infants have greater body surface areas & thin skin
ADDICTION refers to the overwhelming feeling that resulting to faster effect of topical medications.
drives someone to use a drug repeatedly. - slow or irregular peristalsis
- Gastric pH is less acidic because acid-producing cells in
DEPENDENCE is the physiological or psychological need the stomach are immature until approximately 3 years of
for a substance. (relies) age
2 TYPES OF DEPENDENCE: - TBW content is greater that is why the fat content is less.
PHYSICAL DEPENDENCE refers to an altered physical - Immature blood- brain barrier results to more blood
condition caused by the nervous system adapting to entering the brain.
repeated drug use. - Decreased production of protein by immature liver
*WITHDRAWAL SYNDROME results to a decrease in Protein-binding capabilities.
- More toxicity in young infants.
PSYCHOLOGICAL DEPENDENCE shows few signs of - Higher metabolic rates.
physical discomfort when drug is withdrawn; however, the
individual relies for its pleasurable effects Nursing Considerations:
1. Always get the history.
PHASES OF PHARMACEUTICAL RESEARCH 2. Observe Adverse reactions and therapeutic effects
Preclinical Trials 3. Most medications are ordered based on the child’s
- To determine a drug’s toxic and pharmacologic effects weight in kilograms or body surface area.
through in vitro and in vivo animal testing in the laboratory. 4. Measure the amount of drugs in serum drug levels or
plasma levels to establish routes of medication and
Genotoxicity – ability of a compound to damage genetic dosage of drugs
information in a cell, in addition to ADME 5. Calculation of pediatric dosages is based in part in FDA
PHASE 1 – small group of people to determine safety, recommendation, approved protocols, research studies.
safe dosage range, and identify side effects 6. Always consider the developmental and chronological
age, cognition and temperament.
PHASE II – larger group of people to determine effectivity
and evaluate safety ALWAYS DETERMINE THE FOLLOWING FOR
PEDIATRIC CLIENTS.
PHASE III – large groups of people to confirm - Age
effectiveness, monitor side effects, compare it to - Allergies to drugs and food
commonly used treatments, and collect information that - Medical and medication history (including adverse drug
will allow the drug or treatment to be used safely reactions)
- Head-to-toe assessment findings
PHASE IV - after drug has been marketed to gather - Baseline vital signs
information on drug’s effects and its side effects - Weight (important because many doses are calculated
per kilogram and body weight)
GERIATRIC AND PEDIATRIC CONSIDERATIONS
PEDIATRIC CONSIDERATION IN PHARMACOLOGY Pediatric consideration:
- Medications should be called medicines and their
FACTORS THAT AFFECT THE RATE AND DEGREE OF dangers be made known to children.
ABSORPTION - Avoid disguising medications in essential food such as
A. Route of administration milk, orange juice or cereal because the child may
B. Age develop a dislike for the food in the future.
C. Child’s health status - Most medications are better tolerated with 6-8 ounces of
fluids such as juices, water or milk.
- Unless contraindicated adding small amounts of water - Older adults may not fully understand the drug regimen.
to elixirs may help in the child’s tolerance of the Non adherence can cause under dosing or overdosing
medications. that could be harmful to the older adult client’s health
- Keep all medications out of reach of children of all ages.
Secure medications at all times to prevent accidental NOTES: encourage compliance.
poisoning.
- Avoid using the word “candy” in place of “medications” ASSESSMENT (GERIATRIC CLIENT)
- Always document what was successful so that the Age
method be communicated to others E.g. a frozen popsicle Allergies to drugs and food
before administration of an unpleasant tasting pill or Present and past medical and medication history
liquid. (especially prescription and OTC medications being
taken)
GERIATRIC PHARMACOLOGY Use of polypharmacy
- The body ages and the function of several organ Use of home remedies
systems slowly deteriorate after many years of wear and Dietary habits
tear. List of all physicians
Self-medication practices
ABSORPTION: Limitations (sensory, visual, hearing, cognitive/motor
- Gastric pH is less acidic. skills, financial status)
- Gastric emptying is slowed. Results of renal and liver function tests.
- Blood flow to the GI tract is reduced by 40%-50.

POLYPHARMACY
- Administration of many drugs together
- One patient may have several illnesses and be taking
many drugs
- Drastically increases the risk of drug interaction, adverse
reactions and hospitalizations

HYPNOTICS- intended to promote or improve sleep

- Should be taken one hour before bedtime. Taken for
insomnia (difficulty falling asleep), frequently awakening
- Sedatives and hypnotics are the second most common
group of drugs prescribed or taken OTC.
- during the night or awakening early in the morning with
difficulty falling back to sleep.

Examples of These Medications are the following:

Halcion- difficulty falling asleep
Restoril- frequent awakening
Dalmane- not recommended for the elderly because of
the many side effects.

GASTROINTESTINAL
- Anti ulcer meds- Sucralfate
- Cimetidine (Tagamet) not suggested for the older adult
because of its side effects and multiple potential drug
interactions.
- Laxatives-non pharmacological measures are better but
they are frequently taken by the older adult in long term
facilities.

ANTI-DEPRESSANTS
- Tricyclic anti-depressants are effective for the older adult
client
- Prozac (Fluoxetine) common
- MAO (monoamine oxidase) inhibitors not prescribed –
many food-drug interaction, orthostatic hypotension

NARCOTIC ANALGESIC
- Hypotension and respiratory depression may result from
narcotic use.