week 2012 drug 20interactions 20OTC 20drugs 20abuse 20 20herbal 20remedies

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					Chapter 7: Drug Interactions, OTC
           Drugs, and Drug Abuse
   Objectives:
     Discuss  the role of the nurse in the identification
      and prevention of drug interactions
     Describe drug interactions for each step of
      pharmacokinetics
     Define additive, synergistic, and antagonistic
      effects of drugs (and give examples of drugs for
      each)
     Determine why nurses become chemically
      impaired and solutions you can contribute to the
      problem.
Drug Interaction
   Definition:




   As soon as more than one drug (or herb is
    introduced into the human body, drug
    interactions occur. Some interactions are
    favorable, many are unfavorable.
Drug Interactions – Critical Thinking

   How does taking more than one drug at a
    time affect pharmacokinetics?
     Absorption
     Distribution
     Metabolism
     Excretion
    Drug Interaction – Critical Thinking
                          Scenarios
   Explain what happens when Erythromycin is
    given with digoxin. Why does this occur?

   What would happen if digoxin was given
    with a laxative?

   If a pt is given coumadin and aspirin at the
    same time, what will you expect?
Pharmacodynamic Interactions
   3 Pharmacodynamic Interactions
     AdditiveDrug Effect
     Synergistic (Potentiation) Effect
     Antagonistic Effect
Pharmacodynamic Interactions
   Additive Effect
     Definition


     Positive   Interaction example

     Negative     Interaction example
Pharmacodynamic Interactions
   Synergistic Effect
     Definition


     Positive   Interaction example

     Negative     Interaction example
Pharmacodynamic Interactions
   Antagonistic Effect
     Definition


     Positive   Interaction example

     Negative     Interaction example
Other Drug Interactions to be aware of:

    Drug – Food Interactions

    Drug – Lab Interactions

    Drug – Sun Interactions (photosensitivity)
Over-The-Counter Drugs (OTC)
   Drugs that are attainable without a
    prescription.
    FDA OTC Drug Categories
   Allergy Tx Products              Laxatives and Cathartics
   Analgesics (anti-pyretics)       Nicotine gum & transdermal
   Antacids and antiflatulents       patches
   Anti-diarrheal                   Opthalmic Products
   Anti-tussives                    Sedatives and Sleeping Aids
   Bronchodilators                  Stimulants
   Cold Remedies and                Vitamin-Mineral Supplements
    Decongestants                    Weight-loss aids
   Emetics and Anti-emetics         Others?
   Herbal Products
OTC – NSAID’s (Non-steroidal
          Anti-Inflammatory Drugs)
   Examples:
OTC Drugs – Critical Thinking
   How would you respond to an unemployed
    laborer who is taking 500 mg of Tylenol
    every two hours for chronic back pain?
Considerations with OTC Drugs
   May cause delay in professional diagnosis and
    treatment
   Symptoms may be masked
   Can pt read labels and understand?
   Consult health care provider before use
   Inactive ingredients may cause adverse
    reactions
   Potential for overdose
   Intentions of prescription and OTC medicines –
    are they contra-indicated?
Chemical Impairment of Nurses
   Term used by healthcare professionals to
    indicate impaired performance as a result
    of drug use.
     Estimated  that 10-20% of nurses have
      substance abuse problems (300,000-600,000)
     Estimated that 3-6% demonstrate impaired
      practice resulting from the use of drugs or
      chemicals (90,000-180,000)
     Alcohol is most common abused drug among
      nurses
Chemical Impairment – Critical Thinking

    What are contributing factors to cause
     this?

    Suggestions for resolving this problem…
Let’s Discuss… Prescription
               Drug Advertising.

 What’s good?
 What’s not good?
 Should it continue?
Chapter 8: Herbal Therapy &
           Nursing Implications
   Objectives
     Discuss   how the consumer can determine
      safe use of herbs
     Become familiar with German Commission E
      Monographs and other Herbal sources of
      information
     Identify rationale for use of various herbs
Dietary Supplement Health and
Education Act of 1994
   Herbs reclassified as “dietary
    supplements”
     Premarket testing not required
     Manufacturing not standardized
   Clarified marketing regulations
     Physiologic   effects to be noted
   No claims of prevention or curing of
    specific conditions
Forms of Herbs
 Dried herbs
 Fresh herbs
 Oils
 Salves
 Tinctures
 Teas
 Extracts
 Syrups
Tips for Herb Safety
   Do not take if pregnant or nursing
   Do not give herbs to infants or young children.
   Do not take a large quantity of any herbal
    preparation
   Buy only products with plant and quantity listed
    on label.
   Contact health care provider (HCP) before
    stopping a prescription medication.
   Store product in a cool, dry place; dark glass
    containers are preferred.
   Look for expiration dates
Tips for Herb Safety (continued)
 Do not delay in seeking care from HCP for
  persistent/severe symptoms.
 Advise against belief in “miracle cures.”
 Herbs are not placebos.
 There is increased risk of reactions when
  prescription and OTC medications with
  similar actions are combined with herbs.
Sources to help you with Herbs
   German Commission E Monographs
     Oneof the most authoritative studies on
     herbal remedies. Best place to find if the
     herbs you buy are safe and effective
   Mosby’s Drug Guide
     Anexcellent reference for herbs and their
     uses and contraindications
   Kee – Pharm Book
     Many   tables to assist in herb recognition
Selected Herbs
   Aloe vera
     External: relief of pain; promotes burn healing
     Internal: constipation; may cause arrhythmias,
      neuropathies, edema
   Chamomile
     Relief of digestive complaints
     May have sedative effects
   Echinacea
     Stimulates immune system
     For colds, flu, recurrent respiratory  and
      urinary tract infections; limit use to 2 weeks
Selected Herbs (“the 4 G’s”)
   Garlic
     Detoxifiesand increases immune function;
      decreases platelet aggregation; for
      hypercholesterolemia, mild HTN
   Ginger
     Stimulates  digestion; antispasmodic; decreases
      platelet aggregation
   Ginkgo biloba
     Antioxidant;peripheral vasodilator and
      increased blow flow to CNS; decreased platelet
      aggregation
   Ginseng
     Will   also decrease platelet aggregation
Selected Herbs
   Licorice
     Antiinflammatory;   antibacterial; antiviral;
      topical: psoriasis and eczema
   Peppermint
     Internal:stimulates appetite and aids in
      digestion
     External: relief of tension headaches when
      rubbed on forehead (according to research in
      Germany, comparable to acetaminophen)
   Sage: herb of longevity
Selected Herbs
   St. John’s Wort
     Antidepressant  and antiviral; for depression,
      anxiety, sleep disorders; effects in 4 to 8
      weeks; drug interactions:
   Valerian
     Mild   sedative
        Sleep-inducing agent
        “Herbal valium”
        “Dirty socks” odor

				
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