MODULE 2: CHAPTER 1 LEARNING ACTIVITIES

WEBQUEST:

1. Lifespan considerations in giving medications.

The majority of drugs are calculated specifically for each patient based on their size,
weight, and renal function. Pediatric patients' age and size are especially important.
The developmental stage of a child, as well as the size of their internal organs, have a
significant impact on how the body absorbs, digests, metabolizes, and removes drugs.

 Drug Therapy during Pregnancy

A fetus is exposed to many of the same substances as its mother, including any
medicines she consumes, whether prescribed, non prescribed, or on the street. The
risk of drug-induced developmental abnormalities is highest during the first trimester
of pregnancy.

Although not all medications pass the placenta, diffusion is the primary method
of delivering pharmaceuticals and nutrients to the fetus. Diffusion is a passive process
based on changes in concentration between various tissues, as you may recall from
chemistry. Active transport necessitates the use of energy and frequently involves the
use of a cell-surface protein pump.

Drug effects on the fetus are also influenced by maternal circumstances. Any
change in the mother's physiology can have an impact on the amount of drug the fetus
is exposed to. Drug metabolism and excretion are influenced by maternal kidney and
liver function. Higher drug levels and/or extended drug exposure may result from
impaired kidney or liver function, resulting in greater fetal transfer. The way certain
medications are metabolized may also be influenced by the maternal genotype
(pharmacogenetics). When the mother is exposed to a drug that is normally processed
by the specified enzyme, the fetus may experience harmful pharmacological effects
due to a deficiency of particular enzyme systems.

 Drug Therapy During Breast-feeding

Breastfed babies are vulnerable to medications taken by their mothers. A wide

range of medicines can easily pass from the mother's bloodstream to the breast milk
and then to the breastfeeding newborn. Drug qualities that are similar to those
addressed in the previous section have an impact on infants' exposure to drugs
through breastfeeding. Fat solubility, low molecular weight, non ionization, and high
concentration are the key pharmacological qualities that increase the possibility of
drug transmission by breastfeeding.

2. Drug administration during pregnancy and lactation.

The Pregnancy and Lactation Labeling Rule divides medications used by

breastfeeding mothers into two categories: those that are absorbed into the
bloodstream and those that are not. Drugs absorbed into a breastfeeding woman's
system can pass to the newborn and represent a health concern.

The Pregnancy and Lactation Labeling Rule was published in 2014 by the US Food
and Drug Administration to revise earlier standards for the prescription of
medications to pregnant and lactating women. The 2014 Pregnancy and Lactation
Labeling Rule was intended to improve the safety and efficacy of prescription
medications by making pill labels easier for clinicians to comprehend and use. Rather
than using convoluted letter classifications, the Pregnancy and Lactation Labeling
Rule redesigned medicine labels and required them to incorporate narratives
addressing drug-associated dangers to mothers and fetuses.

3. Factors that influence the transfer of drugs into breast milk.

The amount of medication excreted in milk is determined by a number of kinetic

variables, including:

1) the drug's lipid solubility, 2) the drug's molecular size, 3) the blood level achieved
in the maternal circulation, 4) protein binding in the maternal circulation, 5) oral
bioavailability in the infant and mother, and 6) the half-life in the maternal and
infant's plasma compartments.

Using these kinetic factors, one may frequently estimate the likelihood that a
medication will enter will, but the only accurate test is research reports published in
the literature. With these, we can frequently estimate the absolute dosage that infant
will receive from his or her mother's milk.

4. Nursing interventions that maximize pharmacotherapeutic outcomes in the

older adult.

Because of considerations such as age-related changes in body composition and

numerous diseases, prescribing for older adults is difficult. Finding a balance between
treating diseases aggressively while avoiding medication-related harm is a key goal
for healthcare practitioners, but it has proven difficult to achieve in clinical practice
(Steinman 2007).The previous Cochrane Review of Interventions to Improve the
Appropriate Use of Polypharmacy in Older People (Patterson 2014) concluded that,
despite the potential to reduce inappropriate prescribing, it was unclear whether
interventions to improve appropriate polypharmacy in older people resulted in
clinically significant improvements such as reduced hospital admissions or improved
quality of life.
MODULE 2: CHAPTER 2 LEARNING ACTIVITIES

WEBQUESTQUEST CORNER

1. What is astringent effect?

An astringent (also known as an adstringent) is a substance that causes body tissues to
shrink or constrict. The word adstringere is derived from the Latin word adstringere,
which meaning "to tie tightly." Astringency, which is induced by the tannins in unripe
fruits and causes a dry, puckering feeling, allows the fruit to mature by preventing
eating.

2. Sustained release versus enteric coated.

Sustained-release capsules a sustained-release drug delivery device designed to
slowly release a medication in the body over a lengthy period of time, especially to
maintain therapeutic levels versus An enteric coating, is a polymer barrier that is
placed to oral medication to prevent it from dissolving or disintegrating in the
stomach. This aids in the protection of pharmaceuticals from stomach acidity, the
protection of the stomach from the drug's harmful effects, or the release of the drug
after the stomach.

3. Administration guidelines for different drug form.

Solid Oral Dosage Forms

-Tablets -One of the oldest and most common dosage forms is the oral tablet. The
tablet is a solid dosage form that contains an active ingredient (the drug) and may or
may not have additional diluents, binders, lubricants, colorings, flavorings, and/or
disintegrates.
-Medicated Chewing Gum -Recently the use of chewing gum as a delivery
system for medications has increased. For many years aspirin has been available as a
gum, offering the advantage of a topical effect—especially for throat and mouth
discomfort.
-Medicated Thin Strips A novel dosage form has emerged to provide a
convenient dosing mechanism for the mobile world in which we live. The medication
is formulated in a thin flavored strip that dissolves when placed in the mouth. Cough
suppressants and analgesics for children, and breath fresheners and anti-gas
medications for adults are available in this palatable and portable dosage form.
MODULE 2: CHAPTER 3 LEARNING ACTIVITIES

WEBQUEST:

1. Governmental and other agencies that track medication errors.

The US Food and Drug Administration's (FDA) MedWatch program and the United
States Pharmacopeia's (USP) and the Institute for Safe Medication Practices' (ISMP)
Medication Error Reporting (MER) program are two examples. Observational
methods, computerized triggers, retrospective chart checks, and spontaneous reporting
should all be used in the discovery and subsequent reporting of pharmaceutical errors.
However, the procedures in place to report such incidents are frequently built around
spontaneous reporting and are constrained by the small percentage of overall errors
that are actually reported. Because of their potential to discover likely events that
might otherwise go unnoticed or unreported, error detection technologies such as
passive surveillance of electronic pharmacy and medical record data may offer
advantages over spontaneous reporting systems. To gain a better knowledge of error
cause and patterns of occurrence, these strategies should be utilized in unison.

2. Do electronic health record systems and electronic prescribing create new

risks of medication errors?

3. Look-alike and sound-alike drug names.

One of the most prominent reasons of medication error is the presence of ambiguous
medicine names, which is a global concern.With tens of thousands of medications on
the market today, the risk of making a mistake owing to mislabeled drugs is high.
This applies to both nonproprietary and proprietary (trademarked) names. Many drug
names resemble or sound like those of other drugs. Illegible handwriting, a lack of
knowledge of drug names, newly available products, similar packaging or labeling,
similar clinical use, similar strengths, dosage forms, and frequency of administration,
as well as the failure of manufacturers and regulatory authorities to recognize the
difference, all contribute to the confusion.

Dopamine - Dobutamine Sertraline - Cetirizine MS Contin - Oxytocin Amlodipine -

Amitriptyline Atenolol - Allopurinol Vinblastine - Vincristine Rivaroxaban-
Rosuvastatin Carbamazepine -Carbimazole Fluconazole - Voriconazole Hydroxyzine
- Hydralazine Dymenhydrinate - Diphenhydramine Valtrex (valacyclovir) - Valcyte
(valganciclovir)

4. Name at least four of the classes of medications that are considered “high-
alert” drugs.

Examples of high-alert medications include insulin, opioids, neuromuscular blocking

agents, anticoagulants
 5. List of The Joint Commission of “DO NOT USE” abbreviations, but instead
should be written out to avoid misinterpretation.
U MS IU MS04 QD MgS04 QOD trailing zeros naked decimal point

6. Guidelines for appropriate disposal of prescription drugs.

- Take unused, unneeded or expired prescription drugs out of their original

containers then mix the prescription drugs with an undesirable substance like used
coffee grounds or kitty litter, mud or sawdust and put them in impermeable, non
descript containers such as empty cans or sealable bags, further ensuring that the
drugs are not diverted or accidentally ingested by children or pets then throw these
containers in the trash. - Don’t flush meds down the drain. Flush meds down the
toilet only if the accompanying patient information specifically instruct it is safe
to do so. - Return unused, unneeded or expired prescription drugs to
pharmaceutical takeback locations that allow the public to bring unused drugs to a
central location for safe disposal.

CHAPTER 4 - WEBQUEST CORNER

- 1. Key points of Pediatric Pharmacology 

When administering drugs to children, it is vital to understand the developmental

pharmacology of neonates, infants and children. Many aspects of
pharmacodynamics and pharmacokinetics differ between the adults and pediatric
population.  The way that kids process, excrete and metabolize drugs is
completely different than it is in adults and warrants a closer look and adverse
reactions can be very specific and even different than what occurs in adults.
Absorption - in the pediatric population, the key take-away is that the absorption
is going to be more erratic in children than it is in adults. It will also vary based on
if they’re infant, baby, toddler, pre-schooler, adolescent, etc. Distribution -
medications are going to be distributed differently in children due to things like
differences in body composition and total body water. Another factor is the
frequent changes in the ratio of body fat to lean muscles as the child develops. As
children grow and change, some medications will need to be monitored regularly,
especially during times of great physical change during growth spurts and puberty.
Metabolism - the metabolism of drugs is highly complex and variable over the
first year of life. The key take-away is that when the body is undergoing a lot of
physiologic change, there is more likely to be variation in the pharmacokinetics of
medications. Excretion - the excretion of drug is affected in great part by the renal
system. The glomerular filtration rate in newborns is only about 30-40% of adult
values. So medications that are excreted by the kidneys are going to be excreted
more slowly. This means dosing intervals and amounts are going to be continually
evaluated, monitored and adjusted for medications that rely on renal clearance.

2. Key points of Geriatric Pharmacology 

Drug prescription for geriatric patients is one of the most prevalent yet aslo one of the
most interventions in geriatrics.  Geriatric Pharmacology for the older dult requires
special attention to the age-related factors of drug absorption, distribution, metabolism
and excretion.  Modifications in drug therapy for the older adults are frequently
required because of declining organ functioning in older adults, the effects of drug
therapy must be closely monitored to prevent adverse reactions to drugs and possible
drug toxicity.  Physiologic changes that causes adverse reactions to
pharmacokinetics i.e increased body fat, decreased body water, decreased muscle
mass, changes in renal and liver function and in the central nervous system. These
age-related changes make elderly patients at greater risk of adverse