Pharmacology Related to Intravenous Therapy

Chapter 7


Pharmacology Related to Intravenous Therapy




Key Terms



absorption


uptake of medications into the body through or across tissues.


agonist


medication that binds to the receptor site and stimulates the function of that site; a drug that mimics a function of the body.


antagonist


medication that binds to the receptor site to prevent other medications from binding to those sites; cancellation or reduction of one drug’s effect by another drug.


bactericidal


pertaining to the destruction of bacteria; drugs or chemicals that can destroy bacteria.


bacteriostatic


inhibiting or retarding growth of bacteria; drugs or chemicals that can inhibit or retard growth of bacteria.


continuous infusion


an uninterrupted injection of a liquid substance into the vein.


distribution


dispersion of medication particles to sites in the body.


excretion


elimination of a medication from the body.


extravasate


to escape from the vessel into the tissue.


idiosyncratic reaction


unexpected, unusual response to a drug.


intermittent infusion


administration of medications or an infusion that is not continuous but is interrupted between doses.


IV injection (IV push)


the use of a needle attached to a syringe to instill a single dose of medication into a vein.


metabolism


physical or chemical processes in the body that inactivate a drug for excretion; biotransformation.


narcotic


older term for a controlled drug that depresses the central nervous system to relieve pain and has the potential to cause habituation or addiction.


opiate


drug containing or derived from opium.


opioid


drug that is a synthetic analgesic with the strength of a morphine-like substance but is not derived from opium.


patient controlled analgesia (PCA)


a controlled infusion that allows the patient to administer a predetermined amount of analgesic.


peripheral parenteral nutrition (PPN)


method of administering diluted nutritional substances in a peripheral IV site.


pharmacokinetics


processing of drugs in the body.


superinfection


new infection that appears during the course of treatment for a primary infection.


total parenteral nutrition (TPN)


providing nutritional support through a central IV route.


As with all administration of medications, the professional responsible for the intravenous infusion also has many responsibilities other than just starting the infusion. As discussed in Chapter 5, the calculation of the accurate dose and dosage is most important because medications that have been given intravenously cannot be retrieved. The patient assessment prior to infusion is important so that any changes in the patient’s condition can be evaluated based on correct and current information. The importance of understanding the pharmacology of a medication prior to administration cannot be stressed enough.


Legally it is the responsibility of the person administering the medication to be aware of the dosage, indications, side effects, adverse reactions, and allergic reactions to any medication being given. This text cannot cover each medication and its potential problems; therefore the professional should always use reference materials prior to giving drugs, being sure the information is correct as understood. The reference materials should be readily accessible, and this responsibility, both legally and ethically, cannot be overlooked. The professional should have the accurate knowledge base to protect the patient by knowing the physician’s order for the IV fluids is complete, correct, and appropriate for the patient’s physical condition.




PATIENT ASSESSMENT NEEDS RELATED TO MEDICATIONS


As a review of patient differences to medication, the professional should assess the patient for allergies to foods, drugs, and environmental factors. Sensitivities in one area may be transferred when medications are given. Another necessary area of assessment is the lifestyle of the patient and the availability of resources for care, as appropriate. This could include the actual care that is available or it could be the knowledge level of the patient and the ability of the person who will be caregiver to understand the needed care. In some cases, this may present a problem in ensuring the regimen of the physician is followed. Finally, any area that may alter the response to the medication should be evaluated, including genetic factors, preexisting conditions or illnesses, and age. Age, genetics, amount of body fat, and preexisting conditions of body organs that influence absorption, distribution, metabolism, or excretion of administered drugs will also influence the manner in which the patient responds to the treatment.


Even when the evaluation of the patient produces some expected possible problems with IV infusion, the danger comes from the unexpected and undesired effects that may occur. These reactions are not side effects because side effects, although undesirable, are not completely unexpected. Rather, these unexpected effects can be life-threatening, including such responses as drug allergies, tolerance to medication over a period of time, an accumulation of medication because of the composition of the body tissues, or an idiosyncratic reaction. The unpredictable idiosyncrasy, such as the person who is stimulated by diphenhydramine (Benadryl) rather than sedated, does not cause hypersensitivity or allergies but may cause detrimental effects for the patient. The unwanted reactions may also be beneficial when the drug has been given to provide a certain response, such as cyproheptadine (Periactin) being used for patients who need to gain weight. Therefore the patient must be assessed early on and must be carefully followed throughout the entire infusion and for a time thereafter.


Again, this section is only a review of information that has been presented in other chapters of this text. This cannot be reiterated too many times, however, because of the need to protect patient safety and to reduce the opportunities for legal actions. The health care professional must always be cognizant of the patient and the need for safe medical care.



PHARMACOKINETICS RELATED TO IV THERAPY


Pharmacokinetics, from the terms pharmaco- meaning drugs and –kinesis for movement, relates to how the body processes medications, including the IV fluids, and is the base for the administration of the medications. The four processes of pharmacokinetics include absorption, distribution, metabolism or transformation, and excretion. First, with IV administration of medications, the absorption rate is immediate because the drug is injected directly into the bloodstream and absorption through other organs into the bloodstream is not necessary.


Second, the distribution of the drug is not slowed because of the rate of absorption. One of the major dangers of IV medication administration is the immediate distribution throughout the body because the medication is injected immediately in the bloodstream. Although the drug is delivered to the organ or tissues through blood vessels and capillaries, the effect is on the tissues, not on the blood vessels. The amount of drug circulating in the blood is called the drug blood level, and with IV drugs, this is the amount that is infused. At the site for the body’s use of the drug, barriers such as blood-brain membrane barriers and cell permeability may slow the absorption at the distribution site, but the time is not as slow as would be found with other routes of administration that must be disintegrated and absorbed into the bloodstream.


The site of use for the medication will remain as found with the oral or other parenteral forms of the medication. Medications are chosen to be effective for certain conditions at specific physical sites. The selectivity of medications to certain body cells allows some treatment to specific body cells and organs, such as thyroid replacements, whereas other drugs, such as antibiotics, are less selective and are distributed to multiple types of cells throughout the body.


After the drug reaches its site of distribution, a series of chemical reactions occur–converting the medication to be broken down for use, and then prepared for the body to rid itself of the medication that has not been utilized. The primary site for metabolism is the liver so any liver condition would affect the amount of medication the patient metabolizes for excretion, allowing excessive amounts of medication to remain in the body over longer than normal periods of time. The rate of metabolism is especially important for the elderly, people with liver disease, and those with debilitating illnesses. The professional who is administering IV fluids/medications must be aware of these conditions and others that may affect metabolism, distribution, and excretion and monitor the patient accordingly.


Excretion of drugs occurs through respiration, perspiration, urination, and defecation. The rate of excretion is dependent on the chemical composition of the drug, the rate of metabolism, and route of administration. IV infusions will be absorbed, distributed, metabolized, and excreted faster than medications given orally or by other parenteral routes. Thus, some medications given intravenously must be administered more frequently.



IV PHARMACOLOGY RELATED TO BODY SYSTEMS


When looking in drug references most medications are found in alphabetical order by generic name. This is helpful when looking for a specific drug, but to aid in learning the implications of using drugs for IV therapy this text will provide general information related to drug classifications that are used by body systems or by those that affect the entire body. When using a specific medication that is either unknown or the information has not been used for a long period of time, the professional should use either a drug reference or drug insert to do the needed research to provide patient safety. Remember that drug dosages vary greatly even within the same classifications of medications, so this information must be drug specific at the time of administration.



IV Anti-Infective Agents


Anti-infective agents are perhaps the most frequently used of the IV medications, especially antibiotics. Anti-infectives include antibiotics, antifungals, and antiviral medications. Antibiotics may be either bacteriostatic, which inhibit bacterial growth by producing a defective cell wall, or bacteriocidal, which alters the growth of the microorganism itself. The primary contraindication to antibiotics is the prior history of hypersensitivity to the drug. The allergic reactions can be life threatening and, when given intravenously, may occur almost instantaneously. Another disadvantage includes the possibility of superinfections after prolonged used of the drug. Finally because some antibiotics have been used over long periods, some of the bacteria are now found to be drug resistant. Remember that the drug is not ineffective because of its action, but rather the bacteria does not respond to the specific medication and the microbe becomes more dangerous because of the ineffectiveness of the medications. One of the major problems is the inappropriate use of antibiotics for viral infections for which this classification is ineffective.


The professional administering IV anti-infective medications should know normal dosage for the drug, the side effects, and incompatibilities. Important also is to know the time the medication is stable after reconstitution if that is a factor in the administration. Being familiar with side effects and adverse reactions is important, and with antibiotics the professional should always be alert for drug sensitivity and possible anaphylaxis.




Penicillins


Penicillins are both natural and semisynthetic antibiotics that are derived from the fungus Penicillium. With the low cost, low toxicity, and good clinical efficacy, these antibiotics that are classified as bactericidal are often ordered when the microorganism is susceptible and the person is not allergic to the medication. The disadvantages to these medications are the possibility of phlebitis and its drug interactions with other antibiotics. Aminoglycosides cannot be delivered in the same container or tubing as penicillins. Procaine penicillins should never be given intravenously.


Penicillin G potassium (Pfizerpen), a natural penicillin, may be given either as continuous or intermittent IV therapy for bacteriocidal action. Because of being relatively nontoxic, although this medication does have hypersensitivity issues as with other penicillins, treatment of severe infections is one of the main indications for use. Hypersensitivity manifestations are similar to those found with all penicillins, such as dermatologically with rashes and urticaria; serum sickness-like reactions such as myalgia, fever, or malaise; hematologic reactions such as hemolytic anemia or leukopenia; and possibly anaphylaxis.


Second types of penicillin used intravenously are penicillinase-resistant penicillins such as methicillin sodium (Staphcillin). These penicillins are used to treat Staphylococcus aureus or Staphylococcus epidermidis infections. The side effects are similar to those found with natural penicillins. However, nafcillin sodium (Nafcil) found in this category is more likely to cause phlebitis, although it does not cause as many kidney reactions.


Aminopenicillins, such as ampicillin sodium (Unipen or Totacillin-N), may be injected directly or by the more common means of an intermittent infusion. The stability of ampicillin after reconstitution is about 4 hours when added to a solution containing dextrose. However, if the medication is added to isotonic saline without dextrose, the time is extended to 8 hours. Finally, when placed in a minibag, the stability may last for 48 hours. A rash is the most common side effect of using this medication.


Some penicillins have extended or wider spectrums against microorganisms that have been identified by laboratory testing. Mezlocillin (Mezcil) and piperacillin (Pipracil) are typical of this group of antibiotics. These drugs have similar dermatologic and hematologic reactions to the other penicillins. Administration may be direct injection, intermittent infusion, or continuous infusion. It is important to follow the recommended rate of infusion and not exceed the flow rate because rapid infusion of some of this category of medications may result in seizures.



Cephalosporins


Cephalosporins are similar to the penicillins, having similar indications as bactericides, side effects, and contraindications. Cephalosporins are classified by spectrum rather than class. This group of medications has nephrotoxic effects and should not be given to a patient with hypersensitivity to penicillin. Cephalosporins are known to present a high risk for phlebitis so the infusion site should be observed and rotated frequently.


First-generation cephalosporins, such as cefazolin (Ancef and Kefzol) and cephradine (Anspor and Velosef), are used with such bacteria as Staphylococcus microorganisms. Used for severe infections of the many body systems, these drugs have similar side effects as penicillins, including anaphylaxis.


Second-generation cephalosporins include cefoxitin sodium (Mefoxin), cefamandole nafate (Mandol), and cefotetan disodium (Cefotan). The side effects, actions, interactions, and contraindications are similar to those found with first-generation medications. The advantage for these medications is their usefulness with anaerobic microorganisms.


With the ability to cross the blood-brain barrier, third-generation cephalosporins are often used with neurologic infections. Again, these drugs have basically the same side effects, interactions, and contraindications as found in all generations of cephalosporins. Medications typical of this category are cefotaxime sodium (Claforan), ceftazidime (Fortaz and Tazidime), and ceftriaxone sodium (Rocephin). These are usually used in home care because the medication is given as one dose daily.


Fourth-generation cephalosporins, such as cefepime (Maxipime), are relatively new but are being accepted by the Food and Drug Administration (FDA) for use with severe infections, especially of the urinary tract, and for dermatologic conditions. The interactions, side effects, and allergic reactions are similar to other cephalosporins.





Macrolides


Closely related to tetracyclines, macrolides are considered to be bacteriostatic and may have some bactericidal activity when administered in high dosages. Macrolides include erythromycin (only erythromycin lactobionate [Erythrocin] or erythromycin gluceptate [Ilotycin] can be administered intravenously) and azithromycin (Zithromax). These medications tend to cause phlebitis and must be diluted in at least 100 mL of solvent such as normal saline or 5% dextrose solutions and given over a relatively long period of time. Dilution and rotating the site make these medications less irritating for the patient. These medications are considered to be relatively free of serious side effects, so they are considered one of the safest for patients. Macrolides are used for staphylococcal, streptococcal, and pneumococcal infections as an alternative for patients who are allergic to penicillin.


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Aug 10, 2016 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Pharmacology Related to Intravenous Therapy

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