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2014002599-Poly pharmacy Concept Map, Acts and legislation - Coggle Diagram

- - - - Penicillin:
        
        Pharmacokenetics: Has low protein binding in plasma, the bioavailability of penicillin depends on the type; penicillin G has a low bioavailability, below 30%, whereas penicillin V has a higher bioavailability between 60 and 70%. Penicillin is metabolised in the liver, has a short half-life and is excreted via the kidneys.
        
        Route/Dose: PO, IV, IM, IV infusion
        
        Side effects: nausea, vomiting, diarrhoea, hypersensitivity reactions
        
        Pharmacodynamics:Inhibits the formation of a rigid bacterial cell wall needed for the cross linking of peptidoglycans in cell wall biosynthesis. It does this by binding to penicillin binding proteins with the beta-lactam ring, a structure found on penicillin molecules.
        
        Contraindications: Gram- negative bacilli, and those with an allergy or adverse reaction.
        
        Tramadol:
        
        NSAID's:
        
        Pharmacokenetics: Oral route with a 30 minute onset that peaks between 1-2 hours and has a duration of 4-6 hours. It is metabolised in the liver and excreted in the urine.
        
        Route/Dose:PO, IV, PR, Topical. The usual dose for adults is 200 mg to 400 mg 3 or 4 times daily if needed. Do not take more than 1200 mg per day unless clinically indicated. The dose will be different to this if a modified-released tablet has been prescribed.
        
        Adverse effects: GI upset/bleed
        
        Pharmacodynamics: Inhibits prostaglandin synthesis by blocking cyclooxygenase-1 and -2 receptor sites. The lowered prostaglandin level leads to an anti-inflammatory, analgesia and antipyretic effect on the body.
        
        Contraindications: The presence of an allergy to NSAIDs or salicylate, cardiovascular dysfunction or hypertension due to the decreased effect of loop diuretics, peptic ulcers or GI bleed, and Pregnancy/breastfeeding
        
        Pharmacokenetics: Extensively metabolized in the liver by O- and N-desmethylation and by conjugation reactions to form glucuronides and sulphate metabolites. It has a half-life of 5-6 hours and is eliminated through the kidneys, with a small amount excreted in the bile and waste.
        
        Route/Dose: PO (50–100 mg not more often than every 4 hours), IM, IV (50–100 mg every 4–6 hours)
        
        Adverse effects: Respiratory depression is the most serious adverse effect.
        
        Pharmacodynamics:A centrally acting multipurpose analgesic that acts on serotonergic, noradrenergic nociception, and opioid receptors.
        
        Contraindications: Decreased function of the adrenal gland, alcohol withdraw, those with an allergy or adverse reaction.
  - - - Isolation and PPE were not put in place as the attending specialist did not feel the findings were indicative of gastroenteritis of c-diff.
        
        Blood results: CRP-103, WCC- 10.5. All other results within acceptable perimeters. MSU results: 4+ leucocytes, 3+ nitrites, 4+ RBC, and 2+protients.
      - Ongoing treatment: Patient refused PR exam, IV antibiotics (Cefazolin and Metranitazole) charted to treat UTI and quary internal surgical site infection. Admitted to surgical ward for observation and CT abdomen and pelvis the following mane. Ketamine infusion with review from pain management team, additional bag of IV normal saline fluids and patient to eat and drink as tolerated.
        
        Cefazolin
        
        Metranitazole
        
        Pharmacokinetics: Metabolised in the liver and undergoes biotransformation through hydroxylation and glucoronidation. Is excreted in the urine via the kidneys.
        
        Pharmacodynamics: Enters the cell as an antiprotozoal by passive diffusion and is activated in the cytoplasm of the bacteria were drug resistant cells are deficient in drug activation.
        
        Contraindications: Hypersensitivity/anaphylaxis or other allergic reaction or hepatic impairment.
        
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        Ketamine
        
        Pharmacokinetics: Metabolized in the liver and excreted unchanged in the urine.
        
        Pharmacodynamics: an NMDA-receptor antagonist, blocks the excitatory neurotransmitter glutamate. It may also interact with norepinephrine, serotonin, and muscarinic receptors, and with opiate receptors at central and spinal sites. Ketamine induces analgesia, and disrupts association pathways of the brain to produce a dissociative anaesthesia
        
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        Pharmacokinetics: The serum half-life is approximately 1.8 hours following IV administration and approximately 2.0 hours following IM administration. excreted unchanged in the urine. In the first six hours approximately 60% of the drug is excreted in the urine and this increases to 70%-80% within 24 hours
        
        Pharmacodynamics: Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
        
        Contraindications: cephalosporin hypersensitivity
        
        Route/Dose: IV/IV infusion (mild infection 250–500 mg every 8 hours; moderate to severe infection 0.5–1 g every 6–8 hours; maximum 12 g daily) IM (500 mg every 12 hours)
        
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      - Paracetemol
        
        Fentanyl
        
        Cyclizine
        
        Normal saline 0.9% IV fluid
        
        Route/Dose: IV
        
        Isotonic fluid with an osmolarity of 308 mOsm/l. Properties of the solution are those of the sodium and chloride ions to maintain fluid and electrolyte balance.
        
        Route/Dose: PO (50 mg up to 3 times daily), IM/IV (50 mg up to 3 times daily)
        
        Pharmacokinetics: First pass metabolism and excreted in the urine.
        
        Pharmacodynamics: produces its antiemetic effect within two hours and lasts approximately four hours. H1-blockers are well absorbed from the GI tract. Following oral administration effects develop within 30 minutes, are maximal within 1-2 hours and last 4-6 hours.
        
        Contraindications: Presence of an allergy
        
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        Route/Dose: IV (as per protocol), subcutanious infusion (50–300 micrograms over 24 hours titrated according to response)
        
        Pharmacokinetics: Quick acting, predominantly converted by CYP3A4-mediated N-dealkylation to norfentanyl, a nontoxic and inactive metabolite in the liver. It is excreted in the urine and feaces.
        
        Pharmacodynamics: Fentanyl is a full opioid agonist. Opioid agonists bind to opiate receptors in the brain and spinal cord resulting in inhibition of the ascending pain pathways thus altering the perception and response to pain.
        
        Contraindications: The presence of an allergy or acute respiratory depression; when there is a risk of paralytic ileus
        
        Adverse effects: Nausea, vomiting, constipation, and bradycardia.
        
        Pharmacokinetics: Oral route with an varying onset and peak of 30 minutes- 2 hours with a duration of 3-6 hours. It is quickly absorbed by the body through the liver and also excreted quickly through the urine.
        
        Pharmacodynamics: Acts directly on the hypothalamus to cause vasodilation and sweating to reduce fever. The mechanism of action when used as an analgesic is not fully understood. It is known that it works on the E2 proteglanden receptor.
        
        Contraindications: In the presence of an allergy/adverse reaction. Caution should be used in pregnancy/breastfeeding or those with severe hepatic impairment, and should not be taken with alcohol.
        
        Route/Dose: PO (1000mg Q6H, no more than 8 tablets within a 24 hour period), IV (1 g every 4–6 hours; maximum 4 g daily)
- - - - All pediatric patients 12 years and under must have their height and weight recorded on the prescription chart.
      - Rongoā Māori medicine: If health consumers and/or whānau are seeking advice from nurses about traditional Māori medicine, a discussion with all involved, including the tohunga/ practitioner, is advisable to help the client make an informed decision. Aspects to consider include whether or not there are any evidence-based information about the medicine, if the substance is appropriate for the client’s condition, the potential side effects and/or interactions with other prescribed medicines.
      - Certain analgesia/opiods may only to be administered by, or under the direct supervision of, personnel experienced in their use, with adequate training in anaesthesia and airway management, and when resuscitation equipment is available.
    - - Respect
        
        Freedom from discrimination, harassment, coercion, and exploitation.
        
        Dignity and independence
        
        Services of appropriate standards
        
        Effective communication
        
        To be fully informed
        
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