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Pharmacology for Nurses-A Pathophysiologic
Approach Adams - Holland - Urban (Unit 1)
Latest 2025 Update!! Graded A+
Pharmacology - Study of medicine; how drugs are administered; where drugs travel in the body, Response that drugs produce. drug - A chemical substance that is taken to cause changes in a person's body or behavior medication - A substance that is used to treat or prevent disease or relieve pain. biologics - agents naturally produced in animal cells, in microorganisms, or by the body itself Mechanism of Action - how a drug produces its physiological effect in the body Bioavailability - the extent to which the body can absorb and use a nutrient Therapeutic classification of drugs: - Based on what the drug does clinically Pharmacologic Classification - Based on the drug's mechanism of action, or how the drug produces its effect Most Drugs have three names - Chemical, Generic, Trade (CHEMICAL: (1/2)-2-(p- isobutylphenyl) propionic acid; GENERIC: ibuprofen; TRADE: Motrin) Generic vs. Trade-Name Drugs - Trade name drugs with exclusive rights cost more. When rights end, competing companies offer generic form cheaper prescription drugs - Drugs legally available only with a physician's order. Over the counter drugs (OTC) - can be purchased without a prescription Black Box Warnings - One of the primary alerts for identifying extreme adverse drug reactions discovered
during and after the review process; 1997 FDA created "Black Box Warnings" Contraindications - factors that prevent the use of a drug or treatment why should healthcare professionals be concerned about patients taking herbal medicines? - patients could be putting themselves at risk, potential herb-drug interactions U.S. Pharmacopoeia (USP) - 1820; 1st comprehensive publication formulary used in the U.S.; drug purity, strength, and directions for synthesis. USP and National Formulary (NF) - 1852-1975, two drug standards in the US by the American Pharmaceutical Association (APhA). 1. USP - all drug products. 2. National Formulary (NF) - pharmaceutical ingredients. U.S. Pharacopoeia -National Formulary (USP-NF) - 1975 merged into a single publication Biologic Control Act - 1902 standardized serum and blood-related products Pure Food and Drug Act - 1906 - Established government control (FDA) for labeling medicines Shirley Amendment - 1912 - Prohibited drugs labeled with false therapeutic claims Food, Drug, and Cosmetic Act (1938) and amendments - 1938- Thorough testing of drug; Proof of safety and efficacy of drug Dietary Supplement Health and Education Act, 1994 - 1994-Controls misleading industry claims Four Stages of Approval for Therapeutic and Biologic Drugs - 1. Preclinical investigation (1-3 years, average 18months)
- Clinical investigation (2-10 years; average 5 years)
- Review of new drug application (NDA) (2 months -7 years, average 24 months)
Three Checks of Drug Administration - 1. Checking drug with MAR (medical administration record) or medication information system when removing it from storage
- Checking drug when preparing it
- Checking drug before administering it to the patient Drug Compliance - taking a medication in the mannerprescribed by the health care provider ac - before meals ad lib - as desired/as directed AM - morning bid - twice a day cap - capsule gtt - drop h or hr - hour IM - intramuscular IV - intravenous no - number pc - after meals, after eating PO - by mouth PM - afternoon PRN - when needed/necessary qid - four times a day
q2h - every 2 hours (even or when first given) q4h - every 4 hours (even) q6h - every 6 hours (even) q8h - every 8 hours (even) q12h - every 12 hours Rx - take STAT - immediately; at once tab - tablet tid - three times a day Common Protocols and Techniques for All Routes of Administration - 1. Verify medication order, check allergy history
- Wash hands and apply gloves, if indicated
- Use aseptic technique when preparing and administering parenteral medications
- Identify patient (two forms of ID)
- Ask patient about known allergies
- Inform patient about drug
- Position patient
- Remove prepackaged drug at bedside
- Unless instructed to do so, do not leave drugs at bedside
- Document administration and pertinent patient responses Pharmacokinetics - The process by which drugs are absorbed, distributed within the body, metabolized, and excreted. Four Categories of Pharmacokinetic Processes - 1. Absorption -Movement from site of administration, across body membranes, to circulating fluids. Primary
Drug Plasma Concentration and Therapeutic Response - Concentration of medication at target tissue is often impossible to measure, so it must be measured in plasma minimum effective concentration - amount of drug required to produce a therapeutic effect Toxic concentration - level of drug that will result in serious adverse effects Therapeutic range - concentration of drug in the blood serum that produces the desired effect without causing toxicity peak concentration - Absorption rate equals elimination rate steady-rate concentration - the concentration remains stable when the drug is given repeatedly trough concentration - the point at which the lowest amount of drug is in the serum How Drug Reaches and Maintains Therapeutic Range - 1. Repeated doses of drug are given
- Drug accumulates in bloodstream
- Plateau is reached
- Amount administered equals amount eliminated Loading Dose vs. Maintenance Dose - Loading dose-Higher amount of drug given.Plateau reached faster. Quickly produces therapeutic response. Maintenance dose-Keeps plasma-drug concentration in therapeutic range. Agonist - a molecule that, by binding to a receptor site, stimulates a response partial agonist - Medication that produces a weaker, or less efficacious, response than an agonist. Antagonist - competes with the agonists for binding at receptor site
Pharmacodynamics - The process by which a medication works on the body. Therapeutic Index - Measure of a drug's safety margin. The higher the value, the safer the drug. The Nursing Process - Assessing - Collect data; organize data, validate date, document data Diagnosing -analyze data; identify health problems, risks, and strengths; formulate diagnostic statements Planning - Prioritize problems/diagnoses; formulate goals/desired outcomes; select nursing interventions; write nursing interventions Implementing - Reassess the patient; determine the nurse's need for assistance; implement the nursing interventions; supervise delegated care; document nursing activities. Evaluating - Collect data related to outcome; compare date with outcome; relate nursing actions to patients goals/outcomes; draw conclusions about problem status; continue, modify, or terminate the patient's care plan Assessment of the Patient - 1. Systematic collection, organization, validation, and documentation of patient data
- Health history and physical assessment
- Baseline data gathered; will be compared to later information from observations
- Once pharmacotherapy is initiated, assessment focuses on reaction to medication. Watch for: desired response, adverse effects, patient capability of assuming responsibility for self-administration Nursing Diagnoses for Drug Administration - 1. Often most challenging part of nursing
- Focus is on patient's needs, not nurse's
- Three main areas of concerns
- Promoting therapeutic drug effects
- Minimizing adverse drug effects and toxicity
- Why the medication has been prescribed for this particular patient
- How the medication is supplied by the pharmacy
- How the medication is to be administered, including dosage ranges
- What nursing process considerations related to the medication apply to this patient Drug Administration - In order to prepare and administer drugs, it is imperative that you understand and follow the "Six Rights of Medication Administration" • Right dose - In order to avoid medication errors, always complete three checks when preparing medications
- When reaching for the container
- Immediately before preparing the dose
- When replacing or discarding the container • Right Route -Medications must be administered in the form and via the route specified by the prescriber. Right Time - The prescriber will indicate when and how often a medication should be administered.
- Medications can be ordered once a day (daily), twice a day (b.i.d.), three times a day(t.i.d.), or four times a day (q.i.d.). Right Patient - Before administering any medication, it is essential to determine the recipient's identity. At least two identifiers are required by the Joint Commission
- the patient identification bracelet information
- verbalization of the patient's name by the patient or parent
- patient's hospital number or patient's home telephone number. Right Documentation
- Always document the name and dosage of the drug, as well as the route and time of administration, on the MAR.
- Sign your initials immediately after, but never before, the dose is given and include any relevant information:
- patient allergies to medications
- heart rate (when giving digoxin)
- blood pressure (when giving antihypertensive drugs) Drug Label
- Mycobutin (rifabutin)
- capsules
- NDC 0013-5301-
- Bar code
- 150 mg
- Usual Dosage: Two capsules in a single daily administration. For additional prescribing information read package insert.
- USP
- Store at 25 degrees Celsius (77 degree Fahrenheit) excursions permitted to 15- 30 degrees Celsius (59-86 Fahrenheit) see USP Controlled Room temperature.
- expiration date
- Manufacturer - 1. Name of drug: What is trade name of this drug? What is the generic name of this drug? 2.Form of drug:.
- National Drug Code (NDC) number 4.Bar code: Has the NDC number encoded in it.
- Dosage Strength:What is the dosage strength of this drug?
- Dosage recommendations: What is the recommended dosage?
- USP: This drug meets the standards of the United States Pharmacopeia.
- Storage directions: Some drugs have to be stored under controlled conditions if they are to retain their effectiveness. How should this drug be stored?
- Expiration date: The expiration date specifies when the drug should be discarded. What is this drugs expiration date?
- Manufacturer: Drug Prescriptions - directive to the pharmacist for a drug to be given to a patient Medication orders (drug orders, physician's orders) - are directives to the pharmacist for the drugs used in a hospital or other healthcare facility. Orders are written in the sequence: drug name, dose, route, frequency -Written
◦ If patient believes treatment is important and beneficial, it often is more effective Ethnicity and Culture - - Set of beliefs, values, and norms that provide meaning for an individual or group ◦ Cultural Competence
- Ability to provide care to people with diverse values, beliefs, and behaviors, including ability to adapt delivery of care to meet needs of these patients Obstacles to healthcare - • Inadequate health insurance
- Cost of treatment and drugs
- Limited medical care in rural areas
- Literacy Genetic Influences - ◦ Pharmacogenetics = study of genetic variations that give rise to differences in the way patients handle medications Complementary and Alternative Medicine (CAM) - ◦ Considered outside mainstream health care ◦ Very diverse set of therapies and healing systems ◦ Ingested therapies ◦ Alternate health care systems ◦ Biologic
- based therapies ◦ Manual healing ◦ Mind
- body interventions ◦ Spiritual ◦ Other therapies Herbs - ◦ Meaning has changed to refer to any plant product with some useful application either as a food enhancer or a medicine ◦ Documented use for thousands of years Examples of Herbal Supplements - ◦ Garlic - hypercholesterolemia ◦ Soy ◦ St. John's wort - Depression ◦ Cranberry
◦ Ginseng ◦ Stevia ◦ Horse chestnut seed extract - chronic venous insufficiency ◦ Plant sterols & stanols - hyperlipidemia ◦ Hawthorn - hypertension ◦ Valerian - insomnia ◦ Devil's claw, white willow bark - Low back pain ◦ Ginkgo biloba - memory impairment ◦ Black cohosh, St. John's wort - menopausal symptoms Dietary Supplement Health and Education Act of 1994 (DSHEA) - ◦ Regulatory act for dietary supplements ◦ Less rigid than the Food, Drug, and Cosmetic Act (FD&C Act) ◦ Dietary supplements are exempted from FD&C Act standards ◦ Gives Food and Drug Administration power to remove products considered harmful Food, Drug, and Cosmetic Act - Definition of Dietary Supplements - ◦ Products intended to enhance or supplement the diet ◦ Botanicals ◦ Vitamins ◦ Minerals ◦ Metabolites Dietary Supplement Health and Education Act of 1994 (DSHEA) - ◦ Regulatory act for dietary supplements ◦ Less rigid than the Food, Drug, and Cosmetic Act (FD&C Act) ◦ Dietary supplements are exempted from FD&C Act standards ◦ Gives Food and Drug Administration power to remove products considered harmful "Natural" Does Not Always Mean Safer - ◦ Some active chemicals are the same as in
