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CNO Practice Standard: Medication Pharmacokinetic Phase: First-pass Pharmacodynamics: Mechanism of
effect (cont) Action (cont)
Safe, effective, and ethical administration
Knowledge, technical skill, and judgement If large amount of drug is metabolized to an Non-specific interaction
required inactive form, then less is available in circul‐ Drugs interfere with or chemically alter
ation (high first-pass effect) cellular/metabolic processes
Ongoing maintenance of competence
Means that most drugs have bioavailability
Drugs produce their actions through 1 of 3
Evaluation of <100%, whereas same drug given IV is
primary mechanisms of action: Receptors,
100% bioavailable because it has not been
Systematic, ongoing, and dynamic part of enzymes or non-specific interaction
metabolized by the liver
the nursing process
- A drug given via oral route may be extens‐ Receptor Interaction: Drugs will have
Determining status of goals and outcomes
ively metabolized by the liver before affinity to bind to particular receptor – good
of care
reaching systemic circulation (high-pass fit and strong affinity means greatest
Monitoring patient's response to drug
effect) response
therapy (Therapeutic, expected, toxic
- Same drug given IV bypasses liver,
responses)
preventing the first-pass effect from taking Pharmacotherapeutics: Nursing respon‐
Clear, concise documentation place, and more drug reaches circulation sibility
- ie. Nitro
Assessment:
Drug Absorption of Various Oral Prepar‐
- Current medication
ations Pharmacodynamics: Mechanism of
- Pregnancy
Fastest Liquids, elixirs, syrups Action
- Breast feeding
Suspension solution Receptor Interaction - Concurrent illnesses
Powders Drug reacts with a site on the surface of - Allergies/sensitivities
a cell or tissue to elicit/block a physio‐ - Contraindications: Make the use of the
Capsules
logical response drug very dangerous
Tablets
Implementation:
Receptor agonist
Coated tablets - Intent of the therapy, as well as the
Elicit response from the cell
Slowest Enteric-coated tablets psycho-motor skill of administering
Receptor antagonist - Acute therapy
Pharmacokinetic Phase: First-pass effect Do not elicit response (block usual - Maintenance therapy
physiological response) - Supplemental therapy
The metabolism of a drug and its passage
- Palliative therapy
from liver into circulation Enzyme interaction
- Prophylactic therapy
Oral drugs are absorbed from intestinal Drug inhibits/alters physiological Monitoring:
lumen into mesenteric blood system, and go response of enzyme; fools cell to attach
to the liver by means of portal vein to it VS its targeted cells
Once in the liver, it is metabolized by P450
enzyme system and passed into general
circulation
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