NUR=210=PHARMACOLOGY
Exam=1=Unit=1-3
Unit=1=(chp=1,=3,=7,=9,=10)
Unit=2=(Chp=18,=24,=25)
Unit=3=(Chp=17,=19,=22,=23)
Unit=1
- Nursing=Process=-=ADPIE
o Concept
o Assessment
o Patient=problems=(diagnosis)
o Planning
o Nursing=interventions
o Evaluation
Pharmacokinetics,=Pharmacodynamics,=&=Pharmacogenetics
- Pharmacokinetics
o What=the=body=does=to=the=drug
o Kinetics===movement
o Movement=throughout=body=to=drug
o Drug=Phases:=Absorption,=distribution,=metabolism,=excretion
o Absorption
▪ Happens=in=small=intestine
▪ Disintegration
• Breakdown=of=oral=drug=to=small=particles
▪ Dissolution
• Process=of=combining=small=drug=particles=with=liquid=to=form=a=solutio
n
▪ Drug=absorption
• Drug=movement=from=GI=tract=to=bloodstream
▪ Factors=affecting:
• Fillers=in=pill=can=effect=how=fast/slow=gets=absorbed
• Enteric=coating===extended=release=to=be=absorbed=slower
• What=else=is=in=stomach=will=effect=absorption
• **CANT=TAKE=ANYTHING=WITH=ANTACID
• NO=ALCOHOL=OR=GRAPEFRUIT
▪ Route=of=administration
• Order:=IV,=IM,=Subcutaneous,=Oral,=Topical
▪ First-pass=effect
• Only=occurs=in=oral=medications
messages.downloaded_by
, • When=drugs=are=absorbed=in=small=intestine=then=go=through=portal=
vein=to=liver
• Lose=part=of=medication=as=it=goes=through=process
• Active=or=free=drug=–=medication=that=is=still=working
• Inactive=drugs=–=you=lose=it=through=this=process
• Never=have=100%=of=medication=when=taking=ORAL=medication=due
=to=this=effect=because=it=travels=through=GI=tract
▪ Bioavailability
• Percentage=left=of=medication
• Oral=will=never=be=100%=due=to=first-pass=metabolism
o Other=routes=always=100%
• Drug=form=(extended=release=vs=immediate)
• Depends=on=route=of=administration/absorption
• Gastric=mucosa=and=motility
• Administration=with=food=and=other=drugs
• Changes=in=liver=metabolism
o Distribution
▪ Mainly=blood=stream
▪ Movement=of=drug=from=circulation=to=body=tissue
▪ Drug=should=be=easily=distributed=if=good=perfusion
▪ **PROTEIN=BINDING
• Protein=in=body=is=albumin
• Depends=on=how=nourished=you=are
• Some=drugs=that=are=protein=binding=drugs
o Once=it=binds=to=protein=it=becomes=inactive
o If=low=albumin=at=risk=for=drug=toxicity
o Concern=for=pediatric=and=geriatric
• If=you=give=multiple=protein=binding=drugs=at=once=there=is=not=eno
ugh=protein,=one=drug=may=be=less=effective,=one=drug=may=be=too=
effective
• Protein=binding=drugs=bind=to=protein=and=the=rest=circulates=to=bod
y=to=do=job=of=medication
o Metabolism=(biotransformation)
▪ Occurs=in=liver
▪ Process=of=body=chemically=changing=drug=into=a=form=to=be=excreted
▪ **Half-life=(t=½)
• The=time=it=takes=for=the=amount=of=drug=in=the=body=to=be=reduce
d=by=half
• How=long=it=takes=to=excrete=50%=of=drug
• Every=drug=has=a=different=half=life
• If=the=half-
life=is=long=and=takes=a=long=time=to=get=to=therapeutic=level=give=l
oading=dose
▪ Loading=dose
• Usually=double=dose=for=the=first=one=then=regular=dose
• Gets=to=therapeutic=range=quicker
messages.downloaded_by
, o Excretion=(elimination)
▪ Mainly=occurs=in=kidneys
• Can=also=excrete=in=other=ways=(not=as=much)
▪ Excrete=free=drugs=left=over
▪ Body=can=only=absorb=so=much=the=rest=gets=excreted
▪ Should=not=be=excreting=protein=therefore=you=should=not=be=excreting=the=d
rugs=that=bind=to=protein
▪ Kidney=function:=Creatinine,=BUN,=GFR=(Glomerular=filtration=rate)
• Creatinine=is=most=sensitive=test
- Pharmacodynamics
o What=the=drug=does=to=the=body
o Primary=effect
▪ Desirable=response
• What=you=want=to=happen
o Secondary=effect
▪ Desirable=or=undesirable
▪ What=it=is=not=intended=for
▪ Example:=Viagra=–=not=originally=intended=for=that=use
o Therapeutic=index
▪ ED=50===Effective=dose=(on=50%=of=population)
• Dose=that=gives=therapeutic=desired=response=in=50%=of=population
▪ TD=50===Toxic=effect=(on=50%=of=population)
• Toxic=response=in=50%=of=population
▪ Therapeutic=index
• In=between=ED50=and=TD50
▪ Therapeutic=drug=monitoring
• Peak===when=drug=reaches=highest=concentration=in=your=body
o **Oral=medication=2-3=hours=after=is=peak
o **IV=30-60=minutes=to=reach=peak
o You=would=draw=labs=at=this=time=to=check=peak=level
• Trough===lowest=plasma=concentration=in=blood=(how=much=is=left)
o **Doesn’t=matter=what=route=of=administration
o **Draw=lab=right=before=you=give=dose
o If=trough=is=too=high=body=is=not=absorbing/excreting=lik
e=it=should
▪ Becomes=toxic
o If=trough=is=too=low,=antibiotic=is=not=doing=what=it=should,=
dose=needs=to=be=increased
▪ Drug=toxicity
• Drug=level=exceeds=therapeutic=range
o Onset
▪ Time=it=takes=for=drug=to=reach=minimum=effective=concentration
o Duration
▪ How=long=a=drug=exerts=a=therapeutic=effect
messages.downloaded_by
, o Receptor=theory
▪ Drug=binds=to=receptor=to=do=what=it=needs=to=do
• Ex.=Attach=to=pain=receptor=to=relieve=pain
• To=either=activate=receptor=or=block=receptor=depending=on=desir
ed=effect/medication
▪ Agonist
• Activates=receptors
• Produce=desired=response
• Continue=to=agonize===do=what=you=want
▪ Antagonist
• Precent=receptor=activation
• Block=response=or=produce=a=desired=response
• Ex.=Narcan=for=overdose=of=morphine
o Side=effect
▪ Secondary=drug=effect
▪ Usually=get=better=with=continued=use
▪ Expected=effects
o Adverse=reactions
▪ Mild=to=severe
▪ Undesirable=effects
▪ Usually=get=worse=with=continuing=use
▪ Provider=needs=to=be=notified=–=not=expected=effects
o Drug=interactions
▪ Altered=drug=effect=due=to=interaction=with=another=drug
o Pharmacokinetic= interactions
▪ Changes=occurring=in=absorption,=distribution,=metabolism,=and=excretion
o Additive=(NO=QUESTIONS)
▪ Sum=of=effects=of=two=drugs
▪ Ex.=2+2=4
o Synergistic=(NO=QUESTIONS)
▪ Effect=is=much=greater=than=effects=of=either=drug=alone
▪ Ex.=2+2<4
o Drug-nutrient=interactions
▪ Food=may=increase,=decrease,=or=delay=drug=response
o Drug-laboratory= interactions
▪ Drugs=may=cause=changes=in=test=results
o Drug-induced=photosensitivity
▪ Skin=reaction=caused=by=sunlight=exposure,=which=can=cause=a=burn=to=the=ski
n
Geriatric=Considerations
- Physiologic=changes
o Reduction=in=total=body=water=and=lean=body=mass
o Reduction=in=kidney=mass=and=function
o Reduction=in=liver=mass=and=blood=flow
messages.downloaded_by
Exam=1=Unit=1-3
Unit=1=(chp=1,=3,=7,=9,=10)
Unit=2=(Chp=18,=24,=25)
Unit=3=(Chp=17,=19,=22,=23)
Unit=1
- Nursing=Process=-=ADPIE
o Concept
o Assessment
o Patient=problems=(diagnosis)
o Planning
o Nursing=interventions
o Evaluation
Pharmacokinetics,=Pharmacodynamics,=&=Pharmacogenetics
- Pharmacokinetics
o What=the=body=does=to=the=drug
o Kinetics===movement
o Movement=throughout=body=to=drug
o Drug=Phases:=Absorption,=distribution,=metabolism,=excretion
o Absorption
▪ Happens=in=small=intestine
▪ Disintegration
• Breakdown=of=oral=drug=to=small=particles
▪ Dissolution
• Process=of=combining=small=drug=particles=with=liquid=to=form=a=solutio
n
▪ Drug=absorption
• Drug=movement=from=GI=tract=to=bloodstream
▪ Factors=affecting:
• Fillers=in=pill=can=effect=how=fast/slow=gets=absorbed
• Enteric=coating===extended=release=to=be=absorbed=slower
• What=else=is=in=stomach=will=effect=absorption
• **CANT=TAKE=ANYTHING=WITH=ANTACID
• NO=ALCOHOL=OR=GRAPEFRUIT
▪ Route=of=administration
• Order:=IV,=IM,=Subcutaneous,=Oral,=Topical
▪ First-pass=effect
• Only=occurs=in=oral=medications
messages.downloaded_by
, • When=drugs=are=absorbed=in=small=intestine=then=go=through=portal=
vein=to=liver
• Lose=part=of=medication=as=it=goes=through=process
• Active=or=free=drug=–=medication=that=is=still=working
• Inactive=drugs=–=you=lose=it=through=this=process
• Never=have=100%=of=medication=when=taking=ORAL=medication=due
=to=this=effect=because=it=travels=through=GI=tract
▪ Bioavailability
• Percentage=left=of=medication
• Oral=will=never=be=100%=due=to=first-pass=metabolism
o Other=routes=always=100%
• Drug=form=(extended=release=vs=immediate)
• Depends=on=route=of=administration/absorption
• Gastric=mucosa=and=motility
• Administration=with=food=and=other=drugs
• Changes=in=liver=metabolism
o Distribution
▪ Mainly=blood=stream
▪ Movement=of=drug=from=circulation=to=body=tissue
▪ Drug=should=be=easily=distributed=if=good=perfusion
▪ **PROTEIN=BINDING
• Protein=in=body=is=albumin
• Depends=on=how=nourished=you=are
• Some=drugs=that=are=protein=binding=drugs
o Once=it=binds=to=protein=it=becomes=inactive
o If=low=albumin=at=risk=for=drug=toxicity
o Concern=for=pediatric=and=geriatric
• If=you=give=multiple=protein=binding=drugs=at=once=there=is=not=eno
ugh=protein,=one=drug=may=be=less=effective,=one=drug=may=be=too=
effective
• Protein=binding=drugs=bind=to=protein=and=the=rest=circulates=to=bod
y=to=do=job=of=medication
o Metabolism=(biotransformation)
▪ Occurs=in=liver
▪ Process=of=body=chemically=changing=drug=into=a=form=to=be=excreted
▪ **Half-life=(t=½)
• The=time=it=takes=for=the=amount=of=drug=in=the=body=to=be=reduce
d=by=half
• How=long=it=takes=to=excrete=50%=of=drug
• Every=drug=has=a=different=half=life
• If=the=half-
life=is=long=and=takes=a=long=time=to=get=to=therapeutic=level=give=l
oading=dose
▪ Loading=dose
• Usually=double=dose=for=the=first=one=then=regular=dose
• Gets=to=therapeutic=range=quicker
messages.downloaded_by
, o Excretion=(elimination)
▪ Mainly=occurs=in=kidneys
• Can=also=excrete=in=other=ways=(not=as=much)
▪ Excrete=free=drugs=left=over
▪ Body=can=only=absorb=so=much=the=rest=gets=excreted
▪ Should=not=be=excreting=protein=therefore=you=should=not=be=excreting=the=d
rugs=that=bind=to=protein
▪ Kidney=function:=Creatinine,=BUN,=GFR=(Glomerular=filtration=rate)
• Creatinine=is=most=sensitive=test
- Pharmacodynamics
o What=the=drug=does=to=the=body
o Primary=effect
▪ Desirable=response
• What=you=want=to=happen
o Secondary=effect
▪ Desirable=or=undesirable
▪ What=it=is=not=intended=for
▪ Example:=Viagra=–=not=originally=intended=for=that=use
o Therapeutic=index
▪ ED=50===Effective=dose=(on=50%=of=population)
• Dose=that=gives=therapeutic=desired=response=in=50%=of=population
▪ TD=50===Toxic=effect=(on=50%=of=population)
• Toxic=response=in=50%=of=population
▪ Therapeutic=index
• In=between=ED50=and=TD50
▪ Therapeutic=drug=monitoring
• Peak===when=drug=reaches=highest=concentration=in=your=body
o **Oral=medication=2-3=hours=after=is=peak
o **IV=30-60=minutes=to=reach=peak
o You=would=draw=labs=at=this=time=to=check=peak=level
• Trough===lowest=plasma=concentration=in=blood=(how=much=is=left)
o **Doesn’t=matter=what=route=of=administration
o **Draw=lab=right=before=you=give=dose
o If=trough=is=too=high=body=is=not=absorbing/excreting=lik
e=it=should
▪ Becomes=toxic
o If=trough=is=too=low,=antibiotic=is=not=doing=what=it=should,=
dose=needs=to=be=increased
▪ Drug=toxicity
• Drug=level=exceeds=therapeutic=range
o Onset
▪ Time=it=takes=for=drug=to=reach=minimum=effective=concentration
o Duration
▪ How=long=a=drug=exerts=a=therapeutic=effect
messages.downloaded_by
, o Receptor=theory
▪ Drug=binds=to=receptor=to=do=what=it=needs=to=do
• Ex.=Attach=to=pain=receptor=to=relieve=pain
• To=either=activate=receptor=or=block=receptor=depending=on=desir
ed=effect/medication
▪ Agonist
• Activates=receptors
• Produce=desired=response
• Continue=to=agonize===do=what=you=want
▪ Antagonist
• Precent=receptor=activation
• Block=response=or=produce=a=desired=response
• Ex.=Narcan=for=overdose=of=morphine
o Side=effect
▪ Secondary=drug=effect
▪ Usually=get=better=with=continued=use
▪ Expected=effects
o Adverse=reactions
▪ Mild=to=severe
▪ Undesirable=effects
▪ Usually=get=worse=with=continuing=use
▪ Provider=needs=to=be=notified=–=not=expected=effects
o Drug=interactions
▪ Altered=drug=effect=due=to=interaction=with=another=drug
o Pharmacokinetic= interactions
▪ Changes=occurring=in=absorption,=distribution,=metabolism,=and=excretion
o Additive=(NO=QUESTIONS)
▪ Sum=of=effects=of=two=drugs
▪ Ex.=2+2=4
o Synergistic=(NO=QUESTIONS)
▪ Effect=is=much=greater=than=effects=of=either=drug=alone
▪ Ex.=2+2<4
o Drug-nutrient=interactions
▪ Food=may=increase,=decrease,=or=delay=drug=response
o Drug-laboratory= interactions
▪ Drugs=may=cause=changes=in=test=results
o Drug-induced=photosensitivity
▪ Skin=reaction=caused=by=sunlight=exposure,=which=can=cause=a=burn=to=the=ski
n
Geriatric=Considerations
- Physiologic=changes
o Reduction=in=total=body=water=and=lean=body=mass
o Reduction=in=kidney=mass=and=function
o Reduction=in=liver=mass=and=blood=flow
messages.downloaded_by
