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 solution
▪ 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
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, • 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 enough
protein, one drug may be less effective, one drug may be too effective
• Protein binding drugs bind to protein and the rest circulates to body 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 reduced 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 loading dose
▪ Loading dose
• Usually double dose for the first one then regular dose
• Gets to therapeutic range quicker
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, 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 drugs
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 like 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
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, 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 desired
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 skin
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 solution
▪ 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 enough
protein, one drug may be less effective, one drug may be too effective
• Protein binding drugs bind to protein and the rest circulates to body 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 reduced 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 loading 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 drugs
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 like 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 desired
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 skin
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
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