NR293 Week 1-Pharm

Week 1-Pharm
Chapter 1
The nursing process
 A research-supported organizational framework for professional nursing practice
 Ensures the delivery of thorough, individualized, and quality nursing care to patients
 Requires critical thinking
 Ongoing and constantly evolving process
Contemporary Trends: The Quality and Safety Education for Nurses (QSEN) Project
 Preparing future nurses with the knowledge, skills, and attitudes (KSAs) needed to continuously improve the quality
and safety of patient care within the health care system
 KSAs flow out of the QSEN initiatives and are being integrated into nursing education curricula and clinical outcomes.
Six Major Initiatives of QSEN
 Patient-centered care
 Teamwork and collaboration
 Evidence-based practice (EBP)
 Quality improvement (QI)
 Safety
 Informatics
Contemporary Trends: Interprofessional Education Collaboration (IPEC)
 Objective: Develop core competencies for interprofessional collaborative practice
Ø Interprofessional education occurs when students from two or more professionals learn from and with each
other.
 Goal: Improve health outcomes
Five Steps of the Nursing Process
 Assessment
 Nursing diagnosis
 Planning
Ø Goals
Ø Outcome criteria (measurement)
 Implementation, including patient education
 Evaluation
Assessment
 Data collection, review, and analysis
 Medication profile
Ø Any and all drug use
Ø Prescriptions
Ø Over-the-counter medications
Ø Vitamins, herbs, and supplements
Ø Compliance and adherence
 ONLY RN CAN DO IT!!!!
Planning
 Identification of goals and outcome criteria
 Goals
Ø Objective, measurable, and realistic with an established time period for achievement of the outcomes that
are specifically stated in the outcome criteria
 Outcome criteria
Ø Concrete descriptions of patient goals
Ø Expectations for behavior
Ø For drug therapy: outcome is safe and effective administration of medications

Implementation
 Initiation and completion of specific nursing actions as defined by the nursing diagnoses, goals, and outcome criteria
 Independent, collaborative, and dependent
The “Rights” of Medication Administration
 Right drug
 Right dose
 Right time
 Right route

,  Right patient
 Right documentation
Current practice standards suggest these additional “Rights”:
 Right reason or indication
 Right to refuse
Roles of Nursing Students in Medication Administration
 Must do:
o Safe medication practices and contribute to a culture of safety
o Know the limits of own knowledge and judgement, and seek help
o Assess the appropriateness of the medication practice by considering the patient, the medication, and the
environment
o Adhere to the facility Policy expectations for direct supervision when administering
 Nursing student need to assess
o Drug allergies
o Drugs expected actions, dose range, side effects of the medication, and any precautions to be taken
o The developmental stage of the infant/child/adolescent patient as well as adults and elderly patients
o Any alterations in the patient’s condition or functional status which interferes with their physical capacity to
take medication (for instance not being able to swallow oral medications)
Chapter 2
Overview
 Drug
Ø Any chemical that affects the physiologic processes of a living organism
 Pharmacology
Ø Study or science of drugs
Ø Encompasses a variety of principles
Drug Names
Chemical name
 Describes the drug’s chemical composition and molecular structure
Generic name (nonproprietary name)
 Name given by the United States Adopted Names Council
Trade name (proprietary name)
 The drug has a registered trademark; use
of the name is restricted by the drug’s patent owner (usually the manufacturer).
 Drug Classifications
Drugs are grouped together based on similar properties
 Drug classifications
Ø Structure (ex. beta blocker)
• Subclass (ex. selective, nonselective)
Ø Therapeutic use (ex. antibiotic)
• Subclass (ex. penicillins)
Prototypical drugs: first drug in a class of drugs
Pharmacologic Principles
 Pharmaceutics
 Pharmacokinetics
 Pharmacodynamics
 Pharmacogenomics (pharmacogenetics)
 Pharmacotherapeutics
 Pharmacognosy
 Pharmacoeconomics
 Toxicology
Definition of Pharmaceutics
 The study of how various drug forms influence the way in which the drug affects the body.
 Dissolution—dissolving of solid dosage forms and their absorption
Definition of Pharmacokinetics (BODY)
 The study of what the body does to the drug
o Absorption
o Distribution
o Metabolism

, o Excretion
Definition of Pharmacodynamics
 The study of what the drug does to the body
Definition of Pharmacotherapeutics
 The clinical use of drugs to prevent and treat diseases
 Defines principles of drug actions—the cellular processes that change in response to the presence of drug molecules
 Drugs are organized into pharmacologic classes.
Definition of Toxicology
 Science of the adverse effects of chemicals on living organisms
 Clinical toxicology deals specifically with the care of poisoned patients.
Definition of Pharmacognosy
 The study of natural (versus synthetic) drug sources (i.e., plant, animals, minerals)
Definition of Pharmacoeconomics
 Study of the economic factors influencing the cost of drug therapy
 Cost–benefit analysis
Pharmaceutics
 Different drug dosage forms have different pharmaceutical properties.
 Dosage form determines drug dissolution rate.
Enteral Route
 The drug is absorbed into the systemic circulation through the oral or gastric mucosa or the small intestine.
o Oral
o Sublingual
o Buccal
o Rectal (can also be topical)
Parenteral Route
 Intravenous (fastest delivery into the blood circulation)
 Intramuscular
 Subcutaneous
 Intradermal
 Intraarterial
 Intrathecal
 Intraarticular
Topical Route
 Skin (including transdermal patches)
 Eyes
 Ears
 Nose
 Lungs (inhalation)
 Rectum
 Vagina
Pharmacokinetics
 Absorption
Ø Bioavailability
• The extent of drug absorption
Ø First pass effect
• Large proportion of a drug is chemically changed into inactive metabolites by the liver.
• Much smaller amount will be bioavailable.
 Distribution
Ø Transport of a drug by the bloodstream to its site of action
Ø Albumin is the most common blood protein and carries the majority of protein-bound drug molecules.
Ø Metabolism
• Also referred to as biotransformation
• Biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more
potent active metabolite (as in the conversion of an inactive prodrug to its active form), or a less
active metabolite.
Ø Metabolism (cont.)
• Cytochrome P-450 enzymes (or simply P-450 enzymes), also known as microsomal enzymes
• Lipophilic: “fat loving”

, • Hydrophilic: “water loving”
• Enzymes
Ø Excretion
• Elimination of drugs from the body
• Renal excretion (primary organ responsible for excretion)
• Biliary excretion
• Bowel excretion
Ø Half-life: time required for half (50%) of a given drug to be removed from the body
Ø Measures the rate at which the drug is eliminated from the body
Ø After approximately five half-lives, most drugs are considered to be effectively removed from the body.
Ø Steady state
• Physiologic state in which the amount of drug removed via elimination is equal to amount of drug
absorbed with each dose.
Pharmacokinetics Drug Effects cont
 The length of time until the onset and peak of action and the duration of action play an important part in determining
the peak level (highest blood level) and trough level (lowest blood level) of a drug. If the peak blood level is too high,
then drug toxicity may occur.
 Peak level: highest blood level of a drug
 Trough level: lowest blood level of a drug
 Toxicity: occurs if the peak blood level of the drug is too high
 Therapeutic drug monitoring
Pharmacodynamics
 The study of what the drug does to the body
Ø The mechanism of drug actions in living tissues
Ø Therapeutic effect
Ø Mechanism of action
Ø Drug–receptor relationships
Ø Enzymes
Ø Nonselective Interactions
Pharmacotherapeutics
 The clinical use of drugs to prevent and treat diseases
 Defines principles of drug actions—the cellular processes that change in response to the presence of drug molecules
 Drugs are organized into pharmacologic classes.
 Contraindications
 Acute therapy
 Maintenance therapy
 Supplemental (or replacement) therapy
 Palliative therapy
 Supportive therapy
 Prophylactic therapy
 Empiric therapy
 Monitoring
 Therapeutic response
 Adverse effects
 Toxic effects
 Therapeutic index
 Drug concentration
 Patient condition
 Tolerance: decreasing response to repeated drug doses
 Dependence: physiologic or psychological need for a drug
 Physical dependence: physiologic need for a drug to avoid physical withdrawal symptoms
 Psychological dependence: also known as addiction and is the obsessive desire for the euphoric effects of a drug
 Drug interactions
Ø Additive effects
Ø Synergistic effects
Ø Antagonistic effects
Ø Incompatibility
 Adverse drug event (ADE): ex: allergic reaction