Week 1-Pharm
Chapter 1
The nursing process
A research-supported organizational framework for professional nursing practice
Ensures the
... [Show More] 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
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
Goals
Outcome criteria (measurement)
Implementation, including patient education
Evaluation
Assessment
Data collection, review, and analysis
Medication profile
Any and all drug use
Prescriptions
Over-the-counter medications
Vitamins, herbs, and supplements
Compliance and adherence
ONLY RN CAN DO IT!!!!
Planning
Identification of goals and outcome criteria
Goals
Objective, measurable, and realistic with an established time period for achievement of the outcomes that
are specifically stated in the outcome criteria
Outcome criteria
Concrete descriptions of patient goals
Expectations for behavior
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
Any chemical that affects the physiologic processes of a living organism
Pharmacology
Study or science of drugs
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
Structure (ex. beta blocker)
• Subclass (ex. selective, nonselective)
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
Bioavailability
• The extent of drug absorption
First pass effect
• Large proportion of a drug is chemically changed into inactive metabolites by the liver.
• Much smaller amount will be bioavailable.
Distribution
Transport of a drug by the bloodstream to its site of action
Albumin is the most common blood protein and carries the majority of protein-bound drug molecules.
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.
Metabolism (cont.)
• Cytochrome P-450 enzymes (or simply P-450 enzymes), also known as microsomal enzymes
• Lipophilic: “fat loving”
• Hydrophilic: “water loving”
• Enzymes
Excretion
• Elimination of drugs from the body
• Renal excretion (primary organ responsible for excretion)
• Biliary excretion
• Bowel excretion
Half-life: time required for half (50%) of a given drug to be removed from the body
Measures the rate at which the drug is eliminated from the body
After approximately five half-lives, most drugs are considered to be effectively removed from the body.
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
The mechanism of drug actions in living tissues
Therapeutic effect
Mechanism of action
Drug–receptor relationships
Enzymes
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 [Show Less]