Introduction
A. Basic terms
ï‚· Nurses use pharmaco-therapeutics daily
o Understand pharmacology
o Substance use- causes cellular changes and then cause a
o Reaction-(hope) be a positive reaction
ï‚· Pharmacokinetics: what the body does to the drug
ï‚· Pharmacodynamics: what drug does to the body
ï‚· Understand side effects/adverse reactions
ï‚· And drug chemistries such as: half-lives/therapeutic index
B. Drug properties
ï‚· Efficacy: maximal response drug can produce
ï‚· Potency: index of how much to give for desired response
ï‚· Drug (Characteristics): (3)
o Effectiveness-ïƒ Drug does what it is intended to do
 Most important properties
 U.S. Laws require to be proven effective before released for use
o Safetyïƒ Does no harm, even if given at high doses for a long time (there is no drug safe at that level)
 Proper dosing and selection should reduce the adverse effects
o Selectivityïƒ only produces the outcomes intended. There are no side effects
 Know how to administer and signs to watch for
 “There is not thing as a safe and selective drugâ€
 There is laws and rules to protect the patient
C. Therapeutic objective
ï‚· GOAL FOR DRUG USE: Provide maximum benefit with minimum harm
ï‚· Other factors for drug selection:
o Administration ease
o Stability
o Cost
D. Drug intensity (factors):
ï‚· Administrationïƒ dosage size, route and timing are critical (medication errors, patient adherence)
ï‚· Pharmacokineticsïƒ the impact of the body on drugs (absorption, distribution, metabolism, excretion)
ï‚· Pharmacodynamicsïƒ Determines the responses a drug elicits (drug receptor interaction, patient’s functional state,
placebo effects all determine drug elicited responses)
ï‚· Characteristics specific to each patientïƒ gender, age, weight, mayor organ function & potency of drug administered
II. Pharmacology applied in nursing practice
A. Nursing responsibility (roles of the nurse)
ï‚· The 6 rights of medication administration
ï‚· Goal for drug use: Promote benefits and minimize harm
 You just don’t give the medication with the 6 rights
ï‚· Must anticipate patient reactions
ï‚· Recognize when they occur and respond to them efficiently and appropriately
ï‚· Must know drug for the patient
ï‚· Contraindicationsïƒ for a positive therapeutic outcome
ï‚· Patient education
B. Pharmacology and patient care
ï‚· 6 Rights of medication administration
o right medication
o right dose
o right frequency
o right route
o right patient
o right documentation (6th)
C. Patient education (WHAT TO INCLUDE WHEN EDUCATING YOUR PATIENT)
ï‚· Name and therapeutic category drug
ï‚· Dosage size, dosing schedule and route of administration
ï‚· Expected therapeutic responses
ï‚· Nondrug measureïƒ enhance responses
ï‚· Duration of treatment/ drug storage
ï‚· Symptoms of adverse effects
ï‚· How to minimize discomfort
ï‚· Major drug-drug/drug-food interactions
ï‚· Whom to contact when things go wrong; therapeutic failure, severe adverse reactions or interactions
D. Nursing process and drug therapy
III.Drug regulation
A. Landmark legislation
ï‚· Chemical nameïƒ chemical nomenclature
ï‚· Generic name (nonproprietary)ïƒ US adopted names council
ï‚· Trade name (proprietary)ïƒ drug market names
B. Drug nomenclatureïƒ chemical nomenclature
C. OTC drugs
IV.Pharmacokineticsïƒ what the body does to medications once they get into the body and all metabolites have left the body
A. Membrane passage
B. Phases
C. Absorptionïƒ movement of the drug form the site of administration into the blood for distribution into the tissues.
ï‚· Factors that affect absorption
o Rate of dissolutionïƒ the drug must dissolve
o Surface area available for absorption
o Blood flow
o Lipid solubility
o pH partitioning
ï‚· Routes of administrationïƒ routes the drug moves to be absorbed
o Enteral—GI tract: oral
o Parenteral—Outside GI tract
 Intravenous, intramuscular, subcutaneous
D. Distributionïƒ movement of drugs through the body, to its site of action (needed)
ï‚· To occur there must be adequate blood flow to the tissues
ï‚· Blood must be able to exit vascular system and enter cells- to reach site of action, metabolize and excrete
E. Metabolism (biotransformation)ïƒ is the enzymatic alteration of drug’s structure (break down drug)
ï‚· Takes place in the liverïƒ cytochrome P-450 enzymes (microsomal enzymes)
ï‚· There are 6 possible consequences of therapeutic significance in drug metabolism (REFER TO TEXTBOOK)
ï‚· Factors that influence the rate of drug metabolism:
o Age
o Induction of drug metabolism enzymes
o First-pass effect (hepatic inactivation of some oral drugs)
o Nutritional status
o Competition between drugs
F. Excretionïƒ removal of drugs from the body. May occur in the:
ï‚· Urine, bile, sweat, saliva, breast milk and expired air
ï‚· The primary organ responsible for elimination is the kidney by glomerular filtration; and two other organs: liver,
bowel
G. LAST PHASE OF PHARMAKOKINETICS-Time/blood concentration
ï‚· Last part of pharmacokinetics
ï‚· Drug response is related to drug concentration levels
o It is not the drug levels in plasma that is important, but
o at certain levels the drug will be causing a desired effect
o at certain levels the drug will become toxicÂ