Pharmacology Fundamentals

Ch. 1-3

Steps in the nursing process

1. Assessment

2. Analysis

3. Planning

4. Nursing interventions/implementation

5. Evaluation

Subjective:

Based on personal feelings, opinions, or experiences (e.g., “I feel tired”).

Objective:

Based on measurable facts or direct observations (e.g., “Heart rate is 80 bpm”).

The 5 steps of the nursing process are:

Assessment – Gather information about the patient.

Diagnosis – Identify the patient’s problems.

Planning – Set goals and plan care.

Implementation – Carry out the care plan.

Evaluation – Check if goals were met and adjust care.

Drugs in high demand (4)

• Obesity and Diabetes drugs

• Cancer drugs

• Neurologic drugs

• Immunologic drugs

New drugs needed.. (3)

• Antibiotics

• Pain-relievers

• Anti-depressants/anxiety

Drug Development Process (5)

1. Discovery and development

2. Preclinical research

3. Clinical development

4. FDA review

5. Post-market monitoring

FDA-approved Medications

• Promotes safety and protects public health

• Regulates new medication research and development

• All FDA-approved drugs have been tested and deemed safe

• Some FDA-approved drugs have been later recalled

Principles of ethics (know definitions as well) (4)

1. Autonomy – Respect patient’s choices

2. Beneficence – Do good for the patient

3. Nonmaleficence – Do no harm

4. Justice – Treat patients fairly

ANA Code of Ethics

“Was developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.”

• Adopted in 1950

• Revised in 2015

The Nurse’s role in clinical research (4)

• Responsible for patient safety

• Responsible for integrity of research protocol

• Avoid bias

• Protect special populations (children, marginalized groups)

Over-the-Counter Drugs

• Found to be safe and appropriate for use without direct supervision of health care provider

• Available without a prescription

• In 2002, FDA standardized OTC labeling

• Provide consumers with better information

• Describes benefits and risks with OTC drugs

• Nurse’s role

• Be aware of OTC drugs and their implications (interactions, side effects)

Pharmacokinetics & processes (4)

drug movement through the body and what the body does to the drug

• Processes include absorption, distribution, metabolism, excretion (ADME)

Pharmacodynamics & phases (3)

“drug power”

• What the drug does to the body as drug moves throughout the body

• Primary effect

• Desirable response

• Secondary effect

• Desirable or undesirable

Phase involves: receptor binding, postreceptor effects, chemical reactions

Pharmacokinetics: Absorption

Pharmacokinetics: metabolism (biotransformation)

• Process of body chemically changing drug into a form to be excreted

• First pass effect

• Half-life (t½)

• Steady state

• Loading dose

• Protein-bound vs free

bioavailability

The amount of a drug that actually reaches the bloodstream and can have an effect.

First pass effect

When a drug is broken down by the liver before it reaches the bloodstream, reducing its effectiveness.

Protein-bound vs free

Protein-bound: Drug attached to proteins in the blood → inactive.

Free: Drug not attached → active and can work in the body.

Drug Half Life

The time it takes for half of a drug to be removed from the body.

Pharmacokinetics: Drug excretion (elimination) (6)

• **Kidneys

• **Liver (bile)

• Lungs

• Saliva

• Sweat

• Breast milk

Pharmacodynamics: Drug response relationship

Body’s physiologic response to changes in drug

concentration at site of action

Pharmacodynamics: Potency

• Amount of drug needed to elicit specific physiologic response

Pharmacodynamics: Maximal efficacy

• Point which increasing a drug’s dosage no longer

increases desired therapeutic response

Pharmacodynamics: Therapeutic index

• Relationship between therapeutic dose and toxic dose

Pharmacodynamics: Onset

Time it takes for drug to reach minimum effective concentration

Pharmacodynamics: Peak

Highest drug concentration in blood

(risk of toxicity)

Pharmacodynamics: Duration

Length of time drug exerts a therapeutic effect

Pharmacodynamics: Trough

Lowest concentration before next dose

(risk of ineffectiveness)

Pharmacodynamics: Mechanisms of drug action

• Stimulation

• Depression

• Irritation

• Replacement

• Cytotoxic action

• Antimicrobial action

• Modification of immune status

Pharmacodynamics: Agonists

• Activate receptors

• Produce desired response

Pharmacodynamics: Partial Agonists

• Elicit only moderate activity when binding to receptors

• Prevent receptor activation by other drugs

Pharmacodynamics: Antagonists

• Prevent receptor activation

• Block response

Cholinergic receptors and where are they located

Receptors that respond to acetylcholine (ACh).

bladder, heart, blood vessels, stomach, bronchi, and eyes

Epinephrine affects three different receptors: what are they

alpha1, beta1, and beta2.

Alpha1:

Constricts blood vessels → raises blood pressure.

Alpha2:

Reduces norepinephrine → lowers blood pressure.

Beta1:

Increases heart rate and heart strength.

Beta2:

Relaxes lungs and other smooth muscles → opens airways.

Side effects

• Secondary drug effects

Adverse reactions

• Mild to severe

• Unintentional, unexpected

• Undesirable effects

Drug toxicity

• Drug level exceeds therapeutic range

Tolerance:

When the body responds less to a drug over time, so a higher dose is needed to get the same effect.

Medication Safety and Prevention: Common hazards

• Drug interactions

• Overdose

• Allergic reactions

Medication Safety and Prevention: Preventive strategies

• Medication reconciliation

• Barcoding systems

• Double-checking high-alert meds

7 Rights of Medication Administration:

1. Right patient – confirm who will get the med.

2. Right medication – check the correct medication.

3. Right dose – verify the correct amount.

4. Right route – give by the correct method (oral, IV, etc.).

5. Right time – give at the correct time/frequency.

6. Right documentation – record administration accurately

7. Right reason – ensure the drug is given for the correct purpose.