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NURSING DEPARTMENT Date Course Title Credits Course Number 3 NUR 1141 Nursing Math and Pharmacology Pre-requisite (s) MAT 0002, DEP 1000, Co-requisite (s) None NUR 1889, 1822, 1045, 1025, 1025C, Hours 45 theory hours/45 Total outside 90 hours clock hours hours Note: A minimum of 2 hours of outside work is assigned per clock hour. Place and Time of Class Meeting International College of Health Sciences 2300 S Congress Ave, Suite 105 Boynton Beach, FL 33426 Hybrid Name and Contact Information of Instructor Instructor: Felicia Mallett, MSN.Ed, RN E-mail: Text: [email protected] (904) 521 – 2805 Office Hours: Tues, Thurs, Sat; 1400 - 2000 Campus Telephone: (561) 202-6333 Delivery Method: Online Book required (The institution recognizes the use of the textbook in the classroom as part of the educational methodology and strategy applied in diverse materials. The textbook is part of the curriculum and is used to reach the student in an effective manner in the classroom. Every student is expected to acquire and use the textbook.) Lehne’s Pharmacology for Nursing Care, 9/e, Jacqueline Rosenjack Burchum & Laura D. Rosenthal ©2016 | Pearson | Published: 2/2015 ISBN-9780323322614 1|Page NURSING DEPARTMENT Classroom expectations for students Attendance Policy Students must log into their online course prior to the third day of the course as dictated by the drop policy of the college. Failure to log in by end of day three will result in the student being dropped from the course. Attendance in online courses is defined as active participation in the course. Active participation is defined as completion of all expectations outlined in the online courses as contained in lesson plan, syllabi, and other course related documents within the course. These expectations may include but are not limited to participation in discussion forums, submission of completed assignments, and completion of quizzes and exams. NOTE: Plagiarism is defined as the use, without proper acknowledgment, of the ideas, phrases, sentences, or larger units of discourse from another writer or speaker. Plagiarism includes the unauthorized copying of software and the violation of copyright laws. Students who commit plagiarism will obtain a grade of “Failure” on their exam or assignment. Course Description (must correspond exactly to Catalog description) This course combines theory and laboratory experiences to allow for mastery of the basic principles of pharmacotherapeutics and the role of the nurse in safe effective administration of medications with emphasis places on dosage calculations. Learning Objectives The primary goal is to establish knowledge and skills for the safety administration of drug therapy within the role of the registered professional nurse. STUDENT LEARNING OUTCOMES (SLO) All students successfully completing this course will be able to: 1.1.Collect, analyze, and prioritize relevant physical, developmental, psychosocial, cultural, spiritual, and functional assessment data to provide individualized patient care. 2 2. Utilize the nursing process, critical thinking, evidence-based information, and knowledge from the arts and sciences to support sound clinical decisions. 3 3. Communicate effectively through verbal, nonverbal, written, and technological means with individuals, families, and health care team members. 4 4. Plan and implement nursing care in a safe, compassionate, culturally sensitive manner that preserves human dignity and promotes growth of individuals and families. 5 5. Manage the efficient, effective use of human, physical, financial, and technological resources in providing continuity of care within and across healthcare settings. 6 6. Collaborate with individuals, families, and healthcare team members in providing comprehensive, individualized patient care. 2|Page NURSING DEPARTMENT 7 7. Demonstrate accountability in adhering to standards of professional practice within legal and ethical frameworks. 8.8. Participate in activities that promote professional development and personal growth. COURSE OBJECTIVES (CO) All students successfully completing this course will be able to: 1. Describe the mechanism of action, therapeutic uses, side effects, and adverse reactions for each major drug class. (SLO – 1, 2) 2. Discuss basic physiological and pathophysiological mechanisms involved in the rationale for drug therapy. (SLO – 1, 2) 3. Examine recent research findings and developments related to drug therapy. (SLO-2) 4. Demonstrate the ability to accurately calculate drug dosages. (SLO- 3,4, 5) 5. Identify physical, developmental, psychosocial, religious, and cultural factors that impact drug therapy. (SLO-1, 3, 4, 6) 6. Describe the nursing interventions and patient education necessary for safe administration of the major drug classes. (SLO– 2, 3, 5, 7) 7. Explain the nurse’s role in teaching patients receiving drug therapy. (SLO – 3, 5) 8. Identify the legal and ethical standards related to the nurse’s role in drug therapy. (SLO – 3, 7) 9. Recognize the responsibility for continued learning regarding drug therapy. (SLO –3, 8) Topical Outline and Schedule DATE WEEK 1 Describe the course. SPECIFIC OBJECTIVES At the end of this lesson, you will be able to: Compare and contrast antibody-mediated (humoral) immunity and cellmediated immunity, including in the discussion the general mechanisms of antibody production on the host and how antibodies produce actions or defenses in the host. Identify the origins and roles of helper T lymphocytes (CD4 cells), macrophages, and cytolytic T lymphocytes (CD8 cells). State the main roles of the following cells, which are important in the immune response: B lymphocytes (B cells), cytolytic T lymphocytes (T cells, CD8 cells), helper T lymphocytes, macrophages/monocytes, and mast cells/basophils. Explain the general roles of the immunoglobulins and explain why they are divided into five major classes. Explain the MHC and its main functions, considering the functions in terms of preventing autoimmune diseases and aiding organ/tissue/cell transplantation. Compare and contrast the basic mechanisms and outcomes of delayed and immediate hypersensitivity reactions. In discussing delayed hypersensitivity, integrate general concepts about cell-mediated 3|Page NURSING DEPARTMENT immunity. Summarize the main purpose of the classical complement pathway and how its activation eventually leads to cell death. Describe the role of vaccines in maintaining health. Differentiate between active and passive immunity and explain how vaccines work. Summarize the three main contraindications that apply to administration of any vaccine. State where to look for current information on required or recommended vaccinations for children, and explain when and how these vaccines should be given. Explain why multiple doses of a vaccine are given for a particular preventable infectious disease, rather than just a single dose. Identify the two most common clinical uses for immunosuppressive drugs. Explain why immunosuppressants can be considered both a blessing and a potential curse to the host. Summarize the main mechanism of action, pharmacokinetics, toxicity, and drug-drug interactions involving calcineurin inhibitors in the context of a holistic care plan that maximizes the drug’s desired effects while minimizing the risks of adverse responses or drug interactions. Name some of the common autoimmune disorders for which immunosuppressants are used. State the richest physiologic source of histamine and name the part or parts of the body where histamine is found in abundance. Also, describe the two main processes by which this chemical can be released from these structures. nonsteroidal antiinflammatory drugs (NSAIDs). State and describe the physiologic effects of glucose administration on the metabolism, the cardiovascular system, the stress response, fluid and electrolytes, and the respiratory system in neonates. Describe issues related to the timing of glucocorticoid administration, particularly with regard to maximizing therapeutic responses and minimizing adverse responses during corticosteroid administration and discontinuation. Describe the potential risks to and relative glucocorticoid requirements of patients who are under physiologic stress and during discontinuation of systemic glucocorticoids. Discuss issues and concerns related to administering pharmacologic doses of glucocorticoids to women who are pregnant or breast-feeding their infants. Unit 11: Anti-inflammatory, Antiallergic, and Immunologic Drugs Review of the Immune System Childhood Immunization Immunosuppressants TOPIC (S) 4|Page NURSING DEPARTMENT LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS READING ASSIGNMENTS Chapter 67: Review of the Immune System – pp 806 – 816 Chapter 68: Childhood Immunization – pp 817 – 833 Chapter 69: Immunosuppressants – pp 834 – 840 DISCUSSION Discussion of Syllabus/Library Handout Discussion topic Complete Case Study CASE STUDY ASSIGNMENT Review the Syllabus Read assignments Complete discussion question Complete Case study Print, sign, and submit both library and syllabus acceptance and library acceptance forms to class site or fax to the school to the attention of “Ms. Michelle Flint” ASSESSMENTS Discussion Case study Library and syllabus acceptance form (5 points towards discussion and submission section of score). Homework: Chapters 70-72 DATE WEEK 2 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Summarize the main effects of histamine on airway smooth muscle tone, arteriolar and venular tone, gastric acid secretion, and the heart (e.g., rate), and identify the receptor or receptors involved in these effects. Identify the receptors that are blocked by a typical first-generation H1 antagonist, especially as they relate to clinical uses and precautions for their use. Compare and contrast the effects of first- and second-generation H1 antagonists on the central nervous system (CNS). Summarize the benefits or limitations of antihistamines for managing anaphylaxis, the signs and symptoms of the common cold, allergic rhinitis, and asthma. Describe the similarities or differences between the COX-1 and COX-2 pathways and state which (pathologic) physiologic process is mainly responsible for analgesia, antiinflammatory activity, antipyresis, 5|Page NURSING DEPARTMENT bleeding tendencies, and gastric mucosal damage. Discuss the beneficial and adverse actions of NSAIDs and the basic mechanisms by which they occur. Identify situations in which aspirin should not be used, even for relief of mild or episodic headache or fever. Also, state which of the alternative over-the-counter (OTC) analgesic/antipyretic drugs would be a more acceptable alternative to aspirin and why. Compare and contrast the signs and symptoms of acute poisoning with aspirin and with acetaminophen; the time course of the signs and symptoms and underlying causes; and the management of these conditions. Describe the feedback loop and its components that regulate physiologic glucocorticoid secretion. Describe the general mechanism by which glucocorticoids cause their biologic effects. Also, compare the cellular site of glucocorticoid receptors with those of typical agonists, such as epinephrine or acetylcholine. State and describe the main therapeutic uses of glucocorticoids for nonendocrine disorders. In terms of mechanisms and targets of action, state why glucocorticoids have greater antiinflammatory activity than Antihistamines Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen Glucocorticoids in Nonedocrine Disorders READING ASSIGNMENTS Chapter 70: Antihistamines – pp 841 – 848 Chapter 71: Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen – pp 849 – 868 Chapter 72: Glucocorticoids in Nonedocrine Disorders – pp 869 - 917 TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS DISCUSSION Discussion topic ASSIGNMENTS Read assignments Complete discussion topic ASSESSMENT Discussion post Homework: Chapters 73-75 DATE WEEK 3 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Discuss the etiology, pathophysiology, clinical presentation, and long6|Page NURSING DEPARTMENT term complications of rheumatoid arthritis (RA). Discuss the three classes of drugs used in the treatment of rheumatoid arthritis and identify the importance of early use of disease-modifying antirheumatic drugs (DMARDs). Compare and contrast the main adverse effects of the nonbiologic and biologic DMARDs used in the treatment of RA. Discuss the role of nonsteroidal antiinflammatory drugs (NSAIDs) and glucocorticoids in the treatment of RA based on current management guidelines. Discuss the etiology, pathophysiology, clinical presentation, and treatment of gouty arthritis. Discuss the first-line agents for relieving the pain of an acute gouty attack and explain when glucocorticoids and colchicine are acceptable alternatives. Give an overview of the metabolic pathway by which uric acid is formed, starting with the original source, adenosine triphosphate (ATP); name the enzyme involved in the conversion of hypoxanthine to xanthine and xanthine to uric acid; and compare and contrast the solubility of hypoxanthine, xanthine, and uric acid in body fluids (e.g., urine, synovial fluid). Summarize the mechanisms of action of allopurinol, probenecid, and colchicine in the context of hyperuricemia, gout, and gouty arthritis. In addition, state where each fits into a treatment plan for asymptomatic hyperuricemia, treatment of acute gout, and prophylaxis of recurrent attacks, and when and why each should not be used. Describe the dose-dependent effects of aspirin on renal handling of uric acid and discuss the roles of this nonsteroidal antiinflammatory drug (NSAID), which is the one most commonly used in the therapy of asymptomatic hyperuricemia and gout. Briefly describe the roles of parathyroid hormone and vitamin D as they affect absorption of dietary calcium and bone mineral metabolism. Briefly describe the roles of osteoblasts and osteoclasts in bone formation and resorption. Compare and contrast the benefits, limitations, and risks of estrogen replacement therapy with those of raloxifene in terms of their effects on bone metabolism and integrity; risks of breast and endometrial cancer; menstrual bleeding; other signs and symptoms of menopause; the incidence of thromboembolism; and fetal development, should the patient receiving the drug be pregnant. Describe the typical etiologies and characteristic signs, symptoms, and laboratory abnormalities associated with hypocalcemia and hypercalcemia. Describe drug therapies and nondrug interventions that are indicated for osteoporosis, making sure to distinguish between prophylaxis and treatment of the disease once it has been diagnosed. 7|Page NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Drug Therapy of Rheumatoid Arthritis Drug Therapy of Gout Drugs Affecting Calcium Levels and Bone Mineralization Chapter 73: Drug Therapy of Rheumatoid Arthritis Chapter 74: Drug Therapy of Gout Chapter 75: Drugs Affecting Calcium Levels and Bone Mineralization DISCUSSION Discussion topic choose 1 ASSIGNEMNTS Read assignments Discussion Case Study Quiz ASSESSMENT Discussion posts Discussion Case Study Quiz Homework: Read chapters 76-77 DATE WEEK 4 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES State a reasonably accurate definition of asthma that includes an understanding of the roles and involvement of airway smooth muscle hyper-responsiveness and inflammation in the disease. Also, describe the typical signs and symptoms that would lead to the diagnosis of a respiratory disorder as asthma. State the criteria used to classify the severity of asthma based on impairment and risk. Summarize the mechanisms of action, roles, and limitations of the following drugs in the therapy of asthma: beta-adrenergic agonists, glucocorticoids, methylxanthines, mast cell stabilizers, leukotriene modifiers, anticholinergic drugs, and glucocorticoid/LABA combinations. Describe the two basic goals in the treatment of chronic asthma. Compile a list of drugs or drug groups that are relatively or absolutely contraindicated in patients with asthma, and state the main reasons why. Discuss some nondrug interventions that might be used to reduce the frequency and severity of asthma attacks. Review the basic pharmacology of drugs for allergic rhinitis. Summarize the roles of antihistamines, glucocorticoids, and sympathomimetic decongestants in terms of managing the signs, 8|Page NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS symptoms, and underlying causes of the common cold. Discuss the use of zinc and vitamin C for colds in children and adults. Drugs for Asthma and Chronic Obstructive Pulmonary Disease Drugs for Allergic Rhinitis, Cough, and Colds READING ASSIGNMENTS Chapter 76: Drugs for Asthma and Chronic Obstructive Pulmonary Disease Chapter 77: Drugs for Allergic Rhinitis, Cough, and Colds DISCUSSION Discussion topic choose 1 ASSIGNEMNTS Read assignments Discussion Case Study Quiz Math worksheet ASSESSMENT Discussion posts Case Study Quiz Homework: Read chapters 78-80 DATE WEEK 5 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Describe peptic ulcer disease as an imbalance between protective and destructive factors on the gastrointestinal (GI) mucosa. Also, state the contributions of histamine, gastrin, and acetylcholine to overall gastric acid secretion and explain why gastric acid is a necessary (but not in itself sufficient) component of the development of peptic ulcers. Summarize the benefits and limitations of drug therapy targeted at the destructive factors on the GI mucosa and identify which drugs or drug groups truly alter the underlying disease processes rather than creating a local environment that is conducive to natural ulcer healing. Discuss short-term and long-term goals of therapy for peptic ulcer disease and identify one or more drugs or drug groups that can meet those goals quicker or better than others. State conditions for which a trial of over-the-counter (OTC) drug therapy might be indicated, either for peptic ulcer disease (PUD) or gastroesophageal reflux disease (GERD). In addition, recommend a treatment plan that involves OTC drugs; also, with regard to this plan, highlight the limitations and potential dangers of self-medication with OTCs and state findings that necessitate a visit to a physician. 9|Page NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Identify the four main chemicals in single-ingredient antacid products and the major benefits or limitations of each. State the ingredients typically found in proprietary antacid combination products and give the rationale for using them rather than single-ingredient products. Include the main expected effects of single-ingredient antacids on gut motility. Compare and contrast the H2 blockers in terms of efficacy, side effects, and drug-drug interactions. Also, be able to argue for or against the selection of a particular H2 blocker over another. State the role of antihistamines (e.g., diphenhydramine) in the management of PUD. State the role of proton pump inhibitors in the management of PUD. Prepare a short list of drugs or drug groups (classes) that are ulcerogenic. Describe the principal functions of the colon and what constitutes a normal bowel movement. Define constipation and describe nondrug measures to correct it. Identify indications for the use of a laxative. Describe the basic pharmacology of laxatives and distinguish among surfactant laxatives, stimulant laxatives, and osmotic laxatives. Describe the causes, consequences, and treatment of laxative abuse. Discuss the mechanisms by which emesis is triggered and the main neurotransmitters that participate in the triggering of signs and symptoms. Describe the drugs used as antiemetics and summarize their mechanism of action, if known. Describe a care plan for managing chemotherapy-induced nausea and vomiting, including interventions and drugs that would be suitable for the three main types of emesis seen in this setting (anticipatory, acute, and delayed), as well as considerations for effective routes of administration. Drugs for Peptic Ulcer Disease Laxatives Other Gastrointestinal Drugs READING ASSIGNMENTS Chapter 78: Drugs for Peptic Ulcer Disease Chapter 79: Laxatives Chapter 80: Other Gastrointestinal Drugs DISCUSSION Discussion topic choose 1 ASSIGNEMNTS Read assignments Discussion Case study Math quiz 10 | P a g e NURSING DEPARTMENT ASSESSMENT Discussion posts Discussion Case study Math quiz Homework: Read chapters 81-82 DATE WEEK 6 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES State the overall functional role of vitamins in maintaining good health. In general terms, compare and contrast the Recommended Dietary Allowance (RDA), Adequate Intake (AI), Tolerable Upper Intake Level (UL), and Estimated Average Requirement (EAR) with regard to vitamin intake. TOPIC (S) Identify the two major vitamin groups or classifications and the factor or factors that place a vitamin in either of those groups. Recognize the common synonyms or alternative terms (or common pharmaceutical products) for the following vitamins: 1. Niacin ‒ nicotinic acid, nicotinamide; 2. Vitamin A ‒ retinol; 3. Vitamin B1 ‒ thiamine; 4. Vitamin B12 ‒ cyanocobalamin; 5. Vitamin B2 ‒ riboflavin; 6. Vitamin B6 ‒ pyridoxine; 7. Vitamin C ‒ ascorbic acid; 8. Vitamin E ‒ alpha-tocopherol. State the main biochemical roles of the following vitamins and the clinical findings or consequences of inadequate or excessive levels: vitamins A, C, D, E, K, B1, B2, B6, B12, niacin, and folic acid. State the common comorbidities associated with obesity. Give a general overview of the importance of existing comorbidities in determining whether or how to initiate weight-loss therapy. Discuss the management of obesity, including the benefits, risks, and limitations of lifestyle changes, drug therapy, and surgery. Identify the main pharmacologic classes and mechanisms of appetite suppressants and the common medical or psychologic conditions they may aggravate. Describe serotonin syndrome and the weight-loss medication that is most likely to trigger it; also, identify drugs that increase the risk of this serious response. Summarize the main calorie-lowering actions of and indications for orlistat. Also, identify its main site of action, compare it with that of such drugs as sibutramine or the amphetamines, and explain the clinical consequences of orlistat’s different site of action. Identify the main drug used in many over-the-counter (OTC) weightloss aids, the potential adverse peripheral autonomic effects, and common and important contraindications to its use. Vitamins 11 | P a g e NURSING DEPARTMENT LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Drugs for Weight Loss READING ASSIGNMENTS Chapter 81: Vitamins – pp 987 – 995 Chapter 82: Drugs for Weight Loss – pp 996 – 1000 DISCSSION Discussion topics ASSIGNMENTS Read assignments Discussion Math midterm ASSESSMENT Discussion posts Math Midterm Homework: Prepare for Pharm midterm Chapter readings: 83-84. DATE WEEK 7 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Define selective toxicity as it applies to the general mechanisms by which antibiotics work against invading pathogens but not against host cells. Give a working definition of narrow-spectrum antibiotics and broadspectrum antibiotics and state when one or the other would be preferred as a therapeutic approach and why. Explain the fundamental difference between bactericidal and bacteriostatic drugs and state the host-related factors required for successful therapy with a bacteriostatic agent. State the main mechanisms by which microbes develop resistance to antimicrobial drugs. Also, address the important issues of spontaneous mutations and R factors. Understand the concept and purpose of the broth dilution procedure and the disk-diffusion test in determining the susceptibility of bacteria to antibiotics. Discuss the general rationale and need for using antibiotics in combination as well as situations in which antibiotic combinations should be avoided. Describe generally accepted indications for prophylactic antimicrobial therapy. Discuss the misuse of antibiotics, its general prevalence, why misuse persists as a major health problem, and the consequences. Give some examples of common situations in which iatrogenic antibiotic misuse 12 | P a g e NURSING DEPARTMENT occurs. Start preparing a table to be completed in the remaining chapters in this unit. Include (1) the names of each main drug class as well as prototypes and important related drugs; (2) whether and for what infections and infectious organisms the drugs are considered first-line treatment; (3) whether the drugs are bacteriostatic or bactericidal; (4) specific and important contraindications; (5) the relative degree to which resistance develops and a general mechanism by which resistance occurs; (6) the general risk for allergic reactions and whether antibiotics in other classes may cross-react to trigger allergic responses; and (7) any specific host toxicities. Describe the basic mechanism of action of the penicillins. Compare and contrast gram-positive and gram-negative bacteria; state which penicillins are able to penetrate the outer membrane of gramnegative bacteria. Describe the beta-lactam ring. Also, explain why penicillins are part of the family of antibiotics called the beta-lactam antibiotics, and state how that relates to the vulnerability of these antibiotic classes to inactivation by certain bacteria. State the four main classes of penicillins: (1) narrow-spectrum penicillins that are penicillinase sensitive, (2) narrow-spectrum penicillins that are penicillinase resistant, (3) broad-spectrum penicillins, and (4) extended-spectrum penicillins. Also, for each group, identify the prototype and indicate the bacterial types or strains that typically respond to them. Explain the clinical significance of various salts of penicillin G in terms of pharmacokinetics, spectrum of activity, susceptibility to penicillinases, unique side effects, and adverse reactions. Recognize penicillins as a main cause of drug-induced allergic reactions. Also, compare and contrast immediate, accelerated, and delayed hypersensitivity reactions in terms of time of onset and main signs and symptoms. Given a patient’s history of severe hypersensitivity reactions to penicillin, state at least one other group of antibiotics that should not be administered because of the risk of cross-reactivity. Recognize clavulanic acid, sulbactam, and tazobactam as penicillinase inhibitors that are combined with certain broad- or extended-spectrum penicillins and as drugs that lack intrinsic toxicity and antibiotic effects and do nothing to reduce the risk or severity of hypersensitivity reactions in susceptible patients. Describe the general rationale and indications for using both intravenous penicillin and an aminoglycoside. State the practical and correct reason for administering them together. Compare and contrast cephalosporins (as a single large drug class) and penicillins with respect to general mechanisms of action and mechanisms by which resistance develops. 13 | P a g e NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Identify a prototype or representative example for each of the four generations of cephalosporins. Differentiate the groups in terms of mechanism of action, spectrum of action, susceptibility to destruction/inactivation by beta-lactamases, and access to the cerebrospinal fluid. Focus on imipenem as the prototype for carbapenems; also, recognize its broad spectrum of activity and explain how it influences when the drug should or should not be used. State the characteristics of vancomycin that make it such a critically important drug, yet one that is not used unless an infection is very serious or other antibiotics fail or cannot be given to a particular patient. Unit 16: Chemotherapy of Infectious Diseases Basic Principles of Antimicrobial Therapy Drugs that Weaken the Bacterial Cell Wall 1: Penicillins READING ASSIGNMENTS Chapter 83: pp 1001 - 1014 Chapter 84: 1015 – 102 DISCUSSION Discussion topic ASSIGNEMNTS Reading assignments Discussion Pharm midterm ASSESSMENT Discussion posts Pharm midterm Homework: Read Chapters: 85-86 DATE WEEK 8 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Compare and contrast cephalosporins (as a single large drug class) and penicillins with respect to general mechanisms of action and mechanisms by which resistance develops. Identify a prototype or representative example for each of the four generations of cephalosporins. Differentiate the groups in terms of mechanism of action, spectrum of action, susceptibility to destruction/inactivation by beta-lactamases, and access to the cerebrospinal fluid. Focus on imipenem as the prototype for carbapenems; also, recognize its broad spectrum of activity and explain how it influences when the 14 | P a g e NURSING DEPARTMENT drug should or should not be used. State the characteristics of vancomycin that make it such a critically important drug, yet one that is not used unless an infection is very serious or other antibiotics fail or cannot be given to a particular patient. Recognize the drugs discussed in the chapter as mainly bacteriostatic inhibitors of bacterial protein synthesis and explain in general terms why they affect bacteria rather than host cells. State the antibacterial spectrums of the drugs discussed in this chapter and explain whether and why these drugs are first-line (first-choice) agents for the stated indications. Describe the mechanism and potential outcomes of interactions between oral tetracyclines and such minerals as calcium, aluminum, magnesium, iron, and zinc and describe common sources of these interactants. State the drugs (and drug groups) described in this chapter for which caution is warranted regarding use in people with liver and/or renal disease, children, and pregnant women; also, explain the basis for such caution and the potential consequences if the stated drugs are administered to those individuals. Recognize the macrolides as usually good alternatives to penicillin (e.g., penicillin G) for patients who are or may be allergic to penicillins. List the drugs that should not be combined with erythromycin and explain the basic mechanisms and outcomes of interactions caused by combined administration. State the unique adverse responses that apply to chloramphenicol and linezolid. Drugs that Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenens, Vancomycin, Telavancin, Aztronaim, and Fosfomycin Bacteriostatic Inhibitors of Protein Synthesis: Tratracyclines, Marolides, and Others READING ASSIGNMENTS Chapter 85: pp 1025 – 1036 Chapter 86: 1026-1037 DISCUSSION Discussion topic choose 1 TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS ASSIGNEMNTS Read assignments Discussion Essay paper( to be submitted in week 9) Quiz ASSESSMENT Discussion posts 15 | P a g e NURSING DEPARTMENT Essay paper Quiz Homework: Read chapters 87-90 DATE WEEK 9 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Discuss the mechanism of action and main indications for aminoglycosides. Recognize that nephrotoxicity and ototoxicity are the two main toxicities of aminoglycosides and describe precautions that need to be taken to prevent them. Identify other drugs that increase the risk for aminoglycoside-induced nephrotoxicity and ototoxicity and describe the factors that should be considered when deciding whether to use them with aminoglycosides. State the antimicrobial mechanism of action of sulfonamides and of trimethoprim and explain why their effects on susceptible bacteria do not affect human cells at the same time. Describe the primary uses for sulfonamides, trimethoprim, and the combination of the two drugs. Explain the clinical and biochemical rationales for the common combination of sulfamethoxazole with trimethoprim. Recognize the link between sulfonamides and Stevens-Johnson syndrome, hemolytic anemia, and kernicterus. Describe the patient populations at highest risk for these potentially serious disorders. State how a nurse might recognize Stevens-Johnson syndrome or hemolytic anemia; list their major signs and symptoms in the context of how nurses should be monitoring for these untoward responses. Explain the general way that sulfonamide-induced crystalluria occurs and state two simple yet usually effective and appropriate ways to reduce the risks. Name two or three other groups of drugs that might cross-react and cause adverse responses in patients who have had hypersensitivity reactions to sulfonamide antibiotics. Compare and contrast the etiologies and symptoms of acute cystitis and acute pyelonephritis. Recognize Escherichia coli as the main cause of uncomplicated, community-acquired urinary tract infections (UTIs) and the cause of less than 50% of hospital-acquired UTIs. Compare and contrast what the text describes as short-course and conventional therapy for lower UTIs. Identify the major patient populations that generally are not candidates for short-course treatment. State which key aspect of therapy distinguishes pharmacologic approaches to uncomplicated lower UTIs versus acute pyelonephritis. Differentiate between relapse and reinfection as a cause of recurrent 16 | P a g e NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS UTIs and identify the relative prevalence of each. Also, state the general clinical approaches for each and the general clinical presentations that would warrant consideration of long-term prophylaxis. Discuss the concept of targeted tuberculin skin testing for Mycobacterium tuberculosis in the context of who should be targeted and who should be treated if a skin test result is positive. Describe the first-line drugs used for tuberculosis (TB): what they are, their individual and collective risks of toxicity to the host, and drug interactions likely to be encountered. Describe the additional issues involved when treating patients who have TB and also infection with the human immunodeficiency virus (HIV). Recognize that genetically based differences affect how quickly a person metabolizes isoniazid. Given that fact, compare and contrast the effect of slow and fast metabolization on the therapeutic response to this drug and toxicity that affects the liver and other structures or functions. Recognize that rifampin induces hepatic-metabolizing enzymes, including those responsible for its own inactivation. Discuss the other drugs rifampin affects by induction of cytochrome P450 enzymes Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis Sulfonamides and Trimethoprim Drug Therapy of Urinary Tract Infections Antimycobaterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium avium Complex Infections READING ASSIGNMENTS Chapter 87: 1038-1050 Chapter 88: 1051-1058 Chapter 89: 1059-1066 Chapter 90: 1067-1071 DISCUSSION Discussion topic choose 1 ASSIGNEMNTS Read assignments Discussion Submission of Essay paper Quiz ASSESSMENT Discussion posts Submission of Essay paper Quiz 17 | P a g e NURSING DEPARTMENT Homework: Read chapters 91-93 DATE WEEK 10 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Summarize the main clinical uses for the fluoroquinolones, focusing on the organisms or infections for which one of these drugs is considered first-choice therapy. Describe the adverse effects of fluoroquinolones. Recognize that tendon rupture is a rather unusual adverse response associated with ciprofloxacin and other fluoroquinolones. Also, demonstrate understanding of how tendon rupture may occur; point out that the risk means certain patient populations should not use the drug; and explain how to monitor for tendon rupture when the drug is used. Recognize the potential for serious neurotoxicity and nephrotoxicity associated with parenteral use of polymyxin B and the impact of such Compare and contrast opportunistic and nonopportunistic infections (the general terms), particularly the patient populations most likely to acquire them. Identify the drug that is the agent of choice for most systemic mycoses; describe its main mechanism of antifungal action; and state whether it is best used for minor or more serious fungal infections and why. Compare and contrast the basic biology, epidemiology, and treatment of fungi with that of bacteria, explaining why amphotericin B is effective against fungi but not against bacteria and why host-centered toxicity of amphotericin B is much greater and more prevalent than with most antibiotics. Discuss the main indications for intravenous amphotericin B; also, identify the drug’s three most common adverse responses and the precautions that should be taken to minimize their effects. Explain what azole antifungal drugs are and give examples; also, recognize that these drugs, when given systemically, can be a major cause of interactions with other drugs by inhibiting their hepatic metabolism. Summarize the main similarities and differences between how a typical antibiotic affects bacterial metabolism, having minimal or no effects on host-cell metabolism, and how antiviral drugs more often affect both the target organisms and the host. Recognize that acyclovir is the drug of choice for most herpes simplex and varicella-zoster virus infections and explain the drug’s main actions, uses, and other key clinical pharmacologic properties. Describe the adverse effects of acyclovir and ganciclovir and how the route of administration affects those responses. Compare and contrast hepatitis B and hepatitis C, the two most common strains of viral hepatitis, in terms of prevalence, mode of transmission, incidence of acute and chronic disease, lethality, and prevention and management (for example, vaccines, treatments for active disease). 18 | P a g e NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Summarize current guidelines or recommendations for prophylactic influenza vaccination and identify high-risk populations most likely to benefit from prophylaxis. Also, explain why the vaccines seem to keep changing from one flu season to the next. Miscellaneous Antibacterial Drugs: Fluroquinolones, Metronidazole, Daptomycin, Rifampin, Rifaximin, Bacitracin, and Polymyxins, Antifungal Agents Antiviral Agents I: Drugs for Non-HIV Viral Infections READING ASSIGNMENTS Chapter 91: Miscellaneous Antibacterial Drugs: Fluroquinolones, Metronidazole, Daptomycin, Rifampin, Rifaximin, Bacitracin, and Polymyxins,pp. 1086-1092 Chapter 92: Antifungal Agents, pp. 1093-1105 Chapter 93: Antiviral Agents I: Drugs for Non-HIV Viral Infections – pp 1106 - 1123 DISCUSSION Discussion topic choose 1 ASSIGNEMNTS Read assignments Discussion Case study Quiz ASSESSMENT Discussion posts Case study Quiz Homework: Read chapters 94-96 DATE WEEK 11 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Summarize the main clinical uses for the fluoroquinolones, focusing on the organisms or infections for which one of these drugs is considered first-choice therapy. Describe the adverse effects of fluoroquinolones. Recognize that tendon rupture is a rather unusual adverse response associated with ciprofloxacin and other fluoroquinolones. Also, demonstrate understanding of how tendon rupture may occur; point out that the risk means certain patient populations should not use the drug; and explain how to monitor for tendon rupture when the drug is used Recognize the potential for serious neurotoxicity and nephrotoxicity associated with parenteral use of polymyxin B and the impact of such concerns on the use of this medication. Compare and contrast opportunistic and nonopportunistic infections 19 | P a g e NURSING DEPARTMENT (the general terms), particularly the patient populations most likely to acquire them. Identify the drug that is the agent of choice for most systemic mycoses; describe its main mechanism of antifungal action; and state whether it is best used for minor or more serious fungal infections and why. Compare and contrast the basic biology, epidemiology, and treatment of fungi with that of bacteria, explaining why amphotericin B is effective against fungi but not against bacteria and why host-centered toxicity of amphotericin B is much greater and more prevalent than with most antibiotics. Discuss the main indications for intravenous amphotericin B; also, identify the drug’s three most common adverse responses and the precautions that should be taken to minimize their effects. Explain what azole antifungal drugs are and give examples; also, recognize that these drugs, when given systemically, can be a major cause of interactions with other drugs by inhibiting their hepatic metabolism. Summarize the main similarities and differences between how a typical antibiotic affects bacterial metabolism, having minimal or no effects on host-cell metabolism, and how antiviral drugs more often affect both the target organisms and the host. Recognize that acyclovir is the drug of choice for most herpes simplex and varicella-zoster virus infections and explain the drug’s main actions, uses, and other key clinical pharmacologic properties. Describe the adverse effects of acyclovir and ganciclovir and how the route of administration affects those responses. Compare and contrast hepatitis B and hepatitis C, the two most common strains of viral hepatitis, in terms of prevalence, mode of transmission, incidence of acute and chronic disease, lethality, and prevention and management (for example, vaccines, treatments for active disease). Summarize current guidelines or recommendations for prophylactic influenza vaccination and identify high-risk populations most likely to benefit from prophylaxis. Also, explain why the vaccines seem to keep changing from one flu season to the next. Define a retrovirus in terms of the transcription of information between viral deoxyribonucleic acid (DNA) and ribonucleic acid (RNA). Also, compare the sequence of the basic events in retroviruses with what goes on in a typical host cell. Recognize that helper T-lymphocyte (CD4) cells are the main target of HIV. Also, explain what CD4 cells do to/for the human immunodeficiency virus (HIV), why they are important to the host, and how these facts relate to the opportunistic infections that accompany acquired immunodeficiency syndrome (AIDS). Describe the three phases of HIV infection and the likely levels of CD4 cells and HIV in each. Also, explain why the CD4 and HIV levels 20 | P a g e NURSING DEPARTMENT change as they do. In simple terms, explain what the main classes of antiretroviral drugs do to impair viral replication or function biochemically. (Understanding what these drugs do ensures a good grasp of how retroviruses such as HIV cause infections and damage host cells.) Give a reasonable explanation of why HIV infection does not kill people directly, pointing out that infected individuals die of the consequences of other events that develop when the infection turns into AIDS. Briefly summarize the antiretroviral mechanism of action of the protease inhibitors and recognize hyperglycemia and its consequences, a pseudo-Cushing’s syndrome, and hyperlipidemias as key adverse responses to these drugs. Also, state the main monitoring methods or interventions for these adverse responses. Explain highly active antiretroviral therapy (HAART) and indicate why multidrug therapy for HIV/AIDS is important. Also, explain drug or drug class selection and the merits of combination therapy. Recognize that the blood levels, effects, and toxicity of saquinavir as the prototype protease inhibitor are very dependent on the level of activity of the liver’s P450 drug-metabolizing system. Recognize that the proteases, in general, inhibit the P450 system. Identify some of the key drugs that interact with protease inhibitors, either by inhibiting or inducing the P450 system, and predict the consequences of such interactions. Identify the three main reasons for changing antiretroviral therapy and summarize some reasonable guidelines for the process of changing treatment. Identify some of the common opportunistic infections in patients with HIV/AIDS. Also, identify and describe some of the common modalities for prophylaxis and treatment of these opportunistic infections. Explain some of the main impediments to proper, optimal therapy of HIV/AIDS, including not only pharmacologic considerations but also economic and compliance factors. Describe the special therapeutic and preventive approaches that must be taken for pregnant HIV/AIDS patients, for adolescents with active infection, and for infected neonates and infants. Give an accurate definition of sexually transmitted diseases (STDs) and explain how the term encompasses more than one clinical presentation. Make an accurate statement about the overall incidence of an individual STD in the context of diseases likely to be encountered in clinical practice. Describe the various treatments and prophylactic measures for STDs and explain how and why previously effective antibiotic therapies have become outmoded because of resistance. 21 | P a g e NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Describe the symptoms and time courses of the three main stages of syphilis, as well as the typically recommended therapies for syphilis in adults, during pregnancy, and in newborns with congenital exposure to Treponema pallidum. Summarize a general drug plan for a patient with syphilis who also has a history of severe hypersensitivity reaction to penicillin. State the most common route by which neonatal gonococcal infection occurs and the most common and handicapping consequence of that neonatal infection; also, describe the usual prophylactic measures taken with neonates and why they must be done. State the main criterion that differentiates an antiseptic from a disinfectant. Discuss how healthcare providers can use antiseptics and disinfectants to protect patients and themselves from infections. Describe the preferred treatments for established local cutaneous infections. Antiviral agents II: Drugs for HIV Infection and Related Opportunistic Infections Drug Therapy of Sexually Transmitted Diseases Antiseptics and Disinfectants READING ASSIGNMENTS Chapter 94: Antiviral agents II: Drugs for HIV Infection and Related Opportunistic Infections – pp 1124 - 1166 Chapter 95: Drug Therapy of Sexually Transmitted Diseases, pp: 11671174 Chapter 96: Antiseptics and Disinfectants, pp: 1175-1181 DISCUSSION Discussion topics ASSIGNMENTS Reading assignments Discussion Math Quiz Case Study ASSESSMENT Discussion posts Math Quiz Case Study Homework: Chapter readings: Chapters 97-100 Prepare to take the proctored final in week 13. Please call this school to make arrangements. 22 | P a g e NURSING DEPARTMENT DATE WEEK 12 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Give an accurate definition of sexually transmitted diseases (STDs) and explain how the term encompasses more than one clinical presentation. Make an accurate statement about the overall incidence of an individual STD in the context of diseases likely to be encountered in clinical practice. Describe the various treatments and prophylactic measures for STDs and explain how and why previously effective antibiotic therapies have become outmoded because of resistance. Describe the symptoms and time courses of the three main stages of syphilis, as well as the typically recommended therapies for syphilis in adults, during pregnancy, and in newborns with congenital exposure to Treponema pallidum. Summarize a general drug plan for a patient with syphilis who also has a history of severe hypersensitivity reaction to penicillin. State the most common route by which neonatal gonococcal infection occurs and the most common and handicapping. Unit 17: Chemotherapy of Parasitic Diseases TOPIC (S) LEARNING READING ASSIGNMENTS Chapter 97: Anthelmintics, pp: 1182-1186 ACTIVITIES Chapter 98: Antiprotozoal Drugs I: Antimalarial Agents, pp: 11871194 Chapter 99: Antiprotozoal Drugs II: Miscellaneous Agents – pp 1195 1200 Chapter 100: Ectoparasiticides – pp 1201 – 1205 OUTSIDE DISCUSSION Discussion topic (Choose 1) WORK & ASSIGNED READINGS ASSIGNMENTS Read assignments Complete discussion topic Case Study ASSESSMENT Discussion posts Case Study Quiz: Chapters 97-100 Homework: Read Chapters : Chapters 101-103 DATE WEEK 13 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Describe why the three main treatment approaches to cancer (drugs, 23 | P a g e NURSING DEPARTMENT surgery, and radiation) can be considered and often are used as adjuvants to one another. Also, state the general types of cancers for which surgery and radiation therapy generally are not the primary approaches and for which pharmacologic treatment therefore is mainly used. Summarize the main states of the cell cycle (G0, G1, S, G2, M) and briefly describe what occurs in each stage. Also, explain the following: whether or why the cell cycle state is in affects a cell’s response to anticancer drugs; how this relates to the concept of growth fraction; and how, in general, solid tumors differ from disseminated cancers in terms of their responsiveness to cancer chemotherapy. In general terms, compare and contrast the typical cancer chemotherapeutic drug with the typical antibiotic with respect to the concept of selective toxicity. Recognize that cancer cells tend to develop resistance to anticancer drugs through random mutation and that these mutations can have the following consequences in terms of the cancer cells’ response to a specific drug. The cells may do any of the following: become less able to take up the drug, improve their ability to pump the drug out of the cells, lose their ability to transform the drug into an active and cytotoxic metabolite, or develop better or faster ways to repair the damage caused by the chemotherapeutic agent. Summarize the basic principles and concepts that apply to how and why multidrug therapy is preferred for treating cancers. Give a succinct but accurate explanation of why drug therapy of disseminated cancers usually is more successful than drug treatment of solid tumors. Identify and describe the main classes of anticancer drugs in terms of their main mechanisms of action. Differentiate between cell-cycle phase–specific and cell-cycle phase– nonspecific anticancer drugs in terms of their mechanisms of action on cell growth and replication. Also, state the main advantages or limitations of drugs in these two groups in terms of general efficacy against cancer cells. Summarize the main roles of deoxyribonucleic acid (DNA) replication, transfer of DNA’s genetic message to ribonucleic acid (RNA) and onto protein synthesis, and the role of mitosis and microtubular formation as they affect cancer cell growth and reproduction. Identify the side effects and adverse responses that are generally common to all anticancer drugs and explain why they occur. Identify the anticancer drugs that exert selective toxicities that are not shared by many or any other anticancer agents, focusing on pulmonary, cardiac, renal, and hepatic toxicity and neurotoxicity. Compare and contrast the basic mechanisms of action, clinical indications, and general toxicities of anticancer drugs discussed in this chapter. 24 | P a g e NURSING DEPARTMENT TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS Summarize the likely benefits of glucocorticoids, not merely as anticancer drugs per se, but also as useful adjuncts in management of cancers with other drugs or nondrug modalities. Consider the main systemic adverse responses that almost always occur, along with the beneficial effects. State the precautions and related risk factors that should go into a decision about whether to administer tamoxifen either to prevent or treat estrogen-sensitive breast cancers in women. Summarize the desired and unwanted effects of antiestrogens and selective estrogen receptor modifiers (SERMs) when used for cancer. Describe the paradoxic effects of leuprolide on androgen-dependent advanced prostatic cancer, and name the adjunctive intervention that might prevent the drug’s unwanted effects on the cancer. Unit 18: Cancer Chemotherapy READING ASSIGNMENTS Chapter 101: Basic Principles of Cancer Chemotherapy Chapter 102: Anticancer Drugs I: Cytotoxic Agents Chapter 103: Anticancer Drugs II: Hormonal Agents, Targeted Drugs, and Other Noncytotoxic Anticancer Drugs DISCUSSION Discussion topic CASE STUDY ASSIGNEMNTS Read assignments Discussion Math Quiz ASSESSMENT Discussion posts Case Study Math Quiz Homework: Read Chapters 104-108 Take the proctored final. Please call the school to make arrangements DATE WEEK 14 At the end of this lesson, you will be able to: SPECIFIC OBJECTIVES Compare and contrast open-angle glaucoma and angle-closure glaucoma in terms of etiology, prevalence, and management. Summarize how the sympathetic and parasympathetic branches of the autonomic nervous system control pupil size, and explain why pupil size is important for narrow-angle glaucoma. Also state the classes of autonomic drugs that cause miosis and mydriasis, and explain whether the effects of these drugs are beneficial or harmful in glaucoma and 25 | P a g e NURSING DEPARTMENT why. State the fundamental mechanism of all drugs that have been shown to be effective for managing glaucoma, regardless of their particular mechanism of action or class. Give a description of how the following may help lessen IOP: adrenergic agonists, muscarinic agonists, acetylcholinesterase inhibitors, carbonic anhydrase inhibitors, and prostaglandin F2 alpha or its analogs. State comorbidities that might be aggravated by stated drugs or drug groups that are suitable for managing glaucoma. Conversely, name the. drugs or drug classes (and the main indications for their use) that might raise the IOP and aggravate glaucoma. Summarize the basic etiology and pathophysiology of common acne. Also, explain the benefits and limitations of and indications for the main drugs used for acne. Identify the main drugs or other factors that can increase the risk for local or systemic toxicity of topical retinoic acid derivatives. Summarize the main adverse responses associated with isotretinoin therapy and the precautions that should be taken to prevent them or to deal with adverse responses that may occur. Include comments on the drug’s common adverse effects, the potential for psychiatric depression, concerns related to pregnancy and breast-feeding, and interactions with other drugs and vitamins. Compare and contrast acute otitis media (AOM), otitis media with effusion (OME), and antibiotic-resistant otitis media (OM) in terms of the most common pathogenic causes, typical signs and symptoms, and treatment. Comment on the pros and cons of routinely treating all causes of acute otitis media with antibiotics, rather than waiting for a short time and seeing whether the signs and symptoms of the condition resolve spontaneously before treating with antibiotics. Comment on the use of antibiotic prophylaxis for recurrent otitis media in children. For example, demonstrate talking with a mother who has brought her daughter to the pediatrics office three times in the past year with an ear infection and who wants a prescription for antibiotics to prevent another infection. Describe pulmonary arterial hypertension (PAH) and identify the drugs used to treat the condition, their mechanism of action, and significant side effects. State the likely consequences of administering bosentan or sildenafil with drugs that inhibit the liver’s cytochrome P450 system. Also, identify the main groups of these drugs. Discuss the drugs used for neonatal respiratory distress syndrome (RDS) and include time frames for their administration. Describe the pathophysiologic process of cystic fibrosis and explain the effect of the disorder on the pancreas, lungs, and reproductive 26 | P a g e NURSING DEPARTMENT organs. Discuss the pathophysiologic process of amyotrophic lateral sclerosis (ALS) and describe the only medication approved for its treatment. Define the terms dietary supplement and complementary and alternative medicine. Recognize that herbal products usually do contain active ingredients, some of which can cause desired effects and some that can cause serious adverse effects or interact beneficially or not with prescribed FDA-approved drugs. List and describe some of the main reasons patients may turn to herbal products, either as supplements or as alternatives to traditional medicines and medical practice. Recognize what the German Commission E is as it applies to herbal products. Summarize what the Dietary Supplement Health and Education Act (DSHEA-1994) permits (and does not permit) in the way of manufacturing, advertising, and labeling herbal products. Compare and contrast this with the general criteria that a potential manufacturer of a prescription medication must prove before the drug can be marketed. Explain how calling products dietary supplements, rather than drugs, may allow the manufacturers of these products to circumvent standards of purity, efficacy, and safety that apply to FDAapproved drugs, and describe how that ability to skirt more stringent regulations and requirements can be harmful. Recognize that an array of ostensibly equal herbal products, prepared and sold by various individuals or companies, are likely to have very large differences in the amounts of active substance, impurities, and adulterants, thus providing little uniformity. State the main reasons that some practitioners of traditional Western medicine are skeptical of herbal products and nutritional supplements. Unit 19: Miscellaneous Drugs and Therapies READING ASSIGNMENTS Chapter 104: Drugs for the Eye – pp 1267 – 1277 Chapter 105: Drugs for the Skin – pp 1278 – 1295 Chapter 106: Drugs for the Ear – pp 1296 – 1301 Chapter 107: Additional Noteworthy Drugs – pp 1302 – 1317 Chapter 108: Complementary and Alternative Therapy – pp 1318 – 1329 DISCUSSION Discussion topic (Choose 1) TOPIC (S) LEARNING ACTIVITIES OUTSIDE WORK & ASSIGNED READINGS ASSIGNMENTS Read assignments Discussion Case study 27 | P a g e NURSING DEPARTMENT ASSESSMENT Discussion posts Case study Complete remediation if necessary and prepare to retake the proctored final. DATE TOPIC (S) WEEK 15 Proctored Final Exam Instructional Methods The following strategies may be used in this class: 1. Lectures 2. Reading assignments 3. Discussion threads 4. Case studies 5. Quizzes 6. Midterm exam 7. Final exam 8. Internet research References and Resouorces Medline Plus http://www.nlm.nih.gov/medlineplus/ Health information from the National Library of Medicine National Institutes of Health. Easy access to health topics, medical dictionaries, directories, drug information, videos and more. Full-text electronic journal articles at lirn.net Click on “Databases” access code 40149 select “Connect to ProQuest” There you will find full text health and medical information from Joanna Briggs Institute, the Nursing and Allied Health Collection, Health & Medical Complete, and Psychology Journals. PALM BEACH COUNTY LIBRARY ONLINE RESOURCES You need a free Palm Beach County Library card to access, or register for a free “Temporary Research Access Code” at http://edb.pbclibrary.org/TRAC/ If you need help using any of the library websites, click on the “Ask a Librarian” icon and “chat” with a librarian. 28 | P a g e NURSING DEPARTMENT Consumer Health http://www.pbclibrary.org/consumer-health.htm CINAHL® with Full Text - full text articles for more than 610 nursing and allied health journals as well as health care books, nursing dissertations, selected conference proceedings, and more. http://www.pbclibrary.org/online-research LearningExpress - Take online practice tests for Health Careers, Radiography, NCLEXPN and NCLEX-RN. Learn techniques for job searching, resumes, interviewing and workplace skills. http://www.pbclibrary.org/online-research Health and Wellness Resource Center http://www.pbclibrary.org/online-research Assessment Criteria and Methods of Evaluating Students 90 – 100% 80 – 89% 70 – 79% < 75% A B C F Do not count on a curve! Generally, the grades “A” through “C-” are considered passing grades. Grades "W" and "I" indicate that no grades were earned for the course. A "W" grade indicates that the student withdrew from the course. An "I" grade indicates that the student was passing the course, but failed to complete all the required course work. The instructor, in his/her discretion may grant an "I" grade instead of an "F", pending completion of the course work by the student within a specified time arranged by the instructor and told to the student. It is the student's responsibility to follow-up with the instructor to complete the course work. If the course work is not completed by the arranged time, the “I” grade becomes an “F". Distribution of Grade Elements Discussion & submissions: 20% Weekly Quiz 30% Case Studies: 20% Final exam: 30% Total: 100 % Date Syllabus Was Last Reviewed: April 2, 2016 29 | P a g e