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Pharmacology I NURS 1011 North Arkansas College Harrison, AR 1 North Arkansas College Department of Nursing Harrison, AR Course Title: NURS 1011-Pharmacology I (Spring) Course Instructor: Cheryl Kinder, MSN, RN Office: M179 Contact Information: Phone: 870-3914-3561 (office) E-mail: [email protected] Office Hours: Monday Tuesday Wednesday Thursday Friday 8:00 am -2:00pm Clinical Sites (Baxter Regional Med Center) 8:00 am – 3:00 pm 8:30 pm – 4:00 pm (class instruction/office-check schedule) By Appointment Only Course Description: NURS 1011: Pharmacology I is a 16 week course which focuses on giving the nursing student a thorough and practical understanding of pharmacology. Emphasis is placed on generic names, therapeutic actions, indications/uses, side effects, adverse reactions, and nursing implications of medication administration. Safety, clinical reasoning, and patient teaching concepts are stressed to reduce preventable errors and promote positive patient outcomes. Credit and Time Allotment: One Semester Credit Hour One hour lecture weekly Prep time prior to class Course Location: A106 Course Meeting Time: Thursdays 1:30 – 2:20 Prerequisites/Co-requisites: NURS 1114-Medical Surgical Nursing I, NURS 1107 Fundamentals of Nursing Course Requirements: Students are expected to take exams as scheduled. Make up exams will be given only if advance notice of absence is approved and make-up exam is taken within 1 week of the original test date. Students are allowed only one make-up exam per course. Grades ≥ 79% must be maintained for program progression as outlined in Registered Nursing Program Handbook. Nursing students will be expected to progress through the basic collection and comprehension of pharmacologic information into the analysis of application of use and response of varied cohort populations. If exam averages are <79% the student will be expected to see the instructor. 2 April 9, 2016* is the last date for withdrawal. The North Arkansas College catalog informs you that you are responsible for officially withdrawing from the course you are no longer attending and that failure to do so will result in an F on your transcript. I will not withdraw you from the course. *check college calendar for exact date Grading/Attendance: Grading, attendance and examination policies for this course and all nursing courses are found in the North Arkansas Registered Nursing Program Handbook Grading Scale: 91-100 A 84-90 B 79-83 C 70-78 D < 70 F Unit Exams (5) 80% Comprehensive Final (inclusive of safety, calculations) 20% Required Texts: Kee, J., Hayes, E., & McCuistion, L. (2015). Pharmacology: A nursing process approach, (8th ed). St. Louis: Saunders. ISBN: 978-1-4557-5148-8 ATI text: RN Pharmacology for Nursing (7th ed) MAXI-LEARN learning system notebook (current) Registered Nursing Program Handbook (current) Suggested Text/online resource: Current Drug Book Manual of Diagnostic and Laboratory Tests Teaching-Learning Activities Discussion Videos Lecture Simulation (integrated into Medical Surgical Nursing I, Maternal-Newborn Nursing) Clinical Practicum Application Case Studies Tickets to Class 3 Course Objectives: Upon successful completion of this course students will be able to: #1 #2 #3 #4 #5 #6 #7 Discuss drug administration as component of safe effective nursing care, utilizing the nursing process. (Measured by exam and simulation/clinical application) Describe the roles and responsibilities of the registered nurse regarding drug administration. (Measured by exam, clinical practice application and discussion) Explain and demonstrate the 6 rights of medication administration in both classroom assessment and clinical practice (Measured by exam and clinical/lab application) Apply critical reasoning/thinking in simulated situations concerning administration of medications to various populations (Measured by exam, case studies and discussion) Plan nursing interventions necessary to the administration of medications and the teaching strategies necessary to gain client compliance. (Measured by exam, case study) Explain the pharmacologic classification of drugs, their mechanism of action, common side effects; potential for adverse reactions, contraindications and other nursing considerations. (Measured by exam and classroom discussion) Recognize cultural considerations relating to compliance, understanding of, and administration of medications. (Measured by exam and classroom discussion, case study) Correlating Program Outcomes Professional Identity Nursing Judgment Professional Identity Nursing Judgment Professional Identity Nursing Judgment Human Flourishing Nursing Judgment Spirit of Inquiry Professional Identity Human Flourishing Professional Identity Nursing Judgment Professional Identity Human Flourishing Nursing Judgment Spirit of Inquiry ADA Statement: North Arkansas College complies with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Students with disabilities who need special accommodations should make their requests in the following way: (1) talk to the instructor after class or during office hours about their disability or special need related to classroom work; and/or (2) contact Special Services in Room M188 and ask to speak to Kim Brecklein. Student Responsibilities and Statement of Action for cases of suspected and verified Academic Dishonesty as well as what constitutes academic dishonesty is addressed in the Registered Nursing Program Handbook. 4 Study Overview-Pharmacology I Unit I: January 12-January 26 (Exam 1/26) Fluids &Electrolytes Vitamins and Minerals Safety Unit II: February 2 – February 16 (Exam 2/16) Anti-inflammatories Analgesics Drugs of Abuse Unit III: February 23 – March 9 (Exam 3/9) CNS Stimulants CNS Depressants Upper Respiratory Disorders Unit IV: March 16 – April 6 (Exam 4/6) Lower Respiratory Drugs Antibiotics Anti-infectives Unit V: April 13-April 27 (Exam 4/27) Shock Pregnancy L & D, Neonates Postpartum, Newborn Comprehensive Final: May 4 NOTE: check Portal for Assignment Due Dates-Assignments to be turned in as scheduled. Late assignments not accepted. 5 January 2016 Sunday 1 Monday 2 Tuesday 3 Wednesday 4 Thursday 5 Friday 6 8 9 Classes Begin 10 11 12 Orientation Chapter 12, 13 15 16 No School 17 18 19 Chapter 15, 16 13 14 Syllabus Acknowledgement Due 5:00 pm upload 20 21 22 23 24 25 26 Exam 1 29 30 31 27 Saturday 7 28 6 February 2016 Sunday Monday Tuesday Wednesday 1 Thursday 2 Chapter 25 Friday 3 Saturday 4 5 6 7 8 9 Chapters 5, 26 10 11 12 13 14 15 16 17 18 22 Exam 2 23 Chapters 20, 21 24 25 19 20 26 27 21 CNS Study Guide Upload due 5:00 pm 28 7 March 2016 Sunday Monday Tuesday Wednesday 1 Thursday 2 Chapter 40 Friday 3 Saturday 4 5 6 7 8 9 10 11 17 18 25 12 13 14 15 Exam 3 16 Chapter 41 19 Spring Break 20 21 22 23 24 26 27 28 29 30 Chapters 29-32 31 8 April 2016 Sunday Monday Tuesday Wednesday Thursday Friday Saturday 1 2 3 4 5 6 7 8 Exam 4 13 Chapter 59 14 15 9 10 11 12 Dopamine Study Tool-upload Due 5pm 16 17 18 19 20 Chapters 53-55 21 22 23 24 25 26 27 28 29 Exam 5 30 9 May 2016 Sunday Monday 1 Tuesday 2 Wednesday 3 Thursday 4 Friday 5 Class of 2016Pinning Comprehensive Final 7 8 9 10 11 12 Saturday 6 Graduation-10 am 13 Grades posted for Transcripts Summer Break Enjoy… 10 Unit I-Safety, Administration, Vitamins & Minerals, Fluids & Electrolytes Unit Objectives 1. Discuss QSEN initiatives related to safe drug administration. 2. List the 5 + 5 rights of medication administration. 3. Discuss justification for use of vitamins supplements 4. Discuss the classifications of fluids and their uses. 5. Identify symptoms of FVD and FVE and factors contributing to each. Content I. Medication Safety A. Five-Plus-Five Rights B. Nurses 6 Rights C. Culture of Safety D. Safety Risks F. Factors for Prevention of med errors G. Pregnancy Categories A-X II. Medication Administration A. Forms 1. Forms 2. Routes B. Administration of Parenteral medications 1. Sites 2. Equipment III. Vitamins and Minerals A. Vitamins: Fat Soluble; Water Soluble B. Minerals: Iron IV. Fluids & Electrolytes A. Homeostasis B. Fluid Replacement C. Electrolytes 1. Potassium 2. Sodium 3. Calcium 4. Magnesium 5. Chloride 6. Phosphorus Pharmacology 1-1011 Course Outcomes 1-7 Learner Assignments Kee, Hayes, McCuistion Chapter 12: Safety Chapter 13: Medication Administration Chapter 15: Vitamins and Minerals Chapter 16: Fluids and Electrolytes Maxi-Learn Vitamins & Minerals (eg. Vitamin D, Potassium, Iron, etc) ATI Chapters 1, 2, 4, 5, 6, 30 Video: IO Powerpoints, websites, and videos www.qsen.org Handout: Summary of Pharmacology: Pharmaceutic; Pharmacokinetics; Pharmacodynamics and Pharmacogenetics (in syllabus) Exam 1: 1/26 11 Unit II-Anti-inflammatories; Analgesics; Drugs of Abuse Unit Objectives 1. Identify addictive states 2. Discuss the nurse’s role in recognition and treatment promotion of chemically impaired nurses 3. Explain the pathophysiologic basis of the 5 cardinal signs of inflammation 4. Differentiate between acute and chronic pain 5. State the therapeutic ranges of common drugs and complications of over use. Content I. Addictive States II. Terminology of Drug Abuse III. Drugs of Abuse A. Stimulants B. Depressants C. Others: Cannabis, Ecstasy D. Needs of drug abusing patients E. Chemical Impairment IV. Antiinflammatories A. NSAIDS B. Corticosteroids C. Antigout V. Pain VI. Non-opioid VII. Opioid A. agonists B. antagonists Pharmacology 1-NURS 1011 Course Outcomes 2, 3, 4 Learner Assignments Kee, Hayes, McCuistion Chapter 5: Drugs of Abuse Chapter 25: Antiinflammatory Drugs Chapter 26: Nonopioid and Opioid Analgesics Maxi-Learn Antiinflammatories Analgesics Antigout: allopurinol; colchicine ATI Chapters 12, 35, 36 Powerpoints and videos Exam II- 2/16 12 Unit III-CNS Stimulants; CNS Depressants; UR Disorders Unit Objectives 1. Contrast the common side effects of CNS Stimulants 2. Apply the nursing process to the patient taking CNS stimulants. 3. Describe some nonpharmacological methods of inducing sleep 4. Describe the Nursing process to the patient taking benzodiazepines 5. List uses for topical anesthestics 6. Compare the actions of drugs used for upper respiratory disorders. 7. Describe nursing responsibilities for teaching use and management of conditions requiring UR agents Pharmacology 1-1011 Course Outcomes 1, 4, 5 Content I. CNS stimulants A. Ritalin 1. Nursing Interventions II. CNS depressants A. types and stages of sleep B. sedatives and hypnotics 1. barbiturates 2. benzodiazepines 3. age related considerations III. Anesthetics A. Types of anesthesia B. Balanced Anesthesia C. stages of general anesthesia D. nursing assessments IV. Upper Respiratory agents A. common upper respiratory infections B. medications 1. antihistamines 2. decongestants 3. intranasal glucocorticoids 4. antitussives 5. expectorants C. Administration and safe use of URI drugs Learner Assignments Kee, Hayes, McCuistion Chapter 20: CNS Stimulants Chapter 21: CNS Depressants Chapter 40: Drugs for Upper Respiratory Disorders Maxi-Learn Stimulants (e.g. Ritalin, Adderal) Antihistamines Barbiturates benzodiazipines ATI Chapters 7, 15, 16, 18 Powerpoints and videos Handout: Case study-Asthma Exam III: 3/9 13 Unit IV-Lower Respiratory; Antibacterial and Antiinfectives Unit Objectives 1. Define and illustrate the LR disorders 2. Describe the assessment of medication levels...therapeutic vs toxic 3. summarize and list 3 general adverse effects of antibacterial drugs 4. Differentiate between narrow and broad spectrum abx. 5. Explain the importance of peak and trough when using aminoglycosides. 6. Describe nursing interventions for the patient on aminoglycosides and fluorquinolones Content I. Lower respiratory disorders A. COPD 1. asthma 2. chronic bronchitis 3. emphysema 4. bronchial asthma B. Medications C. Nursing Process II. Antibacterials A. PCN, cephalosporins B. Macrolides C. Sulfonamides III. Antituberculars A. drug regimens B. compliance and patient centered care Pharmacology 1-1011 Course Outcomes 1, 2, 6 Learner Assignments Kee, Hayes, McCuistion Chapter 41: Lower Respiratory Disorders (pgs. 583-597) Chapter 29: PCN, Cephlasporins Chapter 30: Macrolides… Chapter 31: Sulfonamides Chapter 32: Antituberculars (437-440) Maxi-Learn Albuterol xopenex theophylline amoxicillin Levaquin Gentamycin Rifampin INH ATI Chapters 17, 43, 44, 45, 47 7. Discuss management of TB patients Powerpoints and videos 8. Compare first and second line antitubercular drugs Exam IV-4/6 14 Unit V-Shock, L&D; Pregnancy; Postpartum; Newborn; Neonate Unit Objectives 1. Define the different types of shock. 2. Describe the treatment for hypovolemic shock 3. List and identify health promoting and detrimental effects of common medications on the pregnant patient. 4. Discuss the drugs used for management of pre-term labor. 5. Describe drugs used for gestational hypertension. 6. Discuss nursing management of patients receiving Oxytocin. 7. Describe the action of surfactant on preterm neonates. 8. Demonstrate teaching of family as to immunizations for the newborn. Content I. Emergency drugs for shock. A. Hypovolemia a. blood and fluids B. Anaphylaxis C. Cardiogenic D. Neurogenic E. Septic F. Insulin II. Drug and Herbals used in pregnancy A. Folic Acid B. Iron, Vitamins C. Minor discomforts of Pregnancy D. Antidepressants III. Preterm Labor IV. Drugs for Gestational Hypertension V. Pain management during labor A. Oxytocin VI. Surfactant Therapy VII. Drugs for postpartum period A. Pain B. Lactation suppression C. Bowel Function VIII. Immunizations A. RhoGam B. Rubella IX. Newborn A. Immunizations-Hep B X. Nursing implications Pharmacology I-1011 Course Outcomes 1-7 Learner Assignments Kee, Hayes, McCuistion Chapter 59: Shock (pgs. 919-922) Chapter 53: Pregnancy-Preterm Chapter 54: L & D, Preterm Neonatal Chapter 55: Postpartum, Newborn Maxi-Learn Oxytocin Phenergan Magnesium sulfate Reglan Folic acid Dopamine ATI Chapter 32 Powerpoints and videos Handout: Blueprint for final Exam V-4/27 15 Assignments are to be uploaded on or before due date. Jan. 13 Feb. 21 April 12 (upload) Syllabus Acknowledgment CNS Reading Guide-due in class (upload) Using the Study Tool on page 21 of the syllabus-answer the questions for the drug: Dopamine 16 Class Preparation-Reading and Note Taking Consider the following challenges as they might apply to you: 1. 2. 3. 4. 5. 6. 7. 8. I really have no clue how to take good notes in a college class. I can’t figure out what is important, so I try to write down everything said. I have a class that is mostly discussion-no idea what to write in my notes. I leave important information out of my notes and it often shows up on tests. One of my instructors jumps all over the place and I can’t follow what is said. Instructors use vocabulary I am not familiar with and I get confused. When I record lectures I find that there is still too much to listen to when I try to review later. I have trouble staying focused in class when I record lectures so I don’t have good notes to refer to when I listen to my recording later. 9. When students answer questions in class I can’t tell if what they are saying is important. 10. I am easily distracted by students who whisper in class. 11. Sometimes instructors add information to the lecture that was not in the book so it doesn’t seem to fit in my notes anywhere. 12. While I am taking notes, I miss what the instructor says next. 13. I take so many notes that later I can’t make sense of them. 14. Most of my classes are boring lectures that make me sleepy. 15. I take notes at home and in class but often find gaps where I fell behind or wasn’t paying attention. 16. I copy notes form the instructor’s PowerPoint slides, but later it seems like I am missing information. 17. My mind wanders in class and I don’t hear what the instructor says. 18. My instructor talks too fast and there is no way I can keep up with my notes. 19. The instructor mostly reads or repeats what in the text so why take notes at all? 20. I can’t concentrate on reading assignments before class so I wait until class to see if instructor will tell me what is important. NOWREADING: Approach with positive attitude Distribute reading for classes with a schedule Read when most alert and where you can concentrate 17 Review past material and preview next reading assignment Pause to “recite-or read out loud” material that is the focus of each section. Complete reading and homework assignments before attending class Go over notes from previous class before attending next class Prepare a list of questions you had during the study-things you didn’t understand. Attend all classes Be organized NOTE TAKING: Listen actively Listen for verbal clues The point is The following is very important Be sure to include this in your notes On page ___ underline the following Let me repeat that The main symptom of this problem is… If you remember only one thing from today’s class The key point here is… AND: This will be on the test Stay focused Take notes with an outline (or concept map…) Use abbreviations Reread your notes and “polish” notes from each class before going to bed DO NOT WAIT UNTIL THE DAY BEFORE AN EXAM TO REVIEW THE MATERIAL-REVIEW AFTER EACH CLASS-REVIEW BEFORE THE NEXT CLASS AND GO OVER ALL MATERIAL DAILY! Adapted from: S. Downing. (2017) On Course-Strategies for creating success in college and in life. Pgs. 268-322, (8e). Cengage, Boston 18 Clinical: Pharmacology Application Classification Action? Assessments Route given Drug/Food Interactions? Labs to monitor? Teaching Potassium (K+) Celebrex Ibuprofen Allopurinol morphine Hydromorphone Xanax Valium Keflex Amoxicillin Oxytocin Folic acid Methagrin Penicillin Erythromycin ophthalmic ointment Acetaminophen Iron Albuterol 19 Things Nurses need to know…. Drugs have a functional and a chemical class-what is the chemical class? What action is expected of this medication? What assessments do you need before administering? Was it given at a certain time because of drug/food interaction? (e.g. cholesterol medication; antacids?) What labs will need to be monitored? Any teaching for the patient? 20 Pharmacology Essentials Study Tool What is the action of the drug or class? What should happen and/or what could happen when a patient takes this medication? Is this a safe dose? When should you collaborate with a pharmacist? If they were having an allergic reaction, how would you know? What information lets you know the drug is effective? Evaluate patient response to medication (therapeutic effects, side effects, adverse reaction). Who should not take? Are there any food, drug or herbal interactions that stand out? What assessment information is required before administration? (labs, vital signs, allergies, contraindications) What safety principles must be followed to safely administer? What teaching do you provide to the patient when giving the medication? What teaching is necessary prior to discharge? What stands out about this medication (unique, such as ototoxicity, compromises renal function, do not stop abruptly, sit up after taking)? 21 Introduction to Pharmacology Route: Tablet/capsule 3 phases 1. pharmaceutic (dissolution)-dissolving into a liquid 2. pharmacokinetic (movement to achieve action) a. absorption b. distribution c. metabolism d. excretion 3. pharmacodynamics (way drug affects the body) Route: Parenterally (IV, IM, subQ) No pharmaceutic phase Pharmaceutic Phase Tablets not 100% drug, fillers and inert substances used allow drugs to be formed into a particular size and shape or enhance dissolution Potassium (K) and Sodium (Na) found in Penicillin potassium and Penicillin sodium enhance absorbability Gastric acid causes poor absorption of PCN-adding K or Na salt makes it easier to absorb. Dissolution rate determines time that the drug needs to become available for absorption by the body. Generally drugs absorb faster in acidic fluids of pH 1-2 than alkaline fluids Very young and older adults have less gastric acidity = slower drug absorption of drugs absorbed in the stomach EC resist disintegration in gastric acid –goes into the alkaline environment of the intestine Do not crush EC or SR tablets (will alter place and time of the drug absorption) Some drugs irritate the gastric mucosa-food or fluids maybe necessary to dilute and protect the mucosa Pharmacokinetic Phase Absorption Most oral are absorbed into surface of small intestine by action of the mucosal villi Protein based drugs-e.g. insulin and growth hormones, destroyed in small intestine by digestive enzymes Drugs given IM absorbed faster in muscles with more blood vessels (deltoids) than those with fewer blood vessels (gluteals); subQ tissue few blood vessels = slower absorption Some drugs go into liver first rather than the systemic system (via portal vein)-drug may be metabolized into inactive form, excreting or reducing amount of active drug (first pass effect); lidocaine and some nitroglycerine not given orally because of first pass metabolism. Bioavailability-% drug dose that reaches the systemic circulation. Oral route always less than 100%. IV = 100%. Factors that alter: [1] form (tablet, capsule, sustained release, liquid, transdermal, rectal suppository, inhalation); [2] Route of administration (oral, rectal, topical, parenteral); [3] GI motility and mucosa; [4] food and other drugs; [5] changes in liver metabolism 22 Distribution Drug available to body fluids and tissues Influenced by blood flow, affinity to tissue, and protein binding effect Drugs with larger volume of drug distribution have longer half-life and stay in the body longer >89% highly protein bound (primarily albumin) 61%-89% moderately highly protein bound 30%-60% moderately protein bound <30% low protein bound When 2 highly protein bound drugs given at the same time they compete for protein binding sites = more free drug released = possible drug toxicity Liver/kidney disease/malnutrition may have low serum albumin meaning fewer binding sites; may need decreased drug dose as there will not be as much protein circulated for binding to Anticonvulsants bind to albumin Antidysrhythmics (lidocaine, quinidine) bind to globulins Abscesses, exudates, body glands, and tumors hinder drug distribution (antibiotics don’t distribute well at sites of abscess and areas of exudates) Some dugs accumulate in fat, bone, liver, muscle and eye tissues BBB-blood brain barrier protects brain from foreign substances; many lipid soluble and lipid non-soluble drugs can cross the placental barrier NURSE SHOULD CHECK PATIENT’S PLASMA PROTEIN AND ALBUMIN LEVELS BECAUSE…. Metabolism (Biotransformation) Body inactivates or biotransforms drugs Half-life (t 1/2) is time it takes for ½ drug to be eliminated (liver/kidney dysfunction t ½ prolonged, if drug taken continuously accumulation can occur) Several half-lives before 90% of drug eliminated 650 mg of aspirin with t ½ of 3 hours -325 mg gone in 3 hours then additional 162mg in 6 hours, ½ of that in 9 hours (81 mg), 40 mg. in 12 hours, 20 mg. in 15 hours, 10 mg. in 18 hours… Short half-life 4-8 hours; long half-life >24 hours (digoxin 36 hours) Steady state-intake of drug equals amount metabolized or excreted NSAIDS should be held (if possible) days before surgery because? Excretion, or Elimination Main route of elimination is through kidneys (urine)-filter free unbound drugs, water soluble drugs and drugs that are unchanged Other routes: bile, feces, lungs, saliva, sweat and breast milk Lungs eliminate volatile drug substances and products metabolized to CO2 and H2O Urine pH 4.5 – 8 (this level may vary slightly from lab to lab) Acidic urine promotes elimination of weak base drugs Alkaline urine promotes elimination of weak acid (e.g. acid) If OD on aspirin can give sodium bicarb to change urine pH to alkaline to promote excretion. Large quantities of cranberry juice will decrease urine pH causing acidic urine and inhibiting elimination of the aspirin Common tests to determine renal function (BUN and GFR [expensive], CLcr) 23 In cases of renal dysfunction drug dosage may need to be decreased pH-abbreviation for potential hydrogen, representing relative acidity or alkalinity of a solution. The numeric value indicates the concentration of hydrogen ions in the solution compared with a standard (one molar) solution Pharmacodynamic Phase The way drugs affect the body Primary effect (desirable); secondary (desirable or undesirable) Diphenhydramine/Benadryl: primary (symptoms of allergy); secondary (CNS depressiondrowsiness) Onset, Peak, Action of duration of Action Onset-time to reach minimum effective concentration Peak-drug reaches highest blood or plasma concentration Duration- length of pharmacological effect Agonists and Antagonists Agonists produce a response (epinephrine/Adrenalin stimulates beta1, beta2 receptors) Antagonists block a response (atropine blocks histamine [H2] preventing excessive gastric acid secretion) Non-specific and Nonselective Drug Effects Drugs that effect various sites are nonspecific (Bethanechol/Urecholine-used for post op urinary retention to increase bladder contraction) *for later…it stimulates cholinergic receptor at other cholinergic sites affecting HR and BP (decreases); gastric acid secretion (increases), bronchioles and pupils (constrict). Nonselective drugs act at different receptors…Chlorpromazine/Thorazine acts on norepinephrine, dopamine, acetylcholine, and histamine receptors Drug action 1. Stimulation or depression 2. Replacement-insulin 3. Inhibition or killing of organisms-penicillin 4. Irritation-laxatives Therapeutic range and Index Therapeutic index (TI) Lethal dose (LD) Low therapeutic index = narrow margin of safety High therapeutic index = wide margin of safety and less chance of toxicity Therapeutic range-concentration of drug in plasma between minimum effective concentration and minimum toxic concentration 24 Peak and Trough Drug Levels Requested for drugs with narrow therapeutic levels (e.g. aminoglycoside antibiotics such as gentamycin) Peak-rate of elimination of the drug 1-3 hours following oral administration 10 minutes for IV medications If peak ordered blood must be drawn at peak time Trough is lowest plasma concentration, measures for therapeutic level Trough drawn immediately before next dose of drug Loading dose Large initial dose to achieve rapid minimum effective concentration in plasma (e.g. digoxin) Side effects and Adverse Reactions, Toxic Effects Side effects-not related to desired effects ALL drugs have desirable or undesirable side effects General result from drugs that lack specificity (e.g. Urecholine/bethanechol) Side effects not necessarily reason to discontinue therapy *NURSE SHOULD TEACH PATIENTS TO REPORT SIDE EFFECTS most side effects managed with dosage adjustments, different drug in same class or other interventions adverse reactions more severe-unintended, occurring at normal doses, mild to severe (anaphylaxis, cardiovascular collapse) Adverse Reactions always undesirable-must be reported and documented Toxic effects Identified by monitoring therapeutic range Pharmacogenetics How effect of the drug varies from predicted response because of genetic factors or hereditary influence Genetic factors can alter metabolism Some more/less sensitive to drugs and actions (e.g. African-Americans less responsive to some antihypertensive medications-ACE inhibitors and some BBs) Caucasians more likely to have abnormally low levels of CYP2D6 enzyme that will affect the metabolism of drugs such as antidepressants, antipsychotics and beta-blockers. As another example, the U.S. Food and Drug Administration has entered into an agreement with the manufacturers of drugs containing carbamazepine(Tegretol) to include product labeling recommending that patients of Asian ancestry be genetically tested before starting on this agent. There is a strong association between serious skin reactions and an inherited variant of the H 1502LA-B gene found in Asians. (pg. 25) Kee, Hayes, & McCuistion (2015). Pharmacology-a patient centered nursing process approach (8th ed.). Elsevier, St. Louis. Drug Names Chemical name-describes chemical structure Generic name- official non-proprietary name for a drug 25 Trade name-name chosen by the drug company If generic drug is bio-equivalent to brand name it is considered therapeutically equivalent = A rating If peak serum concentration and plasma concentration between 80% and 125% it is considered equivalent to brand name Brand name preferred for anticonvulsants (seizures), anticoagulants (e.g Coumadin), medication for heart failure (e.g. Lanoxin), and large dose aspirin for treatment of rheumatoid arthritis. 26 SYLLABUS ACKNOWLEDGMENT COURSE: SEMESTER: NURS 1011 Pharmacology I Spring 2017 I acknowledge by signing below that I have received the syllabus for the course indicated above. I have reviewed the syllabus and understand the objective of this course. I understand how my performance will be evaluated and how my final grade will be determined. I am aware of my instructor’s office hours, and I know how to contact them for help with and/or clarification of course contents or procedures. (Student Signature) (Printed Name) (Date) 27