Download NURS 1011-Pharmacology I Online Syllabus

Pharmacology I
NURS 1011
North Arkansas College
Harrison, AR
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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.
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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
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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.
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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.
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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
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24
25
26
Exam 1
29
30
31
27
Saturday
7
28
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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
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Exam 2
23
Chapters 20, 21
24
25
19
20
26
27
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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
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Spring Break
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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
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24
25
26
27
28
29
Exam 5
30
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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…
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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?
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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)?
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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
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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)
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

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
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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
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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.
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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)
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(Date)
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