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NURSING DEPARTMENT
Date
Course Title
Nursing Math and
Pharmacology
Credits
Course
Number
3 credits
NUR 1141
MAT0002, DEP 1000,
Co-requisite None
NUR 1889, 1822, 1045,
(s)
1025, 1025C, 1025L
Hours
45 theory hours/45 clock Total outside 90 hours
hours
hours
Note: A minimum of 2 hours of outside work is assigned per clock hour.
Pre-requisite (s)
Place and Time of Class Meeting
Institute of Healthcare Professions
2100 45th Street, Suite A2A
West Palm Beach, FL 33407
Hybrid
Name and Contact Information of Instructor
Instructor: Johnnetta Wider RN, MSN
Email: [email protected]
Office Hours: By Appointment
Campus Telephone: (561) 202-6333
Method of Delivery: Online
Book required
Lehne’s Pharmacology for Nursing Care, 9/e, Jacqueline Rosenjack Burchum & Laura D. Rosenthal
©2016 | Pearson | Published: 2/2015
ISBN-9780323322614
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Classroom expectations for students
Attendance Policy
Students are expected to participate in all required instructional activities in their
courses. Online courses are no different in this regard; however, participation must be defined in
a different manner.
1. Student “attendance” in an online course is defined as active participation in the
course as described in the course syllabus. Instructors are responsible for incorporating specific
instructional activities within their course and will, at a minimum, have weekly mechanisms for
documenting student participation. These mechanisms may include, but are not limited to,
participating in a weekly discussion board, submitting/completing assignments in the online
platform, or communicating with the instructor.
2. Students aware of necessary absences must inform the professor with as much advance
notice as possible in order to make appropriate arrangements.
3. Any student absent 20 percent or more of the online course, i.e., non-participatory during
3 or more weeks of an 11 week term, may receive an F for that course.
4. Any student who has not actively participated in an online class prior to the census date
for any given term is considered a "no-show" and will be administratively withdrawn from
the class without record. To be counted as actively participating, it is not sufficient to log in
and view the course. The student must be submitting work as described in the course
syllabus.
5. Additional attendance and participation policies for each course, as defined by the
instructor in the course syllabus, are considered a part of the attendance policy
Termination may occur for any of the following attendance situations:
1. Eight (8) consecutive absences per semester.
2. Absence in excess of 20 percent (20%) of available course hours.
3. Absence in excess of 20 percent (20%) of externship hours.
Student Tardiness Policy
Tardiness for didactic or clinical education will not be tolerated. Anytime beyond the scheduled
reporting time will be considered late or tardy. When attending clinical externship, if a student is
to be late, he or she must notify the clinical instructor at the facility and the program clinical
coordinator. If a student must miss class, he or she must contact the program director or
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instructor at least 30 minutes prior to the class beginning for didactic education five episodes of
tardiness or leaving IHP early per semester will result in an absence.
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.
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
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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 Discuss the library and library resources.
 Define these four basic terms: drug, pharmacology, clinical
pharmacology, and therapeutics.
 List the three most important properties of an ideal drug as well as
several other important properties, and explain why many drugs do not
have these traits.
 Differentiate between therapeutic effect and maximum benefit with
minimum harm.
 Identify factors in determining the intensity of drug responses.
 Utilize mobile applications to access information about medications.
 Relate the five steps of the nursing process to the administration of
medications. List the Five Rights of Drug Administration and the
patient’s rights regarding medications administered by healthcare
providers.
 Discuss the purpose of preadministration assessment.
 Discuss the analysis of the data and development of nursing diagnoses
to (1) judge the appropriateness of the prescribed regimen, (2) identify
health problems the drug might cause, and (3) determine the patient’s
capacity for self-care.
 Develop a plan of care that does the following: (1) defines the goal of
drug therapy; (2) is prioritized based on the drug under consideration
and the patient’s unique characteristics; (3) identifies nursing
interventions based on [a] drug administration, [b] interventions to
enhance therapeutic effects, [c] interventions to minimize adverse
effects and interactions, and [d] patient education; and (4) establishes
objective criteria for evaluation.
 Discuss implementation of the care plan in drug therapy.
 Understand how to record nursing interventions and observations of
the patient’s responses to drug therapy.
 Describe the five diverse and important topics in pharmacology: (1)
landmark drug legislation in the United States that reflects the
evolution in our national viewpoint on regulation of the pharmaceutical
industry; (2) new drug development (e.g., the cost of more than $800
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TOPIC (S)
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million to develop a new drug); (3) the nuances of formulating drug
names; (4) over-the-counter drugs; and (5) sources of drug
information. All of these topics have significant implications for
pharmacology and nursing care. Such information requires the
profession of nursing and individual nurses to participate in continuing
education in pharmacology and its administration.
Discuss Phases I, II, III, and IV of the clinical testing of new drugs.
Discuss the ethical and legal implications for the different phases of
clinical testing. Phase I studies involve the use of healthy human
volunteers to test the drugs. In Phases II and III, drugs are tested in
patients. Upon completion of Phase III, the drug manufacturer applies
to the FDA for conditional approval.
Explain the purpose of Phase IV clinical studies after regulatory (i.e.,
FDA) approval. Discuss the important information that can be gained
from Phase IV (postmarketing surveillance) of clinical drug testing and
explain the roles and responsibilities of the nurse, nurse practitioner,
and physician in gathering and reporting new data.
Discuss chemical, generic, and proprietary (trade or brand) names of
drugs and explain the benefits, if any, of generic drugs over brandname drugs.
Identify appropriate resources for pharmacology information and
patient care and discuss why, in particular, some may be more suitable
than others for a specific purpose (e.g., a specific type of information
that is sought).
Perform basic arithmetic calculations, including addition, subtraction,
multiplication, and division with positive and negative numbers.
Perform calculations incorporating rules for rounding numbers to
achieve the correct result.
Convert among fractions, decimal form, and percentage form.
Convert between metric units.
Convert between metric and nonmetric units.
Perform ration and proportion calculations.
Syllabus
Introduction
 Orientation to pharmacology
 Application of Pharmacology in Nursing Practice
 Drug Regulation, Development, Names, and Information
READING ASSIGNMENTS
Chapter 1: Orientation to Pharmacology – pp 1 - 4
Chapter 2: Application of Pharmacology in Nursing Practice – pp 5 – 13
Chapter 3: Drug Regulation, Development, Names, and Information – pp 14 21
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OUTSIDE
WORK &
ASSIGNED
READINGS
DISCUSSION
 Differentiate between therapeutic effect and maximum benefit with
minimum harm.
 Discuss chemical, generic, and proprietary (trade or brand) names of
drugs and explain the benefits, if any, of generic drugs over brandname drugs.
SUBMISSION
 Math worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete Case Study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 1
Homework: Chapter readings: Chapters 4, 5, 6, 7, 8
DATE
Week 2
At the end of this lesson, you will be able to:
SPECIFIC
OBJECTIVES
 Discuss the four main processes that make up pharmacokinetics
(absorption, distribution, metabolism, and excretion) and appropriately
apply these processes to clinical usefulness.
 Discuss the advantages and disadvantages of the various techniques of
drug administration as they relate to pharmacokinetics, noting
especially any barriers to absorption associated with intravenous,
intramuscular, and oral administration. Also compare oral
administration with parenteral administration.
 Describe blood flow to tissues, the ability of a drug to exit the vascular
system, and the ability of a drug to enter cells, and then discuss the
characteristics of drug molecules that can alter these processes.
 Describe the ultimate “goal” of drug metabolism, also known as
biotransformation. Discuss the general processes involved in drug
metabolism and identify the major or vital organs in which most drug
metabolism occurs. Discuss special considerations in drug metabolism.
 Discuss the importance of excretion of a drug from the body and some
of the routes by which the drug may be excreted.
 Discuss the importance of understanding the time course of drug
responses (plasma drug levels, single-dose time course, drug half-life,
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and drug levels produced with repeated doses). Explain why clinicians
often monitor plasma drug levels, and describe how these levels are
regulated to prevent drug toxicity. Identify the two factors that largely
determine the duration of a single-dose time course, and compare drugs
with short half-lives versus those with long half-lives. Discuss the
negative effects of repeated drug doses.
Discuss the consequences of drug blood levels that fluctuate
considerably or erratically between doses, and describe how nurses
identify such fluctuations. Discuss measures that traditionally have
been taken to minimize fluctuation.
Define pharmacodynamics and its relationship to the action of drugs on
the body.
Discuss dose-response relationships (e.g., basic features of the doseresponse relationships, maximal efficacy, and relative potency), the
effects drugs can produce, and the amount of drug needed to elicit an
effect.
Discuss properties of drug-receptor interactions (e.g., drug receptors,
four primary receptor families, receptors and selectivity for drug
action, theories of drug-receptor interaction, agonists, antagonists,
partial agonists, and regulation of receptor sensitivity).
Describe how receptors function in the responses to many drugs and
physiologic processes, such as the activity of the respiratory and
gastrointestinal systems.
Differentiate drugs that are agonists, partial agonists, or antagonists.
List the four primary families of receptors.
Discuss “receptorless drugs” (e.g., antacids, antiseptics, saline
laxatives, chelating agents, and so on).
Discuss interpatient variability in drug responses and describe how to
measure variability.
Define the ED50 and the LD50.
Discuss the concept of a drug’s therapeutic index and its application
and benefits to clinical practice, such as the relationships between the
doses of a drug and whether its effects are subtherapeutic (inadequate
response), therapeutic (desired response), or toxic (adverse effects
related to excessive dosage).
Discuss the role of the nurse in achieving therapeutic responses of
selected medications.
Implement effective communication tools to advocate for patients in
the clinical setting.
Identify electronic resources available for determining action, side
effects, therapeutic index, and anticipated effects of drugs.
Discuss the consequences of drug-drug interactions, the basic
mechanisms of drug-drug interactions, and the critical steps in
minimizing adverse drug-drug interactions.
Focus on the liver as an example of a drug-metabolizing system and
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explain why it is such a crucial organ in many drug-drug interactions.
Discuss the effect of food on drug absorption, on drug metabolism
(e.g., grapefruit juice), and on drug toxicity and action, as well as the
timing of drug administration with respect to meals.
Give examples of inhibitory interaction of drugs that can produce
dangerous effects and those that are beneficial.
Discuss the mechanisms and clinical consequences of drug-herb
interactions and drug-food interactions. Focus on ways to minimize
adverse drug-drug interactions and drug-food interactions. Include in
the discussion the effect of food on drug absorption and metabolism,
drug toxicity, drug action, and the timing of drug administration with
respect to meals.
Discuss the dilemma that increased consumption of herbal supplements
has created in the pharmaceutical environment because of these
supplements’ potential for common and significant interactions with
prescription and over-the-counter drugs.
Design a plan of care for patients who are prescribed medications that
have known drug-drug or drug-food interactions.
Identify electronic resources available for determining action, side
effects, therapeutic index, and anticipated effects of drugs.
Discuss the scope of the problem of adverse drug reactions.
Discuss definitions for adverse drug reactions (e.g., side effect,
toxicity, allergic reaction, idiosyncratic effect, iatrogenic disease,
physical dependence, carcinogenic effect, and teratogenic effect).
Discuss organ-specific toxicity. Focus on the liver as a drugmetabolizing system and explain why it is such a crucial participant in
organ-specific toxicity with drugs.
Discuss how and why adverse drug reactions occur, given that for a
prescription drug to be approved for use, it must have demonstrated
and been documented for safety, and also given the explicit printed
information provided about such facts as doses, routes, interactions,
and so on.
Discuss adverse reactions to new drugs and the importance of being
alert for unusual responses when giving new drugs. Also point out the
importance of informing other nurses where to report unknown adverse
effects of a new drug and of accessing a website where information on
adverse effects can be reported.
Discuss measures that can be used to minimize adverse drug events.
Define medication errors and explain what constitutes an error, as well
as who makes errors.
Discuss types of medication errors, causes of medication errors, ways
to reduce medication errors, and ways to report medication errors.
Discuss the significance of body weight and composition, focusing on
the effect of weight and the requirement for larger doses of a drug to
obtain a therapeutic effect because of an increase in tissues to perfuse
(percentage of body fat) and an increase in receptor sites in some
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reactive tissue.
Discuss age as a factor in medication administration, noting that drug
sensitivity varies with age and that infants are especially sensitive to
drugs, as are the elderly.
 Discuss the effects of kidney disease, liver disease, acid-base
imbalance, and altered electrolyte status on drug responses.
 Discuss the three categories of drug tolerance: pharmacodynamic
tolerance, metabolic tolerance, and tachyphylaxis.
 Define placebo effects and explain the beneficial and negative effects.
 Discuss bioavailability and other causes of variable absorption. Explain
why differences in bioavailability are a significant concern with drugs
that have a narrow therapeutic index.
 Discuss common mechanisms by which genetic differences modify
drug responses (for example, altered drug-metabolizing enzymes,
altered drug targets).
 Discuss three gender-related differences that can occur in response to
administration of the same drug.
 Discuss two primary determinants of race-related drug responses.
 Discuss factors that may result in the patient’s failure to take
medications as prescribed.
 Discuss drug interaction as a source of variability.
 Discuss the effects of diet on drug responses.
Unit 2: Basic Principles of Pharmacology
 Pharmacokinetics
 Pharmacodynamics
 Drug Interactions
 Adverse Drug Reactions and Medication Errors
 Individual Variation in Drug Responses
READING ASSIGNMENT
 Chapter 4: Pharmacokinetics – pp 22 – 43
 Chapter 5: Pharmacodynamics – pp 44 – 54
 Chapter 6: Drug Interactions – pp 55 – 61
 Chapter 7: Adverse Drug Reactions and Medication Errors – pp 62 -72
 Chapter 8: Individual Variation in Drug Responses – pp 73 - 80
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TOPIC (S)
LEARNING
ACTIVITIES
DISCUSSION
 Discuss the effects of diet on drug responses.
 Define placebo effects and explain the beneficial and negative effects.
 Discuss measures that can be used to minimize adverse drug events.
 Discuss the role of the nurse in achieving therapeutic responses of
selected medications.
SUBMISSION
 Math Worksheet
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ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 2
Homework: Chapter readings: Chapters 9, 10, 11
WEEK 3
SPECIFIC
At the end of this lesson, you will be able to:
OBJECTIVES
 Identify four basic considerations of drug therapy during pregnancy.
 Discuss the physiologic changes that occur during pregnancy and their
effect on drug disposition and dosing.
 Discuss placental drug transfer, focusing on the importance of
clinicians assuming that any drug taken during pregnancy will reach
the fetus.
 Discuss adverse reactions during pregnancy, focusing on the effects of
drugs on the fetus and neonate.
 Discuss the term teratogenesis as it relates to drug therapy during
pregnancy and the stages of fetal development.
 Identify teratogens and measures that can be taken to minimize their
risks.
 Discuss the appropriate steps in determining exposure to teratogens.
 Discuss drug therapy during breast-feeding and the potential risks to
the breast-feeding neonate or infant of a mother who is taking drugs.
Consider the health and well-being of both the mother and the fetus.
 Distinguish among the categories established by the U.S. Food and
Drug Administration (FDA) to classify potential drug risks to the fetus
(A, B, C, D, X). Comment on the meaning of each category with
regard to potential fetal risks, the reasons medications are categorized
as they are, and the evidence upon which each drug is assigned to a
classification.
 Provide an overview of the pharmacokinetics of neonates and infants.
 Discuss drug absorption in neonates and infants, focusing on a drug’s
physicochemical properties and its effects on absorption.
 Discuss drug absorption as it relates to the route of administration in
pediatric patients.
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Discuss factors directly related to drug distribution in neonates and
infants (e.g., protein binding and the blood-brain barrier).
Discuss hepatic metabolism and compare the drug-metabolizing
capacity of a newborn with that of a 1-year-old infant.
Discuss renal excretion and compare the drug-excreting capacity of a
newborn with that of a 1-year-old infant.
Discuss the pharmacokinetics of children 1 year old or older.
Discuss reasons pediatric patients are subject to adverse drug reactions
when drug levels rise too high.
Discuss dosage determination, noting that pediatric doses have been
established for some drugs but not for others and, therefore, for drugs
that do not have established pediatric doses, the doses can be
extrapolated from adult doses.
Discuss methods that are effective at and critical to promoting parent
and guardian adherence to pediatric drug regimens.
Summarize some of the main reasons a very young patient may be
considered “highly” sensitive to drugs, considering both
pharmacokinetic factors (absorption, distribution, and elimination) and
pharmacodynamic factors that affect this apparent sensitivity.
Identify the main age-related physiologic, pathophysiologic, and
pharmacologic factors that influence how older adults respond
differently to drugs and state how those differences could (or likely
would) affect drug responses.
Identify the most important factors that predispose older patients to
adverse drug reactions.
Describe common reasons for noncompliance and nonadherence that
are particularly relevant to older adults and list some approaches for
minimizing those problems and improving compliance.
Unit 3: Drug Therapy Across the Life Span
 Drug Therapy During Pregnancy and Breast-Feeding
 Drug Therapy in Pediatric Patients
 Drug Therapy in Geriatric Patients
READING ASSIGNMENT
 Chapter 9: Drug Therapy During Pregnancy and Breast-Feeding – pp
81 - 87
 Chapter 10: Drug Therapy in Pediatric Patients – pp 88 - 91
 Chapter 11: Drug Therapy in Geriatric Patients – pp 92 – 95
DISCUSSION (Choose 1)
 Discuss adverse reactions during pregnancy, focusing on the effects of
drugs on the fetus and neonate.
 Discuss the pharmacokinetics of children 1 year old or older.
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Describe common reasons for noncompliance and nonadherence that
are particularly relevant to older adults and list some approaches for
minimizing those problems and improving compliance.
SUBMISSION
•
Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 3
Homework: Chapter readings: Chapters 12, 13, 14, 15, 16, 17, 18, & 19
DATE
WEEK 4
At the end of this lesson, you will be able to:
SPECIFIC
 Discuss the reason most neuropharmacologic agents act by altering
OBJECTIVES
synaptic transmission instead of altering axonal conduction.
 Describe the general steps involved in neurotransmission (synaptic
transmission) and axonal conduction. State the elements or processes
that need to occur, regardless of the site in the nervous system, for
synaptic transmission to work.
 Discuss specific ways in which drugs can alter the steps of synaptic
transmission.
 Discuss the relationship between multiple receptor types and selective
drug action.
 Identify the two major divisions of the peripheral nervous system.
 Differentiate between the somatic (motor) nervous system and the
sympathetic and parasympathetic branches of the autonomic nervous
system in terms of (1) overall anatomic organization (numbers, types
of nerves); (2) neurotransmitters made and released by the nerves; and
(3) the targets (effectors) of the neurotransmitters’ actions, whether
those structures are innervated by one or both branches of the
autonomic nervous system, and the effects of activating those
structures.
 Describe the differences distinguishing the four main subtypes of
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adrenergic receptors – alpha1, alpha2, beta1, and beta2 – in terms of
where (on what structures) they are found and the responses their
activation causes.
Describe the differences between the two main subtypes of cholinergic
receptors – nicotinic (both nicotinicN and nicotinicM) and muscarinic
– in terms of where (on what structures) they are found and the
responses their activation causes.
Identify the basic processes by which the main autonomic nervous
system neurotransmitters are terminated physiologically.
State the responses that a muscarinic agonist would be expected to
cause through direct activation of muscarinic cholinergic receptors
(consider bethanechol). The student should focus on the main “targets”
of parasympathetic nervous system activity: eyes, respiratory system,
heart and blood vessels, gastrointestinal (GI) and urinary tracts, and the
secretory activity of exocrine glands (for example, lacrimal, mucous,
and so on).
List cholinergic responses not normally caused when the usual
therapeutic doses of a muscarinic agonist are administered and explain
why these effects do not occur.
State the main side effects of a muscarinic agonist (for example,
bethanechol) and related precautions or contraindications to its use.
Give several reasons why acetylcholine itself is not used to produce
selective muscarinic-activating effects and why other drugs generally
are chosen.
Describe the signs and symptoms of muscarinic antagonist (for
example, atropine) “poisoning,” how it is managed, and how and
where such a syndrome can occur without the patient receiving any
therapeutic product.
Describe the main effects of cholinesterase inhibitors on structures
controlled by the autonomic nervous system and on skeletal muscle,
and state the general mechanism by which these effects occur.
Compare and contrast the effects of the cholinesterase inhibitors with
those of bethanechol, which was described as the most representative
muscarinic agonist (see Chapter 14).
State the main clinical uses of cholinesterase inhibitors and precautions
for and contraindications to their use.
Recognize the meaning and importance of the term quaternary when
applied to the structure of a drug; compare and contrast the actions of
neostigmine and physostigmine in the context of whether they are
quaternary compounds.
Compare and contrast the cholinergic crisis and the myasthenic crisis
in a hypothetical patient with myasthenia gravis; describe simple
assessments that would help distinguish the two conditions; and state
the rationale for using cholinesterase inhibitors to help confirm the
diagnosis.
Describe the signs and symptoms associated with cholinesterase
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inhibitor overdose and the general approaches to managing it.
State the rationales for administering a cholinesterase inhibitor to a
patient who has been intentionally paralyzed (such as, for surgery) with
a neuromuscular blocking drug. State which class of neuromuscular
blockers causes effects that can be reversed by the cholinesterase
inhibitor. State the other main drug that is given as part of the
postoperative reversal procedure and explain when and why it is given.
Describe the signs and symptoms associated with “irreversible”
cholinesterase inhibitors and the general approaches used to manage
poisoning caused by these substances.
Describe the anatomy of the somatic nervous system, the key
transmitter and receptor type involved in skeletal muscle activation,
and the physiologic consequences of activating those cell receptors.
Compare and contrast the mechanisms of action of nondepolarizing
and depolarizing neuromuscular blocking agents and state how these
actions influence the use of one class rather than the other in specified
clinical situations.
Identify three specific uses for neuromuscular blocking agents and
describe the monitoring and other measures necessary with their use.
Discuss the main risks and main cause of death with neuromuscular
blocking agents and describe steps to manage potentially fatal
responses.
Identify the class of drugs used to reverse the effects of
nondepolarizing neuromuscular blockers and describe the mechanism
by which they cause that reversal. Also explain why pharmacologic
reversal is not used when succinylcholine is the neuromuscular
blocker.
Describe the etiology, signs, and symptoms of malignant hyperthermia;
the drugs associated with a high risk for that condition; and
interventions to be implemented should it develop.
Discuss the rationale for the limited applications of mecamylamine.
Recall (for example, from Chapter 13) the sites (effectors) of alpha1-,
beta1-, and beta2-adrenergic receptors and state the expected responses
from their activation by a suitable agonist.
Classify the following agonists in terms of the adrenergic receptors
they activate and the responses they cause as a result of direct receptor
activation: (1) epinephrine, (2) norepinephrine, (3) phenylephrine, (4)
isoproterenol, (5) terbutaline, (6) dobutamine.
Explain the difference between direct cardiac (beta1) effects of
adrenergic agonists and reflex (baroreceptor reflex–mediated) effects
of those same drugs, using norepinephrine, phenylephrine, and
isoproterenol as examples.
Explain how each of the following affects structures controlled by the
sympathetic nervous system, comparing how they work with how a
direct-acting agonist such as epinephrine works, and state one or more
clinical uses for each: (1) ephedrine, (2) amphetamines, (3) cocaine, (4)
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monoamine oxidase (MAO) inhibitors
Identify the desired effects when a therapeutic dose of epinephrine is
given for anaphylaxis and explain the actions of the drug that earn it
the label “drug of choice” for anaphylaxis.
 Identify individuals who should carry an EpiPen, when they should use
it, how dosage should be calculated, and how it should be stored and
replaced.
 Explain the self-injection procedure for the EpiPen.
 Summarize the main adrenergic receptor subtypes that mediate the
ocular, cardiovascular, pulmonary, and uterine responses to
sympathetic nervous system activation.
 Describe the main direct and indirect effects of alpha- and betaadrenergic blockers (antagonists) on the structures listed in the
preceding objective and on stated sympathetic/adrenergic responses.
For each effect, the student should be able to state any applicable
precautions or contraindications to the use of such antagonists and
explain the potential outcome if a stated blocker is administered to a
patient for whom the antagonist ought not to be used.
 Describe the adverse effects of alpha blockade and compare them with
the adverse effects of beta blockade.
 Describe the physiologic changes that affect blood pressure and other
aspects of cardiovascular function as the patient goes from the supine
to the standing position; also, explain the impact of alpha- and betaadrenergic blockers on those compensatory processes.
 Explain the practical clinical implications of classifying some
adrenergic blockers as “cardioselective” and others as having intrinsic
sympathomimetic activity. Describe when and why they may be
suitable (or potentially better) alternatives to nonselective beta blockers
(for example, propranolol) overall, particularly for patients who may
experience adverse responses to the nonselective blockers.
 Summarize the main mechanisms of action of reserpine, guanethidine,
and methyldopa (or clonidine).
 Compare and contrast the general sites and mechanisms of action of
reserpine, clonidine, and methyldopa with those of drugs that block
adrenergic receptors (for example, propranolol and phentolamine).
 Explain the factors that lead to and the characteristics of the “rebound”
phenomenon associated with sudden discontinuation of clonidine.
 Use the effects of the drugs described in this chapter to predict how
responses to the main classes of adrenergic agonists (see Chapter 17)
would be affected.
Unit 4: Peripheral Nervous System Drugs
 Basic Principles of Neuropharmacology
 Physiology of the Peripheral Nervous System
 Muscarinic Agonists and Antagonists
 Cholinesterase Inhibitors and Their Use in Myasthenia Gravis
 Drugs that Block Nicotinic Cholinergic Transmission: Neuromuscular
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TOPIC (S)
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LEARNING
ACTIVITIES
Blocking Agents
Adrenergic agonists
Adrenergic Antagonists
Indirect-Acting Antiadrenergic Agents
READING ASSIGNMENT
 Chapter 12: Basic Principles of Neuropharmacology – pp 96 - 101
 Chapter 13: Physiology of the Peripheral Nervous System – pp 102 –
114
 Chapter 14: Muscarinic Agonists and Antagonists – pp 115 - 126
 Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia
Gravis – pp 127 - 133
 Chapter 16: Drugs that Block Nicotinic Cholinergic Transmission:
Neuromuscular Blocking Agents – pp 134 - 142
 Chapter 17: Adrenergic agonists – pp – 143 - 155
 Chapter 18: Adrenergic Antagonists – pp 156 - 167
 Chapter 19: Indirect-Acting Antiadrenergic Agents – pp 168 - 172
DISCUSSION (Choose 1)
 Discuss specific ways in which drugs can alter the steps of synaptic
transmission.
 Identify the basic processes by which the main autonomic nervous
system neurotransmitters are terminated physiologically.
 Identify three specific uses for neuromuscular blocking agents and
describe the monitoring and other measures necessary with their use.
SUBMISSION
 Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 4
Homework: Chapter readings: Chapters 20, 221, 22, 23, 24, 25, 26, 27, 28,
29, & 30
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DATE
WEEK 5
At the end of this lesson, you will be able to:
SPECIFIC
OBJECTIVES
 Identify the main neurotransmitters of the central nervous system
(CNS) and summarize some of their main physiologic effects.
 Discuss the significance of the blood-brain barrier in allowing or
preventing the effects of drugs in general.
 Describe how, in many cases, control of key activities in the CNS
involves more than one neural pathway, each with its own
neurotransmitter and set of receptors. This is generally important for
understanding much of the specific information presented in later
chapters in this unit.
 Explain the interrelationships between the central nervous system
(CNS) activities of dopamine and acetylcholine as they affect the signs
and symptoms of Parkinsonism and as they relate to the general
biochemical approach to correcting neurotransmitter imbalances with
anti-Parkinsonian drugs.
 Discuss the drug treatment for Parkinson’s disease (PD), and discuss
the current consensus on which agent or agents are recommended for
initiating therapy in most patients with PD.
 Succinctly summarize the main anti-Parkinsonian mechanisms of
action of levodopa, carbidopa, pramipexole, ropinirole, apomorphine,
bromocriptine, amantadine, entacapone, tolcapone, and selegiline.
Also, summarize the main adverse responses elicited by each of these
drugs.
 Summarize the main neural pathologic changes involved in the
etiology of Alzheimer’s disease (AD) (for example, define neuritic
plaques and neurofibrillary tangles and explain how they form) and
describe the main neurotransmitter “deficiency” that seems to account
for most of the signs and symptoms.
 Summarize the main signs and symptoms of AD and the main risk
factors for its development.
 Identify acetylcholinesterase inhibitors as the current main class of
drugs for managing AD. State the main mechanism by which these
drugs seem to confer some symptom relief in AD and summarize
whether they seem to have short- or long-term benefit, providing
symptomatic relief or a true cure. Donepezil should be used as the
example drug.
 State the main properties of donepezil that make it a good first-choice
agent for AD in most cases. Also, summarize one or two key reasons
tacrine is not a preferred agent.
 Describe the therapeutic effects and mechanism of action of
memantine [Namenda].
 Comment on the status of vitamin E and selegiline, nonsteroidal
antiinflammatory drugs (NSAIDs), estrogen, and ginkgo biloba as
agents that might relieve, delay the progression of, or protect against
AD.
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Identify the primary pathology of multiple sclerosis (MS), including
how inflammation occurs, what initiates the autoimmune process, what
happens when an acute attack is over, and whether MS injures the
myelin sheath of peripheral neurons.
Describe the signs and symptoms of MS, including a description of the
diagnostic criteria and the diagnostic tools that can help confirm a
suspected diagnosis of MS.
Describe the four subtypes of MS (relapsing-remitting, secondary
progressive, primary progressive, and progressive-relapsing) and
comment on the symptom patterns that characterize each subtype.
Describe the mechanism of action, therapeutic use, and adverse effects
of immunomodulators and immunosuppressants.
Discuss medications available for symptom management of bladder
and bowel dysfunction, depression, fatigue, spasticity, sexual
dysfunction, neuropathic pain, ataxia and tremor, and cognitive
dysfunction.
Differentiate between seizure and convulsion and between partial
(focal) and generalized seizures.
Describe how seizures are initiated and generated.
State and describe three cellular mechanisms by which antiepileptic
drugs act.
Describe the general goals of the treatment of epilepsy and some of the
problems commonly encountered in reaching them. While considering
the problems, articulate social and occupational factors, not just the
pharmacologic factors.
Discuss important considerations related to selecting an antiepileptic
drug, monitoring its effectiveness (or lack thereof), and recognizing
side effects and how to deal with them.
State the most common reason for “therapeutic failure” of
anticonvulsant drugs and describe steps that might be taken to reduce
the problem.
Summarize the likely problems for which the patient must be assessed
and treated when the decision is made to discontinue one
anticonvulsant drug and switch to another.
Summarize the likely problems for which the patient must be assessed
and treated when a second agent must be added to a treatment plan that
already includes one anticonvulsant drug.
State why, in general, most anticonvulsants interact in important ways
with many other drugs, regardless of their therapeutic classification.
Discuss the risks and benefits of administering anticonvulsants during
pregnancy (as they affect the mother and the fetus and newborn), and
describe any special assessments or interventions indicated for a
pregnant woman with epilepsy.
Summarize a generally accepted drug plan for intervening in status
epilepticus (generalized convulsive) and state why prompt suppression
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of seizures is essential but insufficient as the only goal.
Discuss some basic differences between localized skeletal muscle
spasm and spasticity (etiology, manifestations, and primary and
adjunctive treatments).
Explain the basic differences, in terms of sites and mechanisms of
action, among centrally acting muscle relaxants, baclofen, diazepam,
and dantrolene. State how these different mechanisms and sites of
action relate to the drugs’ clinical uses.
Describe the etiologies, signs and symptoms, and management of
malignant hyperthermia (see Chapter 16). Likewise, demonstrate a
good grasp of the overall pharmacology of the benzodiazepines as a
class (see Chapter 34).
Describe the physiologic manner by which local anesthetics work.
Differentiate between ester and amide types of local anesthetics in
terms of mechanism of action, mechanisms by which they are
eliminated from the body, and adverse effects (particularly with respect
to allergic reactions).
Describe signs and symptoms of systemic local anesthetic toxicity,
how to recognize them, and how to manage them.
State reasons and rationales for including a vasoconstrictor (for
example, epinephrine) in a parenteral formulation of local anesthetic.
Focus on the time course and intensity of local anesthetic action,
toxicity, and allergenicity as affected by the vasoconstrictor.
Describe the properties of individual local anesthetics and discuss their
clinical uses.
Discuss the concept of balanced anesthesia (i.e., the overall goals of
general anesthesia and the fact that no single drug has all the properties
that might be considered “ideal” for inducing surgical anesthesia)
Give a reasonable definition of minimum alveolar concentration
(MAC) and state how it relates to inhaled general anesthetic potency
and the concentrations that must be administered to induce general
anesthesia.
Using halothane or isoflurane as a representative inhaled general
anesthetic, describe the elements of balanced anesthesia that can be
expected with usually effective doses of the drug given alone; desired
elements of balanced anesthesia that cannot be achieved by halothane
alone; elements for which supplemental agents are needed; and the
major toxicities that can occur with respect to the cardiovascular
system.
Describe the uses, benefits, and limitations of nitrous oxide in general
anesthesia.
State the roles for the following as adjuncts to general anesthesia: (a)
barbiturates, especially short-acting ones; (b) benzodiazepines; (c)
opioids; and (d) neuromuscular blockers. Use other chapters to review
the general actions, uses, and toxicities of these drug groups, and
integrate that information in the context of general anesthesia.
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Describe the basic sequence of drug administration for the reversal of
postanesthesia skeletal neuromuscular blockade (paralysis), the
rationale for each medication that is administered, and the expected
effects of each medication.
Describe the signs and symptoms, etiology (including the main
pharmacologic causes), and management of malignant hyperthermia.
State the roles of the mu, kappa, and delta opioid receptors in causing
analgesia, respiratory depression, and euphoria.
Give the precise definition of narcotic (as applied legally to classes of
drugs) and compare it with the way the typical layperson uses the term.
Distinguish among pure opioid agonists, agonist-antagonists, and
antagonists in terms of their mechanism of action; also, place various
named drugs in the appropriate category.
Discuss the therapeutic uses for opioid agonists, agonist-antagonists,
and antagonists.
Discuss the adverse effects of opioids and both their pharmacologic
and nondrug management. The discussion should include a typical
opioid agonist such as morphine, mixed opioid agonist-antagonists,
and pure opioid antagonists.
State how meperidine differs from morphine in terms of adverse
effects and proper clinical use.
Describe opioid drug–related factors that contribute to the development
of physical and psychologic dependence. Identify drug- and
administration-related factors that affect the severity of physical
dependence and the severity and duration of withdrawal signs and
symptoms when administration of that drug is stopped suddenly.
Compare and contrast acute withdrawal from an opioid (assume
physical dependency has occurred) with the withdrawal signs,
symptoms, and likely outcomes of unsupervised withdrawal from
barbiturates, alcohol, and benzodiazepines.
Compare and contrast neuropathic and nociceptive pain in terms of the
causes and the drug classes that typically are (or are not) effective for
managing them.
Describe the various assessment tools used to evaluate the severity of
and discomfort from a patient’s pain, and help plan optimal analgesic
therapy.
Comment on the statement that the various nonsurgical interventions
used to treat cancer – chemotherapy and radiation therapy – can cause
pain that needs to be managed every bit as much as the pain arising
from the cancer itself.
List and describe some of the main barriers or impediments to
providing optimal pain control, particularly with opioids. Consider
attitudes, beliefs, and even what might be described as fears involving
healthcare providers responsible for prescribing and administering
these drugs as well as the patients (and their families) who are
recipients of these medications.
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TOPIC (S)
Articulate the questions that a nurse would ask a patient to assess each
of the following characteristics of the person’s pain: Onset and
temporal pattern of pain; location of the pain; quality of the pain; pain
intensity; modulating or modifying factors; previous treatment; and
impact on function and overall quality of life
Develop a prioritized list of “preferred,” rational, and effective drugs
for a patient, given the type or types and severities of the person’s pain.
The list should include traditional analgesics and drugs identified as
adjuvant (adjunctive) drug therapies.
Compare and contrast the benefits and limitations (or risks) of PRN
pain control with those of around-the-clock administration of
analgesics. Include in the summary the benefits of patient-controlled
analgesia. Assume the patient has long-term pain that must be
controlled.
Summarize some general ways in which the elderly, very young
children, and patients who are physically dependent on and abusers of
opioids differ from an otherwise healthy young adult. Focus on
problems with assessment of pain and its response to treatment, drug
selection and dosing, and monitoring for adverse responses (caused by
the analgesic itself or related to other drugs the patient may be taking).
Explain the purpose of The Joint Commission (TJC), focusing on its
new standards on pain assessment and treatment and patients’ rights in
these important issues.
Identify the various nondrug physical and psychosocial pain
management interventions, and discuss the effectiveness of each
option.
Compare and contrast migraine headaches, cluster headaches, and
tension-type headaches in terms of triggering factors, clinical
presentations, and management.
State the common underlying neurovascular causes of migraine,
including the roles of calcitonin gene–related peptide (CGRP) and
serotonin (5-hydroxytryptamine [5-HT]).
Identify therapies that are usually effective for abortive and
prophylactic therapy of migraine, and state which drugs are suitable for
prophylaxis but not for acute intervention (abortive therapy).
Describe the signs, symptoms, and potential consequences of ergotism
and the main elements of its management.
Unit 5: Central Nervous System Drugs
 Introduction to Central Nervous System Pharmacology
 Drugs for Parkinson’s Disease
 Drugs for Alzheimer’s Disease
 Drugs for Multiple Sclerosis
 Drugs for Epilepsy
 Drugs for Muscle Spasm and Spasticity
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LEARNING
ACTIVITIES
Local Anesthetics
General Anesthetics
READING ASSIGNMENT
 Chapter 12: Basic Principles of Neuropharmacology – pp 96 – 101
 Chapter 13: Physiology of the Peripheral Nervous System – pp 102 –
114
 Chapter 14: Muscarinic Agonists and Antagonists – pp 115 - 126
 Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia
Gravis – pp 127 – 133
 Chapter 16: Drugs that Block Nicotinic Cholinergic Transmission:
Neuromuscular Blocking Agents – pp 134 - 142
 Chapter 17: Adrenergic agonists – pp – 143 – 155
 Chapter 18: Adrenergic Antagonists – pp 156 – 167
 Chapter 19: Indirect-Acting Antiadrenergic Agents – pp 168 - 172
DISCUSSION (Choose 1)
 Discuss specific ways in which drugs can alter the steps of synaptic
transmission.
 Identify the basic processes by which the main autonomic nervous
system neurotransmitters are terminated physiologically.
 Identify three specific uses for neuromuscular blocking agents and
describe the monitoring and other measures necessary with their use.
SUBMISSION
 Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 5A
Homework: Chapter readings: Chapters 31, 32, 33, 34, 35, 36, 37, 38, 39, &
40
DATE
WEEK 6
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At the end of this lesson, you will be able to:
SPECIFIC
OBJECTIVES
 Describe the principal indications for antipsychotic drugs.
 Describe the clinical presentation of schizophrenia and diagnosis based
on the criteria in the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Compare and
contrast the three groups of symptoms: positive, negative, and
cognitive.
 Compare and contrast chlorpromazine and haloperidol with respect to
their mechanisms and onsets of antipsychotic action, their uses, and the
relative incidence of CNS and peripheral autonomic side effects.
 Explain why antipsychotic drugs may cause side effects or adverse
responses that mimic many of the signs and symptoms of Parkinson’s
disease. (Related to this, explain why excessive doses of dopaminergic
drugs used for parkinsonism may trigger some signs and symptoms of
schizophrenia.)
 Summarize the main signs and symptoms of extrapyramidal side
effects caused by antipsychotic drugs and acceptable therapeutic
approaches to minimize or reverse them.
 Associate the neuroleptic malignant syndrome as a relatively rare but
serious adverse reaction to antipsychotic drugs, describe its signs and
symptoms and time of onset after starting antipsychotic drug therapy,
and state interventions that should be implemented if or when
neuroleptic syndrome is suspected or confirmed.
 Highlight the key differences between and similarities of
antipsychotics that are called high potency and those called low
potency.
 State why clozapine, which is considered the prototype of the atypical
antipsychotics, is not a first-line drug for managing schizophrenia but
does seem to be preferred to phenothiazines for managing levodopainduced psychosis. Discuss special monitoring that must be
implemented, as well as special instructions that should be given to the
patient who is receiving clozapine, regardless of the use.
 Describe the diagnostic criteria for major depression and the four
treatment modalities available.
 Identify signs and symptoms that might indicate an increased risk of
suicide in individuals taking antidepressants and explain ways the risk
for suicide may be reduced.
 Compare and contrast the mechanisms of action and main adverse
effects of TCAs, SSRIs, SNRIs, and MAOIs. Also, state the role or
roles of each class in a stepwise approach to the management of
depression pharmacologically; that is, explain which drug or drugs
generally are chosen for first-line treatment and which generally are
used only as a last resort and the reasons.
 Explain the mechanism of action that results in hypertensive crisis
from dietary tyramine in individuals taking MAOIs. Also, describe the
educational information that needs to be given to patients. In addition,
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explain how hypertensive crisis is treated.
Identify the typical manifestations and clinical course of bipolar
disorder (BPD) and the drugs used to manage them.
Describe the best way to determine therapeutic lithium levels.
Describe how and why the body’s sodium balance is important in
maintaining steady blood lithium levels and responses to the drug.
Also, identify drug- and diet-related aspects that affect those lithium
levels and effects.
State the main elements of patient assessment and patient education
with respect to determining therapeutic response or adverse response to
drug therapy.
Explain why benzodiazepines are drugs of first choice for anxiety and
insomnia.
Identify the drug used for diagnosis and treatment of benzodiazepine
overdosage and explain its basic mechanism of action.
Describe the important considerations involved when using sedativehypnotic drugs.
Compare and contrast the withdrawal syndrome associated with abrupt
discontinuation of benzodiazepines with that of barbiturates.
Summarize the main points of sleep fitness – that is, approaches people
can use to help themselves fall asleep, stay asleep, and sleep restfully
without the need for medications.
Compare and contrast the effects of buspirone (BuSpar),
benzodiazepines, and antidepressants that might be prescribed for
generalized anxiety disorder, focusing on the adverse reactions;
interactions with other medications; and pharmacokinetics, particularly
with respect to onset of action.
Compare and contrast characteristics of generalized anxiety disorder,
panic disorder, obsessive-compulsive disorder, social anxiety disorder,
and post-traumatic stress disorder and identify treatment options for
each disorder.
Discuss the central nervous system (CNS) and peripheral autonomic
effects of amphetamines and the general mechanism by which they
occur.
Describe the most common adverse and toxic effects of amphetamines
and their management, and discuss the issues of tolerance, physical
dependence, and abuse.
Describe the various generally accepted drug treatments for attentiondeficit/hyperactivity disorder (ADHD).
Explain why CNS stimulation, such as with amphetamines or
methylphenidate, is beneficial for managing the manifestations of
hyperactivity disorder.
Explain why it can be said that drug abuse is culturally defined. Also,
discuss whether a single medical or social norm can be applied to
determine whether a particular pattern of drug use (or misuse) or the
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use or misuse of a particular drug (or class of drugs) constitutes drug
abuse.
Discuss psychological and drug-related factors that in a broad sense
contribute to substance abuse.
Describe several of the common mechanisms by which tolerance to a
drug’s effects can develop, and state whether the process of tolerance
development depends on the properties of the drug or on processes
inherent in the body.
Differentiate between physical and psychological dependence.
Describe the alleged roles or purposes of the Controlled Substances
Act.
State the prescribing requirements and restrictions on Schedule II, III,
IV, and V medications.
Differentiate between the beneficial and detrimental effects of alcohol.
Discuss the metabolism of ethanol with respect to the following: The
roles of alcohol and aldehyde dehydrogenases, the rate of alcohol
metabolism as a function of blood alcohol levels, and the general
mechanism or mechanisms by which acute high-dose and chronic
“moderate” alcohol consumption affect elimination of many other
drugs that undergo hepatic metabolism.
Identify the major nonhepatic route of elimination of alcohol and its
medicolegal implications.
Identify several drugs – and nondrug measures – that have some hope
of stopping or reducing the problems of chronic alcohol intake.
Compare and contrast the typical signs, symptoms, and outcomes of
acute “unsupervised” withdrawal from alcohol with those of acute
withdrawal from barbiturates and opioids.
Comment on the common use of aspirin to manage some of the
common signs and symptoms of alcohol-induced “hangover.” Describe
whether other over-the-counter analgesics might be preferred for
managing hangovers.
Identify the overall risks of cigarette smoking.
Discuss endeavors to prevent tobacco use. Describe the mechanism of
action and pharmacokinetics of nicotine.
Describe the pharmacologic effects of nicotine on the cardiovascular
system, the gastrointestinal (GI) system, and the central nervous
system (CNS).
Differentiate between tolerance and dependence with regard to
cigarette smoking.
Discuss the treatment options to aid smoking cessation.
Recognize the seven main pharmacologic groups of commonly abused
substances: (1) opioids, (2) psychostimulants, (3) depressants, (4)
psychedelics, (5) dissociative drugs, (6) anabolic steroids, and (7)
miscellaneous drugs of abuse.
State whether any specific antidotes exist for the substances of abuse.
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TOPIC (S)
LEARNING
ACTIVITIES
Also, identify those groups and their antagonists.
Compare and contrast the patterns of abuse for the seven major
categories of abused drugs and summarize their main behavioral and
systemic effects.
Describe the signs, symptoms, and treatment for acute or long-term use
or overdose for the seven major categories of abused drugs.
Describe the key signs and symptoms of opioid withdrawal, its clinical
management, and the likely clinical outcome of unsupervised or
untreated opioid withdrawal.
Discuss the issues of tolerance and cross-tolerance to drugs, focusing
on the opioids and barbiturates.
Cite at least two examples for which signs and symptoms of abuse (or
overuse) of a particular substance cause radically different acute effects
that are dose dependent.
Unit 5: Central Nervous System Drugs
 Antipsychotic Agents and Their Use in Schizophrenia
 Antidepressants
 Drugs for Bipolar Drugs
 Sedative-Hypnotic Drugs
 Management of Anxiety Disorders
 Central Nervous System Stimulants and Attention-Deficit/Hyperactive
Disorder
 Drug Abuse I: Basic Considerations
 Drug Abuse II: Alcohol
 Drug Abuse III: Nicotine and Smoking
 Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and
Nicotine
READING ASSIGNMENT
 Chapter 31: Antipsychotic Agents and Their Use in Schizophrenia– pp
317 - 338
 Chapter 32: Antidepressants – pp 338 - 363
 Chapter 33: Drugs for Bipolar Drugs – pp 364 – 372
 Chapter 34: Sedative-Hypnotic Drugs – pp 373 – 387
 Chapter 35:Management of Anxiety Disorders – pp 388 – 394
 Chapter 36: Central Nervous System Stimulants and AttentionDeficit/Hyperactive Disorder – pp
 Chapter 37: Drug Abuse I: Basic Considerations
 Chapter 38: Drug Abuse II: Alcohol
 Chapter 39: Drug Abuse III: Nicotine and Smoking
 Chapter 40: Drug Abuse IV: Major Drugs of Abuse Other Than
Alcohol and Nicotine
DISCUSSION (Choose 1)
 Discuss the treatment options to aid smoking cessation.
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Differentiate between physical and psychological dependence.
Describe the best way to determine therapeutic lithium levels.
SUBMISSION
 Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 5B
Homework: Chapter readings: Chapters 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,
& 30
DATE
WEEK 7
At the end of this week, the students will be able to:
SPECIFIC
OBJECTIVES
 State the common mechanism or mechanisms by which all diuretics
increase urine production.
 Classify the following as potassium sparing or potassium wasting:
thiazides, loop diuretics, spironolactone, and triamterene; also, state
why a knowledge of the effects of diuretics on renal potassium
excretion is important clinically.
 State factors that should be considered when selecting a diuretic,
focusing on the efficacy of the various agents, dose-response
relationships, and the potential for adverse effects in patients with other
disorders. Also, discuss for which pathologies the various diuretics are
suitable.
 Describe the adverse effects, contraindications, or precautions for the
various diuretics.
 State the expected effects of thiazides and loop diuretics on blood
levels of glucose, lipids, uric acid, calcium, and magnesium and
identify the preexisting conditions that might require extra caution if
use of these diuretics is anticipated.
 State how changes in the serum potassium level influence the effects of
digoxin and the likely impact of hypokalemia or hyperkalemia on
therapy with a cardiac glycoside.
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State whether combinations of named diuretics are rational and give a
reason why. For example, is it reasonable and rational to administer
two thiazides or two loop diuretics to the same patient?
Compare and contrast the mechanisms of action, clinical uses, and
typical adverse effects of mannitol with those of a thiazide or loop
diuretic.
Identify and describe the common etiologies and treatments for
isotonic, hypertonic, and hypotonic volume contractions.
Identify and describe the common etiologies and treatments for
respiratory and metabolic acidosis and respiratory and metabolic
alkalosis.
Identify the main hormone responsible for regulating renal potassium
excretion (or retention), and state the simultaneous effects of that
hormone on renal handling of sodium and water.
Describe the link between serum insulin and potassium levels,
explaining why hyperinsulinism leads to hypokalemia.
Identify the main potassium salt that is preferred (in most situations)
for preventing or managing hypokalemia, and state why it is generally
the preferred salt.
Summarize the main physiologic roles of the pulmonary and systemic
circulatory systems, particularly as they affect blood pressure and
venous return to the heart.
Describe the process that contributes to venous return.
Write the equation used to calculate cardiac output, and state the main
physiologic and pathophysiologic factors that can affect (increase or
decrease) each of the two elements that determine cardiac output.
State the main neural and hormonal controls over blood pressure. State
the endogenous chemicals that help regulate arterial blood pressure.
Compare and contrast the roles and mechanisms of the reninangiotensin-aldosterone system (RAAS) and the autonomic nervous
system (ANS) with respect to regulating hemodynamics.
Explain how increases in the arterial pressure (AP) can affect overall
hemodynamics and ultimately lead to congestive heart failure.
Describe the main components of the renin-angiotensin-aldosterone
system (RAAS) and explain how the overall system is regulated
physiologically.
State the main effects of aldosterone on renal handling of sodium,
potassium, and water. Also, identify the main physiologic stimulus for
aldosterone release and describe the likely effects of increased
aldosterone release on hemodynamics (blood volume, pressure, cardiac
function) and the blood electrolyte composition.
Name the classes of drugs (and a prototype for each) that can affect
blood pressure by altering the RAAS or targets of its activity, and state
how the drugs cause those effects.
Describe the effects of angiotensin-converting enzyme (ACE)
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inhibitors on blood pressure and on renal regulation of sodium,
potassium, and water excretion.
Compare and contrast the actions of angiotensin II receptor blockers
(antagonists/receptor blockers, such as losartan) with those of an ACE
inhibitor or direct renin inhibitors.
State the two main contraindications to administration of ACE
inhibitors, angiotensin II receptor blockers (ARBs), and direct renin
inhibitors.
Discuss the major adverse effect of aldosterone antagonists
(hyperkalemia) and the implications that this effect has with regard to
combination therapy with ACE inhibitors or ARBs.
Briefly describe the calcium channel and the relationships between
intracellular and extracellular calcium concentrations as they affect
smooth and cardiac muscle contractile function.
Describe the functional linkage between beta-adrenergic receptors and
calcium channels in the heart.
Compare and contrast the sites of action of nifedipine with those of
diltiazem or verapamil. Also, explain how the differences between the
dihydropyridines and verapamil or diltiazem affect their clinical use
and name the most common side effects.
Identify other drugs, noted and described in the cardiovascular unit,
which should not be administered with calcium channel blockers
(CCBs) because of the risk of excessive depression of cardiac
contractility, rate, and electrical activity. Also, specify whether these
precautions apply to dihydropyridine-type CCBs, just to verapamil or
diltiazem, or to all CCBs, and explain why.
Identify the main pharmacologic causes of vasodilation. Also, state the
drugs (or drug classes) that have vasodilator action and describe how
they cause blood vessels to dilate.
Explain how reducing afterload and preload can help a patient with
hypertension or heart failure.
Describe how excessive vasodilation can cause adverse effects that can
actually worsen many of the conditions for which vasodilators are
given.
State the expected compensatory cardiac and renal responses that occur
when a drug that does nothing but dilate arterioles is given and identify
adjunctive drugs that might be used to control those responses.
Describe the metabolism of nitroprusside. Also, state precautions that
need to be taken to ensure it is administered as safely as possible and
explain the process of monitoring for its desired and adverse effects.
Describe clinical settings in which diazoxide might be indicated
(parenteral administration) and the likely adverse responses to it
(cardiovascular and otherwise).
State how the following systems contribute to the regulation of blood
pressure and name the classes of antihypertensive drugs that target one
or more of these processes or structures when given to lower elevated
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TOPIC (S)
LEARNING
ACTIVITIES
blood pressure: (1) heart (via the contractile force developed by the left
ventricle); (2) peripheral vasculature; (3) parasympathetic nervous
system; (4) sympathetic nervous system; (5) renin-angiotensinaldosterone system (including the kidneys themselves).
State the criteria used to classify hypertension as essential
hypertension.
State the factors that, beyond blood pressure per se, are used to classify
the severity of hypertension according to Joint National Committee 7
(JNC 7).
Explain how most pathophysiologic processes that occur during longterm hypertension simultaneously contribute to heart failure.
State the major factors that influence the choice of antihypertensive
drug (or drug combination) for a patient with a stated severity of
essential hypertension. State how specified comorbidity (for example,
heart failure, diabetes, asthma) would influence the drug choice for or
against a particular drug class.
State the blood pressure control gains to be expected by progressively
increasing the dosage of one antihypertensive drug rather than adding
drugs in other classes to the initial agent.
State the blood pressure benefits to be gained by switching from one
drug in a particular class to another agent in the same class (for
example, switching from one beta blocker to another).
List and describe several nondrug (for example, lifestyle) factors that
should be encouraged to manage essential hypertension, regardless of
the drug used.
Describe general goals for the safe management of a hypertensive
emergency and list drugs that would be suitable for such a situation.
Discuss the etiology of hypertension during pregnancy, also addressing
preeclampsia and eclampsia and the roles of antihypertensive drugs
and magnesium sulfate. In addition, state the “definitive cure” for
hypertension in eclampsia.
Unit 6: Drugs that Affect Fluid and Electrolyte Balance
 Diuretics
 Agents affecting the Volume and Ion Content of Body fluids
Unit 7: drugs that Affect the Heart, Blood Vessels and Blood
 Review of Hemodynamics
 Drugs Acting on the Renin-Angiotensin-Aldosterone System
 Calcium Channel Blockers
 Vasodilators
 Drugs for Hypertension
READING ASSIGNMENT
 Chapter 41: Diuretics – pp 447 - 458
 Chapter 42: Agents affecting the Volume and Ion Content of Body
fluids – pp 459 - 463
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Chapter 43: Review of Hemodynamics – pp 464 - 469
Chapter 44: Drugs Acting on the Renin-Angiotensin-Aldosterone
System - -pp 470 - 484
Chapter 45: Calcium Channel Blockers – pp 485 - 493
Chapter 46: Vasodilators – pp 494 - 498
Chapter 47: Drugs for Hypertension – pp 499 - 516
DISCUSSION (Choose 1)
 Describe the adverse effects, contraindications, or precautions for the
various diuretics.
 Describe general goals for the safe management of a hypertensive
emergency and list drugs that would be suitable for such a situation.
 Describe the effects of angiotensin-converting enzyme (ACE)
inhibitors on blood pressure and on renal regulation of sodium,
potassium, and water excretion.
SUBMISSION
 Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 6 & 7A
Homework: Chapter readings: Chapters 20, 21, 22, 23, 24, 25, 26, 27, 28, 29,
& 30
DATE
WEEK 8
At the end of this lesson, you will be able to:
SPECIFIC
OBJECTIVES
 Summarize the essence of Starling’s law of the heart and translate it
into factors that relate to ventricular end-diastolic volume. Also,
describe how an alteration in ventricular end-diastolic volume relates
to heart failure.
 Describe the characteristic signs and symptoms of heart failure,
including those that could be called congestive.
 Summarize the characteristics or measures that are used to assign a
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patient with heart failure to the four American College of
Cardiology/American Heart Association stages and those that make up
the New York Heart Association classes.
Discuss the goals for the treatment of chronic and acute heart failure.
Recognize and describe the roles, benefits, and limitations of the
following drugs (or drug groups) in the long-term management of heart
failure: (1) drugs that inhibit the RAAS; (2) diuretics; (3) vasodilators
(other than angiotensin-converting enzyme [ACE] inhibitors and
angiotensin II receptor blockers [ARBs]); (4) beta-adrenergic blockers;
(5) cardiac glycosides; (6) inotropic agents (other than cardiac
glycosides).
Describe what the terms afterload and afterload reduction mean and
explain why afterload reduction is beneficial in the management of
heart failure.
State the main direct and indirect cardiac contractile and
electrophysiologic effects of digoxin and explain the relationship
between them and the serum potassium level.
Explain how digoxin’s desired effects lead to beneficial systemic
hemodynamic and metabolic/ endocrinologic effects.
Explain why digoxin is a mixed blessing for the management of
chronic heart failure, particularly with respect to problems related to
the frequency and severity of toxicity.
Describe how the use of diuretics (for example, furosemide) as an
adjunct to digoxin can be considered both beneficial and dangerous.
State the cardiac and other (noncardiac/extracardiac) signs and
symptoms consistent with digoxin toxicity, especially those that would
lead to suspicion of drug intoxication even before electrocardiographic
and blood test results are available. Also, state the first thing that
should be done or given as an instruction to the patient when digoxin
toxicity is suspected.
State the normal electrophysiologic roles of the following specialized
portions of the heart: sinoatrial node, atrial myocardium,
atrioventricular node, and His-Purkinje system.
State what each of the following parts of a normal electrocardiogram
(ECG) represent in terms of contractile or electrophysiologic activities
of the heart: P wave, QRS complex, T wave, PR interval, and ST
segment.
Explain the pathophysiology of the development of dysrhythmias,
focusing on the main electrophysiologic properties of heart cells and
tissues: automaticity, conduction velocity, and refractoriness.
Define the terms first-degree, second-degree, and third-degree heart
block. Also, explain how the ECG signals that these heart blocks are
occurring. In addition, identify the drugs that can cause heart block,
including not only the antidysrhythmic drugs, but also other drugs that
have been discussed in Unit VII.
Explain how the type of dysrhythmia affects the selection of drugs
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used to manage it.
Recognize the Vaughan Williams classification as one used for
antidysrhythmic drugs and state the general principles that determine
whether a particular drug “fits” in a particular category. State whether
this classification scheme is clinically useful to the extent that it
predicts adverse responses, side effects, or even clinical uses for every
member of a given class.
Summarize current trends and opinions about pharmacologic
management of dysrhythmias (as opposed to nondrug interventions,
such as catheter ablation or no treatment at all), based on the anatomic
origin, severity, and acuity of the rhythm disorder.
Describe the side effects or adverse responses that can be caused by
virtually any antidysrhythmic drug and those that are unique to
quinidine, amiodarone, procainamide, and disopyramide.
Describe the general physiologic and biochemical processes involved
in lipoprotein synthesis and the regulation of serum lipoprotein levels.
Name the drug class generally regarded as the first choice for
hypercholesterolemia and summarize its fundamental mechanism of
action.
Describe the signs and symptoms of rhabdomyolysis; identify the main
class of drugs associated with it, its clinical consequences, and factors
that increase the risk for this syndrome.
Compare and contrast the lipid-lowering mechanisms of action, clinical
indications, and side effects of (1) statins, (2) fibric acid derivatives,
(3) niacin, and (4) bile-acid sequestrants.
Develop a teaching plan that would maximize the therapeutic benefits
of dyslipidemia therapy for patients taking one or several lipidlowering drugs and describe adjustments needed when interactants that
are clinically important are prescribed.
Summarize the main factors that affect myocardial oxygen demand and
oxygen supply and their relationships to angina pectoris.
Describe, compare, and contrast chronic stable angina, variant angina,
and unstable angina in terms of the etiology, clinical presentation, and
drug therapy for each.
Describe the mechanisms of action and therapeutic and adverse effects
of organic nitrates, calcium channel blockers, and beta blockers in
angina therapy.
Identify drugs that can be used interchangeably in the management of
angina.
Compare and contrast cardioselective and nonselective beta blockers
and calcium channel blockers.
Summarize the pros and cons of using sustained-release oral capsules
versus transdermal delivery systems of nitroglycerin for angina
pectoris.
Discuss the use of ranolazine, including adverse effects and drug
interactions.
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Give a basic overview of the pathways involved in hemostasis,
including platelet plug formation and reinforcement of platelet plugs,
and the mechanisms by which the body protects against widespread
coagulation.
Explain the differences between anticoagulant, antiplatelet, and
thrombolytic drugs in terms of what coagulation processes they affect
and their main clinical uses. Likewise, state the main difference
between a thrombus and an embolus.
Describe the usual etiologies of arterial and venous thrombosis and
discuss how prophylactic or interventional drug therapies for these two
conditions are similar or different.
Give a short summary of how and where heparins exert their desired
anticoagulant effects and describe the mechanisms and risks of
paradoxical increases in thrombotic events associated with heparininduced thrombocytopenia.
Compare and contrast unfractionated heparins and low-molecularweight (LMW) heparins in terms of mechanisms of action,
pharmacokinetics, dosing (schedules), suitability for outpatient
therapy, and monitoring of responses.
Summarize the key points that describe the differences between
warfarin and heparin: mechanisms, onset, sites of action, and
monitoring.
Compare and contrast the actions and uses of aspirin with those of
warfarin and heparin and state the typical “targets” for the laboratory
test used to monitor the response to each.
Summarize instructions on the use of aspirin to relieve common
headache, pain, or fever for an outpatient who is taking warfarin; also,
explain situations in which concomitantly taking warfarin and aspirin
is acceptable and those in which doing so can be dangerous.
Summarize general precautions and guidelines that apply when
anticoagulation is indicated for a pregnant woman. In particular, state
the required adjustment to the dosage of warfarin.
Explain the purpose of the glycoprotein IIb/IIIa receptor and the
clinical significance of blocking it.
State how thrombolytic drugs differ in terms of mechanisms of action,
pharmacokinetics, and relative safety, including in the discussion the
need for repeat administration.
State the main adverse response by anticoagulants, antiplatelet drugs,
and thrombolytic drugs.
Describe the pathophysiology involved in myocardial infarction.
Discuss methods of reperfusion therapy.
Describe the adverse effects of reperfusion therapy.
Explain adjunctive drug therapy, including the use of anticoagulants.
Discuss treatment methods for patients experiencing an acute
myocardial infarction (MI).
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Discuss secondary treatment measures for those who have experienced
an MI.
Discuss the pathophysiology, inheritance pattern, and clinical features
of hemophilia.
Identify the cornerstone of treatment for hemophilia A and hemophilia
B.
Discuss pain management options and the reason aspirin should never
be used in patients with hemophilia.
Describe the variances, if any, in the immunization schedule for
children with hemophilia.
Discuss the various preparations used to treat hemophilia, and describe
adverse effects and dosage calculations.
Discuss treatment options for patients who have developed inhibitors
to therapy.
Summarize the roles of erythropoietin, iron, vitamin B12, and folic
acid in erythropoiesis (red blood cell production).
State the main factor that determines daily iron requirements, and
explain how the body adjusts iron uptake from dietary sources to
ensure adequate levels yet prevent iron overload.
List several foods or food groups that are naturally rich sources of iron.
State three common conditions that lead to iron deficiencies, and
explain whether reduced iron delivery or increased iron demand
usually contributes to the imbalance.
Describe the physiologically essential interrelationship between
vitamin B12 and folic acid and the major physiologic roles of active
folate. Also, name the main physiologic roles of each and the signs and
symptoms of deficiency.
Describe the consequences of vitamin B12 deficiency for neural
function, erythrocyte count and appearance, coagulation, and immune
system function. Also, summarize the signs and symptoms likely to be
seen in a patient with vitamin B12 deficiency, and discuss therapy for
mild, moderate, and severe cases of the disorder.
Summarize the likely consequences for the fetus of folate deficiency in
the pregnant mother, as well as general guidelines on folate
supplementation in women, especially during pregnancy. Also, state
the trimester or trimesters in which an adequate maternal intake of
folate is particularly critical.
Discuss the need for epoetin alfa.
Discuss the use of leukopoietic growth factors to reduce the risk of
infection in patients with neutropenia.
Describe the adverse effects of filgrastim.
Discuss the medication used after failure of a bone marrow transplant.
Discuss the therapeutic use and adverse effects of oprelvekin
(interleukin-11) [Neumega].
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TOPIC (S)
LEARNING
ACTIVITIES
Unit 7: Drugs that Affect Heart, Blood Vessels and Blood
 Drugs for heart Failure
 Antidysrhythmic Drugs
 Prophylaxis of atherosclerotic Cardiovascular Disease: Drugs that Help
Normalize Cholesterol and Triglyceride levels
 Drugs for Angina Pectoris
 Anticoagulant, Antiplatelet, and Thrombolytic Drugs
 Management of ST-Elevation Myocardial Infarction
 Drugs for Hemophilia
 Drugs for Deficiency Anemias
 Hematopoietic Agents
READING ASSIGNMENT
 Chapter 48: Drugs for heart Failure – pp 517 - 533
 Chapter 49: Antidysrhythmic Drugs – pp 534 - 555
 Chapter 50: Prophylaxis of atherosclerotic Cardiovascular Disease:
Drugs that Help Normalize Cholesterol and Triglyceride levels – pp
556 - 580
 Chapter 51: Drugs for Angina Pectoris – pp 581 - 593
 Chapter 52: Anticoagulant, Antiplatelet, and Thrombolytic Drugs
– pp 594 - 624
 Chapter 53: Management of ST-Elevation Myocardial Infarction
– pp 625 - 631
 Chapter 54: Drugs for Hemophilia – pp 632 – 639
 Chapter 55: Drugs for Deficiency Anemias – pp 640 – 654
 Chapter 56: Hematopoietic Agents – pp 655 - 666
DISCUSSION (Choose 1)
 Describe what the terms afterload and afterload reduction mean and
explain why afterload reduction is beneficial in the management of
heart failure.
 Discuss the pathophysiology, inheritance pattern, and clinical features
of hemophilia.
 Describe the usual etiologies of arterial and venous thrombosis and
discuss how prophylactic or interventional drug therapies for these two
conditions are similar or different.
SUBMISSION
 Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
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Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 7B
Homework: Chapter readings: Chapters 57, 58, 59, & 60
Week 9
At the end of this lesson, you will be able to:
SPECIFIC
OBJECTIVES
 Discuss the physiologic effects of insulin on carbohydrate, lipid, and
protein metabolism, and identify the body cells and tissues that most
depend on insulin to provide glucose as the main metabolic fuel.
 Differentiate between the two major types of diabetes based on
etiology, demographics, and treatment.
 State three classic signs or symptoms of diabetes, and identify the main
pathophysiologic risks from long-term, poorly controlled diabetes.
 Describe the values and limitations of monitoring diabetes therapy
based on urine testing and blood testing for glucose and ketones.
 Explain the glycosylated hemoglobin (hemoglobin A1c), what it
reflects (in terms of blood chemistry), and why it is an important
adjunct to static (total) blood glucose levels in monitoring the response
of diabetes to therapy.
 State the main goals of therapy for all patients with diabetes in terms of
both symptom control and quantitative targets for fasting blood glucose
levels and for the hemoglobin A1c.
 Differentiate among the different insulins for therapeutic use in terms
of their mechanisms of action, pharmacokinetics, and administration
routes. Also, identify the pharmaceutical formulations that can be
given intravenously and those that cannot, and explain which
pharmaceutical property governs whether intravenous (IV)
administration is safe.
 Discuss insulin resistance in terms of what it means, factors that
contribute to it, and things that can be done to reduce the problem.
 Identify the main groups of drugs that can interfere with diabetes
therapy, whether by directly altering blood glucose levels, or by
interacting with the current antidiabetic drug or drugs.
 Identify the main groups of oral antidiabetic drugs (and a prototype in
each). Compare and contrast their main mechanisms of action, their
main adverse responses, and drug-drug interactions.
 Describe appropriate interventions for managing acute or chronic
hypoglycemia.
 Describe the potential maternal and fetal consequences of poorly
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controlled blood glucose levels during pregnancy. Also, in the case of a
pregnant woman being treated for type 1 or type 2 diabetes, describe
drug therapy changes that usually are indicated until parturition.
Summarize the general cause, signs, symptoms, and clinical outcomes
of diabetic ketoacidosis and hyperglycemic hyperosmolar nonketotic
syndrome (HHNS).
Summarize the biosynthesis of thyroid hormones, the processes for
regulating synthesis and release, and the feedback regulation of both.
Compare and contrast triiodothyronine (T3) and thyroxine (T4) in
terms of relative abundance, biologic activity, and onset and duration
of action.
Describe the physiologic actions of thyroid hormones on basal
metabolism, cell growth, and regulation of adrenergic receptor activity.
Compare and contrast the effects of dietary iodine/iodide deficiency,
normal dietary intake, and high-dose iodine supplementation on
thyroid hormone status and thyroid gland function.
Describe signs and symptoms typically associated with hypothyroidism
and hyperthyroidism.
Compare and contrast the biologic activities of thyroid hormone
replacement products; also, state which are generally preferred for
managing hypothyroidism and why.
Describe the imminent dangers of the two extremes of thyroid
hormone status – myxedema coma and thyrotoxicosis/thyroid storm –
and summarize a reasonable treatment plan for each.
Discuss drug treatments usually used in preparation for thyroidectomy
and the rationales for their use.
Describe the uses of and contraindications to radioactive iodine in
terms of diagnosing or treating thyroid disorders.
Discuss the general pathways and mechanisms by which the pituitary,
hypothalamus, and many endocrine glands in the periphery work in
concert to regulate blood hormone levels.
Summarize the main consequences of growth hormone (GH)
deficiency and excess, comparing and contrasting likely clinical
presentations depending on whether the dysfunction occurs before or
after puberty. Also, state the expected effects on protein and
carbohydrate metabolism.
State the main actions of prolactin and describe how its release is
regulated. Also, summarize the main clinical findings in
hyperprolactinemia and explain its management.
Explain the main systemic effects of antidiuretic hormone (ADH), the
expected effects of hypersecretion and hyposecretion, and their
management.
Demonstrate an understanding of the similarities and differences
between vasopressin, ADH, and oxytocin in terms of composition and
physiologic or pathophysiologic effects.
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TOPIC (S)
LEARNING
ACTIVITIES
State the three classes of steroid hormones produced by the adrenal
cortex and generally describe how their physiologic effects differ.
 Compare and contrast glucocorticoids and mineralocorticoids in terms
of which substance or substances and processes in the body they
mainly regulate. Also, explain why labeling a corticosteroid drug as
either a glucocorticoid or a mineralocorticoid is, to a degree, an
oversimplification.
 Describe the physiologic processes and pathways that regulate cortisol
production and release. Compare and contrast those with how
aldosterone production and release are regulated physiologically.
 State three basic ways hormones or drugs with glucocorticoid activity
promote carbohydrate availability to the brain and other essential
tissues or organs. In addition, state the expected effects of these agents
on protein and lipid metabolism.
 Describe the signs and symptoms of insufficiency and excess of
cortisol and of aldosterone. State the main laboratory test alterations,
applicable diagnostic tests, and reasonable treatment plans for these
conditions.
 Describe how glucocorticoid administration at pharmacologic doses
affects the hypothalamic-pituitary-adrenal (HPA) cortical axis; state
the signs and symptoms and relative duration of withdrawal; and give
some strategies for minimizing suppression of the HPA.
Unit 8: Drugs for Endocrine Disorders
 Drugs for Diabetes mellitus
 Drugs for Thyroid Disease
 Drugs Related to Hypothalamic and Pituitary Function
 Drugs for Disorders of the Adrenal Cortex
READING ASSIGNMENT
 Chapter 57: Drugs for Diabetes Mellitus – pp 667 – 702
 Chapter 58: Drugs for Thyroid Disease – pp 703 – 714
 Chapter 59: Drugs Related to Hypothalamic and Pituitary Function –
pp 715 – 724
 Chapter 60: Drugs for Disorders of the Adrenal Cortex – pp 725 – 732
DISCUSSION (Choose 1)
 Discuss the physiologic effects of insulin on carbohydrate, lipid, and
protein metabolism, and identify the body cells and tissues that most
depend on insulin to provide glucose as the main metabolic fuel.
 Describe appropriate interventions for managing acute or chronic
hypoglycemia.
 Describe the physiologic processes and pathways that regulate cortisol
production and release. Compare and contrast those with how
aldosterone production and release are regulated physiologically.
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NURSING DEPARTMENT
SUBMISSION
 Math Worksheet
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math worksheet & submit by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math worksheet
Case study
Quiz Chapter 8
Homework: Chapter readings: Chapters 61, 62, 63, 64, 65, & 66.
DATE
WEEK 10
At the end of this lesson, you will be able to:
SPECIFIC
OBJECTIVES
 Discuss the menstrual cycle, including phasic changes of hormone
levels and their effects on other body systems, and identify the major
regulatory stimuli for these changes.
 Summarize the main physiologic effects of estrogen and progestin.
 Compare and contrast the benefits and adverse effects of estrogen and
progesterone hormones as replacement therapy compared with the
risks and benefits of not replacing them. Consider such important
outcomes as breast cancer, ovarian or endometrial cancer, and
osteoporosis.
 Describe premenstrual syndrome (PMS) and summarize the effects and
actions of drugs that are effective for it.
 Give a succinct but accurate description of the aims of the Heart and
Estrogen/Progestin Replacement Study (HERS I and II), the Women’s
Health Initiative (WHI) study, and the major findings of each.
 Describe the different methods of birth control and their main known
benefits, adverse effects, and overall contraception rates.
 Describe the general meaning of the term minipill with regard to the
active ingredient or ingredients in one of these birth control drugs.
Also, explain what seems to be the main advantage of the minipill
compared to a combination OC.
 Summarize the main features that distinguish monophasic, biphasic,
and triphasic OCs, including each type’s ingredients, dosages, and
cycle-related changes in the dosages of the ingredients.
 Summarize the main interactions involving oral contraceptives,
including other drugs that may lower the contraceptive effects of OCs
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NURSING DEPARTMENT












and drugs that are targets of interactions caused by OCs. Summarize
the main pharmacokinetic mechanisms responsible for these
interactions. Specifically, focus on the following: (1) warfarin; (2)
anticonvulsants/antiepileptic drugs (for example, phenytoin); (3)
tetracycline antibiotics and ampicillin; and (4) theophylline.
Explain the Yuzpe regimen, including its purpose, the drugs used, the
main way to optimize the desired outcome, and the most common side
effects.
Describe the causes of and treatment strategies for male and female
infertility, including those for unfavorable cervical mucus,
hyperprolactinemia, endometriosis, polycystic ovary syndrome
(PCOS), erectile dysfunction, and idiopathic male infertility.
Describe the therapeutic uses and adverse effects of clomiphene,
menotropins, follitropins, human chorionic gonadotropin (hCG),
dopamine agonists for hyperprolactinemia, and gonadotropin-releasing
hormone (GnRH) agonists for endometriosis.
Describe three major clinical settings in which use of an oxytocic is
deemed acceptable.
Discuss the factors that should be considered in selecting a particular
oxytocic drug or drug class for use before versus after delivery.
State the major risks of magnesium sulfate, used as a tocolytic drug, in
terms of potential adverse effects on the mother, on the fetus, and on
the infant shortly after delivery.
Identify the three main groups of uterine stimulant drugs, compare and
contrast their effects on uterine muscle tone and rhythmicity, and state
why their different intensities of effects do (or do not) make them
suitable for use before or after labor and delivery.
Discuss the physiologic effects of androgens in males and females,
including likely effects in utero, during childhood growth and
development (e.g., through puberty), and in later life.
Summarize the expected beneficial actions of androgens when used to
manage hypogonadism in adult males. Also, discuss the key
physiologic and psychologic signs and symptoms that might lead to a
diagnosis of male hypogonadism and a decision to begin testosterone
therapy.
Summarize current knowledge about the use and abuse of androgens
(anabolic steroids) in athletes, including key points about the desired
(and sometimes clinically proven) physical, metabolic, and
psychologic effects of these drugs. Also, describe adverse responses
that pose risks with such use and explain basic legal or other regulatory
points concerning use of anabolic steroids.
Identify the main patient-related conditions and other applicable
factors that contraindicate safe use of phosphodiesterase type 5 (PDE5)
inhibitors. Also, in doing so, describe the main systemic hemodynamic
effects of the drug.
State the likely consequences of administering PDE5 inhibitors with
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NURSING DEPARTMENT


TOPIC (S)
drugs that inhibit the liver’s cytochrome P450 system (specifically the
enzyme CYP3A4). Also, identify the main groups of these drugs.
Discuss guidelines or recommendations for the use of PDE5 inhibitors
by a patient who is taking nitroglycerin or any other nitrate
vasodilator/antianginal drug; also, describe the likely outcome if these
recommendations are ignored.
Discuss the underlying pathophysiology of benign prostatic
hyperplasia (BPH) and relate it to the mechanism of action of 5-alphareductase inhibitors and alpha blockers.
Unit 9: Women’s Health
 Estrogens and Progestins: Basic Pharmacology and Noncontraceptive
Application
 Birth Control
 Drug Therapy of Infertility
 Drugs that Affect Uterine Function
Unit 10: Men's Health
 Androgens
 Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia
LEARNING
ACTIVITIES
READING ASSIGNMENT
 Chapter 61: Estrogens and Progestins: Basic Pharmacology and
Noncontraceptive Applications – pp 733 – 750
 Chapter 62: Birth Control – pp 751 – 768
 Chapter 63: Drug Therapy of Infertility – pp 769 – 776
 Chapter 64: Drugs that Affect Uterine Function – pp 777 – 787
 Chapter 65: Androgens – pp 788 – 795
 Chapter 66: Drugs for Erectile Dysfunction and Benign Prostatic
Hyperplasia – pp 796 – 805
DISCUSSION (Choose 1)
 Describe premenstrual syndrome (PMS) and summarize the effects and
actions of drugs that are effective for it.
 Describe the different methods of birth control and their main known
benefits, adverse effects, and overall contraception rates.
 Summarize current knowledge about the use and abuse of androgens
(anabolic steroids) in athletes, including key points about the desired
(and sometimes clinically proven) physical, metabolic, and
psychologic effects of these drugs. Also, describe adverse responses
that pose risks with such use and explain basic legal or other regulatory
points concerning use of anabolic steroids.
SUBMISSION
 Math Final
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NURSING DEPARTMENT
ASSIGNMENT
Review the syllabus
Read assignments
Post discussion topic by Wednesday at 11:55 pm EST
Respond to at least one classmate by Friday at 11:55 pm EST
Complete math final by Friday at 11:55 pm EST
Complete case study
ASSESSMENT
Discussion & response
Math final
Case study
Quiz Chapters 9 & 10
Homework: Chapter readings: Chapters 61, 62, 63, 64, 65, & 66.
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
WEEK 11
At the end of this lesson, you will be able to:
1.
WEEK 12
At the end of this lesson, you will be able to:
1.
WEEK 13
At the end of this lesson, you will be able to:
1.
WEEK 14
At the end of the week, the student will be able to:
1.
WEEK 15
At the end of this lesson, the student will be able to:
1.
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NURSING DEPARTMENT
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
DATE
SPECIFIC
OBJECTIVES
TOPIC (S)
LEARNING
ACTIVITIES
WEEK 16
At the end of this lesson, the student will be able to:
1.
WEEK 17
At the end of this lesson, the student will be able to:
1.
WEEK 18
At the end of this lesson, the student will be able to:
1.
WEEK 19
At the end of this lesson, the student will be able to:
1.
WEEK 20
At the end of this lesson, the student will be able to:
1.
The following strategies may be used in this class:
1. Threaded Discussions
2. Case studies
3. Quizzes
4. Readings
5. Exams
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Academic Honesty: When learners fail to complete their own work, they are cheating
themselves out of their education and are committing plagiarism. Plagiarism, or failing to meet
the academic honesty policy, will result in disciplinary actions by the institution.
Plagiarism is dishonest behavior that will not be tolerated. A student will not receive credit if
found to have plagiarized his/her work and may result in suspension or dismissal from the
school. Follow the link for examples of
plagiarism: http://examples.yourdictionary.com/examples/examples-of-plagiarism.html
APA Format: All of your writing must be done following APA format. For more information
regarding this format, go to Purdue Owl or follow this
link:https://owl.english.purdue.edu/owl/resource/560/01/
Late work & Educational Responsibility: All assignments must be completed by the last day
of the schedule unless an alternate due date has been previously approved by your instructor or
documentation has been provided regarding extreme circumstances. It is the learner's
responsibility to communicate with the instructor about extreme circumstances or ask questions
concerning the assignment and their due dates.
Threaded discussions: Students are to respond to the instructor’s weekly discussion post by
Wednesday at 1159 PM (EST). The responses must be substantial (at least 125 words in length
using correct grammar).
These are intended to stimulate discussion and re-enforce course content. The student must also
respond to two other student posts by Friday at 11:59 PM (EST). Please refer to the assignment
calendar for assignment due dates.
ASSESSMENT TESTING FOR NURSING PROGRAM REQUIREMENT:
As part of certain nursing courses, students are required to take third-party computerized
assessments, These assessments are intended to provide students with the tools they need to be
successful in the Nursing program and on the NCLEX; as well as. Increase confidence and
familiarity with computerized testing, The assessments typically include various types of
formats, including multiple choice items, multiple response items, fill-in-the-blank items, dragand drop items, hot spots items, chart/exhibit items, and other items,. The assessments help
identify deficit areas and provide students opportunities to practice and learn. Each assessment
can represent up to the percent (10%) of a student’s course grade. Failure to achieve the
minimum assessment score may result in a loss of points on an examination, or required
remediation or retesting (as outlined in the course syllabus). Students who do not successfully
complete the remediation or retest associated with an assessment examination (as outlined in the
course syllabus) may receive an incomplete in a course and may be required to repeat the course
in its entirety. An incomplete due to failure to successfully complete the assessment testing
remediation or successfully retest is considered a failure for the course.
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Additional Resources
Web sites
Assessment Criteria and Methods of Evaluating Students
90 – 100%
80 – 89%
75 – 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
Discussions
10%
Case Studies:
15%
Math worksheets:
15%
Math Final:
30%
HESI Final:
30%
Total:
100 %
Revised: June 9, 2015
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