Module 1B Introductory Topics for Pharmacology (1) PDF

Cathy Magowan, PhD, MSN, Module 1B RN Introductor D’Youville University y topics for NUR 320 Pharmacolo Pathophysiology/Pharmacolo gy for Nurses gy Spring 2025 Learning Objectives Describe the concepts and principles of drug action Identify developm...

Cathy Magowan, PhD, MSN, Module 1B RN Introductor D’Youville University y topics for NUR 320 Pharmacolo Pathophysiology/Pharmacolo gy for Nurses gy Spring 2025 Learning Objectives Describe the concepts and principles of drug action Identify developmental and cultural considerations of pharmacology Identify developmental and cultural considerations of drug administration Understand terminology and guidelines related to pharmacology  Chapter 1 Introduction to Drugs Some terms to know Adverse effect-also called side effects; not the desired therapeutic effect of a medicine; may be unpleasant, could be dangerous Brand name-name given to a drug by the pharmaceutical company that produces it. Also known as a trade name or proprietary name Generic name-the original name for a drug given when it is developed Off-label use-use of a drug that is not part of the stated therapeutic indication Over-the-counter (OTC) drugs-drugs that can be purchased without a prescription Pharmacology-the study of the biological effects of chemicals Pharmacotherapeutics-the branch of pharmacology that deals with drugs (chemicals used in medicine for the treatment, prevention, and diagnosis of disease in humans Teratogenic-medications that have adverse effects on a developing fetus in the womb  Some terms to know Phase Description Sample size I (one) Pilot study of a potential drug Small number of selected, usually healthy human volunteers II (two) Clinical study of a proposed drug by selected Actual patients who have the physicians disorder the drug is designed to treat III (three) Use of a proposed drug Larger sample of patients who have the disease the drug is thought to treat IV (four) Continuous evaluation of a drug after it has been released for marketing Preclinical Initial trials of a chemical thought to have Either in vitro or in vivo trial therapeutic potential techniques; not human subjects Sources of medications Plant Medication Ricinus communis Seed, oil, castor oil Digitalis purpurea Leaves, dried leaves, digitalis leaf (foxglove) Papaver somniferum Unripe capsule, juice, opium (paragoric), morphine (MS (poppy) Contin), codeine, papaverine Element Therapeutic Use Aluminum Antacid, management of hyperphosphatemia, prevention of phosphate urinary stones Fluorine (as fluoride) Prevention of dental cavities, prevention of osteoporosis Gold Treatment of rheumatoid arthritis Iron Treatment of iron deficiency anemia Legal regulation of drugs In 1938 the Federal Food, Drug, and Cosmetic Act was Started in 1906 with the passed that mandated tests The development and sale Pure Food and Drug Act, for drug toxicity, provided of drugs is regulated by the which requires labeling as a means for recall of drugs, Food and Drug way to eliminate false or established the procedure Administration (FDA). misleading claims for introducing new drugs, and gave the FDA the power of enforcement In 1970 the Comprehensive Drug Abuse Prevention and Control Act was passed that defined drug abuse, There are also local and The most restrictive one is classified drugs by potential state regulations. the one that prevails for abuse, provided strict controls over the distribution, storage, and use of those drugs Safety during pregnancy Controlled substance s  Category What it is Generic Drugs Produced by companies involved solely in the manufacturing of drugs. Must have the same strength of active ingredient as brand name. Usually as effective as Other brand name, but less expensive drug Orphan drugs Are not financially viable to categories produce, so they have not been “adopted” by any drug company. Over-the-counter Available without a drugs prescription; used for self treatment of many complaints.  The care provider has prescribed intravenous hydromorphone, an opioid, for a client using a client-controlled analgesia (PCA) pump. The nurse is aware that this drug has a high abuse potential. Under what category would hydromorphone be classified? A) schedule I Question 1 B) schedule II C) schedule III D) schedule IV Question 2 A nurse is unfamiliar with a drug that a client in the community has recently been prescribed. What information source should the nurse consult? A) Drug Facts and Comparisons B) a nurse’s drug guide C) the website www.drugs.com D) the Physicians’ Drug Reference (PDR)  The nurse receives an order to administer an unfamiliar medication and obtains a nurse’s drug guide published 4 years earlier. What is the nurse’s most prudent action? A) Find a more recent reference source. B) Use the guide if the drug is listed. Question 3 C) Use the guide because it is less than 6 years old. D) Verify the information in the guide with the pharmacist. The client tells the nurse about a new drug being tested to treat the disease they are diagnosed with, and asks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurse’s best response? A) “The doctor would have to complete a great deal of paperwork to get approval to prescribe that drug.” B) “Sometimes pharmaceutical companies are looking for volunteers to test a new drug and the doctor could give them your name.” C) “Drugs in the preclinical phase of testing are only tested on animals and so would not be available to you.” D) “Drugs in the preclinical phase of testing are given only to healthy young men and so would not be available to you.” Question 4 Question 5 A client asks the nurse, “What is a Drug Enforcement Agency (DEA) number?” What is the nurse’s best response? A) “DEA numbers are given to primary care providers (PCPs) and pharmacists when they register with the DEA to prescribe and dispense controlled substances.” B) “Providers must have a DEA number in order to prescribe any type of medication for clients.” C) “DEA numbers are case numbers given when someone breaks the law involving a controlled substance.” D) “DEA numbers the standardized codes for each drug that is on the market in the United States.” Chapter 2 Drugs and the Body  Describe Describe how body cells respond to the presence of drugs Outline the process of dynamic equilibrium Outline that determines the actual concentration of a drug in the body Learning objectives List at least six factors that can influence the List actual effectiveness of drugs in the body Define drug-to-drug, drug-to-alternative Define therapy, drug-to-food, and drug-to-laboratory test interactions  Pharmacodynamics – the study of the interactions between the chemical components of living systems and the foreign chemicals that enter liver organisms; the way a drug affects a body Terms to Pharmacogenomics – the study of genetically determined variations in the know response to drugs Pharmacokinetics – the way a medication travels through the body including absorption, distribution, biotransformation, and excretion; how the body acts on a drug  Absorption – what happens to a drug from the time it enters the body until it enters the circulating fluid Distribution – movement of a drug to body tissues. Depends on the drug’s solubility, perfusion of the area, cardiac output, and binding of the drug to plasma proteins Terms to Excretion – removal of a drug from the body know Passive diffusion – movement of substances across a semipermeable membrane with the concentration gradient. Does not require energy Active transport – movement of substances across a cell membrane against the concentration gradient. Requires energy  Critical concentration – the concentration a drug must reach in the tissues to cause the desired therapeutic effect Terms to know First-pass effect – drugs given orally are carried directly to the liver after absorption where they could be inactivated before they enter the general circulation so it’s action could be decreased Half-life – the time it takes for the amount of drug in the body to decrease to one half of the peak level Loading dose – a higher dose given before the normal doses to allow the drug to reach critical concentration sooner Placebo effect – documented effect of the mind on drug therapy Pharmacodynamics To replace or act as substitutes for missing chemicals (agonists i.e insulin) To increase or stimulate certain Selective cellular activities (agonists i.e toxicity: a drug MAO ) attacks only To depress or slow cellular activities (antagonists i.e systems found antiinflammatories) in foreign cells To interfere with the functioning of (antibiotics foreign cells (antagonists i.e are an antibiotics) example Pharmacokinetics Loading dose Therapeutic Index Critical concentration Giving a higher The ratio of the initial dose of a toxic concentration The level a drug medication to to effective needs to reach in allow it to reach concentration level. the body in order to therapeutic levels be therapeutic sooner.  Absorption Route Factors affecting absorption Time to have an effect Intravenous (IV) None; goes directly into the bloodstream 1-2 minutes Intramuscular Perfusion to muscle 15 – 20 minutes (IM) Solubility of medication in water Temperature of the muscle Subutaneous Perfusion to the tissue 20-30 minutes Fat content of the tissue Temperature of the tissue Oral (PO) Acidity of the stomach 1-2 hours Length of time in stomach Health of GI tract Blood flow to GI tract Presence of interacting food/drugs Absorption Route Factors affecting absorption Time to have an effect Rectal (PR) or Perfusion to the area Varies depending on the vaginal Lesions in tissue or stool in rectum med; about 80% is actually Length of time retained for absorption absorbed can take up to 3 hours Mucous Perfusion to the area 5-10 minutes membranes (SL, Integrity of the mucous membranes buccal) Presence of food or smoking Length of time retained Correct placement of medication Topical or Perfusion to the area Can be 12-24 hours intradermal Integrity of skin (skin) Ability for the medication to adhere to the skin Adequacy of subcutaneous tissue Inhalation Perfusion to the area Most start to work in a few Integrity of lung lining minutes Ability to administer drug properly Inspiratory effort  Absorption processes Process What it means Passive the major process that distributes drugs through the diffusion body. Happens across a concentration gradient. Does not require the use of energy. Quicker with small drug molecules, if it is soluble in water and in lipids, and has no electrical charge Active uses energy to actively move a molecule across a transport cell membrane Filtration Movement through pores in the cell membrane. Either down a concentration gradient, or result of the pull of plasma proteins. Most common with drug  Distribution Tissue perfusion There needs to be blood flow to the area for the medication to get there and have an effect Protein binding How the drug is bound to protein affects how quickly they are released into the tissue Blood-brain barrier System of cellular activity that keeps drugs away from the central nervous system. Highly lipid soluble drugs are able to pass through the BBB Placenta and human Many drugs pass through the placenta and can affect the developing milk fetus. Others are secreted in human milk and can affect the infant Biotransformation Enzymes in the liver, lining of GI tract, and circulating in the body (metabolism) work to detoxify foreign chemicals to maintain homeostasis First pass effect Drugs taken orally go from the small intestine directly to the liver. Enzymes work on the drugs to break them down. There is potential for a large percentage to be destroyed. Hepatic enzyme Cytochrome P450 system of enzymes are abundant in the liver. system There are some drugs that can work to either increase or decrease the action of this system Half-life The time it takes for the amount of a drug to decrease to half of it’s peak level Excretion  Factors influencing drug effects Physiological Pathological factors-sleep/w Weight-heavier Age- Sex- females factors-GI ake cycle, people require metabolism typically have disorder can endocrine larger doses varies with age more fat cells affect system absorption function Psychological Environmental Immunological Tolerance, factors-attitude factors-heat, Genetic factors factors- accumulation, can affect how cold, noise allergies interactions a drug works level Interactions: drug-drug or drug-alternative therapy Site of absorption One drug prevents/accelerates absorption of the other drug During distribution One drug competes for the protein-binding site of another drug. The second drug then cannot be transported to the site During biotransformation One drug stimulates/blocks the metabolism of the other drug During excretion One drug competes for excretion with the other drug. Leads to accumulation and toxic effects of one of the drugs At the site of action One drug is an antagonist of the other drug. Leads to no therapeutic effect Question 1 The nurse is caring for a diverse group of clients. In which client should the nurse assess for an alteration in drug metabolism? A) a 35-year-old woman with cervical cancer B) a 41-year-old man with kidney stones C) a 50-year-old man with cirrhosis of the liver D) a 32-year-old woman with urosepsis Question 2 The serum lithium levels of a client diagnosed with bipolar disorder have risen to the minimum level required to have a therapeutic effect. What term is used to describe this situation? A) critical concentration B) dynamic equilibrium C) a stable half-life D) benefits of active transport Question 3 A nurse is caring for a client who is scheduled to receive three medications at the same time. What action should the nurse perform first? A) Perform hand hygiene before handling the medications. B) Consult a drug guide to check for interactions. C) Assess the client’s knowledge of the medications. D) Identify the client by checking the armband and asking the client’s name. Question 4 What physiologic processes contribute to the achievement of dynamic equilibrium when a nurse administers a drug? Select all that apply. A) distribution to the site where the drug is active B) biotransformation C) absorption from site where the drug enters the body D) excretion from the body E) interaction with other drugs  The nurse is caring for a client diagnosed with a brain infection of bacterial etiology. When administering medications to this client, the nurse should prioritize what variable related to the client’s diagnosis? A) The client will require lipid-soluble antibiotics. B) The client’s blood–brain barrier will not allow medications to affect brain tissue. Question 5 C) Antibiotics will have to be injected directly into brain tissue. D) Active infection may destroy the integrity of the blood–brain barrier. Chapter 3 Adverse reactions and side effects  Define adverse drug reaction and explain the clinical significance of this Learning reaction Objectives List four types of allergic responses to drug therapy  Drug allergy or hypersensitivity: usually involves formation of antibodies to a drug; causes an Some immune response the next time a person is exposed Poisoning: overdose of a drug that terms causes damage to multiple body systems. Has potential to be fatal to Stomatitis: inflammation of the mucous membranes related to drug effects Superinfections: infections caused by know the destruction of normal flora by certain drugs. Allows other bacteria to grow out of control and cause infection  The drug may have other effects on the body besides the therapeutic Adver effect The patient may be sensitive to the se drug being given The drug’s action on the body may cause other undesirable or Effects unpleasant responses The patient may be taking the wrong amount of the drug which can lead to adverse effects. Types of adverse drug effects Type of adverse effect What it is Example Primary action Most common; develops Anticoagulant – excessive, from simple overdose. Most spontaneous bleeding patients suffer from effects BP med – weakness, that are merely an extension dizziness when standing of the desired effect Secondary Actions Effects that occur in addition Antihistamines work to dry to the desired effect secretions and help breathing but also cause drowsiness Antibiotics – treat infection but can cause n/v/d Hypersensitivity The body forms antibodies AKA allergic reactions. to a drug which causes an immune response the next time the drug is taken  Drug induced tissue and organ damage Body system What the reaction could be Nursing considerations Integumentary Rashes, hives (minor) to severe, potentially Watch for development of skin system (skin) fatal exfoliative dermatitis irritation, hives (raised red patches with itching) Mucus Inflammation of the mucus membranes. Monitor for s/s of stomatitis; membranes Symptoms include swollen or inflamed frequent mouth care, nutrition (stomatitis) gums, swollen and red tongue, trouble evaluation, dental consultation. swallowing, bad breath, pain in mouth and Sometimes antifungal agents throat and/or local anesthetics are used GI system Nausea/vomiting/diarrhea, stomach pain, May be able to decrease s/s if constipation, heartburn med is taken with food. Superinfection Infection occurs when normal flora are Supportive measures like decreased by medications. s/s include fever, mouth care, skin care diarrhea, inflamed tongue, mucus membrane lesions, vaginal discharge Blood dyscrasia Bone marrow suppression. s/s include fever, Supportive measures, reduce chills, sore throat, weakness, back pain, dark exposure to potential urine, decreases in blood cells infections, monitor blood Toxicity Hepatotoxicity Nephrotoxicity Drugs go through the liver first (first- Medications are excreted from pass effect) which exposes the liver the kidney, some unchanged to the full impact of the drug. from their original form which can cause damage to the kidneys. Most drugs are metabolized by the liver S/S include elevated BUN and creatinine, decreased urine S/S include fever, malaise, n/v/d, output, fatigue jaundice, change in urine color or change in feces color, altered liver function tests  The caregiver of an older adult client diagnosed with ischemic heart disease tells the nurse that the client is only taking around half of the prescribed dosage of several medications. What possible effect should the nurse explain when providing health education? Question 1 A) increased risk of primary actions B) antibiotic resistance C) superinfection D) adverse effects  The nurse should consider teratogenic effects when caring for what clients? Select all that apply. A) an 81-year-old male with chronic heart failure and peripheral edema B) a 41-year-old male who is immunocompromised following bone marrow transplant C) a 44-year-old female being treated in the intensive Question 2 care unit for multiorgan dysfunction syndrome D) a 29-year-old client receiving prenatal care in her first trimester of pregnancy E) a 37-year-old female client who is taking fertility drugs Question 3 The nurse is caring for a client receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. The nurse should recognize the possibility of what adverse effect? A) dermatologic reaction B) blood dyscrasia C) electrolyte imbalance D) superinfection  The nurse is caring for a client who experienced a severe headache. When the prescribed dose of analgesics did not cause relief, the client took Questio double the dosage 1 hour later. The nurse should assess the client for what adverse effect? n4 A) an allergic reaction B) anaphylactic reaction C) poisoning D) sedative effects Question 5 The nurse administers doxycycline, a drug known to cause gastritis. When the client reports abdominal discomfort after taking the medication, the nurse should classify this discomfort as what type of adverse effect? A) primary action B) secondary action C) hypersensitivity reaction D) allergic reaction  Chapter 4 Nursing Process in Drug Therapy and Patient Safety Learning objectives List the responsibilities of the nurse in drug therapy Outline the important points to assess and consider before administering a drug Describe the role of thenurse and the patient in preventing medication errors Nursing Process/Caputi Method Assess (Gather data) Determine the problem (Make meaning of the data) Plan your interventions Intervene Evaluate results Medication Error  The nurse is gathering assessment data from a client who is the sole caregiver for four children. What assessment information should the nurse prioritize when providing care for this client? Questio A) the children’s history of recreational drug use B) the name and location of the client’s n1 preferred pharmacy C) the client’s level of social and financial support D) the last time the client was hospitalized  Before administering a new medication, the nurse has consulted a drug guide to confirm the recommended dosage range. When interpreting this information, the nurse should consider what principle? A) Recommendations are based on clients of Caucasian ethnicity. B) Recommendations are made by the Question 2 manufacturer based on the most likely recipient population. C) Recommendations are based on 150-pound (68-kg) adult male. D) Recommendations are based on a young adult male with good health. Question 3 The nurse is evaluating the discharge teaching provided to a client concerning drug therapy. What statement from the client would indicate that teaching had been effective? A) “I have to take three pills each day and I can take them at the time that fits my schedule.” B) “I should take the white pill because the doctor wants me to take it.” C) “I’ll add the names and dosages of these new drugs to my medication list in my wallet.” D) “I have prescriptions at different pharmacies. I shop around for the best price for each drug.”  Question 4 The nurse is reviewing the client’s medication orders and finds an order stating “amoxicillin 250 mg every 8 hours.” What is the nurse’s best action? A) Confirm the client’s allergy status. B) Ask the prescriber to confirm the route. C) Assess the client for signs of infection. D) Confirm with the prescriber whether a generic version is mandatory. Question 5 The nurse is preparing to administer a medication to an older adult. The nurse should consider what factor that could affect therapeutic dosing in an older adult? A) Changes in the gastrointestinal (GI) system can reduce drug absorption. B) In older adults, drugs enter into circulation more quickly. C) In older adults, drugs are distributed to a smaller portion of the tissues. D) Drugs are likely to have decreased therapeutic effect