1. B261 Pathophysiology and Pharmacology The study of common diseases and their medication treatments 1

2. Agenda for Week 1, Day 1 Introduction to the Course Review of Activities Lectures Case Studies Review of Assignments for Evaluation of Learning Open-book Quizzes in Canvas Proctored Examinations in ATI ATI Pharmacology Practice Examination Electronic Medication Notebook In-class Learning Activities and/or Homework 2

3. Introduction: Foundations for Drug Therapy 3

4. Core Drug Knowledge: DEFINITIONS Pharmacotherapeutics: The desired, therapeutic effect of the drug Pharmacokinetics: The changes that occur to the drug while it is inside the body Pharmacodynamics: The effects of the drug on the body 4

5. Definitions (cont’d) Contraindications and precautions The conditions under which the drug should not be used or must be used carefully with monitoring Side Effects The unintended and usually undesired effects that may occur with the use of the drug Serious Adverse effects: – Serious side effects that may be dangerous, cause permanent harm or be lethal Drug interactions The effects that may occur when the drug is given along with another drug, food, or substance 5

6. Core Patient Variables Health status: overall health of the patient Life span and gender: age and gender Lifestyle, diet, and habits: occupation, finances, substance use, exercise Environment: where will the drug be administered Culture and inherited traits: cultural beliefs & practices 6

7. Goals of Nursing Management of Drug Therapy Maximize the therapeutic effects of a drug Minimize the adverse effects of a drug Provide patient and family education 7

8. Medication Usage in the United States Approximately 45% of the population receives one drug in any given month. Prescription drug use increases with each age group. Approximately 85% of adults aged 65 and older are receiving one prescription per month. Almost 50% of adults aged 65 and older receive three or more prescriptions a month. 8

9. Prototype Drug Typical of a medication within a drug class Often the first drug of a class Drug has similar characteristics to all drugs in a class of drugs Provides a systematic way to increase knowledge of medications 9

10. Interventions to Maximize Therapeutic Effects of Medications Administer the drug in a manner that will promote its absorption Administer the drug at the appropriate time Monitor relevant laboratory values 10

11. Interventions to Minimize Adverse Effects Verify the patient’s allergies Assess for contraindication for the drug therapy Administer the drug in a manner consistent with standard safety protocols Monitor the patient and relevant laboratory findings Discontinue or withhold a drug based on assessment or laboratory findings Do Patient education 11

12. Minimizing Adverse Effects (cont.) Report evidence of adverse effects to the prescriber Modify administration techniques, when appropriate Assessment to detect the onset of adverse effects 12

13. Core Drug Knowledge Understand the drug’s behavior Basics of teaching patient and family about drug therapy –Name of the drug –Reason the drug was prescribed (pharmacotherapeutics) –Intended effect of the drug (pharmacodynamics) –Important adverse effects that may occur 13

14. Core Patient Variables Health status –Activities that must be performed while the patient receives the drug –Pre-existing health conditions Life span and gender –Adverse effects on a developing fetus –Effects on infants and children –Effects on the elderly 14

15. Core Patient Variables (cont.) Lifestyle, diet, and habits –Changes the patient may need to make during drug therapy Environment –To promote effective self-managed drug therapy Culture and inherited traits –Consider cultural issues and modify content or presentation accordingly 15

16. Evaluation of Medication Interventions To measure the patient’s progress Consider whether the drug achieved the desired effect Evaluate for side/adverse effects Reassess to identify barriers to success for outcomes that are not achieved Identify the reason behind any treatment failure 16

17. Sources of Drugs Plants Animals Synthetic chemicals Genetically engineered chemicals 17

18. Animal Sources for medications Includes agents such as insulin (from pork) or estrogen (from pregnant horses). Today, genetically engineered hormones are rapidly replacing animal-based drugs. The advantage of genetically engineered drugs is their purity More similar to the human animal. 18

19. Synthetic Chemicals Most drugs used today are either partially or wholly synthetic chemical compounds. A partially synthetic agent contains a derivative of a natural substance combined with a pure chemical. Wholly synthetic drugs are pure chemicals. 19

20. Genetically Engineered Drugs Genetically engineered drugs are drugs developed using DNA technologies. Genomics is the study and identification of genes and gene function. This new knowledge has enabled researchers to manipulate the chemical formulas of drugs to produce more specifically targeted drugs with fewer adverse effects. Especially useful in chemotherapy for cancer or HIV 20

21. Drug Nomenclature (Names) Chemical name –Precisely describes the drug’s atomic and molecular structure –e.g. acetyl-salicylic acid Generic name –Nonproprietary name; identifies the drug’s active ingredient –e.g. Aspirin Trade name –Brand or proprietary name –e.g. Bayer, Excedrin, Equate 21

22. Implications for Nursing A drug should be learned by the generic name. Trade names can vary by region Many trade names sound alike. The nurse should check the drug name at least three times. Pharmacy bar code systems help to reduce errors 22

23. Drug Classifications Drugs that share similar characteristics are classified as a pharmacologic group or family. Allows for increased understanding of medications Drugs that share similar characteristics can be classified by –Chemical classification –Physiologic classification –Therapeutic classification 23

24. New Drug Development and Approval The first step is in the discovery of a potential new drug molecule. Preclinical trials are designed to provide basic safety, bioavailability, pharmacokinetic, and initial efficacy data about the drug. Clinical trials are performed on humans in several phases. Only about 10% of new drugs that begin clinical trials are approved. 24

25. Controlled Substances (I, II, III, IV, V) The prescribing, dispensing, and storing of controlled substances is subject to governmental control. Procedures are defined by law for every step, from manufacture to administration to wasting or discarding. Many hospitals use an automated system to electronically track the use of stock drugs. Indiana has an online controlled substance prescription monitoring system called “INSPECT” 25

26. Effect of Legal and Institutional Controls on Nursing Management of Drug Therapy Drug laws and nurse practice acts vary from state to state. Nurses must be familiar with the current regulations in their states and in their practice settings. Nurses must adhere to established drug control laws and protocols. Nurses cannot provide drug therapy without proper authorization. Nurses are responsible for drug security and safe administration. 26

27. Importance of Nursing Management of Drug Therapy  Nurses are legally responsible for the drugs they administer.  Don’t administer a drug that you don’t know!  Safe drug administration requires a thorough understanding of therapeutic drug actions and adverse drug reactions. 27

28. CHALLENGE QUESTIONS 28

29. Question ______________ are the changes that occur to the drug while it is inside the body. –A. Pharmacotherapeutics –B. Pharmacokinetics –C. Pharmacodynamics 29

30. Question Pharmacokinetics are the changes that occur to the drug while it is inside the body. –A. Pharmacotherapeutics –B. Pharmacokinetics –C. Pharmacodynamics 30

31. Question What percentage of the population in the United States takes at least one medication in a month? –A. 10% –B. 25% –C. 33% –D. 45% 31

32. Question What percentage of the population in the United States takes at least one medication in a month? –A. 10% –B. 25% –C. 33% –D. 45% 32

33. Question Objective data are the data collected from the patient’s story. –A. True –B. False 33

34. Question Objective data are the data collected from the patient’s story. –A. True –B. False Objective data are the data the nurse collects by completing a physical examination of the patient. Subjective data are what the patient tells the nurse 34

35. Question The advantage of genetically engineered drugs over those made from animals is less drug reactions. –A. True –B. False 35

36. Question The advantage of genetically engineered drugs over those made from animals is less drug reactions. –A. True –B. False Genetically engineered drugs are considered to be purer, thereby causing fewer negative drug reactions. 36

37. Question For the drug furosemide (Lasix), furosemide is the _____ name of the drug. –A. Chemical –B. Trade –C. Generic –D. Therapeutic class 37

38. Question For the drug furosemide (Lasix), furosemide is the generic name of the drug. –A. Chemical –B. Trade –C. Generic –D. Therapeutic class 38

39. Question As a new nurse, what would be the most appropriate action to take when you administer a medication you are unfamiliar with? –A. Go ahead and give the drug in an emergency situation and look the drug up later –B. Ask a co-worker to give the medication –C. Ask the patient why he or she is taking the medication –D. Look up the drug prior to administration 39

40. Question As a new nurse, what would be the most appropriate action to take when you administer a medication you are unfamiliar with? –A. Go ahead and give the drug in an emergency situation and look the drug up later –B. Ask a co-worker to give the medication –C. Ask the patient why he or she is taking the medication –D. Look up the drug prior to administration 40

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