NURS2500 Winter 2024

Week 3: Pharmacology

Week 3: Introduction to Pharmacology

Concept Extension: Clinical Judgment, Client Safety
Health Assessment: Assessment applied to safe medication administration
Pharmacotherapy: NSAIDs, Acetaminophen
Exemplars:
1. Pharmacokinetics
2. Pharmacodynamics

Student Learning Outcomes:

1. Explain how the following principles, practices and/or processes support safe
pharmacotherapy:
a. Drug classifications
b. Basics of prescriptions, medication orders and prescribers in Canada
c. Characteristics of a safe & effective drug
d. Nurse’s roles and responsibilities in pharmacotherapy including the 10 rights of
drug administration.
2. Describe the pharmacokinetic phases related to drug therapy (ADME)
3. Explain how the general principles of pharmacokinetics and pharmacodynamics support safe,
effective pharmacotherapy
4. Link specific nursing assessments related to the recognition of side effects and life-threatening
adverse effects from drug administration.
5. Differentiate between efficacy and potency related to drug therapy
6. Recognize the four primary receptor families that drugs act on in the body
7. Identify lab values that are linked to pharmacokinetics
8. Outline implications related to drug therapy in children, pregnancy, and older adults

Required Readings

*Bolded are most important to read*

1. Rosenjack Burchum, J., Rosenthal, L.D. (2021). Lehne’s Pharmacology for Nursing Care (11th
ed.). St. Louis: Elsevier
 Chapter 2: Application of Pharmacology in Nursing Practice:
o p. 6-12;
 Chapter 4: Pharmacokinetics
o p. 24-38

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 Absorption: p. 29- 32 (Electronic p. 28-32) (stop at Pharmaceutic

Preparations for Oral Administration);
 Distribution: p.33-34; (Electronic p. 32-34)
 Metabolism: p. 35 -37; (Electronic p. 34-37)
 Excretion: p. 38-39 (Electronic p. 37-38)
 Chapter 5: Pharmacodynamics
o Dose-Response Relationships, Drug-Receptor Interactions
 p. 44-48 (Electronic p. 44-47) (stop at Receptors and Selectivity of Drug
Action);
o Agonists, Antagonists, and Partial Agonists
 p. 49 – 50 (stop at Regulation of Receptor Sensitivity)
o Therapeutic Index
 p. 53 (Electronic p. 52-53)
 Chapter 6: Drug Interactions
o p. 55-62; Don’t memorize enzymes and drugs.
 Chapter 7: Adverse Drug Reactions and Medication Errors
o Adverse Drug Reactions
 p. 63 – 67 (Electronic p. 63-66) (stop at Medication Guides, Boxed Warnings
and REMS)
2. Astle, B.J. & Duggleby, W. (2023). Potter and Perry’s: Canadian fundamentals of nursing (7th
ed). St Louis: Elsevier
 10 Rights of Medication Administration
o p. 743-745 (Electronic p. 744-748) Start Critical Thinking and Stop at Risk
management.

Review the completed drug card for Acetaminophen & prepare a similar card for Ibuprofen:
Class: Non-Opioid Analgesic & Anti-Pyretic
Generic Name: acetaminophen Therapeutic Effects:
Prototypes/Brand Name: Tylenol Reduction in fever
Reduction in pain
Mechanism: Reduces fever by acting directly on
hypothalamic heat-regulating center. Analgesic mechanism
is through inhibition of prostaglandins in the CNS. Not an
anti-inflammatory agent
Administration Indications Contraindications Side Effects Nursing
Considerations
Can be given orally or Treatment of Allergy to Hypersensitivity: Rash, Assess history and
rectally mild-moderate acetaminophen. fever physical condition
pain related to liver and
Assess pain prior to and Use cautiously with Hepatotoxicity kidneys
after administration Reduction in impaired hepatic
fever function, chronic Renal damage Monitor LFTs if
Maximum dose over 24- alcoholism concerned

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hour period: SAFETY: Do not exceed

4000 mg adults, recommended dose. Avoid using
3000 mg geriatric Report nausea, multiple
vomiting, weakness, preparations with
diaphoresis. If acetaminophen
overdose, monitor (Scheduled & PRN)
serum levels. Antidote
is acetylcysteine

Terminology for Know (Testable Terms)

Enteral Parenteral Oral Sublingual
Bioavailability Potency OTC Adverse Drug Reactions

Generic name Trade name PRN

Chemical name
Prescription Paradoxical Effect Idiosyncratic Effect
Side Effect
Hepatotoxicity Nephrotoxicity Ionization
Toxicity
Contraindication Relative Contraindication Pharmacokinetics
Indication
Pharmacodynamics MAR Partial Agonist Polypharmacy
High Alert Drug Efficacy Antagonist
First Pass Effect

Distribution Metabolism Excretion

Absorption

Minimum Effective
Therapeutic Range Agonist
Toxic concentration Concentration

Therapeutic Index Allergic Reaction Rectal

Buccal
Intramuscular Intravenous Topical
Subcutaneous
Inhalation Serum Creatinine Liver Function Tests
Transdermal
Mechanism of Action
Loading Dose Maintenance Dose
Half-Life (MoA)

TID OD Ceiling Effect

BID
Duration of Action Sustained Release Enteric Coated
Onset of Action

Application of Pharmacology to Nursing Practice

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Nurses promote patient safety in drug administration by following rules for drug
administration.

Safety checks are included in the Ten Rights of Medication Administration which are:

1. Right drug
2. Right patient
3. Right dose
4. Right route (e.g. oral, rectal, inhaled, IV, etc)
5. Right time/schedule
6. Right education (patient education)
7. Right documentation (recording that drug was given, documenting effects)
8. Right to refuse (good education can prevent refusal)
9. Right assessment (before giving drug)
10. Right evaluation (after giving drug)

Pharmacokinetics Introduction

The four processes of pharmacokinetics are:

1) Absorption – movement of drug from site of administration (e.g. by mouth, nasal,

intravenous or intramuscular) to the blood.
2) Distribution - movement of the drug from the blood to interstitial space of tissues and
enter the cells. Drug distribution is determined by three major factors: blood flow to
tissues, the ability of a drug to exit the vascular system, and, to a lesser extent, the
ability of a drug to enter cells.
3) Metabolism – drugs need to be metabolized in the liver to be transformed and then
excreted by the kidneys.
a. Some drugs act on specific liver enzymes to increase rate of metabolism- these drugs
are called inducers. When metabolism of a drug is induced, the drug plasma levels fall
and its therapeutic effect is reduced.

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b. Other drugs can decrease rate of metabolism – these are called inhibitors. When
metabolism of a drug is inhibited, the drug plasma levels stay high, increasing the effect
of the drug, possibly to toxicity.
c. Drug interactions occur when the metabolism of one drug is induced or inhibited by
enzymes activated by another drug.
d. The First Pass Effect occurs when drugs are absorbed from the GI tract and immediately
pass through the liver. This results in significant inactivation of the drug and limiting its
therapeutic effect. To bypass this first pass effect, many drugs are given using other
routes (IV, sublingually, topically). Figure 4.6 (Lehne, p. 32).

4) Excretion – The kidneys excrete the majority of drugs.

Drugs can also be excreted through secretion in bile and then excreted in the feces,
through the lungs and in the sweat glands, saliva and breast milk.

Pharmacodynamics Introduction

How drugs produce their effect:

The body depends on different
receptors to regulate physiologic
processes.
(E.g. there are receptors for insulin,
acetylcholine, histamine and
progesterone)
Drugs are chemicals that produce their
effects by primarily binding with receptors
in the body. When a drug binds to its target
receptor, the physiologic activity controlled
by that receptor can either be increased or
decreased.

Drugs can affect receptors in 3 ways:

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1. By activating or mimicking the receptor’s activity. These are called agonists.

2. By preventing the receptor from being activated by an endogenous regulatory
molecules or drugs. These drugs are called antagonists. For an antagonist drug to have
any effect at the receptor site, there must be some agonist molecules present or
nothing will happen.
3. By partially activating the receptor for modest effect. These drugs called partial
agonists, are used to produce modest effects and to minimize adverse side effects that
can result from full activation of the receptor.

Drug Interactions

Focus of Interest to Nursing: Nurses administer drugs with knowledge of factors that can affect
therapeutic benefits and adverse effects of the drugs. Knowledge of the mechanisms and
consequences of drug interactions is fundamental to safe drug administration.

Drug-Drug Interactions – When two or more drugs interact, the result can be 1) intensified
effects, 2) diminished effects or 3) a new effect which could be detrimental or beneficial.

Drug-Food Interactions - Food may affect the rate or extent of absorption of drugs taken orally.
Some foods can inhibit the metabolism of certain drugs and others may increase the toxicity of
the drug.

The typical hospitalized patient is on 6 to 10 drugs. Patients

may take multiple drugs to treat one disorder, increasing their
risks for drug-drug and drug-food interactions.

Basic Mechanisms of Drug-Drug Interactions

1. Pharmacokinetic Interactions (When one drug causes alterations in absorption,

distribution, metabolism or renal excretion, it can impact the effect of other drugs)
a. Altered absorption: One drug can alter the gastric pH (antacids), increase or
decrease transit time through the intestines (laxatives or anti-diarrheals) or
reduce the regional blood flow (epinephrine causes vasoconstriction). These
effects will delay absorption of other drugs
b. Altered distribution: When two drugs compete for same binding site on the
plasma albumin, one will be knocked off, resulting in higher levels of unbound
(free) drug to be distributed. Distribution of a drug also can be altered if the pH
of the extracellular fluid is altered

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c. Altered metabolism is one of the most important mechanisms affecting drug

interactions. The CYP450 liver enzyme system is how most drugs get
metabolized. Certain drugs, foods and herbs can inhibit or induce these
enzymes, affecting how they breakdown or metabolize themselves and other
drugs.
d. Altered excretion: Drugs that reduce renal perfusion will also reduce renal
excretion of other drugs.
2. Pharmacodynamic Interactions
a. Interactions at the same receptor site: When two drugs compete for the same
receptor site, one drug is an agonist (produces the physiologic effect) and the
other the antagonist (blocks the agonist drug from attaching to receptor site).
a. Clinically, these types of interactions are used to manage toxic
(overdose) effects of drugs.
b. Interactions at separate receptor sites: Often two drugs working at two different
receptor sites to produce the same physiologic response can potentiate each
other.