Nova Southeastern University

Assaf College of Nursing

NUR 3193: Pharmacologic Basis for
Nursing Interventions

INTRODUCTION TO
PHARMACOLOGY:
BASIC CONCEPTS
 • Derived from Greek
words: pharmakon which
means “medicine” and
logos which means
“study” or simply defined
as the study of medicine

WHAT IS PHARMACOLOGY? • Broad term for the study

or science of “drugs”

• Includes the study of how

drugs are administered
and how the body
responds
(Lilley et al., 2020)
 Prevent
Cure
DRUGS ARE
USED TO: Diagnose
Alleviate
Relieve
(Lilley et al., 2020)
 Plants Animals Minerals Synthetic Semi-synthetic
Morphine Iron (Fe)
Insulin (older forms) Sodium Bicarbonate Most antibiotics
Aspirin (ASA) (NaHCO3)
Heparin (older forms)
Premarin

PHARMACOGNOSY: STUDY OF
NATURAL SOURCES OF DRUGS

(Lilley et al., 2020)

 DRUG
CLASSIFICATIONS
THERAPEUTIC PHARMACOLOGIC
CLASSIFICATION CLASSIFICATION

• Usefulness in treating specific • Refers to the way the drug works at

diseases or disorders the molecular, tissue, or body system
• Examples: Anticoagulant, • Examples: Diuretic, calcium channel
antihypertensive, antianginal blocker (CCB), vasodilator

Prototype: Well-understood model drug with which other drugs in a pharmacologic class may be compared

(Lilley et al., 2020)

 Chemical
• Relates to the chemical
structure
• Describes the drug’s
chemical composition
NAMING OF • Example: N-acetyl-para-
aminophenol
Generic
• Non-proprietary
• Like the chemical name
• Assigned by the United
States Adopted Name
Council (USANC)

DRUGS – MOST
• Example: acetaminophen
(not capitalized)

DRUGS HAVE Trade Combination

THREE NAMES • Proprietary - assigned by
manufacturer
• Drug product with more
than one active generic
• Registered trademark; use ingredient
of the name restricted by
the drug’s patent owner
• Example: Tylenol
(capitalized)

(Lilley et al., 2020)

 1820 • U.S. Pharmacopoeia (USP)

1852 • National Formulary (NF)

• Federal Bureau of Chemistry  Food
1862 and Drug Administration (FDA)
1902 • Biologics Control Act

1906 • Federal Food and Drug Act (FFDA)

REGULATORY
1912 • Sherley Amendment
ACTS, STANDARDS,
1914 • Harrison Narcotic Act
AND
ORGANIZATIONS 1938 • Federal Food, Drug & Cosmetic Act

1944 • Public Health Service Act

1951 • Durham-Humphrey Amendment

1962 • Kefauver-Harris Amendment

1970 • Controlled Substances Act

(Lilley et al., 2020)

 1975 • USP-NF Merged

1978 • Drug Regulation & Reform Act

1983 • Orphan Drug Act

1986 • Childhood Vaccine Act

REGULATORY 1991 • Accelerated Drug Approval
ACTS, STANDARDS, 1992 • Prescription Drug User Fee Act
AND 1996
• Health Insurance Portability and
ORGANIZATIONS Accountability Act (HIPAA)
1997 • FDA Drug Modernization Act
CONTINUED
2002 • Bioterrorism Act
• Medicare Prescription Drug
2003 Improvement and Modernization Act
• FDA Amendments Act  Critical Path
2007 Initiative
2011 • Health Care Reform

(Lilley et al., 2020)

 FDA DRUG
APPROVAL PROCESS

Phase I Phase II
• Preclinical Investigation • Clinical Investigation

Approval
Process
Phase III Phase IV
• Review of New Drug • Post-Marketing
Application (NDA) Surveillance

(Lilley et al., 2020)

 Drug Abuse Physical Psychological Example Dispensing Restrictions
Schedule Potential Dependency Dependency
Potential Potential
I Highest High High Heroin Only with approved
protocol
II High High High Oxycodone Written prescription
only; no refills;
container must have
warning label
III Moderate Moderate to High Codeine Written or oral
Low combination with prescriptions that
SCHEDULE FOR acetaminophen expires in 6 months;
no more than 5 refills
CONTROLLED in a 6-month period;
SUBSTANCES container must have
warning label
IV Lower Lower Lower Benzodiazepines Written or oral
prescriptions that
expires in 6 months;
no more than 5 refills
in a 6-month period;
container must have
warning label
V Lowest Lowest Lowest Limited Written prescription
quantities of or over-the-counter
opioid

(Lilley et al., 2020)

 OVER-THE-COUNTER (OTC) DRUGS

• Nonprescription drugs
• Use for short-term treatment of common minor EXAMPLES:
illnesses ibuprofen (Advil)
naproxen (Aleve)
• Regulated in 1972 by FDA diphenhydramine
(Benadryl
• Safety and efficacy
loratadine (Claritin)
• Appropriate labeling standards famotidine (Pepcid AC)
• Reclassification omeprazole (Prilosec
OTC)

(Lilley et al., 2020)

 May postpone May delay
effective treatment treatment of serious
of more chronic or life-threatening
disease states disorders

OTC DRUGS: May relieve Interactions with

symptoms of a current
POTENTIAL disorder but NOT prescription drugs
HAZARDS the cause may occur

Toxicity Abuse

(Lilley et al., 2020)

 Dietary supplement – orally administered
alternative medicines, including herbal
supplements

Herbs – plant components, including bark,

HERBAL AND berries, roots, leaves, gums, seeds, stems,

and flowers, used for medicinal qualities
DIETARY
SUPPLEMENTS Herbal medicine – using herbs to heal

Vitamins – Supplements

(Lilley et al., 2020)

 CONSUMER USE OF HERBS

Proactive agents to
Prophylactic agents
Therapeutic agents maintain health and
for long-term
for treatment and wellness and
prevention of
cure of diseases “boost” immune
disease
system

(Lilley et al., 2020)

 • Anxiety
• Colds and cough
• Depression
• Headache (HA)
• Insomnia
• Ulcers
CONDITIONS TREATED • Premenstrual syndrome
WITH HERBAL PRODUCTS • Arthritis
• Constipation
• Fever
• Infection
• Stress
• Weakness
(Lilley et al., 2020)
 COMMONLY USED
HERBAL PRODUCTS

• Aloe Echinacea
• Feverfew Garlic
• Gingko Ginseng
• Goldenseal Hawthorn
• St. John’s Wort Saw Palmetto
• Valerian

(Lilley et al., 2020)

PHARMACOLOGIC
PRINCIPLES
 Pharmaceutics *

Pharmacokinetics *

Pharmacodynamics *

PHARMACOLOGI Pharmacogenomics
C PRINCIPLES Pharmacotherapeutics *

Pharmacognosy

Pharmacoeconomics

Toxicology

(Lilley et al., 2020)

 Different drug dosage forms have
different pharmaceutical properties

Dosage form determines drug

dissolution rate
• Enteral Route
• Drug is absorbed into the systemic circulation
through oral or gastric mucosa or small intestine
PHARMACEUTIC • Oral (PO), sublingual (SL), buccal, rectal
• Parenteral Route
S • Dosage form administered via injection
• Intravenous (IV), intramuscular (IM),
subcutaneous (SC), intradermal, intraarterial,
intrathecal, intraarticular
• Topical Route
• Skin (including transdermal patches), eyes, ears,
nose, lungs (inhalation), rectum, vagina

(Lilley et al., 2020)

PHARMACOKINETICS:
HOW DOES THE DRUG
MOVE THROUGHOUT
THE BODY?

Absorption
Distribution
Metabolism
Excretion

(Lilley et al., 2020)

 ABSORPTION: THE
PROCESS OF MOVING A
DRUG ACROSS BODY
MEMBRANES TO THE
BLOODSTREAM

• Bioavailability
• Extent of drug absorption
• First pass effect
• Large proportion of a drug is
chemically changed into inactive
metabolites by the liver
• Much smaller amount will be
bioavailable

(Lilley et al., 2020)

 FACTORS INFLUENCING
THE ABSORPTION OF
DRUGS

1. Rate of dissolution
• Drug formulation
• Route of administration
2. Size of the drug molecule
3. Surface area of absorptive site
4. Digestive motility
5. Blood flow
6. Lipid solubility of the drug
7. Drug-drug or food-drug interactions

(Lilley et al., 2020)

 DISTRIBUTION:
TRANSPORT OF A DRUG
BY THE BLOODSTREAM
TO ITS SITE OF ACTION

• Areas of rapid distribution are highly vascular

(heart, liver, kidneys, brain)
• Areas of slower distribution (muscle, skin, fat)
• Albumin is the most common blood protein and
carries the majority of protein-bound drug
molecules
• Drug-Drug Interactions
• Blood-Brain Barrier
• Fetal-Placenta Barrier

(Lilley et al., 2020)

 • Process of chemically
converting a drug to a
form that is more easily
removed from the body
(converts an inactive
METABOLISM A.K.A. prodrug to its active form)
BIOTRANSFORMATION • Liver is primary site of drug
metabolism
• Fast and slow acetylators
• Kidneys and intestinal
mucosa also metabolize
drug

(Lilley et al., 2020)

 Process of removing drugs from
the body

EXCRETIO Concentration of drugs in the

bloodstream determines their
N duration of action

Kidney
Organs of Liver
excretion Bowel

(Lilley et al., 2020)

 Onset of Action: Time it
takes for a therapeutic Peak Level: Highest
effect of a medication blood level of a drug
to appear

THERAPEUTIC Half-Life: Time

RESPONSE AND required for half (50%)
of a given drug to
Trough Level: Lowest
DRUG PLASMA removed from the body
blood level of a drug
after administration
CONCENTRATIONS

Toxicity: Occurs if the

Therapeutic drug
peak blood level of the
monitoring
drugs is too high

(Lilley et al., 2020)

PHARMACODYNAMIC
S WHAT DOES THE
DRUG DO TO THE
BODY?

• Mechanism of Action
• Receptor Interactions
• Agonist
• Antagonist
• Enzyme Interactions
• Nonselective Interactions
• Unknown Actions

(Lilley et al., 2020)

 PHARMACOTHERAPEUTICS

Defines principles of
Clinical use of drugs to drug actions – cellular
Drugs are organized in
prevent and treat processes that change in
pharmacologic classes
diseases response to the presence
of drug molecules

(Lilley et al., 2020)

 Type of Therapy

Contraindications

P H A R MA CO T H E RA P EU TI CS
Monitoring
• Therapeutic Effects
• Adverse/Side Effects
• Toxic Effects
• Therapeutic Index
• Drug Concentration
• Patient Condition

(Lilley et al., 2020)

 Dependence:
Tolerance: Decreasing
Physiologic or
response to repeated
psychological need for
drug doses
a drug
P H A RM A CO T H E RA P EU TI C
S : C LI EN T CO N D I TI O N
Physical Dependence: Psychological
Physiological need for Dependence
a drug to avoid (Addiction): Obsessive
physical withdrawal desire for the euphoric
symptoms effects of a drug

(Lilley et al., 2020)

 Hypersensitivit
Pharmacologic
y
ADVERSE
DRUG
EVENTS (ADE)
Idiosyncratic Interaction

(Lilley et al., 2020)

 PHARMACOTHERAPEUTICS: DRUG
INTERACTIONS

ADDITIVE SYNERGISTIC ANTAGONISTIC INCOMPATIBILIT

EFFECTS EFFECTS EFFECTS Y

(Lilley et al., 2020)

 Teratogenic
P H A R MA CO T H E RA P EU TI CS
: O TH ER D R U G E FF EC TS Mutagenic

Carcinogenic
(Lilley et al., 2020)
 TOXICOLOGY

• Science of the adverse effects of

chemicals on living organisms
• Clinically – care of the poisoned client
• Poisoning results from drug overdose
to ingestion of chemicals to snakebites
• Treatment based on system of priorities
• Vital functions
• Prevent absorption or speed up
elimination
(Lilley et al., 2020; Zerwekh et al., 2017)
LIFESPAN CONSIDERATIONS

PREGNANCY AND NEONATAL AND OLDER ADULT CLIENTS

BREASTFEEDING PEDIATRIC CLIENTS
CLIENTS

(Lilley et al., 2020)

 Category Description
A Studies indicate no risk to the human fetus.
B Studies indicate no risk to the animal fetus;
information for humans is not available.

FDA PREGNANCY, C Adverse effects reported in the animal fetus;

information for humans is not available.
LACTATION, AND
D Possible fetal risk in humans has been reported;
REPRODUCTION however, in selected cases consideration of the
potential benefit versus risk may warrant use of these
CATEGORIES drugs in pregnant women.

X Fetal abnormalities have been reported, and positive

evidence of fetal risk in humans is available from
animal and/or human studies. These drugs are NOT to
be used in pregnant women.

(Lilley et al., 2020)

 NEONATAL AND PEDIATRIC CLIENTS
Pharmacokinetics
• Immaturity of vital organs
and functioning affect
absorption, distribution,
metabolism, and excretion of
drugs
Dosage
Pharmacodynamics
calculations
• Maturity of various organs • Weight based
determines how the body
reacts to the drug
• Some drugs are
contraindicated during growth
(Lilley et al., 2020)
Polypharmacy

Physiologic Changes and OLDER

Pharmacokinetics ADULT
(Table 3.3)
CLIENTS
Drugs and Conditions Requiring Special
Considerations (Table 3.4)

(Lilley et al., 2020)

 ETHNOPHARMACOLOG
Y

• Body of knowledge for understanding the

specific impact of cultural factors on client
drug response
• Terms
• Race
• Ethnicity
• Culture
• Assessment
• Drug therapy and client responses

(Lilley et al., 2020)

NURSING PROCESS IN
PHARMACOLOGY
REVIEW:
NURSING
PROCESS

(Zerwekh et al., 2017)

 Food
Allergies Drug
Environment

Medical Health Contraindications

History
ASSESSMEN
T Current/Past
Adverse Reactions
Drug Interactions
Medications OTC, herbals, vitamins,
or other supplements

Habits
Psychosocial Issues Culture
Religious

(Lilley et al., 2020)

 DIAGNOSES/ANALYS
IS

• Promoting therapeutic drug effects

• Minimizing adverse drug effects and
toxicity
• Maximizing the ability if the client
for self-care
• Knowledge
• Skills
• Resources for safe and effective drug
administration
• Human needs statement
(Lilley et al., 2020)
 PLANNING
Planning
Establishing Individualized by
interventions for Two main
goals and client care
safe and effective components
outcomes situation
use

Drug
Client teaching
administration

(Lilley et al., 2020)

 IMPLEMENTATIO
N
• Action on the part of the nurse or client
• Administering the drug
• Providing client teaching
• Initiation of specific actions identifies in
plan of care
• Monitoring client
• Adverse effects
• Therapeutic effects
• Medication administration rights

(Lilley et al., 2020; Zerwekh et al., 2017)

 Determine if the plan of care is
appropriate Partially met or
Met or resolved Revision
resolved

EVALUATION Effectiveness of teaching

Documentation

(Lilley et al., 2020)

 MEDICATION ERRORS: PREVENTING AND
RESPONDING

ANY PREVENTABLE EVENT THAT CLIENT-RELATED EVENTS SYSTEM-RELATED EVENTS

MAY CAUSE OR LEAD TO
INAPPROPRIATE MEDICATION USE
OF CLIENT HARM

(Lilley et al., 2020)

 Procuring
Use of
Prescribing
abbreviations

Sociologic
factors
Transcribing
FACTORS
CONTRIBUTIN
Educational
system
Dispensing G TO ERRORS

Organizational Administering

Monitoring

(Lilley et al., 2020)

 TYPES OF
MEDICATION ERRORS

• No error, although circumstances or

events occurred that could have led to
an error
• “Near Miss”
• “Close Call”
• Medication error that causes no harm
• Medication error that causes harm
• Medication error that results in death

(Lilley et al., 2020)

 ALWAYS check the order THREE times
before giving the drug

Consistent use of the “Six Rights” of

medication administration

Minimize verbal or telephone orders

PREVENTING • Repeat order to prescriber

MEDICATION
• Spell out drug name aloud
• Speak slowly and clearly

ERRORS NEVER assume anything about items NOT

specified in a drug order

Do NOT hesitate to question a drug order

for any reason when in doubt

Do NOT use unapproved abbreviations,

acronyms

(Lilley et al., 2020)

 PREVENTING MEDICATION ERRORS CONTINUED

Use of zeros when writing Take time to learn special ALWAYS verify new Use generic names to avoid
dosages administration techniques of medication administration sound-alike trade names
NEVER use a “trailing zero” (not 1.0 mg certain drug forms records
but 1 mg)

ALWAYS use a “leading zero” for

decimal dosages (not .25 mg but 0.25
mg)

(Lilley et al., 2020)

 Do NOT administer any drug if you did NOT draw up/prepare

Verify high-risk drugs and/or client population with second nurse

ADDITIONAL Know where to find information on

drugs, preparations, adverse effects
Use only current resources
Know the indications

PREVENTIO
N MEASURES Minimize interruptions when preparing/delivering drugs

Check client identification and allergies

ALWAYS listen to and honor any concerns expressed by clients

(Lilley et al., 2020)

 SOURCES OF DRUG
INFORMATION
• Pharmacology Textbook
• Nursing Drug Reference
• Drug Package Inserts
• Pharmacists
• US Pharmacopeia
• Credible Internet Sources
• CDC & NIH Updates
• www.CDC.gov
• www.NIH.gov
(Lilley et al., 2020)
 Report to the prescriber and nursing
management

Document error per policy and

procedure

REPORTING Factual documentation only

MEDICATION •
•
Medication administered
Actual dose
ERRORS •
•
Observed changes in client condition
Prescriber notified and follow-up orders

Ethical issues

• Notification of clients
• Possible consequences for nurses

(Lilley et al., 2020)

 Continuous assessment and Verification
updating of client medication Clarification
information Reconciliation

Process where medications are “reconciled” at all points of entry

and exit from a health care facility

MEDICATION Clients provide a list of all medications currently taking

RECONCILIATION including herbal, OTC, and supplements

Prescriber assesses the medications and decides if to be

continued while hospitalized

Designed to ensure NO discrepancies between what the client is

taking at home and in the hospital

(Lilley et al., 2020)

 REFERENCES

Lilley, L. L., Rainforth Collins, S., & Snyder,

J. (2020). Pharmacology and the nursing
process. (9th ed.). Elsevier. 

Zerwekh, J. Garneau, A, and Miller, C. J.

(2017). Digital collection of the memory
notebooks of nursing. (4th ed.). NursingEd.