pharmacology for nurses week 1

Pharmacology for Nurses

Nur30Mount Saint Mary’s CollegeAssociate Degree in Nursing ProgramMaggie Davis-Kendrick, RN,MSN

Core Concept in Pharmacology

CharacterizationCharacterization of: Pharmacology• Is The Study of Medicine

• Derived from two Greek words

– PharmakonPharmakon – medicine drug– LogosLogos – study

Core Concept In Pharmacology

Concepts• Is a discipline devoted to patient therapy through the use

of drugs

• Pharmacology utilizes concepts from human biology, pathophysiology, and chemistry

HX. Of Pharmacology

One of the oldest form of healthcare, practiced in virtually every culture dating to antiquity

Applying products to relieve suffering has been recorded throughout history by virtually every culture

Modern pharmacology began in the early 19th century through the isolation of specific active agents from their complex mixtures

Regulations and Standards

Created to protect the public from drug misuse

Regulatory agency are responsible for ensuring that drugs and medical devices are safe and effective

The regulatory agency responsible for ensuring that drugs and medical devices are safe and effective is the Food and Drug Administration (FDA)

Regulations and Standards

Laws and other standards formed the basis of modern drug regulation used by agencies and organizations such as the FDA and the U.S. Pharmacopoeia-National Formulary

FormularyFormulary – first standard commonly used by pharmacists

PharmacopoeiaPharmacopoeia – medical reference summarizing standards of drug purity, strength and direction for synthesis

The FDA

Branch of the U.S. Department of Health and Human Services

Primary agency responsible for regulating drug safety

Three branches control policies regarding drug therapies

Branches of the FDA

The Center for Drug Evaluation and Research (CDER)• Exercises control over whether prescription drugs and

OTC maybe used for therapy

The Center for Biologics Evaluation and Research (CBER) • Regulates use of biologics including serums, vaccines, and

blood products

Branches of the FDA

The Center for Food Safety and Applied Nutrition (CFSAN)• Regulates administration of herbal products and dietary

supplements

Drug regulations were created to protect the public from drug misuse

The first drug laws were created by Congress to protect clients from wrongful therapeutic claims

Drug Legislation

1902- Biological Control Act to help standardize- the quality of serum and other blood-related products

1906 - Pure Food and Drug Act, gave the government power to control labeling of medicine

1912- Sherley Amendment prohibited the sale of drugs labeled with false therapeutic claims that were intended to defraud the consumer

Drug Legislation

1938 – Food, Drug, and Cosmetic Act, first law preventing the sale of drugs that had not been thoroughly tested before marketing

1994 – Dietary Supplement Health and Education Act passed in an attempt to control misleading industry claims

Stages of Drug Approval

There are four stages of approval for therapeutic and biologic drugs

• Pre-clinical investigationPre-clinical investigation – involves extensive laboratory research on humans and microbial cells cultured in the laboratory

• Clinical investigationClinical investigation – takes place in three different stages termed clinical phase trials

Stage II Clinical Phase Trials • Longest part of drug approval process

• Essential component of drug evaluation

• Tests performed on healthy volunteers to determine proper dosage and assess for adverse effects

Clinical Phase Trials

Large group of selected patients with the particular disease are given the medicine

Clinical investigators from different medical specialists address concerns, if drug appears effective without serious side effects, maybe used immediately in special cases with careful monitoring

New Drug Application (NDA) with review• Third stage

• FDA permitted six months to initially review a NDA

• Average review time 17-24 months

• Process suspended if rejected until concerns are addressed by the pharmaceutical company

Post Marketing Surveillance• Final stage of drug approval process

• Begins after clinical trials and the NDA are completed

• Purpose is to survey for harmful drug effects in a large population

• Weighs therapeutic benefits versus its identified risks

Classification of Drug TherapeuticTherapeutic

• Clearly states what the drug does clinically• Is the discipline dealing with the treatment of suffering

and the prevention of disease Pharmacologic Pharmacologic –refers to the way an agent work at

the molecular, tissue, and body system • Addresses a drug mechanism of action• More specific than therapeutic• Requires understanding of biochemistry and physiology

Pharmacotherapy or PharmacotherapeuticsPharmacotherapy or Pharmacotherapeutics• Is the application of drugs for the purpose of disease

prevention and treatment of suffering

Classification of Drug

Prototype - used to compare drugs within the same classification

• Original prototype not most widely used

• Newer drugs in same class maybe more effective

• Have more favorable safety profile and longer duration of action

Drug Names

Three basic drug names• Chemical

– Helpful in predicting a substances physical and chemical properties

– Often complicated and difficult to remember or pronounce

– Chemical name for diazepam: 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-benzodiazepin-2-one

Drug Names

Generic• Name is assigned by the U.S. Adopted Names

Council

• Less complicated and easier to remember

• Only one generic name for each drug

• Less expensive

Drug Names

TradeTrade• Assigned by company marketing the drug

• Sometimes called proprietary, product or brand name

• May have multiple names

• Selected to be short and easy to remember

Drug Names

Generic substance• Aspirin

• Diphenhydramine

• Ibuprofen

Brand Name• Anacin, Bayer,

Excedrin

• Benadryl, Caladryl, Allerdryl

• Advil, Motrin, Midol

Generic/Brand Names

Generic Name

• Conjugated Estrogen

• Digoxin

• Levothyroxine Sodium

• Wafarin

Brand Name Equiv.

• Premarin

• Lanoxin

• Synthroid

• Coumadin

Classification of Therapeutics

General categories• Traditional DrugsTraditional Drugs - chemical agent capable of

producing biological responses within the body (therapeutic or adverse) RAM

• BiologicsBiologics - agents naturally produced in animals cells, microorganisms, or by the body itself

• Alternative TherapiesAlternative Therapies - herbal supplements and certain techniques

Controlled Substances

Drugs that have potential for abuse or physical and psychological dependence

Use restricted by the Control Substance Act

A special order form needed to obtain schedule II drugs

There are five drug schedules of controlled substances

Schedule of Controlled Substance

Schedule/Abuse Potential • I/carries highest risk

• II/carries high potential

• III/moderate abuse risk

• IV/low abuse risk

• V/least abuse potential

Therapeutic Use/ Example

• Limited or no use/heroin, LSD, Marijuana

• With prescription/MS, PCP, Cocaine

• With prescript./Codeine, ASA, Tylenol

• With prescript/Darvon, Librium, Valium

• Without prescription OTC

Methods of Dispensing Drugs

TwoTwo major methods

• Purchase of prescriptions drugs with a physician’s order

• Purchase of over the counter (OTC) drugs which do not require a physician’s order

• There are advantages and disadvantages to both methods of dispensing

Principles of Drug Administration

Rights of Drug Administration• Right patient

• Right medication

• Right dose

• Right route

• Right time

• Right documentation

Additional Rights

• Right to refuse

• Right to receive medication education

• Right preparation

Three Checks of medication administration

• Checking the medication with the medication administration record (MAR) when removing it from its stored location

• Checking the medication when preparing it

• Checking the medication before administering it to the patient.

Abbreviations• Table 4.1, Pg. 31 text• Front cover pg. Drug Calculation book

– ac before meal– Po or per os – by mouth – pc – after meals– mEq – milliequivalent– gtt - drop– hs – hour of sleep, at bedtime

Do not use• U or u• IU• q.d. or QD• q.o.d. or QOD• MS• MSO4• Zero after decimal point

Use instead• Unit• International Unit• Daily• Every other day• Morphine• Morphine sulfate• 1

Do not use• MgSO4• mgmg• TIW or tiw• AS• AD• AU• No zero before decimal

dose (0.5mg)

Use instead• Magnesium Sulfate• Micro gram• Three times weekly• Left ear• Right ear • Both ears• .5mg

Time Schedule• ASAP – as soon as possible• STAT – immediately • Single – one time dose• Routine – daily dose • Standing – parameters left to follow• PRN – when needed

Drug Orders• Clonidine .2mg po twice daily, hold for SBP<100

Drug Orders• Vancomycin 750mg IV stat, followed by

Gentamycin 1gm IV

• Lasix 40mg IV now and daily PO

• Tylenol 650mg po or pr, q 4hr prn temp. > 101 or mild pain

Time Schedules (military time)• Daily or q am 0900

• Twice daily 0900 1700

• Three times daily 0900 1300 1700

• Four times daily 0900 1300 1700 2100

• Every pm 1700

Time Schedules (military time)• Every hs (noc) 2200

• Every 4 hours 0001 0400 0800 1200 1600 2000

• Every 6 hours 0001 0600 1200 1800

• Every 8 hours 0001 0800 1600

• Every 12 hours 0600 1800

Documentation• If medication refused or omitted and reason• Any assessment• Dosage and time administered• Medication name and your signature

• Example: Tylenol 650mg pr (rectally) given for temp. 101.6 orally at 1600. M. Davis-Kendrick RN

Nursing Management• Assumes great responsibility for drug administration

• Firm knowledge of drug– Name and classification– Intended or proposed use– Effects on body– Contraindication/special consideration– Side effects

Nursing Management• Why prescribed for this patient

• How supplied by pharmacy

• How is medication to be administered with dosage ranges

• What nursing process consideration related to medication apply to this particular patient

Routes of Drug Administration

Enteral

Enteral • Includes drugs given orally and those administered

through nasogastric or gastrostomy tubes• The sublingual and buccal routes are less commonly

used enteral routes, dissolved directly into blood stream

• Is the most common, convenient, and usually, the least costly of all the routes

Enteral• Tablets

– Maybe formulated to release the drug in a steady controlled manner

– Maybe scored for individual dosage, – Maybe enteric-coated (EC) to dissolve in alkaline

environment of sm. intestines– Sustained- Release also called extended –release (XR),

long acting (LA), or slow-release (SR) – Do not crush EC or slow releasing tablets

Enteral• Capsules

– Drug encased in shell of hard or soft gelatin– Also comes extended release – Extended-release capsules must not be opened

• Sublingual – Placed under tongue and allowed to dissolve– Result in a rapid onset of action

Enteral• Buccal

– Placed in oral cavity between gums and cheeks

– Mucosa less preamble than sublingual

– Slower absorption than sublingual

– Preferred over sublingual for sustained release

• Troches (lozenge)– Commonly used to achieve local effect

– Held within the mouth until dissolved

• NGT/GT– Useful if patient unable to swallow

– Medication is crushed or dissolved

Enteral– Do not crush sustained release drugs or EC

– If tube connected to suction, hold for 30 minutes after giving medication

– If drug interferes with tube feeding hold feeding for 1 hour before and 2 hours after

Enteral• Advantages

– Safe– Convenient – Least expensive

• Disadvantages– Patient must be alert and able to swallow– Need to stay until medicine is taken– Greater chance for refusal and non compliance

Enteral• Nursing Consideration

– Assess patient level of consciousness – Assess allergies– Monitor vital signs or lab result– Perform the 5 rights of administration and– The three checks before administering medication– Documentation

Topical• Application

– Instillations and irrigationsInstillations and irrigations –applied into body cavity or orifices

– These include the eyes, ears, nose bladder, rectum and vagina

InhalationsInhalations – drugs applied to the respiratory tract by inhalers, nebulizers, or positive pressure breathing machines

Topical• Transdermal

– Effective way of delivering specific amounts of medications

– Patches are changed/rotated on a regular basis – Slow release and absorption

• Ophthalmic– Used to treat local conditions of the eye and

surrounding structure– Available in the form of irrigation, drops, ointments,

and medicated disks

Topical• Otic

– Used to treat local conditions of the ear and auditory canal

– Includes eardrops and irrigations– Perform carefully on infants and young children to

avoid injury to sensitive structures of the ear

• Nasal – Used for both local and systemic drug administration– Drops or sprays often used for their local astringent

effect which is to shrink swollen mucous membranes

Topical• Vaginal

– Used to treat local vaginal infections, and to relieve pain and itching

– Inserted in suppositories, creams, jellies, or foam

• Rectal– Used for either local or systemic administration– Normally in suppository form– Slowest rate of absorption

Parenteral• Dispensing of medications via a needle • Usually into the skin layers, subcutaneous tissue,

muscles or veins• Advance deliveries include into arteries, body

cavities and organs• Aseptic technique must be strictly applied

Parenteral• Intradermal (ID)

– ID administered into the dermis (1st layer of skin)– Easily absorbed because of more blood vessels– Usually for allergies, TB, anesthetic, or prior to IV

insertion – Limited to small volumes (0.1 to 0.2ml)– Use only 25 or 27 gauge needle

– Inject into non-hairy skin surfaces (inner forearm)

Parenteral• Subcutaneous (sub-q, SC, SQ)

– Administered into fatty tissue– Less absorption than IM, distributed through

capillaries– Insulin, heparin, vitamins, some vaccines and narcotics– Sites used are upper, lateral arms, anterior thigh,

abdomen and mid back – Doses small in volume (0.5 – 1cc) per injection

Parenteral• Subcutaneous (sub-q, SC, SQ)

– Not necessary to aspirate– Rotate sites– TB and Insulin syringes are not interchangeable– Use 5/8 inch needle– Size of individual determines angle of injection

(45 vs. 90 degree angle)

Parenteral• Intramuscular (IM)

– Delivers medication injected into a certain muscle– Onset of action more rapid than SQ because of

rich blood supply– Many are dry power and must be reconstituted

before administration

Parenteral• Intramuscular (IM) • Most common sites

– DeltoidDeltoid– volume not to exceed

2 ml– Small volume vaccines– 1” needle

Parenteral• Intramuscular (IM) Most common sites

– DorsoglutealDorsogluteal – Up to 3ml/injection– 1-1.5” needle– Aspirate– Inject slow & smooth

Parenteral• Intramuscular (IM) VentroglutealVentrogluteal

Preferred siteContains no large

vessels or nervesSuitable for children

and infants over seven

months

Parenteral• Intramuscular (IM)

– Rectus femorisRectus femoris Used for infants

– Vastus lateralisVastus lateralisMiddle third used for injectionUsed most often in children

Intravenous

Intravenous Administration (I.V.)• Direct delivery into systemic

circulation, bypasses absorption

process• Rapid onset of action• Allows large volumes to be given• Acceptable when no other route

possible

Intravenous Administration (I.V.)• Three Basic TypesThree Basic Types

– Large volume infusionFor maintenance, replacement or supplementMixture of compatible drugs

– Intermittent infusion Intravenous Piggy Back (IVPB)Used to instill adjunct medication (analgesic,

antibiotics)

Intravenous Administration (I.V.)• Three Basic TypesThree Basic Types

– IV Bolus or IV Push

Concentrated dose delivered via syringe

Monitor closely for adverse reaction

May take several minutes depending on the drug

Pharmacokinetics/ Pharmacodynamics

Molecules Receptor Sites

PharmacokineticsDerived from the root words

• Pharmaco – medicine • Kinetics – movement or motion

Focuses on the movement of drugs throughout the body after they are administered

Deals with how the body metabolizes and excretes drugs

PharmacokineticsDescribes the barriers that drugs

must penetrate to achieve therapeutic success

Physiological properties of plasma membranes determine movement of drugs throughout the body

PharmacokineticsDrugs primarily use two processes to cross

body membranes • Diffusion or Passive transport

– Movement of chemical from area of higher concentration to lower concentration

• Active transport– Against a concentration or

electrochemical gradient

Pharmacokinetics

Diffusion

PharmacokineticsPlasma membrane consist of lipid bilayer

with proteins and other molecules interspersed in the membrane• This lipophilic membrane is relatively

impermeable to large molecules, ions, and polar, molecules

• Drugs that are small, uncharged, and lipid soluble are distributed more completely than those that are large, ionized, and water-soluble

• These physical characteristic have direct application on pharmacokinetics

PharmacokineticsThe Processes of Pharmacokinetics

• Absorption – Movement of the drug from it’s

administration site into systemic circulation– Many factors affect drug movement

Rate of Dissolution- how fast the drug dissolve

Surface Area- larger surface area = faster absorption

Blood Flow: Greater blood flow = faster absorption

Lipid Solubility- High lipid solubility = faster absorption

pH Partitioning - ionize in the blood and not at the site of administration

PharmacokineticsPharmacokinetics Processes

• Distribution – Represents how drugs are

transported throughout the body – Variables affecting distribution

Lipid solubility Degree of ionizationPlasma protein binding The blood-brain barriersFetal-placental barrier

• Distribution– Amount of blood flow to body tissue is

the main factor determining distribution

Cardiac outputBody composition( amt. of adipose

tissue)Presence and degree of vessel

constriction or dilatation

• Metabolism (Biotransformation)– Is a process that changes a drug’s

activity and makes it more likely to be excreted.

– Alters drug structure usually in the liver

– First-Pass Effect- Hepatic inactivation of certain oral drugs

– Metabolic enzymes in the liver are less active in infants and geriatric patients

PharmacokineticsProcesses

• Excretion – Elimination of drug from circulation– The main organ involved with excretion

is the kidney – Drugs are eliminate from the body by

Kidney via the urine Lungs via exhaled airSweat glands via perspiration Tears via cryingMammary glands via breast milk and Biliary system

PharmacokineticsPlasma Concentration

• The therapeutic response of most drugs are related to their plasma concentration

– MinimumMinimum – amount required to produce therapeutic effect

– TherapeuticTherapeutic -lies between the minimum effective level and the toxic level.

– ToxicToxic –result in serious adverse effects

• Plasma half-life– Represents the duration of action for

most drugs – The length of time the body takes to

reduce the plasma level of a drug to 50% of its peak value

• Loading dose– Higher amount of drug– Given once or twice to– Quickly induce a therapeutic response

• Equilibrium state – The amount of drug administered is

equal to the amount excreted – Equilibrium state may be reached faster

through the use of loading doses

• Maintenance dose– Given to keep plasma concentration in

therapeutic range

PharmacodynamicsIs comprised of the root words

• Pharmco – medicine

• Dynamics – change !

Pharmacodynamics – the mechanism by which drugs produce biochemical and physiologic changes in the body

The differences in patient responses to medications

PharmacodynamicsFrequency Distribution Curve

• Represents drug action in a specific patient population

• The middle of the curve represents a drug’s median effective dose

• Used to represent safety of a drug Therapeutic Index

• Is a value representing the margin of drug safety

• Equals median lethal dose divided by median effective dose

• Larger the difference the greater the therapeutic index

PharmacodynamicsPotency and Efficacy

• Potency - the dose of medication required to elicit a particular response

• Efficacy - the magnitude of maximal

response to a drug

• Efficacy of a drug is more important to the patient and nurse than the potency

PharmacodynamicsDrug Receptor Interaction

• Used to explain the mechanism of action of many medications

• Majority of receptors are proteins located on the plasma cell membrane

• Some drug responses are nonspecific and do not involve direct receptor interaction

PharmacodynamicsDrug Receptor Interaction

• Drugs compete with endogenous substances and other medications for cellular receptors

– AgonistAgonist - are drugs that bind to a receptor and cause effects that mimic normal cell activities.

– Partial agonistPartial agonist –produces a weaker or less efficacious, response than an agonist

– AntagonistAntagonist - are drugs that bind to a receptor and inhibit normal cell activity

PharmacodynamicsPharmacology of the Future

• Likely be customized to match the genetic make-up of each patient

• Pharmacogenetics - application of genetics to pharmacology with the objective of individualizing therapy

Pharmacotherapy across the Pharmacotherapy across the LifespanLifespanPregnancyPregnancy

• Conducted only when the benefits to the Conducted only when the benefits to the mother outweigh the potential risks to mother outweigh the potential risks to the fetusthe fetus

• Pregnancy Categories guide the Pregnancy Categories guide the practitioner in prescribing drugs for practitioner in prescribing drugs for these patientsthese patients

• Pregnancy Categories have been Pregnancy Categories have been developed by the FDA to assess developed by the FDA to assess potential risk to the fetuspotential risk to the fetus

Pharmacotherapy across the Pharmacotherapy across the LifespanLifespan

PregnancyPregnancy• Drugs and other substances can Drugs and other substances can

appear in breast milk and affect appear in breast milk and affect infants infants

• Refer to FDA Pregnancy Categories Refer to FDA Pregnancy Categories (table 7.1 pg.69 text)(table 7.1 pg.69 text)

Infancy (birth 12 months)Infancy (birth 12 months)• Directed toward safetyDirected toward safety• Administer oral medication slowlyAdminister oral medication slowly

Infancy (birth 12 months)Infancy (birth 12 months)• For suppositories hold buttocks For suppositories hold buttocks

together for 5-10 minutestogether for 5-10 minutes

• Vastus lateralis preferred site for IM Vastus lateralis preferred site for IM injectioninjection

• Medication prescribed in milligrams Medication prescribed in milligrams per kilogram per day (mg/kg/24h)per kilogram per day (mg/kg/24h)

Infancy (birth 12 months)Infancy (birth 12 months)• Alternate method for calculating dosage is Alternate method for calculating dosage is

to use the infants body surface area (BSAto use the infants body surface area (BSA))

– BSA refers to the total area exposedBSA refers to the total area exposed– Derived from height and weightDerived from height and weight– Two formulas usedTwo formulas used

A.A.Formula using metric systemFormula using metric system Weight (kg) x Height (cm)Weight (kg) x Height (cm)

36003600

Pharmacotherapy across the Pharmacotherapy across the LifespanLifespanInfancy (birth 12 months)Infancy (birth 12 months)

B. B. Formula using pounds and inchesFormula using pounds and inches

Weight (lb) x Height (inWeight (lb) x Height (in))

31313131

– BSA written in square meter (m2) BSA written in square meter (m2) – Maybe used to double check orders Maybe used to double check orders

for safefor safe dosagedosage

Pharmacotherapy across the Pharmacotherapy across the LifespanLifespanToddlers (1-3)Toddlers (1-3)

• Major concern, sense of curiosity Major concern, sense of curiosity

• Can swallow liquid, maybe able to Can swallow liquid, maybe able to solid medication solid medication

• IM injection given in the vastus IM injection given in the vastus lateralislateralis

• IV may use scalp or feetIV may use scalp or feet

Preschool (3-5)Preschool (3-5)• Dorsogluteal site used for IM after 1 Dorsogluteal site used for IM after 1

year of walkingyear of walking• Peripheral veins used for IV injectionsPeripheral veins used for IV injections• Often resist medicationOften resist medication

School Age (6-12)School Age (6-12)• Begin to realize the benefits of Begin to realize the benefits of

medications and the reasons why medications and the reasons why medications are neededmedications are needed

School Age (6-12)School Age (6-12)• Give the child a sense of control over Give the child a sense of control over

drug administrationdrug administration • At the same time be firm and giving At the same time be firm and giving

the child praise for cooperationthe child praise for cooperation • Can take chewable tablets, may Can take chewable tablets, may

swallow tablets or capsulesswallow tablets or capsules• Ventrogluteal site preferred for IMVentrogluteal site preferred for IM

AdolescenceAdolescence• Respect need for independence and Respect need for independence and

privacyprivacy

• Concerned with physical appearance Concerned with physical appearance and peer approvaland peer approval

• Indications for pharmacotherapyIndications for pharmacotherapy

– Skin conditions Skin conditions – Headaches Headaches – Menstrual irregularitiesMenstrual irregularities– Sports injuriesSports injuries

Young (18-40) and Middle (40-65) Young (18-40) and Middle (40-65) AdulthoodAdulthood• Generally need little pharmacotherapyGenerally need little pharmacotherapy• Complications associated with pregnancy Complications associated with pregnancy

are of major concernare of major concern • Cardiovascular concerns become Cardiovascular concerns become

important important • Use of antidepressants and antianxiety Use of antidepressants and antianxiety

agents are prominent in the over-50 agents are prominent in the over-50 populationpopulation

Older AdultsOlder Adults• Take more medications (polypharmacy) Take more medications (polypharmacy)

and experience more adverse drug and experience more adverse drug events than any other age group events than any other age group

• Must make accommodations for age-Must make accommodations for age-related changes in physiological and related changes in physiological and biochemical functionsbiochemical functions

• With numerous physical challenges, With numerous physical challenges, which become targets for which become targets for pharmacotherapypharmacotherapy

Older AdultsOlder Adults• Changes in liver and kidney function make Changes in liver and kidney function make

pharmacotherapy more riskypharmacotherapy more risky

• Cardiovascular disease becomes a major Cardiovascular disease becomes a major indication for pharmacotherapyindication for pharmacotherapy

• For drug therapy to be successfulFor drug therapy to be successful must make must make

accommodations for age-related changes in accommodations for age-related changes in physiological and biochemical functions physiological and biochemical functions

Legal and Ethical Issues

Ethics • Branch of philosophy dealing with the

moral principles that guide a person’s behavior or conduct

• Are learned early in life through religious affiliations, family, role models, and peers

Moral • Principles such as beneficence, non-

maleficent behavior, veracity, autonomy, justice, and fidelity are necessary in medication administration

• When making ethical decisions in clinical practice, the nurse uses fundamental moral principles

• Three most important principles • BeneficenceBeneficence - promote the most good

for the patient

• Non-maleficentNon-maleficent – obligation not to harm the patient

• AutonomyAutonomy - allowing the patient the informed right to choose the course of their care

Legal• Nurse Practice Act

– Defines the scope of practice for professional nursing

– Defines the standard of care for practicing nurses

– State the minimum competency for proficiency in nursing

• Documentation of medication administration, including any errors, should be completed immediately

Legal• Medication Errors

– A preventable error that may cause or lead to an adverse reaction

•can result in serious injury to the patient and litigation for the nurse and healthcare agency

Legal and Ethical IssuesLegal

• It is the ethical and legal responsibility of the nurse to report any medication errors

• Documentation necessary for patient

safety

• Finding strategies to prevent of medication errors involves many different processes, including the nursing process

Nursing ProcessIs a systematic method of problem-solving

and consists of clearly defined steps• Assessment

– First step in the nursing process– Baseline data gathered (subjective, objective)– Assessment includes health history information,

physical assessment data, lab values and other measurable data

– Includes an assessment of medication effects: therapeutic, side or adverse effects

Nursing ProcessNursing Diagnosis

• Are developed after an analysis of the assessment data

• Diagnoses are focused on the patient’s problems or potential problems

• Begin by addressing problems that pose immediate threats to the patient’s health

Nursing ProcessGoal

• Developed from the nursing diagnoses • Focus on what the patient will be able to do or

achieve Outcomes

• Objective measures of goals• Define what the patient will do• Under what circumstances and time frame

Goals and outcomes are prioritized to address immediate need first

Nursing ProcessGoals and outcomes may be developed for short-

term or long-term, depending on the specific situation

Planning• Links strategies or interventions to goals and

outcomes Interventions

• Aimed at returning the patient to an optimum level of wellness and limiting adverse effects

Nursing ProcessInterventions

• Key components of implementation include monitoring and documentation of drug effects, and patient education

• Monitoring drug effects is a primary intervention

• Patient teaching is a vital component( considered primary role

• Documentation of both therapeutic and adverse effects is complete during this phase

Nursing ProcessEvaluation

• Final step of the nursing process• Considers the effectiveness of interventions at

meeting goals and outcomes• Evaluation begins a new cycle as new

assessment data is gathered and analyzed • Nursing diagnoses are reviewed or rewritten,

goals and outcomes refined, and new interventions are implemented

System of Measurement

• Include the metric, apothecary, and household systems

Metric • Preferred system of measurement

• Also known as the International System of Units (SI)

• Basic unit of mass (weight) is the gram

• Basic unit of volume (capacity) is the liter

• Milliliter (mL) and cubic centimeter (cc) are used interchangeably

System of MeasurementMetric

• Equivalents frequently used (memorize)• Weight

– 1mg (milligram) = 1000mcg (microgram)

– 1g (gram) = 1000 mg (milligrams)

– 1 kg (kilogram) = 1000 g or Gm (grams) = 2.2 lbs

• Volume – 1L (liter) = 1000cc or 1000 ml

(milliliters)

Apothecary

Apothecary• Apothecary means “Pharmacist”

• Imprecise, old English system of measurement

• Grain, basic unit of weight• Basic unit of volume is the minim,

which = one drop (gtt)

Apothecary• Abbreviation or symbol usually written

before amount or quantity –ex gr 60 = 1 dram

• Measures based on the minim– Fluidram (fl. dr.)– Fluid ounce (fl. Oz.)– Pint (pt.)– Quart (qt.)

• Household

Household• Least accurate system of

measurement

• Measurements approximate

• Becoming increasingly more important with the trend toward home health care

Household• Household Measures

– Tablespoon (Tbs or T)

– Teaspoon (tsp or t)

– Drop (gtt)

Units of Measurements• Measures drugs in terms of their

action

• Vitamins, antibiotics, insulin and heparin are measured in units

• Label indicates units per ml

• No conversion exists for units

Milliequivalent (mEq)

• Measures chemical combining power of electrolytes such as potassium (K+)

• Specific to medication used

• Has no conversion to another system

Dosage measured in percentage• Commonly used in IV solutions

D5W, D5 ½ NS, D10, .45NS, 0.9 NS • Often used with metric measures

• Means part per hundred or number of grams of drug per 100ml of solution

• Often no conversion is necessary (give 10ml of 10% calcium gluconate)

Metric House• 1ml 15-16gtts • 4-5cc 1tsp or• 15-16ml 1Tbs or• 30-32ml 2Tbs• 240-250 1gl or cup• 500ml 2gls or

cups• 1L 1qt, or

Apothecary • 15-16minims• 1 fluid dram• 4 fluid ounces• 8fl. dr or 1oz• 8 oz or ½ pt.• 1pint• 32ounces or 1qt

Metric• 1mg• 60-64mg• 300-325mg • 1kg =2.2lbs• 1gram

Apothecary• 1/60 gr• 1gr• 5grs

• 15-16grs

Conversion between and within systems• 1 g = 1000mg 1000mcg 2.2lbs

• 1T = 0.5L 15mL 3tsp

• 1kg = 1000g 1dr 2.2lb

• 1cc = 500mL 1L 1mL

References• Adams, M, Josephson, D. & Holland, L.

(2005). Pharmacology for Nurses: A pathophysiologic approach, Pearson Prentice Hall, New Jersey

• Aschenbrenner,D & Venable, S (2006). Drug Therapy in Nursing. 2nd Edition, Lippincott Williams & Wilkins,

• Brown, M & Mulholland, J. (2004). Drug Calculations: Process and Problems for clinical Practice 7th Edition, Mosby, St. Louis , Missouri

References• (2004).Straignt A’s in Pharmacology,

Lippincott Williams & Wilkins

• (2005).Dosage Calculations Made Incredible Easy, 3rd Edition, Lippincott Williams & Wilkins

• (2005).Nursing Pharmacology Made Incredible Easy, Springhouse

• www.crnasomeday.com/pharmacology.htm

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