Introduction A. Basic terms  Nurses use pharmaco-therapeutics daily o Understand pharmacology o Substance use- causes cellular changes and then cause a o Reaction-(hope) be a positive reaction  Pharmacokinetics: what the body does to the drug  Pharmacodynamics: what drug does to the body  Understand side effects/adverse reactions  And drug chemistries such as: half-lives/therapeutic index B. Drug properties  Efficacy: maximal response drug can produce  Potency: index of how much to give for desired response  Drug (Characteristics): (3) o Effectiveness- Drug does what it is intended to do  Most important properties  U.S. Laws require to be proven effective before released for use o Safety Does no harm, even if given at high doses for a long time (there is no drug safe at that level)  Proper dosing and selection should reduce the adverse effects o Selectivity only produces the outcomes intended. There are no side effects  Know how to administer and signs to watch for  “There is not thing as a safe and selective drug”  There is laws and rules to protect the patient C. Therapeutic objective  GOAL FOR DRUG USE: Provide maximum benefit with minimum harm  Other factors for drug selection: o Administration ease o Stability o Cost D. Drug intensity (factors):  Administration dosage size, route and timing are critical (medication errors, patient adherence)  Pharmacokinetics the impact of the body on drugs (absorption, distribution, metabolism, excretion)  Pharmacodynamics Determines the responses a drug elicits (drug receptor interaction, patient’s functional state, placebo effects all determine drug elicited responses)  Characteristics specific to each patient gender, age, weight, mayor organ function & potency of drug administered II. Pharmacology applied in nursing practice A. Nursing responsibility (roles of the nurse)  The 6 rights of medication administration  Goal for drug use: Promote benefits and minimize harm  You just don’t give the medication with the 6 rights  Must anticipate patient reactions  Recognize when they occur and respond to them efficiently and appropriately  Must know drug for the patient  Contraindications for a positive therapeutic outcome  Patient education B. Pharmacology and patient care  6 Rights of medication administration o right medication o right dose o right frequency o right route o right patient o right documentation (6th) C. Patient education (WHAT TO INCLUDE WHEN EDUCATING YOUR PATIENT)  Name and therapeutic category drug  Dosage size, dosing schedule and route of administration  Expected therapeutic responses  Nondrug measure enhance responses  Duration of treatment/ drug storage  Symptoms of adverse effects  How to minimize discomfort  Major drug-drug/drug-food interactions  Whom to contact when things go wrong; therapeutic failure, severe adverse reactions or interactions D. Nursing process and drug therapy III.Drug regulation A. Landmark legislation  Chemical name chemical nomenclature  Generic name (nonproprietary) US adopted names council  Trade name (proprietary) drug market names B. Drug nomenclaturechemical nomenclature C. OTC drugs IV.Pharmacokinetics what the body does to medications once they get into the body and all metabolites have left the body A. Membrane passage B. Phases C. Absorption movement of the drug form the site of administration into the blood for distribution into the tissues.  Factors that affect absorption o Rate of dissolution the drug must dissolve o Surface area available for absorption o Blood flow o Lipid solubility o pH partitioning  Routes of administrationroutes the drug moves to be absorbed o Enteral—GI tract: oral o Parenteral—Outside GI tract  Intravenous, intramuscular, subcutaneous D. Distribution movement of drugs through the body, to its site of action (needed)  To occur there must be adequate blood flow to the tissues  Blood must be able to exit vascular system and enter cells- to reach site of action, metabolize and excrete E. Metabolism (biotransformation) is the enzymatic alteration of drug’s structure (break down drug)  Takes place in the liver cytochrome P-450 enzymes (microsomal enzymes)  There are 6 possible consequences of therapeutic significance in drug metabolism (REFER TO TEXTBOOK)  Factors that influence the rate of drug metabolism: o Age o Induction of drug metabolism enzymes o First-pass effect (hepatic inactivation of some oral drugs) o Nutritional status o Competition between drugs F. Excretion removal of drugs from the body. May occur in the:  Urine, bile, sweat, saliva, breast milk and expired air  The primary organ responsible for elimination is the kidney by glomerular filtration; and two other organs: liver, bowel G. LAST PHASE OF PHARMAKOKINETICS-Time/blood concentration  Last part of pharmacokinetics  Drug response is related to drug concentration levels o It is not the drug levels in plasma that is important, but o at certain levels the drug will be causing a desired effect o at certain levels the drug will become toxic