Fall Week 1/2 - Introduction to Pharmacology
Chapter 1: Nursing Practice in Canada and Drug Therapy
• Patient care is getting more complexin Canada.
• Nurses expected to keep up-to-date with rising use of intricate pharmacologicaltherapies.
• Knowledge of drugs, their adverse effects, and interactions is critical for nurses to provide safe,
• Greater accountability expected of nurses with increased attention focused on safe medication
• Nursing process: a frameworkfor professional nursing practice. Five step process:(1) assessment;
(2) nursing diagnosis; (3) planning; (4) implementation;and (5) evaluation.
○ Ensures delivery of thorough, individualized care
Importance of Critical Thinking to the Nursing Process
• Major componentof the nursing process.
• Underpinning to provide the best possible care.
• Using the mind to develop conclusions, make decisions, draw inferences, and reflect on all aspects of
Assessing the Patient and Drugs
• During the assessmentphase, data is collected, reviewed, and analyzed.
• Assessmentallows the nurse to formulate a nursing diagnosis related to the patient's needs and
needs related to drug administration.
• Data categorized as objective and subjective.
• A comprehensivemedication profile should include (not limited to):
○ Drug use;
○ Natural health products;
○ Alcohol, tobacco, and caffeine;
○ Use of OTC meds;
○ Hormonal drugs;
○ Past & present Hx;
○ Family history and background;
○ Any unusual responses to meds;
○ Growth and developmentalstages related to age and med use.
• Assessmentof drug is also important; specific informationshould be collected (dosage, peak times,
contraindications, etc). Use reliable sources: nursing textbooks,drug manufacturer's insert, drug
handbooks, licences pharmacist, reliable online resources.
• Data gathering about patient & drug may be done by asking simple questions.
• Prescription from doctor must be checked for six elements
1. Patient's full name;
2. Date & time order was written;
3. Generic/tradename of drug;
4. Dosage of the drug (includes size, frequency, and number of doses);
5. Route of administration;
6. Signature of the prescriber.
Analysis of Data
• Once nurse has received and reviewed all data, the nurse must analyze and amalgamatethe
information. Info should be verified and documented.
• Sum of info on patient and drug are used to make a nursing diagnosis.
• Used as a means of communicatingand sharing information about the patient and patient
• A result of critical thinking, creativity, and accurate data collection.
• Nursing diagnoses related to drug therapy will most likely develop out of data associatedwith the • Nursing diagnoses related to drug therapy will most likely develop out of data associatedwith the
○ Deficient knowledge;
○ Risk of injury;
○ Various disturbances, deficits, excessesor impairments in bodily functions and other problems
• 3-step process:
1. Human response of the patient to illness, injury or change.
This can be a problem, which may lead to the developmentof another problem or an
opportunity to increase health.
2. Identifying the factor(s) related to the response.
Not necessarily cause/effect,but indicating a relationship between factors and
3. List of cues, clues, evidence, or other data that supports the nurse's claim that this diagnosis is
Example: (1) Risk for injury from (2) erroneous medication, due to (3) decreased vision loss.
• Includes identification of goals and the outcomecriteria.
• Major purpose is to prioritize the nursing diagnoses and specify the goals and outcomecriteria,
including time frames for achievement.
Goals and Outcome Criteria
• Goals are objective,measurable, and realistic, with an established time period for achievementof
• Patient goals reflect expected changes through nursing care.
• The outcome criteria are concrete descriptions of the patient's goals. They should be concise, well
thought-out, and patient-focused.
○ Should include expectations of behaviour (which can be changed) that are met by certain
○ Ultimate aim is the safe and effective administration of medications.
○ Should relate to each nursing diagnosis and guide implementationof nursing care.
○ May address special storage and handling techniques, administration procedures, equipment
needed, drug interactions, adverse effects, and contraindications.
○ Patient-orientedoutcomecriteria must apply to any medicationsthe patient will receive.
• Involves the use of nursing interventions to activatethe plan and is guided by preceding phases of
the nursing process (assessment,nursing diagnosis, planning)
• Requires constant communicationand collaborationwith patient and members of healthcare team.
• Based on nurse's clinical judgement and knowledge.
• Must adhere to safe administration practices to prevent errors (The five "rights" of medication
1. Right drug;
2. Right dose;
3. Right time;
4. Right route;
5. Right patient.
• Additional rights:
1. Right reason: ensuring the drug ordered is being given for the right reason.
2. Right documentation:ensuring documentationof the medication administration is done after
drug has been administered, not before.
3. Right evaluation:ensuring that any special assessment requirements have been made prior to
drug administration (i.e. Pulse rate and BP readings).
4. Right to refuse.
• Check three times for safe medicationadministration.
• Occurs after the collaborative plan of action has been implemented.
• Systematic,ongoing and dynamic part of the nursing process as related to drug therapy. • Systematic,ongoing and dynamic part of the nursing process as related to drug therapy.
• Includes monitoringthe patient's therapeutic response to the drug and its adverse and toxic effects.
Chapter 2: Pharmacological Principles
• A drug is any chemical that affects the processes of a living organism. The study or science of drugs is
• The study of pharmacologyincludes absorption, biochemical effects, biotransformation,distribution,
drug history, drug origin, drug receptor mechanisms,excretion, mechanismsof action, physical and
chemical properties, physical effects, therapeutic (beneficial) effects, toxic (harmful) effects.
○ Knowledge of these areas enables the nurse to better understand how drugs affect humans.
• Throughout its development,a drug will acquire at least three different names:
○ The chemical name, describing the drug's chemical compositionand molecular structure.
○ The generic name (or nonproprietary name), is given to the drug and approved by Health
Canada. Usually shorter and simpler than the chemical name.
○ The trade name (or proprietary name) indicates the drug has a registered trademark.
• Three basic phases of drug activity - pharmaceutics, pharmacokinetics,and pharmacodynamics -
describe the relationship between the dose of a drug given to a patient and the effectivenessof that
drug in treating the patient's disorder.
○ Pharmaceutics (disintegration of dosage form, dissolution of drug): how different dosage
forms (i.e. Injection, capsule, controlled-releasetablet) influence the way in which the drug
affects the body.
○ Pharmacokinetics (absorption, distribution, metabolism,excretion): what the body does to
the drug molecules. Onset of action, peak effect and duration of action of a drug are all part of
A metabolite is the product of one or more biochemical (metabolic)reactions involving
the parent drug (the original drug administered).
A parent drug that is not pharmaceuticallyactive is called a prodrug. Prodrug is then
metabolized into pharmaceutically active metabolites.
Inactive metabolites lack pharmacologicalactivity and are simply drug waste products
awaiting excretion from the body.
○ Pharmacodynamics (drug-receptor interaction): what the drug does to the body.
Examines physicochemicalproperties of drugs and their pharmacological interactions
with drug receptors in the body.
Receptors are specialized protein molecules embedded in the outer surfaces of cells or
within cells to which drug moleculesbind to exert their effects.
○ Pharmacotherapeutics (a.k.a therapeutics) focuses on the use of drugs to prevent and treat
Defines the principles of drug actions - the cellular processes that change in response to
the presence of drug molecules.
Empirical therapeutics refers to drug therapy that is effectivebut for which the
mechanism of drug action is unknown (receptor protein unknown, cellular processes
Rational therapeutics is drug therapy in which specific evidence has been obtained for
the mechanisms of drug action.
○ The study of adverse effects of drugs and other chemicals on living systemsis known as
○ An adverse effect is a direct response to one or more drugs that results in an undesirable
effect. Effects generally minor by are expected to occur in a percentage of the population
receiving a given drug.
○ Pharmacognosy is the study of natural (vs. Synthetic) drug sources.
(A Closer Look at) Pharmaceutics
• Different drug dosage forms have different pharmacologicalproperties.
• Dosage form design determines the rate at which a drug undergoes dissolution (dissolving of solid
dosage forms and their absorption)
Example: Drug ingested orally may be taken in either a solid form (i.e. tablet, capsule or ○ Example: Drug ingested orally may be taken in either a solid form (i.e. tablet, capsule or
powder), a liquid form (i.e. a solution). Oral drugs that are liquids (i.e. syrups) are already
dissolved and are absorbed more quickly than solid dosage forms.
○ Enteric-coateddrugs have a coating that prevent them from being broken down in an acidic
pH environment(i.e. The stomach)and usually don't dissolve until they reach a more alkaline
environment(i.e. the intestines). This results in a slower dissolution.
Liquids, elixirs and syrups Fastest
• Sometimesthe size of the particles inside a capsule can make different capsules containing the same
drug dissolve at different rates.
• A variety of dosage forms exist to provide more accurate and convenientdrug delivery systems.
○ Conveniencein administration correlates strongly with medication adherence.
○ Example: extended-releaseoral dosage forms are more convenientbecause they often require
fewer daily doses.
• Specific characteristics of different dosage forms (i.e. fast-acting, injected subcutaneously, etc) have
a large impact on how and to what extent drug is absorbed.
○ If a drug is to work at a specific part of the body, it must be applied either directly at the site in
an active form or have a way of getting to that site.
Enteric (systemic)administration refers to drugs administered via GI tract (i.e. Oral