BasicPharmacologyForNurses01 PDF

NUR 106: Course Schedule
• 1/24: Ch: 1,2

• 1/31: Ch: 3,7,8
• 2/7: Ch: 9, 10
• 2/14: Exam 1
• 2/21: Ch: 11,12, 14
• 2/28: Ch: 16,20,23
• 3/7: Ch: 25,29
• 3/14: Exam 2
Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 4
NUR 106: Course Schedule Cont’d
• 3/21: Ch: 30,33

• 3/28: Ch: 34,35
• 4/4: No Classes
• 4/11: 27,36
• 4/18: Exam 3
• 4/25: Ch: 42, 46
• 5/2: Ch: 48
• 5/9: Last Day of Class- Exam 4
Chapter 1
Definitions, Names, Standards,
and Informational Sources
Foundations of Pharmacology
2
Types of Drug Names:
Chemical
Generic
Official
Trademark (brand)
Proprietary
CHEMICAL NAME
Sources of Drug Information

• American Drug Index
• American Hospital Formulary Service
• Drug Interaction Facts
• Drug Facts and Comparisons
• Handbook on Injectable Drugs
• Handbook of Nonprescription Drugs
• Martindale–The Complete Drug Reference
• Package inserts
• Natural Medicines Comprehensive Database
• Physicians’ Desk Reference (PDR)
• Nursing journals
3
Sources of Patient
Information
• United States Pharmacopeia Dispensing

Information (USPDI)
• Therapeutic Choices
U.S. Drug Legislation
• Federal Food, Drug, and Cosmetic Act (1938,

1952, 1962)
• Controlled Substances Act (1970)
Foundations of Pharmacology
• Drug review process
4
Chapter 2
Principles of Drug Action and
Drug Interactions
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 1
Basic principles
A strong understanding of the human body’s

processes are important to grasp drug actions
and drug interactions in the body
Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 14
Examples:
Antagonist—beta blockers
Agonist—epinephrine
Partial agonist—pentazocine

Slide 15
5
Drug Stages After Administration
• Absorption
• Distribution
• Metabolism
• Excretion

Slide 16
Categories of Drug Administration
• Enteral route: PO, Rectal, NG
• Parenteral route: subQ, IM, IV
• Percutaneous route: inhalation, sublingual,

topical
Half--life of Drugs
Half
• Factors modifying the

quantity of drug
reaching a site of action
after a single oral dose

Slide 18
6
Terms used in relationship to
medications
• Desired action
• Side effects/ Adverse effects
• Allergic reactions: i.e. hives, urticaria
• Idiosyncratic reactions
• Carcinogenicity
• Teratogen
Slide 19

Drug Interactions
• Desired effect: when a drug enters a patient,
is absorbed and distributed, and produces the
expected response
• Adverse effect: “Any noxious, unintended and

undesired
d i d effect
ff t off a drug,
d which
hi h occurs att
doses used in humans for prophylaxis,
diagnosis or therapy” (World Health Organization)

Slide 20

Drug Interactions (cont’d)
• Drug interaction
Drug interactions represent 3% to 6% of

preventable in-hospital adverse drug reaction
cases
Drug interactions are a major component of

the number of hospital emergency department
visits and admissions

Slide 21
7
Factors Influencing Drug Action
• Age
• Body weight
• Metabolic rate
• Illness
• Psycological aspects
• Tolerance
• Drug dependence
• Cumulative effect
Chapter 3
Drug Action Across the Life
Span
Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23
Drug Action Across the Life Span
• Age and gender affect drug therapy
• Gender-specific medicine
A developing
d l i science
i th
thatt studies
t di ththe
differences in the normal function of men and
women and how people of each sex perceive
and experience disease
8
Across The Life Span
Age Title of Stage
• <38 weeks • Premature
• 0-1 month • Newborn, neonate
• 1-24 months • Infant, baby
• 1-5 years • Young child
• 6-12 years • Older child
• 13-18 years • Adolescent
• 19-54 years • Adult
• 55-64 years • Older adult
• 65-74 years • Elderly
• 75-84 years • The aged
• 85+ years • The very old
Drug Action Across the Life Span
In nearly every body system, men and women

function differently
Men and women perceive and experience

disease differently
Fundamental questions remain about how

humans function and the effect of disease on
function
Pharmacogenetics
Polymorphisms
Drug Absorption: Age Considerations
• Special considerations for pediatric and older

adult patients
Differences in muscle mass, blood flow, and

inactivity affect medicines given
intramuscularly
Topical and transdermal administration differs

in the very young and the very old
9
• Topical administration in infants is effective

because:
Outer layer of skin (stratum corneum) not fully

de eloped
developed
Skin more fully hydrated; plastic diaper

increases skin hydration
Inflammation (diaper rash) increases

absorption
• Difficult to predict in geriatric patients
Dermal thickness decreases with age and may

enhance absorption
Drying, wrinkling, and decreased hair follicles

decrease absorption
Decreased cardiac output and diminishing

tissue perfusion also affect absorption
• Gastrointestinal absorption influenced by:
Gastric pH
Gastric emptying time
Enzymatic activity
Blood flow of mucous lining and intestines
10
Drug Absorption: Gender Considerations
• Increased potential for toxicity and slower
absorption times in women
Empty solids more slowly
Have greater gastric acidity
Have lower gastric levels of alcohol

dehydrogenase needed to metabolize alcohols
Drug Distribution
• Depends on pH, body water concentrations,
presence and quantity of fat tissue, protein
binding, cardiac output, and regional blood
flow
• Infants
I f t have
h larger
l volume
l off water
t content
t t
and require higher dose
• With age, total body water decreases and fat

increases
Drug Distribution
• Highly fat-soluble drugs take longer to act

and accumulate in fat tissues, increasing
potential for toxicity
• Protein
P i bi
binding
di
Drugs that are relatively insoluble are
transported in circulation by binding to
plasma proteins
11
Drug Distribution
Age considerations
• Some drugs have lower protein binding in
neonates and require larger loading dose
• Albumin levels decrease with age
Gender considerations
• Some differences between men and
women in globulin proteins
Drug Metabolism
• Drug metabolism
Process by which the body inactivates

medicine
Affected by genes, diet, age & maturity of

enzyme systems
Liver weight and hepatic blood flow decrease

with age
Routes of Medication Excretion
Primary Routes
• Renal tubules: into the urine
• GI tract: through feces
Minor Routes
• Evaporation: through skin
• Exhalation: from the lungs
• Secretion: in saliva & breast milk
12
Drug Excretion
• Metabolites of drugs (and sometimes the

drug itself) eventually excreted
• Preterm infant has 15% of adult renal

capacity; fully functional by 9 to 12 months
Drug Excretion (cont’d)
• Decreased renal function with age
• No prediction of renal function can be based

solelyy on age
g because of wide individual
variation in changes
Percentages of Body Water
13
Therapeutic Drug Monitoring
• Entails measurement of a drug’s

concentration in biologic fluids to correlate the
dosage administered and the level of
medicine in the body with the pharmacologic
response
• Timing of drug’s administration and collection

of specimen are crucial to accurate
interpretation
Use of Monitoring Parameters
• Before administering medicine, assess

expected therapeutic actions, side effects,
reportable adverse effects, probable drug
interactions
• Monitoring parameters related to patient’s

age
Monitoring Parameters:
Pediatric Patients
• Infants and young children more susceptible

to dehydration
• Weight
g variation affects dosage
g
• Aspirin never to be administered to children
• Allergic reactions occur rapidly in children,

most commonly to antibiotics
14
Monitoring Parameters: Older Adult Patients
• Factors that place older patient at risk:
Reduced renal and hepatic function
Chronic illness
Polypharmacy—multiple-drug therapy required

by chronic illness
A greater likelihood of malnourishment due to

polypharmacy
Monitoring Parameters: Older Adult Patients
• Drug therapy
Take thorough drug history and nutritional

assessment
Determine whether new symptoms
y p have
been induced by existing medicines
Gradually taper dosage when discontinuing
drug
Start at one third to one half normal dosage
when initiating therapy; gradually increase
Review regimen periodically
Potentially Inappropriate Medications

for Older Adult Patients
15
Use of Monitoring
Parameters: Pregnant Women
• Avoid drugs if at all possible
• When taking woman’s history, be alert to

possibility of pregnancy
• Instruct
I patient
i to avoid
id d
drugs, alcohol,
l h l
tobacco
• Try nonpharmacologic treatments before

using medicines
• Avoid herbal medicines

Drugs Known to Be
Teratogenic
Use of Monitoring Parameters:

Breast--Feeding Patients
Breast
• Some drugs are known to enter breast milk

and harm nursing infant
• Discuss all medications with physician
• Take medicine immediately after breast-

feeding or just before infant’s longest
sleeping period
16
Chapter 7
Principles of Medication
Administration
Legal and Ethical

Considerations
• Standards of care: developed by the state’s
nurse practice act, state and federal law,
JCAHO, professional organizations
• Before administering medication, nurse must
have:
Currentt license
C li tto practice
ti
Clear policy statement authorizing the act
Signed medication order
Understanding of rationale for drug use
Understanding of drug action, dosing, dilution,
route and rate of administration, side effects,
adverse effects to report, contraindications
Contents of Patient Charts
• Summary sheet
• Consent forms
• Physician’s order form
• History and physical exam form
• P
Progress notes
t
• Critical pathways
• Nurses’ notes
• Laboratory tests record
17
• Graphic record
• Flow sheets
• Consultation reports
• Other diagnostic reports
• Medication administration record (MAR) or
medication profile
• PRN or unscheduled medication record
• Case management
• Patient education record
Legal and Ethical

Considerations
• Standards of care: developed by the state’s
nurse practice act, state and federal law,
JCAHO, professional organizations
• Before administering medication, nurse must
have:
Currentt license
C li tto practice
ti
Clear policy statement authorizing the act
Signed medication order
Understanding of rationale for drug use
Understanding of drug action, dosing, dilution,
route and rate of administration, side effects,
adverse effects to report, contraindications

• Summary sheet
• Consent forms
• Physician’s order form
• History and physical exam form
• Progress notes
• Critical pathways
• Nurses’ notes
• Laboratory tests record
18
(cont’d)
• Graphic record
• Flow sheets
• Consultation reports
• Other diagnostic reports
• Medication administration record (MAR) or
medication profile
• PRN or unscheduled medication record
• Case management
• Patient education record
The Kardex
Drug Distribution Systems
• Floor or ward stock system
• Individual prescription order system
• Computer-controlled
C t t ll d di
dispensing
i system
t
• Unit dose system
• Long-term care unit dose system
19
Narcotic Control Systems
The Drug Order

• Stat order
• Standing order
• Renewal order
• PRN order
• Verbal orders
• Electronic transmission of patient orders

Medication Errors
• Prescribing errors
• Transcription errors
• Dispensing errors
• Administration errors
• Monitoring errors
20
Nurse Responsibilities
• Verification
Nurse makes professional judgment regarding
acceptability and safety of the drug order,
including type of drug, dose and dose
preparation, therapeutic intent, route, potential
allergic reactions, or contraindications
• Transcription
Nurse is responsible for verification of orders
transcribed by others
The Six Rights

• 1. Right drug
Compare exact spelling and concentration of
drug with medication card and drug container;
drug label should be read three times
• 2. Right
g time
Standard abbreviations
Standardized administration times
Maintenance of consistent blood levels
Maximum drug absorption
Diagnostic testing
PRN medications
The Six Rights (cont’d)

• 3. Right dose
Abnormal hepatic or renal function
Nausea and vomiting
Accurate dose forms
Accurate calculations
Correct measuring devices
• 4. Right patient
Bracelet checking
Pediatric and older adult patients
21
The Six Rights
• 5. Right route
IV route
Intramuscular route
Intravenous route
Subcutaneous route
Oral route
• 6. Right documentation
Safety/ethical considerations
Legal considerations
Always include date/time, drug name, dose,
route, site of administration
Special Documentation
Circumstances
• Patient refuses medication

Thoroughly record incident and reason for
refusal in nurses’ notes
Notify physician
• Medication error occurs

Notify physician
Complete incident report
Chapter 8
Percutaneous Administration
22
• Application of medications to the skin or
mucous membranes for absorption
• Includes:
Topical application of ointments, creams,
lotions or powders to the skin
lotions,
Inhalation of aerosolized liquids or gases
Installation of solutions into the mucous
membranes of the mouth, eye, ear, nose, or
vagina
• Always follow the six rights of drug

administration
• Premedication assessment and explanation

• Patient teaching
Hygiene requirements
Proper application techniques and timing
Cautions particular to drug or drug
administration
Side effects
When to contact physician
• Documentation
Date, time, drug, dosage, route
Record ongoing assessment data, including

signs of adverse drug effects
23
Creams, Lotions, Ointments
• Wash hands, put on gloves, position patient
• Clean area
• Wear gloves
• Shake lotion bottle; use tongue blade to

remove desired amount of ointment or cream
from container
• Use dressings according to orders
Patch Testing
• Method to identify sensitivity to contact
materials (soaps, pollen, dyes)
• Allergens on patch placed in contact with

back, arms, or thighs
• Patch left in place for 48 hours
• Site aired for 15 minutes, then read
• Emergency equipment must be available in

case of anaphylactic response
Patch Testing
• Wash hands, put on gloves,position patient
• Clean the area
• Wear g
gloves
• Apply dose-measuring applicator paper
• Do not rub in ointment
• Cover area with plastic wrap

24
Transdermal Drug Delivery
• Disk or patch providing controlled release of
medication
• Wash hands,put on gloves,position patient
• Apply topical disk or patch
• Application frequency depends on drug
• Wash hands after application
• Label disk with time, date, nurse initials

Topical Powders
• Particles of medication in a talc base
• Wash hands, put on gloves
• Position the patient
• Wash and thoroughly dry area
• Apply powder, smooth over area for even

coverage
Sublingual and Buccal

Tablets
• Sublingual tablets: placed under the tongue
• Buccal tablets: held in the buccal cavity
• Advantage: rapid absorption and onset of

action
• Action is usually systemic, rather than

localized to the mouth
25
Eye Drops, Ointments, and
Disks
• OD (right eye), OS (left eye), OU (both eyes)
• Wash hands, put on gloves,position patient
• Inspect affected eye
• Expose lower conjunctival sac
• Approach eye from below
• Never touch eye with dropper, tube

Ear Drops
• Ensure ear is clear of wax
• Warm medication to room temperature
• Younger than age 3: pull earlobe downward

and back
• Older than age 3 and adults: pull earlobe

upward and back
• Patient should remain on side for a few

minutes
Nose Drops, Nasal Spray

• Patient should blow nose gently
• Nose drops
Position patient lying down with head hanging
back
• Nose spray
Patient is upright
Block one nostril
Shake bottle and insert tip into nostril
Spray while patient inhales
26
Nebulizers and Inhalers
• Nebulizers
Prepare medication and fill nebulizer
Patient exhales
Put nebulizer in mouth; do not seal completely
Patient inhales
• Metered-dose inhalers
Follow instructions on inhaler
• Dry powder inhalers
Follow instructions on inhaler
Vaginal Medications
• Wash hands, put on gloves
• Fill applicator
• Place patient in lithotomy position, elevate
hips with pillow
• Spread
p labia and insert applicator
pp or
suppository
Chapter 9
Enteral Administration
27
Administration of Oral
Medications
• Enteral is direct administration to the GI tract
• Most drugs are available in oral dose forms:
Capsules—small, cylindrical gelatin containers
used to administer unpleasant tasting
medications; timed-release capsules (provides a
gradual and continuous release of the drug);
lozenges or troches—flat disks in a flavored base
Tablets (powdered drugs that have been
compressed)
Elixirs—drugs dissolved in water and alcohol
Emulsions of water-in-oil or oil-in-water
Liquid suspensions and syrups
Administration of Oral
Medications
• Common methods used to administer oral
medications
Unit dose packaging providing a single dose

Soufflé cups
Medicine cups
Medicine droppers
Teaspoons
Oral syringes: plastic syringes calibrated and used
to measure liquid medications
Nipples with additional holes, used for infants
Administration of Solid-
Solid-Form
Oral Medications
• Two techniques for administering medications:
the medication card and unit dose distribution
• Perform premedication assessment in all cases
• All techniques follow FIVE RIGHTS procedure:

RIGHT patient
RIGHT drug
RIGHT route of administration
RIGHT dose
RIGHT time of administration
• ALWAYS check or recheck the FIVE RIGHTS

28
Solid-Form
Oral Medications
• General principles apply to all distribution systems

Give the most important medications first
Do not touch the medication with your hands
Encourage liquid intake to ensure swallowing
Remain with patient while medication is taken; DO
NOT leave the medication at bedside unless an order
to do so exists
Discard the medication container
• Provide complete documentation of administration

and responses to therapy
Solid-Form
Oral Medications
• Documentation of medication administration and
responses to drug therapy is called the “Sixth Right”
• General principles apply to all medication

administration
Chart date, time, drug name, dosage, and route of
administration
d i i t ti
Regularly record patient assessments to evaluate
therapeutic effectiveness
Chart and report any sign of adverse drug effects
• Perform and validate essential education about drug

therapy and other aspects of intervention for the
individual
Administration of Liquid-
Liquid-Form
Oral Medications
• General procedures are the same as with
solid-form oral medications
• Perform premedication assessment in all

cases
• All techniques follow the FIVE RIGHTS

procedure
29
Liquid-Form
Oral Medications (cont’d)
• General principles for infants, children, and
adults
Give adults and children the most important
medications first
NEVER dilute medications without specific
orders. DO NOT leave a medication at the
bedside without an order to do so
Check an infant’s ID and be certain the infant
is alert
• Provide complete documentation of

administration and responses to therapy
Liquid-Form
Oral Medications
• Measuring techniques vary according to
receptacle used
• With a measuring cup:

Cover label to prevent smearing; place
fingernail at exact level on measuring cup;
read the volume at the level of meniscus—see
Figure 9-13. Recheck FIVE RIGHTS.
• With an oral syringe:

Select syringe of appropriate size. Draw up
prescribed volume of medication from bottle or
medicine cup
Administration of Medications
by Nasogastric Tube
• Drugs are administered via NG tube for
specific patients, using a liquid form
whenever possible. Remember:
Always flush the tube before and after
administration
Perform p
premedication assessment
Assemble equipment before administration
30
Administration of Medications
by Nasogastric Tube (cont’d)
• Prepare doses as for administration of solid-

form or liquid-liquid form oral medications
• Three methods for checking NG tube location
• Follow procedure for administering
medication
di i
• DO NOT attach suction for 30+ minutes
Administration of Enteral Feedings via

Gastrostomy of Jejunostomy Tube
• Enteral formulas are in several mixtures to
meet individual needs
• Assemble equipment beforehand
• Prescribed enteral formula should be
checked
Administration of Enteral Feedings Via

Gastrostomy or Jejunostomy Tube (cont’d)
• Formula should be fully labeled

• Discard unused formula every 24 hours
• Follow the guidelines specific for patients
receiving general nutrition via intermittent or
continuous feedings
• Follow FIVE RIGHTS
RIGHT patient, RIGHT drug (formula), RIGHT
route of administration, RIGHT dose (amount,
dilution, strength), RIGHT time
31
Administration of Enteral Feedings via
Gastrostomy or Jejunostomy Tube (cont’d)
• Verify tube placement and initiate feeding

• Flush, then clamp tube
• Proceed with tube feeding technique
Intermittent: use Toomey
y syringe
y g
Continuous: use disposable feeding container
and enough formula for a 4-hour period
Administration of Rectal
Suppositories
• Suppositories are solid medication designed
to dissolve inside a body orifice
• Equipment is simple:
Finger cot or disposable glove
Water-soluble lubricant
Prescribed
P ib d suppository
it
• Perform standard premedication assessment
Administration of Rectal
Suppositories (cont’d)
• Technique begins with FIVE RIGHTS

Explain procedure and check pertinent
parameters
Patient bends uppermost leg
Apply
A l llubricant
bi t tto titip off suppository.
it Pl
Place
suppository about 1 inch beyond orifice, past
internal sphincter
32
Administration of a Disposable
Enema
• The dose form will be a prepackaged,
disposable-type enema solution
• Equipment is simple
• Perform standard premedication assessment
Administration of a Disposable
Enema (cont’d)
• Technique begins with FIVE RIGHTS

Explain procedure and check pertinent
parameters
• Time of last defecation
Patient
P ti t bends
b d uppermostt leg l
Apply lubricant to rectal tube
Insert lubricated tube and insert solution
Parenteral Administration
• Parenteral means drug administration by any
route other than the gastrointestinal tract
• Parenteral route
Intradermal
Subcutaneous
Intramuscular (IM)
Intravenous (IV)
33
Chapter 10
Parenteral Administration:
Safe Preparation of Parenteral
Medications
Equipment Used in Parenteral

Administration
• The syringe has three parts: barrel, plunger,
and tip
• Syringes are calibrated in minims, milliliters,
or cubic centimeters
• Tuberculin syringes are used to measure
smallll volumes
l off medication
di ti accurately
t l

Administration (cont’d)
• The insulin syringe has a special scale for

measuring insulin
• In the United States, insulin is manufactured

in U-100 concentration
The U-100 syringe holds 100 units of insulin
per milliliter
Low-dose insulin syringes are used for
patients receiving 50 units or less of U-100
insulin
34
• Prefilled syringes are disposable and have a

premeasured amount of medication
Advantages: time saved in preparation, less

chance
h off contamination
t i ti
Disadvantages: additional expense, different

holders for different cartridges, volume of
second medication limited

• The needle has three parts:

Hub
Shaft
Beveled tip
• The needle gauge is the diameter of the hole

through the needle
• Needle selection depends on age of patient,

and site (subcutaneous, IM, or IV)—see
Table 10-1

• Major safety development: needleless

systems
Provide an alternative to needles for routine

procedures, reducing the risk of needlesticks
with contaminated sharps
35
• Other safety devices have been developed
BD Safety-Lok Syringe
BD SafetyGlide Shielding Hypodermic Needle
BD SafetyGlide Syringe Tiny Needle Technology
BD Integra Syringe
Parenteral Dose Forms

• Ampules
Glass containers usually containing a single
dose
• Vials
Glass containers that contain one or more
doses
• Mix-O-Vials
Glass containers with one dose, two
compartments
Preparation of Parenteral
Medication
• Equipment needed for preparation of

parenteral medications
Drug in sterile, sealed container

Syringe of the correct volume
Needles of the correct gauge and length
Needleless access device
Antiseptic swab
MAR or medication profile
36
Preparation of Parenteral
Medication
• Techniques for preparing all parenteral

medications
Use the five RIGHTS: Right Patient, Right

Drug, Ri
D Right
ht R
Route
t off Ad
Administration,
i i t ti Ri
Right
ht
Dose (Amount and Concentration), Right Time
of Administration
Check the drug dose form ordered against the

source you are holding
Preparing a Medication from

an Ampule
• Move solution to the bottom of the ampule
• Cover the ampule neck with a sterile gauze

pledget or antiseptic swab while breaking off
top
• Using an aspiration needle, withdraw

medication from ampule
Preparing a Medication from

an Ampule
• Remove the needle from the ampule and

point the needle vertically
• Pull back the plunger. Replace the aspiration

needle with a new sterile needle
• Push plunger until medication is at tip of

needle
37
Preparing a Medication from a
Vial
• Cleanse the top of the vial of diluent
• Pull plunger of syringe to fill with an amount

of air equal to the volume of the solution to be
withdrawn
• Insert the needle or needleless access device

through the diaphragm, inject air
• Withdraw the measured volume of diluent

required to reconstitute the powdered drug
Preparing a Medication from a Vial
• Tap the vial of powdered drug to break up

caked powder; cleanse the rubber diaphragm
with swab
• Insert the needle or needleless access device

iin th
the di
diaphragm
h and
d iinject
j t th
the dil
diluentt iin th
the
powder
• Mix thoroughly to dissolve powder
• Change needle to correct gauge and length

to administer the medication to the patient
Preparing a Medication from a

Mix--O-Vial
Mix
• Tap the container a few times to break up the
caked powder
• Remove the plastic lid protector
• Push firmly on the diaphragm-plunger
• Mix thoroughly
• Cleanse the rubber diaphragm and remove

drug using syringe to administer to patient
38
Special Preparations
• Occasionally two medications may be drawn

into the same syringe for a single injection
• Medications
M di ti need
d tto b
be prepared
d ffor use iin
the sterile field during a surgical procedure
39

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NUR 106: Course Schedule

• 1/24: Ch: 1,2

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 4

NUR 106: Course Schedule Cont’d

• 3/21: Ch: 30,33

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 5

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 6

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 7

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 8

Sources of Drug Information

• United States Pharmacopeia Dispensing

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 10

U.S. Drug Legislation

• Federal Food, Drug, and Cosmetic Act (1938,

• Controlled Substances Act (1970)

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 11

• Drug review process

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc . Slide 12

 A strong understanding of the human body’s

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Categories of Drug Administration

• Enteral route: PO, Rectal, NG

• Parenteral route: subQ, IM, IV

• Percutaneous route: inhalation, sublingual,

• Factors modifying the

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

• Side effects/ Adverse effects

• Allergic reactions: i.e. hives, urticaria

Principles of Drug Action and

• Adverse effect: “Any noxious, unintended and

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Principles of Drug Action and

 Drug interactions represent 3% to 6% of

 Drug interactions are a major component of

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 23

Drug Action Across the Life Span

• Age and gender affect drug therapy

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 24

Drug Action Across the Life Span

 In nearly every body system, men and women

 Men and women perceive and experience

 Fundamental questions remain about how

Drug Absorption: Age Considerations

• Special considerations for pediatric and older

 Differences in muscle mass, blood flow, and

 Topical and transdermal administration differs

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 27

• Topical administration in infants is effective

 Outer layer of skin (stratum corneum) not fully

 Skin more fully hydrated; plastic diaper

 Inflammation (diaper rash) increases

Drug Absorption: Age Considerations

• Difficult to predict in geriatric patients

 Dermal thickness decreases with age and may

 Drying, wrinkling, and decreased hair follicles

 Decreased cardiac output and diminishing

Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc. Slide 29

Drug Absorption: Age Considerations

• Gastrointestinal absorption influenced by:

 Gastric emptying time

A strong understanding of the human body’s

Drug interactions represent 3% to 6% of

Drug interactions are a major component of

In nearly every body system, men and women

Men and women perceive and experience

Fundamental questions remain about how

Differences in muscle mass, blood flow, and

Topical and transdermal administration differs

Outer layer of skin (stratum corneum) not fully

Skin more fully hydrated; plastic diaper

Inflammation (diaper rash) increases

Dermal thickness decreases with age and may

Drying, wrinkling, and decreased hair follicles

Decreased cardiac output and diminishing

Gastric emptying time

Blood flow of mucous lining and intestines

Empty solids more slowly

Have greater gastric acidity

Have lower gastric levels of alcohol

Process by which the body inactivates

Affected by genes, diet, age & maturity of

Liver weight and hepatic blood flow decrease

Reduced renal and hepatic function

Polypharmacy—multiple-drug therapy required

A greater likelihood of malnourishment due to

Take thorough drug history and nutritional