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PHARMACOLOGYPHARMACOLOGYCONNECTIONS TO NURSING PRACTICECONNECTIONS TO NURSING PRACTICE
Second EditionSecond Edition
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
CHAPTER
Introduction to Pharmacology: Concepts and Connections
1
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Learning Outcomes
1. Identify key events in the history of pharmacology.
2. Compare and contrast the terms drug, pharmacology, and pharmacotherapy.
3. Explain the importance of pharmacotherapy to clinical nursing practice.
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Learning Outcomes
4. Using specific examples, explain the difference between the pharmacologic and therapeutic methods of classifying drugs.
5. Identify the advantages of using prototype drugs to study pharmacology.
6. Classify drugs by their chemical, generic, and trade names.
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Learning Outcomes
7. Compare the advantages and disadvantages of a pharmaceutical company being granted exclusivity for the development of a new drug.
8. Analyze possible differences between generic drugs and their brand-name equivalents.
9. Assess the responsibilities of the nurse in drug administration.
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
PharmFact
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Pharmacology as Science
• With science, pharmacology becomes a discipline
• Herbal remedies are first used• Word pharmacology first referenced in
1693• Modern pharmacology begins in 1800s• Chemists first isolated active agents• Early drugs are from natural plants
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Pharmacology Today
• Current practice is complex• Application is still the same• Focus on patient and improving quality
of life – to relieve human suffering• Important part of the art and discipline
of nursing• IN NURSING THIS IS A PART OF OUR
ART AND SCIENCE THAT REQUIRES 100% TIME AND ATTENTION
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.2 Pharmacology is the study of medicines.
Pharmacology: The Study of Medicines
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
What is a Drug?
• Any substance that is taken to:– Prevent– Cure– Reduce
Symptoms of a medical condition
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Role of the Nurse
• Drugs are a form of medical intervention
• Nursing designs interventions for desired health goals
• Pharmacotherapy is a critical intervention
• Nurse administers the drug, assesses the effects and teaches the client about the drug (this is a summary of the role)
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Figure 1.1 Rationale for pharmacotherapy: A partnership between the patient and the health care provider.
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Pharmacology:The Study of Medicine
• The word pharmacology comes from the Greek– Pharmakon = medicine or drugs– Logos = to study
• Pharmacotherapy is the application of drugs for prevention or treatment
• Pharmacology covers administration, metabolism, and response
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.3 The perfect drug is safe and effective.
Characteristics of an Ideal Drug
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Characteristics of Drugs
• Over 11,000 brand, generic, and combination agents
• Each has its own application, interactions, side effects, and actions
• Many have multiple effects on the body• Patient factors can alter responses
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Patient Factors
• Age• Gender• Race• Body Mass• Health Status• Genetics this is an emerging area of
study
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Drug Actions
• New drugs introduced every year• New and old drugs are removed yearly• Drugs can improve quality of life• Drug reactions can also cause disability
or death• Enormous challenge to stay current and
up to date in the application of medications
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Is There a Perfect Drug?
• What is the perfect drug?– It would do everything you want– No side effects– Convenient– Inexpensive– No interactions– Quickly eliminated
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Drug Indications
• All prescription drugs must have some degree of effectiveness
• Drugs are approved by their indications• Every drug has at least one indication• Many drugs have multiple indications• Unapproved indications are unlabelled
or off-label
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Clinical Nursing Practice
• Nurses need to have an understanding of how a drug works
• Drug therapy is a large part of the nursing process
• Nurses need to understand how patient variables affect drug therapy
• Nurses need to stay up to date
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.4 Drugs may be organized by their therapeutic classification or pharmacologic classification.
Classification of Drugs
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Classification of Drugs
• FDA is the Food and Drug Administration
• FDA.com• Orange Book of approved drugs• Classified by therapeutic and
pharmacological properties
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Classification of Drugs
• Pharmacologic – how the drug acts• Used for both prescription and non-
prescription medications
• Therapeutic – what is being treated by the drug
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Therapeutic Classifications
• Therapeutics is the usefulness in treating a specific disease
• A drug may lower blood pressure, but also relieve chest pain
• A drug may lower blood glucose and also lower cholesterol
• Classification is what condition is being treated by the particular drug
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Table 1.1 Organizing Drug Information by Therapeutic Classification
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Pharmacologic Classification
• Pharmacologic is the mechanism of the drug or how the drug produces its effects in the body
• Three different drugs can lower blood pressure, but each differs in its mechanism of action
• May use drug’s chemical name
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Table 1.2 Organizing Drug Information by Pharmacologic Classification
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Classifications
• Drugs can have multiple classifications• Dependent on the clinical use of the
drug• Important to understand and know the
different classifications for each drug• You will be learning drugs by
classification. I will focus on these rather than individual drugs*
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.5 A prototype drug is the agent to which all other drugs in a class are
compared.
Drug Prototypes
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Prototype
• Single drug from each class• May compare all other medications in
the class to the prototype• Usually first drug in its class• Can be combination of traditional and
new drugs• Helps with learning pharmacology
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.6 Drugs have chemical, generic, and trade names.
Naming Drugs
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Chemical Names
• Each drug has only one chemical name• Clear, concise meaning of the nature of
the drug• Often difficult to remember and
pronounce• As nurses we are not concerned about
the chemical name
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Generic Name
• Assigned by United States Adopted Name Council
• Less complicated than chemical names• Many organizations use generic names to
describe and identify• Easy for students to memorize one name• Focus on the generic name• For testing purposes I will give both
generic and trade
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Brand Name
• Name given by the pharmaceutical company marketing the drug
• Tries to be short and easy to remember• Proprietary • Each drug receives period of exclusivity
for marketing
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Trade Names
• Products with the same drug• May contain one or more active
ingredient• Combination drugs have more than one
active generic ingredient
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Generic Drugs
• Usually less expensive than trade name drugs
• Drug formulations may be different• Inert and/or active ingredients may be
same or different• This can change the bioavailability
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Table 1.3 Examples of Generic Drugs Contained in Brand-Name Products
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.7 Generic drugs are less expensive than brand-name drugs, but they may
differ in bioavailability.
Naming Drugs
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Generic Substitution
• Laws vary by state• Pharmacists may substitute generic for
brand• Pharmacists may have to obtain approval
from provider before substituting generic• Can be cost saving for patients• Many pharmacies offer generic lists• PCP may write DAW (dispense as written)
of NO GENERIC SUBSTITUTIONS
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Exclusivity of New Drugs
• Pharmaceutical companies market their brand-name drugs
• Claim significant difference between brand and generic
• Consumer advocates argue generic should be available
• Cost difference between generic and brand can be significant
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Bioavailability
• Defined as the rate and extent to which the active ingredients are absorbed from a drug product and then available at the site of action
• May be different between trade and generic
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Internet Sales
• Drug laws vary by country• Some drugs may be available without a
prescription• Quality control standards may differ• Sources may be unreliable• Nurses must help patients understand
the differences and dangers
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
1.8 Pharmacology is intimately connected to nursing practice and is a
key intervention in relieving and preventing human suffering.
Connecting Pharmacology to Clinical Nursing Practice
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Nursing Practice
• Understanding of pharmacology is critical to nursing practice
• One of the key interventions in nursing care
• The nurse must understand the pharmacotherapeutic principles for all medications
• Key to elimination of medication errors
Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban
Nurse’s Responsibilities
• Name of drug• Intended use (sometimes used for
unlabeled use or side effects)• Dose range• Effects on body• Contraindications and precautions• Special considerations of administration