RANC Faculty Revised & Approved 7/2012
REGION A NURSING CONSORTIUM
Haywood Community College
Tri-County Community College
COURSE OUTLINE/OBJECTIVES
NUR 117 PHARMACOLOGY
COURSE DESCRIPTION
This course introduces information concerning sources, effects, legalities, and the safe use of
medications as therapeutic agents. Emphasis is placed on nursing responsibility, accountability,
and application of the nursing process regarding drug therapy. Upon completion, students should
be able to compute dosages and administer medication safely.
Prerequisites: Admission to the Nursing Program or permission of the Program Director.
Co-requisites: None
Contact Hours: Lecture 1 Lab 3
Credit Hours:
2
REQUIRED TEXTBOOKS
Clayton, Stock and Cooper, Basic Pharmacology for Nurses, ISBN: 9780323057806
Morris, Calculate with Confidence, ISBN: 9780323056298
Mosby’s Nursing Drug Reference Book-2012 Ed.
Zerwekh, Mosby’s Pharmacology Memory Notecards 3rd Ed ISBN: 9780323078009
OTHER RECOMMENDED TEXTBOOKS
Delmar’s Integrative Herb Guide for Nurses. United States: Delmar.
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RANC Faculty Revised & Approved 7/2012
NUR 117 Pharmacology
OBJECTIVES
I.
Discuss terminology, drug sources, and drug classifications related to the
pharmacological aspect of patient care.
A. Define Pharmacology.
B. Discuss terminology related to Pharmacology.
1. Drug
2. Prescription drug
3. Prescription/0TC drug
4. Controlled drug
5. Holistic/herbals
II.
,
Begin to utilize the nursing process in formulating and providing safe culturally
and developmentally appropriate, patient-centered nursing care related to drug
therapy.
A. Discuss specific, important drug information that a nurse must know
to safely administer each medication.
1. Drug names
2. Classifications
3. Therapeutic actions
4. Indications
5. Contraindications/precautions
6. Dosage
7. Adverse effects
8. Interactions
9. Nursing considerations
10. Patient education
B. Discuss the areas of knowledge needed to safely and effectively administer
medications within assigned classes.
1. Insulin
2. Pain Medications-Narcotic and Non-Narcotic
3. Laxatives
4. Antacids
5. Antiemtics
6. Sedatives
7. Hypnotics
8. Antihypertensive agents
9. Diuretics
10. Antimicrobial Agents
11. Herbals
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RANC Faculty Revised & Approved 7/2012
C. Describe special considerations of drug therapy throughout the client’s lifespan.
1. Pregnancy/lactation
a. FDA pregnancy risk ratings
b. therapeutic drug use during pregnancy
2. Neonatal
3. Pediatric
4. Adult
5. Geriatric
a. physiologic changes
b. psychologic changes
c. polypharmacy
D. Describe how culture, ethnicity, race, religion, and health beliefs of individual
clients may impact drug therapy.
1. Caucasians
2. African-American
3. Hispanic American
4. Asian American
5. Native American
6. European American
7. Other
8. Self-treatment
a. Ethno-pharmacology (folk/herbal medicine)
b. Nonprescription (OTC) drugs
9. Personal or symbolic meaning
E. Identify subjective and objective data collection associated with drug therapy
1. Drug history.
a. current medications: type, dose, frequency, length of therapy
i. prescription
ii. over-the-counter (OTC)
iii. herb/homeopathics
iv. supplements/vitamins/minerals
2. Compliance vs. Noncompliance
3. Medical history
4. Inherited/genetic factors
5. Medical diagnosis and co-morbidities
6. Allergies
a. food
b. drug
c. other allergies
d. type of reaction and action taken or outcome
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RANC Faculty Revised & Approved 7/2012
7. Lifestyle choices
a. dietary
b. smoking
c. alcohol use
d. caffeine use
e. occupation
8. Biological data
a. height
b. weight
c. age
9. Physical assessment findings
10. Mental health assessment findings
11. Economics
III. Begin to utilize the nursing process in formulating and providing safe and appropriate
NANDA diagnoses, goals/outcomes associated with drug therapy.
A. Identify common nursing diagnoses related to drug therapy.
B. Identify appropriate goal statements and outcomes related to drug therapy.
IV. Begin to utilize the nursing process in the implementation and evaluation of safe and
appropriate client centered nursing care.
A. Identify nursing responsibilities and actions related to drug therapy.
1. Professionals authorized to prescribe
2. Components of physician’s medication orders/drug labels
3. Types of medication orders
a. routine
b. PRN
c. STAT
d. single or one-time order
e. standing orders
f. protocol
4. Receiving orders
a. written
b. verbal
c. telephone/fax
5. Six Rights of drug administration
6. Knowledge of potential of interactions
7. Patient and family education
B. Identify the evaluation of the patient-centered goals/outcomes related to drug therapy.
1. Ongoing monitoring of patient response to drugs
a. therapeutic response
b. non-therapeutic response
2. Evaluation methods
3. Identifying inappropriate use of medication
a. misuse
b. recreational/leisure
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RANC Faculty Revised & Approved 7/2012
V.
Begin to effectively utilize verbal and written communication skills in collaboration
with clients and health care team members.
A. Utilize accurate terminology and abbreviations related to drug therapy.
B. Compare various types of documentation related to drug therapy.
1. Medication orders
2. Medication administration record (MAR)
a. written
b. electronic
C. Discuss effective communication with other professionals related to drug therapy.
1. Health care provider (physician, etc.)
2. Pharmacy department
a. pharmacist
b. pharmacy technician
3. Nursing staff
4. Utilizing chain of command
D.
VI.
Identify ways in which the nurse can evaluate professional/personal actions
related to medication administration.
Begin to effectively manage and utilize information technology in the
pharmacological care of the client
A. Automated Dispensing Systems
B. Point of Care Identification Systems
VII.
Begin to implement teaching plans to meet the pharmacological needs of clients.
A. Discuss the nurse’s role related to client teaching
1. Determination of client’s knowledge base
2. Assessing readiness to learn.
a. Emotional
b. Motivational
c. Physical/pathophysiological
d. Complexity of regimen
e. Situational
f. Developmental/maturational.
3. Teaching strategies
a. Formal versus on-going teaching
b. Family or caregiver roles
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RANC Faculty Revised & Approved 7/2012
4.
Special needs
a. Low-literacy
b. Elderly
c. Pediatrics
d. Physical impairments
e. Cognitive impairments
f. Cultural/Spiritual needs
g. Non-English speaking
VIII. Begin to demonstrate professionalism through accountability and responsibility for
personal actions, nursing practice and by maintaining legal-ethical standards.
A. Identify ways in which the nurse can effectively collaborate with the client in the
administration of drug therapy.
B. Discuss the legal and historical development of Pharmacology.
1. 1938: Food, Drug and Cosmetic Act
2. 1938: Orphan Drug Act
3. 1970: Controlled Substance Act
4. 1997: The Food and Drug Administration Modernization Act
5. 2003: Health Insurance Portability and Accountability Act (HIPAA)
6. 2003: Medicare Prescription Drug Improvement and Modernization Act (MMA)
C. Discuss the processes of new drug development.
1. Standardization
2. Phases of testing and clinical trials for FDA approval
3. Unlabeled use of drugs
4. FDA pregnancy risk categories
5. Informed Consent
i. age
ii. population testing
iii. mental health
D. Discuss legal and ethical issues associated with medication administration.
1. Licensure
2. Pre-pouring
3. Pre-charting
4. Handling of controlled substances
5. Falsification of documentation
6. Assault and battery
7. Chemical restraints
8. Threat to withhold medications
9. Use of placebos
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E. Identify the scope of nursing management in drug therapy delegation
1. RN
2. LPN
3. Medication Aide
4. Home Health Aides/Technicians
F. Discuss health care accessibility and modes for the uninsured to obtain
prescription medication for the treatment of illness.
IX.
Begin to learn and utilize the necessary skills to manage the pharmacological aspect
of care for individuals and groups.
A. Discuss common routes of medication administration.
1. Oral
2. Ophthalmic
3. Otic
4. Sublingual/buccal
5. Transdermal
6. Rectal
7. Metered Dose Inhaler
8. Nasogastric/gastric tube
9. Parenteral
a. intradermal
b. subcutaneous
c. intramuscular
d. Z-track
e. intravenous
f. epidural
B. Discuss the appropriate use and disposal of medication administration equipment
C. Demonstrate the proper administration of common selected preparations of medications.
1. Oral
2. Rectal
3. Nasogastric/Gastric Tubes
4. Parenteral
a. subcutaneous
b. intramuscular
c. intravenous
D. Discuss information located on medication labels.
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RANC Faculty Revised & Approved 7/2012
E. Discuss how to safely and accurately calculate for medication administration.
1. Reducing fractions to common denominators
2. Adding and subtracting fractions and decimals
3. Dividing and multiplying fractions and decimals
4. Expressing decimals, fractions, ratios and percents as equivalents
5. Solving equations to determine dose (“x”)
6. Using ratio and proportion
7. Using measurement and system conversion
a. metric
b. apothecary
c. household
8. Calculating milli-equivalent, unit, percentage, and ratio strengths
9. Reconstituting drugs
10. Setting up proportions to determine volumes
11. Using the formula method to determine doses
a. metric
b. international units
c. milli-equivalents
12. Using mg/kg, mcg/kg, mg/lb
13. Using Body Surface Area (BSA) formulas
14. Verifying that prescribed dose is therapeutic and safe for client
X.
Begin to utilize evidence-based research to enhance client care.
A. Utilize various sources of drug information.
1. Official
a. The United States Pharmacopeia (USP)
b. National Formulary (NF)
2. Unofficial
a. Pharmacy Services (facility-based formulary, pharmacist)
b. Physicians’ Desk Reference
d. Drug handbooks (text and electronic-PDA)
e. Internet sources
B. Define the mechanisms of drug action.
1. pharmaceutical phase
2. pharmacokinetics
3. pharmacodynamic
4. pharmacotherapeutics/ drug response
5. drug toxicology
C.
Discuss the principles of the pharmaceutical phase of drug action.
1. disintegration
2. dissolution
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D.
Discuss the principles of the pharmacokinetic phase of drug action.
1. Absorption factors
a. transport mechanisms
b. food and fluid
c. condition of absorption
d. pH
2. Distribution factors
a. vascular
b. plasma protein binding
c. tissue binding
d. blood-brain/placenta barriers
3. Metabolism (biotransformation) factors
a. liver
b. hepatic first pass effect
c. metabolites
4. Excretion factors
a. kidneys
b. G.I.
c. lung
d. sweat and saliva
e. breastmilk
f. hemodialysis
5. Biological half life
E. Discuss the principles of the pharmacodynamic phase of drug action.
1. Drug-receptor interaction
2. Drug-enzyme interaction
3. Nonspecific interaction
F.
Discuss the principals of the pharmacotherapeutic phase of drug action .
1. Types of drug therapy
a. acute
b. maintenance
c. supplemental
d. palliative
i. supportive
ii. prophylactic
iii. adjuvant
2. Serum concentration
a. onset
b. peak
c. duration
3. Therapeutic index
4. Drug bioavailability
5. Side effects
6. Adverse reactions
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RANC Faculty Revised & Approved 7/2012
a. patient factors
i. age
ii. BMI
iii. sex
iv. environment
v. time of administration
vi. pathologic state
vii. genetic factors
viii. psychologic factors
7. Iatrogenic responses
8. Allergic reactions
9. Drug-induced reactions
a. tolerance
b. tachyphylaxis
c. cumulative effect
d. idiosyncrasy
e. drug dependence
i. physical
ii. psychological
10. Teratogenic/mutagenic effects
11. Carcinogenic effects
12. Interactions
a. drug-drug
i. drug antagonism
ii. summation (additive effect)
iii.synergism
iv. potentiation
v. incompatibilities
b. drug-food
i. malabsorptions
ii. malexcretion
c. other:
i. enzyme alteration
ii. alcohol
iii.cigarette smoking
iv.caffeine
G.
Discuss the principles of drug toxicity.
H.
Identify lab and diagnostic procedures associated with drug administration.
1. Therapeutic serum drug levels
2. Body fluid analysis
a. Blood: CBC with Differential
b. Urine
c. Culture and Sensitivity
d. Peak and trough
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RANC Faculty Revised & Approved 7/2012
XI.
Begin to utilize quality improvement to insure patient safety and quality of care.
A.
Discuss the importance of knowing and abiding by institutional policies and
procedures.
B.
Identify and discuss types and prevention of medication errors in the
pharmacological management of the client.
C.
Discuss practices that interfere with effective medication management
1. Polypharmacy
2. Overprescription of antibiotics
3. “Look alike-sound alike” drugs
4. HIPAA violations
D.
Begin to analyze medication errors for causes, circumstances, and associated
factors.
E.
Identify procedures for reporting and documenting medication errors.
F.
Identify standards of care with regard to medication administration and
management.
1. Institute for Safe Medication Practices
2. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
G.
Discuss nursing skill competency through continuing education.
H.
Discuss patient advocacy in relationship to pharmacological management of nursing
care.
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