NUR100 Pharmacology
Information to Know for Basic Pharmacology Chapters 1-9
The Nursing Process and Drug Therapy – Chapter 1
 Describe the 5 phases of the nursing process and relate the steps of the nursing process to the
administration of medications; what does the nurse need to know to be able to evaluate the
effectiveness (therapeutic effect) of a patient’s medication? What is involved in developing outcome
statements? Patient-centered, objective, measurable, etc. See p. 5 (remember that assessment and
evaluation are both assessment – one is done prior to providing the nursing intervention and the other
[evaluation] is done after interventions
o ADPIE: Assessment, Analysis/diagnosis, Planning: outcome identification, Implementation,
Evaluation
o Assessment: objective and subjective; pain scale is objective/subjective… its their pain which is
subjective but the actual number on the scale is objective… It’s their “6 out of 10 scale etc”
o Planning: outcome identification- outcomes are patient-centered, objective, measurable, and
realistic with an established time frame for their achievement
o Evaluation: occurs after implementation but also needs to occur at each phase of NP. It is
systemic and ongoing. Monitors pt’s therapeutic response to the drug and its adverse effects and
toxic effects
 Describe the elements of a complete medication history
o Over the counter medications (OTC)
o Prescriptions (Rx) medications
o Street drugs
o Herbal supplements
o Allergies
 AKA  all known allergies
 NKA  no known allergies
 NKDA  no known drug allergies
o Diseases
o Growth and Development
 Describe the Six Rights of safe medication administration and how to ensure each “right” (know that
your book mentions 9 rights, which are recommended) Remember: Documentation is completed after
the med is given.
o 1. Right Drug: Verify spelling with drug order (MAR)
o 2. Right Dose: verify calculations… ask another RN to check if unsure
o 3. Right time: one hour before or one hour after for routine meds… not like insulin
o 4. Right route and form: do not assume.. verify with prescriber if doubt
o 5. Right patient: check ID band; have patient state name and DOB and compare to MAR
o 6. Right documentation: document on MAR; document PRNs and patient response in chart
o 7. Right Reason: confirm rationale for use of med
o 8. Right response: continually evaluate the achievement of desired response as well as any
undesired response
o 9. Right to refuse: respect right to refuse, determine the reason, document, and notify
prescriber… ask why? Could be stomach upset…. Offer snack with it.
o Additional: Right education- use every opportunity to teach patient/ family regarding meds as
well as nonpharmacologic measures to enhance drug therapy (diet, exercise, lifestyle changes,
etc)
 Describe the seven elements that are required in a medication order; question if anything missing
1. Patients name
2. Date the drug order was written
3. Name of drugs
4. Drug dosage amount
5. Drug dosage frequency
6. Route of administration
7. Prescribers signature
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Discuss the nurse’s role/responsibility when questioning a medication order
Pharmacologic Principles – Chapter 2
 Define “pharmacotherapeutics” – (reason for taking a drug to get benefit; evaluating the appropriateness
of a drug used for treating a specific condition)
o The treatment of pathologic conditions through the use of drugs. The types of therapies can be
categorized as acute, maintenance, supplemental/replacement, palliative, supportive,
prophylactic, or empiric
 Define “pharmacokinetics”
o The study of what the body does to the drug. Includes 4 processes: ADME “add me”
 Absorption, distribution, metabolism, excretion
 Movement of the drug through the body from the time its put into the body until the parent
drug and all metabolites have left the body
 Describe the four main processes of pharmacokinetics, to include a discussion of:
*Absorption, distribution, metabolism, and excretion Remember they are in order
*Onset- time it takes for the drug to elicit a therapeutic response.. time it takes drug to start working,
peak- time it takes for a drug to reach is maximum therapeutic response in body or when drug is doing
the best it can, and duration of effect/ action- the length of time that a drug concentration in the blood or
tissues is sufficient to elicit a therapeutic response
*Minimum effective concentration (MEC)- the plasma drug level below which therapeutic effects will not
occur, therapeutic index/window- when the amount of the drug in the plasma is above the minimum
effective concentration MEC and below the toxic concentration. Some drugs have a narrow therapeutic
range like lithium, subtherapeutic- below therapeutic levels and toxic effects/ concentration- when
plasma drug levels climb too high; this is above the therapeutic range
 Discuss the main organ involved in drug metabolism (or biotransformation) and the labs to monitor for its
function LFTs, liver function tests, liver enzymes, etc. Remember that acetaminophen (Tylenol) can be
hepatotoxic
o Liver: drugs are leading cause of acute liver failure… combining hepatotoxic drugs with certain
other drugs may increase damage
o Labs: liver function test (LFTs) should be obtained as a baseline and periodically (ab every 3
months) throughout therapy.
 AST (aspartame aminotransferase) 0-35
 ALT (alanine aminotransferase) 4-36
 Alk phos (alkaline phosphatase) 30-120
 LDH 100-190
 GGT 8-38
 Describe the action of a drug that is an enzyme inhibitor and how that affects drug concentration;
describe the action of an enzyme inducer (also known as just as “inducer”) and how that affects drug
metabolism and serum drug concentrations (may have to increase dose or increase frequency of
administration)
o Drugs that can inhibit drug metabolizing enzymes are called enzyme inhibitors
o Decreases in drug metabolism result in the accumulation of the drug and prolongation of the
effects of the drug, which can lead to drug toxicity
o In contrast, drugs that stimulate drug metabolism are called enzyme inducers. This can cause
decreased pharmacologic effects. Often occurs with repeated administration of certain drugs that
stimulate the formation of new microsomal enzymes
 Grapefruit juice taken with certain medications can affect metabolism and increase risk of toxicity by
inhibiting the metabolism of drugs and raising drug levels in the body
 Discuss the main organ involved in drug excretion and the labs to monitor for its function Kidney; BUN &
creatinine
o The kidneys
 Labs BUN (blood urea nitrogen) and creatine
 BUN 8-20 (I ate 20 buns)
 Creatine 0.6-1.2
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Differentiate between loading dose and maintenance dose and discuss why a patient may receive a
loading dose of digoxin or an anti-infective (antibiotic)
o Loading dose: a large initial dose or doses to achieve steady state (plateau); used with digoxin
and antibiotics… digoxin loading dose also called digitalizing dose
o Maintenance dose: after high drug levels have been obtained with loading dose, plateau can be
maintained by giving smaller doses called maintenance dose
Define “pharmacodynamics” – the study of what the drug does to the body (mechanism of action);
includes drug-receptor relationships
Discuss drug-receptor interactions (agonists, antagonists)
o Drug-receptor interactions: when the action of one drug is affected by the action of another drug.
As number of drugs taken at one time increases so does the risk of interactions
o Agonists: drug that binds to the receptor, producing a similar response to the intended chemical
and receptor.
o Antagonists effect: combined effect is less than the effect produced by the active drug alone;
second drug eliminates or diminishes activity of the first drug. Examples: naloxone (Narcan) for
narcotic OD; antacids and tetracycline… so 1+1=0… drug binds to the receptor but there is no
response… drug prevents binding of agonists
Peak and trough drug monitoring – Remember: if drug gets below therapeutic serum drug level, it is not
effective (below therapeutic range); if it gets above therapeutic range, it becomes toxic level. Definitions
o Onset: time it takes for the drug to elicit a therapeutic response
o Peak: time it takes for a drug to reach its maximum therapeutic response
 Peak level for drug monitoring: highest blood level (shortly after IV or IM dose)
o Trough level for drug monitoring: lowest blood level (usually right before the next dose)
o Duration: time a drug concentration is sufficient to elicit a therapeutic response
Describe the 3 types of drug names (chemical, generic, trade) and be able to recognize common
generic drug names as described in this chapter (acetaminophen [Tylenol], ibuprofen [Advil], aspirin
[Ecotrin], diphenhydramine [Benadryl], etc.)
o Chemical: describes a drug’s chemical composition and molecular structure
o Generic name: everyday, official (nonproprietary) name given to a drug by the manufacturer who
first develops the drug. Longer and more complicated than the trade name
o Trade/ proprietary/ brand name: ex: Tylenol= trade name, generic: acetaminophen
Page 16 Table 2.1 – know rate of absorption of various oral preparations (fastest to slowest)
o Oral disintegration, buccal tablets, and oral soluble wafers
o Liquids, elixirs, syrups
o Suspension solutions
o Powders
o Capsules
o Tablets
o Coated tablets
o Enteric-coated tablets
Describe the purpose of enteric-coated medications and teaching regarding their use
o Covered with material so the drug dissolves in the intestine and protects the drug from stomach
acid. Protects stomach from irritating drugs
Remember that different forms and routes of drugs can affect how quickly a medication will work
(bioavailability)
o Parenteral: general term for any route other than alimentary canal… commonly injectable route
 IV, IM, SQ, Intraarterial, Intraarticular (joint), Intrathecal: within a sheath.. spinal cord
o Enteral: drug is absorbed through the systemic circulation through the oral or gastric mucosa, the
small intestine
 Oral: two barriers to absorption: GI tract epithelial cells and capillary walls
 Sublingual: medication absorbed into the highly vascularized tissue under the tongue;
absorbed rapidly… these drugs bypass the liver.. same for buccal route
Differentiate between a precaution and a contraindication
o Precaution: includes disease states or clinical situations when drug use involves ricks or in which
drug dosage modification is required
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Contraindication: situations when drug use should be avoided or alternatives strongly
considered. Most drugs are contraindicated in pregnancy and lactation. May be absolute
(allergy) or relative
Common poisons and their antidotes for acetaminophen (OD of Tylenol can damage the liver; FDA
recommends 4,000 mg/day and 3,000 mg /day for older adults and those with liver disease);
benzodiazepines (end with –lam or –pam); opiates (naloxone is generic for Narcan) – opiates can cause
resp. depression; see Table 2.11 on p. 31
o Acetaminophen  antidote: acetylcysteine
o Benzodiazepines  flumazenil
o Opiates, opioid drugs  naloxone (generic for Narcan)
Lifespan Considerations – Chapter 3
 Discuss how the risk of drug interactions increases with the number of medications one is taking (esp.
the elderly); see notes in packet regarding Drug Therapy and the Older Adult
o Polypharmacy and drug use
o Geriatric patients take an estimated 35% of all prescription drugs and 42% OTC meds
o As number of meds increase, so does risk of drug interaction. With 10 drugs there is a 100% risk
of drug interactions
o For the older adults, rule is “start low and go slow”
 Dose may be ½ to 2/3 standard adult dose
o Drug nonadherence/ noncompliance is repo0rted in approx. 55% of elderly population… could
be bc of higher cost etc.
o Drug accumulation (renal and hepatic functions decreased)
o Problematic geriatric medications: opioids, NSAIDs (nonsteroidal anti-inflammatory drugs),
Anticoagulants 9heparin, warfarin), anticholinergics, antidepressants, antihypertensives, cardiac
glycosides (digoxin), CNS depressants (muscle relaxants, opioids), sedatives and hypnotics,
thiazide diuretics
 Discuss the physiologic changes that occur during pregnancy and their effect on drug dosing
o 1st trimester fetus is at greatest risk for drug-induced developmental defects. The embryonic
period (3-8 weeks) is when expectant mothers must take special care to avoid exposure to
teratogens (agent or factor that could cause defects)
o Last trimester greatest percentage of maternally absorbed drug will get to the unborn baby.
This is because increased blood flow and lipid soluble drugs cross the placenta the easiest.
o Assume any drug taken can cross the placenta
o Must use drugs with good judgement, during pregnancy included hypertension, epilepsy,
diabetes, asthma, and infection could seriously endanger both the mother and the baby
 Define “teratogenesis” and its relationship to drug therapy during pregnancy
o Teratogenic effect: drugs that cause abnormal fetal development when given to a pregnant woman (birth
defects)
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Distinguish between the pregnancy categories for potential drug risk, and discuss the rationale for a
woman taking a category D drug during pregnancy (know if patient is sexually active, using birth control,
may be pregnant, and risks involved if pregnant) – review risks and benefits for category D drug, as they
increase risk for teratogenic adverse effects
o Category A studies indicate no risk on human fetus
o Category B studies indicate no risk to animal fetus; info for humans not available
o Category C animal studies w/ adverse effects reported in fetus; no controlled studies in women
o Category D possible fetal risk in humans has been reported; potential benefit versus risk may
warrant treatment in pregnant women (asthma, hypertension, epilepsy, infection)
Discuss the age-related pharmacokinetic effects (ADME.. absorption, distribution, metabolism,
excretion) that make the pediatric patient and the elderly patient more sensitive to drug effects
o Pediatric: skin is thinner and more permeable, stomach lacks acid to kill bacteria, lungs have
weaker mucous membranes, body temp is less well regulated and dehydration occurs easily,
liver and kidneys are immature so drug metabolism and excretion is impaired
 Absorption
 gastric PH is less b/c acid in stomach is immature
 Gastric emptying is slowed bc irregular or slow peristalsis
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 1st pass elimination by liver is reduced bc of immaturity of liver
 IM absorption is faster and irregular
Distribution
 Body water weight is 70-85%.. depending on age
 Fat content is lower b/c of greater body water
 Protein binding is decreased bc of decreased production of protein by immature
liver
 More drugs enter brain b/c of immature blood-brain barrier
Metabolism
 Levels of enzymes are decreased bc of immature liver not producing enough
Excretion
 Kidney immature… glomerular filtration rate
 Perfusion to kidneys may be decreased
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Elderly
 Absorption and distribution
 Decreased cardiac output = decreased absorption and distribution
 Decreased blood flow = decreased absorption and distribution
 Higher pH (gastrointestinal) = altered absorption
 Decreased peristalsis = delayed gastric emptying
 Metabolism (liver)
 Decreased enzyme production (liver) = slower metabolism
 Decreased blood flow = slower metabolism
 Excretion (renal)
 Decreased blood flow = decreased excretion
 Decreased function = decreased excretion
 Decreased glomerular filtration rate = decreased excretion
Discuss the pharmacokinetic factors that affect drug dosing in pediatric patients and factors to consider
when calculating pediatric dosages (be able to calculate dosages based upon weight; identify if
therapeutic or not)
o Dose calculations: height and weight (kg) on BSA (body surface area); more accurate method
 Ex: 5mg/kg/day….18 pound baby… 18/ 2.2= 8.18 or 8.2 kg…8.2*5= 41mg/day ****do
practice problems***
Describe polypharmacy and how it relates to adverse drug reactions in the elderly patient; polypharmacy
can produce adverse drug events, increase in healthcare costs, and noncompliance/nonadherence
Culture, Legal/Ethical Considerations – Chapter 4
 Discuss cultural influence of ethnicity and genetics on drug response; Know which ethnic groups
respond differently to antihypertensive drugs and antipsychotic/antidepressant medications (top of p.
50). Know that this is a form of pharmacogenomics.
o Culture affects health, health beliefs, and practices like drug therapy
 Asian and Hispanic: antipsychotic and Anti-Anxiety drugs
 Typically need lower dosages of antidepressants, antipsychotics, and antimanic
drugs
 African American: Antihypertensive drugs
 Respond better to diuretics than beta blockers and ACE inhibitors
 Respond best to calcium channel blockers, especially diltiazem
 Responds less effectively to single-drug therapy (BiDil for heart failure)
 Discuss various cultural factors that may influence an individual’s response to medications and how
cultural assessment should include religious practices, use of herbs, languages spoken, health beliefs
and practices, past uses of medicine, OTC meds, usual responses to illness, responsiveness to medical
treatment, support from patients’ cultural community, dietary habits.
 Know the Common Practices Among Selected Cultural Groups as summarized in your packet
o Asian: opposing forces leading to illness or health based on which force is dominating and
whether balanced
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 Yin: female, neg energies of darkness and cold
 Yang: male, positive energies of light and warmth
 Acupuncture, acupressure, herbs, heat… hot/cold foods; herbs, teas, soups
o Native American: harmony with nature, keeping balances with body, mind, and environment to
maintain health. Ill spirits can cause disease. Ex: medicine man: healer
o African American: practice folk medicine; employ “root doctors” as healers; spiritualists; use
herbs, oils, and roots
o Hispanic: view health as good luck and living right, illness as bad luck or bad deeds. Seek
balance through use of cold/ hot remedies for disease. Use curandero, spiritualist
o Western: increased participation in healthcare; demand more explanation about disease;
prevention of disease
Know definition of pharmacogenomics and drug polymorphism; note examples on pp. 48-50
o Pharmacogenomics: study of how certain genetic traits affect drug response
o Drug polymorphism: refers to the effect of a pt’s age, gender, size, body composition, and other
characteristics on the pharmacokinetics of specific drugs… how the same drug may result in
very diff responses in diff individuals… ex: Asian pts needs lower dosage of an antianxiety vs
white pt
Discuss stages of new drug development, including participants in each phase; participant in an
investigational drug study must sign informed consent and can withdraw from study at any time, no
questions asked
o Phase I: determines optimal dosage range and pharmacokinetics; involves healthy volunteers
(exception are drugs likely to have sever SE)
o Phase II: tests therapeutic utility (effectiveness) and dosage response, as well as adverse
effects; involves small numbers with disease or ailment
o Phase III: test safety and effectiveness, broader range of toxicity; may include placebos;
Evaluated in much larger number of people (multi-center trials)
o Phase IV: post-marketing studies; conducted by the pharmaceutical company (further proof of
therapeutic effects and adverse effects of the new drug); monitors safety under actual conditions
of usage
Know 3 classes of FDA recall on drugs (p. 53) and when to stop drug and notify prescriber
o Class I: most serious; use of drug may produce serious adverse effects (stop the medication)
o Class II: less sever; use may result in temporary adverse effects, but serious or permanent
adverse effects are low (stop med and contact prescriber)
o Class III: lease sever; using the med is not likely to produce significant adverse effects
Know definitions of legal and ethical terms on bottom p. 56 (autonomy, beneficence, etc.)
o Autonomy: self-determination and the ability to act on one’s own; nursing action includes
promoting patients’ decision making, supporting informed consent, and assisting in decisions
when patient is posing harm to himself or herself
o Beneficence: The ethical principle of doing or actively promoting good; nursing action includes
determine how the patient is best served
o Confidentiality: duty to respect privileged info about a patient; nursing actions include not talking
about a PT in public or outside the context of the health care setting
o Justice: the ethical principle of being fair or equal in one’s actions; nursing action include
ensuring fairness in distributing resources for the care of PT’s and determining when to treat
o Nonmaleficence: do no harm to a PT
o Veracity: duty to tell the truth; nursing action include telling truth with regard to placebos,
investigational new drugs, and informed consent
Explain the purpose of “fast tracking” of new drugs and rationale for same
o Certain lifesaving investigational drug therapies available sooner
 AIDs was the first that allowed fast track approval
 Allows pharmaceutical manufacturers to shorten the approval process and allowed
prescribers to give meds that showed promise during early phase I & II clinical trials to
qualified patients
Describe the 5 categories of Scheduled Drugs (controlled substances) and examples of drugs in each
category
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Schedule I: high abuse potential; only w/ approved protocol. Ex: heroin, LSD, marijuana
Schedule II: currently accepted medical use in US w/ high abuse potential resulting in sever
physical or psycho0logical dependence. New Rx must be written each time. Ex: morphine,
codeine, methadone, oxycodone, pentobarbital, cocaine
Schedule III: lower abuse potential for addiction and abuse. New Rx is required after 6 months.
Ex: Tylenol #3, butabarbital (butisol), anabolic steroids
Schedule IV: some abuse potential; same rules as III. Minor tranquilizers and antianxiety. Ex:
pentazocine (Talwin)
Schedule V: lowest abuse potential, some can be dispensed without prescription. Ex:
diphenoxylate (Lomotil), loperamide (Imodium), Robitussin- AC
ANA Standards for Nursing Practice describe scope of practice, function, and role of the nurse. If
standards are not met, nurse becomes liable for negligence and malpractice (see p. 54)
Medication Errors – Chapter 5
 Define terms for adverse drug reactions and explain how and why adverse drug reactions occur, even
when a prescription is deemed safe
o Adverse drug reactions: any unexpected, unintended, undesired, or excessive response to a
medication given at therapeutic dosages (not overdose)
 Allergic reaction: immune response related to prior exposure to the drug, re-exposure
triggers allergic response. Can range from mild itching to severe rash to anaphylaxis
(bronchospasm, laryngeal edema, and drop in BP)… common drugs for causing allergic
response: penicillin, NSAIDs, sulfonamide drugs: antibiotics, diuretics, and oral
hypoglycemic agents
 Carcinogenic effect: ability of certain medications/ chemicals to cause cancer
 Idiosyncratic effect: an uncommon drug response resulting from a genetic predisposition.
Occurs the first time a drug is given
 Mutagenic effect: these drug effects are permanent changes in the genetic composition
of living organisms
 Side effects: an unavoidable secondary drug effect produced at therapeutic doses. Ex:
drowsiness with antihistamines. Generally predictable and intensity is dose dependent
 Teratogenic effect: a drug-induced birth defect
 Toxicity: adverse drug reaction due to excessive dosing. Ex: sever hypoglycemia from
insulin
 Differentiate between a drug allergy and anaphylaxis; describe nursing assessment and interventions for
each; what should the nurse do if a patient states they have an allergy to a medication?
o Anaphylaxis: life threatening response characterized by bronchospasm, laryngeal edema, and
drop in BP
o Pt states allergy.. ask what happens when you are given this medication?
 Define medication errors and what constitutes an error
o Any preventable adverse drug event involving inappropriate medication use by a patient or
health care professional; it may or may not cause patient harm
 Discuss ways to reduce medication errors and how to report medication errors (nurse’s responsibility)
o 6 rights
 Identify abbreviations, symbols, and dose designations that can lead to medication errors (know med.
abbrev.) What do you do if abbreviations on the “do not use” list are in a prescription (not on facility’s
list) – contact prescriber for clarification! Also, review use of leading and trialing zeroes! See
abbreviation sheet for rules.
o A.D. right ear; A.S. left ear; A.U. both ears; cc; D/C discharge or discontinue; h.s bedtime; H.S.
half strength; IU international unit; O.D right eye; O.S. left eye; O.U. both eyes; q.d. daily; q.h.s.
every night; q.o.d. every other day; SC subcutaneous; SQ subcutaneous; ss sliding scale; sSRI;
subq; U unit; ug Microgram
 Identify people who are at risk or prone to adverse drug reactions (see your packet)
 What are high alert medications and what is the biggest concern with these medications?
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Drugs commonly involved in severe medication errors include CNS drugs, anticoagulants, and
chemotherapeutic drugs.
o Potentially toxic nature… are not necessarily involved in more errors than other drugs just a
higher potential for patient harm… high alter meds will be denoted with a red exclamation point !
What sources are best for a nurse who needs to clarify information on a prescription? (remember
reputable drug books and pharmacist; not your peers, Google, or co-workers)
What is the nurse’s responsibility and course of action if he/she makes a med error? All items to be
done; which is priority? Remember your patient is always first priority! (Don’t forget that you need to
have assessment data prior to notifying the healthcare provider.)
Patient Education and Drug Therapy – Chapter 6
 Discuss the importance of patient education in the safe and efficient administration of drugs, to include
prescriptions, OTC meds, and herbal and dietary supplements
 Discuss teaching and learning principles appropriate to patient education and drug therapy across the
lifespan (particularly the older adult); Box 6.1 Strategies to enhance patient education and reduce
barriers to learning; Box 6.3 General Teaching and Learning Principles (p. 75-76). See Table 6.1
Educational Strategies… Related to Aging That May Influence Learning
 Describe the 3 domains of learning and what type of education falls into which category
o Cognitive domain: the level at which basic knowledge is learned and stored.. thinking portion of
the learning process… incorporates individuals previous experiences and perceptions
o Affective domain: most intangible component of learning process. Behavior that expresses
feelings, beliefs, values, opinions
o Psychomotor domain: involves the learning of a new procedure or skill and is often called the
doing domain
 Review essential areas of assessment needed when planning patient education. Keep in mind
motivation and readiness to learn, regardless of other factors such as education. If patient is in pain, are
they ready to learn? If patient is depressed about medical diagnosis, are they motivated to learn?
o Adaption to illness, age, cognitive abilities, compliance w/ previous/ current therapies, coping
mechanisms, cultural background, developmental status, education (including literacy level),
emotional status, environment (home and work), folk medicine or home remedies, family
relationships, financial status, health literacy, language spoken, limitations (physical or
psychological), current medications, motivation, nutritional status, past and present health
behaviors, past and present experience with a drug regimen, race
o Readiness to learn, religious beliefs, self-care ability, sensory status, social support
 Teaching regarding a new medication should include name of medication, reason client is receiving the
medication, prescribed dosage of the med (including frequency), any potential side effects (some are
predictable), and expected timeframe for the medication to take effect (for example, a medication for
lowering cholesterol may not show results for up to 2 weeks)
 Discuss the role of evaluation in client education and how to best evaluate the effectiveness of client
teaching (in each domain) Remember that it must be measurable!
o Validate whether learning has occurred: ask questions, have the pt provide a return
demonstration, behavior (such as compliance and adherence to a schedule), occurrence of few
or no complications
Over-the-Counter, Herbal, and Dietary Supplements – Chapter 7
 Discuss the difference between prescription drugs, over-the-counter drugs, herbals, and dietary
supplements
o OTC: nonprescription drugs; used for short-term treatment of common minor illness
o Herbals: plant components used for medicinal qualities
o Dietary supplements: orally administered alternative medicines including herbals
 Discuss the common therapeutic uses for selected herbal supplements (see p. 20-21 in packet)
o Valerian relief of anxiety
o St Johns Wort depression
o Feverfew anti-inflammatory, headache, fever
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Discuss potential drug interactions associated with selected herbal supplements (biggest one being
increased risk of bleeding if on anticoagulants and herbals); also note that both cranberry and grapefruit
juice either decrease elimination or metabolism of certain drugs, which may lead to toxicity
o Herbs that start with “G” increase risk of bleeding (except ginseng)
Discuss the concept that herbal supplements are considered safe because they are “natural.” Describe
the problem with this belief
o Herbal products may not be safe for pregnant or breastfeeding women, infants, or children
o Natural does not mean safe
o Teach pt to monitor themselves for unusual or adverse reactions
Pharmacology Terms and Principles
 Review terms (many of these are included in other points above); if unclear, research in your textbook;
MAOI’s (monoamine oxidase inhibitors) and foods containing tyramine (aged meats, cheeses, wines,
etc., but not soft cheese, such as cottage cheese or cream cheese); if taken together, can cause
hypertensive crisis
 Describe first pass effect (what does it mean? how does it affect dosing of different drug forms?)
o The rapid hepatic inactivation of certain oral drugs (nitroglycerin has high first-pass effect so its
not usually given via oral route)
o Not 100% bioavailability.. so its not going to ever be 100%
 Define a drug’s half-life; what is it? how does it affect drug concentrations and the steady state?
o If half life is 8 hours and its 50 mg. in 8 hours its 25 and so on. Takes 5 half lives to be
considered out
 Advantages and disadvantages of different drug routes (enteral, topical, parenteral, etc.)
o Parental
 Advantages: rapid onset
 Disadvantages: cost, inconvenience, irreversibility, complications, discomfort
o Enteral
 Advantages: easy and convenient
 Disadvantages: variability, inactivation, patient must be able to swallow, local irritation
o Topical
 Disadvantage: skin irritation
 Relationship of protein binding to serum albumin levels
o Drugs that bind reversibly to plasma proteins (albumin); drug molecules cannot leave the
vascular system (restricts drug distribution). Drugs compete for protein binding. If low in protein it
could become toxic.
 Differentiate between adverse drug event and adverse drug reaction
o Adverse drug event: any undesirable occurrence related to administering or failing to administer
a prescribed medication
o Adverse drug reaction: any unexpected, unintended, undesired, or excessive response to a
medication given at therapeutic dosages (not overdose)
 Know that grapefruit juice can prolong metabolism of certain drugs and increase risk of toxicity….
Inhibits the metabolism of drugs and raises drug levels
Miscellaneous
 Metric conversions (mg to mcg, mL to L, mg to g, mL to ounces, etc.)
o 1 oz= 30 mL
o 1 mg= 1000 mcg
o 1 L= 1000 mL
o 1 g= 1000 mg
o 1 kg= 2.2 lbs
 Calculate dosage based upon weight in kg (know how to convert lb. to kg and kg to lb.)****practice
problems****
 Know how to round (like to nearest tenth, hundredth, to a whole number, etc.)
Gene Therapy and Pharmacogenomics – Chapter 8
Spring 2022
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Know definitions for gene therapy, genetic predisposition, inherited disease, pharmacogenomics
o Gene therapy: new therapeutic technologies that directly target human genes in the treatment or
prevention of illness
o Genetic predisposition: the presence of certain factors in a person’s genetic makeup, or genome
that increase the individual’s likelihood of developing one or more diseases
o Inherited disease: genetic disease that results from defected alleles that are passed from parents
to offspring
o Pharmacogenomics: a branch of pharmacogenetics that involves the survey of the entire
genome to detect multigenic determinants of drug response
Know examples of conditions that have a genetic predisposition (given in class; not in text)
o In your family and you have a chance of getting it
 Malignant hypothermia: elevated body temp which can occur when exposed to general
anesthesia
Maintaining privacy and confidentiality with genetic testing – see pp. 99-100
o Only patient/ healthcare provider are given result….. unless patient gives permission
Review and understand the basic principles of genetic inheritance and genetic predisposition,
particularly what can a person do to help offset a genetic predisposition?
Photo Atlas of Drug Administration – Chapter 9
 Know Box 9.1 Standard Precautions
o Wear clean gloves, hand hygiene, wear a mask, eye protective gear, and face shield if blood/
body fluids
o Never remove, recap, cap, bend, or break any used needle or needle system
 Know the bulleted points on pp. 103-104 regarding preparing and administering medications
 Box 9.2 Safety and Medication Administration
 Know the different types of oral medications and specifics regarding administration, such as don’t
swallow sublingual, etc. (don’t crush or chew enteric-coated, sustained or extended release, etc.)
 Proper way to measure liquid medications (less than 5 mL must be measured in syringe; don’t use
household tsp)
 Technique for administering oral medications to infants and children (p. 107-108)
o Liquids are usually ordered for infants and young children bc they can’t swallow pills
o Plastic disposable oral-dosing syringe..
o May have to partially restrain by holding arms down etc.
o Clean empty nipple may be used to administer meds… infant sucks meds out of nipple
o Avoid aspiration… don’t give to a crying baby
o Don’t add meds to a bottle of formula
o Can add meds with a teaspoon of something sweet like jelly, applesauce, ice cream… do not use honey!!!
Spring 2022