,Part 1: Pharmacology Basics
Chapter 1 – The Nursing Process and Drug Therapy
• Assessment: Collect subjective (patient history, allergies, current meds,
OTC/herbals, pregnancy/lactation) and objective data (vital signs, lab values,
physical exam). Identify medication adherence patterns.
• Human Need Statements (formerly nursing diagnoses): Examples – Risk for
injury related to adverse drug effects (e.g., orthostatic hypotension), Deficient
knowledge related to new insulin regimen.
• Planning: SMART outcomes – "Patient will state two signs of hypoglycemia by
discharge."
• Implementation: Rights of medication administration (original 5 + 3 more: right
reason, right response, right documentation). Patient education.
• Evaluation: Compare actual outcomes to expected. Adjust plan as needed.
Chapter 2 – Pharmacologic Principles (Expanded)
• Pharmaceutics: Dosage forms (tablet, capsule, liquid, transdermal, parenteral)
affect dissolution and absorption. Enteric coating prevents gastric breakdown.
• Pharmacokinetics:
o Absorption: Bioavailability, first-pass effect (oral drugs metabolized in liver
before systemic circulation). IV = 100% bioavailability.
o Distribution: Protein binding (only free drug active). Albumin binding – low
albumin increases free drug and toxicity risk.
o Metabolism: Cytochrome P450 (CYP) system – inducers (carbamazepine,
rifampin) decrease drug effect; inhibitors (grapefruit juice, ketoconazole)
increase toxicity.
o Excretion: Primarily renal – creatinine clearance estimates function. Half-life
determines dosing interval.
, • Pharmacodynamics: Agonists (activate receptor), antagonists (block receptor),
partial agonists. Dose-response curve, therapeutic index (safety margin – narrow
TI drugs require monitoring e.g., digoxin, warfarin, phenytoin).
• Pharmacotherapeutics: Indications, contraindications, adverse effects, toxicity,
tolerance, dependence, drug interactions.
• Pharmacoeconomics: Cost-benefit analysis for drug selection (e.g., generic vs
brand, hospital formularies).
Chapter 3 – Lifespan Considerations (Expanded)
• Pregnancy: FDA Pregnancy and Lactation Labeling Rule (PLLR) replaced old A-B-
C-D-X categories. Risk categories: Pregnancy (3 trimesters), Lactation,
Females/Males of reproductive potential. Teratogens (e.g., isotretinoin, valproate,
warfarin, ACE inhibitors). Nursing: pregnancy testing before teratogenic drugs,
contraception counseling.
• Breastfeeding: Drugs excreted into milk – lipid-soluble, low protein binding,
weak bases concentrate. Most are safe but avoid: amiodarone, lithium,
methotrexate, radioactive drugs. Nursing: time doses after feeding.
• Neonatal/pediatric: Immature liver (reduced metabolism) and kidneys (reduced
excretion) – prolonged half-lives. Weight-based dosing (mg/kg). Intramuscular
absorption erratic. Reye’s syndrome risk with aspirin in viral illness. Nursing:
accurate weight, small volume injections, family education.
• Older adults: Polypharmacy (5+ meds common), altered pharmacokinetics
(reduced renal function most critical – adjust for CrCl), increased sensitivity (CNS
drugs cause falls/delirium), Beers criteria (potentially inappropriate meds for
elderly – e.g., benzodiazepines, anticholinergics). Nursing: simplify regimens,
monitor for adverse effects, assess for frailty and falls.
, Chapter 4 – Cultural, Legal, Ethical (Expanded)
• Cultural: Dietary restrictions (e.g., pork in capsules – some religions). Herbal
remedies (e.g., Ayurveda, Traditional Chinese Medicine). Language barriers – use
interpreters, not family. Health beliefs (e.g., hot/cold theory). Nursing: ask about
folk remedies, respect but educate on interactions.
• Legal: Controlled Substances Act (Schedules I-V). Nurse Practice Acts define
scope. Medication orders require: patient name, drug, dose, route, time,
signature. Telephone orders: read back, verify, cosign. Incident reports for errors –
do not place in patient chart.
• Ethical: Autonomy (patient right to refuse – document education given).
Beneficence (act in patient's best interest). Nonmaleficence (do no harm – check
for allergies, interactions). Justice (fair distribution of expensive drugs). Ethical
dilemmas: off-label use, end-of-life sedation, forced medication for psychiatric
patients.
Chapter 5 – Medication Errors (Expanded)
• Types: Prescribing (wrong drug/dose), transcribing (illegible order), dispensing
(wrong drug from pharmacy), administering (wrong patient/route/time),
monitoring (failure to check labs).
• Contributing factors: Look-alike/sound-alike (e.g., hydralazine/hydroxyzine,
Zyprexa/Zyrtec). Abbreviations (avoid U for unit, QD for daily – use "unit" and
"daily"). Interruptions during med pass.
• Prevention: Rights of administration (original 5: patient, drug, dose, route, time;
plus: reason, response, documentation). Barcode scanning, independent double-
check for high-alert drugs (insulin, heparin, opioids). Tall man lettering (e.g.,
predniSONE vs predniSOLONE).
• Response to error: Assess patient (vital signs, antidote if needed). Notify
provider and pharmacist. Document in medical record (objective facts, not
Chapter 1 – The Nursing Process and Drug Therapy
• Assessment: Collect subjective (patient history, allergies, current meds,
OTC/herbals, pregnancy/lactation) and objective data (vital signs, lab values,
physical exam). Identify medication adherence patterns.
• Human Need Statements (formerly nursing diagnoses): Examples – Risk for
injury related to adverse drug effects (e.g., orthostatic hypotension), Deficient
knowledge related to new insulin regimen.
• Planning: SMART outcomes – "Patient will state two signs of hypoglycemia by
discharge."
• Implementation: Rights of medication administration (original 5 + 3 more: right
reason, right response, right documentation). Patient education.
• Evaluation: Compare actual outcomes to expected. Adjust plan as needed.
Chapter 2 – Pharmacologic Principles (Expanded)
• Pharmaceutics: Dosage forms (tablet, capsule, liquid, transdermal, parenteral)
affect dissolution and absorption. Enteric coating prevents gastric breakdown.
• Pharmacokinetics:
o Absorption: Bioavailability, first-pass effect (oral drugs metabolized in liver
before systemic circulation). IV = 100% bioavailability.
o Distribution: Protein binding (only free drug active). Albumin binding – low
albumin increases free drug and toxicity risk.
o Metabolism: Cytochrome P450 (CYP) system – inducers (carbamazepine,
rifampin) decrease drug effect; inhibitors (grapefruit juice, ketoconazole)
increase toxicity.
o Excretion: Primarily renal – creatinine clearance estimates function. Half-life
determines dosing interval.
, • Pharmacodynamics: Agonists (activate receptor), antagonists (block receptor),
partial agonists. Dose-response curve, therapeutic index (safety margin – narrow
TI drugs require monitoring e.g., digoxin, warfarin, phenytoin).
• Pharmacotherapeutics: Indications, contraindications, adverse effects, toxicity,
tolerance, dependence, drug interactions.
• Pharmacoeconomics: Cost-benefit analysis for drug selection (e.g., generic vs
brand, hospital formularies).
Chapter 3 – Lifespan Considerations (Expanded)
• Pregnancy: FDA Pregnancy and Lactation Labeling Rule (PLLR) replaced old A-B-
C-D-X categories. Risk categories: Pregnancy (3 trimesters), Lactation,
Females/Males of reproductive potential. Teratogens (e.g., isotretinoin, valproate,
warfarin, ACE inhibitors). Nursing: pregnancy testing before teratogenic drugs,
contraception counseling.
• Breastfeeding: Drugs excreted into milk – lipid-soluble, low protein binding,
weak bases concentrate. Most are safe but avoid: amiodarone, lithium,
methotrexate, radioactive drugs. Nursing: time doses after feeding.
• Neonatal/pediatric: Immature liver (reduced metabolism) and kidneys (reduced
excretion) – prolonged half-lives. Weight-based dosing (mg/kg). Intramuscular
absorption erratic. Reye’s syndrome risk with aspirin in viral illness. Nursing:
accurate weight, small volume injections, family education.
• Older adults: Polypharmacy (5+ meds common), altered pharmacokinetics
(reduced renal function most critical – adjust for CrCl), increased sensitivity (CNS
drugs cause falls/delirium), Beers criteria (potentially inappropriate meds for
elderly – e.g., benzodiazepines, anticholinergics). Nursing: simplify regimens,
monitor for adverse effects, assess for frailty and falls.
, Chapter 4 – Cultural, Legal, Ethical (Expanded)
• Cultural: Dietary restrictions (e.g., pork in capsules – some religions). Herbal
remedies (e.g., Ayurveda, Traditional Chinese Medicine). Language barriers – use
interpreters, not family. Health beliefs (e.g., hot/cold theory). Nursing: ask about
folk remedies, respect but educate on interactions.
• Legal: Controlled Substances Act (Schedules I-V). Nurse Practice Acts define
scope. Medication orders require: patient name, drug, dose, route, time,
signature. Telephone orders: read back, verify, cosign. Incident reports for errors –
do not place in patient chart.
• Ethical: Autonomy (patient right to refuse – document education given).
Beneficence (act in patient's best interest). Nonmaleficence (do no harm – check
for allergies, interactions). Justice (fair distribution of expensive drugs). Ethical
dilemmas: off-label use, end-of-life sedation, forced medication for psychiatric
patients.
Chapter 5 – Medication Errors (Expanded)
• Types: Prescribing (wrong drug/dose), transcribing (illegible order), dispensing
(wrong drug from pharmacy), administering (wrong patient/route/time),
monitoring (failure to check labs).
• Contributing factors: Look-alike/sound-alike (e.g., hydralazine/hydroxyzine,
Zyprexa/Zyrtec). Abbreviations (avoid U for unit, QD for daily – use "unit" and
"daily"). Interruptions during med pass.
• Prevention: Rights of administration (original 5: patient, drug, dose, route, time;
plus: reason, response, documentation). Barcode scanning, independent double-
check for high-alert drugs (insulin, heparin, opioids). Tall man lettering (e.g.,
predniSONE vs predniSOLONE).
• Response to error: Assess patient (vital signs, antidote if needed). Notify
provider and pharmacist. Document in medical record (objective facts, not
