MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
STEPS OF THE NURSING PROCESS – ADPIE:
• ASSESSMENT:
o Systematic validation and documentation of information
o Data collection must include subjective and objective data
▪ Subjective = symptoms/how the pt feels
• Current health hx (incl prob w/ swallowing)
• Pt symptoms
• Current meds (incl herbal, vitamins, and OTC)
o Dosage/frequency/route
o Pt knowledge of drug/side effects
o Med compliance
o Allergies
o Use of tobacco, alcohol, caffeine, and illicit drugs
• Past health hx (major injuries, illnesses, mental issues)
• Pts environment – home safety, language needs, ability to
read and follow instructions, ability to perform ADLs,
support network (family/friends), readiness to learn, dietary
patterns, cultural barriers, financial limitations, etc)
▪ Objective = signs/measurable by HCP
• Physical health assessment – motor control, muscle
strength, ROM, eye sight
• Lab and dx tests – always get baseline data
o Data collection here should target the organs most
likely to be affected by the treatment
▪ Ask these 3 questions to check ability for med compliance:
• What things help you take your meds as prescribed?
• What things prevent you from taking your meds
as prescribed?
• What would you do if you forgot to take a dose of meds?
• NURSING DIAGNOSIS – made based on the analysis of the assessment data.
Data serves as the defining characteristic or risk factors for nursing diagnoses.
More than one may be applicable to a certain problem.
o NANDA list
o Help develop individualized care plans
• PLANNING – goal setting/expected outcomes
o Goals = patient centered, describe a specific activity, and include a
time frame for achievement
1
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
, MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
o Needs to be realistic, measurable, acceptable to the pt, and shared w/
other HCPs involved in the pts care.
o EX: patient will independently administer prescribed dose of insulin by
end of the 4th session of instruction
• IMPLEMENTATION – nurse provides education, med admin, pt care, and
other interventions necessary to assist the pt in accomplishing their goals
o Pt teaching readiness to learn is the most important part
o Use assessment data to know who needs the teaching (family/friends)
o For med admin teach general info about the med (why it’s needed, why
med compliance is important, etc.), teach self-administration
(psychomotor skills assessment important here), diet (what to eat/avoid
and when), side effects (know what things to report), cultural
considerations
▪ PROMOTE PT INDEPENDENCE
• EVALUATION – how well goals are obtained
o Interventions may need to be revised, or teaching repeated to reach goals
o If goal not met – nurse collabs w/ pt/family to determine why and what
they can change
5 + 5 RIGHTS OF MED ADMIN:
• PATIENT (2 identifiers – name/DOB)
• DRUG (always know why you are giving the drug and make sure it makes sense)
• DOSE (is the dose safe for this patient, did you draw up the correct amount)
• ROUTE (PO for NPO pt or PO for drug that is destroyed in GI tract)
• TIME (w/ food? Maintaining a therapeutic level?)
• ASSESSMENT
• DOCUMENTATION
• PTs RIGHT TO EDUCATION
• EVALUATION
• PTs RIGHT TO REFUSE
NURSES RIGHTS OF MED ADMIN:
• Right to a complete and clear order
• Right to have the correct drug, route, and dose dispensed (pharmacist)
• Right to have access to information (drug reference guide)
• Right to have policies to guide safe med admin
• Right to admin meds safely and to identify problems in the system
• Right to stop, think, and be vigilant when admin meds
SCHEDULES OF DRUGS:
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
, MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
• 1 – high abuse potential, NO medical purpose. Illicit drugs (Heroin, LSD, etc)
• 2 – high abuse potential but have medical purpose. (fentanyl,
morphine, hydrocodone, codeine)
2
o REQUIRE WRITTEN PRESCRIPTION – no phone orders
• 3 – lower abuse potential. (Tylenol w/ codeine)
o Prescriptions rewritten after 6 mos or 5 refills (need to reassess pt)
• 4 – less abuse potential than 3.
o Prescriptions written or oral. Refills limited to 5x
• 5 – low abuse potential (terpin hydrate – no alcoholics, Lomotil)
DRUG ABSORPTION:
• Affected by route of admin (IV fast, PO moderate, Rectal slow)
• Drugs carried to site of action by albumin binds to drug to get out of
plasma concentration
o If hypoalbuminemia - ↑ amt of drug in plasma OD and toxicity. See w/
geriatrics and liver disease pts.
o Only free, unbound drugs can cause pharmacologic response
o Liver issues - ↓ dosage of drugs
• Half-Life = time required for the total amt of a drug to decrease by ½.
o Determines how frequently a drug needs to be given to maintain
therapeutic levels test w/ serum blood levels
o Most excretion done thru kidneys ↓ renal func = ↓ dosages
o Most drugs are eliminated after 5 half-lives – take 5 half-lives to reach steady
state (Dig loading dose and maintenance doses to reach steady state faster)
FIRST PASS EFFECT: partially metabolized in the liver before passing into the
circulatory system.
• Oral doses are far greater than IV doses to account for this breakdown
• Ex: dopamine, lidocaine, morphine, nitro, propranolol, warfarin
EFFECTS OF AGING ON DRUG METABOLISM & EXCRETION
• PEDIATRIC PTS: give very small doses (measure carefully and double check
all math – easily OD). Pts have immature livers (breakdown and absorption)
and kidneys (excretion)
• GERIATRICS:
o ↓ peristalsis – slower absorption of drugs
o ↓ CO – impaired circulation of drugs
o Drugs are metabolized slower in the liver
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
, MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
o ↓ blood flow and GFR – less excretion
o ↓ albumin levels
o Usually need smaller doses.
o Be aware of POLYPHARMACY – admin of many drugs together d/t
several HCPs, herbal meds, OTC drugs, and continued use of discontinued
drugs
PEAK AND TROUGH:
3
• Peak measured 30 mins-2hrs after admin
• Trough measured 30 mins – right before next dose only one we care about now
o Usually done for potent antibiotics (vancomycin)
o Want consistent level in therapeutic range
o If low: ↑ dose or frequency
o If high: ↓ dose or frequency
AGONIST AND ANTAGONIST:
• Agonist = drugs that display affinity for receptors and enhance or stimulate
the receptors functional properties. Drugs that produce a response!
• Antagonist = drugs that occupy receptor sites and prevent the action of agonists
• An agonist causes an action, an antagonist blocks the action of the agonist
DRUG COCKTAIL FOR ANAPHYLAXIS (ALLERGIC RESPONSE):
• Epinephrine
• Benadryl
• Steroids
• Inhaler/bronchodilator
MOD 2: DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM
CHOLINERGIC AGENTS (parasympathoMIMETICS) “fluids flow”:
Drugs:
• Bethanechol (Urecholine) – prototype
o Cholinergic agonist
o Tx urinary retention (beth can’t pee)
o Should work w/in 1 hr
• Pilocarpine (Isopto Carpine, Pilocar)
o Cholinergic agonist
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
PHARMACOLOGY PRINCIPLES 2022
STEPS OF THE NURSING PROCESS – ADPIE:
• ASSESSMENT:
o Systematic validation and documentation of information
o Data collection must include subjective and objective data
▪ Subjective = symptoms/how the pt feels
• Current health hx (incl prob w/ swallowing)
• Pt symptoms
• Current meds (incl herbal, vitamins, and OTC)
o Dosage/frequency/route
o Pt knowledge of drug/side effects
o Med compliance
o Allergies
o Use of tobacco, alcohol, caffeine, and illicit drugs
• Past health hx (major injuries, illnesses, mental issues)
• Pts environment – home safety, language needs, ability to
read and follow instructions, ability to perform ADLs,
support network (family/friends), readiness to learn, dietary
patterns, cultural barriers, financial limitations, etc)
▪ Objective = signs/measurable by HCP
• Physical health assessment – motor control, muscle
strength, ROM, eye sight
• Lab and dx tests – always get baseline data
o Data collection here should target the organs most
likely to be affected by the treatment
▪ Ask these 3 questions to check ability for med compliance:
• What things help you take your meds as prescribed?
• What things prevent you from taking your meds
as prescribed?
• What would you do if you forgot to take a dose of meds?
• NURSING DIAGNOSIS – made based on the analysis of the assessment data.
Data serves as the defining characteristic or risk factors for nursing diagnoses.
More than one may be applicable to a certain problem.
o NANDA list
o Help develop individualized care plans
• PLANNING – goal setting/expected outcomes
o Goals = patient centered, describe a specific activity, and include a
time frame for achievement
1
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
, MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
o Needs to be realistic, measurable, acceptable to the pt, and shared w/
other HCPs involved in the pts care.
o EX: patient will independently administer prescribed dose of insulin by
end of the 4th session of instruction
• IMPLEMENTATION – nurse provides education, med admin, pt care, and
other interventions necessary to assist the pt in accomplishing their goals
o Pt teaching readiness to learn is the most important part
o Use assessment data to know who needs the teaching (family/friends)
o For med admin teach general info about the med (why it’s needed, why
med compliance is important, etc.), teach self-administration
(psychomotor skills assessment important here), diet (what to eat/avoid
and when), side effects (know what things to report), cultural
considerations
▪ PROMOTE PT INDEPENDENCE
• EVALUATION – how well goals are obtained
o Interventions may need to be revised, or teaching repeated to reach goals
o If goal not met – nurse collabs w/ pt/family to determine why and what
they can change
5 + 5 RIGHTS OF MED ADMIN:
• PATIENT (2 identifiers – name/DOB)
• DRUG (always know why you are giving the drug and make sure it makes sense)
• DOSE (is the dose safe for this patient, did you draw up the correct amount)
• ROUTE (PO for NPO pt or PO for drug that is destroyed in GI tract)
• TIME (w/ food? Maintaining a therapeutic level?)
• ASSESSMENT
• DOCUMENTATION
• PTs RIGHT TO EDUCATION
• EVALUATION
• PTs RIGHT TO REFUSE
NURSES RIGHTS OF MED ADMIN:
• Right to a complete and clear order
• Right to have the correct drug, route, and dose dispensed (pharmacist)
• Right to have access to information (drug reference guide)
• Right to have policies to guide safe med admin
• Right to admin meds safely and to identify problems in the system
• Right to stop, think, and be vigilant when admin meds
SCHEDULES OF DRUGS:
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
, MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
• 1 – high abuse potential, NO medical purpose. Illicit drugs (Heroin, LSD, etc)
• 2 – high abuse potential but have medical purpose. (fentanyl,
morphine, hydrocodone, codeine)
2
o REQUIRE WRITTEN PRESCRIPTION – no phone orders
• 3 – lower abuse potential. (Tylenol w/ codeine)
o Prescriptions rewritten after 6 mos or 5 refills (need to reassess pt)
• 4 – less abuse potential than 3.
o Prescriptions written or oral. Refills limited to 5x
• 5 – low abuse potential (terpin hydrate – no alcoholics, Lomotil)
DRUG ABSORPTION:
• Affected by route of admin (IV fast, PO moderate, Rectal slow)
• Drugs carried to site of action by albumin binds to drug to get out of
plasma concentration
o If hypoalbuminemia - ↑ amt of drug in plasma OD and toxicity. See w/
geriatrics and liver disease pts.
o Only free, unbound drugs can cause pharmacologic response
o Liver issues - ↓ dosage of drugs
• Half-Life = time required for the total amt of a drug to decrease by ½.
o Determines how frequently a drug needs to be given to maintain
therapeutic levels test w/ serum blood levels
o Most excretion done thru kidneys ↓ renal func = ↓ dosages
o Most drugs are eliminated after 5 half-lives – take 5 half-lives to reach steady
state (Dig loading dose and maintenance doses to reach steady state faster)
FIRST PASS EFFECT: partially metabolized in the liver before passing into the
circulatory system.
• Oral doses are far greater than IV doses to account for this breakdown
• Ex: dopamine, lidocaine, morphine, nitro, propranolol, warfarin
EFFECTS OF AGING ON DRUG METABOLISM & EXCRETION
• PEDIATRIC PTS: give very small doses (measure carefully and double check
all math – easily OD). Pts have immature livers (breakdown and absorption)
and kidneys (excretion)
• GERIATRICS:
o ↓ peristalsis – slower absorption of drugs
o ↓ CO – impaired circulation of drugs
o Drugs are metabolized slower in the liver
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
, MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
o ↓ blood flow and GFR – less excretion
o ↓ albumin levels
o Usually need smaller doses.
o Be aware of POLYPHARMACY – admin of many drugs together d/t
several HCPs, herbal meds, OTC drugs, and continued use of discontinued
drugs
PEAK AND TROUGH:
3
• Peak measured 30 mins-2hrs after admin
• Trough measured 30 mins – right before next dose only one we care about now
o Usually done for potent antibiotics (vancomycin)
o Want consistent level in therapeutic range
o If low: ↑ dose or frequency
o If high: ↓ dose or frequency
AGONIST AND ANTAGONIST:
• Agonist = drugs that display affinity for receptors and enhance or stimulate
the receptors functional properties. Drugs that produce a response!
• Antagonist = drugs that occupy receptor sites and prevent the action of agonists
• An agonist causes an action, an antagonist blocks the action of the agonist
DRUG COCKTAIL FOR ANAPHYLAXIS (ALLERGIC RESPONSE):
• Epinephrine
• Benadryl
• Steroids
• Inhaler/bronchodilator
MOD 2: DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM
CHOLINERGIC AGENTS (parasympathoMIMETICS) “fluids flow”:
Drugs:
• Bethanechol (Urecholine) – prototype
o Cholinergic agonist
o Tx urinary retention (beth can’t pee)
o Should work w/in 1 hr
• Pilocarpine (Isopto Carpine, Pilocar)
o Cholinergic agonist
MOD 1: FINAL EXAM BLUEPRINT| INTRO TO
PHARMACOLOGY PRINCIPLES 2022
