introduction

2.0 EXPLANATION ON THE IMPORTANCE OF MEDICATION SAFETY AND

RELATE TO PHARMACODYNAMICS AND PHARMACOKINETICS.

Nurses represent a significant group among health professionals and are well placed in most
inpatient and community settings to provide advice, information and monitor the effects of drugs
on patients in n is currently not as comprehensive in nursing curricula. Current curricula
concentrates on medication competence which comprises accurate administration of drugs (using
the 6 rights- right person, right drug, right dose, right time, right route and right documentation).
However medication competence also includes a detailed and comprehensive understanding of
drugs, how they are absorbed, metabolized and eliminated by the body and what receptor sites
they target once the drug is absorbed (holding implications for either desired or undesired effects
when monitoring drug impact for patients) and an ability to apply that knowledge to the real
world context (Sulosaari et al. 2011).

While most nursing undergraduate curriculums include medication management and

information, the specifics related to the absorption, movement and elimination of drugs are not as
comprehensively covered. This commentary will discuss the additional and essential pharmaco-
considerations (which included the absorption, movement action and interaction of drugs -
pharmacokinetics and pharmacodynamics) required in nursing education. Pharmacokinetics
relates to the absorption, distribution, metabolism and elimination of drugs while
pharmacodynamics relates to the action of drugs once they are in the body (Edward & Alderman
2013). The importance of a comprehensive understanding of the pharmacokinetics and
pharmacodynamics of drugs relates to enhancement of medication competence for nurses.

Nurses are well aware drugs are in the first instance absorbed into the body. This can occur
orally, rectally, paternally (IV), via inhalation, through the skin, or the mucous membranes (via
snorting, sniffing). Not all nurses are familiar however with the details of what happens once the
drug absorbed. Drugs are distributed to the body via the blood stream, passing various barriers to
reach receptors. Barriers to drug distribution include the blood-brain-barrier (a drug diffusing
from blood to brain must move through the cells of the capillary wall and the drug must then
move through the fatty glial sheath) and the placental barrier (these are unique membranes;
Edward & Alderman 2013). Importantly, drugs are generally distributed to several areas of the
body at once and it is not possible to measure the concentration of the drug at any one specific
site, therefore blood levels of a particular drug are usually measured to ascertain drug
concentration. This information is considered in conjunction with the known pharmacokinetic
characteristics of the drug to make a reasonably accurate assessment of how that drug is
performing within that person.

Understanding the metabolism of drugs is important. Drugs can be metabolized by oxidization,

hydration, reduction, and hydrolysis to name a few internal processes. Drug metabolism often
converts the drug into readily excreted products and metabolism occurs in many bodily tissues
however most predominately located in the liver. The liver contains hepatocytes (liver cells)
which contain enzymes that are a major component of drug metabolism (Edward & Alderman
2013). A few of these enzyme families, particularly Cytochrome families are involved in most
drug biotransformations. Important to nursing care, nurses need to understand that drug
metabolism rates vary between patients due to variables such as hydration, organ health,
comorbid conditions, weight, and age. Intuitively if the body increases the amount or activity of
drug metabolizing enzymes, then the rate at which all drugs metabolized by these enzymes
should increase. Therefore, drug tolerance develops as the blood level of a drug for a given
amount taken falls more rapidly than would be expected if tolerance had not developed. Drug
tolerance is known as a state of progressively decreasing responsiveness to a drug. Physical
dependence is an entirely different phenomenon from tolerance, even though the two are often
associated temporally.

In the administration of medications and in consideration of drug metabolism nurses also need to
understand the half-life of the drug. The biological half-life of a drug is the time required for the
drug concentration in the blood to fall by one-half, and also the determinant length of time
necessary to reach a steady state concentration (Edward & Alderman 2013). If a second full dose
of a drug is administered before the body has eliminated the first dose, the total amount of drug
in the body will be greater than the total amount of the first dose. This effect could be cumulative
and toxicity may result.

Drug action is also determined by the pharmacodynamics of the drug, which are factors
complimentary to pharmacokinetic knowledge and are useful to determine the influence of
person-specific factors on drug therapy. These person-specific factors include such things as age,
chronic conditions, and body mass (Edward & Alderman 2013). For many drugs the effects of a
drug within the body occurs by the interaction of the drug with a receptor. But not all drugs exert
actions through direct binding to receptors. For example enzymes facilitate chemical reactions of
drugs and are found throughout the body. The use of drugs in treatment always carries some
degree of risk for unexpected and unwanted effects known as adverse drug reactions (ADRs).
People may present idiosyncratic ADRs (these are quite common in practice), such as a minor
rash on the skin. Other ADRs may be more serious. In either scenario nurses are required to
evaluate and monitor ADRs (a useful tool to use in assessing for ADRs is the Naranjo
Questionnaire) (Naranjo et al. 1981). Furthermore, drug interactions may affect the therapeutic
properties of drugs when people are taking more than one drug. These too are individual where
ADRs may arise in some people on the same drug combination but not in others.

Current and comprehensive knowledge of the pharmacokinetics and pharmacodynamics of drugs

have implications for nursing management of patient care. Medication competence in nursing is
multifaceted requiring broader understanding of medication management than that currently
taught in undergraduate nursing curriculums which focuses on drug administration and drug
calculations, adherence and legal considerations. Using the nursing process (assessment,
planning, intervention and evaluation) nurses can identify and monitor factors that may affect or
alter drug absorption and consequent action. These factors may be related to gastrointestinal
pathology (gastroenteritis), a chronic condition such as diabetes or renal impairment, or
concomitant drug therapy. Since serious effects can arise with alterations to the
pharmacokinetics and the pharmacodynamics of drugs continuous nursing evaluation is
necessary and complete knowledge of the actions and interactions of drugs is essential. Inclusion
of more detailed pharmaco-considerations in undergraduate nursing curriculums is suggested.

REFERENCES

Edward, K., & Alderman, C. (2013). Psychopharmacology: Practice and Contexts. Melbourne,
Australia: Oxford University Press.

Naranjo, C. A., Busto, U., Sellers, E. M., Sandor, P., Ruiz, I., Roberts, E., Greenblatt, D. (1981).
A method for estimating the probability of adverse drug reactions. Clinical Pharmacology &
Therapeutics, 30, 239-245.

Sulosaari, V., Suhonen, R., & Leino‐Kilpi, H. (2011). An integrative review of the literature on
registered nurses’ medication competence. Journal of Clinical Nursing, 20, 464-478.

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