INTRODUCTION TO

NURSING
PHARMACOLOGY
LECTURE NOTES RNUR 201
EDMOND ADJEI BOADU (MSC, MBA, B.PHARM, MPSGH)
 DEFINITIONS
•Drug: any chemical that can affect the living processes

• Pharmacology: the study of drugs and their interactions with living systems
Drug History
Drug origin
Physical and chemical properties
Biochemical effects
Physical effects
Mechanisms of action
Chemical properties
Absorption, distribution, metabolism and excretion
Therapeutic effects
Toxic effects
• Clinical Pharmacology: study of drugs in humans

•Therapeutics /Pharmacotherapeutics: use of drugs to diagnose,

prevent and treat illness
• Two forms: empirical and rational.
 Empirical – no suitable explanation for effectiveness of the drugs involved.
• Rational – the drugs have a known mechanism of action
•Pharmacokinetics: the study of the concentration of a drug during the process of
absorption, distribution, biotransformation (metabolism) and excretion
•What the body does to the drug.
 Absorption
 Distribution
 Metabolism
 excretion
•Pharmacodynamics:
• Pharmacodynamics is the study of the mechanism of drug action on living tissues
• It is the study of what the drug does to the body
•PHARMACEUTICS
•Pharmaceutics is the study of the ways in which various drug forms
influence pharmacokinetic and pharmacodynamic activities
•The science of dosage forms
 SOURCES OF DRUGS
•Four main sources
•PLANTS
• E.g. digitalis, vincristine, and colchicine, cinchona
•ANIMALS AND HUMANS
• E.g. adrenalin, insulin, Acetylcholine
•MINERALS OR MINERAL PRODUCTS
• E.g. Iodine, iron, Epsom salts
•CHEMICAL SUBSTANCES/SYNTHETIC
• E.g. sodium bicarbonate, magnesium hydroxide, sulphonamides, corticosteroids
 DRUG NUMENCLATURE

•3 types of Names
•Chemical Name
• Describes the drug chemical composition and the molecular structure
•Generic Name/ Nonproprietary name
• It is shorter and simpler than the chemical name. It is used in most official drug compendiums to
list drugs
• The generic name is the official medical name for the active ingredient of the medicine.
•Trade/ Brand Name/ Proprietary name
• It is the name given to the drug by the manufacturer or company
 EXAMPLES

Chemical name Generic name Trade names

N-(4-hydroxyphenyl) Acetaminophen/ Tylenol, aspanol, letamol,
acetamide Paracetamol panadol
7-chloro-1,3-dihydro-1- diazepam valium
methyl-5-phenyl-2H-1,4-
benzodiazepin-2-one
2-[4-(2- ibuprofen Brufen, motrin
methylpropyl)phenyl]prop
anoic acid
 COMPARING GENERIC NAMES AND TRADE NAMES

 A single drug can have multiple Trade Names

 Acetaminophen has more than 30 Trade Names
 Recalling Generic name may be easier than trying to remember all the different Trade Names of a drug
 There is More accurate communication if use Generic name
 Less confusing for patient to see only one Generic name on label rather than different Trade Names
which can lead to double dosing.
 Trade Names may be similar but contain different drugs (i.e., Monistat 1 and Monistat 3 are different
drugs but has similar trade names) 
 APC Tablets- contains 3 different drugs (aspirin, acetaminophen and caffeine) – how do you know?
 Trade Names are too misleading for consumer as well as health care practitioner
CLASSIFICATION OF DRUGS

• Two perspectives
• 1. Clinical indication
• E.g. analgesic, antibacterial, antacid
• 2. Body system
• E.g. GIT drugs, cardiovascular drugs, CNS drugs
THE NURSING PROCESS IN PHARMACOLOGY

• The nursing process is a systematic method of problem solving

and consists of clearly defined steps: assessing; diagnosing
client problems, strengths, and needs; planning care through the
formulation of goals and outcomes; implementing
interventions; and evaluating the care provided.
 ASSESSING THE CLIENT IN RELATION TO
DRUG ADMINISTRATION

• Assessing the client who is receiving medications includes obtaining health

history information, physical assessment data, laboratory values, and other
measurable data and assessing medication effects, both therapeutic and side
effects.
• It also includes assessment of the medication ordered in relation to the client’s
medical condition, culture, ethnicity, gender, age, and other factors.
DIAGNOSING FOR THE CLIENT RECEIVING
MEDICATIONS

• Diagnosing occurs after an analysis of the assessment data and

identifies the client’s problems and needs in relation to drug
administration.
• Nursing diagnoses are verified with the client or caregiver.
 SETTING GOALS AND OUTCOMES FOR
DRUG ADMINISTRATION
• In planning, goals and outcomes are established from the nursing diagnoses.
• Goals focus on what the client should be able to achieve, and outcomes
provide the specific, measurable criteria that will be used to measure goal
attainment.
• Interventions are planned to meet the goals.
 KEY INTERVENTIONS FOR DRUG
ADMINISTRATION
• Interventions are implemented in order to return the client to an optimum
level of wellness.
• These include the safe and effective administration of medications.
• Key interventions required of the nurse include monitoring drug effects,
documenting medications, promoting optimal responses to medications,
preventing or limiting adverse effects, and client teaching.
 EVALUATING THE EFFECTS OF DRUG
ADMINISTRATION
• Evaluating whether the medication is producing the desired effects is an
important nursing responsibility.
• Evaluation begins a new cycle as new assessment data are gathered and
analyzed, nursing diagnoses are reviewed, goals and outcomes are refined,
and new interventions are carried out.
 PRINCIPLES OF MEDICATION ADMINISTRATION

•Types of Drug Order

•Routine order
• It means the drug as ordered is to be regularly administered until a formal discontinuation order is written or until a specified
termination date is reached

•PRN order
• Prn drugs are to be administered by the nurse only “ as necessary”. Within the other crieteria specified by the order, the decision
of when to medicate is left to the nurse’s judgement.

•Single order
• A single order is to be administered only once, at the time indicated. An example is an order for a preoperative medication.

•Stat order
• A stat order is a single order that is to be administered immediately
MEDICATION ERRORS

 Prescribing errors
 Transcription errors
 Dispensing errors
 Administration errors
 Monitoring errors
 NURSE RESPONSIBILITIES

•Verification
• Nurse makes professional judgment regarding acceptability and safety of the
drug order, including type of drug, dose and dose preparation, therapeutic
intent, route, potential allergic reactions, or contraindications
• Transcription
• Nurse is responsible for verification of orders transcribed by others
 THE SIX RIGHTS

•Right drug
• Compare exact spelling and concentration of drug with medication card and drug container; drug
label should be read three times

•Right time
 Standard abbreviations
 Standardized administration times
 Maintenance of consistent blood levels
 Maximum drug absorption
 Diagnostic testing
 PRN medications
• Right dose
• Abnormal hepatic or renal function
• Nausea and vomiting
• Accurate dose forms
• Accurate calculations
• Correct measuring devices

• Right patient
• Bracelet checking
• Pediatric and older adult patients
•Right route
 IV route
 Intramuscular route
 Intravenous route
 Subcutaneous route
 Oral route

•Right documentation
• Safety/ethical considerations
 Legal considerations
 Always include date/time, drug name, dose, route, site of administration
 SPECIAL DOCUMENTATION CIRCUMSTANCES

•Patient refuses medication

 Thoroughly record incident and reason for refusal in nurses’ notes
 Notify physician
•Medication error occurs
 Notify physician
• Complete incident report
 NURSE MUST HAVE KNOWLEDGE OF…

 Patient history and drug usage

 What medications are appropriate and be aware of drug interactions (cooperation
between doctor, pharmacist and nurse a must)
 Drug actions and look for abnormal effects
 How to be a patient advocate- check formistakes on part of doctor or
pharmacist!!
• Do NOT blindly follow Dr’s orders-- THINK and respond to errors [ do not be
intimidated]
 PATIENT CARE

•Pre-administration Assessment
 Collecting baseline data to evaluate therapeutic and adverse responses (e.g., get blood
pressure data and cell counts to use to determine whether drugs are effective)
 Identifying high-risk patients (e.g., liver/kidney dysfunction, genetic factors, allergies,
pregnancy, old age and extreme youth)
 Assessing the patient’s capacity for self-care (can they follow directions on their own)
 First two assessments are drug specific & last assessment is for any patient and drug
 DRUG AND DOSAGE ADMINISTRATION

 Drugs may have more than one indication, i.e. each may have more than one action
depending upon dosage
 Aspirin given in low doses to relieve pain & high doses to suppress inflammation (arthritis)
 Drugs can be administered by different routes and dosage depends on route given
 Oral doses usually larger than injected doses (sc, im, ip, im,iv) and may be fatal if given by
incorrect route
 Certain iv drugs can cause local injury if intravenous line becomes extravasated and Nurse
must monitor this
 GUIDELINES TO HELP ENSURE CORRECT ADMINISTRATION

 Read medication order carefully- verify

 Verify identity of patient with drug order
 Read medication label & verify Drug itself
 Amount of drug (per tablet, per volume
 Verify suitability for administration by intended route
 Verify dosage calculations
 Use special handling if drug requires
 
• DO NOT ADMINISTER ANY DRUG IF YOU DO NOT UNDERSTAND THE REASON FOR ITS USE
 EVALUATING AND PROMOTING THERAPEUTIC EFFECTS

 Is the drug doing the right thing? Evaluation criteria

 Must know rationale for treatment and the nature and time course of desired response
 If do not have this then cannot make judgment of progress
 If desired response do not occur then must act quickly Give alternative therapy
 Even if patient gains beneficial responses, must be aware of what drug is supposed to do, because it still
might end up badly
• 
• Nifedipine: given for hypertension & angina pectoris: when given to treat hypertension should monitor for
reduction in blood pressure; if used for treatment of angina, need to monitor for reduction in chest pain
 PROMOTE COMPLIANCE

•Drugs must be taken correctly

• Wrong dose, Wrong route, Wrong time
•Educate patients to how to self medicate with specific instructions.
•– If elderly must also give instructions to another responsible party.
•Implement Non-drug measures to enhance drug effects.
• Breathing exercises, biofeedback, emotional support, exercise, physical therapy, rest,
weight reduction, stop smoking, and sodium restriction (must evaluate individual patient
for specific needs)
•Minimize Adverse Effects
•Know patient history
•Understand disease and treatment and what drug is supposed to do (again, do not give
drug blindly!!!)
•Identify high risk patient
•Educate patient
•Know adverse effects of drug and educate patient to these.
•Know drug interactions with other medications
•This is important part of patient history
 PATIENT EDUCATION

 Drug name and therapeutic category (penicillin & antibiotic)- give generic name and trade name
 Dosage size
 Dosing schedule (PRN not fixed)-what to do if missed?
 Route and technique of administration taught
 Expected therapeutic response and when it should develop
 Non drug measures to enhance therapeutic responses
 Duration of treatment
 Method of drug storage
 Symptoms of major adverse effects, and measures to minimize discomfort and harm
 Major adverse drug-drug and drug-food interactions (along with Pharmacist)
 Whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions