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PHARMACOLOGYPHARMACOLOGYCONNECTIONS TO NURSING PRACTICECONNECTIONS TO NURSING PRACTICE

Second EditionSecond Edition

Pharmacology: Connections to Nursing Practice, Second EditionMichael Patrick Adams • Carol Quam Urban

CHAPTER

Introduction to Pharmacology: Concepts and Connections

1


Learning Outcomes

1. Identify key events in the history of pharmacology.

2. Compare and contrast the terms drug, pharmacology, and pharmacotherapy.

3. Explain the importance of pharmacotherapy to clinical nursing practice.


Learning Outcomes

4. Using specific examples, explain the difference between the pharmacologic and therapeutic methods of classifying drugs.

5. Identify the advantages of using prototype drugs to study pharmacology.

6. Classify drugs by their chemical, generic, and trade names.


Learning Outcomes

7. Compare the advantages and disadvantages of a pharmaceutical company being granted exclusivity for the development of a new drug.

8. Analyze possible differences between generic drugs and their brand-name equivalents.

9. Assess the responsibilities of the nurse in drug administration.


PharmFact


Pharmacology as Science

• With science, pharmacology becomes a discipline

• Herbal remedies are first used• Word pharmacology first referenced in

1693• Modern pharmacology begins in 1800s• Chemists first isolated active agents• Early drugs are from natural plants


Pharmacology Today

• Current practice is complex• Application is still the same• Focus on patient and improving quality

of life – to relieve human suffering• Important part of the art and discipline

of nursing• IN NURSING THIS IS A PART OF OUR

ART AND SCIENCE THAT REQUIRES 100% TIME AND ATTENTION


1.2 Pharmacology is the study of medicines.

Pharmacology: The Study of Medicines


What is a Drug?

• Any substance that is taken to:– Prevent– Cure– Reduce

Symptoms of a medical condition


Role of the Nurse

• Drugs are a form of medical intervention

• Nursing designs interventions for desired health goals

• Pharmacotherapy is a critical intervention

• Nurse administers the drug, assesses the effects and teaches the client about the drug (this is a summary of the role)


Figure 1.1 Rationale for pharmacotherapy: A partnership between the patient and the health care provider.


Pharmacology:The Study of Medicine

• The word pharmacology comes from the Greek– Pharmakon = medicine or drugs– Logos = to study

• Pharmacotherapy is the application of drugs for prevention or treatment

• Pharmacology covers administration, metabolism, and response


1.3 The perfect drug is safe and effective.

Characteristics of an Ideal Drug


Characteristics of Drugs

• Over 11,000 brand, generic, and combination agents

• Each has its own application, interactions, side effects, and actions

• Many have multiple effects on the body• Patient factors can alter responses


Patient Factors

• Age• Gender• Race• Body Mass• Health Status• Genetics this is an emerging area of

study


Drug Actions

• New drugs introduced every year• New and old drugs are removed yearly• Drugs can improve quality of life• Drug reactions can also cause disability

or death• Enormous challenge to stay current and

up to date in the application of medications


Is There a Perfect Drug?

• What is the perfect drug?– It would do everything you want– No side effects– Convenient– Inexpensive– No interactions– Quickly eliminated


Drug Indications

• All prescription drugs must have some degree of effectiveness

• Drugs are approved by their indications• Every drug has at least one indication• Many drugs have multiple indications• Unapproved indications are unlabelled

or off-label


Clinical Nursing Practice

• Nurses need to have an understanding of how a drug works

• Drug therapy is a large part of the nursing process

• Nurses need to understand how patient variables affect drug therapy

• Nurses need to stay up to date


1.4 Drugs may be organized by their therapeutic classification or pharmacologic classification.

Classification of Drugs



• FDA is the Food and Drug Administration

• FDA.com• Orange Book of approved drugs• Classified by therapeutic and

pharmacological properties



• Pharmacologic – how the drug acts• Used for both prescription and non-

prescription medications

• Therapeutic – what is being treated by the drug


Therapeutic Classifications

• Therapeutics is the usefulness in treating a specific disease

• A drug may lower blood pressure, but also relieve chest pain

• A drug may lower blood glucose and also lower cholesterol

• Classification is what condition is being treated by the particular drug


Table 1.1 Organizing Drug Information by Therapeutic Classification


Pharmacologic Classification

• Pharmacologic is the mechanism of the drug or how the drug produces its effects in the body

• Three different drugs can lower blood pressure, but each differs in its mechanism of action

• May use drug’s chemical name


Table 1.2 Organizing Drug Information by Pharmacologic Classification


Classifications

• Drugs can have multiple classifications• Dependent on the clinical use of the

drug• Important to understand and know the

different classifications for each drug• You will be learning drugs by

classification. I will focus on these rather than individual drugs*


1.5 A prototype drug is the agent to which all other drugs in a class are

compared.

Drug Prototypes


Prototype

• Single drug from each class• May compare all other medications in

the class to the prototype• Usually first drug in its class• Can be combination of traditional and

new drugs• Helps with learning pharmacology


1.6 Drugs have chemical, generic, and trade names.

Naming Drugs


Chemical Names

• Each drug has only one chemical name• Clear, concise meaning of the nature of

the drug• Often difficult to remember and

pronounce• As nurses we are not concerned about

the chemical name


Generic Name

• Assigned by United States Adopted Name Council

• Less complicated than chemical names• Many organizations use generic names to

describe and identify• Easy for students to memorize one name• Focus on the generic name• For testing purposes I will give both

generic and trade


Brand Name

• Name given by the pharmaceutical company marketing the drug

• Tries to be short and easy to remember• Proprietary • Each drug receives period of exclusivity

for marketing


Trade Names

• Products with the same drug• May contain one or more active

ingredient• Combination drugs have more than one

active generic ingredient


Generic Drugs

• Usually less expensive than trade name drugs

• Drug formulations may be different• Inert and/or active ingredients may be

same or different• This can change the bioavailability


Table 1.3 Examples of Generic Drugs Contained in Brand-Name Products


1.7 Generic drugs are less expensive than brand-name drugs, but they may

differ in bioavailability.

Naming Drugs


Generic Substitution

• Laws vary by state• Pharmacists may substitute generic for

brand• Pharmacists may have to obtain approval

from provider before substituting generic• Can be cost saving for patients• Many pharmacies offer generic lists• PCP may write DAW (dispense as written)

of NO GENERIC SUBSTITUTIONS


Exclusivity of New Drugs

• Pharmaceutical companies market their brand-name drugs

• Claim significant difference between brand and generic

• Consumer advocates argue generic should be available

• Cost difference between generic and brand can be significant


Bioavailability

• Defined as the rate and extent to which the active ingredients are absorbed from a drug product and then available at the site of action

• May be different between trade and generic


Internet Sales

• Drug laws vary by country• Some drugs may be available without a

prescription• Quality control standards may differ• Sources may be unreliable• Nurses must help patients understand

the differences and dangers


1.8 Pharmacology is intimately connected to nursing practice and is a

key intervention in relieving and preventing human suffering.

Connecting Pharmacology to Clinical Nursing Practice


Nursing Practice

• Understanding of pharmacology is critical to nursing practice

• One of the key interventions in nursing care

• The nurse must understand the pharmacotherapeutic principles for all medications

• Key to elimination of medication errors


Nurse’s Responsibilities

• Name of drug• Intended use (sometimes used for

unlabeled use or side effects)• Dose range• Effects on body• Contraindications and precautions• Special considerations of administration


Nurse’s Responsibilities

• Why it is prescribed• How to administer the drug• Nursing process considerations related

to drug• Application of all 5 steps of the nursing

process

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