PHARMACODYNAMICS  Rate of elimination is the lowest plasma

concentration of drug and measures the w/c the

 Mechanism by which drugs produce change in the drug is eliminated
body
WAYS OF DRUGS ACTS IN THE BODY
DESIRED EFFECT – intended action of drugs
 PROPHYLAXIS – Prevents/lessen severity of
 SIDE EFFECTS disease
 ADVERSE EFFECTS  PALLIATIVE/SYMPTOMATIC – Relieve distressing
 TOXIC EFFECT symptoms of disease
 IDIOSYNCRATIC EFFECT  CURATIVE/SPECIFIC – ELIMINATE THE DISEASE
 SUPPORTIVE – Sustain Pt until measures can be
SIDE EFFECT
instituted that will cure or alleviate the condition
 consequence reaction (desirable/undesirable)  SUBSTITUTE/REPLACEMENT – Replace substance
 should not outweigh benefits of drugs normally found in the body
 Example: Teratogenic (Damaging the fetus),  SUPPLEMENTARY – Added as a supplement or
mutagenic, carcinogenic something that supplies a deficiency
 CHEMOTHERAPEUTIC – Use of certain
ADVERSE EFFECT drugs/chemicals to manage cancer
 Harmful unintended reaction  RESTORATIVE – Help return the body to its normal
state
TOXIC EFFECT  DIAGNOSTIC – radiopaque dyes. Example. MRI
 THERAPEUTIC USE – Desired effects (Ex. Antacids,
 The degree which something is poisonous
antibiotics)
IDIOSYNCRATIC EFFECT
PRESCRIPTION DRUGS – Requires an order from
 UNPREDICTABLE RESPONSE physician/dentist
 Effects that cannot be explained
NON-PRESCRIPTION DRUGS - OTC drugs
HALF LINE
FACTORS INFLUENCING DRUG EFFECTS
 Time it takes to half the drug concentration to be
 WEIGHT
eliminated
 AGE
LOADING DOSE  GENDER
 PHYSIOLOGICAL FACTORS
 Large initial dose given when immediate drug  PATHOLOGICAL FACTORS GENETIC FACTORS
response is desired; double the dose  IMMUNOLOGIC FACTORS
AGONIST  PSYCHOLOGICAL FACTORS
 ENVIRONMENTAL FACTORS
 Drugs that produce a response
COMMON LAW
ANTAGONIST
STANDING ORDER (ACTIVE ORDER)
 Drugs that block a response
 clearly written (drug name, route, frequency
THERAPEUTIC INDEX
 specific circumstances for PRN medications
 Estimates the margin of safety of a drug  do not accept or carry out unclear orders
 Low TI = narrow margin of safety
EMERGENCIES/VERBAL ORDERS
 High TI = wide margin of safety and less danger of
producing toxic effects  emergency situation only
 telephone orders
PEAK DRUG LEVEL
NURSING PROCESS
 Rate of absorption is the highest plasma
concentration of drug at a specific time  Essential care of practice for nurses
 Support nurse in prioritizing the safe, timely
THROUGH DRUG LEVEL
delivery of drug administration

ADPIE
ASSESSMENT  EXAMPLE: The Pt will independently administer
the prescribed dose of 4 units of regular insulin by
 Starts with therapeutic relationship
the end of the fourth session of instruction
SUBJECTIVE DATA
INTERVENTION
 Pt verbalizes the data
 Client education and teaching is the key nursing
 Use of open-ended questions
responsibility during this phase
 Symptoms
 In some practice setting, administration of drug
and assessment of drug are also important
o Current health history
responsibility
o Swallowing problem
o Knowledge of the Pt about medication and side EVALUATION
effects
 Determining whether goals and teaching
o Allergies, tobacco, and alcohol usage
objectives are being met. NOTE: if objective is not
o Financial barriers met, revision is necessary, otherwise if met,
o Caregivers and support systems documentation is warranted
OBJECTIVE DATA
FDAR = FOCUS, DATA, ACTION, RESPONSE
 The nurse directly observes about the Pt’s health
DRUG SAFETY
status
 Signs 1. Check the order
a. Client’s name
o Physical health assessment b. Date and time order was written
o Lab results c. Name of the medication
o Data from physician’s notes d. Dosage
o VS e. Route of delivery
o Body language f. Signature of prescriber
2. Always verify the 6 rights
DIAGNOSIS a. Right Pt
 Based n the analysis of the data b. Right drug
 More than one applicable nursing diagnosis may c. Right dose
be generated d. Right time
 May be actual or potential; Ex. Non-compliant e. Right route
 Individualized for each patient f. Right documentation
 Based from medical condition and the drug he/she RIGHT Pt
is receiving
 Verify Pt with 2 forms of verification
o Knowledge deficit about drug action,  Compare Pt stated name and birth date with Pt’s
administration and side effects related to ID band and MAR (medication administration
language difficulties record
o Potential for injury related side effects of drugs  Scan Pt’s barcode on their ID band
such as dizziness and drowsiness, 2°CVA  Verify Pt’s name with family member if present
o Alteration in thought processes r/t forgetfulness,  Check for “name alert” sticker when have the
same name
affecting whether the client takes medication as
prescribed. RIGHT DRUG
PLANNING  Scan medication
 Check if the order is prescribed by the licenced
 Setting goals, expected outcomes and
healthcare provider
interventions
 Read drug label 3x
 Realistic, measurable, reasonable
- When meds are taken out of the storage
 Acceptance to Pt and nurse
- When meds are being poured/administered
 Dependent on Pt’s ability
- When meds are being put away at bedside
 Shared with other healthcare provider
 Be familiar with Pt’s health record, allergies, lab
results, vital signs
  Know why Pt is receiving meds and correct for Pt’s - Most common drug forms
diagnosis  Liquids
 Check dose calculations - Elixirs, emulsions, suspensions
 Note the beginning and ending date of meds  Transdermal
- Medication restored patched on skin
RIGHT DOSE
 Topical
 Verify dosage calculations - Cream, ointment
 Verify if drug is safe for Pt  Instillations
 If dose is dependent upon Pt’s weight - Drops, sprays
 Validate dose of certain drugs like insulin and
heparin with 2 RNs ROUTES OF ADMINISTRATION
RIGHT TIME ENTERAL

 Use health care agency policy  Oral

 Use of military time reduces errors (24 hr format) - Most commonly used easiest, safer, preferred
 Drugs affected by food are given 1 hr ac or 2 hr pc by clients
 Give food with drugs that irritates the stomach - Slower onset of action, more prolonged effect
 Check scheduled procedures - Do not use when vomiting
 Administer antibiotics at even intervals  Sublingual
 Hold antihypertensives prior to dialysis if ordered - Faster, avoid gastric irritation, and first-pass
effect
RIGHT ROUTE
PARENTERAL
 Necessary for adequate absorption
 Assess the ability to swallow oral meds  Administered via injections
 Do not crush or mix meds w/o  ID
validation/consultation - 0.5cc, 5° - 15° angle
 Offer Pt water but not juice - No aspiration required, don’t massage (wheal)
 Use aseptic technique - Slowest in absorption among parenteral route
 SC
RIGHT DOCUMENTATION - 45° - 90° angle, slow absorption, no aspiration
required
 Record administration immediately
- Slow, sustained rate of absorption. Example:
 Record drug name, dose, route, time, date, RN’s
insulin, heparin
signature or initials according to agency policy
- Bony prominence
 Document response to drug especially analgesics,
 IM
sedative, and antiemetics (for vomiting)
- 0.5cc
- 2cc, Deltoid
3. Question drug orders that are unclear, appear to
- 3cc ventrogluteal
contain errors, or have potential to harm
- Vastus lateralis
4. Prepare drugs for one Pt at a time. Never leave
 Z-TRACK
meds on cart or tray unattended
- Pull skin to one side, hold, insert needle
5. Check history for allergies and potential drug
- Hold skin to side, inject needle and medication
interactions before administering a newly ordered
- Wait for 10 secs, withdraw needle, release
drug
skin
6. Inform prescribing physician of any observed
 IV
adverse effect; if cannot be located, inform
- Needle or tub, very fast effect, 100%
nursing supervisor
bioavailability
7. Take the following actions if an error occurs:
- Standard IV line (replaced after 4 days)
a. Notify nursing supervisor, prescribing
- Central venous catheter (replaced after a
physician, pharmacist
month)
b. Assess client’s condition and provide
- Common site of IV: Radial vein, median
necessary care
cubital, cephalic vein, basilic vein
c. Make an incidence report

DRUG FORMS

 Tablets and capsules