Nursing 330 Pathophysiology and Pharmacology I

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Nursing 330 Pathophysiology and Pharmacology I

  1. 1. 1 Nursing 330 Pathophysiology and Pharmacology I Course Outline Fall 2007 Unit I: Introduction to the Course and Core Concepts in Pharmacology Following completion of the Unit the student will be able to: 1. Identify key events in the history of pharmacology. 2. Define pharmacology, therapeutics, and pharmacotherapeutics. 3. Explain the interdisciplinary nature of pharmacology, pathophysiology and the nursing process 4. Discuss the role of the nurse in relation to pharmacotherapeutics. 5. Identify current challenges of pharmacotherapy. 6. Identify categories of therapeutic agents. 7. Discuss the process of dispensing and regulating drugs. 8. Explain the process of drug approval in the USA. 9. Describe methods of scheduling and classifying drugs 10. Discuss the prototype approach to classification of drugs 11. Define mechanism of action 12. Discuss drug names. 13. Define controlled substances and discuss why drug schedules are necessary. 14. Verbalize responsibilities and processes related to drug administration. 15. Explain the application of pharmacokinetics in practice 16. Describe the principles of pharmacodynamics and their importance to clinical practice Topics: 1. Therapeutics and pharmacology 11. Absorption, distribution, metabolism and 2. Traditional drugs, biologics and alternative excretion of medications therapies 12. Drug plasma concentration and therapeutic 3. Prescription and OTC drugs response 4. Role of the FDA 13. Duration of drug action 5. 4 Stages for Drug approval 14. loading doses and maintenance doses 6. Drug regulations and standards 15. Inter-patient variability 7. Therapeutic and pharmacologic drug 16. Therapeutic index and drug safety classification 17. Graded dose response 8. Chemical, generic and trade names 18. Potency and Efficacy 9. Generic equivalents, controlled substances 19. Cellular receptors and drug action and drug schedules 20. Types of drug-receptor interaction 10. Passage of drugs through plasma 21. Pharmacogenetics membranes Teaching/Learning Activities: Required readings: Adams et. al: Chap.1, 2, 4, 5, 6, Assignment 1: All students interview a professional RN in the work sitting re: problems and advantages of the current medication administration system in use. Activities: History of Pharmacology Time Line Drug names and classifications
  2. 2. 2 Unit II: Pharmacology and the Nurse-Patient Relationship Following completion of this unit the student will be able to: 1. Apply the Nursing Process in the management of medications. 2. Explain the nursing and pharmacologic implications associated with all stages of growth and development 3. Explain how physical, cognitive and psychomotor development influences pharmacotherapeutics. 4. Discuss risk and benefit in relation to drug administration. 5. Define the term teratogen and discuss the implications related to teratogens. 6. Identify Pregnancy categories and discuss the implications for practice. 7. Apply ethical principles to the effective administration of medications 8. Discuss medication errors and risk reduction strategies utilizing the nursing process. 9. Describe the significance of Nurse Practice Acts and Standards of Care in mediation administration 10. Describe how to report a medication error and explain why it is important to do so. 11. Discuss the relevance of client education to medication administration and error reduction. 12. Identify psychosocial, cultural and spiritual values and beliefs that can influence pharmacotherapeutic outcomes 13. Relate the implications of gender, community and environmental factors to the actions of certain drugs. 14. Explain the role of complimentary and alternative medicine in patient wellness Topics: 1. Drug administration during: pregnancy and 7. Realistic plans, goals and outcomes for lactation, infancy, toddler hood, preschool patients receiving meds and school age years, adolescence, young 8. Key intervention strategies to be used with and middle adult hood and older adulthood patients on meds 2. Five pregnancy categories of drugs 9. Evaluating outcomes of medication 3. Physiological and biochemical changes in administration the older adult 10. Moral principles guiding drug administration 4. Review of basic human growth and 11. Nurse Practice acts; ANA standards of care development 12. Documentation of drug administration 5. Assessment data pertinent to drug 13. Medication errors; preventing and reporting administration 14. Holistic Pharmacotherapy 6. Appropriate nursing diagnoses for patients 15. Herbal and dietary supplements; common receiving meds drug-herbal interactions 16. Regulation of herbal and dietary products Teaching/Learning: Required Reading: Adams, et al: Chap. 7,8,9,10,11 Review: Adams, et al Chap 4 (Principles of Drug Administration) Assignment 2: Student reports on drug articles from popular publications, observation of TV and internet advertising
  3. 3. 3 Unit III: The Perioperative Patient and Pharmacotherapeutics (Drugs for control of pain and for local and general anesthesia) Following completion of this unit the student will be able to: 1. Categorize drugs used for anesthesia based on their classifications and drug actions. 2. Describe actions of local and general anesthetics on the nervous system 3. Use the nursing process to care for patients who are receiving medications before, during and after surgery 4. Identify specific prototypes of anesthetic medications 5. Categorize drugs used in the treatment of pain based on their classification and mechanism of action 6. Explain the neural mechanisms for pain and the role of neurotransmitters in pain management 7. Identify specific pain medication prototypes 8. Use the nursing process to manage the pharmacologic aspects of the pain experience Topics: 1. Local anesthetics; Amides (P: 8. Balanced anesthesia lidocaine/Xylocaine), Esters, Misc. Agents 9. Critical responses to anesthesia 2. General Anesthetics: Inhalation agents 10. Opiod receptors and neural pathways for such as gases(P: nitrous oxide); volatile pain liquids (P: halothane/Fluothane) 11. Opiod analgesics(narcotics): opiod 3. IV agents: barbiturates and barbiturate-like agonists(morphine); opiods with mixed agents (P: thiopental/Pentothal); opiods agonist-antagonist activity; opiod and benzodiazepines antagonists (P: naloxone/Narcan) 4. Neuromuscular blocking agents (P: 12. Non opiod Analgesics: Acetaminophen; succinylcholine/Anectine) NSAIDS; Aspirin and other 5. Compare and contrast 5 methods for salicylates,Ibuprofen,Cox-2 inhibitors; administering local anesthetics centrally acting agents 6. 4 Stages of General Anesthesia 13. Antimigraine Agents: Triptans (P: 7. Age, physical and psychological associated sumatriptan/Imitrex); ergot alkaloids, misc. influences on anesthetic administration and agents choice 14. Pain classification Teaching / Learning: Required Reading: Adams, et al Chap 18 & 19 Assignment 3: Submission of 3 page report on a selected patient’s experience with anesthetic or pain medications or both. Activities: Presentation of assigned drugs by selected students
  4. 4. 4 Unit III: The Nervous System Following completion of this unit, the student will be able to: 1. Compare and contrast the types of responses that occur when the different receptors are activated. 2. Compare and contrast drugs that affect the Nervous System in terms of indications, mechanisms of action, primary actions, expected outcomes, contraindications, side effects, and adverse effects. a. ANS b. Anxiety and insomnia c. Seizures and epilepsy d. Degenerative neurological disorders e. Ischemic Stroke 3. Discuss the nurse’s role in the pharmacologic management of patients receiving drugs affecting the Nervous System. a. ANS b. Anxiety and insomnia c. Seizures and epilepsy d. Degenerative neurological disorders e. Ischemic Stroke 4. Identify disorders that require drugs affecting the ANS. 5. Identify brain regions associated with anxiety, sleep and wakefulness. 6. Identify three classes of drugs used to treat anxiety and sleep disorders. 7. Discuss the pathophysiology of seizures and epilepsy. 8. Discuss lab tests used to evaluate effectiveness and adverse effects of antiseizure drugs 9. Explain the pathophysiology and neurochemical basis for Parkinson’s Disease, focusing on the role of dopamine and acetylcholine in the brain. 10. Explain the goals of pharmacotherapy for Alzheimer’s Disease and the existing medications. 11. Explain the pathophysiology of ischemic stroke. 12. Discuss the use of thrombolytics in the emergency treatment of stroke. Topics 1. Synaptic transmission 14. Barbiturates 2. Acetylcholine and cholinergic transmission 15. Buspirone 3. Norepinephrine and adrenergic 16. Zolpidem transmission 17. Pathology of seizures 4. Classification and naming of autonomic 18. GABA agents drugs 19. Hydantoin and phenytoin-like drugs 5. Parasympthomimetics 20. Succinimides 6. Anticholinergics 21. Pathophysiology of Parkinson’s Disease 7. Sympathomimetics 22. Dopaminergic drugs 8. Adrenergic antagonists 23. Cholinergic blockers 9. Myasthenia gravis 24. Anticholinergics 10. Limbic and reticular activating system 25. Pathophysiology of Alzheimer’s Disease 11. Anxiolytics 26. Acetylcholinesterase inhibitors 12. Melatonin 27. Pathophysiology of ischemic stroke 13. Benzodiazepines 28. Thromolytics Teaching/Learning Required Reading: Adams et al., Chapters 13,14,15,16,17,20,21 Assignment 4: Develop a concept map for the use of thrombolytics using a nursing process focus.
  5. 5. 5 Unit VIII: Patients with endocrine problems and Pharmacotherapeutics Following completion of this unit, the student will be able to: 1. Describe the functions of the endocrine system and the concept of negative feedback 2. Identify underlying problems producing pituitary, adrenal, thyroid and pancreatic disorders 3. Categorize drugs used in the treatment of endocrine disorders based on classification and mechanism of action 4. Use the Nursing process to care for Patients who are receiving drug therapy for pituitary, thyroid and adrenal disorders 5. Describe endocrine and exocrine functions of the pancreas 6. Compare Type I and Typ II diabetes 7. Compare types of insulin and other antidiabetic agents 8. Use the nursing process to care for patients receiving drug therapy for pancreatic disorders Topics: 1. The endocrine system and homeostasis 2. Signs and symptoms of deficiencies and excesses of hormonal responses 3. Specific disorders of endocrine glands 4. Hypothalamic and Pituitary Drugs: Anterior pituitary agents (P: vasopressin injection/ Pitressin 5. Thyroid agents (P: levothyroxine/Synthroid); Antithyroid agents(P: propylthiouracil/PTU) 6. Adrenal Drugs: Glucocorticoids (P: hydrocortisone/Aerobes-HC, etc); Anti adrenal agents 7. Insulins (P: regular insulin/Humulin R, Novolin R ,pork Regular Iletin II, Purified pork Insulin) 8. Oral hypoglycemics (P: glipizide/Glucotrol, Glucotrol XL) 9. Pancreatic enzyme replacement (P: pancrelipase/ Pancrease) Teaching/Learning: Required Reading; Adams et al Chapters 43, 44, 45, 46 Assignment 5: Students submit report comparing hypo and hyperglycemia, and appropriate pharmacologic interventions
  6. 6. 6 Unit VII: Patients with problems of the gastrointestinal system and Pharmacotherapeutics Following completion of this unit, the student will be able to: 1. Identify common causes, signs and symptoms of peptic ulcer disease 2. Compare duodenal ulcers and gastric ulcers 3. Categorize drugs used in the treatment of peptic ulcer based on their classification and mechanism of action 4. Use the nursing process to care for patients receiving drug therapy for peptic ulcer disease. 5. Identify conditions where pharmacotherapy of bowel disorders and of nausea and vomiting is indicated 6. Explain pathogenesis of constipation and diarrhea 7. Categorize drugs used in the treatment of bowel disorders, nausea and vomiting based on their classification and mechanism of action 8. Use the nursing process to care for patients who are receiving drug therapy for bowel disorders, nausea and vomiting Topics: 1. H2-Receptor antagonists (P: ranitidine/Zantac) 2. Proton pump inhibitors (P: omeprazole/Prilosec) 3. Antacids(P: aluminum hydroxide/Amphojel, etc) 4. Antibiotics 5. Miscellaneous agents 6. Pathogenesis of peptic ulcer disease 7. Drugs for constipation/Laxatives: Bulk forming (P: psyllium mucilloid /Metamucil; stool softener/surfactant; stimulant; saline and osmotic; miscellaneous agents 8. Antidiarrheals: Opioids (P: diphenoxylate with atropine/Lomotil); miscellaneous agents 9. Drugs for nausea and vomiting: anticholinergics, Antihistamines, Benzodiazepines, Cannabinoids, Glucocorticoids, Phenothiazine and phenothiazine-like drugs (P: prochlorperazine/Compazine); Serotonin-receptor antagonists 10. Drugs for suppressing appetite/Anorexiants (P: sibutramine/Meridia) Teaching/Learning: Required Reading: Adams et al Chapters 40, 41, 42 Assignment 6: Submit report on use of appetite suppressants and laxatives based on 3 patients. What teaching may be necessary?
  7. 7. 7 Unit IV: The Patient with Hematological Problems and pharmacotherapeutics Following completion of this unit, the student will be able to: 1. Discuss the significance of the important steps of hemostasis and fibrinolysis 2. Describe thromboembolic disorders that are indications for coagulation modifiers 3. Identify the primary mechanisms by which coagulation modifiers act 4. Explain the significance of laboratory testing in monitoring anticoagulant pharmacotherapy 5. Categorize coagulation-modifying drugs based on classifications and mechanism of action 6. Use the nursing process to care for patients receiving drug therapy for coagulation disorders 7. Describe the process of hematopoiesis and how it is regulated 8. Classify anemias based on their causes 9. Categorize drugs used in the treatment of hematopoietic disorders based on classification and mechanism of action 10. Use the nursing process to care for patients who are receiving drug therapy for hematopoietic disorders Topics: 1. Anticoagulants: Parenteral anticoagulants (P: heparin/HepLock); Oral anticoagulants(P: warfarin/Coumadin) 2. Antiplatelet Agents: ADP receptor blockers; Glycoprotein llb-llla blockers (P: abciximab/ReoPro); Anticoagulant antagonists; Thrombolytics (P: alteplase /Activase); Antifibrinolytics (P: aminocaproic acid/Amicar) 3. Bleeding disorders, thromboembolic disorders 4. Hematopoietic Growth Factors: Erythropoietin (P: epoetin alfa /Epogen/Procrit); Colony stimulating factors (P: filgrastim/Neupogen); Platelet enhancers 5. Antianemic Agents (P: cyanocobalamin/Cyomin, vitamin B12; Folic acid (Folvite); Iron salts(P: ferrous sulfate/Ferralyn, etc) Teaching/Learning: Required Reading: Adams et al Chapters 27, 28 Assignment 7: Students submit a flow chart diagramming steps of hemostasis and fibrinolysis
  8. 8. 8 Unit V: The Immune Compromised Patient and Pharmacotherapeutics Following completion of this unit, the student will be able to: 1. Compare specific and non specific body defenses 2. Compare humoral and cell mediated immune responses 3. Identify specific drugs related to the immune system as well as their actions and important effects 4. Use the nursing process to care for patients receiving drug therapy for immune disorders 5. Outline the steps of the inflammatory process 6. Use the nursing process to care for patients receiving drug therapy for inflammation, fever and allergies 7. Describe classifications of bacteria 8. Explain the mechanisms of resistance and superinfections 9. Identify specific classes of antibiotics and their prototypes 10. Describe structural components of viruses 11. Identify viral diseases that may benefit from pharmacotherapy 12. Use the nursing process to care for patients receiving drug therapy for viral infections 13. Compare pharmacotherapy of superficial an systemic fungal infections 14. Identify protozoan an helminth infections that may benefit from pharmacotherapy 15. Use the nursing process to care for patients receiving drug therapy for fungal, protozoan and helminth infections Topics: 1. Immunization Agents: vaccines; Immune (P: ciproflaxin/Cipro); Sulfonamides (P: globulin preparations trimethoprim-sulfamethoxazole/Bactrim, 2. Immunostimulants: Interferons (P: Septra); Misc. Antibacterials (P: interferon alfa/ Roferon-A, Intron-A) vancomycin/Vancocin; Antitubercular 3. Interleukins; other agents agents(P: isoniazid/INH 4. Immunosuppressants; Antibodies; 13. Pathogenicity and virulence Antimetabolites and cytotoxic agents; 14. Characteristics of fungi and classification of Calcineurin inhibitors (P: cyclosporine/ mycoses Neoral, Sandimmune) 15. Antifungal drugs: Agents for systemic 5. Glucocorticoids infections (P: amphotericin B/Fungizone)(P: 6. Transplant rejection fluconazole/Diflucan); Agents for topical 7. Anti-inflammatory Drugs: NSAIDs (P: infections (P: nystatin/Mycostatin) celecoxib/Celebrex); Systemic 16. Antiprotozoan Drugs: Antimalarial agents glucocorticoids (P: prednisone/Meticorten, (P: chloroquine/Aralen); Non malarial others) antiprotozoan agents (P: 8. Antipyretics (P acetaminophen/Tylenol) metronidazole/Flagyl; Antiparasitic agents 9. Allergy drugs: Antihistamines (P: 17. Antihelmintic drugs (P: diphenhydramine/Benadryl, others) (P: mebendazole/Vermox) fexofenadine/Allegra) 18. Characteristics of viruses and retroviruses 10. Intranasal glucocorticoids (P: 19. General principles of HIV therapy; HAART fluticasone/Flonase); sympathomimetics (P: 20. Agents for HIV-AIDS; Nucleoside and oxymetazoline/Afrin) nucleotide reverse transcriptase inhibitors 11. Anaphylaxis Drugs: (P: (P: zidovudine/Retrovir, AZT); epinephrine/Adrenalin) Nonnucleoside reverse transcriptase 12. All major classification of antibiotics: inhibiters (P: nevirapine/Viramune); Penicillins (P: penicillin G/Pentids); Protease inhibitors (P: saquinavir mesylate/ cephalosporins (P: cefotaxime/Claforan); Fortovase, Invirase; Fusion Inhibitors Tetracyclines (P: tetracycline HCl 21. Agents for Herpesviruses (P: /Achromycin); Macrolides (P: erythromycin/ acyclovir/Zovirax) E-Mycin Erythrocin); Aminoglycosides (P: 22. Agents for Influenza gentamicin/Garamycin); Fluoroquinolones
  9. 9. 9 23. Agents for hepatitis (P: Interferons, Non interferons) Teaching/Learning: Required readings: Adams et al Chapters 32,33,34,35,36, Assignment 8: Student will write a 2-3 page report on patient receiving at least one drug from unit IV.
  10. 10. 10 Unit V: The cancer patient and pharmacotherapeutics Following completion of this unit, the student will be able to: 1. Explain differences between normal cells and cancer cells 2. Identify causes, lifestyle factors and primary therapies for cancer 3. Explain the significance of growth fraction and cell cycle in chemotherapy 4. Explain the significance of combination therapy and special dosing protocols in chemotherapy 5. List general adverse effects of chemotherapy 6. Categorize anticancer drugs based on classification and mechanism of action 7. Use the nursing process to care for patients receiving antineoplastic medications Topics: 1. Alkylating Agents: Nitrogen mustards (P: 5. Hormone and hormone inhibitors: cyclophosphamide /Cytoxan); Nitro ureas; Adrenocorticoids; Androgens and androgen Misc. alkylating agents antagonists; Estrogens and estrogen 2. Antimetabolites: Folic acid antagonist (P: antagonists (P: Tamoxifen/Nolvadex); methotrexate/Folex, Mexate, etc); Progestins; other hormone agents pyrimidine analogs; purine analogs 6. Miscellaneous Antineoplastics: Biologic 3. Antitumor antibiotics (P: Response Modifiers; Other anticancer doxorubicin/Adriamycin) agents 4. Natural Products: Vinca alkaloids (P: vincristine/Oncovin); Toxoids; Topoisomerase inhibitors Teaching/Learning: Required Reading: Adams et al Chapter 37 Assignment 9: Design a teaching plan for a patient with cancer, with special emphasis on his/her first experience with chemotherapy

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