pharm ch 2: Application of Pharmacology in Nursing Practice

Seven aspects of drug therapy
1) pre-administration assessment
2) dosage and administration
3) evaluating and promoting therapeutic effects
4) minimizing adverse effects
5) minimizing adverse interactions
6) making PRN decisions
7) managing toxicity

Three goals of ASSESSMENT
1) collecting baseline data
2) identifying high-risk patients
3) assessing the pts capacity for self-care.

low doses of Aspirin
relieve pain

high doses of Aspirin
relieve inflammation

Morphine doses
Oral = higher doses
injected = lower doses

to make an evaluation you must know:
-the rationale for treatment
-nature and time course of intended response

Nifedipine
-given for HTN and ANGINA PECTORIS
-used for two cardiovascular disorders

adherence
extent to which a pts behavior coincides with medical advice

carbamazepine
anti-seizure drug

PRN most common for:
hypnotics (sleeping pills)

rifampin
drug for TB – creates a harmless red-orange color to urine, sweat, saliva and tears

phenelzine
antidepressant – can cause dangerous elevations in BP if taken with certain drugs (amphetamines) or certain foods (figs, avocados, most cheeses)

nursing process
1) assessment
2) analysis
3) planning
4) implementation
5) evaluation

4 goals of preadmnistration assessment
1) collection of baseline data needed to evaluate therapeutic responses
2) collection of baseline data needed to evaluate adverse effects
3) identification of high risk patients
4) assessment of the pts capacity for self care

drug hx should include:
-rx drugs
-OTC drugs
-herbal remedies
-drugs taken for non-med purposes (alcohol, nicotine, caffeine, illicit drugs)

idiosyncratic reactions
reactions unique to the individual

contraindication
preexisting condition that precludes use of a particular drug under all but the most desperate circumstances
(allergic reaction to penicillin = contraindication to penicillin unless pt has a life threatening infection that can’t be controlled by another antibiotic)

precaution
preexisting condition that significantly increases the risk of an adverse reaction to a particular drug but not to a degree that is life threatening.

4 groups of nursing interventions
1) drug administration
2) interventions to enhance therapeutic effects
3) interventions to minimize adverse effects and interactions
4) pt education (encompasses info in first 3 groups)

pt education should include:
-pts capacity to learn
-technique of admin
-dosage size
-duration of treatment
-method of drug storage
-measures to promote therapeutic effects
-measures to minimize adverse effects

4 major components of implementation
1) drug admin
2) pt education
3) interventions to promote therapeutic effects
4) interventions to minimize adverse reactions

evaluation
evaluate for:
1) therapeutic response
2) adverse drug reactions/interactions
3) adherence to prescribed regimen
4) satisfaction w/ treatment

amphetamine
adverse effect (AE) = CNS stimulation

aspirin
AE – gastric erosion

atropine
AE – urinary retention

bethanechol
AE – stimulation of GI smooth muscle

clonidine
AE – impotence

cyclophosphamide
AE – reduction in WBC count

digoxin
AE – dysrhythmias

furosemid
AE – excessive urine production

gentamicin
AE – damage to 8th CN

glucocorticoids
AE – thinning of skin

haloperidol
AE – involuntary movements

nitroglycerin
AE – hypotension

propranolol
AE – bradycardia

warfarin
AE – spontaneous bleeding

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