Simmons College
School of Nursing and Health Sciences
NUR 331 Pharmacology
Spring 2017
Course Information
Instructor: Donna M Glynn, PhD, RN, APN-BC
Office:S332 B
Office Hours:TBD
Office Telephone:617-521-2522
E-mail:
Course Description
This course will focus on basic pharmacologic principles and how pharmacologic agents are used in the treatment of a variety of conditions to support physiological function. Course content includes the nurses’ role in monitoring the safety and effectiveness of pharmacological therapies.
Course Goals and Student Learning Objectives
Outcomes/Goals / Nursing Program Outcomes / Content / EvidenceDemonstrate an understanding of Pharmacology concepts / Define pharmacokinetics and pharmacodynamics
Identify factors that influence drug availability, bioavailability.
Describe the four phases of pharmacokinetics and factors that influence the process
Discuss Pharmacotherapeutics
Drug interactions, adverse drug reactions, and individual variation in drug responses.
Identify different types of drug nomenclature
Discuss the regulatory history of pharmacotherapeutics. / Role of the FDA.
FDA reporting
Analyze the role of the nurse in the safe administration and prescription of medications. / Demonstrate correct technique in administering oral, subcutaneous, intramuscular, and intravenous medications
Abbrev
Med term
Master the ability to calculate medication dosages. / 1. IV Fluids
Lab on med admin
Safety reporting
EMAR, barcoding etc.
Root cause analysis of med errors
Apply the nursing process in providing evidenced based pharmacothereutics to patient care / Pharmacotherapeutics to support the perioperative patient
Anesthetics and analgesic
antiintectives
Pharmacotherapeutics to support nursing care for individuals experiencing problems of oxygenation
Pharmacotherapeutics to support nursing care for individuals experiencing problems of Cardiac output and perfusion
Pharmacotherapeutics to support nursing care for individuals experiencing problems of Mobility sensation and cognition
Pharmacotherapeutics to support nursing care for individuals experiencing problems of Digestion, nutrition, elimination
Pharmacotherapeutics to support nursing care for individuals experiencing problems of Regulation and metabolism
Pharmacotherapeutics to support nursing care for individuals experiencing problems of excretion
Pharmacotherapeutics related to cancer care and end of life care
Collaborate (Not a clinical course??) with the inter-professional health care team in the process of administration and evaluation of pharmacotherapeutics
Utilization (? NOT a clinical course, DISCUSS??) Of the principles of therapeutic communication techniques and patient education related to pharmacotherapeutics.
Prerequisite
BIOL 231, BIOL 232, CHEM 111, and CHEM 112 (or CHEM 110)
Textbook & Course Materials
Required Text
Lehne, R.A. (2015). Pharmacology for nursing care (9thed.). St. Louis: Saunders.
ISBN: 13: 978-0-323-32190-7.
Porth, CM (2014) Pathophysiology: Concepts of altered health status (9thed)
Philadelphia: Lippincott Williams & Wilkins ISBN-13: 978-1-4511-4600-4
Methods of Instruction: Using a blend of traditional and contemporary approaches to student learning, the classes will consist of lecture, discussions, case studies and simulated learning scenarios. Everyone is encouraged to attend class and participate by asking questions, commenting on the assigned readings, and discussing patient/pathophysiological conditions and the pharmacological agents used in the clinical settings. Students are expected to check the e-learning site daily for announcements regarding the course.
The case studies, quizzes and exams are designed to reinforce your understand of the basic principles of pharmacology and the nurse’s responsibility in administering medications. Medication calculations are critical to the safe administration of pharmacologic agents and are an important component of the quizzes/exams. The quizzes and exams are cumulative and will cover material on previous quizzes and exams as well as current material. At the end of each quiz/exam, there will be an opportunity to review the quizzes/exams in class.
Please feel free to ask if you have any questions about the lectures, case studies, or if the concepts we are discussing are not clear to you. As nurses, one of the most important lessons to learn is the importance of asking questions and being clear about your responsibilities. Since this is a large group, smaller study group sessions will be available and the times and classrooms will be posted. We are glad to be able to help you.
*NUR 331 Pharmacology
*Spring 2017 Syllabus
Part 3: Topic Outline/Schedule*
Pharmacology New Curriculum Topical Outline
1/19/17: Introduction to Pharmacology
Review of Course Objectives and Requirements
Lehne: Chapters 1
Porth: Chapter 1
Learning Objectives
A.Define these four basic terms: drug, pharmacology, clinical pharmacology, and therapeutics.
B.List the three most important properties of an ideal drug, as well as several other important properties, and explain why many drugs do not have these traits.
1/24/17: Application of Pharmacology to the Nursing Process
Lehne: Chapter 2, 3
Learning Objectives
A.Relate the six steps of the nursing process to the administration of medications. List the Six Rights of Drug Administration and the patient’s rights regarding medications administered by healthcare providers.
B.Discuss the purpose of preadministration assessment. Include patient identification bar code and work arounds
C.Discuss the analysis of the data and development of nursing diagnoses to (1) judge the appropriateness of the prescribed regimen, (2) identify health problems the drug might cause, and (3) determine the patient’s capacity for self-care.
D.Discuss Phases I, II, III, and IV of the clinical testing of new drugs. Discuss the ethical and legal implications for the different phases of clinical testing. Phase I studies involve the use of healthy human volunteers to test the drugs. In Phases II and III, drugs are tested in patients. Upon completion of Phase III, the drug manufacturer applies to the FDA for conditional approval.
E.Explain the purpose of Phase IV clinical studies after regulatory (i.e., FDA) approval.
Discuss the important information that can be gained from Phase IV (postmarketing surveillance) of clinical drug testing and explain the roles and responsibilities of the nurse, nurse practitioner, and physician in gathering and reporting new data.
F.Discuss chemical, generic, and proprietary (trade or brand) names of drugs and explain the benefits, if any, of generic drugs over brand-name drugs.
1/26/17: Pharmacokinetics
Lehne: Chapter 4
Porth: Chapters 38, 46
Learning Objectives
A.Discuss the four main processes that make up pharmacokinetics (absorption, distribution, metabolism, and excretion), and appropriately apply these processes to clinical usefulness.
B.Discuss the advantages and disadvantages of the various techniques of drug administration as they relate to pharmacokinetics, noting especially any barriers to absorption associated with intravenous, intramuscular, and oral administration. Students should also compare oral administration with parenteral administration. Describe smart pumps and omnicells
C.Describe blood flow to tissues, the ability of a drug to exit the vascular system, and the ability of a drug to enter cells, and then discuss the characteristics of drug molecules that can alter these processes.
D.Describe the ultimate “goal” of drug metabolism. Discuss the general processes involved in drug metabolism and identify the major or vital organs in which most drug metabolism occurs. Discuss special considerations in drug metabolism.
E.Discuss the genetic influences that influence hepatic metabolism. Identify the classes of drugs that are metabolized differently in certain races and its impact on the P450 system
F.Discuss the importance of excretion of a drug from the body and some of the routes by which the drug may be excreted.
G.Discuss the importance of understanding the time course of drug responses (plasma drug levels, single-dose time course, drug half-life, and drug levels produced with repeated doses). Explain why clinicians often monitor plasma drug levels and describe how these levels are regulated to prevent drug toxicity.
01/31/17: Pharmacodynamics
Lehne: Chapter 5
Learning Objectives
A.Define pharmacodynamics and its relationship to the action of drugs on the body.
B.Discuss dose-response relationships (e.g., basic features of the dose-response relationships, maximal efficacy, and relative potency), the effects drugs can produce, and the amount of drug needed to elicit an effect.
C.Discuss properties of drug-receptor interactions (e.g., drug receptors, four primary receptor families, receptors and selectivity for drug action, theories of drug-receptor interaction, agonists, antagonists, partial agonists, and regulation of receptor sensitivity).
D.Describe how receptors function in the responses to many drugs and physiologic processes, such as the activity of the respiratory and gastrointestinal systems.
E.Differentiate drugs that are agonists, partial agonists, or antagonists.
F.List the four primary families of receptors.
G.Discuss interpatient variability in drug responses and describe how to measure variability
H.Describe pharmcogenetics. Describe the ultimate goal of improving the safety and effectiveness of drug therapy through use of genetically guided treatment.
I.Define the ED 50 and the LD 50
J.Discuss the concept of a drug’s therapeutic index and its application and benefits to clinical practice, such as the relationships between the doses of a drug and whether its effects are subtherapeutic (inadequate), therapeutic (desired response), or toxic (adverse effects related to excessive dosage).
2/2/17: Adverse Drug Reactions
Medication Errors
Lehne: Chapters 6, 7, 8, 9, 10, 11
Porth: Chapters 2, 3
Learning Objectives
- Discuss the consequences of drug-drug interactions, the basic mechanisms of drug-drug interactions, and the critical steps in minimizing adverse drug-drug interactions.
B.Focus on the liver as an example of a drug-metabolizing system and explain why it is such a crucial organ in many drug-drug interactions.
C.Discuss the effect of food on drug absorption, on drug metabolism (e.g., grapefruit juice), and on drug toxicity and action, as well as the timing of drug administration with respect to meals.
D.Discuss definitions for adverse drug reactions (e.g., side effect, toxicity, allergic reaction, idiosyncratic effect, iatrogenic disease, physical dependence, carcinogenic effect, and teratogenic effect).
E.Discuss measures that can be used to minimize adverse drug events.
F.Define medication errors and explain what constitutes an error, as well as who makes errors.
G.Discuss types of medication errors, causes of medication errors, ways to reduce medication errors, and ways to report medication errors. Describe sentinel events, root cause analysis, IHI and ISMP
H.Discuss individual variations in drug responses (Body Weight, Age, Pathophysiology)
I.Define Tolerance, Placebo Effect and identify genetic factors that affect a drug response
J.Identify clinical challenges related to pregnancy, breast feeding, pediatrics and the elderly
2/7/17: Exam One
2/09/17: Introduction to Neuropharmacology
PNS CNS
Lehne: Chapters 12, 13, 14, 20
Porth: Chapter 17, 56
Learning Objectives
A.Describe the general steps involved in neurotransmission (synaptic transmission) and axonal conduction. State the elements or processes that need to occur, regardless of the site in the nervous system, for synaptic transmission to work.
B.Discuss specific ways in which drugs can alter the steps of synaptic transmission.
C.Discuss the relationship between multiple receptor types and selective drug action.
D.Identify the two major divisions of the peripheral nervous system.
E.Differentiate between the somatic (motor) nervous system and the sympathetic and parasympathetic branches of the autonomic nervous system in terms of the following:
F.Describe the differences distinguishing the four main subtypes of adrenergic receptors— alpha1, alpha2, beta1, and beta2—in terms of where (on what structures) they are found and the types of responses their activation causes.
G.Describe the differences between the two main subtypes of cholinergic receptors—nicotinic (both nicotinicN and nicotinicM) and muscarinic—in terms of where (on what structures) they are found and the responses their activation causes.
H.Identify the main neurotransmitters of the CNS and summarize some of their main physiologic effects.
I.Discuss the significance of the blood-brain barrier in allowing or preventing the effects of drugs in general.
2/14/17: Cholinergic Medications
Adrenergic Medications
Lehne: Chapters 14, 17, 18
Learning Objectives
A.State the responses that a muscarinic agonist would be expected to cause through direct activation of muscarinic cholinergic receptors (consider bethanechol). The student should focus on the main “targets” of parasympathetic nervous system activity: the eyes, respiratory system, heart and blood vessels, gastrointestinal (GI) and urinary tracts, and the secretory activity of exocrine glands (e.g., lacrimal, mucous, and so on).
B.List cholinergic responses not normally caused when the usual therapeutic doses of a muscarinic agonist are administered and explain why these effects do not occur.
C.Describe the mechanism of adrenergic receptor activation
D.Discuss the therapeutic applications and adverse effects of adrenergic receptor activation
E.Describe the therapeutic and adverse response to alpha and beta blockade
2/16/17: Parkinson’s, Alzheimer’s, Epilepsy
Lehne: Chapter 21, 22, 24
Porth: 19, 20, 22
Learning Objectives:
A.Identify the pathophysiology associated with Parkinson’s Disease
B.Discuss the use of medications in the treatment of Parkinson’s disease
C.Identify the pathophysiology associated with Alzheimer’s Disease
D.Discuss the use of medications in the treatment of Alzheimer’s Disease
E.Identify the pathophysiology associated with seizure disorders
F.Discuss the use of medications in the treatment of seizure disorders
G.Identify the therapeutic serum levels of phenytoin, carbamazepine and valproic acid
H.Discuss the Beers Criteria related to medication management in the elderly population
2/21/17: Mental Health 1
Schizophrenia, BiPolar Disorder, Depression
Lehne: Chapter 31, 32, 33
Porth: Chapter 22
Learning Objectives
A.Discuss the pathophysiology associated with Schizophrenia
B.Discuss the use of First Generation antipsychotics and 2nd Generation antipsychotics in the treatment of schizophrenia
C.Identify the pathophysiology associated with depression
D.Discuss the use of SSRIs, SSNIs, TCAs, MAOIs, and atypical anti depression medications.
E.Describe the pathophysiology associated with BiPolar Disorder
F.Discuss the use of mood stabilizers and antipsychotic in the treatment of bipolar disorder
2/23/17: Mental Health 2
Anxiety, Sleep & Opioid Abuse
Lehne: 28, 34, 35, 37
Porth: 21 & 22
Learning Objectives
A.Discuss the pathophysiology related to anxiety and sleep disorders
B.Describe the use of medications (SSRI, Benzodiazepines) in the management of anxiety
C.Describe the sleep phases
D.Identify drug and non drug measures for the management of insomnia
E.Discuss drug abuse and the opioid epidemic F.Describe the principles of addiction treatment. Describe current regulatory issues related to opioid prescribing
2/28/17: Exam Two
3/2/17: Cardiology One
Hypertension
Lehne: Chapters 41, 42, 43, 44, 45, 46, 47
Porth: Chapters 29, 31
Learning Objectives
A.Describe the prevalence and pathophysiology related to hypertension
B.Describe the use of non-drug measures in the treatment of hypertension
C.Discuss the following mechanism of action, side effects, patient education related to a.Diuretics
b.Renin-Angiotension-Aldosterone medications (RAAS)
c.Calcium Channel Blockers
d.Vasodilators
e.Beta Blockers
3/14/17: Cardiology 2
Hyperlipidemia & Heart Failure
Lehne: Chapters 48 & 50
Porth: Chapters 32 & 34
Learning Objectives
A.Describe the prevalence and pathophysiology related to hyperlipidemia & metabolic syndrome
B.Identify the use of non-drug measures in the treatment of hyperlipidemia
C.Describe the use of medications in the treatment of hyperlipidemia
a.HMG-CoA Reductase Inhibitors (Statins)
b.Niacin
c.Bile Acid Sequestrants
d.Fibrates
D.Describe the prevalence and pathophysiology related to heart failure E.Discuss the medication management of heart failure
3/16/17: Cardiology 3
Antidysrhythmics, Acute STEMI & Anticoagulation Therapy
Lehne: Chapters 49, 51, 52 & 53
Porth: Chapter 33
Learning Objectives
A.Describe the pathophysiology related to cardiac dysrhythmias
B.Identify the use of medications in the treatment of angina and cardiac dysrhythmias
C.Discuss the use of anticoagulants (heparin, warfarin and direct thrombin Inhibitors) and the therapeutic serum levels
D.Discuss the use of antiplatelet therapy in cardiac disorders
E.Describe the pathophysiology of STEMI
F.Discuss the use of reperfusion therapy
G.Discuss the use of medications in the treatment of an acute MI
3/21/17: Diabetes 1
Insulin Therapy and Insulin pumps
Lehne: Chapter 57
Porth: Chapter 50
Learning Objectives
A.Describe the prevalence and pathophysiology related to diabetes
B.Discuss non-drug measures in the treatment of Type II Diabetes
C.Describe the types of insulin, concentration, administration, complications of insulin therapy
a.Short Duration: Rapid Acting
b.Short Duration: slower acting
c.Intermediate Duration
d.Long Duration
3/23/17: Diabetes 2
Oral Agent Therapy
Lehne: Chapter 57
Porth: Chapter 50
Learning Objectives
A.Describe the use of medication in the treatment of Type II Diabetes
B.Identify and discuss the following types of medications in the treatment of DM
a.Biguanides
b.Sulfonylureas
c.Meglinitindes
d.Glitazones
e.Alpha-glucosidase inhibitors
f.DPP-4 Inhibitors (Glitins)
g.GLP-1 Agonists
3/28/17: Exam 3
3/30/17: Thyroid Disorders
Lehne: Chapter 58
Porth: Chapter 49
Learning Objectives
A.Discuss the physiology and pathophysiology related to the thyroid function B.Describe the clinical presentation of hypo and hyperthyroidism
C.Discuss the use of thyroid replacement in the treatment of hypothyroidism
D.Discuss the use of medication and ablation in the treatment of hyperthyroidism
a.Antithyroid drugs
b.Radioactive Iodine
4/4/17: Men’s and Women’s Health
Lehne: Chapters 61, 62, 65 & 66
Porth: Chapters 52, 53, 54
Learning Objectives
A.Discuss the physiology and pathophysiology related to men’s and women’s health
B.Discuss the use of estrogen, progesterone and testosterone
C.Describe the use of oral contraception to include the overall safety and adverse effects
D.Discuss issues related to transgender health
E.Discuss the use of medications in the treatment of erectile dysfunction
F.Describe the use and abuse of androgen therapy
4/6/17: Bone and Joint
OA, RA, Osteoporosis and Gout
Lehne: Chapters 71, 72, 73, 74, 75
Porth: Chapters 58 & 59
Learning Objectives
A.Discuss the pathophysiology related to osteoarthritis, RA, Gout and Osteoporosis
B.Discuss immune modulators
C.Describe the medication management for bone and joint disorders
D.Describe the Cox system and the use of cox inhibitors