Chapter 1 IM

Chapter 1 Introduction to Pharmacology: Concepts and Connections Learning Outcomes: 1. Identify key events in the history of pharmacology. Suggested Classroom Activity: Make a time line with students to demonstrate how the science of pharmacology has progressed in the past 200 years. Suggested Clinical Activity: Discuss future developments in pharmacology with the pharmacist at a clinical site. 2. Compare and contrast the terms drug, pharmacology, and pharmacotherapy. Suggested Classroom Activity: Using the examples of water, vitamin C, and natural hormones, discuss how a patient may be confused about the difference between a substance for everyday use or one that naturally occurs in the body, and how these change when used in drug therapy. Suggested Clinical Activity: Have students ask a nurse at a clinical site for an example of how pharmacotherapy made a difference in a patient’s health. 3. Explain the importance of pharmacotherapy to clinical nursing practice. Suggested Classroom Activity: Have students discuss various ways of finding up-to-date drug therapy information. Suggestions include reference books, evidence-based Internet sites, ongoing clinical education, and pharmacists. Suggested Clinical Activity: Have students ask a nurse at a clinical site how he or she learns about new drugs and their indications, side effects, and common dosages. 4. Using specific examples, explain the difference between the pharmacologic and therapeutic methods of classifying drugs. Suggested Classroom Activity: Go to the FDA Orange Book website. Engage students in using the website to search for various drugs. Use the FAQ link to demonstrate how to stay updated on new drugs. [[[COMMENT BY LPalagi]]] AU: The activities here were missing, so I picked them up from the AIE file. Correct? [[[---]]] [[[COMMENT BY Pamela Fowler]]] Yes [[[---]]] Suggested Clinical Activity: Have students compare and contrast medication therapy used for patients who have the same disease state, but are being treated with different drugs. Compare the drug’s pharmacologic and therapeutic classifications. 5. Identify the advantages of using prototype drugs to study pharmacology. Suggested Classroom Activity: Have students use the textbook to locate a prototype drug. Discuss how it is easily identifiable and what important nursing considerations are listed for each prototype. Suggested Clinical Activity: Have students look at a medication administration record for an assigned patient. Compare which drugs are prototypes and which are not. Students could also discuss how different or similar the drug is to the prototype. 6. Classify drugs by their chemical, generic, and trade names. Suggested Classroom Activity: Have students look at popular generics such as acetaminophen, aspirin, and ibuprofen. Have them identify possible trade names that are popular for these drugs. Then look at which products may represent a combination of drugs. Suggested Clinical Activity: Have students take a drug history from a patient. Discuss if the patients identify their medications by generic or trade names. Have students discuss how this could lead to possible medication errors. 7. Compare the advantages and disadvantages of a pharmaceutical company being granted exclusivity for the development of a new drug. Suggested Classroom Activity: Using Internet pharmacy sites, compare and contrast the differences between prices for trade and generic drugs. Suggest Clinical Activity: Have students interview a pharmacist regarding the changes that occur when a pharmaceutical company’s period of exclusivity for the manufacture of a drug expires. 8. Analyze possible differences between generic drugs and their brand-name equivalents. Suggested Classroom Activity: Give examples of drugs that may be available to the patient in both trade and generic names. Suggestions include ibuprofen, loratadine, and pseudoephedrine. Discuss what could change the bioavailability of the drug. Suggested Classroom Activity: Have the student role-play a scene in which a patient asks a nurse if generic substitutions are safe, and how the nurse would respond. Role-play another scene where the patient asks the nurse about using an overseas Internet pharmacy. Suggested Clinical Activity: Have students interview a hospital pharmacist to find out what the law in their state is regarding substitution of generic drugs. Ask how the pharmacist discusses the use of generic drugs with the prescriber. Suggested Clinical Activity: Have students interview a neighborhood pharmacist about insurance reimbursement for generic drugs. 9. Assess the responsibilities of the nurse in drug administration. Suggested Classroom Activity: Have students review the core responsibilities for safe drug administration and discuss how each concept can prevent medication errors. Suggested Classroom Activity: Have students work in small groups and interview each other. Have them identify differences in their own demographics that would influence safe drug therapy. Suggested Clinical Activity: Have students shadow a nurse in a hospital or clinic setting who is assigned to administer medications. Have students observe how the nurse checks to make sure the medications are correct for that patient, if the drugs are dispensed in trade or generic names, what checks the nurse completes before dispensing the medication, and what teaching the nurse offers the patient about the medication. Key Concepts Over 3.6 billion prescriptions are dispensed each year in the United States, with the number rapidly increasing. Pharmacology, now a key aspect of nursing care, started with early man using plants and herbs to relieve disease symptoms. Many early remedies were accidental discoveries. The first “prescriptions” were written in the year 3000 BC by the Babylonians. The Chinese have the first recorded volume of plant remedies in the year 2700 BC. Pharmacology was probably viewed as magic and superstition during the Dark Ages. There is very little recorded data from the Dark Ages. [[[COMMENT BY LPalagi]]] AU: Edit to viewed instead of reviewed correct? [[[---]]] [[[COMMENT BY Pamela Fowler]]] Yes [[[---]]] Pharmacology first began to be practiced as a science in the 17th century, and the first text with the word pharmacology was published in 1693. During the 19th century, chemists were able to make remarkable progress in separating specific substances and the first active agents such as morphine, colchicines, curare, cocaine, and other early drugs were discovered from their natural plant products. Pharmacology was first recognized as a discipline in Estonia in 1847. In the United States, the first pharmacology department was at the University of Michigan in 1890. The 20th century saw great progress and development of new drugs. We are now able to synthesize drugs from “scratch” in the laboratory. A drug is any substance that is taken to prevent, cure, or reduce symptoms of a medical condition. The word pharmacology came from the Greek pharmakon, which means “medicine” or “drugs,” and logos, which means “study.” The subject of pharmacology is expansive and involves understanding what a drug is given for, how it is administered, where it travels in the body, the actual response it produces, and how it is eliminated. Pharmacotherapy or pharmacotherapeutics is the application of drugs for the purpose of disease prevention and treatment. Over 11,000 brand, generic, and combination agents are available, each with its own application, interactions, side effects, and actions. Many drugs have more than one use. They may be prescribed for more than one disease and many produce multiple effects in the body. Patient factors that can cause drugs to elicit a different response are age, gender, race, body mass, health status, and genetics. Staying current and up to date with new drugs is critical for the patient and health care provider. Proper application of a drug can improve quality of life, whereas an improperly applied drug can cause disability or even death. Many people believe that there are perfect drugs and that the perfect drug should and can always be selected for the patient. The perfect or ideal drug is effective, can be given at low doses, works quickly, has no adverse effects, can be taken conveniently, can be taken infrequently, is inexpensive, is quickly eliminated from the body, and does not interact with other medications or food. There is no such thing as a perfect drug. Drugs that are used most often are ones that are close to the perfect drug profile. Drugs that have a profile that strays furthest from the perfect drug profile are used infrequently. Conditions for which drugs are approved are called indications. All prescription drugs have at least one indication and some have multiple indications. Some drugs are used for conditions for which they do not have an approved indication; this is called an unlabeled or off-label use. The Food and Drug Administration (FDA) publishes a document called the “Approved Therapeutic Equivalence Evaluation,” which is also called the “Orange Book.” This document currently lists over 11,000 approved drugs. The list includes both prescription and nonprescription drugs. Drugs are categorized in two ways: a therapeutic classification and a pharmacologic classification. The therapeutic classification is how the drug is used in treating a specific disease. The pharmacologic classification is the mechanism of drug action or how the drug produces its effects in the body. Drugs may also have multiple therapeutic and pharmacologic classifications that are dependent on the clinical use of the drug. The prototype drug is usually the first and best understood drug in its class, but sometimes the prototype may be a new or clinically more useful drug. By learning about the prototype drug, nurses can understand the depth, actions, and adverse effects of other drugs in the same class. Drugs are identified by multiple names, which can be confusing to both the patient and health care provider. Chemical names are assigned by using standard nomenclature established by the International Union of Pure and Applied Chemistry (IUPAC). Each drug has only one chemical name. Drugs can be named and classified by a portion of their chemical structure, known as the chemical group name. Generic names are assigned by the U.S. Adopted Names Council. Generic names are usually less complicated and are easier to remember than chemical names. Each drug has only one generic name. Trade names are also called proprietary, product, or brand names. The trade name is assigned by the pharmaceutical company and is usually short and easy to remember. The FDA grants pharmaceutical companies exclusive rights for naming and marketing a drug for a fixed number of years after the new drug application is approved, allowing the company to recoup the cost of research and development. When this exclusivity expires, competing companies may sell a generic equivalent drug. They may give it a different trade name, which the FDA must approve. Combination drugs are drugs with more than one active generic ingredient. Because of the potential confusion with trade names, it is important for the nurse to identify drugs by their generic names. Some states in the United States allow the pharmacist to routinely substitute a generic drug when the prescription calls for a brand-name drug. In other states, pharmacists must dispense as written or obtain approval before providing a generic substitution. Many pharmacies provide lists of generic drugs. Pharmaceutical companies often lobby aggressively against laws that might restrict the routine use of certain brand-name drugs. They claim that there is a difference between a trade-name drug and its generic equivalent and that switching to a generic may be harmful to the patient. Consumer advocates argue that generic substitutions should always be permitted because they provide cost savings to the patient. Bioavailability is defined by the Federal Food, Drug, and Cosmetic Act as the rate and extent to which the active ingredient is absorbed from the drug product and then becomes available at the site of the drug action to produce the desired effects. Bioavailability may be affected by formulation, inert ingredients, and tablet compression. All of these factors can affect the absorption and/or distribution of the drug. Bioavailability is measured by the time it takes for the drug to exert its effect; it is also known as onset time. Bioavailability may differ between trade and generic drugs. Internet sites may allow patients to purchase drugs at substantial savings. However, the danger of doing so is that the drugs may be sold from other countries and these countries may not have the same quality control standards as the United States. These drugs may be harmful or not effective. The nurse must help patients understand the differences and the potential dangers. The nurse is expected to understand the pharmacotherapeutic principles for all medications received by each patient. The nurse’s responsibilities include knowledge and understanding of what drug is ordered; name (generic and trade) and drug classification; intended or proposed use; effects on the body; contraindications; special considerations, such as how age, gender, weight, body fat distribution, genetic factors, and pathophysiologic states affect pharmacotherapeutic response; and expected and potential adverse events. The nurse must also know why the drug has been prescribed for this particular patient. how the drug is supplied by the pharmacy, how the drug is to be administered, including dose ranges, and what nursing process considerations related to the drug apply to this patient A major goal in studying pharmacology is to eliminate medication errors and to limit the number and severity of adverse drug events. Knowledge of pharmacology is an ongoing, lifelong process that builds as a nurse is in practice and chooses specific clinical areas. Learning prototypes, recognizing key similarities in generic names, and always looking up unknown or new drugs will help build this knowledge base. Adams and Urban, Pharmacology: Connections to Nursing Practice, 3e Instructor’s Resource Manual Copyright 2016 by Education, Inc.