Course Title: Nursing 364 –Pharmacology

Faculty Contact Information: Ms. J. Arzaga, MSN, RN Office number #116 Phone number (310) 233-4384Email address: arzagajb@lahc.edu

Office Hours:Monday 1010-1110; Wednesday 1330-1430; Thursday 0730-0830; or via email for appointment.

Start Date: 02/07/2013 End Date: 05/30/2013

Classroom: NU 133

Time: Thursday 0900-1210

Catalog Description: This course is open to pre-nursing majors, nursing students and those interested in developing an understanding of medications. This course provides an understanding of basic pharmacology and the standards, policies, and regulations involved in mediation administration. A brief review of the math concepts involved in the calculations of dosages is included. The course focus is on drugs classifications, pharmacodynamics, chemical interactions, toxicology and the use of the nursing process in medication administration.

Credit/Contact Hours: 3 Units

Transferability: Conditional

Prerequisites: Admission to LAHC and appropriate registration and payment of fees.

Required Textbooks and Supplies: Adams, M.P. & Holland, L.N. (2014). Pharmacology for nurses: A pathophysiologic approach (4th Ed.). Pearson. ISBN: 9780133026184

Recommended Textbook: Deglin, J.H., Vallerand, A.H., & Sanoski, C. A. (2011). Davis’s drug guide for nurses (12th Ed.). F.A. Davis Company.

Scantrons: Will be required for quizzes and the final exam.

Attendance Policy: Class absences are not to exceed one class lecture. If the student is ill or has an emergency, please contact instructor for the week as soon as possible. Students are urged not to be absent, and are reminded that the student is responsible for all information given during class time. Three tardies will be counted as one absence. Absence that exceeds specified maximum may result in exclusion from the course or receiving an “F” grade. Students who know that there is a strong possibility that they will miss more than one class should not take the course.

Course Credit Challenging Policy: Not applicable.

College and Department Policies: See College Catalog.

Board Policies and Accommodations:

1. Students requiring special accommodations in a course must present official documentation of the type of accommodations required to the nursing faculty.

2. Board Rule 9803.12. Dishonesty, such as cheating, or knowingly furnishing false information to the college. Examples of academic dishonesty: A student copies from another student, to help an academically weaker student by providing answers to a test or using “crib” notes.

3. Board Rule 9803.14. Obstruction or disruption of classes, administration, disciplinary procedures, or authorized college activities.

4. Board Rule 9803.19. Alcohol and Drugs. Any possession of controlled substances which would constitute a violation of Health and Safety Code Section 11350 or Business and Professional Code section 4230, any use of controlled substance, the possession of which are prohibited by the same, or any possession or use of alcoholic beverages.

*Please see college catalog for a listing of all District Board Rules. Also, refer to the Student Discipline Procedure for due process for disciplinary issues, grievances, and the student appeal process.

Course Grading: This course has 200 points. There are 12 quizzes worth 10 points each. The lowest quiz grade will be dropped, resulting in 110 possible quiz points. A 30 point drug group presentation will be required. There will be a 60 point comprehensive final exam.

There are no scheduled make-up quizzes and group presentation. Students are urged to contact the instructor if major illness occurs resulting in missing quizzes and/or the final exam. The grade obtainable for the final taken after the scheduled testing day is 75%. Make-up finals may be multiple choices, fill-in, essay, or a combination of all of the above. To receive a grade of “W” (withdrawal) for the class, the student must officially drop the course in admissions by the date published in the class schedule. There will be no extra credit assignments offered. There will be no grade of Incomplete given for the class.

Drug Presentation: See Appendix A for further details.

Grading Scale: A (90% - 100%) B (81% - 89%) C (75% - 80%) D (60% - 74%) F (Less than 60%)

Learning Resources: College Library, Nursing Learning Lab (over night check-out not allowed), and Learning Resource Center in College Library.

Method of Instruction: Lecture, Discussion, Related Readings, Presentations, and Internet.

Evaluation Method: Objective quizzes, comprehensive final exam, and drug card presentation.

Study Time: The College expects a minimum of two hours of study/preparation by the student for each hour of lecture.

Plagiarism: Any form of academic dishonesty is not tolerated within the Los Angeles Community College District and will result in a zero for the assignment in question and in most cases will result in a fail for the course. Any student with subsequent incident of plagiarism will be referred to the Vice President of Student Services and may be expelled from the college. Please refer to the College Catalog for further information.

Schedule of Assignments:

Date Content Chapters AssignmentsWeek 1 02/07/2013

Introduction to Course Review Syllabus & TextbookIntroduction to Pharmacology: Drug Regulation and Approval Pharmacokinetics & Pharmacodynamics

1, 4, 5

Week 2 02/14/2013

Drug Classes and Schedules Nursing Process in Pharmacology

2, 6

Week 3 02/21/2013

Principles of Drug Administration Prevention of Medication Errors and Risk Reduction Drug Dosages and Calculation

3, 9 Quiz #1 (2 ,4, 5)

Week 4 02/28/2013

Drugs for Seizures Drugs for Emotional and Mood Disorders Drugs for Psychoses

15, 16, 17 Quiz #2 (3, 6, 9, Dosage & Calculations)

Week 5 03/07/2013

Substance Abuse Drugs for Anxiety and Insomnia Drugs for Control of Pain

11, 14 18 Quiz # 3 (15, 16, 17) Group 1 - Lorazepam (Ativan) Group 2 – Morphine (Duramorph)

Week 6 03/14/2013

Drugs for Coagulation Disorders Drugs for Hematopoietic Disorders

27, 28 Quiz #4 (11, 14, 18) Group 3 – Warfarin (Coumadin) Group 4 – Clopidogrel (Plavix)

Week 7 03/21/2013

Hypertension Heart Failure Angina Pectoris and Myocardial Infarction Drugs for Asthma and Other Pulmonary Disorders

23, 24, 25, 39

Quiz #5 (27, 28) Group 5 –Prinivil (Zestril) Group 6 – Metoprolol (Lopressor) Group 7 – Salmeterol (Servent)

Week 8 03/28/2013

Holiday: Spring Recess

Week 9 04/04/2013

Holiday: Spring Recess

Week 10 04/11/2013

Drugs for Bacterial Infections & Viral Infections Drugs for Neuromuscular Disorders Drugs for Bone and Joint Disorders

21, 34, 26, 47

Quiz #6 (23, 24, 25, 39) Group 8 – Acyclovir (Zoviraz) Group 9 – Cyclobenzaprine (Flexeril) Group 10 – Colchicine (Colcrys)

Week 11 04/18/2013

Diuretic Therapy and Drugs for Renal Failures

30, 44 Quiz #7 (21,34, 36, 47) Group11 –

Drugs for Diabetes Mellitus Spironolactone (Aldactone) Group 12 –Human Regular Insulin (Humulin R, Novolin R)

Week 12 04/25/2013

Drugs for Peptic Ulcers Disease Drugs for Bowel Disorders and other Gastrointestinal Conditions Drugs for Fluid Balance, Electrolytes, and Acid-Base Disorders

41, 20, 31 Quiz # 8 (30, 44) Group 13 – Ondansetron (Zofran) Group 14 – Potassium Chloride (KCl)

Week 13 05/02/2013

Drugs for Disorders and Conditions of the Female Reproductive System Drugs for Disorders and Conditions of the Male Reproductive System

45, 46 Quiz # 9 (41, 20, 31) Group 15 – Oxytocin (Pitocin) Group 16 – Sildenafil (Viagra)

Week 14 05/09/2013

Drugs for Autonomic Nervous System Drugs for Degenerative Diseases of the Nervous system

13, 20 Quiz # 10 (45, 46) Group 17 – Atropine (AtroPen) Group 18 – Levodopa (Larodopa)

Week 15 05/16/2013

Drugs for Dysrhythmias Drugs for Shock

26, 29 Quiz # 11 (13, 20) Group 19 – Amiodarone (Cordarone) Group 20 – Dopamine(Dopastat) Complete Course Evaluation (Online)

Week 16 05/23/2013

Last day of class Comprehensive Final Q uiz # 1 2 (10 q u e s tio n s o n Final will be on chapters 26, 29)

Course Topics & Objectives

Week 1 02/07/2013

Introduction to Pharmacology Course 1. Meet class 2. Introduction to Course 3. Review syllabus & textbook

Introduction to Pharmacology: Drug Regulation and Approval (Chapter 1) 1. Define Pharmacology2. Identify the advantages and disadvantages of prescription and overthe-

counter drugs3. Discuss role of the U.S. FDA4. Explain the four stages of approval for therapeutic and biologic drug

Pharmacokinetics (Chapter 4) 1. Define Pharmacokinetics2. Identify and recall the four components of pharmacokinetics3. Describe major processes by which drugs are excreted4. Explain the applications of a drug’s plasma half-life and therapeutic range5. Differentiate between loading and maintenance doses Define and discuss

Pharmacodynamics (Chapter 5) 1. Define Pharmacodynamics 2. Compare and contrast the terms potency and efficacy3. Distinguish between and agonist, a partial agonist, and an antagonist4. Explain the relationship between receptors and drug action

Week 2 02/14/2013

Drug Classes and Schedules (Chapter 2) 1. Explain the basis for placing drugs into therapeutic and pharmacologic classes 2. Discuss the prototype approach to drug classification3. Describe what is meant by a drug’s mechanism of action4. Explain the meaning of a controlled substance 5. Identify the five drug

schedules and give examples of drugs at each level Nursing Process in Pharmacology (Chapter 6)

1. Compare and contrast the different steps of the nursing process: Assessment, Diagnosing, Planning, Implementing, Evaluating

Week 3 02/21/2013

Principles of Drug Administration (Chapter 3)1. Describe the roles and responsibilities of the nurse regarding drug

administration2. State the five rights of drug administration and explain how they affect patient

safety 3. Compare and contrast the three systems of measurement used in pharmacology

Medication Errors and Risk Reductions (Chapter 9) 1. Define medication error and identify factors that contribute to medication

errors 2. Describe specific categories of medication errors3. Explain the impact of medication errors on all aspects of a health care agency4. Describe strategies that the nurse can implement to reduce medication errors

and incidents5. Identify patient teaching information that can be used to reduce medication

errors and incidents Drug Dosages and Calculation (See Appendix A)

1. Identify metric units of measurement commonly used in dosage calculation of oral and parenteral medications

2. State common equivalents in the metric system that are used for medication administration

3. Convert metric weights and volume within the metric system4. Convert body weight from pounds to kilograms5. Use one of the following methods to accurately calculate medication dosages:

D x Q Ration and proportionH

Week 4 02/28/2013

Seizures (Chapter 15) 1. Compare and contrast the terms seizures, convulsions, and epilepsy2. Explain the importance of patient drug compliance in the pharmacotherapy of

epilepsy and seizures3. Describe the nurse’s role in the pharmacologic management of seizures of an

acute nature and epilepsy4. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Phenobarbital (Luminal), Diazepam (Valium), Phenytoin (Dilantin), Valporic Acid (Depakene, Depakote), Ethosuximide (Zarontin)

Emotional and Mood Disorders (Chapter 16) 1. Identify the two major categories of mood disorders and their symptoms 2. Identify symptoms of attention deficit-hyperactivity disorder3. Discuss the nurse’s role in the pharmacologic management of patients with

depression, bipolar disorder, or attention deficithyperactivity disorder4. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Imipramine (Tofranil), Sertraline (Zoloft), Phenelzine (Nardil), Lithium (Eskalith), Methylphenidate (Ritalin)

Psychoses (Chapter 17) 1. Compare and contrast the positive and negative symptoms of schizophrenia2. Explain the importance of drug compliance in the pharmacotherapy of

schizophrenia3. Explain the symptoms associated with extrapyramidal side effects of

antipsychotic drugs4. Describe the nurse’s role in the pharmacologic management of schizophrenia5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Chlorpromazine Hydrochloride (Thorazine), Haloperidol (Haldol), Risperidone (Risperdal)

Week 5 03/07/2013

Substance Abuse (Chapter 11) 1. Explain underlying causes of addiction2. Compare and contrast psychological and physical dependence3. Compare withdrawal syndromes for the various substance abuse classes4. Describe the role of the nurse in delivering care to individuals who have

substance abuse issues Anxiety and Insomnia (Chapter 14)

1. Identify the major types of anxiety disorders2. Discuss factors contributing to anxiety and explain some nonpharmacologic

therapies used to cope with this disorder3. Identify three classes of medication used to treat anxiety and sleep disorders4. Explain the pharmacologic management of anxiety and insomnia5. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of anxiety and insomnia6. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Escitalopram Oxalate (Lexapro), Lorazepam (Ativan), Zolpidem (Ambien)

Drugs for Control of Pain (Chapter 18) 1. Relate the importance of pain assessment to effective pharmacotherapy2. Describe the role of nonpharmacologic therapies in pain management3. Explain the role of opioid antagonist in the diagnosis and treatment of acute

opioid toxicity4. Describe the nurse’s role in the pharmacologic management of patients

receiving analgesics and antimigraine drugs5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Morphine (Astramorph PF, Duramorph), Nalaxone (Narcan), Aspirin (Acetylsalicylic Acid, ASA), Sumatriptan (Imitrex)

Week 6 03/14/2013

Coagulation Disorders (Chapter 27)1. Illustrate the major steps of hemostasis2. Describe thromboembolic disorders that are indicators forcoagulation

modifiers3. Explain how laboratory testing of coagulation parameters is used to monitor

anticoagulant pharmacotherapy4. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of coagulation disorders5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Heparin (Heplock), Warfarin (Coumadin), Clopidogrel (Plavix)

Hematopoietic Disorders (Chapter 28) 1. Describe the process of hematopoiesis2. Describe Vitamin 12 deficiency (pernicious or megaloblastic anemia) and Iron

deficiency anemia3. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of hematopoietic disorders4. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Epoetin Alfa (Epogen, Procrit), Filgrastim (Neupogen), Cyanocobalamin (Vitamin B12), Ferrous Sulfate (Feosol)

Week 7 03/21/2013

Hypertension (Chapter 23) 1. Explain hypertension (HTN) classification2. Summarize long-term consequences of untreated hypertension3. Explain the effects of cardiac output, peripheral resistance, and blood volume

on blood pressure4. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of patients receiving drugs for hypertension5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Hydrocholorthiazide (Microzide), Enalapril (Vasotec), Hydralazine (Apresoline) H

Heart Failure (Chapter 24) 1. Define Heart Failure (HF)2. Review the blood circulation3. Relate how the symptoms associated with heart failure may be caused by

weakened heart muscle and diminsihed cardiac output4. Explain how preload and afterload affect cardiac function5. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of heart failure6. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Lisinopril (Prinivil, Zestril), Furosemide (Lasix), Digoxin (Lanoxin), Metoprolol (Lopressor, Toprol XL)

Angina Pectoris and Myocardial Infarction (Chapter 25) 1. Explain the pathophysiology of myocardial infarction2. Describe factors that affect myocardial oxygen supply and demand3. Describe the nurse’s role utilizing the nursing process in the4. Pharmacologic management of patients with myocardial infarction Review

prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur), Atenolol (Tenormin), Dilitiazem (Cardizem), Retaplase (Retavase)

Asthma and Other Pulmonary Disorders (Chapter 39) 1. Identify major functions of the lower respiratory tract2. Compare the advantages and disadvantages of using the inhalation route of

the drug administration for pulmonary drugs3. Describe the nurse’s role utilizing the nursing process in the pharmacologic

treatment of lower respiratory tract disorders Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Salmeterol (Servent), Ipratropium (Atrovent)

Week 8 03/28/2013

Holiday: Spring Recess

Week 9 04/04/2013

Holiday: Spring Recess

Week 10 04/11/2013

Bacterial Infections (Chapter 34) 1. Explain how bacteria are described and classified2. Explain how resistance can develop to an anti-infective drug3. Explain the importance of culture and sensitivity4. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of bacterial infections5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Gentamycin (Garamycin), Ciprofloxacin (Cipro), Trimethoprimsulfamethoxazole (Bactrim, Septra)

Viral Infections (Chapter 36) 1. Identify viral infections that benefit from pharmacotherapy2. Explain the purpose and expected outcomes of HIV pharmacotherapy3. Explain the advantage of HAART in the pharmacotherapy of HIV infection

4. Describe the nurse’s role utilizing the nursing process in the pharmacologic management of patients receiving antiretroviral and antiviral drugs

5. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Zidovudine (Retrovir, AZT), Nevirapine (Viramune), Acyclovir (Zoviraz)

Neuromuscular Disorders (Chapter 21) 1. Discuss nonpharmacologic therapies used to treat muscle spasms and

spasticity2. Explain the goals of pharmacotherapy with skeletal muscle relaxants3. Describe the nurse’s role in the pharmacologic management of muscle spasms4. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Cyclobenzaprine (Cycoflex, Flexeril), Dantrolene Sodium (Dantrium)

Bone and Joint Disorders (Chapter 47) 1. Describe the role of calcium in the body in maintaining homeostasis in the

nervous, muscular, and nervous systems2. Explain the pharmacotherapy of hypocalcemia, osteomalacia, osteoporosis,

rickets, osteoarthritis, rheumatoid arthritis, and gout3. Describe the nurse’s role in the pharmacologic management of disorders

related to bones and joints Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Calcium Salts, Calcitrol (Calcijex, Rocaltrol), Alendronate (Fosamax), Raloxifene (Evista), Hydroxycholorquine (Plaquenil), Colchicine (Colcrys)

Week 11 04/18/2013

Diuretic Therapy and Drugs for Renal Failures (Chapter 30) 1. Explain the role of the kidneys in maintaining fluid, electrolyte, and acid base

balance2. Describe the adjustments in pharmacotherapy that must be considered n

patients with renal failure3. Identify indications for diuretics4. Describe the general adverse effects of diuretic pharmacotherapy5. Compare and contrast the loop, thiazide, and postassium-sparing diuretics6. Describe the nurse’s role in the pharmacologic management of renal failure,

and in diuretic therapy7. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Chlorothiazide (Diuril), Spironolactone (Aldactone)

Diabetes Mellitus (Chapter 44) 1. Describe the endocrine and exocrine functions of the pancreas2. Compare and contrast type 1 and type 2 diabetes mellitus3. Compare and contrast types of insulin4. Describe the signs and symptoms of insulin overdose and underdose5. Describe the nurse’s role in the pharmacologic management of diabetes

mellitus Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Human Regular Insulin (Humulin R, Novolin R), Metformin (Fortamet, Glucophage, Glumetza)

Week 12 04/25/2013

Peptic Ulcers Disease (Chapter 40) 1. Describe major anatomical structures of upper GI tract2. Identify common causes, signs, and symptoms of peptic ulcer disease Describe

nurse’s role utilizing the nursing process in the pharmacological management of patients with peptic ulcer disease

3. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Ranitidine (Zantac), Omeprazole (Prilosec), Pantoprazole (Protonix)

Bowel Disorders and Other Gastrointestinal Conditions (Ch. 41) 1. Identify major anatomic structures of lower GI tract2. Explain the pathogenesis of constipation and diarrhea3. Discuss conditions in which the pharmacotherapy of bowel disorders is

indicated4. Explain conditions in which pharmacotherapy of nausea/vomiting (N/V) is

indicated5. Describe nurse’s role utilizing the nursing process in the pharmacological

management of bowel disorders, N/V, and other GI conditions6. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Psyllium mucilloid (Metamucil), Diphenoxylate with atropine (Lomotil), Metoclopramide (Reglan), Ondansetron (Zofran)

Fluid Balance, Electrolytes, and Acid-Base Disorders (Chapter 31) 1. Describe conditions for which IV fluid therapy may be indicated2. Explain the pharmacotherapy of sodium and potassium imbalances3. Discuss common causes of alkalosis and acidosis and the medications used to

treat these disorders4. Describe nurse’s role utilizing the nursing process in the pharmacological

management of fluid balance, electrolyte, and acid-base disorders Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Albumin, Sodium replacement therapy, Potassium-replacement therapy

Week 13 05/02/2013

Disorders and Conditions of the Female Reproductive System (Chapter 45)1. Describe the role of the hypothalamus, pituitary, and ovaries in maintaining

female reproductive function2. Explain the mechanisms by which estrogens and progestins prevent

conception3. Explain how drugs may be used to provide emergency contraception and to

terminate early pregnancy4. Describe the role of drug therapy in the treatment of menopausal and

postmenopausal symptoms5. Discuss the use of progestins in the therapy of dysfunctional uterinebleeding 6. Compare and contrast the use of uterine stimulants and relaxants in the

treatment of antepartum and postpartum patients7. Explain how drug therapy may be used to treat female infertility.8. Describe the nurse’s role in the pharmacologic management of disorders and

conditions of the female reproductive system9. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Estradiol and Norethindrone (Ortho-Novum), Conjugated Estrogens (Cenestin, Enjuvia, Premarin), Medroxyprogesterone Acetate (Provera), Ocytocin (Pitocin)

Disorders and Conditions of the Male Reproductive System (Chapter 46)

1. Describe the role of the hypothalamus, pituitary, and testes in regulating male reproductive system

2. Describe the misuse and dangers associated with the use of anabolic steroids to enhance athletic performance

3. Explain the role of medications in the treatment of male infertility4. Describe the etiology, pathogenesis, and pharmacotherapy of erectile

dysfunction5. Describe the pathogenesis of benign prostatic hyperplasia6. Describe the nurse’s role in the pharmacologic management of disorders and

conditions of the male reproductive system7. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Testosterone, Sildenafil (Viagra), Finasteride (Proscar)

Week 14 05/09/2013

Autonomic Nervous System (Chapter 13) 1. Identify the basic functions of the nervous system: central nervous system and

peripheral nervous system2. Compare and contrast the actions of the sympathetic and parasympathetic

divisions of the autonomic nervous system3. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of patients receiving drugs affecting the autonomic nervous system

4. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Phenylephrine (Neo-Synephrine), Atropine (Atro-Pen, Atropair, Atropisol)

Degenerative Diseases of the Nervous System (Chapter 20) 1. Describe symptoms of Parkinson’s disease and Alzheimer’s disease2. Explain the goals of pharmacotherapy for Alzheimer’s disease and the efficacy

of existing medications3. Describe the nurse’s role utilizing the nursing process in the pharmacologic

management of Parkinson’s disease andAlzheimer’s disease4. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Levodopa (Larodopa), Benztropine (Cogentin), Donepezil (Aricept)

Week 15 05/16/2013

Dysrhythmias (Chapter 26) 1. Explain how rhythm abnormalities can affect cardiac function2. Illustrate flow of electrical impulses through normal heart3. Classify dysrhythmias based on their location and type of rhythm abnormality4. Describe nurse’s role in the pharmacological management of patient with

dysrhythmias5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Amiodarone (Cordarone) Shock (Chapter 29)

1. Compare and contrast different types of shock2. Relate general symptoms of shock to their physiologic causes3. Explain initial treatment priorities for a patient who is in shock4. List drugs used in the pharmacotherapy of anaphylaxis5. Review prototype drugs including actions and uses, administration alerts,

pharmacokinetics, adverse effects, and interactions: Normal Serum Albumin

(Albuminar, Plasbumin), Norepinephrine (Levophed), Dopamine (Dopastat, Intropin), Epinephrine (Adrenalin)

Week 16 05/23/2013

Comprehensive Final

Appendix ADrug Presentation

The purpose of this assignment is to provide students with an opportunity to actively participate in their learning, teach others what they have learned, and practice the art of public speaking in a safe and supportive environment.

Objectives:

To familiarize students with common prototype drugs related to each body system as specified by instructor

To gain an understanding of drug classification, pharmacodynamics, chemical interactions, and toxicology in medication administration

Assignment: Students will be divided into groups of 4 or 5 students each. Each group will be provided with a prototype drug to research and present the following key elements:

Trade name/genetic name

Classification of Medication

Indications

Actions

Pharmacokinetics

Contraindications/Precautions

Common Adverse Reactions/Side Effects

Dosages and Calculations

Patient and Family Teaching

Students will select the following choices to present the assigned drug: Powerpoint Presentation, Teaching Brochure, Game, Website, Situational Role Play, and Educational Workshop. Students may utilize any source of instructional media as needed to convey required information to class. Examples may include, but is not limited to internet media, books, lap tops, handouts, props, etc.

*Groups are set and final. It is possible that students may withdraw from the course. Therefore, the remaining members of the group will still be responsible for all required elements of the assignment. *See Appendix C and Appendix D

Appendix B MedicationDosage and Calculation

I. Systems of Medication Measurementsa. Metric System

The metric system is the commonly used system of measurement for prescribing and administering medications. The metric system is a decimal system based on multiples of ten. Numbers to the left of the decimal are whole numbers and numbers to the right of the decimal are fractions of whole numbers. Each number has a place value. The value of each place is ten times the value of the place immediately to its right.

The first number after the decimal point is the tenth place. 0.1 is read as one tenth (1/10).

The second number after the decimal point is the hundredth place. 0.01 is read as one hundredth (1/100).

The third number after the decimal point is the thousandth place. 0.01 is read as one thousandth (1/1000).

Because each place is a multiple of ten, moving a decimal point one place produces a 10-fold change in the number. A medication error involving a misplaced decimal point can result in serious under or overdosages of a medication. For example, if a nurse gives 12ml of a medication instead of 1.2ml, the patient will receive 10 times the dose!

The metric system has three basic units of measure: meter (length), liter (volume), and gram (weight). Metric units important in dosage calculations are liter (L) and gram (gm). Common prefixes are used to indicate the value of each unit of length, volume, or weight.

The following indicate smaller parts than the basic unit of measure:

Prefix to Basic Unit Value Decimal Equivalent Relationship (meter, liter, gram)

deci one tenth 0.1 10 times smallercenti one hundredth 0.01 100 times smallermilli one thousandth 0.001 1,000 times smallermicro one millionth 0.000001 1,000,000 times

smaller

One prefix indicates a larger unit than the basic unit of measure:

Kilo one thousand 1000.0 1000 times greater

It is helpful to memorize some of the common metric unit abbreviations and their equivalents used in clinical dosage calculations (Table 1).

Table 1. Metric Equivalents

WEIGHT1 kilogram (kg) 1000 grams (g)1 gram (g) 1000 milligrams (mg)1 milligram (mg) 1000 micrograms (mcg)VOLUME1 liter (L) 1000 milliliters (mL) or 1000 cubic

centimeters (cc)1 milliliter (mL) 1 cubic centimeter (cc)*The cubic centimeter (cc) is the amount of space the 1mL occupies. The two measures are interchangeable.

As shown above, each of the common units of measure used in dosage calculations differs from the next by 1000. Since each place is a multiple of ten and each zero represents one place value, to convert between these units of measure the decimal point is moved three places. The direction the decimal point is moved is dependent on whether the value is moving down to a smaller unit of measure or moving up to a larger unit of measure. If moving down in value, the quantity becomes larger so the decimal point is mover three places to the right (Table 2). If moving up in value, quantities become smaller and the decimal point is moved three places to the left (Table 3). Being able to convert these common units is important when calculating dosages.

Table 2. Moving down in value. Example:

0.5 gm is equivalent to how many milligrams?

0.5gm 0.500 = 500mg

We converted down the scale. Milligrams are a smaller unit of measure than grams. To convert grams to milligrams, move the decimal point three places to the right and change the units of measurement to milligrams. In order to do this, two zeros must be added.

Another method to convert grams (large) to milligrams (small) is to multiple by 1000.

0.5gm x 1000 = 500mg

Table 3. Moving up in value. Example:

2500mL is equivalent to how many liters?

2500mL 2.500 = 2.5L

We converted up the scale. A liter is a larger unit of measure than a milliliter. To convert mL to L, move the decimal point three places to the left and change the units

to L. Once done, it is possible to drop two zeros as retaining them does not change the value.

Another method to convert milliliters (small) to liters (large) is to divide by 1000.

2500mL ÷ 1000 = 2.5L

Errors in metric system dosage calculations occur more frequently when the dosage contains a decimal. Whenever possible, perform the conversions to eliminate the decimal point. It is also important to always place a zero in front of decimal fractions (Table 4).

Table 4. Proper Notation.

.3 mg is an improper notation0.3mg is the correct notation

b. Other systems of medication measurement. Unit –Medications are sometimes measured in units. A unit measures a medication in terms of its action rather than its weight. There are three major medications measured in units: Heparin, Penicillin, and Insulin.

Milliequivalents –Milliequivalents (mEq) are the number of grams of a medication contained in a mL of solution. Milliequivalents are used to designate measurement in a variety of solutions, especially electrolytes.

Percentage –Percentages (%) are parts per hundred. Specifically, percentages represent the number of grams of medication per 100mL of solution. Please note, the higher the percentage strength, the stronger the mixture. Percentages, as a unit of measure, are used in solutions, topical ointments and other medications. The following illustrates the concentration of medications expressed as percentages:

Lidocaine 2% = 2gm of medication per 100mL of solution D10W = 10gm of dextrose per 100mL of water

Notice that the denominator is always 100, and the numerator shows how many parts out of 100 (Table 5).

Table 5. Changing percent (%) to fraction.

1. Drop the % sign 2. Write the number as the numerator 3. Write 100 as the denominator 4. Reduce to lowest terms

Example: Dextrose 5% = 5gm/100 = 1gm/20 mL

II. Dosage CalculationsTablets and capsules each contain a specific amount of medication (Table 6). Most tablets and capsules come in multiples of the ordered dosage. When necessary, scored tablets may be divided. Most orders requiring giving ½ to 3 tablets. If a nurse’s calculation results in an unusual number, this could be a warning that a calculation mistake has been made. Liquid medication preparations contain a specific amount of medication in a certain volume of solution.

Table 6. Medication Preparations. Example:

One medication may come in a tablet and liquid preparation.

Tablet = 250mg tabletLiquid = 250mg/5mL

When the dosage ordered is different from what is available, dosage calculations are necessary. There are several different ways to calculate medication dosages. The following section will present two common methods of dosage calculations for preparing oral and parenteral medications, dimensional analysis and ratio and proportion (Table 7). Practice the medication calculations using each method presented. Then select one method and work the study questions.

a. Medication calculation using dimensional analysis Dimensional analysis is a method to calculate medication doses using fractions. With dimensional analysis, the problem is set up according to the following:

D x QH

D represents the desired dosage or what the physician has ordered H represents the dosage on hand or the strength availableQ represents the quantity that contains the available dose X represents the volume desired and is the unknown value

Table 7. Steps to calculate medication dosages using dimensional analysis

1. Ensure all units are in the same size. Convert if necessary in a manner that will eliminate the decimal point. When converting be sure to convert to units of the available medication 2. Estimate what would be a reasonable amount to administer 3. Place all the information into the correct position in the formula 4. Calculate the answer

Examples:

#1 Order: 600 mg PO Available: 300 mg tablets

Step 1: Units are already in the same size (mg), no conversion in necessaryStep 2: A reasonable estimate is that more than 1 tablet will be given because the dosage ordered is larger than the dosage on handStep 3: (D)600 mg x (Q)1 tablet = X

(H)300 mg Step 4: 600 mg x 1tab = 2 tablets

300 mg

#2 Order: 0.025 mg PO Available: 50 mcg scored tablets

Step 1: Convert to like units. Convert mg to mcg, to eliminate the decimal point. To do this, multiple by 1000 or move the decimal point 3 places to the right and change units to mcg: 0.025 mg = 25 mcg Step 2: A reasonable estimate is that less than 1 tablet will be given because the dosage ordered is less than the dosage on hand Step 3: (D) 25 mcg x (Q)1 tablet = X

(H) 50 mcg Step 4: 25 mcg = ½ tab

50 mcg

#3 Order: 50 mEq PO Available: 20 mEq/15mL

Step 1: Units are already in the same size, no conversion is necessaryStep 2: A reasonable estimate is that more than 15mL will be given because the dosage ordered is more than the dosage on handStep 3: (D) 50 mEq x (Q) 15 mL = X

(H) 20 mEqStep 4: 50 mEq x 15 mL = 75 = 37.5 mL

20 mEq 2

b. Medication calculations using ratio and proportion method A ratio is a comparison of two numbers which are somehow related to each other. A medication dosage ratio can be used to show the amount of medication contained in one tablet. A dosage ration can also be used to show the amount of medication in a given volume of solution. These relationships (ratios) are expressed by either placing a colon between the numbers or writing the numbers in fraction form (Table 8).

Table 8. Expression of a ratio.

A medication is available in a dose of 250mg per 5 mL. The ration is expressed as: 5mL: 250mg or 250mg

5ml

A proportion is used to prove that two ratios are equal (Table 9 and 10). A proportion me be separated by an equal sign (=) or double colon (::).

Table 9. Expression of a proportion written as a fraction

250 = 500 1 2Read as 250 is to 1 as 500 is to 2

Table 10. Expression of a proportion written as a ratio

250 : 1 : 500 : 2 Read as 250 is to 1 as 500 is to 2

Means

250 : 1 :: 500 : 2

Extremes

Proof of the ratios in a proportion being equal is demonstrated by cross multiplication. When expressed as a fraction, the numerator (top number) of each ratio is multiplied by its opposite denominator (bottom number). When expressed as a ratio, the inside numbers are multiplied, then the outside numbers are multiplied. The products in a true proportion are equal. In the above example in Table 9, the product (answer) of the numerator in the ratio on the left “250” multiplied by the denominator in the ratio on the right “2” is “500”. The product of the numerator in the ratio on the right “500” multiplied by the denominator in the ratio on the left “1” is “500”. Thus, these ratios are equal. In Table 10, proof of the ratios being equal is evident by multiplying the means (1 x 500 = 500) and multiplying the extremes (250 x 2 = 500).

Ratio and proportion can be used to calculate dosages when only one complete ratio is known and the second is incomplete. If three numbers of the ratio are known, the fourth can be determined. In the ratio and proportion method of dosage calculation, the unknown number is represented by X. When setting up a proportion, remember the following key points:

Ratio for known equivalent = ration for unknown equivalent. Keep the “known” information on the left.

X Set up the equation according to the following:

If using fractions, set up like this:dosage on hand = dosage desired amount on hand amount desired (X)

If using ratio, set up like this: Dosage on hand : amount on hand : dosage desired : amount desired (X)

X Label the units and sure the units in the numerators match and the units in the denominators match

Example (fraction): Example (ratio):Order: 150 mg Order: 150 mg Available: 100mg/2 mL Available: 100 mg/ 2 mL

Units on left of the ratio are the same

Numerators are the same

100 mg = 150 mg 100 mg : 2 mL : 150 mg : x mL2mL x mL

Denominators are the same Units on right of the ratio are the same

Table 11. Steps to calculate medication dosages using ratio and proportion method

1. Ensure all units are in the same size, converting if necessary. When converting be sure to convert to the units of the available medication 2. Estimate what would be a reasonable amount to administer 3. Set up the problem as a proportion 4. Calculate the answer by multiplying and solving for X

Example:#1 Order: 600mg PO Available: 300 mg tablets

Step 1: No conversion necessaryStep 2: A reasonable estimate is that more than one tablet will be given because the dosage ordered is more than the dosage on handStep 3: 300 mg = 600 mg

1 tablet X tablet Step 4: Cross multiply, keeping X on the left side of the equation

300 mg = 600 mg 1 tablet X tablet

300X = 600 Solve for X by dividing the number on the right side of the equation by the number in front of X.

300X = 600 300 300 X = 2 tablets

#2 same problem, but in this example, the equation is set up using ratios

Step 1: No conversion necessary Step 2: A reasonable estimate is more than 1 tablet will be given because the dosage ordered is more than the dosage on hand Step 3: 300 : 1 :: 600 : X Step 4: Multiply means and extremes

multiply300X = 600 300: 1: : 600: X

Multiply

Solve for X by dividing the number equation by the number in front of X 300X = 600 300 300 X = 2 tablets

#3 Order: 0.025 mg po Available: 50 mcg scored tablets

Step 1: Convert to like units. To convert mg to mcg, move the decimal point 3 places to the right and change the units to mcg: 0.025 mg = 25 mcg Step 2: A reasonable estimate is that less than 1 tablet will be given because the dosage ordered is less than the dosage on handStep 3: 50 mcg = 25 mcg

1 tab X tabletStep 4: Cross multiply and solve for X

50 mcg = 25 mcg 1 tab X tablet

50X = 25

50X = 25 50 50

X = 0.5 or ½ tablet

#4 Order: 50mEq PO Available: 20 mEq/ 15 mL

Step 1: Units are already in the same size, no conversion is necessary Step 2: A reasonable estimate is that more than 15 mL will be given because the dosage ordered is more than the dosage on handStep 3: 20 mEq = 50 mEq

145 mL X mL

Step 4: Cross multiply and solve for X 20mEq = 50mEq 15mL X mL 20X = 750 20X = 75020 20 X = 37.5 mL

Appendix CGrading Rubric for Drug Card Presentation

Content / Development20 Points

Points EarnedXX/20Additional Comments:

All key elements of the assignment are covered in a substantive way:

Provided generic (or official name) and common trade name(s) (as applicable)

Provided accurate classification of medication

Demonstrated knowledge of different drug indications for use

Described adequately actions and therapeutic effects selected drug

Defined the key components of pharmacokinetics including absorption, distribution, metabolism/excretion, and half-life

Explained sufficiently drug contraindications and precautions

Listed 3-5 adverse reactions and side effects

Provided accurate and common adult dosages and calculations

Mechanics5 Points

Points EarnedXX/5Additional Comments:

Followed rules of grammar, usage, and punctuation

No spelling noted Sentences were complete, clear,

and concise

Overall Presentation/Peer Review 5 Points

Points Earned XX/5

Additional Comments: Presentation was given in 15-30

minutes Group was well prepared and

organized for presentation Group was communicated

thoroughly and accurately about selected drug

Total 30 Points

Points Earned XX/30

Overall Comments:

Appendix D Study Group Peer Evaluation

Name & Drug: _________________________ Date: ________________

Objectively evaluate the team’s performance on the following questions. Students attempt to rate without regard to positive or negative feelings that you may have for individual members.

Using the scale below, individually rate each member of your group, including yourself.

1= No Participation 2= Slight Participation 3= Moderate participation 4= Significant Participation 5= Outstanding Participation

Study Group MemberPreparedness (Research, reading, and assignment complete)Attendance (On-time and stayed for duration)Participation (Contributed best academic abilityCommunication between meetings (Initiates and responds appropriately)Overall Contribution