Introduction to Pharmacology


At the end of presentation learners will be able to:

  • Discuss the terminologies related to pharmacology
  • Discuss the history of pharmacology briefly
  • Identify the purposes of medication
  • Identify the source of medication
  • Discuss the classification of drugs
  • Describe the three type of drug supply system.
  • Discuss the drugs standards and legislation.
  • Identify resource to collect and utilize drug information.
  • Learn to prepare drugs cards


  • Definition: Pharmacology is the science that deals with the study of drugs and their interaction with the living systems.
  • The word Pharmacology is derived from Greek – pharmakon means drug and logos means study.
  • In actual use, however, its meaning is limited to the study of the actions of drugs.
  • Pharmacology has been defined as “an experimental science which has for its purpose the study of changes brought about in living organisms by chemically acting substances (with the exception of foods), whether used for therapeutic purposes or not.”
  • Pharmacology studies the effects of drugs and how they exert their effects.
  • There is a distinction between what a drug does and how it acts.
  • Thus, amoxicillin cures a strep throat, and cimetidine promotes the healing of duodenal ulcers.
  • Pharmacology asks “How”? Amoxicillin inhibits the synthesis of cell wall mucopeptide by the bacteria that cause the infection, and cimetidine inhibits gastric acid secretion by its antagonist action on histamine H2 receptors

Scope Of Pharmacology

  • The scope of Pharmacology is rapidly expanding and Provides the rational bases for therapeutic use of drug.
  • On the basis of study of drug it is divided into two branches .

Branches of Pharmacology

Basic Pharmacology : the study of drugs in isolated tissues animals and other related living beings such as bacteria and viruses for experimental work is called basic Pharmacology.

Clinical pharmacology

  • The study of drugs in human beings is called clinical pharmacology.


  • The study of drugs in animals for treatment of diseases is also called clinical pharmacology.

General Definition of Drug

  • Any chemical agent that is used for diagnosis, prevention, treatment and curement of disease is called drug.
  • This disease oriented definition of drug is not applicable to some drugs such as oral contraceptives and general anesthetics etc.

WHO definition of drug

  • In 1966 WHO define drug as: “Any agent that is used or intended to be used for the treatment of disease or modifying pathological/physiological condition or to explore pathological/physiological condition is called drug”.

Basic definitions

  • Drug means any substance which change the physiology of cell tissue, organ, or organism.
  • Medicine: Whenever, a drug is formulated into a suitable dosage form for prevention, cure, and diagnose of a disease in a proper dose.
  • Dose means the amount of medicine taken
  • Dosage form means the physical form of the medicines (solids, liquids, gas etc.)
  • Therapeutics: Therapeutics deals with the use of drugs in the prevention and treatment of disease.
  • Toxicology: Toxicology deals with the adverse effect of the drug and also the study of poisons, i.e detection ,prevention and treatment of poisoning. (Toxicon =poison in greek.
  • Pharmacodynamics means the mechanism by which the drug exerts its effect. For example, how aspirin work as analgesic. What the drug does to the body.
  • Pharmacokinetics means the movement of drugs within the body (absorption, distribution, biotransformation, and excretion). What the body does to the drug.
  • Over the counter (OTC) medicine: those medicines for which the physician prescription is not required. For examples, analgesics, antacids.
  • Analgesic means those medicines which are used for pain
  • Antipyretics means those drugs which are used for fever
  • Idiosyncratic means unexpected drug reaction
  • Teratogenic means harmful effects of drugs on the fetus
  • Synergism means when the combination of drugs increase the effect
  • Antagonism means when the combination of drugs decreases the effects
  • Patient compliance: The extent to which the patient follows
  • the clinical prescription
  • Pharmacopoeia is an official publication, containing a list of medicinal drugs with their effects and directions for their use.
  • BP: British Pharmacopoeia.
  • USP: United States Pharmacopeia
  • Active ingredient means biologically active substance which produce effect
  • An excipient is a pharmacologically inactive substance formulated alongside the active pharmaceutical ingredient of a medication e.g.. Cellulose derivatives
  • Purposes served by excipients:
  • Provide bulk to the formulation.
  • Facilitate drug absorption or solubility and other pharmacokinetic considerations.
  • Provide stability and prevent from denaturation.
  • Efficacy means maximum effect that a drug can produce regardless of dose.
  • Potency means amount of a drug that is needed to produce a given effect
  • Bioavailability is the degree to which or the proportion of the drug that is available to the site of action or target tissue to produce the desired effect.
  • Half-life (t1/2) is the time taken by the plasma concentration of the drug to decrease by 50%, or reach half of the original concentration. Initially, If a drug has plasma concentration of100 mg/ml and after passing 2 hours it reduces to 50 mg/ml, then the half life would be????..
  • Prophylactic agent is any drug that prevents a disease or illness from occurring (vaccines)

A brief history of pharmacology

  • Originating in the 19th century, the discipline makes drug development possible.
  • Pharmacology is one of the cornerstones of the drug discovery process.
  • The birth date of pharmacology is not as clear-cut.
  • In the early 19thcentury, physiologists performed many pharmacologic studies.
  • François Magendie studied the action of nux vomica (a strychnine-containing plant drug) on dogs, and showed that the spinal cord was the site of its convulsant action. His work was presented to the Paris Academy in 1809.
  • In1842, Claude Bernard discovered that the arrow poison curare acts at the neuromuscular junction to interrupt the stimulation of muscle by nerve impulses.
  • Pharmacology was held to have emerged as a separate science in 1847, when Rudolf Buchheim was appointed professor of pharmacology at the University of Dorpat in Estonia (then a part of Russia).
  • Lacking outside funding, Buchheim built a laboratory at his own expense in the basement of his home. Although Buchheim is credited with turning the purely descriptive and empirical study of medicines into an experimental science, his reputation is overshadowed by that of his student, Oswald Schmiedeberg.

Oswald Schmiedeberg (1838–1921)

  • Oswald Schmiedeberg is generally recognized as the founder of modern pharmacology.
  • Schmiedeberg obtained his medical doctorate in 1866 with a thesis on the measurement of chloroform in blood.
  • In 1872, he became professor of pharmacology at the University of Strassburg, receiving generous government support in the form of a magnificent institute of pharmacology.
  • He studied the pharmacology of chloroform and chloralhydrate.
  • In 1869, Schmiedeberg showed that muscarine evoked the same effect on the heart as electrical stimulation of the vagus nerve.
  • In 1878, he published a classic text, Outline of Pharmacology
  • In 1885, he introduced urethane as a hypnotic.
  • In the United States, the first chair in pharmacology was established at the University of Michigan in 1890 under John Jacob Abel, an American who had trained under Schmiedeberg.
  • In 1893, Abel joined Johns Hopkins University in Baltimore.
  • His major accomplishments include the isolation of epinephrine from adrenal gland extracts (1897–1898), isolation of histamine from pituitary extract (1919), and preparation of pure crystalline insulin (1926). His student Reid Hunt discovered acetylcholine in adrenal extracts in 1906.
  • Today, there is a pharmacology department in every college of medicine or pharmacy.

Purposes of Medication

Medications can be administered for the following purposes

  • Diagnostic Purpose: to identify any disease
  • Prophylaxis: to prevent the occurrence of disease e.g. heparin to prevent thrombosis and antibiotics to prevent infections
  • Therapeutic Purpose: to treat or cure disease / decrease symptoms, restore normal function or maintain normal function

Essentials of medication order

  • The drug order, written by the physician, has 7 essential parts for administration of drugs safely. The nurse should know how to read a drug order. It should have the following components:
      1. Patients full name.
      2. Date and time.
      3. Drug name.
      4. Dosage.
      5. Route of administration.
      6. Time and frequency of administration.
      7. Signature of physician.

Types of Medication Orders

  1. STAT order: needed immediately
  2. Single order: given only once
  3. PRN order: given as needed
  4. Routine orders: given within 2 hours of being written and carried out on schedule
  5. Standing order: written in advance carried out under specific circumstances
  6. Basic principles (Safety) in medication administration3 checks and 7 Rights:
  • Right patient
  • Right dose
  • Right drug
  • Right route
  • Right time
  • Right Frequency
  • Right Documentation

Sources of Drugs

  • Primitive Medicine: observing the reaction of some animals to particular herbs. Through primitive medicine quinine was discovered from Africa; used for malaria and lime juice for Ascorbic acid/Vitamin C and this is used for scurvy and gum bleeding.
  • Plants; Roots, bark, sap, leaves, flowers, seeds were sources for drugs e.g. Digitalis from foxglove, opium from the poppy plant.
  • Animal sources; gave us hormones for replacement in times of deficiencies e.g. Insulin from the pancreases of pigs and cattle, Liver extracts for anemia etc
  • Minerals; including acids, bases and salts like potassium chloride
  • Natural; OCCURRING SUBSTANCES like proteins
  • Happy Chance; Discovery is by chance not by any premeditated effort.
  • Synthesis of Substances; from natural products in the laboratory.


  • Tara V.Shanbhag, Smita Shenoy, Veena Nayak (Pharmacology for Nurses) 2nd Edition

Five primary causes of low sperm count in males and how to prevent them

Over the past 50 years, men’s sperm count has declined by 51 percent.

This is the most important conclusion in the research conducted by Israel’s Hebrew University of Jerusalem and Mount Sinai School of Medicine in America.

Researchers analyzed the data and found that men had an average of 101 million reproductive cells per millimeter of semen in 1970, but that average has now dropped to 49 million.

As well as quantity, there is evidence that the quality of men has also declined, and reproductive cells have declined over the past decades.

“What was most affected was the sperm’s ability to circulate,” says urologist and andrologist Moker Raphael Radelli, vice president of the Razilian Association of Assisted Reproduction. Without this ability, the reproductive capacity of the sperm decreases.

Sperm count affected over time has concerned health experts.

“It’s really worrying because we’re seeing this process accelerate and we don’t even know where it’s going to end,” says Dr. Eduardo Miranda.

According to the same study, between 1970 and 1990, there was a 1.16% decline in sperm count, which has increased to 2.64% since 2000.

What is alarming is that it has become a global problem and scientists are seeing an increase in this trend across the globe.

However, the question is, what could be the reasons behind this problem? According to experts, there are five possible reasons for this. However, the good news is that there are ways to improve it.


If you are overweight, it can affect the health of your sperm.

Obesity leads to increased growth of adipose tissue, which releases a substance that directly affects the hormone testosterone. It is the most important hormone in sperm production.

According to Miranda, obesity also increases oxidative stress, which affects cells in the body.

“Similarly, an obese person also develops obesity around the penis, which can be very dangerous for spermatozoa,” he says.

The testicles, where reproductive cells are stored, should be kept at a temperature one to two degrees cooler than the rest of the body. This is why the scrotal sac is outside the body in men.

This is the reason that due to the increase in fat, the reproductive capacity of the organs is reduced or may be completely eliminated.

According to the World Health Organization, 39% of men worldwide are overweight. This explains why the sperm count has fallen over the past decades.


Alcohol, cigarettes, vaping ie use of electronic cigarettes, use of marijuana, cocaine and steroids. You know what all these items have in common?

All of these affect sperm count and quality in men.

“Some of these things have a direct effect on these cells, while others have an indirect effect,” says Marand. They can also affect the production of hormones that are important for testicular health.

The biggest example in this regard is the testosterone replacement drugs, gels and injections used by experts, which are usually used during bodybuilding.

According to experts, this market has expanded at an alarming rate over the years. Experts further say that when you inject this hormone into the body for no reason, the body thinks that its production is no longer needed.

This can also cause the testicles to decrease in size and the sperm count to drop. This disorder is called azoospermia.

Sexually transmitted infections

Sexually transmitted diseases that cause inflammation of the epididymis, such as chlamydia and gonorrhea, can also cause damage.

The epididymis is actually attached to the testicles and is where the sperm are stored, so any changes here can affect the sperm.

According to World Health Organization estimates, 129 million new cases of chlamydia and 82 million new cases of gonorrhea occurred in men and women in 2020.

Human papillomavirus (HPV) is also involved, says Dr. Radelli.

“It is also said to affect sperm production and even DNA,” he says.

 Habit of sitting with laptop on lap

The testicles, where reproductive cells are stored, should be kept at a temperature one to two degrees cooler than the rest of the body. This is why the scrotal sac is outside the body in men.

According to research published in the last decade, the habit of keeping a laptop on one’s lap can lead to a decrease in sperm count.

Toxic substances

Experts also point to toxins commonly known as endocrine disruptors.

They are found in air pollution as well as in plastics and pesticides.

In short, the structure of these molecules is very similar to the hormones in our body. Just like a key fits into a lock, these substances manage to fit into cell receptors and trigger some unwanted process.

One of the new discoveries in recent research has been linked to reproduction, but research is still ongoing.

“But we don’t know the exact extent of the problem yet, and there’s a lot of research going on to determine that,” Radley says.

Loss of fatherhood

Besides the environmental and lifestyle factors behind low sperm count, there are two internal issues that also contribute to this phenomenon. The first of these is genetic.

An estimated 10 to 30 percent of cases of infertility are related to problems in the male’s DNA.

The second is related to aging and the fact that men’s ability to become fathers increases with age.

“We know that fertility declines throughout life,” he explains. Although the deficiency in men is not as pronounced as in women, there is a reduction in hormones that are important for the production of sperms.

If we consider that the number of sperm has declined by 51% in 50 years and the speed at which this is happening has accelerated in the last two decades, is the trend getting closer and closer to zero?

If this rate of sperm count decline continues at its current rate, by 2050 the reproductive cell concentration will be close to zero. But Miranda believes that is unlikely to happen.

According to Miranda, “The situation is deteriorating, but at some point this process will stop, perhaps with the help of new technologies.”

Methods of rescue

For those who want to have a baby, the first step to increase the chances of success is to make some changes in your lifestyle and thereby eliminate habits that are harmful to the testicles.

Examples include maintaining or losing weight through a balanced diet and regular physical exercise. Abstinence or total abstinence from alcohol, cigarettes and other drugs is also a basic requirement.

If you have recreational sex, it is important to use condoms to prevent other infections, including chlamydia.

People who are vaccinated against HPV at an early age are better protected against the virus and its effects on the body.

If despite all these changes in the routine, the difficulty in conceiving a child persists, a doctor should be consulted immediately.

According to national and international guidelines, the type of treatment will depend on the age of the woman.

“If you’re under 35, couples should try to have a baby for a year,” says Miranda.

“This process should be continued with regular intercourse about three times a week.”

However, if the couple is over 35 years of age, difficulty conceiving beyond six months is a cause for alarm.

“Research needs to involve couples to explore possible causes and identify the best treatments,” Radley says.

If the problem is in men, experts usually recommend vitamin supplements rich in antioxidants that help protect the testicles.

According to Miranda, “Certainly it is possible to correct some diseases with drugs and surgery that are at the root of the problem.”

As a last resort couples may resort to assisted reproductive techniques such as in vitro fertilization.


Sex during periods/Menstruation

Is It Safe to Have Sex During Your Period?

  • Benefits
  • Side Effects
  • Tips,

 Can you have sex during your period?

You will have a menstrual cycle once a month during your reproductive years. There’s no need to avoid sexual activity during your period unless you’re very sensitive. Though period sex might be messy, it is completely safe. Having sex while menstruation can also provide certain benefits, such as relief from menstrual cramps.



There are a few advantages to having sex during your period:

  1. Pain relief from cramping

Menstrual cramps may be relieved by orgasms. Menstrual cramps are caused by your uterus contracting in order to discharge its lining. When you have an orgasm, the muscles in your uterus contract as well. Then they let go. Period cramps should be relieved by this release.

Sex also causes the production of endorphins, which are hormones that make you feel wonderful. Furthermore, sexual activity diverts your attention away from your period discomfort.

  1. Short duration of periods

Sex may cause your periods to be shorter. Muscle spasms during an orgasm force the uterine contents out more quickly. This might lead to shorter durations.

  1. increased sexual desire

Because of hormonal shifts, your libido alters during your menstrual cycle. While many women indicate that their sex desire increases about two weeks before their period, others report feeling more turned on during their period.

  1. Natural lubricant

During your period, you can store the KY. The blood serves as a natural lubricant.

  1. It could help with your headache.

Approximately half of women with migraine headaches have them during their periods. Although most women with menstrual migraines avoid sex during their attacks, many of those who do report that it improves their headaches partially or entirely.

 What are the possible side effects?

The most obvious disadvantage of having sex during your period is the mess. When you have a high flow, blood might go on you, your partner, and the bedding. Aside from making your bed messy, bleeding might make you feel self-conscious. Anxiety over making a mess might detract from the enjoyment of sex.

Another concern about having sex during your period is the possibility of contracting a sexually transmitted infection (STI) such as HIV or hepatitis. These viruses dwell in blood and can be transmitted by contact with contaminated menstrual blood. Using condoms whenever you have sex reduces your chances of transmitting or contracting a STI.

If you intend to have sex while on your period and are wearing a tampon, you must remove it beforehand. During intercourse, a forgotten tampon can be pushed so far up into your vagina that you’ll need to visit a doctor to have it removed.


Can you get pregnant/conceive?

If you aren’t actively attempting to conceive, utilizing protection is a smart idea regardless of where you are in your menstrual cycle. Your chances of becoming pregnant are decreased during your period, but it is still possible.

You are most likely to become pregnant during ovulation, which occurs around 14 days before your period begins. However, each woman’s cycle duration is unique, and your cycle length might alter monthly. If you have a short menstrual cycle, you are more likely to become pregnant during your period.

Consider the fact that sperm may dwell in your body for up to seven days. So, if you have a 22-day cycle and ovulate soon after having your period, you may be releasing an egg while sperm are still in your reproductive tract.


Is it necessary to wear/use protection?

Using protection will also protect you against STIs. Because viruses like HIV thrive in menstrual blood, you can not only get a STI during your period, but you can also more readily transmit one to your partner.

Wear a latex condom every time you have sex to lower your chances of becoming pregnant and contracting a STI. If you or your spouse are allergic to latex, there are other options for protection. You can get advice from your pharmacist or doctor.


Tips on having sex during your period

Here are a few pointers to make period sex more pleasant and less messy:

Communicate openly and honestly with your spouse. Tell them how you feel about having sex during your period and inquire about their feelings. If either of you is apprehensive, discuss the reasons for your unease.

If you’re wearing a tampon, take it out before you start messing about.

To collect any blood drips, place a dark-colored cloth on the bed. Or, to avoid the mess totally, have sex in the shower or bath.

Keep a damp towel or wet wipes beside the bed for cleanup.

Wear a latex condom with your lover. It will provide protection against pregnancy and STIs.

If your typical sexual position makes you uncomfortable, try something new. Try resting on your side with your spouse behind you, for example.


Don’t let your period prevent you from having fun. If you do a little planning, sex may be just as delightful on those five or so days as it is the rest of the month. You might be startled to discover that sex is much more stimulating during your period.

Application of Pharmacology in Nursing Practice

I. Evolution of Nursing Responsibilities Regarding Drugs

A. Five Rights of Drug Administration
– give the right drug to the right patient in the right dose by the right route at the right time
– proper delivery is only the beginning of responsibilities: Important events will take place after the “pill” is delivered, and these must be responded to.
– a broad base of pharmacology knowledge is needed so as to contribute fully to achieving the therapeutic objective
– should include a patient advocate position
PRE-TEST ? When applying pharmacology to patient care what is most important: assessment of the patient

II. Application of Pharmacology in Patient Care
– pharmacologic knowledge is applied in patient care and patient education
A. Pre-administration Assessment
1. Goals
a. collecting baseline data needed to evaluate therapeutic and adverse responses
b. identifying high-risk patients
c. assessing the patient’s capacity for self care
B. Collecting Baseline Data
– baseline data are needed to evaluate drug responses, both therapeutic and adverse

C. Identifying High Risk Patients
– predisposing factors are pathophysiology (especially liver and kidney function), genetic factors, drug allergies, pregnancy, old age, and extreme youth
– tools for identification are the patient history, physical examination and laboratory tests – need to know what to look for: factors that can increase the risk of severe reactions to the drug in question
PRE-TEST ? What predisposing factor can make a patient high risk when giving medications: pathophysiological conditions
D. Dosage and Administration
1. Read the medication order carefully. If the order is unclear, verify it with the prescribing physician.
2. Verify the identity of the patient by comparing the name on the wristband with the name on the drug order or administration record.
3. Read the medication label carefully. Verify the identity of the drug, the amount of drug (per tablet, volume of liquid, etc.) and its suitability for administration by the intended route.
4. Verify dosage calculations.
5. Implement any special handling the drug may require.
6. Don’t administer any drug if you don’t understand the reason for its use.

E. Evaluating and Promoting Therapeutic Effects
1. Evaluating Therapeutic Responses – evaluation is one of the most important aspects of drug therapy
– process that tells us whether or not our drug is doing anything useful
– need to know the rationale for treatment and the nature and time course of the intended response
2. Promoting Compliance – drugs an be of great value to patients, but only if they are taken correctly
3. Implementing Non-drug Measures – supportive measures directly, through patient education, or by coordinating the activities of other healthcare providers
F. Minimizing Adverse Effects – all drugs have the potential to produce undesired effects. In order to help reduce adverse effects, you must know the following about the drugs you’re working with:
– major adverse effects that the drug can produce
– time when these reactions are likely to occur
– early signs that an adverse reaction is developing
– interventions that can minimize discomfort and harm

G. Minimizing Adverse Interactions – when a patient is taking two or more drugs, those drugs may interact with one another to diminish therapeutic effects or intensify adverse effects. Ways to help reduce adverse interactions include:
– taking a thorough drug history
– advising the patient to avoid over the counter drugs that can interact with the prescribed
– monitoring for adverse interactions known to occur between the drugs the patient is taking
– being alert for as-yet unknown interactions
H. Making PRN Decisions – PRN medication order is one in which the nurse has discretion regarding how much drug to give and when to give it.
– PRN is an abbreviation that stands for pro re nata (Latin for as needed or as the occasion arises)
– in order to implement a PRN order rationally, the reason for the drug use and the patient’s medication needs must be known
PRE-TEST ? What does PRN mean: as needed
I. Managing Toxicity – some adverse drug reactions are extremely dangerous; if toxicity is not diagnosed early and responded to quickly, irreversible injury or death can result.
– early signs of toxicity and the procedure for toxicity management must be known
III. Application of Pharmacology in Patient Education
As a patient educator, you must give the patient the following information:
– drug name and therapeutic category – dosage size
– dosing schedule – route and technique of administration
– duration of treatment – method of drug storage
– expected therapeutic response and when it should develop
– non-drug measures to enhance therapeutic responses
– symptoms of major adverse effects and measure to minimize discomfort and harm
– major adverse drug-drug and drug-food interactions
– whom to contact in the event of therapeutic failure, severe adverse reactions, or severe adverse interactions

A. Dosage and Administration
1. Drug Name – if the drug has been prescribed by trade name, the patient should be given its generic name too
– this information will reduce the risk of overdose that can result when a patient fails to realize that two prescriptions that bear different names actually contain the same medicine
2. Dosage Size and Schedule of Administration – patients need to be told how much drug to take and when to take it
3. Technique of Administration – patients must be taught how to administer their drugs
4. Duration of Drug Use – just as patient must know when to take their medicine, they must know when to stop
5. Drug Storage – certain medications are chemically unstable and hence deteriorate rapidly if stored improperly. Patients must be taught how to store their medications correctly. – all drugs should be stored where children cannot reach them

B. Promoting Therapeutic Effects – patients must know the nature and time course of expected beneficial effects
– non-drug measures can complement drug therapy; teaching patients about non-drug measures can greatly increase the chances of success

C. Minimizing Adverse Effects – knowledge of adverse drug effects will enable the patient to avoid some adverse effects and minimize others through early detection
D. Minimizing Adverse Interactions – patient education can help avoid hazardous drug-drug and drug-food interactions.


IV. Application of Nursing Process in Drug Therapy

A. Review of Nursing Process
1. Assessment – consists of collecting data about the patient
– methods of data collection are:

  • patient interview
  • medical and drug use histories
  • physical examination
  • observation of the patient
  • laboratory tests

    2. Analysis: Nursing Diagnosis – nurses analyze the database to determine the actual and potential health problems, which can be physiologic, psychologic or sociologic
    nursing diagnosis – states each problem as an actual or potential health problem that nurses
    are qualified and licensed to treat
    – consists of two statements that are usually separated by the phrase related to:
    a. statement of the patient’s actual or potential health problem
    b. statement of the problem’s probable cause or risk factors
    3. Planning – the nurse delineates specific interventions directed at solving or preventing the problems identified in analysis
    – in the care plan, the nurse must define goals, set priorities, and identify nursing interventions performed by other healthcare providers
    4. Implementation (Intervention) – begins with carrying out the interventions identified during planning
    collaborative interventions – require a physician’s order
    independent interventions – do not require a physician’s order
    – involves coordinating actions of other members of the healthcare team
    – is completed by observing and recording the outcomes of treatment
    5. Evaluation – performed to determine the degree to which treatment has succeeded
    – accomplished by analyzing the data collected during implementation
    – should identify those interventions: – that should be continued
    – those that should be discontinued
    – potential new interventions that should be implemented

    B. Applying the Nursing Process in Drug Therapy – overall objective in drug therapy is to produce maximum benefit with minimum harm
    – therapy must be individualized

    1. Pre-administration Assessment – establishes the baseline data needed to tailor drug therapy to the individual
    a. Basic Goals
    i. collection of baseline data needed to evaluate therapeutic responses
    – in order to know what baseline measurements to make, the reason for the drug use must be known
    ii. collection of baseline data needed to evaluate adverse effects
    – all drugs have the ability to produce undesired effects
    – knowing what data to collect comes directly from your knowledge of the drug under consideration
    iii. identification of high-risk patients
    – just which individual characteristics will predispose a patient to an adverse reaction depends on the drug under consideration
    – multiple factors that can increase the patient’s risk of adverse reactions to a particular drug include:
    – impaired liver and kidney function – age
    – body composition – pregnancy
    – diet – genetic heritage
    – other drugs being used
    – practically any pathophysiological conditions
    – distinguish between factors that put the patient at extremely high risk versus factors that put the patient at moderate or low risk

    contraindication – a pre-existing condition that precludes use of a particular drug under all but the most desperate circumstances

    precaution – a pre-existing condition that significantly increases the risk of an adverse reaction to a particular drug, but not to a degree that is life threatening
    iv. assessment of the patient’s capacity for self-care
    – for drug therapy to succeed, the outpatient must be willing and able to self-administer medication as prescribed
    – factors that can affect the capacity for self-care and probability of adhering to the prescribed regimen include:
    – reduced visual acuity – limited manual dexterity
    – limited intellectual ability – severe mental illness
    – inability to afford drugs
    – individual and/or cultural attitude toward drugs
    – conviction that the drug was simply not needed in the dosage prescribed
    – methods of data collection include:
    – interviewing the patient and family – observing the patient
    – physical examination – laboratory tests
    – patient’s medical history
    – patient’s drug history (including prescription drugs, over the counter drugs, herbal medications, non-medical drugs, such as alcohol, nicotine, caffeine, illicit drugs)
    – prior drug reactions should be noted

    b. Components of Drug History
    i. Allergies to medications (OTC and prescribed) or food

    ***If there are more than 2 medications, BE AWARE***
    ii. Habits
    – dietary
    – recreational drug usage (alcohol, tobacco, stimulants, illicit drugs) ask the patient “How much do you smoke? drink?”
    “What social drugs do you use?”
    iii. Socioeconomic Status
    – age – occupation
    – education level – insurance coverage

    iv. Life Style Beliefs
    – marital status – childbearing status
    – personal support system – utilization of health care system
    – typical pattern of daily activities
    v. Sensory Deficit / Capacity for self-care
    vi. Pre-existing conditions
    vii. Prescription and OTC Drugs:
    – reasons for use – knowledge of drugs
    – frequency of dosage – effectiveness or reaction
    – pattern and route of administration

2. Analysis and Nursing Diagnosis
a. Three objectives:
i. First, judge to appropriateness of the prescribed regimen
– the data collected during assessment must be analyzed to determine if the proposed treatment has a reasonable likelihood of being effective and safe
– judgment is made by considering:
– medical diagnosis – known actions of the prescribed drug
– patient’s prior responses to the drug
– presence of contraindications
– question the drug’s appropriateness:
– if the drug has no actions that are known to benefit individuals with the patient’s medical diagnosis
– if the patient failed to respond to the drug in the past
– if the patient has a serious adverse reaction to the drug in the past
– if the patient has a condition or is using a drug that contraindicates the prescribed drug
ii. Second, identify potential health problems that the drug might cause
– accomplished by synthesizing knowledge of the drug under consideration and the data collected during assessment

iii. Third, determine the patient’s capacity for self-care
– should indicate potential impediments to self-care (visual impairment, reduced manual dexterity, impaired cognitive function, insufficient understanding of the prescribed regimen)
– nursing diagnosis applicable to almost every patient is “deficient knowledge related to the drug regimen”
b. Planning – consists of defining goals, stabling priorities, identifying specific interventions, and establishing criteria for evaluating success

i. Defining Goals – the goal of drug therapy is to produce maximum benefit with minimum harm
– maximize therapeutic responses while preventing or minimizing adverse
reactions and interactions
ii. Setting Priorities – highest priority is given to life threatening conditions and reactions that cause severe, acute discomfort and to reactions that can result in long-term harm
iii. Identifying Intervention – heart of planning
i. Major Groups:
– drug administration = must consider dosage size and route of administration as well as less obvious factors, including timing of administration with respect to meals and with respect to administration of other drugs
– enhanced therapeutic effects = non-drug measures can help promote therapeutic effects and should be included in the planning
– interventions to minimize adverse effects and interactions distinguish between reactions that develop quickly and reactions that are delayed
– patient education = well planned patient education is central to success
– address the following: – technique of administration
– dosage size and timing
– duration of treatment
– method of drug storage
– measures to promote therapeutic effects
– measures to minimize adverse effects
iv. Establishing Criteria for Evaluation – the need for objective criteria by which to measure desired drug responses is obvious: without such criteria we could not determine if our drug was doing anything useful

3. Implementation
a. Four Major Components:
i. drug administration ii. patient education
iii. interventions to promote therapeutic effects
iv. interventions to minimize adverse effects

4. Evaluation – over the course of drug therapy, the patient must be evaluated for:
a. therapeutic responses
– how frequently evaluations are performed depends on the expected time course of therapeutic and adverse effects
– based on laboratory tests, observation of the patient, physical examination and patient interview
– to evaluate therapeutic responses, compare patient’s current status with baseline data
– to evaluate treatment, know the reason for drug use, criteria for success, and expected time course of responses
b. adverse drug reactions and interactions
– to make evaluates, know which adverse effects are likely to occur, how they are manifested, and their probable time course
c. compliance (adhere to prescribed regimen)
– include measurement of plasma drug levels, interviewing patient and counting pills
d. satisfaction with treatment
– satisfaction with drug therapy increases quality of life and promotes compliance
– factors that can cause dissatisfaction include unacceptable side effects, inconvenient dosing schedule, difficulty of administration, and high cost

C. Use of a Modified Nursing Process Format to Summarize Nursing Implications
1. Pre-administration Assessment – summarizes the information you should have before giving a drug
2. Implementation Administration – summarizes the routes of administration guidelines for dosage adjustment, and special considerations in administration
3. Implementation: Measures to Enhance Therapeutic Effects – addresses issues such as diet modification, measures to increase comfort and ways to promote adherence to the prescribed regimen

4. Ongoing Evaluation and Intervention – summarizes nursing implications that relate to drug responses, both therapeutic and undesired
a. Subsections:
i. summary of monitoring = summarizes the physiologic and psychologic parameters that must be monitored in order to evaluate therapeutic and adverse responses
ii. evaluating therapeutic effects = summarizes criteria and procedures for evaluating therapeutic responses
iii. minimizing adverse effects = summarizes the major adverse reactions that should be monitored for and presents interventions to minimize harm
iv. minimizing adverse interactions = summarizes the major drug interactions to be alert for and gives interventions to minimize them
v. managing toxicity – describes major symptoms of toxicity and treatment