N364 Spring, 2014

Los Angeles Harbor College

Division of Nursing

Nursing Pharmacology

N364

Section ____

Spring 2014 Course Syllabus

Instructor: Staff

N364 Spring, 2014

Course Title: Nursing 364 –Pharmacology

Faculty Contact Information:

Office Hours:

Start Date: 02/13/2014 End Date: 05/29/2014

Classroom: NU 153

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.

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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%)

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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 Assignments

Week 1 02/13/2014

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

1, 4, 5

Week 2 02/20/2014

Drug Classes and Schedules Nursing Process in Pharmacology

2 6

Week 3 02/27/2014

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

3, 7, Appendix B

Quiz #1 (2 ,4, 5)

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Week 4 03/06/2014

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

15, 16, 17

Quiz #2 (3, 6, 7, Dosage & Calculations)

Week 5 03/13/2014

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 03/20/2014

Drugs for Coagulation Disorders Drugs for Hematopoietic Disorders

30, 31

Quiz #4 (11, 14, 18) Group 3 – Heparin Group 4 – Warfarin (Coumadin)

Week 7 03/27/2014

Hypertension Heart Failure Angina Pectoris and Myocardial Infarction

25, 26, 27

Quiz #5 (30, 31) Group 5 –Prinivil (Zestril) Group 6 –Nitroglycerin (Nitro-Bid)

Week 8 04/03/2014

Drugs for Asthma and Other Pulmonary Disorders Drugs for Bacterial Infections & Viral Infections

39, 34, 36

Quiz #6 (25, 26, 27) Group 7 – Albuterol (Proventil) Group 8 –Penicillin G

Week 9 04/10/2014

Drugs for Neuromuscular Disorders Drugs for Bone and Joint Disorders

21, 47 Quiz #7 (39, 34, 36)

Week 10 04/17/2014

SPRING BREAK

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Week 11 04/24/2014

Drugs for Degenerative Diseases of the Nervous system Drugs for Diabetes Mellitus

20, 44 Quiz # 8 (21, 47) Group 9 –Cyclobenzaprine (Flexeril) Group 10 –Human Regular Insulin (Humulin R, Novolin R)

Week 12 05/01/2014

Diuretic Therapy and Drugs for Renal Failures Drugs for Fluid Balance, Electrolytes, and Acid-Base Disorders

23, 24

Quiz #9 (20, 44) Group11 –Furosemide (Lasix) Group 12 –Potassium Chloride (KCL)

Week 13 05/08/2014

Drugs for Peptic Ulcers Disease Drugs for Bowel Disorders and other Gastrointestinal Conditions

40, 41 Quiz # 10 (23, 24) Group 13 –Ranitidine (Zantac) Group 14 –Psyllium Mucilloid (Metamucil)

Week 14 05/15/2014

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

45, 46 Quiz # 11(40, 41) Group 15 –Oxytocin (Pitocin) Group 16 –Sildenafil (Viagra)

Week 15 05/22/2014

Drugs for Autonomic Nervous System Drugs for Dysrhythmias Drugs for Shock

13, 29, 28

Quiz # 12 (45, 46) Group 17 –Amiodarone (Cordarone) Group 18 –Dopamine (Dopastat) Complete Course Evaluation (Online)

Week 16 05/29/2014

Last day of class Comprehensive Final

FINAL = 25 ?’S ( questions on Final will be on chapters 13, 29, 28)

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Course Topics & Objectives

Week 1 02/13/2014

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 Pharmacology 2. Identify the advantages and disadvantages of prescription and over-

the-counter drugs 3. Discuss role of the U.S. FDA 4. Explain the four stages of approval for therapeutic and biologic drug

Pharmacokinetics (Chapter 4) 1. Define Pharmacokinetics 2. Identify and recall the four components of pharmacokinetics 3. Describe major processes by which drugs are excreted 4. Explain the applications of a drug’s plasma half-life and therapeutic

range 5. Differentiate between loading and maintenance doses

Define and discuss Pharmacodynamics (Chapter 5) 1. Define Pharmacodynamics 2. Compare and contrast the terms potency and efficacy 3. Distinguish between and agonist, a partial agonist, and an

antagonist 4. Explain the relationship between receptors and drug action

Week 2 02/20/2014

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 classification 3. Describe what is meant by a drug’s mechanism of action 4. 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 02/27/2014

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

administration 2. 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 7)

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1. Define medication error and identify factors that contribute to medication errors

2. Describe specific categories of medication errors 3. Explain the impact of medication errors on all aspects of a health

care agency 4. Describe strategies that the nurse can implement to reduce

medication errors and incidents 5. Identify patient teaching information that can be used to reduce

medication errors and incidents Drug Dosages and Calculation (Appendix B)

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 system 4. Convert body weight from pounds to kilograms 5. Use one of the following methods to accurately calculate medication

dosages: D x Q Ration and proportion

H

Week 4 03/06/2014

Seizures (Chapter 15) 1. Compare and contrast the terms seizures, convulsions, and

epilepsy 2. Explain the importance of patient drug compliance in the

pharmacotherapy of epilepsy and seizures 3. Describe the nurse’s role in the pharmacologic management of

seizures of an acute nature and epilepsy 4. Review prototype drugs including actions and uses, administration

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

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 disorder 3. Discuss the nurse’s role in the pharmacologic management of

patients with depression, bipolar disorder, or attention deficit-hyperactivity disorder

4. 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

schizophrenia

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2. Explain the importance of drug compliance in the pharmacotherapy of schizophrenia

3. Explain the symptoms associated with extrapyramidal side effects of antipsychotic drugs

4. Describe the nurse’s role in the pharmacologic management of schizophrenia

5. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Chlorpromazine, Haloperidol (Haldol), Risperidone (Risperdal)

Week 5 03/13/2014

Substance Abuse (Chapter 11) 1. Explain underlying causes of addiction 2. Compare and contrast psychological and physical dependence 3. Compare withdrawal syndromes for the various substance abuse

classes 4. 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 disorders 2. Discuss factors contributing to anxiety and explain some

nonpharmacologic therapies used to cope with this disorder 3. Identify three classes of medication used to treat anxiety and sleep

disorders 4. Explain the pharmacologic management of anxiety and insomnia 5. Describe the nurse’s role utilizing the nursing process in the

pharmacologic management of anxiety and insomnia 6. 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

pharmacotherapy 2. Describe the role of nonpharmacologic therapies in pain

management 3. Explain the role of opioid antagonist in the diagnosis and treatment

of acute opioid toxicity 4. Describe the nurse’s role in the pharmacologic management of

patients receiving analgesics and antimigraine drugs 5. 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 03/20/2014

Coagulation Disorders (Chapter 30) 1. Illustrate the major steps of hemostasis 2. Describe thromboembolic disorders that are indicators for

coagulation modifiers

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3. Explain how laboratory testing of coagulation parameters is used to monitor anticoagulant pharmacotherapy

4. Describe the nurse’s role utilizing the nursing process in the pharmacologic management of coagulation disorders

5. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Heparin, Warfarin (Coumadin), Clopidogrel (Plavix), Alteplase (Activase)

Hematopoietic Disorders (Chapter 31) 1. Describe the process of hematopoiesis 2. Describe Vitamin 12 deficiency (pernicious or megaloblastic

anemia) and Iron deficiency anemia 3. Describe the nurse’s role utilizing the nursing process in the

pharmacologic management of hematopoietic disorders 4. 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 03/27/2014

Hypertension (Chapter 25) 1. Explain hypertension (HTN) classification 2. Summarize long-term consequences of untreated hypertension 3. Explain the effects of cardiac output, peripheral resistance, and

blood volume on blood pressure 4. Describe the nurse’s role utilizing the nursing process in the

pharmacologic management of patients receiving drugs for hypertension

5. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Spironolactone (Aldacton), Enalapril (Vasotec), Nifedipine (Procardia XL) Hydralazine (Apresoline)

Heart Failure (Chapter 26) 1. Define Heart Failure (HF) 2. Review the blood circulation 3. Relate how the symptoms associated with heart failure may be

caused by weakened heart muscle and diminsihed cardiac output 4. Explain how preload and afterload affect cardiac function 5. Describe the nurse’s role utilizing the nursing process in the

pharmacologic management of heart failure 6. 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 27) 1. Explain the pathophysiology of myocardial infarction 2. Describe factors that affect myocardial oxygen supply and demand 3. Describe the nurse’s role utilizing the nursing process in the 4. pharmacologic management of patients with myocardial infarction

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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)

Week 8 04/03/2014

Asthma and Other Pulmonary Disorders (Chapter 39) 1. Identify major functions of the lower respiratory tract 2. Compare the advantages and disadvantages of using the inhalation

route of the drug administration for pulmonary drugs 3. 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: Albuterol (Proventil), Ipratropium (Atrovent), Beclomethasone (Qvar)

Bacterial Infections (Chapter 34) 1. Explain how bacteria are described and classified 2. Explain how resistance can develop to an anti-infective drug 3. Explain the importance of culture and sensitivity 4. Describe the nurse’s role utilizing the nursing process in the

pharmacologic management of bacterial infections 5. Review prototype drugs including actions and uses, administration

alerts, pharmacokinetics, adverse effects, and interactions: Penicillin G, Gentamycin (Garamycin), Ciprofloxacin (Cipro), Trimethoprim-sulfamethoxazole (Bactrim, Septra)

Viral Infections (Chapter 36) 1. Identify viral infections that benefit from pharmacotherapy 2. Explain the purpose and expected outcomes of HIV

pharmacotherapy 3. 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), Acyclovir (Zoviraz)

Week 9 04/10/2014

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

and spasticity 2. Explain the goals of pharmacotherapy with skeletal muscle

relaxants 3. Describe the nurse’s role in the pharmacologic management of

muscle spasms 4. Review prototype drugs including actions and uses, administration

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

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

in the nervous, muscular, and nervous systems 2. Explain the pharmacotherapy of hypocalcemia, osteomalacia,

osteoporosis, rickets, osteoarthritis, rheumatoid arthritis, and gout 3. 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), Allopurinol (Lopurin)

Week 10 04/17/2014

SPRING BREAK

Week 11 04/24/2014

Degenerative Diseases of the Nervous System (Chapter 20) 1. Describe symptoms of Parkinson’s disease and Alzheimer’s

disease 2. Explain the goals of pharmacotherapy for Alzheimer’s disease and

the efficacy of existing medications 3. Describe the nurse’s role utilizing the nursing process in the

pharmacologic management of Parkinson’s disease and Alzheimer’s disease Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Levodopa, Carbidopa, Benztropine (Cogentin), Donepezil (Aricept)

Diabetes Mellitus (Chapter 44) 1. Describe the endocrine and exocrine functions of the pancreas 2. Compare and contrast type 1 and type 2 diabetes mellitus 3. Compare and contrast types of insulin 4. Describe the signs and symptoms of insulin overdose and

underdose 5. 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 05/01/2014

Diuretic Therapy and Drugs for Renal Failures (Chapter 23) 1. Explain the role of the kidneys in maintaining fluid, electrolyte, and

acid base balance 2. Describe the adjustments in pharmacotherapy that must be

considered n patients with renal failure 3. Identify indications for diuretics 4. Describe the general adverse effects of diuretic pharmacotherapy

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5. Compare and contrast the loop, thiazide, and postassium-sparing diuretics

6. Describe the nurse’s role in the pharmacologic management of renal failure, and in diuretic therapy

7. Review prototype drugs including actions and uses, administration alerts, pharmacokinetics, adverse effects, and interactions: Hydrochlorothiazide (Microzide)

Fluid Balance, Electrolytes, and Acid-Base Disorders (Chapter 24) 1. Describe conditions for which IV fluid therapy may be indicated 2. Explain the pharmacotherapy of sodium and potassium imbalances 3. Discuss common causes of alkalosis and acidosis and the

medications used to treat these disorders 4. 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: Dextran 40, Sodium Chloride (NaCl), Potassium Chloride (KCl)

Week 13 05/08/2014

Peptic Ulcers Disease (Chapter 40) 1. Describe major anatomical structures of upper GI tract 2. 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), Aluminum Hydroxide

Bowel Disorders and Other Gastrointestinal Conditions (Ch. 41) 1. Identify major anatomic structures of lower GI tract 2. Explain the pathogenesis of constipation and diarrhea 3. Discuss conditions in which the pharmacotherapy of bowel

disorders is indicated 4. Explain conditions in which pharmacotherapy of nausea/vomiting

(N/V) is indicated 5. Describe nurse’s role utilizing the nursing process in the

pharmacological management of bowel disorders, N/V, and other GI conditions

6. 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)

Week 14 05/15/2014

Disorders and Conditions of the Female Reproductive System (Chapter 45)

1. Describe the role of the hypothalamus, pituitary, and ovaries in maintaining female reproductive function

2. Explain the mechanisms by which estrogens and progestins

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prevent conception 3. Explain how drugs may be used to provide emergency

contraception and to terminate early pregnancy 4. Describe the role of drug therapy in the treatment of menopausal

and postmenopausal symptoms 5. Discuss the use of progestins in the therapy of dysfunctional uterine

bleeding 6. Compare and contrast the use of uterine stimulants and relaxants in

the treatment of antepartum and postpartum patients 7. 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 system 9. 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 (Depo-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 infertility 4. Describe the etiology, pathogenesis, and pharmacotherapy of

erectile dysfunction 5. Describe the pathogenesis of benign prostatic hyperplasia 6. Describe the nurse’s role in the pharmacologic management of

disorders and conditions of the male reproductive system 7. Review prototype drugs including actions and uses, administration

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

Week 15 05/22/2014

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

system and peripheral nervous system 2. Compare and contrast the actions of the sympathetic and

parasympathetic divisions of the autonomic nervous system 3. 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)

Dysrhythmias (Chapter 29) 1. Explain how rhythm abnormalities can affect cardiac function

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2. Illustrate flow of electrical impulses through normal heart 3. Classify dysrhythmias based on their location and type of rhythm

abnormality 4. Describe nurse’s role in the pharmacological management of

patient with dysrhythmias 5. Review prototype drugs including actions and uses, administration

alerts, pharmacokinetics, adverse effects, and interactions: Amiodarone (Cordarone)

Shock (Chapter 28) 1. Compare and contrast different types of shock 2. Relate general symptoms of shock to their physiologic causes 3. Explain initial treatment priorities for a patient who is in shock 4. List drugs used in the pharmacotherapy of anaphylaxis 5. Review prototype drugs including actions and uses, administration

alerts, pharmacokinetics, adverse effects, and interactions: Normal Normal Serum Albumin (Albuminar, Plasbumin), Norepinephrine (Levophed), Dopamine (Dopastat, Intropin), Epinephrine (Adrenalin)

Week 16 05/29/2014

Comprehensive Final

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Appendix A

Drug 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.

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*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.

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Appendix B

Medication Dosage and Calculation

I. Systems of Medication Measurements

A. 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 Value Decimal Equivalent Relationship to Basic Unit

(meter, liter, gram) deci = one tenth = 0.1 = 10 times smaller centi = one hundredth = 0.01 = 100 times smaller milli = one thousandth = 0.001 = 1,000 times smaller micro = one millionth = 0.000001 = 1,000,000 times smaller One prefix indicates a larger unit than the basic unit of measure:

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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

WEIGHT 1 kilogram (kg) = 1000 grams (g) 1 gram (g) = 1000 milligrams (mg) 1 milligram (mg) = 1000 micrograms (mcg)

VOLUME

1 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.

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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 notation 0.3mg 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.

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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 = 1gm 100 20mL

II. Dosage Calculations

Tablets 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:

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One medication may come in a tablet and liquid preparation.

Tablet = 250mg tablet Liquid = 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 Q

H

D represents the desired dosage or what the physician has ordered H represents the dosage on hand or the strength available Q 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

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Step 1: Units are already in the same size (mg), no conversion in necessary

Step 2: A reasonable estimate is that more than 1 tablet will be given because the dosage ordered is larger than the dosage on hand Step 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 necessary Step2: A reasonable estimate is that more than 15mL will be given because the dosage ordered is more than the dosage on hand Step 3: (D) 50 mEq x (Q) 15 mL = X (H) 20 mEq Step 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.

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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 2 Read 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.

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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 : 2 mL : 150 mg : x mL

Units on right of the ratio are the same

100 mg = 150 mg 2mL x mL Denominators 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 necessary

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Step 2: A reasonable estimate is that more than one tablet will be given because the dosage ordered is more than the dosage on hand Step 3: 300 mg = 600 mg 1 tablet X tablet Step 4: Cross multiply, keeping X on the left side of the equation 300 mg = 600mg 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 multiply 300X = 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 hand Step 3: 50 mcg = 25 mcg 1 tab X tablet

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Step 4: Cross multiply and solve for X 50 mcg = 25 mcg 1 tablet 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 hand Step 3: 20 mEq = 50mEq 145 mL X mL Step 4: Cross multiply and solve for X 20mEq = 50mEq 15mL X mL 20X = 750

20X = 750 20 20 X = 37.5 mL

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Appendix C

Grading Rubric for Drug Card Presentation

Content / Development

20 Points

Points Earned

XX/20

Additional 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

Mechanics

5 Point

Points Earned

XX/5

Additional Comments:

Followed rules of grammar, usage, and punctuation

No spelling noted

Sentences were complete, clear,

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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:

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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. Must submit on scheduled presentation day to receive credit. 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 Member

Preparedness (Research, reading, and assignment complete)

Attendance (On-time and stayed for duration)

Participation (Contributed best academic ability)

Communication between meetings (Initiates and responds appropriately)

Overall Contribution

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