Simmons CollegeSchool of Nursing and Health Sciences

NUR 331 PharmacologySpring 2017

Course Information

Instructor: Donna M Glynn, PhD, RN, APN-BCOffice: S332 BOffice Hours: TBDOffice Telephone: 617-521-2522E-mail: donna.glynn@simmons.edu

Course Description

This course will focus on basic pharmacologic principles and how pharmacologic agents are used in the treatment of a variety of conditions to support physiological function. Course content includes the nurses’ role in monitoring the safety and effectiveness of pharmacological therapies. Course Goals and Student Learning Objectives

Outcomes/Goals Nursing Program Outcomes

Content Evidence

Demonstrate an understanding of Pharmacology concepts

Define pharmacokinetics and pharmacodynamics

Identify factors that influence drug availability, bioavailability.

Describe the four phases of pharmacokinetics and factors that influence the processDiscuss Pharmacotherapeutics Drug interactions, adverse drug reactions, and individual variation in drug responses.

Identify different types of drug nomenclature

Discuss the Role of the FDA.

regulatory history of pharmacotherapeutics.

FDA reporting

Analyze the role of the nurse in the safe administration and prescription of medications.

Demonstrate correct technique in administering oral, subcutaneous, intramuscular, and intravenous medicationsAbbrevMed term Master the ability to calculate medication dosages.

1. IV FluidsLab on med adminSafety reportingEMAR, barcoding etc.Root cause analysis of med errors

Apply the nursing process in providing evidenced based pharmacothereutics to patient care

Pharmacotherapeutics to support the perioperative patientAnesthetics and analgesicantiintectives

Pharmacotherapeutics to support nursing care for individuals experiencing problems of oxygenation

Pharmacotherapeutics to support nursing care for individuals experiencing problems of Cardiac output and perfusion

Pharmacotherapeutics to support nursing care for individuals experiencing problems of Mobility sensation and cognition

Pharmacotherapeutics to support nursing care for individuals experiencing problems of Digestion, nutrition, elimination

Pharmacotherapeutics to

support nursing care for individuals experiencing problems of Regulation and metabolism

Pharmacotherapeutics to support nursing care for individuals experiencing problems of excretion

Pharmacotherapeutics related to cancer care and end of life care

Collaborate (Not a clinical course??) with the inter-professional health care team in the process of administration and evaluation of pharmacotherapeutics

Utilization (? NOT a clinical course, DISCUSS??) Of the principles of therapeutic communication techniques and patient education related to pharmacotherapeutics.

PrerequisiteBIOL 231, BIOL 232, CHEM 111, and CHEM 112 (or CHEM 110)

Textbook & Course Materials

Required TextLehne, R.A. (2015). Pharmacology for nursing care (9th ed.). St. Louis: Saunders.

ISBN: 13: 978-0-323-32190-7.

Porth, CM (2014) Pathophysiology: Concepts of altered health status (9th ed)

Philadelphia: Lippincott Williams & Wilkins ISBN-13: 978-1-4511-4600-4

Methods of Instruction: Using a blend of traditional and contemporary approaches to student learning, the classes will consist of lecture, discussions, case studies and simulated learning scenarios. Everyone is encouraged to attend class and participate by asking questions, commenting on the assigned readings, and discussing patient/pathophysiological conditions and the pharmacological agents used in the clinical settings. Students are expected to check the e-learning site daily for announcements regarding the course.

The case studies, quizzes and exams are designed to reinforce your understand of the basic principles of pharmacology and the nurse’s responsibility in administering medications. Medication calculations are critical to the safe administration of pharmacologic agents and are an important component of the quizzes/exams. The quizzes and exams are cumulative and will cover material on previous quizzes and exams as well as current material. At the end of each quiz/exam, there will be an opportunity to review the quizzes/exams in class.

Please feel free to ask if you have any questions about the lectures, case studies, or if the concepts we are discussing are not clear to you. As nurses, one of the most important lessons to learn is the importance of asking questions and being clear about your responsibilities. Since this is a large group, smaller study group sessions will be available and the times and classrooms will be posted. We are glad to be able to help you.

*NUR 331 Pharmacology*Spring 2017 Syllabus

Part 3: Topic Outline/Schedule*

Pharmacology New Curriculum Topical Outline

1/19/17: Introduction to Pharmacology

Review of Course Objectives and Requirements

Lehne: Chapters 1

Porth: Chapter 1

Learning Objectives

A. Define these four basic terms: drug, pharmacology, clinical pharmacology, and therapeutics.

B. List the three most important properties of an ideal drug, as well as several other important properties, and explain why many drugs do not have these traits.

1/24/17: Application of Pharmacology to the Nursing Process

Lehne: Chapter 2, 3

Learning Objectives

A. Relate the six steps of the nursing process to the administration of medications. List the Six Rights of Drug Administration and the patient’s rights regarding medications administered by healthcare providers.

B. Discuss the purpose of preadministration assessment. Include patient identification bar code and work arounds

C. Discuss the analysis of the data and development of nursing diagnoses to (1) judge the appropriateness of the prescribed regimen, (2) identify health problems the drug might cause, and (3) determine the patient’s capacity for self-care.

D. Discuss Phases I, II, III, and IV of the clinical testing of new drugs. Discuss the ethical and legal implications for the different phases of clinical testing. Phase I studies involve the use of healthy human volunteers to test the drugs. In Phases II and III, drugs are tested in patients. Upon completion of Phase III, the drug manufacturer applies to the FDA for conditional approval.

E. Explain the purpose of Phase IV clinical studies after regulatory (i.e., FDA) approval. Discuss the important information that can be gained from Phase IV (postmarketing surveillance) of clinical drug testing and explain the roles

and responsibilities of the nurse, nurse practitioner, and physician in gathering and reporting new data.

F. Discuss chemical, generic, and proprietary (trade or brand) names of drugs and explain the benefits, if any, of generic drugs over brand-name drugs.

1/26/17: Pharmacokinetics

Lehne: Chapter 4

Porth: Chapters 38, 46

Learning Objectives

A. Discuss the four main processes that make up pharmacokinetics (absorption, distribution, metabolism, and excretion), and appropriately apply these processes to clinical usefulness.

B. Discuss the advantages and disadvantages of the various techniques of drug administration as they relate to pharmacokinetics, noting especially any barriers to absorption associated with intravenous, intramuscular, and oral administration. Students should also compare oral administration with parenteral administration. Describe smart pumps and omnicells

C. Describe blood flow to tissues, the ability of a drug to exit the vascular system, and the ability of a drug to enter cells, and then discuss the characteristics of drug molecules that can alter these processes.

D. Describe the ultimate “goal” of drug metabolism. Discuss the general processes involved in drug metabolism and identify the major or vital organs in which most drug metabolism occurs. Discuss special considerations in drug metabolism.

E. Discuss the genetic influences that influence hepatic metabolism. Identify the classes of drugs that are metabolized differently in certain races and its impact on the P450 system

F. Discuss the importance of excretion of a drug from the body and some of the routes by which the drug may be excreted.

G. Discuss the importance of understanding the time course of drug responses (plasma drug levels, single-dose time course, drug half-life, and drug levels produced with repeated doses). Explain why clinicians often monitor plasma drug levels and describe how these levels are regulated to prevent drug toxicity.

01/31/17: Pharmacodynamics

Lehne: Chapter 5

Learning Objectives

A. Define pharmacodynamics and its relationship to the action of drugs on the body.

B. Discuss dose-response relationships (e.g., basic features of the dose-response relationships, maximal efficacy, and relative potency), the effects drugs can produce, and the amount of drug needed to elicit an effect.

C. Discuss properties of drug-receptor interactions (e.g., drug receptors, four primary receptor families, receptors and selectivity for drug action, theories of drug-receptor interaction, agonists, antagonists, partial agonists, and regulation of receptor sensitivity).

D. Describe how receptors function in the responses to many drugs and physiologic processes, such as the activity of the respiratory and gastrointestinal systems.

E. Differentiate drugs that are agonists, partial agonists, or antagonists. F. List the four primary families of receptors.G. Discuss interpatient variability in drug responses and describe how to

measure variabilityH. Describe pharmcogenetics. Describe the ultimate goal of improving the

safety and effectiveness of drug therapy through use of genetically guided treatment.

I. Define the ED 50 and the LD 50

J. Discuss the concept of a drug’s therapeutic index and its application and benefits to clinical practice, such as the relationships between the doses of a drug and whether its effects are subtherapeutic (inadequate), therapeutic (desired response), or toxic (adverse effects related to excessive dosage).

2/2/17: Adverse Drug Reactions

Medication Errors

Lehne: Chapters 6, 7, 8, 9, 10, 11

Porth: Chapters 2, 3

Learning Objectives

A. Discuss the consequences of drug-drug interactions, the basic mechanisms of drug-drug interactions, and the critical steps in minimizing adverse drug-drug interactions.

B. Focus on the liver as an example of a drug-metabolizing system and explain why it is such a crucial organ in many drug-drug interactions.

C. Discuss the effect of food on drug absorption, on drug metabolism (e.g., grapefruit juice), and on drug toxicity and action, as well as the timing of drug administration with respect to meals.

D. Discuss definitions for adverse drug reactions (e.g., side effect, toxicity,

allergic reaction, idiosyncratic effect, iatrogenic disease, physical dependence, carcinogenic effect, and teratogenic effect).

E. Discuss measures that can be used to minimize adverse drug events.

F. Define medication errors and explain what constitutes an error, as well as who makes errors.

G. Discuss types of medication errors, causes of medication errors, ways to reduce medication errors, and ways to report medication errors. Describe sentinel events, root cause analysis, IHI and ISMP

H. Discuss individual variations in drug responses (Body Weight, Age, Pathophysiology)

I. Define Tolerance, Placebo Effect and identify genetic factors that affect a drug response

J. Identify clinical challenges related to pregnancy, breast feeding, pediatrics and the elderly

2/7/17: Exam One

2/09/17: Introduction to Neuropharmacology

PNS

CNS

Lehne: Chapters 12, 13, 14, 20

Porth: Chapter 17, 56

Learning Objectives

A. Describe the general steps involved in neurotransmission (synaptic transmission) and axonal conduction. State the elements or processes that need to occur, regardless of the site in the nervous system, for synaptic transmission to work.

B. Discuss specific ways in which drugs can alter the steps of synaptic transmission.

C. Discuss the relationship between multiple receptor types and selective drug action.

D. Identify the two major divisions of the peripheral nervous system.

E. Differentiate between the somatic (motor) nervous system and the sympathetic and parasympathetic branches of the autonomic nervous system in terms of the following:

F. Describe the differences distinguishing the four main subtypes of adrenergic

receptors— alpha1, alpha2, beta1, and beta2—in terms of where (on what structures) they are found and the types of responses their activation causes.

G. Describe the differences between the two main subtypes of cholinergic receptors—nicotinic (both nicotinicN and nicotinicM) and muscarinic—in terms of where (on what structures) they are found and the responses their activation causes.

H. Identify the main neurotransmitters of the CNS and summarize some of their main physiologic effects.

I. Discuss the significance of the blood-brain barrier in allowing or preventing the effects of drugs in general.

2/14/17: Cholinergic Medications

Adrenergic Medications

Lehne: Chapters 14, 17, 18

Learning Objectives

A. State the responses that a muscarinic agonist would be expected to cause through direct activation of muscarinic cholinergic receptors (consider bethanechol). The student should focus on the main “targets” of parasympathetic nervous system activity: the eyes, respiratory system, heart and blood vessels, gastrointestinal (GI) and urinary tracts, and the secretory activity of exocrine glands (e.g., lacrimal, mucous, and so on).

B. List cholinergic responses not normally caused when the usual therapeutic doses of a muscarinic agonist are administered and explain why these effects do not occur.

C. Describe the mechanism of adrenergic receptor activation D. Discuss the therapeutic applications and adverse effects of adrenergic

receptor activation E. Describe the therapeutic and adverse response to alpha and beta blockade

2/16/17: Parkinson’s, Alzheimer’s, Epilepsy

Lehne: Chapter 21, 22, 24

Porth: 19, 20, 22

Learning Objectives:

A. Identify the pathophysiology associated with Parkinson’s Disease B. Discuss the use of medications in the treatment of Parkinson’s disease C. Identify the pathophysiology associated with Alzheimer’s Disease D. Discuss the use of medications in the treatment of Alzheimer’s Disease E. Identify the pathophysiology associated with seizure disorders F. Discuss the use of medications in the treatment of seizure disorders G. Identify the therapeutic serum levels of phenytoin, carbamazepine and

valproic acid H. Discuss the Beers Criteria related to medication management in the elderly

population

2/21/17: Mental Health 1

Schizophrenia, BiPolar Disorder, Depression

Lehne: Chapter 31, 32, 33

Porth: Chapter 22

Learning Objectives

A. Discuss the pathophysiology associated with Schizophrenia B. Discuss the use of First Generation antipsychotics and 2nd Generation

antipsychotics in the treatment of schizophrenia C. Identify the pathophysiology associated with depression D. Discuss the use of SSRIs, SSNIs, TCAs, MAOIs, and atypical anti depression

medications. E. Describe the pathophysiology associated with BiPolar Disorder F. Discuss the use of mood stabilizers and antipsychotic in the treatment of

bipolar disorder

2/23/17: Mental Health 2

Anxiety, Sleep & Opioid Abuse

Lehne: 28, 34, 35, 37

Porth: 21 & 22

Learning Objectives

A. Discuss the pathophysiology related to anxiety and sleep disorders B. Describe the use of medications (SSRI, Benzodiazepines) in the management

of anxiety C. Describe the sleep phases D. Identify drug and non drug measures for the management of insomnia E. Discuss drug abuse and the opioid epidemic F. Describe the principles of

addiction treatment. Describe current regulatory issues related to opioid prescribing

2/28/17: Exam Two

3/2/17: Cardiology One

Hypertension

Lehne: Chapters 41, 42, 43, 44, 45, 46, 47

Porth: Chapters 29, 31

Learning Objectives

A. Describe the prevalence and pathophysiology related to hypertension B. Describe the use of non-drug measures in the treatment of hypertension C. Discuss the following mechanism of action, side effects, patient education

related to a. Diuretics b. Renin-Angiotension-Aldosterone medications (RAAS) c. Calcium Channel Blockers d. Vasodilators e. Beta Blockers

3/14/17: Cardiology 2

Hyperlipidemia & Heart Failure

Lehne: Chapters 48 & 50

Porth: Chapters 32 & 34

Learning Objectives

A. Describe the prevalence and pathophysiology related to hyperlipidemia & metabolic syndrome

B. Identify the use of non-drug measures in the treatment of hyperlipidemia C. Describe the use of medications in the treatment of hyperlipidemia

a. HMG-CoA Reductase Inhibitors (Statins) b. Niacin c. Bile Acid Sequestrants d. Fibrates

D. Describe the prevalence and pathophysiology related to heart failure E. Discuss the medication management of heart failure

3/16/17: Cardiology 3

Antidysrhythmics, Acute STEMI & Anticoagulation Therapy

Lehne: Chapters 49, 51, 52 & 53

Porth: Chapter 33

Learning Objectives

A. Describe the pathophysiology related to cardiac dysrhythmias

B. Identify the use of medications in the treatment of angina and cardiac dysrhythmias

C. Discuss the use of anticoagulants (heparin, warfarin and direct thrombin Inhibitors) and the therapeutic serum levels

D. Discuss the use of antiplatelet therapy in cardiac disorders E. Describe the pathophysiology of STEMI F. Discuss the use of reperfusion therapy G. Discuss the use of medications in the treatment of an acute MI

3/21/17: Diabetes 1

Insulin Therapy and Insulin pumps

Lehne: Chapter 57

Porth: Chapter 50

Learning Objectives

A. Describe the prevalence and pathophysiology related to diabetes B. Discuss non-drug measures in the treatment of Type II Diabetes C. Describe the types of insulin, concentration, administration, complications

of insulin therapy a. Short Duration: Rapid Acting b. Short Duration: slower acting c. Intermediate Duration d. Long Duration

3/23/17: Diabetes 2

Oral Agent Therapy

Lehne: Chapter 57

Porth: Chapter 50

Learning Objectives

A. Describe the use of medication in the treatment of Type II Diabetes

B. Identify and discuss the following types of medications in the treatment of DM

a. Biguanides

b. Sulfonylureas c. Meglinitindes d. Glitazones e. Alpha-glucosidase inhibitors f. DPP-4 Inhibitors (Glitins) g. GLP-1 Agonists

3/28/17: Exam 3

3/30/17: Thyroid Disorders

Lehne: Chapter 58

Porth: Chapter 49

Learning Objectives

A. Discuss the physiology and pathophysiology related to the thyroid function B. Describe the clinical presentation of hypo and hyperthyroidism C. Discuss the use of thyroid replacement in the treatment of

hypothyroidism D. Discuss the use of medication and ablation in the treatment of

hyperthyroidism a. Antithyroid drugs b. Radioactive Iodine

4/4/17: Men’s and Women’s Health

Lehne: Chapters 61, 62, 65 & 66

Porth: Chapters 52, 53, 54

Learning Objectives

A. Discuss the physiology and pathophysiology related to men’s and women’s health

B. Discuss the use of estrogen, progesterone and testosteroneC. Describe the use of oral contraception to include the overall safety and

adverse effects D. Discuss issues related to transgender healthE. Discuss the use of medications in the treatment of erectile dysfunction F. Describe the use and abuse of androgen therapy

4/6/17: Bone and Joint

OA, RA, Osteoporosis and Gout

Lehne: Chapters 71, 72, 73, 74, 75

Porth: Chapters 58 & 59

Learning Objectives

A. Discuss the pathophysiology related to osteoarthritis, RA, Gout and Osteoporosis

B. Discuss immune modulatorsC. Describe the medication management for bone and joint disorders D. Describe the Cox system and the use of cox inhibitors E. Discuss the effects of Calcium and Bone Mineralization

4/11/17: Asthma and COPD

Lehne: Chapter 76 & 77

Porth: Chapter35 & 37

Learning Objectives

A. Discuss the physiology and pathophysiology related to Asthma and COPD B. Describe the patient education related to the prevention and treatment of

respiratory disorders C. Discuss and describe the use of the following medication in the treatment of

respiratory disorders a. Anti-inflammatory medications b. Bronchodilators c. Combination inhalation therapy d. Cough medications

4/13/17: GI Disorders and Treatment

Lehne: Chapters 78 & 79

Porth: Chapters 44 & 45

Learning Objectives

A. Identify risk factors for the development of peptic ulcer disease B. Discuss the diagnosis and treatment of h pylori infection C. Discuss non-drug measures in the treatment of constipation

D. Describe medication management of the treatment of GI disorders a. Laxative b. H2RAs c. PPI

d. antiemetics

4/18/17: Exam 4

4/20/17: Antibiotics 1

Lehne: Chapters 83, 84, 85 & 86

Porth: Chapter 12

Learning Objectives:

A. Discuss the mechanisms of action of infectious disease B. Describe the factors related to avoid or decrease the risk of infection C. Discuss the increased resistance and development of “super bugs” D. Discuss the following antimicrobial therapies

a. Penicillin b. Cephalosporin’s c. Vancomycin d. Tetracycline e. Macrolides

4/25/17: Antibiotics 2

Lehne: Chapters 87, 88, 89, 91, 92

Porth: Chapter 12

Learning Objectives:

A. Identify the pathophysiology and prevalence of urinary tract infections B. Discuss the following antimicrobial therapies

a. Sulfonamides and trimethoprim b. Fluoroquinolones c. Rifampin d. Bacitracin e. Metronidazole f. Antifungal agents

i. Topical (steroid cream and antifungals). Systemic

4/27/17: Antivirals and HIV

Lehne: Chapters 93 and 94

Porth: Chapters 15 & 16

Learning Objectives:

A. Identify the pathophysiology and prevalence of non-HIV viral conditions B. Identify the pathophysiology and prevalence of HIV viral illness C. Describe the medication management of non-HIV and HIV antiviral

therapy D. Discuss the increased resistance to medication management

5/2/17: STIs

Lehne: Chapter 95

Porth: Chapter 55

Learning Objectives:

A. Discuss the characteristics and prevalence of STIs B. Discuss the medication treatment for the following conditions

a. Chlamydia b. Gonorrhea c. Syphilis d. PID e. Bacterial vaginosis f. Genital warts

5/4/17: Cancer Care and Pain Management.

Lehne: Chapter 29

Porth: Chapter 8

Learning Objectives:

A. Define neoplasm and explain how neoplastic growth differs from the norm.

B. Discuss chemotherapeutics and biologics in cancer careC. Discuss the pathophysiology of pain C. Describe effective evaluation of pain in the patient with cancer D. Discuss and describe breakthrough pain E. Discuss the Joint commission pain management standards. F. Describe the use of the following medications in the management of pain

in patients with cancer a. Opioid analgesics b. NSAID c. Adjuvant analgesics

Part 4: Grading and Course Policies

Course Policies

This course adheres to the policies as printed in the Nursing Program Student handbook. Students are responsible for reviewing and adhering to these policies.

Graded Course Activities

Students must achieve an exam grade average of 75% to pass the course. There will be no make-up dates for assignments, exams or quizzes.

Exam I 15%

Exam II 15%

Exam III 15%

Exam IV 15%

Final 20%

Quizzes 10%

Case Study 10%

Final Exam: To be determined by the Registrar’s Office. You must be present on the date of the final as determined by the registrar.

INCLUDE ANY POLCIES NOT ALREADY COVERED IN THE HANDBOOK

Exams and Quizzes: Four exams and the final will be administered on the days according to the outline. No make up dates will be allowed for tests or quizzes unless approval is obtained from the course coordinator in advance. Students must contact the course coordinator a minimum of 1 hour prior to the exam if the student is unable to take the exam as scheduled. Medical Documentation must accompany the request. If no contact is made, the student will not be able to take the exam. A total of 4 quizzes will be given either online. The quizzes will contain 5-10 multiple choice questions (including medication calculations).

Case Study: A total of 4 case study assignments will be required during the semester. Students will be required to apply classroom knowledge to the case study and complete the questions related to each patient situation. The students should cite all sources used in the completed on the assignments (APA format). Late submissions will not be accepted unless prior approval is obtained from the course coordinator.

Classroom Assessments

Classroom assessment techniques are evaluation tools used to assess student learning and help the instructor identify concepts that are unclear and guide teaching.

Minute papers will be utilized. Students will be encouraged at the end of class to complete a Minute paper. Students will answer the following questions: What was the most important information I learned in class today? What information presented is unclear and needs to be discussed again?

Student Responsibilities

In order to achieve the objectives of the course, the students must make the commitment to the following areas of study:

Assigned Readings: The readings play an important role in the understanding of the lecture material. The assigned readings regarding the pathophysiology of the disease state and the principles of pharmacology are necessary components in the understanding of the application of pharmacokinetics. The students are required to come to class prepared and to have completed the required readings as posted in the outline.

Learning Logs: The “learning logs” are an optional tool to assist the students in learning the necessary information related to classes of medications. These logs will contain the pharmacodynamics, pharmacokinetics, nursing assessment and implications, adverse effects, contraindications, and precautions for the medications. The information contained in the logs will be an important part of the

testing process and will also be utilized in the clinical settings during the administration of the medications.

Course Evaluations

Course evaluations are administered at the end of the semester. Evaluations help to improve course design and expectations. Student evaluations are valued and encouraged so it is very important that you complete the evaluation as honestly as possible. The end of the semester evaluations will provide information for the faculty to improve the course.

Final Exam: To be determined by the Registrar’s Office. You must be present on the date of the final as determined by the registrar.

This syllabus is not a contract and may be adjusted and revised during the semester.