Review of Knowledge: Introduction to Pharmacologic Principles

Review of Knowledge- NR 291 Chapters 2-7, 36 & 37; Part 1 Chapter 2: Pharmacologic Principles “Any chemical that affects the physiologic processes of a living organism can broadly be defined as a drug. The study or science of drugs is known as pharmacology. Without understanding basic pharmacologic principles, the nurse cannot fully appreciate the therapeutic benefits and potential toxicity of drugs. Drugs are grouped together based on their similar properties. This is known as a drug classification. Drugs can be classified by their structure (e. g. , beta-adrenergic blockers) or bytheir therapeutic use (e. g. , antibiotics, antihypertensives, antidepressants).

Within the broad classification, each class may have subclasses; for example, penicillins are a subclass within the group of antibiotics and beta-adrenergic blockers are a subclass within the group of antihypertensives. Pharmacotherapeutics (also called therapeutics) focuses on the clinical use of drugs to prevent and treat diseases. The following terms are necessary for nurses to know, understand, and apply to their clients”. (Lilley, p. 21) Definitions: Review definitions at the beginning of the chapter.

Identify the 4 phases of pharmacokinetics, and explain briefly what occurs in each phase. 1. absorption it is the movement of drug from its site of administration into the blood stream for distribution to the tissue. 2. distribution it is the movement of drug from its site of administration into the blood stream for distribution to the tissue. 3. Metabolism: is referred to as biotransformation. It involves the biochemical alteration of a drug into inactive metabolite a more soluble compound. 4. Excretion: is the elimination of drugs from the body.

The half-life of a drug is the time required for one-half (50%) of a given drug to be removed from the body. It is a measure of the rate at which the drug is eliminated from the body. For instance, if the peak level of a particular drug is 100 mg/L & the measured drug level is 50 mg/L in 8 hours, then the estimated half-life of that drug is 8 hours. (Potter& Perry p. 28) Fill in the boxes: Half- life is 3 hours 3 hours 6 hours 9 hours 12 hours Drug X dose 200 mg 100mg 50 mg 25mg 12. 5mg Drug X dose 500 mg 250mg 175mg 87. 5mg 43. 75 Route of Administration:

The parenteral route is the fastest route by which a drug can be absorbed, followed by the enteral and topical routes. Parenteral is a general term meaning any route of administration other than the GI tract. It most commonly refers to injection. Intravenous injection delivers the drug directly into the circulation, where it is distributed with the blood throughout the body.

Drugs given by intramuscular injection and subcutaneous injection are absorbed more slowly than those given intravenously 1 Give reasons why you would use the following routes & which form you would use: (SEE CHART ABOVE FOR FORMULATIONS OF MEDS) Enteral: Reason / Formulation Parenteral: Reason / Formulation Topical: Reason / Formulation Easy administration and more economical. Faster absorption. Delivers medication directly to the affected area.

Oral route Example IV route ointments More likely to be reversed. Why can’t extended release oral medications be crushed? Because it could cause accelerated release of drugs from the dosage form and possible toxicity. (p. 21) What are enteric-coated tablets not recommended for crushing? Because it could cause disruption of the tablet coating designed to protect the stomach lining from the local effects of the drug and or protect the drug from being prematurely disrupted by stomach acid.

How can you help a client who has swallowing difficulties take their oral medication? Check to see if medication can be crushed and mixed with food such as apple sauce or pudding or if there is buccal or sublingual form of medication available and consult with the doctor if it can be substituted. First Pass Effect: “A drug that is absorbed from the intestine must first pass through the liver before it reaches the systemic circulation.

If a large proportion of a drug is chemically changed into inactive metabolites in the liver, then a much smaller amount of drug will pass into the circulation (i. e., will be bioavailable). Such a drug is said to have a high first-pass effect (e. g. , oral nitrates)” (Lilly p. 22). First-Pass Routes: List routes that would be considered first-pass. 1. Oral 2. Hepatic arterial 3. Portal Venous 4. Rectal (can be both first and non-first pass) Non–First-Pass Routes: List routes that would be considered first-pass.

1. Aural 2. Buccal 3. Intravaginal 4. Inhalation 5. intraocular 6. Intravenous Put the following enteral routes in order of Fastest to Slowest absorption: Tablet Buccal/sublingual tablets Enteric coated tablet Liquids, elixirs, & syrups 1. Liquids, elixirs, & syrups 2_ Buccal/sublingual tablets 2 ROUTE FORMS Enteral Tablets, capsules, oral soluble wafers, pills, timed-release capsules, timed-release tablets, elixirs, suspensions, syrups, emulsions, solutions, lozenges or troches, rectal suppositories, sublingual or buccal tablets Parente ral Injectable forms, solutions, suspensions, emulsions, powders for reconstitution.

Topical Aerosols, ointments, creams, pastes, powders, solutions, foams, gels, transdermal patches, inhalers, rectal and vaginal suppositories 3. _ Tablet 4. Enteric coated tablet Put the following parenteral routes in order of Fastest to Slowest absorption:

Intramuscular injection Subcutaneous injection Intravenous 1. IV 2. IM 3. Subcutaneous Matching:” a. Prototype drug 1. _L__ Length of time the concentration of a drug in the blood/tissues is able to elicit a response b. Drug nomenclature 2. _A__ First form of a drug in a class c. Drug classifications 3. _H_ Biochemical alteration of a drug into inactive or active metabolite: occurs after distribution d. Pharmacotherapeutics 4. _C_ Refers to a drug’s name e. Pharmacodynamics 5. _I Elimination of drugs from the body. f. Absorption 6. _K__ Maximum concentration of a drug in the body g. Distribution 7.

__B_ Class or chemical name of a drug h. Metabolism 8. _G__ Transport of drug by the bloodstream to its site of action i. Excretion 9. _J__ Time required for a drug to elicit a therapeutic response after dosing j. Onset of action 10. _D=D_ Clinical use of drugs to prevent and treat diseases K. Peak level 11. _E_ The study of what the drug does to the body. l. Duration 12. _M_ The study of the what the body does to the drug m. Pharmacokinetics 13. _F_ Movement of drug from site of administration into bloodstream for distribution to tissues n. Therapeutic effect 14. __N Desired or intended effect of a particular medication.

The organ that is most responsible for drug metabolism is: ___liver____________________. List other routes of metabolism: _ skeletal muscle, kidneys, lungs, plasma, and intestinal mucosa. The organ that is most responsible for drug elimination is: ________kidneys_______________. List other routes of elimination: ___lungs, fecal matter. _________________________________________. “Metabolism is also referred to as biotransformation.

It involves the biochemical alteration of a drug into an inactive metabolite, a more soluble compound, a more potent active metabolite (as in the conversion of an inactive prodrug to its active form), or a less active metabolite.

Hepatic metabolism involves the activity of a very large class of enzymes known as cytochrome P-450 enzymes (or simply P-450 enzymes), also known as microsomal enzymes” (Lilley p 27). “A receptor: can be defined as a reactive site on the surface or inside of a cell” (Lilley, p 30). What is an agonist versus an antagonist? Agonist is a drug the binds to and stimulate the activity of one or more receptors in the body. Antagonist is a drug the binds to and inhibits the activity of one or more receptors in the body.

Antagonists are also called inhibitors. “Enzymes: the substance that catalyze nearly every biochemical reaction in a cell. Drugs produce effects by interacting with these enzyme systems” (Lilley, p 30). 3 Cytochrome P-450 enzymes: 1. What is the Cytochrome P-450 responsible for? It is a general name for a large class of enzymes that play a significant role in drug metabolism and drug interactions. 2. Where is the CYP-450 found in the body? liver 3. Why does CYP-450 vary from person to person? Age, genetics, disease and the concurrent use of other medication plays a role in varying from person to person. 4.

What factors affect the CYP-450 function? What are the most common non-pharmacologic inducers or inhibitors? Many drugs can inhibit drug metabolizing enzymes and are called enzyme inhibitors. Decrease or delays in drug metabolisms result in accumulation of drug and prolongation of the effect of the drug which can lead to drug toxicity. In contracts some drugs can stimulate drugs metabolism and are called enzyme inducers. This can cause decrease pharmacologic effects. This often occurs with repeated administration of certain drugs that stimulate the formation of new micorsomal enzymes. Matching: Pharmacotherapeutics 1.

Acute Therapy a. _6___Therapy provided to prevent illness. 2. Maintenance Therapy b. _3__ Supplies the body with a substance needed to maintain normal function. 3. Supplemental Therapy c. _12 Alteration of the action of one drug by another. 4. Palliative Therapy d. _1__ Implemented in the acutely ill. 5. Supportive Therapy e. _11_ Physiologic or psychological need for a drug. 6. Prophylactic Therapy f. _2_ Used for the treatment of chronic illnesses such as hypertension. 7. Monitoring g. _10_ A decreasing response to repeated drug doses. 8. Therapeutic Index h. _4_Make the patient as comfortable as possible. 9. Drug Concentration i.

_7__Evaluate the clinical response of the patient to the treatment. 10. Tolerance j. _5_ Maintain integrity of body functions while the patient recovers from illness or trauma 11. Dependence k. _8_ The ratio of a drug’s toxic level to the level that provides therapeutic benefits. 12. Drug Interaction l. _9_

Drug reaching a certain concentration in the blood. 13. Contraindication m. _13_ Any patient condition, especially a disease state, that makes the use of the given medication dangerous for the patient Pharmacologic Safety: “All drugs are potentially toxic and can have cumulative effects. Recognizing these toxic effects and knowing their manifestations are integral components of the monitoring process.

A drug can accumulate when it is absorbed more quickly than it is eliminated or when it is administered before the previous dose has been metabolized or cleared from the body” (Lilley, p 32). 4 “The safety of a particular drug therapy is determined by the therapeutic index. A low therapeutic index means that the difference between a therapeutically active dose and a toxic dose is small. A drug with a low therapeutic index has a greater likelihood than other drugs of causing an adverse reaction, and therefore its use requires closer monitoring.

Examples of such drugs are warfarin and digoxin. In contrast, a drug with a high therapeutic index, such as amoxicillin, is rarely associated with overdose events” (Lilley p. 32). “A drug interaction can either increase or decrease the actions of one or both of the involved drugs. Drug interactions can be either beneficial or harmful. Numerous drug interactions can occur and have been reported. Concurrently administered drugs may interact with each other and alter the pharmacokinetics of one another during any of the four phases of pharmacokinetics: absorption, distribution, metabolism, or excretion.

Most commonly, drug interactions occur when there is competition between two drugs for metabolizing enzymes, such as the cytochrome P-450 enzymes listed in Table 2-5. As a result, the speed of metabolism of one or both drugs may be enhanced or reduced. This change in metabolism of one or both drugs can lead to subtherapeutic or toxic drug actions” (p. 32). Briefly explain the following drug interactions: (p 33) 1. Additive effects: Drug interaction in which the effect of a combination of two or more drugs with similar action is equivalent to the sum of the individual effect of the same drug give alone.

2. Synergistic effects: drug interaction in which the effect of a combination of two or more drugs with simalr action is greater than the sum of the individual effect of the same drugs given alone. 3. Antagonistic effects: drug interaction in which the effect of a combination of two or more drugs is less than the sum of individual effect of the same drugs given alone. 4. Incompatibility: the characteristic that causes two paranetral drugs or solution to undergo a reaction when missed or given together that results in the chemical deterioration of at least one of the drugs.

Explain what an Adverse drug event (ADE) is, and list the 2 most common broad categories of adverse drug effect. Give examples of an adverse drug reaction (ADR). (p. 34) NCLEX Questions: 1. The nurse is aware that excessive drug dosages, impaired metabolism, or inadequate excretion may result in which drug effect? a. Tolerance b. Cumulative effect c. Incompatibility D. Antagonistic effect 2. The nurse recognized that drugs given by which route will be altered by the first-pass effect? (select all that apply) a. oral 5 b. sublingual c. subcutaneous d. intravenous e. rectal 3.

If a drug binds with an enzyme and thereby prevents the enzyme from binding to its normal target cell, it will produce which effect? a. receptor interaction b. enzyme affinity c. enzyme interaction d. nonspecific interaction Chapter 3: Lifespan Considerations “The human body changes throughout our lifetime. These changes have a dramatic effect on the four phases of pharmacokinetics—drug absorption, distribution, metabolism, and excretion. Newborn, pediatric, and elderly patients each have special needs. Drug therapy at the two ends of the spectrum of life is more likely to result in adverse effects and toxicity.

Most experience with drugs and pharmacology has been gained from the adult population”. (Lilley 38) Pregnancy: What are factors during pregnancy that contribute to potential adverse effects for the fetus with pharmacotherapeutics? “The FDA classifies drugs according to their safety for use during pregnancy.

This system of drug classification is based primarily on animal studies and limited human studies. This is due in part to ethical dilemmas surrounding the study of potential adverse effects on fetuses”. (Lilley 38) Match each pregnancy safety category with its corresponding description: _D___Category A __B__ Category B _E___ Category C ___A_ Category D __C__

Category X a. Possible fetal risk in humans is reported: however, consideration of potential benefit versus risk may, in selected cases warrant use of these drugs in pregnant women. b. Studies indicate no risk to animal fetuses: information for humans is not available c. Fetal abnormalities are reported & positive evidence of fetal risk in humans available from animal and/or human studies. d. Studies indicate no risk to the human fetus. e. Adverse effects are reported in animal fetuses; information for humans is not available. Breastfeeding: 1. What are the reasons that childrenare at risk for potential adverse effects from pharmacotherapeutics?

Their skin is thinner and more permeable, stomach lack acid to kill bacteria and lungs have weaker mucus barrier. ORGANS ARE NOT MATURED ENOUGH TO SAFELY METOBOLIZE DRUGS 6 2. For the pediatric patient, what are some specific nursing actions that can be utilized when giving medication (p. 48). If needed mix medication in substances other than their favorite food because the medication may alter the flavor and the child may develop dislike to the food. Do not add drugs to fluid in a cup or bottle because if the entire amount of fluid is not consumed.

Always document special techniques used giving drugs. Avoid using the word candy when giving medication to kids. Keep all med out of reach of kids. Inquire how a child usually takes medication. Geriatrics:“Due to the decline in organ function that occurs with advancing age, elderly patients handle drugs physiologically differently than adult patients. Drug therapy in the elderly is more likely to result in adverse effects & toxicity. (Lilley 42) Elderly patients commonly take multiple medications on a daily basis due to frequent occurrence of chronic diseases and the multiple drug options available for treatment”. (Lilley 42)

SYSTEM & PHYSIOLOGIC CHANGE (Lilley, page 43) Cardiovascular v Cardiac output = v absorption and distribution v Blood flow = v absorption and distribution Gastrointestinal ^ pH (alkaline gastric secretions) = altered absorption v Peristalsis = delayed gastric emptying Hepatic v Enzyme production = v metabolism v Blood flow = v metabolism Renal v Blood flow = v excretion v Function = v excretion v Glomerular filtration rate = v excretion Reduced visual acuity- may not be able to read; reduced manual dexterity for handling medication or self-injections, such as insulin; polypharmacy; pill splitting for financial reasons;

Lack of patient education or not understanding their drug regimen, multiple prescribers; use of OTC & complementary/alternative medicines; noncompliance due to finances or side effects. 2. What are other reasons the elderly have difficulty with medication management and how can the nurse decrease risk?

Their motor, cognitive function decreases with age thus they have difficult time remembering the appropriate dose and or time to take their medication. The nurse can decrease this confusion by providing written and oral instruction concerning the drug name, action, purpose, dosage, time of administration, route, adverse effects, safety of admistration, sotrage, interactions and cautions about or contraindications to its use. 3. Monitoring labs: What lab tests are generally monitored for safety in administering medication? Collecting 24 hours urine is the most accurate way to determine creatinine levels. This will provide kidney functions.

Liver function can be assessed by testing blood for liver enzyme aspartate aminotransferase (AST), and alanine aminotransferase (ALT). High risk meds in Elderly: “Certain classes of drugs are more likely to cause problems in elderly patients because of many of the physiologic alterations and pharmacokinetic changes already discussed. Table 3-4 lists some of the more common medications that are problematic. Some drugs to be avoided in the elderly have been identified by various professional organizations such as the American Nurses Association as well as by various other authoritative sources.

Since the 1990s, a very effective tool, the Beers criteria, has been used to identify drugs that may be inappropriately prescribed, ineffective, or cause adverse drug reactions in elderly patients”. (Lilley 44) 7 Chapter 4: Cultural, Legal, and Ethical Considerations Cultural Considerations: “Drug polymorphism refers to the effect of a patient’s age, gender, size, body composition, genetic, and other characteristics on the pharmacokinetics of specific drugs.

Factors contributing to drug polymorphism may be categorized into environmental factors (e. g. , diet and nutritional status), cultural factors, and genetic (inherited) factors, such as enzymatic alterations/deficiencies. G6PD”. (Lilley 52) 1. Define Ethnopharmacology: The study of the effect of ethnicity on drug responses, specifically drug absorption, metabolism, distribution, and excretion. 2.

Therefore, before any medication is administered, complete a thorough cultural assessment. This assessment includes questions regarding the following: (p. 53) Culture: “It is important to be knowledgeable about drugs that may elicit varied responses in culturally diverse patients or those from different racial/ethnic groups. Varied responses may include differences in therapeutic dosages and adverse effects, so that some patients may have therapeutic responses at lower dosages than are typically recommended”. (Lilley 53-54)

Remember to be respectful and culturally sensitive in all manner of care provided, and ask for client preferences. Implement these whenever possible. Use interpreters as needed. Respect family hierarchy and differences in communication pattern & even with touch & personal space. Discuss spiritual preferences and beliefs, including CAM (alternative medical practices).

There are cultural assessment tools & web links that can assist with cultural assessment. Legal Considerations: “Federal and state legislation, standards of care, and nurse practice acts provide the legal framework for safe nursing practice, including drug therapy and medication administration. The FDA reviews and approves drugs for safety & efficacy.

HIPPA protects the client’s confidentiality regarding medication administration and prescriptions. The State Nurse Practice Act defines what the nurse may legally do in regards to administering medication. Other standards for safe drug administration have been established by the ANA, hospital/institutional policies, nursing specialty groups, state/federal hospital licensing laws, and even the Joint Commission. Further, as discussed in Chapter 1, the standard “Six Rights” of medication administration are yet another measure for ensuring safety and adherence to laws necessary for protecting the patient”.

(Lilley 58-59) 1. What is a Controlled Substance? What is a nurse’s responsibility regarding management of controlled substances? Controlled substances are drugs that have some potential for abuse or dependence. It is any drugs listed on one of the “schedules” of the controlled substance as. The nurse needs to be mindful of the potential for dependency and avoid over medicating the patient. 2. How does the nurse ensure safety when administering medications? The nurse needs to practice the 6 rights of medication administration 3 times each time she is giving a medication.

This minimizes the potential for errors. 3. What are areas of potential liability for nurses (malpractice)? Page 58. •Failure to assess and evaluate a patient after giving medication. 8 • Failure to ensure safety, lack of inadequate monitoring, •failure to clarify unclear medication order (medication error). Ethical Considerations Review Ethical Principles on page 58. (You don’t need to write these out) 1. List 2 resources for nursing to follow for a code of ethics:(p. 59) 1. ANA code of ethics. 2. International council of nursing (ICN) 2. Why should nursing follow a code of ethics? (p. 59).

it ensures that the nurse is acting on behalf of the patient and with the patient’s best interest at heart. As a professional the nurse has the responsibility to provide safe nursing care to patients regardless of the setting, person, group, community or family involved. 3. Is the use of a placebo considered ethical or unethical? Why? (p. 60) administering a placebo is unethical for the nurse because it contradicts with the principle of veracity which is the duty to tell the truth; related nursing actions including telling the truth with regard to placebos, investigational new drugs, and informed consent.

While reviewing a newsletter about medications, the nurse notices that one drug has a new black box warning from the Food & Drug Administration (FDA). What does this warning entail? (select all that apply) a. The drug is about the be recalled by the FDA b. Serious adverse effects have been reported with the use of this drug c. The drug can still be prescribed, but the warning is present to make sure that the prescriber is aware of the potential risks d. The drug manufacturer has refused to recall the medication, despite documented problems e. The drug cannot be prescribed.

Chapter 5: Medication Errors: Preventing and Responding. “Numerous health institutions have made prevention of medical errors a top priority. The most important change is to recognize that reporting of errors should not be punitive toward the reporter. In fact, all health care professionals are encouraged to report errors. It has been shown that reporting of errors can prevent errors from occurring. A study also brought forth the notion that most errors occur as a breakdown in the medication use system, as opposed to being the fault of the individual. This concept has been taken a step further and has created.

“just culture. ” Just culture recognizes that systems are generally at fault when an error occurs, but that when professionals do not follow policies or have repeated errors, that professional needs remedial education and must be held accountable”. (Lilley 65) “An adverse drug event is a general term that encompasses all types of clinical problems related to medication use. These include medication errors and adverse drug reactions. (Lilley 65)“High-alert” medications have been identified as those that, because of their potentially toxic nature, require special care when prescribing, dispensing, and/or administering.

High-alert medications are not necessarily involved in more errors than other drugs; however, the potential for patient harm is higher”. (Lilley 65) Please study page 69: “How to Prevent Medication Errors”. Then, answer the following questions. 9 1. How should a nurse take a telephone order for a medication? A verbal order for a medication? Be sure to repeat the order to confirm with the prescriber, speak slowly and clearly and spell drug name aloud. 2. How should a nurse respond when she identifies she has made a medication error? Assess the patient first, call the physician and write an incident report.

3. What should the nurse do if she cannot read an order clearly? Contact the physician for clarification. 4. What should the nurse do if she identifies an order for medication that is higher than the usual dose range? Contact the physician to modify the order. 5. Why do we tell the patient every medication we are giving them before they take it? To encourage patients to take active role in their recovery from illness. 6. What is the current recommendation regarding the use of abbreviations? The U. S pharmacopeia and Institute of Safe Medication Practices endorse the avoidance of abbreviations whenever possible.

Most hospitals and nurse care units are adopting this significant change in documentation. 7. Why is it important to document medication administration immediately upon giving to the patient? To ensure accurate documentation because there is a possibility of forgetting if left for later. 8. What is “Medication Reconciliation” and why is this done? It is a process in which medications “reconciled” at all points of entry and exit to from a heath entity. It is designed to ensure that there are no discrepancies between what the patient was taking at home and the hospital they are being taking care of. 1. The nurse is administering medications.

Examples of high-alert medications include: (Select all that apply. ) a Insulins b Antibiotics c Opiates d Anticoagulants e Potassium chloride for injection Chapter 6: Patient Education & Drug Therapy “Patient education falls within the scope of nursing practice, and it is crucial in assisting patients, family, significant others, and caregivers to adapt to illness, prevent illness, maintain health and wellness, and provide self-care. Patient education is a qualifier found in professional and accreditation standards.

Health teaching is not only included in the American Nurses Association document Nursing: Scope and Standards of Practice (2004) but is also one of the grading criteria used by The Joint Commission (2011)” (Lilley 75). Patient education is also included in the scope of practice for registered nurses in the State Nurse Practice Act. “The Joint Commission standards require nurses and the health care team to assess patients’ learning needs, educational level, motivation, abilities, past education”, (many other areas are appropriate for assessment – see page 75-76 in Lilly).

“and provide education about many topics, including medications, nutrition, correct 10 use of medical equipment, pain, and the patient’s plan of care. Educational efforts should be patient-centered by taking into consideration patients’ own education and experience, their desire & ability to actively participate in the educational process, and their psychosocial, spiritual, and cultural values. It is imperative to evaluate understanding by the client of the nurse’s teaching. Lastly, there must be documented evidence of successful patient education in patients’ medical records” (Potter 328).

Documentation should include the concepts taught, who was present in addition to the client (include families whenever possible), and the response of the client & family to the teaching session. Matching: 1. Teaching __C_ a. the mental state that allows the learner to focus on & comprehend a learning activity 2. Learning ___Hb. a person’s perceived ability to successfully complete a task 3. Learning objective _F__ c. interactive process that promotes learning 4. Cognitive learning __A_ d. force that acts on or within a person, causing the person to behave in a particular way 5.

Affective learning ___Ge. integration of mental & muscular activity, ranging from perception to origination 6. Psychomotor learning _E__ f. describes what the learner will be able to do after successful instruction 7. Attentional set __I_ g. receiving, responding, valuing, organizing, and characterizing 8. Motivation __D_ h. acquisition of new knowledge, behaviors, and skills.

9. Self-efficacy __B_ i. knowledge, comprehension, application analysis, synthesis, and evaluation Contributing to the effectiveness of patient education is an understanding of and attention to the three domains of learning: the cognitive, affective, and psychomotor domains. It is recommended that one or a combination of these domains be addressed in any patient educational session.

The result of effective patient education is learning. (Lilley 75). “Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills (Billings and Halstead, 2009). A teacher provides information that prompts the learner to engage in activities that lead to a desired change” (Potter 329).

“Learning is the purposeful acquisition of new knowledge, attitudes, behaviors, and skills (Bastable, 2008). Teaching is most effective when it responds to the learner’s needs (Redman, 2007). The teacher assesses these needs by asking questions and determining the learner’s interests. Interpersonal communication is essential for successful teaching to occur” (see Chapter 24 in Potter: Potter 329) 1. What strategies enhance patient education and reduce barriers to learning (see box 6-1)? Work with available educational resources in nursing and pharmacy to collect or order and distribute materials about drug therapy.

Make sure that written materials are available to all individuals and are prepared on a reading level that is most representative of the geographical area, such as an eighth-grade reading level. Be sure that written and verbal instructions are available in the language most commonly spoken. Have available information for patients on how they can prevent medication errors. The Institute for Safe Medication Practices offers informative pamphlets on the patient’s role in preventing medication errors as well as web-based resources such as alerts for consumers with the proper citation.

Work collaboratively in the health care setting, inpatient and outpatient, to develop a listing of medications that may be considered error prone, such as cardiac drugs, chemotherapeutic drugs, low–molecular-weight heparin, digoxin, 11 metered-dose inhaled drugs, and acetaminophen. Lack of time for patient education is often a concern for nurses, but efforts should be undertaken to make materials available and to review these with patients and those involved in their care. Use all available resources, such as videotapes, verbal instructions, pictures, and other health care providers. 2. Briefly.

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