SOUTHWESTERN MICHIGAN COLLEGE SCHOOL OF NURSING AND HEALTH SERVICES Dowagiac, Michigan COURSE SYLLABUS SPRING SEMESTER 2017

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1 SOUTHWESTERN MICHIGAN COLLEGE SCHOOL OF NURSING AND HEALTH SERVICES Dowagiac, Michigan COURSE SYLLABUS SPRING SEMESTER 2017 COURSE TITLE: Pharmacology II COURSE NO. NURS 228 CREDITS/CONTACTS: Credit Hours: 2 Lecture Hours/week: 2 Laboratory Hours/week: 0 Weekly Contact Hours: 2 Final Exam Information: INSTRUCTOR: TBA Patti Frontczak RN MSN Office: CSB 1617 Phone: (269) pfrontczak@swmich.edu Office hours: as posted PREREQUISITE: NURS , and 181. COURSE DESCRIPTION: This course focuses on the theoretical application of pharmacology that will be employed with an emphasis on drugs used in those adults with complex and emergent health issues including drug actions, therapeutic uses, administration, adverse drug reactions, and the nurse s responsibilities in the administration of these drugs. DEPARTMENT CHAIR: Deb Green, RNC, MSN Office: CSB dgreen03@swmich.edu Phone: COURSE STUDENT] LEARNING OUTCOMES: After completion of the course, the learner will meet the following objectives:1. Analyze principles of drug therapy within major drug groups in relation to drug selection, dosage, route, side effects, nursing interventions, and use in culturally diverse populations in commonly occurring diseases. 2. Evaluate the effectiveness of drug therapies using evidence-based practice in commonly occurring diseases. 3. Analyze pharmacology principles related to medication education, management and safety. 4. Interpret input from the healthcare team when relevant in decision-making for clients receiving medication therapy. 5. Utilize principles of nursing ethics and practice within the legal scope of nursing when administering medications to clients.

2 TEXTBOOK(s): Required: Lehne, R. (2016). Pharmacology for Nursing Care (9th ed.). St. Louis, MO: Elsevier Saunders. Current nursing drug handbook of choice. Ignatavicius, D. D. & Workman, M. L. (2016). Medical-surgical nursing: Patient-centered collaborative care (8th ed.). St. Louis, MO: Elsevier Saunders. Additional Resources: Southwestern Michigan College Fred L. Mathews Library METHOD OF INSTRUCTION: EVALUATION METHOD: This course will use lecture, discussion, case studies, critical thinking skills, audio-visual material, selected readings, computer aided instruction Note: All assignments are mandatory. All assignments must be completed to successfully pass the course. Late assignments will receive a 10% deduction for each day they are late. Assignments later than 3 days will receive a zero. See Student Handbook for specific information regarding tests, etc. Examinations (4) 70% Kaplan Test (1) 5% Final Exam (1) 25% Total 100% GRADING SCALE: The following grading scale will be in effect for this course in accordance with the School of Nursing Student Handbook guidelines: A % A % B % B % B % C % C % C % D % D % D % Below 66.0% = F PROGRESSION POLICY: Progression in the Nursing Program (SONAHS Nursing Handbook policy 4.1) without interruption is determined academically by achieving a minimal grade of "C" (78.0%) in the theory portion and a Passing grade in the lab portion of the course. All assignments, graded and ungraded, are mandatory and must meet specified criteria. All assignments must be completed and a PASS in lab to successfully pass the course. See Student Handbook for specific information regarding tests, etc.

3 ATTENDANCE POLICY: Attendance is mandatory. Excessive absenteeism may result in course failure. It is the responsibility of the student to contact the instructor as soon as possible when an absence occurs. See the School of Nursing Student Handbook for specific guidelines. TESTING POLICY: Students are expected to take all examinations in the classroom as they are scheduled. Make-up policy is at the discretion of the instructor and described in the School of Nursing Student Handbook. Special learning needs, including testing modifications, need to be documented and on file with Academic Services. INTEGRATED TESTING: The completion of an Integrated test is required for the completion of this course, and will account for 5% of the final class grade. The test is to be taken in the Testing Center, on the Dowagiac campus, using the Kaplan computer program. The test is an evaluation of your cumulative knowledge of Pharmacology Nursing. Once completed, remediation on test questions can be accessed through your Kaplan account from home. In order to receive credit for taking the Kaplan examination, the student must remediate a minimum of 1.5 minutes per question missed. Your instructor will make arrangements for the Integrated test and will notify you of the scheduled date(s)/time(s). You should plan on the integrated test taking 2 hours. Be sure to check the Testing Center hours. Take your SMC identification badge with you when you take the test. OTHER COURSE EXPECTATIONS: The student is expected to have read the material to be covered in class PRIOR to the class. Examinations will cover material from lecture, reading assignments, audio-visual materials and handouts. Therefore, the student is expected to study these sources of material thoroughly. CIVILITY STATEMENT: Students are expected to assist in maintaining a classroom environment that is conducive to learning. In order to assure that all students have the opportunity to gain from time spent in class; students are prohibited from engaging in any form of distraction. Inappropriate behavior in the classroom shall result, minimally, in a request to leave class. ACCEPTABLE USE OF PERSONAL COMMUNICATION TECHNOLOGY: All phones, ipods, ipads, Black Berries, Palm Pilots, pagers, laptops and other technological devices including devices capable of taking photographs must be turned off or placed on vibrate mode and may not brought out during class. If you are expecting or receiving an urgent call, you are required to leave the classroom before answering. Violation of this policy will result in your removal from the classroom for the class period. Multiple violations of this policy will be referred to the appropriate dean for disciplinary action. Further details or ramifications of violations may be found elsewhere in this syllabus. The instructor has the right to modify this policy to meet the needs of this course.

4 HONESTY POLICY Cheating or plagiarizing will absolutely not be tolerated at Southwestern Michigan College. Any student found cheating or plagiarizing material in any manner may be assigned a failing semester/session grade in this course. A second such incident while at SMC could result in suspension or expulsion from the institution. A student found in violation of this section of the syllabus will not be allowed to drop this course. Additional detail regarding cheating and/or plagiarism may be found elsewhere in this syllabus. For more detailed information consult the SMC Student Code of Conduct. NOTICE: Information in this syllabus, was to the best knowledge of the instructor, considered correct and complete when distributed for use at the beginning of the semester. The instructor, however, reserves the rights, acting within the policies and procedures of Southwestern Michigan College, to make changes in course content or instructional techniques without notice or obligation Representative student work will be used as a part of SMC s on- going curriculum assessment program..

5 NURSING 228 PHARMACOLOGY II UNIT OUTCOMES At the completion of the course, the student will: Unit 1: 1. Summarize the main states of the cell cycle (G0, G1, S, G2, M) and briefly describe what occurs in each stage. Also, explain how, in general, solid tumors differ from disseminated cancers in terms of their responsiveness to cancer chemotherapy. (CCC) 2. Summarize the basic principles and concepts that apply to how and why multidrug therapy is preferred for treating cancers. (CCC& EB) 3. Identify and describe the main classes of anticancer drugs in terms of their main mechanisms of action. (CCC) 4. Differentiate between cell-cycle phase specific and cell-cycle phase nonspecific anticancer drugs in terms of their mechanisms of action on cell growth and replication. (CCC) 5. Identify the side effects and adverse responses that are generally common to all anticancer drugs and explain why they occur.(ccc&eb) 6. Summarize the likely benefits of glucocorticoids, as useful adjuncts in management of cancers with other drugs or nondrug modalities. (CCC) 7. State the precautions and related risk factors that should go into a decision about whether to administer tamoxifen either to prevent or treat estrogen-sensitive breast cancers in women.(ccc&eb) 8. Explain the effects of leuprolide on androgen-dependent advanced prostatic cancer.(ccc) 9. Summarize the roles of erythropoietin, iron, vitamin B12, and folic acid in erythropoiesis (red blood cell production). (CCC) 10. State the main factor that determines daily iron requirements, and explain how the body adjusts iron uptake from dietary sources to ensure adequate levels yet prevent iron overload.(ccc) 11. List several foods or food groups that are naturally rich sources of iron.(ccc) 12. Describe the physiologically essential interrelationship between vitamin B12 and folic acid and the major physiologic roles of active folate. Also, name the main physiologic roles of each and the signs and symptoms of deficiency.(ccc) 13. Describe the consequences of vitamin B12 deficiency for neural function, erythrocyte count and appearance, coagulation, and immune system function. Also, summarize the signs and symptoms likely to be seen in a patient with vitamin B12 deficiency, and discuss therapy for mild, moderate, and severe cases of the disorder. (CCC & EB) 14. Summarize the likely consequences for the fetus of folate deficiency in the pregnant mother, as well as general guidelines on folate supplementation in women, especially during pregnancy. (CCC&EB) 15. Discuss the need for epoetin alfa.(ccc) 16. Discuss the use of leukopoietic growth factors to reduce the risk of infection in patients with neutropenia.(ccc) 17. Describe the adverse effects of filgrastim.(ccc) 18. Discuss the therapeutic use and adverse effects of oprelvekin (interleukin-11) (Neumega).(CCC)

6 Unit 2 : 1. Describe the similarities or differences between the COX-1 and COX-2 pathways and state which (pathologic) physiologic process is mainly responsible for analgesia; anti-inflammatory activity; antipyresis; bleeding tendencies; and gastric mucosal damage. (CCC&EB) 2. Discuss the beneficial and adverse actions of NSAIDs and the basic mechanisms by which they occur.(ccc) 3. Identify situations in which aspirin should not be used, even for relief of mild or episodic headache or fever. Also, state which of the alternative over-the-counter (OTC) analgesic/antipyretic drugs would be a more acceptable alternative to aspirin and why. 4. Compare and contrast the signs and symptoms of acute poisoning with aspirin and with acetaminophen; the time course of the signs and symptoms and underlying causes; and the management of these conditions.(ccc) 5. State and describe the main therapeutic uses of glucocorticoids for nonendocrine disorders.(ccc) 6. Describe issues related to the timing of glucocorticoid administration, particularly with regard to maximizing therapeutic responses and minimizing adverse responses during corticosteroid administration and discontinuation.(ccc&s) 7. Describe the potential risks to and relative glucocorticoid requirements of patients who are under physiologic stress and during discontinuation of systemic glucocorticoids.(ccc&s) 8. Discuss the etiology, pathophysiology, clinical presentation, and long-term complications of RA.(CCC) 9. Discuss the three classes of drugs used in the treatment of rheumatoid arthritis and identify the importance of early use of DMARDs.(CCC) 10. Compare and contrast the main adverse effects of the nonbiologic and biologic DMARDs used in the treatment of RA.(CCC&EB) 11. Discuss the role of NSAIDs and glucocorticoids in the treatment of RA based on current management guidelines.(ccc &T) Unit 3: 1. Describe the characteristic signs and symptoms of heart failure. (CCC&S&EB) 2. Summarize the characteristics or measures that are used to assign a patient with heart failure to the four American College of Cardiology/American Heart Association stages and those that make up the New York Heart Association classes. (CCC&EB) 3. Discuss the goals for the treatment of chronic and acute heart failure.(ccc) 4. Recognize and describe the roles, benefits, and limitations of the following drugs (or drug groups) in the long-term management of heart failure (CCC&EB&S) 1) Drugs that inhibit the RAAS 2) Diuretics 3) Vasodilators (other than angiotensin-converting enzyme [ACE] inhibitors and angiotensin II receptor blockers [ARBs]) 4) Beta-adrenergic blockers 5) Cardiac glycosides 6) Inotropic agents (other than cardiac glycosides) 5. Describe what the terms afterload and afterload reduction mean and explain why afterload reduction is beneficial in the management of heart failure.(ccc) 6. Explain why digoxin is a mixed blessing for the management of chronic heart failure, particularly with respect to problems related to the frequency and severity of toxicity. (CCC&EB)

7 7. Describe how the use of diuretics (e.g., furosemide) as an adjunct to digoxin can be considered beneficial on one hand but dangerous on the other.(ccc&eb) 8. State the cardiac and other (noncardiac/extracardiac) signs and symptoms consistent with digoxin toxicity. (CCC&EB) 9. State the normal electrophysiologic roles of the following specialized portions of the heart: sinoatrial node, atrial myocardium, atrioventricular node, and His-Purkinje system. (CCC) 10. State what each of the following parts of a normal electrocardiogram (ECG) represent in terms of contractile or electrophysiologic activities of the heart: P wave, QRS complex, T wave, PR interval, and ST segment. (CCC) 11. Explain how the type of dysrhythmia affects the selection of drugs used to manage it.(ccc) 12. Summarize current trends and opinions about pharmacologic management of dysrhythmias (as opposed to nondrug interventions, such as catheter ablation or no treatment at all), based on the anatomic origin, severity, and acuity of the rhythm disorder. (CCC&EB&T) 13. Describe the side effects or adverse responses that can be caused by virtually any antidysrhythmic drug and those that are unique to quinidine, amiodarone, & procainamide. (CCC&EB) 14. Name the drug class generally regarded as the first choice for hypercholesterolemia and summarize its fundamental mechanism of action. (CCC&EB) 15. Compare and contrast the lipid-lowering mechanisms of action, clinical indications, and side effects of (1) statins; (2) fibric acid derivatives; (3) niacin; and (4) bile acid sequestrants. (CCC) 16. Develop a teaching plan that would maximize the therapeutic benefits of dyslipidemia therapy for patients taking one or several lipid-lowering drugs and describe adjustments needed when interactants that are clinically important are prescribed. (CCC&EB&S& T) Unit 4: 1. Summarize the main factors that affect myocardial oxygen demand and oxygen supply and their relationships to angina pectoris.(ccc) 2. Describe, compare, and contrast chronic stable angina, variant angina, and unstable angina in terms of the etiology, clinical presentation, and drug therapy for each.(ccc&eb) 3. Describe the mechanisms of action and therapeutic and adverse effects of organic nitrates, calcium channel blockers, and beta blockers in angina therapy.(ccc&eb) 4. Summarize the pros and cons of using sustained-release oral capsules versus transdermal delivery systems of nitroglycerin for angina pectoris.(ccc&eb) 5. Discuss the use of ranolazine, including adverse effects and drug interactions.(ccc) 6. Compare and contrast unfractionated heparins and LMW heparins in terms of mechanisms of action, pharmacokinetics, dosing (schedules), suitability for outpatient therapy, and monitoring of responses.(ccc& S) 7. Summarize the key points that describe the differences between warfarin and heparin: mechanisms, onset, sites of action, and monitoring. (CCC&S) 8. Explain the purpose of the glycoprotein IIb/IIIa receptor and the clinical significance of blocking it. (CCC) 9. State how thrombolytic drugs differ in terms of mechanisms of action, pharmacokinetics, and relative safety, including in the discussion the need for repeat administration. (CCC&EB) 10. State the main adverse response by anticoagulants, antiplatelet drugs, and thrombolytic drugs.(ccc) 11. Identify the main patient-related conditions and other applicable factors that contraindicate safe use of PDE5 inhibitors. Also, in doing so, describe the main systemic hemodynamic effects of the drug. (CCC)

8 12. State the likely consequences of administering PDE5 inhibitors with drugs that inhibit the liver s cytochrome P450 system (specifically the enzyme CYP3A4). Also, identify the main groups of these drugs.(ccc&s&eb) 13. Discuss guidelines or recommendations for the use of PDE5 inhibitors by a patient who is taking nitroglycerin or any other nitrate vasodilator/antianginal drug; also, describe the likely outcome if these recommendations are ignored. (CCC&T&EB) 14. Discuss the underlying pathophysiology of BPH and relate it to the mechanism of action of 5- alpha-reductase inhibitors and alpha blockers.(ccc) 15. Define the terms dietary supplement and complementary and alternative medicine.(ccc) 16. Recognize that herbals usually do contain active ingredients, some of which can cause desired effects and some that can cause serious adverse effects or interact beneficially or not with prescribed FDA-approved drugs.(ccc&s) 17. Explain how calling a product a dietary supplement, rather than a drug, may allow the manufacturers of these products to circumvent standards of purity, efficacy, and safety that apply to FDA-approved drugs and describe how that ability to skirt more stringent regulations and requirements can be harmful.(ccc) 18. Discuss indications and side effects that applies to the several selected herbs.(ccc) 19. Identify the main biotoxins, and the common properties that make this diverse group of agents suitable for their malevolent uses.(ccc) 20. Discuss the controversies surrounding the prophylactic use of antibiotics for anthrax by the general population, which is not likely to be exposed to the causative bacterium.(ccc&eb) 21. Describe the signs, symptoms, and typical times to onset (after exposure) of cutaneous and inhalational anthrax. Summarize the general approaches to treating the infection and preventing the spread to others.(ccc) 22. Discuss chemical weapons and describe the signs and symptoms of exposure and of treatment after exposure to these weapons.(ccc) 23. Discuss treatments used after radiation exposure, including how soon treatment must be implemented and the factors that determine the choice of treatment.(ccc)

9 PHARMACOLOGY II COURSE OUTLINE Specific Drug Groups NOTE: Lectures on each specific drug group will utilize the following format. 1. Basic action of drugs on the body 2. Prototype of each group 3. Example drugs for specific disease processes 4. Generic and trade names of indicated drugs 5. Usual dosage range for common drugs 6. Types of adverse effects 7. Special nursing measures for each specific group A. IV Therapy/TPN. B. Cancer Chemotherapy C. Anti-Anemics D. Anti-Inflammatory Drugs E. Drugs for Heart Failure F. Antidysrhythmics G. Antihyperlipidemics H. Anti-Anginals I. Anti-Coagulants and Thrombolytics J. Alternatives ED drugs Herbs Biologic Weapons

10 NURSING 228 PHARMACOLOGY II LEARNING STRATEGIES THEORY UNIT LEARNING STRATEGIES LEHNE TEXT Unit 1 Drug Therapy Review of Lecture Approach IV Therapy/ TPN Handouts, IGGY pg Cancer Chemotherapy Chapters Antianemics Chapter 55,56 Unit 2 Cox Inhibitors Chapter 71 Steroids in non-endocrine Disorders Chapter 72 Drugs for RA Chapter 73 Unit 3 Drugs for Heart Failure Chapter 48 Antidysrhythmics Chapter 49 Antihyperlipidemics Chapter 50 Unit 4 Antianginals Chapter 51 Anticoagulants Chapter 52 and Thrombolytics Alternatives Chapter 66, 108 & 110 Final Examination-as scheduled