BASIC

PHARMACOLOGY
Prepared By: Cristina Benito
LEARNING OUTCOMES:

1. Define the word Pharmacology.

2. Outline the steps involved in developing ad approving a new drug in the United

States.

3. Differentiate between generic and brand-name drugs and over -the-counter and

prescription drugs.

4. Describe how body cells respond to the presence of drugs that are capable of

altering their function.

Learning Outcomes:
5. Outline the process of dynamic equilibrium that determines the actual
concentratiion of a drug in the body.
6. Explain the meaning of half-life oa a drug and calculate the half-life of
given drugs.
7. Define the term adverse drug reaction and explain the clinical
significance of this reaction
8. List the responsibilities of the nurse in drug therapy.
9. Describe the key points that must be incorporated into the
assessment of a patient receiving drug therapy.
10. Describe the role of the nurse and the patient in preventing
medication errors.
Introduction to Pharmacology
PHARMACOLOGY: The study of the biological effects of chemicals.
> branch of medicine concerned with
the uses, effects, and modes of action of drugs.
DRUGS: Chemicals that are introduced into the body to cause some
sort of change.
PHARMACOTHERAPEUTICS: Branch of pharmacology that uses drugs
to treat, prevent, and diagnose disease
Nurses deal with clinical pharmacology or Pharmacotherapeutics
Two key concern of Clinical Pharmacology:
1. Drugs effects on the body
2. Body’s response to the drug.
NURSING RESPONSIBILITIES ON DRUG THERAPY:
Administering drugs
Assessing drug effects
Intervening to make the drug regimen more tolerable
Providing patient teaching about drugs and the drug regimen
Monitoring the overall patient care plan to prevent medication errors
SOURCES OF DRUGS
Natural Sources:
1. Plants: Almost all parts of the plants are used.
Synthetic version of the active chemical found in a plant
a. Leaves:
>Digitalis Purpurea Digitoxin and Digoxin
>Eucalyptus Cough Syrup
> Atropa Belladonna Atropine
FOXGLOVE (Digitalis Purpurea)
EUCALYPTUS
ATROPA BELLADONA
b. Flowers:
> Poppy Papaver Somniferum Morphine
c. Fruits:
> Senna Pod Senokot
d. Seeds:
> Castor Oil Seeds Castor Oil
e. Roots:
> Rauwolfia Serpentina Reserpine
f. Bark:
> Cinchona Bark Quinidine
2. Animal Sources
>Used to replace human chemicals that are not produced because of
disease or genetic problems.
>Various organs and tissue of animals are used as source of drug.
Insulin PANCREAS
Cod Liver Oil Cod Liver
hCG (human chorionic Urine of pregnant mother
gonadotropin)
NATURAL SOURCES
3. Mineral and Earth Sources:
Metallic and non metallic sources
Natural Sources
Natural Sources
Sources of Drugs
4. Synthetic Sources: Some drugs which are earlier obtained from
plants, animals, or the environment are now synthesized in the
laboratory.
>Genetic engineering alter bacteria to produce chemicals that are
therapeutic and effective

Advantages:
Quality can be controlled
Process is easier and cheaper
More potent and safer
Large scale production
SYNTHETIC DRUGS
AMOXICILLIN
MARIJUANA (cannabis)
Active ingredient delta-9-tetra hydrocannabinol
Drug Names

BRAND NAME/TRADE NAME: a medicine that is discovered,

developed and marketed by a pharmaceutical company.
GENERIC NAME: the nonproprietary name assigned by the United
States Adopted Names (USAN) Council.
CHEMICAL NAME: names that reflect the chemical structure of a drug.
Drug Nomenclature
ORPHAN DRUGS: drugs that have been discovered but are not
financially viable and therefore have not been “adopted” by any drug
company
 The Orphan Drug Act of 1983

OVER-THE-COUNTER DRUGS: products that are available without

prescription for self treatment of variety of complaints
Q: What should the nurse tell the patient about the problem of OTC
drugs?
Drug Evaluation:
U.S. Food and Drug Administration (FDA): an agency of the U.S.
Department of Health and Human services that regulates the
development and sale of drugs.

STAGES OF DEVELOPMENT:
a.) Preclinical Trials:
Subject: Animals: Safety, toxicity, pharmacokinetics, and metabolism of
the new chemical.
FDA: reviews extensive animal studies and data on the safety and
effectiveness of the proposed drugs.
 Chemicals that may have therapeutic value are tested on laboratory
animals for two main purposes:
1. determine whether they have the presumed effects in living tissue
2. evaluate any adverse effects
FDA approves an application for an Investigational New Drug (IND)
Preclinical Trials
At the end of the preclinical trials, some chemicals are discarded for the
following reasons:
a. the chemical lacks the therapeutic activity when used with living
animals.
b. the chemical is too toxic to living animals to be worth the risk of
developing into a drug.
c. the chemical is highly teratogenic
d. the safety margins are so small that the chemical would not be useful
in the clinical setting.
Stages of Development
b.) Phase I Studies:
Uses human volunteers to test the drugs (20-80)
These studies are more tightly controlled than preclinical trials
Performed by specially trained clinical investigators
Some chemicals are therapeutic in animals but have no effects in
humans
Investigators scrutinize the drugs being tested for effects in humans
> Toxicity and adverse effects
Phase I Studies
At the end of phase I studies, many chemicals are dropped from the
process for the following reasons:

They lack therapeutic effect in humans

They cause unacceptable adverse effects
They are highly teratogenic
They are too toxic
Stages of Development
c.) Phase II Studies:
Allows clinical investigators to try out the drug in patients who have the
disease that the drug is designed to treat.
Subjects are informed about the possible benefit and risk of the drug.
>they are monitored very closely and evaluate the drugs effects
Performed at various sites across the country
Monitored by the representatives of the pharmaceutical company
studying the drug
Phase II Studies
At the end of phase II studies, a drug may be removed from further
investigation for the following reasons:
It is less effective than anticipated
Its is too toxic when used with patients
It produces unacceptable adverse effects
It has a low benefit-to- risk ratio
It is no more effective than other drugs already on the market, making
the cost of continued research and production less attractive to the drug
company
Stages of Development
d.) Phase III Studies:
Involves use of the drug in a vast clinical market
Prescribers observe patients closely, monitoring them for any adverse
effects.
Prescribers evaluate the reported effects to determine whether they are
caused by the disease or by the drug
> Data is collected by the drug company and the FDA
A New Drug Application (NDA): submitted to FDA when sufficient data
has been collected to justify a request approval of the drug.
FDA evaluates and approves the drug
An approved drug is given:
1. brand name
2. generic name
3. chemical name
Stages of Development
e.) PhaseIV Studies: the phase of continual evaluation
The prescribers are obligated to report to the FDA any untoward or
unexpected adverse effects associated with the drugs they are using
The FDA continually evaluates this information
PHASES OF DRUG DEVELOPMENT:
Legal Regulation Of Drugs:
Safety During Pregnancy
Controlled Substances
EXAMPLE OF DRUG MONOGRAPH
DRUGS AND THE BODY
DRUGS AND THE BODY
PHARMACOKINETICS: The study of absorption, distribution,
metabolism, and excretion of drugs.

 In clinical practice, pharmacokinetic considerations include the Onset

of drug action, drug half-life, timing of the peak effect, duration of drug
effects, metabolism or biotransformation of the drug and the site of
excretion.
 How the human body act on the drugs
CRITICAL CONCENTRATION:
The amount of a drug that is needed to cause a therapeutic effect
LOADING DOSE:
A higher dose than that usually used for treatment
DYNAMIC EQUILIBRIUM:
 The actual concentration that a drug reaches in the body
 It is affected by:
Absorption, Distribution, Biotransformation and Excretion
4 Steps

I. Absorption: the transfer of a drug from its site of administration to the blood
stream.
>Mechanisms of
absorption
* Passive diffusion: A drug moves from an area of higher concentration to one of
lower concentration.
> requires no cellular energy
* Active Transport: A drug moves from an area of lower concentration to one of
higher concentration.
> requires cellular energy
> is used to absorbed electrolytes like sodium and potassium and some drugs
like Levodopa
FACTORS AFFECTING RATE OF DRUG
ABSORPTION
1. Route of Administration
a. Oral
b. Intravenous
2. Dosage/ Concentration: Increase in the concentration of the chemical
there is also an increase in the rate of diffusion
3. Lipid-Solubility: A drug needs to be lipid soluble to penetrate
membrane.
Factors Affecting Absorption
4 Steps in Pharmacokinetics
II. Distribution: Process that allows drug delivery to tissues and fluid of the
body
Factors affecting drug distribution:
a. Blood Flow
Drug is distributed rapidly to organs with a large blood supply.
It is distributed more gradually to other internal organs, skin, fat and
muscle.
Example: A diabetic client with lower leg infection and patient with
peripheral arterial disease (Raynaud Syndrome)
b. Drug Solubility
> a lipid soluble drug can cross the cell membrane more quickly than water
soluble drugs can.
FACTORS AFFECTING DRUG DISTRIBUTION
c. Protein-Binding Capability: refers to the degree to which medications
attach to proteins within the blood.
 Some drugs are tightly bound and are released very slowly thus they
have a very long duration of action because they are not free to be
broken down or excreted
 Drugs that are loosely bound tend to act quickly and be excreted
quickly.
FACTORS AFFECTING DRUG DISTRIBUTION
d. Blood-Brain Barrier: A protective system of cellular activity that keeps
many things away from the CNS.
• Drugs that are highly lipid soluble are more likely to pass through the
blood-brain barrier and reach the CNS
• Drugs that are not lipid soluble are not able to pass the blood-brain
barrier.
FACTORS AFFECTING DRUG DISTRIBUTION
e. Placenta and Breast Milk:
> Many drugs readily pass through the placenta and affect the
developing fetes in pregnant mother
4 Steps in Pharmacokinetics
III. Metabolism/Biotransformation:
It alters a drug to a more active or less active form
Helps convert the drug to a more water soluble form, facilitating
excretion
Primary Site for drug metabolism: Liver
First pass effect
Factors Affecting Metabolism:
 Drugs that induced enzyme activity
 Drugs that inhibit enzyme activity
 Disease, such as cirrhosis and heart failure
4 Steps in Pharmacology
IV. Excretion: Elimination of drugs from the body
Routes Of Excretion:
Kidneys via urine
Liver via bile and into feces
Lungs via exhaled air
Saliva, sweat, and tears
Processes by which a drug is handled by the
Body
ONSET, PEAK, AND DURATION
Onset of Action: refers to the time period from a drug’s
administration to the beginning of its therapeutic
effect.
Peak Level: occurs when the body absorbs more
drug, the level rises in the blood, and more drug
reaches the site of action.
Duration of Action: the length of time a drug produces
therapeutic effects.
HALF- LIFE
The time needed for the total amount of a drug in the body to decrease
by 50%

Half-life is affected by absorption, distribution, metabolism, and

excretion
HALF-LIFE
CALCULATING HALF-LIFE
Factors Influencing Drugs Effect
Weight
Age
Gender
Physiological Factors
Pathological Factors
Genetic Factors
Immunological Factors
Psychological Factors
Environmental Factors
Drug Tolerance
Cumulative Effect
Drug-to-Drug Interactions
 Can occur any time two or more drugs are taken
together.
 Can occur at:
Site of absorption
During distribution
During biotransformation
During excretion
At the site of action
Drug-Food Interactions

• Certain foods interact with drugs

• In most cases, drugs are best taken on an

empty stomach
Drug-Laboratory Test Interactions

• Drugs may alter the results of lab testing.

• Laboratory test may be used to monitor the

effects of other medications.
Drug Action

• Replace or act as a substitute for missing

chemicals
• To increase or stimulate certain cellular
activities
• To depress or slow cellular activities
• To interfere with the functioning of foreign
cells
PHARMACODYNAMICS
Pharmacodynamics: The study of the mechanisms
by which a drug produces biochemical and physiologic changes in the
body
How a DRUG acts:
Changes cell environment physically or chemically
Acts as an agonist, binding with and stimulating receptors, which
creates a response
Acts as an antagonist, binding with but not stimulating receptors, which
prevents a response
Receptor Sites
Receptor sites react to certain chemicals to cause
an effect within the cell.
Agonists
Noncompetitive antagonists-
Competitive antagonists
Drug- enzyme interactions
Selective toxicity
Lock and Key
TOXIC EFFECTS OF DRUGS
Adverse Drug Reaction
• Undesired effects that may be unpleasant or even
dangerous
• Reasons Adverse Drug Reactions Occur
1. The drug may have other effects on the body besides
the therapeutic effect.
2. The patient is sensitive to the drug being given.
3. The drug’s action on the body causes other responses
that are undesired or unpleasant.
4. The patient is taking too much or too little of the drug.
Types of Adverse Reactions
Primary Actions
Overdose; extension of the desired effect
Secondary Actions
Undesired effects produced in addition to the pharmacologic effect
Hypersensitivity Reactions
Excessive response to primary or secondary effect of drug
Types of Drug Alergies
1. Anaphylactic Reaction
2. Cytotoxic Reaction
3. Serum Sickness Reaction
4. Delayed Allergic Reaction
Types of Drug Allergies
Drug-Induced Tissue and Organ Damage
Dermatological Reactions
 Rash/Hives
Assessment
Abnormalities in the skin, red area, blisters
Interventions
May need to discontinue the medication in severe cases
 Stomatitis
Assessment
Inflammation of the mucous membranes
Interventions
Frequent mouth care
Drug-Induced Tissue and Organ Damage
• Superinfections — Destruction of the body’s normal flora
Assessment
Fever, diarrhea, vaginal discharge
Interventions
Supportive care (mouth and skin care), administer antifungal
medications as needed, may also need to stop drug responsible for the
superinfection
• Blood Dyscrasia — Bone marrow suppression
Assessment
Fever, chills, weakness
Interventions
Monitor blood counts, protective isolation
Toxicity
Affecting the body in a very noxious or toxic way
Liver- Assessment
Fever, nausea, jaundice, change in color of urine or stool,
elevated liver enzymes
Interventions
Discontinue medication
Kidney- Assessment
Change in urinary pattern, elevated BUN and creatinine
Intervention
Notify physician, may need to stop medication or decrease the
dosage
Poisoning
1. Poisoning occurs when an overdose of a drug
damages multiple body systems.
2. Damage to multiple systems can lead to a fatal
reaction.
3. Treatment varies accordingly with drug
Altered Glucose Metabolism
Hypoglycemia
Assessment Finding: Low serum blood glucose level
Intervention: Restore glucose to the body
Hyperglycemia
Assessment Finding: High serum glucose level
Intervention: Administer medications to decrease glucose
level
Electrolyte Imbalance
Hypokalemia
Assessment Finding: Decrease in serum potassium levels
Interventions: Replace serum potassium (IV or oral supplement) and
monitor serum levels of potassium
Hyperkalemia
Assessment Finding: Increase in serum potassium level
Interventions: Decrease the serum potassium concentration (Sodium
Polystyrene Sulfonate), monitor serum levels of potassium, and
monitor cardiac rhythm
Sensory Effects
Ocular Toxicity
Assessment Findings: Visual changes
Interventions: Monitor for any visual changes when giving any
medication that is known to cause ocular damage; discontinue
medication as appropriate.
Auditory Damage
Assessment Findings: Dizziness, ringing in the ears (tinnitus), loss of
balance, and loss of hearing
Interventions: Monitor for hearing loss; discontinue medication as
appropriate if a decrease in hearing is noted on assessment.
Neurological Effects
General Central Nervous System (CNS) Effects
Assessment Findings: Altered level of consciousness
Interventions: Prevent injury
Atropine-like (Anticholinergic) Effects
Assessment Findings: Dry mouth, urinary retention, blurred vision
Interventions: Sugarless lozenges to keep mouth moist; have the
patient void before administration of the medication
Neurological Effects
Parkinson-like Syndrome
Assessment Findings: Muscle tremors and changes in gait
Interventions: Discontinue medication as appropriate
Neuroleptic Malignant Syndrome
Assessment Findings: Extrapyramidal symptoms
Interventions: Discontinue medication as appropriate
Teratogenicity
Teratogenicity: Any drug that causes harm to the developing fetus or
embryo
Teaching to prevent teratogenicity
• Advise the pregnant woman that any medication may have
possible effects on the baby.
• Weigh the actual benefits against the potential risks.
• Discuss with pregnant women that they should not take
medications without checking with their health care provider first.
PHARMACOTHERAPEUTICS
Pharmacotherapeutics: The use of drugs to treat disease.
Types of Therapy:
Acute
Maintenance
Supportive
Palliative
Emperic
Supplemental or replacement
THANKS