BACHELOR OF SCIENCE IN NURSING

NCMA 416: PHARMACOLOGY

COURSE MODULE COURSE UNIT WEEK
1 2 2

Pharmacodynamics

✔ Read course and unit objectives

✔ Read study guide prior to class attendance
✔ Read required learning resources; refer to unit
terminologies for jargons
✔ Proactively participate in online discussions
✔ Participate in weekly discussion board (Canvas)
✔ Answer and submit course unit tasks

At the end of the course unit (CU), learners will be able to:

Cognitive:

1. Identify the major types of drug receptors.

2. Gain awareness of the measurements used to quantify the dose-response relationship.
3. Explain the therapeutic window and therapeutic index.
4. Identify the pharmacodynamic factors that can introduce variability to drug response.

Affective:
1. Develop awareness on the process of pharmacodynamics.
2. Manifest professionalism and excellence in understanding drug to drug interaction.
Psychomotor:
1. Determine appropriate pharmacological treatment and nursing responsibilities in medication
administration.
2. Participate in interactive discussion concerning dose-response relationship of drugs.

Pharmacology: A Patient-Centered Nursing Process Approach by Kee, Hayes and McCuistion 8th
Edition
Nursing Drug Handbook

Pharmacodynamics

is the study of the effect of drugs on the body.

Drugs act within the body to mimic the actions of the body’s own chemical
messengers.

Dose-Response Relationship
is the body’s physiological response to changes in drug concentration at
the site of action.
Potency – refers to the amount of drug needed to elicit a specific
physiologic response to a drug.

Efficacy – magnitude of effect a drug can cause when exerting its

maximal effect.
Maximal efficacy – the point at which increasing a drug dosage no longer
increases the desired therapeutic response.
Parameters of Drug Action

Therapeutic Index – (TI) describes the relationship between the

therapeutic dose of a drug (ED50) and the toxic dose of a drug (TD50)

Therapeutic dose of a drug – is the dose of a drug that produces a

therapeutic response in 50% of the population.
Toxic dose of a drug – is the dose that produces a toxic response in 50% of
the population.

Parameters of Drug Action

If the ED50 and TD50 are close- drugs have a narrow therapeutic index.
require close monitoring to ensure patient safety.

Onset – is the time it takes for a drug to reach the minimum effective
concentration (MEC) after administration.
Time from drug administration to first observable effect (T0-T1)

Peak – occurs when it reaches its highest concentration in the blood/plasma

concentration. T0-T2

Duration of action – is the length of time the drug exerts a therapeutic effect.
period from onset until the drug effect is no longer seen. T1-T3

Therapeutic Drug Monitoring

Drug concentration can be determined by measuring peak and trough drug levels.
peak – highest plasma concentration. 30 minutes after infusion.
trough – lowest plasma concentration. 30 minutes prior to the next infusion.

Theories of Drug Action

A.Drug-Receptor Interaction
Certain portion of drug molecule (active site) selectively combines with
some molecular structure (reactive site) on the cell to produce a biologic
effect

Receptor site- drugs act at specific areas on cell membranes; react with
certain chemicals to cause an effect within the cell

“Lock and Key Theory”- specific chemical (key) approaches a cell

membrane and finds fit (the lock) at receptor site- affects enzyme
system within cell- produce certain effects.
Drug+Receptor=Effect

B. Drug-Enzyme Interaction
Interferes with enzyme systems that act as catalyst from various
chemical reactions

If single step in one of enzyme system is blocked- normal function is

disrupted

C. Nonspecific Drug Interaction

Act by biophysical means that do not affect cellular/enzymatic
reactions.
drugs do not bind to receptors but instead saturate the water or lipid
part of a cell- drug actions occur based on the degree of saturation.
Neutralization of stomach acid by antacids.

D. Selective Toxicity
Specific action on cellular structures that are unique to the microbe.
All chemotherapeutic agents would act only in one enzyme system
needed for life of a pathogen or neoplastic cell.
It is essential to the pathogen but not to the host.

Drug Response
Drug Response may be:
1.Primary- always desirable/physiologic effects

2.Secondary- desirable or undesirable

Example: Diphenhydramine (Benadryl)
Primary effect: antihistamine; treat symptoms of allergy
Secondary: Drowsiness

Classification of Drug Action

1.Rapid- few seconds to minutes

- IV, SL, Inhalations

2. Intermediate- 1-2 hours after administration

- IM, SC

3. Delayed/Slow- several hours after administration

- Oral, rectal
Categories of Drug Action

1.Stimulation/Depression

Stimulation- increased rate of cell activity/ secretion from the gland

T3/T4 for hypothyroidism
Depression- decreased cell activity and function of a specific organ.
Iodine, propylthiouracil

2. Replacement- replaces essential body compounds

Example: Insulin

3. Inhibition/Killing of Organism
¡Interfere with bacterial cell growth
¡Example: Antibiotics

4. Irritation
Example: Laxative- irritate the inner wall of colon---increased peristalsis---
increased defecation

Drug-Drug Interaction

1.Additive Effect-2 drugs with similar actions are taken for a doubled effect
1+1=2
Ibuprofen + paracetamol= added analgesic effect
Codeine with acetaminophen = better pain control

2. Synergistic- combined effect of 2 drugs is greater than the sum of the

effect of each drug given alone; 1+1=3
Aspirin = 30% analgesic effect
codeine – 30% analgesic effect
combination = 90% analgesic effect

3. Potentiation- a drug that has no effect enhances the

effects of the second drug
0+1=2
Alcohol enhances the analgesic activity of aspirin.
Prozac + Zestril

4. Antagonistic- one drug inhibits the effect of another drug

1+1=0
Tetracycline + antacid= decreased absorption of tetracycline
Charcoal in alkaloidal poisoning

Adverse Drug Effects

1.Side Effects
Results from the pharmacologic effects of the drug
Most common as a result of lack of specificity of action within the
therapeutic range.

2. Allergic Reactions
Unpredictable adverse drug effects; more serious
Response to patient’s immunological system to the presence of the drug
Do not occur unless the patient has been previously exposed to the agent/
chemical related compound

3. Idiosyncratic Reaction
Occurs when the patient is first exposed to the drug
Abnormal reactivity to the drug caused by a genetic difference between
the patient and normal individual.
a patient with G6PD deficiency will have anemia by using antioxidants.

4. Toxicity
The degree to which a drug can be poisonous and thus harmful to the
human body.

5. Iatrogenic responses
Unintentional responses as a result of medical treatment
Nephrotoxicity; ototoxicity

● Pharmacodynamics - is the study of the effect of drugs on the body.

● Dose-Response Relationship - is the body’s physiological response to changes in drug
concentration at the site of action.
● Potency - refers to the amount of drug needed to elicit a specific physiologic response to a
drug.
 ● Efficacy - magnitude of effect a drug can cause when exerting its maximal effect.
● Maximal efficacy – the point at which increasing a drug dosage no longer increases the desired
therapeutic response.
● Therapeutic Index – (TI) describes the relationship between the therapeutic dose of a drug
(ED50) and the toxic dose of a drug (TD50)
● Therapeutic dose of a drug – is the dose of a drug that produces a therapeutic response in 50%
of the population.
● Toxic dose of a drug – is the dose that produces a toxic response in 50% of the population.
● Onset – is the time it takes for a drug to reach the minimum effective concentration (MEC) after
administration.
● Peak – occurs when it reaches its highest concentration in the blood/plasma concentration. T0-
T2
● Duration of action – is the length of time the drug exerts a therapeutic effect.
● Trough – lowest plasma concentration. 30 minutes prior to the next infusion.
● Additive Effect - Two drugs with similar actions are taken for a doubled effect
● Synergistic- combined effect of two drugs is greater than the sum of the effect of each drug
given alone.
● Potentiation- a drug that has no effect enhances the effects of the second drug
● Antagonistic- one drug inhibits the effect of another drug
● Side Effects - results from the pharmacologic effects of the drug
● Allergic Reactions - unpredictable adverse drug effects; more serious
● Idiosyncratic Reaction - abnormal reactivity to the drug caused by a genetic difference between
the patient and normal individual.
● Toxicity - the degree to which a drug can be poisonous and thus harmful to the human body.
● Iatrogenic responses - unintentional responses as a result of medical treatment

Watch and Learn:

https://youtu.be/PhfhMBO-w9Q #AMBOSSMed #MedicalSchool #Pharmacodynamics 1 and 2

https://youtu.be/tobx537kFaI Pharmacology - PHARMACODYNAMICS (MADE EASY)
Using your drug handbook, answer the following questions:
1. Look for the drug-drug interaction of the following drugs given and give nursing considerations
as you give the drugs together:
1. Celecoxib with ACE inhibitors
2. amitriptyline hydrochloride with barbiturates
3. acetylcysteine with activated charcoal
4. budesonide inhalation with ketoconazole
5. clobazam with hormonal contraceptives
6. esmolol hydrochloride with antdiabetic agents
7. indomethacin with aminoglycosides
8. isoniazid with acetaminophen
9. mesalamine with warfarin
10. rifampicin with probenecid

2. Give the adverse reactions of the following drugs on the systems indicated:
1) cimetidine – GI
2) esterified estrogen – CNS
3) gentamicin sulfate – respiratory
4) iloperidone – EENT
5) meropenem – CNS
6) simvastatin – respiratory
7) trospium chloride – EENT
8) desmopressin acetate – GI
9) ethambutol hydrochloride – musculoskeletal
10) promethazine hydrochloride - metabolic

Textbooks:
Pharmacology: A Patient-Centered Nursing Process Approach by Kee, Hayes and McCuistion 8th
Edition
Nurse’s Drug Handbook

Websites:
#AMBOSSMed #MedicalSchool #Pharmacodynamics 1 and 2
https://youtu.be/PhfhMBO-w9Q #AMBOSSMed #MedicalSchool #Pharmacodynamics 1 and 2
https://youtu.be/tobx537kFaI Pharmacology - PHARMACODYNAMICS (MADE EASY)