Lesson 1: Drug Definitions and Classification

Pharmacology Basics

Pharmacology is the scientific study of the origin,

nature, chemistry, effects, and uses of drugs. This
knowledge is essential to providing safe and
accurate medication administration to your
patientsn (Berry et al., 2016) .

This unit module will provide you insights on the

three basic concepts of pharmacology: Lesson 2: Pharmacokinetics
- Pharmacokinetics - the absorption,
distribution, metabolism, and excretion of Pharmacokinetics
drugs by the body The term kinetics refers to movement.
- Pharmacodynamics - the biochemical and Pharmacokinetics deals with a drug’s actions as it
physical effects of drugs and the moves through the body. Therefore,
mechanisms of drug actions pharmacokinetics discusses how a drug is:
- Pharmacotherapeutics - the use of drugs - Absorbed (taken into the body)
to prevent and treat diseases. - Distributed (moved into various tissues)
- Metabolized (changed into a form that can
Drug Classifications be excreted)
- The Body system that they affect (e.g., the - Excreted (removed from the body)
central nervous system, the cardiovascular
system, the gastrointestinal system)
- Their Therapeutic use or clinical indications
(e.g., antacids, antibiotics,
antihypertensives, diuretics, laxatives)
- Their Physiologic or chemical action (e.g.,
anticholinergics, beta-adrenergic blockers,
calcium channel blockers, cholinergic)
Drugs may be further classified as prescription or
nonprescription.
- Prescription drugs require an order by a
health professional that is licensed to
prescribe drugs, such as a physician, a
nurse practitioner, a physician assistant, a
pharmacist, or a dentist.
- Nonprescription or over-the-counter (OTC)
drugs are sold without a prescription in a Absorption
pharmacy or in the health section of Drug absorption covers the progress of a drug from
department or grocery stores. the time it’s administered through the time it passes
- Illegal drugs, which are sometimes referred to the tissues until it becomes available for use by
to as recreational drugs, are drugs or the body. Factors affecting absorption
chemical substances used for
nontherapeutic purposes. These Various factors—such as the route of
substances are obtained illegally or have administration, the amount of blood flow, and the
not received approval for use by the FDA form of the drug—can affect the rate of a drug’s
(Nurse Key, 2016). absorption.

● If only a few cells separate the active drug

from the systemic circulation, absorption
occurs rapidly, and the drug quickly reaches
therapeutic levels in the body. Typically,
 drug absorption occurs within seconds or
minutes when administered sublingually, IV,
or by inhalation.
● Absorption occurs at slower rates when
drugs are administered by the oral, IM, or
sub-cut routes because the complex
membrane systems of GI mucosal layers,
muscle, and skin delay drug passage.
● Drugs absorbed by the small intestine are
transported to the liver before being
circulated to the rest of the body. The liver
may metabolize much of the drug before it
enters circulation. This mechanism is
referred to as the first-pass effect.
● Increased blood flow to an absorption site
improves drug absorption, whereas reduced
blood flow decreases absorption. More
rapid absorption leads to a quicker onset of
drug action.
In addition to absorption, distribution, metabolism,
and excretion, three other factors play essential
roles in a drug’s pharmacokinetics:
● onset of action
● peak concentration
● duration of action.
How long ‘til we see some action?
- The onset of action refers to the time
interval that starts when the drug is
administered and ends when the
therapeutic effect begins.
When will it reach peak performance?
- As the body absorbs more drugs, blood
concentration levels rise. The peak
concentration level is reached when the
absorption rate equals the elimination rate.
How long will it last?
- The duration of action is the length of time
the drug produces its therapeutic effect.
Distribution
Drug distribution is the process
by which the drug is delivered
to the tissues and fluids of the
body. The delivery of an
absorbed drug within the body
depends on several factors,
including blood flow solubility
protein binding.
● After a drug has
reached the bloodstream, its distribution in
the body depends on blood flow. The drug
is distributed quickly to those organs with an
ample supply of blood, including the heart,
liver, and kidneys.
● As a drug travels through the body, it comes
in contact with proteins, such as the plasma
protein albumin. The drug can remain free
or bind to the protein. The portion of a drug
that’s bound to a protein is inactive and
can’t exert a therapeutic effect.
Metabolism
Drug metabolism, or
biotransformation, refers to
the body’s ability to change a
drug from its dosage form to a
more water-soluble form that
can then be excreted.
● Some drugs inhibit or compete for enzyme
metabolism, which can cause the
accumulation of drugs when they’re given
together. This accumulation increases the
potential for an adverse reaction or drug
toxicity.
● Certain diseases can reduce metabolism.
These include liver disease, such as
cirrhosis, and heart failure, which reduces
circulation to the liver.
● Genetics allows some people to be able to
metabolize drugs rapidly, whereas others
metabolize them more slowly.
● A stressful environment, such as one
involving prolonged illness or surgery, can
also change how a person metabolizes
drugs.
Excretion
Drug excretion refers to the
elimination of drugs from the body.
Most drugs are excreted by the
kidneys and leave the body through
urine. Medications can also be
excreted through the lungs, exocrine
glands (sweat, salivary, or mammary
glands), skin, and intestinal tract.

Half in and half out
● The half-life of a drug is the time it takes for
the plasma concentration of a drug to fall to
half its original value in other words, the
time it takes for one-half of the drug to be
eliminated by the body.
● A drug that’s given only once is eliminated
from the body almost entirely after four or
five half-lives. A drug that’s administered at
regular intervals, however, reaches a steady
concentration (or constant state) after about
four or five half-lives
Lesson 3: Pharmacodynamics
Pharmacodynamics is the study of the drug
mechanisms that produce biochemical or
physiologic changes in the body. The interaction at
the cellular level between a drug and cellular
components, such as the complex proteins that
make up the cell membrane, enzymes, or target
receptors, represents drug action. The response
resulting from this drug action is called the drug
effect.
Lesson 4: Pharmacotherapeutics
Pharmacotherapeutics is the use of drugs to treat
disease. When choosing a drug to treat a particular
condition, health care providers consider the drug’s
effectiveness as well as such factors as the type of
therapy the patient will receive.
The type of therapy prescribed depends on the
severity, urgency, and prognosis of the patient’s
condition. Therapy types include:
● Acute therapy, if the patient is critically ill
and requires acute intensive therapy
● Empiric therapy, based on practical
experience rather than on purely scientific
data
● Maintenance therapy, for patients with
chronic conditions that don’t resolve
● Supplemental or replacement therapy, to
replenish or substitute for missing
substances in the body
● Supportive therapy, which doesn’t treat
the cause of the disease but maintains
other threatened body systems until the
patient’s condition resolves
● Palliative therapy, used for end-stage or
terminal illnesses to make the patient as
comfortable as possible.
Drug interactions
Drug interactions can occur between drugs or
between drugs and foods. They can interfere with
the results of a laboratory test or produce physical
or chemical incompatibilities. The more
medications a patient receives, the higher the
chances are that a drug interaction will occur.
Potential drug interactions include:
● additive effects
● Potentiation
● antagonistic effects
● decreased or increased absorption
● decreased or increased metabolism and
excretion
Adverse drug reactions
A drug’s desired effect is called the expected
therapeutic response. An adverse drug reaction, on
the other hand (also called a side effect or adverse
effect), is a harmful, undesirable response.
Dose-related reactions
Dose-related reactions include:
● Secondary Effects
● Hypersusceptibility
● Overdose
● Iatrogenic Effects.
Secondary effects
- A drug typically produces a significant
therapeutic effect as well as secondary
effects that can be beneficial or adverse.
For example, morphine used for pain
control can lead to two undesirable
secondary effects: constipation and
respiratory depression. Diphenhydramine
used as an antihistamine is accompanied
by the secondary effect of sedation, which
is why the drug is also sometimes used as a
sleep aid.
Hypersusceptibility
- A patient can be hyper susceptible to the
pharmacologic actions of a drug. Even
when given a usual therapeutic dose, a
hyper susceptible patient can experience an
excessive therapeutic response.
Overdose
- A toxic drug reaction can occur when an
excessive dose is taken, either intentionally
or accidentally. The result is an exaggerated
response to the drug that can lead to
transient changes or more severe reactions,
such as respiratory depression,
cardiovascular collapse, and even death.
Iatrogenic effects
 - Some adverse drug reactions, known as
iatrogenic effects, can mimic pathologic
disorders. For example, such drugs as
antineoplastic, aspirin, corticosteroids, and
indomethacin commonly cause GI irritation
and bleeding.
Patient sensitivity–related adverse reactions
- Patient sensitivity–related adverse reactions
aren’t as common as dose-related
reactions. Sensitivity-related reactions result
from a patient’s unusual and extreme
sensitivity to a drug.
Allergic reaction
- A drug allergy occurs when a patient’s
immune system identifies a drug, a drug
metabolite, or a drug contaminant as a
dangerous foreign substance that must be
neutralized or destroyed.
Idiosyncratic response
- Some sensitivity-related adverse reactions
don’t result from the pharmacologic
properties of a drug or from an allergy but
are specific to the individual patient. These
are called idiosyncratic responses.

Lesson 5: Drug Legislation Controlled

Substances

Controlled Substance Act

Establish Protocols such as: Prescribers are
registered with DEA. A registry number is issued to
each person and is renewed annually
● Complete records of all drugs must be kept
for two years.
● Pharmacist records each sale in triplicate.
Schedule II Drug Prescription cannot be
renewed
All Units have a record of every controlled drug on
the unit and two nurses at change of every shift
count all drugs
● All controlled drugs are stored using a
double lock of control of nurses on the unit
● Discarding of controlled substances must
be witnessed by another nurse
● Written renewal orders are required every
72 hours for narcotics and schedule II and
III drugs.