Introduction of Pharmacology

Pharmacologic Terminology

Drug

-any chemical that affects the process of living organism

- Chemicals that ate introduced into the body bring about some sort of change.

Pharmacology

-the study or science of drugs

-study of biological effect of chemicals.

Chemical name

-Name that reflects the drug’s chemical composition and molecular structure

Generic name

-Aka Nonproprietary name.

-Common name of drugs in the same classification

Trade name

-Aka proprietary name/ brand name

-Name given by the manufacturer

-the drugs has registered trademark

Pharmaceutics

-The study of how various drug forms influence pharmacokinetic and pharmacodynamic activities.

Pharmacognosy

-The study of natural (plant and animal) drug sources

PHARMACOKINETICS

-The study of what the body does to the drug

* Absorption

*Distribution

*Metabolism

*Excretion
PHARMACOKINETICS : ABSORPTION

- The rate at which a drug leaves its site of administration , and the extent to which absorption occurs .
*Bioavailability

-Rate at which a drug is absorbed by the body’s circulatory system .

*Bioequivalence

- Comparison of the bioavailability of two or more products .

PHARMACOKINETICS : ABSORPTION

Factors that affect Absorption

-Administration route of the drug

-Food or fluids administered with the drug

-Dosage Formulation

-Status of the absorptive surface

-Rate of blood flow to the small intestine

-Acidity of the stomach

-Status of GI motility

Route

-A drug's route of administration affects the rate and extent of absorption of that drug

*Enteral

*Parenteral

*Topical

Enteral Route

-Drug is absorbed into the systemic circulation through the oral or gastric mucosa , the small intestine ,
or rectum.

* Oral

*Sublingual

*Buccal

*Rectal

DRUG ABSORPTION OF VARIOUS ORAL PREPARATIONS

Liquids , elixirs , syrups Fastest

Suspension solutions

Powders

Capsules

Tablets

Coated tablets

Enteric – coated tablets slowest

First-Pass Effect

-The metabolism of a drug and its passage from liver into circulation

- A drug given via the oral route may be extensively metabolized by the liver before reaching the
systemic circulation (high first-pass effect)

-If given via IV-bypasses the liver, preventing the first-pass effect from taking place =more drug reaches
the circulation

First-Pass Effect

-Route that bypass the Liver:

*Sublingual * Transdermal

*Buccal * Vaginal

*Rectal * Intramuscular

*Intravenous * Subcutaneous

*Intranasal * Inhalation

PHARMACOKINETICS : ABSORPTION

Parenteral Route

* Intravenous * Intramuscular

*Subcutaneous * Intradermal

* Intrathecal *Intraarticular

Topical Route

*Skin ( including transdermal patches) *Eyes

*Ears * Nose

*Lungs (inhalation) * Vagina

PHARMACOKINETICS : DISTRIBUTION
The transport of a drug in the body by the bloodstream to its site of action

-. Protein- binding

- Water soluble vs. fat soluble

-Blood- brain barrier

-Areas of rapid distribution: heart, liver, kidneys , brain

-Areas of slow distribution : muscle, skin, fat

PHARMACOKINETICS : METABOLISM

The biologic transformation of a drug into an inactive metabolite , a more soluble compound , or a more
potent metabolite .

*Liver (main organ )

*Kidneys

* Lungs

* Plasma

* Intestinal mucosa

Factors that decrease Metabolism:

*Cardiovascular dysfunction * Renal insufficiency

*Starvation * obstructive jaundice

*Slow acetylation

Delayed drug metabolism result in:

 Accumulation of drugs
 Prolonged action of the effect of drugs.

Stimulation drug metabolism causes:

 Diminished pharmacologic effects

PHAEMACOKINETICS: EXCRETION

The elimination of drugs from the body

 Kidneys (main organ)

 Liver
 Bowel

Half-Life

-The time it takes for one half of the original amount of a drug in the body to be removed
-A measure of the rate at which drug are removed from the body

PHARMACOLOGIC TERMINOLOGY

Pharmacodynamics

-The study of what the drugs does to the body

-The mechanism of drug actions in living tissues

DRUG ACTION

 The cellular processes involved in the drug and cell interaction

DRUG EFFECT

 The physiologic reaction of the body to the drug

ONSET

 The time it takes for the drug to elicit a therapeutic response .

PEAK

 The time it takes for a drug to reach its maximum therapeutic response .

DURATION

 The time a drug concentration is sufficient to elicit a therapeutic response .

PHARMACODYNAMICS : MECHANISM OF ACTION

The ways by which drugs can produce therapeutic effects

-Once the drug is at the site of action , it can modify the rate (increase or decrease ) at which the cells or
tissues function .

-A drug cannot make a cell or tissue perform a function it was not designed to perform

PHARMACOLOGIC TERMINOLOGY

PHARMACOTHERAPEUTICS

 Aka Clinical Pharmacology .

 Branch of pharmacology that deals with the use of drugs and the clinical indications for drugs to
prevent and treat diseases

PHARMACOTHERAPEUTICS :

TYPES OF THERAPIES

*Acute therapy *Maintenance therapy

* Supplemental therapy *Palliative therapy

*Supportive therapy * Prophylactic therapy

PHARMACOTHERAPEUTICS : MONITORING

 The effectiveness of the drug therapy must be evaluated .

 One must be familiar with the drug’s
*intended therapeutic action (beneficial ) the drug’s
*unintended but potential side effects (predictable , adverse drug reactions )

THERAPEUTIC INDEX

 The ratio between a drug’s therapeutic benefits and its toxic effects

TOLERANCE

 A decreasing response to repetitive drug doses

DEPENDENCE

 A physiologic need for a drug

ADDICTION

 The psychological need for a drug

PHARMACOTHERAPEUTICS : MONITORING

Interactions may occur with other drugs or food

 Drug interactions : the alteration of action of a drug by:

- Other prescribed drugs
-Over -the-counter medications
- Herbal therapies

Types of Drug – Drug Interactions

 Additive effect
 Synergistic effect
 Antagonistic effect
 Incompatibility

SIDE EFFECT

 Expected, well-known reaction that result in little Or change in patients management

 Predictable frequency
 The effect’s intensity and occurrence is related to the size of the dose.

ADVERSE DRUG REACTION

 An undesirable response to drug therapy that is usually unexpected

-Idiosyncratic
-Hypersensitivity reaction
-Drug interaction
LATROGENIC RESPONSES

 Unintentional adverse effects that are treatment-induced.

-dermatologic
-renal damage
-blood dyscrasias
-hepatic toxicity

Other drug- related effects:

 Teratogenic
 Mutagenic
 Carcinogenic

Philippine laws involving PHARMACOLOGY

REPUBLIC ACT 6675

 Aka The Generics Act of 1988 .

 Seeks “to promote , require , and ensure the production of an adequate supply , distribution US
* e_{1} and acceptance of drugs and medicines identified by the generics names .”

REPUBLIC ACT 9502

 Aka The Universally Accessible and Quality Medicine Act of 2008

 the policy of the State to protect public health and when the public interest or circumstances of
extreme urgency so require , it shall adopt appropriate measu to promote and ensure access to
affordable quality drugs and medicines for all.
 Drug manufacturers were also required to include prominent labeling regarding equivalent
therapeutic efficacy of generics.

REPUBLIC ACT 3720

 Aka The Food , Drug , and Cosmetic Act .

 Is an act to ensure the safety and purity of foods , drugs , and cosmetics being made available to
the public by creating the food and drug administration which shall administer and enforce the
laws pertaining thereto .
 This act regulates the production , sale, and distribution of food , drugs , and cosmetics before
they are to the market to protect the public health

Rights to Drug administration

 Right drug/medicine * Right client/patient

 Right route *Right dose
 Right Frequency/time * Right assessment
 Right approach * Right education
 Right evaluation * Right documentation
  Right to refuse * Right principle of care
 Right prescription * Right nurse clinician

Intravenous fluids

Definition of IV Fluids

The word “intravenous “ as a noun refers to an intravenou fluid drip , a solution (usually a balanced
electrolyte solution ) administered directly into the venous circulation .

Intravenous (|V) therapy is the insertion of needle or catheter /cannula into a vein , based on the
physician’s written prescription .

The needle or catheter cannula is attached to a sterile tubing and a fluid container to provide
medication and fluids .

Indications of IV Therapy

• Provide fluid and electrolyte maintenance , restoration, and replacement

 Administer medication and nutritional replacement Administer blood and blood products
 Administer chemotherapy to cancer patients Administer key – controlled analgesics

• Keep a vein open for quick access

TYPES OF IV FLUIDS

1. Colloid
 Solutions that contain large molecules that don’t pass the cell membranes .
 When infused , they remain in the intravascular compartment and expand the intravascular
volume and they draw fluid from extravascular spaces via their higher oncotic pressure .

Volume expander or colloid- increase blood volume following (hemorrhage) severe loss of blood.
Another Condition na pedeng gamitin ito ay SEVERE BURNS. (loss of plasma)

- Explander present in dextran,plasma, and albumin

2. Crystaloid- solutions that contains small molecules that flow easily across the cell membranes
allowing fro trans fer from the bloodstream into the cells and body tissues.

- they will increase fluid volume in both interstitial( refers to the iside the cell) and intravascular spaces .

Crystalloids nagpapasok ng fluid sa loob ng cells + naglalabas den ng fluid sa labas ng cell. Its divided into
3

ISOTONIC- Solution that have same osmololity as body fluids

equal lang ang concentration ni isotonic. Hindi nya pinapa-bulge o shrink si cell. Ang kagandahan po kay
isotonic, since hindi nya pina-pakialaman so cell is maganda yung distribution ng nutrients sa ating body,
that’s why madalas to gamitin sa surgery at sa mga blood loss.

HYPOTONIC- solutions that have a lower osmolality than body fluids

 Ginagawa naman neto is pinapa-bulge (laki) nya ang cell kase pag may dehydration nagshrishrink po si
cell at para matreat yun ay need naten mabalik sa dati ang size.

- Ang concentration ng solute ng hypo is lower compared sa concentration solute sa

blood. (Ang mangyayari dto pag high ang solution is mag swell ang cells. Kase by
principles of osmolarity kung saan higher ang concentration solute duon papasok ang
fluids.

HYPERTONIC- solutions that have a higher osmolality than body fluids

Ang action naman nito ay ilabas ang tubig sa ating cell dahilan para mag shrink (lumiit) si cell.

- Mas maatas ang concentration solute kesa sa cell so mangyayari hihigupin naman ng
hyper -. Ang fluid galing sa cell palabas.

Electrolyte solution (crystalloid)

 Fluids that consist of water and dissolved crystal, such as salth and sugar
 User as maintenance fluids to correct body fluids and electrolyte deficit
 Divided to different types.

Isotonic Fluids

When to consider an isotonic solution ?

 When the concentration of the particles (solutes ) is similar to that of plasma , So it doesn’t
move into cell and remains within the extracellular compartment thus increasing intravascular
volume .

Isotonic Fluids

Types of isotonic solutions include:

 .9\% sodium chloride (0.9 % NaCl )

 lactated Ringer’s solution
 5 % dextrose in water (D5W)
 Ringer’s solution

A-0.9\% sodium chloride (Normal Saline ) When to use :

1- To treat low extracellular fluid , as in fluid volume deficit from suction , fistulas , or wounds
2- Shock
3- Mild hyponatremia
4- Metabolic acidosis (such as diabetic ketoacidosis )
5- it’s the fluid of choice for resuscitation efforts .
6- - it’s the only fluid used with administration of blood products .

0.9% sodium chloride ( Normal Saline )

WOF : Because 0.9% sodium chloride replaces extracellular fluid , it should be used cautiously in certain
patients (those with cardiac or renal disease for fear of fluid volume overload

B- Ringer’s lactate or Hartmann solution When to be used ?

1. To replace tract fluid losses ( Diarrhea or vomiting )

2. Fistula drainage

3. Fluid losses due to burns and trauma

4. Patients experiencing acute blood loss or hypovolemia due to third -space fluid shifts

B- Ringer’s lactate or Hartmann solution

Notice . Both 0.9 % sodium chloride and LR may be used in many clinical situations , but patients
requiring electrolyte replacement ( such as surgical or burn patients ) will benefit more from an infusion
of LR .

– LR is metabolized in the liver , which converts the lactate to bicarbonate . LR is often administered to
patients who have metabolic acidosis not patients with lactic acidosis

-Don’t give LR to patients with liver disease as they can’t metabolize lactate

– Used cautiously in patients with sever renal impairment because it contains some potassium

– LR shouldn’t be given to a patient whose pH is greater than 7.5

Ringer’s solution

Like LR , contains sodium , potassium , calcium , and chloride in similar . But it doesn’t contain lactate .
Ringer’s solution is used in a similar fashion as LR , but doesn’t have the contraindications related to
lactate .

D. Dextrose 5%

* it is considered an isotonic solution , but when the dextrose is metabolized , the solution actually
becomes hypotonic and causes fluid to shift into cells .

How does it work ?

 D5W provides free water that pass through membrane pores to both intracellular and
extracellular spaces . Its smaller size allows the molecules to pass more freely between
compartments , thus expanding both compartments simultaneously
 It provides 170 calories per liter , but it doesn’t replace electrolyte
 The supplied calories doesn’t provide enough nutrition for prolonged use . But still can be
added to provide some calories while the patient is NPO .

COMPLICATIONS

Infection

 redness, swelling and drainage at site ; chills , fever malaise headache

Tissue damage

 skin color change sloughing of skin discomfort at site

Phlebitis

 heat. Redness , tenderness , not hard and swollen

Thrombophlebitis

 heat , redness tenderness , hard and cordlike vein

Infiltration

 Edema , pain, and coolness at the site

Catheter embolism

 decrease BP , pain along vein , weak , rapid pulse , cyanosis of nail beds , loss of consciousness

Circulatory overload

 increased BP distended jugular veins , rapid breathing dyspnea , moist cough and crackles

Electrolyte overload

 signs depend on the specific electrolyte imbalance

Hematoma

 ecchymosis , immediate swelling and leakage of blood at the site and hard painful lumps at the
site

Air embolism

 tachycardia , dyspnea , hypotension , cyanosis , decreased level of consciousness