Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
Fundamental Concepts of Pharmacology
Pharmacology
➔ Derived from the Greek word
pharmakon (“poison” in classic
Greek, “drug” in modern Greek),
logos means study
➔ Study of drugs and its origin,
chemical structure, preparation,
administration, action, metabolism
and excretion.
➔ The study of drugs that alter
functions of living organisms.
Pharmacy Compounding
➔ The process of combining, mixing, or
altering ingredients to create a
medication tailored to the needs of
an individual patient
➔ Preparation of personalized
medications
Compounded Medications
➔ Made based on the practitioners
prescription
➔ Used to help achieve better
therapeutic effects through the
tailored actions of a specific
combination of ingredients
Pharmacy
➔ It is the art of preparing,
compounding, and dispensing drugs
➔ It is also refers to the place where
drugs are prepared and dispensed
Pharmacist
➔ A person licensed to prepare and
dispense drugs.
➔ Counsel patients on safe and
appropriate use of medication
History of Pharmacology
Babylonians
➔ Earliest surviving “prescriptions” on
Sumerian cuneiform clay tablets in
3000 B.C.
Chinese
➔ Recorded the Pen Tsao (Great
Herbal) – a 40- volume compendium
of plant remedies dating to 2700
B.C.
➔ Pen Tsao is the earliest Chinese
materia medica book,
➔ Written by Lee sijin(1578)
Eber’s (Erbs) Papyrus
➔ Archives of remedies on a 110
pages document in 1500 B.C.
➔ Oldest well preserved medical
document from ancient Egyptians
Pharmacologia sen Manuductio and
Materia Medicum
By Samuel Dale in 1693
➔ First recorded reference to the word
pharmacology
➔ Samuel Dale (1659 – 18 March
1739) was an English naturalist and
physician notable for his work in the
natural sciences
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
➔ Chemists isolate specific substances
from complex mixtures
➔ Pharmacologists then study their
effects in animals
Fredrich Serturner
➔ first isolated morphine from opium,
injected himself and three other
friends with huge doses (100mg)
Father of American Pharmacology
John Jacob Abel
➔ Founded the first pharmacology
department in University of Michigan
in 1890
➔ Hopkins’ first professor of
pharmacology
➔ The early focus of his work was on
isolating and characterizing the
hormones of the endocrine system,
especially adrenaline and insulin.
Basic Concepts of Pharmacology
Drugs
➔ Are chemicals that alter
physicochemical processes in body
cells.
➔ They can stimulate or inhibit normal
cellular functions.
➔ Used interchangeably with
medicines.
Drug
➔ A substance recognized by an
official pharmacopeia or formulary
➔ A substance intended for use in the
diagnosis, cure, mitigation,
treatment, or prevention of disease
➔ A substance (other than food)
intended to affect the structure or
any function of the body
Drug Classification
Chemical Structures
➔ Pertain to the molecular
arrangement of atoms in a molecule
and the chemical bonds that hold the
atom together.
Mechanism Of Action (MOA)
➔ Refers to the specific biochemical
interaction through which a drug
substance produces its
pharmacological effect such as an
enzyme or receptor
● EX: Penicillin - inhibits cell
wall synthesis
➔ Describes a functional or anatomical
change, resulting from the exposure
of a living organism to a substance
➔ Observable consequence of a drug
➔ Penicillin: bactericidal, death of
bacteria, decrease signs of
infections
➔ Paracetamol: Antipyretic (decrease
body temp)
➔ Tramadol: Analgesic (decrease pain
perception)
Drug Information
➔ Also referred to as medication
information or drug informatics
➔ Range from discovery, use, and
management of information in the
use of medications
➔ Covers from drug identification,
pharmacokinetics to dosage and
adverse effects.
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Drug Names Drug Action

1. Generic or Nonproprietary Name Local Effect

➢ Group of medicines that have ➢ Response to a medication that is
similar actions confined to a specific part of the
➢ Name approved by the Medical or body
Pharmaceutical Associations in the ➢ E.g: acetazolamide and betaxolol:
original country of manufacture and dilate pupils
is adopted by all countries.
➔ e.g. Paracetamol Systemic Effect
Diphenhydramine ➢ Generalized or widespread response
to a drug by the body because it is
2. Brand name or Trade name or absorbed into the bloodstream
Proprietary Name ➢ E.g: Aspirin or ibuprofen have
➢ Name given by the manufacturer of anti-inflammatory and analgesic
the drug effects throughout the body from
➢ A drug sold by a drug company head to toes
under a specific name or trademark,
registered by patent Therapeutic Effect
➔ e.g. Adol or Panadol or ➢ Also referred as the DESIRED
Biogesic EFFECT
➢ Intended effect of a medication
3. Chemical name ➢ The primary purpose of prescribing
➢ name that describes the atomic or and administering the medication
chemical structure or molecular ➢ e.g.: antibiotics are given either to
structure of the drug kill or to slow the growth of bacteria,
➢ Paracetamol primarily to treat infection
- para-acetylaminophenol
Side effect
Examples of Generic, Chemical, and ➢ Also referred as the SECONDARY
Brand Name EFFECT
➢ Unintended effect
➢ Typically undesirable effect of a drug
Generic Chemical Name Brand ➢ e.g: Antibiotics: nausea, vomiting,
Name Name diarrhea
Fluoxetine N-methyl-3-phen Prozac
HCL yl-propylamine Adverse effect
➢ Severe side effects
Acetamino 4-Hydroxyacetani Tylenol ➢ Undesirable, harmful effect that
phen lide results from taking the medication
Ibuprofen 2-p-Isobutylphen Motrin ➢ e.g: antibiotics: watery diarrhea
yl-propionic acid
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
Contraindication and Precaution
➢ The condition under which the drug
should not be used or must be used
carefully with monitoring
➢ Antidepressant is contraindicated to
alcohol because it increases CNS
sedation
➢ Antibiotics are contraindicated to
pregnancy because of teratogenic
effect
Drug Toxicity
➢ Deleterious effects of a drug
resulting from overdose, ingestion of
external use drug, and accumulation
in the bloodstream, leading to
negative effects
➢ Eg: Therapeutic levels of digoxin are
0.8 -2.0 ng/mL. The toxic level is
>2.4 ng/mL
➔ Paracetamol: >200 mg/kg (or
10 g) ingested over a 24 hour
period
➔ ototoxic, nephrotoxic,
hepatotoxic
“Poisons in small doses are the best
medicines; and useful medicines in too
large doses are poisonous”
- William Withering (1789)
Drug Allergy/ Hypersensitivity Reaction
to drugs
➢ Immunologic reaction to drugs
➢ Abnormal reaction of the immune
system to a medication
➢ Signs: hives, rash or fever
Drug Tolerance
➢ The diminishing effect of a
medication following repeated
administration at a certain dose
➢ Exists in person with unusually low
physiologic response to a drug
➢ May lead to dependence
Drug Dependence
➢ It occurs as a person continues to
use a drug.
Drug Addiction
➢ It occurs as a person is unable to
stop using the drug even if he or she
tried to do so.
Drug Interaction
➔ Idiosyncratic Reactions an
uncommon and abnormal response
to drug
➔ Usually due to genetic abnormality
➔ affect drug metabolism and receptor
sensitivity
➔ Harmful even fatal, appear in low
doses
● e.g: Hemolysis (Anemia) by
antioxidant drugs (G6PD
deficiency)
● Barbiturates: causes
excitement and mental
confusion in some individuals
★ Antagonism 1+1 = 0
The interacting drugs have opposing actions
Ex: Acetylcholine and noradrenaline have
opposing effects on heart rate.
★ Addition or Summation 1+1 = 2
The interacting drugs have the similar
actions and the resultant effects is the sum
of individual drug responses
Ex: CNS depressants like sedatives and
hypnotics,.. Etc
★ Synergism or Potentiation 1+1 > 2
It is an enhancement of action of one drug
by another
Ex: Alcohol enhances the analgesic activity
of aspirin.
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
Drug Regulations and Mandates
The Food and Drug Administration of the
Philippines
➔ Created under the Department of
Health to license, monitor, and
regulate the flow of food, drugs,
cosmetics, medical devices, and
household hazardous waste in the
Philippines
➔ FDA's main goal is to ensure the
health and safety of food and drugs
made available to the public.
Republic Act No. 3720
➔ Known as the Food, Drug, and
Cosmetic Act
➔ 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
Republic Act No. 8203
➔ OTHERWISE KNOWN AS THE
SPECIAL LAW ON COUNTERFEIT
DRUGS
➔ “Unregistered imported drug
product" as distinguished from
counterfeit drugs defined under
Section 3 of R.A., shall refer to
unregistered imported drug products
without a registered counterpart
brand in the Philippines.
Republic Act No. 7394
“Consumer Act of the Philippines”
➔ Protects the interests of the
consumer, promotes general welfare
and to establish standards of
conduct for business and industry
➔ Protects against deceptive, unfair
and unconscionable sales acts and
practices.
Comprehensive Dangerous Drugs Act of
2002 ( Republic Act (R.A.) No. 9165), the
Philippine Drug Enforcement Agency
(PDEA): created for the efficient and
effective law enforcement of all the
provisions on dangerous drugs and/or
precursors and essential chemicals as
provided in R.A.
Two of the most used and valuable illegal
drugs in the country are methamphetamine
hydrochloride (known locally as shabu) and
marijuana.
Practice Guidelines in Medication
Administration
★ RNs are responsible for their own
actions
★ Illegible should be questioned and
clarified
★ RNs should be knowledgeable about
the medication
★ If the RN is uncertain about the
calculation, ask another nurse to
double check
★ Plan medication administration to
avoid disruption
★ Prepare medications for ONE patient
at a time
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

★ What you prefer, be the one to Right time – is the time at which the
administer prescribed dose should be administered
★ Do not leave medications at bedside Daily drug dosages are given at specified
★ If the client vomits, report to charge time during a day such as
nurse, MD, or both ➔ Once a day: OD
★ When error is made, assess the ➔ Twice a day: b.i.d
patient first and report to MD ➔ Three times a day: t.i.d
immediately ➔ Four times a day: q.i.d.
★ OBSERVE 10 RIGHTS ➔ Every 6 hrs: q6h
➔ Every 12 hours: q12
Right client – can be measured by ➔ HS: hours of sleep
checking the client identification bracelet
and by having the client state her or his Right route – is necessary for adequate or
name appropriate absorption
➔ Some client answer to any name or Common routes are the following:
unable to respond, so client ➔ Oral
identification should verified each ➔ Sublingual
time of medication administered ➔ Buccal
➔ In the event of missing identification ➔ Inhalation
bracelet, the nurse must verify the ➔ Topical
client identity before any drug ➔ Instillation
administration ➔ Transdermal
CORRECT IDENTIFICATION OF THE ➔ Suppository, etc.
PATIENT:
ID Band or ID Bracelet (BEST: Kozier) Right assessment – requires the
Ask the patient’s name appropriate data to be collected before
AVOID: Calling the client in NAME: May administration of drugs
answer “YES” to the wrong name
Right documentation – requires that the
Right Drug – means that the client receives nurses immediately record the appropriate
the drug that was prescribed information about drug administered include
➔ Medication orders may be the ff:
prescribed by: ➔ Name of the drug
➢ Physician Dentist ➔ Dose
➢ Podiatrist ➔ Route
➢ License health care provider ➔ Time and date
such as advanced practice ➔ Nurse initial or signature
registered nurse
➢ With authority from the state Nurses Notes:
to order medication ➔ Temperature taken, 39 degrees
Categories of Drug Orders (SOPS) Celsius
- Standing - One-time ➔ Paracetamol 300 mg IV given as
- PRN - STAT PRN order
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Right to educate – requires that the client Medications

received accurate and thorough information
about the medication and how it relates to ORAL MEDICATIONS
his or her situation - Most common route
Contraindications
Client teaching also includes therapeutic ➔ Client is vomiting
purpose, possible side effect of the drugs, ➔ Client with intestinal or gastric
any dietary restriction or requirements skills suction
administration, and laboratory monitoring ➔ Unconscious client
➔ Inability to swallow
Right evaluation – requires that the Tablets or Capsules
effectiveness of the medication be ➔ (+) difficulty swallowing
determined by the client response to ➔ Crush and mix with small amounts of
medication 56 water
Avoid Crushing
Right to refuse – client can and do refuse ➔ Sustained-action
to take medication. It is the nurse’s ➔ Enteric coated
responsibility to determine the possible ➔ Buccal and sublingual tablets
reason of refusal and to take reasonable Liquid Medication
measures to facilitate the client taking the ➔ Mix before pouring
medication ➔ Place medication cup on flat surface
at eye level
(Right) Medication Prescription ➔ Fill the cup with the desired level
using the BOTTOM of the
➔ Components of Medication meniscus
Prescription Date and time the order
is written
General Precautions
➔ Drug name: BN and Generic Name
➔ Drug dosage: 500 mg
➔ Route of administration UNSAFE ACTIONS
➔ Frequency and duration of
administration ➔ Do not crush enteric coated or gel
➔ Any special instructions for -coated tablets
withholding or adjusting dosage ➔ Do not crush long -acting tablets
based on nursing assessment, drug ➔ Do not try to open sealed capsules
effectiveness, or laboratory result ➔ Do not crush contents of spansule –
➔ Physician or other health care with beads or pellets
provider signature or name if TO or ➔ Do not give sublingual formulations
VO orally
➔ Signature of license practitioner ➔ Do not crush sublingual formulations
➔ Do not give oral medications
sublingually
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

SAFE ACTIONS Intramuscular Site: VENTROGLUTEAL

➔ 1y/o and adult
➔ Scored tablets may be split ➔ No large nerve or blood vessels
➔ Chewable medications can be ➔ Sealed off by bone
crushed safely ➔ Contains less fat than buttocks
➔ If a capsule opens easily, powder Intramuscular Site: VASTUS LATERALIS
from the capsules can be mixed with ➔ Site of choice for 1y/o and younger
food or liquid ➔ Infants with poorly developed gluteal
➔ Liquid -filled capsule contents can muscles
be (a) squeezed out, or (b) aspirated Intramuscular Site: DORSOGLUTEAL
then mixed with food or liquid ➔ For adults and children with well
➔ A sublingual formulation can still be developed gluteal muscles
given ever if client is NPO ➔ Contraindicated: children under
➔ Beads from readily opened capsules 3y/o
can be sprinkled over soft food, but ➔ Increase risk of striking the SCIATIC
should not be chewed. NERVE
Intramuscular Site: DELTOID
PARENTERAL MEDICATIONS ➔ Small muscle, very close to the
Intradermal Site: radial nerve and artery
➔ Inner lower arm ➔ Rapid absorption for adults
➔ Upper chest ➔ Don’t administer more than 1 mL
➔ Anterior chest Intramuscular Site: RECTUS FEMORIS
➔ Upper back beneath the scapula - Can be use for self administration
Intradermal Angle: Gauze: #24,23,22,21,20
➔ Almost parallel to the skin Length: 1”, 1 ½”, 2”
➔ 10-15° Max. cc: 2 - 5 mL
Gauze: #25,26,27 Angle: 90-degrees
Length: ⅜, ⅝, ½
Max. cc: 0.1 - 0.2 mL Intravenous/Intravascular
Gauze: #24,23,22,21,20
Subcutaneous Site: Length: 1”, 1 ½”, 2”
➔ Outer aspect of the upper arms Max. cc: PUSH: 10 mL
➔ Anterior thighs Infusion: 4L in 24 hours
➔ Abdomen
➔ Upper back PARENTERAL MEDICATIONS
➔ Ventrogluteal
➔ Dorsogluteal
ID/SC IM/IV
Subcutaneous Angle:
- 45° (1 inch of tissue can be grasped) GAUZE 25 (above) 24 (below)
- 90° (2 inches of tissue can be
grasped) LENGTH <1 inch 1 inch and
up
Gauze: #25,26,27 Length: ⅜, ⅝, ½
Max. cc: 1-3 mL
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
TOPICAL MEDICATIONS
Transdermal Patch Site: TRUNK OR
LOWER ABDOMEN
➔ Areas that are hairless
➔ (+) hair (CLIP, do not shave)
➔ Not subject to excessive movements
or wrinkling
➔ AVOID: cuts, burns, abrasions, distal
extremity
OPHTHALMIC MEDICATIONS
Preparation:
➔ Clean the eyelid and lashes from
INNER to OUTER canthus
➔ Instruction before ADM
➔ Look up
Where and how much to apply:
Liquid
➔ Instill correct number of drops
➔ Outer third of the lower conjunctival
sac
Instruction after installation:
➔ Do punctal occlusion for 30 secs
OTIC MEDICATIONS
Preparation:
➔ Clean the pinna and the meatus of
the ear canal
➔ Warm the medication:
In between hands or place in the
water
Straighten the Auditory Canal:
➔ Adult (3y/o above) Pull the pinna
UPWARD and BACKWARD
➔ Child (3y/o below) Pull the pinna
DOWNWARD and BACKWARD
Instill the medication:
➔ Along the side of the canal
Actions after:
➔ Gently press the tragus
➔ Install small piece of cotton fluff
loosely
Instruction after:
➔ Remain in side-lying for 5 minutes
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

PHARMACODYNAMICS ➔ Maximal efficacy – the point at

➔ 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.
Pharmacology Basics
Agonist - is a drug that binds to the
receptor, producing a similar response to
the intended chemical and receptor.
Antagonist - is a drug that binds to the
receptor either on the primary site, or on
another site, which all together stops the
receptor from producing a response.
Dose-Response Relationship
which increasing a drug's dosage no
longer increases the desired
therapeutic response.
Drug Potency
➢ POTENCY – refers to the amount of
drug needed to elicit a specific
physiologic response to a drug.
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)
For example, if the TD50 is 200 and the
ED50 is 20 mg, the TI would be 10.

Drug Affinity Narrow Wide Therapeutic

Therapeutic Index Index Drugs
➔ How avidly a drug binds its receptor Drugs
or how the chemical forces that
Digoxin Ibuprofen
cause a substance to bind its
receptor. Warfarin Acetaminophen
➔ Drug's desire to connect to an open
receptor Lithium Antihistamines
➔ It refers to how much attraction there
Theophylline Most Antibiotics
is between a drug and a receptor,
like a magnet to metal. Cyclosporine Beta Blockers

Drug Efficacy Tacrolimus Multivitamins

Gentamicin Proton pump

➔ Refers to the drug's ability to activate inhibitors
the receptor once it has bound to it
➔ Maximum response achievable from
Onset – is the time it takes for a drug to
an applied or dosed agent
reach the minimum effective concentration
➔ Maximal effect that a drug produces
(MEC) after administration.
irrespective of concentration (dose)
➔ Time from drug administration to first
observable effect (T0-T1)
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Peak – occurs when it reaches its highest Drug Response

concentration in the blood/plasma Drug Response may be:
concentration. T0- T2 1. Primary- always
➔ Duration of action – is the length of desirable/physiologic effects
time the drug exerts a therapeutic 2. Secondary- desirable or
effect. undesirable
➔ Period from onset until the drug Example: Diphenhydramine (Benadryl)
effect is no longer seen. T1-T3 Primary effect: antihistamine; treat
(trough level) symptoms of allergy
Secondary:
Route Onset Peak Duration
Categories of Drug Action
Tablets 15-30mi 1-2hr 4-6hr
n
1. Stimulation/Depression
Chewable Rapid Unknown 1-4hr - Stimulation- increased rate of
cell activity/ secretion from
Enteric-co 5-30min 2-4hr 8-12hr the gland
ated - T3/T4 for hypothyroidism
Extended 5-30min 1-4hr 3-6hr - Depression- decreased cell
activity and function of a
P.R 5-30min 3-4hr 1-4hr specific organ.
- Iodine, propylthiouracil
Theories of Drug Action
2. Replacement
- replaces essential body
Drug-Receptor Interaction compounds
- Example: Insulin
➔ Certain portion of drug molecule
(active site) selectively combines 3. Inhibition/Killing of Organism
with some molecular structure - Interfere with bacterial cell
(reactive site) on the cell to produce growth
a biologic effect - Example: Antibiotics
➔ Receptor site- drugs act at specific
areas on cell membranes; react with 4. Irritation
certain chemicals to cause an effect - Example: Laxativeirritate the
within the cell inner wall of
➔ “Lock and Key Theory”- specific colon---increased
chemical (key) approaches a cell peristalsis--- increased
membrane and finds fit (the lock) at defecation
receptor site- affects enzyme
systems within cells producing
certain effects.
➔ Drug+Receptor=Effect
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Drug-Drug interaction Adverse Drug Reactions

(ADR)
1. Additive Effect - 2 drugs with
similar actions are taken for a
- sometimes called an adverse drug
doubled effect
event –ADE
- 1+1=2
- a negative event following the
- Ibuprofen + paracetamol= added
prescription and administration of a
analgesic effect
medication
- Codeine with acetaminophen =
- a response to a drug which is
better pain control
noxious and unintended, and which
occurs at doses normally used in
2. Synergistic - combined effect of 2
man for the prophylaxis, diagnosis or
drugs is greater than the sum of the
therapy of disease or for the
effect of each drug given alone;
modification of a physiological
1+1=3
function (WHO)
- Aspirin = 30% analgesic effect
- study of ADRs is called
- codeine – 30% analgesic effect
PHARMACOVIGILANCE
- combination = 90% analgesic effect

Two (2) Types of ADR

3. Potentiation - a drug that has no
TYPE A: AUGMENTED
effect enhances the effects of the
➔ means we can often predict these
second drug
reactions from our knowledge of the
- 0+1=2
pharmacodynamic properties of a
- Alcohol enhances the analgesic
drug.
activity of aspirin.
➔ For example, a patient on an
- Prozac + Zestril
antihypertensive drug may develop
dizziness and fainting due to too
4. Antagonistic - one drug inhibits the
great a lowering of their blood
effect of another drug
pressure
➔ - 1+1=0
➔ Patients on NSAIDs can develop
- Tetracycline + antacid= decreased
gastric irritation due to the drug’s
absorption of tetracycline
action on protective gastric mucus.
- Charcoal in alkaloidal poisoning
TYPE B: BIZARRE
➔ where the reaction is wholly
unexpected and could not be
predicted from the
pharmacodynamic properties of the
drug
➔ An example would be anaphylaxis to
any drug, or a red pinprick rash with
penicillin
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Allergic Reactions Ototoxic Drugs

➔ Unpredictable adverse drug effects; ➢ Aminoglycosides

more serious ➢ Diuretics
➔ Response to patient’s immunological ➢ Antimalarials
system to the presence of the drug ➢ Anticancer drugs
➔ Do not occur unless the patient has ➢ Analgesics
been previously exposed to the ➢ Miscellaneous
agent/ chemical related compound
➔ Occurs when the patient is first PHARMACODYNAMICS: effect that drugs
exposed to the drug have on the body

Idiosyncratic Reaction
Regulatory proteins
➢ Receptors
➔ Type B adverse drug reaction
➢ Enzymes
➔ Abnormal reactivity to the drug
➢ Ion channels
caused by a genetic difference
➢ Transporter
between the patient and normal
individual.
Binds to molecular target
➔ Patients with G6PD deficiency will
➢ Affinity
have anemia by using antioxidants.
➢ Efficacy
➢ Potency
Toxicity

Mechanism of drug action

➔ The degree to which a drug can be
➢ DRUG–RECEPTOR
poisonous and thus harmful to the
INTERACTIONS
human body.
➢ DRUG ACTION
➢ LOCK-KEY THEORY
Iatrogenic Responses

Response to drug
➔ Unintentional responses as a result
➢ DRUG-DRUG INTERACTION
of medical treatment
➢ DRUG ADVERSE REACTIONS
➔ Nephrotoxicity; ototoxicity
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
PHARMACOKINETICS
When drug is taken by mouth, it undergoes
3 phases:
1. Pharmaceutical/dissolution
2. Pharmacokinetics
3. Pharmacodynamics
Two (2) Phases of Pharmaceutic Phase
Disintegration – breakdown into smaller
parts
Dissolution – further breakdown into
smaller parts in GIT – absorption; dissolve
into liquid
Pharmaceutic Phase (Dissolution)
➔ The 1st phase of drug action.
➔ In the GI tract, drugs need to be in
solution so they can be absorbed.
➔ Disintegrate into small particles to
dissolve into a liquid.
➔ Rate of dissolution is the time it
takes the drug to disintegrate and
dissolve to become available for the
body to absorb it.
Excipients
➔ Tablets are not 100% drug.
➔ Fillers and inert substances –
excipients.
➔ Allow drugs to take on particular size
and shape and to enhance drug
dissolution.
Important Uses of Drug Excipients
➔ Aid in the processing of the drug
delivery system during its
manufacture
➔ Protect, support or enhance stability,
bioavailability, or patient
acceptability
➔ Assist in product identification, and
enhance any attribute of the overall
safety
➔ Assist in the effectiveness and /or
delivery of the drug in use
➔ Assist in maintaining the integrity of
the drug product during storage
Factors Affecting Rates of Dissolution
- Form of drug ( LIQUID VS. SOLID) –
liquids more absorbed than solid,
already in solution, rapidly available
for GI absorption
➔ Gastric pH( acidic vs. alkaline) –
acidic media faster disintegration &
absorption
➔ normal gastric pH – 1.5-3.5
➔ Age – young & elderly – increase pH
decrease absorption
➔ Enteric coated drugs – resist
disintegration in gastric acid
Disintegration occurs only in alkaline
environment ( intestine) Should not
be crushed
➔ Presence of food – interfere with
dissolution & absorption, enhance
absorption of other drugs, may be
protectants of gastric mucosa.
Pharmacokinetics
➔ - process of drug movement
throughout the body that is
necessary to achieve drug action.
Four Process
1. Absorption
2. Distribution
3. Metabolism – biotransformation
4. Excretion - elimination
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Absorption 2. Pinocytosis – is the process by which

➔ movement of the drug into the
bloodstream after administration. -
➔ 80% of drugs are taken by mouth –
enteral.
➔ Movement of drug molecules from
site of administration to circulatory
system
cells carry a drug across their membrane by
engulfing the drug particles in a vesicle.
3. ACTIVE TRANSPORT - requires energy
to facilitate the transport of drug molecules
against a concentration gradient, which
usually occurs at specific sites in the small
intestine.

Factors Controlling The Rate and Drug Distribution

Reliability of Drug Absorption
➔ process by which drug becomes
available to body fluids and tissues.
Physiological Physico-chemical
➔ is the movement of the drug from the
Blood flow to Solubility circulation to body tissues.
absorbing site
Protein Binding
Total surface area Chemical stability
for absorption
➔ as drugs are distributed in the
Time of arrival and Lipid to water plasma --- bind with plasma protein.
contact time at partition coefficient ➔ albumin, lipoproteins, alpha-1-acid
absorption site glycoprotein
Degree of
ionization Factors affecting drug distribution:

➔ Size of the organ

Movement of drug particles from GIT to
➔ Blood flow
body fluids involve 3 processes:
➔ Solubility

1. Passive transport
Drug Metabolism
a. Diffusion – drugs move
across the cell membrane
➔ or biotransformation is the process
from an area of higher
by which the body chemically
concentration to one of lower
changes drugs into a form that can
concentration.
be excreted.
b. Facilitated diffusion –passive
transport – requires a carrier
First-pass effect or first-pass metabolism
such as enzyme or protein to
move the drug against a
➔ GI tract --- intestinal lumen -- liver---
concentration gradient. This
some drugs are metabolized to an
does not require energy.
inactive form and excreted---
reduced amount of active drug
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
➔ liver enzymes – cytochrome P450
system – convert drugs to
metabolites.
➔ decreased drug metabolism rate will
result in excess drug accumulation
that can lead to toxicity.
➔ Drug half-life is the time it takes for
the amount of drug in the body to be
reduced by half.
Drug Half-life
➔ It can be achieved when the amount
of drug being administered is the
same as the amount of drug being
eliminated.
➔ A steady state of drug concentration
is necessary to achieve optimal
therapeutic benefit.
➔ Half-life/ Elimination half-life (t ½)-
time it takes for one half of drug
concentration to be eliminated
➔ Short t1/2= 4-8hrs: given several
times a day (ex. Penicillin G)
➔ Long t ½ = >12 hours: given 2x or
1x/day (Ex. Digoxin)
Example:
➔ Ibuprofen has a half life of about 2
hours.
➔ if the patient takes 200 mg, in 2
hours, 50% of the drug will be gone,
leaving 100 mg. after 2 hours - 50
mg.
➔ after 2 hours – 25 mg
➔ after 2 hours – 12.5 mg
➔ after 2 hours – 6.25 mg
Factors affecting biotransformation
➢ Genetic- some people metabolize
drugs rapidly, others more slowly
➢ Physiologic
➔ Liver disease
➔ Infants- decreased rate of
metabolism
➔ Elderlies- decreased liver
size, blood flow, enzyme
production- slows
metabolism
➢ Environment- cigarettes may affect
the rate of some drugs.
➢ Stressful environment- prolonged
illness, surgery, illness.
Drug Excretion
- removal of the drug from the body.
Drug is changed into an inactive
form and excreted by the body.
Routes:
➔ Kidney- main organ for drug
elimination: leave the body through
urine
➔ Free or/unbound/water soluble drugs
filtered in the kidney
➔ (+) kidney disease- dose must be
decreased.
➔ kidneys – main route of drug
excretion
➔ bile, lungs, saliva, sweat and breast
milk.
➔ urine pH influences drug excretion.
➔ Normal urine pH 4.6-8
➔ Acidic urine promotes elimination of
weak base drugs.
➔ Alkaline urine promotes elimination
of weak acid drugs.
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

Drug: Aspirin PHARMACOKINETICS: movement of drug

into, through, and out of the body
➔ Drug Class: example of a weak acid
(RCOO- + H+ ↔ RCOOH )
➔ Pharmacokinetics:
➔ Almost all drugs are filtered by the Drug - Dissolution
glomerulus. administered - Disintegration
➔ The protonated form of a weak acid
is the neutral, more lipid-soluble - Passive Drug - Physiological
Transport absorption -Physico-chemica
form.
- Pinocytosis l
➔ If a drug is in a lipid-soluble form - Active
during passage through the renal Transport
tubule, a significant fraction will be
reabsorbed by passive diffusion Drug Plasma Protein
across membranes and back into distribution binding
component
the blood.
➔ Therefore, weak acids are excreted Drug First-pass effect
faster in alkaline urine because it metabolism factor (liver)
causes a greater fraction of drug to
be in a charged form (which cannot Drug Drug elimination
elimination
be reabsorbed).
➔ pH differences can also cause
trapping or altered absorption in the
stomach & small intestine.
➔ Drug Interactions: Drugs that
alkalinize the urine (e.g. sodium
bicarbonate, potassium or sodium
citrate, thiazide diuretics,
carbonic-anhydrase inhibitors)
increase the rate of salicylate renal
excretion.
➔ Notes: A very large fraction of drugs
in use are either weak acids or weak
bases. Weak organic acids are well
absorbed in the stomach because
they are uncharged at stomach pH.
Weak bases are better absorbed in
the intestines where the pH is
higher.
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
Nursing Process in Pharmacology
Nursing & Pharmacology
➔ It is the art of nurturing and
administering medication to the sick,
combined with the knowledge and
scientific application from other
sciences like chemistry, anatomy,
physiology, biology, nutrition and
psychology, to a particular clinical
situation.
NURSING PROCESS RELATED TO DRUG
THERAPY
➔ Nursing process is a systematic
approach to problem-solving, it is
used to provide efficient nursing care
to maintain basic human function,
➔ It involves gathering information,
formulating a nursing diagnosis
statement, developing patient
centered goals, carrying out
interventions, and evaluating the
process.
➔ It is applied to each step of drug
administration ensuring that
medications are given accurately
and safely.
Nursing Care Plan
➔ A document that provides direction
on the type of nursing care the
individual/ family/ community may
need.
➔ Requires a step-by-step approach to
complete the parts needed for a care
plan correctly
➔ Applying the nursing process, each
individual’s specific need are
addressed, any problems are
identified and a care plan is
developed and implemented to meet
those needs
Steps of the Nursing Process
1. Assessment (Gathering Information)
Subjective Data: (Patient)
Symptoms that are verbalized by the client.
➔ Current health hx including problems
in swallowing, drug allergy
➔ Current Meds: OTC, herbal meds,
nutritional supplements
➔ Past Hx
➔ Client’s Environment
Objective Data: (Nurse)
Client’s Signs are being observed by Nurse:
➔ Check signs & those organs affected
by the drug therapy.
➔ Check the lab. Test.
➔ Blood Chem.
➔ Diagnostic Studies
➔ Physical Assessment
➔ Assess major body systems
for any signs of reaction or
interaction of drugs or
ineffective therapy.
➔ Research about medication order
(MIMS/ Nursing drug handbook)
Comprehensive collection of data:
➔ History: The patient’s past
experiences and illnesses can
influence a drug’s effect.
Relies on 3 sources:
Primary source: patient
Secondary sources: relatives, significant
others, medical records, lab reports
Tertiary Sources: literatures provide
background information; diagnostic tests,
diet
 Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022

➔ Chronic Conditions: can affect the Five Types of Nursing Diagnosis

pharmacokinetics and
pharmacodynamics ➢ Actual: based on human responses
➔ Drug Use: may have an impact on a and supported by defining
drug’s effect characteristics
➔ Allergies: Past exposure to a drug ➢ Risk/high-risk: patient may be more
or other allergens can provoke a susceptible to a particular problem
future reaction ➢ Possible: suspected problems
➔ Level of Education and requiring additional data
Understanding ➢ Wellness: clinical judgment about a
➔ Social Support transition from one level to a higher
➔ Financial Support level
➔ Pattern of Health Care ➢ Syndrome: cluster nursing
➔ Physical Examination: develop a diagnoses that occur together and
baseline information for evaluating best addressed together
the effectiveness of the drug
➔ Weight: helps to determine whether Nursing Diagnosis
the recommended drug dose is
appropriate. ➔ A complete nursing diagnosis
➔ Age: influences pharmacokinetics consists of two or three statements:
and pharmacodynamics; the ➔ A statement of the patient's actual or
immature liver may not metabolize potential health problem, followed by
drugs in the same way as in the ➔ A statement of the problem's
adult probable cause or risk factors
➔ Sign and symptoms (P-E-S)
2. Nursing Diagnosis (Statement of an Problem-Etiology-Signs and
Actual or Potential Problem) Symptoms
- Nurse’s clinical judgment concerning ➔ Knowledge deficit of disease and
a human response to health medication related to inability to
conditions/ life processes or a understand instruction
vulnerability for that response by an ➔ Risk for injury related to side effects
individual, group or community of drug
➔ Alteration in thought processes
Nursing Diagnosis Medical Diagnosis related to drug action
➔ Constipation related to drug action
Focus on unhealthy Identify diseases or side effect
responses to health illness
➔ Fluid volume deficit related to drug
Describes problem treated by Describe problem for action
nurses within the scope of which the physician directs ➔ Ineffective breathing pattern related
independent nursing practice the primary treatment
to drug side effects
May change from day to day Remains the same as long
as patient’s responses change as the disease is present
Pharmacology
BSN 2-YA-15 | De Leon, Sydney | PRELIM REVIEWER | 2022
3. Planning (Prioritized goal setting or
expected outcome)
Four Phases of a Goal Setting
1. Setting priorities: Identify problems and
prioritize
2. Developing measurable goal/outcome
statements: Write short-and long-term goals
for the patient to be followed when providing
care (SMART)
3. Formulating nursing interventions
4. Formulating anticipated therapeutic
outcomes
Plan which intervention to use based on
anticipated patient behavior
4. Implementation (Actions undertaken
to meet a patient’s needs)
Types of Nursing actions
➢ Independent action: provided by
nurse by virtue of education and
license
➢ Dependent actions: performed by a
nurse based on health care
provider’s orders
➢ Interdependent actions
(Collaborative): implemented with
the cooperation of a team
Three types of nursing interventions are
frequently involved in drug therapy:
➔ Drug administration
➔ Provision of comfort measures
➔ Patient/family education.
Proper Drug Administration:
1. 10 rights
2. Comfort Measures
3. Placebo Effect: The anticipation that
a drug will be helpful
4. Manage Adverse Effects
5. Lifestyle Adjustment
6. Patient and Family Education
10 Rights on Medication Administration
1. Right Patient
- Check the name on the prescription
and wrist band.
- Use 2 or more identifiers
- Ask patients to identify themselves
2. Right Medication
➔ Check the name of the medication,
brand names should be avoided.
➔ Check the expiry date.
➔ Check the prescription.
➔ Make sure medications, especially
antibiotics are reviewed regularly
3. Right Dose
➔ Check prescription
➔ Confirm the appropriateness of the
dose.
➔ If necessary, calculate the dose and
have another nurse the check the
dose as well
➔ FORMULA: Dose= D/S x Q IVF
Rate=vol/#hours x DF
Pharmacology
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DOSE & DOSAGE
Dose - It refers to a specified amount of
medication taken at one time
Dosage - It refers to the prescribed
administration of a specific amount, number,
and frequency of doses over a specific
period of time
➔ Give Cephalexin 350 mg susp. thrice
a day
➔ Give Lidocaine 5 mg IV now
Compute for the pediatric dose using the
following information:
Weight: 46 lbs
Age: 5 years
Age: 4 weeks
Adult dose: 12.5 mg
4. Right Route
➔ Check the order and
appropriateness of the route
prescribed.
➔ Confirm that the patient can take or
receive the medication by the
ordered route
Different Routes Implementation
➔ Intravenous (veins): fastest route
(30-60 seconds)
➔ Intramuscular ( 10-20 mins)
➔ Sublingual (3-5 mins)
➔ Subcutaneous (15-30 mins)
➔ Suppository: Rectal (5-30
mins);Vaginal (varies)
➔ Oral ( 30-90 mins)
➔ Buccal ( 5-10 mins)
➔ Intraosseous (bones): 60 secs
➔ Endotracheal (endotracheal tube)
(2-3 mins)
➔ Topical: transdermal (variable: mins
to hours)
5. Right Time
➔ Check the frequency of the
prescribed medication
➔ Double check if you are giving the
prescribed medication at the correct
time
➔ Confirm when the last dose was
given
6. Right Patient Education
➔ Check if the patient understands
what the medication is for.
➔ Make them aware they should
contact a healthcare professional if
they experience side effects or
reactions
HEALTH TEACHING
➔ General Instructions
➔ Self Administration
➔ Diet
➔ Side Effects
➔ Cultural Consideration
7. Right Documentation
➔ Ensure you have signed for the
medication AFTER it has been
administered.
➔ Ensure the medication is prescribed
correctly with a start and end date if
appropriate
Pharmacology
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8. Right to Refuse
➔ Ensure you have the patient consent
to administer medications
➔ Be aware that the patient does have
a right to refuse medication if they
have the capacity to do so.

9. Right to Assessment
➔ Check if your patient actually needs
the medication
➔ Check contraindications.
➔ Baseline observation is required

10. Right Evaluation

➔ Ensure the medication is working the
way it should
➔ Ensure the medications are
reviewed regularly
➔ Ongoing observation is required

KARDEX A medical-patient information

system which uses forms preprinted on
durable card any similar system for paper
based record-keeping.

5. Evaluation (Determining the effects of

the interventions)

Effectiveness of health teaching about drug

therapy & attainment of goals are
addressed in the EVALUATION. If goals are
NOT met, the nurse needs to determine the
reasons for this and revise the PLAN
accordingly, & include additional
ASSESSMENT data & the setting of new
GOALS ( S/E, Adverse , Toxic effects) If
the goals are MET. The plan of care has
been completed. (Therapeutic Effects)