PHARMACOLOGY NOTES

(NCM 106)

➢ Four dominant methods:

PHARMACOLOGY
○ By therapeutic use, types of
➢ Derived from two Greek words: condition they are used to treat.
-PHARMAKON (MEDECINE) ○ By the mechanics of action, specific
-LOGOS (STUDY) biochemical reaction that occurs
 Related to pharmacokinetics & when you take a drug
pharmacodynamics ○ By their mode of action, specific
 Therapeutic (intended) way in which the body respond to
 Potential side effects drug
(unintended/unavoidable) ○ By their chemical source
 Classification:
> Analgesic: decreases body pain ➢ The purpose of drug classification:
> Antipyretic: lowers body temp ○ To ensure that you use a drug
safely to achieve outmost benefit
PHARMACOKINETICS ○ Ultimately, every time you take a
drug, your body chemistry is
➢ Medicine- through mouth (takes up to altered
30 mins to see effect) ○ This effects is meant to be
Ex. therapeutic, it can also cause side
Caplet: neozep effects that are harmful.
Enteric coated: enervon ○ Moreover, if you take multiple
Dragee: size of nips drugs, your body chemistry
may be changed in such a way that
DISINTEGRATION a drug is far less effective or the
- Breakdown of tablet into smaller pieces side effects are far more severe.

DISSOLUTION ➢ Drug-Drug Interactions

- Dissolving smaller particles in GI fluid
before absorption
RATE LIMITING
- Time it takes for the drugs to
disintegrate and dissolve to become
available
• Nephrotoxic- affects your kidneys
• Hepatotoxic- affects your liver
DRUG CLASSIFICATION
- Term used to describe medication that
are group together because of their
similarity
1. Chronic: lasts longer than six months
and can continue when the injury or
illness has been treated.
2. Acute: happens quickly and goes away
when there is no cause.
The effectiveness of a drug can often be
reduced if the action of one drug
diminishes the action of another.
•antacids invariably work by blocking
stomach acid but, by doing so, deplete
the stomach of the acids needed to
break down and absorb a class of HIV
drug known as protease inhibitors. If the
medications are taken together, the HIV
drug will be less able to control the viral
infection
Drug Resistance
• Medications used to treat chronic
infections do so in a specific way.
• If used incorrectly or for a long period
of time, a drug may lose its potency as
the infection becomes resistant to its
effects.

PHARMACOLOGY NOTES Page 1

 ➢ Drug Resistance
• Medications used to treat chronic infections
do so in a specific way.
• If used incorrectly or for a long period of
time, a drug may lose its potency as the
infection becomes resistant to its effects.
• If this occurs, other drugs of the same class
may also fail or not work as well.
• e.g. Antibiotics
➢ Parts of the prescription
The superscription or heading with the
symbol "R" or "Rx", which stands for the
word recipe (meaning, in Latin, to take)
The inscription, which contains the names
and quantities of the ingredients;
The subscription or directions for
compounding the drug, and
The signature which is often preceded by the
sign's standing for signa (Latin for mark).
giving the directions to be marked on the
container
➢ Essentials of medication order
The drug order, written by the physician, it
has 7 essential parts for administration of
drugs safely. The nurse should know how to
read a drug order.
It should have the following components:
1- Patients full name.
2- Date and time.
3- Drug name.
4- Dosage.
5- Route of administration.
6- Time and frequency of administration.
7- Signature of physician.
➢ Forms of Oral Medications
❖ Capsules
-Cannot be broken or divided
❖ Tablets
-Only divided if scored
-Coated tablets are not to be broken
❖ Liquids
-May be measured in a medication cup,
syringe or calibrated dropper
PHARMACOLOGY NOTES Page 2
➢ Drug Approval Drug Names
Each drug may have several names
• Chemical Name
- Describes the drugs chemical structure
(most meaningful to the chemist)
• Generic Name
- Official name for the drug
- Not owned by any drug company
- Universally accepted
• Brand Trade Name
- A registered trademark of a drug
company, easier to spell pronounce
- Cardizem (brand) diltiazem HCL (generic)
➢ Drug Approval Pregnancy
• FDA developed a classification system
related to the effects of drugs on unborn
child (fetus) In drug books and literature,
pregnancy category is indicated for most
drugs
- A- No risk to fetus based on studies
- B-Little to no risk based on animal studies,
some human studies
-C-Risk indicated based on animal studies,
Risk vs. benefit
-D- Risk to fetus proved Risk vs. benefit to
mother
-X-Risk proved Avoid during pregnancy
➢ Prescription & over-the-counter drugs
• Legal drugs are obtained either by a
prescription(Rx)or over the counter (OTC)
There are major differences between the
two methods of dispensing drugs.
- To obtain prescription drugs, the
person must receive a written order
from a person with the legal authority
to write such a prescription.
Pharmacokinetics
-The process of drug movement to achieve
drug action
4 processes: Absorption, distribution,
metabolism (Biotransformation), and
excretion (elimination) - ADME
The nurse must be alert to any adverse drug
effects and to report such findings promptly.
 ➢ Absorption
Passage of drug from its site of
administration into the blood circulating
body fluids
• Rate of absorption depends on the route
of administration Enteral. Parenteral and
percutaneous.
• Passive, active, and pinocytosis are
different types of absorption
- the ingestion of liquid into a cell by
the budding of small vesicles from
the cell membrane.
• Bioavailability is a subcategory of
absorption - the percentage of the drug
dose that reaches the systemic circulation
• Occurs after absorption and hepatic drug
• Oral route is always less than 100%
• Intravenous route is usually 100%
➢ Distribution
The ways in which drugs are transported
by the circulating body fluids to the sites of
action
• Influenced by blood flow, affinity to the
tissue, and protein binding effect drugs are
distributed in the plasma (liquid part of the
lymph and blood) and are bound to varying
degrees w/ protein (albumin)
• Portion of drug bound is inactive - not
available to receptors
• Portion of drug unbound is free, active
- only free drugs can cause a
pharmacologic response
- some circulating drugs
(anticonvulsants, aminoglycosides)
are checked for drug blood levels
• Need to be aware of the condition of
your client - liver or kidney disease = low
serum albumin level less protein-binding
sites = excess free drug = drug toxicity
✓ Remember - The amount of drug that
actually reaches the receptor sites
determines the extent of
pharmacologic.
PHARMACOLOGY NOTES Page 3
Medication
Is a substance administered for the diagnosis,
sure, treatment, or relief of a symptom of for
preservation of disease.
Pharmacology- study of the effect of drugs
Prescription- written direction for the
preparation and administration of a drug.
Purpose of medication:
Drugs can BE ADMINISTERED For these Purposes:
✓ Diagnostic Purpose:
to identify any disease.
✓ Prophylaxis
to prevent the occurrence of disease.
EX. Heparin po prevent Thrombosis or antibiotics
to prevent infection.
✓ Therapeutic purpose: To cure the Disease
Uses of Drugs
• Prevention - used as RH prophylaxis to prevent
Diseases (EG. vaccines, Fluoride - Prevents Tooth
Decay)
• Diagnosis - establishing patient's disease or
problem (e-6. Radio contrast dye, Tuberculosis
(Mantoux Testing)
• Suppression- suppresses the Signs and
symptoms and prevents the disease process from
Progressing.
• Treatment- alleviate the symptoms for patients
with Chronic Disease (e.g. Anti-Asthmatic Drugs)
• Cure- complete eradication of diseases (e.g.
Antibiotics, Anti-Helminthic)
Storage medication:
- medications are disposed by the pharmacy
to nursing units. Once delivered, proper
storage becomes the responsibility of the
nurse. All medications must be store in a
cool dry place (usually in cabinets, medicine,
cart or fridge).
PRINCIPIES OF MEDICATION 5. ASAP
ADMINISTRATION -not as urgent as stat
-as soon as possible
Principles include 3 Checks and 10 RIGHTS: -should be available for administration
to the patient with 30 mins of the
➢ 3 CHECKS ARE: written order

1) CHECK when obtaining the container of 6. ROUTINE ORDER

medicine.
1) CHECK when removing the medicine from
The container.
3) CHECK when replacing the container.
-orders not written as stat, asap, now
or prn
-usually carried out within 2 hrs. of the
time the order is written by the
physician

Dosage Calculations
RIGHTS OF MEDICATION ADMINISTRATION
Basic drug calculation:
1) RIGHT to patient
2) RIGHT medication desired dose quantity (v) vehicle form
3) RIGHT time stock on hand & amount which the drug
4) RIGHT dose come
5) RIGHT route
6) RIGHT to information on drug/client
education
7) RIGHT to refuse medication
8 ) RIGHT assessment e.g. order, Ampicillin (Himox) 350 mg
Stock: Ampicillin (Himax) 500 mg in 5 ml
9) RIGHT documentation
vial
10) RIGHT evaluation
D
➢ Types of medication orders
V = A
H
1. STAT ORDER
-indicates that the medication is to be given D= Desired drug dose
immediately and only once. H= Dose on hand
-often associated with emergency V= Vehicle (the drug form)
medications that are needed for life- A= Amount to be given to patient
threatening situation.
-should be administered within 5 mins or less
► How to calculate drug dosage?
of receiving the written order.
Common Conversions:
2. SINGLE ORDER,
-or known As one -time order indicates that ✓1 Liter = 1000 Milliliters
the medications are to be to be given once at
a specific time. ✓1 Gram= 1000 Milligrams

3. STANDING ORDER, is written in advance

✓1Milligram = 1000 Micrograms
carried out under specific circumstances.
✓1 Kilogram = 2.2 pounds
4. PRN ORDER, "PRN" larin word FOR "pro re
nata", WHICH means "As the thing is need" A
✓1 ounce = 30 mL
PRN order or as needed order, permits the
nurse to give a medication when the client Remember! Before doing the calculation, convert
requires it. units of measurement to one system.

PHARMACOLOGY NOTES Page 4

Example:
The ordered dose is Ceftriaxone 750
mg IV. the container contain 1g in a
10 ml vial.
How to calculate?
You should convert first g to mg,
then:
(D) 750 mg
X (V) 10 ml= 7.5 ml
(H) 1000 mg
Example #1:
Dilantin 125 mg is available as 125
mg/5ml. Dilantin 0.3 g is ordered. How
much should the nurse administer to
the patient?
Step 1: Determine your givens.
Amount desired (D)=0.3g
Amount on hand (H)=125mg
Quantity (V) = 5ml
Step 2: Convert 0.3g to mg (since the
ordered dose is in grams but the drug is
available on hand in milligrams)
0.3g X 1,000 mg/g = 300mg
Step 3: Plug in what you know into the
formula and simplify.
300mg/125mgX 5ml = 12ml
Example #02:
Amount desired (D)= 150mg
Amount on hand (H)=300mg/mL
Quantity (V) = 1ml
How many tablets should be given?
150mg /300mgX 1ml = 0.5 tabs
PHARMACOLOGY NOTES Page 5
Example #03:
Amount desired (D)= 10,000 UNITS
Amount on hand (H)=5000 UNITS/mL
Quantity (V) = 1ml
How many mL should be given?
10, 000units /5000unitsX 1ml = 2mL
How to Read Drug Labels
LEARNING OBJECTIVES
On completion of the materials provided in this
chapter, you will be able to identify the following
parts of each drug label:
1 Trade name of the medication
2 Generic name of the medication
3 Strength of the medication dosage
4 Form in which the medication is provided
5 Route of administration
6 Total amount or volume of the medication
provided in the container
7 Directions for mixing or preparation of the
medication if required
The safe administration of medications to patients
begins with the nurse accurately reading and
interpreting the drug label. Thus, it is important for
the nurse to be familiar and comfortable with the
information that is found on the drug label.
PARTS OF A DRUG LABEL
1. TRADE NAME. The trade name (also known as
brand or proprietary name) is usually capitalized
and written in bold print. It is the first name
written on the label. The trade name is always
followed by the ® registration symbol. Different
manufacturers market the same medication
under different trade names.
2. GENERIC NAME. The generic name is the official
name of the drug. Each drug has only one generic
name. This name appears directly under the trade
name, usually in smaller or different type letters.
Physicians may order a patient’s medication by
generic or trade name. Nurses need to be familiar
with both names and cross-check references as
needed. Occasionally, only the generic name will
appear on the label.
3. DOSAGE STRENGTH. The strength indicates 1. Trade name: Keflex
the amount or weight of the medication that is 2. Generic name: cephalexin
supplied in the specific unit of measure. This 3. Dosage strength: 250 mg
amount may be per capsule, tablet, milliliter, 4. Form: Capsules
and 5. Amount: 100
so on. 6. Directions: Keep tightly closed.
Store at controlled room temperature
4. FORM. The form indicates how the drug is 59° to 86° F (15° to 30° C).
supplied. Examples of various forms are tablets, 7. NDC number: 0777-0869-02
capsules, liquids, suppositories, and ointments. 8. Manufacturer: DISTA
9. Expiration date: (Yellow highlight)
5. ROUTE. The label will indicate how the drug is
to be administered. The route can be oral,
topical, injection (subcutaneous, intradermal, Anti-Infective Agents
intramuscular), or intravenous.
Antibiotics:
6. AMOUNT. The total amount or volume of the
medication may be indicated. Some examples ▪ Sulfonamides
are 250 mL of oral suspension and a bottle that ▪ Penicillins
contains 50 capsules. ▪ Cephalosporins
▪ Tetracyclines
7. DIRECTIONS. Some medications must be ▪ Aminoglycosides
mixed before use. The amounts and types of ▪ Quinolones
diluents required will be listed along with the ▪ Macrolides
resulting strengths of the medication. This
information may also be found on package
inserts. Antibiotics
Medications used to treat bacterial
infections Ideally, before beginning
antibiotic therapy, the suspected
areas of infection should be cultured
(bld. culture & sensitivity)to identify
the causative organism and potential
antibiotic susceptibilities.

➢ Empiric therapy: treatment of

Other information may be found on drug labels: the name an infection before specific
of the manufacturer, expiration date, special instructions culture information has been
for storage, a National Drug Code (NDC) number, and
reported or obtained
contraindications.
➢ Prophylactic therapy: treatment
with antibiotics to prevent an
EXAMPLES FOR PRACTICE IN READING DRUG infection, as in intra-abdominal
LABELS surgery Bactericidal: kill bacteria

•Bacteriostatic: inhibit growth of

susceptible bacteria, rather than
killing them immediately; will
eventually lead to bacterial death

PHARMACOLOGY NOTES Page 6

 ➢ Antibiotics: Sulfonamides
One of the first groups of antibiotics
sulfadiazine
• sulfamethizole
•sulfamethoxazole
•sulfisoxazole
➢ Sulfonamides: Mechanism of Action
Bacteriostatic action
-Prevent synthesis of folic acid required for
synthesis of purines and nucleic acid
-Does not affect human cells or certain
bacteria-they can use preformed folic acid
➢ Sulfonamides: sulfamethoxazole
Therapeutic Uses
Azo-Gantanol
•Combined with phenazopyridine (an
analgesic-anesthetic that affects the mucosa of
the urinary tract).
•Used to treat urinary tract infections (UTIs)
and to reduce the pain associated with UTIs.
Bactrim
• Combined with trimethoprim.
• Used to treat UTIs, Pneumocystis carinii
pneumonia, ear infections, bronchitis,
gonorrhea, etc.
Azo-Gantrisin
•Combined with phenazopyridine
•Used for UTIs
Pediazole
•Combined with erythromycin
•Used to treat otitis media
➢ Sulfonamides: Side Effects
Body System: Blood
EFFECT: Hemolytic and aplastic anemia,
thrombocytopenia
PHARMACOLOGY NOTES Page 7
Body System: Integumentary
EFFECT: Photosensitivity, exfoliative
dermatitis, Stevens-Johnson syndrome,
epidermal necrolysis
➢ Antibiotics: Penicillins
•Natural penicillins
•Penicillinase-resistant penicillins
•Aminopenicillins
•Extended-spectrum penicillins
Natural penicillins
penicillin G, penicillin V potassium
Penicillinase-resistant penicillins
cloxacillin, dicloxacillin, methicillin, nafcillin,
oxacillin
Aminopenicillins
amoxicillin, ampicillin, bacampicillin
Extended-spectrum penicillins
piperacillin, ticarcillin, carbenicillin, mezlocillin
➢ Antibiotics: Penicillins
•First introduced in the 1940s
•Bactericidal: inhibit cell wall synthesis • Kill a
wide variety of bacteria
• Also called "beta-lactams"
•Bacteria produce enzymes capable of
destroying penicillins.
•These enzymes are known as beta-
lactamases.
•As a result, the medication is not effective.
Chemicals have been developed to inhibit
these enzymes:
- clavulanic acid
- tazobactam
- sulbactam
•These chemicals bind with beta lactamase
and prevent the enzyme from breaking down
the penicillin
•Penicillin-beta-lactamase inhibitor
combination drugs:
•These chemicals bind with beta
lactamase and prevent the enzyme from
breaking down the penicillin
•Penicillin-beta-lactamase inhibitor
combination drugs:
- ampicillin + sulbactam = Unasyn
- amoxicillin + clavulanic acid =
Augmentin
- ticarcillin + clavulanic acid =
Timentin
- piperacillin +tazobactam = Zosyn,
Tazocin
➢ Penicillins: Mechanism of Action
-Penicillins enter the bacteria via the cell
wall.
• Inside the cell, they bind to penicillin-
binding protein.
• Once bound, normal cell wall synthesis
is disrupted.
• Result: bacteria cells die from cell lysis.
• Penicillins do not kill other cells in the
body.
➢ Penicillins: Therapeutic Uses
-Prevention and treatment of infections
caused by susceptible bacteria, such as:
- gram-positive bacteria
- Streptococcus, Enterococcus,
Staphylococcus species
➢ Penicillins: Adverse Effects
- Allergic reactions occur in 0.7% -
8% of treatments
- urticaria, pruritus, angioedema
- 10% of allergic reactions are life
threatening and
- of these are fatal
PHARMACOLOGY NOTES Page 8
➢ Penicillins: Side Effects
 Common side effects:
✓ nausea, vomiting, diarrhea,
abdominal pain
✓ Other side effects are less
common
➢ Antibiotics: Cephalosporins
▪ First Generation
▪ Second Generation
▪ Third Generation
▪ Fourth Generation
➢ Antibiotics: Cephalosporins
-Semisynthetic derivatives from a
fungus
-Structurally and pharmacologically
related to penicillins
-Bactericidal action
 Broad spectrum
- Divided into groups according to
their antimicrobial activity
 Broad-spectrum antibiotic
- The term broad-spectrum refers
to an antibiotic that acts against a
wide range of disease-causing
bacteria.
- A broad-spectrum antibiotic acts
against both Gram-positive and
Gram-negative bacteria,in
contrast to a narrow-spectrum
antibiotic, which is effective
against specific families of
bacteria.
 ➢ Cephalosporins: First Generation •ceftriaxone
• ceftazidime
• cefadroxil • cefoperazone
•cephalexin • cefotaxime
•cephradine • moxalactam
• cefazolin
•cephalothin - Most potent group against gram-negative -
•cephapirin Less active against gram-positive
- Good gram-positive coverage
- Poor gram-negative coverage
- used for surgical prophylaxis. URTI otitis media ➢ Cephalosporins: Third Generation

➢ Cephalosporins: Second Generation cefixime (Suprax)

-Only oral third-generation agent
• cefaclor Best of available oral cephalosporins against
• cefonicid gram-negative
•cefprozil • Tablet and suspension
• ceforanide
• cefamandole ceftriaxone (Rocephin)
•cefmetazole -IV and IM, long half-life, once-a-day dosing
•cefoxitin Easily passes meninges and diffused into CSF
•cefotetan to treat CNS infections
• cefuroxime
- Good gram-positive coverage
Better gram-negative coverage than first ➢ Cephalosporins: Third Generation
generation
ceftazidime (Ceptaz, Fortaz, Tazidime, Tazicef)

➢ Cephalosporins: Second Generation •IV and IM

• Excellent gram-negative coverage
✓Cefoxitin • Used for difficult-to-treat organisms such as
Pseudomonas spp.
- (Mefoxin) IV and IM •Eliminated renally instead of biliary route
•Used prophylactically for abdominal or •Excellent spectrum of coverage
colorectal surgeries
•Also kills anaerobes
➢ Cephalosporins: Fourth Generation
√cefuroxime

-(Kefurox and Ceftin) PO cefepime (Maxipime)

•Surgical prophylaxis •Newest cephalosporin agents.
•Does not kill anaerobes
- Broader spectrum of antibacterial
activity than third generation, especially
➢ Cephalosporins: Third Generation against gram-positive bacteria.

•cefixime - Cephalosporins S/E is similar to

•ceftizoxime penicillins
•cefpodoxime proxetil

PHARMACOLOGY NOTES Page 9

  Metabolism
→ Major mechanism of the
termination/inactivation of drug action
• Liver is primary site where drugs are
inactivated by liver enzymes, become inactive
metabolites or H20 (soluble substances), for
excretion
• Liver disease alters drug metabolism - drug
toxicity dit a decrease rate of metabolism
❖ Half-life (112) - the time it takes for 1/2
of a drug to be eliminated
 DRUG HALF-LIFE (t₁/2)
Half-life is the time required to reduce the
plasma concentration to 50% of its original
value
▪ Will determine dosing requirements /
how long a drug will remain in the body
▪ Used in determining dosing interval
▪ Goal - Plateau
Half-life
• The half-life of a given medication is how
long it takes for the body to get rid of half of
the dose.
 Excretion
• Drug removal from the body
• Main route is through the urine - other
routes = bile, feces, lungs, breast milk
• Urine pH influences excretion
•Kidney disease affects excretion
➢ Pharmacodynamics
Def: The drugs mechanism of action
→ Drug response can cause a primary or
secondary physiologic effect, or both
→ Primary effect desirable
→ Secondary effect desirable or
undesirable
PHARMACOLOGY NOTES Page 10
> Pharmacodynamics Peak. Onset, Duration
• Onset of action time it takes to reach the
minimum effective concentration
- Peak action- When the drug reaches its
highest blood or plasma concentration
- Duration of action Length of time drug has
an effect
> Pharmacodynamics: Therapeutic
Index/Range
•Safety of drugs is a major concern
Therapeutic index - estimates the margin of
safety of a drug
Low therapeutic index = narrow safety
•High therapeutic index wide safety margin, less
danger of toxic effects
Therapeutic range = area between the minimum
effective concentration & min toxic
concentration of a drug
Principles of Drug Administration
• Nurses are accountable for the safe
administration of medications
• Nurses are legally liable when giving prescribed
drugs - Even if the dosage is incorrect, or the drug
is contraindicated
• Nurses are liable for the predicted effects of a
drug once it is given
➢ A nocebo effect, is said to occur when
negative expectations of the patient
regarding a treatment cause the treatment
to have a more negative effect than it
otherwise would have.
- e.g. when a patient anticipates a side effect
of a medication, they can suffer that effect
even if the "medication" is actually an inert
substance
In chemistry, the term chemically inert is
used to describe a substance that is not
chemically reactive. Most Group 8 or 18
elements that appear in the last column of
the periodic table (Helium, Neon, Argon,
Krypton, Xenon and Radon) are classified as
inert (or unreactive)
> The placebo effect, is said to occur when
positive expectations improve an outcome.
- Both placebo and nocebo effects are
presumably psychogenic
- Psychogenic (psychiatry) originating
from or caused by state of mind;
having a psychological rather than a
physiological cause
Term Meaning
ED Effective Dose
TD Toxic Dose
LD Lethal Dose
TI Therapeutic Index
TR Therapeutic Ratio
*Graded Dose Response Relationship &
Therapeutic Response
Drug dose-response relationships are
important in assessing the efficacy and
potency of drugs.
- They are also useful for the
interpretation of drug and receptor
interactions.
- There are two types of drug dose-
response relationships:
1. the graded dose-response
2. the quantal dose-response
relationships
PHARMACOLOGY NOTES Page 11
➢ Potency and Efficacy
• Potency is an expression of the
activity of a drug in terms of the
concentration or amount of the drug
required to produce a defined effect
- the maximum response
achievable from a
pharmaceutical drug in research
settings, and to the capacity for
sufficient therapeutic effect or
beneficial change in clinical
settings.
So therefore...
Potency is an expression of the activity
of a drug, in terms of the
concentration or amount needed to
produce a defined effect."
• Both Drug A and Drug B achieve
the same maximum effect, i.e.
they have equal efficacy.
However, drug A achieves this
effect at a lower dose. Thus,
Drug A has higher potency than
Drug B
➢ Agonists and antagonists
•Agonists
- activate receptors to produce
the desired response.
•Antagonists
- prevent receptor activation.
- Antagonists decrease cellular
function if they block the action
of a substance that normally
increases cellular function.