PART 1: INTRODUCTION TO NURSING animals, or inorganic

PHARMACOLOGY compounds.

1: Introduction to Drugs * To become a drug, a chemical

*Pharmacology - study of the must have a demonstrated
biological effects of chemicals. therapeutic value or efficacy
without severe toxicity or damaging
*Drugs - chemicals that are properties.
introduced into the body to cause
some sort of change. ✓ PLANTS
▪ Plants and plant byproducts
*Pharmacotherapeutics, or have become the main
clinical pharmacology - branch of component of the growing
pharmacology that uses drugs to herbal and alternative
treat, prevent, and diagnose therapy movement.
disease. ▪ have ALSO been used as
medicines since prehistoric
Clinical pharmacology addresses times.
two key concerns:
-the drug’s effects on the body Example:
-the body’s response to the drug ▪ Dronabinol (Marinol) –
contains the active
* Adverse effects: Drug effects, ingredient delta-9-
sometimes called side effects, that tetrahydrocannabinol found
are not the desired therapeutic in marijuana.
effects; may be unpleasant or even ▪ This drug helps to prevent
dangerous. nausea and vomiting in
cancer patients.
Nursing responsibilities include the ▪ Ingestion of a plant-derived
following: food can sometimes lead to
▪ Administering drugs a drug effect.
▪ Assessing drug effects
Intervening to make the drug ✓ ANIMAL PRODUCTS
regimen more tolerable ▪ used to replace human
▪ Providing patient teaching chemicals that fail to be
about drugs and drug produced because of
regimens disease or genetic problems.
▪ Monitoring the overall
patient care plan to prevent ✓ INORGANIC COMPOUNDS
medication errors ▪ Salts of various chemical
elements can have
Sources of Drugs: therapeutic effects in the
Drugs – available from varied human body. Aluminum,
sources, both natural and fluoride, iron, and even gold
synthetic. are used to treat various
conditions.
(1) Natural sources Element Therapeutic use
- Chemicals that might prove useful Aluminum -Antacid to
as drugs can come from many decrease gastric
natural sources, such as plants, acidity
 -Prevention of ▪ Preclinical trials
the formation of -involve testing of potential drugs
phosphate on laboratory animals to
urinary stones determine their therapeutic and
Gold -Treatment of adverse effects.
rheumatoid ▪ Phase I studies
arthritis - test potential drugs on healthy
Iron -Treatment of human subjects.
iron deficiency ▪ Phase II studies
anemia - test potential drugs on patients
Fluorine (as -Prevention of who have the disease the drugs
Fluoride) dental cavities are designed to treat.
▪ Phase III studies
(2) Synthetic sources - test drugs in the clinical setting to
- Scientists use genetic engineering determine any unanticipated
to alter bacteria to produce effects or lack of effectiveness.
chemicals that are therapeutic and
effective. Drug labels:
▪ Drug labels have specific
Drug Evaluation information that identifies a
- After a chemical that might have specific drug.
therapeutic value is identified, it
must undergo a series of scientific ✓ brand name: name given to
tests to evaluate its actual a drug by the
therapeutic and toxic effects. pharmaceutical company
that developed it; also called
Drug Enforcement Agency (DEA) a trade name or
▪ controlled substance proprietary name
categories indicate the
abuse potential and ✓ chemical name: name that
associated regulation of a reflects the chemical
drug. structure of a drug.

FDA (Food and Drug ✓ generic drugs: drugs sold

Administration)
▪ An agency of U.S that
carefully regulates the
testing and approval of all
drugs in this country.
▪ For every 100,000
chemicals, only about 5 end
up being marketed.
Before receiving final FDA approval
to be marketed to the public, drugs
must pass through several stages
of development.
These include preclinical trials
and phase I, II, and III studies.
by their generic name; not
brand name or trade name
product
✓ generic name: the original
designation that a drug is
given when the drug
company that developed it
applies for the approval
process
✓ genetic engineering:
process of altering DNA,
usually of bacteria, to
produce a chemical to be
used as a drug.
✓ orphan drugs: drugs that
have been discovered but
would not be profitable for
a drug company to develop;
these orphans can be
adopted by drug companies
to develop.

✓ over-the-counter (OTC)
drugs: are available without
prescription for the self-
treatment of various
complaints.
 2: Drugs and the Body
PHARMACODYNAMICS – How
drug affects the body.
PHARMACOKINETICS – How the
body acts on the drug.
These processes form the basis for
the guidelines that have been
established regarding drug
administration.
Example:
▪ why certain agents are given
intramuscularly (IM) and not
intravenously (IV)
▪ why some drugs are taken
with food and others are not
▪ standard dose that should
be used to achieve the
desired effect
Pharmacodynamics
- the study of the interactions
between the chemical components
of living systems and the foreign
chemicals, including drugs, that
enter those systems.
Drugs usually work in one of four
ways:
1. To replace or act as substitutes
for missing chemicals
2. To increase or stimulate certain
cellular activities
3. To depress or slow cellular
activities
4. To interfere with the functioning
of foreign cells, such as invading
microorganisms or neoplasms
leading to cell death (drugs that act
in this way are called
chemotherapeutic agents).
Drugs can act in several different
ways to achieve these results.
Receptor Sites
- Many drugs are thought to act at
specific areas on cell membranes
called receptor sites.
- Receptor sites react with certain
chemicals to cause an effect within
the cell.
- The interaction between the
chemical and the receptor site
affects enzyme systems within the
cell.
The activated enzyme systems
then produce certain effects, such
as:
✓ increased or decreased
cellular activity
✓ changes in cell membrane
permeability, or
✓ alterations in cellular
metabolism
Receptor theory of Drug
action
A. Agonist interaction with
receptor site on cell
Molecules of Drug A react with
specific receptors sites on cells of
effector organs and change the
cells activity
B. Competitive antagonism
Some drugs react with receptor
sites to block normal stimulation,
producing no effect.
Example:
CURARE (a drug used on the tips
of spears by inhabitants of the
Amazon basin to paralyze prey and
cause death) occupies receptor
sites for acetylcholine, which is
necessary for muscle
contraction and movement.
By blocking the action of
acetylcholine at this receptor site,
curare prevents muscle stimulation,
causing paralysis.
Curare is said to be a competitive
antagonist of acetylcholine.
C. Noncompetitive Antagonism
- Enzyme inhibitors block the
binding of molecules of normal
substrate to active sites on the
enzyme.
Drug–Enzyme Interactions
- Drugs also can cause their effects
by interfering with the enzyme
systems that act as catalysts for
various chemical reactions.
- Enzyme systems work in a
cascade fashion, with one enzyme
activating another, and then that
enzyme activating another, until a
cellular reaction eventually
occurs.
- If a single step in one of the many
enzyme systems is blocked, normal
cell function is disrupted.
Acetazolamide (Diamox) is a
diuretic that blocks the enzyme
carbonic anhydrase, which
subsequently causes alterations in
the hydrogen ion and water
exchange system in the kidney, as
well as in the eye.
Selective Toxicity
Ideally, all chemotherapeutic
agents would act only on enzyme
systems that are essential for the
life of a pathogen or neoplastic cell
and would not affect healthy
cells.
The ability of a drug to attack only
those systems found in foreign
cells is known as selective toxicity.
Example:
Penicillin
▪ an antibiotic used to treat
bacterial infections, has
selective toxicity.
▪ affects an enzyme system
unique to bacteria, causing
bacterial cell death without
disrupting normal human cell
functioning.
Pharmacokinetics
- involves the study of: (“A.D.M.E”)
Absorption
Distribution
Metabolism (biotransformation),
and
Excretion of drugs
In clinical practice, pharmacokinetic
considerations include:
✓ the onset of drug action
(how long it will take to see
the beginning of the
therapeutic effect)
✓ drug half-life
✓ timing of the peak effect
(how long it will take to see
the maximum effect of the
drug)
✓ duration of drug effects
(how long the patient will
experience the drug effects),
metabolism or
 biotransformation of the drug,
and
✓ the site of excretion
Critical Concentration
- The amount of a drug that is
needed to cause a therapeutic
effect.
- After a drug is administered, its
molecules first must be
absorbed into the body; then they
make their way to the reactive
tissues.
- If a drug is going to work properly
on these reactive tissues, and
thereby have a therapeutic effect, it
must attain a sufficiently high
concentration in the body.
- The recommended dose of a drug
is based on the amount that
must be given to eventually
reach the critical concentration.
- Too much of a drug will produce
toxic (poisonous) effects, and too
little will not produce the desired
therapeutic effects.
Loading Dose
- Some drugs may take a
prolonged period to reach a critical
concentration.
- If their effects are needed quickly,
a loading dose is recommended.
- Digoxin (Lanoxin)—a drug used
to increase the strength of heart
contractions—and many of the
xanthine bronchodilators (e.g.,
aminophylline, theophylline) used
to treat asthma attacks are often
started with a loading dose (a
higher dose than that usually used
for treatment) to reach the critical
concentration.
The critical concentration then is
maintained by using the
recommended dosing schedule.
Dynamic Equilibrium
- The actual concentration that a
drug reaches in the body results
from a dynamic equilibrium
involving several processes:
✓ Absorption from the site of
entry
✓ Distribution to the active site
✓ Biotransformation
(metabolism) in the liver
✓ Excretion from the body
These processes are key elements
in determining the amount of
drug (dose) and the frequency of
dose repetition (scheduling)
required to achieve the critical
concentration for the desired length
of time.
When administering a drug, the
nurse needs to consider the
phases of pharmacokinetics so
that the drug regimen can be made
as effective as possible.
1. Absorption
- refers to what happens to a drug
from the time it is introduced to the
body until it reaches the circulating
fluids and tissues.
Drugs can be absorbed from many
different areas in the body:
▪ through the GI tract either
orally or rectally
▪ through mucous membranes
▪ through the skin
▪ through the lung, or
▪ through muscle or
subcutaneous tissues
 Routes of Administration
Drug absorption is influenced by
the route of administration.
Oral route
▪ the most frequently used
drug administration route in
clinical practice.
▪ Absorbed more slowly than
those given parentally.
▪ The acidic environment of
the stomach is one of the
first barriers to foreign
chemicals.
▪ The acid breaks down many
compounds and inactivates
others.
- When food is present, stomach
acidity is higher and the stomach
empties more slowly, thus exposing
the drug to the acidic environment
for a longer period.
- Certain foods that increase
stomach acidity, such as milk
products, alcohol, and protein, also
speed the breakdown of many
drugs
- To decrease the effects of this
acid barrier and the direct effects of
certain foods, oral drugs ideally
are to be given 1 hour before or 2
hours after a meal.
Parental route
▪ IV administered drugs are
absorbed the fastest.
Intravenous (IV) – drugs that
are injected IV reach their full
strength at the time of injection,
avoiding initial breakdown.
✓ These drugs have an
immediate onset and are
fully absorbed at
administration since they
directly enter the blood
stream.
✓ These are more likely to
cause TOXIC EFFECTS
since the margin for error in
dose is much smaller.
Intramuscular (IM)
✓ Absorbed directly into the
CAPPILARIES in the muscle
and sent into circulation.
✓ Men have more vascular
muscles than women do. So,
drug administered to men
via IM route reach a peak
level faster than they do in
women.
Subcutaneous (SC)
✓ Deposit the drug just under
the skin, where it is slowly
absorbed into circulation.
✓ Timing of absorption varies,
depending on the fat
content of the injection site
and the state of local
circulation.
Absorption process
Drugs can be absorbed into
cells through various processes,
which include:
✓ Passive diffusion
✓ Active transport
✓ Filtration
Passive diffusion
✓ Major process through which
drugs are absorbed into the
body.
✓ Occurs across a
concentration gradient.
✓ When there is greater
concentration of drug on
one side of a cell membrane,
the drug will move through
the membrane to the area
of lower concentration.
✓ Does not require any
CELLULAR ENERGY.
 ✓ Has no electrical charge
that could repel it from the
cell membrane.
Active transport
✓ Uses energy to actively
move a molecule across a
cell membrane.
✓ Not very important in the
absorption of most drugs,
but it is often a very
important process in drug
excretion in the kidney.
Filtration
✓ Involves movement through
pores in the cell membrane.
✓ Another process the body
commonly uses in drug
excretion.
2. Distribution
- involves the movement of a drug
to the body’s tissue.
- factors that can affect distribution
include:
✓ The drug’s lipid solubility
and ionization and
✓ The perfusion of the reactive
tissue
Example:
- tissue perfusion is a factor in
treating a patient with diabetes who
has a lower-leg infection and needs
antibiotics to destroy the bacteria in
the area.
Many drugs are bound to proteins
and are not lipid soluble. These
drugs cannot be distributed to the
central nervous system (CNS)
because of the effective blood–
brain barrier, which is highly
selective in allowing lipid-soluble
substances to pass into the CNS.
Protein Binding
✓ Most drugs are bound to
some extent to proteins in
the blood to be carried into
circulation.
✓ The protein–drug complex is
relatively large and cannot
enter into capillaries and
then into tissues to react.
✓ The drug must be freed from
the protein’s binding site at
the tissues.
Blood–Brain Barrier
✓ a protective system of
cellular activity that keeps
many things (e.g., foreign
invaders, poisons) away
from the CNS.
✓ Drugs that are highly lipid
soluble are more likely to
pass through the blood–
brain barrier and reach the
CNS.
✓ Drugs that are not lipid
soluble are not able to pass
the blood–brain barrier.
Placenta and Breast Milk
- Many drugs readily pass through
the placenta and affect the
developing fetus in pregnant
women
- it is best not to administer any
drugs to pregnant women because
of the possible risk to the fetus.
3.Biotransformation(Metabolism)
- Enzymes in the liver, in many
cells, in the lining of the GI tract,
and even circulating in the body
detoxify foreign chemicals to
protect the fragile homeostasis that
keeps the body functioning.
LIVER – most important site of
drug metabolism or
biotransformation, the process by
which drugs are changed into now,
less active chemicals.
First-Pass Effect
- Drugs that are taken orally are
usually absorbed from the small
intestine directly into the portal
venous system (the blood vessels
that flow through the liver on their
way back to the 96 heart).
- Aspirin and alcohol are two
drugs that are known to be
absorbed from the lower end of the
stomach.
- The portal veins deliver these
absorbed molecules into the liver,
which immediately transforms most
of the chemicals delivered to it by a
series of liver enzymes.
- These enzymes break the drug
into metabolites, some of which
are active and cause effects in the
body, and some of which are
deactivated and can be readily
excreted from the body.
- As a result, a large percentage of
the oral dose is destroyed at this
point and never reaches the tissues.
(This phenomenon is known as the
first-pass effect.)
- The portion of the drug that gets
through the first-pass effect is
delivered to the circulatory
system for transport throughout
the body.
Hepatic Enzyme System
- The intracellular structures of the
hepatic cells are lined with
enzymes packed together in what
is called the hepatic microsomal
system.
- Because orally administered
drugs enter the liver first, the
enzyme systems immediately work
on the absorbed drug to
biotransform it.
Phase I biotransformation:
- involves OXIDATION,
REDUCTION, and HYDROLYSIS
of the drug via the CYTOCHROME
P450 system of enzymes.
- These enzymes are found in
most cells but are especially
abundant in the liver.
Phase II biotransformation
✓ usually involves a
conjugation reaction that
makes the drug more polar
and more readily excreted
by the kidneys.
4. Excretion
Excretion is the removal of a drug
from the body.
- The skin, saliva, lungs, bile, and
feces are some of the routes used
to excrete drugs.
- The kidneys, however, play the
most important role in drug
excretion.
FOCUS ON Safe Medication
Administration
LIVER
✓ Very important in
metabolizing drugs in the
body.
KIDNEY
✓ Responsible for a large part
of the excretion of drugs
from the body.
Always get into the habit:
▪ Checking a patient’s liver
and renal function before a
patient starts a drug regimen.
▪ Dose adjustment needs to
be considered.
Half-Life
The half-life of a drug is the time it
takes for the amount of drug in the
body to decrease to one half of
the peak level it previously
achieved.
Example:
▪ If a patient takes 20 mg of a
drug with a half-life of 2
hours, 10 mg of the drug will
remain 2 hours after
administration.
▪ Two hours later, 5 mg will be
left (one half of the previous
level); in 2 more hours, only
2.5 mg will remain.

This information is important in

determining the appropriate
timing for a drug dose or
determining the duration of a drug’s
effect on the body.

Factors Influencing Drug

Effects
- Weight
- Age
- Gender
- Physiological factors
- diurnal rhythm
- electrolyte balance
- acid–base balance
- hydration
- Pathological factors
- disease
- hepatic dysfunction
- renal dysfunction
- gastrointestinal dysfunction
- vascular disorders
- low blood pressure
- Genetic factors Immunological
factors
- allergy
- Psychological factors
- placebo effect
- health beliefs
- compliance
- Environmental factors
- temperature
- light
- noise
- Drug tolerance
- Cumulation effects
- Interactions
 4: Nursing process in Drug Therapy - Past medical history
and Patient Safety - Level of education and
understanding
NURSING PROCESS - Financial and Social support
- Systematic method of problem - Drug use
solving that forms foundation of - Pattern of Healthcare
nursing practice.
NURSING PROCESS -
- Utilizing steps of nursing process DIAGNOSIS
ensures that the interdisciplinary • Diagnosing – clinical judgments
practice of pharmacology results in of patient’s actual or potential
safe, effective, and health problem.
individualized medication • Actual or potential alterations in
administration and outcomes for patient function based on
patients. assessment of the clinical situation.

NURSING PROCESS • When applied to

ASSESSMENT pharmacotherapy, addresses 3
▪ Information gathering main areas of concern:
▪ Patient history - Promoting therapeutic drug
▪ Physical examination effects
- Minimizing adverse drug effects
DIAGNOSIS and toxicity
▪ Information interpretation - Maximizing the ability of the
▪ Stating problems & patient
strengths
NURSING PROCESS -
PLANNING PLANNING
▪ Setting nursing goals • Planning – formulating desired
desired outcomes and outcomes, setting goals and
planning interventions effective drug therapy.
• This includes:
IMPLEMENTATION - effective response to drug therapy
▪ Perform nursing - minimizing adverse effects
interventions - understanding the drug regimen

EVALUATION • When applied to

▪ Patient’s status pharmacotherapy, involves 2 main
▪ Effectiveness of nursing concepts:
interventions - Drug administration
- Patient teaching
NURSING PROCESS –
ASSESSMENT SET GOALS
⊹ Assessment – collection, S- Specific
organization, validation and M- Measurable
documentation of patient data. A- Achievable
⊹ Objective data R- Realistic
⊹ Subjective data T- Timely
⊹ Initial health history
Essential questions related to:
NURSING PROCESS -
IMPLEMENTATION
• Implementation - application of
knowledge, skills, and principles of
nursing care to help move patient
toward desired goal and optimal
wellness.
• Involves nursing interventions.
THREE TYPES OF NURSING
INTERVENTIONS
• Drug administration
• Provision of comfort measures
• Patient/family education
NURSING PROCESS -
EVALUATION
• Evaluation - part of the
continuing process of patient care
that leads to changes in
assessment, diagnosis, planning,
and intervention.
• The patient is continually
evaluated for therapeutic response,
the occurrence of adverse drug
effects, and the occurrence of
drug– drug, drug–food, drug–
alternative therapy, or drug–
laboratory test interactions

• Drug Administration - The nurse • The process of evaluation may

must consider eight points, or lead to changes in the nursing
“rights,” to ensure safe and interventions being used to provide
effective drug administration. better and safer patient care.

8 RIGHTS Medication Errors

1. RIGHT DRUG • Nurse’s Role
2. RIGHT STORAGE OF • The Patient Role
DRUG • Reporting of Medication Errors
3. RIGHT AND MOST
EFFECTIVE ROUTE • Medication Errors - The drug
4. RIGHT DOSE regimen process, which includes
5. RIGHT PREPARATION prescribing, dispensing, and
6. RIGHT TIMING administering a drug to a patient,
7. RIGHT PATIENT has a series of checks along the
8. RIGHT RECORDING OF way to help to catch errors before
ADMINISTRATION they occur.

• Comfort Measures - Nurses are in Nurse’s Role – The task of nurse

a unique position to help the patient
cope with the effects of drug
therapy.
• Placebo Effect
• Managing Adverse Effects
• Lifestyle Adjustments
• Patient and Family Education -
Ensure the patient that they have
all of the information necessary to
ensure safe and effective drug
therapy at home.
is to ensure drug safety by
managing the "rights" in a
consistent manner.
1. Right Patient – it is always
important to make sure that
you are giving the drug to
the correct patient.
2. Right Drug – to prevent
medication errors, always
check to make sure the drug
you are going to administer
is the one that was
prescribed.
 3. Right Storage - some drugs prescription, OTC, and herbal
require specific storage medications
environments. - Never use adult medications to
treat a child.
4. Right Route - determine the - Read all labels before giving your
best route of administration child a drug.
- Measure liquid medications using
5. Right Dose - always appropriate measuring devices.
double-check calculations, - Call your healthcare provider
and always do the immediately if your child seems to
calculations if the drug is not get worse or seems to be having
available in the dose trouble with a drug.
ordered.
• Reporting of Medication Errors
6. Right Preparation - Know – Medication errors must be
the specific preparation reported on a national level as well
required before as on an institutional level to
administering any drug. prevent patient harm.

7. Right Time - timing of

administration is established
and providing written
instructions regarding timing.

8. Right Recording - Always

document drug
administration. If it isn’t
written, it didn’t happen.

• Patient’s Role – Encourage

patients to be their own advocates
and to speak up and ask questions
to prevent medication errors.

Teaching Points :
- Keep a written and/or electronic
list of all medications you are taking,
including prescription, OTC, and
herbal medications
- Know what each of your drugs is
being used to treat
- Read the labels, and follow the
directions
- Store drugs in a dry place, away
from children and pets
- Speak up

For Children :
- Keep a list of all medications you
are giving your child, including