Pharmacology
Introduction Notes
Rodrigo, Kisha Bethel G. BSN 2-D
Tablets and capsules taken by mouth has two phases
- Pharmacokinetic Phase
- Pharmacodynamics
The drug NEEDS to be a solution first, so that it can cross
the biologic membrane of the cell.
When drug is administered Parenterally:(DOESN’T NEED
to be converted to a solution)
- Subcutaneous
- Intramuscular
- Intravenous Routes
PHARMACOKINETIC PROCESSES
- Absorption
- Distribution
- Metabolism or Biotransformation
- Excretion or Elimination
PHARMACODYNAMICS
- A biologic or physiologic results
PHARMACOKINETICS
➔ The process of drug movement throughout the body
that is necessary to achieve drug action.
➔ 4 processes:
1. Absorption
2. Distribution
3. Metabolism or Biotransformation
4. Excretion or Elimination
1. ABSORPTION
➔ Refers to the movement of drug into the
bloodstream after administration
➔ Generally, drugs are disintegrated and
absorbed faster in acidic fluids than in
alkaline fluids
➔ The very young and older adults have less
gastric acidity - drug absorption is slower
➔ Enteric coated drugs are meant to be
absorbed in the small intestine.
➔ Most oral drugs enter the bloodstream
following absorption across the mucosal
lining of the small intestine.The epithelial
lining of a small intestine is covered with
villi finger electrocutions, that increase the
surface area available for absorption.
➔ Absorption is reduced if the villi is
decreased in number because of disease,
drug effect or the removal of some or all of
the small intestine.
➔ Drugs are absorbed in the mucosal lining of
the small intestine through:
1. Passive transport​ (diffusion and
facilitated diffusion)
2. Active transport​ (needs enzyme or
protein)
3. Pinocytosis
Passive transport ​(diffusion and facilitated diffusion)
- DOESN’T require energy to move drugs across the
membrane
- occurs in two (2) processes:
➔ Diffusion - drug moves across the cell
membrane from an area of higher
concentration to lower concentration.
➔ Facilitated Diffusion - relies on a carrier
protein to move the drug from an area of
higher concentration to lower concentration.
Active Transport ​(needs enzyme or protein)
- Requires a CARRIER such as enzyme or a protein
to move drugs against a concentration medium.
- Energy is required for active absorption.
Pinocytosis
- Is a process by which cells carry a drug across their
membrane by engulfing the drug particles into a
vesicle.
- Mucous membrane that lines the GI tract is
composed of lipids or fats and protein such that
- lipid soluble drugs = can pass rapidly through the
mucous membrane
- Water-soluble drugs = needs carrier either an
enzyme or protein to pass through the mucous
membrane
- Large particles can pass through the mucous
membrane if they are non-ionized.
- Drugs that are lipid-soluble and non-ionized
ABSORB FASTER than water-soluble and ionized
drugs.
➔ Drugs in liquid form are more rapidly absorbed than
solid drugs
➔ Pain, stres, and foods that are solid, hot or high in
fat -> drugs remain in the stomach longer
◆ Cause slow gastric emptying time
➔ Poor circulation to stomach hamper absorption.
◆ This can be due to shock vasoconstrictor
drugs or diseases.
➔ Drugs given rectally are absorbed slower than drug
administered by mouth
◆ The composition of the suppository based
drug affects the absorption4
➔ There are drugs that do not pass GIT due to the
route of administration
◆ Just like parenteral routes buccal and
inhalation
 ◆ drugs given intramuscularly are absorbed
faster in muscles that have increased blood
flow like deltoid than those that DO NOT
like gluteus maximus
◆ Subcutaneous has decreased blood flow
when compared with muscle thus
absorption rate is lower in subcutaneous
than in IM.
➔ First-pass effect or first-pass metabolism
➔ Bioavailability - percentage of administered drug
available for activity
➔ Bioavailability of PO drugs is less than 100% and
for IV is is 100%
➔ Factors that alter bioavailability:
◆ Drug form
◆ Route of administration
◆ Gastric mucosa and motility
◆ Administration with food and other drugs
◆ Changes is liver metabolism
● Caused by liver dysfunction or
inadequate hepatic blood flow
● A decrease in liver function or a
decrease in hepatic blood flow can
increase the bioavailability of a
drug, but only if the drug is
metabolized by the liver.
● Less drug is destroyed in the
hepatic metabolism in the presence
of a liver disorder
2. DISTRIBUTION
➔ Refers to the movement of the drug from the
circulation to body tissues and is influenced by the
rate of the blood flow to the tissues. Drugs' affinity
to the tissue and...
➔ Protein Binding
◆ 90% bound to protein are highly known as
highly protein-bound
◆ LESS THAN 10% bound to protein are
weakly protein-bound drugs.
◆ The portion of the drug that is bound to
protein is inactive, because it is not
available to interact with tissue receptors,
and therefore isn’t able to exert a
pharmacologic effect
◆ The portion that remains unbound is free
active drug
◆ Free Drugs can exit blood vessel and reach
their site of action causing a pharmacologic
response
◆ May have significantly lower albumin level:
● Patients with kidney or liver
disease
● malnourished may have
significantly lower albumin levels
◆ Nursing implications: the need to check a
patient's protein and albumin levels when
administering drugs.
➔ Drugs taken during:
◆ 1st Trimester-> spontaneous abortion
◆ 2nd Trimester -> Spontaneous abortion,
teratogenesis, or oother subtler defect.
◆ 3rd Trimester -> alter fetal growth and
development.
3. METABOLISM
● The body chemically changes drugs in to a form
that can be excreted
● The liver is the primary site of metabolism
● Cytochrome P450 system - liver enzyme
● Liver disease inhibit drug-metabolizing enzymes in
the liver
● Decreased drug metabolism -> excess drug
accumulation -> TOXICITY
● Half-life: is the amount of drugs into the body to be
reduced by half the amount of drug administered
and the amount of drug remaining in the body from
the previous dose.
● Example: A 500mg Paracetamol was administered
at 0800h. The medication has a half-life of 4 hours.
0800H-500mg
1200H-250mg
0400H-125mg
0800H-62.5mg
1200H-31.25mg
And so on…
● A loading dose
○ A large initial dose of a medication
4. EXCRETION
● Main route is through the kidneys
● Drugs are also excreted through ile, lungs, saliva,
sweat and breast milk
● Urine pH influences drug excretion
● Prerenal, Intrarenal and postrenal conditions affect
drug excretion
● Creatinine and blood urea nitrogen (BUN) are use
to determine renal function
● It is important for nurses to know their patient’s
kidney function to ensure correct dosage
PHARMACODYNAMICS PHASE
● The study of the effects of the drugs on the body
● Primary and secondary effect
● Dose-Response Relationship
○ It is the body’s physiologic response to
changes in drug concentration at the site of
action
○ Potency
■ Amount of drug needed to elicit a
specific physiologic response to a
drug
■ A drug with high potency produces
significant therapeutic response at
low concentration
■ Low potency produces minimal
therapeutic responses at a low
concentrations
○ Maximal Efficacy
■ The point at which increasing the
drug’s dosage no longer increases
the desired therapeutic response
○ Therapeutic Index
■ Describes the relationship between
the therapeutic dose of the drug
(ED50) and the toxic dose of the
drug (TD50)
■ Difference between the toxic and
therapeutic doses
○ Therapeutic Dose (ED50)
 ■ Is the dose of a drug that produces ● Drug interaction
a therapeutic response in 50% of ○ Altered or modified action or effect of a
the population drug as a result of interaction with one or
○ Toxic Dose (TD50) multiple drugs
■ Is the dose of a drug that produces ● Drug nutrient interactions
a toxic response in 50% of the ○ food may increase, decrease or delay the
population body's pharmacokinetic response to drugs
● Additive drug effect
If therapeutic and toxic doses are close, the drug is said to ○ response is increased beyond what either
have a narrow therapeutic index-require close monitoring to could produce alone
ensure patient safety ○ Example: diuretic and antihypertensive
● Synergist drug effect or potentiation
● Onset, Peak and Duration of Action ○ the clinical effect of the two drugs given
○ Onset together is substantially greater than that of
■ The time it takes of a drug to reach either drug alone
the minimum effective ○ Example: co-amoxiclav
concentration after administration ● Antagonistic drug effect
○ Peak ○ one drug reduces or blocks the effect of the
■ Drug reaches its highest other
concentration in blood ○ example: antidotes
○ Duration of Action ● Pharmacogenetics
■ length of time the drug exerts ○ the study of genetic factors that influence
therapeutic effect an individual's response to specific drug
● Receptor Theory ● Placebo effect
○ The four receptor families: ○ a drug response not attributed to the
1. Cell membrane embedded chemical properties of a drug
enzymes ● Ethnopharmacology
2. Ligand-gated ion channels ○ a subdivision of ethnomedicine and
3. G protein-coupled receptor focuses on the use of herb, powder, teas
systems and animal products as healing remedies
4. Transcription Factors
Related terms in Pharmacology Over-the-counter-drugs
● Agonist ● are drugs that have been found to be safe and
○ Drugs that activate receptors and produce appropriate for use without the direct supervision of
a desired response a healthcare provider
● ANtagonist ● Available for purchase without a prescription and
○ Drugs that prevent receptor activation and many retail locations
block a response ● Nursing implications:
● Nonspecific drug ○ The nurse needs to emphasize that many
○ Drug that affect multiple receptor sites of these drugs are potent and can cause
● Nonselective drug moderate to severe side effects, especially
○ Drug that affect multiple receptors when taken with other drugs
● Side effects ● PAGE 12 OF YOUR BOOKA drug that has
○ Secondary effects of drug therapy cytotoxic action are chemotherapeutics
○ Can be desirable
○ Can be a reason for a client to stop taking Mechanisms of drug action
the medication ● Simulation
Nurse implication: - A drug that stimulates enhances intrinsic
Nurse must include health teaching on side activity Like adrenergic drugs which
effects increases heart rateSweating and
● Adverse reaction respiratory rate an example of a drugThat
○ Are unintentional, unexpected reactions to stimulates is Epinephrine
drug therapy that can occur at normal ● Depression
dosages - Depressant drugs decrease neural activity
○ May be mild to severe And bodily functions just like barbiturates
○ Always desirable Which causes cns depression
● Drug toxicity ● Irritation
○ occurs when drug levels exceed the - Drugs that irritate have noxious effect
therapeutic range example of a medication Laxative
○ toxicity may occur secondary to overdose ● replacement
or drug accumulation - Replacement drugs such as insulin replace
● Tolerance essential body compound
○ A decrease responsiveness to a drug over ● Cytotoxic actionDrugs that modify the immune
the course of therapy status
● Tachyphylaxis - Cytotoxic action drugs selectively kill
○ Acut, rapid decrease in response to a drug invading parasites or Cancer and example
 of a drug that has a cytotoxic action are - Sublingual ​you place some medication
chemotherapeutic drugs also called as under the tongue
antineoplastic medications
● antimicrobial action
- Are drugs that prevent, inhibit or kill
infectious organisms ad example is
Co-Amoxiclav
● modification of immune status
- Drugs that modify the immune status
modify, enhance or Depress the immune
system and example of this medication are
corticosteroids When this medication is
taken a long time it may make the person
immunocompromised

Pregnancy Categories of Drugs

Forms and Routes for Drug Administration

● Tablet
- it is the most common form of oral
medication
● Capsule
- Inside a capsule it may be a liquid or
powder form of the medications
● Time-release Capsule or Spansule
- There are small beads within it
- the medication will be released in small
amounts over time
● Enteric-coated medication
- should not crush the medication why
because the coating is designed to hold the
tablet together in the stomach and the
medication will be released in a small
intestine
Routes of Administration of these drugs
- Oral ​the medication will be swallowed by
the patient
- Buccal ​you place a medication between
the cheek and the gums
 ● Assessment
○ Subjective data:
■ Current health history including
family history
■ Dysphagia
■ s/s of illness as verbalize by client
■ current concerns about the patient
■ Allergies
■ financial barriers
■ use of tobacco alcohol and caffeine
■ cultural dietary barriers
■ patient's home safety needs
○ Objective data:
■ Physical health assessment
■ laboratory and diagnostic test
results
■ data from physicians notes
■ measurement of vital signs
■ the patient's body language

● Diagnosis
○ It is made based on analysis of the
assessment data
○ it determines the type of care of the client
will receive

Technological Advances ● Planning

● Old/Current System: Monitoring of serum glucose is ○ the nurse uses the data collected to set
done manually with the use of glucometer goals or expected outcomes and
interventions
insulin pumps that deliver insulin based on money
tearing of the serum glucose level: ● Implementation
○ The nurse provides education, drug
● Old/Current System: Programming of the infusion administration, patient care, and other
pumps are done manually interventions necessary to assist the patient
in accomplishing established goals
intelligent infusion technology that programs iv ○ patient teachings:
infusion based on scanned information ■ General
■ side effects
● Old/Current Systems: Antibiotics are either ■ Diet
administered orally, parentally or topically ■ cultural considerations

aerosolized antibiotic ● Evaluation

○ The nurse determines whether the goals
● Old/Current Systems: Limited use of herbal plants and teaching objectives are being met
and without extensive research
SAFETY and QUALITY in PHARMACOTHERAPY
Expanding use of medicinal plants in medicine Five plus Five” Rights of Medication Administration
1. Right Patient
● Old/Current Systems: The nurse or the pharmacist - It is essential, the joint commission requires
personally prepares antineoplastic medication two forms of identification
- Ask the patient to state full name and
robotic mixing of antineoplastic drugs birthdate and compare these with the
patient’s identification band and the
Nursing Process medication administration record
I. Assessment - Note: there are hospitals which have
II. Diagnosis electronic health records in which it will
III. Planning allow the nurse or you directly scan the
IV. Implementation barcode from the patient's identification
V. Evaluation band once the band is scanned the nurse
can see the patient's medication record
then you can verify if he or she is a patient
to whom you should administer the
medication
2. Right Drug
 - The nurse must accurately determine the
right drug prior to medication administration
- Check the medication at least three times
prior to the given medication to the patient
- A nurse working in a hospital with electronic
health record once the barcode on the
patient's wrist band has been scanned the
patient's job profile will appear on the
computer screen then you will scan the
patient's medication label it will
automatically validate the time, date and
the nurse administration patient's
medication
3. Right Dose
- Refers to the verification by the nurse that
the dose administered is the amount
ordered and that is safe for the patient for
whom it is prescribed
- Based on the patient’s physical status,
many medication requires the patient’s
weight in order to determine the right dose
4. Right Time
- Refers to the time the prescribed dose is
ordered to be administered
- Best time to administer the medication
5. Right Route
- Is ordered by the health care provider and
indicates the mechanism by which the
medication enters the body
- Ex. nurse needs to assess the patient's
ability to swallow before administering oral
medications
6. Right Assessment
- Requires the collection of appropriate
baseline data before administration of drug
- Ex. taking a complete set of vital signs and
checking laboratory levels prior to drug
administration
7. Right Documentation
- Requires the nurse to record immediately
the appropriate medication the drug
administered
- Document the medication administered
immediately after you have given it to the
patient
8. Right Education
- Requires the patient to receive accurate
and thorough information about the drugs
they are taking and how each drugs relates
to their particular condition
- It includes why the patient is taking the
drug, the expected result of the drug,
possible side effect of the drug, any dietary
restriction or requirements skill
administration with return demonstration
and laboratory test result monitoring
- It is a principle of informed consent which is
the individual having the necessary
knowledge to make a decision.
- Informed patient and families are critical
preventing medication errors
9. Right Evaluation
- Determines the effectiveness of the drug
based on the patient's response to the drug
- Ask whether the medication did for the
patient what it was supposed to do it is
essential that the nurse evaluates the
therapeutic effect of the medication by
assessing the patient for side effects and
adverse reactions.
- Important aspect of patient’s safety
10. Right to Refuse
- the patient has a right to refuse the
medication
- It is the nurse’s responsibility to determine
the reason for the refusalExplained to the
patient the risk involved in refusal And
reinforce the important benefits and the
reasons for taking the medication
- When the medication is refused the refusal
must be documented immediately
- Follow-up is always required Primary nurse
and the healthcare provider should be
informed Cause the omission may pose a
specific threat to the patient
Nurse’s Rights when Administering Medication
1. Right to a Complete and clear order
2. Right to have the correct drug route (form) and this
dose dispense
3. Right to have access to information
4. Right to have policies to guide safe medication
administration
5. Right to administer medication safely and to identify
problems in the system
6. Right to stop, think and be vigilant when
administering medication
Culture of Safety
● ANA encourages the avoidance of punitive
approaches in reporting drug errors because they
focused on punishing individuals for reporting such
errors
● Just culture - does not hold individual practitioners
responsible for a failing system, although it does
not tolerate disregard for a patient or gross
misconduct
● Drug reconciliation
○ an important component in the culture of
safety
○ process of identifying the most accurate list
of all medications that the patient is taking
at transitions in care
○ it prevents discrepancies that can cause
drug error
● The joint commission
○ national patient safety goals
■ the two important goals that
already become standards are the “
do not use” abbreviations and the
list of acceptable abbreviations
■ black box warning by the US FDA
● PAGE 89 OF THE BOOK
● PAGE 88 OF THE BOOK
Counterfeit Drugs
● Look like the desired drug what may have no active,
ingredient, the wrong active ingredient or the
wrong amount of active ingredients
● Report counterfeit products immediately
High alert medications
● High alert drugs can cause significant harm to the
patient
● Example: epinephrine, oxytocin, promethazine.
Insulin, and etc.

Strategies to reduce risk of errors

1. Simplify the storage, preparation, and
administration of high alert drugs
2. write policies concerning safe administration
3. improve information and education
4. Limit access to high alert medication
5. use labels and automated alerts
6. use redundancies ( automated or independent
double checks)
7. closely monitor the patient's response to the
medication

Quality and Safety Education for Nurses (QSEN) and the

Guiding Principles for Patient Engagement
The QSEN competencies are as follow:
● patient and family-centered care
● collaboration and teamwork
● evidence based practice
● quality improvement
● Safety
● Informatics

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Drug standards and legislations

Philippine National Drug Formulary

● Aims to make Quality essential drugs available,
accessible, efficacious, safe and affordable
● It provides the list of medicines registered with FDA
(pharmacopeia)
RA #9711 or Food and Drug Administration Act of 2009
● An act strengthening and rationalizing the
regulatory capacity of BFAD by establishing
adequate testing laboratories and field offices,
upgrading its equipment, argumenting it's human
resource complement, giving a charity to retain its
income, ​renaming it to FDA
RA #9502 or Universally Accessible Cheaper and
Quality Medicines Act of 2008
● A policy of the state to protect public health and
when the public interest or circumstances of
extreme urgency so require, it shall adopt
appropriate measures to promote and ensure
access to affordable quality drugs and medicines
for all
RA #6675 or Generics Act of 1988
● An act to promote, require and ensure production of
an adequate supply, distribution, use and
acceptance of drugs and medicines identified by
their generic name
Interpretation of Drug Label

Amount to administer = amount calculated given to the

patient
Desired dose = dose ordered by the physician
Drug on hand = refers to the amount of drug available
Vehicle = volume of the drug form available

Interpreting Doctor’s Orders

Systems of Measurements
Example:
Administer paracetamol q4H PO to a 5-year old child
whose weight is 14kg and the average adult dose is
600mg. Stock on hand is Paracetamol with a dosage of
200mg/5mL
Then use the Basic Formula to determine the amount to Calculating Intravenous Flow Rate
administer in mL:

Then use the Basic Formula to determine the amount to

administer in mL:

SPECIAL CONSIDERATIONS
● Pediatric Consideration
○ Less develop absorption in neonates and
infants must be considered in dosage
administration
○ drugs for pediatric patients are ordered
based on their weight or body surface area
○ dosing of medication must consider the
child status including age, organ function,
health, and route of administration
○ Atraumatic care principle should be used
when possible
○ nurses may need to crush pills or dissolve
the contents of capsule
○ when injection or venipuncture is necessary
topical anesthetic protocols may be
followed
○ IV infusion sites must be protected
● Geriatric Consideration
○ Aging can significantly alter the drug
distribution
○ renal excretion decreases with age
○ nurses must have a general understanding
of drug classification that requires dosage
adjustments in patient with chronic kidney
disease -> BANDD CAMP
 CNS Notes

Nervous System:
- I​s responsible for sending, receiving and
interpreting information from all parts of the body.
- Responds to external stimuli and also monitors and
coordinates the functions of internal organs.
Central Nervous system​ is composed of the Brain
and spinal cord
- both are enclosed in:
- Protective ​layers called ​Meninges
- Outer ​layer is called​ Dura Mater
- Middle ​layer is called ​Arachnoid Mater
Webinars related to Pharmacology - Inner ​layer is called ​Pia Mater
- The ​Subarachnoid space ​or the ​space between
the arachnoid and pia mater​ is filled with
Cerebrospinal fluid.
Brain
- Is located in the cranium of the skull.
- It is made of three main parts:
- Cerebrum ​- ​largest part of the brain and is
divided into ​left and right hemispheres​.
Each is composed of a ​frontal, temporal,
parietal, and occipital lobe​. The two
hemispheres are ​connected by a nerve
tract​ called the ​Corpus Callosum​. The
surface of the cerebral hemisphere is
folded which increases the surface area.
The Cerebrum is concerned with learning,
memory, interpretation, and personality.

- Cerebellum ​- ​located in the back of the

brain just below the cerebrum. It controls
balance, movement and coordination. The
brainstem is located beneath the cerebrum
and in front of the Cerebellum it connects
the brain with the spinal cord and is
composed of the midbrain, pons, and the
medulla oblongata. The brainstems control
a number of autonomic functions including
respiration and blood pressure.

- Medulla Oblongata​ - ​The spinal cord

extends from the medulla oblongata and
down the back, it is protected by the
vertebral column the spinal cord is a hollow
tube containing cerebrospinal fluid 31 pairs
of spinal nerves arise from the spinal cord.
These nerves transmit information from
body organs to the brain and from the brain
to the organs​.

Peripheral Nervous System

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