NURSING

PHARMACO
LOGYY
 PRINCIPLES OF
PHARMACOLOGY
Nurses must know:
1. ACTION
2. USUAL DOSAGE
3. DESIRED EFFECT
4. POTENTIAL SIDE EFFECT
BRIEF RECALL…
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What

What are drugs

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 PHARMACOLOGY
Greek: PHARMAKON, “drugs”
LOGOS, “science”
-deals with the study of
(chemical) drugs and their
actions on living organism
MEDICATION
-any substance that is
administered for diagnosis,
cure, relief, prevention of
disease
 DRUG
- interchangeable with MEDICATION
- associated with illegally acquired
substances
- DEUTCH: “DROOG”- means
“dry’
 Pharmfacts
 It takes 11 years of research and development before a
drug is submitted to FDA for review
 Phase I clinical trials take about 1 year and involve 20-
80 normal healthy volunteers
 Phase II clinical trials last about 2 years & involve 100-
300 volunteer patients with the disease
 Phase III clinical trials take 3 years and involve 1,000-
3,000 patients in hospitals and clinic agencies
 For every 5,000 chemicals that enter preclinical testing,
only 5 make it to human testing. Of these 5 potential
drugs, only 1 is finally approved
 Since the 1992 Prescription Drug User Free Act was
passed, more than 700 drugs and biologics have come
to the market
 BRANCHES of
PHARMACOLOGY
 1.
PHARMACOGENETICS
- Study of how each
individual will respond
to specific drugs
2. PHARMACOdynamics

- Study of the
biochemical and
physiological effects or
influence of drugs
 DRUG ACTIONS

Drugs usually work in one of four ways:

1. To replace or act as substitutes for missing
chemicals
2. To depress or slow cellular activities
3. To increase or stimulate certain cellular activities
4. To interfere with the functioning of foreign cells,
such as invading microorganisms or neoplasm.
11
FACTORS AFFECTING DRUG ACTION

a. Developmental considerations
b. Weight
c. Sex
d. Genetic and cultural factors
–Differences in responses of patients
receiving the same medication
12
FACTORS AFFECTING
e. Psychological factorsDRUG ACTION
–The patient’s expectations of the
medication affect the response to the
medication.
f. Pathology
–The presence of disease can affect drug
action
g. Environment
–Sensory deprivation and overload may
affect the drug response.
h. Time of administration
13
3. PHARMACOkinetics
 (ADME)
A-bsorption
D-istribution
M-etabolism, and
Excretion of drug
 Key elements in drug dosage and frequency

1.Critical Concentration- amount

of drug that is needed to
cause a therapeutic effect
2.Loading dose- higher dose
than that usually used or
given for treatment
Key elements in drug dosage and frequency
3. Dynamic equilibrium- actual
concentration that a drug reaches in the
body resulting from a balance in
absorption, distribution, metabolism and
excretion.
Involves the ff:
a. Absorption from the site of entry
b. Distribution to the active site
c. Biotransformation in the liver
d. Excretion from the body
 4 STAGES OF
PHARMACOKINETICS (ADME)
1. ABSORPTION- process by
which a drug is transferred from
SITE OF ENTRY into the body
----- CIRCULATING FLUIDS of
body (blood & lymph)
 FACTORS AFFECTING ABSORPTION

a. Route of administration
b. Drug solubility
c. pH
d. Local conditions at the site of administration –
the more extensive the absorbing surface, the
greater the absorption of the drug and the
more rapid the effect
e. Drug dosage
18
 FACTORS AFFECTING ABSORPTION

f. Serum Drug levels

*Therapeutic range
*Peak level- highest plasma
concentration of the drug
*Trough level- point when the drug is
at its lowest concentration
19
 4 STAGES OF
PHARMACOKINETICS (ADME)

2. DISTRIBUTION- ways in
which drugs are
TRANSPORTED to the SITES
OF ACTION (receptors),
METABOLISM AND
EXCRETION
1. Protein binding – a percentage of
the drug has bound to the plasma
proteins, leaving only the amount
not bound free in the circulation to
produce the drug action
eg. If a drug is 50% protein bound and
the dose given is 100 mg, only 50 mg is
available to exert its therapeutic effect.
2. Lipid solubility – it is
important because the cell
membrane has a high
concentration of lipids.
3. Circulation – initial
distribution of the drug depends
on the cardiac output and blood
flow to local tissue.
- drug concentration at specific
sites depends on the density of
blood vessel in the tissue.
 4 STAGES OF
PHARMACOKINETICS (ADME)

3. METABOLISM
-also known as…
BIOTRANS-
FORMATION
 METABOLISM
 process by which the body INACTIVATES
drugs.
 Primary: metabolic process occurs in the liver =
concentrated enzymes that facilitate reaction.
 Minor: GI tract, Lungs, WBC
 Biotransformation of drug substances for easy
elimination.
2 phases of biotransformation

1.Chemical change in
the drug molecule
2.Conjugation
biotransformation may be facilitated
through enzyme systems
* Some metabolites are inactive and
exert no effect, some are active
and continue to exert effects and
others become toxic. 27
 4 STAGES OF
PHARMACOKINETICS (ADME)

4. EXCRETION- elimination of
drug metabolites through GI
tract to FECES and through
RENAL tubules into the
URINE
 4 STAGES OF
PHARMACokinetics (ADME)

4. EXCRETION
**KIDNEYS- major organ of
drug excretion
Pharmacokinetic considerations
 drug action
 timing of the peak effect
 duration of drug effects
5. FACTORS INFLUENCING DRUG
EFFECTS

1.Weight - the
recommended dosage of a drug
is based on drug evaluation
studies and is targeted at a 150-
pound person. 31
2. Age – is a
factor primarily in
children and older
adults. 32
3. Gender –
physiological differences
between men & women
can influence a drug’s
effect
33
4. Physiological factors –
physiological differences
such as diurnal rhythm of the
nervous & endocrine
systems, acid-base balance,
hydration, and electrolyte
balance. 34
5. Pathological factors –
drugs are usually used to treat disease or
pathology
i.e.
GI disorders
vascular disease & Low Blood Pressure
Liver 0r kidney diseases
35
7. Immunological factors
– people can develop an allergy to a drug.

8. Psychological factors –
the patient’s attitude about a drug have a real
effect on how the drug works.
* Placebo effect 36
9. Environmental
factors – some drug effects are
helped by a quiet, cool,
nonstimulating environment.
i.e.
sedating drugs
antihypertensives 37
10. Drug tolerance
- occurs when the body gets used to a
medicine so that either more medicine
is needed or different medicine is
needed.

i.e.
- morphine
38
11. Drug resistance – occurs
when the drug fails to exert its
intended effect.
12. Dependence – occurs
when a client needs the drug to
function. 39
13. Hydration
- adequate hydration is necessary to
flush the metabolites from the system.
Ex. Dehydrated client – blood will have more
concentrated levels of the drug
- is also likely to accumulate a drug in
the kidneys, resulting in renal toxicity
40
13. Cumulative effect – is the
increasing response to repeated
doses of a drug that occurs when
the rate of administration exceeds
the rate of metabolism or
excretion.
41
14. Disease
a. diseases that tends to slow down
body processes.
Eg. CVD, Hypothyroidism, renal,
hepatic, and GI diseases
b. diseases that speed up any of the
body’s processes
Eg. hyperthyroidism
42
15. Body size, weight &
muscle mass
-the greater the client’s weight,
the more the drug can be diluted
in the body
-the lower the client’s body
weight, the more likely the drug
will accumulate and become
toxic.
43
16 . Social factors
smoking and alcohol
use influence the
metabolism of drugs.
44
17. Drug – Food Interaction

18. Drug – drug or Drug –

Alternative Therapy
Interactions
18. Drug – drug or Drug – Alternative
Therapy Interactions

Drug – drug interactions occur in the ff situations:

a. At site of absorption – one drug prevents or
accelerates absorption of another
b. During distribution – one drug competes with the
binding site of another drug so the second drug
cannot be transported to the reactive tissue
c. During biotransformation – one drug stimulates
or blocks the metabolism of the other drug
46
18. Drug – drug or Drug – Alternative
Therapy Interactions

Drug – drug interactions occur in the ff situations:

d. During excretion – one drug competes for excretion with
the other drug leading to accumulation and toxic effects
of one of the drugs
e. At site of action – one drug may be an antagonist of the
other drug or may cause effects that oppose those of the
other drug leading to no therapeutic effect

47
 Ergo,

• actual effects of a drug are determined by the pharmacokinetics,

the pharmacodynamics and the many human factors that can
change the drug’s effectiveness.

• To provide the safest and most effective drug therapy, the nurse
must consider all of the interacting aspects that influence drug
concentration and effectiveness.

48
4. PHARMACOTHERAPEUTICs

 Study of HOW drugs may best be

used in the treatment of diseases
 Study of WHICH drug would be
most or least appropriate to use for
a specific disease & dose required
 6 major drug uses
1. SYMPTOMATIC TREATMENT
 Relieve disease symptoms
 E.g. Aspirin for fever and headache
2. PREVENTIVE DRUGS
 Help body avoid disease
 E.g. Hepatitis vaccine for serum Hepatitis B
 6 major drug uses
3. DIAGNOSTIC DRUGS
 Help determine whether a disease is present
 E.g. radiopaque drugs
4. CURATIVE DRUGS
 Help eliminate disease
 E.g. antibiotics
 6 major drug uses
5. HEALTH MAINTENANCE DRUGS
 Help keep the body functioning normally
 E.g. insulin
2. CONTRACEPTIVE DRUGS
 Prevents pregnancy
 E.g. Oral contraceptives
 Types of Adverse Effects
1. Primary Actions
Ex: anticoagulants; antihypertensive
2. Secondary Actions
Ex: antihistamines
3. Hypersensitivity
Ex. Kidney problems
Body’s response to Drugs
1.DRUG TOLERANCE
-A condition that occurs when
the body gets used to a
medicine so that either more
medicine is needed or different
medicine is needed.
 Drug tolerance
A. CUMULATIVE RESPONSE
- increased response
related to repeated dose,
decreased metabolism and
excretion
 Drug tolerance
B. IDIOSYNCRATIC
REACTIONS
- occurs when something
unusual or abnormal happens
when a drug is first
administered
 Drug tolerance
C. TACHYPHYLAXIS
- Rapid development of
tolerance to drug
Body’s response to Drugs
2. Drug dependence
- a psychologic craving for,
habituation to, abuse of, or
physiologic reliance on a
chemical substance.
Body’s response to Drugs
3. Drug allergy
 Immunologic reaction to a drug
Anaphylactic reaction- severe
allergic reaction; life-threatening
4 classifications of allergic Rxns
1. Anaphylactic reaction
2. Delayed allergic reaction
3. Cytotoxic reactions
4. Serum sickness reaction
 Teratogenic drug

-A teratogen is an agent that can

disturb the development of the embryo
or fetus. Teratogens halt the pregnancy
or produce a congenital malformation
(a birth defect).
 5. pharmacognosy
- Study of drugs derived from
HERBAL and other NATURAL
sources
- Deals with the sources,
procurement, chemistry of
NATURAL PRODUCTS
 6. TOXICOLOGY
- Study of poisons and
poisoning
- Deals with toxic effects of
substances on the living
organism
7. posOLOGY
study of dosage/
amount of drug to
treat diseases
 Drug/substance abuse
- use of illicit drugs or the abuse of
prescription or over-the-counter drugs
for purposes other than those for which
they are indicated or in a manner or in
quantities other than directed
 DRUG
NOMENCLATUR
E
 Chemical NAME
-Names which precisely describes the
CONSTITUENTS of drugs

Ex. 7-chloro-1,3-dihyro-1-methyl-5-
phenyl-2H-1,4-benzodiazepin-2-one
 Generic name
- a.k.a PRESCRIPTION or
NON-PROPRIETARY NAME
- Name given to a drug before it becomes
official
- FIRST LETTER IS NOT
CAPITALIZED
- Example: diazepam
 R.A. 6675
- GENERIC ACT OF 1988

- “An act to promote, require and ensure

the production of an adequate supply,
distribution, use and acceptance of drugs
and medicines identified by their generic
names”
 Official name
- Name after which the drug is LISTED in
one of the official publications

- Listed by the U.S. Food & Drug

Administration (FDA)
- Example: diazepam,USP
 BRAND NAME
a.k.a TRADEMARK or PROPRIETARY
NAME
- Name given by the manufacturer

-
Followed by a symbol® w/c means the
name is REGISTERED and use is
restricted to the owner
- Ex: Valium ®
 Example:
Chemical Name:
4-Thia-azabicyclol [3,2,0] heptane-2carboxylic
acid, 6{[aminophenylacetyl)amino]3,3-
dimethyl-7-oxo-,[2S-[2a,-5a,6B(S*)]]
Generic Name: ampicillin
Official Name: Ampicillin, USP
Brand Name: Amcill, Principen,
Polycillin
SOURCES OF DRUGS
I. NATURAL SOURCES
- carbohydrates, lipids, proteins,
oil, resins, steroids, glycosides,
tannins, alkaloids, vitamins
and antibiotics
 SOURCES OF DRUGS
II. SEMI-SYNTHETIC
a. Anti-microbial agents
--chemically modifying substances available
from natural sources
b. Human insulin products
- Prepared by chemically modifying animal
insulin so it has precisely the same
chemical structure
 SOURCES OF DRUGS
III. SYNTHETIC
- Formed by chemical reactions in a
laboratory
i.e. Synthroid
 SOURCES OF DRUGS
IV. BIOTECHNOLOGY
- Involves the manipulation of proteins
to permit for the large scale
production of complex natural
substances
Example: HORMONES
 biotechnology
GENE SPLICING
- Genetic manipulation of non-pathogenic,
rapidly growing bacteria (i.e E.COLI)
- Purpose: to manufacture complex
biological compounds which are
extremely difficult/costly to prepare