NUR104A-

Pharmacology 1
Sean Juvan S. SyCip, MSN, RN
 Introduction

Drugs – are chemicals that areNursing responsibilities includes:

introduced into the body to ▸ administering drugs
cause some sort of change. ▸ Assessing drug effects
▸ Intervening to make the drug
regimen more tolerable
▸ Providing patient teaching
about drugs and the drug
regimen

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 Pharmacology
is the study of the biological effects of
chemicals.
Pharmacotherapeutics or clinical
pharmacology
- The branch of pharmacology
that uses drugs to treat,
prevent, and diagnose
disease.

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 Pharmacology
- 2 key concerns:
■ The drug’s effects on
the body
(pharmacokinetics)
■ And the body’s
response to the drug
(pharmacodynamics)
Adverse effects – negative or
undesirable effects of the drug.

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 Core Ethical Principles

Three core ethical principles are

relevant to research involving human
subjects:
▸ respect for persons,
▸ beneficence, and
▸ justice.

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 “
Respect for Persons
▸ Patients should be treated as independent
persons who are capable of making
decisions in their own best interests.
Patients with diminished decision-making
capacity are entitled to protection.

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 Informed Consent

“
The two most relevant aspects of the Code are the right to
be informed and that participation is voluntary, without
coercion. If coercion is suspected, the nurse is obligated to
report this suspicion promptly. Informed consent has
dimensions beyond protection of the individual patient’s
choice:
• It is a mutual sharing of information, a process of
communication.
• It expresses respect for the person.
• It gains the patient’s active involvement in their care.
• It respects the patient’s right to self-determination.

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 Beneficence

“
Beneficence is the duty to protect research subjects from
harm. It involves assessing potential risks
and possible benefits and ensuring the benefits are
greater than the risk.

Justice
Justice requires that the selection of research subjects be
fair. Research must be conducted so that
the distribution of benefits and burdens is equitable (i.e.,
research subjects reflect all social classes
and racial and ethnic groups).

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Sources of DRUGS 1
 “
▸ Plants
▸ Animal products
- Genetic Engineering is the process of
altering DNA which permits scientists
to produce human insulin by altering
Escherichia coli bacteria, making
insulin a better product without some
of the impurities that come with
animal products.

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 “
▸ Inorganic Compounds
- Aluminum - to decrease gastric acidity,
management of hyperphosphatemia,
prevention of formation of phosphate
urinary stones
- Fluoride – prevention of dental cavities,
prevention of osteoporosis
- Gold – treatment of rheumatoid arthritis
- Iron – treatment of iron deficiency
anemia

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 Phases of Drug Development
Preclinical Trials
-Chemicals that may have therapeutic value are tested on laboratory animals
for two main purposes:
1. To determine whether they have the presumed effects in living tissue
2. To evaluate any adverse effects
-At the end of the preclinical trials, some chemicals are discarded for the
following reasons:
▹ The chemical lacks therapeutic activity when used with living animals
▹ The chemical are too toxic
▹ The chemical is highly teratogenic
▹ The safety margins are so small
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 Phase I studies
- Use human volunteers to test the drugs
- Volunteers are fully informed of possible risks and may be paid for
their participation.

At the end of phase I Studies, many chemicals are dropped from the
process for the following reasons:
▹ They lack therapeutic effect on humans
▹ They cause unacceptable adverse effects
▹ They are highly teratogenic
▹ They are too toxic

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 Phase II studies
- Allow clinical investigators to try the drug in patients who have the
disease that the drug is meant to treat.

At the end of phase II studies, a drug may be removed from further investigation
for the following reasons:
▹ It is less effective than anticipated
▹ It is too toxic when used with patients
▹ It produces unacceptable adverse effects
▹ It has low low benefit-to-risk ratio
▹ It is no more effective than other drugs already on the market, making the
cost of continued research and production less attractive to the drug
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 Phase III studies and Phase IV studies

- Involve use of the drug in a vast clinical market.

_____________________________________________________
- Continual evaluation of the drug
- An approved drug is given a brand name (trade name) by the
pharmaceutical company that developed it.
- The generic name is the original designation that the drug was given
when the drug company applied for the approval process.
- Chemical names are names that reflect the chemical the chemical
structure of the drug.

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 FDA Pregnancy
Categories

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 Categories

Category A Category B
- Adequate studies in - Animal studies have not demonstrated a
pregnant women have risk to the fetus but there are no
adequate studies in pregnant women, or
not demonstrated a risk
animal studies have shown an adverse
to the fetus in the first effect, but adequate studies in pregnant
trimester of pregnancy, women have not demonstrated a risk to
and there is no evidence the fetus during the first trimester of
of risk in later trimesters pregnancy, and there is no evidence of
risk in later trimesters.

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 Categories

Category C Category D
- Animal studies have shown an - There is evidence of
adverse effect on the fetus but there human fetal risk, but the
are no adequate studies in the potential benefits from the
benefits from the use of the drug in use of the drug in pregnant
pregnant women may be acceptable women may be acceptable
despite its potential risks, or there despite its potential risks.
are no animal reproduction studies
and no adequate studies in humans.

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 Categories

Category X
- Studies in animals or humans demonstrates fetal abnormalities or
adverse reactions; reports indicate evidence of fetal risk. The risk of use
in a pregnant woman clearly outweighs any possible benefit.

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 Drug Enforcement Agency (DEA)
Schedules of Controlled
Substances
Schedule I (C-I)
- High abuse potential and
no accepted medical use
(heroin, marijuana, LSD –
Lysergic acid
Diethylamide)

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 Drug Enforcement Agency (DEA)
Schedules of Controlled
Substances
Schedule II (C-II)
- High abuse potential with
severe dependence
liability (narcotics,
amphetamines, and
barbiturates)

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 Drug Enforcement Agency (DEA)
Schedules of Controlled
Substances

Schedule III (C-III)

- Less abuse potential than
schedule II drugs and moderate
dependence liability
(nonbarbiturate sedatives,
nonamphetamine stimulants,
limited amounts of certain
narcotics)
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 Drug Enforcement Agency (DEA)
Schedules of Controlled
Substances

Schedule IV (C-IV)
- Less abuse potential than
schedule III and limited
dependence liability (some
sedatives, antianxiety agents,
and non – narcotic
analgesics)

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 Drug Enforcement Agency (DEA)
Schedules of Controlled
Substances

Schedule V (C-V)
- Limited abuse potential.
Primarily small amounts of
narcotics (codeine) used as
antitussives or antidiarrheals.

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 !!!!!!!!!!!!!!!

- A highly addictive analgesic drug

01 Heroin derived from morphine, often used
illicitly as a narcotic producing euphoria.

- “cannabis” is a psychoactive drug that

02 Marijuana produces pleasant feeling of being
relaxed

- Psychedelic drug wherein its effects

03 LSD typically include intensified thoughts,
emotions, and sensory perceptions

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 !!!!!!!!

- Are also called opioid pain relievers.

04 Narcotics Often used for pain that is severe.

- An analgesic and narcotic drug obtained

05 Morphine from opium and used medicinally to
relieve pain

Amphetamines - Stimulator of the Central Nervous

06 System

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 !!!!!!

- CNS depressants. They reduce the activity

of nerves causing muscle relaxation.
07 Barbiturates Usually barbiturates can reduce heart rate,
breathing, and blood pressure.

08 Sedatives - Promoting calm or inducing sleep

09 Antianxiety - Medications that reduces anxiety

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 Use diagrams to explain your ideas

- Medicines that suppress coughing also

07 Antitussive known as cough suppressants

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 Over – the – counter
drugs
OTC – are products that
are available without
prescription for self-
treatment of a variety of
complaints.

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 Several problems related to OTC drug use that nurses should consider:

Taking these drugs could mask the signs and symptoms of

underlying disease, making diagnosis difficult

Taking these drugs with prescription medications could

result in drug interactions and interfere with drug
therapy
Not taking these drugs as directed could result in
serious overdose.
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 DRUGS
AND THE
BODY

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 Pharmacodynamics
- Is the science dealing with interactions between
the chemical components of living systems and
the foreign chemical, including drugs that enter
the systems.

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 Drug usually work in four ways:

1. To replace or act as 3. To depress or slow

substitutes for cellular activities
missing chemicals

2. To increase or 4. To interfere with the

stimulate certain functioning of foreign
cellular activities cells, such as invading
microorganisms or
neoplasm.

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 Receptor sites
- The 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.

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 Pharmacokinetics
Pharmacokinetics
- Involves the study of absorption, distribution,
metabolism, and excretion of the drugs.
Critical Concentration
- The amount of a drug that is needed to cause a
therapeutic effect.

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 Dynamic Equilibrium
- The actual concentration that a drug reaches in the
body results from a dynamic equilibrium involving
several factors:
■ Absorption from the site of entry
■ Distribution to the active site
■ Biotransformation (matabolism) in the liver
■ Excretion from the body

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 Absorption

- Refers to what happens to a 1. Passive diffusion – the major process

through which the drugs are absorbed in the
drug from the time it is body.
introduced to the body until it 2. Active transport – is a process that uses
reaches the circulating fluids energy to actively move a molecule across a
cell membrane.
and tissues. 3. Filtration – involves movement through
- Drugs can be absorbed into pores in a cell membrane, either down a
cells through various concentration gradient or as a result of the
processes, which include: pull of plasma protein.

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 Administration
- Route:
■ IV (Intravenous)
■ IM (Intramuscular)
■ SC (Subcutaneous)
■ PO (oral)
■ PR (rectal)
■ Mucous membranes (sublingual, buccal)
■ Topical (skin)
■ Inhalation

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 Administration

Oral IV IM
Patients can easily Drugs that are injected IV Drugs that are injected IM
continue their drug reach their full strength at are absorbed directly into
regimen at home when the time of injection, the capillaries in the
they are taking oral avoiding initial muscle and sent into
medications. breakdown. circulation.

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 Administration

PR
SC
Uses rectum as a route for
Subcutaneous injections
medication administration which
deposit the drug just under
are absorbed by the rectum’s
the skin, where it slowly
blood vessel and flow into the
absorbed into circulation.
body’s circulatory system which
distributes the drug to the body
system.

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 Administration

Topical (Skin) Inhalation

Topical administration can be made Medication administered through
available directly at the intended site of inhalation are dispersed via an
action and because systemic circulation aerosol spray, mist, or powder that
is not reached in great concentration, patients inhale Into their airways.
the risk of systemic side effects is
reduced.

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 Distribution

Distribution
- Involves the movement of a Factors affecting the distribution
drug to the body tissues. ▹ Drug’s lipid solubility
▹ Ionization
▹ Perfusion of the reactive tissue

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 Distribution

Blood-Brain Barrier
- The blood brain barrier is a protective system of cellular activity
that keeps foreign invaders, poison, etc away from the CNS.
Placenta and Breast Milk
- Must be given if it outweighs the risk

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 First Pass effect
▸ Oral drugs are absorbed from
the small intestine to Portal
venous system.
▸ With series of liver enzymes,
these enzymes breaks to
metabolites, some activated,
some deactivates and easily
excreted.
▸ Large percentage of the oral
dose is destroyed and never
reaches the tissues
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 Hepatic-enzyme
system
▸ Phase 1: oxidation
reaction
▸ Phase 2: conjugation
reaction

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 Excretion
▸ Removal of drugs from the
body. E.g saliva, lungs, bile,
and feces.
▸ Kidney plays important role -
Glomerular filtration – the
passage of water-soluble
components from plasma to
renal tubules
▸ Others reabsorbed by active
transport system

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 Active transport

▸ Move drugs into tubule often do by exchanging it to acid

or bicarbonates.
▸ Urine acidity play an important role in drug excretion.

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 Half-life

▸ Time it takes for the amount of drugs in the body to

decrease to one half of peak level it previously achieved.

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 Determining the Half-Life

A patient is taking a drug that has a half-life of 12

hours. You are trying to determine when a 50-mg
dose of the drug will be gone from the body:

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 Factors influencing the
Drug effects
▸ Weight
▸ Age-Pediatric Doses
▸ Gender
▸ Physiologic factors
▸ Pathologic factors
▸ Genetics
▸ Immunologic factors
▸ Psychological factors
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 Factors influencing the
Drug effects

▸ Environmental factors
▸ Drug tolerance
▸ Accumulation effects
▸ Interactions

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 Pediatric Doses

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 Pediatric Doses

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 Pediatric Doses

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 Surface Area Rule

▸ Nomogram – for estimating

surface area of infants and
young children.

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Medication Errors !
 Nursing Considerations

Focus on Safe Medication ▸ Right Patient

Administration- It present important ▸ Right Drug
safety information to help keep the
▸ Right Storage
patient safe, prevent medication errors,
and increase the therapeutic effectiveness ▸ Right Route
of the drugs. ▸ Right Dose
▸ Right Preparation
▸ Right Time
▸ Right Recording

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 Patient’s Role

▸ 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.

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 Patient’s Role

▸ Store drugs in a dry place, away from children and

pets.
▸ Speak up.

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 Patient’s Role – “Children”

▸ Keep a list of all medications you are giving your

child, including prescription, OTC, and herbal
medications.
▸ Never use adult medications to treat a child.
▸ Read all labels before giving your child a drug.
▸ Measure liquid medications using appropriate
measuring devices.
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 Patient’s Role – “Children”

▸ Call your healthcare provider immediately if your

child seems to get worse or seems to be having
trouble with a drug.
▸ When in doubt, do not hesitate to ask questions.

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 Precautions when Reading Drug Labels

▸ Be aware of drug names that sound or look alike;

for example, note the similarity between the trade names Percodan and Percocet. Percocet, which
contains oxycodone and acetaminophen, is the preparation most commonly prescribed.

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 THANK YOU!
“Develop a passion for learning. If you do, you will
never cease to grow.”
-Anthony D’Angelo, educator

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