Subject: Pharmacology
Subject Code: NCM 106
Course Credit: Theory: 3 units (54 hours)
Course Description
This course deals with the methods and utilizations of the nursing
process in pharmacodynamics, therapeutic use of the drugs to clients in
health promotion, especially preventing diseases, maintenance, restoring
the overall balance, as well as rehabilitation, across their lifespan. It will
also include the alternative medicines and therapies, widely accepted by
the health experts. Expectations for the learners are focused on basic
knowledge and skills during medication administration, safe practices and
development of professional behaviors in dealing with drugs.
Chapter 1: Introduction to Drugs
Learning Objectives:
1. Learn the definition of Pharmacology
2. Enumerate different sources of drugs
3. List the pregnancy categories of the FDA
4. Differentiate brand name and generic name of drugs. Learn the
difference of Over-the-Counter Drugs and Prescription Drugs.
Pretest
1. What is the other term for clinical pharmacy?
________________________________________________________
2. Select which term pertains to which? PARACETAMOL (Biogesic)
Generic Name: ________________ Brand Name:
_________________
3. There are _________ categories in pregnancy according to the FDA
4. An orphan drug is
________________________________________________________
________________________________________________________
5. Pregnancy categories of drugs are defined by which agency?
________________________________________________________
Lesson Proper
Pharmacology
The study of biological effects of chemicals
Drugs
Chemicals that are introduced into the body to cause some sort of
change.
Pharmacotherapeutics
Other term for clinical pharmacology.
A branch of pharmacology that uses drugs to treat, prevent, and
diagnose disease.
Focused on:
o The effect of drugs in the body
o The body’s response to the drugs
The Nurse’s Responsibilities in Drug Therapy (5)
1. Administering Drugs
2. Assessing drug effects
3. Performing interventions to ease drug effects
4. Provides teachings regarding the drug regimen and the drugs
5. Preventing medication errors, while following proper care plan
The sources of Drugs (2)
1. Natural Sources – From natural sources
a. Plants
b. Animal Products
c. Inorganic Compounds (aluminum, fluoride, iron, etc.)
2. Synthetic Sources – Genetically engineered bacteria, synthetically
developed after chemicals in plants, animals and the environment.
Example of drugs derived from plants:
o Ricinus communis – used parts: Seed, Oil
o Digitalis pupurea – used parts: leaves
o Papaver somniferum – used parts: unripe capsule, juice
Therapeutic use of the elements (examples)
o Aluminum – Antacid, Management of hyperphosphatemia,
prevents formation of phosphate urinary stones
o Fluorine – Prevention of cavities and osteoporosis
o Gold – Treats rheumatoid arthritis
o Iron – Treats IDA
Brand Name
Also known as Trade Name
Given by the manufacturer
Generic Name
The original designation that the drug was given when the drug
company applied for the approval process
Chemical Name
Reflects the chemical structure of a drug
Example:
Generic Name : levothyroxine sodium
Brand Name : L-thyroxine, T4
Chemical Name : Eltroxin, Levothroid, Synthroid
The Five (5) Pregnancy Categories of the Food and Drug
Administration (FDA)
1. Category A
o Risks = none
2. Category B
o Animal testing = has adverse effects
o Pregnant women tests = no adverse effects
o No risk at all trimesters
3. Category C
o Animal testing = shows adverse effects
o Pregnant women testing = no adequate studies in humans
o Benefit outweighs the harm during use in pregnant women
4. Category D
Human fetal risk studies = there is evidence
Has acceptable benefits versus the risk of use
5. Category X
Fetal abnormalities are present
There is an adverse reaction
The risk outweighs the benefits of use
Teratogenic
Having adverse effects on the fetus
Over-the-counter (OTC) drugs
Available and purchasable even without the prescription of a
physician
Has potential to be overdosed
Can masks underlying diseases’ signs and symptoms
Drug Monograph
Post Test
Based on the example given, select one (1) medication and create
your own complete drug monograph about your chosen medication.
References
Chapter 2: Drugs and the Body
Learning Objectives
1. Describe the response of cells to drugs and how it alters their
function
2. Explain and calculate the half-life of a drug
3. List factors that influence the effectiveness of the drugs in the body
4. Define the following terms:
a. Drug-to-drug interactions
b. Drug-to-alternative therapy interactions
c. Drug-to-food interactions
d. Drug-to-laboratory test interactions
Pretest
1. Drugs given orally are carried directly to the liver after absorption is
termed as: _____________________________________________
2. The way the body deals with a drug, including absorption,
distribution, biotransformation, and excretion:
______________________________________________________
3. the study of the interactions between the chemical components of
living systems and the foreign chemicals, including drugs, that enter
living organisms; the way a drug affects a body:
______________________________________________________
Lesson Proper
Pharmacodynamics
The study of the interactions between the chemical components of
living systems and the foreign chemicals, including drugs that enter
those systems.
Drugs work as:
o Act/replacement to missing chemicals
o Increase/Decrease a certain cellular activity
o Interferes in the functioning of foreign cells (invading
microorganisms)
Receptor Sites
Specific areas on cell membranes that react with certain chemicals
to cause an effect within the cell.
Agonists – Drugs that interact directly with receptor sites to cause
the same activity that natural chemicals would do.
Competitive Antagonists – Drugs that react with receptor sites to
block normal stimulation, producing no effect
Non-Competitive Antagonists – Drugs that prevent the reaction of
another chemical with a different receptor site on a cell.
Selective Toxicity
The ability of a drug to attack only those systems found in foreign
cells.
Example: Penicillin - affects an enzyme system unique to bacteria,
causing bacterial cell death without disrupting normal human cell
functioning.
Pharmacokinetics
The study of absorption, distribution, metabolism
(biotransformation), and excretion of drugs.
Pharmacokinetic Considerations:
1. Onset of drug action
2. Drug half-life
3. Timing of the peak effect
4. Duration of drug effects
5. Metabolism/Biotransformation of the drug
6. The site of excretion
Critical Concentration
The amount of a drug that is needed to cause a therapeutic effect
Loading Dose
The use of a higher dose than what is usually used for treatment to
allow the drug to reach the critical concentration sooner
Recommended if the desired effects are needed quickly
Dynamic Equilibrium
The actual concentration that a drug reaches in the body results
from a dynamic equilibrium involving several processes
1. Absorption from the site of entry
2. Distribution to the active site
3. Biotransformation (metabolism) in the liver
4. Excretion from the body
I. 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.
Factors That Affect Absorption of Drugs
o Intravenous - None: direct entry into the venous
system
o Intramuscular
1. Perfusion/blood flow to the muscle Fat content
2. Temperature of the muscle: cold causes
vasoconstriction (↓absorption), heat causes
vasodilation (↑absorption)
o Subcutaneous
1. Perfusion/blood flow to the tissue
2. Tissue fat content
3. Temperature of the tissue: cold causes
vasoconstriction (↓absorption) ; heat causes
vasodilation (↑absorption)
o PO (oral)
1. Acidity of stomach
2. Length of time in stomach
3. Blood flow to gastrointestinal tract
4. Presence of interacting foods/drugs
o PR (rectal)
1. Perfusion/blood flow to the rectum
2. Lesions in the rectum
3. Length of time for absorption
o Mucous membranes (sublingual, buccal)
1. Perfusion/blood flow to the area
2. Mucous membranes integrity
3. Presence of food/smoking
4. Length of time in area
o Topical (skin)
1. Perfusion/blood flow to the area
2. Skin integrity
o Inhalation
1. Perfusion/blood flow to the area
2. Lung lining integrity
3. Proper administration capability
Absorption Processes
o Passive Diffusion - major process through which drugs are
absorbed into the body. Does not require energy.
o Active Transport - a process that uses energy to actively
move a molecule across a cell membrane.
II. Distribution
involves the movement of a drug to the body’s tissues
factors that can affect distribution:
o Drug’s lipid solubility
o Ionization and the perfusion of the reactive tissue
Blood–Brain Barrier
o An intricate protective system of cellular activity that
keeps foreign bodies away from the CNS.
o Drugs that are highly lipid-soluble have higher chances
to penetrate this system and the CNS.
o Almost all antibiotics are not lipid soluble and cannot
cross the blood–brain barrier.
III. Biotransformation
The process by which drugs are changed into new, less active
chemicals.
Also known as drug metabolism
First Pass Effect – A phenomenon of drug metabolism where
orally taken drugs’ concentration is greatly reduced before it
reaches the systemic circulation.
IV. Excretion
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 kidney is the main organ for excretion
Half-life
The time it takes for the amount of drug in the body to
decrease to one half of the peak level it previously achieved.
Factors influencing drug effects
1. Weight
2. Age
3. Gender
4. Physiological factors—diurnal rhythm, electrolyte balance,
acid–base balance, hydration
5. Pathological factors—disease, hepatic dysfunction, renal
dysfunction, gastrointestinal dysfunction, vascular disorders,
low blood pressure
6. Genetic factors
7. Immunological factors—allergy
8. Psychological factors—placebo effect, health beliefs,
compliance
9. Environmental factors—temperature, light, noise Drug
tolerance
10. Cumulation effects
11. Interactions
Pediatric Doses
1. Fried’s Rule
infant's dose ( <1 year) = infant's age (in months)
150 months
X average adult dose
2. Young’s Rule
child's dose (1–12 year) = child's age (in years)
child’s age (in yrs) + 12
X average adult dose
3. Clark’s Rule
child's dose = weight of child (in pounds)
150
X average adult dose
4. Surface Area Rule
child's dose = surface area of child (in square meters)
1.73
X average adult dose
Drug–Drug or Drug–Alternative Therapy Interactions
This can occur in:
1. Absorption site – one drug prevents/enhances the absorption
of another drug.
Example: Tetracycline cannot be absorbed if the client
recently took calcium supplement/calcium products and
still present on the GI Tract.
2. Upon distribution – Drugs compete for the protein-binding
sites. One drug prevents the other drug to be transported to
reactive tissues
Example: Methotrexate, a chemotherapeutic drug, if taken
with aspirin, will be excreted a lot, because aspirin is more
competitive for the sites.
3. During Biotransformation – drugs can enhance/block the
metabolism other drugs.
Example: Warfarin’s biotransformation will be increased
when taken with barbiturates. This means that the client will
need higher doses in order to achieve a desired effect.
4. During Excretion – Drugs compete for excretion, therefore
leading to accumulation and toxic effects of the drugs least
excreted.
Example: Quinidine and Digoxin, when taken together,
affects the excretion of Digoxin. This leads to increased serum
level of Digoxin of the client, because digoxin cannot be
excreted.
5. The action site – drugs can be antagonistic to another drug,
meaning it can oppose the effect of one another, which leads
to no therapeutic effect.
Example: Antihypertensive drugs’ effects are negated if
taken with antihistamines (anti-allergy), because
antihistamines elevate blood pressure. Also antidiabetic
medications, which lowers blood sugar, should not be taken
with the herb Ginseng, because it also lowers blood sugar,
but with little to no control, that will lead to loss of blood
sugar control.
Drug-Food Interaction
Some food ↑ acid production, therefore speeding the breakdown
of drugs, that will ultimately prevent absorption and distribution
Examples:
1. Tetracycline should not be taken with Iron and Calcium
2. Grapefruit juice affects liver enzymes for up to 48 hours, this
will ↑ or ↓ the serum level of drugs
Drug-Laboratory Test Interaction
Some of the laboratory result ↓ or ↑, is caused by drugs, and not the
body’s own reaction or response
Example: Dalteparin (used to prevent deep vein thrombosis after
abdominal surgery) may cause increased levels of the liver enzymes
aspartate aminotransferase and alanine aminotransferase with no
injury to liver cells or hepatitis.
Post Test
Create 1 drug study focusing on the drug-to-laboratory test interaction
aspect of your chosen drug. State how is it affecting the laboratory test
results.
References:
