NURSING PHARMACOLOGY

CHAP 1

❖​ Pharmacology
➔​ Is the study of the biological effects of chemicals.

❖​ Drugs
➔​ Chemicals that are introduced into the body to cause some sort of
change

Purose of Studying Pharmacology:

-​ The purpose of studying PHARMACOLOGY is to help you learn about
medicines and the WHY, WHAT, HOW, WHEN, and WHERE they are used in
daily life.

➢​ Health care providers focus on how chemicals act on living organisms.

➢​ Nurses deal with pharmacotherapeutics, or clinical pharmacology.
➢​ Some drug effects are therapeutic, or helpful, but others are undesirable or
potentially dangerous (adverse effects)

DEFINITION OF TERMS

❖​ Chemical Name
➔​ Name that reflects the chemical structure of a drug.

❖​ Food and Drug Administration (FDA)

➔​ Govt. agency responsible for the regulation and enforcement of drug
evaluation and distribution policies.

❖​ Brand Name
➔​ Also called Trade name
➔​ Given by the pharmaceutical company that
developed it.

❖​ Generic Name
➔​ The original designation that the drug was
given when the drug company applied for the
approval process.
 ❖​ Generic Name
➔​ Chemicals that are produced by companies who just manufacture the
drugs.
➔​ They do not have the research, the advertising, or sometimes, the
quality control departments that pharmaceutical companies have.

❖​ Orphan Drugs
➔​ Drugs that have been discovered but are not financially viable and
therefore have not been adopted by any drug company.

❖​ Over-the-counter Drugs
➔​ Drugs that are available without prescription for self-treatment of a
variety of complaints.
➔​ Some of these agents were approved as prescription drugs but later
were found to be safe and useful for patients without the need for a
prescription.

SOURCES OF DRUGS

➢​ Natural Sources

★​ Plants
➔​ Synthetic version of the active chemical
found in a plant
➔​ Main component of the growing alternative
therapy movement

★​ Animal Products
➔​ Used to replace human chemicals that are not produced because of
disease or genetic problems
➔​ Genetic engineering
➔​ Many of these preparations are now created synthetically
➔​ Insulin for treating diabetes is exclusively obtained from cow pancreas
tissue. now genetic engineering - the process of altering DNA -permits
scientist to produce human insulin by altering E. coli bacteria.

★​ Inorganic Compounds
➔​ Salts of various elements can have therapeutic effects in the human
body
 ➢​ Synthetic Sources
-​ Drugs are developed synthetically, a small change in the chemical's
structures can make that certain chemical more useful as a drug.

DRUG EVALUATION
I.​ PRECLINICAL TRIALS
➔​ Chemicals tested on laboratory animals

II.​ PHASE I STUDIES

➔​ Chemicals tested on human volunteers

III.​ PHASE II STUDIES

➔​ Drug tried on informed patients with the dis (incomplete)

IV.​ PHASE III STUDIES

➔​ Drug used in vast clinical market

V.​ PHASE IV STUDIES

➔​ Continual evaluation of the drug

CONTROLLED SUBSTANCES

❖​ Controlled Substances
➔​ Control over the coding of drugs and the enforcement of these codes to
the FDA and the Drug Enforcement Agency (DEA), a part of the U.S.
Department of Justice
➔​ Prescription, distribution, storage, and use of these drugs are closely
monitored.
➔​ Local policies and procedures might be even more rigorous.
NURSE’S RESPONSIBILITIES
➢​ Administering drug
➢​ Assessing drug effects
➢​ Intervening to make the drug regimen
more tolerable
➢​ Providing patient teachings about drugs and
the drug regimen
➢​ Monitoring the overall patient care plan to prevent
medication errors

ADMINISTERING MEDICINES

“Other Rights”
➔​ Proper drug storage-refrigerated, some kept away
from direct light, and some (narcotics)
➔​ Careful checking of transcription of orders
➔​ Patient safety
➔​ Close consideration of special situations (requires extra precaution)
➔​ Prevention and reporting of medication errors
➔​ Monitoring for therapeutic effects, side effects, toxic effects

TYPES OF DOCTOR’S ORDERS

❖​ Doctor’s Prescription/Prescription Drugs (Rx)

➔​ Also called prescription medication or
prescription medicine
➔​ Is a pharmaceutical drug that legally requires a medical prescription to
be dispensed.
➔​ In contrast, over-the-counter drugs can be
obtained without a prescription.

Doctor's Orders:
Components of Drug Orders:
➢​ Date and time the order is written
➢​ Drug name
➢​ Drug dosage
➢​ Route of administration
➢​ Frequency of administration
➢​ Physician/provider's signature
Medication Orders:
Components of Drug Orders:
➢​ Full name of client
➢​ Generic or trade name of drug
➢​ Dose, route, frequency
➢​ Date, time and signature of provider
➢​ The nurse will need to look up the
medication ordered to know it's classification,
safe dose, action, how to administer, and
side effects
➢​ The nurse should know why the medication is ordered

❖​ Medication Orders

Categories:
★​ Standing Order
➔​ Protocols derived from guidelines created by healthcare providers for
use in specific settings, for treating certain diseases or sets of
symptoms.
➔​ (Ex. to administer specific treatments without needing a direct doctor's
consultation for that patient)

★​ Standard Order (Routine/Regular)

➔​ May be an ongoing order, may be given for a specific number of doses
or days. May include prn orders

★​ One-time or Single Order

➔​ Given once and usually at a specific time

★​ PRN Orders
➔​ Given at the client's requestland nurse's judgment concerning need
and safety

★​ Stat Orders
➔​ Given once immediately
BENEFITS OF OTC
➢​ Drug products are approved by the US-FDA, may be purchased from sellers
of all kinds.
➢​ Can be purchased without a prescription

RISKS OF OTC
➢​ 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 overdoses.

➢​ Veterinary Drug Products (VET)

➔​ The Generic Animal Drug and Patent Restoration act requires that
each sponsor of an approved animal drug must submit to the FDA
certain information regarding patents held for the animal drug or its
method of use.
➔​ The Act requires that this information, as well as a list of all animal drug
products approved for safety and effectiveness, be made available to
the public.
➔​ This list must be updated monthly under the provisions of the Act. The
list, known as the "Green Book," was first published in January 1989.
CHAPTER 2 (Drugs and the Body)

❖​ Pharmacodynamics
➔​ Is the science dealing with Interactions between the chemical
components of living systems and foreign chemicals, including drugs,
that enter those systems.
➔​ How the drugs affects the body
➔​ Each living system has chemical reactions occurring continuously in
the body.
➔​ When other chemicals (drugs) are added to the body other effects
occur.

❖​ Pharmacokinetics
➔​ The way the body deals with a drug, Including absorption, distribution,
blotransformation, and excretion.
➔​ How the body acts on the drug.

DRUG ACTION
-​ Drugs usually works in 4 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 neoplasm.

RECEPTOR SITES
-​ How do body cells respond to the presence of drugs? (Pharmacodynamics)

❖​ Receptor Sites
➔​ react to certain chemicals to cause an effect within the called the cell.
Drugs are thought to act at specific area receptor sites.

❖​ Agonists
-​ Action: Bind to a receptor and activate it.
-​ Result: Mimics the effect of the body's natural signaling molecules to
produce a biological response.

❖​ Noncompetitive antagonists
-​ Action: Bind to the same active site as the agonist.
-​ Result: Blocks the agonist from binding, but can be overcome
(surmounted) by increasing the concentration of the agonist.
 ❖​ Competitive antagonists
-​ Action: Bind to a different site (allosteric site) or bind irreversibly to the
active site.
-​ Result: Prevents receptor activation regardless of how much agonist is
present; its effect cannot be overcome by increasing agonist
concentration.

❖​ Drug
-​ Ezyme interactions

❖​ Selective Toxicity
-​ The ability of a drug to attack only those systems found in foreign cells.

LOCK AND KEY:

The actual concentration that of drug reaches in the body results from a dynamic
equilibrium involving several processes (pharmacokinetics):
A.​ Absorption from the site of entry.
B.​ Distribution to the active site.
C.​ Biotransformation (metabolism) in the liver.
D.​ Excretion from the body.
PHARMACOKINETICS

❖​ Critical Concentration
➔​ The amount of a drug that is needed to cause a therapeutic effect

❖​ Loading Dose
➔​ A higher dose than that usually used for treatment

❖​ Dynamic Equilibrium
➔​ The actual concentration that a drug reaches in the body

ABSORPTION
-​ What happens to a drug from the time it is introduced to the body until it
reaches the circulating fluids and tissues?

➢​ Administration
-​ Affected by route of administration Oral medications affected by
presence of food in the stomach

➢​ Passive Diffusion
➢​ Active Transport

❖​ Absorption
➔​ Refers to what happened to the drugs from the time it is introduced into
the body until it reaches the circulating fluids and tissues.

DRUGS CAN BE ABSORBED IN THE BODY THROUGH:

➢​ Through the Gl tract orally or rectally.
➢​ Through the mucous membrane
➢​ Through the skin.
➢​ Through the lungs
➢​ Tg hrough muscle or subcutaneous tissue.