Unit -1

Introduction to pharmacology

By Dr. Maira javed

 DEFINITION OF PHARMACOLOGY
Pharmacology is the science that deals with the study of
drugs and their interaction with living systems.
• The word pharmacology derived from Greek
pharmacon means “drug” & logos means “study”.
Drug:
• A drug is a substance used in the diagnosis, prevention,
& treatment of disease.
Two important and interrelated areas are:
1. Pharmacodynamic (what drug does with the body)
2. Pharmacokinetics (what body does with the drug)
 Terminologies related to pharmacology

1. Clinical pharmacology: deals with the scientific study of

drugs in humans for the safe and effective use of drugs.
It is of 2 parts:
I. Pharmacodynamics: it is the study of biochemical and
physiological effects of drugs & their mechanism of action.
“what does drug do to your body?”
II. Pharmacokinetics: it is the study of absorption, distribution,
metabolism and excretion of drugs.
“what the body do to the drug?”
2. Toxicology: This aspect deals with the adverse effects of
chemical agents.
3. Pharmacovigilence: The area of that focuses on the effects
of drugs on patient safety.
4. Pharmacogenetics: study of the genetic variations that cause
differences in drug response.
5. Pharmacoeconomics: study of the cost of medicine taking
into account.
6. Therapeutics: it deals with the use of drugs in human for
prevention, mitigation, treatment and cure of diseases.
7. Metrology: is the study of weights and measures as applied
to the preparation and administration of drugs.
8. Chemotherapy: is the area of pharmacology that deals with
drugs used for the treatment of microbial infections and
malignancies.
 Importance of pharmacology in
nursing
• Pharmacology is and will continue to be one of the most
relevant biomedical sciences. basic, occupying a very
important place within the Nursing Diploma and
constituting an essential pillar for the correct therapeutic
use of drugs. The nurse prepares, administers, detects side
effects, educates the population about the rational
consumption of medications and informs patients about
the main aspects of the medication that must be known,
having a legal responsibility, but about All ethics in the
knowledge of actions, indications, and contraindications of
these substances, so the knowledge of Pharmacology
within this group is fundamental.
 1. Safe Medication Administration
One of the fundamental duties of nurses is the accurate administration
of medications. Knowledge of pharmacology helps nurses determine the
correct dosage, route, and timing while being vigilant for potential adverse
reactions or contraindications.
• Understand drugs and how they can affect living things
• Know the right dosage of drugs and not just quantity
• Identify and respond to drug interactions, reactions and side effects and
treat accordingly
• Know when to use drugs because some conditions do not need drug
therapy.
• Understand the process of drug intake, absorption, distribution, metabolism
and elimination.
• Identify the properties of ideal drugs and otherwise
• Know the application of pharmacology in nursing with regards to the 5
right of;
• Use right drug
• Give to right patient
• Give right dose
• Give by right route
• Give at right time
2. Patient Monitoring and Assessment
After administering medications, nurses must assess
patients for therapeutic effects and possible side
effects. Understanding pharmacodynamics and
pharmacokinetics allows nurses to anticipate patient
responses and take appropriate action if complications
arise.
3. Patient Education
• Nurses educate patients about their
medications, including how to take them,
possible side effects, and the importance of
adherence. This is especially vital for chronic
illnesses that require long-term
pharmacological treatment.
4. Drug Interaction Management
• With patients often taking multiple drugs, the
risk of drug interactions is high.
Pharmacological knowledge equips nurses to
recognize dangerous combinations and
communicate concerns with prescribers
5. Participation in Clinical Decision-Making
• In collaborative healthcare environments,
nurses contribute valuable insights regarding
pharmacotherapy. Their close interaction with
patients enables them to provide feedback to
physicians and pharmacists on treatment
efficacy and tolerability
6. Pharmacology and Evidence-Based Practice
Incorporating current research findings into
pharmacological practice is essential. Nurses must stay
updated on new medications, evolving guidelines, and
clinical trial outcomes to provide the most effective care.
Challenges in Applying Pharmacology
Despite its importance, challenges remain. These include
insufficient pharmacology education in some nursing
programs, the rapid development of new drugs, and high
workloads that limit time for learning. Continuous
education and clinical training are necessary to address
these gaps.
 Sources of Drugs
• The sources of drugs could be natural or synthetic,
• Natural sources
1. Plants: e.g. atropine, morphine, quinine, digoxin, pilocarpine,
and physostigmine.
2. Animals: e.g. insulin, heparin, gonadotrophins, and antitoxic
sera.
3. Minerals: e.g. magnesium sulfate, aluminium hydroxide,
iron, sulphur & radioactive isotopes.
4. Microorganisms: e.g. antibacterial agents are obtained from
some bacteria and fungi. From which we obtained penicillins,
cephalosporins, tetracycline, and other antibiotics.
5. Human: some drugs are obtained from man. E.g.
immunoglobulin from blood, growth hormones from anterior
pituitary.
 • Synthetic sources
• Most drugs are now synthesized. E.g. quinolones, omeprazole,
sulfonamides, neostigmine.
• Many drugs are obtained from cell culture. E.g. urokinase from
cultured kidney cells.
• Some are now produced from recombinant DNA technology.
E.g. human insulin, tissue plasmogen activator and some
drugs by hybridoma techniques.
 History
Ancient Medicine
• Chinese medicine is the earliest and records dated about 2500
B.C. available today give an idea about the medical knowledge
of Chinese.
• Ayurveda or Indian Medicine is equally ancient.
• The Charaka Samhita is believed to have arisen around 400-
200 B.C. This work is considered a redaction of an older and
more voluminous work of Agnivesha Samhita (46,000 verses).
• Egyptian medicine is also very ancient. The Ebers Papyrus (a
kind of medical encyclopaedia) dated about 1500 B.C. gives a
collection of drugs prevalent in Egypt at that time, their
classification and their use. Some of the drugs employed now
such as, castor oil and pomegranate bark are mentioned in this
papyrus.
Pre-Christian Era
• Greek medicine is said to be the origin of modern medicine
and therapeutics. Hippocrates in fifth century B.C. separated
medicine from religion and was known as the father of
medicine.
• Galen (Aelius Galenus or Claudius Galenus) was a famous
Greek physician, surgeon and philosopher in the Roman
Empire who practiced in Rome. He was the father of
polypharmacy (the concurrent use of multiple medications).
Modern medicine:
• By the middle of the 19th century, modern medicine had
brought to fight disease only one effective weapon i.e.
immunization against smallpox.
• Later in quick succession came the anesthetics and antiseptics.
In the last quarter, the causative organisms for malaria, plaque,
cholera etc. were identified.
• Beginning in the 20th century, the fresh wind of synthetic
chemistry began to revolutionize the pharmaceutical industry
and with it the science of pharmacology.
• Further breakthroughs came with the discovery of
sulphonamides by Gerhard Domagk in 1935 and the
development of penicillin during world war II.
• The addition of drugs to the therapeutic jungle is growing with
rapid pace from the latter half of the 20th century.
 Routes of Administration of Drugs
• Definition
A route of administration in pharmacology and toxicology is the
path by which a drug, fluid, poison, or other substance is taken
into the body.
• Most of the drugs can be administered by different routes.
Drug- and patient-related factors determine the selection of
routes for drug administration.
The factors are:
• 1. Characteristics of the drug.
• 2. Emergency/routine use.
• 3. Site of action of the drug—local or systemic.
• 4. Condition of the patient (unconscious, vomiting, diarrhoea).
• 5. Age of the patient.
• 6. Effect of gastric pH, digestive enzymes and first-pass metabolism.
• 7. Patient’s/doctor’s choice (sometimes).
Before consider the various routes of drug administration, let study of how drugs
move within the body:-
 A. Local Route
• It is the simplest mode of administration of a drug at the site where the
desired action is required. Systemic side effects are minimal.
i. Topical: Drug is applied to the skin or mucous membrane at various sites
for local action.
b. Oral cavity: As a suspension, e.g. nystatin; as a troche, e.g. clotrimazole
(for oral candidiasis); as a cream, e.g. acyclovir (for herpes labialis); as
ointment and jelly, e.g. 5% lignocaine hydrochloride (for topical
anaesthesia); as a spray, e.g. 10% lignocaine hydrochloride (for topical
anaesthesia).
c. GI tract: As tablet that is not absorbed, e.g. neomycin (for sterilization of
gut before surgery).
d. Rectum, Vaginal and anal canal: As an enema (administration of drug
into the rectum in liquid form):
• Evacuant enema (for evacuation of bowel): For example, soap water
enema—soap acts as a lubricant and water stimulates the rectum.
• As a suppository (administration of the drug in a solid form into the
rectum), e.g. bisacodyl— for evacuation of bowels.
• d) Eye, ear and nose: As drops, ointments and
sprays (for infection, allergic conditions, etc.), e.g.
gentamicin eye/ear drops.
• e) Bronchi: As inhalation, e.g. salbutamol (for
bronchial asthma and chronic obstructive
pulmonary disease).
• f) Skin: As ointment, cream, lotion or powder, e.g.
clotrimazole (antifungal) for cutaneous candidiasis.
• g) Transdermal: Transdermal patches can provide
prolonged or controlled drug delivery. Systemic
absorption (Transdermal) is better with low dose,
low MWt, lipid soluble drugs.
ii. Intra-arterial route: This route is rarely employed.
It is mainly used during diagnostic studies such as
coronary angiography and for the administration of
some anticancer drugs, e.g. for treatment of
malignancy involving limbs.
iii. Administration of the drug into some deep tissues
by injection: e.g. administration of triamcinolone
directly into the joint space in rheumatoid arthritis.
 B. Systemic Routes (Enteral)
• Drugs administered by this route enter blood and produce
systemic effects. Enteral Routes It includes (i) Oral route, (ii)
Buccal or Sublingual route and (iii) Rectal route.
i. ORAL ROUTE
• It is the most common and acceptable route for drug
administration. Dosage forms are tablet, capsule, syrup,
mixture, etc., e.g., paracetamol tablet for fever, omeprazole
capsule for peptic ulcer are given orally.
• Advantages:
• - Convenient - portable, safe, no pain, can be self-
administered.
• - Cheap - no need to sterilize (but must be hygienic of course)
• - Variety of dosage forms available - fast release tablets,
capsules, enteric coated, layered tablets, slow release,
suspensions, mixtures
• - Convenient for repeated and prolonged use.
Disadvantages:
• Sometimes inefficient dosage:- high dose or low
solubility drugs may suffer poor availability, only part
of the dose may be absorbed.
• First-pass effect :- drugs absorbed orally are
transported to the general circulation via the liver.
Thus drugs which are extensively metabolized will be
metabolized in the liver during absorption. e.g. the
propranolol oral dose is somewhat higher than the IV,
the same is true for morphine. Both these drugs and
many others are extensively metabolized in the liver.
• Food :- Food and G-I motility can effect drug absorption.
Often patient instructions include a direction to take with food
or take on an empty stomach. Absorption is slower with food
for tetracyclines and penicillins, etc. However, for propranolol
bioavailability is higher after food, and for griseofulvin
absorption is higher after a fatty meal.
• Local effect :- Antibiotics may kill normal gut flora and allow
overgrowth of fungal varieties. Thus, antifungal agent may be
included with an antibiotic.
• Unconscious patient :- Patient must be able to swallow solid
dosage forms. Liquids may be given by tube.
 ii. BUCCAL and SUBLINGUAL ROUTE (SL)
• Some drugs are taken as smaller tablets which are held in the mouth
or under the tongue. These are buccal or sublingual dosage forms.
• Buccal tablets are often harder tablets [4 hour disintegration time],
designed to dissolve slowly.
• Nitroglycerin, as a softer sublingual tablet [2 min disintegration
time], may be used for the rapid relief of angina.
This Route of administration is also used for some steroids such as
testosterone and oxytocin. Nicotine containing chewing gum may be
used for cigarette smoking replacement.
• Advantages:
• - Quick onset of action.
• - Action can be terminated by spitting out the tablet.
• - Bypasses first-pass metabolism.
• - Self-administration is possible.
Disadvantages
• It is not suitable for bitter tasting and unpalatable drug.
• It is not suitable for Irritant and lipid-insoluble drugs.
• cannot give to unconscious patient.
• Large quantities cannot be given.
• Cannot be given in severe vomiting.
 iii. RECTAL ROUTE
• Drugs can be given in the form of solid or liquid.
• Suppository: It can be used for local (topical) effect as well as systemic
effect, e.g. indomethacin for rheumatoid arthritis.
• Enema: Retention enema can be used for local effect as well as
systemic effect. The drug is absorbed through rectal mucous membrane
and produces systemic effect, e.g. diazepam for status epilepticus in
children.
Advantages
• - Used in children.
• - Little first pass effect.
• - Can be given in vomiting.
• - Can be given in unconscious patient.
• - Higher therapeutic concentrations of drug are achieved rapidly in
rectum.
• - For rapid evacuation of bowel, usually during gut sterilization before
any surgical or radiological procedure.
Disadvantages
• - Inconvenient, not well accepted. May be some
discomfort
• - Drug absorption is slow and erratic.
• - Irritation or inflammation of rectal mucosa can
occur
 C. Parentral Routes
i. Intravenous route
• Drugs may be given into a peripheral vein over 1 to 2
minutes or longer by infusion, or Drugs are injected
directly into the blood stream through a vein.
Drugs are administered as:
a) Bolus: Single, relatively large dose of a drug injected
rapidly or slowly as a single unit into a vein. For example,
i.v. ranitidine in bleeding peptic ulcer.
b) Slow intravenous injection: For example, i.v. morphine
in myocardial infarction.
c) Intravenous infusion: For example, dopamine infusion
in cardiogenic shock; fluids infused intravenously in
dehydration.
Advantages
• - Bioavailability is 100%.
• - Quick onset of action; therefore, it is the route of choice
in emergency, e.g. intravenous diazepam to control
convulsions in status epilepticus.
• - Large volume of fluid can be administered, e.g.
intravenous fluids in patients with severe dehydration.
• - Highly irritant drugs, e.g. anticancer drugs can be given
because they get diluted in blood.
• - Hypertonic solution can be infused by intravenous route,
e.g. 20% mannitol in cerebral oedema.
• - By i.v. infusion, a constant plasma level of the drug can
be maintained, e.g. dopamine infusion in cardiogenic
shock.
Disadvantages:
• Once the drug is injected, its action cannot be stop.
• - Local irritation may cause phlebitis.
• - Self-medication is not possible.
• - Strict aseptic conditions are needed.
• - Depot preparations cannot be given by i.v. route
Precautions
• - Drug should usually be injected slowly.
• - Before injecting, make sure that the tip of the needle is
in the vein.
 ii. SUBCUTANEOUS (s.c.) ROUTE
• The drug is injected into the subcutaneous tissues
of the thigh, abdomen and arm, e.g. insulin etc.
Advantages:
• - Actions of the drugs are sustained and uniform.
• - Drugs can be given in presence of vomiting and
diarrhea.
• - Drugs can be given to unconscious patients.
• - Drugs that are not absorbed from G.I.T can be
given.
• - Self-administration is possible (e.g. insulin).
Disadvantages
• - Only non-irritant drugs can be given otherwise
severe irritation, pain and necrosis of
subcutaneous tissues can occur.
• - Absorption of the drugs is slow than I/M
injection.
• - Expensive.
• - Danger of infection, if proper sterilization
techniques are not used.
• - Large volumes of drug cannot be given.
 iii. INTRAMUSCULAR (I.M) ROUTE
• The drug is injected deep in the belly of a large
skeletal muscle. The muscles that are usually
used are deltoid, triceps, Gluteus.
• Absorption of drug from gluteal region is slow
especially in females due to high fat deposition.
• Deep intramuscular injections are given at upper
outer quadrant of buttock to prevent the injury
to major nerves.
• Deep I.M injections are less painful than I.M
injections on arm due to high fat content.
• I.M are given at an angle of 90 degrees.
Advantages
• - Rate of absorption is uniform.
• - Rapid onset of action.
• - Irritant substances can be given.
• - Drugs can be given to unconscious patients.
• - Accuracy of dosage is ensured.
• - Useful in emergency situations.
• - First pass effect is avoided.
• - Drugs producing gastric irritation can be given.
• - Drugs that are not absorbed from G.I.T can be
given.
Disadvantages:
• - Small quantities up to 10 ml of the drug can be
given at a time.
• - Local pain and abscess formation.
• - Technical person is needed, self-administration is
difficult.
• - Danger of infection, if proper sterilization
techniques are not used.
• - Chances of nerve damage.
 • iv. INTRATHECAL ROUTE
• Drug is injected into the subarachnoid space (spinal
anaesthetics, e.g. lignocaine; antibiotics, amphotericin
B, etc.).
 v. TRANSDERMAL ROUTE

• The drug is administered in the form of a patch or

ointment that delivers the drug into the circulation for
systemic effect.
• For example, scopolamine patch for sialorrhoea and
motion sickness, nitroglycerin patch/ointment for
angina, oestrogen patch for hormone replacement
therapy (HRT).
Advantages:
• Self-administration is possible
• Duration of action is prolonged
• Systemic side effects are reduced.
• Patient compliance is better.
Disadvantages:
• Expensive
• Local irritation may cause dermatitis and itching.
 vi. INTRAPERITONEAL ROUTE
• Indication: Colon and Ovarian
• Peritoneal space has much surface area;
may not be reached by IV chemo
• Catheters used: implanted port
• Chemotherapy agents used: Cisplatin,
Taxol
• Advantages: less systemic side effects
• Disadvantages: infection, pain.
Thank you

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