Universidad De Dagupan

Arellano St., Dagupan City

School of Health Sciences-College of Nursing

Academic Year. 22-23, First Semester

NCM 106 (Nursing Pharmacology)

Introduction to Nursing Pharmacology

PHARMACOLOGY

• It is the scientific study of the origin, nature, chemistry, effects, and uses of drugs.

• This knowledge is essential to providing safe and accurate medication administration to your
patients.

Three Basic Concepts of Pharmacology

• PHARMACOKINETICS

- The ABSORPTION, DISTRIBUTION, METABOLISM, and EXCRETION of drugs by the body.

• PHARMACODYNAMICS

- The biochemical and physical effects of drugs and the mechanisms of drug actions.

• PHARMACOTHERAPEUTICS

- The use of drugs to prevent and treat diseases.

Naming and Classifying Drugs

• CHEMICAL NAME

- Is a scientific name that precisely describes the drug’s atomic and molecular structure

• GENERIC NAME

- Also known as Non-proprietary name.

- It is an abbreviation of the chemical name.

• TRADE NAME

- Also known as Brand Name.

- Also known as Proprietary Name.

- They are protected by copyright.

- The symbol ®after the trade name indicates that the name is registered by and restricted to the
drug manufacturer.

• Note: To avoid confusion, it’s best to use drug’s generic name because any one drug can have a
number of trade names

• In 1962, the federal government mandated the use of official names so that only one official
name would represent each drug. The official names are listed in the United States
Pharmacopeia and National Formulatory.

REPUBLIC ACT NO. 9502 or “Universally Accessible Cheaper and Quality Medicines Act of
2008”

• AN ACT PROVIDING FOR CHEAPER AND QUALITY MEDICINES, AMENDING FOR THE PURPOSE

• REPUBLIC ACT NO. 8293 OR THE INTELLECTUAL PROPERTY CODE,

• REPUBLIC ACT NO. 6675 OR THE GENERICS ACT OF 1988,

• AND REPUBLIC ACT NO. 5921 OR THE PHARMACY LAW

Drug Classification

• PHARMACOLOGIC CLASS

- Drugs that share similar characteristics are grouped together,

e.g. Beta-adrenergic Blockers

• THERAPEUTIC CLASS
 -A second type of drug groupings according to therapeutic use,

e.g. Antihypertensives

Where drugs come from?

• Natural Sources

• Plants

Traditionally, we are using leaves, roots, bulb, stem, seeds, buds, and blossoms of a plant. As a result,
harmful substances often found their way into the mixture.

• Concoction

• something (such as a food or drink) that is concocted from various elements: something

prepared or devised by combining different ingredients

• Decoction

• the liquor resulting from concentrating the essence of a substance by heating or boiling,
especially a medicinal preparation made from a plant.
DOH 10 HERBAL MEDICINES

PLANTS USES

1. Sambong (Blumea balsamifera L.) Anti-urolithiasis (kidney stones)

2. Ampalaya (Momordica charantia L.)

Lowering blood sugar and anti-diabete
3. Niyug-niyogan (Quisaualis indica)
Mouth wash
4. Tsaang-gubat (Carmona cetusa)

5. Acapulco (Cassia alata) Antifungal

6. Lagundi (Vitex negundo) Cough and asthma

7. Ulasimang-bato (Peperomia pellucida)
Anti-hyperurisemia
8. Bawang/Garlic (Allium sativum) Anti-cholesterol

9. Bayabas/Guava (Psidium guajava)

Oral/skin antiseptic
10. Yerba-Buena (Mentha arvensis)
Analgesic or anti-pyretic

• Researchers sought to isolate and intensify active components while avoiding harmful ones. The
active components of plants vary in character and effect:

• ALKALOIDS, the most active component in plants react with acids to form a salt that’s
able to dissolve more readily in body fluids.

• atropine

• caffeine

• Nicotine

• GLYCOSIDES, are naturally occurring active components that are found in plants
and have both beneficial and toxic effects. E.g Digoxin

• GUMS, give products the ability to attract and hold water

• Seaweed Extraction
 • Seeds with Starch

• RESINS, of which the chief source is pine tree sap, commonly act as local irritants or as laxatives
and caustic agents.

• OILS, thick and sometimes greasy liquids, are classified as volatile or fixed.

• Volatile Oils, which readily evaporate, include peppermint, spearmint, and juniper.

• Fixed Oils, which aren’t easily evaporated, include castor oil and olive oil.

• Animals

• The body fluids or glands of animals are also natural drug sources that includes the
following:

• Hormones, such as insulin.

• Oils and fats (usually fixed), such as cod-liver oil.

• Enzymes, which are produced by living cells and act as catalyst, such as
pancreatin and pepsin.

• Vaccines, which are suspensions of killed, modified, or attenuated microorganisms.

• Minerals

• Metallic Minerals

• Three metals are used in modern medicine:

• Iron, is one of the most vital minerals in our bodies, and medical applications are mined from
iron ore. Although the average person consumes between 8-18 milligrams of iron per day, there
are certain cases where it may be necessary to add in more iron to your diet. For example, iron
supplements are used to treat low blood levels–which is caused by pregnancy, poor diet, blood
loss or the inability to absorb iron.

• Zinc, is a metal found in every tissue of the body. It is often called a “trace element,” because
very small amounts of zinc are needed to support a healthy lifestyle. Zinc can be used to treat a
number of severe medical conditions, such as:

 Crohn’s disease

 Down syndrome

 Hansen’s disease

 Alzheimer’s disease

 Ulcerative colitis or inflammatory bowel disease

 Attention deficit-hyperactivity disorder (ADHD)

 Hypogeusia (or a reduced ability to taste things like sweet, sour, bitter, or salty substances)
 • Research also suggests that zinc stimulates the activity of at least 100 different enzymes in the
human body, which can prevent further risks related to these diseases.

• Platinum, is a precious metal that has been used in a variety of medications and tools since the
early 1970s. Its dense, malleable properties are essential to the production of pacemakers,
catheters, stents and even cancer therapies. According to the International Journal of Cancer
Research and Treatment, platinum-based agents are used in more than 50 percent of the
world’s anticancer drugs. Cisplatin–along with its successor drug, carboplatin–also use platinum
complexes in the treatment of common tumors, such as breast, ovarian and lung cancer.
Although these healthy metals made remarkable improvements in the field of medicine, there’s
still a greater demand for its applications in other industries.

• Non-Metallic Minerals

• Mineral medicine also contains non-metallic compounds, such as talc, white quartz, and
other traditional Chinese medicines containing silicon.

• Talc is a silicate mineral, mainly containing hydrous magnesium silicate, which

has the function of protecting skin and mucous membranes and antibacterial.

• The main component of white quartz is silica, which has sedative, calming,
antitussive and anti-asthmatic effects. In addition, silica, the main component of
the quartz photo album, can be used as a load-bearing coating for various nano-
drugs, exaggerating the stability of the nano-particles and increasing the efficacy
of the nano-particles.

• Iodine

• used to treat overactive thyroid, iodine deficiency, and to protect the thyroid gland from
the effects of radiation from radioactive forms of iodine.

• EPSOM SALT

As a folk remedy, Epsom salt is used on a widespread basis to provide relief for a variety of
conditions. These include:

 itching caused by poison ivy

 skin irritation and inflammation
 sore feet
 sore muscles
 sprains
 stiff joints
 stress
  sunburn

Doctors also administer it intravenously. It’s been shown to be effective for these uses:

 control rapid heartbeat

 relieve migraine headaches
 postpone premature birth
 prevent seizures caused by preeclampsia and eclampsia
 reduce swelling in the brain
 treat barium poisoning
 treat muscle spasms and seizures caused by magnesium deficiency

It’s used orally to treat:

o constipation

o low magnesium levels in blood

o There’s some evidence Trusted Source that magnesium taken orally

has a positive effect for several conditions, including:

o stroke

o heart disease

o diabetes

Laboratory Research

Chemical Science

 To develop synthetic drug sources.

 One advantage of chemically developed drugs is that they’re free from the impurities found in
natural substances.
 Researchers and drug developers can manipulate the molecular structure of substances such as
antibiotics so that slight change in the chemical structure makes the drug effective against
different organism.
 Example is Cephalosporin (1st, 2nd, 3rd, and 4th generation).
 Today, most drugs are produced in laboratories. Examples of such drugs include thyroid
hormone (from natural sources) and cimetidine (from synthetic sources).
 Recombinant deoxyribonucleic acid (DNA) research has led to another chemical source of
organic compounds. For example, the reordering of genetic information enables scientists to
develop bacteria that produce insulin for humans.

HOW DRUGS ARE ADMINISTERED

• A drug’s administration route influences the quantity given and the rate at which the drug is
absorbed and distributed. These variables affect the drug’s action and the patient response.
BUCCAL, SUBLINGUAL, TRANSLINGUAL
Certain drugs, such as nitroglycerin, are given buccally (in the pouch between the cheeks and
the teeth), sublingually (under the tongue), or translingually (on the tongue) to prevent their
destruction of transformation in the stomach or small intestine.

GASTRIC
The gastric route allows direct administration of a drug into the GI system.
This route is used when patients can’t ingest the drug orally.

INTRADERMAL
In intradermal administration, drugs are injected into the skin.
A needle is inserted at a 10- to 15-degree angle so that it punctures only the skin’s surface.
This form of administration is used mainly for diagnostic purposes, such as testing for allergies
or tuberculosis.

INTRAMUSCULAR
Allows drugs to be injected directly into various muscle groups at varying tissue depths.
It provides rapid systemic action and allows for absorption of relatively large doses (up to 3 ml).
Aqueous suspensions and solutions in oil as well as drugs that aren’t available in oral forms are
given IM.

INTRAVENOUS
It allows injection of drugs and other substances directly into the bloodstream through a vein.
Appropriate substances to administer IV include drugs, fluids, blood or blood products, and
diagnostic contrast agents.
It can range from a single dose to an ongoing infusion that’s delivered with great precision.

ORAL
It is usually the safest, most convenient, and least expensive route.
It is administered to patients who are conscious and stable.

RECTAL AND VAGINAL

Suppositories, ointments, creams or gels may be instilled into the rectum or vagina to treat local
irritation or infection.
Some drugs applied to the mucosa of the rectum or vagina can also be absorbed systematically.
RESPIRATORY
Drugs that are available as gases can be administered into the respiratory system through
inhalation, these drugs are rapidly absorbed.
Some of these drugs can be self-administered by devices such as metered-dose inhaler.
It is also used in emergencies, for example to administer some injectable drugs directly into the
lungs via an endotracheal tube.

SUBCUTANEOUS
Small amounts of a drug are injected beneath the dermis and into the subcutaneous tissue,
usually in the patient’s upper arm, thigh, or abdomen.
It allows the drug to move into the bloodstream more rapidly then if given by mouth.
 It includes non-irritating aqueous solutions and suspensions contained up to 1 ml of fluid, such
as heparin and insulin

TOPICAL
It is used to deliver a drug via the skin or a mucous membrane.
This route is used for most dermatologic. Ophthalmic, otic, and nasal preparations.
SPECIALIZED INFUSIONS
These are given directly to a specific site in the patient’s body.
Specific infusions include:
• Epidural
• Intrapleural
• Intraperitoneal
• Intraosseous
• Intraarticular

Phases of New Drug Development

• Phase I
- the drug is tested on healthy volunteers to make sure the drug can be given safely to
people.
• Phase II
- It involves the trials with human subjects who have the disease for which the drug is
thought to be effective.
• Phase III
- It involves large numbers of patients in medical research centers receive the drug in phase
III. The large numbers of subjects provides information about infrequent or rare adverse effects.
• Phase IV
- It is the voluntary and involves post-market surveillance of the drug’s therapeutic effects at
the completion of phase III. The pharmaceutical company usually receives reports from doctors
and other HCPs about the therapeutic results and adverse effects of the drug.
Pharmacokinetics
- It deals with a drug’s actions as it moves through the body.
- This branch of pharmacology is also concerned with a drug’s onset of action, peak,
concentration level, and duration of action.

Phases of Pharmacokinetics:
1. Absorption
2. Distribution
3. Metabolism
4. Excretion

• ABSORPTION
- This covers the progress of a drug from time it’s administered, through the time it passes to the
tissues, until it becomes available for use by the body.
- It is absorbed on a cellular level by means of primarily of ACTIVE or PASSIVE TRANSPORT.
- Pinocytosis is a unique form of active transport that occurs when a cell engulfs a drug particle.
E.g. fat-soluble vitamins (A, D, E, and K)
 - It occurs usually at slower rates when drugs are administered by oral, IM, or sub-Q routes
because of the complex mucosal layer, muscle, and skin delay drug passage.
- At the slowest absorption rates, drugs can take several hours or days to reach peak
concentration levels.
- FIRST PASS EFFECT. The mechanism in which the LIVER metabolizes much of the drug before it
enters the circulation. It usually lowers the amount of active drug released into the systemic
circulation.

• DISTRIBUTION
- This is the process by which the drug is delivered to the tissues and fluids of the body.
- Distribution depends also several factors like:
a. Blood flow
b. Solubility
c. Protein binding
- After a drug has reached the bloodstream, it’s distribution depends on the rate of blood flow,
in which it distributes quickly to those organs who have a large supply of blood such as the
heart, liver and kidneys.
- The ability of the drug to cross a cell membrane depends on whether the drug is water or
lipid (fat) soluble.
- The portion of a drug that’s bound to a protein is inactive and can’t exert a therapeutic effect.

• METABOLISM
- refers to the ability to change a drug from its dosage form to a more water-soluble form
that can then be excreted.
- Drug’s metabolite into it’s inactive form is excreted out of the body. Some drugs can be
converted to active metabolites that has a capability to their own pharmacologic action.
- The LIVER’s enzymes is the one mainly responsible for metabolizing the drug. Some drugs
inhibit or compete for enzyme metabolism, which can cause the accumulation of drugs when
they’re given together that results to adverse reaction or drug toxicity.
- Certain diseases can reduce metabolism such as liver disorders like cirrhosis and heart
failure.
- A stressful environment such as one involving prolonged illness or surgery, can also change
how a person metabolizes drugs.
- Developmental changes can also affects drug metabolism. E.g. infants have immature liver
that reduces the rate of metabolism, and elderly patients experience decline in liver size, blood
flow, and enzyme production that slows metabolism.

• EXCRETION

- Refers to the elimination of drugs from the body. Most drugs are excreted by the kidneys and
leave the body through urine. Metabolites can also be excreted through the lungs, exocrine glands
(sweat, salivary or mammary glands), skin and intestinal tract.

- Half-life is the time of the drug it takes for the plasma concentration of a drug to fall to half its
original value.
 • ONSET, PEAK and Duration of action

Onset – refers to the time interval that starts when the drug is administered and ends when the
therapeutic effect actually begins.

Peak – when the body absorbs more drug, blood concentration levels rise and it is reached when the
absorption rate equals the elimination rate.

Duration – it is the length of time the drug produces its therapeutic effect.

Pharmacodynamics

- Is the study of the drug mechanisms that produce biochemical or physiologic changes in the body.

- Drug action is the interaction at the cellular level between a drug and cellular components such as
proteins that make up the cell membrane, enzymes or target receptors.

- Drug effect is the response resulting from this drug action.

AGONIST – is a drug that interacts with receptors that has an attraction or affinity for a receptor and
stimulates it.

ANTAGONIST – is a drug that has an affinity for a receptor but displays little or no intrinsic activity.

POTENCY – refers to the relative amount of a drug required to produce a desired response. It is also
used to compare two drugs.

Therapeutic index (margin of safety) – the relationship between a drug’s desired therapeutic effects
and it’s adverse effects.

Drug Interactions

• Additive effect – occurs when two drugs with similar actions are administered to a patient

• Potentiation – also called synergistic effect. Occurs when two drugs that produce the same
effect are given together and one drug potentiates (enhances) of the other drug.

• Alteration absorption - when the two drugs given together can change the absorption of one or
both of the drugs.

• Toxicity - this can occur when a drug’s metabolism and excretion are inhibited by another drug.
 • Bioavailability – the amount of a drug dose available to the systemic circulation. ( e.g. tyramine
rich-foods + MAOIs = Hypertensive crisis, Grapefruit = fexofenadine, statin drugs)

Adverse drug reactions

- is a harmful, undesirable response that can range from mild reactions that disappear when the
drug is stopped to debilitating diseases that become chronic.

DOSE-RELATED REACTIONS

• Secondary effects – a drug produces a major therapeutic effect as well as secondary effects that
can be beneficial or adverse. (e.g. morphine – constipation and respiratory depression;
diphenhydramine – sedation (drowsiness) )

• Overdose – this can occur when excessive dose is taken either intentionally or accidentally that
can result to serious reactions such as respiratory depression, cardiovascular collapse and even
death.

• Iatrogenic effects – some adverse drug reactions can mimic pathologic disorders ( e.g. ASA,
corticosteroids causes GI irritation and bleeding, Propranolol can induce asthma, Gentamicin
can induce deafness)

PATIENT SENSITIVITY-RELATED ADVERSE REACTIONS

• Allergic reactions (hypersensitivity)– occurs when a patient’s immune system identifies a drug, a
drug metabolite, or a drug contaminant as a dangerous foreign substance that must be
neutralized or destroyed.

 ANAPHYLAXIS – a fatal type of hypersensitivity reaction that produces broader systemic damage
by initiating cellular release of vasoactive and inflammatory substances that can result to life-
threatening circulatory collapse and laryngeal swelling and bronchospasm.

• Idiosyncratic response – a sensitivity-related adverse reactions that don’t result from the
pharmacologic properties of a drug or from allergy but are specific to the individual patient.

Nursing Management

A. Nursing Process

• ASSESSMENT

- Collection of data that are used to identify the patient’s actual and potential health needs.

- Health history includes documenting drugs and herbal preparations that the patient is taking as
well as any allergies.

• DIAGNOSIS
 - Clinical judgment about individual, family, or community responses to actual or potential health
problems or life processes. (NANDA)

- It should be individualized for each patient, based on the patient’s medical condition and the
drug’s he’s receiving.

• PLANNING

- A written care plan serves as a communication tool among health care team members that helps
ensure continuity of care.

• IMPLEMENTATION

- Putting the care plan into ACTION that encompasses nursing interventions that includes drug
therapy and can involve multidisciplinary approach.

• EVALUATION

- The final step in which the nurse determines the interventions carried out have enabled the patient to
achieve the desired outcomes.

Prevention of Medication Errors

1. MINIMIZE CLUTTER

• The pharmacy environment is often fast-paced and intense, with high prescription volume,
insufficient staffing, and demanding patients.

2. VERIFY ORDERS

• For prescriptions called in by phone, it’s important to write down and then repeat the order to
verify that it was heard correctly.

3. USE BARCODES

• Scanning barcodes plays an important role in checking that the correct drug, dosage form, and
strength has been selected.

4. BE AWARE OF LOOK-ALIKE SOUND-ALIKE (LASA) DRUGS

• ISMP maintains a long list of drugs with similar names that may be confused, which it
recommends printing in bolded tall man (uppercase) letters (e.g. buPROPion/busPIRone)

5. HAVE A SECOND PAIR OF EYES CHECK PRESCRIPTIONS

 • One way to prevent human error is by involving a second human-a pharmacist or technician (as
permitted by state law)-in the dispensing process.

6. DESIGN EFFECTIVE WARNING SYSTEMS

• Various alert strategies can be helpful, but human nature is to overlook the familiar.

7. INVOLVE THE PATIENT

• Patients are their own last line of defense when it comes to medication errors, and investing a
minute or 2 in speaking to them can reap huge dividends in catching medication errors

8. TRUST YOUR GUT

• ” Question the patient and call prescribers to verify, she advised, and if necessary, dig deeper to
obtain clarification on why something was prescribed as it was and whether it was a mistake.

9. BE PROACTIVE

• ISMP has free self-assessment tools that pharmacists in different practice settings can use to
evaluate how well they are maintaining patient safety. Its Medication Safety Self Assessment for
Community/Ambulatory

10. TRACK MEDICATION ERRORS

• Open discussion of medication errors is most helpful when an institution has a just culture
perspective

DRUG CALCULATIONS

MEASURING SYSTEMS

• Metric System - the most widely used system of measure which is based on the decimal system,
so all units are determined as multiples of 10.

- it uses the gram as the basic unit of solid measure and the liter as the basic unit of liquid
measure.

• Apothecary system – the very old system of measure that was specifically developed for use by
the apothecaries or pharmacists and po

- it uses the minim as the basic unit of liquid measure and grain as the basic unit of
solid measure.

• Household system – is the measuring system that is found in recipe books.

 it uses the teaspoon a the basic unit of fluid measure and pound as the basic unit of
solid measure.

Pediatric Considerations:
The Formula Method

DOSE ORDERED
X Amount on hand = Amount to administer
DOSE ON HAND

Computation of IVF Drip Rates:

TAKE NOTE: Drops = gtts

Microdrops = ugtts

DROP FACTOR – the number of drops it takes to make up one ml of fluid.

Microdrops (ugtts) = 60 ugtts/ml;

Macrodrops (gtts) = 15 gtts/ml (or 20 gtts/mL depending on the manufacturer)

To compute for IVF Rate:

IVF RATE (gtts/min) = Volume in cc x Drop Factor

No. of Hours to infused x 60
Prepared by:

Edberg S. De Guzman, MSN, RN, CNN

NCM 106 Instructor

Approved by:

May Jacklyn Radoc-Samson, RN, LPT,

MANc

Dean, School of Health Sciences