Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.

Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Upper Saddle River, NewJ ersey07458
All rights reserved.
Chapter 6
Pharmacodynamics
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Know Principles of Pharmacodynamics
and Clinical Practice
Helps to predict if drug will produce
change
Will ensure that drug will provide safe,
effective treatment
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Frequency-Distribution Curve
Graphical representation of number of
clients responding to drugs at different
doses
Peak of curve indicates largest number of
clients responding to drug
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Upper Saddle River, NewJ ersey07458
All rights reserved.
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Median Effective Dose (ED
50
)
Middle of frequency-distribution curve
Dose that produces therapeutic response
in 50% of a group
Sometimes called averageor standard
dose
Many clients require more or less
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Skill of Nurse Critical in Determining if
Average Dose Is Effective
Client observation
Taking of vital signs
Monitoring lab data
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Median Lethal Dose (LD
50
)
Used to assess safety of a drug
Shown on frequency-distribution curves
Determined in preclinical trials
Is lethal dose in 50% of group of animals
Cannot be experimentally determined in
humans
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Median Toxicity Dose (TD
50
)
Dose that will produce given toxicity in
50% of group of clients
Value may be extrapolated from
Animal data or
Adverse effects in client clinical trials
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Therapeutic Index
Measure of a drugs safety margin
The higher the value, the safer the drug
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Calculating Therapeutic Index
Therapeutic index =
Median lethal dose LD
Median effective dos
50
ee ED
50
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Example of Therapeutic Index
Therapeutic index of 4: need error four
times dose to be lethal
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Figure 6.2 Therapeutic index: (a) drugX has a therapeutic indexof 4: drugZhas a therapeutic indexof 2.
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Three Phases of Graded
Dose-Response Curve
Phase 1: occurs at lowest dose
Few target cells affected by drug
Phase 2: linear relationship
Most desirable range
Linear relationship between amount of drug
administered and degree of client response
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Three Phases of Graded
Dose-Response Curve
Phase 3: plateau reached
Increasing dose has no therapeutic effect
Increased dose may produce adverse effects
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Figure 6.3 Dose response relationship.
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Two Ways to Compare
Medications
Potency
Efficacy
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Potency
Lower dosage with therapeutic effect
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Figure 6.4 Potencyandefficacy: (a) drugA has a higher potencythan drugB (b) drugA has a higher efficacythat
drugB
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Efficacy
Magnitude of maximal response
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs That Act as Agonists
Bind to receptor
Produce same response as endogenous
chemical
Sometimes produce greater maximal
response
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs That Act as
Partial Antagonists
Bind to receptor
Produce weaker response than agonist
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs That Act as Antagonists
Occupy receptor
Prevent endogenous chemical from acting
Compete with agonist for receptor
Inhibit effects of agonist by changing
pharmacokinetic factors
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Receptor Is Macromolecule
Binds with endogenous molecules
Hormones, neurotransmitters, growth factors
Most drug receptors are proteins.
Associated with plasma membrane or
intracellular molecules
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drug Attaches to Receptor
Like key to lock
Triggers second messenger events
Initiates drug action
Can stimulate or inhibit normal activity
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Figure 6.5 Cellular receptors.
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
In the Future: Customized
Drug Therapy
DNA test before receiving drug
Prevention of idiosyncratic responses