Bachelor of Science in Nursing 2YA

NCMA216: BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

Coverage for Prelim: Acacia leaves – to treat internal bleeding.
• Basic Concepts of Pharmacology 4) Pharmacologia sen Manuductio and Materia Medicum
• Pharmacokinetics - First recorded reference to the word pharmacology.
• Pharmacodynamics 5) Early 1800s
• Pediatric Drug Computation - Chemists isolates specific substances from complex
• Nursing Process in Pharmacology mixtures
• Autonomic Nervous System - Pharmacologists then study their effects in animals
- Fredrich Serturner (first isolated morphine from opium,
BASIC CONCEPTS OF PHARMACOLOGY injected himself and three other friends with huge doses
Discussed by Prof. Marivic Ilarde (100mg)
Pharmacology
- Tiningnan nila kung yung morphine is makakatanggal ng
- Is the study of drugs and its origin, chemical structure,
pain
preparation, administration, action, metabolism and excretion.
- They study the effect of substances in animals
(aalamin ang tungkol sa drug, kung saan nangaling,
- John Jacob Abel
ingredients nung gamut, how they are prepared, paano
• Father of American Pharmacology
gagamitin, effect ng gamut sa tao, at paano sila e a absorb and
• (Foundation of the 1st pharmacology – department in
ilalabas kase hindi sila pwede mag stay dahil magiging toxic;
University of Michigan in 1890)
inc. level of chemical comp. in the body lead toxicity)
- The study of drugs that alter functions of living organisms. • Hopkin’s first professor of pharmacology
Pharmacy • The early focus of his work was on isolation and
- Art of preparing, compounding (we mix medication for characterizing the hormones of the endocrine system,
personalized medication), and dispensing drugs. It also refers especially adrenaline and insulin
to the place where drugs are prepared and dispensed. Basic Concepts of Pharmacology
(e.g, Mercury; sila din nag mi mix ng mga drugs- Drug
compounding) - Are chemicals that alter physiochemical processes in body cell.
Pharmacist - They can stimulate or inhibit normal cellular functions.
- A person licensed to prepare and dispense drugs to make up - Used interchangeably with medicines.
prescriptions. Drug Definition
- Nurses can also dispense drugs but not allowed to mix - A substance recognized by an official pharmacopoeia or
medications formulary
- A substance intended for the use in the diagnosis, cure,
History of Pharmacology
mitigation, treatment, or prevent diseases (vaccines or healthy
- Begun when humans used plants to relive symptoms
food).
- Dahil hindi pa uso ang medication dati mga tapal tapal pa mga
- A substance or (other than food) intended to affect the
ginagamit noong sinauna)
structure or any function of the body
1) Babylonians
Drug Classification
- Earliest surviving “prescriptions” on clay tablets in 3000
• Chemical Structure
B.C.
- pertain to the molecular arrangement of atoms in a
- (Herbs or mga dahon)
molecule and the chemical bonds that holds the atom
2) Chinese
together
- Recorded the Pen Tsao (great herbal) – a 40-volume
• Mechanical of Action (MOA)
compendium of plant remedies dating to 2700 B.C.
- refers to the specific biochemical interaction through
- Herbal plants
which a drug substance produces its pharmacological
- They are still using herbs until now to cure illness
effect such an enzyme or receptor
3) Egyptians
- Archives of remedies on a document known as Eber’s • Mode of Action (Moa)
(Erb’s) Papyrus in 1500 B.C. - describes a functional or anatomical change resulting
- Sa Erb’s Papyrus nakasulat ang mga iba’t ibang medicinal from the exposure of a living organism to a substance
plants, anatomy of the body and diseases of plants and Drug Information
- also referred to a medication information or drug informatics
animals.
- range from discovery, use, and management of information in
- Ex. Aloevera - to treat burns or skin diseases.
the use of medication
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- covers from drug identification, pharmacokinetics to dosage Drug Action

and adverse effects. 1) Therapeutic Effect
Drug Names - Also referred as the desired effect (primary effect
1) Generic or Nonproprietary Name intended)
- Name approved by the Medical or Pharmaceutical - Binibigyan ang anti-biotic to slow down growth of bact.
Associations in the original country of manufacture and is to kill the bacteria
adopted by all countries 2) Side Effect
- Ex. paracetamol - also referred as the secondary effect (unintended effect)
- (kung saan nanggagaling yung drugs or na manufactured - ex. Side effect of anti-biotic is diarrhea, nausea, and
yung drugs) vomiting.
2) Brand Name or Trade Name - adverse effect (severe side effect) kaya dpt i-reevaluate pt.
- Name given by the manufacturer of the drug (ex. adol or - not all pare pareho ang effect kaya need talagang e
panadol or biogesic pareho lang ang effects, same lang evaluate ang pt lagi para if may mga effects ma heads up
ang effect) agad ang Doctor
3) Chemical Name 3) Drug Toxicity
- Name that describes the atomic or chemical structure. - deleterious effects of a drug resulting from over dosage,
- Ingredients like N-acetyl-p-aminophenol ingestion of external use drug, and accumulation on the
Examples of Generic, chemical, and brand names: blood stream
Brand - pwedeng ma overdose ang pt kapag mali ang computation
Generic name Chemical name
name (halimbawa ang ibibigay sa baby is .5 kaso ang nabigay is
N-methyl-3phenyl- 5mL so nagkulang ng point you can overdose the pt)
Fluoxetine HCI Prozac
propylamine - Nagkakaroon ng auto toxicity dahil kapag may mga sakit
Acetaminophen 4-hydroxyacetanilide Tylenol kunwari sinisipon lang inom agad ng gamot, nagkaubo
2-p-isobutylphenyl-propionic lang inom agad gamot, masama pakiramdam umiinom
Ibuprofen Motrin agad ng gamut tapos lahat nung ininom mong gamut
acid
merong paracetamol so it will cause problem
- Signs of drug toxicity:
Generic Name - Hepatotoxic- liver damage; necrotoxic- kidney damage;
Route of high blood and etc.
Brand Name medication - like in pregnant woman who have hypertension tapos
bingyan ng magnesium sulfate malalaman kung nag ka
Dosage/ content Action
of vial drug toxicity sya kung bumaba bp, pulse, respiration at
absent na ung patellar reflex so dpt mabigyan siya ng
calcium gluconate sa bed side ng pt. usually nakalagay
lang sa chart is observe for drug toxicity.
4) Drug Allergy
- immunologic reaction to drug or hypersensitivity
- should have skin test for IV drugs
- should ask patient for allergy in oral drugs
- if the pt. have many food allergy then ask the doc.
5) Drug Tolerance
- exists in person with unusually low physiologic response
to a drug
- may mga taong mababa tolerance sa mga substances at
ung iba nmn dhil usual silang uminom ng pain reliever
tumataas pain tolerance nila

Drug Regulation & Mandates

Food and Drug Administration of the Philippines or FDA
- created under the Department of Health or DOH to license,
monitor, and regulate the flow of food, drugs, cosmetics,
medical devices, and household hazardous waste in the
Philippines

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 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
- FDA’s main goal is to ensure the health and safety of the food
and drugs made available to the public
- (sila ang nagbibigay ng lisensya sa mga drugs. Tinitingnan
nila kung may mga ibang substances pa sa drugs. Kapag
meron tine terminate nila yung drugs kase magkakaroon ng
bad effect yun sa katawan ng tao)
- Govt. doctors- write generic name not the brand name
• Republic Act No.3720
- known as the Food Drug, and Cosmetic Act.
- An act to ensure the safety and purity of foods, drugs,
and cosmetics being made available to the public by
creating the food and drug administration which shall
administer and enforce the laws.
• Republic Act No. 8203
- Otherwise known as the special law on counterfeit
drugs.
- “Unregistered and imported drug product” as
distinguished from counterfeit drug defined under
Section 3 of RA…shall refer to unregistered
counterpart brand in the Philippines
- (Ito yung nagche check if totoo or peke yung product)
• Republic Act No.7394
- Consumer Act of the Philippines
- Protects the interest of the consumer, promotes
general welfare and to establish standards of conduct
for business and industry
- Protection against deceptive, unfair, and
unconscionable sales acts and practices.
• Republic Act No.9165
- Comprehensive Dangerous Drugs Act of 2002 the
Philippine Drug Enforcement Agency (PDEA)
- Created for the efficient and effective law
enforcement of all the provisions on dangerous drugs
and or precursor and essential chemicals as provided
in R.A
- Two of the most used and valuable illegal drugs in
the country are “methamphetamine hydrochloride
known as shabu and marijuana”
Principle of Drug Administration
• Are substances administered for the diagnosis, cure, treatment,
or relief of symptom or prevention of disease.
• Practice Guidelines:
- RNs are responsible for own actions, illegible order
should be questioned or clarified.
- RNs should be knowledgeable about the medication.
- If the RN is uncertain about the calculation, ask another
nurse to double check.
- What you prepare, you administer.
- Do not leave medications at bedside.
- If the client vomits, report to charge nurse, MD, or both.
o Charge nurse- does the charting and carry out doc.
Order
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o Medication nurse- focus on pt. get direct care to pt.
and give medications and check pt. chart to check
bago umuwi
- When error is made, assess the patient first and report to
MD immediately.
(there is no room for error because it is cause life of
patient so you should focus on what you are doing)
• Correct Identification of the Patient:
- ID band or ID bracelet (Kozier)
- Ask the patient’s name.
- Avoid: calling the client in Name because they may
answer “Yes” to the wrong Name.
• Observe the Ten Rights:
1) Right medication
- Means that the client receives the drug that was
prescribed
- Medication orders may be prescribed by:
o Physician
o Dentist
o Podiatrist- treat infection in foot and lowerlimb
o License health care provider such as advance
practice registered nurse
o With authority from the state to order medication
- Components of Medication Prescription:
o Component of drug order
o Date and time the order is written
o Drug name: BN and GN
o Drug dosage: 500mg
o Route of administration
o Frequency and duration of administration
o Any special instructions for withholding or
adjusting dosage based on nursing assessment,
drug effectiveness, or laboratory result
o Physician or other health care provider signature
or name if TO or VO
o Signature of license practitioner taking TO or
VO
- Categories of Drug Order:
o Standing- maintenance medications or taken for
several days like anti biotics. Give cephalexin
5mg 1 cup 3x a day for 7 days
o One time- diphenhydramine 50mg IV prior to
blood transfusion.
o PRN / when necessary- some doc. Don’t indicate
prn. Paracetamol 500mg 1 tab every 4 hours for
temp. 38.5 and above. So ang basehan dito ay
temp. kase walang prn. Ibibigay kada 4hrs
tuwing may lagnat na ang temp ay 38.5 pataas.
8am-12pm walang lagnat wag ibigay, 2pm may
lagnat ibigay ang gamot.
o STAT/immediately/now- demerols IM stat, so
ibigay na agad kahit may ginagawa ka pa iwan
mo ginagawa mo balikan mo na lang
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

2) Right dose
- Right dosage of the medicine that will be given to the
client
3) Right route
- Is necessary for adequate or appropriate absorption
- Common routes are the following:
o Oral
o Sublingual
o Buccal
o Inhalation
o Topical
o Inhalation
o Instillation- ex. eyedrops
8) Right to refuse
o Suppository, etc.
- Client can and do refuse to take medication
4) Right time
- It is the nurses’ responsibilities to determine when
- the time at which the prescribed dose should be
possible, the reason for refusal and to take reasonable
administer.
measure to facilitate the client taking the medication
- Daily drug dosages are given at specified time during
- Should have waiver signed by the pt.
a day such as:
9) Right assessment
o Twice a day b.i.d
- Requires the appropriate data be collected before
o Three time a day t.i.d
administration of drugs.
o Four times a day q.i.d.
10) Right evaluation
o Every 6hrs q6h
- Requires that the effectiveness of the medication be
o HS: hour of sleep
determined by the client response to medication
5) Right client
- (you must observe the first 5 rights)
- Can be measured by checking the client identification
bracelet by having and by having the client state her
or his name.
- Tanungin ang name but do not call the name of the
client let the client speak her/his name
- Some client answers to any name or unable to
respond, so client identification should verify each
time of medication administered.
- In the event of missing identification bracelet, the
nurse must verify the client identity before any drug Date prescription was
Prescriber’s Info.
administration. written
6) Right client education
Patient’s Info. Inscription:
- Requires that the client received accurate and Medication Prescribed
thorough information about the medication an d how Superscription:
it relates to his or her situation “Recipe”
Quantity of
- Client teaching also includes therapeutic purpose, Medication
Sigma: Directions
possible side effect of the drugs, any dietary for Patient
restriction or requirements skills administration, and Instruction to the
pharmacy
laboratory monitoring Physician’s License
7) Right documentation and PTR Number Physician’s signature
- Requires that the nurses immediately record the
appropriate information about drug administered - Rx- from latin word recipe means to take. Called
include the ff: superscription
• Name of the drug - Inscription- medication prescribe
• Dose - Sigma- direction for pt. on how to take the medication
• Route - PTR-yearly kumukuha sa munisipyo
• Time and date - S2 no.- used for prescribing drugs that cause addiction like
Demerol
• Nurse initial or signature

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 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

Oral Medications Parenteral Medications

- Most common route Intradermal
- Contradictions: Site Angle Gauge Length Max cc
• Client is vomiting - Inner lower Almost 25, 26, 27 3/8”, 5/8”, ½” 0.1 to 0.2
• Client with intestinal or gastric suction arm parallel to mL
• Unconscious client - Upper the skin
chest 10-15 O
• Inability to swallow
- Anterior
- Unsafe actions chest
• Do not crush enteric coated or gel coated tablets (to - Upper back
prevent form gastric juice) beneath the
• Do not crush long-acting tablets (slowly inaabsorb scapula
gamot) - Perfect wheel should have right angle and hawak sa syringe, if
• Do not try to open sealed capsules (wag itry buksan if no wheel means malalim ang pag inject
mahigpit)
• Do not crush contents of spansule with beads or
pellets
• Do not give sublingual formulations orally
• Do not crush sublingual formulations
• Do not give oral medications sublingually
- Safe actions
• Scored tablets may be split (no scoring wag hatiin) Subcutaneous
• Chewable medications can be crushed safely Site Angle Gauge Length Max cc
• If a capsule opens easily, powder from the capsules can be - Outer aspect 45-degrees 25, 26, 27 3/8”, 5/8”, 1-3 mL
mixed with food or liquid of the upper (1 inch of ½”
• Liquid filled capsule contents can be (a) squeezed out, or arms tissue can
- Anterior be grasped)
(b) aspirated then mixed with food or liquid
thighs
• A sublingual formulation can still be given ever if client is - Abdomen 90-degrees
NPO - Upper back (2 inches of
• Beads from readily opened capsules can be sprinkled over - Ventroglutea tissue can
soft food, but should not be chewed. l be grasped)
- Tablets or Capsule: - Dorsogluteal
• Difficulty in swallowing
• Crush and mix with small amount of water
- Avoid Crushing:
• Sustained-action
• Enteric coated
• Buccal and sublingual tablets
- Liquid Medication:
• Mix before pouring
• Place medication cup on flat
surface at eye level
• Fill the cup with the desired level
using the bottom of the meniscus
Intramuscular
• Site:
- Ventrogluteal
 1y/o and adult
 No large nerve or
blood vessels
 Sealed off by bone
 Contains less fat
than buttock

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 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

- Vastus lateralis - Hairless

 Site of choice for 1 y/o - (+) hair (CLIP, do not shave)
and younger - Not subject to excessive movements or wrinkling
 Infants with poorly • Avoid:
developed gluteal - cuts, burns, abrasions, distal extremity
muscles 2) Ophthalmic medications
- Dorsogluteal • Preparation:
 For adults and children - Clean the eyelid and lashes
with well-developed from inner to outer canthus
gluteal muscles • Instruction before administration:
 Contradicted: For - Look up
adults and children
• Where and how much to apply:
with well-developed
- Liquid: instill correct number
gluteal muscles
of drops
 Increased risk of
- Outer third of the lower
striking the sciatic nerve
- Ointment: discard the first
- Deltoid
bead
 Small muscle, very
- Squeeze 2cm on the lower conjunctival sac
close to the radial
• Instruction after installation:
nerve and artery
- Do punctual occlusion for 30 seconds
 Rapid absorption
- Close but not squeeze the eyelid
for adults
3) Otic medications
 Cannot administer
• Preparations:
more than 1 mL
- Clean the pinna and the
 Recommended site for Hepa B vaccine
meatus of the ear canal
administration
- Warm the medication: In
- Rectus femoris
 Can be used for self- between hands
administration - Place in warm water
 Disadvantage: causes • Straighten the auditory canal:
discomfort - Adult (>3 years old): Pull the pinna upward and
• Angle: backward
 90-degrees - Child (<3 years old): pull the pinna downward and
• Gauge: backward
 24,23,22,21,20 • Instill the medication:
- Along the side of the canal
• Length:
 1”, 1 1/2”, 2” • Actions after:
• Max cc: - Gently press the tragus
 2-5 mL - Insert small piece of cotton fluff loosely
Intravenous/ Intravascular • Instruction after:
• Gauge: 24,23,22,21,20
• Length: 1”, 1 1/2”, 2”
• Max cc:
- Push: 10 mL
- Infusion: 4L in 24 hours
ID/ SC IM/ IV
Gauge 25 24
length <1 inch 1 inch and 

Topical Medication
1) Transdermal patch
• Site:
- Trunk or lower abdomen

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 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
PHARMACOKINETICS
Discussed by Prof. Carmencita Pacis
- Effect of the body to the drug. So, once we ingested a
medication, what your body will do to the medication.
- You need to understand pharmacokinetics and
pharmacodynamics for you to understand the mechanism of a
medication because each medication will have its own kinetics
and dynamics.
Process of Medicine
1. Pharmaceutic phase/ dissolution
- Solid form (tablet or capsule)
- Dissolves to liquid form
- Hindi sa lahat ng gamot. This will occur only if the
medication is taken by oral route and its solid form.
Kailangan matunaw at maging liquid bago sya mag enter
sa pharmacokinetic phase.
- This is the outside pharmacokinetics phase.
- Only will be needed as the first phase drug action for
those medications that is solid form and given by oral
route.
2. Pharmacokinetic phase
- Kinetics and dynamics ay sabay. (may epekto ung
katawan sa gamot, may epekto yung gamot sa katawan)
• Absorption – first pass effect
• Distribution – protein binding
• Metabolism – onset, peak duration
• Excretion – half-life
3. Pharmacodynamics phase
- Kinetics and dynamics ay sabay. (may epekto ung
katawan sa gamot, may epekto yung gamot sa katawan)
• Receptors: agonist and antagonist
2 Phases of Pharmaceutic Phase
1. Disintegration
- breakdown into smaller parts
- Pag tinake sa bibig, hindi agad mageenter sa absorption,
nangyayari ang absorption kapag naconvert na yung solid
form ung gamot into liquid. Kailangan mag break down
into a smaller parts ang capsule or tablets.
2. Dissolution
- Further breakdown into smaller parts in GIT – absorption;
dissolve into liquid.
- Gastric acids will be the one to dissolved the solid
particles.
- Kapag naging liquid na sya, mageenter na sya sa kinetics,
nangyayari to sa small intestines.
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Pharmaceutic Phase (Dissolution)
- The 1st t phase of drug action.
- In the GI tract, drugs need to be in solution so they can be
absorbed.
- Disintegrate into small particles to dissolve into a liquid.
- Rate of dissolution is the time it takes the drug to disintegrate
and dissolves to become available for the body to absorb it.
- Kapag ung gamot ay hindi natunaw, baka yung gamot na yon
ay hindi design to dissolve in acidic environment. May mga
gamot tayo na kailangan ma dissolve sila into a alkaline
environment.
- Kapag hindi na dissolve yung gamot, hindi maabsorp.
- Rate of dissolution – pwedeng mabagal or mabilis. (kung
mabilis, baka mataas yung acidity sa stomach nila)
- Most of the drugs are weak acids. They are designed to
dissolve in a acidic environment.
- Kapag mabagal ang rate of dissolution, mababa din ang
magiging rate of absorption. (domino effect)
Excipients
- Tablets are not 100% drug.
- Fillers and inert substances – excipients.
- Allow drug to take on particular size and shape and to enhance
drug dissolution.
- Additives na binibigay sa gamot para magkaroon sya ng shape,
kulay, lasa, at container.
- Capsule – makintab, pag hinawak mo ng basa ang kamay mo,
didikit sya sa balat mo kasi gelatin coating. Itong gelatin
coating na to, hindi gamot, yan ung excipients. Pag tinake ng
pasyente yung capsule, at nakarating sa stomach, yung acidity
ng stomach tutunawin nya si gelatin. Tapos after non,
tutunawin naman yung gamot sa loob.
- Example: 500mg amoxicillin – yung hawak mong tablet, hindi
yan ung buong 500mg ng amoxicillin na nasa loob pa siya.
Yung nasa labas nya na may lasang orange or matamis,
excipients ang tawag dyan.
- May mga gamot na light sensitive, yung capsule or container
nila hindi mape-penetrate ng ilaw. Kaya yung excipients
pinoprotektahan din yung gamot na nasa loob. Para hindi
masira agad.
- Essential ingredients to ensure that a pharmaceutical drug is
biologically active.
- Important uses of drug excipients:
• Aid in the processing of the drug delivery system during
its manufacture.
• Protect, support or enhance stability, bioavailability, or
patient acceptability.
• Assist in product identification and enhance any attribute
of the overall safety.
• Assist in the effectiveness and/or delivery of the drug in
us.
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
Factors affecting rate of dissolution
Form of drug (liquid vs. solid)
- Liquids more absorbed than solid, already in solution, rapidly
available for GI absorption.
Gastric pH (acidic vs. alkaline)
- acidic media faster disintegration and absorption.
- Normal gastric pH – 1.5-3.5.
- 0-7 The lesser the number, the more acidic. From 8-14 that is
basic/ alkaline.
Age
- young & elderly – Increase pH decrease absorption.
- Yung mga younger patient and very old patient, mabagal ang
kanilang metabolism.
- With this, tumataas ang kanilang Gastric pH. Gastric pH is
inclined more in alkaline side. Pag nasa alkaline side yung
gastric pH, the longer it will take for your solid medication to
dissolve. Ang solution neto ay bigyan ng liquid medication.
Enteric coated drugs
- Resist disintegration in gastric acid
- Disintegration occurs only in alkaline environment (intestine)
- Should not be crushed.
- Enteric coat sila kasi yung gamot sa loob ay gastric irritant.
Halimbawa, natanggal yung coating, pagdating sa stomach –
tinunaw ng acid yung coating nya – pag lumabas yung gamot
sa stomach, eh gastric irritant sya, magkakaroon ng
abdominal pain yung pasyente.
- So may enteric coat sya para hindi matunaw sa acidic
environment, pagdating nya sa small intestine or alkaline
environment, doon palang sya matutunaw. Kaya lang,
expected mo na longer ang time. Kaya hindi sya pwede
durugin kasi sasakit tyan ng pasyente.
Presences of food
- Interfere with dissolution and absorption, enhance absorption
of other drugs, and may be protectants of gastric mucosa.
- Kapag hindi sya naka enteric coat at ang gamot ay gastric
irritant din, dapat tinetake to kasabay ng pagkain. Para
maprevent yung abdominal pain.
Pharmacokinetics
- Process of drug movement throughout the body that is
necessary to achieve drug action.
- Pag naabsorp kasabay na si dynamics. Pag hindi na-absorp,
walang dynamics. Kailangan maabsorp yung gamot para
magkaroon ng effect or mechanism of action.
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Four Process
1. Absorption
- Small intestine (oral route) – intramuscular (muscle) –
subcutaneous (fats) – intradermal (dermis). Kung saan mo
siya inadminister, doon ang organ of absorption.
- Rate of absorption will be affected kung nagkaroon
problem doon sa organ kung saan mo sya inadminister.
2. Distribution
- Main organ: Blood vessels – siya ang nagdidistribute.
After mabsorp, sasama na ang drug molecules sa blood
plasma. And this blood plasma will circulate all
throughout the body hanggang makarating sya sa target
organ, kung saan sya kailangan.
- Mabagal ung circulation – the rate of distribution will be
also affected.
3. Metabolism (Biotransformation)
- Main organ: Liver – because this is the one who release
liver enzymes (Cytochrome P450), na nagcoconvert ng
gamot into metabolites.
- Lahat ng gamot, once na madistribute at umabot sa target
organ, active sya. Bawat isang gamot, may tintawag tayo
“Life” kumbaga hanggang ilan oras dapat magiging active
ung gamot na to sa katawan. So, yung liver enzymes or
Cytochrome P450 will now convert this active drug to
inactive drug. Yan ang tinatwag na biotransformation.
- Bioavailability – kapag hindi sila natranform into inactive
form. Available pa sila for use.
- Pag hindi naconvert yan into inactive form at magbibigay
nanaman tayo ng another dosage of drug, overdose yon.
Dito magstastart yung toxicity.
4. Excretion (Elimination)
- Once maconvert into inactive form yung medication, doon
plng magkakaroon ng process ng excretion.
- Main organ: kidney – will be the one who decide whether
irereabsorp nya or iexcrete nya ung drug molecule. Pag
hindi naexcrete yan, mooverdose din.
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
Will my drug get to where it needs to work?
- Kung may absorption plng may problema ka na, expected
yung distribution mabagal at magkakaroon ng problem.
- Kaya dapat absorption plng maayos. Kasi domino effect
to.
Drug Absorption
- Movement of the drug into the bloodstream after
administration.
- 80% of drugs are taken by mouth – enteral.
- Movement of drug molecules from site of administration to
circulatory system.
- Kailangan matunaw at absorp muna ng small intestine bago
sya makapasok sa blood plasma.
Factors controlling the rate and reliability of drug absorption
1. Physiological
→ Blood flow to absorbing site.
- Fast or slow
- Pag mabagal ung delivery ng blood sa small intestine
mo, ang rate of absorption ng small intestine would
also be slow.
- Fats (insulin) – nainject mo yung matigas na fat kasi
doon ka lagi nagiinject, nursing responsibility
pagdating sa insulin, will be to rotate the site, hindi
pwede yung isang lugar ka lng lagi nagiinject. Kasi
ang effect nito ay Lipodystrophy or ung pagtigas ng
taba. Kaya yung rate ng absorption sa fats ay
magiging slow.
→ Total surface area for absorption.
- Kapag mas malawak yung area kung saan mo sya
gusto mo absorp, mabagal din sya maabsorp.
- Mas maraming area ang dapat mong distributan para
maabsorp sya.
→ Time of arrival and contact time at absorption site
- Yung oral route, tatravel pa yan, tutunawin pa sya
bago maabsorp.
- Pero pag IV, deretso sa blood plasma. (fastest route)
2. Physic-chemical
→ Solubility
- Capacity ng gamot na matunaw.
- Most of the drug are lipid soluble – they need acidic
environment. Mas madali to madissolve kaysa sa
water soluble. Mostly they are ionize, they could
easily penetrate a semipermeable membrane kahit
passive transport lang yan.
- Water soluble – they will be dissolving on the fluid
part of the blood. Commonly they are ionize – hindi
sila madaling maabsorb, they will require energy.
→ Chemical stability
→ Lipid to water partition coefficient
→ Degree of ionization
J.A.K.E 9 of 32
Movement of drugs particles from GIT to body fluids involve 3
processes
1. Passive transport
a) Diffusion
- Drugs move across the cell membrane from an area
of higher concentration to one of lower concentration.
- If galing ka sa area na mataas ang concentration at
pupunta ka sa mababang concentration, hindi mo
kailangan ng energy kasi mataas naman ang
concentration mo at pupunta ka sa may mababang
concentration.
- You could enter to the low concentration because you
are high concentration (HAHAHA sana magets nyu)
- Most of the drugs will be using this passive transport,
lalo na yung lipid soluble.
b) Facilitated diffusion
- Passive transport – requires a carrier such as enzyme
or protein to move the drug against a concentration
gradient. This does not require energy.
- Kailangan ng carrier for them to be able to penetrate
a semipermeable membrane.
2. Pinocytosis
- The process by which cells carry a drug across their
membrane by engulfing the drug particles in a vesicle.
- Commonly sa vaccine.
- Naka store sa katawan. Nakaikot lang to sa circulatory
system. Once the body detected the need for this
medication, that is the time they will be burst or mag
oopen up para magbigay ng effect.
3. Active transport
- Requires energy to facilitate the transport of drug
molecules against a concentration gradient, which usually
occurs at specific sites in the small intestine.
- You need to have a carrier or protein para magkaroon sila
ng energy na makapag penetrate doon sa area of high
concentration.
- Low concentration going to high concentration.
- Ionized medication or water soluble requires a active
transport.
Drug distribution
- Process by which drug becomes available to body fluids and
tissues.
- The movement of the drug from the circulation to body tissues.
- The blood will distribute this drug molecules to the target
organ where this drug will give effect or action.
• Protein binding
 As drugs are distributed in the plasma --- bind with
plasma protein.
 albumin, lipoproteins, alpha-1-acid glycoprotein.
 Yung drug molecules natin ay dapat mag bind sa
protein. Once na magbind sila, ang tawag sakanila
ay “Bound drug”.
 Once u are bounded, you can go to the target side.
 Pero pag hindi sila bounded, free sila. Kapag free
ung gamot, pakalat kalat lang yan sa circulation.
 Kapag na bind yung drug at protein, si protein ang
magbibigay ng signal saknya kung saan ang organ
na kailangang aksyonan.
 Pag hindi sya nakarating sa site of action –
metabolism na, iinactivate yung drug.
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

• Factors affecting drug distribution
- Size of the organ (pag Malaki yung organ, mas mabagal
ang distribution kasi marami kang ididistributan)
- Blood flow
- Solubility
• Drug metabolism
- Biotransformation is the process by which the body
chemically changes drugs into a form that can be excreted.
- Kapag active ang gamot, nasa system mo lang yan. Hindi
pa sya lalabas
• First-pass effect or first-pass metabolism
- GI tract --- intestinal lumen -- liver--- some drugs are
metabolized to an inactive form and excreted---reduced
amount of active drug.
- Oral route – pagkatapos ng absorption, pwede syang
dumeretso sa fast pass effect pero pag other route,
pupunta muna sya sa distribution bago sya magenter ng
metabolism.
- Oral route - Pagabsorp ni small instetine, dadaan muna
sya sa portal vein (sa liver yon, yung may cytochrome
P450) itong enzyme na to ay mag iinactive ng
medicication na to.
- Wala tayong specific amount kung ilan nababawas ang
active drug, kasi depende yan sa dami ng cytochrome
P450, depende rin sa sensitivity ng gamot na tinatake mo
to the liver enzyme. (oral route) pinaka mababa na yung
10-30% yung mababawas sa gamot.
- Pag bababa yung cytochrome P450, ang effect nito will be
decrease drug metabolism rate. At pwede ito mag
overdose or toxicity.
- Liver enzymes – cytochrome P450 system – convert drugs
to metabolites.
- Decreased drug metabolism rate will result to excess drug
accumulation that can lead to toxicity.
Drug half-life
- the time it takes for the amount of drug in the body to be
reduced by half.
- Kailan nagiging kalahati ang amount ng drug or strength ng
drug sa isang katawan ng pasyente.
- Bawat gamot may kanya kanyang drug half-life.
- Pag mas mahaba ang half-life ng gamot, pwedeng once a day
lang sya inumin.
- Bakit kailangan isang gamot may specific na mg? kasi ito ang
requirement natin para ma-maintain natin ung therapeutic state
of the drug.
- Example:
→ Ibuprofen has a half-life of about 2 hours.
→ If the patient takes 200 mg (8am), in 2 hours, 50% of
the drug will be gone, leaving 100 mg. (10am)
→ After 2 hours - 50 mg. (12pm) hindi na to effective kasi
less than the half na sya. Dapat magbigay ka ng another
dose.
→ After 2 hours – 25 mg.
→ After 2 hours – 12.5 mg.
→ After 2 hours – 6.25 mg.
• Drug tolerance – could happen to anyone, may mga
wala kang receptor sa gamot na yon, ibigsabihin
pagnagtake ka ng gamot nito kung wala kang
receptor na nakukuha sa gamot na yon, walang
magiging effect ung gamot, kaya wala kang
makikita na change sa body mo. The doctor will
change the medication.
- It can be achieved when the amount of drug being
administered is the same as the amount of drug being
eliminated.
- A steady state of drug concentration is necessary to achieve
optimal therapeutic benefits. (para mamaintain ito, dapat hindi
bababa sa half ung drug. Halimbawa 200mg na Ibuprofen,
after 2 hrs – may 100mg pa sya. At ito ay effective pa. so
dapat hindi bababa dyan sa 100mg, para ma-maintain itong
steady state of drug concentration)
- Example: kailangan na natin ibigay, tingnan nyo muna yung
half life para maiwasan ung toxicity. Dapat lumagpas ka na
ulit sa half ng dosage.
- Half-life/ Elimination half-life (t ½)- time it takes for one half
of drug concentration to be eliminated.
- Short t1/2= 4-8hrs: given several times a day (Penicillin G)
- Long t ½ = >12 hours: given 2x or 1x/day (Digoxin)

J.A.K.E 10 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

Factors affecting biotransformation

• Genetic – some people metabolize drugs rapidly, others more
slowly. (kapag may liver problem ka, your metabolism will be
slower) kapag matanda na, mabagal na ang metabolism nila,
pati blood flow mabagal. Kaya yung liver need ng oxygen to
function normally. Kaya kapag yung liver nakareceive ng less
oxygen because of the slower blood flow, yung release ng
cytochrome P450 would also be less. Kaya yung magiging
effect nito is konti lang ang dosage na gamot na nagiging
inactive. The result, mas maraming active na gamot naiiwan sa
katawan mo at baka ma-overdose.
• Physiologic
o Liver disease
o Infants- decreased rate of metabolism
o Elderlies- decreased liver size, blood flow, enzyme
production- slows metabolism
• Environment – cigarette smoking may affect rate of some
drugs.
• Stressful environment – prolonged illness, surgery, illness. PHARMACODYNAMICS
Discussed by Prof. Carmencita Pacis
Drug excretion
- Study of the effect of drugs on the body.
- Removal of the drug from the body. Drug is changed into
- Kinetics and dynamics should start at the
inactive form and excreted by the body.
- Yung mga free or unbound na drug molecules – nakakalat lng same time
sila sa blood vessels or circulation. - Drugs act within the body to mimic the
- Water soluble drug – sila yung hindi madali makapenetrate ng actions of the body’s own chemical
semipermeable membrane. Kasi mga ionized sila. So need nila messengers. (Hormones released by the
ng passive transport, para makapenetrate or maitansport cells and each individual 50 types of
papunta sa site of action. hormones with this, each hormone
- Pag may sakit sa kidney, dapat ung dosage ng gamot ay released by specific organs)
decreased. Kapag sobrang taas ng concentration ng gamot na - What will the drug do to the body?
dapat ifilter ni kidney, masisira si kidney, masisira yung - Side effect, mechanism of action – what specific receptor will
kanyang filtration rate. need to bind with the drug molecule para magkaroon ng effect
- Routes: or reaction yung gamot.
• Kidney – main organ for drug elimination: leave the body - Mode of action in drug – ano yung intended effect sa katawan.
through urine. - Purpose of hormones is to create a response. And if that gland
will have abnormality in the production of that hormone
• Free or/unbound/water soluble drugs filtered in the kidney
whether over or under it will create a certain medical condition.
(filtered – pwede ireabsorb para magamit ulit if hindi pa
nila napupunta ang site of action. Or active pa sila para
pag nireabsorb ulit to baka magiging bounded na sya)
• (+) kidney disease- dose must be decreased.
• Kidneys – main route of drug excretion.
• Bile, lungs, saliva, sweat and breast milk.
• Urine pH influences drug excretion.
• Normal urine pH 4.6-8 (dapat pataasin mo acidity ng
urine mo to prevent overdosage) (kapag alkaline ang urine
mo, it will promote elimination of weak acid drugs, kapag
acidic urine, mas nalelelss ung chance na lumabas sila)
• Acidic urine promotes elimination of weak base drugs.
• Alkaline urine promotes elimination of weak acid drugs.

Regulatory Proteins
- They are controlling the number of active drugs that be
circulating our body.
- Maintaining

J.A.K.E 11 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
- Each drugs molecules before it will be able to reach the target
site they need to bind/regulated w/ proteins.
- Regulate amount of active substance/drugs that is circulating
in the body.
1) Enzyme
- Proteins that act as biological catalysts (biocatalysts).
Catalysts accelerate chemical reactions
- Biocatalysts – it will accelerate the chemical reaction of
the drug particle. (pinapabilis nya yung reaction)
- Inhibitor – pineprevent nila yung pagdami at pagsobra.
- Once the drug molecule will bind with enzyme, the
enzyme will metabolize the active medication.
2) Receptors
- Chemical structures, composed of protein, that receive
and transduce signals that may be integrated into
biological systems.
- The one bringing this drug molecules to the target site.
- Kaya kung kulang lang yung receptors, konti lang ung
drug molecules na mapupunta sa target site; kung
sobrang dami nmn ng receptor mas maraming amount
ng ating drug molecules ang makakarating sa target site
Kailangan ng drug molecules ang receptor bago sya
mapunta sa target organ/ site.
3) Ion Channels
- Provide receptors which drugs can interact with:
- Parang pintuan
- Enzyme & receptors – they act mostly in lipids soluble
(unionize) needing passive transport
- They act mostly in water soluble. (ionize medications)
requiring active transport
o Channel Blockers - whereby the drug blocks permeation
of the channel. (isasara yung pinto, so hindi makakapasok
si active drug)
o Channel Modulators - whereby the drug binds to a
receptor site within the ion channel and modulates
permeation. (bubuksan yung pinto)
- Enzyme will act as an inhibitor where in once active drug will
bind with the enzyme nagiging metabolites sila so magiging
inactive sila nababawasan sila
- Receptors will be the one to carry the active particle of the
drug to the target site, ung mga hindi na metabolites ni enzyme
ito ung kukunin ni receptor para makarating sa target site.
- Gamot natin can be inhibitor or stimulator
J.A.K.E 12 of 32
Example: Cimetidine (Receptor)
- Drug class: H2 receptor blockers – Indirect acting dahil ang
binoblock nya ay receptor.
- Kahit maraming kang h2 na maproduce sa body mo, kapag
nagtake ka ng cimetidine, the cimetidine will mimic the
chemical component of h2. So, when the body absorps the
cimetidine, the h2 receptor will think that cimetidine is h2. So,
the h2 receptor will bind with cimetidine (na akala nyang h2),
tapos ang effect ng gamot na ito ay blocker, kaya kahit mag
bind sila, it will not produce any reaction. Kaya ang nangyari,
nababawasan yung amount h2 na dapat mapunta sa stomach.
Kasi dapat ang binabind ni h2 receptor ay h2, kaso kay
cimetidine sya nag babind kaya nasabing nababawasan yung
h2 na pumupunta sa stomach or sa target site. Kaya ang
magiging effect nito ay mababang gastric acidity. (dahil
nababawasan yung h2)
- Once a receptor binds with the drug molecule, hindi na sya
pwede maghiwalay or mag bind uli ng ibang molecule/
receptor. Lock and key theory (dapat loyal ka lang sakanya!
Ganern HAHA)
• Kapag inhibitory ang class ng isang gamot/ blocker, dalawang
classification pa yan. Direct or indirect
• Direct acting – blocking the target organ producing the
hormone that already in excess.
o 2 types of histamine: histamine 1 and histamine 2
o Histamine 2 – target site is the stomach.
o Kapag si histamin 2 kinuha ng histamine 2 receptors will
bring to the stomach. With this, it can maintain the normal
gastric acidity.
o Pag nasobrahan ung histamine 2 sa stomach, the drug now
will act to prevent the secretory cell from producing more
histamine 2 – direct acting
o They act directly on the organ producing or secreting the
hormones.
• Indirect acting
o The histamine 2 will become histamine 2 blocker.
o Ang pineprevent ng gamot ay pag dami ng receptor.
o Kung konti lang kukuha sa histamine 2, edi konti lang din
mapupunta sa target organ,
o They act mostly in the receptors
Example: Iron Channels
- For active transport. They will act as modulator or blocker.
- The purpose of our medication is a blocker, the effect of this
medication will close the iron channel. So, it will prevent
another component to enter the cell which is already in excess.
- Modulator: the effect of this medication on the iron channel
will be open, so that other molecules that are lacking inside the
cell could enter.
Dose-Response Relationship
Drig Affinity
- how avidly a drug binds its receptor or how the chemical
forces that cause a substance to bind its receptor.
- drug's desire to connect to an open receptor
- It refers to how much attraction there is between a drug and a
receptor, like a magnet to metal
- Low affinity – you need to have higher amount, for them to be
able to bind with an open receptor. Hindi kasi gaano kalakas
yung hatak nila kaya need pa nila ng higher amount para
mahatak nila yon. (Like mahina ka or konti lng kayo, need mo
ng help para matulungan ka)
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
- High affinity – only a small amount of the drug on the body
could easily bind with a receptor. (kahit mag-isa ka lng or
konti lang kayo, kayang kaya nyo na)
- Rule: kapag open ang isang receptor, pwede ka magbind. Pero
kung Nakita mong may kabind na sya, hindi ka na pwede mag
bind doon. (Kaya kung Nakita mo may iba na syang mahal,
wag mo na pilitin sarili mo saknya! Hindi ka na pwede! Kasi
taken na sya! Ouch bhi3)
- Agonist – fit sila – effect of this is drug action
- Antagonist – not fit – no drug action – nagbind sila pero hindi
sila fit kaya hindi mapupunta sa target organ.
Drug Efficacy
- Refers to the drug's ability to activate the receptor once it has
bound to it
- Maximum response achievable from an applied or dosed agent
- Maximal effect that a drug produces irrespective of
concentration (dose)
- If a drug will bind with a specific receptor, it is expected they
will produce a reaction (yung reaction na to ay efficacy)
- The degree of efficacy, minsan binebased din natin yan sa
dose. Kapag mas mataas dose mas mataas efficacy
- Maximal efficacy – the point at which increasing a drugs
dosage no longer increases the desired therapeutic response.
- EC50 – this is the minimum concentration, the body required
of the medication to elicit the effect. (ito yung pinaka
mababang dosed na pwede nating ibibigay sa gamot na yon
para magbigay ng therapeutic benefits/ response)
- Emax – maximum dosed na dapat maibigay natin para
makapagbigay pa rin sya ng therapeutic benefit/ response.
10
5
20 100
50 75
mg mg
mg mg
J.A.K.E 13 of 32
Example: Pain Reliever both Drug A and B
- If you will give drug b, sa minimum concentration (EC50) nya
which is 50 mg. katapat ni EC50 yung 50mg ni drug b. Kaya
si drug b, kapag binigay natin 50mg, maachieve nya yung
minimum concentration na makakapagbigay ng pain relief.
- If you will give drug a, the minimum concentration is 75mg.
Kaya si Drug A, kapag nagbigay sya ng 75mg, maaachieve na
nya yung minimum concentration (EC50), at makakapagbigay
sya ng pain relief.
- Ang maximum concentration (Emax) ng drug a and b is
100mg, yan yung maximum na pwede ibigay sa pasyente.
- Kaya kung lumagpas ka pa sa 100mg na maximum
concentration, hindi na sya effective kase na achieve na niya
ung emax niya.
- Kasi minsan may mga pasyente tayong parang kulang pa
saknya, may nararamdaman pa syang sakit. Pero umabot na
sya ng Emax, kaya hindi mo na pwede taasan yon, ang
solusyon nlng dyan ay magbigay ng panibagong medication.
Sample, nun una nagbigay ka ng 50mg, tas sasabihin ng
pasyente masakit pa rin ung nararamdaman nya, kaya
magbibigay ka pa ulit hanggang sa maabot mo yung Emax
which is 100mg. so kung hindi pa rin nawawala yung sakit ni
pasyente, magbigay ka ng bagong medication. Kasi nabigay
mo na saknya yung Emax ng gamot pero d pa rin sya
gumagaling, so ibigsabihin, hindi effective sakanya yung
gamot. Kaya magbibigay ng panibagong gamot.
- Gumagamit pa rin tayo ng half life dito. Sample, nagbigay
tayo ng 50mg ng 8 AM, tapos ang half-life nya is 2hrs. so after
2hrs, 25mg nlng sya, after 2hrs ulit, less than half na, wala na
syang concentration/ effect kasi less than half na. Kaya kung
hindi effective sakanya yung 50mg, Sa susunod na ibibigay
natin ay 100mg na kasi mababa na sa 50mg yung
concentration. (Less than half na kasi).
- Pero kung hindi pa nag leless than half yung ininom nya
(50mg plng concentration nya) at kailangan na nyang humingi
ng gamot, ang ibibigay mo lang ay plus 50mg para umabot ng
Emax. Kasi active pa yung medication sa katawan nya ee,
kaya ang ibibigay mo lang 50mg. Dapat hindi ka pa rin
sumosobra sa dosage mo, hanggang Emax lng dapat.
Drug Potency
- Refers to the amount of drug needed to elicit a specific
physiologic response to a drug.
- Gaano ba kadami ang gamot para magkaroon ka ng
therapeutic effect.
- Both Drug A and Drug B achieve the same maximum
effect, i.e. they have equal efficacy.
- However, drug A achieves this effect at a lower dose.
- Thus, Drug A has higher potency than Drug B.
10 Emax
50 100
mg mg
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
- Para maachieve ni drug a yung efficacy rate of 10, we need to
give 50mg. While for drug b, para maachieve natin yung
efficacy rate of 10 which is Emax, we need to give 100mg.
- Drug A is more potent kasi naachieve nya yung efficacy rate
of 10 or ung Emax na mababa lang ang dosage nya. At a lower
dosed, mas malakas yung strength nya kumpara kay drug b.
(Kahit konti lang yung dosage nya, mataas na yung efficacy
rate nya.) (Kasi kung pantay yung pagbigay mo ng dosage sa
drug a and b. Both silang 50mg, yung drug a nareach na nya
agad yung efficacy rate of 10 which is Emax, pero yung Drug
b, hindi pa or mababa pa yung efficacy rate nya, kasi
kailangan mo pa ng 50mg para umabot ng 100mg na Emax.
Kaya nasabing mas potent ang Drug A kaysa kay drug B.
mataas na agad yung effect ng drug a kahit mababa lang yung
dosage)
- Potency – less dosage is more efficacy, kung mas konti lang
ung amount na kailangan mo para ma-achieve mo ung efficacy
rate na mataas mas potent ka.
Emax
Efficacy EC50
Potency
20 50 100
mg mg mg
Which drug is more potent?
1. A or B? = A
2. A or C? = A
3. A or D? = D
- A kase mas mababa yung mg niya kay drug B. meron syang 50mg to
have therapeutic benefit while drug b needs 100mg para pumasok sa
minimum concentration na mag kakaroon siya ng therapeutic benefit.
- A pa din kase 50mg lang while C needs 100+mg para maka pasok sa
EC50
- D ang sagot sa 3 kasi, Mas nauna sya pumasok sa efficacy kaysa kay
Drug A. 30 mg palang ng D, effective na sya pero yung A, kailangan
nya pa ng more than 30mg para makapasok sa line ng EC50 or para
maging effective sya.
- EC50 – ito ung amount ng gamot na nag karoon na ng effect
Which drug is more efficacious?
1. A or B? = both (pantay lang na 1)
2. A or C? = A (mas mataas si A)
3. A or D? = A (mas mataas si A)
In sentence:
- Drug A is more potent than Drug B but equally efficacious.
- Drug A is more potent and efficacious than C.
- Drug D is more potent than Drug A, but less efficacious
than Drug A.
- Hindi komot mataas ang potency mataas din ang efficacy
J.A.K.E 14 of 32
Examples about Potency:
- Pethidine = 100mg/ 2ml; Morphine 4mg/ ml
- Pethidine is less potent analgesic but more efficacious than
morphine. (P = 50mg/ml; M = 4mg/ ml)
- Mas potent ang morphine kasi 4mg lang kailangan nya para
maging effective pero si pethidine kailangan nya pa ng
50mg para maging effective.
- Furosemide = 40mg/tablet; Metolazone 5mg/ tablet
- Furosemide is less potent diuretics but more efficacious than
Metozolone. (Mas konti mas effective)
- Mas potent si metolazone kasi 5mg lang kailangan nya para
maging effective. Mas nauna yung metolazone na maging
effective kaysa sa furosemide na kailangan nya pa umabot
sa 40mg.
- Aspirin = 80mg/ tablet; Morphine = 10mg/ tablet
- Morphine is more potent analgesic and more efficacious
than Aspirin.
- Mas potent si morphine kasi 10mg lang ang kailangan nya
para maging effective. Mas konti lang ang kailangan sa
morphine kaysa kay aspirin na dapat maabot nya yung 80mg
para maging effective.
Ano ang best na pwede painumin ng pasyente? Yung mas
potent ba or ung mas efficacious?
- Nagsisimula muna sa mababang dosage tas kung hindi
effective yon, saka ka magtataas ng dosage.
- Hindi ka pwede magsimula sa mataas na dosage
Notes:
- Drug tolerance – hindi kana tinatablan ng gamot kahit ano
pang route yan kase wala ka ng receptor sa gamot na un.
Kaya kailangn mo ng ibang medication with same mode
of action but with different mechanism
- Mechanism of action – receptor u need para umepekto
ung gamot sayo
- Mode of action – intended result u want to get sa gamot.
- Kaya kung wala kang receptor sa mechanism ng gamot
ang mode of action ay hindi maachieve.
Parameters of Drug Action
Therapeutic Index – (TI)
- Describes the relationship between the therapeutic dose of a
drug (ED50) and the toxic dose of a drug (TD50)
- Therapeutic window – safe pa yung dosage na memaintain
natin sa katwan.
Toxic Dose
Therapeutic Window
Therapeutic dose
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

8am
8:30am
Peak
- Occurs when it reaches its highest concentration in the
blood/plasma concentration. T0- T2.
- Nag cicirculate na yung gamot natin na maraming
- TD – toxic dose (amount na hindi ka na pwede magbigay ng concentration papunta sa target site.
sobra dyan) - Example: Ibuprofen
- ED – therapeutic response (amount na kailangan para • 8AM the time we administered. (T0)
makapagbigay sya ng therapeutic effect)
• 8:30 am – nagkaroon sya ng minimum concentration na
- TI – Therapeutic index (the higher the number, the less toxic
una nyang naramdaman ay pain relief. (T1)
the medication is) meaning – kapag lumalaki yung number
• At umabot ng 9AM, wala na syang nararamdaman na
natin dito, mas lumalawak ang kanyang therapeutic window.
sakit. (T2)
Ito yung kahit masobrahan ka, hindi pa sya mapupunta agad sa
toxic, kasi malawak yung therapeutic window nya. • Peak = 1 hour (after mo mag take ng medication,
- kapag yung medication na small ang therapeutic window, kailangan mo pa maghintay ng 1hour bago mawala yung
konti lang ang pagitan ng therapeutic response at toxic dose. buong sakit mo, or mawala yung problem mo)
Kaya pag nasobrahan ka ng konti, mapupunta na sya agad sa
toxic.
Narrow Therapeutic Wide Therapeutic
Index Drugs Index Drugs
Digoxin Ibuprofen
Warfarin Acetaminophen
Lithium Antihistamines
Theophylline Most Antibiotics
Cyclosporine Beta Blockers
Tacrolimus Multivitamins Duration of action
Gentamicin Proton pump inhibitors - the length of time the drug
- Narrow therapeutic Index Drugs – pag nasobrahan ka ng konti exerts a therapeutic effect.
doon sa prescribed dosage, pwede na mag lead sa toxicity. period from onset until the
Pero ung wide therapeutic naman, kahit nasobrahan ka ng drug effect is no (longer seen).
konti, hindi pa sya aabot sa toxicity, kasi wide ang window T1-T3 (trough level)
nya, Malaki ang pagitan. - Gaano katagal magbibigay ng
therapeutic effect yung gamot.
Parameters of Drug Action - Example: Ibuprofen
Onset • 8AM the time we
- The time it takes for a drug to reach the minimum effective administered. (T0)
concentration (MEC) after administration • 8:30 am – nagkaroon sya
- Time from drug administration to first observable effect (T0- ng minimum
T1) concentration na una
- The medication will reach the effectiveness on a minimum nyang naramdaman ay
concentration pain relief. (T1)
- Example: Ibuprofen • At umabot ng 9AM, wala na syang nararamdaman na
• 8AM the time we administered will be your T0. sakit. (T2)
• By 8:30 am naramdaman nya yung effectiveness ng • 10 AM – ito ung bumababa na yung effectiveness ng
gamot yun yung T1. gamot.
• Onset = 30 mins (8:00 ~ 8:30 am) • Duration of action = 1hr and 30mins
• Paginom ng medication, 30 mins ka pa maghihintay bago
lumabas yung unang effect.

J.A.K.E 15 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
The Importance of Therapeutic Drug Monitoring
- They must be maintained at steady concentrations year after
year while the person ages and goes through life events that
may alter that individual's therapeutic level, including
pregnancies, temporary illnesses, infections, emotional and
physical stresses, accidents, and surgeries.
- It identifies when a person does not take the medication
regularly as prescribed (patient noncompliance, hindi tinake
gamot sa oras)
- helps to personalize a dose to fit the specific needs of a patient.
Theories of Drug Action
Drug-Receptor Interaction
- Certain portion of drug molecule (active site) selectively
combines with some molecular structure (reactive site) on the
cell to produce a biologic effect
- Receptor site – drugs act at specific areas on cell membranes;
react with certain chemicals to cause an effect within the cell.
- Kapag nagkaroon ng binding with receptor at nag fit sila, it
will produce an effect. Kapag hindi nagfit, no effect.
Lock and Key
- Specific chemical (key) approaches a cell membrane and finds
fit (the lock) at receptor site – affects enzyme system within
cell produce certain effects.
- Drug + Receptor = Effect
- If a drug will enter a receptor and they fit it will produce an
effect but if a drug will enter a receptor that is not fitted
mababind nung gamot si receptor pero walang reaction kase
hindi sila fit.
- Kapag nabind na yung receptor, kahit mali pa yung nabind nya.
Hindi na pwede uli ibind yung tamang molecule sa receptor na
yon. Once na nabind, tapos na. d na pwede ulit magbind
J.A.K.E 16 of 32
Drug Response
Drug Response may be:
1) Primary – always desirable/physiologic effects
(therapeutic effect)
2) Secondary – desirable or undesirable (side effect)
Example: Diphenhydramine (Benadryl)
- Nung na lessen allergic reaction ko na pumasok si ↓
- Primary effect: antihistamine; treat symptoms of allergy
- Together with this ↑ may secondarily effect or the side effect ↓
Categories of Drug Action
1) Stimulation/ Depression
- Stimulation – increased rate of cell activity/ secretion
from the gland. (ineencourage nya yung secretory cells to
produce more hormones that we need)
- T3/T4 for hypothyroidism
- Depression – decreased cell activity and function of a
specific organ. Iodine, propylthiouracil. (Para iprevent si
secretory cells na mag produce ng maraming hormone
dahil marami na yung hormones, ipapatigil na nya pag
produce)
2) Replacement
- Replaces essential body compounds
- Sira na yung organ na nagsesecrete ng hormones.
- Example: Insulin
3) Inhibition/ Killing of Organism
- Interfere with bacterial cell growth
- Example: Antibiotics – pineprevent yung pag travel ng
bacteria sa ibang organ (inhibition)
- Bacteriostatic – inhibits movement of bacteria para hindi
kumalat
- Bactericidal – pinapatay ang m.o
4) Irritation
- It will create a reaction on a target organ para gumalaw
sya.
- Tamad na gumalaw ung organ kaya yung irritation drug
magpapagalaw sa kanya. (parang ikaw, tamad na tamad
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
ka na tas sinigawan ka ng nanay mo “HOY MAGLINIS
KA NG BAHAY” edi syempre gagalaw ka na, baka
masampal ka pa ng nanay mo kung d ka gumalaw dyan
HAHA)
- Example: Laxative irritate the inner wall of colon ---
increased peristalsis --- increased defecation
Drug-Drug Interaction
1) Additive Effect
- 2 drugs with similar actions (mode of action) are taken for
a doubled effect.
- Different mechanism of action but the same mode of
action.
- 1+1=2
- Example: Ibuprofen & Paracetamol – pag ibuprofen lang
tinake mo, 30% lang ung mababawasan na sakit, Pag
paracetamol naman ung tinake mo, 30% din. Pero pag
both mo silang tinake, magiging 60%. Edi mas better
kung mas mataas yung effective rate.
- Kapag nagbibigay ng additive effect, dapat different
mechanism of action sila but same mode of action. hindi
pwede yung dalawang ibuprofen iinumin mo or dalawang
paracetamol.
• Ibuprofen + paracetamol = Added analgesic effect
• Codeine with acetaminophen = Better pain control
2) Synergistic
- Combined effect of 2 drugs is greater than the sum of the
effect of each drug given alone.
- Kapag nagtake ka ng dalawang gamot, parang may extra
ka na rin ininom na gamot.
- 1+1=3
• Aspirin = 30% analgesic effect
• Codeine – 30% analgesic effect
• Combination = 90% analgesic effect
3) Potentiation
- A drug that has no effect enhances the effects of the
second drug.
- Dalawa pa rin yung ininom natin na gamot pero yung isa
walang therapeutic benefit sa condition mo kaya naging 0.
Kaya mo tinake yung gamot na walang therapeutic benefit,
kasi para to sa pagenhance ng pangalawa mong gamot.
Kaya equals 2 sya. Bali yung isang gamot pang enhance
lng sya sa isa pang gamot, wala syang effect sa katawan
mo.
- 0+1=2
• Alcohol enhances the analgesic activity of aspirin.
• Prozac + Zestril
J.A.K.E 17 of 32
4) Antagonistic
- one drug inhibits the effect of another drug
- wag ibigay ang gamot ng sabay dapat may pagitan
- 1+1=0
- Tetracycline + antacid = decreased absorption of
tetracycline
- Charcoal in alkaloidal poisoning
• Arrythmias – need to monitor ECG of the patient
• Toxicity – bawal ibigay ang gamot ng may kasabay, may
pagitan dapat
Adverse Drug Reactions (ADR)
- Sometimes called an adverse drug event – ADE
- A negative event following the prescription and administration
of a medication.
- A response to a drug which is noxious and unintended, and
which occurs at doses normally used in man for the
prophylaxis, diagnosis, or therapy of disease or for the
modification of a physiological function (WHO)
- Study of ADRs is called Pharmacovigilance.
- We will monitor for patient from side effect
Two types of ADR
Type A: Augmented
- Means we can often predict these reactions from our
knowledge of the pharmacodynamic properties of a drug.
- For example, a patient on an antihypertensive drug
- May develop dizziness and fainting due to too great a
lowering of their blood pressure. Expected
- Patients on NSAIDs can develop gastric irritation due to the
drug’s action on protective gastric mucous.
- Most Common Type of ADR
Type B: Bizarre
- Where the reaction is wholly unexpected and could not be
predicted from the pharmacodynamic properties of the drug
- An example would be anaphylaxis to any drug, or a red
pinprick rash with penicillin.
Allergic Reactions
- Unpredictable adverse drug effects; more serious
- Response to patient’s immunological system to the
presence of the drug
- Do not occur unless the patient has been previously
exposed to the agent/ chemical related compound.
(naibigay na sayo dati kaya ok na sa katawan)
- Skin test – para macheck kung magkakaroon ka ng
allergic reaction kapag nainom mo yan.
Idiosyncratic Reaction
- Occurs when the patient is first exposed to the drug
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

- Abnormal reactivity to the drug caused by a genetic DRUG AND IV COMPUTATION

difference between the patient and normal individual. Discussed by Prof. Marivic Ilarde
- patient with G6PD deficiency will have anemia by using Drug Calculation
antioxidants. (RBC nya easily burst when exposed to Universal Formula:
stress or toxins; ex. antioxidants) Desired Amount X Quantity = Dose
- Occurs sa mga may certain condition Stock on Hand
Toxicity Quantity – amount of diluent that you going to incorporate into the
- The degree to which a drug can be poisonous and thus vial.
harmful to the human body Exercise 1
Latrogenic Responses Doctor’s Order:
- Unintentional responses as a result of medical treatment - Give Cefuroxime 500 mg IV every 12 hours.
- Nephrotoxicity; Ototoxicity - For every 1 gram, dilute with 8cc NSS
- Hindi natin gusting makuha ang side effect na ito Solution:
- Ex. Anticancer drug, used to prolong life pero 500 mg
x 12 mL = 4mL
nakakabingi 1500mg
- The desired amount is 500 mg (numerator)
- The stock on hand is 1.5 g (pero dahil mas
malaki si g kay mg you need to convert the grams into mg)
(denominator)
- 1 g = 1,000 mg
- Therefore, you move decimal 3 places to the right (kase kapag
larger unit to small unit pa right yung move ng decimal point
mo) 1.5g = 1,500 mg
- Now you have 1500mg on your stock on hand
- Then multiply to 12 mL your dilution. because in every 1
gram you need to dilute 8 cc, so it is equal to 12mL. (1.5g x
8cc/ ml = 12cc/ ml)
- Then in every 12 hours, 4mL yung ituturok mo para makuha
mo yung 500mg na desire dosage na need ni client.
Exercise 2
Doctor’s Order:
- Give Amikacin 80 mg IV OD (once a day)
Solution:
80 mg
x 4 mL = 0.32 mL
1ooo mg
- OD – once a day
- 80 mg is the desired amount; 1 gram is the stock
on hand; 4 ml is the quantity.
- First convert gram to mg, 1 g = 1000 mg
- Therefore, your stock on hand will be 1000 mg
- And the answer will be 0.32 mL
Shortcut method:

80 mg
x 1 mL = 0.32 mL
250 mg
- Yung sa baba nung box na bote (250mg/ ml) pwede yun
maging stock dose din and mas madali syang gamitin.
- Kapag merong stock dose na small amount yun nalang yung
gamitin.

- A and B is to C and D
- A and B is the “known data” (the stock on hand and the
quantity)
- C and D is the “unknown data” (desired dosage)
- Just multiply the A and D then, the B and C (A x D = B/C)

J.A.K.E 18 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

Exercise 1 Pediatric Computation

Doctor’s Order: - Children need lower dosages of medication compared to adults.
- Keflex 1 gram orally TID - Three formulas are used to help calculate a pediatric dosage
- Compute using the Ratio based on whatever information is available
and Proportion - Formula Pediatric Dosing
Solution: • Fried’s Rule – 1 year and below
Age in months
Child’s Dosage = x Adult Dosage
250 mg : 1 cap :: 1000 mg : x 150
x = 1000
250 • Young’s Rule – 1 year old and above (12yr/old)
Age of child in years
x = 4 Capsules Child’s Dosage = x Adult Dosage
Age of child in years+12
- Per 250mg is equals to 1 capsule
- A = 250 : 1 • Clark’s Rule
- Kailangan nyo pag tapatin ang mga given dosages sa A to D Child’s Dosage =
Child′ s in weight in pounds
x Adult Dosage
(yan ugaliin nyong mag tapat ah para wala kayong nasasaktan 150

emzzz) - Adult dose is always the basis, gaano kalaki or karami ang
- 1 gram : x binibigay na dose sa adult patient
- The 1 gram is given on the example - In pediatric patient we cannot give the same amount of dose of
- Now you just need to find kung ilang capsules ang need ma adult pt to them
take ng pt. - Madali silang ma overdose (parang ikaw madaling ma fall,
- Then, remember (A)(D). therefore, 250 multiply to x. so, it awts rUpokkk emzz)
will be 250x
Exercise 1
- Next, multiply 1 cap to 1 gram (but ang given is mg, kailangan
mo ulit i-convert si gram to mg) - Adult dose: 12.5 mg
- 1 g = 1000mg - Child 1: Age 4 weeks – Fried’s Rule
- After conversion you have the 250x = 1000 - Child 2: 5 years old – Young’s Rule
- Then divide each side by 250 - Child 3: 46 lbs – Clark’s Rule
Solutions:
250x 1000 mg Fried’s Rule
= Age in months
250 250 x adult dose = dose for infants
150
- Left side, cancel the 250 the x will be left
- The ending will be 1000/250 4 weeks = 1 month
- And your x (na unit ah, hindi yung x mo na nang iwan sayo
1 month
choss) x = 4 capsules x 12.5 mg = 0.083 mg
150
Exercise 2
- How many ml of Magnesium Sulfate should the Young’s Rule
patient receive to obtain 4 grams? Age
Solution: x adult dose = dose for child
Age+12
5 g : 10 mL :: 4g : x
5gx 40 mL 5
5
= 5 5+12
x 12. 5 mg = 3.67 mg
x = 8mL
Clark’s Rule
Weight
Exercise: Tablets x adult dose = dose for child
150
Doctor’s order:
- Give Phenytoin 75 46 lbs
x 12.5 mg = 3.83 mg
mg/tab BID for seizures 150 lbs
- For solving the given
situation pwede nyong - Example if the patient is weight is in kg you need to convert
gamitin ang universal the kg to lb which is you need to multiply kg into 2.2lbs
formula or yung ratio - 1kg = 2.2lbs
and proportion pareho lang ang lalabas Exercise 2: Young’s Rule
Solution: Since walang Child 1:
75mg/tab
= 1.5 tablets quantity, pwede - Adult Dose: 500 mg
50mg
gamitin ang - Age of patient: 2 year and 6 months
- Weight: 12 kilos
50mg : 1 tab :: 75mg : x desired over
50x 75 mg stock that would Solutions:
= 50 CD =
2.5 years
x 500 mg = 86. 21 mg
50 be the no. of 14.5 years
x = 1.5 tablets tablets.

J.A.K.E 19 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

- Dahil 2 years and 6 months and bata palang kailangang =

1000 ml
x 0.25 = 31 – 32 gtts/min
maging specific 8 hour
- 6 months is equivalent to a half year kaya naging 2.5years sya - If you have 15 gtts wag na mag long method automatic na mag
Exercise 3: Clark’s Rule short method na kayo multiply by 0.25
Child 1: - How about kapag 20 gtts? 20 / 60 = 0.33 (Multiply agad sa
- Adult Dosage: 500 mg 0.33 kapag 20gtts)
- Weight: 12 kg Micro Drops
CD =
26.4lbs
x 500 = 88 mg Doctor’s Order:
150 - Infused D5LR 1L x 8 hours
- Compute how many gtts/min
- Need iconvert ang kg to lbs so it means you need to multiply it Solutions:
by 2.2 - 1000mL= 1L
- 1kg = 2.2lbs (12kg x 2.2lbs = 26.4 lbs) - 8 hours
Exercise 4 1000 ml 60gtts/ml
Rate = x = 125 ugtt/min
Child 2: 8 hour 60 minutes/ hours
- AD: 300mg
- Age: 8 months - Remember sa micro drop cancelation method nalang
- Weight 7 kilos - Micro drops/minute is equivalent to mL/hr
Solutions: - Halimbawa nag rounds ka the IV Fluid starts at 6 am and nag
Fried’s Rule rounds ka ng 10 am
8 months - What is the level of the IV fluid at 10 am? (ilang lvl na ang
Child’s Dosage = x 300 = 16 mg
150 natira)
Clark’s Rule - 125 x 4 = 500mL (multiply by 4 kasi 6am to 10am, 4 hours)
15.4lbs
x 300 mg = 30.8 mg - Nakapag consume na ang patient ng 500mL in 4 hours and the
150 lbs
remaining fluid is 500 mL.
- Halimbawa kapag ang pt. is 2 years and 8 months ang age Exercise
kailangan mong idivide yung 8 months into 12 months. - 500mL PNSS run for 12 hrs
- 8 ÷ 12 = 0.67 (rounded off) or 2.67/ 2.7 age of patient - IV Fluid started at 7 am
- Gamitin ung pinakamalapit na sagot - How many mL is infused at 9am?
- 1kg = 2.2lbs (7kg x 2.2lbs = 15.4lbs)
500 ml 60gtts/ml
IVF Calculation 7AM = x = 41.6 ugtt/min
12 hours 60 minutes/ hours
Vol. /ml (cc)
Amount to be infused drop factor
gtts/min Rate = x
hours of infusion 60 minutes/ hours 9 AM = 41.6 x 2 = 83.34 mL

1000 ml 15gtts/ml - Multiply 2 kasi: 7am – 9am, 2hours.

Rate = x Notes:
12 hour 60 minutes/ hours
- Cc (mL)/ hr is always equivalent to ugtts/min
- Macro drops = 15 gtts/ml, pag hindi naka specify use 15 - Macroset – 15 drop factor for adult
- Micro drops = 60ugtts/ml - Microset – 60 drop factor for infants
- BT set – used in blood, so 10gtts/ml is used - Ex. Regulation niya is naka 31 drops kase 8 hrs ung 1 liter so
Macro Drops imultiply lang sa 4, para pag palit mo nung una niyang tubing
Doctor’s Order: 31 ung unang regulation then multiplty to 4 (31 x 4 = 124
- Infused D5LR 1L x 8 hours ugtts/min) minultiply sa 4 dhil (60 ÷ 15 = 4)
- Compute how many gtts/min - Microset naman ung nakalagay tapos pinalitan ng macro
Given: ididivide naman siya (124 ÷ 4 = 31)
- 1000 mL= 1L
- 8 hours
Formula: Long and Short Method

1000 ml 15gtts/ml 15,000

Rate = x =
8 hour 60 minutes/ hours 480

= 31.25gtts/min or 31 – 32 gtts/min

or
1000 ml 15gtts/ml
Rate = x
8 hour 60 minutes/ hours

J.A.K.E 20 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
NURSING PROCESS IN PHARMACOLOGY
Discussed by Prof. Marivic Ilarde
- The problem-solving process used to provide efficient nursing
care; it involves gathering information, formulating a nursing
diagnosis statement, carrying out interventions, and evaluating
the process.
- Patient-Centered Pharmacotherapy.
Nursing Care Plan
- A document that provides direction on the type of nursing care
the individual or family or community may need. This
facilitates standardized, evidence based and holistic care.
ADPIE
Nursing Assessment
- Review clinical history assess patient (gather information;
subjective and objective)
- Subjective – verbalized by the patient or significant others.
• Current health history including problems in swallowing
• Current Meds: OTC, herbal meds, nutritional supplements
• Past History
• Client’s Environment
- Objective – medical history, medical procedures, and
laboratories.
• Check sign and symptoms to those organs affected by the
by drug therapy.
• Check laboratory test
• Blood Chemical
• Diagnostic Studies
• Do Physical Assessment
• Assess major body system for any signs of reaction or
interaction of drugs or ineffective of therapy.
• Drug History or interview
• Researching medication order ( MIMS)
- Comprehensive collection of data:
• History - The patient’s past experiences and illnesses can
influence a drug’s effect.
• Chronic Conditions - can affect the pharmacokinetics and
pharmacodynamics
• Drug Use - may have an impact on a drug’s effect
• Allergies - Past exposure to a drug or other allergens can
provoke a future reaction.
• Level of Education and Understanding
• Social Support
• Financial Supports
• Pattern of Health Care
• Physical Examination – develop a baseline for evaluating
the effectiveness of the drug
• Weight - helps to determine whether the recommended
drug dose is appropriate.
• Age – influence pharmacokinetics and
pharmacodynamics; the immature liver may not
metabolize drugs in the same way as in the adult.
- Sources of Information
• Primary source - produced by patient
• Secondary sources - relatives, significant others, medical
records, lab reports
• Tertiary sources - literature to provide background
information, diagnostic tests, diet
J.A.K.E 21 of 32
Nursing Diagnosis
- Knowledge deficit of disease and medication related to
inability to understand instruction.
- Risk for injury related to side effects of drug.
- Alteration in thought processes related to drug action.
- Constipation related to drug action or side effect.
- Fluid volume deficit related to drug action.
- Ineffective breathing pattern related to drug side effects.
- Develop appropriate nursing diagnosis or problem list.
- 3 parts:
1) Problem
2) Ethology
3) Signs and symptoms
Five Types of Nursing Diagnosis
• Actual - based on human responses and supported by defining
characteristics.
• Risk/high-risk - patient may be more susceptible to a particular
problem.
• Possible - suspected problems requiring additional data.
• Wellness - clinical judgment about a transition from one level
to a higher level.
• Syndrome - cluster nursing diagnoses that occur together and
best addressed together.
Problem Etiology Sign and symptoms
Risk for injury related to side effects of drug, such as dizziness /light
headedness as evidenced by…
- Base diagnosis on conclusion about risk factors, actual client
needs or problems based on knowledge base.
- E.g. nursing diagnosis include: Deficient knowledge; risk for
injury; noncompliance.
- Diagnosis based on s/e or risk factors (fatigue, constipation,
impaired tissue perfusion, sexual dysfunction, sleep disturbance,
urinary retention)
Planning
- Prioritize the nursing diagnosis.
- Specify objective, measurable, attainable, realistic goals.
- Establish a time period for achievement of outcomes
- If order is in question - do not give – call physician for
clarification/further instructions.
- Document all information obtained.
- Four phases of a nursing care plan
• Setting priorities - Identify problems and prioritize
• Developing measurable goal/outcome statements - Write
short- and long-term goals for the patient to be followed
when providing care (SMART).
• Formulating nursing interventions.
• Formulating anticipated therapeutic outcomes.
• Plan which intervention to use based on anticipated
patient behavior.
- Develop interdisciplinary plan of care.
- Dependent
- Independent
- Collaborative
- The plan must be SMART
• Specific
• Measurable
• Attainable
• Realistic
• Time-bounded
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

Implementation not met, the nurse needs to determine the reasons for this and
- Nursing actions are suggested revise the plan accordingly and include additional assessment
• Dependent actions - performed by a nurse based on health data and the setting of new goals (adverse, toxic effects). If the
care provider’s orders. goals are met. The plan of care has been completed
• Interdependent actions (Collaborative) - implemented (therapeutic effects)
with the cooperation of a team. - Interpret results evaluate outcomes assess compliance.
• Independent action - provided by nurse by virtue of
education and license.
- Three types of nursing interventions are frequently
involved in drug therapy:
• Drug administration.
• Provision of comfort measures.
• Patient or family education.
- Perform procedures medicate as indicated.
- Proper Drug Administration: 10 rights
- Comfort Measures
- Placebo Effect - The anticipation that a drug will be helpful.
- Managing Adverse Effects
- Lifestyle Adjustment
- Patient and Family Education
- Process:
• Reassess the patient
• Review and revisit the existing NCP
• Organize resources and care delivery
• Anticipate and prevent complication
• Identify areas of assistance
• Implement skills
• Document nursing intervention
- Includes:
• Administer medications per doctor’s order. The Steps of the Nursing Process
• Monitor therapeutic effect. 1) Nursing Process
• Monitor side effects, drug interaction and adverse reaction 2) Assessment
of the drug. 3) Past Hisotry
• Client Teaching. o Chronic condition
- Health teaching: o Drug use
• General Instructions o Allergies
• Self-Administration o Level of education
o Level of understanding of disease and therapy
• Diet
o Social supports
• Side Effects
o Pattern of the health care
• Cultural Consideration
4) Physical Examination
- Checklist for health teaching in drug therapy:
o Weight
• Comprehensive drug and health history o Age
• Reason for medication therapy o Physical parameters related to the disease state or known
• Side effects and adverse reactions drugs effect.
• When to notify health care provider or pharmacist 5) Nursing Diagnosis
• Interactions: 6) Implementation
1) Drug-drug, drug-food 7) Proper drug administration
2) Drug laboratory o Drug
3) Drug environment interactions o Storage
• Recording system o Route
• Discussion and monitoring o Dose
4) Financial resources o Preparation
5) Medication o Timing
6) Associated equipment o Recording
• Development and support of backup system 8) Comfort measure
• Community resources o Placebo effect
Evaluation o Managing side effects
- Effectiveness of health teaching about drug therapy and o Lifestyle adjustments
attainment of goals are addressed in the evaluation. If goals are 9) Patient or family education

J.A.K.E 22 of 32
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

AUTONOMIC NERVOUS SYSTEM - Pag yung parasympathetic nag stimulate, ito ung
Discussed by Prof. Carmencita Pacis stage na rest and digest. Papakalmahin yung
Review of Anatomy and Physiology (Nervous System) katawan nyo kasi kailangan mo magpahinga.
Central Nervous System - (Sympathetic – bumibilis ung heartbeat mo;
1) Brain – information will be delivered Parasympathetic – nagrerelax naman ang puso)
2) Spinal Cord – nagkokonek sa peripheral
Peripheral Nervous system
1) Somatic nervous system
- Voluntary (like u need to have stimulus for you to be able
to respond)
- Skeletal muscles and sensory information
- Carry messages form the outer areas of the body
a) Afferent
- Sensory neurons
- we need to detect using our senses first before
we could be able to process our information.
- This information that we detected from the
outside will be brought to the middle of the body,
which is the brain, wherein the brain will process
the information.
- Then the brain will process and after processing,
the brain will bring back the information via
afferent neuron, may dala dala na syang action.
- May command/ instruction na ipapagawa si
afferent neuron sa efferent/ motor neurons.
- Sample nahawakan mo ung mainit na bagay, at
inalis mo agad ung kamay mo (ganon kabilis
yung afferent and efferent response)
b) Efferent – motor neurons
Parasympathetic nerves Sympathetic nerves
Dilate pupils – when your eyes
Constrict pupils – less light will
are more dilated, it could help
enter. Sample, before you go to
you see better. Ung
sleep, u will turn off the light
surroundings mo mas makikita
para magkaroon ka ng
mo ng mas malawak. Parang
relaxation.
bintana.

Stimulate saliva – nag increase Inhibit salivation – hindi ka

yung laway. gaano naglalaway
Slow heartbeat Increase heartbeat
2) Autonomic nervous system (Automatic) Relax airways – dahil
- Under peripheral nagkakaroon ka ng broncho
Constrict airways – kaya may
- Involuntary physiologic processes. Example: heartbeat, dilation.
snore pag natutulog ka. Kasi
digestion, release ng mga hormones yan ang mga Vasodilation- lumuluwag mga
yung hangin natin dumadaan sa
involuntary. blood vessels, pero pagdating sa
mas makitid na tunnel.
- Cardiac and smooth muscles lungs nag da-dilate – broncho
- Glandular secretions dilation.
a) Sympathetic (Fight or Flight system)
- Nagbibigay ng energy. Stimulate activity of stomach –
Inhibit activity of stomach –
- Ito ung nagkokonek sa mga internal organs to the tinutunaw nya ung laman ng
hindi ka gaano nakakaramdam
brain by the spinal nerves. stomach, nagpoproduce ka ng
ng gutom
- When this sympathetic is stimulated, it will gastric acid.
prepare upper body for stress. When sympathetic
Stimulate release of glucose
stimulated, will increase our heart rate, blood
inhibit gallbladder – there will
pressure, blood flow to the muscle and decrease
Inhibit release of glucose; be sudden energy. Sample
flow to the skin.
stimulate gallbladder – nasunog kapit bahay mo, tas
- Finofocus nya ung delivery ng blood will be
kailangan magtunaw (acid) binuhat mo ung ref, kapag
going towards to heart and lungs.
gantong biglang tumaas
b) Parasympathetic (energy conservation)
adrenalin mo, kapag
- Main organs: GI, Exocrine glands
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 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
nastimulate si sympathetic
because of certain emergency
situation, si liver nagrerelease
ng stored glucose. And this
glucose will give ourselves
energy. Kaya nagagawa or
nabubuhat natin ung isang
activity na hindi naman natin
gnagawa sa normal situation.
Secrete epinephrine and
norepinephrine – main
neurotransmitters in our
sympathetic nerves – main
chemical substance na
narerelease kapag naactivate,
itong system na to.
Relax bladder – nagkakaroon
ng mas maraming capacity for
Contract bladder – nacocontract
the urine to remain in the
yung bladder kaya lumalabas
bladder. Yung bladder neck
yung ihi.
naka constrict kaya hindi
lumalabas yung ihi.
Promote ejaculation and vaginal
Promote erections of genitals.
contraction
Sympathetic nervous system
- Adrenergic system neurotransmitters – norepinephrine,
epinephrine, dopamine
o Alpha1
o Alpha2
o Beta1
o Beta2
- Main neurotransmitter – Ito ung nag rerelease ng chemical
messenger kapag activated sa sympathetic.
- Epinephrine and adrenaline is the same
- Nor – target nila ay blood vessels; Epi – cardiac muscles.
- This chemical messenger cannot reach the target organs, they
need to have receptors. (pharmacodynamics) before a
chemical messenger could be able to give or bring the message
to the target organ, they need to have receptor, kailangan ng
sasakyan.
- Allows the body to function under stress.
- Fight or flight system
J.A.K.E 24 of 32
Effects of activation – Alpha
- If the epinephrine or norepinephrine will bind with alpha
receptors. If this chemical messenger will bind with alpha
receptors.
- Alpha1 will bind with the chemical messenger, the alpha1 will
bring epinephrine or norepinephrine or dopamine to the blood
vessels, eye, bladder, prostate.
o Blood vessels – it will cause vasoconstriction. Kapag
nagconstrict yung blood vessels, nag increased yung
blood pressure and also it will increase the contractibility
of the heart. Mas nagiging malalim ung tibok ng puso.
o Eyes – if alpha1 will bring the neurotransmitters to eyes,
the effect will pupil dilation (mydriasis) (constriction –
miosis) the eyes can accommodate more light.
o Bladder – it will cause relaxation. Kaya mas maraming
urine ma-accommodate. Pero sa bladder neck nya is
constricted kaya hindi ka naiihi.
o Prostate – it will contraction, nagkakaroon ng mataas na
ejaculation. Kapag nagcontract ang muscle, may iniipit
sya, may pinepress kaya may lalabas.
- Alpha2 considered inhibitory ; alpha1 considered stimulate.
Kaya kapag si alpha1 ang binind ng mga ating chemical
messengers, iistimulate nya, pinapataas nya yung effect ng
chemical messengers. Alpha2, nag modulate at nagcocontroll,
kapag sobrang dami na ung epinephrine/ norepinephrine in
your system, Alpha2 will bind with them, para iprevent naman
nya. Inhibitory effect
- If Alpha2 will bind with neurotransmitters, instead bringing
them to the target organ, ang nangyayari dito ay pineprevent
nya na magkaroon ng effect yung ating mga neurotransmitters
on the specific organs.
o Blood vessels – if this will not receive the epinephrine,
instead of vasoconstriction that has epinephrine,
nagkakaroon tayo ng vasodilation. Vasodilation will cause
the blood pressure will go down (nor is for blood vessels,
epi for cardiac muscle) pinigil or pinababa ni alpha2
receptor ung dami na nagcicirculate ng mga chemical
messengers.
o Smooth muscle – it will cause decreased gastrointestinal
tone and motility. Parasympathetic – naka focus kay GI,
alpha receptor is included in the sympathetic, kaya
kabaliktaran yan. Si GI function natin, kapag alpha2
receptor ang nagbind dito at napunta kay GI, pinapababa
nya ung motility. The patient will have constipation, or ito
naman ung ibibigay natin kapag ung patient natin ay super
active ang kanyang GI, nag da-diarrhea, kaya ibibigyan
sya ng alpha2 receptor, mababawasan ung times na mag
dudumi sya.
 PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021

Effects of Activation – Beta

- Beta1 receptor – heart and kidney (activate/ stimulate)

o Heart – once the epinephrine/ adrenaline will bind with
the beta1 receptor, the heart will increase heart
contraction and increased heart rate. Kung problema ng • Sympatholytic (adrenergic blockers) = sympathetic
pasyente natin ay mabagal na heartbeat, we need depressant
medication na nakakapagkataas ng heartrate. So dapat sa - Antagonist – nagbabawas naman sila
classification ng gamot mo, may positive chronotropic - Alpha receptor or beta receptor depende yan sa target
effect. organ mo.
o Kidney – it will increase renin secretion, then the renin - Alpha receptor
secretion will increase angiotensin. (Angiotensin – • Nonselective – itatarget nya pareho 1 and 2
nagpapataas ng calcium release) kaya kapag tumaas ung • Selective – 𝑎𝑎1 , 𝑎𝑎2 selective – yung aatagonize ng
calcium release, tataas ang blood pressure kasi yung gamot natin ung specific number ng alpha receptor na
calcium pagpumasok sa loob ng cells natin, nagpapataas nakalagay sa mechanism of action nya.
yan ng pressure, nag ca-cause sya ng vasoconstriction. - Beta receptor
This will increase the blood pressure. • Nonselective – 𝑏𝑏1 and 𝑏𝑏2
- Beta2 receptor – regulation, inhibitory, modulate the amount
of this neurotransmitter to reach the specific target organs.
o Smooth muscles – decreased G tone and motility. (kapag
sympathetic bumababa ang GI function natin) if the
patient has diarrhea, magbibigay tayo beta2 receptor para
pabagalin ang kanyang peristalsis.
o Lungs – its will cause bronchodilation. (beta2 agonist – u
are stimulating more beta receptor, kaya mas maraming
beta receptor mas broncho dilated, mas nakakahinga ng
maluwag ang pasyente)
o Uterus – causing relaxation of uterine smooth muscle,
kapag nagbigay ng beta2 receptor, napeprevent or
namiminimize yung abnormal labor.
o Liver – it will cause activation of glycogenolysis, - ito ung
breakdown ng glycogen to glucose, masdadami ang
glucose. Then it will increase blood sugar. Pero kapag
laging mataas beta2 receptor mo, pwede mag lead sa
diabetes.
o Ang beta2 receptor ay para lng sa emergency, to give you
extra energy.
Sympathomimetics – imimimic
Sympathetic 1) Direct acting sympathomimetics
• Sympathomimetic (adrenergic) = sympathetic stimulants - Directed on the specific receptors, alpha or beta
- Mimic – gagayahin nya yung mga chemical messenger. - Directly will bind with receptors
- Kulang ang katawan mo sa dopamine/ epinephrin/ 2) Indirect acting
norepinephrine kaya imimimic sya. - it will stimulate the specific secretory cells that are
- Classification: releasing neurotransmitters.
a) Direct – alpha agonist and beta agonist - Reuptake – pineprevent nila mametabolize yung mga
b) Indirect – they will not act directly in producing more existing natin na, norepinephrine or adrelanine so they
alpha and beta receptor, they will focus on the would stay longer na active sa katawan. Hindi sila nag
secretory cells that are producing the epinephrine/ action sa receptor, but they act directly on the secretory
norepinephrine/ dopamine. (produce more on the cells, that are producing the neurotransmitters in
specific secretory cells) releasers sila. or reuptake sympathetic nervous system.
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3) Dual acting it will instruct the smooth muscle to relax. And this will cause
- They could act both. bronchodilation.
- for immediate release, instantly mafifeel mo na lumuluwag
ung daanan ng hangin mo.
- This is direct acting because this drug act directly with the beta
2 receptor.
- So, if you will be giving salbutamol, the effect will be
therapeutic or primary/ secondary effect.
- Nagkakaroon ng adverse effect kasi nasa sympathetic tayo, at
ito ay nagpapaincrease.

• Direct – will bind directly to the receptor

• Indirect – ung drug nag uup sila directly on secretory cells to
produce more neurotransmitter, kaya kapag mas maraming
neurotransmitter. Kaya kapag maraming neurotransmitter, they
could bind with receptor na.
• Mixed acting – pwede sila magbind directly or go to the
secretory cells, so the secretory cell will produce more
neurotransmitter and this neurotransmitter will bind with
receptor

Direct Acting

- Sympathomimetic – Agonist
- Mechanism of action – what specific receptor will the drug Clonidine – sympathomimetic drug (alpha agonist)
bind to.
- It will stimulate the 𝑎𝑎2 adreno receptors.
- Mode of action – ito ung magiging effect kapag binigay natin
- 𝑎𝑎2 ang naactivate, ang effect nya ay mag modulate or to
ung albuterol.
decrease the amount of the circulating epinephrine/
- Pag binigyan ng salbutamol – it will activate b2 receptors in
norepinephrine/ dopamine in the system.
bronchial smooth muscle and it will activate the adenylyl
- Ang effect ni clonidine pagbaba ng pressure.
cyclase activity. (cAMP – Cyclic adenosine monophosphate
which is the second messenger) once na nactivate ung cAMP,
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Indirect acting Adrenergic Agents: Side Effects

Alpha adrenergic effects:
• CNS – headache, restlessness, excitement, insomniam
euphoria (kasi pinataas nya yung mood)
• Cardiovascular – palpitations (dysrhythmias), tachycardia,
vasoconstriction, hypertension.
• Others: anorexia, dry mouth, nausea, vomiting, taste
changes (rare)
Beta-adrenergic effects:
• CNS: mild tremors, headache, nervousness dizziness.
• Cardiovascular: increased heart ratem palpitations
(dysrhythmias), fluctuations in BP.
• Other: sweating, nausea, vomiting, muscle cramps
Sympatholytic Agents (Adrenergic Blockers)
- Drugs that block the effect of the sympathetic NS
- Lytic – pineprevent or binoblock nila
- They will act on the synapse.
- Catecholamines – neurotransmitter.
- Once we take this medication, it will stimulate the synapse to
produce or release more of neurotransmitter.
- Inhibit MAO – Monoamine oxidase – enzyme responsible in
removing yung mga norepinephrine, serotonin, and dopamine
sa system natin. If MAO is increased, wala tayong
catecholamines.
- If u will taking amphetamine, will remove MAO, kaya kapag
walang MAO, mataas ang norepinephrine serotonin and
dopamine). Classification – α- Adrenoceptor Antagonist
- More epinephrine circulating on the body, mataas ang action Non-selective block α1 & α2 (iboblock nya pareho)
ang nervous system. • Reversible
- CNS stimulant, increase alertness, reduce, fatigue, depress - Phentolamine
appetite – kasi yung sympathetic, walang GI. Kaya kapag - Tolazoline (Priscoline)
mataas yung sympathetic, hindi ka nakakaramdam ng gutom • Irreversible
pero sa parasympathetic baliktad naman. - Phenoxyben – zamine
- But this can cause dependence (limit their use) – hahanapin na Selective
ng system mo yan. ang ganda ng pakiramdam mo, d ka o α1 – blovkers
inaantok, d ka nagugutom, d ka napapagod, kaya hahanapin ng - prazosin
katawan mo. (Kailangan ko ata to para matapos lahat ng - terazosin
tasks… HAHAHAHA JOKE hehe) - doxazosin
Mixed Action - alfuzosin and Bunazosin
Ephedrine - Tamsulosin and Silodosin
- Mechanism of action: stimulates both o α2
alpha-and beta receptors, causing - yohimbine
increased heart rate, enhanced, - Idazoxan
cardiac output and, increased BP. - Miscellaneous
- Ergot alkaloids
• Raises systolic and diastolic BP
by vasoconstriction and cardiac
stimulation.
• Also causes bronchodilation but
is less effective than epinephrine.
- They could act directly on secretory
cell. Or they will act directly on
receptor.
- Kapag na-activate si alpha, more of
vasoconstriction pero pag naactivate
din si beta, magka- bronchodilation
ka naman.
- Ang problema dito, kapag may asthmatic at hypertensive ka, Phentolamine (nonselective)
hindi ka pwedeng bigyan ng ephedrine, kasi may - Non specific short acting reversible alpha antagonist
vasoconstriction, lalo tataas BP mo. - Patent competitive antagonist at both 1 and 2 ereceptors
- Quick acting
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- Reduction in Peripheral Resistance – blocking both α1 & - Enter CNS - ↑ BP, HR, motor activity (kapag mataas si A2,
α2 receptors – causes noradreline release and venadilation
pineprevent nya ung sobrang taas ng epinephrin,
more than arteriolar. (si veins nag da-dilate more of the
norepinephrine sa mga target organ. Eh wala na tagacontrol
arteries, kapag mas nagdilate ung blood vessels going to
kasi binolock si a2, tataas ngayon ang concentration ng ating
the heart, mas maraming blood na inaaccomodate ng puso
mga epinephrine/ norepinephrine sa body. Kaya ang effect
natin, kaya ang effect nito will be more of increase
nya vasoconstriction, pagtaas ng BP)
heartrate.) (pero ung palabas sa puso ay hindi, kaya ang
- Actions appear opposite that of clonidine (clonidine –
magiging effect nito ang pressure papunta sa periphery ay
centrally acting, alpha2 agonist – pinapataas ni clonidine
hindi naman mataas kaya pinapaba nito ang blood
yung alpha 2)
pressure pero pinapataas ung heartrate.)
- Used (herbal treatment) for male sexual dysfunction (too
• Cardia stimulation much a2 will result to decrease contraction sa muscle)
- Enhanced NA release due to alpha-2 blockage (si
noradrelanine ang nagcacause ng vasoconstriction, kaya
kapag binolock mo si NA, wala kang vasoconstriction
pero may vasodilation ka bumababa ang BP mo)
- Inhibits serotonin release – muscarinic agonist (?)
• Uses: Pheochromocytoma (tumor sa adrelan gland, ito ung
magiging cause para mag produce mas maraming epinephrine/
norpinephrine), chloride withdrawal, cheese reaction and in
extravasations of NA and Adr injection.
• Dose: 5 mg IV injection and when needed
Selective – A1 – Adrenergic Blockers
Prazosin: Doxazosin, Terazosin
Mechanis of Action Nonselective a blocker – side effects
- Blocka α1 receptors in arterioles and venules thereby
produce vasodilation ↓ peripheral vascular resistance. (a1
cause vasoconstriction, kaya kapag binolock mo yung a1
receptors magkakaron ng vasodilation)
- Uses:
• Mild to moderate hypertension
• Benign prostate enlargement – ang effect ng a1 ay
constriction, kaya kapag nablock ung a1, nawawala ung
constriction at magrerelax sya.
• Raynaud’s phenomenon – ang blood vessels natin ay
mababa papunta sa mga dulo ng daliri. (kapag binolock
natin si a1, lumuluwag ang daanan ng blood natin
papunta sa distal extremities.) Classification of Beta blockers
• Pheochromocytoma (nonselective α blocker
phenoxybenzamine)
- Adv effects:
• Postural hypotension – 1st dose phenomenon (1st dose
should be small and should be administered at bed time)
dahil bumababa BP.
• Nasal stuffiness, dizziness, palpitation
- Blocks α1 AR on resistance vessels from binding NE
released from nerve terminals
- Decreases vascular tone (vasodilates)
- Thereby decrease PVR and BP
Non-Selective
Propranolol
- Class II
- Non-selective (iboblock nya pareho, b1 – pinapataas nya
ung heartrate; b2 – 2 lungs, kapagbinolock si b2,
magkaka- bronchoconstriction)
- D natin pwede ibigay to asthmatic patient kasi
magkakaroon sya ng bronchoconstriction, mahihirapan
Selective – A2 sya huminga dahil binolock din ung beta2 nya.
Yohimbine (Yocon) - Hindi porke highblood ka, magtetake ka na ng kahit
- Competitive antagonist, α2 selective anong klase ng anti-hypertensive medication, kung non
- Bark of Pausinystalia yohimbe selective yan at ikaw ay asthmatic, d mo pwede itake yan.
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- Mechanism: Beta a- adrenergic Antagonists (Beta A- Blockers) Side Effects

• Decrease SA node automaticity
• Decrease AV node conduction speed
• Decrease cardiac contractility
- Similar to calcium channel blockers in effect
- Use: ST, VT, AT
- PO – IV in emergency situation
- Adverse Effects:
• Hypotension
• Bronch ospasm
• Decreased cardiac contractility

Nursing Implications
• Monitor vital signs for bradycardia and hypotension
• Monitor blood glucose for hypoglycemia (kapag binolock
natin ung receptor sa sympathetic, binoblock mo rin ung
pagproduce ng glucose)
• Advise the client about the possibility of impotence

Parasympathetic Nervous System

- Cholinergic system – acetylcholine – neurotransmitter that
innervates the muscles.
• Nicotinic
• Muscarinic
- Regulates vegetative functions
Selective – B1 - Rest and Digest
Metoprolol - These two systems work in constant opposition to control
- Mechanism of Action: Selectively blocks beta-1 receptors, organ response
slowing sinus heart rate, decreasing cardiac output, and
decreasing BP.
- Pwede ibigay to sa asthmatic patient.
- Target nya lang ay heart.

Beta 1 vs Beta 2 Selectivity

o Nicotinic – coordination, movement

o Muscarinic – pagrelease ng mga fluids sa body.

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Parasympathetic • Direct-acting cholinergic agonists

• Parasympathomimetic (cholinergic) = parasympathetic - Action: mimics acetylcholine to produce parasympathetic
stimulants (agonist) papadamihin si acetylcholine stimulation (binds directly with Ach receptors)
• Parasympatholytic (anticholinergics) = parasympathetic - Prototype drugs: bethanechol chloride → for bladder
depressants (antagonist) babawasan ang acetylcholine or atony. (bladder atony – u are not urinating)
icocontrol ang mga receptors na kumukuha kay - Pilocarpine HCI (Pilomann, Pilogel) → for glaucoma
acetylcholine. - Causes: salivation, urination, defecation, sweating,
Parasympathomimetic Agents (Cholonergic Agents) vomiting, and abdominal cramps.
- Drugs that cause the same effect as stimulation of - Side effects: hypotension, hypersalivation, hyperhidrosis,
parasympathetic NS nausea, vomiting, diarrhea.
- (Like putting your foot on the brake) gusto mo magpahinga. Indirect Acting
Physostigmine
- Actions: inhibitors of
cholinesterase; amplifier
of endogenously
released Ach.
(Cholinesterase – ito ung
mga enzyme that
catalyzes the hydrolysis
of acetylcholine. Kapag
maraming Acetylcholine,
o Direct acting – ang purpose ng gamot ay pwede magbind sa minemetabolize ni
receptor agad. They will bind directly with muscarinic or cholinesterase. Kapag nametabolize nya, nagiging
nicotinic. Examples: inactive si acetylcholine. Kaya kapag maraming
- Acetyl-choline cholinesterase, less ang acetylcholine) (acetylcholine –
- Methacholine main neurotransmitter in parasympathetic)
- Carbachol - Indicators
- Bethanechol • Reversal of severe atropine poisoning (IV)
- Pilocarpine • Occasionally used in acute glaucoma (topical)
o Indirect acting – ang purpose neto ay doon sa secretory cells (induced miosis and spasm of accommodation)
na nagpoproduce ng neurotransmitters na si acetylcholine. • Used in intestinal atony (increases their motility)
o - Pharmacokinetics:
Direct acting • Lipid soluble
• Can be used topically in the eye
• Duration: 2-4hours
- Adverse Effect: generalized cholinergic stimulation plus
CNS effects: seizures
- Adverse effects of reversible inhibtors of cholinesterase –
all of the side effects seen w/ direct
parasympathominmetics + caused by increased nicothine
component
- Possible side effects:
• Bradycardia and hypotension (we are on
parasympathetic, binabagal nya ung tibok ng puso)
• Bronchospasm/ respiratory insufficiency – apply
atropine that is parasympatholytic drug (conclusion,
coma)
Parasympatholytic Agents (Cholinergic Blockers)
- Drugs that block the action of parasympathetic NS
- (Like taking your foot off the brake)

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Spasmolytics
Dantrolene (anticholinergic) (DOPA decarboxylase) (dopamine as such cannot be
- Pineprevent nya si used since it does not enter the brain)
acetylcholine. • Levodopa itself is largely inert. Its effects in the brain
- Binabawasan nya yung and are mostly related to activation of D2 receptors.
receptor na kumukuha kay
acetylcholine.
- Naiinhibit nya yung
pagrelease ng calcium kasi binoblock nya si nyanodine
receptor that are receiving the calcium.
- Less calcium – muscle relaxation
- Nicotinic antagonist
Mechanism of action:
• Dantrolene reduces skeletal muscle strength by interfering
w/ excitation-contraction coupling in the muscle fibers Vasico Selective (Anti-muscarinic)
• Normal contraction involves release of calcium from its Oxybutynin
stores in the sarcoplasmic reticulum through a calcium Indications
channel • Neurogenic bladder (hindi mo kaya icontrol ung pagihi
• Dantrolene interferes w/ the release of calcium channel mo)
this sarcoplasmic reticulum calcium channel • Urgency
• Cardiac muscle and smooth muscle are depressed only • Frequency
slightly, perhaps bec. the release of calcium from their • Incontinence
sarcoplasmic reticulum involves a diff. process • Detrusor muscle hyperreflexia
Mydriatics Action:
Anticholinergic mydriatic • anti-muscular/anticholinergic (block muscarinic effects of
- Parasympathetic – constrict; mydriatic = dilate acetylcholine) receptors specific; antispasmodic (ang
- are predominantly acting anticholinergic mydriatic muscarinic receptor pinapataas nya yung urination dahil
substances. secretion sya, so kapag nablock si muscarinic,
- Purpose: Cycloplegic – pinapa- numb nila yung sensation nababawasan ung pagproduce mo ng urine.)
sa mata, Lalo na sa mga pasyenteng ooperahan. To numb Side Effects
and to dilate. • Dry skin
- Pharmacodynamics Action: Produces mydriasis and • Eyes and mucous
cyloplegic effect shorter than atropine membranes
- Therapeutic use: in ophthalmology for retinal examination • Constipation or diarrhea
and pre-operative for cataract • Nausea
- Homatropine, eye drops 1%: Mydriasis and cycloplegia • Tachycardia
are fast and duraza 1-3 days • Blurred vision
- Cyclopentolate, eye drops 1%: Mydriasis and cyclopegia • Somnolence
duraza 24hrs
Caution
• Narrow angle glaucoma

Anti-Parkinsonian
- Hindi mo kaya icontrol ung muscles mo.
- Parkinson disease – mababa ung level ng dopamine. 1) Muscarinic Antagonists
(Dopamine is messenger to the brain that will control the
movement and coordination) - Action: compete with acetylcholine at muscarinic
Levodopa receptors
- Nicotinic antagonist - Uses: preoperatively given to reduce salivation and gastric
- Inaallow nya yung mas maraming dopamine na secretions•
magproduce sa body.
- Chemistry: The amino acid levodopa is the biosynthetic
precursor of dopamine
- MOA:
• In the brain levodopa is taken up by dopaminergic
terminals in the striatum and is converted to
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Side Effects: • Tubocurarine

• Vecuronium
• Pancuronium
- Uses: facilitate endotracheal intubation decrease the
number of anesthetics to be used relaxed skeletal muscles
of intubated patients
- Side effects: hypotension, tachycardia, dysrhythmia,
respiratory depression

Summary

Nursing implications:
- Provide comfort measures for sides
- Encourage fluids to decrease risk of constipation. (dahil
binagal mo ung muscarinic kaya babagal ang peristalsis.)
- Monitor vital signs

2) Nicotinic Antagonists

- Action: block ganglionic nicotinic receptors in both

sympathetic and Parasympathetic NS.
- Dapat balance silang dalawa.
- Kapag tumaas si sympathetic, pinapababa mo naman si
parasympathetic.
- Pero kapag mataas naman si parasympathetic, pinapababa mo
naman ang action ni sympathetic nervous system.

• Hexamethonium – nicotinic receptor antagonist

• Side effects: marked venous pooling-> postural hypotension

(kasi nag vavasodilate ka, kaya epekto sayo neto bababa ang
BP)

b) Neuromuscular blocking drugs (n1)

- Compete with Ach for the receptor sites on motor end

plates or by blocking depolarization

Hirap intindihin yung pharma kung hindi kau nakinig sa discussion

ni doc pacis and mam ilarde! HAHAHA kung may napansin kayo
na correction, pakitama nlng ahhh! Good luuckkk pipol! – Aki

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