NCMA216: Pharmacology

LECTURE 1: BASIC CONCEPT OF PHARMACOLOGY IN NURSING

MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

PHARMACOLOGY
 is the study of drugs and its origin, chemical structure,
preparation, administration, action, metabolism, and
excretion.
 The study of drugs that alter functions of living
organisms.
 PHARMACY
o art of preparing, compounding, and dispensing
drugs. It also refers to the place where drugs
are prepared and dispensed.
 PHARMACIST
o a person licensed to prepare and dispense
drugs to make up prescriptions.
BRANCHES OF PHARMACOLOGY
 The branch of pharmacology concerned with
mechanisms of drug action and the relationships
between drug concentration and responses in the body.
 Pharmacodynamics o Pharmaco means
“medicine” dynamic means
“change”.
o Refers to how a medicine changes the body.
 Pharmacokinetic o Kinetic means “movement or
motion”.
o The study of drug movement throughout the
body.
o How the body deals with medications.
o Actions and side effects of medications in
patient.
 Chinese o Recorded the Pen Tsao (Great Herbal) –
a 40volume compendium of plant remedies dating to
2700 B.C.
 Egyptians o Archives of remedies on a document
known as Erb’s Papyrus in 1500 B.C.
 Pharmacologia sen Manuductio and Materia
Medicum
o First recorded reference to the word
pharmacology
 Early 1800s o Chemists isolates specific
substances from complex mixtures
o Pharmacologists then study their effects in
animals
o Fredrich Serturner (first isolated morphine
from opium, injected himself and three other
friends with huge doses (100mg))
BASIC CONCEPTS OF PHARMACOLOGY
 DRUGS
o are chemicals that alter physiochemical
processes in body cells. o They can
stimulate or inhibit normal cellular functions. o
Used interchangeably with medicines.

 Pharmacognosy
o The branch of knowledge concerned with
medicinal drugs obtained from plants or other
natural resources.

 Pharmacotherapeutics
o The study of the therapeutics uses and effects
of drugs.
o Beneficial and adverse effects of drugs. TYPES OF DRUG NAMES
DRUG NAMES DEFINITION EXAMPLE
 Pharmacovigilance Generic or name approved Paracetamol
o The practice of monitoring the effects of Nonproprietary by the Medical or
medical drugs after they have been licensed for
Name Pharmaceutical
use especially in order to identify and evaluate
Associations in
previously unreported adverse reaction.
the original
country of
 Toxicology o The branch of science concerned
manufacture and
with the nature, effects, and detection of poisons. o
is adopted by all
The measurement and analysis of potential toxins,
countries.
intoxicating or banned substances, prescription
Brand name or name given by Adol
medications present in a person’s body.
trade name the manufacturer Panadol
of the drug. Biogesic
HISTORY OF PHARMACOLOGY
 Babylonians
Chemical name name that Acetaminophen
o Earliest surviving “prescriptions” on clay tablets
describes the
in 3000 B.C.
atomic or
chemical
structure.

pg. 1 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 1: BASIC CONCEPT OF PHARMACOLOGY IN NURSING
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

SOURCES OF DRUGS PHASES OF DRUG ACTION

1. Natural sources 2) Pharmacokinetic Phase

a. Plants o One of the oldest forms of health 3) Pharmacodynamic Phase
care, herbal medicine has been practiced in
virtually every dating to antiquity. PHARMACEUTIC PHASE
o That time, chemists were making  Also known as DISSOLUTION
remarkable progress, isolating specific  Drug becomes a solution to cross the biologic
substances from complex mixture, this membrane (Oral route)
enable scientists to isolate the active  Parenteral administration (IM, ID, SC, IV) – NO
agents from scarce natural sources. o pharmaceutic phase
Examples:  Excipients (fillers and inert substances) – used in drug
• Morphine preparation to allow a drug to form and enhance
• Colchicine dissolution
• Cocaine from cocoa leaves o Potassium (K) and Sodium (Na) – increases
the absorbability of the drug Ex: penicillin Na
Animals o Biologic o
b. Are agents  Disintegration o Breakdown of tablet into smaller
naturally produced in animal cells, by particles
microorganisms, or by the body itself. o  Dissolution
Examples: o Dissolving of the smaller particles in the GI fluid
• Hormones before absorption
• Monoclonal antibodies  Rate Limiting o The time it takes the drug to
• Natural blood products disintegrate and dissolve to be absorbed
• Interferons
• Vaccines
DRUG USES SPECIES Pointers:
Crestor High cholesterol Rats
Rabbits  Liquid preparations are readily absorbed than solid
Dogs preparations
Diovan High blood pressure Rats  Generally, drugs are disintegrated and absorbed faster
Rabbits in an acidic fluid than in alkalinic environment
Lantus Type 1 & 2 diabetes Dogs  Very young and elderly have less gastric acidity
Guinea pigs (absorption is slower)
 ENTERIC COATED
2. Inorganic compounds o Examples: o drugs resists disintegration in gastric acid in
• Lithium carbonate stomach
• Cisplatin o Crushing would alter the place and time of
absorption of the drug
3. Synthetic o Stimulants that mimic the effect of o Disintegration happens in the alkaline
cocaine o Examples: environment of intestine
o NEVER crush enteric coated or
• Ecstasy
extendedrelease tablets
• Molly
o Crushing would alter the place and time of
absorption of the drug
DRUG ACTION  Food may interfere in the dissolution and absorption of
 Therapeutic effect o also referred as the certain drugs however it can also enhance the
DESIRED EFFECT absorption of other drugs
(primary effect intended)  Alkaline Drugs o become ionized and have
 Side effect o also referred as the difficulty crossing cell membrane barriers. Both the very
SECONDARY EFFECT young and older adults have less gastric acidity.
(unintended effect) o ADVERSE Therefore, drug absorption is generally slower for those
EFFECT (severe side effects) drugs absorbed primarily in the stomach.
 Drug Toxicity o Deleterious effects of a drug
resulting from over dosage, ingestion of external use DRUG EVALUATION
drug, and accumulation on the blood stream  a series of scientific tests to evaluate the actual
 Drug Allergy o immunologic reaction to drug therapeutic and toxic effects of chemicals
 Drug Tolerance
o exists in person with unusually low physiologic STEPS:
response to a drug  PRECLINICAL TRIAL
o testing done on laboratory performed in
1) Pharmaceutic Phase animals

pg. 2 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 1: BASIC CONCEPT OF PHARMACOLOGY IN NURSING
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

o tests efficacy and toxicity, at different • produce unacceptable side

doses, it predicts whether the drug will effects
cause harm to humans. • have a low benefit-to-risk ratio
o do not always reflect the way a human • are not as effective as available
responds, testing may overestimate or drugs
underestimate the actual risk to humans.
 PHASE III
 ORPHAN DRUG o chemicals cleared for large-scale clinical
o are drugs that have been discovered but studies
are not financially viable and therefore o some chemicals may not advance further
have not been “adopted” by any drug in the next phase due to the following
company criteria:
o may be useful in treating a rare disease, or • produce unacceptable side
they may have potentially dangerous effects
adverse effect • produce unexpected responses
o are often abandoned after preclinical trials
or phase I studies. o Criteria:  PHASE IV
o drugs approved for marketing by FDA
• lack therapeutic activity
o continues evaluation
• too toxic
• Teratogenic
• have a small margin of safety DOSAGE FORMS OF DRUGS
• Examples: A. Solid Form
 Zavesca (Miglustat) 1. Tablet
 Trisenox (Arsenic a. Scored
trioxide injection) b. Layered
 Aldurazyme c. Enteric – coated
(Laronidase) d. Chewable
 Glivec (Imatnib e. Sustained released
mesylate) 2. Capsule
 Frabrazyme (Agalsidase a. Soft gel
beta) b. Hard gel
 Ventavis (Iloprost) 3. Lozenges
 Litak (Cladribine) 4. Suppository

B. Liquid Form
 PHASE I 1. Syrup
o chemicals cleared for human testing, there 2. Suspension
are significant therapeutic benefits. o 3. Elixir
testing done on healthy male 4. Emulsion
subjects o companies begin 5. Inhalants
developing a brand
name C. Topical Forms
1. Cream
 ORPHAN DRUG 2. Ointment
o are chemicals that are discarded Phase I 3. Lotion
o will not participate in the next phase 4. Patch
criteria: 5. Gels
• lack therapeutic activity in
humans
• too toxic PRINCIPLES OF DRUG ADMINISTRATION
• produce unacceptable side  MEDICATIONS
effects o Are substances administered for the diagnosis,
• teratogenic cure, treatment, or relief of symptom or
prevention of disease
 PHASE II
o chemicals cleared for limited clinical  PRACTICE GUIDELINES
studies o RNs are responsible for own actions, illegible
o some may not further proceed with the order should be questioned or clarified
evaluation due to the following criteria o RNs should be knowledgeable about the
• less effective than expected medication
• are too toxic o If the RN is uncertain about the calculation, ask
another nurse to double check

pg. 3 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 1: BASIC CONCEPT OF PHARMACOLOGY IN NURSING
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

o What you prepare, you administer o Do not MEDICATIONS

leave medications at bedside o If the A. ORAL MEDICATION
client vomits, report to charge nurse, MD, or Most common route:
both.  Contraindications o Client is
o When error is made, assess the patient first and vomiting o Client with intestinal
report to MD immediately Correct identification or gastric suction
of the patient: o Unconscious Client o
o ID band or ID bracelet (BEST: Kozier) o Inability to Swallow
Ask the patient’s name o Avoid: calling 1. Tablet or Capsules
the client in NAME o difficulty in swallowing
o May answer “YES” to the wrong name o Crush and mix with
small amount of water
TEN RIGHTS OF MEDICATION o Avoid Crushing
• Enteric Coated
 Right CLIENT
• Buccal and Sublingual
o can be measured by checking the client
tablets
identification bracelet by having and by having
2. Liquid Medication o Mix
the client state her or his name.
before pouring o Place
 Right DRUG medication cup on flat surface at
o means that the client receives the drug that was eye level
prescribed, check at least three times prior to o Fill the cup with the desired
administration. level using the BOTTOM of
the meniscus
 Right TIME
o is the time at which the prescribed dose should B. PARENTERAL MEDICATIONS
be administered. 1. Intradermal
 Site o Inner lower arm o
 Right ROUTE Upper chest o Anterior
o is necessary for adequate or appropriate chest o Upper back beneath
absorption. the scapula
 Angle
 Right ASSESSMENT o 10º - 15º o almost
o requires the appropriate data be collected parallel to the skin
before administration of drugs Right  Gauge
documentation. o #25, #26, #27
o requires that the nurses immediately record the  Length
appropriate information about drug o ⅜
administered. ”, ⅝”, ½”  Max
cc:
 Right to EDUCATE o 0
o requires that the client received accurate and .1 to 0.2 ml
thorough information about the medication and
how it relates to his or her situation 2. Subcutaneous
o client teaching also includes therapeutic  Site
purpose, possible side effect of the drugs, any o Outer aspect of
dietary restriction or requirements skills the upper
administration, and laboratory monitoring. arms
o Anterior thighs o
 Right EVALUATION Abdomen o
o requires that the effectiveness of the Upper back o
medication be determined by the client Ventrogluteal o
response to medication.
Dorsogluteal
 Angle
 Right to REFUSE
o 45-degrees (1 inch of tissue
o client can and do refuse to take medication. can be grasped)
o It is the nurses’ responsibilities to determine o 90-degrees (2 inches of
when possible the reason for refusal and to tissue can be grasped)
take reasonable measure to facilitate the client
 Gauge
taking the medication.
o #25, #26, #27
 Length
o ⅜”, ⅝”, ½”

pg. 4 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 1: BASIC CONCEPT OF PHARMACOLOGY IN NURSING
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
 Max cc o 1-3 ml
3. Intramuscular
 Site o
Ventrogluteal
• 1 y/o and adult
• No large nerve or blood
vessels
• Sealed off by bone
• Contains less fat than
buttocks
o Vastus Lateralis
• Site of choice for 1 y/o
and younger
• Infants with fully
developed gluteal
muscles
o Dorsogluteal
• For adults and children
with well-developed
gluteal muscles
 Contraindications o
children under
3 y/o o
Increased
risk of striking the
SCIATIC
NERVE
o DELTOID
• Small muscle, very
close to the radial
nerve and artery
• Rapid absorption for
adults
• Cannot administer
more than 1 ml.
• Recommended site
for Hepatitis B
vaccine
administration
o RECTUS FEMORIS
• Can be used for
self-administration
• Disadvantage:
causes discomfort
 Gauge
o #24, 23, 22, 21, 20
 Length
o 1”, 1 1/2”, 2”
 Max. cc o 2-5 ml
 Angle o 90
degrees
4. INTRAVENOUS / INTRAVASCULAR
 Gauge
o #24, 23, 22, 21, 20
 Length
pg. 5 TRANSCRIBED BY: JEM HANNAH BERNARDO
o 1”, 1 .”, 2”
 Max. cc o
Push 10 ml
 Infusion o 4L
in 24 hrs.
ID/SC IM/IV
GAUGE 25 24
LENGTH 1 inch 1 inch and
C. TOPICAL MEDICATIONS
1. Transdermal Patch
 Site o Trunk or lower abdomen o
Areas that are: hairless o
(+) hair (clip, do not shave) o
Avoid: cuts, burns, abrasions,
distal extremity
D. OPHTHALMIC MEDICATION  Preparation:
o Clean the eyelid and lashes from inner
to outer canthus
 Instruction before administration o
Look up
 Where and How to Apply:
1. LIQUID:
o Instill correct number of drops o
Outer third of the lower
conjunctival sac
 Instruction after Instillation o
Do PUNCTAL
OCCLUSION for 30
seconds
2. OINTMENT:
o Discard the first bead o
Squeeze 2 cm on the lower
conjunctival sac
 Instruction after Instillation o
CLOSE but
not SQUEEZE the
eyelid
E. OTIC MEDICATIONS
 Preparation:
o Clean the pinna and the
meatus of the ear canal
o Warm the medication: o
In between hands o
Place in warm water
1. Straighten The Auditory Canal:
o Adult: (>3 y/o): Pull the
Pinna UPWARD and
BACKWARD
o Child: (<3 y/o): Pull the
Pinna DOWNWARD and
BACKWARD 
INSTILL THE MEDICATION:
o Along the side of the canal
 ACTIONS AFTER:
o Gently press the TRAGUS
 NCMA216: Pharmacology
LECTURE 1: BASIC CONCEPT OF PHARMACOLOGY IN NURSING
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

o Insert small piece of cotton fluff

loosely
 Instruction After:
o Remain in side-lying for 5 minutes

TERMINOLOGIES:
 Drug Name
o The systematic naming of drug used in
Pharmacology

 Oral Medication o preparations are taken by

mouth, swallowed with fluid, and absorbed via the
gastrointestinal tract.

 Parenteral Medication o can be defined as a

sterile drug product, suitable for administration by
injection.

 Ophthalmic Medication o a medication comes in

form of drops gel or ointment

 Topical Medication
o a drug suitable for administration applied to a
particular body part most often applied to
surfaces such as skin and mucous membrane.

 Otic Medication o drug products used to treat

conditions of the external and middle ear.

pg. 6 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 2: PHARMACODYNAMICS
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

PHARMACODYNAMICS  Therapeutic Dose of a Drug o is the dose of a

 Is the study of the effect of drugs on the body. drug that produces a therapeutic response in 50% of the
 Drugs act within the body to mimic the actions of the population.
body’s own chemical messengers.
 Toxic Dose of a Drug o is the dose that
produces a toxic response in 50% of the population.

 If the ED50 and TD50 are close o drugs have a

narrow therapeutic index.
o require close monitoring to ensure patient
safety.

 Dose – Response Relationship o Is the body’s
physiological response to change in drug concentration
at the site of action.
 Potency
o Refers to the amount of drug needed to elicit a
specific physiological response to drug.
 Efficacy o magnitude of effect a drug can cause
when exerting its maximal effect.
 Onset
o is the time it takes for a drug to reach the
minimum effective concentration (MEC) after
administration. o Time from drug
administration to first observable effect (T0-T1)
 Peak
o occurs when it reaches its highest
concentration in the blood/plasma
concentration. (T0-T2)
 Duration of Action o is the length of time the drug
exerts a therapeutic effect. period from onset until the
drug effect is no longer seen. (T1-T3)

 Maximal Efficacy o the point at which increasing a

drug dosage no longer increases the desired
therapeutic response.

THERAPEUTIC DRUG MONITORING

 Drug concentration can be determined by measuring
peak and trough drug levels.

 Peak
o highest plasma concentration. 30 minutes after
infusion.
PARAMETERS OF DRUG ACTION
 Trough
 Therapeutic Index – (TI) o describes the o lowest plasma concentration. 30 minutes prior
relationship between the therapeutic dose of a drug to the next infusion.
(ED50) and the toxic dose of a drug (TD50)
THEORIES OF DRUG ACTION
A. Drug-Receptor Interaction o 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 o drugs act at

specific areas on cell membranes; react
with certain chemicals to cause an effect
within the cell.

pg. 1 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 2: PHARMACODYNAMICS
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

 “Lock and Key Theory” o 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
D. Selective Toxicity o Specific action on cellular
structures that are unique to the microbe.
o All chemotherapeutic agents would act only in
one enzyme system
o needed for life of a pathogen or neoplastic cell.
o It is essential to the pathogen but not to the
host.

 Drug Response
Drug Response may be:
a. Primary o
always
desirable/physiologic
effects
b. Secondary o desirable or undesirable
o Ex: Diphenhydramine
(Benadryl)

B. Drug-Enzyme Interaction o Interferes with

enzyme systems that act as catalyst from various
chemical reactions
o If single step in one of enzyme system is
blocked- normal function is disrupted.

 Primary effect: antihistamine; treat symptoms of

allergy
 Secondary: Drowsiness

CLASSIFICATION OF DRUG ACTION

1. Rapid
o few seconds to minutes
C. Nonspecific Drug Interaction o Act by
o IV, SL, Inhalations
biophysical means that do not affect
cellular/enzymatic reactions.
2. Intermediate
o drugs do not bind to receptors but instead
o 1-2 hours after administration o IM, SC
saturate the water or lipid part of a cell- drug
actions occur based on the degree of
saturation. 3. Delayed/Slow
o Neutralization of stomach acid by antacids. o several hours after administration o
Oral, rectal

CATEGORIES OF DRUG ACTION

1. Stimulation/Depression
 Stimulation
o increased rate of cell activity/
secretion from the gland T3/T4
for hypothyroidism
 Depression
o decreased cell activity and
function of a specific organ.
o Iodine, propylthiouracil

pg. 2 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 2: PHARMACODYNAMICS
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

3. Potentiation o a drug that has no effect

enhances the effects of the second drug
o 0+1=2
o Alcohol enhances the
2. Replacement o replaces essential body analgesic activity of aspirin.
compounds o Example: Insulin • Prozac + Zestril

4. Antagonistic o one drug inhibits the effect of

another drug
o 1+1=0 o Ex:
• Tetracycline + antacid=
decreased absorption of
tetracycline
• Charcoal in alkaloidal poisoning

ADVERSE DRUG EFFECTS

3. Inhibition/Killing of Organism o
with bacterial cell growth
o Example: Antibiotics
Interfere 1. Side Effects o Results from the pharmacologic
effects of the drug
o Most common as a result of lack of
specificity of action within the therapeutic
range.

2. Allergic Reactions o Unpredictable adverse

drug effects; more serious
o Response to patient’s immunological
system to the presence of the drug
o Do not occur unless the patient has been
previously exposed to the agent/ chemical
related compound

4. Irritation o Example: Laxative- irritate 3. Idiosyncratic Reaction o Abnormal reactivity to

the inner wall of colon---increased peristalsis-- the drug caused by a genetic difference between
- increased defecation. the patient and normal individual.
o Occurs when the patient is first exposed to
DRUG – DRUG INTERACTION the drug
1. Additive Effect o 2 drugs with similar o a patient with G6PD deficiency will have
anemia by using antioxidants.
actions are taken for a doubled effect
o 1+1=2 o Ex:
4. Toxicity o The degree to which a drug can
• Ibuprofen + paracetamol= added
be poisonous and thus harmful to the human body.
analgesic effect
• Codeine with acetaminophen =
5. Iatrogenic responses o Unintentional
better pain control
responses as a result of medical treatment
o Nephrotoxicity; ototoxicity

2. Synergistic o combined effect of 2 drugs is

greater than the sum of the effect of each drug
given alone o 1+1=3 o Ex:
• Aspirin = 30% analgesic effect
• codeine – 30% analgesic effect
• combination = 90% analgesic
effect

pg. 3 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 3: PHARMACOKINETICS
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

PHAMACOKINETICS
 Is the process of drug movement throughout Movement of drug particles from GIT to body fluids
the body that is necessary to achieve drug involve 3 processes:
action.
1) Passive transport
 Diffusion – drugs move across the cell
membrane from an area of higher
concentration to one of lower
concentration.
2) Facilitated diffusion
 Active transport – requires a carrier such as
enzyme or protein to move the drug against a
concentration gradient. Energy is required. 3)
Pinocytosis
 is the process by which cells carry a drug across
PROCESSES their membrane by engulfing the drug particles in a
Mnemonic “ LAD ME” vesicle.
1. L=
LIBERATION
 The release of the drug from it’s dosage form.
 Is the first step in the process by which
medication enters the body and liberates the
active ingredient that has been administered.
The pharmaceutical drug must separate from
the vehicle or the excipient that it was mixed
with during manufacture. Some authors split
the process of liberation into three steps:
disintegration, disaggregation, and dissolution. Factors affecting drug absorption
A limiting factor in the adsorption of  Drug solubility o lipid soluble drugs pass
pharmaceutical drugs is the degree to which readily through GI membrane,
they are ionized, as cell membranes are o water- soluble drugs need an enzyme or
relatively impermeable to ionized molecules. protein
 The characteristics of a medication's excipient
play a fundamental role in creating a suitable  Local condition at site of absorption o weak
environment for the correct absorption of a acids less ionized in stomach o Readily pass
drug. This can mean that the same dose of a
through the small intestine.
drug in different forms can have different
bioequivalence, as they yield different plasma
 Pain/stress/solid foods/fatty or hot foods o
concentrations and therefore have different
slows down gastric emptying time
therapeutic effects. Dosage forms with
modified release (such as delayed or extended
release) allow this difference to be usefully 3. D = DISTRIBUTION
applied.  The process by which diffuses or is transferred
from intravascular space to extravascular
2. A = ABSORPTION space (body tissue).
 Is the movement of the drug into the  process by which drug becomes available to
body fluids and tissues.
bloodstream after administration.
 is the movement of the drug from the
 80% of drugs are taken by mouth – enteral.
circulation to body tissues.
 Movement of drug molecules from site of
administration to circulatory system

Factors affecting distribution:

1) Size of the organ
2) Blood flow
3) Solubility - lipid soluble drugs can also cross the
blood-brain barrier and enter the brain.
pg. 1 TRANSCRIBED BY: JEM HANNAH BERNARDO
 NCMA216: Pharmacology
LECTURE 3: PHARMACOKINETICS
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

(Ex. Digoxin)
4. M = METABOLISM
 Also known as the Biotransformation Other Sites of Metabolism
 is the process by which the body chemically 1) Plasma
changes drugs into a form that can be excreted. 2) Kidneys
3) Membranes of intestines

Factors affecting biotransformation

1) Genetic – some people metabolize drugs rapidly,
others more slowly
2) Physiologic
3) Liver disease
4) Infants – decreased rate of metabolism
5) Elderlies – decreased liver size, blood flow,
enzyme production- slows metabolism
First-
6) Environment – cigarettes may affect the rate of
pass
some drugs.
effect or first-pass metabolism
7) Stressful environment – prolonged illness,
 GI tract --- intestinal lumen -- liver---some drugs are
surgery, illness.
metabolized to an inactive form and excreted---
reduced amount of active drug
5. E = EXCRETION
 liver enzymes – cytochrome P450 system – convert
 Also known as Elimination
drugs to metabolites.
 the elimination of unchanged drug or metabolite
 decreased drug metabolism rate will result in
from the body via renal, biliary or pulmonary
excess drug accumulation that can lead to toxicity.
processes.
 Drug half-life is the time it takes for the amount of
 removal of the drug from the body. Drug is changed
drug in the body to be reduced by half.
into inactive form and excreted by the body.
Example:
 Ibuprofen has a half life of about 2 hours. If the
patient takes 200 mg, in 2 hours, 50% of the drug
will be gone, leaving 100 mg.
o after 2 hours - 50
mg. o after 2 hours – 25
mg o after 2 hours –
12.5 mg o after 2
hours – 6.25 mg

 By knowing the half-life, the time it takes for a drug

Routes:
to reach a steady state (plateau drug level) can be
 Kidney- main organ for drug elimination: leave the
determined.
body through urine
 it can be achieved when the amount of drug being
 Free or/unbound/water soluble drugs- filtered in the
administered is the same as the amount of drug
kidney
being eliminated.
 (+) kidney disease- dose must be decreased.
 a steady state of drug concentration is necessary to
 kidneys – main route of drug excretion bile, lungs,
achieve optimal therapeutic benefit.
saliva, sweat and breast milk.
 urine pH influences drug excretion.
Half – life / Elimination half – life (t ½)
 normal urine pH 4.6-8
 time it takes for one half of drug concentration to be
 acidic urine promotes elimination of weak base
eliminated
drugs.
 Example:
 alkaline urine promotes elimination of weak acid
o Short t1/2= 4-8hrs: given several times a day
drugs.
(ex. Penicillin G)
 prerenal, intrarenal and postrenal conditions.
o Long t ½ = >12 hours: given 2x or 1x/day

pg. 2 TRANSCRIBED BY: JEM HANNAH BERNARDO

 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
NURSES RIGHTS WHEN ADMINISTERING MEDICATION
The nurses’ six Rights:
1. Right to complete and clear order.
2. Right to have the correct drug;
3. Right to have access to information;
4. Right to have policies to guide safe medication
administration.
5. Right to administer medications safely and to
identify problems in the system;
6. Right to stop, think and be vigilant when
administering meds.
THE NURSING PROCESS: PATIENT – CENTERED
COLLABORATIVE CARE
Purpose of the Nursing Process (Core of the practice):
1. To identify, diagnose, and treat human responses to
health and illness
2. It supports the nurse in prioritizing safe, timely
delivery of drug administration.
 Careful attention to each phase of the
process promotes
 the patient’s success with the prescribed
medication regimen.
THE ASSESSMENT PHASE
 Phase for gathering information from the
patient about the patient’s health and
lifestyle.
 Subjective Data: Verbalized by the patient
as these are imperceptible by the nurses’
senses.
 The nurse may use open-ended questions
that allow the patient to answer directly
such as:
o “ Please tell me about your
current medications.”
o “ Tell me about your problems
related to swallowing your
medicines.”
o “ What problems did you have in
following the prescribed frequency
in taking your meds?”
NURSING PROCESS
Nursing Process: ASSESSMENT
 Current health history, including family history 
Swallowing problems (dysphagia)
 Signs and symptoms of the patient’s illness  as
verbalized by the patient  Current concerns about:
a. knowledge about the medications and side
effects
b. Over the counter (OTC) remedies,
nutritional supplements, herbal remedies
and contraceptives
c. Knowledge of side effects to report to the
MD.
d. Attitude and beliefs about taking the meds.
 Allergies
 Financial Barriers
 Use of tobacco, alcohol and caffeine  Cultural
dietary barriers
pg. 1 TRANSCRIBED BY: JEM HANNAH BERNARDO
 The patient’s home safety needs
 Caregiver needs and support system o
there may be a special support system unique to
the individual .
o These are persons who may assist in
drug preparation, organizing the pills
and ordering the medications.
 Support systems can:
o alert the patient to side effects; o
encourage compliance; and
o notify the health care
provider if a o problem arises.
OBJECTIVE DATA
 what the nurse observes about the patient’s health
status.
 Involves collecting the patient’s health information
by using the senses: seeing, hearing, smelling and
touching.
 It provides information about the patient’s symptoms
and also targets the organs most likely to be
affected by drug therapy.
OBJECTIVE: Data to secure
1. Physical assessment findings and laboratory data
that may influence drug administration.
a. Risk for aspiration/swallowing ability.
2. Preference for fluids, determine if meds could be
given with these fluids; presence of fluid restrictions.
3. Data from the physician’s notes.
4. Vital Signs
5. About the Meds
a. Review pertinent information related to
meds prescribed.
b. Determine contraindications in
receiving the Meds; if there are, Care
Provider should be notified.
6. Accuracy and completeness of Medication
Administration o Record. Clarify incomplete or
unclear orders.
7. Calculate drug dose as necessary; double checked
calculation; o Checked expiration date on all
medications.
STATE THE NURSING DIAGNOSIS Nursing
Diagnosis: o stated based on the analysis of the
assessment data.
o determines the type of care tha patient will receive.
 Abnormal findings:
o may serve as the defining characteristic of a
problem
o supporting the NDx.
• Common NDx related to Drug Therapy (Examples):
• Noncompliance related to perceived complexity of
treatment
• regimen
• Deficient knowledge regarding effects of
anticoagulant
• medications
 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

• Readiness for enhanced Health Management  A primary role of the nurse: teaching both patients
• Ineffective Health Management r/t lack of finances and families about drug administration.
 Acute pain r/t presence of physical injury secondary to  All teachings must be tailored to the patient’s
______ o (i.e. surgery/ educational/ literacy level; and must trust the nurse
abscess) for learning to begin.
 Risk for acute confusion r/t the use of a pharmaceutical
agent
• In planning, the nurse uses the data collected to set
goals and expected outcomes and interventions.
 Goals or expected outcomes should address the
problems in the patient’s nursing diagnoses. Principles to remember when teaching patients about
drug administration: 1. General
Effective Goal setting has the following qualities:  Instruction to take the meds as prescribed.
a. The expected change is realistic, measurable, and Consistency in adhering to the prescribed regimen
includes reasonable deadlines. is important.
b. The goal is acceptable to both patient and nurse. a. Provide simple written instructions
c. The goal is dependent on the patient’s with the doctor, pharmacy names
decisionmaking ability. and phone numbers.
b. Instruct the patient to notify the
NURSING PROCESS: PLANNING Attending Physician (Care
Provider) if any of the following
d. The goal is shared with other health care providers,
occur:
including the family or caregivers.
o Adjustment in the dose,
e. The goal identifies components for evaluation.
frequency or time of the
drug.
1. Identified expected outcomes.
o A female patient
o Example: The patient will independently
becomes pregnant.
administer the prescribed dose of 4 units of
o An OTC supplement is
regular insulin by the end of the fourth
added.
session of instruction.
2. Side effects
2. Explained the need for the medication to the patient
 Give instructions that will help minimize
and the significant others.
any side effects.
o Clarify specially if the patient wants to
 Example:
selfadminister.
o Avoiding direct sunlight with drugs
3. Plan preparation of medications to avoid
interruptions and distractions. Follow Institutional that can cause
protocol. photosensitivity
o Expected changes in urine or
NURSING PROCESS: IMPLEMENTATION stool color
1. Prepared medications using aseptic technique. o Dizziness caused by orthostatic
2. Arrange medication tray and cups in preparation hypotension: o to rise slowly
area neatly. from a sitting to a standing
3. Prepare medication for ONE PATIENT AT A TIME; position.
followed the RIGHTS OF MEDICATION 3. Self- administration
administration.  Ongoing assessment of the patient’s motor
4. Selected the correct drug; compared the name of skills and abilities. Modify the plan as
medication label with the Medication Administration necessary.
Record or medication card.  Instruct patient on drug administration
5. Read the label three times: according to the prescribed route. Include
a. upon removing the medicine container a ret dem as appropriate.
from the meds box;  Use Drug cards as needed in teaching.
b. before pouring/ removing the contents and
c. before returning to the medication box.
6. Check or recalculate drug dose as necessary.
7. For controlled substances:
o Check record for medication count
and compare with current count /
supply available.
8. Explain to the patient or caregiver each of the
medication’s the purpose, action, schedule and side
effects.

IMPLEMENTATION: Patient Teaching

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 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
4. Diet
 Advise patient about foods to include and
avoid in their diet.
 Food-Drug interaction may:
a. Drug absorption
b. Risk of drug toxicity
c. other problems = safety concern
5. Cultural Considerations
 A culturally sensitive nurse must be
alert to the patient’s cultural
expectations.
Points to consider:
1. Prior to the teaching, o learn the ethnicity of the
patient and arrange for an interpreter;
o Avoid having family members as
interpreters as they may not be able to
interpret medical terminology and may
hinder communication on the part of the
patient.
2. Allow time for patients to respond to questions.
o Ask open-ended questions, and have
patients demonstrate their understanding
of treatments rather than verbalizing them.
3. Be flexible in the timing of the medication
administration; o such as with patients who are
praying or fasting.
4. Always be culturally sensitive when providing fluids
to patients when administering medications.
o Ask in advance warm water when
requested.
5. Check for the patient’s culture if they have specific
laws to follow concerning food preparation.
6. Be mindful of body language. Many cultures are
uncomfortable with too much eye contact, touching
or hugging.
Points for Patients and Families to Remember
1. Medications should be taken as prescribed.
o If problems arise, contact your medical
provider.
2. If drugs are placed in a drug box, keep the original
labeled container.
3. Keep ALL drugs out of the reach of children.
4. Before using any OTC drugs (i.e. Vitamins,
nutritional supplements), check with your health
care provider. This includes the use of ibuprofen,
and laxatives. Consider asking the pharmacist
before buying or using a product.
5. Bring all drugs with you when you visit the M.D.
6. Know the purpose of each medication and under
what circumstances to notify the M.D.
7. Do not drink alcoholic beverages around the time
you take your medications. Alcohol is absolutely
contraindicated with certain medications; it can alter
the absorption and action of the meds.
8. Be aware that smoking tobacco also alters the
absorption of some medications (i.e. Pain meds,
pg. 3 TRANSCRIBED BY: JEM HANNAH BERNARDO
antidepressants) Consult your M.D. or Pharmacist
for specific info.
Implementation: Culture of Safety
 Medication Error o any PREVENTABLE
event that may cause or lead to inappropriate
medication use or harm to a patient. o
National Council for Medication o Error
Reporting (2009) o Occurs during:
transcription stage (56%) o
nurse administration stage
(41%) o prescribing stage (3%)
 Culture of Safety o Everyone in the
organization is committed to keep patients safe
from harm.
o Procedures are followed. Protocol for
reporting is followed.
• Risk Management is a process that identifies
weaknesses in the system. It allows changes to be made
in order to minimize the effects of adverse patient
outcomes.
 The Joint Commission National Patient Safety
Goals (TJC) o took the steps to support safety
and quality care in the workplace.
 National Patient Safety Goals o Focus on
problems in health care safety and how to solve
them.
• Written for a variety of health care settings: ambulatory
health care, home care, hospitals, behavioral health
care, laboratory services.
• long-term care and office-based surgery.
 Once a goal becomes a standard, the goal number is
retired. The standard must then be adopted by
JCaccredited agencies.
Among the standards:
o Use of universally accepted abbreviations.
o Black box warning system : adverse effects.
 Drug Reconciliation o a component of culture of
safety o refers to the process of identifying the most
accurate list of all medications that the patient is
taking at transitions in care, which includes
admissions and discharges from the hospital to
another health care settings such as long-term care
or at home.
o aims to prevent discrepancies that can
cause drug error.
o provides continuity during transitions,
promoting safety.
Nurses should advise patients to :
a. Always carry a list of personal drug info in case of
emergency;
 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

b. Update list of drugs whenever a change occurs.

c. Bring a list of medications to each doctor
appointment.

Patient tools and Resources:

http://www.ahrq.gov/professionals/quality-patient-safety/
patient-safety-resources/indes.html

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 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

TJC Standard
o Facilities to find out, record and share info AS a rule, do not crush meds with any of the following: To
on any drugs patients are taking, and it crush or not to crush?
requires them to compare that list of drugs CD Controlled delivery CR Controlled release
with a list of any new drugs being given. DR Delayed release ER Extended release
IM Immediate release LA Long acting
DISPOSAL OF MEDICATIONS MR Modified release SA Sustained action /
If no Program is in place: short acting
1. Remove meds from the original package and mix
SR Sustained release TR Timed release
them with unpalatable substances such as dirt, kitty
liter, or used coffee ground ( DO NOT CRUSH TR Timed release XT Extended release
TABS/CAPS). This to make the meds less XR Extended release
attractive to people and animals.
2. Place the mixture in a sealed container; throw in the Refer to the pharmacist when in doubt. Listing:
household trash. Do-Not-Crush-List
3. Scratch out all personal info on the prescription http://www.ismp.org/tools/donotcrush.pdf
label before disposing of the empty container.
HIGH ALERT MEDICATIONS
 FDA/DEA/BFAD Can cause significant harm to the patient.
o Issued Guidelines for appropriate disposal. o major effect on the patients organs: cardiac,
respiratory, vascular, and neurologic systems. o
 Public/ Private Agencies o Secure, convenient, Also affects the sympathetic and parasympathetic
and responsible methods for collecting and o nervous system.
destroying meds and controlled substances. o High alert meds according to the Institute for Safe
o examples: take-back events, mail-back Medication Practices(ISMP):
programs, collection receptacles • epinephrine, subcutaneous/IV
• methotrexate (non-onco oral use)
 Local collection program: • Oxytocin, IV •
o as authorized by the State for disposal of Nitroprusside sodium inj.
medical waste and hazardous materials. • Sodium chloride
• promethazine, IV and others
 Sharps Safety o OSHA and Needlestick Safety
and Optimize Safety by:
Prevention Act (NSPA)2000 o + 1. Simplifying storage, preparation and administration.
Nurses Organizations campaigned for the 2. Write policies concerning safe administration.
Protection of the Nursing Staff from work 3. Improve information and education.
hazards. 4. Limit access to high-alert medications.
5. Use labels and automated alerts.
SAFETY RISKS WITH MEDS ADMINISTRATION 6. Use redundancies (double checks).
a. Tablet splitting : done by patients to control cost. 7. Close monitoring of patient’s response.
b. Buying drugs over the internet.
o Issues: Convenience VS expired meds and Look-alike and Sound-alike Drug Names o Drugs involved
safety in medication errors and recognized as confusing
 Recommendation: Look for sites that require includes:
prescription; Ask for a contact person & a licensed • Amaryl (glimepiride) VS Reminyl
pharmacist, should there be a need to call. (galantamine)
 Counterfeit Drugs • Captopril VS carvedilol
Drugs that may look like the desired drug but • Depakote (valproic acid) VS Depakote ER
: o may have no active ingredient o wrong (divalproex Na)
amount of active ingredient o improper • Depo-medrol VS Solu-medrol
packaging o contaminated (methylprednisolones)
 Recomm: Purchase drugs from licensed • ephedrine VS epinephrine
pharmacies. Report to the BFAD, DOH, PNP or
DTI.  Recomm: Use of “tall-man” letters as a safety
strategy
Ex: rispiriDONE VS rOPINIRole : for listings &
storage

Other Factors o Creating a distraction-free environment.

45% of the errors are due to interruptions
 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023

PREGNANCY CATEGORIES AND SUBSECTIONS:

o benefits & risks to the fetus; info re: use of the Rx to
pregnant Women; Risk to the child for breast
feeding women.
New Labelling effective June 30, 2015
8.1: Pregnancy: includes Labor and Delivery
8.2: Lactation: includes Nursing Mothers
8.3: Females and Males of Reproductive Potential

Nursing Process: EVALUATION

1. Evaluate/reassess the patient’s response to the meds.
2. Ask the patient or the caregiver to identify drug and
explain purpose, action, schedule and side effects.

 DOCUMENTATION o
MAR:
1. Name of the drug.
2. Dose
3. Route
4. Date and time
5. Refusal : reason for refusal
• FUMC: N/A if meds are
not available

6. Nurse’s initials or signature

 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
THE NURSING PROCESS
 Utilizing steps of nursing process ensures that the
interdisciplinary practice of pharmacology results in safe,
effective, and individualized medication administration
and outcomes for patients.
 Although not all nursing theorists completely agree on
this process that defines the practice of nursing, most do
include certain key elements: assessment, nursing
diagnosis, implementation, and evaluation.
Application of the nursing process with drug therapy
ensures that the patient receives the best, safest, most
efficient, scientifically based, holistic care.
ASSESSMENT
 gathering information is the first step of the nursing
process.
 This involves systematic, organized collection of
data about the patient. The data must include
information about physical, intellectual, emotional,
social, and environmental factors for holistic care.
These data are used to identify actual and potential
health problems. The database established during
assessment provides a foundation for subsequent
steps in the process. Important methods of data
collection are the patient interview, medical and
drug-use histories, the physical examination,
observation of the patient, and laboratory tests.
 Two major aspects associated with assessment are
the patient’s history (past illnesses and the current
problem) and examination of his or her physical
status.
Three reasons for obtaining a drug history o To evaluate
need for medication o To obtain current and past use
of over-the-counter medication
o To identify problems related to drug therapy
Relies on three sources o Primary source: produced by
patient o Secondary sources: relatives,
significant others, medical records, lab reports
o Tertiary sources: literature to provide background
information, diagnostic tests, diet
Comprehensive collection of data, including:
a. History o The patient’s past experiences
and illnesses can influence a drug’s effect. This will
help to promote safe and effective use of the
drug and prevent
adverse effects, clinically
important drug–drug, drug–food,
or drug– alternative therapy
interactions, and medication
errors.
b. Chronic Conditions o Chronic conditions
can affect the
pharmacokinetics and
pharmacodynamics of a drug.
Certain conditions (e.g., renal
disease, heart disease, diabetes,
chronic lung disease) may be
contraindications to the use of a
drug.
c. Drug Use o Prescription drugs, over-
the-counter (OTC) drugs, street drugs,
alcohol, nicotine, alternative therapies, and
caffeine may have an impact on a drugs
effect. Patients often neglect to mention OTC
drugs or alternative therapies because they do
not consider them to be actual drugs or they
may be unwilling to admit their use to the
health care provider.
d. Allergies o A patient’s history of
allergies can affect drug therapy. Past
exposure to a drug or other allergens can
provoke a future reaction or necessitate the
need for cautious use of the drug, food, or
animal product.
e. Level of Education and Understanding o
Gathering information about the patient’s level
of understanding about his or her condition,
illness, or drug therapy helps the nurse to
determine where the patient is in terms of his
or her status and the level of explanation that
will be required. Stress, disease, and
environmental factors can all affect a patient’s
learning readiness and ability.
f. Social Support o Patients are being
discharged from health care facilities earlier
than ever before, often with continuing care
needs. Often patients need help at home with
care and drug therapy.
g. Financial Supports o Financial
constraints may cause a patient not to follow
through with a prescribed drug regimen. For
example, the drug may be too expensive or
the patient may lack the means to get to a
pharmacy to obtain the drug. In some
situations, a less expensive drug might be
appropriate in place of a very expensive drug.
 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
h. Pattern of Health Care o Knowing how a patient
seeks health care provides the nurse with valuable
information to include when preparing the patient’s
teaching plan. Information about patterns of health
care also provides insight into conditions that the
patient may have but has not reported or
medication use that has not been stated.
i. Physical Examination
o To determine if any conditions exist
that would be contraindications or
cautions for using the drug and to
develop a baseline for evaluating the
effectiveness of the drug and the
occurrence of any adverse effects.
j. Weight
o A patient’s weight helps to determine
whether the recommended drug dose
is appropriate.
k. Age
o The child’s developmental age will
influence pharmacokinetics and
pharmacodynamics; the immature liver
may not metabolize drugs in the same
way as in the adult, or the kidneys
may not be as efficient as those of an
adult. As patients age, the body
undergoes many normal changes that
can affect drug therapy, such as a
decreased blood volume, decreased
gastrointestinal absorption, reduced
blood flow to muscles or skin, and
changes in receptor-site
responsiveness.
NURSING DIAGNOSIS
 The nurse analyzes the database to determine actual and
potential health problems. These problems may be
physiologic, psychologic, or sociologic. Each problem is
stated in the form of a nursing diagnosis, which can be
defined as an actual or potential health problem that
nurses are qualified and licensed to treat.
A complete nursing diagnosis consists of two statements:
a) a statement of the patient's actual or potential health
problem, followed by
b) a statement of the problem's probable cause or risk
factors.
 Typically, the statements are separated by the phrase
related to, as in this example of a drug associated
nursing diagnosis: “noncompliance with the prescribed
regimen [the problem] related to inability to
selfadminister medication [the cause].”
Five Types of Nursing Diagnosis
1. Actual
o based on human responses and
supported by defining characteristics
2. Risk/high-risk o patient may be more
susceptible to a particular problem
3.
Possib suspected problems requiring
le o additional data
4.
Wellne clinical judgment about a transition
ss o from one level to a higher level
5. cluster signs and symptoms to
Syndro predict certain circumstances or
me o events
PLANNING
 In the planning step, the nurse delineates specific
interventions directed at solving or preventing the
problems identified in analysis. The plan must be
individualized for each patient. When creating a
care plan, the nurse must define goals, set
priorities, identify nursing interventions, and
establish criteria for evaluating success. In addition
to nursing interventions, the plan should include
interventions performed by other healthcare
providers. Planning is an ongoing process that
must be modified as new data are gathered.
Four phases of a nursing care plan
a. Setting priorities o Identify
problems and prioritize which ones
are more important and must be
attended to first, depending on
patient needs
b. Developing measurable goal/outcome
statements o Write short- and long-term
goals for the patient to be followed
when providing care
c. Formulating nursing interventions and
formulating anticipated therapeutic
outcomes o Plan which
intervention to use based on
anticipated patient behavior
IMPLEMENTATION
 Involves taking the information gathered and
synthesized into nursing diagnoses to plan the
patient care. This process includes setting goals
and desired patient outcomes to assure safe and
effective drug therapy. These outcomes usually
involve ensuring effective response to drug therapy,
minimizing adverse effects, and understanding the
drug regimen.
Nursing actions are suggested o Dependent
actions: performed by a nurse based on health
care provider’s orders
o Interdependent actions: implemented with the
cooperation of a team
 NCMA216: Pharmacology
LECTURE 4: THE NURSING PROCESS IN PHARMACOLOGY
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
o Independent actions: provided by nurse by virtue
of education and license
Three types of nursing interventions are frequently involved in
drug therapy:
a. drug administration
b. provision of comfort measures
c. patient/family education.
a. Proper Drug Administration o The nurse must
consider seven points, or “rights,” to ensure safe and
effective drug administration.
1. Right drug and patient,
2. Right storage of drug,
3. Right and most effective route,
4. Right dose,
5. Right preparation,
6. Right timing, and
7. Right recording of administration.
 Remembering to review each point before
administering a drug will help to prevent medication
errors and improve patient outcomes.
b. Comfort Measures
o A patient is more likely to be compliant with a drug
regimen if the effects of the regimen are not too
uncomfortable or overwhelming.
c. Placebo Effect o The anticipation that a drug will
be helpful (placebo effect) has proved to have
tremendous impact on the actual success of drug
therapy. For example, a back rub, a kind word, and a
positive approach may be as beneficial as the drug
itself.
d. Managing Adverse Effects o Such interventions
include environmental control (e.g., temperature, light),
safety measures (e.g., avoiding driving, avoiding the
sun, using side rails), and physical comfort measures
(e.g., skin care, laxatives, frequent meals).
e. Lifestyle Adjustment o Some medications and their
effects require that a patient make changes in his or her
lifestyle. For example, patients taking diuretics may have
to rearrange their day so as to be near toilet facilities
when the drug action peaks. Patients taking
bisphosphonates will need to plan their morning so they
can take the drug on an empty stomach, stay upright for
at least one-half hour, and plan their first food of the day
at least one-half hour after taking the drug.
f. Patient and Family Education o With patients
becoming increasingly responsible for their own care, it
is essential that they have all of the information
necessary to ensure safe and effective drug therapy at
home. In fact, many states now require that patients be
given written information.
EVALUATION
 Evaluation is part of the continuing process of patient care
that leads to changes in assessment, diagnosis, and
intervention. The patient is continually evaluated for
therapeutic response, the occurrence of adverse drug
effects, and the occurrence of drug–drug, drug–
food, drug– alternative therapy, or drug–laboratory
test interactions. In some situations, the nurse
evaluates the patient simply by reapplying the
beginning steps of the nursing process and then
analyzing for changes, either positive or negative.
The process of evaluation may lead to changes in
the nursing interventions being used to provide
better and safer patient care.
TERMINOLOGIES:
ASSESSMENT
o information gathering regarding the current
status of a particular patient, including
evaluation of past history and physical
examination; provides a baseline of information
and clues to effectiveness of therapy.
EVALUATION
o part of the nursing process; determining the
effects of the interventions that were instituted
for the patient and leading to further
assessment and intervention.
IMPLEMENTATION
o actions undertaken to meet a patient’s needs,
such as administration of drugs, comfort
measures, or patient teaching.
NURSING
o the art of nurturing and administering to the
sick, combined with the scientific application of
chemistry, anatomy, physiology, biology,
nutrition, psychology, and pharmacology to the
particular clinical situation.
NURSING DIAGNOSIS
o statement of an actual or potential problem,
based on the assessment of a particular clinical
situation, which directs needed nursing
interventions.
NURSING PROCESS
o 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.
 NCMA216: Pharmacology
LECTURE 5: DRUGS AFFEECTING THE BODY SYSTEM AND NURSING CONSIDERATIONS (ANS)
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
INTRODUCTION
 Drugs affecting the nervous system alter its functions. A
thorough review of the anatomy and physiology of the
Central Nervous System and Autonomic System would
help students understand the mechanisms of actions of
drugs. The functional unit, neurons basic function is
impulse transmission which happen by electrical and
chemical process. Electrical transmission of impulses
happen by action potential and chemical process make
use of neurotransmitters to achieve its functions.
CENTRAL NERVOUS SYSTEM
o Brain & Spinal Cord – very important structure of
the CNS is its protective mechanisms that not all
chemicals can pass through it, this affects the
pharmacodynamics of drugs because some of them
cannot penetrate the CNS. One vital protective
structure is the Blood Brain Barrier (BBB). This
represents therapeutic challenge to drug treatment
of brain related disorders because a large
percentage of drugs are carried bound to plasma
proteins and are unable to cross the brain.
PERIPHERAL NERVOUS SYSTEM
o Autonomic Nervous System & Somatic Nervous
System – Synapses made by the peripheral
nervous system conduct impulses that is chemical
in nature. These neurotransmitters have specific
receptors in the neural membrane to facilitate
conduction of nerve impulses. Drugs may act in the
nervous system to either stimulate or block the
receptors to correct alterations in the nervous
functions.
o Neurons conduct impulses by Action Potential, the
rapid change in the membrane potential, this
happens by movement of sodium into the cells
causing depolarization and potassium out of the
cells to cause repolarization. This movement of ions
facilitated by channels in the cell membranes will be
acted upon by drugs to correct changes in the
nervous system causing disease process.
AUTONOMIC NERVOUS SYSTEM
o The division of the peripheral nervous system that
supply involuntary muscles, glands and other
effectors not innervated by the somatic nervous
system. Autonomic nervous system is responsible
for all involuntary actions of the body that the
person is not aware of. This is divided into two
divisions:
PARASYMPATHETIC NERVOUS SYSTEM
o Parasympathetic nervous system (PNS) comes
from the cranio – sacral outflow of the peripheral
nervous system. Cranial nerve X, IX, VII, III
participate in the cranial flow. Majority of the PNS
comes from cranial nerve X ( Vagus nerve ). This is
the only cranial nerves that extend up to the thorax
and abdomen to supply majority of parasympathetic
innervation, so a vagal stimulation is synonymous
with parasympathetic innervation. Sacral nerves
also participate in the PNS to supply mostly the
effectors in the pelvic area like urinary bladder.
o The ganglia of the PNS are located near the organ
of innervation. The neurons therefore of the PNS
are pre – ganglionic neuron, the neuron from the
Cranio – sacral outflow to the ganglia and the post –
ganglionic neuron, the neuron from the ganglia to
the organ of innervations. PNS is responsible for
“REST AND DIGEST” involuntary responses of the
body.
o Impulses transmitted across the synapses of the
ganglia are mediated also by the neurotransmitters.
o In the PNS, the neurotransmitter is Acetylcholine.
Receptors for acetylcholine are located in the post
synaptic neuronal membrane. These receptors are
called cholinergic receptors. There are 2 types of
cholinergic receptors
• Nicotinic Receptors
• Muscarinic receptors
SYMPATHETIC NERVOUS SYSTEM
o The division of the autonomic nervous system,
Sympathetic nervous system (SNS) from the
thoraco- lumbar outflow, spinal nerves from this
region send nerve fibers to the sympathetic ganglia
located near the CNS, then post ganglionic neurons
send innervation to the involuntary muscles and
glands and other effectors mostly associated with
involuntary process in the body.
o The preganglionic neuron of the SNS is shorter than
PNS and the post ganglionic neuron is longer than
PNS. SNS is responsible for “FIGHT OR FLIGHT”
involuntary responses of the body. Impulses
transmitted across the synapses also are mediated
by the neurotransmitters. There are two
neurotransmitters in the SNS. Acetylcholine and
Epinephrine and Norepinephrine ( Catecholamines )
o Acetylcholine is released by the preganglionic
neurons, while epinephrine and norepinephrine are
the neurotransmitters released by the post
ganglionic neurons, except for those post ganglionic
neurons innervating adrenal medulla, pilo erector
muscles, sweat glands and some smooth muscles
of the blood vessels, they have sympathetic
innervations but the neurotransmitter in at the
postganglionic neurons is Acetylcholine
o Epinephrine and Norepinephrine may also be called
Adrenalin and Noradrenaline respectively or they
are being referred to as catecholamines. Their
receptors are called Adrenergic Receptors.
o There are 2 types of adrenergic receptors
• Alpha receptors
• Beta receptors
 NCMA216: Pharmacology
LECTURE 5: DRUGS AFFEECTING THE BODY SYSTEM AND NURSING CONSIDERATIONS (ANS)
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
DRUG AFFECTING THE AUTONOMIC NERVOUS SYSTEM ARE
CALLED AUTONOMIC DRUGS
Classifications of Autonomic Drugs
o Drugs affecting the PNS are called Cholinergic
Drugs
o Drugs affecting the SNS are called Adrenergic
Drugs
In the study of pharmacodynamics, one action of the drugs is
its binding with the receptors that may stimulate the
receptors (drugs are called agonist) and drugs that may
block the receptors (drugs are called antagonists). If a
student is aware of the responses of the PNS and SNS, it
would be easier to remember drug actions, they would either
stimulate the receptors and produce the same effect or block
the receptors or inhibit the effects.
Most of the effectors are innervated by both sympathetic and
parasympathetic and in such case the response of the body
is opposite. See examples below:
Therefore, if a drug stimulates the receptors for PNS, it is
called cholinergic agonist, enhancing PNS effect so such
drug is also referred to as parasympathomimetic drug. A
drug that blocks the cholinergic receptors is called
cholinergic antagonist, also called anticholinergic drugs,
inhibiting PNS response and such drug may also be referred
to as parasympatholytic drug
If a drug stimulates receptors for SNS, it is called adrenergic
agonist, increasing SNS effect so such drug is also referred
to as sympathomimetic drugs. A drug that blocks the
adrenergic receptors decreases SNS responses called
adrenergic agonist or it is also called sympatholytic
drugs.
Remember, knowing the responses of the PNS and SNS is
very important to understand actions of autonomic drugs,
because these drugs would only stimulate or block the
receptors.
 Cholinergic drugs – majority of these drugs affect the
PNS.
o Direct acting cholinergic agonist – directly
stimulates the cholinergic receptors to increase
its effects
• Pharmacokinetics: well absorbed with
relatively short half – life. Metabolism and
excretion may occur at the synaptic level
but exact mechanism is unknown
• Contraindications and Cautions: These
drugs enhance parasympathetic effect so
must not be given to patients with
hypotension, bradycardia or heart block,
intestinal obstruction and urinary retention.
• Adverse effects: These are related to
increase parasympathetic responses such
as bradycardia, diarrhea, urinary
incontinence. Increase sweating may
happen because of the acetylcholine
present in the sweat glands.
• Drug – Drug interaction: Effects of these
drugs maybe increase if combined with
anticholinesterase drugs or the indirect
acting cholinergic agonists.
• Examples
▪ Bethanecol – indicated for non –
obstructive urinary retention like
in neurogenic bladder
▪ Carbachol – indicated for
glaucoma, causing pupillary
constriction
▪ Pilocarpine – indicated for
glaucoma, causing pupillary
constriction
o Indirect acting cholinergic agonist – this
drug increases acetylcholine effect by inhibiting
the action of acetylcholinesterase (an enzyme
that removes acetylcholine in the synapse. If
acetylcholinesterase is not removed in the
synaptic cleft, more acetylcholine stays in the
synapse stimulating more receptors, thus
enhancing their effects. These drugs are used
for treatment of Myasthenia gravis and
Alzheimer’s disease
Myasthenia gravis
o is an autoimmune disease of the
neuromuscular junction (NMJ). This is
characterized by destruction of cholinergic
receptors at the NMJ that will slow down
impulses going to the skeletal muscles. This
disease is characterized by the development of
muscle weakness and paralysis. To increase
junctional transmission, indirect acting
cholinergic agonist inhibits acetylcholinesterase
making more acetylcholine present in the
junction to improve impulse transmission and
muscle function. These drugs are also called
anticholinesterase drugs.
Anticholinesterase drugs for Myasthenia gravis include:
• Edrophonium HCL (Tensilon) – short acting
anticholinesterase drug used to diagnose the
disease. The action lasts for 10 to 20 minutes.
• Neostigmine, Physostigmine, Pyridostigmine – long
acting anticholinesterase drugs used for therapeutic
purposes. The onset of action starts 20 to 30
minutes and may last for 3 – 6 hours.
Alzheimer’s Disease
o is a degenerative disease of the CNS
characterized by loss of neurons in the CNS
which may slow down impulse transmission
across the synapses of the CNS. One
important cause of this is explained by loss of
 NCMA216: Pharmacology
LECTURE 5: DRUGS AFFEECTING THE BODY SYSTEM AND NURSING CONSIDERATIONS (ANS)
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
acetylcholine receptors in the post synaptic
neurons, like myasthenia gravis, less receptors
mean lesser impulse transmission. So
anticholinesterase drugs that inhibit
acetylcholinesterase enzyme will increase
acetylcholine effect and promote impulse
transmission in the CNS. Can drugs for
myasthenia gravis be used to patients with
Alzheimer’s disease? The answer is no simply
because those drugs cannot pass the BBB.
Therefore, Alzheimer’s disease will have its
own anticholinesterase drugs.
Acetylcholinesterase drugs used for Alzheimer’s disease are
called Anti Alzheimer’s drugs which include
• Rivastigmine
• Donepezil
• Tacrine
o Pharmacokinetics: These drugs are well absorbed
and distributed in the body. Drugs for myasthenia
do not pass the BBB. The drugs are metabolized in
the liver and excreted in the urine.
o Contraindications and Cautions: The drugs are not
given to those with known allergy to the drugs. The
drugs may exacerbate bradycardia, diarrhea and
urinary incontinence
o Adverse effects: Exacerbation of parasympathetic
effects may be seen in the patient such as
bradycardia, hypotension and incontinence
• Nursing Considerations
▪ Properly administer eye medication
▪ Slow IV administration to avoid severe
cholinergic effects
▪ Cholinergic agonist oral preparation must
be taken with an empty stomach to
decrease nausea and vomiting
▪ Closely monitor vital signs and
exacerbation of parasympathetic effects o
Provide safety measures o Monitor
patients with Alzheimer’s disease for
progression of the disease.
▪ Drugs will not cure the disease o Monitor
patients with Myasthenia gravis for
underside or overdose of medication
▪ Provide health teaching on the name of
drugs, its action and adverse effects to
promote client’s understanding and
compliance
▪ Provide emotional support and
encouragement to help the patient cope
with drug regimen
 Cholinergic antagonist also being referred to as
anticholinergic drug or parasympatholytic. The drugs act
to block the cholinergic receptors in the PNS. The drugs
may also block some cholinergic receptors present in
the SNS.
o Pharmacokinetics: The drugs are well absorbed and
distributed. Drugs pass the BBB, placenta and
breastmilk. The drugs are excreted in the urine.
o Contraindications and Cautions: The drugs are not
given to patients with known allergy to the drugs.
Should not be used in clients with cardiovascular,
gastrointestinal or genitourinary conditions because
they may exacerbate anticholinergic effect add
worsen the conditions. Contraindicated in client with
glaucoma as the drug may cause pupillary dilation
and further increase intraocular pressure. Caution
is used to patients with hepatic or urinary
impairment.
o Adverse effects: These are associated with
anticholinergic effects of drugs such as drying o the
mouth, constipation, urinary retention, tachycardia,
mydriasis. Drowsiness, confusion and insomnia are
all related to the CNS effects of anticholinergic
drugs
o Examples:
▪ Atropine – indicated to decrease
secretions, treat bradycardia,
pylorospams, ureteral colic, cause pupil
dilation (mydriasis) indicated as preop drug
for cataract extraction. Use as antidote for
cholinergic crisis
▪ Dicyclomine – use for hyperactive bowel
in adults
▪ Scopolamine – use in motion sickness,
indicated to decrease secretion, pupil
dilation
 Adrenergic drugs these drugs act to either stimulate or
block the adrenergic receptors in the SNS
o Adrenergic agonist – stimulate the receptors
to increase sympathetic effect and is also
referred to as sympathomimetic drugs
o Adrenergic antagonist – block the receptors
to decrease sympathetic effect and is also
referred to as sympatholytic drugs
Adrenergic receptors have 2 types and subtypes.
Classification is based on their actual locations in the body.
Below are some adrenergic receptor sites and their specific
locations in the body
Types of the Adrenergic Receptors
1. Alpha receptors
a. Alpha 1 receptors
b. Alpha 2 receptors
2. Beta receptor
a. Beta 1 receptors
b. Beta 2 receptors
Study the table below for some important locations of the
receptors
 NCMA216: Pharmacology
LECTURE 5: DRUGS AFFEECTING THE BODY SYSTEM AND NURSING CONSIDERATIONS (ANS)
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
For the sake of the discussion and the given examples of
drugs, the effects of some of drugs in particular receptors will
be discussed first.
Alpha 1 receptors when stimulated will cause
vasoconstriction, pupillary dilation and closure of urinary
bladder sphincter causing urinary retention.
When the receptors are block? What would be the expected
effects?
Alpha 2 receptors in the CNS neurons when stimulated will
decrease norepinephrine flow from the CNS to the SNS
therefore decreasing sympathetic response. Take note that
this is the drug that stimulate adrenergic receptors but
decreasing SNS effect because the receptors being
stimulated are located in the CNS.
Beta 1 receptors in the heart when stimulated will increase
heart rate. When we use a drug that blocks the receptor,
what is the effect?
Beta 2 are located in the lungs, if we use a drug that
stimulates receptors, the effect is bronchodilation, what is the
effect if we block the receptor?
CLASSIFICATION OF ADRENERGIC AGONIST DRUGS
1. Alpha and Beta adrenergic drugs (
Sympathomimetic drugs ) – these drugs stimulate all
adrenergic receptors to enhance their effects.
o Pharmacokinetics: these drugs are rapidly
absorbed, metabolized in the liver and excreted in
the urine. These drugs may cross the placenta and
breastmilk
o Contraindications and Cautions: Should not be
given in client with allergy to these drugs and to
patients with pheochromocytoma as the drugs may
exacerbate the signs and symptoms
o Adverse effects: These are all related to increase
SNS response like tachycardia, hypertension,
constipation, urinary retention, pupillary dilation
o Examples
• Epinephrine – the drug of choice during
CPR, indicated for treatment of shock
• Dobutamine – used for treatment of
congestive heart failure o Dopamine –
usually given for congestive heart failure
and cardiogenic shock
• Norepinephrine – like epinephrine, may
be indicated for cardiac arrest
2. Alpha specific adrenergic agonist – these drugs
specifically stimulate only the alpha receptors and not
the beta receptors
o Pharmacokinetics: these drugs are well absorbed
and distributed, reach peak levels in 20 to 45
minutes. These drugs are metabolized in the liver
and excreted in the urine
o Contraindications and Cautions: these drugs are not
indicated to clients with allergy to the drugs, those
with hypertension and close angle glaucoma.
o Caution is used in clients with cardiovascular
disease.
o Adverse effects: these are related to the overdose
of drugs that may increase sympathetic effects like
hypertension, gastrointestinal depression and
genitourinary effects like urinary retention
o Examples
• Alpha 1 adrenergic agonist –
Phenylephrine used for treatment of
common colds and allergy. This drug
causes vasoconstriction to lessen
congestion in the nose therefore called
decongestants.
• Alpha 2 adrenergic agonist – Clonidine
better known for its brand name as
Catapres acting on the CNS neurons to
decrease norepinephrine flow. This drug is
indicated for treatment of hypertension.
3. Beta specific adrenergic agonist – these drugs
specifically stimulate the beta receptors and not the
alpha receptors.
o Pharmacokinetics: well absorbed and distributed in
the body, metabolized in the liver and excreted in
the urine. The drugs pass the placenta and
breastmilk, use in pregnancy and lactation only if
benefits outweigh the risks
o Contraindications and Cautions: The drugs are
contraindicated in clients with allergy to the drugs.
Caution is used in clients with cardiovascular
disease like hypertension and tachycardia.
o Adverse effects: These are related to the primary
effects of drugs which will increase sympathetic
effects like hypertension and tachycardia.
o Examples
• Isoproterenol – for treatment of
cardiogenic shock and heartblock in
transplanted heart.
• Salbutamol – for treatment of obstructive
respiratory disease like COPD and
bronchial asthma
Nursing Considerations
1. Avoid sudden withdrawal of the drug because it
may cause rebound hypertension, arrhythmias and
flushing
2. Monitor vital signs especially blood pressure and
heart rate o Avoid comfort measures including rest
and environmental control to decrease CNS
irritation.
3. Provide adequate health teaching on the name of
drug, prescribed dosage, effects and adverse
effects to increase patient’s knowledge and
subsequent compliance.
CLASSIFICATION OF ADRENERGIC ANTAGONIST DRUGS
(SYMPHATOLYTIC DRUGS)
1. Alpha and Beta adrenergic antagonist – these drugs
block all adrenergic receptors
o Pharmacokinetics: these drugs are well absorbed
and distributed in the body, metabolized in the liver
and excreted in the urine and the feces.
o Contraindications and Cautions: These drugs
should not be given to clients with allergy to the
drugs. To those with hypotension and bradycardia.
Caution is used in clients with cardiovascular
disease and obstructive lung disorders
 NCMA216: Pharmacology
LECTURE 5: DRUGS AFFEECTING THE BODY SYSTEM AND NURSING CONSIDERATIONS (ANS)
MR. RENOVO ANGELES MIRADOR
1ST SEMESTER | A.Y. 2022-2023
o Adverse effects: these mainly on the effects of the
drugs in the lungs like bronchospasm, blood
vessels causing vasodilation and hypotension.
o Examples
• Carvedilol
• Labetalol
 Both examples maybe indicated to
clients with severe hypertension
caused by pheochromocytoma
2. Alpha adrenergic antagonist – these drugs block only
the alpha receptors, specific drugs act on the alpha 1
and alpha 2 receptors.
o Pharmacokinetics: these drugs are well absorbed
and distributed, metabolized in the liver and
excreted in the urine.
o Contraindications and Cautions: The drugs should
not be given to clients with hypotension and urinary
incontinence
o Adverse effects: related to the primary action of the
drug causing vasodilation and hypotension
o Examples
• Phentolamine – more specific drug
hypertension in pheochromocytoma, that
will have less adverse effects.
3. Alpha 1 selective adrenergic antagonist – these
drugs block only the alpha receptors, specific drugs act
on the alpha receptors on the blood vessels and urinary
bladder to case vasodilation for treatment of
hypertension and bladder emptying for treatment of
urinary retention. Although some drugs may act in both
blood vessels and urinary bladder at the same time
o Pharmacokinetics: drugs are absorbed in the GIT,
metabolized in the liver and excreted in the urine.
o Contraindications and Cautions: Contraindicated in
clients with allergy to the drugs. This may
exacerbate hypotension and urinary incontinence.
Caution is used to clients with cardiovascular
disease, gastrointestinal and genitourinary
conditions
o Adverse effects: related to the sympatholytic effect
of drugs causing hypotension and urinary
incontinence.
o Examples
• Prazosin – indicated for treatment of
hypertension
• Terazosin – indicated for treatment of
hypertension and BPH causing urinary
retention
• Doxazosin – indicated for treatment of
hypertension and BPH causing urinary
retention
• Alfuzosin indicated for treatment of BPH
• Tamsulosin – indicated for treatment of
BPH
4. Beta adrenergic antagonists – these drugs block both
beta 1 and beta 2 receptors, particularly affecting both
the heart and the lungs, these drugs increase heart rate
and bronchoconstriction of the lungs
5. Beta 1 specific adrenergic antagonist these drugs block
specifically beta 1 receptors in the heart. These drugs
are most commonly known as beta blockers. These
drugs are indicated to clients with hypertension,
dysrhythmias, angina and use to support cardiac
function in clients with congestive heart failure
o Pharmacokinetics: these drugs are absorbed in the
gastrointestinal tract and undergo hepatic
metabolism. The presence of food may increase the
bioavailability of some beta blockers. These drugs
are known teratogenic in animals as it passes the
placenta and breast milk
o Contraindications and Cautions: Contraindicated in
clients with allergy to the drugs. Caution should be
used in clients with bradycardia and heart block as
well on patients with obstructive lung diseases like
COPD and bronchial asthma
o Adverse effects: these are related to the
bradycardia and bronchoconstriction effect of the
drug. Gastrointestinal effects like nausea and
vomiting, genitourinary symptoms may be disturbing
to clients as well.
o Examples
• Beta adrenergic antagonists or Beta
blockers
▪ Propranolol
▪ Pindolol
• Beta 1 specific adrenergic antagonists or
Beta 1 blockers
▪ Metoprolol
▪ Atenolol
Nursing considerations
o Avoid sudden withdrawal of the drug because it may
cause rebound hypertension, arrhythmias and
flushing
o Monitor vital signs especially blood pressure and
heart rate
o Monitor ECG
o Avoid comfort measures including rest and
environmental control to decrease CNS irritation.
o Provide adequate health teaching on the name of
drug, prescribed dosage, effects and adverse
effects to increase patient’s knowledge and
subsequent compliance.
TERMINOLOGIES
Neurotransmitters
o chemicals in the body acting as messengers
Sympathetic Nervous System
o a branch of peripheral nervous system involved in
preparing the body for stress-related activities
o “ fight or flight “
Parasympathetic Nervous System
o associated with returning the body to routine, day-
to-day operations
o “ rest and digest “
Adrenergic
o means “working on adrenaline (epinephrine) or
noradrenaline (norepinephrine) (or on their
receptors)
Cholinergics
o means “working on acetylcholine or on their
receptors