15/09/2022

Pharmacology Caring
Beyond Prescriptions
Vincent C. Pananganan
Nurse Educator
 Session Objectives
1. Apply concepts and principles
of nursing and pharmacology to
ensure safe and proper use of
drugs. (Applying)

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Principles of Pharmacology
Pharmacology
• Scientific study of the origin, nature, chemistry, effects, and uses of
drugs.

Drug
• Any chemical that can affect living processes.

Clinical Pharmacology
• The study of drugs in humans.

Therapeutics
• Use of drugs to diagnose, prevent, or treat disease.

Principles of Pharmacology
Pharmacokinetics
• the absorption, distribution, metabolism, and excretion of
drugs by the body.

Pharmacodynamics
• the biochemical and physical effects of drugs and the
mechanisms of drug actions.

Pharmacotherapeutics
• the use of drugs to prevent and treat diseases.
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Drug Name and Classification

Chemical name
• scientific name that precisely describes the drug’s atomic
and molecular structure
Generic name
• Shorter and simpler name than chemical name. •
Drug name assigned by the United States Adopted
Names Council.
Brand name
• Names used to market the drug.
• Created by drug companies.

Generic name

Brand name
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Drug Name and Classification

Pharmacologic class
• Drugs with the similar characteristics and properties
(mechanism of action).
 Therapeutic class

• Drugs with similar effect on the body (therapeutic

use).

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Pharmacologic class
• Non-steroidal anti-inflammatory drugs (NSAID)

Therapeutic class
• Analgesic and Antipyretic

Pharmacologic class
• Angiotensin II Receptor Blocker

Therapeutic class
• Antihypertensive

Pharmacologic class
• Beta-adrenergic blocker

Therapeutic class
• Antihypertensive

Sources of Drugs
Animals
Synthetic Sources
Minerals
Plants Microorganisms

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Phases of
Drug Development
subjects who therapeutic
Phase 1 have the disease
• This larger
sampling effects at the
for which the provides completion of
• Drug is tested on drug is thought to information about phase III.
healthy be effective. infrequent or rare
volunteers to
make sure the Phase 3 adverse effects.

drug can be Phase 4

given safely to • Large numbers of
people. patients in • Voluntary and
medical research
Phase 2 centers receive
involves post
market
the drug in phase surveillance of Pharmaco
• Involves trials III. the drug’s therapeutics
with human
Fever
Reduced Temp

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Pharmacokinetics
• deals with a drug’s actions
as it moves through the
body
• Involves the ADME, onset
of action, peak
concentration, duration of
action.

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Pharmacokinetics
Absorption
• refers to what happens to a drug from the time it is
introduced to the body until it reaches the circulating fluids
and tissues.

Process
• Passive – acts on diffusion
• Active – uses cellular energy
 Distribution
Factors Influencing
Absorption
• Route
• Blood flow
• Surface area for absorption
• Stress
• Food / Stomach contents •
Drug form & Drug interaction
Pharmacokinetics

• the process by which the drug is delivered to the tissues and

fluids of the body.

Factors Influencing Distribution

• Lipid solubility
• Perfusion
• Protein binding
• Blood-Brain barrier
• Placenta and Breast Milk

Pharmacokinetics
Onset of Action
• duration of time it takes for a drug's effects to come to prominence upon administration

Critical Concentration / Minimum Effective concentration

• the amount of a drug that is needed to cause a therapeutic effect.

Peak

• the highest concentration of a drug in the blood, cerebrospinal fluid, or target organ after a dose
is given.

Duration
• the length of time that particular drug is effective

Loading Dose
• a high dose (higher than that usually used for treatment) to reach the critical concentration faster.
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Pharmacokinetics
Metabolism

• refers to the body’s ability to change a drug from its dosage

form to a more water-soluble form that can then be
excreted.
• Stress
• Environment
Area of metabolism • Age
• Liver (majority of drugs
absorbed in the GIT)
• Kidneys
• Plasma
• Tissues

• refers to the elimination of drugs from

the body. Routes of excretion

Pharmacokinetics
Excretion
Factors Influencing Metabolism
Half - life
• Organ functionality
• Disease
bile, feces)
• Kidneys (urine)
• the time interval required for the
• Lungs body’s elimination processes to
• Exocrine glands reduce the concentration of the
• Skin drug in the body by one-half.
• Gastrointestinal tract (saliva,
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Pharmacodynamics
• the study of the drug
mechanisms that produce
biochemical or physiologic
changes in the body.
 Pharmacodynamics
4 ways drugs affect the body
1. To replace or act as substitutes for missing chemicals

2. To increase or stimulate certain cellular activities

3. To depress or slow cellular activities

4. To interfere with the functioning of foreign cells, such as

invading microorganisms or neoplasms leading to cell
death

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 receptor sites to cause the same
Agonist activity that natural chemicals
• drugs interact directly with would cause at that site

• drugs react with receptor sites to

Competitive block normal stimulation, producing
Antagonist no effect.

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Noncompetitive on a cell and, by reacting there, prevent

the reaction of another chemical with a
Antagonist different receptor site on that cell.
• drugs react with specific receptor sites
Agonist

Noncompetitive
Competitive Antagonist
Antagonist
Binds to opiate receptors receptors glutamate, binds to the
Binds in the NMDA receptor extracellular surface of the
Antagonist to all opiate channel pore but the agonist, receptor

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• ability of a drug to attack only those systems found

Selective Toxicity in foreign cells

Pharmacotherapeutics
 Acute Therapy
• For patients needing immediate treatment

Maintenance therapy
• Used to manage chronic conditions

Supplemental therapy
• Replenish or substitute lacking / lost substances in the body

Supportive therapy
• Maintains other body systems but does not treat the main condition

Palliative therapy
• Increase comfort and well-being of terminally ill patients

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Factors
Affecting the Body’s
Response to a Drug

Weight Age Gender

Physiological Pathological factors Genetic factors

factors
Factors Affecting the Body’s
Response to a Drug

Immunologic Psychological Environmental

factors factors factors

Drug tolerance Accumulation effects Interaction

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Efficacy
- capacity of a drug to produce a
maximum response

Potency
- comparative measure of
different doses of two drugs that
are needed to produce the same
pharmacological effect
 Drug Interaction
Additive Effect
• two drugs with similar actions are administered to a patient

Synergism
• two drugs that produce the same effect are given together and one drug
potentiates (enhances the effect) of the other drug

Potentiation
• occurs when a drug with no direct effect but enhances the action of the other
drug.

Antagonistic effect
• occurs when the combined response of two drugs is less than the response
produced by either drug alone

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Adverse Drug
Reactions
Side Effect Predictable

May be harmful or not

Secondary effect
 Mostly mild and self resolving Unpredictable

Adverse Effect Harmful

Unintended Generally more severe

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Assessment
Evaluation

Nursing Process
and Pharmacology
 Diagnosis
Assessment
Chronic condition
Implementation
Planning

HEALTH HISTORY

• Some drugs are contraindicated to individuals with chronic disease. These conditions may require
cautious use or dose adjustment when administering a certain drug.

Drug use
• Prescription drugs, over-the-counter (OTC) drugs, street drugs, alcohol, nicotine, alternative
therapies, and caffeine may have an impact on a drug’s effect.

Allergies
• 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.

Level of education and understanding

• Information about the patient’s level of education provides a baseline from which the nurse can
determine the appropriate types of teaching information to use with the patient.

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Assessment
HEALTH HISTORY

Social support
• Patients need help at home with care and drug therapy.

Financial support
• High cost of healthcare, in general, and of medications, in particular, must
be considered when initiating drug therapy and promoting patient
compliance.

Pattern of healthcare
• Knowing how a patient seeks healthcare provides the nurse with valuable
information to include when preparing the patient’s teaching plan.

Assessment
PHYSICAL EXAMINATION

Weight
• Patient’s weight helps to determine whether the recommended drug dose is
appropriate.

Age
• Patients at the extremes of the age spectrum—children and older adults often require
dose adjustments based on the functional level of the liver and kidneys and the
responsiveness of other organs.

Physical parameters related to the disease

• Specific parameters that need to be assessed depend on the disease process being
treated and on the expected therapeutic and adverse effects of the drug therapy.
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Nursing Diagnosis
•
Statement of patient’s status from a nursing perspective.

• Utilization of the NANDA nomenclature

Planning
• ensuring
effective
response to drug
therapy, • minimizing adverse effects,

• understanding the drug regimen.

Implementation
Proper drug administration
 • Observance of the 10 Rights of Drug Administration.

Provision of comfort measures

• Involves providing non-pharmacologic interventions, managing adverse reactions, and

adjusting lifestyle.

Patient and Family Education

• Emphasizing the importance of client and SO independence.

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Evaluation
•

Continuous evaluation of the

therapeutic response, the
occurrence of adverse drug
effects, and the occurrence of
drug–drug, drug–food,
drug–alternative therapy, or
drug–laboratory test interactions
Prevention of
Medication Errors
Patient’s Role and

Nurse’s Role

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 Adult
Dosage Computation
 Desired Dose
Dose on Hand
Desired
Quantity on
Quantity
Hand

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Adult
Dosage Computation Example:
Doctor’s Order: Cefuroxime 500mg

Stock at hand: Cefuroxime

250mg/5mL
Desired Dose
Dose on Hand
Desired Quantity
Quantity on Hand

Desired Dose
Dose on Hand
(500mg) Desired
(250mg) Quantity on
Quantity (X)
Hand (5mL)
Adult Dosage Computation
Example:
Doctor’s Order: Cefuroxime 500mg

Stock at hand: Cefuroxime

250mg/5mL 250mg (X) =
500mg (5mL)
500mg (5mL) X =
250mg

X = 10mL

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Pediatric Dosage Computation

Fried Rule
• The Fried rule is a calculation method that applies to a child younger than
2 years of age.
 Pediatric Dosage
Computation

Young Rule
• The Young rule is a calculation method that applies to children 1 to 12
years of age.

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Pediatric Dosage
Computation

Clark Rule
• The Clark rule, which can be used for infants under 1 year, uses the
child’s weight to calculate the appropriate dose and assumes that the
adult dose is based on a 150-lb person

Pediatric Dosage
Computation

Nomogram
• The nomogram that uses body surface area (BSA) is more accurate for
determining doses.

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 Weight – based
Calculation
Desired Dose = Recommended Dose x Weight in
kg Desired Dose = (mg/kg) x (kg)

Order: Give Paracetamol 10mg/kg to a 15kg child

Stock at hand: 500mg/5ml

Desired dose = 10mg/kg x 15kg

Desired dose = 150mg

500mg(desired quantity) = 150mg x 5ml

Desired quantity = (150mg)(5mL)
500mg

X = 1.5mL per dose

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 References
• Burchum, J. R. & Rosenthal, L. D. (2019). Lehne’s pharmacology for nursing care (10th
ed.). Elsevier Inc.
• Karch, A. M. (2020). Focus on nursing pharmacology (8th ed.). Wolters Kluwer, Lippincott
Williams & Wilkins
• Kizior, R. & Hodgson, K. (2019). Saunders nursing drug handbook 2019. Elsevier Inc
• Whalen, K. (2019).
Lippincott Illustrated
Review: Pharmacology. Wolters Kluwer, Lippincott Williams & Wilkins.

Unit 1

Introduction to Pharmacology
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Pharmacology Caring
Beyond Prescriptions
Vincent C. Pananganan
Nurse Educator

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