NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares
Contents
• Basic Pharmacology Concepts
• Introduction to Pharmacology
• Pharmacokinetics
• Pharmacodynamics
• Different factors affecting pk and pd
parameters
Pharmacology
Pharmacology – the study of drug use in the
prevention, diagnosis, and treatment of the
disease. (General definition)
• Study of drugs in prevention: could be
vitamins, prophylactic drugs (prep drugs),
polio vaccine, chloroquine (to prevent
malaria)
• Study of drugs in diagnosis:
radiopaque/radioisotopes agents (used for
visualization during x-rays), aspirin, PPD
(purified protein derivative) used to
diagnose TB, Flourecein
• Study of drugs in treatment: Anti-biotic,
anti-inflammatory, etc.
• PK – Pharmacokinetics
• PD – Pharmacodynamics
Pharmacokinetics
• What the body does to the drugs
• How the body process the drug
Pharmacodynamics
• What the drugs does to the body
• Power of the drug
• Effect of the drug to the body
Gamut mnemonics (PD)
G – Ginhawa (Symptomatic)
A – Alisin ang sanhi (Curative)
M – Ibalik sa normal (Restorative)
U – Umiwas (Preventive)
T – Tukuyin ang sanhi (Diagnosis)
Pharmacokinetics
A – Absorption
D – Distribution
M – Metabolism
E – Elimination/Excretion
Empirical doses
• How is the drug being distributed
• Ex: In drugs for neuro, we have blood brain
barrier that prevents the entrance of other
molecules. So, when we have infections in
th brain, we need higher dosage (1,500 ml)
• Being given by the experience
• Nursing responsibility: Monitor the toxic
effects of that medication to our patients.
Absorption
Absorption – uptake into the circulations, how it
can reach the circulation. (Kung gano karami yung
gamit na nar-reach nya yung circulation mo)
bioavailability
• Bioavailability is the rate and extent of
systemic absorption. (Kung gano kadami at
gaano katagal tumatagal yung absorption
into the systemic circulations.)
o Absolute – given na yung absorption
o Relative – another way para maging
bioavailable yung medication (water
soluble, fat soluble) needs certain
precursor to be available
Bioequivalent drugs
NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares
Bioequivalence – biochemical similarity of two or
more drugs that share the same active ingredients
and desired outcomes for the patient.
• Differences in your bioavailability of the
drugs that are not statistically significant.
• Magkakaibang drugs na medyo may
kamukha but not stat significant.
Determination of Absorption
• Disintegration
• Dissolution
• Diffusion
• 80% of drugs are taken orally
o First phase of Drug Action
• GI Tract → medication taken orally will
pass in the GI Tract
Disintegration, Dissolution, &
diffusion
Disintegration – breakdown of tablets in a smaller
particle
Dissolution – drugs will be dissolved in a smaller
particle into the GI fluid before the drugs will be
absorbed
Drugs that are in liquid form are already solution.
Rate Limiting
Rate Limiting – the time you take the drugs to
disintegrate and dissolve for it to have availability
in your body to be absorbed.
• Time it takes to disintegrate and to be
dissolved.
Fillers
• Tablets are not 100% is not all drugs.
• Inserted into substance to prepare the
drugs.
• Used in drug preparation
• For the drug to achieve a particular size or
shape
• May mga gamut kasi nan add-decrease and
absorption sa GI Tract
• For better absorption
• Enhances dissolution process
• Additives: sodium and potassium salt (ex.
Penicillin)
Drugs in liquid form
• Drugs in liquid form are more rapidly
available for GI absorptions since they will
not undergo the disintegration and
dissolution process.
• Drugs dissolved more faster in an acidic
fluid
o Ph 1-2 – Acidic
o Normal Ph in blood: 7.4 (perfect
normal)
Considerations
• Young and elders have different
metabolism.
o Lesser gastric production for them
for better absorption.
o Gastric Irritant – needs food +
causes gastric irritation that will lead
to ulcer
• Azithromax – suspension (needs to be
shaken) mas better na iniinom na walang
NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares

laman ang tyan bcs nababawasan ng 50%
(ang acidic environment) pag kumakain
• Most pain relievers are gastric irritant.
• Enteric coated tablets/capsule - has
specific coating
o to prevent the drugs to be disoluted
o Magkakaroon ng dissolutions into
alkaline environment
intestine)
o Delayed in onset
o Should not be crushed!
• Diet, presence of different pathological
process such as cancer into the intestine,
infections, can decrease mucosal villi =
lesser absorption
• Manner of giving the drugs could be
changed because of certain pathologica
condition either change the dose or change
(small the route
• Surgery – removal portions of the intestine
then you also removes mucosal villi which
decreases absorption

Passive absorption
Pharmacokinetics

• Promotes drug safety • Happens without any requirement of

• Maximize the therapeutic effect and lessen
the harm
• Steroids are highly gastric irritant
• Cell stabilizer to prevent intercranial
pressure to the patient but induces gastric
ulcer
Considerations in pharmacokinetic
factors
• Minimize harm
• Avoids unnecessary effects of the drug into
our patient
• Knows how to select the most effective
route of the drugs, including its dosage and
time of administration
• Reduces drug error
energy
• Diffusion of the drug (no energy)
• No atp, lacks oxygen and glucose
• Pyruvate is produced then to lactate then
lactic acid
Active absorption
• Requires drug to move across to your body
• With the aid of glucose and oxygen
consumption to produce atp
• Requires movement
• Pinocytosis – cell drinking
o Engulf drug particles
o Cells can absorb by means of
drinking

Pathological conditions that affect

absorption

• Absorption happens from the GI tract to

small intestine
NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares

Week 2 - Contents I. Pharmaceutical Type

a. Type of drug
i. Dose formulation (form nung
drugs)
ii. Route of administration
b. Physiochemical properties of the
drugs
i. Lipid solubility
ii. Particle size
c. Excipients and container – inactive
GI membrane substance that actually serves to the
drug for medium of vehicles. (Ex.
It is made up of:
Preservative of the drugs, coloring,
o Fats & CHON (proteins) → fillers)
embedded into the lipid bilayer II. Physiological Type
o 2 phospholipid molecules a. Blood flow/Circulation
• There are drugs that are lipid soluble that i. Ex. Hypertensive drugs which
can pass rapidly to the membrane. Drugs is the captopril – taken in the
that pass rapidly to the membrane are sublingual. Must be cautious
called lipophilic type drugs. in giving this medication to
• Water soluble drugs – it requires or needs those that suffers
energy or enzymes and protein and uses It hypertensive crisis.
as a vehicle. (180/100)
• Non ionized drugs or particles – drugs that ii. temperature
can easily pass through the lining very b. Gastric emptying time and
rapidly. Intestinal motility
o Needs acidic environment for better i. Metabolic state of the body
absorptions like antifungal drugs c. pH level
o Ca CO5 - needs an acidic d. Area of absorption surface
environment for better absorptions. e. Microbial flora – tries to convert
o Give food to stimulate acid using enzymes for absorption of
production in the stomach. certain drugs.
• Some drugs need lesser acidic environment f. Drug concentration – increase in
like aspirin. concentrations of the drugs causes
• HCL Acid – can destroy certain drugs. increase in the absorption of the
o Ex. Penicillin, penicillin-based drugs drug.
o Remedy: Higher dose to upset the
Stomach vs. small intestine
partial losses.

Factors affecting absorptions

NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares

o 3 to 5x a day
o Larger doses in comparison to IV
Absorption is better on the small intestine than the
doses
stomach.
o High hepatic first pass = high hepatic
Stomach Small Intestine toxicity
Total
1 m^2 200m^2
Absorption Factors affecting bioavailability
Blood flow 150 ml/min 1 liter/min
• Drug form (Capsule, tablet, etc.)
Permeability Low High • Route of administrations
• GI mucosa and motility
Factors affecting absorptions • Food and other drugs
• Liver metabolism
• Patient History is very important! o Once the liver is dysfunctional, the
III. Pathological Type haptic blood flow decreases.
IV. Pharmacological Type Drugs are primarily being metabolized by the liver.
a. Drug interaction
b. Effect of drug ↓
Hepatic first pass – stomach → intestinal lumen → Liver disease = less hepatic blood flow
portal vein → liver. In the liver, drugs can be ↓
metabolized into inactive form.
Decrease hepatic blood flow = less drug
• Warfarin Na metabolism
o Morphine – cannot be used when
there is an increase in intra-orbital ↓
pressure or intra-cranial pressure. Less drug metabolism = less conversion into
o NGT (Nasogastric Tubing) inactive from of drugs
Extensive 1st pass - Drugs that are not given orally ↓
• Lidocaine – not given orally, through Less conversion = higher bioavailability
patches
↓
Bioavailability – a subcategory of absorptions. The
High bioavailability = high drug concentration
percent of the administered drug that reaches the
systemic circulations. ↓
• Oral route – bioavailability occurs after High drug concentration = high drug accumulation
absorption and the hepatic drug
↓
metabolism
o Less than 100% -- 20% - 40% (hindi Drug toxicity → death
sya 100% available)
NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares

Absorption
• Metabolism
↑ Rapid absorption of drugs = ↑ drug • Excretion
concentration
Factors affecting drug metabolism
↑ drug concentration = ↑ drug toxicity
↓ slow absorption = ↓ bioavailabilty • Age
↓ bioavailability = ↓ serum drug concentration • Genetic factors
• Change in metabolic rate
Slower absorption of drugs, higher drug dose by o Enzyme induction - facilitates
the doctor. o Enzyme inhibition – inhibits
• Most common dangerous drug that causes Factors affecting excretion
toxicity lever = digitalis drugs (digoxin (ex.
Lanoxin))
• Lanoxin – slows that heartbeat, is given OD • Renal functions
• Drug interactions
distribution o Nephrotoxic (bad to kidney)
o Renal blood flow
Distribution – is a reversible process between the o Change in pH
drug and the protein carrier.
Summary
• Bound and unbound form
Drugs can be distributed by: Drugs
• Receptor sites (produce effect) ↓
• Tissue depot (storage)
• Liver (metabolism) Absorption
• Kidney (excretions) ↓
Factors affecting distribution Distribution
Metabolic Receptor
site site
• Protein (CHON) bound/binding
• Circulations Plasma
• Capillary permeability Free drugs – Bound drugs

Elimination excretion Tissue

site depot

Elimination – irreversible loss of drug in the body.

NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares
Paano magkaroon ng epekto ang
gamot?
For the drugs to have an effect, it needs a receptor
site.
Drug + receptor = Intrinsic activity (Agonist)
Drug + receptor = No intrinsic activity (Antagonist)
• Idiosyncrasy – certain response to the
drugs which are unusual
• Tolerance – High dose is given for the drugs
to produce effect
Therapeutic Index – measurement of the drugs in
line with safety, including the loading dose
• Potency – it is the concurrent to produce
effect. Is also related to the dose and
concentration of the drugs.
• Efficacy – maximal response
Mechanisms of Drug Action
1. Interaction with the receptors – without
the receptors, the drugs will have no
efficacy.
2. Interactions with an enzyme
a. Induction
b. Inhibition
i. ACE (Angiotensin Converting
Enzymes) inhibitors – inhibits
the
conversion of Angiotensin II
which is the most powerful
vasoconstrictor.
ii. Carbidopa – in a form of
Sinemet
1. Sinemet – is a
combination of drugs
carbidopa and
levodopa for the
treatment of
Parkinson’s disease
and its syndrome.
3. Interactions with DNA & RNA – Inhibits
DNA replications and functions
a. Folic acid Analog (In the form of
methotrexate – which is a drug that
inhibits ditropholic reductase)
b. Purine analogs – in the form of
aguanine, that antagonize the
purine synthesis.
c. Pyrimidine analogs – 5FU which
inhibits the pyrimidine synthesis.
Used in cancer drugs.
- Free radical drugs – drugs that inhibit the
topoisomerase of your cells which are toxin
to your cells. It damages your DNA and
destroys your RNA. (such as bleomycin –
antibiotic for cancer)
4. Inhibition to CHON synthesis – inhibits
protein synthesis.
a. Tetracycline
b. chloramphenicol (for typhoid fever))
c. erythromycin
d. aminoglycoside
5. Interaction with cell membrane
a. Digitalis glycoside – inhibit sodium
and potassium pump
b. Local anesthesia – interferes with
the membrane permeability to
sodium and potassium in the form
of lidocaine.
c. Omeprazole, lansoprazole, etc.
(proton pump ihibitors) – inhibits
HCL and potassium (H/K) pump in
the parietal cells in the stomach.
i. Very active H/K pump is
prone to multiple gastric
ulcers.
NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares

ii. Aspirin, steroid drugs are c. Phase 3 – “How well does it work?”
highly ulcerogenic “More positive or negative effect?”
medications causing gastric i. Ex. Doxycycline –
irritant. prophylactic drugs for
1. Always give proton leptospirosis which has
pump inhibitors in positive effects but more
giving it. negative effects in the body.
d. Phase 4 – Post marketing studies.
Net effect of the drug therapy Still studying its effects and develops
it on the safer side.

• The net effect of the drug therapy is the The information needed on the drugs
sum of the pharmacological effects of the
drug and the nonspecific placebo effect is
• Description of the drugs
associated with the therapeutic effort.
• Clinical pharmacology
• Placebo effect – effect of the drugs that is
o Indication and use of the drugs or
actually not in the drugs.
approved us (talaga bang para diyan
o Ex. You were given an antibiotic for
siya?)
your infection and fever, as a
o Contraindications – when not to use
placebo effect of the drugs, you
the drugs
think that your headache is also
▪ Teratogenic –
healed by the drugs (even though
contraindicated for pregnant
antibiotics weren’t for headaches)
woman
o Warning and precautions
Pharmacodynamic interactions o Dosage and administrations
o How is it being supplied (oral form,
• Addition 1+1 = 2 effects to the budy iv form, etc.)
▪ Ex. Anticoagulants durgs
• Synergism 1+1 = 3 or more effects in the
body • Warfarin – oral form
• Potentiation 0+1 = 2 or more effects in the • Heparin – iv form
body
Elements of rational drug use
• Antagonism 1 + 1 = 0 effects in the body

New drug activity • Safe

• Affordability
o Generic act law – make the drugs
1. Pre-clinical stage – studying the affordable and safe to use
compositions of the drug
• Needed
2. Clinical stage – testing stage
• Effectiveness
a. Phase 1 – “is the drug safe?”
• Quality
b. Phase 2 – “does the drug work?”
NRS 2109-7 Pharmacology
Prof. Glenn L. Rianzares

Role of the nurse
• Preparations (example: diluting the iv
drugs)
o Role: Ensure the exact dosing and
sterility of the drugs
• Administration
o Is it intended for IM, SubQ, or
others?
o Role: Must have a concrete
knowledge on how to administer the
drugs and your responsibility while
administering the drugs
o Role: Read the drug insert
o Ex. LMWH – Low molecular weight
heparin in subq. Do not aspirate.
Aspirating will create hematoma
• Health teaching
o Ex. If taking steroids, it must be
consumed after you eat and must be
consumed with proton pump
inhibitors since steroids are very
highly gastric irritant.
o There are medications you cannot
stop abruptly like anti-seizure drugs
(status epilepticus).
• Evaluation
o Evaluate the effects of the
medication to the patient
o Immediate and the long terms
evaluations
o Ex. A patient having a shock because
of blood loss, we give plasma
expanders to support
circulation. In giving that, you need
to evaluate the effects to the patient
long term.
▪ In the form of esteryl:
• Colloids – esteryl,
albumin
• According to studies,
taking 4 colloids gets
the kidney
compromised.
• Crystalloids – mas
mabilis sa katawan
maalis
• Knowledge – knowledge on pharmacology
Legislations & Standards
• Federal
• State
• Policy and guidelines of health care
constitutions
• Medication regulations and nursing practice
Dosage of your administration and
schedule
• ac – before meals
• bid – twice a day
• HS – hours of sleep (At bedtime)
• Qam – Every morning
• prn - As needed
• RTC – round the clock
• TID – three times a day
• QID – four times a day
• Stat - immediately
the