PHARMACOLOGY ‘ © COLLEGE OF NURSING STUDENT COUNCIL | REFERENCE NO: 2022.212-PHAMO1 peu ACADEMICS COMMITTEE AY. 2022-2023 | TRANSCRIBED BY: M.Savadora,H.Arancon 2) CONTRIBUTORS: DL Dengue, MA. Santos, J.D Naval Interacts with receptors Can elther be basic or acidic Normal pH of the body: 7.35-7.46 chemical entities ett irre a ae ac) etl ‘Science of preparing, compounding, and dispensing medicines Basic Principles of Pharmacology. ‘A. Pharmacology B. dng ©. Phannac PHARMACOGNOSY D. Pharmacognosy x Identification anc preparation of crude drugs from E. Toxicology natural sources: F Pharmacotherapeutios = I. Drug Development + Any drug can have a toxic or lethal dose J. Classification of Drugs + Excess paracetamol causes hepatotoxicity and hepatic necrosis because of glutathione Il. Concepts of Pharmacology denletion A. Pharmacokinetics B. Pharmacodynamics Ill, Toxic Effects of the Drugs IV, Bioethical and Legal Aspect ‘A. Ethical principles B. Legal Aspects ©. Common Law V. Nursing Process: A. Assessment B. Nursing Diagnosis C. Planning D. E ‘Also known as Clinical Pharmacology Branch of pharmacology that uses drugs to treat, prevent, and diagnose diseases ‘Address two key concems: The drug's effects on the body and the body's response to the drug Pharmacokinetics - How the drugs are affected by the biological system, What the body does io the drug * Pharmacodynamics - Effects of drugs in biological systems, What the drugs do to the body, where the mechanism of drug action wil take place Implementation Evaluation ML. Dosage Calculation Intravenous Flow Rate Responsibilities ‘Chomical Name - Chemical structure of the drug Generic Name / Official Name Official nonproprietary name of drugs, universally accepted. Brand name/ Trade name - Proprietary name, x It is the science concemed with history, sources, physical, chemical properties of drugs, and ways in Which drugs affect biological systems (chosen by:thesrug company, % branch of science about drugs and medications causing biologic effect in the living system Sources OF OI Foxglove, digitalis- cardiac glycoside, decreases heart rate, medication for heart failure Mineral Source Iron sulfate Animal Source Chemical entities, both endogenous and foreign Capable of reacting with biological systems ‘Are chemicals that are introduced into the body to cause some sort of change SALVADORA, ARANCON REFERENCE NO: 2022.212-PHRMOt | 1 of 8+ Insulin from pigs © Oxycodone (Oxycotin) x Synthetic Drug Source © Succinyicholine (Quelicin) x Microorganism Source © Piperacillin/Tazobactam Zosyn} 4 Penicillin from a fungi © Amoxicillin (Amoxil) PLANT SOURCE MICROORGANISM SOURCE Source [Plant Dag ise x Bacterial, fungi, mould is an important source of ‘many life saving drugs. eat Distais | Digoxin | CHE x These are obtained from MO and used to kill Microorganisms. Bark Cinchona | Quinine | Malaria Drug Microorganism Fruit Opium Morphine | Analgesic Penicillin Penicilium notatum ‘Seed Eserin Anticho | Myasthenia Chloraphenicol Streptomyces linestrase | Gravis, venezuelace sERAUEOORES Griseotluvin Peneilin grisofullivur Streptomycin Streptomyces oriseus Animal | Part Drug Use Neomycin Streptomyces fradiae Cow Pancrees | Insulin Antidiabeti ¢ Hormone 1. Pharmaceutic Phase Fish Sporms | Protasmine | Antidote of Br tna Hak chon of deigaction ssulpnate | heparin x solid form to liquid form. i 7 ‘ x _ Tablet — Disintegration —Dissolution Mia Inteotine a) oS | Sena 4 Disintegration: breakdown of tablet into smaller particles. Ox Lungs Hepa | Anticoagl Dissolution: dissolving of the smaller particles in aide the GI Fluid. 4 In the Gl tract, the drugs need to be in solution so they can be absorbed, MINERAL SOURCE: + Nursing Consideration: hindi pwede i-crush yung enteric-coated tablet since may purpose x Use in pharmacotherapy ‘yung coet hiya, I serves 28 a banier to prevent gastric acids. kapag wala yun madidissolve aga Mineral Use ‘yung tablet sa stomach acid, Ferrous sulfate (FeSo4) | Anaemia 2. Pharmacokinetics Phase x the drug's joumey to our body. Magnesium sulfate Purgative x It passes through 4 phases: Absorption, (M504) Digestion, ‘Metabolism or biotransiormation, and Excretion ‘Sodium bicarbonate Antacid (Natica) 3. Pharmacodynamics Phase x drug action: OPD (Onset, Peak, Duration) ‘Aluminum Hydroxide | Antacid x nagbibind yung drug sa_ receptors, enzymes, at hormones. SYNTHETIC DRUG SOURCE x Most synthetic drugs are really semi-synthetic in that the drug is chemically modified from a natural source. x Examples are: + the ability of the drug to bind to the receptor depends on the chemical interactions. Adcitional Info: Tablet and capsule undergo 3 phase + Parenteral undergo 2 phase SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 |2 of 8+k 80% of the medicine that we are taking are tablets and most of the drugs that taken orally ‘ay naaabsorb ng small intestines 4 prone ang client sa toxicity kapag low protein kasi hindi enough ang pagbibind, and same with high protein. dapat moderate bind lang para hindi nagaagawan kapag high protein at kkulang naman kapag low protein. Pharmacokinetics & Pharmacodynamics ‘ae =, %* In vitro studies study of a certain substance and its effects, + Animal testing- efficacy of substance to animals then proceeds to be an Investigational New Drug + Clinical Testing - Phase 1 (Absorption, Distribution, Metabolism, Elimination, 20-100 subjects) - Phase 2 (Deals with patients with the disease, 100-200 patients) - Phase 3 (Compare with the gold standard treatment, double blind, 1000-6000 patients) ~ If there is no gold standard treatment, placebo is utilized * Marketing - after Phase 3 ~ Patent expires 20 years atter fling of application x Prescription Drugs + This class of drug can only be acquired if the patient has a Physician's prescription. % Includes: pt. name, age, sex, date, generic/brand name, dose, frequency, number of meds, name and sign of doctor , license umber, ptr'no. x Over the Counter Drugs %* Also known as nonprescription medicine. It is safe and usually effective if the instructions trom the label or a healthcare professional are properly followed, %* Example: acetaminophen, aspirin, antacids, decongestants, antihistamines, and laxatives. + Investigational’ drugs/controlled - morphine, ‘sedatives, hypnotic (diazepam), antidepressants, barbiturates, marjuana (cannabis) Investigational Drugs %* Tested in a laboratory and has an approval for testing > Stil haven't passed Phase 3 x Mlicit or Street Drugs Illegal and usually addictive substances ‘* These drugs move in order to achieve drug action. x Itanswers the question: “What doas the body do to the drug?” x There are four processes: Absorption % Distribution ‘SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 |3 of 8+k Metabolism % Elimination ABSORPTION Movement of drugs into the bloodstream after administration. Modes of drug transport across membranes +k Entry of drug into the systemic circulation 2 Time of administration towards bloodstream Passive Diffusion diffusion w/e does not require energy to move across the membrane. most common solute from higher to lower concentration required no energy no protain carriers ‘can easily cross phospholipid bilayer Facilitated Diffusion requires a carrier such as enzymes or protein to move against a concentrated agents, needs utlization of protein channels no energy oh bb Active Transport active transport channels upstream movement noeds ATP. HHO HH Endocytos phagocytosis ‘engulfs a large molecule for it to enter the cell 4H e 2 Pinocytosis, enguifs the drug to cary membrane. it across the we | Physico-Chemical Considerations for Drug Passage Across Barriers 4. Selective permeability of plasma membrane %* only saveral substances such as: nonpolar, uncharged, not protein bound and unionized ‘can pass through 2. Presence of membrane proteins 3. pH of extracellular environment and ionization of drugs + Acidic to acidic- uncharged, will be absorbed Factors affecting absorptior + Basic to basic- uncharged, will be absorbed Acidic to basic, charged, will be eliminated + Basic to acidic- charged, will be eliminated blood flow ~ _ pHafter drug absorption = poor circulation to the stomach = route of administration First Pass Effect/First Pass Hepatic Metabolism %* Gl tract — Portal Circulation + Systemic Circulation + How the drug affects the liver %* Drugs absorbed by the SI are transported to the liver before circulated to the body. In the li drugs are metabolized into an inactive form then, excreted = ex. lidocaine and nitroglycerine Clinical Relevance: Drugs with high first-pass metabolism should be given in doses sufficient to ensure that enough active drug reaches the desired site of action Bioavailability ~The measure of the fraction of a dose that reaches the systemic circulation ~ By definition, intravascular doses have 100% bioavailability IV can immediately reaches its intended effect, however, it can produce more side effects More side effects, it would be more difficult to retract DISTRIBUTION ‘movement of the drug from the circulation to body tissues leaves the bloodstream, enters the target organ influenced by: = rate of blood flow = drugs affinity to the tissue = protein binding ok The larger size, the wider it can be distributed + Different drugs may bind to different receptors, > Highly protein bound ~ mot a true receptor, cannot exert its intended effects, inactive + Free Drug = not protein bound, intended effects, active can exert its SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 | 4 of 8METABOLISM OR BIOTRANSFORMATION Process by which the body chemically changes rugs into a form that can be excreted x liver primary site of metabolism x other sites: - plasma - kidneys intestinal membranes Drug Bruin vedi Matin Fin pas mebholisn ORS Certain disease (iver cirrhosis, hepatitis) Genes- 90% of Asian and Eskimos are acetylators Environment. Age ELIMINATION ‘© elimination of the drugs from the body x Route kidney (main) = liver - bile feces lungs saliva - sweat = breast milk x Hall-life- refers to the time it takes to one half the drug concentration to be eliminated Pharmacokinetics i 3 ‘* Biochemical and physiological effects of drugs as wall as the drugs mechanism of action. TEESE NSO) Pharmacodynamics Suiajpu = Ee '* Onsot- drugs enters the plasma and lasts until it reaches minimum effective concentration (MEC). ‘© Peak Action- drug reaches its highest blood or plasma concentration ‘* Duration of action- length of time the drug has a Pharmacological effect. Plasma drug concentration t Tine ssinsteed JAGONIST AND ANTAGONIST x Agonist- produce a response x Antagonist- biock a response. ‘SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 |5 of 8(OSES Ss x Nonspecific- crugs that affect various sites x Nonselective -drugs that affect various receptors estimates the margin of safety of a drug x Low TI have a narrow margin of safety Had Tl fear tele ote i bs danger of producing toxic effects We ‘Peak drug level- rate of absorption is the highest plasma concentration of drug at a specific time Through Level- rate of elimination is the lowest plasma concentration of a drug and measures the rate which the drug is eliminated WIE © large initial dose given when immediate drug response is desired ISIDE EFFECTS, ADVERSE REACTIONS, & TOXICITY x Side effects- are phylosiogic effects of drugs not r/t desired durg effects, may be desirable or undesirable (expected ) Adverse Reactions- are a range of untoward effects of drugs that cause mild to severe side effects (not expected); ex. drugs cause respiratory dopression x Toxic Effects or Toxicity- when the drug level exceeds the therapeutic range, toxic effects are likely to occur. PHARMACOGENETICS effect of a drug action that varies from a predicted drug response because of genetic factors or hereditary influence + amlodipine and losartan ee x Age : ae S Breda adee : Gases Genetic Immunological Factors Psychological Factors Environmental Factors x Autonomy: self determination x Veracity - trust through truth telling x Non-maleficence- do not harm x Beneficence- prevent harm, do good x Justice- give to each person his/her right or due x Confidentiality- not to divulge information without consent LEGAL A x Generic Act of 1988 (R.A. 6675)- an act to promote, require, and ensure the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified by their GN. Pharmacy Act of R.A. 6921- All prescriptions must contain the following information: name of the prescriber, office address, PRC# (license number), PTR# (Professional Tax Receipt number), client name, age, sex and date of prescription. x R.A. 6425- Dangerous Drugs Act of 1972 x Unolear Orders x Question the prescribing doctor x Consult another dr if the prescribing dr is not available x Ask the Dr to clearly write the drug in a clearer way x _ Familiar with the drug dosage x Telephone order x Depends hospital policies x Write the order (drug name, dosage, route and frequency) ‘Ask the doctor to repeat the order Read the order back to the doctor Immediately write to the doctor order's sheet Document x Standing orders x clearly written (drug name, route and frequency). x Specific circumstances for PRN medication. = Do not accept unclear order if needed, if indicated as warranted) x Emergency/verbal order x Verbal orders- emergency situation only! (ESE ‘Assessment Diagnosis, Planning Implementation Evaluation geen ‘© Subjective Data: % Current Health History, Ciient Symptoms + Current Medications. % Past Health History + Clients Environment © Objective Data SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 |6 of 8Laboratory tests Diagnostic studies Physical Assessment Baseline data for future comparisons Focus on symptoms and those organs most likely to be affected by therapy dot bo Based on the analysis of the data More than one applicable nursing diagnosis may be generated A nursing diagnosis may be actual or potential Individualized for each patient Based on the medical condition and the drug they are receiving. EXAMPLES: Knowledge deficit about drug _—_ action, ‘Administration, and Side Effects R/T Language Ditficulties. Potential for injury R/T Side Effects of drug, such as dizziness and drowsiness Alteration in Thought process F/T forgetfulness, affecting whether the client takes medication as prescribed. Effective goal setting has the FF. qualities. 1, Client centered and clearly states the expected change. Acceptable to both client and nurse (dependent ‘on client decision making ability). Realistic and measurable ‘Shared with other health care providers Realistic deadlines Prescriptive for evaluations Note: Nursing intervention needed to achieve those outcomes. Client education and teaching is the key nursing responsibility during the phase. In some practice setting, administration of drugs and assessment of drug effects are also important rursing responsibilities. KEY POINTS IN GIVING A MEDICATION name of drug reason of taking the drug the dose specific time to take the drug what specific things should or should not do while taking the medication possible SE of medication Effectiveness of health teaching about drug therapy & attainment of goals is addressed The time at w/c the evaluation of goal occurs is dependent on the time frame specified in the statement of a goal If goals are not met, the nurse needs to determine the reasons for this & ravise the plan accordingly. PE ae ras THERAPY Comprehensive drug and health nistory taking 2. Reason for medication of drug therapy 3. expected results 4. SE and AR 5. When to notify the physician, pharmacist or health care provider drug to drug and drug-food interactions required changes in ADL Demenstration of learning listening % discussion +. retum demonstration of psychomotor skills 9, ‘medication schedule associated with ADL as appropriate 10. record and documentation 11. discussing and monitoring the disease to financial resources 12, developing of back up system 13, community resources exe MSEC Nae Err Right Drug Right Client Right Route (p.0, IV, IM, SC, EC, p.r, p.v etc.) Right Dose Right Time Right Assessment Right Approach Right Education ight Evaluation 10, Right Documentation 11, Right to refuse 412. Right Principle of Care 18. Right Prescription 414, Right Nurse Clinician eeregsens| SIFICATION 1, Category A: no evidence of risk 2. Category B: Animal studies have shown an adverse effects, but adequate studies in pregnant women have not demonstrated (a risk to the fetus 3. Category C: there are no animal reproduction studies and no adequate studies in human SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 |7 of 84, Category D: evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women maybe acceptable 5. Category X: evidence of fetal risk and abnormalities NOTE: Regardless of the designated category or Presumed safety, no drug should be administered during pregnancy unless itis clearly needed, [DOSAGE CALCULATIONS. ‘Metric System © Based on decimal system (© Always written in Arabic numerals © Fractions of metric doses are written as decimal fractions. © Basic units of metric measurements: + Meter for length + Liter for volume + Gram for weight Apothecary System © Basic unit for weight is the grain (gr) and the basic unit of volume is mnim (m or rin) © Units in wt scruple, dram, ounce and pound (© Units in volume: fluid dram, fluid ounce, pint, ‘quart and gallon © Dosage quantities are written in lowercase Roman numerals and abbreviation is placed bofore the number, © By convention the Roman numerals are written with a bar over them after the unit of measurement. Household System © Common units include teaspoon (tsp). tablespoon (tbsp), cup and drop (att) Basic Formula: ° (O/S\'a + -D- Desired amount of drug + HIS- amount on hand (Stock) + @ Known quantity of drug mU hour = (amount of solution) / Hours to administer GTT/ min = (mL/min) * (drops/minute of IV set) mUmin = (ML/H) / 60 minutes mU/ hour = Amount of fluid / Hours to administer Drops/min = (mL/nour * drops/ml) / 60 minutes Drops/ min (GTT/ min) = (Amount of fluid x drops) / (mL/ Hours of administer * 60 minutes) ‘Administering Drugs Assessing Drug Effects Intervening to make the drug regimen more tolerable. Providing patient teaching about drugs and drug regimens. Monitoring the overall patient care plan to prevent ‘medication errors. SALVADORA, ARANCON REFERENCE NO: 2022-212-PHRMO1 |8 of 8