Review Guide in Pharmacology – Preliminary Exam

Unit 1 – Fundamental Concepts in Pharmacology

PHARMACOLOGY - is the study of drugs and its origin, chemical structure, preparation,
administration, action, metabolism and excretion.
PHARMACY – art of preparing, compounding, and dispensing drugs. It also refers to the place
where drugs are prepared and dispensed
PHARMACIST – a person licensed to prepare and dispense drugs to make up prescriptions.
PRESCRIPTIONS - written direction for the preparation and administration of drugs
PHARMACEUTIC – first phase of drug when taken via the oral route, solid drugs will be
converted to liquid form by gastric acids.
PHARMACOKINETICS - study of the time course of drug absorption, distribution, metabolism,
and excretion.
PHARMACODYNAMICS - study of a drug's molecular, biochemical, and physiologic effects or
actions

Importance of Pharmacology in Nursing

1. Understanding drugs and how can it affect patient
2. Identify and respond to drug interactions, reactions, and side effects
3. Know the application of pharmacology in nursing with regards to rights of administering
medication
HISTORY OF PHARMACOLOGY
1. Babylonians – clay tablets – earliest written prescription
2. Egyptians – Erb Papyrus
3. Chinese – Pen Tsao – 40 volume compendium of plant remedies
4. Indians – Ayuverdic medicine

DRUG NAMES
1.Generic or Nonproprietary Name - name approved by the Medical or Pharmaceutical
Associations in the original country of manufacture and is adopted by all countries.
e.g. Paracetamol
2. Brand name or trade name - name given by the manufacturer of the drug for selling in the
market.
e.g. Adol or Panadol or Biogesic
3. Chemical name - name that describes the atomic or chemical structure

DRUG CLASSIFICATION
CHEMICAL STRUCTURES: pertains to the molecular arrangement of atoms in a molecule and the
chemical bonds that holds the atom together
MECHANISM OF ACTION (MOA): refers to the specific biochemical interaction through which
a drug substance produces its pharmacological effect such as an enzyme or receptor
MODE OF ACTION (MoA): describes a functional or anatomical change, resulting from the
exposure of a living organism to a substance
DRUG ACTIONS
Excipients - substances that will allow drug to take on particular size and shape and to enhance
drug dissolution.
Therapeutic effect - also referred as the DESIRED EFFECT (primary effect intended)
Side effect - also referred as the SECONDARY EFFECT (unintended effect) – Hold the
medications and inform the doctor.
ADVERSE EFFECT (severe side effects) - Hold the medications and inform the doctor.
Drug Toxicity - Deleterious effects of a drug resulting from over dosage, ingestion of external
use drug, and accumulation on the blood stream
Drug Allergy - immunologic reaction to drug
Drug Tolerance - exists in person with unusually low physiologic response to a drug compared
to other individuals. A person was given a maximum dose of a drug but experienced low
physiologic response/effect.
Repeated administration of the same drug decreases the effectiveness of that drug –
(increasing the dose)
PRINCIPLES OF DRUG ADMINISTRATION
PRACTICE GUIDELINES
 If the RN is uncertain about the calculation, ask another nurse to double check
 What you prepare, you administer
 Correct Identification of patient – check ID band, ask the patient his name, compare in
the patients chart and ID band.
 Observe 10 rights in giving medication
 Right Medication – check at least 3 times
 Right dose – correct drug computation
 Right time -
 Right route-
 Right client - Asking patients name and compare it with ID band.
 Right client education - education about the medication and why it has been
prescribed, evaluation of the patient’s response, laboratory monitoring of
baseline values and possible side effects.
 Right documentation
 Right to refuse – nurse first action is to educate the patient on the importance of
medication.
 Right assessment
 Right evaluation

Principles of Drug Administration

Safe drug administration

1. Oral Medications – most convenient route for drug administration, do not give to
patient who are vomiting.
Avoid crushing – sustained action drugs, enteric coated, buccal or sublingual tablets
Give plenty of water to help swallow big enteric coated capsules or tablets.
Parenteral medications – produces a more rapid response than oral medications.
 2. Eye drops
Holding the tubes between the hands for several minutes before administering the medication

Discard the first centimeter of ointment when opening the tube for the first time.
Instructing the patient to close eyes for 1-2 minutes and roll the eyeball in all directions

Administering the medication under the lower lid of the eye.

3. Transdermal route – has the slowest onset of action
4. If client has been prescribed with a new medication, the nurse should include in the
health teachings
a. Desired effect of the medication
b. Dietary considerations
c. Storage of medication in the refrigerator
d. Written instructions on how to administer the medication

UNIT 2 – PHARMACOKINETICS
¡ PHARMACEUTIC – first phase of drug action for ORAL medications. Oral drugs will
undergo this process before absorption.
¡ PHARMACOKINETICS – how the body moves and process the drugs
¡ Drug Absorption – drug enters the bloodstream from its site of administration.
¡ Factors affecting drug absorption:
¡ Solid preparations are slower to absorb than liquid preparation, it needs to
be dissolved first into a liquid form
¡ Drugs are readily absorbed in acidic than in alkaline environment.
¡ Drug solubility to cross membranes: when the drug is in stomach acid, it
will pass through the stomach walls best if it is an acidic drug.
¡ Lipid soluble drugs are readily absorbed than Non-lipid soluble drugs –
biggest factor determining the concentration of a drug that penetrates the
brain.
¡ Elderly have less gastric acidity that might affect absorption (slower)
¡ Presence of food in the stomach do not always interfere with the
absorption of a drug, some drugs absorbed faster with the presence of
food, other drugs need to ingested in an empty stomach for faster
absorption.
¡ Drug instability in gastric acid - factor associated with drug absorption
that can result in incomplete absorption
¡ Drug Distribution – when drug is in the bloodstream
¡ Drug Metabolism – liver – inactivate drug
¡ First Pass Metabolism – for oral meds – may decrease drug
bioavailability.
¡ First Pass effect - The medication is extensively metabolized in the
patient's liver when it passes through the intestine via the portal vein.
¡ The medication is extensively metabolized in the patient's liver
when it passes through the intestine via the portal vein.
¡ Drug Excretion - kidney
 ¡ EXCIPIENTS - Allow drug to take on particular size and shape and to enhance drug
dissolution.
¡ DRUG HALF-LIFE is the time it takes for the amount of drug in the body to be reduced by
half. It will help determine the frequency of drugs or dosing.
¡ For example: Ibuprofen 500 mg half - life is 2 hours. So after 2 hours 250 mg will
be excreted out of the body.
¡ Depends on drug metabolism, concentration of drug in plasma and rate of drug
elimination
¡ Half-life determines the dosage interval.

UNIT 3 – PHARMACODYNAMICS
¡ It is the study of the effect of drugs on the body
¡ DRUG AFFINITY - how avidly a drug binds its receptor or how the chemical forces that
cause a substance to bind its receptor.
¡ DRUG EFFICACY - refers to the drug's ability to activate the receptor once it has bound
to it.
¡ MAXIMAL EFFICACY - the point at which increasing a drugs dosage no longer increases
the desired therapeutic response.
¡ MAXIMUM EFFECTIVE CONCENTRATION - The concentration of drug in plasma that above
these, toxic effects are precipitated.
¡ POTENCY – refers to the amount of drug needed to elicit a specific physiologic response
to a drug

¡ Both Drug A and Drug B achieve the same maximum effect, i.e. they have equal efficacy.
¡ However, drug A achieves this effect at a lower dose.
¡ Thus, Drug A has higher potency than Drug B.
¡ Drug A is more POTENT than Drug B

¡ Therapeutic Index - describes the relationship between the therapeutic dose of a drug
(ED50) and the toxic dose of a drug (TD50).

¡ The higher the therapeutic index – the drug is more safe to give.
¡ Drug with lower therapeutic window need to be monitored closely for adverse effects.
¡ TI = TD50/ED50
¡ Example: TD50 is 500 mg and ED50 is 250 mg = 500 / 250 = 2
 ¡ If a drug Therapeutic index is small, the drug is a narrow therapeutic index drug.
¡ If a drug Therapeutic Index is big, the drug is a wide therapeutic index drug.

¡ PARAMETERS OF DRUG ACTIONS

¡ ONSET - Time from drug administration to first observable effect
¡ Formula is T0 – T1
¡ PEAK - occurs when it reaches its highest concentration in the blood/plasma
concentration. We need to monitor our patient on the effectiveness of the drug
by this time.
¡ Formula is T0 – T2
¡ DURATION OF ACTION - is the length of time the drug exerts a therapeutic effect.
¡ Formula is T1 – T3
¡ Example: A drug is given at 8AM (T0) and give the minimum effect at 8:15 AM
(T1), at 9AM (T2) the highest effectiveness of the drug was felt. At 10 AM (T3)
the drug was no longer felt.
¡ Onset is 8am to 8:15 am = 15 minutes
¡ Peak is from 8am to 9am = 1 hour
¡ Duration of action is from 8:15 am to 10 am = 1 hour and 45 minutes
¡ DRUG RESPONSE
¡ Primary- always desirable/physiologic effects
¡ Loading dose - is an initial higher dose of a drug that may be given at the
beginning of a course of treatment.
¡ Maintenance dose - amount of a medication administered to maintain a
desired level of the medication in the blood. Lower amount than the
loading dose.
¡ Secondary- desirable or undesirable
¡ Example: Diphenhydramine (Benadryl)
¡ Primary effect: antihistamine; treat symptoms of allergy
¡ Secondary: dizziness, sleepy
¡ DRUG-DRUG INTERACTION – highest priority related to taking more than one
medication.
¡ Additive Effect-2 drugs with similar actions are taken for a doubled effect.
¡ Synergistic- drugs may increase each other’s effect to an amount that is greater
than the sum of their individual effects. It increases the effectiveness of the drug.
¡ Potentiation- a drug that has no effect enhances the effects of the second drug.
¡ Antagonistic- The combined effect of two drugs is less than the sum of their
individual effects. It decreases the effectiveness of the drug.
¡ IDIOSYNCRATIC REACTION - Abnormal reactivity to the drug caused by a genetic
difference between the patient and normal individual.
¡ DRUG TOXICITY - The degree to which a drug can be poisonous and thus harmful to the
human body. deleterious effects of drug over dosage or too much accumulation of drug
on the blood stream.
¡ IATROGENIC RESPONSES - Unintentional responses as a result of medical treatment
UNIT 4 : NURSING PROCESS
  Nursing Assessment – objective and subjective data
 Importance of obtaining a medical history from a patient before beginning
drug therapy to know the specific medical condition that can alter a drug’s
pharmacokinetics and pharmacodynamics, and to have a baseline of
information necessary to evaluate a drug’s effect.
 Nursing Diagnosis – it will determine the nursing intervention, Identify actual or
potential alteration in patient function.
 Nursing Planning - goals
 Nursing Intervention – nursing procedures, independent, dependent, and
collaborative. Health teachings, nursing procedures, monitoring for adverse
effects of the drugs.
 Nursing Evaluation – assessment if goals are met or not, revision of goals.
Assessment of the improvement from the previous condition
 Drug calculation Formula
Calculating Intravenous Fluid Rate:
𝑟𝑎𝑡𝑒 = 𝑎𝑚𝑜𝑢𝑛𝑡 𝑡𝑜 𝑏𝑒 𝑖𝑛𝑓𝑢𝑠𝑒𝑑 ℎ𝑜𝑢𝑟 𝑜𝑓 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 × 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟

Example: The doctor ordered to infused PNSS 1L to run for 16 hours (drop factor 15gtts/cc).

1000 ml x 15 gtts /cc divided by mins

15000 / 960 mins

15.625

15-16 gtts / min

Clark’s Rule: 𝑐ℎ𝑖𝑙𝑑𝑠 𝑑𝑜𝑠𝑒 = 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 × 𝑤𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑝𝑜𝑢𝑛𝑑𝑠 divided by 150

Weight is 7 kg , adult dose is 80 mg

7 kg = 15.4 pounds

80 mg x 15.4 pounds = 1232

1232 / 150 = 8.2 mg

Young’s Rule: 𝑐ℎ𝑖𝑙𝑑 𝑑𝑜𝑠𝑒 = 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 × 𝑎𝑔𝑒 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 divided by 𝑎𝑔𝑒 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 + 12

The average adult dose of Amoxicillin is 500 mg every 8 hrs. The child weighs 26 lbs. and is 18
months old.

500 mg x 1,5 years / 1.5 years = + 12

750 / 13.5 = 55.55

56 mg = child dose

Fried’s Rule: 𝑐ℎ𝑖𝑙𝑑 𝑑𝑜𝑠𝑒 = 𝑎𝑑𝑢𝑙𝑡 𝑑𝑜𝑠𝑒 × 𝑎𝑔𝑒 𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠 divided by 150

The doctor orders an adult dose of Ibuprofen 600 mg PO PRN. The child’s age is 24 months old.

600 mg x 24 / 150

96 mg