Ncma216 Prelim

Bachelor of Science in Nursing 2Y♙
NCM♙216: BSN 2ND YE♙R 1ST SEMESTER PRELIM 2021

Coverage for Prelim: animals.
 Basic Concepts of Pharmacology - Ex. Aloevera - to treat burns or skin diseases.
 Pharmacokinetics
 Pharmacodynamics
 Pediatric Drug Computation
 Nursing Process in Pharmacology
 Autonomic Nervous System
BASIC CONCEPTS OF PHARMACOLOGY

Discussed by Prof. Marivic Ilarde
Pharmacology
- Is the study of drugs and its origin, chemical structure,
preparation, administration, action, metabolism and excretion.
(aalamin ang tungkol sa drug, kung saan nangaling,
ingredients nung gamut, how they are prepared, paano
gagamitin, effect ng gamut sa tao, at paano sila e a absorb and
ilalabas kase hindi sila pwede mag stay dahil magiging toxic;
inc. level of chemical comp. in the body lead toxicity)
- The study of drugs that alter functions of living organisms.
Pharmacy
- Art of preparing, compounding (we mix medication for

personalized medication), and dispensing drugs. It also refers
to the place where drugs are prepared and dispensed.
(e.g, Mercury; sila din nag mi mix ng mga drugs-
compounding)
Pharmacist
- A person licensed to prepare and dispense drugs to make up

prescriptions.
- Nurses can also dispense drugs but not allowed to mix
medications
History of Pharmacology
- Begun when humans used plants to relive symptoms

- Dahil hindi pa uso ang medication dati mga tapal tapal pa mga
ginagamit noong sinauna)
1) Babylonians
- Earliest surviving “prescriptions” on clay tablets in 3000
B.C.
- (Herbs or mga dahon)
2) Chinese
- Recorded the Pen Tsao (great herbal) – a 40-volume
compendium of plant remedies dating to 2700 B.C.
- Herbal plants
- They are still using herbs until now to cure illness
3) Egyptians
- Archives of remedies on a document known as Eber’s
(Erb’s) Papyrus in 1500 B.C.
- Sa Erb’s Papyrus nakasulat ang mga iba’t ibang medicinal
plants, anatomy of the body and diseases of plants and
J.A.K.E 1 of 44
Acacia leaves – to treat internal bleeding.
4) Pharmacologia sen Manuductio and Materia Medicum
- First recorded reference to the word pharmacology.
5) Early 1800s
- Chemists isolates specific substances from complex
mixtures
- Pharmacologists then study their effects in animals
- Fredrich Serturner (first isolated morphine from opium,
injected himself and three other friends with huge doses
(100mg)
- Tiningnan nila kung yung morphine is makakatanggal
ng pain
- They study the effect of substances in animals
- John Jacob Abel
 Father of American Pharmacology
 (Foundation of the 1st pharmacology – department
in University of Michigan in 1890)
 Hopkin’s first professor of pharmacology
 The early focus of his work was on isolation and
characterizing the hormones of the endocrine
system, especially adrenaline and insulin
Drug Basic Concepts of Pharmacology

- Are chemicals that alter physiochemical processes in body cell.
- They can stimulate or inhibit normal cellular functions.
- Used interchangeably with medicines.
Drug Definition
- A substance recognized by an official pharmacopoeia or
formulary
- A substance intended for the use in the diagnosis, cure,
mitigation, treatment, or prevent diseases (vaccines or
healthy food).
- A substance or (other than food) intended to affect the
structure or any function of the body
Drug Classification
 Chemical Structure
- pertain to the molecular arrangement of atoms in a
molecule and the chemical bonds that holds the atom
together
 Mechanical of Action (MOA)
- refers to the specific biochemical interaction through
which a drug substance produces its pharmacological
effect such 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 Information
- also referred to a medication information or drug informatics
- range from discovery, use, and management of information
in the use of medication
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PHARMACOLOGY – BSN 2ND YEAR 1ST SEMESTER PRELIM 2021
- covers from drug identification, pharmacokinetics to dosage

Drug Action
and adverse effects.
1) Therapeutic Effect
Drug Names
- Also referred as the desired effect (primary effect
1) Generic or Nonproprietary Name intended)
- Name approved by the Medical or Pharmaceutical - Binibigyan ang anti-biotic to slow down growth of bact.
Associations in the original country of manufacture and is to kill the bacteria
adopted by all countries 2) Side Effect
- Ex. paracetamol - also referred as the secondary effect (unintended effect)
- (kung saan nanggagaling yung drugs or na manufactured - ex. Side effect of anti-biotic is diarrhea, nausea, and
yung drugs) vomiting.
2) Brand Name or Trade Name - adverse effect (severe side effect) kaya dpt i-reevaluate pt.
- Name given by the manufacturer of the drug (ex. adol or - not all pare pareho ang effect kaya need talagang e
panadol or biogesic pareho lang ang effects, same lang evaluate ang pt lagi para if may mga effects ma heads up
ang effect) agad ang Doctor
3) Chemical Name 3) Drug Toxicity
- Name that describes the atomic or chemical structure. - deleterious effects of a drug resulting from over dosage,
- Ingredients like N-acetyl-p-aminophenol ingestion of external use drug, and accumulation on the
Examples of Generic, chemical, and brand names: blood stream
Brand - pwedeng ma overdose ang pt kapag mali ang computation
Generic name Chemical name (halimbawa ang ibibigay sa baby is .5 kaso ang nabigay is
name
N-methyl-3phenyl- 5mL so nagkulang ng point you can overdose the pt)
Fluoxetine HCI Prozac - Nagkakaroon ng auto toxicity dahil kapag may mga sakit
propylamine
Acetaminophen 4-hydroxyacetanilide Tylenol kunwari sinisipon lang inom agad ng gamot, nagkaubo
2-p-isobutylphenyl-propionic lang inom agad gamot, masama pakiramdam umiinom
Ibuprofen Motrin agad ng gamut tapos lahat nung ininom mong gamut
acid
merong paracetamol so it will cause problem
- Signs of drug toxicity:
Generic Name - Hepatotoxic- liver damage; necrotoxic- kidney damage;
Route of high blood and etc.
Brand Name medication
- like in pregnant woman who have hypertension tapos
Dosage/ content
bingyan ng magnesium sulfate malalaman kung nag ka
Action
of vial drug toxicity sya kung bumaba bp, pulse, respiration at
absent na ung patellar reflex so dpt mabigyan siya ng
calcium gluconate sa bed side ng pt. usually nakalagay
lang sa chart is observe for drug toxicity.
4) Drug Allergy
- immunologic reaction to drug or hypersensitivity
- should have skin test for IV drugs
- should ask patient for allergy in oral drugs
- if the pt. have many food allergy then ask the doc.
5) Drug Tolerance
- exists in person with unusually low physiologic response
to a drug
- may mga taong mababa tolerance sa mga substances at
ung iba nmn dhil usual silang uminom ng pain reliever
tumataas pain tolerance nila
Drug Regulation & Mandates

Food and Drug Administration of the Philippines or FDA
- created under the Department of Health or DOH to license,
monitor, and regulate the flow of food, drugs, cosmetics,
medical devices, and household hazardous waste in the
Philippines
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- FDA’s main goal is to ensure the health and safety of the food
o Medication nurse- focus on pt. get direct care to pt.
and drugs made available to the public
- (sila ang nagbibigay ng lisensya sa mga drugs. Tinitingnan and give medications and check pt. chart to check
bago umuwi
nila kung may mga ibang substances pa sa drugs. Kapag
- When error is made, assess the patient first and report to
meron tine terminate nila yung drugs kase magkakaroon ng
MD immediately.
bad effect yun sa katawan ng tao)
(there is no room for error because it is cause life of
- Govt. doctors- write generic name not the brand name
patient so you should focus on what you are doing)
 Republic Act No.3720
 Correct Identification of the Patient:
- known as the Food Drug, and Cosmetic Act.
- ID band or ID bracelet (Kozier)
- An act to ensure the safety and purity of foods, drugs,
- Ask the patient’s name.
and cosmetics being made available to the public by
- Avoid: calling the client in Name because they may
creating the food and drug administration which shall
answer “Yes” to the wrong Name.
administer and enforce the laws.
 Observe the Ten Rights:
 Republic Act No. 8203
1) Right medication
- Otherwise known as the special law on counterfeit
- Means that the client receives the drug that was
drugs.
prescribed
- “Unregistered and imported drug product” as
- Medication orders may be prescribed by:
distinguished from counterfeit drug defined under
o Physician
Section 3 of RA…shall refer to unregistered
o Dentist
counterpart brand in the Philippines
o Podiatrist- treat infection in foot and lowerlimb
- (Ito yung nagche check if totoo or peke yung product)
o License health care provider such as advance
practice registered nurse
- Consumer Act of the Philippines
o With authority from the state to order medication
- Protects the interest of the consumer, promotes
- Components of Medication Prescription:
general welfare and to establish standards of conduct
o Component of drug order
for business and industry
o Date and time the order is written
- Protection against deceptive, unfair, and
o Drug name: BN and GN
unconscionable sales acts and practices.
o Drug dosage: 500mg
o Route of administration
- Comprehensive Dangerous Drugs Act of 2002 the
o Frequency and duration of administration
Philippine Drug Enforcement Agency (PDEA)
o Any special instructions for withholding or
- Created for the efficient and effective law
adjusting dosage based on nursing assessment,
enforcement of all the provisions on dangerous drugs
drug effectiveness, or laboratory result
and or precursor and essential chemicals as provided
o Physician or other health care provider signature
in R.A or name if TO or VO
- Two of the most used and valuable illegal drugs in o Signature of license practitioner taking TO or
the country are “methamphetamine hydrochloride VO
known as shabu and marijuana” - Categories of Drug Order:
Principle of Drug Administration o Standing- maintenance medications or taken for
several days like anti biotics. Give cephalexin
 Are substances administered for the diagnosis, cure, treatment, 5mg 1 cup 3x a day for 7 days
or relief of symptom or prevention of disease. o One time- diphenhydramine 50mg IV prior to
 Practice Guidelines: blood transfusion.
- RNs are responsible for own actions, illegible order o PRN / when necessary- some doc. Don’t indicate
should be questioned or clarified. prn. Paracetamol 500mg 1 tab every 4 hours for
- RNs should be knowledgeable about the medication. temp. 38.5 and above. So ang basehan dito ay
- If the RN is uncertain about the calculation, ask another temp. kase walang prn. Ibibigay kada 4hrs
nurse to double check. tuwing may lagnat na ang temp ay 38.5 pataas.
- What you prepare, you administer. 8am-12pm walang lagnat wag ibigay, 2pm may
- Do not leave medications at bedside. lagnat ibigay ang gamot.
- If the client vomits, report to charge nurse, MD, or both. o STAT/immediately/now- demerols IM stat, so
o Charge nurse- does the charting and carry out doc. ibigay na agad kahit may ginagawa ka pa iwan
Order mo ginagawa mo balikan mo na lang
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2) Right dose
- Right dosage of the medicine that will be given to the
client
3) Right route
- Is necessary for adequate or appropriate absorption
- Common routes are the following:
o Oral
o Sublingual
o Buccal
o Inhalation
o Topical
o Inhalation
o Instillation- ex. eyedrops
o Suppository, etc. 8) Right to refuse
4) Right time - Client can and do refuse to take medication
- the time at which the prescribed dose should be - It is the nurses’ responsibilities to determine when
administer. possible, the reason for refusal and to take reasonable
- Daily drug dosages are given at specified time during measure to facilitate the client taking the medication
a day such as: - Should have waiver signed by the pt.
o Twice a day b.i.d 9) Right assessment
o Three time a day t.i.d - Requires the appropriate data be collected before
o Four times a day q.i.d. administration of drugs.
o Every 6hrs q6h 10) Right evaluation
o HS: hour of sleep - Requires that the effectiveness of the medication be
5) Right client determined by the client response to medication
- Can be measured by checking the client identification - (you must observe the first 5 rights)
bracelet by having and by having the client state her
or his name.
- Tanungin ang name but do not call the name of the
client let the client speak her/his name
- Some client answers to any name or unable to
respond, so client identification should verify each
time of medication administered.
- In the event of missing identification bracelet, the
nurse must verify the client identity before any drug
Date prescription was
administration. Prescriber’s Info.
written
6) Right client education
Patient’s Info. Inscription:
- Requires that the client received accurate and Medication Prescribed
thorough information about the medication an d how Superscription:
it relates to his or her situation “Recipe”
Quantity of
- Client teaching also includes therapeutic purpose, Medication
Sigma: Directions
possible side effect of the drugs, any dietary for Patient
restriction or requirements skills administration, and Instruction to the
pharmacy
laboratory monitoring Physician’s License
7) Right documentation and PTR Number Physician’s signature
- Requires that the nurses immediately record the
appropriate information about drug administered - Rx- from latin word recipe means to take. Called
include the ff: superscription
 Name of the drug - Inscription- medication prescribe
 Dose - Sigma- direction for pt. on how to take the medication
 Route - PTR-yearly kumukuha sa munisipyo
 Time and date - S2 no.- used for prescribing drugs that cause addiction like
 Nurse initial or signature Demerol
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Oral Medications
Parenteral Medications
- Most common route Intradermal
- Contradictions: Site Angle Gauge Length Max cc
- Inner lower Almost 25, 26, 27 3/8”, 5/8”, ½” 0.1 to 0.2
 Client is vomiting
arm parallel to mL
 Client with intestinal or gastric suction - Upper the skin
 Unconscious client chest 10-15 O
 Inability to swallow - Anterior
- Unsafe actions chest
 Do not crush enteric coated or gel coated tablets (to - Upper back
beneath the
prevent form gastric juice)
scapula
 Do not crush long-acting tablets (slowly inaabsorb
- Perfect wheel should have right angle and hawak sa syringe, if
gamot)
no wheel means malalim ang pag inject
 Do not try to open sealed capsules (wag itry buksan if
mahigpit)
 Do not crush contents of spansule with beads or
pellets
 Do not give sublingual formulations orally
 Do not crush sublingual formulations
 Do not give oral medications sublingually
- Safe actions
 Scored tablets may be split (no scoring wag hatiin) Subcutaneous
 Chewable medications can be crushed safely Site Angle Gauge Length Max cc
- Outer aspect 45-degrees 25, 26, 27 3/8”, 5/8”, 1-3 mL
 If a capsule opens easily, powder from the capsules can be
of the upper (1 inch of ½”
mixed with food or liquid arms tissue can
 Liquid filled capsule contents can be (a) squeezed out, or - Anterior be grasped)
(b) aspirated then mixed with food or liquid thighs
 A sublingual formulation can still be given ever if client is - Abdomen 90-degrees
NPO - Upper back (2 inches of
 Beads from readily opened capsules can be sprinkled over - Ventroglutea tissue can
l be grasped)
soft food, but should not be chewed.
- Dorsogluteal
- Tablets or Capsule:
 Difficulty in swallowing
 Crush and mix with small amount of water
- Avoid Crushing:
 Sustained-action
 Enteric coated
 Buccal and sublingual tablets
- Liquid Medication:
 Mix before pouring
 Place medication cup on flat
surface at eye level
 Fill the cup with the desired level
using the bottom of the meniscus
Intramuscular
 Site:
- Ventrogluteal
 1y/o and adult
 No large nerve or
blood vessels
 Sealed off by bone
 Contains less fat
than buttock
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- Vastus lateralis
 Site of choice for 1 y/o - Hairless
and younger - (+) hair (CLIP, do not shave)
 Infants with poorly - Not subject to excessive movements or wrinkling
developed gluteal  Avoid:
muscles - cuts, burns, abrasions, distal extremity
- Dorsogluteal 2) Ophthalmic medications
 For adults and children  Preparation:
with well-developed - Clean the eyelid and lashes
gluteal muscles from inner to outer canthus
 Contradicted: For  Instruction before administration:
adults and children - Look up
with well-developed  Where and how much to apply:
gluteal muscles - Liquid: instill correct number
 Increased risk of of drops
striking the sciatic nerve - Outer third of the lower
- Deltoid - Ointment: discard the first
 Small muscle, very bead
close to the radial - Squeeze 2cm on the lower conjunctival sac
nerve and artery  Instruction after installation:
 Rapid absorption - Do punctual occlusion for 30 seconds
for adults - Close but not squeeze the eyelid
 Cannot administer 3) Otic medications
more than 1 mL  Preparations:
 Recommended site for Hepa B vaccine - Clean the pinna and the
administration meatus of the ear canal
- Rectus femoris - Warm the medication: In
 Can be used for self- between hands
administration - Place in warm water
 Disadvantage: causes  Straighten the auditory canal:
discomfort - Adult (>3 years old): Pull the pinna upward and
 Angle: backward
 90-degrees - Child (<3 years old): pull the pinna downward and
 Gauge: backward
 24,23,22,21,20  Instill the medication:
 Length: - Along the side of the canal
 1”, 1 1/2”, 2”  Actions after:
 Max cc: - Gently press the tragus
 2-5 mL - Insert small piece of cotton fluff loosely
Intravenous/ Intravascular  Instruction after:
 Gauge: 24,23,22,21,20
 Length: 1”, 1 1/2”, 2”
 Max cc:
- Push: 10 mL
- Infusion: 4L in 24 hours
ID/ SC IM/ IV
Gauge 25 24
length <1 inch 1 inch and 
Topical Medication
1) Transdermal patch
 Site:
- Trunk or lower abdomen
J.A.K.E 7 of 44
nangyayari to sa small intestines.
PHARMACOKINETICS
Discussed by Prof. Carmencita Pacis
- Effect of the body to the drug. So, once we ingested a
medication, what your body will do to the medication.
- You need to understand pharmacokinetics and
pharmacodynamics for you to understand the mechanism of a
medication because each medication will have its own kinetics
and dynamics.
Process of Medicine
1. Pharmaceutic phase/ dissolution

- Solid form (tablet or capsule)
- Dissolves to liquid form
- Hindi sa lahat ng gamot. This will occur only if the
medication is taken by oral route and its solid form.
Kailangan matunaw at maging liquid bago sya mag enter
sa pharmacokinetic phase.
- This is the outside pharmacokinetics phase.
- Only will be needed as the first phase drug action for
those medications that is solid form and given by oral
route.
2. Pharmacokinetic phase
- Kinetics and dynamics ay sabay. (may epekto ung
katawan sa gamot, may epekto yung gamot sa katawan)
 Absorption – first pass effect
 Distribution – protein binding
 Metabolism – onset, peak duration
 Excretion – half-life
3. Pharmacodynamics phase
- Kinetics and dynamics ay sabay. (may epekto ung
katawan sa gamot, may epekto yung gamot sa katawan)
 Receptors: agonist and antagonist
2 Phases of Pharmaceutic Phase
1. Disintegration
- breakdown into smaller parts
- Pag tinake sa bibig, hindi agad mageenter sa absorption,
nangyayari ang absorption kapag naconvert na yung solid
form ung gamot into liquid. Kailangan mag break down
into a smaller parts ang capsule or tablets.
2. Dissolution
- Further breakdown into smaller parts in GIT – absorption;
dissolve into liquid.
- Gastric acids will be the one to dissolved the solid
particles.
- Kapag naging liquid na sya, mageenter na sya sa kinetics,
J.A.K.E 8 of 44
Pharmaceutic Phase (Dissolution)
- The 1st t phase of drug action.
- In the GI tract, drugs need to be in solution so they can
be absorbed.
- Disintegrate into small particles to dissolve into a liquid.
- Rate of dissolution is the time it takes the drug to
disintegrate and dissolves to become available for the body
to absorb it.
- Kapag ung gamot ay hindi natunaw, baka yung gamot na
yon ay hindi design to dissolve in acidic environment. May
mga gamot tayo na kailangan ma dissolve sila into a
alkaline environment.
- Kapag hindi na dissolve yung gamot, hindi maabsorp.
- Rate of dissolution – pwedeng mabagal or mabilis.
(kung mabilis, baka mataas yung acidity sa stomach nila)
- Most of the drugs are weak acids. They are designed to
dissolve in a acidic environment.
- Kapag mabagal ang rate of dissolution, mababa din ang
magiging rate of absorption. (domino effect)
Excipients
- Tablets are not 100% drug.
- Fillers and inert substances – excipients.
- Allow drug to take on particular size and shape and to
enhance drug dissolution.
- Additives na binibigay sa gamot para magkaroon sya ng
shape, kulay, lasa, at container.
- Capsule – makintab, pag hinawak mo ng basa ang kamay
mo, didikit sya sa balat mo kasi gelatin coating. Itong
gelatin coating na to, hindi gamot, yan ung excipients. Pag
tinake ng pasyente yung capsule, at nakarating sa stomach,
yung acidity ng stomach tutunawin nya si gelatin. Tapos
after non, tutunawin naman yung gamot sa loob.
- Example: 500mg amoxicillin – yung hawak mong tablet,
hindi yan ung buong 500mg ng amoxicillin na nasa loob pa
siya. Yung nasa labas nya na may lasang orange or matamis,
excipients ang tawag dyan.
- May mga gamot na light sensitive, yung capsule or

container nila hindi mape-penetrate ng ilaw. Kaya yung
excipients pinoprotektahan din yung gamot na nasa loob.
Para hindi masira agad.
- Essential ingredients to ensure that a pharmaceutical drug is
biologically active.
- Important uses of drug excipients:
 Aid in the processing of the drug delivery system
during its manufacture.
 Protect, support or enhance stability, bioavailability,
or patient acceptability.
 Assist in product identification and enhance any
attribute of the overall safety.
 Assist in the effectiveness and/or delivery of the drug in
us.
J.A.K.E 9 of 44
Factors affecting rate of dissolution

Form of drug (liquid vs. solid) Four Process
- Liquids more absorbed than solid, already in solution, rapidly 1. Absorption
available for GI absorption. - Small intestine (oral route) – intramuscular (muscle) –
Gastric pH (acidic vs. alkaline) subcutaneous (fats) – intradermal (dermis). Kung saan mo
- acidic media faster disintegration and absorption. siya inadminister, doon ang organ of absorption.
- Normal gastric pH – 1.5-3.5. - Rate of absorption will be affected kung nagkaroon
- 0-7 The lesser the number, the more acidic. From 8-14 that is problem doon sa organ kung saan mo sya inadminister.
basic/ alkaline. 2. Distribution
Age - Main organ: Blood vessels – siya ang nagdidistribute.
- young & elderly – Increase pH decrease absorption. After mabsorp, sasama na ang drug molecules sa blood
- Yung mga younger patient and very old patient, mabagal ang plasma. And this blood plasma will circulate all
kanilang metabolism. throughout the body hanggang makarating sya sa target
- With this, tumataas ang kanilang Gastric pH. Gastric pH is organ, kung saan sya kailangan.
inclined more in alkaline side. Pag nasa alkaline side yung - Mabagal ung circulation – the rate of distribution will be
gastric pH, the longer it will take for your solid medication to also affected.
dissolve. Ang solution neto ay bigyan ng liquid medication. 3. Metabolism (Biotransformation)
Enteric coated drugs - Main organ: Liver – because this is the one who release
- Resist disintegration in gastric acid liver enzymes (Cytochrome P450), na nagcoconvert ng
- Disintegration occurs only in alkaline environment (intestine) gamot into metabolites.
- Should not be crushed. - Lahat ng gamot, once na madistribute at umabot sa target
- Enteric coat sila kasi yung gamot sa loob ay gastric irritant. organ, active sya. Bawat isang gamot, may tintawag tayo
Halimbawa, natanggal yung coating, pagdating sa stomach – “Life” kumbaga hanggang ilan oras dapat magiging active
tinunaw ng acid yung coating nya – pag lumabas yung gamot ung gamot na to sa katawan. So, yung liver enzymes or
sa stomach, eh gastric irritant sya, magkakaroon ng Cytochrome P450 will now convert this active drug to
abdominal pain yung pasyente. inactive drug. Yan ang tinatwag na biotransformation.
- So may enteric coat sya para hindi matunaw sa acidic - Bioavailability – kapag hindi sila natranform into inactive
environment, pagdating nya sa small intestine or alkaline form. Available pa sila for use.
environment, doon palang sya matutunaw. Kaya lang, - Pag hindi naconvert yan into inactive form at magbibigay
expected mo na longer ang time. Kaya hindi sya pwede nanaman tayo ng another dosage of drug, overdose yon.
durugin kasi sasakit tyan ng pasyente. Dito magstastart yung toxicity.
Presences of food 4. Excretion (Elimination)
- Interfere with dissolution and absorption, enhance absorption - Once maconvert into inactive form yung medication, doon
of other drugs, and may be protectants of gastric mucosa. plng magkakaroon ng process ng excretion.
- Kapag hindi sya naka enteric coat at ang gamot ay gastric - Main organ: kidney – will be the one who decide whether
irritant din, dapat tinetake to kasabay ng pagkain. Para irereabsorp nya or iexcrete nya ung drug molecule. Pag
maprevent yung abdominal pain. hindi naexcrete yan, mooverdose din.
Pharmacokinetics
- Process of drug movement throughout the body that is

necessary to achieve drug action.
- Pag naabsorp kasabay na si dynamics. Pag hindi na-absorp,
walang dynamics. Kailangan maabsorp yung gamot para
magkaroon ng effect or mechanism of action.
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J.A.K.E 11 of 44
Will my drug get to where it needs to work?  Degree of ionization

- Kung may absorption plng may problema ka na, expected
yung distribution mabagal at magkakaroon ng problem.
- Kaya dapat absorption plng maayos. Kasi domino effect
to.
Drug Absorption
- Movement of the drug into the bloodstream after

administration.
- 80% of drugs are taken by mouth – enteral.
- Movement of drug molecules from site of administration to
circulatory system.
- Kailangan matunaw at absorp muna ng small intestine bago
sya makapasok sa blood plasma.
Factors controlling the rate and reliability of drug absorption

1. Physiological
 Blood flow to absorbing site.
- Fast or slow
- Pag mabagal ung delivery ng blood sa small intestine
mo, ang rate of absorption ng small intestine would
also be slow.
- Fats (insulin) – nainject mo yung matigas na fat kasi
doon ka lagi nagiinject, nursing responsibility
pagdating sa insulin, will be to rotate the site, hindi
pwede yung isang lugar ka lng lagi nagiinject. Kasi
ang effect nito ay Lipodystrophy or ung pagtigas ng
taba. Kaya yung rate ng absorption sa fats ay
magiging slow.
 Total surface area for absorption.
- Kapag mas malawak yung area kung saan mo sya
gusto mo absorp, mabagal din sya maabsorp.
- Mas maraming area ang dapat mong distributan para
maabsorp sya.
 Time of arrival and contact time at absorption site
- Yung oral route, tatravel pa yan, tutunawin pa sya
bago maabsorp.
- Pero pag IV, deretso sa blood plasma. (fastest route)
2. Physic-chemical
 Solubility
- Capacity ng gamot na matunaw.
- Most of the drug are lipid soluble – they need acidic
environment. Mas madali to madissolve kaysa sa
water soluble. Mostly they are ionize, they could
easily penetrate a semipermeable membrane kahit
passive transport lang yan.
- Water soluble – they will be dissolving on the fluid
part of the blood. Commonly they are ionize – hindi
sila madaling maabsorb, they will require energy.
 Chemical stability
 Lipid to water partition coefficient
J.A.K.E 12 of 44
 Pag hindi sya nakarating sa site of action –
Movement of drugs particles from GIT to body fluids involve 3 metabolism na, iinactivate yung drug.
processes
1. Passive transport
a) Diffusion
- Drugs move across the cell membrane from an area
of higher concentration to one of lower
concentration.
- If galing ka sa area na mataas ang concentration at
pupunta ka sa mababang concentration, hindi mo
kailangan ng energy kasi mataas naman ang
concentration mo at pupunta ka sa may mababang
concentration.
- You could enter to the low concentration because
you are high concentration (HAHAHA sana
magets nyu)
- Most of the drugs will be using this passive
transport, lalo na yung lipid soluble.
b) Facilitated diffusion
- Passive transport – requires a carrier such as
enzyme or protein to move the drug against a
concentration gradient. This does not require
energy.
- Kailangan ng carrier for them to be able to
penetrate a semipermeable membrane.
2. Pinocytosis
- The process by which cells carry a drug across their
membrane by engulfing the drug particles in a vesicle.
- Commonly sa vaccine.
- Naka store sa katawan. Nakaikot lang to sa circulatory
system. Once the body detected the need for this
medication, that is the time they will be burst or mag
oopen up para magbigay ng effect.
3. Active transport
- Requires energy to facilitate the transport of drug
molecules against a concentration gradient, which
usually occurs at specific sites in the small intestine.
- You need to have a carrier or protein para magkaroon
sila ng energy na makapag penetrate doon sa area of
high concentration.
- Low concentration going to high concentration.
- Ionized medication or water soluble requires a active
transport.
Drug distribution
- Process by which drug becomes available to body fluids and
tissues.
- The movement of the drug from the circulation to body tissues.
- The blood will distribute this drug molecules to the
target organ where this drug will give effect or action.
 Protein binding
 As drugs are distributed in the plasma --- bind
with plasma protein.
 albumin, lipoproteins, alpha-1-acid glycoprotein.
 Yung drug molecules natin ay dapat mag bind sa
protein. Once na magbind sila, ang tawag sakanila
ay “Bound drug”.
 Once u are bounded, you can go to the target side.
 Pero pag hindi sila bounded, free sila. Kapag free
ung gamot, pakalat kalat lang yan sa circulation.
 Kapag na bind yung drug at protein, si protein ang
magbibigay ng signal saknya kung saan ang organ
na kailangang aksyonan.
J.A.K.E 13 of 44
- Bakit kailangan isang gamot may specific na mg? kasi ito ang
requirement natin para ma-maintain natin ung therapeutic state
of the drug.
- Example:
 Ibuprofen has a half-life of about 2 hours.
 If the patient takes 200 mg (8am), in 2 hours, 50% of
the drug will be gone, leaving 100 mg. (10am)
 After 2 hours - 50 mg. (12pm) hindi na to effective kasi
less than the half na sya. Dapat magbigay ka ng another
dose.
 After 2 hours – 25 mg.
 After 2 hours – 12.5 mg.
 After 2 hours – 6.25 mg.
 Drug tolerance – could happen to anyone, may mga
wala kang receptor sa gamot na yon, ibigsabihin
pagnagtake ka ng gamot nito kung wala kang
receptor na nakukuha sa gamot na yon, walang
 Factors affecting drug distribution magiging effect ung gamot, kaya wala kang
- Size of the organ (pag Malaki yung organ, mas mabagal makikita na change sa body mo. The doctor will
ang distribution kasi marami kang ididistributan) change the medication.
- Blood flow
- Solubility
 Drug metabolism
- Biotransformation is the process by which the body
chemically changes drugs into a form that can be excreted.
- Kapag active ang gamot, nasa system mo lang yan. Hindi
pa sya lalabas
 First-pass effect or first-pass metabolism
- GI tract --- intestinal lumen -- liver--- some drugs are
metabolized to an inactive form and excreted---reduced
amount of active drug.
- Oral route – pagkatapos ng absorption, pwede syang
dumeretso sa fast pass effect pero pag other route,
pupunta muna sya sa distribution bago sya magenter ng
metabolism.
- Oral route - Pagabsorp ni small instetine, dadaan muna
sya sa portal vein (sa liver yon, yung may cytochrome
P450) itong enzyme na to ay mag iinactive ng
medicication na to.
- Wala tayong specific amount kung ilan nababawas ang
active drug, kasi depende yan sa dami ng cytochrome
P450, depende rin sa sensitivity ng gamot na tinatake mo
to the liver enzyme. (oral route) pinaka mababa na yung - It can be achieved when the amount of drug being
10-30% yung mababawas sa gamot. administered is the same as the amount of drug being
- Pag bababa yung cytochrome P450, ang effect nito will be eliminated.
decrease drug metabolism rate. At pwede ito mag - A steady state of drug concentration is necessary to achieve
overdose or toxicity. optimal therapeutic benefits. (para mamaintain ito, dapat hindi
- Liver enzymes – cytochrome P450 system – convert drugs bababa sa half ung drug. Halimbawa 200mg na Ibuprofen,
to metabolites. after 2 hrs – may 100mg pa sya. At ito ay effective pa. so
- Decreased drug metabolism rate will result to excess drug dapat hindi bababa dyan sa 100mg, para ma-maintain itong
accumulation that can lead to toxicity. steady state of drug concentration)
Drug half-life - Example: kailangan na natin ibigay, tingnan nyo muna yung
- the time it takes for the amount of drug in the body to be half life para maiwasan ung toxicity. Dapat lumagpas ka na
reduced by half. ulit sa half ng dosage.
- Kailan nagiging kalahati ang amount ng drug or strength ng - Half-life/ Elimination half-life (t ½)- time it takes for one half
drug sa isang katawan ng pasyente. of drug concentration to be eliminated.
- Bawat gamot may kanya kanyang drug half-life. - Short t1/2= 4-8hrs: given several times a day (Penicillin G)
- Pag mas mahaba ang half-life ng gamot, pwedeng once a day - Long t ½ = >12 hours: given 2x or 1x/day (Digoxin)
lang sya inumin.
J.A.K.E 14 of 44
Factors affecting biotransformation
 Genetic – some people metabolize drugs rapidly, others more

slowly. (kapag may liver problem ka, your metabolism will be
slower) kapag matanda na, mabagal na ang metabolism nila,
pati blood flow mabagal. Kaya yung liver need ng oxygen to
function normally. Kaya kapag yung liver nakareceive ng less
oxygen because of the slower blood flow, yung release ng
cytochrome P450 would also be less. Kaya yung magiging
effect nito is konti lang ang dosage na gamot na nagiging
inactive. The result, mas maraming active na gamot naiiwan sa
katawan mo at baka ma-overdose.
 Physiologic
o Liver disease
o Infants- decreased rate of metabolism
o Elderlies- decreased liver size, blood flow, enzyme
production- slows metabolism
 Environment – cigarette smoking may affect rate of some
drugs.
 Stressful environment – prolonged illness, surgery, illness. PHARMACODYNAMICS
Drug excretion - Study of the effect of drugs on the body.
- Kinetics and dynamics should start at the
- Removal of the drug from the body. Drug is changed into same time
inactive form and excreted by the body. - Drugs act within the body to mimic the
- Yung mga free or unbound na drug molecules – nakakalat lng actions of the body’s own chemical
sila sa blood vessels or circulation. messengers. (Hormones released by the
- Water soluble drug – sila yung hindi madali makapenetrate ng cells and each individual 50 types of
semipermeable membrane. Kasi mga ionized sila. So need nila hormones with this, each hormone
ng passive transport, para makapenetrate or maitansport released by specific organs)
papunta sa site of action. - What will the drug do to the body?
- Pag may sakit sa kidney, dapat ung dosage ng gamot ay - Side effect, mechanism of action – what specific receptor will
decreased. Kapag sobrang taas ng concentration ng gamot na need to bind with the drug molecule para magkaroon ng effect
dapat ifilter ni kidney, masisira si kidney, masisira yung or reaction yung gamot.
kanyang filtration rate. - Mode of action in drug – ano yung intended effect sa katawan.
- Routes: - Purpose of hormones is to create a response. And if that gland
 Kidney – main organ for drug elimination: leave the body will have abnormality in the production of that hormone
through urine. whether over or under it will create a certain medical condition.
 Free or/unbound/water soluble drugs filtered in the kidney
(filtered – pwede ireabsorb para magamit ulit if hindi pa
nila napupunta ang site of action. Or active pa sila para
pag nireabsorb ulit to baka magiging bounded na sya)
 (+) kidney disease- dose must be decreased.
 Kidneys – main route of drug excretion.
 Bile, lungs, saliva, sweat and breast milk.
 Urine pH influences drug excretion.
 Normal urine pH 4.6-8 (dapat pataasin mo acidity ng
urine mo to prevent overdosage) (kapag alkaline ang urine
mo, it will promote elimination of weak acid drugs, kapag
acidic urine, mas nalelelss ung chance na lumabas sila)
 Acidic urine promotes elimination of weak base drugs.
 Alkaline urine promotes elimination of weak acid drugs.
Regulatory Proteins
- They are controlling the number of active drugs that be
circulating our body.
- Maintaining
J.A.K.E 15 of 44
- Each drugs molecules before it will be able to reach the target

site they need to bind/regulated w/ proteins. Example: Cimetidine (Receptor)
- Regulate amount of active substance/drugs that is circulating - Drug class: H2 receptor blockers – Indirect acting dahil ang
in the body. binoblock nya ay receptor.
1) Enzyme - Kahit maraming kang h2 na maproduce sa body mo, kapag
- Proteins that act as biological catalysts (biocatalysts). nagtake ka ng cimetidine, the cimetidine will mimic the
Catalysts accelerate chemical reactions chemical component of h2. So, when the body absorps the
- Biocatalysts – it will accelerate the chemical reaction of cimetidine, the h2 receptor will think that cimetidine is h2. So,
the drug particle. (pinapabilis nya yung reaction) the h2 receptor will bind with cimetidine (na akala nyang h2),
- Inhibitor – pineprevent nila yung pagdami at pagsobra. tapos ang effect ng gamot na ito ay blocker, kaya kahit mag
- Once the drug molecule will bind with enzyme, the bind sila, it will not produce any reaction. Kaya ang nangyari,
enzyme will metabolize the active medication. nababawasan yung amount h2 na dapat mapunta sa stomach.
2) Receptors Kasi dapat ang binabind ni h2 receptor ay h2, kaso kay
- Chemical structures, composed of protein, that receive cimetidine sya nag babind kaya nasabing nababawasan yung
and transduce signals that may be integrated into h2 na pumupunta sa stomach or sa target site. Kaya ang
biological systems. magiging effect nito ay mababang gastric acidity. (dahil
- The one bringing this drug molecules to the target site. nababawasan yung h2)
- Kaya kung kulang lang yung receptors, konti lang ung - Once a receptor binds with the drug molecule, hindi na sya
drug molecules na mapupunta sa target site; kung pwede maghiwalay or mag bind uli ng ibang molecule/
sobrang dami nmn ng receptor mas maraming amount receptor. Lock and key theory (dapat loyal ka lang sakanya!
ng ating drug molecules ang makakarating sa target site Ganern HAHA)
Kailangan ng drug molecules ang receptor bago sya  Kapag inhibitory ang class ng isang gamot/ blocker, dalawang
mapunta sa target organ/ site. classification pa yan. Direct or indirect
3) Ion Channels  Direct acting – blocking the target organ producing the
- Provide receptors which drugs can interact with: hormone that already in excess.
- Parang pintuan o 2 types of histamine: histamine 1 and histamine 2
- Enzyme & receptors – they act mostly in lipids soluble o Histamine 2 – target site is the stomach.
(unionize) needing passive transport o Kapag si histamin 2 kinuha ng histamine 2 receptors will
- They act mostly in water soluble. (ionize medications) bring to the stomach. With this, it can maintain the normal
requiring active transport gastric acidity.
o Channel Blockers - whereby the drug blocks permeation o Pag nasobrahan ung histamine 2 sa stomach, the drug now
of the channel. (isasara yung pinto, so hindi makakapasok will act to prevent the secretory cell from producing more
si active drug) histamine 2 – direct acting
o Channel Modulators - whereby the drug binds to a o They act directly on the organ producing or secreting the
receptor site within the ion channel and modulates hormones.
permeation. (bubuksan yung pinto)  Indirect acting
o The histamine 2 will become histamine 2 blocker.
o Ang pineprevent ng gamot ay pag dami ng receptor.
o Kung konti lang kukuha sa histamine 2, edi konti lang din
mapupunta sa target organ,
o They act mostly in the receptors
Example: Iron Channels
- For active transport. They will act as modulator or blocker.
- The purpose of our medication is a blocker, the effect of this
medication will close the iron channel. So, it will prevent
another component to enter the cell which is already in excess.
- Modulator: the effect of this medication on the iron channel
will be open, so that other molecules that are lacking inside the
cell could enter.
Dose-Response Relationship
Drig Affinity
- how avidly a drug binds its receptor or how the chemical
forces that cause a substance to bind its receptor.
- drug's desire to connect to an open receptor
- Enzyme will act as an inhibitor where in once active drug will - It refers to how much attraction there is between a drug and a
bind with the enzyme nagiging metabolites sila so magiging receptor, like a magnet to metal
inactive sila nababawasan sila - Low affinity – you need to have higher amount, for them to be
- Receptors will be the one to carry the active particle of the able to bind with an open receptor. Hindi kasi gaano kalakas
drug to the target site, ung mga hindi na metabolites ni enzyme yung hatak nila kaya need pa nila ng higher amount para
ito ung kukunin ni receptor para makarating sa target site. mahatak nila yon. (Like mahina ka or konti lng kayo, need mo
- Gamot natin can be inhibitor or stimulator ng help para matulungan ka)
J.A.K.E 16 of 44
- High affinity – only a small amount of the drug on the body

could easily bind with a receptor. (kahit mag-isa ka lng or Example: Pain Reliever both Drug A and B
konti lang kayo, kayang kaya nyo na) - If you will give drug b, sa minimum concentration (EC50) nya
- Rule: kapag open ang isang receptor, pwede ka magbind. Pero which is 50 mg. katapat ni EC50 yung 50mg ni drug b. Kaya
kung Nakita mong may kabind na sya, hindi ka na pwede mag si drug b, kapag binigay natin 50mg, maachieve nya yung
bind doon. (Kaya kung Nakita mo may iba na syang mahal, minimum concentration na makakapagbigay ng pain relief.
wag mo na pilitin sarili mo saknya! Hindi ka na pwede! Kasi - If you will give drug a, the minimum concentration is 75mg.
taken na sya! Ouch bhi3) Kaya si Drug A, kapag nagbigay sya ng 75mg, maaachieve na
- Agonist – fit sila – effect of this is drug action nya yung minimum concentration (EC50), at makakapagbigay
- Antagonist – not fit – no drug action – nagbind sila pero hindi sya ng pain relief.
sila fit kaya hindi mapupunta sa target organ. - Ang maximum concentration (Emax) ng drug a and b is
100mg, yan yung maximum na pwede ibigay sa pasyente.
- Kaya kung lumagpas ka pa sa 100mg na maximum
concentration, hindi na sya effective kase na achieve na niya
ung emax niya.
- Kasi minsan may mga pasyente tayong parang kulang pa
saknya, may nararamdaman pa syang sakit. Pero umabot na
sya ng Emax, kaya hindi mo na pwede taasan yon, ang
solusyon nlng dyan ay magbigay ng panibagong medication.
Sample, nun una nagbigay ka ng 50mg, tas sasabihin ng
pasyente masakit pa rin ung nararamdaman nya, kaya
magbibigay ka pa ulit hanggang sa maabot mo yung Emax
which is 100mg. so kung hindi pa rin nawawala yung sakit ni
pasyente, magbigay ka ng bagong medication. Kasi nabigay
Drug Efficacy mo na saknya yung Emax ng gamot pero d pa rin sya
gumagaling, so ibigsabihin, hindi effective sakanya yung
- Refers to the drug's ability to activate the receptor once it has gamot. Kaya magbibigay ng panibagong gamot.
bound to it - Gumagamit pa rin tayo ng half life dito. Sample, nagbigay
- Maximum response achievable from an applied or dosed agent tayo ng 50mg ng 8 AM, tapos ang half-life nya is 2hrs. so after
- Maximal effect that a drug produces irrespective of 2hrs, 25mg nlng sya, after 2hrs ulit, less than half na, wala na
concentration (dose) syang concentration/ effect kasi less than half na. Kaya kung
- If a drug will bind with a specific receptor, it is expected they hindi effective sakanya yung 50mg, Sa susunod na ibibigay
will produce a reaction (yung reaction na to ay efficacy) natin ay 100mg na kasi mababa na sa 50mg yung
- The degree of efficacy, minsan binebased din natin yan sa concentration. (Less than half na kasi).
dose. Kapag mas mataas dose mas mataas efficacy - Pero kung hindi pa nag leless than half yung ininom nya
- Maximal efficacy – the point at which increasing a drugs (50mg plng concentration nya) at kailangan na nyang humingi
dosage no longer increases the desired therapeutic response. ng gamot, ang ibibigay mo lang ay plus 50mg para umabot ng
- EC50 – this is the minimum concentration, the body required Emax. Kasi active pa yung medication sa katawan nya ee,
of the medication to elicit the effect. (ito yung pinaka kaya ang ibibigay mo lang 50mg. Dapat hindi ka pa rin
mababang dosed na pwede nating ibibigay sa gamot na yon sumosobra sa dosage mo, hanggang Emax lng dapat.
para magbigay ng therapeutic benefits/ response) Drug Potency
- Emax – maximum dosed na dapat maibigay natin para - Refers to the amount of drug needed to elicit a specific
makapagbigay pa rin sya ng therapeutic benefit/ response. physiologic response to a drug.
- Gaano ba kadami ang gamot para magkaroon ka ng
therapeutic effect.
10 - 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.
5
10 Emax
20 100
50 75
mg mg
mg mg
50 100
mg mg
J.A.K.E 17 of 44
- Para maachieve ni drug a yung efficacy rate of 10, we need to

give 50mg. While for drug b, para maachieve natin yung Examples about Potency:
efficacy rate of 10 which is Emax, we need to give 100mg. - Pethidine = 100mg/ 2ml; Morphine 4mg/ ml
- Drug A is more potent kasi naachieve nya yung efficacy rate - Pethidine is less potent analgesic but more efficacious than
of 10 or ung Emax na mababa lang ang dosage nya. At a lower morphine. (P = 50mg/ml; M = 4mg/ ml)
dosed, mas malakas yung strength nya kumpara kay drug b. - Mas potent ang morphine kasi 4mg lang kailangan nya para
(Kahit konti lang yung dosage nya, mataas na yung efficacy maging effective pero si pethidine kailangan nya pa ng
rate nya.) (Kasi kung pantay yung pagbigay mo ng dosage sa 50mg para maging effective.
drug a and b. Both silang 50mg, yung drug a nareach na nya - Furosemide = 40mg/tablet; Metolazone 5mg/ tablet
agad yung efficacy rate of 10 which is Emax, pero yung Drug - Furosemide is less potent diuretics but more efficacious than
b, hindi pa or mababa pa yung efficacy rate nya, kasi Metozolone. (Mas konti mas effective)
kailangan mo pa ng 50mg para umabot ng 100mg na Emax. - Mas potent si metolazone kasi 5mg lang kailangan nya para
Kaya nasabing mas potent ang Drug A kaysa kay drug B. maging effective. Mas nauna yung metolazone na maging
mataas na agad yung effect ng drug a kahit mababa lang yung effective kaysa sa furosemide na kailangan nya pa umabot
dosage) sa 40mg.
- Potency – less dosage is more efficacy, kung mas konti lang - Aspirin = 80mg/ tablet; Morphine = 10mg/ tablet
ung amount na kailangan mo para ma-achieve mo ung efficacy - Morphine is more potent analgesic and more efficacious
rate na mataas mas potent ka. than Aspirin.
- Mas potent si morphine kasi 10mg lang ang kailangan nya
Emax para maging effective. Mas konti lang ang kailangan sa
morphine kaysa kay aspirin na dapat maabot nya yung 80mg
para maging effective.
Efficacy
EC50
Ano ang best na pwede painumin ng pasyente? Yung mas

potent ba or ung mas efficacious?
Potency - Nagsisimula muna sa mababang dosage tas kung hindi
20 50 100 effective yon, saka ka magtataas ng dosage.
mg mg mg - Hindi ka pwede magsimula sa mataas na dosage
Notes:
Which drug is more potent? - Drug tolerance – hindi kana tinatablan ng gamot kahit ano
1. A or B? = A pang route yan kase wala ka ng receptor sa gamot na un.
2. A or C? = A Kaya kailangn mo ng ibang medication with same mode
3. A or D? = D of action but with different mechanism
- A kase mas mababa yung mg niya kay drug B. meron syang 50mg to - Mechanism of action – receptor u need para umepekto
have therapeutic benefit while drug b needs 100mg para pumasok sa ung gamot sayo
minimum concentration na mag kakaroon siya ng therapeutic benefit.
- Mode of action – intended result u want to get sa gamot.
- A pa din kase 50mg lang while C needs 100+mg para maka pasok sa
EC50 - Kaya kung wala kang receptor sa mechanism ng gamot
- D ang sagot sa 3 kasi, Mas nauna sya pumasok sa efficacy kaysa kay ang mode of action ay hindi maachieve.
Drug A. 30 mg palang ng D, effective na sya pero yung A, kailangan
nya pa ng more than 30mg para makapasok sa line ng EC50 or para Parameters of Drug Action
maging effective sya. Therapeutic Index – (TI)
- EC50 – ito ung amount ng gamot na nag karoon na ng effect - Describes the relationship between the therapeutic dose of a
Which drug is more efficacious? drug (ED50) and the toxic dose of a drug (TD50)
1. A or B? = both (pantay lang na 1) - Therapeutic window – safe pa yung dosage na memaintain
2. A or C? = A (mas mataas si A) natin sa katwan.
3. A or D? = A (mas mataas si A) Toxic Dose
In sentence:
- Drug A is more potent than Drug B but equally efficacious.
- Drug A is more potent and efficacious than C.
Therapeutic Window
- Drug D is more potent than Drug A, but less efficacious
than Drug A.
- Hindi komot mataas ang potency mataas din ang efficacy Therapeutic dose
J.A.K.E 18 of 44
8am
8:30am
Peak
- Occurs when it reaches its highest concentration in the
blood/plasma concentration. T0- T2.
- Nag cicirculate na yung gamot natin na maraming
- TD – toxic dose (amount na hindi ka na pwede magbigay ng concentration papunta sa target site.
sobra dyan) - Example: Ibuprofen
- ED – therapeutic response (amount na kailangan para  8AM the time we administered. (T0)
makapagbigay sya ng therapeutic effect)
 8:30 am – nagkaroon sya ng minimum concentration na
- TI – Therapeutic index (the higher the number, the less toxic
una nyang naramdaman ay pain relief. (T1)
the medication is) meaning – kapag lumalaki yung number
 At umabot ng 9AM, wala na syang nararamdaman na
natin dito, mas lumalawak ang kanyang therapeutic window.
sakit. (T2)
Ito yung kahit masobrahan ka, hindi pa sya mapupunta agad sa
toxic, kasi malawak yung therapeutic window nya.  Peak = 1 hour (after mo mag take ng medication,
- kapag yung medication na small ang therapeutic window, kailangan mo pa maghintay ng 1hour bago mawala yung
konti lang ang pagitan ng therapeutic response at toxic dose. buong sakit mo, or mawala yung problem mo)
Kaya pag nasobrahan ka ng konti, mapupunta na sya agad sa
toxic.
Narrow Wide Therapeutic
Therapeutic Index Drugs
Index Drugs
Digoxin Ibuprofen
Warfarin Acetaminophen
Lithium Antihistamines
Theophylline Most Antibiotics
Cyclosporine Beta Blockers Duration of action
Tacrolimus Multivitamins - the length of time the drug
Gentamicin Proton pump inhibitors exerts a therapeutic effect.
- Narrow therapeutic Index Drugs – pag nasobrahan ka ng konti period from onset until the
doon sa prescribed dosage, pwede na mag lead sa toxicity. drug effect is no (longer seen).
Pero ung wide therapeutic naman, kahit nasobrahan ka ng T1-T3 (trough level)
konti, hindi pa sya aabot sa toxicity, kasi wide ang window - Gaano katagal magbibigay ng
nya, Malaki ang pagitan. therapeutic effect yung gamot.
- Example: Ibuprofen
Parameters of Drug Action
 8AM the time we
Onset
administered. (T0)
 8:30 am – nagkaroon sya
- The time it takes for a drug to reach the minimum effective
ng minimum
concentration (MEC) after administration
concentration na una
- Time from drug administration to first observable effect (T0-
T1) nyang naramdaman ay
pain relief. (T1)
- The medication will reach the effectiveness on a minimum
concentration  At umabot ng 9AM, wala na syang nararamdaman na
- Example: Ibuprofen sakit. (T2)
 8AM the time we administered will be your T0.  10 AM – ito ung bumababa na yung effectiveness ng
gamot.
 By 8:30 am naramdaman nya yung effectiveness ng
gamot yun yung T1.  Duration of action = 1hr and 30mins
 Onset = 30 mins (8:00 ~ 8:30 am)
 Paginom ng medication, 30 mins ka pa maghihintay bago
lumabas yung unang effect.
J.A.K.E 19 of 44
Drug Response
The Importance of Therapeutic Drug Monitoring

- They must be maintained at steady concentrations year after
year while the person ages and goes through life events that
may alter that individual's therapeutic level, including
pregnancies, temporary illnesses, infections, emotional and
physical stresses, accidents, and surgeries.
- It identifies when a person does not take the medication Drug Response may be:
regularly as prescribed (patient noncompliance, hindi tinake 1) Primary – always desirable/physiologic effects
gamot sa oras) (therapeutic effect)
- helps to personalize a dose to fit the specific needs of a patient. 2) Secondary – desirable or undesirable (side effect)
Example: Diphenhydramine (Benadryl)
Theories of Drug Action - Nung na lessen allergic reaction ko na pumasok si ↓
Drug-Receptor Interaction - Primary effect: antihistamine; treat symptoms of allergy
- Certain portion of drug molecule (active site) selectively - Together with this ↑ may secondarily effect or the side effect ↓
combines with some molecular structure (reactive site) on the
cell to produce a biologic effect
- Receptor site – drugs act at specific areas on cell membranes;
react with certain chemicals to cause an effect within the cell.
- Kapag nagkaroon ng binding with receptor at nag fit sila, it
will produce an effect. Kapag hindi nagfit, no effect.
Lock and Key
- 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 Categories of Drug Action
- If a drug will enter a receptor and they fit it will produce an 1) Stimulation/ Depression
effect but if a drug will enter a receptor that is not fitted - Stimulation – increased rate of cell activity/ secretion
mababind nung gamot si receptor pero walang reaction kase from the gland. (ineencourage nya yung secretory cells to
hindi sila fit. produce more hormones that we need)
- Kapag nabind na yung receptor, kahit mali pa yung nabind nya. - T3/T4 for hypothyroidism
Hindi na pwede uli ibind yung tamang molecule sa receptor na - Depression – decreased cell activity and function of a
yon. Once na nabind, tapos na. d na pwede ulit magbind specific organ. Iodine, propylthiouracil. (Para iprevent si
secretory cells na mag produce ng maraming hormone
dahil marami na yung hormones, ipapatigil na nya pag
produce)
2) Replacement
- Replaces essential body compounds
- Sira na yung organ na nagsesecrete ng hormones.
- Example: Insulin
3) Inhibition/ Killing of Organism
- Interfere with bacterial cell growth
- Example: Antibiotics – pineprevent yung pag travel ng
bacteria sa ibang organ (inhibition)
- Bacteriostatic – inhibits movement of bacteria para hindi
kumalat
- Bactericidal – pinapatay ang m.o
4) Irritation
- It will create a reaction on a target organ para gumalaw
sya.
- Tamad na gumalaw ung organ kaya yung irritation drug
magpapagalaw sa kanya. (parang ikaw, tamad na tamad
J.A.K.E 20 of 44
ka na tas sinigawan ka ng nanay mo “HOY MAGLINIS

KA NG BAHAY” edi syempre gagalaw ka na, baka 4) Antagonistic
masampal ka pa ng nanay mo kung d ka gumalaw dyan - one drug inhibits the effect of another drug
HAHA) - wag ibigay ang gamot ng sabay dapat may pagitan
- Example: Laxative irritate the inner wall of colon --- - 1+1=0
increased peristalsis --- increased defecation - Tetracycline + antacid = decreased absorption of
tetracycline
- Charcoal in alkaloidal poisoning
Drug-Drug Interaction  Arrythmias – need to monitor ECG of the patient

1) Additive Effect  Toxicity – bawal ibigay ang gamot ng may kasabay, may
- 2 drugs with similar actions (mode of action) are taken for pagitan dapat
a doubled effect.
- Different mechanism of action but the same mode of Adverse Drug Reactions (ADR)
action. - Sometimes called an adverse drug event – ADE
- 1+1=2 - A negative event following the prescription and administration
- Example: Ibuprofen & Paracetamol – pag ibuprofen lang of a medication.
tinake mo, 30% lang ung mababawasan na sakit, Pag - A response to a drug which is noxious and unintended, and
paracetamol naman ung tinake mo, 30% din. Pero pag which occurs at doses normally used in man for the
both mo silang tinake, magiging 60%. Edi mas better prophylaxis, diagnosis, or therapy of disease or for the
kung mas mataas yung effective rate. modification of a physiological function (WHO)
- Kapag nagbibigay ng additive effect, dapat different - Study of ADRs is called Pharmacovigilance.
mechanism of action sila but same mode of action. hindi - We will monitor for patient from side effect
pwede yung dalawang ibuprofen iinumin mo or dalawang Two types of ADR
paracetamol. Type A: Augmented
 Ibuprofen + paracetamol = Added analgesic effect - Means we can often predict these reactions from our
 Codeine with acetaminophen = Better pain control knowledge of the pharmacodynamic properties of a drug.
2) Synergistic - For example, a patient on an antihypertensive drug
- Combined effect of 2 drugs is greater than the sum of the - May develop dizziness and fainting due to too great a
effect of each drug given alone. lowering of their blood pressure. Expected
- Kapag nagtake ka ng dalawang gamot, parang may extra - Patients on NSAIDs can develop gastric irritation due to the
ka na rin ininom na gamot. drug’s action on protective gastric mucous.
- 1+1=3 - Most Common Type of ADR
 Aspirin = 30% analgesic effect Type B: Bizarre
 Codeine – 30% analgesic effect - Where the reaction is wholly unexpected and could not be
 Combination = 90% analgesic effect predicted from the pharmacodynamic properties of the drug
3) Potentiation - An example would be anaphylaxis to any drug, or a red
- A drug that has no effect enhances the effects of the pinprick rash with penicillin.
second drug. Allergic Reactions
- Dalawa pa rin yung ininom natin na gamot pero yung isa - Unpredictable adverse drug effects; more serious
walang therapeutic benefit sa condition mo kaya naging 0. - Response to patient’s immunological system to the
Kaya mo tinake yung gamot na walang therapeutic benefit, presence of the drug
kasi para to sa pagenhance ng pangalawa mong gamot. - Do not occur unless the patient has been previously
Kaya equals 2 sya. Bali yung isang gamot pang enhance exposed to the agent/ chemical related compound.
lng sya sa isa pang gamot, wala syang effect sa katawan (naibigay na sayo dati kaya ok na sa katawan)
mo. - Skin test – para macheck kung magkakaroon ka ng
- 0+1=2 allergic reaction kapag nainom mo yan.
 Alcohol enhances the analgesic activity of aspirin. Idiosyncratic Reaction
 Prozac + Zestril - Occurs when the patient is first exposed to the drug
J.A.K.E 21 of 44
- Abnormal reactivity to the drug caused by a genetic

difference between the patient and normal individual. DRUG AND IV COMPUTATION
- patient with G6PD deficiency will have anemia by using Discussed by Prof. Marivic Ilarde
antioxidants. (RBC nya easily burst when exposed to Drug Calculation
stress or toxins; ex. antioxidants) Universal Formula:
- Occurs sa mga may certain condition Desired Amount X Quantity = Dose
Toxicity Stock on Hand
- The degree to which a drug can be poisonous and thus Quantity – amount of diluent that you going to incorporate into the
harmful to the human body vial.
Latrogenic Responses Exercise 1
- Unintentional responses as a result of medical treatment Doctor’s Order:
- Nephrotoxicity; Ototoxicity - Give Cefuroxime 500 mg IV every 12 hours.
- Hindi natin gusting makuha ang side effect na ito - For every 1 gram, dilute with 8cc NSS
- Ex. Anticancer drug, used to prolong life pero Solution:
500 mg
nakakabingi x 12 mL = 4mL
1500mg
- The desired amount is 500 mg (numerator)
- The stock on hand is 1.5 g (pero dahil mas
malaki si g kay mg you need to convert the grams into mg)
(denominator)
- 1 g = 1,000 mg
- Therefore, you move decimal 3 places to the right (kase kapag
larger unit to small unit pa right yung move ng decimal point
mo) 1.5g = 1,500 mg
- Now you have 1500mg on your stock on hand
- Then multiply to 12 mL your dilution. because in every 1
gram you need to dilute 8 cc, so it is equal to 12mL. (1.5g x
8cc/ ml = 12cc/ ml)
- Then in every 12 hours, 4mL yung ituturok mo para makuha
mo yung 500mg na desire dosage na need ni client.
Exercise 2
Doctor’s Order:
- Give Amikacin 80 mg IV OD (once a day)
Solution:
80 mg
x 4 mL = 0.32 mL
1ooo mg
- OD – once a day
- 80 mg is the desired amount; 1 gram is the stock
on hand; 4 ml is the quantity.
- First convert gram to mg, 1 g = 1000 mg
- Therefore, your stock on hand will be 1000 mg
- And the answer will be 0.32 mL
Shortcut method:
80 mg
250 mg x 1 mL = 0.32 mL
- Yung sa baba nung box na bote (250mg/ ml) pwede yun
maging stock dose din and mas madali syang gamitin.
- Kapag merong stock dose na small amount yun nalang yung
gamitin.
- A and B is to C and D
- A and B is the “known data” (the stock on hand and the
quantity)
- C and D is the “unknown data” (desired dosage)
- Just multiply the A and D then, the B and C (A x D = B/C)
J.A.K.E 22 of 44
Exercise 1 Pediatric Computation

Doctor’s Order: - Children need lower dosages of medication compared to adults.
- Keflex 1 gram orally TID - Three formulas are used to help calculate a pediatric dosage
- Compute using the Ratio based on whatever information is available
and Proportion - Formula Pediatric Dosing
Solution:  Fried’s Rule – 1 year and below
Age in months
Child’s Dosage = x Adult Dosage
250 mg : 1 cap :: 1000 mg : 150
x
x = 1000  Young’s Rule – 1 year old and above (12yr/old)
250
x = 4 Capsules Age of child in years
Child’s Dosage =Age of child in years+12 x Adult Dosage
- Per 250mg is equals to 1 capsule
- A = 250 : 1  Clark’s Rule
Child′s in weight in pounds
- Kailangan nyo pag tapatin ang mga given dosages sa A to D Child’s Dosage = x Adult Dosage
(yan ugaliin nyong mag tapat ah para wala kayong nasasaktan 150
emzzz) - Adult dose is always the basis, gaano kalaki or karami ang
- 1 gram : x binibigay na dose sa adult patient
- The 1 gram is given on the example - In pediatric patient we cannot give the same amount of dose of
- Now you just need to find kung ilang capsules ang need ma adult pt to them
take ng pt. - Madali silang ma overdose (parang ikaw madaling ma fall,
- Then, remember (A)(D). therefore, 250 multiply to x. so, it awts rUpokkk emzz)
will be 250x
Exercise 1
- Next, multiply 1 cap to 1 gram (but ang given is mg, kailangan
mo ulit i-convert si gram to mg) - Adult dose: 12.5 mg
- 1 g = 1000mg - Child 1: Age 4 weeks – Fried’s Rule
- After conversion you have the 250x = 1000 - Child 2: 5 years old – Young’s Rule
- Then divide each side by 250 - Child 3: 46 lbs – Clark’s Rule
Solutions:
250x Fried’s Rule
1000 mg Age in months
250 = x adult dose = dose for infants
250 150
- Left side, cancel the 250 the x will be left
- The ending will be 1000/250 4 weeks = 1 month
- And your x (na unit ah, hindi yung x mo na nang iwan sayo 1 month
choss) x = 4 capsules x 12.5 mg = 0.083 mg
150
Exercise 2
- How many ml of Magnesium Sulfate should the
patient receive to obtain 4 grams? Young’s Rule
Solution: Age
x adult dose = dose for child
5 g : 10 mL :: 4g : x Age+12
5gx 40 mL
5
5 = x 12. 5 mg = 3.67 mg
5 5+12
x = 8mL
Clark’s Rule
Weight
Exercise: Tablets x adult dose = dose for child
150
Doctor’s order:
- Give Phenytoin 75 46 lbs
x 12.5 mg = 3.83 mg
mg/tab BID for seizures 150 lbs
- For solving the given
situation pwede nyong - Example if the patient is weight is in kg you need to convert
gamitin ang universal the kg to lb which is you need to multiply kg into 2.2lbs
formula or yung ratio - 1kg = 2.2lbs
and proportion pareho lang ang lalabas Exercise 2: Young’s Rule
Solution: Since walang Child 1:
75mg/tab
= 1.5 tablets quantity, pwede - Adult Dose: 500 mg
50mg
gamitin ang - Age of patient: 2 year and 6 months
50mg : 1 tab :: 75mg : x desired over - Weight: 12 kilos
75 mg stock that would Solutions:
50x
= x=
50 50 be the no. of 86. 21 mg
1.5 tablets
J.A.K.E 23 of 44
2.5 years x 500 mg =
CD = 14.5 years
J.A.K.E 24 of 44
- Dahil 2 years and 6 months and bata palang kailangang

maging specific 31 – 32 gtts/min
= 8 hour x 0.25 =
1000 ml
- 6 months is equivalent to a half year kaya naging 2.5years sya - If you have 15 gtts wag na mag long method automatic na mag
Exercise 3: Clark’s Rule short method na kayo multiply by 0.25
Child 1: - How about kapag 20 gtts? 20 / 60 = 0.33 (Multiply agad sa
- Adult Dosage: 500 mg 0.33 kapag 20gtts)
- Weight: 12 kg Micro Drops
26.4lbs
CD = x 500 = 88 mg Doctor’s Order:
150 - Infused D5LR 1L x 8 hours
- Compute how many gtts/min
- Need iconvert ang kg to lbs so it means you need to multiply it Solutions:
by 2.2 - 1000mL= 1L
- 1kg = 2.2lbs (12kg x 2.2lbs = 26.4 lbs) - 8 hours
Exercise 4 1000 ml 60gtts/ml
Child 2: Rate = 8 hour x 60 minutes/ hours = 125 ugtt/min
- AD: 300mg
- Age: 8 months - Remember sa micro drop cancelation method nalang
- Weight 7 kilos - Micro drops/minute is equivalent to mL/hr
Solutions: - Halimbawa nag rounds ka the IV Fluid starts at 6 am and nag
Fried’s Rule rounds ka ng 10 am
8 months
Child’s Dosage = x 300 = 16 mg - What is the level of the IV fluid at 10 am? (ilang lvl na ang
150 natira)
Clark’s Rule - 125 x 4 = 500mL (multiply by 4 kasi 6am to 10am, 4 hours)
15.4lbs - Nakapag consume na ang patient ng 500mL in 4 hours and the
150 lbs x 300 mg = 30.8 mg
remaining fluid is 500 mL.
- Halimbawa kapag ang pt. is 2 years and 8 months ang age Exercise
kailangan mong idivide yung 8 months into 12 months. - 500mL PNSS run for 12 hrs
- 8 ÷ 12 = 0.67 (rounded off) or 2.67/ 2.7 age of patient - IV Fluid started at 7 am
- Gamitin ung pinakamalapit na sagot - How many mL is infused at 9am?
- 1kg = 2.2lbs (7kg x 2.2lbs = 15.4lbs)
500 ml 60gtts/ml
IVF Calculation 7AM = 12 hours x 60 minutes/ hours = 41.6 ugtt/min
Vol. /ml (cc)
Amount to be infused drop factor
gtts/min Rate = hours of infusion x 60 minutes/ hours 9 AM = 41.6 x 2 = 83.34 mL
1000 ml 15gtts/ml - Multiply 2 kasi: 7am – 9am, 2hours.

Rate = Notes:
60 minutes/ hours
x - Cc (mL)/ hr is always equivalent to ugtts/min
12 hour
- Macro drops = 15 gtts/ml, pag hindi naka specify use 15 - Macroset – 15 drop factor for adult
- Micro drops = 60ugtts/ml - Microset – 60 drop factor for infants
- BT set – used in blood, so 10gtts/ml is used - Ex. Regulation niya is naka 31 drops kase 8 hrs ung 1 liter so
Macro Drops imultiply lang sa 4, para pag palit mo nung una niyang tubing
Doctor’s Order: 31 ung unang regulation then multiplty to 4 (31 x 4 = 124
- Infused D5LR 1L x 8 hours ugtts/min) minultiply sa 4 dhil (60 ÷ 15 = 4)
- Compute how many gtts/min - Microset naman ung nakalagay tapos pinalitan ng macro
Given: ididivide naman siya (124 ÷ 4 = 31)
- 1000 mL= 1L
- 8 hours
Formula: Long and Short Method
1000 ml 15gtts/ml 15,000

Rate = 8 hour x 60 minutes/ hours = 480
= 31.25gtts/min or 31 – 32 gtts/min
or
1000 15gtts/ml
Rate
ml = x 60 minutes/ hours
8 hour
J.A.K.E 25 of 44
 Tertiary sources - literature to provide background
NURSING PROCESS IN PHARMACOLOGY information, diagnostic tests, diet
Discussed by Prof. Marivic Ilarde
- 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.
- Patient-Centered Pharmacotherapy.
Nursing Care Plan
- A document that provides direction on the type of nursing care

the individual or family or community may need. This
facilitates standardized, evidence based and holistic care.
ADPIE
Nursing Assessment
- Review clinical history assess patient (gather information;

subjective and objective)
- Subjective – verbalized by the patient or significant others.
 Current health history including problems in swallowing
 Current Meds: OTC, herbal meds, nutritional supplements
 Past History
 Client’s Environment
- Objective – medical history, medical procedures, and
laboratories.
 Check sign and symptoms to those organs affected by the
by drug therapy.
 Check laboratory test
 Blood Chemical
 Diagnostic Studies
 Do Physical Assessment
 Assess major body system for any signs of reaction or
interaction of drugs or ineffective of therapy.
 Drug History or interview
 Researching medication order ( MIMS)
- Comprehensive collection of data:
 History - The patient’s past experiences and illnesses can
influence a drug’s effect.
 Chronic Conditions - can affect the pharmacokinetics and
pharmacodynamics
 Drug Use - may have an impact on a drug’s effect
 Allergies - Past exposure to a drug or other allergens can
provoke a future reaction.
 Level of Education and Understanding
 Social Support
 Financial Supports
 Pattern of Health Care
 Physical Examination – develop a baseline for evaluating
the effectiveness of the drug
 Weight - helps to determine whether the recommended
drug dose is appropriate.
 Age – influence pharmacokinetics and
pharmacodynamics; the immature liver may not
metabolize drugs in the same way as in the adult.
- Sources of Information
 Primary source - produced by patient
 Secondary sources - relatives, significant others, medical
records, lab reports
J.A.K.E 26 of 44
Nursing Diagnosis
- Knowledge deficit of disease and medication related
to inability to understand instruction.
- Risk for injury related to side effects of drug.
- Alteration in thought processes related to drug action.
- Constipation related to drug action or side effect.
- Fluid volume deficit related to drug action.
- Ineffective breathing pattern related to drug side effects.
- Develop appropriate nursing diagnosis or problem list.
- 3 parts:
1) Problem
2) Ethology
3) Signs and symptoms
Five Types of Nursing Diagnosis
 Actual - based on human responses and supported by
defining characteristics.
 Risk/high-risk - patient may be more susceptible to a
particular problem.
 Possible - suspected problems requiring additional data.
 Wellness - clinical judgment about a transition from one
level to a higher level.
 Syndrome - cluster nursing diagnoses that occur together
and best addressed together.
Problem Etiology Sign and symptoms
Risk for injury related to side effects of drug, such as dizziness /light
headedness as evidenced by…
- Base diagnosis on conclusion about risk factors, actual client
needs or problems based on knowledge base.
- E.g. nursing diagnosis include: Deficient knowledge; risk for
injury; noncompliance.
- Diagnosis based on s/e or risk factors (fatigue, constipation,
impaired tissue perfusion, sexual dysfunction, sleep disturbance,
urinary retention)
Planning
- Prioritize the nursing diagnosis.
- Specify objective, measurable, attainable, realistic goals.
- Establish a time period for achievement of outcomes
- If order is in question - do not give – call physician for
clarification/further instructions.
- Document all information obtained.
- Four phases of a nursing care plan
 Setting priorities - Identify problems and prioritize
 Developing measurable goal/outcome statements -
Write short- and long-term goals for the patient to be
followed when providing care (SMART).
 Formulating nursing interventions.
 Formulating anticipated therapeutic outcomes.
 Plan which intervention to use based on anticipated
patient behavior.
- Develop interdisciplinary plan of care.
- Dependent
- Independent
- Collaborative
- The plan must be SMART
 Specific
 Measurable
 Attainable
 Realistic
 Time-bounded
J.A.K.E 27 of 44
Implementation - Effectiveness of health teaching about drug therapy and

attainment of goals are addressed in the evaluation. If goals are
- Nursing actions are suggested
 Dependent actions - performed by a nurse based on health
care provider’s orders.
 Interdependent actions (Collaborative) - implemented
with the cooperation of a team.
 Independent action - provided by nurse by virtue of
education and license.
- Three types of nursing interventions are frequently
involved in drug therapy:
 Drug administration.
 Provision of comfort measures.
 Patient or family education.
- Perform procedures medicate as indicated.
- Proper Drug Administration: 10 rights
- Comfort Measures
- Placebo Effect - The anticipation that a drug will be helpful.
- Managing Adverse Effects
- Lifestyle Adjustment
- Patient and Family Education
- Process:
 Reassess the patient
 Review and revisit the existing NCP
 Organize resources and care delivery
 Anticipate and prevent complication
 Identify areas of assistance
 Implement skills
 Document nursing intervention
- Includes:
 Administer medications per doctor’s order.
 Monitor therapeutic effect.
 Monitor side effects, drug interaction and adverse reaction
of the drug.
 Client Teaching.
- Health teaching:
 General Instructions
 Self-Administration
 Diet
 Side Effects
 Cultural Consideration
- Checklist for health teaching in drug therapy:
 Comprehensive drug and health history
 Reason for medication therapy
 Side effects and adverse reactions
 When to notify health care provider or pharmacist
 Interactions:
1) Drug-drug, drug-food
2) Drug laboratory
3) Drug environment interactions
 Recording system
 Discussion and monitoring
4) Financial resources
5) Medication
6) Associated equipment
 Development and support of backup system
 Community resources
Evaluation
J.A.K.E 28 of 44
not met, the nurse needs to determine the reasons for this
and revise the plan accordingly and include additional
assessment data and the setting of new goals (adverse, toxic
effects). If the goals are met. The plan of care has been
completed (therapeutic effects)
- Interpret results evaluate outcomes assess compliance.
The Steps of the Nursing Process

1) Nursing Process
2) Assessment
3) Past Hisotry
o Chronic condition
o Drug use
o Allergies
o Level of education
o Level of understanding of disease and therapy
o Social supports
o Pattern of the health care
4) Physical Examination
o Weight
o Age
o Physical parameters related to the disease state or
known drugs effect.
5) Nursing Diagnosis
6) Implementation
7) Proper drug administration
o Drug
o Storage
o Route
o Dose
o Preparation
o Timing
o Recording
8) Comfort measure
o Placebo effect
o Managing side effects
o Lifestyle adjustments
9) Patient or family education
J.A.K.E 29 of 44
- Main organs: GI, Exocrine glands
AUTONOMIC NERVOUS SYSTEM
Review of Anatomy and Physiology (Nervous System)
Central Nervous System
1) Brain – information will be delivered
2) Spinal Cord – nagkokonek sa peripheral
Peripheral Nervous system
1) Somatic nervous system

- Voluntary (like u need to have stimulus for you to be able
to respond)
- Skeletal muscles and sensory information
- Carry messages form the outer areas of the body
a) Afferent
- Sensory neurons
- we need to detect using our senses first before
we could be able to process our information.
- This information that we detected from the
outside will be brought to the middle of the body,
which is the brain, wherein the brain will process
the information.
- Then the brain will process and after processing,
the brain will bring back the information via
afferent neuron, may dala dala na syang action.
- May command/ instruction na ipapagawa si
afferent neuron sa efferent/ motor neurons.
- Sample nahawakan mo ung mainit na bagay, at
inalis mo agad ung kamay mo (ganon kabilis
yung afferent and efferent response)
b) Efferent – motor neurons
2) Autonomic nervous system (Automatic)

- Under peripheral
- Involuntary physiologic processes. Example: heartbeat,
digestion, release ng mga hormones yan ang mga
involuntary.
- Cardiac and smooth muscles
- Glandular secretions
a) Sympathetic (Fight or Flight system)
- Nagbibigay ng energy.
- Ito ung nagkokonek sa mga internal organs to the
brain by the spinal nerves.
- When this sympathetic is stimulated, it will
prepare upper body for stress. When sympathetic
stimulated, will increase our heart rate, blood
pressure, blood flow to the muscle and decrease
flow to the skin.
- Finofocus nya ung delivery ng blood will be
going towards to heart and lungs.
b) Parasympathetic (energy conservation)
J.A.K.E 30 of 44
- Pag yung parasympathetic nag stimulate, ito
ung stage na rest and digest. Papakalmahin
yung katawan nyo kasi kailangan mo
magpahinga.
- (Sympathetic – bumibilis ung heartbeat mo;
Parasympathetic – nagrerelax naman ang
puso)
Parasympathetic nerves Sympathetic nerves
J.A.K.E 31 of 44
Dilate pupils – when your eyes
Constrict pupils – less light will
are more dilated, it could help
enter. Sample, before you go to
you see better. Ung
sleep, u will turn off the light
surroundings mo mas makikita
para magkaroon ka ng
mo ng mas malawak. Parang
relaxation.
bintana.
Stimulate saliva – nag increase Inhibit salivation – hindi ka
yung laway. gaano naglalaway
Slow heartbeat Increase heartbeat
Relax airways – dahil
nagkakaroon ka ng broncho
Constrict airways – kaya may
dilation.
snore pag natutulog ka. Kasi
Vasodilation- lumuluwag mga
yung hangin natin dumadaan sa
blood vessels, pero pagdating sa
mas makitid na tunnel.
lungs nag da-dilate – broncho
dilation.
Stimulate activity of stomach –

Inhibit activity of stomach –
tinutunaw nya ung laman ng
hindi ka gaano nakakaramdam
stomach, nagpoproduce ka ng
ng gutom
gastric acid.
Stimulate release of glucose
inhibit gallbladder – there will
Inhibit release of glucose; be sudden energy. Sample
stimulate gallbladder – nasunog kapit bahay mo, tas
kailangan magtunaw (acid) binuhat mo ung ref, kapag
gantong biglang tumaas
adrenalin mo, kapag
J.A.K.E 32 of 44
nastimulate si sympathetic Effects of activation – Alpha

because of certain emergency
situation, si liver nagrerelease
ng stored glucose. And this
glucose will give ourselves
energy. Kaya nagagawa or
nabubuhat natin ung isang
activity na hindi naman natin
gnagawa sa normal situation.
Secrete epinephrine and
norepinephrine – main
neurotransmitters in our
sympathetic nerves – main
chemical substance na
narerelease kapag naactivate, - If the epinephrine or norepinephrine will bind with alpha
itong system na to. receptors. If this chemical messenger will bind with alpha
Relax bladder – nagkakaroon receptors.
ng mas maraming capacity for - Alpha1 will bind with the chemical messenger, the alpha1 will
Contract bladder – nacocontract
the urine to remain in the bring epinephrine or norepinephrine or dopamine to the blood
yung bladder kaya lumalabas
bladder. Yung bladder neck vessels, eye, bladder, prostate.
yung ihi.
naka constrict kaya hindi o Blood vessels – it will cause vasoconstriction. Kapag
lumalabas yung ihi. nagconstrict yung blood vessels, nag increased yung
blood pressure and also it will increase the contractibility
Promote ejaculation and vaginal of the heart. Mas nagiging malalim ung tibok ng puso.
Promote erections of genitals.
contraction o Eyes – if alpha1 will bring the neurotransmitters to eyes,
the effect will pupil dilation (mydriasis) (constriction –
Sympathetic nervous system miosis) the eyes can accommodate more light.
o Bladder – it will cause relaxation. Kaya mas maraming
- Adrenergic system neurotransmitters – norepinephrine, urine ma-accommodate. Pero sa bladder neck nya is
epinephrine, dopamine constricted kaya hindi ka naiihi.
o Alpha1 o Prostate – it will contraction, nagkakaroon ng mataas na
o Alpha2 ejaculation. Kapag nagcontract ang muscle, may iniipit
o Beta1 sya, may pinepress kaya may lalabas.
o Beta2 - Alpha2 considered inhibitory ; alpha1 considered stimulate.
- Main neurotransmitter – Ito ung nag rerelease ng chemical Kaya kapag si alpha1 ang binind ng mga ating chemical
messenger kapag activated sa sympathetic. messengers, iistimulate nya, pinapataas nya yung effect ng
- Epinephrine and adrenaline is the same chemical messengers. Alpha2, nag modulate at nagcocontroll,
- Nor – target nila ay blood vessels; Epi – cardiac muscles. kapag sobrang dami na ung epinephrine/ norepinephrine in
- This chemical messenger cannot reach the target organs, they your system, Alpha2 will bind with them, para iprevent naman
need to have receptors. (pharmacodynamics) before a nya. Inhibitory effect
chemical messenger could be able to give or bring the message - If Alpha2 will bind with neurotransmitters, instead bringing
to the target organ, they need to have receptor, kailangan ng them to the target organ, ang nangyayari dito ay pineprevent
sasakyan. nya na magkaroon ng effect yung ating mga neurotransmitters
- Allows the body to function under stress. on the specific organs.
- Fight or flight system o Blood vessels – if this will not receive the epinephrine,
instead of vasoconstriction that has epinephrine,
nagkakaroon tayo ng vasodilation. Vasodilation will cause
the blood pressure will go down (nor is for blood vessels,
epi for cardiac muscle) pinigil or pinababa ni alpha2
receptor ung dami na nagcicirculate ng mga chemical
messengers.
o Smooth muscle – it will cause decreased gastrointestinal
tone and motility. Parasympathetic – naka focus kay GI,
alpha receptor is included in the sympathetic, kaya
kabaliktaran yan. Si GI function natin, kapag alpha2
receptor ang nagbind dito at napunta kay GI, pinapababa
nya ung motility. The patient will have constipation, or ito
naman ung ibibigay natin kapag ung patient natin ay super
active ang kanyang GI, nag da-diarrhea, kaya ibibigyan
sya ng alpha2 receptor, mababawasan ung times na mag
dudumi sya.
J.A.K.E 33 of 44
Effects of Activation – Beta
- Beta1 receptor – heart and kidney (activate/ stimulate) specific secretory cells) releasers sila. or reuptake
o Heart – once the epinephrine/ adrenaline will bind with
the beta1 receptor, the heart will increase heart
contraction and increased heart rate. Kung problema ng
pasyente natin ay mabagal na heartbeat, we need
medication na nakakapagkataas ng heartrate. So dapat sa
classification ng gamot mo, may positive chronotropic
effect.
o Kidney – it will increase renin secretion, then the renin
secretion will increase angiotensin. (Angiotensin –
nagpapataas ng calcium release) kaya kapag tumaas ung
calcium release, tataas ang blood pressure kasi yung
calcium pagpumasok sa loob ng cells natin, nagpapataas
yan ng pressure, nag ca-cause sya ng vasoconstriction.
This will increase the blood pressure.
- Beta2 receptor – regulation, inhibitory, modulate the amount
of this neurotransmitter to reach the specific target organs.
o Smooth muscles – decreased G tone and motility. (kapag
sympathetic bumababa ang GI function natin) if the
patient has diarrhea, magbibigay tayo beta2 receptor para
pabagalin ang kanyang peristalsis.
o Lungs – its will cause bronchodilation. (beta2 agonist – u
are stimulating more beta receptor, kaya mas maraming
beta receptor mas broncho dilated, mas nakakahinga ng
maluwag ang pasyente)
o Uterus – causing relaxation of uterine smooth muscle,
kapag nagbigay ng beta2 receptor, napeprevent or
namiminimize yung abnormal labor.
o Liver – it will cause activation of glycogenolysis, - ito ung
breakdown ng glycogen to glucose, masdadami ang
glucose. Then it will increase blood sugar. Pero kapag
laging mataas beta2 receptor mo, pwede mag lead sa
diabetes.
o Ang beta2 receptor ay para lng sa emergency, to give you
extra energy.
Sympathetic
 Sympathomimetic (adrenergic) = sympathetic stimulants

- Mimic – gagayahin nya yung mga chemical messenger.
- Kulang ang katawan mo sa dopamine/ epinephrin/
norepinephrine kaya imimimic sya.
- Classification:
a) Direct – alpha agonist and beta agonist
b) Indirect – they will not act directly in producing more
alpha and beta receptor, they will focus on the
secretory cells that are producing the epinephrine/
norepinephrine/ dopamine. (produce more on the
J.A.K.E 34 of 44
 Sympatholytic (adrenergic blockers) =

sympathetic depressant
- Antagonist – nagbabawas naman sila
- Alpha receptor or beta receptor depende yan sa
target organ mo.
- Alpha receptor
 Nonselective – itatarget nya pareho 1 and 2
 Selective – 𝑎1 , 𝑎2 selective – yung aatagonize ng
gamot natin ung specific number ng alpha receptor
na nakalagay sa mechanism of action nya.
- Beta receptor
 Nonselective – 𝑏1 and 𝑏2
Sympathomimetics – imimimic
1) Direct acting sympathomimetics
- Directed on the specific receptors, alpha or beta
- Directly will bind with receptors
2) Indirect acting
- it will stimulate the specific secretory cells that are
releasing neurotransmitters.
- Reuptake – pineprevent nila mametabolize yung mga
existing natin na, norepinephrine or adrelanine so they
would stay longer na active sa katawan. Hindi sila nag
action sa receptor, but they act directly on the secretory
cells, that are producing the neurotransmitters in
sympathetic nervous system.
J.A.K.E 35 of 44
3) Dual acting
- They could act both. it will instruct the smooth muscle to relax. And this will cause
bronchodilation.
- for immediate release, instantly mafifeel mo na lumuluwag
ung daanan ng hangin mo.
- This is direct acting because this drug act directly with the beta
2 receptor.
- So, if you will be giving salbutamol, the effect will be
therapeutic or primary/ secondary effect.
- Nagkakaroon ng adverse effect kasi nasa sympathetic tayo, at
ito ay nagpapaincrease.
 Direct – will bind directly to the receptor

 Indirect – ung drug nag uup sila directly on secretory cells to
produce more neurotransmitter, kaya kapag mas maraming
neurotransmitter. Kaya kapag maraming neurotransmitter, they
could bind with receptor na.
 Mixed acting – pwede sila magbind directly or go to the
secretory cells, so the secretory cell will produce more
neurotransmitter and this neurotransmitter will bind with
receptor
Direct Acting
- Sympathomimetic – Agonist
- Mechanism of action – what specific receptor will the drug
bind to. Clonidine – sympathomimetic drug (alpha agonist)
- Mode of action – ito ung magiging effect kapag binigay natin - It will stimulate the 𝑎2 adreno receptors.
ung albuterol. - 𝑎2 ang naactivate, ang effect nya ay mag modulate or to
- Pag binigyan ng salbutamol – it will activate b2 receptors in decrease the amount of the circulating epinephrine/
bronchial smooth muscle and it will activate the adenylyl norepinephrine/ dopamine in the system.
cyclase activity. (cAMP – Cyclic adenosine monophosphate - Ang effect ni clonidine pagbaba ng pressure.
which is the second messenger) once na nactivate ung cAMP,
J.A.K.E 36 of 44
Indirect acting Adrenergic Agents: Side Effects

Alpha adrenergic effects:
 CNS – headache, restlessness, excitement, insomniam
euphoria (kasi pinataas nya yung mood)
 Cardiovascular – palpitations (dysrhythmias), tachycardia,
vasoconstriction, hypertension.
 Others: anorexia, dry mouth, nausea, vomiting, taste
changes (rare)
Beta-adrenergic effects:
 CNS: mild tremors, headache, nervousness dizziness.
 Cardiovascular: increased heart ratem palpitations
(dysrhythmias), fluctuations in BP.
 Other: sweating, nausea, vomiting, muscle cramps
Sympatholytic Agents (Adrenergic Blockers)
- Drugs that block the effect of the sympathetic NS
- Lytic – pineprevent or binoblock nila
- They will act on the synapse.
- Catecholamines – neurotransmitter.
- Once we take this medication, it will stimulate the synapse to
produce or release more of neurotransmitter.
- Inhibit MAO – Monoamine oxidase – enzyme responsible in
removing yung mga norepinephrine, serotonin, and dopamine
sa system natin. If MAO is increased, wala tayong
catecholamines.
- If u will taking amphetamine, will remove MAO, kaya kapag
walang MAO, mataas ang norepinephrine serotonin and
dopamine). Classification – α- Adrenoceptor Antagonist
- More epinephrine circulating on the body, mataas ang action Non-selective block α1 & α2 (iboblock nya pareho)
ang nervous system.  Reversible
- CNS stimulant, increase alertness, reduce, fatigue, depress - Phentolamine
appetite – kasi yung sympathetic, walang GI. Kaya kapag - Tolazoline (Priscoline)
mataas yung sympathetic, hindi ka nakakaramdam ng gutom  Irreversible
pero sa parasympathetic baliktad naman. - Phenoxyben – zamine
- But this can cause dependence (limit their use) – hahanapin na Selective
ng system mo yan. ang ganda ng pakiramdam mo, d ka o α1 – blovkers
inaantok, d ka nagugutom, d ka napapagod, kaya hahanapin ng - prazosin
katawan mo. (Kailangan ko ata to para matapos lahat ng - terazosin
tasks… HAHAHAHA JOKE hehe) - doxazosin
Mixed Action - alfuzosin and Bunazosin
- Tamsulosin and Silodosin
Ephedrine
o α2
- Mechanism of action: stimulates both
- yohimbine
alpha-and beta receptors, causing
- Idazoxan
increased heart rate, enhanced,
- Miscellaneous
cardiac output and, increased BP.
- Ergot alkaloids
 Raises systolic and diastolic BP
by vasoconstriction and cardiac
stimulation.
 Also causes bronchodilation but
is less effective than epinephrine.
- They could act directly on secretory
cell. Or they will act directly on
receptor.
- Kapag na-activate si alpha, more of
vasoconstriction pero pag naactivate
din si beta, magka- bronchodilation
ka naman.
- Ang problema dito, kapag may asthmatic at hypertensive ka, Phentolamine (nonselective)
hindi ka pwedeng bigyan ng ephedrine, kasi may - Non specific short acting reversible alpha antagonist
vasoconstriction, lalo tataas BP mo. - Patent competitive antagonist at both 1 and 2 ereceptors
- Quick acting
J.A.K.E 37 of 44
- Reduction in Peripheral Resistance – blocking both α1 &

α2 receptors – causes noradreline release and venadilation - Enter CNS - ↑ BP, HR, motor activity (kapag mataas si
more than arteriolar. (si veins nag da-dilate more of the A2, pineprevent nya ung sobrang taas ng epinephrin,
arteries, kapag mas nagdilate ung blood vessels going to norepinephrine sa mga target organ. Eh wala na tagacontrol
the heart, mas maraming blood na inaaccomodate ng puso kasi binolock si a2, tataas ngayon ang concentration ng ating
natin, kaya ang effect nito will be more of increase mga epinephrine/ norepinephrine sa body. Kaya ang effect
heartrate.) (pero ung palabas sa puso ay hindi, kaya ang nya vasoconstriction, pagtaas ng BP)
magiging effect nito ang pressure papunta sa periphery ay - Actions appear opposite that of clonidine (clonidine –
hindi naman mataas kaya pinapaba nito ang blood centrally acting, alpha2 agonist – pinapataas ni clonidine
pressure pero pinapataas ung heartrate.) yung alpha 2)
 Cardia stimulation - Used (herbal treatment) for male sexual dysfunction (too
- Enhanced NA release due to alpha-2 blockage (si much a2 will result to decrease contraction sa muscle)
noradrelanine ang nagcacause ng vasoconstriction, kaya
kapag binolock mo si NA, wala kang vasoconstriction
pero may vasodilation ka bumababa ang BP mo)
- Inhibits serotonin release – muscarinic agonist (?)
 Uses: Pheochromocytoma (tumor sa adrelan gland, ito ung
magiging cause para mag produce mas maraming epinephrine/
norpinephrine), chloride withdrawal, cheese reaction and in
extravasations of NA and Adr injection.
 Dose: 5 mg IV injection and when needed
Selective – A1 – Adrenergic Blockers
Prazosin: Doxazosin, Terazosin
Mechanis of Action
- Blocka α1 receptors in arterioles and venules thereby Nonselective a blocker – side effects
produce vasodilation  peripheral vascular resistance. (a1
cause vasoconstriction, kaya kapag binolock mo yung a1
receptors magkakaron ng vasodilation)
- Uses:
 Mild to moderate hypertension
 Benign prostate enlargement – ang effect ng a1 ay
constriction, kaya kapag nablock ung a1, nawawala ung
constriction at magrerelax sya.
 Raynaud’s phenomenon – ang blood vessels natin ay
mababa papunta sa mga dulo ng daliri. (kapag binolock
natin si a1, lumuluwag ang daanan ng blood natin
papunta sa distal extremities.)
 Pheochromocytoma (nonselective α blocker Classification of Beta blockers
phenoxybenzamine)
- Adv effects:
 Postural hypotension – 1st dose phenomenon (1st dose
should be small and should be administered at bed time)
dahil bumababa BP.
 Nasal stuffiness, dizziness, palpitation
- Blocks α1 AR on resistance vessels from binding NE
released from nerve terminals
- Decreases vascular tone (vasodilates)
- Thereby decrease PVR and BP
Non-Selective
Propranolol
- Class II
- Non-selective (iboblock nya pareho, b1 – pinapataas nya
ung heartrate; b2 – 2 lungs, kapagbinolock si b2,
magkaka- bronchoconstriction)
- D natin pwede ibigay to asthmatic patient kasi
magkakaroon sya ng bronchoconstriction, mahihirapan
Selective – A2 sya huminga dahil binolock din ung beta2 nya.
Yohimbine (Yocon) - Hindi porke highblood ka, magtetake ka na ng kahit
- Competitive antagonist, α2 selective anong klase ng anti-hypertensive medication, kung non
- Bark of Pausinystalia yohimbe selective yan at ikaw ay asthmatic, d mo pwede itake yan.
J.A.K.E 38 of 44
- Mechanism:
 Decrease SA node automaticity Beta a- adrenergic Antagonists (Beta A- Blockers) Side Effects
 Decrease AV node conduction speed
 Decrease cardiac contractility
- Similar to calcium channel blockers in effect
- Use: ST, VT, AT
- PO – IV in emergency situation
- Adverse Effects:
 Hypotension
 Bronch ospasm
 Decreased cardiac contractility
Nursing Implications
 Monitor vital signs for bradycardia and hypotension
 Monitor blood glucose for hypoglycemia (kapag binolock
natin ung receptor sa sympathetic, binoblock mo rin ung
pagproduce ng glucose)
 Advise the client about the possibility of impotence
Parasympathetic Nervous System

- Cholinergic system – acetylcholine – neurotransmitter that
innervates the muscles.
 Nicotinic
 Muscarinic
Selective – B1 - Regulates vegetative functions
Metoprolol - Rest and Digest
- Mechanism of Action: Selectively blocks beta-1 receptors, - These two systems work in constant opposition to control
slowing sinus heart rate, decreasing cardiac output, and organ response
decreasing BP.
- Pwede ibigay to sa asthmatic patient.
- Target nya lang ay heart.
Beta 1 vs Beta 2 Selectivity
o Nicotinic – coordination, movement
J.A.K.E 39 of 44
o Muscarinic – pagrelease ng mga fluids sa body.
J.A.K.E 40 of 44
Parasympathetic
 Parasympathomimetic (cholinergic) = parasympathetic  Direct-acting cholinergic agonists
stimulants (agonist) papadamihin si acetylcholine - Action: mimics acetylcholine to produce parasympathetic
 Parasympatholytic (anticholinergics) = parasympathetic stimulation (binds directly with Ach receptors)
depressants (antagonist) babawasan ang acetylcholine or - Prototype drugs: bethanechol chloride  for bladder
icocontrol ang mga receptors na kumukuha kay atony. (bladder atony – u are not urinating)
acetylcholine. - Pilocarpine HCI (Pilomann, Pilogel)  for glaucoma
Parasympathomimetic Agents (Cholonergic Agents) - Causes: salivation, urination, defecation, sweating,
vomiting, and abdominal cramps.
- Drugs that cause the same effect as stimulation of - Side effects: hypotension, hypersalivation, hyperhidrosis,
parasympathetic NS nausea, vomiting, diarrhea.
- (Like putting your foot on the brake) gusto mo magpahinga. Indirect Acting
Physostigmine
- Actions: inhibitors of
cholinesterase; amplifier
of endogenously
released Ach.
(Cholinesterase – ito ung
mga enzyme that
catalyzes the hydrolysis
of acetylcholine. Kapag
maraming Acetylcholine,
minemetabolize ni
o Direct acting – ang purpose ng gamot ay pwede magbind sa
cholinesterase. Kapag nametabolize nya, nagiging
receptor agad. They will bind directly with muscarinic or
nicotinic. Examples: inactive si acetylcholine. Kaya kapag maraming
- Acetyl-choline cholinesterase, less ang acetylcholine) (acetylcholine –
- Methacholine main neurotransmitter in parasympathetic)
- Carbachol - Indicators
- Bethanechol  Reversal of severe atropine poisoning (IV)
- Pilocarpine  Occasionally used in acute glaucoma (topical)
o Indirect acting – ang purpose neto ay doon sa secretory cells (induced miosis and spasm of accommodation)
na nagpoproduce ng neurotransmitters na si acetylcholine.  Used in intestinal atony (increases their motility)
o - Pharmacokinetics:
Direct acting  Lipid soluble
 Can be used topically in the eye
 Duration: 2-4hours
- Adverse Effect: generalized cholinergic stimulation plus
CNS effects: seizures
- Adverse effects of reversible inhibtors of cholinesterase –
all of the side effects seen w/ direct
parasympathominmetics + caused by increased nicothine
component
- Possible side effects:
 Bradycardia and hypotension (we are on
parasympathetic, binabagal nya ung tibok ng puso)
 Bronchospasm/ respiratory insufficiency – apply
atropine that is parasympatholytic drug (conclusion,
coma)
Parasympatholytic Agents (Cholinergic Blockers)
- Drugs that block the action of parasympathetic NS
- (Like taking your foot off the brake)
J.A.K.E 41 of 44
Spasmolytics
Dantrolene (anticholinergic) (DOPA decarboxylase) (dopamine as such cannot be
- Pineprevent nya si used since it does not enter the brain)
acetylcholine.
 Levodopa itself is largely inert. Its effects in the brain
- Binabawasan nya yung
and are mostly related to activation of D2 receptors.
receptor na kumukuha kay
acetylcholine.
- Naiinhibit nya yung
pagrelease ng calcium kasi binoblock nya si nyanodine
receptor that are receiving the calcium.
- Less calcium – muscle relaxation
- Nicotinic antagonist
Mechanism of action:
 Dantrolene reduces skeletal muscle strength by interfering
w/ excitation-contraction coupling in the muscle fibers
Vasico Selective (Anti-muscarinic)
 Normal contraction involves release of calcium from its
stores in the sarcoplasmic reticulum through a calcium Oxybutynin
channel Indications
 Dantrolene interferes w/ the release of calcium channel  Neurogenic bladder (hindi mo kaya icontrol ung pagihi
this sarcoplasmic reticulum calcium channel mo)
 Cardiac muscle and smooth muscle are depressed only  Urgency
slightly, perhaps bec. the release of calcium from their  Frequency
sarcoplasmic reticulum involves a diff. process  Incontinence
Mydriatics  Detrusor muscle hyperreflexia
Action:
Anticholinergic mydriatic
- Parasympathetic – constrict; mydriatic = dilate  anti-muscular/anticholinergic (block muscarinic effects of
- are predominantly acting anticholinergic mydriatic acetylcholine) receptors specific; antispasmodic (ang
substances. muscarinic receptor pinapataas nya yung urination dahil
- Purpose: Cycloplegic – pinapa- numb nila yung sensation secretion sya, so kapag nablock si muscarinic,
sa mata, Lalo na sa mga pasyenteng ooperahan. To numb nababawasan ung pagproduce mo ng urine.)
and to dilate. Side Effects
- Pharmacodynamics Action: Produces mydriasis and  Dry skin
cyloplegic effect shorter than atropine  Eyes and mucous
- Therapeutic use: in ophthalmology for retinal examination membranes
and pre-operative for cataract  Constipation or diarrhea
- Homatropine, eye drops 1%: Mydriasis and cycloplegia  Nausea
are fast and duraza 1-3 days  Tachycardia
- Cyclopentolate, eye drops 1%: Mydriasis and cyclopegia  Blurred vision
duraza 24hrs  Somnolence
Caution
Anti-Parkinsonian  Narrow angle glaucoma
- Hindi mo kaya icontrol ung muscles mo.

- Parkinson disease – mababa ung level ng dopamine.
(Dopamine is messenger to the brain that will control the 1) Muscarinic Antagonists
movement and coordination)
Levodopa - Action: compete with acetylcholine at muscarinic
- Nicotinic antagonist receptors
- Inaallow nya yung mas maraming dopamine na - Uses: preoperatively given to reduce salivation and gastric
magproduce sa body. secretions
- Chemistry: The amino acid levodopa is the biosynthetic
precursor of dopamine
- MOA:
 In the brain levodopa is taken up by dopaminergic
terminals in the striatum and is converted to
J.A.K.E 42 of 44
J.A.K.E 43 of 44
Side Effects:
 Tubocurarine
 Vecuronium
 Pancuronium
- Uses: facilitate endotracheal intubation decrease the
number of anesthetics to be used relaxed skeletal muscles
of intubated patients
- Side effects: hypotension, tachycardia, dysrhythmia,
respiratory depression
Summary
Nursing implications:
- Provide comfort measures for sides
- Encourage fluids to decrease risk of constipation. (dahil
binagal mo ung muscarinic kaya babagal ang
peristalsis.)
- Monitor vital signs
2) Nicotinic Antagonists
- Action: block ganglionic nicotinic receptors in both

sympathetic and Parasympathetic NS. - Dapat balance silang dalawa.
- Kapag tumaas si sympathetic, pinapababa mo naman si
parasympathetic.
- Pero kapag mataas naman si parasympathetic, pinapababa mo
naman ang action ni sympathetic nervous system.
 Hexamethonium – nicotinic receptor antagonist
 Side effects: marked venous pooling-> postural hypotension

(kasi nag vavasodilate ka, kaya epekto sayo neto bababa ang
BP)
b) Neuromuscular blocking drugs (n1)
- Compete with Ach for the receptor sites on motor end

plates or by blocking depolarization
Hirap intindihin yung pharma kung hindi kau nakinig sa discussion

ni doc pacis and mam ilarde! HAHAHA kung may napansin kayo
na correction, pakitama nlng ahhh! Good luuckkk pipol! – Aki
J.A.K.E 44 of 44

Ncma216 Prelim

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Ncma216 Prelim

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Bachelor of Science in Nursing 2Y♙

NCM♙216: BSN 2ND YE♙R 1ST SEMESTER PRELIM 2021

BASIC CONCEPTS OF PHARMACOLOGY

- Art of preparing, compounding (we mix medication for

- A person licensed to prepare and dispense drugs to make up

- Begun when humans used plants to relive symptoms

Drug Basic Concepts of Pharmacology

- covers from drug identification, pharmacokinetics to dosage

Drug Regulation & Mandates

1. Pharmaceutic phase/ dissolution

2 Phases of Pharmaceutic Phase

- May mga gamot na light sensitive, yung capsule or

Factors affecting rate of dissolution

- Process of drug movement throughout the body that is

Will my drug get to where it needs to work?  Degree of ionization

- Movement of the drug into the bloodstream after

Factors controlling the rate and reliability of drug absorption

Factors affecting biotransformation

 Genetic – some people metabolize drugs rapidly, others more

- Each drugs molecules before it will be able to reach the target

- High affinity – only a small amount of the drug on the body

- Para maachieve ni drug a yung efficacy rate of 10, we need to

Ano ang best na pwede painumin ng pasyente? Yung mas

The Importance of Therapeutic Drug Monitoring

ka na tas sinigawan ka ng nanay mo “HOY MAGLINIS

Drug-Drug Interaction  Arrythmias – need to monitor ECG of the patient

- Abnormal reactivity to the drug caused by a genetic

Exercise 1 Pediatric Computation

- Dahil 2 years and 6 months and bata palang kailangang

1000 ml 15gtts/ml - Multiply 2 kasi: 7am – 9am, 2hours.

1000 ml 15gtts/ml 15,000

- A document that provides direction on the type of nursing care

- Review clinical history assess patient (gather information;

Implementation - Effectiveness of health teaching about drug therapy and

The Steps of the Nursing Process

1) Somatic nervous system

2) Autonomic nervous system (Automatic)

Parasympathetic nerves Sympathetic nerves

Stimulate activity of stomach –

nastimulate si sympathetic Effects of activation – Alpha

Effects of Activation – Beta

 Sympathomimetic (adrenergic) = sympathetic stimulants

 Sympatholytic (adrenergic blockers) =

 Direct – will bind directly to the receptor

Indirect acting Adrenergic Agents: Side Effects

- Reduction in Peripheral Resistance – blocking both α1 &

Parasympathetic Nervous System

Beta 1 vs Beta 2 Selectivity

o Nicotinic – coordination, movement

- Hindi mo kaya icontrol ung muscles mo.

- Action: block ganglionic nicotinic receptors in both

 Hexamethonium – nicotinic receptor antagonist

 Side effects: marked venous pooling-> postural hypotension

b) Neuromuscular blocking drugs (n1)

- Compete with Ach for the receptor sites on motor end

Hirap intindihin yung pharma kung hindi kau nakinig sa discussion

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