HISTORICAL TRENDS
 Since the beginning people search to treat illness
and cure disease the oldest known prescription
found on a clay (5,000 years ago).
 Primitive people through the Egyptian period believe
that evil spirit living in the body.
 Hippocrates (5th century) advanced idea that disease
resulted from natural causes.
 The Arabs’ interest of in medicine, pharmacy and
chemistry was reflected in hospitals and schools.
 In twenty first century, the emphasis on providing
quality health care.
 Nursing role which include administering medication
in health care agency, community and home care
setting, teaching client safe and effective self
administration to better care for their clients.
PHARMACOLOGY
 Is a science that studies the effects of drugs within
the living system.
 It deals with all legal and illegal drugs used in society
today.
 In Nursing Practice, it applies knowledge from many
different disciplines including anatomy physiology,
pathology, microbiology, chemistry, mathematics
and psychology.
PHARMACEUTICAL
 Any kind of drug used for medicinal purposes, like
cough syrup or sleeping pills.
WHAT THE NURSE DO?
 Understanding any medication before giving to a
client.
 Knowledge in the usual dosage, route of
administration
 Indication
 Significant adverse effect
 Major drug interaction
 Contraindication
 Nursing responsibilities
DEFINITION OF TERMS:
– is the total of all authorized drugs
available within a country; it contains description, recipes,
strengths, standards of purity, and dosage forms for the drugs.
– substance administered for the diagnosis,
cure, treatment, or relief of a symptom or for prevention of
disease.
– same as medication. A medicine or other substance
which has a physiological effect when ingested or otherwise
introduced into the body.
– drug that can be purchased without prescription.
– the written direction for the preparation and
administration of a drug.
– the name used throughout the drug’s
lifetime.
– given by the drug manufacture and
identifies it as property of that company.
– this is the name which the drug is listed in
the official publications.
– is the name by which a chemist knows it;
describes the constituents of the drug precisely.
– is the primary/desired effect
intended that is the reason the drug is prescribed such as
morphine sulfate is analgesia.
– secondary effect of the drug is one that is
unintended, side effects are usually predictable and may be
either harmless or potentially harmful.
- negative/side effect of a drug that
undesirable and potentially dangerous.
 May justify the discontinuation of a drug.
 The nurse should report this to the health care
provider.
– harmful effect of the drug on an organism
or tissue, result from overdose or external use drug, or buildup
of drug in blood.
– is immunological reaction to a drug.
 Mild allergic reaction
 Severe allergic reactions (anaphylaxis) – this
response can be fatal.
– occurs when administration of one
drug before or after alter effect of one or both drug.
– is the improper use of common medication
in a way that lead to acute and chronic toxicity for example
laxative, antacid and vitamins.
 – is an inappropriate intake continually or
periodically.
– is a person’s reliance on or need to
take drug or substance there are two type of dependence:
 Physiological dependence: is due to biochemical
changes in the body tissue these tissue come to
require substance for normal function.
 Psychological dependence: is emotional reliance
on a drug to maintain a sense of well-being
accompanied with feeling of need.
– denotes a mild form of psychological
dependence.
– also called street drug are those sold illegally.
– the aim to give patient a dose of the drug that achieves
the desired effect without causing with harmful side effect.
– is a measure of the danger of
poisoning and the higher it is the safer of drug is.
 Aspirin (3.5), digoxin (2)
 Bioavailability: means that the drug has reached the
circulation and is therefore available for all the
tissues. (ex: aspirin 600 mg)
 Tolerance: a decreasing response to repetitive drug
doses.
BASIC CONCEPTS OF PHARMACOLOGY
– study of absorption, distribution,
biotransformation, and excretion of drugs. This is how the body
reacts to the drug.
– the effect of drug on the body.
This is how the drug acts in the body.
– is a clinical using of drug.
– the study of natural (plant and animal)
drug sources.
– origin
– movement through body
– use/purpose
– side effects
PROPERTIES OF IDEAL DRUG
1.
 A drug that elicits the response it was meant to.
 It is the most important property.
 No effect = no justification of use (FDA approved with
appropriate experiments).
2.
 Pharmakon = poison in Greek
 Safe even at high concentrations and for long
periods of administration (no such thing as a safe
drug)
 Reduce by administration (iv, im, sc, etc..)
 No habit forming aspects
 No side effects (excessive dosage of opoid
analgesics carries a risk of respiratory failure,
cancer drugs infections, aspirin causes gastric
ulcer etc…)
3.
 One that elicits only the response for which it is given
 Selective for specific reaction with no side effects
(there is no such thing)
 Drowsiness can be caused by
antihistamines
 Morning sickness, cramps, and depression
can be caused by oral contraceptives.
 Constipation, urinary hesitance, and
respiratory depression can be caused by
morphine.
ADDITIONAL PROPERTIES OF IDEAL DRUG (NO
DRUG IS IDEAL!)
1.
 Effects be reversible, i.e., removal/subside w/i
specific time (1/2 life is short but potent during that
time)
 Example: General Anesthetic; Contraceptives
2.
 Know how patient will respond
3.
 Number of doses should be low and easy to
administer
 Increase compliance & decrease errors
o Diabetic patient: Multiple daily injection of
insulin
o Intravenous infusion
4.
 Should not augment or decrease action of other
drugs or have adverse combined effects
  Respiratory depression caused by diazepam
(Valium), which is normally minimal, can greatly
be intensified by alcohol.
 Antibacterial effects of Tetracycline can be
greatly reduced by taking iron or calcium
supplements
5.
 Easy to afford (especially with chronic illness)
 Growth hormone (somatrem) costs between
$10,000 and $20,000.
 Lifelong medication: hypertension, arthritis,
diabetes
6.
 No lose of effectiveness with storage
7.
 Easy to remember and pronounce
 Example: Viagra (sildenafil); Tylenol
(acetaminophen)
Because no drug is ideal….
 No medications are ideal
 No drug is safe
 All drugs produce side effects
 Drug responses may be difficult to predict
 Drug may be expensive
 Drugs may be hard to administer
All members of health care team must exercise care to
promote therapeutic effects and minimize drug induced harm.
 Drugs are substances that are used or intended to
be used in the diagnosis, prevention, treatment or
cure of diseases.
 In early times, these substances were derived from
natural sources, of which plants took up the major
share.
 With the introduction of technology, most drugs today
are manufactured synthetically in the laboratory.
SOURCES OF DRUGS
1.
 Plants are important chemicals that develop into
drugs.
 A number of plants have medicinal qualities and
have been used for centuries as drugs or drug
sources. Although the earliest plant source for drugs
was the leaf, other parts of plants (e.g., barks, fruits,
roots, stem, wood, seeds, blossoms, bulb, etc.) were
also later exploited for drug extraction.
 Where the product is used without further processing
 e.g., ground leaves or bark, boiled concoctions or
powdered sap, the substance is called crude drug.
2.
 are used to replace human chemicals that are not
produced because of disease or genetic problems.
 Many important drugs are derived from animal
source. In most instances, these medicinal
substances are derived from the animal’s body
secretions, fluid or glands. Insulin, heparin,
adrenaline, thyroxin, cod liver oil, musk, beeswax,
enzymes, and antitoxins sera are some examples of
drugs obtained from animal sources. Like plant
products, drugs from animal sources may be crude
(unrefined) or refined material.
o Insulin for treating diabetes is exclusively
obtained from cow pancreas tissue.
o Now genetic engineering – the process of
altering DNA – permits scientist to produce
human insulin by altering E. coli bacteria.
3.
 Several life-saving drugs have been historically
derived from microorganisms.
 Examples include penicillin produced by Penicillum
chrysogenum, streptomycin from Streptomyces
griseus, chloramphenicol from Streptomyces
venezuelae, neomycin from Streptomyces fradiae,
bacitracin from Bacillus subtilis etc. Xanthan
(polysaccharide gum secreted by Xanthomonas
campestris), dextran (polysaccharide of glucose
synthesized by lactic acid bacteria.
4.
 Bioactive compounds from marine flora and fauna
have extensive past and present use in the
prevention, treatment or cure of many diseases.
Coral, sponges, fish, and marine microorganisms
produce biologically potent chemicals with
interesting anti-inflammatory, anti-viral, and
anticancer activity.
 For example, curacin A from marine cyanobacterium
Lyngbya majuscule, eleutherobin from coral
Eleutherobia sp., discodermolide from marine
sponge Discodermia dissolute, etc. show potent anti-
tumor activity.
5.
 Minerals (both metallic and non-metallic minerals)
have been used as drugs since ancient times. Our
body requires trace elements of minerals in order to
maintain homeostasis. Patients lacking on adequate
level of these materials may take specific mineral-
based drugs to raise the level of minerals.
 Examples include ferrous sulfate in iron deficiency
anemia; magnesium sulfate as purgative;
magnesium trisilicate, aluminum hydroxide and
sodium bicarbonate as antacids for hyperacidity and
peptic ulcer; zinc oxide ointment as skin protectant,
in wounds and eczema; gold salts (solganal,
auranofin) as anti-inflammatory and in rheumatoid
arthritis; selenium as anti-dandruff.
6.
 A synthetic drug is produced using chemical
synthesis, which rearranges chemical derivatives to
form a new compound. The synthetic sources of
drugs evolved with human skills in the laboratory and
advanced knowledge and understanding of
phytochemical investigation. At present, majority of
drugs used in clinical practice are exclusively
prepared synthetically in pharmaceutical and
chemical laboratory.
 One of the earliest synthetic drugs was
sulphonamide, which began with the synthesis of
prontosil dye. Other examples include acetylsalicylic
acid (aspirin or ASA), oral antibiotics, antihistamines,
thiazide diuretics, chloroquine, chlorpromazine,
general and local anesthetics, paracetamol,
phenytoin, etc.
 Synthetically manufactured drugs generally have
higher yields that are significantly associated with
quality, purity, and low cost.
7.
 Semi-synthetic drugs are neither completely natural
nor completely synthetic. They are a hybrid and are
generally made by chemically modifying substances
that are available from natural source to improve its
potency, efficacy, and/or reduce side effects.
Sometimes, semi-synthetic processes are used to
prepare drug when the natural sources may yield
impure compounds or when the synthesis of drugs
(complex molecules) may be difficult, expensive, and
commercially unviable.
 In semi-synthetic drugs, the nucleus of drug obtained
from natural source is kept intact but the chemical
structure is altered. Examples of semi-synthetic
medicine include heroin from morphine,
bromoscopolamine from scopolamine, homatropine
from atropine, ampicillin from penicillin etc.
8.
 This is relatively a new field which is being developed
by mixing discoveries from molecular biology,
recombinant DNA technology, DNA alteration, gene
splicing, immunology, and immune pharmacology.
Drugs developed using living organisms with the help
of biotechnology or genetic engineering are known
as biologics, biopharmaceuticals, recombinant DNA
expressed products, bioengineered, or genetically
engineered drugs.
 Examples include recombinant Hepatitis B vaccine,
recombinant insulin and others.
4 STAGES OF NEW DRUG DEVELOPMENT
1.
 Starts with discovery, synthesis and purification of
drug
 Functions:
o To know if with therapeutic value
o Safe in animals
2.
 “testing in humans” stage.
 3 phases:
 Phase I
 Tested in small # of healthy volunteers.
 Initial info on the effects in humans.
 Phase II
 Tested in small, selected population (10-150
subjects)
 To evaluate the therapeutic effect in treating specific
disease/pathologic condition.
 Phase III
 More clients (several hundredths-thousands)
 Provides info on proper dosing and safety.
3.
 The drug is submitted to FDA for new drug
application
4.
 Known as “postmarketing surveillance”
 Final stage of drug approval process.
 It surveys the drug’s harmful effects.
 DRUG CLASSIFICATIONS
1.
 Examples:
 Antibiotics
cefuroxime, penicillin, erythromycin
 Laxatives
o Bulk-forming – sterculia (normacol),
methylcellulose (citrucel)
o Stool softeners – Colace, diocto
o Lubricants or emollient
 Diuretics
 Antacids
2.
 Examples:
1. Beta-adrenergic blockers
o Management of cardiac arrhythmias
o Block the action of epinephrine
norepinephrine
o Ex. Propranolol
3.
 Requiring prescription
 Ordered/dispensed only by an authorize practitioner
4.
 Drugs available over the counter
 Not requiring any prescription for use
 Can be purchased directly by consumer
 Used to treat relatively minor problems and
conditions
 Judged to be safe for used by the consumer without
direct medical supervision
5.
 Use for non-therapeutic purposes.
 Also referred as “recreational drugs”
 Drugs not approved by FDA/BFAD
TOP 10 MOST RECREATIONAL DRUGS
1. Cannabis or Marijuana, Grass, Hemp, Weed, Pot, Hash,
Dope – slightly drunken but euphoric sensation.
2. Heroin/Diamorphine – powerful painkiller and users
experience exhilaration, euphoria and a sense of well-being.
3. Cocaine (Coca plan) – powerful stimulant, appetite
suppressant and anesthetic
4. Ecstasy – psychotherapeutic drug. Produces euphoria and
a feeling of well-being, decreased levels of fear and anxiety and
a physical stimulant and sensational effect in users.
5. Amphetamines – affecting the amount of dopamine and
serotonin in the brain.
6. Barbiturates/Benzodiazepines – a prescription medicine
7. LSD (Lysergic Acid Diethylamide) – most powerful
hallucinogenic
8. Opium – addictive painkiller
9. Psychedelic Mushrooms (hallucinogenic mushrooms)
10. Solvent
LEGAL REGULATIONS OF DRUGS
1.
 Reviews drug labeling information on pregnancy and
risk effects to the fetus
and
2.
 Drug Enforcement Administration (DEA)
 Organize to enforce the Controlled Substance
Act
 To gather intelligence, train and conduct
research in the area of dangerous drug and
drug abuse.
3.
 Drug which is produced and distributed without
patent protection
 Drugs which may still have a patent on the
formulation but not on the active ingredient.
 It must contain the same active ingredients as the
original formulation
 Identical/bioequivalent to the brand name
counterpart since these drugs should be identical in
dose, strength, route of administration, safety,
efficacy and intended use.
4.
 Drugs that have been discovered but not financially
viable and therefore have not been “adopted” by any
drug company.
 LEGAL AND ETHICAL ASPECT OF MEDICATION 1. Clotting
Medical Prescriptions 2. Peptidoglycan synthesis
3. Inflammation
1. It is not permissible to prescribe restricted drugs except by 4. Blocking of virus
authorized doctors, and the restriction related to these drugs
should be followed. 4.

2. The healthcare practitioner should not write a prescription  Each patient is unique in ability to respond and to
only for pleasing his/her patient or the patient’s relatives. how they each respond, but formation of “IDEAL
DRUG” will lessen this variation.
3. The prescription should be written in clear handwriting, with  Age – very important factor
the healthcare practitioner’s name, signature, the name of the  Sex – due to hormonal differences
institution he/she works in, date of prescription, patient’s  Weight – less effective and longer lasting
information, diagnosis, drug dose, its pharmacological form, in obese individuals (storage in fat)
daily dose, and duration of treatment. This all must be reported  Kidney & liver functions – elimination of
in the patient’s record. drug
Note: It is prohibited for a pharmacist to dispense any  Genetic variables – tolerance, allergy
medication without a prescription issued by a physician (though not always genetic)
licensed to practice. See the Law of Practicing Healthcare
Professors.
DOCTOR PRESCRIPTION
Components of prescription need to assess:
THERAPEUTIC OBJECTIVE
 Client
 To provide maximum benefit with minimum harm
 Date
FACTORS THAT DETERMINE INTENSITY OF  Medication
RESPONSE:  Dosage and frequency
1. – dosage size and route  Route

 Because of errors in administration routes and

dosage and at wrong time there are many
discrepancies in what patient gets and could cause
more harm than good
 Errors could be made by pharmacists, physicians, or
nurses
 Should give patients complete instruction about their
medication and how to take it
2. – determines how
much of an administered dose gets to its sites of action
LEGAL REQUIREMENTS NEED TO BE MET
BEFORE ADMINISTER A DRUG
1. The medication order must be valid
2. The physician/prescriber and the nurse must be
licensed
3. The nurse must know the purpose, action, effects,
and major adverse effects of the drug, and the
teaching required to enable the client or caregiver to
self-administer the drug safely and accurately.

 Drug absorption
 Drug distribution SIX RIGHTS OF MEDICATION ADMINISTRATION
 Drug metabolism 1. – the one that was
 Drug excretion prescribed and one that is not contraindicated.
3. – determine the type of response 2. – not someone else
and intensity medication by mistake, nor the medication of the
person in the next bed
 Once a drug has reached its site of action, it must 3. as prescribed and appropriate
first bind to its specific target site at (RECEPTOR) – this may involve simple mathematical computation
4. , form of the drug, and
Receptor:
administration technique prescribed
 May be a chemical, a protein on a cell or in blood or 5. for the dose – usually within 30
tissue spaces or on a bacteria or virus. mins of the time indicated and at beneficial intervals
 Ex. Heparin, antibody, leukotriene receptor (new), as ordered.
penicillin, etc. 6.

Series of events that result in response such as inhibition of:

 PRINCIPLE OF DRUG ACTION
1. Drugs only modify existing functions on a tissue or body
organ; they do not create new functions
 The effects of drugs can be recognized only by
alternations of a known physiologic function or
process such replacing, interrupting or potentiating a
physiologic process in specialized tissues.
 For example, drugs used to treat anemia can replace
iron to restore the adequate production of red blood
cell.
2. Drugs in general exert multiple actions rather than a single
effect.
 Different tissues may use similar or identical system
process and a drug that impacts such system or
processes affects multiple tissues.
 For example, Atropine – a drug that has affinity for
heart, lungs gastrointestinal and other tissues if
administered to client with COPD we observe the
desired improved bronchodilation but may also
observe elevated heart rate, constipation dry mouth
and urinary retention.
3. Drug action results from a physiochemical interaction
between the drug and a functionally important molecule in the
body
 Some drugs act by combining with a small molecule
in the cellular environment like antacids neutralize
gastric acid. However, majority of drugs work by
interacting with specific macromolecular components
in tissues.
 Note: Pharmacodynamics is the study of drug
interaction.
4. For a drug to achieve its function and interaction in the body,
it must be present in adequate quantities at its specific site of
action.
 If a drug has an effect in heart tissue, an adequate
quantity of that drug must reach cardiac tissue to
exert pharmacologic effects.
FACTORS AFFECT DRUG ABSORPTION
1. Nature of the absorbing surface (cell membrane) through
which the drug must cross.
2. Blood flow to the site of administration
3. Solubility of the drug
4. pH – acidity vs. alkalinity
5. Molecular weight – Vancomycin has large molecular weight
administered IV when administered orally is minimally
absorbed into systematic circulation in treating C. difficile
diarrhea.
6. Dosage form
FACTORS CAN ALTER AN INDIVIDUAL’S
RESPONSE TO DRUG THERAPY
1.
 Infants immature body system
 Children-dosage adjustment usually necessary
 Older adult-depressed hepatic and renal system
2.
 The greater the volume of distribution of the drug in
body mass, the lower the concentration of the drug
in the body compartment.
3.
 Woman smaller than men; definite difference during
pregnancy and in relative proportion of fat and water;
drugs and vary by water or fat soluble
4.
 Mood and behavior modified by
 Drug itself
 Personality of the user
 Environment of the user
 Interaction of these three factors
5.
 Present or absence of food
 Biologic rhythms – sleep – wake cycle, circadian 24
hours cycle in absorption and urinary excretion
 Insufficient fluid intake with solid dosage form
6.
 Pain intensifies the need of opioids
 Anxiety may resist to large dose of tranquilizing drugs
 Presence of circulatory, hepatic and renal
dysfunction interfere physiologic process of drugs
7.
 Genetic differences can sometimes explain patient’s
varied/different responses to a given drug
 Some people lack enzyme systems necessary for
metabolizing a drug.
8.
 The patients attitude about a drug has been shown
to have an effect on how the drug work
 A drug is more likely to be effective if the patient
thinks it will work than if the patient believes it will not
work. This is called Placebo effect.
 DIFFERENT CHARACTERISTICS OF DRUG
RESPONSE
1. – refers to a decrease physiologic response
that occurs after repeated administration of a drug or a
chemically related substance.
2. – refers to a quickly developing
tolerance that occurs after repeated administration of a drug.
3. – occurs when the body cannot
metabolize one dose of a drug before another dose is
administered.
4. – is any abnormal or peculiar response to
a drug which may manifest itself by;
 Overresponse or abnormal susceptibility to a drug
 Under response, which demonstrate abnormal
tolerance
 A qualitatively different effect from the one expected
such a excitation after administration of a sedative
 Unpredictable and unexplainable
VARIOUS TYPES OF DRUG ORDERS
1.
 It may or may not have a termination
 It may be carried out indefinitely until an order is
written to cancel it or maybe carried out on a
specified number of dates.
 Example: Demerol 100 mg. IM every 4 hours for 5
days
 Example: Multivitamins 1 tablet daily
2.
 Given at the client’s need and nurse’s judgement
concerning need and safety.
 Example: Hyoscine butylbromide 20 ml. prn.
3.
 Given once and usually at a specific time
 Example: Pre-operation medication. Seconal 100
mg. hs before surgery

5. is the term preferred over the 4.

previous terminology of “habituation” and “addiction” it maybe
physical or psychological.  Given once immediately as a single dose
 Example: Nubain 10 mg. IM stat.
6. occurs when the effects of one drug
are modified by the prior or concurrent administration or an
other drug, thereby increasing or decreasing the INDICATORS FOR EVALUATING THE
pharmacologic action of each. ADMINISTRATION OF MEDICATION
 The drug is administered in the ordered dose
7. occur when the combination effects
 The drug is administered by the ordered route
of two drugs is less than the sum of the drugs acting separately.
 The drug is administered by the ordered site
8. (addition or additive effect) occurs when the  The drug is administered at the ordered rate
combined effect of two drugs produces a result that equals the  The drug is administered in the ordered drug form
sum of the individual effects of each agent. Written as 1 + 1 =  The drug is administered in the ordered schedule
2  The drug is administered using the correct technique
 Example codeine and aspirin both acts as analgesic
when given together they provide greater pain relief
together they provide greater pain relief than when
either one used alone.

9. describes a drug interaction in which the

combined effect of drugs is greater than the sum of each
individual agent acting independently written as 1 + 1 = 3 or
greater.

10. refers to the concurrent administration of

two drugs in which one drug increase the effect of the other
drug.