Module 1
Introduction to Pharmacology and Drugs
Lesson 1
FUNDAMENTAL CONCEPTS OF
PHARMACOLOGY
Drugs - chemicals which when absorbed,
exhibit specific response or action
Pharmacology - science which is concerned
with the history, sources, physical and
chemical properties of drugs as well as ways
in which drugs affect living systems
Pharmacogenetics - study of genetic factors
as determinants of drug responses
Pharmacognosy - study of drugs derived
from natural resources
Pharmacy - science of preparing,
compounding and dispensing medicines
Toxicology - study of harmful effects of
drugs on living tissues
Posology - the study of dosage or amount of
drugs given in the treatment of disease
Therapeutic Effect - desired or primary*
Side Effect - unintended; secondary effect**
Drug Allergy - immunologic reaction to a
drug
Anaphylactic Reaction - a severe reaction
that usually occurs immediately following the
drug administration
Drug Tolerance - decreased physiologic
response to the repeated administration of a
drug or chemically related substance*
Cumulative Effect - increasing response to
the repeated doses of a drug**
Is Alcohol a food or a drug?
ALCOHOL – is classified as a Central
Nervous System Depressant, which mean
drinking alcohol slows down brain functioning,
neural activity and further reduces the
functioning of various vital functions of the
body.
Drug Abuse - inappropriate intake of a
substance either continually or periodically
Drug Dependence - refers to person’s
reliance or a need to take a drug or
substance*
Addiction - the tissues come to require the
substance for normal functioning**
Habituation - the emotional reliance on a
drug to maintain a sense of well-being
accompanied by feelings of need or cravings
for the drug*
Controlled Drugs - drugs that affect the
mind or behavior which can be dispensed
only with a prescription
Idiosyncratic - drug reaction is different from
what is expected**
Drug Interaction - effects of one drug are
modified by the prior or concurrent
administration of another drug*
Drug Antagonism - conjoint effect of 2 drugs
is less than the drug acting separately
Summation - the combined effect of 2 drugs
produces a result that equals the sum of the
individual effects of each agent
Synergism - the combined effect of 2 drugs
is greater than the sum of each individual
agent acting separately
Potentiation - the concurrent administration
of 2 drugs in which one drug increases the
effect of the other drug
DRUGS’ GENERAL PROPERTIES
 drugs do not confer any new function
on a tissue/ organ in the body
 drugs exert multiple actions rather than
a single effect
 drug interactions result from a
physiochemical interaction between
the drug and a functionally important
molecule in the body
 BRAND NAME - drug commercial name
which may vary

THERAPEUTIC ACTIONS
Palliative - relieves the symptoms of a
disease but does not affect the disease itself Therapeutic Equivalence
 Same chemical composition
Curative - treats a disease or condition  FDA conduct studies
 Generic drug is interchangeable with
Supportive - sustains body functions until brand name drug
other treatment of the body’s response can
take over General Terms
 Chemical Similarity
Substitutive - replaces body fluids or  Biological Effect or Use
substances  Physiologic or Chemical Action
Chemotherapeutic - destroys malignant Legal Classification
cells
 OTC/ Non-prescription Drugs
 Prescription Drugs
Restorative - returns the body to health
 Illegal or Recreational Drugs
CATEGORIES OF DRUG ACTION
Stimulation - rate of cell activity or secretion IMPORTANT:
is increased - Learn Drug by category
- Don’t learn each individually
Depression - rate of cell activity or secretion
is reduced **** Prototype
- Drug providers commonly prescribed.
Replacement - replaces essential body - Drug administration table
compounds, etc.
Lesson 2
Inhibition - killing or destroying organisms MAJOR AREAS OF PHARMACOLOGY

Irritation - ex. laxatives irritate the inner wall Areas of PHARMACOLOGY

of the colon increasing peristalsis and Pharmacokinetics - study of the processes
defecation of drug

HOW ARE DRUGS CLASSIFIED? Pharmacodynamics - study of the

biochemical and physiological effects of the
Specific Names drugs as well as their MOA (mechanism of
action)
 4-Thia-1-azabicyclo (3.2.0) heptane-2-
carboxylic acid, 6[(aminophenylacetyl)
Pharmacotherapeutics - study of how drugs
amino)]-3,3- dimethyl-7-oxo ampicillin
may be used in the treatment of the disease
 Ampicin
PHARMACOKINETICS
Generic vs. Brand Name
GENERIC - company develops drug and give
 Absorption: taken into the body
its official name
 Distribution: moved into various
 are usually cheaper than brand or
tissues
Trade name drugs
 Metabolism/ Biotransformation:
 Patient and insurance companies
changed into a form that can be
prefer generic drugs-Helps decrease
excreted
cost of drug
 Excretion: removed from the body
ABSORPTION - the process by which drug Outcome of Metabolism
passes from its site of administration into the  increased renal excretion of
bloodstream medication
 Inactivation of medications
 Increased therapeutic effect
 Activation of pro-medications (also
Factors Affecting Drug Absorption: called pro-drugs) into active forms
 blood flow  Decreased toxicity when active forms
 pain, stress, food of medications become inactive forms
 exercise  Increased toxicity when inactive
 nature of absorbing surface forms of medications become active
 solubility of the drug forms
 pH
 drug concentration EXCRETION - the primary process by which
 dosage form drugs are eliminated from the body
- Drugs can be excreted by the kidneys,
Types of Absorption intestines, lungs, mammary, sweat and
 Passive salivary glands
 Active
 Pinocytosis Factors Affecting Renal Excretion:
 GFR
Different sites of absorption in the GIT  tubular secretion rate
 mouth or oral cavity  urine pH
 stomach  decreased blood flow to the kidneys
 small intestine*  other drugs
 blood concentration levels
*Hepatic first pass/first pass effect**  half-life

DISTRIBUTION - he transportation of a drug Old Age and Drugs

from its site of absorption to its site of action  altered memory
 less acute vision
Factors Affecting Drug Distribution:  decreased renal function
 Circulation  less complete and slower absorption
 Permeability of cell membrane  from the gastrointestinal tract
 Plasma protein binding  increased proportion of fat to lean
 body mass
Bioavailability - percentage of the  decreased liver function
administered drug dose that reaches the  decreased organ sensitivity
systemic circulation  altered quality of organ
responsiveness
METABOLISM - biotransformation or
detoxification PHARMACODYNAMICS
- a sequence of chemical events that
change a drug to a less active form Mechanism of Action (MOA) - explanation
after it enters the body of how a drug produces its effect
- principal site is the liver
- hepatic first pass effect Indication - intended use(s) of any drug
Factors Affecting Drug Metabolism: Contraindication - refers to the situation or
 age circumstance when a particular drug should
 nutrition not be given
 amounts of major body hormones
 liver disease
Maintenance Dose - exact amount of a drug
that is administered to maintain drug blood
level in the therapeutic range
Loading Dose - a large initial dose given to
achieve immediate drug effect
Potency - a measure of the strength of a
drug required to produce a specific response
Receptor Site - specific location on a cell
membrane or within the cell where a drug
attaches to produce an effect
Receptor Theory - drugs act through
receptors by binding to the receptor site to
produce or initiate and to block or prevent a
response
Agonists - drugs that stimulate or produce a
response; 2 properties- affinity and efficacy*
Antagonist - drugs that block or do not
stimulate a response*
Competitive-antagonism - when both
agonist and antagonist drugs are given
together, they may compete with each other
for the same receptor site
Partial Agonists - act as agonists and
antagonists, with limited affinity to receptor
sites.
ONSET, PEAK & DURATION
Onset - the time it takes to reach the
minimum effective concentration (MEC) after
a drug is administered*
Peak - occurs when the drug reaches its
highest blood or plasma concentration
Duration - the length of time the drug has a
pharmacologic effect
Dose Response and Maximal Efficacy
 dose response is the relationship
between the minimal versus the
maximal amount of drug dose needed
to produce the desired drug response
 some patients respond to a lower drug
dose, others need a high drug dose to
elicit the desired response
 all drugs have maximum drug effects
(maximal efficacy)
Receptors
 most are protein in structure and are
found on cells
 drug binding sites are primarily on
proteins, glycoproteins, proteolipids,
and enzymes
 the “ligand binding domain” is the site
on the receptor in which drugs bind
SIDE EFFECTS, ADVERSE REACTIONS &
TOXIC EFFECTS
Side Effects - physiologic effects not related
to the drug’s desired effect; all drugs have
side effects, desirable or not*
Adverse Reactions - more severe than side
effects; range of untoward effects of drugs
that cause mild to moderate side effects
including anaphylaxis; always undesirable
Toxic Effects or Toxicity - can be identified
by monitoring the plasma (serum) therapeutic
range of drug**
Therapeutic Index
 the relationship between a drug’s
desired therapeutic effect and its
adverse effect
 measures the margin of safety of a
drug expressed as the ratio of LD50 to
ED50
 therapeutic ratio = LD50/ED50
 therapeutic range or window: range of
 plasma concentration that produces
the desired effect without toxicity
PHARMACOTHERAPEUTICS
Acute Therapy - if the patient is critically ill
and requires acute intensive therapy
Empiric Therapy - based on practical
experience rather than on pure scientific data
Maintenance Therapy - or patients with
chronic conditions that don’t resolve
Supplemental or Replacement - to
replenish or substitute for missing substances
Supportive - does not treat the cause of the
disease but maintains other threatened body
systems until the patient’s condition resolves
Palliative - used for end-stage or terminal
diseases to make the patient as comfortable
as possible
Lesson 3
PRINCIPLES IN DRUG ADMINISTRATION
IMPORTANT:
 Observe the 12 Rights
 Practice asepsis
 Nurses who administer medications
are responsible for their own actions
 Be knowledgeable about the
medications that you administer
 Keep narcotics and barbiturates in
locked place
 Use medications that are in clearly
labeled containers
10 RIGHTS OF GIVING MEDICATION
1. RIGHT CLIENT
 Verify clients’ identification before each
medication administration.
 Acceptable identifiers include the
client’s name, an assigned
identification number, telephone
number, birthdate, or another person-
specific identifier, such as a photo
identification card.
 Check identification bands for name
and identification number.
 Check for allergies by asking clients,
looking for an allergy bracelet or
medal, and reviewing the MAR. Use
bar-code scanners to identify clients.
2. RIGHT MEDICATION
 Correctly interpret medication
prescriptions, verifying clarity and
completeness.
 Read medication labels and compare
them with the MAR three times: before
removing the container, when
removing the amount of medication
from the container, and in the
presence of the client before
administering the medication.
 Leave unit-dose medication in its
package until administration.
3. RIGHT DOSE
 Use a unit-dose system to decrease
errors. If not available, calculate the
correct medication dose.
 Check a drug reference to ensure the
dose is within the usual range.
 When performing medication
calculations or conversions, have
another qualified nurse check the
calculated dose.
 Prepare medication dosages using
standard measurement devices
4. RIGHT TIME
 Administer medication on time to
maintain a consistent therapeutic
blood level.
 It is generally acceptable to administer
the medication 30 min before or after
the scheduled time. Refer to the drug
reference or the facility’s policy for
exceptions.
 Give priority to time-critical
medications that must act at specific
times (preoperatively).
5. RIGHT ROUTE
 Select the correct preparation for the
route the provider prescribed.
 Always use different syringes for
enteral and parenteral medication
administration.
 Know how to administer medication
safely and correctly.
6. RIGHT DOCUMENTATION
 Immediately record the medication,
dose, route, time, and any pertinent
information, including the client’s
response to the medication.
 Document the medication after
administration, not before.
 For some medications, in particular to
those that alleviate pain, evaluate the
client’s response and document it
later, perhaps after 30 min.
7. RIGHT EDUCATION
  Inform clients about the medication: its
purpose, what to expect, how to take
it, and what to report.
 To individualize the teaching,
determine what the clients already
know about the medication, need to
know about the medication, and want
to know about the medication
8. RIGHT TO REFUSE
 Respect clients’ right to refuse any
medication.
 Explain the consequences, inform the
provider, and document the refusal.
9. RIGHT ASSESSMENT
 Collect any essential data before and
after administering any medication.
 For example, measure apical heart
rate before giving digoxin.
10. RIGHT EVALUATION
 Follow up with clients to verify
therapeutic effects as well as side and
adverse effects.
Sources of Drug Information
Drug Handbook
 medical reference text commonly used
in practice by health professionals
Physician’s Desk Reference (PDR)
 commercially published compilation of
manufacturer’s prescribing information
(package insert) on prescription drugs,
updated annually*
Package Inserts
 prescribing information; a document
provided along with a prescription
medication to provide additional
information about a drug
Nursing Journals
 a magazine or periodical, especially
one published by a nursing specialist
or professional body for nurses
containing information and
contributions relevant to nursing
Medical Letter
 a scientific journal that provides
independent evaluations of drugs
based on novel information
Monthly Index of Medical Specialties
(MIMS)
 contains information about drugs in a
certain country; serves as medical
advertising medium
Legal Aspects of Drug Administration
USA
Food, Drug and Cosmetic Act (1938)
 empowered a governing body, the
Food and Drug Administration (FDA)
to monitor and regulate the
manufacture and marketing of drugs
Durham-Humphrey Amendment to the
1938 Act (1952)
 distinguished drugs that can be sold
with or without prescription and those
that should be refilled without a new
prescription
Kefauver-Harris Amendment (1962)
 made statements about adverse
reactions and contraindications;
introduced drug-testing methodologies
 tightened controls on drug safety,
especially experimental drugs and
required that adverse reactions and
contraindications must be labeled and
included in the literature*
Controlled Substances Act (1970)
 categorized controlled substances
based on their abuse potential
 offered manufacturers incentives to
develop drugs for rare disorders that
have limited market
 designed to remedy the escalating
problem of drug abuse
Provisions
 promotion of drug education and
research into the prevention and
treatment of drug dependence
 strengthening of enforcement authority
 establishment of treatment and
rehabilitation facilities
  designation of schedules or categories
for controlled substances according to
abuse liability
Schedules of Controlled Substances
Schedule I
 high potential for abuse and with no
currently accepted medical use
Schedule II
 high potential for abuse with currently
accepted medical use; can lead to
strong physical and psychological
dependence
Schedule III
 high potential for abuse; requires a
new prescription after 6 months or 5
refills; medically- accepted drugs but
may cause dependence
Schedule IV
 low potential for abuse compared to
the first three; abuse may lead to
limited physical or psychological
dependence; medically-accepted
drugs
Schedule V
 low potential for abuse; dispensed as
any other prescription or without
prescription if the law allows;
medically-accepted drugs with limited
potential for dependence
CANADA
Food and Drug Act (1953)
 states that no drug, food, cosmetic nor
medical devise can be fraudulently
advertised or sold to the public for use
Narcotic Control Act (1982)
 similar to US Controlled Substance
Act; the act requires prescriptions and
strict record keeping for all narcotics
PHILIPPINES
Dangerous Drugs Act (2002)
RA 9165; (1972) RA 6425
 states that sale, administration,
delivery, distribution and transportation
of prohibited drugs are punishable by
law*
Generics Act (1988) RA 6675
 promotes, requires, and ensures
identification of medicines by their
generic names**
Cheaper Medicines Act (2008) RA 9502
 provides for cheaper and quality
medicines
Nursing Law (2002) RA 9173
 focuses on independent and
coordinated function of the nurse
pertaining to the application and
execution of written legal orders of
physician concerning treatment and
medication
Pregnancy Categories for Drugs
Category A
 no risk for fetus; studies have not
shown evidence of fetal harm
Category B
 insufficient data to use in pregnancy;
no risk in animal studies; assumed
there is little to no risk in pregnant
women
Category C
 benefits of the medication could
outweigh the risks; animal studies
indicate a risk to fetus; controlled
studies on pregnant women are not
available
Category D
 risk to fetus exists but the benefits of
the medication could outweigh
probable risks; could be used in life-
threatening conditions
Category X
 avoid use in pregnancy or those who
may be pregnant; potential risks to the
fetus outweigh the potential benefits

Module 2
DRUGS ACTING ON THE RESPIRATORY
SYSTEM
Lesson 1
Antihistamines & Antitussives
ANTIHISTAMINE
 H1 blockers or antagonists*
 decrease nasopharyngeal secretions
by blocking the H1 receptors
 commonly used to treat colds, allergic
rhinitis but not useful in emergency
situations like anaphylaxis
 rapidly absorbed in 15 minutes
1st Generation Antihistamines
 Cause drowsiness, dry mouth and
other anticholinergic symptoms
 diphenhydramine (Benadryl)*
2nd Generation Antihistamines
 non-sedating antihistamines because
they have little to no effect on sedation
 cause fewer anticholinergic symptoms
 patients should be taught not to drink
even moderate amount of alcohol and
not indicated to those taking CNS
depressants
 cetirizine, fexofenadine, loratadine,
azelastine
Pharmacokinetics
 diphenhydramine – IM, oral, IV; well
absorbed from the GIT; highly protein
bound (98%) and has an average of
half-life of 2-7 hours; metabolized by
the liver and excreted as metabolites
in the urine
Pharmacodynamics
 diphenhydramine blocks the effects of
histamine by competing for and
occupying H1 receptor sites
 has anticholinergic effects and should
not be used by patients with narrow-
angle glaucoma*
 sometimes used in sleep-aid products
and as an antitussive**
 onset is 15 minutes (oral) and
immediate (IV and IM); duration is 4-8
hours
 can cause CNS depression if taken
with alcohol, narcotics, barbiturates or
hypnotics
Side Effects
 1st Generation: drowsiness, dizziness,
fatigue, and disturbed coordination;
anticholinergic effects (dry mouth,
urine retention, blurred vision)
ANTITUSSIVES
 suppress or inhibit coughing act on the
cough control center in the medulla to
suppress the cough reflex
 indicated if the cough is nonproductive
and irritating
 major antitussives: benzonatate,
codeine, dextromethorphan*
hydrobromide, hydrocodone bitartrate
 3 types: nonnarcotic, narcotic or
combination preparations
Pharmacokinetics
 dextromethorphan is available in syrup
or liquid form, chewable and lozenges
in numerous cold and cough remedy
preparations
 rapidly absorbed and exerts its effects
15-30 minutes after oral administration
 unknown protein binding percentage
and half- life
 metabolized by the liver and excreted
by the kidneys
Pharmacodynamics
 dextromethorphan suppresses the
cough center in the medulla; however,
it does not depress respiration
 causes neither physical dependence
nor tolerance
  onset is relatively fast, and duration is
3-6 hours
 CNS depression may occur if used
with alcohol, narcotics, sedative-
hypnotics, barbiturates or
antidepressants
 benzonatate acts by anesthetizing
stretch receptor throughout the
bronchi, alveoli and pleura
 codeine, dextromethorphan, and
hydrocodone suppress the cough
reflex by direct action on the cough
center in the medulla of the brain
Pharmacotherapeutics
 benzonatate relieves cough caused by
Pneumonia, Bronchitis, the common
cold, and COPD like Emphysema
 can be used during bronchoscopy
when the patient needs to avoid
coughing
 narcotic antitussives (codeine and
hydrocodone) are used to treat
intractable cough usually associated
with lung cancer
Drug Interactions
 codeine and hydrocodone may cause
excitation, an extremely elevated
temperature, hypertension or
hypotension, and coma when taken
with monoamine oxidase (MAO)
inhibitors
 dextromethorphan use with MAOIs
may produce excitation, an elevated
body temperature, hypotension and
coma
 codeine may increase CNS
depression* when taken with other
CNS depressants including alcohol,
barbiturates, sedative-hypnotics and
phenothiazines
 coronary and pulmonary vessels and
cause diuresis
THEOPHYLLINE
 relaxes the smooth muscles of the
bronchi, bronchioles, and pulmonary
blood vessels by inhibiting the enzyme
phosphodiesterase resulting in an
increased cAMP* which thereby
promotes bronchodilation
 therapeutic range: 10-20 mcg/ml
 prescribed for the maintenance
therapy for clients with chronic stable
asthma and COPDs
 not prescribed for clients with seizure
disorders, cardiac, renal or liver
disease
Pharmacokinetics
 well absorbed after oral administration
and from oral liquids and uncoated
plain tablets
 metabolized by the liver enzymes and
readily excreted by the kidneys (90%)
 tobacco smoking increases
metabolism thus decreasing the half-
life
 non-smokers and older adults have
average half-life of 7-9 hours; smokers
and children, 4-5 hours; patients with
CHF, Cor Pulmonale, COPD or liver
disease, 12 hours

Lesson 2
ASTHMA DRUGS

METHYLXANTHINES
 xanthine derivatives
 bronchodilators used in asthma
 include theophylline and its derivative
 salts – aminophylline, theophylline
sodium glycinate and oxtriphylline
 stimulate CNS and respiration, dilate