COURSE MODULE

NURSING PHARMACOLOGY
NCM 106
LESSON MODULE 2

UNDERSTANDING CONTEMPORARY ISSUES IN

PHARMACOLOGY
 INTRODUCTION
________________________________
This module will guide the student about the laws
like the FDA Act of 2009, the natural alternative
medications, drug abuse and differences in geriatric
and pediatric pharmacological management.
 This lesson Module 2 will cover the following:

4. Herbal therapy

5. Drugs of abuse

6. Pediatric Pharmacology

7. Geriatric Pharmacology

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 4
 LEARNING OBJECTIVES:
At the end of the module, the student will:
1. Recognize the importance of Republic Act No. 9711. Food
and Drug Administration (FDA) Act of 2009”.
2. Relate the use of herbal and alternative drug therapy in
treating common illnesses and disorders
3. Summarize the main actions of Herbal medications
4. Define drug abuse terminologies
5. Explore common drug of abuse and its influence on client’s
well-being
6. Discuss the major considerations in pediatric clients taking
medications.
7. Discuss the major considerations in geriatric clients taking
medications.

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 5
General Instructions

SGEN Gmail Account: Utilized for important

announcement.
Lesson Content will be uploaded in Moodle
Google Classroom: Class work , post exams and Etc.
Google Drive: Docs , Sheets and Slides
Google Calendar
MOODLE:
Google MEET or Zoom for Synchronous Weekly
sessions : ZOOM ID: 828 802 7631
PASSWORD: 8SArkR
 Short Answer Assignment
1.What is Republic Act 9711?
2.What are the potential dangers of herbal
medications
3.Give 5 herbal preparations that are being promoted
by the DOH in the Philippines.
4.Differentiate the meaning of these terminologies.
Drug Misuse, Drug Abuse and drug Addiction?
5.Give the main points of comparison between a
geriatric client and an adult individual in terms of
drug pharmacokinetic and dynamics.

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 7
 HERBAL THERAPY
⚫Republic Act No. 9711
⚫Food and Drug Administration (FDA) Act
of 2009”.
AN ACT STRENGTHENING AND RATIONALIZING THE REGULATORY CAPACITY OF
THE BUREAU OF FOOD AND DRUGS (BFAD) BY ESTABLISHING ADEQUATE
TESTING LABORATORIES AND FIELD OFFICES, UPGRADING ITS EQUIPMENT,
AUGMENTING ITS HUMAN RESOURCE COMPLEMENT, GIVING AUTHORITY TO
RETAIN ITS INCOME, RENAMING IT THE FOOD AND DRUG ADMINISTRATION
(FDA), AMENDING CERTAIN SECTIONS OF REPUBLIC ACT NO. 3720, AS
AMENDED, AND APPROPRIATING FUNDS THEREOF.

Retrieved from:
https://www.officialgazette.gov.ph/2009/08/18/republic-act-no-9711/
Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 8
 HERBAL MEDICATION
Dietary Supplement Health and
Education Act of 1994
⚫Herbs reclassified as “dietary supplements”
◦ Premarket testing not required
◦ Manufacturing not standardized
⚫Clarified marketing regulations
◦ Physiologic effects to be noted
⚫No claims of prevention or curing of specific
conditions

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 9
 REMINDERS for Herb Use
⚫ Do not take a large quantity of any herbal preparation
⚫ Buy only products with plant and quantity listed on
label
⚫ Contact health care provider (HCP) before stopping a
prescription medication
⚫ Store product in a cool, dry place; dark glass containers
are preferred
⚫ Use only current products
⚫ Do not take if pregnant
⚫ Do not take if nursing
⚫ Do not give herbs to infants or young children

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 10
⚫Do not delay in seeking care from HCP for
persisting/severe symptoms
⚫Advise against belief in “miracle cures”
⚫Herbs are not placebos
⚫Increased risk of reactions when Rx and OTC with
similar actions are combined with herbs
Required Labels
⚫Scientific names; part of plant used
⚫Manufacturer’s name and address
⚫Batch and lot number
⚫Date of manufacture and expiration

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 11
 Common Herbs
⚫Aloe vera
◦ External: relief of pain; promote burn healing
◦ Internal: constipation; may cause arrhythmias,
neuropathies, edema
⚫Chamomile
◦ Relief of digestive complaints
◦ May have sedative effects
◦ Rare allergic reactions of urticaria and bronchoconstriction
if allergic to daisy or ragweed
⚫Dong quai
◦ All-purpose woman’s tonic
◦ Frequently mixed with fillers
◦ Contains vitamin B12

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 12
 ECHINACAE
⮚genus plants related to daisy family
⮚ commonly used of Plains Native Americans
⮚ USES:
▪ healing wounds, burns, insect bites (externally)
◦ Stimulates immune system
◦ For colds, flu, recurrent respiratory and urinary tract
infections; limit use to 2 weeks
▪infections, toothache, joint pains, rattle snake bites
▪ used as an antiinfective
⮚ Echinacae purpurea, Echinacae angustifolia, Echinacae
pallida

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 13
 Other Herbs
⚫Evening primrose
◦ Natural estrogen promoter; may lower seizure threshold if taken with
anticonvulsant
⚫Feverfew
◦ Interferes with platelet aggregation; for migraine headaches, RA, PMS

GARLIC
⮚Allium sativum
⮚medical herb
◦ Detoxifies and increases immune function; decreases platelet aggregation; for
hypercholesterolemia, mild HTN
⮚ USES:
▪against bacterial, fungal and viral infections

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 14
GARLIC
⮚sulfur-containing compound and water-soluble amino acid (S-allyl cysteine)
⮚ contains Allicin (responsible for its odor)
⮚ moderate reductions in blood pressure
⮚ reduction in blood cholesterol levels

GINGER
⮚Zingiber officinale
⮚ has green-purpleflowers
◦ Stimulates digestion; antispasmodic; decreases platelet
aggregation
⮚ a.k.a. Jamaican ginger, African ginger, Cochin ginger, black ginger,
and race ginger
⮚ rhizome (underground stem) contains active components
⮚ USES: GINGER
▪ Prophylactic treatment for digestive system problems
▪ nausea, motion sickness and hyperemesis gravidarum
▪ Used to ease symptoms in disorders such as arthritis,
cardiovascular disease and other inflammatory disorders
GINSENG
⮚yellowish, radishlike herb
⮚ slow growing plant that takes at least 6 years of cultivation to produce a
marketable price

⮚ “Panax” – Greek, “all healing”

▪antifatigue and antistress actions

▪ mental performance improvements

▪ immune system enhancement

▪ cardiovascular effects

▪ supportive therapy for diabetes

⚫Ginkgo biloba
◦ Antioxidant; peripheral vasodilator and
increased blow flow to CNS; decreased platelet
aggregation.For vascular insufficiency and dementia
⮚Goldenseal
◦ Stimulates immune system and bile secretion
▪ Has a wide range of physiologic actions
● Vasodilation : treatment of cardiovascular disease and peripheral vascular
disease
● Inhibition of platelet aggregation
● Improved peripheral circulation
● Anti oxidant activity

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 18
⚫ Kava kava
◦ CNS sedation without loss of mental acuity or memory; may
be hepatotoxic 
⚫ Licorice
◦ Antiinflammatory; antibacterial; antiviral; topical: psoriasis
and eczema
⚫ Milk thistle
◦ Increases liver cell regeneration; liver tonic; cirrhotic disease
slows & increased quality of life
⚫ Peppermint
◦ Internal: stimulates appetite and aids in digestion
◦ External: relief of tension headaches when rubbed on
forehead (according to research in Germany, comparable to
acetaminophen)
⚫Sage: herb of longevity

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 19
SAW PALMETTO
Serenoa repens
⮚ shrublike palm tree
⮚Side Effects:
▪ impotent
▪ decrease libido
▪ rare cases of stomach problems
⮚its fruits were used as a mild diuretic and for enlarged
prostate benign prostatic hyperplasia
◦ Decreases size of prostate; discontinue herb 1 to 2 weeks before PSA test
◦ “Plant catheter”
Active Constituent:
▪ derived from herb’s berries – contains saturated and unsaturated fatty acids and
sterols that are used medicinally
 MILK THISTLE

⮚ Silybum marianum
⮚ tall plant with prickly leaves
⮚ with milky sap
⮚ known as liver herb
⮚active constituent: silymarin
- used clinically to counter overdose effects of the death cap mushroom
- other uses:
• treatment of inflammatory liver damage, secondary to cirrhosis
• hepatitis
• fatty infiltration caused by alcohol
ST. JOHN’S WORT
⮚ Hypericum perforatum
⮚ aromatic perennial with small yellow, five-petaled
Flowers
- calm nerves (mild to moderate depression )
- improve mood
- decrease inflammation during wound healing
⮚antiviral and antibacterial agent

• 2 components: hypericin and hyperforin and hypericin

• hypericin
- responsible for antidepressant effects
- responsible for antiviral properties
 VALERIAN
⮚ Valeriana officinalis
⮚preparation from dried rhizome and roots
⮚ minor tranquilizer and sleep aid (insomnia)
⮚ for nervous system disorders, i.e. anxiety
◦ Mild sedative
● Sleep-inducing agent
● “Herbal valium”
● “Dirty socks” odor
⮚ its parts contain volatile oil
- contain monoterpene bornyl acetate and sesquiterpene valerenic acid
- important for valerian’s sedative action
⮚dosage: 300 to 400 mg of standardized valerian root extract,1 hr before
bedtime
BILLBERRY = Promotes healthy vision
Increase visual pigment regeneration

BLACK COHOST = Anti- spasmodic

Decreases symptoms of dysmenorrhea,
PMS, and menopausal symptoms
= Optimizes estorgen
= suppresses LH.
CRANBERRY = Prophylaxis of UTI and kidney
stones

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 24
 Potential Hazards of Herbs
⚫No preparations are safe in all situations
⚫Contamination
⚫Interaction with prescription and OTC
drugs
⚫Refer to Appendix D for interactions

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 25
 Review
herbs
Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 26
herb Main actions

Aloe vera External relief of pain

Promote burn healing

Chamomile Relief of digestive complaints

Dong quai All-purpose woman’s tonic

Contains vitamin B12

Echinacea Stimulates immune system

For colds, flu, Respiratory and
urinary tract infections
healing wounds, burns, insect bites
(externally)
used as an antiinfective

Evening primrose Natural estrogen promoter; may lower

seizure threshold if taken with
anticonvulsan
Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 27
HERB USE

Feverfew Interferes with platelet aggregation; for migraine headaches, RA,

PMS

Garlic Detoxifies and increases immune function; decreases platelet

aggregation; for hypercholesterolemia, mild HTN

Ginger Stimulates digestion; antispasmodic; decreases platelet

aggregation.. For Hyperemesis Gravidarum
- ease symptoms of arthritis, cardiovascular disorders.

Gensing ▪antifatigue and antistress actions

▪ mental performance improvements

▪ immune system enhancement

Ginkgo biloba Antioxidant; peripheral vasodilator and increased blow flow to

CNS; decreased platelet aggregation. Dementia
Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 28
HERB USES :

Goldenseal Stimulates immune system and bile secretion

Kava kava CNS sedation without loss of mental acuity or memory; may be
hepatotoxic 

Licorice Antiinflammatory; antibacterial; antiviral; topical: psoriasis and

eczema

Milk thistle Increases liver cell regeneration; liver tonic; cirrhotic disease slows &
increased quality of life

Peppermint Internal: stimulates appetite and aids in digestion

External: relief of tension headaches when rubbed on forehead

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 29
herb uses

St. John’s wort Antidepressant and antiviral; for

depression, anxiety, sleep disorders

Saw palmetto Decreases size of prostate;

discontinue herb 1 to 2 weeks before
PSA test
“Plant catheter”

MILK THISTLE liver damage, secondary to

cirrhosis
• hepatitis
• fatty infiltration caused by
alcohol

Valerian minor tranquilizer and sleep aid

insomnia

Elsevier items and derived items © 2006, 2003 by Saunders, an imprint of Elsevier Inc. Slide 30
 DRUGS
DRUG ABUSE
OF ABUSE
•Cultural Considerations
•Moslem Middle East, Christian & Mormons – alcohol or mind
altering drugs – ABUSE
•European – alcohol part of social gathering
•American Indians – Psychedelic agents
•White Americans – alcohol & amphetamines
•African Americans & Hispanics – heroine & cocaine
 Terminology of Drug Abuse

• Drug misuse – indiscriminate use other

than indicated
• Drug abuse – drug use inconsistent with
medical & social norms
• Drug addiction – Complex disease of CNS with
compulsive uncontrolled craving for &
dependence on a substance
 Definitions
• Brain reward system –mesolimbic system
• Tolerance – decrease effect
• Craving – subjective need
• Drug craving
• Cue-induced craving
• Relapse – return to abuse during abstinence
 Overview of Addictive States

• Intoxication
• Detoxification
• Withdrawal syndrome – physiologic &
psychologic responses caused by abrupt
cessation or decreased intake
• Cessation and maintaining abstinence
 Stimulants
Nicotine
•Nicotine Replacement Agents
•Gum, Lozenge, Patch, Nasal spray, Inhaler
•Cocaine
•Amphetamines
▪ Caffeine
 Depressants
• Alcohol
– Wernicke’s encephalopathy
– Korsakoff’s psychosis
– Drug therapy for alcohol withdrawal
– Rehabilitation and sustained abstinence
• Sedative-hypnotics
 Depressants
• Opioids
– Pharmacokinetics and pharmacodynamics
– Effects and use
– Treatment
• Overdose: naloxone (Narcan)
• Withdrawal symptoms: methadone (Dolophine),
clonidine (Catapres)
• Opioid antagonist: naltrexone (Trexan, ReVia)
• Anesthetic agents has prolonged sedative effect with liver dysfunction
• Increase dose of analgesics if dependent on opioids
 Other Drugs of Abuse
• Cannabis
• Inhalants
– Volatile solvents
– Aerosols
– Anesthetic agents
– Nitrites
Chemical Impairment in Nurses
•Serious concern
– 10 to 20% of nurses have substance abuse problem
– 3 to 6% demonstrate impaired practice because of drugs
– Alcohol most common followed by other CNS acting drugs
(Demerol,Valium & Oxycodone)

Contributing factors:
Stressors – chronic fatigue, illness, responsibility for clients’
responses to illness & dying, professional dissatisfaction, access to
drugs & others
Changes in personality & behaviors, job performance & attendance
GERIATRIC AND PEDIATRIC
CONSIDERATIONS
PEDIATRIC CONSIDERATION IN PHARMACOLOGY

***FACTORS THAT AFFECT THE RATE AND DEGREE OF ABSORPTION

A. Route of administration
B. Age
C. Child’s health status

POOR MEDICATION ABSORPTION

A. hormonal differences
B. changes in physical maturity
C. Poor nutritional habits, and
D. Gastric and Intestinal conditions in the stomach and intestine affect

the absorption of the drug.

• First-pass elimination is reduced due to of immaturity of the liver and
reduced levels of microsomal enzymes.
• Delayed emptying in children reduces the peak concentration of
medications
Pediatric Considerations
•Conditions that change perfusion such as dehydration in infants, cold
temperature and alterations in cardiac status may impede absorption of
medications at the tissue level.
•Infants have greater body surface areas & thin skin resulting to faster
effect of topical medications.

•slow or irregular peristalsis

•Gastric pH is less acidic because acid-producing cells in the stomach

are immature until approximately 3 years of age
Pediatric consideration
•TBW content is greater that is why the fat content is less.

•Immature blood- brain barrier results to more blood

entering the brain.
•Decreased production of protein by immature liver
results to a decrease in Protein-binding capabilities.

•More toxicity in young infants.

•Higher metabolic rates.

EXCRETION
-decreased renal blood flow.
-Glomerular filtration rate as well as tubular secretion and resorption
are all decreased
-reduced renal function and concentrating ability.
-medications accumulate and may reach toxic levels.
-Water is needed for the effective excretion of medication

PHARMACODYNAMICS

•effect of a drug on the body.

•Maturity of organs affects pharmacodynamics and toxicity of
drugs
•Some drugs affects the growth of children
•Some drugs affect specific organs in the body
Nursing Considerations :

1. Always get the history.

2. Observe Adverse reactions and therapeutic effects
3. Most medications are ordered based on the child’s
weight in kilograms or body surface area.
4. Measure the amount of drugs in serum drug levels or plasma
levels to establish routes of medication and dosage of drugs
5. Calculation of pediatric dosages is based in part in FDA
recommendation, approved protocols, research studies.
6. Always consider the developmental and chronological age,
cognition and temperament.
ALWAYS DETERMINE THE FOLLOWING FOR PEDIATRIC
CLIENTS.
•Age
•Allergies to drugs and food
•Medical and medication history (including adverse drug
reactions)
•Head-to-toe assessment findings
•Baseline vital signs
•Weight (important because many doses are calculated per
kilogram and body weight)
•Height
•Usual response to medications
•Use of prescription and OTC medications
•State of anxiety
•Fears
•Age related concerns
•Level of growth and development
PEDIATRIC CONSIDERATION:
•Medications should be called medicines and their dangers be made
known to children.

•Avoid disguising medications in essential food such as milk,

orange juice or cereal because the child may develop a dislike
for the food in the future.

•Most medications are better tolerated with 6-8 ounces of fluids such
as juices, water or milk.

•Unless contraindicated adding small amounts of water to elixirs

may help in the child’s tolerance of the medications.
PEDIATRIC CONSIDERATION
•Keep all medications out of reach of children of all ages.
Secure medications at all times to prevent accidental
poisoning.
•Avoid using the word “candy” in place of “medications”
•Always document what was successful so that the
method be communicated to others E.g. a frozen popsicle
before administration of an unpleasant tasting pill or
liquid.
GERIATRIC PHARMACOLOGY
•The body ages and the function of several organ systems slowly deteriorate after
many years of wear and tear.
ABSORPTION:
•Gastric pH is less acidic.

•Gastric emptying is slowed .

•Blood flow to the GI tract is reduced by 40%-50.

•The absorptive surface area is decreased.

•Fat content is increased because of decreased lean body mass.

•Protein (albumin) binding sites are reduced because of decreased

production of proteins by aging liver and reduced intake.

•Total body water in adults from 40-60 years old is 55% in male and 47% in
female.
METABOLISM
1.Liver blood flow is reduced by approximately 1.5% per year after age
25, decreasing hepatic metabolism.

2. The levels of microsomal enzymes are decreased because the

capacity of the aging liver to produce them is reduced.

EXCRETION
Number of intact nephrons is decreased.

•Glomerular filtration rate is decreased by 40%-50% primarily because

of decreased blood flow.

POLYPHARMACY
-Administration of many drugs together
-One patient may have several illnesses and be taking many drugs
-Drastically increases the risk of drug interaction, adverse reactions
and hospitalizations
PHARMACODYNAMICS

• Refers to how a drug interacts at the receptor site at the target

organ
• Because there is a lack of affinity to the receptor sites
throughout the body in the older adult the pharmacodynamics
response in the older adult may be altered.
• The older adult could be more or less sensitive to drug action
because of age-related changes in the central nervous system
(CNS)
HYPNOTICS
• Should be taken one hour before bedtime. Taken for
insomnia (difficulty falling asleep), frequently awakening
• Sedatives and hypnotics are the second most common
group of drugs prescribed or taken OTC.
• during the night or awakening early in the morning with
difficulty falling back to sleep.

Examples of These Medications are the following:

• Halcion- difficulty falling asleep
• Restoril- frequent awakening
• Dalmane- not recommended for the elderly because of the
many side effects.
GASTROINTESTINAL

•Anti ulcer meds- Sucralfate

•Cimetidine (Tagamet) not suggested for the older adult
because of its side effects and multiple potential drug
interactions.
•Laxatives-non pharmacological measures are better but they
are frequently taken by the older adult in long term facilities.

ANTI-DEPRESSANTS

•Tricyclic anti-depressants are effective for the older adult

client
•Prozac (Fluoxetine) common

•MAO (monoamine oxidase) inhibitors not prescribed – many

food-drug interaction, orthostatic hypotension
ANTIBACTERIALS
•Some are “nephrotoxic” not usually given to patients 75 years older.

DIURETICS AND ANTIHYPERTENSIVES (CHF)

- Monitor electrolytes with diuretics/antihypertensives, ACE
inhibitors, calcium channel blockers. These may cause orthostatic
hypotension

•ANTICOAGULANTS
•Coumadin (Warfarin)
•Monitor PT (prothrombin time) INR International Normalized Ratio
•Check for bleeding

•CARDIAC GLYCOSIDES
•Digoxin- close monitoring, check apical pulse 60
NARCOTIC ANALGESIC
•Hypotension and respiratory depression may result from
narcotic use.

•Older adults may not fully understand the drug regimen.

Non adherence can cause under dosing or overdosing that
could be harmful to the older adult client’s health

Notes :
encourage compliance.
ASSESSMENT (GERIATRIC CLIENT)
•Age
•Allergies to drugs and food
•Present and past medical and medication history (especially
prescription and OTC medications being taken)
•Use of polypharmacy
•Use of home remedies
•Dietary habits
•List of all physicians
•Self-medication practices
•Limitations (sensory, visual, hearing, cognitive/motor skills,
financial status)
•Results of renal and liver function tests.
SUMMARY
1.You have just learned the use of common Herbal
and alternative drugs in treating common illnesses
and disorders.
2.The difference between stimulants and depressants
used in drug misuse and drug addiction.
3.The main nursing considerations in treating geriatric
and pediatric clients.
What’s next ?
Preview
 Macro
Body
Vitamins and Micro Electrolytes
Fluids
Mineraks
PHARMACOLOGY REFERENCES:
•PHARMACOLOGY A PATIENT CENTERED NURSING PROCESS APPROACH BY:
KEE/HAYES/MCCUISTION (2015)

•FOCUS ON NURSING PHARMACOLOGY BY: AMY KARCH (2013)

•http://docshare04.docshare.tips/files/27843/278436401.pdf
Thank you
REFERENCES:
•PHARMACOLOGY A PATIENT CENTERED NURSING PROCESS APPROACH BY:
KEE/HAYES/MCCUISTION (2015)
file:///C:/Users/Lenovo/Documents/Pharmacology_%20A%20Patient-Centere
d%20Nursing%20Process%20Approach%20(%20PDFDrive.com%20).pdf

•FOCUS ON NURSING PHARMACOLOGY BY: AMY KARCH (2013)

http://docshare04.docshare.tips/files/27843/278436401.pdf