Akademi Keperawatan YKY Yogyakarta

PHARMACODYNAMICS
FARMAKOLOGI KEPERAWATAN
Akademi Keperawatan YKY Yogyakarta

PHARMACODYNAMICS & NURSES

know about drug actions

educate patients about their
medications

Biochemica
Drugs
make PRN decisions
l
evaluate patients for
Physiologic beneficial and harmful drug
effects

when conferring with

prescribers about drug
therapy
 Akademi Keperawatan YKY Yogyakarta

DOSE-RESPONSE RELATIONSHIPS

• Maximal Efficacy
• Diuretics: Furosemide >
Hydrochlorothiazide
• Mild headache: Morphine > Aspirine

• Relative Potency
• Morphine
• Meperidine
Akademi Keperawatan YKY Yogyakarta

DRUG-RECEPTOR INTERACTIONS

• the body’s own receptors :

• hormones
• neurotransmitters
• regulatory molecules

• target molecules:
• enzymes
• ribosomes
Akademi Keperawatan YKY Yogyakarta

THE FOUR PRIMARY RECEPTOR FAMILIES

Akademi Keperawatan YKY Yogyakarta

RECEPTORS & SELECTIVITY OF DRUG ACTION

• neurotransmitter (e.g., NE, acetylcholine,

dopamine)
• hormone (e.g., progesterone, insulin,
thyrotropin)
• other molecules (e.g., histamine,
prostaglandins, leukotrienes)
Akademi Keperawatan YKY Yogyakarta

EVEN THOUGH A DRUG IS SELECTIVE FOR ONLY ONE TYPE OF

RECEPTOR, IS IT POSSIBLE FOR THAT DRUG TO PRODUCE
NONSELECTIVE EFFECTS?
• Morphine: to cause respiratory
depression and constipation along with
reduction of pain
• Botulinum: an cause paralysis of the
muscles of respiration, resulting in death
from respiratory arrest
 Akademi Keperawatan YKY Yogyakarta

THEORIES OF DRUG-RECEPTOR INTERACTION

• Simple Occupancy Theory

• (1) the intensity of the response to a drug is
proportional to the number of receptors occupied by
that drug and that
• (2) a maximal response will occur when all
available receptors have been occupied.

• Modified Occupancy Theory

• Affinity
• Intrinsic activity
 Akademi Keperawatan YKY Yogyakarta

AGONISTS, ANTAGONISTS, & PARTIAL AGONISTS

• Agonists: molecules that activate receptors

• Dobutamine > NE > heart
• Insulin

• Antagonists: produce their effects by preventing receptor

activation by endogenous regulatory molecules and drugs
• Antihistamines > histamines

• Partial Agonists: an agonist that has only moderate

intrinsic activity
• pentazocine vs meperidine
Akademi Keperawatan YKY Yogyakarta

REGULATION OF RECEPTOR SENSITIVITY

• When the receptors of a cell are continually exposed to an agonist, the cell usually
becomes less responsive
• Continuous exposure to antagonists has the opposite effect, causing the cell to become
hypersensitive (also referred to as supersensitive)
 Akademi Keperawatan YKY Yogyakarta

DRUG RESPONSES THAT DO NOT INVOLVE

RECEPTORS
• Antacids neutralize gastric acidity by direct chemical
interaction with stomach acid.
• The antiseptic action of ethyl alcohol results from
precipitating bacterial proteins.
• Magnesium sulfate, a powerful laxative, acts by retaining
water in the intestinal lumen through an osmotic effect.
• Dimercaprol, a chelating agent, prevents toxicity from
heavy metals (e.g., arsenic, mercury) by forming
complexes with these compounds.
 Akademi Keperawatan YKY Yogyakarta

INTERPATIENT VARIABILITY IN DRUG

RESPONSES
• To promote the therapeutic objective, you must be alert to
interpatient variation in drug responses.
• Because of interpatient variation, it is not possible to predict
exactly how an individual patient will respond to
medication.
• Hence, each patient must be evaluated to determine his or
her actual response.
• The nurse who appreciates the reality of interpatient
variability will be better prepared to anticipate, evaluate, and
respond appropriately to each patient’s therapeutic needs.
Akademi Keperawatan YKY Yogyakarta

CLINICAL IMPLICATIONS OF INTERPATIENT

VARIABILITY
Interpatient variation has four important clinical consequences. As a nurse you should be aware of these
implications:
• The initial dose of a drug is necessarily an approximation.
• When given an average effective dose, some patients will be undertreated, whereas others will have received
more drug than they need.
• Because drug responses are not completely predictable, you must monitor the patient’s response for both
beneficial and harmful effects to determine whether too much or too little medication has been administered.
• Because of variability in responses, nurses, patients, and other concerned individuals must evaluate actual
responses and be prepared to inform the prescriber about these responses so that proper adjustments in dosage
can be made
Akademi Keperawatan YKY Yogyakarta

THANK YOU