NURSING
PHARMACOLOGY
WILMA MARTINEZ-RUIZ, RN, MAN
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INTRODUCTION TO DRUGS:
◦ PHARMACOLOGY
◦ THE STUDY OF THE BIOLOGICAL EFFECTS
OF CHEMICALS/DRUGS TO PROVIDE
SAFE, HIGH QUALITY AND EFFECTIVE
NURSING CARE.
◦ DRUGS
◦ CHEMICALS THAT ARE INTRODUCED
INTO THE BODY TO CAUSE SOME SORT
OF CHANGE
◦ PHARMACOTHERAPEUTICS/CLINICAL
PHARMACOLOGY
◦ BRANCH OF PHARMACOLOGY THAT
USES DRUGS TO TREAT, PREVENT, AND
DIAGNOSE DISEASE
Sources of Drugs:
NATURAL
 Plants – oldest source of drugs
Leaves, stem, bark, fruits and roots
 Fungi
Animal Products
Sheep thyroid, Cod liver, Blood, Stomach
tissues
 Inorganic Compounds
Aluminum, Fluoride, Iron, Gold, Zinc
SYNTHETIC
Made by chemical synthesis
When the nucleus of the drug from natural
source as well as it’s chemical structure is
altered.
Aim to mimic the effect of existing drugs.
Sources of Drugs:
SEMI-SYNTHETIC
When the nucleus of the drug
obtained from natural source is
retained but the chemical structure is
altered.
Ex. Ampicillin, Morphine, Ethinyl
Estradiol
 Microbiological Sources
Fungi –Penicillium Notatum which
gives Penicillin
Gentamicin and Tobramycin are
derived from Streptomycis and
micromonosporas
Actinobacteria give Streptomycin
DRUG EVALUATION
◦ PRECLINICAL TRIALS
◦ CHEMICALS THAT MAY HAVE THERAPEUTIC VALUES
ARE TESTED ON LABORATORY ANIMALS FOR TWO
MAIN PURPOSES:
◦ TO DETERMINE WHETHER THEY HAVE THE PRESUMED
EFFECTS IN A LIVING TISSUE
◦ TO EVALUATE ANY ADVERSE EFFECTS
◦ REASONS FOR DISCARDING SOME CHEMICALS:
◦ CHEMICALS LACK THERAPEUTIC ACTIVITY WHEN USED
WITH LIVING ANIMALS
◦ CHEMICAL IS TOO TOXIC TO LIVING ANIMALS TO BE
WORTH THE RISK OF DEVELOPING INTO A DRUG
◦ CHEMICAL IS HIGHLY TERATOGENIC(CAUSING ADVERSE
EFFECTS TO THE FETUS)
◦ THE SAFETY MARGINS ARE SO SMALL THAT THE CHEMICAL
WOULD NOT BE USEFUL IN THE CLINICAL SETTING
DRUG EVALUATION
◦ PHASE I STUDIES
◦ USES HUMAN VOLUNTEERS TO TEST THE DRUGS.
◦ MORE TIGHTLY CONTROLLED THAN PRECLINICAL
TRIALS AND ARE PERFORMED BY SPECIALLY TRAINED
CLINICAL INVESTIGATORS
◦ PHASE II STUDIES
◦ ALLOWS CLINICAL INVESTIGATORS TO TRY OUT THE
DRUG IN PATIENTS WHO HAVE THE DISEASE THAT THE
DRUG IS DESIGNED TO TREAT.
◦ PHASE III STUDIES
◦ INVOLVES USE OF THE DRUG IN A VAST CLINICAL
MARKET. PRESCRIBERS ARE INFORMED OF ALL THE
KNOWN REACTIONS TO THE DRUG AND
PRECAUTIONS REQUIRED FOR ITS SAFE USE.
DRUG EVALUATION
◦ FOOD AND DRUG ADMINISTRATION (FDA) APPROVAL
◦ DRUGS THAT FINISH PHASE III STUDIES ARE EVALUATED BY
THE FDA, WHICH RELIES ON COMMITTEES OF EXPERTS
FAMILIAR WITH THE SPECIALTY AREA IN WHICH THE
DRUGS WILL BE USED.
◦ ONLY THOSE DRUGS THAT RECEIVE FDA COMMITTEE
APPROVAL MAY BE MARKETED.
◦ PHASE IV STUDIES
◦ AFTER A DRUG IS APPROVED FOR MARKETING, IT ENTERS
A PHASE OF CONTINUAL EVALUATION, OR PHASE IV
STUDY.
◦ PRESCRIBERS ARE OBLIGATED TO REPORT TO THE FDA
ANY UNTOWARD OR UNEXPECTED ADVERSE EFFECTS
ASSOCIATED WITH DRUGS THEY ARE USING, AND THE FDA
CONTINUALLY EVALUATES THIS INFORMATION.
Legal Regulation of Drugs
Safety
during
pregnancy
Controlled
substances
Orphan
Drugs
Generic
Drugs
Over the
counter
drugs
Sources of Drug Information
◦ Drug Labels
◦ Package Inserts
◦ Reference Books
◦ Journals
◦ Internet
Information
DRUGS AND THE BODY
◦ PHARMACODYNAMICS
◦ THE STUDY OF THE INTERACTIONS BETWEEN THE
CHEMICAL COMPONENTS OF LIVING SYSTEM AND
THE FOREIGN CHEMICALS, INCLUDING DRUGS THAT
ENTER THOSE SYSTEMS
◦ FOUR WAYS DRUGS WORK:
◦ REPLACE OR ACT AS SUBSTITUTE FOR MISSING
CHEMICALS
◦ INCREASE OR STIMULATE CERTAIN CELLULAR
ACTIVITIES
◦ DEPRESS OR SLOW CELLULAR ACTIVITIES
◦ TO INTERFERE WITH THE FUNCTIONING OF FOREIGN
CELLS
◦ PHARMACOKINETICS
◦ THE STUDY OF ABSORPTION, DISTRIBUTION,
METABOLISM, AND EXCRETION OF DRUGS
◦ FACTORS INFLUENCING DRUG EFFECTS
Factors influencing Drug Effects:
◦ Weight
◦ Age
◦ Gender
◦ Physiological Factors
◦ Pathological Factors
◦ Genetic Factors
◦ Immunological Factors
◦ Psychological Factors
◦ Environmental Factors
◦ Tolerance
◦ Cumulation
◦ Interactions
DRUGS AND THE BODY
PHARMACODYNAMICS
 Receptor Sites
Drug Enzyme Interactions
Selective Toxicity
PHARMACOKINETICS
 Critical Concentration – amount of a drug that is
needed to cause a therapeutic effect
Loading Dose – if effects are needed quickly
Dynamic Equilibrium – actual concentration that a
drug reaches in the body.
Absorption
Distribution
Biotransformation
Excretion
Dynamic Equilibrium:
ABSORPTION
◦ Route of Administration
◦
◦
◦
◦
◦
◦
Oral
Intravenous
Intramuscular
Subcutaneous
Topical
Inhalation
◦ Absorption Processes
◦ Passive Diffusion
◦ Active Transport
◦ Filtration
Dynamic Equilibrium:
◦ Distribution
◦ Protein binding
◦ Blood-Brain Barrier
◦ Placenta and Breastmilk
◦ Biotransformation
◦ First Pass Effect
◦ Hepatic Enzyme System
◦ Excretion
◦ Half-Life
TOXIC EFFECTS OF DRUGS
ADVERSE EFFECTS
◦ UNDESIRED EFFECTS THAT MAY BE
UNPLEASANT OR EVEN DANGEROUS
◦ TYPES:
◦ PRIMARY ACTIONS
◦ SECONDARY ACTIONS
◦ HYPERSENSITIVITY
DRUG ALLERGY
◦ OCCURS WHEN THE BODY FORMS ANTIBODIES
TO A PARTICULAR DRUG, CAUSING AN
IMMUNE RESPONSE WHEN THE PERSON IS REEXPOSED TO THE DRUG
DRUG-INDUCED TISSUE AND ORGAN DAMAGE
◦ DRUGS CAN ACT DIRECTLY OR INDIRECTLY TO
CAUSE MANY TYPES OF ADVERSE EFFECTS IN
VARIOUS TISSUES, STRUCTURES AND ORGANS
TOXIC EFFECTS OF DRUGS
TOXICITY
◦ THESE EFFECTS ARE NOT ACCEPTABLE ADVERSE
EFFECTS BUT ARE POTENTIALLY SERIOUS
REACTIONS TO A DRUG
◦ LIVER INJURY
◦ RENAL INJURY
◦ POISONING
ALTERATIONS IN GLUCOSE METABOLISM
◦ HYPOGLYCEMIA
◦ HYPERGLYCEMIA
ELECTROLYTE IMBALANCES
◦ HYPOKALEMIA
◦ HYPERKALEMIA
SENSORY EFFECTS
◦ OCULAR DAMAGE
◦ AUDITORY DAMAGE
TOXIC EFFECTS OF DRUGS
NEUROLOGICAL EFFECTS:
◦ GENERAL CNS EFFECTS
◦ ATROPINE-LIKE (ANTICHOLINERGIC) EFFECTS
◦ PARKINSON-LIKE SYNDROME
◦ NEUROLEPTIC MALIGNANT SYNDROME
TERATOGENICITY
◦ ABILITY OF A DRUG TO CAUSE FETAL
ABNORMALITIES OR DEFORMITIES
NURSING PROCESS:
• ASSESSMENT
• HISTORY
• PHYSICAL EXAMINATION
• NURSING DIAGNOSIS
• PLANNING
• IMPLEMENTATION
• PROPER DRUG
ADMINISTRATION
• COMFORT MEASURES
• PATIENT AND FAMILY
EDUCATION
• EVALUATION
ASSESSMENT:
• HISTORY
• Chronic Conditions
• Drug use
• Allergies
• Level of Education and
Understanding
• Social and Financial
Supports
• Pattern of Health care
• PHYSICAL EXAMINATION
• Weight
• Age
• Physical parameters
related to disease or
drug effects
NURSING DIAGNOSIS:
 Statement of the
patient’s status from a
nursing perspective
PLANNING:
 Involves taking and
prioritizing the
information gathered
and synthesized in the
nursing diagnosis to
plan the patient care
IMPLEMENTATION:
• PROPER DRUG
ADMINISTRATION
• COMFORT MEASURES
• PATIENT AND FAMILY
EDUCATION
EVALUATION
MEDICATION ERRORS
• Reporting
NURSE’S ROLE
PATIENT’S ROLE
Dosage
Calculations
• Measuring
Systems
• Conversion
between Systems
• Calculating Dose
• Parenteral Drugs
• Pediatric
Considerations
Measuring Systems
• Metric System
•
Gram - solid measure
•
Liter - liquid measure
• Apothecary System
•
Minim – liquid measure
•
Grain – solid measure
• Household System
•
Teaspoon – liquid measure
•
Pound – solid measure
• Avoirdupois System
•
Ounces
•
Grains
• Other Systems
•
Unit
•
Milliequivalent
Conversion
between
Systems
• Metric
• Apothecary
• Household
Calculating
Dose
• Oral
• Parenteral
• Intravenous
Solutions
• Pediatric
Considerations
1. There is an order
for Digoxin 0.5 mg.
PO. The nurse has
250 mcg. Tablets on
hand. How many
tablets will the nurse
give?
2. A dose of
Indomethacin 50
mg. QID is ordered
for a client. The unit
has oral suspension
25mg/5ml. How
much would the
nurse give per
dose?
3. An order is written
for 700mg.
Ampicillin PO. The
drug is supplied in
liquid form as
1gm/3.5ml. How
much of the liquid
should be given?
THANK YOU FOR LISTENING
WITH THE EAR OF YOUR
HEART!