Pharmacology
Day 1
Elizabeth Keele, RN/BSN
Course Objective #2
• Describe the dynamic process
between the giver and the receiver
of medications, which promotes
positive medication compliance.
“Dynamic Process”
• dy·nam·ic
• dīˈnamik/
• adjective
• 1. ( process or system) characterized by
constant change, activity, or progress.
“Dynamic Process”
• Giver
• Receiver
“Mutual process”
• Key characteristics:
– Knowledge
– Teaching
– Communication
– Observation skills
– Evaluation skills
Turn to your neighbor and take turns…
• Describing the dynamic process
between the giver and the receiver
of medications, which promotes
positive medication compliance.
• (Course objective #2)
Course Objective #1
• Identify limitations/deficits
commonly seen in D.D. clients that
prevent them from asking questions
or reporting adverse effects
regarding medications they receive.
Limitations to “mutual process” of
medication administration
• Understanding
• Communication
• Awareness
•
•
•
•
•
Knowledge
Teaching
Communication
Observation
Evaluation
Limitations to “mutual process” of
medication administration
• The NURSE must
“account and
compensate” for
these limitations
Medication Administration is…
• Invasive
• Risk to benefit
Turn to your neighbor and take turns
• Identify limitations/deficits commonly
seen in D.D. clients that prevent them
from asking questions or reporting
adverse effects regarding medications
they receive.
• (Course objective #1)
Course Objective #3
• Describe the importance of patient
teaching with regard to prescribed
medication regimen.
Why is patient teaching important?
Teaching / Learning Process
• Teaching
– Interactive process
• Learning
– Acquiring new
knowledge
• Motivation
– Desire
3 Domains of Learning
• Cognitive
– Intellectual activities
• Affective
– Attitudes & beliefs
• Psychomotor
– Physical skills
Turn to your neighbor and…
• Describe the importance of patient
teaching with regard to prescribed
medication regimen.
• (Course objective #3)
Course Objective #4
• Describe the electrochemical
processes of the central nervous
system, which allow CNS drugs to
cause their desired effects.
Course objective #12
• Explain how chemicals and electrical
impulses interact to make up the
electrochemical properties of the
nervous system.
The nervous system consists of:
• Divided system
– Central Nervous System (CNS)
• Brain & Spinal Cord
– Peripheral Nervous System (PNS)
• Nerves (peripheral & Cranial)
Nervous System
• Controls and coordinates
the body
• By transmission of electrical
impulses (Electrical-chemical
system)
Nerve Impulse
• The nervous system is
powered by electrical
and chemical energy
–
–
–
–
K+
Na+
Cl(Ca+)
Course objective #9
• Differentiate between afferent and
efferent neuron.
Neuron
• Basic functional unit
– Afferent neuron
• Sensory
• Carry info from PNS  CNS
– Efferent neuron
• Motor
• Carry into from CNS  PNS
Neuron structure
• Cell body/ Soma
– Nucleus
– Neurotransmitters synthesized
• Dendrites
– Carry impulses toward the cell
body
• Axons
– Carry impulses away from the
cell body
• CNS =
Cool Fact
Damaged Neuron
– Irreversible
• PNS =
– will repair itself if
the cell body is not
destroyed
Course Objective #10
• Describe the role played by
neurotransmitters in nerve impulse
transmission within the synapse.
Synaptic Junction
• Neuron connect to each
other end to end
• Where two neurons come
together
– Synaptic junction
– Synapse
– Inter-neuron space
Anatomy of the NS
• Synapse = the space between one neuron &
the next
Pre-synaptic
neuron
Post-synaptic
neuron
29
Synaptic Junction
• Terminal end of Axon =
Pre-Synaptic Vesicles
• Nerve impulse reaches the
vesicle  release substance
 neurotransmitters (nt)
into the synaptic junction
• Nerve impulses must have a
receptor site
Synaptic events
•
•
•
•
Electrochemical message received
Vesicle opens
NT are released into synapse
NT finds its receptor site that it fits into on the
next neuron
• Activation of receptor  nerve impulse in postsynaptic vessel
• Re-uptake of NT
– MAO action
Neurotransmitters
• Synthesized in the soma
• Special Properties
– Excitability
– Inhibitory
• 30+ neurotransmitters
Course objective #11
• Describe the role played by
monoamine oxidase in nerve
impulse transmission within the
synapse.
Monoamine oxidase (MAO)
• ENZYME
• Released into the synaptic space
• Action
–breakdown or inactivates NT 
• Result
–i NT levels
34
Course Objective #5
• Differentiate between the following
neurotransmitters:
– Acetylcholine
– Norepinephrine
– Dopamine
– Serotonin
– Gamma-aminobutyric acid
– Glycine
Neurotransmitters
• Synthesized in the soma
• Special Properties
– Excitability
– Inhibitory
• 30+ neurotransmitters
Excitatory Neurotransmitters
• Serotonin
–
–
–
–
–
Sleep
Sensory perception
Temperature
Mood
Inhibits pain
Excitatory Neurotransmitters
• Dopamine
– Subconscious
movement
– Fine motor skills
– Emotional responses
Excitatory Neurotransmitters
• Norepinepherine
– Maintains arousal
– Overall activity
– Mood
• Acetylcholine
– Vital for short term
memory
Inhibitory Neurotransmitters
• Cholinergic
– Stabilizers
Inhibitory Neurotransmitters
• Gammaamniobutyricacid
• GABA
– #1
– h concentration in
• brain
– Stop/slow firing of neurons
• Glycine
– h concentration in
• Spinal Cord
Inhibitory Neurotransmitters
• Dopamine
– Basal Ganglia
– Dopamine &
Acetylcholine are
opposites which work
together to create
homeostasis
Course Objective #6
• Identify psychiatric disorders that
appear to be related to the body’s
inability to regulate the availability
of neurotransmitters.
h or i Neurotransmitters
• Imbalance  disease or
disorder
Schizophrenia
• h dopamine
Depression
• i Serotonin
Alzheimer’s Disease
• i acetylcholine
Generalized Anxiety Disorder
• Norepinephrine
• Serotonin
ADHD
(Attention deficit hyperactivity disorder)
• Imbalance
–Norepinephrine
–Dopamine
Drug Addictions
• Affects dopamine areas of the brain
Alcohol
• Interacts with GABA receptors
Course Objective #7
• Describe the ‘principle of opposition’
between the operation of the
sympathetic and parasympathetic
branches of the autonomic nervous
system.
The nervous system consists of:
• Divided system
– Central Nervous System
(CNS)
• Brain & Spinal Cord
– Peripheral Nervous System
(PNS)
• Nerves (peripheral &
Cranial)
Nervous System
CNS
Somatic
Nervous System
PNS
Autonomic
Nervous System
Peripheral Nervous System
PNS comprised of Cranial and Spinal Nerves
Somatic Nervous System
Process: Voluntary
Function: Respond to changes in
external environment
Effector site: skeletal muscle
Sympathetic NS
Autonomic Nervous system
Process: Involuntary
Function: Respond to changes in
the internal environment
Effector sites: Internal organs
Parasympathetic NS
Autonomic Nervous System
Sympathetic
Nervous System
Parasympathetic
Nervous System
• Chemical process:
• Chemical Process
– Adrenergic
• Function
– Energize
– Cholinergic
• Function
– Stabilize
Sympathetic NS
Rate
Dilates
Dilates
secretions
Parasympathetic NS
rate
Heart
Vessels of
Skeletal
muscles
Bronchi
Lung
secretions
Peristalsis
Salivary
secretions
0
Constricts
secretions
Sympathetic NS
Closes
Relaxes
Closes
Dilate
far vision
secretions
Release glucose
secretions
Parasympathetic NS
Anal sphincter
Bladder
Urinary
sphincter
Pupil
Eye
accommodation
Opens
Contracts
Opens
Constrict
near vision
secretions
Pancreas
Liver
Adrenal
Medulla
0
0
Principle of Opposition
Sympathetic
“Fight or Flight”
Energizes
Adrenergic
Parasympathetic
“Rest & Digest”
Stabilizes
Cholinergic
(Adrenal gland) 
Epinephrine
Norepinephrine
Acetylcholine
Adrenergic vs. Cholinergic
Agents
Adrenergic
Sympathetic N.S.
Norepinephrine /
Epinephrine
Adrenergic Agent
Drug that mimics
Sympathetic stim.
Cholinergic
Parasympathetic N.S.
Acetylcholine
Cholinergic Agent
Drug that mimics
Parasymathetic stim.
Course Objective #8
• Differentiate between an agonistic
drug and an antagonistic drug.
Agonist
• Bind with receptor 
• Enhances response
Antagonist
• Binds with receptor 
• Blocks response
Course objective #13
• Describe the variable responses seen
depending on the fit of drugs to
receptor sites.
Drug Action
• “Target” cells
Drug Action
• Rx fits / “binds”
receptor site 
• Influences
reaction
• Mimics natural
body chemicals
• “BIND”
– Similar shape
– Closer the fit 
Stronger the effect
Types of Antagonists
Competitive
Non-competitive
• “Push off” agonist
• h dose 
• Block action of agonist
• Does not “push off an
agonist from receptor
• h dose …