nursing

pharmacology
An Introduction by Tristan Eugene G. Gula, R.N.
 HISTORY

Early drug – plants, animals & minerals



2700 BB – earliest recorded drug use



found in Middle East & China

1550 BC – Egyptians created Ebers


Medical Papyrus
 Castor oil – laxative
 Moldy bread – wounds & bruises
 HISTORY

 Opium – pain

 HISTORY

Galen (131-201 AD) Roman physician;



initiated common use of prescriptions

1240 AD – introduction of apothecary


system (Arab doctors)

 1st set of drug standards &
measurements (grains, drams,
minims), currently being phased out
 HISTORY

15th century – apothecary shops owned



by barber, surgeons, physicians,

independent merchants
18th century – small pox vaccine (by


Jenner)
 Digitalis from foxglove plant for
strengthening & slowing of
heartbeat Vitamin C from fruits
 HISTORY

19th century – morphine & codeine extract



from opium
 Introduction of atropine & iodine
 Amyl nitrite used to relieve anginal pain
 Discovery of anesthetics (ether, nitrous
oxide)
Early 20th century – aspirin from salicylic


acid
 Introduction of Phenobarbital, insulin,
sulforamides
 HISTORY

Mid 20th century



1940 – Discovery antibiotics (penicilline,



tetracycline,
streptomycin), antihistamines, cortisone


1950 – discovery antipsychotic drug,



antihypertensives, oral contraceptives,

polio vaccine
Dr Albert Sabin, b. 1906, developer of the


oral live polio vaccine.

PHARMACOLOGY

DEFINITION AND
SUBDIVISION
Pharmacology
 study of the manner in which the
function of living system is affected by
chemical agents/drugs
 Science concerned with history,
sources, physical & chemical
properties of drugs & the way in which
drug affects living system
 is the study of drugs (chemicals) that
alter functions of living organisms.
Drug
 chemical introduced into the body to
cause some changes
 WHO def: any product/subs used to
modify/explore physiologic
system/pathologic states for the
benefit of the patient
Drug therapy
 also called pharmacotherapy, is the use
of drugs to prevent, diagnose, or treat
signs, symptoms, and disease
processes. When prevention or cure is
not a reasonable goal, relief of
symptoms can greatly improve quality
of life and ability to function in
activities of daily living. Drugs given
for therapeutic purposes are usually
called medications.
Subdivisions of
Pharmacology:
1. Pharmacodynamics – study of the
biochemical & physiological effects of
drugs & mechanisms of action
 what the drug does to the body
2. Pharmacokinetics – deals with the

absorption, distribution,
biotransformation & excretion of drugs
 what the body does to the drug
Subdivisions of
Pharmacology
3. Pharmacotherapeutics – study of drugs
used in the diagnosis, prevention,
suppression, & treatment of diseases
 deals with beneficial effects of the drugs
(medicines)
4. Pharmacognosy – study of drugs in their

original unaltered state; origin of drugs

 source of drugs
 ex: penicillin from penicillium (fungi)
Subdivisions of
Pharmacology
5. Toxicology – study of biologic toxins:


study of poison & its effects deals with

deleterious effects of physical &
chemical agents (including drugs) in
human
Other Terminologies
 Pharmacoeconomics – study of
relationship of drugs & economics
 Pharmacovigilance – science of
collecting, researching, analyzing, &
evaluating set of information about
adverse drug effects.
 Receptor – a component of the cell that
interacts with drug, initiating a chain
of biochemical events leading to
drugs’ observed effects
 Things to Remember
 Human body works through
complicated series of chemical
reactions & processes
Important aspects of nursing:
understanding how drugs act on
the body to cause changes & apply
that knowledge in clinical setting
Patients take complicated drug
regimen & receive potentially toxic
drug
Some manage their own care at
 Nursing responsibilities
regarding drug therapy:
 Administering drugs
 Assessing drug effects
 Intervening to make drug regimen
more tolerable
 Provide patient teachings about
drugs & drug regimen
 Remember
 Knowing how drug works
--- easier to handle ---
enhances drug therapy
GOALS AND RESPONSIBILITIES
OF NURSING CARE RELATED
TO DRUG THERAPY
 GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY

 Enhancing therapeutic effects by

administering drugs accurately and
considering clients’ individual
characteristics that influence
responses to drug therapy.

 GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY

 Preventing the need for drug therapy,

when possible, by promoting health
and preventing conditions that require
drug therapy.
 Using appropriate and effective
nonpharmacologic interventions
instead of, or in conjunction with, drug
therapy when indicated. When used
with drug therapy, such interventions
may promote lower drug dosage, less
frequent administration, and fewer
adverse effects.
GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY

 Preventing or minimizing adverse drug

effects by knowing the major adverse
effects associated with particular
drugs, identifying clients with
characteristics that may increase risks
of experiencing adverse effects, and
actively monitoring for the occurrence
of adverse effects. When adverse
effects occur, early recognition allows
interventions to minimize their
severity. Because all drugs may cause
adverse effects, nurses must maintain
a high index of suspicion that
symptoms, especially new ones, may
 GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY

Teaching clients and caregivers

about accurate administration of
medications, nonpharmacologic
treatments to use with or instead of
pharmacologic treatments, and
when to contact a health care
provider.
 Classification of
Therapeutic Agents
 DRUGS
§ In pharmacology, a drug is "a chemical
substance used in the treatment, cure,
prevention, or diagnosis of disease or used to
otherwise enhance physical or mental well-
being."
§
 BIOLOGICS
§ include a wide range of medicinal products such as vaccines,
blood and blood components, allergenics, somatic cells,
gene therapy, tissues, and recombinant therapeutic
proteins created by biological processes (as opposed to
chemically).
§ Biologics can be composed of sugars, proteins, or nucleic
acids or complex combinations of these substances, or
may be living entities such as cells and tissues. Biologics
are isolated from a variety of natural sources - human,
animal, or microorganism - and may be produced by
biotechnology methods and other technologies. Gene-
based and cellular biologics, for example, often are at the
forefront of biomedical research, and may be used to treat
a variety of medical conditions for which no other
treatments are available.
§ In some jurisdictions, biologics are regulated in a different
manner than are drugs and medical devices.

 Alternative
Therapies

4444
A botánica, such as this one in


Massachusetts, caters to the

Latino community and sells folk
medicine alongside statues of
saints, candles decorated with
prayers, and other items.

§ In Western culture, alternative medicine is any healing practice
"that does not fall within the realm of conventional medicine",or
"that which has not been shown consistently to be effective.”
Alternative medicine is often based on the belief that a particular
health regimen has efficacious effects even while there exists
various bodies of evidence to contradict such a belief under the
rigorous standards of evidence based medicine. In practice,
alternative medicine encompasses therapies with a historical or
cultural, rather than a scientific, basis. Commonly cited examples
include naturopathy, chiropractic, herbalism, traditional Chinese
medicine, Unani, Ayurveda, meditation, yoga, biofeedback,
hypnosis, homeopathy, acupuncture, and diet-based therapies, in
addition to a range of other practices. It is frequently grouped
with complementary medicine, which generally refers to the
same interventions when used in conjunction with mainstream
techniques under the umbrella term complementary and
alternative medicine, or CAM.
Traditional Chinese
Medicine
Acupuncture chart from Hua Shou
(fl. 1340s, Ming Dynasty). This
image from Shi si jing fa hui
(Expression of the Fourteen
Meridians). (Tokyo : Suharaya
Heisuke kanko, Kyoho gan 1716).
DOH warns against Iridology
 By Katherine Evangelista
INQUIRER.net
First Posted 19:06:00 08/04/2008
Filed Under: Health, Diseases

MANILA, Philippines – Iridology is “neither a diagnostic tool nor a therapeutic

modality in alternative medicine,” the Department of Health (DoH) on Monday said.
“There is no scientific validation for the use of iridology and it does not have strong

evidence of having value either for diagnosis or treatment of diseases,” Health

Secretary Francisco Duque III said in a statement.
Iridology, or iridodiagnosis, is an alternative medicine technique where a patient’s iris

is examined to determine information abut his or her health.

After examination, iridologists encourage patients to purchase “alleged herbal
medicines” to cure or prevent the spread of their “diagnosed disease,” the DoH said.
These herbal medicines may have implications on the health of a person who does

not need them, it said.

Duque fears that iridology puts the lives of patients at risk if it is used as replacement

for established diagnostic tools since a patient might be given wrong information on
his or her health condition.

 Ten ( 10 ) Herbal Medicines in
the Philippines
Approved by the Department of
Health ( DOH )
1 . Akapulko ( Cassia
alata )
also known as "bayabas-bayabasan" and "ringworm


bush" in English, this herbal medicine is used to treat

ringworms and skin fungal infections.
2 . Ampalaya ( Momordica
charantia )
known as "bitter gourd" or "bitter melon" in English, it


most known as a treatment of diabetes (diabetes

mellitus), for the non-insulin dependent patients.
3 . Bawang ( Allium
sativum )
popularly known as "garlic", it mainly reduces


cholesterol in the blood and hence, helps control blood

pressure.
4 . Bayabas ( Psidium
guajava )
"guava" in English. It is primarily used as an


antiseptic, to disinfect wounds. Also, it can be used as

a mouth wash to treat tooth decay and gum infection.
5 . Lagundi ( Vitex
negundo )
known in English as the "5-leaved chaste tree". It's


main use is for the relief of coughs and asthma.

6 . Niyog - niyogan ( Quisqualis
indica L . )
is a vine known as "Chinese honey suckle". It is effective in the


elimination of intestinal worms, particularly the Ascaris and Trichina.

Only the dried matured seeds are medicinal -crack and ingest the
dried seeds two hours after eating (5 to 7 seeds for children & 8 to
10 seeds for adults). If one dose does not eliminate the worms, wait
a week before repeating the dose.
7 . Sambong ( Blumea
balsamifera )-
English name: Blumea camphora. A diuretic that helps
in the excretion of urinary stones. It can also be used
as an edema.
8 . Tsaang Gubat ( Ehretia
microphylla Lam . )
Prepared like tea, this herbal medicine is effective in treating
intestinal motility and also used as a mouth wash since the
leaves of this shrub has high fluoride content.
9 . Ulasimang Bato | Pansit - Pansitan ( Peperomia
pellucida )
It is effective in fighting arthritis and gout. The leaves can be eaten


fresh (about a cupful) as salad or like tea. For the decoction, boil a
cup of clean chopped leaves in 2 cups of water. Boil for 15 to 20
minutes. Strain, let cool and drink a cup after meals (3 times day).
10 . Yerba Buena ( Clinopodium
douglasii )
commonly known as Peppermint, this vine is used as an analgesic to


relive body aches and pain. It can be taken internally as a decoction

or externally by pounding the leaves and applied directly on the
afflicted area.
Tips on Handling Medicinal
Plants / Herbs:
 If possible, buy herbs that are grown organically - without
pesticides.
 Medicinal parts of plants are best harvested on sunny mornings.
Avoid picking leaves, fruits or nuts during and after heavy
rainfall.
 Leaves, fruits, flowers or nuts must be mature before harvesting.
Less medicinal substances are found on young parts.
 After harvesting, if drying is required, it is advisable to dry the
plant parts either in the oven or air-dried on screens above
ground and never on concrete floors.
 Store plant parts in sealed plastic bags or brown bottles in a cool
dry place without sunlight preferably with a moisture
absorbent material like charcoal. Leaves and other plant parts
that are prepared properly, well-dried and stored can be used
up to six months.
Tips on Preparation for
Intake of Herbal
Medicines:
 Use only half the dosage prescribed
for fresh parts like leaves when
using dried parts.
 Do not use stainless steel utensils
when boiling decoctions. Only use
earthen, enamelled, glass or alike
utensils.
As a rule of thumb, when boiling
leaves and other plant parts, do
not cover the pot, and boil in low
flame.
Tips on Preparation for
Intake of Herbal
Medicines:
 Decoctions loose potency after some
time. Dispose of decoctions after
one day. To keep fresh during the
day, keep lukewarm in a flask or
thermos.

 Always consult with a doctor if

symptoms persist or if any sign of
allergic reaction develops.

Prescription and Over
the counter Drugs
Prescription/legend drug

 can be dispensed if with

prescription order; with
specific name of drug &
dosage regimen to be used
by patient
Non-prescription drug

 can be dispensed over –the-

counter/without prescription
order
 for self treatment of variety of
complaints
 vitamin supplements, cold/cough
remedies, analgesics, antacids,
herbal products
Cautions in use of OTC
drugs:

1. delay in professional diagnosis &



treatment of serious/potentially
serious condition may occur
2.
 symptoms may be masked
making the diagnosis more
complicated
3.
 clients’ health care
provider/pharmacist should be
consulted before OTC preparations
are taken
Cautions in use of OTC
drugs:

 4. labels/instructions should be
followed carefully
 5. ingredients in OTC drug may
interact with prescribed drug
 6. inactive ingredients may
result in adverse reactions
Cautions in use of OTC
drugs:

 7. potential for overdose

 8. multiple medication users
are at risk as more
medications are added to
therapy regimen
 9. interactions of medications
are potentially dangerous
Drug Regulations
and
Standards
 PHARMACOLOGY
 R.A. 6425- Dangerous Drugs
Act

It stip u la te s
 th a t th e sa le ,
a d m in istra tio n , d e live ry , d istrib u tio n
a n d tra n sp o rta tio n o f p ro h ib ite d
d ru g s is p u n ish a b le b y la w .
 R.A. 9165 – the new
Dangerous Drug Act of
2002
Food and Drug
Administration
 a p p ro ve s m a n y n e w d ru g s
a n n u a lly

Pregnancy Categories

 Research into the development of the

human fetus, especially the nervous
system, has led many health care
providers to recommend that no drug
should be used during pregnancy
because of potential effects on the
developing fetus.
 In cases in which a drug is needed, it is
recommended that the drug of
choice be one for which the benefit
outweighs the potential risk
FDA Pregnancy Categories
 Category A: No risk in pregnant women and fetus
 Category B: No risk in pregnant women and fetus
 Animal studies have shown adverse effect.
 Category C: Animal studies have shown risk for fetus
 No adequate studies in humans
 Benefits from the use of drugs accepted
 Category D: Evidence of human fetal risk
 Benefits from the use of drugs accepted
 Category X: Animal and human studies demonstrate fetal
abnormalities or adverse reactions. The risk for pregnant
women clearly outweighs any possible benefit.
Controlled
Substance
PHARMACOLOGY
CATEGORIES OF CONTROLLED
SUBSTANCES

 Schedule I
 Drugs that are not approved
for medical use and have
high abuse potentials:
heroin, lysergic acid
diethylamide (LSD), peyote,
mescaline,
tetrahydrocannabinol,
marijuana.

CATEGORIES OF CONTROLLED
SUBSTANCES

Schedule II


 Drugs that are used medically and

have high abuse potentials:
opioid analgesics (eg, codeine,
hydromorphone, methadone,
meperidine, morphine,
oxycodone, oxymorphone),
central nervous system (CNS)
stimulants (eg, cocaine,
methamphetamine,
methylphenidate),and
barbiturate sedative-hypnotics
(amobarbital,
CATEGORIES OF CONTROLLED
SUBSTANCES

Schedule III


 Drugs with less potential for abuse

than those in Schedules I and II,
but abuse may lead to
psychological or physical
dependence: androgens and
anabolic steroids, some CNS
stimulants (eg, benzphetamine),
and mixtures containing small
amounts of controlled
substances (eg, codeine,
barbiturates not listed in other
schedules).
CATEGORIES OF CONTROLLED
SUBSTANCES

Schedule IV


 Drugs with some potential for

abuse: benzodiazepines
(eg, diazepam,lorazepam,
temazepam), other
sedative-hypnotics (eg,
phenobarbital,chloral
hydrate), and some
prescription appetite
suppressants(eg, mazindol,
phentermine).
CATEGORIES OF CONTROLLED
SUBSTANCES

Schedule V


 Products containing moderate

amounts of controlled
substances.
 They may be dispensed by the
pharmacist without a
physician’sprescription but with
some restrictions regarding
amount, record keeping, and
other safeguards. Included are
antidiarrheal drugs, such as
diphenoxylate and atropine
 Orphan Drugs
p Are drugs that have been discovered
but are not financially viable and
therefore have not been “adopted”
by any drug company.
Generic Drugs
  PHARMACOLOGY

COMMON SOURCES /4 MAJOR

SOURCES (ORIGINS) OF
DRUGS:
 1. Animal sources
 from organs, organ secretion or organ cells
Used to replace human chemical not
produces because of disease or genetic
problems
Thyroid drugs & growth hormones
preparations – from animal thyroid &
hypothalamus tissue (many of these
preparations are now created
synthetically – safer & purer)
Insulin – from pancreas of animals (hog,
cattle, sheep): thru genetic engineering –
could produce human insulin by altering
E. coli bacteria making it a better product
without impurities that come with animal
products
 2. Vegetable/Plant
sources
roots, bark, sap, leaves, flowers, seeds of
medicinal
Plants digitalis from wildflower, purple
foxglove, dried leaves of plant
active principles of plants
§ alkaloids – alkaline in reaction, bitter in
taste, powerful in physiologic activity
o atropine & scopolamine
o morphine sulfate, cocaine, quinine, nicotine,
caffeine
o procaine
 2. Vegetable/Plant
sources
 glycosides – digitalis
 resin – soluble in alcohol; example –
colonic irritant found in laxative
cascara
 gums – used in bulk-type laxatives:
some used in certain skin
preparations for their soothing
relief
 oils – castor oil, oil of wintergreen
 3. Mineral sources
 from free elements, both metallic &
non-metallic usually in form of
acids bases, salts found in food
 Dilute HCI – control/prevent
indigestion
 Calcium, aluminum, fluoride, iron,
gold, potassium
 4. Synthetic sources
 many drugs developed synthetically
after chemical in plants, animals, or
environment have been screened
for signs of therapeutic activity
more potent, more stable, less toxic
Ø steroids – arthritis & other diseases
Ø sulfonamides/chemotherapeutic
agents – kill microorganism slow
their growth
Ø meperidine HCI (Demerol)
PHARMACOLOGY

PHASES OF DRUG
DEVELOPMENT
Preclinical Trials
 Chemicals are tested on laboratory
animals to determine if:
1. they have the presumed effects on

living tissue;
2. and to evaluate any adverse effects
Some chemicals are discarded
after preclinical trial for the
following reasons:
 Lack of therapeutic activity when
introduced with a living organism
 Too toxic to living organism
 Highly teratogenic (abnormalities or
adverse effects to the fetus)
 The safety margin is too small
Ex. Lithium - 0.6 mg/dl- therapeutic

 - 0.5 mg/dl- useless

 - 0.7 mg/dl- toxic
PHASE I Studies
 Drugs are tested on human volunteers
 a few doses are given to a few healthy
volunteers to determine safe dosages,
routes of administration, absorption,
metabolism, excretion, and toxicity.
PHASE II Studies
 Drugs are tested on patients with the
disease that the drug is meant to
treat.
 a few doses are given to a few subjects
with the disease or symptom for
which the drug is being studied, and
responses are compared with those of
healthy subjects.
PHASE III Studies
 Using the drug in a vast clinical market
 the drug is given to a larger and more
representative group of subjects.
DRUG NOMENCLATURE

PHARMACOLOGY
DRUG NOMENCLATURE
1. TRADE/BRAND/PROPRIETY NAME – name
given by the drug company that
developed it
 followed by the symbol R or TM, 1st letter
is capitalized
2. GENERIC NAME/NON-PROPERTY NAME-

 original designation given to the drug

when the drug company applies for
approval process
 universally accepted & not capitalized;
before drug becomes official, used in all
countries
protected by law; not capitalized

3. CHEMICAL NAME-

 atomic/molecular structure of drug

DRUG NOMENCLATURE
 chemical name – acetylsalicylic acid
 generic name – aspirin
 trade name – Aspilet


 minoxidil
Generic name
 Rogaine
Brand name
PHASE IV Studies
 the FDA evaluates the data from the
first three phases for drug safety and
effectiveness, allows the drug to be
marketed for general use, and
requires manufacturers to continue
monitoring the drug’s effects.