The purpose of studying

PHARMACOLOGY is to
help you learn about
medicines and the WHY,
WHAT, HOW, WHEN,
and WHERE they are used
in daily life.
> a branch of medical science
> deals with the mechanism of action, uses,
adverse effects, and fate of drugs in animals
and humans
> is essential in the practice of human
medicine, where drugs are used to treat
disease
1. Pharmacodynamics- the study
of what the drug does to the
body
2. Pharmacokinetics- the study
of what the body does to the
drug. It involves four processes:
Absorption- the transfer of a drug from its site
of administration to the blood stream
Distribution- the process by which drug
reversibly leaves the blood stream and enters
the tissues
Metabolism/Biotransformation- process by
which drug structure is altered for removal
from the body. Liver is the major site of drug
metabolism.
Excretion/Clearance- usually thru feces, urine
3. Pharmacotherapeutics- the study of drugs in the
treatment and prevention of disease (intended or
desired effects)
4. Clinical Pharmacology- drug tests regarding its
safety
5. Pharmacovigilance- all scientific and data gathering
activities that relate to detection, assessment,
understanding and prevention of adverse events
6. Pharmacoeconomics- cost effectivity of drugs
7. Toxicology- deals with adverse effects of drugs
Three different names of drugs:
1. Chemical name is the scientific name that precisely
describes the drug’s atomic and molecular structure.
2. Generic (Non-proprietary) name is selected by the
original manufacturer of the drug based on the chemical
structure; abbreviation of chemical name
eg. Paracetamol (p-Acetaminophenol)
3. Trade/Brand name (Proprietary) is a name selected by
the drug company selling the product. Trade names are
protected by copyright. It is best to use a drug’s generic
name because any one drug can have a number of trade
Chemical name
• (+/-)-2-(p-isobutylphenyl)
propionic acid

Generic name
• Ibuprofen

Trade name
• Alaxan®, Advil®
1. Therapeutic Classifications are broad
categories based on therapeutic intent.
Therapeutic classes include several
pharmacologic classes. They are not
chemically similar and have different
mechanism of action.

eg. Antihypertensives, Antibacterial

2. Pharmacologic Class are drugs that share similar
characteristics and same mechanism of action.
Eg. “angiotensin-converting enzyme inhibitors” (ACE
inhibitors) tell you exactly how the drugs works—they inhibit
the enzyme that converts angiotensin I to angiotensin II thus
reducing blood pressure.
Clues to Pharmacologic Class: Generic names of drugs in
the same pharmacologic class often have the same suffix.
Eg. ACE inhibitors , the pharmacologic class of medications
in the therapeutic class of Antihypertensives, end in “- pril ”
Drugs were mainly
derived from
Plants (eg, morphine)
Animals (eg, insulin)
Minerals (eg,
iron,iodine)
Synthetic (eg,
Antibiotics:1st to 4th
generation)
Medications are available
in a variety of forms and
preparations
The form of the med will
determine its route of
administration
Composition of med is
designed to enhance its
absorption & metabolism
Tablet
Capsule
Caplet
Elixir
Enteric-coated
Suppository
Suspension
Transdermal patch
Drops
Injections
Ointment
Tincture
Liniment
Aerosol
*most convenient, most
economical
Eg. Pills, capsules,
tablets, liquids
Sublingual (SL), Buccal
Nasogastric,
Gastrostomy tubes (oral
prep are used)
 Advantages
• Most convenient
• Usually least expensive
• Safe, does not break skin
barrier
• Administration usually does
not cause stress
Disadvantages
• Inappropriate for patients with
nausea and vomiting
• Drug may have unpleasant taste or
odor
• Inappropriate when GIT has
reduced motility
• Inappropriate if patient cannot
swallow or is unconscious
• Cannot be used before certain
diagnostic tests or surgical
procedures
• Drug may discolor the teeth
• Drug may irritate gastric mucosa
 FIRST-PASS EFFECT

It happens most commonly when the drug is

administered orally. The drug then is absorbed in the
GIT and enters enters the portal circulation before
entering the systemic circulation. Via the portal
circulation it enters the liver where some drugs undergo
extensive biotransformation and the drug concentration
is decreased.
Thus it is the fraction of lost drug during the process of
absorption generally related to the liver.
 Advantages
• Same as oral route
• More potent than oral route
because drug directly enters
the blood and bypasses the
liver
Disadvantages
• If swallowed, drug may be
inactivated by gastric juice
• Drug must remain under the
tongue until dissolved and
absorbed
• Drug is rapidly absorbed in
the bloodstream
 Advantages Disadvantages
• Can be used when drug has • Dose absorbed is
objectionable taste or odor unpredictable
• Drug released at slow, steady
rate
 Advantages Disadvantages
• Provides local therapeutic • Limited use
effect
 Advantages Disadvantages
• Provides a local effect • Maybe messy and may soil
• Few side effects clothes
• Drug can enter body through
abrasions and cause systemic
effects
 Advantages
• Prolonged systemic effect
• Few side effects
• Avoids gastrointestinal
absorption problems
Disadvantages
• Leaves residue on the skin
that may soil clothes
 PARENTERAL ROUTES

1. Intradermal-drugs injected to the skin 10-15 degree

angle usually for diagnostic purposes such as testing for
allergies and tuberculosis
2. Intramuscular-drugs injected directly into various
muscle groups; allows absorption of large doses upto
5ml
3. Subcutaneous-injected beneath the dermis and into
subcutaneous tissue; allows absorption of 0.5-2ml of
fluid
4. Intravenous-injection of drugs directly into the
bloodstream through a vein
 Advantages Disadvantages
• Onset of drug action faster • Must involve sterile
than oral technique because it breaks
skin barrier
• More expensive than oral
• Can administer only small
volume (0.5-2ml)
• Slower than intramuscular
administration
• Some drugs can irritate
tissues and cause pain
 Advantages Disadvantages
• Pain from irritating drugs is • Breaks skin barrier
minimized • Can produce anxiety
• Can administer larger
volume than subcutaneous
• Drug is rapidly absorbed
 Advantages Disadvantages
• Absorption is slow (this is an • Amount of drug
advantage in testing for administered must be small
allergies) • Breaks skin barrier
 Advantages Disadvantages
• Rapid effect • Limited to highly soluble
drugs
• Drug distribution inhibited
by poor circulation
 Advantages
• Introduces drug throughout
respiratory tract
• Rapid localized relief
• Drug can be administered to
unconscious client
Disadvantages
• Drug intended for localized
effect can have systemic
effect
• Of use only for the
respiratory system
Ventral forearm
Upper chest
Shoulder
Outer aspects of
the arms & thighs
Hip & lower
abdomen
Above the iliac
crest
Ventrogluteal
for 1 year and
above
Vastus lateralis
below 1 year old
Dorsogluteal - clients w/ well-developed gluteal
muscles
Deltoid
(IV) is the installation of fluid
and/or electrolytes, or
nutrient, medication
substances into a vein.
skin, ophthalmic, otic,
nasal, vaginal, rectal
 SIDE-EFFECTS ADVERSE EFFECTS
1. Unintended 1. Unintended
2. Insignificant/dangerous 2. Insignificant/dangerous
3. Can occur 3. Can occur
immediately/months later immediately/months later
4. Anticipated 4. Rare
5. Known/ Expected 5. Harm is caused with normal
use at a normal dose report to
FDA for study
Toxicity Hypersensitivity
Drug is acting as a Healthy immune system has an
toxin or poison undesirable exaggerated
response to a foreign substance
Idiosyncratic reaction (perceived foreign substance)
Unique response to an
individual/small group Type I (Allergic reaction)
of people Occurs when the body
recognizes the drug as foreign
and responds by histamine
release
Laboratory values reflecting function of liver and kidneys
need to be looked at.
BUN and Creatinine – kidney function
Liver function tests:
ALT – alamine aminotransferase (elevated in
hepatitis)
AST or SGOT– aspartate aminotransferase –
elevated in liver disease
Bilirubin levels – infants – gallstones in adults
 Abbreviation Meaning Abbreviation Meaning
A Before Ac Before meals
Ad lib As desired As Left ear
Ad Right ear aq water
Au Both ears biw Twice a week
BID, bid Twice in a day caps capsule
c With d/c discontinue
/d Per day hs At bedtime
Dx Diagnosis Injection inj
gtt Drops/guttae IV Intravenous
H Hour IM Intramuscular
ID Intradermal NKA No known allergies
 Abbreviation Meaning Abbreviation Meaning
OD Right eye OS Left eye
OU Both eyes P After
pc After meals prn As needed
po By mouth pt Patient

q Every q2h Every 2 hours

qid Four times a day ss One-half
s Without SC/SQ Subcutaneous
Stat Immediately Tbsp Tablespoon
SL Sublingual Tsp Teaspoon
sx Symptom Tiw Three times a week
tid Three times a day mL milliliter
1 tsp=____ml 1g=____mg
1 tbsp=____ml 1kg=____g
1oz=____ml 1L=____ml
1cup=____ml 1cc=____ml
1cup=____oz 30ml=____tbsp.
1kg=____pounds 1gallon=____L
1lb=____grams 1L=____quart
1mg=____mcg 1000ml=____oz
1g=_____mcg 500ml=____oz
Laboratory measurement of the amount of drug in the
blood at a particular time
A minimum effective concentration (MEC) must be
present before a drug exerts its action on a cell.
Excessive level of a drug in the body
Single large dose
Repeated small doses
Slow metabolism which allows drug to accumulate in
the body
Slow excretion from the body by the kidneys or
gastrointestinal tract
Serum drug levels indicate the onset, peak and duration
of the drug action
No
When do we need them?
Drugs with narrow margin of safety (digoxin,
aminoglycoside antibiotics, lithium)
To check to see if the drug is at therapeutic levels –
seizure medications
When drug overdose is suspected
Serum half-life or elimination half-life is the time it takes
the serum concentration of the drug to reach 50%
A drug with a short half-life requires more frequent
administration
A drug with a long half-life requires less frequent
administration
Half-life determines how often a drug is given
Daily in the morning
At bedtime
Q.I.D - four times a day
T.I.D – three times a day
Q4 hours – every four hours
Q 12 hours – 9 am and 9 pm
 • The study of what
the drug does to
the body the
mechanism of drug
actions in living
tissues

“WHAT THE DRUG DOES TO THE BODY”

What does a cell do?
Exchange material
Obtain energy from
nutrients
Synthesize hormones,
neurotransmitters,
enzymes, structural
proteins and other
complex molecules
Duplicate themselves
Drugs can:
1. Inhibit
2. Activate
3. Replace
Enzymes are substances that catalyze nearly every
biochemical reaction in a cell
Drugs can interact with enzyme systems to alter a
response
Inhibits action of enzymes-enzyme is “fooled” into
binding to drug instead of target cell
Protects target cell from enzyme’s action (ACE Inhibitors)
Most drugs exert their
effects by chemically biding
with receptors at the cellular
level.
Receptors are proteins
located
on the surfaces of cell
membranes
within the cells
The receptors are often
described as the lock into
which the drug molecule fits
as a key.
All body cells do not respond
to all drugs even when all the
cells are exposed to the drug.
Receptors are regulated in
TWO WAYS:
1. Agonists (activators)
– bind to the receptor
and act to produce a
pharmacologic effect
2. Antagonists (blockers)
– bind to the receptor
and prevent the cell from
producing an effect
Number of receptors site
available will effect drug
action so giving a higher dose
does not necessarily produce
additional pharmacological
effects.
Often the first dose is higher
in an effort to bring the
therapeutic blood serum
levels up quicker
Food can slow absorption
Food substances can react
with certain drugs
How to give medication is
information provided in you
drug manual
Some drugs taken together will enhance each other
Tylenol with codeine
Some drugs taken together will interfere with another
drugs actions
Some drugs are given to decrease or reverse the toxic
effects of a drug
Narcotic antidote is naloxone
Body becomes accustomed to
drug over period of time
Undesired response
Allergic reaction
Drowsiness
Nausea / vomiting / GI upset
Liver or kidney damage
Fevers
Drug dependency
Cancinogenicity – ability to cause cancer
Teratogenicity – cause damage to fetus
 The use of drugs
and the clinical
indications for drugs
to prevent and treat
diseases
The effectiveness of the
drug therapy must be
evaluated.
One must be familiar with
the drug’s intended
therapeutic action
(beneficial) and the drug’s
unintended but potential
side effects (predictable,
adverse drug reactions).
Acute therapy
Maintenance therapy
Supplemental therapy
Palliative therapy
Supportive therapy
Prophylactic therapy
Therapeutic Effect
Side Effects
Adverse Effects
Toxic Effect
Idiosyncratic Reactions
Allergic Reaction
Medication Interactions
Iatrogenic Response
The expected or
predictable
physiological response
a medication causes
A single med can have
several therapeutic
effects
‘A drug that does Unintended secondary effects a
medication predictably will
not cause side- cause
effects is a drug May be harmless or serious
that does not If side effects are serious
work.’ enough to negate the beneficial
effect of meds therapeutic
action, it may be D/C
People may stop taking
medications because of the side
effects
• Medication misadventures
– Adverse drug events
– Adverse drug reactions
– Medication errors
Undesirable response of a
medication
Unexpected effects of drug
not related to therapeutic
effect
Must be reported to FDA
Can be a side effect or a
harmful effect
Can be categorized as
pharmacologic, idiosyncratic,
hypersensitivity, or drug
interaction
Toxicology
The study of poisons
and unwanted responses
to therapeutic agents
May develop after prolonged
intake or when a medicine
accumulates in the blood
because of impaired
metabolism or excretion, or
excessive amount taken
Toxic levels of opioids can
cause respiratory depression
Antidotes available to reverse
effects
Table 2-9 Common
Poisons and Antidotes
Unpredictable effects-
overreacts or under reacts
to a medication or has a
reaction different from
normal
Normal effect is produce
by a small fraction of the
standard dose.
Unpredictable response to a
medication
Makes up greater than 10% of
all medication reactions
Client may become sensitized
immunologically to the initial
dose, repeated administration
causes an allergic response to
the medicine, chemical
preservative or a metabolite
Medication acts as
an antigen
triggering the
release of the
body’s antibodies
May be mild or
severe
A postoperative client is receiving morphine
sulfate via a PCA. The nurse assesses that the
client’s respirations are depressed. The effects
of the morphine sulfate can be classified as:
A. Allergic
B. Idiosyncratic
C. Therapeutic
D. Toxic
35 - 109
Teratogenic-Structural
effect in unborn fetus
Carcinogenic-Causes
cancer
Mutagenic- Changes
genetic composition
(radiation, chemicals)
Unintentional adverse effects that occur during
therapy
Treatment Induced Dermatologic
rash, hives, acne
Renal Damage
Aminoglycoside antibiotics, NSAIDS, contrast
medium
Blood Dyscrasias
Destruction of blood cells (Chemotherapy)
Hepatic Toxicity
Elevated liver enzymes
Interactions
Additive effect
Synergistic effect
Antagonistic effect
Incompatibility
Drugs are said to have an
additive effect when they
have similar actions.
Lower doses are needed
when the drugs are given
together.
Similar therapeutic activity
can cause problems if
administered together
Effect of 2 meds
combined is greater than
the meds given separately
Alcohol & Antihistamines,
antidepressants,
barbiturates, narcotics
Combined effect is less
than each of them alone.
Drugs with opposite
action to that of another
drug or natural body
chemical
Examples: Beta-blockers
the ‘olol’ drugs
Drugs are incompatible
when combining them
causes chemical
deterioration of one or
both
 NURSING
RESPONSIBILITY
 Assessment

Evaluation Diagnosis

Implementation Planning
Assessment
• Data collection Assessment

– Subjective, objective
– Data collected on the patient, drug, environment
• Medication history Evaluation Diagnosis

• Nursing assessment
• Physical assessment
• Data analysis
Implementation Planning
• A “double-check”
• The entire “system” of
medication administration
• Ordering, dispensing,
preparing, administering,
documenting
• Involves the physician,
nurse, nursing unit,
pharmacy department,
and patient education
1. Right Patient
2. Right Medication
3. Right Dosage
4. Right Route
5. Right Time
6. Right Documentation
7. Right Client Education
8. Right to Refuse
9. Right Assessment
10. Right Evaluation
Proper drug storage
Careful checking of
transcription of orders
Patient safety
Close consideration of special
situations
Prevention and reporting of
medication errors
Monitoring for therapeutic
effects, side effects, toxic
effects
 Ongoing part of the
Assessment nursing process
Determining the status
Evaluation Diagnosis
of the goals and
outcomes of care
Monitoring the patient’s
response to drug
Implementation Planning
therapy
The day shift charge nurse is making rounds. A patient
tells the nurse that the night shift nurse never gave him his
medication, which was due at 11 PM. What should the
nurse do first to determine whether the medication was
given?

1. Call the night nurse at home.

2. Check the Medication sheet.
3. Call the pharmacy.
4. Review the nurse’s notes.
The patient’s Medication sheet lists two antiepileptic
medications that are due at 0900, but the patient is NPO for
a barium study. The nurse’s coworker suggests giving the
medications via IV because the patient is NPO. What
should the nurse do?

1. Give the medications PO with a small sip of water.

2. Give the medications via the IV route because the
patient is NPO.
3. Hold the medications until after the test is completed.
4. Call the physician to clarify the instructions.
Clients expect you to be knowledgeable
You gain this knowledge be looking up medications
Drug hand book
PDA
Pharmacist
The nurse is responsible for
safe and accurate administration
having sufficient drug knowledge to recognize
and question erroneous orders
actions delegated to other persons – orderly
cannot give medications
monitor clients response to a medication
following safe practices – the ten rights
Each facility has a system
for administering
medication
Be familiar with this
process & need to learn at
each new facility
Basics of medication
administration guidelines
should always be observed
Full name of client
Generic or trade name of drug
Dose, route, frequency
Date, time and signature of provider
The nurse will need to look up the medication
ordered to know it’s classification, safe dose,
action, how to administer, and side effects
The nurse should know why the medication is
ordered
• Pregnancy
• Breast-feeding
• Neonatal
• Pediatric
• Geriatric
First trimester is the period of
greatest danger for drug-
induced developmental
defects
Drugs diffuse across the
placenta
FDA pregnancy safety
categories
Class A
Studies failed to demonstrate
fetal anomalies.
Class B
Animal studies have not
demonstrated a fetal risk.
Information in human is not
available
Class C
Studies in animal have
revealed an adverse effect
Class D
There is a positive evidence
of fetal risk but in some cases
may warrant the use of these
drugs
Class X
Studies in animal and human
have revealed abnormalities
• Breast-fed infants are at risk
for exposure to drugs
consumed by the mother
• Consider risk-to-benefit ratio
• Absorption
– Gastric pH less acidic
– Gastric emptying is slowed
– Topical absorption faster
through the skin
– Intramuscular absorption
faster and irregular
• Distribution
– TBW 70% to 80% in full-
term infants, 85% in
premature newborns, 64% in
children 1 to 12 years of age
– Greater TBW means fat
content is lower
– Decreased level of protein
binding
– Immature blood-brain barrier
• Metabolism
– Liver immature, does
not produce enough
microsomal enzymes
– Older children may
have increased
metabolism, requiring
higher doses
– Other factors
• Excretion
– Kidney immaturity affects
glomerular filtration rate
and tubular secretion
– Decreased perfusion rate
of the kidneys
Skin is thin and permeable
Stomach lacks acid to kill bacteria
Lungs lack mucus barriers
Body temperatures poorly regulated and
dehydration occurs easily
Liver and kidneys are immature, impairing drug
metabolism and excretion
• Body weight dosage
calculations

• Body surface area method

Geriatric:
older than age 65
Healthy People 2010:
older than age 55
Use of OTC
medications
Polypharmacy
• Absorption
– Gastric pH less acidic
– Slowed gastric emptying
– Movement through GI
tract slower
– Reduced blood flow to the
GI tract
– Reduced absorptive surface
area due to flattened
intestinal villi
• Distribution
– TBW percentages lower
– Fat content increased
– Decreased production of
proteins by the liver,
resulting in decreased
protein binding of drugs
• Metabolism
– Aging liver produces
less microsomal
enzymes, affecting drug
metabolism
– Reduced blood flow to
the liver
• Excretion
– Decreased glomerular
filtration rate
– Decreased number of
intact nephrons
• Analgesics
• Anticoagulants
• Anticholinergics
• Antihypertensives
• Digoxin
• Sedatives and hypnotics
• Thiazide diuretics
• By definition, all ADRs are
also ADEs
• But all ADEs are not ADRs
• Two types of ADRs
– Allergic reactions
– Idiosyncratic reactions
• Preventable
• Common cause of
adverse health care
outcomes
• Effects can range from
no significant effect to
directly causing
disability or death
Minimize verbal or
telephone orders
Repeat order to prescriber
Spell drug name aloud
Speak slowly and clearly
List indication next to
each order
Avoid medical shorthand,
including abbreviations
and acronyms
Never assume anything about
items not specified in a drug
order (i.e., route)
Do not hesitate to question a
medication order for any
reason when in doubt
Do not try to decipher
illegibly written orders;
contact prescriber for
clarification
NEVER use “trailing ALWAYS use a
zeros” with medication “leading zero” for
orders decimal dosages
Do not use 1.0 mg; use Do not use .25 mg;
1 mg use 0.25 mg
1.0 mg could be .25 mg may be
misread as 10 mg, misread as 25 mg
resulting in a tenfold “.25” is sometimes
dose increase called a “naked
decimal”
• Check medication order
and what is available while
using the “10 rights”

• Take time to learn special

administration techniques
of certain dosage forms
Always listen to and honor
any concerns expressed by
patients regarding
medications

Check patient allergies

and identification
Nurses are legally required to document medications
that are administered to clients. The nurse is
mandated to document:
A. Medication before administering it
B. Medication after administering it
C. Rationale for administering the
medication
D. Prescriber’s rationale for prescribing the
medication
35 - 161
If a nurse experiences a problem reading a
physician’s medication order, the most
appropriate action will be to:
A. Call the physician to verify the order.
B. Call the pharmacist to verify the order.
C. Consult with other nursing staff to
verify the order.
D. Withhold the medication until the
physician makes rounds.
35 - 162
Meter is used for linear
measure, gram for
weight and liter for
volume
Grains, minims, drams,
ounces, pounds, pints,
and quarts
Drops, teaspoons,
tablespoons and cups
Important since this is often
how people take medications
mEq – drugs
ordered in number
of units per dose
Insulin
heparin
mL = milliliter. This
is a VOLUME
measurement. it is
1/1000 of a liter.
when talking about
water or similar
liquids, it is
equivalent to one
cubic centimeter.
cc = cubic
centimeter. This is
also a VOLUME
measurement. Most
syringes measure
their capacity in cc's.
If you have a 5cc
syringe, it will hold
~5mL of liquid in it.
1 mL = 1cc
1 cc = 15 to 16 minims
1 cc = 15 to 16 drops

Fluids are generally written in

cc’s to standardize the
abbreviation – you may see
mL’s written but this
abbreviation is being
eliminated
5 cc = 1 tsp (teaspoon)
15 cc = 1 tbs (tablespoon)
30 cc = 1 oz (ounce) = 2 tablespoons
240 cc = 8 oz or 1 cup
mg = milligram. This is a WEIGHT measurement. It is
1/1000 of a gram. the amount of chemical substance is
often measured in milligrams. For injectable solutions,
this will be reported as a concentration of weight to
volume, such as mg/ml (milligrams per milliliter).
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