PNUR 1104 Pharmacology for Health Professionals

Overview of Pharmacology

Overview of Pharmacology
PNUR 1104 Online Pharmacology for Health Professionals

Objectives
Define selected key pharmacological terms Identify common sources of drugs Discuss how drugs are classified Differentiate between chemical, generic, and trade names of drugs Identify sources of drug information

Objectives
Summarize the standards and laws which govern drug use. Discuss the categories of controlled substances. Discuss the role of the Food and Drug Administration.

Definition of Terms
Pharmacology Drug Drug therapy Medication Local effects Systemic effects Prototype Drug classification Therapeutic classification Pharmacologic or chemical classification Chemical name Generic name

Definition of Terms
Trade or brand name Bioequivalent Prescription drugs Non-prescription or over-the-counter (OTC) drugs Controlled substances

Sources of Drugs
Historically derived from plants Synthetic drugs manufactured in labs Semisynthetic drugs are naturally occurring substances that have been chemically altered. Biotechnology ( recombinant deoxyribonucleic acid technology)

Drug Classification
Similar drugs are grouped together for purpose of study & for ease of prescribing. Drugs are classified according to their effects on particular body systems, their therapeutic uses & their chemical characteristics.

Drug Classification
Pharmacologic classification Therapeutic classification Chemical classification Other classifications: Body system, General use, Family, Primary action, and indication.

Drug Classification
Example: Morphine is a CNS depressant, narcotic analgesic & opiate as well as the prototype of narcotic analgesics.

Uses of Drugs
Therapeutic uses Palliative uses Prophylactic uses Diagnostic uses Replacement uses

Drug Nomenclature
Chemical name
Generic or nonproprietary name Trade (Brand) or proprietary name

Sources of Drug Information

Pharmacology textbooks Drug reference books: Physicians desk reference (PDR), Nursing drug reference books Journal articles & newsletters Internet sites Poison Control Centers Clinicians and Pharmacists

Laws and Standards

State laws regulate some aspects of drug use, sale and distribution, but federal laws regulate most major aspects.
Food and Drug Administration (FDA) Public Health Service Federal Trade Commission

Laws and Standards

Pure Food & Drug Act of 1906 Sherley Amendment of 1912 Harrison Narcotic Act of 1914 Food, Drug & Cosmetic Act of 1938 Amendment of 1945 Durham-Humphrey Amendment of 1952

Laws and Standards

Kefauver-Harris Amendment of 1962 Comprehensive Drug Abuse Prevention & Control Act of 1970 (Controlled Substance Act) Drug Regulation Reform Act of 1978 Orphan Drug Act of 1983 FDA Modernization Act of 1997 Drug Price & Patent Term Restoration

Categories of Controlled Substances

Schedule I: not approved for medical use, have high abuse potential Schedule II: used medically & have high abuse potential Schedule III: less potential for abuse Schedule IV: some potential for abuse Schedule V: contain moderate amounts of controlled substances

FDA Pregnancy Categories

Category harm Category Category Category harm Category harm A: Remote risk of fetal
B: Slightly More risk than A C: Greater risk than B D: Proven risk of fetal X: Proven risk of fetal

Drug Approval Process

FDA is responsible for approving all new drugs and certain other aspects of drug use - reviews all research studies related to drugs. Does not do testing itself. Newly developed drugs have to be extensively tested.

Testing Process
Begins with animal studies reviewed by the FDA for approval to go to next step. Next is clinical trials in humans:
Phase I, Phase II, Phase III, Phase IV (FDA evaluates data) Double-blind, placebo controlled, crossover studies, control studies and subject matching

Cellular physiology
Because all body functions, disease processes, and most drug interactions take place at the cellular level, we must understand cellular physiology.

Cellular physiology
Each body cell has the capacity to function and respond to injury. Although cells differ in various tissues according to location & function, they have common characteristics:
Exchange materials with their environment Communicate with each other

Characteristics of Inflammatory Response

The characteristics of the inflammatory response can be local or systemic reactions. These reactions may vary according to the cause and/or extent of the injury.

Characteristics of Inflammatory Response

LOCAL REACTION:
Erythema or redness Heat Edema or swelling Pain Purulent discharge

Characteristics of Inflammatory Response

SYSTEMIC REACTION:
Leukocytosis ( increased WBCs) Increased erythrocyte sedimentation rate (ESR) Fever Headache Loss of appetite Lethargy Weakness

Questions?

Basic Concepts and Processes

Objectives
Identify factors that decrease absorption of an oral drug. Identify mechanisms of drug movement in the body. Discuss absorption, distribution, metabolism, and excretion of drugs in the body.

Objectives
Discuss the main elements of the receptor theory of drug action. Discuss variables that effect drug actions in the body. Identify adverse effects of drugs on the body.

Definition of Terms
Pharmacotherapeutics Pharmacokinetics Passive diffusion Facilitated diffusion Active transport Absorption Distribution
Metabolism Excretion Serum half-life Pharmacodynamics Dose Dosage Toxic dose

Definition of Terms
Lethal dose Route of administration Drug-diet interaction drug-drug interaction Additive effects Synergism Interference Displacement Agonist Antagonist Pharmacogenetics Pharmacoanthropology

Definition of Terms
Adverse effects or side effects Therapeutic effects Toxic effects Hepatotoxicity Nephrotoxicity Ototoxicity Hypersensitivity or allergic reaction Drug fever Idiosyncrasy Anaphylactic reaction Drug dependence

Definition of Terms
Carcinogenicity Teratogenicity Tolerance Cross tolerance Metabolite Drug action Onset of action Peak of action Duration of action Therapeutic blood level Peak blood level Toxic blood level Indication(s) Contraindications

Definition of Terms
Precautions Incompatibility Loading dose Maintenance dose Cumulative effects

Mechanisms of Drug Movement

To act on body cells, drugs given for systemic effects must reach adequate concentrations in blood & other tissue fluids surrounding the cells. Thus, they must enter the body & be circulated in the bloodstream. After they act on cells, they must be eliminated from the body, as are other chemical bodies.

Mechanisms of Drug Movement

Passive diffusion: higher to lower
Facilitated diffusion: drug molecules combine with a carrier substance Active transport: lower to higher

Mechanisms of Drug Movement

Drug movement & therefore drug action are affected by a drugs ability to cross cell membranes. Cell membranes are complex structures composed of lipid & protein:
Lipid soluble drugs Water soluble drugs

Pharmacokinetics
Absorption:
Dosage form Route of administration GI function Increased gastric emptying Food in the stomach SQ or IM injections IV therapy Skin absorption Mucous membrane Lungs

Pharmacokinetics
Distribution: involves the transport of drug molecules within the body.
Carried to sites of action, metabolism & excretion Depends largely on adequacy of circulation Protein binding Only free or unbound portion of drug acts on body cells

Drug distribution in CNS is unique Drug distribution during pregnancy & lactation is unique

Pharmacokinetics
Metabolism: method by which drugs are inactivated or biotransformed by the body.
Changed into one or more inactive metabolites & excreted Kidney can only excrete water soluble substances Most drugs are metabolized by enzymes in the liver

Pharmacokinetics
Metabolism:
Enzyme induction Enzyme inhibition Rate of metabolism Oral drugs absorbed in the GI tract that are extensively metabolized in the liver reduce systemic circulation

Pharmacokinetics
Excretion: refers to elimination of a drug from the body.
Requires adequate functioning of the circulatory system & organs of excretion Most drugs are excreted by the kidneys
Bile Feces Lungs Skin

Pharmacokinetics
Serum half-life: also called elimination half-time, is the time required for the serum concentration of a drug to decrease by 50%. Determined primarily by drugs rates of metabolism & excretion

Short half life require more frequent administration 4-5 half lives are required to achieve steadystate concentrations Eliminated gradually over several half-lives

Pharmacodynamics
Receptor theory of drug action
Specific receptors: enzymes, proteins, nucleic acids Changes in cellular metabolism Changes permeability of cell membrane Modifies physiologic process of cell Receptors vary in type, location & number

Pharmacodynamics
When drug molecules chemically bind with cell receptors, pharmacologic effects are agonism or antagonism:
Agonists Antagonists

Pharmacodynamics
Nonreceptor drug actions: relatively few drugs act by other mechanisms.
Antacids Osmotic diuretics Structurally similar to nutrients Metal chelating agents

Variables That Affect Drug Actions

Drug related variables:
Dosage Route of administration Drug-diet interaction Drug-drug interactions

Drug-Drug Interactions
Additive effects Synergism or potentiation Interference Displacement Specific antidote Decreased intestinal absorption due to binding activation of enzymes Increased excretion

Client Related Variables

Age Body weight Genetic &ethnic characteristics Gender Pathologic conditions Psychological considerations

AGE
Children Pregnancy Newborns Older infants 1 -12 year olds After age 12 Older adults (65 & over)

Body Weight
Larger than average person requires more than average person. Nurse may have to calculate by mg per kg of weight. Fat cells may store drug and release later.

Gender
Altered responses to drugs have been demonstrated possibly due to hormonal influence.

Pathologic Conditions
Disorders may cause an alteration in the pharmacokinetic process:
Hypotension, shock, low plasma Vomiting, diarrhea, malabsorption Liver or kidney disease Malnutrition

Psychological Considerations
Placebo response Attitude and expectations Compliance

Adverse Effects of Drugs

All drugs can produce adverse effects May be common, rare, mild or severe May occur with usual therapeutic doses of drugs and are often called side effects.

Adverse Effects of Drugs

CNS effects GI effects Hematologic effects Hepatotoxicity Nephrotoxicity Hypersensitivity Drug fever Idiosyncrasy Drug dependence Carcinogenicity Teratogenicity

Tolerance and Cross-Tolerance

Drug tolerance Cross-tolerance Tachyphylaxis

Questions?

Nursing Process in Drug Therapy

Objectives
Discuss general principles of drug therapy. Identify information to be included in a medication history. Identify the Food and Drug Administration Pregnancy Categories for drugs.

Introduction
Drug therapy is one of the many nursing responsibilities in client care. To fulfill this responsibility the nurse must be:
Be knowledgeable about pharmacology Monitor responses to drug therapy Teach clients and families about drugs

Using Prototypes Approach to Study Pharmacology

Concentrate on therapeutic classifications, groups of drugs & prototypes of those groups. Know major characteristics for a group. Set guidelines for effective study

Legal Responsibilities of the Nurse

Nurses are legally empowered to give medications ordered by licensed physicians and dentists (in all states but GA, NPs). When giving medications, the nurse is legally responsible for safe and accurate administration (5 Rights).

Legal Responsibilities of the Nurse

The nurse is expected to have sufficient drug knowledge to recognize & question erroneous orders. The nurse is responsible for storing narcotics & other controlled substances in locked containers, administer only to people for whom they are prescribed, recording each dose given on the appropriate form & on MAR, counting the amount of each drug at the end of shift and reporting any discrepancies.

Legal Responsibilities of the Nurse

The nurse is expected to observe clients for therapeutic & adverse effects, as well as, teach clients safe and effective self-administration of drugs when indicated. Medication errors can be eliminated by following safe practices & guidelines.

Applying the Nursing Process

The nursing process is a systematic way of gathering information and using that information to plan, provide, and to evaluate client care and outcomes required for drug therapy. Assessment Nursing diagnosis Planning/goals Nursing interventions Evaluation

General Principles of Drug Therapy

The goal of drug therapy Benefits should outweigh the adverse effects Drug therapy should be individualized Drug costs and effects on quality of life should be considered

General Drug Selection & Dosage Considerations

Use as few drugs in as few doses as possible Individual drugs allow greater flexibility & individualization of dosage than fixed The least amount of the least potent drug that will yield therapeutic benefit should be given to decrease adverse effects.

General Drug Selection & Dosage Considerations

Recommended dosages are listed in amounts likely to be effective for most people, but are only guidelines to be interpreted according to client characteristics. Treatment with a particular drug can be started rapidly or slowly. Different salts of the same drug rarely differ pharmacologically.

Drug Therapy in Children

Special considerations Pharmacokinetics less predictable Fewer studies/ less research Neonates immature kidney/liver function Most meds given to adults are given to children as well Use general principles, techniques of drug administration as with adults but with additional guidelines

Additional Guidelines for Drug Administration to Children

Drug therapy is guided by childs age, weight, and level of growth and development. Choices of drug is often restricted. Safe therapeutic dosage ranges are less well defined for children. Use the oral route of administration when possible. Use thigh muscle for IM injections. Child-proof containers.

Drug Therapy for Older Adults

Adverse effects are especially likely to occur due to physiological changes associated with aging, pathologic changes due to disease processes, multiple drug therapy for acute and chronic disorders, impaired memory & cognition & difficulty in complying with medication orders.
The overall goal may be care instead of cure with efforts to prevent or control symptoms & maintain ability of ADL function .

Additional Guidelines for Drug Therapy in the Older Adult

Physiologic age (organ function) is more important than chronological age. S&S attributed to age may be caused by drug therapy. Medications should be taken only when necessary. Review current meds before prescribing new medications.

Additional Guidelines for Drug Therapy in the Older Adult

Give smallest number of effective drugs. Give for shortest effective time needed and reassess periodically. Smallest number of doses necessary prescribed to least disrupt routine. Start slow, go slow. Use non-drug measures as much as possible.

Additional Guidelines for Drug Therapy in the Older Adult

Long term drug therapy - home safety/ effectiveness guidelines: Label containers/Magnifying glass Use easy open containers Special devices & methods Enlist help of family members Observe for changes in S&S related to adverse drug reactions as opposed to aging process

Questions?