NURSING PHARMACOLOGY

PHARMACOLOGY
• Is the study of the biologic effects of
chemicals.
• Drugs = are chemicals that are introduced into
the body to cause some sort of change.
– Clinical Pharmacology (Pharmacotherapeutics)
• The branch of pharmacology that uses drugs to treat,
prevent, and diagnose disease.
Sources of Drugs:
• Natural sources:
– Plants = ex: digitalis products used to treat cardiac
disorders came from Digitalis purpurea (foxglove
plant) and various opium, codeine, and morphine
came from Papaver somniferum (poppy plant).
Sources of Drugs:
• Natural sources:
– Animal products = ex: insulin for treating diabetes
was obtained exclusively from the pancreas of
cows and pigs.
– However, today due to genetic engineering – the
process of altering DNA – permits scientists to
produce human insulin by altering Escherichia coli
bacteria making insulin a better product without
some of the impurities that come with animal
products.
Sources of Drugs:
• Inorganic compounds = elements that are
used to have therapeutic effects in the human
body.
– Ex:
• Aluminum = antacid to decrease gastric acidity,
management of hyperphosphatemia, prevention of the
formation of phosphate urinary stones.
• Fluoride = prevention of dental cavities
• Gold = treatment of rheumatoid arthritis
• Iron = treatment of iron deficiency anemia
Sources of Drugs:
• Synthetic sources = the use of genetic
engineering to alter bacteria to produce
chemicals that are therapeutic and effective.
Chemically altering the original drug component
may make it more potent, more stable, and less
toxic.
Drug Evaluation
• Bureau of Food and Drugs = the agency in the Philippines
responsible for the regulation of development and sale of
drugs.
• Stages of Drug Development:
– Preclinical trials = chemicals that may have therapeutic
value are tested on laboratory animals for two main
purposes:
• To determine whether they have the presumed effects
in living tissue.
• To evaluate any adverse effects (drug effects that are
not the desired therapeutic effects; may be unpleasant
or even dangerous).
Drug Evaluation
• Bureau of Food and Drugs = the agency in the Philippines
responsible for the regulation of development and sale of
drugs.
• Stages of Drug Development:
– Preclinical trials = chemicals that may have therapeutic
value are tested on laboratory animals for two main
purposes:
• To determine whether they have the presumed effects
in living tissue.
• To evaluate any adverse effects (drug effects that are
not the desired therapeutic effects; may be unpleasant
or even dangerous).
Drug Evaluation
• At the end of the preclinical trials, some chemicals are
discarded for the following reasons:
– The chemicals lack therapeutic activity when used
with living tissues
– The chemical is too toxic to living animals to be worth
the risk of developing into drug.
– The chemical is highly teratogenic.
– The safety margins are so small that the chemical
would not be useful in the clinical setting.
Drug Evaluation
• Phase I study = uses human volunteers to test
the drugs. Usually the volunteers are healthy
young men fully informed of the possible risks
and may be paid for their participation.
• Phase II study = allows the clinical investigators
to try out the drug in patients who have the
disease that the drug is designed to treat.
Drug Evaluation
• Phase III study = involves use of the drug in a vast
clinical market.
• Phase IV study = after a drug is approved for
marketing, it enters a phase of continual
evaluation. Prescribers are obligated to report to
the BFAD any untoward or unexpected adverse
effects associated with drugs they are using.
Drug Names:
• Generic name = are chemical names that are produced
by companies involved solely in the manufacturing of
drugs.
• Brand name = name given to a drug by the
pharmaceutical company that developed it; also called a
trade name.
• Chemical name = name that reflects the chemical
structure of a drug.
• Orphan drugs = are drugs that have been discovered
but are not financially viable and therefore have not
been “adopted” by any drug company.

• Over-the-counter (OTC) drugs = are products that

are available without prescription for self-treatment
of a variety of complaints.
Drugs and The Body
• Pharmacodynamics = how the drug affects
the body.
• Pharmacokinetics = how the body acts on the
drug.
Pharmacodynamics
• is the science that deals with the interactions
between the chemical components of living
systems and the foreign chemicals, including
drugs, that enter living organisms.
Pharmacodynamics
• Receptor sites = many drugs are thought to
act at specific areas on cell membranes, called
receptor sites. The receptor sites react with
certain chemicals to cause an effect within the
cell. In many situations, nearby enzymes break
down the reacting chemicals and open the
receptor for further stimulation.
Pharmacodynamics
• Receptor sites
– Agonist = some drugs interact directly with
receptor sites to cause the same activity that
natural chemicals would cause at that site.
• Ex: insulin reacts with specific insulin-receptor sites to
change cell membrane permeability, thus promoting
the movement of glucose into the cell.
Pharmacodynamics
• Receptor sites
– Antagonist = some drugs react with specific
receptor sites to block normal stimulation,
producing no effect.
• Ex: Curare prevents muscle stimulation, causing
paralysis.
• Curare is antagonist to acetylcholine. Curare occupies
receptor sites for acetylcholine.
• Acetylcholine is necessary for muscle contraction and
movement.
Pharmacodynamics
• Drug-enzyme interactions = drugs also can
cause their effects by interfering with the
enzyme systems that act as catalysts for
various chemical reactions.
Pharmacodynamics
• Selective toxicity = ideally, all
chemotherapeutic agents would act only on
enzyme systems that are essential for the life
of a pathogen or neoplastic cell and would not
affect healthy cells.
– Ex: penicillin, an antibiotic used to treat bacterial
infections, affects an enzyme unique to bacteria,
causing bacterial cell death without disrupting
normal human cell functioning.
Pharmacokinetics
• involves the study of absorption, distribution,
metabolism (biotransformation), and
excretion of drugs.
– Critical concentration = the concentration a drug
must reach in the tissues that respond to the
particular drug to cause the desired effect.
• Too much of a drug will produce toxic (poisonous)
effects, and too little will not produce the desired
therapeutic effect.
Pharmacokinetics
• Loading dose = some drugs may take a
prolonged period to reach a critical
concentration, so a higher dose than that
usually used for treatment is used to allow the
drug to reach the critical concentration
sooner.
Pharmacokinetics
• Dynamic equilibrium
– Absorption = refers to what happens to a drug
from the time it is introduced to the body until it
reaches the circulating fluids and tissues.
Pharmacokinetics
• Routes of Administration:
– Parenteral
• Intravenous = direct entry into the venous system;
drugs are absorbed the fastest.
• Intramuscular = drugs are absorbed directly into the
capillaries in the muscle and sent into the circulation.
Drug absorption in men reaches a peak level faster than
they do in women.
• Subcutaneous = deposit the drug just under the skin,
where it is slowly absorbed into the circulation.
Pharmacokinetics
• Routes of Administration:
– Oral = not invasive, less expensive, and safest way
to deliver drug.
• Barrier: acidic environment of the stomach.
– Mucous membrane
• Sublingual = is placed under the tongue, where it
dissolves
• Buccal = means “pertaining to the cheeks”. A
medication, usually a tablet, is held in the mouth
against the mucous membranes of the cheek until the
drug dissolves.
Pharmacokinetics
• Routes of Administration:
– Topical = drug is administered into the skin
Pharmacokinetics
• Absorption processes
– Passive diffusion = is the major process through
which drugs are absorbed into the body. When
there is a greater concentration of drug on one
side of a cell membrane, the drug will move
through the membrane to the area of lower
concentration.
• Does not require any cellular energy.
Pharmacokinetics
• Absorption processes
– Active transport = is a process that uses energy to
actively move a molecule across a cell membrane.
The molecule may be large, and it is often a very
important process in drug excretion in the kidney.
– Filtration = involves movement through pores in
the cell membrane, when pushed by hydrostatic,
blood, or osmotic pressure.
Pharmacokinetics
• Distribution = involves the movement of a
drug to the body’s tissues.
– Biotransformation (metabolism) = the process by
which drugs are changed into new, less active
chemicals.
Pharmacokinetics
• Biotransformation
Drugs absorbed into the intestine
↓
Drugs absorbed by the portal system
↓
Liver (the most important site of drug metabolism) = everything that is
absorbed from the GI tract first enters the liver to detoxify many chemicals.
↓
Drugs bound to plasma protein in the circulation
↓
Drug distributed throughout the body
Pharmacokinetics
– First pass effect = a phenomenon in which drugs
given orally are carried directly to the liver after
absorption, where they may be largely inactivated
by liver enzymes before they can enter the general
circulation; oral drugs frequently are given in
higher doses than drugs given by other routes
because of this early breakdown.
Pharmacokinetics
– Blood brain barrier = is a protective system of
cellular activity that keeps many things (e.g.,
foreign invaders, poisons, drugs) away from, the
CNS.
• Drugs that are highly lipid soluble are more likely to
pass through the BBB.
Pharmacokinetics
– Excretion = is the removal of the drug from the
body.
• Routes: skin, saliva, lungs, bile, and feces. Kidneys play
the most important role in drug excretion.
• Note: nurses should always consider the patient’s
kidney function because kidney dysfunction can lead to
toxic levels of a drug in the body because the drug
cannot be excreted.
Pharmacokinetics
– Half-life
• Half-life of a drug is the time it takes for the amount of
drug in the body to decrease to one half of the peak
level it previously achieved.
– Ex: a 20 mg drug with 2 hours half-life
Factors Influencing Drug Effects:
• Weight = people who are much heavier may
require larger doses to get a therapeutic effect
from a drug. People who weigh less than the
norm may require smaller doses of a drug.
• Age = the older the person the larger the dose
they may need.
• Gender = men have more vascular muscles,
while women have more fat cells.
Factors Influencing Drug Effects:
• Physiological factors = diurnal rhythms, acid-
base balance, hydration, and electrolyte
balance.
• Pathological factors = ex: GI disorders can
affect the absorption of oral drugs.
Factors Influencing Drug Effects:
• Genetic factors = genetic differences can
sometimes explain patient’s varied responses to a
given drug.
– Pharmacogenomics = is a new area of study that
explores the unique differences in response to
drugs that each individual possesses based on
genetic makeup.
• Ex: Trastuzumab (Herceptin) is a drug that was developed to
treat breast cancer when the tumor expresses human
epidermal growth factor receptor 2 – a genetic defect in
some breast cancer.
Factors Influencing Drug Effects:
• Immunological factors = people can develop
an allergy to a drug.
• Psychological factors = the patient’s attitude
about a drug has been shown to have an
effect on how that drug works. A drug is more
likely to be effective if the patient thinks it will
work than if the patient believes it will not
work. This is called the placebo effect.
Factors Influencing Drug Effects:
• Environmental factors = ex: antihypertensives
that work well during cold, winter months
may become too effective in warmer
environment.
• Tolerance = the drug no longer causes the
same previous reaction, therefore increasingly
larger doses are needed to achieve a
therapeutic effect.
– Ex: Morphine = an opiate used for pain relief.
Factors Influencing Drug Effects:
• Cumulation = the accumulation of drug in the
body due to:
– A drug is taken in successive doses at intervals
that are shorter than recommended.
– The body is unable to eliminate a drug properly
leading to toxic levels and adverse effects.
Factors Influencing Drug Effects:
• Interactions = when two or more drugs or
substances are taken together, there is a
possibility that an interaction can occur,
causing unanticipated effects in the body.
– Drug-drug interaction
– Drug-food interaction
– Drug-laboratory test interactions
Toxic Effects of Drugs
• Adverse effects = are undesired effects that
may be unpleasant or even dangerous.
– Cause:
• overdose
• hypersensitivity = excessive responsiveness of the
person’s immune system to the drug.
Toxic Effects of Drugs
Allergy Type Assessment Interventions
Anaphylactic reaction Hives, rash, difficulty Administer epinephrine,
This allergy involves an breathing, increased BP, 0.3 mL, SQ and massage
antibody that reacts dilated pupils, to speed absorption
with specific sites in the diaphoresis, “panic” rate.
body to cause the feeling, increased heart Notify the prescriber
release of histamine rate, respiratory arrest and discontinue the
that produce mucous drug causing allergy.
membrane swelling and Counsel patient to wear
constricting bronchi that Medic-Alert
can lead to respiratory identification.
distress and respiratory
arrest.
Toxic Effects of Drugs
Allergy Type
Cytotoxic reaction
This allergy involves
antibodies that circulate in
the blood and attack
antigens (the drug) on the
cell sites, causing death of
that cell.
Serum sickness reaction
This allergy involves
antibodies that circulate in
the blood and cause
damage to various tissues
by depositing in blood
vessels.
Assessment
CBC showing damage to
blood-forming cells
(decreased hematocrit,
WBC count, and platelets);
liver function tests show
elevated liver enzymes;
renal function test shows
decreased renal function
Itchy rash, high fever,
swollen lymph nodes,
swollen and painful joints,
edema of the face and
limbs
Interventions
Notify the prescriber and
discontinue the drug
causing allergy.
Notify the prescriber and
discontinue the drug
causing allergy.
Administer antipyretic or
Anti-inflammatory agents
Ice compress to joints
Toxic Effects of Drugs
Allergy Type Assessment Interventions
Delayed allergic reaction Rash, hives, swollen joints Notify the prescriber and
This reaction occurs several discontinue the drug
hours after exposure and causing allergy.
involves antibodies that Administer antihistamine
are bound to specific or topical corticosteroid
WBCs.
Toxic Effects of Drugs
Drug-Induced Tissue and
Organ Damage
Stevens-Johnson
syndrome (Erythema
Multiforme Exudativum)
Meprobamate (Miltown), a
drug used to treat anxiety,
is associated with SJS.
Assessment
Characterized by dark red
papules appearing on the
extremities with no pain or
itching, often in rings or
disk-shaped patches.
Interventions
Instruct patient to avoid
rubbing, wearing tight or
rough clothing and using
harsh soaps or perfumed
lotions.
Administer antihistamines
Administer corticosteroids
Administer emollients
Toxic Effects of Drugs
Drug-Induced Tissue and Assessment
Organ Damage
Stomatitis Gingivitis = swollen, inflamed
Inflammation of the gums
mucous membranes Glossitis = swollen red tongue
Ex: antineoplastic agents Dysphagia (difficulty
swallowing)
Halitosis (bad breath)
Pain in the mouth and throat
Superinfections Fever, diarrhea, dark or hairy
Infections caused by tongue, glossitis, mucous
organisms that are usually membrane lesions, vaginal
controlled by the normal discharge with or without
flora. itching
Interventions
Provide frequent mouth
care with a nonirritating
solution.
Frequent, small meals
Antifungal agents
Local anesthetics
Provide frequent mouth
care, skin care
Small and frequent meals
Administer antifungal
therapy
Discontinue drug
responsible for the
superinfection
Toxic Effects of Drugs
Drug-Induced Tissue Assessment
and Organ Damage
Toxicity = serious reactions/ effects causing the patient harm
Hepatotoxicity = liver Fever, malaise, nausea and
injury vomiting, jaundice, change in
color or urine or stools,
abdominal pain,
Elevated liver enzymes
(aspartate aminotransferase
[AST], alanine
aminotransferase [ALT])
Nephrotoxicity = renal Elevated BUN
injury Elevated creatinine
Gentamycin concentration
(Garamycin) = an Decreased hematocrit
antibiotic is frequently Electrolyte imbalance
associated with renal Fatigue, malaise, edema,
injury irritability and skin rashes
Interventions
Discontinue the drug and
notify the prescriber
Small, frequent meals
Skin care, and cool
environment, and rest
periods.
Discontinue the drug and
notify the prescriber
Diet and fluid restrictions
Electrolyte therapy
Rest periods
Dialysis
Toxic Effects of Drugs
Drug-Induced Tissue Assessment Interventions
and Organ Damage
Toxicity = serious reactions/ effects causing the patient harm
Ocular damage Blurring of vision, color vision Consult with the prescriber
(Oculotoxicity) changes, corneal damage, and Discontinue the drug if
Chloroquine (Aralen) blindness appropriate
Ethambutol
Teratogenicity = The exact effects of a drug on All pregnant women
adverse effects to the the fetus may not be known. should be advised not to
developing fetus or self-medicate.
embryo causing death
or congenital defects.
Toxic Effects of Drugs
Drug-Induced Tissue Assessment Interventions
and Organ Damage
Alterations in Glucose Metabolism
Hypoglycemia = a low Hunger, anxiety, headache Give orange juice
blood glucose Cold, clammy skin, shaking and Administer IV glucose
concentration lack of coordination, increased Institute measures to
ex: Glipizide heart rate, increased blood prevent injury or falls
(Glucotrol), Glyburide pressure, numbness and
(DiaBeta) tingling of the mouth
Confusion, rapid and shallow
respirations
Seizures and coma
Hyperglycemia = high Fatigue, restlessness Administer insulin
serum glucose Polyuria, polydipsia, polyphagia Provide access to
concentration Kussmaul respiration bathroom facilities
ex: Ephedrine Hot, flushed skin Provide mouth care
Diazoxide (Hyperstat) Fruity odor breath (acidosis)
 Toxic Effects of Drugs
Drug-Induced Tissue and Assessment
Organ Damage
Electrolyte Imbalances
Hypokalemia = low Muscle cramps, weakness,
serum potassium levels numbness, and tingling sensation
(lower than 3.5 mEq/L) in the extremities
Ex: loop diuretics Nausea, vomiting, diarrhea,
decreased bowel sounds
(paralytic ileus)
Irregular and weak pulse
Orthostatic hypotension and
disorientation
Hyperkalemia = Weakness, muscle cramps, numbness
increased serum and tingling
potassium level (higher Diarrhea
Slow, irregular heart rate, low BP,
than 5.0 mEq/L)
dyspnea
Decreased UO
Interventions
Replace serum potassium
(IV)
Safety precautions to
prevent injury or falls
Comfort measures for pain
and discomfort
Cardiac monitoring
Administer Sodium polystyrene
sulfonate (Kayexelate)
Institute safety measures to
prevent injury or falls
Cardiac monitoring
Dialysis
Toxic Effects of Drugs
Drug-Induced Tissue Assessment Interventions
and Organ Damage
Neurological Effects
Central Nervous Confusion, delirium, insomnia, Provide safety measures to
System Effects drowsiness, hallucinations, prevent injury
numbness, anxiety, and Caution the patient to
(Beta-blockers) nightmares avoid driving a car or
operating dangerous
machinery.
Consult with the prescriber
to decrease drug dose
Toxic Effects of Drugs
Drug-Induced Tissue and Assessment Interventions
Organ Damage
Neurological Effects
Anticholinergic Effects Dry mouth, altered taste Provide sugarless lozenges
perception, dysphagia, and mouth care
(Atropine, heartburn, constipation, Have the patient void
Antihistamines) bloating, paralytic ileus before taking the drug
Urinary hesitancy and Avoid hot environment
retention Prevent dehydration
Impotence, blurred vision,
cycloplegia, photophobia,
Headache, mental confusion,
palpitation
Dry skin
Toxic Effects of Drugs
Drug-Induced Tissue Assessment Interventions
and Organ Damage
Neurological Effects
Parkinson-Like Akinesia Provide small, frequent
Syndrome Muscular tremors feedings
Antipsychotic Drooling, rigidity or spasms Provide safety measures
Akathisia = extreme Discontinue the drug if
restlessness or “jitters” necessary

Neuroleptic malignant Slowed reflexes, rigidity, Discontinue the drug if

syndrome hyperthermia, hypertension, necessary
General anesthetics tachycardia Safety precautions
DOSAGE CALCULATIONS
Oral Drugs:
amount of drug available amount of drug prescribed
• =
one tablet or capsule number of tablets or capsules to give

• For example: Sulfamethoxazole (Bactrim) 800

mg tablet is ordered. The available tablet form
is containing 400 mg/tablet. How many
tablets should the nurse administer to the
patient?
Parenteral medications:
Liquids
amount of drug available amount of drug prescribed
• =
volume available volume to administer

• For example: An order has been written for

250 mg of sulfisoxazole. The bottle states that
the solution contains 125 mg/5 mL. How
much of the liquid should the nurse
administer?
IV Fluid rate:
volume in cc × gtt factor
• gtts (drops)ൗmin =
no. of hours to consume × 60 min

• For example: The doctor’s order is to

administer D5LR 1L to a pediatric patient to be
infused for 18 hours. How should the nurse
regulate the fluid rate?
IV Fluid rate:
• Another example: The doctor’s order tells you
to administer 1L of D5LR to a 30-year-old
client for 8 hours only. The IV tubing delivers
15 mL/drop. How many drops/min should the
nurse regulate the flow of the fluid?
IV Fluid rate:
cc volume in cc
• =
hr no. of hours to consume

volume in cc
• duration in hours =
cc/hr
Pediatric doses:
• Fried’s Rule:
Infant’s dose (<1 year)
infant’s age (in months)
= x average adult dose
150 months
Pediatric doses:
• Young’s Rule:
Child’s dose (1 – 12 years)
child′ s age (in years)
= x average adult doses
child′ s age in years +12
Pediatric doses:
• Clark’s Rule:
Child’s dose
weight of child (in pounds)
= x average adult dose
150
– Ex: the usual adult dose of diphenhydramine
(Benadryl) is 50 mg. What would be the safe dose
for a child weighing 27 lbs?
Pediatric doses:
• Surface Area Rule:
Child’s dose
surface area of child (in square meters)
= x average adult dose
1.73