PHARMACOLOGY FOR NURSES

Definition of Terms

 Drug - Any chemical substance that affects living systems by changing their structure or function.
 Pharmacology - The science concerned with the history, sources, and physical and chemical properties of
drugs, as well as the ways in which drugs affect living systems.
 Pharmancy - The art and science of preparing and dispensing drugs and medicines.
 Pharmacodynamics - Study of the biochemical and physiological effects of drugs; Study of drugs’
mechanisms of action
 Pharmacokinetics - Study of the absorption, distribution, biotransformation (metabolism), and excretion of
drugs
 Pharmacotherapeutics - Study of how drugs may best be used in the treatment of illness; Study of which
drug would be most or least appropriate to use for a specific disease, what dose would be require, etc.
 Pharmacognosy - Study of drugs derived from herbal and other natural sources
 Toxicology - Study of poisons and poisonings

History
A. Early Civilization
- disease was viewed with great superstition
- prevention and treatment is directed toward driving away evil spirits and magical powers
- began to experiment with plants; discovered agents used as poisons
B. Ancient Egypt
- credited as the cradle of pharmacology
- Ebers Papyrus (Egyptian medical sources which listed remedies to treat specific ailments)
- Hippocrates declared that knowledge about health and disease only come through the study of natural
laws – led to the first systematic dissection of the human body
C. First Century
- Discorides prepared De Materica Medica (plants were classified by substance rather than the disease
intended for)
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D. 16 Century
- Paracelsus (Swiss scientist) first advocate dthe use of single drugs rather than mixtures or potions
- He wrote “ all things are poisons, for there is nothing without poisonous qualities. It is only the dose
which makes a thing a poison.”
- Paracelsus as the Father of Pharmacology
E. 17th Century
- William Harvey first began to explain how drugs exert their beneficial or harmful effects by
demonstrating the circulation of blood in the body; introduced IV administration
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F. 19 Century
- Francois Magendie and Claude Bernard demonstrated that certain drugs work at specific sites of action
within the body
- Lister and Semmelweis first introduced the use of antiseptics for infection prevention during surgery
- Ehrlich discovered antibiotics
- Banting and Best discovered insulin

Sources of Drugs
1. Natural Sources – animals, plants, natural clays
2. Semisynthetically – chemically modifying substances available from natural sources
3. Synthetic – formed by chemical reactions in laboratory
*Biotechnology – manipulation of protein to permit the large-scale industrial production of complex natural
substances or genetically altered biological substances

Drug Uses
1. Symptomatic treatment
2. Preventive drugs help the body avoid disease
3. Diagnostic drugs help the physician determine whether a disease is present
4. Curative drugs eliminate the disease
 5. Health maintenance drugs help keep the body functioning normally
6. Contraceptive drugs prevent pregnancy

Dosage Forms
1. Tablets
- most popular and easiest to administer
- contain a disintegrating agent (cornstarch) that swells when in contact with fluid in the stomach
- many are scored for convenient division
- most are intended to be swallowed but some are chewed prior to swallowing
- others are dissolved under the tongue or in the inner lining of the cheeks
- some are coated (enteric-coated/ec) with a substance
 Timed or Sustained-Release Tablets – drugs to be released from tablets in a controlled fashion
 Layered tablets – different layers or cores that separate different incompatible drugs released at
different times
2. Capsules
- enclosed in either a hard or soft soluble shell usually made of gelatin
- hard gelatin capsules consists of two parts that slide together to enclose the powdered medicinal
contents
- soft gelatin capsules are usually designed to encapsulate medicinal liquids; completely sealed
 Sustained-release capsules
3. Troches
- lozenges; generally disc-shaped that should be dissolved slowly in the mouth
- designed to release medication that exerts an antiseptic or anesthetic effect on the tissues of the oral
cavity or throat
4. Suppositories
- inserted into one of the external body orifices
- once inserted, it dissolves slowly in the body fluids or melts at body temperature to release the
medicinal content
- may effect locally of systemically
- most popular vehicle, or base, is cocoa butter
5. Solution
- clear liquid preparation containing one or more solvents
- easy administration for pediatric and geriatric clients
- most are given orally; solutions for injection (parenteral); ophthalmic solutions, etc.
 Syrups – sweetened solutions used to mask unpleasant taste of drugs
 Elixirs - solvent mixture of alcohol and water as well as other components
 Tinctures – contain alcohol as the primary solvent but may contain some water
 Douche – to be used in cleansing a body part or cavity
6. Suspensions
- liquid forms that contain solid drug particles that are suspended in a suitable liquid medium
- most are administered orally; some are applied to the skin as lotion or liniments
- must be shaken thoroughly immediately prior to administration to assure dosage uniformity
7. Emulsions
- dispersions of fine droplets of an oil in water or water in oil
8. Topical
- Semisolids are utilized to apply drugs onto the skin surface
- Topical patches pass through the skin and into the bloodstream to exert systemic effects
9. Implants
- Administered for extended periods of time by administering them in small flexible capsules made of a
Sylastic polymer
- Surgically implanted subdermally
10. Parenteral Products
- Ampules are sterile, sealed, glass or plastic containers containing a single liquid dose.
- Vials are either single- or multi-dose glass or plastic containers that are sealed with a rubber diaphragm
- Prefilled syringes contain a single dose medication
Drug Names
1. Chemical name – systematically derived name which identifies the chemical structure of the drug
2. Code designation – represents temporary name since chemical name is often quite complex; generally
discarded once drug becomes commercially available (example: investigational drugs)
3. Generic or non-proprietary name – easier to pronounce and remember than chemical name
4. Brand or trade name – assigned when ready for commercial distribution
Example:
Chemical name: 7-chloro-2 methylamino- 5phenyl-3H-1,4 –benzodiazepine 4 –oxide
hydrochloride
Generic name: chlordiazepoxide hydrochloride
Brand name: Librium

Classification of Drugs
1. Prescription or Legend Drugs
- have on their labels the prescription legend
- filed at FDA (include description, toxicity, and results of experimental clinical trials)
- may be prescribed by legally authorized health practitioners
- prescription is an order for medication which specifies precisely the name of the drug and the dosage
regimen to be used by the client for whom it is written
- includes: descriptive client information, date of prescription, Rx symbol, name and dosage strength of
the prescribed medication, dispensing instructions for the pharmacist, directions for use (signa) which
the pharmacist will place on the prescription label, and the prescriber’s information.
2. Nonprescription Drugs
- drugs that may be legally acquired without a prescription
- also known as over-the-counter drugs; relatively safe for layperson to use
- prescription order is not required however are capable of producing considerable toxicity
3. Investigational Drugs
- new drugs intended to be marketed but need to fulfil the requirements of the FDA
- clinical studies performed on human subjects prior to marketing are usually divided into four phases
4. Illicit Drugs
- “street” drugs which are used and/or distributed illegally
- they may be: drugs which are not legal for sale under any circumstance or drugs which may be sold
legally under certain circumstances but which have been manufactured illegally or diverted or stolen
from normal channels of distribution
- usually used for non-medical purposes

The Product Insert

- a detailed description of a drug product that is required to be included in the package of all legend
products
- must be approved by the FDA
- periodically updated for current information
- includes:
o brand name – name which the manufacturer may exclusively use to call theproduct
o generic name – name which is commonly used to describe the active drug/s in the product; can
be used by anyone
o description – describes the physical and chemical properties of the active drug in the product (
appearance, solubility, chemical formula and structure)
o clinical pharmacology – describes the mechanism of action of the active drug in the human body
o indications and usage – description of the illnesses for which the drug is approved for use; usage
describes how and for how long the drug is generally used
o contraindications – describes the situations when the drug product should not be used
o warnings – situations in which there is a threat of imminent and serious danger if the drug
product is used
o precaution – suggested steps for safe use
o overdosage – lists the dangers, if any, of using excessive quantities of the drug product
o dosage and administration – listing of the dosage and administration techniques recommended
for the use of the product
 o how supplied – lists the dosage forms, strengths, and package sizes of the drug product available
from the manufacturer

Principles of Drug Action

1. Drugs do not create new cellular functions but rather alter existing ones.
2. Drugs may interact with the body in several different ways (by: altering the chemical composition of a body
fluid; drugs accumulate in certain tissues because of their affinity; forming a chemical bond with specific
receptors within the body)
3. Different drugs whose molecules precisely fit into the a given receptor can be expected to elicit a
comparable drug response; those which do not perfectly fit with the receptor shape may produce only a
weak response or no response at all.
4. Drugs which interact with a receptor to produce a response are known as agonists; drugs with no specific
pharmacological action of their own but interact with a receptor to inhibit or prevent the action of an
agonist are known as specific or pure antagonist

Adverse Drug Effects

1. Side effects – most common from the pharmacological effects of the drug
2. Drug toxicity – related to the dose of drug administration
3. Unpredictable adverse drug effects
a. Allergic/hypersensitivity reactions; anaphylaxis in severe cases
b. Idiosyncratic reactions – abnormal reactivity to a drug caused by genetic difference
4. Teratogenic effects – cause of congenital defect in an infant
5. Drug tolerance – development of resistance to drug effects
6. Drug dependence – physical drug dependence; psychological dug dependence

 Key Nursing Implications

1. Negative side effects and adverse effects are those resulting from the normal
pharmacological effects of a drug. Side effects may also be positive.
2. Toxic effects are those related to the dosage administered. All drugs are capable of
producing toxic effects.
3. Allergic reactions are not a result of the pharmacological effects of the drug, but rather a
response of a client’s immunological system to the presence of the drug. Prior
sensitization to the drug is generally required.
4. Drug tolerance occurs when the client requires a higher dose or more frequent
administration to produce the desired drug effect.

Pharmacokinetic Factors in Drug Therapy

1. Liberation – how drugs are dissolved before they can be absorbed into the bloodstream; bioavailability
(absorption efficiency of a particular drug)
2. Absorption – process by which a drug passes from its site of administration into the fluids of the body to its
site/s of action; first step in the passage of a drug through the body; various factors influence absorption
3. Distribution – process by which a drug is carried form its site of absorption to its site of action; most rapid
rapid in organs with extensive blood supply
4. Metabolism (Biotransformation) – to convert drugs to a more soluble form; permits the body to inactivate a
potent drug before it accumulates and produce toxic effects; mostly occurring in the liver by its enzymes
(microsomal enzymes); metabolites (reaction products which can be active or inactive); microcomal enzymes
inducer drugs stimulate release of these enzymes greater than would normally excreted
5. Elimination – drugs and their metabolites may be eliminated from the kidneys (most important route), in the
feces, exhaled via the respiratory tract, in breast milk, saliva, and/or sweat.