INTRODUCTION TO

PHARMACOLOGY
notes by Kemi Peterside
 PHARMACOLOGY
notes by Kemi Peterside

THE NURSING PROCESS KEY TERMS

• Assessment - recognize cues • Drug - chemical that affects
• Diagnosis - identify problems physiological process of the body
• Planning - outcome identification • Medication error - preventable adverse
• Implementation - includes patient drug event
education • Generic name - name given by the
• Evaluation - includes documentation united states adopted name council
• Trade name - name given by the
9 RIGHTS OF MEDICATION manufacturer
• Right drug • Pharmacokinetics - study of what the
• Right dose body does to medication
• Right time • First pass effect - drug metabolism in
• Right route liver
• Right patient • Bioavailability - drug available for use
• Right documentation after absorption
• Right indication • Prodrug - inactive form of drug to
• Right response active
• Right to refuse • Pharmacodynamics - what drugs do to
the body
PRINCIPLES OF PHARMACOKINETICS
ABSORPTION - from site of administration of drug to the bloodstream. The rate
of administration affects drug absorption.
ADMINISTRATION ROUTES
- Enteral: GI tract (PEG, Buccal, Oral, Rectal, Sublingual) drugs go through
first pass effect
- Parenteral: IV, Subcutaneous, Intramuscular. Fasted delivery for drugs
- Topical: Inhaler, Rectal, Patches, ointment, eye, nasal, & ear drops, cream. Can
be used for systemic or local treatments.
FACTORS AFFECTING ABSORPTION —> age, pH of stomach, food or fluids,
site of administration, low blood flow, low peristalsis
 ~ notes by Kemi Peterside

DISTRIBUTION - from bloodstream to site of action. Areas of rapid

distribution are the brain, heart, kidneys, and liver due to high blood
circulation.Areas of slow distribution are fat, muscle, and skin due to low
blood circulation.
FACTORS AFFECTING DISTRIBUTION —> low fat, low water & blood
volume, low albumin (burns & malnutrition)
• unbound/active drug: distribute freely to
METABOLISM - is altering drug to
tissues
make it usable. Main organ for
• Bound/inactive: too large to penetrate
metabolism is the liver.
capillary wall
FACTORS AFFECTING METABOLISM
• Low metabolism —> toxicity
- hepatic disease. - jaundice
• High metabolism —> low bioavailability
- renal insufficiency - starvation
• P-450 enzymes metabolize drugs in liver
- cardiovascular dysfunction

EXCRETION - drug eliminated from the body, mostly takes place in the
kidneys (also bowels & liver), if elimination is not done properly it can lead to
toxicity
FACTORS AFFECTING EXCRETION —> kidney problems, constipation, age,
dehydration

KEY TERMS • Duration - how long drug elicits

• Agonist - drug binds to receptor to produce therapeutic response
a response • Peak - maximum therapeutic effect
• Antagonist - binds to receptor to prevent • Trough - minimum therapeutic effect
agonist from binding • Side effect - expected effect
• Pharmacotherapeutics -use of drug to treat • Toxicity - poisonous level of drug in
conditions blood
• Drug interaction - two drugs or substance • Tolerance - decreased response to a
(food) cause effects when taken together
repeated drug
• Half life - time it takes for half a drug to
• Dependence - need for a drug
be removed from the body. It takes 5 half
• Therapeutic index - ratio of drug toxic
lives for a drug to reach a steady state.
• Onset - time required for drug to reach level to therapeutic benefit
therapeutic state • Therapeutic effect - intended action of
drug
 ~ notes by Kemi Peterside

TYPES OF THERAPY DRUG EFFECTS

• Acute therapy - for critically ill • Adverse effect - unexpected effect
patients that can cause harm
• Maintenance therapy - prevent • Additive effects - unintended
progression of a condition additional effect
• Supplemental therapy - supplies • Synegistic effect -working together
body with substance needed to • Antagonistic effect - one drug
maintain function doing one thing, other doing the
• palliative therapy - make patient as opposite
comfortable as possible • Pharmacognosy - study of drugs
• Supportive therapy - maintains made from plant and animals
integrity of body function while • Pharmacogenomics - how genes
patient is recovering affect drug
• Prophylactic therapy -to prevent
illness PREGNANCY SAFETY
• Empiric therapy - based on CATEGORY
probability of illness based on Category A - no harm to fetus
patient presenting symptoms Category B - no harm to animal fetus
Category C - adverse effect in animal
LIFESPAN CONSIDERATIONS fetus
INFANTS Category D - possible fetal risk in
- liver, kidney, blood brain barrier are humans
not fully developed so infants are at Category X -fetal abnormalities &
risk of toxicity evidence of fetal risk in humans
- oral medication can be given as long
as infant is awake and can swallow ANTIDOTES
- fat soluble medications can pass
Opioids - naloxone
through breastmilk
Acetaminophen - acetylcysteine
OLDER ADULTS
Benzodiazepines - flumazenil
- low pH affect absorption
- low peristalsis affect excretion
- low blood volume & high body fat
affect distribution
- low albumin & enzymes in liver
affect metabolism
 ~ notes by Kemi Peterside

ANALGESICS
They relieve pain without causing loss of consciousness.
TYPES
OPIOID ANALGESIC (moderate - severe pain)

MECHANISM OF ACTION
• Agonist - bind to receptor to produce a response
• Antagonist - bind to receptor but does not provide a response

CLASS
- Mild opioid agonist - codeine & hydrocodone
- Strong opioid agonist - oxycodone, fentanyl, morphine, hydromorphone,
meperidine, methadone
- Opioid antagonists/antidotes - naloxone & naltrexone
- Opioid agonist-antagonist - buprenorphine, pentazocine, butorphanol,
nalbuphine
INDICATIONS —> cough, diarrhea, anesthesia
CONTRAINDICATIONS —> allergy, hypersensitivity, pregnancy, severe
asthma, sleep apnea, obesity, liver disease, paralytic ileus, older adults, history of
opioid addiction, undiagnosed abdominal pain
ADVERSE EFFECTS —> CNS depression, Respiratory depression, Constipation,
Itching, nausea, vomiting, flushing, bradycardia, hypotension, urinary
retention
WITHDRAWAL SYMPTOMS —>nausea, vomiting, chills, anxiety, irritability,
hot flashes
DRUG INTERACTIONS —> alcohol, other opioids, CNS depressants,
barbiturates, benzodiazepines, dipherihydramine, MAOI
 ~ notes by Kemi Peterside

NON OPIOID ANALGESIC (mild - moderate pain)

ACETAMINOPHEN/TYLENOL: pain & antipyretic (fever)
- similar to salicylates
- blocks pain impulses peripherally by blocking prostaglandin (cause pain &
inflammation response) synthesis
ROUTES —> IV, oral, rectal
HIGHEST DOSE OF TYLENOL —> 3000mg/day, 2000mg/day for older adults
or people with liver disease.
CONTRAINDICATIONS —> liver failure, liver disease, allergy, G6PD (cause RBC
to breakdown in response to certain medications)
ADVERSE EFFECTS —> nausea, vomiting, liver toxicity, renal failure, stevens
johnson syndrome
OVERDOSE SIGNS —> jaundice, NORMAL LAB VALUES
abdominal pain, nausea, vomiting - BUN - 12 -20 - Creatine - up to 1.1
- Potassium - 3.5 - 5 - Hemoglobin 12 - 16 (F)
14 - 18 (M). - ALT & AST - < than 40

MISCELLANEOUS ANALGESIC (moderate - moderately severe)

TRAMADOL: central acting, inhibits seratonin & norepinephrine.
CONTRAINDICATIONS —> hypersensitivity, alcohol, CNS depression, sedatives,
opioids, breastfeeding, GI obstruction, respiratory depression, children
younger than 12yrs
SIDE EFFECTS —> drowsiness, dizziness, nausea, vomiting, constipation,
headaches, risk of seizures, respiratory depression
OTHERS
NSAID —> over the counter cold medication, non steroids, anti inflammatory
drugs e.g advil & motrin
ADJUVANT DRUGS —> taken in combination with other medication e.g
antidepressants, anticonvulsants, corticosteroids.
* amitriptyline - used for depression & migraines
 ~ notes by Kemi Peterside

ENDOCRINE DRUgS
Hypothalamus communicates to the pituitary glands to release hormones
through negative feedback loop to promote homeostasis.

ANTERIOR PITUITARY DRUGS

COSYNTROPIN: stimulates the secretion of cortisol.
INDICATION —> HIV infection associated wasting syndrome, diagnosis of
adrenocortical insufficiency
CONTRAINDICATION —> hypersensitivity
ADVERSE EFFECTS —> edema, hypertension, congestive heart failure

SOMATROPIN: acts like growth hormone , promotes skeletal growth

INDICATIONS —> HIV associated wasting syndrome, growth hormone
deficiency e.g dwarfism & Turner’s syndrome
CONTRAINDICATION —> hypersensitivity, diabetes
ADVERSE EFFECTS —> hyperglycemia, muscle/joint pain, hypothyroidism,
renal calculi
DRUG INTERACTION —> GLUCOCORTICOIDS (hyperglycemia)

OCTREOTIDE: inhibits release of growth hormone

INDICATION —> acromegaly, esophageal varices, severe diarrhea, flushing,
hypotension
CONTRAINDICATION —> diabetes, renal impairment, hypersensitivity
ADVERSE EFFECTS —> hypo/hyperglycemia, joint pain(arthralgia), fatigue,
headache, impaired gallbladder function, liver enzymes impairment, prolonged
QT syndrome
DRUG INTERACTION —> Ciprofloxacin
 ~ notes by Kemi Peterside

POSTERIOR PITUITARY DRUGS

VASOPRESSIN & DESMOPRESSIN: increase sodium & water retention in
kidneys
INDICATIONS (VASOPRESSIN) —> hypotensive emergencies, diabetes
insipidus, pulseless cardiac arrest, stop bleeding from esophageal varices
INDICATION (DESMOPRESSIN) —> nocturnal enuresis, blood disorders
CONTRAINDICATIONS —> coronary artery disease, renal impairment
ADVERSE EFFECTS —> edema, hypertension, nausea, headache, myocardial
infarction
DRUG INTERACTIONS —>Lithium, Alcohol, Norepinephrine, Fludrocortisone

THYROID & ANTITHYROID DRUGS

HYPOTHYROIDISM: low thyroid hormone
INDICATION —> goiter, constipation, weight gain, cold intolerance, slow
metabolism
TREATMENT —> LEVOTHYROXINE (taken before breakfast)
CONTRAINDICATION —> myocardial infarction, thyrotoxicosis (thyroid
storm)
ADVERSE EFFECTS —> cardiac dysrhythmias, angina, hyperthyroidism
effects
DRUG INTERACTION —> Soy, Anti ulcer medications

HYPERTHYROIDISM: high thyroid hormone, caused by graves disease, multi

nodular disease, plummer’s disease, thyroid storm
TREATMENT —> PTU, Methimazole, Iodine, Surgery (total/partial)
INDICATIONS —> hyperthyroidism, graves disease, block thyroid hormone,
thyroid storms
CONTRAINDICATIONS —> pregnancy, lactation, bone marrow depression, liver
disease, immunosuppression
ADVERSE EFFECTS —> hypothyroidism symptoms, liver toxicity, bone marrow
toxicity, leukopenia
CONSIDERATIONS —> avoid foods high in iodine e.g tofu, seafood, iodine salt,
soy sauce