Lecture 1-Introduction Dr. Sana (2024) - Copy
Lecture 1-Introduction Dr. Sana (2024) - Copy
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❑This unit will be divided into several parts:
▪ Part 1:
✓Introduction, terminologies, principles of pharmacy
▪ Part 2:
✓Dosage forms
✓Methods of administration
✓Pharmaceutical abbreviations
▪ Part 3:
✓ Pharmacokinetics: absorption, distribution, metabolism, and
excretion.
▪ Part 4:
✓Pharmacodynamics: Drug–Receptor Interactions, how drug effect
occurs, agonists & antagonists, dose-Response Relationships
▪ Part 5 :
✓Toxic effect of drugs
✓The nursing process in drug therapy and patient safety
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Introduction to drugs
❑The word drug→ is derived from the French drogue
▪ Originally meant dried herbs
▪ It was applied to herbs in the marketplace for cooking rather than for
any medicinal reason.
❑Drugs→ are chemicals that are introduced into the body to cause
some change
• Poisons are drugs that have almost exclusively harmful effects.-
• However, Paracelsus (1493–1541) famously stated that “the dose
makes the poison,” meaning that any substance can be harmful if taken
in the wrong dosage.
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The cold chain
• The system used for storing vaccines in good condition is
called the cold chain.
❑Pharmacology:
▪ The word comes from Greek roots:
• Pharmakon (medicine or drugs)
• Logos (to study)
▪ Pharmacology is:
✓the study of substances that interact with living systems through
chemical processes
✓the study of the biological effects of chemicals.
✓the study of drugs (chemical substances/ natural products).
▪ Pharmacology covers:
✓ Drug Administration
✓Therapeutic use
✓Response / therapeutic effect
✓Side effects/ adverse effects **
❑ Drug interaction:
▪ is a reaction between two (or more) drugs or between a drug and a food,
beverage, or supplement.
✓Drug-drug interaction
✓Drug-food interaction
✓Drug-condition (disease) interaction (eg: nasal decongestant with HTN)
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Indication vs. Contraindication
❑Indication of a drug:
▪ Is the approved uses for a medication are known
▪ The reason to use a certain treatment.
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❑ Controlled drugs
▪ Need prescription
▪ Special restrictions:
→(high levels of regulation by
government)
▪ Use and distribution are tightly controlled because of their abuse
potential or risk (can cause physical and mental dependence).
▪ eg: Morphine, Tramadol
❑ Supplement medications
▪ Herbal and dietary supplements
▪ They are not drugs.
▪ Can cause side effects and interact with medications
▪ Not subjected to the same regulatory process as medicines/drugs
▪ Not tested by the Food and Drug Administration (FDA) for safety.
Note: The FDA → has sped up the process for drug review
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What is FDA? Food and Drug Administration
▪ Advantage :
✓Useful when the oral route is unavailable due
to vomiting
✓Less/ minimum 1st pass effect** than oral
✓ In general,→ faster onset, higher bioavailability
▪ Disadvantage :
✓Patient compliance
✓Inconvenient when the patient has
diarrhea
❑What is first pass effect (1st pass metabolism):
▪ When a drug gets metabolized in the body (liver) → ↓concentration
of the active drug upon reaching its site of action or the systemic
circulation → ↓ bioavailability
✓Bioavailability → extent and rate at which the drug or metabolite enters
systemic circulation → thereby accessing the site of action.
3. Sublingual (SL) & Buccal
✓S.L → Under the tongue
✓Buccal→ placing a drug between the gums and cheek.
✓Advantage:
1. No 1st pass metabolism** (passing directly into superior vena cava) →
(bioavailability ≈ 100%)**
2. Rapid absorption into the systemic circulation→ used in ER situation
(Nitroglycerin)
2. Intramuscular (IM)
▪ Usually given in gluteus maximus
▪ Advantage :
1. More rapid action than PO but less rapid than IV
2. No first pass metabolism
▪ Disadvantage : Painful
3. Subcutaneous (SC)
▪ The injection is given in the fatty tissue, just under the skin.
▪ Subcutaneous tissue has few blood vessels → drugs injected
into it are intended for slow sustained rates of absorption
▪ Like insulin injections
4. Intradermal injections (ID)
▪Injections administered into
the dermis, just below the
epidermis.
▪These types of injection are
used for sensitivity tests (T.B,
allergy)
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5. Intrathecal (I.T)
▪ Injection into the spinal subarachnoid space (space between the
arachnoid mater & pia mater in the spine)
o i.e; delivered directly into the CSF and into the superficial spinal
cord
▪ Advantage :
✓Used in cases of acute CNS infection, spinal anesthesia,
chemotherapy (can bypass the BBB)
✓Avoid 1st pass metabolism
✓ Systemic S.Es can be avoided → given in smaller doses for
localized action in the nervous system.
✓Classical S.E: N,V, urinary retention, headache, paranesthesia
(anesthesia)
▪ Disadvantage :
✓ Personal error is risk
(neurologic complications)
6. Epidural injection
▪ Injection of drugs through a catheter placed into the epidural space
▪ Diffuses through the dura into the CSF
7. Intraosseous (IO)
▪ It is placement of a specialized hollow bore needle through the cortex
of a bone into the medullary space/ bone for medical infusion →
medications and fluids to go directly into the vascular system.
▪ When used?
✓ To o provide fluids & medication when IV access is not available not
feasible.
▪ What are the sites for IO injection?
✓ 1 cm medial to the tibial tuberosity
✓ or just below the patella (ie, about 1 cm or one finger width)
Others
1. Inhalation
▪ Inhalers and nebulizers
▪ Drugs are directly administered to the lungs → and target lung
& airways.
✓ Anti-asthmatic medications
▪ Advantages: ↓ amount of drugs administered & ↓ risk S.E
2. Intranasal 3. Transdermal
▪ Nasal spray (Nasal ▪ Medicated adhesive patch
decongestants) ▪ Placed on the skin to deliver a
▪ Nasal solution (saline specific dose of medication through
solution) skin & into the bloodstream
4. Topical
▪ Substance is applied directly where its action is desired
▪ Examples:
✓ Ear drops
✓ Eye drops
✓ Creams
✓ Ointments
✓ Gel
✓ Emulgel (combines both a gel and a cream)
Nursing responsibilities/ roles:
1) Nursing assessment process (history/chronic diseases/ allergy)
2) Administering drugs (safe & effective drug administration)
3) Assessing the effect of the drug
4) Teaching the patient about the drug
5) know why drug has been prescribed for this patient
6) know contraindications (C.I) and precautions
7) Should know potential side effect/s (S.E)
8) Intervening to make the drug regimen more tolerable
9) Monitoring the overall patient care plan to prevent
medication error
10) Reporting of Medication Errors
❑What should you check and double check?
1. Have you got the right drug?
2. Check the strength of the formulation and the label on the
ampoule as well as the box.
2. Has its shelf life expired? Check the “use by” date.
3. Has it been reconstituted and diluted properly?
4. Have you got the right patient? Check the name band.
5. Have you got the right dose?