Pharmacology I

Introduction To Nursing Pharmacology

Dr. Sana’ AL Aqqad

Ph.D. in Clinical Pharmacy

& Therapeutics

[email protected]
[email protected]
❑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.

❑ Drug → Any substance that is taken to:

• Prevent → condition/disease
• Cure → condition/disease
• Reduce →Symptoms of a medical condition

❑ Drug →Any substance that brings about a change (effect) in

biological function through its chemical actions.

❑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.

• Hormones & N.Ts are also drugs

• Better term is medication or medicine.

• Medicine → Substance used to treat, diagnose or prevent a disease

• Drugs are, in general, referred to
by:
o Chemical name (“generic”) name
oTrade or brand name, the symbol ®
is used

• Both same active ingredients for

same drug, but differ in size, color,
packing …..
 Storage Storage temperatures are defined by
European pharmacopoeia as follows:
• Inappropriate storage: Freezer - 15 to 0 °C
oTemp. Refrigerator + 2 to + 8 °C
oAir Cool + 8 to + 15 °C
Room temperature + 15 to + 25 °C
o Light
o Humidity
All → affect the drug stability and then quality.

▪ Most drugs are perfectly stable at room temperature

▪ Special considerations apply to the storage of vaccines (stored
refrigerator between 2 °C-8 °C)
▪ Many vaccines are damaged if they are not kept between 2°C and 8°C
at all times, even during transit and delivery.
▪ Vaccines, immunoglobulins, most hormones and antisera → sensitive
to heat & light (refrigerator between 2 °C-8 °C)

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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 **

• Pharmacology is divided into 2 main subdivisions:

1. pharmacokinetics
2. pharmacodynamics
❑ Side Effects (S.E)
▪ Also known as adverse effects or adverse reactions
▪ Known as drug effects that are unwanted, undesirable, unintended
▪ Can be minor problems (eg: runny nose) to life-threatening events (heart attack
or liver damage).
▪ Usually with the therapeutic dose

Toxicity →commonly applied to effects of over-ingestion (accidental or

intentional) or to elevated blood levels or enhanced drug effects that occur during
appropriate use

❑ 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.

❑Contraindication (CI) of a drug:

▪ Is a condition (factor) that serves as a reason not to take a certain
medical treatment due to the harm that it would cause the patient.
Or
▪ Is a specific situation in which a drug (procedure, surgery) should not
be used because:
✓ it may be harmful to the person
✓risk of use outweighs any possible benefit.
▪ eg: having a severe allergic or anaphylactic reaction to a medication
▪ Some CIs are temporary: pregnancy

▪ Precaution: A condition that may increase the risk of an adverse

reaction
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 Prescribed Drugs and
Over-the-Counter Drugs
❑Prescribed drug
▪ Patient must receive authorization (prescription) to receive the drug.
• May be too harmful for self-administration
• Some require skill to administer
• Treat complex conditions.
• Need Patient teaching and patient follow-up.

❑ Over-the-counter (OTC) drug

▪ Do not require authorization from the health care provider
▪ Patients may treat themselves.
▪ Usually safe and effective when used according to label instructions.
▪ No monitoring from health care provider needed
▪ May be ineffective or harmful.
▪ May interact with food, herbals, prescription, or other OTC drugs

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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

▪ FDA is → an agency of the U.S. Department of Health and Human

Services that regulates the development and sale of drugs.
▪ FDA-regulated tests are designed to ensure the safety and
reliability of any drug approved in this country.
▪ For every 100,000 chemicals that are identified as being potential
drugs, only about five end up being marketed
❑ Patient factors can alter responses:
1. Age: children vs. older adults vs. geriatrics
2. Gender
3. Race
4. Genetics
5. Body mass
6. Health status**: GI disorders, liver & kidney diseases
7. Tolerance: the drug no longer causes the same reaction
8. Concurrent medication/s
9. Psychological Factors ???!!!!
✓eg: placebo effect
✓ eg: the nurse’s positive attitude, combined with additional
comfort measures
 Some Main Pharmaceutical Abbreviations:

Abb. Meaning Abb. Meaning Abb. Meaning

IV Intravenous Susp. Suspension b.i.d. twice daily
IM Intramuscular Syr. syrup q.i.d. 4- times daily

S.C Subcutaneous oint. Ointment q.d One daily

SL Sublingual Sup. Suppository t.i.d 3- times daily
I.T Intrathecal Pt. Patient wk. Week
P.O Oral/ by s.o.s if necessary/ if IU International
mouth needed Unit
Inj. Injection p.r.n When required tsp. Teaspoonful
amp. Ampule NPO Nothing by tbsp. Tablespoonful
mouth
Tab. Tablet Stat. Immediately a.m In morning
Cap. Capsule D.C discontinue p.m In evening
❑ Pharmaceutical preparation/ dosage form:
1. Tablets → normal or SL or Buccal
2. Chewable tablets
3. Effervescent tablets
4. Enteric-coated tablets
5. Caplets (smooth-coated tablets)
6. Sustained (extended)-release products
7. Capsules: soft/ liquid or solid
8. Lozenge
9. Solutions (syrup, elixir) and Suspensions
10. Sterile solutions, sterile powders (for reconstitution) and
suspensions →for parenteral administration

11. Skin Patches (Transdermal skin patches)

12. Ointments, Creams, Lotions
13. Suppositories : rectal, vaginal
14. Aerosols: administered by inhalation through the nose or
mouth.
 Routes of drug administration:

1. Enteral 2. Parenteral 3.Other

• Oral • Intravenous (IV) • Inhalation
• Rectal • Intramuscular • Intranasal
• Sublingual (SL) (IM) • Intrathecal
• Buccal • Subcutaneous • Intraosseous (IO)
(S.C) • Intraventricular
• Transdermal
• Topical:
✓ Eye ,ear & nose
drops
✓Ointments
✓Creams
 Eternal
▪ Substance is given through the GI tract
▪ Usually, the desired effect is systemic
▪ Includes:
1. Oral (P.O)
✓ The most common
✓ Include tablet, capsule, caplet, syrup, suspension
✓ Can be given by NG tube
✓ Advantage :
1. Good patient compliance
2. Easy to take
3. Painless
✓ Disadvantage :
1. First pass metabolism** (will discuss later)
2. Not suitable for unconscious patients
2. Rectal
▪ By Suppository or Enema
▪ Alternative site for systematic drugs (esp. when pt. has N, V, seizure)
▪ Can be used for local 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)

✓Disadvantage :Not all drugs can be formulated as SL or baccal

 Parenteral
▪ Usually used for drugs given by injection or infusion.
▪ Includes :
1. Intravenous (IV)
▪ Direct injection into the vascular system
▪ Advantage:
1. Rapid effect
2. No 1st pass effect because →100% of the drug enters the
circulation (Bioavailability 100%)
▪ Disadvantage:
1. Need specialized persons like you
2. Painful

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?

6. Have two people independently checked steps 1–5 with the

prescription chart?
7. Have you picked up the right syringe? Deal with one patient at
a time.
8. Is the IV line patent? Have you got the right line? Is it correctly
positioned?
9. Is a separate flush solution needed?