nursing
pharmacology
An Introduction by Tristan Eugene G. Gula, R.N.
HISTORY
Early drug – plants, animals & minerals
2700 BB – earliest recorded drug use
found in Middle East & China
1550 BC – Egyptians created Ebers
Medical Papyrus
Castor oil – laxative
Moldy bread – wounds & bruises
HISTORY
Opium – pain
HISTORY
Galen (131-201 AD) Roman physician;
initiated common use of prescriptions
1240 AD – introduction of apothecary
system (Arab doctors)
1st set of drug standards &
measurements (grains, drams,
minims), currently being phased out
HISTORY
15th century – apothecary shops owned
by barber, surgeons, physicians,
independent merchants
18th century – small pox vaccine (by
Jenner)
Digitalis from foxglove plant for
strengthening & slowing of
heartbeat Vitamin C from fruits
HISTORY
19th century – morphine & codeine extract
from opium
Introduction of atropine & iodine
Amyl nitrite used to relieve anginal pain
Discovery of anesthetics (ether, nitrous
oxide)
Early 20th century – aspirin from salicylic
acid
Introduction of Phenobarbital, insulin,
sulforamides
HISTORY
Mid 20th century
1940 – Discovery antibiotics (penicilline,
tetracycline,
streptomycin), antihistamines, cortisone
1950 – discovery antipsychotic drug,
antihypertensives, oral contraceptives,
polio vaccine
Dr Albert Sabin, b. 1906, developer of the
oral live polio vaccine.
PHARMACOLOGY
DEFINITION AND
SUBDIVISION
Pharmacology
study of the manner in which the
function of living system is affected by
chemical agents/drugs
Science concerned with history,
sources, physical & chemical
properties of drugs & the way in which
drug affects living system
is the study of drugs (chemicals) that
alter functions of living organisms.
Drug
chemical introduced into the body to
cause some changes
WHO def: any product/subs used to
modify/explore physiologic
system/pathologic states for the
benefit of the patient
Drug therapy
also called pharmacotherapy, is the use
of drugs to prevent, diagnose, or treat
signs, symptoms, and disease
processes. When prevention or cure is
not a reasonable goal, relief of
symptoms can greatly improve quality
of life and ability to function in
activities of daily living. Drugs given
for therapeutic purposes are usually
called medications.
Subdivisions of
Pharmacology:
1. Pharmacodynamics – study of the
biochemical & physiological effects of
drugs & mechanisms of action
what the drug does to the body
2. Pharmacokinetics – deals with the
absorption, distribution,
biotransformation & excretion of drugs
what the body does to the drug
Subdivisions of
Pharmacology
3. Pharmacotherapeutics – study of drugs
used in the diagnosis, prevention,
suppression, & treatment of diseases
deals with beneficial effects of the drugs
(medicines)
4. Pharmacognosy – study of drugs in their
original unaltered state; origin of drugs
source of drugs
ex: penicillin from penicillium (fungi)
Subdivisions of
Pharmacology
5. Toxicology – study of biologic toxins:
study of poison & its effects deals with
deleterious effects of physical &
chemical agents (including drugs) in
human
Other Terminologies
Pharmacoeconomics – study of
relationship of drugs & economics
Pharmacovigilance – science of
collecting, researching, analyzing, &
evaluating set of information about
adverse drug effects.
Receptor – a component of the cell that
interacts with drug, initiating a chain
of biochemical events leading to
drugs’ observed effects
Things to Remember
Human body works through
complicated series of chemical
reactions & processes
Important aspects of nursing:
understanding how drugs act on
the body to cause changes & apply
that knowledge in clinical setting
Patients take complicated drug
regimen & receive potentially toxic
drug
Some manage their own care at
Nursing responsibilities
regarding drug therapy:
Administering drugs
Assessing drug effects
Intervening to make drug regimen
more tolerable
Provide patient teachings about
drugs & drug regimen
Remember
Knowing how drug works
--- easier to handle ---
enhances drug therapy
GOALS AND RESPONSIBILITIES
OF NURSING CARE RELATED
TO DRUG THERAPY
GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY
Enhancing therapeutic effects by
administering drugs accurately and
considering clients’ individual
characteristics that influence
responses to drug therapy.
GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY
Preventing the need for drug therapy,
when possible, by promoting health
and preventing conditions that require
drug therapy.
Using appropriate and effective
nonpharmacologic interventions
instead of, or in conjunction with, drug
therapy when indicated. When used
with drug therapy, such interventions
may promote lower drug dosage, less
frequent administration, and fewer
adverse effects.
GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY
Preventing or minimizing adverse drug
effects by knowing the major adverse
effects associated with particular
drugs, identifying clients with
characteristics that may increase risks
of experiencing adverse effects, and
actively monitoring for the occurrence
of adverse effects. When adverse
effects occur, early recognition allows
interventions to minimize their
severity. Because all drugs may cause
adverse effects, nurses must maintain
a high index of suspicion that
symptoms, especially new ones, may
GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED
TO DRUG THERAPY
Teaching clients and caregivers
about accurate administration of
medications, nonpharmacologic
treatments to use with or instead of
pharmacologic treatments, and
when to contact a health care
provider.
Classification of
Therapeutic Agents
DRUGS
§ In pharmacology, a drug is "a chemical
substance used in the treatment, cure,
prevention, or diagnosis of disease or used to
otherwise enhance physical or mental well-
being."
§
BIOLOGICS
§ include a wide range of medicinal products such as vaccines,
blood and blood components, allergenics, somatic cells,
gene therapy, tissues, and recombinant therapeutic
proteins created by biological processes (as opposed to
chemically).
§ Biologics can be composed of sugars, proteins, or nucleic
acids or complex combinations of these substances, or
may be living entities such as cells and tissues. Biologics
are isolated from a variety of natural sources - human,
animal, or microorganism - and may be produced by
biotechnology methods and other technologies. Gene-
based and cellular biologics, for example, often are at the
forefront of biomedical research, and may be used to treat
a variety of medical conditions for which no other
treatments are available.
§ In some jurisdictions, biologics are regulated in a different
manner than are drugs and medical devices.
Alternative
Therapies
4444
A botánica, such as this one in
Massachusetts, caters to the
Latino community and sells folk
medicine alongside statues of
saints, candles decorated with
prayers, and other items.
§ In Western culture, alternative medicine is any healing practice
"that does not fall within the realm of conventional medicine",or
"that which has not been shown consistently to be effective.”
Alternative medicine is often based on the belief that a particular
health regimen has efficacious effects even while there exists
various bodies of evidence to contradict such a belief under the
rigorous standards of evidence based medicine. In practice,
alternative medicine encompasses therapies with a historical or
cultural, rather than a scientific, basis. Commonly cited examples
include naturopathy, chiropractic, herbalism, traditional Chinese
medicine, Unani, Ayurveda, meditation, yoga, biofeedback,
hypnosis, homeopathy, acupuncture, and diet-based therapies, in
addition to a range of other practices. It is frequently grouped
with complementary medicine, which generally refers to the
same interventions when used in conjunction with mainstream
techniques under the umbrella term complementary and
alternative medicine, or CAM.
Traditional Chinese
Medicine
Acupuncture chart from Hua Shou
(fl. 1340s, Ming Dynasty). This
image from Shi si jing fa hui
(Expression of the Fourteen
Meridians). (Tokyo : Suharaya
Heisuke kanko, Kyoho gan 1716).
DOH warns against Iridology
By Katherine Evangelista
INQUIRER.net
First Posted 19:06:00 08/04/2008
Filed Under: Health, Diseases
MANILA, Philippines – Iridology is “neither a diagnostic tool nor a therapeutic
modality in alternative medicine,” the Department of Health (DoH) on Monday said.
“There is no scientific validation for the use of iridology and it does not have strong
evidence of having value either for diagnosis or treatment of diseases,” Health
Secretary Francisco Duque III said in a statement.
Iridology, or iridodiagnosis, is an alternative medicine technique where a patient’s iris
is examined to determine information abut his or her health.
After examination, iridologists encourage patients to purchase “alleged herbal
medicines” to cure or prevent the spread of their “diagnosed disease,” the DoH said.
These herbal medicines may have implications on the health of a person who does
not need them, it said.
Duque fears that iridology puts the lives of patients at risk if it is used as replacement
for established diagnostic tools since a patient might be given wrong information on
his or her health condition.
Ten ( 10 ) Herbal Medicines in
the Philippines
Approved by the Department of
Health ( DOH )
1 . Akapulko ( Cassia
alata )
also known as "bayabas-bayabasan" and "ringworm
bush" in English, this herbal medicine is used to treat
ringworms and skin fungal infections.
2 . Ampalaya ( Momordica
charantia )
known as "bitter gourd" or "bitter melon" in English, it
most known as a treatment of diabetes (diabetes
mellitus), for the non-insulin dependent patients.
3 . Bawang ( Allium
sativum )
popularly known as "garlic", it mainly reduces
cholesterol in the blood and hence, helps control blood
pressure.
4 . Bayabas ( Psidium
guajava )
"guava" in English. It is primarily used as an
antiseptic, to disinfect wounds. Also, it can be used as
a mouth wash to treat tooth decay and gum infection.
5 . Lagundi ( Vitex
negundo )
known in English as the "5-leaved chaste tree". It's
main use is for the relief of coughs and asthma.
6 . Niyog - niyogan ( Quisqualis
indica L . )
is a vine known as "Chinese honey suckle". It is effective in the
elimination of intestinal worms, particularly the Ascaris and Trichina.
Only the dried matured seeds are medicinal -crack and ingest the
dried seeds two hours after eating (5 to 7 seeds for children & 8 to
10 seeds for adults). If one dose does not eliminate the worms, wait
a week before repeating the dose.
7 . Sambong ( Blumea
balsamifera )-
English name: Blumea camphora. A diuretic that helps
in the excretion of urinary stones. It can also be used
as an edema.
8 . Tsaang Gubat ( Ehretia
microphylla Lam . )
Prepared like tea, this herbal medicine is effective in treating
intestinal motility and also used as a mouth wash since the
leaves of this shrub has high fluoride content.
9 . Ulasimang Bato | Pansit - Pansitan ( Peperomia
pellucida )
It is effective in fighting arthritis and gout. The leaves can be eaten
fresh (about a cupful) as salad or like tea. For the decoction, boil a
cup of clean chopped leaves in 2 cups of water. Boil for 15 to 20
minutes. Strain, let cool and drink a cup after meals (3 times day).
10 . Yerba Buena ( Clinopodium
douglasii )
commonly known as Peppermint, this vine is used as an analgesic to
relive body aches and pain. It can be taken internally as a decoction
or externally by pounding the leaves and applied directly on the
afflicted area.
Tips on Handling Medicinal
Plants / Herbs:
If possible, buy herbs that are grown organically - without
pesticides.
Medicinal parts of plants are best harvested on sunny mornings.
Avoid picking leaves, fruits or nuts during and after heavy
rainfall.
Leaves, fruits, flowers or nuts must be mature before harvesting.
Less medicinal substances are found on young parts.
After harvesting, if drying is required, it is advisable to dry the
plant parts either in the oven or air-dried on screens above
ground and never on concrete floors.
Store plant parts in sealed plastic bags or brown bottles in a cool
dry place without sunlight preferably with a moisture
absorbent material like charcoal. Leaves and other plant parts
that are prepared properly, well-dried and stored can be used
up to six months.
Tips on Preparation for
Intake of Herbal
Medicines:
Use only half the dosage prescribed
for fresh parts like leaves when
using dried parts.
Do not use stainless steel utensils
when boiling decoctions. Only use
earthen, enamelled, glass or alike
utensils.
As a rule of thumb, when boiling
leaves and other plant parts, do
not cover the pot, and boil in low
flame.
Tips on Preparation for
Intake of Herbal
Medicines:
Decoctions loose potency after some
time. Dispose of decoctions after
one day. To keep fresh during the
day, keep lukewarm in a flask or
thermos.
Always consult with a doctor if
symptoms persist or if any sign of
allergic reaction develops.
Prescription and Over
the counter Drugs
Prescription/legend drug
can be dispensed if with
prescription order; with
specific name of drug &
dosage regimen to be used
by patient
Non-prescription drug
can be dispensed over –the-
counter/without prescription
order
for self treatment of variety of
complaints
vitamin supplements, cold/cough
remedies, analgesics, antacids,
herbal products
Cautions in use of OTC
drugs:
1. delay in professional diagnosis &
treatment of serious/potentially
serious condition may occur
2.
symptoms may be masked
making the diagnosis more
complicated
3.
clients’ health care
provider/pharmacist should be
consulted before OTC preparations
are taken
Cautions in use of OTC
drugs:
4. labels/instructions should be
followed carefully
5. ingredients in OTC drug may
interact with prescribed drug
6. inactive ingredients may
result in adverse reactions
Cautions in use of OTC
drugs:
7. potential for overdose
8. multiple medication users
are at risk as more
medications are added to
therapy regimen
9. interactions of medications
are potentially dangerous
Drug Regulations
and
Standards
PHARMACOLOGY
R.A. 6425- Dangerous Drugs
Act
It stip u la te s
th a t th e sa le ,
a d m in istra tio n , d e live ry , d istrib u tio n
a n d tra n sp o rta tio n o f p ro h ib ite d
d ru g s is p u n ish a b le b y la w .
R.A. 9165 – the new
Dangerous Drug Act of
2002
Food and Drug
Administration
a p p ro ve s m a n y n e w d ru g s
a n n u a lly
Pregnancy Categories
Research into the development of the
human fetus, especially the nervous
system, has led many health care
providers to recommend that no drug
should be used during pregnancy
because of potential effects on the
developing fetus.
In cases in which a drug is needed, it is
recommended that the drug of
choice be one for which the benefit
outweighs the potential risk
FDA Pregnancy Categories
Category A: No risk in pregnant women and fetus
Category B: No risk in pregnant women and fetus
Animal studies have shown adverse effect.
Category C: Animal studies have shown risk for fetus
No adequate studies in humans
Benefits from the use of drugs accepted
Category D: Evidence of human fetal risk
Benefits from the use of drugs accepted
Category X: Animal and human studies demonstrate fetal
abnormalities or adverse reactions. The risk for pregnant
women clearly outweighs any possible benefit.
Controlled
Substance
PHARMACOLOGY
CATEGORIES OF CONTROLLED
SUBSTANCES
Schedule I
Drugs that are not approved
for medical use and have
high abuse potentials:
heroin, lysergic acid
diethylamide (LSD), peyote,
mescaline,
tetrahydrocannabinol,
marijuana.
CATEGORIES OF CONTROLLED
SUBSTANCES
Schedule II
Drugs that are used medically and
have high abuse potentials:
opioid analgesics (eg, codeine,
hydromorphone, methadone,
meperidine, morphine,
oxycodone, oxymorphone),
central nervous system (CNS)
stimulants (eg, cocaine,
methamphetamine,
methylphenidate),and
barbiturate sedative-hypnotics
(amobarbital,
CATEGORIES OF CONTROLLED
SUBSTANCES
Schedule III
Drugs with less potential for abuse
than those in Schedules I and II,
but abuse may lead to
psychological or physical
dependence: androgens and
anabolic steroids, some CNS
stimulants (eg, benzphetamine),
and mixtures containing small
amounts of controlled
substances (eg, codeine,
barbiturates not listed in other
schedules).
CATEGORIES OF CONTROLLED
SUBSTANCES
Schedule IV
Drugs with some potential for
abuse: benzodiazepines
(eg, diazepam,lorazepam,
temazepam), other
sedative-hypnotics (eg,
phenobarbital,chloral
hydrate), and some
prescription appetite
suppressants(eg, mazindol,
phentermine).
CATEGORIES OF CONTROLLED
SUBSTANCES
Schedule V
Products containing moderate
amounts of controlled
substances.
They may be dispensed by the
pharmacist without a
physician’sprescription but with
some restrictions regarding
amount, record keeping, and
other safeguards. Included are
antidiarrheal drugs, such as
diphenoxylate and atropine
Orphan Drugs
p Are drugs that have been discovered
but are not financially viable and
therefore have not been “adopted”
by any drug company.
Generic Drugs
PHARMACOLOGY
COMMON SOURCES /4 MAJOR
SOURCES (ORIGINS) OF
DRUGS:
1. Animal sources
from organs, organ secretion or organ cells
Used to replace human chemical not
produces because of disease or genetic
problems
Thyroid drugs & growth hormones
preparations – from animal thyroid &
hypothalamus tissue (many of these
preparations are now created
synthetically – safer & purer)
Insulin – from pancreas of animals (hog,
cattle, sheep): thru genetic engineering –
could produce human insulin by altering
E. coli bacteria making it a better product
without impurities that come with animal
products
2. Vegetable/Plant
sources
roots, bark, sap, leaves, flowers, seeds of
medicinal
Plants digitalis from wildflower, purple
foxglove, dried leaves of plant
active principles of plants
§ alkaloids – alkaline in reaction, bitter in
taste, powerful in physiologic activity
o atropine & scopolamine
o morphine sulfate, cocaine, quinine, nicotine,
caffeine
o procaine
2. Vegetable/Plant
sources
glycosides – digitalis
resin – soluble in alcohol; example –
colonic irritant found in laxative
cascara
gums – used in bulk-type laxatives:
some used in certain skin
preparations for their soothing
relief
oils – castor oil, oil of wintergreen
3. Mineral sources
from free elements, both metallic &
non-metallic usually in form of
acids bases, salts found in food
Dilute HCI – control/prevent
indigestion
Calcium, aluminum, fluoride, iron,
gold, potassium
4. Synthetic sources
many drugs developed synthetically
after chemical in plants, animals, or
environment have been screened
for signs of therapeutic activity
more potent, more stable, less toxic
Ø steroids – arthritis & other diseases
Ø sulfonamides/chemotherapeutic
agents – kill microorganism slow
their growth
Ø meperidine HCI (Demerol)
PHARMACOLOGY
PHASES OF DRUG
DEVELOPMENT
Preclinical Trials
Chemicals are tested on laboratory
animals to determine if:
1. they have the presumed effects on
living tissue;
2. and to evaluate any adverse effects
Some chemicals are discarded
after preclinical trial for the
following reasons:
Lack of therapeutic activity when
introduced with a living organism
Too toxic to living organism
Highly teratogenic (abnormalities or
adverse effects to the fetus)
The safety margin is too small
Ex. Lithium - 0.6 mg/dl- therapeutic
- 0.5 mg/dl- useless
- 0.7 mg/dl- toxic
PHASE I Studies
Drugs are tested on human volunteers
a few doses are given to a few healthy
volunteers to determine safe dosages,
routes of administration, absorption,
metabolism, excretion, and toxicity.
PHASE II Studies
Drugs are tested on patients with the
disease that the drug is meant to
treat.
a few doses are given to a few subjects
with the disease or symptom for
which the drug is being studied, and
responses are compared with those of
healthy subjects.
PHASE III Studies
Using the drug in a vast clinical market
the drug is given to a larger and more
representative group of subjects.
DRUG NOMENCLATURE
PHARMACOLOGY
DRUG NOMENCLATURE
1. TRADE/BRAND/PROPRIETY NAME – name
given by the drug company that
developed it
followed by the symbol R or TM, 1st letter
is capitalized
2. GENERIC NAME/NON-PROPERTY NAME-
original designation given to the drug
when the drug company applies for
approval process
universally accepted & not capitalized;
before drug becomes official, used in all
countries
protected by law; not capitalized
3. CHEMICAL NAME-
atomic/molecular structure of drug
DRUG NOMENCLATURE
chemical name – acetylsalicylic acid
generic name – aspirin
trade name – Aspilet
minoxidil
Generic name
Rogaine
Brand name
PHASE IV Studies
the FDA evaluates the data from the
first three phases for drug safety and
effectiveness, allows the drug to be
marketed for general use, and
requires manufacturers to continue
monitoring the drug’s effects.
