NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

Lesson 1: Introduction to Pharmacology FACTORS AFFECTING ABSORPTION:

Pharmacology – study of how a drug works on the 1. Intravenous – non direct entry to the venous
body, its side effects on the body, and the way the system.
body uses the drug. 2. Intramuscular – perfusion of blood flow to the
muscle fat content of the muscle/
Drugs – chemicals that are introduced into the body
- Temperature of the muscle:
to cause some sort of change.
-cold cause vasoconstriction - decrease
- When drugs are administered, the body begins a
absorption.
sequence of processes designed to handle the
new chemicals. -heat cause vasodilation – increase absorption
4 PHARMACOLOGIC PRINCIPLES: 3. Subcutaneous – perfusion or blood flow to the
muscle fat content of the muscle.
1. Pharmaceutics
2. Pharmacokinetics 4. P.O. (oral) – acidity of stomach, length of time
3. Pharmacodynamics in stomach.
4. Pharmacotherapeutics
- blood flow to GI tract
PHARMACEUTICS
- presence of interacting foods or drug
– the branch of Pharmacology concerned with
5. P.R. (rectal) – perfusion or blood flow to rectum
the preparation, use or sale of medicinal drugs.
- lesions
- Determines the rate at which drug will be
dissolved and be absorbed. - length of time retained or absorption.
>IV >SL >Topical 6. Mucous Membrane ( SL, buccal) – perfusion or
blood flow
>IM >INH >Rectal
-integrity of mucous membrane
>PO >SQ >Intraosseous
-presence of food or smoking
PHARMACOKINETICS
7. Topical (skin) – perfusion or blood flow
– the transport of a drug in the body by the
blood stream to its site of action. -integrity
- Pharmacokinetics involves the study of 8. Inhalation – perfusion or blood flow
(ADME) Absorption, Distribution, Metabolism,
-integrity of lung lining
Excretion.
- Pharmacokinetics considerations include the -ability to administer drug properly.
onset of drug action, drug half-life, timing of
peak effect, duration of drug effect. Absorption process

Absorption – refers to what happens to a drug – drugs can be absorbed into cells through
from the time it is introduced to the body until it various processes.
reaches the circulating fluids and tissues. 1. Passive diffusion – major process through
which drugs are absorbed into the body.
- Occurs across a concentration gradient
- When there is a greater concentration of drug
on one side of cell membrane, the drug will
NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

move through the membrane to the area of 2. Peak – time it takes for the drug to reach its
lower concentration. maximum response.
2. Active transport – process that uses energy 3. Duration – time drug concentration is
to actively move a molecule across a cell sufficient to elicit a therapeutic response.
membrane. 4. Half time – time it takes one half of the
- Often a very important process in drug original amount of a drug in a body to be
excretion in the kidney. removed.
3. Filtration – involves movement through - Measure of the rate at which drugs are removed
pores in the cell membrane, either down a from the body.
concentration gradiant or as a result of the - Most of the drugs are considered to be
pull of plasma proteins. effectively removed after about five –half life.
Distribution PHARMACODYNAMICS
– involves movement of the drug to the body’s – also known as mechanism of action.
tissues.
- Pharmacodynamics is the study of the
- As with absorption, factors that can affect interactions between the chemical components
distribution include the drug’s lipid solubility of living systems and the foreign chemicals,
and ionization of the perfusion of the reactive including drugs, that enter those systems.
tissue.
*Drug usually work:
Metabolism
- to replace or act as substitutes for missing
– also called biotransformation chemicals.
- Is a chemical reaction which leads to - to increase or stimulate certain cellular activities.
modification of drugs.
- to depress or slow cellular activities
- Enhance excretion by transforming the drug to
a less lipid soluble, less rapidly reabsorbed - to interfere with the functioning of foreign cells,
form. such as invading microorganisms or neoplasms
- Termination of drug action (drugs that act in this way are called
chemotherapeutic agents).
First – pass effect – term used for the hepatic
metabolism of drug when it is absorbed from GIT A positive change in a physiologic system is called
and delivered to the liver via portal circulation. “Therapeutic Effect”.
Excretion Therapeutic effect – the goal of drug therapy.
– removal of drug from the body. PHARMACOTHERAPEUTICS
- The skin, saliva, lung bile, feces are some of the – also called clinical pharmacology.
routes used to excrete drugs.
- The branch of pharmacology that uses drugs to
- The kidney, however, play the most important
treat, prevent, and diagnose disease.
role in drug excretion.
- Addresses two key concerns:
*Mostly through urination
1. The drug’s effects on the body.
*Kidney filters blood.
2. The body’s response to the drug.
Other principles of pharmacokinetics:
1. Onset – time it takes for the drug to elicit Nursing responsibilities:
therapeautic response.
1. Administering drugs
NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

2. Assessing drug effects - At the end of the phase 2 studies, a drug may be
3. Intervening to make the drug regimen more removed from further investigation for the
tolerable following reasons:
4. Providing patient teaching about drugs and 1. It is less effective than anticipated
the drug regimen. 2. It is too toxic when used with patients
3. It produces unacceptable adverse effects
14 RIGHTS ON DRUG ADMINISTRATION:
4. It has low benefit-to-risk ratio, meaning that the
1. Right medication/drug therapeutic benefit it provides does not
2. Right client/patient outweigh the risk of potential adverse effects
3. Right route that it causes.
4. Right dose 5. It is no more effective than other drugs already
5. Right frequency/time on the market, making the cost of continued
6. Right assessment research and production less attractive to the
7. Right approach drug company.
8. Right education
Phase 3 – study involves use of the drug in a vast
9. Right evaluation
clinical market. Prescribers are informed of all the
10. Right documentation
known reactions to the drug and precautions
11. Right to refuse
required for its safe use.
12. Right principle of care
13. Right prescription - A drug that produces unacceptable adverse
14. Right nurse clinician effects or unforeseen reactions is usually
removed from further study by the drug
4 STUDY PHASES:
company.
Phase 1 – uses human volunteers to test the drugs. - In some cases, the FDA may have to request
These studies are more tightly controlled than pre- that a drug be removed from the market.
clinical trials and are performed by specially trained
Phase 4 – after a drug is approved for marketing, it
clinical investigators.
enters a phase of continual evaluation, or phase 4
- At the end of phase 1 studies, many chemicals study.
are dropped from the process for the following
- Prescribers are obligated to report to the FDA
reasons:
any untoward or unexpected adverse effects
1. They lack therapeutic effect in humans
associated with drugs they are using, and the
2. They cause unacceptable adverse effects.
DSA continually evaluated this information.
3. They are highly teratogenic.
- Some drugs cause unexpected effects that are
4. They are too toxic.
not seen until wide distribution occurs.
Phase 2 – allows clinical investigators to try out the
Brand name (Trade name) – is given by the
drug in who have the disease that the drug is
pharmaceutical company that developed it.
designed to treat.
Chemical name – are names that reflect the
- Usually phase 2 studies performed at various
chemical structure of a drug.
sites across the country in hospitals, clinics, and
doctors’ offices and are monitored by the Generic name – a drug is the original designation
representative of the pharmaceutical company that the drug was given when the drug company
studying the drug. applied for the approval process.
NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

TOXIC EFFECTS OF DRUGS: defects, which can include skeletal and limb
abnormalities, CNC alterations, heart defects and
1. Adverse effects are undesired effects that
the like.
may be unpleasant or even dangerous.
*They can occur for many reasons, including
the following: THE NURSING PROCESS IN DRUG
THERAPY AND PATIENT SAFETY
- The drug may have other effects on the body
besides the therapeutic effect.
- The patient may be sensitive to the drug being
Assessment
given.
- The drug’s action on the body may cause other - first step of the nursing process. This involves
responses that are undesirable or unpleasant. systematic, organized collection of data about
- The patient may be taking too much or too little the patient.
of the drug, leading to adverse effects.
Past history:
2. Drug allergy – a drug allergy occurs when
the body forms antibodies to a particular - Chronic conditions
drug, causing an immune response when the - Drug use
person is re-exposed to the drug. - Allergies
3. Drug-induced tissue and organ damage – - Level of education
drugs can act directly or indirectly to cause - Level of understanding of disease and therapy
many types of adverse effects in various - Social supports
tissues, structures, and organs. - Financial supports
Dermatological reactions – rashes, hives, - Pattern of health care
stomatitis Physical examination:
Superinfections – infections caused by organisms - weight
that are usually controlled by the normal flora. - age
Blood Dyscrasia – is bone marrow suppression - physical parameters related to the disease state
caused by drug effects. This occurs when drugs that or known drug effects
can cause cell death. Nursing diagnosis
Toxicity – liver injury, renal injury, poisoning - is simply a statement of the patient’s status
Alterations in glucose metabolism – from a nursing perspective. The nurse analyzes
hyperglycemia, hypoglycemia the information gathered during assessment to
arrive at some conclusions that lead to a
Electrolyte imbalances – hypokalemia, particular goal and set of interventions.
hyperkalemia - These diagnoses, culled from the north
Sensory effects – ocular damage, auditory damage. American nursing diagnosis association
(NANDA-I
Neurological effects – general central nervous
system effects, atropine-like (Anticholinergic)
effects, Parkinson-like syndrome, neuroleptic Implementation
malignant syndrome. - Involves taking the information gathered and
Teratogenicity – drugs that reach the developing sysnthesized into nursing diagnoses to plan the
fetus or embryo can cause death or congenital patient care.
NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

- Proper drug administration Gram (Weight) – the basic unit of weight

- Comfort measures
- the weight of distilled water in 1 cubic cm at a
Placebo effect:
temp of 4 degrees centrigrade
For example: a back rub, a kind word, and a - a cube is 1.cm3
positive approach may be as beneficial as the drug - equal to a volume of 1ml in 1cc
itself. - abbreviated as g.
- 1g = 1ml = 1cc
Managing adverse effects
Lifestyle adjustment
BASIC DRUG COMPUTATIONS
- Patient and family education
For tablets and capsules:
Evaluation
D/S
– is a part of the continuing process of patient care
For liquid form:
that leads to changes in assessment, diagnosis, and
intervention D/S x Q
- The patient is continually evaluated for
therapeutic response, the occurrence of adverse
drug effects, and the occurrence of drug-drug,
drug-food, drug-alternative therapy, or drug- mggt/min = volume infused per hour (ml/hr) x 60 mggt/ml (constant)
laboratory test interactions 1 hour x 60 minutes

LESSON 2: DOSAGE CALCULATION

Metric system - a decimal system based on
multiples of ten.
The metric system has standards unit of
measurement.
The metric abbreviation always follows the Arabic
numeral: 0.2ml 10kg
Fractional units are expressed as decimals: 0.5cc not
½cc.
Zeros are only used in front of the decimal point to
clarify the decimal: 0.5cc not 0.50cc
Liter (volume) – a liter is the basic unit of volume.

- Abbreviated as L Intravenous Fluid Flow Rates:

- Equal to 1000ml = 1000cc
- It is the total volume of liquid in a cube that  ml/hr = Total infusion volume (ml)
measure 10cm x 10cm x 10cm Total infusion time (hr)

CC – a cc is the amount of space occupied by one

ml of volume.
NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

 gtts/min = V (total volume) x drop factor  Compatible with NSS, D5W, LRS
T (hr) x 60min (total time in min)  Stock dose – 200mg in 5ml solution per
ampule
 Dose range – 2.5 - 10mcg/kg/min for a 50kg
Common drop factor as follows:
patient.
 Macro: 10 gtts = 1ml  Preparation:
15 gtts = 1ml ‐ 200mg dopamine in 250ml solution
20 gtts = 1ml ‐ 400mg dopamine in 250ml solution
 Dopamine Drip:
 Micro: 60 gtts = 1ml
Rate (ml/hr) = wt. in kg x D (desired mcg/kg/min)
13.3 x no. of ampules of vials
Quick Formula:
 gtts/min = milliliters per hour (ml/hr) x drop factor
Dobutamine
60 minutes
– increases myocardia contractility and stroke
volume.
 ml/hr = gtts/min x (60 x drop factor)
 Decreases peripheral vascular resistance,
reduces ventricular filling pressure and
facilitate AV node
Converting drip rate from ml/hr to mggt/min:
 Dosage:
‐ 2.5 to 10mcg/kg/min
‐ Up to 40mcg/kg/min
 Adverse reactions – Increases BP and heart
To Calculate Infusion Time (TOTAL HOURS): rate
 Dobutamine must never be infused
 Determine total volume to be infused
together with NaHCO3 drip using the
 Determine ml/hr
same IV line!
 Convert gtts/min to ml/hr if ml/hr is
 Never to be given as direct IV push
unknown
 Given as an infusion
 Determine drop factor if gtts/min is
‐ 250mg in 250 ml of D5W
unknown
‐ 500mg in 250 ml of D5W
 Formula:  Dobutamine Drip:
Infusion time = total volume
ml/hr Rate (ml/hr) = wt. in kg x D (desired mcg/kg/min)
16.6 x no. of ampules or vials
ALL ABOUT DRIPS
 Stock dose = 250 mg/5 ml/ampule
Dopamine 250 mg/20 ml/ vial
 Dose range = 2.5 – 20mcg/kg/min for a
– immediate precursor of epinephrine in the
50kg patient
body.
 Increases myocardial contraction cardiac
output
NCM 106: Pharmacology MAGA, MEDIONA, OPONDA, SALUD

Norepinephrine (Levophed)
 Stock dose = 2mg in 2ml per ampule
 Dose = 0.1 – 3.0 mcg/kg/min
 Concentration:
2,000mcg/250 ml D5W = 8mcg/ml – once
4,000mcg/250 ml D5W = 16mcg/ml – double
6,000mcg/250 ml D5W = 24mcg/ml – triple
8,000mcg/250 ml D5W = 32mcg/ml – quadro