I.

INTRODUCTION
DRUG- is any substance that interacts with a molecule or protein that plays a regulator role in living
systems. Any chemical that affects the processes of a living organism.
PHARMACOLOGY- is an extensive science that includes pharmaceutics, pharmacokinetics,
pharmacodynamics, pharmacotherapeutics, pharmacognosy and toxicology. The study and science of
drugs.
IMPLICATION TO NURSES- the nurse needs to know and understand all the information about the
patient and about each medication prescribed.
The following are the 10 RIGHTS OF DRUG ADMINISTRATION:
1. Right Drug. Check if its the right name and form.
2. Right Patient. Ask the name of the client before giving the medication.
3. Right Dose. Check the medication sheet and the doctors order before medicating.
4. Right Route. Check the order if its oral, IV, SQ, IM, etc..
5. Right Time and Frequency. Check the order for when it would be given and when was the last
time it was given.
6. Right Documentation. Make sure to right the time and any remarks on the chart correctly.
7. Right History and Assessment. Secure a copy of the clients history to drug interactions and
allergies.
8. Drug approach and Right to Refuse. Give the client enough autonomy to refuse to the
medication after thoroughly explaining the effects.
9. Right Drug-Drug Interaction and Evaluation. Review any medications previously given or the
diet of the patient that can yield a bad interaction to the drug to be given.
10. Right Education and Information. Provide enough knowledge to the patient of what drug
he/she would be taking and what are the expected therapeutic and side effects.
DRUG NAMES:
1. Chemical name- describes the drugs chemical composition and molecular structure.
2. Generic name(nonpropriety name)- identification of a drug by its scientifically and
internationally recognized active ingredients or by their official generic name as determined by
the Food and Drug Administration of the DOH;
GENERICS ACT of 1988- a) All government health agencies and their personnel as well as other
government agencies shall use generic terminology or generic names in all transactions related
to purchasing, prescribing, dispensing and administering of drugs and medicines.
b) All medical, dental and veterinary practitioners, including private practitioners, shall write
prescriptions using the generic name. The brand name may be included if so desired.
3. Trade name(propriety name)- a propriety name given by the manufacturer to distinguish its
product from those of the competitors.
NOTE: GIVE EXAMPLES then quiz
COMMON DRUGS AND THEIR ANTIDOTES
DRUG
Acetaminophen/Tylenol/Paracetamol
Anticholinesterase

ANTIDOTE
Acetylcysteine (Mucomyst)
Atropine sulfate or pralidoxime

Anticholinergics
Benzodiazepines
Betablockers
Calcium Channel Blockers
Copper
Coumadin/Warfarin
Cyanide
Cyclophosphamide
Demerol
Digoxin
Dopamine
Extrapyramidal symptoms (EPS)
Ethylene glycol
Fluorouracil
Heparin
Insulin reaction
Iron
Lead
Magnesium Sulfate
Methotrexate
Methylergonovine
Morphine
Narcotics
Neostigmine
Opioid analgesics
Oxytocin
Penicillin
Potassium
Thrombolytic
Tricyclic antidepressants
Curare

Physostigmine
Flumazenil
Glucagon
Glucagon
Penicillamine
Vitamine K, Fresh Frozen Plasma
Amyl nitrate, sodium nitrate, sodium thiosulfate,
methylene blue
Mesna
Naloxone (Narcan)
Digibind, Digoxine immune fab
Phentolamine (Regitine)
Diphenhydramine (Benadryl)
Fomepizole
Leucoverin calcium
Protamine sulfate
Glucose (Dextrose 50%)
Deferoxamine
Dimercaprol, edetate disodium, succimer
Calcium gluconate
Leucoverin calcium
Magnesium sulfate
Naloxone Hcl (Narcan)
Naloxone (Narcan)
Pralidoxine Chloride
Namefene or naloxone
Magnesium sulfate
Epinephrine
Albuterol inhaler, insulin and glucose, NaHCO3,
kayexalate
Amino caproic acid
Physostigmine or NaHCO3
Edrophonium tensilon

PHARMACEUTICS- study of how various dosage forms influence the way in which the body metabolizes
a drug (Pharmacokinetics) and the way in which the drug affects the body (Pharmacodynamics).
PHARMACOKINETICS- the study of what the body does to the drug. Components: Absorption,
Distribution, Metabolism, Elimination or Excretion.
PHARMACODYNAMICS- the study of what the drug does to the body; refers to the mechanism of drug
actions in living tissues.
PHARMACOTHERAPEUTICS- the use of drugs and the clinical indications for drugs to prevent and treat
diseases.
PHARMACOGNOSY- the study of natural (plant and animal) drug sources

Other Definition of terms:

Endogenous (inside, beginning)- substances made inside the body. Ex. Hormones
Exogenous(outside, beginning)- made outside of the body
Poisons are drugs that have almost exclusively harmful effects
Toxins- are poisons of biologic origin, usually synthesized by plants or animals
Receptor- a specific molecule, usually a protein, that interacts with a specific chemical that causes a
change in specific molecule, causing a change in the regulatory system
Agonist- any drug that binds to a receptor and activates the receptor. Lock and key
Antagonist- any drug that binds to a receptor and prevents the activation of the receptor.
II.
PHARMACOKINETICS, PHARMACODYNAMICS, PHARMACEUTICS
PHARMACOKINETICS:
Absorption- rate at which drug leaves its site of administration, and extent to which absorption occur.
(Bioavailability- the fraction of administered dose that reaches the systemic circulation; Main
determinants: 1. Properties of the drug 2. Route of administration; Bioequivalent).
FACTORS THAT AFFECT ABSORPTION
- Route of administration of drug
ROUTES OF ADMINISTRATION:
a) Enteral- thru the GI system (oral or gastric mucosa, SI, Rectum); examples are oral,
sublingual, buccal, rectal
Drug Absorption of various drugs
From fastest to slowest (Liquids, Elixir, Syrups; suspension solutions; Powders;
Capsules; Tablets; Coated Tablets; Enteric-Coated Tablets)
b) Topical- skin, eyes, ears, nose, lungs (inhalation), Vagina
c) Parenteral- IV, IM, Subcutaneous, Intradermal, Intrathecal, Intraarticular,
- Food or fluids administered with the drug
- Dosage formulation
- Status of the absorptive surface
- Rate of blood flow to the small intestine
- Acidity of the stomach
- Status of GI motility
1. Distribution- transport of a drug in the body by the bloodstream to its site of action. From
vascular or plasma to extravascular space.
- Protein-binding
- Water soluble v fat soluble
- Blood-brain barrier
- Areas of rapid distribution: heart, liver, kidney, brain
- Areas of slow distribution: muscle, skin, fat
2. Metabolism- AKA Biotransformation; the biologic transformation of a drug into an inactive
metabolite, a more soluble compound, or a more potent metabolite by liver enzymes.
SITES OF METABOLISM: LIVER(main), Kidneys, lungs, plasma, intestinal mucosa
FACTORS THAT DECREASE METABOLISM:

- Cardiovascular dysfunction
- Renal insufficiency
- Starvation
- Obstructive jaundice
- Slow acetylator
- Erythromycin or ketoconazole drug therapy
FACTORS THAT INCREASE METABOLISM:
- Fast acetylator
- Barbiturates
- Rifampicin therapy
DELAYED DRUG METABOLISM RESULTS IN:
- Accumulation of drugs
- Prolonged action of the effects of the drugs
STIMULATING DRUG METABOLISM CAUSES:
- Diminished pharmacologic effects
ex. DRUG A DRUG B (not necessarily breakdown the drug but add some to it to make it polar
inorder to eliminate it or activate it
FIRST PASS EFFECT- metabolism of a drug and its passage through the liver before it reaches
systemic circulation
Outcomes of metabolizing drugs:
Active molecule->inactive(prodrug) vis versa ex of prodrug to active as in codeine metabolized
to become morphine
Toxic-> non-toxic vis a visex of non to toxic is acetaminophen where 5% of the drug may be
metabolized to be toxic or hepatotoxic
Lipid soluble (easily passes thru cell membranes)-> water soluble;
Why and how we metabolize drugs:
1. Drugs are foreign compounds inorder for them to be absorbed by the intestines,
they become lipid soluble. But inorder to excrete them they must be metabolized to
become water soluble therefore making it easily excreted.
3. Excretion/Elimination- elimination of drugs from the body
SITES: Kidney(main), Liver, bowel(biliary excretion, enterohepatic circulation), bowel(feces),
saliva, sweat, breast milk.
HALF-LIFE- the time it takes for one half of the original amount of a drug in the body to be removed; a
measure of the rate at which drugs are removed from the body.
PHARMACODYNAMICS:
Drug actions: the cellular process involved in the drug and cell interactiongg
Drug effect: The physiologic reaction of the body to the drug

Onset- the time it takes for the drug to elicit a therapeutic response
Peak- the time it takes for a drug to reach its maximum therapeutic response
Duration- the time a drug concentration is sufficient to elicit a therapeutic response
Mechanisms of action- the ways by which drugs can produce therapeutic effects:
- Once the drug is at the site of action, it can modify the rate (increase or decrease) at
which the the cells or tissues function.
- A drug cannot make a cell or tissue perform a function it was not designated to perform.
>Receptor interaction
>Enzyme interaction
>Nonspecific interaction
Indication- the use of the drug for treating a particular disease
Side effect
Adverse effect
Tolerance- when a person begins to require higher doses to produce the same effects that lower doses
once provided. Ex. Heroine addiction-body metabolizes the drug more rapidly than before
Dependence- aka addiction or habituation; occurs when person is unable to control the ingestion of
drugs; common on scheduled or controlled medications such as opiates and benzodiazepines. May be
physical:withdrawal symptoms or psychological: emotionally attached to the drug.
Cumulative effect: a drug may accumulate in the body if the next doses are administered before
previously administered doses have been metabolized or excreted. May lead to drug toxicity.
Over-the-counter- non-prescription drugs sold without a prescription in a pharmacy.
Placebo- drug usually in a form of tablet or capsule that has no pharmacologic activity because the
dosage form has no active ingredients.
PHARMACOTHERAPEUTICS:
TYPES OF THERAPIES:
- Acute therapy
- Maintenance therapy
- Supplemental therapy
- Palliative therapy
- Supportive therapy
- Prophylactic therapy
MONITORING:
- the effectiveness of the drug therapy must be evaluated;
- one must be familiar with drugs: intended therapeutic action (beneficial) and the
drugs unintended but potential side effects (predictable, adverse drug reactions)
- therapeutic index- the ratio between a drugs therapeutic benefits and its toxic effects
- drug concentration
- patients condition

tolerance(a decreasing response to repetitive drug doses) and dependence(physiologic

and psychologic need for a drug)
interactions
Drug interactions: the alteration of action of a drug by other prescribed drugs, OTC
meds, Herbal therapies
additive effect
synergistic effect
antagonistic effect
incompatibility
side effects/ adverse drug effects
MEDICATION MISADVENTURES
Adverse drug events- all are preventable, medication errors that result in
patient harm
Adverse drug reactions- inherent, not preventable event occurring in normal
therapeutic use of drug; any reaction that is unexpected, undesirable, and
occurs at doses normally used.
Side effects- expected, well-known reactions that result in little or no change in
patient management; predictable frequency; the effects intensity and
occurrence is related to the size of the dose.
ADRs may be classified into:
- idiosyncratic-unintentional adverse effects that are treatmentinduced(dermatologic, renal damage, blood dyscrasias, hepatic toxicity)
- Hypersensitivity reactions
- Drug interactions
- Other drug related reactions: teratogenic, mutagenic, carcinogenic
III.

DOSAGE CALCULATIONS

Questions
1. What is the difference between PK and PD?
2. What are the four components of PK?
3. Define the 4 components
4. Where in the do each of these predominantly occur?
Questions:
1. Which organ, if it became dysfunctional, would most likely to affect drug metabolism?
- In which part of the cell is metabolism occurring?
2. What is first pass metabolism?
- Name 2 routes of drug administration that would be subject to first pass metabolism
- Name 2 routes of administration that would be subject NOT be subject to first pass
metabolism
3. What are the three outcomes of drug metabolism?

Which is most common?

Give examples
4. Why do we need to metabolize drugs