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

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 home

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 be
drug-induced.

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 wellbeing."

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. Genebased 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
A botnica, 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.

4444

 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 patients 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 thecounter/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 stipulates that the sale, administration,
delivery, distribution and transportation of
prohibited drugs is punishable by law.

R.A. 9165 the new

Dangerous Drug Act of
2002

Food and Drug

Administration
approves many new drugs
annually

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,
pentobarbital,secobarbital).

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 sedativehypnotics
(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
physiciansprescription but with
some
restrictions
regarding
amount, record keeping, and other
safeguards.
Included
are
antidiarrheal
drugs,
such
as
diphenoxylate
and
atropine
(Lomotil).

Orphan Drugs

Are drugs that have been discovered

but are not financially viable and
therefore have not been adopted
by any drug company.

Generic Drugs
When a drug receives approval for marketing from the
FDA, the drug formula is given a time-limited patent, in
much the same way as an invention is patented.
Generic drugs are chemicals that are produced by
companies that just manufactures 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

o
o

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
atropine & scopolamine
morphine sulfate, cocaine, quinine, nicotine,
caffeine
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
steroids arthritis & other diseases
sulfonamides/chemotherapeutic
agents kill microorganism slow their
growth
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.

D R U G N O M EN C LATU R E
PHARMACOLOGY

D R U G N O M EN C LATU R E
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

D R U G N O M EN C LATU R E
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 drugs effects.