NCM 2144: PHARMACOLOGY

Ateneo de Davao University, School of Nursing (BSN 2A)

June 15, 2019
 OBJECTIVES

That within my 2 hour span of discussion,

the students will be able to:

✓integrate knowledge of physical, natural

and health sciences and humanities in
nursing pharmacology;
 OBJECTIVES

✓apply appropriate nursing concepts and

actions holistically and
comprehensively; and

✓discuss the pharmacodynamics of

specific drugs.
 MEDICINE

- A chemical preparation administered to

produce therapeutic effects.

- May be in the form of endogenous hormones

but are administered rather than released by
physiologic mechanisms.
PHARMACOLOGY

- The study of the effects of drugs on the

function living systems.

- The impetus for pharmacology came from

the need to improve the outcome of
therapeutic intervention by doctors.
 HISTORY
- During the dawn of civilization, man has been using
medicines to cure himself from illnesses (herbs and
plant extracts).

• Pharmacopoeias- an official books of drugs that

contain the drug descriptions, their corresponding
effects, and the directions for their use.

• 17th century: the material medica was developed

science of drug preparation and the
medical use of drugs
 HISTORY
- Still no known methods that could find out more about
drug actions.

• Francois Magendie and later his student, Claude

Bernard (late 18th and early 19th century)
➢ Develop the methods of experimental
physiology and pharmacology.

➢ Lots of experiments done as to how drugs

work inside the body.
DRUG

- Refers to a chemical substance of known

structure, other than a nutrient or an
essential dietary ingredient, which, when
administered to a living organism, produces a
biological effect.
ROUTE AND FORMS

ROUTE OF ADMINISTRATION PHYSICAL FORM

ORAL SOLID
TOPICAL SEMI-SOLID
RECTAL LIQUID
VAGINAL GASEOUS
PARENTERAL
INHALATION
OPHTHALMIC
OTIC AND NASAL
 PHYSICAL FORMS

I. ORAL (Solid Preparations)

1. Tablet
✓hard, compressed
medication in round, oval or square shape.

2. Sublingual/ Buccal
✓administered by placing in the
mouth, either under the tongue
(sublingual) or between the gum
and the cheek (buccal).
 PHYSICAL FORMS

I. ORAL (Solid Preparations)

3. Effervescent Tablets
✓uncoated tablets that generally
contain acid substances intended
to be dissolved or dispersed in water before use.

4. Chewable Tablets
✓ chewed prior to swallowing.
 PHYSICAL FORMS
I. ORAL (Solid Preparations)

5. Capsule
✓ medication in a gelatin
container
✓Hard-shelled capsules (used for dry,
powdered ingredients)

✓Soft-shelled capsules (used for oils and

for active ingredients that are dissolved
or suspended in oil)
 PHYSICAL FORMS

I. ORAL (Solid Preparations)

6. Lozenge
✓solid preparation used to
medicate the mouth and throat for
the slow administration of
indigestion or cough remedies.
 PHYSICAL FORMS
I. ORAL (Solid Preparations)

7. Granules
✓ consist of solid, dry aggregates
of powder particles often
supplied in single-dose sachets.
Some granules are placed on
the tongue and swallowed with
water, others are intended to be
dissolved in water before taking.
 PHYSICAL FORMS
I. ORAL (Solid Preparations)

8. Powder (Oral)
✓ mixtures of dry finely divided drug
or chemicals intended for internal or
external use.

✓ may be stored in dry form and mixture

prepared by the pharmacist when
required for dispensing
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

i. Oral solution
▪ clear Liquid preparations for oral use
containing one or more active
ingredients dissolved.
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

i. Oral emulsion

▪ stabilized oil-in-water
dispersions, either or both
phases of which may contain
dissolved solids either oil is
dispersed in finely divided
form in water or vice versa
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

iii. Oral suspension

▪ containing one or more active
ingredients suspended in a
bottle, may show a sediment
which is readily dispersed on
shaking to give a uniform
suspension which remains
sufficiently stable to enable the
correct dose to be delivered
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

iv. Syrup
✓ concentrated aqueous solution
of a sugar, usually sucrose to
which medications are added.

✓ Flavored syrups are a convenient

form of masking disagreeable
tastes.
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

9. Elixir
✓ is pleasantly flavored clear liquid
oral preparation of potent or
nauseous drugs.

✓ The preparation may contain a high

proportion of ethanol or sucrose
together with antimicrobial
preservatives which confers the stability of the
preparation.
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

10. Oral Drops

✓ is intended to be administered
in small volumes with the aid of
a suitable measuring device.
They may be solutions,
suspensions or emulsions.
 PHYSICAL FORMS
I. ORAL (Liquid Preparations)

11.Gargles

✓ Liquid solutions used in the

prevention or treatment of
throat infections.
 PHYSICAL FORMS
II. TOPICAL DOSAGE FORMS
1. Ointments

✓ semi-solid, greasy preparation intended for

application to the skin, rectum or nasal
mucosa.
 PHYSICAL FORMS
II. TOPICAL DOSAGE FORMS

2. Creams
✓ Oil-in-Water creams:
▪ composed of small droplets of oil dispersed in a
continuous aqueous phase.

✓ Water-in-Oil creams:
▪ composed of small
droplets of water
dispersed in a
continuous oily phase.
 PHYSICAL FORMS
II. TOPICAL DOSAGE FORMS

3. Gels (Jellies)
✓ Semi-solid substance used for medication,
and lubrication.
 PHYSICAL FORMS
II. TOPICAL DOSAGE FORMS

4. Liniments

✓ Fluid, semi-fluid, or occasionally,

semi-solid preparations intended
for application to the skin.

✓ may be alcoholic or oily solutions

or emulsions.
 PHYSICAL FORMS
II. TOPICAL DOSAGE FORMS

5. Lotions
✓ fluid preparations for external
application without friction
 PHYSICAL FORMS
II. TOPICAL DOSAGE FORMS

6. Pressurized Dispensers (Aerosol Sprays)

✓ packaged in pressurized
dispensers producing
droplets used as surface
disinfectants, wound or
burn dressing, relieve
irritation of bites.
 PHYSICAL FORMS
III. RECTAL DOSAGE FORMS

1. Suppository
✓ small solid cone-shaped medicated mass, inserted
either into the rectum or vagina where it melts at body
temperature.
 PHYSICAL FORMS
III. RECTAL DOSAGE FORMS
2. Enema
✓ Introduction of liquids into the rectum and
colon via the anus.
▪ Fleet Enema
▪ Cleansing Enema
PHYSICAL FORMS
IV. VAGINAL DOSAGE FORMS

1. Suppository
✓ small solid medicated preparations
designed for insertion into the vagina
where they melt or dissolve.
 PHYSICAL FORMS
V. PARENTERAL DOSAGE FORMS

1. Intravenous
✓ a liquid administered directly into the
bloodstream through a vein. It is
advantageous when a rapid onset of
action is needed.
 PHYSICAL FORMS
V. PARENTERAL DOSAGE FORMS

2. Intramuscular
✓ injection of a substance directly into a muscle
 PHYSICAL FORMS
V. PARENTERAL DOSAGE FORMS

3. Subcutaneous
✓ given by injecting a fluid into the subcutaneous layer
of the skin.
 PHYSICAL FORMS
VI. INHALED DOSAGE FORMS

1. Inhaler
✓ Inhalation of medication released
through a mouthpiece.
 PHYSICAL FORMS
VI. INHALED DOSAGE FORMS
2. Nebulizer
✓ device used to administer medication to
people in forms of a liquid mist to the airways
 PHYSICAL FORMS
VII. OPHTHALMIC DOSAGE FORMS

1. Eye Drops
✓ saline-containing drops used
to administer medication in
the eye.

2. Eye Ointment and Gel

✓ sterile semi-solid
Preparations intended for
application To the
conjunctiva or eyelid margin.
 PHYSICAL FORMS
VIII.OTIC & NASAL DOSAGE FORMS
1. Ear Drops
✓ Medication instilled into the ear
with a dropper used to treat or
prevent ear infections, especially
infections of the outer ear and
ear canal.
2. Nasal Drops and Sprays
✓ instilled into the nose from a
dropper or from a plastic
squeeze bottle.
 DRUG CLASSIFICATION

• Therapeutic Classification:
• Categorizes drugs by the disease state they
are used to treat.

• Pharmacologic Classification:
• Based on the drug’s mechanism of action.
 DRUG CLASSIFICATION

I. NEUROLOGIC AND NEUROMUSCULAR AGENTS

 DRUG CLASSIFICATION
I. AUTONOMIC NERVOUS SYSTEM AGENTS
A. Adrenergics (Sympathetic NS)
Epinephrine, Norepinephrine
▪ Stimulates SNS (mimics Sympathetic
Neurotransmitter)
▪ (Maintenance of BP & HR,
Bronchodilation)
B. Adrenergic Blocker
Carvedilol, Propanolol
▪ Blocks stimulation of Beta1 and Beta2
adrenergic receptor site
 DRUG CLASSIFICATION
I. AUTONOMIC NERVOUS SYSTEM AGENTS
C. Cholinergics (Parasympathetic NS)
▪ Donepezil, Neostigmin
▪ Inhibits acetylcholinesterase thus
producing more acetylcholine.

D. Anticholinergics
▪ Atropine, Ipratropium bromide
▪ Inhibits the action of acetylcholine at
post ganglionic site
*Acetylcholinesterase- enzyme that causes breakdown of acetylcholine
 DRUG CLASSIFICATION
II. NEUROLOGIC & NEUROMUSCULAR AGENTS
A. CNS Stimulants
▪ stimulate the brain, speeding up both
mental and physical processes.
▪ Methylphenidate (Ritalin)

B. CNS Depressants
▪ slow brain activity, making them useful for
treating anxiety, panic, acute stress
reactions, and sleep disorders.
▪ Barbiturates (Phenobarbital)
DRUG CLASSIFICATION

C. Drugs for Pain Management:

▪ Nonnarcotic
▪ Aspirin, Acetaminophen, Ibuprofen,
Naproxen
▪ Narcotic Analgesics
▪ Meperidine, Morphine

D. Anticonvulsants
▪ Phenytoin, Valproic Acid, Gabapentin
 DRUG CLASSIFICATION
E. Drugs for Neurologic Disorders:
Parkinsonism and Alzheimer’s Disease
▪ Levodopa, Amantadine, Akineton
▪ Donepezil, Memantine

F. Drugs for Neuromuscular Disorders:

Myasthenia Gravis, Multiple Sclerosis and Muscle
Spasms
▪ Pyridostigmine Bromide, Tensilon
▪ Diazepam, Baclofen
 DRUG CLASSIFICATION
III. PSYCHIATRIC AGENTS

A. Antipsychotics and Anxiolytics

▪ Haloperidol
▪ Benzodiazepines (Alprazolam)

B. Antidepressants and Mood Stabilizers

▪ Mood elevators (Sertraline HCl)
▪ Stabilization of Bipolar d/o (Lithium)
 DRUG CLASSIFICATION

IV. ANTIINFLAMMATORY & ANTIINFECTIVE AGENTS

➢Used to alleviate inflammatory process and fight

disease causing microorganisms (pathogen)

➢Antibacterials: inhibits the growth of bacteria

(Penicillins & Cephalosporins)
 DRUG CLASSIFICATION

IV. ANTIINFLAMMATORY & ANTIINFECTIVE AGENTS

➢Antibacterials
(Macrolides, Tetracyclines, Aminoglycosides and
Fluoroquinolones)

➢Antibacterials
(Sulfonamides)
DRUG CLASSIFICATION

▪ Antitubercular Drugs (RIPES), Antifungal Drugs,

Peptides and Metronidazole

▪ Antiviral, Antimalarial and Antihelminthic Drugs

▪ Drugs for Urinary Tract Disorders

▪ Urinary Antiinfective: Nitrofurantoin
 DRUG CLASSIFICATION
V. IMMUNOLOGIC AGENTS

A. HIV and AIDS related Agents

▪ Zidovudine
B. Vaccines
▪ (Hepatitis B, Tetanus)
▪ Rubella (German Measles)

*Active immunity: human immune response

activated when a pathogen enters
the body
 DRUG CLASSIFICATION

VI. CANCER AGENTS

A. Anticancer Drugs
▪ Not selective (both are affected)
▪ Cyclophosphamide, Cytarabine HCl

B. Biologic Response Modifiers

▪ Enhance the body’s immune system
▪ Epoeitin Alfa (for anemia)
 DRUG CLASSIFICATION

VII.RESPIRATORY AGENTS

A. Drugs for Common Upper Respiratory Disorders

▪ Cold, Allergic Rhinitis (Antihistamines)

B. Drugs for Acute and Chronic Lower Respiratory

Disorders
▪ COPD, Asthma (Ventolin)
 DRUG CLASSIFICATION

VIII.CARDIOVASCULAR AGENTS

❑ Drugs for Cardiac Disorders:

A. Cardiac Glycosides (CHF: Digoxin)

B. Antianginals (Angina Pectoris: Isordil)
C. Antidysrhythmics (Bradycardia, Tachycardia,
Arrythmia: Beta blockers)
D. Diuretics (decreases: BP and edema)
 DRUG CLASSIFICATION

❑ Antihypertensive
A. Antihypertensive (Beta blockers, Calcium
channel blockers)

❑ Drugs for Circulatory Disorders

A. Anticoagulant (clot formation)
B. Antiplatelets (thrombosis in the arteries)
C. Thrombolytics (occlusion of an artery)
D. Antilipidemics
E. Peripheral Vasodilators
 DRUG CLASSIFICATION

IX. GASTROINTESTINAL AGENTS

A. Drugs for Gastrointestinal Tract Disorders

(Metoclopramide)

B. Antiulcer Drugs
(Ranitidine)
 DRUG CLASSIFICATION

X. EYE, EAR AND SKIN AGENTS

A. Drugs for Disorders of the Eye and the Ear

(Glaucoma)

B. Drugs for Dermatologic Disorders

(Psoriasis, Contact Dermatitis)
 DRUG CLASSIFICATION

XI. ENDOCRINE AGENTS

A. Endocrine Pharmacology: Pituitary, Thyroid,

Parathyroids and Adrenals
(Hyperthyroid: Thyroid hormone)

B. Antidiabetic Drugs
(Insulin)
 DRUG CLASSIFICATION
XII.REPRODUCTIVE AND GENDER RELATED
AGENTS

A. Drugs Associated with the

Female Reproductive Cycle I: Pregnancy and Preterm
Labor

B. Drugs Associated with the

Female Reproductive Cycle II: Labor, Delivery and the
Preterm Neonate
DRUG CLASSIFICATION

C. Drugs Associated with the

Postpartum and the Newborn

D. Drugs related to Women’s Health and Disorders

E. Drugs related to Reproductive Health: Male

Reproductive Disorders

F. Drugs related to Reproductive Health: Infertility and

Sexually Transmitted Diseases
DRUG CLASSIFICATION

XIII.EMERGENCY AGENTS

A. Cardiac B. Neurosurgical

a. Nitroglycerin a. Mannitol
b. Morphine b. Methylprednisolone
c. Amiodarone
d. Epinephrine
DRUG CLASSIFICATION

XIII.EMERGENCY AGENTS

C. Poisoning D. Shock

a. Naloxone a. Dopamine
b. MgSO4 b. Dobutamine
c. Norepinephrine
d. Albuterol
DRUG CLASSIFICATION

XIII.EMERGENCY AGENTS

E. Hypertensive Crisis and Pulmonary Edema

a. Sodium Nitroprusside
b. Furosemide
c. Morphine Sulfate
DRUG ACTION

3 phases of Drug Action:

✓ Pharmaceutic

✓ Pharmacokinetic

✓ Pharmacodynamic
 PHARMACEUTIC

• First phase of drug action.

• Disintegration: breakdown of a tablet into
smaller particles.

• Dissolution: dissolving of smaller particles

in the GI fluid before
absorption.

* Rate Limiting: time it takes the drug to disintegrate and

dissolve to become available for the body to absorb it.
PHARMACEUTIC
 PHARMACOKINETICS

• A process of drug movement to achieve drug

action.

❖ 4 Processes:
• Absorption
• Distribution
• Metabolism (Biotransformation)
• Excretion
 PHARMACODYNAMICS

• Study of drug concentration and its effects on

the body.
Drug Response can cause:

✓ Primary Physiologic Effect

▪ Desirable effect

✓ Secondary Physiologic Effect

▪ May be desirable or undesirable.
 PHARMACODYNAMICS
• EXAMPLE of drug with primary and secondary effects:

• DIPHENHYDRAMINE, Benadryl (Antihistamine)

• Primary Effect: to treat the symptoms of

allergy

• Secondary effect: Central Nervous System

depression that causes
DROWSINESS.
 PHARMACODYNAMIC PHASE
• THERAPEUTIC INDEX

✓estimates the margin of safety of a drug through the

use of a ratio that measures the effective (therapeutic
or concentration) dose in 50% of persons or animals
and the lethal dose in 50% in animals.

• LOW THERAPEUTIC INDEX

✓have a narrow margin of safety

✓Drug dosage may need adjustment, and plasma drug
levels need to be monitored.
 PHARMACODYNAMIC PHASE

Example: Cardiac Drugs (Digoxin)

Anti-epileptics (Phenobarbital, Phenytoin)
Bronchodilators (theophylline)
Immunosupressants (Cyclosporine)
Anti-cancer (Cytarabine, Cisplatin)
Psychiatric Drugs (Lithium)
Protease Inhibitor (HIV meds- Indinavir,
Lopinavir)
Antibiotic (Aminoglycosides, Vancomycin)
 PHARMACODYNAMIC PHASE

• HIGH THERAPEUTIC INDEX

✓have a wide margin of safety and less danger of

producing toxic effects.

✓plasma drug levels do not need to be monitored

routinely.
PHARMACODYNAMIC PHASE
 PHARMACODYNAMIC PHASE

• AGONISTS
✓Drug that produce a response
✓Nalbuphine (Opioid Agonist): binds to opiate
receptors in the CNS producing generalized
CNS depression thus decreasing pain.

• ANTAGONISTS
✓Blocks a response
✓Ranitidine (H2 Antagonist): inhibits H2
receptor site resulting in inhibition of gastric
acid secretion.
 PHARMACODYNAMIC PHASE

• NONSPECIFIC DRUG EFFECTS

➢Drugs that affect various sites

Example: BETHANECOL
- prescribed for post-op urinary retention to
increase bladder contraction
- affects the cholinergic receptor, therefore
other cholinergic sites are also affected.
PHARMACODYNAMIC PHASE
 PHARMACODYNAMIC PHASE

• NONSELECTIVE DRUG EFFECTS

➢Drugs that affect various receptors and a
variety of responses result from action at
these receptor sites.

Example:
Epinephrine
Acts on Alpha1, Beta1 and Beta2 receptors
PHARMACODYNAMIC PHASE
 PHARMACODYNAMIC PHASE

• CATEGORIES OF DRUG ACTION

1. Stimulation or Depression
Stimulation:
➢Increases the rate of the cell activity or the
secretion from gland
Depression
➢Reduce cell activity and function of a specific
organ
 PHARMACODYNAMIC PHASE

• CATEGORIES OF DRUG ACTION

2. Replacement
➢Drugs that replace essential body compounds
(Insulin)
3. Inhibition or killing of organism
➢Drugs that interfere bacterial cell growth
(Penicillins)
 PHARMACODYNAMIC PHASE

• CATEGORIES OF DRUG ACTION

4. Irritation
➢ drugs that act as irritants to increase specific
organs
(Laxatives)
 PHARMACODYNAMIC PHASE

• ONSET OF ACTION
✓The time it takes to reach the minimum effective
concentration (MEC) after the drug is
administered.

• PEAK ACTION
✓Occurs when the drug reaches its highest blood
or plasma concentration.
 PHARMACODYNAMIC PHASE

• DURATION OF ACTION
✓The length of time the drug has a pharmacologic
effect.

• TIME RESPONSE CURVE

✓Evaluates three parameters of drug action:
✓Onset
✓Peak
✓Duration
PHARMACODYNAMIC PHASE
 PHARMACODYNAMIC PHASE

• DOSE RESPONSE
✓The relationship between the minimal versus the
maximal amount of drug dose needed to produce
the desired drug response.

• PROPERTIES OF DRUGS
1. POTENCY
✓Measure of the amount of drug necessary to
produce an effect of a given magnitude.
 PHARMACODYNAMIC PHASE

Cont.
✓Refers to the concentration of a drug required to
produce 50% of that drug’s maximal effect.

2. MAXIMAL EFFICACY
✓Maximum drug effect
 PHARMACODYNAMIC PHASE

• CELLULAR RECEPTORS
✓ Found on cell membrane (Protein in structure)
✓ Drugs act through receptors by binding through the
receptors to initiate a response or to block a
response.

DRUG BINDING SITES:

✓Proteins
✓Glycoproteins
✓Proteolipids
✓Enzymes
 PHARMACODYNAMIC PHASE

• RECEPTOR FAMILIES (Types of Receptors)

1. Cell membrane – embedded enzymes

✓The drug activates the enzyme (inside the cell), and
a response is initiated.

2. Ligand – gated ion channels

✓The channel opens, allowing for the flow of ions into
and out of the cells.
✓Ions are primarily sodium and calcium.
 PHARMACODYNAMIC PHASE

• RECEPTOR FAMILIES

3. G Protein – coupled receptor systems

❑ 3 Components:
▪ Receptor
▪ G protein that binds with guanosine triphosphate
(GTP)
▪ Effector: either enzyme or an ion channel

4. Transcription factors
✓Found on DNA (Deoxyribonucleic Acid) in the cell
nucleus
THANK YOU!!! ☺