Pharmacology For Nurses: A Pathophysiologic Approach: Fifth Edition

Pharmacology for Nurses: A Pathophysiologic
Approach
Fifth Edition
Chapter 1
Introduction to
Pharmacology
Copyright © 2017, 2014, 2011 Pearson Education, Inc. All Rights Reserved
History of Pharmacology
• Records exist in every culture dating to antiquity

• Records describe use of plants (herbs) to relieve
symptoms
• Dark Ages show few records; still using herbs
Pharmacologia Sen Manuductio and
Materiam Medicum
• Written by Samuel Dale in 1693

• First recorded reference to pharmacology
Modern Pharmacology Began in Early
1800s
• Chemists isolated pharmacological substances from

natural substances
• Early researchers used themselves as test subjects
Pharmacology Recognized as Distinct
Discipline
• First department of pharmacology established at Estonia

in 1847
John Jacob Abel
• Father of American pharmacology

• Founded first pharmacology department in United States
at University of Michigan in 1890
20th Century to Present
• Drugs synthesized in laboratory

• Drugs tested for relatively short time
• Increased understanding of how drugs produce their
effects
• Focus is on improvements in quality of life
Pharmacology
• Simply defined, from the Greek, as the study of medicine

• Pharmacology is an expansive subject encompassing:
– How drugs are administered
– Where drugs travel in the body
– Responses that drugs produce
Interrelated Subject Areas
• Anatomy and physiology

• Chemistry
• Microbiology
• Pathophysiology
Pharmacology Is Challenging and Always
Changing (1 of 2)
• 10,000 drugs currently available

• Each drug has its own characteristics:
– Therapeutic applications
– Interactions
– Adverse effects
– Mechanisms of action
Pharmacology Is Challenging and Always
Changing (2 of 2)
• Many drugs prescribed for more than one disease

• Drugs elicit different responses depending on individual
factors:
– Age
– Sex
– Body mass
– Health status
– Genetics
Nursing and Pharmacology
• Knowledge of pharmacology essential to the nursing

profession
• Nurses are health care providers most often directly
involved in patient care
– Applies to nurses in all settings from clinics and
hospitals to home care
– Applies to nurses who teach and to students entering
nursing profession
• Study of pharmacology is gradual process that continues
throughout life
Therapeutics and Pharmacology Are
Closely Connected
• Therapeutics is concerned with

– Prevention of disease
– Treatment of suffering
• Pharmacotherapy is the application of drugs for
– Disease treatment
– Alleviation of suffering
Traditional Drugs Are Chemical Agents
• Synthesized in a laboratory
• Produce biological responses in the body
– If desirable response—therapeutic
– If undesirable response—adverse
• After a drug is administered, it is called a medication
Biologics
• Biologics are agents naturally produced in animal cells,

by microorganisms, or by the body itself
Examples of Biologics
• Hormones
• Monoclonal antibodies
• Natural blood products and components
• Interferons
• Vaccines
Complementary and Alternative Therapies
• Natural plant extracts, herbs, vitamins, minerals, dietary

supplements
• Physical therapy, manipulations, massage, acupuncture,
hypnosis, biofeedback
Drug Are Organized in Two Ways
• Therapeutic classification
• Pharmacologic classification
Therapeutic Classification of Drugs
• Based on therapeutic usefulness in treating particular

diseases or disorders
• Examples:
– Antidepressants
– Antipsychotics
– Antineoplastics
Table 1.1 Therapeutic Classification
Focus: Cardiovascular Function
Usefulness Drug Classification

Influence blood clotting Anticoagulant
Lower blood cholesterol Antihyperlipidemic
Lower blood pressure Antihypertensive
Restore normal cardiac rhythm Antidysrhythmic
Treat angina Antianginal
Pharmacologic Classification of Drugs (1 of 2)
• Based on the way a drug works at the molecular, tissue,

or body system level
• Addresses a drug’s mechanism of action
– How a drug produces its physiological effect in the
body
Pharmacologic Classification of Drugs (2 of 2)
• Requires understanding of biochemistry and physiology

• May be described with varying degrees of complexity
Table 1.2 Pharmacologic Classification
Focusing on Therapeutic Application:

Pharmacotherapy for Hypertension
Mechanism of Action Drug Classification

Lowers plasma volume Diuretic
Blocks heart calcium channels Calcium channel blocker
Blocks hormonal activity Angiotensin-converting enzyme Inhibitor
Blocks physiological reactions to Adrenergic antagonist
stress
Dilates peripheral blood vessels Vasodilator
Pharmacological Classification of Drugs
• Examples:
– Calcium channel blockers
– Diuretics
– Adrenergic antagonists
“Prototype” Drug—Serves as Model for a
Drug Class
• Is well understood
• Has known action and adverse effects
• Is used to compare other drugs in the same
pharmacologic class
• May not be the most widely used drug in its class
• Disagreements may exist over which drug should serve
as prototype drug
Newer Drugs in the Same Class
• Newer drugs in the same class may replace the prototype

drug because they:
– Are more effective
– Have a more favorable safety profile
– Have longer duration of action
Most Drugs Have Three Names
• Chemical
• Generic
• Trade
Drug Has One Chemical Name (1 of 2)
• Assigned using standard nomenclature established by

International Union of Pure and Applied Chemistry (IUPAC)
• Describes physical and chemical properties of drug
• Sometimes helpful in predicting a substance's physical and
chemical properties
Drug Has One Chemical Name (2 of 2)
• Often complicated, and difficult to remember or

pronounce
– Example:
▪ Chemical name for diazepam: 7-chloro-1, 3-
dihydro-1-methyl-5-phenyl-2H-1, 4-benzodiazepin-
2-one
Chemical Group Name
• Drugs are sometimes classified by a portion of their

chemical structure:
– Phenothiazines, thiazides, and benzodiazepines
• Chemical group names can become invaluable to nursing
students as they understand major drug actions and
adverse side effects
Generic Name
• Assigned by the U.S. Adopted Name Council

• Less complicated and easier to remember
• Lowercase
Each Drug Has One Generic Name
• Used by many organizations

– U.S. Food and Drug Administration (FDA)
– U.S. Pharmacopoeia
– World Health Organization (WHO)
A Drug Has Several Trade Names (1 of 2)
• Assigned by company marketing the drug

• Short, easy to remember
• Also called proprietary, product, or brand name
A Drug Has Several Trade Names (2 of 2)
• Drug developer has exclusive rights to name and market

a new drug for 17 years in the United States
– Example:
 diphenhydramine is the generic name for Benadryl
(one of many trade names)
Trade Names (1 of 2)
• After 17 years, competing companies may sell a generic

equivalent drug, sometimes using a different name, which
the FDA must approve
• Capitalized
Trade Names (2 of 2)
• Trade names can be difficult because many drugs

contain similar ingredients
– Combination drug contains more than one active
generic ingredient
– Rule of thumb is that active ingredients in a drug are
described by their generic name, which is lowercase
Table 1.3 Examples of Trade-Name Products
Containing Popular Generic Substances
Generic Substance Trade Names

aspirin Acuprin, Anacin, Aspergum, Bayer, Bufferin,
Ecotrin, Empirin, Excedrin, Maprin, Norgesic,
Salatin, Salocol, Salsprin, Supac, Talwin,
Triaphen-10, Vanquish, Verin, Zorprin
diphenhydramine Allerdryl, Benadryl, Benahist, Bendylate, Caladryl,
Compoz, Diahist, Diphenadril, Eldadryl, Fenylhist,
Fynex, Hydramine, Hydril, Insomnal, Noradryl, Nordryl,
Nytol, Tusstat, Wehdryl
ibuprofen Advil, Amersol, Apsifen, Brufen, Haltran,
Medipren, Midol 200, Motrin, Neuvil, Novoprofen,
Nuprin, Pamprin-IB, Rufen, Trendar
Prescription Drugs and Over-The-Counter
(OTC) Drugs
• Prescription drugs require that the recipient obtain a

written order from a person with the legal authority to
write such a prescription
Advantages and Disadvantages of
Prescription Drugs (1 of 2)
• Advantages
– Health care provider or nurse practitioner examines
the patient, determines a specific diagnosis, and
orders the proper drug
▪ Amount and frequency of drug is controlled
▪ Instructions on use and side effects of drug are
discussed
Advantages and Disadvantages of
Prescription Drugs (2 of 2)
• Disadvantages
– Require a prescription to obtain
– Need for health care provider appointment
Advantages and Disadvantages of OTC
Drugs (1 of 2)
• Advantages
– No health care provider appointment required
– Often less expensive than prescription drugs
Advantages and Disadvantages of OTC
Drugs (2 of 2)
• Disadvantages
– Patient may choose wrong drug
– Patient may not know reactions or interactions
– Ineffective treatment may result in progression of
disease
Rights Issues (1 of 2)
• A pharmaceutical company with exclusive rights to a drug

often makes price very high
• When rights end, competing companies offer the generic
form of the drug for less money
Rights Issues (2 of 2)
• Depending on the state, a pharmacist may offer the

generic form of a prescribed drug, or may only be allowed
to dispense the exact form written in the prescription
– Drug companies lobby against easy substitution of
generic drugs
– Consumer advocates lobby the opposite
Generic vs. Trade-Name Drugs (1 of 2)
• It is difficult to tell a difference in effect between two

forms of a drug, even if dosage is same
– Inert ingredients may be different
Generic vs. Trade-Name Drugs (2 of 2)
• Key to comparison is bioavailability—the physiologic

ability of the drug to reach its target cells and produce its
effect.
• Measuring how long a drug takes to exert its effect gives
a crude measure of bioavailability.
Some States Have a Negative Formulary
List (1 of 3)
• List of trade-name drugs that pharmacists may not

dispense as generic drug substitutes
• Differences in bioavailability between generic and trade-
name drugs
List (2 of 3)
• Pharmaceutical companies and some health care

practitioners support list
• Claim that differences could adversely affect patient
outcomes
• Laws relating to these lists often change
List (3 of 3)
• Efforts of consumer advocacy groups have led to

changes in or elimination of negative formulary lists
Decisions Relative to Proper Drug Choices
• Pharmacoeconomics: a subdiscipline of health

economics that helps assess factors involved in broad
application of a particular drug therapy. Examples:
– State and national debate about legalization of
marijuana for the treatment of disorders
– Issue of how to contain a virus (e.g., Ebola); how to
effectively finance, develop, and distribute vaccines to
the public
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Доступные форматы

Pharmacology for Nurses: A Pathophysiologic

• Records exist in every culture dating to antiquity

• Written by Samuel Dale in 1693

• Chemists isolated pharmacological substances from

• First department of pharmacology established at Estonia

• Father of American pharmacology

• Drugs synthesized in laboratory

• Simply defined, from the Greek, as the study of medicine

• Anatomy and physiology

• 10,000 drugs currently available

• Many drugs prescribed for more than one disease

• Knowledge of pharmacology essential to the nursing

• Therapeutics is concerned with

• Biologics are agents naturally produced in animal cells,

• Natural plant extracts, herbs, vitamins, minerals, dietary

• Based on therapeutic usefulness in treating particular

Focus: Cardiovascular Function

Usefulness Drug Classification

• Based on the way a drug works at the molecular, tissue,

• Requires understanding of biochemistry and physiology

Focusing on Therapeutic Application:

Mechanism of Action Drug Classification

• Newer drugs in the same class may replace the prototype

• Assigned using standard nomenclature established by

• Often complicated, and difficult to remember or

• Drugs are sometimes classified by a portion of their

• Assigned by the U.S. Adopted Name Council

• Used by many organizations

• Assigned by company marketing the drug

• Drug developer has exclusive rights to name and market

• After 17 years, competing companies may sell a generic

• Trade names can be difficult because many drugs

Generic Substance Trade Names

• Prescription drugs require that the recipient obtain a

• A pharmaceutical company with exclusive rights to a drug

• Depending on the state, a pharmacist may offer the

• It is difficult to tell a difference in effect between two

• Key to comparison is bioavailability—the physiologic

• List of trade-name drugs that pharmacists may not

• Pharmaceutical companies and some health care

• Efforts of consumer advocacy groups have led to

• Pharmacoeconomics: a subdiscipline of health

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