INTRODUCTION TO PHARMACOLOGY  To learn the discipline well, nursing students need a thorough

Definition of drug understanding of concepts from various foundation areas such as

 A drug is defined as any chemical that can affect living processes anatomy and physiology, chemistry, microbiology, and
 virtually all chemicals can be considered drugs, since, when pathophysiology.
exposure is sufficiently high, all chemicals will have some effect on  the branch of medicine concerned with the uses, effects, and modes
life. of action of drugs.
Terminology  the study of drugs and their interactions with living systems.
 absorption: what happens to a drug from the time it enters the body  the study of the physical and chemical properties of drugs as well as
until it enters the circulating fluid; intravenous administration their biochemical and physiologic effects
causes the drug to directly enter the circulating blood, bypassing the  knowledge of the history, sources, and uses of drugs as well as
many complications of absorption from other routes knowledge of drug absorption, distribution, metabolism, and
 active transport: the movement of substances across a cell excretion
membrane against the concentration gradient; this process requires Definition of Clinical Pharmacology
the use of energy biotransformation.  Clinical pharmacology is defined as the study of drugs in humans.
 chemotherapeutic agents: synthetic chemicals used to interfere  The study of drugs in patients as well as in healthy volunteers
with the functioning of foreign cell populations; this term is (during new drug development).
frequently used to refer to the drug therapy of neoplasms, but it also Definition of Therapeutics
refers to drug therapy affecting any foreign cell  also known as pharmacotherapeutics, is defined as the use of
 critical concentration: the concentration a drug must reach in the drugs to diagnose, prevent, or treat disease or to prevent pregnancy.
tissues that respond to the particular drug to cause the desired effect.  defined as the medical use of drugs.
 distribution: movement of a drug to body tissues; the places where  help you understand how drugs produce their therapeutic and
a drug may be distributed depend on the drug’s solubility, perfusion adverse (undesirable) effects, the reasons for giving a particular
of the area, cardiac output, and binding of the drug to plasma drug to a particular patient, and the rationale underlying selection of
proteins dosage, route, and schedule of administration.
 enzyme induction: process by which the presence of a chemical  help you understand the strategies employed to promote beneficial
that is biotransformed by a particular enzyme system in the liver drug effects and to minimize undesired effects.
causes increased activity of that enzyme system.  Therapeutics is the branch of medicine concerned with the
 excretion: removal of a drug from the body; primarily occurs in the prevention of disease and treatment of suffering.
kidneys, but can als  Pharmacotherapy, or pharmacotherapeutics, is the application
 first-pass effect: a phenomenon in which drugs given orally are of drugs for the purpose of disease prevention and the treatment of
carried directly to the liver after absorption, where they may be suffering.
largely inactivated by liver enzymes before they can enter the  Drugs are just one of many tools available to the nurse for these
general circulation; oral drugs frequently are given in higher doses purposes.
than drugs given by other routes because of this early breakdown 3 Phases of Drug Action (PHARMACEUTIC PHASE,
occur through the skin, lungs, bile, or feces PHARMACOKINETIC PHASE and PHARMACODYNAMIC
 glomerular filtration: the passage of water and water-soluble PHASE)
components from the plasma into the PHARMACEUTIC PHASE
 half-life: the time it takes for the amount of drug in the body to  Approximately 80% of drugs are taken by mouth.
decrease to one half of the peak level it previously achievedrenal  The pharmaceutic phase (dissolution) is the first phase of drug
tubule action.
 hepatic microsomal system: liver enzymes tightly packed together  In the gastrointestinal (GI) tract, drugs need to be in solution so they
in the hepatic intracellular structure, responsible for the can be absorbed.
biotransformation of chemicals, including drugs  A drug in solid form (tablet or capsule) must disintegrate into small
 loading dose: use of a higher dose than that which is usually used particles to dissolve into a liquid, a process known as dissolution.
for treatment to allow the drug to reach the critical concentration  Drugs in liquid form are already in solution.
sooner
 passive diffusion: movement of substances across a semipermeable
membrane with the concentration gradient; this process does not
require energy.
 pharmacodynamics: the science that deals with the interactions
between the chemical components of living systems and the foreign
chemicals, including drugs, that enter living organisms; the way a
drug affects a body
 pharmacogenomics: the study of genetically determined variations
in the response to drugs
 pharmacokinetics: the way the body deals with a drug, including
absorption, distribution, biotransformation, and excretion
 placebo effect: documented effect of the mind on drug therapy; if a
person perceives that a drug will be effective, the drug is much
more likely to actu
 receptor sites: specific areas on cell membranes that react with
certain chemicals to cause an effect within the cell ally be effective  Disintegration is the breakdown of a tablet into smaller particles.
 selective toxicity: property of a chemotherapeutic agent that affects  Dissolution is the dissolving of the smaller particles in the GI fluid
only systems found in foreign cells without affecting healthy human before absorption.
cells (e.g., specific antibiotics can affect certain proteins or enzyme  Rate of dissolution is the time it takes the drug to disintegrate and
systems used by bacteria but not by human cells) dissolve to become available for the body to absorb it. (delaying
Definition of Pharmacology times sometimes 2 hrs or 3 hrs depending on the drug)
 The word pharmacology is derived from two Greek words,  Drugs in liquid form are more rapidly available for GI absorption
pharmakon, which means "medicine," and logos, which means than are solids.
"study." (liquid is good for absortion)
 Thus, pharmacology is most simply defined as the study of PHARMACOKINETIC PHASE
medicine.  Pharmacokinetics is the process of drug movement to achieve drug
 Pharmacology is an expansive subject: ranging from understanding action.
 how drugs are administered  The four processes are :
 to where they travel in the body  absorption
 to the actual responses produced.  distribution

PHARMACOLOGY 1
  metabolism (or biotransformation)
 excretion (or elimination).

PHARMACOKINETIC PHASE
 Absorption
 Absorption is the movement of drug particles from the GI tract to
body fluids by passive absorption, active absorption, or pinocytosis.
 Most oral drugs are absorbed into the surface area of the small
intestine through the action of the extensive mucosal villi.
 Absorption is reduced if the villi are decreased in number because
of disease, drug effect, or the removal of small intestine.
 Protein-based drugs such as insulin and growth hormones are
destroyed in the small intestine by digestive enzymes. (mostly inject
than it takes but they are some insulins that need to take)
 Passive absorption occurs mostly by diffusion (movement from
higher concentration to lower concentration). With the process of
diffusion, the drug does not require energy to move across the
membrane.
 Active absorption requires a carrier such as an enzyme or protein
*Lorazepam- anti anxiety agent
to move the drug against a concentration gradient. Energy is
Rifampin- drug for TB
required for active absorption.
Act life (based on minutes before they act)
 Pinocytosis is a process by which cells carry a drug across their
membrane by engulfing the drug particles. (in gulping the drug
Moderately Protein Bound and low protein bound
itself or the particles of the drug and distributed in to the cell)

 Distribution
 Distribution is the process by which the drug becomes available to
body fluids and body tissues. Drug distribution is influenced by
blood flow, the drug’s affinity to the tissue, and the protein-binding Protein Binding
effect  Most drugs are bound to some extent to proteins in the blood to be
carried into circulation.
 The protein–drug complex is relatively large and cannot enter into
capillaries and then into tissues to react.
 The drug must be freed from the protein’s binding site at the tissues.
Some drugs are tightly bound and are released very slowly.
 These drugs have a very long duration of action because they are
not free to be broken down or excreted.
 Therefore, they are released very slowly into the reactive tissue.
Some drugs are loosely bound; they tend to act quickly and to be
excreted quickly.
 Some drugs compete with each other for protein binding sites,
altering effectiveness or causing toxicity when the two drugs are
given together. (sometimes when you give paracetamol and
(it takes time to drug to get act before you get the effect of the drug) nepanamic there is a possible interactions in your kidneys there are
 Protein Binding toxicity happen it should have time interval)
 As drugs are distributed in the plasma, many are bound to varying PHARMACOKINETIC PHASE
degrees (percentages) with protein (primarily albumin).  Blood–Brain Barrier
 Drugs that are greater than 89% bound to protein are known as  The blood–brain barrier is a protective system of cellular activity that
highly protein-bound drugs; keeps many things (e.g., foreign invaders, poisons) away from the
 drugs that are 61% to 89% bound to protein are moderately highly CNS.
proteinbound;  Drugs that are highly lipid soluble are more likely to pass through the
 drugs that are 30% to 60% bound to protein are moderately blood–brain barrier and reach the CNS.
protein-bound; and  This is clinically significant in treating a brain infection with
 drugs that are less than 30% bound to protein are low protein- antibiotics.
bound drugs.  Effective antibiotic treatment can occur only when the infection is
severe enough to alter the blood–brain barrier and allow antibiotics
to cross.
Drugs that highly protein drug  Many drugs can cause adverse CNS effects, often the result of
indirect drug effects and not the actual reaction of the drug with CNS
tissue.

PHARMACOLOGY 2
 For example, alterations in glucose levels and electrolyte changes
can interfere with nerve functioning and produce CNS effects such as
dizziness, confusion, or changes in thinking ability.
 Placenta and Breast Milk
 Many drugs readily pass through the placenta and affect the
developing fetus in pregnant women.
 As stated earlier, it is best not to administer any drugs to pregnant
women because of the possible risk to the fetus.
 Drugs should be given only when the benefit clearly outweighs any
risk.
 Many other drugs are secreted into breast milk and therefore have the
potential to affect the neonate.
 Always check the ability of a drug to pass into breast milk when
giving a drug to a breast-feeding mother.
 Metabolism, or Biotransformation
 Metabolism is the process by which the body inactivates or
 Phase II biotransformation usually involves a conjugation
biotransforms drugs.
reaction that makes the drug more polar and more readily excreted
 Drugs can be metabolized in several organs; however, the liver is the
by the kidneys.
primary site of metabolism.
PHARMACOKINETIC PHASE
 Most drugs are inactivated by liver enzymes and are then converted
 Excretion
or transformed by hepatic enzymes to inactive metabolites or water-
 Excretion is the removal of a drug from the body.
soluble substances for excretion.
 The skin, saliva, lungs, bile, and feces are some of the routes used
 Think of the liver as a sewage treatment plant.
to excrete drugs.
 Everything that is absorbed from the GI tract first enters the liver to
 The kidneys, however, play the most important role in drug
be “treated.”
excretion.
 The liver detoxifies many chemicals and uses others to produce
 The lungs eliminate volatile drug substances and products
needed enzymes and structures.
metabolized to carbon dioxide (CO2) and water (H2O).
 Pharmacokinetics affects the amount of a drug that reaches
reactive tissues. Very little of an oral dose of a drug actually
reaches reactive sites.

First-Pass Effect
 Drugs that are taken orally are usually absorbed from the small
intestine directly into the portal venous system (the blood vessels
that flow through the liver on their way back to the heart).
 The portal veins deliver these absorbed molecules into the liver,
which immediately transforms most of the chemicals delivered to it PHARMACODYNAMIC PHASE
by a series of liver enzymes.  Pharmacodynamics is the science dealing with interactions between
 These enzymes break the drug into metabolites, some of which are the chemical components of living systems and the foreign
active and cause effects in the body, and some of which are chemicals, including drugs, that enter those systems.
deactivated and can be readily excreted from the body.  pharmacodynamics—is the study of the way drugs affect the body
 Large percentage of the oral dose is destroyed at this point and  Drugs usually work in one of four ways:
never reaches the tissues.  1. To replace or act as substitutes for missing chemicals.
 This phenomenon is known as the first-pass effect. The portion of  2. To increase or stimulate certain cellular activities.
the drug that gets through the first-pass effect is delivered to the  3. To depress or slow cellular activities.
circulatory system for transport throughout the body.  4. To interfere with the functioning of foreign cells, such
 Hepatic Enzyme System as invading microorganisms or neoplasms.
 The intracellular structures of the hepatic cells are lined with (chemotherapeutic agents.)
enzymes packed together in what is called the hepatic microsomal  Many drugs are thought to act at specific areas on cell
system. membranes called receptor sites. The receptor sites react
 Because orally administered drugs enter the liver first, the enzyme with certain chemicals to cause an effect within the cell.
systems immediately work on the absorbed drug to biotransform it.
 first-pass effect is responsible for neutralizing most of the drugs that
are taken.
Hepatic Enzyme System
 Phase I biotransformation involves oxidation, reduction, or
hydrolysis of the drug via the cytochrome P450 system of enzymes.
These enzymes are found in most cells but are especially abundant
in the liver.

 Dose Response and Maximal Efficacy

PHARMACOLOGY 3
  Dose response is the relationship between the minimal versus the A drug that stimulates or blocks the cholinergic receptors affects all anatomic
maximal amount of drug dose needed to produce the desired drug sites of location.
response. Drugs that affect various sites are nonspecific drugs and have properties of
 Some patients respond to a lower drug dose. nonspecificity.
 Others need a high drug dose to elicit the desired  Nonspecific and Nonselective
response.  Bethanechol (Urecholine) may be prescribed for postoperative
 The drug dose is usually adjusted to achieve the desired urinary retention to increase bladder contraction.
drug response.  This drug stimulates the cholinergic receptor located in
PHARMACODYNAMIC PHASE the bladder, and urination occurs by strengthening bladder
 Dose Response and Maximal Efficacy contraction.
 All drugs have a maximum drug effect (maximal efficacy).  Because bethanechol affects the cholinergic receptor,
 For example, morphine and tramadol hydrochloride (Ultram) are other cholinergic sites are also affected. The heart rate
prescribed to relieve pain. The maximum efficacy of morphine is decreases, blood pressure decreases, gastric acid secretion
greater than tramadol hydrochloride, regardless of how much increases, the bronchioles constrict, and the pupils of the
tramadol hydrochloride is given. The pain relief with the use of eye constrict. These other effects may be either desirable
tramadol hydrochloride is not as great as it is with morphine. or harmful. Drugs that evoke a variety of responses
 Onset, Peak, and Duration of Action throughout the body have a nonspecific response
 Onset of action is the time it takes to reach the minimum effective
concentration (MEC) after a drug is administered.
 Peak action occurs when the drug reaches its highest blood or
plasma concentration.
 Duration of action is the length of time the drug has a
pharmacologic effect.

 Nonspecific and Nonselective

 Drugs that affect various receptors are nonselective drugs or have
properties of no selectivity.
 Chlorpromazine (Thorazine) acts on the norepinephrine, dopamine,
acetylcholine, and histamine receptors, and a variety of responses
result from action at these receptor sites.
 Epinephrine acts on the alpha1, beta1, and beta2 receptors.
 Drugs that produce a response but do not act on a receptor may act
by stimulating or inhibiting enzyme activity or hormone production.

 Receptor Theory
 Drugs act through receptors by binding to the receptor to produce
(initiate) a response or to block (prevent) a response.
 The activity of many drugs is determined by the ability of the drug
to bind to a specific receptor.
 The better the drug fits at the receptor site, the more biologically
active the drug is.
 It is similar to the fit of the right key in a lock.

Categories of Drug Action

The four categories of drug action include (1) stimulation or
depression, (2) replacement, (3) inhibition or killing of organisms,
and (4) irritation.
 In drug action that stimulates, the rate of cell activity or the
secretion from a gland increases.
 In drug action that depresses, cell activity and function of a specific
organ are reduced.
 Replacement drugs such as insulin replace essential body
 Agonists and Antagonists compounds.
 Drugs that produce a response are called agonists, and drugs that  Drugs that inhibit or kill organisms interfere with bacterial cell
block a response are called antagonists. growth (e.g., penicillin exerts its bactericidal effects by blocking the
 Epinephrine (Adrenalin) stimulates beta1 and beta2 receptors, so it synthesis of the bacterial cell wall).
is an agonist. Atropine, an antagonist, blocks the histamine (H2)  Drugs also can act by the mechanism of irritation (e.g., laxatives
receptor, thus preventing excessive gastric acid secretion. The irritate the inner wall of the colon, thus increasing peristalsis and
effects of an antagonist can be determined by the inhibitory (I) defecation).
action of the drug concentration on the receptor site. IC50 is the Drug Definitions and Classifications
antagonist drug concentration required to inhibit 50% of the  ANTI-ALZHEIMER’S AGENTS
maximum biological response.  ANTIANEMICS
Nonspecific and Nonselective  ANTIANGINALS
Cholinergic receptors are located in the bladder, heart, blood vessels,  ANTIANXIETY AGENTS
stomach, bronchi, and eyes.  Management of Alzheimer’s dementia.
 Prevention and treatment of anemias.
PHARMACOLOGY 4
 Nitrates are used to treat and prevent attacks of angina. sustained-release metoprolol only) and hyperthyroidism
 Antianxiety agents are used in the management of various forms of (management of symptoms only).
anxiety, including generalized anxiety disorder (GAD).
 BONE RESORPTION INHIBITORS
 ANTIARRHYTHMICS  BRONCHODILATORS
 ANTIASTHMATICS  CALCIUM CHANNEL BLOCKERS
 ANTICHOLINERGICS  Used to treat and prevent osteoporosis in postmenopausal women.
 Suppression of cardiac arrhythmias.  Used in the treatment of reversible airway obstruction due to
 Management of acute and chronic episodes of reversible asthma or chronic obstructive pulmonary disease (COPD).
bronchoconstriction.  Used in the treatment of hypertension (amlodipine, diltiazem,
 Used to reduce the amount of saliva is produced, and therefore can felodipine, isradipine, nicardipine, nifedipine, nisoldipine,
decrease drooling  verapamil) or in the treatment and prophylaxis of angina pectoris or
coronary artery spasm (amlodipine, diltiazem, felodipine,
 ANTICOAGULANTS nicardipine, verapamil).
 ANTICONVULSANTS
 Prevention and treatment of thromboembolic disorders including  CENTRAL NERVOUS SYSTEM STIMULANTS
deep vein thrombosis, pulmonary embolism, and atrial fibrillation  CORTICOSTEROIDS
with embolization.  Used in the treatment of narcolepsy and as adjunctive treatment in
 Used to decrease the incidence and severity of seizures due various the management of attention deficit hyperactivity disorder (ADHD).
etiologies  Used in replacement doses (20 mg of hydrocortisone or
equivalent)systemically to treat adrenocortical insufficiency.
 ANTIDEPRESSANTS
 ANTIDIABETICS  DIURETICS
 ANTIDIARRHEALS  HORMONES
 Used in the treatment of various forms of endogenous depression,  Used alone or in combination in the treatment of hypertension or
often in conjunction with psychotherapy edema due to HF or other causes.
 Insulin is used in the management of type 1 diabetes mellitus.  Used in the treatment of deficiency states including diabetes
 For the control and symptomatic relief of acute and chronic mellitus (insulin), diabetes insipidus (desmopressin),
nonspecific diarrhea. hypothyroidism (thyroid hormones), and menopause (estrogens or
estrogens/progestins).

 ANTIEMETICS  IMMUNOSUPPRESSANTS
 ANTIFUNGALS  LAXATIVES
ANTIHISTAMINES  LIPID-LOWERING AGENTS
 Used to manage nausea and vomiting of many causes, including  Used with corticosteroids in the prevention of transplantation
surgery, anesthesia, and antineoplastic and radiation therapy. rejection reactions.
 Treatment of fungal infections.  Used to treat or prevent constipation or to prepare the bowel for
 Relief of symptoms associated with allergies, including rhinitis, radiologic or endoscopic procedures.
urticaria, and angioedema, and as adjunctive therapy in  Used as a part of a total plan including diet and exercise to decrease
anaphylactic reactions. blood lipids in an effort to decrease the morbidity and mortality of
atherosclerotic cardiovascular disease and its sequelae.

 ANTIHYPERTENSIVES  MINERALS/ELECTROLYTES/pH MODIFIERS

 ANTI-INFECTIVES  NATURAL/HERBAL PRODUCTS
 ANTINEOPLASTICS  Prevention and treatment of deficiencies or excesses of electrolytes
 Used to lower fever of many causes (infection and inflammation). and maintenance of optimal acid/base balance for homeostasis.
 The goal of antiretroviral therapy in the management of HIV  These remedies are used for a wide variety of conditions.
infection is to improve CD4 cell counts and decrease viral Prescriptions are not required and consumers have the choice of
 Antirheumatics are used to manage symptoms of rheumatoid many products.
arthritis (pain, swelling) and in more severe cases to slow down
 NONOPIOID ANALGESICS
joint destruction and preserve joint function. Load.
 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
 ANTITUBERCULARS  OPIOID ANALGESICS
 ANTIULCER AGENTS  Used to control mild to moderate pain and/or fever.
 ANTIVIRALS  NSAIDs are used to control mild to moderate pain, fever, and
 Used in the treatment and prevention of tuberculosis. various inflammatory conditions, such as rheumatoid arthritis and
 Treatment and prophylaxis of peptic ulcer and gastric osteoarthritis.
 Management of moderate to severe pain.
hypersecretory conditions such as Zollinger-Ellison syndrome.
 Used in the management of viral infections
 SEDATIVE/HYPNOTICS
 SKELETAL MUSCLE RELAXANTS
 ANTITUBERCULARS  Sedatives are used to provide sedation, usually prior to procedures.
 ANTIULCER AGENTS Hypnotics are used to manage insomnia.
 ANTIVIRALS  Two major uses are spasticity associated with spinal cord diseases
 Used in the treatment and prevention of tuberculosis. or lesions (baclofen and dantrolene) or adjunctive therapy in the
symptomatic relief of acute painful musculoskeletal conditions
 Treatment and prophylaxis of peptic ulcer and gastric
(cyclobenzaprine, diazepam, and methocarbamol).
hypersecretory conditions such as Zollinger-Ellison syndrome.
 Used in the management of viral infections
 THROMBOLYTICS
 VACCINES/IMMUNIZING AGENTS
 Acute management of ST-segment-elevation MI. Alteplase is also
 BETA BLOCKERS
used in the management of acute pulmonary embolism and acute
 Management of hypertension, angina pectoris, tachyarrhythmias,
ischemic stroke.
migraine headache (prophylaxis), MI (prevention), glaucoma
 Immune globulins provide passive immunization to infectious
(ophthalmic use), heart failure (HF) (bisoprolol, carvedilol and
diseases by providing antibodies.

PHARMACOLOGY 5
 VASCULAR HEADACHE SUPPRESSANTS
 VITAMINS
 WEIGHT CONTROL AGENTS
 Used for acute treatment of vascular headaches (migraine, cluster
headaches, migraine variants).
 Used in the prevention and treatment of vitamin deficiencies and as
supplements in various metabolic disorders.
 These agents are used in the management of exogenous obesity as
part of a regimen including a reduced-calorie diet

Drug Forms
 Oral
 Tablets  Epicutaneous, transdermal
 Capsules  Ointments, gels
 Solutions  Creams
 Syrups  Infusion pumps
 Elixirs  Pastes
 Suspensions  Plasters
 Magmas  Powders
 Gels  Aerosols
 Powders  Lotions
 Tablets and capsules are the most common forms of drugs. Patients  Transdermal patches, disks,
prefer tablets or capsules over other routes and forms because of  solutions
their ease of use.

The use of transdermal patches provides an effective means of delivering

 Sublingual certain medications. Examples include nitroglycerin for angina pectoris and
 Tablets scopolamine (Transderm-Scop) for motion sickness.
 Troches, lozenges
 Drops (solutions  Conjunctival
For sublingual and buccal administration, the tablet is  Contact lens inserts
not swallowed but kept in the mouth. The mucosa of the  Ointments
oral cavity contains a rich blood supply that provides an
excellent absorptive surface for certain

 OHTHALMIC ADMINISTRATION The ophthalmic route is used to

treat local conditions of the eye and surrounding structures.
Common indications include excessive dryness, infections,
glaucoma, and dilation of the pupil during eye examinations.

 NASOGASTRIC AND GASTROSTOMY DRUG

ADMINISTRATION  Intraocular
 A nasogastric (NG) tube is a soft, flexible tube inserted by  Solutions
way of the nasopharynx with the tip lying in the stomach.  Suspensions
 A gastrostomy (G) tube is surgically placed directly into
the patient's stomach.

PHARMACOLOGY 6
  Rectal
 OPHTHALMIC ADMINISTRATION The ophthalmic route is  Solutions
used to treat local conditions of the eye and surrounding  Ointments
structures. Common indications include excessive dryness,  Suppositories
infections, glaucoma, and dilation of the pupil during eye  Gels
examinations.

 Intraaural
 Solutions
 Suspensions

The rectal route may be used for either local or systemic drug
administration. Rectal drugs are normally in suppository form.

 VAGINAL
 Solutions
 Ointments
 Emulsion foams
 OTIC ADMINISTRATION The otic route is used to treat local  Gels
conditions of the ear, indud.ing infections and soft blockages of  Tablets
the aud.itory canal. Otic medications include eardrops and  Inserts, suppositories, sponge
irrigations, which are usually ordered for cleaning purposes.

 Intranasal
 Solutions
 Sprays
 Inhalants
 Ointments

The vaginal route is used to deliver medications for treating local infections
and to relieve vaginal pain and itching. Vaginal medications are inserted as
suppositories, creams, jellies, or foams

 URETHRAL
 Solutions
The nasal route is used for both local and systemic drug administration.  Suppositories
The nasal mucosa provides an excellent absorptive surface for certain
medications.

 Intrarespiratory
 Aerosols

PHARMACOLOGY 7
  Parenteral
 Solutions
 Suspensions

 Intradermal Injections are administered into the corium of the

skin, usually in volumes of about 0.1 mL. Common sites for the
injection are the arm and the back. The injections are frequently
performed as diagnostic measures, as in tuberculin and allergy
Parenteral administration refers to the dispensing of medications by routes testing.
other than oral or topical. The parenteral route delivers drugs via a needle
into the skin layers, subcutaneous tissue, muscle, or veins.

 Subcutaneous Injections administration of drugs entails injection

through the skin into the loose subcutaneous tissue

 Intramuscular Injections are performed deep into the skeletal Toxic Effects of Drugs
muscles, generally the gluteal or lumbar muscles. ADVERSE EFFECTS
 Adverse effects are undesired effects that may be unpleasant or
even dangerous. They can occur for many reasons, including the
following:
 The drug may have other effects on the body besides the therapeutic
effect.
 The patient may be sensitive to the drug being given.
 The drug’s action on the body may cause other responses that are
undesirable or unpleasant.
 The patient may be taking too much or too little of the drug, leading
to adverse effects.
Primary Actions
 One of the most common occurrences in drug therapy is the
development of adverse effects from simple overdose.
 In such cases, the patient suffers from effects that are merely an
extension of the desired effect.
 Intravenous Injections an aqueous solution is injected directly into  These effects can be caused by individual response to the drug, high
the vein at a rate commensurate with efficiency, safety, comfort to or low body weight, age, or underlying pathology that alters the
the patient, and the desired duration of drug response. effects of the drug
 administered intravenously as a single dose Secondary Actions
 small-volume injection  Drugs can produce a wide variety of effects in addition to the
 a large volume desired pharmacological effect.
 slow intravenous drip infusion  Sometimes the drug dose can be adjusted so that the desired effect
is achieved without producing undesired secondary reactions.
Hypersensitivity

PHARMACOLOGY 8
  Some patients are excessively responsive to either the primary or
the secondary effects of a drug.
 This is known as hypersensitivity, and it may result from a
pathological or underlying condition.
DRUG ALLERGY
 A drug allergy occurs when the body forms antibodies to a
particular drug, causing an immune response when the person is re-
exposed to the drug.
 A patient cannot be allergic to a drug that has never been taken,
although patients can have cross-allergies to drugs within the same
drug class as one formerly taken.
 Drug allergies fall into four main classifications: anaphylactic
reactions, cytotoxic reactions, serum sickness, and delayed
reactions

Dermatological Reactions
 Rashes, Hives - dermatological lesions
 Assessment Severe reactions may include exfoliative dermatitis,
which is characterized by rash and scaling, fever, enlarged lymph
nodes, enlarged liver, and the potentially fatal erythema multiforme
exudativum (Stevens–Johnson syndrome) - characterized by dark
red papules appearing on the extremities with no pain or itching,
often in rings or disk-shaped patches.
 Interventions In mild cases, provide frequent skin care; instruct the
patient to avoid rubbing, wearing tight or rough clothing, and using
harsh soaps or perfumed lotions; and administer antihistamines.
 In severe cases, discontinue the drug and notify the prescriber
and/or primary caregiver.
 Addition to these interventions, topical corticosteroids,
antihistamines, and emollients are frequently used.
Stomatitis - inflammation of the mucous membranes
 Assessment Symptoms can include swollen gums, inflamed gums
(gingivitis), and swollen and red tongue (glossitis). Other symptoms
include difficulty swallowing, bad breath, and pain in the mouth and
throat.
 Interventions Provide frequent mouth care with a nonirritating
solution. Offer nutrition evaluation and development of a tolerated
diet, which usually involves frequent, small meals. If necessary,
arrange for a dental consultation. Note that antifungal agents and/or
local anesthetics are sometimes used.
Superinfections
 Superinfections - infections caused by organisms that are usually
controlled by the normal flora.
 Assessment Symptoms can include fever, diarrhea, black or hairy
tongue, inflamed and swollen tongue (glossitis), mucous membrane
lesions, and vaginal discharge with or without itching.
 Interventions Provide supportive measures (frequent mouth care,
skin care, access to bathroom facilities, small and frequent meals).
Administer antifungal therapy as appropriate. In severe cases,
discontinue the drug responsible for the superinfection.
Blood Dyscrasia
 Blood Dyscrasia - is bone marrow suppression caused by drug
effects.
 Assessment Symptoms include fever, chills, sore throat, weakness,
back pain, dark urine, decreased hematocrit (anemia), low platelet
count (thrombocytopenia), low white blood cell count (leukopenia),
and a reduction of all cellular elements of the complete blood count
(pancytopenia).
 Interventions Monitor blood counts. Provide supportive measures
(rest, protection from exposure to infections, protection from injury,
avoidance of activities that might result in injury or bleeding). In
severe cases, discontinue the drug or stop administration until the
bone marrow recovers to a safe level.
Toxicity
DRUG-INDUCED TISSUE AND ORGAN DAMAGE  Introducing chemicals into the body can sometimes affect the
 Drugs can act directly or indirectly to cause many types of adverse body in a very noxious or toxic way. These effects are not
effects in various tissues, structures, and organs acceptable adverse effects but are potentially serious reactions
to a drug.
Liver Injury
 Oral drugs are absorbed and passed directly into the liver in the
first-pass effect. This exposes the liver cells to the full impact
of the drug before it is broken down for circulation throughout
the body
 Assessment Symptoms may include fever, malaise, nausea,
vomiting, jaundice, change in color of urine or stools,
abdominal pain or colic, elevated liver enzymes (e.g., aspartate
aminotransferase [AST], alanine aminotransferase [ALT]),
PHARMACOLOGY 9
 alterations in bilirubin levels, and changes in clotting factors (Hyperstat) a drug used for treatment malignant hypertension,
(e.g., partial thromboplastin time). causes a decrease in insulin release, leading to an increase in blood
 Interventions Discontinue the drug and notify the prescriber glucose levels.
and/or primary caregiver. Offer supportive measures such as  Assessment Fatigue, increased urination (polyuria), increased thirst
small, frequent meals, skin care, a cool environment, and rest (polydipsia), deep respirations (Kussmaul respirations),
periods. restlessness, increased hunger (polyphagia), nausea, hot or flushed
Renal Injury skin, and fruity odor to breath may be observed.
 The glomerulus in the kidney has a very small capillary network  Interventions Administer insulin therapy to decrease blood glucose
that filters the blood into the renal tubule. Some drug molecules are as appropriate,while carefully monitoring glucose levels. Provide
just the right size to get plugged into the capillary network, causing support to help the patient deal with signs and symptoms (e.g.,
acute inflammation and severe renal problems. Some drugs are provide access to bathroom facilities, control the temperature of the
excreted from the kidney unchanged; they have the potential to room, decrease stimulation while the patient is in crisis, offer
directly irritate the renal tubule and alter normal absorption and reassurance, provide mouth care—the patient will experience dry
secretion processes. Gentamicin (Garamycin),a potent antibiotic, is mouth and bad breath with the ensuing acidosis, and mouth care
frequently associated with renal toxicity. will help to make this more tolerable).
 Assessment Elevated blood urea nitrogen (BUN), elevated Electrolyte Imbalances
creatinine concentration, decreased hematocrit, electrolyte  Because they are chemicals acting in a body that works by
imbalances, fatigue, malaise, edema, irritability, and skin rash may chemical reactions, drugs can have an affect on various
be seen. electrolyte levels in the body. The electrolyte that can cause
 Interventions Notify the prescriber and/or primary caregiver and the most serious effects when it is altered, even a little, is
discontinue the drug as needed. Offer supportive measures—for potassium.
example, positioning, diet and fluid restrictions, skin care, Hypokalemia
electrolyte therapy, rest periods, a controlled environment. In severe  Some drugs affecting the kidney can cause low serum
cases, be aware that dialysis may be required for survival. potassium levels (hypokalemia) by altering the renal exchange
Poisoning system. For example, loop diuretics function by causing the
 Poisoning occurs when an overdose of a drug damages multiple loss of potassium, as well as of sodium and water. Potassium is
body systems, leading to the potential for fatal reactions. essential for the normal functioning of nerves and muscles
 Assessment parameters vary with the particular drug. Treatment of  Assessment Symptoms include a serum potassium
drug poisoning also varies, depending on the drug. Specific
concentration ([K]) lower than 3.5 mEq/L, weakness,
antidotes or treatments for poisoning are identified, if known.
numbness and tingling in the extremities, muscle cramps,
Emergency and life support measures often are needed in severe
cases. nausea, vomiting, diarrhea, decreased bowel sounds, irregular
Alterations in Glucose Metabolism pulse, weak pulse, orthostatic hypotension, and disorientation.
 All cells need glucose for energy; the cells of the central nervous In severe cases, paralytic ileus (absent bowel sounds,
system are especially dependent on constant glucose levels to abdominal distention, and acute abdomen) may occur.
function properly. The control of glucose in the body is an  Interventions Replace serum potassium and carefully monitor
integrated process that involves a series of hormones and enzymes serum levels and patient response; achieving the desired level
that use the liver as the place for glucose storage or release. Many can take time, and the patient may experience high potassium
drugs have an impact on glucose levels because of their effects on levels in the process. Provide supportive therapy (e.g., safety
the liver or the endocrine system. precautions to prevent injury or falls, reorientation of the
Hypoglycemia patient, comfort measures for pain and discomfort). Cardiac
 Some drugs affect metabolism and the use of glucose, causing a low monitoring may be needed to evaluate the effect of the
serum blood glucose concentration, or hypoglycemia. Glipizide fluctuating potassium levels on heart rhythm.
(Glucotrol) and glyburide (DiaBeta) are antidiabetic agents that Hyperkalemia
have the desired action of lowering the blood glucose level but can
 Some drugs that affect the kidney, such as the potassium sparing
lower blood glucose too far, causing hypoglycemia.
diuretics, can lead to potassium retention and a resultant increase in
 Assessment Symptoms may include fatigue; drowsiness; hunger;
serum potassium levels (hyperkalemia). Other drugs that cause cell
anxiety; headache; cold, clammy skin; shaking and lack of
death or injury, such as many antineoplastic agents, also can cause
coordination (tremulousness); increased heart rate; increased blood
the cells to release potassium, leading to hyperkalemia.
pressure; numbness and tingling of the mouth, tongue, and/or lips;
 Assessment Symptoms include a serum potassium level higher than
confusion; and rapid and shallow respirations. In severe cases,
5.0 mEq/L, weakness, muscle cramps, diarrhea, numbness and
seizures and/or coma may occur.
tingling, slow heart rate, low blood pressure, decreased urine
 Interventions Restore glucose—orally, if possible, or intravenously
output, and difficulty breathing.
(IV). Provide supportive measures (e.g., skin care, environmental
 Interventions Careful monitoring is important until the patient’s
control of light and temperature, rest). Institute safety measures to
potassium levels are stable. Offer supportive measures to cope with
prevent injury or falls. Monitor blood glucose levels to help
discomfort. Institute safety measures to prevent injury or falls.
stabilize the situation. Offer reassurance to help the patient cope
Monitor for cardiac irregularities because potassium is an important
with the experience.
electrolyte in the action potential, which is needed for cell
Hypoglycemia
membrane stability. When potassium levels are too high, the cells
 Some drugs affect metabolism and the use of glucose, causing a low of the heart become very irritable and rhythm disturbances can
serum blood glucose concentration, or hypoglycemia. Glipizide occur. Be prepared for a possible cardiac emergency. In severe
(Glucotrol) and glyburide (DiaBeta) are antidiabetic agents that cases, be aware that dialysis may be needed.
have the desired action of lowering the blood glucose level but can Sensory Effects
lower blood glucose too far, causing hypoglycemia.
 Drugs can affect the special senses, including the eyes and ears.
 Assessment Symptoms may include fatigue; drowsiness; hunger;
Alterations in seeing and hearing can pose safety problems for
anxiety; headache; cold, clammy skin; shaking and lack of
patients.
coordination (tremulousness); increased heart rate; increased blood
Ocular Damage
pressure; numbness and tingling of the mouth, tongue, and/or lips;
 The blood vessels in the retina are very tiny and are called “end
confusion; and rapid and shallow respirations. In severe cases,
seizures and/or coma may occur. arteries,” that is, they stop and do not interconnect with other
 Interventions Restore glucose—orally, if possible, or intravenously arteries feeding the same cells. Some drugs are deposited into these
(IV). Provide supportive measures (e.g., skin care, environmental tiny arteries, causing inflammation and tissue damage. Chloroquine
control of light and temperature, rest). Institute safety measures to (Aralen), a drug used to treat some rheumatoid diseases, can cause
prevent injury or falls. Monitor blood glucose levels to help retinal damage and even blindness.
stabilize the situation. Offer reassurance to help the patient cope  Assessment Blurring of vision, color vision changes, corneal
with the experience. damage, and blindness may be noted.
 Interventions Monitor the patient’s vision carefully when the patient
Hyperglycemia is receiving known oculotoxic drugs. Consult with the prescriber
 Some drugs stimulate the breakdown of glycogen or alter and/or primary caregiver and discontinue the drug as appropriate.
metabolism in such a way as to cause high serum glucose levels, or Provide supportive measures, especially if vision loss is not
hyperglycemia. Ephedrine (generic), a drug used as a reversible. Monitor lighting and exposure to sunlight.
bronchodilator and antiasthma drug and to relieve nasal congestion, Auditory Damage
can break down stored glycogen and cause an elevation of blood
 Tiny vessels and nerves in the eighth cranial nerve are easily
glucose by its effects on the sympathetic nervous system. Diazoxide
irritated and damaged by certain drugs. The macrolide antibiotics
PHARMACOLOGY 10
 can cause severe auditory nerve damage. Aspirin, one of the most  The exact effects of a drug on the fetus may not be known. In some
commonly used drugs, is often linked to auditory ringing and eighth cases, a predictable syndrome occurs when a drug is given to a
cranial nerve effects. pregnant woman.
 Assessment Dizziness, ringing in the ears (tinnitus), loss of  In any situation, inform any pregnant woman who requires drug
balance, and loss of hearing may be assessed. therapy about the possible effects on the baby. All pregnant women
 Interventions Monitor the patient’s perceptual losses or changes. should be advised not to self-medicate during the pregnancy.
Provide protective measures to prevent falling or injury. Consult
Emotional and physical support is needed to assist the woman in
with the prescriber to decrease dose or discontinue the drug.
dealing with the possibility of fetal death or birth defects.
Provide supportive measures to cope with drug effects.
Neurological Effects
 Many drugs can affect the functioning of the nerves in the periphery
and the central nervous system. Nerves function by using a constant
source of energy to maintain the resting membrane potential and
allow excitation. This requires glucose, oxygen, and a balance of
electrolytes.
General Central Nervous System Effects
 Although the brain is fairly well protected from many drug effects
by the blood–brain barrier, some drugs do affect neurological
functioning, either directly or by altering electrolyte or glucose
levels. Beta-blockers, which are used to treat hypertension, angina,
and many other conditions, can cause feelings of anxiety, insomnia,
and nightmares.
 Assessment Symptoms may include confusion, delirium, insomnia, DOSSAGE AND CALCULATION
drowsiness, hyperreflexia or hyporeflexia, bizarre dreams,
hallucinations, numbness, tingling, and paresthesias.
 Interventions Provide safety measures to prevent injury. Caution
the patient to avoid dangerous situations such as driving a car or
operating dangerous machinery. Orient the patient and provide
support. Consult with the prescriber to decrease drug dose or
discontinue the drug
Atropine-Like (Anticholinergic) Effects
 Some drugs block the effects of the parasympathetic nervous
system by directly or indirectly blocking cholinergic receptors.
Atropine, a drug used preoperatively to dry up secretions and any
other indications, is the prototype anticholinergic drug. Many cold
remedies and antihistamines also cause anticholinergic effects.
 Assessment Dry mouth, altered taste perception, dysphagia,
heartburn, constipation, bloating, paralytic ileus, urinary hesitancy
and retention, impotence, blurred vision, cycloplegia, photophobia,
headache, mental confusion, nasal congestion, palpitations,
decreased sweating, and dry skin may be noted.
 Interventions Provide sugarless lozenges and mouth care to help
mouth dryness. Arrange for bowel program as appropriate. Have the
patient void before taking the drug, to aid voiding. Provide safety
measures if vision changes occur. Arrange for medication for
headache and nasal congestion as appropriate. Advise the patient to
avoid hot environments and to take protective measures to prevent
falling and to prevent dehydration, which may be caused by
exposure to heat owing to decreased sweating.
Parkinson-Like Syndrome
 Drugs that directly or indirectly affect dopamine levels in the brain
can cause a syndrome that resembles Parkinson’s disease. Many of
the antipsychotic and neuroleptic drugs can cause this effect. In
most cases, the effects go away when the drug is withdrawn.
 Assessment Lack of activity, akinesia, muscular tremors, drooling,
changes in gait, rigidity, extreme restlessness or “jitters” (akathisia),
or spasms (dyskinesia) may be observed.
 Interventions Discontinue the drug, if necessary. Know that
treatment with anticholinergics or antiparkinson drugs may be
recommended if the benefit of the drug outweighs the discomfort of
its adverse effects. Provide small, frequent meals if swallowing
becomes difficult. Provide safety measures if ambulation becomes a
problem.
Neuroleptic Malignant Syndrome
 General anesthetics and other drugs that have direct central nervous
system effects can cause neuroleptic malignant syndrome, a
generalized syndrome that includes high fever.
 Assessment Extrapyramidal symptoms, including slowed reflexes,
rigidity, involuntary movements; hyperthermia; and autonomic
disturbances, such as hypertension, fast heart rate, and fever, may
be noted.
 Interventions Discontinue the drug, if necessary. Know that
treatment with anticholinergics or antiparkinson drugs may be
required. Provide supportive care to lower the body temperature. METRIC SYSTEM
Institute safety precautions as needed.
Teratogenicity
 Many drugs that reach the developing fetus or embryo can cause
death or congenital defects, which can include skeletal and limb
abnormalities, central nervous system alterations, heart defects, and
the like.

PHARMACOLOGY 11
Conversion within the Metric System

HOUSEHOLD SYSTEM

PHARMACOLOGY 12
METRIC, APOTHECARY, AND HOUSEHOLD EQUIVALENTS

PHARMACOLOGY 13
INTERPRETING ORAL AND INJECTABLE DRUG LABELS

INJECTABLE PREPARATIONS
 Vial
 Ampule

Insulin Injections

INTRAMUSCULAR INJECTION
 Order: gentamicin (Garamycin) 50mg IM
 Available: gentamicin 80mg/2 mL in a via

TWO METHODS ARE USED TO ADMINISTER IV FLUIDS AND

DRUGS:
 Continuous intravenous administration
 Intermittent intravenous administration

PHARMACOLOGY 14
CONTINUOUS INTRAVENOUS ADMINISTRATION
 Intravenous Sets
 drop factor
 macrodrip set
 microdip
 minidrip set

METHODS OF CALCULATION

PHARMACOLOGY 15
PHARMACOLOGY 16
PHARMACOLOGY 17
Drug Definitions and Classifications

PHARMACOLOGY 18
PHARMACOLOGY 19
 The nurse is preparing to give a medication for pain. The label states that the
drug is "lipid soluble." Based on the nurse's knowledge of lipid-soluble drugs,
how quickly would the nurse expect to observe the effects of the drug?
Rapidly
Conversion: 5 L= ml 
500 ml
The nurse has administered several oral medications to the patient. Which
factors will influence the absorption of these medications?
 Presence of food in the stomach
Drug Forms  pH of the stomach
 Oral
 Tablets  Form of drug preparation
 Capsules  Pain
 Solutions
The nurse administers 650 mg of aspirin at 7 PM. The drug has a half-life of 3
 Syrups
 Elixirs hours. The nurse interprets this information to mean that 325 mg of the
 Suspensions medication will have been eliminated from the patient's system by what time?
 Magmas 10 pm
 Gels The nurse is administering an injection to a patient and wants the medication
 Powders to take effect as quickly as possible. Which injection site will the nurse select?
 Tablets and capsules are the most common forms of drugs. Patients Deltoid
prefer tablets or capsules over other routes and forms because of Conversion: 68 mcg= G 
their ease of use. 0.000068 G
Sublingual Conversion:  15 ml= oz 
 Tablets 0.5oz
 Troches, lozenges The nurse recognizes that the administration of a drug influences cell
 Drops (solutions) physiology. What is the term for this concept?
 For sublingual and buccal administration, the tablet is not
Pharmacodynamics
swallowed but kept in the mouth. The mucosa of the oral cavity
The nurse is teaching the client about newly prescribed medication. Which
contains a rich blood supply that provides an excellent absorptive
statement made by the client would indicated the need for further medication
surface for certain drugs.
education?
Conjunctival
If I take more, I’ll have a better response
 Contact lens inserts
 Conversion: 55 ml= tsp 
 Ointments
11tsp
 OPHTHALMIC ADMINISTRATION The ophthalmic route is used
 Conversion: 956 mcg= mg 
to treat local conditions of the eye and surrounding structures.
0.96 mg
Common indications include excessive dryness, infections,
The nurse 5 ters 100 mg of drug X by mouth. After the drug moves through
glaucoma, and dilation of the pupil during eye examinations.
the hepatic system, very little active drug is left in the general circulation as a
Intraocular
result of what?
 Solutions
 Suspensions First-pass effect
Intraaural The nurse is administering medications to a patient with chronic renal failure.
 Solutions What is the nurse's priority action?
 Suspensions Assess the patient for toxicity to the medications.
 OTIC ADMINISTRATION The otic route is used to treat local Conversion: 9 tsp= L 
conditions of the ear, indud.ing infections and soft blockages of the 0.045 L
aud.itory canal. Otic medications include eardrops and irrigations, Conversion: 12 L= cc 
which are usually ordered for cleaning purposes. 12,000 cc
Intranasal The nurse realizes that a drug administered by which route will require the
 Solutions most immediate evaluation of therapeutic effect?
 Sprays Intravenous
 Inhalants
 Ointments Which statement best indicates that the nurse understands the meaning of
 The nasal route is used for both local and systemic drug pharmacokinetics?
administration. The nasal mucosa provides an excellent absorptive It explains the distribution of the drug between various body
surface for certain medications. compartments.
Intrarespiratory Conversion: 1200 mcg= G 
 Aerosols 0.0012 G
Rectal
Conversion: 10cc= ml 
1. Solutions
10 ml
2. Ointments
The nurse should strictly follow safety precautions when administering
3. Suppositories
4. Gels intravenous (IV) medications for which reason?
5. The rectal route may be used for either local or systemic drug IV administration is irreversible.
Conversion: 29 ½ ml= oz 
PRACTICE REVIEW 0.98 oz
Conversion: 4 ½ G= mg  The nurse reads that the half-life of the medication being administered is 12
4500 mg hours. What interpretation will guide the nurse's care of this patient?
A nurse is administering two highly protein-bound drugs to the patient. Which This medication will be 50% eliminated in 12 hours, so the dosing will be
is the safest course of action for the nurse to take? spread apart.
Assess the patient frequently for the risk of drug-drug interactions. Conversion: 7 tsp= ml 
Conversion: 9 G= mcg  35 ml
9,000,000 mg Conversion: 27 mg= mcg 
Conversion: 35 ml= cc  27,000 mcg
35 cc Conversion: 195 kg= lb 
Conversion: 19 ml= L  429 lb
0.019 L The nurse prepares to give a drug that will prevent receptor activation. Which
A patient is complaining of pain rated "10" on a scale of 1 to 10. The nurse term would describe this drug?
has several choices of pain medication to administer. Which order is the best Antagonist
for the nurse to administer at this time? The pharmacist states that the patient's biotransformation of a drug was
Morphine sulfate 1 mg IV (intravenous) altered. The nurse interprets this to mean that
PHARMACOLOGY 20
metabolism has affected the drug.
Conversion: 9 oz = ml 
270 ml
Conversion: 5 ¼ oz= ml 
157.5 ml

PHARMACOLOGY 21