Pharmacology

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session 1

LESSON TITLE: INTRODUCTION TO PHARMACOLOGY Materials:

LEARNING OUTCOMES: Notebook, pens ,paper and index card
At the end of the lesson, the nursing student can:
References:
1. Differentiate the three phases of drug action; Kee, Joyce LeFever, Hayes, Evelyn R. &
2. Describe the four processes of pharmacokinetics; McCuistion E. Pharmacoloy A Nursing
3. Explain the meaning of pharmacodynamics Process Approach 6th edition.. Singapore:
4. Define the terms half- life, therapeutic index, Elsevier Saunders Company.
therapeutic drug range, side effects, adverse reaction
and drug toxicity.

SUBJECT ORIENTATION & GETTING TO KNOW EACH OTHER ACTIVITY (20 minutes)
You will now take note everything about the subject orientation

1. Calendar of activities
2. Classroom rules and regulations
3. Computation of grades
4. Grading of modules
5. Election of officers
6. Requirements – Drug study per period/ term

MAIN LESSON (45 minutes)

THREE PHASES OF DRUG ACTION

1st 2nd 3rd

Pharmaceutic Pharmacokinetics Pharmacodynamics

Solid form Absorption Drug action : onset, peak &
Liquid form Distribution duration
Metabolism / Receptors
Biotransformation Enzymes
Excretion Hormones

I. Pharmaceutic Phase
o Disintegration – is the breakdown of tablet into smaller particles
o Dissolution - dissolving of the smaller particles in the GI fluid before absorption
o 1st phase of drug action
o Rate limiting – time it takes for the drug to disintegrate and dissolve to become available for the body to absorb it.

II. Pharmacokinetic Phase

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 o Is the process of drug movement to achieve drug action
o 2nd phase of drug action
o What the body does to the drug- refers to the study of how the body processes drugs
o It includes the 4 basic components of :
1. Absorption
2. Distribution
3. Metabolism (Biotransformation)
4. Excretion

1. Absorption – the movement of drug particles from the G.I. tract to body fluids by :
a. Passive absorption
b. Active absorption
c. Pinocytosis
a. Passive absorption
o Movement of a drug from the site of administration into the bloodstream.
o Absorption determines how long it takes for a drug to take effect.
o Usually the more rapid the absorption, faster the drug works
o Drugs can be absorbed through plasma primarily by: Diffusion (movement from higher concentration to lower
concentration)
o Does not require energy to move across the membrane.
b. Active absorption
o Requires a carrier such as an enzyme or protein
o Energy is required for active absorption
c. Pinocytosis
o Process by which cells carry drug across their membrane by engulfing the drug paticles

Factors Affecting Absorption

o Surface area
o Contact time with surface
o Circulation
o Solubility (water soluble vs lipid soluble)
o Ionization (weak versus strong acid/base)
o Drug form & drug concentration
o Bioavailability ( after first pass thru liver)
o Route of administration (enteral & parenteral)
o Additives: alter the location of disintegration of drugs as well as increase or decrease the rate of absorption
o Enteric coating allows a drug to dissolve only in an alkaline (pH greater than 7.0) environment such as the
small intestine.
o Sustained release drugs:allow drugs to be released slowly over time, rather than quickly, like conventional
tablets.
o Size of drug particles: smaller the particle, faster the onset.

Drug Absorption varies by form

Liquids, elixirs, syrups Fastest

Suspension solutions

Powders

Capsules

Tablets

Coated tablets

Enteric-coated tablets Slowest

2. Distribution: the transport of drugs from the blood to the site of action. A drug must be distributed to its site of action
to have an effect

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 o Drugs are also distributed to tissues where it has no effect. Competition for drug binding sites affects the amount
of drug available for action in the body.
o Volume of Distribution (Vd) - The degree of distribution of a drug into various body compartments and tissue

Factors Affecting Distribution

1. Perfusion Rate
2. Permeability of Membranes
3. Protein binding
4. Tissue Localization
5. Blood Brain Barrier
6. Placenta

3. Metabolism (breakdown of the drug)

o Biotransformation: process by which the body changes the chemical structure of a drug to another form called a
metabolite.
o Metabolite: a more water soluble compound that can be easily excreted. The major organ for this process is the
liver
o First Pass Phenomenon - Drugs are first absorbed through the small intestine then arrive at the liver via the
portal circulation
o There they undergo considerable biotransformation before entering the systemic circulation.
o There will be less active drug available for action in the body cells after this first Pass through the Liver

Variations in Metabolism
o Pharmacogenetics - hereditary influences on drug responses, refers to variations in which individuals
metabolize drugs.
o Circadian Rhythms - the rate of drug absorption, hepatic clearance, half-life and duration of action, have all
been shown to differ depending upon the time of day a drug is administered.
o Effects of Gender and Age
Elimination of the drug from the body is directly influenced by age. Newborns and elderly experience the
effects of drugs for longer and the drug takes a lot longer to be eliminated from the body.

• Newborns : When babies are born to term, their renal function is very quick to establish similar levels to adults within
one week after birth. If the baby is born prematurely it can take 8 weeks or more to reach the level of enzymes
necessary. If drugs are given before the renal function is at this level, the drug elimination from the body takes a lot
longer and so do the effects of the drugs.
• Elderly : Renal filtration rate begins to decline at 20 years of age and by 50 years of age it has declined by 50%. This
again will affect the elimination of drugs from the body.

4. Excretion: process where drugs are removed from the body. Kidneys are the major organs of excretion.
o Lungs excrete gaseous drugs.
o Biliary excretion (bile & feces) is important for a few drugs. These drugs may be reabsorbed when passing
through the intestines from the liver ( enterohepatic re-circulation ).
o Intestines, sweat, saliva and breast milk constitute minor routes of drug excretion
o Clearance of drugs - elimination of drugs from circulation by all routes. It affects the time a drug remains in the
body and the dosage required.
Renal Clearance
Hepatic clearance

PLASMA HALF-LIFE
o The elimination half-life of a drug is a pharmacokinetic parameter that is defined as the time it takes for the
concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. In other words,
after one half-life, the concentration of the drug in the body will be half of the starting dose.
o Drugs with short half-lives are quickly eliminated from the body. ( Ex: analgesics : given several X per day )
o Drugs with longer half-lives stay in the body longer
(Ex: Digoxin given once a day )

III. PHARMACODYNAMIC PHASE

o What a drug does to the body- refers to the study of the mechanism of drug action on living tissue.

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 o Drugs may increase, decrease or replace enzymes, hormones or body metabolic functions.
o Chemotherapeutic drugs alter an abnormal parasite or growth on the body such as bacteria, viruses or neoplastic
tissue. examples: antibiotics and antineoplastic drugs.

Effects of Drugs
• Therapeutic / Desired effect
a. curative (cures a disease or condition)
b. supportive (supports a body function until other treatments or the body's response can take over
c. substitutive (replaces body fluids or substances)
d. chemotherapeutic (destroys malignant cells)
e. restorative (returns the body to health)

• Adverse drug reaction (ADR) is an unwanted or harmful reaction experienced following the administration of a
drug or combination of drugs under normal conditions of use and is suspected to be related to the drug. An ADR
will usually require the drug to be discontinued or the dose reduced.
• Adverse event is harm that occurs while a patient is taking a drug, irrespective of whether the drug is suspected
to be the cause.
• Side-effect is any effect caused by a drug other than the intended therapeutic effect, whether beneficial, neutral
or harmful. The term ‘side-effect’ is often used interchangeably with ‘ADR’ although the former usually implies an
effect that is less harmful, predictable and may not even require discontinuation of therapy (e.g. ankle oedema
with vasodilators).
• Drug toxicity describes adverse effects of a drug that occur because the dose or plasma concentration has risen
above the therapeutic range, either unintentionally or intentionally (drug overdose).
• Drug abuse is the misuse of recreational or therapeutic drugs that may lead to addiction or dependence, serious
physiological injury (such as damage to kidneys, liver, heart), psychological harm (abnormal behavior patterns,
hallucinations, memory loss), or death.
• Hypersensitivity / allergy: exaggerated adverse reaction to drug

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice
1. What is pharmacokinetics?
a. The study of biological and therapeutic effects of drugs
b. The study of absorption, distribution, metabolism and excretion of drugs
c. The study of mechanisms of drug action
d. The study of methods of new drug development
ANSWER: B
RATIO: Pharmacokinetics is the study of absorption, distribution, metabolism and excretion of drugs. It is a branch of
pharmacology concerned with the movement of drugs within the body.

2. The interaction of one drug increased by the presence of a second drug is known as:
a. Potentiation
b. Addictive effects
c. Antagonism
d. Synergism
ANSWER: A
RATIO: Potentiation is when one drug does not elicit a response on its own but enhances the response to another drug.

3. Considering the absorption of medications during administration, which of the following routes would yield the quickest
response?
a. Oral Medications
b. Subcutaneous injections

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c. Intravenous medications
d. Topical medications
ANSWER: C
RATIO: Intravenous administration is the best way to deliver a prcise dose quickly and in a well-controlled manner
throughout the body.

4. Which of the following best defines the process of pharmacokinetics?

a. The effect of medication on the body
b. The effect of the body on medication
c. The study of medications
d. The preparation of medications for administration
ANSWER: B
RATIO: The process of pharmacokinetics is the effect of the body on medication.

5. When performing an assessment about medication drug history should include which of the following?
a. Complete vital signs
b. Reason for medication
c. Client’s goal therapy
d. Administration of OTC medications
ANSWER: D
RATIO: Administration of OTC medications should be included in performing an assessment about medication in drug
history.

6. When considering the pharmacotherapeutic effects of drugs administered to clients, the nurse considers which
property of most Importance:
a. Efficacy
b. Potency
c. Interaction with other drugs
d. Toxicity
ANSWER: A
RATIO: Efficacy should the nurse consider in property of most Importance. It is the ability to produce a desired or intended
result.

7. Safety of a drug is determined by the degree between which of the following?

a. Therapeutic and toxic doses
b. Potency and efficacy
c. Subtherapeutic and toxic levels
d. Side and adverse effects
ANSWER: A
RATIO: Therapeutic and toxic doses is determined by the degree in Safety of a drug.

8. The nurse is monitoring the therapeutic drug level for a client on vancomycin (Vancocin) and notes that the level is
within the acceptable range. What does this indicate to the nurse? Select all that apply.
a. The drug should cause no toxicities or adverse effects
b. The drug level is appropriate to exert therapeutic effects
c. The dose will not need to be changed for the duration of treatment
d. the nurse will need to continue monitoring because each client response to a drug is unique
ANSWER: B, D

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RATIO: The drug level is appropriate to exert therapeutic effects and the nurse will need to continue monitoring because
each client response to a drug unique. These statements indicate to the nurse.

9. When a drug is 50% protein bound it means that:

a. 50% of the drug destroys protein
b. A drug not bound to protein is an active drug
c. 50% of the dose is at work
d. Protein must be restricted in the diet
ANSWER: C
RATIO: If a drug is 50% protein bound, it mean that 50% of the dose is at work.

10. When reviewing the patient’s medication regimen, the nurse understands that the interval of drug dosage is related to
what?
a. Half-life
b. Biotransformation
c. Metabolism
d. Therapeutic effect
ANSWER: A
RATIO: The nurse understands that the interval of drug dosage is related to Half-life.

11. It is important for the nurse to be aware of the four sequential processes of the pharmacokinetic phase. What are
these processes?
a. Distribution, metabolism, excretion, absorption
b. Biotransformation, excretion, absorption, metabolism
c. Absorption, distribution, metabolism, excretion
d. Metabolism, distribution, absorption, excretion
ANSWER: C
RATIO: The four sequential processes of the pharmacokinetics phase are Absorption, Distribution, Metabolicm, and
Excretion.

12. The nurse is teaching the client about newly prescribed medication. Which statement made by the client would
indicated the need for further medication education?
a. "the liquid form of the drug will be absorbed faster than the tablets."
b. "If I take more, I'll have a better response"
c. "taking this drug with food will decrease how much gets into my system."
d. "I can consult my health care provider if i experience unexpected adverse effects"
ANSWER: B
RATIO: “If I take more, I’ll have a better response”, this statement made by the client would indicate the need for further
medication education.

13. The nurse is caring for several clients. Which client will the nurse anticipate is most likely to experience an alteration in
drug metabolism?
a. A 3 day old premature infant
b. A 22 year old pregnant female
c. A 32 year old man with kidney stones
d. A 50 year old executive with hypertension
ANSWER: A

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RATIO: A 3 day old premature infant will the nurse is most likely to experience an alteration in drug metabolism.

14. A client is being discharged from the hospital with a nebulizer for self-administration of inhalation medication. Which
statement made by the client indicates to the nurse that the client education has been successful?
a. "Inhaled medications should only be taken in the morning."
b. "Doses for inhaled medications are larger than those taken orally"
c. "Medicines taken by inhalation produce a very rapid response."
d. "Inhaled drugs are often rendered inactive by hepatic metabolism reaction”
ANSWER: C
RATIO: “Medicines taken by inhalation produce a very rapid response”, this statement made by the client indicates to the
nurse that the client education has been seccussful.

15. The Nurse is caring for a client with hepatitis and resulting in hepatic impairment. The nurse would expect the duration
of action for most medications to:
a. Decrease
b. Improve
c. Be unaffected
d. Increase
ANSWER: D
RATIO: The nurse would expect the duration of action for most medications to increase.

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

Muddiest Point

In today’s session, what was least clear to you?

For next session, review Principles of Drug Administration, Dosage Calculations

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