NCMA216: PHARMACOLOGY IN NURSING

WEEK 2: PHARMACODYNAMICS PHASE

PROFESSOR: CARMENCITA R. PACIS, RN, MAN, PhD
1st SEMESTER | A.Y 2023 – 2024 | TRANSCRIBER: BENGIE ESPINAS

OUTLINE Potency
I. Pharmacodynamics
II. Dose-Response Relationship  refers to the amount of drug needed to elicit a
a. Potency specific physiologic response to a drug.
b. Efficacy
Efficacy
c. Maximal Efficacy
III. Parameters of Drug Action  magnitude of effect a drug can cause when exerting
a. Therapeutic Index its maximal effect.
b. Therapeutic Dose of a Drug
c. Toxic Dose of a Drug Maximal Efficacy
d. Onset
e. Peak  the point at which increasing a drugs dosage no
f. Duration of Action longer increases the desired therapeutic response.
IV. Therapeutic Drug Monitoring
V. Theories of Drug Action PARAMETERS OF DRUG ACTION
a. Drug-Receptor Interaction Therapeutic Index
b. Drug-Enzyme Interaction
c. Nonspecific Drug Interaction  (TI) describes the relationship between the
d. Selective Toxicity therapeutic dose of a drug (ED50) and the toxic
VI. Drug Response dose of a drug (TD50)
a. Primary
b. Secondary
VII. Classification of Drug Action
a. Rapid
b. Intermediate
c. Delayed/Slow
VIII. Categories of Drug Action
a. Stimulation/Depression
b. Replacement
c. Inhibition/Killing of Organism
d. Irritation
IX. Drug-Drug Interaction Therapeutic Dose of a Drug
a. Additive Effect
b. Synergistic  is the dose of a drug that produces a therapeutic
c. Potentiation response in 50% of the population.
d. Antagonistic
X. Adverse Drug Effect
a. Side Effects
b. Allergic Reactions
c. Idiosyncratic Reaction
d. Toxicity
e. Iatrogenic Responses

PHARMACODYNAMICS Toxic Dose of a Drug

 is the study of the effect of drugs on the body.  is the dose that produces a toxic response in 50% of
 Drugs act within the body to mimic the actions of the population.
the body’s own chemical messengers.  If the ED50 and TD50 are close drug has a narrow
therapeutic index.
DOSE-RESPONSE RELATIONSHIP  require close monitoring to ensure patient safety.
 is the body’s physiologic response to changes in
drug concentration at the site of action.

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 Onset Nonspecific Drug Interaction

 is the time it takes for a drug to reach the minimum  Act by biophysical means that do not affect
effective concentration (MEC) after administration. cellular/enzymatic reactions.
 Time from drug administration to first observable  drugs do not bind to receptors but instead saturate
effect (T0-T1) the water or lipid part of a cell drug actions occurs
based on the degree of saturation.
Peak
 Neutralization of stomach acid by antacids.
 occurs when it reaches its highest concentration in Selective Toxicity
the blood/plasma concentration. T0- T2
 Specific action on cellular structures that are
Duration of Drug Action
unique to the microbe.
 is the length of time the drug exerts a therapeutic  All chemotherapeutic agent would act only in one
effect. enzyme system needed for life of a pathogen or
 period from onset until the drug effect is no longer neoplastic cell.
seen. T1-T3  It is essential to the pathogen but not to the host.

THERAPEUTIC DRUG MONITORING DRUG RESPONSE

 Drug concentration can be determined by Primary

measuring peak and trough drug levels.
 always desirable/physiologic effects
 peak – highest plasma concentration. 30 minutes
after infusion. Secondary
 trough – lowest plasma concentration. 30 minutes
 desirable or undesirable
prior to next infusion.
 Example: Diphenhydramine (Benadryl)
THEORIES OF DRUG ACTION o Primary effect: antihistamine; treat
symptoms of allergy
Drug-Receptor Interaction
o Secondary: Drowsiness
 Certain portion of drug molecule (active site)
CLASSIFICATION OF DRUG ACTION
selectively combines with some molecular structure
(reactive site) on the cell to produce a biologic Rapid
effect
 Receptor site - drugs act at specific areas on cell  few seconds to minutes
membranes; react with certain chemicals to cause  IV, SL, Inhalations
an effect within the cell. Intermediate
 “Lock and Key Theory”- specific chemical (key)
approaches a cell membrane and finds fit (the lock)  1-2 hours after administration
at receptor site affects enzyme system within cell-  IM, SC
produce certain effects.
Delayed/Slow
 Drug + Receptor = Effect
 several hours after administration
Drug-Enzyme Interaction
 Oral, rectal
 Interferes with enzyme systems that act as catalyst
CATEGORIES OF DRUG ACTION
from various chemical reactions
 If single step in one of enzyme system is blocked- Stimulation/Depression
normal function is disrupted
 Stimulation - increased rate of cell activity/
secretion from the gland
 T3/T4 for hypothyroidism
 Depression - decreased cell activity and function of
a specific organ.
 Iodine, propylthiouracil
Replacement

 replaces essential body compounds

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 Example: Insulin  Do not occur unless the patient has been previously
exposed to the agent/ chemical related compound
Inhibition/Killing of Organisms

 Interfere with bacterial cell growth

 Example: Antibiotics
Irritation

 Example: Laxative
 irritate the inner wall of colon → increased
peristalsis → increased defecation
Idiosyncratic Reaction
DRUG-DRUG INTERACTION
 Occurs when the patient is first exposed to the drug
Additive Effect
 Abnormal reactivity to the drug caused by a
 2 drugs with similar actions are taken for a doubled genetic difference between the patient and normal
effect individual.
 1+1=2  patient with G6PD deficiency will have anemia by
 Ibuprofen + paracetamol = added analgesic effect using antioxidants.
 Codeine with acetaminophen = better pain control Toxicity
Synergistic  The degree to which a drug can be poisonous and
 combined effect of 2 drugs is greater than the sum thus harmful to the human body.
of the effect of each drug given alone Iatrogenic Responses
 1+1=3
 Aspirin = 30% analgesic effect  Unintentional responses as a result of medical
 codeine – 30% analgesic effect treatment
 combination = 90% analgesic effect  Nephrotoxicity; ototoxicity

Potentiation

 a drug that has no effect enhances the effects of

the second drug
 0+1=2
 Alcohol enhances the analgesic activity of aspirin.
 Prozac + Zestril
Antagonistic

 one drug inhibits the effect of another drug

 1+1=0
 Tetracycline + antacid= decreased absorption of
tetracycline
 Charcoal in alkaloidal poisoning
ADVERSE DRUG EFFECT
Side Effects

 Results from the pharmacologic effects of the drug

 Most common as a result of lack of specificity of
action within the therapeutic range.
Allergic Reactions

 Unpredictable adverse drug effects; more serious

 Response to patient’s immunological system to the
presence of the drug

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