WEEK 1_ FUNDAMENTALS CONCEPTS OF PHARMACOLOGY.pdf

WEEK 1: FUNDAMENTALS CONCEPTS OF PHARMACOLOGY NCMA 216 - PHARMACOLOGY (LECTURE) 2ND YEAR - BS NURSING | FIRST SEM (PRELIMS) OUTLINE 1.2 HISTORY OF PHARMACOLOGY 1. Basic Concepts of Pharmacology 1. Babylo...

WEEK 1: FUNDAMENTALS CONCEPTS OF PHARMACOLOGY NCMA 216 - PHARMACOLOGY (LECTURE) 2ND YEAR - BS NURSING | FIRST SEM (PRELIMS) OUTLINE 1.2 HISTORY OF PHARMACOLOGY 1. Basic Concepts of Pharmacology 1. Babylonians 1.1. Pharmacology - Earliest surviving “prescriptions” on clay tablets 1.2. History of Pharmacology in 3000 B.C. 1.2.1. Branches of Pharmacology 2. Chinese 1.2.2. Three Basic Concepts of - Recorded the Pen Tsao (Great Herbal) – a Pharmacology 40-volume compendium of plant remedies dating 1.2.3. Pharmacokinetics Phases to 2700 B.C. 1.2.4. Abbreviations 3. Egyptians 1.3. Drugs - Archives of remedies on a document known as 1.3.1. Drug Names Erb’s Papyrus in 1500 B.C. 1.3.2. Drug Action 4. Pharmacologia sen Manuductio and Materia 1.3.3. Sources of Drugs Medicum 1.3.4. Drug Evaluation - First recorded reference to the word 1.3.5. Dosages Forms of Drugs pharmacology 1.3.6. Drug Administration 5. Early 1800s 1.4. Principles of Drug Administration - Chemists isolates specific substances from complex mixtures 1.4.1. Ten Rights of Medication - Pharmacologists then study their effects in Administration animals 1.4.2. Oral Medications - Fredrich Serturner (first isolated morphine from 1.4.3. Parenteral Medications opium, injected himself and three other friends 1.4.4. Topical Medications with huge doses (100mg) 1.4.5. Ophthalmic Medications 1.4.6. Otic Medications 1.2.1 BRANCHES OF PHARMACOLOGY 2. Informations 1. Pharmacodynamics 2.1. Terminologies - Pharmaco means “medicine” and dynamic 2.2. References means “change”. - Refers to how a medicine changes the body, the branch of pharmacology concerned with 1. BASIC CONCEPTS OF PHARMACOLOGY mechanisms of drug action and the relationships between drug concentration and responses in 1.1 PHARMACOLOGY the body. - Is the study of drugs and its origin, chemical 2. Pharmacokinetics structure, preparation, administration, action, - Pharmaco means “medicine”, kinetic means metabolism and excretion. “movement or motion”. - The study of drugs that alter functions of living - The study of drug movement throughout the organisms. body. - The branch of science that deals with drugs, its - How the body deals with medications. Actions effects and complications associated with it. and side effects of medications in patients. - 2 main branches: 3. Pharmacognosy - Pharmacokinetics: studies about the - The branch of knowledge concerned with movement of medications inside the medicinal drugs obtained from plants or other body. natural resources. - Pharmacodynamics: relates to different 4. Pharmacotherapeutics effects of the medication in our body. It - The study of the therapeutic uses and effects of could be a positive effect or a negative drugs. effect. How it affects our physiological - Beneficial and adverse effects of drugs. responses. 5. Pharmacovigilance Pharmacy - The practice of monitoring the effects of medical - Art of preparing, compounding, and drugs after they have been licensed for use dispensing drugs. It also refers to the especially in order to identify and evaluate place where drugs are prepared and previously unreported adverse reactions. dispensed 6. Toxicology Pharmacist - The branch of science concerned with the - A person licensed to prepare and nature, effects, and detection of poisons. dispense drugs to make up - The measurement and analysis of potential prescriptions. toxins, intoxicating or banned substances, and prescription medications present in a person’s body.  1.2.2 THREE BASIC CONCEPTS OF PHARMACOLOGY 1.3 DRUGS 1. Pharmacokinetics - Are chemicals that alter physicochemical - The absorption, distribution, metabolism, and processes in body cells. excretion of drugs by the body. - They can stimulate or inhibit normal cellular 2. Pharmacodynamics functions. - The biochemical and physical effects of drugs - Used interchangeably with medicines. and the mechanisms of drug actions. 3. Pharmacotherapeutics 1.3.1 DRUG NAMES - The use of drugs to prevent and treat diseases. 1. Generic or Nonproprietary Name - Name approved by the Medical or 1.2.3 PHARMACOKINETIC PHASES Pharmaceutical Associations in the original country of manufacture and is adopted by all countries. Absorption - e.g. Paracetamol - How does the drug enter the body? 2. Brand name or trade name ↓ - Name given by the manufacturer of the drug - e.g. Adol or Panadol or Biogesic Distribution 3. Chemical name - How does the drug get where it needs to go? - Name that describes the atomic or chemical structure ↓ - e.g. para-acetylaminophenol Metabolization - How does the drug break down? 1.3.2 DRUG ACTION ↓ 1. Therapeutic effect Excretion - Also referred as the DESIRED EFFECT (primary - How does the drug leave the body? effect intended) 2. Side effect - Also referred as the SECONDARY EFFECT (unintended effect) 1.2.4 ABBREVIATIONS - ADVERSE EFFECT (severe side effects) 3. Drug Toxicity - Deleterious effects of a drug resulting from ROUTES OF TIMES OF MEDICATION overdose, ingestion of external use drug, and ADMINISTRATION accumulation on the blood stream 4. Drug Allergy PO - by mouth ac - before meals - Immunologic reaction to drug 5. Drug Tolerance IM - intramuscular pc - after meals - Exists in person with unusually low physiologic response to a drug PR - per rectum daily - everyday SC - subcutaneous BID - 2x a day 1.3.3 SOURCES OF DRUG SL - sublingual TID - 3x a day 1. Natural sources a. Plants ID - intradermal QID - 4x a day - One of the oldest forms of health care, herbal medicine has been practiced in GT - gastrostomy tube qh - every hour virtually every culture dating to antiquity. - The Babylonians recorded the earliest IV - intravenous ad lib - as desired surviving “prescriptions” on day tablets in 3000 B.C. IVP - intravenous push stat - immediately - The Chinese recorded the Pen Tsao (Great Herbal), a 40-volume IVPB - intravenous q2h - every 2 hrs compendium of plant remedies dating to piggyback 2700 B.C. - The Egyptians followed in 1500 B.C. by NG - nasogastric tube q4h - every 4 hrs archiving their remedies on a document known as Ebers Papyrus. q6h - every 6 hrs - e.g morphine, colchicine, cocaine - At that time, chemists prn - as needed were making remarkable progress, isolating specific hs - at bedtime substances from complex BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 2  mixtures, this enabled scientists (Agalsidase beta), Ventavis (iloprost),Litak to isolate the active agents from (cladribine). scarce natural sources, - ex. morphine. I. PHASE I - Cocaine from - cocoa leaves - Chemicals cleared for human testing, there are significant therapeutic benefits. b. Animals - Testing done on healthy male subjects - Biologic: are agents naturally - Companies begin developing a brand name produced in animal cells, by microorganisms, or by the body ORPHAN DRUG itself. - Are chemicals that are discarded Phase I - e.g. hormones, monoclonal - Will not participate in the next phase antibodies, natural blood products, Interferons and Criteria: vaccines. - Lack therapeutic activity in humans - Too toxic DRUG USES SPECIES - Produce unacceptable side effects - Teratogenic Crestor high cholesterol rats, rabbits, dogs II. PHASE II - Chemicals cleared for limited clinical studies Diovan high blood pressure rats, rabbits - Some may not further proceed with the evaluation due to the following criteria Lantus type 1 & 2 diabetes dogs, guinea - Less effective than expected pigs - Are too toxic - Produce unacceptable side effects 2. Inorganic compounds - Have a low benefit-to-risk ratio - e.g. Lithium carbonate - Are not as effective as available drugs - Cisplatin 3. Synthetic III. PHASE III - e.g Ecstasy or Molly - stimulants that mimic the - Chemicals cleared for large-scale clinical studies effect of cocaine - Some chemicals may not advance further in the next phase due to the following criteria: - Produce unacceptable side effects 1.3.4 DRUG EVALUATION - Produce unexpected responses - A series of scientific tests to evaluate the actual therapeutic and toxic effects of chemicals IV. PHASE IV - Drugs approved for marketing by FDA - Continues evaluation STEPS: PRECLINICAL TRIAL 1.3.5 DOSAGE FORMS OF DRUGS - Testing done on laboratory performed in animals - Tests efficacy and toxicity, at different doses, it I. SOLID FORMS predicts whether the drug will cause harm to humans. 1. Tablet - Do not always reflect the way a human responds, a. Scored testing may overestimate or underestimate the b. Layered actual risk to humans. c. Enteric-coated d. Chewable ORPHAN DRUG e. Sustained - Are drugs that have been discovered but are not released financially viable and therefore have not been “adopted” by any drug company - May be useful in treating a rare disease, or they may have potentially dangerous adverse effect 2. Capsule - Are often abandoned after preclinical trials or phase I studies. Criteria: - Lack therapeutic activity - Too toxic - Teratogenic - Have a small margin of safety - e.g. Zavesca (miglustat), Trisenox (arsenic trioxide injection), Aldurazyme (Laronidase), Glivec (Imatinib mesylate), Fabrazyme BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 3  a. Soft gel 3. Elixr b. Hard gel 4. Emulsion 5. Inhalants 3. Lozenges III. TOPICAL FORMS 1. Cream 4. Suppository 2. Ointment II. LIQUID FORMS 1. Syrup 3. Lotion 2. Suspension 4. Patch BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 4 5. Gel Intra-articular Injected into a joint Intrathecal Injected into the spinal canal 1.4 PRINCIPLES OF DRUG ADMINISTRATION MEDICATIONS 1.3.6 DRUG ADMINISTRATION - Are substances administered for the diagnosis, 1. Buccal, sublingual and translingual cure, treatment, or relief of symptom or - Buccal (in the pouch between the cheek and prevention of disease teeth), Sublingual (under the tongue), or Translingual (on the tongue) PRACTICE GUIDELINES - This is to prevent their destruction or - RNs are responsible for own actions, illegible transformation in the stomach or small intestine. order should be questioned or clarified 2. Gastric - RNs should be knowledgeable about the - The gastric route allows direct administration of a medication drug into the GI system. - If the RN is uncertain about the calculation, ask - This route is used when patients can’t ingest the another nurse to double check drug orally. This route is accessed through a tube - What you prepare, you administer placed directly into the GI system, such as a - Do not leave medications at bedside “G-tube.” - If the client vomits, report to the charge nurse, 3. Oral MD, or both. - Oral administration is usually the safest, most - When error is made, assess the patient first and convenient, and least expensive route. report to MD immediately - Oral drugs are administered to patients who are - Correct identification of the patient: conscious and able to swallow - ID band or ID bracelet (BEST: Kozier) 4. Topical - Ask the patient’s name - The topical route is used to deliver a drug via the - Avoid: calling the client in NAME skin or a mucous membrane. - May answer “YES” to the wrong name - This route is used for most dermatologic, ophthalmic, otic, and nasal preparations. 1.4.1 TEN RIGHTS OF MEDICATION 5. Rectal and vaginal ADMINISTRATION - Suppositories, ointments, creams, or gels may be instilled into the rectum or vagina to treat local Right Client - can be measured by checking irritation or infection. the client identification - Some drugs applied to the mucosa of the rectum bracelet by having and by having or vagina can also be absorbed systemically. the client state her or his name 6. Respiratory Some client answer to - Drugs that are available as gasses can be any name or unable to administered into the respiratory system through respond, so client inhalation. identification should - These drugs are rapidly absorbed. In addition, verified each time of some of these drugs can be self-administered by medication administered devices such as the metered-dose inhaler. In the event of missing - The respiratory route is also used in identification bracelet, the emergencies—for example, to administer some nurse must verify the injectable drugs directly into the lungs via an client identity before any endotracheal tube. drug administration SPECIALIZED INFUSIONS Right Drug - means that the client receives Epidural Injected into the epidural the drug that was prescribed space Medication orders may be prescribed by: Intrapleural Injected into the pleural ○ Physician cavity ○ Dentist ○ Podiatrist Intraperitoneal Injected into the ○ License health peritoneal cavity care provider such as Intraosseous Injected into the rich advanced vascular network of a practice long bone registered nurse ○ With authority BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 5  from the state to drugs order medication Prescriptions: Right - requires that the nurses ○ Component of Documentation immediately record the drug order appropriate information about drug ○ Date and time administered include the ff: the order is Name of the drug written Dose ○ Drug name Route ○ Drug dosage Time and date ○ Route of Nurse initial or signature administration ○ Frequency and Right to - equires that the client received duration of Educate accurate and thorough information administration about the medication and how it ○ Any special relates to his or her situation instructions for - Client teaching also includes withholding or therapeutic purpose, possible side adjusting dosage effects of the drugs, any dietary based on nursing restriction or requirements skills assessment, administration, and laboratory drug monitoring. effectiveness, or laboratory result Right - requires that the effectiveness of ○ Physician or Evaluation the medication be determined by other health care the client response to medication provider signature or Right to Refuse - client can and do refuse to take name if TO or VO medication ○ Signature of - It is the nurse's responsibility to license determine when possible the practitioner reason for refusal and to take taking TO or VO reasonable measures to facilitate Categories of drug the client taking the medication. orders: ○ Standing ○ One-time 1.4.2 ORAL MEDICATIONS ○ PRN ○ STAT Most common route CONTRAINDICATIONS: Right Time - is the time at which the ○ Client is vomiting prescribed dose should be ○ Client with intestinal or gastric suction administer ○ Unconscious Client Daily drug dosages are ○ Inability to Swallow given at specified time Tablet or Capsules during a day such as ○ (+) difficulty in swallowing Twice a day b.i.d ○ Crush and mix with small amount of Three time a day t.i.d water Four times a day q.i.d. Avoid Crushing Every 6hrs q6h ○ Enteric Coated ○ Buccal and Sublingual Tablets Right Route - is necessary for adequate or Liquid Medication appropriate absorption ○ Mix before pouring Common routes are in the ○ Place Medication cup on flat surface at following: eye level ○ Oral ○ Fill the cup with the desired level using ○ Sublingual the BOTTOM of the meniscus ○ Buccal ○ Inhalation 1.4.3 PARENTERAL MEDICATIONS ○ Topical ○ Inhalation Intradermal ○ Instillation ○ SITE ○ Suppository, etc. Inner lower arm Upper chest Right - requires the appropriate data be Anterior chest Assessment collected before administration of Upper back beneath the scapula BATCH 2025 TRANSCRIBED BY: AJ & MJ | PLEASE DO NOT REMOVE THIS TO GIVE CREDIT FOR THEIR EFFORTS. 6  Angle : almost parallel to the skin 10 - 15 INTRAVENOUS/INTRAVASCU degrees LAR Gauge: #25, #26, #27 Gauge: #24, 23, 22, 21, Length: ⅜”, ⅝”, ½” 20 Max cc: 0.1 to 0.2 ml Length: 1”, 1 ½”, 2” Max. cc: Push 10 ml Subcutaneous Infusion: 4L in 24 hrs. ○ SITE Outer aspect of the upper arms 1.4.4 TOPICAL MEDICATIONS Anterior thighs Abdomen Transdermal Patch Upper back ○ SITE Ventrogluteal Trunk or lower abdomen Dorsogluteal Areas that are: hairless (+) hair (clip, do not shave) Angle: 45-degrees (1 inch of tissue can be Avoid: cuts, burns, abrasions, grasped) distal extremity 90-degrees (2 inches of tissue can be grasped) Gauge: #25, #26, #27 Length: ⅜”, ⅝”, ½” 1.4.5 OPHTHALMIC MEDICATIONS Max cc: 1-3 ml Preparation: ○ Clean the eyelid and lashes from inner Intramuscular to outer canthus ○ SITE ○ Instruction before administration Ventrogluteal ○ Look up > 1 y/o and adult Where and How to Apply: No large nerve or blood vessels ○ LIQUID: Sealed off by bone Instill correct number of drops Contains less fat than buttocks Outer third of the lower conjunctival sac Vastus Lateralis Instruction after Instillation Site of choice for 1 y/o and ○ Do PUNCTAL OCCLUSION for 30 younger seconds Infants with fully developed ○ OINTMENT: gluteal muscles Discard the first bead Squeeze 2 cm on the lower Dorsogluteal conjunctival sac For adults and children with well Instruction after Instillation developed gluteal muscles ○ CLOSE but not SQUEEZE the eyelid CONTRAINDICATED: children under 3 y/o Increased risk of striking the 1.4.6 OTIC MEDICATIONS SCIATIC NERVE Preparation: ○ Clean the pinna and the meatus of the DELTOID ear canal Small muscle, very ○ Warm the medication: close to the radial ○ In between hands nerve and artery ○ Place in warm water Rapid absorption for Straighten The Auditory Canal: adult ○ Adult: (>3 y/o): Pull the Pinna UPWARD Cannot administer and BACKWARD more than 1 ml. ○ Child: (