Pharmacology Prelim Transes
Pharmacology Prelim Transes
Pharmacology Prelim Transes
AREAS OF PHARMACOLOGY
PRELIMS 1. Pharmacodynamics
● Refers to biologic and therapeutic
WEEK 1 AND 2 effects of drugs at the site of action
or on the target organs.
Pharmacology ● Deals with the physiological effects
● Derived from the Greek word of the drug on the body.
pharmakon, meaning “drugs” and
logos, means “study”. 2. Pharmacokinetics
● Is a branch of science that deals ● Deals with the movements of drugs
with the study of drugs and their in the body from absorption to
actions on living systems - that is, elimination.
the study of how drugs work in the ● Study of the absorption, distribution,
body (sometimes referred to as biotransformation (metabolism), and
‘drug actions’). (DOH) excretion of drugs.
● To understand this, we need to ● 4 Phases - ADME
consider: 1. Absorption
2. Distribution
A. What a drug is 3. Metabolism
B. How it affects our physical, 4. Excretion
emotional and psychological
wellbeing 3. Pharmacotherapeutics
C. The type of drug being used ● Is the clinical purpose or indication
D. The modes of administration for giving a drug.
E. How the drug is absorbed ● Deals with therapeutic uses of
F. The characteristics of the drugs.
person taking the drug. ● Study of how drugs may best be
used in the treatment of illnesses.
Why is Pharmacology important in ● Study of which drug would be most
nursing? appropriate to use for a specific
disease; what dose would be
● Nurses play an integral role in required; etc.
administering medication to
patients, and depending on the 4. Posology
environment in which they work, ● Deals with the drug dosages
could be doing so as often as every required to produce therapeutic
few minutes. As a result, it’s effects.
imperative that nurses have a solid ● Concerned with “treatment dosage”
understanding of pharmacology, and and “dosage regimen”
potentially fatal drug interactions. ● DOSE - quantitative amount
administered/taken by a patient for
intended medical effect.
Example: ● Studying compositions of natural
● Most drugs in children are dosed substances helps to gain knowledge
according to body weight (mg/kg) for developing synthetic versions.
● Care must be taken to properly
convert body weight from pounds to ❖ Synthetic drugs - are
kilogram (1kg = 2.2 lbs) compounds that are obtained
● Before calculating doses based on from chemical synthesis and
body weight whose source is the
● Order: Amoxicillin laboratory. Synthetic drugs
suspension 400mg/kg/day/5ml are aspirin, diazepam,
40mg/kg/day BID indomethacin, propranolol,
Pediatric patient’s weight = 22lbs etc.
7. Toxicology
CONVERT WEIGHT
● Study of poisons and poisonings.
Pounds to Kilogram ● Deals with the toxic effects of
(22 x 1/ 2.2lb = 10kg) substances on the living organism.
Excipients
THREE PHASES OF DRUG ADDICTION
● Are fillers and inert substances used
in drug preparation to allow the drug
1. Pharmaceutic Phase
to enhance drug dissolution.
2. Pharmacokinetic Phase
● Disintegration is the breakdown of
3. Pharmacodynamic Phase
a tablet into smaller particles and
Dissolution is dissolving of the
smaller particles in the GI fluid
before absorption.
PHARMACEUTIC PHASE
3. Pinocytosis
● Is a process by which cells carry a
drug across their membrane by
engulfing the drug particles.
6. Route of administration
Factors Affecting Drug Absorption
● Oral drugs the faster the
pharmaceutic phase.
1. Solubility
❖ IM - absorbed faster
● More fat soluble, faster the (deltoids)
absorption because cell ❖ Subcutaneous - slower
membranes are composed of (fat tissue beneath the
lipids. skin)
● Impenetrable barricade/blockade
built from a tightly woven mesh of
capillaries that protect the brain
from potentially dangerous
substances such as “poison, virus
or bacteria”
● Example:
❖ Branded name drug
Sinemet is a combination
of Carbidopa and
Levodopa. Factors Affecting Drug Metabolism
❖ Diphenhydramine
(Benadryl)
AGE
PLACENTAL BARRIER
● Neonate and pediatrics and older
● Placenta is permeable to some adults
medications and can cause harm
to the unborn fetus during any DIET STATE & NUTRITION
trimester.
● Example: ● Low CHON diet decreases drug
❖ Opiates (Morphine), metabolism, grapefruit & sour
Atropine, Beta-blockers orange juice inhibits drug
metabolism.
3. METABOLISM (Biotransformation) GENDER
● Is the process by which the body
inactivates, or bio transform drugs. ● Women on contraceptive pills
● The enzymatic modification or metabolize some drugs at a slow
rate.
degradation of drug structure.
● LIVER - primary site of metabolism. PRESENCE OF LIVER & OTHER
❖ Most drugs inactivated by DISEASES
liver enzymes and
transformed to inactivate by ● Major effects are seen in diseases
affecting the LIVER.
liver enzymes and
transformed to inactive BODY TEMPERATURE
metabolites or water-soluble
substances for renal ● Mild & moderate hypothermia can
excretion. have an effect on some drug
metabolism.
GENETIC
VARIATION/PHARMACOGENETICS
LOADING DOSE
● When immediate drug response is
desired, a large initial dose (loading
nose), of a drug is given to achieve a
rapid minimum effective
concentration in the plasma.
● A loading dose is most useful for
drugs that are eliminated from the
body slowly (with long systemic ❖ Rashes, jaundice, anemia,
half-life). decrease wbc, kidney
● Example of drugs that requires damage and nerve injury that
loading dose is DIGOXIN, a digitalis may impair vision or hearing.
preparation.
● Digitalization is the process by which TOXIC EFFECTS/TOXICITY
the minimum effective concentration ● Toxic effects/toxicity of a drug can be
level for digoxin is achieved in the identified by monitoring the plasma
plasma within a short time. (serum) therapeutic range of the
drug.
SIDE EFFECTS ● When the drug level exceeds the
● Are physiologic effects not related to therapeutic range, toxic effects are
desired drug effects. likely to occur from overdosing, or
● All drugs have desirable and drug accumulation.
undesirable side effects.
● It can occur even with the correct
dosage.
● Mostly side effects occur from drugs
that lack specificity, such as
Betanechol (Urecholine).
● Side effects are called adverse
reactions (at times).
● Can be used interchangeably but
they are different.
● Some side effects are expected as
part of drug therapy. And the
occurrence of these expected but
undesirable side effects is not a
reason to discontinue therapy.
TOLERANCE AND TACHYPHYLAXIS
ADVERSE REACTIONS ● TOLERANCE - refers to a
● Any noxious and untoward or decreased responsiveness over the
unintended response to a drug course of therapy.
which occurs at a dose for ● TACHYPHYLAXIS - refers to a rapid
prophylaxis, guide to establish or decrease in response to the drug.
indicate a diagnosis or therapy. ❖ An “acute tolerance”.
● Are more severe than side effects ❖ Drug categories that can
and always undesirable. cause tachyphylaxis include
● Adverse reactions must always be narcotics, barbiturates,
reported and documented because laxatives and psychotropic
they represent variances from agents.
planned therapy. ● FOR EXAMPLE: Drug tolerance to
● Example: narcotics can result in decreased
pain relief for the patient.
❖ If the nurse does not Culture
recognize the development ● Sets of learned behavior and ideas
of drug tolerance, the that human beings acquire as
patient’s request for more members of a community.
pain medication might be
interpreted as drug-seeking Community
behavior associated with ● Cluster of individuals who function
addiction. as a group to attain cultural
universals.
PLACEBO EFFECT
● A psychological benefit from a Cultural Universals
compound that may not have the ● Are designed to meet the
chemical structure of a drug effect. community’s survival needs and
● Placebo is effective in approximately common goals.
⅓ persons who take a placebo
compound. COMMUNICATION
● The placebo effect is when an
improvement of symptoms is ● Occurs verbally and nonverbally
observed, despite using a non active ● Nurses must be alert to different
treatment. It’s believed to occur due types of communication styles
to psychological factors like among patients to provide culturally
expectations or classical competent care.
conditioning. Research has found ● Examples of cultural competence in
that the placebo effect can ease nursing:
things like pain, fatigue, or ❖ Speaking in terms that are
depression. easy for the patient to follow
and understand.
❖ Not judging or disregarding a
WEEK 5
patient’s belief and religious
background, but encouraging
ETHNOPHARMACOLOGY them to do what works best
for them.
● The study of responses that may be ❖ Empathizing with the patient
unique to an individual owing to at all times.
social, cultural, and biologic
phenomena. LANGUAGE
● Pharmacogenetics integrates the
study of pharmacokinetics, ● Patient’s use of language other than
pharmacodynamics and variations of English.
the predicted response to a drug due ● Professional translators should be
to genetic factors. used whenever possible to
safeguard a patient’s confidentiality.
● There can be miscommunication SPACE
between the patient, the translator,
and the nurse. ● The amount of space around a
● Nurses should not confuse person’s body is an important
politeness with meaningful psychological consideration.
communication. ❖ Americans - desire a great
deal of personal space.
VERNACULAR ENGLISH ❖ Some cultures population
density may dictate limited
● Common language or words spoken personal space.
in particular social and cultural ● TOUCH - all cultures have taboos
groups. regarding touch and added
● Example: considerations when the patient is of
❖ “African-American Vernacular different gender than the nurse.
English”, used to describe a ❖ Nurses should inquire about
style of English speaking that a patient's preferences
is used among some African regarding touch before
Americans. implementing nursing care.
● More generally, vernacular English is
any style of English that varies from SOCIAL ORGANIZATION
standard English.
● Its used by patients can lead to ● Families are basic social units.
misunderstanding by the nurse or to ❖ Delivery of nursing care can
other communication difficulties. be enhanced by including the
family whenever appropriate.
GREETINGS AND COMMUNICATION ❖ American health care
STYLES long-standing practice is
limiting the amount of time a
● Nurses must keep in mind that patient can visit with
patient-nurse interactions in health members of the social group.
care settings are considered formal ❖ In Philippines, it is expected
and that informal styles of that family members will stay
communication should be used only by the patient’s bedside and
after careful consideration. participate in his or her care.
❖ Asian - some Asian descent
speak in a soft tone of voice TIME
and avoid direct eye contact.
❖ Asian Americans and ● Different perceptions of time
Native Americans - may be between nurses and their patients.
comfortable with periods of ❖ Time moves slowly for an
silence. anxious or in pain patient but
❖ Latin American, African, or moves quickly for a nurse
European - uneasy during who has a demanding
periods of silence. workload.
❖ Use of vague terms to dependence on strict time
denote may cause disparity schedules for economic and
between nurses’ and social activities.
patients’ perception of time ➢ Patients with
(words like now, soon, or present-oriented
later). perception of time
❖ Concepts of linear and people are more likely
circular time. to discontinue
➢ Linear time - present mainstream
flows into the future. prescriptive therapies
“I must do this now”. when they feel well.
➢ Circular time - ❖ Cultural groups steeped in
present has more traditional practices or
stability and the need perceive that their cultural
to do things at the identities are threatened
moment has less have a past orientation of
urgency. “I will have time.
the opportunity to do ➢ May lead to the use
this later”. of traditional health
● Cultural aspect of time has a practices.
profound effect on ● REMEMBER: Health behaviors of
pharmacotherapeutic adherence. individuals are also influenced by the
● All cultures have a concept of time quantity and quality of past
as it is related to the past, present, experiences with the healthcare
and future. system.
❖ Western European descent
exhibits a great deal of future ENVIRONMENTAL CONTROL
orientations.
➢ Can lead to health ● A major aspect of culture is the
practices perceived to desire to control nature to facilitate
prevent illness. the needs of human beings.
➢ Concern for the future ● Illness may be attributed to cosmic
serves as motivation forces and believed to be cured or
to take steps to make better by persons who
control chronic possess special abilities.
illness, which is likely ❖ Traditional healers - play a
to lead to greater role in traditional health
adherence to practiced (80% of the
long-term population nationwide).
pharmacotherapy. ❖ Healers and spiritual
❖ Non-European such as advisors - can be beneficial
African, Asian, Native in healthcare settings.
American or Latin American ➢ Canadian health
have exhibited less care system - First
Nation, Inuit and action of substrates and accounts for
Metis were developed the variations in drug metabolism in
to improve the health individuals and groups.
care of its indigenous ● Genetic markers - predominantly
people (the use of characteristics of a certain biologic
traditional healers group.
and spiritual guides). ● Example:
❖ Caucasian in the US have
BIOLOGIC VARIATIONS abnormally low CYP2D6
enzyme that metabolizes
● Human Genome Project - drugs such as
international collaborative research antidepressants,
program, the field of antipsychotics, and beta
pharmacogenomics is rapidly blockers than Asian or
expanding. African.
● Pharmacogenomics refers to the ❖ African Americans respond
general study of all different genes poorly to several classes of
that determine drug behavior. antihypertensive agents
● Example: (beta blockers and
❖ Cytochrome P-450 (CYP) angiotensin-converting
enzymes effect on drug enzyme inhibitors).
response, drug-drug ❖ Differences in skin structure
interactions and adverse and physiology can affect
drug events. response to dermatologic
● The Genographic Project - and topically applied
performed DNA testing on products.
populations worldwide, findings ➢ African Americans
reveal that human beings are 99.9% demonstrated lower
genetically identical (not multiple responses to
races but multiple genotypes). interferon-alpha
❖ Genomes - are a complete (treatment for
set of chromosomes and Hepatitis C).
make up a cell’s DNA ❖ Asian - has inherited variant
❖ Polymorphisms - are DNA H 1502LA-B gene,
variants that occur within recommending to be
specific population at a genetically tested before
frequency greater than 1% starting Carbamazepine
❖ Substrate - a substance that (Tegretol) because of
binds to and is metabolized association to serious skin
by one or more enzymes. reactions.
Drugs are chemical ➢ These intrinsic
substances of substrate. biologic factors along
● Cytochrome P-450 (CYP) enzyme with extrinsic factors
system either induces or inhibits the such as diet and
environmental and
● Exhibit moderate amounts of
sociocultural issues to touching among group members.
prescribe effective
therapies and provide LATIN AND NATIVE AMERICAN
holistic health care.
● Comfortable with a small amount
of personal space.
COMMUNICATION STYLES ● Latin American value touching
● Native Americans use touch
EUROPEAN lightly.
EUROPEAN EUROPEAN
AFRICAN AFRICAN
AFRICAN
● Spiritually oriented
● Important to include clergy in care.
● Believe in being united with a deity
in the afterlife.
● Spiritually oriented
● Followers of Christian religion
derive comfort from religious
artifacts such as rosary beads.
● There may be multiple deities in
indigenous religions.