PHARMACOLOGY Chemical name
• (1/2)-2-(p-isobutylphenyl) propionic acid
Pharmacologic Principles Generic name
• ibuprofen
Drug Trade name
• Any chemical that affects the processes of a • Motrin
living organism
Pharmacology
• The study or science of drugs
DRUG NAME
Chemical name
• The drug’s chemical composition and
molecular structure
GENERIC NAME (non-proprietary name)
• Name which contains the active ingredient
• Same efficacy as the branded ones
Trade name ( brand
name/trademark/proprietary name)
• The drug has a registered trademark; use
of the name restricted by the drug’s owner
(usually the manufacturer)
• has the symbol ® or TM beside it
Pharmacologic Principles: Drug Names
Chemical name
• N-acteyl-p-aminophenol
Generic name
• Paracetamol
Trade name Pharmacologic Principles
• Biogesic
Chemical name • Pharmaceutics
• 2S,5R,6R)-6-[[(2R)-2-amino-2-(4- The study of how various drug forms
hydroxyphenyl)acetyl]amino]-3,3-dimethyl-7- influence pharmacokinetic and
oxo-4-thia-1-azabicyclo[3.2.0]heptane-2-
pharmacodynamic activities
carboxylic acid
Generic name • Pharmacokinetics
• Amoxicillin
Trade name The study of what the body does to the
• Himox drug:
– Absorption
– Distribution
– Metabolism
– Excretion
• Pharmacodynamics
The study of what the drug does to the
body:
– The mechanism of drug actions in living
tissues
• Pharmacotherapeutics
The use of drugs and the clinical indications
for drugs to prevent and treat diseases
• Pharmacognosy
The study of natural (plant and animal) drug
sources
Drug Administration
A. Enteral capsule, tablet,
Oral syrup, suspension
NGT
B. Parenteral ampule;vial
Intravenous
Intramuscular
Intradermal
Subcutaneous
C. Topical cream; ointment
EXAMPLES OF DRUG FORMS
Tablet
Drug absorption of various oral preparations • A drug’s route of administration affects the
or forms rate and extent of absorption of that drug.
– Enteral
Liquids, elixirs, syrups Fastest – Parenteral
Suspension solutions – Topical
Powders
Capsules Enteral Route
Tablets
Coated tablets • Drug is absorbed into the systemic circulation
Enteric-coated tablets Slowest through the oral or gastric mucosa, the small
intestine, or rectum.
– Oral
When a drug is administered it undergoes 2 – Sublingual
phases: – Buccal
1) Pharmacokinetic Phase – Rectal
2) Pharmacodynamics Phase
First-Pass Effect
Pharmacokinetics The metabolism of a drug and its passage from
➢ Process of drug movement throughout the liver into the circulation.
the body necessary for drug action • A drug given via the oral route may be
➢ It is what the body does to the drug extensively metabolized by the liver before
➢ 4 processes of Pharmacokinetics reaching the systemic circulation (high first-pass
effect).
a. Absorption • The same drug—given IV—bypasses the liver,
b. Distribution preventing the first-pass effect from taking
c. Metabolism (biotransformation place, and more drug reaches the circulation.
d. Excretion
A. Absorption
Definition:
It is the movement of the drug from the site of
administration up to the bloodstream
Factors That Affect Absorption
• Administration route of the drug
• Food or fluids administered with the drug
• Dosage formulation
• Status of the absorptive surface
• Rate of blood flow to the small intestine
• Acidity of the stomach
• Status of GI motility
Bioavailability (BA)
Routes
➢ the percentage of available
administered drug for activity or use
*BA of orally administered drugs is always less B. Distribution
than 100%
The transport of a drug in the body by the
*BA of IV drugs is 100% bloodstream to its site of action.
• Protein-binding effect
• Water soluble vs. fat soluble
Factors affecting Bioavailability (BA) • Blood-brain barrier
1) drug form • Areas of rapid distribution: heart, liver,
2) route of administration kidneys, brain
3) gastric mucosa and motility • Areas of slow distribution: muscle, skin, fat
4) food and other drugs
5) changes in liver metabolism C. Metabolism
(also known as Biotransformation)
The biologic transformation of a drug into
• Routes that bypass the liver: an inactive metabolite, a form which can be
easily excreted
– Sublingual Transdermal • Liver (main organ)
– Buccal Vaginal • Kidneys
– Rectal* Intramuscular • Lungs
– Intravenous Subcutaneous • Plasma
– Intranasal Inhalation • Intestinal mucosa
*Rectal route undergoes a higher degree of Factors that decrease metabolism:
first-pass effects than the other routes listed. • Cardiovascular dysfunction
• Renal insufficiency
Parenteral Route • Starvation
• Intravenous* • Obstructive jaundice
• Intramuscular • Slow acetylator
• Subcutaneous • Erythromycin or ketoconazole drug therapy
• Intradermal • Fast acetylator
• Intrathecal • Barbiturates
• Intraarticular • Rifampin therapy
*Fastest delivery into the blood circulation Delayed drug metabolism results in:
• Accumulation of drugs
Topical Route • Prolonged action of the effects of the drugs
• Skin (including transdermal patches) Stimulating drug metabolism causes:
• Eyes • Diminished pharmacologic effects
• Ears
• Nose Half-Life
• Lungs (inhalation)
• Vaginal mucosa • The time it takes for one half of the original
amount
of a drug in the body to be removed.
• A measure of the rate at which drugs are
removed from the body.
Loading Dose • The time it takes for a drug to reach its
maximum therapeutic response
• giving a large initial dose to achieve the
steady state (drug level ) faster Duration
• The time a drug concentration is sufficient to
D. Excretion elicit a therapeutic response
The elimination of drugs from the body
Kidneys (main organ)
Liver
Bowel
biliary excretion
enterohepatic circulation
Lungs, saliva, sweat, breast milk
“Drug activity profile” (also known as the concentration-response graph).
The drug-plasma level time curve indicates a number of pharmacodynamic
parameters: the onset of action, duration of action, the therapeutic index,
the minimum toxic concentration (MTC), and minimum effective
concentration (MEC) for a given drug.
Pharmacodynamics:
Mechanisms of Action
The ways by which drugs can produce
therapeutic effects:
• Once the drug is at the site of action, it can
modify the rate (increase or decrease) at which
Pharmacodynamics the cells or tissues function.
• A drug cannot make a cell or tissue perform a
Drug actions: function it was not designed to perform.
• The cellular processes involved in the drug • Receptor interaction
and cell interaction • Enzyme interaction
• Nonspecific interactions
Drug effect:
• The physiologic reaction of the body to the
drug
Onset
• The time it takes for the drug to elicit a
therapeutic response
Peak
Pharmacotherapeutics:
Types of Therapies
• Acute therapy
• Maintenance therapy
• Supplemental therapy
• Palliative therapy
• Supportive therapy
A, Drugs act by forming a chemical bond with specific receptor sites, similar
• Prophylactic therapy
to a key and lock. B, the better the ‘fit’, the better the response. Those with
complete attachment and response are called agonists. C, drugs that attach
and do not elicit a response are called antagonists. D, Drugs that attach, Pharmacotherapeutics: Monitoring
elicit a response, and also block other responses are called partial agonist.
• The effectiveness of the drug therapy must
DOSE-RESPONSE RELATIONSHIP (CURVE) be evaluated.
• One must be familiar with the drug’s
• intended therapeutic action (beneficial)
• and the drug’s unintended but potential side
effects (predictable, adverse drug reactions).
• Therapeutic index
• Drug concentration
• Patient’s condition
• Tolerance and dependence
• Interactions
• Side effects/adverse drug effects
Therapeutic Index
• The ratio between a drug’s therapeutic
benefits and its toxic effects
Tolerance
• A decreasing response to repetitive drug
doses
Dependence
• A physiologic or psychological need for a drug
Interactions may occur with other drugs or food
• Drug interactions: the alteration of action of
a drug by:
– Other prescribed drugs
– Over-the-counter medications
– Herbal therapies
Interactions
• Additive effect
• Synergistic effect
• Antagonistic effect
• Incompatibility
Medication Misadventures – Half-life
The half-life of a drug is the time it takes for the
Adverse drug events amount of a drug's active substance in your
• ALL are preventable body to reduce by half. This depends on how
• Medication errors that result in patient harm the body processes and gets rid of the drug. It
can vary from a few hours to a few days, or
Adverse drug reactions sometimes weeks.
• Inherent, not preventable event occurring in
the normal therapeutic use of a drug – Therapeutic index
• Any reaction that is unexpected, undesirable, The therapeutic index (TI; also known as
and occurs at doses normally used therapeutic ratio) is a ratio that compares the
blood concentration at which a drug causes a
Some adverse drug reactions are classified as therapeutic effect to the amount that causes
side effects. death (in animal studies) or toxicity (in human
• Expected, well-known reactions that result in studies)
little or no change in patient management
• Predictable frequency – Therapeutic drug range
• The effect’s intensity and occurrence is The therapeutic range of a drug is the dosage
related to the size of the dose range or blood plasma or serum concentration
usually expected to achieve the desired
Adverse Drug Reaction therapeutic effect.
An undesirable response to drug therapy
• Idiosyncratic – Side effects
• Hypersensitivity reactions Side effects, also known as adverse reactions,
• Drug interactions are unwanted undesirable effects that are
possibly related to a drug. Side effects can vary
Iatrogenic Responses from minor problems like a runny nose to life-
Unintentional adverse effects that are threatening events, such as a heart attack or
treatment-induced liver damage.
• Dermatologic
• Renal damage – Adverse reaction
• Blood dyscrasias An adverse drug reaction is a “response to a
• Hepatic toxicity drug which is noxious and unintended and
which occurs at doses normally used in man for
Other Drug-Related Effects prophylaxis, diagnosis, or therapy of disease or
• Teratogenic for the modification of physiologic function.”
• Mutagenic Note that there is a causal link between a drug
• Carcinogenic and an adverse drug reaction.
• Define terms: – Drug toxicity
Drug toxicity refers to the level of damage that
– Protein-bound drugs a compound can cause to an organism. The
Protein binding drugs are loosely bound to toxic effects of a drug are dose-dependent and
plasma proteins such as albumin and alpha-1 can affect an entire system as in the CNS or a
acid glycoprotein, forming an equilibrium ratio specific organ such as the liver.
between bound and unbound drugs.
Drug Classification:
1) According to Body System
2) Therapeutic/Clinical Indication
3) Prescription/Non-prescription (OTC)
4) Illegal (recreational drugs)
Components of a Prescription
a) patients full name
b) date
3) drug name
4) route of administration
5) dose of the drug
6) duration and frequency
7) signature of the prescriber
Medication or Drug Order
Types:
1) STAT
Diazepam 1 amp IM now
2) PRN
Mefenamic acid 500mg/tab,
1 tab q6 as needed
3) STANDING
Nitroglycerin 5mg/tab, 1 tab
SL x 3 doses 5 minutes apart
for chest pain
4) ONE-TIME
Amoxcillin 500mg/cap, 1 cap
TID x 7 days
Verbal Orders
Electronic Orders
Nurse Responsibilities:
1) Verification
a) therapeutic intent
b) usual dose
c) preparation
d) mathematical computation
2) Transcription
Rights of Drug Administration
Right Drug Right Assessment
Right Time Right Education
Right Dose Right Evaluation
Right Patient Right to Refuse the Drug
Right Route Right Documentation
Generic Act of 1988 (Republic Act 6675)
Dangerous Drugs Act of 1972 (Republic Act
9165)
- for controlled drugs
- yellow form and S2 number
Universally Accessible Cheaper and Quality
Medicines Act of 2008 (Republic Act 9502)
- generic names only
- parallel importation ->BFAD
- price control and creation of drug
watch board
