Introduction
● Drug: substance with physiologic effect on body
● Pharmacology: study of drugs & their interactions w/ living systems
● Clinical pharmacology: study of drugs in humans
● Pharmacotherapeutics (therapeutics): use of drug to diagnose, prevent illness,
and treat disease
○ Ex: prevention - birth control
● Prototype drugs → one drug that represents a group of drugs
○ New drugs compared to the prototypes
○ May be the first drug of the group
■ Ex: penicillin for antibiotics, morphine for opiods, aspirin for
NSAIDS
● Med classification
○ Prototype - drugs with similar characteristics grouped together in a class
○ Therapeutic classification - by therapeutic use (antidepressant, antibiotic,
antihypertensive
○ Chemical name - chemical makeup (b- lactam antibiotics, benzodiazepine)
○ Mechanism of action/ pharmacological classification - how drug produces
its physiological effect in the body
■ Receptor target: agonist, antagonist (angiotensin II receptor
antagonist)
■ Enzyme target: activate or inhibit (NSAID, PPI, ACE)
○ Mode of action: common cellular mode of action (diuretics, cholinergic)
● Most important properties of an ideal drug
○ Efficacy - most important property, how well it works
○ Safety - drug cannot produce harmful effects
○ Selectivity - elicits only the response it is given (never 100%)
● Maximum benefit with minimum harm
○ Ideal = once a day dose, low cost
● The nurse must know
○ Appropriate meds for patients
○ Contraindicated meds
○ Probably consequences of drug interactions
● Role as advocate
○ Last line of defense for PT
○ If pharmacists make a mistake - nurse gets in trouble
○ Ethically and legally responsible
■ Must know what drug is for, and why
■ If it can harm the pt, do not give!!
,● 6 rights - prevents med errors
○ Right drug
○ Right dose
○ Right time
○ Right patient
○ Right assessment
○ Right documentation
○ Right evaluation
○ Right patient education
○ Right of patient to refuse care
● Implementing non drug measures
○ Drug therapy can often be enhanced by non drug measures
○ These include biofeedback, emotional support, smoking cessation, sodium
restriction, and so on
● Stages of new drug development
○ Preclinical testing → done on animals
○ Clinical testing
■ Phase I: well population
● Done on a healthy population
● Dosage, excretion, metabolism
■ Phase II (small sample w/ disorder) and III (large sample w/
disorder)
■ Phase IV: post marketing surveillance
● Drugs gets released by FDA
● Adverse effects can be uncovered here
● Drugs can be removed from market
● Drug Names
○ 3 types → chemical name, generic name, trade name
■ Ex: generic name → acetaminophen, trade name → tylenol
○ Use generic name
● OTC drugs
○ 60% of all doses administered
○ Problems w/ misuse and abuse
■ Not taken as instructed
■ People think the more = the better
○ Over 10,000 otc drugs
○ Can wreak havoc due to drug - drug interactions
● Drug schedules
○ schedule I: high abuse, no medical use
■ Heroin
○ schedule II: high abuse, medically indicated
■ Morphine
○ schedule III: ex → hydrocodone w/ acetaminophen
, ○ Schedule IV: low to moderate abuse
■ Benzodiazepines
○ Schedule V: very low potential for abuse
■ Low dose codeine
Pharmacokinetics
● Movement of drugs throughout the body
● Absorption
○ Site of administration → blood
○ 5 major factors that affect absorption:
■ Lipid solubility → more lipid soluble, the faster
■ Route of administration
■ Dosage
■ Surface area → greater the SA, faster absorbed
■ Rate of dissolution → rate at which a solid becomes a liquid
○ Diffusion through plasma membrane -
■ Simple diffusion
■ Carrier-mediated facilitated diffusion
■ Channel-mediated facilitated diffusion
■ Osmosis
○ Routes of Drug administration
■ Enteral → through stomach
■ Parenteral → IV, IM, SC
■ sublingual/buccal → fast absorption
■ Inhaled → fast absorption
■ sublingual/buccal and lungs avoid first pass effect, creates a
greater concentration of drug
● Distribution
○ Blood flow to tissues
○ Exiting the blood, entering the cells
○ Bioavailability: the fraction of a drug dose of unchanged drug that
reaches systemic circulation
■ Ex → bioavailability of an IV med = 100% (no barrier to absorption)
○ Blood brain barrier
■ Tight junctions between cells
■ Drugs must pass through the cells
■ Only lipid soluble drugs or drugs w/ a transport system can go
through
○ Protein binding
■ Drugs can form reversible bonds w/ various proteins
■ Albumin is most abundant protein
● Manufactured in liver
● Many drugs bind to it
● Affects drug distribution
● Does not go through metabolism
● Drug: substance with physiologic effect on body
● Pharmacology: study of drugs & their interactions w/ living systems
● Clinical pharmacology: study of drugs in humans
● Pharmacotherapeutics (therapeutics): use of drug to diagnose, prevent illness,
and treat disease
○ Ex: prevention - birth control
● Prototype drugs → one drug that represents a group of drugs
○ New drugs compared to the prototypes
○ May be the first drug of the group
■ Ex: penicillin for antibiotics, morphine for opiods, aspirin for
NSAIDS
● Med classification
○ Prototype - drugs with similar characteristics grouped together in a class
○ Therapeutic classification - by therapeutic use (antidepressant, antibiotic,
antihypertensive
○ Chemical name - chemical makeup (b- lactam antibiotics, benzodiazepine)
○ Mechanism of action/ pharmacological classification - how drug produces
its physiological effect in the body
■ Receptor target: agonist, antagonist (angiotensin II receptor
antagonist)
■ Enzyme target: activate or inhibit (NSAID, PPI, ACE)
○ Mode of action: common cellular mode of action (diuretics, cholinergic)
● Most important properties of an ideal drug
○ Efficacy - most important property, how well it works
○ Safety - drug cannot produce harmful effects
○ Selectivity - elicits only the response it is given (never 100%)
● Maximum benefit with minimum harm
○ Ideal = once a day dose, low cost
● The nurse must know
○ Appropriate meds for patients
○ Contraindicated meds
○ Probably consequences of drug interactions
● Role as advocate
○ Last line of defense for PT
○ If pharmacists make a mistake - nurse gets in trouble
○ Ethically and legally responsible
■ Must know what drug is for, and why
■ If it can harm the pt, do not give!!
,● 6 rights - prevents med errors
○ Right drug
○ Right dose
○ Right time
○ Right patient
○ Right assessment
○ Right documentation
○ Right evaluation
○ Right patient education
○ Right of patient to refuse care
● Implementing non drug measures
○ Drug therapy can often be enhanced by non drug measures
○ These include biofeedback, emotional support, smoking cessation, sodium
restriction, and so on
● Stages of new drug development
○ Preclinical testing → done on animals
○ Clinical testing
■ Phase I: well population
● Done on a healthy population
● Dosage, excretion, metabolism
■ Phase II (small sample w/ disorder) and III (large sample w/
disorder)
■ Phase IV: post marketing surveillance
● Drugs gets released by FDA
● Adverse effects can be uncovered here
● Drugs can be removed from market
● Drug Names
○ 3 types → chemical name, generic name, trade name
■ Ex: generic name → acetaminophen, trade name → tylenol
○ Use generic name
● OTC drugs
○ 60% of all doses administered
○ Problems w/ misuse and abuse
■ Not taken as instructed
■ People think the more = the better
○ Over 10,000 otc drugs
○ Can wreak havoc due to drug - drug interactions
● Drug schedules
○ schedule I: high abuse, no medical use
■ Heroin
○ schedule II: high abuse, medically indicated
■ Morphine
○ schedule III: ex → hydrocodone w/ acetaminophen
, ○ Schedule IV: low to moderate abuse
■ Benzodiazepines
○ Schedule V: very low potential for abuse
■ Low dose codeine
Pharmacokinetics
● Movement of drugs throughout the body
● Absorption
○ Site of administration → blood
○ 5 major factors that affect absorption:
■ Lipid solubility → more lipid soluble, the faster
■ Route of administration
■ Dosage
■ Surface area → greater the SA, faster absorbed
■ Rate of dissolution → rate at which a solid becomes a liquid
○ Diffusion through plasma membrane -
■ Simple diffusion
■ Carrier-mediated facilitated diffusion
■ Channel-mediated facilitated diffusion
■ Osmosis
○ Routes of Drug administration
■ Enteral → through stomach
■ Parenteral → IV, IM, SC
■ sublingual/buccal → fast absorption
■ Inhaled → fast absorption
■ sublingual/buccal and lungs avoid first pass effect, creates a
greater concentration of drug
● Distribution
○ Blood flow to tissues
○ Exiting the blood, entering the cells
○ Bioavailability: the fraction of a drug dose of unchanged drug that
reaches systemic circulation
■ Ex → bioavailability of an IV med = 100% (no barrier to absorption)
○ Blood brain barrier
■ Tight junctions between cells
■ Drugs must pass through the cells
■ Only lipid soluble drugs or drugs w/ a transport system can go
through
○ Protein binding
■ Drugs can form reversible bonds w/ various proteins
■ Albumin is most abundant protein
● Manufactured in liver
● Many drugs bind to it
● Affects drug distribution
● Does not go through metabolism
