elsevier items and derived items 2009 by saunders, an imprint of elsevier inc. some material was...

Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published.

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Pharmacology: Principles and Pharmacology: Principles and ApplicationsApplications

22ndnd edition edition



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Chapter 2 critical thinking case ofChapter 2 critical thinking case ofBasics of PharmacologyBasics of Pharmacology

Yvette, a new patient, has been diagnosed Yvette, a new patient, has been diagnosed by the physician as hypertensive. The by the physician as hypertensive. The

physician has prescribed two new physician has prescribed two new medications for her to take. Yvette is also medications for her to take. Yvette is also

taking several other medications for taking several other medications for osteoarthritis and allergies; these were osteoarthritis and allergies; these were

prescribed by another physician, but she prescribed by another physician, but she cannot remember all of the names. What cannot remember all of the names. What can you do to make certain you have all can you do to make certain you have all the right information about Yvette’s new the right information about Yvette’s new medications so that they will not cause medications so that they will not cause

any adverse or toxic reactions?any adverse or toxic reactions?


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Learning ObjectivesLearning Objectives

Providing definitions of the key words using the Providing definitions of the key words using the appendix or a medical dictionary.appendix or a medical dictionary.

Stating healthcare workers’ responsibilities in Stating healthcare workers’ responsibilities in regard to adverse reactions, side effects, and regard to adverse reactions, side effects, and toxic reactions.toxic reactions.

Defining a drug and an ideal drug.Defining a drug and an ideal drug. Describing the five fundamental categories of Describing the five fundamental categories of

pharmacology and how these factors influence pharmacology and how these factors influence medications in the body.medications in the body.

Describing the indications of medicationsDescribing the indications of medications


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Chapter 2Chapter 2

Lesson 2.1Lesson 2.1


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What is a Drug? What is an Ideal What is a Drug? What is an Ideal Drug?Drug?

any chemical used for any chemical used for therapeutic applicationtherapeutic application

can help or harm an can help or harm an individualindividual

may alter biochemical may alter biochemical function of the bodyfunction of the body


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What is a Drug? What is an Ideal What is a Drug? What is an Ideal Drug? (cont’d.)Drug? (cont’d.)

Drug componentsDrug components active ingredientactive ingredient inert ingredientinert ingredient vehiclevehicle


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Ideal drug:Ideal drug: produces no side effects or adverse reactionsproduces no side effects or adverse reactions produces same effect each time the same produces same effect each time the same

dose is givendose is given easy to administereasy to administer inexpensiveinexpensive easy to pronounce, remembereasy to pronounce, remember


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No drug is completely safe.No drug is completely safe. All drugs cause some side effects or adverse All drugs cause some side effects or adverse

reactions.reactions. Drug must be as safe as possible.Drug must be as safe as possible.

Should have no harmful effects when taken in high Should have no harmful effects when taken in high doses over a long period of time.doses over a long period of time.

Be aware of a drug’s effects in order to safely Be aware of a drug’s effects in order to safely administer medications.administer medications.


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Five Basic Categories of Five Basic Categories of PharmacologyPharmacology

PharmacognosyPharmacognosy: origins of drugs: origins of drugs PharmacokineticsPharmacokinetics: how drugs are processed : how drugs are processed

by the bodyby the body PharmacodynamicsPharmacodynamics: actions of drugs on : actions of drugs on

the bodythe body PharmacotherapeuticsPharmacotherapeutics: effects of drugs on : effects of drugs on

the bodythe body ToxicologyToxicology: the poisonous effects of drugs : the poisonous effects of drugs

on the bodyon the body


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Pharmacognosy—The Origins of Pharmacognosy—The Origins of DrugsDrugs

Historically, drugs came from four basic Historically, drugs came from four basic sources:sources: plantsplants animalsanimals mineralsminerals synthetic substancessynthetic substances

Recently, recombinant DNA technology Recently, recombinant DNA technology (gene-splicing) is being used to create drugs.(gene-splicing) is being used to create drugs.


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SourceSource DrugDrugPurple foxglove (digitalis)Purple foxglove (digitalis) digoxindigoxin

Rose hipsRose hips vitamin Cvitamin C

Cinchona barkCinchona bark quinidinequinidine

Opium poppyOpium poppy morphine, codeine, paregoricmorphine, codeine, paregoric

Periwinkle (vinca)Periwinkle (vinca) vincristinevincristine

SnakerootSnakeroot reserpinereserpine

BelladonnaBelladonna atropine, scopolamineatropine, scopolamine

Willow barkWillow bark aspirinaspirin

Castor beanCastor bean castor oilcastor oil

Drug Sources—PlantsDrug Sources—Plants


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SourceSource DrugDrugGoldGold Salganol, auranofinSalganol, auranofin

ZincZinc zinc oxidezinc oxide

CalciumCalcium Os-Cal, Cal-Bid, CitraCal, Rolaids, TumsOs-Cal, Cal-Bid, CitraCal, Rolaids, Tums

MagnesiumMagnesium Milk of Magnesia, Mylanta, MaaloxMilk of Magnesia, Mylanta, Maalox

AluminumAluminum Amphojel, GelusilAmphojel, Gelusil

Drug Sources—MineralsDrug Sources—Minerals


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SourceSource DrugDrug

CodfishCodfish cod liver oilcod liver oil

Pancreas of cow or hogPancreas of cow or hog insulininsulin

Stomachs of hogsStomachs of hogs pepsinpepsin

Animal thyroid glandsAnimal thyroid glands thyroid hormonethyroid hormone

PlacentaPlacenta hair productshair products

Drug Sources—AnimalsDrug Sources—Animals


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SourceSource DrugDrug

InorganicInorganic sulfonamides, oral contraceptives, sulfonamides, oral contraceptives, barbituratesbarbiturates

OrganicOrganic penicillin, cephalosporinspenicillin, cephalosporins

Drug Sources—SyntheticsDrug Sources—Synthetics


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SourceSource DrugDrugInsulinInsulin HumulinHumulin

ErythropoietinErythropoietin EpogenEpogen

Drug Sources—Recombinant DNA Drug Sources—Recombinant DNA TechnologyTechnology


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Pharmacokinetics—How the Body Pharmacokinetics—How the Body Processes DrugsProcesses Drugs

Involves four processes:Involves four processes: AbsorptionAbsorption: movement of a drug from its : movement of a drug from its

administration site into the bloodadministration site into the blood DistributionDistribution: movement of a drug from the : movement of a drug from the

blood into tissues and cellsblood into tissues and cells MetabolismMetabolism: physical and chemical alteration : physical and chemical alteration

of a drug in the bodyof a drug in the body ExcretionExcretion: removal of waste products from : removal of waste products from

the bodythe body


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Drug Activity in the BodyDrug Activity in the Body


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Medications are administered by three routes.Medications are administered by three routes.

AbsorptionAbsorption


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Absorption (cont’d.)Absorption (cont’d.)

Physical properties that affect absorption rates:Physical properties that affect absorption rates: solubilitysolubility pHpH absence or presence of food in stomachabsence or presence of food in stomach fat solubilityfat solubility length of contactlength of contact inhalation factors inhalation factors drug concentrationdrug concentration


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Route of Drug Administration and Route of Drug Administration and RatesRates


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a drug is delivered to a drug is delivered to tissues through tissues through blood vessels and blood vessels and capillaries.capillaries.

a drug’s effect takes a drug’s effect takes place in tissues, not place in tissues, not blood vessels.blood vessels.

Modified from Leahy, JM, Kizilay, PE (1998).

Foundations of nursing practice. Philadelphia:

Saunders.

DistributionDistribution


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Distribution (cont’d.)Distribution (cont’d.)

Factors affecting drug distribution:Factors affecting drug distribution: permeability of capillaries to drug’s moleculespermeability of capillaries to drug’s molecules chemical makeup of drugchemical makeup of drug amount givenamount given size of personsize of person amount of protein in bloodamount of protein in blood drug’s ability to pass through tissue’s cell drug’s ability to pass through tissue’s cell

membranemembrane


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Distribution (cont’d.)Distribution (cont’d.)

Barriers to drug distribution:Barriers to drug distribution: Blood-brain barrier (water-soluble electrolytes Blood-brain barrier (water-soluble electrolytes

cannot cross, but fat-soluble substances can)cannot cross, but fat-soluble substances can) Placental barrier (allows water and fat-soluble Placental barrier (allows water and fat-soluble

substances to cross)substances to cross) Selective distribution (drugs are attracted to Selective distribution (drugs are attracted to

specific organ cells)specific organ cells)


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series of chemical reactions altering a drug by converting it into a water-soluble compound for excretion

Modified from Leahy, JM, Kizilay, PE (1998). Foundations of nursing practice. Philadelphia: Saunders.

Metabolism, or BiotransformationMetabolism, or Biotransformation


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Metabolism, or Biotransformation Metabolism, or Biotransformation (cont’d.)(cont’d.)

Factors affecting drug metabolism:Factors affecting drug metabolism: condition of livercondition of liver first-pass effect—rapid inactivation of some first-pass effect—rapid inactivation of some

oral medications by the liveroral medications by the liver age of patientage of patient drug half-life—time in which half the available drug half-life—time in which half the available

drug is metabolized by the body for excretiondrug is metabolized by the body for excretion


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occurs through respiration, perspiration, urination, or defecation

Modified from Leahy, JM, Kizilay, PE (1998). Foundations of nursing practice. Philadelphia: Saunders.

Excretion or EliminationExcretion or Elimination


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Excretion or Elimination (cont’d.)Excretion or Elimination (cont’d.)

Factors affecting rate of excretion:Factors affecting rate of excretion: chemical composition of drugchemical composition of drug rate of metabolismrate of metabolism administration routeadministration route condition of excreting organscondition of excreting organs

good renal function essential good renal function essential milk glands also excrete some medicationsmilk glands also excrete some medications

Nursing mothers should check with physician Nursing mothers should check with physician before taking any medication.before taking any medication.


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Review of PharmacokineticsReview of Pharmacokinetics

Drug AdministrationDrug Administration Routes – enteral, parenteral, percutaneousRoutes – enteral, parenteral, percutaneous

AbsorptionAbsorption Absorbed and transported to site of actionAbsorbed and transported to site of action

DistributionDistribution Transported to body areas via circulating fluidsTransported to body areas via circulating fluids

MetabolismMetabolism Medication altered to be used by the bodyMedication altered to be used by the body

ExcretionExcretion Unused medication removed from bodyUnused medication removed from body


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Pharmacodynamics—Action of Pharmacodynamics—Action of Drugs in the BodyDrugs in the Body

Drug actionDrug action: physiological change occurring : physiological change occurring in the body in response to the drug.in the body in response to the drug.

Drugs cannot give body organs and tissues Drugs cannot give body organs and tissues new functions.new functions.

Drugs can slow down or speed up cell Drugs can slow down or speed up cell processes.processes.

Drugs can replace natural substances, Drugs can replace natural substances, protect body from foreign materials, and protect body from foreign materials, and inhibit cell growth.inhibit cell growth.


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Pharmacodynamics—Action of Pharmacodynamics—Action of Drugs in the Body (cont’d.)Drugs in the Body (cont’d.)

Four major effects:Four major effects: depressiondepression: lessens body activity: lessens body activity stimulationstimulation: increases body activity: increases body activity irritationirritation: produces areas of inflammation: produces areas of inflammation demulcencedemulcence: produces soothing effect: produces soothing effect


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Pharmacodynamics—Action of Pharmacodynamics—Action of Drugs in the Body (cont’d.)Drugs in the Body (cont’d.)

Additional effects:Additional effects: synergismsynergism: two drugs taken together boost : two drugs taken together boost

each other’s effect.each other’s effect. antagonismantagonism: one drug counteracts or : one drug counteracts or

reduces the effect of another drug when reduces the effect of another drug when taken together.taken together.


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Pharmacotherapeutics—Effects of Pharmacotherapeutics—Effects of Drugs on DiseaseDrugs on Disease

Five categories of reasons to prescribe Five categories of reasons to prescribe medications:medications:

curativecurative: cure disease: cure disease palliativepalliative: relieve symptoms: relieve symptoms preventativepreventative: prevent disease: prevent disease diagnosticdiagnostic: diagnose conditions: diagnose conditions substitutivesubstitutive: replace natural body substances: replace natural body substances


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Pharmacotherapeutics—Effects of Pharmacotherapeutics—Effects of Drugs on Disease (cont’d.)Drugs on Disease (cont’d.)

Effects of drugs:Effects of drugs: desired effectdesired effect: intended response to a : intended response to a

medicationmedication side effectside effect: mild, annoying, undesirable : mild, annoying, undesirable

response to a medicationresponse to a medication


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Sites of ActionSites of Action

Local Action Local Action Drug action is limited to the site of administration Drug action is limited to the site of administration

or surrounding tissuesor surrounding tissues Systemic ActionSystemic Action

Drug action is felt throughout the bodyDrug action is felt throughout the body Remote ActionRemote Action

Drug action is at site distant from the site of Drug action is at site distant from the site of administrationadministration


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Toxicology—Poisonous Effects of Toxicology—Poisonous Effects of DrugsDrugs

All drugs taken in excess act as poisons.All drugs taken in excess act as poisons. Medication dose can mean the difference Medication dose can mean the difference

between therapeutic effect and toxic effect.between therapeutic effect and toxic effect. Antidotes can be given to reverse overdose Antidotes can be given to reverse overdose

symptoms or stop toxic effects.symptoms or stop toxic effects.


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Toxicology—Poisonous Effects of Toxicology—Poisonous Effects of Drugs (cont’d.)Drugs (cont’d.)

Unwanted effects of drugs:Unwanted effects of drugs: adverse reaction: unintended, undesirable, adverse reaction: unintended, undesirable,

often unpredictable effects causing unwanted often unpredictable effects causing unwanted symptomssymptoms

allergic reaction: hypersensitivity to a drug, allergic reaction: hypersensitivity to a drug, often after just one doseoften after just one dose

hypersensitivity reaction: cell-mediated hypersensitivity reaction: cell-mediated allergic reactionallergic reaction


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Anaphylaxis:Anaphylaxis: severe, potentially fatal, allergic responsesevere, potentially fatal, allergic response occurs a short time after the drug is occurs a short time after the drug is

administeredadministered symptoms include:symptoms include:

hiveshives reddened skinreddened skin bronchospasmbronchospasm blood pressure blood pressure

changeschanges diaphoresisdiaphoresis

Toxicology—Poisonous Effects of Toxicology—Poisonous Effects of Drugs (cont’d.)Drugs (cont’d.)

cyanosiscyanosis dyspneadyspnea vascular collapsevascular collapse loss of consciousnessloss of consciousness cardiac arrhythmiascardiac arrhythmias cardiac arrestcardiac arrest


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Chapter 2Chapter 2

Lesson 2.2Lesson 2.2


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0102030405060708090

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

EastWestNorth

Undesirable EffectsUndesirable Effects Identifying undesirable Identifying undesirable

effectseffects Did the patient follow instructions Did the patient follow instructions

accuratelyaccurately When did the symptoms first When did the symptoms first

occur? How long after the first use occur? How long after the first use of the drug?of the drug?

Has the patient started anything Has the patient started anything else new or changed something? else new or changed something? Has a new household product been Has a new household product been used?used?

If the drug was discontinued, did If the drug was discontinued, did the signs and symptoms the signs and symptoms disappear?disappear?


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Undesirable Effects (cont’d.)Undesirable Effects (cont’d.) If the drug was restarted did the same effects If the drug was restarted did the same effects

occur?occur? Could the illness cause the symptoms? Are the Could the illness cause the symptoms? Are the

signs and symptoms consistent with the signs and symptoms consistent with the diagnosis?diagnosis?

Could other drug or products that are being used Could other drug or products that are being used concurrently cause the reaction?concurrently cause the reaction?

Is there a possibility of a drug-drug or drug-food Is there a possibility of a drug-drug or drug-food interaction?interaction?


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Undesirable Effects (cont’d.)Undesirable Effects (cont’d.)

Allied health professional important in Allied health professional important in evaluating undesirable effectsevaluating undesirable effects

Patient education should include early Patient education should include early identification of possible unwanted reactionsidentification of possible unwanted reactions

Evaluate medications on an individualized Evaluate medications on an individualized basisbasis


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Drugs and Receptor SitesDrugs and Receptor Sites

Drugs attach to appropriate receptor sitesDrugs attach to appropriate receptor sites Drug molecules travel in the blood until they Drug molecules travel in the blood until they

reach and attach to receptor sitereach and attach to receptor site The better the fit of the drug to the receptor The better the fit of the drug to the receptor

site, the better is the expected responsesite, the better is the expected response Drugs may be used to prevent other Drugs may be used to prevent other

chemicals from attaching to a receptor sitechemicals from attaching to a receptor site


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Drugs at Receptor SitesDrugs at Receptor Sites


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Agonists vs Antagonists vs Agonists vs Antagonists vs SynergismSynergism

Agonist – drug that mimics body functionAgonist – drug that mimics body function May compete with previously bound drugsMay compete with previously bound drugs

Synergist – One drug potentiates another Synergist – One drug potentiates another drugdrug

Antagonist – drug that binds to a receptor Antagonist – drug that binds to a receptor site and does not activate the sitesite and does not activate the site Prevents the activation of the receptor site by the Prevents the activation of the receptor site by the

agonist agonist Counteract the expected effects of other drugsCounteract the expected effects of other drugs


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Drug-Drug InteractionsDrug-Drug Interactions

Potentiation – One drug prolongs or augments Potentiation – One drug prolongs or augments the effects of anotherthe effects of another

Tolerance – Long-term use of drug lessens the Tolerance – Long-term use of drug lessens the expected effectexpected effect

Summation – Two drugs are given together and Summation – Two drugs are given together and each drug has the expected effecteach drug has the expected effect

Cumulation (accumulation) – Drug is not Cumulation (accumulation) – Drug is not excreted as expected and it accumulates in the excreted as expected and it accumulates in the bodybody See Table 2-8See Table 2-8


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Food-Drug InteractionsFood-Drug Interactions

Foods may react with drugs to induce toxic Foods may react with drugs to induce toxic effects or cause failure of therapyeffects or cause failure of therapy

Absorption may be decreased by food in the Absorption may be decreased by food in the stomachstomach

Some medications must be taken with food to Some medications must be taken with food to prevent gastric irritationprevent gastric irritation See Box 2-4 See Box 2-4


Yvette, a new patient, has been diagnosed by the Yvette, a new patient, has been diagnosed by the physician as hypertensive. The physician has physician as hypertensive. The physician has prescribed two new medications for her to take. prescribed two new medications for her to take. Yvette is also taking several other medications Yvette is also taking several other medications for osteoarthritis and allergies; these were for osteoarthritis and allergies; these were prescribed by another physician, but she cannot prescribed by another physician, but she cannot remember all of the names. What can you do to remember all of the names. What can you do to make certain you have all the right information make certain you have all the right information about Yvette’s new medications so that they will about Yvette’s new medications so that they will not cause any adverse or toxic reactions?not cause any adverse or toxic reactions?

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elsevier items and derived items 2009 by saunders, an imprint of elsevier inc. some material was...

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