Introduction to Nursing Pharmacology

A. Introduction to Drugs The human body works through a complicated series of chemical reactions and processes. Drugs are chemicals that are introduce into the body to cause some sort of change. Drugs will undergo process with in the body which involve breaking and eliminating the drugs, in turn affect the bodys complex series of chemical reactions. Understanding how drugs act on the body to cause changes and applying that knowledge in the clinical setting are important aspects of nursing practice. The nurse is in a unique position regarding drug therapy because nursing responsibilities include the following: Administering drugs Assessing drug effects Intervening to make the drug regimen more tolerable Providing patient teaching about drugs and drug regimen. Monitoring the overall patient care plan to prevent medication error Knowing how drugs works make these tasks easier to handle, thus enhancing drug therapy. B. History Early drug plants, animals & minerals 2700 BC earliest recorded drug use found in Middle East & China 1550 BC Egyptians created Ebers Medical Papyrus Castor oil laxative Opium pain Moldy bread wounds & bruises Galen (131-201 AD) Roman physician; initiated common use of prescriptions

1240 AD introduction of apothecary (pharmacy) system (Arab doctors) 1st set of drug standards & measurements (grains, drams, minims), currently being phased out 15th century apothecary shops owned by barber, surgeons, physicians, independent merchants 18th century small pox vaccine (by Eward Jenner, British Doctor) Digitalis from foxglove plant for strengthening & slowing of heartbeat Vitamin C from fruits 19th century morphine & codeine extract from opium Introduction of atropine & iodine Amyl nitrite used to relieve anginal pain Discovery of anesthetics (ether, nitrous oxide) Early 20th century aspirin from salicylic acid Introduction of Phenobarbital, insulin, sulforamides Mid 20th century 1940 Discovery antibiotics (penicilline, tetracycline,streptomycin), antihistamines, cortisone 1950 Discovery antipsychotic drug, antihypertensives, oral contraceptives, polio vaccine C. Pharmacology Is the study of the biological effects of chemicals. It is the scientific study of the origin, nature, chemistry, effects and uses of drugs. In clinical practice, health care providers focus on how chemicals act on living organisms. Subdivisions of Pharmacology Pharmacodynamics study of the biochemical & physiological effects of drugs & mechanisms of action what the drug does to the body

Pharmacokinetics deals with the absorption, distribution, biotransformation & excretion of drugs what the body does to the drug deals with beneficial effects of the drugs (medicines) source of drugs ex: penicillin from penicillium (fungi) Pharmacotherapeutics study of drugs used in the diagnosis, prevention, suppression, & treatment of diseases Pharmacognonsy study of drugs in their original unaltered state; origin of drugs Toxicology study of biologic toxins: study of poison & its effects deals with deleterious effects of physical & chemical agents (including drugs) in human Nurses deal with Pharmacotherapeutics, or Clinical Pharmacology, the branch of pharmacology that uses drugs to treat, prevent, and diagnose diseases. Clinical Pharmacology Addresses two key concerns The drugs effects on the body The bodys response to the drug Because drug can have many effects the nurse must know which ones may occur when a particular drug is administered.

Effects of the Drug 1. Therapeutic Effect The primary effect intended, that is the reason the drug is prescribed. Also called desired effect. 2. 3. Side Effect The effect of the drug that is not intended. Also called secondary effect. Drug Allergy The immunologic reaction to the drug.

4. Anaphylactic Reaction A severe allergic reaction which usually occurs immediately following administration of the drug. 5. Drug Tolerance A decreased physiologic response to the repeated administration of a drug or chemically related substance. Excessive increase in the dosage is required in order to maintain the desired therapeutic effect. 6. Drug Interaction Effects of one drug are modified by the prior or concurrent administration of another drug, thereby increases or decreases the pharmacological action. Drug Antagonism the conjoint effects of two drugs is less than the drugs acting separately. Summation The combined effect of two drugs produces a result that equals the sum of the individual effect of each agent.

Synergism The combined effects of drugs is greater than the sum of each individual agent acting independently. Potentiation The concurrent administration of two drugs in which one increases the effect of the other drug. Therapeutic Effects of Drugs 1. Palliative Relieves the symptoms of a disease but not affect the disease itself. Ex. Analgesic for pain 2. Curative Treats the disease condition Ex. Antibiotic for infection 3. Supportive Sustains body functions until other treatment of the bodys response can take over. Ex Mannitol to reduce/ICP in a client for surgery due to brain tumor. 4. Substitutive Replaces body fluids or substances. Ex. insulin injection for diabetes mellitus 5. Chemotherapeutic Destroys malignant cells Ex. Cyclophophamide for cancer of the prostate gland. 6. Restorative Returns the body to health. D. Drug Nomenclature

GENERIC NAME/NON-PROPERTY NAME original designation given to the drug when the drug company applies for approval patents universally accepted & not capitalized; before drug becomes official, used in all countries protected by law; not capitalized ex. aspirin TRADE/BRAND/PROPRIETY NAME name given by the drug company that developed it followed by the symbol R or TM, 1st letter is capitalized ex. Aspilet E. Sources of Drugs

Plants roots, bark, sap, leaves, flowers, seeds of medicinal plants digitalis (use as a herat stimulant) from wildflower, purple foxglove, dried leaves of plant active principles of plants alkaloids alkaline in reaction, bitter in taste, powerful in physiologic activity atropine & scopolamine morphine sulfate, cocaine, quinine, nicotine, caffeine procaine glycosides digitalis resin soluble in alcohol; example colonic irritant found in laxative cascara

CHEMICAL NAME atomic/molecular structure of drug Ex. acetylsalicylic acid

gums used in bulk-type laxatives: some used in certain skin preparations for their soothing relief oils castor oil, oil of wintergreen Animal Products from organs, organ secretion or organ cells Used to replace human chemical not produces because of disease or genetic problems Thyroid drugs & growth hormones preparations from animal thyroid & hypothalamus tissue (many of these preparations are now created synthetically safer & purer) Insulin from pancreas of animals (hog, cattle, sheep): thru genetic engineering cld produce human insulin by altering E. coli bacteria making it a better product without impurities that come with animal products Inorganic Compounds from free elements, both metallic & non-metallic usually in form of acids bases, salts found in food Dilute HCI control/prevent indigestion Calcium, aluminum, fluoride, iron, gold, potassium more potent, more stable, less toxic steroids arthritis & other diseases sulfonamides/chemotherapeutic agents kill microorganism slow their growth meperidine HCI (Demerol)

Synthetic Sources many drugs developed synthetically after chemical in plants, animals, or environment have been screened for signs of therapeutic activity

Genetic engineering alter bacteria to produce chemicals that are therapeutic and effective. Reordering of genetic information enables scientists to develop bacteria that produce insulin for human. Chemical alterations Scientists alter chemical with proven therapeutic effectiveness to make it better. Sometimes a small change in a chemicals structure can make that chemical more useful as a drug, more potent, more stable, less toxic. F. Drug Classification

By Action Ant- infectives antiseptics, disinfectants, sterilants Antimicrobials, metabolic, diagnostic materials, vitamins & minerals Vaccine & serums, antifungals, antihistamines, antineoplastics, antacids By Body System CNS (+)/(-) actions of neural pathways & centers; ex. Phenobarbital ANS governs several bodily functions so that drugs that affect ANS will at the same time affect other systems functions; ex. scopolamine GIT acts on muscular & glandular tissues; ex. loperamide

Respiratory System act on resp. tract, tissues, cough center, suppress, relax, liquefy & stimulate depth & rate of respiration; salbutamol Urinary system act on kidney & urinary tract; ex. furosomide Circulatory system act on heart, blood vessels, blood; ex. Metroprolol G. Kinds of Drugs

Interactions of medications are potentially dangerous 3. Investigational drug new drugs undergoing clinical trails

4. Illicit/street drug used/distributed illegally for non-medical purposes to alter mood of feeling

1. Prescription Drugs Also known as legend drugs Can be dispensed if with prescription order; with specific name of drug & dosage regimen to be used by patient. 2. Non-Prescription Drugs Also known as Over the Counter Drugs can be dispensed without prescription order for self treatment of variety of complaints vitamin supplements, cold/cough remedies, analgesics, antacids, herbal products Cautions in use of OTC drugs: Delay in professional diagnosis & treatment of serious/potentially serious condition may occur Symptoms may be masked making the diagnosis more complicated Clients health care provider/pharmacist should be consulted before OTC preparations are taken Labels/instructions should be followed carefully Ingredients in OTC drug may interact with prescribed drug Inactive ingredients may result in adverse reactions Potential for overdose Multiple medication users are at risk as more medications are added to therapy regimen