Pharmacology: Reasons and Effect

on Society

In the field of health, one of the main concerns in the XXI century is the
academic orientation towards excellence, within this perspective it is important
not only the profile offered by the university but also the way of teaching and
learning that the student receives from the teacher both in theory and in practice
to achieve a highly competitive student for the benefit of comprehensive patient
care.
Pharmacology is one of the disciplines most closely linked to Nursing. A drug is
considered as any chemical substance capable of inducing a reaction or
change in cellular functioning and living tissues.
Medical pharmacology can then be defined as the branch of medical sciences
that deals with the study of drugs used for the diagnosis, prevention or
treatment of human diseases. More specifically, it can also be defined as the
branch of biomedical sciences that studies the origin and chemistry of drugs
useful in medicine, their pharmacological actions, their mechanisms of action at
the molecular or cellular level, how they pass through the body, their adverse
effects and their therapeutic applications.
The objectives of clinical pharmacology are:
(a) To obtain information on the actions of drugs in humans through clinical
research, by means of clinical trials and clinical pharmacokinetics,
pharmacovigilance and drug utilization studies.
b) Collect, critically evaluate and systematize information on the most
appropriate use of drugs and disseminate this information.
c) Apply this knowledge to improve drug utilization in clinical practice through
the establishment of a drug utilization policy, therapeutic consultation,
monitoring of serum drug levels, compliance monitoring and development of
pharmacovigilance programs.
Nurses are in charge of a great diversity of functions and tasks, however, drug
administration is part of their daily work, so knowledge of this branch is
essential, in addition to the fact that, in this work, they face a permanent legal
risk, related to errors in practice, given the responsibility and frequency with
which it is performed.
The health and even the life of the patient depends on the adequate knowledge
of the drugs, because from this knowledge, these professionals can be able to
detect adverse reactions, drug interactions and medication errors, in addition, it
guarantees an effective and safe administration, and allows them to guide the
patient on the consumption of the drugs.
The learning of pharmacology can be complex, especially for students, because
they consider that it involves a lot of memorization of data, so it is advisable to
work with the help of case studies, real situations or not, that occur to a problem
patient with whom they are going to work. In this way it is easier to retain doses,
quantities, aspects, etc. Another way of studying is to work with drugs by
classifying them according to the part of the body on which they act, which is
the most common way of finding pharmacological manuals.
Based on the above, the aim of this article is to update the most relevant
aspects to be taken into account by the nursing staff when administering drugs.
All societies in the world link their development to the biological capacity of
man, hence the fundamental duty of governments is to protect the health of all
citizens, or to recover it when it is altered.
The importance of the knowledge of this branch of medical sciences,
pharmacology, can be easily understood if one considers that, in his
professional relationship with the patient, the physician must ultimately solve
only two unique and fundamental problems:
making the diagnosis and establishing the best therapeutic, which is why the
importance of the physician's knowledge of Pharmacology is inescapable, but
would this be enough to achieve the true purposes on human health? The
doctor - nurse binomial is impossible to dissolve in all aspects from the labor
point of view.
To achieve quality care, it is insufficient to make a diagnosis and choose the
appropriate therapy. There is no doubt that these are the first aspects to be
taken into account for the cure, relief, and even prophylaxis of a given disease,
but if the medication is not administered in the right way, the whole process
would be affected, this is the beginning of the analysis of the important role of
the knowledge of Pharmacology by the nursing staff.
The Nursing Care Process (PAE) is the nurse's action strategy to provide the
patient with total care. It is based on the application of the scientific method and
consists of a series of actions designed to fulfill the nursing objective. Within the
PAE, there are five stages that can very well be linked to pharmacology:
assessment, diagnosis, planning, execution and evaluation.
According to the latest OM survey, more than 50% of the world's population
uses medicines every day. This may be due to the fact that, in general,
medicines are identified with health and almost all people suffering from any
illness expect to find a solution in them. Pharmacological therapeutics have
made a notable contribution to improving the health of the population; diseases
that were incurable a short time ago now have treatment; mortality from cancer
or myocardial infarction has been reduced thanks to drugs; vaccines have
reduced the incidence of childhood diseases and the mortality linked to them.
But to consider only the beneficial effects of drugs is to take a partial view of the
issue.
If a substance modifies the course of a disease, it is because it is capable of
influencing some biological function of the patient and, as a consequence, it can
also produce harmful effects that we know as adverse reactions. The question
is to determine which ones predominate and, above all, to assess the degree of
risk that can be accepted as a consequence of their use.
Before using a drug, it is necessary to establish the balance between the
benefits and risks expected from it. This assessment begins in the pre-
marketing research but must continue throughout the drug's life. Before
prescribing a drug, the physician should do it and even the patient, adequately
informed, should also analyze the benefit-risk ratio before taking the drug,
especially if he/she does so without prior professional advice.
According to the 2001 national health survey, self-medication is practiced by
one out of four patients. Some drugs, aimed at the treatment of banal
processes, can be dispensed at the pharmacy without a prescription and their
use as self-medication is correct if it is done with adequate information and
accepting that adverse reaction may occur. Unfortunately, sometimes, self-
medication is done with pharmaceutical specialties that require a prescription,
which is a dangerous behavior that should be avoided.
The risk that can be assumed by the use of drugs depends on the severity of
the disease to be treated; the greater the severity, the greater the acceptable
risk. Few people will be willing to suffer anemia produced by a drug for the
treatment of a mild infection, but almost no one doubts that anemia is a lesser
evil when treating HIV infection or cancer.
The ease of obtaining drugs in our environment and the low frequency with
which they present adverse reactions have led us to consider them as a real
consumer good, but we should be aware that zero risk does not exist even in
the consumption of drugs. Moreover, we forget that for more than 80% of the
world's population they are a scarce commodity and that a large part of
mortality in third world countries is due not to a lack of medicines, but of drinking
water. This fact shows that the health enjoyed by 20% of the population living in
industrialized countries is not only linked to the consumption of more than 80%
of the medicines manufactured in the world, but also to good living conditions.
Moreover, there is the paradox that many of the drugs we consume are
intended for the treatment of diseases that are the consequence of an
unhealthy lifestyle. The correct and responsible use of drugs also includes the
modification of lifestyle habits. Obesity or cardiovascular diseases cannot be
treated with drugs alone.
Medicines are nowadays an industrial product and this means that their use has
economic connotations. Most of the financing of the pharmacy bill is public and
reducing it would allow other needs to be covered with part of the resources
allocated to drugs. The use of drugs has health, but also social and economic
consequences, which is why it is important to include it in scientific
dissemination programs. Only a well-informed society will be able to make
reasonable and responsible use of drugs, a task that concerns the
Administration and healthcare professionals, but above all the population that
uses and finances them.
Benefits for society
The pharmaceutical industry is an industry with characteristics that differentiate
it from any other. It invests heavily in technology and knowledge, and the
ultimate aim of its products is to improve the health of the population. It is an
industry that radically changes the lives of people and societies, for which it is
sufficient to recall just a few examples of advances in medicines throughout
history, such as penicillin, insulin, and vaccines.
But it is also one of the most regulated sectors of the entire economy, which is
why governments exercise exhaustive control over it as they do over almost no
other industry. It is one of the most closely monitored not only in terms of the
dissemination of its products, with strict supervision of its marketing campaigns,
but also in terms of its developments. To be approved, a new drug must pass
through several complex audits by regulatory bodies, which also keep a
permanent watch once the drug is on the market.
The pharmaceutical industry is also one of the most avant-gardes in terms of
innovation. And several studies have measured how healthcare innovation has
indeed had a highly positive impact not only at the individual level but also on
healthcare systems around the world. Medicines, together with diagnostic
advances and public health policies, allow us to live longer and better lives.
These are some of the indicators that confirm this:
1. Life expectancy. The relative improvement in life expectancy attributable to
the pharmaceutical sector is significant: between 2000 and 2009, 1.74 years of
life expectancy were gained, 73% of which is due to the effect of innovation in
the sector.
2. Vaccines. Except for water purification, no other public health measure has
contributed to reducing mortality and morbidity in the human species to such an
extent. Also, vaccination schedules continue to be updated with new vaccines,
such as HPV.
3. AIDS. Antiretrovirals have succeeded in turning this deadly disease into a
chronic condition. Between 2010 and 2015 alone, 13 million deaths were
prevented worldwide. And today the life expectancy of a person with HIV under
treatment is the same as someone who is not infected with the virus.
4. Cancer. This is another disease whose paradigm has changed radically
since the 1990s, thanks to new medications. The number of days’ cancer
patients spend in hospital has also decreased significantly and their quality of
life has improved due to the fewer adverse effects of these therapies.
5. Hepatitis C. Also, in this case, antiviral agents achieved an unprecedented
response in the treatment of the disease, reaching cure rates of 95%.
6. Biological drugs. Unlike chemically synthesized molecules, these
revolutionary drugs are made up of proteins produced by living organisms. The
application of biotechnology not only opens up a promising future but has
already changed the paradigm of care for diseases such as psoriasis and
rheumatoid arthritis.
7. Rare diseases. In recent years there have been major advances in the
treatment of rare diseases, although most of them still have no cure. The pool of
approved orphan drugs has helped to reduce premature mortality and increase
the number of years of life gained. Specific treatments for many other rare
diseases are expected to be approved shortly.
8. Fewer hospitalizations. A study in Canada showed that the estimated
reduction in hospital spending was more than double the increase in
pharmaceutical spending attributable to the innovation.
9. Improved quality of life. The new drugs not only made it possible to change
the outlook for life-threatening diseases, but also benefited patients suffering
from pathologies that are not life-threatening, but which do have a high
emotional and productive cost, such as rheumatoid arthritis, psoriasis, and
migraine.
10. Increased productivity. The benefits of innovative drugs are not only
directly measurable in terms of population health. In the United States, lost work
and school days due to illness or injury decreased significantly between 1997
and 2010, correlating with the increased prescription of new drugs.
Patient education
Although it may seem distant from the topic discussed, another aspect of
relevant importance is patient education by the nursing profession.
In 1970, WHO Technical Report 446, "Clinical Pharmacology: activities,
services, and teaching", was published, recommending the development of the
specialty as an integrated discipline in health systems, and in which its functions
include "improving patient care by promoting a more effective and safer use of
drugs, increasing knowledge through research, transmitting this knowledge
through teaching and promoting services such as information on drugs, drug
analysis, drug abuse monitoring and advice on study design".
This definition aims to highlight aspects such as "integrated discipline",
"promotion of the effective use of medicines", "transmitting knowledge about
medicines", "promoting information on the use of medicines", all with the
purpose of "improving patient care". The only way to be able to comply with
what is established by the WHO is through a full knowledge of pharmacology,
otherwise, it is impossible to pretend to guide the patient on how or which is the
best way to use medicines and preserve their health.
It is impossible to separate pharmacological and non-pharmacological
treatments for a given disease, both complement each other substantially. It is
in the pharmacology books where this information is shown and it is the nursing
professional who is the person in charge of
and educate the patient about compliance with the same.
According to the WHO, health education can be defined in two ways. On the
one hand, it consists of providing the population with the knowledge, skills, and
abilities necessary for the promotion and protection of health. On the other
hand, health education contributes to empowering individuals to actively
participate in defining their needs and developing proposals to achieve certain
health goals.
To improve people's health, individuals must increase their knowledge about
health and disease, about the body and its functions, the usefulness of health
services, and the factors that act on health.
The nursing staff uses, together with other members of the health team, two
main activities: educational talks and group demonstrations. Bearing in mind
that the relationship with the user is the main activity of any member of the
team, both at home and in the health center.
Nursing encompasses the care, autonomous and collaborative, provided to
people of all ages, families, groups, and communities, sick or healthy, in all
contexts, and includes health promotion, disease prevention, and care of the
sick, disabled, and dying. Essential functions of nursing are advocacy,
promotion of a safe environment, research, participation in health policy and
management of patients and health systems, and education.
Health problems are different for each age group. In young individuals, the main
cause of death is accidents, which cause a decrease in the workforce, creating
a certain degree of dependency in the case of hospitalized patients.
Another of the problems that occur with great frequency is an acute illness,
such as, for example, infection of the upper respiratory tract; but it is with stress
that gastric and duodenal ulcers develop, and can lead to self-destructive
behaviors, such as drug abuse, alcoholism or suicide, which together with the
accidents already mentioned above comprise the main causes of death in
young adults.
In middle-aged adults, the main forms of illness are cardiovascular and
pulmonary diseases, rheumatoid arthritis, cancer, diabetes mellitus, obesity,
alcoholism, anxiety, and depression, most of which frequently result in
admission to specialized care units.
In the elderly, the forms of illness have peculiar characteristics, with an increase
in diseases of degenerative origin such as heart disease, cancer, chronic
obstructive pulmonary disease, pneumonia, pulmonary edema, vascular
disease, arthritis, skin diseases, and accidents (falls, burns, poisoning), all of
which cause long periods of hospitalization. Other common conditions of old
age are hearing loss, cataracts and refractive errors, bone and joint pain, with
the particularity that, as one gets older, the probability of experiencing several
conditions at the same time increases.
Gestation is also a stage in the life of the woman and the couple where
education is needed. Psychoprophylaxis of childbirth has contributed a lot today
to obtain better results when the baby is born. All these groups, according to
their characteristics, need health education, especially when many of these
processes tend to be chronic, such as Diabetes Mellitus and cardiovascular
diseases, which causes the patient to abandon treatment or a healthy lifestyle.
These examples clearly show the usefulness of nursing staff, whose profession
is oriented to provide direct care to patients, either to restore their health or to
adapt to the sequelae of a disease suffered or to avoid complications.