ST.

LUKE’S COLLEGE OF NURSING

1st Semester
School Year: 2021-2022

GENERAL DISCUSSION SCHEDULE

COURSE CODE : NCM 106

COURSE TITLE : Pharmacology
LESSON NUMBER : 01 – Introduction to Pharmacology
TIME ALLOTMENT : 3 Hours
PRESCRIBED FLO : Preferred: e-Learning (E1, E2)
Alternative: Modular (M2)

TOPIC LEARNING OUTCOMES:

After the end of the lesson, the student should be able to:

1. Discuss the brief history of Pharmacology

2. Identify the various Philippine laws that governs the use, regulation, and distribution of drugs
3. Discuss the various application to clinical settings of the Philippine laws that governs the use, regulation, and distribution of drugs.
4. Identify major Pharmacologic principles and discuss its application to the clinical setting
5. Identify the stages of drug action under Pharmacokinetics

1 Pharmacology 01 – Introduction to Pharmacology

 Activities Strategies TA Remarks
1 ATTENTION Open the class with updates on school matters and today’s topic 5 minutes

2 OBJECTIVE Discussion of the learning objectives for the day 5 minutes

3 RECALL Ask the class on what medications they or any family members usually take. Ask on 5 minute
what they know about the medications they mentioned.
4 STIMULUS Deliver a 2-hour lecture 120 minutes

5 GUIDANCE Open the discussion for any inquiries from the class 5 minutes

6 PERFORMANCE Conduct a 10-item post-test 10 minutes

7 FEEDBACK Rationalize post-test answers 10 minutes

8 ASSESSING Conduct a 10-item pre-test 10 minutes

9 RETENTION Summarize the lesson, highlighting the salient points. 10 minutes

LESSON/TOPIC DISCUSSION

Learning Resources:
1. eBook
o Pharmacology: A Patient-Centered Nursing Process Approach, 9e by Linda E. McCuistion, Saunders (2017), Edition: 9
o Pharmacology and the Nursing Process by Lilley, L., Collins, S. & Snyder, J. (2017). 8th ed. St. Louis, Missouri: Elsevier.
o Mosby's 2020 Nursing Drug Reference, 33rd ed. by Linda Skidmore-Roth, St. Louis, MO : Elsevier (2020), Edition: 33
o Introducing Pharmacology: For Nursing and Healthcare by Roger McFadden, Routledge (2019), Edition: 3
o Pathophysiology and Pharmacology in Nursing (Transforming Nursing Practice Series) by Sarah Ashelford, Learning Matters (2019), Edition:
Second
o Lippincott NCLEX-RN Pharmacology Review by Hill
2. Scanned Reference Books
o PHARMACOLOGICAL REVIEWS Vol. 59, No. 4. 2007 by The American Society for Pharmacology and Experimental Therapeutics 70102/3301314
o Pharmacol Rev 59:289 –359, 2007
2 Pharmacology 01 – Introduction to Pharmacology
 3. Online Resources
o Philippine Drug Enforcement Agency. Laws and Regulations. https://pdea.gov.ph/laws-and-
regulations#:~:text=WHEREAS%2C%20by%20virtue%20of%20the,chemicals%20as%20provided%20in%20R.A.

LESSON 1 TOPICS:
A. Introduction to Pharmacology
B. History of Pharmacology
C. Drug Laws in the Philippines
D. Pharmacologic Principles

ACTIVITY 1: INTRODUCTION
• Open the class with updates on school matters and today’s topic
• Discuss the objectives of today’s lesson

ACTIVITY 2: PRE-TEST
DIRECTIONS: Read each questions below and choose the letter that best describe the answer for each. Rationalize the answers after.

1. These are chemicals obtained from plants or animals, or products of genetic engineering:
a. Medicine
b. Food
c. Drugs
d. Manna

2. These are chemical preparation, which contains one or more drugs, administered with the intention of producing a therapeutic effect:
a. Medicine
b. Food
c. Drugs
d. Manna

3 Pharmacology 01 – Introduction to Pharmacology

2. He discovered penicillin in 1928:
a. Jonas Salk
b. Selman A. Waksman
c. Alexander Fleming
d. Felix Hoffman

3. He is considered to be the “Founder of Modern Pharmacology:”

a. Jonas Salk
b. Selman A. Waksman
c. Alexander Fleming
d. Oswald Schmiedeberg

4. The organ that primarily metabolizes drugs is the:

a. Stomach
b. Kidney
c. Liver
d. Pancreas

5. This is the range where in the plasma concentration of shows its therapeutic effect:
a. Therapeutic window
b. Therapeutic index
c. Tachyphylaxis
d. Dose-response and Maximal effect

6. Which of the following statement is TRUE?

a. Water-soluble drugs are easy to absorb and easy to excrete
b. Water-soluble drugs are difficult to absorb and difficult to excrete
c. Lipid-soluble drugs are easy to absorb but difficult to excrete
d. Lipid-soluble drugs are difficult to absorb but easy to excrete

7. During what period did vaccines significantly been develop?

a. Middle Ages

4 Pharmacology 01 – Introduction to Pharmacology

 b. Renaissance
c. 19th Century
d. 20th Century

8. Which of the following statements is TRUE?

a. All drugs are medicine
b. All medicine are drugs
c. Medicines are taken in its purest form to illicit its pharmacologic effect
d. Drugs are taken in its purest form to illicit its pharmacologic effect

9. This is the proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect:
a. Biotransformation
b. Bioavailability
c. Therapeutic index
d. Therapeutic window

10. Epinephrine is an adrenergic agonist drug. Which of the following drug action does it has?
a. Stimulation of receptor to cause a pharmacologic effect
b. Depression of a receptor to illicit a pharmacologic effect
c. Replacement of a neurotransmitter in the body
d. Irritate cells to cause a pharmacologic effect

ACTIVITY 3: INTRODUCTION TO PHARMACOLOGY

A. Introduction to Pharmacology
• Pharmacology - study of substances that interact with living systems through chemical processes.
• Drug - chemicals obtained from plants or animals, or products of genetic engineering.
• Medicine - chemical preparation, which contains one or more drugs, administered with the intention of producing a therapeutic effect.

B. History of Pharmacology

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 Table 1.1: History of Pharmacology: Stone age-Rennaissance

Stone Ages Ancient Times Middle Ages Renaissance

Alchohol – nutrition, medicine Hippocrates – Inorganic salts as Medical care taken over Paracelsus – challenged Galenic medicine.
and rituals medications. by the Church. He also promoted use of chemicals and
minerals (zinc) in medicine.
Medicine became a
Primitive men – recognized the
Galen –dogmatic approach to matter of faith and
benefits/toxic effects of plants
medicine prescriptions became
and animal materials
prayers.

• Dose-response relationship - It correlates exposures with changes in body functions or health. In general, the higher the dose, the more severe the response.
It is based on observed data from experimental animal, human clinical, or cell studies.
• Paracelsus: “Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy.”
• Reason for failure of Medicine during the Middle Ages:
○ Poor knowledge of the functioning of the body.
○ Lack of experimentation and observation.
○ Close relationship between religion and treatment of diseases (drugs were thought to be magical!).

Table 1.2: History of Pharmacology: 18th Century-21st Century

18th Century 19th Century 20th Century 21st Century

Francois Magendie &

By the early 1900’s, there were
Claude Bernard – American Civil War – Rapid growth of information and
an estimated 250,000 addicts in
Experimental Physiology & morphine use understanding of the molecular basis for drug
the United States.
Pharmacology. action
Morphine, laudanum,
Simultaneous developments Various US laws has been
cocaine, heroin were
in botany, zoology, chemistry established to address drug
completely unregulated and
& physiology. addiction
prescribed freely by the
6 Pharmacology 01 – Introduction to Pharmacology
 physicians for a wide variety
of ailments.

Nutritional deficiencies has been

addressed

Numerous vaccine discoveries

• Oswald Schmiedeberg (1838–1921) - founder of modern pharmacology

• Felix Hoffman develops aspirin (acetyl salicylic acid) in 1899 from the juice from willow tree bark to relieve pain.
• Pure Food and Drug Act of 1906 - First national drug law in the US, which required accurate labeling of patent medicines containing opium and certain
other drugs.
• Harrison Narcotic Act of 1914 - forbade sale of substantial doses of opiates or cocaine except by licensed doctors and pharmacies
• In 1906, Sir Frederick Gowland Hopkins suggested that vitamins are essential to health and suggests that a lack of vitamins causes scurvy and rickets
• In 1921:
o Edward Mellanby discovers vitamin D and shows that its absence causes rickets.
o Frederick Banting and Charles Best discovered insulin
o Fidel Pagés pioneered epidural anesthesia
• 1928: Scottish bacteriologist Sir Alexander Fleming discovered penicillin.
• 1943: Microbiologist Selman A. Waksman discovers the antibiotic streptomycin, later used in the treatment of tuberculosis and other diseases.
• 1955: Jonas Salk developed the first polio vaccine.
• The recognition of fetal alcohol syndrome* brought warning tablets to alcohol products.
• The addictive nature of prescription drugs such as Diazepam (valium) became known, and caffeine came under scrutiny as well.
• The Comprehensive Drug Abuse Prevention and Control Act of 1970 repealed, replaced, and updated all previous federal laws concerned with narcotics
and all other dangerous drugs.
• The Anti-Drug Abuse Acts of 1986 and 1988 increased funding for treatment and rehabilitation of drug addiction.
• Currently, modern pharmacology uses genetics, molecular biology, biochemistry, and other advanced tools to transform information about molecular
mechanisms and targets into therapies directed against disease, defects or pathogens, and create methods for preventative care, diagnostics, and ultimately
personalized medicine.

7 Pharmacology 01 – Introduction to Pharmacology

 • COVID-19 vaccination is one of the global measures utilized to transition out of the current pandemic. Without them, that natural herd immunity would
not have been sufficient to restore society to its normal status quo and that it would have resulted in extreme fatality. In 2021, numerous vaccines were
given emergency approval and begin their global roll out in countries across the world. As of March 2021, almost 300 million vaccine doses had been
administered worldwide.
C. Drug Laws in the Philippines:
• RA 9165 - Comprehensive Dangerous Drugs Act Of 2002
o It is a state policy to safeguard the integrity of its territory and the well-being of its citizenry from the harmful effects of dangerous drugs
• EO 218 - Creation of the Philippine Drug Enforcement Agency (PDEA)
o By virtue of the Comprehensive Dangerous Drugs Act of 2002 (RA 9165), the Philippine Drug Enforcement Agency (PDEA) was created for
effective law enforcement of all dangerous drugs and/or precursors and essential chemicals
o PDEA - Leading anti-drug law enforcement agency, responsible for preventing, investigating and combating any dangerous drugs, controlled
precursors and essential chemicals within the Philippines
• RA 10640 - Strengthening of Section 21 of the Comprehensive Dangerous Drugs Act Of 2002
o The PDEA shall have custody of all dangerous drugs, plant sources, essential chemicals, as well as instruments/paraphernalia and/or laboratory
equipment
• RA 6675 - Generic Acts Of 1998
o An act to promote, require and ensure the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified by
their generic names
o Amended to RA 6675
▪ All medical, dental and veterinary practitioners shall write the generic names on the prescription
o Government institutions: Only writes the generic name
o Private institutions: have an option to include the brand name, given that the generic name SHOULD ALWAYS be written
• RA 9502 - Cheaper Medicine Act Of 2008
o An act providing for cheaper and quality medicines, amending for the purpose republic act no. 8293 or the intellectual property code, republic act
no. 6675 or the generics act of 1988, and republic act no. 5921 or the pharmacy law, and for other purposes
o Gives the President of the Philippines, upon the recommendation of DOH-secretary the power to impose maximum retail prices over any or all
drugs and medicines:
▪ drugs indicated for treatment of chronic illnesses and life-threatening conditions
▪ Drugs and medicines indicated for prevention of diseases, e.g., vaccines, immunoglobulin, anti-sera
▪ Drugs and medicines indicated for prevention of pregnancy, e.g., oral contraceptives
▪ Anesthetic agents

8 Pharmacology 01 – Introduction to Pharmacology

 ▪ Intravenous fluids
▪ Drugs and medicines that are included in the Philippine National Drug Formulary (PNDF) Essential Drug List
▪ All other drugs and medicines which, from time to time, the Secretary of the Department of Health determines requiring price regulation
o Strengthening Bureau of Food and Drugs Administration (for quality assurance of drugs)

D. Pharmacologic Principles
• Pharmaceutics - formulation of drugs to their delivery and disposition in the body to help them achieve therapeutic effects at their sites of action.
• Enteral and Parenteral Drugs
o 80% of drugs are taken orally (enteral).
o Oral meds must be disintegrated and combined with a solution to be absorbed by the GI tract and into the bloodstream.
o Parenteral drugs do not pass the GI tract.
• Disintegration – Breakdown of tablet into smaller particles
• Dissolution – Dissolving of smaller particles in the GIT
• Remember!
o Food in the GI tract may interfere with dissolution
o Some drugs may be gastric irritant, so food may be necessary to dilute drug concentration
o Liquid form are more rapidly available for absorption
o Drugs are better absorbed in acidic pH
o Young and elderly have less gastric acidity
• Enteric-coated drugs - polymer barrier applied on oral medication that prevents its dissolution or disintegration in the gastric environment, causing
delayed onset/ sustained release

• Pharmacokinetics - process of drug movement to achieve drug action

o Absorption
▪ Active
▪ Passive
▪ Pinocytosis
o Distribution - Drug in plasma
o Metabolism
▪ Drug in tissues
▪ Liver

9 Pharmacology 01 – Introduction to Pharmacology

 o Elimination
▪ Metabolites in tissues
▪ Metabolites in urine/feces
• Drug Absorption
o Movement of a drug into the bloodstream after administration.
o Absorption affects bioavailability*
• Bioavailability
o Percentage of administered dose that reaches systemic circulation
o Proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect
• Factors Influencing Bioavailability:
o Drug form: tablets, capsule, liquid, transdermal patch, suppository, inhalation
o Route of administration: enteral, topical or parenteral
o GI mucosa and motility
o Administration with food or other drugs
o Change in liver metabolism due to liver dysfunction or decrease in hepatic bloodflow
• Drug Absorption through GI Membrane
o Active Absorption: energy dependent (ATP) – Requires an enzyme or protein – may be from low to high concentration
o Passive Absorption: no energy
▪ Diffusion – high to low concentration
▪ Facilitated Diffusion – rely on carrier protein from high to low concentration
o Pinocytosis – Cells carry drug across membrane by engulfing drug particles
• Water-soluble Drugs – Drugs that dissolve in water
o Ex. antihypertensive drug atenolol, tend to stay within the blood and the fluid that surrounds cells (interstitial space).
• Lipid-soluble Drugs – Drugs that dissolve in fat
o Ex. antianxiety drug clorazepate, tend to concentrate in fatty tissues.
• Remember!
o GI tract is lined with lipids, thus lipid-soluble drugs pass rapidly through the mucous membrane
o Water-soluble drugs need a carrier (enzyme or protein) to pass thru mucous membrane
• Factors Affecting Drug Absorption
o Blood flow
o Pain
o Stress

10 Pharmacology 01 – Introduction to Pharmacology

 o Hunger
o Fasting
o Food
o pH
• Remember! Certain drugs need acid for better absorption (thus taken after meals)
Hepatic First-pass Effect
o A fraction of the drug can be metabolized in the liver before it even reaches the systemic circulation.
o Therefore, the bioavailability of the drug is reduced.
• Distribution - Movement of a drug to and from the blood and various tissues of the body (Ex. fat, muscle, and brain tissue) and the relative proportions of
drug in the tissues.
• Plasma Protein-binding Effect - Degree to which medications attach to proteins within the blood.
• Common Blood Proteins that Drugs Bind:
o Human Serum Albumin
o Lipoprotein
o Glycoprotein
o α, β‚ and γ Globulins

• Remember: The less bound a drug is, the more efficiently it can traverse cell membranes or diffuse
• Free drugs AKA Unbound drug - An active drug or other compound that is not bound to a carrier protein
• Volume of Drug Distribution (Vd)
o Information on the drug’s distribution in the body.
o Calculated as the ratio of the dose present in the body and its plasma concentration
• Blood-brain Barrier (BBB) - highly selective semipermeable border of endothelial cells that prevents solutes in the circulating blood from non-selectively
crossing into the extracellular fluid of the central nervous system where neurons reside.
• Metabolism (Biotransformation)
o Chemical alteration of chemicals such as nutrients, amino acids, toxins, and drugs in the body.
o Liver: primary site; metabolizes lipid soluble drugs into water-soluble drugs for excretion
• Half-life (t ½)
o Time it takes for one-half of the drug concentration to be eliminated
o Takes approximately six half-lives for a drug to be eliminated around 98%
• Loading Dose - Initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance
dose

11 Pharmacology 01 – Introduction to Pharmacology

 • Excretion
o Most drugs, particularly water-soluble drugs and their metabolites*, are eliminated by the kidneys in urine.
o Others: sweat, feces, saliva, bile and breast milk
o Therefore, drug dosing depends largely on kidney function.
• Creatinine Clearance
o Measures renal function
o Normal: 85-135 ml/min
• Pharmacodynamics
o Branch of pharmacology concerned with the effects of drugs and the mechanism of their action.
o Study of drug concentration and its effects in the body
• Receptor Theory - A drug receptor is a specialized target macromolecule that binds a drug and mediates its pharmacological action.
o Ex. enzymes, nucleic acids, or specialized membrane-bound proteins.
o The formation of the drug-receptor complex leads to a biological response.
• Receptor Site - Proteins that are on the surface of each cell that act as receivers of chemical messenger molecules in the intercellular fluid surrounding
every cell.
• Agonists - activate receptors to produce the desired response; drugs that produce a similar response
o The drug agonist that has an exact fit with a receptor is a strong agonist and is more biologically active
• Antagonists - prevent receptor activation; drugs that block a response
• Non-specific Drug Effect - Drugs that affect multiple receptor cites
o Ex. Cholinergic drugs may affect all cholinergic receptors*: bladder, heart, blood vessels, stomach, bronchi, and eyes.
• Non-selective Drug Effect - Drugs that affect multiple receptor
o Ex. Epinephrine affects three different receptors: alpha, beta1, and beta2.
• Categories Of Drug Action:
o Stimulation or depression – stimulate/depresses cell action ex. CNS drugs
o Replacement – replaces biological substance ex. hormones
o Inhibition or killing of organisms – ex. antimicrobials
o Irritation – can cause inflammatory responses
• Dose-response and Maximal effect - relationship between the minimal and maximal amount of drug dose needed to produce the desired drug response
• Onset - Time it takes to reach the minimum effective concentration (MEC) after a drug is administered
• Peak action - Occurs when the drug reaches its highest blood or plasma concentration
• Duration of action - Length of time the drug has a pharmacologic effect
• Side Effects - Physiologic effects not related to desired drug effects, which can be desirable or undesirable

12 Pharmacology 01 – Introduction to Pharmacology

 • Adverse Effects - Range of untoward effects of drugs that may cause mild to severe side effects, these are always undesirable
• Toxic Effects
o Level of damage that a compound can cause to an organism.
o When the drug level exceeds the therapeutic range of the drug
• Tachyphylaxis - Rapidly diminishing response to successive doses of a drug, rendering it less effective.
• Placebo Effect – beneficial effect that cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient's belief in that
treatment.
• Pharmacotherapeutics - The use of drugs and the clinical indications for drugs to prevent and treat diseases
• Therapeutic Index - Margin of safety of a drug through the use of a ratio that measures the effective (therapeutic concentration) dose (ED) in versus the
lethal dose (LD)
o Low therapeutic index drug has a narrow margin of safety, and the drug effect should be closely monitored.
o High therapeutic index drug has a wide margin of safety and carries less risk of drug toxicity.
• Therapeutic Window - Range of doses that produces therapeutic response without causing any significant adverse effect in patients; between the
minimum effective concentration (MEC and the minimum toxic concentration (MTC)
• Therapeutic Failure - Failure to achieve or maintain desired therapeutic effect of a drug.
• Causes of Therapeutic Failure:
o Poor Compliance
o Factors affecting Biotransformation
o Factors affecting Bioavailability
o Drug Interactions
o Drug Tolerance
o Quality of Drugs
o Inappropriate Indication
o Untoward effects

ACTIVITY 4: DISCUSSION / EXERCISE

• Ask the class for any questions that they may have regarding the lecture.

ACTIVITY 5: POST TEST

DIRECTIONS: Read each questions below and choose the letter that best describe the answer for each. Rationalize the answers after.
13 Pharmacology 01 – Introduction to Pharmacology
1. Who is considered to be the founder of the dogmatic approach to Pharmacology?
a. Galen
b. Paracelsus
c. Hippocrates
d. Bacchus

2. Metoprolol is a Beta Blocker antihypertensive drug. Which of the following drug action does it has?
a. Stimulation of receptor to cause a pharmacologic effect
b. Depression of a receptor to illicit a pharmacologic effect
c. Replacement of a neurotransmitter in the body
d. Irritate cells to cause a pharmacologic effect

3. This is the law that established the Philippine Drug Enforcement Agency:
a. EO 218
b. EO 214
c. RA 9165
d. RA 10640

4. This was the first drug law in the US passed in the 20th century to require pharmaceutical companies to add in their labels any medicines containing opium
and certain other drugs:
a. Pure Food and Drug Act
b. Harrison Narcotic Act
c. Comprehensive Drug Abuse Prevention and Control Act
d. Anti-Drug Abuse Act

5. Which of the following is FALSE?

a. Food in the GI tract may interfere with dissolution
b. Some drugs may be gastric irritant, so food may be necessary to dilute drug concentration
c. Liquid form are more rapidly available for absorption
d. Drugs are less likely to be absorbed in acidic pH

6. Which of the following is the study of drug concentration and its effects in the body?

14 Pharmacology 01 – Introduction to Pharmacology

 a. Pharmaceutic
b. Pharmacokinetics
c. Pharmacodynamics
d. Pharmacotherapeutics

7. This are drugs that affect multiple receptor cites:

a. Agonists
b. Antagonists
c. Non-specific drugs
d. Non-selective drugs

8. Who is considered to be the “Father of Pharmacology?”

a. Galen
b. Paracelsus
c. Hippocrates
d. Bacchus

9. Drug X when taken, will start to have a therapeutic effect after 2 hours of administration, will have its strongest effect after 4 hours of administration, and
will lose its effect after 6 hours of administration. If a patient takes Drug X at 6PM, when will the peak effect happen?
a. 8PM
b. 10PM
c. 12MN
d. 2AM

10. Carlo was prescribed antibiotic therapy for 7 days for his gonorrhea. On the seventh day, he was still having pyuria. Upon further consultation, he mentioned
that he failed to take his meds on the 3rd and 4th day. Which of the following is the reason for his antibiotic therapy failure?
a. Poor Compliance
b. Drug Interactions
c. Drug Tolerance
d. Quality of Drugs

15 Pharmacology 01 – Introduction to Pharmacology

ACTIVITY 6: SYNTHESIS / EXERCISE

• Summarize the lesson, highlighting the salient points.

Prepared by: Reviewed by: Approved by:

Dr. Tristan Jourdan C. Dela Cruz, RN Dr. Mike Daniel Tai, RN Dr. John Michael O. Lorena, RN
Lecturer, Pharmacology Academic Head Dean

16 Pharmacology 01 – Introduction to Pharmacology