PHARMA INTRODUCTION ● Examples: abdominal pain, confusion,

Nursing Process decreased adherence, need for health

● Concept teaching.
● Assessment ● focuses on individual patient care related to
● Patient problem actual problems from the patient's illness and
● Planning not the actual disease process.
● Implementation
● Evaluation Planning
● Set goals and expected outcomes and
Concept interventions to address patients' problems.
● “What is the reason care is given to the ● Patient-centered, Specific, time-bound
patient?” ● involves development of nursing interventions
● Holistic view of patient to meet medication goals.
● Includes health, illness, and health promotion. ● collaboration with patients/or family is
● Preventive, primary, acute, and chronic necessary.
health care.
Qualities of effectiveness goal-setting
Assessment ● Expected change is realistic, measurable, and
● Information gathering includes reasonable deadlines.
● Subjective ● The goal is acceptable to both the patient and
● Objective the nurse.
● Basis for patient’s plan of care. ● The goal is dependent on the patient's
decision-making ability.
Subjective ● The goal is shared with other health care
● Current health history providers, including family and caregivers.
● Dysphagia ● The goal identifies components of evaluation.
● Verbalization of signs and symptoms of illness
● Knowledge of medication and side effects Implementation of nursing intervention
● OTC remedies, nutritional supplements, herbal ● Provision of education, drug administration,
medicines, contraceptives. patient care, and other intervention necessary
● Allergies to assist patients in accomplishing the
● Use of tobacco, alcohol, and caffeine. established medication goals.
● Administration of drugs and assessment of
Objective drug’s effectiveness.
● Physical health assessment
● laboratory and diagnostic test result Patient technique
● data from physician's order ● Patient readiness to learn and investment in his
● Measurement of vital signs or her learning.
● patient’s body language ● timing and environment
● language barriers
Patient’s Problem ● Age
● Based on the analysis of the assessment data ● level of education
● determines type of care patient will receive
● more than one capable problem may be
generated
● guides the development of the plan of care
Principles of Drug health teaching - genotoxicity: ability of a compound to
● General damage genetic information in a cell.
- Instruct to take drugs as prescribed. consistency to
prescribed drug regimen is important. ● Human clinical experimentation
-Provide simple written instructions. Phase 1- evaluate safety, determine a safe
- advice to notify health care provider if the following dosage range, and identify side effects
occur: Phase 2- determine effectivity and further
< doze, frequency, or time or time of drugs is evaluate safety
adjusted Phase 3- Larger group of people to confirm
< female patient becomes pregnant. effectiveness, monitor side effects, compared
<OTC medication or supplement is added. with commonly used treatments, and collect
● Side effects information that will allow drug to be used
-Instruct methods to help minimize side effects. safely.
- Advise on any expected changes in color of urine or Phase 4- Done after released in the market to
stool. gather information on drugs effects various
- Counsel to rise slowly from sitting to standing position populations and assess in a long-term side
with dizziness from orthostatic hypotension. effect.
● Self-administration
- assess motor skills and abilities Core ethical principle
- instruct the patient according to the prescribed 1. Respect for person
route . Include a return demonstration when 2. Beneficence
appropriate 3. justice
-Use drug cards- name of the drug, reason for taking
the drug, drug dose, timing, possible side effects, ● Respect for person
adverse effects, when to notify health care provider, -Patients should be treated as
and specific facts that should or should not be done independent persons capable of making
when taking the medication. decisions and their own best interest.
● diet -Patients with diminished decision-
-Many foods interact with certain drugs. making should be protected.
- decrease drug absorption, increase risk of drug - make patient aware of alternatives
toxicity, or create other problems. and consequences from those
alternatives.
Evaluation - autonomy- right to self-
● Determine whether the goals and teaching determination
objectives have been met.
● Continually use ongoing assessment data to
evaluate success in attainment of objectives and ● Informed consent
goals -The most important relevant aspects:
● Revision of objectives, goals, and interventions. right to be informed and voluntary
participation.
Drug development and ethical considerations - mutual sharing information
-expresses respect for the person
● Preclinical trials -gains patients active involvement in
- determine drug’s toxic and pharmacologic their care
effects through in vitro and in vivo animal - Respects the patient's right to self-
testing in the laboratory. determination.
 ● Drugs are disintegrated and absorbed faster in
● Beneficence acid fluids with the PH of 1 or 2.
-Duty to protect research subjects from harm. ● Very young and early old have lesser gastric
ensuring the risk and possible benefits are clearly acidity.
defined, and ensuring the benefits are greater than the ● Enteric-coated tablets undergo disintegration
risk in the alkaline environment of the small
- risk-benefit ratio intestine.
● EC tablets or capsules and sustained release
● Justice capsules should not be crushed.
-Collection of research subjects and should be fair. ● Passive transport
-distribution of benefits and burdens is equitable. - Diffusion- high concentration> low
concentration
Drug names - facilitated diffusion- carrier protein
● Chemical name- drugs chemical structure ● Active Transport - requires a carrier such as an
● generic name- official, nonproprietary name enzyme or protein to move the drugs against
● brand name- proprietary name, chosen by the the concentration ingredient and energy is
drug company required for active absorption.
● Pinocytosis - a process in which a cell carries a
Over the counter drugs drug across their membrane by engulfing the
● Safe and appropriate for use without the direct drug particles in a vesicle.
supervision of a health care provider. ● The mucous membrane of the GI tract is
● Available for purchase without a prescription. composed of lipids and protein
- Lipid-soluble drugs has pass rapidly.
Pharmacokinetics and pharmacodynamics - water soluble drugs need a carrier
( enzyme or protein)
Pharmacokinetics ● Non-iodized particle pass easily
● What the body does to the drug. ● Poor circulation to the stomach hampers
● Process of drug movement throughout the absorption.
body necessary to achieve drug action. ● Pain, stress, and foods that are solid, hot, or
● Four processes: absorption, distribution, high in fat slow gastric emptying time.\
metabolism( biotransformation), ● Exercise shunts blood to peripheral muscles.
excretion(elimination). ● Rectally-administered drugs are absorbed
slower.
Drug Absorption ● First-pass effect- drugs that pass through the
● Movement of the drugs into the bloodstream liver and are metabolized to an inactive form.
after administration. ● Other routes (IV,IM, SQ, nasal, sublingual, and
● fillers and inert substances- excipients- allow buccal) are not subjected to first-pass
the drug to take on a particular size and shape metabolism.
and enhance drug dissolution.(e.g. potassium ● Bioavailability- percentage of administered
and sodium salt in penicillin) drug available for activity
● Disintegration- breakdown of oral drugs into -Oral drugs- less than 100%
small particles. - IV drugs- 100%
- Rate of dissolution- time it takes for Factors:
drugs to disintegrate and dissolve To - drug form
become available for absorption. - route of administration
- gastric mucosa and motility
 - administration with food and other drugs of drug administered, the amount of drug
- changes in liver metabolism remaining in the body from the previous dose,
metabolism, and elimination.
Drug distribution - used to determine dosing interval
● Movement of drug from the circulation of the - Steady-state- occurs when the amount
body tissues. of drugs being administered is the same
● Influenced by vascular permeability and as the amount being eliminated;
permeability of cell membranes, regional blood optimal therapeutic benefit.
flow and ph, cardiac output, tissue perfusion, ● Loading dose- large initial dose as compared to
ability of drug to bind tissue and plasma maintenance dose for therapeutic effects to be
proteins, and lipid solubility. obtained while steady state is reached.
● protein binding ● maintenance dose- doze Needed to maintain
-Drugs band with plasma proteins (e.g. drug concentration at steady state when given
albumin, lipoprotein, and alpha-1-acid repeatedly at a constant dose and constate
glycoprotein) dosing interval.
- acidic drugs (e.g. aspirin) and neutral
drugs bind with albumin or lipoproteins Drug excretion
- Basic drugs bind to AGP ● Kidneys- main route of elimination
- Highly protein-bound drugs- more - Filter free drugs, water-soluble drugs,
than 90% bound to protein. and drugs that are unchanged.
- The portion of drug bound to protein - Normal urine ph: 4.6 - 8.0
is inactive. Unbound portion are free active - acidic urine promotes and emanation
drugs of weak base drugs
● When two highly protein-bound drugs - Alkaline urine promoted elimination of
are administered together, they weak acidic drugs.
compete for protein binding sites, ● Creatinine- metabolic by-product of muscle
leading to an increase in the free drug excreted by the kidneys
being released into the circulation. ● blood urea nitrogen- Metabolic breakdown
● Low protein plasma levels may product of protein metabolism.
potentially decreases the number of ● eGFR- Creatinine level, age, body size, and
available binding sites and lead to an gender.
increase in the amount of free drugs.
Pharmacodynamics
Drug metabolism ● Effect of drugs on the body
● Biotransformation- Those needed to maintain ● primary effect- desirable effect
drug concentration by which the body ● secondary effect- desirable or undesirable.
chemically changes drugs into a form that can ● Dose-response relationship- Body's psychologic
be exerted. response the changes in drug concentration at
● liver- primary site of metabolism the site of action.
● Cytochrome P450- liver enzymes that convert ● Potency- Amount of drug needed to elicit a
drugs to metabolites. specific psychologic response to a drug.
● Prodrug- Compound that is metabolized into an ● Maximal efficacy- Point at which increasing a
active pharmacologic substance and designed drugs dosage no longer increases the desired
to improve drug bioavailability. therapeutic response.
● Half-life- time it takes for a drug in the body to
be reduced by half and it is affected by amount
● Therapeutic Index(TI)- Describes relationship
between the therapeutic dose of the drug
(ED50) And toxic dose of the drug(TD50).
● ED50- dose of drug that produces a therapeutic
response and 50% of the pollution.
● TD50- dose of a drug that produces a toxic
response in 50% of the pollution.
● Narrow therapeutic index
● Onset- time it takes for a drug to reach the
minimum effective concentration(MCE) after
administration.
- MEC- Minimum amount of drug
required for drug effect.
● Peak- time when drug reaches its highest
concentration in the blood stream.
● Duration of action- length of time the drugs
exerts a therapeutic effect.
● therapeutic drug monitoring
- Peak drug level- highest plasma
concentration of a drug at a specific
time and indicates rate of drug
absorption.
-Peak is too low, effective
concentration has not been reached.
- Trough drug level- lowest plasma
concentration of a drug and measures
rate of drug elimination.
● Receptor theory
- Drugs act by binding receptors
- The better the drug fits at the receptor
site, the more active the drug is.
- Receptors are found on cell surface
membranes or within the cell itself.
● ligand -binding domain- site on the receptor at which drugs bind.
● Four receptor families
1. Cell membrane- embedded enzymes- ligand binding domain is on the cell surface and drug activates
enzyme inside the cell.
2. Ligand-gated ion channels- channels crosses cell membrane; primarily affects sodium and calcium ions.
- Ligand-binding domain- site on the receptor at which drugs bind.
3. G-protein- coupled receptor systems- Drug> receptor> G protein> Effect.
4. Transcription factors- cell nucleus on DNA; regulates protein synthesis and is prolonged.
- Side effects- secondary effects of drug therapy.
- Adverse drug reaction- unintentional, unexpected reactions to drug therapy that occur at
normal drug dosages
- Drug toxicity- occurs when drug level exceed the therapeutic range either through overdose or
drug accumulation.
- Tolerance- decreased responsiveness to a drug over the course of therapy.
- Tachyphylaxis- acute, rapid decrease in response to drug
- Placebo effect- drug response not attributed to the chemical properties of the drugs.
- Additive effect- two drugs are administered in combination and response in increased; sum of
the effects of two drugs
- Synergic effect- effect of two drugs given together is substantially greater than that of either
drug alone.
- Antagonist effect- one drug reduces or blocks the effect of the other.