i am lecturer at DOW INSTITUTE OF NURSING DOW UNIVERSITY O HEALTH SCINCES

1. INTRODUCTION TO
PHARMACOLOGY
Syed Yousaf Shah
Lecturer
Institute of Nursing
DUHS

2.
GRADE /GPA REQUIREMENT FOR EACH
SEMESTER & GRADUATION

3. Assessment
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Pattern (formative and summative)
Criteria for formative assessment :
Attendance class participation quizzes, Assignment and
presentation.
 Internal evaluation 30%
Criteria for Summative :
Midterm 30% weightage (Conducted by Examination
Department)
End of semester 40 % weightage
Overall assessment 100 % weightage

4. TEACHING/
LEARNING
STRATEGIES

Lecture/tutorials/handouts, self-directed
learning, drug cards and quiz.

5. PHARMACOLOGY-I
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Topic
Introduction to Pharmacology
Introduction to Pharmacology
Introduction to Pharmacology
Introduction to Pharmacology
Quiz I (5%)
Drugs Used to Treat and Prevent Infections
Drugs Used to Treat and Prevent Infections Assignment I(5%)
Drugs Used to Treat and Prevent Infections
Drugs Affecting the Gastrointestinal System
Drugs Affecting the Gastrointestinal System
Midterm 30%
Drugs Affecting Haematology System
Drugs Affecting Haematology System
Drugs Affecting Haematology System Quiz II (5%)
Anti-neoplastic-Drugs
Anti-neoplastic-Drugs
Assignment II (5%)
Anti-neoplastic-Drugs
Presentation & submission (10%)
Final Exam 40%
Date
9-11-13
16-11-13
23-11-13
30-11-13
7-12-13
14-12-13
21-12-13
28-12-13
04-12-13

6. References:
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1. Aucker, L. (2001). Pharmacology and the nursing
process. (3rd ed.). London: Mosby.
2. Boyer, M. J. (2002). M th fo r nurs e s . (5th ed.).
a
Philadelphia: Lippincott.
3. Bruegal, C. (2003). Staying a step ahead of
migraines. N ing 3 3 , (1 1 ), pp.56-58.
urs
4. Clayton, B. D. & Stock, Y. N. ((2001). Ba s ic
p ha rm a c o lo g y fo r nurs e s . 1 2 th e d London: Mosby.
5. Clayton, B. D. & Stock, Y. N. (2001). Drugs used to
treat glaucoma and other eye disorders. In (12th ed.).
Ba s ic p ha rm a c o lo g y fo r nurs e s . (pp. 430 - 468). London:
Mosby.
6 . Do s a g e c a lc ula tio ns : M d e inc re d ibly e a s y (2001).
a

7. LEARNING
OBJECTIVES
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Define drug and pharmacology
Discuss the terminologies related to pharmacology
Discuss the history of pharmacology briefly
Briefly discuss routes of administration.
Identify the purposes of medication
Identify the source of medication
Discuss the classification of drugs
Describe the three type of drug supply system.
Discuss the drugs standards and legislation.
Identify resource to collect and utilize drug
information.

8. PHARMACOLOGY
“A branch of
medical sciences
that study drugs
and their action on
living organisms”

9. DRUG
“Any substance
that brings about
a change in
biologic function
through its

10. DRUG
“chemical substance used in
the treatment, cure,
prevention, or diagnosis of
disease or used to
otherwise enhance physical
or mental well-being."

11. HISTORY OF
PHARMACOLOGY







Chinese medicine – oldest
Sumerian tablet – ointment and medicines
containing potassium nitrate, asafoetida.
Eberspapyrus  more than 700 pharmacopeal
documents including
beer,turpentine,berries,poppy,lead,salt & crushed
precious stones etc.(Egyptian remedies).
Hippocrates – Father of medicine.
Aristotle – separated Superstition from fact
Paracelsus – mercurials in syphilis
Francois megendiea – concept of scientific
methods in drug study.

12. 
Ostwald schimiedorg , jacob abel – modern for
experimental Pharmacology.

13. WHY DO NURSES STUDY
PHARMACOLOGY??
“ To safely administer
medications and to monitor
patients who receive these
medications”

14. GENERAL
CLASSIFICATION OF DRUG





Prescription Drugs
Official Drugs
OTC Drugs
Controlled Drugs
High Alert Medications

15. Therapeutic Classification

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
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

Analgesics
Anxiolytics
Anesthetics
Anti- Asthmatics
Antiinfectives
Antibacterials
Antivirals
Antifungal
AntiTuberculer Drug

16. 











Antimalarials
Antacids
Antiacne
Antihypertensives
Antianginal
Antiarrythmics
Antiinflammatory
Hypolipidemics
Antiepileptics
Antiemetics
Antidiarrheal
Antihistamines

17. RELATED
DEFINITION



Receptor
“A specific protein in either the plasma
membrane or interior of a target cell
with
which a chemical messenger/drug combines”
Mechanism of Action
“The ways by which drugs can produce
therapeutic effects”
Dose
“The amount of a drug to be administered at
one time”

18. Pharmacology, Definitions
 Indications
“The reasons for administering a
medication or performing a
treatment”
 Contra-indications
“Factor that prevents the use of a
medication or treatment (e.g.,
Allergies)”
 Effects (therapeutic effect)
“The desired results of
administration of a medication”
 Side Effects (adverse effects)
“Effects that are harmful and
undesired, and that occur in
addition to the desired
therapeutic effects”

19. 
Duration
“The time a drug concentration is sufficient to elicit a therapeutic
response”

Onset
“The time it takes for the drug to elicit a therapeutic response”

20. FIVE R’s

21. DRUG
SOURCES
1. Plant Sources:
Examples include digoxin from digitalis and
morphine from opium.
2. Animal Sources: Glandular products from
animals are used, such as insulin and thyroid.
3. From micro-organisms (fungi, bacteria)
Penicillin was discovered by Alexander Fleming
in 1928 as a product of penicillium notatum (a
mold growing in his lab)

22. Mineral Sources: from minerals,
for example, lithium carbonate
(an antipsychotic), MgSO4 (a
laxative)
Synthetic Sources:
Examples include sulfonamides,
and aspirin.

23. SOURCES OF DRUG
INFORMATION






Text books
Materia medica
Pharmacopea
Formulary
Journals
Pharmacists

24. Drug Nomenclature
 Chemical name - represents the exact description of the drug’s chemical
composition
 Generic name (non-proprietary)
- simpler than the chemical name and
- derived from the chemical name itself
- easier to remember
 the chemical name 2-methyl-5-nitroimidazole-l-ethanol is metronidazole. The
word methylnitro is condensed to metro and ni-dazole is due to its imidazole ring

25. 
is developed by
the company requesting approval for the drug
and identifies it as the exclusive property of
that company.
Brand or trade name (proprietary) 




Flagyl® is the trade name for metronidazole.
Metoclon® is the trade name for Metoclopramide.
Amoxil® is the trade name for amoxycillin.
Panadol® is the trade name for Acetaminophene.

26. Pregnancy Categories



Category A-studies in pregnant women failed
to show risk to the fetus
Category B- animal studies have failed to
show a risk to the fetus but there are no
adequate studies in women
Category C-animal studies have shown an
adverse effect on the fetus, no adequate
human studies, benefits may outweigh risks

27. Pregnancy Categories


Category D-positive evidence of human fetal risk.
Category X-animal or human studies have shown
fetal abnormalities or toxicity

28. DRUG BODY
INTERACTION

29. PHARMACOKINETICS
What the Body Does with the DRUG

32. PHARMACODYNAMICS
What the Drug Does to the Body

33. LOCK AND KEY
MODEL

hormones or neurotransmitters (the"key")
affect target cells by binding to specific
receptors (the "lock”), which are often
located in the cell membrane
"unlocks" the cell's response.
 Effect of hormone


35. AGONIST
“A chemical messenger that binds to a
receptor and triggers the cell’s response
often refers to a drug that mimics a normal
messenger’s action”.
 PILOCARPINE
- muscarinic receptor agonist,
bind to and activate muscarinic receptors

36. Drug Receptor Interactions
Lock and key mechanism
Agonist
Receptor
Agonist-Receptor
Interaction

37. ANTAGONIST
“A molecule that competes for a receptor with a
chemical messenger normally present in the
body. The antagonist binds to the receptor but
does not trigger the cell’s response”
 Atropine
- muscarinic receptor antagonist ,
can bind to muscarinic receptors but it does
not trigger the cell’s response.

38. Drug Receptor Interactions
Competitive
Inhibition
Antagonist
Receptor
DENIED!
Antagonist-Receptor
Complex

39. Definition
“A path by which a drug,
fluid, poison, or other
substance is brought into
contact with the body.”

40. Routes & Targets
o
Drug delivery intended to
local effect.
• Eye, ear, nose
o
Drug delivery intended to
systemic effect
• Circulatory system

42. Routes of
Administration
o
2 classes of routes of
administration.
Enteral
2)Parenteral
1)

43. Factors Deciding Choice
of
Route
Type of desired effect,
systemic or local.
o Physiochemical properties,
solid or insoluble.
o Rapidity of effect.
o Dosage form available.
o Patient’s age.
o

44. Enteral Routes
“Drug placed directly in the GI
tract”
o Most common, economical, and
safest.
o Most unreliable and slow.
• Sublingual
• Buccal
• Oral

45. Oral Route
p.o. or PO
o Most conventional
o Economical
o safe
o self administered
o acceptable to patient
o Patient’s Feasibility
o Painless
o

46. Advantages
Overcome by antidotes or
emesis
 unconscious patients via NG
tube (nasogastric)


47. Disadvantages
Stomach acid inactivation.
o First Pass effect
o Drug interaction
o Food interaction
o Absorption slow or irregular
o Poorly or erratically absorbed
drug
o

48. Esophageal ulceration
o Unconscious
o Precision
o Very high dose
o Rapid administration
o

49. Factors affecting Drug
Absorption Orally
Form of drug
o Food
o Digestive transit
o Drug interaction in
digestive tract
o

50. Form of drug
o
Drops or Tablets  not
have same kinetics
o
Sustained-release delays
and extends its absorption.

51. Food
o
o
o
When should a drug be taken:
under fasting conditions, before,
during, after meals?
consider Pharmacokinetic and
Pharmacodynamic parameters.
Bioavailability when taken during
meals;
o reduced: tetracyclines, isoniazid,
penicillamine, captopril.
o unchanged or little modified:

52. Food

An hypoglycemic drug 
before meals.

A gastric protectant  taken
apart from meals and in the
evening at bedtime.


53. Digestive Transit

54. Drug Interactions in the
Digestive Tract
o
Metals i.e. Fe++, Al ++ form
organometallic complexes with
antibiotics.
o
Activated charcoal

56. Sublingual / Buccal
o
o
o
o
o
“held in the mouth or cheeks or under
the tongue.”
SL
SL - Rapid absorption
Buccal – slower absorption
Drug stability
Clinically useful drugs in sublingual :
•
Nitroglycerine
•
Isosorbide dinitrate
•
GTN
•
Clonidine

58. Sublingual Route Of
Administration

59. BUCCAL DRUG ROUTE

60. Advantages
o Avoid first-pass effect
o Low incidence of infection
Disadvantages
 inconvenient
 small doses
 unpleasant taste of some drugs
 Erratic absorption.

61. Rectal Route
in recurrent vomiting or
unconscious
o bypass liver
o Absorption incomplete, erratic
o glycerine, diclofenac
o Enema & suppository
o

62. Advantages
o
o
o
Bypass liver 50%
For children
In emesis
Disadvantages
o
o
Inconvenient & embarrassing
Rectal inflammation occurs

63. Parenteral Route
For poorly absorbed drugs
o For unstable drugs
o Unconscious patients
o Irreversible route
o Cause pain, fear, infection.
o must be sterile and little
irritant.
o

64. Parenteral Route
o
o
o
o
Intravenous
Intramuscular
Intradermal
Subcutaneous

69. Intravenous Route
“Placing a drug directly into the blood
stream”
o
o
o
o
o
o
o
IV
Precision of dose quickly.
Prompt effects
Absorption phase is bypassed
100% bioavailability
precise, accurate and almost immediate
onset of action,
fairly pain free

71. Intravenous route
well-controlled throughout the
body.
o for irritating solutions
o single dose or by continuous
infusion.
o

73. Disadvantages
o
o
o
o
o
Greater risk of adverse effects
a. high concentration attained
rapidly
b. Embolism
c. Hemolysis
Lack of sterility
IV more difficult In obese person.
Oily solutions & insoluble substances
 not suitable

74. Intramuscular Route
o
o
“injection of liquid into the area of
greatest mass of a large muscle”
more rapid absorption than SC
only 5 IM sites
a. deltoid
b. vastus lateralis
c. rectus femoris
d. ventrogluteal
e. dorsogluteal

75. Intramuscular Route
o
o
o
o
o
o
IM
Aqueous Solution or specialized
Depot Preparations
contra-indicated  anticoagulant
therapy.
Rapid effect  aqueous solution
Slow, sustained effect  depot
preparation
Moderate volume, oily vehicles,
irritant,

76. Subcutaneous Route
o
o
o
o
o
o
o
“injection into the fatty layer of tissue just below the
dermis of the skin but above the muscle layer”
SQ, SC, subQ, s.c.
Absorption slow, sustained
Rapid effect aqueous solution
For insoluble suspension & solid pellet implantations
Only nonirritant drugs.
over weeks or months,e.g Testosterone , Insulin
adrenaline, heparin, vaccines inj. SC

77. Disadvantages
Not suitable for large
volume
o Not for irritant drugs
o Pain, necrosis, tissue
sloughing
o

78. Subcutaneous Route

79. Intradermal Route
“Drug injects into layers of skin”
o Multiple puncture of epidermis
o BCG, Small pox vaccination
o Testing drug sensitivityPenicillin's
o Mantoux test for TB

81. Intrathecal Route
“A needle is inserted between two
vertebrae in the lower spine and into
the space around the spinal cord.”
o
o
o
o
o
o
Local route
Rapid effects
local & Spinal anesthesia
BBB & Blood CSF Barrier
Drug entry into CNS
Acute CNS infections & brain tumors

82. Disadvantages
infection at site.
o Require skilled personel.
o

84. Other Routes
o
o
o
Topical
Transdermal
Inhalation

85. .
o
o
o
o
Topical
Application
More convenient
Localized effect on skin lesions
Conjunctiva, nasopharynx, oropharynx, vagina,
urethra, urinary bladder, ear, nose, anal canal for
local effects.
Absorption rapid.

86. Topical
Disadvantage & Toxicity
Local irritation
o Timolol eye drops
contraindicated bronchial
asthma and COPD
o

87. Transdermal Route
“ Applied to the skin via physical delivery through a porous
membrane.”
o
o
o
o
o
o
o
More convenient
Sustained therapeutic blood levels via stratum corneum
Alcohol  enhances penetration
Improved compliance
Patch delivers drug at constant rate
Single patch 7 days
GTN, nictotine, fentanyl, hyoscine, clonidine

88. Disadvantages
o
Local irritation & erythema
o
expensive

91. Vaginal Route
“Administered vaginally to women as
a solution, tablet, cream, gel,
suppository, or ring. “
o
o
o
Slow absorption
Estrogen at menopause
Prevent thinning of the vaginal wall.

92. Intranasal Route
“Administration of drugs directly into
nose”
o either local or systemic effect
o nasal decongestants
o Desmopressin
o Cocaine
o Peptide hormone for osteoporosis

93. Advantages
Fast effect
o Prevent drug
degradation.
o

94. Disadvantages
limited volume for
administration.
o Drugs for continuous
and frequent
administration  less
suitable
o

96. Inhalation Route
o
o
o
“Inhaling of a drug in gas or liquid form; drug is
absorbed through alveoli of the lungs”
Atomized into smaller particles.
Smaller droplets go deeper  drug absorption.
for systemic effects
o medical gases and general anesthetics by
inhalation.
o Oxygen, nitric oxide and nitrous oxide.

97. o
for local treatment
o bronchial indications
o partial absorption and general effects.
o Antibiotics, mucolytic, beta-adrenergic mimetic,
muscarinic receptor antagonists.

98. Disadvantage
o Oral thrush
o
Sore throat

99. American Drug Laws and
Amendments


1938 Food, Drug and Cosmetic Act required
proof of safety, authorized factory inspections,
established penalties for fraudulent claims.
1952 Durham-Humphrey Amendment
designated drugs that must be prescribed by a
physician and dispensed by a pharmacist
(e.g., controlled substances, etc.)

100. American Drug Laws cont.



1970 Comprehensive Drug Abuse Prevention
and Control Act; Title II, Controlled Substances
Act.
Categorized according to potential for abuse.
Regulated distribution of narcotics and other
drugs of abuse

101. Categories of Controlled
Substances


Schedule I—not approved for medical use and
have high abuse potentials; LSD, heroin,
peyote, ecstasy
Schedule II—used medically. High abuse
potential (methadone, meperidine, cocaine)

102. Categories of Controlled
Substances



Schedule III - less potential for abuse than I
and II but may lead to psychological or
physical dependence (Tylenol with codeine)
Schedule IV - some potential for abuse
(Valium)
Schedule V - contain moderate amounts of
controlled substances.
(atropine and diphenoxylate)

103. Drug administration cardinal
rules



Wash hands before giving meds
Read MAR carefully. If ever in doubt, check
the original order
Never give medications you are uncertain of
unless you have looked them up or have
consulted with pharmacy

104. Drug Administration Cardinal
Rules





Never give more than 3cc per IM injection
Wear gloves with all injections
For sub q injections, use 25G, 5/8” needles
Do not give oral meds if patient is vomiting,
sedated, NPO or is unconscious
Follow narcotic protocol for signing out of
narcotics

105. QUESTIONS???

106. References
Text book of pharmacology
for nurses – J.K Grover –
Monica malik
o Lippincott illustrated review
of Pharmacology
o Katzung. B. G. Basic and
clinical Pharmacology
o J.D tripathy, Essential of
o

107. THANK YOU