An Introduction by Tristan Eugene G. Gula, R.N.

NURSING PHARMACOLOGY

HISTORY

Early drug – plants, animals & minerals

2700 BB – earliest recorded drug use found in Middle East & China

1550 BC – Egyptians created Ebers Medical Papyrus

Castor oil – laxative

Moldy bread – wounds & bruises

HISTORY

Opium – pain

HISTORY

Galen (131-201 AD) Roman physician; initiated common use of prescriptions

1240 AD – introduction of apothecary system (Arab doctors)

1st set of drug standards & measurements (grains, drams, minims), currently being phased out

HISTORY

15th century – apothecary shops owned by barber, surgeons, physicians, independent merchants

18th century – small pox vaccine (by Jenner)

Digitalis from foxglove plant for strengthening & slowing of heartbeat Vitamin C from fruits

HISTORY

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

HISTORY

Mid 20th century

1940 – Discovery antibiotics (penicilline, tetracycline,

streptomycin), antihistamines, cortisone

1950 – discovery antipsychotic drug, antihypertensives, oral contraceptives, polio vaccine

Dr Albert Sabin, b. 1906, developer of the oral live polio vaccine.

DEFINITION AND SUBDIVISION

PHARMACOLOGY

Pharmacology study of the manner in which the

function of living system is affected by chemical agents/drugs

Science concerned with history, sources, physical & chemical properties of drugs & the way in which drug affects living system

is the study of drugs (chemicals) that alter functions of living organisms.

Drug chemical introduced into the body to

cause some changes WHO def: any product/subs used to

modify/explore physiologic system/pathologic states for the benefit of the patient

Drug therapy also called pharmacotherapy, is the use

of drugs to prevent, diagnose, or treat signs, symptoms, and disease processes. When prevention or cure is not a reasonable goal, relief of symptoms can greatly improve quality of life and ability to function in activities of daily living. Drugs given for therapeutic purposes are usually called medications.

Subdivisions of Pharmacology:1. Pharmacodynamics – study of the

biochemical & physiological effects of drugs & mechanisms of action

what the drug does to the body2. Pharmacokinetics – deals with the

absorption, distribution, biotransformation & excretion of drugs

what the body does to the drug

Subdivisions of Pharmacology3. Pharmacotherapeutics – study of drugs

used in the diagnosis, prevention, suppression, & treatment of diseases

deals with beneficial effects of the drugs (medicines)

4. Pharmacognosy – study of drugs in their original unaltered state; origin of drugs

source of drugs ex: penicillin from penicillium (fungi)

Subdivisions of Pharmacology5. Toxicology – study of biologic toxins:

study of poison & its effects deals with deleterious effects of physical & chemical agents (including drugs) in human

Other Terminologies Pharmacoeconomics – study of

relationship of drugs & economics Pharmacovigilance – science of

collecting, researching, analyzing, & evaluating set of information about adverse drug effects.

Receptor – a component of the cell that interacts with drug, initiating a chain of biochemical events leading to drugs’ observed effects

Things to Remember Human body works through complicated

series of chemical reactions & processes Important aspects of nursing: understanding

how drugs act on the body to cause changes & apply that knowledge in clinical setting

Patients take complicated drug regimen & receive potentially toxic drug

Some manage their own care at home

Nursing responsibilities regarding drug therapy:

Administering drugs Assessing drug effects Intervening to make drug regimen more

tolerable Provide patient teachings about drugs &

drug regimen

Remember

Knowing how drug works --- easier to handle --- enhances

drug therapy

GOALS AND RESPONSIBILITIES OF NURSING CARE RELATED

TO DRUG THERAPY

GOALS AND RESPONSIBILITIES OF NURSING CARE RELATEDTO DRUG THERAPY

Enhancing therapeutic effects by administering drugs accurately and considering clients’ individual characteristics that influence responses to drug therapy.

GOALS AND RESPONSIBILITIES OF NURSING CARE RELATEDTO DRUG THERAPY

Preventing the need for drug therapy, when possible, by promoting health and preventing conditions that require drug therapy.

Using appropriate and effective nonpharmacologic interventions instead of, or in conjunction with, drug therapy when indicated. When used with drug therapy, such interventions may promote lower drug dosage, less frequent administration, and fewer adverse effects.

GOALS AND RESPONSIBILITIES OF NURSING CARE RELATEDTO DRUG THERAPY

Preventing or minimizing adverse drug effects by knowing the major adverse effects associated with particular drugs, identifying clients with characteristics that may increase risks of experiencing adverse effects, and actively monitoring for the occurrence of adverse effects. When adverse effects occur, early recognition allows interventions to minimize their severity. Because all drugs may cause adverse effects, nurses must maintain a high index of suspicion that symptoms, especially new ones, may be drug-induced.

GOALS AND RESPONSIBILITIES OF NURSING CARE RELATEDTO DRUG THERAPY

Teaching clients and caregivers about accurate administration of medications, nonpharmacologic treatments to use with or instead of pharmacologic treatments, and when to contact a health care provider.

Classification of Therapeutic Agents

DRUGS In pharmacology, a drug is "a chemical

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

BIOLOGICS

include a wide range of medicinal products such as vaccines, blood and blood components, allergenics, somatic cells, gene therapy, tissues, and recombinant therapeutic proteins created by biological processes (as opposed to chemically).

Biologics can be composed of sugars, proteins, or nucleic acids or complex combinations of these substances, or may be living entities such as cells and tissues. Biologics are isolated from a variety of natural sources - human, animal, or microorganism - and may be produced by biotechnology methods and other technologies. Gene-based and cellular biologics, for example, often are at the forefront of biomedical research, and may be used to treat a variety of medical conditions for which no other treatments are available.

In some jurisdictions, biologics are regulated in a different manner than are drugs and medical devices.

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Alternative Therapies

A botánica, such as this one in Massachusetts, caters to the Latino community and sells folk medicine alongside statues of saints, candles decorated with prayers, and other items.

In Western culture, alternative medicine is any healing practice "that does not fall within the realm of conventional medicine",or "that which has not been shown consistently to be effective.” Alternative medicine is often based on the belief that a particular health regimen has efficacious effects even while there exists various bodies of evidence to contradict such a belief under the rigorous standards of evidence based medicine. In practice, alternative medicine encompasses therapies with a historical or cultural, rather than a scientific, basis. Commonly cited examples include naturopathy, chiropractic, herbalism, traditional Chinese medicine, Unani, Ayurveda, meditation, yoga, biofeedback, hypnosis, homeopathy, acupuncture, and diet-based therapies, in addition to a range of other practices. It is frequently grouped with complementary medicine, which generally refers to the same interventions when used in conjunction with mainstream techniques under the umbrella term complementary and alternative medicine, or CAM.

Traditional Chinese MedicineAcupuncture chart from Hua Shou (fl. 1340s, Ming Dynasty). This image from Shi si jing fa hui (Expression of the Fourteen Meridians). (Tokyo : Suharaya Heisuke kanko, Kyoho gan 1716).

DOH warns against Iridology By Katherine EvangelistaINQUIRER.netFirst Posted 19:06:00 08/04/2008

Filed Under: Health, Diseases

MANILA, Philippines – Iridology is “neither a diagnostic tool nor a therapeutic modality in alternative medicine,” the Department of Health (DoH) on Monday said.“There is no scientific validation for the use of iridology and it does not have strong evidence of having value either for diagnosis or treatment of diseases,” Health Secretary Francisco Duque III said in a statement.Iridology, or iridodiagnosis, is an alternative medicine technique where a patient’s iris is examined to determine information abut his or her health.After examination, iridologists encourage patients to purchase “alleged herbal medicines” to cure or prevent the spread of their “diagnosed disease,” the DoH said.These herbal medicines may have implications on the health of a person who does not need them, it said.Duque fears that iridology puts the lives of patients at risk if it is used as replacement for established diagnostic tools since a patient might be given wrong information on his or her health condition.

Ten (10) Herbal Medicines in the Philippines

Approved by the Department of Health (DOH)

1. Akapulko (Cassia alata) also known as "bayabas-bayabasan" and "ringworm bush" in English, this herbal medicine is used to treat ringworms and skin fungal infections.

2. Ampalaya (Momordica charantia)known as "bitter gourd" or "bitter melon" in English, it most known as a treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients.

3. Bawang (Allium sativum)popularly known as "garlic", it mainly reduces cholesterol in the blood and hence, helps control blood pressure.

4. Bayabas (Psidium guajava) "guava" in English. It is primarily used as an antiseptic, to disinfect wounds. Also, it can be used as a mouth wash to treat tooth decay and gum infection.

5. Lagundi (Vitex negundo) known in English as the "5-leaved chaste tree". It's main use is for the relief of coughs and asthma.

6. Niyog-niyogan (Quisqualis indica L.) is a vine known as "Chinese honey suckle". It is effective in the elimination of intestinal worms, particularly the Ascaris and Trichina. Only the dried matured seeds are medicinal -crack and ingest the dried seeds two hours after eating (5 to 7 seeds for children & 8 to 10 seeds for adults). If one dose does not eliminate the worms, wait a week before repeating the dose.

7. Sambong (Blumea balsamifera)- English name: Blumea camphora. A diuretic that helps in the excretion of urinary stones. It can also be used as an edema.

8. Tsaang Gubat (Ehretia microphylla Lam.)Prepared like tea, this herbal medicine is effective in treating intestinal motility and also used as a mouth wash since the leaves of this shrub has high fluoride content.

9. Ulasimang Bato | Pansit-Pansitan (Peperomia pellucida)It is effective in fighting arthritis and gout. The leaves can be eaten fresh (about a cupful) as salad or like tea. For the decoction, boil a cup of clean chopped leaves in 2 cups of water. Boil for 15 to 20 minutes. Strain, let cool and drink a cup after meals (3 times day).

10. Yerba Buena (Clinopodium douglasii)commonly known as Peppermint, this vine is used as an analgesic to relive body aches and pain. It can be taken internally as a decoction or externally by pounding the leaves and applied directly on the afflicted area.

Tips on Handling Medicinal Plants / Herbs:

If possible, buy herbs that are grown organically - without pesticides.

Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits or nuts during and after heavy rainfall.

Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal substances are found on young parts.

After harvesting, if drying is required, it is advisable to dry the plant parts either in the oven or air-dried on screens above ground and never on concrete floors.

Store plant parts in sealed plastic bags or brown bottles in a cool dry place without sunlight preferably with a moisture absorbent material like charcoal. Leaves and other plant parts that are prepared properly, well-dried and stored can be used up to six months.

Tips on Preparation for Intake of Herbal Medicines:

Use only half the dosage prescribed for fresh parts like leaves when using dried parts.

Do not use stainless steel utensils when boiling decoctions. Only use earthen, enamelled, glass or alike utensils.As a rule of thumb, when boiling leaves and other plant parts, do not cover the pot, and boil in low flame.

Tips on Preparation for Intake of Herbal Medicines:

Decoctions loose potency after some time. Dispose of decoctions after one day. To keep fresh during the day, keep lukewarm in a flask or thermos.

Always consult with a doctor if symptoms persist or if any sign of allergic reaction develops.

Prescription and Over the counter Drugs

Prescription/legend drug can be dispensed if with

prescription order; with specific name of drug & dosage regimen to be used by patient

Non-prescription drug can be dispensed over –the-

counter/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:

1. delay in professional diagnosis & treatment of serious/potentially serious condition may occur

2. symptoms may be masked making the diagnosis more complicated

3. clients’ health care provider/pharmacist should be consulted before OTC preparations are taken

Cautions in use of OTC drugs:

4. labels/instructions should be followed carefully

5. ingredients in OTC drug may interact with prescribed drug

6. inactive ingredients may result in adverse reactions

Cautions in use of OTC drugs:

7. potential for overdose8. multiple medication users

are at risk as more medications are added to therapy regimen

9. interactions of medications are potentially dangerous

Drug Regulations and

StandardsPHARMACOLOGY

R.A. 6425- Dangerous Drugs Act

It stipulates that the sale, administration, delivery, distribution and transportation of prohibited drugs is punishable by law.

R.A. 9165 – the new Dangerous Drug Act of

2002

Food and Drug Administration

approves many new drugs annually

Pregnancy Categories

Research into the development of the human fetus, especially the nervous system, has led many health care providers to recommend that no drug should be used during pregnancy because of potential effects on the developing fetus.

In cases in which a drug is needed, it is recommended that the drug of choice be one for which the benefit outweighs the potential risk

FDA Pregnancy CategoriesCategory A: No risk in pregnant women and fetusCategory B: No risk in pregnant women and fetus

Animal studies have shown adverse effect.Category C: Animal studies have shown risk for fetus No adequate studies in humans

Benefits from the use of drugs acceptedCategory D: Evidence of human fetal risk Benefits from the use of drugs acceptedCategory X: Animal and human studies demonstrate fetal

abnormalities or adverse reactions. The risk for pregnant women clearly outweighs any possible benefit.

Controlled SubstancePHARMACOLOGY

CATEGORIES OF CONTROLLED SUBSTANCES

Schedule I Drugs that are not approved

for medical use and have high abuse potentials: heroin, lysergic acid diethylamide (LSD), peyote, mescaline, tetrahydrocannabinol, marijuana.

CATEGORIES OF CONTROLLED SUBSTANCES

Schedule II Drugs that are used medically and

have high abuse potentials: opioid analgesics (eg, codeine, hydromorphone, methadone, meperidine, morphine, oxycodone, oxymorphone), central nervous system (CNS) stimulants (eg, cocaine, methamphetamine, methylphenidate),and barbiturate sedative-hypnotics (amobarbital, pentobarbital,secobarbital).

CATEGORIES OF CONTROLLED SUBSTANCES

Schedule III Drugs with less potential for abuse

than those in Schedules I and II, but abuse may lead to psychological or physical dependence: androgens and anabolic steroids, some CNS stimulants (eg, benzphetamine), and mixtures containing small amounts of controlled substances (eg, codeine, barbiturates not listed in other schedules).

CATEGORIES OF CONTROLLED SUBSTANCES

Schedule IV Drugs with some potential for

abuse: benzodiazepines (eg, diazepam,lorazepam, temazepam), other sedative-hypnotics (eg, phenobarbital,chloral hydrate), and some prescription appetite suppressants(eg, mazindol, phentermine).

CATEGORIES OF CONTROLLED SUBSTANCES

Schedule V Products containing moderate

amounts of controlled substances. They may be dispensed by the

pharmacist without a physician’sprescription but with some restrictions regarding amount, record keeping, and other safeguards. Included are antidiarrheal drugs, such as diphenoxylate and atropine (Lomotil).

Orphan Drugs Are drugs that have been discovered but are

not financially viable and therefore have not been “adopted” by any drug company.

Generic DrugsWhen a drug receives approval for marketing from the

FDA, the drug formula is given a time-limited patent, in much the same way as an invention is patented.

Generic drugs are chemicals that are produced by companies that just manufactures drugs.

COMMON SOURCES /4 MAJOR SOURCES (ORIGINS) OF DRUGS:

PHARMACOLOGY

1. Animal sources 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 – could produce human insulin by altering E. coli bacteria making it a better product without impurities that come with animal products

2. Vegetable/Plant sources

roots, bark, sap, leaves, flowers, seeds of medicinal Plants digitalis from wildflower, purple foxglove,

dried leaves of plant active principles of plants alkaloids – alkaline in reaction, bitter in taste,

powerful in physiologic activityo atropine & scopolamineo morphine sulfate, cocaine, quinine, nicotine, caffeineo procaine

2. Vegetable/Plant sources

glycosides – digitalis resin – soluble in alcohol; example – colonic

irritant found in laxative cascara gums – used in bulk-type laxatives: some

used in certain skin preparations for their soothing relief

oils – castor oil, oil of wintergreen

3. Mineral sources 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

4. Synthetic sources many drugs developed synthetically after

chemical in plants, animals, or environment have been screened for signs of therapeutic activity more potent, more stable, less toxic

steroids – arthritis & other diseases sulfonamides/chemotherapeutic agents –

kill microorganism slow their growth meperidine HCI (Demerol)

PHASES OF DRUG DEVELOPMENT

PHARMACOLOGY

Preclinical Trials Chemicals are tested on laboratory

animals to determine if:1. they have the presumed effects on

living tissue;2. and to evaluate any adverse effects

Some chemicals are discarded after preclinical trial for the following reasons: Lack of therapeutic activity when introduced

with a living organism Too toxic to living organism Highly teratogenic (abnormalities or adverse

effects to the fetus) The safety margin is too smallEx. Lithium - 0.6 mg/dl- therapeutic

- 0.5 mg/dl- useless- 0.7 mg/dl- toxic

PHASE I Studies Drugs are tested on human volunteers a few doses are given to a few healthy

volunteers to determine safe dosages, routes of administration, absorption, metabolism, excretion, and toxicity.

PHASE II Studies Drugs are tested on patients with the

disease that the drug is meant to treat. a few doses are given to a few subjects

with the disease or symptom for which the drug is being studied, and responses are compared with those of healthy subjects.

PHASE III Studies Using the drug in a vast clinical market the drug is given to a larger and more

representative group of subjects.

DRUG NOMENCLATURE

PHARMACOLOGY

DRUG NOMENCLATURE1. TRADE/BRAND/PROPRIETY NAME – name given

by the drug company that developed it followed by the symbol R or TM, 1st letter is

capitalized2. GENERIC NAME/NON-PROPERTY NAME- original designation given to the drug when the

drug company applies for approval process universally accepted & not capitalized; before

drug becomes official, used in all countriesprotected by law; not capitalized3. CHEMICAL NAME- atomic/molecular structure of drug

DRUG NOMENCLATURE chemical name – acetylsalicylic acid generic name – aspirin trade name – Aspilet

minoxidilGeneric name RogaineBrand name

PHASE IV Studies the FDA evaluates the data from the

first three phases for drug safety and effectiveness, allows the drug to be marketed for general use, and requires manufacturers to continue monitoring the drug’s effects.