mastering pharmacology

1. OF
PHARMACOLOGY
CYNTHIA R. ACOSTA, RN, MAN

2. PHARMACOLOGYPHARMACOLOGY
Greek word:
“PHARMAKON” which means
“DRUGS”
“LOGOS” which means
“SCIENCE”

3. PHARMACOLOGYPHARMACOLOGY
- deals with the study of drugs and
their actions on living organisms

4. DRUGSDRUGS
- are chemical substances that have an
effect on living organisms
THERAPEUTIC DRUGSTHERAPEUTIC DRUGS
- often called MEDICINE, drugs used in
the prevention or treatment of diseases

5. DRUG USES
• SYMPTOMATIC TREATMENT –
Drugs are used to relieve symptoms
• PREVENTIVE DRUGS- helps the
body avoid disease
• DIAGNOSTIC DRUGS – help the
physician determine whether a
disease is present

6. DRUG USES
• CURATIVE DRUGS – eliminate the
disease
• HEALTH MAINTENANCE DRUGS –
help keep the body functioning
normally
• CONTRACEPTIVE DRUGS – prevent
pregnancy

7. DOSAGE FORMSDOSAGE FORMS
LIQUID PREPARATIONS
SOLUTIONS
SUSPENSIONS
EMULSIONS

8. DOSAGE FORMSDOSAGE FORMS
LIQUID PREPARATIONS
EYE DROPS NOSE DROPS

9. DOSAGE FORMSDOSAGE FORMS
SOLID DOSAGE FORMS
TABLETS
COATED TABLETS
CAPSULES

10. Solid preparations for oral application

11. Dosage forms controlling rate of drug
dissolution

12. ORAL
ADMINISTRATION:
DRUG RELEASE
AND ABSORPTION

13. DOSAGE FORMSDOSAGE FORMS
PARENTERAL DRUGS
AMPULES
VIALS

14. DOSAGE FORMSDOSAGE FORMS
PARENTERAL
INTRAVENOUS
INTRAMUSCULAR
SUBCUTANEUOS

15. DOSAGE FORMSDOSAGE FORMS
RECTAL/VAGINAL ROUTE
SUPPOSITORIES
VAGINAL TABLETS

16. DOSAGE FORMSDOSAGE FORMS
POWDERS/OINTMENTS/PASTES

17. DOSAGE FORMSDOSAGE FORMS
INHALATION

18. DRUG ACTION:
Pharmaceutic,
Pharmacokinetic, and
Pharmacodynamic
Phases

19. 3 PHASES OF DRUG ACTION
PHARMACEUTIC PHASE
-drug becomes solution
PHARMACOKINETIC PHASE
-absorption, distribution, metabolism,
excretion
PHARMACODYNAMIC PHASE
- physiologic response

20. 80% of drugs are taken by
mouth
No PHARMACEUTIC
Phase in IV, IM, SC

21. PHARMACEUTIC PHASE
1st
Phase: also called ‘DISSOLUTION’
•The drug becomes a solution so
that it can cross the cell membrane

22. Dosage forms controlling rate of drug
dissolution

23. PHARMACOKINETIC PHASE
The process of drug movement to
achieve drug action
FOUR BASIC PROCESSES:
Absorption, Distribution, Metabolism
and Elimination

24. PHARMACOKINETIC PHASE
Four Basic Processes:
1. ABSORPTION – movement of drug
particles from the GI tract to the body
fluids
- can be affected by route of
administration or an impairment in
circulation

26. ORAL
ADMINISTRATION:
DRUG RELEASE
AND ABSORPTION

27. MODE OF APPLICATION AND TIME
COURSE OF DRUG CONCENTRATION

28. Absorption
HEPATIC 1st
PASS EFFECT –
-some drugs may not go directly to the
systemic circulation after absorption from the
GI tract,
-it 1st passes to the liver via the portal vein;
-some of the drug may become inactive in
the liver thus reducing the amount of active
drug in the systemic circulation
Example: Warfarin (Coumadin)

29. Absorption
• BIOAVAILABILITY- subcategory of
absorption; describes the percentage of
the drug dose that reaches the systemic
circulation
- usually occurs after hepatic 1st
pass in
oral drugs; always less than 100% in PO
drugs and always 100% in IV drugs
- oral drugs with high hepatic 1st
pass
should have double the dose of IV drugs

30. PHARMACOKINETIC PHASE
Four Basic Processes:
2.Distribution – Process by which the
drug becomes available to body
fluids and body tissues

31. FROM
APPLICATION TO
DISTRIBUTION

32. PHARMACOKINETIC PHASE
Four Basic Processes:
3. Metabolism – many drugs pass
initially through the liver prior to being
available to tissue.

33. Liver disease may  or 
action of a drug depending on the
metabolism of the body
Infants and elderly have  liver
function

34. PHARMACOKINETIC PHASE
Four Basic Processes:
4. Excretion –
KIDNEYS: primary site of elimination
OTHER ROUTES: hepatic metabolism, bile,
feces, lungs, saliva, sweat and breast milk

36. PHARMACODYNAMIC PHASE
The study of drug concentration and
its effects on the body (primary and
secondary physiologic effects)
• PRIMARY PHYSIOLOGIC
EFFECTS – desirable
• SECONDARY PHYSIOLOGIC
EFFECTS – may be desirable or
undesirable

37. PHARMACODYNAMIC PHASE
Example:
DIPHENHYDRAMINE (Benadryl):
anti-histamine effects decreases
allergic reactions;
but causes drowsiness due to CNS dep

38. ADVERSE DRUG EFFECT
OVERDOSING

39. ADVERSE DRUG EFFECT
INCREASED SENSITIVITY

40. DRUG TOXICITY IN PREGNANCY
AND LACTATION
Drugs taken by the mother can be
passed on transplacentally or via
breastmilk and adversely affect the
unborn or the neonate

42. LACTATION: MATERNAL INTAKE OF
DRUG

43. Determinants That Affect
Drug Therapy

44. SYSTEMSSYSTEMS
PHARMACOLOGYPHARMACOLOGY

45. NERVOUS SYSTEM
consists of brain, spinal cord and
peripheral nerves
MAJOR
FUNCTION:
to detect, analyze,
and transmit
information

46. These actions are
controlled by
NEURONS,
-which are
interconnected to
form signaling
networks that
comprise motor and
sensory systems

47. MAJOR FUNCTIONS OF
NEURONS
-to receive, integrate, and transmit
information to other cells
- basic structure of the nervous system

48. SENSORY NEURONS
- transmit impulses to the CNS
MOTOR NEURONS
- transmit impulses from the CNS

49. PARTS OF NEURONS
DENDRITES – conduct impulses to the
cell body and are called AFFERENT (“to”
or “toward”) nerve fibers
AXON – projects and conducts impulses
away from the cell body
- It is called EFFERENT (“away from”)
nerve fiber

50. PARTS OF NEURONS

51. CENTRAL NERVOUS SYSTEM
BRAIN
SPINAL CORD
PERIPHERAL NERVOUS SYSTEM
CRANIAL NERVES
SPINAL NERVES

52. AUTONOMIC NERVOUS SYSTEM
DIVISIONS:
SYMPATHETIC NERVOUS SYSTEM
PARASYMPATHETIC NERVOUS SYSTEM
-generally function antagonistically
toward each other
- critical to the stability of our internal
environment (homeostasis)

53. SYMPATHETIC NERVOUS SYSTEM
- regulates the expenditure of energy
- Neurotransmitter are known as
CATECHOLAMINES – epinephrine,
norepinephrine, and dopamine
- controls “fight-or-flight responses”

54. SYMPATHETIC NERVOUS SYSTEM
ENZYMES:
Monoamine oxidase (MAO) &
Catechol-O-methyltransferase
(COMT)
4 TYPES OF RECEPTORS:
alpha1, alpha2, beta1, beta2

55. PARASYMPATHETIC NERVOUS
SYSTEM
-Works to conserve body energy and
is partly responsible for slowing heart
rate, digesting food, and eliminating
body wastes
- “rest and digest”
-Neurotransmitter: ACETYLCHOLINE

56. PARASYMPATHETIC NERVOUS
SYSTEM
ENZYME:
Acetylcholinesterase
2 TYPES OF RECEPTORS:
Nicotinic, Muscarinic (both are
alkaloids)

57. CHOLINERGIC FIBERSCHOLINERGIC FIBERS – are
NERVE ENDINGS that liberate
ACETYLCHOLINE
ADRENERGIC FIBERSADRENERGIC FIBERS – are
NERVE ENDINGS that secrete
NOREPINEPHRINE
- They produce opposite responses

58. EXAMPLE:
HEART
ADRENERGIC AGENTS
increase the heart rate
CHOLINERGIC AGENTS
slow the heart rate

59. RESPONSES TO
SYMPATHETIC
ACTIVATION

60. RESPONSES TO
PARASYMPATHETIC
ACTIVATION

61. ANS + DRUG CLASSIFICATION
RULE # 1:
Drugs that mimic the effects of
norepinephrine are called
SYMPATHOMIMETIC drugs (adrenergic
drugs)
Drugs that mimic the effects of acetylcholine
are called PARASYMPATHOMIMETIC
drugs (cholinergic drugs)

62. ANS + DRUG CLASSIFICATION
RULE # 2:
Drugs that block the effects of each
system are called sympatholytics or
parasympatholytics respectively

63. ANS + DRUG CLASSIFICATION
RULE # 3:
adrenergic and cholinergic drugs have
opposite effects

64. ANS + DRUG CLASSIFICATION
RULE # 4:
a drug that mimics the SNS and a drug
that blocks the PNS can cause similar
responses in the same organ
EXAMPLE: Sympathomimetics and
parasympatholytics both increases
heart rate

65. DRUGS ACTING ON
SYMPATHETIC NERVOUS
SYSTEM

66. ADRENERGIC AGENTS
(SYMPATHETIC NS)
A.K.A – adrenergics, adrenergic
agonists, sympathomimetics or
adrenomimetics (agonists – promotes;
mimetics – mimics)
- These agents act on one or more
adrenergic receptor sites located on
the cells of smooth muscles

67. ALPHA-ADRENERGIC RECEPTORS –
smooth muscles of the blood vessels
BETA 1 RECEPTORS –
cardiac muscles
1
BETA 2 RECEPTORS –
smooth muscles of the lungs,
uterus, (some in skeletal
muscles)
2

68. EFFECTS:
Stimulation of ALPHA 1
vasoconstriction
increased peripheral resistance
increased blood pressure

69. EFFECTS:
Stimulation of ALPHA 2
vasodilation
decreased blood pressure
decreased norepinephrine

70. EFFECTS:
Stimulation of BETA 1
increased pulse rate
increases myocardial contractility and
heart rate
1

71. EFFECTS:
Stimulation of BETA 2
bronchodilation
Relaxation of the smooth muscles of
the lungs
2
Relaxation of the uterine smooth muscles –
decreased uterine contraction

72. ADRENERGIC AGENTS
EPINEPHRINE
Classification: CATECHOLAMINES
Receptors: stimulates alpha1, beta1
and beta2 (non-selective)
Effects: increased blood pressure (alpha1),
tachycardia (beta1),
pupil dilatation (alpha1),
bronchodilation (beta2)

73. ADRENERGIC AGENTS
ALBUTEROL SULFATE
(Proventil) (Ventolin)
Classification: BRONCHODILATOR
Receptors: stimulates beta2 (selective)
Effects:
bronchodilation (beta2)

74. ADRENERGIC ANTAGONISTS
A.K.A. adrenergic blockers, adrenergic
antagonists, sympatholytics
- These agents block the effects of the
alpha and beta neurotransmitter receptor
sites (alpha1, beta1, beta2)
EFFECTS: basically opposite the
agonists

75. ALPHA 1
vasodilation
BETA 1
decreased heart rate
BETA 2
constricts bronchioles
contracts uterus

76. ALPHA-ADRENERGIC BLOCKERS
(ALPHA BLOCKERS)
TOLZOLINE (PRISCOLINE HCL,
PRAZOSIN HCL)
Receptors: selective alpha1
Effects: promotes vasodilation for
peripheral vascular diseases (prolonged
vasodilation could cause orthostatic
hypotension and reflex tachycardia), anti-
hypertensive

77. BETA-ADRENERGIC BLOCKERS
BETA BLOCKERS
Receptors: Beta 1, Beta 2
Effects: decreases heart rate;
decreases blood pressure (most are
non-selective)
““LOL TEAM”LOL TEAM”

78. CHOLINERGICS AND
ANTICHOLINERGICS
CHOLINERGICS: drugs that stimulate
the parasymphathetic N.S., a.k.a.
parasympathomimetics

79. TYPES OF CHOLINERGIC
RECEPTORS
1. MUSCARINIC RECEPTORS
- stimulate smooth muscle & slow
heart rate
2. NICOTINIC RECEPTORS
- (neuromuscular) affects the
skeletal muscles.

80. EFFECTS OF CHOLINERGIC DRUGS
CVS - HR, dec. BP, slows
AV node conduction
GIT - inc. tone & motility & peristalsis,
sphincter relaxed
GUT - contracts muscles of UB,
tones ureters, relaxes
bladder sphincter, promotes
urination

81. EFFECTS OF CHOLINERGIC DRUGS
Bronchial - stimulates bronchial
smooth muscle contraction
& inc. bronchial secretion

82. CHOLINERGICS DRUGS
Metoclopramine Hcl ( reglan)
Pilocarpine Hcl (pilocar)

83. ANTICHOLINERGICS DRUGS
•Drugs that inhibit the actions of
acetylcholine by occupying receptors.
A.K.A. cholinergic/muscarinic
antagonists, anti-spasmodics.

84. Effects of anti-cholinergics
• CVS - inc. HR w/ large doses; dec.
HR in small doses
• GI - relaxes smooth m. tone of
GIT, dec. GI motility &
peristalsis, dec. GI secretions
• GU - relaxes the bladder, & inc.
consriction of internal
sphincter. Urinary retention
results

85. • Ocular - dilates pupils (mydriasis) &
paralyses of ciliary
muscle (cyclopegia) dec. in
accomodation
• Bronchial - dilates the bronchi & dec.
bronchial secretions
• CNS - dec. tremors & rigidity of
muscles. Drowsiness,
disorientation & hallucination
in large doses
Effects of anti-cholinergics

86. Anticholinergic drugs
• Atropine (prototype)
• Scopolamine
• Both drugs act on the muscarinic
receptor but have little effect on the
nicotinic receptors.

87. Uses of atropine
• Preoperative medication to decrease
salivary secretions
• Antispasmodic drug to treat peptic
ulcers
• Increases HR when bradycardia is
present
• Antidote for muscarinic agent
poisoning such as bethanechol

88. ANTIHYPERTENSIVE
DRUGS

89. RENIN AND SODIUM
RETENTION
- Cells in the kidneys respond to low
blood pressure by releasing an enzyme
called RENIN
RENIN – an enzyme from the kidneys
that activates angiotensin

90. Through a complex series of events,
RENIN causes the kidneys to reabsorb
sodium
Sodium reabsorption, in turn, is always
accompanied by water retention, which
helps to restore blood volume and
blood pressure

91. ANGIOTENSIN AND BLOOD
VESSEL CONSTRICTION
- Renin also activates the blood protein
angiotensinogen to angiotensin
ANGIOTENSIN is a powerful
VASOCONSTRICTOR: it narrows the
diameters of blood vessels, thereby
raising the blood pressure

92. CONCEPT: ANTIHYPERTENSIVECONCEPT: ANTIHYPERTENSIVE
AGENTSAGENTS
Monitor blood pressure and pulse
closely
Rise slowly to reduce orthostatic
hypotension
Eating must be considered (diet)

93. CONCEPT: ANTIHYPERTENSIVECONCEPT: ANTIHYPERTENSIVE
AGENTSAGENTS
Stay on medications. Client has a
high tendency to stop a medication
when they are feeling better

94. ACE INHIBITORS
“PRIL” SISTERS
Benazepril (Lotension)
Captopril (Capoten)
Enalapril (Vasotec)
ACTION: Suppresses renin-
angiotensin-aldosterone system: blocks
conversion of angiotensin I to
angiotensin II

95. BETA BLOCKERS
“LOL” TEAM
ACTION: Blocks beta receptors in the
heart
Acebutolol (Sectral)
Atenolol (Tenormin)
Metoprolol (Lopressor)

96. ALPHA ADRENERGIC BLOCKERS
“SIN”
ACTION: Blocks alpha1 adrenergic
receptors
Prazosin (MInipress)
Terazosin (Hytrin)

97. ANGIOTENSIN II RECEPTOR
BLOCKERS (ARBS)
“SARTAN”
ACTION: Blocks the binding of
angiotensin II to the AT 1 receptor
Losartan (Cozaar)
Telmisartan (Micardis)

98. EMERGENCY
DRUGS

99. DRUGS AND
DELIVERY

100. ROUTES OF
ADMINISTRATION
 peripheral intravenous
 central venous
 tracheal.

101. DRUGS administered
by the peripheral route
must be
followed by at least a
20 ml flush of 0.9%
saline and if possible
elevation of the
extremity.

102. TRACHEAL ADMINISTRATION OF
DRUGS
 2–3 times the dosage of the drug can be
given via the ET tube, diluted to a volume
of 10–20 ml
- this technique
requires the presence
of an endotracheal or
tracheostomy tube

103. Drugs that can be administered via
TRACHEA:
Adrenaline/Epinephrine
Vasopressin
Atropine
Lignocaine (Lidocaine)
Naloxone

104. Drugs that cannot be administered via
TRACHEA:
Calcium Salts
Sodium Bicarbonate
Amniodarone

105. ADRENALINE/EPINEPHRINE
is a naturally occurring substance that
stimulates the sympathetic nervous system
(SNS)

106. ADRENALINE/EPINEPHRINE
in a beating heart it increases myocardial
contractility
 The dose in cardiac arrest is 1mg
every three minutes

107. ATROPINE
 blocks the action of acetylcholine at
muscarinic receptors in the parasympathetic
nervous system (PNS). sympathetic nervous
system (SNS)
 Parasympathetic stimulation via the vagus
nerve slows the heart. Blocking this in the
sinoatrial (SA) node increases automaticity
and therefore heart rate

108. AMIODARONE
 is a complex drug, acting in many ways.
 It works by increasing the duration of the
action potential, though it also has
antisympathetic and calcium channel-blocking
properties

109. LIGNOCAINE/LIDOCAINE
 is indicated for refractory VF/VT when
the first three defibrillator shocks have
failed to produce are turn of spontaneous
circulation and when amiodarone is
unavailable
 It acts by suppressing the excitability of
ventricular cells

110. CHILDREN - SAFETY
OBSERVE, REPORT, TEACH
ABOUT UNDESIRABLE EFFECTS
MEDICATIONS – NO OVER THE
COUNTER WITHOUT CONSULTATION
PREGNANCY/LACTATING ARE
OUT WITH MEDICATIONS
LIVER MUST BE INTACT

111. INTERACTIONS-
PHARMACOLOGICAL, ASSESS AND
TEACHALLERGIES-ASSESS; DO NOT
ADMINISTER MEDS IF ALLERGIC
NUTRITION MUST BE CONSIDERED;
NO CRUSHING SUSTAINED
RELEASE TABLETS

112. COMPLIANCE WITH TIME AND
TAKING FULL COURSE
ELDERLY-SAFETY EVALUATE
OUTCOMES