Introduction to Pharmacology

Introduction to Pharmacology
The science of drugs, their properties,
use and effects
Medicinal drugs do not include:
Non-prescription
Nicotine
Alcohol
Illegal Drugs
Pharmacology Definition
Study of the effect of chemical
substances on living tissue
The study of medicinal drugs
The study of chemicals and toxic properties
The study of the use of chemicals for
psychotropic or social purposes
History of Drugs
Primitive
Herbal Remedies
Arrow Poisons
Mood altering foods
Opium
Cocoa


History of Drugs (cont.)
Ancient
Preservation substances (Egyptian
Mummification)
100 A.D. = 600 substances listed in the
Roman Materia Medica
History of Drugs (cont.)
Medieval
Plants and herbs are classified
Relationship of dose to toxicity is
recognized
Use of poisons for homicide prevalent
History of Drugs (cont.)
17
th
and 18
th
Century
Increased knowledge of drugs and shared
with world as increase in world travel
continued
Widely accepted by physicians and lay
persons
History of Drugs (cont.)
19
th
Century
The beginning of the modern science of
pharmacology
Problems Recognized
Dose effect relationship
Processes involved in absorption/excretion
Localization of the site of action of a drug
Specific mechanisms of drug action
Relation between chemical makeup & biologic activity of
substances
History of Drugs (cont.)
Developed
Anesthetics
Injection technique
Antipyretics (Aspirin)
History of Drugs (cont.)
Modern Medicine
Complex science Big business
Virtually every body function can be enhanced,
suppressed, or manipulated by chemical means
Problem with drug abuse worldwide
Chemical technology
Herbicide
Insecticide
Fuel/solvents
Poison affecting our health and environment
We need to use this new technology wisely;
without poisoning ourselves and environment
Drug Laws
Drug Standards
Drugs of the same name must have the
same strength, quality, and purity
Federally approved requirements for safety
of consumer
Three major acts that provide consumer
safety
Drug Laws (cont.)
1906 Pure Food & Drug Act
Empowered federal government to enforce
standards set by US Pharmacopoeia and National
Formulary
Drugs must meet standards of strength & purity
Type & amount of narcotics must be listed on
label of opiate mixture
1912 Sherley Amendment to FFDCA prohibits
fraudulent therapeutic claims
Drug Laws (cont.)
1914 Harrison Narcotic Act
Legally defines the term narcotic
Regulates manufacture, import, sale, and
use of cocaine and opiates
Revision to Harrison Act regulates the use
of marijuana and synthetic opiates
Drug Laws (cont.)
1938 Food, Drug and Cosmetic Act
Requires drugs & products be tested for harmful
effects
Drug labels and literature must be complete &
accurate, setting dose, manufacturers name &
address, names & amounts of potentially harmful
ingredients, a warning if habit forming, direction
for use, and contraindications
Medical devices must be safe & effective and
cosmetics must be safe
Drug Laws (cont.)
1952 Durham-Humphrey Amendment
Distinguishes between prescription and
over the counter medication
A prescription for narcotics, hypnotic,
habit-forming drugs, and potentially
harmful drugs can be refilled only with a
new prescription, and requires that the
label state this fact
Drug Laws (cont.)
1962 Kefauver-Harris Act
Allows FDA to evaluate the testing
methods of drug manufacturers
Requires manufacturers to prove that a
drug is effective, not just nontoxic
Drug Laws (cont.)
1970 Controlled Substance Act
Controls substances (narcotics, tranquilizers,
barbiturates, & amphetamines) into 5 categories
(schedules) based on drugs potential for abuse &
medical effectiveness
Limits the number of RX refills for controlled
substances each 6 months
Lists drugs that can be called into pharmacy
(prescriber must register with DEA)
Symbol for schedule = C
Drug Laws (cont.)
1984 Drug Price Competition and Patent
Term Restoration Act
Makes it possible for generic drugs of
bioequivalent equals to be marketed
without duplicating clinical trials
Gives longer patent protection to
companies introducing new drugs
Drug Laws (cont.)
1992 Prescription Drug User Fee Act
Allowed FDA to collect user fees from
pharm companies (with new drug apps) to
shorten review time
Specified a review time of 12 months for
standard drugs/6 mos for priority drugs
Drug Laws (cont.)
1997 FDA Modernization Act
Updated regulation of biologic products
Increased client access to experimental
drugs and medical devices
Accelerated review of important new drugs
Allowed drug companies to disseminate
info about off-label (non-FDA approved)
uses and costs of drugs
Extended user fees
Drug Laws (cont.)
FDA (Federal Drug Administration)
General safety standards
Approval & removal of products on market
DEA (Drug Enforcement Administration)
Controlled substances
Only enforces laws against illegal drug use
Monitors need for changing schedules of
abused drugs
Controlled Substances
Groups of medications that have
potential for abuse or physical &
psychological dependence
Proper handling of controlled
substances is essential
Violations may result in suspension of
your nursing license
5 Schedules
Controlled Substances (cont.)
Schedule I - C
I

Highest risk for abuse
Not acceptable for prescription use
May be available for investigational use
Includes
Cannabinols (marijuana)
Hallucinogens (LSD, heroin, & mescaline)
Controlled Substances (cont.)
Schedule II - C
II

Medically useful, but carry high potential for abuse
and may lead to physical & psychological
dependence
Includes certain barbiturates, narcotics (opiates),
and stimulants (MS, codeine, meperidine)
Prescriptions may not be refilled
Medically useful drugs with high abuse potential
Includes pure preparations of narcotics (opiates)
Includes stimulants (uppers)
Includes stimulants (uppers) used for treatment of
hyperactive children
Controlled Substances (cont.)
Schedule III - C
III

Lesser abuse potential that schedule I or II
Includes nonbarbiturate sedatives,
narcotics in combination with other drugs,
stimulants, anabolic steroids & paregoric
(Tylenol with codeine)
Controlled Substances (cont.)
Schedule IV - C
IV

Low potential for abuse, with psychological
dependence more common that physical
dependence
Includes benzodiazepines, propoxyphene
(Darvon), and chlordiazepoxide (Librium)
Controlled Substances (cont.)
Schedule V - C
V

Least abuse potential
Have a small amount of narcotic combined
with an antitussive or antidiarrheal
Controlled Substances (cont.)
Scheduled Drugs in Hospital & Nrsg.
Home
II, III, and IV
Nurses
All are signed for with patients name, date, time,
reason, nurses signature.
While student, controlled substances must have a
second signature of licensed nurse.
All are counted at change of work shift, with two
nurses: leaving and arriving
Records and signatures may be written or on computer.
Locked with two different keys, either actual or virtual
Controlled Substances (cont.)
Scheduled Drugs in Hospital & Nrsg
Home
II, III, and IV
Doctors and nurses
Schedule II drug prescriptions/orders in effect only
72 hours
Schedule III drug prescriptions/orders in effect for up
to one month
Nurses must not give drug if order is out of date
Nurses remind doctors with regular visit
Rules change
Controlled Substances (cont.)
Five pregnancy categories established
by FDA
Controlled Substances (cont.)
Cat A
No demonstrated risk to fetus in first
trimester of pregnancy
No evidence of risk in second and third
trimester
Controlled Substances (cont.)
Cat B
Animal studies have not demonstrated risk
to fetus or have demonstrated adverse
effect, but adequate studies on pregnant
women have not demonstrated a risk to
fetus during 1
st
, 2
nd
, or 3
rd
trimesters
Controlled Substances (cont.)
Cat C
Animal studies have shown adverse effects
on fetus, but there are no adequate studies
on humans
Controlled Substances (cont.)
Cat D
Evidence indicates a risk to the human
fetus
Potential benefit from use of drug may
outweigh the risk to the fetus
Controlled Substances (cont.)
Cat X
Studies in animals and humans
demonstrated fetal abnormalities or reports
indicate evidence of fetal risk
Nursing Process in Medication
Administration
The nurse is the primary member of the
health care team responsible for the
timely, safe, and accurate
administration of drugs
Using the nursing process can minimize
drug errors or omissions
Nursing Process (cont.)
Assessment (collection of data about patient)
Allergies?
Current medications?
Why is the patient taking RX or OTC drugs?
Condition of the patient skin?
Current level of use of tobacco, alcohol, etc.
Amount of coffee, tea, cola use?
Known problems with drug metabolization?
Physical or mental problem affecting ability to take
med?
Learning need, language, & literacy level?
Nursing history?

Nursing Process (cont.)
Diagnosis
Consists of 3 elements
Problem
Its etiology
Signs and symptoms
Address problems that post immediate threats
Knowledge deficit
Risk for injury
Ineffective management of therapeutic regimen
Noncompliance
Nursing Process (cont.)
Planning
Establishing short & long term goals & objectives
for care
Take into consideration patients physical,
psychological, and sociocultural life-style needs
Following three teaching sessions, patient will
identify the reasons for delaying the eating
and drinking of milk products for at least 2
hours after taking tetracycline.
Nursing Process (cont.)
Implementation
Follow the 5 rights of drug administration
Administer meds as prescribed
Monitor for therapeutic effect
Evaluate for adverse reaction
Provide patient teaching
Consider legal aspect associated with drug therapy
Complete med order, question any handwriting difficult
to read, unclear dosages, or if drug is incompatible
Nursing Process (cont.)
Evaluation
The nurse to determine whether the goals
have been met
Nursing Process (cont.)
Patient Teaching and Medication Therapy
Name of medication
Purpose of medication
How and when to take medication
How to monitor med effectiveness
Drugs that may interact with prescribed meds
Any required dietary changes
Possible adverse effects
Signs & symptoms to bring to MD attention
Required follow-up procedures
Nursing Process (cont.)
Documentation
Serves as a way to communicate with
other members of health care team
Nursing Process (cont.)
Legal responsibilities regulated by SNPA
To administer medication safely and accurately
(5Rs)
Must be familiar with the pharmacologic profile of
the drug to eliminate or decrease errors
Common Errors: dose amount, dosing interval,
inappropriate route
Accurate recording of all drugs given
Nurse might be found liable for not
recognizing and reporting adverse reaction
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