Pharma intro by yousaf shah

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

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Pharma intro by yousaf shah

  1. 1. INTRODUCTION TO PHARMACOLOGY Syed Yousaf Shah Lecturer Institute of Nursing DUHS
  2. 2.   GRADE /GPA REQUIREMENT FOR EACH SEMESTER & GRADUATION
  3. 3. Assessment        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. 4. TEACHING/ LEARNING STRATEGIES  Lecture/tutorials/handouts, self-directed learning, drug cards and quiz.
  5. 5. PHARMACOLOGY-I s.# 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 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. 6. References:       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. 7. LEARNING OBJECTIVES           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. 8. PHARMACOLOGY “A branch of medical sciences that study drugs and their action on living organisms”
  9. 9. DRUG “Any substance that brings about a change in biologic function through its
  10. 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. 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. 12.  Ostwald schimiedorg , jacob abel – modern for experimental Pharmacology.
  13. 13. WHY DO NURSES STUDY PHARMACOLOGY?? “ To safely administer medications and to monitor patients who receive these medications”
  14. 14. GENERAL CLASSIFICATION OF DRUG      Prescription Drugs Official Drugs OTC Drugs Controlled Drugs High Alert Medications
  15. 15. Therapeutic Classification          Analgesics Anxiolytics Anesthetics Anti- Asthmatics Antiinfectives Antibacterials Antivirals Antifungal AntiTuberculer Drug
  16. 16.             Antimalarials Antacids Antiacne Antihypertensives Antianginal Antiarrythmics Antiinflammatory Hypolipidemics Antiepileptics Antiemetics Antidiarrheal Antihistamines
  17. 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. 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. 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. 20. FIVE R’s
  21. 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. 22. Mineral Sources: from minerals, for example, lithium carbonate (an antipsychotic), MgSO4 (a laxative) Synthetic Sources: Examples include sulfonamides, and aspirin.
  23. 23. SOURCES OF DRUG INFORMATION       Text books Materia medica Pharmacopea Formulary Journals Pharmacists
  24. 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. 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. 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. 27. Pregnancy Categories   Category D-positive evidence of human fetal risk. Category X-animal or human studies have shown fetal abnormalities or toxicity
  28. 28. DRUG BODY INTERACTION
  29. 29. PHARMACOKINETICS What the Body Does with the DRUG
  30. 30. PHARMACODYNAMICS What the Drug Does to the Body
  31. 31. 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 
  32. 32. 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
  33. 33. Drug Receptor Interactions Lock and key mechanism Agonist Receptor Agonist-Receptor Interaction
  34. 34. 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.
  35. 35. Drug Receptor Interactions Competitive Inhibition Antagonist Receptor DENIED! Antagonist-Receptor Complex
  36. 36. Definition “A path by which a drug, fluid, poison, or other substance is brought into contact with the body.”
  37. 37. Routes & Targets o Drug delivery intended to local effect. • Eye, ear, nose o Drug delivery intended to systemic effect • Circulatory system
  38. 38. Routes of Administration o 2 classes of routes of administration. Enteral 2)Parenteral 1)
  39. 39. 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
  40. 40. Enteral Routes “Drug placed directly in the GI tract” o Most common, economical, and safest. o Most unreliable and slow. • Sublingual • Buccal • Oral
  41. 41. 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
  42. 42. Advantages Overcome by antidotes or emesis  unconscious patients via NG tube (nasogastric) 
  43. 43. 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
  44. 44. Esophageal ulceration o Unconscious o Precision o Very high dose o Rapid administration o
  45. 45. Factors affecting Drug Absorption Orally Form of drug o Food o Digestive transit o Drug interaction in digestive tract o
  46. 46. Form of drug o Drops or Tablets  not have same kinetics o Sustained-release delays and extends its absorption.
  47. 47. 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:
  48. 48. Food  An hypoglycemic drug  before meals.  A gastric protectant  taken apart from meals and in the evening at bedtime. 
  49. 49. Digestive Transit
  50. 50. Drug Interactions in the Digestive Tract o Metals i.e. Fe++, Al ++ form organometallic complexes with antibiotics. o Activated charcoal
  51. 51. 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
  52. 52. Sublingual Route Of Administration
  53. 53. BUCCAL DRUG ROUTE
  54. 54. Advantages o Avoid first-pass effect o Low incidence of infection Disadvantages  inconvenient  small doses  unpleasant taste of some drugs  Erratic absorption.
  55. 55. Rectal Route in recurrent vomiting or unconscious o bypass liver o Absorption incomplete, erratic o glycerine, diclofenac o Enema & suppository o
  56. 56. Advantages o o o Bypass liver 50% For children In emesis Disadvantages o o Inconvenient & embarrassing Rectal inflammation occurs
  57. 57. 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
  58. 58. Parenteral Route o o o o Intravenous Intramuscular Intradermal Subcutaneous
  59. 59. 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
  60. 60. Intravenous route well-controlled throughout the body. o for irritating solutions o single dose or by continuous infusion. o
  61. 61. 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
  62. 62. 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
  63. 63. 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,
  64. 64. 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
  65. 65. Disadvantages Not suitable for large volume o Not for irritant drugs o Pain, necrosis, tissue sloughing o
  66. 66. Subcutaneous Route
  67. 67. 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
  68. 68. 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
  69. 69. Disadvantages infection at site. o Require skilled personel. o
  70. 70. Other Routes o o o Topical Transdermal Inhalation
  71. 71. . 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.
  72. 72. Topical Disadvantage & Toxicity Local irritation o Timolol eye drops contraindicated bronchial asthma and COPD o
  73. 73. 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
  74. 74. Disadvantages o Local irritation & erythema o expensive
  75. 75. 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.
  76. 76. 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
  77. 77. Advantages   Fast effect o Prevent drug degradation. o
  78. 78. Disadvantages limited volume for administration. o Drugs for continuous and frequent administration  less suitable o
  79. 79. 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.
  80. 80. o for local treatment o bronchial indications o partial absorption and general effects. o Antibiotics, mucolytic, beta-adrenergic mimetic, muscarinic receptor antagonists.
  81. 81. Disadvantage o Oral thrush o Sore throat
  82. 82. 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.)
  83. 83. 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
  84. 84. 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)
  85. 85. 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)
  86. 86. 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
  87. 87. 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
  88. 88. QUESTIONS???
  89. 89. 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
  90. 90. THANK YOU

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