1. INTRODUCTION TO NURSING PHARMACOLOGY
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2. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Medicines
Sources of drugs
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3. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Sources of drugs
Plant products
Plants
Fox Glove Digoxin
Poppy Opium
Belladonna Atropine
Coffee Caffeine
Tobacco Nicotine
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4. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Animal products
Hormones:
Premarin (conjugated Oestrogen)
from Pregnant Mares
Insulin from pigs & cows
Heparin: from pigs & cows
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5. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Inorganic compounds
(compounds with no Carbon)
Sodium + Chloride ions: Sodium Chloride
Zinc + Sulphate ions: Zinc Sulphate (Calamine lotion)
Aluminium +Hydroxyl: Aluminium hydroxide
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6. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Synthetic sources
(Laboratory Derived Products)
Human Insulin (genetically engineered,
biosynthetic human insulin or
recombinant or DNA-derived insulin,
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7. The Development of Medicines
Pharmacokinetics
Absorption, distribution,
metabolism & excretion of drugs
Pharmacodynamics
Biochemical & physical effects of drugs: Mechanisms of drug action
Pharmacotherapeutics
evidence based approach to the use of drugs to treat disease
Toxicology
toxicity & adverse effects of drugs
Science of Pharmacology
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8. Development of new drugs
Preclinical trials
New drugs or treatment approaches are often tested first on animals or live human cells in test tubes. Scientists identify an approach that is most likely to succeed, and then carry out preliminary research into safety and effectiveness.
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9. Phase 1 studies: Early Clinical Trials
These first trials usually involve a small number of individuals (less than 100) who are healthy; however, there are times when the new compound is tested first in people who have the condition that the drug is meant to treat, especially when the drug is meant to treat a very serious disease and is likely to have serious side effects.
The objective= to find out if the new drug is safe.
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10. Phase 2 Continuing Clinical Trials
If the new compound is considered safe on animals, testing is expanded to see if it is effective,
Trials include people who
have the disease or condition
against which the researchers
think a new compound will be
effective. Safety testing
continues and is expanded &
animal testing also
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11. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Phase 3 studies
A drug is tested in several hundred to several thousand subjects.
This large-scale testing provides more information about the drug's effectiveness, possible side effects, and safety in a broader range of people.
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12. The Medicines Control Agency -responsible for regulating medicines
the European drugs licensing authority is currently under discussion is the UK
Pregnancy categories
Controlled substances Opiates
Generic / proprietary drugs Panadol: Paracetamol
Orphan drugs – rare diseases/small populations
Over-the-counter (OTC) drugs Paracetamol
Prescription Only Medicines (POM) Warfarin
Nurse Prescriber’s Extended minor ailments, minor
Formulary injuries, health promotion & palliative care.
Sources of drug information Data Sheets
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13. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Defining the word Pharmacology The study of the action of drugs on the body:
i.e. the interaction between drugs, the drug itself and how drugs work
Defining the word Pharmacokinetics
the study of drug absorption distribution, metabolism and excretion
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14. Defining the word Pharmacodynamics
involves study of the effects of the
drug in the body & its mechanisms of action
Defining the word Pharmacotherapy
The use of drugs to treat disease and include assessment implementation, monitoring and reassessment
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15. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Drug action is its pharmaceutical, pharmacokinetic and pharmacodyamic properties
Adverse reactions =
predictable & unpredictable, iatrogenic (caused by practitioners), carcinogenic (causing cancer) & teratogenic (causing embryonic deformities)
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16. Pharmacokinetics
The study of drug absorption distribution, metabolism and excretion
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17. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Case Base Analysis
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18. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Important Pharmacokinetic Principles Differences between a 25 year old fit healthy adult an elderly adult & an Infant
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19. Absorption of drugs-infant
Gastric Cells are immature until approx. 3 years of age, therefore gastric pH is less acid than an adults gastric pH
Emptying is slowed because of slow and irregular peristalsis
Immaturity of liver and reduced levels of (microsomal) liver enzymes means that first pass elimination is limited
Proportionately greater body surface and thin skin layers means that topical absorption is greater
Intramuscular absorption is faster and unpredictable because of proportionately greater mass and lack of maturity of vaso control
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20. Distribution of drugs-infant
Total Body Water is much greater: 65%-75% more in infants than adults
Fat content is less because of greater TBW content
Protein binding is less because of less protein is produced within immature liver
Blood brain barrier immaturity means that more drugs can enter the brain.
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21. Metabolism of drugs-infant
Liver immaturity means that microsomal enzymes are low in number
Older children have an increased metabolism
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22. Excretion of drugs-infant
Immaturity of kidney (i.e. possible immature glomeruli, renal tubules and a shorter loop of Henle) means that filtration, tubular reabsorption and secretion is decreased due to initial low perfusion rates.
This leads to a reduced renal function and a decreased ability to concentrate urine.
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23. Absorption of drugs- Elderly adult
A gradual reduction in gastric cells results in a reduction in gastric pH = less acid than and younger adult
Emptying is slowed because of gradual decline in muscle tone and motor activity
Peristalsis is also slowed because of a decline in muscle tone and motor activity
Blood flow to the GI tract is reduced by 40%-50% because of decreased Cardiac Output and decreased blood flow
Liver (microsomal) enzymes decrease by approx. 1.5% for each year after the age of 25 years and this ultimately effects reduction in first pass elimination
The GI absorptive surface area is decreased as the villi both blunt
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24. Distribution of drugs- Elderly adult
Body composition changes with age:
TBW is decreased and the ratio of fat to water increases
Fat content increases because of a decease in lean body mass
The ageing liver is less able to manufacture adequate levels of protein resulting in a reduction in protein binding sites.
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25. Metabolism of drugs- Elderly adult
The ageing liver is less able to produce microsomal enzymes
Liver blood flow is decreased by 1.5% per year after the age of 25 years.
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26. Sites for Administration of Drugs
Topical: Skin, eyes (eye lids/conjunctiva), ears
Oral (or naso/oral: tube)
Nasal
Anal/rectal
Vaginal
Injections: S/C, IM, Intra Ocular, Intra Venous, intrathecal, intra abdominal, Trans catheter etc.
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27. UWCM/SONMS/Pharm/Clinical Science team/MJohn
Go to a pharmacy and check the ingredients of four or five different OTC drugs for comparison and to familiarize yourself with the difficulty a layperson may encounter while trying to find this information. Bring the detail of these products into the classroom for comparison in future studies & discuss this with your mentor.
Give rationale for why some drugs need to be kept under lock and key on the hospital unit. Discuss this with your mentor.
Familiarize yourself with 4 or 5 drugs that are often prescribed & administered in your placement setting.
Outline the role of the nurse in the safe administration these drugs. Discuss this with your mentor & your clinical teacher.
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28. Branch pharmacology study
Adult– work book available on –line at beginning of module 4 Problem solving case study
Child– Pharmacology studies & guided study
Mental health– PBL
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