DRUG ACTION

3 PHASES
• PHARMACEUTIC
• PHARMACOKINETIC
• PHARMACODYNAMIC
PHARMACEUTIC PHASE
• Also known as DISSOLUTION
• In GI tract, drugs need to be in solution to be absorbed
• DISINTEGRATION
• DISSOULTION – liquid form
• EXCIPIENTS – filler and inert substances
PHARMACOKINETIC PHASE

• how the body acts on the drug.

• ABSORPTION
• DISTRIBUTION
• METABOLISM
• EXCRETION
 ABSORPTION (Pharmacokinetic Phase)
• Is the movement of drug particles from the GI tract to body fluids by
• - PASSIVE ABSORPTION
 is the major process through which drugs are absorbed into the body.
When there is a greater concentration of drug on one side of a cell
membrane, the drug will move through the membrane to the area of
lower concentration.
 Does not require any cellular energy.
• - ACTIVE ABSORPTION/PINOCYTOSIS
 is a process that uses energy to actively move a molecule across a cell
membrane. The molecule may be large, and it is often a very important
process in drug excretion in the kidney.
 DISTRIBUTION (Pharmacokinetic Phase)

• The process by which the drug becomes available to body

fluids and body tissues
• - blood flow
• - the drug’s affinity to the tissue
• - protein binding effect
• PROTEIN BINDING EEFECT
• - As drugs are distributed in the plasma, many are bound to varying
degree with protein
• HIGHLY PROTEIN-BOUND DRUGS, MODERATELY HIGH,
MODERATELY, LOW PROTEIN-BOUND DRUGS
• The portion of the drug that is bound is inactive because it is not
available to receptors, and the portion that remains unbound is FREE
(ACTIVE DRUG)
• ONLY FREE DRUGS –are active and can cause a pharmacologic
response
 BLOOD BRAIN BARRIER
 Is semi-permeable membrane in the CNS that protects the brain from
foreign substances
 = is a protective system of cellular activity that keeps many things (e.g.,
foreign invaders, poisons, drugs) away from, the CNS.
 Highly lipid- soluble drugs are able to cross the BBB
 During PREGNANCY – both lipid-soluble and lipid-insoluble drugs are
able to cross the placental barrier which can affect the mother and fetus
 RISK-BEENFIT RATIO should be considered before drugs are given
during pregnancy
 During LACTATION – drugs can be secreted into breast milk
METABOLISM/BIOTRANSFORMATION (Pharmacokinetic Phase)
Drugs absorbed into the intestine
↓
Drugs absorbed by the portal system
↓
Liver (the most important site of drug metabolism) = everything that is
absorbed from the GI tract first enters the liver to detoxify many
chemicals.
↓
Drugs bound to plasma protein in the circulation
↓
Drug distributed throughout the body
• HALF-LIFE
• Refers to the time it takes for the amount of drug in the body to
decrease to one half of the peak level it previously achieved.
• Determines the appropriate timing for a drug dose or the duration of a
drug’s effect on the body.
• Example: if a patient takes 20 mg of a drug with a half-life of 2 hours.
 10 mg remains 2 hours after
 5 mg will be left 2 hours later
 2.5 mg will remain in 2 more hours
• Factors to consider in determining the half-life of a drug
include:
 Absorption rate
 Distribution to the tissues
 Biotransformation
 Excretion
EXCRETION (Pharmacokinetic Phase)
• Is the removal of a drug from the body.
• Routes include the skin, saliva, lungs, bile, and feces.
• Kidneys play the most important role.
• Creatinine
clearance (CLcr) and blood urea nitrogen
(BUN) – common tests used to determine renal functions
• Glomerular filtration rate (GFR) – may be the best test
but it is expensive
Activity
• A patient
is taking telithromycin that has a half-life of 10
hours. You are trying to determine when a 800-mg dose of
the drug will be left in the body after 60 hours:
• A patient
is taking amantadine that has a half-life of 15
hours. You are trying to determine when a 200-mg dose of
the drug will be left in the body after 60 hours:
• A patientis taking foscarnet that has a half-life of 4 hours.
You are trying to determine when a 50-mg dose of the
drug will be left in the body after 12 hours:
PHARMACODYNAMICS
• The science dealing with interactions between the chemical
components of living systems and the foreign chemicals,
including drugs, that enter those systems.
• Drugs usually work in one or four ways:
 To replace or act as substitutes for missing chemicals.
 To increase or stimulate certain cellular activities.
 To depress or slow cellular activities.
 To interfere with the functioning of foreign cells, such as
invading microorgansims or neoplasms (chemotherapeutic
agents).
• Receptor sites
 Refers to specific areas at which many drugs are thought to act on cell
membranes.
 Lock (cell membrane) and key (enzyme) theory
 Agonist interaction with receptor site
 Competitive antagonism – some drugs react with receptor sites to
block normal stimulation, producing no effect
 Noncompetitive antagonism – other drugs react with specific
receptor sites on a cell, and by reacting there, prevent the reaction
of another chemical with a different receptor site on the cell
• Selective Toxicity
 Refers to the ability of a drug to attack only those systems found in
foreign cells.
Factors Influencing Drug Effects
• Weight
• Age
• Gender
• Physiological factors – electrolyte imbalance, acid-base balance,
hydration
• Pathological factors – disease, liver, GI and kidney dysfunction,
vascular disorders, low BP
• Genetic factors (pharmacogenomics) – study that explores the
unique differences in response to drugs that each individual
possesses based on genetic makeup.
• Immunological factors – allergy (mild to severe)
• Psychological factors – placebo effect, health beliefs,
compliance
• (placebo effect - a drug is more likely to be effective if the
patient thinks it will work than if the patient believes it will not
work)
• Environmental factors – temperature, light, noise
• Drug tolerance
• Cumulation effects
• Interactions
 PEAK & TROUGH DRUG LEVELS
• PEAK DRUG LEVELS – the rate of absorption of the drug

• - the highest plasma concentration of drug at a specific time

• THROUGH DRUG LEVEL – indicate the rate of elimination of the drug

• - lowest plasma concetration of a drug, it measures the rate at which the drug is
eleminated

• Drawn immediately before the next dose of drug is given

• Both are requested for drugs that are considered toxic

LOADING DOSE
• When immediate drug response is desired , a large initial dose known as the
LOADING DOSE

• To achieve rapid a minimum effective concentration in the plasma

• After initial dose, a prescribed dosage per day is ordered

Toxic Effects of Drugs
• SIDE EFFECTS – are physiologic effects not related to desired drug effects

• Even with correct drug dosage, side effects occur and are predicted
Toxic Effects of Drugs
• Adverse Effects
 Are undesired effects that may be unpleasant or even
dangerous.
 Occur for many reasons:
 The drug may have other effects on the body besides the
therapeutic effect.
 The patient may be sensitive to the drug being given.
 The drug’s action on the body may cause other responses that
are undesirable or unpleasant.
 The patient may be taking too much or too little of the drug,
leading to adverse effects.
 Types of adverse drug effects
• PrimaryActions
 Can be extensions of the desired effect
• Secondary Actions
 Are effects that the drug causes in the body that are not
related to the therapeutic effects
• Hypersensitivity
 Are individual reactions that may be caused by increased
sensitivity to the drug’s therapeutic or adverse effects
Drug Allergy
• Occurs when a patient develops antibodies to a
drug after exposure to the drug.
 Classifications:
• Anaphylactic reactions
 Involves the release of chemicals like histamine that
produce immediate reactions that can lead to respiratory
distress and even respiratory arrest
 Assessment: hives, rash, dyspnea, increased BP, dilated
pupils, diaphoresis, “panic feeling”, increased HR
 Interventions: Administer epinephrine, subQ, massage
site to speed absorption, notify physician, d/c drug,
medic-alert bracelet
• Cytotoxic reactions
 Involves antibodies that circulate in the blood and attack
antigens on cell sites, causing cellular death
 Reaction is not immediate but may be seen over a few
days
 Assessment: Decreased hct, wbc, platelets, decreased
renal function
 Interventions: notify physician, d/c drug, conserve
energy until allergy is over
• Serum Sickness Reaction
 Causes damage to various tissues by depositing in blood
vessels.
 Reaction may occur up to 1 week or more after exposure
to the drug
 Assessment: rash, high fever, swollen lymph nodes,
swollen and painful joints, edema in the face and limbs
 Interventions: notify physician, d/c drug, comfort measures
(cool environment, skin care, ice to joints, antipyretics,
anti-inflammatory)
• Delayed Allergic Reaction
 Occurs several hours after exposure and involves
antibodies that are bound to specific WBC.
 Assessment: rash, hives, swollen joints
 Intervention: notify physician, d/c drug, skin care,
comfort measures (antihistamine or topical
corticosteroids)
 Drug-Induced Tissue and Organ Damage
• Dermatological Reactions
 Are adverse reactions involving the skin.
 Example: Rashes, Hives
 Examples of drugs: Procainamide (Pronestyl) for
cardiac arrhythmias; Meprobamate (Miltown) for anxiety
 Assessment for severe reactions: rash and scaling,
fever, enlarged lymph nodes, enlarged liver
 Interventions: (mild) skin care, avoid rubbing, wearing
tight clothing,, administer anti-histamine. (severe) d/c
drug and notify physician, antihistamines
• Stomatitis
 Inflammation of the mucous membranes.
 Example: antineoplastic drugs
 Assessment: swollen gums, inflamed gums (gingivitis), swollen and
red tongue (glossitis), difficulty swallowing, bad breath, pain in mouth
and throat
 Interventions: mouth care, small frequent meals, dental consultation
• Superinfections
 Are infections caused by organisms that are usually controlled by the
normal flora.
 Assessment: fever, diarrhea, inflamed and swollen tongue, mucous
membrane lesions, vaginal discharge
  Interventions: mouth care, skin care, access to bathroom
facilities, small and frequent meals, d/c the drug causing
superinfection
• Blood Dyscrasia
 A bone marrow suppression caused by drug effects.
 Examples: antineoplastics & antibiotics cause cell death
 Assessment: fever, chills, sore throat, weakness, back
pain, dark urine, decreased hematocrit (Anemia), low
platelet count, low WBC
 Interventions: monitor blood counts, rest, protection from
infections and injury, avoid injuries that may result to
bleeding, d/c drug
• Toxicity
 Are not acceptable adverse effects but are potentially serious drug
reactions
 Liver injury
 Assessment: fever, malaise, n/v, jaundice, change in color of urine
and stools, abdominal pain, elevated liver enzymes (ASPARTATE
AMINOTRANSFERASE, ALANINE AMINOTRANSFERASE),
change in bilirubin levels, changes in clotting factors
 Interventions: d/c drug and notify physician, small, frequent meals,
skin care, a cool environment, rest
 Renal injury
 Example: Gentamicin (Garamycin) is associated with renal toxicity
 Assessment: elevated BUN, elevated creatinine, decreased
hematocrit, electrolyte imbalance, fatigue, malaise, edema,
irritability, skin rash
  Interventions: notify the physician, d/c drug, positioning,
diet and fluid restrictions, skin care, rest, dialysis for severe
cases
 Poisoning
 Occurs when an overdose of drug damages multiple body
systems leading to fatal reactions
• Alterations in Glucose Metabolism
 Hypoglycemia
 Example: Glipizide (Glucotrol) and Glyburide (DiaBeta) are
antidiabetic agents
 Assessment: fatigue, drowsiness, hunger, anxiety, headache,
cold, clammy skin, shaking and lack of coordination,
increased HR and BP, numbness and tingling of mouth,
confusion, rapid and shallow respirations, seizure and coma
for severe cases
  Interventions: give glucose (oral/IV), skin care, rest,
safety measures, monitor blood glucose
 Hyperglycemia
 Example: Ephidrine & Diazoxide (Hyperstat)
 Assessment: fatigue, polyuria, polydipsia, deep
respirations, restlessness, polyphagia, nausea, fruity
odor to breath, nausea
 Interventions: insulin therapy, mouth care
• Electrolyte Imbalances
 Hypokalemia
 Assessment: weakness, numbness and tingling in the
extremities, muscle cramps, n/v, diarrhea, decreased bowel
sounds, irregular and weak pulse, disorientation
 Interventions: replace K loss and monitor serum levels,
reorientation, safety precautions, comfort measures
 Hyperkalemia
 Assessment: weakness, muscle cramps, diarrhea, numbness
and tingling, slow HR, low BP, decreased UO, difficulty
breathing
 Interventions: give sodium polystyrene sulfonate, comfort
measures, safety precautions,
Sensory Effects

• Ocular damage
 Example: Chloroquine (Aralen) for RA cause retinal damage
and even blindness.
 Assessment: blurring of vision, color vision changes, blindness
 Interventions: monitor patient’s vision, d/c drug and notify
physician, protection from sunlight
• Auditory Damage
 Example: Aspirin
 Assessment: dizziness, tinnitus, loss of balance, loss of hearing
 Interventions: safety precautions, d/c drug and notify physician
• Neurological Effects
 Assessment: confusion, delirium, insomnia, drowsiness,
hallucinations, numbness, tingling, and paresthesia
 Interventions: safety measures, orient patient, d/c drug and notify
physician
• Atropine-Like (Anticholinergic) Effects
 Assessment: dry mouth, dysphagia, heartburn, constipation,
bloating, urinary retention, impotence, blurred vision,
photophobia, headache, mental confusion, nasal congestion,
palpitations, decreased sweating, dry skin
 Interventions: sugarless lozenges, mouth care, safety
measures, avoid hot environments
• Parkinson-Like Syndrome
 Assessment: akinesia, lack of activity, tremors, drooling,
changes in gait, rigidity, akathisia, dyskinesia
  Interventions: d/c drug, small and frequent meals, safety
precautions
• Teratogenecity

• Neuroleptic Malignant Syndrome

 Assessment: slowed reflexes, rigidity, involuntary
movements, hyperthermia
 Interventions: d/c drug, safety precautions
The NURSING PROCESS in Drug Therapy and
Patient Safety
• Nursing process is a decision-making, problem-
solving process used by nurses to provide
efficient and effective care.
• Ensures that the patient receives the best,
safest, most efficient, scientifically based,
holistic care.
I. Assessment

• First step in the nursing process

• Involvessystemic, organized collection of data
about the patient
• Has two major aspects:
 Patient history
 Physical examination
History
• Chronic conditions
 Can affect the pharmacokinetics and
pharmacodynamics of a drug
 Renal disease, heart disease, diabetes
• Drug use
 Prescription drugs, OTC drugs, alcohol,
nicotine, caffeine
• Allergies
 Can affect drug therapy
• Level of Education and Understanding
• Social supports
• Financial supports
• Pattern of health care
Physical Examination
To determine if any conditions exists that would be
contraindications or cautions for using the drug
• Weight
 Determine whether the recommended drug dose is
appropriate.
 Recommended dose typically is based on a 150-
pound adult man.
• Age
II. Nursing Diagnosis

• A statementof the patient’s status from a

nursing perspective.
• Refers to the analysis of information gathered
during assessment to arrive at some conclusion
that lead to a particular goal and set of
interventions.
• Shows actual or potential alterations in patient
function
 III. Implementation
• Involvestaking the information gathered and
synthesized into nursing diagnoses to plan the
patient care.
• Includessetting goals and desired patient outcomes
to assure safe and effective drug therapy.
• Threetypes of nursing interventions frequently
involved in drug therapy:
A. Proper Drug Administration
• Seven points or “rights”:
 Correct drug and patient
 Correct storage of drug
 Correct and most effective route
 Correct dose
 Correct preparation
 Correct timing
 Correct recording of administration
B. Comfort Measures
A patient is more likely to be compliant with a drug
regimen if the effects of the regimen are not too
uncomfortable and overwhelming.
• Placebo Effect
 Is the anticipation that a drug will be helpful.
• Managing Adverse Effects
 Environmental control, safety measures, physical
comfort measures
• Lifestyle Adjustment
C. Patient and Family Education
• Ensures safe and effective drug therapy at
home.
IV. Evaluation
• A partof the continuing process of patient care
that leads to changes in assessment, diagnosis,
and intervention.
 Prevention of Medication Error
• Nurse’s Role
 Seven “rights” of medication administration
 Right drug
 Always CHECK!
 Drugs may look alike or have sounds-alike names
 If unsure, ask for the GENERIC and BRAND
names
 NEVER assume, double CHECK!
 Avoid abbreviations, ASK!
 Right storage
 Refrigeration
 Protection from light
 Right route
 Determine the BEST route!
 Right dose
 Double check calculations
 Do not assume that the pharmacy is correct
 Make sure the tab can be cut, crushed, or chewed.
 If a dose seem too big, QUESTION it!
 Right preparation
 Right time
 Right recording
 Always document.
 If it isn’t written, it didn’t happen.
• Patient’s Role
 Keep a written list of all medications you are
taking, including prescription, OTC, and herbal
medications.
 Useful in emergency situation
 Know what each of your drugs is being used to
treat.
 Read the labels, and follow the directions.
 Make a calendar if you take drugs on alternating
days or use a weekly pillbox.
 Store drugs in dry place, away from children and
pets.
 Speak up.
Parent teaching about their
children’s drug regimen
• Keep a list of all medications you are giving your
child, including prescription, OTC, and herbal
medications.
• Never use adult medications to treat a child.
 Children respond differently to drugs
• Read all labels before giving your child a drug
• Measureliquid medications using appropriate
measuring devices.
• Call your health care provider immediately if your
child seems to get worse or seems to be having trouble
with a drug.
 Many drugs can cause serious or life-threatening
problems; act immediately.
• When in doubt, do not hesitate to ask questions.
 You are your child’s best advocate.