PHARMACOLOGY

INTRODUCTION
• Pharmacology- The study of substances that interact
with living systems through chemical processes.
• Pharmacokinetic: absorption, distribution, and
elimination processes determine how rapidly and for
how long the drug will appear at the target organ.
• Pharmacodynamics: drug effects and their
mechanisms of action (effect)
• Drug- a chemical substance that produces a biological
effect when administered to a living organism
• Placebo: Any component of therapy that is without
specific biological activity e.g. inactive substance
such as normal saline or distilled water usually used
in clinical trials research and for psychological
treatment.
 Pharmacokinetics
• Definition: It refers to the study of the process that
determines the processes that determine the concentration of a
drug in the body over time.
• 1. Absorption- The process by which a drug enters the
bloodstream.
• 2. Distribution- The process by which the drug disperses
throughout the body’s fluids and tissues.
• 3. Metabolism- The biochemical transformation of a drug,
primarily occurs in the liver.
• 4. Excretion- The process of eliminating the drug from the
body, primarily through the kidneys ( urine) but also via sweat,
saliva and faces
 Drug nomenclature

Nomenclature is the systematic naming of drugs,

especially pharmaceutical drug
Drugs in the majority of circumstances have three types of
names.
1. i)Chemical/molecular/ scientific name: this is the
chemical/ molecular structure of a drug. It states the
structure in terms of atoms and molecules accompanied by a
diagram of the chemical structure. Most useful to a few
technically trained personnel e.g. chemist or research
pharmacist the names are unsuitable for general use since
they are long. e.g. acetyl-p- amino-phenolis for paracetamol or
acetaminophen
Drug Nomenclature Conti……

ii)Generic/non-proprietary/approved name; this is the

abbreviated and approved name. it is the official medical name
assigned by the producer in collaboration with the food and
drugs board and nomenclature committee. The generic name can
be used by any interested party and it removes confusion of giving
several names to the same drug regardless of who manufactures
them once they have the same chemical structure. A generic
name is not capitalized e.g. acetylsalicylic acid commonly known
as aspirin,
iii)Trade name/proprietary/brand name: name given to the
drug by the manufacturing and marketing company. One drug
may have so many trade name e.g. acetaminophen has about 30
Chemical name Generic name Trade names

ibrufen
2-(4- Brufen, advil,
isobutylphenyl)prop nurofen
anoic acid

N-acetyl-para- Paracetamol, Calpol, Panadol,

aminophenol acetaminophen tylenol

metronidazole Flagyl ,metrogyl

2-(2-methl-5-
nitro-1h-imidazol1-
y)ethyl benzoate.
 Two major methods of dispensing drugs

• Over-the-counter drugs (OTC): they do not need a prescription and

can be purchased at the chemical shops; examples are pain relief, blood
tonics, vitamin preparation, ORS, antacids, and antimalarial.
• Prescription drugs: They need a prescription and must be controlled
from abuse and dependence; e.g. antibiotics, anti-hypertensives,
sedatives, diabetics drugs etc.
Patients' education -about OTC drugs
• You need to give your attention to all the drugs the patient is taking
whether prescription or OTC.
• Caution patients not to treat themselves with OTC drugs.
• Inform them that most of the OTC medication contain more than one
active ingredient.
• Tell the patient that interactions can occur when takes more than one OTC
medication at a time or takes one with a prescription drug.

• Inform patients about special considerations and drug safety

precautions.
• Encourage: complete medication list and complete adverse reaction list.
 Routes of drug administration

A drug’s route of administration affects the rate and extent of

absorption.
Enteral route: drugs given along any portion of the [Link] is most
common, safe, and convenient. and economical. but it is the slowest, it
can be orally, sublingually, and rectally.
Parenteral route: intradermally, subcutaneous, intramuscular,
intrathecal intravenous.
 Pulmonary route: administered by inhalation.
topical: applied on the skin, mucus membrane of eyes, ears, nasal
mucosa, bladder, vagina and the penis.
 Factors to consider when choosing the route of drug
administration
1. The time at which the effect of the drug is required.
2. The method most suitable for the drug required.
3. The site of drug action.
4. Patients' status whether conscious or unconscious.
5. Desire off the patient.
 Principles of Drug Administration

• For you to administer any medication, it is important to avoid errors to

adhere to the principles of drug administration.
• To provide safe administration of drugs a Clinical officer should
practice the rights of drug administration... they are;-
Right patient.
Right drug.
Right dose.
Right time.
Right route.
 Principles of Drug Administration
Conti…..
Five additional rightsare essential in Clinical Practice; These includes;-
The right assessment e.g. patient’s ability to swallow, allergies,
contraindication, new signs and symptoms that may indicate adverse
effects of administration, heart, liver or kidney disorders etc.
 The right documentation.
The clients right to information on name, purpose, action and potential
side effects.
 The right evaluation.
The client’s right to refuse medication regardless of the
consequences.
Principles of Drug Administration Conti…..

• Right client or patient:

You should make sure that the right client receives the right drug.
You should only give drugs to the person for whom they are prescribed
or recommended.
If the patient is wearing an identification bracelet, check the client’s
name on the identification bracelet with the name, and hospital
number on the medication card in your hand.
Alternatively, if the patient is conscious and sane simply call out the
patient’s name.
 Principles of Drug Administration Conti…..
Right drug
• You must check and double check the package label of the drug.
• The right drug label should be read at list three times;
--Before preparing or measuring the actual prescribed does.
-Before replacing the drug on the shelf just before administering the drug
to the client.
• You must prepare the medication you give yourself and DO NOT giver
drugs prepared by someone else.
A Mentally alert person will notice a change in medication or mention
problems that have arisen from the medication.
Ensure that you take the following precaution when
administering medicine.
 All doses are best prepared from the original
container.
 Medicines should not be prepared in the dark
 You should caution clients about the use of non-labelled
pillboxes
 Do not mix supplies of several tablets or capsules in a single
container
 make sure you check the medication label before removing
from the shelf before pouring or measuring and when
returning to the shelf.
The right dose:
To obtain the right dose you must carefully measure the
medicine.
when pouring solid drugs such as capsules and tablets use
proper technique to avoid contaminating the drugs. you should
pour the medication in the container cap, and transfer the
number of units required from the cap to the medication cup
Right route:
• The right route must be used for drug delivery.
• Most drugs are given orally or by topical application.
• Ensure the patient understands how the drug is to be taken.
• sub lingual or chewable tablets should NOT BE swallowed
whole.
• Crush oral drugs if swallowing is difficult or if they are to be
taken in liquid form.
• Demonstrate to the patient the procedures for
application of topical drugs.
•Always check the doctors’ orders,the cards and the
treatment sheet to verify the medication route.
Right time:
• For example;
The hourly interval between doses
The relationship of dose to the clients’ activity, such as before or
after meals, on rising or retiring, every 4 hours, hour, 12 hours.
 Medication errors

 Wrong client
 Wrong route
 Wrong medication or IV fluids
 Wrong dose or IV rate
 Omission of dose
 Incorrect discontinuation of treatment.
Classification of
drugs
Classification systems enable us to readily
identify the similarities and differences among
a large number of medications within or outside
a classification.
Drugs can be classified according to;
1. Body systems as follows;
-Respiratory system medications
-Cardiovascular system
-Nervous system
-GIT medications.
2. Their functions or usage e.g.
Antidepressant
Diuretics
Analgesics
Antibiotics

3. Their chemical make-up

Estrogens
Opioids
 Factors Influencing Drug Response
• 1. Genetic Factors- Genetic variations can affect drug
metabolism
• 2. Age- Elderly and pediatric patients may metabolize
drugs differently therefore requiring adjusted dosages.
• 3. Body weight- It might affect the drug distribution and
dosing.
• 4. Gender- Hormonal differences and body composition
affect drug metabolism and drug effects
• 5. Comorbidities- Chronic diseases ( Liver and kidney)
can alter drug metabolism and excretion.
• 6. Concurrent medication- Drug interactions
can enhance or diminish drug effects, impacting
safety and efficacy.
• 7. Diet and Nutrition- Food can affect drug
absorption and metabolism.
• 8. Lifestyle factors- Smoking, and alcohol use
may affect or influence drug metabolism.
Forms of prescription formats
• 1. Blank Prescription- given to ambulatory
patients to purchase from pharmacies
• 2. Order sheets- given to patients in institutional
settings. The pharmacists receive the orders in
print or electronically.
Types of Drug orders
• PRN- As-needed order
• Start Order- Single dose immediately
• OD- Once a day
• BD- Twice a day
• TDS- Thrice a day
• QID- Four Times a day
• NOCTE- At night
Sources of Drugs
• Mineral- Liquid paraffin
• Animals- Insulin, heparin
• Plants- Morphine, quinine
• Synthetic- Aspirin, atropine
• Microorganism- Penicillin
• Genetic engineering- Human insulin
• Dependence: State arising from repeated
periodic or continuous administration of a drug
that results in harm to the individual. They are
normally taken to induce good feelings or avoid
the discomfort of their absence
• 1. Psychological dependence- Emotional
distress like fear, anxiety, and irritability occurs
when the drug is withdrawn.
• 2. Physical dependence- there is a physical
illness that accompanies the withdrawal.
Routes of drug administration
Determined by
 Drug properties
 Therapeutic objectives

• Common routes
3. Other routes
includes:  Oral inhalation
1. Enteral  Nasal inhalation
 Oral
 Sublingual  Intrathecal/intraventricular
2. Parenteral  Topical
 Intravenous (IV)  Transdermal
 Intramuscular (IM)
 Subcutaneous (SC)  Rectal
Forms and preparation of drugs
• Solids e.g. Tablets, Caplets, Capsules, Troches
(lozenge) pastilles;
• Liquids e.g. Solutions, Syrups, Elixirs, Tinctures,
Suspensions, Emulsions ;
• Aerosols, Baths, Creams, Foams, Gels, Liniments,
Lotions,
Nebulizers, Ointments, Pastes, Patches, Powders, Soaks,
Sprays,
• Suppositories, Tinctures, Ampoules, Vials, Cartridges,
Intravenous infusions fluids;
• Implants e.g. Capsules, Pellets
Role of the nurse in drug therapy.
• Patient education
• Ensure compliance
• Note side effects
• Report any change in patients clinical state
• Administration of medication
• Use safe and recommended drugs by ensuring
safe administration and correct drugs.
Patient education.
• Explain reason for drug therapy
• Explain dosage
• Instruct how to administer
• Report side effects
• Advice on danger of sudden withdrawal
• Advice on drug interaction
• Not to share drugs
• Keep drugs safely away from children
 Uses of drugs/medications

• Curative purpose- This could be primary therapy e.g. in

treating infections or auxillary therapy e.g. application of
anaesthetic medication.
• ii. Suppress, signs and symptoms, hence improve quality of
life without attaining cure e.g. anti diabetics.
• iii. Preventive/ prophylaxis- This could be primary e.g. use
of vaccines to prevent one from getting a disease or
secondary to stop progression of an already existing
disease.
• iv. Diagnosis of disease- For instance the use of tuberculin
• Adverse Drug Reactions (ADRs)
• ADRs are unwanted or harmful effects caused by a
drug.
• Examples:
• Allergic reactions (e.g., rash, anaphylaxis).
• Side effects (e.g., nausea, drowsiness).
• Toxicity (e.g., liver damage from overdose).
• Community health workers should educate
patients about recognizing and reporting ADRs.
Rational Use of Drugs

• Rational use means prescribing the right drug, at

the right dose, for the right duration, and at the
lowest cost.
• Key principles:
• Use drugs only when necessary.
• Avoid overuse or misuse of antibiotics.
• Educate patients about proper drug use.
Role of Community Health Workers in
Pharmacology

• Educate communities about:

• Proper use of medications.
• Importance of adherence to prescribed
regimens.
• Recognizing and reporting adverse effects.
• Promote preventive measures (e.g., vaccines).
• Monitor and report drug misuse or abuse in the
community.
Common Drug Categories in Community Health

• Antibiotics: Treat bacterial infections (e.g.,

amoxicillin).
• Analgesics: Relieve pain (e.g., paracetamol,
ibuprofen).
• Antimalarials: Treat malaria (e.g., artemisinin).
• Antihypertensives: Lower blood pressure (e.g.,
amlodipine).
• Antidiabetics: Manage diabetes (e.g., metformin).
ANTIBIOTICS
Mechanism of
Class Examples
Action
Block bacterial Gentamicin,
Protein Synthesis
ribosome function Tetracycline,
Inhibitors
(30S/50S) Erythromycin
Inhibit
Cell Wall Penicillin,
peptidoglycan
Synthesis Ceftriaxone,
cross-linking or
Inhibitors Vancomycin
synthesis
Target DNA gyrase
DNA Synthesis Ciprofloxacin,
or generate free
Inhibitors Metronidazole
radicals
Folate Synthesis Inhibit folate Sulfamethoxazole,
• Inhibition of Cell Wall Synthesis
• Some antibiotics stop bacteria from building their
cell wall. The cell wall is essential for the bacteria
to keep its shape and stay intact. Without it, the
bacteria burst open. Think of it like taking away
the outer shell of an egg, causing it to break.
• Example: Penicillin
• Inhibition of Protein Synthesis
• Bacteria need to make proteins to grow and
survive. Certain antibiotics prevent bacteria from
building these proteins by targeting their
ribosomes, the "factories" where proteins are
made. Without proteins, bacteria can't function or
reproduce.
• Example: Tetracycline
• Inhibition of Nucleic Acid Synthesis
• Bacteria also need to copy their DNA to
reproduce. Some antibiotics stop this process, so
the bacteria can't divide and multiply. It's like
preventing them from making new copies of their
blueprint.
• Example: Ciprofloxacin
• Folic acid inhibitors
• Folic acid inhibitors are a class of antibiotics that
work by interfering with the bacteria's ability to
produce folic acid, a vitamin that is essential for
their growth and survival. Folic acid is needed for
making DNA, RNA, and other molecules involved
in cell division and metabolism.
• Example: Sulfonamides and Trimethoprim
 Mechanism of
Class Examples
Action
Promote sodium Thiazides:
and water Hydrochlorothiazi
excretion, de,
reducing blood Chlorthalidone
volume and Loop Diuretics:
Diuretics vascular Furosemide
resistance Potassium-
Sparing
Diuretics:
Spironolactone,
Amiloride
Calcium Channel Block calcium Dihydropyridine
Blockers (CCBs) influx into s: Amlodipine,
vascular smooth Nifedipine
muscle, causing Non-
vasodilation Dihydropyridine
Direct Vasodilator Relax vascular Relax vascular
smooth muscle, smooth muscle,
causing vasodilation causing vasodilation
• Diuretics (Water Pills):
• Diuretics help the body get rid of excess salt and
water, reducing the volume of blood, which lowers
blood pressure.
• Example: Hydrochlorothiazide
• Calcium Channel Blockers:
• These prevent calcium from entering the heart
and blood vessel muscles, which relaxes and
widens the blood vessels, lowering blood pressure.
• Example: Amlodipine
• Beta-Blockers:
• Beta-blockers reduce the heart rate and the force
of the heart's contractions, which lowers blood
pressure. They also help reduce stress on the
heart.
• Example: Atenolol
• ACE Inhibitors (Angiotensin-Converting
Enzyme Inhibitors):
• These block the production of a hormone called
angiotensin II, which normally narrows blood
vessels and raises blood pressure. By blocking it,
blood vessels relax, lowering blood pressure.
• Example: Lisinopril
Renin-Angiotensin-Aldosterone
System (RAAS)
• The Renin-Angiotensin-Aldosterone System
(RAAS) is a hormonal system that regulates blood
pressure, fluid, and electrolyte balance.
• Activation: It is triggered by low blood pressure,
low sodium levels, or sympathetic nervous system
activation.
• Renin Release: The kidneys release renin, an
enzyme, into the bloodstream.
• Angiotensin I Formation: Renin converts
angiotensinogen (produced by the liver) into
angiotensin I.
• Angiotensin II Production: Angiotensin I is
converted into angiotensin II by the enzyme ACE
(angiotensin-converting enzyme), primarily in the
lungs.
• Effects of Angiotensin II: Causes
vasoconstriction, raising blood pressure.
• Stimulates the adrenal glands to release
aldosterone, which increases sodium and water
reabsorption in the kidneys, raising blood volume
and pressure.
• Overall Outcome: Blood pressure and blood
volume are restored to maintain homeostasis.
Drug interactions
• Drug interactions occur when one drug affects the
activity of another. These can be:
• Drug-drug interactions: E.g., taking aspirin with
blood thinners increases bleeding risk.
• Drug-food interactions: E.g., grapefruit juice can
increase the effects of some drugs.
• Drug-disease interactions: E.g., NSAIDs can
worsen kidney disease or gastric disease
Antibiotic Resistance

• Antibiotic resistance occurs when bacteria

evolve to survive the effects of antibiotics.
• Causes:
• Overuse or misuse of antibiotics.
• Incomplete treatment courses.
• Community health workers can help by:
• Educating patients about completing
antibiotic courses.
• Discouraging self-medication with
antibiotics.
Ethical Considerations in Pharmacology

• Informed consent: Patients should be fully

informed about the benefits and risks of
medications.
• Equity: Ensure access to essential medicines for
all, regardless of socioeconomic status.
• Confidentiality: Protect patient information
related to medication use.