Chapter Summary 2-1

Lilley’s Pharmacology for Canadian Health Care Practice, 4th Canadian

Edition
Chapter 02: Pharmacological Principles

Chapter Summary

OVERVIEW

 The nurse’s role in drug therapy and the nursing process as it relates to pharmacological
treatment involves understanding all aspects of pharmaceutics, pharmacokinetics, and
pharmacodynamics and applying this knowledge to a variety of clinical situations.
 Nursing considerations vary, depending on the drug as well as the route of administration.
 Any chemical that affects the physiological processes of a living organism can broadly be
defined as a drug.
 Throughout the process of its development, a drug will acquire at least three different names.
The chemical name describes the drug’s chemical composition and molecular structure. The
generic name, or nonproprietary name, is shorter and simpler. The trade name, or
proprietary name, is the drug’s registered trademark; commercial use is restricted to the
owner of the patent.
 Drugs groupings are called drug classifications. Drugs can be classified by their structure or
by their therapeutic use.
 The patent life of a newly discovered drug molecule is normally 20 years in Canada:
approximately 10 years for research and development and 10 years for sales profit. After the
patent expires, generic drugs with the same active ingredient may be produced.
 The study of the adverse effects of drugs and other chemicals on living systems is known as
toxicology. Toxic effects are often an extension of a drug’s therapeutic action.
 The study of natural drug sources (i.e., plants, animals, minerals) is called pharmacognosy.
 Pharmacoeconomics focuses on the economic aspects of drug therapy.

PHARMACEUTICS

 Pharmaceutics is the study of how various dosage forms influence the way in which the drug
affects the body.
 Dosage form determines the rate at which drug dissolution and absorption occur.
 Dosage forms are designed to achieve a desired therapeutic response with minimal adverse
effects; many dosage forms were developed to encourage patient adherence to the
medication.

PHARMACOKINETICS

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Chapter Summary 2-2

 Pharmacokinetics involves the processes of drug absorption, distribution, metabolism, and

excretion.
 Pharmacokinetics concerns what happens to a drug from the time it enters the body until the
parent drug and all metabolites are excreted.
 The pharmacokinetic terms absorption, distribution, metabolism, and excretion are used to
describe the movement of drugs through the body, as well as time to onset of action, time to
peak effect, and duration of action.
 Absorption is the movement of a drug from its site of administration into the bloodstream for
distribution to the tissues. The term bioavailability expresses the extent of a drug’s
absorption.
 If a large proportion of a drug is chemically changed into inactive metabolites in the liver,
then a smaller amount will pass into the circulation; such a drug has a high first-pass effect.
 In enteral administration, the drug is absorbed in the mucosa of the stomach or intestines.
 Drugs administered by the sublingual route are absorbed in the highly vascularized tissue
under the tongue (the oral mucosa).
 The term parenteral refers to any route of administration other than the gastrointestinal tract;
it usually refers to injection. The parenteral route is the fastest route for absorption, followed
by enteral and topical routes.
 Drugs can be injected intradermally, subcutaneously, intra-arterially, intramuscularly,
intrathecally, intra-articularly, or intravenously.
 Physicians or advanced-practice nurses usually give intra-arterial, intrathecal, or intra-
articular injections.
 Medications given by the parenteral route bypass the first-pass effect of the liver, resulting in
100% bioavailability.
 The topical route of drug administration involves the application of medications to various
body surfaces, such as the skin, eyes, ears, nose, lungs, rectum, or vagina.
 Transdermal drug delivery through adhesive patches is an elaborate topical drug
administration route commonly used for systemic drug effects.
 Inhaled drugs are delivered to the lungs as micrometre-sized drug particles necessary for the
drug to be transported to the small air sacs within the lungs. Drug absorption is fairly rapid.
 Distribution refers to the transport of a drug by the bloodstream to its site of action. Drugs
are distributed first to those areas with extensive blood supply.
 Metabolism, also referred to as biotransformation, involves biochemical alteration into an
inactive metabolite, a soluble compound, a potent active metabolite, or a less active
metabolite.
 All drugs must eventually be removed from the body by excretion. The primary organ
responsible for this elimination is the kidney.
 Another pharmacokinetic variable is the half-life of the drug, the time required for 50% of a
given drug to be removed from the body.
 Drug effects are the body’s physiological reactions to the drug. Onset of action is the time
required for the drug to elicit a therapeutic response. Peak effect is the time required for a
drug to reach its maximum therapeutic response; if the peak blood level is too high, drug
toxicity may occur. Trough level is the lowest blood level of a drug. The duration of action
of a drug is the length of time that the drug concentration is sufficient (without more doses)
to elicit a therapeutic response.

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Chapter Summary 2-3

PHARMACODYNAMICS

 Pharmacodynamics is the study of what a drug does to the body. If is the relationship
between drug concentrations and the pharmacological response (actions of the drug).
 A positive change in a faulty physiological system is called a therapeutic effect of a drug.

PHARMACOTHERAPEUTICS

 Pharmacotherapeutics defines the principles of drug actions—the cellular processes that

change in response to the presence of drug molecules.
 Before drug therapy is initiated, a desired therapeutic outcome is established. This desired
outcome is specific to the patient, established in collaboration with the patient, and
determined with other members of the health care team.
 Patient therapy assessment is the process by which a practitioner integrates knowledge of
medical and drug-related facts with information about a patient’s medical and social history.
 Considered in the assessment are drugs currently being used, pregnancy and breastfeeding
status, and concurrent illnesses that could contraindicate the initiation of a given medication.
 A contraindication for a medication is any patient condition, especially a disease state, that
makes the use of the given medication dangerous for the patient.
 Acute therapy often involves intensive drug treatment and is implemented in the acutely ill
(those with rapid onset of illness) or even the critically ill to sustain life or treat disease.
 Maintenance therapy does not eradicate problems the patient may already have but will
prevent the progression of a disease or chronic condition.
 Supplemental therapy (also called replacement therapy) supplies the body with a substance
needed to maintain normal function because the body cannot make the substance or produce
it in insufficient quantity.
 Palliative therapy focuses on providing patients with relief from the symptoms, pain, and
stress of a serious illness and on improving the quality of life for both the patient and the
patient’s family.
 Supportive therapy maintains the integrity of body functions during illness or trauma
recovery.
 Prophylactic therapy is drug therapy to prevent illness or other undesirable outcomes during
planned events.
 Evaluating the clinical response requires familiarity with both the drug’s intended therapeutic
action (i.e., beneficial effects) and its unintended possible adverse effects.
 The ratio of a drug’s toxic level to the level that provides therapeutic benefits is referred to as
the drug’s therapeutic index; the safety of a particular drug therapy is determined by this
index.
 A low therapeutic index means that the difference between a therapeutically active dose and
a toxic dose is small; therefore, the medication’s use requires closer monitoring.
 Tolerance to a drug is a decreasing response to repeated doses of that drug.
 Dependence is a physiological or psychological need for a drug.

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Chapter Summary 2-4

 Drugs may interact with other drugs, with foods, or with agents administered as part of
laboratory tests. A knowledge of drug interactions is vital for the appropriate monitoring of a
drug’s effects.
 When two drugs with similar actions are given together, they can have additive effects.
 Synergistic effects occur when two drugs that are administered together interact in such a way
that their combined effects are greater than the sum of the effects of each drug given alone.
 Antagonistic effects are said to occur when the combination of two drugs results in drug
effects that are less than the sum of the effects for each drug given separately.
 Drug incompatibility occurs when two parenteral drugs or solutions are mixed and a
chemical deterioration of one or both drugs occurs or a physical precipitate forms.
 An adverse drug event is broadly any undesirable occurrence involving medications. A
similarly broad term also used in the literature is drug misadventure.
 A medication error is a preventable situation involving compromise of the “ten rights”; it
occurs during the prescribing, dispensing, administering, or monitoring of drug therapy.
 An adverse drug reaction (ADR) is any drug reaction that is unexpected and undesirable and
that occurs at therapeutic drug dosages. ADRs may or may not be caused by medication
errors.
 An allergic reaction (also known as a hypersensitivity reaction) is an immunological
hypersensitivity reaction resulting from the patient’s unusual sensitivity to a particular
medication.
 An idiosyncratic reaction occurs unexpectedly in a particular patient and originates from a
genetically determined abnormal response to normal dosages of a drug. The study of such
traits, which are solely revealed by drug administration, is called pharmacogenomics.
 Teratogenic effects of drugs or other chemicals result in structural defects in the fetus.
Compounds that produce such effects are called teratogens.

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