INTRODUCTION TO PHARMACOLOGY  DEFINITION:  Pharmacology is the science that deals with the study of drugs and their interaction with the living systems.  The word Pharmacology is derived from Greek – pharmacon means drug and logos means study.  DRUG:  Drug is a substance used in the diagnosis ,prevention or treatment of disease.  PHARMACOKINECTICS:  Pharmacokinectics is the study of the absorption distribution ,metabolism and excretion of drugs,i.e what the body does the drug (in greek kinesis = movement). 3. INTRODUCTION TO PHARMACOLOGY  DEFINITION:  PHARMACODYNAMICS :  Pharmacodynamics is the study of the effect of the drugs on the body and their mechanism of action ,i.e what the drug does the body.  THERAPEUTICS:  Therapeutics deals with the use of drugs in the prevention and treatment of disease.  TOXICOLOGY :  Toxicology deals with the adverse effect of the drug and also the study of poisons,i.e detection ,prevention and treatment of poisoning.(Toxicon =poison in greek. 4. INTRODUCTION TO PHARMACOLOGY  CHEMOTHERAPHY :  Chemotheraphy is the use of chemicals for the treatment of infections.the term now also includes the use of chemical to treate malignancies.  PHARMACY :  Pharmacy is the science of identification , compounding and dispensing of drugs .It also includes collection , isolation, purification , synthesis and Standardization of medical substances.    5. SOURCES OF DRUGS  The sources of drugs could be natural or synthetic ,  NATURAL SOURCES:  1.PLANTS,e.g Atropine ,Morphine ,Quinine ,digoxine,pilocarpine,physostigmine.  2.ANIMALS e.g . Insulin ,heparin ,gonadotrophins and antitoxic sera.  3.MINERALS,Magnesium sulphate , Aluminium hydroxide ,iron ,sulphur and radio active isotopes.  4.MICROORGANISMS ,Antibacterial agents are obtained from some bacteria and fungi.we thus have pencillins,cephalosporins,tetracycline and other antibiotics. 6. SOURCES OF DRUGS  5.HUMAN: some drugs are obtained from man ,e.g  Immunoglobulin from blood,growth hormone from anterior pituitary and chorionic gonadotrophins from the urine of pregnant woman.  SYNTHETIC :  Most drugs are now synthesized .e.g quinolones,omeprazole,sulfonamides,pancuronium,neostigmi ne.  Many drugs are obtained from cell culture ,e.g urokinase from cultured kidney cells.  some are now produced by recombinant DNA technology ,e.g human insulin, tissue plasmogen activator and some drugs by Hybridoma technique, e.g monoclonal antibodies. 7. ROUTES OF DRUG ADMINISTRATION  Drugs may be administered by various routes .the choice of the route in a given patient depends on the properties of the drug and the patients requirements.A knowledge of advantage and disadvantage of the routes of drug administration is essential.  The route can be broadly divided into:  Enteral  Parenteral  Local 8. ENTERAL ROUTE (ORAL INGESTION )  This is the most common ,oldest and safest routes of drug administration. the large surface area of the GI ,the mixing of its content

1. MS VARSHA S.
Ass. Professor

2. Objective
⚫Upon completionof the topic the health care
professionals understands the importance of safe
administrationof medications and appreciate the
knowledgeabout theactionsand effects of
medications to safely and accurately administer
medications and understandsabout pharmacologic
principles.

3. Contents
Introduction to pharmacology
⚫ Definitions
⚫ Sources
⚫ Terminologyused
⚫ Route of drug administration
⚫ Types: Classification
⚫ Pharmacodynamics: Actions, therapeutic
⚫ Adverse, toxic
⚫ Pharmacokinetics : absorption, distribution, metabolism,
interaction, excretion
⚫ Review: Routesand principlesof administrationof drugs
⚫ Indian pharmacopoeia : Legal issues
⚫ Rational useof drugs
⚫ Principlesof therapeutics

4. Introduction
⚫Pharmacology is the studyof drugs including their
origins, history, uses, and properties.
⚫Theword pharmacologycomes from the Greek
words pharmakos, meaning medicine or drug,
and logos, meaning study.
⚫Drug therapy playsa majorrole in the treatmentof
patients.
⚫It involvesthe useof drugs toprevent, diagnoseorcure
disease processes or to relieve signs and symptoms
withoutcuring the underlying disease.

5. Definitions
⚫Pharmacology is the scientific study of the effects of
drugsand chemicalson living organisms wherea drug
can be broadly defined as any chemical substance,
natural orsynthetic, which affectsa biological system.
⚫Pharmacology is the science thatdealswith the study
of drugsand their interactions with the living system.
⚫Pharmacology is the science thatdealswith drugs,
theirsources, natureand properties.

6. TERMINOLOGY
DRUG: Any substance, which is synthetic, semisynthetic, natural or
biotechnological used for diagnosis, prevention, treatment or cure of a
diseases or disorder is known as drug.
Pharmacodynamics: it is a branch of pharmacology, which deals with
the effects of drugs on the different body system and includes mechanism
of action of drugs at the molecular, cellular and organ level.
Pharmacokinetics: it is a branch of pharmacology, which deals with the
journey or movement of drug in, through and out from the body.
Pharmacy: It is a branch of medical science, which deals with
compounding and dispensing of drugs. Its includes collection,
identification, purification, isolation, synthesis, standardization and
quality control of medicinal substances.

7. SOURCES OF DRUGS
1 Natural Sources
- Plants
- Animals and human
- Microorganisms
- Heavy metals, minerals and mineral oils
2. Synthetic and Semi-Synthetic Sources
3.Engineered Sources/ Biosynthetic sources

8. Sources of drugs
⚫ Drugsaresubstances thatareused or intended to be used in the diagnosis, prevention,
treatmentorcureof diseases.
⚫ The majorsources of drugs can begrouped into the following;
1. Plant Sources
plant source fordrugs are the leaf and otherparts of plants (e.g., barks, fruits, roots, stem, wood,
seeds, blossoms, bulb etc.)
Plant part
Leaves
Flowers
Fruits
Seeds
Roots
Bark
Stem
Drugs
Digoxin, digitoxin (from Digitalis purpurea/foxglove plant);
atropine (from Atropa belladonna)
Vincristine, vinblastine (from Vinca rosea)
Physostigmine (from Physostigma venenosum/calabar bean)
Strychnine (from Nux vomica); physostigmine
(from Physostigma venenosum/calabar bean)
Emetine (from Cephaelis ipecacuanha); reserpine (from Rauwolfa
serpentina)
Quinine (from Cinchona); atropine (from Atropa
belladonna)
Tubocurarine (from Chondrodendron tomentosum)

9. ⚫2. Animal Sources
• Medicinal substances are derived from the animal’s
body secretions, fluid orglands.
• Insulin, heparin, adrenaline, thyroxin, cod liveroil,
musk, beeswax, enzymes, and antitoxins sera are some
examples of drugs obtained from animal sources.
3. Microbial sources
• Several life-saving drugs have been historically
derived from microorganisms.
• Examples include penicillin produced by
Penicillium chrysogenum,
• streptomycin from Streptomyces griseus,.

10. 4. Marinesource
⚫ Bioactivecompounds from marine flora and fauna haveextensive past
and presentuse in the prevention, treatmentorcureof manydiseases.
⚫ Coral, sponges, fish, and marine microorganisms produce biologically
potent chemicals with interesting anti-inflammatory, anti-viral, and
anticanceractivity.
5. Mineral sources
⚫ Minerals (both metallic and non-metallic minerals) have been used as
drugs since ancient times.
⚫ Examples include ferrous sulfate in iron deficiency anemia;
magnesium sulfate as purgative;
⚫ Magnesium trisilicate, aluminum hydroxideand sodium bicarbonateas
antacids for hyperacidity and peptic ulcer;
⚫ Zinc oxide ointment as skin protectant, in woundsand eczema;
⚫ Gold salts (solganal, auranofin) as anti- inflammatoryand
⚫ In rheumatoid arthritis; selenium as anti-dandruff.

11. 6. Synthetic/chemical derivative
• A synthetic drug is produced using chemical
synthesis, which rearranges chemical derivatives to
form a new compound.
Examples includeacetylsalicylicacid (aspirin orASA),
oral antidiabetics, antihistamines, thiazide diuretics,
chloroquine, chlorpromazine, general and local
anaesthetics, paracetamol, phenytoin etc.

12. 7. Semi-synthetic Sources
⚫Semi-synthetic drugs are neither completely
natural norcompletelysynthetic. Theyarea hybrid
and are generally made by chemically modifying
substances thatareavailable from natural source to
improve its potency, efficacy and/or reduce side
effects.
⚫Examples of semi-synthetic medicine include
heroin from morphine, bromoscopolamine from
scopolamine, homatropine from atropine,
ampicillin from penicillinetc.

13. 8. Biosyntheticsources (geneticallyengineered
drugs)
This is relativelya new field which is being developed
by mixing discoveries from molecular biology,
recombinant DNA technology, DNA alteration,
gene splicing, immunology, and immune
pharmacology.
Drugs developed using living organisms with the
help of biotechnology or genetic engineering are
known as biologics, biopharmaceuticals,
recombinant DNA expressed products,
bioengineered, or genetically engineered drugs
Examples includerecombinant Hepatitis B vaccine,
recombinant insulinand others.

14. SYSTEM OF MEASUREMENT
1. APOTHECARY SYSTEM
2. METRIC SYSTEM
3. HOUSEHOLD SYSTEM

15. APOTHECARY SYSTEM
• It is the oldest system of measurement.
• This system was based on arbitrary units and later on
replaced by metric system.
METRIC SYSTEM
• Invented in France.
• It includes gram and liter as basic units.
• Arabic numerals, fraction and decimal were also
included.

16. Household system
• This is household methods for measuring liquid
item.
• The accuracy is not established for measuring
medicine and other products but it is still in use.

18. Medication Forms
Solid :
1. Powders
2. Tablet
3. Granules
4. Capsules
5. Cachets
6. Pills
7. Lozenges
8. Suppositories
9. Poultices

19. Solid form
1. Powders : it contains finelty divided particles in micron size of
drugs
2. Tablet: it contains medicaments with or excipients
3. Granules: aggregate of particles of drugs
4. Capsules: drugs enclosed with cylindrical gelatin containers,
which alter the taste of drug.
5. Cachets: drugs enclosed with wafer sheet of rice
6. Pills: small tablet containing excipients
7. Lozenges: it contain sugar and gum used to medicate mouth
and throat.
8. Suppositories: it contain medicament with suitable
suppository base that inserted into the body cavities.
9. Poultices: solid dosage form converted to paste like prepration
used externally in the skin to reduce inflammation.

20. Medication Forms
Semisolid Solid :
1. Ointments
2. Creams
3. Paste
4. Gels
5. Poultices

21. Semisolid Solid :
1. Ointments : semisolid dosage forms for external use
containing with or without medicaments with suitable
ointment base.
2. Creams: semisolid dosage forms external use containing
with or without medicaments with suitable fatty base.
3. Paste: semisolid dosage forms for external use containing
high proportion of powered medicaments with suitable fatty
base.
4. Gels: transparent semisolid dosage forms for external use
containing hydrophillic and hydrophobic base with gelling
agents
5. Poultices: for external use containing medicaments
applied to the skin to hold the dressing and
protective.

22. Medication Forms
Liquid dosage:
1. Collodions
2. Droughts
3. Exlixirs
4. Emulsions
5. Suspensions
6. Enemas
7. Gargles
8. Gels
9. Linctuses
10.Liniments
11. Mixtures
12.Mouth washes

23. Liquid dosage:
1. Collodions: liquid prepration for external use having nitro cellulose used
to protect the skin.
2. Droughts : liquid preparation for oral containing medicaments available
in single dose or multiple doses.
3. Exlixirs ;
4. Emulsions
5. Suspensions
6. Enemas
7. Gargles
8. Gels

24. Medication Forms
Liquid :
1. Nasal drops
2. Paints
3. Solutions
4. Syrups
Gaseous
1 Aerosol
2. Inhalations
3. Sprays

25. Pharmacological Concepts:
Classification
⚫A medication mayalso be partof more than oneclass
⚫Aspirin is an analgesic, antipyretic, anti-inflammatory,
and anti-platelet

26. Pharmacological concepts: Medication forms
⚫Medications are available in avarietyof forms and
preparations
⚫The form of the med will determine its route of
administration
⚫Composition of med is designed toenhance its
absorption & metabolism
⚫Many meds areavailable in several forms

27. ROUTE OF DRUG ADMINISTRATION

28. Pharmacologic Principles
• Pharmaceutics
• Pharmacokinetics
• Pharmacodynamics
• Pharmacotherapeutics
• Pharmacognosy

29. Pharmaceutics
The study of how various drug forms influence
pharmacokinetic and pharmacodynamic activities

30. Pharmacokinetics
• The studyof what the bodydoes to thedrug
– Absorption
– Distribution
– Metabolism
– Excretion

31. Pharmacokinetics: Absorption
• The rate at which a drug leaves its site of
administration, and theextenttowhich absorption
occurs
– Bioavailability
– Bioequivalent

32. Factors That Affect Absorption
• Administration routeof the drug
• Ability of Med to Dissolve
• Food or fluids administered with thedrug
• Body Surface Area
• Status of theabsorptive surface
• Rateof blood flow to the small intestine
• Lipid Solubilityof Med
• Status of GI motility

33. Routes of Administration
• A drug’s routeof administrationaffects the rateand
extentof absorptionof thatdrug
1. Enteral (GI tract)(oral): Drug is absorbed into the
systemiccirculation through the oral or gastric
mucosa, the small intestine, or rectum
2. Subcutaneous : the drug are deposited in the
vicinity of capillaries and absorption occur through
the large paracellular space around the capillaries.
large molecule of drug not absorb through
capillaries

34. Conti…
1. Intramuscular : the absorption Is faster than sc and
more consistent. The muscular exercise and
application of heat at the site increase the rate of
absorption.
2. Intravenous : here the drug is directly put into the
circulation and within no time the drug circulate
throughout the body.

35. Distribution
The transportof adrug in the body by the
bloodstream to its siteof action
• Protein-binding
• Watersoluble vs. fat soluble
• Blood-brain barrier
• Areas of rapid distribution: heart, liver,
kidneys, brain
• Areas of slow distribution: muscle, skin, fat

37. The distribution of drug depends upon the
following factors.
• Lipid solubility
• Lipid water partition coefficient
• Ionization at physiological pH
• extent of binding to plasma and tissue proteins
• Differences in regional blood flow
• Diseases renal failure, liver failure, heart failure.

38. Metabolism/Biotransformation
(cont'd)
Delayed drug metabolism results in:
• Accumulation of drugs
• Prolonged action of thedrugs
Stimulating drug metabolismcauses:
• Diminished pharmacologic effects

39. Metabolism
(Also Known As Biotransformation)
The biologic transformation of a drug into
an inactive metabolite, a more soluble compound,
ora more potent metabolite
• Liver (main organ)
• Kidneys
• Lungs
• Plasma
• Intestinal mucosa

40. EFFECTS OF METABOLISM
• Inactivation of the active drugs: drug are made
inactive or less active.
• Ex : Paracetamol
• Activation of inactive drug: some drugs needs
conversion in the body to active form and are
inactive as such drug called prodrug.
• EX : Acyclovir- Acyclovir triphosphate
• Active metabolites formation from an active drug:
some drugs are active even after their conversion to
their metabolites. These metabolism can also act as
the original drug. These are called active metabolites.

41. Types of metabolism reactions
1. Non-synthetic/ phase I reactions: A functional
group is generated or exposed metabolite may be
active or inactive.
The non-synthetic reaction involve oxidations,
reduction,
2. Synthetic / phase I reactions: here the drug or its
phase I metabolites are conjugated with an
endogenously derived substrate to form an easily
excretable substance. This reaction requires energy. Its
involve: glucuronide conjugation, acetylation,
methylation.

42. Excretion
Theeliminationof drugs from the body
• Kidneys (main organ)
• Liver
• Bowel
– Biliaryexcretion
– Enterohepaticcirculation

43. Pharmaco dynamics
• The studyof what thedrug does to the body
– The mechanismof drug actions in living
tissues

44. Figure 2-2 Phases of DrugActivity. (From
McKenry LM, Salerno E: Mosby’s
pharmacology in nursing—revised and
updated, ed 21, St. Louis, 2003, Mosby.)

45. Pharmacotherapeutics
The useof drugsand theclinical
indications fordrugs to prevent
and treatdiseases

46. Pharmacognosy
The studyof natural (plantand animal) drug sources

47. Pharmacodynamics
⚫Studyof the mechanismof drug actions in living
tissue
⚫Drug-induced alterations to normal physiologic
function
⚫Positivechange-Therapeutic effect-Goal of therapy

48. Mechanism of Action
⚫Ways in which a drug can producea therapeuticeffect
⚫Theeffects thata particulardrug has dependson the
cellsororgan targeted by thedrug
⚫Once thedrug hits its “siteof action” itcan modify the
rateatwhich a cell or tissue functions

49. Mechanism of Action
⚫ReceptorInteraction
⚫Enzyme Interaction
⚫Non-Specific Interaction

50. Receptor Interaction
⚫Drug structure is essential
⚫Involves the selective joining of drug molecule
with a reactive siteon thecell surface that elicitsa
biological effect
⚫Receptor is the reactivesiteon a cell or tissue
⚫Once the substance binds toand interactswith the
receptor, a pharmacologic response is produced

51. Receptor Interaction
⚫Affinity- degree towhich a drug binds with a
receptor
⚫Thedrug with the best “fit” oraffinitywill elicit the
best response
⚫Drug can mimic body’s endogenous substances
that normally bind to receptorsite
⚫Drugs that bind to receptors interact with
receptors in differentways toeither block orelicita
response

52. Receptor Interaction
⚫Agonist-Drug binds to receptor-there is a response
(Adrenergic Agents)
⚫Antagonist-drug binds to receptor-no response-
prevents binding of agonists (Alpha & Beta Blockers)

54. Enzyme Interaction
⚫Enzymes are substances that catalyze nearlyevery
biochemical reaction in a cell
⚫Drugs can interactwith enzyme systems toaltera
response
⚫Inhibits action of enzymes-enzyme is “fooled” into
binding todrug instead of target cell
⚫Protects target cell from enzyme’s action (ACE
Inhibitors)

55. Non-Specific Interaction
⚫Not involving a receptorsiteoralteration in
enzyme function
⚫Main siteof action is cell membrane orcellular
process
⚫Drugs will physically interfereorchemically alter
cell process
⚫Final product is altered causing defectorcell death
⚫Cancerdrugs, Antibiotics

57. The nurse is giving a medication that has a
high first-pass effect. The physician has
changed the route from IV to PO. The nurse
expects theoral dose to be:
1. Higher becauseof the first-pass effect.
2. Lower becauseof the first-pass effect.
3. The same as the IV dose.
4. Unchanged.

58. Type of Medication Action
⚫Therapeutic Effect
⚫Side Effects
⚫Adverse Effects
⚫Toxic Effect
⚫Idiosyncratic Reactions
⚫Allergic Reaction
⚫Medication Interactions
⚫Iatrogenic Response

59. Therapeutic Effect
⚫The expected or predictable physiological responsea
medicationcauses
⚫A single med can haveseveral therapeuticeffects
(Aspirin)
⚫It is important for the nurse to knowwhy med is being
prescribed

60. Side Effects
⚫Unintended secondary effectsa medication
predictably will cause
⚫May be harmless orserious
⚫If side effects are serious enough to negate the
beneficial effectof meds therapeutic action, it may
be D/C’d
⚫People may stop taking medications becauseof the
sideeffects

61. Adverse Effects
⚫Undesirable response of a medication
⚫Unexpected effectsof drug not related to
therapeutic effect
⚫Must be reported to FDA
⚫Can bea sideeffectora harmful effect
⚫Can be categorized as pharmacologic,
idiosyncratic, hypersensitivity, ordrug interaction

62. Adverse Effects
⚫Adverse Drug Events
⚫Adverse Drug Reactions (ADR)

63. Toxic Effect
n
⚫May developafterprolonged intakeorwhen a med
accumulates in the blood because of impaired
metabolism or excretion, or excessive amount
taken
⚫Toxic levels of opioidscan cause resp.depressio
⚫Antidotes available to reverse effects

64. Idiosyncratic Reactions
⚫Unpredictableeffects-overreactsorunderreacts to
a medication or has a reaction different from
normal
⚫Geneticallydetermined abnormal response
⚫Idiosyncraticdrug reactions are usually caused by
abnormal levels of drug-metabolizing enzymes
(deficiencyoroverabundance)

65. Allergic Reaction
⚫Unpredictable response toa medication
⚫Makes up greater than 10% of all medication
reactions
⚫Client may become sensitized immunologically to
the initial dose, repeated administration causes an
allergic response to the med, chemical preservative
ora metabolite

66. Allergic Reaction
⚫Medication acts as an antigen triggering the
release of the body’s antibodies
⚫May be mild orsevere
⚫Among thedifferentclasses of meds, antibiotics
cause the highest incidenceof allergic reaction
⚫Severe reaction-Anaphylactic reaction
⚫Mild reaction-hives, rash, pruritis

69. Other Drug Reactions
⚫Teratogenic-Structural effect in unborn fetus
(thalidomide)
⚫Carcinogenic-Causes cancer
⚫Mutagenic- Changes genetic composition (radiation,
chemicals)

70. Drug Interactions
⚫Occurswhen one med modifies theaction of another
⚫Common in people taking several medicationsatonce
⚫One med may potentiateordiminish theaction of
anotheroraltertheway it is absorbed, metabolized or
eliminated
⚫Warfarin and Amiodarone

71. Iatrogenic Responses
⚫Unintentional adverseeffects that occurduring
therapy
⚫Treatment-Induced Dermatologic-rash, hives,
acne
⚫Renal Damage-Aminoglycoside antibiotics,
NSAIDS, contrast medium
⚫Blood Dyscrasias- Destruction of blood cells
(Chemotherapy)
⚫Hepatic Toxicity-Elevated liverenzymes (hepatitis-
like symptoms)

72. Synergistic Effect
⚫Effectof 2 meds combined is greater than the
meds given separately
⚫Alcohol & Antihistamines, antidepressants,
barbiturates, narcotics
⚫Notalways undesirable, physician may combine
meds to create an interaction that will have
beneficial effects (Vasodilators & diuretics to
control high BP)

73. Medication Dose Responses
⚫Exceptwhen administered IV, meds take time to
enter bloodstream
⚫Thequantity & distribution of med in different
bodycompartments change constantly
⚫Goal is to keepconstant blood level within a safe
therapeutic range
⚫Repeated doses are required toachievea constant
therapeutic concentration of a med because a
portion of med is always being excreted

74. Medication Dose Responses
⚫Serum Half-Life:Time it takes forexcretion
processes to lower the serum medication
concentration by ½
⚫Regular fixed doses must begiven to maintain
therapeutic concentration
⚫Dosage schedules set by institutions (TID, q8h,
HS, AC, STAT, PRN)
⚫Peak & Trough levels
⚫Therapeutic drug monitoring

75. Half-life
• The time it takes for one half of the original
amountof a drug in the body to be removed
• A measure of the rateat which drugs are removed
from the body

76. Onset, Peak, and Duration
Onset
• The time it takes for the drug toelicita
therapeutic response
Peak
• The time it takes fora drug to reach its
maximum therapeutic response
Duration
• The timea drug concentration is sufficient to
elicita therapeutic response

77. Pharmaco therapeutics: Types of
Therapies
• Acute therapy
• Maintenance therapy
• Supplemental therapy
• Palliativetherapy
• Supportivetherapy
• Prophylactic therapy
• Empiric therapy

78. Monitoring
• Theeffectivenessof thedrug therapy must be
evaluated
• One must be familiarwith thedrug’s:
– Intended therapeuticaction (beneficial)
– Unintended but potential side effects (predictable,
adverse reactions)

79. Monitoring (cont'd)
• Therapeutic index
– The ratio betweena drug’s therapeutic
benefitsand its toxiceffects

80. Monitoring (cont'd)
• Tolerance
– A decreasing response to repetitivedrug doses

81. Monitoring (cont'd)
• Dependence
– A physiologicorpsychological need fora drug

82. Monitoring (cont'd)
Interactions mayoccurwith otherdrugsor food
• Drug interactions: thealteration of action of
a drug by:
– Otherprescribed drugs
– Over-the-counter medications
– Herbal therapies

83. Monitoring (cont'd)
• Drug interactions
– Additiveeffect
– Synergisticeffect
– Antagonisticeffect
– Incompatibility

84. Monitoring (cont'd)
• Medication misadventures
– Adverse drug events
– Adverse drug reactions
– Medicationerrors

85. Monitoring (cont'd)
Someadversedrug reactionsareclassified as side
effects
• Expected, well-known reactions that result in little
or nochange in patient management
• Predictable frequency
• The effect’s intensityand occurrence are related to
the size of the dose

86. Adverse Drug Reaction
An adverseoutcomeof drug therapy in which a patient
is harmed in someway
• Pharmacologic reactions
• Idiosyncratic reactions
• Hypersensitivity reactions
• Drug interactions

87. Other Drug-Related Effects
• Teratogenic
• Mutagenic
• Carcinogenic

88. Toxicology
The studyof poisonsand unwanted responses to
therapeuticagents

89. e 2 9 mon
Poisons and Antidotes

90. INDIAN PHARMACOPOEIA
⚫The Indian Pharmacopoeia (IP) is a compilation of
official standards fordrugs manufactured in India.
⚫Standards in the IP are expressed in the form of
specifications and test methods for determining
compliancewith such standards.
⚫The pharmacopoeiasor formulariescontain a listof
drugs and other related substances regarding their
source, descriptions, standards, tests, formulae for
preparing the same, action and uses, doses, storage
conditionsetc

91. ⚫Indian Pharmacopoeia (IP) is published by the Indian
Pharmacopoeia Commission (IPC) on behalf of the
Ministryof Health & Family Welfare, Governmentof India
in fulfillment of the requirements of the Drugs and
Cosmetics Act, 1940 and Rules 1945 there under.
⚫ IP is recognized as the official book of standards for the
drugs being manufactured and/or marketed in India. IP
contains acollection of authoritativeprocedures of analysis
and specifications of drugs for their identity, purity and
strength.
⚫The standards of the IP areauthoritative in natureand are
enforced by the regulatoryauthorities forensuring the
qualityof drugs in India. During qualityassurance and at
the timeof dispute in thecourt of law the IP standards are
legallyacceptable.

92. ⚫ 1946- Indian Pharmacopoeial Listwas published by Govt. of
India.
⚫ 1955 -Firstedition of Indian Pharmacopoeiawas published.
⚫ 1960 -Supplementof IP 1955 was published.
⚫ 1966 - Second edition of IP was published.
⚫ 1975 -Supplementof IP 1966 was published.
⚫ 1985- Third editionof IP was published.
⚫ 1989 -Addendum-I to IP 1985 was published.
⚫ 1991 -Addendum-II to IP 1985 was published.
⚫ 1996 -Fourth edition of IP was published followed by its
addendum 2000, supplement 2000 forVeterinary Products,
addendum 2002 and addendum 2005;
⚫ Indian Pharmacopoeia 2007 - Fifth edition, followed by
addendum 2008;
⚫ Indian Pharmacopoeia 2010 - Six editionwith DVD followed by
itsaddendum 2012;
⚫ Indian Pharmacopoeia 2014 – Seventhedition with DVD
followed by itsaddendum 2015 and addendum 2016;
⚫ Indian Pharmacopoeia 2018 with DVD - Eighth edition

94. Medication Misadventures
• Medicationerrors (MEs)
• Adversedrug events (ADEs)
• Adversedrug reactions (ADRs)

95. Medication Misadventures
(cont'd)
• Bydefinition, all ADRsarealso ADEs
• Butall ADEsare not ADRs
• Two typesof ADRs
– Allergic reactions
– Idiosyncratic reactions

96. Me
• P
d
re
iv
c
ea
ntt
ab
il
o
e n Errors
• Commoncauseof adverse health careoutcomes
• Effectscan range from no significant effect todirectly
causing disabilityordeath

97. Box 5-1 Common classes of medications
involved in serious errors

98. Preventing Medication Errors
• Minimizeverbal or telephoneorders
– Repeatorder to prescriber
– Spell drug namealoud
– Speak slowly and clearly
• List indication next toeach order
• Avoid medical shorthand, including abbreviationsand
acronyms

99. Preventing Medication Errors
(cont'd)
• Neverassumeanything about items not
specified in a drug order (i.e., route)
• Do not hesitate toquestiona medicationorder
forany reason when in doubt
• Do not try todecipher illegiblywritten orders;
contactprescriber forclarification

100. Preventing Medication Errors
(cont'd)
• NEVER use “trailing zeros” with medicationorders
• Do not use 1.0 mg; use 1 mg
• 1.0 mg could be misread as 10 mg, resulting in a
tenfold dose increase

101. Preventing Medication Errors
(cont'd)
• ALWAYS usea “leading zero” fordecimal dosages
• Do not use .25 mg; use 0.25 mg
• .25 mg may be misread as 25 mg
• “.25” is sometimescalled a “naked decimal”

102. Preventing Medication Errors
(cont'd)
• Check medication orderand what is availablewhile
using the “5 rights”
• Take time to learn special administration techniquesof
certain dosage forms

103. Preventing Medication Errors
(cont'd)
• Always listen toand honoranyconcernsexpressed by
patients regarding medications
• Check patientallergiesand identification
• Medication Reconciliation

104. Medication Errors
• Medication error has the potential to lead to harm to the
patient. It is the leading cause of threatens trust in the
healthcaresystem, inducecorrective therapy, and prolong
patients’ hospitalization, produces extra costs and even
death.
• Possibleconsequences to nurses
• Reporting and responding to MEs
– ADE monitoring programs
– USPMERP (United States Pharmacopeia Medication Errors
Reporting Program)
– MedWatch, sponsored by the FDA
– Institute for Safe Medication Practices (ISMP)
• Notificationof patientregarding MEs

105. Administer medications safely