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The Basics of Pharmacology

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THE BASICS OF PHARMACOLOGY An Overview Jassin M. Jouria, MD Dr. Jassin M. Jouria is a practicing Emergency Medicine physician, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serve as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e- module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT The science of pharmacology and the responsibility relationship building with patients are important elements of a health professional’s clinical knowledge and skills to provide safe and appropriate pharmacotherapeutic regimens in everyday practice. Interdisciplinary members of the health team are required to continually interpret specific patient health data to implement and evaluate outcomes of medication treatment. All health clinicians are increasingly relying on practice guidelines and the applied specialized training of health team members when obtaining the patient health history 1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com to improve therapeutic medication regimens, avoid adverse effects, and to safely and effectively treat a disease state. Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 3 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology content is 3 hours. Statement of Learning Need Online pharmacology continuous learning has become a highly satisfying method for interdisciplinary health clinicians to increase and maintain proficiency in medication prescribing and administration. Pharmacotherapy education tailored to enhance clinical knowledge in the treatment of specific disease states are expected to lead to improved collaborative practice among health professionals and patient care outcomes. Course Purpose 2 nursece4less.com nursece4less.com nursece4less.com nursece4less.com To improve knowledge for health clinicians at all levels of experience in basic pharmacology of medication prescribing, administration and monitoring of medication treatment outcomes. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA Susan DePasquale, MSN, FPMHNP-BC - all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on 3 nursece4less.com nursece4less.com nursece4less.com nursece4less.com page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. 1. The process of drug absorption, distribution in the body, metabolism and excretion is called a. pharmacodynamics. b. pharmacokinetics. c. therapeutic pharmacology. d. pharmacogenomics. 2. The relationship determined by a drugs concentration and time at the preferred action site, along with the drug's effects, both therapeutic and adverse, are referred to as a. pharmacodynamics. b. pharmacokinetics. c. therapeutic pharmacology. d. pharmacogenomics. 3. The deciding factor in choosing which medication may be a more effective treatment for a patient is the drug with an EC50 that has a. a higher EC50. b. a lower EC50. c. the EC50 has no impact on this type of decision. d. the EC50 is the same for both drugs. 4. Therapeutic levels of a drug a. are best monitored with tissue samples. b. cannot cause toxicity. c. are not altered by diversity of medical conditions. d. give the best medication therapy with minimized side effects. 5. If normal dose of a medication is 10 milligrams/kilogram (10 mg/kg), an individual weighing 110 pounds (50 kilograms) would be given _______ mg. a. 50 4 nursece4less.com nursece4less.com nursece4less.com nursece4less.com b. 250 c. 500 d. 1000 Introduction There are two distinct sets of responsibilities that health clinicians must fulfill relative to pharmacology. One is a social responsibility to engage and inform patients of their medication and the second is a scientific responsibility that involves understanding the benefits and risks of medication. Drug prescribing and administration falls squarely at the intersection of these two responsibilities. Not only do all health clinicians need to understand the scientific elements of pharmacology but the social component, as well. Clinicians need to build relationships in order to glean important information from their patients and to educate both patients and their families. This first part of a 3-part series on pharmacology will provide basic definitions and discussion on pharmacokinetics and pharmacodynamics to prepare clinicians in a medical and therapeutic milieu where medication selection and ongoing treatment becomes indicated. Advancements In Medication Treatments The field of pharmacology is the most vital and extensively researched field of the medical sciences. There now exists a seemingly unlimited variety of medications. The rapid advancement in medication has brought forward new cures, therapies and treatments for diseases and medical conditions that previously were incurable. These advancements in pharmacology involve the study of drug actions on living organisms. Health clinicians need to be aware 5 nursece4less.com nursece4less.com nursece4less.com nursece4less.com of both the widely used pharmaceuticals as well as any advancements in the current research and new medications that may influence medical treatment. A medication suitable for one patient might not necessarily be suitable to another even if that patient is exhibiting a similar condition. The information that clinicians obtain from their patients is critical to avoid drug-drug interactions and drug-food interactions, allergic reactions, and other adverse effects. Without a strong background in the scientific elements of pharmacokinetics and pharmacodynamics1, this information is not as useful. The study of drugs and their mechanisms of action (MOAs) should not be neglected in clinical practice. A comprehensive understanding regarding drug usage and precautionary measures that need to be considered while giving patients different drugs is required so that drug benefits can be maximized and harmful side effects minimized.2 The science of pharmacology has existed for millennia. The application and usage of pharmacologic products to relieve adverse conditions and suffering has been accepted practice in almost every country throughout the world. Modern trends and advancement in medical science have greatly enhanced pharmacology.2,3 Drugs have historically been a fundamental component of the treatment of various diseases from the earliest existence of humankind, where various materials found in nature were used, such as from tree bark, roots, herbs, animal parts, plant seeds, etc. The MOA was unknown and, as such, usages of these substances were based solely on the observed therapeutic benefits or the lack thereof. With the passage of time, through trial and error, knowledge was developed to distinguish between harmful and beneficial substances to be used as medication. 6 nursece4less.com nursece4less.com nursece4less.com nursece4less.com Modern pharmacology started in the mid 19th century through scientific study of the chemical separation of particular active agents from their complicated and complex mixtures, often plant extracts. It began with scientists predicting the impacts of the medicine on the human patient. This developed into further investigations of the effects of specific agents on isolated organs; an example among many of this development in modern pharmacology is the studied effect of ergometrine on strips of uterine muscle. The origin of experimental pharmacology is usually linked with the work of the French physiologist, Francois Magendie, at the start of the 19th century. Magendie’s research was based on strychnine-containing plants that clearly established the action site of these substances. The sites of action were
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