pharmacotherapy pharmacy 3rd shifting

8/16/2019 Pharmacotherapy Pharmacy 3rd Shifting

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PHARMACOTHERAPHY

UST Faculty Of Pharmacy


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Lecture Outline

Definition

Pharmacotherapy

Drugs

Medicine Sources of Drugs

Drug Nomenclature

Drug Classification

Non-Rx Drugs

Illegal Drugs

Sources of Drug Standards

Standards of Practice

Pharmaceutical Dosage

Forms The Rx

Administration ofMedication

Drug action

Drug Effects Sources of Drug

Information


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Pharmacotherapy

application of drugs in the prevention,

treatment or diagnosis of disease and theiruse in purposeful alteration of normal

functions


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Pharmacotherapy

division of Pharmacy which correlates

pharmacodynamics with the pathologic physiology or microbiologic or biochemical

aspect of disease


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Pharmacokinetics- The study of the

absorption, distribution, metabolism, and

excretion (ADME) of drugs by living

organisms.

Pharmacodynamics- The study of thebiochemical and physiologic mechanisms

of drug action.


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Drugs

chemical substances that have an effect on

living organisms.

Therapeutic drugs often called medicines, are

those drugs used in the prevention or treatment

of diseases.


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Drug vs Medicine

Drug

• any substance that alters physiologic

function w/potential for affecting healthMedicine

• drug administered for therapeutic effects

– All medications are drugs

– Not all drugs are medications


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Sources of Drugs

from many sources.

from living organisms

- Many inorganic materials:

* metals, are chemotherapeutic

*hormones, alkaloids, vaccines, and antibiotics

Other are synthetic or semisynthetic.

- Synthetics are often more effective and less toxic

than the naturally obtained substances and are

easier to prepare in standardized units.


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Sources of Drugs

Plants - digitalis and opium

Animals - insulin and thyroid

Minerals or mineral products - potassium,chloride, and lithium carbonate

Synthetic chemical compounds - barbiturates,

sulfonamides, and aspirin.

Biotechnology - genetically engineered pharmaceutical products ( vaccines)


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Drug Nomenclature

Drugs used as therapeutic agents may be

conveniently divided into two main groups:(1) nonprescription drugs

(2) prescription drugs


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Drug Names: Chemical Name

exactly the:

- chemical constitution of the drug

- exact placing of its atoms or molecular

groupings.

composition of the drug by its molecular

structure

Example: acetylsalicylic acid


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Generic Name

(Nonproprietary Name)

provided by the United States Adopted

Names (USAN) Council

Is equivalent to the same drug with a brandname, but is less expensive

Example: Aspirin


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Drug Name: Official Name

name under which the drug is listed by the

U.S. Food and Drug Administration (FDA).FDA- empowered by Federal Law to name

drugs for human use in the U.S.


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Trademark (Brand Name)

followed by the symbol ® which indicates:

- name is registered

- use is restricted to the owner of the drug,

manufacturer of the product.

Consistent bioavailability, more easily

recognized by appearance.

Example: Bayer


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Drug Classifications

Drugs may be classified according to the bodysystem they affect

• by their therapeutic use or clinicalindications

Ex. Antacids, Antibiotics, Antihypertensive,

Diuretics, Laxatives

• using the physiologic or chemical action

• as prescription or non-prescription drugs


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Drug Classification Indicates

Effect on a body system

Symptoms relieved

Desired effect


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Classification of Drugs

Antineoplastic Agents

Cardiac Muscle Drugs

Diuretics

Antihistamines Anti-Infective Agents

Antifungal Antibiotics

Anti-Inflammatory Agents

-Steroids-Non-steroidal Agents

Joint Drugs

Blood Coagulants Anticoagulants

Hemorrheologic Agents

Dental Agents

Ears, Eyes and NoseVasoconstrictors

GI Enzyme and Acid

Agents Gastrointestinal Muscle

Movement Agents

Genitourinary Muscle Relaxants


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Glaucoma Agents

Adrenal agents Glucocorticoids

Mineralocorticoids

Pituitary Agents

Reproductive Agents

Thyroid Agents

Nervous System Adrenergic Agents

(Sympathomimetic)

Nervous System Anticonvulsants,Sedatives & Hypnotics

Tranquilizers Nervous System

Cholinergic and Anticholinergic Agents


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Respiratory Smooth

Muscle Relaxants

Serums, Toxoids, &

Vaccines Skin & Mucous

Membrane Agents and

Enzymes

Vitamins and CaloricAgents

Nervous System Skeletal

Muscle Relaxants

Nervous SystemStimulants

Pain Agents -also known

as Analgesics

Respiratory Antitussives,Expectorants, and

Mucolytics


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Non-Prescription Drugs

over the counter medications (OTC)

which can be purchased by anyone.

No Rx needed

Examples: Tylenol, Maalox, Tums


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Illegal Drugs

recreational drugs

used for non-therapeutic purposes

Obtained illegally or have not received

approval for use by the FDA


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Sources of Drug Standards


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United States Pharmacopoeia

verifies the: identity,

strength,

purity, and

quality of:

- dietary supplement finished products,

- dietary supplement ingredients

- pharmaceutical ingredients.


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A National Formulary

a manual containing:

a list of medicines

approved for prescription throughout the

country,

indicates which products are

interchangeable.

http://en.wikipedia.org/wiki/Manualhttp://en.wikipedia.org/wiki/Medicineshttp://en.wikipedia.org/wiki/Prescriptionhttp://en.wikipedia.org/wiki/Prescriptionhttp://en.wikipedia.org/wiki/Medicineshttp://en.wikipedia.org/wiki/Manual


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USP Dictionary of

International Drug Names

database contains:

- more established drug name listings than

any other comparable resource.


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Drug Standards Ensure

Strength or potency

Purity

Efficacy

Safety

Bio-availability


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Standards of Practice

Information for Administering Medications

– Generic Name/Trade Name/Classification

– Clinical Uses/Safe Dosage

– Mechanism of Action

– Side Effects/Adverse Effects

– Contraindications/Precautions

– Significant Drug Interactions – Monitoring Needs/Patient Education

– Evaluation of Effectiveness


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Pharmaceutical Dosage

Forms

Drug substances are:

seldom administered alone,

a part of a formulation in combination withone or more no medical agents

serve varied and specialized pharmaceutical

functions.


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Types of Dosage Forms

Syrups

Elixirs

SuspensionsEmulsions

Capsules

Tablets

Creams

Ointments

SuppositoriesAerosols

Parenteral


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Introduction to Drug Dosage


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Prescription

comes from the Latin "praescriptus"

compounded from:

- "prae", before

- scribere, to write = to write before.

Historically, a prescription was written

before the drug was prepared and

administered.


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Parts of a prescription

The superscription (or heading)

- symbol R or Rx which stands for the word

Recipe, meaning (in Latin) to take;


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The Rx

inscription - contains the names and quantities of theingredients;

subscription

- directions for compounding the drug

signature

- often preceded by the sign s. standing forsigna, mark,

- giving the directions to be marked on thecontainer.


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Administration ofMedications


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Route of administration

the path

- a drug, fluid, poison or other substance is

brought into contact with the body.

Mode of drug administration- affects the rate at which onset of action occurs

and may affect the therapeutic response that

resultscrucial in determining the suitability of a drug

http://en.wikipedia.org/wiki/Medicationhttp://en.wikipedia.org/wiki/Medication


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Routes of Administration

Enteral - drug administered along any

portion of GI tract

– Sublingual, Oral, Buccal, Rectal, NasogastricParenteral - any med route other than

alimentary canal

– IV, IM, ID, SQ, Instillation, Inhalation,Topical, Transdermal,


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Drug Action

biochemical physiological

mechanisms

(pharmacodynamics) by

which the chemical

produces a response in

living organisms


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Three Phases of Action

Copyright © 2003 by W. B. Saunders Company. All rights reserved.


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First Pass Effect

Drugs given orally and absorbed from GItract

Carried to the liverExtensively metabolized

Only part of the dose reaches systemiccirculation for distribution

Bioavailability - %of drug that reachessystemic circulation


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First pass/hepatic first pass

– Enter liver first• Coumadin

• Morphine

• Lidocaine• Some NTGs


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Drug EffectsTherapeutic effects (primary)

Side effects (secondary)

Adverse effects (secondary)

Toxic effects (secondary)


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Desired effect

– Therapeutic effect-example

Adverse effect / Side effect – Harmful, undesirable response

– Mild reactions to debilitating disease that can become chronic


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Dose related or patient sensitivity

Drug allergy - patient’s immune system

identifies a drug as dangerous to the body….must be destroyed or neutralized-mild itching to life threatening


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Adverse drug reactions

any noxious unintended and undesired

effects of a drug that occur at doses used for

prevention, diagnosis or treatment.


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ADR

Type “A” reactions

AUGMENTED

Predictable, common and related topharmacological action of the drug

ex. Side effects, secondary effects, drug

interaction


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ADR

Type “B” reactions

BIZAARE

Unpredictable, uncommon, usually notrelated to the pharmacological actions of

the drug.

ex. Idiosyncratic reaction,pseudoallergenic, hypersensitivity


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ADR

Type “C” reactions

CONTINUOUS

associated with long-term drug therapye.g. Benzodiazepine dependence andAnalgesic nephropathy.

are well known and can be anticipated.


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ADR

Type “D” reactions

DELAYED

refer to carcinogenic and teratogeniceffects.

are delayed in onset and are very rare since

extensive mutagenicity and carcinogenicitystudies are done before drug is licensed.


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ADR

Type “E” reactions

ENDING OF USE

Withdrawal syndromes• Alcohol (delirium tremens)

• Barbiturates (restlessness, mental confusion,

convulsions

• Opioids (narcotic withdrawal)


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ADR

Type “F” reactions

FAILURE OF EFFICACY

Result of imperfect or counterfeitmanufacture of the product.

Examples of failed efficacy:• Failure to control infection

• Uncontrolled HPN

• Intractable pain


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Idiosyncratic/peculiar response

(something out of the ordinary)

– Sensitivity related adverse reactions…. – Specific to the individual patient

– Sometimes has genetic cause

– They don’ t know

di i i


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Idiosyncratic Reactions vs.

Allergic Reactions

idiosyncratic reaction

--an uncharacteristic, non-immunological

response to a drug that is not related to its pharmacological actions

“allergic” or “hypersensitivity reaction”

--immunologically mediated

i i


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Toxic Reactions

Occur in response to:

high dose or long-term use but may

occur with normal doses if drug

elimination is impaired.May cause

organ dysfunction, blood disorders

(physiological toxicity) or behavioralchanges (behavioral toxicity).


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Toxicity vs. Carcinogenicity

Toxicity

--something that will make you sick, either

right away or later.Carcinogencity

--will cause cancer, which maybe the

results of being exposed to something toxic.

All i R i N


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Allergic Reactions vs. Non-

allergic drug reactions

drug allergy

- your immune system mistakes a

medication for a disease-causing agent. Nonallergic drug reactions have a:

- wide variety of causes, including the drug's

intended mechanism of action.


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Allergic ReactionsIndicated by:

- skin reactions ranging from mild rashes toflaming red patches of hives.

More severe reactions

- cause facial swelling, shortness of breath ordizziness.

Anaphylaxis (rare, an extremely severe

allergic reaction)- blood pressure may fall rapidly and thethroat may rapidly swell shut, cutting off theairway.

H iti it


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Hypersensitivity

allergic response to a drug after it has been

used more than once

May cause:- rash, swelling, fever, or, in the worst cases,

anaphylactic shock (hypotension,

bronchospasm, blocking or airways).


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Carcinogencity

study to determine the propensity of a drug

to produce or exacerbate tumors or cancer

cells in humans or animals


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Teratogenicity

study to determine whether a drug can cause

physical defects in a developing embryo.


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Common or Serious Side Effects

CNS effects

Gastrointestinal effects

Hematological effects

Hepatotoxicity

Nephrotoxicity


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Allergic or hypersensitivity reaction

Drug fever

Idiosyncratic reaction

Carcinogenicity

Teratogenicity

Drug dependence

Drug tolerance


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Sources of Drug Information

Pharmacology textbook

Pharmacists

Internet sources

Journal articles

Drug reference books

Wh t h ld k


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What you should know

about drugs……


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