1. CHAPTER 22
Pharmacology

2. Pharmacology Overview
Field of medicine that specializes in the study of drugs, their sources, appearance, chemistry, actions, and uses
Drug
Any substance that when taken into the body, may modify one or more of its functions

3. Pharmacology Overview
Pharmacodynamics
Study of how drugs interact in the human body
Pharmacist
One who is licensed to prepare and dispense drugs

4. Pharmacology Overview
Pharmacy
Drug store
Toxicology
Study of poisons, their detection, their effects
Establishing antidotes and methods of treatment for conditions they produce

5. Drug Laws Food, Drug, and Cosmetic Act (FDCA) 1938
Regulates quality, purity, potency, effectiveness, safety, labeling, and packaging of food, drug, and cosmetic products
Enforced by the Food and Drug Administration (FDA)

6. Drug Laws Controlled substance act
Regulates manufacture, distribution, and dispensing and administration of controlled substances
Drugs that have the potential of being abused and of causing physical or psychological dependence
Enforced by the Drug Enforcement Administration (DEA)

7. Controlled Substances or Schedule Drugs
Schedule I Drugs
Not considered to be legitimate for medical use in the United States
Used for research only and cannot be prescribed
High risk for abuse
Examples: LSD, heroin, marijuana

8. Controlled Substances or Schedule Drugs
Schedule II Drugs
Accepted medical use but have a high potential for abuse or addiction
Must be ordered by written prescription
Cannot be refilled without a new, written prescription
Examples: morphine, cocaine, codeine, demerol, dilaudid

9. Controlled Substances or Schedule Drugs
Schedule III Drugs
Moderate potential for abuse or addiction, low potential for physical dependence
May be ordered by written prescription or by telephone order
Prescription expires in six months – may not be refilled more than five times in six-month period
Examples: Tylenol with codeine, butisol, hycodan

10. Controlled Substances or Schedule Drugs
Schedule IV Drugs
Less potential for abuse or addiction than those of Schedule III, with limited physical dependence
May be ordered by written prescription or by telephone order
May be refilled up to five times in a six-month period – prescription expires in six months
Examples: Librium, valium, darvon, equanil

11. Controlled Substances or Schedule Drugs
Schedule V Drugs
Have a small potential for abuse or addiction
May be ordered by written prescription or by telephone order
No limit on prescription refills
Some of these drugs may not need prescription
Examples: Robitussin-AC, donnagel-PG, lomotil

12. Drug Standards
Rules established to control strength, quality, and purity of medications prepared by various manufacturers
Require all preparations called by the same drug name to be of a uniform strength, quality, and purity

13. Drug Standards United States Pharmacopeia/National Formulary (USP/NF)
Contains formulas and information that provide standards for preparation and dispensation of drugs
Recognized by U.S. government as the official listing of standardized drugs in the United States
FDCA specifies a drug is official when it is listed in USP/NF

14. Drug References
Available for health professionals responsible for safe administration of medications
Provide the following information:
Composition, action, indications for use, contraindications for use, precautions, side effects, adverse reactions, route of administration, dosage range, and what forms are available

15. Drug References Hospital formulary
Lists all drugs commonly stocked in the hospital pharmacy
Provides information about the characteristics of drugs and their clinical use

16. Drug References Physicians’ Desk Reference
Published yearly by Medical Economics Company
Manufacturers pay to list information about their products in the PDR
Same information that appears on Package Inserts (as required by the FDA)
Generic name, indications, contraindications, adverse effects, dosage, and route of administration

17. Drug References Medical economics company references
Physicians’ Desk Reference for Nonprescription Drugs
Physicians’ Reference for Ophthalmology
Drug Interactions and Side Effects Index
Indications Index

18. Drug References Drug facts and comparisons
Loose-leaf binder reference that provides information on drugs according to their therapeutic classification
Same basic facts as other drug references
Particularly helpful in comparing the various drugs within each category to other products
In reference to effectiveness, content, and cost

19. Drug Sources

20. Drug Names Chemical name Describes chemical structure of the drug
Formula that indicates composition of the drug

21. Drug Names Generic name
Name that was established when drug was first manufactured
Written in lowercase letters
Official name of a drug
Each drug has only one generic name
Original manufacturer is only company that can use generic name for the first 17 years

22. Drug Names
Brand name
Name under which the drug is sold by a specific manufacturer
Spelling always begins with a capital letter
Also known as the Trade Name
Name is owned by the drug company and no other company may use that name
Each brand name carries a registered trademark symbol ®

23. Drug Actions – Drug Interactions
How drugs produce changes within the body
Drug effect
Changes that take place in the body as a result of drug action
Slowing down or speeding up processes
Destroying certain cells or parts of cells
Replacing substances that the body lacks or fails to produce

24. Drug Actions – Drug Interactions
Desired effect
Effect of drug in the body that was intended
Side effect
Additional effect on the body by the drug that was not part of the goal for that medication
Not usually severe enough to warrant discontinuing the medication

25. Drug Actions – Drug Interactions
Adverse reaction
One in which the body reacts to a drug in an unexpected way that may endanger a patient’s health and safety
Contraindication
Any special symptom or circumstance that indicates that the use of a particular drug or procedure is dangerous, not advised, or has not been proven safe for administration

26. Drug Actions – Drug Interactions
Local effect
Response to a medication that is confined to a specific part of the body
Systemic effect
Generalized or widespread response to a drug by the body because it is absorbed into the bloodstream

27. Drug Actions – Drug Interactions
Cumulation
Occurs when a drug is not completely excreted from the body before another dose is given
Drug starts to accumulate in the body tissues when repeated doses are given
Toxic effects may occur

28. Drug Actions – Drug Interactions
Idiosyncracy
An unusual, inappropriate response to a drug or to the usual effective dose of a drug
Anaphylactic Shock = severe idiosyncratic reaction
Acute respiratory distress, hypotension, edema, tachycardia, cool pale skin, cyanosis, and possible convulsions shortly after administration of the medication

29. Drug Actions – Drug Interactions
Potentiation
Occurs when two drugs administered together produce a more powerful response than the sum of their individual effects
Tolerance
Resistance to effect of a drug
A characteristic of drug addiction

30. Routes of Administration
Oral
Given by mouth and swallowed
Advantage
Easiest and safest method
Most economical method
Disadvantage
Slow method of absorption
Possibility of being destroyed by gastric juices

31. Routes of Administration
Sublingual
Placed under the tongue – dissolves in saliva
Advantage
More rapid absorption rate than oral
Higher concentration of medication reaches bloodstream
Disadvantage
Not convenient route of administration for bad-tasting medications or irritating medications

32. Routes of Administration
Buccal
Placed in mouth next to cheek (tablet form)
Advantage
More rapid absorption rate than oral
Higher concentration of medication reaches bloodstream
Disadvantage
Possibility of swallowing the pill

33. Routes of Administration
Inhalation
Medication is sprayed or inhaled into nose, throat, and lungs
Advantage
Good absorption due to large surface contact area
Provides rapid treatment
Disadvantage
Sometimes difficult to regulate dose
Not suitable method for medications that irritate mucous membrane lining

34. Routes of Administration
Rectal
Medication inserted into rectum and is slowly absorbed into mucous membrane lining of rectum (suppository)
Advantage
One method of choice when patient is nauseated or cannot take medications orally
Disadvantage
Absorption is slow and irregular

35. Routes of Administration
Vaginal
Medication is inserted into the vagina in the form of a suppository, cream, foam, or tablet
Advantage
Easiest method for treating the specific area
Disadvantage
Medications sometimes stain underwear
No other disadvantages

36. Routes of Administration
Topical
Medication is applied directly to the skin or mucous membrane for a local effect to area
Advantage
Easy method, convenient
Disadvantage
Slow absorption through skin

37. Routes of Administration
Transdermal
Method of applying a pre-measured amount of medicine to unbroken skin through an adhesive-backed disk
Advantage
Good method for administering medications slowly into bloodstream over a period of time
Disadvantage
Units can be dangerous if they come in contact with skin of children or pets

38. Routes of Administration
Parenteral
Administered by injecting medication into body using a needle and syringe
Must be in liquid form
Administered by one of following methods
Intradermal
Intramuscular
Intravenous
Subcutaneous

39. Routes of Administration
Intradermal
Small amount of medication is injected just beneath epidermis
Used for allergy testing, tuberculin skin testing, and some vaccinations
Needle Angle: 10 to 15-degree

40. Routes of Administration
Intramuscular
Medication is injected directly into muscle
Used for administering antibiotics, medications that might be irritating to layers of the skin, and medications that require dosages larger than amount allowed for subcutaneous injections
Needle Angle: 90-degree

41. Routes of Administration
Intravenous
Medication is injected directly into the vein, entering the bloodstream immediately
Used when medication is needed quickly
Used for infusing medication over a period of time, by adding the medication to a bag of intravenous fluids
Needle Angle: 25-degree

42. Routes of Administration
Subcutaneous
Medication is injected into subcutaneous layer, or fatty tissue of skin
Used for administering insulin, hormones, and local anesthetics
Needle Angle: 45-degree

43. Parenteral Routes of Administration

44. DRUG CLASSIFICATIONS
Pharmacology

45. Analgesic Pronounced (an-al-JEE-sik) General definition Relieves pain
Example: acetylsalicylic acid, aspirin, Bayer Children’s Aspirin

46. Anesthetic Pronounced General definition (an-ess-THET-ik)
Partially or completely numbs or eliminates sensitivity with or without loss of consciousness
Example: lidocaine (Xylocaine)

47. Antiarrhythmic Pronounced General definition (an-tee-ah-RITH-mik)
Corrects cardiac arrhythmias (irregular beats)
Example: digoxin (Lanoxin)

48. Antibiotic (Anti-infective)
Pronounced
(an-tih-BYE-ot-ik)
General definition
Stops or controls growth of infection-causing microorganisms
Example: phenoxymethyl-penicillin sodium (Pen-Vee-K, Penicillin VK, Veetids, V-Cillin K)

49. Anticoagulant Pronounced General definition (an-ti-koh-AG-yoo-lant)
Prevents clot continuation and formation
Example: warfarin sodium (Coumadin)

50. Anticonvulsant Pronounced General definition (an-tih-kon-VULL-sant)
Prevents or relieves convulsions (seizures)
Example: clonazepam (Klonopin)

51. Antidepressant Pronounced General definition (an-tih-dee-PRESS-ant)
Prevents, cures, or alleviates mental depression
Example: amitriptyline hydrochloride (Elavil, Amitril)

52. Antidiabetic Pronounced General definition (an-tih-dye-ah-BET-ik)
Helps control the blood sugar level
Example: metformin (Glucophage)

53. Antidiarrheal Pronounced General definition (an-tih-dye-ah-REE-ul)
Prevents or treats diarrhea
Example: loperamide hydrochloride (Imodium)

54. Antidiuretic Pronounced General definition (an-tih-dye-yoo-REH-tic)
Suppresses the formation of urine
Example: vasopressin (Pitressin)

55. Antiemetic Pronounced General definition (an-tih-ee-MET-ik)
Prevents or relieves nausea and vomiting
Example: meclizine hydrochloride (Bonine, Dramamine II, Antivert)

56. Antifungal Pronounced General definition (an-tih-FUNG-gal)
Destroys or inhibits the growth of fungi
Example: fluconazole (Diflucan)

57. Antihistamine Pronounced General definition (an-tih-HISS-tah-meen)
Opposes action of histamine, released in allergic reactions
Example: cetirizine (Zyrtec)

58. Antihypertensive Pronounced General definition
(an-tih-high-per-TEN-siv)
General definition
Prevents or controls high blood pressure
Example: nadolol (Corgard)

59. Anti-infective (Antibiotic)
Pronounced
(an-tih-in-FEK-tiv)
General definition
Stops or controls the growth of infection-causing microorganisms
Example: amoxycillin (Amoxil, Polymox)

60. Anti-Inflammatory Pronounced General definition
(an-tih-in-FLAM-ah-toh-ree)
General definition
Counteracts inflammation in body
Example: naproxen sodium (Anaprox, Aleve)

61. Antineoplastic Pronounced General definition (an-tih-nee-oh-PLASS-tik)
Prevents development, growth, or reproduction of cancerous cells
Example: fluorouracil (Adrucil)

62. Antitussive Pronounced General definition (an-tih-TUSS-iv)
Relieves cough due to various causes
Example: dextromethorphan hydrobromide (Benylin DM, Robitussin Pediatric, Vick’s Formula 44)

63. Antiulcer Agent Pronounced General definition (an-tih-ULL-ser agent)
Treats and prevents peptic ulcer and gastric hypersecretion
Example: ranitidine hydrochloride (Zantac)

64. Antiviral Agent Pronounced General definition (an-tih-VYE-ral agent)
Treats various viral conditions such as serious herpes virus infections, chickenpox, and influenza A
Example: acyclovir (Zovirax)

65. Beta Blocker Pronounced General definition (BAY-tah BLOCK-er)
Treats hypertension, angina, and various abnormal heart rhythms
Example: metoprolol tartrate (Lopressor)

66. Bronchodilator Pronounced General definition (brong-koh-DYE-lay-tor)
Expands bronchial tubes by relaxing bronchial muscles
Example: theophylline (Bronkodyl)

67. Calcium Channel Blocker
Pronounced
(KAL-see-um CHAN-ell BLOCK-er)
General definition
Treats hypertension, angina, and various abnormal heart rhythms
Example: amlodipine (Norvasc)

68. Diuretic Pronounced General definition (dye-yoor-RET-ik)
Increases urine secretion
Example: furosemide (Lasix)

69. Hormone Pronounced General definition (HOR-mohn)
Treats deficiency states where specific hormone level is abnormally low
Example: estrogen, conjugated (Premarin)

70. Hypnotic Pronounced General definition (hip-NOT-ik)
Induces sleep or dulls the senses
Example: pentobarbital (Nembutal)

71. Immunosuppressant Pronounced General definition
(im-yoo-noh-suh-PRESS-ant)
General definition
Suppresses the body’s natural immune response to an antigen, as in treatment for transplant patients
Example: cyclosporine (Sandimmune)

72. Laxative Pronounced General definition (LACK-sah-tiv)
Prevents constipation or promotes the emptying of the bowel contents with ease
Example: docusate calcium (Surfak)

73. Lipid-Lowering Agent Pronounced General definition
Reduces blood lipid (fat) levels
Example: atorvastatin (Lipitor)

74. Sedative Pronounced General definition (SED-ah-tiv)
Exerts a soothing or tranquilizing effect on the body
Example: phenobarbital (Nembutal)

75. Skeletal Muscle Relaxant
Pronounced
(SKELL-eh-tal muscle rih-LAK-sant)
General definition
Relieves muscle tension
Example: carisoprodol (Soma)

76. Vitamin Pronounced General definition (VIGH-tah-min)
Prevents and treats vitamin deficiencies and used as dietary supplement
Example: ascorbic acid (vitamin C)

77. Common Charting Abbreviations
Guidelines
Medical abbreviations are a form of shorthand
Serve as a universal language for medical professionals
Provide specific information and/or orders in an abbreviated format
Health professional should use standard abbreviations accepted by their place of employment
When abbreviations have more than one meaning