module 17 – Flashcard

Before we can look too far into the study of pharmacology, we must consider what a drug is. A drug is a substance that is used to treat, diagnose, cure, or relieve symptoms of a disease or abnormal condition. In America, the Food and Drug Administration (FDA) regulates all drugs to ensure that they are both effective and safe. The FDA determines whether a drug requires a prescription or if it is safe enough to be available over-the-counter (OTC) to the public. Dietary supplements are substances that promote general good health and include substances such as vitamins, minerals, and herbs. These are not regulated by the FDA. In addition, the independent United States Pharmacopeia (U.S.P.) also reviews drugs as clinically useful and pure.

Marketed drugs are always assigned at least two, often three, different names. For example, every drug has a chemical name, which is simply its chemical formula. For legal and scientific purposes, it is also assigned a generic name. If the drug falls into competitive marketing, each manufacturer will distribute and sell the drug under its own trade name, or brand name, to differentiate it from competitors' products. Here we see an example of amoxicillin, a fairly common prescription antibiotic drug, with its three names.

Routes of administration—how a drug is introduced into the body—vary widely, depending on the chemical nature of the drug in question and the needs of the patient. Many drugs have more than one dose form so that they can be delivered in ways that are amenable to more than one situation or type of patient. Enteral administration is any route that uses the gastrointestinal tract, including oral, sublingual and rectal routes of administration. Oral administration is the most convenient form of administration and refers simply to drugs given by mouth. However, the oral form is slower than most other forms and also requires that the drug be able to withstand the digestive system's challenges. A much faster route is sublingual administration in which drugs are dissolved under the tongue rather than swallowed. This route of absorption bypasses the slower, more cumbersome digestive route and is valuable when time is crucial, as in the use of nitroglycerin for treatment of angina. Rectal administration involves the insertion of a suppository or solution into the rectum. This route is helpful when the patient is experiencing nausea and vomiting and cannot tolerate swallowing. Parenteral administration includes any route that avoids the digestive tract. Finally, transdermal patches and ointments are designed to control the release of drugs directly into the systemic circulation. Patches for the administration of pain-relieving drugs, birth control, and smoking cessation drugs are being prescribed regularly.

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Injections involve the administration of a drug from a tube syringe through a hollow needle placed directly into the body. There are six basic types of parenteral injections. The least invasive is the subcutaneous injection (Fig. A). In this injection, a hypodermic needle is inserted into the subcutaneous tissue under the skin, usually in the upper arm, thigh, or abdomen. The second type of injection is the intradermal injection (Fig. B), which is made into the upper layers of the skin. This type of injection is used in skin testing for allergies.

Topical administration is the application of a spray, ointment, cream, lotion, or transdermal patch to deliver drugs through the skin. Inhalation administration involves the patient inhaling a vapor or gas through the nose or mouth. The medication is absorbed through the thin walls of the air sacs in the lung, often through the use of an aerosol, which suspends drug particles in air. Thus, inhalation is a pulmonary route

a.c. before meal ad lib as desired b.i.d. two times per day NPO nothing by mouth p.c. after meal p.o. by mouth prn as needed q.i.d. four times per day qAM every morning qhs every bedtime qPM every evening t.i.d three times per day

After absorption, a drug's metabolism refers to the changes the drug undergoes within the body. Excretion is the drug's elimination from the body. Sometime between absorption and excretion, the drug's therapeutic effects can take place. If two or more drugs are administered that produce the same outcome, the therapeutic effects can be additive—a combination of the effects of two or more drugs taken together—or they can result in synergism, or potentiation. This means that the drugs given in combination cause an effect that is even greater than the sum of the individual effects if each were given alone.

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There are a wide range of negative effects possible from a drug—many of them much more serious than a stomachache. These reactions are called side effects or adverse reactions. For instance, we know that Sophie has come to depend heavily on antacids to give her some relief. With some drugs, the body gets so used to a drug that greater amounts are required to achieve the same effect; this is called drug tolerance. Although tolerance can be a feature of addiction, it is not the same thing. Addiction is more severe, occurring as a physical and psychological dependence that shows clear negative effects when the drug is withdrawn. There are other possible negative effects from drugs as well. Drug toxicity, the poisonous or dangerous effects of some drugs, can fall into several categories. Idiosyncrasy, for example, can be mild, hardly toxic at all, or severely toxic. In itself, idiosyncrasy is simply an unexpected effect of a drug. This occurs rarely in very specific patients but may be life-threatening. For instance, people allergic to penicillin may go into anaphylaxis, an acute hypersensitivity, which is often a life-threatening condition. When a patient has a serious unwanted reaction to a drug, often an antidote must be given. This is a drug that counteracts the unwanted effect of another drug.

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The nausea, vomiting, and alopecia that routinely accompany cancer chemotherapy are considered: iatrogenic effects

Analgesics are drugs that relieve pain and can range from mild to potent. Among the most potent are the narcotics (narc/o = numbness, stupor, or sleep) or opioids, which are used to relieve only the most severe pain; morphine is an example. Derived from opium, opioids induce a near unconsciousness that inhibits mental and physical activity. Because they can be habit-forming and induce tolerance with use, they are limited in their applications. None of these, however, describe the pills Sophie has been taking for her swollen ankle. Milder, non-narcotic analgesics—non-steroidal anti-inflammatory drugs (NSAIDs)—reduce fever, pain, and inflammation without exposing the patient to steroid hormones, such as cortisone. NSAIDs inhibit the prostaglandins that sensitize our peripheral pain receptors.

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Anesthetics reduce or eliminate our sensitivity to all kinds of sensation. They can inhibit nerve conduction in a single region, as when using a local anesthetic such as novocaine. Or, using a general anesthetic, particularly for surgical procedures, can depress the activity of the central nervous system and produce a loss of consciousnes

Anticoagulant and antiplatelet drugs affect blood clotting, or coagulation, in slightly different ways. Anticoagulants like heparin or warfarin prevent clotting in conditions such as thrombosis and embolism or in blood used in transfusions. Others, like tissue-type plasminogen activator (tPA), can dissolve clots in the coronary arteries after a myocardial infarction, thus reopening the pathway for blood flow. Antiplatelet drugs, like aspirin, have a slightly different effect, reducing the tendency of platelets to stick together. This can be helpful in coronary artery disease

Antidiabetics, drugs used to treat diabetes mellitus, vary significantly depending on the type of diabetes. Patients with type 1 diabetes are insulin-dependent. In other words, they must receive daily injections of human insulin (as opposed to the animal-derived insulins of just a few years ago) because their own body's insulin hormone is either not being produced or is ineffective. However, patients with the milder type 2 diabetes, which is not insulin-dependent, may receive oral antidiabetic drugs, such as the sulfonylureas, which lower glucose levels by stimulating insulin production; the biguanides, which increase the body's sensitivity to insulin and reduce liver production of glucose; the alpha-glucosidase inhibitors, which temporarily block enzymes that digest sugars; the thiazolidinediones, which enhance glucose uptake; and the meglitinides, which stimulate the beta cells in the pancreas to produce insulin. As type 2 diabetes disease progresses, insulin may be required. These can be in the form of a basal (long acting), an NPH (medium acting) or regular, a short acting insulin

Dr. Teller is able to determine that although Sophie had been experiencing some frustration and sadness as she adjusted to her new environment, these are reasonable reactions. Had this been a true clinical depression, however, Dr. Teller may have prescribed an antidepressant. Antidepressants, such as amitryptyline, relieve depression in a variety of ways: by elevating mood, increasing activity and alertness, and improving appetite and sleep patterns. Their sites of actions can also vary. For instance, the tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) increase available neurotransmitters by blocking their reuptake from synapses between nerve cells. Others, like the monoamine oxidase inhibitors (MAOIs), help neurotransmitters to work longer by blocking their natural inhibitor, the enzyme monoamine oxidase.

It is common to use angiotensin-converting enzyme inhibitors (ACE inhibitors) to improve the heart's performance and reduce its workload as well as keep the blood vessels dilated to lower blood pressure. These work by preventing angiotensin I from converting to the powerful vasoconstrictor angiotensin II. This contributes to the treatment of patients with hypertension (like Sophie), congestive heart failure, and a history of a heart attack. For those patients who do not tolerate ACE inhibitors, the angiotensin II receptor antagonists lower blood pressure by preventing angiotensin from acting on receptors in blood vessels. Note, then, that the word antagonist, which you will encounter in many discussions of drugs, refers to an agent or substance that slows or prevents another agent's effects.

By now, most consumers are aware that high cholesterol levels in the blood, or hypercholesterolemia, are a contributor to heart disease. Part of Sophie's normal health regimen—ever since being diagnosed with hypertension—has been to watch her blood cholesterol through healthy eating. But exercise and good diet are not always enough. Cholesterol-lowering drugs reduce circulating levels of bad cholesterol. There are a variety of agents with different mechanisms available that can affect the blood levels of either good or bad cholesterol and also triglycerides. Statins, or HMG-CoA reductase inhibitors, are the most commonly prescribed agents in this class. Finally, diuretics are used to reduce blood volume by stimulating the kidney to remove water and salt through urine, as shown in the illustration.

Endocrine drugs are intended to mimic the actions of specific naturally occurring (or endogenous) hormones. For instance, androgens are hormones that are normally produced by the testes and adrenal glands. They are used for male hormone replacement therapy; in women, they are helpful in treating endometriosis and breast cancer. The female hormones, or estrogens, are normally produced by the ovaries. They can be used in replacement therapy to ease the symptoms of menopause and to prevent osteoporosis associated with postmenopause. Both categories of drugs have antagonists—these are drugs that have the opposite effect or that offset the effects of these hormones when they occur naturally. For instance, one antiandrogen drug is flutamide. It is useful in the treatment of prostate cancer. Estrogens, too, have an opposite effect. The drug tamoxifen is an anti-estrogen drug used to prevent the recurrence of breast cancer and to treat metastatic breast cancer. Aromatase inhibitors also reduce the amount of estrogen (estradiol) in the blood.

Thyroid hormones can be administered therapeutically when the patient's thyroid gland produces an insufficient quantity (a condition known as hypothyroidism). In patients with hyperthyroidism or thyroid cancer, antithyroid agents are used to reduce the production of thyroid hormones. The adrenal corticosteroids—mineralocorticoids or glucocorticoids—have a wide range of uses. They are used in the treatment of inflammation; arthritis; gastrointestinal, skin, respiratory, and blood disorders; and cancer

If Sophie's symptoms included diarrhea, she might be prescribed an antidiarrheal drug to decrease the rapid movement of the walls of the colon. By contrast, a cathartic agent is used to either relieve constipation or to promote defecation for diagnostic or treatment procedures. Cathartics can act in one of several ways: to increase intestinal salts, which encourages fluid to fill the intestines; or to increase fecal bulk, which prompts movement in the intestinal wall, called peristalsis. A third way in which cathartics can act is to lubricate the intestinal tract and soften stools. Cathartics are either laxatives, which are mild, or purgatives, which are strong.

Antibodies (immunoglobulin G [IgG]) to H. pylori can be measured in serum, plasma, or whole blood. If this is not definitive, Dr. Teller will conduct an upper GI endoscopy. Test results show that Sophie does indeed have peptic ulcer disease (PUD). In her case, an anti-ulcer drug (like Prevacid) will promote healing by blocking secretion of histamine, which stimulates secretion of gastric acid from the lining of the stomach. Dr. Teller also prescribes two antibiotics to be taken in conjunction with the anti-ulcer drug.

Mild tranquilizers, like the benzodiazepines, control minor anxiety symptoms. For instance, after traumatic events, patients may receive mild tranquilizers in association with grief therapy. The major tranquilizers, like the phenothiazines, control more severe behavior disturbances and disorders.

a.c. before meal ACE inhibitor angiotensin-converting enzyme inhibitor ad lib as desired b.i.d. two times per day FDA Food and Drug Administration IgG immunoglobulin G IM intramuscular IV intravenous MAOI monoamine oxidase inhibitors NPO nothing by mouth NSAIDs nonsteroidal anti-inflammatory drugs p.c. after meal p.o. by mouth prn as needed q.i.d. four times per day qAM every morning qhs every bedtime qPM every evening SERM selective estrogen receptor modulator SSRI serotonin selective reuptake inhibitor t.i.d three times per day TCAs tricyclic antidepressants tPA tissue-type plasminogen activator

Lasix is prescribed for Mr. Garrison to lower his blood pressure. Since it reduces blood volume by stimulating the kidney to remove water and salt (excreted in the urine), it is categorized as a(n):