In addition, the independent United States Pharmacopeia (U.S.P.) also reviews drugs as clinically useful and pure.
Here we see an example of amoxicillin, a fairly common prescription antibiotic drug, with its three names.
Let’s look at the pharmacist’s role in this country.
When a patient receives a prescription for a drug, a pharmacist is licensed to prepare and dispense that drug. The pharmacist is the most accessible health care professional to the public, so they regularly provide advice regarding disease and medications to anyone who asks. A pharmacist may also consult with and advise licensed practitioners about drug choices for specific cases. A pharmacist must have completed a 6- to 7-year Doctorate of Pharmacy (Pharm.D.) course of study as well as pass a licensing examination in his or her state.
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.
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.
Other types of parenteral injection are more complex. In an intrathecal injection, the drug is delivered into the space underlying the membranes, or
meninges, that surround the spinal cord and brain. An example of this technique is in the delivery of chemotherapy for the treatment of leukemia. An intracavitary injection is made into a body cavity, such as the peritoneal cavity or the pleural cavity.
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
The number of times a day is indicated with b.i.d (bis in die, or two times per day), while t.i.d is Latin for ter in die, or three times per day, and q.i.d stands for quater in die or four times per day.
Some drugs are most effective if taken on an empty stomach, while others need to be taken with or after meals. The abbreviation a.c. (ante cibum or before food) is used for the first, while p.c. (post cibum) indicates after food.
The general time of day is referred to by qAM (every morning), qPM (every evening), and qhs (every bedtime).
two times per day
nothing by mouth
four times per day
three times per day
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.
apart, away from
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.
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.
numbness, stupor, sleep
pertaining to killing
pertaining to vomiting
pertaining to controlling
More caution is taken now with the use of antibiotics than when they were first used in the mid-1940s. Considered wonder drugs, these remarkable agents were used with increasing frequency to treat more and more disorders and with excellent success. Indiscriminate use, however, revealed that the pathogenic organisms we were targeting could become resistant to that agent
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
Anticonvulsants have proved so effective in some cases of epilepsy that patients who were not allowed to drive, in case they should have a seizure, are now able to drive safely. In most states, there is a time limit—typically six months to a year—during which an individual who has experienced a seizure must remain seizure-free before he or she is allowed to resume driving.
Antiosteoporosis drugs help prevent abnormal loss of bone density and increase calcium deposition in bone. These include calcium, vitamin D, and estrogen. The bisphosphonates prevent bone loss, while the hormone-like drugs—that is, the SERMs (selective estrogen receptor modulators)—actually increase bone formation.
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.
Cardiovascular drugs are as varied in effect and purpose as the variety of cardiovascular disorders. However, these drugs do have one thing in common: They act on the heart or blood vessels to treat hypertension, angina, heart attack, congestive heart failure, and arrhythmias.
One of the first steps in preventing or controlling several cardiovascular disorders is the administration of aspirin to prevent blood vessel clots. Emergency sublingual nitroglycerin dilates coronary blood vessels, slows the heart rate, and puts more force into the heart’s contractions. Digoxin can control arrhythmias by slowing the heart rate and is used to treat congestive heart failure by helping the heart to pump more forcefully.
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.
But what exactly are beta-blockers?
Useful in the treatment of angina, hypertension, arrhythmia, and following heart attack, beta-blockers act as vasodilators. They work by blocking the action of epinephrine at receptor sites in the heart and blood vessels to reduce blood pressure as well as decreasing muscle tone in blood vessels and increasing the output of the heart. They also work to decrease the number of contractions of the heart, decreasing the heart rate – thus improving the output and work load of the heart.
Calcium is necessary for blood vessel contraction. By inhibiting its entry into the heart muscles and blood vessels, calcium channel blockers, or antagonists, dilate the blood vessels, lowering blood pressure. This makes them particularly useful in treating angina and arrhythmias.
Antiarrhythmics, another type of heart drug, can reverse abnormal heart rhythms by slowing the response of heart muscle to nervous stimulation or by slowing the rate at which nervous system impulses are carried through the heart.
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.
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.
Progestins are endocrine drugs used as part of hormone replacement therapies and as oral contraceptives. They are also used to reduce abnormal uterine bleeding and hormonal imbalances. In its natural state, the hormone progestin affects the lining of the uterus during pregnancy.
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
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.
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.
For patients with insomnia and other sleep disorders, sedatives and hypnotics can depress the central nervous system to help promote drowsiness and sleep. Some drugs can play the role of both sedatives and hypnotics. Many of these drugs have a risk of dependency, so they are not always the optimal treatment of insomnia.
angiotensin-converting enzyme inhibitor
two times per day
Food and Drug Administration
monoamine oxidase inhibitors
nothing by mouth
nonsteroidal anti-inflammatory drugs
four times per day
selective estrogen receptor modulator
serotonin selective reuptake inhibitor
three times per day
tissue-type plasminogen activator