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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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Classification of Drugs
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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Classification of Drugs
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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