UHSP Pharmacy Technician Training Module 4 & 5 - Pharmacology and Medication Theraphy

Reconstitution

Some medications come in a powdered form and require reconstitution with a specific diluent before administration

• Techs must carefully follow instructions for reconstitution to ensure accurate dosing

Drug Action

The specific biochemical interaction between a drug and its target in the body to produce a therapeutic effect

Pharmacokinetics

The study of how the body absorbs, distributes, metabolizes, and excretes drugs

Pharmacodynamics

The study of the physiological effects of drugs and their mechanisms of action

NSAIDs

Mechanism: Inhibit prostaglandin synthesis

Terminology: anti-inflammatory, analgesic

Analgesic

Mechanism: inhibit bacterial growth

Terminology: broad-spectrum, narrow-spectrum

Antidepressants

Mechanism: Alter neurotransmitter levels

Terminology: selective serotonin reuptake inhibitors (SSRIs), tricyclic

HIV Etiology & Epidemiology

• HIV Etiology: A retrovirus that attacks the immune system's CD4 cells, eventually leads to AIDS. Transmitted through contact with blood, semen, vaginal fluids, and breast milk

• Epidemiology: Global impact with varying prevalence; Sub-Saharan Africa is the most heavily affected

Types of tests for HIV

• antibody tests

• antigen/antibody tests

• nucleic acid tests

Infection Control Guidelines - Universal Precautions

• Wash hands often, especially if they come in contact with blood or bodily fluids

• Wear gloves, gowns, masks, and protective eyewear when doing any work that may come in contact with blood or bodily fluids

• Use caution when handling needles. Place them in puncture-resistant sharps containers

• Report any unknown blood or bodily fluid to a supervisor and handle following proper bloodborne pathogen procedures

• Report any needlesticks as soon as possible to minimize the risk of HIV transmission

Stages of HIV Infection

• Asymptomatic Stage: the early stage without apparent symptoms

• Symptomatic Stage: Mild symptoms may occur, indicting a weakened immune system

• AIDS: The advanced stage where the immune system is severely compromised, leading to opportunistic infections or cancers

Antiretroviral treatment (ART)

ART involves a combination of medications to suppress HIV replication, preventing the progression of the virus. Pharmacy technicians are instrumental in dispensing these medications, providing information about dosage, potential side effects, and ensuring patients adhere to their treatment plans. 

Common medications:

• Tenofovir/emtricitabine

• Atazanavir

• Dolutegravir

Dermatologic Medication: Mechanisms of Action

Dermatologic medications act through various mechanisms, including anti-inflammatory effects, antifungal properties, antibacterial actions, and anti-pruritic (anti-itch) activities

Topical Corticosteroids

Indications: Eczema, psoriasis, dermatitis

Mechanisms of Action: Reduce inflammation by inhibiting immune response

Side Effects: Skin thinning, redness, stinging

Monitoring: Assess for skin thinning and irritation

Interactions: Possible drug interactions with oral corticosteroids

Precautions: Avoid use on sensitive areas like the face and groin

Antihistamines

Indications: Bug bites, stings, allergies

Mechanisms of Action: Block histamine receptors, reducing allergic reactions

Side Effects: Drowsiness, dry mouth, blurred vision

Monitoring: Monitor Enhanced sedative effects with alcohol or other sedating drugs

Precautions: Caution in elderly patients due to increased risk of falls

Anti-parasitic agents

Indications: Head lice infestations

Mechanisms of Action: Kill or inhibit the growth of parasites like head lice

Side Effects: Skin irritation, itching, rash

Monitoring: Check for treatment efficacy and adverse reactions

Interactions: Minimal interactions reported

Precautions: Avoid contact with eyes and mucous membranes

Generic and Brand Names:

• Generic - Permethrin (for head lice)

• Brand - Nix

Ophthalmic Medications

Focus on treating eye conditions such as infections, glaucoma, and inflammation

Otic Medications

Target ear conditions like infections and inflammation

Ophthalmic Antibiotics

Treat bacterial eye infections

Beta-Blockers

Lower intraocular pressure in glaucoma

Ophthalmic Corticosteroids

Reduce inflammation in the eye

Otic Analgesics

Provide pain relief for ear conditions

Restless Legs Syndrome (therapies)

Therapies may include dopamine agonists such as ropinirole and pramipexole

Osteoporosis (therapies)

Therapies may include bisphosphonates (agents that inhibit bone resorption) such as alendronate and risedronate

Gamma-aminobutyric acid (GABA)

Inhibitory neurotransmitter that regulates neuronal excitability

Reuptake

Prevents the reabsorption of neurotransmitters, increasing their concentration in the synaptic cleft

Receptor agonism

Binds to and activates receptors, mimicking the effects of endogenous neurotransmitters

Receptor antagonism

Binds to receptors without activating them, blocking the effects of endogenous neurotransmitters

Enzyme inhibition

Blocks the activity of enzymes involved in neurotransmitter synthesis or metabolism

Anxiolytics

Anxiolytics are medications used to alleviate anxiety disorders. Common examples include benzodiazepines (e.g. diazepam, alprazolam), and buspirone. They work by enhancing the effects of the neurotransmitter GABA, resulting in calming effects.

Side Effects: Sedation, dizzinessm confusion, and potential for dependence

Antidepressants

Antidepressants are used to treat depression and other mood disorders. They include selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline, serotonin-norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine, and tricyclic antidepressants (TCAs) like amitriptyline. These medications work by increasing the levels of neurotransmitters like serotonin and norepinephrine in the brain.

Side Effects: Nausea, sexual dysfunction, weight gain, and increased risk of suicidal thoughts in young adults. 

Antipsychotics

Antipsychotics are medications used to manage psychotic disorders like schizophrenia. They can be categorized into typical antipsychotics (e.g. haloperidol) and atypical antipsychotics (e.g. risperidone, olanzapine). Antipsychotics work by blocking dopamine receptors in the brain, helping to alleviate psychotic symptoms

Side Effects: Extrapyramidal symptoms (EPS), weight gain, metabolic changes, and increased risk of diabetes. 

Stimulants

Stimulants are medications used to treat attention-deficit/hyperactivity disorder (ADHD) and narcolepsy. Examples include methylphenidate and amphetamine salts. They work by increasing the levels of dopamine and norepinephrine in the brain, improving focus and attention

Side Effects: Insomnia, decreased appetite, irritability, and potential for abuse.

Mood Stabilizers

Mood stabilizers are used to manage bipolar disorder and stabilize mood fluctuations. Examples include lithium and valproate. They help regulate neurotransmitter activity in the brain, preventing manic and depressive episodes

Side Effects: Weight gain, tremor, gastrointestinal disturbances, and potential for lithium toxicity. 

Drug PTSD Treatments

• SSRIs such as Sertraline (Zoloft) and Paroxetine (Paxil) are commonly used as first-line pharmacological treatments for PTSD. They help alleviate symptoms of depression, anxiety, and intrusive thoughts associated with PTSD

• SNRIs like Venlafaxine (Effexor XR) may also be prescribed to manage PTSD symptoms by modulating serotonin and norepinephrine levels in the brain

• Prazosin is an alpha-1 adrenergic blocker that may be used off-label to reduce nightmares and improve sleep disturbances in patients with PTSD

Drug Treatments for ADHD

Stimulant Medications:

• Methylphenidate (Ritalin, Concerta): Methylphenidate is a central nervous system stimulant that enhances the activity of neurotransmitters such as dopamine and norepinephrine in the brain. It helps improve focus, attention, and impulse control in individuals with ADHD

• Amphetamine and Dextroamphetamine (Adderall): Adderall is another commonly prescribed stimulant medication for ADHD, working similarly to methylphenidate by increasing dopamine and norepinephrine levels in the brain

Non-stimulant Medications:

• Atomoxetine (Strattera): Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that is often used as an alternative to stimulant medications for ADHD treatment. It works by increasing the availability of norepinephrine in the brain, leading to improvements in attention and impulse control.

• Guanfacine (Intuniv): Guanfacine is an alpha-2 adrenergic agonist that may be prescribed for ADHD, particularly in individuals who cannot tolerate stimulant medications. It works by targeting alpha-2 receptors in the brain, resulting in enhanced attention and reduced hyperactivity. 

Potential Drug Interactions with ADHD Meds

• timulant medications may interact with certain antidepressants, antipsychotics, and monoamine oxidase inhibitors (MAOIs), leading to an increased risk of serotonin syndrome.

• Non-stimulant medications such as atomoxetine may interact with drugs that inhibit the CYP2D6 enzyme, potentially increasing atomoxetine levels and the risk of adverse effects.

Diuretics

Terminology: Medications that increase urine production and help reduce fluid retention

Therapeutic Drug Class: Used to treat conditions like edema and hypertension by increasing urine output to reduce fluid retention

Anticholinergics

Terminology: Medications that block the action of acetylcholine on the bladder muscles, reducing bladder spasms

Therapeutic Drug Class: Used to manage overactive bladder symptoms, such as urgency and frequency

Examples: Oxybutynin, Tolterodine, Solifenacin

Indications: Management of overactive bladder symptoms, such as urgency and frequency.

Side Effects: Dry mouth, constipation, blurred vision, urinary retention.

Monitoring: Assess for anticholinergic effects, such as dry mouth and constipation.

Precautions: Use with caution in elderly patients due to increased risk of adverse effects.

Antibiotics (Urinary System)

Terminology: Medications used to treat bacterial infections in the urinary tract

Therapeutic Drug Class: Used to treat urinary tract infections caused by bacteria

Examples: Ciprofloxacin, Nitrofurantoin, Trimethoprim/Sulfamethoxazole

Indications: Treatment of UTIs caused by bacterial infections.

Side Effects: Nausea, vomiting, diarrhea, allergic reactions.

Monitoring: Renal function tests, complete blood count (CBC) if indicated.

Precautions: Avoid in patients with known allergies or renal impairment. 

Alpha-Blockers

Terminology: Medications that relax the muscles in the prostate and bladder neck to improve urine flow

Therapeutic Drug Class: Used to improve urinary flow in conditions like BPH

Examples: Tamsulosin, Alfuzosin, Doxazosin

Indications: Treatment of benign prostatic hyperplasia (BPH) to relieve urinary symptoms.

Side Effects: Dizziness, orthostatic hypotension, retrograde ejaculation.

Monitoring: Monitor blood pressure for orthostatic changes.

Precautions: Use with caution in patients with a history of orthostatic hypotension. 

Common side effects of urinary medication

Dehydration, electrolyte imbalances, dizziness, constipation, urinary retention. It’s crucial to monitor and assess kidney function, electrolyte levels, blood pressure, and urinary symptoms in patients taking urinary drugs.

Potential drug interactions with urinary medications

NSAIDs, potassium supplements, certain antibiotics

Ciprofloxacin

Brand Name: Cipro

Indication: Treatment of UTIs, including cystitis and pyelonephritis.

Side Effects: Nausea, diarrhea, headache, tendon rupture (rare).

Monitoring: Renal function tests, liver function tests if prolonged use. 

Oxybutynin

Brand Name: Ditropan 

Indication: Management of overactive bladder symptoms.

Side Effects: Dry mouth, constipation, blurred vision.

Monitoring: Assess for anticholinergic effects. 

Antihypertensives

Examples: Lisinopril, Amlodipine, Metoprolol

Indications: Management of high blood pressure to reduce the risk of cardiovascular events.

Side Effects: Hypotension, dizziness, cough (with ACE inhibitors).

Monitoring: Blood pressure monitoring, renal function tests.

Precautions: Use with caution in patients with renal impairment.

Anticoagulants

Examples: Warfarin (Coumadin), Rivaroxaban (Xeralto), Apixaban

Indications: Prevention and treatment of thromboembolic disorders, such as deep vein thrombosis (DVT) and atrial fibrillation.

Side Effects: Bleeding, bruising, hematoma formation.

Monitoring: International normalized ratio (INR) for warfarin therapy, renal function tests for direct oral anticoagulants (DOACs).

Precautions: Avoid in patients with active bleeding or high bleeding risk.

Lisinopril

Brand Name: Zestril

Indication: Treatment of hypertension, heart failure, and post-myocardial infarction.

Side Effects: Cough, hypotension, hyperkalemia.

Monitoring: Blood pressure monitoring, renal function tests

Warfarin

Brand Name: Coumadin

Indication: Prevention and treatment of thromboembolic disorders.

Side Effects: Bleeding, bruising, skin necrosis (rare).

Monitoring: International normalized ratio (INR) monitoring. 

Vasodilator

Medication that widens blood vessels

Beta-blocker

Medication that blocks the effects of adrenaline on the heart

Beta-2 Agonists

These bronchodilators stimulate beta-2 receptors in the airways, causing relaxation of the smooth muscles.

Examples include albuterol and salmeterol. 

Bronchodilators

Examples: Albuterol, Salmeterol, Tiotropium

Indications: Relief of bronchoconstriction in asthma and COPD.

Side Effects: Tachycardia, tremors, palpitations.

Monitoring: Lung function tests, heart rate monitoring.

Precautions: Use with caution in patients with cardiac arrhythmias.

Corticosteroids

These anti-inflammatory medications reduce swelling and mucus production in the airways.

Examples: Fluticasone, Budesonide, Prednisone

Indications: Anti-inflammatory therapy for asthma and COPD.

Side Effects: Oral thrush, adrenal suppression, bone density loss.

Monitoring: Symptom improvement, bone density monitoring.

Precautions: Rinse mouth after inhaler use to prevent thrush.

Mucolytics

These medications help break down and thin mucus, making it easier to clear from the airways.

Example: acetylcysteine. 

Expectorants

These medications help loosen and thin mucus in the respiratory tract, making it easier to clear by coughing.

Example: guaifenesin

Albuterol

Brand Name: ProAir, Ventolin

Indication: Quick-relief treatment of asthma symptoms, including wheezing and shortness of breath.

Side Effects: Tachycardia, tremors, nervousness.

Monitoring: Symptom improvement, heart rate monitoring. 

Fluticasone

Brand Name: Flovent

Indication: Maintenance treatment of asthma and COPD.

Side Effects: Oral thrush, hoarseness, cough.

Monitoring: Symptom improvement, regular mouth rinses. 

Metered dose inhalers (MDI)

Administer the medication as a mist and require a deep breath to get the medicine in the lungs

Dry powdered inhalers (DPI)

Contain a dry powder that patients need to take a deep breath to get access to the medication

Oral Antidiabetic Agents

Medications used to treat hypothyroidism by supplementing thyroid hormones.

• Biguanides, Sulfonylureas, Thiazolidinediones, DPP-4 Inhibitors, SGLT-2 Inhibitors, GLP-1 Receptor Agonists. 

Thyroid Hormones

Medications used to treat adrenal insufficiency and inflammation.

• Levothyroxine (Synthroid), Liothyronine (Cytomel). 

Glucagon-Like Peptide-1 (GLP-1) Agonists

Medications used to manage blood sugar levels in diabetes, including oral and injectable drugs.

• Exenatide (Byetta), Liraglutide (Victoza)

Pharmacology of Endocrine Medications

Indications: Management of diabetes, hypothyroidism, adrenal insufficiency.

Side Effects: Hypoglycemia, weight gain, gastrointestinal disturbances, allergic reactions. 

Monitoring: Blood glucose levels, thyroid function tests, adrenal function tests.

Interactions: Insulin interactions with oral antidiabetic agents, thyroid hormone interactions with certain medications 

Precautions:

• Hypoglycemia risk with insulin and certain oral antidiabetic agents.

• Allergic reactions to thyroid hormone medications.

• Drug interactions with other medications.

Antacids

Medications that neutralize stomach acid to alleviate heartburn and indigestion.

Ex: Magnesium hydroxide (Milk of Magnesia), Calcium carbonate (Tums, Rolaids)

Gastroesophageal Reflux Disease (GERD)

A chronic condition characterized by acid reflux from the stomach to the esophagus

Proton Pump Inhibitors (PPIs)

Medications that reduce gastric acid production and treat conditions like GERD and ulcers

Ex: Omeprazole (Prilosec), Esomeprazole (Nexium) 

H2 Receptor Antagonists

Medications that block histamine receptors, reducing stomach acid production

Ex: Ranitidine (Zantac), Famotidine (Pepcid)

Antidiarrheals

Medications used to control diarrhea by slowing down bowel movements

Ex: Loperamide (Imodium), Bismuth subsalicylate (Pepto-Bismol) 

Laxatives

Medications used to promote bowel movements and relieve constipation

Ex: Psyllium (Metamucil), Docusate (Colace) 

Antiemetics

Medications used to prevent or treat nausea and vomiting by blocking signal pathways that trigger these symptoms

Ex: Ondansetron (Zofran), Meclizine (Antivert). 

Hormonal Contraceptives

Include combined oral contraceptives, progestin-only contraceptives, and contraceptive patches

• Combined Oral Contraceptives: Ethinyl estradiol/levonorgestrel (Alesse), Ethinyl estradiol/drospirenone (Yaz)

• Progestin-Only Pills: Norethindrone (Camila), Levonorgestrel (Plan B)

Indications:

• Prevention of pregnancy, regulation of menstrual cycles.

Side Effects:

• Nausea, headache, breast tenderness, mood changes

Monitoring:

• Blood pressure, lipid levels, menstrual cycles

Interactions: 

• may interact with certain medications, including antibiotics and antiepileptic drug

Testosterone Replacement Therapy

Medications such as testosterone gel, injections, and patches.

• Testosterone Gel: Testosterone (AndroGel), Testosterone (Androderm)

• Testosterone Injections: Testosterone cypionate (Depo-Testosterone), Testosterone enanthate (Delatestryl)

Indications:

• Treatment of hypogonadism, improvement of symptoms related to low testosterone.

Side Effects:

• acne, fluid retention, increased risk of cardiovascular event

Monitoring:

• testosterone levels, hematocrit, prostate-specific antigen (PSA) levels

Interactions:

• may interact with anticoagulants and insulin

Erectile Dysfunction Medications

Phosphodiesterase type 5 (PDE-5) inhibitors like sildenafil (Viagra) and tadalafil (Cialis).

• Phosphodiesterase Type 5 (PDE5) Inhibitors: Sildenafil (Viagra), Tadalafil (Cialis)

• Alprostadil: Available as injections or urethral suppositories 

Indications:

• Treatment of erectile dysfunction, enhancement of sexual performance.

Side Effects:

• headache, flushing, nasal congestion

Monitoring:

• blood pressure, medication efficacy

Interactions:

• nitrate medications used for angina, alpha-blockers, alcohol 

Emergency Contraceptives

Products like levonorgestrel and ulipristal acetate.

• Levonorgestrel-based pills: Plan B One-Step, Take Action and My Way

• Ulipristal acetate pill: Ella 

Indications:

• Prevention of pregnancy following unprotected intercourse or contraceptive failure. 

Side Effects:

• nausea, fatigue, headache, breast tenderness, changes in menstrual bleeding, abdominal pain or cramps

Monitoring:

• menstrual cycle, effectiveness, side effects

Interactions: 

• may interact with medications that induce liver enzymes potentially reducing their effectiveness

• herbal supplements may also reduce the effectiveness of emergency contraceptives by inducing liver enzymes