Introduction to pharm

pharmacology

the science concerned with the origin, nature, effects, and uses of drugs

drug

a substance that, when taken into a living organism, may modify 1 or more of its functions

Physician’s Desk Reference (PDR)

includes all information on FDA regulated drugs

• accepted uses

• side effects

• contraindications

• doses

classification of drugs

name

action

method

classification by name

chemical name

• identifies actual chemical structure

  • 2-diphenylmehoxy-N

trade/brand name

• name given by a specific company

  • benadryl

generic name

• name given when drug becomes commercially available

  • diphenhydramine

classification by action

drugs that have similar chemical actions are grouped into categories called drug families

EX:

• analgesics: pain relief

• antihypertensive: treat high blood pressure

• anti-inflammatory: fight inflamation

legal classification

prescription

• requires an order by a legally authorized health care provider

• pharmacist - person who is licensed to prepare and dispense drugs

nonprescription

• over-the-counter drugs

• obtained legally without a prescription

dose forms

tablet

capsule

inhalant

solution

suppository

suspension

transdermal patch

tablet drugs

most common oral dose form and one of the easiest to administer

a granulated drug that has been compressed into a solid hard disk

only ones with dash can be cut in half

• if it does not have the dash, the coating is protecting the pt or it is a delayed response, so you don’t want to cut

capsule

dose form in which a powdered or liquid drug is contained in a gelatin shell

• shell dissolves in the stomach and releases its contents

• can also sometimes be opened and contents dumped out

inhalants

can be used for a local or systemic effect

allows for high concentration to be deposited in the respiratory mucosa and exert action by producing bronchodilation or reducing inflammation

EX:

• local effects: asthma treatments or chronic obstructive pulmonary disease

• systemic effects: anesthesia

solution

dose forms which one or more drugs are dissolved in a liquid carrier

rapidly absorbed

commonly administered orally or parenterally (injection)

suppository

inserted into an orifice

• rectum, vagina. urethra

dissolves and absorbed

suspension

one or more drugs in small particles are suspended in a liquid carrier

orally

shaken thoroughly just before administration

never administered intravenously

transdermal patch

permits a drug to be applied on the skin surface, where it is absorbed into the bloodstream

water-resistant covering

drug released gradually over time

analgesics

drugs that relieve pain without a loss of consciousness

nonopioids: not habit forming

• acetaminophen (Tylenol), ibuprofen (Motrin)

opioids: physiologically habit forming

• oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine

anesthetics

agents that reversibly depress neuronal function, producing loss of ability to perceive pain and/or other sensations

general: systemic with loss of consciousness

• propofol (Diprivan), ketamine, Etomidate

local: limited area and nerve block

• mepivacaine (Carbocaine) and lidocaine (Xylocaine)

anti-anxiety agents

used in the treatment of anxiety

act on the CNS to calm or relax an anxious pt

• diazepam (Valium) and lorazepam (Ativan)

antiarrhythmic

drugs used to treat arrhythmias

• depends on what type of arrhythmias needs to be treated

• EX:

  • amiodarone (Cordarone) is used for ventricular arrythmias

antibiotics

drugs used to kill or inhibit the growth of microorganisms

broad spectrum: effective against a large number of micro-organisms

• ciprofloxacin (Cipro)

• amoxicillin/clavulanic acid (Augmentin)

narrow spectrum: is effective against only a small number or microorganisms

• penicillin VK, amoxicillin (Amxil)

Allergic reactions are common with antibiotics

• can range from mild to severe or even fatal

anticholinergics

used to reduce smooth muscle tone, motility of the GI tract, secretions from the respiratory tract and secretory glands

AKA: antispasmodics

EX:

• oxybutynin (Ditropan), tolterodine (Detrol LA)

anticoagulants

drugs that inhibit clotting of the blood or increase the coagulation time

• used to prevent or treat thromboembolic disorders

• orally

  • warfarin (Coumadin)

  • rivaroxaban (Xarelto)

• parenteral

  • heparin

  • enoxaparin (Lovenox)

anticonvulsants

used to prevent or control the occurrence of seizures

AKA: antiepileptic

NOT used to treat the cause of seizures, but reduce seizure activity

can be given orally or parenteral

• Klonopin

  • for petit mal seizures

• Dilantin

  • for grand mal seizures

antidepressants

used in the treatment of depression

often require 6 to 12 weeks to achieve their maximal therapeutic effects

EX:

• citalopram (Celexa)

• venlafaxine (Effexor)

• sertraline (Zoloft)

antiemetics

used to prevent and treat nausea and vomiting

more effective in preventing nausea and vomiting than they are in treating symptoms once they have started

orally or parenterally

• prochlorperazine (Compazine)

• ondansetron (Zofran)

antihistamines

used primarily to treat allergic disorders, both acute and chronic

sedating (first generation)

• Diphenhydramine (Benadryl)

non-sedating (second generation)

• loratadine (Claritin)

• fexofenadine (Allegra)

antihypertensive

used to treat hypertension

recommended BP less than 140/90

EX:

• losartan (Cozaar)

• metoprolol tartrate (Lopressor)

• lisinopril (Zestril)

antiulcer agents

used to treat ulcers, gastric and duodenal, and GERD

GERD is caused by the reflux of acid from the stomach into the esophagus and the more common symptom is heart burn

EX:

• ranitidine (Zantac)

• famotidine (Pepcid)

• omeprazole (Prilosec)

antiviral agents

inhibit development of virus

do NOT kill pathogens

used to treat things like herpes siplex, chicken pox, influenza, hepatitis, and HIV

oral, topical, and parenteral

• acyclovir (Zoviraz)

bronchodilators

used in treatment of asthma and COPD

relax the smooth bronchial smooth muscle and dilate the respiratory passages

can be short acting or long acting

• epinephrine (Adrenalin)

• albuterol (ProAir HFA)

• tiotropium (Spiriva)

coagulants

used to control hemorrhage or to speed up coagulation

most are a makeup of vitamin K

oral and parenteral

• phytonadione (Mephyton)

corticosteroids

used to reduce the symptoms associated with chronic inflammatory disorders for the short-term treatment of acute inflammatory conditions

some are used systemically and some are used locally

prolonged use can cause a variety of adverse side effects such as osteoporosis and cataracts

EX:

• dexamethasone (Decadron)

• prednisone (Deltasone)

• methylprednisolone (depoMedrol)

diuretics

used to increase the amount of urine excreted by the kidneys, thus removing sodium and water from the body

pts need to be monitored when on diuretics for excessive fluid loss

EX:

• furosemide (Lasiz)

• hydrochlorothiazide (Hydrodiuril)

emetics

used to promote/produce emesis

given when something unintended was ingested

Oral only

EX:

• Ipecac

Hormones

act as stimulants to increase the functional activity of a particular organ or gland

the most important clinical application of these drugs is their use in replacement therapy like hypothyroidism

EX:

• levotyroxine (Synthroid)

• estrogen (Premarin)

laxatives (cathartic)

drugs that act to promote the passage and elimination of feces from the large intestines

used in radiology to prepare for GI procedures

oral and rectal

EX:

• bisacodyl (Dulcolax)

• polyethylene glycol (Miralax)

• magnesium citrate

sedatives

AKA: hypnotics

can produce varying degrees of CNS depression ranging from mild sedation to sleep

EX:

• zolpidem (Ambien)

• eszopiclone (Lunesta)

stimulants

increases the activity of the brain and spinal cord

can be used to treat ADHA

can be habit forming drugs (opiods)

EX:

• amphetamine salts (Adderall)

• methylphenidate (Ritalin)

vasoconstrictors

drugs that cause the blood vessels to constrict

increases HR and BP

EX:

• norepinephrine (Levophed)

  • needs to be injected intravenously because it can cause tissue necrosis if infiltrated

vasodilators

drugs that cause blood vessels to dilate

treat vascular disease, particularly angina

EX:

• nitroglycerin (Nitrostat)

• nitroprusside (Nitropress)

Nitroglycerin

a very common and very effective coronary vasodilator

most COMMONLY given sublingually

• can also be given orally, topically, or parenterally

Crash Cart Meds

adenosine

amiodarone

aspirin

atropine sulfate

Benadryl

Cardizem

epinephrine

Lopressor

Narcan

nitroglycerin spray

pronestyl

solumedrol

pharmacokinetics

study of how a drug is absorbed into the body, circulates, is changed by the body, and leaves the body

four basic factors influence the movement of a drug

absorption

• during movement from the site of administration into the blood

distribution

• drug movement from the blood to various tissues and organs of the body

metabolism

• chemical alteration of the drugs

• main organ in metabolism is the liver

  • turns fat soluble drugs into water soluble drugs

excretion

• drug movement out of the body

• main organ in excretion is the kidneys

factors that affect the intended drug effect

age

sex

genetics

weight

route

time of administration

drug interaction

modification of a drug’s effect by previous or concomitant administration of another drug food

EX:

• Warfarin and vitamin K producing products

idiosyncratic reactions

unusual response to a drug that is a peculiar to the individual

these responses are unpredictable and not explained by pharmacologic properties of the drug

EX:

• genetic differences

side effects

consequence other than the one for which a drug is used

EX:

• antihistamine is indented to counteract an allergic condition, but one side effect is drowsiness

toxic effect

related to the dose of the drug

too much of a good thing

allergic reaction

occurs when the body’s immune system is hypersensitive to the presence of the drug

can be delayed or immediate

therapeutic effect

purpose of the medication

what you want to happen

six rights to drug administration

right drug

right amount

right patient

right time

right route

right charting

right drug

read entire label on drug

check 3 times

never used unlabeled containers

right dose

make sure correct amount is administered

right patient

double verify the patient receiving the drug

• check name, DOB, and wristband

right time

tech doesn’t determine what time, but must administer at the correct time

right route

make sure it is administered by the route chosen by the physician

right charting

include the:

• name

• dosage

• route

• date

• time

• injection site

• EXP/LOT when appropriate

ac

before meals

bid

twice a day

C

with

et

and

g

gram

gtt

drop(s)

h

hour

hs

at bedtime

hypo

hypodermic

IM

intramuscular

IV

intravenously

mg

milligramm

mL

milliliter

od

in the right eye

os

in the left ete pc

pc

after meals

PO

by mouth

pm

as needed

qh

every hour

q2h

every 2 hours

q3h

every 3 hours

qid

4 times a day

S

without

routes of administration

enteral - within the GI tract

parenteral - a route other than the GI tract

enteral routes

oral

sublingual

buccal

rectal

oral

most common method

most accurate and fast-acting method

sublingual

drug is placed under the tongue and allowed to dissolve

buccal

drug is placed against the mucus membranes of the cheek

rectal

option when the pt is not capable of taking a drug orally

topical

application of drug onto the skin

diffused through the skin and absorbed into the bloodstream

lotions, ointments, sprays, tinctures, and transdermal patches

parenteral routes

valuable for emergencies

4 types of injections:

• intradermal (ID)

• intramuscular (IM)

• subcutaneous (subcut)

• intravenous (IV)

intramuscular

drug is placed into the muscle tissue

long needle (1-3 inches)

deltoids, gluteus maximus, vastust lateralis

subcutaneous

the drug is placed under the skin into the subcutaneous tissue

slower than intramuscular because of lack of vascularity

inner thigh, upper back, lower abdomen

intravenous

drug placed directly into the bloodstream

rapid action

cephalic vein, basilic vein, posterior hand

intradermal

injection between the layers of the skin

inside of upper arm, upper back, shoulder blades, chest

EX: TB skin test, allergy testing

venipuncture

the act of puncturing a vein with a needle

extravasation

escape of fluid from a vessel into the surrounding tissue

to stop spread - apply cold

to stop pain - apply heat

bolus

a concentrated amount of fluid injected at once

drip infusion

an “IV” infusion of a large volume of fluid over a long period of time

parts of a syringe

needle

• smaller diameter = bigger gauge #

hub

barrel

plunger

ampule

sealed glass container

single dose

small volume

vial

small glass or plastic bottle with a sealed rubber cap

different sizes

multiple dose