Pharma

Key Terms

  • Antagonism → a situation in which two drugs or agents work against each other, diminishing the overall effect.

  • Compliance → the extent to which a patient correctly follows medical advice and adheres to prescribed medication regimens.

  • Contraindications → specific situations or conditions under which a particular drug or treatment should not be used because it may be harmful to the patient.

  • Dosage/dose → Amount of an substance prescribed to be taken or administered at one time, which is critical in ensuring the effectiveness and safety of a medication.

  • Holistic → Form of medication which takes into account the whole person, including physical, emotional, and social factors, rather than just the symptoms of a disease.

  • Idiosyncratic → A unique reaction to a drug that is not commonly seen in the majority of patients, which can result in unexpected effects or side effects.

  • Meridians → Pathways in the body through which vital energy flows, according to traditional Chinese medicine, influencing various physiological functions and overall well-being.

  • Parenteral → Referring to the administration of medication by injection, bypassing the digestive system, which allows for rapid absorption and effect.

  • Placebo → A substance with no therapeutic effect that is used as a control in testing new drugs, often leading to improvements in symptoms due to patient expectations rather than the drug itself.

  • Synergism → The interaction between two or more drugs or substances that produces a combined effect greater than the sum of their individual effects, enhancing efficacy and reducing the likelihood of adverse effects.

  • Synthesized → The process of chemically creating drugs in the laboratory, allowing for controlled manufacturing and the possibility of modifying molecular structures to enhance drug properties and therapeutic effects.

  • Therapeutic → The intended beneficial effects of a drug or treatment on a patient, primarily aimed at alleviating symptoms or curing diseases.

  • Drug → Substance that alters biologic activity in a person.

Various Routes for Drug Administration

  • Oral tablet, capsule or liquid

    • Simple and easily portable.

    • Long onset (30-60 minutes) and included loss in digestive system.

      • Flows through digestive tract then to liver before release into blood.

    • Advantages: Tablets stable, costs varies and safe.

    • Disadvantages: Taste and swallowing problems, gastric upset and uncertain absorption.

  • Sublingual (under the tongue)

    • Simple and easily portable.

    • Immediate onset (as it skips digestion); delivered directly to blood with little loss.

    • Advantages: convenient and rapid.

    • Disadvantages: tablets soft and unstable.

  • Subcutaneous Injection:

    • Requires syringe, self-administered and portable.

    • Slow onset, delivered directly into blood with some loss of drug.

    • It is an simple injection, smaller dosages can be only be given.

    • Requires equipment, asepsis and can be irritating.

  • Intramuscular injection:

    • Requires syringe and technique.

    • Good absorption into blood; some lag and drug loss until absorption.

    • Can be used when patient unconscious or nauseous; it is rapid and has prolonged effect.

    • Requires asepsis and equipment; shorter shelf-life and comes with discomfort.

  • Intravenous injection

    • Requires equipment and technique into vein.

    • Immediate onset and no drug loss.

    • Predictable drug level and can be used when patient unconscious or nauseous.

    • It is costly, skill required, no recovery of drug and irritation at site can present.

  • Inhalation

    • Portable inhalers (puffer) or machine w/ technique required.

    • Rapid onset and little loss of drug.

    • Local effect or absorption into alveolar capillaries. Rapid effect and good for anesthesia.

  • Topical (Trans-dermal)

    • Local application, portable and can be applied in eyes, ears, vaginal, and rectal areas.

    • Onset is rapid with some loss. Absorption varies.

    • Easy to apply; few systemic effects and useful for local anesthesia.

    • Can be messy and some applications can be difficult.

  • Intraperitoneal pump

    • Requires surgery, costly and infection may present.

    • Excellent control of blood levels and onset is immediate.

Common Abbreviations

  • PO: Orally; by mouth.

  • IM: Intramuscular

  • SQ / SC: Subcutaneous

  • IV: Intravenous

  • OD

    • Ocular Dexter: Right eye

    • Overdose

  • OS (Ocular Sinister): Left Eye

  • OU (Ocular Uterine): Uterus

  • HS (Hora Somni): Before sleep.

  • AC (Ante cibum): Before food.

  • PC (Post cibum): After food.

  • Q 4 hr: Every 4 hours.

  • QD: Once a day.

  • BID: Twice a day

  • TID: 3 times a day

  • QID: 4 times a day

Pharmacology

  • Pharmacology is study of drugs and how they interact with the body.

    • This includes all medications, whether prescribed or over-the-counter.

    • Pharmacodynamics → drug-induced responses of physiologic and biochemical systems.

    • Pharmacokinetics → Drug amounts at different sites after administration.

    • Pharmacotherapies → Choice and drug application for disease prevention, treatment, or diagnosis.

    • Toxicology → Study of body’s responses to drugs, harmful effects, mechanisms of actions, symptoms, treatment and identification.

    • Pharmacy → Preparation, compounding, dispensing, and record keeping of therapeutic drugs.

  • Integrated medical science involving chemistry, biochemistry, anatomy, physiology, microbiology, and others.

Drugs

  • Drugs intent is to promote:

    • Healing, prevention and curing of disease.

    • Increase comfortability and lower excessive activity in body.

    • Replacement therapy.

  • Drug effects can be therapeutic or bad:

    • Stimulation or inhibition of cell function.

    • Physical or mechanical action.

    • Drugs classified based on effects.

    • Indications are known provided use for drug while Contradictions are circumstances in which drug use should be avoided.

      • Off-Label use refers to the prescribing of medication for purposes other than those officially approved by regulatory agencies, which can be beneficial in certain cases but may also come with risks.

Side Effects

  • Side effects → Unwanted actions and are generally mild.

    • Adverse ortoxic side effects → Dangerous side effects that can result in severe health complications, requiring immediate medical attention.

  • Hypersensitivity → An exaggerated immune response to a medication, which can lead to symptoms such as rash, swelling, or in severe cases, anaphylaxis.

  • Idiosyncratic (paradoxic) reactions → Unpredictable responses that occur in a small percentage of patients, often unrelated to the drug's pharmacological effects, and may cause unexpected symptoms or complications.

  • Iatrongic (iatrogenic) reactions → Adverse effects that are directly caused by the actions of healthcare professionals, including medication errors, misdiagnoses, or incorrect dosages.

  • Teratogenic reactions → The potential for a medication to cause developmental abnormalities in a fetus when administered to a pregnant individual, leading to birth defects or other significant health issues.

  • Interactions → The effects that occur when two or more substances influence each other's pharmacological activity, resulting in enhanced or diminished therapeutic effects or adverse reactions.

Combination

  • Synergism → effects of two drugs produce an increased effect — harmless or beneficial.

  • Antagonism → occurs when one drug reduces or counteracts the effects of another, potentially leading to diminished efficacy or increased risk of adverse effects.

  • Potentiation → One drug enhances the effects of another drug.

Administration and Distribution of Drugs

  • Dose → Amount of an drug given at a single time.

  • Dosage → total amount of drug given at a total period of time.

  • “Loading dose” → initial higher dose given to quickly achieve the desired therapeutic effect before switching to a maintenance dose.

  • Frequency of dosing → refers to how often a drug is administered, which can affect the drug's overall effectiveness and the patient's adherence to the medication regimen.

    • Absorption → the process by which the drug enters the bloodstream from the site of administration, influencing the onset and intensity of its therapeutic effect.

      • Influenced by location where drug is administered, absorption can vary significantly depending on factors such as the route of administration (oral, intravenous, subcutaneous, etc.) and the presence of food or other substances in the gastrointestinal tract.

    • Distribution → the process by which a drug disperses throughout the body after entering the bloodstream.

    • Half-life → the time it takes for the concentration of the drug in the bloodstream to decrease by half, which is a critical factor in determining dosages and the duration of action.

    • Biotransformation → the chemical modification made by an organism on a chemical compound, primarily occurring in the liver, which affects the drug's efficacy and elimination from the body.

  • Administration pathways and Factors

    • Factors include:

      • Circulation and cardiovascular function.

      • Age and gender.

      • Body weight and body fat proportions.

      • Activity level/exercise.

      • Ability to absorb, metabolize, and excrete drugs (liver and kidney function).

      • Food and fluid intake.

      • Genetic factors.

      • Health status of a individual — disease or no disease.

    • Systemic administration can include transdermal, oral, sublingual, rectal, inhalation, subcutaneous or intramuscular injection, intravenous injection, and intrathecal injection.

    • Local administration can include topical, mucosal, oral, inhalation and iontophoretic administration.

  • Drug Mechanisms and Receptors

    • several receptors present on cells in the body:

      • Natural substances → enzymes, natural hormones (estrogen, testosterone).

      • Neurotransmitters (e.g. acetylcholine, norepinephrine and gamma-aminobutyric acid)

      • Electrolytes (e.g. Calcium, sodium and potassium)

    • Agonist → substance which binds to a receptor to stimulate it.

    • Antagonist → substance that binds to a receptor but does not activate it, effectively blocking the action of agonists.

  • Responses:

    • Dose effects: establishment of minimum effective dose to elicit a therapeutic response, as well as the determination of maximum tolerated dose to avoid adverse effects.

    • Time effects: time of administration, onset and cessation of effect, peak effect, duration, latency and threshold.

    • Variability (biotransformation): Chemical properties, Toxic effects, liver and kidney issues, age and gender, genetics, metabolic cycles and overall health.

    • Toxicity: Physiochemical properties, routes and rates of administration and rates of absorption, biotransformation, and excretion.

  • Drug Classifications:

    • Prescription (Rx) → Signed legal document which includes patient’s name, address, and age; prescriber’s name, address and identification; date; name and dosage of the medication; instructions for use; and refills if necessary.

    • Chemical names → Complex nomenclature that provides a precise description of a drug's molecular structure, often including information about its functional groups and stereochemistry.

    • Generic names → Simplified names used to identify drugs; often derived from the chemical names and are not trademarked, making them more widely accessible.

    • Drug names which are similar to each other are typically similar; However, this may not be the case.

Schedule of Controlled Substances

  1. Schedule 1 → High probability for abuse, no therapeutic usage and lack of safety controls.

  2. Schedule 2 → High probability of abuse, therapeutic use accepted under close restrictions.

  3. Schedule 3 → Less potential for abuse then 1 & 2, therapeutic use accepted with low potential for physical and psychological dependence.

  4. Schedule 4 → Lower potential for abuse compared to schedules 1, 2, and 3, acceptable for therapeutic use with a lower risk of dependence than higher schedules.

  5. Schedule 5 → Lowest potential for abuse among all the schedules, accepted for therapeutic use, generally safe with minimal risk of dependence.

  • US Food and Drug Administration → Regulates production, labeling, distribution, and other aspects of drug control.

  • Over the Counter (OTC) drugs →

Traditional and Alternative Forms of Therapy

Traditional Therapies

Physiotherapy

  • Physiotherapists assess physical function, and attempt to restore or prevent any deficit in physical function.

  • Rehabilitation and long-term care.

Occupational Therapy

  • Occupational therapists provide a functional assessment of patient capabilities related to normal activities of daily livings (ADLs).

  • Assessment includes an evaluation of motor, cognitive, and visual-spatial ability.

  • Educating clients in use of adaptions to meet client’s needs.

Speech/Language Therapy

  • Speech/language therapists assess communication and swallowing disorders, focusing on both expressive and receptive language skills.

  • Therapy may involve exercises to improve articulation, language understanding, and social communication skills.

  • Dysarthria & asphyia

Nutrition/Diet

  • Evaluating dietary habits is crucial as it can directly affect a patient’s ability to live a proper functional quality life.

  • Therapists often collaborate with nutritionists to create personalized meal plans that cater to the specific needs of individuals with disease such as diabetes.

Massage Therapy and Chiropractic Therapy

  • Registered massage therapist use a variety of techniques to increase circulation, reduce pain, and increase flexibility for clients experiencing joint pain or problems with body alignment.

    • Aromatics, acupuncture or other modalities may be used.

  • Chiropractors use their doctrine that one’s health status is dependent on the state of the nervous system. In order to ensure a healthy nervous system, chiropractors often perform spinal manipulations to alleviate pressure on nerves and promote overall wellness.

Alternative/Complementary therapies

  • Alternative therapies are therapeutic practices considered to be outside of traditional Western medicine that also focus on prevent and healing from disease.

  • They adapt a “holistic” or whole-body view that seeks to address not just physical symptoms, but also mental and emotional well-being, fostering a more comprehensive approach to health.

  • Integrative medicine → a combination of conventional medical treatments and alternative therapies, promoting a multidimensional approach to patient care that emphasizes the importance of treating the whole person.

    • Shunned by Western medicine practitioners due to ability of “quackery".

  • Chinese medicine considered it’s own field of study that includes practices such as acupuncture, herbal remedies, and tai chi, which aim to balance the body's energy and improve overall health.

Noncontact Therapeutic Touch

  • Energy is exchanged between people to to relieve pain and anxiety to promote healing.

  • Intention is to form a positive “intent to heal” and maintain it.

  • Imagery, light, or colors might be included in the treatments.

Naturopathy

  • Naturopathic treatments are based on promoting natural foods, massage, exercise and fresh air as a way of life. These treatments emphasize the body's inherent ability to heal itself by harnessing the power of nature and integrating holistic approaches.

  • Acupuncture, herbal medicines, nutrition, massage, and physical manipulations can be incorporated too.

Homeopathy / Osteopath (DO)

  • Homeopathic medicines intents are to stimulate the immune system and natural healing power in the body through use of plant, animal, and mineral products.

  • Osteopaths are medically licensed in many jurisdictions. They use body’s self-healing functionality to improve conditions of disease/illness.

Herbal Medicine

  • Medicinal herbs first documented to be used in ancient Egypt. However it’s use has been global through several cultures.

  • Medicinal herbs use their active compounds to help relieve symptoms, enhance recovery, and improve overall health outcomes by targeting specific ailments.

Aromatherapy

  • Aromatherapy is rising in popularity.

  • Essential oils are derived from plants and are believed to provide therapeutic benefits through inhalation or topical application, making them a key component of holistic health practices.

Asian Concepts of Disease and Healing

  • Asian therapies stress balance of life energy called qi in Chinese medicine.

  • Disease is caused by a deficit or excess of qi that disrupts the harmony within the body, leading to various health issues.

  • Qi is derived from three sources: inherited or ancestral factors, food ingested, and air breathed in. Imbalances in harmony between yin (lack of qi) and yang (excess qi) may be caused by diet, stress, metabolism, activity, or environment.. leading to disease.

  • Meridians are channels through which qi flows in the body, connecting various organs and systems.

Acupuncture

  • Acupuncture is a Chinese therapeutic discipline expanding 3000 years where needles are inserted into meridian acupoints to balance body energy.

  • There are 365 acupoints, however only 150 are typically used today.

  • Moxibustion → form of acupuncture that treats cold or deficiency patterns by burning moxa (a herb derived from the mugwort plant) near the acupoints to promote healing and improve circulation.

Shiatsu

  • Japanese-refined version of Chinese anma massage, or acupuncture without needles.

  • Zen shiatsu uses fingers, thumbs, palms, elbows, and knees to deliver pressure to acupoints. Emphasizes psychological/emotional causes of disharmony.

  • Normal shiatsu uses just thumbs and is more of a massage.

Yoga

  • Ancient Indian discipline of various forms that combines physical activity in the form of body stretching postures with meditation.

  • Yoga improves flow of prana, the Indian equivalent to Chinese qi.

  • Prana circulates through the body by channels called nadis which connect to seven chakras that align in the middle.

Reflexology

  • Reflexology → A therapy from ancient China and Egypt, relates points on the feet and hands to 10 longitudinal zones in the body.

  • When foot is stimulated, it can elicit changes in distant organs or structures.

Craniosacral Therapy

  • Craniosacral therapy → A gentle, hands-on method that aims to release tension deep in the body by manipulating the craniosacral system, which encompasses the membranes and fluid that surround the brain and spinal cord.

Ayurveda

  • Ayurveda → An ancient Indian medical system that emphasizes balance in the body through natural means, including herbs, diet, and lifestyle adjustments, aiming to promote holistic health and well-being.