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Pharmacology: PVN 106E. Chapter 1. Drugs and Factors Affecting Their Action. History of Pharmacology. Plants – original pharmacy Egypt: ancient remedies from over 3,000 years ago Hippocrates: natural laws to understand health and disease
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Chapter 1 Drugs and Factors Affecting Their Action
History of Pharmacology • Plants – original pharmacy • Egypt: ancient remedies from over 3,000 years ago • Hippocrates: natural laws to understand health and disease • Various other scientists studied throughout the centuries • We now have thousands of drugs available with more being developed all the time
Key Terms • Pharmacology • Pharmacodynamics • Pharmacokinetics • Pharmacotherapeutics • Pharmacognosy • Toxicology
Pharmacology • Study of the history, sources, and physical and chemical properties of drugs • Looks at the ways in which drugs affect living systems • Various subdivisions of pharmacology have evolved
Pharmacodynamics • Study of the biochemical and physiological effects of drugs • Study of drugs’ mechanisms of action
Pharmacokinetics • Study of the absorption, distribution, metabolism, and excretion of drugs • This is drug card info
Pharmacotherapeutics • Study of how drugs may best be used in the treatment of illnesses • Which drug would be most appropriate to use for a specific disease at what dose, etc.
Pharmacognosy • Study of drugs derived from herbal and other natural (plant and animal) drug sources • Studying compositions of natural substances helps to gain knowledge for developing synthetic versions
Toxicology • Study of poisons and poisonings • All drugs have the potential to become toxic
Sources of Drugs • Natural • Semisynthetic • Synthetic • Biotechnology
Drug Uses • Treatment of symptoms (pain relievers) • Preventative drugs (vaccines) • Diagnostic drugs (dyes) • Cure (antibiotics) • Health maintenance (insulin) • Contraceptives (birth control)
Dosage Forms • Tablets • Time released tablets • Capsules (useful for liquids) • Troches or lozenges • Suppositories • Solutions • Suspensions • Emulsions • Topicals • Implants • Parenteral products
Common medication routes • Intravenous or IV – injected into a vein • Intramuscular or IM – injected into a muscle • Intradermal – injected under the skin • Subcutaneous or SQ – injected into fatty tissue • Oral or PO – by mouth
U.S. Drug Legislation • Pure Food and Drug Act of 1906 - Required all drugs to meet minimal standards • Federal Food, Drug, and Cosmetic Act of 1938 - Required the drug to be safe before being distributed over state lines
U.S. Drug Legislation • Comprehensive Drug Abuse Prevention and Control Act 1970 - Also known as Controlled Substance Act which classified drugs according to their abuse potential - Regulates the manufacture and distribution of drugs causing dependence
Drug Classification • As a result of legislation, four general drug categories were identified: 1. Prescription drugs 2. Non-prescription drugs (over the counter or OTC) 3. Investigational drugs - Drugs being tested under the FDA 4. Illicit or “street” drugs
Drug Information Resources • The Physicians Desk Reference (PDR) • The American Drug Index • Drug Facts and Comparisons • The Handbook of Non-prescription Drugs • Drug Interactions • The Product Insert • The Pharmacist • Nursing Drug Guides • Formulary
Physicians Desk Reference (PDR) • An annual publication containing several types of drug information including appearance and chemical properties of drugs. Primarily used by prescribers (physicians, nurse practitioners, etc.) • The PDR can be a good reference book, but it does not provide nursing implications. Nurses may find that specific nursing drug guides are more helpful for everyday use.
The Product Insert • A detailed description • Approved by the FDA • Categories - Brand name - Generic name - Description - Clinical Pharmacology - Contraindications - Warnings - Precautions - Over dosage - Dosage and administration - How supplied
Drug Names • Chemical name - The drugs chemical composition and molecular structure • Generic name (non-proprietary name) - Name given by the United States Adopted Names Council - Allows the drug to be marketed
Drug Names • Brand name - Also called trade name (proprietary name) - The drug has a registered trademark; use of the name is restricted by the drug’s owner (usually the manufacturer) for life of patent – usually 17 years - Allows the drug to be commercially distributed - The superscript ® is registered by the U.S. Patent Office and approved by the Food and Drug Administration (FDA)
Examples of Drug Names • Chemical name ٠(+/-)-2-(p-isobutylphenyl) propionic acid • Generic name ٠Ibuprofen • Trade or Brand name ٠Motrin or Advil
Principles of Drug Action • Drugs alter existing cellular or chemical functions • Some drugs exert their action by forming a chemical bond with specific receptors within the body – referred to as a lock and key effect - Agonists: substance that interacts with receptor to produce response - Antagonists: substance preventing action of agonist
Principles of Drug Action • Receptors - The better the fit, the stronger the drug’s affinity; therefore, the drug’s effect occurs at lower doses
Principles of Drug Action • Primary effect - Desired or therapeutic effect of the medication • Secondary effect - All other effects produced by the drug, whether desirable or undesirable • example: Compazine’s primary effect is anti-emetic. Secondary effect is anti-psychotic
Liberation • Oral administration – may require full glass of fluid to aid administration • Dissolves in the gastric or intestinal fluids
Absorption • First step in the passage of a drug into the body (bloodstream) • Absorption can be faster when drug is consumed with fluids as it increases rate of dissolution • Presence of food may slow absorption • Most drugs are absorbed in the small intestine • Bioavailability describes absorption efficiency
Distribution • The transport of a drug in the body by the bloodstream to its site of action
Metabolism • Occurs before excretion and makes drugs water soluble to be able to pass through the kidneys • Also called “biotransformation” • Metabolism occurs in the liver where liver enzymes react with the drug
Elimination/Excretion • The elimination of drugs from the body - Kidneys (primary organ for excretion) - Liver - Bowel
Adverse Drug Reaction (ADR) • ADR is the term used to describe unwanted, negative consequences associated with the use of a medication • Alternative terms are side effect and adverse effect
Types of ADR’s • Allergic Reactions - Type of unpredictable ADR - Response of the Patient’s immune system to the presence of the drug - Does not occur unless the patient has been previously exposed to the drug - Response may range from mild (rash) to life threatening (anaphylaxis)
Types of ADR’s • Drug Idiosyncrasy - Abnormal reactivity to a drug caused by genetic differences – can occur on first exposure • Drug Tolerance - Patient requires a higher dosage or more frequent administration for a therapeutic effect
Types of ADR’s • Toxic Reactions - Related to dosage administered - All drugs have the capability of producing a toxic effect • Teratogenic Effect - Drug causes congenital defects – usually in first trimester
Common Lab Tests to Measure Drug Action • Therapeutic levels • Tests based on what the drug is supposed to do • Examples: CBC for antibiotics or PTT for Coumadin, peak/trough for antibiotics (gentamicin)
Pharmacokinetics • Half life - The time it takes for one half of the original amount of a drug to be excreted from the body • Used to maintain drug levels over a 24 hour period
Factors Influencing Drug Response • Age • Weight • Gender • Disease • Route of Administration
Drug Interactions • Drug-drug interaction occurs when the effects of one drug are potentiated or diminished by another drug - Example: Antacids diminish the effect of tetracycline • Drug-food interaction occurs when a specific food ingested increases or decreases the effect of a drug - Example: Grapefruit juice increases effects of calcium channel blockers
Drug Incompatibilities • Drugs are chemical compounds • Can interact with each other • Most often an issue in parenteral administration when mixing solutions • Must always determine the safety of mixing solutions before giving to patients • When in doubt, give separately
Herbals and Botanicals • Herbs are used by 80% of the world population • Sold in nutrition stores, major drug chains, and discount retail stores (even supermarkets) • Herbals are not regulated by the FDA • Herbals are chemicals • Must assess patients use of these products as some can have interactions with prescription drugs