Chapter 6: General Principals of Pharmacology

Part 1:
Drugs- a chemical used to diagnose, treat, or prevent disease. Pharmacology- the study of drugs and their interactions w/ the body. Drug Names Chemical name- the most detailed name for any drug, which states its chemical composition & molecular structure. Ex) 7-chloro-1, 3-dihydro-1-methyl-5phenyl-2H-1, 4-benzodiazepin-2-one Generic name- is usually suggested by the manufacturer and confirmed by the United States Adopted Name Council. Ex) diazepam Official name- it becomes the FDAs official name when it is listed in the United States Pharmacopoeia (USP). Ex) diazepam, USP Brand name- manufacturer gives drug a brand name to foster brand loyalty among its customers. Ex) Valium or 4 Main Sources of Drugs Plants- Oldest source Animals Minerals Synthetic (Laboratory Made) Sources of Drug Information USP (United States Pharmacopoeia) PDR (Physicians Desk Reference) Drug Information Monthly Prescribing Reference AMA Drug Evaluation Legal -The laws and Regulations come from 3 distinct authorities: Federal law o Pure Food and Drug Act of 1906 o Harrison Narcotic Act of 1914 o Federal Food, Drug and Cosmetic Act of 1938 1951 Durham-Humphrey Amendment- also known as the prescription drug amendment o Comprehensive Drug Abuse Prevention and Control Act of 1970 State law Individual agency regulations Schedules of Drugs According to the Controlled Substance Act of 1970 Schedule I- High abuse potential; may lead to severe dependence; no accepted medical indications; used for research, analysis or instruction only. Ex) Heroin, LSD, Mescaline

Schedule II- High abuse potential; may lead to severe dependence; accepted medical indications. Ex) Opium, cocaine, morphine, codeine, oxycodone, methadone, secobarbital. Schedule III- Less abuse potential than Schedule I & II; may lead to moderate or low physical dependence or high psychological dependence; accepted medical indications. Ex) Limited opioid amounts or combined w/noncontrolled substances: Vicodin, Tylenol w/codeine Schedule IV- Low abuse potential compared to Schedule III; limited psychological and /or physical dependence; accepted medical indications. Ex) Diazepam, lorazepam, Phenobarbital Schedule V- Lower abuse potential compared to Schedule IV; may lead to limited physical or psychological dependence; accepted medical indications. Ex) Limited amounts of opioids; often for cough or diarrhea. Components of a Drug Profile Names- usually drug generic & trade name Classification- (in Part 2) is the broad group to which the drug belongs. Mechanism of action- the way in which a drug causes its effects; its pharmacodynamics. Indications- conditions that make administration of the drug appropriate. Pharmacokinetics- How the drug is absorbed, distributed, and eliminated; typically includes onset & duration of action. Side effects/adverse reactions- the drugs untoward or undesired effects. Routes of administration- How the drug is given. Contraindications- conditions that make it inappropriate to give the drug. Unlike when the drug is simply not indicated, a contraindication means that a predictable harmful event will occur if the drug is given in this situation. Dosage- the amount of the drug that should be given. How supplied- this typically includes the common concentrations of the available preparations; many drugs come in different concentrations. Special considerations- How the drug may affect pediatric, geriatric, or pregnant patients. 6 Rights of Medication Administration Right Medication Right Dose Right Time Right Route Right Patient Right Documentation -Teratogenic drug- medication that may deform or kill the fetus. Pharmacokinetics- how drugs are transported into and out of the body Absorption Distribution

 Biotransformation- metabolism of drugs Elimination Pharmacodynamics- how a drug interacts with the body to cause its effects. Drug Routes Enteral route- delivery of a medication through the gastrointestinal tract. o Oral (PO) o Orogastric/Nasogastric tube (OG/NG) o Sublingual (SL) o Buccal o Rectal Parenteral route- delivery of a medication outside of the gastrointestinal tract, typically using needles to inject medications into the circulatory system or tissue. o Intravenous (IV)- is the preferred route in most emergencies o Endotracheal (ET)- Double the medication down the tube, except Vasopressen o Intraosseous (IO)- in the bone o Umbilical o Intramuscular (IM) o Subcutaneous (SC, SQ, SubQ)o Inhalation/Nebulized o Topical o Transdermal o Nasal o Instillation- is similar to topical administration, but places drug directly into a wound or an eye. o Intradermal- for allergy testing, Intradermal administration delivers a drug or biologic agent between the dermal layers Drug Forms Solid forms- generally given orally o Pills- shaped spherically to be easy to swallow o Powderso Tablets- powders compressed into a disklike form. o Suppositories- drugs mixed w/ a waxlike base that melts @ body temperature, allowing absorption by rectal or vaginal tissue. o Capsules- gelatin containers filled w/powders or tiny pills Liquid drugs-usually solutions or a solid drug dissolved in a solvent. Given Enterally & Preenterally. o Solutions- H2O based, some oil based o Tinctures- prepared using an alcohol extractions process o Suspensions- Preparations in which the solid does not dissolve in the solvent.

o Emulsions- suspensions w/ an oily substance in the solvent, even when well mixed globules of oil separate out of the solution. o Spirits- solution of a volatile drug in alcohol. o Elixirs- alcohol and water solvent, which is flavored. o Syrups- sugar, water, and drug solutions. Gas forms o Nitrous oxide (N2O)

Pharmacodynamics- how a drug interacts with the body to cause its effects. Types of Drug Actions Binding to a receptor site o Agonist- drug that binds to a receptor and causes it to initiate the expected response. o Antagonist- drug that binds to a receptor but does not cause it to initiate the expected response. Changing the physical properties of cells Chemically combining with other chemicals Altering a normal metabolic pathway Responses to Drug Administration Allergic reaction- hypersensitivity Idiosyncrasy- a drug effect that is unique to the individual Tolerance- decreased response to the same amount of drug after repeated administrations. Cross tolerance- tolerance for a drug that develops after administration of a different drug. Tachyphylaxis- rapidly occurring tolerance to a drug. May occur after a single dose. Cumulative effect- Increased effectiveness when a drug is given in several doses. Drug dependence- the patient becomes accustomed to the drugs presence in his body and will suffer from withdrawal symptoms upon its absence. Drug interaction- the effects of one drug alter the response to another drug. Drug antagonism- the effects of one drug block the response to another drug. Summation (Additive effect)- 2 drugs that both have the same effect are given together, analogous to 1+1=2. Synergism- 2 drugs that both have the same effect are given together and produce a response greater than the sum of their individual responses, analogous to 1+1=3. Potentiation- one drug enhances the effect of another. A common ex) Phenergan enhances the effects of morphine. Interference- the direct biochemical interaction between 2 drugs; one drug affects the pharmacology of another drug.

-Onset of action- the time from administration until a medication reaches its minimum effective concentration. -Minimum effective concentration-minimum level of drug needed to cause a given effect. -Duration of action- length of time the amount of drug remains above its minimum effective concentration. -Termination of action- time from when the drugs level drops below its minimum effective concentration until it is eliminated from the body. -Therapeutic index ratio of a drugs lethal dose for 50% of the population to its effect give dose for 50% of the population. Factors Affecting Drug-Response Relationship Age Body mass Sex Environment Time of administration Pathology Genetics Psychology

Part 2: Drug Classifications

Drug Uses Drugs used to affect the Nervous system Central Nervous System- brain & spinal cord Analgesics- medication that relieves the sensation of pain. Opioids- Morphine Nonopioid derivatives- salicylates (aspirin), NSAIDS (ibuprophen), & para-aminophenol derivates (acetaminophen) Antagonists- drug that binds to a receptor but does not cause it to initiate the expected response and blocks other drug responses. (Narcan) Anesthetic- medication that induces a loss of sensation to touch or pain. Ex) Benzodiazepines (diazepam [Valium]) & [Versed]). Antianxiety & Sedation Antiseizure or Antiepileptic Drugs- ex) Valium, Ativan CNS Stimulants Increase the release or effectiveness of excitatory neurotransmitters Decrease the release or effectiveness of inhibitory neurotransmitters Psychotherapeutic medications- treat Schizophrenia, Depression, & Bipolar disorders Drugs used to treat Parkinsons Disease

 Peripheral Nervous System- all nerves outside the CNS Autonomic Nervous System Medications- part of the nervous system that controls involuntary actions. Basic Anatomy and Physiology o Pre-ganglionic nerves- nerve fibers that extend from the CNS to the autonomic ganglia. (Take massage from CNS to Autonomic Ganglia o Autonomic ganglia- groups of autonomic nerve cells located outside the CNS (connects the Pre & Post-ganglia) o Post-ganglionic nerves- nerve fibers that extend from the autonomic ganglia to the target tissues. (takes message to target tissues and organs) o Neuroeffector junction- specialized synapse between Postganglia and target tissue o Neurotransmitter- chemical messenger that conducts a nervous impulse across a synapse. Cholinergic- pertaining to the neurotransmitter acetylcholine. Adrenergic- pertaining to the neurotransmitter norepinephrine. o lytic- (prefix) substance that blocks or inhibits actions Acetylcholine is utilized in the pre-ganglionic and post-ganglionic nerves of the Parasympatholytic nervous system. Acetylcholine is utilized in the pre-ganglionic nerves of the Sympatholytic nervous system. Norepinephrine is utilized in the post-ganglionic nerves of the Sympatholytic nervous system. Parasympathetic Nervous System Medications o Parasympathomimetic (Cholinergics)- drug that gives parasympathetic response. Decrease HR, hypotension, & SLUDGE o Parasympatholytic (Anticholinergics)- drug or other substance that blocks or inhibits the actions of parasympathetic nervous system. Ex) paralytics, Atropine Parasympathetic Acetylcholine Receptors Muscarinic- parasympathetic receptor; Ex) Atropine Nicotinic- parasympathetic receptor o NicotinicN (neuron) o NicotinicM (muscle) Sympathetic Nervous System Medications o Sympathomimetic (Adrenergic)- drug that gives sympathetic response.

Adrenergic Receptors Alpha 1 (Constriction) heart- vasoconstriction Alpha 2 (Constriction) lungs Beta 1 (Dilation) heartHR, contractility Beta2 (Dilation) lungs Dopaminergic- vasodilation o Common Catecholamines Natural Epinephrine Norepinephrine Dopamine Synthetic Isoproterenol Dobutamine

o Sympatholytic (Antiadrenergic)- drug or other substance that blocks the actions of the sympathetic nervous system. Beta Blockers (Beta adrenergic antagonists)- blocks Beta 1&2 receptors Drugs used to affect the Cardiovascular system o Antidysrhythmics Sodium Channel Blockers (Class 1, 1A, 1B, 1C)- slows the propagation of impulses down the specialized conduction system of the atria and ventricles, but doesnt effect the SA or AV nodes. Ex) procainamide, lidocane) Beta Blockers (Class II)- Beta Adrenergic antagonists Potassium Channel Blockers (Class III) block the efflux of potassium. Ex) Amiodarone Calcium Cannel Blockers (Class IV) decrease SA &AV node automaticity. Ex) Cardizem, verapamil Miscellaneous (Class IV)- Ex) Adenosine, Digoxin, Magnesium. o Antihypertensives Diuretics- drug used to reduce circulating blood volume by increasing the amount of urine. Ex) Furosemide (Lasix) Beta Blockers & Antiadrenergic drugs- drug or other substance that blocks the actions of the sympathetic nervous system. ACE inhibitors- to prevent Hypertension Calcium Channel Blockers Direct vasodilatorso Hemostatic Agents Antiplatelets- drug that decreases the formation of platelet plugs

Anticoagulant- drug that interrupts the clotting cascade. Thrombolytics- drug that acts directly on thrombi to break them down. o Antihyperlipidemic agents- drug used to treat high blood cholesterol. Drugs used to affect the Respiratory system o Antiasthmatic medications o Cough & Rhinitis Drugs Drugs used to affect the Gastrointestinal system o Peptic ulcers o Constipation o Diarrhea and emesis- Ex) Phenergan o Digestion Drugs used to affect the Eyes Drugs used to affect the Ears Drugs used to affect the Endocrine system o Pituitary Gland o Parathyroid & Thyroid Glands o Adrenal Cortex o Pancreas Insulin- substance that decreases blood glucose level. Glucagon- substance that increases blood glucose level. o Female reproductive system- Ex) Estrogens & Progesins o Male reproductive system- Ex)Testosterone o Drugs that affect Sexual behavior- Ex) L-Dopa, Viagra (Do NOT give anyone who has taken Viagra any NTG) Drugs used to treat Cancer o Antineoplastic Agent- drug used to treat cancer. Drugs used to treat Infectious diseases and inflammation o Antibiotic- agent that kills or decreases the growth of bacteria. o NSAIDs (NonSteroidal AntiInflammatory Drugs)- are commonly used as analgesics (reduce pain) and antipyretics (reduce fever). o Serum- solution containing whole antibodies for a specific pathogen. o Vaccine- solution containing a modified pathogen that dont actually cause disease but still stimulates the development of antibodies specific to it. Drugs used to affect the Skin Drugs used to supplement the Diet o Vitamins & Minerals o Fluids & Electrolytes Drugs used to treat Poisoning and Overdoses

o SLUDGEM (Salivation, Lacrimation, Urination, Defecation, Gastric motility, and Emesis) these are symptoms of Organophosphate Poisoning. Treatment is Atropine and 2-PAM.