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Chapter 1 Studying Pharmacology © Paradigm Publishing, Inc. 2 Chapter 1 Topics • • • • • • Phases of Pharmacology Strategies for Learning Pharmacology Drug Classifications Common Pharmacy Abbreviations and Terms Dosage Forms and Routes of Administration Topical Routes of Administration © Paradigm Publishing, Inc. 3 Phases of Pharmacology Introduction • Drugs are used for preventing, treating, and curing illness • Sources of drugs Natural sources include plants, animals, and minerals Synthetic processes and bioengineering methods • Pharmacology is the study of how drugs from these sources work inside the body for their intended purposes • Physiology (the study of normal body function) is useful to learn how drugs affect body processes • Pathophysiology (the study of abnormal body processes or disease) is also important to learn © Paradigm Publishing, Inc. 4 Phases of Pharmacology The Three Phases • Are pharmaceutics, pharmacokinetics, and pharmacodynamics Pharmaceutics • Is the study of how drugs enter the body Many oral drug dosage forms (capsules, tablets, and liquids); also spread on skin, inhaled, injected, and inserted • Studies how the forms deliver a drug to the body and achieves desired drug absorption into the bloodstream • Focuses on dosage forms and routes of administration © Paradigm Publishing, Inc. 5 Phases of Pharmacology Pharmacokinetics • Is the study of what the body does with drugs Absorption: how drugs are absorbed into the bloodstream Distribution: how drugs are circulated to tissues throughout the body Metabolism: how drugs are inactivated (metabolized) Excretion: how drugs are eliminated from the bloodstream over time • Focuses on how these four processes affect the effectiveness, dosing schedule, and use of drugs © Paradigm Publishing, Inc. 6 Phases of Pharmacology Pharmacodynamics • Is the study of drugs and their receptors on the molecular level (what the drugs do to the body) • Focuses on translating chemistry to drug activity within the entire body Pharmacotherapeutics • Is the study of how drugs are used in clinical practice for individual patients • Focuses on the use and study of drugs in people Pharmaceutics and pharmacokinetics are laboratory sciences © Paradigm Publishing, Inc. 7 Phases of Pharmacology How a Drug Works • Enters the bloodstream (I.) • Reaches the site of action in sufficient concentration (II.) • Interacts with appropriate receptors to cause a beneficial effect (III.) © Paradigm Publishing, Inc. 8 Strategies for Learning Pharmacology How to Learn Pharmacology • You must remember many drug names and understand mechanisms of action for this course Learn the rules for each drug class and connect the individual drugs to that set of rules Learn the exceptions to rules (often side effects) • Find out your preferred methods of learning Take a learning styles inventory Use the “Your PILS” feature(s) in the chapters to help you learn in ways that make sense to you © Paradigm Publishing, Inc. 9 Drug Classifications Brand versus Generic Drug Names • Drugs Are categorized in various ways, some based on legal divisions and others on mechanism of action Must be tested before it is marketed Has three different names during testing process Chemical name of new medical molecule Generic name assigned by government agency Brand name assigned by company that will manufacture and sell it; easier to pronounce than generic name © Paradigm Publishing, Inc. 10 Drug Classifications Brand versus Generic Drug Names (continued) • Phase I clinical trials Drug is tried in healthy human subjects Generic drug name assigned • Phase II and Phase III clinical trials Drug is tested in human having condition or disease the drug is meant to treat End of Phase III FDA approval sought and brand name assigned • Phase IV clinical trials Called postmarketing study Brand name trademarked and used for marketing © Paradigm Publishing, Inc. 11 Drug Classifications Brand versus Generic Drug Names (continued) • Pharmacy Technicians must know both generic and brand names of drugs due to generic substitution • Generic substitution occurs often Physicians’ prescriptions are often written in brand name Pharmacies are organized by generic name and prescriptions are filled with generic product • Generic names are often similar Makes it easy to determine a drug’s class, mechanism of action, and uses © Paradigm Publishing, Inc. 12 Drug Classifications Major Drug Classes • Are groups of medications categorized according to their mechanism of action Usually given similar names with a common stem (see Table 1.1) • Therapeutic classes Are individual drug classes grouped according to their use on a particular body system • Generic drug names within a class are often similar; this helps to know drug actions and therapeutic uses • “Look-alike” and “sound-alike” drug names cause errors • ISMP publishes a confused drug list names on its Web site © Paradigm Publishing, Inc. 13 Drug Classifications Prescription versus OTC Medications • Prescription (legend) drugs Are medications available only by prescription Dispensed from a pharmacy on receipt of a prescription from a prescriber Have legal limitations to dispensing • OTC medications Can be bought without a prescription • New drugs enter the market as prescription medications Move to OTC status if safe enough to be used by patients without medical supervision © Paradigm Publishing, Inc. 14 Drug Classifications Controlled versus Noncontrolled Substances • Controlled substances Are medications with potential for abuse and dependence categorized by the U.S. DEA Are placed into one of five schedules, based on their degree of potential for abuse • Schedule I substances Are illegal or only available for research or experimental purposes • Schedule II–V drugs Are legally dispensed with restrictions on numbers of refills and quantity Dispensing procedures and inventory control measures are strictly regulated at the federal and state levels © Paradigm Publishing, Inc. 15 Drug Classifications Controlled versus Noncontrolled Substances (continued) • Schedule II has the most stringent restrictions (see Table 1.2 for description of controlled substances schedules) • Precursors Can be used to make crystal methamphetamine Sale of precursor is limited in pharmacies Examples: pseudoephedrine and phenylpropanolamine Have legitimate medical uses and when used properly do not cause dependence or abuse Sale of precursor is limited; purchased if over eighteen years old and must be stored behind counter in the pharmacy © Paradigm Publishing, Inc. 16 Drug Classifications Pregnancy Categories • All drugs marketed in the United States receive a pregnancy categorization of A, B, C, D, or X (see Table 1.3) • Category A drugs are safest during pregnancy • Category X drugs are contraindicated in pregnancy • Teratogenic drugs Can cause birth defects or malformations in a fetus • Breast-feeding characteristics No special categorization system available Technicians should refer patients inquiring about drug safety to the pharmacist © Paradigm Publishing, Inc. 17 Your Turn Question 1: Before a drug is marketed, it must be tested. What is the difference between the generic name and the brand name of a drug during this process? Answer: A generic drug name is assigned to a medical molecule by a government agency and is used during Phase I, II, and III clinical trials. Near the end of Phase III, a brand name is assigned by the company that will manufacture and sell the drug. Question 2: What restriction applies to a drug that is in the pregnancy category of X? Answer: The drug cannot be given to patients during pregnancy. © Paradigm Publishing, Inc. 18 Drug Classifications Alternative and Complementary Treatments • Western medicine Called traditional medicine Relies on observation and experimentation • Eastern medicine Uses herbs and alternative therapies Recognizes holistic strategies and natural ingredients • Vitamins and herbal products Are dietary and nutritional supplements Regulated by FDA as food, not as drugs Are not regulated for safety and efficacy © Paradigm Publishing, Inc. 19 Drug Classifications Alternative and Complementary Treatments (continued) • Homeopathy Involves very diluted substances (often herbs) used for treating an ailment • Chinese medicine Eastern medical philosophies of holistic health Employs balance of yin and yang Often uses acupuncture and herbs and acupressure © Paradigm Publishing, Inc. 20 Drug Classifications Alternative and Complementary Treatments (continued) • Chiropractic therapy Uses nondrug modalities such as manipulation for body alignment and health • Ayurveda East Indian medicine Involves spiritual and whole-body well-being and employs diet and lifestyle changes • Biofeedback A method used to control body function Uses mental exercise and relaxation to slow heartbeat, lower blood pressure, and reduce stomach problems © Paradigm Publishing, Inc. 21 Common Pharmacy Abbreviations and Terms Pharmacy Abbreviations • Used along with prescribing terms by most prescribers for writing prescriptions and medical orders • Are usually based on Latin or Greek terms Medication Errors • A patient is harmed by a medication in some way that could have been prevented • Technicians need to be careful in the use and interpretation of abbreviations to avoid harm to patients • Correct drug administration involves giving the right drug to the right patient at the right time in appropriate strength and route © Paradigm Publishing, Inc. 22 Common Pharmacy Abbreviations and Terms Correct Drug Administration: Five Rights • Is the correct patient listed on the drug order? • Does the dose ordered make sense for this drug? • Does the strength ordered make sense for the drug and its dosage form? • Is the frequency or timing of doses appropriate? • Does the route of administration match up to the drug, its intended use, and the dosage form ordered? A problem with any “five rights” can result in medication error © Paradigm Publishing, Inc. 23 Common Pharmacy Abbreviations and Terms Medication Errors (continued) • ISMP Publishes a list of abbreviations most pharmacies and institutions are trying to eliminate from use List is long and changes periodically Updated ISMP Table of Error-Prone Abbreviations is on the ISMP Web site • Technicians must promote accuracy and patient safety, including curbing use of dangerous abbreviations © Paradigm Publishing, Inc. 24 Dosage Forms and Routes of Administration Systemic Effect and Local Effect • Drugs are administered in a way to reach the site of action in a sufficient amount to produce desired effect • Drug delivery Depends on the dosage form (how it is delivered) Depends on the route by which it is administered • Systemic effect Drugs enter the bloodstream to reach its site of action Drugs are absorbed or administered directly into bloodstream • Local effect (topical) Drugs are administered directly without first traveling through the bloodstream © Paradigm Publishing, Inc. 25 Dosage Forms and Routes of Administration Systemic Routes of Administration • Used when a drug is intended to enter the bloodstream and travel to its site of action • Enhances drug delivery because a variety of dosage forms are available for each systemic route Allows the use of the most effective form for a patient Provides options for patients with difficulties taking or using any one route © Paradigm Publishing, Inc. 26 Dosage Forms and Routes of Administration Systemic Routes and Corresponding Dosage Forms Route of Administration Oral Most Common Dosage Forms Tablet, capsule, liquid, suspension Buccal or sublingual Tablet, spray, lozenge, troche Parenteral Injectable, solution, some suspensions Rectal Suppository, solution Transdermal Implant Patch, paste, cream, ointment Drug encasement carrier © Paradigm Publishing, Inc. 27 Dosage Forms and Routes of Administration Systemic Routes: Oral • Means giving a drug by mouth (peroral or PO) • Most convenient and cost-effective method for systemic route • Most medications today are pills (tablets or capsules) Are usually swallowed whole, then absorbed into bloodstream by the GI system • Dosage forms include tablets, pills, and syrups Tablets can be coated or uncoated and some are chewed; also ODTs, sublingual, and buccal are available Oral liquids such as solutions and suspensions (shake before dose) are also available © Paradigm Publishing, Inc. 28 Dosage Forms and Routes of Administration Systemic Routes: Parenteral • Administered by injection Used for patients who are unconscious or cannot swallow when rapid action is needed Used for drugs that have a large first-pass effect Systemic Routes: Parenteral—IM Injection • Are given directly into a muscle Most common injection sites are the deltoid in the upper arm and the gluteus medius in the buttocks Most common dosage form is solution © Paradigm Publishing, Inc. 29 Dosage Forms and Routes of Administration IM Injection • Typically, a 1-inch needle is used • Needle is injected at a 90-degree angle so that the drug is administered within the muscle tissue © Paradigm Publishing, Inc. 30 Dosage Forms and Routes of Administration Systemic Routes: Parenteral—IV Injection • Are given directly into a vein • Continuous infusion—small catheter inserted into a vein while IV fluid with the drug runs through it into the blood • Peripheral IV line—inserted into vein in arm, wrist, or hand Used when small amounts of fluid are given or the time over which the fluid will infuse is a few days or less • Central IV line—inserted surgically into a large vein in the upper chest area near the clavicle (collarbone) Used for large volumes of fluid, many repeated infusions, or infusions of more than few days © Paradigm Publishing, Inc. 31 Dosage Forms and Routes of Administration IV Injection • The size and angle of the needle used depend on the area of the body and the vein into which the drug is delivered • Dosage form is IV solutions © Paradigm Publishing, Inc. 32 Dosage Forms and Routes of Administration Systemic Routes: Parenteral—SC Injection • Are given into the fatty tissue under the dermal layer of the skin and above the muscular tissue • Common injection sites include abdomen, upper thigh, and back of the upper arm Drug is absorbed by the blood supply over a few minutes to hours • Dosage forms are solutions and some suspensions © Paradigm Publishing, Inc. 33 Dosage Forms and Routes of Administration SC Injection • For delivery of insulin a very fine, short needle is injected at a 90degree angle • For delivery of other drugs a 1-inch needle is injected at a 45-degree angle © Paradigm Publishing, Inc. 34 Dosage Forms and Routes of Administration Systemic Routes: Parenteral—IT and Epidural • IT Are injections given into the spinal column between vertebrae in the back • Epidural Use a small catheter to deliver a drug directly into the spinal column over time • Both used for regional anesthesia such as childbirth and delivery • Anesthesiologists or anesthetists administer injections • Technicians may be involved in preparing products if their institution supports surgical or birth and delivery services © Paradigm Publishing, Inc. 35 Dosage Forms and Routes of Administration Systemic Routes: Parenteral—ID • Are injections given just underneath the top layer of skin (epidermis) • Used for TB skin tests (PPD), local anesthesia, and allergy skin testing • Usually not prepared by a pharmacy • Technicians and other healthcare workers may be required to get an annual PPD test for TB exposure © Paradigm Publishing, Inc. 36 Dosage Forms and Routes of Administration Intradermal Injection • After an ID TB injection, patient returns in two to three days for examination of the injection area • Redness and swelling at the site indicate possible exposure to TB © Paradigm Publishing, Inc. 37 Dosage Forms and Routes of Administration Systemic Routes: Rectal • Are drugs inserted into the rectum to melt or dissolve • Mostly intended for systemic effect but a few for local activity, such as treating hemorrhoids • Common dosage forms include suppositories and enemas Systemic Routes: Transdermal • Application of a drug delivery system, such as a patch with adhesive backing, is applied to the skin • Drug is slowly and evenly absorbed through skin over time Systemic Routes: Implant • Inserted just below the skin to release a drug slowly © Paradigm Publishing, Inc. 38 Dosage Forms and Routes of Administration Topical Routes of Administration • Used for local effect not for systemic absorption • Delivered topically to lung tissue, eyes, and vagina Topical Routes: Dermal • Applied topically to the skin • Dosage forms include creams, lotions, gels, ointments, powders, solutions, and pastes • Used to treat local infections, wounds, sunburns, and rashes • Systemic absorption possible if large amount in large area © Paradigm Publishing, Inc. 39 Dosage Forms and Routes of Administration Topical Routes: Inhalation • Administration of a drug into the lungs by breathing it in through the mouth • Allows for direct treatment to lung tissue • Devices: metered dose inhalers, dry powder inhalers, and nebulizers Topical Routes: Intranasal • Are sprayed into the nose • A dosage form (solution) delivers drug to nasal mucosa • Patients should not sniff forcefully when administering © Paradigm Publishing, Inc. 40 Your Turn Question 1: A patient will receive a flu shot at the pharmacy. What is the likely location of the injection site? Answer: The patient will probably have the injection in the deltoid muscle in the upper arm. Question 2: What is the purpose of administering a drug by inhalation? Answer: This route provides the drug directly to lung tissue. © Paradigm Publishing, Inc. 41 Dosage Forms and Routes of Administration Topical Routes: Ophthalmic • Delivered topically to the eye • Dosage forms are eyedrops and eye ointments Topical Routes: Otic • Delivered into external ear canal • Dosage forms are eardrops, both solutions and suspensions Topical Routes: Vaginal • Inserted and applied into the vagina • Dosage forms include creams, gels, solutions, suppositories, ointments, and tablets © Paradigm Publishing, Inc. 42 Dosage Forms and Routes of Administration Ophthalmic Administration Applying Eyedrops Applying Ointment © Paradigm Publishing, Inc. 43 Dosage Forms and Routes of Administration Otic Administration • Patients turn their head horizontally • Pull on earlobe while squeezing the bottle to allow drops to fall into ear canal Pull upward for adults © Paradigm Publishing, Inc. Pull downward if under age three 44 Summary • Pharmacology is the study of how drugs work in the body • Drugs are categorized by classes with similar mechanisms of action • Drugs are also either prescription (legend) or OTC • Some prescription medications are controlled substances • Medications are ranked into pregnancy risk categories • FDA does not regulate dietary, herbal products, or vitamins • Many common routes of drug administration and dosage forms for each route © Paradigm Publishing, Inc. 45