Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Chapter 9 Pharmacology Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Overview • Clinical pharmacology is the study of the biologic effects of a drug on a patient when it is used as a medical treatment • Drug effects on different systems of the body will be summarized in this chapter Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacology and the Central Nervous System • Drug classifications affecting the central nervous system (CNS) include: – – – – – Sedatives Antianxiety drugs Antiparkinson drugs Antipsychotics Anesthetics − Hypnotics − Anticonvulsants − Antidepressants − Narcotic analgesics Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Sedatives, Hypnotics, and Antianxiety Drugs • Sedatives and hypnotic drugs are used to treat anxiety and sleep disorders • Sedation is characterized by decreased anxiety, motor activity, and mental acuity • Hypnosis is defined by an increased tendency to sleep • Anxiety is a persistent, irrational fear of a specific object, activity, or situation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anticonvulsants • Seizure is a term for events caused by epilepsy • Convulsion refers to abnormal motor movements • Anticonvulsants prevent or stop convulsive seizures Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antiparkinson Drugs • Parkinson’s disease is characterized by: – – – – – Resting tremor Resistance to passive movement Akinesia (inability to initiate movements) Loss of postural reflexes Behavioral manifestations Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antidepressants • Depression is one of the most common psychiatric disorders in the United States • It is characterized by feelings of: – – – – – Intense sadness Worthlessness Inability to experience pleasure in activities Sudden weight gain or loss Helplessness (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antidepressants • Depression is characterized by feelings of: – Impaired functioning – Loss of energy – Changes in sleep habits Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Antidepressants • Tricyclic antidepressants: – amitriptyline (Elavil) and nortriptyline (Aventyl) • Second-generation cyclic antidepressants – bupropion (Wellbutrin) • Monoamine oxidase inhibitors – phenelzine (Nardil) • Selective serotonin reuptake inhibitors – citalopram (Celexa) and fluoxetine (Prozac) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antipsychotics • Psychosis is a mental disorder in which a person’s capacity to recognize reality is distorted by hallucinations and delusions • Antipsychotics can be classified as conventional and atypical agents Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Narcotic Analgesics • Narcotic analgesics are also referred to as opioids • They reduce pain and induce tolerance and physical dependence • Drugs made from opium are referred to as opiates Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Narcotic Analgesics • • • • • • hydrocodone (Hycodan) hydromorphone (Dilaudid) meperidine (Demerol) methadone (Dolophine) pentazocine (Talwin) propoxyphene (Darvon-N) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anesthetics • Anesthesia is the unique condition of reversible unconsciousness or loss of sensation • It is characterized by 4 actions: – – – – Unconsciousness Analgesia Immobility Amnesia Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of General Anesthetics • diazepam (Valium) • propofol (Diprivan) • thiopental (Pentothal) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacology and the Endocrine System • The endocrine system consists of specialized cell clusters, glands, hormones, and target tissues • Endocrine drugs are used to treat deficiencies or excesses of specific hormones or nonendocrine diseases Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Selected Drugs for Thyroid Gland Conditions • Diseases of the thyroid gland include: – Hypothyroidism – Hyperthyroidism – Overproduction of thyroid hormone Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Selected Drugs for Diabetes Mellitus • The two general classifications for diabetes mellitus include: – Type I – insulin-dependent diabetes mellitus (IDDM) must be treated with insulin – Type II – non-insulin-dependent diabetes mellitus (NIDDM) may require SC or IV insulin Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Insulins • Rapid-Acting – Lispro (Aspart) • Short-Acting – Regular • Intermediate-Acting – NPH and Lente • Long-Acting – Ultralente and Glargine Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Oral Hypoglycemic Drugs • Sulfonylureas: – chlorpropamide (Diabinese) and glipizide (Glucotrol) • Meglitinides (secretogogues): – nateglinide (Starlix) and repaglinide (Prandin) • Biguanides: – metformin (Glucophage) (continues) – Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Oral Hypoglycemic Drugs • Thiazolidinediones (glitazones): – pioglitazone (Actos) and rosiglitazone (Avandia) • Alpha-glucosidase inhibitors: – miglitol (Glyset) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Oral Contraceptives • Manipulating estrogen and progesterone levels can prevent pregnancy • Oral contraceptives include: – Estrogen and progestin combinations – Progestin-only preparations Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacology and the Cardiovascular System • Cardiovascular disorders are among the most common causes of death in the United States • These disorders include: – – – – Angina pectoris Hypertension Myocardial infarction Hyperlipidemia Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antianginal Drugs • Angina pectoris often causes a sharp pain that is usually felt in the chest or arm • There are three groups of medications for angina pectoris: – Nitrates – Beta-adrenergic blockers – Calcium channel blockers Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Antianginal Drugs • Nitrates: – isosorbide (Imdur) and nitroglycerin (Nitrolingual) • Beta-Adrenergic Blockers: – atenolol (Tenormin) and propranolol (Inderal) • Calcium Channel Blockers: – diltiazem (Cardizem) and verapamil (Calan) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antihypertensive Drugs • Hypertension is an abnormal increase in arterial blood pressure • Drugs used to treat hypertension include: – – – – – – Diuretics Beta-blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARB) Calcium channel blockers Alpha-blockers Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Diuretics • Thiazide diuretics: – chlorthalidone (Hylidone and Hygroton) • Loop Diuretics: – ethacrynic acid (Edecrin) and furosemide (Lasix) • Potassium-sparing diuretics: – Spironolactone (Aldactone) and triamterene (Dyrenium) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of other Antihypertensive Drugs • Beta-blockers: – atenolol (Tenormin) and bisoprolol (Zebeta) • ACE Inhibitors: – enalapril (Vasotec) and lisinopril (Zestril) • Angiotensin II receptor blockers (ARBs): – irbesartan (Avapro) and valsartan (Diovan) • Calcium channel blockers: – amlodipine (Norvasc) and nifedipine (Procardia) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antiarrhythmics • Arrhythmias are derivations from the normal pattern of the heartbeat • Common arrhythmias include: – – – – – Atrial fibrillation Atrial flutter Premature ventricular contractions Ventricular tachycardia Ventricular fibrillation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Drug Therapy for Heart Failure • Heart failure is the inability of the heart muscle to contract with enough force to properly circulate blood • Drugs used for heart failure include: – – – – Cardiac glycosides Diuretics ACE inhibitors Beta-blockers Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antihyperlipidemic Drugs • Diseases associated with plasma lipids can manifest as an: – Elevation in triglyceride levels (hyperlipidemia) – Elevation in the cholesterol level • Antihyperlipidemic drugs are used only if diet and exercise programs fail Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Lipid-Lowering Drugs • Bile acid sequestrants: – colesevelam (Welchol) and colestipol (Colestid) • Fibric acid derivatives: – clofibrate (Atromid-S) and gemfibrozil (Lopid) • Niacin (nicotinic acid): – immediate release (Niacor) and sustained-release (Niaspan) • Statins: – atorvastatin (Lipitor) and simvastatin (Zocor) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Anticoagulant Drugs • Without clotting, it is possible to bleed to death • When clot formation is not desired, however, anticoagulants prevent formation of blood clots (thrombi) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Anticoagulants • heparin sodium (Hep-Lock) • warfarin sodium (Coumadin) • Low Molecular-weight Heparin: – dalteparin sodium (Fragmin) – tinzaparin sodium (Innohep) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacology and the Musculoskeletal System • Musculoskeletal pain and inflammation in muscles or joints is common • Skeletal muscle relaxants are neuromuscular blocking agents that block somatic motor nerve impulses • Another type, used for painful muscle contractions, are centrally acting skeletal muscle relaxants Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Analgesics, Antipyretics, and Anti-inflammatory Drugs • Some pain is relieved with opioid analgesics and other types of pain are relieved with nonopioid analgesics • Many nonopioid analgesics affect pain, fever, and inflammation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Nonsalicylate AntiInflammatory and Analgesic Agents (NSAIDs) • • • • • diclofenac (Voltaren) ibuprofen (Advil, Motrin) indomethacin (Indocin) meclofenamate (Meclofen) meloxicam (Mobic) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antimicrobial Agents • Pathogenic microorganisms produce infections • Invading microorganisms include: – – – – – Viruses Bacteria Fungi Protozoa Parasites Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antibacterial Agents • Antibacterial agents are classified as either bactericidal or bacteriostatic • Bactericidal refers to an agent capable of killing bacteria • Bacteriostatic means an agent inhibits, but does not necessarily kill, bacteria Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Beta-Lactam Antibiotics • An antibiotic is derived from a natural source rather than a synthetic source • Beta-lactam antibiotics include: – – – – Penicillins Cephalosporins Carbapenems Monobactams Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Penicillins • Penicillins were the first antibiotics developed • They are classified as: – Natural penicillins – Antistaphylococcal penicillins – Extended-spectrum penicillins Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Cephalosporins, Macrolides, and Sulfonamides • Cephalosporins are semisynthetic antibiotics related to penicillins • Macrolides are especially useful against respiratory infections • Sulfonamides were the first drugs to prevent and cure human bacterial infections Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Cephalosporins • First Generation: – cefazolin (Ancef) and cephalexin (Keflex) • Second Generation: – cefaclor (Ceclor) and cefotetan (Cefotan) • Third Generation: – cefdinir (Omnicef) and cefprozil (Cefzil) • Fourth Generation: – cefepime (Maxipime) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Common Macrolides • • • • azithromycin (Zithromax) clarithromycin (Biaxin) erythromycin (Erythrocin) erythromycin ethylsuccinate (EryPed) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Sulfonamides • Short-acting sulfonamides: – sulfisoxazole (Gantrisin) • Intermediate-acting sulfonamides: – sulfadiazine (Microsulfon) and Sulfamethoxazole (Sulfamethoxazole) • Long-acting sulfonamides: – Sulfasalazine (Azulfidine) • Combination sulfonamides: – Trimethoprim/sulfamethoxazole (Bactrim) and sulfathiazole/sulfacetamide/sulfabenzamide (Sultrin) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Tetracyclines and Aminoglycosides • Tetracyclines are effective against certain bacterial strains that are resistant to other antibiotics • Aminoglycosides are used primarily for infections caused by gram-negative enterobacteria, but they have high toxicity Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Aminoglycosides • • • • • amikacin (Amikin) gentamicin (Garamycin) kanamycin (Kantrex) neomycin (Mycifradin) streptomycin (Streptomycin) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Fluoroquinolones and Miscellaneous Agents • Fluoroquinolones may be useful in penicillinallergic patients • Miscellaneous antibacterials include: – Chloramphenicol – Clindamycin – Metronidazole Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Fluoroquinolones • • • • • • cinoxacin (Cinobac) ciprofloxacin (Cipro) gatifloxacin (Tequin) nalidixic acid (NegGram) nitrofurantoin (Furadantin) norfloxacin (Noroxin) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antiviral Agents • Antivirals are used to treat viral infections • They act by influencing viral replication, either of the DNA or RNA type • Antiretroviral agents effective against HIV include: – – – – Nucleoside reverse transcriptase inhibitors (NRTIs) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) Fusion inhibitors (FIs) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of HIV Antiviral Agents • NRTIs: – lamivudine (Epivir) and zidovudine (Retrovir) • NNRTIs: – delavirdine (Rescriptor) and efavirenz (Sustiva) • PIs: – indinavir (Crixivan) and nelfinavir (Viracept) • FIs: – enfuvirtide (Fuzeon) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Highly Active Antiretroviral Therapy (HAART) • Antiviral agents are being used either alone or in combination to treat HIV • HAART involves the combination of three to four drugs effective against HIV, especially: – Nucleoside analogs, and – Protease inhibitors Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antifungal Agents • Antifungals are often used for: – Systemic – Local fungal, and – Topical fungal infections Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacology and the Respiratory System • Upper respiratory tract infections are more common than lower respiratory tract infections • They may be caused by viruses, bacteria, or fungi Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antihistamines • Drugs that counteract the action of histamine are called antihistamines • The conventional type, used for allergies, blocks H1 histamine receptors • The second type, used for peptic ulcers and gastritis, blocks H2 histamine receptors Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antitussives • Agents that relieve or prevent coughing are called antitussives • They are classified into two major groups: – Opioid – Nonopioid Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Corticosteroids • Corticosteroids are the most potent and effective anti-inflammatory agents available • Administration with a metered dose inhaler (MDI) is often accomplished with one or two puffs from a handheld pressurized device • A dry powder inhaler (DPI) delivers medication in the form of micronized powder into the lungs Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Corticosteroids for Treating Asthma • • • • • • beclomethasone (Beclovent) budesonide (Pulmicort) dexamethasone (Decadron) fluticasone (Flovent) prednisolone (Prelone) prednisone (Deltasone) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Bronchodilators • Bronchodilators are agents that widen the diameter of the bronchial tubes • Bronchodilators include: – – – – Beta-adrenergic agonists Theophylline Anticholinergic drugs Xanthine derivatives Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Bronchodilators Used for Treating Asthma • • • • albuterol (Proventil) metaproterenol (Alupent) salmeterol (Serevent) Xanthenes: – aminophylline (Truphylline) – theophylline (Elixophyllin) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antitubercular Agents • Tuberculosis is more prevalent in: – Patients with AIDS – Drug abusers – Homeless shelter and nursing home residents (continues) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antitubercular Agents • Primary antitubercular drugs include: – – – – – Isoniazid Ethambutol Rifampin Pyrazinamide Streptomycin Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Pharmacology and the Digestive System • The digestive tract is the organ system primarily responsible for food absorption and elimination of solid waste • This chapter focuses on treatment of: – Peptic ulcer – Diarrhea – Constipation Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antacids • The various types of antacids differ in: – – – – – Cation content Neutralizing capacity Duration of actions Side effects Cost • Antacids are over-the-counter (OTC) drugs Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Histamine Receptor Antagonists • There are three types of histamine receptors • One type mediates acid secretion by gastric parietal cells and is preferred to other antiulcer agents because of: – Convenience of use – Lack of effect on GI motility Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Histamine (H2) Receptor Antagonists • • • • cimetidine (Tagamet) famotidine (Pepcid) nizatidine (Axid) ranitidine (Zantac) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Proton Pump Inhibitors • The final common pathway in gastric acid secretion is the “proton pump” • It is an enzyme that exchanges hydrogen ions for potassium ions • Proton pump inhibitors should be taken before meals, preferably in the morning Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Examples of Proton Pump Inhibitors • lansoprazole (Prevacid) • omeprazole (Prilosec) • rabeprazole (AcipHex) Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Antidiarrheal Agents • Diarrhea is the manifestation of many illnesses • The most commonly used antidiarrheals are: – – – – Anticholinergics Opioid narcotics Meperidine congeners Loperamide Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED. Laxatives and Stool Softeners • Constipation is difficult or infrequent passage of stool • Constipation is a symptom rather than a disease • Laxatives either accelerate fecal passage or decrease fecal consistency Copyright © 2011 Delmar, Cengage Learning. ALL RIGHTS RESERVED.