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Transcript
Unit I Introduction to Pharmacology EFFECTS OF DRUGS DEFINE: 1. 2. 3. 4. 5. Therapeutic effect Side effect Toxic effect Lethal effect Allergic reaction PHARMACEUTICAL TERMS DEFINE: 1. 2. 3. 4. 5. 6. 7. 8. 9. Mechanism of action (MOA) Site of action Receptor Site Lock and Key Agonist drug Antagonist drug (blocker) Physical Dependence Psychological Dependence Tolerance DRUG INTERACTIONS Additive effect - when the combined effect of 2 drugs each producing the same biological response by the same MOA, is = to the sum of their individual effects. 1+1=2 Synergistic effect - when 2 drugs having the same biological response, NOT by the same MOA, are given together, the effect is greater than the sum of the effects of each drug if given alone. 1+1=3 HPRS 2300 27 NEW DRUG DEVELOPMENT FDA Investigational New Drug Application (INDA) – Chemical Name – Generic Name 4 Phases Human Studies Informed Consent (I.C.) Purpose: a. involves explanation of the purpose of the study b. procedures to be used c. risks involved PHASE I: Small # of healthy volunteers Determine: a. optimal dosage range b. pharmacokinetics c. several tests – blood samples PHASE II: Small # of volunteers that have the disease/condition. Determine: a. drug’s effectiveness b. side effects PHASE III: Large # of patients at medical research centers. Determine: a. infrequent and rare side effects b. look for risks of drug c. dosage range, safety, effectiveness PHASE IV: (Optional) – used to compare new drug with already existing medication in that class. New drug application (NDA): National Drug Code (NDC): – brand name or trade HPRS 2300 28 DRUG NOMENCLATURE Chemical Name: 7-chloro-1, 3-dihydro-1-methyl-5-phenyl-2H, 1, 4-Benzudiazepin2-one Generic Name: Diazepam Trade Name or Brand Name: Valium® GENERAL EQUIVALENT: A. PHARMACEUTICALLY EQUIVALENT B. THERAPEUTICALLY EQUIVALENT A. PHARMACEUTICALLY – drug product that has identical amounts of the same active chemical ingredients in the same dosage form that has the same Strength Quality Purity B. THERAPEUTICALLY – when drug administered in the same amount, it will provide the same therapeutic effect – including duration and intensity. HPRS 2300 29 Dose-Response Curve Figure 1.3 A typical dose-response curve Time-Response Curve Figure 1.4 A typical time-response curve HPRS 2300 30 I. Dose – Response Curve: Purpose: 1) To compare and evaluate a drug response among different drugs that are similar. 2) Potency is determined here as well. The strength or concentration needed to produce a desired (therapeutic) effect. II. Time – Response Curve: Purpose: To determine frequency of administration of medication in order to maintain an effective drug response. HPRS 2300 31 DRUG LEGISLATION DEFINE: Pure Food and Drug Act of (1906): – Designed “The U.S. Pharmacopeia” (USP) which set up an official standard for drugs. Harrison Narcotic Act (1914): Food, Drug and Cosmetic Act of (1938): Durham-Humphrey Amendment of (1952): – “Birth of the Legend” Kefauver-Harris Amendment of (1962): Controlled Substance Act of (1970): DEA (1973): Orphan Drug Act (1983): HPRS 2300 32 How To Figure Out If a DEA Number Given Is Legal The authenticity of a DEA prescriber registration number can be confirmed by the following formula: Step 1: Add the 1st , 3rd, and 5th digits of the DEA number; Step 2: Add the 2nd, 4th, and 6th digits; Step 3: Multiply the sum of Step 2 by 2; AND Step 4: Add the 2 numbers from Step 1 and Step 3 together. Step 5: The last digit of this sum is the same as the last digit of the DEA prescriber registration number. NOTE: There are 2 letters that proceed a DEA number. The first letter is either an A or a B. The second letter is the first letter of the prescriber’s last name. EXAMPLE: AS1234563 This is the DEA number for Dr. Alfred Smith. 1: 2: 3: 4: 1 + 3 + 5 = 9; 2 + 4 + 6 = 12; 12 X 2 = 24; 9 + 24 = 33. AS1234563 This is a legal DEA number. *Be able to figure out if a DEA number is legal. HPRS 2300 33 Controlled Substances Schedule I Drugs Heroin, LSD, Marijuana Schedule II Meperidine® Pentobarbital Percodan® Mepergan Fortis® Amphetamines Ritalin® Schedule III Fiorinal® Tylenol c codeine® Empirin c codeine® Vicodin® Marinol® Schedule IV Dalmane® Librium® Valium® Tranxene® Schedule V Lomotil Robitussin AC HPRS 2300 34 PHARMACOKINETICS A. Absorption 1. Diffusion 2. Filtration 3. Osmosis Three factors affecting the rate of absorption 1. Solubility of the drugs 2. Route of Administration a. Enteral – b. Parenteral – c. Percutaneous – 3. Amount of blood flow through the tissues B. Distribution Three factors influencing distribution 1. Plasma Proteins: 2. Blood Flow: 3. Blood-Brain Barrier C. Metabolism – liver Enzyme: DMMS – Drug microsomal metabolizing system 1. Enzyme Inducers – 2. Enzyme Inhibitors HPRS 2300 35 Metabolism Enzyme Inducers Smoking Phenobarbital Phenytoin Carbamazapine Chronic alcohol ingestion Enzyme Inhibitors Cimetidine (Tagamet®) Erythromycin Allopurinol Calcium Channel Blockers Fluoxetine (Prozac®) Short-term Acute alcohol ingestion FIRST-PASS EFFECT Routes that avoid the first-pass effect: sublingual intravenous vaginally inhalation transdermal buccal subcutaneous topical intraocular intramuscular D. Excretion: 1. 2. 3. 4. Kidneys* GI Tract Lungs Sweat HPRS 2300 36 Types of Interactions A. Drug-Drug: when one drug increases or decreases the effect of another drug or both drugs. (Enzyme induction or enzyme inhibitor) EX: glyburide and alcohol Effect: acute-inhibition of enzymes-hypoglycemia chronic-enzyme inducer- hyperglycemia B. Drug-Disease: when a drug interferes with the pathophysiology of a disease. EX: Diabetes mellitus and prednisone (a steroid) Effect: increases blood sugar levels C. Drug-Food/Drink: When food/drink increases or decreases the effects of a drug. EX: MAO Inhibitors and bean, cheese, or wine Effect: hypertensive crisis or stroke D. Disease-Food/Drink: When food/drink is consumed and causes the disease/condition to worsen. EX: Gout patient consuming sardines, anchovies, liver, cheese, beer, or wine Effect: more uric acid to accumulate in joints causing pain HPRS 2300 37 Types of Doses Usual Dose - dose that is generally appropriate for the patient. Loading Dose - the first dose given, which is higher than the other doses to elevate the blood level quickly. IV route is used. Minimum Dose effect. smallest amount of drug that will produce a therapeutic Maximum Dose - largest amount of a drug that will produce a desired effect. Maintenance Dose therapeutic state. dose required to keep drug blood level at steady Initial Dose - any first dose of a drug. Lethal Dose - dose that causes death. Toxic Dose - dose that will produce harmful effects. HPRS 2300 38 3 Routes of Entry into the Body DEFINE: A. Enteral Route – 1. Oral Administration – 2. Nasogastric Administration – 3. Rectal Administration – DEFINE: Oral Medication Forms – Enteral route A. Tablets 1. Scored tablets 2. Enteric - coated tablets B. Capsules – time-released (sustained released) C. Lozenges D. Elixirs E. Emulsion F. Suspensions G. Syrups HPRS 2300 39 B. Parenteral Route A. Intradermal –Slow absorption due to a decrease in blood supply B. Subcutaneous (SUB Q) –Medication is slowly, but completely absorbed –Slow onset of action, but long duration Parenteral Route C. D. HPRS 2300 Intramuscular –Rapid and complete absorption Intravenous (IV) –Fastest way of getting into our system –Increase onset of action 40 C. Percutaneous Route * 7 areas associated with mucous membranes: * Identify location for the following: A. B. C. D. E. F. G. Sublingual Buccal Eye Ears Nose Inhaled into Lungs Vaginal HPRS 2300 41 Percutaneous route: absorption of medication through the skin or mucous membranes. Types of Topical Medications 1. Creams - a semi-solid mixture that contains medication in a water soluble base. Ex: 2. Ointments - a semi-solid preparation of medication in an oily base, the base being petrolatum. The ointment is oily in texture, but makes for good, long skin contact that is not easily removed. Ex: 3. Lotions - an aqueous preparation containing suspended medication that soothes or cleans the skin. Must shake well. Ex: 4. Powders - medication in talc form or in a talc base that is used for drying, cooling, or protecting the skin. Ex: 5. Patches - this is placed on the skin, a semipermeable membrane is present between the patch and the skin that contains medication that is released over a 24 hour period; the dosage released depends on the concentration of the patch. Ex: 6. Astringents: alcohol based medication for cooling or drying the skin. Ex: 7. Shampoos - medication for the scalp/hair in an aqueous or alcohol bases. Ex: Nizoral 8. Define Solutions – HPRS 2300 42 Study Sheet for Exam #1 1. Review definitions: –Pharmacology –Site of Action –Receptor Site –Mechanism of Action –Agonist Drug –Antagonist Drug –Lock and Key –Physical Dependence –Psychological Dependence –Tolerance –Therapeutic Effect –Side Effect –Toxic Effect –Additive Effect –Synergistic Effect 2. Become familiar with the understanding and meaning of the concepts, enzyme inducers and enzymes inhibitors. 3. Be able to identify from drug list which ones are enzyme inducers and enzyme inhibitors. 4. Pharmacokinetics: define and understanding of concepts: –Absorption –Distribution –Metabolism –Excretion –Know the factors that can influence each of these processes 5. Define Solutions. 6. Know calibrations on: a. insulin syringe - 100 units = 1 ml b. tuberculin syringe - 1cc or ½ cc c. 3 cc, 10 cc, 20cc syringe 7. Define percentages and ratios. 8. Know common equivalents. 9. Know the difference between an ampule and a vial. 10. Become familiar with the procedure in administering the following: HPRS 2300 43 –Drawing medication from an ampule and a vial –Rectal –Nasogastric 11. Define Gauge: Rule: “The smaller the number, the larger the needle.” 12. One calculations problem from chapter 13 and 1 bonus problem from reconstitution. 13. Define: –Diffusion –Osmosis –Filtration –Passive Transport –Active Transport 14. Know abbreviations: be able to write it out. 15. Become familiar with different route of drug entry into the body and their examples: A. Enteral–define: 1) oral, 2) nasogastric, 3) rectum B. Parenteral: intradermal, subcutaneous, intramuscular, intravenous C. Percutaneous–define 16. Know the three ways to obtain a prescription drug. 17. Know the different parts to a prescription. 18. Who can write prescriptions, ie., MD, Dentist, etc.? 19. Who or what has a DEA#? 20. Be able to define and match drug legislation – dates included –Harris Narcotic Act –Durham-Humphrey Amendment –Kefauver Harris Act –Federal Food and Drug Act –Pure Drug and Food Act –Control Substance Act –Orphan Drug Act 21. Become familiar with schedule 1-5 and the examples that belong to each. What is the difference between schedule 1 and schedule 4 or 5? 22. Be able to trace the steps on how a drug becomes reviewed by FDA for public use (New Drug Development). Phase I – Phase IV. HPRS 2300 44 23. Know the drug nomenclature process 24. Be able to use and interpret a dose – response curve and a time-response curve. 25. Become familiar with different type of oral medication forms. –Extended release capsule –Elixirs –Tablets vs. Enteric-coated Tablet –Syrups –Capsules –Lozenges 26. Know different type of topical medications –Creams –Patches –Ointments –Etc. 27. Know type of interactions 28. Know different types of dosing –Loading Dose –Maximum Dose –Etc. 29. Know major areas of pharmacology –Pharmacodynamic –Pharmacokinetics –Pharmacy –Toxicology 30. Become familiar with the First-Pass Effect and the routes that avoid this effect. 31. Define: –Bioavailability –Half-life –Incompatibility –Reconstitution HPRS 2300 45 32. Define: –Buccal –Sublingual –Vaginal 33. Be able to distinguish between the five pregnancy safety categories. 34. Review the Self Pharmacology Test at the back of this packet. 35. Review in “Dimensional Analysis For Meds,” Chapters 5 - 10. Look at Dimensional Analysis “Worksheet” given at orientation for pages to read, problems to work, and what to concentrate on for the exam. Become familiar with the concepts. NOTE: Focus on pages under “Pharmaceutical Dosage Calculations” section in this packet. HPRS 2300 46