Pharmacology Unit 2

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Pharmacology Unit 2
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2013-09-02 20:56:22
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Pharmacology Unit 2 w/ vocabs
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  1. 1) Ø Know the difference between the official name, chemical name, generic name and trade name of a drug
    • a) Official name
    • i) – name used in the official drug reference, USP (Pharmacopoeia of the United States)
    • (1) Between 1906 & 1974 the NF (National Formulary) was also “official”
    • (a) Now combined w/ the USP
    • ii) (Ex: tetracycline hydrochloride)
    • b) Chemical name
    • i) –name describes the exact chemical composition of a drug
    • ii) (Ex: 4-dimethylamino-4.12 aoctahydro-3,6,10,12,12a-pentahydroxyl1-6-methyl,1,11-dioxi-2-napthacenecarboxamide hydrochloride)
    • c) Generic name
    • i) –For older drugs, this is the name handed down through antiquity
    • ii) –For newer drugs, it is usually the “code” name given during testing phase that is based upon the chemical name
    • (1) –the naming decision is made by the United States Adopted Name (USAN) committee
    • iii) –the generic name will become official name if drug is included in USP
    • (1) (Ex: tetracycline hydrochloride)
    • iv) Contrast w/: Therapeutic Equivalent
    • (1) Different drug completely
    • (a) (Not a Generic Equivalent: exact same active ingredients)
    • (b) Only in managed care setting
    • (c) May be on a particular hospital’s “substitution” list as having equivalent therapeutic usefulness
    • d) Trade name
    • i) –copyrighted name whose use is restricted to a single company:
    • (1) May be renewed
    • (a) Name remains w/ one company
    • (2) This is in contrast to the 17 year patent on the drug itself
    • (a) After 17 years may see generic products
    • (i) (Drug doesn’t stay w/ the company after patent expires: other people then can make it)
    • (b) Ex:
    • (i) Tetracyn (Pfiphermeces)
    • (ii) Achromycin (Lederle Labs)
    • (iii) Symcin (Squibb)
  2. 2) Ø Review the drug reference books we discussed and the key characteristics of each.
    • a) “The Pharmacopeia of the United States of America” (USP)
    • i) 1st published in 1820
    • ii) Published every 5 years w/ supplements as needed
    • (1) Single drugs
    • (2) Full time director, voluntary team of pharmacologists, physicians, pharmacists, nurses, consumer activist
    • (3) Older drugs deleted in favor of newer, more effective agents
    • (a) (Authoritative: Gives average dose, toxicity, methods of administration
    • (i) Also: How to prepare drugs, standards for tablet disintegration, etc.)
    • b) “National Formulary” (NF)
    • i) 1888-1975, but now combined w/ USP
    • ii) Single drugs and formulas for drug mixtures
    • iii) Often included drugs deleted from USP
    • (1) NF and USP in combination are the ONLY official drug references
    • c) AMA Drug Evaluation
    • i) –prepared by appointed experts
    • ii) Drug grouped according to use
    • iii) General discussion provide of each group
    • (1) *Favorable and unfavorable judgments expressed
    • d) “Physician’s Desk Reference” (PDR)
    • i) Also PDR for non-prescription medications
    • ii) -manufacturers buy space (like bunch of ads)
    • iii) Information similar to drug inserts
    • iv) Cross-reference to generic and chemical names
    • (1) Especially useful section on drug identification and dosage forms
    • (a) Manufacturers can’t promote :”unlabeled” or “off-label” uses listed (meaning not FDA approved); unless filing a supplemental application
    • (i) Note: 1997 “FDA Modernization Act” does permit drug company to disseminate peer reviewed articles for unlabeled uses the company has committed to file a supplemental application on
    • e) “Drug Facts and Comparisons”
    • i) Drugs grouped according to use
    • ii) *Comparison of various drug forms including cost comparison
    • (1) Includes over-the-counter medications
    • iii) Now includes color photo section
    • f) “American Hospital Formulary Service” (AHFS)
    • i) Similar to DF&C
    • ii) Pharmacist use
    • g) Other sources:
    • i) Journals
    • (1) Nursing and Medical Journals
    • (a) “The Medical Letter”
    • (i) (publish every 2 weeks, current – good record for recognizing significant changes)
    • ii) Package insert
    • (1) Must be approved by FDA
    • (2) Legally may only include “labeled” uses
    • (3) Other reference sources may include “unlabeled” uses
    • iii) Textbooks
    • (1) “Goodman and Gilman’s The Pharmacological Basis of Therapeutics”
  3. 3) Ø What is the difference between local and systemic drug activity. Be able to identify an example
    • a) Local drug activity
    • i) –drug action occurring only at the site of application
    • (1) Usually on skin or mucous membranes
    • (2) May be in a join, in the stomach or anywhere
    • (a) Action is where the drug is placed!
    • b) Systemic drug activity
    • i) –Action of a drug that is absorbed then distributed throughout the body
    • (1) Action may be on
    • (a) Whole body
    • (b) Or a specific target organ
    • (c) (key: it’s at some place other than place you place it)
    • (2) Toxic effects may occur when drug applied for local effects = become systemically absorbed
  4. 4) Ø Review the routes of drug administration and the major advantage/disadvantage of each.
    • a) Skin and Mucous Membranes (Chiefly “topical” routes)
    • i) Skin
    • (1) Local action usually intended
    • (a) Uses- antiseptic, cleansing, emollient
    • (b) Caution – skin broken
    • (2) (Systemic examples?
    • (a) Transdermal patches, nicotine patches, estrogen patches, etc)
    • ii) Nasal mucosa
    • (1) Local: sprays, nose drops, decongestants, hemostatic
    • (a) Caution:
    • (i) If too much applied may become systemically absorbed
    • (ii) Even if correctly used, patient may have contraindications such as high BP or glaucoma
    • (2) Systemic: vasopressin, cocaine, heroin
    • iii) Inhalation
    • (1) Local:
    • (a) Antibiotics
    • (b) Detergents and enzymes for breaking up secretions
    • (2) Systemic:
    • (a) Anesthetics, CO2, O2 & NO
    • iv) Genitourinary
    • (1) Local action intended
    • (a) Caution: Traumatized tissue: dangerous systemic effect
    • b) Gastrointestinal Tract (Enteral Routes)
    • i) Oral
    • (1) –usually for systemic effect (exception: antacids, etc)
    • (2) Reasons used:
    • (a) Convenience: simplest route to bloodstream
    • (b) Safety: takes 1.1.5 hours to see full effect
    • (c) Cost: less expensive than injections
    • (3) Timing around meals
    • (a) Before: quicker absorption, but more easily destroyed
    • (b) With: drug irritations
    • (c) After: slower absorption desired
    • (4) Contraindications of oral route
    • (a) (-Why you would not want some1 to use it)
    • (b) Patient vomiting or unconscious
    • (c) Drug too irritating
    • (d) Drug doesn’t reach blood in high enough concentration
    • (i) (-if low bioavailability )
    • (ii) Not absorbed through GI tract
    • (iii) Destroyed by digestive enzymes
    • (iv) Destroyed by liver (metabolism)
    • 1. Portal system
    • 2. Sublingual, buccal, or rectal route will bypass the portal circulation
    • ii) Sublingual and Buccal
    • (1) Systemic
    • (a) For drugs destroyed by liver or digestive enzymes
    • (b) Do not chew, swallow, or take w/ water
    • (2) Local
    • (a) Anesthetic or antiseptic (dentist)
    • iii) Rectal
    • (1) Local
    • (a) Stimulate defecation reflex
    • (2) Systemic
    • (a) Retention enemas or suppositories
    • (3) Why Use?
    • (a) Bypass liver and digestive enzymes
    • (b) Irritating to stomach
    • (c) Uncooperative or unconscious patient
    • (d) Antiemetic
    • c) Parental routes – Refers to injections (literally: other than GI tract)
    • i) More hazardous route
    • (1) Rapidly absorbed
    • (a) Difficult to prevent total absorption and adverse effects
    • (2) Local tissue damage
    • (3) Entrance of microorganisms
    • ii) Type of injection depend upon placement of needle
    • (1) Intradermal – w/in dermin
    • (2) Subcutaneous (hypodermic)
    • (a) Usually use for drugs that are not irritating to the tissue
    • (b) Ex: insulin, epinephrine
    • (c) Slower than intravenously, faster than oral
    • (3) Intramuscular
    • (4) Intravenous
    • (5) Intraarterial
    • (6) Intraspinal – often used in “general” way
    • (a) Epidural
    • (b) Subdural
    • (c) Subarachnoid
    • (7) Intraarticular
    • (a) To joints (very local)
    • iii) The most commonly given injections are:
    • (1) Subcutaneous
    • (a) –must be highly soluble and potent in small volume
    • (b) May use ice or a tourniquet in case of reaction
    • (2) Intramuscular
    • (a) Spreads over larger surface area
    • (i) Absorption watery fluids may be more rapid
    • (ii) Suspensions absorbed very slowly
    • (b) Fewer sensory nerve endings
    • (c) Irritation less likely to lead to necrosis
    • (i) Caution- blood vessels and nerves in area
    • (3) Intravenous
    • (a) –most rapid and dangerous rout (even ice or tourniquet won’t help)
    • (i) (No absorption required)
    • (ii) Injection – irritating substances or emergency administration
    • (iii) Infusion- often just fluids and electrolytes
    • 1. *if drug added, must be labeled (watch for incompatibilities w/ solution)
    • (b) Ex: “iv”

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