Pharmacology

Pharmacology

Introduction
Introduction
Key
Key Topics
Topics
•• How
How are
are drugs
drugs described
described and
and referenced?
referenced?
•• What
What are
are the
the relevant
relevant drug
drug laws
laws and
and
regulations?
regulations?
•• What
What are
are the
the factors
factors affecting
affecting how
how drugs
drugs
are
are given?
given?
•• What
What are
are some
some ofof the
the key
key terms?
terms?
Drug
Drug Descriptions
Descriptions
•• Names
Names
•• Sources
Sources
•• Forms
Forms
•• Reference
Reference Materials
Materials
•• Components
Components of
of Drug
Drug Profiles
Profiles
Drug
Drug Names
Names
•• Chemical
Chemical Name:
Name: 2-(diethylamino)-2’,6’-
2-(diethylamino)-2’,6’-
acetooxylid
acetooxylid monohydrochloride
monohydrochloride
monohydrate.
monohydrate.

Not
Not
Particularly
Particularly
Useful!
Useful!
Drug
Drug Names
Names
•• Generic
Generic Name:
Name: lidocaine
lidocaine hydrochloride
hydrochloride
•• Official
Official Name:
Name: Lidocaine
Lidocaine Hydrochloride,
Hydrochloride,
USP
USP
•• Brand
Brand (Trade)
(Trade) Name:
Name: Xylocaine
Xylocaine®®
Much
Much
More
More
Useful
Useful
Drug
Drug References
References
•• USP
USP
•• PDR
PDR
•• Drug
Drug Inserts
Inserts
•• Nursing
Nursing Drug
Drug References
References
•• Pocket
Pocket Field
Field Guides
Guides
•• Digital
Digital Guides
Guides
–– Jeff’s
Jeff’s Pharmacology
Pharmacology Review
Review
http://www.templejc.edu/ems/drugs/PharmIndex.html
http://www.templejc.edu/ems/drugs/PharmIndex.html
Components
Components of
of aa Drug
Drug Profile
Profile
•• Names
Names •• Side
Side Effects
Effects
•• Classification
Classification •• Interactions
Interactions
(including
(including prototype)
prototype) •• Routes
Routes of
of
•• Mechanism
Mechanism of of Action
Action Administration
Administration
•• Kinetics
Kinetics •• Dosage
Dosage
•• Indications
Indications •• How
How Supplied
Supplied
•• Contraindications
Contraindications •• Special
Special Considerations
Considerations
Drug
Drug Laws
Laws
•• Pure
Pure Food
Food and
and Drug
Drug Act
Act of
of 1906
1906
•• Harrison
Harrison Narcotic
Narcotic Act
Act of
of 1914
1914
•• Federal
Federal Food,
Food, Drug
Drug and
and Cosmetic
Cosmetic Act
Act of
of
1938
1938
–– Durham-Humphrey
Durham-Humphrey Amendments
Amendments
•• Comprehensive
Comprehensive Drug
Drug Abuse
Abuse Prevention
Prevention and
and
Control
Control Act
Act of
of 1970
1970
Controlled
Controlled Substances
Substances
High abuse potential with risk of
Schedule I severe dependence; no medical use.
High abuse potential with risk of
Schedule II severe dependence. Some medical
indications

Moderate abuse potential with risk

Schedule III of moderate to low physical
dependence and/or high
psychological dependence.

Low abuse potential with limited

Schedule IV risk of dependence.
Lowest abuse potential with limited
Schedule V dependence risks.
State
State and
and Local
Local Laws
Laws
•• ‘Scope
‘Scope of
of Practice’
Practice’ Laws
Laws
•• Responsibility
Responsibility vs
vs Authority
Authority of
of Medical
Medical
Direction
Direction
Drug
Drug Standardization
Standardization
•• Assays
Assays
•• Bioequivalence
Bioequivalence
•• Bioassay
Bioassay
•• USP
USP isis the
the official
official standard
standard
Research
Research and
and Development
Development
•• Key
Key points
points from
from FDA
FDA handout
handout
–– Purpose?
Purpose?
–– What
What are
are controls?
controls?
–– What
What are
are the
the phases?
phases?
–– What
What isis an
an IND?
IND? An
An NDA?
NDA?
–– Why
Why isis skepticism
skepticism important?
important?

Handout Source: http://www.fda.gov/fdac/special/newdrug/testing.html

Six
Six Rights
Rights of
of Medication
Medication
Administration
Administration
•• Right
Right Medication
Medication
•• Right
Right Dose
Dose
•• Right
Right Time
Time
•• Right
Right Route
Route
•• Right
Right Patient
Patient
•• Right
Right Documentation
Documentation
Pregnancy
Pregnancy Considerations
Considerations
•• Increased
Increased maternal
maternal HR,
HR, CO
CO and
and blood
blood
volume
volume
–– May
May affect
affect absorption,
absorption, distribution,
distribution,
effectiveness
effectiveness
•• Drugs
Drugs may
may cross
cross placenta
placenta
•• Drugs
Drugs may
may cross
cross into
into breast
breast milk
milk
•• Tertatogens
Tertatogens
Pregnancy
Pregnancy Categories
Categories
•• A:
A: controlled
controlled studies
studies in
in pregnancy
pregnancy (<1 (<1 %).
%).
•• B:
B: animal
animal studies
studies show
show no no risk;
risk; Inadequate
Inadequate
human
human data.
data.
•• C:
C: animal
animal studies
studies show
show risk,
risk, inadequate
inadequate
human
human data.
data.
•• D:
D: human
human data
data show
show risk,
risk, benefit
benefit may
may
outweigh
outweigh risk.
risk.
•• X:
X: animal
animal or
or human
human data
data positive
positive for
for risk.
risk.
Use
Use unwarranted.
unwarranted.
Pediatric
Pediatric Considerations
Considerations
 Oral
Oral absorption
absorption
•• Thinner
Thinner skin
skin (
( topical
topical absorption)
absorption)
 Plasma
Plasma protein
protein concentration
concentration
 Free
Free protein-bound
protein-bound drug
drug availability
availability
 Extracellular
Extracellular fluid
fluid in
in neonate
neonate
•• Altered
Altered metabolic
metabolic rates
rates
 Elimination/metabolism
Elimination/metabolism
•• BSA/weight
BSA/weight based
based dosing
dosing important!
important!
Geriatric
Geriatric Considerations
Considerations
 Oral
Oral absorption
absorption
 Plasma
Plasma protein
protein concentration
concentration
 Muscle mass,  body
Muscle mass, body fat
fat
 Liver/renal
Liver/renal function
function
•• Multiple
Multiple drugs
drugs
•• Multiple
Multiple diseases
diseases
Some
Some Terminology
Terminology
•• Receptor
Receptor affinity
affinity •• Inhibition
Inhibition
•• Efficacy
Efficacy (antagonism)
(antagonism)
•• –– Competitive
Competitivevs.
vs.
1°
1° vs.
vs. 22ndnd messengers
messengers noncompetitive
noncompetitivevs.vs.
•• Up
Up vs.
vs. down
down receptor
receptor irreversible
irreversible
regulation
regulation •• Allergic
Allergic reaction
reaction
•• Agonist
Agonist vs. vs. antagonist
antagonist •• Idiosyncrasy
Idiosyncrasy
•• -lytic
-lytic vs.
vs. -mimetic
-mimetic •• Tolerance
Tolerance
More
More Terminology
Terminology
•• Cross
Cross tolerance
tolerance •• Synergism
Synergism (1+1=3)
(1+1=3)
•• Tachyphylaxis
Tachyphylaxis •• Potentiation
Potentiation
•• Cumulative
Cumulative effect
effect •• Interference
Interference
•• Dependence
Dependence
•• Drug
Drug interactions
interactions
•• Summation
Summation (1+1=2)
(1+1=2)
–– Additive
Additiveeffect
effect
Basics
Basics of
of Drug
Drug Classification
Classification
•• Knowledge
Knowledge grouping
grouping
•• Prototype
Prototype drug
drug
•• Predictive
Predictive value
value
Drug
Drug Classification
Classification
•• By
By chemistry
chemistry
–– electrolytes
electrolytes
•• By
By mechanism
mechanism
–– Beta
Beta blockers
blockers
–– benzodiazepines
benzodiazepines
•• By
By disease
disease
–– antihypertensives
antihypertensives
–– Antiemetics
Antiemetics
Resources
Resources
•• Clinical
Clinical Pharmacology
Pharmacology 2000
2000
–– http://cp.gsm.com/default.asp
http://cp.gsm.com/default.asp
•• University
University of
of Kansas
Kansas Medical
Medical Center
Center
–– http://www.kumc.edu/AMA-
http://www.kumc.edu/AMA-
MSS/study/pharmacology.htm
MSS/study/pharmacology.htm
•• Infomed
Infomed Online!
Online!
–– http://www.infomed.org/index-e.html
http://www.infomed.org/index-e.html
•• Mosby’s
Mosby’s GenRX
GenRX
–– http://www.genrx.com/genrxfree/Top_200_2000/Top_200_2000.html
http://www.genrx.com/genrxfree/Top_200_2000/Top_200_2000.html
Resources
Resources
•• Hardin
Hardin MD
MD (Meta-Directory)
(Meta-Directory)
–– http://www.lib.uiowa.edu/hardin/md/pharm.html
http://www.lib.uiowa.edu/hardin/md/pharm.html
•• Top
Top 200
200 Prescription
Prescription Drugs
Drugs
–– http://www.rxlist.com/top200.htm
http://www.rxlist.com/top200.htm
•• Medline
Medline Plus:
Plus: Consumer
Consumer Information
Information on
on
Prescription
Prescription Drugs
Drugs
–– http://www.nlm.nih.gov/medlineplus/druginformation.html
http://www.nlm.nih.gov/medlineplus/druginformation.html
•• FDA
FDAOnline
Online(Testing
(TestingDrugs
Drugsin
inPeople)
People)
–– http://www.fda.gov/fdac/special/newdrug/testing.html
http://www.fda.gov/fdac/special/newdrug/testing.html