Pharmacology is the field of medicine that studies drugs-their nature, origin, and effect on the body.

It is a broad medical specialty and contains many subdivisions of study, including medical chemistry, pharmacodynamics, pharmacokinetics, molecular pharmacology, chemotherapy, and toxicology.

MEDICINAL

PHARMACODYNAMICS PHARMACOKINETIC MOLECULAR

CHEMISTRY PHARMACOLOGY New drug Drug effects Synthesis on the body

Drug Concentration In tissues and blood Is measure over a Period of time

Interaction Drugs and Subcellular Components

CHEMOTHERAPY Use of drugs In treatment of Disease

TOXICOLOGY Study of harmful chemicals and their effects on the body

Subspecialty areas of pharmacology Drugs are chemical or biological substances used in the prevention or treatment of disease, or to alter bodily functions in a beneficial way. Drugs are dispensed by a pharmacist, whose shop or store is called a pharmacy. Medicinal chemistry is the study of new drug synthesis and the relationship between chemical structure and biological effects in the body. Scientists may also study the processes of drug absorption (how drugs pass into the bloodstream), metabolism (change drugs undergo within the body), and excretion (removal of the drug from the body.) the mathematical description of drug disposition (appearance and disappearance) in the body over time of called pharmacokinetics.

Molecular pharmacology concerns the study of the interaction of drugs and subcellular entities, such as DNA, RNA, and enzymes. These studies provide important information about the mechanism of action of the drug. Chemotherapy is the study of drugs that destroy microorganisms, parasites, of malignant cells within the body. Chemotherapy includes treatment of infectious diseases and cancer. Toxicology is the study of harmful chemicals and their effects on the body. Toxicological studies in animals are required by law before new drugs can be tested in humans. A toxicologist is also interested in finding proper antidotes to any harmful effects of drugs. Antidotes are substances given to neutralize unwanted effects of drugs.
A Drug can have three different names: The chemical name is the chemical formula for the drug. This name, often long and complicated, is useful for the chemist because it shows the structure of the drug. The generic or official name is a shorter, less complicated name that is recognized as identifying the drug for legal and scientific purposes. The generic name becomes public property after 17 years of use by the original manufacture, and any drug manufacturer may use it thereafter. There is only one generic name for each drug. The brand (trade of proprietary) name is the private of the individual manufacturer, and no competitor may use it. Brand names often have the superscript after or before the name, indicating that this is a registered trade name. Most drugs have several brand names because each manufacturer producing the drug gives it a different name. When a specific brand name is ordered a prescription by a physician, it must be dispensed by the pharmacist; no other name may be substituted. It is usual practice to capitalize the first letter of a brand name. The following list gives the chemical, generic and brand names of the antibiotic drug ampicillin, note that the drug can have several brand names but only generic, or official, name:

Chemical Name Derivative of 6-aminopenicillanic acid

Generic Name ampicillin

BrandName Amcill capsules Omnipen Polycillin Principen

Administration The various methods of administering drug are: 1. Oral Administration. Drugs are given by mouth and are slowly into the bloodstream through the stomach or intestinal wall. 2. Sublingual Administration. Drugs are not swallowed but are placed under the tongue and allowed to dissolve in the saliva. 3. Rectal Administration. Suppositories (cone-shaped objects containing drugs) and aqueous solutions are inserted into the rectum. At times, drugs are given by rectum when oral administration presents difficulties, such as when the patient is nauseated and vomiting. 4. Parenteral Administration. This type of administration is accomplished by injection of the drug from a syringe (tube) through a hollow needle placed under the skin, into a muscle into a vein, or into a body cavity.Several types of parenteral injections are:

1.

Subcutaneous injection (SC). This is also called a hypodermic injection, and it is given just under the skin. The outer surface of the arm is a usual location for this injection.

2.

Intradermal injection. This shallow injection is made into the upper layers of the skin and is used chiefly in skin testing for allergic reactions. Intramuscular injection (IM). The buttock or upper arm is usually the site for this injection into muscle. When drugs are irritating to the skin or when a large volume of a long-acting drug is needed, IM injections are advisable. Intravenous injection (IV). This injection is given into the veins. It is given when an immediate effect from the drug is desired or when the drug cannot be safely given into other tissues. Good technical skill is needed for administering this injection, because leakage of drugs into surrounding tissues may result in irritation and inflammation. Intrathecal injection. This injection is made into body cavity, such as the peritoneal or pleural cavity. For example, nitrogen mustard is injected into the pleural cavity in people who have pleural effusions due to malign disease. The drug causes the pleural surfaces to adhere, thus obliterating the pleural space and preventing accumulation of fluid.

3.

4.

5.

 Inhalation. Vapors, or gases, are taken into the nose or mouth and are absorbed into the bloodstream through the walls of the air sacs in the lungs. Aerosols (particles of drug suspended in air) are administered by inhalation, as many anesthetics. Examples of aerosols are pentamidine, used to treat a form of pneumonia associated with acquired immunodeficiency syndrome (AIDS), and various aerosolized medicines used to treat asthma (spasm of the airways). Topical Application. Drugs are locally applied on the skin or mucous membranes of the body. Antiseptics (agar infection) and antipruritics (against itching) are commonly used as ointments, creams and lotions. Transdermal patches are used to deliver drugs (such as estrogen, pain medications, and nicotine) continuously through the skin.

Table 4.1 ROUTES OF DRUG ADMINISTRAION Oral Sublingual Rectal Parenteral Tablets Tablets Suppositories Injections Subcutaneous Intradermal Intramuscular Intravenous Inthrathecal Intracavity
Drug Toxicity Drug toxicity is the poisonous and potentially dangerous effects of some drugs. Idiosyncrasy is an example of an unpredictable type of drug toxicity. Other types of drug toxicity are more predictable and are based on the dosage of the drug given. Physicians are trained to be aware of the potential toxic effects of all drugs that they prescribe. Iatrogenic (produced by treatment) disorders can occur, however, as a result of mistakes in drug use or of individual sensitivity to a given agent. Side effects are toxic effects that routinely results from the use of a drug. They often occur with the usual therapeutic dosage of a drug and are generally tolerable. For examples, nausea, vomiting, and alopecia are common side effects of the chemotherapeutic drugs used to treat cancer.

Inhalation Topical Aerosols Lotions Creams Ointments Transdermal patches

Contraindications are factors in a patients condition that make the use of a drug dangerous and ill advised. For example, in the presence of renal failure, it is unwise to administer a drug that is normally eliminated by the kidneys. Excess drug will accumulate in the body and cause side effects. Classes of Drugs The following are major classes of drugs with explanations of their use in the body. The names of specific drugs are included in tables for your reference (trade or brand names are capitalized; generic names begin with a small letter). Analgesics An analgesic (alges/o means sensitivity to pain) is a drug that relieves pain. Mild analgesics are used for mild to moderate pain, such as caused by myalgias, headache, and toothache. More potent analgesics are narcotics or opioids, because they contain or are derived from opium. These are used only to relieve severe pain because they may produce dependence (habit formation) and tolerance. Morphine is an example of a narcotic analgesic.

Some non-narcotic analgesics reduce fever, pain, and inflammation and are used in rheumatic (joint) disorders. These agents are not steroid hormones (such as cortisone) and are known as nonsteroidal antiinflammatory drugs (NSAIDs). NSAIDs act on tissues to inhibit prostaglandins (hormone-like substances that sensitize peripheral pain receptors). Analgesics Mild acetaminophen(Tylenol) Aspirin Narcotic (opioid) Codeine Hydromorphone (Dilaudid) Morphine NONSTEROIDAL ANTI INFLAMMATORY DRUG (NSAID) Ibuprofen (motrin, advil) Naproxen (naprosyn) Anesthetics General ether halothane (fluothane) nitrous oxide thiopental (pentathlon) Local Hydro

Anesthetics An anesthetic is an agent that reduces or eliminates sensation. This can affect the whole body (general anesthetic) or a particular region (local anesthetic). General anesthetics are used for surgical procedures and depress the activity of the central nervous system producing loss of consciousness. Local anesthetics inhibit the conduction of impulses in sensory nerves in the region in which they are injected or applied. Table 4-2 gives examples of specific anesthetics. Antibiotics An antibiotic is a chemical substance produced by a microorganism that inhibits or stops the growth of bacteria, fungi, or parasites. The use of antibiotics has largely controlled many diseases such as pneumonia, rheumatic fever, and mastoiditis. Caution about the use of antibiotics is warranted because they are powerful agents. With indiscriminate use, pathogenic organisms can develop resistance to the antibiotic and thus destroy the antibiotics diseasefighting capability. Table 4-3. Antibiotics with Specific examples ANTIFUNGALS Amphotericin B (Fungizone) Ketoconazole (nizoral) fluconazole (diflucan) ANTIMALARIALS Choloroquine (arales ) Pyrimethamine (Daraprim) ANTITUBFRCULARS Isoniazid (INH) Rifampin (Rifadin) ANTIVIRALS acyclovir (zovirax) zidovudine or AZT (Retrovir) CEPHALOSPORINS Cefaclor (iceclor) Cephradine (keflin) Cephradine (anspor) ERYTHROMYCINS AND LIRE
DRUGS

PENICILLINS amoxicillin (amoxil) ampicllin (omnipen) penicillin V potassium(Pen Vee K) TETRACYCLINES Doxycycline Tetracyline SULFONAMIDES (SULFA DRUGS) Sulfasalazine (azufidine) Sulfisoxazole ( )

Azithromycin clarithromycin erythromycin

Anticoagulants This type of drug prevents the clotting (coagulation) of blood. Anticoagulants are used to prevent the formation of clots or to break up clots in blood vessels in conditions such as thrombosis and embolism. They are also used to prevent coagulation in preserved blood used for transfusions. Heparin is a natural anticoagulant produced by liver cells and some white blood cells.

Table 4-4 gives examples of anticoagulants. ANTICOAGULANTS Dicumarol Heparin Sodium warfarin (Coumadin) Tissue plasminogen activator (IPA) ANTIDEPRESSANTS Oral drugs amitriptyline (Elavil) (Diabinese) Fluoxetine (prozac) (Glucotrol) Imipramine (Tofranil) Metformin (glucophage) Nortriptyline (Pamelor) Tolbutamide (orinase ) paroxetine (paxil) ANTIDIABETICS Insulins Humulin Lietin Lente

ANTICONVULSANTS Carbamazephine (tegretol) Phenobarbital Phenyton (Dilantin)

ANTHISTAMINES Chlorphenaramine maleate (Chlor-Trimeton) (Dramamine) Diphennydramine (Benadryl) Terfenadine (Seldane)

Table 4.4 Anti Coagulants, Anti Convulsants, Antidepressants, Antidiabetic & Antihistamines Anticonvulsants These drugs treat symptoms of depression. They can elevate mood, increase physical activity and mental alertness, and improve appetite and sleep patterns. Many antidepressants are also mild sedatives and treat mild forms of depression associated with anxiety. One of the most commonly prescribed antidepressants is Prozac (fluoxetine). It works by allowing a neurotransmitter, serotonin, into nerve cells. Table 4-4 gives the names of some antidepressants. Antidiabetics These drugs are used to treat diabetes mellitus (a condition in which the hormone insulin is either not produced by the pancreas or not effective in the body). Patients with type I (insulin dependent) diabetes must receive daily injections of insulin of insulin. Patients with type II (noninsulin-dependent) diabetes are given oral antidiabetic drugs (sulfonylureas agents) that stimulate the production and release of insulin by the pancreas. A newly approved drug called metformin is used as an option to sulfonylureas. It suppresses glucose production in the liver and increases tissue sensitivity to insulin without stimulating insulin secretion. An insulin pump is a device strapped to the patients waist that periodically delivers (via needle) the desired amount of insulin.

Table 4-4 lists antidiabetic drugs. Antihistamines These drugs block the action of histamine, which is normally released in the body in allergic reactions. Histamine cause allergic symptoms such as hives, bronchial asthma, lay fever, and in severe cases anaphylactic shock (dyspnea, hypotension, and loss of consciousness). Antihistamines cannot cure the allergic reaction, but they can relieve its symptoms. Many antihistamines have strong antiemetic (prevention of nausea) activity and are used to prevent motion sickness. The most common side effects of antihistamines are drowsiness, blurred vision, tremors, digestive upset, and lack of motor coordination. Table 4.4 lists common antihistamines. Cardiovascular Drugs

Cardiovascular drugs act on the heart or blood vessels. Those drugs that act on the heart by increasing the force and the efficiency of the heartbeat are called cardiotonic drugs. Cardiotonic drugs are useful in congestive heart disease. Other drugs, called antiarrhythmics, such as betablockers and calcium blockers, correct abnormal heart rhythms. These drugs, along with other drugs, are also effective in preventing angina (chest pain due to insufficient oxygen reaching heart muscle). The drugs that prevent angina are called antianginal medications.

One type of drug that affects blood vessels is an antihypertensive. Antihypertensive vasodilators dilate the walls of blood vessels to lower blood pressure. Diuretics lower blood pressure by promoting the kidney to excrete urine, so that more fluid leaves the body. ACE inhibitors reduce hypertension by preventing the conversion of angiotensin I to angiotensin II, which is a powerful vasopressor (vasoconstrictor).

Vasoconstrictor drugs narrow the walls of blood vessels and thereby raise blood pressure. These drugs are used in cardiac and respiratory failure and in bronchial asthma (they dilate the bronchial tubes) and to prolong the action of local anesthetics.

Cholesterol-lowering drugs decrease the breakdown of body fats by reducing the amount of fat manufactured by the liver and increasing the excretion of bile acids (and cholesterol) in the stool. These drugs are prescribed for people with very high blood cholesterol levels who have nor responded to dietary changes. Table 4-5 gives examples of the different types of cardiovascular drugs.

Table 4-5 Cardiovascular Drugs CHOLESTEROL LOWERING ANTIHYPERTENSIVE Beta blockers* Cholestyramine resin (Questran) Calcium channel blockers Calcium channel blockers Gemfibrozil (lopid) Nitroglycerin Lovastatin (mevacor) Antiarrhythmics Vasodilators Vasoconstrictor Calcium channel blockers digitoxin Norepinephrine Procainamide (Pronestyl) Di ANTIANGINAL

Endocrine Drugs

These drugs act in much the same manner as the naturally occurring (endogenous) hormones. Androgens are male hormones that are used for male hormone replacement or to treat endometriosis and breast cancer in women. An androgen antagonist is flutamide, which is used to treat prostate cancer. Estrogens are female hormones that are used for symptoms associated with menopause (estrogen replacement therapy) and to prevent postmenopausal osteoporosis. They are also used as chemotherapy for some types of cancer (for example, prostate cancer). An important antiestrogen drug is tamoxifen (Nolvadex), which is used to prevent recurrence of breast cancer and also to treat metastatic breast cancer. Progestins are prescribed for abnormal uterine bleeding due to hormonal imbalance and, together with estrogen, in hormone replacement therapy and oral contraceptives. Levonorgestrel (Norplant) is a contraceptive drug embedded under the skin. Thyroid hormone is administered when there is a low output of hormone from the thyroid gland. Glucocorticoids (adrenal corticosteroids) are prescribed for reduction of inflammation and a wide range of other disorders including arthritis. Severe skin and allergic conditions, respiratory and blood disorders, gastrointestinal ailments, and malignant conditions.

Table 4-6.Endocrine Drugs ANDROGEN Fluosymesterone (Halotestin) methyltestosterone (Virifon) ANTI ANDROGEN Flutamide ESTROGEN Estrogens (Premarin, estradiol) ANTIESTROGEN Tamoxifen (Novadex) GLUCOCORTICOID Dexamethasone (Decadron) Prednisone (Deltasone) PROGESTIN medroxyprogesterone (provetral) megestrol (Megace) THYROID HORMONE Levothyroxine (Synthroid) liothronine (Cytomel) Liotrix (Lothroid)

Gastrointestinal Drugs

These drugs are often used to relieve uncomfortable potentially dangerous symptom, rather than as cures for specific diseases. Antacids neutralize the hydrochloric acid in the stomach to relieve symptoms of peptic ulcer, esophagitis, and epigastric discomfort. Antiulcer drugs block secretion of acid by cells in the lining of the stomach and are prescribed for patients with gastric and duodenal ulcers.

Antidiarrheal drugs relieve diarrhea and decrease the rapid movement of the walls of the colon. Cathartics relieve constipation and promote defection for diagnostic and operative procedures and are used in the treatment of the disorders of the gastrointestinal tract. Some cathartics increase the intestinal salt content to cause fluid to fill the intestines; others increase the bulk of the feces to promote peristalsis (movement of the intestinal wall). Another type of cathartic lubricates the intestinal tract to produce soft stools.

Laxatives are mild cathartics, and purgatives are strong cathartics. Antinauseants (antiemetics) relieve nausea and vomiting and overcome vertigo, dizziness, motion sickness, and labyrinthitis (inflammation of the inner ear) as well.

Table 4-7 lists the various types of gastrointestinal drugs and examples of each. ANTACID ANTIHISTAMINES (ANTIEMETIC) Aluminum and magnesium antacid Magnesium antacid (milk of magnesia) Aluminum antacid (Rolaids) ANTIDIARRHEAL Diphenoxylate and atropine (Lomotil) Loperamide (Imodium) Paregonic

Respiratory Drugs These drugs are prescribed for the treatment of emphysema, asthma and respiratory infections such as pneumonia and bronchitis. Bronchodilators are used to open the air passages (bronchial tubes) and can be administered to injection or aerosol (inhalers). Table 4-8 lists common bronchodilators and a steroid drug that is used as an inhale or intranasal product to reduce inflammation in nasal passages. Sedatives Sedatives are drugs that relax and calm nervousness. They work by depressing the central nervous system (brain causing reduced mental activity and weakness. Hypnotics are sedative drugs that produce sleep. A patient cat develop tolerance to barbiturates, making the drugs habit forming. Table 4-8 lists sedatives-hypnotics and barbiturates. Stimulants These drugs act on the brain and are used to speed up vital processes (heart and respiration) in cases of shock and collapse. They also increase alertness and inhibit hyperactive behavior in children. High doses can produce restlessness, insomnia, and hypertension. Examples of stimulants are amphetamines-used to prevent narcolepsy (seizures of sleep), to suppress appetite, and to calm hyperkinetic children. Caffeine is also a cerebral stimulant. It is used in drugs to relieve certain type of headache by constricting cerebral blood vessels. Table 4-9 lists examples of stimulants. Table 4-8 Respiratory Drugs & sedatives Respiratory Drugs Bronchodilators albuterol (proventil) aminophylline (Amoline) epinephrine theophylline (Theo-dur) Steroids beclomethasone (Beclovent, Vanenase Nasal inhaler) Sedative Hypnotics flurazepam (Dalmane) Barbiturates Phenobarbital (Luminal)

termazeopam (Restoril) Secobarbital (seconal) triazolam (halcion) zolpidem (Ambien) Sodium Phenobarbital (Nembutal)

Tranquilizers These drugs are useful in controlling anxiety. Minor tranquilizers (benzodiazepines) are used to control minor symptoms of anxiety. Major tranquilizers (phenothiazines) are used to control more severe disturbances of behavior. Table 4-9 lists examples of minor and major tranquilizers.

2. VOCABULARY

Additive action Aerosol Anaphylaxis Antidote Brand name Chemical name Contraindications Food anddrug Administration (FDA)

Drug action in which the combination of two similar drugs is equal to the sum of the effects of each. Particles of drug suspended in air. An exaggerated hypersensitivity reaction of the body to a drug of foreign organism. Agent given to counteract an unwanted effect of drug Commercial name for a drug; trade name Chemical formula for a drug. Factors in the patients condition that prevents the use of a particular drug or treatment. Government agency having the legal responsibility for enforcing proper drug manufacture and clinical use.

Stimulants Caffeine dextroamphetamine sulfate(dexedrine) methylphenidate (Ritalin)

Tranquilizers Minor alprazolam (Xanax) chlordiazepoxide (Librium) clorazepate (Tranxene) diazepam (Valium) flurazepam (Dalmane) oxazepam (Serax)

Major Chlorpromazine (Thorazine) lithium thioridazine (Mellaril) trifluoperazine (Stelazine) Table 4-9

Generic name Barbiturate Beta-blocker

Caffeine Calcium channel blocker Cardiotonic Cathartic Diuretic Emetic Glucocorticoid Hypnotic Laxative Narcotic Purgative Sedative Stimulant Tranquilizer

The legal noncommercial name for a drug. Sedative-hypnotic drug derived from barbituric acid. Drug that blocks the action of epinephrine at sites on receptors of heart muscle cells, the muscle lining of blood vessels, and bronchial tubes; antiarrhythmics, antianginals, and antihypertensive. Central nervous system stimulant Drug that blocks the entrance of calcium into heart muscle and muscle lining of blood vessels; used as antiarrhythmics, antianginals, and antihypertensives. Drug that promotes the force and efficiency of the heart. Drug that relieves constipation Drug that increases the production of urine and thus reduces the volume of fluid in the body; antihypertensive. Drug that promotes vomiting Hormone from the adrenal cortex that raises blood sugar and reduces inflammation. Agent that produces sleep. Weak cathartic Habit-forming drug (potent analgesic) that relieves pain by producing stupor or insensibility. Strong cathartic Mildly hypnotic drug that relaxes without necessarily producing sleep. Agent that excites and promotes activity. Drug used to control anxiety and severe disturbances of behavior.

ABBREVIATIONS ac ad lib bid c caps cc FDA gm gt, gtt h IM IV qam qd qh qhs qid qns before meals freely as desired two times a day with capsule cubic centimeter food and drug administrator gram drops hour intramuscular intravenous every morning every day every hour at bedtime four times a day quantity not sufficient mg NPO NSAID os oz. pc PDR po prn Q (q) qpm s subq sig. sos tab tid qod milligram nothing by mouth nonsteroidal anti-inflammatory drug mouth ounce after meals physicians Desk Reference by mouth when requested; pro re nata(required) Every every evening Without subcutaneous injection let it be labeled if necessary (si opus sit) tablet three times a day every other day

Prescriptions The usual order of drug prescription is name of the drug, dosage, route of administration, time or administration. At times the physician will include a qualifying phrase to indicate why the prescription is written. Not all information is listed with every prescription. Consider the following. 1. Fluoxetine (Prozac) 20 mg po bid 2. Dimenhydrinate (Dramamine) 10 mg 2 tab q 4-6h 3. Ondansetron (Zafran) 4mg 1 tab/caps tid prn for nausea 4. Ranitidine (Zantac) 300 mg 1 tab pc rd 5. Pseudoephedrine (Sudafed) 60 mg 1 caps qid for 15 days. 6. Acetaminophen (300 mg) & codeine (30 mg) 1 tab qid prn for pain

Top 20 prescription Drugs

Drug (Trade Name) 1. Premarin 2. Zantac

Generic name estrogen ranitidine

Type Hormone Antiulcer

3. Amoxil 4. synthroid 5. Procardia 6. Lanoxin 7. Xanax 8. Trimox 9. Vasotec 10. Cardizem 11. Ceclor 12. Augmentin 13. Proventil 14. Naprosyn 15. Provera 16. Prozac 17. Mevacor 18. Seldane 19. Ortho-Novum 7/7/7 20. Capoten

amoxicillin levothyroxine nifedipine digoxin alprazolam amoxicillin enalapril diltiazem HCI cephalosporin amoxicillin/clavulanic acid albuterol naproxen medroxyprogesterone fluoxetine HCI lovastatin terfenadinel estrogen and progesterone captopri

Antibiotic (penicillin-type) Hormone (thyroid) Calcium channel blocker Cardiotonic Tranquilizer Antibiotic (penicillin-type) Antihypertensive Calcium channel blocker Antibiotic Antibiotic Bronchodilator NSAID (analgesic) Hormone Antidepressant Cholesterol-Lowering drug Antihistamine Oral contraceptive Antihypertensive (ACE inhibitor)