3 Treating a Disease Objectives In this chapter we will study + strates for the treatment of disease ‘measures for infeetion contro in the lines + modical word roots for clinical procedures; + types of drugs and routes of administration and + symbols and abbreviations usd in pharmuceuties The Aims of Therapy Once a disease has been diagnosed, appropriate ‘therapy (treatment) can begin. Incurable diseases suet as Alzheimer disease can be managed only with Palliative treatment, which is aimed at alleviating the symptoms and maximizing the patient's comfort rather than curing the disease. Preventive treatment is aimed at warcing off a disease to which a patient hhas been exposed or is likely fo be exposed ‘Vaceinations are an example of preventive treatment. IFthe disease is curable, a plan of active treatment is instituted to eliminate the cause and restore homeostasis, The Therapeutic Partnership An effective trentment plan (regimen) i, a its best, {partnership between the clinician and the patient ot the patients carosivers. Deponding on the diagnosis, it may incinde medicine, surgery, and a combination of dist, oxercise, physical therapy, and other restorative activities, Patients have the right to refuse treatment tothe extent permitted by law. Some healthe care feilties require patients to sign an informed consent form testifying that they have beon adequately informe! of the diagnosis, prognosis, and risks end benefits of the treatment, and have made a voluntary decision to pursue the treatment plan. ‘This is specially important if the treatment plan includes specialized disgnostic procedures, surgery, or experimental therapy. One ofthe eretest obstacles to successful treatmeat is noncompliance, the failure oF inability of the patient or caregivers to follow the plon—for example, by not taking a prescription drug regularly, not adhering to a det, oF not returning for follow-1p examinations and care, 6 Controlling Infections of Clinical Origin ‘The clinical setting itself poses some challenges to ‘weatment. Many people under treatment. contract fections nequired in a clinic or hospital by exposure to pathogens introduced into that environment by other patients. Tho very fucilities ‘that ate intended to cure disease are, for some, the indirect cause of death, ‘Thorefore, it is important to rigorously control the spread of pathogens in the clinical environment Sterilization means the complete removal of microbes from medicel instruments and other objects, It isa contradiction in terms to describe something as “partially sterile’—either it is sterile or it isn't. Techniques of sterilization include pressurized steam (2s in an autoclave), dry beat, ultraviolet light o¢ other radiation, chemicals such as alcohol and phenol, or filration, as in preparing sterile intravenous solutions Disinfection is the use of chemical and physical agents to destroy microorganisins and thei toxins, bu it does not completely eliminate them as sterilization cal asepsis (sterile technique) consists of procedures that render an area entirely clear of microorganisms and keep it that way. A high level of ssepsis is needed in surgery because the pationt’s body open and his or her natural dofeases against pathogens have been breached, Medical asepsis (Gleam technique) is a lower level of asepsis invelving procedures that reduce the population of microorganisms and limit their transfer from person to person, but do not absolutely rid the area of them, ‘Medical asepsis relies partially on the patient's natural defenses, especially the skin and mucous membranes, to provide protectionSome Treatment Approaches ‘The approaches to treatment of disease are almost as diverse as the diseases themselves, Some major therapeutic approaches are the following: ‘+ Chemotherapy, in the broad sense, is any use of chemicals (drugs) to treat any disease. Originally, it meant the wse of drags that ars toxic (0 a causative organisin without being toxic to the patient. The word is now applied especially to the chomical treatment of cancer * Gene therapy is the replacement of a patient's defective gene with a normal gene. To date, gene therapy is mostly a goal of medical research; it thas not yet resulted in a permanent cure for any clisense, + Hemodialysis is « procedite that compen-sates for inadequate kidney function by purp-ing the blood through a device that removes is wastes by dialysis + Immunotherapy attempts to use the body's natural responses to attack cancer calls, other defective cells, of pathogens, Methods inelude introcucing antibodies produced by another individual into the patients body and boosting the paticats own immune response, pational therapy (OT) is the use af work, play, and self-care activities t> prevent or treat physical disabilities and to maximize a patients independence and quality of life, ‘+ Physical therapy (PI) uses exercise, massage, heat, electricity, and hydrotherapy (as opposed 10 medical or surgical methods) to prevent or treat physical disabilities and maximize a patient's independence and quality of life ‘+ Radiotherapy isthe treatment of any disoase with ionizing radiation (X rays, ultraviolt rays, or radiation from radioisotopes); itis used especially to destroy malignant tumors + Surgery isthe treatment of diseases, deformities, ‘and infuries by ether manipulation or operation (cutting). Surgery without cutting is ealled closed surgery: examples include realigning the ends of a brokea bone or treating dislocated joint. Terminology of Diagnosis and Treatment Most medioa! terminology is composed of word roots that denote an anatomical structure combined with roots, prefixes, or suffixes that denote a noemal or abnormal condition oF a treatment. Table 2.1 in the previous chapter tisted word elements that denote Clinical conditions, signs, and symptoms, Table 3.1 lists @ number of commonly used! word elements that denote diagnostic and therapeutic procedures. -opsy ‘Viewing procedure “poy phylexis Prevention plasty Surgical repaie thophy Suture, sew up copy Viewing provedure siherapy Treatment tomy Making an incislon tipsy Crushing Table 3.1 Word Elements for Diagnostic and Therapeutic Procedures Meaning Example |-coueis Puncture Amniocentesis (sampling amniotic uid) sion Cutting ireumcision (cuting of? the foreskin) Ierigation, lavage Gasirotysis (ivigation of the stomach) Cutting out Splencciomy (removal of the spleen} Recording process Mammography (photographing the breast with X rays) Treatment Psychiatry (eneical treatment of mental disorders) Measuring process Cepalometry (moaurement of kead dimensions) [Biopsy (examination of iving tissue sample) rail reatuchment Nephropexy (attaching a kidney to Une abdominal wall) Prophylaxis (disease prevention) Rhinoplasty (repair or remodeling of the nose) Hiterorrhaphy (suturing the uterus) Aitnrascopy (viewing the interior ofa joint) -stomy Making are opening Colestomy (making @ new opening ito the colon) CCaemodherapy (treatment sith chemicals) Phlebotomy (piseing or cutinga vein) Lithotipsy (rushing gallstones or kidney stones)Basic Facts About Medication A drug is ¢ chemical used to aid in diagnosis, prevent disease, treat disease, relieve pain and other disease symptoms, oF improve any physiologic or pathologic condition, Note that this definition focuses on drugs used for therapeutic offect and excludes drugs of abuse. Although food may have some of the same effects that certain drugs have, drugs do not include food; they are nonnultitive chemicals ‘Today, @ vast numbor of drugs are available to consumers, both over-the-counter and by prescription only, In the United States, drugs cannot be legally prescribed or sold until they are approved by the Food and Drug Administration (FDA), In order to gain approval, a proposed new drug must pass through a three-phase process of clinical trials in which the sciantific method is rigorously applied (see Case ‘Study 3 at the end ofthis chapter). Routes of Administration ‘The mulkiple routes by which drugs can be introduced ito the body include oral, transdermal, via mucous membranes, and by injection, Oral The simplest, most common, and most ‘comfortable route of medication is by mouth. Drugs {or oral use are macuifactured in the form of pills (tn solid masses containing the drug and diluting and binding substances, which are to be chewed or swallowed), tablets (solids compressed into disklike for other shapes), capsules (doses of medicine contained in small containers of soluble gelatin), syrups (liquid preparations of medicine in a highly concentrated sugar solution), and elixirs (medicines dissolved in a sweetened solution of water and alcoho). Transdermal Many drugs can be absorbed through the skin, Drugs to be administered to the skin aro manufactured in tho form of lotions (liquids appliod ‘externally, iniments (liquids generally applied to the skin with fiction), ointments (semisolid, somewhat ‘easy preparations), and patches (or example, those used to control motion sickness, heart pain, or smoking). Via Mucous Membranes Certain lotions and liniments are applied tothe oral mucosa (the gums, for example), while some pills and tablets (nitroglyverin, for example) are meant to be held under the tongue or between the cheek and gum until the medicine is absorbed. Other medications are administered by suppository, a small solid mass shaped for easy insertion into the vagina, rectum, or urethra. The suppository melts at body temperature and roleasos a drug that is absorbed through the mucous membrane Drugs may also be given by enema or dowche— flushed jn liquid form over the mucous membrane of the rectum or vagina, respectively. Some drugs are aiven by inhalation to be absorbed through the nasal Tucosa; nonprescription antihistamines ere a common example Injection For relatively quick action, some drugs can be injected by needle oF catheter into specific tissues: the _hypodermis (subcutaneous, or hypodermic, injection); the muscles (intramuseula [LM injection); the veins (intravenous [1LV.] injection, or infusion); the vertebral canal (spinal injection); or the peritoneal cavity (intraperitoneal [LP.| injection). Types of Drugs Drugs can also be classified as either topical ot systemic. A topical modication is applied externally to 2 specific region to be treatsd, such as an ointment used 19 treat inflammation or skin infections. A systemic medication is administered orally, by injection, or in other ways intended to distribute the «rug throughout the body. (Some topical medicines become generally distributed after they are absorbed ‘through the skin.) Still another way to classify drugs is by their intended effect. Table 3.2 lists several clases of drugs defined according to the You will encounter these terms again as we discuss specific diseases and their treatments in subsequent chapters of| this mara,Table 3.2 Classification of Drugs by Their Intonded Effect Procuces physiological action by binding to receptor fora naturally oceuring substance. pain by abolishing all sonsory perception, citer locally (local anesthetic) or by Extracted from molds or bacterin prevents other microorganisms from multiplying. Ago Analgesic Relieves pain without easing unconsciousness. Anesthetic Roti Producing unconsciousness (general anesthetic) Anthelmintic Destroys parasitic wortns or enables the body to expel them, Antibiotic Anticongant Inhibits blood clotting. ‘Aotidepressant CCounteracts depression and thus elevates mood, Antiistarine Aatiindlammatory drug CCounteracts the effects of histamine and thus relieves concitions such as congestion and allergy, I ts inflammation, Relieves congestion or swelling of tissue due to fluid, Increases urine output aten used to lower blood pressure. Antipytetic Reduces fever Anticussive Relieves coughing, Decongestant Diuretic Expectorant Immonosuppeessant Promotes bronchial secretion and facitates the expulsion of mucus rom the respiratory trac nbibits the immune response; often used to reduce the body's tendency te reject an organ transplant or tissue gra, Interferon ‘A glycoprotein that inhibits the replication of viruses and enhances the komme response; sed ‘to treat some Forms of cancer and viral infections. Laxative Mildly sticaulates bowel motility snd promotes defecation. Sedtive Inhibits nervous activity or nervous stimulation of a particular organ—for example, a respiratory, gnste, or cardiac sative, Teanquiizer ras a calming or soothing effect without a sedative or depressant effet. Pharmaceutical Abbreviations therefore varios from one substance to another. For Pharmacenties is the science of dig. preparation, dosage, and administration, A pharmacist (Qruggist, apothecary) bas a specialized knowledges. of ‘the properties and interactions of drugs anki is licensed to prepare and dispense them, ‘Table 3.3 lists some symbols used «© specify drug quantities. About 20 drops of water make 1 mL. Three teaspoons make a tablespoon, and § teaspoons make a fhuid ounce; a fluid dram is 1 tsp. or 1/8 ox, A minim is 1460 of a ‘uid dram. ‘An international uni ([U) is @ quantity variously defined for different substances—especially fat- soluble vitamins, enzymes, hormones, and vaocines-— by the Intemational Conférence for the Unification of Formulae. It is defined by its biological effect and ‘enzymes, an IU isthe amount of enzyme that produces 1 ole of product pet iminute under standard conditions of temperature, pH, and substrate concentration, For various hormones, an IU is the amount that produces a physiological effect equal 10 that ofa specified quantity (uch as 1 yg or | mg) ofa puritied hormone preserved at a specified institution 19