PHARMACOTHERAPHY

Lecture Outline

Definition
Pharmacotherapy
Drugs
Medicine
Sources of Drugs
Drug Nomenclature
Drug Classification
Non-Rx Drugs
Illegal Drugs

Sources of Drug Standards

Standards of Practice
Pharmaceutical Dosage

Forms
The Rx
Administration of
Medication
Drug action
Drug Effects
Sources of Drug
Information

Pharmacotherapy
application of drugs in the prevention,

treatment or diagnosis of disease and their

use in purposeful alteration of normal
functions

Pharmacotherapy
division of Pharmacy which correlates

pharmacokinetics and pharmacodynamics

aspect.

 Pharmacokinetics- The study of the

absorption, distribution, metabolism, and

excretion (ADME) of drugs by living
organisms.
Pharmacodynamics- The study of the
biochemical and physiologic mechanisms
of drug action.

Drugs
chemical substances that have an effect on

living organisms.
Therapeutic drugs often called medicines, are
those drugs used in the prevention or treatment
of diseases.
Up until a few decades ago, dried plants were
the greatest source of medicines; thus the word
drug was applied to the active ingredient.

Drug vs Medicine
Drug
any substance that alters physiologic function
w/potential for affecting health.
Refers to active ingredient
Could be poison

Medicine
drug administered for therapeutic effects
Refers to active + inactive ingredients
All medications are drugs
Not all drugs are medications

Sources of Drugs
Drugs are obtained from many sources.
1. Natural Sources:

Hormones, alkaloids, vaccines, and antibiotics come

from living organisms; Chemotherapeutics are from
many inorganic materials, such as metals.
Other examples:
Plants - digitalis and opium
Animals - insulin and thyroid
Minerals or mineral products - potassium, chloride, and lithium
carbonate

Sources of Drugs
Drugs are obtained from many sources.

2. Other drugs are synthetic or semisynthetic.

- Synthetics are often more effective and less toxic than the naturally
obtained substances and are easier to prepare in standardized units.

Synthetic chemical compounds - barbiturates, sulphonamides, and aspirin.

Biotechnology - genetically engineered pharmaceutical products

Drug Nomenclature
Drugs used as therapeutic agents may be

conveniently divided into two main groups:

(1) nonprescription drugs
(2) prescription drugs

Drug Names: Chemical Name

exactly the chemical constitution of the

drug and the exact placing of its atoms or

molecular groupings.
chemical name composition of the drug by
its molecular structure
Example: acetylsalicylic acid

Generic Name
(Nonproprietary Name)
provided by the United States Adopted

Names (USAN) Council

Is equivalent to the same drug with a brand
name, but is less expensive
Example: Aspirin

Drug Name: Official Name

name under which the drug is listed by the

U.S. Food and Drug Administration (FDA).

FDA- empowered by Federal Law to name
drugs for human use in the U.S.

Trademark (Brand Name)

followed by the symbol . This indicates

that the name is registered and that its use is

restricted to the owner of the drug, who is
usually the manufacturer of the product.
Should have a consistent bioavailability
More easily recognized by appearance.
Example: Bayer

Drug Classifications
Drugs may be classified:
1. According to the body system they affect
2. According their therapeutic use or clinical indications

3. According to their physiologic or chemical action

4. According to prescription or non-prescription drugs

Drug Classification Indicates

Effect on a body system
Symptoms relieved
Desired effect

Classification of Drugs
(effect on the body system)
Nervous System Skeletal

Muscle Relaxants
Nervous System
Stimulants
Respiratory Antitussives,
Expectorants, and
Mucolytics
Respiratory Smooth
Muscle Relaxants
Skin & Mucous
Membrane Agents and
Enzymes

Joint Drugs
Blood Coagulants
Anticoagulants
Hemorrheologic Agents

Dental Agents
Ears, Eyes and Nose

Vasoconstrictors
GI Enzyme and Acid
Agents
Gastrointestinal Muscle
Movement Agents
Genitourinary Muscle
Relaxants

Classification of Drugs
(Clinical indications or therapeutic uses)
Laxatives

Antihypertensives

Antibiotics

Mucolytics

Analgesics
Antitussives,

Classification of Drugs
(physiologic/ chemical action)
Glaucoma Agents
Adrenal agents

Glucocorticoids
Mineralocorticoids

Pituitary Agents
Reproductive Agents
Thyroid Agents
Adrenergic Agents
(Sympathomimetic)

Anticonvulsants,
Sedatives & Hypnotics
Tranquilizers
Cholinergic and
Anticholinergic Agents
Serums, Toxoids, &
Vaccines
Vitamins and Caloric
Agents

Classification of Drugs
(physiologic actions/ chemical actions)

Antineoplastic Agents
Cardiac Muscle Drugs
Diuretics
Antihistamines
Anti-Infective Agents
Antifungal Antibiotics
Anti-Inflammatory
Agents
-Steroids
-Non-steroidal Agents

Non-Prescription Drugs
over the counter medications (OTC)

which can be purchased by anyone.

No Rx needed
Examples: Tylenol, Maalox, Tums

Illegal Drugs
Illegal drugs- recreational drugs
Drugs and chemical substances used for

non-therapeutic purposes
Obtained illegally or have not received
approval for use by the FDA

Sources of Drug Standards

United States Pharmacopoeia

USP verifies the identity, strength, purity,

and quality of dietary supplement finished

products, dietary supplement ingredients,
and pharmaceutical ingredients.

A National Formulary
a manual containing a list of medicines that

are approved for prescription throughout the

country, indicating which products are
interchangeable.

USP Dictionary of USAN and

International Drug Names
database contains more established drug

name listings than any other comparable

resource.

Drug Standards Ensure

Strength or potency
Purity
Efficacy
Safety

Bio-availability

Standards of Practice
Information for Administering Medications
Generic Name/Trade Name/Classification
Clinical Uses/Safe Dosage
Mechanism of Action
Side Effects/Adverse Effects
Contraindications/Precautions
Significant Drug Interactions
Monitoring Needs/Patient Education
Evaluation of Effectiveness

Pharmaceutical Dosage
Forms
Drug substances are seldom administered

alone, but rather as a part of a formulation

in combination with one or more no medical
agents that serve varied and specialized
pharmaceutical functions.

Types of Dosage Forms

Syrups

Creams

Elixirs

Ointments

Suspensions

Suppositories

Emulsions

Aerosols

Capsules

Parenteral

Tablets

Introduction to Drug Dosage

Prescription
comes from the Latin "praescriptus"

compounded from "prae", before + scribere,

to write = to write before.
Historically, a prescription was written
before the drug was prepared and
administered.

Parts of a prescription
The superscription (or heading) with the

symbol R or Rx which stands for the word

Recipe meaning (in Latin) to take or
take thou;

The Rx
The inscription which contains the names

and quantities of the ingredients;

The subscription or directions for
compounding the drug to the pharmacist
Transcription- signa, direction to patient
The signature which is often preceded by
the sign s. standing for signa, mark, giving
the directions to be marked on the
container.

Administration of
Medications

Route of administration
the path by which a drug, fluid, poison or other

substance is brought into contact with the

body.
Mode of drug administration affects the rate at
which onset of action occurs and may affect
the therapeutic response that results
crucial in determining the suitability of a drug

Routes of Administration
Enteral - drug administered along any

portion of GI tract
Sublingual, Oral, Buccal, Rectal, Nasogastric

Routes other than alimentary canal

IV, IM, ID, SQ, Instillation, Inhalation,
Topical, Transdermal,

Drug Action
biochemical

physiological
mechanisms by which
the chemical produces
a response in living
organisms

Three Phases of Action

Copyright 2003 by W. B. Saunders Company. All rights reserved.

First Pass Effect

Drugs given orally and absorbed from GI

tract
Carried to the liver
Extensively metabolized
Only part of the dose reaches systemic
circulation for distribution
Bioavailability -%of drug that reaches
systemic circulation

First pass/hepatic first pass

Enter liver first

Coumadin
Morphine
Lidocaine
Some NTGs

Drug Effects
Therapeutic effects (primary)
Side effects (secondary)
Adverse effects (secondary)
Toxic effects (secondary)

 Desired effect
Therapeutic effect-example
Adverse effect / Side effect
Harmful, undesirable response
Mild reactions to debilitating disease that can
become chronic

 Dose related or patient sensitivity

Drug allergy - patients immune system

identifies a drug as dangerous to the

body.must be destroyed or neutralizedmild itching to life threatening

Adverse drug reactions

any noxious unintended and undesired

effects of a drug that occur at doses used for

prevention, diagnosis or treatment.

ADR
Type A reactions
AUGMENTED
Predictable, common and related to

pharmacological action of the drug

ex. Side effects, secondary effects, drug
interaction

ADR
Type B reactions
BIZAARE
Unpredictable, uncommon, usually not

related to the pharmacological actions of

the drug.
ex. Idiosyncratic reaction,
pseudoallergenic, hypersensitivity

ADR
Type C reactions
CONTINUOUS
associated with long-term drug therapy

e.g. Benzodiazepine dependence and

Analgesic nephropathy.
are well known and can be anticipated.

ADR
Type D reactions
DELAYED
refer to carcinogenic and teratogenic

effects.
are delayed in onset and are very rare since
extensive mutagenicity and carcinogenicity
studies are done before drug is licensed.

ADR
Type E reactions
ENDING OF USE
Withdrawal syndromes
Alcohol (delirium tremens)
Barbiturates (restlessness, mental confusion,
convulsions
Opioids (narcotic withdrawal)

ADR
Type F reactions
FAILURE OF EFFICACY
Result of imperfect or counterfeit

manufacture of the product.

Examples of failed efficacy:
Failure to control infection
Uncontrolled HPN
Intractable pain

 Idiosyncratic response

Something out of the ordinary

Sensitivity related adverse reactions.

Specific to the individual patient
Sometimes has genetic cause
They don t know

Idiosyncratic Reactions vs.

Allergic Reactions
idiosyncratic reaction--an uncharacteristic,

non-immunological response to a drug that

is not related to its pharmacological actions
allergic or hypersensitivity reaction-immunologically mediated

Toxic Reactions
--Occur in response to high dose or longterm use but may occur with normal
doses if drug elimination is impaired.
--May cause organ dysfunction, blood
disorders (physiological toxicity) or
behavioral changes (behavioral
toxicity).

Toxicity vs. Carcinogenicity

Toxicity--something that will make you

sick, either right away or later.

Carcinogencity--will cause cancer, which
maybe the results of being exposed to
something toxic.

Allergic Reactions vs. Nonallergic drug reactions

In a drug allergy, your immune system

mistakes a medication for a disease-causing

agent.
Nonallergic drug reactions have a wide
variety of causes, including the drug's
intended mechanism of action.

Allergic Reactions
Indicated by skin reactions ranging from

mild rashes to flaming red patches of hives.

More severe reactions cause facial
swelling, shortness of breath or dizziness.
Anaphylaxis (rare)--an extremely severe
allergic reaction in which blood pressure
may fall rapidly and the throat may rapidly
swell shut, cutting off the airway.

Hypersensitivity
allergic response to a drug after it has been

used more than once

May cause rash, swelling, fever, or, in the
worst cases, anaphylactic shock
(hypotension, bronchospasm, blocking or
airways).

Carcinogencity
study to determine the propensity of a drug

to produce or exacerbate tumors or cancer

cells in humans or animals

Teratogenicity
study to determine whether a drug can cause

physical defects in a developing embryo.

Common or Serious Side Effects

CNS effects
Gastrointestinal effects
Hematological effects
Hepatotoxicity
Nephrotoxicity

 Allergic or hypersensitivity reaction

Drug fever
Idiosyncratic reaction
Carcinogenicity
Teratogenicity
Drug dependence
Drug tolerance

Sources of Drug Information

Pharmacology textbook
Pharmacists
Internet sources
Journal articles

Drug reference books

What you should know

about drugs