PHARMACOTHERAPHY

UST Faculty Of Pharmacy

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

pharmacodynamics with the pathologic

physiology or microbiologic or biochemical
aspect of disease

 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.

Drug vs Medicine
Drug
any substance that alters physiologic
function w/potential for affecting health
Medicine
drug administered for therapeutic effects
All medications are drugs
Not all drugs are medications

Sources of Drugs
from many sources.

from living organisms

- Many inorganic materials:

* metals, are chemotherapeutic
*hormones, alkaloids, vaccines, and antibiotics
Other 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.

Sources of Drugs
Plants - digitalis and opium
Animals - insulin and thyroid
Minerals or mineral products - potassium,
chloride, and lithium carbonate

Synthetic chemical compounds - barbiturates,

sulfonamides, and aspirin.

Biotechnology - genetically engineered

pharmaceutical products ( vaccines)

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

- exact placing of its atoms or molecular
groupings.
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 which indicates:

- name is registered
- use is restricted to the owner of the drug,
manufacturer of the product.
Consistent bioavailability, more easily
recognized by appearance.
Example: Bayer

Drug Classifications
Drugs may be classified according to the body

system they affect

by their therapeutic use or clinical
indications
Ex. Antacids, Antibiotics, Antihypertensive,
Diuretics, Laxatives
using the physiologic or chemical action
as prescription or non-prescription drugs

Drug Classification Indicates

Effect on a body system
Symptoms relieved
Desired effect

Classification of Drugs

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

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
Glaucoma Agents
Adrenal agents
Glucocorticoids
Mineralocorticoids

Pituitary Agents
Reproductive Agents
Thyroid Agents
Nervous System
Adrenergic Agents
(Sympathomimetic)

Nervous System

Anticonvulsants,
Sedatives & Hypnotics
Tranquilizers
Nervous System
Cholinergic and
Anticholinergic Agents

Classification of Drugs
Nervous System Skeletal

Muscle Relaxants
Nervous System
Stimulants
Pain Agents -also known
as Analgesics
Respiratory Antitussives,
Expectorants, and
Mucolytics

Respiratory Smooth

Muscle Relaxants
Serums, Toxoids, &
Vaccines
Skin & Mucous
Membrane Agents and
Enzymes
Vitamins and Caloric
Agents

Non-Prescription Drugs
over the counter medications (OTC)

which can be purchased by anyone.

No Rx needed
Examples: Tylenol, Maalox, Tums

Illegal Drugs
recreational drugs
used for non-therapeutic purposes
Obtained illegally or have not received

approval for use by the FDA

Sources of Drug Standards

United States Pharmacopoeia

verifies the:
identity,
strength,
purity, and
quality of:
- dietary supplement finished products,
- dietary supplement ingredients
- pharmaceutical ingredients.

A National Formulary
a manual containing:
a list of medicines
approved for prescription throughout the
country,
indicates which products are
interchangeable.

USP Dictionary of
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,
a part of a formulation in combination with
one or more no medical agents
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)

- symbol R or Rx which stands for the word

Recipe, meaning (in Latin) to take;

The Rx
inscription

- contains the names and quantities of the

ingredients;
subscription
- directions for compounding the drug
signature
- 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

- 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

Parenteral - any med route other than

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

Drug Action
biochemical

physiological
mechanisms
(pharmacodynamics)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/peculiar 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 long-term 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

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)
- 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