Introduction to Pharmacology Study Guide

Chapter 3 & 4

Pharmacology: The study of all drug information

Therapeutics: appropriate use of drugs for targeted medicinal use

Pharmacokinetics: study of the absorption, distribution, metabolism and excretion of drugs from the
body

Toxicology: study of the symptoms and treatment of poisonous effects and side effects

Pharmacognosy: study of natural sources of drugs and herbs

Drug: A substance taken in the body or applied for altering the body’s biochemical functions

Indications: Common intended use of drugs

Contraindications: Situations in which drugs should not be used because it will be harmful to the patient

Drug interactions: when a drug affects the intended indication of another medication or reacts poorly
about it.

Side effects: Unintended reaction to drugs

Bioequivalent: Drug that is both pharmaceutically equivalent and therapeutically equivalent, though not
necessarily identical in appearance.

Pharmaceutically equivalent: Contains the same amount of active drug in the same dosage form with
the same time release characteristics.

Therapeutically equivalent: Provides the same medicinal benefit at the same dosage rates with the same
degree of safety under the conditions specified in the labeling.

The FDA Orange Book: official legal source on drug substitution

Biological drugs (genetically engineered drugs): come from a variety of live or once-live sources including
animals, humans, and microorganisms such as bacteria and cannot be chemically reproduced with
exactitude

Biological reference product: in biological drugs, original version or brand name drug known as
the biological reference product, generic version known as biosimilar

Interchangeable biological drug: drug must be both biosimilar and therapeutically equivalent
to reference drug

The FDA Purple Book: best source on biologic drugs their substitutions

Types of drugs: prescription, over-the-counter (OTC), supplements, and homeopathic

Prescription drugs: only available with a written prescription from prescriber

Central
Nervous Analgesic and Anti-Inflammatory Agents
System (CNS)  Drugs to treat pain: non-opioid pain relievers, opioid pain relievers (also
Agents (brain known as narcotics), anti-inflammatory agents, other adjuvant medications.
meds)  Narcotics induce:
 analgesia, relieving or reducing pain
 sedation, allaying anxiety and causing drowsiness
 euphoria, producing feelings of extreme high mood and energy
 dysphoria, developing feelings of anxiety, disordered thoughts,
hyperfear, restlessness, malaise, or hallucinations
 DEA restricts access to controlled substances
 Example: limiting the number of permitted refills
 Some narcotics more addictive than others:
 DEA Schedule II > Schedule III > Schedule IV > Schedule V
 Refills on C-IV controls must occur within 6 months of the prescription
date.
 C-II controls. No refills are allowed. A new prescription is required each time
it is filled.
Antianxiety and Hypnotic CNS Agents

 Also known as psychoactive drugs

 Moderate potential for addiction, classified as C-IV controlled substances
 Hypnotic medications: induce sleep, e.g., zolpidem (Ambien), eszopiclone
(known as “Z-drugs”)
 CNS depressants—similar limitations as narcotic pain medications (e.g., do
not mix with other psychiatric medications, OTC sleeping medications, or
alcohol)
 Antianxiety medications: treat anxiety, panic attacks, seizures, and
insomnia, e.g., lorazepam (Ativan), diazepam (Valium), clonazepam,
alprazolam (known as “benzos”)

Antipsychotic and Antidepressant Agents

 Antidepressants: provide relief from depression by acting on

neurotransmitters in brain
 Serotonin affects memory, mood, appetite, sexual desire and function; too
little may lead to depression
 Norepinephrine “stress hormone” helps address challenges with increased
breathing, blood pressure, and sugar levels; too much can lead to
overstressing system and psyche
 Dopamine associated with movement, desire, motivation, pleasure,
enjoyment
o CNS depressants—should not be mixed with other CNS depressants
such as narcotics, alcohol

 Limit use to short-term if possible, use lower doses to treat older individuals
 Antidepressants: Increase risk of suicidal thoughts and behavior in children,
adolescents, and young adults, thus carry black box warning
 Antipsychotics: may cause or aggravate diabetes and high cholesterol,
potential cardiovascular adverse reactions in older patients; immediately
notify physician of rigidity, tremor, or involuntary muscle twitching
 Antidepressants and antipsychotic medications should not be discontinued
abruptly.
Cardiovascular Antihypertensive Agents
Agents (heart  Calcium channel blockers such as amlodipine (Norvasc) dilate blood vessels.
meds)  Beta blockers such as atenolol (Tenormin) slow heart rate. Generic drug
suffix ends with “ olol”
 Diuretics such as hydrochlorothiazide reduce water retention and
increase salt elimination
 ACE inhibitors such as lisinopril and ARBs such as losartan
hamper production of an enzyme that constricts blood vessels.
 ACEIs generic drug suffix ends with “ pril”
 ARBs generic drug suffix ends with “sartan”
 Complications of untreated or undertreated hypertension include
kidney failure, stroke, heart attack.
 Dangerous Drug Interaction: Patients who are prescribed nitrates should
not use erectile dysfunction drugs such as sildenafil (Viagra) because the
combination can cause a dangerous drop in blood pressure.
Antihyperlipidemic (Cholesterol-Lowering) Agents
 Elevated cholesterol: important risk factor for hypertension, general heart
disease
 Cholesterol consists of
 LDL (low-density lipoprotein) aka bad cholesterol
 HDL (high-density lipoprotein) aka good cholesterol
 triglycerides (three fatty acids combined)
 Statins prevent production of “bad cholesterol” by blocking key enzyme in
the liver that makes it (HMG-CoA Reductase). Generic drug suffix ends with
“statin”
 Statins should not be taken with grapefruit juice as this will increase risk of
side effects (muscle fatigue aka rhabdomyolysis)
 Digoxin (Lanoxin) (derived from foxglove plant) helps weak heart beat
stronger.
 Toxic at high doses, blood levels monitored periodically
 Toxic effects: nausea, vomiting, abnormal heart rhythms
Anti-Infective  Microorganisms: living beings, adapt to drug agents become resistant, or
Agents immune
(infection  Patients should take full dosage for entire course of treatment, should not
meds) quit taking the prescription when symptoms stop
 Common side effects: Gastrointestinal side effects, such as diarrhea
 Influenza can be treated with oseltamivir (Tamiflu).
o Maximum benefit is achieved if treatment is initiated within 48
hours of onset of symptoms.

Endocrine and  The endocrine system: network of glands that secrete the hormones to
Metabolic regulate bodily functions, including metabolism, or the processes of
Agents producing energy from nutrition
(hormonal Estrogens and Birth Control Agents
meds)
  Most birth control medications contain combinations of an estrogen and a
progestin (a synthesized progesterone) to simulate pregnancy and thereby
prevent ovulation.
 Most birth control therapies include 3 weeks of active medication and 1
week of placebo.
 Some packets contain tablets with varying hormone amounts for each week
of the month.
 Antibiotics may interfere with birth control pills

Antidiabetic Agents
 Diabetes is caused by an insufficient amount of the hormone insulin being
secreted by the pancreas for sugar processing.
 Type 1 diabetes (aka Juvenile diabetes)- treated with insulin
 Type 2 diabetes, most common. Treated with nutrition and lifestyle
changes, oral medications, and/or insulin injections.
  Bisphosphonates such as alendronate (Fosamax)
 Usually taken weekly
 Must be taken first thing in the morning (to increase absorption)
 Should be taken with water, while in an upright position, in order to
minimize esophageal erosions.

Respiratory  Drugs used for asthma and COPD provide relief by opening the airways.
Agents
(breathing
meds)

 Albuterol (ProAir inhaler) is fast acting, should be used for acute attacks
o Side effects include increased heart rate, blood pressure.
  Ipratropium (Atrovent) is a fast-acting anticholinergic, used in COPD and
severe asthma.
Gastrointestina Gastrointestinal agents are used to treat heartburn, ulcers, gastroesophageal reflux
l Agents disease (GERD)
(stomach  Drugs used for these conditions:
meds)  proton pump inhibitors (PPIs) generic name suffix ends with
“prazole”
 histamine-2 antagonists generic name suffix ends with “tinidine”

Renal and  Drugs in this group treat hypertension, enlarged prostate, erectile
Genitourinary dysfunction, and other conditions.
Agents  Diuretics (“water pills”) act on the kidneys to eliminate excess salt and
water in the body.
 Treat hypertension and other heart conditions such as heart failure
 Most common diuretics: hydrochlorothiazide
(Microzide), furosemide (Lasix)
 Cause potassium loss, so potassium supplementation may
be needed
 Enlarged prostate is treated with tamsulosin (Flomax), finasteride (Proscar),
others
 Tamsulosin relaxes the prostate and bladder-neck muscles, making it easier
to urinate.
 Finasteride reduces the production of the sexual hormone that enlarges the
prostate
Hematologic  Hematological drugs are used to alter blood cell production, quality, and
Agents decrease clotting.
 Warfarin (Coumadin): a blood thinner that is used both short- and long-
term to prevent blood clots in high-risk patients.
o It works by inhibiting vitamin K–dependent clotting factors.
o Diet can affect the efficacy of warfarin: patients who take warfarin
must maintain a stable intake of vitamin K, which is found mainly in
green vegetables.
o Warfarin patients must be monitored on a routine basis with a
blood test (the international normalized ratio [INR]) to measure
how well their blood is clotting.

Drug  Product Package Insert

References  Micromedex
 Facts and Comparison
 Physician Desk Reference (PDR)

Drug Therapeutic- treat a medical condition
classifications Prophylactic- prevent a medical problem example vaccines
Diagnostic – dyes or chemical used to diagnose a medical condition example
contrast
 Destructive drugs- kill specific organisms or cells example chemotherapy
Major Scientic  Small pox -first vaccine discovered by Dr. Edward Jenner
Discoveries  Germ theory- rench scientist Louis Pasteur proved that diseases can be
caused by germs/microorganisms. Surgeons began to use chemicals to
sterilize wounds; cleanliness improved in hospitals.
 In 1897 Ronald Ross showed that mosquitoes transmitted infectious
diseases such as malaria.
o Mosquito netting became a tool for preventing infection, along with
quinine and vaccines.
o Rodents can transmit bubonic plague.
o Deer ticks carry Lyme disease.
 German physician Robert Koch isolated microbes causing anthrax,
tuberculosis, cholera in the 1880s, 1890s.
 Penicillin- First antibiotic discovered by Dr. Alexander Fleming
 Polio Vaccine discovered by Dr. Jonas Salk
 In 1920 insulin isolated by Canadians Frederick Bantin and Charles Best
 1960 first birth control approved
 Thorazine – first drug for mental health - schizophrenia
Active  Biochemically active components
Ingredient  Exert desired effects (e.g., eradicate bacteria, lower blood pressure)
Inert  Inactive ingredients
Ingredient  Ensure stability, preserve drug
 Provide a vehicle for the active ingredient, such as a cream
Prescription  FDA responsible for ensuring approved drugs are both safe and effective
Drug Approval
Process

 Abbreviated New Drug Application (ANDA)

o Generic drugs are approved by FDA via this process.
o Not required to include preclinical and clinical data to establish
safety and effectiveness
National Drug  10–11 digit number that identifies a drug (OTC drug or prescription drug)
Code Number
(NDC)

 Four to five digit labeler code identifying the manufacturer or distributor

 Three or four product code identifying the drug (active ingredients and
dosage form)
 One or two digit package code identifying the package size and type