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ATTR 326
Clinical Drug Application
Pharmacology NoteBook
Drug Reference Sources
Physicians Desk Reference (PDR)
- Available for about 60 years
- New edition is published annually
- Not all drugs/medications will be listed in the PDR
o Must pay to be included in this publication
PDR Contents
White Pages: manufacturers index (and product information)
- List the drugs manufacturer, address, contacts, medications sold
etc. and the associated page numbers
- Lists the entries of over 3,000 various pharmaceuticals
alphabetically by the manufacturer
- Provides indications, contraindications, usages, adverse reactions,
warnings
Pink Pages: brand (trade) and generic name index
- All meds have a chemical name (long and difficult to pronounce) but
the generic name is shorter and derived from the chemical name
Ex) chemical name: (RS)-2-(4isobutylphenyl)-proplonic acid
generic name: Ibuprofen
brand name: Advil, Nuprin, Motrin (many companies
manufacture an identical generic product with different brand/trade
names)
- Generic names are listed followed by the brand name(s) with the
manufacturer listed in italics
Blue Pages: product category index
- Drugs are listed by category
i.e. analgesics, anesthetics, fertility, relaxants, etc.
Gray Pages: product identification guide
- Full color actual photo size of the various medications
- Drugs listed alphabetically by the manufacturer
Questions:
What happens when a patent expires on a drug?
When a patent expires on a drug, other companies may then
manufacture and identical
generic product
How long before a drug patent expires?
Drug patents expires after 17 22 years
How do you know that a generic medication is safe?
The manufacturer must prove that it is a chemical duplicate of the
original and have
bioavailability*
What happens to the name of a drug when a generic equivalent is
produced?
Companies must list a new trade name (most generic manufacturers
simply list the drugs generic name)
*Vocabulary:
Bioavailability: rate and extent of absorption into the bloodstream
Drug Sources
Traditionally drugs came from natural sources
- Plants
- Animals
- Minerals
Many medications today are synthetic
Synthetic meds usually are free of impurities
Synthetic: produce artificially through the combination of other
substances
Natural medications contain many impurities
Drug manufacturers can manipulate the molecular structure of synthetic
drug/medication to alter its chemical composition
- May make the drug effective against different organisms
Active Components of Drugs
- How the drug/meds provide strength and power to fulfill its purpose
Alkaloids: most active component in plants
- React with acids to form a salt that more readily dissolves in body
fluids
- Alkaloids and alsts usually end in the ine
Ex) caffeine, morphine, nicotine
Gums: gives the product ability to attract and hold water
Ex) seaweed and seed with starch
Resins: chief source is pine tree sap
- Acts as a local irritant, laxative or caustic* agent
Oils: volatile or fixed
Ex) Volatile: peppermint, spearmint, juniper
Ex) Fixed: dont evaporate as easily and include castor and olive
Castor: comes from a bean plant and irritates the intestines
- Sold as an OTC laxative
Midwife cocktail: castor oil and juice to induce labor
Body fluids or glands of animals are used to manufacture drugs such as:
- Hormones: insulin
- Oils and fats: cod liver oil
- Vaccines: microorganisms that are killed or modified
o Cows produce milk containing lactoferrin to treat human
infections
o Goats milk contains antithrombin III to prevent blood
coagulation
Other drug information:
- Minerals from nature in combination with other substances, are used
in iron iodine and Epson salts
- Drugs today produced in labs and may be all synthetic or
natural/synthetic combinations
- Also use DNA to alter genetic chain to develop bacteria to produce
insulin for humans
*Vocabulary
Caustic: burns your skin
Quinine: poisoning
Beta Blockers
o Used for long term prevention of angina and hypertension
Effects include decreased blood pressure, decreased
heart rate, and force of hearts contraction, thus
resulting in a lower demand of oxygen
Used by rifle athletes and banned by NCAA and USOC
NSAIDS may reduce the hypotensive effects of
betablockers
Used as prophylactic for migraines
Not good for asthmatic patients examples are
Lopressor and inderol
Antibiotics side effects and adverse reactions
- Nausea, vomiting, diarrhea
- Erythromycin is not as well tolerated as others
o s/s may range from a mild rash to anaphylaxis
- sulfa drugs can cause Stevens-Johnson syndrome
o rare but fatal hypersensitivity cutaneous skin reaction
o ttetracyclines may cause GI distress
eliminate if taken with food, increased sensitivity to UV
light, bad sunburn with moderate exposure
Athletics may also see ethyl chloride used cooling effect similar to ice
but is much quicker
- Use caution may cause frostbite
Examples of topical anesthetics
Benzocaine, Nupercainal, xylocaine
Nupercainal - hemorrhoids
General anesthtics
Injection and inhalation are the 2 types:
Infection used when anesthesia only needed for a short amount of time
out patient
- Promotes rapid anesthesia
Inhalation complex procedure of combined drugs
Needed to prepare, achieve and bring the patient back from
anesthesia
Pharmokinetics of inhalation enters from the lungs and distributed to
other tissues
- Most rapid to the heart, brain, liver and kidneys
- Eliminated primarily by the lungs
Pharmodynamics depresses the CNS, producing a LOC, loss of
responsiveness to sensation/pain and muscle relaxation
Side effects are lethargy, confusion, depressed breathing, hypothermia
Nitrous oxide and isoflurane are examples
Malignant hyperthermia
Sudden and lethal increase in body temperature
- Serious and unexpected to inhalation anesthetics
May also occur to athletes in hot/humid conditions
- Breakdown of muscle tissue due to lack of water intake, leads to
calcium inbalance and cellular damage
Non-Steroidal Anti-imflammatory Drugs (NSAIDS)
NSAIDS inhibit the boddys inflammatory response and produce several
effets:
- Analgesia: reduce pain
- Antipyresis: reduce fever
- Anti-coagulation: thinning of blood
- Anti-inflammatory
Five signs of inflammation:
- Pain, swelling, erythema, heat, loss of function
Inflammation and drug therapy
Vascular response to physiological tissue damage
Short period of vasoconstriction and then a release of what?
- Chemical mediators such as:
o Histamines
o Bradykinin
o Leukotrienes
o Prostaglandins
Causes vessel vasodilation, making them more permeable and allowing
WBC to enter the injury site
- With a membrane permeability, there is an increased flow of cellular
fluid causing edema (swelling)
Indomethacin (Indocin)
Strong COX inhibitor and one of the first NSAIDS to be developed in 1965
- Take with milk/food to minimize GI upset
- Abdominal discomfort, headaches, dizziness are side effects
Ketorolac (Toradol)
Newer NSAID that has been around 20-25 years
- Produces excellent analgesia similar to morphine and minimal side
effects (no side effects)
2 Precautions
Not on burns
3 Examples (Neosporin, Bacitracin)
Neomysin antibiotic, can be senstivit to use single entity
item then
Antiseptics broad range of activity, anti-bacterial, cleanse
1 Action
Cleanse wound
2 Examples (betadine)
Betadine iodine contained in, can be sensitive to hibiclens
Phisohex was popular in the 50s but wasnt washed off and
deaths occured
Antifungals
1 Action
2 Examples (tinactin, Desenex, micatin)
Fungistatic keep under control (foot powder) doesnt treat
Fungicidal killing (majority fall under this (tinactin))
Toe nail systemic (vicks vapo rub works well for toe fungus)
Antibiotics can allow overgrowth
Cannot be cured overnight, must be patient
Steroidal antiflammatory (can mask inflammation)
1 Action
2 Examples (Cortaid, Cortizone-10)
Can thin the skin (avoid face) - benydryl is a nice option
Emollients lubricant, lotion (to hydrate the skin)
1 Action
2 Examples (Vaseline, Eucerin, Lubriderm)
Vaseline best for lips (classic example)
Lanolin like vasoline, people can be sensitive to (red bumps)
Petroleum based is better vs water based or alcohol based
Aqua 4 good healing (not antibiotic) just moisturizing,
hydrating
Cleansing Agents not a lot of antibacterial
1 Action
2 Examples (hydrogen Peroxide, Isopropyl alcohol)
Water/saline work well
Ear Products wax or water in ears
1 Action
Thin wax hydrogen peroxide
Dry water - alcohol
2 Examples (Debrox, swim ear)
Eye Products dryness, allergies (red itchy), contacts
1 Action
2 Examples (Murine, Tears Naturale)
Eye wash (mild purified water, berolic acid) cleanse irritants
For allergies anti-histamines in eye drops (visine A)
Decongestant- vasoconstricts redness
Some people react to preservatives
Hydrate eyes at night
Dental Products tooth loss, ulcer, gums (keep clean & numb)
1 Actions
Quick but short durations
2 Examples (Anbesol, Orabase w/Benxocaine, Glyoxide)
Glyoxide peroxide based
Anbesol numbing
Orabase w/Benzocaine paste (numbing)
Extremely temporary, every couple hours
Bit tongue heals well on its own just keep clean
Gastrointestinal Products stomach diarrhea, constipation
1 Action
2 Examples (Kaopectate, Emetrol)
Emetrol works like pepto (carbohydrate base) eat with ice
chips
Imdium calms down, slows down diarrhea
Diarrhea - excess fluid
Outside environment, hydrate, sometimes dont treat let
resolve in 24 hours
Constipation lack of fluid
Look at diet, dehydration (add water, eat fruit), change
normal environment
Post-surgery medication to avoid constipation
Tums as calcium supplement more often than emergency
antacid
Pepto aspirin based, poor product (can cause irritation)
Respiratory Medications
Athsma, allergies, common cold, coughs are treated with different
medications
o Inhalers, decongestants, expectorants, antitussive, steroids
Antihistamines
FIN