Pharmac ology NUR 3050 Fall 2022 Adrian Week 1 - Intro to pharm ↑ August 15-19, 2022 Chapters 1,2,3,4,6 Color code key Definitions Headers Illustration Page Subparts Topic & Date Definition Pharmacology : is the study of the biological effects of chemicals. The 4 sources of drugs Natural d .. - Plant Animal - Synthetic- Drug evaluation Preclinical Trials: Chemicals tested on laboratory animals Phase I Studies: Chemicals tested on human volunteers Phase II Studies: Drug tried on informed patients with the disease Phase III Studies: Drug used in vast clinical market FDA Approval: Drug evaluated by FDA; if approved, may be marketed Phase IV Studies: Continual evaluation of the drug Page 7 1.2 - 1.3 The 5 drug pregnancy categories Page 11 Box 1.1 Category A: Adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy, and there is no evidence of risk in later trimesters. Category B: Animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women, or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy, and there is no evidencef of risk in later trimesters. Category C: Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in humans; the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks, or there are no animal reproduction studies and no adequate studies in humans. Category D: There is evidence of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks. Category X: Studies in animals or humans demonstrate fetal abnormalities or adverse reactions; reports indicate evidence of fetal risk. The risk of use in a pregnant woman clearly outweighs any possible benefit. 7 Drugs and Pregnancy Category A B C D X Animal Human The 5 classes of controlled substances Page 12 I: High abuse potential, no accepted medical use (heroin, marijuana, LSD) Box 1.2 II: High abuse potential, severe dependence liability (narcotics, amphetamines, and barbiturates) III: Less abuse potential than schedule II, moderate dependence liability (nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics) IV: Less abuse potential, limited dependence liability (sedatives, anti anxiety agents, and no narcotic analgesics V: Limited abuse potential, over the counter drugs Sources of drug info Package inserts Label Reference books Journals Internet Definition Pharmacodynamics : the study of the interactions between components of living systems and foreign chemicals that enter the body. Pharmacokinetics : study of the absorption, distribution, metabolism (biotransformation), and excretion of drugs Critical Concentration : The amount of a drug that is needed to cause a therapeutic effect Loading Dose : A higher dose than that usually used for treatment Dynamic Equilibrium : The actual concentration that a drug reaches in the body Factors affecting drug effect Weight Immunological Factors Age Psychological Factors Gender Environmental Factors Physiological Factors Tolerance Pathological Factors Accumulation Genetic Factors Interactions Types of adverse effects Primary Actions Table 3.1 - Page 37 Overdose; extension of the desired effect Secondary Actions Undesired effects produced in addition to the pharmacologic effect Hypersensitivity Excessive response to primary or secondary effect of drug Drug Allergy Body forms antibodies to a drug, causing an immune response when reexposed Anaphylactic Cytotoxic Serum sickness Delayed reactions Page 28-29 Drug-Induced Tissue and Organ Damage Dermatological Reactions Superinfections — Destruction of the body’s normal flora Blood Dyscrasia — Bone marrow suppression Toxicity Liver & Renal Poisoning Poisoning occurs when an overdose of a drug damages multiple body systems. Damage to multiple systems can lead to a fatal reaction. Treatment varies accordingly with drug Definition Teratogenicity: Any drug that causes harm to the developing fetus or embryo OTC Drugs Those “grandfathered in” not tested to the extent that new drugs are today Can mask the signs and symptoms of disease Can interact with prescription drugs Can be taken in greater than the recommended dose, leading to toxicity Over the counter The patients role Keep list of all medications: Rx, OTC, herbal Know what each drug is being used to treat Read labels, follow directions Store drugs in dry place, away from children and pets Speak up Children’s drug regimens Keep list of all child’s medications: Rx, OTC, herbal Never use adult medications to treat a child Read all labels before giving your child a drug Measure liquid medications using appropriate measuring devices Call healthcare provider immediately if child gets worse or has trouble with a drug Don’t hesitate to ask questions Alternative Therapies & Herbal Medicine #1 The active ingredient has not been tested by the FDA Incidental ingredients are unknown Patients do not always mention these therapies to their health care providers Drug–alternative therapy interactions may occur Fun facts Assessment will include History & Physical Examination Oral route most common route of medication administration but can affected by presence of food in the stomach The liver is the single most important site for biotransformation (metabolism). Kidneys play the most important role in excretion of medication Week 2 - Infection o August 22nd - 26th Chapters 7-11 Antiinfective Activity Bactericidal – kill the cell Bacteriostatic – prevent reproduction of the cell Narrow Spectrum of Activity - Effective against only a few microorganisms with a very specific metabolic pathway or enzyme Broad Spectrum of Activity - Useful in treating a wide variety of infections ⑧ The first step in treating a infectious agent Human Immune Response Goal of antiinfective therapy is reduction of the population of the invading organism. Drugs that would eliminate all traces of any invading pathogen might be toxic to the host as well. Immune response is a complex process involving chemical mediators, leukocytes, lymphocytes, antibodies, and locally released enzymes and chemicals. Treatment of Systemic Infections Identification of the infecting pathogen is done by culture Sensitivity testing to determine which drugs are capable of controlling the particular microorganism Combination therapy Use of a smaller dosage of each drug Some drugs are synergistic - I In infections caused by more than one organism, each pathogen may react to a different anti-infective agent Sometimes, the combined effects of the different drugs delay the emergence of resistant strains Resistance Natural or acquired: Ability over time to adapt to an anti-infective drug and produce cells that are no longer affected by a particular drug. Antiinfectives act on specific enzyme system or biological processes. Producing an enzyme that deactivates the antimicrobial drug Changing cellular permeability to prevent the drug from entering the cell Altering transport systems to exclude the drug from active transport into the cell Altering binding sites on the membranes or ribosomes, which then no longer accept the drug Producing a chemical that acts as an antagonist to the drug 🤒 Antibiotics - Defined as: Chemicals that inhibit specific bacteria Made in three ways Chapter 9 (pages 98-140) Classes of Antibiotics By living microorganisms By synthetic manufacture Through genetic engineering Signs of Infection Fever Aminoglycosides Carbapenems Cephalosporins Fluoroquinolone Penicillins Sulfonamides Lethargy Slow-wave sleep induction Classic signs of inflammation (redness, swelling, Tetracyclines Antimycobacterials heat, and pain) Bacteria Classification Gram-positive - The cell wall retains a stain or resists decolorization with alcohol Gram-negative - The cell wall loses a stain or is decolorized by alcohol Aerobic - Depend on oxygen for survival Anaerobic - Do not use oxygen Antivirals # E Chapter 10 (Pages 141-169) . Viruses that respond antiviral therapy Influenza A and some respiratory viruses Herpes viruses Cytomegalovirus (CMV) Human immunodeficiency virus (HIV) that causes acquired-immune deficiency syndrome (AIDS) Hepatitis B and C Some viruses that cause warts and certain eye infections TAMIFLU T – Take as soon as symptoms are detected A- Assess for symptoms (fever, cough, fatigue, headache, weakness) M- Milk and food before medication to decrease GI irritability I – Immunization should still be taken – this med only decreases FLU symptoms; it doesn’t prevent FLU Characteristics of common viruses A virus cannot replicate on its own. It must attach to and enter a host cell. It then uses the host cell’s energy to synthesize protein, DNA, and RNA. Viruses are difficult to kill because they live inside our cells. Any drug that kills a virus may also kill our cells. House of shingles is haunted Consists of herpes zoster, chicken pox varicella zoster, herpes simplex, and the cytomegaly virus is most often repaired with drugs what include VIR in them. The house is haunted and shaky because the recipient of these drugs may experience a headache and shakes from chills. It’s enough to make you throw up. Antifungals How does fungus differ from bacteria? ↳ - 12 * Chapter 11 (Pages 171-183) Fungus Composed of a rigid cell wall made up of chitin and various polysaccharides, and a cell membrane containing ergosterol. Protective layers of the fungal cell make the organism resistant to antibiotics. Patients susceptible to fungal infections Patients with AIDS and AIDS-related complex (ARC) Patients taking immunosuppressant drugs Patients who have undergone transplantation surgery or cancer treatment Members of growing elderly population no longer protected from environmental fungi Systemic anti-fungals A culture should be obtained prior to prescribing antifungal agents. Patients on antifungal agents are typically immunosuppressed and should not be placed at additional risks for incorrect agent and toxic effects.
