BHS 254.1 – General Pharmacology
Notetaker: Sharonda Q. Bradley
Date: 08/13/2013, 1st hour
Page1
General Definitions
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Pharmacology: The study of the interaction of chemicals with biological systems
o
Not just limited to drugs, but includes all chemicals that interact with biological systems
o
Has a very broad definition and incorporates many disciplines
Drug: Any chemical that affects living processes
o
In optometry, must be able to understand all available drug options, how they work, why a
particular drug is used, and any associated toxicity
Areas of study under Pharmacology
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Pharmacodynamics
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What the drug does to the body
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The effect of the drug on the body (E.g. Raise BP,  Heart Rate, Miosis or Mydriasis
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Typically looks at drug-receptor interaction at location of interest (site of action)
Pharmacokinetics
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What the body does to the drug
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Events occurring in the body that will influence the concentration of drug at the site of action
o
Determines how much drug gets to the site of action for receptor interaction
o
Pharmacokinetics has a large impact on how a patient responds to a drug
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If too little drug is present at the site of action, an effect will not be observed
Therapeutics
o
Using a drug to treat disease
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Utilizing a drug to change normal physiology or state (i.e. birth control)
Clinical Pharmacology: Has more depth since it combines therapeutic benefits of drug with
pharmacokinetic features and bioavailability
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Toxicology
o
A subspecialty of pharmacology that focuses on the toxic effects of drugs and chemicals on
the body
BHS 254.1 – General Pharmacology
Notetaker: Sharonda Q. Bradley
Date: 08/13/2013, 1st hour
Page2
Why should you care about pharmacology?
1. Terms related to pharmacology need to be understood in order to comprehend literature of
optometry and medicine.
2. Important in understanding health and disease
o
Much of what we know about physiology comes from studying enodgenous chemicals
and hormones that are pertinent in normal physiology
3. Many drugs are given to patients. Must be able to explain a drug, why the patient is taking it and
any effects on vision.
4. One must know if for board certification (NBEO Part 1 and 2)
Case Study: Patient JR
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CC: Blurred Vision and Ocular Pain
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(+) Hypertension; Medication: Norvasc (amlodipine) 10mg, QD; allergic to aspirin
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BP: 160/85; Normal BP: < 120/ < 80
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POH: Posterior vitreous detachment OD, OS
o
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Spectacles for Myopia
Slip lamp examination: Cells (White Blood cells in the anterior chamber) and Flare (Exudates or
proteins that have leaked in anterior chamber). Injection of the conjunctiva
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Dx: Anterior Uveitis
What do we have to do for this patient?
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Treat anterior uveitis by addressing white blood cells and flare in the anterior chamber.
Flare
Injection
Cell
BHS 254.1 – General Pharmacology
Notetaker: Sharonda Q. Bradley
o
o
Date: 08/13/2013, 1st hour
Page3
Use Pred forte (Prednisolone acetate 1%) every 2 hours.
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Anti-inflammatory steroid
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Given at a high frequency in the beginning to decrease inflammation.
Homatropine 5% once a day (QD) or Atropine
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Cycloplegic (relaxes ciliary body muscle to relieve spasms,) and Mydriatic (dilates
pupil)
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Helps relieve a lot of ocular pain
What is Norvasc, how might it interact with any of the meds prescribed topically?
o
Norvasc is a calcium channel blocker. Decreases BP by Slowing Heart rate and Relaxing
Blood vessels.
o
Side effect and toxicity are used interchangeably. All considered Adverse Drug Reactions
(ADRs)
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Ocular Side effects of Norvasc: Blurred vision, conjunctivitis and diplopia (all
transient effects)
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o
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Non-visual side effects of Norvasc: Fainting, heart palpitations, lethargy, fatigue
No major interactions with meds prescribed topically
Sometimes a drug can be given because the side effects are therapeutic
o
E.g. Symdex; antihistamine. Drowsiness is a side effect and can be used as a sleep aid
Why isn’t JR’s BP under control?
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Has not been to PCP in a while. Needs to be re-evaluated.
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Review of Blood Pressure Chart
Systolic (mmhg)
Diastolic (mmhg)
Normal
< 120
< 80
Prehypertension
120 – 139
80 – 89
Stage 1 hypertension
140 – 159
90 – 99
Stage 2 hypertension
160+
100+
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Not taking Norvasc regularly potentially due to side effects.
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85% of people with high BP have essential hypertension, which means there is no known cause.
For patient JR, whatever is causing the high blood pressure problem could be getting worse
BHS 254.1 – General Pharmacology
Notetaker: Sharonda Q. Bradley
Date: 08/13/2013, 1st hour
Page4
What caused the anterior uveitis?
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Most times idiopathic.
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Could also be caused by trauma, infectious disease, systemic diseases (inflammatory collagen
disorders)
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All JR lab tests were negative
At 6 weeks:
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Still improving because less cells in anterior chamber.
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IOP is 20 and 24 mmHg OD, OS. Initial visit: 15 and 13 mmHg OD, OS
o
Is this an anomaly? Or is he a steroid responder?
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Rise in IOP is not likely caused by anterior uveitis because his condition is improving
o
Follow up in two weeks to monitor IOP (officially 2 months after initial treatment)
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IOP is still elevated. What do you do?
Clicker questions
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Pharmacodynamics is best described as:
1. What does the Drug do to the body
2. What does the Body do to the drug
3. The ever changing uses of drugs for therapy
4. The study of the duration of drugs effects
Answer: 1
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What pharmacologic type of drug is Norvasc?
1. Anti-inflammatory steroid
2. Pain reliever
3. Calcium Channel Blocker
4. Beta-adrenergic Blocker
Answer: 3