Y khoa - Dược - Chapter 51: Principles of pharmacology

51Principles of Pharmacology51.1 Identify the medical assistant’s role in pharmacology.51.2 Recognize the five categories of pharmacology and their importance to medication administration.51.3 Differentiate the major drug categories, drugs names, and their actions.Learning Outcomes51.4 Classify over-the-counter (OTC), prescription, and herbal drugs.51.5 Use credible sources to obtain drug information.51.6 Carry out the procedure for registering or renewing a physician with the Drug Enforcement Administration (DEA) for permission to administer, dispense, and prescribe controlled drugs.Learning Outcomes51.7 Identify the parts of a prescription, including commonly used abbreviations and symbols.51.8 Discuss nonpharmacological treatments for pain. 51.9 Describe how vaccines work in the immune system.Learning OutcomesIntroductionPharmacology – science or study of drugsMedication errors can result in injury or deathMedical assistantKnowledge of the foundations of pharmacologyUnderstand role of drugs in ambulatory medical facilitiesMedical Assistant’s Role in PharmacologyPrescription drugs vs. OTC drugs The medical assistant shouldBe sure the physician is aware of all medications the patient is takingAsk patients about use of alcohol and recreational drugsProvide patient educationMedical Assistant’s Role in Pharmacology (cont.)To administer drugsCheck state regulations / scope of practiceUnderstand pharmacologic principlesTranslate prescriptionsAnswer basic patient questionsAdhere to legal requirementsKeep accurate recordsApply Your KnowledgeWhat is the role of the medical assistant in pharmacology?ANSWER: The medical assistant should be sure the physician is aware of all medications the patient is taking, including OTC medications; ask patients about use of alcohol and recreational drugs; and provide patient education. If the scope of practice permits, the medical assistant may also be responsible for administering some medications.Correct !PharmacologyDrug – chemical compound used to prevent, diagnose, or treat diseasePharmacology – study of drugs Pharmachologist – specialist in pharmacologyPharmacognosyPharmacologyPharmacodynamicsPharmacokineticsPharmacotherapeutics Toxicology Pharmacology (cont.)A physician prescribes a drug Administer a drug by any route that introduces it into the patient bodyA healthcare professional dispenses a drugSources of Drugs (Pharmacognosy)Natural productsPlants AnimalsMineralsBacteria and fungi Chemical development Synthesis of chemical makeup of a drugManipulation of genetic informationFoxglove – source of digitoxinPharmacodynamicsMechanism of action of a drug to produce a therapeutic effectDrugs are categorized based on mechanism of actionInteraction between drug and their target cells and the body’s response to the interactionPharmacokineticsWhat the body does to a drugAbsorption ~ conversion of a drug into a form the body can useDistribution ~ transportation of a drug from site of administration to site of actionPharmacokinetics (cont.)MetabolismDrug molecules are transformed into metabolitesAffected by age, genetic makeup, and characteristics of drugExcretionManner in which a drug is eliminated from the bodyMost via urinePharmacotherapeuticsIndication and labelingIndication Reason for using a drugMust be approved by FDA to be part of labelingLabeling ~ includes drug formOff-label prescribingPharmacotherapeutics (cont.)SafetyDetermined by adverse effects of a drugBe alert to patient complaints after starting a new drugEfficacy – drug is working as expectedPharmacotherapeutics (cont.)Kinds of therapy AcuteEmpiricMaintenancePalliativeProphylacticReplacement SupportiveSupplemental ToxicologyStudy of poisonous effects of drugsAdverse effects Drug interactionsPatient educationInform physician of any adverse effectsDiscuss concerns with physician or pharmacist Apply Your KnowledgeMatching:___ Study of poisons ___ Study of what the body does to drugs___ Used to prevent, diagnose, or  treat disease___ Study of what drugs do to the  body___ Study of how drugs are used to  treat disease___ Study of characteristics of  natural drug and their sourcesANSWER:FEDCBAImpressive!PharmacokineticsPharmacognosyToxicologyPharmacotherapeuticsPharmacodynamicsDrugsDrug Names and CategoriesDrug namesGeneric International nonproprietary nameChemical nameTrade Generic and trade names used most oftenDrug Names and Categories (cont.)Prescribed by either generic or trade nameCategorized by Action on the bodyGeneral therapeutic effectBody system affectedApply Your KnowledgeWhat is the difference between the trade name and generic name of a drug?Very Good!ANSWER: Trade name – the brand or proprietary name chosen by the manufacturer.The generic name – the drug’s official name selected by the U.S. Adopted Names (USAN) Council. It is nonpropiretary.FDA Regulation and DrugsNew drug approvalAnimal trials ~ toxicityClinical trials ~ ratio of benefit to riskRegulation of drug manufacturingDrugs shipped between statesUse exact formula approvedQuality of ingredients FDA Regulation and Drugs (cont.)OTC drugs – nonprescriptionPrescription drugsPregnancy categories Available information on risk to fetusMost drugs are Category CComplementary and alternative therapiesApply Your KnowledgeWhat drugs are regulated by the FDA?ANSWER: All drugs are regulated by the FDA in some manner. This includes prescription, OTC and CAM therapies.Fantastic!Sources of Drug InformationSources must be up-to-date and crediblePDRInformation provided by pharmaceutical companiesInformation closely resembles packageinsertPDR Internet siteSources of Drug Information (cont.)USP/NF Official source of drug standardsPublished about every 5 yearsAHFS® – published by the American Society of Hospital Pharmacists Epocrates®Sources of Drug Information (cont.)Package insert Describes the drugPurpose and effectsIndications and contraindicationsWarning, precautions and adverse reactionsDrug abuse and dependence Overdosage, dosage and administration How drug is suppliedSources of Drug Information (cont.)Drug labelsApply Your KnowledgeWhich of the following sources of drug information is most like the package insert?AHFS PDR USP/NF Drug EvaluationsANSWER:Truly Great!Controlled SubstancesPotentially dangerous and addictive Comprehensive Drug Abuse Prevention and Control Act (1970)Created the DEAStrengthened drug enforcement authoritySchedules ~ based on abuse potentialScheduleAbuse PotentialExampleIHighHeroin; GHB; LSDIIHighOpioids (narcotics): Morphine;Barbiturates IIILower than II (moderate dependence)Anabolic steroids; Vicodin® Controlled Substances (cont.)ScheduleAbuse PotentialExampleIVLower than III (limited dependence)Xanax®, Diazepam VLower than IV (very limited dependence)Antitussives and antidiarrheals with opioids Controlled Substances (cont.)Controlled Substances (cont.)Labeling – identification Doctor registration and drug orderingRegister with DEAComply with CSA Drug securityControlled Substances (cont.)Record keepingDispensing recordsSchedule II drugs – separate from patient recordSchedule III through V – with patient recordInventory records ~ every two yearsDisposing of drugs ~ follow DEA regulationsApply Your KnowledgeWhat does the Controlled Substances Act regulate?ANSWER: Controlled substance labeling Doctor registrationDrug ordering Drug securityRecord keeping Dispensing recordsInventory records Disposing of drugsNice Job!PrescriptionsPrescriber informationPatient informationMedication SubscriptionPrescriptionsSignaSignatureDEA numberPrescriptions (cont.)Managing prescriptionsPrescription blanksE-prescribing Telephone prescriptionsNew or renewals may be called to pharmacyOnly the physician may call for Schedule II drugsApply Your KnowledgeMatch ___ Before meals ___ Instructions to the  pharmacist ___ Patient instructions apl DAW MDI drop CBAANSWER:Correct! SubscriptionSignaacDispense as writtengttMetered dose inhalerApplicatorful GDFENonpharmacologic Pain ManagementChiropractors Massage therapyAcupunctureYogaMeditationHypnotism Nonpharmacologic Pain ManagementGlucosamine chondroitinMagnetic therapyBiofeedback CAM Less expensiveFewer side effectsMore accessible Apply Your Knowledge Why do patient’s consider complementary and alternative medicine?ANSWER: It is generally less expensive, has fewer side effects and more accessible than traditional medical treatmentsVaccinesPreparationsProduce reduced sensitivityIncrease immunityImmunity – formation of antibodies Antibody FormationResponse to an antigenLymphocytes produce antibodies to neutralize antigenAntibodies are antigen specificPrevents the reaction or diseaseImmunizationsImmunization schedulesChildrenAdultsPost-exposure immunizations AntiserumAntitoxinBe familiar with vaccines used in your workplaceApply Your KnowledgeANSWER: Vaccines are administered to a person to produce reduced sensitivity to or increase immunity to an infectious disease.Why are vaccines given to patients?Very Good!In Summary51.1 The role of the medical assistant in pharmacology includes being attentive to ensure the physician is aware of all medications, both prescription and OTC, that a patient is taking; asking each patient about alcohol and recreational drug use (both past and present), as well as herbal remedies; assisting in managing and renewing medication prescriptions; and educating the patient, using guidelines provided by the licensed practitioner, about the purpose of a drug and how to take the drug for maximum effectiveness and minimum adverse effects.In Summary (cont.)51.2 The five categories of pharmacology include: pharmacognosy, pharmacokinetics, pharmacodynamics, pharmacotherapeutics, and toxicology. It is important to understand each of these in order to carry out the medical assistant’s role in pharmacology.51.3 Drug categories are sometimes named based on their  action. The major drug categories and their actions  are outlined in Table 51-1.In Summary (cont.)51.4 Nonprescription drugs, including herbal and OTC drugs, can be obtained without a physician’s order. For prescription drugs, patients must have a physician’s written (or oral) order.51.5 Credible sources for drug information are the Physicians’ Desk Reference® (PDR), United States Pharmacopeia-National Formulary, and the American Hospital Formulary Service (AHFS®). You may also access medication information from package inserts, drug labels, and other reliable Internet sites.In Summary (cont.)51.6 The medical assistant should assist the physician with registration, renewal, and ordering of controlled substances, as outlined in the Controlled Substance Act of 1970 and Procedure 51-1.51.7 A prescription must be complete to be filled. The medical assistant must be able to interpret a prescription in order to manage new and refilled medications. Procedure 51-2 and Table 51-4 will assist the medical assistant in performing these tasks.In Summary (cont.)51.8 Multiple nonpharmacologic methods are used to treat pain, including CAM therapies such as massage, yoga, biofeedback, chiropractic, acupuncture, magnetic therapy, hypnotism, and glucosamine chondroitin.51.9 Immunizations usually contain killed or weakened organisms. When given, they stimulate the body to build up a resistance to the organism. They are used to provide immunity against specific diseases.End of Chapter 51It is easy to get a thousand prescriptions but hard to get one single remedy.  ~Chinese Proverb