Oral Pharmacology: Chapter 1+2

What is pharmacology?
The study of drugs

What is a drug?
Also referred to as a ligand. A chemical that is used in the diagnosis, treatment, or prevention of diseases in the body.

Biological
Agents that are naturally produced in animal or human bondy
Ex. vaccines, blood and blood components, antibodies, and interferon. leukotrienes
plants (digoxin and atropine)

Pharmacodynamics
Actions of a drug on a target organ
-mechanism of action
-dose response relationship
-therapeutic
-side effects
-toxic reactions
**What the drug does to the organism**

Pharmacokinetics
how the drug moves through the body
how the drug gets to the site of action
-absorption
-distribution
how the drug is removed from the body
-metabolism
-excretion
**What the organism does to the drug**

Posology
The study of the dosages of drugs

Toxicology
Study of poisons
A poison is any substance that causes incapacitation, illness, death

Pharmacotherapeutics
the use of drugs in the prevention, diagnosis and tx of diseases

Names of some sources of reference material you can use to learn about medicine?
dailymed.gov
epocrates.com
medfacts.com
medline.com
pubmed.com
medscape.com
rxlist.com

What is the FDA? What do they regulate?
Food and Drug Administration
Regulates the safety of food and drugs

What is DEA? What do they regulate?
Drug Enforcement Agency
Regulates the illegal use, sale and distribution of drugs

What are the schedules and drugs in each group?
CI; Highest; No safe medical use; maryjane, pcp, lsd, heroin
CII; High; Safe medical use; some narcotics, stimulants, depressants, cocaine, morphine, methadone, methamphetamine, oxycodone, ritalin
CIII; Moderate; Tylenol #3/4, vicodin, anobolic steroids
CIV: Low; Truazolon(sedative), chloral hydrate, valium, phenobarbital, xanax
CV: Lowest, cough meds containing codeine

What are the stages of approval for therapeutic and biological drugs?
1. preclinical testing, research and development, animal testing
2. Clinical research and development, healthy subject single dose, small group w/ disease, long term side effects and risks; Large group w/ disease
3. New Drug Application Review
4. Post Marketing Surveillance

3 names for each drug?
Chemical name
Generic name
Brand name (Trade name)

What are the parts of a prescription?
Heading: Prescriber & pt info, pt age, date of Rx
Body: Rx drug name, strength (in metric units), Disp#, dosage, directions, Sig: take 2 tabs PO
Closing: Rx signaturen DEA#, Refill info, check off box to label drug name, labeling instructions

Write a Rx for Tylenol #3

Write a Rx for Ibuporfen

Write a Rx for vicoden

Write a Rx for perioguard

What is bioequivalence
Generic drugs. Prescribing generic drugs offers the pharmacist flexiblility in selecting the drug to be dispensed and the patient possible savings.
Contains the same amount of active drug as the brand drug and shows no different in the rate and extent of absorption

What is bioavailability
Both generic and brand name should get to the target tissue and act equally

Know an example of a drug in each teratogenic category specific to dental hygiene
Flouride
Tetracycline
Penicillin
Amoxicillin

What are the different routes of administration?
Enteral- Oral, sublingual, buccal, rectal
Parenteral- Intravenous, intravascular, subcutaneous, intradermal, intrathecal

What is enteral administration?
Involves a drug being absorbed from the GI tract and includes oral, sublingual, buccal and rectal

What is parenteral administration?
Delivers drugs via a needle into skin layers, subcutaneous tissue, muscle, csf, or veins, angles at different degrees depending on the type of injection

What does ADME mean?
Absorption
Distribution
Metabolism
Elimination
The amount of drug in the body at any given time is determined by these four processes.

What are the primary factors that affect drug absorption?
pH
molecular size
lipid and water solubility

What are the special barriers the body has?
Epithelial cells and blood vessel walls
-intestinal mucosa-blood barrier
-placenta barrier
-oral mucosa-blood barrier
-blood tissue barrier
-blood-brain barrier

Where are most drugs absorbed?
Small intestine-has greater surface area

What is the first pass effect?
metabolism through the liver via the hepatic portal vein

Which routes of administration have no first pass effect?
IV
Sublingual
Transdermal
Inhalational

What is volume of distribution?
Use this to determine dose
-if all drug leaves the blood=high Vd
-if little drug leaves the blood=low Vd

Why do some drugs stay in the blood?
Plasma protein binding decreasse the distribution of drug to site of action

Which form of the drug does all the work?
free drugs
-leave the blood and go to work

Factors that affect distribution?
-route of administration
-plasma protein binding
-lipid solubility, ionization, size,pH
-blood flow to the organ

What is biotransformation?
metabolism

Where does biotransformation take place?
liver

Why do we need biotransformation for most drugs?
to eliminate it from the body

Do all drugs go through biotransformation?
no
some are eliminated unchanged
-lithium
-PenVk

What is a prodrug?
When orally administered they are inactive, but become active in liver (biotransformation)
-Levodopa (Parkinson’s disease) metabolized to dopamine
-Codeine turns to morphine

Two phases of biotransformation and the basics of each?
*Phase I
-microsomal
-cytochrome P450enzymes (CYP)
-nonmicrosomal
-oxidation/reduction/hydrolysis
*Phase II
-conjugation
-add a water soluble sugar

P450 inducers do what?
speed drug breakdown
-ETOH
-Smoking
-Charbroiled foods

Primary means of excretion?
kidneys (for most drugs)

What is a secondary means of excretion?
bile “bilary excretion”

Name drugs that are excreted in the bile?
Erythromycin
Tetracyclines

What is a half life?
time it takes for the concentration of the drug in the blood to fall to half (50%) of its original value

Why do we need to know the half life of a drug?
to determine the time interval between doses

How many half lives are needed to remove all of a drug?
4-5

Therapeutic effect
desirable effect of drug

Dose response curve
As the dose of a drug increases, a maximal response or plateau is reached.
ASA: antiplatelet effect>reduces pain>ringing in ears>hyperventilation>dehydration>death

Potency
Dose or amount of drug required to produce a particular effect

Efficacy
Ability to produce a therapeutic effect regardless of the dose

Therapeutic index
(TI) Ratio of a drugs toxic dose to its therapeutic dose
The “safe” drug will have a high therapeutic index (generally at least 10)
TI=LD50/ED50

Effective dose (50)
The dose that produces 50% of he maximum possible response

Lethal dose
(LD50) The dose at which 50% o the animals die

ADE
Adverse drug events “error”
Unfavorable and unintended response to a drug
Predictable and preventable
Medication Error (e.g. miscalculation, overdose, misunderstanding of verbal orders)

ADR
Adverse drug reaction
Adverse effects
Dose related
Predictable and affect nontarget organ sites

Allergic reaction
Not dose dependant and are predictable

Idiosyncratic reaction
Genetically related abnormal drug response
“we don’t know”

Teratongenic
refers to drug induced damage that develop in the fetus

Mutagenic
drug induced damage to parents genes
-defect passed to child by parent

Basic drug interactions?
Occur between
-drug and drug
-drug and food
-drug and disease
Produce an unusual response

What is pharmocodynamics?
Actions drug has on the body
*mechanism of action of drug
*clinical effect

What are the mechanisms of pharmacodynamics?
agonist and antagonist

Most common mechanism of pharmocodynamics? Explain.
agonist
-act like endogenous chemical (hormone, enzyme etc)
-initiate same response
-rapidly lets go of receptor

What is an agonist drug?
drugs act like endogenous chemical (hormone, enzyme etc). Initiate same response, rapidly lets go of receptor

What is an antagonist drug?
blocks natural chemical
-binds to same receptor (competitive)
-binds to different receptor (non-competitive)

What is a partial agonist drug?
binds to part of receptor
-produces a limited therapeutic response
-sometimes acts like an antagonist Ex: Talwin

P450 inhibitors do what?
Inhibit the biotransformation
-slow all drug removal
*Cimetidine
*Fluconozole
*Erythromycin

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Pharmacodynamics facts Pharmacodynamics is the science of dealing with interactions between living organisms and foreign chemicals. Each living system has chemical reactions occurring continuously in the body. When other chemicals (drugs) are added to the body other effects occur. Drug …

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Absorption refers to the movement of drug into the bloodstream, with the rate dependent on the physical characteristics of the drug and its formation. Refers to the passage of drug molecules from the site of administration into the circulation. Active …

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