CHAPTER 1 ORIENTATION I.

FOUR BASIC TERMS

TO

PHARMACOLOGY

A. DRUG – defined as any chemical that can affect living processes and have therapeutic applications B. PHARMACOLOGY - defined as the study of drugs and their interactions with living systems - encompasses the study of the physical and chemical properties of drugs as well as their biochemical and physiologic effects - includes knowledge of the history, sources, and uses of drugs as well as knowledge of drug absorption, distribution, metabolism, and excretion C. CLINICAL PHARMACOLOGY – defined as the study of drugs in humans (patients as well as healthy volunteers) - interaction between drugs and people D. THERAPEUTICS – also known as pharmacotherapeutics - defined as the use of drugs to diagnose, prevent, or treat disease or to prevent pregnancy - medical use of drugs

II.
A.

PROPERTIES
BIG THREE:

OF AN

IDEAL DRUG - there is no such thing as a perfect drug

1. Effectiveness – an effective drug is one that elicits the responses for which it is given. - effectiveness is the most important property a drug can have ***IF A DRUG IS NOT EFFECTIVE, IT SHOULD NOT BE USED*** 2. Safety – a safe drug is one that cannot produce harmful effects – even is administered in very high doses and for a very long time - there is no such thing as a safe drug - pharmakon – Greek word meaning poison 3. Selectivity – one that elicits only the response for which it is given - there is no such thing as a selective drug: All medications cause side effects B. ADDITIONAL PROPERTIES 1.
OF AN

IDEAL DRUG

Reversible Action – it is important that effects be reversible - we want drug actions to subside within an appropriate time

2. Predictability – since each patient is unique, the accuracy of certain predictions cannot be guaranteed 3. Ease of Administration – an ideal drug should be simple to administer, the route should be convenient, and the number of doses per day should be low a. Benefits: - it can enhance patient adherence - it can decrease errors in drug administration 4. Freedom from Drug Interactions – when taking two or more drugs, those drugs can interact with one another in that they either augment or reduce drug responses - possible impact of drug interactions must be considered 5. Low Cost – an ideal drug would be easy to afford 6. Chemical Stability – some drugs lose effectiveness during storage; others which are stable on a shelf can rapidly lose effectiveness when put into a solution - losses in efficacy result from chemical instability 7. Possession of a Simple Generic Name – generic names are usually complex and difficult to remember and pronounce - as a rule, the trade name for a drug is simpler than its generic name

III.

THERAPEUTIC OBJECTIVE
The objective of drug therapy is to provide maximum benefit with minimum harm.

IV.

FACTORS

THAT

DETERMINE

THE

INTENSITY

OF

DRUG RESPONSES

A. ADMINISTRATION – dosage size, route and timing of administration are important determinants of drug responses B. PHARMACOKINETICS – pharmacokinetic processes determine how much of an administered dose gets to its sites of action 1. Major Pharmacokinetic Processes (impact of the body on drugs): a. drug absorption b. drug distribution c. drug metabolism d. drug excretion

C. PHARMACODYNAMICS (IMPACT OF DRUGS ON THE BODY) – once at the site of action, pharmacodynamic processes determine the nature and intensity of the response

- initial step leading to a response is the binding of a drug to its receptor which is followed by a sequence of events the ultimately results in a response PRESCRIBED DOSE ↓ Administrati ↓ ↓ ADMINISTERED DOSE ↓ Pharmacoki ↓ ↓ ↓ ↓ CONCENTRATION @ SITES OF ACTION ╟physiologic variables ↓ variables ↓ variables ↓ interactions ↓ INTENSITY OF RESPONSES D. ╟drug-receptor interaction ╟patient’s functional state ╟placebo effects
Pharmacodyna

╟medication errors ╟patient compliance ╟absorption ╟distribution ╟metabolism ╟excretion Sources of individual variation ╟pathologic ╟genetic ╟drug

SOURCES OF INDIVIDUAL VARIATION - characteristics unique to each patient can influence pharmacokinetic and pharmacodynamic processes and, by doing so, can help determine the patient’s response to a drug - sources include drug interactions, physiologic variables (age, gender, weight), pathophysiologic variables (especially diminished function of the kidneys and liver, the major organs of drug elimination), and genetic variables (can alter the metabolism of drugs and can predispose the patient to unique drug reactions) ***PATIENT ALWAYS HAS THE RIGHT TO REFUSE MEDICIATIONS*** Critical Thinking: pain? What would be the perfect drug for a patient in chronic

First of all, there is no perfect drug. Then consider: effectiveness fast acting affordable

safe reversibility

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