DT dures, Proce BB PHARMACOLOGY Pharmacology is the study of the nature, uses, and effects of drugs for medical purposes (pharmac means drug, and -ology means study of). BA pharmacist is a licensed specialist who formulates, and dispenses prescribed medications. Frequently Used Drug Admi Abbreviations and Symbols Many abbreviations used in prescriptions and drug administration come from Latin terms. It may be helpful to look at the original words to remember their meanings and common abbreviations. See Table 15.2. The Joint Commission has released a list of “do not use” abbreviations designed to cut back on medication errors by eliminating some commonly confused abbrevia- tions (see Chapter 1 for more information about this). When in doubt, write it out! ‘Many of the symbols used in prescriptions are similar to those used in mathematics (see Table 15.3). Prescription and Over-the-Counter Drugs HA prescription drug is a medication that can legally be dispensed only by a pharmacist with an order from a licensed professional such as physician or dentist. Hi An over-the-counter drug, also known as an 01 is a ‘medication that ean be purchased without a prescription, Generic and Brand-Name Drugs HA generic drug is usually named for its chemical structure and is not protected by a brand name or trademark. For example, diazepam is the generic name of a drug frequently used as skeletal muscle relaxant, sedative, and anti-anxiety agent. HA brand-name drug is sold under the name given the drug by the manufacturer. A brand name is always spelled with a capital letter. For example, Valium brand name for diazepam. TABLE 15.3, Frequently Used Drug Adi [ symbol Meaning @ at =: with t t increase 1 decrease > greater than > greater than or equal to < less than E less than or equal to E g female E g maleTABLE 15.2 Frequently Used Drug Administration Abbreviations | ‘Abbreviation Meaning Latin Origin ac before meals ante cibum ad lib as desired ad libitum B.. amount bid twice a day bis in dio | NPO nothing by mouth nil per 0 ope after meals post cibum po by mouth per os pm as nooded pro ro nata E an every hour quaque plus h for hour aid four times a day quater in die Re prescription recipe (to take) sig to be labeled accordingly signa (to write) | ota three times 2 day ter in die Terminology Related to Pharmacology 1 An addiction is compulsive, uncontrollable dependence on a drug, alcohol, or other substance. It ean also be a ‘habit or practice that cannot be stopped without causing severe emotional, mental, or physiologic reactions. Drug tolerance is when the body has become accus- tomed to a medication after being on it for a length of time, and higher doses are required to achieve the desired effect. 1 Anadverse drug reaction (ADR), also known as a side effect, is an undesirable reaction that accompanies the principal response for which the drug was taken. 1 Compliance is the patient's consistency and accuracy in following the regimen prescribed by a physician or other health care professional. As used here, regiinen means directions or rules. BA contraindication is a factor in the patient's condi- tion that makes the use of a medication or specific treatment dangerous or ill advised. HA drug interaction is the result of drugs reacting with each other, often in ways that are unexpected or potentially harmful. Such interactions can occur when medications are taken along with herbal remedies or when more than one prescription drug is taken at the same time,I An idiosyncratic reaction (id-ee-oh-sin-KRAT-ick) is ‘an unexpected reaction to a drug that is peculiar to the individual. 1 A palliative (PAL-ee-ay-tiv) is a substance that eases the pain or severity of the symptoms of a disease, but does not cure it, Palliative care is treatment that focuses on alleviating pain and relieving symptoms rather than curing the disease. A paradoxical reaction is the result of medical treat- ment that yields the exact opposite of normally expected results, Paracloxical means not being nor- mal or the usual kind, A placebo (plah-SEE-boh) is an inactive substance, such as a sugar pill or liquid, that is administered only for its suggestive effects. In medical research, placebo is administered to one group and the drug being studied is administered to another group. An antipyretic (an-tih-pye-RET-ick) is medication administered to prevent or reduce fever (anti- means ‘against, pyret means fever, and -ic means pertaining to). These medications, such as aspirin and acetamin- ‘ophen, act by lowering a raised body temperature; however, they do not affect a normal body tempera- ture when a fever is not present. 1B An anti-inflammatory relieves inflammation and pain without affecting consciousness. Medications for Pain Management Analgesics The term analgesic (an-al-JEE-zick) refers to the class of rugs that relieves pain without affecting consciousness. ‘These include such drugs as aspirin, acetaminophen, and ibuprofen. Non-narcotic analgesics, such as aspirin, are sold over the counter for mild to moderate pain. Prescription pain relievers, sold through a pharmacy under the direc- tion of a physician, are used for more moderate to severe pain. Narcotic analgesics, such as morphine, Demerol, and codeine, are available by prescription only to relieve severe pain. These medications also have a sedative (calming) effect and can cause physical dependence or addiction. Sedatives are discussed in Chapter 10. Acetaminophen (ah-seet-ah-MIN-oh-fen) is an anal- gesic that reduces pain and fever, but does not relieve inflammation; however, it does not have the negative side effects of NSAIDS. This substance is basic ingre- dient found in Tylenol and its generic equivalents,1 Nonsteroidal anti-inflammatory drugs, commonly known as NSA Ds, are non-narcotic analgesics administered to control pain by reducing inflamma- tion and swelling. NSAIDS, such as aspirin and ibu- profen, are available over the counter. Stronger NSAIDs are available by prescription. Medications in this group can cause side effects, including attacking the stomach lining and thinning the blood. I Ibuprofen (eye-byoo-pro-fen) is a non-steroidal anti- inflammatory medicine that is sold over the counter under the brand names of Advil and Motrin. This medication acts an analgesic and an antipyretic. 1 Although pain management is not their primary role, anticonvulsants and antidepressants have been found to be effective as part of some chronic pain management programs, Avficonvulsants are tradi- tionally administered to prevent seizures such as those associated with epilepsy. Antidepressants are primar- ily administered to prevent or relieve depression. Additional Pain Control Methods 1 Pain-relieving creams are applied topically to relieve pain due to conditions such as osteoarthritis and, rheumatoid arthritis. The primary active ingredient in these ointments is capsaicin, a chemical found in chili peppers. 1 Transcutaneous electronic nerve stimulation, also known as TPNS, is a method of pain control by wearing a device that delivers small electrical impulses, as needed, to the nerve endings through the skin (trans- means across, cutane means skin, and -ous means pertaining to). These electrical impulses cause changes in muscles, such as ‘numbness or contractions, which produce temporary pain relief, The term transcutaneous means per- formed through the unbroken skin. Methods of Drug Administration I Inhalation administration describes vapors and gases taken in through the nose or mouth and absorbed into the bloodstream through the lungs. One example is the use of a metered-dose inhaler to treat asthma (see Chapter 7) or the gases used for general anesthesia (see Chapter 10). Hl Oral administration refers to medications taken by mouth to be absorbed through the walls of the stom- ach or small intestine, These drugs can be in the form of liquids, tablets (pills), or capsules. Medications to be released in the small intestine are covered with an enteric coating to prevent them from being absorbed in the stomach,1 Rectal administration is the insertion of medication in the rectum either in the form of a suppository or a liquid. A suppository is medication in a semi-solid form that is introduced into the rectum. The supposi- tory melts at body temperature, and the medication is absorbed through the surrounding tissues. 1 Sublingual administration is the placement of medi- cation under the tongue where it is allowed to dissolve slowly (sub- means under, lingu means tongue, and -al means pertaining to). Because the sublingual tissues are highly vascular, the medication is quickly absorbed directly into the bloodstream. Higiely vascular means containing many blood vessels. A topical application is a liquid or ointment that is rubbed into the skin on the area to be treated, for example, cortisone ointment is applied topically to relieve itching and to speed healing; attibiotic oint- ‘ments are applied over minor wounds to prevent infection, HA transdermal medication is administered from a patch that is applied to unbroken skin (trans- means through or across, derm means skin, and -al means pertaining to). The medication, which is continu- ously released by the patch, is absorbed through the skin and transmitted to the bloodstream so that it ean produce a systemic effect. These multilayered patches are used to convey medications, such as nitroglycerin for angina, hormones for hormone replacement therapy, or nicotine patches for smok- ing cessation.Parenteral Administration ‘The term parenteral (pah-REN-ter-al) means taken into, the body or administered in a manner other than through the digestive tract. The most common use of parenteral administration is by injection through a hypodermic syringe (Figure 15.21). A subcutaneous injection (SC) is made into the fatty layer just below the skin. i An intradermal injection is made into the middle layers of the skin. An intramuscular injection (IM) is made directly into muscle tissue (intra- means within, muscul means ‘muscle, and -ar means pertaining to). i An intravenous injection (IV) is made directly into a vein (intra- means within, ven means vein, and -ous ‘means pertaining to). A PIC line, which is the abbreviation for peripler- ally inserted central catheter, is frequently used for a patient who will need IV therapy for more than 7 days. HA bolus (BOH-lus), which is also known as a bolus infusion, is a single, concentrated dose of drug usually injected into a blood vessel over a short period of time. The term bolus is also used in relation to the digestive system (see Chapter 8). Intramuscular ‘Subcutaneous Intravenous Intradermal a i i iComplementary Medicine ‘Types of complementary medicine can be broken down into three categories: mind-body therapies, hands-on therapies, and energy therapies. Mind-Body Therapies Mind-body therapies try to reduce stress and prevent its negative effects on the body. They can be used for stress reduction, pain management, lifestyle changes, and depression. These therapies are based on the belief that ‘emotions, such as stress, trigger physiological responses, By becoming aware of and reducing stressful emotions and thoughts, it is possible to decrease physical stress and its negative effects. I Biofeedback is a patient-guided treatment that tea- ches individuals to control muscle tension, pain, body temperature, brain waves, and other bodily functions through relaxation, visualization, and other cognitive control techniques. I Guided imagery is a type of treatment in which a patient follows verbal prompts to envision a specific, peaceful location in detail, distancing him- or herself from any pain or stress the patient is currently experiencing, I Hypnosis is a type of therapy in which a patient is, placed in a state of focused concentration and nar- rowed attention that makes him or her more suscep- tible to suggestions, and then given suggestions directed toward the patient's treatment goal. IH Mindfulness meditation focuses on becoming aware of thoughts and emotions and their physiological responses, as well as accepting them and maintaining a calm, constant awareness. Energy Therapies Energy therapies tty to improve or maintain health by manipulating the body's energy flow, or qi. Qi is believed to be the fundamental life energy responsible for health and vitality. These therapies are based on the belief that illness is linked to blocked or insufficient energy levels. Mi Acupressure (AK-que-presh-ur) is a traditional Chi- nese touch therapy involving finger pressure applied to specific areas of the body to restore the flow of qi. BH Acupuncture (AK-que-punk-tyour) is a traditional Chinese medical practice using very thin acupuncture needles inserted into specific points of the body to restore the flow of qi (Figure 15.22) Qi Gong (CHEE-gong) is a Chinese system of move- ment, breathing techniques, and meditation designed to improve and enhance the flow of qi.Hands-on Therapies Hands-on therapies try to improve body function by physically manipulating or massaging the body. They can be used for neck or back pain, relaxation, and increased range of motion. This therapy is based on the belief that the body functions more efficiently when it is in proper alignment, and that itis possible to identify and correct poor movement and posture habits. i Chiropractic manipulative therapy is a system of mechanical spinal adjustments made by a chiropractor to correct biomechanical problems in the skeletal framework of the body. See Chapter 3 for the defini- tion of chiropractor. Hl Osteopathic manipulative therapy is mechanical spi- nal adjustment used in conjunction with conventional medical therapies by an osteopath. See Chapter 3 for the definition of osteopath. Mi Craniosacral therapy (kray-nee-ob-SAK-ral) is the use of gentle touch to help the body release tension, stress, and trauma to correct restrictions resulting. from stress on the central nervous system (crani/o means skull, and sacral means referring to the sacrum). I Myofascial release (my-oh-FASH-ee-ahl) is a special- ized soft-tissue manipulation technique used to ease the pain of conditions such as fibromyalgia, myofascial pain syndrome, movement restrictions, temporoman- dibular joint disorders (TMJ), and carpal tunnel syn- drome (my/o means muscle, and fascial refers to the fascia) (See Chapter 4). Neuromuscular therapy (NMT) is a form of massage that uses soft-tissue manipulation focusing on apply- ing pressure to trigger points to treat injuries and alleviate pain. A ‘rigger point is a particularly taut band of muscle that is tender to the touch. FIGURE 15.22 Acspunctre uses thin needles inserted into specie body points