DENTALELLE TUTORING Pharmacology

INFORMATION, SOURCES AND AGENCIES PRESCRIPTION WRITING CHAPTER ONE

INTRODUCTION Definition of Pharmacology Defined as the production, preparation and dispensing of a drug Pharmaco-: drugs Pharmaco-: drugs -ology: the study of -ology: the study ofPharmacology: the study of drugs

Definitions of DRUG “a therapeutic agent; any substance, other than food, used in the prevention, diagnosis, alleviation, treatment, or cure of disease.” “a therapeutic agent; any substance, other than food, used in the prevention, diagnosis, alleviation, treatment, or cure of disease.”OR any chemical substance that affects biological systems any chemical substance that affects biological systems

DEFINITIONS Over-the-Counter (OTC): drug available to the general public (without a prescription) Over-the-Counter (OTC): drug available to the general public (without a prescription) Prescription (Rx): usually a controlled substance and requires a written authorization for its use Prescription (Rx): usually a controlled substance and requires a written authorization for its use

Pharmacology & The Oral Health Care Providers Obtaining a medical/health history Obtaining a medical/health history Administering drugs in the office (e.g Fl, *anesthetics) Administering drugs in the office (e.g Fl, *anesthetics) Handling emergency situations (epi. For allergy) Handling emergency situations (epi. For allergy) Planning appointments (diabetic ct in am vs pm) Planning appointments (diabetic ct in am vs pm) Choosing self-medication (OTC meds – eg. Advil & Vitamins – Herbals). Choosing self-medication (OTC meds – eg. Advil & Vitamins – Herbals). Discussing drugs (use correct terminology; make sure ct. is aware of drugs and certain oral side effects). Discussing drugs (use correct terminology; make sure ct. is aware of drugs and certain oral side effects). Life-long learning (be current – up to date with new drugs) Life-long learning (be current – up to date with new drugs)

CHEMICAL NAME: DRUG NAMES – DEFINITIONS determined by the drugs’ chemical structure used during the investigative & developmental stage by a company shows the exact chemical composition of the drug

GENERIC NAME: official name the drug is known globally & in scientific publications drugs listed by the Food & Drug Administration (FDA) by this name – only one name per drug first letter of name is NOT capitalized DRUG NAMES – DEFINITIONS

TRADE OR BRAND NAME: assigned to a drug by a pharmaceutical company which manufactures it commercially usually followed by ® - registered trademark & can only be used by one company – patented for “x” # of years; once expired, generic can be available can have several names first letter of name ALWAYS Capitalized DRUG NAMES – DEFINITIONS

Chemical Name: Drug Names – Example #1 4-dimethylaminmo – 1,4, 4a,5,5a,6,11,12a – octahydro -3,6,10,12,12a – pentahydroxy- 6 – methyl – 1,11, dioxo -2 – naphthacenecarboxamide Generic Name: tetracyclinetetracycline Trade or Brand Name: Achromycin, Apo-Tetra, Novo-Tetra, Nu-Tetra, TetracynAchromycin, Apo-Tetra, Novo-Tetra, Nu-Tetra, Tetracyn

Chemical Name: Drug Names – Example #2 2-diethylamino-2,6 acetoxylidide2-diethylamino-2,6 acetoxylidide Generic Name : lidocainelidocaine Trade or Brand Name: Xylocaine, Dolicaine, OctocaineXylocaine, Dolicaine, Octocaine

Figure 1-1: A COMPARISON BETWEEN THE TRADE AND GENERIC DRUG NAMES OF LIDOCAINE.

DRUG SUBSTITUTION Similar drugs can sometimes substitute each other Similar drugs can sometimes substitute each other Drugs can be similar: Chemically Chemically Biologically Biologically Therapeutically Therapeutically

Drug Substitution Chemically Equivalent – Two formulations of a drug meet established chemical and physical standards Biologically Equivalent – Two formulations produce similar concentrations in blood and tissues Therapeutically Equivalent – Equal therapeutic effects during a clinical trial 8

IF oversees: The Food and Drug Act The Proprietary or Patient Medicine Act The Narcotic Control Act These acts are designed to protect the consumer from fraud, deception, and health hazards due to the use of foods, drugs, cosmetics, and medical devices. The Department of National Health and Welfare also authorizes substance abuse treatment, including the use of methadone, for narcotic addicts

CLINICAL EVALUATION OF A NEW DRUG A discovered or synthesized compound must pass through many steps before it is approved to become a marketed drug – Animal studies begin by measuring both acute and chronic toxicity – The median lethal dose is determined for several species of animals

Long-term animal studies continue, including a search for teratogenic effects – Toxicity and pharmacokinetic properties are also noted – An investigational new drug application (INDA) must be filed before any clinical trials are performed Human studies involve four phases CLINICAL EVALUATION OF A NEW DRUG

Clinical Evaluation of a New Drug PHASE I – Small and then increasing doses are administered to a limited number of healthy human volunteers Primarily to determine safety – Determines biologic effects, metabolism, safe dose range in humans, and toxic effects of the drug

Clinical Evaluation of a New Drug PHASE 2 – Larger groups of humans are given the drug and any adverse reactions are reported to the FDA Primarily to test effectiveness

Clinical Evaluation of a New Drug PHASE 3 – More clinical evaluation takes place involving a large number of patients who have the condition for which the drug is indicated Both safety and efficacy must be demonstrated Dosage is determined

Clinical Evaluation of a New Drug PHASE 4 – Postmarketing surveillance Toxicity that occurs in clients taking the drug after it is released is recorded Several drugs in recent years have been removed from the market only after phase 4 has shown serious toxicity

ROLE OF THE DENTAL HYGIENIST IN PHARMACOLOGY Drugs used should be entered into the treatment record, including drug, dose, and route of administration Any drug recommended or given as a sample to a client should be recorded in the treatment record with the client’s instructions Drug or herbal supplement history review should include investigation of potential drug effects and modifications of the treatment plan

CONTROLLED SUBSTANCE ACT OF 1970 Requirements of the Act – Prescriptions for a controlled substance require a Drug Enforcement Agency (DEA) number. – Schedules II-V require a written prescription. – Schedule II prescriptions must be signed in ink, no refills, phone-ins are emergency only. – Schedules III-V can be telephoned in and can have 5 refills over 6 months. – Several states require “duplicate” or “triplicate” prescription blanks for Schedule II drugs. 10

PRESCRIPTION WRITING

A prescription is an order for a specific medication for a specific patient at a particular time, with appropriate instructions for how the patient is to use the prescribed medication.

PRESCRIPTION FORMAT Parts of a Prescription: In the Past, Latin was used. Superscription* Inscription* Subscription* Signature* * Required by law to make valid prescription

PRESCRIPTIONS - FORMAT Superscription: Includes the patient’s name, address, and age, date, and the symbol (Rx) (Latin for recipe,”{you} take” or “take thou of”) Inscription: Includes the name of the drug, dose (amount needed), and dose form

PRESCRIPTIONS - FORMAT Subscription: Includes the directions to the pharmacist. Transcription: or Signature Includes the directions to the patient

1.Superscription 2.Inscription 3.Subscription 4.Transcription Fig 1-3, p.10 - A typical prescription form PRESCRIPTIONS - FORMAT

CURRENT PRESCRIPTIONS FORMAT HEADING: Contains M.D.’s info. & client’s info. – Date of the prescription (most commonly missed)* – Name, address & phone # of dental office* – Name, address, age of client* – Weight for children *(not a legal prescription unless the date is filled in)

CURRENT PRESCRIPTIONS FORMAT BODY Includes the symbol (Rx)* Name and dose size or concentration (liquids) of the drug* Amount to be dispensed* Directions to the patient

CURRENT PRESCRIPTIONS FORMAT Rx symbol is the name of the drug being prescribed Size – if tablet (milligrams); if liquid (milligrams per millilitre mg/ml) Quantity to be dispensed is the number of capsules or tablets or millilitres of liquid; the number is written in roman numerals

CURRENT PRESCRIPTIONS FORMAT “Sig.” are the directions to the patient. Directions must be completely clear and explicit and should include the amount of medication and the time, frequency and route of administration. The pharmacist will transcribe Latin abbreviations into English on the label when the prescription is filled.

CURRENT PRESCRIPTIONS FORMAT CLOSING Refill information* Drug enforcement administration number if required Generic substitution instructions Signature of Prescriber* *Required by law to make valid prescription The DIN (Drug Identification Number is included in this section if it is a controlled substance (Canada)

Example of a Prescription Label CURRENT PRESCRIPTIONS FORMAT

ABBREVIATIONS Used to save time but also makes alteration of the prescription by a patient more difficult – ac: before meals – d: day – h: hour – hs: at bedtime – pc: after meals – prn: as needed – sig: write (label) – stat: immediately – bid: twice per day – tid: three times per day – qid: four times per day **You may see some of these on your tests

PRESCRIPTIONS - RECORDS Record all prescriptions in chart Record reason for prescription & date written If photocopy taken - put into client chart, stroke through the photocopy or write “COPY” to prevent the copy from being used for fraudulent purposes