CHAPTER © 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part. 51 Principles of Pharmacology

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Identify the medical assistant’s role in pharmacology Recognize the five categories of pharmacology and their importance to medication administration Differentiate the major drug categories, drugs names, and their actions. Learning Outcomes

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Classify over-the-counter (OTC), prescription, and herbal drugs Use credible sources to obtain drug information 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 Outcomes

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Identify the parts of a prescription, including commonly used abbreviations and symbols Discuss nonpharmacological treatments for pain Describe how vaccines work in the immune system. Learning Outcomes

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Introduction Pharmacology – science or study of drugs Medication errors can result in injury or death Medical assistant –Knowledge of the foundations of pharmacology –Understand role of drugs in ambulatory medical facilities

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Medical Assistant’s Role in Pharmacology Prescription drugs vs. OTC drugs The medical assistant should –Be sure the physician is aware of all medications the patient is taking –Ask patients about use of alcohol and recreational drugs –Provide patient education

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Medical Assistant’s Role in Pharmacology (cont.) To administer drugs –Check state regulations / scope of practice –Understand pharmacologic principles –Translate prescriptions –Answer basic patient questions –Adhere to legal requirements –Keep accurate records

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge What 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.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacology Drug – chemical compound used to prevent, diagnose, or treat disease Pharmacology – study of drugs Pharmachologist – specialist in pharmacology Pharmacognosy

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacology Pharmacodynamics Pharmacokinetics Pharmacotherapeutics Toxicology

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacology (cont.) A physician prescribes a drug Administer a drug by any route that introduces it into the patient body A healthcare professional dispenses a drug

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Sources of Drugs (Pharmacognosy) Natural products –Plants –Animals –Minerals –Bacteria and fungi Chemical development –Synthesis of chemical makeup of a drug –Manipulation of genetic information Foxglove – source of digitoxin

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacodynamics Mechanism of action of a drug to produce a therapeutic effect Drugs are categorized based on mechanism of action Interaction between drug and their target cells and the body’s response to the interaction

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacokinetics What the body does to a drug –Absorption ~ conversion of a drug into a form the body can use –Distribution ~ transportation of a drug from site of administration to site of action

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacokinetics (cont.) –Metabolism Drug molecules are transformed into metabolites Affected by age, genetic makeup, and characteristics of drug –Excretion Manner in which a drug is eliminated from the body Most via urine

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacotherapeutics Indication and labeling –Indication Reason for using a drug Must be approved by FDA to be part of labeling –Labeling ~ includes drug form –Off-label prescribing

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacotherapeutics (cont.) Safety –Determined by adverse effects of a drug –Be alert to patient complaints after starting a new drug Efficacy – drug is working as expected

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Pharmacotherapeutics (cont.) Kinds of therapy –Acute –Empiric –Maintenance –Palliative –Prophylactic –Replacement –Supportive –Supplemental

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Toxicology Study of poisonous effects of drugs –Adverse effects –Drug interactions Patient education –Inform physician of any adverse effects –Discuss concerns with physician or pharmacist

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge Matching: ___ 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 sources ANSWER: F E D C B A A.Pharmacokinetics B.Pharmacognosy C.Toxicology D.Pharmacotherapeutics E.Pharmacodynamics F.Drugs

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Drug Names and Categories Drug names –Generic –International nonproprietary name –Chemical name –Trade Generic and trade names used most often

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Drug Names and Categories (cont.) Prescribed by either generic or trade name Categorized by –Action on the body –General therapeutic effect –Body system affected

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge What 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.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part FDA Regulation and Drugs New drug approval –Animal trials ~ toxicity –Clinical trials ~ ratio of benefit to risk Regulation of drug manufacturing –Drugs shipped between states –Use exact formula approved –Quality of ingredients

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part FDA Regulation and Drugs (cont.) OTC drugs – nonprescription Prescription drugs Pregnancy categories –Available information on risk to fetus –Most drugs are Category C Complementary and alternative therapies

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge What drugs are regulated by the FDA? ANSWER: All drugs are regulated by the FDA in some manner. This includes prescription, OTC and CAM therapies.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Sources of Drug Information Sources must be up-to-date and credible PDR –Information provided by pharmaceutical companies –Information closely resembles package insert –PDR Internet site

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Sources of Drug Information (cont.) USP/NF –Official source of drug standards –Published about every 5 years AHFS ® – published by the American Society of Hospital Pharmacists Epocrates ®

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Sources of Drug Information (cont.) Package insert –Describes the drug –Purpose and effects –Indications and contraindications –Warning, precautions and adverse reactions –Drug abuse and dependence –Overdosage, dosage and administration –How drug is supplied

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Sources of Drug Information (cont.) Drug labels

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge Which of the following sources of drug information is most like the package insert? A.AHFS B.PDR C.USP/NF D.Drug Evaluations ANSWER:

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Controlled Substances Potentially dangerous and addictive Comprehensive Drug Abuse Prevention and Control Act (1970) –Created the DEA –Strengthened drug enforcement authority –Schedules ~ based on abuse potential

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part ScheduleAbuse PotentialExample I High Heroin; GHB; LSD IIHigh Opioids (narcotics): Morphine; Barbiturates III Lower than II (moderate dependence) Anabolic steroids; Vicodin ® Controlled Substances (cont.)

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part ScheduleAbuse PotentialExample IV Lower than III (limited dependence) Xanax ®, Diazepam V Lower than IV (very limited dependence) Antitussives and antidiarrheals with opioids Controlled Substances (cont.)

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Controlled Substances (cont.) Labeling – identification Doctor registration and drug ordering –Register with DEA –Comply with CSA Drug security

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Controlled Substances (cont.) Record keeping –Dispensing records Schedule II drugs – separate from patient record Schedule III through V – with patient record –Inventory records ~ every two years –Disposing of drugs ~ follow DEA regulations

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge What does the Controlled Substances Act regulate? ANSWER: Controlled substance labelingDoctor registration Drug orderingDrug security Record keepingDispensing records Inventory recordsDisposing of drugs Nice Job!

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Prescriptions Prescriber information Patient information Medication Subscription BWW Medical Associated, PC 305 Main Street, Port Snead YZ Tel: , Fax: Web: BWW Associates.com Pt: Valerie Ramirez 198 Elm St. Sherman, TX DOB: 08/04/19XX Paul F. Buckwalter, MD Lic: J87877 DEA AJ /27/XX Allegra 180 mg disp: 30 thirty sig: i po q am Refill: 6 Paul F. Buckwalter, MD ***Electronic Signature Verified*** Paul F Buckwalter. MD A generically equivalent drug product may be dispensed unless the practitioner hand writes the words ‘BRAND NECESSARY’ or ‘ BRAND MEDICALLY NECESSARY’ on the prescription face

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Prescriptions Signa Signature DEA number BWW Medical Associated, PC 305 Main Street, Port Snead YZ Tel: , Fax: Web: BWW Associates.com Pt: Valerie Ramirez 198 Elm St. Sherman, TX DOB: 08/04/19XX Paul F. Buckwalter, MD Lic: J87877 DEA AJ /27/XX Allegra 180 mg disp: 30 thirty sig: i po q am Refill: 6 Paul F. Buckwalter, MD ***Electronic Signature Verified*** Paul F Buckwalter. MD A generically equivalent drug product may be dispensed unless the practitioner hand writes the words ‘BRAND NECESSARY’ or ‘ BRAND MEDICALLY NECESSARY’ on the prescription face

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Prescriptions (cont.) Managing prescriptions –Prescription blanks –E-prescribing Telephone prescriptions –New or renewals may be called to pharmacy –Only the physician may call for Schedule II drugs

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge Match ___ Before meals ___ Instructions to the pharmacist ___ Patient instructions apl DAW MDI drop C B A ANSWER: Correct! A.Subscription B.Signa C.ac D.Dispense as written E.gtt F.Metered dose inhaler G.Applicatorful G D F E

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Nonpharmacologic Pain Management Chiropractors Massage therapy Acupuncture Yoga Meditation Hypnotism

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Nonpharmacologic Pain Management Glucosamine chondroitin Magnetic therapy Biofeedback CAM –Less expensive –Fewer side effects –More accessible

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 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 treatments

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Vaccines Preparations –Produce reduced sensitivity –Increase immunity Immunity – formation of antibodies

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Antibody Formation Response to an antigen Lymphocytes produce antibodies to neutralize antigen –Antibodies are antigen specific –Prevents the reaction or disease

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Immunizations Immunization schedules –Children –Adults Post-exposure immunizations –Antiserum –Antitoxin Be familiar with vaccines used in your workplace

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part Apply Your Knowledge ANSWER: Vaccines are administered to a person to produce reduced sensitivity to or increase immunity to an infectious disease. Why are vaccines given to patients?

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part In Summary 51.1 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.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 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 Drug categories are sometimes named based on their action. The major drug categories and their actions are outlined in Table 51-1.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 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 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.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 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 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.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part 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 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.

© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part End of Chapter 51 It is easy to get a thousand prescriptions but hard to get one single remedy. ~Chinese Proverb