1. 54
Pharmacology
Lesson 1:

2. Lesson Objectives
Upon completion of this lesson, students should be able to:
Define and spell the terms to learn for this chapter.
Differentiate between the legal (generic) and commercial (trade) and chemical names for a drug.

3. Lesson Objectives
Upon completion of this lesson, students should be able to:
Describe the drug reference resources that should be accessible in all physician offices.
List the five schedules of the Controlled Substances Act.

4. Pharmacology Pharmacology
Study of medications and drugs including their forms, intentions for use, and effects
Drugs come from many natural sources: plants, animals, minerals; others artificially created
Some drugs, such as vitamins, found naturally in the foods we eat

5. Pharmacology
Medications, such as penicillin and other antibiotics, come from molds, a form of plant life
Vast majority of drugs today are synthetic, created in a laboratory by artificial means

6. Pharmacology Drugs prescribed for a variety of reasons
To help improve a condition
To eradicate a condition
To prevent the onset of a condition

7. Drug Names Generic Name "Official" or "nonproprietary" name of a drug
Typically written in lowercase letters
Legal name for the drug
Required by FDA regulations to have same effectiveness, safety, active ingredients, quality, strength, purity, and stability as brand name drugs 7

8. Drug Names
Brand Name
Typically written with capitalized initial letters
Name given to a drug by specific manufacturer
Called the proprietary name 8

9. Drug Names Brand Name Often most familiar name for a specific drug
Company that holds the patent for the drug can manufacture and produce that drug, under that brand name, for 20 years from date of the patent 9

10. Drug Names
Brand Name
Generic drugs cannot be sold as long as a brand name manufacturer of that drug holds a patent
Once brand name patent expires, both brand and generic version of same drug may be sold
Generic drugs usually priced lower than drugs with brand names

11. Drug Names Brand Name Bioequivalent
Having same strength and action as brand name version of the drug
Active ingredients in generic drugs required to be bioequivalent

12. Drug Names
Brand Name
Nonactive ingredients, such as dyes or flavorings, may differ
Generic drugs not as closely monitored as brand name drugs

13. Drug Names Chemical Name
Chemical formula typically used by manufacturers and pharmacists
Generic name of a drug is usually somehow related to its chemical name 13

14. Regulations and Standards
Food and Drug Administration (FDA)
Department within U.S. Department of Health and Human Services
Responsible for ensuring human drugs are safe and effective
That these products are honestly, accurately, and informatively represented to the public

15. Regulations and Standards
Federal Food, Drug, and Cosmetic Act of 1938
Stipulates the control of drugs
Law enacted to ensure the safety of food, drugs, and cosmetics sold within U.S. borders

16. Regulations and Standards
Drug Enforcement Administration (DEA)
Agency of federal government responsible for drug control enforcement
All physicians required to register with DEA to prescribe, dispense, administer controlled substances

17. References Physicians' Desk Reference (PDR) Hospital Formulary
United States Pharmacopeia National Formulary (USP-NF) 17

18. References Physicians' Desk Reference (PDR) Updated annually
Information provided by drug manufacturers
Essentially a compilation of the package inserts that come with drugs

19. TABLE 54-1 The Three Names Given to a Drug

20. References Physicians' Desk Reference (PDR)
Divided into color-coded sections
White section
Manufacturer's index
Pink section
Product name index
Blue section
Lists drugs grouped by therapeutic classes

21. References Physicians' Desk Reference (PDR)
Divided into color-coded sections
Gray/multi-colored
Color photos of most commonly prescribed tablets and capsules
Second white section
Product information; reprint of the manufacturers' package inserts

22. References Physicians' Desk Reference (PDR)
Divided into color-coded sections
Green section
Diagnostic product information

23. References Electronic References Online Resources
Many electronic health record (EHR) platforms have electronic versions of reference books
Online Resources
Web MD and Medline are two Internet resources considered to be reliable

24. Classifications of Drugs
Prescription drug
Nonprescription drug
Over-the-counter (OTC)
Controlled substance 24

25. Classifications of Drugs
Prescription Drugs
Physicians responsible for prescribing medications
Some specially licensed professionals (physician's assistants and advanced practice nurses) can also write prescriptions

26. Classifications of Drugs
Prescription Drugs
Prescription is a written explanation to a pharmacist specifying name of medication, dose, route, and times of administration

27. Classifications of Drugs
Prescription Drugs
Antibiotics
Antihypertensives
Pain medications
Others

28. Classifications of Drugs
Prescription Drugs
When dispensed from a pharmacy, label on drug container for one of these drugs must read "Caution: Federal Law prohibits dispensing without prescription"

29. Classifications of Drugs
Nonprescription Drugs
Also known as over-the-counter (OTC) drugs
Medications such as aspirin, cold medications, antibiotic ointments
Do not require prescription; regulated by FDA

30. Classifications of Drugs
Nonprescription Drugs
If taken incorrectly, some OTC drugs can be unsafe
Some OTC drugs may react negatively with a prescription drug patient is taking

31. Classifications of Drugs
Nonprescription Drugs
Remind patients that OTC medications they need to report include supplements like vitamins and herbs they may purchase at a health food store and not think of as drugs

32. Classifications of Drugs
Controlled Substances
Have potential for addiction or abuse
DEA strictly enforces control of these medications
CSA regulates manufacture and distribution of drugs that can cause dependencies
Psychoactive drugs regulated by CSA: narcotics, hallucinogens, depressants, stimulants

33. Classifications of Drugs
Controlled Substances
CSA guidelines for controlled substances; divided into five categories (schedules) based on their potentially addictive level of abuse
Generally kept under double lock and key in a non-movable secured cabinet
Strict control must be maintained 33

34. Schedule for Controlled Substances
Schedule I
Highest potential for addiction and abuse
Not accepted for medical use
Examples: cocaine, heroin, methamphetamine 34

35. Schedule for Controlled Substances
Schedule II
High potential for addiction and abuse
Accepted for medical use in United States
Examples: codeine, morphine, opium, secobarbital 35

36. Schedule for Controlled Substances
Schedule III
Moderate to low potential for addiction and abuse
Examples: butabarbital, anabolic steroids, APC (aspirin, phenacetin, caffeine) with codeine

37. Schedule for Controlled Substances
Schedule IV
Lower potential than Schedule III drugs
Examples: chloral hydrate, phenobarbital, diazepam

38. Schedule for Controlled Substances
Schedule V
Low potential for addition and abuse
Examples: low-strength codeine combined with other drugs to form a cough suppressant

39. Classifications of Drugs
Controlled Substances Log
Track all controlled substances
Inventory in stock
Who administers controlled substance
How much was given
How much was wasted

40. Classifications of Drugs
Controlled Substances Log
Date and name of patient receiving drug
Must be kept on file for at least two years
Must be available for inspection from DEA

41. Classifications of Drugs
Controlled Substances
Physicians required to register with DEA to prescribe, dispense, administer controlled substances
Special form, DEA 224, must be completed and submitted to the DEA
Renewal required every three years, using Form 224a 41

42. Classifications of Drugs
Controlled Substances
All controlled substances must be labeled according to CSA specifications, showing drug's assigned schedule
Schedule identification number written as Roman numeral inside a capital letter C, which stands for controlled substance

43. FIGURE 54-2 Label used to indicate a class IV controlled substance.

44. Classifications of Drugs
Controlled Substances
Anabolic steroids
Butabarbital
Chloral hydrate
Codeine
Diazepam
Morphine
Opium 44

45. Classifications of Drugs
Controlled Substances
Phenobarbital
Secobarbital
Acetaminophen (Tylenol) with codeine 45

46. Classifications of Drugs
Inventory of Office Medications
Medications kept on hand can range from samples provided by pharmaceutical companies to medications commonly used within the office
Offices and facilities store both oral medications and injectable drugs

47. Injectable Drugs Commonly Stocked in the Medical Office
Elavil
Dimetane
Thorazine
Valium
Dramamine
Benadryl
Diphtheria, tetanus toxoid
Lasix 47

48. Injectable Drugs Commonly Stocked in the Medical Office
Garamycin
Heparin sodium
Dilaudid
Xylocaine
Compazine
Phenergan
Bacteriostatic 0.9% sodium chloride
Tetanus and diptheria toxoids 48

49. Injectable Drugs Commonly Stocked in the Medical Office
Tetanus antitoxin
Tine test
Water for injection
Cordarone
Epinephrine
Levophed
Electrolytes/Ringer's 1,000 mL 49

50. Classifications of Drugs
Medication Logbook
Paper document or electronic file
Name of each medication stored
Dosages of each medication
Quantity on hand for each dosage
Expiration dates
Separate section used to indicate when a medication is dispensed to a patient 50

51. Classifications of Drugs
Medication Logbook
Many electronic health record platforms will allow for medications that are dispensed to be scanned into patient's record
Can reduce or eliminate charting errors
Once a month review inventory to ensure that a sufficient supply of each drug is available and that no medication has expired

52. Classifications of Drugs
Medication Logbook
When disposing of expired medications, follow office policy
Individual state policies indicate credentials needed of staff members allowed to destroy medications
Local DEA office should be contacted regarding discarding practices for large amounts of controlled substances

53. Drug Abuse Drug abuse Drug dependency
Use of a drug improperly or wrongly
Drug dependency
Reliance or use of medication for psychological support
Individuals who become physically dependent are those who continuously use a substance to function or to avoid physical pain 53

54. Drug Abuse
For physical dependency to occur, abused substance produces changes in nervous system on which body begins to rely
Once substance removed, individual experiences withdrawal symptoms
Depending on level of addiction, withdrawal symptoms mild to severe

55. Drug Abuse Commonly Abused Drugs Analgesic Antianxiety Antidepressant
Sedative
Illegal drugs 55

56. Drug Abuse Identifying Drug Abuse Step 1 Step 2
Notify the physician immediately
Step 2
Check local pharmacies to see if patient is obtaining medications from multiple pharmacies 56

57. Drug Abuse Identifying Drug Abuse Step 3
Tell patients who are frequently calling for refills that another refill will require an office visit 57

58. Drug Abuse Identifying Drug Abuse
Safeguard items in medical office that could be stolen and misused for drug abuse
Syringes
Needles
Prescription pads

59. TABLE 54-5 Drug Classifications and Descriptions of Use

60. TABLE 54-5 (continued) Drug Classifications and Descriptions of Use

61. TABLE 54-5 (continued) Drug Classifications and Descriptions of Use

62. TABLE 54-5 (continued) Drug Classifications and Descriptions of Use

63. TABLE 54-5 (continued) Drug Classifications and Descriptions of Use

64. TABLE 54-5 (continued) Drug Classifications and Descriptions of Use

65. Questions? 65