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Looking at Drugs

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Ben Rieke

on 8 September 2013

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Transcript of Looking at Drugs

Looking at Drugs: Framing the Essentials
is any chemical that affects the physiologic processes of a living organism.

is the study of drugs.

What the DRUG
does to the BODY
Kind of a combination of pharmacokinetics and pharmacodynamics. Study of how various dosage forms influence the way in which the body metabolizes a drug, and the way the drug affects the body
The study of natural sources of medications, either from plants, fungi or animals
What the BODY does to the DRUG
D istribution
A bsorbtion
M etabolism
E xcretion

Psalm 16:11
"You make known to me the path of life; you will fill me with joy in your presence, with eternal pleasures at your right hand"

Now...where to begin?
I do love me some

The rate at which a drug leaves its site of administration, and the extent to which absorption occurs

Compare Diphenhydramine's

The transport of a drug in the body by the bloodstream to its site of action

Compare BENADRYL (diphenhydramine)
and ALLEGRA (fexofenadine)

Metabolism & Biotransformation
The biochemical transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite

The body's ability to get rid of a drug

Renal disease
Hepatic impairment
Nutrition status
Circulatory status
Will an ischemic bowel absorb drug well?
Can topical drugs be applied to broken skin?
What route of nitroglycerin would you
give a patient having a heart attack?
Nitro paste? Sublingual tablets?
Intravenous injection?
How does physics play into absorption?
Think of your phases of matter.
Why might a malnourished
person have decreased distribution?
How might old age effect
metabolism of a drug?
What are some of the genetic variations that influence drug metabolism?
Why would a dehydrated patient have trouble clearing a drug?
So many ways to give drugs...

Routes of drug administration can be put into two groups
If it's going over the lips and through the gums...
Chances are that you're using an
route. These medications are absorbed in the GI tract

If you're about to jab your patient with a needle...
Chances are that you are giving
a drug via the
These medications are not reliant
on the GI mucosa for absorption
tablets, elixirs, syrups, capsules, suspensions...
Usually solutions, sometimes transdermal patches
Problems with PO
Drugs which are absorbed by the stomach and
small intestine pass through the mucosa and
into the blood stream of the hepatic portal system.
The liver destroys chemicals as they pass through.
Evolutionarily, this protected us from ingested poisons
accidentally eaten (think mushrooms, berries, etc.).
Don't blame your liver though...it doesn't know any better
Topical meds
These medications 'stays where you put them' so to speak. Topical medications take their effect where they are placed, and are commonly applied to the:
-skin, eyes and ears
-lungs (like an inhaler)
-rectum or vagina
Match the Drug to the Route
glycerin suppository
nitroglycerin paste
buccal fentanyl
albuterol inhaler
azithromycin tablet
Tylenol suppository
intrathecal bupivacaine

Tip: Consider where
the drug is taking
Timing is Everything
Half Life: The time it takes for half of the original amount of drug to be removed from the body
Onset: The time it takes for the drug
to elicit a therapeutic response
Peak: The time it takes for a drug to reach its maximum therapeutic response
Duration: The time a drug stays at a concentration sufficient to produce
a therapeutic response
Blood may be taken at intervals
after giving a medication to determine
its concentration in the blood.
Hopefully, these levels will be consistent
with established medication norms for
metabolism and excretion.
Is it working? Appropriate dose?
Is my patient experiencing adverse effects related to their medication? Are they growing tolerant, or dependent?
Are their medications interacting? -additive, idiosyncratic, synergistic
Is this medication safe for my patient? Contraindications.

Infants and Children
Basically, infants and children are still immature in their development, and are therefore very sensitive to drugs. They require individualized dosing, and close monitoring for problems. Kids don't clear drug as rapidly as adults, so toxicity can set on if not closely watched. Babies and kids also have more water content in their bodies that can cause decreased absorption of fat soluble meds.
The Elderly
The elderly also have differences in the way that they respond to drug therapies. Older persons have decreased gastric pH, decreased CO and perfusion, decreased peristalsis, slower metabolism, and do not clear drug as rapidly as younger adults. They are at increased risk for drug toxicity, supratherapeutic peaks/troughs, and adverse effects. Their physiology has less water, too, so unlike children fat soluable meds will stay bioavailable longer.
Pregnant Women
Pregnant women need to be cautious about what they consume for the safety of the development of the fetus. Drugs are classified on a teratogenic scale (A,B,C,D, or X) depending on how toxic a drug is to a fetus. The first trimester is when a fetus is most at risk for drug related defect, and the third is when it is most susceptible to cognitive/developmental disability. DRUGS CAN PASS INTO BREAST MILK! Lactating mothers must talk to their PCP or OB about medications and breast feeding.
Lifespan Considerations
West Nomogram
Federal Food & Drug Act
Ensured that foods and drugs shipped between states were labeled with accurate ingredients and manufacturing dates
Laid the foundation for the eventual creation of the FDA
Sherley Amendment
Made sure that claims regarding a drug's therapeutic or curative claims were substantiated.
This amended the Federal Food and Drug Act of 1906, since it did not protect consumers from false advertising claims, only mislabeling of ingredients
Harrison Narcotic Act
Regulated a new drug cohort termed 'narcotics' which included opiates and cocaine
Coined and defined the term 'narcotic'
Really was made to ensure taxation of these drugs, but eventually led to their regulation and loss of legality

Federal Food, Drug & Cosmetic Act
Replaces the Food and Drug Act of 1906 after a disaster killing 100 patients due to drug contamination
Created the FDA as we know it today
Regulates food, drugs, medical devices, food additives and preservatives, and dietary supplements
Durham-Humphrey Amendment
Estabilished two catagories of medications: those which can be sold over the counter, and those which must be prescribed (legend drugs)
Defined that prescription drugs are those unsafe for self-medication

Kefauver-Harris Amendment
Made drug companies prove the efficacy of their product, and certify its safety
Disclosure of adverse effects must be made in its packaging
Enter the world of formalized clinical trial and study
Controlled Substance Act
Created cohorts of drugs based on dependency potential whose provision and sales would be regulated by a 'schedule'
Schedule one drugs were deemed to serve no routine medical purpose and are Federally banned
Schedule five drugs are not heavily restricted, and generally have little to no known physical dependency risk
Orphan Drug Act
Incentivized the development and manufacturing of drugs used for very rare diseases
Decreases barriers to obtain grants and facilities for research and development of 'orphan drugs'
Now Entering a Content Zone with Potentially Boring Stuff That Can Trip You Up on the Exam
(and will)
The Dreaded HIPAA
Health Insurance Portability and Accountability Act

Secures identifiable patient information such as medical and procedural records, payment information, and associated info
Info is on a need-to-know basis
Info being released may be depersonalized in certain circumstances
Make your care patient centered,
and support your patient's ability to do
for himself/herself, and make his/her
own decisions
Always tell the truth. Do not hide the truth in making clinical decisions, or in trying to coax a desired clinical outcome
Beneficence /Nonmaleficence
Do no harm. Act always in the best interest of your patient, and do not knowingly do anything to worsen their condition. Do not punish, or withhold necessary treatment or assistance.
What happens to the patient in your charge stays between you, the patient, and the immediate medical team. Disclosure of information cannot take place without patient consent.
Always act in fairness. Make clinical decisions that are objective and outcome oriented.
Over the Counter
Can be used safely and effectively
for the management of minor conditions (headaches, hay fever, etc.)

of OTC Meds
Pts. may not seek care for major problems until they are more serious
OTCs may cause untoward effects in people with certain conditions
People may disregarding dosing and measurement
OTCs can sometimes be used as precursors to illicit drugs
Old people cannot read the label correctly
Children can have unusual idiosyncratic reactions
May interact with prescriptions
OTCs are cheap, fairly safe, and readily available meds
People can help themselves with minor problems, thus freeing professionals to assist more critically ill patients
Make the cost of healthcare decrease
Acetaminophen (Tylenol)
Ibuprofen (Advil), Naproxen (Aleve), Aspirin (Bayer)
and other NSAIDs
May cause liver failure with chronic use and misuse.
not to exceed four grams
per day from all sources.
Hepatotoxicity has developed at doses less than 4g. however
NSAIDS increase bleeding risks and should not be used in patients
recieving blood thinners. Chronic use, or high doses, may cause serious GI bleeding, stomach ulceration, renal disease, and renal failure.
Herbals &
Dietary Supplements
Are generally safe for most healthy people. Have been used for thousands of years.
Support diet (vitamins), help prevent illness, and augment tissues and glands for optimal health
Not without risks, however

PROS and CONS of
Herbals & Supplements
Available without prescription
Vitamins, minerals and some herbs have been shown to help manage and prevent certain illnesses
Plants are the basis for many medications, and have been used in medical applications for 1000s of years
Many Are Not Evaluated
by the FDA
Herbals and supplements are often marketed as food products, and therefore do not meet the strict scrutiny of the FDAs drug approval process
Efficacy as a treatment, cure, or prophylaxis cannot be determined or certified
Herbals Can Interact
with Prescriptions
Many herbals do interact with prescription drugs
May cause minor problems, or serious side effects
Natural ≠ safe
Allergies, Toxicities,
and Purity
Many people are allergic to herbs, and may not know until they have taken them
Some herbs, especially those prepared in non-domestic markets may be impure and toxic
Purity of product is sometimes questionable. Product may contain little active ingredient in a lot of 'filler'
Full transcript