PHARMACOLOGY
AND
VENIPUNCTURE
By Shalom James B. Apura, RPh
GENERAL PHARMACOLOGIC PRINCIPLES
01 02
Uses and impact of
Pharmacokinetics drug categories and
and contrast agents'
Pharmacodynamic categories on the
principles of drugs patient.
03 04
Beam attenuation Six rights of drug
and pharmacologic
safety
profile of contrast
agents
INTRAVENOUS CONTRAST MEDIA
AND MEDICATION ADMINISTRATION
01 02 03
Venous anatomy Acceptable Correct
and correct universal preparation and
circulatory precaution administration of
physiology techniques and intravenous (IV)
pertinent patient contrast media,
assessments and the
performance of
safe and accurate
venipuncture
procedure.
PHARMACOLOGY
STUDY OF SELECTIVE BIOLOGIC ACTIVITY OF DRUGS
STUDY OF SUBSTANCES THAT INTERACT W/ LIVING
SYSTEMS THROUGH CHEMICAL PROCESSES, ESPECIALLY BY
BINDING TO REGULATORY MOLECULES &
ACTIVATING OR INHIBITING NORMAL PROCESSES
DRUGS
ARTICLES FOR USE IN THE DIAGNOSIS, CURE, MITIGATION,
TREATMENT, OR PREVENTION OF DISEASE IN MAN OR
OTHER ANIMALS.
SUBSTANCES THAT ACT ON BIOLOGIC SYSTEMS AT THE
CHEMICAL (MOLECULAR) LEVEL AND ALTER THEIR
FUNCTIONS(KATZUNG
DRUG NOMENCLATURE
1. CHEMICAL NAME = GENERIC NAME
2. CODE NUMBER = TRADE NAME
3. CHEMICAL NAME (FOR RESEARCH PURPOSES)
4. GENERIC NAME (INTRODUCCED THE PUBLIC)
5. TRADE NAME (FOR MARKETING)
6.
DRUG NOMENCLATURE
<--- GENERIC NAME
<---------------- BRAND NAME
LEGEND DRUGS
(PRESCRIPTION DRUGS)
MEDICATIONS THAT REQUIRE A PRESCRIPTION
Patient Name
Route of administration
Drug name
Dosage
LEGAL PRESCRIPTION
Date order written Dosage form
Prescriber’s Signature
Identification Numbers
Room Number or address
1. PATIENT NAME, ROOM NUMBER OR ADDRESS, AND
IDENTIFICATION NUMBERS
2. DRUG NAME (GENERIC OR BRAND)
3. DOSAGE
4. DOSAGE FORM
5. ROUTE OF ADMINISTRATION
6. DATE ORDER IS WRITTEN
7. PRESCRIBER’S SIGNATURE
CHARTING
SHOULD TELL AN ACCURATE, CHRONOLOGIC HISTORY OF
EVENTS AS THEY OCCUR IN THE SUPERVISION OF THE
MEDICAL PROFESSIONALS
BIOPHARMACEUTICS
AREA IN PHARMACOLOGY THAT FOCUSES ON THE METHOD
OF ACHIEVING EFFECTIVE DRUG ADMINISTRATION
DOSAGE FORMS
1. SOLID
2. LIQUID
3. GAS
SOLID DOSAGE FORMS
1. TABLET
GENERALLY, CONSISTS OF AN ACTIVE
INGREDIENT, VARIOUS FILLERS AND
DISINTEGRATORS, DYES, FLAVORING AGENTS
AND AN OUTSIDE COATING
SOLID DOSAGE FORMS
1.1 COMPRESSED TABLET
ARE COMPACTED WITH NO SPECIAL COATING
SUBJECTED TOO CHEMICAL DEGRADATION FROM
THE ENVIRONMENT
SOLID DOSAGE FORMS
1.2 SUGAR COATED TABLETS
HAVE A THIN COATING OF SUGAR DESIGNED TO
MASK BAD TASTE AND PROTECT THE ACTIVE
INGREDIENTS FROM CHEMICAL OXIDATION
SOLID DOSAGE FORMS
1.3 SUGAR COATED TABLETS
HAVE A THIN COATING OF SUGAR DESIGNED TO
MASK BAD TASTE AND PROTECT THE ACTIVE
INGREDIENTS FROM CHEMICAL OXIDATION
SOLID DOSAGE FORMS
1.4 FILM COATED TABLETS
TABLETS THAT ARE DESIGNED TO PASS THEOUGH
THE GASTRIC AREA AND RELEASE THE ACTIVE
INGREDIENTS INTO THE SMALL INTESTINE.
SOLID DOSAGE FORMS
1.5 MULTIPLE -COMPRESSED
DESIGNED TO MASK TASTE, PROTECT CONTENTS
AGAINST CHEMICAL OXIDATION.
SOLID DOSAGE FORMS
1.6 EFFERVESCENT
CONTAIN SODIUM BICARBONATE AND AN ORGANIC
ACID SUCH AS CITRATE.
SOLID DOSAGE FORMS
1.7 BUCCAL OR SUBLINGUAL
DESIGNED TO DISINTEGRATE IN THE BUCCAL OR
SUBLINGUAL SPACE AND BECOME ABSORBED
THROUGH THE BUCCAL OR SUBLINGUAL
VASCULATURE.
SOLID DOSAGE FORMS
2. CAPSULES
GENERAL CONSIST OF EITHER A HARD OR A SOFT
GELATIN SHELL THAT ENCLOSES THE ACTIVE
INGREDIENT.
SOLID DOSAGE FORMS
3. TORCHES
LOZENGES
CONTAINS MEDICINE IN HARD SUGAR
LIQUID DOSAGE FORMS
1. SOLUTION
2. EMULSION
3. SUSPENSION
LIQUID DOSAGE FORMS
1. SOLUTION
2. EMULSION
3. SUSPENSION
LIQUID DOSAGE FORMS
1. SOLUTION - A HOMOGENOUS MIXTURE OF SOLID,
LIQUID, OR GAS DISSOLVED IN ANOTHER LIQUID. THE
SOLUTE (DRUG) IS DISPERSED IN THE SOLVENT
(VEHICLE)
LIQUID DOSAGE FORMS
2. EMULSION - A DOSAGE FORM CONSISTING OF TWO
IMMISCIBLE’ LIQUIDS. ONE LIQUID APPEARS AS
GLOBULES UNIFORMLY DISPERSED THROUGHOUT
THE OTHER LIQUID. GENERALLY, AN EMULSIFYING
AGENT IS REQUIRED TO MAINTAIN GLOBULAR
STABILITY.
LIQUID DOSAGE FORMS
3. SUSPENSION - A SOLID MEDICATION DISPERSED
THROUGHOUT A LIQUID MEDIUM. A SUSPENDING
AGENT IS GENERALLY ADDED TO HELP MAINTAIN
UNIFORM DISPERSION. SUSPENSIONS GENERALLY
REQUIRE AGITATION (SHAKIN) BEFORE
ADMINISTRATION.
LIQUID DOSAGE FORMS
PARENTERAL DOSAGE FORMS - GIVEN BY INJECTION
UNDER OR THROUGH ONE OR MORE LAYERS OF SKIN
OR MUCOUS MEMBRANE.
1. SUBCUTANEOUS
2. INTRADERMAL
3. INTRATHECAL
4. INTRACISTERNAL
5. INTRAMUSCULAR
6. INTRAVENOUS
7. INTRAARTERIAL
GAS DOSAGE FORMS
TYPICALLY USED FOR OXYGEN
THERAPY, ANESTHESIA, AND AEROSOL
INHALERS.
PHARMACOLOGY
STUDY OF SELECTIVE BIOLOGIC ACTIVITY OF DRUGS
STUDY OF SUBSTANCES THAT INTERACT W/ LIVING
SYSTEMS THROUGH CHEMICAL PROCESSES, ESPECIALLY BY
BINDING TO REGULATORY MOLECULES &
ACTIVATING OR INHIBITING NORMAL PROCESSES
PHARMACOKINETICS
Katawan - Drug
VS
PHARMACODYNAMICS
Drug - Katawan
PHARMACOKINETICS
Katawan - Drug
PHARMACOKINETICS
Consists of the process of how drug is:
01 Absorbed
02 Distributed
03 Metabolized
04 Eliminated
ABSORPTION
Numerous anatomic sites,
including GI tract, lungs,
mucous membranes, eyes,
skin, muscle, and
subcutaneous tissues, can be
used for systemic drug
absorption.
ABSORPTION
Drug absorption depend on
dissolution properties of the
dosage form. properties of
the dosage form;
1. Surface area at the site
2. Blood flow to the site
3. Concentration of drug at
the site
ABSORPTION
4. Acid-base properties
surrounding the absorbing
surface
5. Lipophilicity (attraction to
fat) of the drug
6. Compatibility with other
chemicals or drugs.
DISTRIBUTION
Defined as the transport of
a drug in body fluids from
the bloodstream to various
tissues of the body and
ultimately to its site of
action.
DISTRIBUTION
Factors that affect distribution, as follows:
1. Cardiac output: amount of blood pumped by
the heart per minute.
2. Regional blood flow: amount of blood supplied
to a specific organ or tissue.
3. Drug reservoirs: drug accumulations that are
bound to specific sites, such as plasma, fat tissue,
and bone tissue.
DISTRIBUTION
Two barriers to distribution made up
of biologic membranes:
1. Blood-Brain Barrier
2. Placental Barrier
METABOLISM
AKA bio-transformation
Chemically changes a drug into a
metabolite that can be excreted
from the body. The liver is primarily
responsible for this task, although
the plasma, kidneys, lungs, and
intestinal mucosa also play a role.
METABOLISM
Phase 1
RedOx reaction & hydrolysis -
gaining an electron to decrease
positive valence.
Phase 2
Conjugation - transform a drug
to water-soluble substance that
can be excreted through biliary
tract.
ELIMINATION
1. kidneys - They filter the
blood and remove
unbound, water-soluble
compounds. This is one
reason why drug testing
is often done on urine.
ELIMINATION
2. Intestines - After
metabolism by the liver, a
metabolite may be secreted
into the bile, passed into the
duodenum, and eliminated in
the feces.
ELIMINATION
3. Respiratory system - Gases
or volatile liquids that are
administered through the
respiratory system usually are
eliminated by the same route.
Breast milk, sweat, and saliva also contain certain drug
compounds but are not the body’s predominant
mechanisms for elimination.
PHARMACODYNAMICS
Drug - Katawan
PHARMACODYNAMICS
the study of how the effects of a drug are
manifested.
-mechanism of action,
-onset of action,
-therapeutic effect,
-adverse effect,
-toxicity,
-termination of action,
-side effect
-allergic reaction.
PHARMACODYNAMICS
Mechanism of Action
The method by which a drug elicits effects.
Drugs produce effects through drug-receptor interactions
(stimulation or blockade), drug-enzyme interactions, or
nonspecific drug interactions.
PHARMACODYNAMICS
Drug-Receptor interaction
Receptors are specific biologic sites located on a cell surface
or within a cell.
PHARMACODYNAMICS
Drug-Enzyme interaction
Enzymes occur throughout body systems and are generally
considered catalysts responsible for initiating biochemical
reactions.
ex. Nerve gas (sarine gas)
PHARMACODYNAMICS
Nonspecific Drug Interactions
some drugs may elicit pharmacologic effects through nonspecific
pharmacodynamics.
ex. The radiopaque contrast media, elicit their desired effects
through the radiopaque iodine contained within their structure.
Some drugs penetrate cell membranes or accumulate within a
cell or cavity so that interference with normal cell biochemical
function occurs
PHARMACODYNAMICS
Drug-Response Relationships
Efficacy - the degree to which a drug is able to produce the
desired effect (how great the effect will be)
Potency - the relative concentration required to produce that
effect (how much drug is needed).
PHARMACODYNAMICS
Drug-Response Relationships
Efficacy - the degree to which a drug is able to produce the
desired effect (how great the effect will be)
Potency - the relative concentration required to produce that
effect (how much drug is needed).
Drug-Response Relationships
PHARMACODYNAMICS
Half-life
The time required for the current serum drug concentration to
decline by 50% is termed the biologic half-life, or half-life of
elimination.
PHARMACODYNAMICS
Therapeutic Index
The therapeutic index is a measure of the relative safety of a
drug. It is a ratio between:
Lethal dose (LD50) - the dose at which a drug is lethal to 50% of
the population.
Effective dose (ED50) - the dose required to produce a
therapeutic effect in 50% of the population.
PHARMACODYNAMICS
Adverse Effects
side effect - a predictable pharmacologic action on body systems
other than the action intended. (Side effects can be either “good”
or “bad,” depending on the situation)
.adverse effect - any unwanted effect
PHARMACODYNAMICS
Adverse Effects
Toxicity - is directly related to dose (the higher the dose, the
greater the toxic effects).
Allergic reaction - results from an immune-mediated response by
the body against the drug and is not necessarily related to dose.
*Both toxic and allergic effects are adverse
PHARMACODYNAMICS
Drug-Drug Interactions
occurs when two or more drugs act in unison to produce additive
agonist, synergistic, or antagonist responses.
PHARMACODYNAMICS
Drug-Drug Interactions
1. Addition (1 + 1 = 2) - response is equal to the combined effects
of the individual drugs
2. Synergism (1+1 = 3) - response is greater than the combined
effects of the individual drugs
3. Potentiation (1+0 = 2) - a drug with no inherent activity will
enhance the effect of another drug
4. Antagonism (1+1 = 0) - drug inhibits the effect of the other
DRUG
CLASSIFICATIONS
CARDIAC MEDICATIONS
Antiarrhythmic
Medications are those drugs that affect the electrical
conduction system of the myocardium.
The ultimate goal for this class of medications is to
suppress excess electrical conduction within the
cardiac system and thus decrease arrhythmia
(dysrhythmia) production.
CARDIAC MEDICATIONS
Antiarrhythmic
Common drugs: 8. atenolol 16. verapamil
1. lidocaine 9. metoprolol 17.adenosine
2. procainamide 10. acebutolol 18. ibutilide
3. flecainide 11. esmolol 19. dofetilide
4. disopyramide 12. labetolol 20. digoxin
5. mexilitine 13. sotalol
6. moricizine 14. propafenone
7. amiodarone 15. diltiazem
CARDIAC MEDICATIONS
Antihypertensive
Medications assist in lowering the blood pressure to
safe, long-term goals.
A - ACEi & ARBs (-pril & -sartan)
B - Beta Blockers (-olol)
C - Ca Channel Blockers (-dipine)
D - Diuretics
CARDIAC MEDICATIONS
Diuretics
1. Carbonic Anhydrase Inhibitors (-zolamide)
2. Potassium-sparing diuretics
3. Osmotic
4. Loop
5. Thiazide
CARDIAC MEDICATIONS
Anticoagulant, Antiplatelet, & Thrombolytics
Anticoagulant - medication is frequently used in patients who have
either a history of blood clot formation or the potential to develop
blood clots.
Antiplatelet - medication is generally used in patients who have
experienced an acute ischemic event to either their heart or their
brain in the past.
Thrombolytic - medication is used to actively break up a newly
formed clot, such as found in patients with acute myocardial
infarction, acute stroke secondary to blood clot, or lower leg
ischemia.
ANALGESIC MEDICATIONS
Analgesic
Used to treat both acute and chronic pain
syndromes.
Narcotic
Medications stimulate central nervous system
receptors known as opioid receptors and cause a
decrease in the perception of pain.
ANALGESIC MEDICATIONS
Nonsteroidal anti-inflammatory drugs (NSAIDS)
Used to treat pain associated with inflammation
ex. ibuprofen, naproxen, diclofenac, celocoxib
ANALGESIC MEDICATIONS
Muscle Relaxants
Used to treat pain associated with muscle spasms.
ex. cyclobenzaprine, baclofen, diazepam, lorazepam,
clonazepam, alprazolam, methocarbamol, and
metaxalone
ANALGESIC MEDICATIONS
Acetaminophen
It acts by inhibiting prostaglandins in the central
nervous system that are responsible for pain
production.
Low-potency pain reliever and must not exceed
4000 mg per day because it is associated with
severe liver damage at high doses.
ANTIHISTAMINE MEDICATIONS
Antihistamine
Medications used to block histamine from
producing adverse effects such as itching,
inflammation, respiratory distress, and overall
allergic reactions.
ANTIHISTAMINE MEDICATIONS
Antihistamine
hydroxyzine (Vistaril, Atarax)
diphenhydramine (Benadryl)
fexofenadine (Allegra)
loratadine (Claritin)
cetirizine (Zyrtec)
ENDOCRINE MEDICATIONS
Antidiabetic
Insulin
OHA
glimeprimide, glipizide, glyburide, rosiglitazone,
pioglitazone, nateglinide, and metformin
ENDOCRINE MEDICATIONS
Metformin
Should be held before and for at least 48 hours
after receiving a radiopaque contrast agent.
Risk for severe metabolic acidosis secondary to
metformin metabolite accumulation, in the event
renal dysfunction is caused by the radiopaque
contrast agent.
ENDOCRINE MEDICATIONS
Thyroid medication
Hypothyroidism
levothyroxine, thyroxine, liothyronine, and
desiccated thyroid
Hyperthyroidism
methimazole and propylthiouracil.
CENTRAL NERVOUS SYSTEM
MEDICATIONS
Antiseizure (anticonvulsant)
-medications are used to prevent and to treat seizure
disorders.
Ex. phenytoin, diazepam, clonazepam, lorazepam,
valproic acid, carbamazepine, amobarbital
CENTRAL NERVOUS SYSTEM
MEDICATIONS
Antipsychotic
-medications are used to treat psychotic episodes and
disorders.
ex. haloperidol, valproic acid, divalproex, olanzapine,
clozapine, quetiapine, aripiprazole, chlorpromazine,
fluphenazine, triflupromazine, loxapine, mesoridazine,
thioridazine, amoxepine, perphenazine, risperidone,
ziprasidone, thiothixine, and pimozide
CENTRAL NERVOUS SYSTEM
MEDICATIONS
Antidepressant
-medications are use to treat clinical depression that
results from neurotransmitter deficiencies.
Ex. amitriptyline, nortriptyline, desipramine,
imipramine, protriptyline, trimipramine, amoxapine,
maprotiline, isocarboxazid, tranylcypromine,
sertraline, citalopram, escitalopram, fluoxetine,
venlafaxine, mirtazapine, trazadone, buproprion, and
nefazodone
CENTRAL NERVOUS SYSTEM
MEDICATIONS
Antianxiety
-medications are used for treating acute and chronic
anxiety states.
Ex. diazepam, lorazepam, midazolam, alprazolam,
chlordiazepoxide, clonazepam, and buspirone
ANTIINFECTIVE AGENTS
Antibiotics
Therapeutic agents used to kill or suppress pathologic
microorganisms responsible for causing infectious
diseases.
Ex. Penicillins (oxacillin, cloxacillin, nafcillin, ampicillin,
ticarcillin, piperacillin)
Cephalosporins (cefazolin, cefuroxime, ceftriaxone,
cefpodoxime, cefotetan, cefamandole, cefaclor,
cefalexin, cefadroxil, ceftazidime, cefipime),
ANTIINFECTIVE AGENTS
Antibiotics
Ex. Carbapenams (meropenam, imipenam,
ertapenam)
Tetracyclines (tetracycline, minocycline, doxycycline)
Macrolides (erythromycin, clarithromycin,
azithromycin)
Lincosamides (clindamycin), and nitroimidazoles
(metronidazole)
ANTIINFECTIVE AGENTS
Antifungals
Agents used to kill mycotic (fungal) organisms
Ex. Amphotericin B, fluconazole, voriconazole,
caspofungin, clotrimazole, flucytosine, itraconazole,
miconazole, ketoconazole, nystatin, and terbinazine.
ANTIINFECTIVE AGENTS
Antiviral
Used to suppress and limit the spread or shedding of
viruses that invade the human body.
Ex. Acyclovir, famciclovir, ganciclovir, ribavirin,
valacyclovir, valganciclovir, rimantidine, foscarnet, and
interferon.
CHEMOTHERAPY AGENTS
Chemotherapy drugs are extremely toxic compounds
designed to kill off rapidly growing (e.g., cancerous)
cells of the human body by altering or destroying the
various stages in cellular division.
Ex. Adriamycin, etoposide, vincristine, VP-16,
cyclophosphamide, bleomycin, flurouracil, doxirubucin,
paclitaxel, docetaxel, methotrexate, and nitrogen
mustard
