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4 LOM Pharm

Terms

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4. intrathecal injection
(parenteral administration)
⬢Injection into the space under the membrane (meninges) surrounding the spinal cord and brain.

⬢Methotrexate (a cancer chemoth. Drug) is injected intrathecally for treatment of leukemia.
5. intravenous injection (IV)
(parenteral administration)
⬢Injection directly into the vein.

⬢Used when immediate effect from drug is desired;

⬢Or when drug cannot be safely introduced into other tissues.

⬢Hypodermic needle into subq tissue under skin

⬢Usually on upper arm, thigh, or abdomen.
6. subcutaneous injection (SC)
(parenteral administration)
⬢Hypodermic needle into subq tissue under skin

⬢Usually on upper arm, thigh, or abdomen.
Inhalation
⬢Vapors, gases; absorbed into bloodstream thru thin walls of air sacs in the lungs.

⬢Aerosols, administered by inhalation, like many anesthetics.

⬢Pentamidine, treat pneumonia associated with AIDS.

⬢Various aerosolized medicines treat asthma.
Topical Application
⬢Drugs locally applied on skin or mucous membranes

⬢Antiseptics (against infection)

⬢Antipruritics (against itching)

⬢Commonly used as ointments, creams, and lotions.

⬢Transdermal patches are used to deliver drugs (estrogen, pain medications, nicotine) continuously thru the skin.
Synergism
⬢Combination of two drugs is greater than the total effects of each drug by itself.

⬢Penicillin and streptomycin, given together in treatment of bacterial endocarditis.
Antagonistic
Two drugs give less than an additive effect.
Additive effect
⬢Combination of two similar drugs is equal to the sum of the effects of each.

⬢Drug A gives 10% tumor kill as chemoth. agent, Drug B gives 20% tumor kill as chemoth. agent, together would give 30% tumor kill.
Anaphylaxis
⬢Acute hypersensitivity with asthma and shock. An idiosyncrastic reaction to penicillin is an example.

⬢Idiosyncrasy: an unpredictable type of drug toxicity.
ANTICOAGULANTS
and
ANTIPLATELET
DRUGS
⬢Prevent clotting of blood

⬢Prevent and break up clots in blood vessels in thrombosis and embolism.

⬢Prevent coagulation in preserved blood used in transfusions.

⬢Heparin is a natural anticoagulant produced by liver cells and some white blood cells.

⬢warfarin (Coumadin) is manufactured.

⬢Antiplatelet drugs reduce the tendency of platelets to stick together.

⬢Aspirin , recommended for coronary artery disease and for those who've had heart attacks.
Tissue-type plasminogen activator
(tPA)
⬢dissolves clots and is used to open vessels after myocardial infarction.
ANTICONVULSANTS
⬢prevents or reduces the frequency of convulsions in various types of epilepsy.

⬢Depress abnormal spontaneous activity of the brain arising from areas of scar or tumor, w/o affecting normal brain function.
ANTIDEPRESSANTS
⬢Elevate mood

⬢Increase physical activity and mental alertness

⬢Improve appetite and sleep patterns.

⬢Many are mild sedatives for derpession associated with anxiety.
Tricyclics (TCAs)

Selective serotonin reuptake inhibitors (SSRIs)
⬢Largest class of antidepressants

⬢Increase the action of neurotransmitters by blocking their removal (reuptake) from the synapses.
Monoamine oxidase inhibitors (MAOIs)
⬢Increase the length of time neurotransmitters work by blocking monoamine oxidase, an enzyme that normally inactivates neurotransmitters.
ANTIDIABETICS
⬢Treatment of diabetes mellitus (a condition in which the hormone insulin is either not produced by the pancreas or is not effective in the body).
insulin
⬢Type 1(insulin-dependent) diabetes patients must receive daily injections of insulin.

⬢Human insulin produced by recombinant DNA research has replaced animal-derived insulin.

1.Rapid or short-acting insulin, starts to work in 30-60 minutes, lasts 12-16 hours.

2.Intermediate-acting insulin, 1 to 2-1/2 hours, lasts 24 hours.

3.Long-acting insulin, begins working in 4-8 hours, lasts 36 hours or more.
Type 2 (non-insulin-dependent) diabetes
Given oral antidiabetic drugs.
Sulfonylureas
Biguanides
Alpha-glucosidase inhibitors
Thiazolidinediones
Meglitinides
Biguanides
Increase the body's sensitivity to insulin and reduce production of glucose by liver.
Thiazolidinediones
Enhance glucose uptake into tissues
Meglitinides
Stimulate the beta cells in the pancreas to produce insulin.
Alpha-glucosidase inhibitors
Temporarily block enzymes that produce sugars.
Sulfonylureas
Lowers the levels of glucose in the blood by stimulating the production of insulin.
Histamine
Causes allergic reactions such as hives, bronchial asthma, hay fever, and in severe cases anaphylactic shock.
Anaphylactic shock
Dyspnea, hypotension, and loss of consciousness.
Antihistamines
⬢Cannot cure the allergic reaction, but relieve the symptoms.

⬢Many antihistamines have strong antiemetic activity and used to prevent motion sickness.

⬢Most common side effects are drowsiness, blurred vision, tremors, digestive upset, and lack of motor coordination.
Antiosteoporosis drugs
⬢Calcium, vitamin D, and estrogen are prescribed to increase calcium deposition in bone.

⬢Bisphosphates prevent bone loss

⬢Selective estrogen receptor modulators(SERMs)(hormone-like drugs), increase bone formation.
Cardiovascular drugs
Act on the heart to treat:
Hypertension
Angina (pain due to decreased oxygen delivery to heart muscles)
Heart attack
Congestive heart failure
Arrythmias

Often, daily aspirin therapy (prevents clots in blood vessels) and sublingual nitroglycerin (dilates coronary blood vessels) are prescribed. Digoxin (Lanoxin) helps the heart pump more forcefully in heart failure.
Cardiovascular drugs
Types
1.Angiotensin-Converting Enzyme (ACE) inhibitors.
2.Angiotensin II receptor antagonists.
3.Antiarrythmics.
4.Beta-Blockers.
5.Calcium Antagonists or Calcium Channel Blockers.
6.Cholesterol-Lowering Drugs.
7.Diuretics.
Angiotensin-Converting Enzyme (ACE) Inhibitors
⬢Prevent conversion of angiotensin I to angiotensin II, a powerfu vasopressor(vasoconstrictor).

⬢Dilate blood vessels to lower blood pressure, improve heart performance, reduce its workload.

⬢Reduce the risk of heart attack, stroke and death even if the patient is not hypertensive.
Angiotensin II receptor antagonists
⬢Lower blood pressure by preventing angiotensin from acting on receptors in blood vessels.

⬢Used in patients who don't tolerate ACE inhibitors because of cough or angioedema (swelling of tissues).
Antiarrythmics
⬢Reverse abnormal heart rhythms.

⬢Slow response of heart muscles to nervous system stimulation or

⬢Slow the rate at which the nervous system impulses are carried through the heart.
Beta-Blockers
⬢Decrease muscular tone in blood vessels (vasoldilation)

⬢Decrease output of the heart

⬢Reduce blood pressure by blocking the receptors of epinephrine at receptor sites in the heart muscle and blood vessels.

⬢For angina, hypertension, and arrythmias and prevention of second heart attacks.
Calcium Antagonists or
Calcium Channel Blockers
⬢Inhibit the entry of calcium (necessary for blood vessel contraction) into the heart muscles and blood vessels.

⬢Dilate blood vessels and lower blood pressure

⬢Used to treat angina and arrhythmias.
Cholesterol-lowering drugs
⬢Reduce hypercholesterolemia, a major factor in the development of heart disease.

⬢Cholestyramine (Questran) lowers cholesterol by promoting its excretion in feces.

⬢Statins or HEMOGLOBIN-CoA reductase inhibitors, lower cholesterol by reducing its production in the liver.
Diuretics
⬢Reduce the volume of blood in the body by promoting the kidney to remove water and salt through urine.

⬢Treatment of hypertension and congestive heart failure.
Androgens
⬢Made by the testes and adrenal glands

⬢Used for male hormone replacement

⬢Tretment of endometriosis and breast cancer in women.
Antiandrogens
⬢Slow the uptake of androgen or interefere with their binding in tissues.

⬢Prescribed for prostate cancer.
Estrogens
⬢Female hormones, normally produced by the ovaries.

⬢Used for symptoms associated with menopause (estrogen replacement therapy).

⬢Prevent postmenopausal osteoporosis.

⬢Used as chemotherapy for some types of cancer (prostate cancer).
Antiestrogens
⬢tamoxifen (Nolvadex), used to prevent recurrence of breast cancer and to treat metastatic breast cancer.
Aromatase inhibitors
⬢reduce the amount of estrogen(estradiol) in the blood.
Selective estrogen receptor modulator(SERM)
⬢has estrogen-like effects on bone (increase in bone mineral density) and on lipid (decrease in cholesterol levels) metabolism.

⬢But, it lacks estrogenic effects on uterus and breast tissue.

⬢Progestins , prescribed for abnormal uterine bleeding caused by hormonal imbalance and, together with estrogen, in hormone replacement therapy, and oral contraceptives.
Glucocorticoids
(adrenal corticosteroids)
⬢Prescribed for reduction of inflammation

⬢Wide range of other disorders, including arthritis

⬢Severe skin and allergic conditions

⬢Respiratory and blood disorders

⬢Gastrointestinal ailments

⬢Malignant conditions.
Gastrointestinal Drugs
⬢Used to relieve uncomfortable and potentially dangerous symptoms rather than as cures for specific diseases.

⬢Antacids

⬢Antiulcer

⬢Antidiarrheal

⬢Cathartics, laxatives, purgatives

⬢Antinauseants (antiemetics)
Antacids
⬢Neutralize the hydrocholric acid in the stomach to relieve symptoms of:

⬢Peptic ulcer
⬢Esophagitis
⬢Epigastric discomfort.
Antiulcer
⬢Block secretion of acid by cells lining the stomach

⬢For gastric and duodenal ulcers and gastroesophageal reflux disease (GERD).
Histamine H2-receptor antagonists
⬢ranitidine (Zantac)

⬢cimetidine (Tagamet)

⬢Turn off the system (histamine) that produces stomach acid.
omeprazole
(Prilosec)
⬢Works by stopping acid production by a different method (proton-pump inhibition).
Antidiarrheal
⬢Relieve diarrhea

⬢Decrease the rapid movement of the walls of the colon
Cathartics
⬢Relieve constipation

⬢Promote defecation for diagnostic and operative procedures

⬢Used to treat disorders of the gastrointestinal tract.

⬢Some cathartics increase the intestinal salt conent, causes fluid to fill the intestines.

⬢Others increase the bulk of feces to promote peristalsis.

⬢Another type lubricates the intestinal tract to produce soft stools.
Antinauseants
(antiemetics)
⬢Relieve nausea and vomiting

⬢Also overcome vertigo, dizziness, motion sickness, and labyrinthitis (inflammation of the inner ear)
Respiratory Drugs
⬢Treatment of asthma, emphysema, chronic bronchitis, and bronchospasm.

⬢Bronchodilators
⬢Steroid drugs
⬢Leukotriene modifiers.
Bronchodilators
⬢Open bronchial tubes

⬢Administered by injection or aerosol inhalers.
Steroid drugs
⬢Reduce chronic inflammation in respiratory passageways.

⬢Inhaled or given intravenously and orally.
Leukotriene modifiers
⬢Recent additons to the anti-inflammatory therapy of asthma

⬢Prevent asthma attacks by blocking leukotriene (a bronchoconstrictor) from binding to receptors in respiratory tissues.
Sedatives and Hypnotics
⬢Depress the central nervous system

⬢Promote drowsiness and sleep

⬢Prescribed for insomnia and sleep disorders.

⬢Very high abuse potential, should only be used for short periods of time and under close supervision.
Benzodiazepines
⬢Influence the part of the brain responsible for emotions

⬢Low doses may act as sedatives

⬢High doses, as hypnotics (to promote sleep).
Stimulants
⬢Drugs act on the brain to speed up vital processes (heart and respiration) in cases of shock and collapse.

⬢Increase alertness, inhibit hyperactive behavior in children.

⬢High doses can produce restlessness, insomnia, and hypertension.
Amphetamines
⬢Stimulants

⬢Prevent narcolepsy (seizures of sleep)

⬢Suppress apetite

⬢To calm hyperkinetic children
Caffeine
⬢Cerebral stimulant

⬢Used in drugs to relieve headaches by constricting cerebral blood vessels
Tranquilizers
⬢Controlling anxiety

⬢Minor (benzodiazepine), for minor symptoms of anxiety.

⬢Major (phenothiazines), control more severe disturbances of behavior.

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