Pharmacotherapeutics: Drug Use in Disease Treatment

Pharmacotherapeutics

• Pharmacotherapeutics involves using drugs and understanding their clinical indications to prevent and treat diseases.
• Pharmacotherapy entails therapy using pharmaceutical drugs.
• Therapies other than pharmacotherapy are: surgery, radiation, movement, aromatherapy, diet therapy, herbalism, massage therapy, meditation, phototherapy, reflexology, and spiritual healing.

Kinds of Therapy

• Acute therapy aims to improve life-threatening or serious conditions.
• Empiric therapy is administered until tests confirm another therapy is more appropriate.
• Maintenance therapy sustains a condition.
• Palliative therapy reduces the severity of a condition.
• Prophylactic therapy prevents a disease or condition.
• Supportive therapy addresses conditions other than the primary disease.
• Supplemental therapy prevents deficiencies.
• Adjunctive therapy enhances the effectiveness of a primary treatment.
• Drugs are selected based on their efficacy, safety, route of administration and elimination, dosing frequency, and cost.

Drug Profile and Labeling

• A drug profile should include names, therapeutic classification, mechanisms of action, pharmacokinetics, indications, side effects, interactions, routes of administration, dosage, and how it is supplied.
• Patient Information Leaflets (PILs) or PLIs provide additional information about a drug along with the prescription medication.
• Indications identify the purpose or reason for using a drug.
• The FDA approves identifications, which must be part of labeling.

Medical Prescription

• A prescription is implemented by a medical practitioner containing instructions for a patient’s care plan which may include orders performed by a patient, caretaker, nurse, pharmacist, or other therapist.
• The term prescription commonly means an order to take medication.
• Prescriptions are typically written, but can be entered electronically via computerized order entry systems or issued verbally.
• Prescriptions have legal implications, signifying the prescriber's responsibility for the patient's clinical care and safety monitoring.
• Prescriptions should be based on objective data, not routine or commercial pressure.
• The misuse of prescriptions or dispensation can result in ineffective and dangerous treatments, exacerbate illness, cause distress and suffering, and increase costs.

Components of a Prescription

• Must include patient information: name, age, weight, and gender; this is important for accurate dosing and identifying contraindications.
• The date the prescription is written which helps track validity and therapy duration.
• The superscription of the symbol "Rx" indicating the start of a prescription.
• Inscription: the drug name, either generic or brand, the strength or specific dose (e.g., 500 mg), and the form of the drub e.g. tablets, capsules, injection, etc.
• The Subscription includes instructions for the pharmacist on preparing or dispensing the medication (e.g., "dispense 20 tablets").
• The Signa (Sig) includes instructions for the patient like the route of administration (oral, intravenous, topical, etc.), dosage (amount per dose), frequency (how often to take the medication e.g., BID, TID), and duration (how long to take the medication e.g., for 7 days).

Types of Medical Prescriptions

• Acute Prescription: for a short-term condition with a limited duration of use like antibiotics for 7 days.
• Chronic Prescription: for long-term conditions, and may include refills and long-term management plans.
• PRN (Pro re nata) Prescription: for medications taken as needed.

Rational Prescribing

• In pharmacology, the prescriber goes from the medicine to the disease rather than the reverse.
• Prescribing medicine follows an inverse stepwise process, starting from the diagnosis to choosing the medicine.
• Considerations should include age, sex, build, and sociocultural factors in selecting treatment.
• A prescription must be based on a sequence of rational steps: provide a specific diagnosis, consider the pathophysiologic implications of the diagnosis, select a specific therapeutic objective, select a drug of choice, determine the correct dosing regimen, create a plan for monitoring the drug's action and decide on the end point for therapy, and design a program of patient education.
• The "recipe" symbol is an abbreviation of Latin "recipe" or "recipere" meaning "take thou," or to take in the imperative form.
• Literally, "recipe" means "take" when a medical practitioner writes a prescription.

The Rule of Six Rights

• A prescription should ensure the right patient is well diagnosed.
• The correct drug should be labeled effective for their disease.
• The right dose should be at a therapeutic level for an individual.
• Administer via the right route, which is convenient.
• Administer at the right time: regular schedule of administration.
• Correct documentation should be given about how to take, consider side effects, precautions, contraindications, pregnancy category.

Principles in Administering Medications

• Observe the six rights of drug administration.
• Checking the patient's identity before administering each medication dose is extremely crucial for safety.
• Check the chart confirms the patient's name, ID number, age, and allergies.
• Check the drug three times, when removing the medication from the trolley or shelf, when removing the drug from its container, and before returning the container to storage, check the expiry date of the drug.
• Be familiar with both the generic and trade names of the drug.
• The use of the generic name in clinical practice is preferred to reduce error.
• Confirm the right dose by checking the label. calculate using proper measuring devices for liquids, and avoid crushing tablets or opening capsules unless directed by a pharmacist.
• Enteric coated tablets should not be crushed prior to administration.
• Suspensions should not be administered intravenously.
• Sublingual drugs have to be placed under the tongue to dissolve.
• Buccal medication remains in the mouth against the mucous membranes until it dissolves.
• Parenteral routes of administration by needle: Intradermal (ID) - under the epidermis (into the dermis), Subcutaneous (SC) - in the subcutaneous tissue, Intramuscular (IM) - into the muscle, Intravenous (IV) - into a vein, Intraarterial - into an artery, Intraosseous - into the bone.
• For routine medication orders, medications must be given no more than 30 minutes before or after the specified time.
• Changing the dose or timing of a medicine should not be underestimated, as skipping doses could be life-threatening.
• Document, into the patient's chart always the date & time of the medication administered, name, dose, route & site of the administration symptoms has been improved or the patient symptoms the patient is experiencing and teaching.

Medical Prescription Information

• Prescriber identification includes information about the medical practitioner that prescribes medication.
• Patient identification includes personal information about the patient for effective prescription and correct dosing
• Prescription includes drug name and strength and quantity.
• Posology and remarks are included for more information.
• The date and signature of the prescriber are required.

Medical Prescription Restrictions

• Permissions for who can write prescriptions are governed by local legislations
• In the USA medical practitioners, veterinarians, dentists and pediatrics can prescribe
• In addition, clinical pharmacists can be authorized to prescribe in most states
• If there are confusing or ambiguous prescriptions they have to be avoided
• Prescriptions that are allowed include the posology, OD which is, omne in die- one dose, BID which is, bis in die- two doses, TDS which is ter die sumendus- three doses, TID three doses.

The Details in Prescriptions

• A prescription needs to contain a date, names, and address of patient.
• It needs a quantity of drug depending on device, directions of use, age, weight
• There can be a legible message on why a drug is being prescribed if one is needed.
• One needs to include a rubber stamp, or something typed by hand of the prescriber with a license.

Role of the Pharmacist

• Pharmacists check for any errors and interactions and verify if prescriptions are dispensed correctly.
• Pharmacists provide details on instructions on the medication they dispense.
• Pharmacists follow up on how a patient is dealing with chronic disease.

Categories of Drugs

• After the approval from the market, it is assigned to a drug or substance.
• The types are drugs, nonprescription drugs or controlled substances.
• It is potentially harmful unless their use is supervised.
• They are also called legend drugs
• They are prescribed by a health provider.
• If taken correctly, they don't need a subscription.
• Should read and read until the directions area understood.
• Monitored of other drugs because of the high usage.
• These are monitored to prevent health and safety risks.
• The schedule is what is written with a specific address as well as a drug enforcement number.
• There are drugs that can only be refilled up to 6 months.

Special Populations

• Special populations are pregnant women, children and elderly that needs specific attention.
• There are hormones and a high volume of blood.
• Special characteristics include administration of the pregnant woman, they may cross the placenta and breastmilk.
• Can have a variety of effects on the child.
• reduced absorptions due the presence of too many metabolizing enzymes.

Geriatrics Consideration

• There is reduced liver function as well as renal function.
• There is a need to pay attention to elderly drugs as well as diseases.

Safety and Efficacy

• One must immediate action if an allergic reaction occurs.
• Patients needs to always understand drug use so they take it correctly.

Adverse Drug Events (ADE)

• ADEs are noxious, unintended, undesired effects of a drug with possible causes of medications of errors, reactions, or overdose.
• ADEs can cause morbidity and mortality which can require careful monitoring.
• ADE is an undesirable event associated with the use of drugs.
• ADR is an unintended reaction at normal doses with proper use.
• All ADRs are considered ADEs but not all ADEs are ADRs.

Types of Adverse Drug Events

• ADRs can have augmented effects of pharmacologic hypertensive or bizarre anaphylaxis effect.
• Others can be chronic with long-term usage, like Osteonecrosis of the jaw.

Drug Events Based on Characteristics

• Includes pharmacology, predictable responsiveness.
• Rechallenge: The recommencing of a drug to show signs of efficacy.
• Types of events include drug overdose, drug interactions, or medication
• There are also cases of patient symptoms.

Adverse Drug Events Classification

• Seriousness and severity in patients from the FDA can be deaths, disability and a need for special intervention.
• The classifications of severity are mild, moderate or severe based on certain factors.
• Location can be local or systemic but can lead to systemic circulation.
• Better drug use can be done by better understanding biochemistry.

Mechanisms of Adverse Drug Events

• Abnormal pharmacokinetics is used with comorbidities.
• Genetic factors show that either there is phase one or phase two with abnormal cell interactions.
• Includes new interactions with drugs as well as risks with drug interactions.
• Interactions or protein change can lead to binding.

Drug Abuse

• Drug abuse is when something is inappropriate and self administered.
• Drug abuse is the misuse of drugs.
• Drug abuse is behavior a person exhibits and the cause of chronic toxicity in a body.
• Drug dependence means one needs a drug to be normal.
• It is associated with positive well being.

Mechanisms of Drug Dependence

• Brain Chemistry Alteration: Drugs affect neurotransmitters
• Dopamine Pathway Activation: Drugs activate the brain's
• Tolerance Development: increase drug use
• Withdrawal Symptoms: When the drug is no longer taken

Signs Drug Dependence

• Increased Tolerance: Needing higher doses to achieve the
• Inability to Quit: Unsuccessful attempts
• s: Experiencing symptoms
• Psychological Symptoms:
• of Responsibilities:
• There are a variety of medications that can treat this to stop someone from using
• Cognitive behaviors can be used to change the perspective of someone.
• There needs to support groups that someone has to lean on.
• Psychological Dependence:
• A form of dependence in which a person believes they need the
• The craving or emotional attachment to the drug
• Of the various things that a person can be psychologically
• dependent on

Physiological Dependence

• The body needs drug for normal physiological function
• It is usually associated with increased tolerance
• The physically dependent patient tends to increase the dose because
• of tolerance
• Physical dependence alone doesn't not imply the addiction
• Psychological dependence is also there
• A common stimulant that can cause
• Drugs that are dependent can be taken or associated with physical dependence.

Physiological Versus Psychological

• Withdrawal symptoms are a hallmark of physical
• dependence.
• Often seen with opioids, alcohol, benzodiazepines, and
• often associated stimulants.
• Characterized by cravings and emotional dependence.
• associated with drugs like cannabis, cocaine, and
• amphetamines.

Drug Abuse Classifications

• Drug addiction is characterized by a drug the person is dependent on.
• The physiological and mental are also a factor.
• Drug tolerance Is a reduced feeling from drug.
• Includes desensitizations
• Is a physiological change.

Drug Dependence Types

• CROSS-DEPENDENC administered to achieve the same outcome as that of
• When a drug is administered
• another drug.

Drug Tolerance Issues

• Requires higher doses of drugs to have the same effect.
• Can be a need of other drugs to be taken in a situation
• Requires the same kind of class.