Concepts of Pharmacology 藥理學 PDF

CONCEPTS OF PHARMACOLOGY 藥理學 Ms. Belle LAU Introduction Medication ~ Chemical compound / substance for administered for diagnosis 診斷, prevention, cure, treatment 治療 or relief of a symptom or for prevention of disease, that affects physiological 生理 function in living organisms Pr...

CONCEPTS OF PHARMACOLOGY 藥理學 Ms. Belle LAU Introduction Medication ~ Chemical compound / substance for administered for diagnosis 診斷, prevention, cure, treatment 治療 or relief of a symptom or for prevention of disease, that affects physiological 生理 function in living organisms Prescription 處方 ~ Written direction for the preparation and administration of a drug, contains the patient’s name, medication name, dose, route, frequency, amount of medication, doctor’s signature Nonprescription / OTC medication ~ Medication can be purchased without a prescription, used to promote health or treat mild health problem Introduction Pharmacology 藥理學 ~ the study of the effects of drugs on the function of living systems Pharmacy ~ the place for preparing, compounding, and dispensing drugs. Pharmacist ~ the man that prepares, makes, and dispenses drugs as ordered by a physician/ dentist. Sources of drugs… Natural, semisynthetic, or synthetic Plants e.g., foxglove 毛地黃→digoxin Animals e.g., pregnant mare 母馬 serum → 新西蘭有毒植物 conjugated estrogens 毛地黃Foxglove Micro-organisms e.g., Penicillium mold 霉 菌 naturally produces the antibiotic penicillin. Minerals e.g., iron Synthetic 合成 chemistry Genetic engineering (biotechnology) e.g., insulin 胰島素 Penicillium mold 青黴菌  Drug Names 1. Chemical name describes the structures of the drug, based on the atomic/molecular structure/ functional group of the drug, seldom used in medical practice 2. Generic name 通用名 assigned by the manufacturer after approval by the regulatory body in the country of origin (e.g. the United States Adopted Names Council) and used throughout the drug’s lifetime. Selected & recognized internationally. A drug usually has only one generic name. 3. Brand name 品牌名 / Trade name/ proprietary name Given by the drug manufacturer, identified as property of that company under patent protection, usually short and easy to remember One drug may be manufactured by several companies and have several trade names. Drug Names Chemical Name Generic Name Trade Name N-(4-hydroxyphenyl) acetamide Acetaminophen Tylenol, Panadol必 (Paracetamol 撲熱 理痛, Fortolin 幸 息痛) 福止痛素 7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H- Diazepam Valium 1,4-benzodiazepin-2-one N''-cyano-N-methyl-N'-[2-[[(5-methyl- 1H- Cimetidine Tagamet imidazol-4-yl) methyl]thio]ethyl]guanidine (+)-3-(4-Chlorophenyl)-NN-dimethyl-3-(2- Chlorpheniramine Prition pyridyl)propylamine hydrogen maleate Meleate 扑爾敏胺  Brand Generic refers to the similarity of two drugs in terms of their absorption rate and extent, as well as their therapeutic effects Food and Drug Administration (FDA) regulates bioavailability testing of drugs that differ in sizes, forms, etc.  Pharmacology 藥理學 Pharmacokinetics 藥代動力學 Pharmacodynamics 藥效學 What the body does to the drug What the drug does to the body The actions of the body on drugs身體 The drug actions on the body藥 對藥物的作用 物對身體的作用 Absorption吸收 - Drug passes Relates to mechanism of action into the bloodstream (MOA) - the interaction of the Distribution - Transportation of drug (e.g., agonists or drug to various parts antagonists) with its receptor 受 Metabolism代謝 體 or other primary sites of (biotransformation 生物轉化) action, resulting the drug effect. Modify drug by body chemically. Often detoxify解毒. Activate prodrug Excretion排泄 - elimination of drug Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/ Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Pharmacokinetics 藥代動力學 What the body does to the drug The actions of the body on drugs 身體對藥物的作 用 Absorption 吸收 - Drug passes into the bloodstream Distribution - Transportation of drug to various parts Metabolism 代謝 (biotransformation 生物轉化) Modify drug by body chemically. Often detoxify解毒. Activate prodrug Excretion排泄 - elimination of drug Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Drug Absorption 吸收 Absorption is the process that drugs enter the bloodstream 血液. The correct form 形式 of the drug must be administered through the correct route 正確的途徑. Give drugs directly into the veins 靜脈/ arteries 動脈, this absorption is the greatest 最大. Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Bioavailability (BA) 生物利用度 Bioavailability is the percentage % of drug 藥物嘅百分比 that reaches the systemic circulation 體循環, thereby accessing the site of action. It neglects 忽略 the rate of absorption 吸收率. E.g., Intravenous (IV) 靜脈注射 ~ absorption is complete (100% BA) The level of absorption 吸收水平 can affect the speed and the quantity of the drug at the site of action 影響藥物在作用部位的速度和數量 The rate 速度 and extent 程度 of absorption of the drug 藥物吸收的速度 is greatly affected by the nature 性質 and the route of administration of the drug 給藥途徑 Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/  Bioavailability (BA) Many factors affect absorption and bioavailability 影響吸收和生物利用度的因素 including Drug properties 藥物性質, The physiology生理機能 of the person, its speed of emptying 排空速度 Food can slow down the dissolution 溶解 and absorption of some drugs, combine with drug molecules 分子結構, change their molecular structure and subsequently inhibit or prevent their absorption, delay 延緩 their passage into the small intestine, Acid 酸性 medium in the stomach vary according to the time of day, foods ingested, use of antacid 抗酸藥 medications, and the age of the client Some drugs may be destroyed 破壞 by stomach enzymes 胃酶 or acids 酸, lower the absorption in GI tract First Pass Metabolism Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/  Bioavailability (BA) - First pass metabolism /effect Oral medication absorbed from gastrointestinal (GI) tract via hepatic portal vein 肝門靜脈 enters the liver. The liver metabolizes 肝臟代謝/ destroys many drugs, reduces the amount of active 活性 drug reaching the blood circulation system, reduce the bioavailability 生物利用度 of drug reaching its site of action. Some oral drugs first pass through the liver and are partially metabolized prior to reaching the target organ, which requires higher oral doses 更高劑量 to achieve the appropriate effect 適當效果 E.g., Morphine 嗎啡 BA: 30% by PO, because 70% are metabolized at liver 肝臟代謝. i.e., IV morphine effect = PO effect x3 Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ First pass metabolism /effect Blood capillaries in the villi absorb sugar, amino acid, … drugs through the hepatic portal vein 肝門靜脈 to the liver and then the heart to pump to different parts of the body. The liver filters toxics to prevent them from circulating in the bloodstream. Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Prodrug 前藥 Some drugs cannot be administered as active drugs 活性藥物. They need to be administered as inactive drugs, called prodrugs. The prodrug is metabolized (via first pass effect) and converted to be active drug 轉 化為活性藥物 and to have pharamalogical effect. Instead of administering a drug directly, a corresponding prodrug can be used to improve how the drug is absorbed, distributed, metabolized, and excreted. Prodrugs are often designed to improve bioavailability when a drug itself is poorly absorbed from the gastrointestinal tract 胃腸道吸收不良, e.g., Acyclovir (Acyclovir is an antiviral drug.) Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/  Drug forms 藥物形式 Specific drug forms are used to release 釋放 the drug at the desire speed. Aqueous Tablet E.g. Tablets, capsules, suppositories 栓劑, Transdermal patch transdermal patches 透皮貼劑, and solutions. If a tablet releases the drug quickly, drug levels in the blood may become too high. Slow-release緩釋 tablet may result in low Capsule levels of absorption. Powder/ drug extracts Per Rectal (PR) *dissolution (noun) = dissolve (verb) = the incorporation of solid into liquid  Drug forms Drugs must be dissolved 溶解 in solution before being absorbed. Liquid medications are absorbed faster than tablets as dissolution is not required. The smaller the size of the drug, the larger the surface area, the faster the rate of dissolution and absorption. E.g., powder 粉末 form, crystal 晶體 form, etc. *dissolution (noun) = dissolve (verb) = the incorporation of solid into liquid Drug forms Most drug molecules diffuse across cell membranes 穿過細胞膜 E.g., the gastrointestinal (GI) tract, skin layers, etc. into the blood from high concentration area to low concentration area. 由高濃度區域擴散到 血液中  Common drug forms Aqueous Tablet Capsule Powder/ drug extracts Delayed-release Lozenge products Transdermal patch Injection Ointment creams Drops And more! Types of Drug Preparations Types Descriptions Aerosol A liquid, powder, or foam deposited in a thin layer on the skin by air pressure Aqueous solution One or more drugs dissolved in water Aqueous One or more drugs finely divided in a liquid such as water suspension Caplet A solid form, shaped like a capsule, coated and easily swallowed Capsule A gelatinous container to hold a drug in powder, liquid, or oil form Cream A nongreasy, semisolid preparation used on the skin Elixir A sweetened and aromatic solution of alcohol used as a vehicle for medicinal agents Extract A concentrated form of a drug made from vegetables or animals Gel or jelly A clear or translucent semisolid that liquefies when applied to the skin Liniment A medication mixed with alcohol, oil, or soapy emollient and applied to the skin Lotion A medication in a liquid suspension applied to the skin. Lozenge (troche) A flat, round, or oval preparation that dissolves and releases a drug when held in the mouth Types of Drug Preparations Types Descriptions Ointment A semisolid preparation of one or more drugs used for application to the skin and mucous membrane Paste A preparation like an ointment, but thicker and stiff, that penetrates the skin less than an ointment Pill One or more drugs mixed with a cohesive material, in oval, round, or flattened shapes Powder A finely ground drug or drugs; some are used internally, others externally Suppository One or several drugs mixed with a firm base such as gelatin and shaped for insertion into the body (e.g., the rectum); the base dissolves gradually at body temperature, releasing the drug Syrup An aqueous solution of sugar often used to disguise unpleasant-tasting drugs Tablet A powdered drug compressed into a hard small disk; some are readily broken along a scored line; others are enteric coated to prevent them from dissolving in the stomach Tincture An alcoholic or water-and-alcohol solution prepared from drugs derived from plants Transdermal patch A semipermeable membrane shaped in the form of a disk or patch that contains a drug to be absorbed through the skin over a long period of time Routes of Administration Enteral (腸道) Parenteral (非腸道) Per Oral (PO) Per Rectal (PR) Intraarterial Sublingual (SL) Buccal Intramuscular (IM) Subcutaneous (SC) Intravenous (IV) Inhalation Intradermal (ID) Topical Drug Absorption Route Significant Features Oral (PO) Convenient; subject to first-pass metabolism by liver, which alters bioavailability (fraction of an unchanged drug reaching the systemic circulation following any route administration) E.g. morphine BA: 30% by PO as 70% are metabolized at liver IV morphine effect = PO effect x3 Intravenous (IV) Rapid; 100% bioavailability Intramuscular (IM) Allows for larger amounts to be administered; higher bioavailability than PO; avoids first-pass metabolism Subcutaneous (SC) Slower absorption than IM; larger volumes of administration not possible Buccal Between the cheeks and gums; absorption without first-pass metabolism Sublingual (SL) Below the tongue; absorption bypass first-pass metabolism. E.g., TNG SL Rectal (PR) Less first-pass metabolism than PO administration Inhalation Allows for drug delivery directly to respiratory tissues; allows for rapid absorption due to large surface area of alveoli Topical Method of administration for local effect; slowest absorption rate Transdermal (TD) Skin application to achieve systemic effects 26 Pharmacokinetics: Drug Distribution Drug distribution 分配 is the process of drug moving from systemic circulation 體循環 to the target site 目 標部位 of action in the body. Organs with more blood supply 較多血液供應 (i.e., liver, kidneys, and heart, brain) receive drug faster. Drug molecule Body areas with lower blood supply 較少血液供應 (i.e. skin and muscles) receive the drug slower Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Blood Flow The blood flow to each internal organ is different The liver, kidneys and brain receive the largest blood supply and hence exposed to the largest amount of drug Across capillary wall The capillary wall is composed of a single layer of endothelial cells 單層內皮細胞. The drug molecules diffuse across the endothelial cells of capillary → into interstitial fluid 間質液 → and then into tissues. Drug molecule The drug will attain distribution equilibrium 分佈平衡 between the circulating plasma and various body compartments (tissues and organs) depending on the nature of the drug. Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Across cell membrane to receptor site. The cell membrane is composed mainly of phospholipids. The ability of a drug crossing cell membrane depends on whether the drug is water or lipid (fat) soluble. Lipid-soluble 脂溶性 drugs cross through cell membranes easily. Grogan S, Preuss CV. Pharmacokinetics. [Updated 2023 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557744/ Drug Distribution Lipid-soluble 脂溶性 drugs Unionize, easier to cross through cell membranes easily, cross the blood-brain barrier and enter the brain. E.g., general anesthetics are highly lipid soluble and can penetrate cell membranes quickly to deliver effects. Water soluble drugs Dissolve in aqueous solution, Drug Ionization - ionize to form positive and negative ions (called electrolytes), form weak acids or bases, stay in plasma and interstitial fluid, hardly goes into cells. Distribution: Blood-brain barrier (BBB) Blood-brain barrier (BBB) is a lining of endothelial cells surrounding the blood supply to the brain regulates the entrance of substances from the blood into the brain protects the brain from harmful substances such as alcohol the membranes of endothelial lining are lipid-based so lipid-soluble drugs could easily pass e.g., anaesthetics Plasma proteins binding Drug molecules may be bound to plasma protein albumin 血漿蛋白, become inactive, and cannot bind to drug targets e.g., receptors, and cannot produce a pharmacological effect. Only free, or unbound drug remain active to bind to drug target e.g., receptors, have pharmacological effects. A drug is said to be highly protein-bound if more than 80% of the drug is bound to protein. Plasma proteins binding The ratio of bound to unbound未結合 drug molecules depends on the type of drug used and the presence of other plasma血漿 substances e.g., another drug type competing競爭 for binding sites on plasma proteins, etc. The higher the amount of free 游離 drug molecules, the greater the pharmacological effects But too much free drug molecules may lead to overdose過多游離藥物分子可能導致過量 Drug Metabolism Drug metabolism, also called biotransformation 生物轉化, is the chemical alteration of drugs and foreign compounds in the body. Some drugs need to be chemically altered to detoxify the drugs, in order to be excreted. CYP450 enzymes CYP450 enzymes are responsible for oxidation (gaining of oxygen) and reduction (removal of oxygen) reactions To turn lipid-soluble drugs to water-soluble drugs for excretion by kidneys To convert certain drugs into pharmacologically active metabolites Drug Metabolism  Developmental changes can also affect drug metabolism.  Example:  Infants have immature livers that reduce the rate of metabolism.  Elderly patients experience a decline in liver size, blood flow, and enzyme production that also slows metabolism.  Nurses must be alert to the accumulation of the active drug in these clients and to subsequent toxicity 毒性。 Drug Excretion 排泄 Drug excretion refers to the elimination 清除 / removal of drugs from the body. Renal Excretion 腎臟排泄 Most drugs are excreted through the kidneys and leave the body through urine 尿液. The efficiency depends largely on kidney function 腎功 能. Kidneys excrete drugs and metabolites diminishes with age 隨著年齡的增長而減少 Older people and renal patients may require smaller doses because metabolites may accumulate蓄積 in the body 老人和腎臟患者可能需要較小的劑量  Drug Excretion GI excretion – Some drugs are eliminated by excretion in the bile (a greenish yellow fluid secreted by the liver and stored in the gallbladder) as faeces. Respiratory, bodily fluids excretion - Some drugs can also be excreted through the lungs (e.g. general anesthetic agents 麻醉劑), exocrine (sweat, salivary, or mammary) glands, skin. Via breast milk / placenta - cautions Drug Half-life 半衰期 = half the drug Drug Half-life is the time taken to eliminate one-half of the drug in the body. 藥物半衰期是消除體內一半藥物所需的時間 Factors that affect a drug’s half-life include its rate of absorption, metabolism, and excretion. Knowing how long a drug remains in the body helps determine how frequently it should be administered. A drug that’s given only once is eliminated from the body almost completely after five half-lives. Drug Excretion - Drug Half-life Repeated doses are required to maintain a constant drug level in the body. Example: A drug’s half-life is 8 hours, then the amount of drug in the body. T1/2 Hours taken % Remaining 0 Initially 100% 1 After 8 hours 50% 2 After 16 hours 25% 3 After 24 hours 12.5% 4 After 32 hours 6.25% 5 After 40 hours 3.125%  Pharmacokinetics Loading dose and a loading dose followed by maintenance dose a maintenance dose A loading dose is an initial higher dose of a drug that may be given at the beginning of a course of treatment before dropping down to a lower maintenance dose Pharmacokinetics  Peak plasma level  As the body absorbs more drug, blood concentration levels rise.  The peak concentration level is reached when the absorption rate equals the elimination rate.  Given intravenously (IV), the drug level is high immediately A graphic plot of drug concentration in the blood plasma following a single dose Pharmacokinetics  Plateau 平台期  Administer a series of scheduled maintenance doses 定期給藥, after about four or five half-lives, the drug concentration in plasma reaches a steady level (Plateau 平台期) 大約 四到五個半衰期後達到穩定濃度  The duration of action  The duration of action means the length of time the drug produces its therapeutic effect.  Loading dose Maintenance doses Loading dose given at the onset of therapy with the aim of achieving the Maintenance dose target concentration rapidly the rate of drug administration is adjusted such that the rate of input equals to rate of loss, and that the target steady state plasma concentration is maintained. Pharmacodynamics 藥效學 What the drug does to the body The drug actions on the body 藥物對身體 的作用 Relates to mechanism of action (MOA) - the interaction of the drug (e.g., agonists or antagonists) with its receptor 受體 or other primary sites of action, resulting the drug effect. Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/  Receptor 受體 Receptor is the drug’s specific target, like “lock and key”; it is usually a protein located on the surface of a cell membrane or within the cell. The drug (molecules that can bind to certain receptors are the ligands 配位体 of that receptor) binds to the receptor, it enhances or inhibits the normal cellular function. The binding is usually reversible 可逆的 and the action of the drug terminated 終止 once the drug leaves the receptor. Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/ Receptor 受體 Most drugs exert 發揮 their effects 作用 by chemically binding with receptors at the cellular level. Hormones, neurotransmitters, etc. operate by binding to receptors. Some drugs are designed to bind to specific receptors to deliver therapeutic effects! Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/ Agonists and Antagonists Agonists are drugs that stimulate a receptor and mimics the endogenous transmitter e.g., glucocorticoids. Antagonists are drugs that block a receptor and blocks/prevents the action of the endogenous transmitter e.g., beta-blockers. Both agonists and antagonists have affinity for certain receptors, but only agonists have efficacy. Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/  Agonist 激動劑藥 Agonist displays an affinity 親和力 for a receptor, bind to the receptor, stimulate the receptor, and produce the same type of response as the physiological or endogenous substance. E.g., Epinephrine-like drugs 腎上腺素樣藥物 act on the heart to increase the heart rate. alpha α Stimulate Adrener gic + and beta β sympathetic nervous system 刺 Partial agonist 部分激動劑: A drug that binds to drugs receptors 受 激交感神經系統. 體 its receptor but produces a smaller effect than a full agonist Increase heart rate Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/  Antagonist 拮抗藥 Antagonist has an affinity 親和力 for a receptor but displays without producing a response and inhibits cell function. E.g., Naloxone (Narcan) is an opioid Example antagonist 阿片類藥物拮抗劑, used as an Naloxone (Narcan) antidote 解毒劑 for respiratory depression caused by an opioid drug (e.g., Morphine) Block 抑制 Block 抑制 Opioid Receptors that competes with opioid receptor sites in the brain and prevents the opioid from binding to drug (e.g., Morphine) + 受體 in the Have effects body its receptors, by blocking the effect of the Block 抑制 opioid, respiratory depression is reversed. Reduce pain, happy, drowsiness, 阿片類藥物抑制呼吸，Naloxone 與大腦中阿片受體位競爭並 Respiratory depression 阻止阿片類藥物與受躰結合，透過阻斷阿片類藥物的作用， 呼吸抑制被逆轉。 Marino M, Jamal Z, Zito PM. Pharmacodynamics. [Updated 2023 Jan 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507791/  Agonists and Antagonists Antagonist 拮抗藥 Hormone in the Receptors Block 抑制 Block 抑制 Hormone in body or Agonist + 受體 in the Have effects Receptors drugs 激動劑 body the body or some drugs + 受體 in the Have effects body References  Bardal, S.K., Waechter, J. E. & Martin, D.S. (2011). Applied pharmacology. [electronic resource]. St. Louis, Mo.: Elsevier.  Berman, A., Snyder, S. J., & Frandsen, G. (2020). Kozier & Erb’s Fundamental of Nursing: Concepts, process, and practice (11th ed.). Harlow: Pearson.  Hinkle, J.L., & Cheever, K.H. (2018). Brunner & Suddarth's Textbook of Medical-Surgical Nursing. (14th ed. e-Book). Philadelphia: Wolters Kluwer  Karch, Amy M.. 2020 Lippincott Pocket Drug Guide for Nurses. Wolters Kluwer Health. Kindle Edition.  Katzung, B.G., Masters, S.B. & Trevor, A.J. (2021). Basic & clinical pharmacology (electronic resource, 12th ed.). London: McGraw-Hill.  Kee, J.L., Hayes, E.R. & Linda, E.M. 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