Pharmacology and Venipuncture PDF

PHARMACOLOGY AND VENIPUNCTURE VALERIE S. HUISO, RTRP, MHA (c)  CLASSIFICATIONS OF DRUGS WHAT IS A DRUG? In pharmacology, a drug is a chemical substance, typically of known structure, which, when administered to a living organism, produces a biological effect. A pharmaceutical drug, also cal...

PHARMACOLOGY AND VENIPUNCTURE VALERIE S. HUISO, RTRP, MHA (c)  CLASSIFICATIONS OF DRUGS WHAT IS A DRUG? In pharmacology, a drug is a chemical substance, typically of known structure, which, when administered to a living organism, produces a biological effect. A pharmaceutical drug, also called a medication or medicine, is a chemical substance used to treat, cure, prevent, or diagnose a disease or to promote well-being. A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via inhalation, injection, smoking, ingestion, absorption via a patch on the skin, suppository, or dissolution under the tongue  WHAT ARE DRUG CLASSIFICATIONS? Drug classifications organize drugs into categories. There are three main methods of drug classifications: 1. Chemical makeup 2. Effects 3. Legal definition What is the Purpose of Drug Classification? At the same time, some drugs are grouped under one drug classification but the drugs may not be together under another classification. At the same time, a drug can be in multiple classes within the same classification. The purpose of drug classification is to ensure drug use is safe and beneficial. But, each time a drug is used, people’s body chemistry is changed. And although drugs are meant to be helpful, they can be harmful. Sadly, taking multiple drugs can change body chemistry so much it makes drugs less useful. Above all, it makes side effects more severe.  Pharmacology Classification of Drugs By Chemical Makeup Chemical similarities classify drugs because they often have the same impact and risks. Alcohol Opioids Benzodiazepines Cannabinoids Barbiturates ALCOHOL The most misused substance is alcohol. Although alcohol is legal in all states, it impacts most body systems. In turn, it has many effects on users. The effects of alcohol include euphoria and lower ambitions, impairs judgment, perception, and reaction time. It is also a central nervous system depressant. But above all, it causes severe long-term liver damage. Forms of alcohol include: Beer Wine Liquor OPIODS Opioids or opiates come from opium or chemicals that mimic it. They work by attaching to brain neurotransmitters and block the signals they send. This is why opioids are strong pain killers. But, the feelings of pleasure quickly leads to addiction. For example, opioid addiction is a severe problem in America. Just like they are addictive, they are also deadly. Common opioids include: Heroin Fentanyl Oxycodone  BENZODIAPINES Benzodiazepines or benzos, function by interacting with the neurotransmitter GABA-A (gamma-aminobutyric acid-A). But each benzo interacts differently. So, each benzo affects the mind and body differently. Benzos treat a variety of mental issues and sleep conditions. However, benzos are often misused. Because they are highly addictive, benzos cause many medical and mental problems when misused. Common benzos include: Ativan Valium Xanax Benzodiazepines like Xanax are effective when used as prescribed, but misuse can lead to serious consequences, including Xanax withdrawal. Withdrawal symptoms can be both physically and mentally challenging, often requiring medical supervision to manage safely. CANNABINOIDS Cannabinoids are a drug class chemically similar to THC or tetrahydrocannabinol. THC is the active agent of marijuana. Cannabinoids cause feelings of happiness, but they also do serious mental and physical harm. Even though they are the second-most abused drug, they are becoming legally acceptable. Cannabinoids include: Marijuana Hashish Shatter Distillate BARBITURATES Barbiturates are derivatives of barbituric acid and slow down the central nervous system (CNS). They have long been used for treating mental disorders and sleep issues. They are also still used for anesthesia, epilepsy, and headaches. But, barbiturates are highly addictive. They also cause body systems to shut down. For this reason, barbiturates have high overdose rates. Examples of barbiturates include: Amytal Luminal Pentobarbital Pharmacology Classification of Drugs Based on Effects Drug classification by their impact on the mind and body is another way of classifying drugs. For example, one drug makes a person energetic. However, another drug makes them relax. Depressants Stimulants Hallucinogens Inhalants DEPRESSANTS Depressants, or downers, create feelings of relaxation and tiredness. And while they are useful for mental illness and sleep issues, they are highly misused. This misuse is because they create a high or buzz. Depressants are not only highly misused, but they are also dangerous and can lead to overdose. Common depressants include: Alcohol Opiates Barbiturates STIMULANTS Stimulants, or uppers, increase energy, focus, and wakefulness. They also provide a “rush.” Short-term use increases productivity; it also produces a pleasure high. But, long-term use of stimulants leads to misuse and addiction. Stimulants include: Adderall Cocaine Meth Stimulants come in various forms and can have significant differences in how they affect the brain and body. In the case of amphetamine vs methamphetamine, a small difference in their chemical structure leads to different impacts on the brain, altering how quickly and intensely each substance takes effect. HALLUCINOGENS Hallucinogens alter a person’s perception of reality. Hallucinogens often lead to auditory and visual hallucinations or “tripping.” Although they are less addictive than other drug classifications, their fast-acting effects are more severe. Examples of hallucinogens include: LSD PCP Psilocybin mushrooms HALLUCINOGENS Lysergic acid diethylamide, commonly known as LSD (from German Lysergsäure-diethylamid) Lysergic acid diethylamide, commonly known as LSD (from German Lysergsäure-diethylamid), is a potent psychedelic drug that intensifies thoughts, emotions, and sensory perception. Often referred to as acid or lucy, LSD can cause mystical, spiritual, or religious experiences. The meaning of LSD is lysergic acid diethylamide. Made from lysergic acid, this drug is one of the strongest mind-altering chemicals. PHENCYCLIDINE (PCP) Phencyclidine (PCP) is an illegal street drug that usually comes as a white powder, which can be dissolved in alcohol or water. It can be bought as a powder or liquid. PCP can be used in different ways: Inhaled through the nose (snorted) Injected into a vein (shooting up) Smoked Swallowed Street names for PCP include angel dust, embalming fluid, hog, killer weed, love boat, ozone, peace pill, rocket fuel, super grass, and wack. PSILOCYBIN MUSHROOMS "Magic mushrooms" are mushrooms that contain hallucinogens - usually psilocybin and psilocin. Taking magic mushrooms may cause you to see, hear or feel things that are not there, or to experience anxiety, fear, nausea and muscle twitches accompanied by increased heart rate and blood pressure INHALANTS Inhalants are chemicals that are ingested by breathing them in or “huffing.” But most inhalants are not made to be consumed by humans. And although there are many kinds of inhalants, most produce a “high” feeling. For the most part, inhalants aren’t studied as much as other drugs. And, while they are dangerous and have severe health risks, they aren’t as addictive as other drugs. Common inhalants include: Paint thinner Nail polish remover Gasoline  Pharmacology Classification of Drugs by Legal Definition In 1970 the federal government passed the Controlled Substance Act. It was in response to the drug epidemic. The Act establishes five pharmacology classifications of drugs or schedules. The drug’s schedule is based on potential medical use, the potential for misuse, and addiction risk. But international treaties are an exception. The U.S. must use certain drug classifications to comply with diplomatic agreements. These agreements include the Single Convention on Narcotic Drugs. Schedule V Schedule IV Schedule III Schedule II Schedule I SCHEDULE V Schedule V drugs have the lowest penalties and few regulations. They have an acceptable medical purpose. And generally, the lowest risk of misuse and addiction. Common Schedule V drugs include: Lomotil Motofen Lyrica SCHEDULE IV The regulations and penalties for these drugs are a little more than Schedule V drugs. But they are less than Schedule III drugs. Schedule IV drugs have a medical purpose. They also have a low risk of misuse and addiction. Common Schedule IV drugs include: Ambien Darvocet Tramadol SCHEDULE III Schedule III drugs have harsher penalties and more regulations than Schedule IV drugs. However, they are less than a Schedule II drug. Schedule III drugs have a medical purpose. They are also a low misuse rate and low to medium risk of addiction. Schedule III drugs include: Anabolic steroids Ketamine Vicodin SCHEDULE II The only pharmacology classification of drugs with more regulations and penalties than Schedule II drugs is Schedule I drugs. Schedule II drugs have a medical purpose. But, they have a high risk of misuse and severe addiction risk. Schedule II drugs include: Codeine Methadone Ritalin SCHEDULE I Schedule I drugs are the most regulated and have the harshest penalties of all the drugs. They do not have a medical purpose. Above all, they have a high risk of misuse and addiction. Schedule I drugs include: Ecstacy Quaaludes GHB GAMMA-HYDROXYBUTYRATE (GHB) gamma-hydroxybutyrate (GHB). GHB has legitimate medical uses prescribed under the name sodium oxybate (Xyrem) to treat excessive daytime drowsiness (narcolepsy) and can also treat alcohol misuse, substance withdrawal, and more. Known on the streets as 'G' or 'liquid ecstasy' - GHB is a colourless oily liquid that produces feelings of euphoria, relaxation, and sometimes drowsiness. There's also the street drug gammabutyrolactone (GBL), which is identical but is used as a stain, rust, and superglue remover. It's also a paint remover. There's such a fine line between 'safe' use and overdose - there's a small margin between a dose producing the desired effect or causing an overdose.  What types of methods are available for GHB testing? Despite having a rapid half-life and shorter detection windows, there are still all the standard methods of drug testing available for GHB. Still, several court-ordered and GHB-specific drug tests will detect misuse within set timeframes: Urine Test GHB is detectable in urine for up to 12 hours after ingestion and is most detectable four hours after consumption. Blood Test Blood tests are one of the most effective testing methods for GHB misuse, being detectable for up to 72 hours. Legal and healthcare professionals should note that concentration and detectable levels peak in the bloodstream roughly 30 minutes after consumption, but metabolites remain in the system. For an ongoing court case like a child custody case, blood tests might not be as effective. It's more effective closer to the time of an offense like at the roadside.  Saliva Test A saliva test is less reliable than a court-ordered blood or urine test and the presence of GHB in the saliva is short-lived. GHB traces are most detectable on saliva tests within 10 minutes of consumption and can remain detectable for up to 6 hours - it depends on the brand of saliva test and how much is consumed. Hair Test Hair testing is the most reliable test for detecting most drugs. For GHB, hair testing is the most reliable method. The hair is cut into 0.5cm segments and you look for a spoke in GHB in one segment as GHB naturally occurs in the hair. Most incidents of GHB are detected through hair testing. If a court includes a hair drug test as part of its proceedings, the detection window is up to 90 days. Fingernail Test A fingernail drug test for GHB is the same as a hair test - there's nothing reliable on the market that would be suitable for legal proceedings. DRUGS MAY BE CLASSIFIED AS FOLLOWS Over-the-counter drug Prescription drug Dangerous drug regulated drug prohibited drug Exempt drug preparations PHARMACOLOGIC/THERAPEUTIC CATEGORIES OF THE DRUG Drugs acting on the central nervous system Drugs acting on the musculoskeletal system Anti-infectives Immunologicals Cardiovascular drugs Diuretic I. DRUGS ACTING ON THE CENTRAL NERVOUS SYSTEM Analgesic Hypnotic Local anesthetic Anxiolytic Anticonvulsant Antidepressant Anti-gout Anti-psychotic Anti-migraine Antiemetic Anti- parkinsonism Antivertigo Antipyretic Anti- motion sickness ANALGESICS a drug that suppresses pain perception without inducing loss of consciousness. Example: Paracetamol Ibuprofen Tramadol HCl LOCAL ANESTHETIC a drug that eliminates pain perception in a limited body area by local action on sensory nerves. Example: Proparacaine HCl; Lidocaine HCl; Bupivacaine HCl ANTICONVULSANT drug that arrests convulsion by inducing general CNS depression. Example: Valproic acid Carbamazepine Phenobarbital ANTI-GOUT a drug that reduces tissue deposits of uric acid in general gout or suppress the intense inflammatory reaction of acute gout. Example: Allopurinol Colchicine Probenecid ANTI-MIGRAINE a drug that reduces incidence or severity of migraine vascular headache. Example: Ergotamine tartrate Divalproex Na Flunarizine HCl ANTI- PARKINSONISM a drug that suppresses the neurologic disturbances and symptoms of parkinsonism. Example: Biperiden Amantadine sulfate Carbidopa Levodopa ANTIPYRETIC a drug that restores normal body temperature in the presence of fever. Example: Paracetamol Ibuprofen HYPNOTIC a central nervous system depressant used to induce sleep. Example: Midazolam Zolpidem Nitrazepam ANXIOLYTIC a drug that suppresses symptoms of anxiety. Example: Diazepam Alprazolam Clorazepate dipotassium ANTIDEPRESSANT a centrally acting drug that induces mood elevation, useful in treating mental depression. Example: Fluoxetine HCl Clomipramine HCl Imipramine HCl ANTI-PSYCHOTIC a drug that suppresses symptoms of psychoses of various diagnostic types. Example: Haloperidol Chlorpromazine HCl Thioridazine HCl ANTIEMETIC a drug that suppresses nausea and vomiting. Example: Meclizine HCl Metoclopramide Domperidone ANTIVERTIGO a drug that suppresses dizziness. Example: Metoclopramide HCl Meclizine HCl ANTI- MOTION SICKNESS a drug that suppresses motion-induced nausea, vomiting, and vertigo. Example: Meclizine HCl Metoclopramide HCl Dimenhydrinate II. DRUGS ACTING ON THE MUSCULOSKELETAL SYSTEM Non-steroidal anti-inflammatory Muscle relaxant Antirheumatic Neuromuscular blocker  NON-STEROIDAL ANTI-INFLAMMATORY (NSAID) an analgesic, anti-inflammatory drug that inhibits prostaglandin synthesis. Example: Mefenamic acid; Naproxen, Meloxicam MUSCLE RELAXANT a drug that inhibits contraction of voluntary muscles. Example: Vecuronium Br Baclofen Tizanidine HCl ANTIRHEUMATIC an anti-inflammatory drug used to treat arthritis and rheumatoid disorder. Example: Celocoxib Piroxicam Methotrexate NEUROMUSCULAR BLOCKER a drug that paralyzes skeletal muscles by preventing transmission of neural impulses to them. Example: Pancuronium Atracurium besylate Vecuronium Br  III. ANTI-INFECTIVES Antiamebic Antibacterial Antifilarial Antifungal Antihelmintic Anti-malarials Antiprotozoal Anti- shistosoma Antiviral ANTIAMEBIC a drug that kills or inhibits protozoan parasites such as Entamoeba histolytics causature organism of amoebaisis. Example: Metronidazole Etofamide Secnnidazole ANTIBACTERIAL a drug that kills or inhibits pathogenic bacteria. Example: Penicillin; Amoxicillin; Cefalexin ANTIFILARIAL a drug that kills or inhibits pathogenic filarial worms. Example: Diethylcarbamazine ANTIFUNGAL a drug that kills or inhibits pathogenic fungi. Example: Ketoconazole Fluconazole Terbinafine HCl ANTI-MALARIALS a drug that kills or inhibits the parasite causing malaria. Example: Chloroquine phosphate; Mefloquine HCl; Quinine sulfate ANTIPROTOZOAL a drug that kills or inhibits protozoa. Example: Diloxanidine, Metronidazole ANTI- SHISTOSOMA a drug that kills or inhibits pathogenic flukes of genus schistosoma. Example: Praziquantel ANTIVIRAL a drug that kills or inhibits viral infections. Example: Acyclovir Zidovudine Indinavir sulfate  IV. IMMUNOLOGICALS VACCINES IMMUNE SERA serum of an animal or human an antigen containing drug containing antibodies against a used to induce active specific disease, used to confer immunity against an passive immunity to that infectious disease. disease. Example: Example: Hepatitis B Immunoglobulin; BCG Vaccine, Hepatitis B Tetanus Immunoglobulin; Vaccine, Rabies Vaccine Immunoglobulin Normal, Human V. CARDIOVASCULAR DRUGS Adrenergic agent Inotropic agent Anti-angina Anti- arrhythmic Anti-lipidemic Cholinergic agent ADRENERGIC AGENT a drug that activates organs innervated by the sympathetic nervous system; a sympathomeiometic agent. Example: Dobutamine; Dopamine; Epinephrine INOTROPIC AGENT an agent that increases the contractile strength of heart muscle; a cardiotonic. Example: Digoxin, Epinephrine, Dopamine ANTI-ANGINA a coronary vasodilator useful in preventing or treating attacks of angina pectoris. Example:’ Isosorbide dinitrate; Diltiazem; Metoprolol ANTI- ARRHYTHMIC a cardiac depressant useful in suppressing rhythm irregularities of the heart. Example: Lidocaine, Amiodarone, Atenolol ANTI-LIPIDEMIC a drug that lowers the lipid in the blood. Example: Pravastatin; Simvastatin CHOLINERGIC AGENT a drug that activates organ innervated by the parasympathetic nervous system; a parasympathetic drug. Example: Acetylcholine; Carbachol, Pilocarpine VI. DIURETIC a drug that promotes renal excretion of electrolytes and water useful in treating generalized. Example Furosemide  VII. RESPIRATORY DRUG Anti-asthmatic Antitussive Mucolytic Nasal decongestant Repiratory stimulant ANTI-ASTHMATIC A drug that relieves asthma symptoms. Example: Salbutamol; Terbutaline; Hydrocortisone ANTITUSSIVE A drug that suppress coughing Example: Dextromethorphan; Butamirate MUCOLYTIC A drug that hydrolyzes mucoprotein, useful in reducing the viscosity of pulmonary mucous. Example: Bromhexine NASAL DECONGESTANT An adrenergic drug used orally or topically to induce vasoconstriction in nasal passages. Example Phenylpropanolamine RESPIRATORY STIMULANT A drug that selectively stimulates respiration. Example: Doxapram HCl ANTI-ALLERGIC AND IMMUNOSUPPRESSANTS Antineoplastic Immunosuppressant Immunomodulator ANTINEOPLASTIC A drug that attacks malignant cells in the body Example: Cytarabine; Fluorouracil, Mercaptopurine IMMUNOSUPPRESSANT A drug that inhibits immune response to foreign materials, used to suppress rejection of tissue grafts. Example: Azathioprine, Ciclosporin, Prednisone IMMUNOMODULATOR A drug that acts to determine the immune response by augmenting or reducing the ability of the immune system to produce specifically modified serum antibodies. Example: Interferon ANTIDOTES GENERAL ANTIDOTE SPECIFIC ANTIDOTE A drug that reduces the effects of A drug that reduces the effects of a ingested poisons by adsorpting toxic systemic poison by mechanism that materials. relates to the particular poison. Example: Example Activated Charcoal Acetylcysteine (Paracetamol Lorazepam poisoning) Sodium sulfate Ethyl Alcohol ( Methyl alcohol poisoning) Ascorbic acid (Methemoglobinemia) Dimercaprol ( Mercury, lead and Arsenic poisoning) Deferoxamine (Iron poisoning) GASTROINTESTINAL DRUGS Antacid H2 Antagonist Anticholinergic Spasmolytic Antiemetic Antimotility Laxative, cathartic ANTACID A drug that neutralizes excess gastric acid. Example: Aluminum hydroxide Aluminum hydroxide + Magnesium hydroxide H2 ANTAGONIST A drug that inhibits histamine mediated gastric acid secretion used to treat peptic ulcer and duodenal ulcer. Example Ranitidine Cimetidine Nizatidine ANTICHOLINERGIC A drug that inhibits response to parasympathetic nerve impulses and cholinergic drugs. Example: Atropine Dicycloverine SPASMOLYTIC A drug that inhibits motility of visceral smooth muscles. Example: Hyoscine-N-butylbromide Dicycloverine HCl ANTI-EMETIC Drug that suppresses nausea and vomiting Example: Meclizine HCl Metoclopramide Domperidone ANTIMOTILITY Drug that suppresses motility Example Loperamide LAXATIVE, CATHARTIC Drug that promote defecation Example: Bisacodyl Castor oil Senna SOLUTIONS CORRECTING WATER ELECTROLYTE DISTURBANCE Oral Rehydrating Solution Parenteral Solution, large volume injection Electrolyte or Parenteral additive injection Peritoneal dialysis solution Hemodialysis solution ORAL REHYDRATING SOLUTION A solution containing electrolytes, carbohydrates, and water used for replacement of fluid and nutrients from the body. Example Oral Maintenance Salt (OMS) Oral Rehydration Salts (ORS) PARENTERAL SOLUTION/ LARGE VOLUME INJECTION A solution given intravenously to maintain adequate hydration, restore blood volume, re- establish loss electrolyte or partial nutrition. Example: 5% Dextrose in 0.45% Sodium chloride; Lactated Ringer’s Solution; 0.9% Sodium chloride ELECTROLYTE OR PARENTERAL ADDITIVE INJECTION Any solution containing electrolytes prepared for oral, parenteral or rectal administration for the replacement or supplementation of ions necessary for homeostasis. Example: Calcium gluconate; Sodium bicarbonate; Magnesium sulfate PERITONEAL DIALYSIS SOLUTION A solution used in peritoneal dialysis, a procedure which is used to correct imbalance of fluid or electrolyte in the blood. Composition: Sodium lactate anhydrous, sodium chloride, calcium chloride dihydrate, magnesium chloride hexahydrate HEMODIALYSIS SOLUTION A solution used in hemodialysis, a procedure in which the impurities are removed from the blood. Composition: Magnesium chloride hexahydrate; Calcium chloride dihydrate; Sodium acetate trihydrate; Sodium chloride DERMATOLOGICAL AND MUCOUS MEMBRANE AGENTS (TOPICAL) Antibacterial Antifungal Scabicide/Antiscabies Pediculicide/ Anti-lice Anti-inflammatory Antipruritic Keratolytic Keratoplastic Astringent Antiseptic, disinfectant ANTIBACTERIAL Example: Mupirocin, Silver sulfadiazine, Fusidate sodium ANTIGUNGAL Example: Benzoic acid+ Salicylic acid Sodium thiosulfate Tioconazole SCABIES/ANTISCABIES An insecticide suitable for eradication of the itch mite Sarcoptes scabei (Scabies) Example: Sulfur PEDICULICIDE/ ANTI-LICE An insecticide suitable for eradicating louse infestation (pediculous) Example: Permethrin ANTI-INFLAMMATORY A drug that inhibits physiologic response to cell damage (inflammation) Example Hydrocortisone Betamethasone Fluocinonide ANTIPRURITIC A drug that reduces itching Example Calamine KERATOLYTIC A topical drug that softens the superficial keratin containing layer of the skin and promotes SHRIN Example: Benzoyl peroxide Benzoic acid + Salicylic acid ANTISEPTIC, DISINFECTANT An agent that destroys microorganisms in contact and suitable for sterilizing animate or inanimate objects. Example: Povidone iodine Ethyl alcohol Isopropyl alcohol OPTHALMOLOGICAL PREPARATIONS Antibacterial Antifungal Antiviral Anti-inflammatory Local anesthetics Mydriatic, cycloplegic Miotic ANTIBACTERIAL Example: Erythromycin Gentamicin Chloramphenicol  ANTI- ANTIFUNGAL INFLAMMATORY Example Example: Oxytetracycline Prednisolone Ofloxacin Dexamethasone Tobramycin Diclofenac MYDRIATIC, CYCLOPLEGIC An adrenergic drug that topically in the eye to induce dilation of the pupil Example: Atropine Tropicamide MIOTIC A cholinergic drug used to topically in the eye to induce constriction of the pupil. Example Pilocarpine Carbachol EARS, NOSE AND THROAT PREPARATIONS Antibacterial Antifungal Anti-inflammatory VITAMINS AND MINERALS VITAMINS MINERALS An organic chemical essential in An inorganic substance occurring small amounts for normal naturally which plays a vital role metabolism used therapeutically in regulating many bodily to supplement the vitamin functions. content Example Example: Ferrous salt Ascorbic acid; Riboflavin (Vit B2)