Fundamentals of Medical Pharmacology Paterson Public Schools Written by Néstor Collazo, Ph.D. Jonathan Hodges, M.D. Tatiana Mikhaelovsky, M.D. for Health and Related Professions (H.A.R.P.) Academy March 2007 Course Description This fourth year course is designed to give students in the Health and Related Professions (H.A.R.P.) Academy a general and coherent explanation of the science of pharmacology in terms of its basic concepts and principles. Students will learn the properties and interactions between chemical agents (drugs) and living organisms for the rational and safe use of drugs in the control, prevention, and therapy of human disease. The emphasis will be on the fundamental concepts as they apply to the actions of most prototype drugs. In order to exemplify important underlying principles, many of the agents in current use will be singled out for fuller discussion. The course will include the following topics: ¾ The History of Pharmacology ¾ Terminology Used in Pharmacology ¾ Drug Action on Living Organisms ¾ Principles of Pharmacokinetics ¾ Dose-Response Relationships ¾ Time-Response Relationships ¾ Human Variability: Factors that will modify effects of drugs on individuals ¾ Effects of Drugs Attributable to Varying Modes of Administration ¾ Drug Toxicity ¾ Pharmacologic Aspects of Drug Abuse and Drug Dependence Pre-requisites Students must have completed successfully the following courses: Biology, Chemistry, Anatomy and Physiology, Algebra I and II Credits: 5 credits Basic Principles of Drug Action Introduction to Pharmacology a. Basic Mechanisms of Drug Actions b. Dose-response relationships c. Drug absorption d. Biotransformation of Drugs e. Pharmacokinetics f. Factors Affecting Drug Distribution g. Drug Allergy and Pharmacogenetics h. Case History i. Laboratory Reports and Problem Solving Drugs Affecting the Autonomic Nervous System a. Adrenergic drugs b. Adrenergic blocking drugs c. Adrenergic nerve terminal d. Cholinergic Agonists e. Ganglionic blockers f. Diuretic drugs g. Antihypertensive drugs Pharmacology of the Cardiovascular System a. Clinical Correlation b. Cardiac Review c. Cardiac Glycosides d. Antiarrhythmic Drugs e. Anti-Anginal drugs f. Anticoagulants g. Prescription writing h. Autonomic Laboratory i. Case History Pharmacology of Drugs Affecting the CNS a. Drugs affecting the basal ganglia b. Treatment of sleep disorders c. Anxiety drugs d. Anticonvulsant drugs e. Stimulant drugs f. Antidepressant drugs g. Conferences h. Histamine and Antihistaminic drugs i. Case history j. Emetics and Antiemetics The Pharmacologic Management of Pain a. Pharmacologic intervention of pain b. Centrally acting analgesics c. Clinical correlation d. Peripherally acting analgesics e. Non-steroidal anti-inflammatory agents f. General anesthetics g. Neuromuscular blocking agents h. Local anesthetics i. Alcohol and drugs of abuse Principles and Mechanisms of Anti-Infective and Antineoplastic Agents a. Introduction to Chemotherapy b. Treatment of urinary tract infections c. Sulfonamides d. Penicillin e. Cephalosporin f. Penicillin Substitutes g. Broad Spectrum Anti-biotics h. Amino glycosides i. Antifungal and Antiviral drugs j. Chemotherapy and Tuberculosis k. Antimlarial drugs l. Clinical correlation m. Antiprotozoal and antihelmintic drugs n. Cancer chemotherapy o. Case history Pharmacology of the Endocrine Drugs a. Hypothalamic-Pituitary interactions b. Androgens, anabolic steroids, and estrogens c. Antifertility agents and Uterotropics d. Adrenal steroids e. Insulin and Oral hypoglycemic agents f. Thyroid and antithyroid drugs g. Parathyroid drugs Toxicology and Special Topics a. Introduction to Toxicology b. Self-study c. Environmental Toxicology d. Clinical Toxicology e. Toxicology of heavy metals f. Clinical correlations g. Drug interactions h. Pharmacology and Toxicology of ionizing radiation i. Drugs affecting the Gastrointestinal system j. Case history k. Immunosuppressives l. Role of nutrition in Pharmacology m. Developmental and perinatal Pharmacology DRUGS AFFECTING THE AUTONOMIC NERVOUS SYSTEM h. Adrenergic drugs i. Adrenergic blocking drugs j. Adrenergic nerve terminal k. Cholinergic Agonists l. Ganglionic blockers m. Diuretic drugs n. Antihypertensive drugs Adrenergic drugs 1. GENERIC NAME: albuterol BRAND NAMES: Ventolin; Proventil DRUG CLASS: Albuterol is a bronchodilator used in treating asthma and other conditions with reversible airway obstruction. Asthma is a breathing problem involving widespread narrowing of the airways (bronchial tubes). Airways are breathing passages that allow air to move in and out of the lungs. These airways can be narrowed due to the accumulation of mucus, spasm of the muscles that surround these airways, or swelling of the lining of the airways. Airway narrowing leads to shortness of breath, wheezing, cough, and congestion. Albuterol dilates bronchial airways by relaxing the surrounding bronchial muscles. Albuterol can also be helpful in patients with emphysema and chronic bronchitis when their symptoms are partially related to reversible airway obstruction. PRESCRIBED FOR: Albuterol is used in the relief and prevention of airway obstruction (bronchospasm) in patients with asthma and in patients with exercise-induced asthma. Albuterol can also be used in treating those patients with emphysema and chronic bronchitis when their symptoms are related to reversible airway obstruction. The inhaled form of albuterol starts working within 15 minutes and can last up to 6 hours. DOSING: Albuterol inhalations should not be administered more often than prescribed. Excessive use of inhaled albuterol can have adverse effects on the heart. Albuterol inhalations should be administered with proper technique and the specific instructions accompanying the drug packaging should be exactly followed. Use in children should be supervised by an adult. Patients requiring more inhalations for relief of symptoms should seek medical advice. DRUG INTERACTIONS: Albuterol is used with caution in patients with coronary heart disease or in patients with cardiac rhythm disturbances (arrhythmias). Use of albuterol together with other stimulant medications is discouraged because of their combined effects on the heart rate, blood pressure, and the potential for causing chest pain in patients with underlying coronary heart disease. Tricyclic antidepressants, such as Elavil, should not be used together with albuterol because of their combined toxicity to the vascular system. In rare patients, inhaled albuterol can paradoxically precipitate life threatening bronchospasm. Allergic reactions may rarely occur and can cause rash, hives, swelling, bronchospasm, and anaphylaxis (shock). Worsening of diabetes and lowering of potassium have also been reported. SIDE EFFECTS: Albuterol can cause side effects including palpitations, fast heart rate, elevated blood pressure, tremor, nausea, nervousness, dizziness, and heart burn. Throat irritation and nose bleeds can also occur. 2. GENERIC NAME: amphetamine and dextroamphetamine BRAND NAME: Adderall, Adderall XR DRUG CLASS AND MECHANISM: Amphetamine and dextroamphetamine are used in combination to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. Adderall stimulates the brain and also can increase blood pressure. In a recent small study in children with ADHD, the effects of Adderall lasted longer and were preferred over methylphenidate (Ritalin), the most commonly used drug for ADHD. Adderall XR is an extended release form of Adderall.═ Adderall was approved by the FDA in 1996. PRESCRIBED FOR: Adderall is used for the treatment of attention-deficit hyperactivity disorder (ADHD) and narcolepsy. DOSING: Adderall usually is taken once or twice a day. Adderall XR is taken once daily.═ The dose is adjusted carefully by the physician to achieve the desired effects. DRUG INTERACTIONS: Adderall should not be taken with monoamine oxidase (MAO) inhibitor drugs including phenelzine (Nardil) and tranylcypromine (Parnate). Patients receiving antihypertensive medications may experience loss of blood pressure control with Adderall. SIDE EFFECTS: Side effects of Adderall include excessive stimulation of the nervous system leading to nervousness, restlessness, excitability, dizziness, headache, fear, anxiety, tremor, and even hallucinations and convulsions (seizures). Blood pressure and heart rate may increase, and patients may experience palpitations of the heart. Adrenergic blocking drugs. 1. GENERIC NAME: doxazosin mesylate BRAND NAME: Cardura DRUG CLASS AND MECHANISM: Cardura is an inhibitor of the alpha 1 adrenergic nervous system. It is in a class of drugs referred to as alpha blockers that includes alfusosin (Uroxatral), terazosin (Hytrin), tamsulosin (Flomax), and prazosin (Minipress). Elevated blood pressure (hypertension) is lowered as the action of these nerves, which promote constriction of blood vessels, is blocked. Cardura was also found to relax the muscles around the prostate gland which is also under the influence of the alpha adrenergic portion nervous system. This can makes urination easier for men affected by enlarged prostate glands. PRESCRIBED FOR: Cardura is used for the control of elevated blood pressure (hypertension) and for benign prostatic hyperplasia (noncancerous enlargement of the prostate gland). DOSING: Cardura should be taken at doses specifically directed by your physician. This medication can be taken with or without food. Cardura should be taken the same time each day to maintain proper blood levels. Do not take Cardura within two