Pharmacology Basics

Introduction to Pharmacology

THIRD YEAR DENTISTRY STUDENTS

 CONTENT
• Introduction: definitions and sources of drugs
• Routes of drug administration
 Definitions
• Pharmacology:
It is the science that deals with effects of drugs on living
system.
• This includes the study of source, physicochemical
properties, dosage forms, methods of administration,
absorption, distribution, mechanism of action,
biotransformation, excretion, clinical uses and adverse
effects of drugs
• Drug
Any substance or product that is used or intended to be
used to modify physiological systems or pathological
states for the benefit of the recipient.
A substance used in the prevention, treatment or diagnosis
of disease.
• Pharmacokinetics (PK): “ What the body does to a
drug”
The movement of the drug within the body which includes
the processes of absorption, distribution metabolism and
excretion (ADME) of drugs

• Pharmacodynamics (PD): “What the drug does to the

body”
The study of the mechanism of action, pharmacological
effect (clinical response) of the drug
• Toxicology:
The study of poisons, their action, detection, prevention
and the treatment of poisoning
• Pharmacotherapeutics:
It deals with the proper selection and use of drugs for the
prevention and treatment of disease
• Pharmacognosy:
The study of plants and possible natural substances as
possible sources of drugs. It deals with drugs in crude or
unprepared form
Pharmacogenomics:
The study of genetic factors that underlie variation in
drug response

Pharmacoeconomics:
Compares the value of one pharmaceutical drug or
drug therapy to another

Pharmacoepidemiology:
The study of the use of and the effects of drugs in
large numbers of people
 Where do drugs come from?
Classification of drug sources:

Natural sources :
• Plants: the whole plant, leaves, root, bark, seeds,
flowers
• Human or animal-derived proteins/steroids
• Microorganisms: Fungi/bacteria

Synthetic: produced artificially

Semisynthetic: obtained from natural sources and
chemically modified
8
 Drug Names
• Chemical name: The drug’s chemical composition and
molecular structure
• Generic name (nonproprietary name): Name given by
the United States Adopted Name Council
• Trade name (proprietary name): The drug has a
registered trademark; use of the name is restricted by
the drug’s owner/discoverer/manufacturer
Grouping of drugs:

• Pharmacologic class (or family):

– drugs that share similar characteristics
– Example: beta adrenergic blockers are an
example of a pharmacologic class

• Therapeutic class:
– groups drugs by therapeutic use
– Example: Antihypertensive
Principles of Prescription Writing
 Definition

A prescription is a written,
verbal, or electronic order
from a practitioner or a
designated agent to a
pharmacist for a particular
medication for a specific
patient
 Prescription Formatting

Heading

Body

Closing
 The Five “Rights” of
Medication Administration

❖Right drug
❖Right dose
❖Right time
❖Right route
❖Right patient
 Abbreviations
• Tablets - tab
• Capsule – cap
• Syrup – syr
• Suspension – susp
• Injection – Inj
• Metered dose inhaler – as such (MDI)
• Lotion – as such (LOT)
 Routes of Administration: abbreviations
• PO: by mouth
• PR: per rectum
• IM: intramuscular
• IV: intravenous
• ID: intradermal
• IN: intranasal
• TP: topical
• SL: sublingual
• BUCC: buccal
• IP: intraperitoneal
 Controlled Substance
• Definition - a prescription drug whose
use and distribution is tightly controlled
because of its abuse potential/ risk of
abuse
• Regulation is more strict
Routes of Drug Administration
ROUTES OF DRUG ADMINISTRATION
• Drug and patient-related factors determine the
selection of routes for drug administration
1. Properties of the drug
➢ water or lipid solubility, ionization, effect of gastric pH, digestive
enzymes, first pass metabolism
2. Therapeutic objectives
➢ Onset of action/ duration of treatment (emergency/ routine use)
➢ Site of action (local / systemic).
3. Condition of the patient (unconscious, vomiting, diarrhea)
4. Age of the patient
5. Patient`s/doctor`s choice
ROUTES OF DRUG ADMINISTRATION

• Major routes of drug administration include:

A. Enteral: oral, sublingual, buccal.

B. Parenteral: Intravenous (IV), Intramuscular (IM),

Subcutaneous (SC), Intradermal (ID) .

C. Other: transdermal, nasal inhalation, oral

inhalation, topical (skin cream, eye drops, ear
drops), rectal, vaginal … etc.
1. Oral:
• Most common and acceptable route
• Advantages:
• Convenient - can be self-administered, pain free, easy to
take
• Absorption - takes place along the whole length of the GI
tract
• Cheap - compared to most other parenteral routes
• Safe- low risk of infection
• Overdose and toxicities can be overcome by antidotes, such
as charcoal
1. Oral:
• Disadvantages:
• Sometimes inefficient - only part of the drug may be
absorbed
✓ Absorption can be affected by several factors, as gastric pH
✓ Destruction of drugs by gastric acid and digestive juices
✓ First-pass effect - drugs absorbed orally are initially transported to
the liver via the portal vein
• Irritation to gastric mucosa - nausea and vomiting
• Effect is too slow for emergencies
• Unpleasant taste of some drugs
• Unable to use in unconscious patient
First-pass Effect
• The intestinal and hepatic degradation or alteration of a
drug or substance taken by mouth.

• The greater the first-pass effect, the less the agent will
reach the systemic circulation when the agent is
administered orally
1. Oral:

• Wide range of oral preparations including:

A. Enteric-coated preparations
B. Extended- release preparations
A. Enteric-coated preparations:
is a chemical envelope that resists the action of fluids and
enzymes in the stomach but dissolves readily in the upper
intestine.

• Such coat is useful for:

1. Drugs that are acid unstable (e.g. Omeprazole)
2. Stomach irritating drugs (e.g. Aspirin)
B. Extended-release Preparations (ER or XR):
• Have special coating (molecular sieve) or ingredients that
control how fast the drug is released from the pill into the body

Advantages:
• Slower absorption and prolonged duration
• Better patient compliance
• May maintain concentrations within acceptable therapeutic
range over a long period of time
• These preparations are advantageous for drugs with short half
lives
2. Sublingual/ Buccal:
Placement under the tongue allows a drug to diffuse into the
capillary network and enter the systemic circulation directly
• The buccal route: drug is placed between cheek and gum

Advantages:
– Ease of administration
– Rapid absorption
– Low risk of infection
– Bypass of the harsh GI environment
– Avoid the first-pass metabolism
2. Sublingual/ Buccal:

• Disadvantages
• Inconvenient to some
• Small doses
• Unpleasant taste of some drugs
II. Parenteral route (IV, IM, SC, ID):
Introduces drugs directly into systemic circulation

• Uses:
– Drugs that are poorly absorbed from GI tract (e.g.
heparin).
– Drugs that are unstable in the GI tract (e.g. insulin)
– In patients unable to take oral medication (e.g.
unconscious patients)
– Circumstances that require a rapid onset of action
• Advantages:
– Avoid first-pass metabolism or harsh GI environments.
– provides the most control over the actual dose of drug
delivered to the body.
– Good bioavailability

• Disadvantages:
– Irreversible
– Low convenience, may cause pain, fear
– local tissue damage, and infections.
1. Intravenous (IV):

• Drugs are injected directly into the blood stream through

a vein
• Drugs are administered as:
– Bolus
– Intravenous push
– intravenous injection
– Intravenous infusion
 1. Intravenous (IV):

Uses and advantages:

• For drugs that are not absorbed orally
• For administering chemicals that may cause irritation when
administered via other routes
• Control over the amount of drug delivered
• Absorption phase is bypassed (100% bioavailability)
• Precise, accurate and almost immediate onset of action
• Large quantities can be given, fairly pain-free
1. Intravenous (IV)

Disadvantages:
• Irreversible
• May introduce infection at the site of injection
• Risk of embolism
• Risk of adverse reactions by the too-rapid delivery of
high concentrations of a drug to the plasma and tissues
2. Intramuscular (IM):

• Drugs are injected into a large muscle

• Drugs administered IM:
1. can undergo very rapid absorption in aqueous
solution
2. can be slow-release preparations: Depot Effect
3. can cause pain at injection sites (for certain drugs)
 Depot Preparations

• Often consist of a suspension of the drug in a non-aqueous

vehicle such as polyethylene glycol
• Vehicle diffuses out of the muscle
• The drug precipitates at the site of injection
• The drug then dissolves slowly, providing a sustained dose
over an extended period of time
3. Subcutaneous (SC):

• This route provides absorption via simple

diffusion
• Slower than the IV route
• Advantages of SC injection:
– Minimizes the risks of hemolysis or thrombosis
associated with IV injection
– May provide constant, slow, and sustained
effects.
• SC route should not be used with drugs that
cause tissue irritation
• Absorption is limited by blood flow (adipose
tissue), affected if circulatory problems exist
4. Intradermal (ID)

• The intradermal (ID) route involves injection into the dermis,

the more vascular layer of skin under the epidermis.
• Agents for diagnostic determination and desensitization tests
(TB, allergy, etc.) are usually administered by this route
III. Other routes of administration

1. Oral inhalation

• Gaseous and volatile agents and aerosols

• Rapid onset of action due to rapid access to
circulation
a.Large surface area
b.Thin membranes separates alveoli from
circulation
• This route is particularly effective and convenient for
patients with respiratory complaints (such as
asthma)
3. Nasal inhalation:
• Administration of drugs directly into the nose
• Local effect
– Nasal decongestants, such as oxymetazoline
– Anti-inflammatory corticosteroids
• Systemic effect
3. Intrathecal/intraventricular:

Introduces drugs directly into cerebrospinal fluid,

when:
• Drugs cannot cross the blood-brain barrier to the CNS
• Local, rapid effects are needed, and when it is necessary
to introduce drugs directly into the cerebrospinal fluid.
4. Topical:
• Drug is applied to the skin or mucosal membranes at
various sites for local effect
• Mucosal membranes (eye, nasal, vaginal, rectal,,,,,.)
• Skin: ointment, cream
5. Rectal
Advantages
• Unconscious patients and children
• If patient is nauseous or vomiting
• Good for drugs affecting the bowel such laxatives
• Easy to terminate exposure

Disadvantages:
• Absorption may be variable
• Irritating drugs are contraindicated
6. Transdermal
• The drug is administered in the form of a patch that
delivers the drug into systemic circulation (systemic effect)
I. Stable blood levels
II. No first pass metabolism
III. Drug must be potent, or patch becomes too large
IV. Variable rate of absorption
 Important
point to remember

The ROA is determined by the physical

characteristics of the drug, the speed with which
the drug is absorbed and/ or released, as well as
the need to bypass hepatic metabolism and
achieve high concentration at the target site