Notes in Pharmacology - From Net

Monte laiza Eunice T.
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PHARMACOLOGY
- came from the Greek word "Pharmakon" which means "Drug" and "ogos" which means
"Discourse" ! "ogia" "atin# - "$tud%".
- it is a science that deals with the chemical and &h%sical &ro&erties of drugs' their sources'
effects' (iotransformation and e)cretion.
- it is the stud% of the effects of chemical su(stances u&on li*ing tissues.
HISTORY OF PHARMACOLOGY
Pharmacologic thought had its (eginning when earl% humans (egan to wonder wh% the
chewing of certain &lant roots or lea*es altered their awareness or functions. +s e)&erience in
root and leaf chewing &rogressed into thera&eutic (err% &icking and smoke smelling' the
e)&eriences were s&read and shared. +s time &rogressed' some indi*iduals (ecame more
astute in o(ser*ing and remem(ering that &lant &roducts &roduced &redicta(le effects. Thus'
the first &harmacologist was (orn. Clearl% this hum(le (eginning has e*ol*ed through the
%ears into a huge industrial and academic communit% that is concerned with the stud% and
de*elo&ment of drugs. Drugs that e*ol*ed are then &rescri(ed and dis&ensed through the
&ractice of medicine' dentistr%' and &harmac%. "for continuation - refer to ,olro%d#
The histor% of &harmacolog% can (e di*ided into - &eriods. the earl% &eriod dates (ack to
anti/uit% and is characterized (% em&irical o(ser*ations in the use of crude drugs. 0t is
interesting that e*en &rimiti*e &eo&le could disco*er relationshi&s (etween drugs and disease.
The use of drugs has (een so &re*alent throughout histor% that $ir 1illiam 2sler stated "3456#
with some 7ustification that man has an in(orn cra*ing for medicine.
0n contrast to this ancient &eriod' modern &harmacolog% is (ased on e)&erimental
in*estigations concerning the site and mode of action of drugs. The a&&lication of the
scientific method to studies on drugs was initiated in 8rance (% 8rancois Magendie and was
e)&anded (% Claude Bernard "3439-34:4#. The name of 2swald $chiemie De(ug "3494
35-3# is commonl% associated with the de*elo&ment of E)&erimental Pharmacolog% - in
German% and ;ohn ;aco( +(el "34<:-3594# &la%ed a similar role in the =.$.
The growth of &harmacolog% was greatl% stimulated (% the rise of s%nthetic organic
chemistr% which &ro*ided new tools and new thera&eutic agents. More recentl%'
&harmacolog% has (enefited from de*elo&ments of other (asic sciences and in turn has
contri(uted to their growth.
$ome of the greatest changes in medicine that ha*e occurred during the last few decades
are directl% attri(uta(le to the disco*er% of new drugs.
Claude Bernard - e)&anded a&&lication in scientific method.
+le)ander 8leming - disco*ered &enicillin.
,i&&ocrates - father of medicine
;ohn ;aco( +(el - de*elo&ment of e)&eriments in &harmacolog%
2swald $chieme De(ug - de*elo&ment of e)&erimental &harmacolog%
;ose&h ister - antise&tic techni/ue
BRANCHES OF PHARMACOLOGY
3. Pharmacokinetics - concerned with the a(sor&tion' distri(ution' (iotransformation' and
e)cretion of drugs.
- mo*ement of drugs in the (od%. ",ow the (od% handles the drug>"
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-. Pharmaco!namics - deals with the effects of drugs in the (od%? deals with the mechanism
of action!effect of a drug in li*ing organisms and their corres&onding res&onses and the
&h%siologic and (iochemical effects of the drug. ",ow the drug &roduces its effect>" "1hat
the drug does to the (od%>"
9. Pharmaco"nos! - identification and &rocurement of crude and naturall% occurring drugs.
8ormer name. "Materia Medica"
6. Pharmac! - &rocurement' &re&aration and dis&ensing of drugs.
<. Pharmaco"enetics - effects of drug on &eo&le with congenital a(normalities of meta(olism.
e./. Eskimos - h%drol%ze isoniazid @ faster than other races.
(ar(iturates - geriatrics @ stimulation instead of de&ression
A. Poso#o"! - stud% of dosage of drugs.
:. To$ico#o"! - stud% of the ad*erse effects of drugs.
4. Biochemor%ho#o"! - alteration of the chemical structure of drugs to &roduce a different effect.
5& 'e(e#o%menta# %harmaco#o"! - effects of drugs in fetal de*elo&ment.
e./. Thalidomide (a(ies - teratogenic.
3B. Pharmacothera%e)tics - "clinical &harmacolog%C - the uses!a&&lication of drugs in the
treatment of disease? the art and science of using drugs in the diagnosis' treatment' and
&re*ention of disease.
33. 'escri%ti(e %harmaco#o"! - /ualitati*e effects of drugs in man.
3-. C#inica# Pharmaco#o"! * the stud% of the effects of drugs in man.
39. Mo#ec)#ar %harmaco#o"! * the stud% of drug effects at the molecular le*el.
IMPORTANCE OF PHARMACOLOGY TO 'ENTISTRY
3. To (e a(le to cure diseases
-. To (e a(le to &rescri(e drugs to the &atient a&&ro&riate for his condition.
9. To (e a(le to communicate with the medical staff and &ractitioners.
DDDThe dentist should (e a(le to o(tain the ma)imal ad*antage while &roducing the minimal
disad*antages.
DDDThe &rescri(er should (e aware of how drugs ma% modif% the &h%siolog% of the &atient.
'R+GS - an% chemical su(stance that affects ! modifies the (iologic s%stem.
- chemical necessar% for the maintenance of life &rocesses (% their a(ilit% to act
selecti*el% in (iologic s%stems to accom&lish a desired effect.
- a single entit% that ma% (e one of the constituent of medicine.
Meicine - ma% contain one or more acti*e constituents "drugs# together with additi*es to
facilitate administration.
*** "All medicines are drugs, but not all drugs are medicine."
SO+RCES OF 'R+GS
3. Eatural
a. +nimals - glandular &roducts are the chief medicinal currentl% o(tained form animal
sources. e./. th%roid hormone' insulin from &ancreas of cattle and &igs'
e&ine&hrine and +CT,.
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(. Plants - crude drugs ma%(e o(tained from an% &art of *arious &lants used medicinall%.
E./ ea*es - Pito-&ito' +lagaw' Bana(a' etc.? digitalis from fo)glo*e &lant.
c. Minerals - iron' commonl% used in the form of ferrous sul&hate
-. $%nthetic!Chemical $u(stances - done in the la(orator% (% chemists.
a. Pure drugs and other sim&le su(stances
(. Products of com&le) s%nthesis "anti(iotics' sulfonamides and adrenocorticosteroids#.
STAGES IN THE 'E-ELOPMENT OF A 'R+G
E*olution of a Eew Drug
Drug de*elo&ment $trategies
E)&erimental Pharmacolog%
To)icological +ssessment
Clinical E*aluation
Marketing and Promotion
STRATEGIES
D $erendi&it% "luck and intuition#
D Molecular Foulette "random clinical s%nthesis#
D Program Basic Fesearch with $%nthesis of $&ecific Chemicals.
D Clinical 2(ser*ation of Drug +ction in the Practice.
PRINCIPAL IN'I-I'+AL.S/ STAGES IN THE 'E-ELOPMENT OF A 'R+G
CONCERNE'
Garious 0deas
Chemist Eatural or s%nthetic chemical com&ounds
Pharmacologists Pharmacological Tests
Biochemists Performs "(iologic assa%s"
To)icologists +cute to)icit% Chronic to)icit% tests
Mutagenicit% Teratogenesis Carcinogenecit%
Pharmacists Pharmaceutical formulation ! Clinical trials
Clinical Pharmacologists Phase 3. + &ilot in*estigation made in a small num(er
Eormal Golunteers of normal *olunteers
Dentist!Doctor!Patients Phase -. +n o&en clinical trial carried out in a small
Clinical Pharmacologists num(er of &atients
Eurse Patients $tatistician Phase 9. arge scale clinical trial
Practicing Dentists!Doctors Phase 6. Monitored release and &ost- marketing
and their &atients sur*eillance of new drug
+cce&ted drug
CLINICAL E-AL+ATION
Phase I
D + &ilot stud% that uses small num(ers of human *olunteers
D 0nitiall%' low doses of drug that are graduall% increased are used and the to)ic or e)aggerated
effects are monitored
Phase II
D The drug is tested in limited num(ers of hos&italized &atients with the disease the drug is
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intended to treat
D The test drug is com&ared to esta(lished drugs and &lace(o
Phase III
D Testing is intended to large grou& of out&atients to &ermit e*aluation of the drug under
conditions that ma% e)ist if the drug is marketed.
D 0f the drug is safe and effecti*e for its intended use' the 8D+ ma% a&&ro*e the drug for
marketing.
Phase I-
D + new drug is usuall% marketed onl% after a few hundreds' or at most few thousand &atients ha*e
(een e)&osed to it for a relati*el% short &eriod of time.
D Post-marketing sur*eillance is necessar% to assess efficac% and to)icit% of a new drug on a
larger scale.
1 0 MA2OR PHASES IN A PRE3CLINICAL TESTS
3. +cute To)icit% Test
-. $u(-acute "&rolonged# To)icit% Test
9. Chronic To)icit% Test
PRINCIPLES OF 'R+G ACTION
3. Cure disease
-. +lle*iate s%m&toms
9. Fe&lace deficiencies
F+N'AMENTAL ACTION OF 'R+GS
3. $T0M=+T02E - drugs that increases the o*erall acti*it% of s&ecialized organs' tissue' or cell.
e./. caffeine "coffee - CE$ stimulant? can cause tach%cardia "inc. heart acti*it%#.
-. DEPFE$$02E - drugs that decreases the o*erall functional acti*it% of cells' tissues' or organs.
e./. alcohol' (ar(iturates.
9. 0FF0T+T02E - either inc. or dec. (ut it is said that stimulation is &ushed too far to the &oint
of in7uring the cell.? manifested as nausea' *omiting' itchiness' redness.
6. FEP+CEMEET ! $=PPEMEET - drugs that can (e used as su(stitutes for what is lacking
in the (od%. e./. *itamins.
<. +ET0M0CF2B0+ ! +ET0B+CTEF0+ - when the action of the drug is directed towards
the in*ading microorganism in the (od%. e./. anti(iotics.
A. +EE$T,ET0C - a solution that tends to &roduce a tem&orar% (lock or ner*e conduction.
:. PF2P,H+CT0C - to &re*ent an% untoward occurrences!illnesses in the (od%. e./. DPT'
&olio *accines' etc.
D+ll drugs e)ert some effect on a (iologic s%stem
D 0n most instances' a gi*en effect can (e related to drug dosage in a /uantitati*e fashion.
DTwo im&ortant e)&ressions of drug action can (e demonstrated. P2TEECH and E880C+CH.
Potenc! - amount!strength of a drug re/uired to &roduce the desired effect or action
3 is a measure of drug acti*it% in terms of the amount re/uired to &roduce an effect of
gi*en intensit%.
E44icac! - a(ilit% of the drug to elicit its ma)imum inherent &h%siologic effect.
- the "Ma)imum 0ntensit% of Effect" of a certain drug.
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D 8or e)am&le' one drug "drug +# &roduces com&lete eradication of &remature *entricular
contractions "PGCs# at a dose of 3B mg. + second drug "drug B# &roduces com&lete
eradication of PGCs at a dose of -B mg. Therefore' (oth drugs ha*e the same efficac%
"com&lete eradication of PGCs#' (ut drug + is more &otent than drug B. 0t takes less of drug +
to &roduce the same effect. + third drug "drug C# can reduce the PGCs (% onl% ABI' and it
takes a dose of <B mg. to achie*e the effect. Therefore' drug C has less efficac% and less
&otenc% in the reduction of PGCs com&ared with (oth drug + and drug B.
CHARACTERISTICS OF 'R+G ACTION
3. +ccording to Biochemical +ction
E./. ,%&ogl%cemic agents? ,emostatic agents
-. +ccording to Ph%siologic Effects
E./. Muscle rela)ants? +nti-h%&ertensi*e agents
9. +ccording to the 2rgan $%stem on which the% e)ert their Thera&eutic +ction
E./. CE$ stimulants
+SES OF 'R+GS
3. Diagnosis - e./. (arium enema
-. Pre*ention - e./. DPT *accine
9. Contrace&tion - e./. &ills' de&ro*era' etc.
6. Treatment - e./. analgesics' anti(iotics
MECHANISM OF 'R+G ACTION
3. +ction on a Fece&tor
-. +ction on an Enz%me
9. +ction on Mem(rane 0onic Channels
6. C%toto)ic action
0. +CT02E 2E + FECEPT2F
Rece%tor - a s&ecific macromolecule usuall% a &rotein to which a s&ecific grou& of drug
or naturall% occurring su(stances such as neurotransmitter or hormone can
(ind.
RECEPTORS IN-OL-E' IN THE ACTION OF COMMONLY +SE' 'R+GS
RECEPTOR MAIN ACTION OF NAT+RAL AGONISTS
+DFEE2CEPT2F
3 Gasoconstriction
- ,%&otension ? $edation
B 3 ,eart Fate
B - Bronchodilation
Gasodilation
=terine Fela)ation
C,20EEFG0C
Muscarinic ,eart Fate
$ecretion
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Gut Motilit%
Bronchoconstriction
Eicotinic Contraction of $triated Muscle
,0$T+M0EE
,3 Bronchoconstriction
Ca&illar% Dilation
,- 0ncreased Gastric +cid
D2P+M0EE CE$ Eeurotransmitter
2P02D CE$ Eeurotransmitter

00. +CT02E 2E EEJHME
Enz%me - &rotein macromolecule with which su(stances interact to &roduce Kacti*ationL
or Kinhi(itionL.
DDrugs in clinical use which e)ert their effect thru enz%me action generall% do so (%
Kinhi(itionL.
E./. +s&irin inhi(its &latelet c%clo-o)%genase? +llo&urinol inhi(its )anthene o)idase.
000. +CT02E 2E MEMBF+EE 02E0C C,+EEE$
The conduction of im&ulse in ner*e tissues and electrochemical cou&ling in muscles
de&ends on the mo*ement of ions &articularl% sodium' calcium' and &otasium through
mem(rane channels.
D$e*eral grou& of drugs that interfere with these &rocessess. +ntiarr%thmic drugs'
General and local anesthesia' +nticon*ulsant.
0G. CHT2T2M0C +CT02E$
This mechanism ha*e (een defined in terms of effects on s&ecific rece&tors or enz%mes.
But in other cases' chemical action "+lk%lation# damages DE+ or other macromolecules
and results in cell death or failure of cell di*ision.
E./. Drugs used in cancer or in treatment of infection ma% kill malignant cells or
Microorganisms.
P+BLICATIONS IN PHARMACOLOGY
+&S&P& +nite States Pharmaco%oeia
- Fe&resentati*es from school of medicine and &harmac%
- +merican medical +ssociation
- +merican Pharmaceutical +ssociation
- $tate Medical $ocieties
- +merican Chemical $ociet%
- 2ther scientific organization and federal agencies
Pur&ose of =.$.P. . 0t sets the official chemical and &h%sical standards that relate
essentiall% to strength and &urit% of drug.
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N&F& Nationa# Form)#ar!
- issued e*er% < %ears
- esta(lishes official standards for drugs not descri(ed in the =.$.P.
- descri(ed e)tent of drugsC use and thera&eutic *alue
British Pharmaco%oeia
- English e/ui*alent of =.$.P. "Great Britain and Canada#
Pharmaco%oeia Internationa#is
- issued (% 1.,.2.
A&'&T& Acce%te 'enta# Thera%e)tics
A&'&R& Acce%te 'enta# Remeies
- (iennial &u(lication of the Council on Dental Thera&eutics "CDT# of the +merican Dental
+ssociation
- drugs of recognized *alue that are la(eled and ad*ertised in accordance with CDT are
included.
- Primaril% a hand(ook of dental &harmacothera&eutics and intended to assist the dental
&ractitioner in the selection of drugs.
P&'&R& Ph!sician8s 'esk Re4erence
- a hand(ook &u(lished annuall% (% some -BB manufacturers
Special Value:
3. Pu(lished annuall% and therefore includes relati*el% u& to date information
-. 0t is cross-inde)ed to include the use of &ro&rietar% names
Disadvantages:
3. Products or drugs are arranged (% manufacturers rather than (% &harmacologic class
-. 0nformation ma% (e "(iased".
1 REP+BLIC ACT 7796 - known as the GENERIC ACT OF 1:;;
- an act to Promote' Fe/uire and Ensure the &roduction of an ade/uate su&&l%'
distri(ution' use and acce&tance of drugs and medicines identified (% their generic names.
+0M.
3. To &romote' encourage and re/uire the use of generic terminolog% in the im&ortation'
manufacturing' distri(ution' marketing' ad*ertising and &romotion' &rescri&tion and
dis&ensing of drugs.
-. To ensure the ade/uate su&&l% of drug with generic names through a rational s%stem of
&rocurement and distri(ution.
9. To encourage the e)tensi*e use of drug with generic names through a national s%stem of
&rocurement and distri(ution.
Importance of R.A. 6675
3. 8or health &rofessionals to (ecome more aware and cognizant of their thera&eutic effecti*eness.
-. To &ro*ide drugs to indigent &atients at the lowest &ossi(le cost.
9. To ha*e health% com&etition among drug manufacturers
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Who Shall se !eneric "erms#
+ll go*ernment health agencies
+ll medical' Dental and Geterinar% &ractitioners
+ll drug esta(lishments
+ll drug outlets
Pena#t! 4or NOT com%#!in" to R&A& 7796
$irst %ffense
Fe&rimand which will (e recorded in the Professional Fegulation Commission Book.
Second %ffense
8ine . Eot less than P-'BBB.BB (ut not greater than P<'BBB.BB.
"hird %ffense
8ine . Eot less than P<'BBB.BB (ut not greater than P3B'BBB.BB.
$ourth and Succeeding
8ine . Eot less than P3B'BBB.BB and sus&ension of license to &ractice for one %ear.
'R+G NOMENCLAT+RE
1& CHEMICAL NAME
"80F$T E+ME" gi*en to com&ound of known com&osition
- con*e%s the chemical structure of the com&ound.
E./. E-+cet%l &-amino&henol
C2DE DE$0GE+T02E - con*enient means of referring to the com&ound (efore it has (een
assigned either a generic or trade name.
- T%&es of Code Designation
3. + letter and num(er com(ination e./. $, <A:
letter!s - research la(orator% in*ol*ed
num(er!s - ar(itraril% assigned
-. etter com(ination e./. +JT - +zoth%midine
TP+ - Tissue Plasminogen +cti*ator
+$+ - +cet%l $alic%lic +cid
,& TRA'E NAME "Commercial Eame? Pro&rietar% Eame? Brand Eame#
- name of the com&an% who manufactured the drug
- gi*es no or little information a(out the drug itself
BRAN' NAME - name of the com&an% marketing the &roduct
- distinguishes its &roduct from others.
- E./. Biogesic' Ponstan' 8lana)' +mo)il'
Two 0m&ortant Disad*antages of Trade Eame.
3. Makes the &ro(lem of drug identification more com&le)
-. De&ri*e the &atient to a*ail of a less e)&ensi*e generic &re&arations.
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+d*antages of Trade Eames.
3. The% are con*enient and sa*es time when writing &rescri&tions for multi&le-entit% drugs
-. Trade names are usuall% shorter and easier to remem(er than generic names.
9. The use of trade names demands the &roduct of a s&ecific manufacturer in whose
manufacturing &ractices the &ractitioner ma% ha*e s&ecial confidence.
0& GENERIC NAME - "2fficial" name of the drug? "Eon-Pro&rietar% name.
+d*antages of using Generic Eames
3. ,ealth% com&etition among drug manufacturers
-. Pro*ides a wide selection of drugs
9. 0t is uni*ersall% acce&ted.

Disad*antages of using Generic Eames
3. Eot all &re&arations are &re&ared as the% should (e.
-. 0t is hard to remem(er.
9. 0t is incon*enient when written.
E.g.
Chemica# . --dieth%lamino -'A aceto)%lidide . E-acet%l &-amino&henol
Generic . idocaine . +cetamino&hen
Trae Name . M%locaine . T%lenol
Dolicaine . Tem&ra
2ctocaine . Galadol
-caine . Datril
111 Ho< to )se the PIMS = MIMS
PIMS - Phili&&ine 0nde) for Medical $&ecialties
MIMS - Monthl% 0nde) for Medical $&ecialties. 0t is a glo(al term for a thera&eutic inde).
Brand Eame !Manufacturer ! Distri(utor
Contents " C #
0ndication!s " 0 #
Dosage " D #
Contraindications " C!0 #
$&ecial Precautions " $P #
+d*erse Feactions " +F #
Drug 0nteractions " D0 #
Presentation ! Price " P!P #
&'ample: "Based from M0M$ Dental Phils. -BB- &age A4#
ATMOSE Morishita-$eggs F) "+tmose is the &ro&rietar% name of the
"Metro Drug# drug?
C& Mefenamic +cid Morishita-$eggs is the name of the
I& Felief of mild to moderate &ain including com&an% who manufactured the drug
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headache' dental &ain' &ost-o& and &ost&artum Metro Drug is the name of the
&ain' d%smenorrhea' osteoarthritis and F+. com&an% marketing the &roduct
'& +dult and children N 36 %r. 0nitiall% <BB mg. F) means this drug needs &rescri&tion
then -<B mg A hrl%. P!P. +tmose is a*aila(le in ca&sule
CI. Pe&tic ulceration or inflammator% (owel disease. form at a dosage of <BB mg.?
SP& ,e&atic or renal im&airment? e&ile&s%. M3BB means in one (o) there are
AR& G0 distur(ances? &e&tic ulceration' G0 (leeding? 3BB ca&sules that costs
drowsiness? dizziness? ner*ousness? *isual Ph&9<:.A9
distur(ances? skin rash? urticaria? (lood d%scrasias.
'I& Enhances the effects of the coumarin anticoagulants.
P=P. Ca& <BB mg M 3BBOs "P9<:.A9#
PHARMACOLOGICAL CLASSIFICATION IN'E>
Pharmaco#o"ica# C#asses an S)?3c#asses
"(ased on M0M$ Dental Phils -BB-#

I& ALIMENTARY SYSTEM
3. +ntacids and +ntiulcerants
-. G0T regulators' +ntiflatulents and +nti-0nflammatories
9. +ntis&asmodics
6. +ntidiarrheals
<. a)ati*es' Purgati*es
A. Digesti*es
:. Cholagogues' Cholelithol%tics and ,e&atic Protectors
II& CAR'IO-ASC+LAR AN' HEMATOPOIETIC SYSTEM
3. Cardiac Drugs
-. +nti-anginal Drugs
9. +CE 0nhi(itors
6. Beta Blockers
<. Calcium +ntagonists
A. Diuretics
:. +ntidiuretics
4. Peri&heral Gasodilators and Cere(ral +cti*ators
5. Gasoconstrictors
3B. Migraine Drugs
33. ,aemostatics
3-. +nticoagulants' +ntithrom(otics and 8i(rinol%tics
39. ,aemorrhoidal' Phle(itis and Garicose Pre&arations
36. ,aemorrheologicals
3<. ,aemato&oetic +gents
3A. 2ther Cardio*ascular Drugs
III& RESPIRATORY SYSTEM
3. Fes&irator% $timulants
-. +ntiasthmatic Pre&arations
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9. Cough and Cold Femedies
6. Decongestants and other Easal Pre&arations
<. 2ther drugs acting on Fes&irator% $%stem
I-& NE+ROM+SC+LAR SYSTEM
3. +nti-inflammator% Enz%mes
-. +nalgesics and +nti&%retics
9. +ntirheumatic' +nti-inflammator% +nalgesics
6. Gout Pre&arations
<. Minor Tran/uilisers
A. Ma7or Tran/uilisers
:. ,%&notics and $edati*es
4. +nticon*ulsants
5. +ntide&ressants
3B. CE$ $timulants
33. Eootro&ics and Eeurotonics
3-. +ntiemetics and +nti*ertigo Drugs
39. Eeurodegenerati*e Disease Drugs
36. +nti&arkinsonism Pre&arations
3<. Eeuromuscular Disorder Drugs
3A. Muscle Fela)ants
-& HORMONES
3. +ndrogens and Felated $%nthetic Drugs
-. 2estrogens and Progesterones and Felated $%nthetic Drugs
9. Com(ined $e) ,ormones
6. Corticosteroid ,ormones
<. Tro&hic ,ormones and Felated $%nthetic drugs
A. +na(olic +gents
:. 2ther ,ormone Felated Drugs
-I& CONTRACEPTI-E AGENTS
3. De&ot Contrace&ti*es
-. 2ral Contrace&ti*es
9. 2ther Contrace&ti*es
-II& ANTIBIOTICS
3. +minogl%cosides
-. Ce&halos&horins
9. Chloram&henicols
6. Macrolides
<. Penicillins
A. Puinolones
:. Tetrac%clines
4. +ntifungals
5. +nti(acterial Com(inations
3B. 2ther +nti(iotics
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-III& OTHER CHEMOTHERAPE+TICS
3. +ntitu(erculous +gents
-. $ul&honamides
9. +ntiamoe(ics
6. +nthelmintics
<. +ntile&rotics
A. +nti*irals
:. +ntineo&lastics
4. +ntimalarials
5. eishmaniacides' Tr%&anocides
3B. 8ilaricides
I>& GENITO3+RINARY SYSTEM
3. Pre&arations for Gaginal Conditions
-. =rinar% +ntise&tics
9. Drug acting on =terus
6. 2ther Drugs +cting on Genito-=rinar% $%stem
>& METABOLISM
3. 0nsulins
-. 2ral +ntidia(etic +gents
9. Th%roid Pre&arations
6. +ntith%roids
<. +ntih%&erli&idaemic +gents
A. 2ther +gents +ffecting Meta(olism
>I& -ITAMINS AN' MINERALS
3. Gitamins +' D' E
-. Gitamin BOs ! with C
9. Gitamin C
6. Calcium ! with Gitamins
<. Multi*itamins ! with Minerals
A. Gitamins with ,ormones ! Geriatric Pre&arations
:. Pediatric Gitamins and Minerals
4. Electrol%tes and Minerals
5. +ntianemics ! Pre and Post Eatal Gitamins
>II& N+TRITION
3. 0nfant ! 8ollow-2n 8ormulae
-. Enteral ! Eutritional Products
9. Parenteral Eutrition
6. Tonics
<. +&&etite $timulants
A. +ntio(esit% +gents
1,
DCB
>III& EYEA EARA MO+TH = THROAT
DEHE
3. E%e +nti-infecti*es and +ntise&tics
-. E%e corticosteroids
9. E%e +ntise&tics with Corticosteroids
6. M%driatic Drugs
<. Miotic Drugs
A. Glaucoma Pre&arations
:. 2ther E%e Pre&arations
DE+F
3. Ear +nti-infecti*es and +ntise&tics
-. Ear Corticosteroids
9. Ear +ntise&tics with corticosteroids
6. 2ther Ear Pre&arations
DMouth ! Throat
3. Mouth ! Throat Pre&arations
>I-& 'ERMATOLOGICALS
3. To&ical +nti-infecti*es
-. To&ical +nti-infecti*es with Corticosteroids
9. To&ical Corticosteroids
6. +cne Treatment Pre&arations
<. +ntise&tics and Disinfectants
A. Medicated $urgical Dressings
:. To&ical 8ungicides and +nti&arasites
4. Psoriasis' $e(orrhea and 0chth%osis Pre&arations
5. To&ical +nti*irals
3B. Qeratol%tics
33. $kin Protecti*es
3-. To&ical +ntihistamines ! +nti&ruritics
39. To&ical +nalgesics and +nti-inflammatories
36. 2ther Dermatologicals
>-& ANAESTHETICS
3. ocal +nesthetics
-. General +nesthetics
>-I& 'IAGNOSTIC AGENTS
3. =rinal%sis +gents
>-II& ALLERGY AN' IMM+NE SYSTEM
3. +ntihistamines and +ntiallergies
-. Gaccines' +ntisera and 0mmunologicals
9. 0mmunosu&&ressants
10
DCB
>-III& ANTI'OTES AN' 'ETO>IFYING AGENTS
>I>& INTRA-ENO+S AN' OTHER STERILE SOL+TIONS
>>& MISCELLANEO+S
'i44erent Factors A44ectin" Res%onseB
Foutes of Drug +dministration
Passage of Drug +cross Bod% Mem(ranes
Molecular Mechanism of +ction
+(sor&tion
Distri(ution 8+TE of a DF=G
Meta(olism
E)cretion
RO+TES OF 'R+G A'MINISTRATION
ENTERAL
2ral
Fectal
PARENTERAL
()podermic Routes
0ntra*enous
0ntramuscular
$u(cutaneous
0ntradermal
0ntrathecal
0ntra&eritoneal

Additional Routes
To&ical
0nhalation
$u(lingual
Transdermal
LOCAL RO+TE
To&ical
0ntradermal
0ntrathecal
0ntranasal
0ntracon7ucti*al
0ntra-oral
0ntra-articular
0ntra-arterial
2ther s&ecial routes
15
DCB
SYSTEMIC RO+TES
Enteral
Parenteral
*** +ocall) administered drugs ma) ,e a,sor,ed at a rate and to an e'tent sufficient to result in
the production of s)stemic effects.
ENTERAL RO+TES - drug is &laced directl% into the G0T from where a(sor&tion occurs.
A& ORAL RO+TE
- sim&lest and most con*enient for self administration.
Contraindication for 2ral Foute
3. Patients with gastrointestinal intolerance
-. Patients &re&aring for anesthesia
9. Patients with gastrointestinal surger%
6. Precluded in coma
Disad*antages of 2ral Foute
3. 0rritant drugs cannot alwa%s (e gi*en (% mouth for it ma% cause sickness.
-. 0t is not feasi(le to gi*e drugs (% this route to &atients who are *omiting or mori(und.
9. Man% drugs are destro%ed (% the action of the digesti*e ferments (efore the% can (e
a(sor(ed.
6. 0ntestinal a(sor&tion ma% (e irregular due to other su(stances in the git.
<. 0ntestinal a(sor&tion ma% (e affected (% changes in gastric em&t%ing which ma%
increase or decrease the rate of a(sor&tion.
CFirst Pass E44ectC - refers to the meta(olism of a drug en route from the gut lumen to
the s%stemic circulation.
- a &rocess that ra&idl% deacti*ate some drugs in the li*er that was
gi*en orall% and was initiall% &erfused into the he&atic &ortal
circulation.
$ome drugs do not go directl% into the s%stemic circulation following a(sor&tion
(ut &ass from the intestinal lumen to the li*er' (% the &ortal *ein. 0n the li*er' most of
the drug is meta(olized to an inacti*e drug form for e)cretion' reducing the amount of
acti*e drug.
0m&ortance of 8irst Pass Meta(olism
3. 0t is one of the reasons for the a&&arent differences in drug a(sor&tion (etween
indi*iduals.
-. 0n &atients with se*ere li*er disease' first-&ass meta(olism ma% (e dramaticall%
reduced leading to the a(sor&tion of greater amounts of &arent drug.
Drugs with ,igh 8irst Pass Meta(olism
+nalgesics
+s&irin
Mor&hine
Paracetamol
Pentazocine
16
DCB
Pethidine
Fes&irator% Drugs
$al(utamol
Ter(utaline
Drugs +cting on Central Eer*ous $%stem
Chlormethiazole
Chlor&romazine
0mi&ramine
e*odo&a
Eortri&t%line
2ral Contrace&ti*es
Cardio*ascular Drugs
Gl%cer%l Trinitrate
0so&renaline
Eifedi&ine
Prazosin
Pro&anolol
Gera&amil
ignocaine
Metro&olol

RECTAL RO+TE
- drugs are given via the rectum. &... solid form / suppositories0 li.uid form / enemata.
- used when oral administration is im&ossi(le.
- avoids the acidit) and en1)mes of the gastric 2uice and first pass meta,olism.
- Both local and s%stemic effects are o(tained (ut a(sor&tion of man% drugs are often
irregular and incom&lete. 0ndications. Pediatrics ! Geriatrics
PARENTERAL RO+TES - generall% chosen when s&eed or relia(ilit% are s&eciall% desired.
+. 0n7ection R essential if the drug is to (e a(sor(ed in acti*e form.
- a(sor&tion is usuall% more &redicta(le and more ra&id
- re/uires s&ecial skill? drugs cannot (e withdrawn easil%.
Disadvantages
3. Difficult for the &atients to &erform the in7ection (% themsel*es.
-. $trict ase&sis must (e maintained to a*oid infection
9. =suall% more costl% and less safe.
6. Can cause &ain.
TYPES OF IN2ECTION
Intra(eno)s .I-/
- route of choice for emergenc% cases
- Most ra&id route ! method to elicit drug res&onse.
+d*antages
3. Fa&id action
-. Can (e used for drugs which are irritant (% 0M in7ection.
9. =seful for ill' hos&italized &atients when a slow 0G infusion &ro*ides a stead% flow
without distur(ing the &atient
17
DCB
Disad*antages
3. Tend to &roduce more immediate ad*erse reactions.
-. Too high concentration of the drug is readil% o(tained when in7ected ra&idl%.
9. The chance of &enetration into an arter% instead of a *ein is a &ossi(ilit%.
Com&lications.
3. Drug $hock
-. +cute' serious' allergic res&onses
9. Phle(itis
6. Eecrosis around the in7ection site.
Intraerma# .c)taneo)s/ - E./. skin testing.

+ction.
- local effect
- small amount is in7ected into the e&idermis of the skin so that *olume does not interfere
with wheal formation or cause a s%stemic reaction.
- used for o(ser*ation of an inflammator% "allergic# reaction to foreign &roteins.
- rarel% em&lo%ed e)ce&t in certain Diagnostic and test &rocedures "screening for
allergic or local irritant res&onses#.
- takes the longest time for drug a(sor&tion.
$ites.
- ocations are chosen so that inflammator% reaction can (e o(ser*ed. Preferred areas
are lightl% &igmented' thinl% keratinized' and hairless such as *entral mid-forearm'
cla*icular area of chest' sca&ula area of (ack' and medial as&ect of thighs.
E/ui&ment.
Eeedle. -A R -: gauge
$%ringe. 3 ml. cali(rated in B.B3 ml. increments
=suall% B.B3 R B.3 ml. in7ected.
Techni/ue.
Cleanse area using circular motion? o(ser*e sterile techni/ue.
,old skin taut.
0nsert needle' (e*el u&' at a 3< degree angle? outline of needle under the skin should (e
*isi(le.
0n7ect medication slowl% to form a wheal "(lister or (le(#.
Femo*e needle slowl%.
Make a mark or encircle the (le( with a &en.
Do not massage area? instruct client not to do so.
+ssess for allergic reaction in -6 R :- hours? measure diameter of local reaction.
S)?c)taneo)s - for drugs which are not irritant to tissues. E./. mor&hine sul&hate'
adrenaline' and insulin.
- *olume is usuall% 3 ml. or less? seldom e)ceeds - ml.
- cutaneous (lood flow is slower com&ared to 0M
- sustained effect can (e o(tained (% &lacing a &ellet of drug su(cutaneousl%? e./.
19
DCB
Estradiol &lants.
- drug is in7ected in the su(cutaneous la%er into the al*eolar connecti*e tissue 7ust (elow the
skin.
+ction.
- $%stemic effect
- $ustained effect? a(sor(ed mainl% through ca&illaries? usuall% slower in onset than with
intramuscular route.
- =sed for small doses of non-irritating water-solu(le drugs.

$ites.
- ocations for su(cutaneous in7ection are chosen for ade/uate fat &ad size and include the
a(domen' u&&er hi&s' u&&er (ack' lateral u&&er arms' and lateral hi&s.
E/ui&ment.
Eeedle. -< R -: gauge
S - <!4 in. in length
$%ringe. 3 R 9 ml.
=suall% B.< R 3.< ml. in7ected.
0nsulin s%ringe measured in units for use with insulin onl%.
Techni/ue.
Cleanse area with circular motion using sterile techni/ue
Pinch the skin.
0nsert needle at angle a&&ro&riate to (od% size. 6< to 5B degrees.
Felease skin.
+s&irate' e)ce&t with he&arin.
0n7ect medication slowl%.
Femo*e needle /uickl%.
Gentl% massage area' unless contraindicated with he&arin.
+&&l% &laster if needed.

+d*antages.
3. $&read the action out o*er a num(er of hours.
-. +*oid too intense or too short res&onse
9. +*oid fre/uent in7ections.

+a)er of s3in and site of in2ections:
E&idermis
Cutaneous
Dermis
Mem(rane
8ascia
$u(cutaneous
Muscle
1;
DCB
Intram)sc)#ar .IM/
- more dangerous than 0G? (etter for irritant tissues.
+ction.
- s%stemic effect.
- =suall% more ra&id effect of drug than with su(cutaneous.
- =sed for irritating drugs' a/ueous sus&ensions' and solutions in oils.
- indicated when an immediate effect is not re/uired (ut a &rom&t effect is desira(le.- 3B R
9B minutes a(sor&tion.
$ites.
ocations are chosen for ade/uate muscle size and minimal ma7or ner*es and (lood
*essels in the area. Preferred locations include *entrogluteal' dorsogluteal' deltoid' and
*astus lateralis.
E/ui&ment.
Eeedle. 34 R -3 gauge
3 R 3.< in. in length
$%ringe. 3 R9 ml.
=suall% B.< R 3.< ml. in7ected
Techni/ue.
$ame as for su(cutaneous in7ection e)ce&t that needle is inserted at 5B degree angle into
the muscle.
Fi")reB +ngles for in7ections. "+# 0M 5B "B# "C# "D# $C 5B ' AB ' 6< "E# 0D 3B@3< .
Intra%eritonea# R in7ected into the &eritoneal ca*it% (% a(sor&tion of messenteric *eins
Intra%#e)ra# - introduce into the &leural ca*it%? for as&iration of fluids.
1:
DCB
Intratheca# = Intras%ina# - for s&inal analgesia into the s&inal su(arachnoid s&ace.
- administered into the cere(ros&inal fluid at an% le*el of the cere(ros&inal a)is.
Intrane)ra# - used in trigeminal neuralgia.
Intrasterna# - drugs which normall% do not cross the (lood (rain (arrier.
B+CCAL an S+BLING+AL ro)te
- an enteral route infre/uentl% used (ut useful in drugs with first &ass he&atic meta(olism.
E./. gl%cer%l trinitrate for angina attack (ut ineffecti*e when swallowed as its first &ass
meta(olism a&&roaches 3BB &er cent
- drugs that are susce&ti(le to degradation (% the G0T and e*en the li*er are safel%
administered su(linguall%.
INHALATION - E./. inhalation anesthetics' aerosol inhalation for asthma.
- inhalation is *ia the mouth? a(sor&tion occurs in the small (ronchioles. E./. disodium
cromogl%cate *ia a K$&inhalerL.
- drug is a(sor(ed through the &ulmonar% endothelium at the al*eoli to gain ra&id access
to the general circulation.
Feasons for ra&id a(sor&tion
3. +l*eolar and *ascular e&ithelial mem(ranes of the lungs are /uite &ermea(le.
-. Blood flow is a(undant.
9. There is al large surface for a(sor&tion.
Particle $ize
3. Particles greater than 0 um in diameter - tend to settle in the (ronchi.
-. Particles less than B.< um - fail to settle? mainl% are e)haled.
TOPICAL
- least effecti*e.
- drug is a&&lied to the skin and other e&ithelial surfaces with glo*e' tongue (lade' or
cotton-ti&&ed a&&licator.
- utilized for local drug effect.
- =se a&&ro&riate techni/ue to remo*e medication form container and a&&l% to clean' dr%
skin' when &ossi(le. Do not contaminate medication in container' use glo*es or an
a&&licator.
Methods of enhancing drug a(sor&tion *ia the To&ical route
3. 0onoto&hresis - uses gal*anic current
-. 0nunction - mechanical ru((ing of drug into the skin.
TRANS'ERMAL
- stored in a &atch &laced on the skin and a(sor(ed through skin' ha*ing s%stemic effect
- Transdermal drugs &ro*ide more consistent (lood le*els and a*oid G0 a(sor&tion
associated with oral &roducts.
,@
DCB
PHARMACE+TICAL PREPARATIONS AN' 'OSAGE FORMS
Pharmaceutical &re&arations are the forms in which drugs are &re&ared (% the &harmacist or
&harmaceutical chemist for administration in the treatment of the sick.
SOLID PREPARATIOS
Aeroso#s - &acked with com&ressed gas under &ressure for to&ical a&&lication. =&on release' the
aerosol takes the form of a fine mist' foam' semisolid fluid or solid.
Am%)#es - are hermeticall% sealed glass containers for medicinal su(stances containing a sterile
solution for &arenteral use.
Ca%s)#es - small gelatin rece&tacles of *arious sizes for oral administration. Generall% dissol*e
in the stomach e)ce&t the enteric ca&sules which dissol*es in the intestines. The%
ma%(e of firm or fle)i(le consistenc%.
Car%)#es - are glass tu(es enclosed on (oth ends with ru((er sto&&ers' one acting as a &lunger'
the other as a dia&hragm. Contain a drug in solution and designed for &arenteral
medication
Con4ections - medicinal su(stances formed into a mass with sugar' hone%' and water as
confection of rose.
E44er(escent Sa#ts - &owdered drug which gi*e off C2- gas and go into solution when added to
water.
Donsea#s - "rice flour ca&sules# or wafers "thin sheets of dried flour &aste# R sometimes used to
enclose drug &owders.
Pa%ers - &a&er im&regnated with medicinal su(stances. E./. mustard &a&er
Pi##s - small s&herical masses of drugs intended for swallowing co*ered with *arious su(stances
as gelatin' salol' sugar' chocolate' etc. and generall% colored? &owdered drugs mi)ed
with adhesi*e su(stances like glucose or hone% and molded in s&herical or o*oid forms.
S)%%ositories - solid (odies of *arious weights and sha&es ada&ted for introduction into orifices
"*agina' rectum' urethra' etc.# of the human (od% and usuall% melting'
softening' or dissol*ing at (od% tem&erature. 8or urethral use' the% are called
(ougies.
Fectal $u&&ositories - conical or (ullet-sha&ed' usuall% weigh a(out - grams.
=sed to &roduce local and s%stemic effects and to &roduce catharsis.
Gaginal $u&&ositories - conical or s&herical in sha&e and weigh from 6 R 3B
grams. =sed to confer antise&sis' to com(at *arious infections' and as
s&ermatocides.
=rethral $u&&ositories - &encil-sha&ed and weigh for - R 6 grams. =sed mainl%
for local treatment of the female urethra
Ta?#ets - solid dosage forms containing granulated or &owdered drugs that are com&ressed or
molded into round or discoid sha&es.contains medicinal su(stances with or without
suita(le diluents. The% *ar% in sha&e' size and weight. 0t ma% (e classed according to
the method of manufacture' as molded ta(lets or com&ressed ta(lets.
Troches - lozenges intended to (e dissol*ed in the mouth for local effect on the mucous
mem(rane of the mouth and throat.
SE!I"SOLID PREPARATIOS
Cerates - unctuous &re&arations ha*ing for their (ases the sim&le cerate. $imilar to ointments in
consistenc% (ut do not melt at (od% tem&erature. E./. Cantharides cerate.
Creams - semi-solid emulsions of either the oil-water or the water in oil t%&e for to&ical
,1
DCB
a&&lication.
E$tracts - concentrated &re&aration of *egeta(le or animal drugs. Made in 9 forms. 3# $emi
li/uids or li/uids of s%ru&% consistenc% -# Plastic masses "&ilular or solid e)tracts#
and 9# Dr% &owders "&owdered e)tracts.
Ointments - for e)ternal a&&lication. Medicinal su(stances are com(ined with a (ase of
sufficient softness which tend to fall into two grou&s. h%dro&hilic such as the
lanolin and the li&o&hilic' such as the &etrolatum. E./. J2E ointment
Pastes - com&rise two classes of ointment-like &re&arations intended for e)ternal a&&lication.
3#,%drogels R such as h%drated &ectin? and -# 8att% &astes R such as J2E &aste' which
consist of thick' stiff ointments which do not ordinaril% flow at (od% tem&erature and
therefore ser*e as &rotecti*e coatings o*er the areas the% are a&&lied.
P#asters - adhesi*e' fatt% or resinous com&ounds s&read on te)tile fi(ers' leather' muslin' etc.'
Either soft or dr% and intended for local a&&lication. E./. Belladone &laster' etc..
Po)#tices .Cata%#asma/ 3 semi-li/uid mi)tures of such su(stances as fla)seed' elm (ark' or
(read' etc.' with hot water or milk' s&read u&on cloth and used as a means for a&&l%ing
heat and moisture or stimulation to the (od% surfaces. E./. Cata&lasma Qaolini.
Trit)rations - &owders consisting of an acti*e remed% triturated with sugar or milk' usuall% of
3BI strength. E./. Triturations of Elaterin.
LI#$ID PREPARATIOS
Aromatic <aters - saturated "B.-I# a/ueous solutions of *olatile su(stances' usuall% *olatile
oils. Generall% used as *ehicle for water-solu(le drugs. E./. &e&&ermint
water.
Co##oions - li/uid &re&arations ha*ing for their (ase a solution of guncotton "&%ro)%lin# in a
mi)ture of ether and alcohol. E./. 8le)i(le collodion.
Co##!ria - Medicinal e%ewashes.
'ecoctions - solutions of *egeta(le su(stances &re&ared (% (oiling with water in a closed
container for 3< minutes and strained R as decoction of coffee and sarsa&arilla.
E#i$irs - clear' sweetened' h%droalcoholic li/uids intended for oral use. Contains fla*oring
su(stances. Because of alcoholic content' the% are misci(le with tinctures.
Two t%&es.
3. +romatic eli)ir - used mainl% for diluting other li/uid &re&arations
-. Medicated eli)irs - include Pheno(ar(ital eli)ir' Di&henh%dramine ,%drochloride
Eli)ir' and Ter&in ,%drate and Codeine eli)ir.
Em)#sions - a/ueous &re&arations in which oils' oleoresins' (alsams' resins' or other su(stances
which are insolu(le in water are sus&ended (% means of gum or other *iscid
e)ci&ients. E./. Cod li*er oil emulsion' milk and egg%olk.
F#)i e$tracts - li/uid e)tractions of drugs &re&ared (% &ercolation. Concentrated tinctures in
which 3 g. of the drug corres&onds to 3 ml. of the finished &roduct. E./. Ergot
fluid e)tract.
Gar"#es - mi)tures or h%droalcoholic solutions for a&&lication to the &har%n) and mouth.
Ge#s - sus&ension in a water medium' of insolu(le drugs in h%drated form wherein &article size
a&&roaches or attains colloidal dimensions.
G#!cerites - mi)tures or solutions of medicinal su(stances with or in gl%cerin. E./. Tannic acid
gl%cerite.
Hone!s - solutions of drug in clarified hone%. E./. ,one% of rose.
InEections - sterile &re&arations for &arenteral use. Com&rise of 3# $olutions for in7ection -#
Dr% solids' which u&on the addition of suita(le sol*ents %ield solutions conforming
,,
DCB
in all res&ects to the re/uirements for in7ections 9# $olids sus&ended in a suita(le
fluid medium which are not to (e in7ected 0G or into the s&inal canal 6# dr% solids'
which u&on the addition of suita(le *ehicles' %ield &re&arations conforming to the
re/uirements for sterile sus&ensions and <# emulsions of fluids in fluid media'
suita(le for &arenteral administration' (ut are not to (e in7ected in the s&inal canal.
Liniments - li/uid ointments a&&lied with friction to the skin.
Lotions - mi)tures or solutions of medicinal agents intended for e)ternal a&&lication with
soothing and &rotecti*e effect.
Mi#ks - sus&ension of &oorl% solu(le drugs in water medium and distinguished from gels mainl%
in that the sus&ended &articles are larger. The% tend to se&arate on standing and must (e
shaken well (efore use. E./. Milk of magnesia.
Mi$t)res 3 sus&ension of drugs in an a/ueous *ehicle. E./. Brown mi)ture.
O#eates - solutions of metallic salts or alkaloids in oleic acid. E./. 2leate of Mercur%.
So#)tions - li/uid &re&arations that contain one or se*eral solu(le chemical su(stances "non
*olatile# in water.
S%irits or Essences - *olatile su(stances dissol*ed in alcoholic solution. Man% are fla*oring
agents. E./. Pe&&ermint s&irit Ralso used as a carminati*e. +romatic
+mmonia $&irit R a medicated s&irit used as a refle) stimulant.
S)s%ensions - finel% di*ided drugs either intended for sus&ension in some suita(le li/uid *ehicle
&rior to use or alread% in sus&ension in a li/uid *ehicle.
S!r)%s - highl% concentrated solutions of sugar such as sucrose in water' carr%ing fla*ors or
medicinal su(stances R as s%ru& of 2range' $%ru& of 1ild cherr%. $%ru&s ser*es as
*ehicle or &reser*ati*es. $ome contain acti*e thera&eutic agents.
- Classes of $%ru&s.
3. 8la*ored s%ru&s - em&lo%ed to mask the taste of un&leasant tasting drugs and
to add sta(ilit% to &re&arations. E./ +cacia s%ru&' Cocoa s%ru&.
-. Medicated s%ru&s - E./ 0&ecac s%ru& "emetic' e)&ectorant#? Chloral ,%drate
s%ru& "h%&notic#' contain some added medicinal su(stances.
Tinct)res - h%droalcoholic solutions of medicinal su(stances usuall% o(tained (% e)tractin of
*egeta(le drugs? generall% alcoholic e)tracts of *egeta(le or animal drugs o(tained
(% &ercolation. E./. Belladona tincture? Ganilla tincture "used as fla*oring agents#?
0odine tincture "used as antise&tic#.
Faters - ma% (e a natural &roduct' as ta& water' or distilled and de-ionized to form a more
&urified and sterile &roduct. E./. 1ater for in7ection.
SYSTEMS OF MEAS+REMENT
Three s%stems of measurement "metric' a&othecar%' and household# are used in measuring
drugs and solutions. The metric s%stem de*elo&ed in the late eighteenth centur%' is the
internationall% acce&ted s%stem of measure. 0t is re&lacing the a&othecar% s%stem' which dates
(ack to the middle ages and had (een used in England since the 3:
th
centur%. 0t is &ro&osed that
the a&othecar% s%stem will &hase out (% the end of this centur%. ,ousehold measurement is
commonl% used in communit% and home settings.
I& METRIC - to measure (ased on decimals and +ra(ic num(ers? the official s%stem used in
the =$P.

,0
DCB
=nits. Meter "m# @ for length
iter "l# @ for ca&acit%
Gram "gm.# @ for weight
Metric Ta?#esB
Ta?#e o4 Len"th Ta?#e o4 Ca%acit! Ta?#e o4 Fei"ht
3 km. @ 3'BBB m. 3 kl. @ 3'BBB l. 3 kg. @ 3'BBB gm.
3 hm. @ 3BB m. 3 hl. @ 3BB l. 3 hg. @ 3BB gm.
3 dkm @ 3B m. 3 dkl @ 3B l. 3 dkg @ 3B gm.
3 dm. @ B.3 m. 3 dl. @ B.3 l. 3 dg. @ B.3 gm.
3 cm. @ B.B3 m. 3 cl. @ B.B3 l. 3 cg. @ B.B3 gm.
3mm. @ B.BB3 m. 3ml. @ B.BB3 l. 3mg. @ B.BB3 gm.
Proce)re 4or Con(ersion Bet<een +nits o4 the Metric S!stemB
3. To change milligrams to grams' milliliters to liters' or grams to kilograms'
di*ide (% 3BBB.
-. To change liters to milliliters' grams to milligrams' kilograms to grams'
multi&l% (% 3BBB.
E)am&les.
a. A6 mg. @ > gm.
3BBB mg. . 3 gm. @ A6 mg. . ) gm.
3BBB ) @ A6
) @ . A6 .
3BBB
@ B.BA6 gm.
(. 9-< ml. @ >
3BBB ml. . 3. @ 9-< ml. . ) .
3BBB ) @ 9-<
) @ . 9-< .
3BBB
@ B.9-<

II& APOTHECARIEGS OR ENGLISH SYSTEM - 0n this older s%stem' Foman numerals
and common fractions are used to designate units. +lso' the units of measure &recede the
numeral in correct form. e./ the correct wa% to signif% -B grains would (e Kgr.)).L +
line is often written a(o*e the numerals' and a dot is &laced a(o*e the numeral 0 to
distinguish more clearl% (etween the two 0Os and a G or M hastil% written. 1hen using the
a&othecar% s%stem in calculations' howe*er' the +ra(ic num(ers are used.
Procedure for Con*ersion 1ithin the a&othecar% $%stem
3. 1rite the e/ui*alent (etween the terms to (e con*erted as the first two terms of the
&ro&ortion.
,5
DCB
-. Being careful to kee& the units in the last two terms in the same order as the% occur
in the first' write the known /uantit% and the unknown e/ui*alent as the third and
fourth terms of the &ro&ortion.
E)am&les.
a. A drams @ > ounces
4 drams . 3 ounce @ A drams . M ounces
4 ) @ A
) @ . A . @ . 9 . ounce
4 6
(. - drams @ > minims
AB minims . 3 dram @ ) minims . - drams
3 ) @ 3-B
) @ 3-B minims

T+BE 28 1E0G,T
AB grains @ 3 dram
4 drams @ 3 ounce
3- ounces @ 3 l(.
T+BE 28 C+P+C0TH
AB minims @ 3 fluidram
64B minims or 4 fluidrams @ 3 fluid ounce
:A4B minims or 3A fluid ounces @ 3 &int
- &ints @ 3 /uart
6 /uarts @ 3 gallon
III& HO+SEHOL' SYSTEM 3 The household s%stem of measurement is not as accurate as
the metric s%stem (ecause of the lack of standardization of s&oons' cu&s' and glasses.
The measurements are a&&ro)imate.
,2=$E,2D =E0T$ 28 ME+$=FEMEET
AB dro&s "gtt# @ 3 teas&oon
9 teas&oon @ 3 ta(les&oon "t(s#
A teas&oon @ 3 ounce
- t(s @ 3 oz.
A oz. @ 3 tea cu&
4 oz. @ 3 glass
4 oz. @ 3 measuring cu&
2T,EF EP=0G+EET$
3'BBB cc. @ 3 @ 3 /uart
<BB cc. @ 3 &int
9B cc. @ 3 fluidounce @ - t(s&.
< cc. @ 3 fluidram @ AB minims @ 3 ts&.
3 cc. @ 3< minims
3 kg. @ 3BBB gms. @ -.-. l(s.
,6
DCB
6 gms. @ 3 dram @ AB grains
TEMPEF+T=FE C2EGEF$02E
Celsius to 8arenheit. " C # "5!<# T 9-
8arenheit to Celsius. " 8 R 9- # "<!5#
METRIC 'OSES <ith APPRO>IMATE APOTHECARY EH+I-ALENTS
" (% Musser!2OEeil D re&rinted from =$P MG0#
LIH+I' MEAS+RE
A%%ro$imate
METRIC APOTHECARY
eI)i(a#ents
A%%ro$imate
METRIC APOTHECARY
eI)i(a#ents
3BBB ml. 3 /uart 9 ml. 6< minims
:<B ml. 3 S &ints - ml. 9B minims
<BB ml. 3 &int 3 ml. 3< minims
-<B ml. 4 fluid ounces B.:< ml. 3- minims
-BB ml. : fluid ounces B.A ml. 3B minims
3BB ml. 9 S fluid ounces B.< ml. 4 minims
<B ml. 3 U fluid ounces B.9 ml. < minims
9B ml. 3 fluid ounce B.-< ml. 6 minims
3< ml. 6 fluid drams B.- ml. 9 minims
3B ml. - S fluid drams B.3 ml. 3 S minims
4 ml. - fluid drams B.BA ml. 3 minim
< ml. 3 V fluid drams B.B< ml. U minim
6 ml. 3 fluid drams B.B9 ml. S minim
FEIGHT
A%%ro$imate
METRIC APOTHECARY
EI)i(a#ents
A%%ro$imate
METRIC APOTHECARY
eI)i(a#ents
9B Gm. 3 ounce 9B mg. S grain
3< Gm. 6 drams -< mg. 9!4 grain
3B Gm. - S drams -B mg. 3!9 grain
:.< Gm. - drams 3< mg. V grain
A Gm. 5B grains 3- mg. 3!< grain
< Gm. :< grains 3B mg. 3!A grain
6 Gm. AB grains "3 dram# 4 mg. 3!4 grain
9 Gm. 6< grains A mg. 3!3B grain
- Gm. 9B grains < mg. 3!3- grain
3.< Gm. -- grains 6 mg. 3!3< grain
3 Gm. 3< grains 9 mg. 3!-B grain
B.:< Gm. 3- grains - mg. 3!9B grain
B.A Gm. 3B grains 3.< mg. 3!6B grain
B.< Gm. : S grains 3.- mg. 3!<B grain
,7
DCB
B.6 Gm. A grains 3 mg. 3!AB grain
B.9 Gm. < grains B.4 mg. 3!4B grain
B.-< Gm. 6 grains B.A mg. 3!3BB grain
B.- Gm. 9 grains B.< mg. 3!3-B grain
B.3< Gm. - S grains B.6 mg. 3!3<B grain
B.3- Gm. - grains B.9 mg. 3!-BB grain
B.3 Gm. 3 S grains B.-< mg. 3!-<B grain
:< mg. 3 V grains B.- mg. 3!9BB grain
<B mg. 3 grains B.3< mg. 3!6BB grain
AB mg. U grain B.3- mg. 3!<BB grain
6B mg. -!9 grains B.3 mg. 3!ABB grain
APPRO>IMATE HO+SEHOL' EH+I-ALENTS
HO+SEHOL' APOTHECARY METRIC
3 dro& "gt# 3 minim "m or min# B.BA milliliter "ml.#
3< dro&s "gtt# 3< min 3 ml. "cc.#
3 teas&oon "ts&# 3 fluidram "AB minims# < or 6 ml. D
3 ta(les&oon "t(s&# 6 fluid dram 3< ml.
- T(s. 3 fluid ounce 9B ml.
3 ounce 3 fluid ounce 9B ml.
3 tea cu& A fluid ounce 34B ml.
3 glass 4 fluid ounce -6B ml.
3 measuring cu& 4 fluid ounce -6B ml.
- measuring cu&s 3 &int "&t# <BB ml.
'OSE CALC+LATIONS
Children are not a(le to tolerate adult doses of drugs. There are se*eral formulas for
graduating dosage according to age and weight. The recommended dosage for kg. or l(. of (od%
weight is more accurate than calculating dosage according to age. 2ther factors (eside age and
weight enter into dosage for children. 8or this reason' some &h%sicians' use the .(od% surface
areaL method to estimate the dosage for children. Charts are a*aila(le to determine the (od%
surface area in s/uare meters according to height and weight.
%or In&ants and Presc'ool c'ildren
C#arkGs R)#e
Weight 4l,s.5 6 Adult dose
---------------------------------- 7 Infant dose
3<B
,9
DCB
FrieGs R)#e
- sometimes used in calculating dosages for infants less than - %ears old.
+ge "mos.# M +dult dose
--------------------------------- @ 0nfant dose
3<
%or Presc'ool to Adolescent (ears)
Yo)n"Gs R)#e
- not *alid after 3- %ears of age. 0f the child is small enough to warrant a reduced
dose after 3- %ears of age' the reduction should (e calculated on the (asis of
ClarkOs rule.
+ge "%r.# M +dult dose
---------------------------------- @ Child dose
+ge "%r.# T 3-
Co<#in"Gs R)#e
+ge "at ne)t (-da%# M +dult dose
------------------------------------------- @ Child dose
-6
Ca#c)#ation ?ase on Bo! S)r4ace Area .BSA/ B
- considered to (e the most accurate wa% to calculate the drug dose for infants'
children' older adults' and clients who are on antineo&lastic agents or whose (od%
weight is low. The B$+' in s/uare meters is determined (% where the &ersonOs height
and weight intersect the nomogram scale.
$urface area M +dult dose
----------------------------------- @ Child dose
-.BB
OR
Multi&l% the drug dose ordered (% the num(er of s/uare meters.
E)am&le.
2rder. C%clo&hos&hamide "C%to)an# 3BB mg. ! m
-
! da%' P2
Patient is < ft. 3B in. ":B in.# tall and weighs 3AB l(s.
a. :B in. and 3AB l(s. intersect the nomogram at 3.5: m
-
"B$+#
(. 3BB mg. ) 3.5: @ 35: mg.
+nswer. +dminister C%clo&hos&hamide 35: mg. or -BB mg.!da%.
,;
DCB
,:
DCB
0@
DCB
PRESENTLY +SE' 'OSE CALC+LATIONB
Fei"htB .Iea# Bo! Fei"ht/
+t Birth. 9BBB Grams
ess than A months. 1eight 0n Grams
+ge in Months M ABB T Birth 1eight
A R 3- Months. 1eight in Grams
+ge in Months M <BB T Birth 1eight
3 R A Hears. 1eight in Qilograms
+ge in Hears M - T 4
: R 3- Hears. 1eight in Qilograms
+ge in Hears M : - <
-

$uggested Dose.
+ge 39 R 34 %ears @ -<B mg.
35 R a(o*e @ <BB mg.
E)am&le.
!iven: +ge of child @ - %ears old
Fecommended dose @ 3B mg.
+*aila(le dose. -<Bmg.!<ml. ) 9B ml.
8ormula. +ge in %ears M - T 4
$olution. - M - T 4 @ 3- kg.
3B mg. M 3- Qg. @ 3-B mg. "dose needed (% a --%ear old child#
1hat &art of -<B mg. is 3-B mg.>
To com&ute for the e)act dose!ml.' multi&l% 3-B mg. to <ml. and -<Bmg.
to M"ml.# then di*ide to -<Bmg.
-<Bmg. ! <ml. @ 3-Bmg ! M"ml.#
<ml. M 3-Bmg. @ ABBmg.!ml.
-<Bmg. M >ml @ -<Bmg.
Then di*ide.
ABBmg.!ml.
-<B mg.
J ,&5 m#&
D3-Bmg. com&uted dose of the child is -.6ml. in a -<Bmg.!<ml. &re&aration of the drug.
01
DCB
'OSE CALC+LATION ACCOR'ING TO DEE AN' HAYES
Basic 8ormula.
D
------ M G @ +
,
1here. ' @ is the desired dose? drug dose ordered (% the &h%sician
H @ is the on hand dose? drug dose on la(el of container "(ottle' *ial#.
- @ is the *ehicle? drug form in which the drug comes "ta(let' ca&sule' li/uid#
A @ is the amount calculated to (e gi*en to the client.
E)am&le.
2rder. +m&icillin "Pol%cillin# B.< g.' P2' (id
+*aila(le "drug la(el#. Pol%cilin -<B mg.!ca&sule
$olution. The unit of measure that is ordered' grams' and the unit on the (ottle'
milligrams' are from the same s%stem of measurement' the metric s%stem.
Con*ersion to the same unit is necessar% to work the &ro(lem. $ince the
(ottles is in milligrams' con*ert grams to milligrams. To con*ert grams
"large *alue# to milligrams "small *alue#' mo*e the decimal &oint three
s&aces to the right.
B&< G. @ B&<BB mg. or <BB mg.
D <BB mg. <BB
------ ) G @ --------- ) 3 ca&sule @ ------- @ - ca&sules
, -<B mg. -<B
RATIO AN' PROPORTIONB
3 the oldest method currentl% used in calculating drug dosage.

Qnown Desired
, . G . . D . )
means
e)tremes
) @
E)am&le.
2rder. +m&icillin 3BB mg.' P2' /id
+*aila(le. +m&icillin "Pol%cillin# -<B mg.!<ml.
$olution. Con*ersion is not needed since (oth are e)&ressed in the same unit
of measure.
0,
DCB
, . G . . D . )
-<B mg. . < ml. . . 3BB mg. . ) ml.
means
e)tremes
-<B) @ <BB
) @ - ml.
+nswer. +m&icillin 3BB mg. @ - ml.
'R+G LISTB
NARCOTIC ANALGESICS
3. MEPEF0D0EE ,C "DEMEF2#
Eli)ir. <Bmg!<ml.
Ta(let <B'3BB mg.
0n7ection 3BB mg.!ml.
Dose. Amg.!kg.!Da% or B.< R 3.B mg.!Qg.!Dose
-. E+B=P,0EE "E=B+0E#
0n7ection 3B mg.!ml.
Dose. B.3 R B.- mg.!Qg.!Dose
NON3NARCOTIC ANALGESIC
3. +$+ "+$P0F0E#
AB' 43' -BB' 9BB' ABB' mg. Ta(let
Dose. A.< mg.!Qg.!Da%
-. +CET+M0E2P,EE
+fe(rin' Tem&ra' T%lenol' Cal&ol' Fe)idol' Ea&re)' Panadol
3BB mg.!<ml.' 3-Bmg.!<ml.' -<Bmg.!<ml. $%ru&
ABmg.!B.A ml. Dro&s
Dose. 3B R -B mg.!Qg.!Dose
9. ME8EE+M0C +C0D
Ponstan' Dolfenal
<B mg.!<ml. $us&ension
-<B' <BB mg. Ta(let' Ca&sule
Dose. A.< mg.!Qg.!Dose "Pedia#
00
DCB
BETA3LACTAM ANTIBIOTICS
PENICILLIN G
3. PEE0C00E G BEEJ+T,0EE
=sual Dose. Eew(orn"EB#' 0nfants "0E#. <B'BBB R units!kg!single dose 0M
Children "C,# "NAB l(s.# and +dults "+#. ABBBBB-3-BBBBB units 0M /
9 weeks for rheumatic fe*er &ro&h%la)is
-.6 million units 0M once "di*ided into - in7ection sites at one *isit# for
three treatment of earl% s%&hilis' weekl% M 9 doses for s%&hilis of more
than one %ear duration.
Pre&aration. "Penadur -+#. 3.- M units and -.6 M units!*ial.
-. CFH$T+0EE PEE G "BEEJHPEE0C00E#
=sual dose. EB - -<'BBB =!Qg. / A' 4' 3-
0E' C, - 3BB'BBB R -<B'BBB =!Qg. di*. /6h.
Pre&aration. Pen G. 3 M units!*ial and < M units!*ial
9. P,EE2MHMET,HPEE0C00E "PEE0C00E G#
=sual Dose. 0E' C, - -<-<B mg.!Qg.!Da% or -<'BBB-3BB'BBB =!Qg.!Da%
di*./A-4 h' P2
3-- g!d or 3.A-9.- million u!d di*./Ah' P2
Pre&aration. 2ral - -<B' <BB' A-< mg. ca&sule
3-< mg.!<ml? -<mg.!<ml' sus&ension AB ml.
Eote. +dminister on em&t% stomach "3-- hours after meal#
BROA' SPECTR+M PENICILLINS
3. +M2M0C00E
=sual Dose. 0E' C,- -B-6B mg.!kg.!da% di*.(% 9 doses "/4h# P2
+dults- :<B-3<BB mg.!da% di*. /4h' P2
Pre&arations. Dro&s - 3BBmg.!ml. Granules!Powder for sus&ension' 3Bml. dro&s
3-<' -<B mg.!<ml. AB-:B ml.
Ca&sule- -<B' <BB mg.
0n7ection- -<B'<BBmg.!*ial
-. +MP0C00E
=sual Dose. EB- -<-<B mg.!kg. PA-3- 0G
0E' C,- 3BB--BB mg.!kg.!da% di*./6-A h.
+- --3- Grams infusion di*. /Ah.
"+m&icin' +mo&en dro&s. 3BB mg!ml.? sus&ension 3-<' -<B mg.!<ml.?
ca&sule- -<B'<BBmg.? 0n7ection- 3BB' -<B' <BB mg.!*ial#
COMBINATION OF A PENICILLIN AN' BETA3LACTAMASE INHIBITOR
3. B+C+MP0C00E
=sual Dose. 0E' C, - -<-<B mg.!kg.!da% di*.(% - doses "/3-# P2
+- 4BB-3ABB mg. (id
"Penglo(e sus&. -BBmg.!<ml.? Ta(let- -BB' 6BB' 4BB mg.
-. C2-+M2M0C+G
05
DCB
=sual Dose. EB- not recommended
0E' C,- 6B mg.!kg.!da% di*. /4h P2 and 0G.
+- :<B R 3.< Grams!d di*./4 P2 and 0G.
Pre&arations. 3<A.-< mg.!<ml "9B-AB ml#
9:<' A-< mg. ta(let
ABB'3-BB mg.!*ial
PENICILLINASE RESISTANT PENICILLIN
3. C2M+C00E
=sual Dose. 0E' C, - <B-3BB mg.!kg.!da% di*./Ah "6 doses# P2
+dults - --6 Grams!da% di*./A P2
Pre&arations. $us&ension - 3-< mg.!<ml ) AB ml.
Ca&sule - -<B mg.' <BB mg.
0n7ection - -<B' <BB mg.! *ial
CEPHALOSPORINS
First Generation
+. CEP,+EM0E
=sual Dose. 0E' C, - -<-<B mg.!kg.!da% di*./Ah' P2
+dults - 3-6 Grams!da% di*./Ah' P2
Pre&arations. 3-< mg.! <ml. Granules!Powder for $us&ension "<B-:B ml#.
3BB mg.! < ml. Granules!Powder for dro&s "3B ml.#
Ca&sule - -<B' <BB mg.
B. CEP,+J20E
=sual Dose. EB - -B mg.!kg. /3-h
0E' C, - <B-3BB mg.!kg.!da% di*. /4h' 0M or 0G
+dults - 3-A Grams!da% di*./4h' 0M or 0G.
Pre&aration. 3 Gram *ial
Secon Generation
+. CE8+C2F
=sual Dose. 0E' C, - -B-6B mg.!kg.!da% /4-3-h' P2
+dults - :<B R 3<BB mg.!da% di*./4-3- h' P2
Pre&arations. $us&ension 3-<mg.!<ml. Granules! Powder for sus&ension
Pu*ule -<B' <BB mg.
<B mg.!ml. Granules!Powder for dro&s "-Bml.#
B. CE8=F2M0ME
=sual dose - 9B-<B mg.!kg.!da%
0n7ection -<B-:<B mg.!*ial

Thir Generation
+. CE8TF0+J2EE
=sual Dose. <B-3BB mg.!kg.!da%
0n7ection -<B' <BB mg.' 3 G ! *ial
06
DCB
B. CE8T+J0D0ME
=sual Dose. 9B-<B mg.!kg.!da%
0n7ection -<B' <BB mg.' 3 G.! *ial
AMINOGLYCOSI'ES
3. GEET+MHC0E $=8+TE
=sual Dose. 0E' C,' + - 9.<-4 mg.!kg.!da% di*./4 0M or 0G
Pre&aration. 0n7ection - -B' 6B' 4B mg.!ml. "*ial#

-. +M0Q+C0E $=8+TE
=sual Dose. 0E'C,'+ - 3<mg.!kg.!da% loading' 3Bmg.!kg.!da% maintenance
Pre&aration. 0n7ection - <B' 3-<' -<B mg.!ml. "*ial#
'R+GS THAT ACT ON 0@ S RIBOSOMAL S+B+NIT
TETRACYCLINE
=sual Dose. C,"N4%ears# - -<-<B mg.!kg.!da% di*. /Ah' P2
+dults - 3-- Grams ! da% di*./Ah' P2
Pre&arations. 2ral - -<B' <BB mg. ca&sules
2ther &re&arations. Do)%c%cline - --6 mg.!kg.!da%
Do)in ca&sule - 3BB mg.
Minoc%cline "Minocin# - ca&sule. <B mg.' 3BB mg.
'R+GS THAT ACT ON 6@ S S+B+NIT
CHLORAMPHENICOL
=sual Dose. 0E' C, - <B-3BB mg.!kg.!da% di*./Ah' P2' 0M' 0G
+dults - <B-3BB mg.!kg.!da% di*./Ah' P2' 0M' 0G
Pre&arations. 2ral - 3-< mg.!< ml.' AB ml. sus&ension
-<B' <BB mg. ca&sules
0n7ection - 3 Gram *ials
ERYTHROMYCIN
=sual Dose. 0E' C, - 9B-<B mg.!kg.!da%' di*. /Ah P2' 0G
+dults - 3-- Grams!da% di*. /A P2' 0G
Pre&arations. -<B' <BB mg. ta(let? <BB mg. ca&sules? 3BBmg.!-.< ml. "9B ml. dro&s#?
-BB' 6BB mg.!<ml. "AB ml. sus&ension#
CLIN'AMYCIN
=sual Dose. 0E' C, - 3B--< mg.!kg.!da%' di*. /Ah P2' 0G
+dults - ABB-34BB mg.!da% di*. /A P2
Pre&arations. 2ral - 3<B' 9BB mg. ca&sule? :< mg.!< ml. ) 9B ml. sus&ension
TRIMETHOPRIM 3 S+LFAMETHO>AKOLE
.COTRIMO>AKOLE/
=sual Dose. 0E' C, - 4 mg. TMP and 6B mg. $MM!kg.!d di*./3-h P2
+dults - 9-B mg. TMP and 3ABB $MM!d di*./3-h P2
Pre&arations. 2ral - 3BB'BBB units!ml. 9B ml. sus&ension? <BB'BBB units &er ta(let
Gaginal - 3BB'BBB units ta(lets
07
DCB
DETOCONAKOLE
=sual Dose. C, - <-3B mg.!kg.!da% di*. /3---6 h' P2
+dults - -BB R 6BB mg. /d P2
Pre&arations. 2ral - -BB mg. ta(lets
ISONIAKI'
=sual Dose. 3B--B mg.!kg.!da%
Pre&aration. $%ru& - 3<B mg.!<ml.
Ta(let - 6BB mg.
METRONI'AKOLE
=sual Dose. 8or amoe(iasis and +naero(ic 0nfections.
0E' C, - 9<-<B mg.!kg.!d di*. /4h' P2
+dults - :<B mg. tid' P2
Pre&arations. 2ral - -<B' <BB mg. ta(lets? 3-< mg.!<ml. "AB ml. sus&ension#
0n7ection - <mg.!ml. 3BB ml. *ial
Fectal - 3 G $u&&ositor%
H+INOLONES
=sual Dose. +dults - 6BB-4BB mg.!da% di*/3-h' P2' 0G
Pre&arations. 2flo)acin "0nofla)#' Ci&roflo)acin "Co&ro(a%# - -BB' 6BB mg. ta(lets
RIFAMPICIN
=sual Dose. 3B--B mg.!kg.!da% P2
Pre&arations. $%ru& - 3BB mg.!ml. and -BB mg.!<ml. "<B-AB ml. sus&ension#
Ca&sule - 3<B' 9BB' 6<B' ABB mg.
ANTIF+NGALS
AMPHOTERECIN B
=sual Dose. 0E' C, - B.3-B.-< mg.!kg.!da% "single 0G dose#
+dults - B.-<-3 mg.!kg.!da%
Pre&aration. 0n7ection - < mg.!ml. "3B ml. *ial#
NYSTATIN
=sual Dose. EB - 6BB'BBB units!da% di*./6-A h P2
0E' C, - 6BB'BBB-4BB'BBB units ! da% di*./6-A h P2
+dults - 4BB'BBB R -'BBBBBB units!da% di*. /6-A h P2
PRINCIPLES OF PRESCRIPTION OR'ER FRITING
Prescri%tion - a written order for medicines written (% a /ualified Medical' Dental or Geterinar%
&ractitioner to the &harmacist for a &atient.
LSim*leM - if containing onl% one ingredient.
L+om*oundM - if containing more than one ingredient.
09
DCB
Drugs ma) ,e com,ined in prescriptions for the follo8ing reasons:
3. To o(tain the con7oint effect of two or more acti*e su(stances.
-. To diminish or annul undesira(le effects &roduced (% one or more of the acti*e
ingredients.
9. To increase the solu(ilit% or aid in the dis&ensing of the acti*e su(stances.
6. 2ccasionall%' to &roduce a new com&ound.
PARTS OF AN I'EAL PRESCRIPTION
WWWWWWWWDoctorOs EameWWWWWWWWW
WWWWWWWWWWWWW+ddressWWWWWWWWWWWWWW
WWWWWWWWTel. Eo.WWWWWWWW
----------------------------------------------------------------------------------------------------------------------
PatientOs name. WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW Date.WWWWWWWWWWWWW
+ddress.WWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWW
Tel. Eo. WWWWWWWWWWWWWWWWWW +ge. WWWWWW $e). WWWWWW
R$

Generic name of drug' dosage form and amount .
"Brand name of drug#
Direction to the &harmacist .
Direction to the &atient .
WWWWWWWWWWWWWWWWWW D.M.D.
Prescri(erOs $ignature
PFC icense Eum(er
P.T.F. Eum(er .
Earcotic icense Eum(er " $--#
T.0.E. Ta) 0dentification Eum(er

WWWWWWWWWWWWWWWWWWWW
Refill Information
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Parts o4 the Prescri%tion
S)%erscri%tion . PatientOs name' address' and age? date and the s%m(ol F).
Inscri%tion . Eame of drug' dosage form' and amount.
S)?scri%tion . Directions to the &harmacist
Transcri%tion = Si"nat)re . Direction to the &atient
HEA'ING
Eame' address and &hone num(er of the &rescri(er.
Eame' address' age' and &hone num(er of the &atient' and date
BO'Y
The s%m(ol F)
Eame and dosage unit or concentration "li/uids# of the drug.
+mount to (e dis&ensed
Directions to the &atient
CLOSING
Prescri(erOs signature
$&ace for DE+ num(er
Fefill instructions
KPlease &lace name of drug on la(elL
0m&ortance of &lacing the name of the drug on la(el.
3. 0n case of o*erdose or ad*erse reactions' the drugsO identit% can (e /uickl% o(tained.
-. 2ther &ractitioners can identif% drugs the &atient is taking.
9. 0n most cases' the &atient has the right to know what drug he or she is taking.
,ints for Prescri&tion 1riting
3. 1rite legi(l% in ink or ha*e it t%&ewritten
-. =se the metric s%stem
9. +*oid a((re*iations
6. Qee& a co&% of each &rescri&tion or transcri(e the information to the &atientOs record.
<. 0nclude com&lete information for the &atient.
a. Ee*er use Ktake as directedL unless a written instruction sheet is &ro*ided.
(. 0nclude the intended &ur&ose.
c. =se &recautions to remind a &atient of a drugOs side effects. E./. KCaution. $edation
or drowsiness.L
d. +dd reminder &hrases to increase the &atientOs com&liance. E./. KTake until all are
gone.L
A. 0t must contain the following &articulars.
a. The address and usual signature of the &ractitioner gi*ing it.
(. The date on which it was signed (% the &ractitioner.
c. +n indication of whether the &ractitioner is a dentist' doctor' or *eterinar% surgeon.
d. The name' address' age "if under 3-# of the &erson whose treatment is gi*en.
:. The &rescri&tion shall not (e dis&ensed not later than si) months after the date of
signature.
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Considerations in Drug +dministration ! Prescri(ing
3. Tolerance R the a(ilit% of a client to res&ond to a &articular dose of a certain drug ma%
diminish after da%s or weeks of re&eated administration. + com(ination of drugs ma% (e
gi*en to decrease or dela% the de*elo&ment of tolerance for a s&ecific drug.
-. Pathologic $tate ! Pre-e)isting Disease $tate - i*er' kidne%' heart' circulator% and
gastrointestinal disorders are e)am&les of &ree)isting states that can affect a res&onse to a
drug. 8or instance' dia(etics should not (e gi*en eli)irs or s%ru&s than contain sugar.
9. +ge - The age of a &atient will affect his or her res&onse to drugs. Children and elderl%
&ersons are more sensiti*e to drugs? the% re/uire less than the usual adult dose.
6. 1eight - the more a &erson weighs' the more dilute the drug will (ecome and a smaller
amount will accumulate in the tissues. 2n the other hand' the less a &erson weighs' the
greater accumulation in the tissues and a more &owerful drug effect is &roduced.
<. $e) - 1omen are more susce&ti(le to the action of certain drugs and are usuall% gi*en
smaller doses.
A. Drug-Drug 0nteraction - the effects of a com(ination of drugs ma% (e greater then' e/ual
to' or less than the effects of a single drug. $ome drugs ma% com&ete for the same
rece&tor sites. +n ad*erse reaction ma% lead to to)icit% or com&lication such as
ana&h%la)is.
:. Ps%chological factors ! Emotional factors - + &ersonOs &ersonalit% often &la%s an
im&ortant &art in his res&onse to drugs? comments a(out the drug and its side effects ma%
influence its effects.
4. Genetic factors - drug idios%ncras% is an a(normal susce&ti(ilit% of some indi*iduals that
causes them to react differentl% than most &eo&le. This intolerance to small amounts of
some drugs is thought to (e due to genetic factors. 0f %our mother or father has an ad*erse
reaction to a drug' %ou ma% also.
5. En*ironmental factors - the setting in which the drugs are gi*en and the attitude of the
&erson gi*ing the medication ma% influence the effects of drugs.
3B. Method of administration - generall%' larger doses are ordered when a medication is
gi*en (% mouth or (% rectum and smaller doses when the &arenteral route is used.
33. Blood le*el cur*es and dosing regimens
3-. Pregnant and (reastfeeding mothers - +dministration of medication in the earl% weeks of
&regnanc% ma% cause damage to the fetus. During the third trimester' there is the
&ossi(ilit% of &remature la(or caused (% drugs that ma% stimulate muscular contractions.

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LATIN PHRASES an ABBRE-IATIONS
+ se in PRESCRIPTION FRITING
A??re(iations L a t i n E n " # i s h
a. ante (efore
aa ana of each
a.c. ante ci(um (efore meals
ad ad to' u& to
ass. adde' addantur add' let them (e added
ad li(. ad li(itum at &leasure
ac/. ac/ualis e/ual
agit. agita shake
a/. a/ua water
a/. dest. a/ua distilata distilled water
am&. --- am&ule
(. (is twice
(ene (ene well
(.i.d. (is in die twice a da%
c ci(um meal
c. cum with
ca&. ca&sula ca&sule
co. ? com&. com&ositus com&ound
coch. mag. cochleare magnum a ta(les&oonful
coch. med. cochleare medium a desserts&oonful
coch. &ar*. cochleare &ar*um a teas&oonful
cong. congium a gallon
d. dies a da%
da da gi*e
d. in &. ac/. di*idatur in &artes ac/uales let it (e di*ided into e/ual &arts
d.t.d. dentus tales doses gi*e such doses
die( alt. die(us alternis e*er% other da%
dil dilitus dilute
dis&. dis&ensa' dis&ensetur dis&ense
di*. di*ide di*ide
dos. dosis a dose
E.C. --- enteric coated
eli). eli)ir eli)ir
Et et and
E) e) out of
E)t e)tractum e)tract
e) a/. e) a/ua with water
e.m.&. e) modo &rescri&to after the manner &rescri(ed
f. fiat' fiant make' let (e made
8ac face make
fl. or fld. fluidus fluid
8t. fiat make
gm. --- gram
gr. --- grain
gtt. gutta' guttae a dro&' dro&s
h hora hour
h.s. hora somni at (edtime"hour of slee&#
h%&o --- h%&odermicall%
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'R+G THERAPY
Pharmace)tica# Process
Pharmacokinetics Process
Pharmaco!namics Process
Thera%e)tic Process
PHARMACE+TICAL PROCESS
Is the drug getting into the patient#
+&&ro)imatel% 4BI of drugs are taken (% mouth? therefore' the &harmaceutic &hase is the
first &hase of drug action. 0n the gastrointestinal tract' drugs need to (e in solution to (e
a(sor(ed. + drug in solid form "ta(let or &ill# must disintegrate into smaller &articles in order
for it to dissol*e into a li/uid.
'isinte"ration is the (reakdown of the ta(let or &ill into smaller &articles.
'isso#)tion is the dissol*ing of smaller &articles in gastrointestinal fluid for a(sor&tion.
Rate Limitin" is the time it takes for the drug to disintegrate and (ecome a*aila(le for the
(od% to a(sor( it.
8actors to consider
3. Particle size - the smaller the &article size' the faster it can (e a(sor(ed in the (od%.
-. E)ci&ients of drug - fillers and inert su(stances are used in drug &re&aration to allow the
drug to take on a &articular size and sha&e and to enhance dissolution of the drug. $ome
additi*es such as Q and Ea in &enicillin Q and &enicillin Ea' increase the a(sor(a(ilit% of
the drug.
9. Coating material - Enteric-coated "EC# drugs resist disintegration in the gastric acid in
the stomach' so disintegration does not occur until the drug reaches the alkaline
en*ironment in the small intestine.
PHARMACODINETIC PROCESS
Is the drug getting into its site of action#
- is the &rocess of drug mo*ement to achie*e drug action.
- concerned with the a?sor%tionA istri?)tion an e#imination .meta?o#ism an e$cretion/
of drugs.
ABSORPTION
- &rocess (% which drug molecules are transferred form the site of administration in the (od%
to the circulating fluids
8actors +ffecting +(sor&tion
3. Ph%sico-chemical factors
-. $ite of a(sor&tion ! Blood flow at the site
9. Drug $olu(ilit%
6. Effects of food
a. Blood flow
(. Gastric em&t%ing
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DCB
the non-ionized &ortion (eha*es as a non-&olar li&id solu(le com&ound which readil%
tra*erses (od% mem(ranes.
The amount of ionization that an% weak electrol%tes undergoes de&end on the &, at the
drug site in the tissues and its dissociation characteristics.
0ncrease &, "weak acids# - the greater the degree of ionization
Decrease &, "weak (ases# R the greater the degree of ionization.
2ral a(sor&tion R de&ends on the dosage form of drugs.
+(sor&tion on in7ection sites - de&ends on the solu(ilit% of drug and the (lood flow at the
site? also affected (% dosage form. E./. drugs in sus&ension are a(sor(ed much ore
slowl% than those in solution.
Effects of food on drug a(sor&tion
- (% affecting the (lood flow and gastric em&t%ing. E./. li/uid glucose meal decreases
flow and a meal rich in &rotein increases flow.
- some drugs are irritating to the stomach mucosa' so fluids or food are necessar% to
dilute drug concentration
- there are drugs that are a(sor(ed easil% in the &resence of food.
8actors that Modif% the Fate of +(sor&tion
3. Drug Concentration at the $ite
-. Circulation to the $ite of +(sor&tion
9. +rea of +(sor&ti*e surface
FACTORS GO-ERNING THE FATE OF A 'R+G
1& Mo#ec)#ar Fei"ht
- su(stances with high molecular weight are not usuall% a(sor(ed intact e)ce&t in minute
/uantities.
- the% are a(sor(ed (% enz%matic actions. E./. insulin is a &rotein R it undergoes
enz%matic (reakdown in the git and is not a(sor(ed.
,& Chemica# Sta?i#it!
- unsta(le drugs ma%(e inacti*ated in the git. E./. Benz%l&enicillin in unsta(le in acid
medium and cannot (e effecti*e if gi*en (% mouth. Pheno)%meth%l&enicillin is more
sta(le in acid medium.
0& Li%i So#)?i#it!
- if the drug is li&id solu(le' it can easil% &ass through the mem(rane.
5& 'e"ree o4 IoniNation
- the unionized &ortion of a drug is li&id solu(le and so is readil% a(sor(ed? ionized
&ortion is li&id insolu(le.
THE CELL MEMBRANE
Com&osition.
i&ids "6BI# &hos&holi&ids
- makes mem(rane relati*el% im&ermea(le to ions and &olar molecules
Proteins "<B-ABI#
- make u& the structural com&onents of the mem(rane
- acts as enz%me during trans&ort
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DCB
Car(oh%drates "remainder# 2ligosaccharide
- linked co*alentl% to form com&le)es of gl%co&roteins and gl%coli&ids
1PRINCIPAL MECHANISMS IN-OL-E' IN THE PASSAGE OF 'R+GS
ACROSS CELL MEMBRANE
1& Li%i 'i44)sion .Sim%#e 'i44)sion#
- drug molecules dissol*es in the mem(rane to &enetrate through the other side.
Can take &lace either *ia.
i&o&rotein mem(rane
Paracellular s&aces
,& AI)eo)s 'i44)sion .Fi#tration thro)"h Pores/
- the size of the drug molecule is relati*e to the size of the &ores.
- water solu(le drugs with molecular weight less than 3BB Daltons are a(le to cross
the cell mem(rane (% &assing through the &olar &ores. E./. Ethanol "6A#? =rea "AB#
0& S%eci4ic Carrier Meiate Trans%ort S!stem
Acti(e Trans%ort
- &rocess (% which a su(stance is trans&orted against a concentration gradient.
Drug molecules are mediated (% trans&ort KcarrierL that furnish energ% for the
trans&ortation of drug from lower concentration through higher concentrations.
E./. Ea' Q' Ca' 8e' amino acids' and glucose.
9 8eatures
3. +(ilit% to work against concentration gradient' osmotic' electrical' or
h%drostatic gradient
-. $&ecificit% R a(ilit% to concentrate a selected su(stance on one side of the cell
mem(rane.
9. Each s%stem re/uire an energ% source "+TP#' to which it is directl% cou&led.
Faci#itate 'i44)sion
- a &assi*e &rocess where(% drugs can mo*e across cell mem(ranes more ra&idl%
than sim&le diffusion.
- in*ol*es the action of a s&ecific (ut satura(le carrier s%stem
- can onl% work in the &resence of an a&&ro&riate concentration gradient.
'ISTRIB+TION
- the &assage of drug into *arious (od% fluids com&artments such as &lasma' intestinal fluids
and intracellular fluids? &rocess (% which the drug (ecomes a*aila(le to (od% fluids and
(od% tissues.
8actors affecting Distri(ution
3. Blood flow
-. +ffinit% to the tissue
9. Protein (inding

8orms of Drug inside the Bod%
3. 8ree ! =n(ound state - free acti*e drug
55
DCB
-. Bound - inacti*e drug
Binding to Plasma Proteins - e./. salic%lic acid and warfarin (ind to +l(umin
Basic drugs (ind to acid gl%co&roteins and li&o&roteins
Binding to Cells - drugs (ecome (ound onto the surface or inside the cells.
D2nl% free drugs or drugs not (ound to &rotein are acti*e and can cause a
&harmacologic res&onse. +s the free drug in the tissues decreases' more (ound drug is
released from the &rotein to maintain the (alance of free drug.
Checking the &rotein-(inding &ercentage of all drugs administered is im&ortant in
order to a*oid &ossi(le drug to)icit%. E./. Drug accumulation and to)icit% can result if
two highl% &rotein-(ound drugs are gi*en concurrentl% (ecause the% will com&ete for &rotein
(inding sites causing more free drug to (e released into the circulation? +lso' a low &rotein
le*el decreases the num(er of &rotein (inding sites' causing an increase in the amount of
free drug in the &lasma. Drug o*erdose ma% result (ecause drug dosage is &rescri(ed
according to the &ercentage in which the drug (inds to &rotein.
$T2F+GE DEP2T "Eon-s&ecific $ite# - hel&s &re*ent &rolong the action or areas for
transient storage.
+880E0TH T0$$=E$ - ma%(e sites of action or areas for transient storage? some drugs
accumulate in &articular tissues such as fat' (one' li*er' e%e' and muscle.
E.g.
Guanethidine - (inds to heart and skeletal muscle
Puinacrine - (inds to li*er and skeletal muscles
Tetrac%cline - (one and enamel
Thio&ental - adi&ose tissue
METABOLISM
- i*er R main organ of meta(olism
- most drugs are inacti*ated (% li*er enz%mes and are then con*erted (% he&atic enz%mes to
an inacti*e meta(olite or water solu(le su(stance for e)cretion. ,owe*er' some drugs are
transformed into acti*e meta(olites causing an increased &harmacologic res&onse.
E)am&le of li*er disease that affects meta(olism - cirrhosis and he&atitis.
3. E)cretion in the original form e./. ,e)amethonium R a highl% ionized antih%&ertensi*e
com&ound e)creted in the urine unchanged.
-. Transformation into one or more Meta(olites
2ther organs. G.0.T.' ung' kidne%' skin and &lacenta.
B02TF+E$82FM+T02E - a &rocess wherein &arent drug is con*erted (% enz%mes
into drug meta(olites read% to &erform its action.
Biotransformation of Drugs has Two Effects
3. 0t alters the &harmacological acti*it%' usuall% decreasing it (ut sometimes con*erting
the drug to a com&ound similar or greater acti*it% "&otenc%# than the original.
-. Fesults in meta(olites that are more water-solu(le and less li&id solu(le than the &arent
com&ounds and therefore more readil% e)creted in the urine.
56
DCB
D Two General T%&es of Chemical Feaction
9hase : 4;on-S)nthetic reaction5
3. 2)idation - Diaze&am
-. Feduction - Eitraze&am' Cortisone
9. ,%drol%sis - $u)amethonium' +methocaine
9hase < 4S)nthetic 4=on2ugation5 Reaction5
-0t in*ol*es con7ugation to form one or more of the following.
3. Glucoronide e.g. Mor&hine' Paracetamol
-. $ul&hate e.g. 0so&renaline
9. +cetate e.g. 0soniazid' ,%dralazine
6. Glutathione e.g. Paracetamol
BIOLOGIC HALF3LIFE .t1=,/ - is the time it takes for one half of the drug concentration to
(e eliminated.
- a drug goes through se*eral half-li*es (efore more than 5BI is eliminated.
E)am&le. A<B mg. of +s&irin t3!- @ 9 hours
N)m?er .t1=,/ Time o4 E#imination.h/ 'osa"e Remainin" .m"/ O#e4t
1 0 0,6 6@
, 7 17, ,6
0 : ;1 1,&6
5 1, 5@&6 7&,6
6 16 ,@ 0&1
7 1; 1@ 1&66
- it takes three hours for the first half-life to eliminate 9-< mg and the second half-life
"Ah# for an additional 3A- mg. to (e eliminated' and so until the A
th
half-life "34h#
when 3B mg. of as&irin is left in the (od%.
- a short half-life is 6-4 hours.
- a long half-life is -6 hours or longer "e./ Digo)in 9A hours#? it takes se*eral da%s until
the (od% com&letel% eliminates the drug.
8actors +ffecting Drug Meta(olism
3. +ge
-. $e)
9. i*er Disease
6. En*ironmental 8actors
<. Genetic 8actors
A. Foute of +dministration
M0CF2$2M+ DF=G MET+B20J0EG $H$TEM - the most im&ortant of the man%
(iochemical s%stem in the (od% in*ol*ed in (iotransformation.
- located &rimaril% in the smooth Endo&lasmic Feticulum of he&atic cells.
57
DCB
CHT2C,F2ME P6<B - the most im&ortant enz%me in the microsomal enz%me s%stem
in*ol*ed in the o)idati*e trans&ort &rocesses.
E>CRETION
- ma7or wa% (% which the acti*it% of the drug is terminated
- mainl% in the Qidne%? some *ia the "E)tra Fenal Foute# .Bile' $kin "sweat#' ungs
"e)&ired air#' $ali*a' 8eces
and Breast Milk
- e)&ressed in terms of KFenal Plasma ClearanceL R the *olume of &lasma effecti*el% cleared
of the drug (% the kidne% in unit time.
FEE+ EMCFET02E - most im&ortant route of drug elimination
D9 Processes 0m&licated in Fenal E)cretion
3. Glomerular 8iltration
- de&ends u&on the &lasma concentration of drugs and molecular weight.
- 3-< ml.!min.
-. "u,ular Rea,sorption > +cti*e $ecretion in the Pro)imal tu(ule
9. "u,ular Secretion ! Passi*e Fe-a(sor&tion in the distal tu(ule
PHARMACO'YNAMICS
Is the Drug producing the re.uired 9harmacological &ffect#
- stud% of a drugOs effect on cellular &h%siolog% and (iocehmistr% and the drugOs mechanism
of action.
0. Drugs which act *ia Pharmacological Fece&tors.
3. +ct at low concentration
-. Feact with s&ecific rece&tors
9. $how structure acti*it% relation
6. Can (e antagonized (% s&ecific antagonist
e./. acet%lcholine? adrenaline? noraduraline and histamine
e
00. Drugs which D2 E2T act *ia Pharmacological Fece&tors.
f 3. +ct at higher concentrations
g -. Do not react with s&ecific rece&tors
h 9. Tend to show structure-acti*it% relationshi&s
i 6. Do not ha*e s&ecific antagonists
e./. General anesthetics and non-s&ecific destructants of cell mem(ranes such as
detergents.
'R+G3RECEPTOR INTERACTION
Rece%tor - a macromolecule with s&ecial sites to which s&ecific su(stances (inds.
"Drug!igands R Fece&tor#.
$0TE$ 28 FECEPT2F$
3. 2n or within Cell Mem(ranes
-. 0nside Cells
59
DCB
Most rece&tors' &rotein in structure' are found on cell mem(ranes. Drugs act through
rece&tors (% (inding to the rece&tor to &roduce "initiate# a res&onse or (lock "&re*ent# a
res&onse. The acti*it% of man% drug is determined (% the a(ilit% of the drug to (ind to a
s&ecific rece&tor. The (etter the drug fits at the rece&tor site' the more (iologicall% acti*e
the drug is. 0t is similar to the fit of the right ke% in a lock.
Fi")reB Two drug agonists attach to the rece&tor site. The drug agonist that has an
e)act fit is a strong agonist and is more (iologicall% acti*e than the weak agonist.

A"onist - a drug "hormone or neurotransmitter# which com(ines with its s&ecific rece&tor'
acti*ates it and initiates a se/uence of effects.
E./. 0so&roterenol stimulates the (eta3 rece&tor.
Anta"onist - a drug which interferes with the action of an agonist (ut does not ha*e an%
effect itself unless it &ossess &artial agonist acti*it%.
E./. Cimetidine (locks the ,- rece&tor thus &re*enting e)cessi*e gastric
secretion.
Partia# A"onist - a drug that act on a rece&tor with an intrinsic acti*it% or efficac% of X 3.
Mi$e A"onist3Anta"onist - a drug that act simultaneousl% on a mi)ed grou& of
rece&tor with an agonist action on one set and an antagonist action on another.
111'R+G ANTAGONISM 3 occurs when their (iological effect is less than the e)&ected sum of
their indi*idual effects.
P'armacological Antagonism)
3. Fe*ersi(le Com&etiti*e ! E/uili(rium +ntagonism
- su(stances are com&eting d%namicall% for the same &harmacological rece&tor
-. 0rre*ersi(le Com&etiti*e ! Eon-E/uili(rium +ntagonism
- drugs form *er% strong (onds
on"+om*etitive Antagonism - (lock action of an agonist not at the rece&tor le*el (ut at
some &oint (etween rece&tor and effector that leads to the action of the agonist.
P'(siological Antagonism - occurs when two drugs that act on different rece&tors &roduce
o&&osite effects. E./. +drenaline antagonizes the effects of histamine on (ronchial
smooth muscle.
+'emical Antagonism - occurs when one drug com(ines chemicall% with another to
&roduce inacti*e &roduct.
5;
DCB
P'armaco,inetic +ntagonism - occurs when one drug effecti*el% reduces the
concentration of another at its site of action (% altering its a(sor&tion' distri(ution or
elimination.
111Re#ationshi% Bet<een the 'ose o4 'r)" an the E44ect it %ro)cesB
"8o ")pes of Relationship.
1& H)antitati(e .Grae/ res%onses or e44ects
- the effect increases as the dose is increased until the ma)imum is reached. Be%ond
this &oint' an% increase in the dose is not accom&anied (% an increase in effect or
res&onse.
Grae - refers to that characteristic of an effect which (egins at some low le*el and
increase through &rogressi*e stages until it reaches some higher le*el.
,& H)anta# res%onses or e44ects
- K+ll or EoneL res&onse. E./. 0n to)icit% test' a dose could either kill or not.
'e4inition o4 TermsB
Onset o4 Action - (egins when the drug enters the &lasma and lasts until it reaches minimum
effecti*e concentration "MEC#.
Peak Action - occurs when the drug reaches its highest (lood or &lasma concentration.
')ration o4 Action - is the length of time the drug has a &harmacologic effect.
Time3res%onse3c)r(e - e*aluates three &arameters of drug action. the onset of drug' &eak action'
and duration of action.
Bio#o"ic -ariation - connotes the sum total of all the sources of *ariation that com(ine to
cause one (iologic unit to *ar% from one another.
Thresho# 'ose - lowest case of a drug that will &roduce a measura(le res&onse.
P#atea) - end&oint!terminal &oint in a graded dose res&onse cur*e.
Thera%e)tic Ine$ - the difference (etween the dose which will &roduce the desired effect
and that which will cause ad*erse effect.
- estimates the margin of safet% of a drug (% using a ration that measures the
effecti*e thera&eutic dose in <BI of animals "ED<B# and lethal dose in <BI
of animals "D<B#. The closer the ratio is to 3' the greater the danger of
to)icit%.
- a figure that gi*es measure as to the amount (% which thera&eutic dose
made e)ceeded (efore eliciting a to)ic effect. 8or clinical situation' a
(etter measure would (e ad*erse effect dose ED<B in which a s&ecific
ad*erse effect is considered' rather than the lethal median dose.
Meian E44ecti(e 'ose .E' 6@/ - smallest dose causing the gi*en &harmacologic effect in
<BI of the indi*iduals of a sam&le.
Re#ati(e Sa4et! - dose of the drug re/uired to &roduce the desired thera&eutic effect
relati*e to the dose of the drug re/uired to &roduce to)ic or lethal effects.
Thera%e)tic E44ects - desira(le clinical action of a drug.
CRisk 3 Bene4it RatioC - to)icit% taken into consideration --- "the risk of treatment weighed
against the risk of disease" e./. the use of known highl% to)ic drugs
such as those used in the treatment of cancer a&&lies this &rinci&le.
5:
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THERAPE+TIC PROCESS
0s the Pharmacological effect (eing translated into a desired thera&eutic effect>
Factors <hich 'etermine the Re#ationshi% Bet<een
Prescri?e 'r)" 'osa"e an 'R+G E44ect
Dosage Pat'-a( In&luences on Drug E&&ect
Prescri(ed dose Patient com&liance
Medication errors
+dministered dose Fate and e)tent of a(sor&tion
Bod% size and com&osition
Distri(ution in (od% fluids
Binding in &lasma and tissues
Fate of elimination
Concentration at locus of action Ph%siological *aria(les
Pathological factors
Genetic factors
0nteraction with other drugs
De*elo&ment of tolerance
0ntensit% of effect Drug rece&tor interaction
8unctional state
Place(o effects
PHARMACOLOGY OF INFLAMMATION
- a reaction of the *ascular and su&&orting elements of a tissue to in7ur% which results in a
&rotein-rich e)udate' &ro*ided the in7ur% has not (een so se*ere as to destro% the area.
C0E0C+ $0GE$ 28 0E8+MM+T02E
3 Fu(or - Fedness
-. Tumor - $welling
9. Calor - ,otness
6. Dolor - Pain
<. 8unctio aesa - oss of function
CLINICAL ME'IATORS
(IS"A?I;&
- a *asoacti*e amine found in most tissues of the (od%
- formed (% the decar(o)%lation of the amino acid histidine.
P,+FM+C22G0C+ PF2PEFT0E$ 28 ,0$T+M0EE
- rela)ation of the *ascular smooth muscle
- contraction of the (ronchi and gut wall
- secretion of e)ocrine glands
- &roduction of &ain and itch
- acts as neurotransmitter in the CE$ "control of thirst' secretion of antidiuretic hormone'
control of (lood &ressure' and &ain &erce&tion#.
6@
DCB
THPE$ 28 ,0$T+M0EE FECEPT2F$
H1 @ &rimaril% related to smooth m. acti*it%
H, @ &rimaril% in*ol*ed with the stimulation of gastric secretions
H0 @ mediates CE$ effects of histamine on histaminergic ner*e terminals
E44ects o4 HistamineB
,eart - increase heart rate Y force of contraction which results in an increase in cardiac
out&ut
- increase histamine ma% cause arrh%tmias due to slowing of +-G conduction
- dilation of small (.* leads to flushing' lowered &eri&heral resistance' and a dro& in
(lood &ressure.
$mooth muscles - KBronchial muscleO
- acti*ation of ,3 rece&tor results to (ronchoconstriction.
- Patients who suffer from asthma are &articularl% sensiti*e to the action of histamine on
the (ronchial musculature howe*er' antihistamines are of no *alue in the treatment of
asthma.
Gastric secretion - e*en a slow concentration can cause co&ious secretion of the gastric
7uices mediated (% ,- rece&tor.
Pain and 0tch - caused (% direct stimulation of free ner*e endings when in7ected.
- $u(cutaneous in7ection of histamine causes shar& &ain of short duration like a was&Os
sting (ut when in7ected into a more su&erficial la%er of the skin' causes itching.
ANAPHYLA>IS AN' ALLERGY
Ana%h!#actic reaction R most dangerous acute allergic reaction occurring hour after drug
administration.
- histamine will (e released due to an antigen com(ining with s&ecific anti(od% attached
to the surface of mast cells "DEGF+E=+T02E# causing the e)trusion of histamine
from the secretor% granules in the mast cells.
- e./. of su(stances that can cause ana&h%la)is and allerg%. Penicillin' animal fur'
&ollen.
A(erse E44ects - undesira(le clinical action of a drug? a range of untoward effects
"unintended and occurring at normal doses# of drugs that cause mild to
se*ere side effects' including ana&h%la)is? +lwa%s undesira(le.
Sie E44ects - are &h%siologic effect not related to desired rug effects? Ma%(e desira(le or
undesira(le and are &redicted.
To$ic E44ects - ad*erse effects of an une)&ected nature resulting from the direct action
of a drug.
A##er"! - altered ca&acit% of the (od% to react to *arious antigens.
Iios!ncracies - co*ers unusual or (izarre drug effects that cannot readil% (e e)&lained in an
indi*idual reci&ient.
A+TOCOI'S R deri*ed from the Greek word KautosL "self# and ZakasL "remed%#. 0t refers
61
DCB
su(stances which ha*e local hormone-like acti*it% at or near the site of
&roduction.
EICOSANOI'S R a term that denotes the meta,olites of certain -B-car(on
&ol%unsaturated fatt% acids' mainl% arachidonic acid.
- &roducts of arachidonic acid meta(olism are di*ided into two main grou&s on the
(asis that the% are ultimatel% deri*ed from the action of one of the two enz%mes
s%stems "c%clo-o)%genase or li&o)%genase# on arachidonic acid.
+F+C,0D2E0C +C0D - a -B - &ol%unsaturated fatt% acid
Two sources .
3. Meta(olic &ool - endogenous s%nthesis of arachidonic acid
-. Cell mem(rane &ool - stimulated s%nthesis such as trauma? ma7or source of the
eicosanoid &recursor in inflammation.
+rachidonic acid -----meta(olized------ results to meta(olites "eicosanoids - a term[# (% the
action of the - enz%me "c%clo-o)%genase and li&o)%genase#
D0n most cells and tissues' &hos&oli&ids are thought to (e the ma7or source of arachidonic acid.

3. The first ste& in eicosanoid s%nthesis. li(eration of the +rach. +cid from cell mem(rane
&hos&oli&ids (% the action of a grou& of enz%mes known as the &hos&oli&ases &articularl%
&hos&oli&ase +- res&onsi(le for its (ulk.
-. The second ste& . formation of c%clo-o)%genase on free arachidonic acid " results in the
insertion of - o)%gen molecules into the fatt% acid car(on chain to form PGG- which is
ra&idl% transformed (% the &ero)%dase-like acti*it% of c%clo-o)%genase into the
h%dro)%&ero)ide' PG,-#. This is followed (% the formation of one of the three grou&s
de&ending on the &articular cell and circumstances in*ol*ed' the &rostaglandins'
throm(o)ane' and &rostac%clin.
CYCLO3O>YGENASE PRO'+CTSB
PROSTAGLAN'IN 3 3
st
identified in 359B (ut their structure and function were
elucidated until 35AB.
- occur in e*er% tissue and (od% fluid.
* *asodilators @ fall in (lood &ressure
< ")pes: PGE and PG8 series
THROMBO>ANE AN' PROSTACYCLIN
"(R%?@%6A;& A< - Main s%nthesis in &latelets &la%s an im&ortant role in &latelet
aggregation
9R%S"A=A=+I; - a &otent *asodilator and acts as an antagonist of &latelet
aggregation? main s%nthesis in *essel walls.
DT and P are (iologicall% o&&osite &oles of the mechanism for regulating the &latelet
*essel wall interaction and the formation of hemostatic &lug. Both are unsta(le'
with *er% short half li*es.
6,
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LIPO>YGENASE PRO'+CTSB
LE+DOTRIENES - has &otent chemotactic &ro&erties? &ro(a(l% in*ol*ed in the
&rocess of cellular infiltration that accom&anies
inflammation. T%&es. T+6? TB6? TC6? TD6? TE6
PLATELET ACTI-ATING FACTOR
- a li&id autocoid s%nthesized mainl% (% &latelets' leukoc%tes' and endothelial cells.
- action includes *asodilation' inc. in *ascular &ermea(ilit%' white (lood chemota)is'
and the release of l%sosomal enz%mes.
- a &otent stimulator of &latelet aggregation.
- ma% also (e im&ortant in the &athogenesis of asthma.
Arachionic Aci Meta?o#ism Pro)ct
C!c#o3o$!"enase %ro)ct Li%o$!"enase %ro)ct

Prosta"#anins Le)kotrienes
Throm?o$anes Com%o)ns ?ase on
Prostac!c#in eicosatetraenoic aci
BRA'YDININ AN' DALLI'IN
- Pol%&e&tides formed from the &lasma al&ha glo(ulins (% a com&le) series of
&roteol%tic reactions.
- Potent *asodilators
- 0ncrease ca&illar% &ermea(ilit% @ oedema
- Cause (ronchoconstriction
- Brad%kinin. 3BM acti*e than histamine? effects are (rought (%. Binin Receptors . B3
and B-
63HY'RO>YTRYPTAMINE .63HT/
7 - amine formed (% the h%dro)%lation of tr%&to&han stored in gastric mucosa
k - dilatation of arteries and constriction of *eins *ia rece&tors <,T3 ? <,T- ? <,T9
l - high concentrations are found in &latelets.
- &harmacologic &ro&erties. role in inflammation is uncertain and ma%(e insignificant?
dilation of arteries and constriction of *eins.
CYTODINES 3 Proteins secreted (% cells that ha*e effects on other cells
LYMPHODINES 3 c%tokines &roduced (% sensitized T l%m&hoc%tes and to a lesser
e)tent (% B l%m&hoc%tes in res&onse to antigenic challenge
60
DCB
+ctions of %m&hokines.
3. Chemotactic for macro&hages
-. Macro&hage acti*ation
9. Macro&hage inhi(ition
6. Chemotactic for other mononuclear 1BC
<. Mutagenic for other l%m&hoc%tes
A. 0ncreased *ascular &ermea(ilit%
:. +cti*ation of osteoclasts.
INTERLE+DINS
- c%tokines from macro&hages and l%m&hoc%tes during inflammation and immune
res&onse.
- e)erts a num(er of inflammator% actions which include the stimulation of PG and
collagenase &roduction' chemoattraction for 1BC and enhancement of the he&atic
s%nthesis of acute &hase &roteins.
- ,as 4 t%&es. 0nterleukins 3 R 4.
COMPLEMENT
- consist of a series of &rotein that react in a cascade fashion

ANTIHISTAMINES
- antagonize histamine at the rece&tor sites? do not alter the formation or release of histamine
from tissues or mast cells.
- classified as ,3 or ,- rece&tor (lockers "antagonists#
,3 Fece&tor +ntagonists
- interact with ,3 rece&tor on cell mem(ranes - results in a decrease in the a*aila(ilit% of
these rece&tors for the action of histamine? well a(sor(ed from the git? thera&eutic effects
can (e o(ser*ed within 3<-9B min. after dosage? widel% distri(uted in the (od% and (roken
down in the li*er.
- Thera&eutic uses. Treatment and &re*ention of a *ariet% of allergic conditions "e./. rhinitis'
ha% fe*er' and certain allergic dermatoses such as acute urticaria#. To&ical a&&lication is
useful in relie*ing the itching associated with insect (ites? widel% used as common cold
remedies usuall% com(ined with decongestants "e./. +ctifed#.
- no effect on (ronchos&asm or se*ere h%&otension associated with ana&h%lactic shock? no
*alue in the treatment of asthma.
=nwanted effects. $edation? ma% cause stimulation? dr%ness of the mouth? *ariet% of g.i
distur(ances.
DDD +lcohol should (e a*oided while taking ,3 (lockers as it enhances the sedati*e effect.
(< R eceptor Antagonists
- antagonizes the action of histamine at ,- rece&tor.
- commonl% used are Cimetidine and Fanitidine.
- reduce gastric secretion? Treatment of duodenal ulcers and gastric h%&ersecretion.
=nwanted effects. slight such as headache' dizziness' consti&ation or diarrhea' and skin
rashes
65
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63HT ANTAGONISTS - Ergot alkaloids are a grou& of com&ounds that are antagonists for
<-,T' Ergotamine.
CORTICOSTEROI'S - ha*e &otent anti-inflammator% &ro&erties? widel% used in the treatment
of recurrent oral ulceration and other oral mucosal lesion such as erosi*e lichen &lanus'
er%thema multiforme' and &em&higus. E./. B.3I Triamcinolone "to&ical# ? h%drocortisone
sodium succinate -.< mg. ? Bethamethasone 3:-*alerate "to&ical s&ra%# ? etc.
- &ul&al inflammation? TM; &ain? BellOs &als%? &ost-o&erati*e &ain and swelling after dental
surger%? +na&h%lactic and allergic reactions.
PHARMACOLOGY OF PAIN
Pain - an un&leasant sensor% and emotional e)&erience associated with actual or &otential tissue
damage' or descri(ed in terms of such damage.
Ana#"esia - a(sence of &ain in res&onse to stimulation which would normall% (e &ainful.
H!%era#"esia - an increased res&onse to a stimulus which is normall% &ainful
Ne)ra#"ia - &ain in the distri(ution of a ner*e.
Ne)ritis - inflammation of a ner*e or ner*es.
Nocice%tion - acti*it% in a ner*e fi(er which arises as the result of stimulation of nocice&tors.
0f nocice&tion reaches consciousness' it is &ercei*ed as &ain.
Nocice%tor - a rece&tor &referentiall% sensiti*e to a no)ious stimulus or to a stimulus which
would (ecome no)ious if &rolonged.
Pain thresho# - the least stimulus intensit% at which a su(7ect &ercei*es &ain.
Pain to#erance #e(e# - the greatest stimulus intensit% causing &ain that a su(7ect is &re&ared to
tolerate.
A##o!nia - &ain due to a stimulus which does not normall% &ro*oke &ain.
Ca)sa#"ia - a s%ndrome of sustained (urning &ain' allod%nia and h%&er&athia after a traumatic
ner*e lesion' often com(ined with *asomotor d%sfunction and later tro&hic changes.
H!%eraesthesia - increased sensiti*it% to stimulation e)cluding s&ecial senses.
H!%er%athia - a &ainful s%ndrome characterized (% increased reaction to a stimulus' es&eciall%
re&etiti*e stimulus' as well as an increased threshold.
Ne)ro%ath! - a distur(ance of function or &athological change in a ner*e? in one ner*e'
mononeuro&ath%? in se*eral ner*es' mononeuro&ath% multi&le)? if diffuse and
(ilateral' &ol%neuro&ath%.
T<o Main T!%es o4 NOCICEPTORS
3. ,igh Threshold Mechanorece&tor
-. Pol%modal Eocice&tor
THEORIES OF PAIN
3. $PEC080C0TH Theor% - concerned &rimaril% with the sensor% discriminati*e as&ects of
&ain and its /ualit%' location on the skin' intensit% and duration.
-. CEETF+ $=MM+T02E "P+TTEFE# Theor% R &ain is not a se&arate entit%' (ut
results from o*er stimulation of other &rimar% sensations.
9. $EE$2FH 0ETEF+CT02E Theor% R stresses inhi(ition as an im&ortant &h%siological
mechanism in &ain transmission.
66
DCB
6. G+TE C2ETF2 Theor% - stressed the im&ortance of (oth descending control
mechanism and acti*it% in large sensor% fi(er in modulating the &ain e)&erience.
PEF0P,EF+ MED0+T2F$ 28 P+0E
3. BF+DHQ0E0E
-. ,0$T+M0EE
9. E0C2$+E20D$
8our Main Grou&s of Eicosanoids
3. Prostaglandin
-. Prostac%clin
9. Throm(o)ane
6. eukotrienes
CEETF+ MED0+T2F$ 28 P+0E
3. +mino +cids
-. Pe&tides
MET,2D$ T2 FE0EGE P+0E
3. Femo*e &eri&heral stimulus
-. 0nterru&t nocice&ti*e in&ut
9. $timulate nocice&ti*e inhi(itor% mechanism
6. Modulate central a&&reciation of &ain and!or emotional concomitants
<. Block or remo*e secondar% factors maintaining &ain.
I& NON * NARCOTIC ANALGESICS
General Characteristics
3. Felie*es &ain without altering consciousness.
-. $afer than narcotics.
9. Produce fewer side effects.
6. Eot addicting.
<. +ct &rinci&all% on &eri&heral ner*e endings.
A. 0nhi(its the s%nthesis of &rostaglandins.
Pharmacologic+ction
3. +nalgesia
-. +nti&%resis
9. +ntiinflammator%
SALICYLATES R e)tracts of willow (ark containing the (itter gl%coside salicin.
Thera%e)tica##! +se4)# SALICYLATES
1& Sa#ic!#ic Aci - &arent com&ound.' to)ic internall%' to&ical fungicide' keratol%tic agent.
,& Soi)m Sa#ic!#ate - internal use as an analgesic' less effecti*e than as&irin' ma% (e
used in &atients allergic to as&irin.
0& Meth!# Sa#ic!#ate "oil of wintergreen# R e)ternal use as a counterirritant' fla*oring in
cooking.
5& Acet!#sa#ic!#ic aci - wides&read use as an analgesic' anti&%retic and antirheumatic
67
DCB
6& Sa#ic!#amie R internal use as an analgesic? less effecti*e than as&irin? less G.0.
irritation.
7& 'i44#)nisa# R an in*estigational salic%late? &ossi(l% (etter tolerated ' effecti*e at lower
doses? a&&arent thera&eutic ad*antage o*er as&irin and &erha&s other inflammator%
agents.
ASPIRIN
- a(sor(ed from the git? &artl% from stomach (ut mainl% in the u&&er small intestine

Pharmaco#o"ica# Pro%erties
3 +nalgesic "mild analgesic# R due to inhi(ition of the s%nthesis of PGE.
$uita(le regimen. ABB-3-BBmg. e*er% 6-A hours.
- +nti-inflammator% R inhi(it s%nthesis of eicosanoids? ,igh concentrations can inhi(it
the function and acti*it% of PME leukoc%tes
- +nti&%retic R lowers an ele*ated (od% tem&. "&%re)ia# due to infection' tissue damage'
malignanc% or other disease states? due to inhi(ition of &rostaglandin
&roduction in the h%&othalamus.
- +ntithrom(otic effect
+n<ante e44ects
- Gastrointestinal R e&igastric &ain' nausea' gastric erosions leading to (lood loss
- ,aemostatic effects R &rolongs (leeding time? inhi(iting the s%nthesis of &latelet
throm(o)ane.
- Tinnitus R hearing loss due to rise in la(%rinth &ressure
- =ricosuric effect R increase &lasma uric acid. $hould Eot (e gi*en to &atients with
gout"a disorder of uric acid meta(olism#.
- Effects on kidne% R decrease renal (lood flow? also enhances sodium and water
retention.
+s&irin ,%&ersensiti*it% R from rhinitis to life threatening lar%ngeal edema.
+s&irin 2*erdose R 3B-9B gm. can (e fatal.
+s&irin and Fe%eLs $%ndrome R an acute ence&halo&athic illness and fatt% degeneration
of the *iscera' es&eciall% the li*er that arises after an infectious illness such as
chicken&o) or influenza.
- interaction (etween as&irin and the *iral infection leads to damage of cell mitochondria
in geneticall% susce&ti(le indi*iduals.
PARA3AMINOPHENOLS
+. +cetamino&hen "&aracetamol' E-acet%l#
B. Phenacetin "aceto&henetidin#
ACETAMINOPHEN
Pharmacologic Pro&erties
3. +nalgesic
-. +nti&%retic
9. +ntiinflammator% "not clinicall% significant#
6. Do not &roduce gastric (leeding
<. Do not affect &latelet adhesi*eness
69
DCB
A. Do not affect uric acid e)cretion
:. Enhances water trans&ort in the kidne%.
4. Peak &lasma concentration usuall% occur 9B minutes. +fter dosage' and the half life
is usuall% - hours.
5. Con7ugated in the li*er and e)creted in the urine.
+d*erse Effect.
3. Methemoglo(inemia "Phenacetin#
- condition that results from con*ersion of the iron in hemoglo(in to an o)idized state
that cannot effecti*el% carr% o)%gen.
$igns. 3. C%anosis
-. D%s&nea on e)ertion
9. +nemia
-. ,emol%tic +nemia
- ,emol%sis is caused (% minor meta(olites that o)idize glutathione in the FBC and
there(% la(ilize the er%throc%te mem(rane to o)idati*e destruction.
$igns. 3. +(dominal or lower (ack &ain
-. ;aundice
9. ,emoglo(inuria
6. +nemia
9. ,e&atic Eecrosis
- ma% occur after ingestion of a single dose of 3B to 3< Grams.
6. Ee&hroto)icit%
+dult dose. 9-< to <BB mg. or - ta(lets or ca&sules? not more than 6 Grams in -6
hours.
=nwanted effects. few? most serious is he&ato)icit%
Paracetamol 2*erdose. 3B-3< gm. R acute li*er damage R manifests (etween --A da%s
after o*erdose -< gm. R fatal
Treatment. Gastric la*age &ro*ided it is in the first hour after dosage? X3- hrs. R E
acet%lc%steine? after -6 hrs. R the success of treatment de&ends on the
magnitude of the initial dose. "&) will suffer a slow and distressing death#.
- 0n &osto&erati*e dental &ain' efficac% is E2T dose-related.
NON3STEROI'AL ANTI3INFLAMMATORY 'R+GS .NSAI'S/
- share man% of as&irinOs &harmacological &ro&erties.
- anti-inflammator% and analgesic (ecause the% can inhi(it the s%nthesis of eicosanoids.
- &roduce unwanted effects similar to those of as&irin.
A& PHENYLPROPIONIC ACI' 'ERI-ATI-ES R 0(u&rofen' Ea&ro)en' 8lur(i&rofen and
8eno&rofen
Pharmacologic Pro&erties
3. The mechanism of action a&&ears to (e related to inhi(ition of &rostaglandin
s%nthetase.
6;
DCB
-. +nalgesic' anti&%retic' and anti-inflammator%.
9. 0ndicated for the s%m&tomatic treatment of rheumatoid arthritis.
+d*erse Feaction
3. Gastointestinal u&set
-. CE$ effects such as dizziness' headaches' drowsiness and tinnitus.
Ea&ro)en. t3!- 39 hours.
0(u&rofen R &eak &lasma concentration R 3.< hrs. after dosage and the &lasma half life is
- hours? (roken down in the li*er? e)creted in the urine? has similar
unwanted effects as as&irin.
B& IN'OLEACETIC ACI'
3. 0ndomethacin
- most &otent inhi(itors of c%clo)%genase
- analgesic' anti&%retic' &owerful anti-inflammator% agent.
- used in rheumatoid arthritis.
- first drug of choice to treat gout.
+d*erse reaction.
- G0 com&laints
- CE$ - dizziness' headache' tinnitus' *ertigo' confusion R unknown' (ut ma% (e
due to PG inhi(ition
-. $ulindac
- has analgesic' anti&%retic effect.
- treatment of rheumatoid arthritis.
C& PYRROLACETIC ACI'
Tolmentin
Jome&irac

'& FENAMIC ACI' 'ER-IATI-ES .FENAMATES/
3. Mefenamic acid
- treatment of &ain' d%smenorrhea
- sedation can occur
- a(sor(ed after oral dose? &eak &lasma concentrations R after - hrs.? half-life is 9-6
hours.
- meta(olized in li*er' half of meta(olites e)creted in the urine' half in the feces.
- Diarrhea occurs in -<I of &atients
- as acti*e as as&irin?
- incidence of unwanted effects es&. G0 distur(ance is high.
-. Meclofenamate
- treatment of arthritis
- dose. initial R <BB mg. followed (% -<B mg. e*er% si) hours.
E& PYRAKOLONES
Phen%l(utazone
2)%&hen(utazone
6:
DCB
F& 'IFFL+NISAL
- a difluoro&hen%l deri*ati*e of salic%lic acid? has similar &harmacologic &ro&erties as
as&irin
- long &lasma half-life R 4 hrs. "onl% (.i.d.#
II& NARCOTIC ANALGESIC
$imilarities. The% all &roduce.
3. Potent analgesia
-. +ddiction
9. Fes&irator% de&ression
6. $edation
<. Emesis
A. Consti&ation
CLASSIFICATION
3. 2P0=M +Q+20D$
-. $EM0$HET,ET0C DEF0G+T0GE$
9. $HET,ET0C DEF0G+T0GE$
I& OPI+M ALDALOI'S
- o&ium is the dried 7uice o(tained from the unri&e seed ca&sules of the &o&&% &lant
"Pa&a*er somniferum#
A& Mor%hine
most &otent analgesic in use
named after Mor&heus "Greek God of Dreams#
undergoes e)tensi*e first &ass meta(olism in the li*er.
Parenteral solutions of mor&hine sulfate and oral &re&arations are a*aila(le.
t3!- @ 9 hours
Dosage. +dult R 3B to 3< mg. su(cutaneousl% e*er% 6-A hours.
Children R B.3 to B.- mg!kg!dose
Ma)imum dose. 3< mg.
Pharmacological Pro&erties
3. +nalgesia - effecti*e against continuous dull &ain.
-. G0T R used to treat diarrhea and d%senter%? &roduce degree a degree of
consti&ation.
9. Cough su&&ression - effecti*e antitussi*e.
6. Cardio*ascular - cause the release of histamine.
=nwanted Effects
3. Fes&irator% de&ression
-. De&endence
9. Eausea and Emetic effect
6. Cause constriction of the &u&il "M02$0$#
<. +ctions on the (ladder.
7@
DCB

B& Coeine or Meth!# Mor%hine
- Dose. +dult R 3<-AB mg "3!6 to 3 grain#
Pharmacological Pro&erties
3. Effecti*e when taken (% mouth
-. =se in treating mild to moderate &ain
9. Ger% effecti*e antitussi*e.
=nwanted Effects
3. Eausea' *omiting' sedation' dizziness
-. Can de&ress res&iration
9. Can cause consti&ation
C& Heroin
- &roduced (% acet%lation of mor&hine
- - to <M as &otent as mor&hine as an analgesic.
- highl% eu&horic and addicting drug
II& SEMISYNTHETIC 'ERI-ATI-E OF MORPHINE OR CO'EINE
A& H!romor%hone
- more &otent than mor&hine.
- &rinci&al use is for acute &ain.
B& H!rocoone .CooneA 'icoi/
C& O$!mor%hone
- e)tremel% addicting and a &otent res&irator% de&ressant.
- Dose. +dult - 3mg. su(cutaneousl%.
- +*aila(le onl% for &arenteral use.
III& SYNTHETIC NARCOTICS
A& Me%eriine .'emero#/
- most common narcotic a(used (% &rofessionals.
- Dose. +dult R <B to 3BB mg. orall%' su(cutaneousl%' or intramuscularl%.
- Pre&aration. Ta(lets' eli)ir' and solutions for in7ections.
- a*aila(le in com(ination with acetamino&hen or &romethazine.
+d*erse Effect
3. $edation
-. Fes&irator% de&ression
9. 0ncreased tone and secretions of G0T
6. Produces addiction
<. Tolerance de*elo&s.
B& A#%a%roine
C&
71
DCB
'& Ani#eriine
- Dose. usual +dult dose R -< to <B mg. e*er% si) hours.
- can (e gi*e orall%' intramuscularl% or su(cutaneousl%.
- a*aila(le in ta(lets and in7ection.
OPIOI' ANTAGONIST
Na#o$one
- mainl% used to treat o&ioid o*erdose' &articularl% the effects on res&iration.
- must (e gi*en intra*enousl%.
- B.6 to B.4 mg for immediate effect
- t3!- 3 hour
COMPREHENSI-E 'R+G AB+SE PRE-ENTION an CONTROL ACT OF 1:9@
$C,ED=E 3 $=B$T+ECE$
Drugs with a high &otential for a(use and no currentl% acce&ted medical use.
Eot for &rescri&tion use (ut ma% (e o(tained for research &ur&oses.
E./. ,eroin Qeto(emidone
Mari7uana Benz%lmor&hine
Pe%ote Eicomor&hine
Mescaline Metha/ualone
$D Dih%dromor&hine
Eicodeine Facemoramide
Mor&hine meth%lsulfonate
e*omoramide

Drugs with a high &otential for a(use with se*ere lia(ilit% to cause &s%chic or &h%sical
de&endence.
Consists of certain o&ioid drugs and drug containing am&hetamines or metaam&hetamines as
the single acti*e ingredient or in com(ination with each other.
Categorized as KClass + Earcotic Drugs.L
E.g. 2&ium Mor&hine
Codeine ,%dromor&hone
+mo(ar(ital Methadone
Me&eridine Cocaine
2)%codone Pento(ar(ital
Di&heno)%late Phemetrazine
Meth%l&henidate $eco(ar(ital
Metham&hetamine De)troam&hetamine
Etor&hine h%drochloride
Drugs with a &otential for a(use that is less than those in schedules 0 and 00 su(stances.
7,
DCB
Their a(use ma% lead to moderate or low &h%sical de&endence or high &s%chological
de&endence.
Drugs included was formerl% known as KClass B Earcotic drugsL &lus a num(er of non-
narcotic agents.
E./. Chlorhe)adol Gluthethimide
Meth%l&r%lon $ulfodieth%lmethane
$ulfonmethane Ealor&hine
Benz&hetamine Chlor&hentermine
Phendimetrazine
Certain (ar(iturates e)ce&t those listed in another schedule.
$C,ED=E 0G $=B$T+ECE$
Drugs with low &otential for a(use that leads onl% to limited &h%sical or &s%chological
de&endence relati*e to drugs in $chedule 000.
E./. Bar(ital Pheno(ar(ital
Ethinamate Paraldeh%de
Phentermine Methohe)ital
8enfluramine Meth%l&heno(ar(ital
Chloral (etaine Chloral h%drate
Me&ro(amate Pro&o)%&hene
Benzodiaze&ines Me(utamate
Ethchlor*%nol
$C,ED=E G $=B$T+ECE$
Drugs ha*e a lower &otential for a(use than those in $chedule 0G for which there is currentl%
acce&ted medical use in the =.$.
Drugs are categorized as KE)em&t Earcotics.L
HEMOSTATICS
ocall% a&&lied su(stances that are em&lo%ed to arrest e)cessi*e (leeding or hemorrhage.
S!m%athomimetics
- reduce (leeding (% local *asoconstriction. E./. E&ine&hrine
St!%tics an Astrin"ents
- &reci&itates the tissue &roteins in the immediate area.
E./. Jinc Chloride' +luminum Chloride' 8erric $ulfate
Mechanica# A"ents
- acts as matrices in which (lood cells ! fi(rin can (e entra&&ed.
E./. Gel foam' 2)idized Cellulose' 2)idized Fegenerated Cellulose.
Throm?in
- normal constituent of the (lood coagulation scheme' com(ines with fi(rinogen.
HEMOSTASIS AN' HEMOSTATIC AGENTS
70
DCB
8actors in the +rrest of ,emorrhage
1& -esse# <a## contraction
- of short duration "<--B minutes#
- can (e &rolonged (% to&ical or local infiltration of +drenaline.
,& Ahesion an A""re"ation o4 P#ate#ets
- Platelets are non-nuclear cells with a c%to&lasm rich in granules.
- normal count. 3<B'BBB R 6BBB'BBB cells!ml.
- half life is : to 3B da%s
- releases +denosine Di&hos&hate "+DP# and Throm(o)ane +-
- forms Platelet P=G
0& A?i#it! o4 ?#oo to coa")#ate
$tage 0 - +cti*ation of 8actor M --- Ma
$tage 00 R Prothrom(in "00# --- Throm(in
$tage 000 - 8i(rinogen "0# --- 8i(rin --- Clot
$tage 0G - 8i(rin Clot - %sed fi(rin and fi(rin &e&tides.

5& Fi?rino#!sis .The ?reako<n o4 ?#oo c#ot/
- can (e influenced (% age' se)' diet' smoking' altitude' e)ercise.
-ITAMIN D - fat solu(le *itamin that is essential for the normal he&atic (ios%nthesis of
se*eral factors re/uired for (lood clotting. "00' G00' 0M' M#
ANTICOAG+LANTS
- the% directl% or indirectl% interfere with the normal clotting mechanism of (lood.
- &atients recei*ing are those with a histor% of m%ocardial infarction' cere(ro*ascular
throm(osis' *enous throm(osis' and &ulmonar% em(olism.
A& He%arin
- enhances the acti*it% of antithrom(in 000 "neutralizes se*eral of the acti*ated clotting
factors 0)a' Ma' Mia' and M00a. 0t also inacti*ates &rothrom(in (% forming an
irre*ersi(le com&le) with it#.
- must (e administered &arenterall%.
- half life is (etween 3 to < hours "the higher the dose' the higher the half life#
- =nwanted effects. ,eamorrhage and Throm(oc%to&enia.
- the effect can (e re*ersed (% the s&ecific antagonist "Protamine $ul&hate# at eh dose
regimen of 3 mg. of &rotamine for e*er% 3BB units of he&arin.
B& Co)marin Anticoa")#ants
- 2ral anticoagulants
- includes 1arfarin $odium and Phenindione.
- antagonist to *itamin k
- reduces s%nthesis of *itamin Q de&endent clotting factors "00' G00' 0M' M#.
- affected (% diet' (owel disease' &%re)ia' age' &regnanc%' li*er disease.

ANTIPLATELET 'R+GS
- +ntithrom(otic
75
DCB
- decrease throm(in formation
E./. +s&irin' Di&r%damole' $ul&hin P%razone.
FIBRINOLYTIC 'R+GS
- &romotes the (reakdown of throm(i (% acti*ation of &lasminogen to form &lasmin.
E./. $tre&tokinase' =rokinase' Tissue Plasminogen +cti*ator.
ANTIFIBRINOLYTIC 'R+GS
- these encourage the sta(ilization of fi(rin (% inhi(iting &lasminogen acti*ator.
E./. Trane)amic acid
- effects. Eausea' diarrhea' h%&otension.
'ENTAL MANAGEMENT OF PATIENTS FITH HEMOSTATIC PROBLEMS
1& Im%aire P#ate#et F)nction
- due to reduction in &latelet count or im&aired aggregation due to drug thera&%.
- Treatment. ow &latelet count R Platelet transfusion (efore surger%.
Throm(oc%to&enia due to immune destruction of &latelet R +dministration
of corticosteroid
- it is a wise &recaution to suture and &ack the socket to minimize the risk of &ost
e)traction hemorrhage.
- drugs that im&air &latelet aggregation and increase (leeding time includes +s&irin'
E$+0DOs' $odium Gal&roate' and Phen%toin.
,& -asc)#ar 'e4ects
- associated with *itamin C deficienc% and long term corticosteroid thera&%.
- &atients ha*e increased ca&illar% fragilit% which can cause (leeding &ro(lems after
surger%.
- can (e controlled (% &ressure' suturing' and &acking.
0& Im%aire Coa")#ation
A& Haemo%hi#ia
- se)-linked? affects onl% males.
- &atients ha*e reduced factor G000 acti*it%.
- can (e corrected (% re&lacement thera&% of freeze-dried factor G000
"cr%o&reci&itate#.
- drugs used in con7unction with factor G000 include anti-fi(rinol%tic agents' e&silon
aminoca&roic acid which should (e started &re-o&erati*el%.
B& Christmas 'isease
- associated with a deficienc% of factor 0M "deri*ed from &lasma (ut not &resent in
cr%o&reci&itate#.
- Fe&lacement thera&%.

C& -on Fi##e?ranGs isease
- inherited disorder associated with (oth &rolonged (leeding time and deficienc% of
factor G000.
- re&lacement thera&% is necessar%.
76
DCB
LOCAL ANESTHETICS
- re*ersi(le Blockade of Peri&heral Eer*e Conduction? drugs that ha*e little or no irritating
effects when in7ected into the tissues and that will tem&oraril% interru&t conduction when
a(sor(ed into the ner*e.
A)tonomic Losses in the )s)a# orer
3. $ense of Cold
-. 1armth
9. Pain
6. Touch
<. Pressure
A. Gi(ration
:. Pro&rioce&tion
4. Motor function
Com%onents o4 Loca# Anesthetics
+. +nesthetic Drug
B. Gasoconstrictor
e.g. e&ine&hrine' le*onordefrin
Ro#e o4 -asoconstrictor in Loca# Anesthetics
Prolong ocal Block
Dela% $%stemic +(sor&tion
imit To)icit%
C. +ntio)idant
e.g. $odium Bisulfite or $odium P%rosulfite
D. +ntise&tics
m meth%l&ara(en
n
Iea# Pro%erties o4 Loca# Anesthetics
3. Potent ocal +nesthesia
-. Fe*ersi(le ocal +nesthesia
9. +(sence of ocal Feactions
6. +(sence of $%stemic Feactions
<. +(sence of +llergic Feactions
A. Fa&id 2nset
:. $atisfactor% Duration
4. +de/uate Tissue Penetration
5. ow Cost
3B. $ta(ilit% in $olution "long shelf life#
33. $terilization (% +utocla*e
3-. Ease of Meta(olism and E)cretion
T<o Gro)%s. ESTER grou& and AMI'E grou&
77
DCB
CHEMISTRY OF LOCAL ANESTHETICS
Aromatic ;ucleus +in3age Amino !roup
E$TEF
2 F9

F3 ------ -- = / % / R< -- ------ ;
F6
CCCCCCCCCCCCCCCCCCCC o r CCCCCCCCCCCCCCCCCCCCCCCCCCCC
+M0DE
, 2 F9

F3 ------ -- E R C R F- -- ------ E
F6
+(sor&tion. 0ncrease *asodilation @ 0ncrease s&eed of circulation
Distri(ution. Brain' li*er' kidne%s' lungs' s&leen.
Meta(olism. Ester R h%drol%zed in &lasma (% &lasma cholinesterase.
+mide R i*er
Prilocaine R ungs
E)cretion. Qidne%
Pharmacologic Effects
3. Fe*ersi(le &eri&heral ner*e conduction
-. $mooth muscle effects R rela)ation of smooth muscle (ecause sensor% rece&tors are
de&ressed.
9. +nalgesic effect
6. +nticon*ulsant effects.
Most ocal +nesthetics are $%nthetic e)ce&t Cocaine
3. +n +romatic' i&o&hilic Grou&
-. +n 0ntermediate Chain "Ester or +mide inkage#
9. + ,%dro&hilic -\ or 9\ amino grou&' which forms water solu(le salts when
com(ined with acids.
Generall% almost without e)ce&tion' Drugs thus formed are.
1hite and 2dorless
Viscid +i.uids or Amorphous Solids
8at $olu(le (ut relati*el% 0nsolu(le in water
+ll are Bases and form 1ater $olu(le $alts with +cids
To)icit% of ocal +nesthetics. Descending stimulation of the C.E.$. followed (%
79
DCB
DEPFE$$02E of certain areas of the (rain
Classic Progression.
3. Festlessness' +&&rehension and Tremors &rogressing to E)citement and Con*ulsions
-. 0ncrease Blood Pressure and Pulse Fate
9. 0ncrease Fes&irator% Fate
o 6. Fes&irator% and cardio*ascular de&ression with oss of refle)es and consciousness.
Characteristics o4 Liocaine To$icit!B
D&9R&SSI%;D generall% the cause of Death' ma% a&&ear without initial stimulation.
GENERAL ANESTHESIA
- the drug induced a(sence of the &erce&tion of all sensation allowing surger% or other &ainful
&rocedures to (e carried out.
- de&resses the CE$? alle*iate &ain and cause a loss of consciousness.
,0$T2FH
Eitrous 2)ide Klaughing GasL descri(ed (% 7ohn Priest
,orace 1ells o(ser*ed its effects as anesthetics.
Ether R (% T.G. Morton and C.T. ;ackson
,ighl% flamma(le' *olatile' &ungent odor.
Chloroform - *olatile li/uid? (% ;.H. $im&son
T,E2F0E$ 2E MEC,+E0$M 28 +CT02E 28 G.+.
3. i&id or Me%er 2*erton Theor%
-. 0nhi(ition of (iochemical +ction
9. Molecular theories
Pharmacologic Effects
3. CE$ de&ressants
-. CG$ de&ression
9. =rine out&ut is reduced
6. Ma% &roduce li*er damage.
<. Felease of +CT,' antidiuretic hormone' s%m&athetic neurotransmitters.
STAGES OF ANESTHESIA .G)ee#Gs C#assi4ication/
$tage 0 . A;A+!&SIA
- from administration of anesthesia R loss of consciousness
+nalgesia
Eu&horia
Perce&tual distortions
+mnesia
$tage 00 . DE0F0=M
- loss of consciousness R (eginning of surgical anesthesia
E)citement
0n*oluntar% muscular acti*it% "0ncrease muscle tone#
0rregular (reathing
7;
DCB
,%&ertension
Tach%cardia
$tage 000 . $=FG0C+ +EE$T,E$0+
- state of analgesia associated with ma7orit% of surgical &rocedures
- s&ontaneous res&iration ceases
* E 9lanes ,ased on:
Fes&iration
$ize of &u&ils
Refle' characteristics
E%e(all mo*ement
$tage 0G . MED=+FH DEPFE$$02E ! FE$P0F+T2FH P+F+H$0$
- (egins with cessation of res&iration R circulator% colla&se
- Pu&ils fi)ed and dilated
- Eo lid or corneal refle)es
0f not re*erse immediatel%' Death occurs.
PHASES O% ANESTHESIA
"8lagg#
IN'+CTION
- encom&asses all the &re&aration and medication necessar% for a &atient u& to the time the
surgeon is read% to (egin.
MAINTENANCE
- (egins with the &atient at a de&th of anesthesia sufficient to allow surgical mani&ulation
and continues until com&letion of &rocedure.
RECO-ERY
- (egins with the termination of the surgical &rocedure and continues through the &ost
o&erati*e &eriod until the &atient is full% res&onsi*e to the en*ironment.
CLASSIFICATION OF G&A& BY RO+TE OF A'MINISTRATION
In'alation Intravenous Agents
Gases -o#ati#e #iI)is
Eitrous 2)ide ,alogenated ,%drocar(on Eeurole&tics
Chloroform 8entan%l with Dro&eridol
Eth%l Chloride "0nno*ar#
C%clo&ro&ane Trichloroeth%lene
7:
DCB
"Trilene' Trimar# Dissociati*e
Eth%lene ,alothane "8luothane# Qetamine
"Qetalar' Qeta7ect#
,alogenated Ether Bar(iturates
Metho)%flurane Methohe)ital
"Penthrane# "Bre*ital#
Enflurane Thiam%lal $odium
"Enthrane# "$urital#
0soflurane Thio&ental $odium
"8orane# "Pentothal#
Ether Earcotics
Dieth%l Ether 8entan%l "$u(limaze#
"Ether# Mor&hine
Gin%l Ether
"Ginethene#
KB++ECED +EE$T,E$0+L
- PFE-+EE$T,ET0C MED0C+T02E-
- 0ED=CT02E-
- EE=F2M=$C=+F B2CQ0EG -+GEET
- +EE$T,ET0C$-
. O A L )
+E+GE$0+
$EEP
M=$CE FE+M+T02E
+B20T02E 28 FE8EME$
PREME'ICATION
8eatures Fe/uired of PFEMED0C+T02E +gents
3. +lle*iate &re-o&erati*e an)iet%.
-. Pro*ide some degree of &ost-o&erati*e amnesia es&. in children.
9. Make the induction and maintenance anaesthesia easier.
6. Feduce the amount of anaesthetic agents re/uired (% enhancing their effects
<. Pro*ide additional analgesia.
A. Feduce sali*ar% and (ronchial secretions.
:. Feduce acti*it% in the &aras%m&athetic ner*ous s%stem.
PREME'ICATION AGENTS
OPIOI'S - e./. Mor&hine' Pethidine' Pa&a*erum
Thera&eutic Effects. +nalgesic' $edati*e' Eu&horiant' Fes&irator% de&ression'
$u&&ression of cough refle)
9@
DCB
=nwanted Effects. Eausea' Gomiting
AN>IOLYTICS - e./. Benzodiaze&ines
- used orall% to &ro*ide &ost-o&erati*e sedation.
ANTIPSYCHOTICS "Eeurole&tics# e./. Penothiazines deri*ati*es R &romethazine and
Trime&razine.
- &re-anaesthetic sedati*es? anti-emetic? for &atients who fear or has &redis&osition to
&ost-o&erati*e *omiting? de&resses res&iration. cause *ar%ing amount of h%&otension.
ANTICHOLINERGIC +tro&ine $ul&hate? ,%oscine? Gl%co&%rrolate
- reduce secretions? &re*ent o*eracti*it% of the &aras%m&athetic ner*ous s%stem.
Atro%ine S)#%hate - commonl% used to reduce sali*ar% and (ronchial secretions
during anesthesia (% antagonizing the actions of acet%lcholine at muscarinic
rece&tors.
H!oscine - antagonizes the effect of endogenous acet%lcholine at muscarinic rece&tors?
gi*en 0M 9B-AB minutes (efore induction anesthesia? a CE$ de&ressant R causes
drowsiness and de&ression of the *omiting center -anti-emetic. +thigh doses' it ma%
act as stimulant of the CE$. Both atro&ine and h%oscine (lock the action of
acet%lcholine released from the *agal ner*e endings which gi*es some &rotection
against *agal stimulation.
G#!co%!rro#ate - a /uarternar% ammonium? &roduces &rolonged and good control of
sali*ar% and &har%ngeal secretions? less effect on the cardio*ascular s%stem? used as
&reo&erati*e or intrao&erati*e antimuscarinic to attenuate or &re*ent the
intra-o&erati*e (rad%cardia sometimes associated with the use of su)amethonium or
due to cardiac *agal refle)es..
NE+ROM+SC+LAR BLOCDING AGENTS
- (% s&ecific (lockage of the neuromuscular 7unction' the% ena(le light le*els of anesthesia
to (e used with ade/uate rela)ation of the muscles of the a(domen and dia&hragm?
&roduce rela)ation of the a(dominal muscles' and &aral%sis of the res&irator% muscles?
rela)es the *ocal cords allowing the &assage of a tracheal tu(e.
T<o T!%es o4 Ne)rom)sc)#ar B#ockin" A"ents
0. E2E DEP2+F0J0EG M=$CE FE+M+ET$"com&etiti*e#
T)?oc)rarine - highl% ionized? gi*en 0G ? &roduce &aral%sis of all *oluntar% muscles?
action commences 9-6 mins. and lasts u& to 6B mins.? used as an ad7unct to G.+.?
action ma% (e re*ersed (% administration of neostigmine ? a weak ganglion (locker
R causes the release of histamine -- &eri&heral *asodilation - - will lower the (.&. ?
ma% also cause flushing and (ronchos&asm due to the release of histamine?
does not cross the (lood (rain (arrier or the &lacenta.
Panc)roni)m - more &otent than Tu(ocurarine (ut has a shorter action? acts (%
com&etiti*e (lock (ut does not normall% (lock transmission in autonomic ganglia
91
DCB
and so does not significantl% alter the (lood &ressure. ,owe*er' if ra&idl% in7ected
0G' it ma% cause a rise in (& due to *agal (locking and tach%cardia? does not cause
histamine to (e released? ma% also (e used to &roduce rela)ation in a num(er of
&athological conditions such as tetanus? also used e)tensi*el% in 0C=.
Atrac)ri)m and -ecoroni)m - most often used at the &resent time? ha*e little effect
on the cardio*ascular s%stem? ma% release little of histamine? more ad*antageous
to &atientOs with renal or he&atic im&airment.
00. DEP2+F0J0EG M=$CE FE+M+ET$
S)$amethoni)m - de&olarizes the &osts%na&tic mem(reane and maintains this state so
that the ad7acent m. fi(ers are electricall% ine)cita(le? in7ected 0G? &roduces
com&lete muscular rela)ation in half a minute? has a num(er of muscarinic action
including increase in sali*ar% secretion' muscle in7ur% occasionall% due to direct
action on the muscle or ma% follow Q de&letion from muscles.? ma% cause
malignant h%&er&%re)ia R ma%(e treated (% ra&id cooling' inhalation of 3BBI
o)%gen and 0G of Dantrolene 3 mg!kg of (od% weight.
* ?S=+& =%;"RA="I%;
action &otential ---- tra*els down the motor ner*e---- release of &ackets of acth "/uanta-
millions of acth molecules# ----- acth crosses the s%na&tic cleft and interacts with the
cholinergic rece&tors on the end &late of a muscle fi(er ---- surge of acth (rings a massi*e
increase in the &ermea(ilit% of the &ost-s%na&tic mem(rane to Ea ions and to a X e)tent to
Q ions "Ea ions enter and generate a local end &late &otential "de&olarization# until it
reaches a critical threshold --- triggers off a muscle action &otential &ro&agated along the
muscle fi(er causing it to contract.
+cth is then (roken down (% cholinesterase in the neuromuscular 7unction? the motor end
&late &olarizes and is then read% to (e stimulated again.
IN'+CTION AGENTS .I- ANESTHETIC AGENTS/
- widel% used to induce anaesthesia
Soi)m Thio%entone - an ultra short acting (ar(iturate? gi*en 0G? &roduces loss of
consciousness in 3B--B seconds. Ma). de&th occurs 6B secs. ? &) (ecomes conscious --9
mins. after dosage? &ro*ide anes. for short o&erati*e &rocedures? induce unconsciousness
&rior to inhalation anaesthesia? ra&idl% enters the (rain? 4<I (ound to &lasma &rotein?
meta(olized in the li*er? e)creted in the kidne%? de&resses man% of the functions of CE$?
no analgesic &ro&erties? low doses ma% increase sensiti*it% to &ain? an anticon*ulsant?
often associated with lar%ngos&asm? (ronshos&asm? cough? e)tra*ascular in7ection ma%
cause &ain and necrosis when the concentration is N -.<I? endothelial and dee&er la%er
ma% (e damaged when inad*ertentl% in7ected into an arter%? must not (e gi*en to &atients
with &or&h%ria no effect on the uterus (ut can cross the &lacenta and de&ress the fetal
cardio*ascular s%stem? there is transient dro& in (lood &ressure.
Methohe$itone - an ultra short acting (ar(iturate?
Pharmacological &ro&erties R same with Thio&entone
=nwanted effects - &ain on in7ection' in*oluntar% mo*ements' cough' and lar%ngos&asm?
has con*ulsant &ro&erties
9,
DCB
Etomiate - a car(o)%lated imidazole deri*ati*e? ra&id reco*er% and lack of Khango*erO
effect ma% (e due to short &lasma half life? does not release histamine? &ainful' cause
in*oluntar% mo*ements? &rolonged use ma% cause adrenocortical su&&ression in 0C=?
has little or no effect on the cardio*ascular s%stem.
Detamine - gi*en 0G (ut can (e gi*en 0M? associated with &rofound sedation and
analgesia? &roduces dissociation (ut not sedation and so airwa% refle)es are maintained?
*i*id hallucinations and nightmares? raises (.&. and &ulse rate? useful in management of
mass casualties.
Pro%o4o# - a new &henolic 0G induction agent and maintenance anaesthesia &ro*ided the
surgical &rocedure does not e)ceed 3 hour.? reco*er% is usu. ra&id and often accom&anied
(% eu&horia? se)ual fantasies can also occur? highl% li&o&hilic? More e)&ensi*e.
=nwanted effects - cardiac res&irator% de&ression? a&nea and marked h%&otensi*e effect?
&ain on in7ection.
INHALATION ANAESTHESIA
- most widel% used form of maintenance anaesthesia
0E,++T02E +E+E$T,ET0C +GEET$
Nitro)s O$ie 3 E&I& Entono$ colorless' odorless gas? weak anaesthetic? an ad7unct to
other inhalation agents? ma% &roduce se*ere h%&o)ia when used alone? an e)cellent
analgesic agent? a direct m%ocardial de&ressant? stimulates s%m&athetic ner*ous
s%stem? ma% cause nausea' *omiting' "megalo(lastic anemia and neuro&ath% in
animals#? su&&resses s&ermatogenesis and &roduction of 1BC and FBC in (one
marrow? =ses. changing &ainful dressing' an aid to &ost-o&erati*e &h%siothera&% and
emergenc% am(ulances.
Ha#othane - a halogenated h%drocar(on? colorless at room tem&erature? has &leasant
smell?not inflamma(le? non e)&losi*e? causes dose-related reduction in (.&.'slowing of
heart rate? se*ere d%srh%thmia? (ronchodilation ? de&resses res&iration? no analgesic
&ro&ert% and does not &roduce a degree of rela)ation? ma% cause he&atic necrosis.
En4#)rane - a halogenated ether? colorless at room tem&erature? non flamma(le with a
mild sweet odor? alters electrical acti*it% in the (rain? 4BI e)creted unchanged in
e)&ired gases' -.< I meta(olized in the li*er and e)creted in the kidne%? &roduces a
dose-related reduction in (.&.? causes res&irator% de&ression? twitching of the lim(s'
7aws' face and neck (ut self limiting? no significant effect on the li*er
Iso4#)rane - isomer of enflurane? a halogenated meth%leth%l ether? &h%sical &ro&erties
similar to enflurane? reduction in (.&. (ut has little or no effect on cardiac out&ut?
increase in heart rate (ut no arr%thmias? de&resses res&iration and stimulates airwa%
refle)es causing increased secretion' coughing and lar%ngos&asm.
Ether - one of the earliest and safest *olatile li/uids irritating to the mucus mem(rane?
inflamma(le and e)&losi*e? often associated with nausea and *omiting? now rarel%
used.
ANAESTHETIC EMERGENCIES
3. Fes&irator% 2(struction
-. ,%&ersensiti*it% reaction
90
DCB
ANTISEPTICS AN' 'ISINFECTANTS
- su(stance that kill or &re*ent the growth of microorganism
Antise%tics - used on li*ing tissues.
'isin4ectants R a&&lied on inanimate o(7ects.
1& ALCOHOLS
A& Eth!# A#coho# and 0so&ro&%l +lcohol
B& Ch#orhe$iine and Ioine
C& S)r"ica# S%irits R mi)ture of eth%l!meth%l alcohol
,& AL'EHY'ES
A& Forma#eh!e R (actericidal acti*it% on (acteria' fungi' and *iruses? action is *er% slow
R B.<I will take 3- hrs.? --4I concentrations to disinfect inanimate o(7ects.
B. G#)tara#eh!es R acts against all microorganisms? less *iruses' odor? -I concentration?
for cold sterilization? for articles contaminated (% he&atitis B *irus that cannot (e heat
sterilized? 3 R 3- hour e)&osure.
C. Ch#orhe$iine ",i(itane# R antise&tic and disinfectant
& 3. Hi?iscr)? ICI R &re-o&erati*e &re&aration of skin and hand disinfection.
/ -. Hi?iso# ICI R disinfection of sin and hands.
r 9. Corso!# ICI R in dental gel? mouthwash B.-I solution.
s
t ,i(itane 2(stetric cream "0C0# R &re-o&erati*e &re&aration of hands and skin of
u midwife!doctor.
* ,i(itane Concentrate R general &ur&ose antise&tic
w
0& 'YES R com&le) organic su(stances from coal tar e./. aniline d%es' gentian *iolet' (rilliant
green' acnidine d%es' acrifla*in and &rofla*ine.
5& HALOGENS R reacts with (acterial &roteins.
6& CHLORINE R has a ra&id' &otent and (rief action? effecti*e against most (acteria' some
fungi' %east' and *iruses? in the form of h%&ochlorites' organic chloramines' chlorinated
isoc%anurates? inacti*ated (% organic matter.
7. IO'INE R acts as much the same wa% as chlorine (ut not readil% inacti*ated (% organic
matter? (actericidal and fungicide? &resent in weak solution of -.<I iodine in &otassium
iodine' water and alcohol? stains skin.
9. IO'OFORM R mild antise&tic E./. whiteheads *arnish incor&orated into ri((on gauze for
infected sockets and dressing for surgical remo*al? contains iodoform with (enzoin'
stora)' and (alsam of tolu in sol*ent ether? Qri-&aste- used as root canal filler? Qri
li/uid - sterilize root canals.
;& IO'OPHORS R com(ination of iodine and surface acti*e detergents? effecti*e against
gram T - organisms after 3< secs.? doesnOt stains skin. E./. Po*idone 0odine
95
DCB
:. O>I'IKING AGENTS R li(erates o)%gen which o)idizes &roteins of (acteria and tissue
&roteins.
H!ro"en Pero$ie R mild antise&tic? 9BI a/ueous solution to (leach discolored root
filled teeth? mouthwash in acute ulcerati*e gingi*itis.
Soi)m Per?orate R treatment of acute ulcerati*e gingi*itis? li(erates o)%gen when in
contact with organic matter.
1@& PHENOLSA CREOSOLS and their deri*ati*es
Pheno# - 4BI in water? irritant and caustic &roducing a (urning &ain? &roduces feeling of
anesthesia
CMCP "Cam&horated &ara-amino&henol# R 9<I in cam&hor? medicament in root canals.
Creso# R 9) (acteridal &otenc% of &henol? also to)ic E./. Metacrs%l acetate "Cresatin# R
irrigation of root canals? not irritant to &eria&ical tissues.
Ch#oro$!#eno#s R less effecti*e than &henolic agents? acti*it% reduced in the &resence of
organic matter. E./. Dettol "<I chloro)%lenol#.
He$ach#oro%ane R e)cellent disinfectant? for gram T cocci? not *er% irritant to tissues (ut
has neuroto)ic effects on (a(ies "dusting &owders#.
11& S+RFACE ACTI-E AGENTS
Classification according to ionic charge.
=A"I%;I= - &ositi*e charge? includes /uarternar% ammonium com&ounds such as.
3. Benzalkonium chloride "Je&iran#
-. Cet%l&%ridinium "Cee&r%n#
9. Cetrimide "Ceta*lon#
- (actericidal against some gram T and some gram negati*e (acteria? little effect on tu(ercle
(acilli' s&ore forming micro(es and &suedomonas aeruginosa?

A;I%;I= - negati*e charge? not (actericidal' onl% enhances &h%sical remo*al of (acteria?
effecti*e against gram T microorganism? E./. $odium laur%l sulfate and green soa&.
'ENTAL +SES OF ANTISEPTICS
3. $kin &re&aration (efore surger% or in7ection
-. Pre-o&erati*e &re&aration of the oral mucosa
9. $ometimes as an ingredient of dentrifices
6. 0nhi(ition of dental &la/ue
<. Cleaning of o&erating areas
A. Cold sterilization of instruments and e/ui&ment
:. $torage of sterilized surgical e/ui&ment
4. Pre&aration of surgeonOs hand
5. 0rrigation of root canals in endodontics.
'EFINITION OF TERMS
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DCB
Antimicro?ia# A"ents R su(stances that kill or su&&ress the growth or multi&lication or &re*ent
the action of microorganisms
Anti3in4ecti(e A"ents R su(stances that act against or tend to destro% infection.
Anti?acteria# A"ents R su(stances that destro% or su&&ress the growth or multi&lication of
(acteria.
Anti(ira# A"ents R su(stances that destro% or su&&ress the growth or multi&lication of *iruses.
Anti34)n"a# A"ents R su(stances that destro% or su&&ress the growth or multi&lication of fungi.
Anti?iotic A"ents R chemical su(stances &roduced (% microorganisms that ha*e the ca&acit%' in
dilute solutions' to destro% or su&&ress the growth or multi&lication of
organisms or &re*ent their action.
+nti(acterial "+ntimicro(ials# R are o(tained from natural sources or are manufactured
+nti(iotic R chemicals that are &roduced (% one kind of microorganism that inhi(it or kill another
kind of organism.
D The difference (etween anti(iotic and s%nthetic anti(acterial agents is that anti(iotics are
&roduced (% microorganisms and the anti(acterial agents are made in the la(orator%.
C#assi4ication o4 Anti?acteria#s Accorin" to its ACTION
3. Bacteriostatic
R inhi(it or retard the multi&lication or growth of (acteria (ut does not kill them.
E./. Tetrac%clines' sulfonamides' chloram&henicol
- (acteria can grow again when drug is withdrawn.
- ,ost defense mechanism "e./. &hagoc%tosis# are re/uired to kill the microorganism.
-. Bactericia# R drugs that kill (acteria.
E./. Penicillin' Ce&halos&horins' +minogl%cosides' Gancom%cin' Metronidazole'
0mi&enem.
- (est choice in treatment es&eciall% in life threatening infections' endocarditis and in
&atients whose leukoc%te count is X<BB!

D some drugs ma% (e (acteriostatic at low concentrations and (actericidal at high
concentrations against the same or different microorganisms? 0n &atients with im&aired
defense mechanism' a (actericidal is &referred o*er a (acteriostatic agent (ecause the (od%Os
a(ilit% to fight infection is com&romised.
C#assi4ication Accorin" to RANGE OF ACTI-ITY
S%ectr)m R the range of acti*it% of a drug.
3. ;arro8 Spectrum R acts against either gram &ositi*e or gram negati*e organisms.
one t%&e of organism? onl% selecti*e. E./. Penicillin and
er%throm%cin R gram T (acteria.
-. @road Spectrum R acts against a wide *ariet% of organisms R effecti*e on (oth gram P
and gram * (acteria as well as some *iruses? treats infection not
identified (% culture and sensiti*it% test.
E./. Tetrac%lcine and Ce&halos&horins.
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DCB
INFECTION R in*asion of the (od% (% &athogenic microorganism and the reaction of the
tissues to their &resence and to the to)ins generated (% them.
Princi%a# 4actors that etermine a microor"anism ca)sin" an in4ection
3. Girulence of the microorganism
-. Eum(er of organisms &resent
9. Fesistance of the host
Ho< o Microor"anism ca)se an in4ectionQ
3. 0nfecti*it% "must enter the right &ortal of entr%#
-. 0t must (e a(le to multi&l% on the (od% of the susce&ti(le host.
9. 0n*asi*eness "effecti*e mechanism for transmission#
6. 0t must (e a(le to &roduce to)ins' enz%mes and other meta(olites that affect the cell
or to)igenecit%.
Two Goals to (e achie*ed to &re*ent infection
3. Feduce the num(er of (acteria in the surgical wound.
-. Enhance the hostOs defenses so as to &re*ent the (acteria that entered the wound from
causing clinicall% e*ident infection.
IN'ICATION FOR ANTIMICROBIAL AGENTS
A& Pro%h!#actic Inications
- used for high risk &atients whose immune s%stem are weak. E./. in rheumatic or
congenital heart disease' Fenal dial%sis &atients' or the &resence
of a heart &rosthesis. +n% dental &rocedure ma% &reci&itate a (acteremia' therefore'
&ro&h%lactic anti(iotics must (e gi*en to &re*ent (acterial endocarditis.
B& Thera%e)tic Inication
- for the treatment of infection.
KDoes this &articular &atient need the assistance of antimicro(ial agents to resol*e
this &articular infection>"
D E2T + 0E8ECT02E$ FEP=0FE +ET0B02T0C T,EF+PH' it all de&ends on.
:. "he patient. Khost res&onsesL
- Defense mechanism is considered.
- The &resence or a(sence of s%stemic manifestation such as fe*er' malaise' and
l%m&hadeno&ath% are indicators of how well the &atient is doing without
antimicro(ial thera&%.
<. "he Infection.
- The *irulence and in*asi*eness of the etiologic microorganism are im&ortant in
determining the acuteness' se*erit%' and s&reading tendenc% of the infection
which is o(*iousl% need to (e treated with antimicro(ial agents.
Fi(e Basic Princi%#es in the +se o4 Anti?iotics = Antimicro?ia#s
3. 0nfection must (e &resent or imminent - consider the signs of inflammation.
-. 0dentif% the organism - accom&lished through culturing' gram stain or educated guesses.
Pur&ose. To determine the s&ecific t%&e of antimicro(ial sensiti*e to the s&ecific t%&e of
microorganism.
9. Choose the s&ecific t%&e of anti(iotic
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DCB
---------------------------------------------------------------------------------------------------------
+nti(iotics G- Y GT G-
--------------------------------------------------------------------------------------------------------
Pheno)%meth%l Penicillin TTTT T
Penicillin G TTTT T
+m&icillin TTT
Er%throm%cin TTT TT
Clindam%cin TTT T
Ce&halos&orins TTT T
Tetrac%cline TT TTT
+minohl%coside T TTTT
----------------------------------------------------------------------------------------------------------
6. +dminister anti(iotics &ro&erl%
<. Pre*ent and minimize to)icit% and h%&ersensiti*it%.
a. right dose
(. right dose inter*al
c. right dose form
d. right duration of thera&%
Duration of dosage.
- +n antimicro(ial agent should (e continued long enough to &rohi(it a regrowth of the
causati*e microorganism' (ut not so long to induce to)ic drug s%m&toms or alter the
normal flora to the e)tent that su&erinfection results
DD 0t should continue 64 hours after the s%m&toms of infection are a(sent. 0f (eta
hemol%tic stre&tococci are the causati*e organisms' usuall% &enicillin should (e
continued for at least 3B da%s. 8or osteom%elitis' it should (e continued for 36 da%s after
fe*er and tenderness are a(sent and drainage has ceased. 0n &atients with a de&ressed
immune s%stem or histor% of &rolonged healing' co*erage usuall% needs to (e continued
longer than in normal &atient.
MECHANISM OF ACTION OF ANTIBACTERIALS
1& Inhi?ition o4 ce## <a## s!nthesis
a. 0nhi(ition of cross linking "trans&e&tidation# of &e&tidogl%can. e./. Penicillins?
Ce&halos&orins.
(. 0nhi(ition of other ste&s in &e&tidogl%can s%nthesis. e./. Gancom%cin'
C%closerin' Bacitracin.
,& Inhi?ition o4 %rotein s!nthesis
) a. +ction on <B$ ri(osomal su(unit e.g. Chloram&henicol' Er%throm%cin'
% Clindam%cin.
z (. +ction on 9B$ ri(osomal su(unit. e./. Tetrac%clines and +minogl%cosides.
0& Inhi?ition o4 n)c#eic aci s!nthesis
aa a. 0nhi(ition of nucleotide s%nthesis e./. $ulfonamides and trimetho&rim
(( (. 0nhi(ition of DE+ s%nthesis e./. Puinolones "2flo)acin#
cc 5& A#teration o4 ce## mem?rane 4)nction
a. +nti(acterial acti*it% e./. Pol%m%)in
(. +ntifungal acti*it% e./. +m&hotericin B' E%statin' ketoconazole.
6& +ncertain mechanisms
9;
DCB
E.g. 0soniazid' Metronidazole.
Resistance R a(ilit% of a microorganism to (e unaffected (% an antimicro(ial agent.
;atural resistance R occurs when an organism has alwa%s (een resistant to the antimicro(ial
+gent? occurs without &re*ious e)&osure to the drug.
Ac.uired resistance R occurs when the organism that was &re*iousl% sensiti*e to an
antimicro(ial agent de*elo&s resistance! caused (% &rior e)&osure to
the drug.
=ross Resistance - occurs with anti(acterials that ha*e similar actions. E./. Penicillin?
Ce&halos&orins.
Genetic recom(ination including con7ugation' transformation ' and transduction' can result
in the &assing on of resistance from one (acterial strain to another. The second strain
(ecomes resistant to the same anti(iotics as the first strain without ha*ing (een e)&osed to
the anti(iotic.
DD+ction de&ends on de&ends on se*eral *aria(les.
3. =sual thera&eutic concentration of that agent
-. T%&e of organism
9. The mechanism of action of that agent.
GEEEF+ +DGEF$E FE+CT02E$ T2 +ET0B+CTEF0+$
3. +llerg% ! ,%&ersensiti*it% - ma% (e mild to se*ere. E./ rash' &ruritus' hi*es-treated
with antihistamine.
-. +na&h%lactic $hock - shortness of (reath is the first s%m&tom? treatment is
e&ine&hrine (ronchodilators and antihistamines.
9. $u&erinfection' $u&rainfection - infection caused (% &roliferation of microorganisms
that are different than those causing the original infection.
- a secondar% infection that occurs when the normal micro(ial flora of the (od% are
distur(ed during anti(iotic thera&%. E./. 8ungal infections.
- often caused (% (road s&ectrum anti(iotics such as tetrac%cline
C+LT+RE AN' SENSITI-ITY TESTS
- onl% wa% in which one can reasona(l% ensure that a &articular drug will kill or inhi(it the
growth of an infecting microorganism. ,owe*er' it will not show the &otenc% of the drug
nor differentiate (etween (actericidal and (acteriostatic effects' the% will onl% show
which drug ad*ersel% affect the growth of the microorganism on the culture &late.
C)#t)re R a sam&le from the infected site is taken and grown on culture media. +fter the
&athogen is grown' sensiti*it% test can (e conducted.
Sensiti(it! R after the organism is identified' it is again grown on culture media and the
effect of different antimicro(ial agents on the organism is tested. 2ne to two
da%s are re/uired (efore the result of this test are a*aila(le
A(anta"es o4 C)#t)re an Sensiti(it! tests
3. +n earl% correction of thera&% is &ossi(le if the drug selected is ineffecti*e against the
microorganism causing the infection
-. Pathogens grown on culture (efore anti(iotic thera&% is (egun can (e more easil%
9:
DCB
identified than after a thera&eutic failure has occurred.

B#oo #e(e# R the concentration of the anti(acterial agent &resent in the (lood or serum? an
im&ortant inde) to drug dosage' since certain concentration of the drug is re/uired
in the (od% fluids to inhi(it or kill the microorganism.
S!ner"ism R effect when a com(ination of two anti(iotics is more ra&idl% (actericidal than either
drug used alone. Com(inations of anti(iotic that are (actericidal generall% are
s%nergistic. Com(inations of those that are (acteriostatic are merel% additi*e.
Anta"onism R effect when the (actericidal rate for the com(ination of two drugs is less than that
for either drug used alone? often e)hi(ited when a (ateriostatic and a (actericidal
agent are used in com(ination.
'ENTALLY +SEF+L ANTI3INFECTI-E AGENTS
1& PENICILLINS
- can (e di*ided into three grou&s
+. Penicillin G and G
B. Penicillinase-resistant &enicillins
"Methacillin' Clo)acillin' Eafcillin' 8lo)acillin' Diclo)acillin#
C. E)tended-$&ectrum &enicillins
"+m&icillin-like agents' car(enicillin-like agents and amino-&enicillin grou&.
Administration and /od( 'andling
- can (e administered orall% or &arenterall%.
- should not (e a&&lied to&icall% (ecause of its allergenecit%.
- Penicillin G is (etter a(sor(ed orall% than &enicillin G
- degraded (% the gastric fluid-it should (e administered one hour (efore meals or -
hours after meals.
- crosses &lacental (arrier and a small amount a&&ears to (e e)creted in the milk and
sali*a.
S*ectrum)
- *er% &otent (actericidal agent that acts (% interfering with the s%nthesis of the
(acterial cell wall.
- its narrow s&ectrum of acti*it% includes gram &ositi*e aero(ic and facultati*e
organism"cocci. $tre&tococcus'and $ta&h%lococcus? rods. Bacillus'
Cor%ne(acterium and Clostridium? $&irochetes.Tre&onema &allidium? and certain
gram negati*e aero(ic cocci. Eeisseria gonorrhea and E. meningitidis#
Adverse reactions )
- most common cause of drug allergies.
3. To)icit%
- large doses of &enicillin G ha*e (een associated with renal damage manifested as
fe*er' eosino&hilia' rashes' al(uminuria.
- gastrointestinal irritation can manifest itself as nausea with or without *omiting.
-. +llerg% and ,%&ersensiti*it%
0mmediate - less than 9B minutes includes ana&h%la)is.
;@
DCB
+ccelerated - - to 64 hours includes serum sickness and lar%ngeal edema.
ate - 9 or more da%s includes rashes' oral lesions' and other s%m&toms.
$ses)
- for dental infections
a. +E=G R &enicillin G
(. Periodontal a(scess - &enicillin G
c. +(scess' cellulitis' &ericoronitis R &enicillin G
d. 2steom%elitis - &enicillin G
e. Fheumatic heart disease - &enicillin G.
,& ERYTHROMYCIN
- administered orall%? a*aila(le in ta(lets and ca&sules' oral sus&ensions and 0G and 0M
forms.
- formulated as enteric-coated ta(let' ca&sule or insolu(le ester to reduce degradation (%
the stomach acid.
- it should (e administered - hours (efore meals or se*eral hours after meals.

Activit( and S*ectrum)
- usuall% (acteriostatic (ut ma% (e (actericidal at normal thera&eutic doses.
- used against gram &ositi*e (acteria.
- also a drug of choice for whoo&ing cough' di&hteria' s%&hilis' and gonorrhea.
- cross-resistance has (een re&orted (etween er%throm%cin and clindam%cin.
- &oor second choice to treat dental infections.
Adverse E&&ect)
3. Gastrointestinal Effects
- include stomatitis' a(dominal cram&s' nausea' *omiting and diarrhea.
-. Cholestatic ;aundice
- s%m&toms include nausea' *omiting and a(dominal cram&s followed (% 7aundice
and ele*ated li*er enz%me le*els.
9. +llerg%
- *er% uncommon.
Drug Interaction)
- &atients taking Theo&h%lline chronicall% for asthma or acutel% for (ronchitis ma%
e)hi(it a drug interaction with er%throm%cin.
- has (een im&licated in the failure of oral contrace&ti*e efficac%.
$ses)
- drug of first choice in &atients allergic to &enicillin.
- indicated certain situations for the &ro&h%la)is of rheumatic heart disease.
- usual adult dose is (etween -<B and <BB mg /id.
- for (acterial &ro&h%la)is- 3 gm 3 hour (efore the dental a&&ointment
0& TETRACYCLINE
- (road s&ectrum anti(iotics affecting a wide range of microorganisms.
- most commonl% gi*en (% mouth.
;1
DCB
- secreted in the sali*a and milk of lactating mothers.
- stored in the dentin and enamel of uneru&ted teeth.
- also concentrated in the gingi*al cre*icular fluid.
T(*es)
3. Do)%c%cline - e)creted in the feces
-. Tetrac%cline R eliminated (% glomerular filtration'
- oral a(sor&tion is decreased (% administration of food with high calcium content'
dair% &roducts' oral iron su&&lements or antacids.
9. Minoc%cline - meta(olized in the li*er and e)creted in urine.
dd - ma% (e gi*en to &atients with renal d%sfunction
Spectrum:
Bacteriostatic and interfere with the s%nthesis of (acterial &rotein
Broad s&ectrum
Adverse Reactions:
3. Gastrointestinal effects
- anore)ia' nausea' *omiting' diarrhea' gastroenteritis' glossitis' stomatitis'
)erostomia' and su&erinfection "moniliasis#
-. ,e&ato)icit% - large dose of &arenteral tetrac%cline
9. Fenal to)icit%
6. ,ematologic effects - hemol%tic anemia' leukoc%tosis' throm(oc%to&enic &ur&ura
<. Effects on teeth and (ones
A. $u&erinfection
:. Photosensiti*it%R e)aggerated sun(urn
4. +llerg%
ses:
3. +lternati*e drug to treat chlam%dial and rickettsial infections
-. =sed to treat cholera' acne' and &ulmonar% infections
9. Do)%c%cline is used to treat tra*elers diarrhea
6. 0ndicated for the treatment of &eriodontitis
<. Mi)ture of e/ual &arts of tetrac%cline s%ru& and lidocaine *iscous for the
management of recurrent a&hthous stomatitis
A. +E=G ma% also (e treated with tetrac%cline
5& CLIN'AMYCIN
- (acteriostatic anti(iotic effecti*e &rimaril% against gram-&ositi*e organisms.
- administered orall%' intramuscularl%' or intra*enousl%.
ee - food does not interfere with a(sor&tion
ff - cross-resistance (etween Clindam%cin and tetrac%cline "com&etition for (inding site#
Adverse Reaction:
3. Gastrointestinal effects "Pseudo Mem(ranous Colitis- PMC #
-se*ere' &ersistent diarrhea and the &assage of (lood and mucus in the stool
-. $u&erinfection
9. +llerg%
;,
DCB
ses:
3. $hould (e used onl% when s&ecificall% indicated
-. Mi)ed infections insensiti*e to &enicillin- anaero(es
6& METRONI'AKOLE
- taken orall%
- (actericidal and &enetrates all (acterial cells.
Adverse Reactions:
3. Gastrointestinal effects - nausea' anore)ia' diarrhea and *omiting' e&igastric
distress and a(dominal cram&ing
-. 2ral effects - un&leasant metallic taste? altered taste of alcohol? glossitis'
stomatitis and a (lack furred tongue? dr%ness of the mouth
9. Effects on CE$ - headache' dizziness' *ertigo' ata)ia' confusion' de&ression'
weakness' insomnia' and con*ulsi*e seizures
6. Fenal to)icit% - c%stitis' &ol%uria' d%suria' incontinence
<. Disulfiram-like reaction - alcohol should (e a*oided? s%m&toms include
nausea' a(dominal cram&s' flushing' *omiting or headache
ses:
3. Treatment of trichomoniasis' ame(iasis
-. Eot the drug of choice for an% dental infections "alternati*e drug#
9. $hown to (e effecti*e for the treatment of B. fragilis infections following
mandi(ular fracture
7& CEPHALOSPHORINS
- chemicall% related to &enicillin
- (actericidal agents
- can (e administered orall%' intramuscularl%' or intra*enousl%.
Adverse Reactions)
3. Gastrointestinal effects
-. Ee&hroto)icit%
9. $u&erinfection
6. ocal reaction
<. +llerg%
A. Cross sensiti*it% with &enicillin
$ses)
3. 8or infections that are sensiti*e to these agents (ut resistant to &enicillin
9& -ANCOMYCIN
- administered onl% intra*enousl%
- (actericidal
- narrow s&ectrum of action against man% gram &ositi*e cocci.
Adverse Reactions)
;0
DCB
3. 2toto)icit%
-. Ee&hroto)icit%
9. +na&h%la)is
6. $u&erinfection
$ses)
3. =seful in the &ro&h%la)is of infecti*e endocarditis for &atients with &rosthetic heart
*al*es who are allergic to &enicillin.
-. =sed orall% to treat PMC.
;& AMINOGLYCOSI'ES
"Eeom%cin' $tre&tom%cin' Qanam%cin' Gentam%cin' To(ram%cin' +mikacin' Eetilmicin#
- (actericidal
- ha*e a (road anti(acterial s&ectrum
- &oorl% a(sor(ed after oral administration Y so must (e administered (% 0M or 0G
in7ection for a s%stemic effect
- used for the treatment of aero(ic gram-negati*e infections
Adverse Reaction:
3. 2toto)icit%
- to)ic to the F
th
cranial nerveD which can lead to auditor% and *esti(ular
distur(ances. Patients ma% ha*e difficult% in maintaining e/uili(rium and can
de*elo& *ertigo.
-. Ee&hroto)icit% - can cause kidne% damage
9. Eeuromuscular (lockade - act as weak neuromuscular (locking agents'
&otentiall% &roducing a&nea
ses:
- reser*ed for hos&italized &atients with the serious gram-negati*e infections
Gentamicin is used in dentistr% to &ro&h%la)is &atients with &rosthetic heart *al*es
:& CHLORAMPHENICOL
- (road s&ectrum
gg - (acteriostatic
- acti*e against a large num(er of gram-&ositi*e and gram negati*e organisms'
rickettsiae' and some chlam%diae. Particularl% acti*e against $almonella t%&hi.
- has serious side effects like fatal (lood d%scracias "a&lastic anemia' and
throm(oc%to&enia#
- KGre% (a(% s%ndromeL occurs when infants gi*en cannot con7ugate it.
- +nti(iotic of first choice in the treatment of life-threatening influenza and t%&hoid
fe*er.
S+LFONAMI'ES
- cannot (e classified as an anti(iotic (ecause the% are not &roduced (% li*ing organisms.
- (acteriostatic against man% gram &ositi*e and gram negati*e (acteria.
+d*erse Feaction.
3. +llergic reaction "rash' urticaria' &ruritus' fe*er' fatal e)foliati*e dermatitis#.
;5
DCB
-. Eausea' *omiting' a(dominal discomfort' headache and dizziness.
9. i*er damage' de&ressed renal function' (lood d%scrasias.
=ses.
- used when anti(iotics are ineffecti*e or cannot (e used.
- should not (e used to&icall% for oral lesions
ANTIF+NGAL 'R+GS
1& NYSTATIN
- effecti*e against candida al(icans
- not a(sor(ed from the skin or mucuos mem(ranes.
- used for local effects in the treatment of candidiasis on the skin or an% &art of the
alimentar% tract.
- has a *er% un&leasant taste.
$ses)
a. Thrush
(. Denture stomatitis
c. +nti(iotic stomatitis
d. $ome forms of mucocutaneous candidiasis.
,& AMPHOTERICIN B
- &oorl% a(sor(ed from the G0T and &ro(a(l% not all from the un(roken skin.
- used locall% to treat conditions for which n%statin could (e used.
- a*aila(le in intra*enous in7ection.
0& IMI'AKOLE AGENTS
"Miconazole' Qetoconazole#
- used in the treatment of s%stemic fungal infections and candidiasis
----------------------------------------------------------------------------------------------------------------------------------------------
G E N E R A L R E F E R E N C E S
+nsel' ,.C.' Po&o*ich' E.G.' and +llen' .G.. KPharmaceutical Dosage forms and Drug Deli*er%
$%stemsL' $i)th edition' 1illiam and 1ilkins' =$+' 355<.
+s&erheim' M. Q.. KPharmacolog% +E 0ETF2D=CT2FH TEMTL' $e*enth Edition
1.B. $aunders Com&an%' Philadel&hia' Penns%l*ania' =$+' 355-.
Gra7eda-,igle%' .. K=nderstanding Pharmacolog%. + Ph%siologic +&&roachL' +&&leton and
ange' $tanford' =$+ -BBB.
;6
DCB
Qee' ;.. and ,a%es' E.F.. KPharmacolog%. + Eursing Process +&&roachL' 3
st
edition' 1.B.
$aunders Com&an%' Philadel&hia' Penns%l*ania' =$+.
Musser' F. D. and 2OEeil' ;. ;.. KPharmacolog% and Thera&euticsL' 6
th
edition. The McMillan
Com&an%' ondon' 35A5.
M%cek ' M. ;.' ,ar*e%' F. +.' and Cham&e' P. C.. Ki&&incottOs 0llustrated Fe*iews.
Pharmacolog%L' -
nd
edition' i&&incott-Fa*en Pu(lishers' 0nc. Eew Hork 355:
2lson' ;.. KClinical Pharmacolog% Made Fidiculousl% $im&leL' international editions -BBB'
McGraw-,ill Book Com&an%' $inga&ore' 355:.
$tringer' ;... KBasic Conce&ts in Pharmacolog%L' + $tudentOs $ur*i*al Guide' -
nd
edition'
McGraw-,ill Com&anies' 0nc.' $inga&ore' -BB3.
1alton' ;. G.' Thom&son ;. 1.' and $e%mour' F. +.. KTe)t(ook of Dental Pharmacolog% and
Thera&euticsL' $econd edition' 2)ford =ni*ersit% Press' Eew Hork' 3556
----------------------------------------------------------------------------------------------------------------------
CENTRO ESCOLAR +NI-ERSITY
Co##e"e o4 'entistr!
Course Title. PHARMACOLOGY

Course Eum(er. P,+3BB!P,+3BB
=nits. ecture R - ,ours ! 1eek. ecture R - hours!week
a(orator% R 3 a(orator% R 9 hours!week
Pre-re/uisites. +nesthesiolog%
Course Descri&tion.
The course &resents the &rinci&les in the use of drugs for the diagnosis' &re*ention' and
treatment of diseases. Each drug is considered according to its indication' mechanism of action'
&harmacokinetics' contraindications and &recautions' unwanted effects and drug interactions. The
course deals more on the commonl% &rescri(ed drugs used and related in the &ractice of Dentistr%.
General 2(7ecti*es.
3. To e)&lain the (asic and clinical &harmacolog% u&on which drug thera&% is (ased with
&articular em&hasis on drugs used in Dentistr%.
-. To demonstrate the &h%sical and (iological (eha*ior of some drugs in order to familiarize
students with the actual effects of drugs.
9. To e)&ose students to the t%&e of /uestions the% will encounter in the licensure
e)aminations.
;7
DCB
CO+RSE PLANB
Co)rse
Content
S%eci4ic O?Eecti(es
S)""este
Teachin"
Methoo#o"!=
Strate"! an
Materia#s
Time A##otment
.no& o4 ho)rs/
E(a#)ati(e Meas)res
an ReI)irements
0ntroduction
to
Pharmacolog%
To introduce the
general &rinci&les of
&harmacolog%
ecture ec. @ 6
a(. @ 9
Fecitation!Puizzes
a(orator% Manual
Drug
Eomenclature
To identif% drugs
according to their
generic' chemical' and
trade names
ecture ec. @ -
a(. @ 9
Fecitation!Puizzes
a(orator% Manual
M0M$
Drug Thera&% To know and
understand the
different &rocesses
in*ol*ed in drug
thera&%.
ecture ec. @ 6 Fecitation!Puizzes
Foute of Drug
+dministration
+. 0M!
$u(cutaneous
B. Cutaneous
To effecti*el% a&&l%
drugs according to its
route of administration
ecture
demonstration
method
a(. @ 9
a(. @ 9
Practical e)ercise
Puizzes
Dosage 8orms To familiarize students
on the different dosage
forms of drugs?
differentiating one
from the other
K$how and
Tell MethodL
a(. @ A 1ritten Fe&ort
2ral Fe&ort
a(orator% Manual
Practical!1ritten Puiz
Drug
iterature
To inter&ret different
drug literature
ecture a(. @ 9 0nter&retation of
literatures
a(orator% Manual
$%stems of
Measurement
Con*ersion
To know how to
con*ert units and
doses of drugs
ecture
Board
e)ercises
ec. @ -
a(. @ 9
E)ercise!Puizzes
a(orator% Manual
Com&utation
of a childOs
dose
To know how to
&ro&erl% com&ute for a
childOs dose.
ecture
Board
e)ercises
ec. @ -
a(. @ 9
E)ercise!Puizzes
a(orator% Manual
Prescri&tion
1riting and
Prescri&tion
2rders
To e/ui& students with
the knowledge of
&rescri&tion writing.
To learn how to
inter&ret &rescri&tion
order.
ecture
Board
e)ercises
ec. @ -
a(. @ A
Puizzes
a(orator% Manual
Pharmacolog%
of Pain and
0nflammation
To know the different
&rocesses in*ol*ed
with &ain.
ecture ec. @ - Fecitation
Puizzes
;9
DCB
To know the different
mediators of
inflammation.
+nalgesics To know the
mechanism of action
and a&&lication of the
different grou&s of
analgesics.
ecture
Prescri&tion
1riting
e)ercises
ec. @ 6 Fecitation
Puizzes
+ntihistamines To know the
&harmacokinetics and
&harmacod%namics of
antihistamines
ecture ec. @ - Fecitation
Puizzes
,emostasis !
,emostatic
agents
To know the
mechanism of action
of hemostatic agents
and its im&ortance in
Dentistr%.
ecture
Test for
(leeding
time!clotting
time of white
mice
ec. @ -
a(. @ 9
Fecitation
Puizzes
a(orator% Manual
+nesthetic
agents
To descri(e the
&harmacod%namics of
these drugs.
ecture
Tests the
effects on
white mice
ec. @ -
a(. @ 9
Fecitation
Puizzes
a(orator% Manual
+ntimicro(ials To know the different
t%&es of antimicro(ials
and its corres&onding
mechanism of action.
To a&&l% through
&rescri&tion writing
the antimicro(ials
learned.
ecture
0noculation
of (acteria
Culture and
sensiti*it%
Test
ec. @ 6
a(. @ 9
Fecitation
Puizzes
Practical e)ercises
a(orator% manual
+ntise&tics and
Disinfectants
To know the
&harmacod%namics of
these drugs.
ecture ec. @ -
a(. @ 9
Fecitation
Puizzes
a(orator% manual
Drugs acting on
the Central
Eer*ous
$%stem
To descri(e the
mechanism of action
of sedati*e-h%&notics
ecture ec. @ -
a(. @ 9
Fecitation
Puizzes
a(orator% manual
Thera&eutic
Measures of
Common
Dental
Conditions and
Emergenc%
Drugs.
To familiarize students
with common dental
diseases and its
thera&eutic measures.
To understand the
&ro&er management of
some dental office
emergencies.
To understand the
ecture ec. @ A
a(. @ 5
Fesearch &a&ers
Fecitation
Puizzes
a(orator% manual
;;
DCB
&harmacologic
orientation of +0D$
and ,e&atitis.
$uggested Feferences.
Te)t(ook of Dental Pharmacolog% and Thera&eutics (%. ;ohn G. 1alton
Pharmacolog% (%. Goodman and Gillman
Pharmacolog% (%. Qatzung
Clinical Pharmacolog% in Dental Practice (%. $am G. ,olro%d
LABORATORY TOPICS MAN+AL TOPICS LECT+RE TOPICS
3. 0ntroduction and definition
of terms
3. 0ntroduction to
Pharmacolog%
3. 0ntroduction and definition
of terms
-. Demonstration of Foutes of
+dministration
-. Drug Eomenclature -. Drug Eomenclature
9. $kin Testing 9. Foutes of Drug
+dministration
9. Drug Thera&%
6. 0nter&retation of Drug
0nserts
6. $kin Testing 6. Foutes of Drug
+dministration
<. Con*ersion of doses and
measurements
<. Drug Dosage 8orms <. Dosage 8orms
A. Prescri&tion 1riting A. Drug iteratures A. Drug iteratures
:. Prescri&tion 2rders :. $%stem of measurements :. $%stem of Measurements
PFE0M EM+M 4. Con*ersions 4. Prescri&tion 1riting !
2rders
4. Earcotics and Eon-
Earcotics +nalgesics
5. Prescri&tion 1riting 5. +nalgesics
5. ,istamine and
+ntihistamines
3B. Prescri&tion 2rders 3B. General +nesthetics
3B. ,emostasis and
,emostatic +gents
33. +nalgesics 33. ocal +nesthetics
33. General +nesthetics 3-. +ntihistamines 3-. ,istamines and
+ntihistamines
3-. ocal +nesthetics 39. ,emostasis and 39. ,emostasis and hemostatic
;:
DCB
,emostatics +gents +gents
39. +ntimicro(ials R culture
and $ensiti*it%
36. General +nesthetics 36. +ntimicro(ials
3<. ocal +nesthetics 3<. +ntise&tics ! Disinfectants
36. $edati*e R ,%&notics 3A. +ntimicro(ials 3A. $edati*e-,%&notic Drugs
3<. +ntise&tics and
Disinfectants
3:. $edati*e-,%&notic Drugs 3:. 2ffice Emergencies
3A. Common 2ral Diseases 34. +ntise&tics ! Disinfectants 34. Common 2ral diseases
3:. 2ffice Emergencies 35. Common Dental Diseases 35. +0D$ ! ,e&atitis
34. +0D$ and ,e&atitis -B. 2ffice Emergencies
-3. +0D$ and ,e&atitis
O+TLINE OF TOPICS IN PHARMACOLOGY
PRELIM
LECT+RE
:st ?eeting
2rientation
<nd ?eeting
Definition of terms
0ntroduction
,istor% of &harmacolog%
Branches of Pharmacolog%
0m&ortance of Pharmacolog% to dentistr%
8undamental action of drugs
=ses of Drugs
Drug Eomenclature
Drug Pu(lications
Puiz
:@
DCB
Grd ?eeting
$tages in the de*elo&ment of a drug
0ntroduction to Drug Thera&%
Puiz

E
th
meeting
Process of Drug Thera&%
Puiz
5
th
meeting
Continuation of Drug Thera&%
Puiz
ECT=FE PFE0M EM+M
LABORATORY
:st ?eeting
2rientation
<nd ?eeting
E)ercise - Y 9
DE)ercise 3 will (e gi*en as a /uiz
,ow to use M0M$
Puiz
Grd ?eeting
E)ercise 6
Foutes of Drug administration
Puiz
E
th
meeting
E)ercise <
Puiz
+B2F+T2FH PFE0M EM+M
General Princi&les ! 8actors ! Terminologies
3. 8actors affecting PatientCs Feaction to Drugs
+. Foutes of Drug +dministration
3. Enteral
-. Parenteral
B. Passage of Drug +cross Bod% Mem(rane
3. +cti*e Transfer
-. Passi*e Trans&ort
C. 8ate of Drug
:1
DCB
3. +(sor&tion
-. Distri(ution
9. Meta(olism ! Biotransformation
6. E)cretion ! Elimination
-. Considerations in Drug +dministration
+. Tolerance
B. Pathologic $tate
C. +ge and 1eight
9. +ction *s. Effect
+na&h%la)is
Place(o
0mmunit%
0dios%ncras%
Tolerance
Tach%&h%la)is
Drug Fesistance
Fefractor%
,%&oreaction
,%&er-reaction
,%&ersensiti*it%
$u&ersensiti*it%
44444444444444444444
Grd ?eeting
General +nesthetics
ocal +nesthetics
ocall% +cting Medication. +ntimicro(ials' ,emostatics and Protecti*es
Eth ?eeting
Diuretics and +ntih%&ertensi*e
$edati*e ,%&notics
Ps%chothera&eutic
5th ?eeting
Central Eer*ous $%stem $timulants
+nticon*ulsant
+ntineo&lastic
+drenocorticosteroids
FINALS
:,
DCB
D $PEC0+ T2P0C$

:st ?eeting
Emergenc% Drugs
<nd ?eeting
Pharmacologic Considerations
Grd ?eeting
Disease $tatus of Common 0nterest
Eth ?eeting
Pharmacologic Management of Certain Common 2ral Disease Entities
5th ?eeting
Drug 0nteractions
Predicta(le Feaction.
3. E)cess &harmacological acti*it%
-. Fe(ound res&onse u&on discontinuation
E)cessi*e Pharmacological Effects.
3. Fes&irator% de&ression in se*ere (ronchitic &atients gi*en mor&hine or (enzodiaze&ine
h%&notics
-. ,%&otension resulting in stroke' m%ocardial infarction or renal failure in &atients recei*ing
e)cessi*e doses of antih%&ertensi*e drugs.
9. Brad%cardia in &atients recei*ing e)cessi*e D0G2M0E
1ithdrawal $%m&toms.
3. E)treme agitation' tach%cardia' confusion' delirium and con*ulsions ma% occur following the
discontinuation
of long-term CE$ de&ressants such as (ar(iturates' (enzodiaze&ine and alcohol.
-. +cute +ddisonian crisis ma% (e &reci&itated (% the a(ru&t cessation of corticosteroid thera&%.
9. $e*ere h%&ertension and s%m&toms of s%m&athetic o*eracti*it% ma% arise shortl% after
discontinuing
clonidine thera&%.
6. 1ithdrawal s%m&toms after narcotic analgesics.
+llergic Fes&onses.
A##er"! - altered ca&acit% of the (od% to react to *arious antigens with which it comes in
contact.
:0
DCB
D - T%&es of ,%&ersensiti*it%.
3. 0mmediate
- anti(od% is circulating or fi)ed to certain tissues.
- +ntigen reacts to anti(od%.
-. Dela%ed
- a reaction of T-cells that ha*e (een stimulated (% antigen to react against targets such as
infectious agents.
- +nti(od% is not in*ol*ed.
Geneticall% Determined effects - ma7or to)icit% of some drugs is restricted to indi*iduals with
&articular
genot%&e or genetic make-u&.
DE8ECT T2M0C DF=G $HMPT2M$
Pseudocholinesterase
Deficienc% $uccin%lcholine Paral%sis
+&nea
Glucose-A-Phos&hate
Deh%drogenase deficienc% $ulfonamides
Puinidines ,emol%sis
Prima/uine
+cet%lator-Pol%mor&hism Procainamide $%stemic u&us
,%dralazine
0soniazid Eeuro&ath%
,e&atic Por&h%ria Bar(iturates $%m&tomatic &ro&h%ria
0dios%ncratic Drug Feaction.
Iios!ncrac! - used &rimaril% to co*er unusual' une)&ected' (izarre drug effects that cannot
readil% e)&lained or &redicted in indi*idual reci&ients.
DDF=G 0ED=CED M+0GE+ET D0$E+$E 0$ 82FT=E+TEH F+FE...
PHARMACOLOGY OF THE A+TONOMIC NER-O+S SYSTEMB
- generall%' all drugs influence (lood &ressure' heart rate' &otassium &um&
Di*ersit% of +E$ on Bod% functions s&ecific to Dentistr%.
3. Practical a&&lication of *asoconstrictors in local anesthetic solutions.
-. +gents that reduces sali*ar% flow
9. +lterations of the +E$ mechanism (oth centrall% and &eri&herall% antih%&ertensi*e drug.
6. $ignificant &eri&heral changes in +E$ acti*it% &roduced (% anti&s%chotic &henothiazines and
antide&ressants.
<. Entire conce&t of chemical neurotransmitters and rece&tors are founded on the &rinci&les of the
+E$.
1, 'i(isions o4 the ANS
:5
DCB
3. $%m&athetic
-. Paras%m&athetic
D Both are regarded as &eri&heral in modes of action and drug reactions e*en though these cell
(odies are
located within the CE$ and recei*e considera(le CE$ in&ut.
+utonomic Eer*ous $%stem - concerned with the maintenance of a constant internal en*ironment
to &ro*ide
for o&timal cellular function and sur*i*al.
8unctions.
Fefle) *asodilation
Fegulates Bod% tem&erature
Blood glucose le*el
Cardiac Fate
1ater Balance
SYMPATHETIC 'I-ISION - designed to co&e with sudden emergencies. E./. 8right and flight
&henomenon
PARASYMPATHETIC 'I-ISION - conser*ation of (odil% &rocesses E./. Fefle) slowing of
the heart
Action Potentia# - (ioelectric signals ! self &ro&agated im&ulses along the ner*es.
Ne)rotransmitters - chemical mediators that transmit signals across ner*e to ner*e' or ner*e
to effector tissue.
Acet!#cho#ine - s&ecific chemical mediator at all autonomic ganglia and &aras%m&athetic &ost
ganglionic s%na&ses.
- transmitter su(stance of the neuromuscualr 7unction in skeletal muscle.
Nore%ine%hrine - &rinci&al chemical mediator of the s%m&athetic &ostganglionic neuron.
E%ine%hrine - ma7or mediator released (% the adrenal medulla.
Cho#iner"ic - ner*es releasing acet%lcholine.
Arener"ic - ner*es releasing nore&ine&hrine.

:6

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