Transcript Chapter_033

Principles of Pharmacology
Chapter 33
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
1
Clinical Pharmacology
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Study of the biological effects of a drug on a
patient and the actions of the drug over time
Medical assistants must understand:
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Drug action
Typical side effects
Route of administration
Recommended dose
Individual patient factors that can alter the drug’s effect
and elimination
Be prepared to provide safe drug therapy patient
education.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
2
Government Regulation
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Several federal agencies regulate drugs in the United States.
FDA regulates development and sale of prescription drugs and
OTCs.
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New drugs must gain FDA approval before release.
Drug must pass tests starting in the laboratory on animals and
then in human clinical trials.
Drug must have an acceptable benefit-to-risk ratio.
Copyright awarded to pharmaceutical company for 17 years.
FDA ensures generic brands are effective and safe.
DEA enforces federal laws designed to control drug abuse and
also educates the public on drug-abuse prevention.
FTC regulates OTC advertisement.
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3
Generic Drug Standards
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Generic must have the same active ingredients, labeled
strength, route of administration, and dosage form.
Do not have to replicate the human clinical trials but must
prove the product performs exactly as the brand-name
version.
Generic must deliver the same amount of active ingredient
into the bloodstream in the same amount of time.
Label must contain the same information.
Manufacturing process must have comparable quality and
production standards.
FDA has found no difference in rates of side effects
between brand name and generic drugs.
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4
Controlled Substances Act (CSA)
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DEA enforces CSA regulations.
Drug that has potential for illegal use and abuse
must be placed on controlled substance list.
Any new medication that has action similar to a
drug already on the controlled list is
automatically considered a controlled substance.
CSA divides controlled substances into five
sections according to drug addictive abilities and
potential for abuse.
Refer to Table 33-1
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5
Classification of Controlled Substances
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Schedule I—No accepted medical use; illegal to possess.
Examples: heroin, LSD, Quaalude, amphetamines.
Schedule II—Severe restrictions; high potential for abuse.
Examples: morphine, cocaine, cannabis, Percodan.
Schedule III—Accepted use; moderate to low physical and
high psychological dependence. Examples: Tylenol with
codeine, paregoric, anabolic steroids.
Schedule IV—Accepted for use; low potential for abuse.
Examples: Librium, Valium, Darvon, Tranxene, Xanax.
Schedule V—Accepted for use; low potential for abuse;
drug mixtures that contain limited amounts of narcotics.
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6
Regulations for Management of
Controlled Substances
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Physician Controlled Substance Registration
Certificate
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Documentation
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DEA registration number must be included on all prescriptions
for controlled substances.
Renewable every 3 years and specific to site of practice.
Number of doses dispensed and administered.
Count of doses on site before and after medication is
dispensed.
Specific forms developed for this purpose.
Any discrepancy in drug count must be cosigned.
Record keeping
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Records maintained on purchase and use.
Kept separate from patient chart for 2 years.
Be readily available for DEA inspection.
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7
Controlled Substance Regulations
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Controlled substance disposal
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Drug loss must be reported to DEA immediately.
Drug disposal requires two employees to witness and
document the procedure (Critical Thinking
Application).
Contact DEA for guidelines on disposal of large
amount.
Storage
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Immovable locked cabinet.
Limited access to keys.
MA must be aware of specific state regulations.
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8
Controlled Substance Prescriptions
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Must be written in ink or typed.
Prescription must include name and address of patient;
physician information including DEA number; amount
prescribed, written out, and usually for small quantities;
must be manually signed by the physician.
Orders for Schedule II drugs cannot be phoned in except in
an absolute emergency, and written prescription must be
delivered to the pharmacy within 72 hours. Prescription
cannot be refilled.
Schedule III, IV, and V drugs may be prescribed by phone
or written and refilled up to five times in a 6-month period.
In some states Schedule V drugs can be dispensed by the
pharmacist without a physician prescription.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
9
Drug Abuse
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Patients may misuse or abuse prescription, OTC,
and illegal drugs.
Drug dependence—inability to function unless
under the influence of the substance.
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Can have acute and chronic effects
Physical dependence (addiction)—biochemical
changes within the body that require the substance
to be used continuously in order for the person to
function and to avoid physical discomfort
Psychological dependence—compulsive craving for
the substance
• Habituation—mild form (caffeine)
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10
Prevention of Drug Abuse
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Monitor patients who repeatedly call for
controlled substance prescription refills.
Request medical records for patients with a
history of controlled substance use.
Keep prescription pads in a safe place.
Store limited amount of controlled substances
in office.
Maintain complete and accurate records; keep
patient records accurate and complete.
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11
Drug Names
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A single drug may have as many as three
names: chemical, generic, and trade.
Chemical name is the drug’s formula.
Generic or official name is assigned to the
drug and may reflect the chemical name. Is not
protected by copyright law.
The trade or brand name is the name given
the compound by the developing
pharmaceutical company and is protected by
copyright for 17 years.
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12
Approaches to Studying Pharmacology
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Using drug reference materials is crucial to the
safe administration of medications.
Most drug reference books supply the action,
indication, contraindications, precautions,
adverse reactions, dosage, administration
guidelines, and method of packaging.
The most frequently consulted drug reference
guide is the PDR, but package inserts also can
be used.
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13
PDR Sections
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Manufacturer’s index—white: alphabetical listing of
pharmaceutical companies
Brand and generic section—pink: alphabetical listing
with complete information of all drugs included in the
PDR volume
Product category index—blue: alphabetic listing
according to drug category
Product identification section—gray: illustrated section
that shows actual size photographs of medications
General and diagnostic product information area—
white: alphabetical listing of diagnostic product
information and their uses
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14
Pregnancy Risk Categories
A Remote risk; controlled studies in women have failed
to demonstrate risk to fetus
B Slightly more risk than A; animal studies show no risk
but controlled human studies have not been done or
animal studies show risk, but controlled studies in
women have shown no risk
C Greater risk than B; Animal studies have shown risk,
but no controlled human studies have been done or
no studies have been done in animals or women
D Proven risk of fetal harm; human studies show proof
of fetal damage, but the potential benefits of use
during pregnancy may make its use acceptable
X Proven risk of fetal harm; studies in women or
animals show definite risk of fetal abnormality; risks
outweigh any possible benefit
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15
Learning about Drugs
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Take opportunities to observe the use of drugs
in patient care.
Concentrate on the most important drugs in
each classification.
Learn about a drug’s primary action and use,
then expand your knowledge to its other
actions and uses.
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16
Drug Use Terminology
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Diagnostic — determines the cause of a
particular health problem
Palliative — does not cure but provides relief
from pain or symptoms related to the disorder
Prophylaxis — prevents occurrence of a
condition
Replacement — provides substances
needed to maintain health
Therapeutic — used to treat the disorder and
cure it
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17
Dispensing Drugs:
Over-the-Counter Drugs
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OTC drugs may interfere or interact with
prescription drugs.
Gather information about OTC use at each office
visit.
Patient education for safe use of OTCs:
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Carefully read label and insert for use guidelines.
Take only the recommended dose.
Discard when expired.
Inform the physician of OTC use.
Be aware of OTC contraindications.
Check with pharmacist if you have questions.
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18
Dispensing Drugs: Prescription Drugs
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Written order by a physician for the dispensing and
administration of a drug for a particular patient.
Must be signed by a physician to be legal.
MA may phone in a prescription to a pharmacy, but
the order must first be written down and reviewed by
the physician for accuracy.
Phoned order must be documented on the patient
chart as a record of the medication.
The MA may write a prescription dictated by the
physician, but the physician must review and sign
the prescription.
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19
Sample Prescription
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20
Six Parts of a Prescription
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Superscription: Patient's name and address,
the date, and the symbol Rx (for the Latin
“recipe,” meaning “take”)
Inscription: Main part of the prescription;
name of the drug, dosage form, and strength
Subscription: Directions for the pharmacist;
size of each dose, amount to be dispensed,
and the form of the drug such as tablets or
capsules
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
21
Six Parts of a Prescription
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Signature: Directions for the patient; usually
preceded by the symbol Sig: (for the Latin “signa,”
meaning “mark”). The physician writes instructions
for the label that tell the patient how, when, and in
what quantities to use the medication.
Refill information: May be regulated by federal law
if drug is a controlled substance; must write number
of times refill is allowed.
Physician signature: Must include manual
signature
of the physician and DEA number when indicated.
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22
Common Prescription Abbreviations
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Refer to Table 33-3 for medical abbreviations
that are used when writing prescription orders
and documenting medication administration.
Refer to Table 33-4 for TJC’s “Do Not Use”
list of abbreviations and symbols
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23
Preparing a Prescription
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Refer to Procedure 33-1 for steps in
preparing a prescription for the physician’s
signature.
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24
Drug Interactions with the Body:
Pharmacokinetics
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Study of the movement of drugs throughout the
body
Four actions occur when a drug is taken:
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Absorption
Distribution
Metabolism
Excretion
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25
Pharmacokinetic Terms
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Absorption: How a drug is absorbed into the
body's circulating fluids
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May have local or systemic effect
Rate of absorption depends on route of
administration
• Oral—convenient, safe, relatively inexpensive
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Some drugs can be destroyed by the GI system
Food slows absorption rate and may interfere with action
Metabolism in liver may require higher oral dose
Drug may require enteric coating to prevent destruction or
GI irritation
Some drugs are difficult to absorb through the GI mucosa
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26
Pharmacokinetic Terms
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Parenteral—Administration of drugs by injection
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Administered directly into the bloodstream (IV) or into
tissues with rich blood supply
Fastest acting route of administration (IV, IM, SC)
Rate of absorption increased with massage at site
Pharmaceutical preparation may prolong absorption
(PenG)
Topical and mucous membrane absorption
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Local or systemic effects
Examples: suppositories, nasal sprays, transdermal
patches, inhalants
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27
Pharmacokinetic Terms
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Distribution: How a drug is transported from the site
of administration
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Drugs attach to plasma proteins and are carried in the
bloodstream to target tissue
 Blood-brain barrier—functional barrier between brain cells
and capillaries
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Metabolism: How the drug is inactivated, including
the time it takes for a drug to be detoxified and
broken down into byproducts
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Occurs in the liver for excretion in the kidneys
 Drug tolerance—liver destroys it so rapidly that doses must
be increased continuously for the same effect
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28
Pharmacokinetic Terms
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Excretion: The route by which a drug is
excreted, or eliminated, from the body and the
amount of time such a process requires
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Primarily eliminated by the kidneys, also by
exhalation, milk glands, skin, and so on
Drug half-life—time required for drug amount to be
decreased by 50%
Half-life used to determine frequency of medication
administration to maintain therapeutic blood levels
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29
Terms Related to Drug Interactions
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Antagonism The action of one drug
decreases the intensity or shortens the
duration of action of another drug.
Synergism One drug increases the intensity
or prolongs the action of another drug.
Potentiation A form of synergism in which
the action of one of the drugs is increased by
the presence of another drug. In this case the
two drugs have different actions, but one
increases the effect of the other.
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30
Top 50 Prescribed Drugs
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Refer to Table 33-5 for details about the most
frequently prescribed medications in the
United States.
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31
Factors That Affect Drug Action
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Body weight
Age
Sex
Time of day
Pathological factors
Immune responses
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32
Factors That Affect Drug Action
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Psychological factors
Tolerance
Accumulation
Idiosyncrasy
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33
Geriatric Responses to Medications
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Increased risk of stomach irritation and
ulceration
Increased likelihood of drug storage in fat;
may lead to drug toxicity
Decreased ability for drugs to pass through
cell membranes; increases drug blood levels
Decline in liver function
Decreased kidney function
Peripheral vascular disease decreases
distribution of drugs to periphery
Increased risk of vertigo and confusion
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34
Classifications of Drug Actions
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Drugs are generally classified according to
their actions on the body or according to the
body system they affect.
May have multiple actions and therefore
multiple classifications.
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35
Adrenergics
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Action: Constricts blood vessels, narrows the
lumen of a vessel
Examples: Epinephrine, phenylephrine
(Neo-Synephrine)
Primary use: Stops superficial bleeding,
increases and sustains blood pressure, and
relieves nasal congestion
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36
Adrenergic-Blocking Agents
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Action: Vasodilation; decreases blood
pressure; increases muscle tone of GI walls.
Examples: Lisinopril (Prinivil); amlodipine
(Norvasc); metoprolol (Toprol-XL);
methyldopa (Aldomet); propranolol (Inderal);
atenolol (Tenormin); carvedilol (Coreg);
tamsulosin (Flomax).
Primary uses: Control of hypertension and
peripheral vascular disease; treatment of
prostatic hypertrophy.
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37
Analgesics
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Action: Lessens the sensory function of the
brain
Examples:
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Nonnarcotic—aspirin; acetaminophen (Tylenol);
ibuprofen (Advil, Motrin)
Narcotic—oxycodone (OxyContin); meperidine
(Demerol); hydrocodone (Vicodin); propoxyphene
(Darvon)
Primary use: Pain relief
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38
Anesthetics
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Action: Produces insensibility to pain or the
sensation of pain
Examples: Bupivacaine (Marcaine); lidocaine
(Xylocaine); lidocaine topical (Lidoderm).
Primary use: Local or general anesthesia
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39
Antacids
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Action: Decreases the acidity in the stomach
Examples: omeprazole (Prilosec);
esomeprazole (Nexium); rabeprazole
(Aciphex); lansoprazole (Prevacid);
pantoprazole (Protonix); magaldrate (Riopan);
calcium carbonate (Maalox)
Primary use: Treatment of gastric hyperacidity
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40
Antianxiety
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Action: Reduces anxiety and tension
Examples: Chlordiazepoxide (Librium);
diazepam (Valium); alprazolam (Xanax)
Primary use: Produces calmness and releases
muscle tension
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41
Antibiotics
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Action: Kills or inhibits the growth of
microorganisms
Examples: Cefaclor (Ceclor); levofloxacin
(Levaquin); tetracycline (Acromycin);
amoxicillin (Augmentin); ciprofloxacin (Cipro)
Primary use: Treatment of bacterial invasions
and infections
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42
Anticholinergics
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Action: Parasympathetic blocking agent,
reduces spasm in smooth muscle
Examples: Scopolamine; atropine sulfate;
tiotropium inhalation (Spiriva).
Primary use: Dry secretions; prevent
bronchospasm.
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43
Anticoagulants
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Action: Delays or blocks the clotting of blood
Examples: Heparin; warfarin sodium
(Coumadin)
Primary use: Prevention of blood clots;
thrombophlebitis; prevention of clot formation.
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44
Anticonvulsants
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Action: Prevents seizures; reduces excessive
stimulation of the brain
Examples: Clonazepam (Klonopin);
gabapentin (Neurontin); phenytoin (Dilantin);
phenobarbital; carbamazepine (Tegretol);
lamotrigine (Lamictal); pregabalin (Lyrica)
Primary use: Treatment of epilepsy and other
neurological disorders such as peripheral
neuropathy
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45
Antidepressants
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Action: Treats depression
Examples: Venlafaxine hydrochloride (Effexor);
sertraline (Zoloft); escitalopram (Lexapro);
duloxetine (Cymbalta); bupropion (Wellbutrin);
trazodone HCl (Desyrel); fluoxetine (Prozac);
imipramine pamoate (Tofranil); amitriptyline
(Elavil)
Primary use: Mood elevator
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46
Antiemetics
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Action: Acts on hypothalamus center in the
brain
Examples: Prochlorperazine (Compazine);
trimethobenzamide (Tigan); metoclopramide
(Reglan); granisetron (Kytril); ondansetron
(Zofran)
Primary use: Prevent and relieve nausea and
vomiting
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47
Antifungals
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Action: Slows or retards the multiplication of
fungi
Examples: Miconazole (Monistat); nystatin
(Mycostatin); fluconazole (Diflucan);
ketoconazole (Nizoral)
Primary use: Treatment of systemic or local
fungal infections
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48
Antihistamines
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Action: Counteracts the effects of histamine;
may inhibit gastric secretions
Examples: Fexofenadine (Allegra); cetirizine
(Zyrtec); chlorpheniramine (Chlor-Trimeton);
diphenhydramine (Benadryl); promethazine
(Phenergan); cimetidine (Tagamet); ranitidine
(Zantac).
Primary use: Relief of allergies; prevention of
gastric ulcers
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49
Antihypertensives
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Action: Blocks nerve impulses that constrict
arteries; or slows heart rate, decreasing
contractility; or restricts the hormone aldosterone
in the blood
Examples: Amlodipine (Norvasc); atenolol
(Tenormin); doxa-zosin mesylate (Cardura);
metoprolol (Lopressor or Toprol); methyldopa
(Aldomet); valsartan (Diovan); amlodipine (Lotrel)
Primary use: Reduces and controls blood pressure
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50
Antiinflammatory
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Action: Antiinflammatory or antirheumatic
Examples:
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Nonsteroidal (NSAIDs): Ibuprofen (Advil, Motrin);
naproxen (Naprosyn); celecoxib (celebrex);
etanercept (Enbrel)
Steroidal (SAIDs): Dexamethasone (Decadron);
prednisone (Cortisone); monte-lukast sodium
(Singulair); fluticasone propionate (Flonase)
Primary use: Treatment of arthritic and other
inflammatory disorders
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51
Antimigraines
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Action: Alter circulation to the brain
Examples: Topiramate (Topamax);
sumatriptan (Imitrex); zolmitriptan (Zomig)
Primary use: To treat or prevent migraine
headaches
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52
Antineoplastics
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Action: Inhibits the development of and
destroys cancerous cells
Examples: Interferon alfa-2a (Roferon-A);
hydroxyurea (Hydrea); cyclophosphamide
(Cytoxan); fluorouracil (Adrucil)
Primary use: Cancer chemotherapy
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53
Antipruritics
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Action: Relieve itching
Examples: Calamine lotion; hydrocortisone
ointment; Benadryl
Primary use: Allergies or topical exposures that
cause itching
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54
Antipsychotics
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Action: Alter the chemical actions in the brain
Examples: Quetapine (Seroquel); risperidone
(Risperdal); aripiprazole (Abilify); olanzapine
(Zyprexa)
Primary use: Treat the symptoms of
schizophrenia and bipolar disorder
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55
Antipyretics
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Action: Reduces body temperature
Examples: Aspirin, acetaminophen, ibuprofen
Primary use: Reduces fever
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56
Antispasmodics
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Action: Relieves or prevents spasms from
musculoskeletal injury or inflammation
Examples: Methocarbamol (Robaxin);
carisoprodol (Soma); cyclobenzaprine
(Flexeril)
Primary use: Sport injuries
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57
Antitussives (Cough Suppressants)
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Action: Inhibits the cough center
Examples:
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
Narcotic: Codeine sulfate
Nonnarcotic: Dextromethorphan (Romilar,
Robitussin DM)
Primary use: Temporarily suppresses a
nonproductive cough; reduces the thickness of
secretions
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
58
Bronchodilators



Action: Relaxes the smooth muscle of the
bronchi
Examples: Aminophylline (Aminophyllin);
theophylline (Theo-Dur); epinephrine
(Adrenalin, Sus-Phrine); albuterol (Ventolin,
Proventil); isoproterenol (Isuprel)
Primary use: Treatment of asthma,
bronchospasm; promotes bronchodilation
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
59
Cathartics (Laxatives)



Action: Increases peristaltic activity of the large
intestine
Examples: Magnesium hydroxide (milk of
magnesia); bisacodyl (Dulcolax); casanthranol
(Peri-Colace); psyllium hydrophilic muciloid
(Metamucil)
Primary use: Increases and hastens bowel
evacuation (defecation)
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60
Contraceptives



Action: Inhibits conception
Examples: Medroxyprogesterone acetate
(Depo-Provera); norgestrel (Ovrett); ethinyl
estradiol and ethynodiol diacetate (Demulen
1/35); Ortho Evra; etonogestrel (NuvaRing)
Primary use: Family planning
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
61
Decongestants



Action: Relieves local congestion in the tissues
Examples: Ephedrine or phenylephrine
(Neo-Synephrine); pseudoephedrine
(Sudafed); oxymetazoline (Afrin); mometasone
(Nasonex)
Primary use: Relief of nasal and sinus
congestion caused by common cold, hay fever,
or upper respiratory tract disorders
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
62
Diuretics



Action: Inhibits the reabsorption of sodium and
chloride in the kidneys
Examples: Hydrochlorothiazide (Dyazide,
Esidrix, HydroDiuril); furosemide (Lasix);
triamterene (Dyrenium)
Primary use: Increases urinary output,
decreases blood pressure
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
63
Expectorants



Action: Increases secretions and mucus from
the bronchial tubes; allows patient to cough up
secretions in lungs
Examples: Diphenhydramine (Benylin);
guaifenesin guaiacolate (Fenesin, Robitussin)
Primary use: Upper respiratory tract congestion
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
64
Hemostatic Agents



Action: Controls bleeding, a blood coagulant
Examples: Phytonadione, vitamin K (Konakion);
absorbable hemostatics, such as Gelfoam and
Surgicel, are applied directly to a wound
Primary use: Control of acute or chronic
blood-clotting disorder; formation of absorbable,
artificial clot
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
65
Hematopoietic Agents



Action: Promotes red blood cell production
Examples: Epoetin-alfa (Epogen, Procrit)
Primary use: Treatment of anemia in
chemotherapy patients
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
66
Hormone Replacement



Action: Replaces hormones or compensates
for hormone deficiency
Examples: Insulin (Humulin); levothyroxine
sodium (Synthroid or Levoxyl); estrogen
(Premarin); vasopressin (Pitressin)
Primary use: Maintenance of adequate
hormone levels
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
67
Hypnotics (Sedatives)



Action: Induces sleep and lessens the activity
of the brain
Examples: Zolpidem tartrate (Ambien);
eszopiclone (Lunesta); Secobarbital (Seconal);
flurazepam (Dalmane); temazepam (Restoril);
barbiturates
Primary use: Insomnia; lower doses sedate
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
68
Lipid-Lowering Agents



Action: Decreases blood cholesterol levels
and/or increases HDL levels
Examples: Atorvastatin calcium (Lipitor);
simvastatin (Zocor); ezetimibe (Vytorin or
Zetia); rosuvastatin (Crestor); fenofibrate
(Tricor).
Primary use: Management of high blood
cholesterol
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
69
Miotics



Action: Causes the pupil of the eye to constrict
Examples: Carbachol (Isopto Carbachol);
isoflurophate (Floropryl); pilocarpine (Isopto
Carpine)
Primary use: Counteracts pupil dilation
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70
Mydriatics (Anticholinergics)



Action: Dilates the pupil of the eye
Examples: Atropine sulfate (Isopto Atropine)
Primary use: Ophthalmologic examinations
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
71
Narcotics


Action: Depresses the central nervous system
and causes insensibility or stupor
Examples:



Natural narcotics: Opium group (codeine phosphate,
morphine sulfate)
Synthetic narcotics: Meperidine (Demerol),
methadone (Dolophine), and propoxyphene
hydrochloride (Darvon)
Primary use: Pain relief
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
72
Oral Hypoglycemics



Action: Decreases blood glucose levels by
increasing insulin production and/or decreasing
target cell resistance to insulin or by delaying
glucose absorption
Examples: Pioglitazone (Actos); rosiglitazone
(Avandia); metformin HCL (Glucophage); acarbose
(Precose); chlorpropamide (Diabinese); glimepiride
(Amaryl); glipizide (Glucotrol); glyburide
(Micronase)
Primary use: Management of Type 2 diabetes
mellitus
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
73
Osteoporosis Treatment



Action: Inhibits bone reabsorption and/or
promotes usage of calcium
Examples: Alendronate (Fosamax); risedronate
(Actonel); calcitonin (Miacalcin nasal spray
and Calcimar); dihydrotachysterol; etidronate
(Di-dronel)
Primary use: To promote bone mineral density
and reverse the progression of osteoporosis
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
74
Herbal and Alternative Therapies





Alternative therapies, often called either
complementary or holistic medicine, are frequently
used.
Limited scientific studies prove the effectiveness of
herbs; their use is definitely on the rise.
Patients are hesitant to discuss the use of herbal
products with physicians.
Physicians need to assess potential drug-herb
interactions.
Need to be familiar with common alternative
therapies and include questions about their use when
gathering the patient's medication history.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
75
Regulation of Herbal Products




FDA regulates dietary supplements under the
Dietary Supplement Health and Education Act of
1994.
Products are not registered with the FDA and do
not have to go through a rigorous approval
process.
No standardization between products produced by
different companies or among batches from the
same company.
By June of 2010 supplement manufacturers will
have to show evidence that products are pure and
contain what the label claims.
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76
Dietary Supplement Labels








Product name with the word "supplement" on the
label
Name and location of manufacturer or distributor
Can state benefit claims but must include required
FDA statements
Directions for use
Name of plant or part of plant used
Blended products must list components and weight
of each ingredient
Nondietary ingredients such as fillers and artificial
colors listed in descending order of weight
May identify warnings about use but lack of
warning does not mean adverse effects are absent
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
77
Commonly Used Herbal Products



Table 33-7 summarizes commonly used
herbal products.
Information about herbal remedies is
constantly changing.
Refer to the National Center for
Complementary and Alternative Medicine at
http://nccam.nih.gov/ and the National
Institutes of Health Office of Dietary
Supplements at
http://ods.od.nih.gov/index.aspx.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
78
Alternative Therapies



Acupuncture treatments use thin metal needles
inserted through the skin to stimulate specific
points in the body to restore and maintain
health.
Chiropractic practitioners perform
manipulations or anatomical adjustments to
correct alignment problems and help the body
heal itself.
Mind-body therapy uses biofeedback to teach
patients to use their thoughts to control certain
body reactions.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
79
Patient Education: Interactions







Monitor for pregnancy.
Question drug allergies each office visit.
Observe patient for 20 minutes after drug
administration.
Educate patient on possible drug side effects.
Educate patient on dose, time of administration,
and drug storage.
Question patient on whether medication is being
taken as ordered.
Answer questions or consult the physician.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
80
Therapeutic Communications with
Patients from Diverse Cultures




Investigate healing practices of the primary
cultures in your area.
Encourage cultural sensitivity in your
co-workers.
Provide patients with educational materials in
their native language.
Ask patients if they are using home remedies
or are consulting a healer from their culture. If
so, get as much detail as possible so you can
share this information with the physician.
Copyright © 2011, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc. All rights reserved.
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