PHARMACOLOGY AND HEALTHCARE

Pharmacology is a fascinating and multifaceted discipline which impacts not only on our professional careers, but on our personal lives as well.  From our role as members of the healthcare team to that of consumers, pharmacology plays a part in our lives.

The study of pharmacology covers a broad spectrum of diverse yet interrelated topics, such as botany, molecular chemistry, research, clinical observation, toxicology, legislation, and patient education.

Pharmacology is the study of drugs and their interactions with living organisms.  The term ‘pharmacology’ comes from a Greek word meaning ‘medicine.’  The term ‘drug’ is derived from a Dutch word which means ‘dry’ and refers to the use of dried herbs and plants as the first medicines.  The Latin word for ‘drug’ is ‘medicina’ from which we derive our term ‘medicine.’  Pharmacology is concerned with the nature of drugs and medications, their actions in the body, drug dosages, side effects of drugs, etc.  Drugs are used to prevent, treat, and cure diseases, and in some instances to diagnose diseases.

Different forms of a drug are appropriate for different routes of administration.  Some drugs are ineffective when administered in a certain form, while others are available and approved for use in several forms.  Some common manufactured drug forms are the tablet, the capsule, creams, ointments, lotions, powders, liquids, and foams.

There are various routes of drug administration.  Some drugs may be approved for use via more than 1 route and are manufactured in different forms appropriate for those different routes.  Each route of administration has distinct advantage and disadvantages.  A drug given by one route may be therapeutic, while given by another route it may be ineffective, harmful, or even fatal.  Therefore, every drug prescription or drug order always includes the form of the drug as well as the route of administration.

The oral route of administration is through the mouth.  It is routinely abbreviated as p.o., which is Latin for per os, which means through the mouth.  Tablets, capsules, and liquids are all given orally.  The oral route is the most convenient route of administration and the most commonly used.  Drugs may be swallowed to then dissolve in the stomach, or they may be placed under the tongue to dissolve.  This is known as the sublingual route of administration.  Drugs may also be given by the rectal route of administration or vaginally.  A relatively new route of administration is that of transdermal.  The drug is applied to the skin, but its effects are felt throughout the entire body.  Some drugs, particularly those intended for the respiratory system, may be inhaled in the form of a gas or finely vaporized liquid solution and absorbed in the lungs.  Another route of administration is parenteral.  This is a general term which includes all those routes of administration other than by mouth.  In particular, the parenteral route of administration includes intradermal, subcutaneous, intramuscular, and intravenous routes of administration.

Drugs exert their effects in a number of ways and at a number of sites within the body.  Basically, drugs act in 2 ways:  locally or systemically.  A local effect is limited to the site of administration and those tissues immediately surrounding it.  Drugs applied topically are an example of those that exert a local effect.  A systemic drug effect is not limited to the site of application, but can be felt throughout the body, particularly evident in certain organs and tissues.  Drugs taken intravenously and intramuscularly always exert a systemic effect.  Drugs taken orally and subcutaneously usually exert a systemic effect.  In addition, all drugs have both a therapeutic or intended effect, and side effects.  The therapeutic effect is the drug’s main action for which it was prescribed by the physician.  The therapeutic effect will cure a disease, decrease disease symptoms, or prevent disease.  The perfect drug would have a complete therapeutic effect perfectly suited for its use, but would have no side effects.  Unfortunately, this perfect drug does not exist.  Side effects vary widely with the type of drug administered.  They may be mild or quite severe.  Many drugs exert gastrointestinal side effects which include anorexia, nausea, vomiting, or diarrhea.  Common side effects which are expressed in the central nervous system may include drowsiness, excitement, or depression.  Also, drugs may react with other drugs in the system causing side effects.  Many patients are treated with more than 1 drug at a time.  In particular, elderly patients with chronic medical problems may consume a number of medications several times a day.  When administered simultaneously, some drugs react to each other in a particular way to either accentuate or diminish the action of each.

Before we begin a discussion of various body systems and the drugs that are prescribed for them, it would be wise to take a brief look at the subject of drug references.  Drug reference books are an invaluable source of information for the healthcare professional.  No medical transcription practitioner or student should be without an up-to-date drug reference source.  A number of excellent references are available on loan from libraries and hospitals or by direct purchase from the publisher.  These include ‘the American Drug Index’, ‘the Physicians’ Desk Reference’, as well as medical word and phrase books which contain drug terms.  More detailed drug information can be found in ‘Drug Facts and Comparisons’ and ‘the American Hospital Formulary.’  If a reference book cannot provide the answer to a drug question, the medical transcriptionist may even seek help from a pharmacist.  Some drug references are arranged in alphabetical order.  Other references are grouped by color-coded pages into generic, trade or brand names, and classification of drugs.  Some drug references give an extensive description of the drug, its indications, dosages, etc.  Others provide a briefer description or simply give the heading or classification to which a drug belongs.  In looking up a drug name, it is important not only to verify the correct spelling, but to also determine that the drug that you have selected is appropriate for the medical condition described.  This is an extremely important consideration because many drugs sound very much alike in their pronunciation but differ greatly in their use.  For example, Xanax and Zantac sound very much alike in their pronunciation; however, their uses are quite different.  Xanax is used to treat anxiety, while Zantac is used to treat duodenal or gastric ulcers.

Drugs are generally given in very small dosages and must be measured with extreme care.  Nearly all drugs manufactured and prescriptions written are done so according to standard metric measurements.  These measurements include the gram, milligram, and microgram.  Amounts less than 1 are indicated with a decimal point.  A less widely used form of measurement, not from the metric system, is that of grain.  Grains come from the old apothecary system used during colonial times.  We still use other apothecary measurements including the pint, quart, and gallon.  Amounts less than 1 are expressed as a fraction, rather than a decimal.  An example of a drug still commonly prescribed in grains is that of the thyroid medication, Synthroid.

We will now look at various medical specialties and the drugs which are prescribed to treat diseases in these various body systems.

Because of the superficial nature and location of most dermatologic diseases, they respond well to topical drug therapy.  Mild cases of skin diseases, such as acne, psoriasis, poison ivy, contact dermatitis, etc., can be successfully treated with topical agents.  Dermatologists commonly prescribe categories of drugs, such as anti-inflammatories or steroids, antipruritics, acne drugs, antifungal drugs, and local anesthetics.  See if you can successfully locate and spell the following dermatological drugs.  Some of these drugs are generic, which means that they should not be capitalized; others are trade or brand names, which means that the first letter should be capitalized:  Accutane, which is used for acne; Benadryl, which is an antihistamine used for itching; Lotrimin, which is an antifungal agent; Kwell, which is used to treat scabies; triamcinolone, which is a topical corticosteroid; Valisone, which is also a topical corticosteroid; Xylocaine, which is a local anesthetic; salicylic acid, which is used to remove warts; and Betadine, which is a skin cleanser with antibacterial action.

Urologists treat patients with a variety of medical conditions, including urinary retention, kidney stones, and urinary tract infections.  See if you can successfully locate and spell the following urologic drugs, both generic and trade names:  Duvoid, an antispasmodic prescribed for urinary bladder retention; Pyridium, a urinary analgesic; Bactrim, an antibiotic for urinary tract infections.

For diseases of the gastrointestinal tract, gastroenterologists prescribe a variety of classifications of drugs.  These include antacids, antispasmodics, histamine antagonists (also known as H2 blockers), antiflatulents, laxatives, and drugs to prevent diarrhea.  See if you can successfully locate and spell the following gastrointestinal drugs, both generic and trade names:  Maalox, an antacid; Carafate, a drug used to treat duodenal ulcer; Tagamet, a drug used to treat duodenal and gastric ulcers; ranitidine, a drug used to treat duodenal and gastric ulcers; Axid, a drug used to treat duodenal ulcer; simethicone, a drug which relieves the formation of gas in the stomach; Dulcolax, a laxative; Colace, a laxative; Lomotil, used to relieve diarrhea; and Azulfidine, an antibiotic-type preparation used to treat ulcerative colitis.

In the treatment of musculoskeletal disorders, the orthopedist or orthopedic surgeon sees many patients with medical conditions such as arthritis, bursitis, sprains and strains, as well as fractured bones.  A majority of the medications prescribed are for the relief of pain, muscular spasm, or to relieve inflammation.  See if you can successfully locate and spell the following orthopedic drugs, both generic and trade names:  Flexeril, a muscle relaxant; Robaxin, a muscle relaxant; cortisone, given as an injection for problems such as bursitis; ibuprofen, a nonsteroidal anti-inflammatory drug; Feldene, a drug which belongs to the category NSAID; and Voltaren, a drug used for osteoarthritis and rheumatoid arthritis.

The cardiologist treats patients with disorders of the cardiovascular system.  These disease processes may include high blood pressure, congestive heart failure, peripheral vascular disease, arteriosclerotic heart disease, angina pectoris, and cardiac arrhythmias.  See if you can successfully locate and spell the following cardiac drugs, both generic and trade names:  Digoxin, a cardiac glycoside which is used to treat congestive heart failure; Lasix, a diuretic, in fact, but which is used to treat congestive heart failure; nitroglycerin, which is used sublingually, as an ointment, or transdermally as a patch for the prevention and treatment of angina pectoris; lidocaine, which is used to treat ventricular arrhythmias; Procan SR, an antiarrhythmic drug; Procardia, which belongs to the classification of drugs known as calcium channel blocking agents; Lopressor, a drug used to treat hypertension, which belongs to the category known as beta blockers; clonidine, a drug used for hypertension; and Capoten, an antihypertensive agent which is also known as an ACE inhibitor.

Respiratory drugs are prescribed for the treatment of emphysema, asthma, and respiratory infections such as pneumonia or bronchitis.  See if you can successfully locate and spell the following respiratory drugs, both generic and trade names:  Proventil, a bronchodilator; theophylline, a bronchodilator; Theo-Dur, a bronchodilator; Beclovent, a steroid which is inhaled into the lungs; ampicillin, an antibiotic given for upper respiratory tract infections; and Septra, an antibiotic.

Common disorders of the endocrine system include diabetes mellitus and hypo- or hyperthyroidism.  There are 2 types of diabetes mellitus.  Type 1, or insulin-dependent diabetes mellitus, can be treated only with subcutaneous injections of insulin.  Type 2 diabetes mellitus, also known as
non-insulin-dependent diabetes mellitus or adult-onset diabetes mellitus, can be managed with weight control, dietary restrictions, and the use of oral medication.  This oral medication is not insulin, but is able to stimulate the pancreas to produce just enough insulin to supply the patient’s need.  It is interesting to note that insulin is measured in units, not with the metric system as are most other drugs.  Hypothyroidism is treated with the administration of a synthetic thyroid hormone.  As mentioned previously, thyroid hormone is administered in units of measure known as grains.  See if you can successfully locate and spell the following endocrine drugs, both generic and trade names:  NPH insulin; Humulin insulin; DiaBeta, an antidiabetic agent; Diabinese, an antidiabetic agent; Glucotrol, an oral hypoglycemic agent; Synthroid, a thyroid supplement; and Cytomel, a thyroid supplement.

The practicing obstetrician or gynecologist encounters many disease conditions of the female reproductive system.  These include pelvic inflammatory disease and endometriosis, sexually transmitted disease, yeast and Trichomonas infections, and abnormal bleeding patterns.  In addition, nondisease conditions, such as menopause, pregnancy, and the need for contraception, may warrant drug administration.  See if you can successfully locate and spell the following gynecological drugs, both generic and trade names:  Estraderm, an estrogen replacement drug used for menopause, which is given by the transdermal route; Premarin, an estrogen supplement for menopause; Estrovis, used for menopause; Provera, used to treat amenorrhea and abnormal uterine bleeding; Ortho-Novum, a birth control pill; Demulen, an oral contraceptive; Norinyl, an oral contraceptive; Vibramycin, an antibiotic used to treat pelvic inflammatory disease; Bicillin, a penicillin used to treat syphilis; Flagyl, used to treat Trichomonas infection; Monistat, an antifungal medication given as a vaginal suppository to treat yeast infections; prenatal vitamins, given to pregnant women; Clomid, to induce ovulation in women with fertility problems; and Danocrine, for the treatment of endometriosis.

Medical conditions of the ears, nose, and throat consist mainly of infections and allergic responses.  These are treated with various antibiotics, decongestants, antihistamines, and steroids.  See if you can successfully locate and spell the following ENT drugs, both generic and trade names:  Sudafed, a nasal decongestant; Vancenase, a topical nasal steroid; Entex LA, a long-acting decongestant; Benadryl, an antihistamine; amoxicillin, an antibiotic for throat and ear infections.

Ophthalmic drugs include Timoptic, used to treat glaucoma; Opticrom, used to treat allergic conjunctivitis; and Viroptic, used to treat herpes simplex virus infections of the eye.

Neurological and psychiatric drugs encompass those used to treat epilepsy, Parkinson disease, sleep disorders, anxiety, psychosis, and depression.  See if you can successfully locate and spell the following neurological and psychiatric drugs, both generic and trade names:  Dilantin, used to treat grand mal seizures; phenobarbital, used to treat grand mal seizures; Valium, given intravenously to treat status epilepticus and also used to prevent seizures during alcoholic withdrawal; Sinemet, used to treat Parkinson disease; Cogentin, used to treat Parkinson disease; lithium, a drug used to treat manic-depressive disorders; Librium, used to treat anxiety; amitriptyline, an antidepressant; Ludiomil, an antidepressant; Desyrel, an antidepressant; and Dalmane, a sleeping pill.

Susan M. Turley, MA, CMT

Author, Understanding Pharmacology

(Regents/Prentice Hall, Englewood Cliffs, New Jersey)

FOOTNOTE

Lines 17-22, 44-46 (Page 1).  Words under discussion (pharmacology, drug, etc.) may be enclosed in quotation.

Line 2 (Page 3).  The dictated error was corrected; Drug was changed to Desk (Physicians’ Desk Reference).

Line 44 (Page 4).  NSAID (nonsteroidal anti-inflammatory drug).

Line 14 (Page 5).  ACE (angiotensin-converting enzyme).