The profession of pharmacist

The licensed pharmacist dispenses medications ordered by the physician and is the professional who has the ultimate (максимальну) responsibility for the accuracy and appropriateness of those medications. A patient should get the right medication, in the right amount, at the right time, by the right route of administration.

Recognizing these rights, recent federal requirements mandate that a pharmacist shall provide patient counseling (консультація) concerning drug effects, dosage and form, medication and food compatibility, and dose scheduling. This is very important to the patient because the cooperation, or synergy, a given medication has with other drugs being taken or with certain foods can determine whether a toxic situation might arise.

This is where the work of a toxicologist becomes significant (значний). This pharmacological specialty studies harmful chemicals and their effects on the body and seeks antidotes for drugs that have toxic effects.

Pharmacy and toxicology are but two of the many specialties within the field of pharmacology. Others include medicinal chemistry, pharmacodynamics, pharmacokinetics, and molecular pharmacology. As modern medicine evolves (розвивається), new areas continue to open.

 

Sources of Drugs

Drugs of medical value are obtained from mineral, animal and plant sources. An increasing number of organic drugs are obtained by synthesis in the chemical laboratory.

Mineral drugs. The earliest medicine men used crude (необроблені, сирі) natural minerals as a source of many of his medicines. These natural minerals have been used throughout the centuries and are still used today in purified form. Iron oxide obtained by the exposure of iron to the elements was used by the ancient Greek physician in the treatment of anemia. Today, iron in purified form constitutes specific therapy for treatment of certain types of anemia. Many other minerals are employed in the treatment of disease, such as iodine, copper, manganese, and cobalt.

Animal drugs. The organs of animals have been used since the earliest records of medicine in the treatment of disease. Originally this treatment was entirely empirical. Today, it represents one of the greatest achievements of modern medicine. Extracts or whole organs are employed therapeutically in replacement therapy in patient showing a failure of that organ..

Desiccated thyroid gland is used in treatment of hypothyroidism; insulin extracted from the pancreas, in treatment of diabetes mellitus; extracts of the posterior pituitary, in treatment of diabetes insipidus, and a purified extract of the anterior pituitary (ACTH) can be used to stimulate production of hormones by the adrenal cortex. Recent advancements in biochemistry have made possible the isolation and preparation of therapeutic agents of animal origin in relatively pure form so that they may be used for therapeutic purposes in alleviating disease.

Synthetic drugs. Currently the most fruitful source of drugs is the organic chemistry laboratory. Many drugs formerly available only from animal or plant tissues have recently been produced in the chemical laboratory in a more pure state. The use of pure drugs is the ultimate objective of the pharmacologist. In recent years cooperative studies by the pharmacologist and the organic chemist have been particularly successful in producing therapeutic agents for the prevention, treatment, and alleviation (полегшення) of disease. An outstanding example is the sulfonamides. These drugs were produced exclusively in a chemical laboratory and had found wide use in the control of disease. Many other drugs including the organic arsenicals, antimonials, antihistamines, and synthetic hormones have come from the chemical laboratory to the aid of the pharmacologist and medical scientists in general.

Vegetable drugs. Many of the vegetable drugs employed in the past have been succeeded by newer synthetic agents of greater potency and lesser toxicity. Despite the extensive development of drug synthesis in the chemical laboratory, medicine is still dependent upon nature for many important drugs.

The roots, leaves, and barks of plants were principal sources of drugs used by primitive man in the treatment of disease. However, the majority of vegetable drugs used centuries ago are no longer employed. A few vegetable drugs, such as digitalis, belladonna, and opium, have no satisfactory substitutes. A wide variety of substances of plant origin are employed in medicine with less specific effects.

DRUG NAMES

Drugs can have four names - a generic name (родова назва) (which any drug manufacturer may use); an official name; a trade, private, or brand name, and a chemical name.

The generic name is the common name by which a medication is known. The name can be used by any manufacturer.

The official name is the name of the medication as it appears in the official reference. Generally, it is the same as the generic name.

The trade, private, or brand name indicates ownership by a manufacturer and usually bears a superscript ® or ™ to the right of the name. The ® indicates registry with the Patent and Trademark Office, and ™ indicates a trademark but no federal registration.

The chemical name indicates the chemical content of the medication. The chemical name is not commonly used in a doctor's practice.

The following is an example of one drug's brand, chemical, and generic names: Sinemet, (-)-3-(3,4-dihydroxyphenyl)-L-alanine, levodopa

Sometimes a number is a part of the trade name. The purpose of this number is to differentiate it from a product that is almost identical. The number often refers to the amount of one of the components of the medication (e.g., 650 mg), but may simply indicate a difference in delivery medium or dosage level. The referenced component of the medication may also be a controlled substance. As a rule, the higher the number, the more there is present of a given substance.

A physician may order medications using either the trade or generic name. A list of commonly prescribed medications and their generic names follows.

TRADE NAME GENERIC NAME

Benadryl diphenhydramine hydrochloride

Dulcolax bisacodyl

Pavabid papaverine hydrochloride

Robaxin methocarbamol

Tylenol acetaminophen

Valium diazepam

 

In addition to the terms identified above, medications may be referred to as OTS drugs, legend drugs, or controlled substance. OTS is an abbreviation for over-the-counter drugs, which do not require a prescription. Examples are Aspirin and certain ointments. Legend drugs are prescription drugs. They are not safe for over-the-counter purchase because if they are taken without doctor’s guidance, they may cause harmful side effects. Examples are antibiotics and birth control pills. Controlled substances are medications that may become addictive if taken without supervision, such as codeine and morphine.

 

Complete the list of over-the-counter drugs and legend drugs.

2.Explain the meanings of different drug names: generic, trade, chemical.

3. Answer the questions:

1. How can the drugs be grouped?

2. What is the action of antiseptics and disinfectants?

3. What is the difference between laxatives and purgatives?

4. What are the applications?

5. Can you describe the major characteristics of drugs?

6. What are the requirements for drugs for children and aged persons?

7. What ways are drugs most commonly administered in?

 

DRUG-RELATED WORDS

Below are drug-related words that have particular meanings for pharmacist and other allied health specialists. After reviewing them, complete the dictionary exercises.

allergy	adverse response to a foreign chemical resulting from a previous exposure to that substance
amphetamine	stimulant for the central nervous system
analgesic	drug that relieves pain
Anaphylactic reaction	possibly fatal allergic response
antagonism	interaction created when drugs won't work together
anesthetic	drug agent that reduces or eliminates sensation
anthelmintics	drugs that destroy worms
antibiotic	drug that slows down or stops the growth of bacteria, fungi, or parasites
anticoagulant	drug that prevents clotting or coagulation of blood
anticonvulsant	drug that prevents or reduces the severity of convulsions
antidepressant	drug that elevates moods and treats symptoms of depression
antidiabetic	drug that treats Type I and Type II diabetes mellitus
antihistamine	drug that blocks the action of histamine, a substance that causes allergic reactions
barbiturate	drug to sedate a person
cardiovascular	drug that acts to increase the efficiency of the heart and blood vessels
dependence	situation where removal or withholding of a drug may produce adverse psychological and/or physical symptoms
diuretic	drug that increases volume of urine excreted
emetic	drug that induces vomiting
endocrine drug	drug that simulates naturally occurring hormones such as androgens, estrogens, progestin, thyroid, etc.
gastrointestinal drug	drug, such as an antacid, antiulcer, antidiarrheal antinauseant or laxative, used to relieve uncomfortable or dangerous gastrointestinal feeling
hypersensitivity	immune response (allergy to a drug)
idiosyncrasy	unusual response to a drug that is peculiar to the individual
isotonic	pertaining to solutions that have the same osmotic pressure
lipid	family of compounds soluble in organic solvents but not in waterм
narcotic	drug having both an analgesic and a sedative action
placebo	substance that resembles a medication but does not contain the drug
placebo effect	heightened physical response to a drug because of the positive feeling the patient has about the drug
resistance	decrease in the response to a drug by the causative factor (e.g., bacteria)
sedative	drug that relaxes an individual by depressing the central nervous system
stimulant	drug that speeds up vital processes such as heart and respiration
synergism	combining of two or more drugs that work together to produce a greater effect than either produces separately

 

 

EFFECTS OF MEDICATIONS

Effects of medications are categorized as being either systemic or local. Any substance that has the ability to be absorbed and distributed throughout the body has a systemic effect. However, when the effect is limited to the area of the body where it is administered, it has a local effect.

Once (щойно) the chemical substance is in the body, it is absorbed, distributed, metabolized, and finally, excreted. Absorption is the process of getting a chemical substance into the bloodstream. This process is affected by the medication's degree of acidity and lipid (fat) solubility, as well as whether there is food in the stomach. That is why some prescriptions are labeled "Give before meals" or "Take with food."

The specific composition of the chemical substance will determine its distribution - that is, the process of moving from the bloodstream into the tissues and fluids of the body. Some chemical substances are attracted to specific organs or cells, while others may or may not be able to cross a lipid membrane.

The chemical substance undergoes physical and chemical alterations in the body (metabolism). Chemical substances are transformed in the liver to more water-soluble by-products (побічний продукт) that can be easily excreted by the kidneys. Some drugs may be eliminated through perspiration, feces, bile, or breast milk, as well as through the kidneys.

Excretion is the process of eliminating substances such as the waste products of drug metabolism from the body. If not excreted properly, some chemicals may have a cumulative effect that can cause toxicity - a poisonous and potentially dangerous situation for the patient. These toxic levels must be monitored carefully when certain medications are prescribed. Toxic and other unintended effects that may occur with some medications are called side effects. For individual patients, the use of a particular chemical substance may have harmful effects. Contraindications are the specific factors that the physician considers in selecting medications for an individual patient.

Other factors that affect the way medications work include age, weight, gender, psychological state, interactions of medications and food with one another, dosage, drug resistance or tolerance, genetic factors, allergies, and method of administration.

Vitamins are not commonly regarded as drugs, but are natural or synthetic substances that have a positive or negative effect on the body. Water-soluble vitamins (vitamins B and C) must be replaced on a regular basis. On the other hand, vitamins A, D, E, and K are fat-soluble vitamins whose effects are cumulative. Therefore, if abnormal amounts are consumed, whether in foods or in synthetic forms, they can lead to toxicity.

TASKS:

1. How are medical substance eliminated from the body?

2. What may improper excretion lead to?

3. Explain (define) the following terms: systemic effect, local effect, metabolism, side effect, toxicity.

 

 

DRUG ACTION

Drug action has several meanings. For example, drug action can refer to the action the drug has on specific cells, tissues, organs, or systems. Drug action can also refer to the effect the drug has on a disease or disease symptoms. The following words refer to the latter usage of the term drug action.

Palliative. A drug is said to have a palliative effect when it relieves the symptoms of the disease, but does not cure the disease. A very common example is the use of Tylenol to reduce a fever: The medication relieves the symptom (fever) but does not cure or combat the underlying cause of the fever.

Placebo. The layman's term for placebo is sugar pill. Currently, placebos are most commonly used in controlled studies to help determine how well a tested medication works. In the past, however, patients who insisted on medication they didn't need were given a placebo - an inactive substance or preparation to satisfy their psychological need.

Prophylactic. Medications have a prophylactic action if they tend to ward off or prevent disease. Immunizations using vaccines are prime examples of prophylactic medications.

Therapeutic. A medication used to cure or treat the disease or disease process is defined as therapeutic. Many of the antibiotics are therapeutic medications in that they actually produce a cure.

TASKS:

1. Define placebo, palliative, prophylactic, therapeutic medications.

2. Give examples of drugs from each of the above mentioned groups.

3. What drugs with prophylactic action have you got in your childhood?

4. What is the therapeutic effect of aspirin?

5. What action do most analgesics produce?

 

ORAL ROUTES

ORAL ADMINISTRATION. The oral route (спосіб, шлях) is the easiest and the most commonly used. Medications are given by mouth and swallowed with fluid. Orally administered medications are less expensive than IV solutions and many topical preparations. They have a slower onset of action and a more prolonged effect than parenteral medications. Clients generally prefer the oral route.

SUBLINGUAL ADMINISTRATION. Some drugs are designed to be readily absorbed after being placed under the tongue to dissolve. A drug given sublingually should not be swallowed. Otherwise the desired effect will not be achieved. Nitroglycerin is commonly given sublingually. A drink should not be taken by the client until the drug is completely dissolved.

BUCCAL ADMINISTRATION. Administration of a drug by the buccal route involves placing the solid medication in the mouth and against the mucous membranes of the cheek until the drug dissolves. Clients should be taught to alternate (чергувати) cheeks with each subsequent dose to avoid mucosal irritation. Clients are also warned not to chew or swallow the drug or to take any liquids with it. A buccal medication acts locally on the mucosa or systemically as it is swallowed in a person's saliva.

TASKS:

1. How is the nurse involved in choosing the route for administration?

2. Describe the oral / sublingual, buccal/ administration of drugs.

3. What is the most clients` preferable way of taking drugs?

4. Name the medicines which are administered sublingually.

5. When is water not taken with drugs?

6. Translate the names of oral routes.

 

 

PARENTERAL ROUTE

Parenteral administration involves giving a drug by a route other than the gastrointestinal tract.

One form of parenteral administration involves injection. The four major sites of injection are:

1. Subcutaneous: Injection into tissues just below the dermis of the skin (hypodermic).

2. Intramuscular (IM): Injection into muscle body.

3. Intravenous (IV): Injection into a vein.

4. Intradermal: Injection into the dermis just under the epidermis.

A physician may use additional routes for parenteral injections, including the intrathecal or intraspinal, intracardiac, intrapleural, intraarterial, and intraarticular routes.

Strict sterile technique must be used when preparing medications for parenteral injection. Contamination of medication solutions, syringe needles, or the syringe itself can lead to infection.

ADMINISTRATION OF INJECTIONS

Administering an injection is an invasive procedure that must be performed using aseptic techniques. After a needle pierces (проколює) the skin, there is risk of infection. The nurse administers drugs parenterally by one of the following routes: subcutaneous, intramuscular, intradermal, and intravenous. Each type of injection requires certain skills to ensure that the drug reaches the proper location. The effects of a parenterally administered drug can develop rapidly, depending on the rate of drug absorption. The nurse closely observes the client's response.

TASKS:

1.What does parenteral administration mean? 2.Name 4 main sites of injection. 3.What is the main reason the physician uses parenteral instead of oral route? 4.Copy out the words with productive prefixes from the text.

 

SYRINGES

A variety of syringes and needles is available; each designed to deliver a certain volume of a drug to a specific type of tissue. Most health care institutions use disposable, single-use plastic syringes, which are inexpensive and easy to manipulate.

Syringes come in a number of sizes, from 1 to 60 ml. It is unusual to use a syringe larger than 5 ml for an injection. A 2 to 3 ml syringe is adequate for intramuscular and subcutaneous injections; a larger volume creates discomfort. The 2.5 or 3 ml hypodermic syringe often comes prepackaged with a needle attached. However, the nurse may change needle sizes. The hypodermic has two scales along the barrel (корпус); one is divided into minims and the other into tenths of a milliliter.

An insulin syringe holds 1 ml and is calibrated in units. Insulin syringes are U-100s, designed for use with U-100 strength insulin. Each milliliter of solution contains 100 units of insulin.

The tuberculin syringe has a long, thin barrel with a preattached thin needle. The syringe is calibrated in sixteenths of a minim and hundredths of a milliliter and has a capacity of 1 ml. The nurse uses a tuberculin syringe to prepare small amounts of potent drugs. A tuberculin syringe is also useful when preparing small, precise (точні) doses for infants or young children.

The nurse uses large hypodermic syringes to administer certain intravenous drugs, add medications to intravenous solutions, and irrigate (промивати) wounds or drainage tubes.

TASKS:

1. What syringes do most health care institutions use?

2. Name the types of syringes.

3. Describe insulin and tuberculin syringes.

4. Find out the sentences in which the same words are translated as different parts of speech.

 

ANTIBIOTICS

Antibiotic substances are chemical compounds produced as a result of the metabolic activities of living cells which inhibit, in very low concentrations, the growth of microorganisms.

Penicillin was the first antibiotic to be produced and it still assumes a position of major importance in this field.

Antibiotic -producing organisms can be obtained by: testing pure cultures of organisms available in culture collections or isolated from natural sources, and selection from the vast heterogeneous mixed populations of the soil or other natural habitations of microorganisms.

Once detected, the antagonist is isolated in pure culture and identified, and the conditions for maximum production of the antibiotic substance produced by it are investigated. Generally, this involves finding the optimum temperature, pH, and age of the culture. Important also is the composition of the medium (середовище).

Different organic and inorganic nitrogenous substances are tested, with and without various carbohydrates, minerals, heavy metals, etc.

Antibiotics are complex, rather large molecular weight substances whose synthesis may be extremely difficult.

Chloramphenicol is believed to be the first naturally occurring compound which contains a nitro group or which is a derivative (похідний) of dichloroacetic acid. Chloramphenicol can be obtained from the filtrate of a Streptomycin culture by extraction with ethyl acetate. Chloramphenicol is rapidly absorbed from the gastrointestinal tract; significant serum levels are obtained in 30 minutes and peak blood concentrations of 40 to 60 mg/ml are reached in about 2 hours. The drug is no longer detectable in the blood after 12 to 18 hours.

Chloramphenicol is marketed in capsules (50, 100, 250 mg) for oral use, as an ophthalmic ointment and solution (25 mg in a special buffer to be diluted with distilled water), and an injection for parenteral use.

The drug is ordinarily administered by the oral route, but it can be injected intramuscularly or intravenously.

 

TASKS:

1.Finish the sentences:

I. The drug is ordinarily administered by.... 2. The initial oral dose is....

3. Chloramphenicol is rapidly absorbed from....4. Antibiotic substances inhibit.... 5. Penicillin is.... 6. Antibiotic-producing organisms can be obtained by....

2. Questions for the Discussion about Antibiotics:

1. -What does the term “antibiotic” mean?

-“Anti” means “against”, “bios” means “life”.

2. -Who discovered the effect of antibiotics? When?

-The effect of antibiotics was discovered by Fleming in 1929.

3. -What was the first of antibiotics?

-The first antibiotic was called Penicillin.

4. -How is Penicillin administered?

-It is administered orally, intramuscularly and intravenously.

5. -What diseases are treated with antibiotics?

-Infectious diseases such as quinsy, pneumonia, acute bronchitis, urinary tract infections and sexually transmitted diseases are treated with antibiotics.

6. -When should the patient stop talking antibiotics?

- He should stop taking antibiotics 3-4 days after the temperature becomes normal.

7. -What may happen if he does not do so?

-Weak microorganisms will be killed, but the most vivid ones will survive.

8. -What are the most effective antibiotics?

-Flemoxin, Erythromycin, Furacillin.