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Basics of pharmacy
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Basics of stereochemistry for level 1 pharmacy studentsWHAT IS SCIENCE? - is a way in which answers related to NATURAL events are proposed. - a way in which people can learn and UNDERSTAND events in the NATURAL WORLD - based on OBSERVABLE EVENTS - a study of the NATURAL WORLD - a method of DISCOVERY and UNDERSTANDING by using a PROBLEM-SOLVING process called the?? - A systematic body of knowledge based on observation and experimentation. FOUR COMMON CHARACTERISTICS OF SCIENCE: 1. It focuses on the NATURAL WORLD. 2. Goes through experiment. 3. Relies on evidence. 4. Passes through the scientific community. WHAT IS TECHNOLOGY? Brian Arthur (2009) defined technology as: 1. a means to fulfill a human purpose 2. assemblage of practices and components 3. a collection of devices and engineering practices available to a culture. SOCIETY ST (Science Technology) would not exist without society. WHAT IS STS? Science and Technology and Society (STS) is the study of how society, politics and culture affect scientific research and technological innovation and how these, in turn affects society, politics and culture. EVENTS IN THE HISTORY OF SCIENCE AND TECHNOLOGY THAT TRANSFORMED THE SOCIETY (IN THE WORLD) ANCIENT PERIOD 3500 BC. - 500 AD EUROPE - use of fire by Homo Erectus CA 750,000 - Stone Headed Spears CA 45,000 - Wooden bow and arrow CA 20,000 - The Minoans build palaces in Crete CA 2,000 THE AMERICAS - The Folsom people living on eastern side of the Rocky Mountain developed sophisticated tools CA 8,000. - Pottery is made in South America CA 6,000 - Olmec sculpture carves figurines and giant human heads. CA 1200 ASIA AND OCEANA - Earliest known clay pots are made in Japan CA 11,000. - Bronze is first made in Thailand CA 4000 - A lunar calendar is developed in China CA 2950 - Chinese doctors begin using acupuncture CA 2500 - The Hindu calendar of 360 days was introduced in India CA 1000 AFRICA AND MIDDLE EAST - Homo erectus uses stone tools CA 1000000 - CA 15000 in Africa, bone harpoons are used for fishing. - Clay tokens are used for record keeping in Mesopotamia CA 7500 - Mesopotamian mathematicians discover the Pythagorean Theorem MEDIEVAL PERIOD CA 500 -1500 - Dark ages because few written records and evidences remained - Scholastic tradition was established by Charlemagne - Vertical windmills, spectacles, mechanical clock, water mills, gothic style were invented - Johannes Gutenberg invented the printing press RENAISSANCE PERIOD 14TH – 17TH CENTURY - Rebirth of revival - Printing with movable type allowed Bible, secular books made in large amount - Nicolas Copernicus presented a heliocentric theory - Galileo Galilei invented telescope INDUSTRIAL REVOLUTION 18TH CENTURY - Skilled workers were set aside because of the machines - Iron production, steam engine and textile flourished - Scottish James Watt improved steam engine Robert Fulton (steam boat) - The following were invented: Light bulb, telephone, first steam powered locomotive 19TH CENTURY - Age of machine and tools - Herman Helmholtz (law of conservation of energy) - James Clark Maxwell (light as electro-magnetic wave) - Henry Becquerel (radioactivity) - Marie and Pierre Curie (radium) - Hans Christian Oersted (electric current near the magnet) - Michael Faraday (magnet produces electricity) - Atomic Theory proposed by John Dalton - Electron discovered by JJ. Thomson - Telegraph developed by Samuel Morse 20TH CENTURY - Communication, transportation, military research were developed - Personal computer was created - Intel developed microprocessor - Apple was introduced by Steve Jobs and Steve Wozniak - Internet was created (ARPANET) - Henry Ford's mass production of cars - Artificial Intelligence was invented SCIENCE, TECHNOLOGY AND SOCIETY (PHILIPPINE HISTORY) Stone Age - Archeological findings show that modern man from Asian mainland first came over land on across narrow channels to live in Batangas and Palawan about 48,000 B.C. - Subsequently they formed settlement in Sulu, Davao, Zamboanga, Samar, Negros, Batangas, Laguna, Rizal, Bulacan and Cagayan. Inventions - They made simple tools and weapons of stone flakes and later developed method of sawing and polishing stones around 40,000 B.C. - By around 3,000 B.C. they were producing adzes ornaments of seashells and pottery. Pottery flourished for the next 2,000 years until they imported Chinese porcelain. Soon they learned to produce copper, bronze, iron, and gold metal tools and ornaments. Iron Age - The Iron Age lasted from the third century B.C. to 11th century A.D. During this period Filipinos were engaged in extraction smelting and refining of iron from ores, until the importation of cast iron from Sarawak and later from China. INVENTIONS AND DISCOVERIES - They learn to weave cotton, make glass ornaments, and cultivate lowland rice and dike fields of terraced fields utilizing spring water in mountain regions. - They also learned to build boats for trading purposes. - Spanish chronicles noted refined plank built warships called caracoa suited for interisland trade raids 10TH CENTURY A.D. - Filipinos from the Butuan were trading with Champa (Vietnam) and those from Ma-I (Mindoro) with China as noted in Chinese records containing several references to the Philippines. These archaeological findings indicated that regular trade relations between the Philippines, China and Vietnam had been well established from the 10th century to the 15th century A.D. TRADING - The People of Ma-I and San-Hsu (Palawan) traded bee wax, cotton, pearls, coconut heart mats, tortoise shell and medicinal betel nuts, panie cloth for porcelain, leads fishnets sinker, colored glass beads, iron pots, iron needles and tin. SOME PRESPANISH FILIPINO SCIENCE AND TECHNOLOGY - Curative values of plants extract use as medicine - Alphabet (Alibata) - Counting Methods - Weights - Measuring system (isang gatang) - Calendar based on the periods of moon - Banaue Rice Terraces SPANISH REGIME Religion the Catholic Church - The latter part of the 16th Century Development of schools: - Colegio de San Ildefonso-Cebu-1595 - Colegio de San Ignacio-Manila-1595 - Colegio De Nuestra Senora del Rosario-Manila 1597 - Colegio De San Jose-Manila-1601 Colegio De San Ildefonso De Cebu - In 1863 the colonial authorities issued a royal degree to reform the existing educational system. In 1871 the school of medicine and pharmacy were opened to UST, after 15 years it had granted the degree Of Licenciado En Medicina to 62 graduates. Medicine - Development of hospitals San Juan Lazaro hospital the oldest in the far east was founded in 1578. Roads and Bridges Among other Spanish contributions: - Arithmetic - Algebra - Geometry - Trigonometry - Physics - Hydrography - Meteorology - Navigation - Pilotage American Period and Post Commonwealth Era - BUREAU OF GOVERNMENT LABORATORIES (1901) - BUREAU OF SCIENCE (1905) - INSTITUTE OF SCIENCE (1946) RA 2067 OTHERWISE KNOWN AS THE “SCIENCE ACT OF 1958”. - This was enacted to integrate, coordinate, and intensify scientific and technological research and development and to foster invention including allocation of funds and other purposes. NATIONAL RESEARCH COUNCIL WAS ESTABLISHED ON DECEMBER 8, 1933. - Its Mandate (Nrcp) Promotes And Supports Fundamental Or Basic Research For The Continuing Total Improvement Of The Research Capability Of Individual Scientists Or Group Of Scientists; Provides Advice On Problems And Issues Of National Interest; Promotes Scientific And Technological Culture To All Sectors Of Society; And Fosters Linkages With Local And International Scientific Organizations For Enhanced Cooperation In The Development And Sharing Of Information NATIONAL RESEARCH COUNCIL WAS ESTABLISHED IN DECEMBER 8, 1933. - Its Mandate (NRCP) promotes and supports fundamental or basic research for the continuing total improvement of the research capability of individual scientists or group of scientists; provides advice on problems and issues of national interest; promotes scientific and technological culture to all sectors of society; and fosters linkages with local and international scientific organizations for enhanced cooperation in the development and sharing of information. It was during the American Period when Science was inclined towards: - Agriculture - Food Processing - Forestry - Medicine - Pharmacy - NursingChapter 22 Antihypertensive Drugs Hypertension Defined (JNC-8) Pharmacology Overview 7 main categories of drugs to treat HTN Adrenergic drugs (old friend) Angiotensin-converting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Calcium channel blockers (CCBs) Diuretics Vasodilators Direct renin inhibitors A. Adrenergic Drugs: 5 Subcategories and where they act A1. Adrenergic neuron blockers (central and peripheral)- we won’t talk about this A2. Alpha1 receptor blockers (peripheral) A3. Alpha2 receptor agonists (central) A4. Beta receptor blockers (peripheral) A5. Combined α and β receptor blockers (peripheral) A2. Peripherally Acting Adrenergic Drug Alpha1 Blockers (we’ve met these) Doxazosin, prazosin, alfuzosin Block alpha1-receptors which causes BP to decrease Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels Main Use: benign prostatic hyperplasia (BPH) Alpha1 Blockers REMEMBER Tamsulosin (Flomax)* is an α1 blocker BUT *Tamsulosin is not used to control BP, just for BPH. A3. Centrally Acting Adrenergic Drugs Alpha 2 agonist Clonidine and methyldopa 1- Stimulate alpha2-adrenergic receptors. in the brain Decreases sympathetic outflow from the CNS which decreases NE production 2. Stimulate alpha2-adrenergic receptors in kidneys remember alpha 2 opposes alpha 1 Dilates peripheral blood vessels → lowers peripheral resistance → Results in decreased BP So ….Clonidine (Catapres) Used primarily for its ability to decrease blood pressure in an urgent setting Also use in opioid withdrawal as previously discussed Oral (multiple times a day), and topical patch formulations Do not stop abruptly as it may lead to rebound hypertension In reality, Clonidine and methyldopa Not prescribed as first-line home antiHTN drugs High incidence of unwanted adverse effects: orthostatic hypotension, fatigue, and dizziness MIGHT be uses as adjunct drugs after other drugs have failed, in conjunction with other antiHTN such as diuretics A4. Adrenergic Drugs Selective Beta 1 Blockers Metoprolol, Atenolol Reduction of HR through β1 receptor blockade (remember adrenergic blocking of this receptor???) HR results in BP Cause reduced secretion of renin = BP A4. Adrenergic Drugs Selective Beta1 Blockers Nebivolol (Bystolic) Uses: hypertension and HF Action: blocks β1 receptors and produces vasodilatation, which results in a decrease in SVR High doses loses selectivity and blocks both β1 and β2 Less sexual dysfunction All BB- Do not stop abruptly; must be tapered over 1 to 2 weeks A4. Adrenergic Drugs NONSelective Beta Blockers Propranolol Acts equally on β1 and β2 Other uses include situational anxiety associated with public speaking, test taking As mentioned on previous slide, nebivolol at high doses becomes beta nonselective A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Dual antihypertensive effects of reduction in heart rate (beta1 receptor blockade) and vasodilation (alpha1 receptor blockade) Examples are carvedilol (common) and labetalol (not as common) A5. Dual-Action Adrenergic Drugs α1 and β Receptor Blockers Carvedilol (Coreg) Widely used drug that is well tolerated Uses: HTN, mild to moderate HF in conjunction with digoxin, diuretics, and ACE inhibitors Contraindications: severe bradycardia or unstable HF, bronchospastic conditions such as asthma, and various cardiac conduction problems Adrenergic Drugs Indications - HTN But also for Glaucoma (topical) BPH: doxazosin, prazosin, and terazosin (2 for 1) Management of severe HF when used with cardiac glycosides and diuretics Contraindications Acute HF- have to stabilize first MOAIs- yeah doesn’t everything interact with MAOIs? Peptic ulcers Severe liver/kidney disease Asthma (with beta blockers) Adrenergic Drugs: Adverse Effects Orthostatic hypotension 1st-dose syncope Rebound hypertension with abrupt discontinuation Most common: Dry mouth, drowsiness, constipation, sedation Interactions- always check for specific drug interactions Can cause additive CNS depression with alcohol, benzodiazepines, opioids Question #1 When administering an alpha-adrenergic drug for hypertension, it is most important for the nurse to assess the patient for the development of what response? Hypotension Hyperkalemia Oliguria Respiratory distress Answer A Hypotension This is a key point in patient education These drugs have strong vasodilating properties and may cause severe hypotension, especially at the beginning of therapy. B. Angiotensin-Converting Enzyme Inhibitors aka ACE Inhibitors or ACEi Large group of safe and effective drugs Currently are 10 ACEi Often used as first-line drugs for HF and hypertension May be combined with a thiazide diuretic, loop diuretic, or Calcium Channel Blocker (CCB) You need to understand the basics ACE Inhibitors: Review RAAS ACE converts angiotensin I, formed through the action of renin, to angiotensin II Angiotensin 2 is a potent vasoconstrictor and also induces aldosterone secretion by the adrenal glands Aldosterone stimulates sodium resorption (H20 follows Na Both act to raise BP which causes kidneys to reduce renin production ACEi= Great drug to treat HTN BUT contraindicated in pregnancy (2nd,3rd trimester due to fetal renal damage) and breastfeeding first few weeks after birth B. ACE Inhibitors - PRIL Lisinopril (Prinivil) super common, often the 1st drug Enalapril (Vasotec) also common Captopril (Capoten) great if liver disease present Benazepril (Lotensin) Fosinopril (Monopril) Perindopril (Aceon) Quinapril (Accupril) Ramipril (Altace) Trandolapril (Mavik) Primary Effects of the ACE Inhibitors Prevent Na (and H2O) resorption by inhibiting aldosterone secretion (volume reduction) (GO BACK TO RAAS DIAGRAM) blood volume decreases work of the heart preload, or the left ventricular end-diastolic volume which is important in HF ACE SUMMARY OF ACTIVITY 1) Prevent vasoconstriction caused by angiotensin 2 (2) Prevent aldosterone secretion less sodium and water resorption Cardioprotective Effects of ACEi They slow progression of left ventricular hypertrophy (ventricular remodeling) after MI so considered cardioprotective ACE inhibitors have been shown to decrease morbidity and mortality in patients with HF Renal Protective Effects of ACEi ACE inhibitors: reduce glomerular filtration pressure by volume reduction Cardiovascular drug of choice for patients with diabetes since it helps protect kidneys by reducing pressure. Sometimes used low dose for kidney protection with DM without HTN B. ACEi Enalapril (Vasotec) Only ACEi available in both oral and IV Enalapril IV does not require cardiac monitoring Oral enalapril: prodrug (metabolized in liver) Improves patient’s chances of survival after an MI Reduces the incidence of HF B. ACEi Captopril (Capoten) Uses: prevention of ventricular remodeling after MI; reduce the risk of HF after MI Shortest half-life Must be administered multiple times throughout the day so this limits its use Not a prodrug so good for patient with liver disease Question #2 A patient with diabetes has a new prescription for the ACE inhibitor lisinopril. She questions this order because her provider has never told her that she has hypertension. What is the best explanation for this order? The doctor knows best The patient is confused This medication has cardioprotective properties This medication has a protective effect on the kidneys for patients with diabetes Answer D ACE inhibitors have been shown to have a protective effect on the kidneys because they reduce glomerular filtration pressure. This property makes them the cardiovascular drug of choice for patients with diabetes. Question #3 A patient with a history of pancreatitis and cirrhosis is also being treated for hypertension. Which drug will most likely be ordered for this patient? Clonidine Prazosin Diltiazem Captopril Answer D Captopril Captopril is not a prodrug; therefore, it does not need to be metabolized by the liver to be effective. This is an advantage in patients with liver disease. ACE Inhibitors: Adverse Effects *Dry, nonproductive cough, which reverses when therapy is stopped. This is a class effect Dizziness- Note: First-dose hypotensive effect may occur Headache & Fatigue Possible hyperkalemia ** Angioedema: rare but potentially fatal Not safe in pregnancy-are contraindicated during the second and third trimesters of pregnancy because of increased risk of fetal renal damage C. Angiotensin II Receptor Blockers (ARB) Considered an alternative to ACEi Less likely to cause a dry cough and hyper K+ that is common with ACE inhibitors Angiotensin II Receptor Blockers: Mechanism of Action Go back to RAAS diagram! ARBs affect primarily 2 places 1. Vascular smooth muscle - blocks vasoconstriction 2. Adrenal gland -Selectively blocks the binding of Ang 2 to certain Ang 2 receptors inhibiting secretion of aldosterone Lowers volume retention and BP Angiotensin II Receptor Blockers -ARTAN Losartan (Cozaar)- very common Eprosartan (Teveten) Valsartan (Diovan) Irbesartan (Avapro) Candesartan (Atacand) Olmesartan (Benicar) Telmisartan (Micardis) Azilsartan (Edarbi) C. ARB Losartan (Cozaar) Beneficial in patients with HTN and HF Used with caution in patients with kidney or liver dysfunction and in patients with renal artery stenosis ***Not safe for breastfeeding women and should not be used in pregnancy (Cat C 1st trimester, Cat D 2nd-3rd trimester), potential fetal toxicity Appear to be equally effective for the treatment of hypertension and well tolerated ARBs less likely to cause cough and hyperK+ but can still happen Evidence that ARBs are associated with lower mortality after MI than ACE inhibitors Never take ACEi and ARBs at the same time* 5. Calcium Channel Blockers (CCB) Primary use: HTN, angina, some dysrhythmias Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction Results in: Relaxed blood vessels to the heart Decreased peripheral smooth muscle tone Decreased SVResistance Decreased BP E. Diuretics First-line antiHTN in JNC 8 guidelines Decreases fluid volume The results from diuresis: preload, Peripheral resistance Overall effect Decreased workload of the heart and decreased BP Thiazide diuretics are the most commonly used diuretics for HTN Ie hydrochlorothiazide (HCTZ), chlorthalidone We will discuss diuretics further in the chapter on diuretics F. Vasodilators Directly relax arterial or venous smooth muscle (or both) Results in: Decreased SVR Decreased afterload Peripheral vasodilation Indicated for treatment of HTN May be used in combination with other drugs F. Vasodilators Hydralazine (Apresoline) Orally: routine cases of essential hypertension Injectable: hypertensive emergencies BiDil: specifically indicated as an adjunct for treatment of HF in African-American patients F. Vasodilators Sodium Nitroprusside (Nitropress) *Sodium nitroprusside and IV diazoxide are reserved for the management of hypertensive emergencies. Contraindications: severe HF, known inadequate cerebral perfusion (especially during neurosurgical procedures) F. Vasodilators Adverse Effects Hydralazine: dizziness, headache, tachycardia, edema, dyspnea, N/V/D, vitamin B6 deficiency, rash Sodium nitroprusside: hypotension, bradycardia, decreased platelet aggregation, rash G. Direct Renin Inhibitors Aliskirin (Tekturna) Blocks the RAS pathway at the point of activation. Inhibiting renin production prevents the downstream production of Ang II (potent vasoconstrictor) Adverse effects: N/V, severe hypotension, hyponatremia, hyperkalemia… Contraindicated in patients with DM taking ACEi or ARB Miscellaneous Antihypertensives Eplerenone (Inspra) Newer class of drugs called selective aldosterone blockers (remember RAAS?) Reduces BP by blocking the actions of aldosterone at its corresponding receptors in the kidney, heart, blood vessels, and brain Indications: routine treatment of hypertension and for post-MI HF Contraindicated if serum potassium levels are high (above 5.6 mEq/L) A Special Form of HTN Treatment of Pulmonary Hypertension Sildenafil and Tadalafil Commonly used for erectile dysfunction Used for pulmonary hypertension but with different trade names Sildenafil: Revatio* (Viagra for ED) Tadalafil: Adcirca* (Cialis for ED)Can you please create a pretest of basic cardiology involving topics of ecg, anatomy and physiology, pharmacology and Arrhythmias. 15 Multiple choice questionsBasics of ChessBasics of c languageBasics of Qualitative ResearchBasics of ultrasound