CHAPTER

CONTENT

.............................

862

Drug Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

862

Drug Standards.

863

Overview.

........................

Drug References.

.......................

864

Vocabulary. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

865

Word Elements.

869

........................

DrugSources. . . . . . . . . . . . . . . . . . . . . . . . . . . 871
DrugNames. . . . . . . . . . . . . . . . .. . . . . . . . . . 871
DrugActions/Interactions. . . . . . . . . . . . . . . . 872
Routesof Administration for Medications. . . . 874
Drug Classification.

.....................

Common Charting Abbreviations.

877

. . . . . . . . . 881

Written and Audio Terminology Review. . . . . 882

ChapterReview Exercises. . . . . . . . . . . . . . . . . 885
Answers to Chapter Review Exercises. . . . . . . . 893

KEY

COMPETENCIES

Upon completing

this chapter and the review exercises at the end of the chapter, the learner should be able to:

1. Identify the laws and governing agencies that enforce the safe manufacture, distribution, and use of foods, drugs,
and cosmetics.
2. List five drug schedules used for categorizing controlled substances as identified in this chapter.

3. List four drug referenc~s identified in this chapter.

4. Identify four sources of drugs, giving examples for each source, as identified in this chapter.
5. Identify five different names given to drugs to identify either their chemical formula, their manufacturer's
name, or the name under which they are sold.

6. Identify at least 10 drug actions/interactions

that occur within the body.

7. Identify 10 different forms of administration

of medications.

original

8. Identify at least 14 classifications of drugs identified in this chapter.

9. Correctly spell and pronounce each new term introduced in this chapter using the Activity CD-ROM and Audio
CD, if available.
10. Identify at least 30 abbreviations related to pharmacology.
861

862

CHAPTER22

OVERVIEW
Health care professionalsmust know the basics of pharmacologyand understand
the interactions of drugs within the body. A knowledge of the sources,forms,
routes of administration, classifications, indications, range of dosages,desired
effects, and side effects of drugs is essential.Additionally, health care professionals must know the laws regulating the distribution and useof medications.A concentrated study of pharmacology will provide the background necessaryfor
understandingthe needfor safe administration of medicationsas prescribedbythe
physician, and for acquiring a strong senseof responsibility concerning administering medications.

Pharmacologyis the field of medicinethat specializesin the study of drugs,their

sources,appearance,chemistry, actions, and uses.A drug is any substancethat,
when taken into the body, may modify one or more of its functions.
Pharmacodynamicsis the study of how drugsinteract in the humanbody.A pharmacist is one who is licensedto prepareand dispensedrugs. A pharmacyis a drugstore. Chemotherapyis the study of drugs that have a specific and deadly effect
on disease-causingmicroorganisms.Thesedrugs are used in the treatment of certain infectious diseasesand cancer.Toxicologyis the study of poisons,their detection, their effects, and establishing antidotes (substancesthat opposethe action
of poisons) and methodsof treatment for conditions they produce.
Thereare manyterms related to pharmacology.Health care professionalsmayuse
these terms on a day-to-day basis when involved in administering medications,
instructing patients in the useof medications,charting the administration of medications, or transcribing information regarding medicationsin the patient's chart.
This chapter is devoted to the study of terms that relate to the field of pharmacology. Whereappropriate throughout the chapter, word elementswill be identified and defined.

Drug Laws
To ensure the safe manufacture, distribution, and use of medications, drugs are subject to numerous state and federal laws. The Food, Drug, and Cosmetic Act (FDCA)
was passed in 1938. This law regulates the quality, purity, potency, effectiveness, safety,
labeling, and packaging of food, drug, and cosmetic products. The government agency
responsible for administering and enforcing the FDCA within the United States is the
Food and Drug Administration
(FDA). The federal law concerned with the manufacture, distribution, and dispensing of controlled substances, those drugs that have the
potential of being abused and of causing physical or psychological dependence,
administering, and enforcing the Controlled Substances Act is the Drug Enforcement
Administration
(DEA). Physicians who administer controlled substances must enter
their DEA number on the prescription. Drugs that fall under the Controlled
Substances Act are known as controlled substances or schedule drugs. These drugs
are identified by a classification system that categorizes them by their potential for
abuse. The schedule is divided into five categories: Schedules I to V. The five schedules.
for controlled substances are listed in Table 22-1 with examples of specific medicines
appearing in each schedule.

PHARMACOLOGY. 863

Table 22-1 Schedule of Controlled Substances

DRUG
SCHEDULE

DESCRIPTION

EXAMPLE DRUGS

Schedule III drugs have moderate potential

for abuse or

Tylenolwith codeine,
butisol,
hycodan

II

III

physicalde
ordered by
telephone order. P
months. Theymay n
than five times in a 6-month period.

Librium,
valium,
darvon,
equaniL

v
by
there is no limit on
Some of these drugs may

Robitussin A-C,
donnagel-PG,
lomotil

*Limited special permission has been obtained in some states for MDs to prescribe marijuana for
treatment of side effects, such as nausea and vomiting, in patients receiving chemotherapy.

Drug Standards
The law requires that all preparations called by the same drug name must be of a uniform strength, quality, and purity. This assures the patient of getting the same quality,
purity, and strength of medication from the pharmacy each time it is prescribed and
anywhere in the United States that it is prescribed. These rules, or standards, have been
established to control the strength, quality, and purity of medications prepared by various

864

CHAPTER22
manufacturers. The United States Pharmacopeia/National
Formulary (USP/NF) is an
authorized publication of the United States Pharmacopeial Convention, Inc. It contains
formulas and information that provide the standard for preparation and dispensation of
drugs. The USP/NF is recognized by the U.S. government as the official listing of standardized drugs in the United States. The FDCA specifies that a drug is official when it is
listed in the USP/NF. This publication is updated every 5 years.

Drug References
There are several reference books available to physicians, nurses, and other health care
professionals who are responsible for the safe administration of medications. These references normally provide the following information about drugs listed within them:
composition, action, indications for use, contraindications for use, precautions, side
effects, adverse reactions, route of administration, dosage range, and what forms are
available.
The Hospital Formulary is a reference listing of all the drugs commonly stocked in the
hospital pharmacy. This reference provides information about the characteristics of
drugs and their clinical usage. This information is continuously revised to provide the
most up-to-date information available.
The Physicians' Desk Reference (PDR) is published yearly by Medical Economics
Company. See Figure 22-1.
Manufacturers pay to list information about their products in the PDR. The information provided by the manufacturers is the same basic information that is found in package inserts that accompany each container of medication. The FDA requires that the

-- -~
*

.-,

..

Figure

22-1

Physicians' Desk Reference (PDR)

PHARMACOLOGY. 865

drug's generic name, indications, contraindications, adverse effects, dosage, and route of
administration be described in package inserts. Four additional references published by
the Medical Economics Company are as follows:
1. Physicians' Desk Reference for Nonprescription

Drugs

2. Physicians' Desk Reference for Ophthalmology

3. Drug Interactions and Side Effects Index

4. Indications Index
The Drug Facts and Comparisons is a reference for health care professionals. It is
issued yearly and is updated monthly. This loose-leaf binder reference provides information on drugs according to their therapeutic classifications. It contains the same
basic facts as the other drug references listed and is particularly helpful in comparing
the various drugs within each category to other products in reference to effectiveness,
content, and cost.
q

Vocabulary
The following vocabulary words are frequently used when discussing
pharmacology.
WORD

DEFINITION

adverse reaction

The body's reaction to a drug in an unexpected way that may endanger a patient's health and safety.

anaphylactic shock
(an-ah-fih-LAK-tic SHOCK)

A life-threatening, hypersensitive reaction to food or drugs. The

patient experiences acute respiratory distress, hypotension, edema,
tachycardia, cool pale skin, cyanosis, and possibly convulsions shortly
after administration of the medication.

bacteriostatic
.bacteri/o= bacteria

Stopping or controlling the growth of bacteria.

brand name

The name under which the drug is sold by a specific manufacturer.

This name is owned by the manufacturer and no other company may
use that name. Each brand name carries a registered trademark
symbol.

buccal medication

Medication that is placed in the mouth next to the cheek, where it is

absorbed into the mucous membrane lining of the mouth.

(BUCK-al med-ih-KAY-shun)
bucc/o = cheek
-al = pertaining to
chemical name

The chemical name for a drug is the description of the chemical

structure of the drug. It is listed in the Hospital Formulary along with
the chemical formula diagram.

chemotherapy
(kee-moh- THAIR-ah-pee)
chem/o = chemical reaction

The treatment of diseases using drugs that have a specific deadly effect
on disease-causing microorganisms. These drugs are used in the treatment of certain infections and cancer.

-therapy = treatment

.
~

866

CHAPTER22

contraindication
(kon-trah-in-dih- KAY -shun)

Any special symptom or circumstance that indicates that the use of a

particular drug or procedure is dangerous, not advised, or has not
been proven safe for administration.

controlled substances

Drugs that have a potential for abuse. These drugs are placed into five
categories ranging from Schedule I drugs, which are the most dangerous and most likelyto be abused, to Schedule V drugs, which are the
least dangerous and least likelyto be abused; also known as schedule
drugs.

Controlled Substances Act

The federal law concerned with the manufacture, distribution, and

dispensing of controlled substances. These drugs have the potential of
being abused and of causing physical or psychological dependence.

cumulation

Cumulation means that a drug level begins to accumulate in the body

with repeated doses because the drug is not completely excreted from
the body before another dose is administered.

(KYOO-mew-Iay-shun)
desired effect

The effect that was intended; that is, if the drug lowered the blood
pressure as was intended, the desired effect was achieved.

drug

Any substance that, when taken into the body, may modify one or
more of its functions.

drug action

Drug action describes how a drug produces changes within the body.

drug effect

Drug effect describes the change that takes place in the body as a
result of the drug action.

Drug Enforcement
Administration

The government agency responsible for administering and enforcing

the Controlled Substances Act.

Drug Facts and

Comparisons

A reference book for health care professionals that provides information on drugs according to their therapeutic classifications. This reference compares the various drugs within each category with other
products.

druggist

Pharmacist.

first dose

Initial dose.

first-dose effect

An undesired effect of a medication that occurs within 30 to 90 minutes after administration of the first dose.

Food and Drug

Administration

The government agency responsible for administering and enforcing

the Food, Drug, and Cosmetic Act within the United States.

Food,Drug,and
Cosmetic Act

A law that regulates the quality, purity, potency, effectiveness, safety,

labeling, and packaging of food, drug, and cosmetic products.

generic name
(jeh-NAIR-ik)

The name that is established when the drug is first manufactured. This
name is protected for use only by the original manufacturer for a
period of 17 years; after that time, the name of the drug becomes public property and can be used by any manufacturer.

Hospital Formulary
(FORM-yoo-lair-ee)

A reference book that lists all of the drugs commonly stocked in the
hospital pharmacy. This book provides information about the characteristics of drugs and their clinical usage.

PHARMACOLOGY.

867

hypotension
(high-poh- TEN-shun)
hypo- = under, below,
beneath, less than
normal

Low blood pressure; less than normal blood pressure.

idiosyncrasy
(id -ee-oh -SIN -krah -see)

An unusual, inappropriate response to a drug or to the usual effective

dose of a drug. This reaction can be life threatening.

inhalation medication
(in-hah-LAY-shun)

Medication is sprayed or breathed into the nose, throat, and lungs. It

is absorbed into the mucous membrane lining of the nose and throat
and by the alveoli of the lungs.

initial dose

The first dose of a medication.

intradermal medication

Medication that is inserted just beneath the epidermis using a syringe

and needle.

(in-trah-DER-mal)
intra- = within
derm/o = skin
-al = pertaining to
intramuscular medication

Medication that is injected directly into the muscle.

(in -trah -MUSS- kyoo-lar)

intra- = within
muscul/o = muscle
-ar = pertaining to
intravenous medication
(in -trah -VEE- nus)
intra- = within
ven/o = vein

Medication that is injected directly into the vein, entering the blood
stream immediately.

-ous = pertaining to
local effect

A response to a medication that is confined to a specificpart of the

body.

maintenance dose

The dose of a medication that will keep the concentration of the medication in the bloodstream at the desired level.

official name

Generic name.

package insert

An information leaflet placed inside the container or package of prescription drugs. The FDArequires that the drug generic name, indications, contraindications, adverse effects,dosage, and route of
administration be described in the leaflet.

parenteral medication
(par-EN-ter-al)

Medication that is injected into the body using a needle and syringe.

pharmacist
(FAR-mah-sist)
pharmac/o = drugs, medicine
-ist = specialist

One who is licensed to prepare and dispense drugs; also known as a

druggist.

pharmacodynamics
(far-mah-koh-dye-NAM

The study of how drugs interact in the human body.

-iks)

868

~,

'''~''''''C''~

h,~

CHAPTER22

pharmacology
(far- mah-KALL-oh -jee)
pharmac/o = drugs,medicine
-logy = the study of

The field of medicine that specializes in the study of their sources,

pharmacy
(FAR-mah-see)

Drugstore.

Physicians' Desk Reference

A reference book that provides the same information that is found in

package inserts that accompany each container of medication:
description of the drug, actions, indications and usage (why medication is prescribed), contraindications, warnings, precautions, adverse
reactions, overdosage, and dosage and administration.

potency
(POH-ten-see)

Strength.

potentiation
(poh-ten-she-AY -shun)

The effect that occurs when two drugs administered together produce
a more powerful response than the sum of their individual effects.

rectal medication
(REK-tal)
recti 0 = rectum

Medication that is inserted into the rectum and is slowly absorbed

into the mucous membrane lining of the rectum. It is in the form of a
suppository, which melts as the body temperature warms it.

appearance, chemistry, actions, and uses.

'

-al = pertainingto

route of administration

The method of introducing a medication into the body.

side effect

An additional effect on the body by a drug that was not part of the
goal for that medication. Nausea is a common side effect of many
drugs.

standards

Rules that have been established to control the strength, quality, and
purity of medications prepared by various manufacturers.

subcutaneous

medication

(sub- kyoo- TAY-nee- us)

sub- = under, below
cutane/o = skin

Medication that is injected into the subcutaneous layer, or fatty tissue,

of the skin.

-ous = pertaining to
sublingual medication
(sub-LING-gwal)
sub- = under

Medication that is placed under the tongue, where it dissolves in the

patient's saliva and is quickly absorbed through the mucous membrane lining of the mouth.

lingu/o = tongue
-al = pertaining to
systemic effect
(sis-TEM-ik effect)

A generalized response to a drug by the body. The drug has a widespread influence on the body because it is absorbed into the bloodstream.

tachycardia
(tak -ee- KAR-dee-ah)
tachy- = rapid
cardi/o = heart

Rapid heartbeat, over 100 beats per minute.

-ia

= noun

ending

PHARMACOLOGY. 869

therapeutic dose
(thair-ah-PEW-tik)

The dose of a medication that achieves the desired effect.

tolerance
(TALL-er-ans )

The body's resistance to the effect of a drug.

topical medication
(TOP-ih-kal)

Medication that is applied directly to the skin or mucous membrane

for a local effect to the area.

toxicology
(tocks-ih- KALL-oh-jee)
toxic/o = poisons, toxins
-logy = the study of

The study of poisons, their detection, their effects, and establishing

antidotes and methods of treatment for conditions they produce.

trade name

Brand name.

United States Pharmacopeia

(far-mah-koh-PEE-ah)

An authorized publication of the United States Pharmacopeial

Convention, Inc. that contains formulas and information that provide
a standard for preparation and dispensation of drugs. Recognized by
the U.S. government as the official listing of standardized drugs.

vaginal medication
(VAJ-in-al)
vagin/o = vagina
-al = pertaining to

Medication that is inserted into the vagina; may be in the form of a

suppository, cream, foam, or tablet.

Word Elements
The following word elements pertain to pharmacology. As you review the
list, pronounce each word element aloud twice and check the box after you
"say it." Write the definition for the example word given for each word
element. You may use your medical dictionary.

WORD ELEMENT

PRONUNCIATION

alges/o

al-JEE-soh

analgesic

an-al-JEE-sik

anti-

AN-tih

antidepressant

an -tih -dee-PRESS-ant

arrhythm/o
antiarrhythmic

an -tee-ah -RITH -mik

bilo

BYE-oh

antibiotic
bronch/o
bronchodilator

an-tih-BYE-ot-ik

"SAY IT"

MEANING

sensitivity to pain

against

rhythm

life

BRONG-koh
brong-koh-DYE-Iay-tor

airway

bucc/o

BUCK-oh

cheek

buccal

BUCK-al

-----

-----

ah-RITH-moh

870

CHAPTER22

chem/o

KEE-moh

chemotherapy

kee-moh- THAIR-ah-pee

-----

coagul/o
anticoagulant
cutane/o
subcutaneous

oo

drug
~

""

koh-AG-yoo-Ioh
an-tih-koh -AG-yoo-Iant

clotting

---'--'---"-

_00

kyoo- TAY-nee-oh

"_.-

skin

sub-kyoo-TAY-nee-us
'__.'_00._-'

cyan/o
cyanosis

sigh-AN-oh

esthesi/o
anesthesia

ess-THEEZ-ee-oh
an-ess- THEEZ-ee-ah

sigh-ahcNOH-sis

--'-'

fung!o
antifungal

""

"

blue

feeling, sensation

-.----.-----.-----

'

'00

00'_-

FUNG-oh

fungus

an-tih-FUNG-al
"'-"

gloss/o
hypoglossal
hyperantihypertensive

GLOSS-oh

tongue

excessive, high

high -poh -GLOSS-al

""~~~._-------_.__._._.__._.._-_._--_....__._HIGH-per
an-tih-high-per- TEN -siv
'

'-'.'-'

"--------

hypnohypnotic

HIP-noh

-ia

EE-ah

analgesia

an -al- JEE-see-ah

immun/o
immunosuppressant

IM-yoo-noh
im -yoo- noh-suh -PRESS-ant

intraintradermal

IN-trah
in-trah-der-mal

-ist
pharmacist

1ST
FAR-mah-sist

lingu/o
sublingual

LlNG-yoo-oh
sub-LlNG-gwal

lip/o
lipid

LlP-oh
LlP-id

-logy
pharmacology

LOH-jee
far-mah-KALL-oh-jee

------------..

"-"'-

hip-NOT-ik

sleep

---.-.---..--------------

condition; noun
ending
------

immune, protection
00.____-

within

-,-,---"---'-------

a specialist in a field
of study

---------

0._--_._---------

tongue

----.--.-.--.------.--..---

fat

---.--.----.----.--...---..--..--

the study of
.--.----.

museui/o
MUSS- kyoo-Ioh
intramuscular medication
in -trah -MUSS- kyoo-Iar
.--------------..-.-----.------..-....-----------....--NEE-oh
ne/o
an- tih-nee-oh- PLASS-tic
antineoplastic

----------.

muscle

new
".-----.-.-----.---

PHARMACOLOGY. 871

or/o
oral medication

OR-oh
OR-al

mouth

pharmac/o
pharmacy

FAR-mah-koh
FAR-mah-see

drugs, medicine

rect/o
rectal medication

REK-toh
REK-tal

rectum

skelet/o
skeletal muscle relaxant

SKELL-eh-toh

skeleton

SKELL-eh-tal muscle rih-LAK-sant

sub~

SUB

under, below

subungual

sub-UNG-gwal

toxic/o

TOCKS-ih-koh

toxicology

tocks-ih-KALL-oh-jee

vaginlo
vaginal medication

VAJ-in-oh
VAJ-in-al

vento
intravenous

VEE-noh
in-trah-VEE-nus

------

pOlson
----

vagma

----------------

vem

Drug Sources
The origin of many of the drugs used today can be traced to ancient civilizations. Many
drugs were prepared from plants, leaves, herbs, roots, and barks, with plants being a primary source of medicinal substances. Examples of plant sources of medications are the
purple fox glove, which is a source for digitalis, a medication used to treat heart arrhythmias and congestive heart failure, and the poppy plant, which is a source of opium, and
is used in antidiarrheal medications and analgesics. Leaves and herbs were sources of
medicinal-type teas in the earlier generations.
As time evolved, animals and minerals became additional sources of drugs. An example
of an animal source for drugs commonly used today is insulin, which is extracted from
the pancreas of animals (hogs and cows). An example of a mineral source of drugs is sulphur, which is used in many bacteriostatic medications.

A more recent source of drugs has been pharmaceutical laboratories that produce synthetic drugs. Medications such as Demerol, a narcotic analgesic, and Lomotil, an
antidiarrheal, are examples of synthetic forms of medications. Insulin and sulphur drugs
are also produced synthetically in pharmaceutical laboratories. See Figure 22-2.

Drug Names
The chemical name of a drug describes the chemical structure of the drug. It is the formula that indicates the composition of the drug.
The generic name or official name of a drug is the name that was established when the
drug was first manufactured. The spelling of the generic name is written in lowercase

872

CHAPTER22

Source

cinchona bark
purple foxglove

magnesium

gold

Classification

Drug name

Example

quinidine

antiarrhythmic

digitalis

cardiotonic

Milk of Magnesia

antacid, laxative

Solganal;
auranofin

anti-inflammatory

used to treat
rheumatoid
arthritis

pancreas of
cow, hog

insulin

thyroid gland
of animals

thyroid, USP

I hormone

meperidine

Demerol

analgesic

diphenoxylate

Lomotil

antidiarrheal

antidiabetic
hormone

Figure 22-2 Drug sources

letters. The original manufacturer of the drug is the only company that can use the
generic name for the drug for the first 17 years of its use; then the name of the drug
becomes public property and can be used by any manufacturer. Each drug has only one
generic name. The official (generic) name for each drug is listed in the USP/NF.
The brand name or trade name of a drug is the name under which the drug is sold by a
specific manufacturer. The name is owned by the drug company and no other company
may use that name. Each brand nam.e drug carries a registered trademark symbol (@)
after its name, showing that it is restricted to the particular manufacturer. A drug may

be known by several different brand names. The spelling of the brand name or trade
name alwaysbeginswith a capital letter.
-..---...-...----..----.-.-...--...--

Drug Actions/Interactions
When drugs are ingested or administered into the body, they are absorbed into the
bloodstream or into the body tissues. The drugs then combine with, or alter, the molecules in the body cells, changing the way the cells work. How the drugs produce these
changes within the body is known as drug action. The changes that take place in the
body as a result of the drug action is known as the drug effect. Some drugs act in the
body by either slowing down or speeding up the ordinary processes that the cells carry
out. Other drugs destroy certain cells or parts of cells, such as drugs that destroy diseaseproducing microorganisms and cancer cells. Yet other drugs act by replacing substances
that the body lacks or fails to produce, such as vitamins.

The effect of the drug in the body may be a desired effect, achieving the response by the
body that is intended; that is, the desired effect was to lower the blood sugar, and the
patient's blood sugar level did drop. A drug is usually prescribed for its desired effect. A
side effect, is an additional effect on the body by the drug that was not part of the goal
for that medication; nausea is a common side effect of many drugs. Even though side
effects are bothersome, they are not usually severe enough to warrant discontinuing the
medication. An adverse reaction is one in which the body reacts to a drug in an unexpected way that may endanger a patient's health and safety. A contraindication
is any
special symptom or circumstance that indicates that the use of a particular drug or procedure is dangerous, not advised, or has not been proven safe for administration.
Drugs may affect only a specific part of the body, having a local effect, or they may affect
the body as a whole, having a systemic effect. A local effect of a drug is one that is confined to a specific part of the body; for example, the dentist may administer a medication to numb only one tooth, thus, the medication has a local effect on that particular
area of the body.
A systemic effect of a drug is one that has a widespread influence on the body because it
is absorbed into the bloodstream. The remaining terms in this section describe the
action and interaction of drugs in the body after they have been absorbed into the
bloodstream; that is, those having a systemic effect on the body.
cumulation
(KYOO-mew-Lay-shun)

Cumulation occurs when a drug is not completely excreted from the

body before another dose is given.
When repeated doses of the drug are given, the drug starts to accumulate
in the body tissues and toxic effects may occur.

idiosyncrasy
(id-ee-oh-SIN-krah-see)

------An idiosyncracy is an unusual, inappropriate response to a drug or

to the usual effective dose of a drug.
This reaction may be life threatening. An example of a severe idiosyncratic
reaction to a drug or its dosage is anaphylactic shock in which the patient
experiences acute respiratory distress, hypotension, edema, tachycardia,
cool pale skin, cyanosis, and possibly convulsions shortly after administration of the medication; penicillin is a medicine that is known to cause anaphylactic reactions in some individuals.

potentiation
(poh-ten-she-AY-shun)

Potentiation occurs when two drugs administered together produce

a more powerful response than the sum of their individual effects.
Patients who are taking blood thinners are advised to avoid taking aspirin,
which will potentiate the thinning effect on the blood.

tolerance

Tolerance is resistance to the effect of a drug.

(TALL-er-ans)

The individual develops a decreased sensitivity to subsequent doses of the

drug and requires increasinglylarger doses to get the full effectof the drug.
Tolerance is also a characteristic of drug addiction.
When a drug is given for the first time by whatever method, it is called the
initial dose. The initial dose is also known as the first dose. Sometimes

874

CHAPTER22

patients will have an undesired effect after the initial or first dose of a medication, particularly with some medications given for treatment of hypertension; that is, a sharp drop in blood pressure and fainting within 30 to
90 minutes after the first dose of the medication. This response to the initial dose of a medication is known as first -dose effect.
The dose of a medication that achieves the desired effect is known as the
therapeutic dose. Some medications have to be given in increasing doses
until the desired level of concentration in the bloodstream is achieved. A
maintenance dose will keep the concentration of the medication in the
bloodstream at the desired level. Medications given to slow and strengthen
the heartbeat are often given in increments until the maintenance dose
level is achieved.
....

Routes of Administration
for Medications
Medications can be introduced into the body using several different methods, referred to as the route of administration. The route of administration determines how rapidly a drug is absorbed into the bloodstream, how
well the drug is absorbed, and how long the drug acts within the body. The
route of administration is usually based on the type of medication given,
the dosage form, and the desired effect. The following is a list of the major
routes of administration for medications. The list is not alphabetized, but
is presented in the order in which routes of administration of medications
are usually discussed in pharmacology textbooks.
oral

An oral medication is one that is given by mouth and swallowed.

(OR-aL)

orjo

mouth
-aL = pertaining to
=

This drug is then slowlyabsorbed into the bloodstream through the lining
of the stomach and intestines. See Figure 22-3.
Advantage: easiest and safest method, most economical method.
Disadvantage: slow method of absorption, possibility of being destroyed
by the gastric juices.

Figure 22-3 Oral medications

sublingual
(sub-LING-gwaL)
sub- = under, beLow
Lingujo = tongue
-aL = pertaining to

A sublingual medication is one that is placed under the tongue.

It dissolves in the patient's saliva and is quickly absorbed through the
mucous membrane lining of the mouth; also known as hypoglossal.
Advantage: more rapid absorption rate than oral, higher concentration of
medication reaches the bloodstream by not passing through the stomach.
Disadvantage: not a convenient route of administration for bad-tasting
medications or those that might irritate the mucous membrane.

PHARMACOLOGY. 875

buccal

A buccal medication is one that is placed in the mouth next to the

cheek; it is in tablet form.

(BUCK-al)

buee/o =

cheek

-aL = pertaining

to

The medication is absorbed into the mucous membrane lining of the

mouth.
Advantage: more rapid absorption rate than oral, higher concentration of
medication reaches the bloodstream by not passing through the stomach,
effects of the medication stop if the tablet is removed.

Disadvantage: possibility of swallowing the pill.

inhalation
(in-hah-LAY-shun)

Medicationsadministered by inhalation are th~se that are sprayed

or inhaled into the nose, throat, and lungs. See Figure 22-4.
The medication is absorbed into the mucous membrane lining of the nose
and throat and by the alveoli of the lungs. These drugs are in the form of
inhalers, sprays, mists, and sometimes steam vapor.
Advantage: good absorption due to large surface contact area, provides
rapid treatment.
Disadvantage: sometimes difficult to regulate the dosage, not suitable for
medications that might irritate the mucous membrane lining, sometimes
considered to be an awkward method of administering medication.
Figure 22-4 Medicationsby inhalation

rectal
(REK-tal)
reet/o = rectum
-aL = pertaining to

Rectalmedications are those that are inserted into the rectum and
are slowlyabsorbed into the mucousmembranelining of the rectum.
This medication is in the form of a suppository, which dissolves as the

body temperaturewarmsand meltsit. SeeFigure 22-5A.

Advantage: one method of choice when the patient is nauseated or cannot
take medications orally.
Disadvantage:

absorption is slow and irregular.

Figure 22-5 (A) Rectal medications; (B) vaginal medications

876

CHAPTER22

vaginal
(VAJ-in-al)

vaginjo = vagina
-al = pertaining to

.--------.---.---------------...

Vaginal medications are those that are inserted into the vagina.
This medication may be in the form of a suppository, cream, foam, or
tablet. The medication dissolves as the body temperature warms and melts
it. See Figure 22-58. Vaginal medications are usually given for their local
effect on the mucous membrane lining the vagina.
Advantage: easiest method for treating the specific area.
Disadvantage: no particular disadvantage, other than the fact that medications sometimes stain underwear.

topical
(TOP-ih-kal)

A topical medication is one that is applied directly to the skin or

mucous membrane for a local effect to the area.
These medications are in the form of creams, ointments, sprays, lotions,
liniments, liquids, and powders.
Advantage: easy method, convenient.
Disadvantage: slow absorption through the skin.

transdermal
trans- = across
dermjo = skin
-al = pertaining to

A methodof applyinga drugto unbrokenskin. Thedrugis

absorbedcontinuouslyand producesa systemiceffect.
Medications administered by the transdermal infusion system are packaged in
an adhesive-backed disk. The disk contains a premeasured amount of medication. When the disk is applied, the medication is released through the skin
into the bloodstream at a controlled rate, producing a systemic effect.
Examples of transdermal medications include vasodilators such as nitroglycerin, hormones such as estrogen, and medications used to help stop smoking.
Advantage: good method for administering medications that need to be
released slowly into the bloodstream over a period of time.
Disadvantage: units can be dangerous if they come in contact with the skin
of children or pets. There are a very limited number of drugs available at
this time that can be administered by the transdermal patch. Removal of
the patch does not guarantee immediate stoppage of absorption of the
medication, should an adverse reaction occur. See Figure 22-6.

Figure 22-6 Transdermaldeliverysystem

---------parenteral
(par-EN-ter-al)

Parenteralmedications are those administered by injecting the medication into the body using a needle and syringe. See Figure 22-7.

par- = apartfrom
enterjo = intestine
-al = pertaining to
intradermal
(in-trah-der-mal)
intra- = within
dermjo = skin
-al = pertaining to

Parenteral medication must be in a liquid form and is administered by one

of the following four methods.

A small amount of medication is injected just beneath the

epidermis.
Intradermal injections are used for allergy testing, tuberculin skin testing,
and some vaccinations.

PHARMACOLOGY. 877
Intramuscular

Subcutaneous

Intravenous

10- to 15degree angle

Epidermis
Dermis
Subcutaneous
tissue
Muscle

gO-degree
angle

Intramuscular
(1M)

Intradermal

Subcutaneous
(SC)

Intravenous
(IV)

Intradermal
(10)

Figure 22-7 Parenteralmedications

intramuscular

The medication is injected directLyinto the muscle.

(in-trah-MUSS-kyoo-lar)

intra- = within
mU5culfo = muscle
-ar = pertaining to

intravenous
(in-trah-VEE-nus)
intra- = within
venjo = vein
-OU5= pertaining to

IntramuscuLar injections are used for administering antibiotics, medications that might be irritating to the layers of the skin, and medications
that require dosages larger than the amount allowed for a subcutaneous
injection.

The medication is injected directLy into the vein, entering the

bLoodstream immediateLy.
Intravenous injections are used when medication is needed quickly, and
for administering medication over a period of time, by adding the medication to a bag of intravenous fluids (a process known as infusion).
-"-----------

subcutaneous
(5ub-kyoo- TAY-nee-us)

5ub- = under, below

cutanejo = skin
-OU5= pertaining to

The medication is injected into the subcutaneous Layer,or fatty tissue, of the skin.
Subcutaneous injections are used for administering insulin, hormones,
and local anesthetics.

Drug Classification
Drugs are classified, or categorized, according to their primary or
main effect(s) in the body. Table 22-2 lists most of the major classifications of drugs, along with a basic description of each category and
a common example of a medicine from each classification. The
generic name is written in lowercase letters and the brand name
begins with a capital letter.

878

CHAPTER22

Table 22-2 Major Drug Classifications

DRUGCLASSIFICATION

GENERAL-PURPOSE DEFINITION

COMMON EXAMPLE

analgesic
(an-al-JEE-sik)
an- = without
aLgesjo =
= pertaining
anesthetic
(an-ess-THET-ik)
an- = without
esthetjo = feeling nervous
sensation or
sense of
perception
-ic = pertaining to
antiarrhythmic
(an-tee-ah-RITH-mik)

anti- = against
arrhythmjo =
-ic = pertaining
antibiotic
(anti-infective)

phenoxymethyl-penicillin sodium
(Pen-Vee-K, Penicillin VK,
Veetids, V-Cillin K)
trimethoprim and sulfamethoxazole (Bactrim, Bactrim OS)

(an-ti h-BYE-ot-ik)

anti- = against
bijo = life
-tic = pertaining to
anticoagulant
(an-ti h-koh-AG-yoo-lant)
anti- = against
coaguLjo = clotting

heparin calcium (Calcilean)

warfarin sodium (Coumadin)

anticonvulsant

phenobarbital sodium
(Luminal Sodium)
diazepam (Valium)

(an- ti h-kon-VULL-sant)

antidepressant

hydrochloride

(an-ti h-dee-PRESS-ant)

antidiabetic
(an-tih-dye-ah-BET-ik)

antidiarrheal
(an-tih-dye-ah-REE-ul)

Helps control the blood sugar level

treats diarrhea

chlorpropamide (Oiabenese)
tolazamide (Tolinase)
insulin
diphenoxylate-atropi ne
sulfate (Lomotil)
loperamide hydrochloride
(Imodium)

PHARMACOLOGY. 879
-~-~~"-

antidiuretic
(an-tih-dye-yoo-REH-tic)
antiemetic
(an-tih-ee-MET -ik)

antifungal
(an-tih-FUNG-gal)

anti- = against
fungjo = fungus
-al = pertaining to
antihistamine
(an-tih-HISS-tah-meen)

ine hydrochloride

ed in allergic
maleate

antihypertensive
(an-tih-high-per-TEN-siv)

anti- = against
hyper- = excessive
Polymox)
(Vibramycin)

anti-infective (antibiotic)
(an-tih-in-FEK-tiv)

nabumetone (Relafen)
naproxen sodium (Anaprox,
Aleve)

anti-inflammatory
(an- tih- in-FLAM-ah-toh -ree)

fluorouracil (Adrucil)
methotrexate (Rheumatrex

antineoplastic
(an-ti h-nee-oh-PLASS- tik)

= against

Dose Pack)

nejo
plasjo
formation
-tic = pertaining to
antitussive

hydrobromide
DM,Robitussin
Vick's Formula 44,
44 Pediatric

(an-tih- TUSS-iv)

hydrochloride
Decongestant,
PE, Sudafed

antiulcer agent
(an-tih-ULL-ser)
antiviral agent
(an-tih-VYE-ral)

Treats and prevents peptic ulcer and

gastric hypersecretion

as

ranitidine hydrochloride (Zantac)

nizatidine (Axid)
(Zovirax)
(Vira-A)

880

CHAPTER22

beta blocker
(BAY-tahblock-er)
bronchodilator
(brong-ko h-DYE-lay-tor)
bronch/o = bronchus;
airway

(KAL-see-umCHAN-ell
BLOCK-er)

diuretic
(dye-yoor-RET -ik)

hormone
(HOR-mohn)

(Premarin)

hypnotic
(hip-NOT-ik)
hypno- = sleep
-tic = pertaining to
(Sandimmune)
(Imuran)

immunosuppressant
(im-yoo- no h-suh-PRESS-ant)

immun/o = immunity
laxative

docusate calcium (Surfak)

bisacodyl (Oulcolax)
psyllium hydrophilic muciloid
(Metamucil)

(LACK-sah-tiv)

lipid-lowering agent
(LIP-id)
liP/o = fat

niacin (Nicobid)
lovastatin (Mevacor)

sedative
(SED-ah-tiv)

phenobarbital (Nembutal)
diazepam (Valium)
flurazepam hydrochloride
(Dalmane)

(SKELL-eh-tal muscle
rih-LAK-sant)

dantrolene sodium (Dantrium)

carisoprodol (Soma)
cyclobenzaprine- hydrochloride
(Flexiril)

skeletjo = skeleton
-al = pertaining to
muscul!o = muscle

-e = nounending
vitamin
(VIGH-tah-min)

Prevents and treats vitamin deficiencies

and used as dietary supplement

VitaminsA, 0, E, etc.
ascorbic acid (vitamin C)
cyanocobalamin (vitamin 812)

880

CHAPTER22

beta blocker
(BAY-tahblock-er)
bronchodilator
(brong-koh-DYE-lay-to r)
bronch/o = bronchus;
airway

e,

(KAL-see-umCHAN-ell
BLOCK-er)

(Vascor)

diuretic
(dye-yoor-RET-ik)

hormone
(HOR-mohn)

(Premarin)

hypnotic
(hip-NOT-ik)

hypno-

sleep

-tic = pertaining to

(Sandimmune)
(Imuran)

immunosuppressant
(im-yoo-noh-suh-PRESS-ant)

immun/o=

immunity

laxative

docusate calcium (Surfak)

bisacodyl (Oulcolax)
psyllium hydrophilic muciloid
(Metamucil)

(LACK-sah-tiv)

lipid-lowering agent
(LIP-id)
lip/o = fat

niacin (Nicobid)
lovastatin (Mevacor)

sedative

phenobarbital (Nembutal)
diazepam (Valium)
flurazepam hydrochloride
(Oalmane)

(SED-ah-tiv)

Relieves

dantrolene sodium (Oantrium)

carisoprodol (Soma)
cycLobenzaprine- hydrochloride
(FLexiril)

vitamin

Prevents and treats vitamin deficiencies

(VIGH-tah-min)

and used

Vitamins A, 0, E, etc.
ascorbic acid (vitamin C)
cyanocobalamin (vitamin B12)

(SKELL-eh-tal muscle
rih-LAK-sant)

skelet/o = skeleton
-al = pertaining to

muscul/o = muscle

-e =

noun ending

as dietary supplement

PHARMACOLOGY.

881

Common Charting Abbreviations

Medical abbreviations are a form of shorthand that serve as a universal
language for medical professionals to provide specific information and/or
orders in an abbreviated format. These abbreviations may be used on a
daily basis by those involved in all aspects of health care. It is essential that
health care professionals commit these abbreviations to memory to transmit and receive clear and concise meanings. Some of the more commonly
used abbreviations that relate to pharmacology and are used for charting
are listed below.As you continue your studies in pharmacology and other
aspects of the medical field, your list of abbreviations will expand.

ABBREVIATION

MEANING

ABBREVIATION

MEANING

aa

of each

h,hr

hour

a.c.

beforemeals

h.s.

hour of sleep

ad lib.

as desired

H2O

water

AM

mormng

AQ, aq

water

b.i.d.

twice a day

Celsius (Centigrade)

I:

intradermal
intramuscular
injection

inj.
I.U.

International Units

with

IV

intravenous

cap(s)

capsule, capsules

kg

kilogram

cc

cubic centimeter

LorI

liter

em

centimeter

Ib

pound

dc, D/C

discontinue

mg

milligram

DEA

Drug Enforcement Administration

mEq

milliequivalent

disp

dispense

mL or mI

milliliter

dr

dram

DS

double strength

n.p.o., NPO

nothing by mouth

elix

elixir

O2

oxygen

Fahrenheit

O.D.

right eye

FDA

Food and Drug Administration

oint., ung

ointment

FDCA

Food, Drug, and Cosmetic Act

O.S.

left eye

gal

gallon

OTC

over the counter (drugs)

Gm., g, gm

gram

O.U.

both eyes

gr

grain

oz

ounce

gtt

drops

after

mInIm

882

CHAPTER22

p.c.

after meals

se. subq.sub-Q

subcutaneous

PDR

Physicians' Desk Reference

sig

write on label (let it be labeled)

PM

afternoon

sol

solution

p.o.

by mouth (per os)

sos

if necessary

p.r.n.

as needed

ss

one-half

pt

pint

stat.

immediately

q.

every

supp.

suppository

q.a.m.

everymormng

T. Tbsp.

tablespoon

q.d.

everyday

t.tsp.

teaspoon

q.h.

every hour

tab.

tablet

q.2 h.. q.3 h... . . .

every2 hours,every3 hours. . . .

t.i.d.

three times a day

q.h.s.
q.i.d.

at bedtime (every hour of sleep)

tinct.

tincture

four times a day

TO

telephone order

q.o.d.

every other day

unit

q.s.

quantity sufficient

ung. oint.

ointment

qt

quart

USP/NF

United States Pharmacopeia/

rectal

Rx

take; treatment;

without

National

Formulary

VO

verbal order

times, multiplied by

prescription

'"

Written and Audio

Terminology Review
Review each of the following

terms from this chapter. Study the spelling of

in the space provided. If you have the

each term and write the definition

Audio CD available, listen to each term, pronounce it, and check the box
once you are comfortable saying the word. Check definitions by looking
the term up in the glossary/index.

TERM

PRONUNCIATION

adverse reaction

AD-vers reaction

analgesic

D
D

an-al-JEE-sik

D
D

an-ess- THEEZ-ee-ah

anaphylactic shock
anesthesia
anesthetic

an-ah-fih-LAK-tic

an-ess-THET-ik

DEFINITION

SHOCK

PHARMACOLOGY. 883

an-tee-ah-RITH-mik
an-tye-BYE-ot-ik

antidepressant

D
D
D
D

antidiabetic

an-tih-dye-ah-BET-ik

antidiarrheal

an-tih-dye-ah-REE-al

antiemetic

an-tih-ee-MET-ik

antifungal

an-tih-FUNG-gal

antihistamine

an-tih-HISS-tah-meen

antihypertensive

D
D
D

an-tih-high-per-

D
D
D
D
D

an-tih-nee-oh-PLASS-tik

D
D
D

brong-koh-DYE-lay-tor

antiarrhythmic
antibiotic
anticoagulant
anticonvulsant

anti-infective
anti-inflammatory
antineoplastic
antitussive
antiulcer
antiviral
beta blocker
bronchodilator
buccal medication
calcium channel blocker

an-tih-koh-AG-yoo-lant
an-tih-kon-VULL-sant
an-tih-dee-PRESS-ant

TEN-siv

an-tih-in-FEK-tiv
an-tih-in-FLAM-ah-toh-ree

an-tih- TUSS-iv
an-tih-ULL-ser
an-tih-VYE-ral
BAY-tah blocker

BUCK-al med-ih-KAY-shun
KAL-see-um CHAN-ell
BLOCK-er

chemical name

KEM-ih-cal name

chemotherapy

kee-moh-THAIR-ah-pee

contraindication

kon-trah-in-dih-KAY-shun

cumulation

KYOO-mew-lay-shun

cyanosis

D
D

diuretic

dye-yoor-RET-ik

generic

D jeh-NAIR-ik

hormone

D HOR-mohn

Hospital Formulary

hospital FORM-you-lair-ee

hypnotic

hip-NOT-ik

---J

sigh-ah-NOH-sis

884

CHAPTER22

hypoglossal

high-poh-GLOSS-al

hypotension

high-poh- TEN-shun

idiosyncrasy

id-ee-oh-SIN-krah-see

immunosuppressant

D
D
D

im-yoo-noh-suh-PRESS-ant

D
D
D

in~trah-MUSS-kyoo-lar

LlP-id lowering agent

oral

D
D

parenteral

par-EN-ter-al

pharmacist

FAR-mah-sist

pharmacodynamics

far-mah-koh-dye-NAM-iks

pharmacology

D far-mah-KALL-oh-jee

pharmacopeia

D far-mah-koh-PEE-ah

pharmacy

D FAR-mah-see

potency

D POH-ten-see

potentiation

D poh-ten-she-AY-shun

rectal

D REK-tal

sedative

D SED-ah-tiv

skeletal muscle relaxant

D SKELL-eh-talmuscle

inhalation
intradermal
intramuscular
intravenous
laxative
lipid-lowering agent

in-hah-LAY-shun
in-trah-der-mal

in-trah-VEE-nus
LACK-sah-tiv

OR-al

rih-LAK-sant
subcutaneous

sub-kyoo-TAY-nee-us

sublingual

sub-LlNG-gwal

subungual

sub-UNG-gwal

systemic

D
D

therapeutic

thair-ah-PEW-tik

tolerance

TAHL-er-ans

topical

TOP-ih-kal

toxicology

tocks-ih-KAHL-oh-jee

vaginal

VAJ-in-al

vitamin

D VIGH-tah-min

sis-TEM-ik