Course Overview Course Introduction This course describes healthcare professionals who can identify the four subdivisions of pharmacology and different drug classifications, including vitamins and minerals. Pathology and Pharmacology will also prepare you to explain the causes of infectious disease and techniques used to stop its spread. Finally, you'll review the basic etiology of common diseases and conditions.     Course Materials All of your course materials are included in this course experience. You'll find it easiest to study this course by following these steps: Look over the syllabus, paying close attention to the course and lesson objectives. Read each objective. Pay close attention to main concepts and definitions. Complete each resource and exercise as you come to it. When you've completed each objective, look over the lesson review. When you're confident you understand the material, complete the lesson exam. Course Objectives By the end of this course, you'll be able to Describe four subdivisions of pharmacology: pharma codynamics, pharmacokinetics, pharmaco-therapeutics, and toxicology Identify different drug classifications, including vitamins and minerals, which a patient may take for a variety of health conditions Explain causes of infection, disease, and techniques used to stop the spread of infectious disease Explain basic etiology of common diseases and conditions

Lesson 1 Overview All medical and allied health professionals should study pharmacology. Pharmacology helps you to better understand how different medications interact with the various systems of the body. The level or extent to which one should study pharmacology depends on the medical profession that’s chosen. This lesson will provide you with a broad general overview of pharmacology. Lesson Objectives Define pharmacology and types of drug interactions Recognize types of drug nomenclature and generic drugs as well as regulatory agencies and abuse prevention techniques Describe how to read, interpret, and document medication orders Explain how drugs can be administered Recognize parts of a prescription Explain how to make common coversions and vary dosage Summarize the importance of medical compliance  List medical professionals that can prescribe medications

Introduction Pharmacology is the study of drugs and their interactions on living systems. Different academic areas, such as chemistry, anatomy, pathology, and psychology comprise our understanding of pharmacology. Allied health professionals in a variety of career paths need to understand the basics of pharmacology, as they will inevitably encounter the use of drugs and medications in their work with patients.   Studying Drugs Allied health professionals like medical coders, transcriptionists, and front-office employees need to have a basic understanding of pharmacology. So let's start by defining it. Pharmacology is the study of drugs and their interactions on living systems. Pharmacology draws on knowledge from many other areas of science, like anatomy and physiology, pathology, chemistry, and psychology, to name a few. Anatomy provides an understanding of the structures within the body.  Pathology contributes an understanding of what happens when body structures aren't functioning normally due to disease or injury. Chemistry contributes significantly to understanding the chemical composition of medications and how they interact with the body. Psychology is important because it's related to how patients perceive their health status and understand the health education being provided. Psychology also plays an important role in understanding and encouraging medication compliance.   In addition to these terms, you should be familiar with the difference between a pharmacist and a pharmacologist. A pharmacist is a person who dispenses drugs at a pharmacy. A pharmacologist is a scientist who studies all aspects of drugs including their origins, functions, chemistry, effects, and uses. Major Subdivisions of Pharmacology   Medicinal chemistry is the study of new-drug synthesis. Pharmacodynamics is the study of drug action and effects on the body. Pharmacokinetics is the study of the movement of drugs in the body. Molecular pharmacology is the study of the interaction of drugs with molecules such as DNA, RNA, and enzymes. Pharmacotherapeutics is the treatment of disease with therapeutic medications. Toxicology is the study of poisons.    Sources of Drugs Drugs are substances that change physiological processes in the body. These changes can be therapeutic (helpful) or toxic (harmful). The substances that are used to make the drugs may be derived from plants, animals, or minerals, or they may be synthesized from chemicals in a laboratory. People have been creating and writing down recipes for medicinal treatments since as early as 2000 BCE. The medicinal qualities of opium, alcohol, and many other substances have been long known. Today, drugs are made from five sources: plants, minerals, animals, synthetic sources, and modern engineering (recombinant DNA technology). Plants have always provided effective folk remedies. Berries, seeds, sap, stems, bark, leaves, oils, and roots were used in these remedies. Today, plants are still important sources of drugs. An example of medication derived from a plant source is digoxin, which is a medication used to treat certain heart conditions.   Minerals are naturally occurring substances. They usually come from the ground. Many minerals are also present in the human body and must, in fact, occur in sufficient amounts for the body to function properly. Salt, iron, and potassium are just a few examples. Also, many drugs contain minerals—for example, Philips' Milk of Magnesia contains magnesium, Tums contains calcium, and Clearasil contains sulfur. Animals provide another natural source of drugs. Substances missing from a human body may be found in the body tissues of animals. Many drug substances are taken from animals that are slaughtered for food, particularly drugs used in hormone replacement therapy. The insulin used to treat diabetics may be derived from the pancreas of cows or hogs, depending on the formulation.   The advances of science since the nineteenth century made it possible to manufacture, or synthesize, drugs from chemicals in a laboratory. Synthetic drugs duplicate the desired properties of natural substances. However, they don't have the inconsistency or unpredictable side effects of other drugs, because chemists can control their purity and potency. One of the most common synthetic drugs is aspirin.  Recombinant DNA technology is one of the fastest-growing areas in pharmacological studies. This technology uses artificially manipulated DNA segments from different organic sources by transferring a cell from a different species to a different host cell to change the way the cell reproduces. Basically, the cell becomes a protein factory that creates genetic instructions, leading the organism to produce chemical substances for use as drugs. The newer forms of insulin have been produced by this technique. Also, some skin grafts can be produced with this technology. Medications produced by recombinant DNA technology are often referred to as biologics.   Pharmacokinetics Pharmacokinetics refers to the movement of drugs through the body. There are four processes involved in pharmacokinetics: Absorption refers to the movement of a drug from its site of administration into the blood. Distribution is the movement of a drug from the blood into the tissues and cells. Metabolism involves physical and chemical alteration of the drug in the body. Excretion (elimination) refers to the removal of waste products of drug metabolism from the body.   The rate of absorption of a drug is related to the route of administration and the drug's ability to dissolve (solubility). Some medications dissolve rapidly and others dissolve slowly. The primary sites of absorption are as follows: Mucosa of the mouth Lungs Stomach Small intestine and rectum Subcutaneous tissue Blood vessels in muscle tissue   There are several factors that can influence the rate of absorption. Administration  Incorrect administration of a drug influences the rate of absorption. The medication could be destroyed before it reaches the site of action. For correct absorption, medication must be administered according to the package insert instructions. Drug PH The pH of a drug also influences how it's absorbed. An acidic medication like aspirin is more readily absorbed in the stomach compared to an alkaline antacid, which is more readily absorbed in the small intestine.  Food Food in the stomach will slow the rate of absorption but will also usually help to decrease stomach irritation from medications. On the other hand, an empty stomach will increase the rate of absorption but increase the stomach irritation that can be caused by medications. A high concentration of medication tends to be absorbed more rapidly. Location Medications that are easily absorbed in fats and lipids are more readily absorbed in the gastrointestinal tract. Medications that have an alcohol base are more easily absorbed in lipids. Medications with low lipid solubility are better absorbed when given in routes other than oral. Topical The absorption of topical drugs is influenced by the length of contact with the skin, the size of the area to which the medication is applied, skin thickness, and how well hydrated the skin tissue is at the application site. Inhalation When medication is administered through the inhalation route, the depth of respiration, patient's level of hydration, blood supply to the lungs, amount of medication administered, and surface area in the lungs will all influence the rate of absorption.   The fat solubility and the protein-binding ability of a drug influences its distribution. The amount of drug circulating in the bloodstream is the drug blood level. Fat-soluble drugs can be stored in the fatty tissues and provide a relatively stable reserve of the drug. Drugs like hormones in an oil base administered by injection tend to have a longer duration.   Some drugs can't pass through certain types of cell membranes. The blood-brain barrier protects the brain by restricting entry of water-soluble electrolytes. However, lipid-soluble drugs can pass into the brain and cerebrospinal fluid. The placental membrane barrier isn't as restrictive as the blood-brain barrier. Water- and fat-soluble drugs can cross this barrier. Many medications given to a mother will also reach the fetus. Therefore, an expectant mother should take medications only as prescribed by the physician.    Metabolism is a process of chemical reactions that change the drugs into water-soluble compounds for excretion. Without metabolism, the drug would continue to build up in a person's system, eventually causing toxic effects. The liver is the primary site for drug metabolism. The rate of metabolism is an important issue when a physician is deciding drug dosages. The drug half-life is the time the body takes to metabolize half of the available drug. Patients who are elderly or have liver or renal impairment may not have adequate metabolism of the drug, and the physician may need to prescribe a lower dosage. The rate at which a drug is excreted or eliminated depends on the chemical composition of the drug, the rate of metabolism, and the route of administration. When people age, their metabolic and excretory functions naturally slow down. Because the elderly can't process and eliminate drugs at an ideal rate, they're at increased risk for overdose. Drugs tend to accumulate in the elderly; the cumulative effect is more likely to occur in debilitated patients or those with chronic medical conditions.     Pharmacodynamics and Pharmacotherapeutics The term pharmacodynamics refers to the way in which a drug works, such as its mechanism of action in the body or the body's chemical reaction to the drug. Drugs can change and modify the way the body acts, but drugs don't give body organs and tissues new functions. Drugs normally slow down or speed up ordinary cell functions. No drug has one single action. When a drug enters the body, a fairly predictable chemical reaction is expected. However, all individuals can react differently to the same drug, and many unpredictable drug reactions can occur.  A desired effect happens when the expected response occurs from the drug administration. A side effect occurs when a predictable but undesired response occurs. For example, the desired effect of a narcotic analgesic is pain relief. A side effect is drowsiness. The site of the drug action may be either local or systemic. A local action is limited to the site of administration and the area immediately surrounding the application site. Topical lotions and creams applied to an area are examples of local action. When the drug effect occurs throughout the body, not just at the site of administration, the result is considered systemic action. *Pharmacotherapeutics refers to the effect of a drug in the treatment of disease. It's the combination of biologic, physical, and psychological changes that occur in the body.  A physician may order medications as part of a treatment plan for a medical condition. This disease or illness often has signs or symptoms that then become the reason, or indication, for ordering a medication.    Uses of Medication and Toxicology As mentioned earlier, toxicology is the study of poisons. More specifically, it's the study of the adverse effects that chemicals (and drugs) can have on living organisms. All drugs and chemicals have a level at which they become toxic. When taken in excess, these drugs act as poisons. The goal of pharmacology is to select medication in a dose that produces the desired effect with minimal side effects. This dosage is called the therapeutic dose. A toxic dose, on the other hand, is the smallest amount of a drug that would produce an adverse effect in a person.   The difference between the therapeutic dose and the toxic dose is referred to as the margin of safety. Here are some terms related to toxicology: Antidote is a drug used to counteract the effect of an excessive drug toxicity level. Adverse effects are unintended and undesirable effects that result from a drug. Adverse effects are more severe than side effects. An allergic reaction is a type of adverse effect. Allergic reactions may occur after only one dose of a drug that has been taken. These reactions occur either because the drug was taken many years before or because the person is allergic to a similar substance. Anaphylaxis is a medical emergency that can occur with drug administration, insect stings, and some foods. It is a severe life-threatening allergic reaction that occurs a short time after drug administration. It has been noted most often after administration of antibiotics, especially from the penicillin family. Signs and symptoms of an allergic reaction are: itching, rash, hives, difficulty breathing, wheezing, and swelling of eyes, lips, or tongue. Signs and symptoms of anaphylaxis are: hives and reddened skin, rapid swelling of the mouth and throat, and difficulty breathing. Swelling of the eyelids, lips, mouth, throat, hands, and feet due to an accumulation of fluid in the subcutaneous tissue (angioedema). Eventually, a person will experience cyanosis, low blood pressure, shortness of breath, vascular collapse, arrhythmias, and cardiac arrest. Contraindication is a condition in which the use of a specific medication should be avoided. For example, a previous allergic reaction to a drug is a contraindication for future use.   Key Points Pharmacology is the study of drugs and their interactions with living systems. A pharmacist is a person who dispenses drugs at a pharmacy. A pharmacologist is a scientist who studies all aspects of drugs. Drugs are substances that change physiological processes in the body, either therapeutic (helpful) or toxic (harmful). Drugs are made from five sources: plants, minerals, animals, synthetic sources, and modern engineering, such recombinant DNA technology. Pharmacokinetics refers to the movement of drugs through the body. There are four processes: absorption, distribution, metabolism, and excretion. The rate of absorption of a drug is related to the route of administration and the drug's solubility. The fat solubility and the protein-binding ability of a drug influences its distribution. The rate at which a drug is excreted depends on the chemical composition of the drug, the rate of metabolism, and the route of administration. Pharmacodynamics refers to the way in which a drug works, such as its mechanism of action in the body or the body's chemical reaction to the drug. Pharmacotherapeutics refers to the effect of a drug in the treatment of disease. Toxicology is the study of adverse effects that chemicals and drugs can have on living organisms.

Introduction Individuals who work in the healthcare field need to have a understanding of drugs and their use in patients. This includes how drugs work in the body, how they interact with other drugs, and which patients would benefit from their use. There are many different aspects of prescribing drugs, including their common identifying names, generic uses, regulations, ethics, and abuse-prevention strategies. All of these elements comprise a basic understanding of drugs.   Understanding Drugs and Their Use Healthcare professionals must have a complete and thorough working knowledge of drugs, including the following topics: Drug actions on the body Precautions and contraindications of drug use Reasons that physicians order specific drugs Categories of medications as related to therapeutic effects on body systems By understanding how patients respond to medication, healthcare professionals can do the following: Explain possible drug interactions with other medications or food Educate patients to ensure compliance and understanding Answer patients' questions about possible reactions Explain undesired effects and interactions   A drug is any chemical used for therapeutic purposes such as treating an illness, relieving a symptom, or conducting diagnostic testing.  An ideal drug is a theoretical concept that a drug would have all good effects and qualities and no negative effects or qualities. An ideal drug would produce the same effect each time that the same dose is given to all patients. The ideal drug would be very easy to administer and convenient to use, and it would require dosing only once a day. The ideal drug would also be affordable so that all patients who need the medication would have access to it. And finally, an ideal drug would have a name that's easy to pronounce and remember. However, at this time there are no ideal drugs. No drug is completely safe, because all drugs have some side effects. But there are safe drugs that can be taken in adequate doses over long periods of time with no harmful effects.   Types of Drug Interactions A drug interaction is the combined effect of medications taken together. Drugs interact in various ways with other drugs, but they can also interact with nutrients. When multiple drugs are given together, some of the interactions are desirable, but others are undesirable. In fact, sometimes medications are ordered together to achieve a desired effect. Other drugs may counteract or augment a drug's effects or may interfere with the absorption, metabolism, and excretion of a drug. Interactions must be addressed so they don't cause the patient harm. *The most common interactions are drug-drug interactions, but interactions can also take place between drugs and food.   Drug-Drug When two or more drugs are prescribed together, three actions can occur: The drugs will have no effect on each other's action. One drug will increase the effect of the other, or both drugs will increase the effects of each other. One drug will decrease the effect of the other, or both drugs will decrease the effects of each other. Most drugs don't have major interactions with other drugs or foods. However, when such an interaction occurs, it can be serious and even life-threatening. An example of a drug-drug interaction is Coumadin (warfarin) and St. John's wort. The St. John's wort can decrease the blood-thinning effects of the Coumadin. Nutrient-Drug Nutrient-drug interactions aren't all that well understood. In fact, they're still being studied. They can cause toxic effects or they can cause failure of therapy, depending on the drug-nutrient combination. Food in the stomach can significantly change the absorption of drugs. Some medications must be taken on an empty stomach, resulting in a more rapid absorption. Other medications are taken with food to maximize the absorption rate and decrease stomach irritation. Consider this example: Green leafy vegetables, broccoli, Brussels sprouts, and cabbage contain vitamin K, which inactivates Coumadin. A patient who is to take Coumadin should be instructed to maintain the same dietary intake of these vegetables and not to vary their intake greatly. The dosage of Coumadin for each patient is based on that patient's bloodwork. If the patient's diet is stable with the amount of these types of vegetables, then the Coumadin will be dosed correctly. If the patient decides to eat several big, green, leafy salads filled with vitamin K–rich vegetables for a few days, then the result will be a decrease in the Coumadin's effectiveness. Disease-Drug Some drugs used to treat one disease can cause an exacerbation in or interfere with another disease or disorder that a patient may have at the same time. These disease-drug interactions tend to be be more common in older adults and patients with multiple chronic diseases. An example is over-the-counter (OTC) cold preparations that contain ingredients known to be contraindicated for glaucoma and high blood pressure. Patients should always check with their physicians before taking any over-the-counter preparations.    Drug Nomenclature Drug nomenclature refers to all of the names by which a drug can be identified. All drugs have a chemical name, a generic name, a brand name, and possibly an OTC name. The chemical name is usually a very long name of the chemical composition of the drug. It can be found in the package insert. It isn't often used in the dispensing process, but it's important to the FDA and the offices that register the patent on the drug. It's also important to chemists and other scientists working in the field of pharmaceuticals.  For safety reasons, the proper way to express the name of a medication in the pharmacy and medical literature is by the generic name, also called the nonproprietary and approved name. This name is the official medical name assigned by the producer. It's found in the United States Pharmacopeia/National Formulary (USP-NF), a book of public standards related to pharmacology.   The brand name, also known as a trade or proprietary name, is given to a drug by the manufacturer, which means that the manufacturer owns the drug. The brand name is the one patients are more apt to recognize. These names have a registered trademark and are sold through a specific pharmaceutical manufacturer, which is generally the sole source of the product. Lipitor, Nexium, and Glucophage are examples of brand names. Fortunately, in the United States, the National Drug Code (NDC) is indispensable in helping to identify each individual drug, regardless of which name is being used to describe the drug. The following example should clarify your understanding of the distinction among these three names. It provides the three names for the common drug known as Tylenol. Chemical Name          N-acetyl-p-aminophenol Generic Name            Acetaminophen      Brand Name               Tylenol   Generic Drugs Generic drugs are made with the same ingredients and same dosage as brand-name drugs; however, they're not protected by a trademark. The generic drug is considered to be equivalent to the brand-name drug, but it's sold under the generic, or nonproprietary, name of the medication. Here are some examples:  Brand Name        Generic Name Lipitor                   atorvastatin Nexium                 esomeprazole Glucophage         metformin   Generic drugs have their own names as well. Both brand-name and generic drugs are regulated by the FDA.   You may be wondering if generic drugs are as effective as brand-name drugs. Generic drugs are the same as brand-name in the following ways: Safety Strength Quality Dosage Function Generic drugs use the same active ingredients as brand-name drugs, so they have the same benefits and risks. The Food and Drug Administration (FDA) requires generic drugs to be the same quality, strength, purity, and stability as brand-name drugs.   New drugs are continually being developed and tested. First, scientists develop a new drug, which is first known by its chemical name but is usually referred to by its generic name. Once the FDA approves the drug, the manufacturer markets the drug with a brand name. Usually, the brand name is shorter than the generic name—it's a name that consumers can remember. A superscript "R" on the product label indicates that the drug has been registered by the U.S Patent and Trademark office, and a superscript "TM" indicates a trademark. A pharmaceutical company holds the patent to a new brand-name drug for about 20 years after its discovery. During this time, research and tests are conducted to approve the drug for FDA sale. The company usually has 11 to 12 years of sole rights to sell the drug to the public. After this time has expired, other companies can make a generic version of the drug. The generic version goes through a series of studies and must have FDA approval before it's marketed.   Let's take an example of a drug that everyone knows fairly well. The chemical name of this drug is 2-(4-Isobutylphenyl) propanoic acid. The generic name for this drug is Ibuprofen. It's a pain reliever and inflammation reducer that's approved for use by adults and children. The drug was first synthesized in the early 1960s in England and became available in the United States in 1974 as part of the class of drugs known as NSAIDS (nonsteroidal anti-inflammatory drugs). This drug was originally marketed in the United States by Upjohn as a prescription-strength drug called Motrin. It was 10 years later that an over-the-counter strength was approved.  Now we know this drug by many names: Motrin, Advil, and others. Most of the time, you can also find this drug simply under its generic name, ibuprofen, on store shelves. As you can see, the timeline for drugs' production, even after they're discovered, can be lengthy.   Drug Regulations and Ethics The Food and Drug Administration (FDA) is the government agency that decides what drugs may be sold and under what legal restrictions. In reference to a drug, the term over-the-counter (OTC) is actually a legal term, indicating that the FDA has placed no restrictions on the drug. A legend drug, on the other hand, can be distributed only by prescription because it may cause harmful side effects if not used with caution. Finally, controlled substances are drugs that are dangerous and subject to abuse. Many controlled substances do have acceptable medical usages and thus are allowed—under very rigid rules. The FDA sets legal standards for the strength, purity, and quality in the manufacture of medications. In manufacturing a drug, a pharmaceutical company must produce the exact formula as approved by the FDA, with each dose at the exact same strength. The drug must be clearly identified by color, form, shape, size, and label. *All health professionals must use confidentiality in all areas of patient care, from the front office to the back office. Medical offices have policies and procedures in place to help protect patient confidentiality.    The approved indications and treatment for conditions are found in the package insert for the medication. However, some medications have off-label uses—that is, a medication can be prescribed to treat a condition that hasn't been studied by the manufacturer for FDA approval. The off-label use of drugs is becoming more frequent as physicians use medications and report their unexpected effects after the initial FDA approval has already occurred. An example of an off-label use is tricyclics used to treat chronic-pain syndrome.   The FDA enforces laws pertaining to the manufacture, packaging, and dispensing of prescription drugs and cosmetics. The Drug Enforcement Administration (DEA), on the other hand, regulates the manufacture and sale of dangerous drugs, such as narcotics. These substances became regulated by the DEA with passage of the Controlled Substances Act in 1970. The DEA categorizes controlled substances under five schedules, based on the potential for abuse and the medical usefulness of the drug. These schedules include the regulations for how the drug may be prescribed and stored.                                                                                              Controlled Substances  Schedule: Schedule 1: Uses: Drugs, substances, or chemicals with no currently accepted medical use and a high potential for abuse. Examples: Heroin, LSD, marijuana, ecstasy, methaqualone, and peyote Schedule: Schedule 2: Uses: Schedule 2 drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Examples: Vicodin, cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin Schedule: Schedule 3: Uses: Schedule 3 drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. The abuse potential of Schedule 3 drugs is less than Schedule 1 and Schedule 2 drugs but more than Schedule 4. Examples: Tylenol with codeine, ketamine, anabolic steroids, and testosterone Schedule: Schedule 4: Uses: Schedule 4 drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Examples: Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, Tramadol Schedule: Schedule 5: Uses: Schedule 5 drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule 4 and consist of preparations containing limited quantities of certain narcotics. Schedule 5 drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Examples: Cough preparations with less than 200 milligrams of codeine per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin    Because the DEA strictly enforces the regulations for controlled substances, the physician's office must keep precise and accurate records for Schedule 2 medications. If schedule 2 medications are stocked and administered in a physician's office, then there must be complete documentation kept from the time that the medication arrives in the facility until the medication is administered. Physicians and other licensed health professionals who prescribe, dispense, or administer controlled substances must have a current state license to practice, be registered with the DEA, and have a DEA number assigned to them. Some states also require a state controlled substance license. Physicians must renew their DEA registration every three years for their DEA registration to remain valid.     Preventing Drug Abuse Drug abuse is a national and international problem. Those working in the healthcare field must be aware of the problem and understand the responsibility to patients and society by being observant for signs and symptoms of drug abuse. Prescription pads that physicians use for ordering need to be protected at all times. They should be kept in a locked drawer or cabinet when not being used. Prescription pads should not be left in the examination rooms. Many offices today primarily enter prescriptions electronically, thereby decreasing the risk of drug abuse occurring from prescription pad theft. Signs and symptoms of drug abuse can include: Change in behavior, erratic behavior, or a lack of focus Frequently changing healthcare providers, doctor shopping, or doctor hopping (not receiving care from one primary physician) Physical health issues including lack of energy or motivation, drowsiness Sudden change in work or school performance, neglected appearance, or lack of interest in grooming   Key Points A drug is any chemical used for therapeutic purposes such as treating illness, relieving a symptom, or conducting diagnostic testing. A drug interaction is the combined effect of medications taken together—how they interact with other drugs or nutrients. Drug nomenclature refers to all of the names by which a drug can be identified. The chemical name is the name of the chemical composition of the drug. The generic (nonproprietary; approved) name is the official medical name assigned by the producer and found in the USP-NF.  Generic drugs are made with the same ingredients and same dosage as brand name drugs but aren't protected by a trademark. The Food and Drug Administration (FDA) is the government agency that decides what drugs may be sold and under what legal restrictions. The FDA sets legal standards for the strength, purity, and quality in the manufacture of medications. The Drug Enforcement Administration (DEA) regulates the manufacture and sale of dangerous drugs, such as narcotics. The DEA regulates controlled substances; they're categorized under five schedules based on the potential for abuse and the medical usefulness of the drug. Medical professionals must be alert for signs and symptoms that indicate potential drug abuse. All health professionals must use confidentiality in all areas of patient care. Prescription pad theft is one of the most common ways people abuse drugs; use of an electronic system for prescriptions will decrease the issue of theft.

Introduction When using and prescribing drugs and different medications, there are many elements to understand before giving advice to a patient. A career in the healthcare field requires you to be able to read, interpret, and document drug orders. For over-the-counter medications, you can use the Physicians' Desk Reference, drug monographs, and package inserts as sources of information to pass on to patients to ensure proper use of drugs and medications.   Physicians' Desk Reference (PDR) The Physicians' Desk Reference (PDR) is a compilation of information on FDA-approved prescription (Rx) and over-the-counter drugs. The PDR, which is updated annually, was initially designed to provide physicians with information relevant to writing prescriptions. It's now widely available and frequently used by other medical and healthcare providers and even by consumers. You'll see physicians and other healthcare providers accessing this information as apps on their mobile devices. The information that the physicians and nurses need is at their fingertips.   There are many different publishers of PDRs. For the purpose of this course, we're using the PDR Nurse's Drug Handbook. PDRs generally refer to a drug's generic name. Within the PDR Nurse's Drug Handbook is the generic name of the drug in bold, along with the phonetic pronunciation. In the header are the classification (the type of drug or class under which the drug is listed), the FDA's pregnancy category, trade names (names under which the drug is marketed), and whether the drug is prescription or over-the-counter. After the header is additional information, such as uses, contraindications (symptoms or conditions that make a particular treatment or procedure inadvisable), side effects, laboratory test considerations, drug interactions, dosages, and more.    Drug Monographs and Packaging A drug monograph is a concise collection of information about a given drug that's required by the FDA to describe the characteristics of the drug. It's usually a printed document containing detailed information that has been reviewed and approved by the FDA for accuracy and detail, and it describes all aspects of the use of the drug for medical purposes. The information in the drug monograph has been derived from the multitude of data submitted in the New Drug Application (NDA) to the FDA and has been transformed into an organized, concise, and official description of the actions of the drug. The monograph is filed with the FDA as the official information that must, by law, accompany the drug, possibly in edited form, in all advertising, promotion, and descriptions of the drug. It is, in a sense, a legally binding document that can be used to describe the actions of the drug if questions concerning these actions arise. A copy of the drug monograph can be obtained by anyone upon request to the FDA.   The drug monograph or its edited version can be found in many sources of drug information, including the insert that accompanies a drug package as distributed to the pharmacy, the Physicians' Desk Reference, and other official and unofficial compendia of drug information. Drug monographs that accompany the promotional literature of a drug present a great deal of information in a very concise manner.    A package insert is a copy of a drug monograph that accompanies the drug in its package when distributed for sale and use. Each new drug package opened for dispensing in the pharmacy contains the package insert for that drug. If the medicine is packaged in a box or plastic container, the package insert is folded and placed inside the box. If the medicine is available as pills or liquid in a bottle, the insert is affixed with some type of adhesive to the outside of the bottle. Drug monographs accompany drugs when they're shipped throughout the country to pharmacies and other dispensaries. Once the monograph is folded and placed into the drug package, it then becomes known as the package insert. Because the package insert is the drug monograph, it's concise, contains a great deal of information, and takes up a very small space. The package insert is affixed to the outside of the medication bottle in its original configuration. The original packet takes up a space of 1 1/2 inches by 2 1/2 inches. If the insert is unfolded, it opens to a final size of 12 inches by 18 inches. Since both sides of the 12-by-18-inch paper are filled with type, the entire package insert holds about 32,400 words—a lot of information! These inserts change shape and size frequently, but an online version of this information is almost always available. Package inserts come in various sizes, depending on how they accompany the medicine and the size of the medicine bottle or box. Imagine a small ointment tube in a box into which an insert must be placed. In this case, the insert is probably folded many times and printed in very small type. A large box of medicine, however, probably contains a larger printed insert.   Key Points The Physicians' Desk Reference (PDR) is a compilation of information on FDA-approved prescription and over-the-counter drugs. The PDR is updated annually and provides physicians with information relevant to writing prescriptions. A drug monograph is a concise collection of information about a specific drug that is required by the FDA to describe the drug's characteristics. A package insert is a copy of the drug monograph that is packaged with the drug when distributed for sale and use. One of the roles of a healthcare provider is to read, interpret, and document medication orders. A prescription is a written order for dispensing or administering medications. Prescriptions are usually written by physicians, dentists, and other licensed healthcare professionals as allowed by law. A medication order is a written or verbal order issued by a licensed healthcare professional for administration of a medication in a healthcare setting. Latin abbreviations are used frequently in prescription writing; this allows the prescriber to write long sentences quickly. A pharmacist must rewrite Latin abbreviations into a complete English sentence and place it on the label for the patient to understand.

Introduction Administering medication can take on different forms and routes for both the healthcare professional and the patient. Routes of administration, or how the medicine is absorbed into the body, will vary widely for each patient and drug used. Patients need to fully understand how to administer their prescribed medication through order forms, descriptions, different types of packaging, and education.   Patients and Medication Usage Some medications are now packaged so that they're convenient and discreet for patients to carry with them. Here are just a few examples: Oral contraceptives are packaged in a compact that's designed to remind the user to take the medication as prescribed. Insulin pens are a great way for patients to carry their insulin with them. The pen contains a vial of insulin. When patients need an injection, they just change the needle and dial in the amount of insulin needed on their pen. The needles are disposed of after each use. Once the insulin in the pen has been used, the whole pen is discarded and a new pen is used. Insulin pumps are another great way for patients to monitor and control their blood sugars in an easy, on-the-go style. *The drug forms that a physician prescribes must be adjusted to take into account a patient's lifestyle and overall physical condition.   Each patient's medical record is considered a legal document. Therefore, every aspect of the patient's care, including medication and refill orders, should be documented. Patients should be reminded to bring all medications in their original bottles to every appointment. This includes all prescription medication, over-the-counter medication, and all vitamin and herbal supplements. Patients should be educated on all three of these types of medication. People tend to be more compliant when they have a better understanding of medications prescribed. Patient's Medical Records The following medical order information should be documented in the patient's medical record: Date, time, and name of medication Strength and amount of medication Directions for medication use Sample medications given All medications must be included in a patient's medical record. Failure to include this information in the medical record could lead to potential drug interactions.   Key Points Drugs come in many dosage forms, which vary the rate and site of actions and the amount of medication delivered. When medication is administered using the oral route, it's taken by mouth and swallowed or taken through the nasogastric tube, where it's passed through the esophagus into the stomach. Drugs administered by the oral route may be affected by GI functions and have a slower onset of action because they must go through the GI tract to be absorbed. Using the percutaneous route, medications are applied to the skin or mucous membranes as topical preparations. Topical medications are applied directly to the body surface. Transdermal medications are absorbed through the skin using a form of topical application, such as a patch. Sublingual medications are tablets placed under the tongue to be dissolved by saliva and absorbed by mucous membranes. Inhalation medications are vapors or gases taken into the bloodstream via the lungs.  Parenteral medications are administered by injection and include: the intravenous (IV) route, the intramuscular (IM) route, the subcutaneous (SC) route, and the intradermal (ID) route. Some highly specialized injections are typically performed by a physician, including intracardiac (into the heart); intracavitary (into a body cavity); and intraspinal (into the subarachnoid space). Some medications are packaged to be convenient and discreet for the patient to carry, such as oral contraceptives, insulin pens, and insulin pumps. Each patient's medical record is a legal document; every aspect of a patient's care should be documented.

Introduction A prescription is a written order from a medical professional that tells the pharmacist the correct drug and dosage to give to the patient. The doctor or medical professional is responsible for all of the components of a prescription that are written or sent to the pharmacist. The pharmacist then deals with the prescription order, directions, and label for proper use by the patient. The patient must be instructed to properly take the medication and follow the orders as told by the doctor.   Types of Prescriptions Prescriptions may be filled upon the request of the patient if refills were indicated on the original written prescription. Over half of the prescriptions filled on a daily basis are refills of an original prescription. When a refill is needed, the patient provides the pharmacy with the prescription number (label number) of the prescription to be refilled. This number was stamped on the original prescription when dispensed and is used as a filing number for future reference. The patient will either call in the number over the telephone or take the empty prescription container to the pharmacy. In some cases, the doctor's office will call with the prescription number to request the refill. Once the prescription number is known, the prescription can be identified from the files, and the medicine is dispensed as instructed on the original prescription.   When a refill is dispensed, the label on the bottle indicates that one less refill is remaining. For example, if the original prescription was written for a medicine with two refills, then "2 refills remaining" is typed on the label when the prescription is filled for the first time. Each time a patient refills the prescription, a new label is typed. On each new label, the number of refills remaining must be reduced by one. A prescriber can call new prescriptions into a pharmacy over the telephone. The pharmacist transfers the telephone order onto a prescription blank. The prescription is dispensed as if it were the original written prescription.   Doctors can order medications for patients while they're in the hospital. If a doctor orders a medication in a hospital, it's known as a medication order or physician's order. It's not called a "prescription" as it is at the local pharmacy.  Hospitals now use computerized systems to track all physicians' orders for each patient. The physician can enter his or her orders directly into the system used by the hospital. There are six components that must be included on hospital medication orders. Components of Hospital Medication Orders Date Patient's name Medication name Dosage or amount of medication Route of administration Time/frequency of administration   Key Points A prescription is a written order from a prescriber; it tells the pharmacist what drug to give a patient. A prescription must provide with complete accuracy the name, strength, and quantity of the drug to dispense; the patient to whom it is to be given; and exact directions for taking for the patient. A prescription blank is the form used to write a prescription; it typically includes the prescriber's name, address, and telephone number preprinted on it. A typical prescription order follows a defined pattern to simplify its interpretation. This includes the patient's name and address, the date, the symbol Rx, the name of the medication, its dose form, and the strength of the medication. Directions to the pharmacist specify dispensation amounts, and directions to the patient indicate how to take the medication; refill information is also included in the prescription. Prescriptions may be filled by request of the patient if refills are indicated on the original prescription. Hospital medication orders are ordered by a doctor for patients while they're in the hospital.

Introduction Measurements in pharmacology are taken in a variety of ways. Each system used in pharmacology must be understandable and convertible for real world usage. The measurement and ultimate dosage of a prescription needs to correlate with the specific needs, characteristics, and diagnosed illnesses of each patient.   Effects of Drug Dosages and Actions No two people respond exactly alike to medications. Even the same person may not respond to the same drug the same way if a different dose is administered or administered at a different time of day or via a different route. Besides its properties of absorption, distribution, metabolism, excretion, and interaction with other medications, a drug's action and effect on the body are influenced by the patient's age, weight, diet, gender, genetics, and chronic diseases. The bodies of the very young and the very old don't respond in exactly the same ways as "average" adults. Drugs distribute differently in bodies that are very lean or very high in fat content. The physician will take these variables into account when prescribing dosages.  Let's examine some of the common variables that have an effect on the dosage of a medication. 1. Age. The very young may be more sensitive to medications because of immature body organs. On the other hand, older adults are more sensitive than younger adults because of decreased function of organs, especially the liver and kidneys. Gender. Women may require a lower dose of some medications because of their smaller size and higher average body fat. Body fat serves as a reservoir for fat-soluble medications and can therefore slow the excretion of those drugs. Mental attitude. Let's not overlook the power of positive thinking! Having a healthy attitude about a drug's potential action tends to have a synergistic effect. In fact, scientific studies have shown that sometimes a positive physical response can be all in the mind. Patients in experiments have reported feeling better after being given a placebo, a substance that looks like a medication but doesn't contain any active drug. On the other hand, pessimism can diminish the effectiveness of a drug. 2. Weight. For drug therapy to be effective, a certain concentration of the drug in the patient's body is needed for the desired therapeutic effects. Doses may need to be altered for patients who don't fall into the "normal" weight and age range. Patients who are heavier may require higher doses of medication compared to a patient with less body fat or mass. Sometimes, dosages for medications are calculated on the basis of body surface area (BSA) . This method is often used for calculating chemotherapeutic drugs. The BSA accounts for the relationship of the patient's weight to height. 3. Diet. A healthy diet is always good to help promote health. Even a healthy diet can affect the potency, availability, metabolism, absorption, and therapeutic effect of medications. A poor diet or one that's high in fat may slow the metabolism of some drugs. Chronic diseases. Chronic diseases affecting the renal system and hepatic system will affect the dosage required for a medication. The hepatic system works to metabolize the medications, and the renal system works to eliminate them from the body. If either of these systems is impaired, it will result in medication building up in the patient's system. 4. Children. A child's ability to absorb, metabolize, and excrete medications is very different from an adult's ability. Drug dosages for children are based on the child's body surface area (BSA) rather than age. Age isn't a reliable guide for dosing medications in infants and children. As a child grows, the dose needed will increase. Medications should be recalculated regularly to make sure the dose is in the therapeutic range.   Before we end this section on the variables that may effect medications, let's look at some of the terminology that has developed around medicine dosages. Minimum dose is the smallest amount of a medication that would have any effect. In other words, any less wouldn't do any good. Maximum dose is the largest amount of medication that can be given to an individual before it has a toxic effect. In other words, any more would be toxic. Loading dose is an initial high dose to "load up" the bloodstream with the drug. Maintenance dose is the amount of medication necessary to keep a steady drug level. Lethal dose is the amount of medication that would cause death. Usual dose is the customary dose for body weight.   Polypharmacy Polypharmacy refers to the simultaneous use of a number of drugs to treat a single patient for one or more conditions. Polypharmacy is more likely to occur in older adults, who are more likely to be treated for multiple chronic disease processes. However, it can occur in any patient who is taking many medications for multiple health conditions. This problem is increased when a patient also takes over-the-counter medications, vitamins, and herbal supplements. Sometimes, polypharmacy is easy to spot when a patient is receiving more than one medication from a drug class or several different medications from different classes to treat the same condition. Often, new medications are added to the patient's regimen to treat the side effects of another medication, thereby leading to the patient taking even more medication. This increases the likelihood of a negative outcome or effect, such as an adverse drug reaction or interaction.   Key Points The metric system is a system of decimal measurement based on meter (length), liter (volume), and gram (weight). The apothecary system is occasionally used for weighing and calculating drugs and is based on grain (weight) and minim (volume). The household measurement system uses basic tools of measurement that can be found around the house, such as droppers, teaspoons, cups, and so on. Healthcare professionals must often convert units of one measurement system into units of another measurement system, most commonly time and temperature. There are two commonly used standards for time, the 12-hour clock, which uses a.m. and p.m. designations, and the 24-hour clock, also known as military time. There are two temperature scales in use: Celsius (or centigrade) and Fahrenheit. On the Celsius scale, 0°C is the freezing point of water, and 100°C is the boiling point. On the Fahrenheit scale, 32°F is the freezing point of water, and 212°F is the boiling point. There are many variables to be taken into account when prescribing doses, including age, weight, and mental attitude, among others. Polypharmacy refers to the simultaneous use of a number of drugs to treat a single patient for one or more conditions. It also increases the likelihood of a negative outcome or effect such as an adverse drug reaction or interaction.

Introduction Medication and drug compliance relates to the patient following the directions of the healthcare team. If a patient isn't complying with the directives of the medical team, the communication must be assessed to ensure the patient is educated on his or her medical needs. Quality assurance and the Seven Rights of Medication Administration help the healthcare team maintain high standards when dispensing drugs and medications.   Medication Compliance and Quality Assurance In the healthcare field, compliance refers to the degree to which a patient follows the directions of his or her healthcare providers. There are many reasons for medication noncompliance. For example, a patient may not understand the instructions, the medication may be too expensive, or side effects may be creating problems for the patient. Eliminating some or all of these reasons can be helpful in increasing compliance. Written and verbal instructions should be provided to patients. If possible, instructions should be given to both the patient and a family member or caregiver who is with the patient at the time of the office visit. *Barriers to communication need to be assessed and evaluated before instructing the patient. Language barriers, hearing and vision deficiencies, and differing cultures and religions can cause confusion in giving directions and can lead to noncompliance. Accurate communication is vital for medication compliance.   Quality assurance is all about establishing high standards in patient care and developing professional practices towards those standards. You'll find quality assurance included in the policies and procedures in each medical office and medical facility. The goal of quality assurance is that the policies and procedures provide the patient with a high-quality standard of care. When the policies or procedures aren't followed, the potential for errors in the delivery of patient care increases. Safety with medications, whether over-the-counter medicines or prescriptions, is an important factor in providing good patient care. Healthcare professionals have the responsibility to obtain a list of all medications that a patient is currently taking. This includes prescription, herbal, over-the-counter medications (OTC).   Here are some important points to remember when you're discussing OTC medications with patients: Caution. OTC drugs must be taken with the same caution as prescription medications. The patient should be taught to read all of the instructions on the OTC label. Safe Dose. The safe dose for a 24-hour period, which is noted on OTC labels, shouldn't be exceeded. Interactions. All OTC medications should be evaluated to make sure that an adverse drug-to-drug interaction won't occur. Allergies. Allergies are an important consideration in choosing OTC medications. OTC medications can have changes in their inert ingredients between batches of the same brand or between various brands and manufacturers. Encourage patients to read labels carefully before they buy any OTC drug to verify that allergens aren't listed in the ingredients and interactions won't occur.  Home Use. Using over-the-counter medications at home for a condition can cause a patient to delay seeking medical care. Dosages. Patients should know that OTC dosages of medications are low and may not be therapeutic, depending on the patent's condition. An example is Aleve, an OTC brand of naproxen that's taken for chronic pain. Aleve comes in 200-mg tablets, only one or two of which should be taken daily. Yet naproxen also can be prescribed by a medical professional in dosages of 375 to 500 mg, two to three times a day.   Medication Standards and Administration Many people think that pharmacology is the administering of medications. However, pharmacology is really the knowledge necessary to safely administer medications. The term medication administration means giving a dose of medication to a person. In most cases, a patient self-administers. There are three primary healthcare professionals directly involved with medication administration: Physician Pharmacist Allied health professional   We know that blood and body fluids can contain microorganisms that are capable of causing disease. In July 1992, the Occupational Safety & Health Administration (OSHA) began to require and enforce safety precautions for bloodborne pathogens. OSHA requires that every medical facility have a workplace exposure plan. Here are some OSHA standards specific to administering medication: Barrier equipment should be worn if there's a chance of body fluids splashing or spraying during administration of medications. Healthcare providers should wear gloves when performing injections. Disposable equipment and needles that have come in contact with body fluids must be properly disposed of in puncture-proof containers. All syringes and needles should have a safety system, such as a retractable cap. A puncture-proof biohazard container should be in close proximity to the area of use. If a needle does need to be recapped, then the "scoop" method should be used. Contaminated waste must be disposed of according to local, state, and federal regulations. All exposures to body fluids must be evaluated. Then, a post-exposure follow-up plan, including an incident report and medical evaluation, should be completed.   Seven Rights of Medication Administration Even though you won't be responsible for administering medications, the healthcare professionals that you'll be working with in your new career may be responsible for the ordering and administering of medications. There are seven vital steps that all healthcare professionals follow when preparing to administer medications. Healthcare professionals who follow these "seven rights" are applying their knowledge to administer drugs safely. Right Patient The healthcare professional must verify that he or she has the correct patient. Right Drug The healthcare professional must make sure to verify that he or she has the correct drug. Many drugs may look alike, and their spelling and pronunciation may also be similar. Right Dose The healthcare professional must verify the dose that was ordered is the dose that he or she is preparing to administer. Right Time The healthcare professional must verify with the order that it's the right time. Medications like vaccines have certain spacing requirements. Giving a vaccine too early can render it ineffective, and the patient would need to be reimmunized at a later date. Right Route The healthcare professional must double-check the order and verify the correct route (example: intramuscular injection or subcutaneous injection). Right Technique The healthcare professional must select an appropriate site and use the correct administration techniques for administering the medications (example: identifying the correct anatomical site and using the correct technique for an intramuscular injection). Right Documentation The healthcare professional must document in the patient's record immediately after administering the medication.   Key Points Compliance refers to the degree to which a patient follows the directions of his or her healthcare providers. Some problems leading to noncompliance include the patient not understanding the instructions, the cost of the medication, or side effects that create problems for the patient. Written and verbal instructions should be given to the patient and a family member or caregiver. Barriers to communication must be assessed and resolved in order to provide accurate communication. Quality assurance establishes high standards in patient care and develops professional practices towards those standards. The goal of quality assurance is that the policies and procedures provide the patient with a high-quality standard of care. Medication administration means giving a dose of medication to a person; most typically, this is done by a physician, pharmacist, or allied health professional. The Occupational Health & Safety Administration (OSHA) requires and enforces safety precautions for bloodborne pathogens. OSHA requires that all medical facilities have a workplace exposure plan. The seven vital steps, or Seven Rights, that all healthcare professionals follow when preparing to administer medications are: right patient, right drug, right dose, right time, right route, right technique, and right documentation.

Introduction Medical professionals who prescribe medications must have the authority to do so. Each medical professional, doctor, or surgeon will have a different focus regarding the patient's medication needs. A doctor's specialty or area of expertise will greatly influence the types of medications that he or she prescribes the patient.   Who Can Prescribe Medications? For a healthcare professional to be able to prescribe medications, he or she must be licensed and have prescriptive authority. We'll now look at some of these professionals. Family practice physicians, or general practitioners, are the traditional family doctors who treat patients of all ages for a wide array of medical problems. Family practice physicians are often the first healthcare professionals that patients turn to for treatment, advice, and referrals to specialists. Family practice physicians often treat acute conditions like upper respiratory infections and the common cold virus, as well as common chronic conditions like asthma and COPD (chronic obstructive pulmonary disease). Allergists are doctors who specialize in the diagnosis and treatment of allergic reactions. One of the most common allergic reactions is hay fever. Antihistamines are commonly ordered for the treatment of allergies. For some patients, an allergy can be so severe that it can be life-threatening. This type of allergic reaction is called an anaphylactic allergic reaction. Bee stings, in addition to shellfish, peanuts, and other foods, are common triggers for anaphylaxis. Patients with such allergies need an allergy plan and need to be trained on the use of an epinephrine autoinjector like the EpiPen or Auvi-Q. Dermatologists are doctors who diagnose and treat diseases of the skin. A dermatologist undergoes three to four years of specialty training after medical school. At the end of the specialty training, the individual must pass an oral and a written exam for certification. Major skin disorders requiring drug therapy from a dermatologist include certain types of skin infections and skin inflammation. Ophthalmologists are doctors who specialize in diagnosing and treating diseases of the eye. An eye doctor usually completes three years of specialized training after graduation from medical school, plus one year of active practice. Applicants must then take an examination for certification as ophthalmologists. Ophthalmologists may prescribe medications used to treat glaucoma, eye infections, and inflammation.   Rheumatologists are doctors who diagnose and treat diseases of the joints, muscles, and bones. Rheumatologists commonly treat arthritis, certain autoimmune diseases like lupus and fibromyalgia, and rheumatoid arthritis. They may also treat tendonitis, gout, and osteoporosis.  Unfortunately, there's no absolute cure for arthritis, so doctors of rheumatology prescribe drugs to treat the symptoms of pain and inflammation. Reducing inflammation in the joints is very important to delay permanent damage to the joints, and relieving pain is essential to allow patients to participate in their usual activities of daily living. Rheumatologists rely on both anti-inflammatory and analgesic medications for treating common forms of arthritis. Patients with rheumatoid arthritis may be ordered on immunomodulators or disease-modifying antirheumatic drugs (DMARDs) to help slow the progression of the disease. Some medications used to treat rheumatoid arthritis are intravenous infusions that are administered in the physician's office by a registered nurse. Urologists treat diseases of the urinary tract, which includes the kidneys, the ureters, and the urethra. Urology is also a surgical specialty. The American Board of Urology requires a minimum of five years of postgraduate medical training and practicing in a community for 16 months. After that, the candidate may sit for the written and oral exam to become certified.  Urologists treat both men and women for kidney and bladder stones, cancers of the urinary system, conditions related to infertility, and any other diseases or infections of the urinary system. Urologists often prescribe urinary antiseptics and antibiotics.  Endocrinologists are doctors who diagnose and treat disorders of the endocrine system. These disorders are known as glandular diseases because the endocrine system is composed of different glands that secrete hormones. For example, diabetic patients may follow up and see an endocrinologist for management of their blood sugars. While obstetricians focus on childbirth, gynecologists focus on the care of medical and surgical conditions that apply only to female patients. A gynecologist often practices obstetrics too. Such a doctor is called an OB/GYN.  The American Board of Obstetrics and Gynecology requires the completion of four years of postgraduate residency training. After residency, a physician may seek certification through the American Board of Obstetrics and Gynecology. The candidate must pass a written and oral examination to become certified. One common drug classification prescribed by OB/GYNs is oral contraceptives. They're usually ordered as a form of contraception, but they may also be prescribed to treat several other health conditions. Gastroenterologists are doctors who specialize in the treatment of disorders of the gastrointestinal tract, which includes the esophagus, stomach, intestines, and lower bowel. Common conditions that a gastroenterologist may treat are gastroesophageal reflux (heartburn) and peptic ulcers.   Orthopedic physicians deal with injuries and disorders of the musculoskeletal system. Therefore, the orthopedic physician is often called on to perform bone surgery. Orthopedic doctors treat bone fractures. Some bone fractures require surgery to set the bone so that it will heal correctly. These physicians also perform joint replacement surgery for the treatment of severe degenerative joint disease. Pain is always involved when bone fractures occur. Pain is also a normal component of the postoperative period after orthopedic surgery. These physicians often prescribe medications used to relieve pain. General surgeons are physicians who specialize in the surgical treatment of the abdominal organs, including the intestines, esophagus, stomach, colon, liver, and gallbladder. The general surgeon is a highly trained physician who deals with diseases and injuries that require some sort of surgical treatment. Many general surgeons receive further training to specialize as cardiac surgeons, vascular surgeons, plastic surgeons, neurosurgeons, and other similar specialties. Many of the medications prescribed are for pain and antibiotics to treat infection. The American Board of Surgery requires five years of specialized surgical residency training before an applicant can be examined for general surgery certification by the board.  Geriatricians are physicians who specialize in healthcare for older patients, generally defined as people who are over the age of 65 years. Geriatricians commonly deal with heart problems and other cardiovascular disorders, arthritic disease, diabetes, thyroid disorders, problems with hearing and eyesight, insomnia, nutritional disorders, and neurological and memory disorders. Geriatricians specialize in treating the multiple disease problems that older patients often encounter and can develop special care plans that address the healthcare needs of the patient. These physicians prescribe a variety of different medications to treat many different conditions. It's important to note that geriatric patients often have increased sensitivity to medications and may need lower doses of some prescribed drugs. Hospitalists are physicians who specialize in the care of patients in hospitals. These physicians generally work only in hospitals and see patients on a daily basis while they're in the hospital for treatment. On-site hospitalists can sometimes provide more effective care for hospitalized patients than primary care physicians, who would need to travel from their private offices to the hospital to check on their patients. Hospitalists prescribe a wide variety of medications needed to treat patients while they're hospitalized. Neurologists are doctors who treat disorders of the brain and the central nervous system. Neurologists don't perform surgery, but they're responsible for the care of patients with brain vascular disease, migraine headaches, epilepsy, multiple sclerosis, muscular dystrophy, and brain and spinal cord tumors. Neurologists commonly treat seizures and headaches. These physicians prescribe anti-seizure medications, medications for migraines, and sometimes muscle relaxants or antianxiety agents. The American Board of Psychiatry and Neurology certifies neurologists and psychiatrists. There are two pathways of study that may be used to meet the training requirements for certification. Depending on the pathway used, the board requires four to six years of residency and postgraduate training. The candidate must apply to the board and pass an examination prior to certification.   Psychiatry is the branch of medicine that deals with the origin, prevention, diagnosis, and treatment of mental and emotional disorders. Psychiatrists are licensed doctors of medicine. The American Board of Psychiatry and Neurology requires that a candidate complete three years of specialized residency training and postgraduate training prior to being eligible to sit for the examination for certification. Psychiatrists often prescribe medication for a variety of mental health conditions such as anxiety, depression, attention deficit disorders, bipolar disorder, and schizophrenia.   Pediatricians specialize in treating children from birth through puberty. A pediatrician focuses on nutrition, mental and physical growth, immunization against infectious disease, and the management of acute and chronic illnesses. Pediatricians often prescribe antibiotics because of the many ear and throat infections diagnosed in children. The American Board of Pediatrics requires medical school graduates to complete three years of graduate pediatric training, followed by two years of pediatric practice. The candidate must also pass written and oral examinations. Cardiologists are doctors who treat diseases of the heart. Some of the major diseases of the heart that are treatable with drugs are congestive heart failure, arrhythmia, angina, arteriosclerosis. Cardiologists often prescribe medications like anti-hypertensives for high blood pressure, anticoagulants to thin the blood, antiarrhythmics to help the heart rhythm, and diuretic medications to help get rid of extra fluid in the body.   A variety of doctors who work in the dental field can prescribe medication based on the needs of their patients. Some specialists will prescribe medications more than others, but all have the ability based on the needs of their patient. Orthodontists and prosthodontists are two different dental specialties that do occasionally prescribe medications. Orthodontists specialize in the diagnosis of malocclusion and the correction of tooth misalignments by the repositioning of the crooked teeth with braces and other appliances. An orthodontist will occasionally prescribe medications that reduce saliva formation in order to be better able to place orthodontic appliances on the teeth. Prosthodontists specialize in making and fitting dentures for patients who have lost some or all of their teeth. A prosthodontist may occasionally prescribe a cream or ointment to treat gum irritation caused by ill-fitting dentures. Periodontists are dental specialists who study and treat gum disease. Periodontists diagnose the causes of gum disease and treat the disease with improvement in oral hygiene, drug therapy, and surgery. Periodontists prescribe many types of antibiotics to treat gum disease and analgesics to reduce pain after periodontal surgery. Endodontists are dentists who treat disorders of the tooth pulp, which is located inside the tooth and extends into the canals inside the root of the tooth. These canals carry the nerves and the blood supply that provides the tooth with nutrients. If the tooth pulp canal becomes infected with bacteria, the outcome is severe inflammation and pain that results in a toothache. Instead of removing the tooth, the endodontist saves the tooth by performing a root canal. The endodontist prescribes antibiotics and anti-inflammatories.  General-practice dentists provide dental care ranging from tooth cleaning to restorative procedures on teeth, simple extractions, simple root canal procedures, and simple orthodontic treatments. These dentists may prescribe many medications, including analgesics, antibiotics, sedatives, and anti-inflammatories. Pediatric dentists provide dental care to children and adolescents. They very rarely prescribe medications. Occasionally, fluoride preparations are prescribed for children who live in areas without fluoridated water. Oral medicine/oral pathology specialists treat diseases of the head, neck, and soft tissues of the oral cavity. They work with patients to diagnose and treat oral and jaw pain, as well as bacterial infections, fungal infections, and viral infections. These specialists also diagnose and treat head and neck cancer. They can prescribe medications from many of the drug classifications, including analgesics, antibiotics, antifungals, and antiviral agents.   Podiatrists specialize in treating medical problems of the feet. Doctors of podiatry graduate from schools of podiatric medicine that offer a four-year curriculum after graduation from a four-year baccalaureate college. Podiatry focuses on the examination, diagnosis, treatment, and prevention of diseases affecting the foot. Disorders of the foot include foot pain, circulatory disorders, nerve disorders, skin and toenail disorders, tumors and cysts, arthritic and inflammatory disorders, and trauma. Podiatrists write prescriptions for medications to treat foot disorders. Common drug classifications that podiatrists may prescribe are analgesics, antibiotics, anti-inflammatories, topical preparations, and foot soaks. Nurse practitioners are able to provide a broad range of health services and care to patients, including obtaining a patient's history; performing a physical exam; and ordering lab work, tests, and procedures. Nurse practitioners are able to diagnose, treat, and manage diseases. They have the authority to write prescriptions (some states do have restrictions on the extent of prescriptive authority) and perform some procedures. There are variations in prescribing laws among the states. Variations include the independent authority to prescribe, restrictions on prescribing, dealing with controlled substances, and the necessity to collaborate with the physician. Nurse practitioners may order medications from a wide range of drug classifications, depending on the patient's condition. Most nurse practitioners have a master's degree and several years of nursing experience. Nurse practitioners are licensed in the state where they practice, and most of them are certified. National certification is available, and some states require certification for the nurse practitioner to practice. With the implementation of the Affordable Care Act, the scope of practice and prescriptive authority is expected to continue to broaden. Physician assistants are members of the healthcare team who work with and under the supervision of physicians. They're permitted to obtain patients' medical histories, perform comprehensive physical exams, order diagnostic testing, and perform routine medical procedures. They may also develop health management plans for patients. In most states, physician assistants may write prescriptions.   Key Points Healthcare professionals must be licensed and have prescriptive authority to be able to prescribe medications. General practice doctors or hospitalists treat and prescribe medicine to patients for a wide variety of disorders, symptoms, and diseases. Specialists prescribe medications based on the specific needs of their patients and their own areas of expertise. Surgeons will generally prescribe medications for infection and pain for patients. Dentists, both general and in specialty areas, will prescribe medications to patients based on their medical needs pertaining to dental work and oral health. Nurse practitioners and physician assistants are medical professionals who can prescribe medications for patients while they work with a doctor for the patient's care.

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Lesson 2 Overview All medical and allied health professionals should study pharmacology. The extent of study will be determined by the medical profession that’s chosen. This lesson provides you with a broad overview of the different drug classifications, including vitamins and minerals, which a patient may take for a variety of health conditions. This lesson will help prepare you with the entry-level knowledge that you need to understand and communicate effectively with the physicians and other health professionals with whom you’ll be working in your new career.   Lesson Objectives Classify types of drugs, drug interactions, and drug reactions Describe various types of anti-infective drugs Identify drugs used in the integumentary system and the musculoskeletal system Identify drugs used in the cardiovascular system and the respiratory system Identify drugs used in the gastrointestinal system, and the sensory and nervous systems Identify drugs used in the endocrine system, urinary system, reproductive system, and lymphatic system List examples of biologics, antineoplastic agents, vaccines, psychiatric drugs, and antilipemic drugs Explain the role of vitamins, minerals, and herbs in healthcare

Introduction Drug classification, or the grouping and organizing of drugs, is a common task for someone in the medical field who deals with healthcare documentation. Drug classifications are used frequently in the field and are necessary when beginning to understand a patient and his or her medical chart.   Drug Classifications Healthcare documentation specialists such as medical coders and medical transcriptionists need to have a basic understanding of drug classifications. They should also be familiar with commonly ordered medications that are often documented in the patient's medical record. Many drug references organize drug listings by classifications and sub-classifications; therefore, a solid understanding of drug classes will make looking up unfamiliar generic and brand names faster and more efficient. Remember, though, that medications may have several different effects, and therefore some references may cross-list them under more than one classification. For instance, you might take an ibuprofen for one of several reasons—to ease a headache, to lower a fever, or to reduce inflammation. Drug classifications are used very frequently in medical settings—in fact, you'll probably understand many of them without our definitions, probably from personal experience.   Analgesics are drugs that relieve pain (algesi/o means "pain"; an- means "without"). Some medications to relieve pain are available over the counter, while others require a prescription. it's important to remember they may still cause side effects, interact with other medications, and may not be safe for everyone.  In addition to being analgesics, acetaminophen and ibuprofen are also antipyretics because they lower fevers. Ibuprofen and naproxen are also anti-inflammatory agents because they reduce swelling and inflammation. Additionally, ibuprofen and naproxen are available in a higher strength with a prescription. Analgesics and Antipyretics Most common over-the-counter analgesics: Acetylsalicylic acid (aspirin)—Bayer, Bufferin Acetaminophen—Tylenol Ibuprofen—Advil, Motrin Naproxen—Aleve Other anti-inflammatory agents include: Indomethacin Meloxicam (Mobic) Diclofenac   Narcotics are a sub-classification of analgesics. These potent drugs work to relieve severe pain. They're associated with side effects such as drowsiness, confusion, and constipation. Narcotics are classified as controlled substances because they can be habit-forming. Here are some examples: Morphine Codeine Oxycodone Oxycodone with acetaminophen (Percocet) *Reminder: It's important to keep the differences between generic and brand names straight in your mind. One way of doing that is to remember that in our examples, as in other medical documents, brand names are capitalized but generic names aren't (except when they start a sentence).   Anesthetics reduce or eliminate sensation.  There are four general types of anesthetics: Topical anesthetics Local anesthetics Regional anesthesia General anesthesia Topical anesthetics are used on the surface of the skin or other tissue. They numb the tissue to which they're directly applied. Local anesthesia is for anesthetizing a small part of the body. It's often injected into the area and affects only that area. Common examples of local anesthetics include the following: Hydrocortisone acetate (Orabase) Lidocaine (Xylocaine)  Procaine (Novocain) Regional anesthesia works in a similar way to local anesthesia, but it affects a larger part of the body. Examples of regional anesthesia include spinals, epidurals, and peripheral nerve blocks. General anesthesia eliminates sensation in the whole body and renders the patient completely unconscious. Here are some examples: Halothane (Fluothane) Nitrous oxide Thiopental (Pentothal)   The mode of induction (how the anesthesia is administered) differs depending on the type of anesthesia. General anesthesia is administered through the lungs or into a vein. Gas anesthetic is administered either with a face mask or through a tube placed in the trachea or bronchi. Liquid anesthetic is administered with an intravenous pump. Regional anesthesia is administered by nerve block, sometimes called simply "block." The anesthetic is injected along a nerve path to stop nerve impulses in that area. Local anesthesia is administered by infiltration—the anesthetic is injected into the tissue of the area that needs to be anesthetized, where it spreads to adjoining tissue. Usually, the area anesthetized by this method is only a few cubic centimeters in size.   Who today would fear imminent death at the onset of a bad cough with a high fever? Until 1945, when penicillin became available for general use, infections were often life-threatening. Today, when a bacterial infection is suspected or diagnosed, we can take an antibiotic to stop the growth of whatever strain of bacteria is responsible for the disease. Antibiotics kill or inhibit the growth of bacteria. Since 1945, pharmacologists have developed many other antibiotics to fight a broad spectrum of bacteria.   Antibiotics are divided into classes such as penicillin's, cephalosporins, sulfonamides, and quinolones. Different types of infections require different antibiotics because no antibiotic can treat all the different types of bacteria that cause infection. The health provider will choose an antibiotic based on what type of infection it is and what organism is causing the infection. You may have heard of sulfa drugs, or sulfonamides, a form of antibiotic drug very effective against urinary tract and GI infections. These antibiotics have been prescribed since the 1930s, but care must be taken as many patients experience allergic reactions to sulfa drugs. The major sulfa drug is trimethoprim sulfamethoxazole (Bactrim, Septra). Examples of Antibiotics Penicillin V (Pen-Vee K, V-Cillin K) Benzathine Penicillin G (Bicillin)  Procaine Penicillin G (Wycillin, Duracillin) Ampicillin (Amcill, Omnipen) Amoxicillin (Amoxil) Tetracycline HCI (Achromycin V, Sumycin) Doxycycline (Oracea, Targadox) Erythromycin (E-mycin, Erythrocin, llosone, Pediamycin) Cephalexin (Keflex, Keflin) Gentamicin sulfate (Garamycin)   Drug Action and Effect How do drugs do what they do? And how does the body react to the presence of drugs? These are big questions for pharmacologists. And the answers aren't just fascinating—they're also important to know. All drugs cause changes in cells, called drug action. This action in turn causes some physiological change in the body, or effect. Depending on the drug's action, the effect may be systemic (throughout the body) or local (limited to the area where administered). Before it can take effect, a drug has to get where it's going. Once the drug is administered, the first phase of its journey through the body is absorption—getting into the bloodstream. The route of administration effects the speed of absorption, as do many other variables. For instance, some oral drugs will be absorbed more quickly when taken on an empty stomach than when taken with food. However, some drugs irritate an empty stomach and should be taken with food. That's just one reason why it's always important to read labels! Drugs have a "target" substance on the cell, called a receptor. The receptor might be a particular chemical that will react with the drug to speed up or slow down normal cell processes. The drug reaches the receptor by a process called distribution, in which the drug moves from the bloodstream across the cell membrane.   Once metabolized, or processed, the drug can do its work in the cell. It might depress or stimulate the cell's processes, destroy the cell or certain parts of the cell, or replace a substance in the cell that the body hasn't produced on its own (as with hormone replacement therapy). The final phase of the drug's medicinal journey is excretion, the elimination of the waste products of drug metabolism. Most drugs leave via the kidneys, though some may be exhaled or perspired out of the body. Even the excretion of a drug can be a factor in its proper use. In patients with kidney problems, certain drugs can be contraindicated, or considered dangerous and ill-advised, because of the renal condition.   Drug Reactions and Interactions Once a drug has entered the body and begun its action, there are many possible effects for which the healthcare provider must be alert while the patient is taking the medication. The effectiveness of the drug over time will be one consideration. For example, does it lose potency or build up in the tissues? Healthcare providers must also alert for any possible effects of drug interaction, which occurs when two or more drugs that are used simultaneously alter each other's effects on the body. The following are some terms related to the effects of drugs: Additive action—Two or more drugs act together without diminishing or increasing each other's effects. Antagonism—Two drugs decrease or cancel out one another's effectiveness. Cumulative action—The more a drug is given, the stronger its toxic effect on tissue. The dose may have to be reduced to limit damage to the body. Dependency—This is the psychological and physical need for a drug resulting in withdrawal symptoms when the drug is absent. Latrogenic disorder—This refers to pathology produced from medical care, including drug treatment. Idiosyncrasy—This is any unexpected effect. An example of idiosyncrasy is anaphylaxis (immune responses of milder degrees are termed hypersensitivity). Potentiation—One drug prolongs or intensifies the effect of another drug. Synergism—Two drugs act together to surpass the additive effect of the individual drugs. The whole is greater than the sum of its parts. Teratogenic effect—this refers to physical defects in a fetus caused by exposure to a drug (or other substance) during pregnancy. Tolerance—The more a drug is given, the weaker the effect of the drug. The dose must be increased to maintain the desired effect. Toxicity—This refers to a harmful or fatal effect from exposure to either a poison or a dangerous amount of a drug that's safe in smaller amounts.   The combined effects of medications can be either desirable or undesirable. Thus, you may hear about desirable synergism or undesirable synergism, desirable potentiation or undesirable potentiation, and so on. Therapeutic drugs often also have effects that are normal and expected but not quite what the doctor ordered. That is, they aren't part of the therapeutic plan; they just happen. These are called side effects, and they can be unnoticeable, mildly unpleasant or inconvenient, or even dangerous. Patients may be able to feel some side effects; however, other side effects of medications may be noticed as a result of lab work or a physical exam. This is why it's so important for the patient's medical record to contain an accurate list of all medications that the patient is currently taking. The list at right contains several common side effects of various medications. You may already be familiar with many of these terms. Anorexia (diminished appetite), impotence, anxiety, insomnia, blurred vision, irritability, breast tenderness, itching, bruising, lightheadedness, burning sensation, low blood pressure, chest pains, menstrual irregularities, confusion, nasal congestion, constipation, nausea, cramps, nervousness, depression, palpitations, diarrhea, rash, dizziness, restlessness, drowsiness, sweating, dry mouth/nose/skin, tingling, dyspnea (difficulty breathing), tinnitus (ringing in ears), edema, tremors, fatigue, twitching, fever, urinary frequency, flushing, urine discoloration, headache, urine retention, heartburn, vaginal discharge, hiccups, weakness, hives, weight gain   Key Points Many drug references organize drug listings by classifications and sub-classifications; understanding drug classes makes it easier to reference them. Analgesics are drugs that relieve pain. Antipyretics are drugs that lower fevers. Anti-inflammatory agents reduce swelling and inflammation. Narcotics are a sub-classification of analgesics used to relieve severe pain; they can also cause grogginess and are habit-forming so they're classified as controlled substances. Anesthetics reduce or eliminate sensation, allowing doctors to perform surgery. They include topical anesthetics, local anesthetics, regional anesthetics, and general anesthetics. Antibiotics kill or inhibit the growth of bacteria. All drugs can cause change in cells, known as the drug action, which in turn causes a physiological change in the body, or effect. Additive action means two or more drugs act together without diminishing or increasing each other's effects.

Introduction Anti-infective drugs are a diverse group of drugs that are used to kill or slow the growth of the many pathogens that can invade the body and cause infection. They can be applied topically (on the surface area of the skin) or systemically (through the bloodstream) to eliminate infections.   Anti-Infective Drugs Anti-infectives include antibiotics, antivirals, antifungals, and antiprotozoals. These four groups of anti-infectives are further subdivided based on several criteria, including the following: Chemical structure (for example, penicillins and aminoglycosides) What kind of organisms they inhibit or kill (for example, anaerobic bacteria—broad versus narrow spectrum) Disease states for which they're used (for example, HIV/AIDS, tuberculosis)  Ways Anti-Infectives Are Delivered  Anti-infectives are delivered in a variety of ways, including the following: Oral dosage forms (tablets, capsules, suspensions) Injectable forms (for IM or IV use) Topical forms (creams, lotions, ointments) Otic forms (ear drops) Ophthalmic forms (drops and ointments)   Antibiotics The antibiotics, or antibacterials, are a class of drugs that inhibit the growth of or kill bacteria. These drugs are effective against bacteria only, not viruses or fungi. It's important that they're used only when they're needed. For example, antibiotics should not be used to treat the common cold, which is caused by a virus. Using antibiotics inappropriately may lead to antibiotic resistance. Antibiotic resistance occurs when the antibiotic is no longer able to kill or slow down the growth of a target organism. In other words, the organism has now found a way around the effects of the antibiotic, and has, in essence, grown stronger than the drug that once was able to kill it. 1. Antibiotic resistance occurs when antibiotics are misused (prescribed when they're not needed) and when people don't finish the full course of their antibiotic prescription. When patients don't finish a full course of antibiotics, they're killing only the weakest of the bacteria infecting them. The stronger organisms are left to multiply and grow, passing their stronger characteristics on to their progeny. These stronger organisms can now reinfect the person or be passed on to other people. 2. Two examples of antibiotic-resistant bacteria are methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). MRSA and VRE are sometimes called "superbugs" because there aren't many drugs available to kill them, and people who are infected with them become very sick. Treatment may involve hospitalization with isolation, intravenous antibiotics, sometimes surgery. 3. Antibiotic resistance is a very serious issue. Here are the important points to remember: An antibiotic isn't necessary or indicated every time a person gets sick. A prescriber shouldn't be pressured into prescribing antibiotics. The prescriber should be the judge of what treatment is appropriate. Antibiotics are useless against colds or the flu, which are caused by viruses and can actually do more harm than good. It's very important to take the full course of antibiotics prescribed. A patient may feel better after a few days but should finish the full antibiotic course of therapy to completely kill the bacteria. If the prescriber changes an antibiotic therapy, the patient should dispose of the remaining drug properly. It shouldn't be saved "just in case" the patient gets ill in the future. He or she should be examined properly to see if an antibiotic is necessary at that time. Antibiotics shouldn't be shared or given to others. Others may have the same symptoms, but it's important that they are examined properly to see if an antibiotic is necessary for them. 4. The major classes of antibiotics covered in this section are: Penicillins Cephalosporins Macrolides Tetracyclines Aminoglycosides Sulfonamides Fluoroquinolones  We'll also present other antibiotics that don't fit in these major classes but are important nonetheless.   Types of Antibiotics In 1928, Sir Alexander Fleming discovered that a mold of the genus Penicillium notatum killed bacteria. From that discovery, the first antibiotic, penicillin, was created. Penicillin was found to be very effective in eradicating pathogenic organisms that cause serious and sometimes life-threatening infections. Since the discovery of the original penicillin, many derivatives have been made from the natural products found in the Penicillium mold. The penicillins are also called beta-lactams because the chemical structure of all penicillins contains a beta-lactam ring.   The penicillin family is divided into the original penicillins, penicillinase-resistant penicillins, aminopenicillins, and extended-spectrum penicillins. The penicillinase-resistant penicillins are so called because they resist an enzyme secreted by bacteria called penicillinase. Penicillinase can destroy the penicillin molecule, rendering it ineffective. The extended-spectrum penicillins are so called because they eradicate a broad range of pathogenic bacteria.   The spectrum of activity of an antibiotic indicates the range of organisms that are susceptible to its antimicrobial effects. A narrow range usually indicates activity against only specific organisms. A broad range usually indicates effects against many possible organisms and may include both gram-positive and gram-negative bacteria. Several penicillin-containing products combine penicillin with either potassium clavulanate, sulbactam, or tazobactam. These compounds inhibit penicillinase and protect the penicillin from breakdown by the enzyme. They also extend the antimicrobial spectrum of the penicillin to include bacteria that would normally be resistant to it. The following table shows the different categories of penicillins. Drug Name                                               Brand Name                                        Classification                             Route Penicillin G                                                 Bicillin C-R Pfizerpen                            Natural penicillin                        IM, IV Penicillin V                                                 Pen-Vee K, Veetids, V-Cillin-K              Natural penicillin                        Oral Dicloxacillin                                               N/A                                                          Penicillinase-resistant               Oral Nafcillin                                                     N/A                                                          Penicillinase-resistant                IV Amoxicillin                                                Amoxil, Trimox                                      Aminopenicillin                           Oral Amoxicillin/clavulanate potassium      Augmentin                                             Aminopenicillin                           Oral Ampicillin                                                 Principen                                                Aminopenicillin                           Oral, IM, IV Ampicillin/sulbactam                             Unasyn                                                   Aminopenicillin                           IM, IV Piperacillin/tazobactam                        Zosyn                                                      Extended-spectrum                    IV Ticarcillin/clavulanate                           Timentin                                                 Extended-spectrum                    IV     The cephalosporin group of antibiotics is pharmacologically and chemically related to the penicillins. Like the penicillins, the cephalosporins also contain a beta-lactam ring. The cephalosporins are classified into four different generations. Each generation differs from the others in its position on the spectrum of antimicrobial activity. First-generation cephalosporins are active against gram-positive organisms and some gram-negative organisms. Second-generation agents have a broader spectrum of activity against gram-negative organisms, and third- and fourth-generation drugs have an even broader spectrum of activity against gram-negative organisms.   The following table summarizes the four generations of cephalosporin antibiotics. Categories of Cephalosporins                                First-generation cephalosporins Drug                                                  Route                               Brand Name Cephalexin                                        Oral                                  Keflex, Keftab Cefadroxil monohydrate                Oral                                  Duricef Cefazolin                                           IM, IV                                Ancef, Kefzol                            Second-generation cephalosporins Cefaclor                                            Oral                                   Ceclor, Keflor           Cefpodoxime proxetil                    Oral                                    Vantin Cefprozil                                           Oral                                   Cefzil Cefuroxime sodium                       Oral, IM, IV                        Ceftin, Kefurox, Zinacef Loracarbef                                       Oral                                   Lorabid                                  Third-generation cephalosporins Cefixime                                           Oral                                   Suprax Cefoperazone sodium                   IM, IV                                Cefobid Ceftriaxone sodium                       IM, IV                                Rocephin Cefotaxime sodium                       IM, IV                                Claforan                                  Fourth-generation cephalosporins Cefepime hydrochloride               IV                                      Maxipime     The tetracyclines are a series of chemically related compounds used to treat a broad spectrum of infections. Tetracyclines are bacteriostatic, meaning that while they don't kill bacteria outright, they prevent the growth of the bacteria. In addition to treating active infections, tetracycline antibiotics are often used long-term by patients who suffer from severe acne.   The erythromycins are known as macrolide antibiotics since they're chemically composed of a large molecule. They're effective in treating infections that are susceptible to penicillins since they have similar spectrums of action. Depending on the infection that needs to be treated, the macrolides may be an option in patients who are allergic to penicillin. Another class of drugs, the ketolides, is structurally similar to the macrolides. Ketek (telithromycin) is a ketolide.   The aminoglycosides are a series of compounds that share similar chemical and pharmacological properties. Aminoglycosides have a broad spectrum of activity. They're associated with significant ototoxicity and nephrotoxicity, meaning they can cause damage to hearing (including deafness) and to the kidneys. Patients on aminoglycosides must be monitored to be sure that drug levels are in a safe range.   The following table lists specific drugs within these three classes of antibiotics: tetracyclines, macrolides, and aminoglycosides. Categories of Antibiotics: Tetracyclines, Macrolides, and Aminoglycosides                                 Tetracyclines Drug                                                                Route                                           Brand Name Demeclocycline hydrochloride                   Oral                                               Declomycin Deoxycycline hyclate                                    Oral, IV                                         Doryx, Vibramycin Minocycline hydrochloride                          Oral, IV                                         Minocin Tetracycline hydrochloride                          Oral                                              Sumycin                                 Macrolides Azithromycin                                                 Oral, IV                                         Zithromax, Z-Pak Clarithromycin                                              Oral                                              Biaxin Erythromycin base                                       Oral                                              Ery-Tab, ERYC Erythromycin estolate                                 Oral                                              llosone Erythromycin ethylsuccinate                     Oral                                               E.E.S., EryPed Erythromycin stearate                                Oral                                               Erythrocin Stearate                                 Aminoglycosides Amikacin sulfate                                          IM, IV                                                                           Amikin Gentamicin sulfate                                      IV, IV, intrathecal                                                       Garamycin Kanamycin sulfate                                      Oral, IM, IV, Intraperitoneal, inhalation                  Kantrex Neomycin sulfate                                        Oral                                                                             Mycifradin Streptomycin sulfate                                  IM                                                                                Streptomycin Tobramycin sulfate                                     IM, IV                                                                           Nebcin, Tobi Paromomycin sulfate                                 Oral                                                                             Humatin     Antibacterials Our study of anti-infectives continues with the anaerobic, quinolone, and carbapenem antibacterials. In addition, we'll look at the sulfa-type antibacterials, antitubercular agents, antifungals, antivirals, antiretroviral agents, antimalarial drugs, and drugs used to treat trichomoniasis and intestinal parasites. The carbapenem antibacterials are related to penicillins in that they also contain a beta-lactam ring. These drugs have a broad spectrum and are often used as the antibiotics of last resort with very serious infections where other antibiotics have failed. Patients on carbapenems are usually in a hospital or other skilled-care facility. Anaerobic antibacterials are useful in the treatment of infections caused by anaerobic bacteria, which won't grow in the presence of oxygen. Clindamycin, whose brand name is Cleocin, is effective in the treatment of infections that resist other antibiotics such as erythromycins and penicillins. Metronidazole (Flagyl) is an agent that has long been used to treat protozoal infections such as trichomoniasis. It's also useful in the treatment of serious anaerobic infections.   Fluoroquinolones are used to treat a variety of infections and many of them have a broad spectrum of activity. Examples include ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin, and ofloxacin. The FDA recently issued a warning stating that because of potential side effects involving the tendons, muscles, joints, and nerves, these antibiotics should be reserved for patients who can't take other antibiotics for their condition.  Most of the oral fluoroquinolones can bind to calcium or magnesium, so it's important to tell patients to take these drugs separately from vitamins, antacids, and foods that contain calcium.   The sulfa drugs (or sulfa-type antibacterials) get their name from the fact that they're all derivatives of sulfanilamide, an antibacterial that was first used in the 1930s. The molecule contains the sulfur atom, hence the name "sulfa" drugs. Sulfamethoxazole and trimethoprim-sulfamethoxazole are examples of sulfa antibiotics and are often used to treat genitourinary tract infections. There are other sulfa drugs that aren't antibiotics. For example, sulfasalazine is used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease.   Aztreonam (Azactam) is useful in the treatment of serious gram-negative infections. Chloramphenicol is reserved for very limited use, such as typhoid fever.  Vancomycin is a powerful agent usually reserved as the last line of defense when all other antibacterials or antibiotics have failed. (That's why VRE, vancomycin-resistant enterococci, is such a serious problem).   Other Anti-Infectives Viruses are responsible for many infections ranging from the common cold to acquired immunodeficiency syndrome (AIDS). Some drugs specifically treat viral infections. Amantadine and oseltamivir phosphate are used to treat influenza. Acyclovir, famciclovir, and valacyclovir are used to treat infections caused by the herpes virus, including genital herpes, oral herpes (cold sores), and herpes zoster (shingles). Peramivir injection was approved in 2014 for the treatment of acute uncomplicated influenza in patients over the age of 18. Antiretroviral agents are used specifically to treat HIV, the human immunodeficiency virus. This is the virus responsible for causing AIDS. Many treatment options are available to treat HIV. HIV therapy is constantly evolving to respond to how the virus changes in the body. There are many combination drugs available that contain multiple medications to cut down on the number of pills patients have to take in a day to improve compliance. Some of these drugs are very toxic, and many of them have black-box warnings. Antimalarials. Malaria is caused by a parasitic organism that infects the blood and specific organs such as the liver. The following drugs are used to eradicate the malarial parasite: chloroquine (Aralen), pyrimethamine (Daraprim), quinacrine (Atabrine), and quinine.  Antiparasitic Drugs. Metronidazole is the most effective drug for the treatment of trichomoniasis, primarily a parasitic disease of the vagina. Helminthiasis, an infestation of parasitic worms in the gastrointestinal (GI) tract, is believed to be the most common form of a parasitic disease that affects humans. Anthelmintic drugs are used for eradicating the worms that cause this condition. Antiparasitic drugs include praziquantel (Biltricide), pyrantel pamoate (Antiminth), thiabendazole (Mintezol), and mebendazole (Ovex, Vermox, Antiox, and Pripsen). Antiviral Drugs.  Drugs                                    Brand Name amantadine                         Symmetrel acyclovir                               Zovirax zidovudine                           Retrovir, AZT didanosine                          Videx stavudine                            Zerit oseltamivir                         Tamiflu famciclovir                          Famvir valacyclovir                         Valtrex peramivir injection            Rapivab   Fungal infections differ from bacterial infections in that they're more difficult to eradicate. Specific drugs are required to effectively cure fungal infections. Since many fungal infections occur on the skin, several antifungals are available in topical forms such as creams, ointments, lotions, and shampoo. This allows the drug to be applied directly to the site of infection.  *Antitubercular drugs are specifically used to treat tuberculosis, a highly contagious disease caused by a specific bacterium that thrives inside the lungs. Some typical antitubercular drugs include isoniazid (also known as INH) and rifampin. Antitubercular Drugs Drug                                                            Brand Name Aminosalicylate sodium                           Sodium P.A.S. Capreomycin sulfate                                Capastat Sulfate Cycloserine                                                Seromycin  Ethambutol                                               Myambutol Isoniazid                                                    Nydrazid Rifabutin                                                   Mycobutin Antifungal Drugs Drug                            Brand Name Nystatin                       Mycostatin Miconazole                 Monistat Ketoconazole             Nizoral Fluconazole                Diflucan Itraconazole               Sporanox Griseofulvin               Fulvicin   Corticosteroid Preparations Corticosteroids are anti-inflammatory agents used to treat a variety of diseases associated with inflammation. They replace or enhance the steroids that are normally produced by the body. A wide variety of corticosteroids on the market are used as inhalers, intranasal applications, tablets to be taken orally, and topical creams and ointments to be applied locally (in one spot). Corticosteroids promptly relieve symptoms associated with many allergic conditions, including asthma, allergic rhinitis, hay fever, adverse drug reactions, and allergic dermatitis. The inhaled and intranasal products are useful in treating and controlling asthma or allergic rhinitis.   Anti-inflammatory medications used in asthma inhalers help prevent asthma attacks y reducing swelling and mucus production in the airways. Examples of inhaled corticosteroids include Qvar (beclomethasone), Flovent (fluticasone), and Pulmicort (budesonide). The inhaled corticosteroid may be combined with another agent called a long-acting beta2-agonist (LABA). Examples of combination corticosteroid/LABA inhalers include Advair (fluticasone/salmeterol) and Symbicort (budesonide/formoterol).   Corticosteroids are available in dosage forms other than inhalers, including topical, oral, and intravenous forms. The topical corticosteroids are divided into four degrees of potency: low, medium, high, and very high. Oral and intravenous corticosteroids have several different indications. Some examples are asthma, COPD exacerbations, and rheumatoid arthritis. Inhaled Corticosteroids Drug                                  Brand Name Beclomethasone              Qvar Budesonide                      Pulmicort Ciclesonide                       Alvesco Fluticasone                       Flovent Flunisolide                        Aerobid Intranasal Corticosteroids Drug                                     Brand Name Fluticasone                          Flonase Budesonide                         Rhinocort Beclomethasone                Beconase, Vancenase Oral and Intravenous Corticosteroids Drug                                              Brand Name Methylprednisolone                   Medrol Prednisone                                  Deltasone Prednisolone                               Prelone Dexamethasone                         Decadron Betamethasone                          Celestone Topical Corticosteroids (Creams and Ointments) Low potency Drug                                        Brand Name Alclometasone                       Aclovate Dexamethasone                    Decadron Medium potency Drug                                      Brand Name Betamethasone                   Diprosone, Diprolene, Valisone Fluocinolone                        Synalar Fluticasone                           Cutivate High potency Drug                             Brand Name Fluocinonide               Lidex Triamcinolone            Aristocort Halcinonide                Halog Very high potency Drug                        Brand Name Clobetasol              Temovate Halobetasol            Ultravate    Key Points Anti-infective drugs are a diverse group of drugs used to kill or slow the growth of pathogens that cause infection. Anti-infectives include antibiotics, antivirals, antifungals, and antiprotozoals. Antibiotics, or antibacterials, inhibit the growth of or kill bacteria; they aren't effective against viruses or fungi. Classes of antibiotics include penicillin, cephalosporins, macrolides, tetracyclines, and aminoglycosides. Antitubercular drugs are specifically used to treat tuberculosis. Antifungals are used to treat fungal infections, which can be difficult to eradicate; many fungal infections occur on the skin. Antivirals treat viruses that cause infections ranging from the common cold to AIDS. Antiretrovirals are used specifically to treat HIV. Antimalarials are used to treat malaria, which is caused by a parasite that infects the blood and organs. Antiparasitic drugs treat various parasitic diseases. Corticosteroids are powerful anti-inflammatory agents used to treat a variety of diseases associated with inflammation. Corticosteroids replace or enhance the steroids that are normally produced by the body.

Introduction There are various drugs used for treatment of disorders, illnesses, and malfunctions in the integumentary and musculoskeletal system. Each drug has a different function to relieve or treat the symptom of a patient. Your career in the healthcare field will require an understanding of these drugs since you'll be working with a variety of patients.   Integumentary Drug Classifications The integumentary system comprises the skin, hair, nails, glands, and nerves of the body. The skin protects the body and acts as a barrier from the elements of the world. The drugs listed are used to treat conditions, diseases, and common issues of the skin. Topical corticosteroids are anti-inflammatory drugs applied to the surface of the skin to relieve three common symptoms of skin disorders: pruritis (itching), vasodilation (dilation of blood vessels), and inflammation. Antipruritics prevent or relieve itching. Antiseptics are topically applied agents that destroy bacteria. They prevent the development of infections in cuts, scratches, and surgical incisions.  Keratolytics destroy and soften the outer layer of the skin so that it can be shed. Certain keratolytics such as salicylic acid are effective for removing warts and corns. Other keratolytics are used to promote the shedding of scales and crusts in eczema, psoriasis, and seborrheic dermatitis. Antiparasitics, as the name suggests, kill insect parasites that infest the skin. For example, medications such as mebendazole, albendazole, or ivermectin treat pinworm infections. Scabicides kill mites that cause scabies. Examples include permethrin cream and sulfur ointment. pediculicides kill lice that cause pediculosis. Pyrethrins and permethrin lotions are examples of medications used to treat lice. Protectives and astringents are used to cover, cool, dry, or soothe inflamed skin. Protectives don't penetrate the skin or soften it but form a long-lasting film. This film protects the skin from air, water, and clothing during the natural healing process. Astringents shrink the blood vessels locally, dry up secretions from seeping lesions, and lessen the sensitivity of the skin. Topical anesthetics are prescribed for pain on skin surfaces or mucous membranes caused by wounds, hemorrhoids, or sunburns. These topical anesthetics relieve pain and itching by numbing the nerves in the skin layer or mucous membranes. They're applied directly to the painful areas by means of sprays, creams, gargles, suppositories, and other preparations.   There are many medications that are available as eyedrops to treat a variety of conditions including infection, redness, dryness, irritation, and glaucoma. Eyewashes are used to flush and bathe the eye, usually to remove foreign particles or chemical irritants. We'll discuss eyedrops and eyewashes in more detail when we cover drugs related to the sensory system.   Sunburn is caused by an abundance of ultraviolet rays hitting the skin. Mild sunburn is tender to the touch, and the patient may complain of a hot, tight feeling to the skin. A patient with more severe sunburn may experience intense pain, inability to tolerate contact with clothing, and symptoms of fever and chills. Local anesthetics are useful in relieving the pain associated with sunburn. Protectants are often included with the anesthetic to provide additional relief for the burning sensation. These protectants include cocoa butter, glycerin, shark liver oil, and petrolatum (petroleum jelly).   Sunscreens are used to protect the skin from the sun's UV rays and prevent sunburn. They also protect exposed areas of the body in susceptible individuals from the long-term hazards of skin cancer and premature aging. An important measure of sunscreens is the sun protection factor (SPF). The SPF measures the time it takes for skin to be visibly damaged by sun exposure from the UVB rays of the sun. The higher the SPF number, the greater the protection from the sun's rays. For example, an individual who would start to burn after 10 minutes would theoretically be protected from burning for 150 minutes when using sunscreen with an SPF factor of 15. Most of the products on the market contain a combination of sunblock of agents. Opaque sunblock agents are visible when applied to the skin. They're used by people who can tolerate very little exposure to the sun. Zinc oxide ointment is the sunblock favored by most people.   The Skin Cancer Foundation recommends using a product with an SPF factor of 15 every day for everyone over the age of six months. People who are in the sun more may require higher SPF sunscreens that are water-resistant. Every sunburn increases a person's risk of developing skin cancer. But it's also important to understand that even without a sunburn, the skin can be experiencing damage from UVA exposure. More than 20 chemical agents have been proven to be effective as sunscreens and sunblocks. These chemicals include aminobenzoic acid, ethylhexyl p-methoxycinnamate, and menthyl anthranilate. The commercial products all contain one of these agents or a combination of several. There are three types of sunscreens: Sunburn preventive agents Sun-tanning agents Opaque sunblock agents   External Analgesics External analgesics are topically applied agents with analgesic, anesthetic, anti-itching, and counterirritant effects. They can reduce symptoms caused by burns, cuts, abrasions, insect bites, and skin lesions. The analgesic and anesthetic effects result from the depression of the skin receptors for pain, itching, and burning. Topical analgesics and anesthetics include benzocaine, tetracaine, dibucaine, lidocaine, benzyl alcohol, and dyclonine hydrochloride. Some of these agents may be available as lozenges or sprays for sore throat or as an ointment/cream for a painful sensation on the skin. One example of a topical anti-itching agent is diphenhydramine. Topical corticosteroids may also be used to treat itching due to a rash, eczema, or hemorrhoids. Cold sores are caused by a virus and are difficult to treat. Medications help with the pain associated with cold sores and contain an astringent, or drying agent (benzyl alcohol, zinc sulfate); a protectant (dimethicone); a counterirritant to help with itching (menthol, camphor, phenol); and a topical anesthetic to help numb the area (benzocaine, dyclonine, dibucaine). One product, however, is different. Docosanol (Abreva) is the only product that has antiviral properties; thus, it helps to shorten the severity and duration of cold sores, especially if used at the onset of the cold sore.   Counterirritant effects are the mainstays of these external products. Counterirritants are applied to produce a mild, local, inflammatory reaction with the objective of providing relief in another site, usually next to or underlying the skin surface being treated. The counterirritant drug is usually applied to the skin where pain is experienced. The counterirritants found in commercial analgesic rubs include: 1. Oils, such as eucalyptus or turpentine 2. Methyl salicylate  3. Menthol 4. Capsicum preparations 5. Camphor   Topical anti-infectives are used to counteract local infections of the skin or mucous membranes caused by bacteria or fungi. Most bacterial infections occur as localized skin infections and are caused by strains of staphylococcus. Gram-negative anaerobic bacteria may also cause skin infections. Fungal infections often last longer than bacterial infections and are sometimes more difficult to eliminate. Antibacterial components of topical anti-infectives include bacitracin, polymyxin B sulfate, and neomycin. Antifungal components of these products include undecylenic acid and miconazole. As you learned previously the antiviral docosanol is a component in the cold sore medication Abreva. There are also many topical products available for the treatment of fungal infections. The most common fungal infections include athlete's foot and vaginal yeast infections. Antifungal preparations to treat yeast infections are available as creams and vaginal suppositories for internal use. Many of these also come with a small tube of cream for external use for relief of itching and discomfort. There are seven-day, three-day, and one-day regimens (drug-dosing intervals) available. The active ingredients in these preparations include miconazole, butoconazole, clotrimazole, and tioconazole. Some of these same agents are available in creams or sprays to treat athlete's foot.   Topical corticosteroids treat atopic dermatitis and contact dermatitis. Atopic dermatitis is one of the most common skin disorders seen in children and young adults. Symptoms of atopic dermatitis are scaling, reddening, and weeping of the skin and serious itching. The cause is unknown. Contact dermatitis is a similar condition, but the symptoms occur because of contact with an irritating substance such as poison ivy, soap powders, or latex gloves. Topical corticosteroids are available in creams and ointments, and are effective in treating these two types of dermatitis. Topical corticosteroids should be applied sparingly (in very small amounts) as recommended by a healthcare provider. Although many patients will tend to apply large amounts of hydrocortisone, assuming that more is better, this is incorrect, and much of the cream goes to waste. Healthcare providers should instruct patients to apply a thin film to the area and massage it into the skin thoroughly. Additionally, patients should make sure they're applying corticosteroids to intact skin only.   Drugs Used in the Musculoskeletal System Muscles may become sore or inflamed through overuse or injury, resulting in pain and tenderness.  Muscle spasms may occur because of overuse, dehydration, or low potassium levels. Muscle spasms can be acute and happen infrequently, or may be a long term issue. Spasticity is defined as stiffness in the muscles and sustained, involuntary muscle spasms. This is a symptom that may occur in patients with multiple sclerosis or spinal cord injuries. Drugs used to treat muscle spasms: There are a few different medications used to treat muscle spasms. Patients that have acute spasms may take medications such as cyclobenzaprine, methocarbamol, carisoprodol, or metaxalone. Baclofen, tizanidine, or dantrolene may be used more long-term for spasticity. Benzodiazepines such as diazepam may be considered as adjunct therapy for spasticity; they're generally avoided for patients with acute muscle spasms because of the likelihood for tolerance and dependence.   Key Points Topical corticosteroids are anti-inflammatory drugs applied to the skin to relieve itching, dilation of blood vessels, and inflammation. Topical corticosteroids treat atopic dermatitis and contact dermatitis. Antiseptics are topically applied agents that prevent infection by destroying bacteria. Keratolytics destroy and soften the outer layer of skin so that it can be shed; they're often used to remove corns and warts. Parasiticides kill parasites that infest the skin. Protectives are used to cover, cool, dry, or soothe inflamed skin. Topical anesthetics are used to treat pain on the skin or mucous membranes. Eyedrops are used to treat irritation and dryness of the eye; eyewashes are used to flush and bathe the eye. Sunburn preparations treat sunburn, which is caused by too much ultraviolet light hitting the skin. External analgesics are topically applied agents with analgesic, anesthetic, anti-itching, and counterirritant effects. Topical anti-infectives are used to counteract local infections of the skin or mucous membranes caused by bacteria or fungi.

Introduction The cardiovascular system deals with the heart and blood vessels. Different types of drugs are used to treat conditions related to the heart and blood based on the issue that the patient is experiencing. Respiratory conditions and kidney disorders are also treated in this way.   Drugs Used in the Cardiovascular System A variety of subclassifications apply to drugs that act on the heart and blood vessels. Antiarrhythmic drugs are given to correct variations from normal heart rhythms. Some work as beta blockers, that is, blocking the action of epinephrine that may be overexciting the heart and blood vessels. Others are calcium-channel blockers, which block the entrance of calcium into cells. Antihypertensive drugs fight high blood pressure. High blood pressure is often called the "silent killer" because there are often no symptoms to recognize that the blood pressure is higher than it should be. But if it's detected and brought under control, the person with hypertension can live a long and healthy life.   There are many classes of medications used to treat high blood pressure. First-line treatment options usually include diuretics, angiotensin-converting enzyme inhibitors (ACE-I), angiotensin II receptor blockers (ARB), or calcium-channel blockers. Diuretics are antihypertensives because they cause the kidneys to excrete more urine, resulting in a lower volume of blood in the body and therefore less pressure on the blood vessels.  Other classes of drugs to treat high blood pressure include vasodilators and beta blockers. Vasodilators act as antihypertensives by widening blood vessel walls, which makes it easier for blood to pass through without excessive pressure. Medications that work in the cardiovascular system may have more than one indication for use. For example, vasodilators, beta blockers, and calcium-channel blockers may be effective for angina. Beta blockers and calcium-channel blockers act as antihypertensives as well as antiarrhythmics.   Vasoconstrictors narrow the blood vessels and raise blood pressure. Obviously, this wouldn't be desirable in most people suffering from cardiovascular diseases. But it's sometimes necessary to get blood moving during cardiac or respiratory failure. Atherosclerosis, a condition where plaque builds up in the arteries, is a factor in many cardiovascular diseases. Since cholesterol contributes to atherosclerosis, cholesterol-lowering drugs are important, too. Anticoagulants may be used to break up clots that form within blood vessels; thus, they're effective for patients with thrombosis or embolism. Anticoagulants can prevent clot formation in susceptible patients and in donated blood that's being stored for transfusions. Heparin is a natural anticoagulant produced by the liver and white blood cells. Coagulant may be given if a patient receives an overdose of anticoagulant or has a clotting deficiency.    Antihypertensives Used in Treatment High blood pressure, or hypertension, affects millions of people in the United States. No one knows what causes most forms of high blood pressure. If left untreated, however, high blood pressure leads to additional diseases such as stroke, renal failure, blindness, and heart failure. It's imperative to return high blood pressure to a normal level. Blood pressure can sometimes be lowered through weight loss, exercise, and reduction of salt intake. Often, however, antihypertensive drugs must be used. Antihypertensive drugs work in several ways to lower high blood pressure, depending on the mechanism of action of the medication. If the arteries are constricted, causing the pressure inside them to rise, drugs may be used that dilate (open up) the arteries, resulting in decreased blood pressure. Drugs that dilate constricted arteries are angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium-channel blockers, and others such as alpha 1 receptor blockers. Some antihypertensives act on the heart to make it beat more slowly and with less force, reducing the amount of blood volume that's pumped into the arteries. Drugs that act on the heart to reduce blood outflow are called beta-adrenergic blocking agents (beta blockers).   Diuretics cause increased urination, which decrease the volume of fluid in the plasma. Less fluid volume within the arteries usually results in less pressure within the cardiovascular system. These drugs are often combined with antihypertensives to increase the antihypertensive effect.    Angiotensin-converting enzyme (ACE) is normally present in the blood as part of the body's blood pressure regulation system. ACE causes production of a very powerful constricting substance; overproduction contributes to high blood pressure. ACE inhibitors block the actions of this enzyme, causing dilation of the blood vessels and reducing blood pressure. These drugs have a beneficial effect on the kidneys. The names of ACE inhibitors end in "pril." For example, enalapril, lisinopril, and benazepril are the generic names for three popular ACE inhibitors. One of the more annoying side effects of ACE inhibitors is a dry cough; if this happens, then a patient may be told to stop taking the ACE-I and to take an ARB (angiotensin II receptor blocker) instead.   Related to ACE inhibitors are angiotensin II receptor blockers (ARBs). ARBs prevent angiotensin II, a vasoconstrictor, from binding to receptors; this reduces blood pressure. ARBs are less likely to produce the dry cough caused by ACE inhibitors. Popular drugs in this class include Diovan (valsartan), Avapro (irbesartan), and Cozaar (losartan). Notice that the generic names of all of the ARBs end in "-sartan." Calcium-channel blockers (CCBs) lower blood pressure by dilating constricted blood vessels. The smooth muscle cells that line the arteries use calcium to regulate their contraction. Calcium passes through channels in the cell membranes when they open in response to certain hormones. When calcium is taken into the cell, it contracts, causing tightening within the blood vessels. CCBs block these channels and therefore the uptake of calcium. The blockage of calcium by CCBs eases this tightening effect and leads to dilated blood vessels and lower blood pressure. There are two different subclasses of calcium-channel blockers, each one having a different indication. For high blood pressure, CCBs such as nifedipine (Procardia), amlodipine (Norvasc), or felodipine may be prescribed. For other cardiovascular conditions, CCBs such as verapamil or diltiazem may be used. Although these may help lower blood pressure as well, they're not typically used just to treat high blood pressure alone.   Beta-adrenergic receptor blockers decrease the heart's rate and force of contraction. This in turn lowers oxygen use to prevent myocardial ischemia and pain. Beta blockers are often used for the chronic management of angina. The names of beta-adrenergic receptor blockers end in "-olol." Examples are atenolol, metoprolol, carvedilol, and propranolol. There are other ways to cause dilation of the arteries. Drugs that don't fit into the previous categories are found in the alpha-blocker class of antihypertensives. Two drugs in this category are prazosin (Minipress) and doxazosin (Cardura). They block alpha receptors within the arterioles to cause vasodilation. In addition to reducing blood pressure, some medications in this class may be used to treat benign prostate hypertrophy (BPH).   Cholesterol-Lowering Drugs Cholesterol-lowering drugs are used to treat hyperlipidemia (high cholesterol) and prevent atherosclerotic risk in patients. Cholesterol is believed to contribute to atherosclerosis, which is related to many heart problems. Thus, these drugs are important for managing heart health. Statin therapy is considered to be the first-line treatment option to treat high cholesterol and prevent cardiovascular disease in patients. Statins are grouped by their intensity, which is the percentage of LDL-lowering expected from the medication. High intensity statins that lower LDL by at least 50% include atorvastatin and rosuvastatin. Moderate-intensity statins are lower doses of atorvastatin or rosuvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, and simvastatin. Low-intensity statins include lower doses of flavustatin, lovastatin, simvastatin, pitavastatin, and pravastatin. In addition to statins, there are other medications that lower levels of triglycerides and increase levels of HDL, the good cholesterol.   Types of Heart Medication Medical conditions associated with the heart also include heart failure, arrhythmia, angina, and myocardial infarction, which is also known as a heart attack. Antiplatelet medications may be used to prevent recurrence of strokes and heart attacks in survivors of these two conditions. Drugs that reverse arrhythmia are called antiarrhythmics, and drugs that prevent angina are called antianginals. The anticoagulant class of heart medicines is often referred to as blood thinners.    Heart failure means that the heart muscle is unable to pump the blood sufficiently to provide body tissues with oxygen. Many of the medication classes that you've learned about also have a place in therapy for heart failure. There are different types of heart failure—it's in the type called heart failure with reduced ejection fraction (HFrEF) that many of these medications have been proven to prolong life, improve the functioning of the heart, and lessen complications related to heart failure. ACE-I, ARBs, and the newest class of medication, called angiotensin-receptor neprilysin inhibitor (ARNI), help improve the way the heart works and reduce deaths related to heart failure. There's only one drug available at this time in the ARNI class, called sacubitril/valsartan (Entresto). Only one medication from the ACE-I, ARB, or ARNI class should be used at one time because these classes work similarly. Combining medications from these drug classes can be dangerous. Another new class is the /f channel blocker and there's only one drug available in that class, called ivabradine (Corlanor).   Beta blockers are also used for heart failure. One way they work is by allowing the left ventricle to fill more completely by slowing the heart rate. The three beta blockers that have shown the most benefit for patients with HFrEF are bisoprolol, carvedilol, and metoprolol succinate. Other classes of medications that are prescribed include aldosterone antagonists, which are also potassium-sparing diuretics, and a vasodilator (hydralazine) combined with isosorbide dinitrate. Diuretics are an important treatment for patients with heart failure if they have any edema or fluid buildup in their body including the lower legs, feet, and lungs. Digoxin may also be used in some patients to help with symptoms if the other standard therapies aren't enough to treat the heart failure.   There are many diverse drugs that reverse the disorderly pattern of heartbeats seen in cardiac arrhythmias. Cardiac arrhythmias are disorders of electrical impulse conduction throughout the heart. The beating of the heart is initiated and stimulated by electrical impulses from the sinoatrial node, which is located in the muscle of the right atrium. This node is a natural peacemaker. Electrical impulses ordinarily allow for a smooth pattern of heartbeats. When the electrical conduction becomes disorderly, the normal beating pattern is lost and heart rhythm changes. The following drugs are commonly used to treat arrhythmias: quinidine, verapamil (Calan), digoxin, propafenone (Rythmol), sotalol (Betapace), acebutolol (Sectral). The many drugs used to manage and correct arrhythmia do so by several different complicated mechanisms. Many of these medications are also associated with side effects and drug interactions.   Angina pectoris, or angina, is characterized by an intense pain in the chest caused by cardiac oxygen deprivation, a lack of oxygen in the heart muscle. The classic symptoms of an angina attack are tightness of the chest, excruciating pain of the chest, shortness of breath, and pain radiating down the left arm. Angina isn't the same as a heart attack. Angina usually occurs because of a blockage in the coronary arteries (ischemia). The diseased arteries can't deliver enough oxygen to meet the heart's demand. Some angina attacks occur at rest and aren't associated with an increased myocardial demand. The pain associated with this form of angina is believed to be caused by reductions in oxygen supply because of coronary artery spasm and occlusion.  Nitrates such as nitroglycerin dilate the coronary blood vessels to allow for adequate oxygen flow to the heart muscle. Nitroglycerin is the most commonly used drug to treat angina. It's often prescribed in pill form; the pill is placed under the tongue for rapid effect during an angina attack. However, when exposed to air and light, nitroglycerin degrades. To solve this problem a spray was developed, which is contained in an airtight cylinder until it's sprayed under the tongue. Nitroglycerin is also prescribed in the form of a skin patch that's worn to prevent angina attacks. Other nitrates that are prescribed to prevent angina include isosorbide dinitrate and isosorbide mononitrate. Drugs that treat angina by dilating the coronary blood vessels are bepridil (Vascor) and nifedipine (Procardia), both of which are calcium-channel blockers. Beta-adrenergic receptor blockers, such as propranolol, are also used to treat angina because they decrease the workload of the heart.   Anticoagulants and antiplatelets reduce the blood's ability to clot. They're used to treat conditions such as deep vein thrombosis (DVT), pulmonary embolism (PE), and to prevent stroke in patients with atrial fibrillation. They may also be used short-term in the hospital to prevent clots. Antiplatelets drugs are used to prevent clotting in the arterial circulation and are typically used to prevent heart attack and stroke in patients who are at high risk. Warfarin (Coumadin) was one of the first available oral anticoagulant drugs. Warfarin requires rigorous monitoring of patients. Newer oral options of anticoagulants have become available that don't require the same rigorous monitoring that warfarin does; however, they may not be an appropriate alternative for all patients who require an anticoagulant. Examples of these newer anticoagulants include: dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis). Two of the more common injectable anticoagulants include heparin and Lovenox. Examples of antiplatelets medications include aspirin, clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta), and ticlopidine (Ticlid). Cilostazol (Pletal) is a mediction that's used to treat peripheral artery disease.   Types of Kidney Medication Diuretics are medicines that promote the excretion of sodium, along with large amounts of water, from the kidneys. Medical conditions in which the accumulation of water is harmful are treated with diuretics. These conditions include high blood pressure, congestive heart failure, and edema (swelling due to excess fluid under the skin). Diuretic drugs are categorized according to their mechanisms of excretion: thiazide diuretics, carbonic anhydrase inhibitors, loop diuretics, and potassium-sparing diuretics.   The thiazide diuretics are so called because of the chemical nature of their molecules. They contain a sulfur atom that's identified in chemistry as "thia." Thus, thiazide means "sulfur-containing molecule." The thiazides promote the excretion of sodium ions from the kidneys. Sodium ions in turn carry large amounts of water with them, and volumes of water are effectively released from the body. Many patients on thiazide diuretics will also be on potassium supplements, since the body tends to excrete potassium along with sodium. Other drugs such as chlorthalidone, though chemically different from thiazides, are similar in action. Thiazides are the most widely used diuretic agents and the drug hydrochlorothiazide (HCTZ) is the most popular thiazide. Other common thiazides include indapamide (Lozol) and metolazone (Zaroxolyn). HCTZ and chlorthalidone are considered to be first-line treatment options for high blood pressure in many patients.   Carbonic anhydrase is an enzyme involved in the normal kidney function of urine formation and water retention. Inhibition of this enzyme results in more water excretion than retention. Thus, diuresis occurs with these drugs. Acetazolamide (Diamox) is the most common carbonic anhydrase inhibitor. Although these drugs are classified as a type of diuretic, they're more commonly used in the treatment of glauoma. The nephron is the functional unit of the kidney where urine formation occurs. The portion of the nephron that contains the greatest concentration of urine is called the loop of Henle. Loop diuretics act on this loop to allow for the formation of large amounts of urine. Therefore, large amounts of water are excreted. As with the thiazides, patients on loop diuretics will also likely be on potassium supplementation since potassium gets lost to the urine along with sodium. Loop diuretics are the most effective diuretics and are used when the passage of large amounts of water is desired. Furosemide (Lasix) is the most popular loop diuretic. Other useful loop diuretics are torsemide (Demadex) and bumetanide (Bumex). Loop diuretics are often the diuretic of choice in patients who have edema because of heart failure.   The previously mentioned diuretics cause not only excretion of sodium and water but also potassium. Loss of potassium is dangerous in some patients, particularly those with heart problems. Many patients who take these diuretics also take extra potassium in the form of supplemental tablets or potassium-rich food such as bananas.  Potassium-sparing diuretics keep potassium within the body so that the patient doesn't need potassium supplements. Potassium-sparing diuretics aren't as effective as thiazides and loop diuretics, but some products, such as triamterene with hydrochlorothiazide (Dyazide), combine potassium-sparing diuretics and thiazides to improve efficacy. Other potassium-sparing diuretics are amiloride (Midamor) and spironolactone (Aldactone).   Types of Respiratory Medications Respiratory drugs are used primarily to treat, prevent, or relieve conditions in the respiratory system including cold, cough, allergies, asthma, and COPD. One of the reasons allergy symptoms occur is because of a release of histamine. 1. Antihistamines oppose the action of histamine. 2. Antitussives prevent or relieve coughing, usually by acting on the medullary center of the brain to inhibit the cough reflex. 3. Decongestants reduce the swelling of mucous membranes in nasal passages. 4. Expectorants thin mucus secretions, allowing them to drain or be more easily expelled from the system.   A major healthcare problem in the United States is the inappropriate use of antibiotics for respiratory conditions. Many of these diseases are viral in nature, so they don't respond to antibiotics. Only bacterial infections respond to antibiotics. But some clinicians nevertheless prescribe antibiotics. Part of the problem is that medical professionals face great public pressure to prescribe. When people see a doctor for an illness, they generally want a prescription medication that will cure it. This pressure may influence some doctors to prescribe antibiotics for viral illnesses. The other contributing factor is that some viral infections are difficult to distinguish from bacterial infections. Antibiotic-Resistant Bacteria The most serious problem of the overprescribing of antibiotics is that it encourages the emergence of antibiotic-resistant bacteria, which aren't affected by the usual drugs. Infections caused by such antibiotic-resistant bacteria are difficult to eradicate. A person who has been exposed to multiple regimens of antibiotics can easily develop a resistant infection. The most effective method of battling this problem is using antibiotics appropriately. This means that viral illnesses shouldn't be treated with antibiotics. Instead, viral rhinitis, sinusitis, or bronchitis can be treated with other medications, such as decongestants, bronchodilators, and inhaled corticosteroids.   Antihistamines work against histamine, which causes the mucous membranes of the respiratory system to become inflamed and produce fluid, as seen in nasal and seasonal allergies. This effect of histamine results from its action on specific cell sites called histamine "type 1" (H1) receptors. Histamine also causes excess secretion of stomach acid in conditions of gastric hyperacidity or heartburn. This effect of histamine results from its action on specific cell sites in the stomach called histamine "type 2" (H2) receptors. Antihistamines can block the actions of histamine at either the H1 receptor sites (H1 blockers) or the H2 receptor sites (H2 blockers). Blocking the H1 receptor sites results in the reduction of allergy symptoms associated with rhinitis. Blocking the H2 receptor sites results in decreased stomach acid production. The H1 blockers are further subdivided into antihistamines that produce sedation and drowsiness as a side effect and those that are nonsedating. Many antihistamines can now be purchased without a prescription.   Bronchodilators open up the airway passages to allow for better air intake in conditions of asthma. Bronchodilators are administered as inhalants, dispensed from pressurized handheld containers, or orally in the form of tablets and liquids. There are two types of asthma inhalers: metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs). The technique required to use each type of inhaler is different. These drugs are also available in solutions that are delivered via a nebulizer, which is a breathing machine that changes the medication from a liquid to a mist for inhalation. Asthma is a chronic condition characterized by wheezing, chest tightness, difficulty breathing, and coughing. Asthma is caused by a partial obstruction of the bronchi and bronchioles due to abnormal contraction of the muscles in the bronchial walls. When the bronchi become blocked, the mucous membranes become swollen with fluid. Stale air then becomes trapped, and the amount of new air that can enter the lungs becomes limited, resulting in a characteristic wheezing sound. There's no cure for asthma, but the symptoms can be treated and prevented.   Both adults and children may have asthma—in 2015, it was estimated that about 8.4% of children and 7.6% of adults have asthma in the United States. In people suffering from asthma, a genetic factor may predispose them to be hypersensitive to certain allergens, such as dust, pollens, animal dander, or some foods. Asthma exacerbations, also known as asthma attacks, can stem from infections, certain drugs, vigorous exercise, and stress. An asthma attack is defined as a sudden worsening of asthma symptoms.   Drugs that cause dilation of the bronchi and bronchioles have been found to be effective in reducing the symptoms of asthma. The drugs open the passages to allow for optimal air intake and breathing. There are two types of bronchodilators—short-acting and long-acting beta2-agonists. The short-acting bronchodilators act quickly to open the bronchi and bronchioles and are used to provide immediate relief of asthma symptoms. Representative inhalants and oral bronchodilators are listed in the following table. The long-acting bronchodilators are used to prevent asthma symptoms and are most often combined with an inhaled corticosteroid. Less commonly, theophylline is taken orally for the treatment of asthma. For patients with underlying allergies and asthma, drugs such as zafirlukast (Accolate), montelukast (Singulair), and zileuton (Zyflo) may also be used. Representative inhalants and oral bronchodilators are listed in the table.   Medications for Coughs, Colds, and Allergies The common cold is the most common cause of time lost from work and school, more than any other illness. It's the most prevalent illness in the winter months. The public spends hundreds of millions of dollars on over-the-counter cough and cold preparations each year. Children 1 to 5 years old are the most susceptible to the common cold and may average up to 12 episodes per year. Individuals 25 to 30 years old average about six respiratory illnesses per year. Viruses cause the common cold. Symptoms include mucus accumulation in the nose and sinuses, profuse watery discharge from the nose (rhinorrhea), sneezing, and fever (usually low-grade). Sneezing is caused by a combination of nasal irritation, discharge, and congestion. It subsides when the secretions clear. There are no curative remedies for the common cold, and medications are intended to provide relief from the symptoms of this ailment. Antitussives A cough is usually associated with the common cold. Coughs are classified as productive or nonproductive. A productive cough removes secretions and phlegm from the lower respiratory tract. A nonproductive cough is a dry cough in which secretions or phlegm aren't present. OTC medicines used to stop coughs are called cough suppressants or antitussives. Cough suppressants are taken when there's a need to stop a persistent cough. The two cough suppressants found in commercial products are codeine and dextromethorphan. Codeine is the most effective antitussive agent, to which all other are compared. Codeine cough medicines are available only by prescription because of their narcotic content. Dextromethorphan is a non-narcotic anticough medication used in OTC cough medicines. Dextromethorphan affects the cough center in the medulla, increasing the threshold at which we're stimulated to cough, which in turn makes us cough less. Expectorants Expectorants act to decrease the viscosity (thickness) of the sputum (saliva and respiratory discharge) in coughing conditions. This action promotes ease of expectoration (the discharge of matter from the throat). The most popular expectorant is guaifenesin. Examples of over-the-counter products that have guaifenesin as an ingredient include Robitussin and Mucinex. Although not federally mandated, many retailers have restricted the sale of products containing dextromethorphan to persons over the age of 18 because dextromethorphan has become a drug of abuse among the adolescent population. At very high doses, dextromethorphan can cause euphoria and hallucinations. These high doses are very dangerous and can cause death, especially since dextromethorphan is commonly combined with other active ingredients that can also become toxic at high doses. Decongestants Another drug class used to treat colds is decongestants. Decongestants are drugs that cause constriction of the blood vessels in the nasal passages. This action results in shrinkage of the swollen vessels and mucous membranes and reduction of nasal discharge. It also promotes drainage and relieves stuffiness. The drugs are delivered either as nasal sprays, tablets, or liquids. People who have high blood pressure should talk to their healthcare provider before taking any form of decongestant because these medications may elevate their blood pressure. Nasal decongestants are sprayed into the nose to cause constriction of the dilated blood vessels that produce congestion. Intranasal application of decongestants provides prompt relief of nasal congestion. Shrinkage of the mucous membranes not only makes breathing easier but also permits the sinus cavities to drain. These nasal decongestants should be used for a maximum of three days to prevent rebound nasal congestion. The following nasal decongestant agents are used in most commercial products: Naphazoline (in Privine and others) is a potent vasoconstrictor that has a duration of about six hours. Phenylephrine (in Neo-Synephrine and others) is commonly applied as two or three drops or as a spray every four hours. Oxymetazoline and xylometazoline (in Afrin and others) are longer-acting agents having a decongestant effect of five to six hours. There are two oral decongestants that are swallowed as pills to provide systemic relief of nasal congestion: pseudoephedrine and phenylephrine. In an effort to combat methamphetamine use, the sale of pseudoephedrine is restricted. The Methamphetamine Anti-Proliferation Act requires that sales of pseudoephedrine products be tracked, either electronically or in a written log. In many states, pseudoephedrine products are kept behind the pharmacy counter and customers must present a valid photo ID to buy them. There are also restrictions on the maximum amount of pseudoephedrine that can be sold to one person. Phenylephrine is available over the counter, without any restrictions for purchase. Although there isn't enough evidence to say one is more effective than the other, some think pseudoephedrine may be more effective. The other difference between pseudoephedrine and phenylephrine is that phenylephrine is available only in a short-acting formulation, so it needs to be taken several times a day, while pseudoephedrine is available in short-acting, 12-hour, and 24-hour formulations.   Mold spores and plant pollens that depend on the wind for cross-pollination are the agents responsible for most seasonal allergies. Ragweed, grass, and tree pollens cause many seasonal allergies. The main symptoms of seasonal allergies are swelling (edema) of the nasal mucosa, sneezing, nasal itching, and nasal congestion. Antihistamines Histamine is the causative agent that contributes to cold and allergy symptoms, and antihistamines block the effects of histamine in tissues and reduce these symptoms. Antihistamines act by blocking histamine receptor sites and are most effective in controlling allergic rhinitis. The most common antihistamines found in commercial products are diphenhydramine, phenyltoloxamine, doxylamine, and chlorpheniramine.  First-Generation Antihistamines First-generation can be considered sedating antihistamines. The first-generation antihistamines are effective at controlling cold and allergy symptoms, but they can cause drowsiness in the patient. These medications may be chosen over second-generation antihistamines due to their effectiveness over certain allergic reactions. Second-Generation Antihistamines  The second-generation antihistamines have the advantage of not causing drowsiness. Thus, they may be preferred by a patient. Loratadine (Claritin), fexofenadine (Allegra), and cetirizine (Zyrtec) are second-generation antihistamines that are available over the counter. Levocetirizine (Xyzal) and desloratadine (Clarinex) are other second-generation antihistamines, currently available by prescription only.   Key Points Antiarrhythmic drugs are given to correct variations from normal heart rhythms. Beta blockers block the action of epinephrine, which may overexcite the heart and blood vessels. Antihypertensive drugs fight high blood pressure. Vasodilators widen blood vessels, making it easier for blood to pass through. Diuretics cause the kidneys to excrete more urine, resulting in a lower volume of blood in the body. Angiotensin-converting enzyme (ACE) is normally part of the body's blood-pressure regulation system, causing production of a powerful constricting substance. ACE inhibitors block the actions of ACE, causing dilation of the blood vessels and reducing blood pressure. Angiotensin II receptor blockers (ARBs) prevent angiotensin II, a vasoconstrictor, from binding to receptors, reducing blood pressure. Calcium-channel blockers (CCBs) lower blood pressure by dilating constricted blood vessels by blocking the calcium that regulates contraction. Beta-adrenergic receptor blockers decrease the heart's rate and force of contraction; this lowers oxygen use to prevent myocardial ischemia and pain. Antiarrhythmics reverse the disorderly pattern of heartbeats seen in cardiac arrhythmias, which are disorders of electrical-impulse conduction through the heart. Antianginals treat angina, an intense pain in the chest caused by a lack of oxygen in the heart muscle. Anticoagulants reduce the blood's ability to clot; clots that form within blood vessels can cause stroke and heart attack. Diuretics are medicines that promote excretion of sodium and large amounts of water from the kidneys; they're prescribed with potassium supplements since potassium gets lost to urine along with sodium. Diuretics are used to treat high blood pressure, congestive heart failure, and obesity, all conditions in which an accumulation of water is harmful. Respiratory drugs are used primarily for opening bronchial tubes and reversing the effects of histamines, which cause inflammation of the respiratory system. Antihistamines counteract the action of histamine. Antitussives prevent or relieve coughing by inhibiting the cough reflex. Decongestants reduce swelling of mucous membranes in nasal passages. Expectorants thin mucous secretions, allowing them to drain or be more easily expelled from the system.

Introduction There are a wide variety of drugs used to treat issues involving the gastrointestinal system, sensory organs, and the nervous system. Some of these are available over the counter, while others require a prescription. It's important for healthcare workers to have an understanding of the common drugs in these categories and the conditions they treat.   Drugs Used in the Gastrointestinal System You probably have some gastrointestinal drugs in your medicine cabinet. Many of them are over-the-counter preparations designed to relieve symptoms such as indigestion, nausea, and diarrhea. Antacids are medications that neutralize the hydrochloric acid that causes heartburn and pain from ulcers, esophagitis, or other stomach problems. Antiulceratives go beyond neutralizing stomach acid; they decrease the amount of acid secreted. Drugs called cathartics relieve constipation and may also be given to stimulate defecation for diagnostic or operative purposes. The term laxative refers to mild cathartics; purgative refers to strong cathartics. Antidiarrheals stop diarrhea. Antiemetics are drugs that inhibit nausea and vomiting. These drugs are also used to counteract dizziness, motion sickness, and labyrinthitis (inflammation of the inner ear). In contrast, it's occasionally necessary to ingest an emetic, a drug that will induce vomiting, such as in cases of poisoning.    Many gastrointestinal disorders are caused by excess stomach acid. Excess acid contributes to heartburn or dyspepsia, indigestion, burning sensations in the stomach, and peptic ulcers. One sure way to reduce these effects is to reduce the amount of acid. There are three ways to reduce the effects of excess stomach acid: Antacids H2 receptor antagonists Proton-pump inhibitors   Proton-pump inhibitors (PPI) are widely used to treat gastroesophageal reflux disease (GERD). These drugs reduce the amount of acid made in the stomach by turning off the "pumps" that produce acid. This gives the tissue lining the stomach and esophagus time to heal from erosion that too much acid can cause. Most of the PPI agents are now available over the counter to treat heartburn and gastric reflux.   [refer to saved transcripts for the rest]

Lesson 3 Overview As an allied health professional, it’s important to have a basic understanding of the causes of disease, signs, symptoms, and treatment. This lesson is a foundation of knowledge that you’ll apply as you work through the rest of your lessons. Infectious diseases have bothered humans since the beginning of time. Advances with antibiotics, vaccines, and infection control over the course of the last century have significantly reduced the risk of mortality for what were previously fatal or debilitating infectious diseases. Although medical advances have decreased the mortality and morbidity from infectious disease, you must not underestimate the potential of resurgence and adaptability of pathogens.   Lesson Objectives Recognize specialized fields in pathology, common terms used in pathology, and the history of pathology Identify techniques used by healthcare providers to obtain information about disease Explain how pathologists examine differences between cells and attempt to determine causes Recognize how cell adaptation and injury occurs Describe how microorganisms grow and multiply Recognize how pathogens cause infection and can be spread Describe how the human body protects against pathogens Explain how healthcare workers can protect themselves from contracting infectious diseases

Introduction In this section, you'll be introduced to pathology. You'll review the history of pathology and different specialties within the science of pathology.   What is Pathology? Pathology is the study of disease and injury and how they affect the body. The study of pathology helps to form a bridge between basic science and the clinical practice of taking care of patients. Pathology, more specifically, is the branch of medicine that specializes in studying how disease affects the body at both the microscopic and macroscopic, or gross, levels. The term macroscopic refers to something that's visible to the naked eye. Microscopic, on the other hand, refers to something that's so small that it can't be seen without the use of a microscope. A pathologist is a doctor who specializes in the study of disease and injury and how it affects the body. A pathologist examines cells and tissues using a tool called a microscope. There are three main studies within the science of pathology: 1. Anatomic pathology focuses on the gross and microscopic changes in the tissues caused by disease and injury. 2. Clinical pathology is the laboratory study and analysis of bodily fluids and waste products such as blood, urine, and sputum. 3. Forensic pathology is a combination of both anatomic and clinical pathology that focuses on issues in civil and criminal law.   Within each of these main studies are specializations that further focus on specific areas within pathology. A medical technologist is an allied health professional who performs much of the day-to-day clinical pathology testing in the clinical lab setting. When we talk about pathology, we must think about what constitutes health and what constitutes disease. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. So, health incorporates all aspects of a human being, not just the physical well-being. On the other hand, disease is an abnormal alteration of a structure or function in the body. Some other terms that are commonly used in pathology with which you should be familiar are listed here: Epidemiology. The study of when and where disease occurs. Etiology. The study of the cause of disease within the population. Exacerbation. Sudden increase in the severity of disease. Usually, there's an increase in the signs and symptoms during the exacerbation. Illness. The reaction of the patient to the disease in the form of symptoms. Lesion. A visible characteristic change in tissues and cells, usually localized to one specific area on or in the body. They may be benign or cancerous. Morphology. The study of the structural changes at the cellular and tissue level. Pathogenesis. The development of a disease. Patient. The person affected by the disease. Physical signs. Functional implications from the disease that are felt by the patient. Remission. A period of decreased disease activity; less intense for a period of time. This may be temporary. Sequelae. The late-term effects, or aftereffects, produced by the disease.   History of Pathology Pathology is a science that has been developing and progressing since ancient times. In ancient times, people believed that disease was caused by a "curse" or the "evil eye" of the spirits. As time progressed, scientists discovered the real reasons behind illness. Following are some of the major contributors to the science of pathology: In 1665, Robert Hooke discovered the cell, the basic structural, functional, and biological unit of living organisms. In 1839, Theodor Schwann developed the cell theory, the concept that all living organisms are composed of one or more cells, and that all cells come from preexisting cells. Cell theory also states that vital functions of an organism occur at the cellular level and that the genetic information necessary for regulating cell function was copied and pasted on to the daughter cells during reproduction. In the late 1600s, Antony Van Leeuwenhoek worked on developing lenses and magnification. His work on the microscope contributed significantly to the discovery and study of single-celled organisms. During the 1800s, Louis Pasteur worked as a scientist and researcher in the university setting. He's known for developing the process of pasteurization, in which a substance is heated to a specified temperature and for a specified time to kill microbes. Pasteurization has helped reduce the spread of foodborne illness. Milk is a common pasteurized product. Pasteur also discovered the principle of vaccination.   The main objective of pathology is to understand the nature of disease by focusing on the following ideas: Identifying the etiology Understanding the pathogenesis Understanding the pathological changes Identifying the clinical features, including the functional and structural changes (this would also include the patient's signs and symptoms) Preventing complications Developing a prognosis Histopathology. The study of diseases in the tissues, at either the gross/macroscopic or microscopic level. Histopathology is often associated with surgery, as samples are analyzed to determine the extent of disease. There's also a forensic science subspecialty. Cytopathology. The study of disease at the cellular level. A Pap smear is a good example of the type of cell samples that are studied and evaluated. Hematology. A branch of medicine specializing in blood disorders. A hematologist would treat patients with sickle-cell anemia, for example. Microbiology. The study of microbes and single-celled organisms. Immunology. A branch of medicine specializing in conditions of the lymphatic and immune system. Geographic Pathology. A specialty that focuses on the study of diseases in populations in different parts of the world. Medical Genetics. The study of the relationship between heredity and disease. Molecular Pathology. Molecular pathology focuses on the detection and diagnosis of disease at the DNA level.   Key Points A pathologist is a doctor who specializes in the study of disease and injury and how it affects the body. There are three main studies within the science of pathology: anatomic, clinical, and forensic. Louis Pasteur worked as a scientist and researcher in the 1800s and developed the process of pasteurization. In pasteurization, a substance is heated to a specified temperature and duration to kill microbes. Specialties within the science of pathology include histopathology, cytopathology, hematology, microbiology, immunology, geographic pathology, medical genetics, and molecular pathology.

Introduction In this section, you'll learn about diseases. You'll review basic variations of diseases and their classification into five main groups.   Variations in Disease There are several components that account for the variations in disease. These can be classified into the following five main groups: congenital, inflammatory, neoplastic, degenerative, and iatrogenic. Here, you'll examine each one separately. A congenital disease is a condition that exists at or before birth, or that develops during the first month of life. A congenital disease may be the result of genetic abnormalities, damage to the developing fetus, or several other causes. A genetic disorder is an illness caused by one or more abnormalities in the genome, which can be either inherited or arise spontaneously. Cystic fibrosis is an example of an inherited disease, whereas Down syndrome is usually caused by a spontaneous genetic mutation. Inflammatory diseases can be caused by trauma, infection, or immune responses. Examples of inflammatory disease are appendicitis and tuberculosis (TB). Trauma can result in hemodynamic changes, resulting in a patient going into shock. Inappropriate immune responses can result in autoimmune diseases, such as Graves' disease. The term hemodynamic refers to the functioning and mechanics of blood circulation. Autoimmune relates to antibodies or T cells that attack molecules, cells, or tissues of the organism producing them; it's an immune response of the body against itself. Neoplastic diseases are growth disorders that produce tumors. Tumors may be cancerous or benign. Lung cancer is an example of a cancerous growth disorder. Moles and uterine fibroids are examples of benign tumors. The aging process can result in degenerative diseases, such as osteoarthritis.  Iatrogenic diseases are caused by medical treatment or drugs. For example, a patient may develop Cushing's syndrome from high-dose steroids. Aplastic anemia can develop from treatment with chloramphenicol.   Key Points As a disease occurs and progresses, damage occurs within the body caused by the disease process and the body's response. Four types of assessment techniques used by healthcare providers to obtain objective information include observation and inspection, auscultation, palpation, and percussion. A symptom is a subjective feeling that the patient is reporting; they often can't be easily measured or observed. The five main groups used to classify variations in disease include congenital, inflammatory, neoplastic, degenerative, and iatrogenic diseases.

Introduction In this section, you'll review learning in pathology, etiology, types of diseases, and the method of study in diseases.   How Pathologists Learn Pathologists study by comparison between what's normal and what's abnormal in the human body. They learn what a normal cell looks like and then they can compare it with another cell. If there are differences between the cells, then they document those findings. Pathologists use the following terms when examining cells: Diagnosis is the examination of the sample to help to identify the underlying process that's occurring with the patient. Grade is the degree of deviation from a normal cell. Stage is the extent of the disease.   Etiology Etiology is the study of cause or origination. Finding out the cause of the disease is very important. Knowing the cause is how a diagnosis can be made. An accurate diagnosis is needed so that the treatment is appropriate for the condition. Disease can be caused by the following: 1. Environmental factors 2. Genetic factors 3. Indirect causes Environmental Factors Several environmental factors can affect the human body: 1. Physical agents like radiation, trauma, electricity, x-rays 2. Chemical agents like pesticides, toxins, venoms 3. Nutritional deficiencies or excesses 4. Infections and infestations 5. Abnormal immunological reactions Genetic Factors Genetic factors, such as abnormal genes or gene expression, can't be changed or modified easily. Indirect Causes Indirect causes include the following: Age Race Sex Climate Personal habits (for instance, tobacco use) A disease can be caused by just one etiologic agent that results in one disease, several etiologic agents that result in one disease, or one etiologic agent that results in several diseases. Smoking is an example of one etiologic agent that can cause more than one disease. Heart disease is an example of a disease caused by multiple etiological agents.   Types of Diseases and Methods of Study Acute A disease with a sudden onset that ends in a short period of time. The common cold is an example of an acute disease. Chronic A disease that has a slow onset and a long duration. Communicable Diseases that are transmitted by agents, fomites (surfaces), and vectors. A mosquito is an example of a vector. A TV remote control or shopping cart handle is an example of a fomite. Contagious A disease that's transmitted by direct contact. Fulminating Acute, sudden, severe onset of a disease. Idiopathic A disease with unknown cause. Infectious Disease caused by pathogenic microorganisms. Teratogenic Diseases that are caused by drugs that cross the placental barrier and harm the fetus. Venereal Disease that's transmitted by sexual contact.   The following methods of studying disease include: Autopsy—The systematic dissection and examination of a cadaver to identify any abnormal changes or lesions that may be present. Biopsy—The surgical removal and examination of tissues.   Key Points Pathologists study by comparison between what's normal and what's abnormal in the human body. Etiology is the study of cause or origination; determining the cause helps make the diagnosis. A disease can be caused by environmental factors, genetic factors, or indirect causes. A prognosis is the physician's estimate of the severity and possible outcome of a disease.

Introduction In this section, you'll learn about prognosis and cellular changes and adaptations that can take place. Additionally, you'll review cellular injury.   Prognosis and Cellular Adaptations The prognosis is the physician's estimate of the severity and possible outcome of the disease process. For example, the prognosis of the common cold is a full recovery. Prognosis of pancreatic cancer is more grave. In response to environment and injury or insult, our cells adapt and change. These changes begin to deviate from normal and can indicate the potential for the beginnings of a disease process. This process doesn't happen overnight, but is rather a culmination of time and insults that allow for the changes to occur.   In response to environment and injury or insult, changes or adaptations that can take place are atrophy, dysplasia, hyperplasia, hypertrophy, hypoplasia, and metaplasia. Cellular injury depends on the type, duration, and severity of the insult. The length of time the cell was exposed and the severity of the occurrence will have a direct impact on the cell's overall health and ability to function. For example, with ischemia, the cell isn't getting enough oxygen. Not having enough oxygen for a long period of time can stress the cell and result in cell death. Atrophy The lack or loss of normal development of cells, resulting in smaller cells. Dysplasia A change in cell structure. Hyperplasia Excessive development of normal cells within an organ. Hypertrophy Increase in the bulk or size of the cells. Hypoplasia Decrease in development of normal cells within an organ. Metaplasia A change in cells from one type of cell to another in response to an insult or injury. This change is better suited for the current environment and isn't necessarily cancerous.   Key Points A prognosis is the physician's estimate of the severity and possible outcome of a disease. In response to environment, injury, or insult, cells adapt and change. The length of time a cell was exposed and the severity of the occurrence has a direct impact on the cell's overall health and ability to function.

Introduction In this section, you'll review how microorganisms grow and survive.   Microorganisms Healthcare professionals are always working on preventing the spread of infection and promoting health in their patients. Sometimes, it's the simplest tasks that can make the biggest difference in decreasing the spread of infection. Some of what you'll learn here can be incorporated into your everyday life to help you and your family to stay healthy. Since the early nineteenth century, morbidity and mortality from infectious disease has been on the decline due to major advances in medicine like antibiotics and vaccines. Healthcare professionals and scientists also conducted many studies on ways to reduce the spread of infection. The results of many of these studies have provided the foundation of our modern infection control principles. Do you remember the definition of infection control? The goal of infection control is to prevent the spread of infectious diseases. To best understand how infections are spread, look at the basic process of infection. The body contains living microorganisms that help maintain certain bodily functions. Think of the normal flora in your intestinal tract. They're beneficial microorganisms you need to help aid in the digestion of the food you eat. Other microorganism, called pathogens, cause infectious diseases. Pathogens cause disease when the opportunity arises and they're allowed to grow and multiply in the human body.   For microorganism to grow and survive, they must be in an environment that's suitable for them. One pathogen may thrive in one type of environment, and another pathogen may not. The following list includes the environmental factors required for growth to occur: 1. Oxygen. Some microorganisms need oxygen to live, but many others don't. Microorganisms that require oxygen are called aerobic. Those that require very little or no oxygen at all are called anaerobic. An example of anaerobic bacteria is streptococcus, which is the common pathogen that causes strep throat. 2. Moisture. Microorganisms thrive in moist areas. Our bodies do provide moisture for pathogens. 3. Food. All microorganisms need a food source to grow and thrive. Our bodies can provide plenty of nutrients for pathogens. 4. Temperature. Different microorganisms can grow and multiply at varying temperatures depending on the individual organism. However, the human body provides a nice warm place at approximately 98.6°F, which is an optimal temperature for many microorganisms. One reason people develop a fever when sick with certain pathogens is that the higher temperature is unsuitable for the pathogens to thrive 5. Limited light/darkness. Sunshine and bright light can dry out a moist area. Microorganisms prefer dark areas that are more consistently moist. 6. Neutral or slightly alkaline pH. Most microorganisms don't like acidic environments. Most prefer a neutral or even slightly alkaline area to grow and thrive.   Key Points The goal of infection control is to prevent the spread of infectious diseases. Microorganisms called pathogens cause infectious disease when they're able to grow and multiply within the body. Microorganisms that require oxygen are called aerobic; those that require little or no oxygen are called anaerobic.

Introduction In this section, you'll learn about how infection can spread. Specifically, you'll review the chain of infection and how medical professionals look for a way to break the chain.   The Chain of Infection For disease to spread, there are six steps that need to occur. These steps are called the chain of infection. Healthcare professionals are always looking for a way to break the chain of infection, thereby stopping the spread of diseases. The chain of infections includes: 1. Infectious Agents 2. Reservoir 3. Portal of Exit 4. Means of Transmission 5. Portal of Entry 6. Susceptible Host   Any microorganism capable of causing disease is considered to be a pathogen, or infectious agent. This is the first link in the chain of infection. In order for disease to occur, the pathogen must be present. There are five classifications of pathogenic microorganisms: viruses, bacteria, fungi, parasites, or rickettsiae.  Viruses are pathogens that need a living cell of a host to be active and reproduce. They're considered to be intracellular parasites because they actually have to be inside the target cell to multiply and cause disease. Viruses are very good at mutating and adapting to their environment, making them very hard to cure. There are only a few pharmacologic agents that are used to treat viruses. Most are considered to be palliative because they treat and reduce only the symptoms of the viral disease instead of eliminating the disease itself. The term palliative describes a treatment or medicine that reduces the effects or symptoms of a medical condition without curing it. Bacteria are single-celled microorganisms that live in the body's tissues. Many bacteria are able to survive and reproduce outside the host organism. They're identified and classified by their characteristic shapes and morphology. There are three classifications based on bacterial shape: cocci (shaped like a sphere or a dot), bacilli (rod-shaped), and spirilla (spiral-shaped). Bacteria can also be grouped by how they stain in the laboratory setting. Gram-negative bacteria become visibly red under the microscope when stained. Gram-positive bacteria appear violet under the microscope. If the bacteria doesn't accept the bacterial stain at all, they're considered to be spores. Spores have a covering (like a hard shell) that protects them, making it very challenging to kill this type of bacteria with chemical disinfectants or heat. Humans have nonpathogenic bacteria that reside on the skin and in the mucous membrane areas of the body. These nonpathogenic bacteria are called normal flora. This flora is necessary and important to help us maintain our body's homeostasis and minimize the growth of pathogens. Fungi may be single- or multicelled. Mushrooms and mold are nonpathogenic. Pathogenic fungi cause athlete's foot, ringworm, and Candida infections. Any organism that lives in or on another organism is classified as a parasite. These organism may be single- or multicelled. A protozoan is a single-celled parasite. Examples of protozoa are malaria and dysentery. Metazoans are multicelled parasites that include pinworms, tapeworms, and hookworms. Rickettsiae are intracellular, parasitic, nonmoving bacteria. They're a little larger than the typical virus. These types of bacteria are susceptible to antibiotics. Examples of rickettsial infections include typhus, Lyme disease, and Rocky Mountain spotted fever. These infections often have a characteristic rash caused by the rickettsia invading the small blood vessels.   The reservoir is the second link in the chain of infection. This is the place where the pathogen lives and grows as it waits for the next opportunity to spread. People, animals, insects, water, and the food supply are all examples of potential reservoirs. Methods for breaking the chain of infection at this second link include hand washing, disinfection, and sterilization.    The portal of exit is the third link in the chain of infection. There needs to be a way for the pathogen to leave the reservoir and spread. Pathogens usually leave via secretions or excretions such as mucus, vomit, blood, urine, feces, vaginal fluid, and semen.   Now, if the pathogen has a portal of exit, then it needs a way to travel to the next reservoir to continue to spread. The fourth link in the chain of infection is means of transmission. Pathogens can be transmitted in several different ways, as shown. Direct Contact A person directly touches the pathogen or comes in direct contact with a body fluid. Airborne Transmission A pathogen is in the air and it's inhaled. The common cold and tuberculosis are two examples of pathogens that can be transmitted through the air. Bloodborne Transmission Infected blood or body fluids enter a susceptible host. Ingestion  Pathogens are transmitted through eating or drinking from contaminated sources. Indirect Contact Transmission Pathogens enter when interaction with a fomite occurs. Remember, fomites are inanimate objects and surfaces that we can touch. Door knobs, remote controls, and keyboards are all examples of fomites. How long a pathogen can be on a fomite and still cause infection depends on each individual pathogen, and to some extent whether the fomite is a porous or nonporous surface. Vector Animals or insects that carry disease easily transmit pathogens. Mosquitoes can carry the West Nile virus and deer ticks can carry Lyme disease.   Even if a pathogen can travel, it still needs a way to get into a person. The fifth link in the chain of infection is the portal of entry.  Pathogens can enter through breaks in the skin, mucous membranes, inhalation and ingestion, and sexual intercourse. To break the chain of infection at the portal of entry, healthcare workers employ methods of infection control such as correct wound care, transmission-based precautions, and aseptic technique.   For a person to become infected with a pathogen, he or she must be a susceptible host, the sixth and final link in the chain of infection. A susceptible host is someone who is able to contract the pathogen. Vaccines can help break this link in the chain of infection, therefore making a person not susceptible. Susceptibility of a person depends on several factors: The number and species of pathogen The duration of exposure to the pathogen The host's overall general physical condition The host's psychological health status The host's occupational or lifestyle environment Age of the host The presence of underlying diseases or conditions in the host     Nosocomial Infections Nosocomial infections are infections that are acquired while patients are in the hospital. These infections can be caused by pathogens present on the healthcare staff's hands, equipment, or instruments. Nosocomial infections are preventable and should not occur. Studies have demonstrated that clostridium difficile, which is a spore-forming bacterium, can remain intact on surfaces such as the hospital curtains and TV remote controls for an extended period of time. That's why disinfecting and sanitizing hospital rooms and equipment is very important.   Key Points For a disease to spread, the six steps of the chain of infection need to occur:                                                                                                                         1. An infectious agent must be present.                                                                                                                                                                                           2. The reservoir allows the pathogen to live and grow.                                                                                                                                                                 3. The portal of exit allows the pathogen to leave the reservoir.                                                                                                                                                 4. The means of transmission allows the pathogen to spread.                                                                                                                                                   5. The portal of entry allows the pathogen to leave the body.                                                                                                                                                     6. The susceptible host is someone who then contracts the pathogen. Nosocomial infections are acquired while patients are in the hospital.

Introduction In this section, you'll review how bodies protect themselves from pathogens. Protections include inflammatory responses, the immune system, and standard precautions.   The human body is designed with many protective features to help keep pathogens from getting in. These are just a few examples of some of its defenses. The skin is the body's first line of defense. It is not only the largest organ, but also a major factor in keeping pathogens out. As long as the skin is intact, the body can keep many pathogens out. Eyelashes and eyebrows help protect the eyes from pathogens. Cilia help trap pathogens that may try to enter through the respiratory system. Tears, mucus, saliva, and other body secretions help to trap, cleanse, and remove pathogens and debris from the body.   Inflammatory Response Inflammation is the body's way of responding and fighting when it's invaded by a pathogen or injured through trauma. Inflammation can occur with any threat or injury to the body. If a pathogen is present, the body has specific steps that it goes through to mount an immune response against the pathogen. Inflammation has specific signs and symptoms: Redness Heat Swelling Pain  These signs and symptoms can vary from being very mild to moderate to severe.   If the inflammatory response isn't effective, then the immune response is the body's next step to fight pathogens. Below are indications that the inflammatory response isn't enough to get rid of the pathogen: Accumulation of purulent drainage (pus) Fever Lymph node enlargement Septicemia, an infection that occurs when the pathogens have entered the bloodstream Septicemia requires immediate antibiotic therapy.   Immune System The purpose of the immune system is to protect against pathogens and abnormal cell growth. There are two types of immune responses that can occur: Cell-mediated immunity is usually involved in attacking and fighting viruses, fungi, cancer cells, and organ transplants. Humoral immunity produces antibodies that are capable of killing microorganisms and recognizing the same pathogen in the future. This type of immunity is part of how vaccinations work in our bodies. There are four general phases that occur in both types of immunity: 1. Recognition of the invader 2. Growth of T cells and B cells 3. T cells and B cells mount attack against the pathogen 4. A slowdown of the immune system after the death of the pathogen   Standard Precautions The Centers for Disease Control and Prevention (CDC) spent many years studying and revising precautions that should be taken by all healthcare providers who have direct contact with patients. Standard precautions are the minimum infection prevention practices that apply to all patient care, regardless of infection status of the patient. All direct care workers in the medical field need to follow the standard precautions. Standard precautions include the following: Hand hygiene Use of personal protective equipment, or PPE (gloves, gowns, masks) Safe injection practices Safe handling of potentially contaminated equipment or surfaces in the patient environment Respiratory hygiene/cough etiquette For standard precautions to be effective, they must be practiced at all times when working with patients. The healthcare worker assumes that every patient is potentially infectious when providing patient care. In the next section, you'll look at how exposure can occur and what can be done to prevent it.   Key Points The human body has many protective features to keep the pathogens from entering, including skin, eyelashes, and cilia. Inflammation is the body's way of responding and fighting when it's invaded by a pathogen or injured by trauma. Signs and symptoms are redness, heat, swelling, and pain. The purpose of the immune system is to protect against pathogens and abnormal cell growth. Standard precautions are the minimum infection-prevention practices that apply to all patient care.

Introduction In this section, you'll review ways people who work in healthcare take precautions from acquiring infectious diseases.   Body Fluids Body fluids are any fluid that comes from the human body. Here are some examples of body fluids healthcare workers may come in contact with while working with patients. Blood While drawing or handling blood samples When changing dressings on an open wound When taking care of a patient with epistaxis Vaginal Secretions When assisting the physician with an OB/GYN exam When handling any specimens  Synovial Fluid When assisting the physician with any arthroscopic procedures When handling specimens Semen When handling semen specimens Sputum When handling sputum specimens When working with any patients who are expectorating sputum Saliva When assisting with any dental or oral procedures   Transmission-Based Precautions If a patient has been diagnosed or is suspected of having a highly contagious disease, then healthcare workers take extra precautions in addition to the standard precautions. These precautions are referred to as transmission-based precautions (TBP). The goal of TBP is to reduce the risk of airborne, droplet, and contact exposure for healthcare workers. For example, in an ambulatory setting, a patient with suspected active tuberculosis (TB) would need to wear a surgical face mask in the waiting room and be moved into an airborne infection isolation room (AIIR) as soon as possible. A patient in the inpatient setting would be placed in an AIIR with negative pressure, which keeps air from flowing out of the room when the door is opened. Healthcare personnel should limit transferring and moving the patient among the general population. When the patient needs to be out of isolation, the patient needs to wear a surgical mask. Depending on the patient's diagnosis, the healthcare workers may need to wear specially designed respirators for protection. All of this would be completed in addition to the standard precautions.   Personal Protective Equipment Personal protective equipment (PPE) is a barrier that's used to protect healthcare workers against body fluids. However, personal protect equipment doesn't protect from needle stick injuries. PPE consists of gloves, mask, goggles or face shield, gown, and shoe covers. What PPE a medical assistant uses depends on the type of patient care that the assistant is providing. Healthcare workers can be exposed to blood during an accidental needle stick injury after giving a patient an injection. The Occupational Safety and Health Administration (OSHA) mandates that employers provide the safest needle device available to protect workers. All used sharps must be placed in a container designated for sharps. These containers are puncture-proof and have a safety device on the top that prevents the sharps from escaping once they're placed in the container. If a needle that the healthcare worker is using doesn't have any type of safety device on it and the sharps container isn't within arm's reach, then the worker will use the scoop technique to place the cap back on and then proceed to the sharps container to dispose of the sharp.   OSHA Regulations The Occupational Safety and Health Administration (OSHA) protects employees by developing and implementing regulations that employers must follow to ensure the workplace is healthy and safe for workers. The bloodborne pathogen standard is in place to protect employees from becoming exposed to body fluids in the workplace. Every healthcare facility must have an exposure plan. The plan must list how the employer will comply with the bloodborne pathogen standard.   OSHA mandates that employers be in compliance with the following precautions: Standard precautions—Hand washing is a focus. Employers are required to provide sinks to wash hands. Engineering controls/work practice controls—Employers must provide the equipment and devices necessary for employees to perform their jobs as safely as possible. A sharps container placed close to where employees give injections is an example of an engineering/work practice control. Personal protective equipment—Employers must provide PPE, make sure that it's accessible to the employees, and ensure they know how to use it. Cleanliness of work areas—It's the employer's responsibility to make sure the workplace is clean and sanitary. Employers need to have written documentation detailing the cleaning schedule. Hepatitis B vaccine—Employers must offer the vaccine to employees free of charge. Follow-up plan after exposure—If an employee has an accidental exposure, there must be a plan in place, including a medical evaluation, and that plan must be followed. Medical records—If an employee has an occupational exposure, then the medical record must be maintained for the length of employment plus an additional 30 years. The medical record is confidential. The employer doesn't have privilege to see the medical record.   Key Points Healthcare workers should take extra precautions when dealing with a patient who has been diagnosed or is suspected of having a highly contagious disease. These precautions are known as transmission-based precautions (TBP). Personal protective equipment is a barrier that's used to protect healthcare workers against body fluids, but not from needle stick injuries. OSHA protects employees by developing and implementing regulations to ensure a safe, healthy workplace. Medical asepsis techniques are used to decrease the risk of spreading infection. Sanitization is the actual physical washing and cleaning of equipment. Disinfection uses chemicals or boiling water on objects and surfaces to destroy many pathogens.

Lesson 4 Overview In this lesson, you'll learn about common diseases and conditions that can affect the body systems. You'll focus on signs and symptoms, as well as common treatments. Learning pathology allows you to understand and effectively communicate with doctors and other healthcare providers with whom you’ll be working in your new career. This lesson isn't intended to provide a complete list of all conditions treated by physicians or all the medications and treatments that may be prescribed. However, when you complete this lesson, you’ll be familiar with many of the medications and treatments used to treat these common diseases and conditions. You’ll start by learning a few common respiratory ailments that are frequent causes of doctor visits in the family practice setting.  This lesson is not intended to diagnose, recommend treatment, or replace a healthcare provider’s professional assessment for any medical condition.   Lesson Objectives Classify the common diseases and conditions that can affect the respiratory system Classify the common diseases and conditions that can affect the cardiovascular and endocrine systems Classify the common diseases and conditions that can affect the digestive and urinary systems Classify the common diseases and conditions that can affect the reproductive system Classify the common diseases and conditions that can affect the musculoskeletal system Classify the common neurologic diseases and conditions Classify the common diseases and conditions that can affect the sensory system Classify the common diseases and conditions that can affect the immune system

Introduction The upper respiratory system consists of the structures in the head and neck that are involved in breathing: the nose, sinuses (nasal cavities), throat, and larynx (voice box). Common illnesses of the upper respiratory system include nasal congestion and the common cold. The lower respiratory system consists of the structures in the chest that are involved in breathing: the trachea, bronchi, bronchioles, and lungs (including alveoli). Common illnesses of the lower respiratory system include cough, asthma, bronchitis, and pneumonia.   Nasal Congestion Key Facts The family practice physician writes many prescriptions for medications to treat nasal congestion. Nasal congestion results in a feeling of stuffiness and blockage of the breathing mechanism through the nose. Etiology, Signs, and Symptoms Nasal congestion may be caused by allergies, viruses, or bacterial infections. Common symptoms are sneezing, stuffiness, runny nose, and postnasal congestion and drip. These symptoms may evolve into chronic nasal or sinus infections.   The physician may recommend using a humidifier, to keep the air in the room moist, or a saline nasal spray. If the patient doesn't have any other medical conditions that would contraindicate a decongestant, then one may also be recommended for acute short-term use. A medication or treatment is contraindicated when it would do more harm than good. Nasal decongestants provide temporary relief of symptoms by getting rid of the excess fluid in the nose that's causing the congestion. These medications constrict the arterioles in the nose, thereby reducing blood flow in the engorged area. Since the nasal tissue may be inflamed, corticosteroids can be used to manage the stuffiness. Corticosteroids exert a marked anti-inflammatory  effect on the nasal mucosa when applied topically—that is, when applied directly to the area. They're used alone or with nasal decongestants. Nasal corticosteroids are dispensed as nasal sprays.   The following are some of the most common medications that the family physician may recommend for the short-term management of acute nasal congestion: Afrin, a nasal decongestant spray Sudafed, or pseudoephedrine, tablets Beconase, a prescription corticosteroid nasal spray The physician reviews all of the patient's health conditions prior to recommending any over-the-counter (OTC) preparations or prescribing any drugs. Some conditions, such as narrow angle glaucoma, benign prostatic hyperplasia, and hypertension are contraindications to taking medications like pseudoephedrine. Over-the-counter preparations are for short-term acute use only.   The Common Cold and Sinus Congestion Key Facts The common cold is a diffuse upper respiratory tract infection caused by any of a wide range of viruses. It's transmitted between individuals through droplets from one respiratory tract to another, as when someone sneezes. The family physician may recommend a variety of remedies to treat the symptoms of the common cold. These remedies usually contain decongestants to relieve nasal stuffiness and sinus congestion and antihistamines to dry the nasal and sinus tissues. Some preparations also contain pain relievers to reduce pain in the sinus cavities.    Etiology, Signs, and Symptoms The common cold is caused by a viral infection and affects primarily the nose and the throat. Cold symptoms should subside in approximately seven to ten days. Colds are very common in young children. Colds most often occur in the fall and winter months. Diagnosis is made by physical exam. Sinusitis or other secondary bacterial infection can occur as a complication. Signs and symptoms include the following: Rhinorrhea (runny nose) Nasal congestion Sneezing Itchy or scratchy throat Watery eyes Fatigue   The following are some remedies used to treat symptoms of the common cold: Increased fluid intake Rest Humidifier to increase humidity in room Gargle Saline nasal drops These are examples of some OTC medications that the physician may suggest to help treat cold symptoms, depending on the patient's other medical conditions. Chlorpheniramine (Chlor-Trimeton) Diphenhydramine (Bendadryl) Brompheniramine (Bromfed) Clemastine (Tavist) NyQuil Cold & Flu Multisymptom Relief (also contains acetaminophen and dextromethorphan) Pseudoephedrine (Sudafed) Oxymetazoline (Dristan nasal spray) *For patients who suffer from a more persistent rhinorrhea, nasal preparations such as Atrovent (ipratropium) may be prescribed by the physician.   The lower respiratory system employs defense mechanisms such as mucus, a sticky secretion, and cilia, tiny hair-like structures, to protect the lungs from pathogens. A respiration, or breath, delivers air to the lower respiratory tract. The contraction and the relaxation of the respiratory muscles move the air in and out of the lungs. Normal respiration is passive. We don't have to think about taking each breath. The adult lung contains approximately 300 million alveoli, or air sacs. Each one of these alveoli is linked to many capillaries, the smallest blood vessels. Oxygen crosses the alveolar-capillary membrane and enters the bloodstream through a process called diffusion. Then the circulating blood delivers the oxygen to the cells throughout the body for metabolism. While the blood is circulating, it also picks up metabolic waste and carbon dioxide (CO2) and transports them back to the lungs to be exhaled. When the CO2 reaches the alveolar capillaries, it diffuses across the alveolar-capillary membrane and into the alveoli. The CO2 is then removed from the alveoli during exhalation.   Cough Key Facts A cough is a symptom, not a disease. Most cough symptoms are caused by disorders in the lower respiratory system. Less commonly, a cough may be caused by other diseases in the head or stomach.  Etiology, Signs, and Symptoms A cough may be caused by allergies, respiratory infections, or chronic respiratory diseases. A cough may be productive, meaning the patient is able to expectorate (cough up) mucus, or it may be nonproductive, meaning the patient isn't able to expectorate mucus.   When diagnosing the cause of a cough, the physician will listen to the lungs. A chest x-ray may be ordered. There are numerous prescription and OTC products available to treat coughs, and most of them are taken in liquid form as syrups or elixirs (aqueous mixtures of water and alcohol). Many cough syrup preparations contain expectorants that increase and liquefy the mucus secretions in the respiratory tract, making it easier for the patient to cough up the mucus. Antitussives are commonly ordered for the dry, hacking, nonproductive cough that keeps the patient up at night. An antitussive helps to suppress the cough. Cough preparations may also contain antihistamines to dry up secretions, decongestants to reduce swelling in the nasal passages, and flavoring to improve the taste.   The most effective ingredient in the prescription products is codeine, which is an opioid derived from poppies. Hydrocodone, a synthetic derived from codeine, is also a popular choice. Hydrocodone and codeine are controlled drugs and can't be purchased without a prescription. Most of the popular anticough preparations that are commonly prescribed by family practice physicians contain one or more of the following ingredients: Expectorants, such as guaifenesin (Brand names include Robitussin and Mucinex.) Antitussives, such as codeine, hydrocodone (both prescription drugs), or dextromethorphan (OTC) (The brand name Cheracol contains codeine and guaifenesin.) Antihistamines, such as chlorpheniramine or brompheniramine  Decongestants, such as pseudoephedrine or phenylephrine   Asthma Asthma is a chronic lung disease that inflames and narrows the airways. Asthma affects people of all ages, but it most often starts in childhood. Key Facts 1. The inflammation caused by asthma makes the airways swollen and very sensitive. When the patient is exposed to a trigger like an allergen, a hypersensitivity to cold air, or strenuous exercise, asthma can be exacerbated. The airway will react and the muscles around the airway will tighten. This results in the airway being further narrowed, meaning less air can flow into the lungs. During the reaction, the swelling can also worsen, making the airway even narrower. 2. Sometimes during a reaction, the cells in the airway will make more mucus than usual, which can further impair and narrow the airway. This chain of events can lead to extremely impaired respiration, or even a complete inability to breathe. 3. The severity of asthma is described as Mild intermittent: symptoms occur fewer than two times per week Mild persistent: symptoms occur more than two times per week Moderate persistent: symptoms occur daily Severe persistent: symptoms occur continuously    Etiology, Signs, and Symptoms Triggers include the following: Allergens from dust, pet dander, and pollens Irritants like cigarette smoke and air pollution Medicines like aspirin, nonsteroidal anti-inflammatory drugs Signs and symptoms include the following: Wheezing (a whistling sound that may be heard on inspiration, expiration, or both) Feeling of tightness in the chest Shortness of breath Cough Inspiration means inhalation; expiration means exhalation.   Not all patients with asthma will have these symptoms, and not all people who have these symptoms have asthma. There are other conditions that can cause patients to experience these symptoms. The best way for a physician to diagnose asthma is to obtain a thorough medical history and order pulmonary function tests (PFTs). Eosinophils, a type of white blood cell, increase during flare-ups. Skin tests may identify allergens that exacerbate asthma.  Asthma is chronic disease with no known cure. The goal of treatment is to control it. The physician will work with the patient, especially with children, to develop an asthma action plan. This plan will list the steps for prevention of flare-ups as well as what to do when a flare-up occurs. Some patients may be candidates for allergy injections to help decrease their sensitivity to the trigger substance.   Short-term medications called rescue inhalers are used during acute attacks. These medications contain a bronchodilator to dilate (open) the tightened airways. Albuterol (Proventil or Ventolin) is the most commonly ordered rescue inhaler. This medication is to be used to treat acute symptoms only. Long-term treatment medications are used regularly to maintain and control symptoms. They may be administered via nebulizer, inhalers, tablets, or in liquid form.  Theophylline, available in tablet or liquid form, is used most often for long-term control of asthma. Montelukast (Singulair), an antileukotriene, comes in tablets. Cromolyn can be administered via nebulizer. Medications delivered by inhaler include  Flovent Pulmicort Symbicort Qvar Azmacort   Complications of asthma are very serious. Status asthmaticus, an acute, severe asthma attack that doesn't respond to the usual use of inhaled bronchodilators, is associated with symptoms of potential respiratory failure. It's considered a medical emergency. Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination. Acute respiratory failure is also a medical emergency.   Chronic Obstructive Pulmonary Disease Key Facts Chronic obstructive pulmonary disease (COPD) is a progressive disease that makes it hard to breathe. COPD also includes the diseases emphysema and chronic bronchitis. COPD is a general term for this group of diseases that limit the airflow in the respiratory system, producing symptoms that aren't fully reversible.  Etiology, Signs, and Symptoms Cigarette smoking is the leading cause of COPD. Long-term exposure to lung irritants like air pollution, chemical fumes, and a dusty environment may also contribute to the development of the disease. COPD is more prevalent in urban than rural environments and is also related to occupational factors. In COPD, less air flows through the airways because of several factors: The airways and alveoli have lost their elasticity. The walls between many of the air sacs have been destroyed. The walls of the airway are chronically inflamed and have thickened as the disease progressed. The airway makes more mucus than usual, which can clog up the airway. Signs and symptoms include the following: Coughing, which may be accompanied by expectoration of large amounts of mucus Wheezing Shortness of breath Tightness in the chest Pursed lip breathing Inability to lie flat in bed Tripod positioning   Treatment consists of monitoring the patient's respiratory status to detect baseline changes, to assess response to treatment, and to prevent and detect complications. The physician should monitor the arterial blood gases, pulmonary function tests, and oxygen saturation levels (SaO2) periodically. Patients with all types of COPD should receive the Pneumococcal vaccine.   The following are some of the common drugs that are prescribed for asthma and COPD: Anticholinergics Atrovent nasal spray (ipratropium) Spiriva (tiotropium) Corticosteroids Pulmicort (budesonide) Aerobid (flunisolide) Flovent (Fluticasone) Antileukotriene Tablets Singulair (montelukast) Accolate (zafirlukast) Beta-agonists Proventil and Ventolin (albuterol) Tornalate (bitolterol) Serevent (salmeterol) Foradil (formoterol)   Bronchodilators are also used to open the airway to allow better air intake. They're usually sprayed into the mouth from a small canister and inhaled. These bronchodilators act immediately and quickly relax the tightened muscles in the airway to allow better airflow. Some bronchodilators are taken as pills to produce longer-lasting effects.   Chronic Bronchitis Key Facts Chronic bronchitis is a form of COPD. Chronic bronchitis results in inflammation of the bronchi, and it can be caused by irritants or infection. In chronic bronchitis, there's a hypersecretion (excess production) of mucus and chronic productive cough that lasts at least three months of the year and occurs for at least two consecutive years. Children of parents who smoke are at higher risk for respiratory tract infection that can lead to chronic bronchitis.  Etiology, Signs, and Symptoms Chronic bronchitis may be caused by several factors: Exposure to irritants Cigarette smoking Genetic predisposition Organic or inorganic dusts Noxious gases Frequent respiratory infections Signs and symptoms include the following: Gray, white, or yellow sputum Dyspnea (shortness of breath) Cyanosis (bluish coloring in fingers and lips) Tachypnea (rapid breathing) Pedal edema (swelling of the lower portion of legs and feet) Wheezing, rattling sounds   Chronic bronchitis is diagnosed by the following tests: Chest x-ray will show hyperventilation. PFTs will have residual volume, with decreased vital capacity. Arterial blood gas (ABG) (a blood test that uses a sample drawn from an artery instead of a vein) shows decreased PaO2 and normal or increased PaCO2. PaO2 is partial pressure of oxygen in the blood, and PaCO2 is partial pressure of carbon dioxide. Chronic bronchitis can be treated, but not cured. Treatments include the following: Encourage smoking cessation Avoidance of air pollutants Use of bronchodilators listed for COPD Chest physiotherapy to help with drainage and expectoration of secretions Nebulizer treatments Patients with all types of COPD should receive the Pneumococcal vaccine. They should also be warned that exposures to blasts of cold air may bring on a bronchospasm. *Complications of chronic bronchitis can be very serious: Recurrent respiratory tract infections Pulmonary hypertension, or high blood pressure in the lungs Cor pulmonale, or pulmonary heart disease, is the enlargement and failure of the right ventricle of the heart as a response to increased vascular resistance in the lungs. Heart failure Acute respiratory failure   Emphysema Key Facts Emphysema is a form of COPD. Emphysema is an inflammatory response that results in abnormal tissue changes in the lungs, resulting in narrowing of the small airways and breakdown of lung tissue with destruction of alveolar walls. The alveoli lose their elasticity so the lungs can't recoil normally after expanding. This causes the bronchioles to collapse on expiration. The amount of air expired passively is diminished, trapping air in the lungs that can't be exhaled. Etiology, Signs, and Symptoms Emphysema is more prevalent in males and risk increases with age. The main causes include: Smoking Pollution Alpha-1 antitrypsin (AAT) deficiency (genetic) Signs and symptoms include Shortness of breath and chronic cough Anorexia and feeling of malaise Barrel chest (bulging ribcage) Breathing through pursed lips Decreased breath sounds   Diagnosis can be made by a variety of tests: Chest x-ray ABG PFT Treatment is essentially the same for all types of COPD-related diseases: Avoiding smoking and air pollution Bronchodilators, as previously listed for COPD Mucolytics, which help loosen the mucus to help patients expectorate it Corticosteroids Patients with all types of COPD should receive the Pneumococcal  vaccine. *Potential complications include the following: Cor pulmonale Respiratory failure Recurrent respiratory tract infections   Pneumonia  Key Facts Pneumonia is the most common infectious cause of death. Pneumonia occurs throughout the year and affects patients of all ages. The clinical manifestations are more frequently severe in the very young, elderly, and chronically ill. Etiology, Signs, and Symptoms For pneumonia to occur, there has to be an opportunity for microorganisms to invade the normally sterile lower respiratory tract. This can occur in three ways: 1. Inhaled as aerosolized particles 2. Spread from a site of infection outside of the lungs 3. Aspiration of foods or liquids   Pneumonia is classified based on the types of germs that caused the infection and where an individual acquired it. Community-acquired pneumonia is contracted through normal social contact outside of healthcare settings. It's the most common type. Bacteria, viruses, fungi, and parasites can cause community-acquired pneumonia. Bacterial community-acquired pneumonia can occur if a person encounters a bacterial strain that causes pneumonia, or as a secondary infection after a cold or influenza. This type of pneumonia is often called lobar pneumonia because it often affects one area, or lobe, of the lung. Pneumonia caused by some strains of bacteria may result in milder signs and symptoms. The term walking pneumonia is used to describe pneumonia that doesn't require bed rest. Viruses most commonly cause pneumonia in children younger than two years old. Pneumonia caused by viruses is usually mild, but certain viral strains can become very serious. Fungi, which can be found in soil and in bird droppings, most commonly cause pneumonia in people with an underlying health problem or weakened immune system. They may also cause pneumonia in people who have inhaled an especially large quantity of the organisms. Hospital-acquired pneumonia is usually a bacterial infection. People exhibit signs of this type of pneumonia about 48 hours or more after being hospitalized for a different condition. This type of pneumonia can be caused by antibiotic-resistant bacteria, so it can be more serious. Healthcare-associated pneumonia is also usually a bacterial infection. It affects people who live in long-term care facilities or who have been treated in outpatient clinics such as a dialysis center. Similar to hospital-acquired pneumonia, healthcare-associated pneumonia can be antibiotic-resistant. Aspiration pneumonia occurs when a person inhales food, drink, vomit, or saliva into his or her lungs. The item inhaled irritates the lungs and can cause the person to become sick. Whether aspiration pneumonia is caused by a true infection or an inflammatory process remains the subject of debate.   There are several factors that may predispose a patient to develop pneumonia: Decreased immune resistance Infection Alteration in cough reflex A mucosal injury  Pulmonary edema (fluid in the lungs) Obstructions Signs and symptoms include the following: Fever Chills Cough Rust-colored sputum Dyspnea  Pleuritic chest pain (a sudden, sharp stabbing, burning, or dull pain in the chest caused by inflammation of the membrane surrounding the lungs) Elevated white blood cell (WBC) count *Potential complications include the following: Acute respiratory distress syndrome (ARDS), which consists of flooding of the alveoli and lung collapse Pleural effusion (fluid around the lung) Lung abscesses  Respiratory failure (requiring ventilator) Sepsis (may lead to organ failure)   Diagnosis is made by obtaining the patient's medical history, reviewing the patient's signs and symptoms, and performing a chest x-ray (CXR). A CT scan may be ordered if a definitive diagnosis can't be made with a chest x-ray. Lobar pneumonia will show consolidation confined to the lobes of the lungs. Bronchopneumonia will show patchy consolidations, usually in the bases of both lungs. The goal of treatment is to eradicate the microorganism. If the pneumonia is caused by bacteria, an appropriate antibiotic needs to be selected. If it's caused by a viral infection, antivirals may be ordered along with supportive care. If the pneumonia is caused by a fungal infection, antifungals would be ordered. Supportive care for pneumonia includes the following: Humidified O2 Bronchodilators (albuterol) Chest physiotherapy with postural drainage Adequate hydration Expectorants Analgesic/antipyretic for pleuritic chest discomfort and fever   Key Points The upper respiratory system consists of the structures in the head and neck that are involved in breathing: the nose, sinuses, throat, and larynx. The common cold affects primarily the nose and throat; signs and symptoms include rhinorrhea, nasal congestion, sneezing, itchy or scratchy throat, watery eyes, and fatigue. Sinusitis or other secondary bacterial infections can occur as a complication of the common cold. The lower respiratory system consists of the structures in the chest that are involved in breathing: the trachea, bronchi, bronchioles, and lungs. Asthma is a chronic lung disease that inflames and narrows the airways; inflammation makes the airways swollen and very sensitive. Chronic obstructive pulmonary disease (COPD) is a progressive disease that makes it hard to breathe; it includes emphysema and chronic bronchitis. Pneumonia is the most common infectious cause of death and is classified based on the types of germs that caused the infection and where the infection was acquired.

Introduction The cardiovascular system is made up of the heart, arteries, veins, and the lymphatic system. It's the body's transport system. The body needs the cardiovascular system to bring oxygen and nutrients to cells, remove metabolic waste products, and carry hormones. This system is also called the circulatory system because the blood circulates through the arteries, veins, and capillaries. The endocrine system consists of organs and glands that secrete chemical messengers called hormones into the bloodstream. Hormones regulate metabolic activities and maintain internal homeostasis.   The Cardiovascular System The cardiovascular system begins to develop when the fetus is barely four weeks old and is the last body system to cease activity at death. This system helps define the presence of life. The heart has a big job to do all day, every day. The heart pumps blood to the lungs, where it picks up oxygen and eliminates the carbon dioxide that it picked up as it flowed through the body. This is called pulmonary circulation. The circulation of blood throughout the rest of the body is called systemic circulation. During systemic circulation, the blood carries oxygen and nutrients to active cells and transports waste away for excretion.   Acute Coronary Syndrome Acute coronary syndrome (ACS) is a general term for situations where the blood supplied to the heart muscle is suddenly blocked. Myocardial infarction (heart attack) and angina (chest pain and pressure) are part of the ACS group. Key Facts Usually, a rupture or erosion of plaque in an artery is the initiating event. This rupture results in platelet adhesions, fibrin clot formation, and activation of thrombin. The thrombus grows and eventually occludes blood flow. The degree of blockage, the time elapsed, and the blood vessel affected will determine the type of infarct (cell death) that occurs. Because not enough oxygen is able to reach that area of the heart, an imbalance of oxygen supply and demand occurs. Death commonly results when an ACS event isn't treated immediately. Etiology Several risk factors can lead to ACS: Family history Obesity Smoking Diet high in fat and carbohydrates Sedentary lifestyle   Angina Key Facts Angina pectoris, commonly known as angina, is the sensation of chest pain, pressure, or squeezing, often due to ischemia (restriction in blood supply) of the heart muscle due to obstruction or spasm of the coronary arteries. There are four major forms of angina: 1. Stable (chronic) angina is the most common form of angina. Symptoms arise with effort and subside with rest. 2. Unstable angina is either a new onset of angina or a change in the patient's usual pattern of chest discomfort. Angina at rest is also considered unstable angina. This is a warning sign of a heart attack. 3. Microvascular angina, or cardiac syndrome X, affects the heart's smallest blood vessels. Spams occur in the walls of the vessels and result in decreased blood flow to the heart. Chest pain with this type of angina can last longer than 30 minutes. 4. Variant angina is an extremely rare form of angina caused by spasms of a coronary artery that tend to come in cycles. It may occur with or without a diagnosis of heart disease. Etiology, Signs, and Symptoms Angina is caused by reduced blood flow to the heart muscle. The muscle cells need a steady supply of oxygen delivered by the blood to be able to perform the work needed to keep the heart pumping. When the muscle cells aren't getting the oxygen that they need, chest pain occurs. Ischemia means that cells aren't getting enough oxygen. Necrosis occurs when the lack of oxygen causes the cells to die. During angina, cell ischemia occurs, but not cell necrosis. Many patients experience angina with symptoms of burning, squeezing, and tightness in the chest. Angina often follows physical exertion, emotional excitement, exposure to cold, or a large meal.   The physician may order several different tests to help diagnose angina: Electrocardiogram (ECG or EKG) An electrocardiogram traces the heart's electrical signals with each heartbeat. Stress Test The patient exercises on a treadmill or pedals a stationary bike. During this exercise, the patient's blood pressure and an electrocardiogram are continuously monitored. Echocardiogram An echocardiogram uses sound waves to see the heart. Nuclear Stress Test A radioactive substance is injected into the bloodstream. A scanner detects the radioactive substance and creates images of the heart. If an area of the heart isn't getting enough oxygen, it will show up as a light spot on the images.   Treatments for angina are as follows: Nitrates relax and widen the blood vessels, allowing more blood and oxygen to reach the heart. Nitroglycerin SL is commonly used for immediate relief of angina symptoms. This form of nitroglycerin is placed under the tongue (sublingual) and allowed to dissolve. Aspirin reduces the ability of the blood to clot. Patients may be ordered to take 81 mg of aspirin daily as a preventive measure. Beta blockers block the effects of epinephrine, resulting in the heart beating more slowly and with less force, reducing the heart's workload. Beta blockers also help the blood vessels to relax and widen, which increases the blood flow to the heart. Ranexa (ranolazine) is an antiangina medication that may be prescribed with other angina medications. It reduces oxygen requirements for the heart muscle. Balloon angioplasty is an endovascular procedure used to open up and widen obstructed arteries. A deflated balloon catheter is inserted and passed to where the obstruction is located. Then the balloon is inflated to a specified size. This stretches the vessels. A stent may be placed during the procedure. The stent ensures that the vessel stays open.   Myocardial Infarction Key Facts A myocardial infarction occurs when the myocardial cells are deprived of oxygen due to a blockage in the artery that supplies the area of the heart. A myocardial infarction results from the death of myocardial cells. Myocardial cells don't regenerate, so the heart damage is permanent. There are different names given to myocardial infarctions, depending on the area of the heart that's involved: Inferior Anterior Septal Lateral Anterolateral Posterior Right ventricular Etiology, Signs, and Symptoms Many of the signs and symptoms are very similar to angina symptoms: Chest pain Burning, squeezing, and pressure in the chest Diaphoresis (excessive sweating) Jaw pain Indigestion or heartburn Back pain   Myocardial infarction is diagnosed by a physical exam, obtaining a 12-lead EKG, and blood test for the following: Troponin levels Creatine kinase levels Cardiac enzymes Myoglobin levels Emergency care focuses on assessing and recording the severity of the pain, location, type, and duration. Treatment attempts to save as much viable heart muscle as possible and to prevent further complications. Therapies include the following: Nitroglycerin Percutaneous transluminal coronary angioplasty (PTCA) IV beta-adrenergic blocker (followed by oral therapy) ACE inhibitors Stent placement Lipid-lowering drugs Trans-myocardial revascularization (laser surgery) Epinephrine Defibrillation Thrombolytic therapy, which should be initiated within three hours of the onset of the symptoms if the patient is a candidate Oxygen supplementation (with respiratory distress only) *Potential complications include the following: Heart failure Cardiogenic shock Heart arrhythmias  Pericarditis Multisystem organ failure Death   Congestive Heart Failure Congestive heart failure (CHF) is also known simply as "heart failure." This condition occurs when the heart muscle doesn't pump blood as well as it should. Treatments can improve the signs and symptoms of heart failure and increase the quality of life for the patient. Heart failure can be chronic or it can be an acute condition. Heart failure can involve the left ventricle, right ventricle, or both ventricles. The left ventricle is the heart's main pumping chamber and this side is usually affected first. The condition is termed "congestive heart failure" because the blood backs up into and congests the liver, abdomen, and lower extremities.    The main chambers of the heart don't fill properly between beats. When the heart becomes weakened, the ventricles stretch to the point that the heart can no longer keep up with the demands placed upon it. The heart isn't able to pump the blood to the rest of the body effectively. Coronary artery disease, high blood pressure, uncontrolled diabetes, or obesity can, over time, leave the heart too weak or stiff to pump efficiently. Patients who have leaky heart valves or myocarditis can also develop heart failure The ejection fraction is an important measurement of how well the heart is pumping. It's used to help classify the type of heart failure. In a healthy heart, the ejection fraction is 50 percent or higher. This means that more than half of the blood that fills the ventricle is pumped out with each beat. There are cases where a patient has hypertension and the heart becomes stiff over time, yet the ejection fraction remains in a normal range. The most common symptoms of left-sided heart failure is fluid accumulating in the patient's lungs, which causes shortness of breath. The most common symptom of right-sided heart failure is fluid accumulating in the patient's abdomen and lower extremities, causing swelling. There are other common signs and symptoms of heart failure: Sudden weight gain Ascites (fluid buildup in the space between the lining of the abdomen and abdominal organs) Difficulty concentrating or decreased alertness Dyspnea Fatigue and weakness Edema in the lower extremities Rapid or irregular heartbeat Wheezing or a persistent cough (often expectorating white mucus)   In addition to physical examination, there are several different tests and procedures that may be performed to diagnose CHF: B-type natriuretic peptide (BNP) blood test (BNP is a substance secreted from the ventricles in response to changes in pressure that occur with heart failure.) Chest x-ray Echocardiogram Stress test   Treatments for congestive heart failure include the following: ACE inhibitors, such as enalapril (Vasotec), lisinopril (Zestril), or captopril (Capoten) Angiotensin II receptor blockers, such as losartan (Cozaar) or valsartan (Diovan), are good alternatives for patients who can't tolerate an ACE inhibitor. Beta blockers, such as carvedilol (Coreg), metoprolol (Lopressor), and bisoprolol (Zebeta) Diuretics, such as furosemide (Lasix) Digoxin (Lanoxin), also called digitalis, works to increase the strength of the patient's heart muscle contractions and slow the heart rate. Supplemental oxygen as needed If other conditions are causing the heart failure, surgical intervention, such as heart valve replacement and coronary artery bypass surgery (CABG), may be appropriate. *Potential complications include debilitation, arrhythmia, and eventually death.   The Endocrine System The nervous system sends signals to the endocrine system, which secretes hormones in response. Hormones act on receptors in target tissues to deliver the chemical message and regulate tissue activity. This is called a feedback loop. Many endocrine organs are active all the time. The amount of hormone that they secrete varies depending on the time of day, activity level, or other factors. Homeostasis is the state of equilibrium in the body, including acid-base balance, temperature, and metabolism. Many of the body's chemical and physical characteristics have a set point, or standard level. For example, blood pressure, heart rate, temperature, blood oxygen, and blood sugar all have normal ranges for optimum health. The nervous and endocrine systems work to keep these levels at or near the ideal range. The negative feedback loop is a physiological process that works to bring a level back to its set point.   If any of the body's levels stray too far from the ideal range, the nervous system will send a signal to the endocrine system, which will work to bring the level back to the set point and restore homeostasis in the body. The body also has a positive feedback system, which increases a level away from a set point. During positive feedback, physiological processes send body chemistry or other attributes further and further away from the equilibrium (set point). The trend continues until something breaks the cycle. Sometimes positive feedback can be harmful, but sometimes the positive feedback is necessary for an important process to be completed. An example is childbirth. When it's time for the baby to be born, the hypothalamus releases the hormone oxytocin from the posterior pituitary. The oxytocin increases the intensity of uterine contractions. As the baby moves down into the birth canal, the signal to the hypothalamus is to release more oxytocin and the contractions become more frequent and intense. This cycle of increasing uterine contractions and increasing oxytocin continues right up until the baby is born.   One of the major endocrine glands is the pancreas. The pancreas is mainly responsible for maintaining correct blood glucose (sugar) levels. The pancreas makes two hormones that control blood glucose. Insulin promotes the absorption of glucose from the blood into the cells so it can be used for metabolism. It also directs the liver to store excess glucose as glycogen. Glucagon does the opposite of insulin. Glucagon puts glucose into the bloodstream by directing the liver to release the stored glucose. Insulin and glucagon act as a feedback loop that keeps blood glucose levels stable.    The thyroid gland is another part of the endocrine system. It's located in the anterior portion of the neck. This gland is responsible for secreting the hormones thyroxine (T4) and triiodothyronine (T3) when stimulated by the pituitary gland. T4 and T3 are essential for controlling cell metabolism and growth. Overproduction or underproduction of these hormones can cause a variety of clinical symptoms. The thyroid also secretes a third hormone called calcitonin. Calcitonin is responsible for stimulating bone-building cells, thereby decreasing the amount of calcium in the blood. There are two small pairs of glands in the posterior portion of the thyroid called the parathyroid glands. They produce parathyroid hormone (PTH), which regulates the levels of calcium in the bloodstream. If the calcium in the blood gets too low then the parathyroid stimulates the release of PTH.   Diabetes Diabetes mellitus is a disorder that occurs when the pancreas doesn't secrete enough (or any) insulin. Insulin is the hormone responsible for the proper utilization of blood sugar by cells in the body. Without insulin, the glucose in the blood doesn't get into cells, the blood glucose level rises, and eventually it spills over into the urine. Urinary detection of glucose is a positive diagnostic sign of diabetes. Diabetes mellitus is classified as either type 1 or type 2. Type 1 diabetes as formerly called insulin-dependent diabetes mellitus (IDDM), or juvenile diabetes, because the age of onset was predominantly before adulthood. Patients with type 1 diabetes require insulin injections to sustain life. Type 2 diabetes is usually diagnosed in adulthood.   Type 1 Diabetes Key facts Type 1 diabetes is usually diagnosed in children and young adults. Only 5 percent of people with diabetes have this form of the disease.  In type 1 diabetes, the body doesn't produce insulin. Etiology, Signs, and Symptoms The exact cause is unknown. In most cases, the patient's own immune system destroys the islet cells in the pancreas, which produce insulin. Genetics may be a factor. It's also thought that exposure to certain environmental factors, such as viruses, may be a trigger. Signs and symptoms include the following: Increased thirst Frequent urination Extreme hunger Bedwetting in children who previously didn't wet the bed during the night Fatigue and weakness Irritability and mood changes Vaginal yeast infections Unintended weight loss   As mentioned earlier, sugar in the urine is diagnostic for diabetes. Further diagnosis will be made using one or more of the following blood tests: Glycosylated hemoglobin (A1C) test indicates the average blood sugar for the past 2–3 months. A normal level is less than 5.7 percent. Random blood sugar test involves a blood sample taken at a random time without regard to when the last meal was consumed. Fasting blood sugar test involves a blood sample taken after fasting overnight. A fasting blood sugar of less than 100 mg/dl is normal. Oral glucose tolerance level involves multiple steps. The patient fasts overnight and the fasting blood sugar is measured. Then the patient drinks a sugary liquid and the blood sugar is measured periodically for the next two hours. Treatment revolves around maintaining a consistent level of blood sugar: Take insulin as prescribed Monitor blood sugar regularly Count carbohydrates at meals and adjust insulin according to carbohydrates consumed Eat a healthy diet and exercise regularly Potential complications, which are worse if blood sugars are uncontrolled, include the following: Heart and blood vessel disease Neuropathy (nerve damage) Nephropathy (kidney damage) Diabetic retinopathy (eye damage) Skin conditions such as slower wound healing Poor circulation in the lower extremities can result in foot ulcers, which may in some cases require amputation     Type 2 Diabetes Key Facts Type 2 diabetes was once known as adult onset or non-insulin dependent diabetes mellitus (NIDDM). Type 2 diabetes is a chronic condition that affects the way the body metabolizes glucose. The body may resist the effects of insulin or may not be producing enough insulin to meet its needs. Although type 2 is most common in adults, it's increasingly affecting children as childhood obesity increases. There's no cure for type 2 diabetes, but there are ways to treat and manage the condition well. Etiology, Signs, and Symptoms The exact cause isn't known. However, genetics, environmental factors, excess weight, and a sedentary lifestyle are associated with the development of the disease.  Symptoms can evolve slowly over a period of years: Increased thirst and frequent urination Increased hunger Weight loss Fatigue and irritability Frequent infections Blurred vision Slow-healing wounds Acanthosis nigricans (patches of darkened skin, most likely to occur in the axillary area and neck)   Diagnosis is made using the same tests as for type 1 diabetes: Glycosylated hemoglobin (A1C) test Random blood sugar test Fasting blood sugar Oral glucose tolerance level Treatment is different from type 1 diabetes because of the difference in cause. Lifestyle changes including healthy eating, regular exercise, and maintaining a healthy weight are very important. Blood sugar monitoring is also important. Insulin may be prescribed, but not always. Oral hypoglycemics are often used to treat this form of diabetes to stimulate the pancreas to secrete insulin. Some commonly prescribed oral hypoglycemics include the following: Januvia Micronase Glucotrol Glucophage Glynase Precose Amaryl Actose   Gestational Diabetes Key Facts Gestational diabetes is a condition that develops during pregnancy and usually resolves after pregnancy. Like the other types of diabetes, gestational diabetes affects how the body's cells use glucose. Etiology, Signs, and Symptoms Women older than 25 are more likely to develop the condition, as are those who have a family history or personal history of diabetes or are overweight. For most pregnant women, gestational diabetes doesn't cause any noticeable signs or symptoms.   Diagnosis requires different tests than those used for the other forms of diabetes: Glucose challenge test—The patient drinks a sugary liquid, and one hour later the blood sugar is evaluated. A blood sugar of less than 130–140 mg/dl is usually normal. Follow-up glucose tolerance testing—The patient fasts overnight, then drinks a concentrated high-glucose liquid. The patient's blood sugar is checked every hour for three hours. If two out of the three readings are elevated, the patient is diagnosed with gestational diabetes. Treatment hinges on monitoring blood sugar levels regularly and doing the following: Healthy diet Exercise Possible insulin therapy during pregnancy Close monitoring of the growth and development of the fetus   Hypoglycemia Key Facts Hypoglycemia is a condition caused by abnormally low blood sugar. Hypoglycemia isn't a disease by itself, but rather an indicator of an underlying health problem. Hypoglycemia is usually indicated by blood sugar lower than 70 mg/dl or when the patient feels symptomatic.  Etiology, Signs, and Symptoms Hypoglycemia is the most common side effect of hypoglycemic medications used for the treatment of diabetes. Signs and symptoms include the following: Heart palpitations Fatigue Pale skin Shakiness Anxiety Sweating Hunger Irritability  As hypoglycemia progresses, symptoms worsen: Confusion and abnormal behavior Patient may slur words and appear intoxicated Visual disturbances, blurred vision Seizures and loss of consciousness   Diagnosis is made by the presence of symptoms and will be confirmed by documenting the blood sugar levels. Disappearance of the symptoms when the patient is treated for the condition is also diagnostic. Treatment involves immediate glucose/carbohydrate intake to raise the blood sugar level. If the patient isn't alert enough to eat or drink, intramuscular or intravenous glucagon needs to be administered. Longer-term treatment requires treating the underlying condition that is causing the hypoglycemia.   Hyperglycemia Key Facts Hyperglycemia is a condition caused by abnormally elevated blood sugar. Hyperglycemia isn't a disease by itself, but rather an indicator of an underlying health problem. Hyperglycemia is usually indicated by blood sugar greater than 200 mg/dl or when the patient feels symptomatic. Etiology, Signs, and Symptoms Hyperglycemia is usually seen in diabetic patients who haven't yet been diagnosed or in known diabetic patients who are currently uncontrolled. The signs and symptoms of hyperglycemia are essentially the same as for diabetes: Frequent urination Increased thirst Blurred vision Fatigue Headache   Treatment for hyperglycemia and ketoacidosis focuses on bringing down the blood sugars and getting them back into a normal range. Ketoacidosis occurs when the high blood sugars remain untreated and continue to rise. Ketones begin to build up in the patient's blood and urine to toxic levels. Signs and symptoms of ketoacidosis are as follows: Breath smells fruity Nausea and vomiting Shortness of breath Dry mouth Weakness Confusion Abdominal pain Coma   Hypothyroidism Key Facts Hypothyroidism is a condition in which thyroid hormone production by the thyroid gland is diminished. Hypothyroidism most often affects the middle-aged population and is more predominant in older women. However, anyone can develop the condition, including infants and children. Etiology, Signs, and Symptoms Many causes can be attributed to the development of hypothyroidism: Congenital (present from birth) Autoimmune disorder Previous treatment for hyperthyroidism Total or partial removal of the thyroid gland through surgery can leave a patient with hypothyroidism. Previous radiation therapy Certain medications, such as lithium Pituitary disorders that diminish the production of TSH Hypothyroidism can develop during pregnancy or in the postpartum period. Generally, the condition develops slowly over a period of time. Signs and symptoms will vary but may include: Fatigue Dry skin Constipation Puffy face Hoarseness Muscle weakness High cholesterol Unexplained weight gain Increased sensitivity to the cold Muscle aches, tenderness, and stiffness Pain, stiffness, or swelling of joints   A blood test for TSH level is used to diagnose hypothyroidism. Treatment is lifelong replacement with levothyroxine (Levothroid or Synthroid). The oral medication is taken every morning on an empty stomach. Myxedema, a swelling of the connective tissues, is a rare complication but can be life-threatening.   Hyperthyroidism Key Facts Hyperthyroidism is caused by an overactive thyroid. The thyroid gland produces too much thyroxine. This results in an overall increased metabolism. Etiology, Signs, and Symptoms There are several conditions that can cause the thyroid to become overactive: Graves' disease is an autoimmune disease that may have a genetic predisposition. It's more common in women. Toxic adenoma Plummer's disease is characterized by goiter, an enlarged thyroid. Thyroiditis (inflammation of the thyroid) Hyperthyroidism can mimic other health problems and can be challenging to diagnose. Older adults are likely to have more subtle signs, like increased heart rate, heat intolerance, and fatigue. Other symptoms include the following: Sudden weight loss Increased appetite Tachycardia Anxiety, irritability, feeling nervous Tremor Sweating Menstrual pattern changes Increased sensitivity to heat Changes in bowel movement pattern, especially increased frequency Fatigue and muscle weakness Difficulty sleeping Thinning of the skin Fine, brittle hair Goiter   Diagnosis is usually made by obtaining a medical history and reviewing the patient's symptoms, doing a physical exam, and testing the TSH level. Treatments include the following: Radioactive iodine Anti-thyroid medication—propylthiouracil and methimazole Thyroidectomy  Potential complications include the following: Graves' ophthalmopathy is an autoimmune inflammatory disorder that affects the eye. The eye will protrude beyond the normal protective orbits, often quite noticeably. Patients may complain of dry, red, swollen eyes. Brittle bones result from untreated hyperthyroidism. Thyrotoxic crisis, or thyroid storm, is a sudden increase and intensification of symptoms, including high fever, rapid heartbeat, and vomiting. This condition requires immediate medical care.   Key Points Acute coronary syndrome (ACS) is a general term for situations in which the blood supplied to the heart muscle is suddenly blocked. Myocardial infarction (heart attack) and angina (chest pain and pressure) are part of the ACS group. Congestive heart failure (CHF) is also known simply as "heart failure." CHF occurs when the heart muscle doesn't pump blood as well as it should. The most common symptom of left-sided heart failure is fluid accumulating in the lungs, causing shortness of breath. The most common symptom of right-sided heart failure is fluid accumulating in the abdomen and lower extremities, causing swelling. Diabetes mellitus is a disorder that occurs when the pancreas doesn't secrete enough insulin, the hormone responsible for proper utilization of blood sugar by cells. Patients with type 1 diabetes require insulin injections to sustain life; this is usually diagnosed in children or young adults. Type 2 diabetes is a chronic condition that affects the way the body metabolizes glucose, either by resisting the effects of insulin or not producing enough insulin. Gestational diabetes occurs during pregnancy and usually resolves after pregnancy. Hypoglycemia is abnormally low blood sugar; hyperglycemia is abnormally high blood sugar. Both aren't diseases themselves, but an indicator of an underlying health problem. Hypothyroidism is when thyroid hormone production by the thyroid gland is diminished; it can cause fatigue, increased sensitivity to the cold, dry skin, constipation, and many other symptoms. Hyperthyroidism is caused by an overactive thyroid producing too much thyroxine, increasing metabolism. Hyperthyroidism can be caused by Graves' disease, toxic adenoma, Plummer's disease, and thyroiditis (inflammation of the thyroid).