Clinical Pharmacology

Introduction
by
Dr. Fadhil s. Alnasrallah :
Lecture :1
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Objectives

Define pharmacology, clinical pharmacology , Pharmacy ,●

therapeutics, Pharmacogentics , and drug toxicology
Describe drug classification systems , and the routes of drug ●
:administration (ROA )
●Differentiate among the following drug names: generic name,
official name, trade name, and chemical name
● Identify the sources of drugs , Drugs formulations ,
Pharmacogentics , Pharmacopoeia
● Differentiate among the Posology : The pharmacological study
of drug dosage , and the dosage quantity and prescription , as
loading dose and maintenance dose, toxic dose and lethal dose
● Differentiate and knowing the Principle of Drug Therapy, which
include Pharmacokinetics , and Pharmacodynamics
Definitions
Pharmacology: The word pharmacology is derived from the
Greek pharmacon meaning drug or poison and logos: science word
or discourse.
● It is the study of interaction of drugs with living organisms.
-It covers the use of drugs in the prevention (prophylaxis) and
treatment of diseases.
-It also includes history, source, physicochemical properties, dosage
forms, methods of administration, absorption, distribution,
mechanism of action, biotransformation, excretion, clinical uses and
adverse effects of drugs.
Clinical Pharmacology:
It is the science that studies the characteristics , effects , properties ,
reactions and uses of drugs – especially their therapeutic effect in
human – including toxicology , safety pharmacodynamics and
pharmacokinetics.
● It evaluate the pharmacological action of drug , preferred route of
administration and safe dosage range in human by clinical trails.
● It evaluate the pharmacological action of drug , preferred route of
administration and safe dosage range in human by clinical trails.
● It studies the actions of medication on the organism of a sick
patient , with knowing the prevention and timely removal of
adverse reactions and undesirable consequences of cooperation of
medications .
Pharmacotherapeutics
Pharmacotherapy :
Drug therapy
It deals with the proper selection and use of drugs for the prevention
and treatment of disease.
Drugs:
Drugs are chemicals that alter functions of living organisms , and are
generally given for the diagnosis, prevention, control or cure of the
disease.
Drug-Derived from Drogue (French word)= A Dry Herb
Pharmacy: It is the science of identification, selection,
preservation, standardization , compounding and dispensing of
medical substances.
Toxicology: It is the science of poisons. It is the area of
pharmacology concerned with the undesirable effects of chemicals
and biological on cellular functions.
Poisons : Are substances that cause harmful, dangerous or fatal
symptoms in living substances.
-Many drugs in larger doses may act as poisons .
Toxins (venom)originated within living cells or organisms , sting.
Pharmacognosy:
Origin and sources of drugs :
1. Minerals: Liquid paraffin, magnesium sulfate, magnesium
trisilicate, kaolin, etc.
2. Animals: Insulin, thyroid extract, and antitoxin sera, etc.
3. Plants: Morphine, digoxin, atropine, castor oil, etc.
4. Synthetic source: Aspirin, sulphonamides, paracetamol,
zidovudine, etc.
5. Micro organisms: Penicillin, streptomycin and many other
antibiotics.
6. Genetic engineering: Human insulin, human growth hormone etc.
Drugs formulations:
1- Injections ( Ampoules, vials); 2. Liquid ( syrup, suspension N);
3. Tablets, capsule; 4. Suppositories, pessaries;
5. Sprays and inhalants; 6. Ointments and creams;
7. Trans dermal patches; 8. Drug implants;
9. Micro and nanoparticles; 10. Targeted drug delivery
Naming of Drugs
(Drug nomenclature) :
They are of three types:
1) Chemical name
2) Generic/Non-proprietary / Approved/ Official
3) Trade /proprietary /Commercial / Brand name
Examples:
Aspirin
Acetylsalicylic acid (Chemical n.)●
●Aspirin (Generic n )
● (Trade n).: Eras , Dospine (India)., Bayer’s aspirin(USA)..Ecospirin--
Aspegic …
: Paracetamol
,Chemical n: N-acetyl- Para - aminophenol (APAP) ●
Acetaminophen
Generic n: Paracetamol ●
, Brand names :Panadol , Adol, Panamax ●
Tylenol ,Acetalgin ,calpol
: BNZs: Benzodiazepine agent as ●
1,4Benzodiazepine analog (Chemical n)
Alprazolam (Generic n)=Alprazolam , USP(Official n)●
●Alprax (Brand n)..
:Diclofenac
● Chemical n :[2-(2,6-dichloroanilino)phenyl]acetic acid
● Generic n: Diclofenac sodium.
● Brand n : Cataflam, Voltaren-XR, Dyloject, Cambia, Zorvolex .
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:Pharmacogentics
It is the branch of pharmacology , that deals with the altered drug
, response shown due to variation in the Genetics
- Now known as pharmacogenomics .

SO: While prescribing a drug dosage and frequency of

administration , genetic differences MUST be considered by the
physician .
Pharmacopoeia
●An official code containing a selected list of the established drugs
and medical preparations with descriptions of their source, chemical
nature, physical properties and tests for their identity, purity and
potency, route of administration, dynamic effects and kinetic
parameters.
●It also included:
Indications (under what circumstances is the drug used).
Drug action (what clinical effect does the drug have.
Adverse effects (are there clinically relevant side effects of the drug).
Contraindications (are there circumstances in which the drug should
not be administered to certain patient populations e.g: the elderly,
those with renal insufficiency, pregnant women etc).
British Pharmacopoeia (B.P),
United States Pharmacopoeia (USP)…etc
Methods of drug classification:
1) Chemical nature : organic as alkaloids , glycosides , proteins
(insulin , oxytocin), and esters , amides , alcohol, glycerides .. /or
inorganic as metal and their salts (ferrous sulphate , zinc sulphate ,
Mg sul…
2) The source : natural ( morphine , Atropine) , synthetic
(sulphonamides , procaine), semisynthetic (Amoxicillin , Ampicillin
Doxycycline) , Bio-synthetic(erythropoietin , bovine somatotropine)
3)Target organ :that acting on CNS , CVS , RS GIT , US
Mode of action : inhibitors of bacterial cell wall synthesis as )4
Penicillins , Calcium channel blockers inhibitors of protein synthesis
5) Therapeutic uses/ site of action , as antimicrobials , ant diabetics
antihypertensive …
6) Physiological system , as sympathomimetic ,
parasympathomemitics, .
7) Physical effects , as Emollients lanolin , Vaseline), Caustic
(silver nitrate ), Demulcents (zinc oxide , tannic acid ).
Drugs administration:
Routes of drug administration (ROA ):
Definition : Is the path by which a drug , fluid , poison or other
substance is brought into contact with the body.
▪ No single method of drug administration is ideal for all drugs
in all circumstances
A. Oral:
Oral route is the most common route of drug administration.
It is mostly used for the neutral drugs. It may be in the form of tablets,
capsules, syrup, emulsions or powders.
Advantages:
It is convenient, It is the cheapest available route,
It is easy to use , and It is safe.
Disadvantages:
-Not suitable for all drugs, Some drugs are destroyed by gastric
juices. eg: insulin., Absorption is slow, so is not preferred during
emergency., May cause gastric irritation, May objectionable in taste.,
- May cause discoloration of teeth e.g. tetracyclines below 14 cause
brown discoloration so are not advisable during pregnancy.,
-First pass effect : hepatic metabolism of drug when absorbed and
delivered through portal blood.
-Greater the first pass effect, less amounts of the drug reach the
systemic circulation.
B. Parenteral Routes
1-Intravenous injections:
Intravenous injections might be applied to the cubital, basilic and
cephalic veins.
Advantages:
Immediate action takes place , This route is preferred in emergency
situations, This route is preferred for unconscious patients., Titration
of dose is possible., Large volume of fluids might be injected by this
route, Diluted irritant might be injected. , Absorption is not required.,
No first pass effect takes place., Blood plasma or fluids might be
injected.
Disadvantages:
There is no retreat. , This method is more risky. , suitable for insoluble
pr. Sepsis-Infection might occur. , Phlebitis (Inflammation of the blood
vessel) might occur., Infiltration of surrounding tissues might result.,
-This method is not suitable for oily preparations.
2-Intramuscular injection:
Drugs may be injected into the arm (deltoid), thigh (vastus lateralis)
or buttocks (gluteus maximus). The volume used is 3 ml.
Advantages:
Absorption is rapid than subcutaneous route., Oily preparations can be
used. ,Slow releasing drugs can be given by this route.
Disadvantages
Some time painful, Not suitable for irritant drugs., Using this route
might cause nerve or vein damage.
3. Subcutaneous injection:
Some drugs, notably insulin, are routinely administered SC.
Drug absorption is generally slower SC than IM, due to poorer
vascularity.
- Absorption can be facilitated by heat, massage or vasodilators.
It can be slowed by co-administration of vasoconstrictors, a practice
commonly used to prolong the local action of local anesthetics.
As above, arm > thigh.
4- Intraperitoneal injection:
Is the injection of a substance into the peritoneum (body cavity).
In general , it is rarely used in human (fearing from peritonitis), it is
preferred when large amounts of replacement fluids are needed, or
when low blood pressure or other problems prevent the use of a
suitable blood vessel for intravenous injection.
5- Intradermal injection:
Is injection of drug in the dermis, it is one of the routes used for
administration of vaccins and for the test of allergy.
C. Topical application to the skin and mucus membranes:
a. Eye For desired local effects.
b. Intravaginal for infections or contraceptives.
c. Intranasal for alleviation of local symptoms.
d. Respiratory mucus membrane: inhalers
e. Skin Topical drug administration for skin disorders minimizes
systemic exposure. However, systemic absorption does occur and
varies with the area, site, drug, and state of the skin.
f- Sublingual (buccal) : Certain drugs are best given beneath the
tongue or retained in the cheek pouch and are absorbed from these
regions into the local circulation. These vascular areas are ideal for
lipid-soluble drugs that would be metabolized in the gut or liver, since
the blood vessels in the mouth bypass the liver (do not undergo first
pass liver metabolism), and drain directly into the systemic
circulation. This route is usually reserved for nitrates and certain
hormones.
g. Rectal: The administration of suppositories is usually reserved for
situations in which oral administration is difficult. This route is more
frequently used in small children. The rectum is devoid of villi, thus
absorption is often slow.
h. Inhalation Volatile anesthetics, as well as many drugs which affect
pulmonary function, are administered as aerosols. Other obvious
examples include nicotine and tetrahydrocannabinol (THC), which are
absorbed following inhalation of tobacco or marijuana smoke.
-The large alveolar area and blood supply lead to rapid absorption
into the blood. -Drugs administered via this route are not subject to
first-pass liver metabolism.
D- Administration of drugs by special routes:
-Intrathecal and epidural injection:
Drugs are given via lumbar puncture and injection into the
subarachnoid space such as using life-threatening, antibiotics,
antifungals and anticancer and also in spinal anesthesia to by bass
blood-brain barrier
-Intra-arterial injection:
Used in certain special situations, notably with anticancer drugs, in
an effort to deliver a high concentration of drug to a particular tissue.
-Typically, the injected artery leads directly to the target organ.
-Intra-articular:
Injected directly into a joint e.g. hydrocortisone
Posology :
The pharmacological study of drug dosage – the study of dosage
quantity and prescription.
Usual Recommended dose : the amount of drug that will ordinarily
produce the effect for what is intended .
Minimum dose : the smallest dose of drug that produces therapeutic
effect
Maximum dose : the largest dose that can safely administered ex:
acetaminophen 10 or 15 mg/kg dose .
Toxic dose : Amount of drug that cause harmful effect
Lethal dose : Amount of substance that will cause death
Single dose : Amount of drug to be taken at one time
Daily dose : Amount to be taken in 24 h period
Maintenance dose : Amount to be taken to maintain the therapeutic
effective dose .
Loading dose : First dose given to achieve maintenance drug level
quickly .
Principle of Drug Therapy
Pharmacokinetics:
Word derived from pharmacon means ‘’the drug’’ and kinetics mean
‘’movement’’ . Is defined as the quantitative study of drug movement
in , through , and out of the body . Is defined as
What the body does to the drug ?
Study of the absorption, distribution , metabolism and excretion ,
they are all named pharmacokinetic processes (ADME).
Pharmacodynamics:
Word derived from pharmacon means ‘’the drug’’ and dynamics
which is mean ‘’ power ’’. Is defined as
What the drug does to the body ?
The study of the biological and therapeutic effects of drugs .This
refers to the study of interaction of drug and sites of drug action that
responsible for the biological response/or effect of drug in the body
THE END
THANK YOU
References
: Lippincott IIIustrated Reviews_ Pharmacology .Sixth Edition -1
. Karen Whalen
. D R Laurence ,Clinical pharmacology-2
Davidson's Essentials of Medicine ,2nd Edition .J. Alastair Innes -3
Harrison's principles of internal medicine , 19th Edition, Pushpa-4
Man Shrestha Ayurved Campus TU, Kirtipur Nepal
. Basic &Clinical Pharmacology ,13 Edition . Bertram G . Katzung -5
. Anthony J . Trevor
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