CLINICAL PHARMACOLOGY

Pharmacology is the study of drugs (chemicals)

that alter functions of living organisms.

CLINICAL PHARMACOLOGY is the use of

drugs to prevent, diagnose, or treat signs, symptoms, and disease processes. When prevention or cure is not a reasonable goal, relief of symptoms can greatly improve quality of life and ability to function in activities of daily living.

PHARMACOKINETICS
Pharmacokinetics involves drug

movement through the body (ie, what the body does to the drug) to reach sites of action,metabolism, and excretion. Specific processes are absorption, distribution, metabolism (biotransformation), and excretion.

PHARMACODYNAMICS
Pharmacodynamics involves drug

actions on target cells and the resulting alterations in cellular biochemical reactions and functions (ie, what the drug does to the body).

ENTRY AND MOVEMENT OF DRUG MOLECULES

ABSORPTION
ABSORPTION is the process that occurs from the

time a drug enters the body to the time it enters the bloodstream to be circulated. Onset of drug action is largely determined by the rate of absorption; intensity is determined by the extent of absorption. Numerous factors affect the rate and extent of drug absorption, including -dosage form, -route of administration, -blood flow to the site of administration, -GI function, -the presence of food or other drugs, and other variables.

CONT....
Dosage form is a major determinant of a drugs bioavaibility. An intravenous drug is 100% bioavailable; an oral drug is always less than 100% bioavailable because some is not

absorbed from the GI tract and some goes to the liver and is partially metabolized before reaching the systemic circulation.

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Most oral drugs must be swallowed, dissolved in gastric

fluid, and delivered to the small intestine which takes longer time.
Liquid medications are absorbed faster than tablets or capsules. Drugs injected into subcutaneous (SC) or intramuscular

IM) tissues are usually absorbed more rapidly than oral drugs because they move directly from the injection site to the bloodstream. Absorption is rapid from IM sites because muscle tissue has an abundant blood supply. Drugs injected intravenously (IV) do not need to be absorbed because they are placed directly into the bloodstream.

DISTRIBUTION
Once a drug enters into systemic circulation by absorption

or direct administration, it must be distributed into interstitial and intracellular fluids. Factors that affect distribution Physical volume of an organism:The greater plasma concentration the lower is the volume of distribution Plasma protien binding:clinical conditions that modify the levels of plasma proteins may have an impact on the effect and toxicity of a drug that has a binding rate with plasma proteins Lipophilicity of drug: lipophilic drugs accumulate in adipose tissue

METABOLISM

EXCRETION
Renal excretion:Only the free fraction

of a drug that is dissolved in the blood plasma can be removed through the kidney. Bile excretion:It is excreted from feces Pulmonary excretion:expired in the air

TESTING AND CLINICAL TRAILS

The testing process begins with animal studies to

determine potential uses and effects. The next step involves FDA review of the data obtained in the animal studies. The drug then undergoes clinical trials in humans. Most clinical trials use a randomized, controlled experimental design that involves selection of subjects, random assignment of subjects to experimental groups, and administration of the test drug to one group and a control substance to another group.

DRUG ACTION ALSO DEPENDS ON

Age
Body Weight Genetic and Ethnic Characteristics Gender (Except during pregnancy and lactation, gender

has been considered a minor influence on drug action). Pathologic Conditions Psychological Considerations

ADVERSE EFFECTS OF DRUGS

he term adverse effects refers to any undesired responses to

drug administration, as opposed to therapeutic effects, which are desired responses.

CNS effects may result from CNS stimulation (eg,

agitation,confusion, delirium, disorientation, hallucinations,psychosis ) or CNS depression (dizziness, drowsiness, impaired level of consciousness,sedation, coma, impaired respiration and circulation). Gastrointestinal effects (anorexia, nausea, vomiting, constipation, diarrhea) Hematologic effects (blood coagulation disorders, bleeding disorders, bone marrow depression, anemias, leukopenia, thrombocytopenia)

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Hepatotoxicity (hepatitis, liver dysfunction or failure,

biliary tract inflammation or obstruction) Nephrotoxicity (nephritis, renal insufficiency or failure) Hypersensitivity or allergy Drug fever Drug dependence Carcinogenicity is the ability of a substance to cause cancer. Teratogenicity is the ability of a substance to cause abnormal fetal development when taken by pregnant women.