prescribers of drugs

Study Unit

Prescribers of DrugsBy

Richard L. Wynn, Ph.D., R.Ph.

Reviewed By

Gary Mead, R.Ph., M.H.A.

About the Author

Richard L. Wynn is Professor of Pharmacology at the University ofMaryland College of Dentistry in Baltimore. He holds a bachelor’s degreein pharmacy, a master’s degree in physiology, and a doctorate degreein pharmacology from the University of Maryland at Baltimore. He is aregistered pharmacist in Maryland. Dr. Wynn chaired the Departmentof Pharmacology at the University of Maryland Dental School from 1980to 1985. Previously, he chaired the Department of Oral Biology at theUniversity of Kentucky College of Dentistry in Lexington from 1976 to1980. His pharmacy experience includes a previous faculty appointmentat the University of Maryland School of Pharmacy and over 10 years ofexperience as a pharmacist in hospital, community, and retail chain phar-macies. He was the recipient of the Rexall Drug Award as the top studentin his graduating class and is a member of the Rho Chi National HonoraryPharmacy Society. He’s a member of the American Association for theAdvancement of Science, the Society for Neuroscience, the AmericanSociety for Pharmacology and Experimental Therapeutics, and theInternational Association for Dental Research.

Dr. Wynn has published over 160 research papers as well as textbooks andmonographs on the discovery of new drugs and new drug reviews. Hisresearch laboratories have contributed to the development of new types ofanalgesics and anesthetics. He’s currently funded by the drug industry andgovernment agencies for the development of new drugs and has been aconsultant to the drug industry for over 20 years. He’s a consultant to theU.S. Pharmacopeia (Dental Drugs and Products Section) and the Academyof General Dentistry.

Dr. Wynn’s primary interest is in teaching pharmacology and pharmacy tostudents in professional schools, community colleges, and distance educa-tion programs. He has presented more than 300 continuing-educationcourses on the practical aspects of drug therapeutics throughout theUnited States, Canada, and Europe.

This study unit was reviewed by Gary Mead, R.Ph., M.H.A.

All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text should not beregarded as affecting the validity of any trademark or service mark.

Copyright © 2008 by Penn Foster, Inc.

All rights reserved. No part of the material protected by this copyright may bereproduced or utilized in any form or by any means, electronic or mechanical,including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton,Pennsylvania 18515.

Printed in the United States of America

02/07/14

iii

Previe

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wThis study unit describes healthcare professionals whoare licensed to prescribe medications for the treatmentof disease and illness. The most frequent prescriber is thephysician, who may be either a general practitioner or aspecialist. In this unit, you’ll review the common conditionsthat each type of physician treats, and learn about the med-ications that are prescribed for those conditions.

Next, you’ll learn about other healthcare providers who arelicensed to prescribe drugs. These professionals include den-tists, podiatrists, nurse practitioners, physician assistants,and veterinarians. (Veterinarians are also discussed in detailin a separate study unit.) Healthcare professionals who aren’tlicensed to prescribe medications are also described.

This study unit isn’t intended to be a complete list of allconditions treated by physicians and all the medications theyprescribe. However, when you complete this study unit, youshould be familiar with many of the common medicationsyou’ll be dispensing as a pharmacy technician, some of whichare the most widely used drugs in the world today.

When you complete this study unit, you’ll beable to

• Define the medical specialties presented in this unit

• Identify the conditions that each medical specialisttreats, and some of the drugs prescribed for them

• Identify healthcare providers other than physicians whoare licensed to prescribe drugs

• Identify the types of drugs that each of these licensedhealthcare providers prescribes and the condition forwhich each type of drug is prescribed

• Name five prominent healthcare professionals whoaren’t licensed to write prescriptions

Remember to regularly check “My Courses” on your student homepage.Your instructor may post additional resources that you can access toenhance your learning experience.

PHYSICIANS AS DRUG PRESCRIBERS 1

Family Practice Physicians 1Allergists 12Dermatologists 13Rheumatologists 15Ophthalmologists 16Endocrinologists 21Obstetricians and Gynecologists 23Gastroenterologists 25Urologists 28Orthopedic Physicians 31General Surgeons 32Geriatricians 34Hospitalists 36Neurologists 38Psychiatrists 40Pediatricians 47Cardiologists 48

OTHER HEALTHCARE PRACTITIONERS AS PRESCRIBERS 56

Dental Prescribers 56Orthodontists and Prosthodontists 56Periodontists 57Endodontists 58Oral and Maxillofacial Surgeons 58Pediatric Dentists 58General Practice Dentists 59Oral Medicine/Oral Pathology Specialists 59Podiatrists 60Nurse Practitioners 61Practitioners of Alternative Medicine 62Veterinarians 65

HEALTHCARE PROFESSIONALS WITH PRESCRIPTION-WRITING RESTRICTIONS 67

Chiropractors 67Physician Assistants (PAs) 67Nurses 67Pharmacists 68

v

Contents

Contents

Contentsvi

Pharmacy Technicians 68Dental Hygienists 68Dental Assistants 68

SELF-CHECK ANSWERS 71

1

PHYSICIANS AS DRUG PRESCRIBERS

Family Practice Physicians

Family practice physicians or general practitioners are thetraditional “family doctors” who treat patients of all ages for awide array of medical problems. Family practice physiciansare often the first healthcare professionals that patients turnto for treatment, advice, and referrals to specialists.

Some of the typical ailments treated by the family practicephysician are nasal congestion, coughs, and the commoncold. These are very common illnesses in the general popula-tion and are responsible for many days lost from work andschool. Family practice physicians also treat respiratorydisorders, which include asthma and chronic obstructivepulmonary disease. In both of these conditions, the airwayhas closed down or has become constricted, thus preventingadequate air intake. The family physician also prescribesmedications to treat and eradicate infectious diseases.

The Upper Respiratory System: Nasal Congestion

In the body, the upper respiratory system includes the struc-tures in the head and neck that are involved in breathing.These structures are the nose, sinuses (nasal cavities),throat, and larynx (voice box). The family practice physicianwrites many prescriptions for medications to treat nasal

Prescribers of Drugs

Prescribers of Drugs2

congestion. Nasal congestion results in a feeling of stuffinessand blockage of the breathing mechanism through the nose.Initial symptoms are sneezing, stuffiness, runny nose, andpostnasal congestion and drip. These symptoms may evolveinto chronic nasal or sinus infections. Nasal decongestantsprovide temporary relief by getting rid of the excess fluid inthe nose that’s causing the congestion. These medicationsconstrict the arterioles in the nose, thereby reducing bloodflow in the engorged area. Since the nasal tissue may beinflamed, corticosteroids are used as anti-inflammatoriesto manage the stuffiness. Corticosteroids exert a markedanti-inflammatory effect on the nasal mucosa when appliedtopically, that is, when applied directly to the particular area that requires treatment. They’re used alone or with nasaldecongestants. Nasal decongestants and corticosteroids aredispensed as nasal sprays (Figure 1). The following are someof the most common medications that the family physicianwill prescribe for the management of nasal congestion:

• Afrin, a nasal decongestant spray

• Sudafed, or pseudophedrine tablets

• Beconase, a corticosteroid nasal spray

FIGURE 1—Nasal sprays are pre-scribed for relief of nasal congestion.

Prescribers of Drugs 3

The Upper Respiratory System: The Common Coldand Sinus Congestion

The common cold is a diffuse upper respiratory tract infec-tion caused by different types of viruses. It’s transmittedbetween individuals through droplets from one respiratorytract to another. The family physician may prescribe a varietyof remedies to treat the symptoms of the common cold. Theseremedies usually contain decongestants to relieve nasalstuffiness and sinus congestion and antihistamines to drythe nasal and sinus tissues. Some preparations also containpain relievers to reduce pain in the sinus cavities.

The following are some common antihistamine preparationsthat are used to treat symptoms of the common cold:

• Chlorpheniramine (Chlor-Trimeton)

• Diphenhydramine (Benadryl)

• Brompheniramine (Bromfed)

• Clemastine (Tavist)

• NyQuil Cold/Flu Multisymptom Relief (also containsacetaminophen and dextromethorphan)

The following decongestants may also be used to relieve coldsymptoms:

• Pseudophedrine (Sudafed)

• Oxymetazoline (Dristan Nasal Spray)

Nasal preparations such as Atrovent (ipratropium) may alsobe recommended by the physician to reduce rhinorrhea (nasaldischarge or runny nose).

The Lower Respiratory System: Cough

Many cough symptoms are caused by disorders in the lowerrespiratory system. This system contains the deeper breath-ing structures in the chest, including the trachea (windpipe)and lungs. Less commonly, a cough may be caused by otherdiseases in the head or stomach.


There are numerous prescription products and over-the-counter products available to treat coughs, and most of themare taken in liquid form as syrups or elixirs (aqueous vehiclesof water and alcohol). The single most effective ingredient inthe prescription products is codeine, which is one of the mosteffective agents to stop coughs. Hydrocodone is also a popu-lar choice among physicians. Hydrocodone and codeine can’tbe purchased without a prescription.

Many cough syrup preparations contain expectorants thatincrease and liquefy (make liquid) the mucous secretionsin the respiratory tract, making it easier for the patient tocough up the mucous. Cough preparations may also containantihistamines that dry up secretions, decongestants thatreduce swelling in the nasal passages, and flavoring toimprove the taste.

Most of the popular anticough preparations that arecommonly prescribed by family practice physicians containone or more of the following ingredients:

• Expectorants, such as guaifenesin

• Antitussives, such as codeine or hydrocodone (bothprescription drugs) or dextromethorphan (OTC)

• Antihistamines, such as chlorpheniramine or brompheniramine

• Decongestants, such as pseudophedrine or phenylephrine

Some popular brand name cough preparations include thefollowing:

• Robitussin (guaifenesin)

• Mucinex (guaifenesin)

• Cheracol cough syrup (codeine and guaifenesin)


The Lower Respiratory System: Asthma andRespiratory Diseases

The patient with asthma experiences wheezing and laboredbreathing. The patient with chronic obstructive pulmonarydisease (COPD) may have chronic bronchitis, emphysema, orother lung disorders. COPD is a general term for this groupof diseases that limit the airflow in the respiratory system,and that produce symptoms that aren’t fully reversible.

The most common drugs used today to treat disorders of thelower respiratory system are beta agonists, anticholinergics,corticosteroids, and antileukotrienes. In very simple terms,the beta agonists and the anticholinergics work by helpingthe muscles that are wrapped around the airways to relax.In contrast, corticosteroids and antileukotrienes are anti-inflammatory drugs, which work by reducing swelling andby limiting the production of thick mucous in the airways.The physician may prescribe any of these medicines, orcombinations of them, to help a patient breathe more easily.

The following are some of the common drugs that are pre-scribed for asthma and COPD:

• Atrovent nasal spray (ipratropium), an anticholinergic

• Spiriva (tiotropium), an anticholinergic

• Pulmicort (budesonide), a corticosteroid

• Aerobid (flunisolide), a corticosteroid

• Flovent (fluticasone), a corticosteroid

• Singulair tablets (montelukast), an antileukotriene

• Accolate tablets (zafirlukast), an antileukotriene

• Proventil and Ventolin (albuterol), beta agonists

• Tornalate (bitolterol), a beta agonist

• Seravent (salmeterol), a beta agonist

• Foradil (formoterol), a beta agonist


Bronchodilators are also used to dilate and open the airway toallow better air intake and breathing. They’re usually sprayedinto the mouth from a small canister and inhaled (Figure 2).These bronchodilators act immediately, and quickly relax thetightened muscles in the airway to allow better air flow. Somebronchodilators are taken as pills to produce longer-lastingeffects.

Another form of delivery uses an inhaler device with a cap-sule of medication that’s punctured at the time of use, andthen mobilized for inhalation.

The following are some of the popular quick-relief or “rescue”bronchodilators prescribed to treat asthma. Note that all ofthese are classified as short-acting beta agonists:

• Proventil and Ventolin (albuterol)

• Maxair Autoinhaler (pirbuterol)

• Serevent (salmeterol)

• Foradil (formoterol)

FIGURE 2—Bronchodilatorsare usually prescribed tobe inhaled.


Long-term asthma relief is often provided by inhaled cortico-steroids, which reduce swelling of the affected airways.

A drug called theophylline is sometimes used to treat moreserious or long-term lung diseases, such as emphysema andchronic bronchitis. Theophylline causes the muscles in theairways to relax, making it easier to breathe. It may be givenin an intravenous solution, in tablet form, or in a syrup. Thefollowing are some brand-name theophylline drugs that maybe prescribed for pulmonary disease:

• Uniphyl

• Theo-24

• Quibron-T

Asthma and other lung diseases may also be treated withnebulizer therapy. A nebulizer is a machine that pumps airthrough a liquid medicine, turning the medicine into a mistor vapor. The vaporized medicine is transferred throughplastic tubing to an inhaler, where it’s then inhaled by thepatient. The nebulizer makes it easier for a patient to inhalemedicine into the lungs, and is therefore especially usefulfor patients who are weak or have difficulty breathing.Nebulizers are often prescribed for infants, children, andelderly patients with breathing problems. Note that thenebulizer is only a machine, not the medicine itself. Thepatient will receive a separate prescription from his or herdoctor for a medication to use in the nebulizer.

Acute Infectious Disease

Infections resulting from various infectious diseases canoccur at any time in people of any age, and most patientswith the symptoms of an infection will see their familyphysician for diagnosis and treatment (Figure 3). Pathogenicbacteria, viruses, fungi, and other microbial organismscan cause infections. Infections can be dangerous andeven life-threatening, particularly in infants, children, andelderly people.

Doctors commonly prescribe drugs called antibiotics tocombat infections. An antibiotic is a chemical compoundthat either kills or inhibits the growth of microorganisms,


such as bacteria and fungi. Depending on the type of infec-tion the patient has, the physician will prescribe a specificantibacterial, antiviral, or antifungal medication in an attemptto eradicate the particular infectious organism. There are agreat many antimicrobials available to treat a great manydifferent infectious agents. As a pharmacy technician, you’llencounter many different types of prescriptions from thefamily physician for the treatment of infections.

The following anti-infective drugs are sometimes prescribedfor pharyngitis, scarlet fever, pneumonia, and bronchitis:

• Penicillin VK tablets

• Avelox (moxifloxacin)

• Keflex capsules

• Amoxil, Biomox, Trimox, Wymox (amoxicillin)

• Erythromycin tablets

• Levaquin (levofloxacin)

• Azithromycin

Some forms of pneumonia are treated with the followingdrugs:

• Amoxicillin and cephalosporins

• Clarithromycin, azithromycin, doxycycline, clindamycin

FIGURE 3—Familypractice physiciansprescribe medica-tions for a widevariety of illnesses.


• Fluoroquinolones (moxifloxacin, gatifloxacin, levofloxacin)

The anti-infective drug metronidazole (brand names Flagyland Rozex) is sometimes prescribed for yeast infections,peptic ulcer disease, gingivitis (a gum disease), and certainskin infections.

The following medications are effective for treating systemicfungal infections (infections that affect the body as a whole):

• Nizoral tablets

• Diflucan tablets

• Sporanox tablets

The antibiotic tetracycline is sometimes used to treat infec-tions of the respiratory tract, sinuses, middle ear, urinarytract, and intestines. However, it’s not used as often as it wasin the past because some microorganisms have developedresistance to it (which means that the drug is no longer effec-tive against the infection). Tetracycline is still an effectivedrug in many situations, though.

Note that the problem of resistance can occur with manyantibiotic drug treatments, and for this reason, physiciansare very careful when treating infections with antibiotics.When an infection is serious or life-threatening, the physicianmust choose the prescribed drugs very carefully and observethe patient closely to make sure he or she is respondingproperly to the treatment.

In the past, about 100 years ago, antibiotic medicationsdidn’t exist (they hadn’t been discovered yet). People whodeveloped infections after injuries, or who contracted com-mon infectious diseases like influenza, often died becausethere were no medicines that could help them. Today, we’relucky to have many different antibiotic medications available.If one drug fails to work for a particular patient’s infection,another type of drug can be prescribed. Also, if a patient isallergic to or resistant to a particular drug, the physician canprescribe an alternative. In your work as a pharmacy techni-cian, you’ll see these drugs prescribed in many combinationsand for many different types of diseases.

Now, take a few moments to review what you’ve learnedbefore going on to complete Self-Check 1.


NOTES


Self-Check 1At the end of each section of Prescribers of Drugs, you’ll be asked to pause and check your understanding of what you’ve just read by completing a “Self-Check” exercise.Answering these questions will help you review what you’ve studied so far. Please complete Self-Check 1 now.

1. This type of drug is prescribed by the family doctor to reduce the stuffy nose feeling of nasalcongestion.

a. Antitussive drug c. Sleeping pillb. Bronchodilator d. Nasal decongestant

2. This type of drug is prescribed to open up a constricted airway in an asthma sufferer.

a. Antitussive drug c. Sleeping pillb. Bronchodilator d. Nasal decongestant

3. If a patient with emphysema presented symptoms of bronchitis, the doctor might prescribethis drug.

a. Corticosteroid nasal spray c. Sleeping pillsb. Quibron-T d. Penicillin

4. A family doctor may prescribe this antimicrobial medication to treat a yeast infection.

a. Dristan nasal spray c. Flagyl tabletsb. Tetracyclines d. Codeine

5. A machine that’s used to turn asthma medicine into a mist that can be inhaled by a patientis called a(n)

a. antimicrobial. c. nebulizer.b. COPD. d. expectorant.

6. If you dispensed a medicine containing this drug, the patient may be using it to treat pharyngitis.

a. Amoxicillin tablets c. Phenobarbital tabletsb. Contac Cold capsules d. Codeine

Check your answers with those on page 71.


Allergists

The allergist is a doctor who specializes in diagnosing andtreating allergic reactions. One of the most common allergicreactions is hay fever. Hay fever allergy results in unpleasantsymptoms such as a runny nose, a red and swollen nose,hives (itchy patches on the skin), puffy and teary eyes, andsneezing. Hay fever, in a susceptible individual, is causedby a reaction of a foreign substance such as grass or treepollen with a specific protein in the body (called an antibody)to produce the symptoms. The reaction acts to release a veryirritating substance from blood cells called histamine, whichcauses all the effects described. Therefore, the commontreatment for hay fever is to use antihistamines to block orprevent the effects of histamine. Antihistamines that weredeveloped some time ago cause significant drowsiness alongwith their histamine-blocking action. Some newer types ofantihistamines don’t cause such drowsiness and are referredto as nonsedating antihistamines.

The following antihistamines are popular for the treatmentof hay fever:

• Astelin

• Allegra and Allavert

• Benadryl capsules and elixir

• Tavist tablets

• Chlor-Trimeton tablets

• Dimetane tablets

• Seldane tablets

• Hismanal tablets

• Claritin and Clarinex tablets

• Zyrtec tablets


Dermatologists

Dermatologists are doctors who diagnose and treat diseases ofthe skin. Certification of a doctor by the American Board ofDermatology specifies three to four years of specialty trainingafter graduation from a medical school plus a written andoral examination. Major skin disorders requiring drug therapyfrom a dermatologist include skin infections and skin inflam-mation. Skin infections appear in conjunction with skin disorders such as wounds, burns, insect bites, and preexistingfungal infections. Pathogenic bacteria such as theStaphylococcus genus are the most common causative agentsin skin infections. Once the dermatologist makesthe diagnosisof infection, antibiotic ointments are prescribed to eradicatethe organism. Inflammatory skin reactions result in a redden-ing of the affected area, which is hot and painfully sensitiveto the touch and swollen in a localized area.

Corticosteroid ointments are very effective anti-inflammatoriesthat reduce the inflammatory response within hours afterapplication. In long-term chronic inflammatory skin diseases,systemic corticosteroid tablets are often used in conjunctionwith topical corticosteroids. The dermatologist will write pre-scriptions for these topical medicines to effectively treat allthree conditions.

Topical antibiotic drugs prescribed by dermatologists are thefollowing:

• Bacitracin ointment

• Neosporin ointment

• Polysporin ointment

Dermatologists prescribe the following topical corticosteroidsfor skin inflammation:

• Hydrocortisone cream

• Decadron cream

• Synalar cream

• Cordran cream

• Locorten cream


• Valisone cream

• Kenalog cream

• Lidex cream

A common systemic corticosteroid that’s prescribed by der-matologists is prednisone.

Fungal infections occur both in the skin and the nails, and inmucocutaneous tissues such as the oral cavity and vagina.Fungal infections of the skin and nails are treated with acombination of topical antifungal creams and antifungalsystemic tablets. Mucocutaneous fungal infections arecaused by an organism called Candida albicans. This is ayeast-like fungus normally present on the skin and mucousmembranes of the mouth, gastrointestinal tract, and vaginalareas. When the patient is compromised by illnesses orthe use of antibiotics, the yeast organism often becomes apathogen and produces a localized fungal infection. Thisyeast infection is easily treated by a number of antifungalcreams. The antifungal agents listed here are examples of thetypes of medicines you’ll see prescribed by the dermatologist.

Some antifungal topical preparations are

• Lotrimin cream

• Gyne-Lotrimin cream

• Mycelex cream

• Monistat 7 cream

• Monistat-Derm cream

• Mycostatin cream

• Griseofulvin tablets

• Nizoral tablets


• Sporanox tablets


Rheumatologists

Rheumatologists are doctors who diagnose and treat diseasesof the joints, muscles, and bones. Rheumatologists commonlytreat arthritis, certain autoimmune diseases (such as lupusand fibromyalgia), tendonitis, gout, and osteoporosis.

Note that there are several different types of arthritis, aserious disease that causes damage to the joints of the body.Rheumatoid arthritis is a painful disorder characterized byinflammation of the joints and bones, with destructive effectson cartilage and bone tissue. Major symptoms are prolongedmorning stiffness, pain on motion, and tenderness andswelling of joints. Rheumatoid arthritis is considered to bea systemic disease in that many joints are affected at thesame time, and also because it may have effects on otherbody parts (such as the lungs and kidneys).

Gouty arthritis, or simply gout, is caused by high levels ofuric acid in the blood. This is caused by underlying metabolicdiseases in the individual, and may be affected partly by diet.If uric acid crystals form, they can be deposited in the joints,eventually resulting in inflammation. Attacks of gouty arthri-tis result in pain and stiffness, frequently in the big toe.

Osteoarthritis is characterized as a more specific formof arthritis because fewer joints are involved. It usuallyaffects the knee joints, hip joints, and finger joints, andis associated with degeneration and distortion of the jointitself. Osteoarthritis can occur from both ordinary agingand simple strain and overuse of the joints (for example, insports). Osteoarthritis can occur in anyone with a joint strainor injury (even young athletes) but is still most common inolder people.

Unfortunately, there’s no absolute cure for arthritis, sodoctors of rheumatology prescribe drugs to treat the symp-toms of pain and inflammation. Reducing inflammationin the joints is very important to prevent (or at least delay)permanent damage to the joints, and relieving pain is essen-tial to allow patients to participate in their usual activities.Rheumatologists therefore rely on both anti-inflammatorydrugs and painkillers (and combinations of them) to treatthe symptoms of the three types of arthritis.


Some of the common drugs that are prescribed for rheuma-toid arthritis and osteoarthritis are

• Ibuprofen (Advil or Motrin tablets)

• Naproxen (Aleve, Anaprox, or Naprosyn tablets)

• Etodolac or Lodine

• Diclofenac or Cataflam

• Ketorolac or Toradol

• Ozaprozin or Daypro tablets

• Relafen tablets

• Diflunisal or Dolobid tablets

• Indomethacin or Indocin capsules

• Cortisone and hydrocortisone

• Prednisone

The following drugs are prescribed for gouty arthritis:

• Colchicine tablets

• Indocin capsules

• Benemid tablets

• Zyloprim tablets

• Probenecid

Arthritis is a very common disorder that affects millionsof people, and there are many drugs available to treatthe various forms of arthritis. As a working pharmacytechnician, you should be very familiar with the names ofthese commonly prescribed and important drugs.

Ophthalmologists

Ophthalmologists are doctors who specialize in diagnosingand treating diseases of the eye (Figure 4). Ophthalmologywas originally a part of the specialty of otolaryngology, or eye,ear, nose, and throat (EENT), but it has since developed into aspecialty of its own. An eye doctor usually completes three


years of specialized training after graduation from medicalschool, plus one year of active practice. Applicants must thentake an examination for certification as an ophthalmologist.

One common eye disease that the ophthalmologist treats andwrites prescriptions for is glaucoma. Glaucoma is a conditionin which fluid builds up inside the eye, causing pressureon the optic nerve. This pressure inside the eye is calledintraocular pressure, and it can be painful. The pressuremust be treated to prevent permanent damage to the opticnerve, which could result in a loss of vision. Drugs in theform of eyedrops are used to relieve the intraocular pressure.One common drug that the eye doctor will prescribe is aneyedrop called pilocarpine. Pilocarpine is a miotic (a substancethat causes constriction of the pupil) that allows the fluidinside the eye to drain out through the tear duct. This medi-cine is prepackaged by the manufacturer in small plasticsqueeze bottles. The patient squeezes drops of the medicationinto the eye as instructed by the physician.

FIGURE 4—Ophthalmologists treat diseases of the eye.


Ophthalmologists also treat eye infections and inflammation.Anti-infective agents are applied topically as drops or oint-ments to treat infections of the conjunctiva and cornea andas ointments for infections of the eyelids. Topical therapyalone is often adequate for superficial infections of thesestructures (Figure 5). Ointments provide more prolongedcontact than solutions but may interfere with vision whenused during the daytime.

Most infections of the eyelids and conjunctiva aren’t seriousand are eradicated in a very short period of time by eyedropscontaining the proper antibacterial agent to kill the causativeorganism. The most common organism causing eye infectionsis Staphylococcus aureus. Infection sometimes has an associ-ated inflammatory component resulting in swollen, tender,and somewhat painful eyelids and conjunctiva. In these conditions, an anti-inflammatory agent is used in combina-tion with the antibacterial agent. The most effective anti-inflammatory agents are the corticosteroids. In someconditions of the eye, inflammation may be present in theconjunctiva without any associated bacterial infection. Inthese conditions, the corticosteroid anti-inflammatory agentis administered without need for the antibacterial component.The ophthalmologist prescribes these drugs either as oph-thalmic sterile ointments that come prepackaged in a 3.5gram (g) tube or as antibiotics in eyedrops that comeprepackaged in either 2.5 ml, 5 ml, or 15 ml plastic squeezebottles. The ointments, being in such a small tube, are usu-ally dispensed by placing the small tube in a larger box andputting the label on the box. The plastic squeeze bottles areusually placed inside a plastic prescription vial with the labelplaced on the vial.

FIGURE 5—Topicalointments areprescribed to treateyelid infections.


Eyedrops for the treatment of glaucoma include the following:

• Timoptic Ocudose (eyedrop dispenser)

• Isopto Carpine eyedrops

Eyedrops used to treat infections include the following:

• Tobrex ointment

• Sulamyd (sulfacetamide) ophthalmic ointment

• Baciquent ophthalmic ointment

• Garamycin ophthalmic ointment

• Ciprofloxacin

• Neosporin ophthalmic ointment

• Polysporin ophthalmic ointment

• Chloromycetin ophthalmic ointment

• Stoxil ophthalmic ointment

Infections may also be treated with these eyedrops:

• Isopto Cetamide drops

• Vasosulf drops

Eye doctors may prescribe the following preparations for eyeinflammation associated with infection:

• Neo-Decadron ophthalmic ointment and drops

• Neo-Delta-Cortef ophthalmic ointment and drops

• Cortisporin ophthalmic ointment and drops

• Vasocidin drops

• TobraDex ointment

• Fluorometholone

Now, before going on to learn about drugs prescribed byendocrinologists, gastroenterologists, and urologists, taketime to complete Self-Check 2.


Self-Check 21. The doctor treating hay fever may prescribe this type of drug to reduce the symptoms of

sneezing.

a. Antibiotic c. Antihistamineb. Sleeping pill d. Bronchodilator

2. This substance is released from blood cells when a susceptible person inhales pollen.

a. Histamine c. Proteinb. Antibody d. Allergen

3. Dermatologists often treat fungal infections of the skin and nails. Which drugs below are oftenused to treat this condition?

a. An ointment to reduce inflammation and a systemic corticosteroidb. An antihistamine and a topical antibioticc. An ointment applied to the jointsd. An antifungal cream and antifungal tablets taken systemically

4. Rheumatologists use the following two classes of drugs to treat arthritis.

a. Painkillers and anti-infectivesb. Anti-infectives and anti-inflammatoriesc. Anti-inflammatories and painkillersd. Painkillers and antibiotics

5. Ophthalmologists commonly treat this condition in which fluid builds up inside the eye.

a. Glaucoma c. Skin allergyb. Eye infection d. Fungal infection in the eye

6. If a patient presented symptoms of a red and infected eye, which type of drug will be pre-scribed by the eye doctor to treat the infection?

a. A painkiller in a tablet to be swallowedb. An antihistamine in eyedropsc. An antibiotic in eyedropsd. An antibiotic in a tablet to be swallowed



Endocrinologists

Endocrinologists are doctors who diagnose and treat disordersof the endocrine system. These disorders are known as glandular diseases because the endocrine system is com-posed of different glands that secrete hormones. Lack of hormonal production and secretion by specific glands causessome major disorders of the endocrine system. The lack ofestrogen production from the ovaries of middle-aged femalesis known as menopause. The lack of insulin production orsecretion from the pancreas is known as diabetes. The lackof thyroid hormone production and secretion from the thyroidgland is known as thyroid disorder. Included in the broadfield of endocrinology is the use of oral contraceptives toprevent pregnancy. However, as you’ll soon learn, oralcontraceptives are ordinarily prescribed by gynecologists.

Diabetes

Endocrinologists treat diabetes mellitus, which is a disorderthat occurs due to a lack of insulin production or secretionfrom the pancreas. Insulin ordinarily is the hormone respon-sible for the proper utilization of blood sugar by cells in thebody. Without insulin, the sugar in the blood doesn’t get intocells, and the blood sugar level rises and eventually spillsover into the urine. Urinary detection of sugar is a sure diagnostic sign of diabetes. Diabetes mellitus is classified as either insulin-dependent diabetes (IDDM Type I) or non-insulin-dependent diabetes (NIDDM Type II). IDDM wasformerly called juvenile diabetes because the age of onset waspredominantly before adulthood. Patients with IDDM requireinsulin to sustain life (Figure 6). Insulin injection is pre-scribed to treat IDDM in order to replace the insulin thatisn’t being produced.

NIDDM was previously known as maturity onset or adultonset diabetes. In this form of diabetes, insulin is producedby the pancreas but isn’t secreted by the gland. Thus, it isn’tavailable in the blood to utilize the blood sugar. Medicinescalled oral hypoglycemics are used to treat this form of dia-betes to stimulate the pancreatic secretion of insulin.


Some commonly prescribed oral hypoglycemics are

• Orinase

• Micronase

• Glucotrol

• Glucophage

• Glynase

• Precose

• Amaryl

• Actose

Thyroid Disorders

Endocrinologists treat thyroid disorders. Thyroid hormoneprincipally affects metabolism, growth, and development.Hypothyroidism is the condition in which thyroid hormoneproduction by the thyroid gland is diminished. Symptoms aretiredness, intolerance to cold, irritability, a sleepy appear-ance, and dry rough skin. The treatment is thyroidreplacement therapy using either thyroid hormones isolated

FIGURE 6—Insulin-dependent diabeticsinject themselves withinsulin prescribed by anendocrinologist.


from the thyroid glands of animals (thyroid tablets), a prepa-ration called thyroglobulin (Proloid), or a synthetic thyroidhormone, such as Synthroid.

Endocrinologists treating hypothyroidism will write many pre-scriptions for the following thyroid replacement drugs:

• Thyroid tablets

• Synthroid tablets

• Levoxyl (levothyroxine sodium) tablets

Obstetricians and Gynecologists

Before specialization in medicine became popular, obstetricswas one of only three medical divisions—medicine, surgery,and obstetrics. While obstetrics focuses on childbirth, gynecology, a relatively new specialty, focuses on the care ofmedical and surgical conditions that apply only to females.The gynecologist usually practices obstetrics also. TheAmerican Board of Obstetrics and Gynecology requires thecompletion of three years of postgraduate residency trainingfollowed by one and one-half years of practice prior to appli-cation for certification. Gynecologists spend a great deal oftime advising their patients about birth control and methodsto prevent pregnancy. Oral contraceptives (OCs) are a very popular method of birth control, and gynecologists prescribemany different brand names, depending on the preference ofthe patient. Birth control pills are provided as a monthlypackage of pills to be taken once a day to prevent ovulation.No pregnancy can occur if ovulation doesn’t occur.

Because oral contraceptive pills contain various formulationsof hormones, they may be prescribed for women for purposesother than pregnancy prevention. In a serious conditioncalled endometriosis, the endometrium (the inner lining of theuterus) grows abnormally, and can cause pelvic pain, severebleeding, and infertility. Oral contraceptives are often pre-scribed to relieve the symptoms of endometriosis. They mayalso be prescribed to treat polycystic ovary syndrome (anendocrine disorder involving the ovaries), dysmenorrhea(painful menstruation), and even severe acne (skin inflamma-tion and breakouts).


Oral contraceptives generally contain various combinationsand strengths of the hormones estrogen and progestin, orprogestin only. These medications are manufactured by manydifferent companies under a wide variety of brand names.However, the drug ethinyl estradiol or EE (a synthetic form ofestrogen) is used in almost all modern oral contraceptives.

As a pharmacy technician, the following are some commonoral contraceptives you’ll be dispensing frequently. Note thateach of these drugs combines ethinyl estradiol (EE) withanother type of hormone:

• Ethinyl estradiol and levonorgestrel (brand names Alesse,Aviane, Levlite, Nordette, Tri-Levlen, Triphasil, Seasonale,Levora, Lybrel)

• Ethinyl estradiol and norethindrone (brand namesLoestrin, Microgestin, Necon, Ortho-Novum, Ovcon,Brevicon, Norinyl, Nortrel)

• Ethinyl estradiol and norgestrel (brand names LoOvral,Low-Ogestrel, Ogestrel)

• Ethinyl estradiol and desogestrel (brand names Apri,Desogen, Ortho-Cept, Mircette)

• Ethinyl estradiol and drospirenone (brand name Yazmin)

• Ethinyl estradiol and norgestimate (brand names Ortho-Cyclen and Ortho Tri-Cyclen)

• Ethinyl estradiol and ethynodiol (brand names Demulenand Zovia)

Both gynecologists and endocrinologists treat menopause,which is a condition resulting from decreased estrogen pro-duction in older women. Menopause is a natural conditionthat occurs with aging, and isn’t generally classified as anillness. However, the uncomfortable symptoms associatedwith menopause can be severe enough to require medicationin some patients. The hormonal changes associated withmenopause can also contribute to osteoporosis (bone lossthat can lead to fractures) and may cause vasomotorsymptoms of “hot flashes” (a sensation of heightened bodytemperature, often accompanied by sweating). Mild depres-sion may also accompany menopause in some women.


Symptoms of menopause may be treated with hormonaltreatments that include estrogen and progestin, separately orin combination. The following are some of the common brandnames of these drugs:

• Premarin tablets

• Cenestin

• Estrace

• Provera or Amen

• Aygestin

• Prometrium

• Prempro or Premphase

• FemHRT

Supplements of calcium and vitamin D are commonly pre-scribed to prevent the bone loss related to osteoporosis.However, the following medications may also be prescribed towomen to prevent or treat osteoporosis:

• Fosamax tablets

• Actonel

• Evista

• Boniva

• Calcimar

• Aredia

• Miacalcin

Gastroenterologists

Gastroenterologists are doctors who specialize in the treat-ment of disorders of the gastrointestinal tract, which includesthe esophagus (stomach tube), stomach, intestines, and lowerbowel (Figure 7). One of the important esophageal disordersthat responds to drug treatment is reflux esophagitis or gastroesophageal reflux disease (GERD). In this disorder,


commonly known as heartburn, stomach acid spills up intothe stomach tube and causes a burning sensation that’s feltin the chest region. In extreme cases, the chest pain fromGERD may be severe enough to make patients feel likethey’re having a heart attack. Repeated spills of stomach acidinto the esophagus can eventually cause permanent damageto the area.

There are several types of medicines available to treat GERDand related gastrointestinal illnesses. Antacids that containmagnesium, aluminum, or calcium carbonate are takenshortly after eating a meal, and can help to neutralizethe acid produced by the stomach. Antacids are generallyavailable over-the-counter.

Some common antacid brands include

• Tums

• Maalox

• Mylanta

FIGURE 7—The gastro-enterologist often prescribes a combinationof drugs to treat gastriculcers.


Another type of drug that reduces the secretion of acid in thestomach is effective in preventing GERD, since there’s lessacid to spill up into the stomach tube. The drugs that reducestomach acid are called H2 receptor antagonists. The phraseH2 stands for the histamine “type two” receptor that’s respon-sible for releasing acid from the stomach. When this receptoris blocked by any of the drugs just mentioned, acid secretionis reduced and the esophageal burning disappears. The following drugs are the most important H2 antagonistsprescribed by gastroenterologists for the relief of heartburn:

• Ranitidine, or Zantac

• Cimetidine, or Tagamet

• Famotidine, or Pepcid

• Nizatidine, or Axid

Note that these drugs are available over-the-counter, withouta prescription.

Another important class of drugs used to treat GERD arecalled proton pump inhibitors (PPIs). These drugs work bybinding to the cells that produce gastric acid in the stomach,and rendering them useless. These medicines are usuallytaken once per day, and include the following:

• Prilosec and Prilosec OTC

• Nexium

• Aciphex or Pariet

• Protonix

• Prevacid

Another common disease of the gastrointestinal system is thepeptic ulcer. A peptic ulcer is an open lesion (a sore or hole)that appears in the lining of the lower esophagus, stomach,or intestines. Because this type of ulcer is located in areasnear stomach acids, they can be extremely painful.

Years ago, it was thought that some peptic ulcers werecaused by improper diet. However, it’s now known that mostpeptic ulcers are caused by an infection of the bacteria calledHelicobacter pylori. These bacteria seem to be able to survive


in the acid environment of the stomach, and can causethe destruction of areas of the stomach wall that results inbleeding ulcers. Eradication of this bacteria has been shownto cure these ulcers. It’s been demonstrated that certainantibiotics (such as the drug clarithromycin, or Biaxin) incombination with acid reducers can kill or control the growthof the H. pylori bacteria.

The following combination of drugs is prescribed to reducethe symptoms of gastric ulcer and even cure the gastric ulcerwhen they’re given at the same time.

• Biaxin tablets

• Prilosec capsules

• Zantac tablets

• Pepto-Bismol liquid

Urologists

Urologists treat diseases of the urinary tract, which includesthe kidneys (the organs that form urine), the ureters (thetubes that convey urine to the bladder), and the urethra(the structure that drains the urine to the outside of thebody). Urology is also a surgical specialty. Certification by theAmerican Board of Urology requires three years of approvedpostgraduate training followed by two years of urologicalpractice. Certification is approved upon passing the writtenand oral examinations. Urologists treat both men and womenfor kidney and bladder stones, cancers of the urinary system,conditions related to infertility, and any other diseases orinfections of the urinary system.

Stones, tumors, congenital conditions, or injuries to theurinary system may produce urinary stagnation that invitesinfection in the urethra. This condition is called cystitis.Because of the prevalence of urinary tract infections treatedby the urologist, you’ll often see prescriptions for urinarytract antiseptics. Any anti-infective agent that’s excretedprimarily in the urine is useful in the treatment of urinarytract infections. Primary drugs include amoxicillin, ampicillin,


ciprofloxacin, tetracyclines, sulfonamides, and combinationproducts containing trimethoprim and sulfamethoxazole(such as Bactrim or Septra).

The following agents are active against common urinary tractpathogens and, because they’re concentrated in the urine,have been classified as urinary tract antiseptics:

• Nitrofurantoin (Furadantin, Macrodantin)

• Nalidixic acid (NegGram)

• Methenamine (Mandelamine)

Sulfa drugs prescribed for urinary tract infections are

• Bactrim

• Septra

• Ciprofloxacin

• Tequin

• Levaquin

• Moxifloxacin

• Noroxin tablets

Urologists treat a condition called benign prostatic hyperplasia (BPH), in which the prostate gland is enlarged.These specialists have at their disposal two drugs that arethought to reduce the size of an enlarged prostate gland.

Some of the drugs prescribed for the treatment of prostateproblems are

• Prazosin or Minipress

• Flomax

• Proscar

• Hytrin

Before going on to learn about the drugs prescribed by ortho-pedic physicians, general surgeons, and geriatricians, taketime to complete Self-Check 3.


Self-Check 31. If you received a prescription from a doctor for insulin, the patient would have which disorder

of the endocrine system?

a. Thyroid disorder c. Gastric ulcersb. Menopause d. Diabetes

2. If you fill a prescription for a sulfa drug, it was most likely prescribed by a(n)

a. urologist. c. endocrinologist.b. gastroenterologist. d. ophthalmologist.

3. Birth control pills are prescribed by the gynecologist or endocrinologist to do what?

a. Release insulin from the pancreasb. Inhibit ovulation to prevent pregnancyc. Cause the patient to conceived. Reverse a thyroid disorder

4. If you dispensed a prescription for Bactrim tablets, the patient would be suffering from whichdisorder?

a. Gastric ulcers c. Heartburnb. A urinary tract infection d. Either gastric ulcers or heartburn

5. If you dispensed a prescription for a drug called Zantac, the patient could be suffering fromwhich disorder?

a. Gastric ulcers c. Arthritisb. Cystitis d. Either gastric ulcers or heartburn

6. For what condition do patients take Synthroid?

a. Thyroid disorder c. Cystitisb. Insulin-dependent diabetes d. Gastric ulcers

7. If you received a prescription for this drug, the patient is being treated for an enlargedprostate gland.

a. Bactrim tablets c. Zantac tabletsb. Penicillin tablets d. Proscar tablets

8. Why would a gastroenterologist prescribe a drug that kills bacteria to treat ulcers?

a. Because he or she made a mistake and specified the wrong drugb. Many forms of gastric ulcers are caused by a pathogenic bacterial organism.c. Treating a bacteria is a good way to start a treatment for any disease.d. Another drug isn’t as effective as an antibiotic alone.



Orthopedic Physicians

Orthopedic surgery or orthopedics is the branch of surgerythat deals with injuries and disorders of the musculoskeletalsystem. Therefore, the orthopedic physician is often called onto perform bone surgery. Orthopedic doctors treat fractures(broken bones) by setting the bones so they’ll heal back totheir original shape and regain normal function. They mayalso perform surgeries to place artificial knee joints and hipjoints (prostheses) in patients who have degenerative jointdisease (such as arthritis).

Pain is always involved when broken bones and fracturesoccur. Pain is also a normal component of the postoperativeperiod of orthopedic surgery. As a pharmacy technician,many of the prescriptions that you’ll see from orthopedicphysicians will be for the relief of pain. The orthopedic doctor

FIGURE 8—Orthopedic physicians prescribe painkillers for patients who have had broken bones set.


will prescribe the narcotic codeine-type drugs when the painis somewhat severe, and the non-narcotic Motrin-type drugswhen the pain is less severe (Figure 8).

The four most popular painkillers that are prescribed by theorthopedic physician are

• Vicodin tablets (narcotic)

• Motrin tablets (non-narcotic)

• Toradol injection and tablets (non-narcotic)

• Ultram tablets

General Surgeons

A general surgeon is a physician who specializes in thesurgical treatment of the abdominal organs, including theintestines, esophagus, stomach, colon, liver, and gallbladder.The general surgeon isn’t merely a doctor who operates, butis a highly trained physician who deals with diseases andinjuries that require some sort of surgical treatment. TheAmerican Board of Surgery requires four years of specializedsurgical residency training before an applicant can be exam-ined for certification by the board.

Typically, most general surgeons focus on surgery for abdominal conditions, traumatic situations, and tumorconditions. However, there’s no restriction on their activities,and many general surgeons take on additional fields astheir training and interests dictate. Some surgeons receivefurther training to specialize as cardiac surgeons, gynecologicsurgeons, plastic surgeons, thoracic surgeons, vascularsurgeons, urologic surgeons, neurosurgeons, and so on.

Many of the prescriptions you’ll see written by a generalsurgeon will be for medicines to treat post-surgical pain andinfections (Figure 9). Pain, or both pain and infection, com-monly occur as a result of the healing process after surgery.The types of painkillers prescribed by the surgeon range fromvery powerful narcotics, such as Demerol, to non-narcoticagents, such as Motrin. Antibiotics are prescribed to prevent


or eradicate bacterial infections that may arise as a result ofthe surgery. Any type of antibiotic from penicillin products tociprofloxacin may be prescribed.

The following painkillers are commonly prescribed by generalsurgeons:

• Demerol tablets

• Acetaminophen with codeine tablets

• Acetaminophen with hydrocodone (Vicodin, Lorcet)

• Acetaminophen with oxycodone (Percocet)

• Toradol tablets

• Motrin tablets

General surgeons may also prescribe the following antibioticsto treat postsurgical infection:

• Keflex capsules

FIGURE 9—General surgeons commonly prescribe painkillers and antibiotics for their patients.


• Augmentin tablets

• Clindamycin tablets

• Cipro tablets

• Levaquin


• Ceftin tablets

Geriatricians

Geriatricians are physicians who specialize in health carefor older patients. Older patients are generally defined aspeople who are over the age of 65 (Figure 10). Geriatricianscommonly deal with heart problems and other cardiovasculardisorders, arthritic disease, diabetes, thyroid disorders,cancer, problems with hearing and eyesight, insomnia(difficulty in getting proper sleep), nutritional disorders,

FIGURE 10—Geriatriciansprovide medical care tosenior citizens.


neurological and memory disorders that are more commonin older people (such as dementia and Alzheimer’s disease),and any other disorders pertinent to aging.

Geriatricians specialize in treating the multiple or combineddisease problems that older patients often have, and candevelop special care plans that address the healthcare needsof older adults. Many geriatricians act as healthcare man-agers for their patients, and may coordinate care for a patientwho sees several different specialist physicians.

Physicians of geriatric medicine may prescribe a wide varietyof drugs, many of which have been mentioned in the previousspecialties. It’s important to note that geriatric patients oftenhave increased sensitivity to medications, and may thereforeneed lower doses of some prescribed drugs. Geriatricians arefamiliar with the safe use of drugs in their patients and willbe able to adjust prescriptions to their needs.

One illness that geriatricians often treat in their olderpatients is Alzheimer’s disease (AD). Alzheimer’s disease is aserious disease of the brain that results in the deteriorationof a person’s cognitive (thinking) abilities and memory. Itoccurs most often in older people, although younger patients(in their 40s and 50s) are occasionally affected. Alzheimer’sdisease is complex, and its causes aren’t completely under-stood. However, it’s important to understand that AD causesactual physical changes in the brain, including the atrophy(shrinkage) of brain cells, deposits of sticky substances calledplaques in the brain tissue, and the creation of tangles in thenerve fibers. The formation of plaques and tangles eventuallyprevents the brain cells from operating properly, and theperson begins to show symptoms of slowed thinking andmemory loss. The disease gets worse over time in affectedpatients, and there’s no cure.

One type of drug that has shown some effectiveness inslowing down the progress of Alzheimer’s disease is thecholinesterase inhibitor. This drug improves the effectivenessof the chemical acetylcholine in the brain and can lessensome of the symptoms of the disease. These drugs appear towork best in the early and middle stages of Alzheimer’s.


Three drugs that may be prescribed for Alzheimer’s diseaseare

• Donezipil (Aricept)

• Galantamine (Razadyne)

• Rivastigmine (Exelon)

A drug that may be prescribed to help in the later stages ofAlzheimer’s disease is memantine (Namenda).

Hospitalists

Physicians who specialize in the care of patients in hospitalsare called hospitalists (Figure 11). These physicians generallywork only in hospitals and see patients on a daily basis whilethey’re in the hospital for treatment. On-site hospitalists cansometimes provide more effective care for hospitalized patientsthan primary care physicians, who would need to travel fromtheir private offices to the hospital to check on patients. A hospitalist may also work with office-based physicians toprovide care for a patient, coordinating services with them.

Before going on to learn about drugs prescribed by neurolo-gists and psychiatrists, take time to complete Self-Check 4.

FIGURE 11—Hospitalistsspecialize in the care ofpatients who are in thehospital for treatment.


Self-Check 41. If you saw this medicine prescribed by a general surgeon, you would suspect that the patient

had pain during the healing process.

a. Motrin tablets c. Halcion tabletsb. Premarin tablets d. Keflex tablets

2. A geriatrician treats what general category of patients?

a. Men only c. Senior citizensb. Women only d. Children

3. The general surgeon prescribes medication to treat pain and infection. Which of the followingcombinations might you dispense for a patient who has had surgery?

a. Demerol tablets and Halcion tabletsb. Toradol tablets and Cipro tabletsc. Halcion tablets and Vicodin tabletsd. Penicillin VK tablets and Augmentin tablets

4. This drug may be prescribed by the orthopedic doctor after resetting a fractured bone andplacing the bone in a cast.

a. Motrin tablets c. Halcion tabletsb. Proscar tablets d. Augmentin tablets

5. The drug Aricept would be prescribed for which condition?

a. Infertility c. Alzheimer’s diseaseb. Insomnia d. Postoperative infection

6. Which drug below is an antibiotic used by the general surgeon to treat postsurgical infections?

a. Codeine c. Motrin tabletsb. Butisol tablets d. Erythromycin tablets



Neurologists

Neurologists are doctors who treat disorders of the brain and the central nervous system. They function mainly asdiagnosticians. Neurologists don’t perform surgery but areresponsible for the care of patients with brain vascular disease, migraine headaches, epilepsy, multiple sclerosis,muscular dystrophy, and brain and spinal cord tumors. Aneurosurgeon performs surgery on the brain and spinal cord.The American Board of Psychiatry and Neurology certifiesneurologists and psychiatrists. The board requires neurolo-gists to complete two years of residency and two years ofpractice before applying for certification.

One of the major disorders of the brain is epilepsy, whichtakes many forms. Grand mal epilepsy, also known as tonic-clonic epilepsy, is associated with seizures that causethe victim to fall to the ground, become unconscious, andexperience major muscle spasms. Petit mal epilepsy, alsoknown as absence epilepsy, is associated with brief blackoutsin children. Partial epilepsy, also known as temporal lobeseizures, is associated with brief seizures with or withoutunconsciousness. The drugs most frequently prescribed bythe neurologist to treat the many forms of epilepsy are thefollowing:

• Gabapentin, or Neurontin

• Levetiracetam, or Keppra

• Lamotrigine, or Lamictal

• Dilantin

• Phenobarbital or phenobarbitone

• Tegretol

• Topamax

Headache is one of the most common symptoms that peopleexperience and may be precipitated by emotional stress,fatigue, and illness (Figure 12). In some cases, there may beno apparent underlying cause for headache pain. In othercases, chronic recurrent headache may be associated withneurological disorders.


Migraine headache is one type of neurologic headache.It’s characterized by recurring attacks of steady throbbingpain associated with nausea and vomiting. Attacks may beinduced by noise, anxiety, the consumption of certain foods,or a woman’s menstrual cycle. Many migraines appear tohave no cause. A migrainous prodromal aura (a premonitionof an oncoming migraine attack), which consists of visual,sensory, and motor reactions, immediately precedes amigraine attack. Cluster headache is another type of neuro-logical disorder. This type of headache is related to migraineand appears as a 30- to 40-minute excruciating, nonthrob-bing pain in the frontal or temporal region in a series ofclusters or closely spaced attacks. Muscle-contractionheadaches account for the largest percentage of headachesfor which doctors are consulted. This type of headache iscalled tension or nervous headache and may be precipitatedby emotional factors. These headaches aren’t as severe asmigraines but last for a longer period of time. Trigeminalneuralgia can lead to severe headache. The headache isthought to be a result of the underlying disease, althoughthe cause of trigeminal neuralgia is unknown. Neurologistsprescribe specific drugs for each of these types of headachesto ease the pain during the attack, to try to prevent theattack, and to try to shorten the duration of the attack.

FIGURE 12—Severeheadache is a commoncondition treated by theneurologist.


Drugs that you’ll dispense as a pharmacy technician fortreatment of migraine headache include the following:

• Inderal tablets

• Imitrex subcutaneous injection

• Imitrex tablets

• Cafergot (a member of the ergot drug family)

Some drugs prescribed by neurologists for tension headacheinclude

• Fiorinal (butalbital and aspirin)

• Fioricet (butalbital and acetiminophen)

• Valium

• Metaxalone, or Skelaxin (a muscle relaxant)

Some of the drugs prescribed by neurologists for the treat-ment of trigeminal neuralgia headache are the same as thoseused to treat epilepsy (for example, Tegretol tablets).

Psychiatrists

Psychiatry is the branch of medical science that deals withthe origin, prevention, diagnosis, and treatment of mentaland emotional disorders. Psychiatrists are licensed doctors ofmedicine. The American Board of Psychiatry and Neurologyrequires that a physician complete three years of accreditedpostgraduate study and training and practice psychiatry fortwo years before being eligible to apply for certification as apsychiatrist.

Psychologists also specialize in the study of human behavior.They generally hold a doctorate or master’s degree in psy-chology. Psychologists are usually involved in experimentalwork in collaboration with psychiatrists or other doctors. Theclinical psychologist is trained to diagnose and treat variousmental problems. This field of practice is specified in differentways by various state licenses. Psychologists and clinicalpsychologists don’t require a medical degree and neither isallowed to write prescriptions.


Psychiatrists treat major mental illnesses including psy-chosis, schizophrenia, depression, and bipolar disorder(manic depression), and commonly prescribe medications totheir patients.

Psychosis

A psychosis is a serious mental disorder that’s characterizedby a gross impairment of personality, a loss of contact withreality, and a deterioration of normal social functioning. Aperson may suffer from psychosis as a result of a physicalbrain injury or due to an underlying mental illness. A personwith a psychosis may have a distorted capacity to processinformation, an inability to draw logical conclusions, andimpaired judgment. The person may experience hallucina-tions and delusions, and may become violently aggressive orseverely overexcited. The following are some drugs that thepsychiatrist may prescribe to treat various types of psychosis:

• Risperidone, or Risperdal

• Aripiprazole, or Abilify

• Olanzapine, or Zyprexa

• Quetiapine, or Seroquel

• Clozapine, or Clozaril

• Chlorpromazine, or Thorazine

• Thioridazine, or Mellaril

• Haloperidol, or Haldol

Schizophrenia

Schizophrenia is a serious mental illness that’s characterizedby impairments in concept formation and the perception ofreality. A person suffering from schizophrenia may exhibitbizarre delusions, become incoherent, and experience visualor auditory hallucinations. The person may have a history ofmajor depressive or manic episodes, and a persistenceof symptoms for at least six months. The person’s workperformance and personal relationships may deteriorate, and


he or she will often be unable to perform normal self-care(eating, dressing, and so on). In general, the person withschizophrenia exhibits a major personality change, along witha withdrawal from social contacts and the surfacing of a dif-ferent, delusional type personality. In the catatonic form ofschizophrenia, there’s a complete lack of communicationfrom the affected individual.

Symptoms of schizophrenia are usually treated with a varietyof antipsychotic medications. These medications may be usedin varying combinations and dosages. The prescribing psychi-atrist may need to adjust an individual patient’s medicationsand dosages frequently to produce the desired result, withoutexcessive side effects.

The following are some medications prescribed for symptomsof schizophrenia:

• Abilify

• Clozaril

• Geodon

• Haloperidol, or Haldol

• Mellaril

• Prolixin

• Risperdal

• Seroquel

• Thorazine

• Zyprexa

Depression

Clinical depression (also known as depressive disorder) is oneof the most common disorders in the United States. Whilethe term depression is often casually used to refer to ageneral state of unhappiness or low mood, the term clinicaldepression refers to a state of intense sadness or despair thathas become severe enough to interfere with a person’s dailyliving activities and social functioning. In other words, while


most of us occasionally feel unhappy or dissatisfied, a personwho is experiencing true clinical depression has an illnessthat may need treatment by a physician.

Depression may include a loss of interest or pleasure in all(or almost all) usual activities and pastimes. Some or allof the following symptoms may be present in a depressedperson: an inability to experience pleasure in usual activities;feelings of helplessness; indecisiveness and an inability toconcentrate; agitation; insomnia; loss of appetite; and fatigueor loss of energy. Some individuals may experience persistentthoughts of suicide.

In the brain, substances called neurotransmitters help tocontrol a person’s moods. These neurotransmitters includeserotonin and norepinephrine. In a depressed person, thesesubstances aren’t processed correctly in the brain, andthere’s a reduction in their effects. In very general terms,the drugs that are prescribed for depression act to restorenormal brain chemistry by increasing or extending the actionof norepinephrine and serotonin. When the drugs work prop-erly, the person may experience an improvement in mood.

Depression is a very common illness, but its exact causes areunknown. Research has confirmed that depressive episodescan be triggered by (or made worse by) a variety of factors,including genetic predisposition, underlying illnesses, hor-monal imbalances, lack of sleep, malnutrition (poor diet), andstressful life events (such as the death of a loved one).

It’s very important to note that suicide occurs in as many as15 percent of depressed patients. Alcoholism and substanceabuse are also common problems for depressed people whodon’t receive treatment. For these reasons, it’s critical thatdepression be treated, and that patients take their medica-tions properly.

The following are some of the common drugs that psychia-trists prescribe to treat depression:

• Prozac

• Zoloft

• Paxil

• Lexapro


• Remeron

• Cymbalta

• Effexor

• Wellbutrin

Bipolar Disorder

Bipolar disorder is a condition in which patients experienceboth manic episodes and depressive episodes. (Note that“bipolar disorder” has generally replaced the older termmanic depression as the name for this illness.) In bipolardisorder, a person experiences recurring episodes of mooddisturbance that range from severe depression to mania. Inmania or a manic state, the person has an extremely elevatedmood, high energy, and unusual thought patterns. The per-son’s mood may quickly switch from depressed to manic, orvice versa. The length of each phase can last from a few daysto several months, and many bipolar people will experienceseveral episodes per year.

One family of drugs that’s especially effective in the treatmentof bipolar disorder is the lithium compounds. Lithium has theability to smooth out the bouts of depression and mania to amanageable level.

The following drugs are prescribed by psychiatrists forbipolar disorder:

• Lithium carbonate (Eskalith)

• Lithium carbonate (Lithane)

• Lithium carbonate (Lithobid)

• Lithium citrate (Cibalith-S)

• Divalproex sodium (Depakote)

• Carbamazepine (Tegretol)

In addition, antidepressants and antipsychotics may be pre-scribed as needed for individual patients.


Anxiety and Sleep Disorders

The day-to-day pressures of earning a living, raising a family,finding a job, and attempts at living a busy, productive lifeall contribute to feelings of anxiety. Panic disorder, a formof anxiety, is characterized by sudden, spontaneous, un-explained anxiety with feelings of terror and a flight response.Generalized anxiety disorder is persistent anxiety over aperiod of one month or more. Sleep disorders are conditionsin which an individual either can’t fall asleep, has difficultyobtaining a full night’s sleep, or has poor sleeping habits.

Sleep disorders may occur in patients who have psychologicalproblems, but they can also occur in otherwise healthy peo-ple. Thus, both psychiatrists and family practice physicianscommonly prescribe tranquilizers to counteract anxietiesand prescribe sleeping pills to counteract sleep disorders.The following tranquilizers are effective in treating anxietyconditions:

• Valium tablets

• Xanax tablets

• Lorazepam (Ativan)

These sleeping pills are prescribed to treat sleep disorders:

• Halcion tablets

• Flurazepam (Dalmane)

• Temazepam (Restoril)

• Zolpidem (Ambien)

• Lunesta

• Sonata

• Rozerem

Before going on to learn about drugs prescribed by pediatri-cians, cardiologists, and physicians who treat hypertension,take time to complete Self-Check 5.


Self-Check 51. A psychiatrist would prescribe this drug to treat schizophrenia.

a. Lithium tablets c. Tegretol tabletsb. Prozac tablets d. Prolixin tablets

2. Drugs sometimes referred to as “mood elevators” work to correct an imbalance in brain chemistry by

a. decreasing the levels of norepinephrine and serotonin in the brain.b. increasing the levels of norepinephrine and serotonin in the brain.c. decreasing the level of norepinephrine and increasing the level of serotonin in the brain.d. increasing the level of norepinephrine and decreasing the level of serotonin in the brain.

3. This drug is one of the classic phenothiazine drugs used in psychiatry to treat psychoses.

a. Lithium tablets c. Thorazine tabletsb. Prozac tablets d. Prolixin tablets

4. This family of drugs is especially effective in the treatment of bipolar disorder.

a. Lithium compounds c. Thorazine tabletsb. Prozac tablets d. Prolixin tablets

5. Neurologists often prescribe this drug to treat tension headache.

a. Tegretol tablets c. Dilantin capsulesb. Cafergot tablets d. Fiorinal tablets

6. This drug is a member of the ergot family of drugs found to be effective in treating migraineheadache.

a. Tegretol tablets c. Dilantin capsulesb. Cafergot tablets d. Fiorinal tablets

7. Two different neurological disorders for which Tegretol tablets are prescribed are

a. migraine headache and tension headache.b. migraine headache and cluster headache.c. epilepsy and trigeminal neuralgia headache.d. epilepsy and cluster headache.



Pediatricians

The term pediatrics covers medical care in children, frombirth through puberty (Figure 13). Pediatric care includesattention to nutrition and growth (mental and physical),immunization against infectious diseases, and the manage-ment of acute and chronic illnesses. Specialty certification bythe American Board of Pediatrics requires medical schoolgraduates to complete three years of graduate pediatric train-ing followed by two years of pediatric practice. The candidatemust then pass written and oral examinations.

One of the most common groups of drugs that the pediatri-cian will prescribe is the penicillin family. You’ll dispensemany types of penicillin products in dose forms that are easyfor children to take, such as liquids and chewable tabletsThese dose forms come in flavors like bubble gum, cherry,and other flavors to appeal to young patients. Penicillins areprescribed frequently by pediatricians because of the many

FIGURE 13—Pediatricians specialize in providing medical care for children.


ear and throat infections diagnosed in children. These infec-tions are usually caused by bacteria that can be eradicatedvery easily by some form of penicillin. The following is a list ofpopular penicillin products prescribed by pediatricians:

• Amoxil chewable tablets

• Pen-Vee K suspension

• Amcill suspension

• Augmentin suspension and chewable tablets

In some cases, the infectious bacteria in ear and throat infec-tions in children may be somewhat resistant to penicillin VKand the pediatrician will prescribe a type of antibiotic otherthan a penicillin VK. The more common antibiotics that areprescribed in place of these penicillins follow:

• Keflex suspension

• Ceclor suspension

• Pediamycin suspension and chewable tablets

• Augmentin suspension and chewable tablets

• Biaxin tablets

• Suprax tablets

• Ceftin tablets

Cardiologists

Cardiologists are doctors who treat diseases of the heart(Figure 14). The major diseases of the heart that are treatablewith drugs are congestive heart failure, in which the heartfails to pump blood adequately; arrhythmia, in which theheart beats in abnormal rhythm or skips beats; angina, inwhich the heart exhibits intense pain due to lack of oxygen;clot formation (embolism), in which a blood clot causes blockage of the arteriole system of the heart muscle; andarteriosclerosis (commonly called “hardening of the arteries”)caused by high blood cholesterol.


Heart doctors have a wide variety of drugs at their disposalto treat each of these conditions. In congestive heart failure, digitalis (a cardiac glycoside) is used to improve the muscularcontraction of the heart muscle. This drug can induce whatseems to be a miraculous reversal of heart failure, and candramatically improve the cardiovascular health of the patient.

For arrhythmia, drugs known as antiarrhythmics can be usedto regulate the erratic beating of the heart.

In angina, a lack of blood flow to the heart muscle in thearteries of the heart causes severe pain that may feel likea heart attack. The blood flow in these arteries can beimproved with nitroglycerin tablets and other drugs thatdilate the arteries to allow increased blood flow. Drugs thatcause the heart to work less hard are also useful in thetreatment of angina.

Blood clots in the arteries of the heart can cause a shutdownof cardiac circulation, eventually leading to death. Drugs thatprevent blood clot formation are called anticoagulants.

High cholesterol levels in the blood can be treated by drugsthat block the formation of cholesterol in the liver. Thus, lesscholesterol is available to produce arteriosclerosis.

FIGURE 14—Cardiologiststreat the major diseasesof the heart.


Drugs prescribed by cardiologists to reverse congestive heartfailure are

• Digoxin or Lanoxin

• Digitoxin

Drugs that can help an abnormal heart rhythm to return tonormal are

• Amiodarone

• Adenosine, or Adenocard

• Quinidine

• Verapamil

• Metoprolol, or Lopressor

• Digoxin, or Lanoxin

• Sotalol, or Betapace

Drugs that dilate blood vessels are

• Nitroglycerin tablets or skin patches

• Procardia tablets

• Cardizem tablets

Drugs that slow down the workload of the heart are

• Propranolol, or Inderal

• Tenormin

• Metoprolol, or Lopressor

A cardiac patient may also be prescribed an anticoagulantdrug to prevent the formation of blood clots. A popular anti-coagulant is warfarin, with the brand names of Coumadinand Jantoven.

The following are some drugs that lower blood cholesterol:

• Mevacor tablets

• Zocor tablets

• Lopid tablets


Hypertension is the technical term for high blood pressure.In the human body, the blood pressure is the amount offorce exerted by the blood against the inner walls of theblood vessels as it circulates. If this pressure is too strong,it can cause damage to the blood vessels and lead to seriousillnesses. Hypertension, if left untreated, can lead to long-term damage of organs such as the heart and kidneys, leadto stroke, and eventually result in a shorter life expectancy.High blood pressure is also a significant risk factor for thedevelopment of major cardiovascular complications, includingcongestive heart failure and coronary heart disease.

A person’s blood pressure can be measured with a devicecalled a sphygmomanometer (blood pressure meter) by apply-ing an inflatable cuff to the upper arms (Figure 15). A restingblood pressure reading of 120/80 (spoken as “one twentyover eighty”) is considered to be normal or healthy. A healthyperson’s blood pressure reading will often be higher than120/80 if he or she is exercising or under stress. However, aresting blood pressure reading that’s significantly higher than120/80 may indicate hypertension.

Unfortunately,hypertension is avery common condi-tion that affectsmillions of people inthe United States.It’s usually treatedby cardiologists orby family practicephysicians. However,there are also physi-cians calledhypertensionspecialists who spe-cialize in treatinghypertension.Hypertension spe-cialists will usuallybe found in majormedical centers orteaching hospitals.

FIGURE 15—There areapproximately 50 millionpatients with high bloodpressure in the UnitedStates.


Sometimes, high blood pressure can be reduced by a combi-nation of exercise, low-fat diet, weight loss, and lowered saltintake. If these modifications in lifestyle aren’t completelysuccessful in restoring normal blood pressure, then drugtherapy may be added to the regimen.

There are several ways that drugs can act to treat hyper-tension. Diuretic drugs reduce the amount of fluid in thecardiovascular system through the process of diuresis(elimination of sodium and water by the kidneys). Less fluidin the cardiovascular system results in lower blood pressure.

A second method is to dilate (open up) the arteries, which willresult in a reduction of high blood pressure. One type of drugthat dilates the blood vessels is the ACE inhibitor (short forangiotensin converting enzyme inhibitor). Another type of drugthat relaxes the heart muscles and the blood vessels is thecalcium channel blocker (CCB). These drugs slow the heartrate, dilate the blood vessels, and reduce the heart’s output.

Another way to treat hypertension is to slow down the heart-beat and reduce the contraction force of the heart, thuscausing less blood volume from the heart to pass into theblood vessels. Less blood volume in the blood vessels willresult in a reduction of blood pressure. Drugs that slow downthe heart rate and reduce the volume of the heart’s outputare called beta receptor antagonists, or simply beta-blockers.

There are approximately 50 million patients with hyper-tension in the United States, and many of them are beingtreated with antihypertensive medications. As a pharmacytechnician, you’ll be dispensing many prescriptions writtento treat hypertension. There are dozens of antihypertensivedrugs on the market today.

Drugs prescribed to cause dilation of the arteries are

• Nifedipine, or Procardia tablets

• Diltiazem, or Cardizem

• Nitroglycerin sublingual tablets

• Enalapril, or Vasotec tablets


Some common diuretic drugs that are prescribed to causeloss of sodium and water from the kidneys are

• Hydrochlorothiazide (abbreviated HCT or HCTZ)

• Chlorothiazide, or Diuril

• Chlorthalidone, or Hygroton

• Indapamide, or Lozol

• Methyclothiazide, or Enduron

• Metolazone, or Zaroxolyn

• Furosemide, or Lasix

• Dyazide tablets

• Bumetanide, or Bumex

• Amiloride, or Midamor

• Spironolactone, or Aldactone

• Triamterene, or Dyrenium

Some common beta-blocker drugs that are prescribed toreduce the strength of contractions of the heart are

• Propranolol or Inderal

• Metaprolol or Lopressor

• Atenolol or Tenormin

• Acebutolol or Sectral

• Bisoprolol or Zebeta

• Nadolol or Corgard

• Timolol or Blocadren

The following are some common ACE inhibitors:

• Benazepril, or Lotensin

• Captopril, or Capoten

• Fosinopril, or Monopril

• Lisinopril, or Prinivil


• Quinapril, or Accupril

• Ramipril, or Altace

The following are some common calcium channel blockers:

• Amlodipine, or Norvasc

• Felodipine, or Plendil

• Isradipine, or DynaCirc

• Nicardipine, or Cardene

• Verapamil, or Verelan

Before going on to learn about drugs prescribed by otherhealthcare practitioners, take time to complete Self-Check 6.


Self-Check 61. A group of drugs that the pediatrician will often prescribe to treat ear and throat infections is

known as

a. phenothiazines. c. antitussives.b. antihistamines. d. penicillins.

2. Cardiologists prescribe these drugs to prevent arteriosclerosis.

a. Antiarrhythmics c. Drugs to lower cholesterolb. Anticoagulants d. Artery vasodilators

3. These types of drugs will prevent artery occlusion and angina.

a. Antiarrhythmics c. Drugs to lower cholesterolb. Anticoagulants d. Artery vasodilators

4. An example of a beta-blocker drug for angina is

a. Inderal tablets. c. Coumadin tablets.b. Nitroglycerin tablets. d. Lopid tablets.

5. This drug is prescribed as an anticoagulant.

a. Coumadin tablets c. Inderal tabletsb. Lopid tablets d. Nitroglycerin tablets

6. This drug is called a diuretic and is used to lower high blood pressure.

a. Digitalis c. Procardia tabletsb. HCTZ (hydrochlorothiazide) d. Vasotec tablets

7. This drug causes dilation of the arteries to lower high blood pressure.

a. Digitalis c. Procardia tabletsb. HCTZ (hydrochlorothiazide) d. Keflex suspension



OTHER HEALTHCARE PRACTITIONERS AS PRESCRIBERS

Dental Prescribers

In dentistry, drugs can play an important part in a patient’soverall care. Dentists prescribe many types of medications,for pain, to treat infection, and to treat oral diseases.Dentistry consists of a number of specialties, and somedental specialists prescribe more drugs than others.

The following sections describe the dental specialties that arerecognized by the American Dental Association (ADA), andlist some of the medications you’ll fill and dispense fromthese dental prescribers. These specialties all require certifi-cation by a board of examiners and reviewers. In general,these specialties require two to five years of postgraduatetraining after graduation from an accredited dental school.After completion of the postgraduate program in the givenspecialty, certification can be approved after passing awritten and oral examination given by the specialty board.

Orthodontists and Prosthodontists

These two specialists account for the least drug use in thetreatment of the dental patient. Orthodontists specialize inthe diagnosis of malocclusion (misalignment of the upper jawto the lower jaw and the misalignment of associated teethand mouth structures) and the correction of the misalign-ments by the repositioning of the crooked teeth with bracesand other appliances. Prosthodontists specialize in makingand fitting dentures (false teeth) for patients who have losta portion or all of their teeth. Orthodontists will occasionallyprescribe drugs that act to dry the inside of the mouth(reduce saliva formation) in order to be better able to placeorthodontic appliances on the teeth. Prosthodontists mayoccasionally prescribe a cream or ointment to treat gum irritation caused by ill-fitting dentures.


Periodontists

Periodontists are dental specialists who study and treat gum disease. It’s estimated that 50 percent of people overthe age of 35 in the United States will acquire some form ofgum disease (Figure 16). Periodontists diagnose the causes ofgum disease and treat the disease with improvement in oralhygiene, drug therapy, and surgery. As a result, periodontistswill prescribe many types of antibiotics to treat gum diseaseand analgesics to reduce pain after periodontal surgery.

Endodontists

Endodontists are dentists who treat disorders of the toothpulp, which is located inside the tooth and extends intothe canals inside the root of the tooth. These canals carrythe nerves and the blood supply that provides the toothwith nutrients. Occasionally, the tooth pulp canal becomesinfected with bacteria, causing severe inflammation and painthat results in a classic “toothache.” Instead of removing theoffending tooth from the mouth, endodontists save the toothby removing the inflamed tissue from the canal and insertinga soothing material into the canal. This procedure is referredto as a root canal. Endodontists will prescribe painkillers and

FIGURE 16—Gum diseaseis very common in adultsover age 35.


anti-inflammatories to reduce the pain prior to the root canalprocedure. They may also prescribe antibiotic medicines toreduce the infection in the root canal.

Oral and Maxillofacial Surgeons

Oral and maxillofacial surgeons perform surgery on the oralcavity and associated facial structures. These surgeriesinclude tooth extractions (removing teeth), resetting the jawfor better occlusion (bite alignment), trauma surgeries,repairs to facial deformities, and the removal of head andneck tumors. Oral and maxillofacial surgeons often prescribepainkillers to treat postoperative pain. They also prescribeantibiotics to treat bacterial infections of the oral cavity.Occasionally, these practitioners will prescribe tranquilizersand sedatives to relax the patient prior to surgery.

Pediatric Dentists

Pediatric dentistry is the specialty that provides dental care tochildren and adolescents. Very few drugs are ever prescribedby pediatric dentists because much of the dental treatmentfor their patients deals with routine checkups and restorationof teeth destroyed by cavities. Occasionally, fluoride prepara-tions are prescribed for children who live in areas withoutfluoridated water. Fluoridated water has been shown to pre-vent cavities in children and adults.

General Practice Dentists

The dentist in general practice provides dental care rangingfrom teeth cleaning, to restorative procedures on teeth, tominor surgery such as simple extractions, to simple rootcanal procedures, and simple orthodontic treatments. Thesedentists prescribe many types of medications, includingpainkillers (analgesics), antibiotics, tranquilizers and seda-tives, and anti-inflammatories. Occasionally, the dentist willbe required to prescribe an antibiotic for the patient who hasa history of rheumatic fever or heart infection. The antibioticis given to the patient before dental treatment as a protection


against any damaging bacteria getting to the heart from themouth during dental procedures. Three antibiotics that areprescribed by general practice dentists are amoxicillin, erythromycin, and clindamycin.

Oral Medicine/Oral PathologySpecialists

These dentists are specialists who treat diseases of the headand neck and the soft tissues of the oral cavity. They’rethought of as the “doctors of the mouth.” They diagnose andtreat oral pain and jaw pain; they treat bacterial infections,fungal infections, and viral infections of the mouth; andthey treat ulcerations of the soft tissues and tongue. Thesespecialists also diagnose and treat head and neck cancer.To treat these disorders, many different types of medicationsare prescribed by these practitioners. These drugs includeanalgesics to reduce pain, antibiotics to eradicate infectionscaused by bacteria, antifungal medicines, antiviral medicines,agents to help heal mouth ulcers, and drugs to treat cancer.

Painkillers frequently prescribed by dentists are

• Motrin tablets

• Vicodin tablets

• Tylenol with codeine tablets

Antibiotics frequently prescribed by dentists are

• Penicillin VK tablets

• Amoxicillin tablets


• Clindamycin tablets

• Flagyl tablets

• Tetracycline capsules

Antifungals frequently prescribed by dentists are


• Nizoral tablets


• Mycelex troches

Antivirals frequently prescribed by dentists are

• Zovirax capsules

Other drugs frequently prescribed by dentists are

• Valium for tranquilization

• Kenalog for denture irritation

• Probanthine to dry the mouth

Other healthcare prescribers will now be discussed.

Podiatrists

Podiatrists are trained to treat medical problems of the feet.Doctors of podiatry graduate from schools of podiatric medi-cine that offer a four-year curriculum after graduation froma four-year baccalaureate college. Podiatry deals with theexamination, diagnosis, treatment, and prevention of diseasesaffecting the foot. Podiatrists therefore write prescriptionsfor medications to treat foot disorders. Disorders of the footinclude foot pain, circulatory disorders, nerve disorders, skinand toenail disorders, tumors and cysts, arthritic and inflam-matory disorders, and trauma. As a pharmacy technician,you’ll see many types of medicines prescribed by podiatrists.

Medicines to treat foot pain are

• Aspirin-type analgesics

• Motrin/Advil-type analgesics

• Codeine-type analgesics

Medicines to treat bacterial infections of the foot are

• Penicillins

• Other type antibiotics


Medicines to treat inflammatory conditions (arthritic pain) ofthe foot are

• Motrin tablets

• Indocin capsules

Medicines as topical rubs to treat general conditions of thefoot are

• Antibiotic ointments

• Antifungal ointments

• Corticosteroid ointments

• Steroid-antibiotic combination ointments

• Enzyme preparations

Medicines used as soaks for the feet are

• Wet dressings and soaks with antibacterial agents suchas Betadine or chlorhexidine gluconate

• Domeboro tablets

Nurse Practitioners

The nurse practitioner (NP) is a professional nurse trained toprovide a full range of primary care services in a communitysetting. The American Nurses Association has described thefunctions of the NP in the original Nurse Training Act of 1971to be, in part, “obtaining a health history; assessing health-related status; entering a person into the healthcare system;sustaining and supporting persons who are impaired, infirm,or ill, and during programs of diagnosis and therapy; manag-ing a medical care regimen for acute and chronically illpatients within established standing orders.” Permission forthe nurse practitioner to write prescriptions is controlled byeach state. Today, nurse practitioners in all 50 states have atleast some authority to write prescriptions.

Standing orders are medical guidelines of patient carefor specific diseases such as hypertension, diabetes, andpharyngitis (sore throat). These guidelines are usually estab-lished by a committee of the faculty of a medical school.


A typical standing order includes the definition and etiology(cause) of the disease, clinical features of the disease, andlaboratory values for diagnosis and treatment procedures,including appropriate medicines to be prescribed. Dependingon the state in which the NP practices, he or she may writeand sign prescriptions on standing orders of the doctor ormay need to have the prescription signed by a supervisingphysician. A nurse practitioner usually has a four-yeardegree plus certification, while a nurse may have a two-yearor four-year degree.

Some typical prescriptions written by NPs are for penicillinor erythromycin as an anti-infective for sore throat, HCTZ(hydrochlorothiazide) as a diuretic for high blood pressure,and insulin for diabetes.

Practitioners of Alternative Medicine

Alternative medicine is defined as any method of healing ortreating disease that’s not part of the conventional or tradi-tional medical system in the United States. Some areas ofalternative medicine include chiropractic (manipulating thespine and musculoskeletal system), naturopathic medicine(the use of good nutrition and natural remedies to healthe body), herbalism (the use of plant-based remedies), andtraditional Chinese medicine. Complementary medicine refersto certain practices of alternative medicine that may be usedalong with mainstream medical treatments.

A practitioner of alternative medicine is trained to provideservices in their chosen field, but he or she is not a licensedphysician. Therefore, practitioners of alternative medicine arenot authorized to write prescriptions for any of the drugsfound in a traditional pharmacy. However, practitioners ofalternative medicine may suggest or recommend the use ofplant-based remedies or dietary supplements to their clients.Plant-based remedies and herbal supplements can be pur-chased over-the-counter, without a prescription, in healthfood stores, herb shops, and vitamin stores (Figure 17).

It’s important to be aware that alternative medicine is acomplex and controversial topic. Most alternative treatmentshaven’t been tested in a laboratory (or simply can’t be

tested), and there’s little scientific evidence to supporttheir effectiveness. Therefore, many scientists and licensedphysicians don’t support the use of alternative treatmentsbecause they haven’t been proven to work.

However, some physicians don’t object to the use of alterna-tive treatments as long as the treatment does no harm, andtheir patients feel they benefit from it. Alternative treatmentsmay help to reduce stress and make the patient feel better,and some physicians may allow their use for this purpose.

For example, a cancer patient who is being treated withsurgery and traditional chemotherapy may want to tryaromatherapy to reduce stress. (In the practice of aroma-therapy, pleasant-smelling herbal or floral extracts are usedto promote feelings of health and well-being.) On review, thephysician judges that the procedure is harmless and won’thave an impact on the patient’s usual medical treatment, sothe patient is allowed to receive the aromatherapy.


FIGURE 17—Practitioners of alternative medicine may suggest herbal remedies to their clients.

On the other hand, it’s important to be aware that herbalremedies (and even ordinary vitamin supplements) can inter-act with prescription drugs. Plant-based remedies aren’tharmless; they can cause dangerous drug interactions, resultin allergic reactions, or prevent drugs from working properly.For this reason, physicians take a cautious approach to alter-native remedies, and usually ask their patients to report anyherbal remedies or dietary supplements they’re using.

Community and hospital pharmacies don’t ordinarily stockherbal remedies or dietary supplements and as a pharmacytechnician, you won’t be dispensing remedies prescribed bypractitioners of alternative medicine. However, because of thepopularity of these remedies, it’s a good idea for you to beaware of them and familiar with some of their names.

The following are some of the more popular herbal remediesand supplements and their suggested uses:

• Echinacea, for symptoms of the common cold

• Ginkgo biloba, to improve memory and mental alertness

• Eucalyptus oil, as a natural insect repellent

• Garlic, to mildly lower total cholesterol levels and bloodpressure

• Peppermint tea, for stomach upset

• Aloe vera juice, for mild cuts, burns, and eczema

• Ginseng, as a general energy tonic



Veterinarians

Veterinarians are specialists who are trained to diagnoseand treat illness and disease in animals. To obtain a degreein veterinarian medicine, the candidate must attend a four-year veterinary school after completing a four-year collegeundergraduate program. Veterinarians prescribe many typesof drugs to treat animal disease and you’ll see many prescrip-tions written by veterinarians (Figure 18). Veterinarians asprescribers is presented as a separate topic in another study unit.

Before going on to learn about healthcare professionals whocan’t write prescriptions, or who have prescription writingrestrictions, take time to complete Self-Check 7.

FIGURE 18—Veterinariansprescribe medications foranimals, both householdpets and farm livestock.


Self-Check 71. These healthcare professionals can’t legally write prescriptions in every state.

a. Podiatrists and periodontistsb. Homeopathic physicians and veterinariansc. Nurse practitionersd. Nurse practitioners and general practice dentists

2. Which of the following herbal remedies is commonly suggested for the relief of minor burns?

a. Echinaceab. Peppermint teac. Garlicd. Aloe vera juice

3. A periodontist would prescribe this type of medicine to treat gum disease.

a. Antibioticb. Codeine-type analgesicc. Anti-inflammatory cream such as corticosteroidd. A drug to dry the mouth

4. An endodontist may prescribe a medication like this to treat toothache.

a. Antibioticb. Tranquilizersc. Anti-inflammatory cream such as corticosteroidd. A drug to dry the mouth

5. These specialized dentists, or “mouth doctors,” treat diseases of the head and neck and softtissues of the mouth.

a. Family dentistsb. Oral medicine/oral pathology specialistsc. Pediatric dentistsd. Prosthodontists



HEALTHCARE PROFESSIONALSWITH PRESCRIPTION-WRITINGRESTRICTIONS

Chiropractors

Chiropractic treatment is a system of healing based upon thetheory that disease results from a lack of normal nerve func-tion. The chiropractor employs scientific manipulation andspecific adjustment of body structures like the spinal columnand utilizes physical therapy when necessary. Drugs aren’t apart of chiropractic treatment.

Physician Assistants (PAs)

Physician assistants (PAs) are members of the healthcareteam who work with, and under the supervision of, physicians.They provide medical services as assistants to physicians.They’re trained to obtain patient medical histories, performcomprehensive physical examinations, order diagnostic tests,perform routine medical procedures, develop patient manage-ment plans, and are trained in patient counseling. In 39 statesand the District of Columbia, physician assistants may writeprescriptions. This trend is anticipated to continue, allowingphysician assistants to write prescriptions in most states.

Nurses

Nurses provide comprehensive patient care and treatment butaren’t allowed to prescribe medications except to a limitedextent as a nurse practitioner.


Pharmacists

Pharmacists are experts in pharmacology and keep currentwith advances in drug therapy. Their role is to dispensemedications upon the request of a prescriber and to provideexpertise to the patient in the proper use of the medication.A few states have passed legislation allowing some limitedprescribing by pharmacists. For the most part, however,pharmacists aren’t allowed to prescribe medications.

Pharmacy Technicians

Pharmacy technicians aren’t legally allowed to prescribe medications. Your role is to dispense medications undersupervision of the pharmacist, not to prescribe medications.

Dental Hygienists

These dental professionals complete a two-year or four-yeartraining program in dental hygiene and function in theimportant role of prevention of oral disease. Although they’relicensed by a governing board to diagnose oral disease andcounsel patients in oral hygiene, prescription writing mustlegally be performed by the dentist.

Dental Assistants

These professionals assist the dentist in the delivery of dentalcare but aren’t trained to diagnose oral disease or to providedirect dental treatment. Therefore, they have no legal author-ity to prescribe drugs.

Take time now to complete Self-Check 8.


Self-Check 81. A few states have granted limited authority for these healthcare professionals to write

prescriptions.

a. Pharmacy technicians c. Chiropractorsb. Dental hygienists d. Pharmacists

2. These professionals are licensed to diagnose oral disease but aren’t licensed to write prescriptions.

a. Dental hygienists c. Chiropractorsb. Dental assistants d. Pharmacy technicians

3. This is a practice based on a theory that disease results from lack of normal nerve functionand that medications aren’t needed to restore health.

a. Chiropractic c. Dentistryb. Osteopathy d. Pharmacy



NOTES

71

Self-Check 11. d

2. b

3. b

4. c

5. c

6. a

Self-Check 21. c

2. a

3. d

4. c

5. a

6. c

Self-Check 31. d

2. a

3. b

4. b

5. d

6. a

7. d

8. b

Answers

Answers

Self-Check Answers72

Self-Check 41. a

2. c

3. b

4. a

5. c

6. d

Self-Check 51. d

2. b

3. c

4. a

5. d

6. b

7. c

Self-Check 61. d

2. c

3. d

4. a

5. a

6. b

7. c

Self-Check Answers 73

Self-Check 71. c

2. d

3. a

4. a

5. b

Self-Check 81. d

2. a

3. a

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