Applied Pharmacology

• Theories of Concordance

  Shared Decision Making:

  • Definition: A collaborative approach where healthcare professionals and patients make decisions together based on the best available evidence and the patient's preferences.
  • Key Components: Information exchange, deliberation, and agreement on the chosen treatment plan.
• Theories of Concordance

  Transtheoretical Model of Change:

  • Stages: Precontemplation, contemplation, preparation, action, maintenance, and termination.
  • Process: Individuals progress through these stages as they change their health behaviors.
• Patient Engagement with Rehabilitation or Medical Treatment

  Terms:

  • Adherence: The extent to which a patient follows a prescribed treatment regimen.
  • Compliance: Historically used interchangeably with adherence, but with a more paternalistic connotation.
  • Concordance: Emphasizes collaboration between patients and healthcare providers in treatment decision-making.
• Patient Engagement with Rehabilitation or Medical Treatment

  Terms:

  • Adherence
  • Compliance
  • Concordance
• Impact and Consequences of Non-Engagement

  Consequences:

  • Disease Progression: Lack of engagement can lead to worsening symptoms and progression of the underlying condition.
  • Complications: Non-compliance with medication or rehabilitation regimens can result in avoidable complications or hospitalizations.
  • Reduced Quality of Life: Failure to engage with treatment can negatively impact overall well-being and functional abilities.
• Impact and Consequences of Non-Engagement

  Consequences:

  • Disease Progression
  • Complications
  • Reduced Quality of Life
• Reasons for Non-Engagement

  Barriers:

  • Lack of Understanding: Patients may not fully comprehend the importance of treatment or rehabilitation.
  • Fear: Fear of side effects, pain, or the unknown can deter patients from engaging.
  • Logistical Challenges: Issues such as transportation, financial constraints, or time constraints can hinder participation.
• Encouraging Patient Engagement

  Strategies:

  • Education: Providing clear, understandable information about the condition and treatment options.
  • Shared Decision Making: Involving patients in treatment decisions empowers them and increases commitment to the chosen plan.
  • Tailored Approaches: Considering individual patient preferences, beliefs, and circumstances when developing treatment plans.
  • Support Systems: Offering resources, support groups, or counseling to address barriers and provide encouragement.
• Encouraging Patient Engagement

  Strategies:

  • Education
  • Shared Decision Making
  • Tailored Approaches
  • Support Systems
• NSAIDs:

  • Pharmacokinetics: Rapid absorption from the gastrointestinal tract, primarily metabolized in the liver, and excreted in the urine. Inhibit cyclooxygenase enzymes, reducing inflammation and pain.
  • Pharmacodynamics: Block prostaglandin synthesis, resulting in analgesic, anti-inflammatory, and antipyretic effects.
• Paracetamol:

  • Pharmacokinetics: Well-absorbed from the gastrointestinal tract, metabolized in the liver, and excreted in the urine. Mechanism of action not fully understood but involves central inhibition of prostaglandin synthesis.
  • Pharmacodynamics: Exhibits analgesic and antipyretic effects but has minimal anti-inflammatory activity.
• Opiate Analgesics:

  • Pharmacokinetics: Highly lipid-soluble, allowing rapid penetration of the blood-brain barrier. Metabolized in the liver and excreted in the urine. Bind to opioid receptors in the central nervous system, modulating pain perception.
  • Pharmacodynamics: Act on mu, kappa, and delta opioid receptors to produce analgesia, sedation, and euphoria.
• Theories of Concordance

  • Patient-Centered Care
  • Mutual Agreement
  • Active Participation
  • Positive Outcomes
• Theories of Concordance

  • Patient-Centered Care: Emphasizes collaboration between patients and healthcare professionals to make shared decisions about treatment plans.
  • Mutual Agreement: Both parties (patient and healthcare professional) agree on the treatment plan, taking into account the patient's preferences and values.
• Theories of Concordance

  • Active Participation: Patients actively engage in their treatment plans, understanding the rationale behind decisions and the importance of adherence.
  • Positive Outcomes: Concordance theory suggests that when patients are actively involved in decision-making, treatment adherence improves, leading to better health outcomes.
• Different Terms for Patient Engagement with Rehabilitation or Medical Treatment

  • Adherence
  • Compliance
  • Concordance
  • Participation
• Different Terms for Patient Engagement with Rehabilitation or Medical Treatment

  • Adherence: Refers to the extent to which patients follow the instructions or recommendations provided by healthcare professionals regarding their treatment plans.
  • Compliance: Historically used but now considered outdated due to its paternalistic connotations, compliance implies patients passively following orders without considering their own preferences or circumstances.
• Different Terms for Patient Engagement with Rehabilitation or Medical Treatment

  • Concordance: Reflects a collaborative approach where patients and healthcare providers work together to reach agreements on treatment plans that align with the patient's preferences and values.
  • Participation: Indicates the active involvement of patients in decision-making processes regarding their treatment.
• Impact and Consequences of Non-Engagement with Rehabilitation or Medical Treatment

  • Worsening of Condition
  • Complications
  • Reduced Quality of Life
  • Financial Costs
• Impact and Consequences of Non-Engagement with Rehabilitation or Medical Treatment

  • Worsening of Condition: Failure to engage with treatment may lead to the exacerbation of symptoms or progression of the underlying disease or condition.
  • Complications: Non-adherence can increase the risk of complications, such as infections, hospital readmissions, or the need for more invasive interventions.
• Impact and Consequences of Non-Engagement with Rehabilitation or Medical Treatment

  • Reduced Quality of Life: Failure to follow prescribed treatments may result in diminished functional abilities, decreased independence, and poorer overall quality of life.
  • Financial Costs: Non-engagement with treatment can lead to increased healthcare costs due to the need for additional interventions or prolonged hospital stays.
• Possible Reasons for Non-Engagement in Rehabilitation or Medical Treatment

  • Lack of Understanding
  • Fear or Anxiety
  • Practical Barriers
  • Psychological Factors
  • Health Beliefs
• Possible Reasons for Non-Engagement in Rehabilitation or Medical Treatment

  • Lack of Understanding: Patients may not fully comprehend the importance of their treatment or the potential consequences of non-adherence.
  • Fear or Anxiety: Anxiety about treatment procedures, fear of side effects, or concerns about the effectiveness of treatment may deter patients from engaging fully.
• Possible Reasons for Non-Engagement in Rehabilitation or Medical Treatment

  • Practical Barriers: Issues such as financial constraints, transportation difficulties, or scheduling conflicts may hinder patients' ability to adhere to treatment plans.
  • Psychological Factors: Depression, denial, or a sense of hopelessness can all contribute to non-engagement with treatment.
  • Health Beliefs: Cultural or personal beliefs about illness and treatment may influence patients' willingness to adhere to medical advice.
• Ways to Encourage Patient Engagement

  • Education
  • Shared Decision-Making
  • Support Systems
  • Tailored Approaches
  • Regular Follow-Up
• Ways to Encourage Patient Engagement

  • Education: Providing clear, understandable information about the condition, treatment options, and potential benefits of adherence can empower patients to take an active role in their care.
  • Shared Decision-Making: Involving patients in treatment decisions and respecting their preferences fosters a sense of ownership and accountability.
• Ways to Encourage Patient Engagement

  • Support Systems: Offering support services such as patient advocacy groups, peer mentoring, or counseling can help address practical and emotional barriers to engagement.
  • Tailored Approaches: Recognizing individual needs and preferences and adapting treatment plans accordingly can enhance patient buy-in and motivation.
  • Regular Follow-Up: Monitoring patients' progress, addressing concerns promptly, and providing ongoing feedback and encouragement can reinforce engagement and adherence.
• Mechanism of Action of Corticosteroids : Corticosteroids bind to intracellular receptors, modulating gene expression and exerting anti-inflammatory and immunosuppressive effects.
• Administration Routes of Corticosteroids : Corticosteroids can be administered orally, topically, intravenously, intramuscularly, or via inhalation, depending on the condition being treated.
• Side Effects of Corticosteroids : Common side effects include weight gain, fluid retention, hypertension, hyperglycemia, osteoporosis, and increased susceptibility to infections.
• Mechanism of Action for Local Anesthetics such as Lidocaine

  • Mechanism of Action: Local anesthetics block voltage-gated sodium channels in neurons, preventing the generation and propagation of action potentials. This results in reversible loss of sensation in the area where the drug is applied.
• Drug Partitioning as a Key Process in the Activity of Local Anesthetics such as Lidocaine

  • Partitioning: Local anesthetics must partition into neuronal membranes to access their target (voltage-gated sodium channels). Lipid solubility is a key determinant of partitioning and thus affects the potency and duration of action of local anesthetics.
• Mechanism of Action for Common Antibiotics such as Penicillin-like Drugs and Erythromycin

  • Penicillin-like Drugs: Inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins, leading to cell lysis and death.
  • Erythromycin: Inhibits bacterial protein synthesis by binding to the 50S subunit of bacterial ribosomes, preventing peptide bond formation and inhibiting bacterial growth.
• Mechanisms of Antibiotic Resistance

  • Mutation: Bacteria can acquire mutations that confer resistance to antibiotics, allowing them to survive and proliferate in the presence of these drugs.
  • Horizontal Gene Transfer: Bacteria can exchange genetic material through mechanisms such as conjugation, transformation, and transduction, transferring antibiotic resistance genes between species.
  • Selection Pressure: Overuse and misuse of antibiotics create selective pressure, favoring the survival of resistant bacteria and driving the spread of resistance genes.
• Mechanisms of Antibiotic Resistance

  • Mutation
  • Horizontal Gene Transfer
  • Selection Pressure
• Topical Administration


  Corticosteroids applied directly to the skin or mucous membranes
• Intravenous Administration


  Corticosteroids injected directly into a vein
• Oral Administration


  Corticosteroids taken by mouth in the form of pills or tablets
• Intramuscular Administration


  Corticosteroids injected into a muscle
• Inhalation Administration


  Corticosteroids inhaled through a device like an inhaler