#1 Pharm

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immunosuppressants; uses and toxicities

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uses: prevention of organ rejection
toxicity: increase risk of infection, increase risk of neoplasm

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cyclosporine (Sandimmune)

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drug of choice for organ rejection (kidney, liver and heart) of allogenic transplant; used in some autoimmune diseases

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3 adverse effects of cyclosporine

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nephrotoxicity, infection, hepatotoxicity

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tacrolimus (Prograf)

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alternative to cyclasporine; somewhat more effective, but also more toxic; major concern of nephrotoxicity.

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3 uses of Glucocorticoids

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suppression of allograft rejection, treatment of asthma, and of rheumatoid arthritis (& other autoimmune diseases)

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cytotoxic immunosuppressants adverse effects

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bone marrow suppression; neutropenia, thrombocytopenia, and GI disturbances

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Methotrexate

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cytotoxic; suppresses rheumatoid arthritis

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3 uses of cyclooxygenase inhibitors

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suppress inflammation, relieve pain, reduce fever

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3 adverse effects of COX inhibitors

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gastric ulceration, bleeding, renal impairment

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2 classes of COX inhibitors

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Anti-inflammatory drugs: NSAIDs (aspirin)
Drugs w/out anti-inflammatory properties: acetomenophin (tylenol)

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what do NSAIDs inhibit that mediates inflammation?

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prostaglandin

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nonaspirin 1st generation NSAIDs

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ex: ibuprofen. reversible inhibition of COX1 and COX2; rheumatoid arthritis and osteoarthritis; do not protect against MI and stroke; fever reducers

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salicylism

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ringing in ears; a reaction to aspirin and other meds

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unique function of Aspirin

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suppresses platelet aggregation; protects in thrombotic disorders; protective against MI and stroke, lower incidence of cancers and alzheimers

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2nd generation NSAIDs

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(celebrex) inhibits only COX2; somewhat lower risk for GI side effects; increases risk for MI and stroke.

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acetominophen adverse reaction and treatment for o.d.

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very seldom side-effects in normal doses. hepatotoxicity; treatment for overdose: acetylcysteine

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stepped-care approach

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small dose and build up as needed, as recommended by American Health Association

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problems w/ stopping Glucocorticoids

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d/c can cause imbalance of glucose metabolism, fluid & electrolytes. important to taper off dosage.

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levels of Glucocorticoids

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low dose assists in adrenocortical insufficiency; high dose suppresses inflammation and immune response

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drug interactions of glucocorticoids

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insulin and oral hypoglycemics, live vaccines, NSAIDs

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contraindications of glucocorticoids

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systemic infections and live virus vaccines

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adverse effects of glucocorticoids

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infection, osteoporosis, glucose intolerance, fluid and electrolyte imbalance, psychologic disturbances, peptic ulcer disease, Iatrogenic Cushing's syndrome, cataracts and glaucoma

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nonbiologic DMARDs

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methotrexate

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major biologic DMARDs

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tumor necrosis factor inhibitors; etanercept (enbrel), Adalimumab (Humira)

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3 types of drugs used to treat Gout

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long term: Uricosuric drugs, NSAIDs, Glucocorticoids

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drug therapy for hyperuricemia

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Allopurinol (Zyloprim), Febuxostat (Uloric); inhibits production of uric acid

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antibiotic

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a chemical produced by one microbe that has the ability to harm other microbes

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antimicrobial agent

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any agent that has the ability to kill of suppress microorganisms

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ways to delay emergence of drug resistance

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avoid contaminating cultures, know when to say no to vanco, identify the organism as specific as possible, don't always treat the colonized person, treat the sick person.

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empiric therapy

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antibiotic therapy for patients before causative organism is positively identified in cases of immediate demand; narrow it down some based on location on body

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indications of antibiotic combinations

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mixed infections, prevention of resistance, decreased toxicity, enhanced bactericidal action

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prophylactic uses of antimicrobials

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surgery, prevention of endocarditis from dental procedure, neutropenia,

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misuses of antimicrobial drugs

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attempted treatment of untreatable infection, treatment of fever of unknown origin, improper dosage, treatment in the absence of adequate bacteriologic information, omission of surgical drainage

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monitoring antimicrobial therapy

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cultures, signs of improvement, serum drug levels

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reason for bacterial resistance of penicillin

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penicillinase

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classifications of penicillins

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narrow spectrum: penicillinase-sensitive, penicillinase-resistant; broad spectrum; extended spectrum

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penicillin G

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least toxic of all antibiotics; penicillins are most common cause of all drug allergies

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anaphylaxis

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laryngeal edema, bronchoconstriction, severe hypotension; treat w/ epinephrine stat

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prevention of allergic reaction to penicillin

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skin test

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augmentin

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common oral penicillin combination

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zosyn

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common hospital penicillin combination

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most widely used group of antibiotics

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cephalosporins

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ancef

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prototype drug of cephalosporin

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drug interactions of cephalosporins

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probenecid, alcohol, drugs that promote bleeding, calcium and ceftriaxone

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special use of cephalosporins

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can cross BBB

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carbapenems

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Beta-lactam antibiotics with low spectrum, low toxicity

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vancomycin

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otoxocity; reversible or permanent. nephrotoxicity. Red man syndrome--inflammatory response. Use in sever infections only

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aztreonam

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prototype of monobactam; narrow spectrum, parenteral, Beta lactam

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tetracyclines

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broad-spectrum, increasing bacterial resistance, used in atypical infections--lyme disease, cholera, anthrax, acne, peptic ulcer disease

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absorption of tetracyclines

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calcium supplements, milk products, iron supplements, magnesium-containing laxatives, most antacids can affect absorption

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adverse effects of tetracyclines

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discoloration of teeth, renal toxicity, hepatotoxicity, superinfection