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384 Cards in this Set

  • Front
  • Back
History of Medicinal Drugs
The very concept of an outside force influencing bodily function must be considered one of humanity's greatest advances.
History of Medicinal Drugs
Humans have used drugs to gain increased control over their lives and to make their lives better and longer. Throughout history, drugs have held a special fascination for humans.
History of Medicinal Drugs
Pharmacology is a broad term that includes the study of drugs and their actions on the body.
History of Medicinal Drugs
The twentieth century brought major breakthroughs in medical care. The first antibiotic, sulfa, was soon followed by penicillin.
Contemporary Pharmacology Practice
Observations of interactions between potent chemicals and living systems contribute to knowledge of biologic processes and provide effective methods for diagnosing, treating, and preventing many diseases. Compounds used for these purposes are called drugs.
Contemporary Pharmacology Practice
Drugs are derived from sources such as plant, animals, minerals, synthetic materials, and bioengineering advances.
Contemporary Pharmacology Practice
Billions of dollars are spent every year on alternative medicines. However, there is very little governmental regulation over this industry. These medications can also interact with prescription medications.
Drug Regulation
Laws govern the drug industry and protect patients' rights.
Drug Regulation
Medication guides must be provided to the patient on all dispensing of any drug for which the FDA requires a guide.
Drug Regulation
A Black Box warning makes the prescriber aware of any serious problems that have occurred with a drug since it has been on the market.
Drug Regulation
The FDA requires that all new drugs be proved effective and safe before they can be approved for marketing.
Drug Regulation
Controlled clinical trials, in which results observed in patients receiving the drugs are compared to the results of patients receiving a different treatment, are the best way to determine what a new drug really does.
Drug Regulation
When the benefits outweigh the risks, the FDA considers a drug safe enough to be approved.
Drug Regulation
Drugs are not tested on pregnant women, but based on all available information, drugs are grouped into safety categories for use during pregnancy.
Drug Regulation
Federal law divides controlled substances into five schedules according to their potential for abuse and clinical usefulness: C-I (research only), C-II (dispensing is severely restricted), C-III (can be refilled up to five times in six months if authorized by the physician), C-IV (same restrictions as C-III), C-V (may, depending on state law, be sold without a prescription)
Drug Regulation
Generic drugs must be equivalent to the brand-name drugs, and the FDA has devised an A/B rating system to establish this.
Drug Regulation
Pharmacy technicians can play an important role in helping patients identify ingredients in the OTC medications, especially when it is possible that the ingredients of a previously purchased OTC medication have changed.
FDA Food Health Claims
The FDA sets food labeling standards to ensure that consumers know what is in the food they are buying.
Drug Actions
A receptor is a molecule on the surface of or within a cell that recognizes and binds with specific molecules, producing some effect in the cell.
Drug Actions
By binding to receptors on or within body cells, drugs can mimic or block the action of chemical messengers to exert powerful and specific actions in the body
Drug Actions
One drug can compete with another drug for its intended receptor
Drug Actions
Pharmacokinetics is the study of the time course of absorption, distribution, metabolism, and excretion of drugs and their metabolites in relation to the time they are present in the body.
Drug Actions
The pharmocokinetic process is sometimes referred to as ADME.
Drug Actions
The primary sites of elimination are the kidney and the liver. Drugs may also be exhaled by the lungs or excreted in perspiration.
Drug Actions
Testing body fluids over time demonstrates how the body handles the drug.
Drug Actions
The volume of distribution is important for calculating the loading dose, clearance is important for calculating the maintenance dose, and half-life is important for determining the dosing interval.
Drug Effects
Drug effects include therapeutic effects, adverse reactions, and side effects.
Drug Effects
Drugs can interact with other drugs, food and the patient's own body.
Drug Effects
Two drugs may be subscribed together because the combination has fewer or more tolerable side effects than a high dose of either.
The Prescription
A request for the dispensing of medication to a patient is called an order in a hospital setting; outside the hospital setting it is called a prescription.
The Prescription
To fill a prescription or order, the pharmacy technician must understand the meanings of abbreviations. Certain abbreviations should not be used on prescriptions or instructions because there is extensive evidence to document them as the source of medication errors.
Correct Drug Adminstration "Rights"
The "rights" for correct drug administration are the right patient, the right drug, the right strength, the right route, and the right time.
Dosage Forms and Routes of Administration
The three primary routes of administration are oral, parenteral, and topical. The pharmacy technician must be familiar with each dosage form.
The Most Common Dosage Forms and Routes of Administration
Peroral (PO)- tablets, capsules, syrups, solutions, suspensions. Parenteral- intravenous (IV) injection, epidural injections, intramuscular injections, subcutaneous injections. Topical- ointments, creams, gels, suppositories, patches, lotions, inhalants.
Factors That influence Drug Action
Altered drug responses in the elderly are due to age-related in organ functions and body composition. These physiologic changes include visual, auditory, gastrointestinal, pulmonary, cardiovascular, renal, hormonal, and compositional alterations.
Factors That influence Drug Action
Some special problems of the elderly are poor nutrition, adverse drug reactions, and poor compliance with drug regimens.
Factors That influence Drug Action
There are some drugs that are especially hazardous when prescribed for elderly patients.
Factors That influence Drug Action
Empathy and not sympathy is very important for communication with the elderly.
Factors That influence Drug Action
Body surface area is the best measure to use in determining dosage for children, but is difficult to ascertain; consequently, weight is most frequently used.
Factors That influence Drug Action
Immunization is the process whereby the immune system is stimulated to acquire immunity to a specific disease.
Factors That influence Drug Action
The development of a safe and effective vaccines to prevent infectious diseases has been responsible for the substantial decline in morbidity and mortality associated with those diseases.
Factors That influence Drug Action
There are two types of histamines receptors. Antihistamines block the H1 receptors. A class of drugs referred to as H2 blockers blocks the H2 receptors.
Factors That influence Drug Action
An important role for the pharmacy technician is determining patient allergies.
Teaching Patients Medication Management
Patient compliance with the dose schedule and the specific requirements of a drug regimen is important.
Teaching Patients Medication Management
A pharmacy technician can positively influence patient drug therapy by accurately collecting and recording the patient's medication history in the patient profile.
Teaching Patients Medication Management
Pharmacy technicians can help patients understand how to read medication labels.
Teaching Patients Medication Management
Patients should read the information provided with OTC drugs to understand their action, interactions, cautions, and possible side effects.
Medication Safety
E-prescribing will eliminate poorly written prescriptions.
Medication Safety
Hospitals that use physician order entry (POE) have documented a decrease in errors.
Medication Safety
Medication reconciliation, a national patient safety goal, will prevent many errors.
Fighting Bacterial Infections
Bacteria are single celled organisms that occur in almost all environments. They can penetrate body tissues and set up areas of infection.
Fighting Bacterial Infections
Gram-negative bacteria predominate in the hospital environment and are often found in hospital acquired (nosocomial) infections.
Fighting Bacterial Infections
Gram positive bacteria are most commonly isolated in community acquired infections.
Fighting Bacterial Infections
General signs of infection that suggest a bacterial origin are fever (101F or greater) and an increased number (>12000/mm3) of white blood cells. The onset of fever alone is not diagnostic of bacterial infection.
Fighting Bacterial Infections
The outcome of antibiotic treatment is measured two ways:(1) the clinical response, meaning the signs and symptoms disappear, or (2) the microbiologic response, meaning the organism is completely eradicated.
Fighting Bacterial Infections
An antibiotic works in one of six ways: (1) preventing folic acid synthesis, (2) inhibiting cell wall formation, (3) blocking protein formation, (4) interfering with DNA formation, or (5) disrupting the cell membrane, or (6) disrupting DNA structure.
Fighting Bacterial Infections
An infection is an invasion of the body by pathogens, resulting in tissue response to organisms and toxins.
Fighting Bacterial Infections
Bacterial infections are contagious until antibiotics have been taken for 24 to 48 hours.
Fighting Bacterial Infections
A bactericidal agent kills bacteria.
Fighting Bacterial Infections
A bacteriostatic agent inhibits growth or multiplication of bacteria.
Fighting Bacterial Infections
A superinfection is a new infection that complicates the course of therapy of an existing infection. It is due to invasion by bacteria or fungi resistant to the drugs in use.
Fighting Bacterial Infections
Antibiotics may interfere with the effectiveness of birth control pills.
Penicillins
Penicillin has many therapeutic uses. Penicillin is the drug of choice for streptococcal infections. It is used in gram-positive infections.
Penicillins
Ampicillin and amoxicillin have broader antimicrobial spectrums than penicillin G and V. Amoxicillin is used more often because it is dosed only three times a day; ampicillin should be dosed four times a day. Many prescibers are unaware of this difference, so to get better coverage for the patient, they should be called when the drug is dosed inappropriately.
Penicillins
Penicillin is bactericidal in that it kills bacteria by preventing them from forming the rigid wall needed for survival. Human cells do not have cell walls and are, therefore, uninjured by penicillin.
Penicillins
Penicillin should be taken on an empty stomach with water because food slows its absorption. The acids in fruit juices or colas could deactivate the drug. The most common side effect of the penicillins is diarrhea.
Penicillins
Antibiotic prophylaxis is recommended for patients with a heart prosthesis, congenital heart disease, idiopathic hypertonic subaortic stenosis, a heart murmur, mitral valve prolapse, or a history of rheumatic heart disease.
Penicillins
Patients should be medicated 30 to 60 minutes before a surgical procedure, and then a dose or doses should be given afterward. This varies with the procedure. Dental prophylaxis recommends only a single 2g dose before dental procedures with no follow up.
Penicillins
A patient allergic to penicillin has a 1% possibility of also being allergic to cephalosporins, and vice versa. The pharmacy technician will find both allergies in the computer because most systems enter the drugs under penicillin-cephalosporins allergy.
Cephalosporins
Cephalosporins have a mechanism of action similar to penicillins but a broader spectrum of coverage.
Cephalosporins
The first-generation cephalosporins are similar to the penicillinase-resistant penicillins, with modest gram negative coverage. The second generation ones have broader coverage especially against H.influenza. The third generation is active against a wide spectrum of gram negative organisms. the new fourth generation cephalosporin is considered "broad spectrum" with both gram negative and somewhat less gram positive coverage.
Cephalosporins
Cephalopsporins are probably the most commonly used antibiotics because they cover a very wide range of organisms and have lower toxicity than other antibiotics with the same coverage.
Cephalosporins
Carbapenems, carbacephems, and monobactams are beta-lactams differing slightly form penicillins and cephalosporins.
Tetracyclines & Tigecycline
Tetracyclines are bacteriostatic. They are the drugs of choice for Rocky Mountain spotted fever ans Lyme disease, which are both transmitted by ticks.
Tetracyclines & Tigecycline
Patients taking tetracycline should be warned to avoid sun, dairy products, and antacids and to take the drug on an empty stomach. The exception to these effects is doxycyline, which accounts for its popularity.Children and pregnant women should not take tetracyclines.
Tetracyclines & Tigecycline
Always watch the expiration date on tetracyclines. It can be very dangerous to dispense one of these drugs if it is out of date. When most drugsreach their expiration date, they simply lose effectiveness. That is not true with tetracyclines; they can cause a fatal renal syndrome. This is especially important with the government is stocking in case of an anthrax attack.
Tetracyclines & Tigecycline
Manufacturers are packaging drugs to promote compliance, but this increases the cost. The same drug can be dispensed with the same instructions in less expensive packaging.
Tetracyclines & Tigecycline
A drug class related to the tetracyclines is glycyclines. There is only one drug in that class: tigecycline (Tygacil).
Macrolides
The macrolides are used primarily to treat pulmonary infections caused by Legionella and gram positive organisms.
Macrolides
As a rule of thumb, antibiotics are to be taken on a empty stomach to allow faster absorption into the bloodstream. A few, especially the older macrolides, are exceptions to this rule because they cause GI upset. In most cases, food will not lessen the effect of the antibiotic, but will just slow down the absorption rate. A sticker is placed on such antibiotics telling the patients to take the medication with food because their primary side effect is GI upset, and food intake can minimize this.
Quinolones
Quinolones are among the drug that penetrates bone and thus are good for bone joint infections. They have many other uses and are especially good for UTIs and upper respiratory infections. Quinolones should not be used in children or pregnant. A short course of some of the quinolones can knock out a UTI.
Quinolones
The primary side effect of the quinolones is GI upset. Antacids should not be taken with these drugs. They are phototoxic ans increase the risk of theophylline toxicity.
Streptogramins
Streptogramins are a drug class with side effects similar to those of the quinolones. They are the alternative for gram positive bacteria resistant to vancomycin. Since the drugs are such an important advance in antimicrobial therapy, they were approved under the accelerated approval regulations of the FDA. Synercid is a combination of two streptogramins.
Aminoglycosides
Aminoglycosides are used to treat very serious infections. They are ototoxic and nephrotoxic and may cause neuromuscular blockade. After initial dosing, they should be adjusted according to plasma concentration in the individual patient. Some current evidence supports once daily dosing; it can be as effective as multiple daily dosing and with fewer side effects.
Cyclic Lipopeptides
Cyclic lipopeptides are a new class of drugs that bind to bacterial membranes and cause the membranes to depolarize, leading to an inhibition of DNA and RNA synthesis. Daptomycin (Cubicin) belongs to this class.
Storage Of Liquid Antibiotics
After reconstitution, some antibiotics need to be stored in the refrigerator, whereas others my be kept at room temperature.
Storage Of Liquid Antibiotics
The pharmacy technician may give the patient information as to whether the drug needs to be refrigerated- it is not counseling.
Ophthalmic Antibiotics
Ophthalmic dosage forms may be used in the ear, but otic dosage forms should never be put in the eye.
Ophthalmic Antibiotics
Ophthalmic antibiotics are very expensive because of the stringent manufacturing requirements. The technician often needs to know which antibiotic is less expensive in order to advise the prescriber.
Treating Complications of Infections
Drotrecogin alfa (Xigris) which is not truly an antibiotic, is a powerful drug used to treat complications of severe sepsis. It is a recombinant form of Activated Protein . Its anticoagulant properties are very important.
Fungi & Fungal Diseases
A fungus is a microscope, eukaryotic organisms, such as mushrooms, yeasts, and molds, that reproduces by spores and does not contain chlorophyll. A difference between human and fungal cells is that human cells contain cholesterol, whereas fungi contain ergosterol. This difference is the basis for some antifungal drugs.
Fungi & Fungal Diseases
Systemic fungus diseases are most likely to develop in patients whose immune system is depressed by disease or drug therapy such as the use of corticosteroids or antineoplastics.
Fungi & Fungal Diseases
Women who take antibiotics frequently need an OTC antifungal medication to treat vaginitis, which occurs in response to the antibiotic activity.
Fungi & Fungal Diseases
Antifungal agents prevent the synthesis of erosterol, a building block for fungal cell membranes; or inhibit fungal cytochrome P-450, which is different form human cytochrome P-450; or interfere with the production of the fungal cell wall, which human cells do not have. Therefore, antifungal drugs have little effect on human cells.
Fungi & Fungal Diseases
Pulse dosing for fungal nail infections appears to be very effective, with fewer side effects and less costly than continuously daily dosing.
Viruses & Viral Infections
Viruses are highly specialized infectious agents that replicate within a cell by using the host cell's metabolic process.
Viruses & Viral Infections
A virus has a spectrum of cells it can infect, and only in the these can it multiply. These host cells can be animal, plant, and bacteria.
Viruses & Viral Infection
All virus-infected cells have some characteristics that are different from those of uninfected cells. These differences offer ways to block viral division without affecting normal cells.
Viruses & Viral Infection
Latency is a problem with viruses. They can lie dormant and then, under certain conditions, reproduce and behave once more like an infective agent, causing cells damage. Herpes virus and HIV both have this characteristic.
Viruses & Viral Infection
Some virus-infected cells produce interferon, which protects neighboring uninfected cells from viral infection.
Viruses & Viral Infection
Even though the body has defense mechanisms, such as producing interferons, some viruses can cause normal animal cells to be transformed into cancer cells.
Viruses & Viral Infection
A major problem in the development of antivirals is the intimate relationship between host and virus. The search for selective inhibitors of viral activity that are not too toxic to the human host is a major area of research. The use of interferons from outside the body is the leading the way.
Viruses & Viral Infections
Hepatitis B is a viral infection. When someone is diagnosed with HIV, it is no longer an early death sentence, but a chronic disease.
Systemic Antifungal
Acyclovir
(Zovirax)
IV form of this drug of choice for a form of herpes encephalitis and severe herpes in immunocompromised persons.
Viruses & Viral Infections
Famciclovir (Famvir), Acyclovir (Zovirax), and Valacyclovir (Valtrex) are used to manage acute herpes zoster.
Viruses & Viral Infections
Amantadine (Symmetrel) and Rimantadine (Flumadine) can be prescribed for influenza prophylaxis or treatment. Flumadine has fewer side effects. Symmetrel is also used for Parkinsons Disease.
Viruses & Viral Infections
Ganciclovir (Cytovene) is primarily used in treating cytomegalovirus (CMV) infections in immunocompromised patients. When mixing this drug, technicians must use chemotherapy agent precautions, and the drug must be labeled appropriately. It is also very important that hydration (IV fluids) orders accompany an order for this drug. If these orders are missing, contact the prescriber.
Viruses & Viral Infections
An inhalation antiviral is Ribavirin (Virazole). Maximum absorption occurs with use of aerosol generator via endotracheal tube. Side effects are fatigue, headache, and insomnia. Virazole is especially useful in patients with respiratory syncytial virus (RSV), which usually occurs in children. Pregnant women must avoid exposure to ribavirin.
Viruses & Viral Infections
Ganciclovir (Vitrasert) is an ophthalmic antiviral.
HIV-AIDS & Antiretroviral Agents
Human immunodeficiency virus (HIV) is a retrovirus. It copies its RNA onto DNA using the reverse transciptase enzyme and inserts the copy into the DNA of the host cell.
HIV-AIDS & Antiretroviral Agents
Nucleoside reverse transcriptase inhibitors (NRTIs) mimic a DNA building block to preventing the multiplication of the virus.
HIV-AIDS & Antiretroviral Agents
Zidovudine or AZT (Retrovir) was one of the first drugs available specifically for treatment of HIV. (Even though you need to know what AZT means, do not use this abbreviation for this drug, it could lead to medication errors).
HIV-AIDS & Antiretroviral Agents
Nucleotide reverse transciptase inhibitors (NtRTIs) mimic a DNA building block to stop the formation of the DNA copy with less toxicity than with NRTIs.
HIV-AIDS & Antiretroviral Agents
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) inhibit the action of reverse transcriptase, preventing the formation of the DNA copy of viral RNA.
HIV-AIDS & Antiretroviral Agents
Protease inhibitors (PIs) inhibit the protease enzyme, which cleaves certain HIV protein precursors that are necessary for replication of the virus.
HIV-AIDS & Antiretroviral Agents
Fusion inhibitors and chemokine coreceptors prevent HIV from entering the immune cells.
HIV-AIDS & Antiretroviral Agents
An integrase inhibitor blocks the enzyme integrase, which inserts DNA produced by reverse transcriptase into the patient's DNA.
HIV-AIDS & Antiretroviral Agents
The standard of care for HIV patients involves the combination of three or more antiretroviral drugs. Since these regimens are often complex and difficult to follow, compliance is an issue. None of the current drugs can eradicate the disease,but they can improve immunological status and prolong life. Some drug combinations should be avoided; didanosine with stavudine and zalcatabine, zidovudine with stavudine.
HIV-AIDS & Antiretroviral Agents
More and more manufacturers are combining these drugs into one tablet in order to decrease pill load and improve compliance. This is very important because partial compliance in these patients can lead to drug resistance.
The Nervous System
The primary CNS transmitters are acetylcholine, norepinephrine, dopamine, GABA, glutamate, serotonin.
The Nervous System
The primary PNS transmitters are acetylcholine and norepinephrine.
The Nervous System
The major transmitters of the sympathetic system are acetylcholine, norepinephrine, dopamine, and epinephrine.
The Nervous System
The only transmitter of the parasympathetic system is acetylcholine.
The Nervous System
If a drug is classified as an acetylcholinergic, the followingside effects may occur decreased GI motility, decreased sweating, decreased urine, pupil dilation dry eyes, and dry mouth.
Anesthesia
Drugs that allow painless, controlled surgical, obstetric, and diagnostic procedures constitute the cornerstone of modern pharmacologic therapy. The hallmark of anesthetic drugs is controllability. For this reason, most potent anesthetics are gases or vapors.
Anesthesia
One anesthetic may be superior to another, depending on the clinical circumstances. Final selection is based on those drugs and anesthetic techniques judged safest for the patient.
Anesthesia
General anesthesia is the unique condition of reversible unconsciousness and absence of response to stimulation. It is characterized by four reversible actions: unconsciousness, analgesia, skeletal muscle relaxation, and amnesia on recovery.
Anesthesia
The purposes of premedication are sedation, helping with postoperative pain relief, and reducing anxiety.
Anesthesia
Dantrolene (Dantrium) is a skeletal muscle relaxant; it is the drug of choice to treat malignant hyperthermia.
Anesthesia
The advantage of nitrous oxide is that it is rapidly eliminated.
Anesthesia
Fentanyl is used extensively for open heart procedures because it lacks some of the cardiac depressant actions of other anesthetics.
Anesthesia
Naloxone (Narcan), Nalnefene (Revex), and Flumazenil (Romzicon) are given to reverse overdoses of specific drugs.
Anesthesia
Neuromusccular blocking is important as an adjunct to general anesthesia to facilitate endotracheal intubation and to ensure that the patient does not move during surgery.
Anesthesia
Blocking agents act via a depolarizing mechanism or as antagonists to acetylcholine at receptor sites on the muscle cell.
Anesthesia
Anticholinesterase agents reverse neuromuscular blockers.
Anesthesia
Local anesthetics are advantageous because they affect all types of nervous tissue. They relieve pain without altering alertness or mental function.
Pain Management
Pain itself can be a disease; it is classified as acute, chronic nonmalignant, or chronic malignant.
Pain Management
Pain is now considered to be the " fifth" vital sign. All narcotics have the potential to induce tolerance and dependence.
Pain Management
The effects of narcotics differ on different individuals.
Pain Management
The patient-controlled analgesia (PCA) pump is an effective means of controlling pain; the pump allows the patient to regulate, within certain limits, the amount of drug received. Better pain control is achieved with less drug.
Pain Management
The transdermal patch provides pain control and allows the patient to remain more alert than with most other methods.
Pain Management
Methadone (Dolophine), Buprenorphine (Buprenex, Subutex), and Buprenorphine-naloxone (Suboxone) are drugs used to treat opioid addiction.
Pain Management
Morphine is the standard against which all other narcotic analgesics are measured.
Pain Management
Fentanyl is manufactured as a lozenge and a patch. The patch is approved for chronic use, not acute pain following surgery.
Pain Management
Narcotics act on an area of the brain identified as the chemotrigger zone, which in turn stimulates the vomiting center.
Pain Management
It is as important to watch the aspirin or acetaminophen dose in narcotic combinations analgesic as it is to watch the narcotic dose.
Pain Management
The pharmacy team must serve as the advocate and gatekeeper when dispensing narcotics.
Migraine Headaches
Patients with migraine headaches should be taught to initiate therapy immediately at the first hint of an episode.
Migraine Headaches
Treatments for migraine headaches are divided into two groups: abortive and prophylactic therapies.
Migraine Headaches
Prophylactic drugs include anticonvulsants, beta blockers, calcium channel blockers, estrogen, feverfew, NSAIDs, SSRIs, and tricyclic antidepressants.
Migraine Headaches
Sumatriptan (Imitrex) is used for the relief of migraine headaches. It should be used at the first sign of headaches. If it brings partial, but not total, releif, the patient may receive a second dose at least 1 hour after the first dose.
Migraine Headaches
Midrin is a combination drugwith fewer side effects than ergotamine. The patient should take two capsules at the onset of headache and then one every 1 to 2 hours until the pain stops. up to 5 capsules in 12 hours.
Depression & Mood Disorders
Antidepressants are not controlled substances.
Depression & Mood Disorders
Antidepressants are classified as SSRIs (selective serotonin reuptake inhibtors), TCAs (tricyclic and tetracyclic antidepressants), SNRIs serotonin and norepinephrine reuptake inhibitors), and MAOIs (monoamine oxidase inhibtors).
Depression & Mood Disorders
SSRIs block the reuptake of serotonin, with little effect on norepinephrine. They have fewer side effects than the older antidepressant medications.
Depression & Mood Disorders
TCAs can be cardiotoxic in high doses. MAOIs are a second line treatment because of their many interactions with drugs and foods.
Depression & Mood Disorders
The maximum daily dose of bupopion (Wellbutrin, Zyban). should not exceed 450mg. It may take at least 2 weeks of the antidepressants to be effective.
Depression & Mood Disorders
Lithium is the drug of choice for treating bipolar (manic-depressive) disorder and acute mania and for prophylaxis of unipolar and bipolar disorders.
Depression & Mood Disorders
A patient taking lithium must have frequent blood tests to assess lithium levels and maintain a therapeutic range.
Depression & Mood Disorders
Carbamazepine (Tegretol) or divalporex (Depacote) may be substituted if patients cannot tolerate lithium.
Psychosis
An antipsychotic that has a ceiling dose is thioridazine, which should not exceed 800mg/day.
Psychosis
The older agents are identified as "typical" or first-generation antipsychotics and are effective, but serious long term side effects limit their use. Prescribers are steering away from these drugs and moving toward the newer "atypical" antipsychotics such as ariprazole (Abilify), clozapine (Clozaril), Olanzapine (Zyprexa), paliperidone (Invega), quetiapine (Seroquel), Risperidone (Risperdal), and Ziprasidone (Geodon).
Psychosis
Anticholinergics can minimize some of the side effects of typical antipsychotic drugs.
Anxiety
Anxiety is a state of uneasiness characterized by apprehension and worry about possible events.
Anxiety
The most common self-prescribed and/or administered remedy for anxiety is alcohol.
Anxiety
The benzodiazepines, buspirone, and, to a lesser extent, the beta blockers are the most appropriate pharmacologic treatments for panic attacks.
Anxiety
A sedative is an antianxiety drug; a hypnotic drug induces sleep. Some drugs fit both descriptions.
Sleep & Sleep Disorders
All hypnotic agents except the benzodiazepines and chloral hydrate reduce REM sleep.
Sleep & Sleep Disorders
Benzodiazepines that are FDA approved for hypnotic use are estazolam (ProSom), flurazepam (Dalmane), Quazepam (Doral), Temazepam (Restoril), and Triazolam (Halcion)
Sleep & Sleep Disorders
Hypnotic medications should be administered 1 hour before bedtime. Patients should take hypnotic drugs only a limited number of times each week, and the duration of use should be restricted to a 4 to 6 week period.
Sleep & Sleep Disorders
Rozerem is not a controlled substance because it works in a different way from other hypnotics.
Sleep & Sleep Disorders
The Z hypnotics are the preferred treatment of sleep disorder. Zaleplon (Sonata) is the shortest acting hypnotic, with a duration of action of 4 hours. Therefore it may be taken in the middle of the night.
Sleep & Sleep Disorders
Zolpidem (Ambien), a schedule IV drug, has many of the same properties as the benzodiazepines, but is structurally dissimilar.
Sleep & Sleep Disorders
Eszopiclone (Lunetsa) is approved for long term use. Antihistamines are the safest drugs to use in treating insomnia.
Alcoholism
Alcoholism is an incurable and potentially fatal disease. It can be controlled through behavioral changes. Alcoholism is linked to genetics.
Alcoholism
Alcoholics have an increased ability to metabolize ethanol rapidly, and neurons in the CNS adapt to the presence of ethanol.
Alcoholism
Four drugs have been approved for treatment of alcoholism; they are disulfiram (Antabuse), Acamprosate (Campral), Topirmate (Topamax), Naltrexone (ReVia).
Epilepsy
Epilepsy is a common neurologic disorder defined as paroxysmal seizures. It involves disturbances of neuronal electrical activity that interfere with normal brain function.
Epilepsy
Two major classifications of seizures are generalized and partial. The objective of antiepileptic drug therapy is to eliminate seizures without compromising the patients quality of life because of adverse effects.
Epilepsy
Different of seizures types require different drugs. All anticonvulsants have very narrow dose/therapeutic ranges. A slight dosage change can result in loss of seizure control or toxicity; therefore, prescribers often write for the brand name drug.
Epilepsy
Boxed warnings are special warnings about a drug highlighted in a box in the FDA approved product information. A Black Box warning is the most serious.
Parkinson Disease
For normal movements to be performed, the two primary neurotransmitters- dopamine (an inhibitor) and acetylcholine (stimulator)- must be in balance. In Parkinson Disease, these transmitters are not in balance.
Parkinson Disease
Dopamine will not cross the blood brain barrier. Sinemet, a levodopa-carbidopa preparation, is probably the most commonly used drug in Parkinson Disease.
Parkinson Disease
Bromocriptine (Parlodel) is used to treat Parkinson Disease; it is also used to dry up breast milk in nursing mothers. Selegiline (Eldepryl) is an MAOI used in treating Parkinson Disease.
Other Central Nervous System Disorders
Acetylcholinterase drugs can produce clinical improvement in all forms of myasthenia gravis.
Other Central Nervous System Disorders
Methylphenidate (Concerta, Daytrana, Metadate, Metadate ER, Methylin, Ritalin, Ritalin SR) is the drug of choice to treat attention-deficit disorders. It is a CNS stimulant and schedule II controlled substance used primarily for attention-deficit disorders. Improved dosage forms allow the drug to be taken only in the morning and one form comes as a patch, improving compliance.
Other Central Nervous System Disorders
Atomoxentine (Strattera) and Modafinil (Sparlon) are the only nonstimulant medications indicated for treatment of ADHD in patients 6 years or older.
Other Central Nervous System Disorders
Riluzole (Rilutek) is the first drug approved for amyotrophic lateral sclerosis (Lou Gehrigs Disease). It inhibits the release of glutamate and seems to improve survival by about 3 months.
Other Central Nervous System Disorders
Among the drugs used to treat multiple sclerosis are two chemically different interferons.
Other Central Nervous System Disorders
Glatiramer acetate (Copaxone) is an MS drug that must be kept frozen.
Other Central Nervous System Disorders
Tizanidine (Zanaflex) is the first oral drug approved for spasticity since baclofen (Lioresal).
Other Central Nervous System Disorders
Alzheimers disease is a progressive form of dementia. Tacrine (Cognex) and Donezepil (Aricept) are used to treat Alzheimers disease; donepezilhas fewer side effects. There is evidence that memantine (Namenda) slows Alzheimer Disease. Ginko has been shown to have good results in improving cognitive function and social behavior in Alzheimer patients in some studies.
Asthma
Asthma is a disease in which inflammation causes the airways to tighten; asthma is a reversible condition.
Asthma
The asthmatic lung is more sensitive and responds to lower doses of challenge from allergens than do normal lungs.
Asthma
Asthma is a pulmonary condition with the following characteristics: reversible small airway obstruction, progressive airway inflammation, and increased airway responsiveness to stimuli.
Asthma
The most useful measure for assessing severity and following the course of asthma is the peak expiratory flow rate (PEFR). Drug therapy is the mainstay of asthma management.
Asthma
In 2008 the FDA mandated that all inhalers will no longer use the ozone-depleting propellant chlorofluorocarbon (CFC).
Asthma
A rescue course of corticosteroids may be needed at any time. Exercise-induced asthma is best treated with the inhalation of terbutaline or albuterol before exercising. This will provide protection for 2 hours after inhalation.
Asthma
Asthmatics should not use antihistamines in acute attacks and should always avoid beta blockers. Other drugs to be avoided include aspirin, NSAIDS, penicillins, cephalosporins, and sulfas.
Asthma
With an MDI, the patient inhales slowly, whereas with a dry powder inhaler the patient breathes in quickly to activate the inhaler.
Asthma
Nebulizers are effective delivery systems, for children too young to use inhalers. Home nebulizers can easily become contaminated, leading to bronchitis, if not cleaned properly on a daily basis.
Asthma
A spacer is recommended with an MDI to decrease the amount of spray that is deposited on the back of the throat and swallowed. It improves the penetration of drug into the lungs.
Asthma
Epinephrine is the drug of choice for an acute attack of asthma. Many patients with asthma carry an EpiPen for this purpose. Short acting inhaled bronchodilators are albuterol, isoproterenol, metaproterenal, and pirbuterol.
Asthma
Levabuterol, one of two isomers of albuterol, is more effective than other isomer and has fewer side effects. Salmeterol (Serevent) should be used exactly as directed and never for acute situations.
Asthma
Salmeteral and terbutaline are long acting inhaled bronchodilators.
Asthma
Formoterol (Foradil) is a long acting bronchodilator with an onset of just a few minutes. It should be refrigerated before it is dispensed, but it does not have to be refrigerated after dispensing. The pharmacy team must put a date on it to indicate that after that date it cannot be used and should be thrown away.
Asthma
Theophylline should used only in lung diseases unresponsive to other drugs because of its high interaction profile.
Asthma
Leukotrienes are 100 to 1000 times more potent than histamine; therefore, when these receptors are antagonized, inflammatory responses do not take place.
Asthma
Zafirlukast (Accolate) is a leukotriene receptor antagonist that has shown very good results.
Asthma
Zileuton (Zyflo) is a leukotriene inhibtor that carries strong warnings about liver toxicity and can double theophylline levels.
Asthma
Montelukast (Singulair) is indicated for prophylaxis and chronic treatment of asthma. It is approved for use in adults and children 12 months and older.
Asthma
Corticosteroids are reserved for the more difficult cases of asthma and are usually prescribed on an alternate day basis or as tapering doses when short term therapy is indicated, when the liquid or pill form is prescribed. The primary side effect of inhaling these drugs is oral candidiasis. The patient should always be advised to rinse the mouth after using these inhalers.
Asthma
Many asthmatics still are not using corticosteroids. Always use the lowest effective dose of a corticosteroid. Add salmeterol to inhaled corticosteroid needed for control.
Asthma
Fluticasone (Flovent) is a corticosteroids inhaler that comes in three strengths. Budesonide (Pulmicort Turbuhaler) is a dry powder inhalant with no propellant because it it breath activated. Pulmicort Respules is the first formulation of budesonide for home nebulizers.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) encompasses emphysema and chronic bronchitis. COPD is irreversible.
Chronic Obstructive Pulmonary Disease
Emphysema is characterized by destruction of the tiny alveoli, walls, or air sacs of the lungs.
Chronic Obstructive Pulmonary Disease
Chronic bronchitis can be caused by cigarette smoke; exposure to occupational dusts, fumes, and environmental pollution; and bacterial infection.
Chronic Obstructive Pulmonary Disease
Pharmacologic management of bronchitis and emphysema is still largely empirical, with methylxanthines, corticosteroids, beta agonists, and ipratropium forming the foundation of therapy.
Chronic Obstructive Pulmonary Disease
One of the best expectorants is water. Tiotropium (Spiriva) is similar to ipratropium (Atrovent) but is dosed only once daily; it is used for treatment of COPD). Other drugs indicated only for COPD are combivent, DuoNeb, Brovana, and Perforomist.
Other Lung Diseases
Respiratory diseases syndrome occurs in newborns and is treated with surfactants. The treatment regimen for TB varies depending on the patients syndrome.
Other Lung Diseases
Histoplasmosis is often referred to as the summer flu. It is usually benign, but some rare cases can be life threatening. The only drug that is effective is amphotericin B.
Cold, Cough, and Allergy
Antitussives, expectorants, decongestants, and antihistamines each have a different mechanism of action and purpose. Most are OTC products.
Antitussives
Antitussives are indicated to reduce the frequency of a cough, especially when dry and nonproductive. The cough reflex can be stopped at several points in the reflex pathway.
Antitussives
Codeine, commonly referred to as the "gold standard of antitussives" is the antitussive against which all others are compared.
Antitussives
Dextromethorphan may be as effective as codeine. One must be over 18 years old and show proof of age to purchase dextromethorpan.
Expectorants
Expectorants decrease the thickness and stickiness of mucus by decreasing viscosity. Guaifenesin is the most used expectorant, but water may work as well.
Decongestants
Decongestants stimulate the alpha adrenergic receptors of the vascular smooth muscle, constricting the dilated arteriolar network and shrinking the engorged mucous membranes. This promotes drainage of the sinus cavities and makes breathing easier. This sympathetic nervous system stimulation also increases heart rate and blood pressure and stimulates the CNS.
Decongestants
Topical application of decongestants (nasal sprays and drops) can cause a rebound phenomenon, rhinitis medicamentosa.
Decongestants
Pseudophedrine is the most effective decongestants but now may be purchased only in limited quantities and by someone who is over 18 years old and by showing identification.
Antihistamines
Antihistamines are used primarily to combat allergic reactions, nausea, vertigo, and insomnia. They prevent binding of histamine to the receptor sites.
Antihistamines
The most common side effects of antihistamines are sedation, and anticholinergic responses (dry mouth, constipation, urinary retention).
Antihistamines
Many antihistamines are sold OTC. Diphenhydramine is the major ingredient in OTC sleep medications.
Antihistamines
Fexofenadine (Allegra) is less sedating than most antihistamines currently available. Clemastine (Tavist Allergy) is the least sedating OTC antihistamine. It has been approved by the FDA for treatment of symptoms of the common cold. The most effective treatment for allergic rhinitis is application of nasal steroids.
Smoking Cessation
Benefits of smoking cessation include a longer life and better health. The key to smoking cessation is total abstinence.
Smoking Cessation
Most nicotine cessation drugs are OTC. Chantix has been the most successful.
The Gastrointestinal System
The gastrointestinal tract is a tube that begins in the mouth; extends through the pharynx, esophagus, stomach, small intestine, and large intestine; and ends in the anus.
The Gastrointestinal System
The digestive and absorptive processes take place in the GI tract.
The Gastrointestinal System
Mucous membranes protect the entire digestive system against abrasions and strong digestive chemicals.
Gastrointestinal Diseases
GERD is commonly known as heartburn. Alcohol, nicotine, and caffeine exacerbate GERD.
Gastrointestinal Diseases
Phase I medications for GERD are antacids that exert their action by neutralizing the acidic stomach contents so that if reflux does occur, the contents will be less irritating to the esophageal lining. Phase II medications serve two functions. First they improve gastric motility. Second, they decrease acid production in the stomach (H2 blockers, proton pump inhibitors)
Gastrointestinal Diseases
The bedtime dose of the H2 blockers is the most important one. The three types of ulcers are gastric, duodenal, and stress.
Gastrointestinal Diseases
There are drug regimens for the treatment of Helicobactor pylori (H. Pylori), understood to be a factor to be eradicated in treating ulcers. Helidac therapy is a kit with a 14 day supply of tetracycline, metronidazole, and bismuth subsalicylate to treat ulcers.
Gastrointestinal Diseases
Gastritis is an irritation and superficial erosion of the stomach lining. Ulcerative colitis is an irritation of the large bowel.
Gastrointestinal Diseases
Infliximab (Asacol, Pentasa, Rowasa) is used in Chrohn disease and ulcerative colitis.
Gastrointestinal Diseases
Sulfasalazine (Azulfidine) should not be taken for longer than 2 years. It decreases inflammatory response in the colon. It can change color of the urine and stain soft contact lenses.
Gastrointestinal Diseases
Olsalazine (Dipentum) is used for patients resistant to sulfasalazine.
Gastrointestinal Diseases
Balasalzide (Colazal) is better tolerated than sulfasalazine because there is no sulfa entity. Urosdiol (Actigall) is used to dissolve gallstones, but it can take several months.
Diarrhea
Diphenoxylate-atropine (Lomotil) is a combination drug and a controlled substance used for diarrhea.
Diarrhea
Loperamide (Imodium) has been found to be as effective as diphenoxylate atropine and is available OTC.
Constipation and Related GI Diseases
Dietary fiber increases colon content, decreases colon pressure, and increases propulsive motility.
Constipation and Related GI Diseases
Chronic constipation is often associated with low fiber diets.
Constipation and Related GI Diseases
Aluminum hydroxide-magnesium hydroxide simethicone is a gastric defoaming antiflatulent agent. It reduces surface tension, causing bubbles to be broken or to coalesce into a foam that can be eliminated more easily by belching or passing flatus.
Constipation and Related GI Diseases
Constipation can be relieved with osmotic laxatives, saline laxatives, irritant/stimulant laxatives, surfactant laxatives, bulk forming agents.
Constipation and Related GI Diseases
Constipation and lack of dietary fiber increase the likelihood of other diseases including diverticular disease, hiatal hernia, and hemmorrhoids.
Nausea & Vomiting
The chemoreceptor trigger zone (CTZ) is involved in vomiting. Some antiemetics bind to serotonin (5-HT) receptors to prevent nausea.
Obesity
Male ideal body weight (IBW) in kg= 50+ (2.3 x height in inches over 5 feet). Female IBW in kg= 45.5 (2.3 x height in inches over 5 feet)
Obesity
Morbid obesity is the condition of weighing two or more times the ideal body weight; it is so called because it results in many serious and life threatening disorders. Obesity has become a major health problem.
Obesity
BMI (body mass index) is determined by dividing the patient's weight in kilograms by the patient's height in meters squared. The BMI is used as a guide to determine whether pharmacologic treatment should be used for obesity.
Obesity
Stimulants are the most commonly used agents for weight reduction.A BMI of at least 30 or, in the presence of other risks factors, 27 is required to initiate pharmacologic intervention with orlistat (Xenical)
Parasites & Protozoa
Praziquantel (Biltricide) rids the body of tapeworms. Albendazole (Albenza) is used to treat tapeworms and microsporidiosis. Liver enzymes must be watched carefully when taking this drug.
Parasites & Protozoa
Mebendazole (Vermox) is used in the treatment of pinworms, whipworms, hookworms, and ascarides. Pyrantel (Pin-X) is used to treat pinworms.
Parasites & Protozoa
Thiabendazole (Mintezol) is used for treatment of Trichinella and Strongyloides. Intestinal protozoa are spread by the feces to mouth route.
Parasites & Protozoa
Amebiasis is treated with metronidazole (Flagyl, Flagyl IV). Sulfamethoxazole-trimethoprim (Bactrim, Bactrim DS, Cotrim, Septra, Septra DS) treats isosporiasis and cyclosporiasis.
Parasites & Protozoa
Malaria is acquired by the bite of an infected Anopheles mosquito. There are various treatments, but most effective is probably atovaquone-proguanil (Malarone). It is used prevention and treatment.
Hepatitis
Hepatitis has several forms; A,B, C are the most common. Hepatitis A & B can be transmitted form one person to another through contact, blood and body fluids, or the fecal-oral route.
Function of the Renal System
Acute renal failure is a rapid reduction in kidney function resulting in accumulation of nitrogen and other waste. Uremia is the clinical syndrome resulting form renal dysfunction.
Function of the Renal System
Renal disease is divided into four stages: (1) loss of renal reserve, (2) renal insufficiency, (3) chronic renal failure, (4) end stage renal disease.
Function of the Renal System
Contrast dyes are the third most common cause of renal failure in hospitalized patients. Renal failure is commonly caused by prerenal, intrarenal, or postrenal events.
Function of the Renal System
Most renal patients show evidence of erythroproietin deficiency. Sucralfate and aluminum-containing antacids can cause aluminum toxicity in a patient on dialysis.
Function of the Renal System
Folic acid (vitamin B9) is required for erythropoiesis. If a renal transplant is necessary, the patient must take drugs to prevent the rejection of the new organ. Mycophenolic acid (Myfortic) is indicated specifically to prevent rejection of the kidney.
Drugs for Urinary Tract Diseases and Disorders
Methenamine (Cystex, Hiprex, Urex) has a local anesthetic effect on urinary tract mucosa. Pentosan polysulfate sodium (Elmiron) is the first oral therapy for intestinal cystitis. It is used for relief of bladder pain, presumably by exerting a protective effect on the bladder wall to reduce irritation and inflammation.
Drugs for Urinary Tract Diseases and Disorders
Oxybutynin (Ditropan, Oxytrol) and tolterodine (Detrol) are urinary antispamodics used to decrease urinary frequency. Tolterodine has greater selectively for urinary bladder receptors than salivary receptors.
Drugs for Urinary Tract Diseases and Disorders
UTIs are treated with antibiotics, some of which require only a short course to clear the infection. Used for prostatic disease, tamsulosin (Flomax) is an alpha-1 blocker but is more selective than terazosin (Hytrin).
Drugs for Urinary Tract Diseases and Disorders
Nilutamide (Nilandron) is used for advanced prostate cancer. Flutamide (Eulexin) can cause gynecomastia.
Diuretics
The primary action of diuretics is to rid of excess fluid and electrolytes. Diuretics have different mechanisms of action. They are classified by where and how they work in the kidney: thiazide diuretics, loop diuretics, potassium sparing diuretics, carbonic anhydrase inhibitors, osmotic diuretics, and miscellaneous.
Diuretics
Triamterene-hydrochlorothiazide (Dyazide, Maxzide) theoretically does not waste potassium. The tablet Maxzide is better absorbed than the capsule Dyazide.
The Cardiovascular System and Causative Factors of Cardiovascular Disease
The heart is a complicated organ. Many factors contribute to the development of heart disease. Some, such as heredity, gender, and age, are predetermined, but others can be influenced by lifestyle modification.
The Cardiovascular System and Causative Factors of Cardiovascular Disease
Proper diet, exercise, and rest can do a lot to keep the heart functioning for a long time.
Angina
Angina pectoris is an imbalance between oxygen supply to the heart and oxygen demand form the heart. The three types are stable, unstable, and variant.
Angina
Drugs used to treat angina are beta blockers, nitrates, calcium channel blockers, and a metabolic modifier. Beta blockers may mask symptoms of hypoglycemia; therefore, diabetics should avoid them.
Angina
Carvedilol (Coreg) is a beta blocker used for hypertension. It is nonselective and the only beta blocker approved for and used in heart failure.
Angina
Sotalol (Betapace) is a beta blocker indicated for the treatment of arrhythmias that are life threatening. Nitrates are the drugs most used for angina; they dilate coronary vessels, leading to redistribution of blood flow to ischemic tissues. They reduce preload on the heart, which reduces cardiac workload.
Angina
A transdermal nitroglycerin patch should be removed at night to avoid development of tolerance to the drug. The label should instruct the patient in this procedure. When patients begin using nitroglycerin, they commonly experience a severe headache.
Angina
Nitroglycerin should be sold and stored in an amber glass container. Nitroglycerin should be replaced every 3 months; the patient should discard any remaining drug.
Angina
Covera HS is a time released verapamil tablet designed for bedtime dosing. It is approved for either angina or hypertension. The tablets do not release until about 4 to 5 hours after they have been swallowed. The drug is pumped out of two laser holes in the tablet. Patients may see a ghost tablet in their stool.
Angina
Generic names of many beta blockers end in "lol".
Generic names of many calcium channel blockers end in "ipine".
Arrhythmia
Normal heart rhythm is generated by the sinoatrial (SA) node and propagated to the myocardium so that first the atria contract to fill the ventricles, then the ventricles contract to eject blood into the arteries.
Arrhythmia
Heart rate abnormalities can be caused by ischemia, infarction, or alteration of chemical balances that allow heart cells other than the SA node to fire automatically and become ectopic pacemakers.
Arrhythmia
Various types of arrhythmic show specific patterns on the ECG and are associated with different degrees of danger of sudden death.
Arrhythmia
The various classes of antiarrhythmic drugs have characteristics electrophysiologic effects on the myocardium.
Arrhythmia
The classes of drugs used to treat arrhythmias are grouped as Class I (membrane stabilizing agents), Class II (beta blockers), Class III (potassium channel blockers), Class IV (calcium channel blockers), and others.
Arrhythmia
Phenytoin (Dilatin) is an antiarrhythmic drug that is also used to control seizures. Digoxin (Lanoxicaps, Lanoxin) is an important drug in managing atrial flutter, fibrillation, and congestive heart failure. It increases the force of contraction, the refractory period, and stimulation due to ion imbalance. Atropine is used for bradycardia, or heart rates less than 60 beats per minute. It is also used preoperatively to inhibit salivation and secreations.
Congestive Heart Failure
Congestive heart failure (CHF) occurs when the pumping ability of the heart can no longer sustain the blood flow required to meet the metabolic needs of the body.
Congestive Heart Failure
In CHF, blood accumulates in the heart and circulation to other parts of the body is reduced; the kidney responds to the reduced blood flow by retaining water, causing fluid to accumulate in the body tissues.
Congestive Heart Failure
Fluid accumulates in the lungs when the left side of the heart fails. Fluid accumulates in the abdomen and lower extremities when the right side of the heart fails.
Congestive Heart Failure
Medications to treat the effects of heart failure include vasodilators, angiotensin-converting enzyme (ACE) inhibitors and human B-type natriuretic peptide. These medications counteract contraction of small blood vessels (thus reducing the stress on the heart) and retention of fluids. Generic names of most ACE inhibitors end in "pril".
Hypertension
Cardiac output, which is the product of heart rate and stroke volume, is determined by preload, afterload, and contractility.
Hypertension
Hypertension is treated in stepwise fashion.
Step 1. Change lifestyle
Step 2. Add a first line drug
Step 3. Add a diuretic if not
given in step 2
Step 4. Add a third drug that is
synergistic with the
others.
Hypertension
High blood pressure should be treated with salt restriction, weight control, regular exercise, reduction of alcohol consumption, cessation of smoking, stress control, and medicine as prescribed.
Hypertension
The first-line drug for hypertension can be a diuretic, a beta blocker, an ACE inhibitor, or a calcium channel blocker.
Hypertension
ACE inhibitors reduce blood pressure by competitive inhibition of angiotensin-converting enzyme (ACE), preventing the conversionof angiostensin I to angiotensin II, a potent vasoconstrictor.
Hypertension
Angiotensin receptor blockers (ARBs) reduce blood pressure by blocking angiotensin II at its receptors. Bound antiotensin II is not able to exert its effects. ARBs lead to less coughing and angioedemia than ACEIs do because ACE, which breaks down bradykinin, is not inhibited. Generic names of most ARBs end in "artan".
Hypertension
Calcium channel blockers reduce blood pressure by arteriolar dilation, which leads to reduced peripheral resistance.
Hypertension
Beta blockers, calcium channel blockers and ACE inhibitors are all equally effective drugs used in the treatment of hypertension.
Hypertension
Clonidine is the only antihypertensive that has a transdermal delivery system. Minoxidil (Loniten, Rogaine) reduces blood pressure and stimulates hair growth.
Hypertension
Combination drugs have additive effects to relax blood vessels and lower pressure. Two low doses of different drugs usually cause fewer effects than pushing the dose of either drug.
Myocardial Infarction (MI)
Myocardial infarction (MI) occurs when there is a prolonged decrease in oxygen delivery to a region of cardiac muscle, which dies. MI is the leading cause of death in industrialized nations.
Myocardial Infarction (MI)
Symptoms include oppressive or burning tightness or squeezing in the chest, a feeling of choking and indigestion like expansion, a sense of "impending doom" and substernal pain, which may radiate to the neck, throat, jaw, shoulders, and one or both arms.
Myocardial Infarction (MI)
Beta blockers and low dose aspirin are prescribed for reducing the risk of death or recurrence following an MI.
Blood Clots
Blood clots in the bloodstream (thrombi) can cause life threatening pulmonary embolism and other serious damage.
Blood Clots
Anticoagulants prevent clot formation by affecting clotting factors; antiplatelets reduce the risk of clot formation by inhibiting platelet aggregation.
Blood Clots
The therapy for deep vein thrombosis (DVT) is either low dose heparin, adjusted dose heparin, or low molecular weight heparin and warfarin (Coumadin). The purpose is to prevent fatal blood clotting while ensuring adequate coagulation.
Blood Clots
Partial thromboplastin time (PTT) measures the function of the intrinstic and common pathways; it does not dissolves a clot that has already formed.
Blood Clots
Lepirudin (Refludan) is an alternative and anticoagulant for patients who cannot tolerate heparin.
Blood Clots
Protamine sulfate is the antidote for heparin. Phytonadione, vitamin k (mephyron) is an antidote for warfarin.
Blood Clots
Low molecular weight heparins are given 12 hours after surgery. The advantages of these heparins are reduced bleeding, reliable dose response, longer plasma half life, and no effect on platelets.
Blood Clots
Tinzaparin (Innohep) should not be interchanged with the other low molecular weight heparins. Aspirin is prescribed to prevent strokes and MIs.
Blood Clots
Glycoprotein antagonists are administered during invasive procedures to prevent artery closure.
Blood Clots
Eptifibatide (Integrilin) mimics native protein sequences in the platelets receptors. It is used in conjunction with heparin and aspirin. Fibrinolytic agents dissolves clots. They are used for massive PE & MI.
Stroke
A stroke may be caused by one of two primary events; cerebral hemorrhage and cerebral infarction.
Stroke
A TIA is a very strong predictor of an impending stroke. Risk factors for stroke include advanced age, male gender, hypertension, smoking, alcohol abuse, diabetes, and high cholesterol levels. Emphasis should be on stroke prevention.
Stroke
Antiplatelets agents prevent platelets activation and formation of the platelet plug. Anticoagulant agents are used for deep vein thrombosis and pulmonary emboli and in prevention of stroke.
High Cholesterol and Related Diseases
Food fats contain a mixture of three fatty acids: saturated, monosaturated, and polyunsaturated. The liver packages triglycerides, cholesterol, and carrier proteins in spherical particles called lipoproteins, which circulate in the blood.
High Cholesterol and Related Diseases
LDLs (low density lipoproteins) not used by the cells may be deposited in artery walls, eventually clogging them.
High Cholesterol and Related Diseases
HDLs (high density lipoproteins) may prevent cholesterol buildup in arteries. Triglycerides release free fatty acids in the blood to be stored in adipose cells.
High Cholesterol and Related Diseases
Drugs are used as an adjunct to proper diet to prevent buildup of LDLs.
High Cholesterol and Related Diseases
Some combinations of these drugs are synergistic; others can be dangerous. Any symptom of muscle pain should be reported to the physician immediately.
High Cholesterol and Related Diseases
Thiazide diuretics, loop diuretics, and glucocorticords all increase the lipid profile unfavorably.
High Cholesterol and Related Diseases
Simvastatin (Zocor) acts on the enzyme that catalyzes the rate limiting step in cholesterol biosynthesis.
High Cholesterol and Related Diseases
Atorvastatin (Lipitor) is a potent lipid lowering drug. It lowers LDLs significantly and also lowers triglycerides. Before this drug, physicians had to resort to niacin or gemfibrozil to reduce triglyceride levels.
High Cholesterol and Related Diseases
Statins are HMG-CoA reductase inhibitors and the generic name ends in "statin".
High Cholesterol and Related Diseases
Fenofibrate (Tricor) increases the catabolism of VLDLs.
High Cholesterol and Related Diseases
Ezetimibe (Zetia) decreases cholesterol by inhibiting the absorption of cholesterol at the brush border of the small intestine.
High Cholesterol and Related Diseases
Manufacturers have combined drugs with synergistic mechanisms of action to lower cholesterol.
Muscle Relaxants
The side effects of muscle relaxants are sedation, reduced mental alertness, reduced motor abilities, and GI upset. Patients taking these drugs should avoid alcohol.
Muscle Relaxants
Diazepam (Valium), a benzodiazepine, is a highly effective muscle relaxer, but its abuse potential restricts its use.
Muscle Relaxants
Methocarbamol (Robaxin) causes skeletal muscle relaxation by reducing the transmission of impulses from the spinal cord to skeletal muscles.
Muscle Relaxants
Orphenadrine (Norflex) is an indirect skeletal muscle relaxant thought to work by central atropine like effects. The tablet should be swallowed whole, not chewed or crushed.
Muscle Relaxants
Carisoprodol (Soma) is subject to abuse. Once the drug is ingested, the molecules are cleaved to the major metabolite, meprobamate, which is a controlled substance. Soma is a controlled substance in many states.
Muscle Relaxants
Chlorzoxazone (Paraflex, Parafon Forte DSC) is for symptomatic treatment of muscle spasms and pain associated with acute musculoskeletal conditions. It acts on the spinal cord and subcortical levels by depressing polysynaptic reflexes.
Muscle Relaxants
Cyclobenzaprine (Flexeril) is a centrally acting skeletal muscle relaxant that is pharmacologically related to tricyclic antidepressants. Onset of action is usually within one hour, and the drug should not be used more than 2 to 3 weeks.
Muscle Relaxants
Baclofen (Lioresal) is used for treating reversible spasticity, spinal cord lesions, and multiple sclerosis and is sometimes used for hiccups. It should be taken with food or milk.
Inflammation & Swelling
Analgesics are used for mild-to-moderate pain, inflammation, and fever. A widely accepted mechanism for many of their actions is their ability to inhibit the enzyme cyclooxygenase and thereby decrease the conversion of arachidonic acid to prostaglandins (PGs), thromboxane A2, or prostacylin.
Inflammation & Swelling
Somatic pain (from injury to skin, muscle, and bone) is dull and throbbing, while visceral pain (from the organs) is sharp and stabbing.
Inflammation & Swelling
Fever is a response by the body's temperature regulating center (the hypothalamus) to substances called endogenous pyrogens produced as a result of bacterial or viral infections. The subsequent release of PGs from the brain causes the body "thermostat" to reset at a higher temperature.
Inflammation & Swelling
Adverse GI effects may limit the use of nonnarcotic analgesics. Aspirin, salicylate, is the prototype NSAID. Salicyates have analgesic anti inflammatory and antipyretic properties.
Inflammation & Swelling
The primary analgesic actions of salicylates are peripheral rather than central. Their primary antipyretic action is central and presumed to be in the hypothalmus.
Inflammation & Swelling
Salicylates are indicated for simple headache, arthritis, pain and fever, with influenza, muscular aches and pains, menstrual cramps, and inflammation.
Inflammation & Swelling
Salicylates cause gastrointestinal ulceration. They should be avoided by patients with asthma, nasal polyps, chronic sinusitis, bleeding ulcers, and hemophilia. They should not be taken after surgery or tooth extraction.
Inflammation & Swelling
More than 4g of aspirin per day can cause problems; 10g can be lethal. Mild salicylate intoxication is characterized by ringing in the ears, dizziness, headache, and mental confusion.
Inflammation & Swelling
Acetaminophen acts centrally to cause antipyresis. It is an effective analgesic and antipyretic without anti inflammatory, antirheumatic, or uric acid excretory effects of aspirin.
Inflammation & Swelling
A patient with severe liver disease or alcoholism should not take acetominophen. At a dose of above 4g of acetaminophen per day, liver damage can occur.
Inflammation & Swelling
Alcohol can cause a problem with OTC analgesics, according to the FDA. For acetaminophen, the problem is liver toxicity; for NSAIDS, it is increased GI bleeding.
Arthritis & Related Disorders
The most common complaint from arthritis patients is persistent pain. Because cartilage has no nerves, pain originates from surrounding joint structures, such as bone, tendon, ligament, and muscle.
Arthritis & Related Disorders
Therapy for arthritis is aimed at relieving pain, maintaining or improving mobility, and minimizing disability. It may include medication, physical therapy, and patient education.
Arthritis & Related Disorders
NSAIDS take longer to reduce fever than other products, but the effect lasts longer. NSAIDS are used for headache, menstrual cramps, backache, muscle aches, flu, fever, and the pain and inflammtion of arthritis, rheumatism, and gouty arthritis.
Arthritis & Related Disorders
NSAIDS inhibit PG synthesis in inflamed tissues, thereby preventing the sensitization of pain receptors to mediators of inflammation. Thus, they generally act peripherally rather than centrally as other pain killers do.
Arthritis & Related Disorders
PGs perform three protective functions in the GI tract: increased mucosal blood flow, increased mucus production, and decreased free acid production.
Arthritis & Related Disorders
Side effects of NSAIDS are GI upset, nausea, abdominal cramps, heartburn, indigestion, ringing in the ears, ulcers, jaundice, dizziness, and rash. Gastropathy develops in one in five chronic NSAIDS users.
Arthritis & Related Disorders
Many patients will need to take a proton pump inhibitor with NSAIDS. Concurrent use of multiple NSAIDS should be discouraged, as the combination may lead to additive or synergistic toxicity rather than increased efficacy. However, some research indicates that the use of NSAIDS and opiates may be synergistic.
Arthritis & Related Disorders
Clinical trials have not shown the superiority of any NSAIDS over the others for the management of rheumatoid arthritis.
Arthritis & Related Disorders
Inadequate response or loss of response to one NSAID does not imply that the others would be ineffective. There is considerable patient to patient variability in response. Usually, after 2 to 3 weeks, if the patient is not responding to one NSAID, a change can be made to another one.
Arthritis & Related Disorders
All NSAIDs should be administered with food and dispensed with a Medication Guide. Ketorolac (Toradol), when injected, has shown pain relief equal to narcotics. It is for short term use only.
Arthritis & Related Disorders
Sulindac (Clinoril) is a renal sparing drug that is metabolized in the liver. Nabumetone (Relafen) should be taken in the morning with food. Naproxen (Naprosyn) is the least risky NSAID for cardiovascular events.
Arthritis & Related Disorders
Tramadol (Ultram) acts centrally to bind to opiate receptors. It is used for moderate to severe pain. Its onset is slow, but once it begins to act, pain control appears to be equivalent to that provided by narcotics.
Arthritis & Related Disorders
DMARDS are disease modifying antirhuematic drugs that are second line agents for rheumatoid arthritis. Even though these drugs may slow progression of the disease, the side effects limit their use.
Arthritis & Related Disorders
Mild rheumatoid arthritis should be treated with more than NSAIDs because joint damage occurs earlier than thought.
Arthritis & Related Disorders
Methotrexate (Rheumatrex) should be taken on an empty stomach, and exposure to the sun should be avoided. Methotrexate is an antieoplastic agent commonly used to treat arthritic conditions.
Arthritis & Related Disorders
Hydroxychloroquine (Plaquenil) is an antimalarial drug also used to treat arthritis. Aspirin should not be given to a patient with gout; it competes with uric acid for kidney excretion.
Arthritis & Related Disorders
Cytotoxic agents, diuretics, ethanol, nicotinic acid, and salicylates can precipitate a gout attack.
Arthritis & Related Disorders
Colchicine is the drug of choice for an acute gout attack. Colchicine, probenecid-colchicine, indomethacin, allopurinol, and sulfinpyrazone are all used for gout.
Silver Nitrate
Source: Mineral- Silver

Therapeutic Effect: Anti Infective
Prilosec
Source: Synthetic- Omeprazole

Therapeutic Effect: Gastric Acid Inhibitor
Epogen
Source: Bioengineering- Erythropoietin

Therapeutic Effect: Stimulator of red blood cell formation
FDA Pregnancy Categories
A: No Risk
B: Risk Cannot Be Ruled Out
C: Caution Is Advised
D: Is A Definite Risk
X: Do Not Use
Digoxin
Source: Plant- Foxglove

Therapeutic Effect: Cardiotonic
Pepsin
Source: Animal- stomach of hog or cow

Therapeutic Effect: Digestive Enzyme
Peroral (PO, By Mouth)
Oral (swallowed)
Sublingual (under the tongue)
Buccal (dissolves in cheek)
Parenteral (Injection)
Intravenous (IV) (vein)
Intra-Arterial (artery)
Intracardiac (heart)
Intraspinal/Intrathecal (spinal fluid)
Epidural (fibrous membrane of spinal cord)
Intrasynovial (joint fluid area)
Subcutaneous (beneath the skin)
Intramuscular (IM) (muscle)
Topical (Surface Of Skin)
Transdermal (skin surface)
Conjuctival (conjuctiva)
Intraocular (eye)
Intranasal (nose)
Aural (ear)
Intrarespiratory (lung)
Rectal (rectum)
Vaginal (vagina)
Urethral (urethra)
Peroral (PO, Mouth)
Tablets, capsules, solutions, syrups, elixirs, suspensions, gels, powders, troches/lozenges
Parenteral
Solutions & suspensions
Topical
Ointments, Creams, Pastes, Powders, Aerosols, Lotions, Transdermal patches, Sprays, Inhalants, suppositories, enemas, emulsions, sponges, & gels.
Common Adverse Reactions Potentiated in the Elderly
CNS changes, constipation, dermatitis, diarrhea, drowsiness, falls, gi upset, incontinence, insomnia, RA, sexual dysfunction, urinary retention, xerostomia (dry mouth)