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90 Cards in this Set
- Front
- Back
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11 miillion Americans
Chronic Inflammatory disorder of the airway Etiology Immmune response to known allergens Idiopathic Broncoconstriction & Inflammation Roe of inlammation has caused change in how treated |
Asthma
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Bronchodilators
inhibition of bronchospasm by relaxing smooth muscle suppress histamine release in the lung Inhaled immediate treatment & prevention Oral-long term prevention of attacks Newer drugs are more selective Short acting (quick) exercise induced asthma break through symptoms Long acting (last longer) prevention of attacks |
Asthma Managment: Beta 2 agonists
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Most effective anti-asthma drugs available
prophylaxis for chronic asthma decreased release of mediators, decreased activity of inflammatory cells, decreased vascualr permeability (edema) |
Asthma (inflammation) Glucocorticoids
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Adverse Effects:
Adrenal suppression, bone loss long term-cataracts, glaucoma can decrease growth in children |
Asthma (inlammation) Glucocorticoids Oral
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Doses cause adrenal suppression
Endogenous glucocorticoids facilitate immune response and inflammatory response Patients must be weaned off slowly so adrenal glands can pick up the production |
Oral Glucocorticoids
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Little reaches the systemic circulation
Changing from oral to inhaled must include weaning |
Inhaled Glucocorticoids
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Suppress the effects of leukotrienes
bronchoconstriction, eosinophil infiltration, mucous production, and edema |
Leukotriene Modifiers
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Inflammation of upper airway, lower airway, and eyes
Symptoms: sneezing, rhinorrhea, pruritus, nasal congestion Allergens bind to IgE on mast cells histamine, leukotrienes, prostaglandins Hay fever Perennial |
Allergic rhinitis
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Medications for seasonal rhinitus
Sneezing, rhinorrhea, nasal itching |
Oral antihistamine
Diphenhydramine/benadryl Fexofenadine/Allegra |
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Anti-inflammatory
Medications for seasonal rhinitus prevent/suppress all majory symptoms Safe and effective |
Intranasal Glucocorticoids
Beclomethasone, Budesonide, Dexamethazone, etc |
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Medications for seasonal rhinitus
Suppresses release of histamine Safe and effective Takes 1-2 weeks to work |
Intranasal cromolyn
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Medications for allergies/colds
Decongestants-vasoconstriction of membranes alpha 1 of sinus membranes relieves "stuffiness" not sneezing, runny nose rebound congestion with prolonged use restlessness, insomnia, anxiety, irritability |
Sympathomimetics (oral/nasal)
Pseudophedrine & ephedrine (methamphetamine) |
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Characteristics of Neoplastic Cells
Unresponsive to feedback system that control growth in normal tissue |
Persistent Proliferation
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Characteristics of Neoplastic Cells
Normal cells are segregated |
Invasive Growth
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Characteristics of Neoplastic Cells
Migration |
Metastases
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Characteristics of Neoplastic Cells
Telomerase (end of chromosome becomes smaller as cell replicates) |
Immortality
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Activation of oncogenes-cancer causing
Inactivation of tumor suppressor genes prevent replication of cancer cells Caused by chemicals, viruses, radiation (x-rays, ultraviolet light) |
Alterations in DNA
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Initiation, promotion, progression
Changes activate the gene for telomerase |
Three stages of malignant development
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Barriers to successful treatment
Neoplastic cells and normal cells are similar Need unique biochemical features telomerase |
Toxicity to normal cells
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Barriers to Successful Treatment
Immunosuppression Immune system less likely to recognize invaders |
No Host Defense
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Barriers to Successful Treatment
A constant percentage of cells will be killed with each round Each dose must be EQUALLY STRONG |
First Order Kinetics
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Barriers to Successful Treatment
At <1 million cells cancer is undetectable True early detection not possible 1cm tumor is >1 billion cells The earlier detected the more vulnerable the tumor |
No visible end point
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Barriers to Successful Treatment
Greater % of G0 "resting" cells De-bulking a tumor can decrease # of G0 |
Solid Tumor respond poorly
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Barriers to Successful Treatment
Random DNA mutations cause P-glycoprotein to pump drugs out of the cell Anti-cancer drugs kill the non-mutated cells that are not resistant Mutated cells continue to reproduce |
Drug Resistance
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Barriers to Successful Treatment
Subpopulation with varying characteristics |
Heterogeneity of tumor cells
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Barriers to Successful Treatment
Location of blood supply can prevent drug from reaching the tumor Blood brain barrier prevents access to CNS |
Limited drug access to tumor
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Everytime give treatment kill off certain # of normal cells which will hopefully proliferate during resting period
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Intermittent therapy
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Resistance suppression
random mutations less likely to be resistant to multiple drug actions Increased cancer cell kill multiple drug actions yield broader kill Reduced injury to normal cells use a combination of drugs that do not have overlapping toxicity (side effects) cell kill is enhanced but the toxicity is not |
Combination Therapy
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Dosing Schedules
Drug half life determine if there is active drug available when appropriate cycle is active Intra-arterial direct attack on solid tumor Intrathecal CNS cancers Specialized routes |
Administration Cancer
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Toxicities
High proliferation rates infection, bleeding, anemia Leucopenia (destroy all WBC), nadir (lowest point) Anemia Thrombocytopenia (no platelets) |
Bone marrow suppression
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Toxicities
Epithelial lining of the tract diarrhea, stomatitis, poor nutrition |
GI tract
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Toxicities
Fast dividing cells |
Alopecia (hair follicles)
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Toxicities
uric acid from breakdown of DNA |
Hyperuricemia
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Toxicities
Tissue damage from IV infiltration |
Extravasation
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Toxicities
from DNA damage |
Carcinogenesis
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Direct attack on cells
cell-cycle specific or non-specific Administration need to follow safe handling procedures Avoid toxicity to the nurse IV access central lines are best avoid previously irradiated areas monitor closely |
Cytotoxic Agents
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Form cross links between DNA strands
Cell cycle-nonspecific agent Drug resistance is common increased production of enzymes that repair DNA Adverse effects in high-growth tissues |
Alkylating agents
Nitrogen mustards Cyclophophamide (Cytoxan) Nitrosoureas Carmustine (BCMU) Platinum compounds Cisplatin (Platinol-AQ) |
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Disrupt metabolic process (imposters)
Folic acid analog (DNA, RNA, proteins) Methotrexate (Rheumatrex) Pyrimidine analogs (DNA, RNA) Cytarabine (Cytosar-U) Purine analogs (nucleic acids) Mercaptopurine (Purinethol) |
Anti-Metabolites
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Used only to treat cancer-direct interaction with DNA
Administered IV only-GI toxic Cardiotoxic delayed cardiomyopathy |
Anti-tumor Antibiotics (only for tumor cells)
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Act during the M phase of cell division
peripheral neuropathy Vinca alkaloids-lymphomas Vincristine (Oncovin) (bone marrow sparing) Vinblastine (Velban) Vinorelbine (Navelbine) Taxoids- Ovarian, lung, breast, Kaposi's Paclitaxil (Taxol) (hypersensitivity reactions) Docetaxel (Taxotere) |
Mitotic Inhibitors
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S phase of the cycle
relieves strain on DNA by creating single strand breaks that are reversible Topotecan (Hycamtin) Irinotecan (Camptosar) Etoposide (VePesid) testicular, lung |
Topoisomerase Inhibitors
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Anti-estrogens
Breast Cancer block some estrogen receptors tumor deprived of estrogen needed to grow Stimulate other estrogen receptors increase bone density, decrease LDL, increase HDL Adverse thromboembolism and endometriosis Tamoxifen/Nolvodex, Raloxifene/Evista |
SERMS (selective estrogen receptor modulators
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Anti-Estrogen
post menopausal breast cancer Block only breast tumor estorgen not ovarian Well tolerated, flushing, headache, N/V, HTN Estrogen depletion increases risk of osteoporosis Anastrozole (Arimidex) Letrozole (Femara) Exemestane (Aromasin) |
Aromatase Inhibitors
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For tumors that over express HER2 receptors
human epidural growth factor receptors 25-30% of breast tumors over-express stops cell proliferation promotes antibody- dependent cell death Cardiotoxicity |
Monoclonal Antibody
Breast Cancer Trastuzumab/Herceptin |
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Act on bone marrow to stimulate formation of blood cells
Type Hematopoietic growth factor RBCs, WBCs Thrombopoietic growth factor Platelets |
Hematopoietic and Thrombopoietic Growth Factors
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Hematopoietic growth factor-RBCs
Need iron, folic acid, & B12 or it won't work Uses Chronic renal failure Chemotherapy Anemia in patients facing surgery Adverse Effects Hypertension Autoimmune red cell aplasia |
Epoetin alfa (Epogen, Procrit)
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Hepatopoietic growth factor-WBCs
Uses Elevation of neutrophil counts in patients with cancer Treatment of severe chronic neutropenia Adverse Effects Bone pain |
Filgrastim/Neupogen
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Thrombopoietic growth factor
Uses Used with myelosuppressive chemotherapy to minimize thrombocytopenia Adverse Effects Fluid retention Cardiac dysrhythmias Effect on the eye- infection Sudden death |
Oprelvekin (Interleukin-11)
Oprelvekin (Neumega) |
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Iron replacement (oral) IV Iron Dextran
high incidence of anaphylactic reactions Vitamin B12 essential for DNA Synthesis Deficit due to absorption from bowel disease or decreased stomach acid Oral, nasally, IM, IV Folic Acid essential for DNA synthesis and cell division Oral replacement |
Anemia
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Stimulate the use of energy
oxygen consumption & heat production Stimulate the heart oxygen demand and cardiac output Promote growth and development Brain Nervous System Skeletal Muscle |
T3 (liothyronine) T4 (levothyroxine)
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Required for T3 and T4 production
Low level causes increase in TSH (hypothyroid) Thyroid increases in size (goiter) Increase may be sufficient to meet need High level causes decrease in iodine uptake (hypothyroid) Synthesis and release of hormones is suppressed idiopathic |
Iodine
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Pale puffy face, cold skin, brittle hair, decreased heart rate, fatigue, lethargy
Hashimoto's chronic autoimmune thyroiditis (stops putting out the hormone) Replacement therapy-T4 Study shows some women need T3 added Increases coumadin levels Surgical loss, low iodine in diet, radioactive iodine |
Hypothyroidism
Myxedema/adults Cretinism/Children |
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Increase in all metabolic rates
Exophthalmos (Graves' only) Immune-mediated infiltration of periorobital muscles and fat (tx: oral glucocorticoids) Treatment Surger-need life long replacement Radioactive Iodine (iodine-131) Effective over about 2 months Less mortality than surgery and only thyroid tissue is damaged |
Hyperthyroidism
Graves' & Plummers' (toxic nodular goiter) |
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Block T3/4 production
Treatment for 2 yrs, then stop 40% euthyroid (normal thyroid) Used in conjunction with drugs to block thyroid symptoms beta blockers (decrease HR, BP) Agranulocytosis |
Hyperthyroidism
Propylthiouracil/PropylThyrocil & Methimazole/Tapazole |
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Dysrhythmias, CNS stim, skeletal muscle weakness, increased metabolic rate, mental processes, fast speech, progress to fatigue, coma, death
Treat with potassium iodine or other iodine salts (overload thyroid stops production) High iodine decreases uptake and suppresses release of thyroid hormones. Low pH 7.21 totally acidotic |
Hyperthyroidism
Thyrotoxicosis...Thyrotoxic Crisis Thyroid storm |
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Controls growth, protein synthesis and carbohydrate metabolism
Childhood deficiency Proportional small stature Only treatment is GH replacement Somatrem/Prototropin, Somattropin/Genotropin Increases glucose levels |
Growth Hormone
Dwarfism |
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Puberty excess
Surgical removal or radiation of pituitary |
Growth Hormone Gigantism
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Adult excess
Octreotide/sandostatin analogue of somatostatin (GH) Side effects N/V/D- subside quickly Very expensive Non-approved use in intractable diarrhea |
Growth Hormone
Acromegaly |
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Reabsorbs H2O in kidney tubules
used for DI (nasal administration) Causes smooth muscle contraction Gi bleed (continuous IV administration) Support circulation in shock or arrest (IVP) Adverse Effects Fluid overload, tissue ischemia or necrosis, increase cardiac workload |
Antidiuretic Hormone
Arginine Vasopressin |
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Coagulation, bone, nerve, & muscle function
98% in bone- undergoes continuous remodeling 10mg/dL in blood, 1/2 is ionized (available) reabsorbed from bone, absorbed from gut, excreted by kidney The blood calcium level is maintained at the expense of the bone |
Calcium
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activates vit D (increases gi absorption) promotes reabsorption from bone, and decreases excretion
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Calcium
Parathyroid Hormone |
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increases absorption, promotes gi reabsorption from bone, & decreases excretion
Must be activated requiring sunlight, hepatic action (bile), renal action |
Calcium
Vit D |
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Decreases plasma levels
Released from thyroid when levels are high Inhibits reabsorption of Ca from bone |
Calcium control
Calcitonin |
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spinach, bran, and whole grain
decrease Ca absorption |
Calcium Control
Glucocorticoids & some foods |
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Cancer & Hyperparathyroidism
Treatment IV saline, promote urinary excretion for life threatening situation Decrease mobilization from bone (calcitonin) Decrease intestinal absorption (bran) Increase Ca excretion loop diuretic (lasix) Glucocorticouids (Prednisone) |
Hypercalcemia
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Increases neuromuscular excitability
Spasms, tetany, convulsions Causes Deficiency of PTH, vitamin D, or calcium Treatment Calcium supplementation Vitamin D Low bone mass and increased bone fragility Diagnosis bone mineral density (BMD) Dual-energy x-ray absorptionmetry (DEXA) |
Hypocalcemia
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Estrogen effects in some tissue
preserves bone density, lowers cholesterol pro-coagulant Anti-estrogen effects in others prevents cancer in breast and endometrium Side effects: Blood clots legs and lungs only for people with severe condition |
Osteoporosis
SERMS- selective estrogen receptor modulators |
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Weaken the cell wall, causing bacteria to take up excessive water and rupture of cell
Bactericidal Kill bugs Bacterial resistance Gram negative cell wall impervious to drug Beta-lactamase enzyme made by bacteria to inactivate drug (penicillnase) Inactivate Aminogl6ycosides Give seperately (at least 2hr apart) |
Drugs that weaken the bacterial cell wall: Penicillins
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Most widely used group of antibiotics
Beta-lactamase resistant Similar to penicillin structure (Gram +) Bactericidal Usually given parenterally Adverse Effects Allergy rash diarrhea Bleeding-interfere with Vit K metabolism Thrombophlebitis-for IV infusions ETOH- disulfiram/antabuse reactions nasuea, vomit |
Cephalosporins Weaken Cell Wall
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Inhibits cell wall synthesis
(not killed but cannot reproduce) Uses Severe infections Methicillin-resistant Staphylococcus aureus or C. Difficile Adverse Effects OTOTOXICITY- (peak and trough) >30ug/ml Thrombophlebitis Allergy |
Vancomycin (Lyphocin)
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Action
Broad spectrum antibiotic Inhibits protein synthesis Uses Rickettsial disease Chlamydia trachomatis Brucellosis Cholera Mycoplasma pneumoniae Lyme disease Anthrax Helicobacter pylori |
Tetracyclines (not used very often used for very specific infections)
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Absorption-chelation-form a bond rendered inert
Calcium supplements, milk products, iron supplements, magnesium- contaiing laxatives, and most antacids Adverse effects Gastrointestinal Discolored teeth Superinfection (c dif) Hepatotoxicity Renal Toxicity |
Tetracyclines-Adverse Effects
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Inhibits protein synthesis
Can induce antibiotic-associated pseudomembranous colitis Superinfection in teh bowel with C. Dif Indicated only for certain anaerobic infections located outside the CNS |
Clindamycin (Cleocin)
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Broad spectrum antibiotic
Inhibits protein synthesis Uses Only for LIFE THREATENING infections for which safer drugs are ineffective or contraindicated Advers Effects Reversible bone marrow depression Aplastic anemia GI effects Peripheral neruopathy |
Chloramphenicol (Chloromycetin)
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Can cause serious injury to inner ear and kidney
Narrow spectrum antibiotic aerobic gram negative bacilli Microbial resistance more than 20 resistant enzymes Adverse effects Nephrotoxicity Ototoxicity Hyerpsensitivity reactions Neruomuscular blockage ++ Drug interactions (PCN) inactivates them |
Aminoglycosides
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Serious infections caused by aerobic gram-negative bacilli
Pseudomonas aeruginosa Escherichia coli Klebsiella Seratia Proteus mirabilis Adverse effects nephrotoxicity Ototoxicity |
Gentamicin (Garamycin)
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Most common infections
Acute cystitis Acute urethral syndrome Recurrent UTIs |
Drug Therapy of UTI
Lower |
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Broad spectrum antibiotics
Suppresses bacterial growth by inhibiting folic acid production UITs Adverse effects Hypersensitivity reactions Steven-Johnson syndrome slough off all skin Hematologic effects Neutropenia, megaloblastic anemia Kernicterus (toxic to CNS of babies) Bilirubin deposits in the brain of newborns Crystalluria low solubility |
Sulfonamides
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First Generation
urinary tract infections Heamtologic side effects |
Sulfonamides
Trimethoprim/Proloprim |
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Second Generation
Bactrim or Septra Uncomplicated urinary tract infections pneumocystitis carinii Gi infections Adverse effects Gastrointestinal Rash Crystalluria |
Sulfonamides
Trimethroprim-Sulfamethoxazol |
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2 billion year worldwide
Mycobacterium tuberculosis Person to person inhaled infected aerosol Screening Tuberculin Skin test (PPD) Diagnosis Cytology (sputum sample) and chest x ray Disease process Necrosis and cavitaion of lung tissue |
Drugs for Tuberculosis, Leprosy, and Mycobacterium avium Complex infections
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Acquired
contract resistant TB Indadequate drug therapy Repeated effectual courses of treatment Too low dose Too short course of treatment 6 months 12-24 for HIV Poor adherence Inappropriate drug use need two or more types because of resistance |
Drug Resistant TB
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Two phases
Induction Phase- 2 months eliminate active tubercle bacilli isoniazid, rifampin, ethambutol Continuation phase Eliminate intracellualr persisters isoniazid, rifampin Multiple drugs for more resistant cases |
Treatment Regimens for TB
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For induction use with another agent
Use alone for continuation Adverse effects Peripheral neuropathy from pyridoxine vitamin b6 deficiency Hepatotoxicity Alcohol increases liver problems Optic neruitis Anemia |
Isoniazid (Laniazid) (INH)
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Broad spectru antibiotic
TB, leprosy, H Flu, Staph, Legionella Prohylaxis P450 enzymes increase decrease levels of other drugs oral contraceptives, Warfarin, HIV drugs Adverse effects Hepatitis Discoloration of body fluids (orange red urine) |
Rifampin (Rifadin)
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Bacteriostatic
Uses: tuberculosis multi drug regimens Adverse effects Optic neuritis Allergy Hyperuricemia Active against all strains of MT Stops cell wall formation |
Ethambutol (Myambutol)
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Infection with M. leprae
Skin lesions, neuropathy, resp tract |
Hansen's Disease
Rifampin, Dapsone, Clofazimine Single Lesions ROM- rifampin, oloxacin, minocycline |
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M. Avium and M. intracellulare
Respiratory lesions, can spread to any organ Prohylaxis Acute infection same as prophylaxis plus ethambutol |
Mycobacterium avium complex
Azithromycin Carithromycin |
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Broad spectrum antibiotic, inhibits bacterial DNA
Uses: multiple systems drug of choice for anthrax Adverse effects GI, headache, Candida of pharynx and vagina Interactions Cat-ion couplounds reduce absorption Increase warfarin and theophylline levels |
Miscellaneous Antibacterial Drugs
Fluoroquinolones "floxins" Ciprofloxacin (Cipro) |
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Bactericidal
Many Gi infectious agents Uses Protozoal infections infections caused by anaerobes Helicobacter pylori Adverse effects Neruotoxicity Allergy Superinfections |
Metronidazole (Flagyl)
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