Pharmacology

Front 1

History of Medicinal Drugs

Back 1

The very concept of an outside force influencing bodily function must be considered one of humanity's greatest advances.

Front 2

History of Medicinal Drugs

Back 2

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.

Front 3

History of Medicinal Drugs

Back 3

Pharmacology is a broad term that includes the study of drugs and their actions on the body.

Front 4

History of Medicinal Drugs

Back 4

The twentieth century brought major breakthroughs in medical care. The first antibiotic, sulfa, was soon followed by penicillin.

Front 5

Contemporary Pharmacology Practice

Back 5

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.

Front 6

Contemporary Pharmacology Practice

Back 6

Drugs are derived from sources such as plant, animals, minerals, synthetic materials, and bioengineering advances.

Front 7

Contemporary Pharmacology Practice

Back 7

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.

Front 8

Drug Regulation

Back 8

Laws govern the drug industry and protect patients' rights.

Front 9

Drug Regulation

Back 9

Medication guides must be provided to the patient on all dispensing of any drug for which the FDA requires a guide.

Front 10

Drug Regulation

Back 10

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.

Front 11

Drug Regulation

Back 11

The FDA requires that all new drugs be proved effective and safe before they can be approved for marketing.

Front 12

Drug Regulation

Back 12

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.

Front 13

Drug Regulation

Back 13

When the benefits outweigh the risks, the FDA considers a drug safe enough to be approved.

Front 14

Drug Regulation

Back 14

Drugs are not tested on pregnant women, but based on all available information, drugs are grouped into safety categories for use during pregnancy.

Front 15

Drug Regulation

Back 15

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)

Front 16

Drug Regulation

Back 16

Generic drugs must be equivalent to the brand-name drugs, and the FDA has devised an A/B rating system to establish this.

Front 17

Drug Regulation

Back 17

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.

Front 18

FDA Food Health Claims

Back 18

The FDA sets food labeling standards to ensure that consumers know what is in the food they are buying.

Front 19

Drug Actions

Back 19

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.

Front 20

Drug Actions

Back 20

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

Front 21

Drug Actions

Back 21

One drug can compete with another drug for its intended receptor

Front 22

Drug Actions

Back 22

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.

Front 23

Drug Actions

Back 23

The pharmocokinetic process is sometimes referred to as ADME.

Front 24

Drug Actions

Back 24

The primary sites of elimination are the kidney and the liver. Drugs may also be exhaled by the lungs or excreted in perspiration.

Front 25

Drug Actions

Back 25

Testing body fluids over time demonstrates how the body handles the drug.

Front 26

Drug Actions

Back 26

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.

Front 27

Drug Effects

Back 27

Drug effects include therapeutic effects, adverse reactions, and side effects.

Front 28

Drug Effects

Back 28

Drugs can interact with other drugs, food and the patient's own body.

Front 29

Drug Effects

Back 29

Two drugs may be subscribed together because the combination has fewer or more tolerable side effects than a high dose of either.

Front 30

The Prescription

Back 30

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.

Front 31

The Prescription

Back 31

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.

Front 32

Correct Drug Adminstration "Rights"

Back 32

The "rights" for correct drug administration are the right patient, the right drug, the right strength, the right route, and the right time.

Front 33

Dosage Forms and Routes of Administration

Back 33

The three primary routes of administration are oral, parenteral, and topical. The pharmacy technician must be familiar with each dosage form.

Front 34

The Most Common Dosage Forms and Routes of Administration

Back 34

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.

Front 35

Factors That influence Drug Action

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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.

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Factors That influence Drug Action

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Some special problems of the elderly are poor nutrition, adverse drug reactions, and poor compliance with drug regimens.

Front 37

Factors That influence Drug Action

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There are some drugs that are especially hazardous when prescribed for elderly patients.

Front 38

Factors That influence Drug Action

Back 38

Empathy and not sympathy is very important for communication with the elderly.

Front 39

Factors That influence Drug Action

Back 39

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.

Front 40

Factors That influence Drug Action

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Immunization is the process whereby the immune system is stimulated to acquire immunity to a specific disease.

Front 41

Factors That influence Drug Action

Back 41

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.

Front 42

Factors That influence Drug Action

Back 42

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.

Front 43

Factors That influence Drug Action

Back 43

An important role for the pharmacy technician is determining patient allergies.

Front 44

Teaching Patients Medication Management

Back 44

Patient compliance with the dose schedule and the specific requirements of a drug regimen is important.

Front 45

Teaching Patients Medication Management

Back 45

A pharmacy technician can positively influence patient drug therapy by accurately collecting and recording the patient's medication history in the patient profile.

Front 46

Teaching Patients Medication Management

Back 46

Pharmacy technicians can help patients understand how to read medication labels.

Front 47

Teaching Patients Medication Management

Back 47

Patients should read the information provided with OTC drugs to understand their action, interactions, cautions, and possible side effects.

Front 48

Medication Safety

Back 48

E-prescribing will eliminate poorly written prescriptions.

Front 49

Medication Safety

Back 49

Hospitals that use physician order entry (POE) have documented a decrease in errors.

Front 50

Medication Safety

Back 50

Medication reconciliation, a national patient safety goal, will prevent many errors.

Front 51

Fighting Bacterial Infections

Back 51

Bacteria are single celled organisms that occur in almost all environments. They can penetrate body tissues and set up areas of infection.

Front 52

Fighting Bacterial Infections

Back 52

Gram-negative bacteria predominate in the hospital environment and are often found in hospital acquired (nosocomial) infections.

Front 53

Fighting Bacterial Infections

Back 53

Gram positive bacteria are most commonly isolated in community acquired infections.

Front 54

Fighting Bacterial Infections

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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.

Front 55

Fighting Bacterial Infections

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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.

Front 56

Fighting Bacterial Infections

Back 56

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.

Front 57

Fighting Bacterial Infections

Back 57

An infection is an invasion of the body by pathogens, resulting in tissue response to organisms and toxins.

Front 58

Fighting Bacterial Infections

Back 58

Bacterial infections are contagious until antibiotics have been taken for 24 to 48 hours.

Front 59

Fighting Bacterial Infections

Back 59

A bactericidal agent kills bacteria.

Front 60

Fighting Bacterial Infections

Back 60

A bacteriostatic agent inhibits growth or multiplication of bacteria.

Front 61

Fighting Bacterial Infections

Back 61

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.

Front 62

Fighting Bacterial Infections

Back 62

Antibiotics may interfere with the effectiveness of birth control pills.

Front 63

Penicillins

Back 63

Penicillin has many therapeutic uses. Penicillin is the drug of choice for streptococcal infections. It is used in gram-positive infections.

Front 64

Penicillins

Back 64

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.

Front 65

Penicillins

Back 65

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.

Front 66

Penicillins

Back 66

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.

Front 67

Penicillins

Back 67

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.

Front 68

Penicillins

Back 68

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.

Front 69

Penicillins

Back 69

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.

Front 70

Cephalosporins

Back 70

Cephalosporins have a mechanism of action similar to penicillins but a broader spectrum of coverage.

Front 71

Cephalosporins

Back 71

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.

Front 72

Cephalosporins

Back 72

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.

Front 73

Cephalosporins

Back 73

Carbapenems, carbacephems, and monobactams are beta-lactams differing slightly form penicillins and cephalosporins.

Front 74

Tetracyclines & Tigecycline

Back 74

Tetracyclines are bacteriostatic. They are the drugs of choice for Rocky Mountain spotted fever ans Lyme disease, which are both transmitted by ticks.

Front 75

Tetracyclines & Tigecycline

Back 75

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.

Front 76

Tetracyclines & Tigecycline

Back 76

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.

Front 77

Tetracyclines & Tigecycline

Back 77

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.

Front 78

Tetracyclines & Tigecycline

Back 78

A drug class related to the tetracyclines is glycyclines. There is only one drug in that class: tigecycline (Tygacil).

Front 79

Macrolides

Back 79

The macrolides are used primarily to treat pulmonary infections caused by Legionella and gram positive organisms.

Front 80

Macrolides

Back 80

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.

Front 81

Quinolones

Back 81

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.

Front 82

Quinolones

Back 82

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.

Front 83

Streptogramins

Back 83

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.

Front 84

Aminoglycosides

Back 84

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.

Front 85

Cyclic Lipopeptides

Back 85

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.

Front 86

Storage Of Liquid Antibiotics

Back 86

After reconstitution, some antibiotics need to be stored in the refrigerator, whereas others my be kept at room temperature.

Front 87

Storage Of Liquid Antibiotics

Back 87

The pharmacy technician may give the patient information as to whether the drug needs to be refrigerated- it is not counseling.

Front 88

Ophthalmic Antibiotics

Back 88

Ophthalmic dosage forms may be used in the ear, but otic dosage forms should never be put in the eye.

Front 89

Ophthalmic Antibiotics

Back 89

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.

Front 90

Treating Complications of Infections

Back 90

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.

Front 91

Fungi & Fungal Diseases

Back 91

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.

Front 92

Fungi & Fungal Diseases

Back 92

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.

Front 93

Fungi & Fungal Diseases

Back 93

Women who take antibiotics frequently need an OTC antifungal medication to treat vaginitis, which occurs in response to the antibiotic activity.

Front 94

Fungi & Fungal Diseases

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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.

Front 95

Fungi & Fungal Diseases

Back 95

Pulse dosing for fungal nail infections appears to be very effective, with fewer side effects and less costly than continuously daily dosing.

Front 96

Viruses & Viral Infections

Back 96

Viruses are highly specialized infectious agents that replicate within a cell by using the host cell's metabolic process.

Front 97

Viruses & Viral Infections

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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.

Front 98

Viruses & Viral Infection

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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.

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Viruses & Viral Infection

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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.

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Viruses & Viral Infection

Back 100

Some virus-infected cells produce interferon, which protects neighboring uninfected cells from viral infection.

Front 101

Viruses & Viral Infection

Back 101

Even though the body has defense mechanisms, such as producing interferons, some viruses can cause normal animal cells to be transformed into cancer cells.

Front 102

Viruses & Viral Infection

Back 102

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.

Front 103

Viruses & Viral Infections

Back 103

Hepatitis B is a viral infection. When someone is diagnosed with HIV, it is no longer an early death sentence, but a chronic disease.

Front 104

Systemic Antifungal
Acyclovir
(Zovirax)

Back 104

IV form of this drug of choice for a form of herpes encephalitis and severe herpes in immunocompromised persons.

Front 105

Viruses & Viral Infections

Back 105

Famciclovir (Famvir), Acyclovir (Zovirax), and Valacyclovir (Valtrex) are used to manage acute herpes zoster.

Front 106

Viruses & Viral Infections

Back 106

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.

Front 107

Viruses & Viral Infections

Back 107

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.

Front 108

Viruses & Viral Infections

Back 108

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.

Front 109

Viruses & Viral Infections

Back 109

Ganciclovir (Vitrasert) is an ophthalmic antiviral.

Front 110

HIV-AIDS & Antiretroviral Agents

Back 110

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.

Front 111

HIV-AIDS & Antiretroviral Agents

Back 111

Nucleoside reverse transcriptase inhibitors (NRTIs) mimic a DNA building block to preventing the multiplication of the virus.

Front 112

HIV-AIDS & Antiretroviral Agents

Back 112

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).

Front 113

HIV-AIDS & Antiretroviral Agents

Back 113

Nucleotide reverse transciptase inhibitors (NtRTIs) mimic a DNA building block to stop the formation of the DNA copy with less toxicity than with NRTIs.

Front 114

HIV-AIDS & Antiretroviral Agents

Back 114

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) inhibit the action of reverse transcriptase, preventing the formation of the DNA copy of viral RNA.

Front 115

HIV-AIDS & Antiretroviral Agents

Back 115

Protease inhibitors (PIs) inhibit the protease enzyme, which cleaves certain HIV protein precursors that are necessary for replication of the virus.

Front 116

HIV-AIDS & Antiretroviral Agents

Back 116

Fusion inhibitors and chemokine coreceptors prevent HIV from entering the immune cells.

Front 117

HIV-AIDS & Antiretroviral Agents

Back 117

An integrase inhibitor blocks the enzyme integrase, which inserts DNA produced by reverse transcriptase into the patient's DNA.

Front 118

HIV-AIDS & Antiretroviral Agents

Back 118

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.

Front 119

HIV-AIDS & Antiretroviral Agents

Back 119

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.

Front 120

The Nervous System

Back 120

The primary CNS transmitters are acetylcholine, norepinephrine, dopamine, GABA, glutamate, serotonin.

Front 121

The Nervous System

Back 121

The primary PNS transmitters are acetylcholine and norepinephrine.

Front 122

The Nervous System

Back 122

The major transmitters of the sympathetic system are acetylcholine, norepinephrine, dopamine, and epinephrine.

Front 123

The Nervous System

Back 123

The only transmitter of the parasympathetic system is acetylcholine.

Front 124

The Nervous System

Back 124

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.

Front 125

Anesthesia

Back 125

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.

Front 126

Anesthesia

Back 126

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.

Front 127

Anesthesia

Back 127

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.

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Anesthesia

Back 128

The purposes of premedication are sedation, helping with postoperative pain relief, and reducing anxiety.

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Anesthesia

Back 129

Dantrolene (Dantrium) is a skeletal muscle relaxant; it is the drug of choice to treat malignant hyperthermia.

Front 130

Anesthesia

Back 130

The advantage of nitrous oxide is that it is rapidly eliminated.

Front 131

Anesthesia

Back 131

Fentanyl is used extensively for open heart procedures because it lacks some of the cardiac depressant actions of other anesthetics.

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Anesthesia

Back 132

Naloxone (Narcan), Nalnefene (Revex), and Flumazenil (Romzicon) are given to reverse overdoses of specific drugs.

Front 133

Anesthesia

Back 133

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.

Front 134

Anesthesia

Back 134

Blocking agents act via a depolarizing mechanism or as antagonists to acetylcholine at receptor sites on the muscle cell.

Front 135

Anesthesia

Back 135

Anticholinesterase agents reverse neuromuscular blockers.

Front 136

Anesthesia

Back 136

Local anesthetics are advantageous because they affect all types of nervous tissue. They relieve pain without altering alertness or mental function.

Front 137

Pain Management

Back 137

Pain itself can be a disease; it is classified as acute, chronic nonmalignant, or chronic malignant.

Front 138

Pain Management

Back 138

Pain is now considered to be the " fifth" vital sign. All narcotics have the potential to induce tolerance and dependence.

Front 139

Pain Management

Back 139

The effects of narcotics differ on different individuals.

Front 140

Pain Management

Back 140

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.

Front 141

Pain Management

Back 141

The transdermal patch provides pain control and allows the patient to remain more alert than with most other methods.

Front 142

Pain Management

Back 142

Methadone (Dolophine), Buprenorphine (Buprenex, Subutex), and Buprenorphine-naloxone (Suboxone) are drugs used to treat opioid addiction.

Front 143

Pain Management

Back 143

Morphine is the standard against which all other narcotic analgesics are measured.

Front 144

Pain Management

Back 144

Fentanyl is manufactured as a lozenge and a patch. The patch is approved for chronic use, not acute pain following surgery.

Front 145

Pain Management

Back 145

Narcotics act on an area of the brain identified as the chemotrigger zone, which in turn stimulates the vomiting center.

Front 146

Pain Management

Back 146

It is as important to watch the aspirin or acetaminophen dose in narcotic combinations analgesic as it is to watch the narcotic dose.

Front 147

Pain Management

Back 147

The pharmacy team must serve as the advocate and gatekeeper when dispensing narcotics.

Front 148

Migraine Headaches

Back 148

Patients with migraine headaches should be taught to initiate therapy immediately at the first hint of an episode.

Front 149

Migraine Headaches

Back 149

Treatments for migraine headaches are divided into two groups: abortive and prophylactic therapies.

Front 150

Migraine Headaches

Back 150

Prophylactic drugs include anticonvulsants, beta blockers, calcium channel blockers, estrogen, feverfew, NSAIDs, SSRIs, and tricyclic antidepressants.

Front 151

Migraine Headaches

Back 151

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.

Front 152

Migraine Headaches

Back 152

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.

Front 153

Depression & Mood Disorders

Back 153

Antidepressants are not controlled substances.

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Depression & Mood Disorders

Back 154

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).

Front 155

Depression & Mood Disorders

Back 155

SSRIs block the reuptake of serotonin, with little effect on norepinephrine. They have fewer side effects than the older antidepressant medications.

Front 156

Depression & Mood Disorders

Back 156

TCAs can be cardiotoxic in high doses. MAOIs are a second line treatment because of their many interactions with drugs and foods.

Front 157

Depression & Mood Disorders

Back 157

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.

Front 158

Depression & Mood Disorders

Back 158

Lithium is the drug of choice for treating bipolar (manic-depressive) disorder and acute mania and for prophylaxis of unipolar and bipolar disorders.

Front 159

Depression & Mood Disorders

Back 159

A patient taking lithium must have frequent blood tests to assess lithium levels and maintain a therapeutic range.

Front 160

Depression & Mood Disorders

Back 160

Carbamazepine (Tegretol) or divalporex (Depacote) may be substituted if patients cannot tolerate lithium.

Front 161

Psychosis

Back 161

An antipsychotic that has a ceiling dose is thioridazine, which should not exceed 800mg/day.

Front 162

Psychosis

Back 162

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).

Front 163

Psychosis

Back 163

Anticholinergics can minimize some of the side effects of typical antipsychotic drugs.

Front 164

Anxiety

Back 164

Anxiety is a state of uneasiness characterized by apprehension and worry about possible events.

Front 165

Anxiety

Back 165

The most common self-prescribed and/or administered remedy for anxiety is alcohol.

Front 166

Anxiety

Back 166

The benzodiazepines, buspirone, and, to a lesser extent, the beta blockers are the most appropriate pharmacologic treatments for panic attacks.

Front 167

Anxiety

Back 167

A sedative is an antianxiety drug; a hypnotic drug induces sleep. Some drugs fit both descriptions.

Front 168

Sleep & Sleep Disorders

Back 168

All hypnotic agents except the benzodiazepines and chloral hydrate reduce REM sleep.

Front 169

Sleep & Sleep Disorders

Back 169

Benzodiazepines that are FDA approved for hypnotic use are estazolam (ProSom), flurazepam (Dalmane), Quazepam (Doral), Temazepam (Restoril), and Triazolam (Halcion)

Front 170

Sleep & Sleep Disorders

Back 170

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.

Front 171

Sleep & Sleep Disorders

Back 171

Rozerem is not a controlled substance because it works in a different way from other hypnotics.

Front 172

Sleep & Sleep Disorders

Back 172

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.

Front 173

Sleep & Sleep Disorders

Back 173

Zolpidem (Ambien), a schedule IV drug, has many of the same properties as the benzodiazepines, but is structurally dissimilar.

Front 174

Sleep & Sleep Disorders

Back 174

Eszopiclone (Lunetsa) is approved for long term use. Antihistamines are the safest drugs to use in treating insomnia.

Front 175

Alcoholism

Back 175

Alcoholism is an incurable and potentially fatal disease. It can be controlled through behavioral changes. Alcoholism is linked to genetics.

Front 176

Alcoholism

Back 176

Alcoholics have an increased ability to metabolize ethanol rapidly, and neurons in the CNS adapt to the presence of ethanol.

Front 177

Alcoholism

Back 177

Four drugs have been approved for treatment of alcoholism; they are disulfiram (Antabuse), Acamprosate (Campral), Topirmate (Topamax), Naltrexone (ReVia).

Front 178

Epilepsy

Back 178

Epilepsy is a common neurologic disorder defined as paroxysmal seizures. It involves disturbances of neuronal electrical activity that interfere with normal brain function.

Front 179

Epilepsy

Back 179

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.

Front 180

Epilepsy

Back 180

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.

Front 181

Epilepsy

Back 181

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.

Front 182

Parkinson Disease

Back 182

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.

Front 183

Parkinson Disease

Back 183

Dopamine will not cross the blood brain barrier. Sinemet, a levodopa-carbidopa preparation, is probably the most commonly used drug in Parkinson Disease.

Front 184

Parkinson Disease

Back 184

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.

Front 185

Other Central Nervous System Disorders

Back 185

Acetylcholinterase drugs can produce clinical improvement in all forms of myasthenia gravis.

Front 186

Other Central Nervous System Disorders

Back 186

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.

Front 187

Other Central Nervous System Disorders

Back 187

Atomoxentine (Strattera) and Modafinil (Sparlon) are the only nonstimulant medications indicated for treatment of ADHD in patients 6 years or older.

Front 188

Other Central Nervous System Disorders

Back 188

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.

Front 189

Other Central Nervous System Disorders

Back 189

Among the drugs used to treat multiple sclerosis are two chemically different interferons.

Front 190

Other Central Nervous System Disorders

Back 190

Glatiramer acetate (Copaxone) is an MS drug that must be kept frozen.

Front 191

Other Central Nervous System Disorders

Back 191

Tizanidine (Zanaflex) is the first oral drug approved for spasticity since baclofen (Lioresal).

Front 192

Other Central Nervous System Disorders

Back 192

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.

Front 193

Asthma

Back 193

Asthma is a disease in which inflammation causes the airways to tighten; asthma is a reversible condition.

Front 194

Asthma

Back 194

The asthmatic lung is more sensitive and responds to lower doses of challenge from allergens than do normal lungs.

Front 195

Asthma

Back 195

Asthma is a pulmonary condition with the following characteristics: reversible small airway obstruction, progressive airway inflammation, and increased airway responsiveness to stimuli.

Front 196

Asthma

Back 196

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.

Front 197

Asthma

Back 197

In 2008 the FDA mandated that all inhalers will no longer use the ozone-depleting propellant chlorofluorocarbon (CFC).

Front 198

Asthma

Back 198

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.

Front 199

Asthma

Back 199

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.

Front 200

Asthma

Back 200

With an MDI, the patient inhales slowly, whereas with a dry powder inhaler the patient breathes in quickly to activate the inhaler.

Front 201

Asthma

Back 201

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.

Front 202

Asthma

Back 202

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.

Front 203

Asthma

Back 203

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.

Front 204

Asthma

Back 204

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.

Front 205

Asthma

Back 205

Salmeteral and terbutaline are long acting inhaled bronchodilators.

Front 206

Asthma

Back 206

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.

Front 207

Asthma

Back 207

Theophylline should used only in lung diseases unresponsive to other drugs because of its high interaction profile.

Front 208

Asthma

Back 208

Leukotrienes are 100 to 1000 times more potent than histamine; therefore, when these receptors are antagonized, inflammatory responses do not take place.

Front 209

Asthma

Back 209

Zafirlukast (Accolate) is a leukotriene receptor antagonist that has shown very good results.

Front 210

Asthma

Back 210

Zileuton (Zyflo) is a leukotriene inhibtor that carries strong warnings about liver toxicity and can double theophylline levels.

Front 211

Asthma

Back 211

Montelukast (Singulair) is indicated for prophylaxis and chronic treatment of asthma. It is approved for use in adults and children 12 months and older.

Front 212

Asthma

Back 212

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.

Front 213

Asthma

Back 213

Many asthmatics still are not using corticosteroids. Always use the lowest effective dose of a corticosteroid. Add salmeterol to inhaled corticosteroid needed for control.

Front 214

Asthma

Back 214

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.

Front 215

Chronic Obstructive Pulmonary Disease

Back 215

Chronic obstructive pulmonary disease (COPD) encompasses emphysema and chronic bronchitis. COPD is irreversible.

Front 216

Chronic Obstructive Pulmonary Disease

Back 216

Emphysema is characterized by destruction of the tiny alveoli, walls, or air sacs of the lungs.

Front 217

Chronic Obstructive Pulmonary Disease

Back 217

Chronic bronchitis can be caused by cigarette smoke; exposure to occupational dusts, fumes, and environmental pollution; and bacterial infection.

Front 218

Chronic Obstructive Pulmonary Disease

Back 218

Pharmacologic management of bronchitis and emphysema is still largely empirical, with methylxanthines, corticosteroids, beta agonists, and ipratropium forming the foundation of therapy.

Front 219

Chronic Obstructive Pulmonary Disease

Back 219

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.

Front 220

Other Lung Diseases

Back 220

Respiratory diseases syndrome occurs in newborns and is treated with surfactants. The treatment regimen for TB varies depending on the patients syndrome.

Front 221

Other Lung Diseases

Back 221

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.

Front 222

Cold, Cough, and Allergy

Back 222

Antitussives, expectorants, decongestants, and antihistamines each have a different mechanism of action and purpose. Most are OTC products.

Front 223

Antitussives

Back 223

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.

Front 224

Antitussives

Back 224

Codeine, commonly referred to as the "gold standard of antitussives" is the antitussive against which all others are compared.

Front 225

Antitussives

Back 225

Dextromethorphan may be as effective as codeine. One must be over 18 years old and show proof of age to purchase dextromethorpan.

Front 226

Expectorants

Back 226

Expectorants decrease the thickness and stickiness of mucus by decreasing viscosity. Guaifenesin is the most used expectorant, but water may work as well.

Front 227

Decongestants

Back 227

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.

Front 228

Decongestants

Back 228

Topical application of decongestants (nasal sprays and drops) can cause a rebound phenomenon, rhinitis medicamentosa.

Front 229

Decongestants

Back 229

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.

Front 230

Antihistamines

Back 230

Antihistamines are used primarily to combat allergic reactions, nausea, vertigo, and insomnia. They prevent binding of histamine to the receptor sites.

Front 231

Antihistamines

Back 231

The most common side effects of antihistamines are sedation, and anticholinergic responses (dry mouth, constipation, urinary retention).

Front 232

Antihistamines

Back 232

Many antihistamines are sold OTC. Diphenhydramine is the major ingredient in OTC sleep medications.

Front 233

Antihistamines

Back 233

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.

Front 234

Smoking Cessation

Back 234

Benefits of smoking cessation include a longer life and better health. The key to smoking cessation is total abstinence.

Front 235

Smoking Cessation

Back 235

Most nicotine cessation drugs are OTC. Chantix has been the most successful.

Front 236

The Gastrointestinal System

Back 236

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.

Front 237

The Gastrointestinal System

Back 237

The digestive and absorptive processes take place in the GI tract.

Front 238

The Gastrointestinal System

Back 238

Mucous membranes protect the entire digestive system against abrasions and strong digestive chemicals.

Front 239

Gastrointestinal Diseases

Back 239

GERD is commonly known as heartburn. Alcohol, nicotine, and caffeine exacerbate GERD.

Front 240

Gastrointestinal Diseases

Back 240

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)

Front 241

Gastrointestinal Diseases

Back 241

The bedtime dose of the H2 blockers is the most important one. The three types of ulcers are gastric, duodenal, and stress.

Front 242

Gastrointestinal Diseases

Back 242

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.

Front 243

Gastrointestinal Diseases

Back 243

Gastritis is an irritation and superficial erosion of the stomach lining. Ulcerative colitis is an irritation of the large bowel.

Front 244

Gastrointestinal Diseases

Back 244

Infliximab (Asacol, Pentasa, Rowasa) is used in Chrohn disease and ulcerative colitis.

Front 245

Gastrointestinal Diseases

Back 245

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.

Front 246

Gastrointestinal Diseases

Back 246

Olsalazine (Dipentum) is used for patients resistant to sulfasalazine.

Front 247

Gastrointestinal Diseases

Back 247

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.

Front 248

Diarrhea

Back 248

Diphenoxylate-atropine (Lomotil) is a combination drug and a controlled substance used for diarrhea.

Front 249

Diarrhea

Back 249

Loperamide (Imodium) has been found to be as effective as diphenoxylate atropine and is available OTC.

Front 250

Constipation and Related GI Diseases

Back 250

Dietary fiber increases colon content, decreases colon pressure, and increases propulsive motility.

Front 251

Constipation and Related GI Diseases

Back 251

Chronic constipation is often associated with low fiber diets.

Front 252

Constipation and Related GI Diseases

Back 252

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.

Front 253

Constipation and Related GI Diseases

Back 253

Constipation can be relieved with osmotic laxatives, saline laxatives, irritant/stimulant laxatives, surfactant laxatives, bulk forming agents.

Front 254

Constipation and Related GI Diseases

Back 254

Constipation and lack of dietary fiber increase the likelihood of other diseases including diverticular disease, hiatal hernia, and hemmorrhoids.

Front 255

Nausea & Vomiting

Back 255

The chemoreceptor trigger zone (CTZ) is involved in vomiting. Some antiemetics bind to serotonin (5-HT) receptors to prevent nausea.

Front 256

Obesity

Back 256

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)

Front 257

Obesity

Back 257

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.

Front 258

Obesity

Back 258

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.

Front 259

Obesity

Back 259

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)

Front 260

Parasites & Protozoa

Back 260

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.

Front 261

Parasites & Protozoa

Back 261

Mebendazole (Vermox) is used in the treatment of pinworms, whipworms, hookworms, and ascarides. Pyrantel (Pin-X) is used to treat pinworms.

Front 262

Parasites & Protozoa

Back 262

Thiabendazole (Mintezol) is used for treatment of Trichinella and Strongyloides. Intestinal protozoa are spread by the feces to mouth route.

Front 263

Parasites & Protozoa

Back 263

Amebiasis is treated with metronidazole (Flagyl, Flagyl IV). Sulfamethoxazole-trimethoprim (Bactrim, Bactrim DS, Cotrim, Septra, Septra DS) treats isosporiasis and cyclosporiasis.

Front 264

Parasites & Protozoa

Back 264

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.

Front 265

Hepatitis

Back 265

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.

Front 266

Function of the Renal System

Back 266

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.

Front 267

Function of the Renal System

Back 267

Renal disease is divided into four stages: (1) loss of renal reserve, (2) renal insufficiency, (3) chronic renal failure, (4) end stage renal disease.

Front 268

Function of the Renal System

Back 268

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.

Front 269

Function of the Renal System

Back 269

Most renal patients show evidence of erythroproietin deficiency. Sucralfate and aluminum-containing antacids can cause aluminum toxicity in a patient on dialysis.

Front 270

Function of the Renal System

Back 270

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.

Front 271

Drugs for Urinary Tract Diseases and Disorders

Back 271

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.

Front 272

Drugs for Urinary Tract Diseases and Disorders

Back 272

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.

Front 273

Drugs for Urinary Tract Diseases and Disorders

Back 273

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).

Front 274

Drugs for Urinary Tract Diseases and Disorders

Back 274

Nilutamide (Nilandron) is used for advanced prostate cancer. Flutamide (Eulexin) can cause gynecomastia.

Front 275

Diuretics

Back 275

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.

Front 276

Diuretics

Back 276

Triamterene-hydrochlorothiazide (Dyazide, Maxzide) theoretically does not waste potassium. The tablet Maxzide is better absorbed than the capsule Dyazide.

Front 277

The Cardiovascular System and Causative Factors of Cardiovascular Disease

Back 277

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.

Front 278

The Cardiovascular System and Causative Factors of Cardiovascular Disease

Back 278

Proper diet, exercise, and rest can do a lot to keep the heart functioning for a long time.

Front 279

Angina

Back 279

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.

Front 280

Angina

Back 280

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.

Front 281

Angina

Back 281

Carvedilol (Coreg) is a beta blocker used for hypertension. It is nonselective and the only beta blocker approved for and used in heart failure.

Front 282

Angina

Back 282

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.

Front 283

Angina

Back 283

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.

Front 284

Angina

Back 284

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.

Front 285

Angina

Back 285

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.

Front 286

Angina

Back 286

Generic names of many beta blockers end in "lol".
Generic names of many calcium channel blockers end in "ipine".

Front 287

Arrhythmia

Back 287

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.

Front 288

Arrhythmia

Back 288

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.

Front 289

Arrhythmia

Back 289

Various types of arrhythmic show specific patterns on the ECG and are associated with different degrees of danger of sudden death.

Front 290

Arrhythmia

Back 290

The various classes of antiarrhythmic drugs have characteristics electrophysiologic effects on the myocardium.

Front 291

Arrhythmia

Back 291

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.

Front 292

Arrhythmia

Back 292

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.

Front 293

Congestive Heart Failure

Back 293

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.

Front 294

Congestive Heart Failure

Back 294

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.

Front 295

Congestive Heart Failure

Back 295

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.

Front 296

Congestive Heart Failure

Back 296

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".

Front 297

Hypertension

Back 297

Cardiac output, which is the product of heart rate and stroke volume, is determined by preload, afterload, and contractility.

Front 298

Hypertension

Back 298

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.

Front 299

Hypertension

Back 299

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.

Front 300

Hypertension

Back 300

The first-line drug for hypertension can be a diuretic, a beta blocker, an ACE inhibitor, or a calcium channel blocker.

Front 301

Hypertension

Back 301

ACE inhibitors reduce blood pressure by competitive inhibition of angiotensin-converting enzyme (ACE), preventing the conversionof angiostensin I to angiotensin II, a potent vasoconstrictor.

Front 302

Hypertension

Back 302

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".

Front 303

Hypertension

Back 303

Calcium channel blockers reduce blood pressure by arteriolar dilation, which leads to reduced peripheral resistance.

Front 304

Hypertension

Back 304

Beta blockers, calcium channel blockers and ACE inhibitors are all equally effective drugs used in the treatment of hypertension.

Front 305

Hypertension

Back 305

Clonidine is the only antihypertensive that has a transdermal delivery system. Minoxidil (Loniten, Rogaine) reduces blood pressure and stimulates hair growth.

Front 306

Hypertension

Back 306

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.

Front 307

Myocardial Infarction (MI)

Back 307

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.

Front 308

Myocardial Infarction (MI)

Back 308

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.

Front 309

Myocardial Infarction (MI)

Back 309

Beta blockers and low dose aspirin are prescribed for reducing the risk of death or recurrence following an MI.

Front 310

Blood Clots

Back 310

Blood clots in the bloodstream (thrombi) can cause life threatening pulmonary embolism and other serious damage.

Front 311

Blood Clots

Back 311

Anticoagulants prevent clot formation by affecting clotting factors; antiplatelets reduce the risk of clot formation by inhibiting platelet aggregation.

Front 312

Blood Clots

Back 312

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.

Front 313

Blood Clots

Back 313

Partial thromboplastin time (PTT) measures the function of the intrinstic and common pathways; it does not dissolves a clot that has already formed.

Front 314

Blood Clots

Back 314

Lepirudin (Refludan) is an alternative and anticoagulant for patients who cannot tolerate heparin.

Front 315

Blood Clots

Back 315

Protamine sulfate is the antidote for heparin. Phytonadione, vitamin k (mephyron) is an antidote for warfarin.

Front 316

Blood Clots

Back 316

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.

Front 317

Blood Clots

Back 317

Tinzaparin (Innohep) should not be interchanged with the other low molecular weight heparins. Aspirin is prescribed to prevent strokes and MIs.

Front 318

Blood Clots

Back 318

Glycoprotein antagonists are administered during invasive procedures to prevent artery closure.

Front 319

Blood Clots

Back 319

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.

Front 320

Stroke

Back 320

A stroke may be caused by one of two primary events; cerebral hemorrhage and cerebral infarction.

Front 321

Stroke

Back 321

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.

Front 322

Stroke

Back 322

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.

Front 323

High Cholesterol and Related Diseases

Back 323

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.

Front 324

High Cholesterol and Related Diseases

Back 324

LDLs (low density lipoproteins) not used by the cells may be deposited in artery walls, eventually clogging them.

Front 325

High Cholesterol and Related Diseases

Back 325

HDLs (high density lipoproteins) may prevent cholesterol buildup in arteries. Triglycerides release free fatty acids in the blood to be stored in adipose cells.

Front 326

High Cholesterol and Related Diseases

Back 326

Drugs are used as an adjunct to proper diet to prevent buildup of LDLs.

Front 327

High Cholesterol and Related Diseases

Back 327

Some combinations of these drugs are synergistic; others can be dangerous. Any symptom of muscle pain should be reported to the physician immediately.

Front 328

High Cholesterol and Related Diseases

Back 328

Thiazide diuretics, loop diuretics, and glucocorticords all increase the lipid profile unfavorably.

Front 329

High Cholesterol and Related Diseases

Back 329

Simvastatin (Zocor) acts on the enzyme that catalyzes the rate limiting step in cholesterol biosynthesis.

Front 330

High Cholesterol and Related Diseases

Back 330

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.

Front 331

High Cholesterol and Related Diseases

Back 331

Statins are HMG-CoA reductase inhibitors and the generic name ends in "statin".

Front 332

High Cholesterol and Related Diseases

Back 332

Fenofibrate (Tricor) increases the catabolism of VLDLs.

Front 333

High Cholesterol and Related Diseases

Back 333

Ezetimibe (Zetia) decreases cholesterol by inhibiting the absorption of cholesterol at the brush border of the small intestine.

Front 334

High Cholesterol and Related Diseases

Back 334

Manufacturers have combined drugs with synergistic mechanisms of action to lower cholesterol.

Front 335

Muscle Relaxants

Back 335

The side effects of muscle relaxants are sedation, reduced mental alertness, reduced motor abilities, and GI upset. Patients taking these drugs should avoid alcohol.

Front 336

Muscle Relaxants

Back 336

Diazepam (Valium), a benzodiazepine, is a highly effective muscle relaxer, but its abuse potential restricts its use.

Front 337

Muscle Relaxants

Back 337

Methocarbamol (Robaxin) causes skeletal muscle relaxation by reducing the transmission of impulses from the spinal cord to skeletal muscles.

Front 338

Muscle Relaxants

Back 338

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.

Front 339

Muscle Relaxants

Back 339

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.

Front 340

Muscle Relaxants

Back 340

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.

Front 341

Muscle Relaxants

Back 341

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.

Front 342

Muscle Relaxants

Back 342

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.

Front 343

Inflammation & Swelling

Back 343

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.

Front 344

Inflammation & Swelling

Back 344

Somatic pain (from injury to skin, muscle, and bone) is dull and throbbing, while visceral pain (from the organs) is sharp and stabbing.

Front 345

Inflammation & Swelling

Back 345

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.

Front 346

Inflammation & Swelling

Back 346

Adverse GI effects may limit the use of nonnarcotic analgesics. Aspirin, salicylate, is the prototype NSAID. Salicyates have analgesic anti inflammatory and antipyretic properties.

Front 347

Inflammation & Swelling

Back 347

The primary analgesic actions of salicylates are peripheral rather than central. Their primary antipyretic action is central and presumed to be in the hypothalmus.

Front 348

Inflammation & Swelling

Back 348

Salicylates are indicated for simple headache, arthritis, pain and fever, with influenza, muscular aches and pains, menstrual cramps, and inflammation.

Front 349

Inflammation & Swelling

Back 349

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.

Front 350

Inflammation & Swelling

Back 350

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.

Front 351

Inflammation & Swelling

Back 351

Acetaminophen acts centrally to cause antipyresis. It is an effective analgesic and antipyretic without anti inflammatory, antirheumatic, or uric acid excretory effects of aspirin.

Front 352

Inflammation & Swelling

Back 352

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.

Front 353

Inflammation & Swelling

Back 353

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.

Front 354

Arthritis & Related Disorders

Back 354

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.

Front 355

Arthritis & Related Disorders

Back 355

Therapy for arthritis is aimed at relieving pain, maintaining or improving mobility, and minimizing disability. It may include medication, physical therapy, and patient education.

Front 356

Arthritis & Related Disorders

Back 356

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.

Front 357

Arthritis & Related Disorders

Back 357

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.

Front 358

Arthritis & Related Disorders

Back 358

PGs perform three protective functions in the GI tract: increased mucosal blood flow, increased mucus production, and decreased free acid production.

Front 359

Arthritis & Related Disorders

Back 359

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.

Front 360

Arthritis & Related Disorders

Back 360

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.

Front 361

Arthritis & Related Disorders

Back 361

Clinical trials have not shown the superiority of any NSAIDS over the others for the management of rheumatoid arthritis.

Front 362

Arthritis & Related Disorders

Back 362

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.

Front 363

Arthritis & Related Disorders

Back 363

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.

Front 364

Arthritis & Related Disorders

Back 364

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.

Front 365

Arthritis & Related Disorders

Back 365

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.

Front 366

Arthritis & Related Disorders

Back 366

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.

Front 367

Arthritis & Related Disorders

Back 367

Mild rheumatoid arthritis should be treated with more than NSAIDs because joint damage occurs earlier than thought.

Front 368

Arthritis & Related Disorders

Back 368

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.

Front 369

Arthritis & Related Disorders

Back 369

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.

Front 370

Arthritis & Related Disorders

Back 370

Cytotoxic agents, diuretics, ethanol, nicotinic acid, and salicylates can precipitate a gout attack.

Front 371

Arthritis & Related Disorders

Back 371

Colchicine is the drug of choice for an acute gout attack. Colchicine, probenecid-colchicine, indomethacin, allopurinol, and sulfinpyrazone are all used for gout.

Front 372

Silver Nitrate

Back 372

Source: Mineral- Silver

Therapeutic Effect: Anti Infective

Front 373

Prilosec

Back 373

Source: Synthetic- Omeprazole

Therapeutic Effect: Gastric Acid Inhibitor

Front 374

Epogen

Back 374

Source: Bioengineering- Erythropoietin

Therapeutic Effect: Stimulator of red blood cell formation

Front 375

FDA Pregnancy Categories

Back 375

A: No Risk
B: Risk Cannot Be Ruled Out
C: Caution Is Advised
D: Is A Definite Risk
X: Do Not Use

Front 376

Digoxin

Back 376

Source: Plant- Foxglove

Therapeutic Effect: Cardiotonic

Front 377

Pepsin

Back 377

Source: Animal- stomach of hog or cow

Therapeutic Effect: Digestive Enzyme

Front 378

Peroral (PO, By Mouth)

Back 378

Oral (swallowed)
Sublingual (under the tongue)
Buccal (dissolves in cheek)

Front 379

Parenteral (Injection)

Back 379

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)

Front 380

Topical (Surface Of Skin)

Back 380

Transdermal (skin surface)
Conjuctival (conjuctiva)
Intraocular (eye)
Intranasal (nose)
Aural (ear)
Intrarespiratory (lung)
Rectal (rectum)
Vaginal (vagina)
Urethral (urethra)

Front 381

Peroral (PO, Mouth)

Back 381

Tablets, capsules, solutions, syrups, elixirs, suspensions, gels, powders, troches/lozenges

Front 382

Parenteral

Back 382

Solutions & suspensions

Front 383

Topical

Back 383

Ointments, Creams, Pastes, Powders, Aerosols, Lotions, Transdermal patches, Sprays, Inhalants, suppositories, enemas, emulsions, sponges, & gels.

Front 384

Common Adverse Reactions Potentiated in the Elderly

Back 384

CNS changes, constipation, dermatitis, diarrhea, drowsiness, falls, gi upset, incontinence, insomnia, RA, sexual dysfunction, urinary retention, xerostomia (dry mouth)