Pharmacology Quiz 4

Front 1

Difinition of Antimicrobial

Back 1

- chemical substance which is capable in low (and relatively safe) concentrations of inhibiting the growth or killing microorganisms. Mold is capable of producing penicillins that kill other microorganisms.

Front 2

changing side chains of penicillin could change __________, and _________

Back 2

Spectrum (Broad and Narrow), and Pharmacokinetics (specifically half life)

Front 3

Broad Spectrum (antimicrobial)

Back 3

-kills or inhibits the growth of many different organisms including infecting and NON-INFECTING organisms

-alters natural flora - can lead to super-infection and pseudomembranous colitis (C.defficile)

-USES: unidentified organisms, mixed infections, no other alternatives.

Front 4

Narrow Spectrum (antimicrobial)

Back 4

-Inhibits the growth or kills a limited number of different organisms

-Less potential for super-infections

Front 5

Bacteriocidal

Back 5

-at safe serum levels kills sensitive organisms

-effective in immuno-compromised individuals

Front 6

advantage of Narrow Spectrum?

Back 6

-more specific, and limited impact on normal flora = less chance of opportunistic super-infection, and psuedomonas colitis

Front 7

Bacteriostatic

Back 7

-at safe serum levels, inhibits the growth of sensitive micro-organisms

-allows the body's immune system to kill the micro-organisms

-ineffective in immuno-compromised individuals

Front 8

Bacteriostatic vs. Bacteriocidal

Back 8

-bacteriostatic = p.o. , and at low concentration only

-bacteriocidal = I.V. and at high concentration

Front 9

mechanism of action (antimicrobials)

Back 9

-only effective in replicating organisms

-interrupts cell wall synthesis, protein synthesis, vitamin utilization

Front 10

Resistance : 2 types

Back 10

-Inherent = organisms never has been sensitive to a particular antimicrobial agent

-Acquired = organism had previously been sensitive but has acquired an insensitivity (associated with over use of antimicrobial agents)

Front 11

antimicrobial selection

Back 11

-cost

-identify organism and its sensitivity (2-3 days culture. sometimes longer)

-identify source of infection (where in the body. ex: UTI)

-select the most narrow spectrum agent possible

-avoid hypersensitivity

-use synergistic combination in immuno-compromised pts.

Front 12

causes of antimicrobial failure

Back 12

-fever not due to infection (ex. treating symptom, not what caused the infection)

-improper dose

-improper selection of antimicrobial

-improper duration of therapy (usually in ambulatory)

-failure to utilize ancillary measures (incision and drainage of WBCs)

Front 13

patient variables (antimicrobials)

Back 13

-genetic = metabolism of antimicrobial agents (getting rid of it too fast is a problem)

-allergies = cross allergies (penicillin and cephalosporins)

-age = Quinolones affects tendons in children, and Tetracyclines no used in children due to adverse reactions of teeth mottling and effect on bone growth.

Front 14

Penicillins

Back 14

-bacteriocidal

-allergic to one -allergic to all penicillins

-narrow to broad spectrum

-crosses BBB

Front 15

Penicillinase Resistant Penicillins

Back 15

-resistant to penicillinase enzyme (enzyme that kills penicillin) produced by Staph Aureus

-MRSA strains can still destroy this antimicrobial agent

-narrow spectrum = Staph Aureus causes skin infections, otitis, respiratory inf.

Front 16

Penicillin G's

Back 16

Spectrum:
-strept pneumonia =causing, resp., skin infections, and otitis
-anaerobic strept =causing resp. infection
-((Neisseria)) =causing Gonorrhea = however, the organisms found resistance *
-trepenema pallidum (syphilis) =STD.

Front 17

wider spectrum penicillins

Back 17

-examples: Ampicillin, Amoxicillin

-Spectrum:
-same as penicillin G's
-E.coli = GI, and UTI
-Hemophilus influenza = resp. and otitis
-Enterococcus = GI, and UTI (but starting to get resistance to penicillin and back-up, Vancomycin) ***

Front 18

Extended spectrum penicillins

Back 18

-examples: Piperacillin, Ticarcillin, Mezlocillin

-synergistic with aminoglycosides

-Spectrum:
-same as wider spectrum
-pseudomonas aeruginosa (which usually hits immuno-compromised) GI, and UTI

Front 19

Penicillin potentiators

Back 19

-examples : Clavulanate, Tazobactam, Sulbactam (look at drug list)

-overcomes resistant organisms

-overcomes enzymes that would destroy the penicillin antimicrobial agent

Front 20

Cephalosporins

Back 20

-bacteriocidal (for immuno-compromised)

-10% cross allergenicity with penicillins

-first generation does not cross BBB

-only CEFUROXIME of second generation crosses BBB

-All third generation cross BBB

Front 21

first generation Cephalosporins

Back 21

spectrum:
-E.coli
-Staph
-Hemophilus Influenza
-Klebsiella (resp. infections)

Front 22

second generation Cephalosporins

Back 22

-may be effective in first generation resistance

spectrum (broadens = super infection and maybe pseudomonas colitis)
-Bacteroides (anaerobe) =GI, resp., skin

Front 23

third generation Cephalosporins

Back 23

-may be effective against organisms resistant to 1st and 2nd generation

-synergistic with aminoglycosides

spectrum:
-similar to second generation
-pseudomonas

Front 24

Macrolides: Erythromycin

Back 24

-Bacteriostatic (p.o) but can be made into BACTERIOCIDAL when administered IV (in high doses)

-Forms:
-base form =oral, poorly absorbed, useful for bowel sterilization prior to GI surgery. cleans out the GI
-stearate form = well absorbed, causes GI upset: solution = slow release
-estolate form (p.o)-well absorbed, little GI upset, but associated with cholestatic hepatitis
-Gluceptate, Lactobionate = IV use, CANNOT give IM.

Front 25

Macrolides: Erythromycin Use and Side Effects

Back 25

-Penicillin allergy to gram positive cocci for treating respiratory, otitis and syphilis
-topical use for acne
-Legionnaire's Disease = caused by Legionella found in the water

-Side Effects: significant GI upset

Front 26

Macrolides : Azithromycin (Zithromax), Clarithromycin (Biaxin)

Back 26

-Azithromycin = respiratory infection. mycobacterium avium cannot be cured because it's dormant but use "Z-pack"

-Clarithromycin = respiratory infection, mycobacterium avium, helicobacter pylori (ulcers)

Front 27

Clindamycin

Back 27

-Bacteriostatic - not to be used in immuno-compromised unless given IV.

-Use: anaerobic infections- GI, respiratory

-Adverse Reactions:
-Diarrhea
-pseudomembranous colitis, therefore limit therapy to no more than 7 days (10 days max)

Front 28

Metronidazole

Back 28

-Bacteriostatic (p.o), Bacteriocidal (IV)

-Use:
-trichomonas (STD)
-Anaerobic infections
-Helicobacter pylori (for ulcers)

-Adverse Reactions:
-Disulfiram like reaction with alcohol = can get you very very sick with any alcohol

Front 29

Vancomycin

Back 29

-Bacteriocidal

-NO oral absorption, but given orally to treat pseudomembranous colitis

-Use:
-penicillin allergy for gram positive cocci
-MRSA
-pseudomembranous colitis

Front 30

Vancomycin: monitor and adverse reactions

Back 30

-Monitor:
-" peak and trough blood levels" = the highest and the lowest blood levels

-adverse reactions = ototoxic (lose hearing), and Nephrotoxic (permanent) if we do not let blood level to drop at a certain level. = peak and through

Front 31

Tetracyclines

Back 31

-bacteriostatic

-extremely broad spectrum = risks of super-infection

-food/drug interaction
=minerals: Mg, Ca, Fe, Al (antiacids)

-avoid in children = affects teeth and long bone

-side effects: photosensitivity, GI upset

-do not use expired medication: esp. Tetracyclines!!! for tetracyclines it's dangerous because it degrades to toxic agents, leading to Fanconi Syndrome (total inflammation of any organ in the abdominal cavity)

-use: chlamydia, acne, COPD, cholera

Front 32

Chloramphenicol

Back 32

-hepatic elimination
-poor elimination in infants
-crosses BBB

-Adverse reaction : APLASTIC ANEMIA(destroys bone marrow) = only cure is bone marrow
transplant)

-Use: meningitis, and anaerobic infections

Front 33

Aminoglycosides

Back 33

-No oral absorption except "Neomyocin"

-Nephrotoxic and Ototoxic

-Monitor therapy with peak and trough levels

-good gram negative coverage

-synergistic with penicillins*

-Tobramycin and Amikacin reserved for resistance to Gentamicin

-Neomycin used orally for bowel sterilization - and Neosporin (only OTC antibiotic - topical)

Front 34

Aminoglycosides Use

Back 34

-IV for systemic gram negatives

-topical

-ophthalmic and otic (eye/ear drops)

Front 35

Quinolones

Back 35

-Broad Spectrum

-minerals block absorption

-affects tendon growth in children

-increasing rate of resistance

-use:
-UTI, and respiratory infection

Front 36

Urinary Tract Infectioin (UTI)

Back 36

-increasing resistance in hospital and community acquired infections

-Sulfonamides (Sulfa) not very useful any more = resistance

Front 37

Sulfa?

Back 37

-sulfa blocks the conversion steps to activate folic acid in bacterias.

Front 38

Sulfonamides

Back 38

-high acquired resistance

-use in combo with Trimethoprim to overcome resistance

-Trimethoprim/Sulfamethoxazole (co-trimoxazole) inhibits bacteria ability to activate folic acid to tetrahydrofolate

Front 39

Co-trimoxazole

Back 39

-Use:
-UTI, Respiratory infection, Pneumocystis Carinii (parasit in the lungs, common in AIDS pts) =high dose therapy

Adverse Reactions
-Anemia associated with high dose therapy = Megaloblastic Anemia = Leucovorin
-serious skin rashes
-diarrhea

Front 40

Methenamine

Back 40

-breakes down to formaldehyde (one of the most potent antimicrobial) in acidic environment

-enteric coated to avoid breakdown in the stomach * (to avoid killing normal flora)

-cranberry juice and Vitamine C (ascorbic acid) help acidify urin

-not useful with indwelling foley catheters

Front 41

Fungal infections

Back 41

Systemic :
-respiratory (coccidioidomycosis)
-urinary
-meningitis

Dermatologic
-athlete's foot

Front 42

Amphotericin B

Back 42

-for fungal infection

-IV and bladder irrigation

-precipitates in Saline, therefore IV admixtures in Dextrose and bladder irrigation in Water

-protect from light

-test dose is administered

-dose is gradually increased

Front 43

Amphotericin B: Adverse Reactions

Back 43

-headache, chills, fever (premedicate with antipyretic, steroids, and/or antihistamines)

-Thrombophlebitis (premedicate with an anticoagulant)

-Hypokalemia

-Nephrotoxicity - reversible

Front 44

Fluconazole

Back 44

-for fungal infection

-1 dose for vaginal fungal infection

-oral and IV therapy

-less effective than Amphotericin

-less side effects

-advantage : oral agent for systemic infecteions

Front 45

Fluconazole : Nystatin

Back 45

-for fungal infection

-oral and topical

-oral use for candida/thrush (from antibiotics)

-topical use for skin and vaginal infections

Front 46

Fluconazole : Flucytosine

Back 46

-oral use

-adjunct therapy for meningitis (never by itself)

-

Front 47

Fluconazole : Misc.

Back 47

-Miconazole = topical and vaginal use. ex: athlete's foot

-Griseofulvin (can destroy liver**) = oral for dermatologic and nail infections -duration of therapy can be 6 months to a year with (pt. liver monitor)

-Ketoconazole = dermatologic and oral infections

-Terbinafine = Nail infections and athlete's foot

-Mycobacterium = slow growing organism, difficult to eradicate, mycobacterium tuberculi can be cured but not M. avium

Front 48

TB therapy

Back 48

-non-compliance leads to resistance

-minimal to Moderate disease requires two drugs for two years

-advance (disseminated) disease requires three drugs for three years

-Prophylactic therapy for healthy positive converters (pt. with healthy liver) for 9 to 12 months

-most medications are hepatotoxic

Front 49

Viral therapy

Back 49

-some viral infections cannot be cured (if body cannot clear virus, it cannot be cured however, it can be controlled)
ex: HIV, herpes

-some agents may stop flare ups (Acyclovir)

-Some agents may hasten recovery (Amantadine - Influenza type A)

Front 50

Chemotherapy General Principles: DNA review

Back 50

-double helix structure
-chromosomes that direct cellular life
-directs formation of RNA
-protein synthesis dependent on mRNA and tRNA
-each 3 codones make up an amino acid
-chemo can block synthesis

Front 51

Chemotherapy General Principles: Cancer cell cycle

Back 51

-S phase is replicating phase (most drugs work on this phase)

-G phase is non-replicating phase
(NO DRUGS can work on this phase)

Front 52

Chemotherapy General Principles: drug resistance

Back 52

-innate (certain cancers will not be susceptible to therapy)

-acquired

Front 53

Chemotherapy General Principles:

Back 53

-drugs kill by first order kinetics ?? (effective therapy kills 99.9% of tumor cells - .1% were in the G phase and could not be killed).

-importance of scheduling regimens

-advantages of combination therapy = best way to get to 99.9 %

Front 54

Alkylating agents

Back 54

-causes abnormal pairing of DNA strands

-toxicities = rapid growing normal tissues - hematopoetic (blood cells - pt. become anemic), GI, hair, gonads

-bone marrow depression occurs slowly and recovers in 4 to 6 weeks

Front 55

Nitrosoureas

Back 55

-crosses BBB

-effective against CNS tumors

Front 56

Cisplatin

Back 56

extremely toxic

-nephrotoxicity = must use fluids and diuretics to protect kidneys (ex. loop or osmotic diuretics)
-extensive nausea/vomit = prevention includes : - marijuana derivative Dronabinol (Marinol), - Metoclopramide (Reglan) , - 5HT-3 Antagonist - Ondasetron (Zofran), Granisetron (Kytril)

Front 57

Doxorubicin

Back 57

toxicities
-bone marrow aplasia (decrease production)
-delayed cadiotoxicity leading to CHF (after drug accumulation in the heart) - cannot exceed max. cumulative lifetime dose

Front 58

Bleomycin

Back 58

-used in combo (good combo drug b/c it doesn't affect the bone marrow*)

toxicities:
-Pneumonitis
-Minimal effect on bone marrow

Front 59

Methotrexate

Back 59

-interferes with activation of folic acid to tetrahydrofolate (also kills normal cells)

-may require Leucovorin rescue (unfortunately, also remaining cancer cells)

Front 60

Hormonal Therapy

Back 60

-Palliative Therapy = not curative
-First line Therapy = less toxic
-Sex Hormone Therapy
=Estrogens = tx of testosterone sensitive tumors
=Testosterone = tx of estrogen sensitive tumors (very rare)
=Progesterone = tx of uterine cancers

Front 61

Anti-estrogens

Back 61

-palliative therapy of breast cancer

-prevention of breast cancer

-possible adverse reaction of uterine cancer

Front 62

Corticosteroids

Back 62

adjuct therapy
-lymphomas
-leukemias

Front 63

Vincristine

Back 63

-used in combo

toxicities
-Neurologic numbness and weakness
-Minimal effects on bone marrow

Front 64

Immunoadjuvant

Back 64

-Levamisole (in GI cancers)

-BCG Vaccine (TB vaccine, but not used in the US for that reason, here it is used in bladder)

-Interferons (body's own antiviral product) -virus association with cancer

-Laetrile ?? =FAD

Front 65

toxicity review

Back 65

-nausea/vomiting (most of these therapy) = pretreat prior to therapy

-alopecia - hair loss

-bone marrow depression = treat with Filgrastim (Neupogen)

-Extravasation of vesicant drugs (prevented with careful administration

Front 66

Misc. Cancer therapy

Back 66

-combination therapy regimens

-dose by surface area (mg/M2) or the body, instead of body weight of pt.

Front 67

3 classes of Penicillins?

Back 67

-Penicillin G

-Penicilinase Resistant

-Extended Spectrum

Front 68

Patient w/ disuria, sterile pyuria?

Back 68

Non-specific urethritis chlamydia

No culture in urine

Front 69

4 penicillinase resistant : relatively narrow spectrum

Back 69

-Dicloxacillin (Dynpen)

-Methicillin (Staphcillin)

-Nafcillin (Unipen)

-Oxacillin (Bactocil, Prostaphlin)

Front 70

8 Extended Spectrum Penicillins

Back 70

-Ampicillin (Omnipen)

-Amoxicillin (Amoxil)

-Ticarcillin (Ticar)

-Piperacillin (Pipracil)

-Ticarcillin/Clavulanate ** (Timentin)

-Amoxicillin/Clavulanate ** (Augmentin) --> can be used in ambulatory

-Ampicillin/Sulbactam (Unasyn)

-Piperacillin/Tazobactam (Zosyn)

Front 71

Cephalosporins : 2 first gen. oral

cross or do not cross BBB?

Back 71

-Cephalexin (Keflex)

-Cephradine (Anspor, Velosef)

DO NOT CROSS BBB

Front 72

Cephalosporins : 3 first gen inj

cross or do not cross BBB?

Back 72

-Cephalothin (Keflin)

-Cephapirin (Cefadyl)

-Cefazolin (Kefzol, Ancef)

DO NOT CROSS BBB

Front 73

Cephalosporins : 3 second gen. oral

cross or do not cross BBB?

Back 73

-Cefaclor (Ceclor)

-Cefuroxime (Ceftin)*

-Cefadroxil (Duricef)

only Cefuroxime can cross BBB

Front 74

Cephalosporins : 3 second gen inj

cross or do not cross BBB?

Back 74

-Cefoxitin (Mefoxin)

-Cefotetan (Cefotan)

-Cefuroxime (Zinacef)

DO NOT CROSS BBB

Front 75

Cephalosporins : 4 third gen inj

Back 75

-Cefoperazone (Cefobid)

-Cefotaxime (Claforan)

-Ceftriaxone (Rocephin)

-Ceftazidime (Fortaz, Tazicef, Tazidime)

Front 76

5 Macrolides

Back 76

-Erythromycin Stearate

-Erythromycin Estolate

-Erythromycin Lactobionate inj

-Azithromycin (Zithromax)

-Clarithromycin (Biaxin)

Front 77

Clindamycin (Cleocin)

Back 77

class of its own

Front 78

Vancomycin (Vancocin)

Back 78

class of its own

Front 79

3 Tetracyclines

Back 79

-Tetracycline (Sumycin, Tetracyn)

-Doxycycline (Vibramycin)

-Minocycline (Minocin)

Front 80

Chloramphenicol (Chloromycetin)

Back 80

class of its own

Front 81

Metronidazole (Flagyl)

Back 81

class of its own

Front 82

4 Aminoglycosides

Back 82

-Amikacin (Amikin) resistance*

-Gentamicin (Geramycin)

-Tobramycin (Nebcin) resistance*

-Neomycin **

Front 83

5 Quinolones

Back 83

-Norfloxacin (Noroxin)

-Ciprofloxacin (Cipro)

-Ofloxacin (Oflox)

-Levofloxacin (Levaquin)

-Moxifloxacin (Avelox)

Front 84

5 UTI agents

Back 84

-Sulfamethoxazole (Gantanol)

-Sulfisoxazole (Gantrisin)

-Co-Trimoxazole (Trimethroprim/Sulfamethoxazole), (Bactrim, Septra)

-Methenamine (Mandelamine)

-Nitrofurantoin (Macrodantin)

Front 85

8 Antifungal

Back 85

-Amphotericin B (Fungizone) -IV*

-Nystatin (Mycostatin)

-Flucytosine (Ancoban)

-Miconazole (Monistat) - topical

-Griseofulvin (Fulvicin)

-Ketoconazole (Nizoral)

-Fluconazole (Diflucan)

-Terbinafine (Lamisil) - topical, p.o.

Front 86

4 TB therapy

Back 86

-Isoniazid (INH)

-Streptomycin

-Rifampin (Rifadin)

-Ethambutol (Myambutol)

Front 87

4 Antiviral

Back 87

-Acyclovir (Zovirax) inj, po, topical

-Zidovudine (Retrovir) (AZT)

-Lamivudine (Epivir)

-Amantadine (Symmetrel)

Front 88

3 Alkylating agents

Back 88

-Mechlorethamine (Mustargen)

-Cyclophosphamide (Cytoxan)

-Chlorambucil (Leukeran)

Front 89

2 Nitrosoureas

Back 89

-Carmustine (BCNU)

-Lomustine (CCUN)

Front 90

1 Misc. cancer agents

Back 90

-Cisplatin (Platinol)

Front 91

4 Antitumor Antibiotics

Back 91

-Doxorubicin (Adriamycin)

-Daunomycin (Cerubidine)

-Plicamycin (Mithracin)

-Bleomycin (Blenoxane)

Front 92

5 Antimetabolites

Back 92

-Methotrexate (Mexate)

-6-Mercaptopurine (Purinethol)

-Azathioprine (Imuran)

-5-Fluorouracil (Fluorouracil)

-Cytosine Arabinoside (Cytosar)

Front 93

2 Hormonal cancer agents

Back 93

-Diethylstilbestrol (DES)

-Medroxyprogesterone (Provera)

Front 94

7 Antihormonal cancer agents

Back 94

-Tamoxifen (Nolvadex)

-Anastrozole (Arimidex)

-Flutamide (Eulexin)

-Bicalutamide (Casodex)

-Leuprolide (Lupron)

-Goserelin (Zoladex)

-Mitotane (Lysodren)

Front 95

2 Corticosteroid cancer agents

Back 95

-Prednisone (Orasone)

-Dexamethasone (Decadron)

Front 96

2 Plat Alkaloids

Back 96

-Vincristine (Oncovin)

-Vinblastine (Velban)

Front 97

watch http://www.youtube.com/watch?v=HzqOkRnXBFw for antibiotics

Back 97

:)

Front 98

watch http://www.youtube.com/user/agonsho#p/u/7/mZHYKCYVWeQ for antifungal

Back 98

:)

Front 99

watch http://www.youtube.com/user/agonsho#p/u/8/zQBZK_fD6LY for antiretroviral

Back 99

:)

Front 100

watch http://www.youtube.com/user/agonsho#p/u/9/TwdjMhVKbDU for antitubercular

Back 100

:)

Front 101

watch http://www.youtube.com/user/agonsho#p/u/10/De4ioH9E2MI for antibiotics 2

Back 101

:)

Front 102

what antimicrobial agent (both bacteriostatic and bacteriocidal) can cause Disulfiram like reaction with alcohol?

Back 102

Metronidazole

Front 103

An antimicrobial that causes Aplastic Anemia?

Back 103

Chloramphenicol

Front 104

Coccidioidomycosis affects what organ?

Back 104

lungs.

Front 105

True or False. pt. on TB agent must get their liver monitored?

Back 105

True. Drugs on the drugs lists have potentially hepatotoxic.

Front 106

Histamines. where found and where produced?

Back 106

-naturally occurring in human tissue (skin, intestinal mucosa, respiratory tract)

-stored in mas cells --> that go to H1 & H2 receptors

Front 107

Histamine pharmacology on cardiovascular

Back 107

- H1 EFFECT

causes :
-cerebral vessel dilation that causes histamine headache

-capillary dilation (increased vascular volume that leads to decrease BP --> histamine shock)

-also increases capillary permeability (gets "leaky") --> as a result, it allows free passage of plasma and protein = mucous production or fluid filled hives, going on from allergic reactions (leads to edema)

Front 108

hismatine on lungs and sensory nerve

Back 108

H1 EFFECTS

-bronchoconstriction

-sensory nerve ending = itch.

Front 109

histamine on stomach

Back 109

-H2 EFFECT

-Secretagogue -->
-- increases gastric acid secretion
-- direct effect on parietal cells

Front 110

mechanism of action of histamine

Back 110

-stimulate histamine receptors

-- H1 receptor can be blocked by ANTI HISTAMINE
-- H2 receptor can be blocked by ANTI-ULCER H2 antagonist (ex. zantac, pepsid...)

Front 111

functions of histamine

Back 111

-hypersensitivity reaction includes : allergy, anaphylactic shock,

-Normal physiology =regulate microcirculation (in the capillaries) , tissue growth and repair, gastric acid secretion

Front 112

clinical use of histamine

Back 112

-diagnositc agent
=achlorhydria --> (no H+ = no acid = if the stomach is releasing acid of not, if not it could be a sign of cancer, gastritis...etc)

Front 113

inhibition of histamine release

Back 113

-cromolyn
--> prophylactic (b/c if acute histamine will already be in the receptor), agent that INHIBITS histamine RELEASE from mast cells (takes 3 days to work)***

-->oral inhaler, nasal inhaler, and ophthalmic use

Front 114

antihistamines

Back 114

-blocks (prohylactic and takes 3 days to work) H1 receptors so that histamines cannot bind and stimulate
-onset of H1 blockade can be delayed 3 days if histamines have already been released
-other properties (anticholinergic --> cold products have this)

Front 115

antihistamine pharmacology

Back 115

-Vascular
--> blocks permeability and vasodilation

-Nervous system
--> blocks itch

-Smooth muscle
--> antagonizes bronchoconstriction not an acute therapy, (EPINEPHRINE aka adrenaline is used for acute)

Front 116

side effects of antihistamines

Back 116

-sedation

-anticholinergic

Front 117

therapeutic uses of antihistamine

Back 117

-symptomatic relief of allergies
---> exudative allergies
---> allergic dermatoses - hives, urticaria
---> pruritis

Front 118

antihistamines ineffective for:

Back 118

-anaphylactic shock (we use epinephrine instead)

-acute bronchial asthma (could also use antichol. or epinephrine)

-common cold = utilize antichol. properties**

Front 119

antihistamines

Back 119

-diphenhydramine, certizine =highly SEDATING

-brompheniramine, chlorpheniramine = less sedating

-fexofenadine, loratidine = long acting, low incidence of drowsiness

Front 120

Theophyllines pharma. (for COPD and ASTHMA)

Back 120

-bronchocodilation (smooth muscle effect)

-diuretic effects (chemically related to caffeine)

-increases heart rate at high doses (not common in ambulatory) - WARNING SIGN = tachycardia, can lead to INDUCING SEIZURES for its toxicity

-induces seizures at toxic doses

Front 121

Leukotriene receptor antagonists (copd and asthma)

Back 121

-relaxes bronchiole smooth muscle = safer than Theophyllines = use as temporary replacement for theophyllines

-have effects on children = depression***

Front 122

Adrenergics (copd and asthma)

Back 122

-beta 2 property
--> bronchodilation
--> beware of beta 1 spill over (tachycardia, sweating, shakiness...) = need to make beta 2 specific by INHALATION!

Front 123

Corticosteroids (copd and asthma)

Back 123

-inhaler is preferred route (MAX of 7 DAYS) = over use can lead to fungal infection, and if used more than 7 days , it can lead to addiction
--> avoid adrenal suppression

Front 124

expectorant (copd and asthma)

Back 124

-stimulates increased production of mucous
-decreases viscosity of mucous (loosens it up so we can cough it up)
-facilitates removal of mucous through ciliary action and cough
-controversial effectivenes

Front 125

mucolytic (copd and asthma)

Back 125

-Acetylcysteine
--> administered via respiratory therapy (can be inhaled with nebulizer)
--> breaks up mucous in respiratory tract
--> also utilized as an antidote to ACETAMINOPHEN TOXICITY

Front 126

constipation

Back 126

-definition = passage of unduly hard feces, usually occurs wen intestinal transit time is prolonged and excessive.

-cause by lack of motility and/or moisture

-symptoms include : abdominal discomfort, and loss of appetite

Front 127

laxative use

Back 127

-acute constipation

-chronic constipation

-preparation for radiologic or gastrointestinal exam

-preparation for GI surgery

-to avoid straining

-postoperative

-CHF

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diet correction to constipation

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-WATER/FLUIDS, FIBER, EXERCISE (INCREASE ALL!)

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classification of laxatives

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-hydrophillic colloids (bulk forming)

-saline cathartic

-surface wetting (stool softener)

-lubricant oils

-stimulant cathartics

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hydrophillic colloids

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THE ONLY NON ADDICTING CLASS (because it's only fiber)

-indigestible fibers increases bulk, which increases H20 in intestinal lumen, leading to increased motility.
-MUST consume with water and also exercise
-onset of action: 24 to 72 hrs (not for acute use)
-exampe :Psyllium (metamucil)
-use: chronic constipation

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saline cathartics

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ADDICTING (saline = salt)

-inorganic, poorly absorbed salts
-increases osmotic pressure which increases water in intestinal lumen, which increases bulk which increases motility

-onset: 30 min. to 3 hrs.
-use: acute constipation or prepare for exam
-side effects: diarrhea, habit forming

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Surface wetting agents (aka stool softener)

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ADDICTING

-reduces stool surface tension promoting water and fat mixture
-onset: 1 to 3 days (non acute)
-use: prevent constipation, prevent straining (ex. to prevent rupture of stitches after surgery)
- habit forming

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Lubricants

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ADDICTING

-lubricates intestinal lumen

-onset 6 to 8 hrs.

-use: acute and chronic constipation

-side effects: habit forming, decreases absorption of fats and fat soluble medications (vitamins A, D, E, K will also be absorbed by this agent, not by the body)

-aspiration pneumonitis if taken at bed time**

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Stimulant cathartics

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ADDICTING

-irritates intestinal mucosa and STIMULATES PERISTALSIS

-onset: 2 to 8 hrs.

-use: acute constipation, preparation for exam

-side effects: camping, habit forming

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Diarrhea

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-etiology = increase amount of osmotically active substance in GI lumen
-increase rate of intestinal secretion

-alteration of permeability of intestinal lumen

-increased rate of peristalsis

-infection *

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drug therapy

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-narcotic derivatives =contraindicated in infectious diarrhea.

-adsorbants

-hydrophillic colloids (fiber = for constipation and diarrhea)
= absorbs water, restore intestinal flora

-electrolyte replacement

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adsorbants

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-absorbs toxins and bacteria causing diarrhea (ex. peptobismol)

-also absorbs medications and vitamins

-administer at different time

-useful to prevent infectious diarrhea especially when traveling

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restore intestinal flora

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-replaces natural flora bacteria in intestinal tract (lactobacillus adicophillus) --> live bacteria and must be REFRIGERATED

-useful following broad spectrum antibiotic therapy = replaces lost bacteria to prevent super-infection

-onset: 1 to 2 days

-alternatives : dairy products

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electrolyte replacement

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-especially useful in children that have had diarrhea

-replaces fluid and electrolytes

-examples: Pedialyte (comes in popsicles also)

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Ulcers

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-etiology : stress (physiologic NOT psychologic) --> pts. in ICU are prone to this kind of ulcer = cortisol are being released causing ulcers

-alcoholism
-idiopathic
-drug induced (ex. aspirin and NSAIDS)
-bacteria induced (H. pylori)

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drug therapy

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-narcotic derivatives =contraindicated in infectious diarrhea.

-adsorbants

-hydrophillic colloids (fiber = for constipation and diarrhea)
= absorbs water, restore intestinal flora

-electrolyte replacement

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adsorbants

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-absorbs toxins and bacteria causing diarrhea (ex. peptobismol)

-also absorbs medications and vitamins

-administer at different time

-useful to prevent infectious diarrhea especially when traveling

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restore intestinal flora

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-replaces natural flora bacteria in intestinal tract (lactobacillus adicophillus) --> live bacteria and must be REFRIGERATED

-useful following broad spectrum antibiotic therapy = replaces lost bacteria to prevent super-infection

-onset: 1 to 2 days

-alternatives : dairy products

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electrolyte replacement

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-especially useful in children that have had diarrhea

-replaces fluid and electrolytes

-examples: Pedialyte (comes in popsicles also)

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Ulcers

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-etiology : stress (physiologic NOT psychologic) --> pts. in ICU are prone to this kind of ulcer = cortisol are being released causing ulcers

-alcoholism
-idiopathic
-drug induced (ex. aspirin and NSAIDS)
-bacteria induced (H. pylori) - can be cured with 14 days of therapy of antibiotic

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ulcer therapy

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-antibiotics
-antacids
-histamine 2 antagonists
-proton pump inhibitors
-sucralfate

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antacids

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-neutralizes excess acid that causes ulcerations
-provides symptomatic relief
-promotes healing of ulcers
-goal : buffer stomach pH between 4 and 5. --> exceeding pH of 5 leads to REBOUND ACIDITY
-administration time : 1 and 3 hours POST MEAL

-not for pt. with recurrent ulcers??

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antacids (part 2)

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-Sodium bicarbonate
-->best neutralizing antacid, high NA content (not for hypertensive pts)
-->may neutralize too well and exceed pH 5

-Aluminum Hydroxide
--> weak antacid, constipating

-Magnesium Hydroxide
--> good antacid, may cause diarrhea

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histamine 2 blockers

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-blocks H2 receptor (produces acid) in stomach

-blocks secretion of acid

-promotes healing of ulcers (6 to 8 weeks)

-utilized to prevent recurrence of ulcers (life long therapy -- ex: nocturnal acid release)

-prevents nocturnal acid

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Proton pump inhibitors

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-positively charged cation =H+ = pH

-prevents acid secretion
-prevents GERD
-promotes healing of ulcers

-examples : Omeprazole (prilosec), and Lansoprazole (prevacid)

-onset is 6 weeks
-must be given 30 min. before meal*

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sucralfate

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-non-absorbed
-disaccharide sugar that is attracted to ulcer "wounds" --> acts as a barrier on the ulcer
-allows ulcer to heal by preventing acid contact (that takes about 6 weeks to heal) not used to prevent ulcer***

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11 antihistamines

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-brompheniramine maleate (dimetane)

-chlorpheniramine maleate (chlor-trimeton)

-cypropheptadine (periactin)

-diphenhydramine (benadryl) =most sedating **

-tripelennamine citrate (pyribenzamine)

-triprolidine (actidil)

-hydroxyzine (atarax, vistaril)

-cetirizine (zyrtec)

-fexofenadine (allergra)

-loratadine (claritin)

-desloratadine (clarinex)

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5 bronchodilators : Adrenergic type

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-epinephrine (adrenalin)

-isoproterenol (isuprel)

-albuterol (ventolin, proventil)=most beta 2 specific

-metaproterenol (alupent)

-terbutaline (brethine, bricanyl)

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2 bronchodilators: theophylline type

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-aminophylline

-theophylline (theodur)

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2 bronchodilators: leukotriene receptor antagonists

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-zafirlukast (accolate)

-montelukast (singulair)

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1 bronchodilator : mast cell stabilizer

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-cromolyn (intal, nasalcrom)

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2 expectorants

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-guaifenesin (robutussin)

-potassium iodide (SSKI)

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1 mucolytic agent

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-acetylcysteine (mucomyst)
= antidote for tylenol OD

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4 corticosteroid (inhaler)

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-beclomethasone inhaler (Qvar)

-triamcinolone acetonide (azmacort)

-flunisolide (aerobid)

-fluticasone (flovent)

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1 laxative : hydrophillic colloid type

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-psyllium seed (metamucil)

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4 laxatives : saline cathartics type

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-milk of magnesia = commonly used in hospitals

-magnesium citrate = carbonated, flavored, salt solution (usually 10 oz)

-epsom salt

-golytely = 1 gallon jug (4L) filled with powder mix

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2 laxatives: surface wetting/stool softener type

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-dioctyl sodium sulfosuccinate (doss, colace)

-dioctyl calcium sulfosuccinate (surfak)

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1 laxative: lubricant type

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-mineral oil

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4 laxatives: stimulant cathartics type

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-senna (senokot) = senna tea is still habit forming

-cascara = sometimes mixed with milk of magnesia

-castor oil

-bisacodyl (dulcolax)

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antidiarrheal : adsorbants, restore intestinal flora, electrolyte replacement

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-adsorbants
-->bismuth salt (peptobismol, kaopectate)

-restore intestinal flora
--> lactobacillus acidophillus (bacid, lactinex)

-electrolyte replacemnt
--> pedialyte

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3 ulcer therapy : antacid type

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-sodium bicarbonate (rolaids)

-aluminum hydroxide (alternagel, amphojel)

-magnesium hydroxide/aluminum hydroxide (maalox, mylanta) both

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3 ulcer therapy : histamine H2 blockers

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-cimetidine (tagamet)

-ranitidine (zantac)

-famotidine (pepcid)

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5 ulcer therapy: proton pump inhibitors

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-esomeprazole (nexium)

-lansoprazole (prevacid) (over the counter and generic)

-omeprazole (prilosec) (over the counter and generic)

-rabeprazole (aciphex)

-pantaprozole (protonix)

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1 ulcer therapy misc.

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-sucralfate (carafate)