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169 Cards in this Set
- Front
- Back
Difinition of Antimicrobial
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- 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.
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changing side chains of penicillin could change __________, and _________
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Spectrum (Broad and Narrow), and Pharmacokinetics (specifically half life)
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Broad Spectrum (antimicrobial)
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-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. |
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Narrow Spectrum (antimicrobial)
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-Inhibits the growth or kills a limited number of different organisms
-Less potential for super-infections |
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Bacteriocidal
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-at safe serum levels kills sensitive organisms
-effective in immuno-compromised individuals |
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advantage of Narrow Spectrum?
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-more specific, and limited impact on normal flora = less chance of opportunistic super-infection, and psuedomonas colitis
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Bacteriostatic
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-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 |
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Bacteriostatic vs. Bacteriocidal
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-bacteriostatic = p.o. , and at low concentration only
-bacteriocidal = I.V. and at high concentration |
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mechanism of action (antimicrobials)
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-only effective in replicating organisms
-interrupts cell wall synthesis, protein synthesis, vitamin utilization |
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Resistance : 2 types
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-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) |
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antimicrobial selection
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-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. |
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causes of antimicrobial failure
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-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) |
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patient variables (antimicrobials)
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-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. |
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Penicillins
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-bacteriocidal
-allergic to one -allergic to all penicillins -narrow to broad spectrum -crosses BBB |
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Penicillinase Resistant Penicillins
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-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. |
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Penicillin G's
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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. |
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wider spectrum penicillins
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-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) *** |
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Extended spectrum penicillins
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-examples: Piperacillin, Ticarcillin, Mezlocillin
-synergistic with aminoglycosides -Spectrum: -same as wider spectrum -pseudomonas aeruginosa (which usually hits immuno-compromised) GI, and UTI |
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Penicillin potentiators
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-examples : Clavulanate, Tazobactam, Sulbactam (look at drug list)
-overcomes resistant organisms -overcomes enzymes that would destroy the penicillin antimicrobial agent |
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Cephalosporins
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-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 |
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first generation Cephalosporins
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spectrum:
-E.coli -Staph -Hemophilus Influenza -Klebsiella (resp. infections) |
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second generation Cephalosporins
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-may be effective in first generation resistance
spectrum (broadens = super infection and maybe pseudomonas colitis) -Bacteroides (anaerobe) =GI, resp., skin |
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third generation Cephalosporins
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-may be effective against organisms resistant to 1st and 2nd generation
-synergistic with aminoglycosides spectrum: -similar to second generation -pseudomonas |
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Macrolides: Erythromycin
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-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. |
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Macrolides: Erythromycin Use and Side Effects
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-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 |
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Macrolides : Azithromycin (Zithromax), Clarithromycin (Biaxin)
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-Azithromycin = respiratory infection. mycobacterium avium cannot be cured because it's dormant but use "Z-pack"
-Clarithromycin = respiratory infection, mycobacterium avium, helicobacter pylori (ulcers) |
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Clindamycin
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-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) |
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Metronidazole
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-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 |
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Vancomycin
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-Bacteriocidal
-NO oral absorption, but given orally to treat pseudomembranous colitis -Use: -penicillin allergy for gram positive cocci -MRSA -pseudomembranous colitis |
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Vancomycin: monitor and adverse reactions
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-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 |
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Tetracyclines
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-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 |
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Chloramphenicol
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-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 |
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Aminoglycosides
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-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) |
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Aminoglycosides Use
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-IV for systemic gram negatives
-topical -ophthalmic and otic (eye/ear drops) |
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Quinolones
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-Broad Spectrum
-minerals block absorption -affects tendon growth in children -increasing rate of resistance -use: -UTI, and respiratory infection |
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Urinary Tract Infectioin (UTI)
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-increasing resistance in hospital and community acquired infections
-Sulfonamides (Sulfa) not very useful any more = resistance |
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Sulfa?
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-sulfa blocks the conversion steps to activate folic acid in bacterias.
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Sulfonamides
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-high acquired resistance
-use in combo with Trimethoprim to overcome resistance -Trimethoprim/Sulfamethoxazole (co-trimoxazole) inhibits bacteria ability to activate folic acid to tetrahydrofolate |
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Co-trimoxazole
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-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 |
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Methenamine
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-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 |
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Fungal infections
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Systemic :
-respiratory (coccidioidomycosis) -urinary -meningitis Dermatologic -athlete's foot |
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Amphotericin B
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-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 |
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Amphotericin B: Adverse Reactions
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-headache, chills, fever (premedicate with antipyretic, steroids, and/or antihistamines)
-Thrombophlebitis (premedicate with an anticoagulant) -Hypokalemia -Nephrotoxicity - reversible |
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Fluconazole
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-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 |
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Fluconazole : Nystatin
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-for fungal infection
-oral and topical -oral use for candida/thrush (from antibiotics) -topical use for skin and vaginal infections |
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Fluconazole : Flucytosine
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-oral use
-adjunct therapy for meningitis (never by itself) - |
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Fluconazole : Misc.
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-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 |
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TB therapy
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-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 |
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Viral therapy
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-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) |
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Chemotherapy General Principles: DNA review
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-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 |
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Chemotherapy General Principles: Cancer cell cycle
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-S phase is replicating phase (most drugs work on this phase)
-G phase is non-replicating phase (NO DRUGS can work on this phase) |
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Chemotherapy General Principles: drug resistance
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-innate (certain cancers will not be susceptible to therapy)
-acquired |
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Chemotherapy General Principles:
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-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 % |
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Alkylating agents
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-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 |
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Nitrosoureas
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-crosses BBB
-effective against CNS tumors |
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Cisplatin
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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) |
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Doxorubicin
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toxicities
-bone marrow aplasia (decrease production) -delayed cadiotoxicity leading to CHF (after drug accumulation in the heart) - cannot exceed max. cumulative lifetime dose |
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Bleomycin
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-used in combo (good combo drug b/c it doesn't affect the bone marrow*)
toxicities: -Pneumonitis -Minimal effect on bone marrow |
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Methotrexate
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-interferes with activation of folic acid to tetrahydrofolate (also kills normal cells)
-may require Leucovorin rescue (unfortunately, also remaining cancer cells) |
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Hormonal Therapy
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-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 |
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Anti-estrogens
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-palliative therapy of breast cancer
-prevention of breast cancer -possible adverse reaction of uterine cancer |
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Corticosteroids
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adjuct therapy
-lymphomas -leukemias |
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Vincristine
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-used in combo
toxicities -Neurologic numbness and weakness -Minimal effects on bone marrow |
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Immunoadjuvant
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-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 |
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toxicity review
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-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 |
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Misc. Cancer therapy
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-combination therapy regimens
-dose by surface area (mg/M2) or the body, instead of body weight of pt. |
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3 classes of Penicillins?
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-Penicillin G
-Penicilinase Resistant -Extended Spectrum |
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Patient w/ disuria, sterile pyuria?
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Non-specific urethritis chlamydia
No culture in urine |
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4 penicillinase resistant : relatively narrow spectrum
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-Dicloxacillin (Dynpen)
-Methicillin (Staphcillin) -Nafcillin (Unipen) -Oxacillin (Bactocil, Prostaphlin) |
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8 Extended Spectrum Penicillins
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-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) |
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Cephalosporins : 2 first gen. oral
cross or do not cross BBB? |
-Cephalexin (Keflex)
-Cephradine (Anspor, Velosef) DO NOT CROSS BBB |
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Cephalosporins : 3 first gen inj
cross or do not cross BBB? |
-Cephalothin (Keflin)
-Cephapirin (Cefadyl) -Cefazolin (Kefzol, Ancef) DO NOT CROSS BBB |
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Cephalosporins : 3 second gen. oral
cross or do not cross BBB? |
-Cefaclor (Ceclor)
-Cefuroxime (Ceftin)* -Cefadroxil (Duricef) only Cefuroxime can cross BBB |
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Cephalosporins : 3 second gen inj
cross or do not cross BBB? |
-Cefoxitin (Mefoxin)
-Cefotetan (Cefotan) -Cefuroxime (Zinacef) DO NOT CROSS BBB |
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Cephalosporins : 4 third gen inj
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-Cefoperazone (Cefobid)
-Cefotaxime (Claforan) -Ceftriaxone (Rocephin) -Ceftazidime (Fortaz, Tazicef, Tazidime) |
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5 Macrolides
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-Erythromycin Stearate
-Erythromycin Estolate -Erythromycin Lactobionate inj -Azithromycin (Zithromax) -Clarithromycin (Biaxin) |
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Clindamycin (Cleocin)
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class of its own
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Vancomycin (Vancocin)
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class of its own
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3 Tetracyclines
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-Tetracycline (Sumycin, Tetracyn)
-Doxycycline (Vibramycin) -Minocycline (Minocin) |
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Chloramphenicol (Chloromycetin)
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class of its own
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Metronidazole (Flagyl)
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class of its own
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4 Aminoglycosides
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-Amikacin (Amikin) resistance*
-Gentamicin (Geramycin) -Tobramycin (Nebcin) resistance* -Neomycin ** |
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5 Quinolones
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-Norfloxacin (Noroxin)
-Ciprofloxacin (Cipro) -Ofloxacin (Oflox) -Levofloxacin (Levaquin) -Moxifloxacin (Avelox) |
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5 UTI agents
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-Sulfamethoxazole (Gantanol)
-Sulfisoxazole (Gantrisin) -Co-Trimoxazole (Trimethroprim/Sulfamethoxazole), (Bactrim, Septra) -Methenamine (Mandelamine) -Nitrofurantoin (Macrodantin) |
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8 Antifungal
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-Amphotericin B (Fungizone) -IV*
-Nystatin (Mycostatin) -Flucytosine (Ancoban) -Miconazole (Monistat) - topical -Griseofulvin (Fulvicin) -Ketoconazole (Nizoral) -Fluconazole (Diflucan) -Terbinafine (Lamisil) - topical, p.o. |
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4 TB therapy
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-Isoniazid (INH)
-Streptomycin -Rifampin (Rifadin) -Ethambutol (Myambutol) |
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4 Antiviral
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-Acyclovir (Zovirax) inj, po, topical
-Zidovudine (Retrovir) (AZT) -Lamivudine (Epivir) -Amantadine (Symmetrel) |
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3 Alkylating agents
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-Mechlorethamine (Mustargen)
-Cyclophosphamide (Cytoxan) -Chlorambucil (Leukeran) |
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2 Nitrosoureas
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-Carmustine (BCNU)
-Lomustine (CCUN) |
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1 Misc. cancer agents
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-Cisplatin (Platinol)
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4 Antitumor Antibiotics
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-Doxorubicin (Adriamycin)
-Daunomycin (Cerubidine) -Plicamycin (Mithracin) -Bleomycin (Blenoxane) |
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5 Antimetabolites
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-Methotrexate (Mexate)
-6-Mercaptopurine (Purinethol) -Azathioprine (Imuran) -5-Fluorouracil (Fluorouracil) -Cytosine Arabinoside (Cytosar) |
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2 Hormonal cancer agents
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-Diethylstilbestrol (DES)
-Medroxyprogesterone (Provera) |
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7 Antihormonal cancer agents
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-Tamoxifen (Nolvadex)
-Anastrozole (Arimidex) -Flutamide (Eulexin) -Bicalutamide (Casodex) -Leuprolide (Lupron) -Goserelin (Zoladex) -Mitotane (Lysodren) |
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2 Corticosteroid cancer agents
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-Prednisone (Orasone)
-Dexamethasone (Decadron) |
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2 Plat Alkaloids
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-Vincristine (Oncovin)
-Vinblastine (Velban) |
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watch http://www.youtube.com/watch?v=HzqOkRnXBFw for antibiotics
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:)
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watch http://www.youtube.com/user/agonsho#p/u/7/mZHYKCYVWeQ for antifungal
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:)
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watch http://www.youtube.com/user/agonsho#p/u/8/zQBZK_fD6LY for antiretroviral
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:)
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watch http://www.youtube.com/user/agonsho#p/u/9/TwdjMhVKbDU for antitubercular
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:)
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watch http://www.youtube.com/user/agonsho#p/u/10/De4ioH9E2MI for antibiotics 2
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:)
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what antimicrobial agent (both bacteriostatic and bacteriocidal) can cause Disulfiram like reaction with alcohol?
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Metronidazole
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An antimicrobial that causes Aplastic Anemia?
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Chloramphenicol
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Coccidioidomycosis affects what organ?
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lungs.
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True or False. pt. on TB agent must get their liver monitored?
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True. Drugs on the drugs lists have potentially hepatotoxic.
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Histamines. where found and where produced?
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-naturally occurring in human tissue (skin, intestinal mucosa, respiratory tract)
-stored in mas cells --> that go to H1 & H2 receptors |
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Histamine pharmacology on cardiovascular
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- 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) |
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hismatine on lungs and sensory nerve
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H1 EFFECTS
-bronchoconstriction -sensory nerve ending = itch. |
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histamine on stomach
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-H2 EFFECT
-Secretagogue --> -- increases gastric acid secretion -- direct effect on parietal cells |
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mechanism of action of histamine
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-stimulate histamine receptors
-- H1 receptor can be blocked by ANTI HISTAMINE -- H2 receptor can be blocked by ANTI-ULCER H2 antagonist (ex. zantac, pepsid...) |
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functions of histamine
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-hypersensitivity reaction includes : allergy, anaphylactic shock,
-Normal physiology =regulate microcirculation (in the capillaries) , tissue growth and repair, gastric acid secretion |
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clinical use of histamine
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-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) |
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inhibition of histamine release
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-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 |
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antihistamines
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-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) |
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antihistamine pharmacology
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-Vascular
--> blocks permeability and vasodilation -Nervous system --> blocks itch -Smooth muscle --> antagonizes bronchoconstriction not an acute therapy, (EPINEPHRINE aka adrenaline is used for acute) |
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side effects of antihistamines
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-sedation
-anticholinergic |
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therapeutic uses of antihistamine
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-symptomatic relief of allergies
---> exudative allergies ---> allergic dermatoses - hives, urticaria ---> pruritis |
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antihistamines ineffective for:
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-anaphylactic shock (we use epinephrine instead)
-acute bronchial asthma (could also use antichol. or epinephrine) -common cold = utilize antichol. properties** |
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antihistamines
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-diphenhydramine, certizine =highly SEDATING
-brompheniramine, chlorpheniramine = less sedating -fexofenadine, loratidine = long acting, low incidence of drowsiness |
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Theophyllines pharma. (for COPD and ASTHMA)
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-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 |
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Leukotriene receptor antagonists (copd and asthma)
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-relaxes bronchiole smooth muscle = safer than Theophyllines = use as temporary replacement for theophyllines
-have effects on children = depression*** |
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Adrenergics (copd and asthma)
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-beta 2 property
--> bronchodilation --> beware of beta 1 spill over (tachycardia, sweating, shakiness...) = need to make beta 2 specific by INHALATION! |
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Corticosteroids (copd and asthma)
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-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 |
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expectorant (copd and asthma)
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-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 |
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mucolytic (copd and asthma)
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-Acetylcysteine
--> administered via respiratory therapy (can be inhaled with nebulizer) --> breaks up mucous in respiratory tract --> also utilized as an antidote to ACETAMINOPHEN TOXICITY |
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constipation
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-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 |
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laxative use
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-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
|
-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 |
|
restore intestinal flora
|
-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 |
|
electrolyte replacement
|
-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)
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