PHARMACOTHERAPEUTICS FINAL EXAM STUDY GUIDE MONDAY , 12120 @ 12 PM 74 Chapter NSAIDs ' < Uses - Drug Therapy first line - better > relief should occur decreased renal function > alcohol > liver and swelling subsides over the next few : interactions warfarin & > ACE inhibitor Uses cardiovascular events kidney damage > ( just : anticoagulant ) GOUT ! : > treats > reduces incidences of attack > aborts acute an gouty impending attack attack Adverse Effects : > GI disturbances > myelosuppression > myopathy bone marrow → contraindications > Older adults ; disease; Allopurinol ' risk of increased contraindications > ' arthritis fluid retention colchicine ' gouty brand new ! GI ulceration Drug drug - within 24 hrs ; > - - toe looks < > > - for acute Adverse Effects : > - drug therapy ! tolerated than colchicine > days - short term of first choice agents : agent for for GOUT TI : diarrhea! pancytopenia : debilitated pts ; pts w/ pregnant pts Febuxostat Indication : to treat chronic Monitor cardiac , renal for effectiveness : tophaceous gout check uric acid blood levels , hepatic & GI , Chapter 75 for Disorders Drugs Bi ' Drugs - involving Bone Mineralization Calcium Levels and calcium phosphonates may include side effects : atypical ' Affecting ocular inflammation , osteonecrosis of the jaw femur fractures , (a atrial fibrillation (ONJ ) , fib ) patient teaching : > for glass of water and sit esophageal severe chapter [F-Osama × Alendronate 76 - , Fosamax Plus D] , educate pts to take for 30min after administration upright full > causes ulceration for Asthma and Chronic Obstructive Drugs w/ Pulmonary Disease Beta 2- Adrenergic Agonists use in asthma & COPD Inhaled short-acting beta 2 agonists ( SABAS ) : taken PRN - to abort an ongoing attack Exercise-induced broncho constriction (EIB) : taken before ' prevent to an attack Hospitalized pts undergoing - . is the traditional - Delivery w/ an exercise a nebulized SABA severe acute attack : treatment of choice MDI in the outpatient setting may equally be effective Inhaled long Long ' - - ' - acting beta 2 term control in Dosing on pts . agonists (LABAS) fixed schedule , not PRN effective in treating when used to treat asthma * albuterol Only COPD stable , must attacks frequent who experience always is the PRN ! be combined w/ a steroid w/ it! a glucocorticoid - use in asthma when pt . is is contraindicated ! getting LABA , need to get Adverse Effects : Inhaled preparations systemic Oral underlying cardiac : effects : SNS response , & preparations : excessive & tremor tachycardia angina oropharyngeal dosage angina pectoris tachydysrhythmias : , , BI! candidiasis < tremor disease wash month after Theophylline ( Poor ' ' 20 - > ' - 30 Mcg 1mL stop Theophylline activated charcoal w/ > dysrhythmias respond a 77 - for Drugs to treat v. bronchi > narrow therapeutic index restlessness fib ) & cathartic convulsions Allergic Allergic syrup of ipecac lidocaine to diazepam may help control IV Drugs - treatment : , the : > Chapter better dysrhythmias ( ex severe > > ' : ML diarrhea , insomnia , of lower end the adverse effects uncommon 25 Mcg 1mL : N & V Toxicity ' : smooth muscle by relaxing level 10 to 20 Mcg / Mcg 1mL < 20 • - broncho dilation produces plasma IV ) seizures Rhinitis , cough and colds , Rhinitis Glucocorticoids ( intranasal ) Antihistamines ( oral & intranasal ) sympathomi metics ( oral & intranasal ) Intranasal Glucocorticoids first choice ' most effective treatment to Mild adverse effects > drying prevent rhinitis : of nasal mucosa or sore throat > epistaxis ( nosebleed ) > headache > rarely systemic . effects (adrenal suppression and slowing of linear pediatric growth) oral ' antihistamines should be taken regularly throughout allergy Mild adverse effects : sedation w/ first Intranasal Antihistamines : ' ' allergic can Azelastine & rhinitis in adults & children cause somnolence Adverse Effects : > season ! generation ( much less w/ 2nd ) Olopatadine 12 yrs old (sleepiness) nosebleeds ; anticholinergic effect ; unpleasant bitter taste ! Intranasal ' cromolyn sodium prophylaxis ; response Minimal adverse effect : I -2 Wks less than w/ any other drug for allergic rhinitis sympathomimetics reduce nasal ' congestion Adverse effects : rebound congestion > > CNS stimulation > cardiovascular effects and > systemic In co > > > 5 days ! insomnia , irritable : will be even more stroke vasoconstriction arrhythmias > abuse > ( oral pfendofedrin Nasal topical administration: . > used to topical act use longer than 5 more quickly than oral , BUT oral act longer than topical pseudoephedrine cough Antitussives days ! : , for make meth should NOT phenylephrin e ephedrine F-✗ : Drugs > ) sympathomimetics Drops us sprays acts in CNS to elevate cough drugs that suppress cough Opioid Antitussives codeine & hydrocodone - congested ! ! HBP > ' should not be used for < : threshold : Adverse Effect : act ' in suppress respirations Nonopioid ' & ' , the CNS to elevate potential cough threshold Adverse Effect : can for abuse Antitussives : Dextromethorphan , Benzo notate , Diphenhydramine , (a.k.a TessaIan perles) . euphoria and mild dissociation Expectorants Guaifenesin - renders [Mucin ex cough , Hum ibid ] more productive by stimulating tract secretions ' ' be needed higher dose may Adverse effect : ?? to be effective flow of respiratory 78 Chapter Histamine , - cimetidine ' Drug - Drugs - for < drug interactions : warfarin > phenytoin > Theophylline > Lidocaine > antacids reduce absorption of cimetidine can : > cimetidine and antacids should > elderly pts Lactu lose : administered at least 1hr apart ! + lidocaine Laxatives - added response of laxative that has an gut ammonia ; works on the be prone to CNS excitation are ↳ cimetidine 79 Disease Receptor Antagonists [Tagamet] cyp inhibitor > chapter peptic Ulcer ridding the body of and enhances secretion of ammonia from flora gut classification of Laxatives ' Bulk > - forming laxatives : Psy Ilium function similar to softens dietary preferred > adverse effect : treatment of > produce > lowers > acts (2) on ( in this respect : Bisacodyl ' widely : intestinal oral or water to form a gel that > days , [COlace ] after onset of treatment facilitates penetration of water into feces (1) inhibit fluid absorption and surfactants electrolytes into intestinal resemble stimulant laxatives) Bisacodyl [Dulcolax] increase amounts ' several sodium stimulate secretion of water & stimulates > w/ obstruction intestinal wall to stimulant laxatives > ¥ soft stool swell mass Docusate surface tension lumen - a : constipation esophageal surfactant Laxatives : ' fecal & increases > fiber [Metamucil ] motility of water and suppository electrolytes in intestinal lumen route used & abused Used for opioid - induced constipation from slow intestinal transit and for constipation qq.IQ Bisacodyl : enteric coated is w/ antacid DO NOT take • Osmotic Laxatives > : milk of absorbed salts poorly CANNOT be crushed - or ionic nor chewed ! products ! ! Magnesia (MOM ) that draw water fecal mass softens and swells , intestinal lumen ; into wall stretches and , peristalsis is stimulated > low doses > high > adverse effects doses : results in : substantial water loss acute renal failure : like to take MOM sodium load classification of Laxatives Group exacerbated HTN , HF sodium retention : ppl I: Act consistency bowel movement 2- 6 hrs > older 12 hrs - dehydration high - 6 > ↳ * results in : rapidly , anything w/ exacerbates HF ! : Therapeutic effect 2- 6 hrs ) preparing , edema nonmetal has > (within ; useful for ' swollen & volume and retention give stool a watery diagnostic bowel for procedures surgery or - Group II Intermediate : latency ( 6- 12 hrs ) ; produce semi a fluid stool Group III - act most : ( I -3 slowly chapter 84 days ) treating include - frequently produce to chronic Drugs That abused by a the soft constipation , general public ; formed and weaken the Bacterial stool ; uses strain preventing cell wall I : Penicillins Penicillin • - Allergy Implications Anaphylaxis if pt has > > - - history if history if history structure : penicillin allergy who is of mild reaction , consider of anaphylaxis beta-lactam Beta-lactam > of , AVOID ring ( what SHOULD NOT give lactam to anything w/ beta ppl w/ penicillin allergy , cephalosporin administration of makes family : cephalosporins receiving penicillin TQ : OR cephalosporin drug work ) azetronam , penicillin imipenem cross , etc sensitivity ! . - Chapter 85 that weaken the Bacterial cell wall II : Drugs - cephalosporins , carbapenems vancomycin , Aztreonam , Cephalosporins ' ' Resistance Drug > beta : ( cephalosporinoses) lactamases - interactions : Probenecid : drug that helps U elimination & cephalosporin of penicillin > Alcohol > drugs > calcium & ' ' that promote > used to beta disulfiram reaction can cause bleeding : WI warfarin & NSAIDs be careful Bacteria manage ceftaro line < : producing lactase inhibitors : clavulanic acid - extends antimicrobial spectrum beta ONLY Ticarci 11in clavulanic acid " " > Chapter / 86 Bacteriostatic Inhibitors - Tetracyclines , Macrolide , ! combined w/ penicillinuse when [Timentin] Piperacillinltazobactam [zosyn] Piptazo > that covers tazobactam , sulbactam , Ampicillin / sulbactam [unasyn] IV Amoxicillin / clavnlanic acid [Augmentin] > one lactamase MRSA sensitive antibiotics : > / antabuse ceftriaxone generation cephalosporin Fifth Drugs cephtriaxone : of } protein - IQ ! synthesis : and others Tetracyclines . ' Adverse effects : > GI irritation > effects > super infection > hepatotoxicity > renal > photosensitivity on : disrupts gut bone & teeth flora children > should NOT take NO tetracycline for pts < 8 tetracycline yrs old !! toxicity Major precautions : > Tetracycline in → urine ; they Tetracyclines permanent demeclocycline and accumulate can cause teeth in are pts . eliminated primarily W/ kidney disease discoloration of deciduous & diarrhea may indicate > suprainfection > high dose IV potentially a life threatening - of the bowel therapy has associated w/ been liver severe damage Drug ' > and food interaction absorption milk > calcium > iron > tetracyclines decreased if is drug is given with : products > > of Minocycline supplements ONLY supplements magnesium containing - eat laxatives is the one safe to w/ food ! antacids most clindamycin [Cleocin] Adverse effects : ' > CDAD : c. > hepatic > blood > diarrhea > diff associated diarrhea toxicity dyscrasias hypersensitivity Chapter 87 - reactions Aminoglycosides : Bactericidal Inhibitors Of Protein Synthesis Aminoglycosides Adverse effects : • 0+0 hypersensitivity blood > > : > want levels to be as close to zero as possible ! (obtained 15min levels) before 4th dose) reactions general it with w/ concurrent use anesthetics , and in neuromuscular myasthenia gravis blocking can worsen v vancomycin can 4 toxicity ! [Garamycin] Adverse effects : give calcium gluconate treat ! nephrotoxicity cause lethal inhibition Drug trough ! dyscrasias mixing Gentamicin > cumulative & neuromuscular blockade , ) toxicity toxicity (total agents > IV infusion will indicate > > w/ of a calcium salt nephrotoxicity > - reverse > > - ( & Oto toxicity of bacterial protein synthesis interactions : DO NOT mix other penicillin w/ aminoglycosides nephrotoxic and Ototoxic drugs in same IV solution ! to 90 Chapter Anti mycobacterial Anti tuberculosis ' Isoniazid : > Drugs for treatment and hepatotoxicity optic > ' > monthly monitoring ; : vitamin 136 ) pt prescribed prescribed alongside INH , ✓ it 136 it vit 136 ? [Rifadin] Cyp inducer < discoloration of > - > hcpatotoxic / hepatitis > body : have to monitor fluids : < monthly ! yellow & sweat brown ! this the is LFT turns tears GI disturbances Pyrazinamide > be , Adverse effects: > ' prevention of TB neuritis anemia Ri fam pin for Tuberculosis : should > : peripheral neuropathy (pyridoxine > > First : primary agent Adverse effects Agents Drugs line drugs first line agent for treating TB ? Adverse Effects : > hepatotoxicity > non gouty parathralgias > hyper uricemia > GI disturbances > photosensitivity Ethambutol > [Myambutol] Adverse effect : chapter 91 - optic neuritis Miscellaneous Antibacterial Drugs : Metronidazole Daptomycin , Rifampin , , Rifaximin , Fluoroquinolones Bacitracin , and Polymyxins Fluoroquinolones side effects ' AVOID in in generally pts < pts > mild but 18 yrs old b/c tendons 60 yrs old tendon can cause rupture ( low risk) developing blc tendons degenerating Cipro flax in - Adverse Effects : > > GI : N & V , diarrhea , abdominal pain CNS : Dizziness , headache , > tendon rupture restlessness , confusion , rarely seizures , > ' phototoxicity > Candida infections : > increased risk of Clostridium Older > > * pts , motility s > tardive to given muscles compounds : > magnesium > iron salts > zinc salts > sacralfate > milk and Elevation of ↳ b/c interactions aluminum antacids antacids * iron needs to be given 6 hours before ! binds to gums & certain drugs / ionic compounds diary products drug levels Theophylline (used for asthma ) ( an anticoagulant) warfarin Metronidazole Fluoroquinolones should NOT be dyskinesia s > > r GI tract absorption reduced by > : T levels of warfarin [Flagyl ] antifungal drug - first line agents to treat c. diff ; great bactericidal anaerobic coverage Uses : > > > > - of muscles prolongation QT > cationic ' of > Drug and Food > ( CPI) psychosis , visual disturbances / hallucinate somnolence , : se ' vagina difficile infection Myasthenia gravis weakening Metoclopramide [Reglem] & > & : confusion ↳ T ' Pharynx protozoal infections infections caused Helicobacter by obligate anaerobes pylori CDI Adverse Effects : > neurotoxicity > allergy > super infections TQ_ : not to be mixed w/ alcohol (F-TOH) blc it will cause disulfiram reaction ! Chapter 92 Amphotericin Infusion > Antifungal Agents - B Reaction fever , chills > caused by > symptoms begin → - - - - - can w/ lipid help hydrocortisone Amphotericin can be - based amphotericin B formulations pretreatment options : meperidine IV months after start of infusion and last 1- 3 Diphenhydramine Aspirin proinflammatory cytokines 1 hour less intense Mild reactions and headache nausea , , release of for about - rigors , or acetaminophen & but may increase dantrolene can be infusion minimized can be renal damage given if rigors occur caution given w/ produces high incidence by changing peripheral of phlebitis ; venous sites administering amphotericin through a large central pretreatment w/ heparin to I risk of phlebitis vaginal candidiasis Treatment - ' - ' . 1- 7 days single dose & topical therapy of fluconazole Nystatin [Myostatin] - Antiviral [Zovirax] : Intravenous > Phlebitis : > reversible > → Agents extremely irritating nephrotoxicity : : pt might . Therapy GI vertigo stinging Drugs for Non - HIV Viral Infection Adverse Effects Topical Therapy > I: therapy neurotoxicity Oral > - , Mi Cona 201C Acyclovir . often , Clotrimazole Chapter 93 ' of vein this sensations to vein vancomycin (run have jerks it over 2 hrs ) [Tami flu] Oseltamivir ' start vaccine < IQ : days 2 Dose early ! so it 's most efficient - GI side effect Chapter Major - (loss infection bleeding ( loss > anemia Neutropenia B_Q > Nadir, : marrow suppression ) neutrophils) of platelets) of > ( loss Principles Of Chemotherapy cancer chemotherapy (bone Myelosuppression ! ' Basic - Toxicities of > - 101 of major consequences erythrocytes) reduction in neutrophils occurs between 10 Thrombocytopenia - 14 days reduction in : circulating platelets , which in the risk of serious > Oprelvekin [ Nen Anemia ' > ' reduction : tract injury if • - TQ ' containing a topical anesthetic (ex antihistamine ( ex diphenhydramine) systemic opioid lidocaine ) if severe , : : treatment : oral loperamide treatment : premedication w/ anti emetics Alopecia gouty Hyperuricemia : prophylaxis with arthritis allopurinol < reproductive toxicity local injury Unique - erythropoietin : N &V > ' circulating erythrocytes ( RBCs ) diarrhea > - the # of mild , mouthwash & > > in to retain fluid stomatitis : inflammation of oral mucosa > > . Treatment : transfusion of Digestive > bleeding < causes pt mega] from extravasation of vesicants port toxicities > Daunorubicin > cisplatin : > vincristine : can can carcinogenesis > : can cause serious injure the injury cath - central line to the heart EF checked ! kidneys peripheral developing cancer injure a nerves neuropathy
